Meningococcal disease in Auckland, July 1992 - June 1994.

AIMS: To assess two years of meningococcal disease in the Auckland area, the outcomes and management issues, and the specific socio-geographic groups that are affected. METHODS: Using the nationally agreed case definition, a retrospective chart review was undertaken. Case finding was through the National surveillance system at ESR, backed by hospital laboratory and coroner case findings. RESULTS: There were 106 cases of meningococcal disease, both adult and paediatric, from July 1992 to June 1994. Group B (n=61), was predominant throughout this period especially in the winter months. There were two main age groups most affected. The first, and most striking, was in Maori and New Zealand Pacific Island children younger than five years, with rates of 52.6 and 54.2/100,000 respectively. The second peak was in European, and to a lesser extent Maori, 15-24 year-olds, (rates 11.7 and 8.5/100,000, respectively). The annual incidence was 5.6/100,000 with an overall case fatality rate of 6.6%, (n=7). South Auckland had the greatest proportion of cases with 42/106. Two-thirds of the cases were referred for hospital admission by a general practitioner. From both general practitioner and self-referred groups, two-thirds had a petechial/purpuric rash on arrival at hospital. For general practitioner referred cases, 24 received parenteral antibiotics on referral, and from these cases there was one death, (1/24). Those not treated with antibiotics (general practitioner or self-referred) had a mortality of 2/41. There were 31 cases of paediatric meningococcal meningitis. Nineteen cases had dexamethasone in appropriate dose and timing; no hearing loss occurred in the 17 cases that survived (0/17), compared to 2/12 not treated with dexamethasone. This compares to a published rate of 5-7%. CONCLUSIONS: Meningococcal disease, predominantly serogroup B, is of high incidence in Auckland. The highest rates of disease are occurring in the under five-year-olds, where an effective group B vaccine is awaited. The benefit of dexamethasone is suggestive. There was no clear benefit in outcome by pre-treatment with parenteral antibiotics for paediatric meningococcal disease though no suggestive detrimental effect either.     

The clinical features of paediatric meningococcal disease Auckland, 1985-87

An epidemic of group A meningococcal disease began in Auckland in May 1985. There were 122 paediatric cases of meningococcal disease in the next 25 months including 98 cases due to group A. The commonest clinical symptoms were vomiting, headache and photophobia, while frequent signs included fever, seizures, petechial rash and meningism or a bulging fontanelle. Complications were uncommon and included sterile arthritis and prolonged fever. The majority had disease confirmed by positive blood or cerebrospinal fluid culture. Significantly fewer positive cultures were seen in those treated with antibiotics prior to admission. The overall mortality was 7%. If the acute illness was survived, the only detected long term sequela was sensorineural hearing loss seen in 6%. A vaccine programme has been undertaken to control this epidemic.     

Haemophilus influenzae type b disease in Auckland children 1981-87

Haemophilus influenzae type b invasive disease was reviewed in the Auckland paediatric population. A total of 205 episodes were confirmed by sterile cavity culture in 203 patients under 15 years of age over a seven year period. The incidence of invasive disease was 14/100,000/year in those under 15 years and 41/100,000/year in under 5 year olds. The age range was from 1 month to 11 years, with 91% under 5 years and 64% under 2 years. Most cases were due to meningitis (63%). Other diseases included epiglottitis, pneumonia, cellulitis, arthritis, and occult bacteraemia. There was only one fatality. Beta lactamase production was found in 9% of meningeal isolates. Recently a new conjugated haemophilus vaccine has been licensed in the United States for use in children 18 months and older. Consideration should be given to introducing this vaccine in New Zealand.     

Insulinoma in Auckland 1970-1985

This paper presents summaries of the eight cases of insulinoma which occurred in the Auckland area (annual incidence 1 in 1.5 x 10(6) between 1 January 1970 and 31 December 1985. These were five males (ages 28, 28, 31, 55, 57) and three females (ages 46, 49, 54). Seven patients proceeded to operation. Six tumours were removed successfully at laparotomy, one was malignant. There was no instance of synchronous multiple tumours.     

