bluuebunny/crossref_metadata_2025 huggingface dataset:
Single Day or Single Dose Treatment of Urinary Tract Infection with Co‐trimoxazole
Authors: Russ G. R. , Mathew T. H. , Caon A.
Published: March 2008

Summary Forty‐eight women with urinary tract infection due to Co‐trimoxazole sensitive organisms were randomly allocated to receive either two tablets (0·96 grams) of Co‐trimoxazole twice a day for one day, four tablets (1·92 grams) of Co‐trimoxazole as a single dose, or, two tablets of Co‐trimoxazote twice a day for seven days. The infection cure rate was comparable in each group being 82%, 87% and 81% respectively. The patients who received the single dose had a high incidence of minor side effects. Accordingly one‐day treatment appears to be the treatment mode of choice. Failure to respond to single dose or single day treatment may indicate those patients requiring investigation of their urinary tract.
Transhepatic Embolisation of Gastro‐oesophageal Varices in the Management of Variceal Haemorrhage
Authors: Williams D. , Goldin A. , Willing R. , MacKinnon M.
Published: March 2008

Summary The difficulty of controlling variceal haemorrhage has led to the recent development of methods designed to sclerose the bleeding vessels. This study describes the application of percutaneous transhepatic portal catheterization with emboiisation and sclerosis of varices in eight consecutive patients admitted with bleeding oesophago‐gastric varices. Portal hypertension was documented and varices demonstrated in each case. Bleeding ceased rapidly in seven patients, two patients rebled 1–3 weeks after the procedure, and five patients were subsequently discharged from hospital. In no instance was death related to continued gastrointestinal haemorrhage. Initial experience with transhepatic embolisation of bleeding oesophago‐gastric varices indicates that this technique is effective in controlling variceal haemorrhage.
Serial Thallium‐201 Myocardial Perfusion Scanning in Acute Myocardial Infarction*
Authors: Dunnt R. F. , Kelly D. T. , Freedman S. B. , Uren R. F.
Published: March 2008

Summary Serial myocardial perfusion scanning was performed in 30 patients with acute myocardial infarction. Scanning was commenced less than six hours after onset of symptoms in 12 patients, 6–24 hr in eight and 24–120 hr in ten. All 30 patients showed thallium defects corresponding to the ECG site of infarction.

When initial and four‐hour scans were compared, constant defects were present in ten patients and changing defects in 20. Of the 169 segments with defects on the initial scan, 117 (69%) remained constant, 41 (24%) improved, and 11 (7%) deteriorated. More defects changed in the patients scanned earlier (< 6hr) than in the patients scanned later (> 6hr) (42% vs 23% P < 0·025), and more defects changed in patients with subendocardial compared to transmural infarction (49% vs 26% P < 0·025).

During a mean follow‐up period of 18 months, seven patients died, two developed left ventricular failure, seven had angina and 14 remained asymptomatic. The non‐survivors had significantly larger thallium defects than the survivors (55 ± 15% vs 37 ± 14%, P < 0·005). Serial change on thallium scanning was not related to the clinical course.

Perfusion defects on serial thallium scanning are useful in detecting and localising early myocardial infarction and the size of defects is related to the subsequent clinical course. Changing perfusion defects on serial scanning suggesting peri‐infarctional ischaemia are common, and make assessment of therapeutic interventions to limit infarct size difficult, but are not related to the clinical course.
Exercise Testing and Thallium‐201 Myocardial Imaging in Relation to Coronary Artery Disease in Patients with Severe Aortic Valve Disease*
Authors: Taylor R. R. , Mews G. C. , Van der Schaal A. , Dickie G. , Surveyor I.
Published: March 2008

Summary Thirty‐three patients with aortic valve disease, fifteen with regurgitation, eleven with stenosis and seven with mixed disease, undergoing assessment for valve replacement which included adequate coronary angiography, were studied. A symptom limited graded treadmill exercise test was undertaken with administration of 40–70 MBq of 201TI. Myocardial imaging was started within 15 minutes and repeated after four hours using a 37 PM tube Searle gamma camera.

Myocardial images were read independently by three observers. Of the 33 sets of images, 21 were‐ve, 5 + ve, 2 I (Indeterminate) and 5 D (Difference of opinion). Eight of the 33 patients had significant coronary artery disease (CAD) and of these three were scored + ve (all triple vessel). Two patients without CAD were scored + ve. Eight subjects developed angina during exercise testing, of whom four had CAD, and four with CAD did not develop angina. Historically, 13 of the 33 subjects had typical angina, six having CAD; an additional eight had other significant chest pain, two having CAD.

In these subjects with severe aortic valve disease, exercise testing and myocardial imaging with 201TI was of little value in detecting CAD. All patients with CAD gave a history of significant chest pain.
Treatment of Atrial Arrythmias After Cardiac Surgery With Intravenous Disopyramide
Authors: Campbell T. J. , Morgan J. J.
Published: March 2008

Summary The aim of this study was to investigate the efficacy of intravenous disopyramide in patients with persistent atrial tachyarrhythmias after open‐heart surgery.

Thirty patients whose arrhythmia persisted more than four hours after an initial bolus of intravenous digoxin 0–75 mg were randomly assigned to two groups (15 in each group). One group was given a further 12 hr of intravenous digoxin therapy, and the second was given 12 hr of intravenous disopyramide as a loading dose (2 mg/kg) followed by a constant infusion.

Patients who had not reverted 12 hr after randomisation were “crossed‐over” to the alternate therapy for 12 hr. Of the 25 patients eventually given disopyramide for a 12‐hr period, 17 returned to sinus rhythm during that period (68%) and 13 of these reversions occurred within the first hour. These results were significantly better (P < 0–01) than for the 21 patients given 12 hr of digoxin therapy of whom only five reverted (none within one hour).

