bluuebunny/crossref_metadata_2025 huggingface dataset:
DIFFUSE LARGE CELL LYMPHOMA: A TEACHING HOSPITAL EXPERIENCE
Authors: ELLIS D. , MARKS D. , SHERIDAN W. , GREEN M. , FOX R. , BOYD A. , MORSTYN G.
Published: March 2008

Improvement in the treatment of diffuse large cell lymphoma (DLCL) over the last 15 years has been one of the notable successes of modern chemotherapy. This paper reports a three year experience (1985–87) of 46 unselected consecutive patients with DLCL in a single teaching hospital. A striking finding was that visceral, extranodal presentations were disproportionately common. The excellent response of stage I patients to chemotherapy alone is emphasised as is the role of immunophenotyping in diagnosis.
ENDOSCOPIC SCLEROTHERAPY FOR ESOPHAGO‐GASTRIC VARICES: A CRITICAL REAPPRAISAL
Authors: SARIN S. K.
Published: March 2008

Amongst the many non‐surgical techniques for the treatment of variceal bleeding, endoscopic sclerotherapy (EST) has shown great promise. EST can successfully obliterate esophageal varices and prevent variceal rebleeding. It is also very effective in the control of active bleeding from esophageal varices. The technique of EST is simple and can be carried out with a conventional, forward viewing, flexible endoscope and a teflon injector. Weekly intravariceal injections of an aqueous sclerosant are prefer‐rable. Though complications of EST in experienced hands are low, prophylactic EST at present should be advocated only to patients at high risk of bleeding. While controversy exists, most reports indicate that EST improves survival of patients with portal hypertension who have bled from esophageal varices. With regular follow‐up endoscopics, recurrence of varices and bleeding from them can be substantially reduced. Sclerotherapy may successfully obliterate gastric varices in some patients either following EST for esophageal varices or by direct gastric variceal injections. For the long‐term management of portal hypertension, combination of pharmacotherapy before as well as after eradication of esophageal varices, needs proper evaluation.
SERUM THYMIDINE KINASE AS A MARKER OF DISEASE ACTIVITY IN PATIENTS WITH MULTIPLE MYELOMA
Authors: BROWN R. D. , IOANNIDIS R. A. , JOSHUA D. E. , KRONENBERG H.
Published: March 2008

Serum thymidine kinase (STK) levels have recently been used to detect tumour regression and progression in a number of hematological malignancies. In this study, patients with myeloma were monitored longitudinally for STK and several other potentially useful tumour markers to determine which laboratory parameters are the most useful for differentiating between stable and progressive disease. STK was determined by radioenzyme assay, lymphocyte surface markers were analysed by flowcytometry, plasma cell labelling index (LI) by immunofluorescence with anti BU‐1, serum B2‐microglobulin (SB2M) by radioimmunoassay and M proteins by radial immunodiffusion. Detailed multiparameter longitudinal investigations of 5 patients and ongoing studies of 70 other patients suggest that STK is a more reliable marker of progressive disease than either SB2M, LI, M‐protein or CD10 positive lymphocytes. A rise in STK during the emergence of progressive disease at least paralleled and usually preceded any change in the other parameters which often did not change at all. All samples from patients with progressive disease (n = 29) had a STK above the normal range (0–5U/I) whereas 76% of patients in clear stable disease had a STK within the normal range. All samples (n = 34) from patients with light chain isotype suppression (LCIS) had STK values of less than 12 U/L and 82% of samples (n = 33) from patients without LCIS had a STK above the normal range (0–5U/L). The correlation between STK and LI was r = 0.65; p < 0.001 (n = 21). The radioenzyme assay for STK is simple, reproducible and a valuable tool for monitoring patients with myeloma and when used in conjunction with other clinical and laboratory investigations, aids in the separation of patients with stable myeloma from patients whose disease is progressive.
FIBRILLARY GLOMERULONEPHRITIS – A REPORT OF TWO CASES
Authors: PERRY G. J. , WYNDHAM R. N. , LIN B. P. C. , KALOWSKI S.
Published: March 2008

Two patients with an uncommon form of glomerulonephritis are described. The main clinical features were hematuria and proteinuria associated with normal renal function. The glomerular lesions consisted of mesangial hypercellularity and capillary wall thickening. Immunofluorescence was positive for IgG and C3 in both cases. Widespread deposition of microfibrils (mean diameters 17.0 nm and 18.4 nm) within mesangial areas and capillary basement membranes was seen on electron microscopy. Congo red staining for amyloid was negative. In both patients there was no evidence of underlying disease or extra‐glomerular involvement and hence the disorder appeared to represent a primary glomerulonephritis.
PROGNOSIS OF PATIENTS WHO PRESENT WITH AN EPISODE OF MYELOPATHY OF UNKNOWN ORIGIN IN MALAYSIA: A RETROSPECTIVE STUDY OF 52 PATIENTS
Authors: TAN C. T.
Published: March 2008

Fifty‐four per cent of 52 patients presenting to the University of Malaya Medical Centre with a myelopathy for which appropriate investigations uncovered no definite etiology, subsequently developed clinically definite or probable multiple sclerosis. In the subgroup of patients with a presentation indicative of acute/subacute transverse myelopathy, 14 or 52% also went on to develop clinically definite or probable multiple sclerosis, a far higher proportion than previously recorded in the literature. This finding is probably a further manifestation of racial difference in the behaviour of multiple sclerosis. For the group as a whole, the only factor which appeared to be associated with an increased risk of developing multiple sclerosis was female sex; 67% of 33 female patients went on to develop multiple sclerosis after a mean follow‐up period of 5.5 years. Other factors such as age of onset, racial composition, level of spinal cord involvement, presence of fever and CSF finding were found not to be important.
IMMUNE HEMOLYSIS AFTER AN ABO MISMATCHED RENAL TRANSPLANT
Authors: PERKINS A. C. , RICHARDS V. L. , GIBSON J. , JOSHUA D. E. , JOHNSON J. R. , KRONENBERG H.
Published: March 2008