Stillbirths in Auckland 1983-1986

One hundred and ninety eight stillbirth deliveries occurred in three major obstetric departments of Auckland hospitals between July, 1983 and June, 1986. Post mortem examinations were performed in 74.7% of cases. The overall stillbirth rate was 5.92 per 1000 total births and the major causes of death were fetal abnormality, fetal anoxia and unexplained fetal death. Of normally formed stillbirths, about 60% occurred in uncomplicated pregnancies. Intracranial haemorrhage was common amongst Pacific Island patients while abruptio placentae occurred more commonly in caucasians. The study suggests that stillbirths occur more commonly in small for dates infants at earlier gestations, but this trend has disappeared by term. Cord problems were rare and occurred mainly in babies over 2500 g, and the absence of post mortem evidence of anoxia in the majority of these babies may suggest that the cord complications occurred as a post mortem phenomenon. Cardiotocographs were recorded 24 hours prior to death in 16 patients. The risk of stillbirth during each subsequent week of pregnancy is calculated and it is found that this risk increases sharply after 42 weeks gestation.     

Renal biopsy pathology in Auckland, 1969-1976.

The pathology of 1058 samples of kidney tissue studied during the past seven years as part of the renal biopsy service in Auckland is reviewed. About half of the samples were examples of glomerulonephritis, with diffuse proliferative and exudative glomerulonephritis being the most common finding. In the group of focal glomerular disease, lupus nephropathy and Goodpasture's Syndrome were frequently diagnosed.     

不完全川崎病与典型性川崎病对比分析

目的 探讨不完全川崎病与典型性川崎病的异同以便早诊断、早治疗.方法 回顾分析60例确诊为川崎病患儿的临床和实验室资料.结果 不完全川崎病临床诊断指标中的症状出现率较典型性川崎病低（x2 =16.46、10.10、11.71、34.43,均P＜0.01）,两者实验室检查指标WBC、Pt、ESR及CRP之间差异无统计学意义（x2 =0.04、0.12、0.04、0.26,均P＞0.05）,两者冠状动脉病变发生率差异有统计学意义（x2=31.43,P＜0.05）.结论 川崎病的早期诊断要结合临床特点、实验室检查和超声心动图检查.     

Endoscopic management of bile duct stones at Auckland Hospital in 1988 and 1989

OBJECTS: to define the role of endoscopic management of bile duct calculi in a tertiary referral institution. METHODS: an unselected series of 466 patients presenting for ERCP over a two year period were reviewed and 103 patients with bile duct calculi identified. The results of endoscopic management of these patients is reviewed. RESULTS: endoscopic sphincterotomy was successful in 98% of patients, and resulted in clearance of calculi from the bile duct in 75%, and in a further 8% symptoms were successfully controlled by sphincterotomy with or without endoprostheses, despite residual calculi. Seventy-nine percent of the patients with choledocholithiasis were successfully managed endoscopically, minor complications occurring in 16% which were significant in only 4%, with no procedure related mortality. CONCLUSIONS: endoscopic sphincterotomy provides a safe and effective means of managing bile duct calculi, even if stone extraction cannot be completed.     

Cryptococcal meningitis in Auckland 1969-89

Twenty-six patients with cryptococcal meningitis were seen in Auckland between 1969 and 1989. The incidence of cryptococcal meningitis in Auckland residents was 0.12 cases/100,000/year. Ten (38%) of the patients were Maori or Pacific Island Polynesians. Nineteen (73%) had a predisposing cause, including immunosuppressive therapy in nine and the acquired immunodeficiency syndrome (AIDS) in seven. The most common presenting syndrome was a subacute or chronic meningitis. Other clinical syndromes included a slowly progressive ataxia, polyradiculopathy, and headache with vomiting. In two patients, the symptoms of meningitis were overshadowed by those of systemic cryptococcal infection. Delay in making the diagnosis was common. The most sensitive method for diagnosing cryptococcal meningitis was the cerebrospinal fluid cryptococcal antigen test. Antifungal therapy cured 17 of the 25 (68%) treated patients overall, 15 of the 19 (79%) without AIDS and six of the seven with no underlying disease.     

