Archive for the ‘Government Health’ Category

I know this is not about health as such but, i just went and did my tax and for the first time i have to pay the ATO, this is because Greater Southern health and BCS have not taken enough tax out durning the financial year.   Apparently i’m not the first to be stung and stung hard.


Editer’s Grip

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Progressive non-infectious anterior vertebral fusion, split cord malformation and situs inversus visceralis

Ali Al Kaissi1,2 email, Farid Ben Chehida3 email, Maher Ben Ghachem2 email, Franz Grill4 email and Klaus Klaushofer1 email

1Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of WGKK and AUVA Trauma Centre Meidling, 4th Medical Department, Hanusch Hospital. Heinrich Collins Str. 30 A-1140, Vienna, Austria

2Department of Paediatric Orthopaedic Surgery-Children Hospital of Tunis, Jabari, 1007, Tunisia

3Center of Radiology-Department of Imaging Studies-Ibn Zohr Institute, Tunis, City Khadra 1003, Tunisia

4Orthopaedic Hospital of Speising, Paediatric Department, Speisinger Str. 109, Vienna-1130, Austria

author email corresponding author email

BMC Musculoskeletal Disorders 2006, 7:94doi:10.1186/1471-2474-7-94

The electronic version of this article is the complete one and can be found online at: http://www.biomedcentral.com/1471-2474/7/94

Received: 24 July 2006
Accepted: 5 December 2006
Published: 5 December 2006

© 2006 Al Kaissi et al; licensee BioMed Central Ltd.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.



Progressive non-infectious anterior vertebral fusion is a unique spinal disorder with distinctive radiological features. Early radiographic findings consist of narrowing of the anterior aspect of the intervertebral disk with adjacent end plate erosions. There is a specific pattern of progression. The management needs a multi-disciplinary approach with major input from the orthopaedic surgeon.

Case report

We report a 12-year-old-female with progressive anterior vertebral fusion. This occurred at three vertebral levels. In the cervical spine there was progressive fusion of the lateral masses of the Axis with C3. Secondly, at the cervico-thoracic level, a severe, progressive, anterior thoracic vertebral fusion (C7-T5) and (T6-T7) resulted in the development of a thick anterior bony ridge and massive sclerosis and thirdly; progressive anterior fusion at L5-S1. Whereas at the level of the upper lumbar spines (L1) a split cord malformation was encountered. Situs inversus visceralis was an additional malformation. The role of the CT scan in detecting the details of the vertebral malformations was important. To our knowledge, neither this malformation complex and nor the role of the CT scan in evaluating these patients, have previously been described.


The constellations of the skeletal abnormalities in our patient do not resemble any previously reported conditions with progressive anterior vertebral fusion. We also emphasise the important role of computerized tomography in the investigation of these patients in order to improve our understanding of the underlying pathology, and to comprehend the various stages of the progressive fusion process. 3D-CT scan was performed to improve assessment of the spinal changes and to further evaluate the catastrophic complications if fracture of the ankylosed vertebrae does occur. We believe that prompt management cannot be accomplished, unless the nature of these bony malformations is clarified.


Progressive non-infectious anterior vertebral fusion is a unique spinal disorder with distinctive radiological features. Early radiographic findings consist of narrowing of the anterior aspect of the intervertebral disk with adjacent end plate erosions. There is a specific pattern of progression. The management needs a multi-disciplinary approach with major input from the orthopaedic surgeon.

Case presentation

The child was referred to our department at the age of 12 years because of progressive thoraco-lumbar kyphoscoliosis and progressive limitations of neck movement (fig 1). She was born at full term, the product of an uneventful gestation. At birth her length, weight, and OFC were around the 10th percentile. The mother was a 27-year-old-healthy woman, gravida 1 abortus 0, married to a 32-year-old unrelated man.

thumbnailFigure 1. Lateral radiogram showed the severe kyphosis.

At birth the parents observed a patch of hair over the lumbar region, and the child was investigated for this. A split cord malformation was identified, but the parents refused further interventions. At the age of 9 years the parents observed marked worsening of the spinal tilting and problems in bending over. Her head movements became difficult, particularly flexion, and this was accompanied by pain, more marked in the occipital and suboccipital regions. Walking a distance was difficult.

