bluuebunny/crossref_metadata_2025 huggingface dataset:
Revising the Code of Ethics of the Royal Australian and New Zealand College of Psychiatrists: Process and Outcome
Authors: Steinberg Ben , Bloch Sidney , Riley Geoff , Zelas Karen
Published: March 2003

Objective: To describe the procedure adopted by the Ethics Committee of the Royal Australian and New Zealand College of Psychiatrists in revising its 1992 foundational code of ethics and to outline the substantial changes agreed upon and subsequently ratified by the College's General Council.

Method: The members of the Ethics Committee reviewed their experience of revising the code by monitoring the process as we went along, examining all relevant documents that emerged over the 18 months it took, and discussing both procedure and outcome with the benefit of hindsight.

Results and Conclusion: The revision process comprised two consultative stages, three face to face meetings of the committee and a presentation to General Council for its consideration. The second consultation, in which an advanced draft was circulated to various arms of the College and to pertinent community organisations, yielded a highly satisfactory response compared to the first consultation's desultory results. The most notable change is the introduction of an entirely new principle which addresses directly the power differential in the psychiatrist–patient relationship and its potential for exploitation of the patient. Sexual exploitation is explicitly and emphatically cited, in that sexual relations between psychiatrist and patient, including a former patient, are always unethical. Other forms of exploitation, such as on the grounds of age, gender, race, ethnicity, sexual orientation, creed, disability, religion and political affiliation, are carefully spelled out. One specific form of exploitation, sexual harassment, is entirely new; its scope is outlined and examples provided. The new code pays more attention than its predecessor to the role of the family and other carers in a patient's life, as well as to the fact that many features of the family are culturally specific. The final principle, covering responsibilities psychiatrists have to society overall, has been modified in several ways. All the principles and their respective annotations have been brought up to date. The new code pertains to affiliates and trainees as well as to Fellows.
An Experience of Psychiatry in Ladakh, India
Authors: Monasterio Erik
Published: March 2003

Objectives: To describe the author's experience of mental health services available in Ladakh, a remote region of India.

Method: A review of inpatient medical files was undertaken to ascertain the possible incidence of psychiatric presentations to the regions only hospital. Case descriptions are presented, as well as a summary of educational material provided.

Results: Approximately 0.1% of admissions were for an apparent primary psychiatric condition.

Conclusion: There is a very significant lack of services and expertise to deal with mental health problems in Ladakh.
The Mental Health of Young People in Australia: Child and Adolescent Component of the National Survey — A Commentary
Authors: Birleson Peter , Sawyer Michael , Storm Victor
Published: March 2003

Objective: This article reports some of the main findings from the recent national survey of the mental health and well-being of children and adolescents and considers its implications.

Conclusions: There is a high prevalence of mental health problems in Australian children and adolescents, and these have a significant impact on sufferers and their families. We will need to collect ongoing data about child and adolescent mental health to monitor the effectiveness of our response to these problems. ADHD is surprisingly common and greater attention needs to be given to research on ADHD in Australia. The resources devoted to child and adolescent mental health services are currently not adequate or equitable and need boosting, as do efforts to increase primary mental health care for this population. Whole population and selected prevention and early intervention approaches offer the most logical method for lowering the prevalence and burden of disorder. Community education for parents, and a boost to research and training in child and adolescent mental health is required if we are to make a difference.
Educational Aims and Objectives for Working in Multidisciplinary Teams
Authors: Burke David , Herrman Helen , Evans Mandy , Cockram Alex , Trauer Tom
Published: March 2003

Objective: The aims of this paper are to discuss the issues surrounding multidisciplinary teamwork and to enunciate a set of educational aims and objectives for RANZCP trainees and supervisors to utilise in training rotations that involve the trainee in multidisciplinary teamwork.

Conclusions: The paper identifies a number of key areas in multidiscipli-nary teamwork, including role definition, leadership, clinical responsibility and accountability, and understanding between the professions. The paper proposes that effective teamwork is supported by key factors including agreed goals, an agreed plan, effective communication styles, clear team roles, and competent leadership. The paper also presents the advantages of collaborative teamwork, including continuity of care, the ability to take a comprehensive view of the patient, the availability of a range of skills, and mutual professional support and education.
Creeping Custodialism
Authors: Patfield Martyn
Published: March 2003

Objective: To draw attention to the increasing prominence given to issues of safety and security in psychiatric inpatient units at the expense of therapeutic considerations.

Conclusion: Progressive removal of “hazards” in order to prevent self harm, often in response to coronial inquests or law suits, is leading to inpatient units becoming stark and oppressive. We risk returning to a dark era wherein our patients will fear our inpatient facilities, which will have become suicidogenic.
Psychiatry in Tasmania: From Old Cobwebs to New Brooms
Authors: Ratcliff Eric , Kirkby Kenneth
Published: March 2003

Objectives: To highlight some major historical trends in psychiatric practice in Tasmania from the inception of the asylum culture in the 1830s to the dynamic of deinstitutionalisation since the 1960s. Source material includes asylum registers and case notes from the early colonial period, annual reports of the Mental Health Services Commission and some oral history, particularly from the first author. The introduction of community, subspecialty, university and general hospital services is briefly chronicled and the role of a generation of psychiatrists in this process is acknowledged.

