Twin and singleton growth patterns compared using US

Sonography has been used widely in the evaluation of singleton fetal growth. Twin gestations, however, have received less careful attention. In a statistical study of 103 twin pregnancies, the growth patterns of twin biparietal diameter (BPD), fetal femur length (FFL), and abdominal circumference (AC) were compared with those of singletons. The results of the study revealed a decrease in twin BPD growth after 31 to 32 weeks of gestation relative to singletons. Twin AC growth rate decreases after 32-33 weeks of gestation relative to singletons, but the twin FFL growth pattern does not deviate from that of singletons throughout gestation. Because of the significant difference in growth patterns of BPD and AC between twins and singletons in our population, new growth charts for twin BPD and AC are proposed.     

Computed tomography in the evaluation of Brown syndrome of the superior oblique tendon sheath

Computed tomographic (CT) findings in 4 patients with superior oblique tendon sheath syndrome (congenital or acquired Brown syndrome) are described. When the inferior oblique muscle moves the eye upward, the superior oblique muscle normally relaxes, while its tendon lengthens and slides freely through the trochlea. In Brown syndrome this process is somehow restricted, which is most apparent during attempts at elevation when the eye is adducted, resulting in an apparent inferior oblique "palsy" (pseudopalsy). Brown syndrome is the most common cause of an apparent isolated limitation of the inferior oblique muscle. CT is a valuable tool in understanding the pathophysiology and management of acquired Brown syndrome, showing thickening and inflammatory changes of the reflected portion of the superior oblique tendon.     

Emergency department staff and susceptibility to pertussis: A seroprevalence study

Objective: To determine the proportion of ED staff who are susceptible to pertussis. There was evidence that some winter leave in southern Tasmania might be a reason of pertussis infection among unimmunized staff. This results in loss of individual earning and loss of availability of staff during the peak demand periods in the ED. There is evidence in the literature that underdiagnosis and undertreatment of pertussis occurs worldwide. Methods: All ED staff were approached to participate in this seroprevalence study. A self‐completed questionnaire was used to record pervious immunization history for pertussis. Blood samples were collected and analysed to detect and quantify immunoglobulin G and immunoglobulin A titres for pertussis. All confidence intervals (CI) are at 95%. Settings: The Royal Hobart Hospital and the co‐located Hobart Private Hospital. Results: Ninety‐seven of 106 eligible staff took part in the present study, a participation rate of 92% (CI 84–96). Ninety‐one of 97 subjects (94%, CI 87–98) believed that they had been immunized for pertussis in childhood; six subjects had either not been immunized or were unsure (6%, CI 2–13). Twenty‐three subjects (24%, CI 16–33) had been immunized as adults. There was serologic evidence of recent infection for 21 participants (22%, CI 14–31). Thirty‐one participants (32%, CI 23–42) were susceptible to pertussis on the basis of low immunoglobulin G titres. Conclusion: ED staff should routinely be offered booster immunization for pertussis.     

Clorazepate and lorazepam: clinical improvement and rebound anxiety

Sixty-two anxious patients were treated under double-blind conditions for 4 weeks with either clorazepate or lorazepam. Two-thirds of each treatment group were then switched abruptly to placebo for 2 weeks, while one-third continued to receive active medication. Two major findings were obtained. About 70% of the patients maintained improvement during the 2-week placebo period. Some patients, however, experienced rebound anxiety, which appeared to be more intense and occurred earlier when placebo was substituted for a benzodiazepine with a short half-life (lorazepam) than for one with a long half-life (clorazepate). The clinical relevance of these findings is discussed.     

Malignant biliary obstruction: intracavitary treatment with a high-dose- rate remote afterloading device

A new technique of intracavitary brachytherapy for malignant biliary obstruction is presented. The technique involves the use of a high-dose-rate remote afterloading device, which offers all the advantages of conventional brachytherapy with the added benefit that the dose can be delivered in a single treatment over a few minutes. The potential problems associated with conventional brachytherapy are thereby minimized.