We describe a case of immune hemolysis due to anti‐B occurring in a blood group B patient 16 days after a cadaveric renal transplantation from a blood group O donor. Transfusional support was initially required and the direct antiglobulin test (DAT) remained positive for 80 days. Cyclosporin A (CSA), which was used for rejection prophylaxis in this case, has unique immunosuppressive capabilities which protects transplanted organs from rejection, but which might permit this type of ‘graft versus host’ reaction.
INITIAL CHEMOTHERAPY FOLLOWED BY SURGERY IN MALIGNANT THYMOMA
Authors: MACKINTOSH J. F. , HAWSON G. A. T. , MATAR K. S. , JOHNSTON N. G.
Published: March 2008

Initial combination chemotherapy with cisplatinum, adriamycin and cyclophosphamide was given prior to surgery in a young woman with an unresectable malignant thymoma. Complete remission was achieved following three cycles of chemotherapy. Subsequent thymectomy revealed no evidence of residual malignancy. Prolonged remissions following cisplatin‐based chemotherapy have recently been achieved in metastatic thymoma. Initial chemotherapy should now be considered prior to surgery or radiotherapy in those patients presenting with very bulky or unresectable disease.
DETECTION OF REARRANGEMENT WITHIN THE BREAKPOINT CLUSTER REGION OF CHROMOSOME 22 IN THE DIAGNOSIS OF CHRONIC MYELOID LEUKEMIA
Authors: HUTCHINS C. , CASEY G. , WHITE D. , MOORE S. , RUDZKI Z. , KIMBER R.
Published: March 2008

Chronic myeloid leukemia (CML) is characterised by the presence of a Philadelphia (Ph) chromosome in approximately 95% of patients. Molecular analysis has shown that the Ph chromosome translocation breakpoints are clustered within 5.8kb on chromosome 22 (breakpoint cluster region or bcr). This has facilitated the diagnosis of CML by nucleic acid hybridisation using probes specific for the bcr to detect DNA rearrangement in this region. Forty patients diagnosed with CML, including four with variant Ph chromosome translocations and three with normal karyotypes were analysed for rearrangement within the bcr. All except one patient with Ph negative CML had rearrangement within the bcr. In contrast, none of the patients diagnosed with other hematological disorders such as the myelodysplastic or myeloproliferative syndromes (16 patients), acute myeloid leukemia (AML) (six patients), acute lymphoblastic leukemia (ALL) (five patients), including Ph positive ALL (two patients), showed rearrangement within the bcr. Analysis for rearrangement within the bcr is useful in the diagnosis of CML, especially when cytogenetic analysis is unsuccessful or in patients with normal karyotypes or variant Ph chromosome translocations.
LEFT VENTRICULAR VOLUMES IN MODERATE ALCOHOL USERS: A STUDY FROM THE WORKPLACE
Authors: SILBERBERG J. S. , BOWMAN L. K. , MURTON F. J. , CRANNEY G. B. , WALSH W. F. , GILES R. W.
Published: March 2008

Abstract We measured resting and exercise left ventricular volumes by a count‐based, nongeometric radionuclide method in 23 healthy volunteers grouped according to reported average daily alcohol consumption: 0–20 g (Gp A), 21–50 g (Gp B) and >50 g (Gp C). No patient had measurable alcohol in his blood at the time of study. Mean resting LV Ejection Fraction (EF) was 65 ± 2% in Group A, 64 ± 2% in Group B, and 65 ± 3% in Group C. Exercise EF was 76 ± 1,75 ± 3 and 74 ± 4%, respectively. Resting Endsystolic Volume Indices in the three groups were 19.2 ± 3, 18.9 ± 2 and 21.8 ± 3 ml/m2; exercise values were 15.9 ± 2, 12.8± 2 and 13.3 ± 2 ml/m2, respectively. This cohort was selected for absence of markers of alcohol‐related illness, and all subjects were employed. We found no evidence for impaired left ventricular systolic function with moderate alcohol usage using a sensitive radionuclide technique.
HEPATIC INVOLVEMENT IN LISTERIOSIS
Authors: GEBAUER K. , HALL J. C. , DONLON J. B. , HERRMANN R. , ROFE S. , PLATELL C.
Published: March 2008

Abstract We report an adult with listeriosis. Sequential liver biopsies demonstrated the resolution of associated granulomas and microabscesses after the administration of high doses of penicillin for ten days. This observation has not previously been reported.
HYPOXIC CARDIOMYOPATHY: ACUTE MYOCARDIAL DYSFUNCTION AFTER SEVERE HYPOXIA
Authors: SMITH F. , LEE R. , HAINDL W.
Published: March 2008

Abstract Five cases of acute transient myocardial dysfunction in previously well people after severe hypoxic episode are described. In all cases the hypoxic episode was associated with drug overdose and its complications. Pulmonary infiltrates on chest X‐ray consistent with pulmonary edema developed in four cases and gated heart pool scanning confirmed severe cardiovascular dysfunction in all cases.
ASSESSMENT OF A Psti POLYMORPHISM OF THE APOLIPOPROTEIN‐AI GENE IN AUSTRALIAN PATIENTS WITH CORONARY ARTERY DISEASE
Authors: DOROW D. S. , BURKE J. , GODING J. W.
Published: March 2008