Conclusions: The fixity of institutional culture for more than a century and its gradual attrition over the past forty years are well illustrated in Tasmania. New challenges are emerging as the identity of mental health is diluted in the broader health and administrative sectors.
The Role of The Psychiatric Nurse
Authors: Grigg Margaret
Published: March 2003

Objective: To provide an overview of the interdisciplinary team from the perspective of a psychiatric nurse.

Conclusion: Psychiatric nursing has undergone many changes over the years, including changes to the training and registration of nurses and the scope and location of their activities. Tensions within the interdisciplinary team may emerge from a lack of understanding of the skills and abilities of the nurse. Nurses bring a breadth of skills to the interdisciplinary team, but often lack depth within individual skills. Models of interdisciplinary teamwork also need to consider the variety of practice settings that nurses work within, including residential settings and rural and remote communities.
Effective Interdisciplinary Teamwork: An Occupational Therapy Perspective
Authors: Fossey Ellie
Published: March 2003

Objective: First, to describe the focus and scope of occupational therapy and some contributions of occupational therapy in mental health settings. Second, to identify opportunities for enhancing interdisciplinary teamwork so as to effectively address the full range of needs and issues experienced by people living with mental illness, from an occupational therapist's perspective.

Conclusions: The significance of occupation for health and wellbeing needs to be better understood within the mental health field, and wider community, if interdisciplinary teams are to more effectively address the occupational and other needs of those living with mental illness. To this end, improved opportunities for dialogue through shared education and professional development, informed dialogue about balancing generic, specialist and nonprofessional roles in service delivery, as well as inclusion of consumers and carers in these dialogues, are recommended.
“Chemical Imbalance”: A Clinical Non Sequitur
Authors: Lachter Bruce
Published: March 2003

Objective: To discuss the impact on the depressed patient of being told that he or she is suffering from a “chemical imbalance”.

Conclusions: This ‘explanation’ encourages a flight from self-reflection - for both patient and psychiatrist - and is likely to perpetuate the former's suffering and the latter's ignorance.
ICD-10 as a Coding Tool in Psychiatry
Authors: Janca Aleksandar
Published: March 2003

Objective: The aim of this paper is to provide an overview of the structure, construction principles and coding conventions of importance for the application of the Tenth Revision of the International Classification of Diseases (ICD-10) in the coding of psychiatric diagnoses.

Method: The method involved an extensive review of the various versions of ICD-10 and ICD-10-related documents, instruments and literature.

Results: ICD-10 differs from its predecessors in many ways including the introduction of a novel alphanumerical coding scheme; development of the concept of a “family” of disease and health-related classifications; inclusion of diagnostic guidelines and explicit criteria for mental disorders; production of the mental disorders chapter of the classification in different versions and for different types of users; and provision for incorporation of nationally relevant coding standards which facilitates preparation of national adaptations of the classification such as the Australian Modification of ICD-10 or ICD-10-AM.

Conclusions: Relatively late and slow implementation of ICD-10 into psychiatric coding practices in Australia is mainly due to a lack of organised ICD-10 educational programs and activities at the national and State levels. In view of the fact that, as one of the Member States of the World Health Organization, Australia has an obligation to report mortality and morbidity statistics at an international level using the ICD-10, the development of comprehensive ICD-10 educational and training strategies for all types of mental health professionals dealing with coding and recording of psychiatric diagnoses should be seen as a priority in this country. APAIS, ASSIA, BIOSIS, Cambridge Scientific Abstracts, CancerLIT, CINAHL, Current Contents/Clinical Medicine and Social & Behavioral Sciences, EMBASE/Excerpta Medica, Health Services Abstracts, Index Medicus, Inpharma Weekly, International Nursing Index, MEDLINE, Psychiatric Rehabilitation Journal, Psychological Abstracts, PsycINFO, PsycLIT, Reactions Weekly, Research Alert, Science Citation Index, SciSearch, Social Planning/Policy & Development Abstracts, Social Sciences Citation Index, Social SciSearch, Sociological Abstracts, Year Book of Psychiatric and Applied Mental Health
Psychiatric Care in Nursing Homes: More Must be Done
Authors: Snowdon John , Arie Tom , Chiu Edmond
Published: March 2003

Objective: The purpose of this review is to highlight the prevalence of mental disorders in Australian nursing homes and to provoke discussion of the current inadequacy of mental health services in these facilities.

Method: Comparisons were made between mental health care in Australian and United States (US) nursing homes. Relevant literature was reviewed.

Results and Conclusions: In both US and Australian nursing homes, the prevalence of mental disorders is high, but there is under-recognition and under-treatment of these conditions. When adequately resourced, old age psychiatry services can have a beneficial impact on mental health care in nursing homes.
Why we should Reject Mandatory MOPS
Authors: Morstyn Ron
Published: March 2003

Objective: To critically review General Council's decision designating participation in the MOPS program as mandatory for retention of Fellowship from 1 January 2003.

Conclusions: Mandatory CME is increasingly being used overseas to pave the way for Managed Care. The RANZCP MOPS program, in both its compulsory audit and structured improvement components, explicitly and implicitly encourages Managed Care benchmarks, objectives and values. Managed Care inevitably leads to damage to the patient-therapist relationship and demoralisation of doctors. Mandatory MOPS is unproven, overly expensive, bureaucratic, unfair, intrusive and educationally counterproductive. It will give excessive control to the College over psychiatrists' practices and will lead to a number of legal problems. The decision of General Council should be reversed, the mandatory audit components of MOPS dropped and a more flexible, inexpensive and truly educationally based MOPS program developed.

