To assess injury patterns and incidence in the Australian Wallabies rugby union players from 1994 to 2000. To compare these patterns and rates with those seen at other levels of play, and to see how they have changed since the beginning of the professional era.Prospective data were recorded from 1994 to 2000. All injuries to Australian Wallabies rugby union players were recorded by the team doctor. An injury was defined as one that forced a player to either leave the field or miss a subsequent game.A total of 143 injuries were recorded from 91 matches. The overall injury rate was 69/1000 player hours of game play. The injury rates in the periods before (1994-1995) and after (1996-2000) the start of the professional era were 47/1000 player hours and 74/1000 player hours respectively. The lock was the most injured forward, and the number 10 the most injured back. Most injuries were soft tissue, closed injuries (55%), with the head being the most commonly injured region (25.1%). The phase of play responsible for most injuries was the tackle (58.7%). Injuries were more likely to occur in the second half of the game, specifically the third quarter (40%). The vast majority of injuries were acute (90%), with the remainder being either chronic or recurrent.Injury rate increases at higher levels of play in rugby union. Injury rates have increased in the professional era. Most injuries are now seen in the third quarter of the game, a finding that may reflect new substitution laws. There is a need for standardised collection of injury data in rugby union.
Intrathoracic teratomata occupying an endobronchial position have been described on only three previous occasions.A further example of this condition is reported and the clinicopathological features discussed. Case reportThe patient, a 5-year-old girl (AM), was admitted to hospital in June 1963, with a one-week history of nausea, fever, and back pain.Physical examination was unre- markable except for evidence of left upper lobe consolidation.A chest radiograph demonstrated diffuse opacifi- cation of the left upper lobe with a small area of perihilar calcification.The haemoglobin was 11-2 g/dl, WCC 17 x 109/l (70% neutrophils) and the ESR 70 mm/hr.Sputum, urine, and gastric washings were negative for tubercle bacilli on smear, culture, and guinea pig in- oculation.The Mantoux test was strongly positive after recent elective BCG inoculation.Bronchoscopy was normal.Pulmonary tuberculosis was diagnosed and treatment started with PAS and isoniazid.This was
Precis: As new glaucoma treatments arise, including minimally invasive glaucoma surgeries and new classes of glaucoma medications, it is important to examine the prescription trends of current topical glaucoma medications and how they may change. Purpose: To determine the prescribing trends of topical glaucoma medications in Australia from 2001 to 2017. Methods and Analysis: Pharmaceutical Benefits Scheme (PBS) item numbers were used to determine glaucoma medication prescribing rates from 2001 to 2017. All data were adjusted for population (/100,000) as per the Australian Bureau of Statistics (ABS) population data. Results: Overall prescription rates for glaucoma medications ranged between 67,904 and 86,936 per 100,000 from 2001 to 2017. An upward trend was noted from 2001 to 2015, with the exception of a notable decline in 2013 by 14.7%, before then increasing by 13.7% in 2014. After 2015, prescribing rates were seen to decrease over the subsequent years in the study period. Latanoprost remained the most prescribed medication and prostaglandin the most prescribed class. Prescribing rates of single-agent beta-blockers were noted to decrease during the 17-year period, particularly with the introduction of combination agents, which note an upward trend. Brinzolamide/brimonidine has increased by 50.0% from 2016 to 2017. Conclusions: Total rates of prescriptions have remained relatively stable from 2001 to 2017. The number of medications prescribed when considering combination agents separately was seen to be increasing from 2001 to 2015. From 2015 to 2017, a downward trend was noted in the number of medications prescribed. Prostaglandins remain the most prescribed class throughout the study period.