It is concluded that intravenous disopyramide administered after a loading dose of digoxin is an effective therapy for postoperative atrial arrhythmias.
Disopyramide Induced Atypical Ventricular Tachycardia
Authors: Chia B. L.
Published: March 2008

Summary A patient presenting with atypical ventricular tachycardia due to oral disopyramide given in normal doses over a period of four months is described. This arrhythmia was preceded by marked prolongation of the QTc. It is suggested that patients receiving treatment with oral disopyramide should be closely monitored for symptoms of ventricular tachyarrhythmias, particularly in the face of a prolonged QTc.
The Association of Diabetes Insipidus with Hypoparathyroidism, Addison's Disease and Mucocutaneous Candidiasis
Authors: Clifton‐Bligh P. , Lee C. , Smith H. , Posen S.
Published: March 2008

Summary: A case of central diabetes insipidus is reported in association with idiopathic hypoparathyroidism, adrenal failure and mucocutaneous candidiasis.

The diabetes insipidus was recognised at the same time as the discovery of aldosterone and cortisol deficiency, and occurred several years after the initial onset of mucocutaneous candidiasis and hypocalcaemia. Control of the diabetes insipidus was achieved initially with nasal aqueous lysine vasopressin and later with desmopressin.

The development of diabetes insipidus may be a further aspect of endocrine secretory failure associated with idiopathic hypoparathyroidism.
HLA Typing and ACTH Stimulation in the Detection of Carriers for 21‐Hydroxylase Deficiency*
Authors: Stuckey M. S. , Boyne P. , Macdonald W. B. , Christiansen F. T. , Houliston J. B. , Dawkins R. L.
Published: March 2008

Summary: Two methods of carrier detection were applied to the siblings of two children with congenital adrenal hyperplasia due to 21‐hydroxylase (21‐OH) deficiency. HLA geno‐typing showed that the affected children were HLA identical. One of the siblings possessed only one of the relevant haplotypes, and was shown to be heterozygous for 21‐OH deficiency by the 77α hydroxyprogesterone response to ACTH stimulation. The other sibling had a maternal recombination between the DR and glyoxylase‐1 (GLO) loci. The ACTH stimulation test was normal and therefore confirms recent reports suggesting that the 21‐OH gene is between the HLA‐A and the GLO loci. Although HLA typing of family members will identify heterozygous 21‐OH deficiency in most instances, biochemical definition is still required for some cases with recombinations in the short arm of chromosome 6.
Cost and Effectiveness of Clinical Investigation: The State of the Art
Authors: Clarke R. M. , Mason B. , Leeder S. R.
Published: March 2008

Summary: Clinical investigation by means of special technical tests has increased in clinical practice during recent years. Pressures causing this increase are said to include: rapid technological change making many more tests available, clinical uncertainty, peer pressure, greater patient awareness, and concern for diagnostic completeness. Cost factors do not appear to have influenced test‐ordering behaviour to any large extent, and those ordering investigations are frequently ignorant of the cost of the tests which they are ordering, both to the patient and the community.

The relation of clinical investigational activity to quality of outcome of patient care remains largely unestablished. Studies of the possible modification of test‐ordering behaviour through educational and institutional policy pressures are reviewed. A rational approach to investigating the effectiveness of techniques designed to encourage the more economic and effective use of investigations is presented in brief on the basis of this review of previously published work.
Echocardiographic Assessment and Systolic Time Interval Measurements in the Evaluation of Severe Hypertension in Nigerian Africans*
Authors: Adesanya C. O. , Sanderson J. E. , Verheijen Ir. P. J. T. , Brinkman A. W.
Published: March 2008

Abstract: Echocardiograms, systolic time interval measurements and electrocardiograms were obtained before treatment of 15 Nigerian patients with severe hypertension (WHO stage 2) but without overt heart failure. These were compared with the measurements in 12 normo‐tensive controls. In the hypertensive subjects, left ventricular (LV) posterior wall thickness, septal thickness, relative wall thickness and LV wall mass were greater than normal (P < 0 ‐ 01 respectively). However, the LV cavity size was within the normal range. The increase in LV wall mass correlated positively with the increase in mean blood pressure (r = 0.96, P <0.001). The ejection fraction (EF) and mean velocity of circumferential fibre shortening (mVcf) were decreased (P<0.01, P<0.05) respectively, while the calculated systemic vascular resistance (SVR) was elevated (P <0.01). The pre‐ejection period (PEP) was prolonged, but left ventricular ejective time (LVET) was shortened and therefore PEPILVET was increased. Eiectrocardiographic criteria did not detect left ventricular hypertrophy in four out of the 15 hypertensive patients, all of whom had left ventricular hypertrophy by echocardiography. These findings are similar to the abnormalities described for non‐African hypertensive patients; and show that hypertension causes LV dysfunction before the onset of overt heart failure
Immunoreactivity in vitro to Human Testis in Patients with Lepromatous Leprosy*
Authors: Wall J. R. , Walters B. A. J.
Published: March 2008

Abstract: Patients with lepromatous leprosy and tuber‐culoid leprosy, together with normal aged matched controls, were tested for in vitro immunoreactivity against a panel of soluble extracts prepared from normal human tissues. The panel consisted of a soluble homogenate of human testis as well as two partially purified fractions of this extract, and control extracts from other human tissues. Immunoreactivity was assessed by extract induced peripheral blood lymphocyte (PBL) transformation, leucocyte migration inhibition (LMI) and leucocyte adherence inhibition (LAI).