“If it looks like a duck, and quacks like a duck, we have at least to consider the possibility that we have a small aquatic bird of the family Anatidae on our hands.”

Douglas Adams, Dirk Gently's Holistic Detective Agency 1
A Psychiatrist in Bougainville
Authors: Storm Victor
Published: March 2003

Objective: This paper gives a brief background on the recent history of Bougainville and the consequences for health services. An outline of a series of mental health workshops is given, together with impressions gained from this experience. The role of a visiting consultant in this unusual situation is described.

Conclusion: Short term consultation and education visits to regions without psychiatrists appear to play some role in support of community leaders during civic reconstruction. Ongoing support from Australia and New Zealand would further assist this process.
Seeking Refuge, Losing Hope: Parents and Children in Immigration Detention
Authors: Mares Sarah , Newman Louise , Dudley Michael , Gale Fran
Published: March 2003

Objective: To record observations made by the authors on a series of visits between December 2001 and March 2002 to two of Australia's immigration detention centers and to consider the mental health consequences of Australia's policy of mandatory immigration detention of asylum seekers for families and children.

Conclusions: Parents and children in immigration detention are often vulnerable to mental health problems before they reach Australia. Experiences in prolonged detention add to their burden of trauma, which has an impact not only on the individual adults and children, but on the family process itself. Immigration detention profoundly undermines the parental role, renders the parent impotent and leaves the child without protection or comfort in already unpredictable surroundings where basic needs for safe play and education are unmet. This potentially exposes the child to physical and emotional neglect in a degrading and hostile environment and puts children at high risk of the developmental psychopathology that follows exposure to violence and ongoing parental despair. Psychiatrists have a role in advocating for appropriate treatment of these traumatized and vulnerable parents and children.
American and Australasian Systems in Psychiatry: Crossing the Bridge
Authors: Pavuluri Mani
Published: March 2003

Objective: To familiarize Australasian psychiatrists about differences in the psychiatric systems of the United States and Australasia. A secondary objective is to contribute towards a multi-leveled collaboration between the Australian and New Zealand College of Psychiatrists and the American College of Psychiatry and Neurology.

Conclusions: There appear to be multiple differences, including in aspects of training, acquiring credentials, cross accreditation, the effect of managed care on clinical practice, volume of research, and interpersonal relations. Despite differences in the systems, it seems critical to anchor oneself to the bio-psycho-social model in order to maintain the integrity of psychiatric practice.
Best Evidence Medical Education in Psychiatry Training
Authors: McGuckin Cathy , Burke David , McGuckin Cathy
Published: March 2003

Objectives: To examine the evidence-base in medical education and psychiatry training, in relation to: the most effective method of imparting the attitudes, skills and knowledge essential to prepare future psychiatrists for modern psychiatric practice; the most effective method of optimising trainees' motivation to learn and their enjoyment of learning; and the most effective method of fostering trainees' commitment to self-directed, life-long learning.

Methods: The current available literature was reviewed by searching medical and education computer data-bases up to December 2001; a web search of evidence-based education was conducted; and the references cited in the articles obtained were scanned for papers not yielded by the database and web searches.

Results: There is evidence to support the use of both the directed and the constructivist approaches to education, there is evidence to support the use of problem-based learning in medical education, and there is no evidence for adult learning theory or transformative learning theory, although elements of both appear to be incorporated into problem-based approaches.

Conclusions: The emphasis in modern medical education is on a con-structivist approach, dominated by problem-based learning and built around small-group activities. Postgraduate psychiatry training could be improved significantly by adopting the evidence-based advances that have been made in education and undergraduate medical education over the past three decades.
Description of a Rural Australian Free Call Telephone Mental Health Information and Support Service
Authors: Ledek Veronica , Deane Frank P , Lambert Gordon , McKeehan Catherine
Published: March 2003

Objective: To describe the activity of a rural-based free call 1800-Mental Health Information and Support Service (1800-MHISS) which provides a 24-hour single point of contact for people experiencing a mental health problem.

Method: Routine data collected during a 15 month period concerning service utilisation, caller characteristics, service provision, triage assessment and the impact of the service on after-hours services are described. Qualitative data from a survey of emergency department and community mental health is discussed.

Results: The service received an average of 1117 calls per month. While a majority of calls were for information and support, 13% required a triage assessment and, of these, 13% resulted in an emergency response. Analysis of pre and post study data demonstrated a 43% reduction in the activation of after-hours services.

Conclusions: Overall, the study suggests the 1800-MHISS provides a safe and efficient response to psychiatric emergencies and is valued by Emergency Department and community mental health staff.
Doctor to the Dictator: The Career of Theodor Morell, Personal Physician to Adolf Hitler
Authors: Kaplan Robert
Published: March 2003

Objective: To examine the life and career of Theodor Morell, personal physician to Adolf Hitler.

