Gender difference in the incidence of shingles.

We investigated age- and gender-specific incidence of shingles reported in a large sentinel practice network monitoring a defined population over the years 1994-2001. In total, 5915 male and 8617 female incident cases were studied. For each age group, we calculated the relative risk of females to males presenting with shingles. Incidence rates of chickenpox and herpes simplex were examined similarly. Shingles incidence was greater in females in each age group (except for 15-24 years). Relative risks (female to male) were greatest in age groups 45-64 years (1.48) and 0-14 years (1.43). There were no gender differences in the incidence of chickenpox except in the 15-24 years age group (female excess): for herpes simplex there were female excesses in all age groups. Gender-specific age-standardized incidence rates of shingles were calculated for each year and showed a consistent female excess in each of the 8 years (average annual excess 28%).

Report of a feasibility study of accident surveillance in general practice.

BACKGROUND: There is a nationally established mechanism for surveillance of accidents operating in a sample of accident and emergency (A&E) departments but no equivalent in primary care. Reduction of accidents presenting to hospitals or family doctors is a target set out in the Department of Health's Our Healthier Nation document. AIMS: To assess the merit and feasibility of collecting information on accidents in primary care, and documentation of the range and severity of accidents presenting. DESIGN OF STUDY: General practitioner (GP) reports following accidents to persons presenting to primary care. SETTING: GPs in six large practices in the Midlands (69,000 registered patients) completed questionnaires for 1233 persons sustaining accidents at home or during leisure activity during one year from September 1997. RESULTS: Main outcome measures were validation of results and description of the type of accidents presenting to primary care. Recruitment varied considerably between practices, but it was not possible for this to be validated, chiefly because of the limitations of morbidity coding systems. Overall, 18 per 1000 registered persons a year reported an accident initially to the GP, approximately one-sixth of the number presenting to A&E departments. Nine-tenths of the injuries reported were trivial or minor. There were similarities between GP and A&E patients concerning the mechanism or location of injury, but proportionately more elderly and females presented to primary care. CONCLUSIONS: Surveillance of accidents in primary care is possible, but the discipline required for reliable data capture is considerable and hindered by limitations of morbidity coding systems regarding accidents. However, there are important differences in terms of the types of accidents and injuries seen and the age and sex of persons presenting in primary care and A&E departments.

Long survival in subacute sclerosing panencephalitis.

A case is reported of a boy who at the age of 14 years developed subacute sclerosing panencephalitis. He deteriorated over a period of 9 months, improved greatly and remained stable for 7 years before relapse. The final deterioration to death extended over 6 years. During the whole period he was examined regularly and the electroencephalogram recorded at 3 to 6 monthly intervals. The brain was examined histologically after death. Electroencephalographic and pathological features are described.

Breach rhythm: the EEG related to skull defects.

From 33 patients with skull defects 89 EEGs were recorded, most with X ray control of the electrode sites. In 10 patients records were made shortly before and about 10 days after bone replacement. The remaining cases had EEGs either with or without bone replacement. The amplitude of alpha and frontal fast rhythms might be increased over or near unilateral posterior and frontal defects respectively. This enhancement was by a factor of less than 3. Since the electrode involved might not be in the defect but on adjacent bone this does not seem to be an effect of greater proximity to the generators. In 21 cases with defects involving or near to electrodes C3(/) and T3(4) sharply focal mu-like rhythms at 6--11 c/sec, usually with faster components, were seen. They formed two groups, at C3(4), responsive to fist clenching and other stimuli (not to eye opening) and at T3(4), unresponsive to any stimulus. In both groups the waves often had spike-like negative phases, but true spikes and also random slow waves with the same restricted focus and responsiveness were sometimes seen. Because of this complexity we prefer the term breach rhythm to mu or mu-like. Bone (or acrylic) replacement abolished central breach rhythm in 3 cases, but not in others and it might or might not restore the symmetry of alpha rhythm or fast rhythm, but burr holes, saw cuts etc., always remain after craniotomy. It is argued that, with the possible exception of 2 patients, the breach rhythms described in this series do not represent enhanced normal mu rhythm. Breach rhythm, even when very spike-like, appears to have little relationship to epilepsy and is not an indicator of recurrence of a tumour.

Evidence on the periodic mechanism in herpes simplex encephalitis.

A case of herpes simplex encephalitis is described in which the EEG was recorded 5 times between the 5th day of illness and death on the 13th day. Repetitive discharges occurred at intervals of 3.5 or 2 sec; at first they were larger and earlier on the right side, finally on the left; on day 11 they could be earlier on either side and sometimes ceased briefly on either side. They were associated with jerks. It is argued that this periodicity cannot be explained by cortical isolation or a single pacemaker and hence favours a third possibility, a more or less diffuse disturbance of the time constant of excitability at the cellular level.