Breast cancer incidence and mortality in Auckland, 1981-6

Age standardised incidence and mortality rates were calculated for breast cancer for the Auckland area. Incidence of female breast cancer for 1981-4 was significantly higher in Auckland compared with all New Zealand, with a standardised incidence ratio of 1.11. While total incidence was the same across the three Auckland districts, there were wide discrepancies in mortality rates. Women in Takapuna had a far lower risk of dying of breast cancer compared with all New Zealand for 1981-6 and had a standardised mortality ratio of 0.86. Central Auckland and south Auckland women had increased risks--1.10 and 1.18 respectively. Similar discrepancies were evident in the important 45-64 age group. Possible reasons for the reported differences are discussed with socioeconomic factors seeming the most likely agency.     

Measles epidemic in Auckland 1984-85

Epidemics of measles had been seen biennially over the past two decades at Princess Mary Hospital, Auckland, until 1980. After a four year gap, there has been a further epidemic. The medical records of 201 measles cases seen between July 1984 and August 1985 were reviewed. Maori and Pacific Island children were over-represented (86%), as were children aged less than 2 years (53%). Two children died. The most common complications were otitis media (98 cases), pneumonia (70 cases) and croup (28 cases, for which five children were ventilated). The epidemic was chiefly due to low immunisation rates and represents a failure of current immunisation programmes. Recommendations are made for improved immunisation strategies.     

Trends in tuberculosis incidence in the Auckland region, 1974-1983

The trends in incidence of tuberculosis in the three Auckland health districts were examined comparing the rates among Maoris, Pacific Islanders and Europeans. There was a continued falling incidence during the period 1974 to 1983, particularly in Maoris and Pacific Islanders. The age-specific rates were studied and related to case finding activities and BCG vaccination. Neonatal BCG vaccination offered to Maoris and Pacific Islanders was not shown to have any impact on incidence rates. Most childhood cases of tuberculosis were discovered by active public health screening activities, while the majority of adult cases were detected by routinely available general practitioner and hospital medical services.     

Genetic polymorphisms in Kawasaki disease

Kawasaki disease (KD) is an acute febrile systemic vasculitis, and the cause of KD is not well understood. It is likely due to multiple interactions between genes and environmental factors. The development of genetic association and genome-wide association studies (GWAS) has opened an avenue to better understanding the molecular mechanisms underlying KD. A novel ITPKC signaling pathway was recently found to be responsible for the susceptibility to KD. Furthermore, the GWAS demonstrated the functionally related susceptibility loci for KD in the Caucasian population. In the last decade, the identification of several genomic regions linked to the pathogenesis of KD has made a major breakthrough in understanding the genetics of KD. This review will focus on genetic polymorphisms associated with KD and describe some of the possible clinical implications and molecular mechanisms that can be used to explain how genetic variants regulate the pathogenesis in KD.     

Parotid cancer in Auckland 1970-1986--too little, too late

We have reviewed the records of 98 parotid cancer patients seen in Auckland over the seventeen year period January 1970 to December 1986. The average duration of symptoms prior to receiving surgical attention was fifteen months and 58% of patients had stage III disease on presentation. The histological profile of our group of patients was different from that reported in other series with increased numbers of patients having bad outlook tumours. There were seven histological types of parotid cancer and these could be divided into two distinct prognostic groups with mucoepidermoid, malignant mixed, adenoid cystic and acinic cell comprising the more indolent tumours and squamous cell, undifferentiated and adenocarcinoma following a more agressive course. The overall five year cure rate was 35%: 65% of patients were either dead or had developed recurrent disease within this period. Radiotherapy appeared to be beneficial for stage I and II lesions, but in advanced cases it had no obvious impact on survival. The initial surgery for parotid cancer should comprise at least a superficial parotidectomy plus a suprahyoid neck dissection if possible. In addition, patients with positive nodes or more aggressive histology should undergo radical neck dissection. All patients with parotid cancer should have adjuvant radiotherapy.     