Conclusions: For nine years, Dr Theodor Morell had almost exclusive access to Hitler. Hitler, an illness phobic, lied about his medical history, refused to be examined except in the most superficial fashion and tended to accept or reject treatment according to his whim. Morell used a range of complementary treatments, intravenous glucose, amphetamines and opioid injections. While Morell's methods were suspect, it is doubtful he did his patient much harm. Dismissed by the disillusioned Dictator, he was captured by the Allies but never prosecuted, dying in 1948.
Hepatic plasmacytomas: Case report and review of imaging features
Authors: Ng P , Slater S , Radvan G , Price A
Published: March 2003

Extramedullary plasmacytomas are uncommon and have a better prognosis than disseminated myeloma. We describe the second case of hepatic plasmacytomas (multiple) following a solitary bone plasmacytoma. The imaging characteristics of the few reported cases of these rare hepatic tumours are compared. The value of ultrasound in the assessment of liver lesions is emphasized.
Spontaneous rupture of the renal pelvis
Authors: Ashebu Sd , Elshebiny Yh , Dahniya Mh
Published: March 2003

The object of the case report is to present a case of spontaneous rupture of the renal pelvis with no underlying pathological condition to account for the rupture, a very rare and unusual occurrence. The patient was a 46‐year‐old Korean who presented with severe left loin pain and vomiting. The diagnosis was suspected on intravenous urography and confirmed by CT. Treatment was by ureteral stenting. The patient made a complete recovery. The differential diagnosis of this condition is discussed and the literature is reviewed.
Symptomatic ossification of the posterior longitudinal ligament of the cervical spine: Pictorial essay
Authors: Soo Mys , Rajaratnam S
Published: March 2003

Symptomatic ossification of the posterior longitudinal ligament (OPLL) of the cervical spine is a rare but well‐documented condition. It is the causative factor in up to 5% of cases presenting with cervical radiculopathy or myelopathy. Computed tomography is the modality of choice in showing the distinctive characteristics and extent of the disease. Magnetic resonance imaging (MRI) is sensitive in detecting cord compression and its attendant complications. Cervical OPLL commonly affects those of middle and advanced age, and the condition is noted to be particularly common in Japanese, although other racial groups are also affected. A ‘mushroom’ or ‘hill’ shape on axial CT typifies OPLL. A sharp radiolucent line separating the posterior vertebral margin from the superficial component of the ossified ligament is a characteristic feature.
Trans‐sphenoidal and sphenoethmoidal encephalocele: Report of two cases and review of the literature
Authors: Koral Korgün , Geffner Mitchell E , Curran John G
Published: March 2003

Basal encephaloceles are the least common form of encephalocele. Due to the critical position of the bony defect, visual and endocrinological abnormalities are frequently associated with basal encephaloceles. There is significant confusion in the classification of basal encephaloceles, particularly among trans‐sphenoidal, sphenoethmoidal and intrasphenoidal subtypes. Two cases of basal encephaloceles are presented (one trans‐sphenoidal and one sphenoethmoidal), along with a review of the literature. The relationship between the basal encephaloceles and endocrinological abnormalities is also emphasized.
Imaging the sphenoid sinus: Pictorial essay
Authors: Chong Vfh , Fan Yf , Lau Dpc , Chee Lwj , Nguyen Tm , Sethi Ds
Published: March 2003

This paper focuses on the spectrum of sphenoid sinus lesions that may be seen radiologically and the mapping of disease extent. Imaging plays a central role in the assessment of sphenoid sinus disease. Although primary sphenoid sinus disease is uncommon, this sinus is nevertheless affected secondarily by a variety of pathological processes.
Nodular fasciitis of the breast simulating breast cancer on imaging
Authors: Dahlstrom Je , Buckingham Jm , Bell S , Jain S
Published: March 2003

Nodular fasciitis is a rare benign soft tissue tumour of the breast that clinically and radiologically can mimic invasive duct carcinoma. The clinical, radiological and pathological findings of nodular fasciitis of the breast in a 38‐year‐old woman, who presented with a palpable lesion in the upper inner aspect of the left breast, are described. The tumour is characterized histologically by a stellate spindle cell tumour with a focal myxoid background containing scattered inflammatory cells and microhaemorrhages. Pathological assessment of the lesion is essential in making the diagnosis.
Pneumothorax preceding pulmonary blastoma in a child
Authors: Shyamkumar NK , Athyal RP , Govindarajulu G , Narayan VP , Rangad F , Govil S , Chacko J
Published: March 2003

Serial plain radiographic, ultrasound and CT findings of an unusual case of pulmonary blastoma are described with a review of the literature.
Spongiform leucoencephalopathy following intravenous heroin abuse: Radiological and histopathological findings
Authors: Robertson Alasdair S , Jain Sanjiv , O'Neil Ross A
Published: March 2003

A case of spongiform leucoencephalopathy in a known intravenous heroin abuser is presented. To our knowledge, this is the only case of heroin‐related spongiform leucoencephalopathy reported in Australia. The relationship to intravenous rather than inhaled heroin is particularly unusual with only one other possible case documented in the literature. The imaging and histopathological findings are described.
Choroid plexus carcinoma in an adult
Authors: Wyatt Sarah S , Price Richard A , Holthouse David , Elsaleh Hany
Published: March 2003

