PROPRANOLOL FOR MIGRAINE PROPHYLAXIS

SYNOPSIS
The preventive effect of propranolol on migraine attacks was compared to placebo in a double-blind cross-over trial. Thirty-two patients with serious and prolonged migraine participated in the 12-week study. The effect of propranolol was significantly better than that of placebo. The number of migraine attacks during the propranolol period was reduced in 22 patients (69%), and in 11 of these (34%) a reduction of more than 50% was seen. The intensity of headache was significantly reduced during the propranolol period. The intake of analgesics and preparations containing ergotamine was significantly reduced during the propranolol period also. No serious side effects were noted.     

An evaluation of automated indirect blood pressure measurement during pregnancy

An automatic microcomputer-assisted instrument (Dinamap) for indirect determination of blood pressure was evaluated in 10 healthy women in the last trimester of pregnancy. Blood pressure determined intra-arterially was significantly (p less than 0.001) higher than indirect blood pressure determined with the Dinamap instrument or by manual sphygmomanometry. However, there was no significant difference in the mean change in blood pressure determined by the three techniques under investigation. A close correlation was recorded between systolic and diastolic blood pressure determined intra-arterially and with the Dinamap instrument (r = 0.92, r = 0.90), and between blood pressure determined intra-arterially and indirectly by auscultation (r = 0.93, r = 0.81). There was no significant difference in the reproducability of individual blood pressure values determined intra-arterially (systolic, 2.4 mmHg, diastolic, 3.7 mmHg) or by the Dinamap instrument (systolic, 2.8 mmHg, diastolic, 3.4 mmHg) or by auscultation (systolic, 5.0 mmHg, diastolic, 4.9 mm Hg). The Dinamap instrument proved reliable for the measurement of changes in blood pressure during late pregnancy. The technique eliminates the problem of inter-observer error which otherwise becomes evident when checking blood pressure antenatally.     

Genital papillomavirus infection in women treated for chlamydial infection.

Samples for chlamydia testing were taken from 298 and PAP smear from 284 non-pregnant sexually active young women in a midwife-run family planning dervice. Chlamydia was found in 36 (12.1%). Three women (1.1%) had cytological atypia corresponding to CIN I or II. Koilocytosis was seen in 9 smears (2.8%). Thirty-two of the chlamydia-positive women were followed for a mean of 15 months by a gynaecologist with chlamydia tests, colposcopy, PAP-smears and in some cases biopsies. There were 7 reinfections with chlamydia (22%). Signs of genital papillomavirus infection (GPVI) were found in 24 of the 32 chlamydia cases during follow-up. Twenty chlamydia-positive patients had abnormal colposcopy, 15 of them had other changes suggestive of GPVI, seven of these had CIN I or II. At follow-up 6 patients had cytologic atypia (18.8%) compared with the average 1.5% in this department during this period. Among 12 patients with normal colposcopy there were no cytological changes. Chlamydial infection calls for increased alertness regarding abnormal vaginal cytology even among young patients not commonly included in PAP smear screening programmes.     

Vibrio cholerae O1 El Tor cluster in Sydney linked to imported whitebait

Three cases of cholera in women aged 71, 72 and 84 years were notified in November 2006 in Sydney, New South Wales. This is the first reported cluster of cholera in Australia for over 30 years, and was an unusual outbreak in patients with no history of recent travel to cholera-endemic areas. A food trace-back investigation found that the only exposure common to all cases was consumption of raw whitebait imported from Indonesia. This outbreak demonstrates that the practice of eating raw whitebait does occur in Australia, albeit in the process of taste-testing uncooked fritter batter. All three patients were undergoing long-term therapy with proton-pump inhibitors, which may have contributed to their susceptibility to the disease. A review of importation practices of food from cholera-endemic regions may be required to prevent future transmission.     

Enhanced surveillance of hepatitis B infection in inner-western Sydney

OBJECTIVES: We developed an enhanced surveillance system for hepatitis B to improve the detection of newly acquired cases and to collect epidemiological data. METHODS: The study was undertaken from February to June (inclusive) 2005 at the Sydney South West Area Health Service Eastern Zone Public Health Unit. A letter was sent to treating doctors on receipt of a notification, requesting additional information on cases. Cases identified by the treating doctors as newly acquired were followed up by telephone. RESULTS: There were 295 notifications of hepatitis B in the period, of which three were newly acquired infections. Only one of these three cases was identified through enhanced surveillance. Information on ethnicity was obtained. CONCLUSIONS: This enhanced surveillance system is of limited value as an ongoing process. We recommend that it be undertaken periodically to monitor the epidemiology of the disease.     

Postabortal endometritis in chlamydia-negative women--association with preoperative clinical signs of infection

The relations between clinical signs of infection and postoperative endometritis were studied among 429 women with negative preoperative chlamydial and gonococcal cultures. Clue cells and a vaginal smear not dominated by rods and positive amine tests were more common among the 12 patients (2.8%) with endometritis. In the stepwise logistic regression procedure the presence of greater than 20% clue cells remained statistically significant and was associated with the highest relative risk, 5.6, with 95% confidence limits 1.82-17.2. This also implies clinical significance--women with clue cells constitute a group at risk of postabortal endometritis.     

Measurement of Cardiac Stroke Volume During Cesarean Section: A Comparison Between Impedance Cardiography and the Dye Dilution Technique

Simultaneous determination of cardiac stroke volume by impedance cardiography and the dye dilution technique was compared in ten women undergoing elective cesarean section performed under general or epidural anesthesia. The influence of delivery and the anesthetic procedures used on stroke volume determination by the two methods was evaluated and compared. The correlation coefficients for measurements performed before and during anesthesia showed little variation and were largely unchanged after delivery of the child (r = 0.90-0.97). Mean stroke volume determined by impedance cardiography was significantly (P less than 0.001) lower than mean stroke volume calculated from the dye dilution technique. However, there was no significant difference between the mean change in stroke volume determined by the two techniques during serial measurements. Impedance cardiography was found to be a safe, reliable, non-invasive technique for the measurement of changes in stroke volume during cesarean section. The ability of the impedance method to determine changes in stroke volume was unaffected by the anesthetic procedures employed or by delivery of the child.