To evaluate the short-term changes in inner retinal function using the photopic negative response (PhNR) after intraocular pressure (IOP) reduction in glaucoma.Forty-seven participants with glaucoma who were commencing a new or additional IOP-lowering therapy (treatment group) and 39 participants with stable glaucoma (control group) were recruited. IOP, visual field, retinal nerve fiber layer thickness, and electroretinograms (ERGs) were recorded at baseline and at a follow-up visit (3 ± 2 months). An optimized protocol developed for a portable ERG device was used to record the PhNR. The PhNR saturated amplitude (Vmax), Vmax ratio, semi-saturation constant (K), and slope of the Naka-Rushton function were analyzed.A significant percentage reduction in IOP was observed in the treatment group (28 ± 3%) compared to the control group (2 ± 3%; P < 0.0001). For PhNR Vmax, there was no significant interaction (F1,83 = 2.099, P = 0.15), but there was a significant difference between the two time points (F1,83 = 5.689, P = 0.019). Post hoc analysis showed a significant difference between baseline and 3 months in the treatment group (mean difference, 1.23 µV; 95% confidence interval [CI], 0.24-2.22) but not in the control group (0.30 µV; 95% CI, 0.78-1.38). K and slope were not significantly different in either group. Improvement beyond test-retest variability was seen in 17% of participants in the treatment group compared to 3% in the control group (P = 0.007, χ2 test).The optimized protocol for measuring the PhNR detected short-term improvements in a proportion of participants following IOP reduction, although the majority showed no change.
Between October 1970 and November 1984, 26 infants and children aged 11 days to 18 years (mean 5.7 years) received 42 permanent cardiac pacemakers (26 primary implants, 16 re-implants) for congenital or surgically acquired heart block, bradycardia and sinus node dysfunction. Twenty-two patients had unipolar pacing and 4 bipolar pacing. Of 26 primary implantations, 2 had fixed rate epicardial pacing, 16 ventricular demand pacing (13 epicardial, 3 endocardial), 3 epicardial VAT (P-synchronous) pacing and 5 DDD (universal) pacing (4 epicardial, one endocardial). Fourteen patients required a further 19 operations for change of generators (16), ventricular lead (1), generator site (1) and generator encasing (1).
In a 20-year period (1958-77) 43 patients underwent combined pulmonary and chest wall resection for bronchial carcinoma with local invasion of the thoracic wall. The clinical data, symptoms, surgical procedures, pathology, and results are reviewed. Pain was the usual presenting symptom. The operative mortality was 16%, respiratory complications causing most of the postoperative morbidity and mortality. These complications were less common after pneumonectomy. Long-term survival was achieved in only three cases with a corrected three-year survival rate of 10%. The survivors had certain pathological and operative features in common that may have prognostic significance. Recurrent carcinoma was responsible for most late deaths. Despite the poor overall prognosis, surgical management provided reasonable palliation and occasionally resulted in prolonged disease-free survival.
Non-penetrating ocular injuries from badminton shuttlecocks can result in severe damage and life-long complications. This case series highlights the morbidity of such injuries, particularly in regard to post-traumatic glaucoma.This is a retrospective case series of 12 patients with shuttlecock-related blunt eye injuries sustained during badminton play without eye protection. By approaching colleagues through conference presentations and networking, the authors have attempted to gather all known cases of shuttlecock ocular injury managed in tertiary ocular emergency departments or private ophthalmological clinics in Victoria and New South Wales, Australia in 2015.This is the first multicentre case series to describe badminton-related ocular injuries in Australia. Our case series demonstrates, in particular, long-term glaucoma-related morbidity for patients over a large age range (16 to 77 years), with one patient requiring ongoing management 26 years following their initial injury. The cases reported further add to the literature promoting awareness of badminton-related ocular injury.We encourage player education and advocacy on badminton-related eye injuries and appropriate use of eye protection to reduce associated morbidity.
The standard braided wire lead used for temporary pacing following open heart surgery may be rendered ineffective by high current thresholds. In this study braided leads were compared with a lead incorporating a localised stainless steel electrode in 17 patients undergoing routine cardiac surgical procedures. Each patient acted as his own control. The localised electrode lead gave significantly lower current and voltage thresholds compared to the braided lead, this difference being apparent both on the day of operation and prior to lead removal (p less than 0.0005). Use of a lead incorporating a localised electrode is therefore less likely to be restricted by difficulties in capture and sensing.
We report the case of a seven-year-old boy who sustained near-total transection of the aortic arch following apparently minor blunt injury. The radiological and operative findings and the successful outcome of urgent surgical repair support an aggressive approach to the diagnosis and management of suspected aortic injuries in children.
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