Amygdaloid neurosurgery for aggressive behaviour, Sydney, 1967-1977: chronological narrative.

OBJECTIVE: The aim of this paper is to record an historical narrative of amygdaloid neurosurgery at Callan Park Mental Hospital, Sydney in the period 1967-1977. In this paper, this is denoted the Amygdaloid Neurosurgery Project (ANP). The goal of the project was to ameliorate aggressive or self-harming behaviour by selective ablative surgery on the amygdaloid nucleus. CONCLUSIONS: In 1964, Professor Leslie Gordon Kiloh became acting director of the newly built neurosurgical research facility at Callan Park Mental Hospital. In 1966, he advised bilateral amygdaloidotomy for the treatment of a 16-year-old aggressive and self-harming male patient. Following major improvement in that patient's condition, a further 19 patients were treated by amygdaloid surgery. In 1974, Kiloh's team reported that 39% of the first 18 patients treated had persisting improvement but one patient sustained persisting hemiplegia. The program was suspended in 1977 by the New South Wales (NSW) Government, following allegations by a senior nurse that patients at the neurosurgical unit had been mistreated. A Ministerial Committee of Inquiry proposed that stringent legislative controls should be applied to psychosurgery. The Committee expressed reservations about amygdaloid psychosurgery in particular. Psychosurgery referrals declined after that date. Since 2007, under the revised NSW Mental Health Act, all forms of neurosurgery for psychiatric disorder are prohibited.

Amygdaloid neurosurgery for aggressive behaviour, Sydney, 1967-1977: societal, scientific, ethical and other factors.

OBJECTIVES: In 1967, despite escalating international hostility towards psychosurgery, a program of amygdaloid neurosurgery for the reduction of aggressive and self-harming behaviour commenced in Sydney. In this paper, the second of two articles on the Amygdaloid Neurosurgery Project (ANP), we analyse the relative contributions of seven nominated societal, ethical and other factors to the genesis and demise of the ANP, and consider implications of the history of the ANP for the future of neurosurgery for psychiatric disorders (NPD) in New South Wales (NSW) and elsewhere. CONCLUSIONS: Leadership and the availability of resources were crucial factors in the genesis of the project. Its scientific foundations were doubtful in 1967, and remain so in 2009. Ethical issues became the focus of hostile media and Government attention in 1977 and precipitated the project's demise. Lessons derived from an historical analysis of the ANP should assist the medical profession develop appropriate approaches to recent advances in NPD, including deep brain stimulation, new ablative procedures and stem cell implantation.

Gonorrhoea testing and positivity in non-remote Aboriginal Community Controlled Health Services.

Background Gonorrhoea occurs at high levels in young Aboriginal and Torres Strait Islander people living in remote communities, but there are limited data on urban and regional settings. An analysis was undertaken of gonorrhoea testing and positivity at four non-remote Aboriginal Community Controlled Health Services participating in a collaborative research network. METHODS: This was a retrospective analysis of clinical encounter data derived from electronic medical records at participating services. Data were extracted using the GRHANITE program for all patients aged 15-54 years from 2009 to 2013. Demographic characteristics and testing and positivity for gonorrhoea were calculated for each year. RESULTS: A total of 2971 patients (2571 Aboriginal and/or Torres Strait Islander) were tested for gonorrhoea during the study period. Among Aboriginal and/or Torres Strait Islander patients, 40 (1.6%) tested positive. Gonorrhoea positivity was associated with clinic location (higher in the regional clinic) and having had a positive chlamydia test. By year, the proportion of patients aged 15-29 years tested for gonorrhoea increased in both men (7.4% in 2009 to 15.9% in 2013) and women (14.8% in 2009 to 25.3% in 2013). Concurrent testing for chlamydia was performed on 86.3% of testing occasions, increasing from 75% in 2009 to 92% in 2013. Factors related to concurrent testing were sex and year of test. CONCLUSIONS: The prevalence of gonorrhoea among young Aboriginal and/or Torres Strait Islander people in non-remote settings suggests that the current approach of duplex testing for chlamydia and gonorrhoea simultaneously is justified, particularly for women.