In 1986 Ordovas et al.,1 reported that a polymorphism in the 3' flanking region of the apolipoprotein Al gene was strongly associated with premature coronary artery disease. This polymorphism affects a restriction site for the endonuclease Pstl, resulting in the identification of a 3.3 kb band, rather than the more common 2.2 kb band, when genomic blots of Pstl digested human DNA are probed with an apolipoprotein Al gene probe. In a study population of 88 patients with severe coronary artery disease before the age of 60, 28 (32%) carried the 3.3 kb allele, which was found in only five (4%) of 123 randomly chosen control subjects. In the present study, we have assessed the prevalence of this polymorphism in coronary artery disease patients and outpatients with abnormal lipid levels at the Alfred Hospital, Melbourne, and in normal volunteers. The 3.3 kb allele was present in 7–12% of subjects in these populations, and showed no association with coronary artery disease.
THE NEUROLOGICAL FEATURES OF EARLY AND ‘LATENT’ HUMAN IMMUNODEFICIENCY VIRUS INFECTION
Authors: BREW B. J. , PERDICES M. , DARVENIZA P. , EDWARDS P. , WHYTE B. , BURKE W. J. , GARRICK R. , O'SULLIVAN D. , PENNY R. , COOPER D. A.
Published: March 2008

Neurological manifestations of unknown cause occurring in patients who become or are HIV antibody positive with presumed normal immune function have been described recently. This report adds a further six cases, all of whom had normal CD4 + cell counts either throughout the period of observation or after the episode of seroconyersion. Three had an acute presentation, two in the context of documented seroconversion consisting of one of the following: an encephalitis, an ataxia, and confusion with neuralgic amyotrophy. Three had a subacute disorder occurring at a later phase of HIV infection but before opportunistic infections or neoplasms, and marked by a static mild cognitive deficit. This report extends the range of abnormalities that may be seen at seroconversion and documents the presence of a non‐progressive cognitive deficit occurring in the latent phase of HIV infection.
HYPERVISCOSITY SYNDROME SECONDARY TO RHEUMATOID ARTHRITIS
Authors: BACH L. A. , BUCHANAN R. R. C. , SCARLETT J. D. , FRASER K. J.
Published: March 2008

A woman with longstanding seropositive rheumatoid arthritis presented with the insidious onset of a hyperviscosity syndrome. This responded to plasma exchange and corticosteroids. Plasma exchange was complicated by severe bleeding which was associated with disturbances of coagulation and of platelet function related to the marked increase in plasma immunoglobulins.
LEFT HEART INVOLVEMENT WITH CARDIAC SHUNT COMPLICATING CARCINOID HEART DISEASE
Authors: MILLWARD M. J. , BLAKE M. P. , HUNG J. , GIBSON P. , BYRNE M. J.
Published: March 2008

The manifestations of carcinoid heart disease are usually right heart failure due to pulmonary and tricuspid valve disease and sometimes high output failure due to peripheral vasodilation. Recently there has been one case report of progressive central cyanosis due to right to left shunting through a patent foramen ovale.1 We present a similar case where such a shunt developed and was also complicated by significant valvular disease affecting the left side of the heart.
ACUTE LITHIUM TOXICITY—CHOREA, HYPERCALCEMIA AND HYPERAMYLASEMIA
Authors: MATSIS P. P. , FISHER R. A. , TASMAN‐JONES C.
Published: March 2008

Lithium is widely used in the management of patients with manic depressive illnesses. It is a valuable drug with a good safety record but occasionally causes severe disorders. A 71‐year‐old woman is described who previously had a good response to lithium carbonate treatment of a manic depressive illness. Because the patient appeared depressed and withdrawn, lithium carbonate dosage was increased. The development of confusion and choreiform movements precipitated hospital admission. The symptoms were relieved when lithium was stopped but recurred with the reinstitution of lithium. Spontaneous choreiform movements were again relieved on lithium withdrawal. Associated with the abnormal movements were alterations in the serum calcium concentrations, a rise in the parathyroid hormone concentration and a rise in the serum amylase concentration without features of acute pancreatitis.

This patient presents uncommon complications of therapy with lithium carbonate. Hypercalcemia is a well reported complication of lithium therapy and the associated raised parathyroid hormone may be due to modification of the threshold of parathyroid tissue to calcium under the influence of lithium. Chorea in lithium toxicity is uncommon and is not yet fully explained. Hyperamylasemia has not been previously reported. We suggest that in patients having long‐term lithium therapy that periodic checks of the serum calcium, parathyroid hormone and amylase levels should be undertaken.
TRANSESOPHAGEAL ELECTROCARDIOGRAPHY AND ATRIAL PACING IN ACUTE CARDIAC CARE: DIAGNOSTIC AND THERAPEUTIC VALUE
Authors: TWIDALE N. , ROBERTS‐THOMSON P. , TONKIN A. M.
Published: March 2008

The utility of transesophageal electrocardiography using a bipolar ‘pill electrode’ was assessed in 17 consecutive patients with tachycardia presenting to our casualty department. Standard 12‐lead electrocardiography showed regular narrow QRS tachycardia in 12 patients, and five patients had wide QRS tachycardia. Esophageal atrial electrogram recordings were obtained in 14 patients (82%), and these were helpful in determining the mechanism of tachycardia in 11 patients (78%). Of these 11, seven patients fulfilled criteria for atrioventricular junctional (AVJ) tachycardia based on measurement of the minimum interval between the onset of ventricular depolarisation and earliest atrial (esophageal) activity. One of these patients had presented with a wide QRS tachycardia. The other four patients were diagnosed as having ventricular tachycardia (VT) following diagnosis of AV dissociation. Atrial overdrive pacing, via the pill electrode, successfully reverted four of the nine patients (44%) with narrow QRS tachycardia but no patient with VT. Esophageal recording during tachycardia is a simple, relatively non‐invasive technique which is helpful in suggesting the mechanism of tachycardia both in patients with narrow and wide QRS tachycardia, and may have a therapeutic role in patients with AVJ tachycardia. (Aust NZ J Med 1989; 19: 11–15.)
A COLOUR ATLAS OF THE TONGUE IN CLINICAL DIAGNOSIS. D.W. Beaven, S.E. Brooks.
Authors: Sheridan Brian F.
Published: March 2008