Choroid plexus carcinomas are rare in adults. They can behave aggressively and their optimal management is uncertain. An adult patient with choroid plexus carcinoma who was treated with an incomplete surgical resection and postoperative radiotherapy is reported. Despite an identifiable local response to radiotherapy, disease progression resulted in death 4 years after presentation. This report reviews the current literature and discusses the management issues regarding this uncommon adult malignancy.
Imaging with F‐18 FDG PET is superior to Tl‐201 SPECT in the staging of non‐small cell lung cancer for radical radiation therapy*
Authors: MacManus Michael P , Hicks Rodney J , Ball David L , Ciavarella Filomena , Binns David , Hogg Annette , Kalff Victor , Ware Rob , Wirth Andrew , Salminen Eeva , McKenzie Allan
Published: March 2003

Thallium‐201 (Tl‐201) single photon emission computed tomography (SPECT) is funded for evaluation of malignancy in Australia and may have utility for staging of non‐small cell lung cancer (NSCLC) if CT results are equivocal. Fluorine‐18 fluorodeoxyglucose (F‐18 FDG) positron emission tomography (PET) is superior to CT for staging NSCLC but is more expensive and less widely available than Tl‐201 SPECT. Therefore, these techniques were prospectively compared in 27 radical radiation therapy candidates. Patients were allocated a conventional, PET and Tl‐201 stage. Tumour to background ratios (TBR) were recorded for the primary on both techniques. Metastatic disease was confirmed by surgical pathology, serial imaging or clinical follow up. Tumour to background ratios were consistently higher for FDG PET than Tl‐201 SPECT (P < 0.0001). Positron emission tomography detected all known primary tumours but Tl‐201 failed to image four primary tumours (15%). In 10 of 18 cases of discordance between PET and Tl‐201 SPECT regarding stage, corroboration was available from pathology or disease progression. Positron emission tomography was shown to have a 100% positive predictive value, including all three patients with PET‐detected distant metastases (P = 0.002). Results indicate that PET is superior to Tl‐201 SPECT scanning in the staging of NSCLC for radical radiation therapy, and that the low sensitivity for detection of local and metastatic disease is likely to limit the clinical impact and cost‐effectiveness of this technique despite its lower cost.
Colour duplex Doppler ultrasonography evaluation of non‐vasculogenic male erectile dysfunction: An Indian perspective
Authors: Bhargava R , Srivastava DN , Thulkar S , Berry M , Gupta NP
Published: March 2003

We present the study of colour duplex Doppler ultrasonography on Indian patients with non‐vasculogenic erectile dysfunction. Patients with a history suggestive of psychogenic impotence along with a normal clinical response to intracavernosal papaverine were presumed to have non‐vasculogenic erectile dysfunction. In our patients, the incidence of psychogenic impotence was much higher and the mean age of patients presenting with erectile dysfunction was lower as compared to patients from developed countries reported in research. The Doppler flowmetry showed much higher mean peak systolic velocities (PSVs) with a negative correlation between age and PSV. End diastolic velocity, resistive index and acceleration time values conformed to the literature.
MRI of perforated gall bladder
Authors: Sood Bimal , Jain Manoj , Khandelwal Niranjan , Singh Paramjit , Suri Sudra
Published: March 2003

Gall bladder perforation is a dreaded complication of acute cholecystitis that, if not diagnosed early in the course, might have a poor prognosis. Both CT and ultrasonography have been used until now extensively for the diagnosis of acute cholecystitis, but diagnosis of perforation is always difficult. Magnetic resonance, by its superior soft tissue resolution and multiplanar capability, is a better modality and should fare better than ultrasonography and CT, as demonstrated in our case. Magnetic resonance imaging demonstrates the wall of the gall bladder and defects to a much better advantage and more convincingly. In addition, MR colangiopancreatography images demonstrate the biliary tree better than other modalities. We suggest that in the case of acute cholecystitis, if perforation is suspected and CT and ultrasonography are not conclusive, MR should be the modality of choice. It can be used as a first line of investigation; however, it might not be cost‐effective.
Comparison of cost and outcome of endovascular and neurosurgical procedures in the treatment of ruptured intracranial aneurysms
Authors: Bairstow Phillip , Dodgson Andrew , Linto Jennie , Khangure Mark
Published: March 2003

Endovascular techniques for the treatment of intracranial aneurysms have gained rapid acceptance in some countries as an alternative to conventional neurosurgical treatment. The International Subarachnoid Aneurysm Trial (ISAT) is the first multicentre prospective randomized trial comparing neurosurgery with endovascular coil (Guglielmi detachable coil) treatment of acute subarachnoid haemorrhage. The cost and outcome of endovascular procedures was compared with neurosurgical procedures in the treatment of ruptured intracranial aneurysms within the context of the ISAT. Two groups of patients (Endovascular group with 10 patients and the Neurosurgical group with 12 patients) were drawn from admissions to Royal Perth Hospital and Sir Charles Gairdner Hospital, Perth, Western Australia, as detailed in the ISAT trial protocol. Data were collected in the following categories: patient, procedure, hospitalization, morbidity and mortality. While the endovascular procedure tended to be the more expensive in terms of the cost of consumables, this expense was more than compensated by savings in staffing costs, and the period and cost of hospitalization. Following an endovascular procedure, patients tended to return to normal activity or paid employment sooner and have a favourable functional outcome compared with patients following a neurosurgical procedure.
Hypertensive encephalopathy
Authors: Phal Pramit , Molan Maurice , Clare Ian
Published: March 2003

