Diabetes care in rest homes in Christchurch, New Zealand.

AIM: To determine the prevalence and describe the management of known diabetes in a group of New Zealand rest homes. METHODS: A random sample of 54 rest homes in Christchurch were studied. Residents with known diabetes were identified by rest home staff and interviewed. Selected staff members of all rest homes were also interviewed using structured questionnaires. The medical and nursing records and laboratory results of all residents with known diabetes were reviewed and all information pertaining to diabetes management recorded. RESULTS: The prevalence of known diabetes in Christchurch rest homes was 11.7%. Residents with known diabetes had a mean of five other comorbidities and were prescribed a mean of 7.5 medications. Of residents with diabetes, 45% were taking oral glucose-lowering agents, 28% were on a diet alone and 27% on insulin treatment. The mean blood pressure was 134/73 mmHg. The mean HbA(1c) was 7.3%. Routine blood glucose monitoring was performed often but residents with possible hypoglycaemic episodes frequently did not have their blood glucose level checked. CONCLUSIONS: The prevalence of known diabetes in Christchurch rest homes is similar to that found in British studies but less than that found in studies from the USA. Indicators of quality of care in residents with diabetes in this study appeared to be satisfactory, in contrast to other studies. There was poor recognition by staff of the necessity of checking acutely blood glucose levels in residents with diabetes who became unwell.     

Renal sarcoidosis in Christchurch, New Zealand 1970–1998

Aim : To identify patients presenting to a nephrologist in whom a diagnosis of sarcoidosis could be made, to assess the relevant causes of renal involvement and to review treatment and long-term follow-up of this group.
Method : A retrospective review of the computer database PROTON^TM for patients given the diagnosis of sarcoidosis, followed by a case note review of identified patients with respect to the mode of presentation, clinical and laboratory features, treatment and subsequent follow-up.
Results : Nineteen patients (15 males) were identified, mean age 45 years, all were Caucasian, and follow-up was four months to 26 years (mean 9.3 years). Most common mode of presentation was acute renal failure (11) during spring/summer (14). Evidence for systemic disease was present in all patients. Mean plasma creatinine on presentation was 0.52 mmol/L and calcium 3.01 mmol/L. Hypercalcaemia was present in 60%. Kidney biopsy was performed in seven patients with the predominant findings of tubular atrophy and interstitial fibrosis; significant granulomata were present in only two. Treatment in all patients was with corticosteroids with good result. Mean long term plasma creatinine was 0.17 mmol/L at 9.3 years. Steroid withdrawal was attempted in all patients, successful in five, with the mean time to relapse of five months in the remaining 14. Mean steroid dose in this group was 7.6 mg on long term follow-up.
Conclusions : Sarcoidosis causes renal dysfunction mainly through altered calcium metabolism. Treatment with corticosteroids is successful in improving renal function, but relapse is common on steroid withdrawal and prolonged treatment is necessary for disease control.     

Outcome from surgical management of secretory pituitary adenomas in Christchurch,New Zealand

Abstract
Background:  Recent evidence has highlighted the importance of the neurosurgeon in the management of secretory pituitary tumours, but most reports are from major centres.
Aims:  To audit the surgical outcome of patients with acromegaly and Cushing's disease treated in a small centre (Christchurch, New Zealand) by a dedicated neurosurgeon with an interest in pituitary disease, and follow-up through an outpatient Department of Endocrinology.
Methods: All cases of acromegaly and Cushing's disease admitted for surgery in Christchurch Hospital between 1984 and 2000 were audited. Data concerning preoperative findings, surgical remission rate, complications and follow-up were obtained from 44 patients (28 acromegaly, 16 Cushing's disease).
Results: Of the 28 acromegalic patients, 14 patients (50%) had a mean growth hormone level <2.5 µg/L within the first postoperative week. Of the 15 Cushing's disease patients in whom the pituitary fossa was explored, 13 patients (87%) entered a postoperative remission, defined as an 08.00 h cortisol <200 nmol/L (normal range 250−800 nmol/L). No perioperative deaths occurred. Two of the 43 patients (4.7%) developed permanent diabetes insipidus, while eight of the 28 patients who were operated on for acromegaly (29%) eventually required some replacement treatment for hypopituitarism during follow-up (one presented with apoplexy and seven were treated with postoperative radiotherapy).
Conclusion: In a small centre with a dedicated pituitary surgeon, operative remission rates approach those obtained in larger, more specialized centres. However, given New Zealand's small, but geographically spread population, consideration should be given to establishing one or two units for the surgical management of secretory pituitary adenomas. (Intern Med J 2003; 33: 168−173)     

Rapid landscape transformation in South Island, New Zealand, following initial Polynesian settlement