A COLOUR ATLAS OF THE TONGUE IN CLINICAL DIAGNOSIS. D.W. Beaven, S.E. Brooks.
ACUTE LYMPHOBLASTIC LEUKEMIA IN CHINESE ADULTS IN HONG KONG
Authors: CHENG P. N. M. , TSO S. C. , CHAN T. K. , TODD D. , LAWTON J. W. M. , HO F. C. S.
Published: March 2008

Forty‐four previously untreated Chinese adult patients with acute lymphoblastic leukemia (ALL) were treated with vincristine, adriamycin and prednisone with or without L‐asparaginase. The clinical features and prognostic factors were similar to those reported in Caucasian series. Overall complete remission (CR) rate was 52%. Duration of first remission and overall median survival were nine and 12 months respectively. The addition of L‐asparaginase did not improve CR rate or duration of remission and was associated with clotting dysfunction and other adverse reactions. Factors associated with a higher CR rate include age < 40 years, blast count < 10 times 109/1 and CALLA+phenotype at presentation. Sex, platelet count and FAB morphology did not affect CR rate.

Bone marrow relapse occurred in 11 patients and was associated with short survival after relapse (median two months; mean two months; range 0.5–7 months). Central nervous system relapse occurred in four patients and was compatible with relatively long survival after relapse (median 13 months; mean 12 months; range 6–12 + months).

The poor CR rate and short median survival in this study could not be adequately explained by an increase in risk factors and is likely to be due to what is currently regarded as suboptimal chemotherapy. (Aust NZ J Med 1989; 19: 37–43.)
BOOKS REVIEW
Authors: Gable Alan
Published: March 2008

Josef Stippig, Aloys Berg and Joseph Keul. CARDIAC REHABILITA TION‐OUTPA TENT PHYSICAL TRAINING METHODS.
THE EFFECTS OF LONG TERM GLICLAZIDE ADMINISTRATION ON INSULIN SECRETION AND INSULIN SENSITIVITY
Authors: MA A. , KAMP M. , BIRD D. , HOWLETT V. , CAMERON D. P.
Published: March 2008

Gliclazide (80 mg bd) was administered to nine subjects with type 2 (non insulin dependent) diabetes inadequately controlled on diet only. Twenty‐four hour glucose, insulin and c‐peptide profiles were obtained before and after one week and four months of therapy. Insulin sensitivity was assessed by euglycemic hyperinsulinemic clamp before and after four months of treatment. Twenty‐four hour glucose levels were significantly lowered after one week and four months. Insulin secretion, as assessed by the areas under the insulin and c‐peptide curves, was enhanced after one week. The increase was most noted during the day in response to meals. The enhancement was maintained after four months of treatment with the increase in the postabsorptive phase becoming significant. Glucose utilisation rate was significantly increased at four months. It is concluded that both acute and prolonged gliclazide therapy directly or indirectly 1) enhances both meal stimulated and post absorptive insulin secretion and 2) increases insulin sensitivity. The relative contribution of each to improved diabetic control has not been established. (Aust NZ J Med 1989; 19: 44–49.)
PHYSICAL TREATMENTS INPSYCHIATRY. By L. G. Kiloh, S. J. Smith, G. F. Johnson.
Authors: Ellard J.
Published: March 2008

PHYSICAL TREATMENTS INPSYCHIATRY. By L. G. Kiloh, S. J. Smith, G. F. Johnson.
PSYCHIA TRIC BIBLIOGRAPHY 1960‐1984. By Johan Schioldann‐Nielsen. FAMOUS AND VERY IMPORTANT PERSONS ‐ MEDICAL, PSYCHOLOGICAL,
Authors: Gandevia B.
Published: March 2008

PSYCHIA TRIC BIBLIOGRAPHY 1960–1984. By Johan Schioldann‐Nielsen. Odense University Press, FAMOUS AND VERY IMPORTANT PERSONS ‐ MEDICAL, PSYCHOLOGICAL,
AN APPRAISAL OF CARDIOVASCULAR STANDARDS FOR AUSTRALIAN CIVILIAN FLYING LICENCES
Authors: VOHRA J. , PLOWRIGHT R.
Published: March 2008

This paper summarises recommendations drawn up at a meeting of a group of Cardiologists and Aviation Medical personnel to review cardiovascular standards for Australian Civil Flying Licences.

Major recommendations were in the field of ischemic heart disease which remains the commonest cause of disqualification. The panel recommended consideration of coronary risk factors and increased attention to the high risk group as a preventive measure for loss of licence. Licensing, with appropriate safeguards and continued supervision, was considered permissible in carefully selected subjects with ischemic heart disease. Guidelines were also drawn up for various licence categories for subjects with valvular heart disease, cardiac arrhythmias, implanted pacemakers, cardiomyopathy and hypertension. (Aust NZ J Med 1989; 19: 76–82.)
Randomised controlled trial of recombinant human interferon ‐αA for chronic active hepatitis B
Authors: Williams S. J. , Craig P. I. , Cooksley W. G. E. , Bye W. A. , Bilous M. , Grierson J. M. , Nightingale B. N. , Burnett L. , Hensley W. J. , Batey R. G. , Farrell G. C.
Published: March 2008

