Primary ciliary dyskinesia syndrome and primary generalised epilepsy.

A child with primary ciliary dyskinesia syndrome (PCDS) developed primary generalised epilepsy (PGE). The PGE had characteristics of both childhood absence epilepsy (CAE) and juvenile myoclonic epilepsy (JME). The association of PCDS and PGE has not previously been recorded.

Cogan's syndrome: a rare systemic vasculitis.

A 4 year old girl presented with keratitis and ataxia. Over the next two months she developed profound hearing loss, arthritis, and polychondritis. A diagnosis of Cogan's syndrome was made. The literature on the condition is reviewed and the importance of early diagnosis to prevent hearing loss is highlighted.

The challenge of disseminating new medical technologies: treatment of cardiac arrhythmias.

Although new health care technologies and procedures can improve the quality of patient care, payers may be reluctant to pay for them, clinicians must be carefully trained to use them effectively, and primary care physicians must keep track of a vast number of developments to make appropriate referrals. This article illustrates the challenges presented by new technology by discussing the cost-quality-access issues raised by technology developed to diagnose and treat cardiac arrhythmias.

Unknown syndrome: Noonan-like craniofacial features, digital anomalies, and premature birth.

We report a mother and two of her children, one female and the other male, who have ptosis, hypertelorism, epicanthic folds, downward slanting palpebral fissures, broad nasal bridge, and minor digital anomalies (fig 1); the children had delayed closure of a large anterior fontanelle. All three affected persons were born prematurely.

Reactive arthritis complicating cryptosporidial infection.

Two cases of reactive arthritis in association with cryptosporidial enteritis in childhood are reported. Oocysts of cryptosporidium should be sought when arthritis complicates diarrhoeal illnesses.

Cryptosporidiosis in the West of Scotland.

During the two years 1986 and 1987 83 cases of cryptosporidiosis were identified by the finding of oocysts in the faecal samples submitted to a single microbiology laboratory. There were 58 children and 25 adults. Cryptosporidiosis was the commonest cause of gastrointestinal infection identified in children and the third commonest overall. Spring and autumn peaks were identified. The main symptoms were diarrhoea (median 10 days), vomiting (median seven days), abdominal pain (median seven days) and fever (median three days). A variety of other less common symptoms were noted including reactive arthritis. Three cases occurred during late pregnancy and the puerperium. Contact tracing supported both person-to-person transmission and an animal origin for cases within the group. Cryptosporidiosis is shown to be an important cause of traveller's diarrhoea. The incubation period was from two to 11 days.

Shedding of oocysts of Cryptosporidium in immunocompetent patients.

Forty nine patients (19 adults and 30 children) with oocysts of Cryptosporidium in their faeces had repeated stool specimens taken until oocysts could no longer be identified. They were found in the stools up to 35 days after the onset of symptoms in one patient, but most had stopped shedding them by 20 days. In 25 of the 49 patients in whom symptoms could be compared with the shedding of oocysts, 19 (76%) had symptoms corresponding to the shedding period while symptoms persisted in four (16%) after shedding had stopped.

The incidence of childhood diabetes in certain parts of Scotland.

The incidence of diabetes in children under 12 years of age has been studied in three regions of Scotland from 1976 to 1986. These areas represent more than half of the Scottish population of that age group. The overall annual incidence is 17.6 per 100,000, ranging from 16.8 in densely populated areas to 23.4 in more rural areas. Earlier studies have concerned the age group 0-18 years so the present results from a younger age group are, as expected, slightly lower but show the same trends. After a rise to 1983 there appears to have been a drop, but not in all areas. The danger of drawing conclusions from areas of low population or from short periods of time is stressed.

Has modern perinatal practice caused the fall in perinatal mortality? The experience of a district maternity hospital.

During the first 12 years of operation the perinatal mortality rate in Paisley Maternity Hospital fell steadily from 27 per 1,000 in 1970 to 10 per 1,000 in 1981. During this period the nulliparous birth rate remained constant, but the parous birth rate fell. Improved survival of premature babies, falling numbers of babies with neural tube defects and reduction in intrapartum asphyxia are identified as responsible for this fall. Unexplained intra-uterine death remains an unsolved problem.

Toxoplasmosis and the wild rabbit Oryctolagus cuniculus in Victoria, Australia with suggested mechanisms for dissemination of oocysts.