Treatment of Kawasaki disease

The epidemiology, etiology, diagnosis, and treatment of Kawasaki disease are reviewed. Kawasaki disease, or mucocutaneous lymph node syndrome, is an acute, usually self-limiting, multiple-organ-system disease of childhood that occurs both epidemically and endemically worldwide. The etiology of the disease is unknown but may involve an infectious agent. To be diagnosed, a patient must be febrile for at least five days and show four of five additional clinical features: bilateral conjunctivitis, changes in the oral mucosa, changes in the extremities, rash, and cervical lymphadenopathy. The most important complications are cardiac; patients may develop aneurysms or thrombosis of the coronary arteries or myocarditis. Other complications include arthritis, conjunctivitis, and hydrops of the gallbladder. Aspirin, intravenous immune globulin, corticosteroids, and antithrombotic agents have been investigated for use in the treatment of Kawasaki disease with varying results. Current recommendations suggest therapy with aspirin 80-100 mg/kg/day every six hours for the first 14 days after diagnosis and intravenous immune globulin 400 mg/kg/day for the first four days. The dose of aspirin should then be reduced and continued for six to eight weeks if no coronary artery abnormalities are present. Treatment guidelines for Kawasaki disease are being refined. Current evidence supports early use of aspirin and intravenous immune globulin to prevent cardiac complications.     

Patterns in the drug treatment of hypertension in Auckland, 1982-7

This paper examines the pattern of drug treatment of hypertension in Auckland in the period 1982 to 1987 using data from a representative sample of the adult population interviewed in 1982 and followed up in 1987. In 1982 the age standardised prevalence of antihypertensive treatment for people aged 40-64 years was 12.2% (95%Cl 10.4, 14.0) and in 1987 it was 10.2% (95%Cl 8.5, 11.8). Over the five year period of this study, 6% of the sample untreated in 1982 began treatment with antihypertensive medication, while 24% of those on drugs in 1982 had stopped treatment by 1987. The most common medications used in both 1982 and 1987 for hypertension were diuretics and beta blockers. Over the five year period diuretic use fell and beta blocker use remained constant. In 1982 3% of hypertensives were taking a calcium antagonist but in 1987 13% were on these drugs and a further 13% were using ACE inhibitors. This study suggests that the prevalence of drug treatment for hypertension has plateaued in New Zealand; coincidentally there is a trend towards use of more expensive drugs.     

静脉丙种球蛋白治疗不完全川崎病与典型川崎病患儿的疗效

目的探究典型和不完全川崎病患者均行静脉丙种球蛋白治疗的效果差异性。方法选取2017年1～12月我院收治的60例川崎病患儿为研究对象,根据患儿病变情况进行分组,其中24例典型川崎病患儿为典型组,36例不完全川崎病患儿为不完全组,两组患者均行静脉丙种球蛋白治疗法,应用统计学软件对两组患儿临床症状改善及住院时间进行比较,对两组患儿治疗前后血液检测指标及冠状动脉病变情况进行比较。结果不完全组患儿发热、粘膜充血、皮疹、手足肿胀及淋巴结肿大等临床症状消退时间及住院时间相较于典型组患儿显著更少,数据经比较差异有统计学意义(P 0.05);治疗前两组患儿血小板、白细胞、血沉、C反应蛋白水平等血液检测指标,及冠状动脉病变发生率经比较差异无统计学意义(P 0.05),治疗后不完全组患儿4项血液检测指标及冠状动脉病变发生率相比典型组显著更低,数据经比较差异有统计学意义(P 0.05)。结论静脉丙种球蛋白对小儿不完全川崎病的疗效显著优于典型川崎病患儿,提示针对典型川崎病患儿需要加大给药剂量,延长给药时间以提升其临床疗效,同时针对不完全川崎病患儿的治疗可采取本次研究所用疗法,并可用于临床推广。