The efficacy of interferon treatment for Australian patients with chronic active hepatitis B (CAH‐B) was assessed by a three‐centre randomised controlled trial in Sydney and Brisbane. Thirty patients (29 with histologically‐proven CAH‐B with and without cirrhosis and one with chronic persistent hepatitis) were allocated to receive either thrice weekly intramuscular injections of recombinant human leucocyte interferon ‐αA (either 2.5, 5.0 or 10.0 million units/m2) for six months followed by 12 months of observation, or to be observed for 18 months without active treatment. Three of 23 treated patients but none of seven controls underwent clinical, biochemical and histological resolution of their disease with loss of HBsAg, HBeAg and HBV‐DNA from serum. An additional six treated and two control patients underwent a sustained partial remission of their disease. This was characterised by resolution of symptoms and serum aminotransferase abnormalities in association with seroconversion from HBeAg positive to negative, loss of HBV‐DNA from serum but persistent hepatitis B surface antigenaemia. In such patients, there was significant improvement in histological appearances but some necroinflammatory activity remained and fibrosis was unchanged. Although total response rates were similar in treated and control subjects, they appeared to occur earlier after interferon treatment.

Treatment with interferon was associated with predictable but minor side effects that usually did not necessitate dose reduction and rarely compromised the patient's life style. Interferon is thus a feasible treatment for CAH‐B. Complete responses occurred only in treated patients and partial responses appeared to occur earlier in treated than in untreated patients. However, differences in the partial response rate at 18 months were not significant and seroconversion from HBeAg positive to negative was not associated with complete histological resolution of disease activity. Hence, while interferon is a promising agent for treatment of CAH‐B, efforts must continue to define more optimal treatment regimes and to identify those patients most likely to respond to this agent.
Pathology of fatal acute myocardial infarction in the Chinese
Authors: Woo K. S.
Published: March 2008

Post‐mortem examinations were performed on 89 Chinese with fatal acute myocardial infarction, who represented an unselected 45.6% of a series comprising 195 consecutive hospital deaths from acute myocardial infarction in Hong Kong. In 83 patients (93.3%), the acute infarcts were correctly identified, and old infarct scars or patchy fibrosis were found in 21 patients (23.6%). Of the 85 sudden deaths, 33 patients (38.8%) had no definite mechanical complication and therefore could have died of primary arrhythmias, ten patients (11.8%) had rupture in the free ventricular wall with cardiac tamponade. Two other patients had rupture of the interventricular septum and one more patient had rupture of papillary muscle. Evidence of significant coronary atherosclerosis was identified in 94.7% of patients, with one‐vessel disease in 18.7%, two‐vessel disease in 33.3% and three‐vessel disease in 42.7% of patients respectively. Critical lesions were present in left main stem in 8%, left anterior descending artery in 45.3%, circumflex artery in 8% and right coronary artery in 17.3% respectively. Occlusive coronary thrombi were identified in 18.7% of patients. These pathological findings were compared with reports on fatal myocardial infarctions from the western countries.
Hypoxia during bronchoalveolar lavage
Authors: Gibson P. G. , Breit S. N. , Bryant D. H.
Published: March 2008

The aim of this study was to determine the degree and duration of hypoxaemia during bronchoalveolar lavage (BAL) and to examine the effect of supplemental oxygen on this response. Transcutaneous oxygen tension (PO2) was recorded continuously in 22 patients having bronchoscopy alone (Group 1), and during BAL in patients with a variety of connective tissue disorders. Thirty eight of these patients were breathing room air (Group 2) and 28 were given supplemental oxygen (Group 3). The mean fall in PO2 in Group 1 was 12 ±3 mmHg and the PO2 in these subjects rose promptly to the initial value once the bronchoscopy was finished. The mean falls in Groups 2 and 3 were 24±4 and 32±5 mmHg and the mean times taken for the PO2 values to return to baseline after the procedure were 47±9 and 53±10 minutes respectively. The PO2 fell to less than 60 mmHg in 76% of the patients in Group 2 but in only 25% of those in Group 3. It is recommended that supplemental oxygen be given to all patients having BAL during and for one hour after the procedure and that oxygenation be monitored continuously throughout the bronchoscopy. Arterial blood gases should be always measured prior to bronchoscopy and BAL. In those cases where it is not possible to maintain the PaO2 at 70 mmHg or more the procedure should be undertaken with great care and with due consideration of the risk of the hypoxaemia that may occur.
Unusual pulmonary manifestations of pneumocystis carinii infection in immunocompromised patients
Authors: Connor H. , Lavoipierre A. M.
Published: March 2008

Three proven cases and one presumed case of Pneumocystis carinii pneumonia are presented in which the radiological appearance mimics tuberculosis.

The classic and unusual X‐ray findings of P. carinii pneumonia are discussed.
Sarcocystis infection of human muscle
Authors: Pamphlett R. , O'Donoghue P.
Published: March 2008

A 31‐year‐old man with fatigue and muscle aches was found to have protozoan cysts within the most painful muscle upon microscopic examination of biopsy material. Electron microscopic studies revealed the ultra‐structural characteristics of the cysts to conform to those of the genus Sarcocystis. This report represents the first ultrastructural study of human tissue infection with Sarcocystis, which may be a rare cause of muscle aching in humans.
Spontaneous complete remission of chronic myeloid leukaemia following haematological relapse after allogeneic bone marrow transplantation
Authors: Alkam M. , Bradstock K. F. , Hughes W. G. , Watson N. , Bowyer I.
Published: March 2008