The case report of a patient with hypertensive encephalopathy is presented here. The findings of reversible bilateral thalamic changes on T2‐weighted MR imaging is an atypical manifestation of the reversible posterior leucoencephalopathy syndrome (RPLS), which is the neuroradiological correlate of hypertensive encephalopathy. The importance of prompt and accurate diagnosis of hypertensive encephalopathy / RPLS is stressed.
MRI in ankle tuberculosis: Review of 14 cases
Authors: Zacharia TT , Shah JR , Patkar D , Kale H , Sindhwani V
Published: March 2003

We reviewed the MR imaging features of ankle tuberculosis and determined the role of MR in its diagnosis. A retrospective analysis of 14 cases of ankle tuberculosis imaged with MRI was performed. Plain radiographs were also reviewed where available, and the imaging characteristics were noted. We also reviewed the medical records in order to assess the impact of the imaging findings on management of these patients. Magnetic resonance imaging is extremely helpful for detection, mapping the extent and resolution of the disease. It can identify cases, enables early institution of antituberculous chemotherapy and might obviate the need for surgery.
TENSION OSCILLATION IN ARTERIES AND ITS ABNORMALITY IN HYPERTENSIVE ANIMALS
Authors: Shimamura Keiichi , Sekiguchi Fumiko , Sunano Satoru
Published: March 2003

1. The mechanisms of oscillatory contraction of arterial smooth muscle in vitro are discussed.

2. The membrane potential and cytoplasmic free Ca2+ concentration in smooth muscle cells oscillate in the presence of agonists.

3. The oscillatory change in the membrane potential of smooth muscle cells is related to Ca2+ release from intracellular stores.

4. Gap junctions between smooth muscle cells play important roles in the synchronized oscillation of the cytoplasmic free Ca2+ concentration in this population of cells.

5. Endothelial cells may increase or decrease the tension oscillation of smooth muscle cells.

6. In arteries from hypertensive rats, an increase in membrane excitability and the number of gap junctions between smooth muscle cells and impaired endothelial function are the main factors responsible for the modulation of tension oscillation.
INCREASED OXIDATIVE DNA DAMAGE IN STROKE‐PRONE SPONTANEOUSLY HYPERTENSIVE RATS
Authors: Negishi Hiroko , Ikeda Katsumi , Sagara Miki , Sawamura Makoto , Yamori Yukio
Published: March 2003

1. The amount of urinary 8‐hydroxy‐2′‐deoxyguanosine (8‐OHdG), a biomarker of the total systemic oxidative stress in vivo, in stroke‐prone spontaneously hypertensive rats (SHRSP) was not different from that in control normotensive Wistar‐Kyoto (WKY) rats at 6 weeks of age, but became higher than control values after the development of severe hypertension at 14–17 weeks of age.

2. The amount of urinary 8‐OHdG was not significantly different between SHRSP treated with anti‐hypertensive agents and those not treated at 14 weeks of age.

3. Stroke‐prone spontaneously hypertensive rats were exposed to DNA damage by oxidative stress at the early stage when they developed severe hypertension, but this increase in DNA damage was not the secondary effect of hypertension.
AMLODIPINE, A LONG‐ACTING CALCIUM CHANNEL BLOCKER, ATTENUATES MORNING BLOOD PRESSURE RISE IN HYPERTENSIVE PATIENTS
Authors: Ishimitsu Toshihiko , Minami Junichi , Kawano Yuhei , Numabe Atsushi , Shuichi Takishita
Published: March 2003

1. The effects of once‐daily calcium channel blockers with different plasma half‐lives on diurnal blood pressure changes were examined in hypertensive patients.

2. Patients with essential hypertension, nine men and 13 women aged 61±2 years, were treated with amlodipine or nitrendipine in a random cross‐over design for 12–16 weeks each. The study drugs were given once daily as monotherapy (n = 8) or in combination with other classes of antihypertensive drugs (n = 14). The plasma half‐life of amlodipine is as long as 36 h, while that of nitrendipine is 10 h. At the end of each treatment period, 24 h ambulatory blood pressure and pulse rate were monitored.

3. Average office blood pressure was comparably controlled below 140/90 mmHg by either amlodipine or nitrendipine, both in the monotherapy and the combination therapy groups; however, pulse rate was greater in nitrendipine than in amlodipine either in the monotherapy (by 6 b.p.m., P < 0.05) or in the combination therapy (by 5 b.p.m., P < 0.01).

4. In 24 h blood pressure monitoring, morning (05.30–09.00 h) blood pressure was higher in nitrendipine than in amlodipine by 6/4 mmHg in the monotherapy (P < 0.05) and by 7/5 mmHg in the combination therapy (P < 0.03), although the blood pressure in the remainder of the 24 h did not differ between the two treatment periods. In addition, pulse rate in the daytime (09.30–18.00 h) was greater in nitrendipine than in amlodipine by 6 b.p.m. in the monotherapy (P < 0.01) and by 7 b.p.m. in the combination therapy (P < 0.02).