Although no difference in PBL transformation, LMI, or LA1 was obtained between the groups with the control tissue extracts, significant reactivity was obtained for the patients with lepromatous leprosy in at least one of the in vitro tests, when one of the testis extracts was used (Mann‐Whitney test). No such reactivity to the testis extracts was obtained in the patients with tuberculoid leprosy or the normal control subjects. Of the twenty‐two patients studied with lepromatous leprosy, thirteen had clinical evidence of testicular disease and nine of these patients had raised PBL transformation and LAI reactivity to the testis extracts.

This finding of immunoreactivity against testicular extracts in a significant number of patients with lepromatous leprosy by at least one of the in vitro tests used, suggests that the associated in vivo testicular atrophy that occurs in these patients may have an autoimmune basis.
Glyoxalase Phenotypes in Patients with Diabetes Mellitus
Authors: McCann V. J. , Davis R. E. , Welborn T. A. , Constable I. J. , Beale D. G.
Published: March 2008

Abstract: Caucasian diabetic patients in Australian surveys showed a significant difference in the distribution of glyoxalase phenotypes. Insulin dependent diabetic patients with age of onset less than 40 years had a relative excess of glyoxalase homozygote 1–1 and a deficiency of types 2–7 and 2–2. Non‐insulin dependent diabetic patients were not significantly different from non‐diabetic subjects in the distribution of glyoxalase phenotypes.

Insulin dependent diabetic patients without the complications of retinopathy or neuropathy also showed a significant excess of glyoxalase type 1–1 in relation to the control group. Genes controlling glyoxalase polymorphism appear to be associated with the variations of diabetes and its complications.
Thyrotrophin‐binding Inhibitory Immunoglobulin and HLA‐DRW3—Two Prognostic Factors in Graves' Disease*
Authors: Teng C. S. , Yeung R. T. T. , Kawa A. , Nakamura S. , Nornoto K. , Arima N. , Koreeda N. , Tsuji K. , Ho P. W. M.
Published: March 2008

Abstract: Thyrotrophin‐binding inhibitory immuno‐globulin (TBII) activity and HLA typing were performed in 38 Chinese patients with Graves' disease to find out the relationship among TBII activity, HLA antigen and relapse. Twelve out of 13 patients who were TBII‐positive at anti‐thyroid drug withdrawal relapsed. All seven patients with HLA‐DR3 antigen relapsed, whereas all ten patients in remission did not have DR3. Therefore, both TBII activity at drug withdrawal and DR3 antigen could predict subsequent relapse. However, a larger patient sample is required to determine the precise relationship between TBII activity and HLA‐DR3 antigen.
The Echocardiographic Assessment of Cardiomyopathy: Diagnosis, Classification and Problems
Authors: Leitl G. P. , McDonald I. G.
Published: March 2008

Abstract: Two‐hundred‐and‐sixty‐three patients with cardiomyopathy were studied by M‐mode echocardiography. Measurements of left ventricular cavity size, wall thickness and myo‐cardial contraction were used to classify cardiomyopathy into “congestive” (272 patients) and “hypertrophic” (50 patients) groups; the “hypertrophic” group was further divided into asymmetric septal hypertrophy (37) and symmetric (concentric) mural thickening (13). Using clinical and electro‐cardiographic information as well as echocardiographic data, the latter group could then be further classified into “concentric infiltrative cardiomyopathy” (9) and “concentric hypertrophic cardiomyopathy” (4). The former either presented with signs of restriction or were known to have systemic amyloidosis; the electrocardiograph showed low voltage and myocardial contraction was impaired in advanced cases. The latter had evidence of severe left ventricular hypertrophy and resembled asymmetric septal hypertrophy clinically. Problems encountered with the echocardiographic diagnosis of congestive cardiography were mainly concerned with proper clinical interpretation of the echocardiographic data whilst technical difficulties in recording the echocardiogram and in interpretation of tracings were a common problem in hypertrophic cardiomyopathy.
Medical Treatment of Hypertension and Renal Failure in Scleroderma
Authors: Barnett A. J.
Published: March 2008

Abstract: Until recently acute renal failure in sclero‐derma has been uniformly fatal. Since 1973 there have been several reports of successful treatment by peritoneal and haemodialysis and nephrectomy, sometimes followed by renal transplantation. During the past few years there have been several reports of patients managed successfully with drug treatment. The present paper reports on a patient with scleroderma who is clinically well with stable renal function with drug treatment three years after the onset of acute renal impairment and hypertension. Other similar cases are reviewed.
Pseudoaneurysm of the Left Ventricle
Authors: Davidson P. I. , Richmond D. R. , Baird D. K.
Published: March 2008

Abstract: A case study is reported of a patient with rheumatoid arthritis who developed a pseudoaneurysm of the left ventricle after inferior myocardial infarction. The clinical diagnosis was confirmed by radionuclide cardiac blood pool imaging and by contrast ventricu‐lography; the aneurysm was successfully excised.
Effect of High Dose Busulphan on Leukaemic Progenitor Cells in Chronic Myeloid Leukaemia
Authors: Morstyn G. , Sullivan J. , Fairhead S. , Cowling D. , Hurley T.
Published: March 2008

Abstract: Six patients with Philadelphia positive chronic myeloid leukaemia (CML) were treated with single high doses of busulphan.

The action of busulphan on the in vivo kinetics of circulating progenitor cells (colony forming cells) was measured using an agar culture system which involved scoring of total colonies and clusters at 7 days and of granulocyte, monocyte and eosinophil colonies at 14 days.

