The Medical journal of Australia
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When the H1N1 subtype of influenza reappeared in the Northern Hemisphere during 1977, after a 20-year absence, it behaved very differently from the H3N2 subtype still in circulation. In Sydney, we studied the incidence of both subtypes of laboratory-proven influenza type A in 287 unvaccinated volunteers whose serum antibody titres were measured before and after each winter, to facilitate the detection of subclinical as well as clinical infection. During a 1977 epidemic, the A/Victoria/3/75 strain of the H3N2 subtype attacked participants of all age groups, whereas during epidemics of 1979 and 1981, the A/USSR/90/77 and A/Brazil/11/78 strains of the H1N1 subtype attacked only subjects born after 1950. The older participants apparently possessed homologous protection, acquired as a result of exposure to H1N1 more than 20 years earlier and not dependent upon strain-specific haemagglutination inhibition antibody.
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Strains of methicillin-resistant Staphylococcus aureus (MRSA) isolated in the Royal Perth Hospital (RPH) in Western Australia have been analysed genetically and three main types were characterized: (i) strains similar to those isolated in Europe before 1973. These strains caused small outbreaks in the RPH during the period 1966-1974, but have not been isolated in recent years, except from one patient with reactivation of osteomyelitis after 16 years; (ii) strains of the type prevalent in eastern and northern Australia, one of which caused a difficult-to-control outbreak in the RPH in 1982. Strains of this type have previously been isolated only from patients who had been in hospitals in eastern and northern Australia, but recently were isolated also from other patients--which indicates that this type of MRSA is now present in the Western Australian community; and (iii) strains, which are genetically different from either of the above two types, were isolated from patients who had been in hospitals in Southeast Asia, but have not yet caused an outbreak in the RPH.
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A case of pituitary apoplexy which occurred in a patient with prolactinoma is reported. The signs and symptoms on presentation were headache, loss of vision, sixth-nerve palsy, subarachnoid haemorrhage and fever. Physicians are alerted to the necessity of prompt and accurate diagnosis in this condition to allow urgent decompression of the anterior visual pathways.
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Norwegian scabies is a rare, but distinctive, variant of scabies. The infestation by the parasite is massive, and the lesions consist of hyperkeratotic plaques affecting the skin of the whole body. Predisposition to this form of scabies occurs in association with a variety of conditions. Three cases of Norwegian scabies, which occurred in full-blood Australian Aborigines, and were managed in the Royal Darwin Hospital, are reported.