Sera or serum eluates from 1697 wild rabbits [Oryctolagus cuniculus (L)], collected over the past 10 years from 24 sites in 5 geographic regions of Victoria, were examined for antibodies to Toxoplasma gondii. Sera generally were classified into three broad groups, negative (titre less than 10), weakly reactive (titre 10 to 100) and strongly positive (titre greater than 1000). Strongly positive sera came from rabbits collected in a small number of localized areas, most significantly the Melbourne and Metropolitan Board of Works (MMBW) Sewerage Farm at Werribee and Mud Island in Port Phillip Bay.

Lack of serological evidence for venereal spirochaetosis in wild Victorian rabbits and the susceptibility of laboratory rabbits to Treponema paraluis-cuniculi.

Sera from 608 wild rabbits were examined using serological tests for syphilis as an indicator of infection with Treponema paraluis-cuniculi. Only eight sera gave positive or weakly positive results in the rapid plasma reagin (RPR) test, and none of these eight sera gave positive results in the Treponema pallidum haemagglutination assay (TPHA). Thus, it appears that wild rabbit populations in Victoria, Australia, are not naturally infected with T paraluis-cuniculi. Normal Australian laboratory rabbits however were readily infected with T paraluis-cuniculi, either by intradermal or intratesticular inoculation or by the venereal route. In the latter case, treponeme-containing lesions developed after about five months' cohabitation with infected mates. The disease was successfully transmitted from male to female and from female to male rabbits by the venereal route. In most cases infected rabbits became RPR-positive (17/19 rabbits) and in all cases TPHA-positive (19/19), indicating that serological tests for syphilis can be used to screen rabbits for this disease.

Myxomatosis: the emergence of male and female European rabbit fleas Spilopsyllus cuniculi (Dale) from laboratory cultures.

The sex ratios and the emergence patterns of the European rabbit flea bred under animal house conditions were examined. An overall preponderance of female fleas was found. This was due to the greater preponderance of female fleas in the primary emergence, whereas the sex ratios in the secondary emergence were about 1:1.

Myxomatosis: the release and spread of the European rabbit flea Spilopsyllus cuniculi (Dale) in the Central District of Victoria.

The European rabbit flea was first released in Victoria in August 1969 at Werribee. Releases were made on five different land forms. At one site the first flea was recovered 2 weeks after release. Fleas were recovered between 4 and 6 weeks after release at the other sites. Differences in establishment and spread on the different land forms were due to physically restricted movement of some rabbit populations. By June 1971 80% of rabbits were infested but an occasional young uninfested rabbit was still found in August 1978. Infestation numbers were higher than in the Mallee region especially on pregnant does.

Myxomatosis: changes in the epidemiology of myxomatosis coincident with the establishment of the European rabbit flea Spilopsyllus cuniculi (Dale) in the Mallee region of Victoria.

Outbreaks of myxomatosis during the winter or spring have coincided with the establishment of the European rabbit flea in the Mallee region. The severity of these outbreaks has varied from causing complete suppression of the normal spring increase in rabbit numbers to being completely ineffective in a year in which late spring rains allowed rabbit breeding to extend into the early summer.In 1973 and 1974 effective spring myxomatosis caused heavy mortality in kittens before they emerged from the warrens. The age of the population increased as the result of few young rabbits coming into the population and of the lessened stress on old rabbits in a low summer-autumn population. This effect was reversed in the late-breeding year, 1976, when flea numbers were apparently too low to maintain a spring outbreak and rabbit numbers increased rapidly.

Myxomatosis in the Mallee region of Victoria, Australia.

Sharp reductions in the wild rabbit (Oryctolagus cuniculus (L.)) population in the Mallee are associated with annual myxomatosis epizootics. The extent to which the population reductions are the direct result of the epizootics varies with time of epizootic occurrence. All grazing animals in the Mallee are under nutritional stress each summer and autumn. When the epizootic occurs during the early summer heavy losses occur in a previously healthy population. Similar losses which occur in the late summer and autumn are the result of a nutritional stress - epizootic complex. The end result in each case is a population reduction of about 80%. This reduction occurs in a population which is the most resistant to myxomatosis known in Victoria and in association with epizootics caused by field strains of myxoma virus of moderate virulence only. The earlier summer epizootics are of considerable economic importance because they sharply reduce the pressure on the limited food available for other grazing animals.