High dose busulphan was found to be effective in suppressing circulating granulocyte, monocyte and eosinophil progenitor cells. The effect of busulphan on progenitor cells was rapid and their levels fell by at least 83% within five days. By contrast, the white blood cells fell by only 9% and the platelets fell by 10% over this time. Subsequently, the white cell count and platelet count fell to near normal levels. The progenitor cell levels began to rise again at a mean of 35 days following busulphan treatment and the white blood cells at a mean of 39 days in four patients. One patient remained in haematological remission for six months following 100 mg of busulphan with less than 1 progenitor per 5 × 105 peripheral blood nucleated cells. One patient in myeloblastic transformation had a previously not described culture pattern consisting of a high cluster to colony ratio at 7 days and of an increased number of predominantly eosinophilic colonies at 14 days. There was no significant fall in progenitor cell levels following busulphan and this patient died.
Cardiac Beat to Beat Variation: Age Related Changes in the Normal Population and Abnormalities in Diabetics*
Authors: Chipps D. R. , Kraegen E. W. , Zelenka G. S. , McNamara M. E. , Chisholm D. J.
Published: March 2008

Abstract: Determination of heart rate variation (RR interval variation) is a non‐invasive technique which may be used for assessment of diabetic autonomic dysfunction. Interpretation has been complicated by age changes in the normal population and by uncertainty as to the optimum conditions for the performance of the test. This study was designed to establish a normal age‐related range for RR interval variation performed under the simplest conditions (resting, seated) applicable to an outpatient diabetic clinic and to compare these measurements with augmented RR variation due to deep breathing (ARRIV) and with the Valsalva ratio (VR).

Using an ECG recorder and a computer analysis program, resting RR interval variation (RRIV) was assessed in 100 non‐diabetics (N) aged 12–80 years and 60 randomly selected diabetics (D) aged 14–74 years. RRIV, the standard deviation of RR intervals, declined progressively after age 40 in normal subjects. The diabetics had significantly (p < 0.001) reduced RRlV compared with normals; 65% having RRIV values more than 1 SD and 25% more than 2 SD below the age related mean for normals.

RRlV was compared with ARRIV in 54 subjects (N40, 014) and with VR in 84 subjects (N54, D27). There was a significant correlation of RRlV with both indices but RRlV resulted in greater discrimination between N and D than ARRIV or VR. There was no significant correlation between RRlV and duration of diabetes but mean RRlV was significantly reduced in diabetics with peripheral neuropathy compared to those without. In seven diabetics studied both before and after substantial improvement in metabolic control RRlV improved by a mean of 51% (p < 0.005).

Measurement of RRlV is a simple non‐invasive technique for assessment of diabetic autonomic dysfunction. Interpretation, however, depends on knowledge of an age‐related reference range.
Infective Endocarditis: A Lethal Disease
Authors: Ormiston J. A. , Neutze J. M. , Agnew T. M. , Lowe J. B. , Kerr A. R.
Published: March 2008

Abstract: One‐hundred‐and‐eighty‐nine episodes of Infective Endocarditis were seen in 177 patients in the Green Lane Cardiology Unit over an 18‐year period. Hospital survival was 79% and 13‐year actuarial survival was 47%. A number of factors including the underlying cardiac lesion, infecting organism, clinical features and surgical intervention were related to outcome.

No patient with extreme heart failure survived without operation. Hospital survival in patients with severe heart failure was 69% (9/13 patients) where surgery was carried out before completion of antibiotic treatment, and 40% (6/15 patients) where the antibiotic course was completed. Survival was 53% in patients who still had a fever after one week of antibiotic treatment and 96% if the temperature was normal. In 61% of patients with a fever at one week, extended infected pannus was present compared with 6–10% where the temperature was normal. In patients undergoing operation before completion of antibiotics, the surgical mortality was higher but neither the incidence of recurrence of endocarditis nor the need for re‐operation was increased.

We believe that better results will be achieved with a policy of surgical intervention when signs of infection and heart failure have not settled within one week of treatment.
The Management of Patients with Suspected Wolff‐Parkinson‐White Syndrome—A Four Year Review
Authors: Hamer A. W. F. , Vohra J. K. , Sloman J. G. , Hunt D.
Published: March 2008

Abstract: Thirty‐six patients with the electrocardiographic pattern of Wolff‐Parkinson‐White (WPW) Syndrome had electrophysiological (EP) studies over a four year period. Thirty‐two patients were symptomatic and supraventricular tachycardia (SVT) or atrial fibrillation (A Fib) had been demonstrated in 19 of these patients. Four patients were asymptomatic.

The diagnosis of WPW was confirmed in 33 of the 36 patients at EP studies and in 24 of 33 the location of the accessory atrioventricular connection (AAVC) from the surface ECG was confirmed at EP studies. The effective refractory period of the AAVC in 30 patients ranged from 200–550 ms (m 284 ± 58 ms). A Fib could be induced in 20 of the 32 patients and SVT in 21 of the 33 patients. In 14 of 21 patients the SVT had narrow QRS complexes; in three patients the QRS was wide and in four patients both types were noted. In three patients the diagnosis of WPW was disproved at EP studies.

On the basis of EP studies, drug therapy was recommended in 21 patients. In 12 of the 21 patients previous drug therapy was changed. Nine of these 12 patients showed symptomatic improvement. Of the remaining patients one required surgery because of failed medical treatment; the two other patients died and their deaths could be attributed to failure of medical therapy. In seven patients no change was made in drug therapy and in two, intermittent drug therapy was recommended. In six patients no drug therapy was prescribed.

Two patients were treated with magnetactivated implantable pacemakers capable of delivering coupled, fixed‐interval right ventricular extrastimuli. Neither of these was successful and thus surgery was recommended. Six patients have undergone surgical section of their AAVC with complete control of tachycardia; two patients are awaiting surgery.

