The Medical journal of Australia
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Comparative Study Clinical Trial
Management of lumbar nerve-root pain by intrathecal and epidural injections of depot methylprednisolone acetate.
Sciatica is one of the most incapacitating and difficult to treat of all benign pains. This is a report of the results of using epidural and intrathecal corticosteroids in depot form, methylprednisolone acetate (Depo-Medrol), in 108 patients who presented with a clinical diagnosis of acute lumbar disc prolapse and nerve-root pain. ⋯ Patients with a high level of protein in their cerebrospinal fluid appeared to have a higher response rate. The treatment is most likely to be effective when the patient is male, the duration of symptoms is less than four weeks, and the patient has irritant rather than compressive neuropathy.
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Comparative Study Clinical Trial
Blood pressure changes: oestrogens in climacteric women.
An analysis of data from a prospective study which compared the effect of conjugated equine oestrogens (Premarin) with that of piperazine oestrone sulphate (Ogen) demonstrated that postmenopausal women who received conjugated equine oestrogens had a higher rate of a rise in blood pressure and development of hypertension than women who received piperazine oestrone sulphate. Conversely, a greater proportion of women who took oestrone sulphate had a fall in blood pressure than those who took equine oestrogens. A hypothesis to account for these differences, based on the known potent biological action of equine oestrogen, is developed.
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Breast feeding was prevalent and sustained in a prospective growth study of healthy Perth infants and was accompanied by slower weight gains, compared to figures from the 1960s. This may have important effect on the future of young Australians.
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As part of a Queensland survey, we made an assessment of the attitudes of general practitioners to continuing education. We analysed responses for age, sex, type and geographical location of practice. Almost all the respondents (99%) agreed that commitment to CME is lifelong. ⋯ Most feel that GP skills can be taught through CME courses, which should focus on patient management. Informal communication with colleagues is a useful mode of learning. Although exactly half the doctors felt that CME should be mandatory, a greater proportion of younger doctors were in favour.
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This paper describes the successful use of funnel-web antivenom in two severe cases of envenomation from bites by a male funnel-web spider, Atrax robustus. Rapid resolution of the syndrome occurred in both cases. Although the first patient, a 49-year-old man, may have slowly recovered without antivenom, it is unlikely that the other patient, a three-year-old boy, would have survived without antivenom therapy. In both cases the duration of hospitalisation was dramatically reduced.