The Medical journal of Australia
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Verapamil, a calcium antagonist, has been shown to be effective in delaying death in mice after intravenous challenge with box-jellyfish (Chironex fleckeri) venom. Death from a challenge of up to three mouse-lethal doses of venom was significantly delayed after the prior intravenous administration of verapamil (P = 0.003). A smaller dose of verapamil could "rescue" mice previously envenomed with 1.25 mouse-lethal doses (P = 0.0001). These data suggest that verapamil injections should be added to the first-aid procedures performed on the beach for victims of box-jellyfish stings.
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The low incidence of breast cancer among women under the age of 25 years may not justify the routine excision biopsy of breast lumps in this age group. A policy of conservative management has been tested in 70 women between the ages of 17 and 25 years. Excision biopsy was eventually performed in 23 women - fewer than half of those with a palpable mass. ⋯ The accuracy of clinical diagnosis was high and, of 31 breast lumps diagnosed as benign mammary dysplasia, more than three-quarters resolved without surgical intervention. Indications for surgery are defined. Because breast cancer does occasionally occur in this age group, accurate clinical diagnosis and review are essential components of conservative management.
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Comparative Study
Fine-needle aspiration cytology in the management of breast disease.
The results of a series of fine needle aspiration biopsies of breast lumps were reviewed to evaluate the accuracy of this diagnostic method and its place in the clinical management of breast lesions. A high level of diagnostic accuracy was achieved. There were no false positive diagnoses of malignancy and fewer than 3% of diagnoses were falsely negative. ⋯ For the patient with a cytological diagnosis of malignancy, discussion of the nature of her surgery and subsequent care is possible before operation. In selected cases of carcinoma, mastectomy can be performed without frozen-section confirmation. Diagnostic accuracy is dependent upon experience, especially in aspiration technique, and optimum results are obtained if the pathologist/cytologist also performs the procedure.
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Twenty-six cases of extradural haematoma in children were reviewed over a 10-year period. The incidence of extradural haematoma was 3.3/1000 patients admitted to hospital with head injuries. Of 26 patients, 23% had no skull fracture and, in a further 8%, the fracture was not radiographically detectable. ⋯ The lucid interval lasted three hours or less in one-third of patients; 24 hours after injury, the level of consciousness had declined in 73% of patients. Of particular interest was the occurrence of a secondary lucid interval, definite and dramatic in 8% of patients, and definite, but slight, in a further 12%. All patients made a good recovery, except one, who died from massive pulmonary fat embolism.