Her subsequent course of development has been described as within the normal limits, except for a moderate delay in motor development. There was no history of serious illnesses. Physical examination at the age of 12 years revealed; short stature. Her height was 121 cm (-3SD) and her head circumference was 53 cm (+2SD). She was of normal intelligence, and neurological examination, apart from a neuropathic bladder was unremarkable. Hearing and vision were normal. Stiffness of the neck was noted, with limitation of neck movement, particularly in flexion. Musculo-skeletal examination showed relative ligamentous hyperlaxity in the limbs, normal hands and feet, and the skeletal survey did not reveal limb abnormalities. The spinal column showed; severe, rigid, thoraco-lumbar kyphoscoliosis (fig 2, 3, 4, 5, 6).

thumbnailFigure 2. Early stage of progressive vertebral fusion in which C4-C6, showed progressive anterior disc narrowing and end plate irregularities (arrows; a-b), whereas (arrow c) showed the development of a thick anterior and posterior bony ridge.

thumbnailFigure 3. End stage of the progressive anterior vertebral fusion and the multi-level anterior fusion with disc space obliteration (T1-T5). There is a massive bony ridge extending anteriorly and in some vertebrae, posteriorly as well. However, (arrow b) note the sparing of the disc space posteriorly, whereas the anterior end plate is totally obliterated (arrow a). Absence of the normal concavity of the anterior body surface. There is a proliferation of sclerotic bone.

thumbnailFigure 4. 3 d reconstruction CT scan showed the massive anterior fusion of (C7-T5) and (T6-T7), and the apparent anterior thick bony ridge (arrow), the latter developed secondary to progressive ossification of the anterior longitudinal ligament. from T7-T12; note the narrowing of the anterior part of the disc space, accompanied by erosion and irregularity of the anterior end plates.

thumbnailFigure 5. Note sparing of the lumbar spines and progressive anterior fusion of L5-S1, and the exaggerated lumbar lordosis secondary to massive fusions of the thoracic vertebrae.

thumbnailFigure 6. sagittal MRI imaging showed a split cord malformation, atthe level of L1, with a bony bar at the L1 level. It also revealed situs inversus visceralis. MRI imaging of the brain did not show any abnormality, and sagittal MRI of the cervical region did not reveal any Arnold-Chiari malformation. Other imaging studies such, as echo-cardio-Doppler was normal. The pelvic ultrasound showed normal ovaries, uterus and vagina, and renal ultrasound showed a normal genito-urinary system.

Laboratory tests included hematological indices, urine screening for metabolic abnormalities, karyotype (for the child and her parents) and rhematological screening. These were all normal and the HLA B-27 was negative.

Family history was unremarkable. Parents were reluctant to give any relevant information.

Progressive, non-infectious anterior vertebral fusion is a rare disorder; which is often referred to as the Copenhagen syndrome [1]. In the classical form, there may be a characteristic anterior defect in the affected vertebrae from shortly after birth, associated with narrowing of the anterior part of the disc space. This is accompanied by erosion and irregularity of the anterior end plates, and when the process of narrowing progresses with age, there is eventual disc space obliteration and bony ankylosis anteriorly, via a thick bony ridge [2].

It is important, to differentiate progressive non-infectious anterior vertebral fusion from the congenital form of block vertebrae, firstly by its clinical history and secondly, by using CT scanning (fig 3, 4, 5)

Scoliosis and kyphoscoliosis in children can occur either in isolation or as a part of a number of syndromes. Spinal malsegmenatation occurs in many of these syndromes, and this includes spondylocarpotarsal synostosis, spondylothoracic dysplasia, and other rare conditions [3,4]. All of these disorders have characteristic patterns of vertebral malformation, such as a posterior unsegmented spinal bar, congenital block vertebra, carpal and tarsal malformations [5].

Knutsson et al., [6] and others [1,2,7] reported children with progressive anterior vertebral fusion as the only malformation, and in none was this part of a syndrome.

