172 THE MEDICAL JOURNAL OF AUSTRALIA Vol 153 August 6, 1990 LETTERS TO THE EDITOR 172 173 .... 172 The Huntington's Disease Centre of New South Wales. Elizabeth McCusker . Survival after burial by avalanche. Patrick Giddings ........ ........ 172 Secondary school teacher awareness and knowledge of diabetes. Erica Wright, Jeanette Sharp, J Dennis Wilson . Death and diabetes. Pat Phillips, David Wilson, Melanie Wakefield, Justin Beilby ....................... 173 "Repetition strain injury": the patient speaks. John Donovan . Effects of omega 3 polyunsaturated fatty acids on human health. Andrew J Sinclair, Robert A Gibson 174 Counting the costs of mammography screening: first year results from the Sydney study. Susan Hurley ..... . ... ... . .. ... ... 174 Karen Gerard, Glen Salkeld, Jane Hall 175 Michael Stanford...................... 175 Karen Gerard, Glenn Salkeld, Jane Hall ..... 175 A case of dysphagia caused by cricopharyngeal dysfunction that responded well to surgery. Joseph Sandanam, Ian C O'Rourke, Elizabeth Iskander ... ........... 176 Yellow kidney dishes. Brian J Parker. . 176 The Huntington's Disease Centre of New South Wales To the Editor: As this issue of The Medical Journal of Australia features Huntington's disease, I would like to draw readers' attention to additional care facilities now available in New South Wales for Huntington's disease patients and their families. In December 1988, The Huntington's Disease Centre of New South Wales was opened at Lidcombe Hospital to provide inpatient and outpatient assessment, day care and beds for respite and longer term care. A voluntary register of Huntington's disease families is also held at the hospital. Enquiries regarding the centre and register can be directed to the social worker attached to the centre. For interested families the offices of the Australian Huntington's Disease Association (NSW), are in an adjoining section of the Centre. For 15 years the Association has provided liter- ature and newsletters and organized support groups for those at risk, carers and patients. Enquiries can be made through the Executive Director. This year has seen the commencement of the predictive testing programme for Huntington's diseasein New South Walesin collaboration with the Human Genetics Unit, Royal Alexandra Hospital for children, Camperdown and the Department of Molecular Biology, Royal Prince Alfred Hospital. In order for an interested, at risk individual to be considered for the predictive test it is essential that blood samples be stored after consent from affected and key non-affected family members. More information regarding the storage of blood and the predictive test protocol can be obtained by contacting the social worker attached to the predictive test programme, Ms Fiona Richards, telephone (02) 692 6273. Elizabeth McCusker, FRACP The Huntington's Disease Centre of New South Wales Lidcornbe Hospital Joseph Street l.idcombe. NSW 2141 Survival after burial by avalanche To the Editor: On August 29, 1989 a 36-year-old man was skiing with friends in an unpatrolled area of the Mount Hotham ski area at about 3.30 p.m. There had been heavy snowfalls in the two days before. The temperature was just below zero and it was snowing lightly. The slope that he was skiing on at the time gave way. He was knocked over, partially buried, and carried 70 metres by an initial avalanche. A large slab of snow higher up the slope then gave way and buried the skier completely carrying him to the bottom of the slope, a further 30 metres. The total length of the avalanche was about 100 metres. A search was immediately commenced. A systematic "pole search" of the area was performed led by a ski patroller on exchange from the United States experienced in such tech- niques. This eventually proved successful 1 hour and 40 minutes after the avalanche had taken place. At the time of rescue the skier was fully alert and oriented complaining only of feeling cold. His only injury was a laceration to his left knee. He was amnesic from the time of burial until a short time before rescue. More detailed exami- nation 30 minutes after rescue found him to have a rectal temperature of 36.8°C with otherwise normal vital signs and neurological status. He was transferred to the local district hospital for observationand was dischargedon the following day. The relatively warm climate of the Australian Alpine Region with its usual cycle of freezing and thawing develops a relatively stable pack of snow. As in this case avalanche conditions can occur when large amounts of snow accompa- nied by high winds fall on a hard icy surface under cold conditions, thus developing soft "wind slabs" on a hard icy layer. These are commonly thin but their effect may be magni- fied by the terrain as in this case, where a wide upper slope "funnelled" into a very narrow gully and creek bed. Burial by avalanche in Australia is not unknown. In 1985 a man died when the cornice he was standing on near the summit of Mount Feathertop collapsed and a woman was killed after burial by avalanche while asleep in a building in the Snowy Mountains in 1956.' I have heard of no other reports of anyone having been completely buried by an avalanche in Australia and surviving. Overseas experience with victims completely covered by an avalanche indicates an 80% chance of survival if the victim is immediately recovered, reducing by half with each ensuing hour of burial.' These figures highlight how lucky our patient was. Death in European avalanche victims has been caused mainly by suffocation and mechan- ical trauma with hypothermia accounting for less than 4% of cases.' Our patient's higher than expected core temperature was presumably attributable to his warm winter clothing and the insulating properties of snow. In European and North American ski areas awareness of the avalanche threat is at a high level. In Australia, avalanche awareness and preparedness is understandably almost non- existent. However, avalanches do occur and survival after complete burial for almost two hours is possible in Australian conditions. There is clearly a need to maintain skills related to avalanche rescue in this country. Patrick Giddings, FRACGP Mount Hotham Medical Centre Hotham Heights. VIC 3741 1 Sherry E. Clout L. Deaths associated with skiing in Australia: a 32-year study of cases from the Snowy Mountains. Med J Aust 1988: 149 615-618 2 Stalsberg H, Albretsen C, Gilbert M, et al. Mechanism of death in avalanche victims. Virchows Arch [A] 1989: 414 415-422 Secondary school teacher awareness and knowledge of diabetes To the Editor: In Australia 125 per 100000 school children have diabetes mellitus. I These