Visitors to the hospitals of Papua New Guinea are often surprised by the many beds occupied by young men with an asymmetrical arthritis, predominantly affecting the legs. Scrutiny of their notes often elicits the enigmatic term "tropical arthritis." Such patients have been the subject of several studies. Maddocks came down firmly in favour of Reiter's disease as the diagnosis in most of these cases.' A later study from Goroka Base Hospital founTd no extra-articular manifestations of Reiter's disease and concluded that the disease was a distinctive type of arthritis of unknown aetiology.2 Subsequently Brewerton et al described a close link between HLA-B27 and Reiter's disease.3 HLA studies in patients with arthritis in Papua New Guinea have not previously been published. Patients, methods, and results We studied 64 patients with arthritis, who presented to the physician (JER) at Goroka Base Hospital between October 1984 and March 1985. During this period only four other patients with arthritis were seen (two with gout, one with osteoarthritis, and one with rheumatic fever). All patients were examined by JER. Sixty two were of highland origin and two were from the coast. Histocompatibility testing was done by the procedure outlined by Bhatia et al.4 The frequency of HLA antigens in the patients was compared with that in 128 Papua New Guinean blood donors matched for age, sex, and province of origin (two controls per patient). HLA-B27 was found in 45 (70%) of the 64 patients and in 16 (13%) of the 128 controls. It was present in all 10 patients with the classic triad of symptoms of Reiter's disease and in 13 (87%) of the 15 patients with less complete forms of Reiter's disease (table). Information about sexual exposure before arthritis was not readily obtained. Shigella flexneri serotype I had been isolated from one patient during an earlier admission for dysentery. Keratoderma blennorrhagicum and other mucocutaneous lesions (except balanitis) were not seen. HLA-B27 was noted in 22 (56%) of the 39 patients with symptoms confined to joints.

were already on dialysis. Median operative time was 100 minutes. Fifty-six percent patients received general anesthesia. Forty-one (2.0%) patients developed a wound infection, 51 (2.5%) patients developed mechanical failure of the fistula requiring intervention, and 109 (5.4%) patients had to return to the operating room. Thirty-day morbidity and mortality rates were 11.7% and 1.1%, respectively. On multivariate analysis, three preoperative predictors of mortality were identified: age, dyspnea, and admission from chronic care facility.Conclusions: Morbidity and mortality rates following AVF formation are low, making them relatively safe procedures. We present outcomes from this large database to define an average for the surgeon to compare their experience. These data will be used by third party interests, and surgeons must understand it to place their outcomes into the national norm.