Hughes et al., [8] reported three children with progressive fusion, and other congenital and developmental abnormalities. However, there were no distinctive clinical or radiological features signifying a syndromic association, apart from one child, who presented with spinal dysraphism, but neither cervical vertebral fusion nor situs inversus visceralis were described. Philip et al. [9] described involvement of both the upper thoracic (T2-T5) and lower thoracic (T10-S1) vertebrae, associated with radio-ulnar synostosis, exostosis, short and broad clavicles, and a balanced t(10;20)(p11;p13) translocation. There was no cervical vertebral fusion, spilt cord malformation or situs inversus visceralis.

Farrior et al., [10] described a male child with progressive vertebral fusion of the cervical, thoracic, and lumbar vertebrae, with additional manifestations, such as absence of one cervical vertebra, clefting of the vertebral bodies, and other few minor non-spinous abnormalities. The overall features were different from these found in our patient.

Fryns et al., [11], described a child who presented with progressive anterior vertebral body fusion, and other abnormalities such as a generalised overgrowth, especially of the hands and feet, and unusually thick skin and subcutaneous tissue of upper and lower limbs. There was facial dysmorphism. These features were not seen in our patient.

Tubbs et al., [12,13] reported split cord malformation in association with Klippel-Feil syndrome, and another child presented with split cord malformation and situs inversus totalis and scoliosis. They focused on the possibility that defects of the midline and laterality defects (situs inversus) are etiologically related. However, the reported patient manifested congenital blocked vertebrae and not the progressive condition as described here (fig 3, 4, 5, 6).

McRae and Barnum [14] reviewed 25 patients who presented with atlanto-occipital fusion. They found a bony continuity between the anterior arch of the atlas and the anterior lip of the foramen magnum. However, it is uncertain given the absence of sophisticated imaging techniques whether the bony continuity was because of progressive fusion, or was congenital. Situs inversus was not documented.

Kalifa et al., [15] described the nature of progressive non-infectious vertebral fusion, in which the lesions involved mainly the anterior end plates and sparing the posterior parts, whereas in congenital vertebral blocking (failure of segmentation) it usually involves the posterior part of the disk.


The constellations of the skeletal abnormalities in our patient do not resemble any previously reported conditions with progressive anterior vertebral fusion. We also emphasise the important role of computerized tomography in the investigation of these patients in order to improve our understanding of the underlying pathology, and to comprehend the various stages of the progressive fusion process. 3D-CT scan was performed to improve assessment of the spinal changes and to further evaluate the catastrophic complications if fracture of the ankylosed vertebrae does occur. We believe that prompt management cannot be accomplished, unless the nature of these bony malformations is clarified.

Competing interests

The author(s) declare that they have no competing interests.

Authors’ contributions

All authors contributed to this work and all read and approved the final manuscript.

A A: Was responsible for, writing the manuscript, Conception and design and data analysis.

F B C, and M B G: Data analysis.

F G and K K: Conception and design.


We wish to thank Dr. Michael Baraitser (Institute of Child Health-Clinical and Molecular Genetics-University College London) for his unlimited help. And we thank Dr. Marwa Hilmi, West Hertfordshire Hospitals, Watford Herts, UK, for her technical help.

We also thank the patient’s family for their cooperation and a written consent was obtained from the patient’s family for publication of study


  1. Andersen J, Rostgaard-Christensen E: Progressive non-infectious anterior vertebral fusion.

    J Bone Joint Surg [Br] 1991, 73:859-62. PubMed Abstract | Publisher Full Text OpenURL

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  2. Smith JRG, Martin IR, Shaw DG, Robinson RO: Progressive non-infectious anterior vertebral fusion.

    Skelet Radiol 1986, 15:599-604. OpenURL

    totext()Return to text

  3. Maroteaux P, Le Merrer M: Maladies osseuses de l’ enfant. 4th edition. Medicine-Science, Flammarion, Paris; 2002:266-268. OpenURL

    totext()Return to text

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Henoch-Schonlein purpura


Henoch-Schonlein purpura is a disease that involves purple spots on the skin, joint pain, gastrointestinal problems, and glomerulonephritis (a type of kidney disorder).