5. These results suggest slow pharmacokinetics of amlodipine provides an advantage in controlling morning blood pressure and mitigating reflex activation of the sympathetic nervous system.
SARCOPLASMIC RETICULUM IN VASCULAR CELLS IN HYPERTENSION AND DURING PROLIFERATION
Authors: Lompré Anne‐Marie
Published: March 2003

1. Multiple sarco(endo)plasmic reticulum Ca2+‐ATPase (SERCA) and two types of sarcoplasmic reticulum Ca2+ channels, the ryanodine receptor and the inositol 1,4,5 triphosphate (IP3) receptor are expressed. The heterogeneity of the Ca2+ pumps and Ca2+ channels in vascular cells will be discussed.

2. An age‐related change in expression of the SERCA isoforms is observed in smooth muscle cells.

3. The sarcoplasmic reticulum Ca2+‐uptake rate and the level of SERCA 2 mRNA are different in thoracic than in abdominal aortas and in aortas from spontaneously hypertensive rats than from normotensive rats.

4. Proliferation of vascular smooth muscle cells is associated with major changes in intracellular Ca2+‐handling mechanisms.
ANALYSIS IN SPONTANEOUSLY HYPERTENSIVE RATS
Authors: Nara Y , Mashimo T , Tamada T , Matsumoto C , Ishinaga Y , Nabika T , Ikeda K , Sawamura M , Yamori Y
Published: March 2003

1. Linkage analysis is performed between basal or salt‐ sensitive high blood pressure and several loci on chromosomes in F2 progenies obtained from crossing stroke‐prone spontaneously hypertensive rats (SHR) and normotensive Wistar‐Kyoto rats.

2. Basal hypertensive genes are mapped to a region near the D1Mit2 locus on chromosome 1 and near the D3Mgh8 locus on chromosome 3 in the male and female F2 progenies.

3. Salt‐sensitive hypertensive gene is mapped to a region near RR1023 locus on chromosome 10 in the male F2 progenies.

4. Salt‐sensitive hypertensive gene is mapped to a region near D3Mgh12 locus on chromosome 3 in the female F2 progenies.
ANGIOTENSIN II BLUNTS, WHILE AN ANGIOTENSIN‐CONVERTING ENZYME INHIBITOR AUGMENTS, REFLEX SYMPATHETIC INHIBITION IN HUMANS*
Authors: Miyajima EIJI , Shigemasa TOMOHIKO , Yamada YUTAKA , Tochikubo OSAMU , Ishii MASAO
Published: March 2003

1. The role of angiotensin (Ang)II in and the effects of angiotensin‐converting enzyme (ACE) inhibitors on the regulation of sympathetic neural activity were examined in humans.

2. We measured baseline values of muscle sympathetic nerve activity (MSNA) and its reflex inhibition in 28 patients with essential hypertension with elevated plasma renin activity (PRA; >1.0 ng/mL per h = 0.28 ng/L per s) before and after either acute or chronic oral administration of an ACE inhibitor or placebo and in 20 normotensive subjects before and after infusion of either AngII (5 ng/kg per min = 4.8 pmol/kg per min) or vehicle (5% dextrose). Muscle sympathetic nerve activity was recorded from the tibial nerve and its reflex inhibition was evaluated during pressor responses to bolus injection of phenylephrine (2 μg/kg, i.v.).

3. Blood pressure was significantly decreased (P < 0.01) after the acute oral administration of captopril (25 mg), accompanied by a slight increase in MSNA in patients with essential hypertension compared with control patients who received placebo administration. Reflex changes in MSNA were significantly augmented after oral administration of captopril (–4.1±0.5 vs–6.2±0.6%/mmHg, respectively; P < 0.01), with a significant reduction of plasma AngII, while they were not affected by placebo administration.

4. In contrast, acute AngII infusion was accompanied by decreases in both PRA and MSNA in normotensive subjects. Reflex changes in MSNA were significantly reduced after AngII infusion (–11.0±0.8 vs–7.4±1.0%/mmHg, respectively; P < 0.01) but not after vehicle alone.

5. Chronic ACE inhibition by 12 week oral imidapril administration (5–10 mg/day) significantly (P < 0.05) decreased baseline values of MSNA, which were accompanied by a significant (P < 0.05) increase in the reflex inhibition of MSNA, while plasma concentrations of noradrenaline were unaffected.

6. These results indicate that AngII blunts reflex inhibition of sympathetic neural activity and that inhibition of the renin–angiotensin system by an ACE inhibitor augments reflex regulation of sympathetic neural activity and reduces baseline values in patients with essential hypertension.
GROWTH HORMONE AS A CYTOKINE
Authors: Waters MJ , Shang CA , Behncken SN , Tam S‐P , Li H , Shen B , Lobie PE
Published: March 2003

1. The growth hormone (GH) receptor was the first of the class 1 cytokine receptors to be cloned. It shares a number of structural characteristics with other family members and common signalling mechanisms based on common usage of the Janus kinase 2 (JAK2).

2. Growth hormone receptor activation is initiated by GH‐induced homodimerization of receptor molecules. This has enabled the creation of specific hormone antagonists that block receptor dimerization.

3. The details of the transcription factors used by the activated receptor are being revealed as a result of promoter analyses and electrophoretic mobility gelshift analysis.