Humans have altered natural patterns of fire for millennia, but the impact of human-set fires is thought to have been slight in wet closed-canopy forests. In the South Island of New Zealand, Polynesians (Māori), who arrived 700-800 calibrated years (cal y) ago, and then Europeans, who settled ～150 cal y ago, used fire as a tool for forest clearance, but the structure and environmental consequences of these fires are poorly understood. High-resolution charcoal and pollen records from 16 lakes were analyzed to reconstruct the fire and vegetation history of the last 1,000 y. Diatom, chironomid, and element concentration data were examined to identify disturbance-related limnobiotic and biogeochemical changes within burned watersheds. At most sites, several high-severity fire events occurred within the first two centuries of Māori arrival and were often accompanied by a transformation in vegetation, slope stability, and lake chemistry. Proxies of past climate suggest that human activity alone, rather than unusually dry or warm conditions, was responsible for this increased fire activity. The transformation of scrub to grassland by Europeans in the mid-19th century triggered further, sometimes severe, watershed change, through additional fires, erosion, and the introduction of nonnative plant species. Alteration of natural disturbance regimes had lasting impacts, primarily because native forests had little or no previous history of fire and little resilience to the severity of burning. Anthropogenic burning in New Zealand highlights the vulnerability of closed-canopy forests to novel disturbance regimes and suggests that similar settings may be less resilient to climate-induced changes in the future.     

Naturally occurring antibody response to DNA is associated with the response to retroviral gp70 in autoimmune New Zealand mice

The spontaneous occurrence of retroviral gp70 immune complexes (ICs) in the blood of autoimmune New Zealand black and (New Zealand black X New Zealand white)F1 ([NZB X NZW]F1) mice is determined by a single dominant locus of the NZB strain (provisionally designated Agp-1). A combined effect of 2 unlinked dominant NZB loci (Ads-1 and Ads-2) is required for the production of anti-double-stranded DNA (anti-dsDNA) antibodies in these mice. The present genetic studies using (NZB X NZW)F1 X NZW backcross mice and their second through fourth generation progeny revealed that Agp-1 and Ads-1 exist in common or are closely linked on chromosome 17 of NZB mice and are related to the occurrence of renal disease. The renal disease and the serum level of both anti-dsDNA antibodies and gp70 ICs were more intense in (NZB X NZW)F1 hybrids than in NZB mice, indicating the contribution of NZW genes. In (NZB X NZW)F1 mice, a single dominant locus from the NZW strain, Agp-3, intensified the magnitude of gp70 IC formation, and a combined effect of 2 unlinked dominant loci from the NZW strain, Ads-3 and Ads-4, acted to increase the serum titers of anti-dsDNA antibodies. This study clearly indicates that the NZW loci Agp-3 and Ads-3 exist in common or are tightly linked on chromosome 17, are closely linked to the H-2 complex, and are associated with the severity of renal disease in (NZB X NZW)F1 hybrids.(ABSTRACT TRUNCATED AT 250 WORDS)     

2011年澳大利亚与新西兰慢性心力衰竭防治指南更新的简介

2006年11月,澳大利亚国家心脏基金会公布了慢性心力衰竭预防、诊断与治疗指南。2011年3月,澳大利亚国家心脏基金会、澳大利亚及新西兰心脏协会共同对该指南进行修订,并发表在《澳洲医疗杂志》上。增加了自2006年12月以来,有关慢性心力衰竭的诊断、治疗和预防方面进展,引用参考文献42条,反映了心力衰竭的诊断、治疗及预防是一个循序渐进、不断深化的过程。现对该更新指南作一简介。     

Renal and blood pressure changes in response to vasopressin antagonism in the New Zealand genetically hypertensive rat

The effects of a mixed pressor and antidiuretic vasopressin antagonist on blood pressure and renal function have been investigated in New Zealand genetically hypertensive and normotensive rats. Vasopressin antagonism was associated with a diuresis, compensatory polydipsia and kaliuresis in both normotensive and hypertensive animals. Hypertensive animals alone exhibited a natriuresis and a fall in systolic blood pressure, which was associated with a reduction in water balance and plasma sodium compared with antagonist-treated normotensive animals. The data suggest that vasopressin may exert a long-term influence on blood pressure through renally rather than vascularly mediated effects.     

B cell infiltration of the thymic medulla in New Zealand black, New Zealand white, and (New Zealand black x New Zealand white)F1 mice. Effect of total lymphoid irradiation

Thymuses from female (New Zealand black x New Zealand white)F1 [( NZB x NZW]F1), New Zealand black, and New Zealand white mice of different ages were examined by immunohistochemical and flow cytometric analysis. Two-and-a-half-month-old (NZB x NZW)F1 mice showed infiltration of the thymus with B cells, and by 6-8 months of age, showed a disruption of the entire medullary area. More than 80% of the thymic B cells had the phenotypic characteristics of conventional B cells (IgM+, IgD+, Ly-1-). Total lymphoid irradiation induced a marked depletion of medullary B cells and a restoration of the thymic architecture.