EP studies were helpful in the management of the majority of symptomatic patients with suspected WPW Syndrome. Surgery offers an attractive alternative to long term, and occasionally unsuccessful, drug therapy and should be considered in suitable patients.
Myelography with Metrizamide—An Analysis of the Complications Encountered in Cervical, Thoracic and Lumbar Myelography
Authors: McCormick C. C. , ApSimon H. T. , Chakera T. M. H.
Published: March 2008

Abstract: Detailed analysis of complications in 363 patients undergoing myelography with metrizamide is presented. Patients have been separated into three groups: those who had lumbar myelograms via lumbar puncture; patients who had cervical myelograms via lumbar route and patients who had cervical myelograms via cervical puncture (lateral C1/C2. approach).

Analysis has revealed that the incidence of minor complications like headaches, nausea, and vomiting is higher than that associated with myodil myelography. Nevertheless, it is concluded that because of lack of long term disability of arachnoiditis, and because of greater diagnostic accuracy, metrizamide represents the best contrast medium for myelography currently available.
Consequences of Legislative Restriction on the Sale of Compound Analgesics in Newcastle (N.S.W., Australia)
Authors: Hardes G. , Egger G. , O'Neill P. , Nanra R. S. , Leeder S. R.
Published: March 2008

Abstract: In June 1979 legislation was enacted in New South Wales to restrict the sale of compound analgesics. The consequences of this legislation were assessed by a household survey in Newcastle, New South Wales, during November 1979. This survey followed an identical survey in the same community in November 1977. After legislation, a marked decrease was found in the proportion of homes having compound analgesics. A small decrease in total analgesic usage was also observed, though this was not necessarily related to the legislative restrictions. The legislative restrictions did not result in any substantial increase in use of the doctor to obtain prescriptions for compound analgesics, or any substantial increase in reported health problems. The results suggest that legislation is an effective method of inducing rapid change in health‐related behaviour.
Progressive Systemic Sclerosis in Auckland: A Ten Year Review with Emphasis on Prognostic Features
Authors: Eason R. J. , Tan P. L. , Gow P. J.
Published: March 2008

Abstract: The clinical records of all patients with scleroderma or Raynaud's phenomenon who attended hospitals or specialist practice in Auckland during the ten year period of 1970–79 were examined. Forty‐seven patients were found to satisfy the American Rheumatism Association criteria for progressive systemic sclerosis (PSS). Thirteen of these patients had CRST features which comprise calcinosis, Raynaud's phenomenon, sclerodactyly and telangiectasiae. All but two of the 23 surviving patients were interviewed. The incidence of PSS was 6.3/million/year and no significant difference in incidence was found between Caucasians and Polynesians. Raynaud's phenomenon was most frequently the presenting symptom. Oesophageal involvement was the commonest clinical visceral manifestation. Cumulative survivaI rates showed that the adverse prognostic features were renal, cardiac and to a lesser extent pulmonary involvement. Patients with the CRST features had a better prognosis and none had renal complications. The natural history of the CRST group was characterised by a long latency between the presenting symptom and the other features of the disease. Therefore, the recognition of the CRST variant was of retrospective rather than predictive clinical value. In this first clinical study of PSS patients in New Zealand, results of therapeutic intervention were disappointing.
Vocal Cord Paralysis (VCP)—An Aetiologic Review of 100 Cases Over 20 Years
Authors: Kearsley J. H.
Published: March 2008

Abstract: A retrospective analysis of the aetiology of 100 cases of vocal cord paralysis (VCP) seen over two consecutive decades at a large general hospital has been performed. One half of the cases seen were due to malignancy, mainly carcinoma of lung; 16% of cases were due to trauma or surgical procedures, while cardiac and neurological‐related diseases were associated with 7% and 6% of cases respectively and miscellaneous causes accounted for 6%. Fifteen per cent of all cases remained undiagnosed.

When the first and second decades were compared for evolving trends, there was a decrease in the incidence of VCP as a complication of lung cancer, but no significant change following thyroid surgery. The nature of idiopathic VCP is discussed in some detail.
Amrinone—A New lnotropic Agent in Chronic Resistant Congestive Cardiac Failure
Authors: Robinson P. J. , Lvoff R. , Chong B. , Barrett P. A.
Published: March 2008

Abstract: A patient with severe cardiac failure due to idiopathic congestive cardiomyopathy resistant to conventional therapy, responded to amrinone, a new non‐glycosidic non‐catecholamine positive inotropic agent.

Amrinone produced significant haemodynamic improvement during both intravenous and oral administration. Thrombocytopaenia, however, was induced, necessitating cessation of the drug.

Amrinone is a promising, orally effective inotropic agent for patients with refractory congestive cardiac failure, but is limited by its tendency to cause thrombocytopaenia.
Potassium Handling by the Kidney. Hyperkalaemia
Authors: Barratt L. J.
Published: March 2008

Abstract: In this brief review, an attempt is made to summaries the renal handling of potassium and factors influencing the excretion of this ion and from these concepts develop a series of theoretical mechanisms which might explain most of the clinical situations in which hyperkalaemia has been observed.
Aspects of Renal Bone Disease
Authors: Cochran M.
Published: March 2008

Abstract: In advanced chronic renal failure hypo‐calcaemia can be due to a combination of factors. These include decreased delivery of calcium into the plasma and increased renal tubular leakage of calcium. The secondary hyperparathyroidism that follows the hypo‐calcaemia leads to osteosclerosis, probably by movement of cortical mineral into trabecular bone. In the dialysis population, an atypical and readily identifiable form of osteomalacia sometimes occurs and is probably secondary to a water‐borne toxin.
IgA, Glomerulonephritis and Liver Disease
Authors: Woodroffe A. J.
Published: March 2008