4. Growth hormone receptors are widespread and their discovery in certain tissues has led to the assignment of new physiological roles for GH. Some of these involve local or paracrine roles for GH, as befits its cytokine status.

5. Four examples of such novel roles are discussed. These are: (i) the brain GH axis; (ii) GH and the vitamin B12 axis; (iii) GH in early pre‐implantation development; and (iv) GH in development of the tooth.

6. We propose that the view that GH acts through the intermediacy of insulin‐like growth factor‐1 is simplistic; rather, GH acts to induce an array of growth factors and their receptors and the composition of this array varies with tissue type and, probably, stage of development.
STUDIES ON AGE‐RELATED CHANGES IN VASCULAR SMOOTH MUSCLE AND THEIR Ca2+ MECHANISMS
Authors: Wang YY WEN, SX , Chen
Published: March 2003

1. Increases in cell proliferation and DNA synthesis were observed in vascular smooth muscle cells (VSMC) from old rats. These effects were significantly enhanced by noradrenaline but were inhibited by nifedipine.

2. Ginsenosides, traditional Chinese drugs, inhibited the proliferation and DNA synthesis in VSMC from old rats. Cytosolic and nuclear Ca2+ levels, as well as calmodulin activity, were clearly higher in old rats compared with young rats.

3. Both Ca2+ and calmodulin levels rose abruptly in the late G1 phase in the VSMC cell cycle in old rats.

4. The increase in inositol phosphate levels stimulated by phenylephrine in VSMC was greater in old than in young rats.

5. The platelet‐derived growth factor (PDGF) gene was overexpressed in old rats. The results indicate that vascular ageing is related to enhanced proliferation of VSMC. Abnormal Ca2+ homeostasis as well as overexpression of the PDGF gene may be responsible.

6. Nifedipine and ginsenosides may inhibit VSMC proliferation with age.
Soluble Dietary Fibre Improves Insulin Sensitivity By Increasing Muscle Glut‐4 Content In Stroke‐Prone Spontaneously Hypertensive Rats
Authors: Song Young‐Ju , Sawamura Makoto , Ikeda Katsumi , Igawa Shoji , Yamori Yukio
Published: March 2003

1. The effects of soluble dietary fibre (psyllium) on peripheral insulin sensitivity and skeletal muscle GLUT‐4 protein expression were studied in 12 male stroke‐prone spontaneously hypertensive rats (SHRSP) fed a high‐caloric diet from 5 to 9 weeks of age.

2. In the psyllium‐supplemented group, fasting plasma glucose was significantly reduced and glucose levels following an oral glucose tolerance test were significantly lower than in the cellulose‐supplemented group at 30 (P < 0.05) and 60 min (P < 0.01). However, there was no difference in insulin secretion.

3. In the psyllium‐supplemented group, skeletal muscle GLUT‐4 content was significantly increased in the plasma membrane (P < 0.001), but not in the intracellular membrane.

4. No significant difference was found in phosphatidylinositol 3 (PI3)‐kinase activity between cellulose and psyllium diet not only in the basal state but also when stimulated by insulin.

5. These results demonstrate that psyllium increases blood glucose disposal by increasing skeletal muscle plasma membrane GLUT‐4 content without PI3‐kinase activation.
Multiple Inferences Using Confidence Intervals
Authors: Ludbrook John
Published: March 2003

1. In a recent review article, the problem of making false‐ positive inferences as a result of making multiple comparisons between groups of experimental units or between experimental outcomes was addressed.

2. It was concluded that the most universally applicable solution was to use the Ryan–Holm step‐down Bonferroni procedure to control the family‐wise (experiment‐wise) type 1 error rate. This procedure consists of adjusting the P values resulting from hypothesis testing. It allows for correlation among hypotheses and has been validated by Monte Carlo simulation. It is a simple procedure and can be performed by hand.

3. However, some investigators prefer to estimate effect sizes and make inferences by way of confidence intervals rather than, or in addition to, testing hypotheses by way of P values and it is the policy of some editors of biomedical journals to insist on this. It is not generally recognized that confidence intervals, like P values, must be adjusted if multiple inferences are made from confidence intervals in a single experiment.

4. In the present review, it is shown how confidence intervals can be adjusted for multiplicity by an extension of the Ryan–Holm step‐down Bonferroni procedure. This can be done for differences between group means in the case of continuous variables and for odds ratios or relative risks in the case of categorical variables set out as 2 × 2 tables.
Excitation–Contraction Coupling In Skeletal Muscle: Comparisons With Cardiac Muscle
Authors: Lamb Gd
Published: March 2003

1. The present review describes the mechanisms involved in controlling Ca2+ release from the sarcoplasmic reticulum (SR) of skeletal muscle, which ultimately regulates contraction.

2. Comparisons are made between cardiac and skeletal muscle with respect to: (i) the role of the dihydropyridine receptors (DHPR) as Ca2+ channels and voltage‐sensors; (ii) the regulation of the ryanodine receptor (RyR)/Ca2+‐release channels in the SR; and (iii) the importance of Ca2+‐induced Ca2+ release.

3. It is shown that the key differences of the skeletal muscle Ca2+‐release channel (RyR1), namely the increase in its stimulation by ATP and its inhibition by Mg2+, are critical for its direct regulation by the associated DHPR and, consequently, for the fast, accurate control of skeletal muscle contraction.