A 31‐year‐old woman with Philadelphia (Ph) chromosome‐positive chronic myeloid leukaemia (CML) underwent allogenic bone marrow transplantation during accelerated phase. Non‐T‐cell‐depleted marrow from a male sibling mismatched at one Class 2 histocompatibility locus was infused after conditioning with total body irradiation and intravenous cyclophosphamide. Cyclosporin and methotrexate were given for prevention of graft‐versus‐host disease (GVHD). Prompt engraftment occurred with donor karyotype cells, followed by transient moderate acute GVHD. However, by day 60 after BMT, haematological relapse occurred with increasing splenomegaly, leucocytosis, increasing marrow fibrosis, and cytogenetic mosaicism, consisting of 47% donor metaphases with 53% Ph‐positive host metaphases, some containing additional structural changes. Thirty days later further cytogenetic progression was evident. A slowly progressive fungal pneumonia concurrently present was treated with intravenous amphotericin and gradual reduction of cyclosporin. Subsequently, without further cytotoxic chemotherapy, pancytopenia and bone marrow hypoplasia developed, and on day 144 only donor karyotype marrow cells were seen. Chromosomes have remained of donor type on subsequent occasions, and the patient has a normal performance status 25 months after BMT. The patient's course illustrates that factors operating after allogeneic BMT contribute to long‐term control of CML. The factors potentially responsible for this spontaneous remission, after early relapse, are discussed.
Remission of Menetrier's disease associated with ranitidine administration
Authors: Kang J. Y. , Tang K. F. , Goh A. , Sundram F. X. , Seah C. S.
Published: March 2008

We describe a patient with Menetrier's disease in whom acute administration of ranitidine reduced gastric protein loss more effectively than cimetidine or propantheline. Thispatient went into remission following a course of ranitidine. We reviewed the literature on remissions in Menetrier's disease occurring without surgery. More detailed studies of various anti‐secretory agents on individual patients are required to determine whether ornot they are truly efficacious.
Managing hypertension: drugs, life‐style manipulation or benign neglect? Medical, ethical and economic considerations*
Authors: Simpson F. O.
Published: March 2008

Antihypertensive drugs have been of major benefit to people with moderate or severe hypertension and have contributed enormously to fundamental physiological knowledge. Antihypertensive therapy in milder hypertension reduces the incidence of stroke by 40% or more, may reduce myocardial infarction and prevents progression to more severe hypertension or heart failure but is being criticised as not cost‐effective. Much of this criticism is based on deductions from inappropriate data. Nevertheless, it is likely that money is in some cases being wasted on the treatment of people who were not truly hypertensive in thefirst place. It is also likely that drug dosage is often unnecessarily high. Clearly it is vital that treatment is delivered as economically as possible.

A reduction in the prevalence of hypertension would be the best way to reduce costs. Obesity and a high alcohol intake are associated with a higher blood pressure at any age. A high salt intake throughout life appears to be associated with a rise in blood pressure in the second half of life and may well be the main factor in hypertension. A radical rethinking of the method of pricing of medical care should be considered, so as to provideincentives to people to adopt life‐style measures that lead to avoidance of hypertension (and other cardiovascular risk factors) or, in established hypertension, to a reduction in the need for medication.
The clinical role of transoesophageal echocardiography
Authors: Black I. W. , Hopkins A. , Lee C. L. , Jacobson B. , Walsh W. F.
Published: March 2008

The role of transoesophageal echocardiography (TEE) was evaluated in a consecutive series of 100 procedures performed in 86 patients (age 17–81, mean 56 years). All patients had prior transthoracic echocardiography (TTE). TEE was performed with a 5 MHz phased array transoesophageal transducer with pulsed wave Doppler and colour flow mapping capability. Forty‐four per cent of patients received intravenous sedation and 36% received antibiotic prophylaxis. There were no complications of TEE. The TTE and TEE findings were compared. In patients referred for possible cardiac source of embolism, left atrial thrombi were detected in 8/27 TEE studies but in none of 27 TTE studies. In 12 patients with prosthetic valve dysfunction TEE distinguished prosthetic from periprosthetic regurgitation in 9/12 studies compared to 3/12 with TTE. In 11 patients with suspected aortic dissection TEE correctly detected dissection in all seven cases in which the diagnosis was subsequently confirmed, whereas TTE showed only equivocal findings in two cases. Vegetations were detected by TEE in 4/5 studies in patients with proven native valve endocarditis and by TTEin 2/5. No vegetations were detected by TTE or TEE in five studies in patients with proven prosthetic valve endocarditis. Compared with other investigations there were no false positive TEE studies and one possible false negative study. We conclude that TEE is a safeprocedure which often provides additional clinical information to transthoracic echocardiography.
HLA‐DR RFLP distributions in two groups of Aboriginal Australians
Authors: Davies R. , Pace R. , Jazwinska E. C. , Serjeantson S. W.
Published: March 2008

HLA‐DR and ‐DQ typing by restriction fragment length polymorphism (RFLP) in Aboriginal Australians from the Kimberleys and from Coen shows a restricted number of HLA‐DR types in these populations. The polymorphism is essentially limited to DR2, DR4, DRw14 and DRw8. The most common DR.DQ RFLP haplotype in Aborigines shows a novel arrangement of DR and DQ alleles that has important implications for histocompatibility matching if the RFLP patterns reflect functional variation in HLA class II molecules.
Lead intoxication in an anuric patient: management by intraperitoneal EDTA
Authors: Roger S. D. , Crimmins D. , Yiannikas C. , Harris D. C. H.
Published: March 2008

Treatment of lead intoxication with intravenous ethylene‐diamine‐tetra‐acetic acid (EDTA) depends on the urinary excretion of chelated lead. This route of excretion was absent in a 48‐year‐old patient with childhood lead exposure and end stage renal failure who developed encephalopathy and a rapidly progressive neuropathy thought to be due to acute lead intoxication. Diagnosis was confirmed by lead chelation with EDTA and neurophysiological studies. EDTA was added by the patient to her chronic ambulatory peritoneal dialysis (CAPD) fluid each week and chelated lead excreted in the dialysate. Intraperitoneal administration of EDTA was 70% as efficient in removing lead as intravenous administration. Four months of home chelation therapy was associated with resolution of the encephalopathy but no improvement in the peripheral neuropathy.
Treatment of severe orthostatic hypotension with the somatostatin analogue octreotide
Authors: Woo J. , Or K. H. , Teoh R. , Nicholls M. G.
Published: March 2008