Abstract: Data from our Unit suggest that soluble immune complexes (IC) are responsible for the mesangial deposits of IgA and C3 in patients with IgA nephropathy. These IC are of intermediate size (9–17S) and contain IgA, IgG and less commonly IgM. Ubiquitous exogenous antigens have been implicated in some patients and primary defects in antigen exclusion or reticuloendothelial sequestration have been proposed to account for the formation and persistence of IC. The liver plays a central role in the clearance of antigens, polymeric IgA and IC, and liver disease is associated with alimentary hyper‐immunization, hypergammaglobulinaemia (including IgA polymers) and circulating IC. At autopsy, mesangial (14/28), skin (10/18) and choroid plexus. (2/3) deposits of IgA were found in patients with alcoholic cirrhosis compared with 1/75, 3/10 and 2/5 respectively in controls. Raised serum antibodies to E. coli and to BSA were noted in patients with alcoholic cirrhosis but no specific antibodies have been detected in the kidney eluates. Circulating IC and mesangial deposits of IgA and C3 have also been demonstrated in rats with carbon tetrachloride‐induced cirrhosis and after portacaval shunting. Measurement of reticuloendothelial function and the clearance of IgA polymers and IC is now required in patients with primary IgA nephropathy and HSP. In the meantime, IgA nephropathy is best regarded as a syndrome with primary and secondary forms, and as a clinical spectrum from isolated glomerulonephritis to systemic IC disease (HSP).
Fulminant Meningococcemia
Authors: Kearsley J. H. , Delohery J. , Croll F. J.
Published: March 2008

Abstract: A case of fulminant meningococcal septicemia is reported in whict an acute gastroenteritis was the presenting symptom. Disseminated intravascular coagulation, profound hypotension and a haemorrhagic skin rash were the dominant clinical features. Successful treatment was directed towards the replacement of coagulation factors, treatment of the underlying infection and reversal of hypotension with the inotropic agent, dopamine. Corticosteroids were used in pharmacological doses, but heparin was not used.

The pathogenesis of several abnormalities in this disease is briefly reviewed.
Comparison of Five Guaiac Resin Paper Tests for Demonstrating the Presence of Blood in Faeces
Authors: Frommer D. , Logue T.
Published: March 2008

Abstract: Four recently available kits of guaiac resin‐impregnated paper for demonstrating the presence of blood in faeces were compared with Hemoccult II® in in vitro testing. Hemo‐FEC® most closely resembled Hemoccult II® in its sensitivity with freshly prepared kits and kits prepared one week earlier with or without rehydration before testing. Gamma Fe‐Cult and Fecatest® were more sensitive than Hemoccult II® whereas Camco‐Pac® Guaiac was much less sensitive.

Rehydration of kits prepared several days beforehand appears to be useful in restoring sensitivity lost by all the kits tested.
Evaluation of Group Versus Individual Nutrition Education in Overweight Patients with Myocardial Infarction*
Authors: Wright J. , Wood B. , Hale G.
Published: March 2008

Abstract: Thirty‐nine obese patients (weighing in excess of 110% of ideal weight) were studied for 52 weeks following admission to the Coronary Care Unit with a diagnosis of acute myocardial infarction. The aim of the study was to compare, chiefly by anthropometric measurements, the response to a structured nutrition education program provided by a dietitian using three different levels of time involvement with the patients, firstly individual patient education, secondly group education and thirdly the issuing of written material only. Although there was no significant difference in the mean weight loss between the three education groups (8.1, 7.5 and 8.9 kg respectively) there was a trend towards more uniform weight reduction in those who received individual education. All but two of the 28 who attended at 52 weeks achieved weight loss. Thirteen patients attained 110% or less of their ideal weight, a 46% success rate. Reduction in body weight and most of the other anthropometric measurements occurred in the first twelve weeks of ‘study’, with no further significant weight change to 52 weeks. While these observations suggest that the overweight patient with acute myocardial infarction need not be subject to intensive nutrition education at the time of presentation, a more aggressive follow‐up programme in subsequent months is recommended.
Relationship of Psychological Factors to Failure of Antihypertensive Drug Treatment
Authors: Zacest R. , Barrow C. G. , O'Halloranz M. W. , Wilson L. L.
Published: March 2008

Abstract: Personality traits and pretreatment symptoms of 69 hypertensive patients were documented witn self‐administered questionnaires. Thirteen patients (19%) dropped out during 12 months of treatment. Five of these were lost from follow up and eight failed to tolerate their allotted medication.

In this series treatment failure did not seem dependent on the type of drug used, but was linked with a high suspiciousness level and a high pretreatment symptom score. Both measures varied independently of one another and a select group of 10 patients who scored highly on both, had a failure rate of 60%.