Alternative Names

Anaphylactoid purpura; Vascular purpura


Henoch-Schonlein is a type of hypersensitivity vasculitis and inflammatory response within the blood vessel. It is caused by an abnormal response of the immune system. It is unclear why this occurs.

The syndrome is usually seen in children, but it may affect people of any age. It is more common in boys than in girls. Many people with Henoch-Schonlein purpura had an upper respiratory illness in the previous weeks.


Exams and Tests

The doctor will examine your body and look at your skin. The physical exam will reveal skin lesions and joint tenderness.

A urinalysis shows microscopic blood in the urine. A skin biopsy shows vasculitis.


There is no specific treatment. Most cases go away on their own without treatment. If symptoms persist, your doctor may recommend therapy with corticosteroids such as prednisone.

Outlook (Prognosis)

The disease usually resolves spontaneously without treatment.

Possible Complications

  • Symptoms return
  • Kidney problems (may occur in rare cases)

When to Contact a Medical Professional

Call for an appointment with your health care provider if:

  • Symptoms of Henoch-Scholnlein purpura develop, particularly if they last for more than a few days
  • If low urine output develops after an episode of Henoch-Schonlein purpura


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A new study has revealed an explosion in weight loss surgery procedures in Western Australia over the past two decades.

The study by the University of Western Australia’s School of Population Health is published in the latest edition of the Medical Journal of Australia.

It found there were 20 times more bariatric procedures, such as gastric banding, performed in 2004 than in 1988.

Sixty-four-year-old Pamela Vigers was an acute diabetic who weighed 116 kilograms. She lost 40kg after surgery and says it has changed her life.

“I don’t take insulin or any type of diabetic medication, the diabetes is totally under control because I can exercise now,” she said.

Researchers say while the study focussed on WA, the increase is indicative of a national trend.

The study’s co-author Fiona Smith says much of the rise can be attributed to the worsening obesity problem.

“Certainly we found that some of the rise in the surgery can be attributed to the increasing population prevalence of obesity,” she said.

“There are other likely factors though – things like increasing publicity and awareness of the surgery.”

Ms Smith says the research also found the surgery is safe.

“There was relatively few complications recorded and very little difference in survival outcomes between the bariatric surgery patients and the general population,” she said.

Australian Medical Association national president Rosanna Capolingua says the surgery has improved over the past two decades.

“Certainly there have been improvements in this sort of surgery over that period of time,” she said.

“Laparoscopic surgery is now available. It is safer, it is a more realistic option.”

But Ms Capolingua says surgery should only be used as a last resort.

“It is an appropriate treatment after other methods of weight loss have failed and in certain groups, [for example] patients with a BMI over 35.”

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The City of Cockburn has voted to ban smoking at a number of public places, including beaches and playgrounds.

The smoking ban will take effect immediately and will also include council buildings, sporting facilities and bus stops.

The motion was passed six to four by the Cockburn City Council last night.

The council’s chief executive officer Stephen Cain says signs will be erected in areas where smoking is banned, but there will not be a strong focus on punishing people who do not comply.

“It’s certainly voluntary. In the event that a ranger asks someone not to smoke and they persist, yes, they can be fined, ” he said.

The Cities of Perth and Fremantle have both banned smoking in alfresco dining areas.

Mr Cain says that may be the next move the council considers.

“We’re looking at this as a first stage review and depending on the results we might consider other locations, “he said.

“I know that a number of other local authorities have banned smoking in alfresco areas and maybe that will be appropriate for council in time.”

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SA Health has issued a warning about a Chinese medicine after a 60-year-old man had an adverse reaction to it.

Nangen Zengzhangshu is promoted as a treatment for sexual and erectile dysfunction and is available over the internet.

The medicine contains the drugs sildenafil and glibenclamide otherwise only available on prescription in Australia.

SA Health says people with pre-existing heart disease who take sildenafil can suffer sudden cardiac death, heart attacks or strokes.

Glibenclamide is used to treat diabetes and can cause dangerously low blood pressure, vomiting, loss of consciousness and fits.