The long‐acting somatostatin analogue octreotide was used in a patient with severe orthostatic hypotension resistant to conventional treatment. 0.4 ug/kg octreotide given subcutaneously abolished the postural drop in systolic blood pressure for about four hours and was more effective than a combination of fludrocortisone and pindolol.
Longstanding pleural effusion in an elderly man due to non‐Hodgkin's lymphoma (multilobulated nuclear cell type)
Authors: Raina V. , Boyd G. , Soukop M.
Published: March 2008

A 68‐year‐old man presented with left sided pleural effusion. Investigations were suggestive of non‐Hodgkin's lymphoma of multilobulated nuclear cell type. Symptomatic treatment by repeated thoracic aspiration was carried out every three to four months over nine years, after which the patient developed left axillary lymphadenopathy and a chest wall mass. Biopsy of the mass revealed multilobulated B cell lymphoma. Complete remission including disappearance of the pleural fluid was achieved with combination chemotherapy. Pleural effusion was the only clinical feature of lymphoma for nine years and this has not been described before.
Practical management of diabetic ketoacidosis and hyperosmolar coma
Authors: Hamblin P. S. , Topliss D. J. , Stockigt J. R.
Published: March 2008

In diabetic ketoacidosis (DKA) and particularly in hyperosmolar coma, rapid normalisation of the measured extracellular fluid abnormalities cannot be equated with optimal management. In both disorders there are complex imbalances between extra‐ and intracellular compartments that are best corrected in a series of rational steps, based on an understanding of pathophysiology. Fluid administration in DKA can generally be divided into three successive phases: (i) a short period of rapid isotonic saline infusion, (ii) slower infusion of isotonic saline with potassium chloride, and (iii) glucose‐potassium infusion until oral food intake is well established. In severe cases, there is a definite place for judicious use of isotonic sodium bicarbonate in small amounts. While insulin infusion is desirable, intramuscular insulin remains a satisfactory alternative. Biochemical monitoring is mandatory and management must be reviewed and modified every three to four hours on the basis of the clinical and biochemical response.

In the management of hyperosmolar coma, insulin and fluid therapy are more conservative, with the aim of achieving complete rehydration and normoglycaemia only after 36 to 72 hours. Pulmonary complications and the effects of tissue ischaemia, as well as thromboembolic events, remain important causes of death in both disorders. The frequent recurrences of DKA that occur in a group of psychiatrically‐unstable young patients remain an unsolved problem.
The prognosis of acute post infectious glomerulonephritis in adults: a long‐term prospective study
Authors: Richmond D. E. , Doak P. B.
Published: March 2008

The contributions of pre‐selected predictions of outcome for survival and renal function following acute post infectious glomerulonephritis were tested in a group of 41 adults, followed up for a mean of 13 years 5 months (range: 2 weeks to 15 years 2 months), using a proportional hazards model. The best predictor of outcome was the severity of the renal lesion, as judged by histology obtained at renal biopsy. The extent of functional deterioration during the acute phase and the aetiology were also related to outcome, though less significantly. Other variables including sex, age, race and the presence or absence of hypertension during the acute phase did not appear in this model to have an important bearing on prognosis, whether the latter was determined by patient and renal survival or by the extent of renal functional deterioration in survivors.
A serial study of gastric emptying in anorexia nervosa and bulimia
Authors: Szmukler G. I. , Young G. P. , Lichtenstein M. , Andrews J. T.
Published: March 2008

To determine the natural history of delayed gastric emptying of solid foods in anorexia nervosa (AN), gastric emptying was assessed by scintigraphy in 20 consecutive inpatients; eight had restrictive AN, ten had both AN and bulimia nervosa (BN), and two BN alone. Initial gastric half‐emptying time (HET) exceeded 110 min (the upper limit of normal for the laboratory) in 16; their body mass index ranged from 11.7 to 18.1. HET showed a significant negative correlation with body mass (r = 0.71; p<0.001) but not age, duration of illness or use of psychotropic medication. Fourteen patients with prolonged emptying were retested; HET improved in nine of 12 retested at one month (p= 0.0005) but none showed a change in the lag phase of emptying. All four patients retested a further one to two months later achieved a HET < 110 min. Fourteen patients reached a body mass index of 16.3 during treatment and HET improved to better than 110 min in all but one of these. However, normalisation occurred while body mass was still subnormal (<20.3) and with amenorrhea still present. This study shows that delayed gastric emptying in AN improves quite rapidly as feeding recommences; thus the motility disturbance is secondary to restriction in food intake and is not fundamental to the disorder.
Ranitidine‐associated recurrent acute pancreatitis
Authors: Herrmann R. , Shaw R. G. , Fone D. J.
Published: March 2008

Ranitidine is a safe, widely prescribed drug for the treatment of peptic ulcer disease and is rarely associated with serious adverse reactions. This report describes a patient who suffered three episodes of acute pancreatitis associated with ranitidine prescribed for duodenal ulcer disease. On each occasion the pancreatitis resolved after withdrawal of ranitidine and recurred upon re‐exposure. Underlying biliary and pancreatic disease was excluded. There has been no recurrence of pancreatitis in the five years of follow‐up since ranitidine was discontinued.
Community‐acquired pseudomonas pneumonia in a normal host complicated by metastatic panophthalmitis and cutaneous pustules
Authors: Quirk J. A. , Beaman M. H. , Blake M.
Published: March 2008

