The success of men's health nights and health sessions.

Men's health nights and men's health sessions have proven to be remarkably successful in rural and some suburban regions of Victoria. In the rural regions, enough interest has been generated to run follow-up health sessions on topics selected at the initial nights. Approximately 2000 men attended these events and 575 filled in questionnaires giving information such as age, occupation, health concerns and perceptions of health professionals. The results indicated that men's health nights appeal to older men who are more likely to be professional or retired. These men saw cardiovascular disease, cancer and stress management as their main health concerns. The majority indicated that they would be interested in attending more men's health sessions. The follow-up sessions provide initial pathways by which men may address the issues of their own health. The data collected contributed to the development of the Men's Awareness Network model for men's health.

[Endosonographic demonstration of extrapancreatic and extraintestinal gastrinoma]. / Endosonographischer Nachweis eines extrapankreatischen und extraintestinalen Gastrinoms.

HISTORY AND CLINICAL FINDINGS: No cause had been found for chronic diarrhoea in a 57-year-old man. Up to 15 watery stools daily had been without relation to food intake and without blood admixture. But muscular cramps had developed, especially in the legs. The patient had a history of recurrent peptic ulcers for which a selective proximal vagotomy had been performed 13 years ago. Physical examination was unremarkable. INVESTIGATIONS: Alkaline phosphatase activity (182 U/l) and C-reactive protein (9.3 mg/l) were slightly raised; serum iron was 42 micrograms/dl, while all other routine laboratory tests, including protein electrophoresis, blood picture and differential count were within normal limits. Gastroscopy revealed ulcerative duodenitis, gastritis with erosions and numerous ulcers and reflux oesophagitis, grade III-IV. Endosonography showed enlarged gastric mucosal relief as sign of foveolar hyperplasia and a ca. 4 x 3 cm tumour next to the duodenal bulb. Gastrin level was 7537 pg/ml (normal < 150 pg/ml). Computed tomography and somatostatin receptor scintigraphy confirmed the site and size of the gastrinoma. TREATMENT AND COURSE: Treatment with omeprazole (40 mg three times daily) slightly improved the symptoms. The tumour was excised a week after diagnosis. The patient has been symptom-free since then. CONCLUSION: Chronic diarrhoea of unknown aetiology can be caused by an endocrine tumour; endosonography can often provide information on the diagnosis and location of such a tumour.

[Miliary tuberculosis and silicosis with predominantly cerebral symptoms]. / Miliar-Silikotuberkulose mit vorwiegend zerebraler Symptomatik.

HISTORY AND CLINICAL FINDINGS: About 10 weeks before admission to hospital a 73-year-old woman developed a fever of up to 40 degrees C for three days. She then had subfebrile temperature for several weeks with some rises to 39 degrees C. She was known to have type II a diabetes mellitus and pulmonary silicosis, having worked in a porcelain and ceramic factory for many years. Before admission her cerebral functions were rapidly deteriorating, especially short-term memory. This was followed by increasing paraplegia of the legs with inability to walk. She finally had urinary and faecal incontinence and swallowing difficulties with tendency to aspiration, which necessitated hospitalisation. INVESTIGATIONS: Both lactate dehydrogenase (339 U/l) and C-reactive protein (112 mg/l) were elevated; the platelet count was low (73000/microliters). Cerebrospinal fluid was unremarkable, as was computed tomography of the skull. But magnetic resonance imaging revealed multiple spotty lesions with low contrast-medium uptake throughout the brain, pointing to a disseminated bacterial or mycotic infection. 3 days later the chest-ray showed small nodular soft shadows in the lungs, and lung functions had decreased. Mycobacteria were found in the urine and liver biopsy showed granulomatous hepatitis, establishing the diagnosis of miliary tuberculosis in the presence of silicosis. TREATMENT AND COURSE: Tuberculostatic treatment was instituted with four drugs (pyrazinamide, ethambutol, isoniazid and streptomycin. After 6 weeks the patient was again able to walk and continent of urine during the day. All cerebral functions gradually improved. CONCLUSION: Miliary tuberculosis should be included in the differential diagnosis of ill-defined feverish disease, especially in the elderly.

Ex-hospital clients evaluate their aftercare experiences.

Seventy-two previously hospitalized clients of an inner-city community clinic, assigned to three treatment groups - medication-only, medication plus individual therapy, and medication plus therapy plus group experiences - evaluated their respective aftercare programs by responding to five questions. As compared with the others, medication-only clients were less inclined to see either the clinic or the medication as preventing rehospitalization, were alone in reporting that the clinic was responsible for preventing rehospitalization to the extent that the medication was effective, and responded to the question of rehospitalization by emphasizing worsening symptoms. Others emphasized therapy failure. Clients agreed with the professionals - aftercare should not be medication alone.