Our results suggest that hypertensives with an increased predisposition to drug treatment failure can be identified at the pretreatment stage. Recognition of such individuals should assist in their routine clinical management and in the design of antihypertensive drug trials.
The Maximal Expiratory Flow/Volume Curve in 197 Healthy New Zealanders: A Comparison with Recent American Standards
Authors: Macfie A. E. , Harris E. A. , Whitlock R. M. L.
Published: March 2008

Abstract: Maximal expiratory flow/volume curves were recorded from 155 healtby, non‐smoking Europeans aged seven to 71 yr and 42 Polynesian children aged nine to 11 yr. Forced vital capacity (FVC), forced expiratory volume in 1s (FEV1), FEV 1/JFVC, peak expiratory flow (PEF) and flow at 50 and 25% of FVC (V50 and V25) were compared with the predictions made from the equations of Schoenberg, Beck and Bouhuys, describing healthy people in Connecticut, USA. In general the equations described our subjects well; the small but significant discrepancies may reflect either technical factors or possibly a true difference in populations.
Mitral Stenosis and Mitral Incompetence due to Libman‐Sacks Endocarditis with Mitral Valve Replacement
Authors: Evans D. T. P. , Sloman J. G.
Published: March 2008

Abstract: A patient is described with recurrent severe left heart failure induced by combined mitral stenosis and incompetence secondary to Libman‐Sacks endocarditis. Marked improvement followed mitral valve replacement with a 29 mm St. Jude Medical Bi‐Leaflet prosthesis. There was no evidence of rheumatic valve disease either macroscopically at operation or on histological examination of the excised valve.
Glomerulonephritis Secondary to Mixed Polyclonal Cryoglobulinaemia: Response to Immunosuppression and Plasmapheresis
Authors: McKenzie R. G. , Anavekar S. N. , Dawborn J. K. , Evans S. M. , Ham K. , McPherson G. , Riglar A. G. , Xipell J. M.
Published: March 2008

Abstract: A case of acute renal failure is described which was due to glomerulonephritis associated with mixed polyclonal (type 3) cryoglobulinaemia. The patient was treated with plasmapheresis and dialysis and was maintained on pred‐nisolone and cyclophosphamide for eight weeks resulting in full clinical and biochemical recovery.
AUTOANTIBODIES TO SMALL NUCLEAR RIBONUCLEOPROTEINS. A STRONG ASSOCIATION BETWEEN ANTI‐SS‐B (La), HLA‐B8, and SJÖGREN'S SYNDROME
Authors: WHITTINGHAM S. , MACKAY I. R. , TAIT B. D.
Published: March 2008

The heterogeneity within multisystem autoimmune disease was evaluated according to the presence of antinuclear antibodies to ribonucleoproteins and the HLA‐A1, B8, DR3 phenotype. Patients with various multisystem autoimmune diseases were tested by a highly sensitive radioimmunoassay for autoantibodies to the small nuclear ribonucleoproteins known as SS‐B (La) and ribonucleoprotein (RNP), and HLA phenotypes were determined. The 210 patients included 64 with systemic lupus erythematosus (SLE), 11 with “atypical SLE”, 41 with Sjögren's syndrome, 22 with mixed connective tissue disease (MCTD), 21 with rheumatoid arthritis (RA), 16 with primary biliary cirrhosis (PBC) and 35 with autoimmune chronic active hepatitis (A‐CAH).

Anti‐SS‐B (La) was present in high frequency in Sjögren's syndrome and was strongly associated with HLA‐A1, B8, DR3. Anti‐RNP was detected predominantly in MCTD and had no association with HLA‐A1, B8, DR3. There were sharply defined serological and genetic differences between primary Sjögren's syndrome and Sjögren's syndrome associated with RA. Anti‐SS‐B (La) was present in 70% of patients with primary Sjögren's syndrome but in none with Sjögren's syndrome with RA, and the respective frequencies of HLA‐A1, B8, and DR3 were 88%, 94% and 75% in the former compared with 38%, 29% and 14% in the latter. Thus primary Sjögren's syndrome differs immunogenetically from Sjögren's syndrome with RA. There was a notable absence of anti‐SS‐B (La) in PBC, an autoimmune disease associated with the Sjögren's syndrome. These findings illustrate the value of studying immunological and genetic markers in detecting heterogeneity within groups of diseases whose symptoms cannot be distinguished clinically. (Aust NZ J Med 1983; 13: 565–570.)
TUMOUR VISUALISATION USING A RADIOLABELLED MONOCLONAL ANTIBODY*
Authors: ZALCBERG J. R. , THOMPSON C. H. , LICHTENSTEIN M. , LEYDEN M. J. , ANDREWS J. T. , SULLIVAN J. R. , McKENZlE I. F. C.
Published: March 2008

A radiolabelled monoclonal antibody was injected intravenously into two patients with disseminated carcinoma of the colon and serial scintigrams were then obtained on three consecutive days. In addition to the “specific” antibody image, blood pool and conventional liver scans were also obtained. After computer‐based subtraction discrete hepatic metastases could be demonstrated in both patients, while in the second patient, the primary colonic tumour was also visualised for the first time. The study demonstrates the specific localisation of primary and secondary carcinoma of the colon with a radiolabelled monoclonal anti‐tumour antibody and offers an improved method of specifically detecting tumours in man. (Aust NZ J Med 1983; 13: 571–577.)
A SIMPLE AID TO THE DIFFERENTIAL DIAGNOSIS OF OLIGURIA
Authors: BROWN M. A. , TREW P. A. , SMART R. C.
Published: March 2008

A study was conducted in oliguric and acutely azotemic patients, measuring: (i) the fractional excretion of sodium (FENa) using creatinine clearance as a measure of glomerular filtration rate, and (ii) sodium clearance relative to urea clearance, designated as the sodium/urea clearance ratio (Na:urea CR).

