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Nelson, New Zealand

We describe three cases of tutu berry (Coriaria arborea) ingestion resulting in tonic-clonic seizures in two individuals and mild symptoms in the third. Tutu poisoning in humans appears to be a rare occurrence; the last reported case in the medical literature being over 40 years ago. We review the literature on tutu poisoning and recommend extending the period of observation for poisoned individuals from 8 hours to 12 hours or longer. We also recommend that prophylactic benzodiazepine use should be considered in those with mild to moderate symptoms of poisoning.

Plummer C.,Center for Clinical Neurosciences and Neurological Research | Spring P.J.,Concord Repatriation General Hospital | Marotta R.,Center for Clinical Neurosciences and Neurological Research | Chin J.,Center for Clinical Neurosciences and Neurological Research | And 5 more authors.
Mitochondrion | Year: 2013

Multiple Symmetrical Lipomatosis (MSL) is an unusual disorder characterized by the development of axial lipomas in adulthood. The pathoetiology of lipoma tissue in MSL remains unresolved. Seven patients with MSL were followed for a mean period of 12. years (8-20 years). All patients had cervical lipomas ranging from subtle lesions to disfiguring masses; six patients had peripheral neuropathy and five had proximal myopathy. Myoclonus, cerebellar ataxia and additional lipomas were variably present. All patients showed clinical progression. Muscle histopathology was consistent with mitochondrial disease. Five patients were positive for mtDNA point mutation m.8344A. >. G, three of whom underwent lipoma resection - all samples were positive for uncoupling protein-1 mRNA (unique to brown fat). Lipoma from one case stained positive for adipocyte fatty-acid protein-2 (unique to brown fat and immature adipocytes). This long-term study hallmarks the phenotypic heterogeneity of MSL's associated clinical features. The clinical, genetic and molecular findings substantiate the hypothesis that lipomas in MSL are due to a mitochondrial disorder of brown fat. © 2013 Elsevier B.V. and Mitochondria Research Society.

Stewart R.A.H.,Green City | Stewart R.A.H.,University of Auckland | Kerr A.J.,Middlemore Hospital | Whalley G.A.,University of Auckland | And 9 more authors.
European Heart Journal | Year: 2010

AimsLeft ventricular (LV) hypertrophy and abnormal non-invasive measures of LV diastolic function are common in patients with severe aortic stenosis (AS) but their prognostic importance is uncertain. This study aimed to determine whether tissue Doppler measures of LV systolic and/or diastolic function or echocardiographic LV hypertrophy are useful for risk stratifying asymptomatic patients with severe calcific AS. Methods and resultsOne hundred and eighty-three initially asymptomatic patients with moderate or severe AS (valve area mean 0.96 ± SD 0.3 cm2) and a normal LV ejection fraction were followed for median 31 (IQR 14-40) months. Peak systolic (S′) and diastolic (E′) mitral annular velocities and LV mass were measured by echocardiography at baseline and during follow-up. During follow-up 106 (58) patients suffered symptomatic deterioration, including three sudden deaths and one resuscitated cardiac arrest. Peak aortic velocity (for 0.5 m/s increase HR = 1.43, 95 CI 1.25, 1.64, P < 0.0001) and aortic valve area (-0.1 cm 2/m2 HR = 1.23, 95 CI 1.12, 1.35, P = 0.004) at baseline were most strongly associated with symptomatic deterioration. After peak aortic velocity adjustment neither LV mass index nor any measure of LV systolic or diastolic function was associated with symptomatic deterioration (P > 0.2 for all). ConclusionIn patients with calcific AS who have a normal LV ejection fraction the severity of stenosis is the most important correlate of symptomatic deterioration. Tissue Doppler measures of LV systolic and diastolic function and LV mass provide limited predictive information after accounting for the severity of stenosis. © 2010 The Author.

Munro A.,Nelson Hospital
The New Zealand medical journal | Year: 2013

To assess the utility of a decision rule for determining short-term risk in syncope patients presenting to the Emergency Department (ED) of Nelson Hospital (Nelson, New Zealand). Sixty-eight of 83 eligible syncope patients who presented to the ED with syncope were consecutively enrolled. Follow-up for an adverse event within 7 days of index presentation was performed. Actual event rate was compared with the prediction tool known as the San Francisco Syncope Rule (SFSR). Sensitivity and specificity for the SFSR was 83% (95% Confidence Interval (CI) of 44-97%) and 82% (95%CI 71-91%) respectively. There was a negative predictive value of 98% (95% CI 90-99%). Positive and negative likelihood ratios were 4.7 (95% CI 2.5-9.0) and 0.2 (95% CI 0.03-01.22) respectively. Syncope patients who present to the ED with no obvious cause and who are being considered for discharge may benefit from application of the SFSR for short-term risk assessment.

Law C.J.,Anglesea Hospital | Jacobson G.M.,University of Waikato | Kluger M.,Waitemata District Health Board | Chaddock M.,Waitemata District Health Board | And 2 more authors.
British Journal of Anaesthesia | Year: 2014

Background Our hypothesis was that deep anaesthesia, as estimated by a low target bispectral index (BIS) of 30-40, would result in less postoperative pain than that achieved at a conventional depth of anaesthesia. Methods We undertook a randomized double-blind controlled study at two tertiary teaching hospitals in New Zealand (2010-1) recruiting 135 adult patients ASA I-II presenting for non-emergent surgery under general anaesthesia requiring tracheal intubation. Anaesthesia was maintained with desflurane and a multimodal analgesia regimen comprising fentanyl infusion, i.v. paracetamol, and parecoxib. Patients were randomly assigned to either a low BIS (30-40) group or a high BIS (45-60) group. Desflurane concentrations were titrated to achieve these targets. Postoperative pain was assessed by: the pain on awakening (0-10, verbal rating scale, VRSawake) in the post-anaesthetic care unit; pain on activity at 20-24 h after operation (VRSd1A); and the rate of morphine patient-controlled analgesia (PCA) usage over the first 24 h. Results There was no statistically significant difference between the two groups for any of the pain scores. The median [inter-quartile range (IQR)] VRSawake was 4.0 (0-8) for the low and 4.0 (0-8) for the high BIS groups (P=0.56). The median (IQR) VRSd1A was 3.0 (1-5) for the low and 3.0 (1.5-4.5) for the high BIS groups (P=0.83). The median PCA morphine consumption in the low BIS group was 0.61 mg h-1 (0.04-1.5) vs 0.43 mg h-1 (0-1.59) in the high BIS group (P=0.98). Conclusions We conclude that there is no clinically useful analgesic effect of a deep anaesthesia regimen. © The Author [2013].

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