Pseudomonas aeruginosa is a frequent pathogen of patients with chronic underlying disease in the hospital environment. This organism is, however, an extremely rare cause of either community‐acquired pneumonia in a normal host, metastatic bacterial endophthalmitis or metastatic cutaneous pustules. We report here a case combining these three rare manifestations in a previously well young woman, to highlight the serious disease that may result from this pathogen and the difficulties of treatment.
Multiple pneumatocoeles and bilateral tension pneumothoraces complicating Pneumocystis pneumonia in AIDS
Authors: Summers Q. A. , Helprin G. A. , Tarala R. A. , French M. A. H.
Published: March 2008

Pneumatocoele and pneumothorax are uncommon complications of Pneumocystis carinii pneumonia. We report a patient with the Acquired Immune Deficiency Syndrome who developed multiple bilateral pneumatocoeles which we demonstrate to have ruptured leading to the subsequent bilateral tension pneumothoraces and to death. The computerised tomographic appearances, and histopathology of these unusual complications are presented. The literature on these manifestations is reviewed and management discussed.
What has happened to programmes in quality assurance by physicians in large teaching hospitals in Australia and New Zealand?
Authors: Richmond D. E.
Published: March 2008

Hospital Quality Assurance (QA) programmes by divisions and departments of medicine have developed since the late 1970s. The Continuing Education Unit of the Royal Australasian College of Physicians played a facilitatory role in this development, especially in the first five to six years.

A survey of 38 major teaching hospitals in Australia and New Zealand early in 1989 revealed that of the 35 responding all had introduced a formal QA programme in internal medicine between 1976 and 1988.

The ‘Austin Hospital Method’ of review seminars was the most popular format when QA programmes were introduced and 26 hospitals still maintain such a format – at least as a component of their programmes. Most programmes have been subject to modification to suit local needs. There have been no serious problems in maintaining confidentiality of information derived from QA exercises.

Despite a formidable array of constraining forces, the majority of continuing QA programmes appeared to be stable. Seventeen hospitals reported that the organising group was recognised as an official committee of their hospital's administration.

Although eight programmes have been discontinued in the last four years, nearly as many new ones have been introduced.
Validation of prognostic models in primary biliary cirrhosis
Authors: Jeffrey G. P. , Hoffman N. E. , Reed W. D.
Published: March 2008

Abstract Prognostic models in primary biliary cirrhosis have been validated for large population groups but the predictive value for individual patients has not been tested. We used data from ten deceased patients with primary biliary cirrhosis to test three prognostic models: the Shapiro model (bilirubin); the Christensen model (age, bilirubin, albumin, presence of cirrhosis or cholestasis, azathioprine treatment); and the Dickson model (age, bilirubin, albumin, prothrombin time, oedema). The predictive value of each model for individual patients was determined by assessing whether it would have accurately predicted appropriate timing of liver transplantation in patients prior to death. The Dickson model predicted that four of nine cases would have been considered for liver transplantation one year before death and one of seven cases two years before death. The Christensen model predicted that this procedure would have been considered in three of seven cases two years before death. The Shapiro model was demonstrated to be the least predictive of the three tested. Although none of the three models assessed was found to accurately predict survival, no model predicted a worse survival than actually occurred. Liver transplantation is indicated in those cases with a poor predicted survival
A comparison of two methods of eliciting the ankle jerk
Authors: Schwartz R. S. , Morris J. G. L. , Crimmins D. , Wilson A. , Fahey P. , Reid S. , Joffe R.
Published: March 2008

Abstract Two methods of eliciting the ankle jerk have been compared. One, the traditional method, involved tapping the Achilles tendon (the tendon tap); the other (the plantar tap) involved tapping the sole of the foot. The study was done on 110 inpatients in the medical wards of a teaching hospital.

The results showed an 89% agreement between the two methods. The extent of agreement was unrelated to the level of experience of the examiner. Forty three per cent of patients favoured the plantar tap method; 14% the tendon tap. The plantar tap method of eliciting the ankle jerk is an acceptable alternative to the traditional method.
Nonvalvular atrial fibrillation associated with cardioembolic stroke: the role of hypertensive heart disease
Authors: Seneviratne B. I. , Reimers J.
Published: March 2008

Abstract Epidemiologists have not identified high risk groups nor the entire spectrum of heart disease, especially the subclinical forms underlying nonvalvular atrial fibrillation (NVAF) predisposing to cardioembolic (CE) stroke. We analysed 36 cases of ‘isolated’ NVAF among 106 consecutive cases of CE stroke after excluding cases of AF associated with valvular disease, myocardial infarcts, ischaemic and other cardio‐myopathies (34 cases). This revealed echocardiographic left ventricular hypertrophy (LV mass index 136 ± 25 g, vs normal 68 ± 12 g p < 0.001), enlarged left atria (left atrial area 27.4 ± 3.6 cm2 vs normal 14.3 ± 1.6 cm2p < 0.001), normal systolic function and formed the largest group associated with CE stroke (34%), mean age 72.6 years – Study Group D. Eighty nine per cent had known or undetected hypertension compared to 60% in matched controls (x2= 8.3 df= 1 p < 0.01), and hypertension remained the predominant risk factor for left ventricular hypertrophy (LVH). Although all had echocardiographic LVH, 60% had neither electrocardiographs LVH nor cardiomegaly on chest X‐ray. Hence usual epidemiologic methods may fail to detect these cases. Hypertensive heart disease is known to predispose to left atrial enlargement and AF. Progressive atrial enlargement is associated with increasing risk of embolie stroke.

We conclude that NVAF associated with hypertensive heart disease forms a major component of the spectrum of heart disease associated with NVAF predisposing to CE stroke. Detection and treatment of hypertension to prevent or reverse LVH and atrial enlargement should be an important preventive measure.