SA Health says the medicine poses a risk because it contains two drugs which should only be taken under medical supervision with a prescription.

South Australia’s chief medical officer Professor Paddy Phillips says sildenafil can cause serious heart problems.

“Sildenafil is used for erectile dysfunction and can cause low blood pressure, chest pain, abnormalities of heart rhythm, even stroke,” he said.

“Especially it can cause problems if it’s used for, if it’s used in combination with certain medicines used for heart disease such as nitrate medicines.”

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A Hobart discrimination hearing has heard the risk of Tasmania’s blood supply being infected by HIV would be extremely low if gay men who practice safe sex were allowed to donate blood.

The risk calculations were made by the lawyer representing a man who has accused the Red Cross of discrimination.

The Red Cross refused Michael Cain’s blood because he had been in a gay relationship.

Mr Cain argues screening should be based on safe sexual practices, not sexual orientation.

Canadian risk analysis expert William Leiss told the Anti-Discrimination Tribunal such a change would increase the risk of infection.

But Mr Cain’s lawyer, Peter Tree, said statistics showed if gay men who have safe sex were allowed to donate blood, the risk of Tasmania’s blood supply being infected by HIV would be once every 5,769 years.

Dr Leiss said that could be right, but such a screening system had not been researched.

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A national medical conference in Sydney has been told that not enough is being done to ensure stroke patients are treated quickly.

New research shows that giving patients medical treatment in an ambulance and sending them to a hospital with a special stroke unit can significantly improve outcomes.

Denis Crimmins from Gosford and Wyong Hospitals on the New South Wales central coast says they have introduced a program which involves ambulance officers giving patients more aggressive treatment before they reach the hospital.

“When someone has a stroke they have a probably a 20 per cent chance of dying from the stroke or a 20 to 30 per cent chance of being left totally disabled,” he said.

“By giving this drug early on we can actually take patients with severe deficits and nearly bring them back to complete normality.”

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Free condoms in Beijing


Beijing’s health authorities have distributed 400,000 free condoms in over 400 hotels in the Olympic city in a bid to raise awareness of safe sex and AIDS prevention, state media reported.

The condoms were placed in rooms in hotels rated three stars and above, Jin Dapeng, director of Beijing’s municipal health bureau, told the official Xinhua news agency.

According to Mr Jin, thousands of Olympic volunteers have been trained in AIDS prevention for the Olympic Games, the news agency reported.

“Now 180 college students and 500 community volunteers are ready to publicise AIDS-related knowledge,” Mr Jin was quoted as saying.

“We have opened 40 clinics in Beijing’s 18 districts and counties to offer free HIV tests and AIDS counselling.”

Health authorities also distributed 250,000 free pamphlets on AIDS prevention and control, Xinhua said.

The latest study by China’s health ministry, the WHO and the United Nations found that 700,000 people were HIV positive in China at the end of 2007, although campaigners have warned the figure could be up to 10 times higher.

Thousands were infected during the 1990s through tainted blood transfusions at illegal blood collection stations, but the focus of attention is now shifting to high risk groups such as gay men and sex workers.

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Aged care providers are calling for urgent action to redress a critical shortage of registered nurses.

Anglicare says while the number of high-needs-residents requiring greater medical care has increased, the new funding mechanism from the Commonwealth has effectively cut the budget of many nursing homes.

Anglicare’s Di Flecknoe-Brown says lower pay rates and a high workload in aged care are exacerbating the shortage of registered nurses, and not-for-profit aged care providers cannot match the pay offered by public and private hospitals.

“If we haven’t got the right funding as the structure that underpins everything we cannot provide any of the resources that are needed properly,” she said.

“Our money supply is not a bottomless pit and to look after people properly they have to have people who can look after them and those people need to be rewarded and remunerated appropriately.

“Many of these people would have been kept in private hospital beds or public hospital beds.

“In real terms they’re not just residents, they’ve become patients, because they have complex wound management, behavioural management, depression, they’ve got Alzheimers, they’ve got senile dementia or they’ve had a major stroke, or a physical disability and all of that requires a multi-disciplinary team to look after them.”

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