The Medical journal of Australia
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The avian blood fluke, Austrobilharzia terrigalensis (Trematoda: Schistosomatidae), is recorded in Western Australia for the first time, and is implicated as the cause of dermatitis among users of the Swan estuary in Perth. Quantitative data provided by a questionnaire sent to affected people showed that infection occurred from November to March in the shallows throughout the "middle" estuary and that children from five to 14 years old were most frequently affected. Most cases of dermatitis were contracted between 11 a.m. and 12 noon--the time of day when the emergence of A. terrigalensis cercariae from the intermediate host, Velacumantus australis, reaches a peak. ⋯ The lesions, which were sometimes widespread over the body and itched severely, persisted for one to two weeks and longer if they were secondarily infected. Approximately 38% of affected people consulted doctors about their condition. These results are discussed in relation to findings on the ecology of the parasite's intermediate and definitive hosts.
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Medullary carcinoma of the thyroid is a rare entity. Most cases present with a lump in the neck. An unusual presentation as fatal asphyxia is reported.
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A young epileptic presented with spasticity as well as ataxia, diplopia and nystagmus; his serum phenytoin level was very high. All the abnormal signs disappeared after withdrawal of phenytoin. Spasticity, hyperreflexia, and clonus are features of phenytoin intoxication, present in this case, which are not commonly seen, and which have rarely been mentioned previously in the literature.
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The management problems of 22 patients with solitary liver abscess are reviewed. To achieve earlier diagnosis, and reduce the high mortality rate of this condition (32% in this series), clinicians need to change their data base of the clinical presentation and also to incorporate liver imaging as part of the routine investigation of a patient with pyrexia of uncertain origin. ⋯ The need for careful bacteriological cultures is emphasized, and the use of the most appropriate antibiotics is described. While in many cases the cause of the liver abscess remains unknown, in Australia the possibility of the abscess being amoebic or an infected hydatid cyst should be kept in mind.
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Thirteen cases of granuloma inguinale were diagnosed in just over a twelve-month period at the Australian Government Health Laboratory and the General Hospital, Townsville. Seven patients were males, four of whom were immates of Her Majesty's Prison, Townsville. Two of the patients were married, and two were sisters. ⋯ The provisional diagnosis was confirmed by the presence of intracytoplasmic Donovan bodies in crushed tissue smears stained with Wright's stain and pinacyanole. The diagnosis of granuloma inguinale could not be reliably made from sections of formalin-fixed tissue alone. The clinical findings, methods of laboratory diagnosis, management and treatment of this disease are also described with an added emphasis on treatment during pregnancy.