The Purley train crash mechanism: injuries and prevention.

On the afternoon of Saturday 4th March 1989 two trains, both bound for London Victoria Station, collided. Part of the rear train rolled down a steep railway embankment and jack-knifed against a tree. The mechanism of the crash and the injuries sustained by the 55 victims who were seen in the A&E Department of the Mayday University Hospital are described. Improvements in signalling technology and design of rolling stock which may reduce both the risk of collision and severity of injury in future accidents are discussed.

Plant hair dermatitis.

OBJECTIVE: To survey the ill effects of plant hairs on humans in Australia, incorporating new records. DESIGN: Retrospective analysis of new records, in some cases confirmed and supplemented by experimental skin contacts, along with a general survey of relevant literature. METHODS: Reports of accidental injuries submitted to the authors, through either medical or other sources, and to the Botanic Gardens of Adelaide and State Herbarium of South Australia, were studied and compared with existing literature; in some cases the effects were confirmed experimentally. RESULTS: A general survey of plant hair dermatitis in Australia is offered. Most species included have been referred to in the scattered earlier literature, but a few plants not previously recorded as irritating are included, notably Apalochlamys spectabilis, Wisteria sinensis and Grevillea species. Attention is also called to the penetrating and irritating pod spines of Brachychiton spp. (kurrajongs and relatives) and Lagunaria patersonii (Norfolk Island hibiscus or pyramid tree), which are often planted as ornamental street trees. Generally those most likely to receive these injuries are gardeners and children.

Injuries from larval Neuroptera.

Bites from larval Neuroptera (lacewings) in Australia are recorded. This order of insects is among the most primitive of the higher or holometabolous insects, those with a life-history of complete metamorphoses--namely, from egg to larva to pupa to adult. The mobile instars (larva and adult) live by predation. Larvae have generally long, sharp-pointed jaws, which are used in piercing and sucking prey. One family (Chrysopidae) has larvae with jaws capable of piercing human skin. The larvae seek their prey on leaves of shrubs and trees, and occasionally cause bites to gardeners and others, but as these larvae commonly camouflage themselves with the cast skins of their prey (small insects and mites), as well as other material, such as caterpillar faeces and scraps of vegetable debris, they are mostly not recognised by their human victims. The effects are of immediate local pain with erythema and a local papule, lasting a few hours or at most a day or so. No treatment is required.

Injuries from Coleoptera.

The effects of Coleoptera (beetles) on humans in the Australian region are surveyed. Ill-effects range from the immediate trauma of a bite, possibly with minor effects from the beetle's salivary secretions, to the effects of the vesicating beetles of the families Meloidae, Oedemeridae and Staphylinidae, and also the acute corneal erosion that is attributed to the small beetle Orthoperus sp. (family Corylophidae) in southeastern Australia. Reference also is made to other effects that are known as a result of beetle metabolites or structures, such as "carpet beetle dermatitis" from the irritating hairs of Anthrenus larvae (family Dermestidae), and inhalational asthma from beetles, notably the grain weevil Sitophilus, the causative agent of certain cases of grain-worker's asthma. Beetles as human intestinal inhabitants, and their role as intermediary hosts of metazoal diseases are discussed.

Effects of stings of Australian native bees.

Five cases of stings by native bees are reported. The reactions were various and include a fatality as a result of the sting of a presumed Lasioglossum sp. (Halictidae). The effects of stings from Lasioglossum spp., Homalictus dotatus (Cockerell) (Halictidae), and Euryglossa cf adelaidae Cockerell (Colletidae) are described. The rarity of severe allergic reactions to native bees and the rarity of stings by the same species makes a programme of immunotherapy inappropriate.

Conservative surgery for ureteric tumours.

Eleven patients with ureteric transitional cell tumours were reviewed and conservative management recommended.

Successful Whipple's operation for pancreatic injury.

A case is presented of severe pancreatic injury in a 30-year-old man following a road traffic accident. A Whipple's operation was performed successfully. Despite some postoperative complications, the patient is well and back at work 1 year after the operation.

Control of severe vesical haemorrhage by therapeutic embolisation.

Therapeutic embolisation is now recognised as having a role in the management of bladder haemorrhage and is particularly valuable in severe cases where the patient's life is at risk. This paper describes the procedures which were used to manage two patients with massive haematuria, from a tumour in one case and from an arterial malformation in the other. Previous reports indicate that haemorrhage from a bladder tumour can usually be controlled by embolisation which is limited to the tumour itself but haemorrhage due to post-radiation telangiectasis requires more extensive arterial occlusion and this was taken into account in planning the embolisation procedure in the first case. Neither patient developed gluteal pain after embolisation which was probably due to the fact that the superior gluteal arteries were not completely occluded. The left axillary approach was used as a catheter passing down the aorta can usually be manipulated into the internal iliac arteries and their smaller branches on both sides without difficulty.

Non-union of carpal scaphoid fractures in children.

Fracture of the carpal scaphoid is uncommon in children, but does occur and may fail to unite. Eight patients with established non-union have been reiewed, with an average follow-up of almost four years. All non-unions were grafted with autogenous bone. Excellent clinical and radiological results have been obtained. It is concluded that non-union in children is best managed by bone grafting through the anterior approach. Possible aetiological factors concerned in non-union of scaphoid fractures in this age group are discussed.

Spiders of the genus Loxosceles in Australia.

A previous report of the presence of loxoscelid spiders in Australia is confirmed by a further finding of Loxosceles rufescens at a second suburban locality in Adelaide, South Australia. There is thus a third genus of potentially lethal spiders in Australia.

The neurologic effects of noxious marine creatures.

The concept of the sea as a source of noxious agents is perhaps not a familiar one to clinical neurologists, judging by the lack of reference to these agents in standard textbooks. Chemical, physiologic, and pharmacologic laboratories are increasingly investigating the properties of marine toxins, finding in them compounds with interesting and novel structures or unusual physiologic effects. Such substances are seen as possible agents for biologic and, more particularly, physiologic research, and as possible sources of new pharmaceuticals. These include hormone-like substances and antiviral or antitumor agents. Despite these specialized developments, which are in large measure a consequence of the technological advances of the present century, the clinician is at times directly concerned with the effects of marine toxic substances. For example, in Japan, puffer fish or tetrodotoxic poisoning is one of the major causes of deaths from food poisoning. Another marine toxin that has caused many explosive outbreaks of food poisoning. with many deaths in various parts of the world, comes from clams or mussels. This toxin, saxitoxin, is produced by species of marine protozoa including Gonyaulax, and is concentrated in filter-feeding molluscs. These two examples were of significant interest in medicine long before the technologic developments of the twentieth century. In the last few decades, entirely new problems of marine intoxication have arisen as a result of marine pollution from the disposal of industrial wastes in the sea. The most striking example of a man-made marine intoxication has been the outbreak of Minamata disease. In Minamata, Japan, the disposal of mercury-contaminated industrial wastes from a plastics factory into an enclosed bay, followed by human consumption of the contaminated fishes, crabs, or shellfish, led to many instances of acute cerebral degeneration. With the increasing exploration of the sea for both pleasure and economic exploitation, which is a feature of the second half of the twentieth century, it may be expected that the frequency and variety of human intoxications by marine creatures will be increased. This chapter reviews the neurologic effects of noxious substances of marine biologic origin. The subject is now developing so rapidly that overall surveys, such as this, of the general animal life of theocens will soon be beyond the scope of a single review. Nevertheless, it is hoped that the references given will enable the interested reader to pursue particular aspects further.