It was found that FENa discriminated between “tubular” and “non‐tubular” disorders in 96% of patients. Further, Na:urea CR was as discriminating as FENa. Patients with Na:urea CR above 2.5% can be reliably diagnosed as having acute tubular necrosis or acute urinary tract obstruction; those with a value less than 2.5% will have acute glomerulonephritis or pre‐renal azotemia. As urea and sodium measurements are so readily available, this test can now be applied in the assessment of the oliguric or acutely azotemic patient in any hospital practice. (Aust NZ J Med 1983; 13: 608–612.)
BREATHING DURING SLEEP: THE RESPONSES TO ASPHYXIA and PROCHLORPERAZINE IN NORMAL SUBJECTS and PATIENTS WITH OBSTRUCTIVE SLEEP APNEA*
Authors: OLSON L. G. , HENSLEY M. J. , SAUNDERS N. A.
Published: March 2008

:The effects of sleep and prochlorperazine (12.5 mg intravenous bolus) on the ventilatory and arousal responses to asphyxia were studied in normal subjects and patients with obstructive sleep apnea (OSA). The ventilatory response to asphyxia was reduced during non‐rapid eye movement sleep in the six normal subjects studied (1.93 ± 0.181 min‐1. % SaO2 awake vs. 1.01 ± 0.10 I min‐1. ± SaO2 asleep; rnean ± SEM; p<0.01) (SaO2= arterial oxygen saturation). In the two normal subjects studied during sleep following prochlorperazine administration, ventilatory responsiveness was increased (p<0.05) but arousal response to asphyxia was depressed (p<0.025). Although prochlorperazine increased waking ventilatory responsiveness to asphyxia in five of six patients with OSA (2.26 ± 0.44 I min‐1.% SaO2vs.4.77 ± 1.39 I min‐1.% SaO2; mean ± SEM; p<0.01), the drug had no clinically significant effect on upper airway obstruction during sleep; in three patients, apnea frequency was slightly reduced but in four of six patients severity of hypoxemia during apnea was increased with drug administration. We conclude that prochlorperazine administration is unlikely to benefit patients with obstructive sleep apnea despite its ventilatory effects during wakefulness and sleep. This lack of effect may be explained by separate effects of the drug on ventilatory and arousal responses to asphyxia. (Aust NZ J Med 1983; 13: 613–620.)
POST PARTUM NEPHROTIC SYNDROME IN MIXED ESSENTIAL CRYOGLOBULINEMIA
Authors: GOODMAN G. J. , RYAN P. F. J. , SINCLAIR R. A.
Published: March 2008

The clinical and histological findings of a patient with mixed essential cryoglobulinemia (MECG) who developed post partum renal failure and the nephrotic syndrome are described. The renal insufficiency responded dramatically to intensive plasma exchange and longer term immunosuppression with associated resolution of the renal histological changes. To our knowledge deterioration of renal function in the post partum period has not been previously described in the syndrome of MECG. (Aust NZ J Med 1983; 13: 633–635.)
POLYCYTHEMIA VERA AND GLOMERULONEPHRITIS
Authors: PLOMLEY R. F. , SULLIVAN J. R. , WHITWORTH J. A. , KINCAID‐SMITH P. S. , FAIRLEY K. F. , BROWN R. W.
Published: March 2008

Abstract: Six patients with polycythemia vera and proteinuria are described. Three patients had histologically defined glomerulonephritis. It is proposed that there is an association between polycythemia vera and the development of glomerulonephritis. Possible pathogenetic mechanisms are discussed.
MANTLE IRRADIATION FOR STAGE I AND STAGE II HODGKIN'S DISEASE – RESULTS OF A 10 YEAR EXPERIENCE
Authors: LIEW K. H. , DING J. C. , MATTHEWS J. P. , IRONSIDE P. J. , BEADLE G. F. , COOPER I. A. , MADIGAN J. P. , PARKIN F. G.
Published: March 2008

Abstract: One hundred and thirty patients with Stage I and II supradiagphragmatic Hodgkin's disease treated with mantle irradiation alone at the Peter MacCallum Hospital, Melbourne between 1968–1977 were analysed retrospectively. The median followup was 7.4 years with a minimum of three years.

There were 64 clinically staged (CS) and 66 pathologically staged (PS) patients. The major difference between the two groups was the transdiaphragmatic relapse which occurred in 33% of CS patients, and 7.5% in PS patients. The actuarial five year relapse free survival (RFS) was 48% for CS patients and 67% for PS patients, but the five year overall survival was 90% for both groups, reflecting the impact of salvage treatment.

Avid attention must be given to radiotherapy techniques to minimise local treatment failures. High grade nodular sclerosis Hodgkin's disease is associated with poor RFS even after adjustment has been made for stage and constitutional symptoms (p < 0.003). Further studies will be made on this group of patients who may benefit from combined modality treatment. For PS I and II patients mantle irradiation gives a five year RFS of 67%, thus offering potential for cure in these patients.
DERMAL NECROSIS AND CHROMOSOME Iq ABNORMALITY IN A MAN WITH A FAMILIAL MYELOPROLIFERATIVE DISORDER
Authors: ROBINSON C. W. , NORMAN J. E. , CLELAND L. G. , FORD J. H.
Published: March 2008

Abstract: A 33 year old man, with pre‐existing psoriasis and a family history of multiple occurrence of acute myeloid leukemia and other myeloproliferative disorders, developed steroid‐responsive ulcerating skin lesions, pancytopenia, marrow hypoplasia, hyperglobulinemia and polyarthritis. An abnormal karyotype (47, XY + i(1q)) was detected in the bone marrow, and comparison with a case previously reported by Lee et al. suggested that this abnormality may be significant. His sister, who developed chronic leucocytoclastic vasculitis, had pre‐existing psoriasis, variable mild leucopenia and marrow dysplasia. Review of available records of other affected family members documented the occurrence of steroid responsive pancytopenia, knee swelling and terminal lipoid pneumonia in a first cousin. Four other relatives died with acute myeloblasts leukemia and another died with myelofibrosis. Two healthy first degree relatives were subjected to laboratory investigations with essentially negative findings.