bluuebunny/crossref_metadata_2025 huggingface dataset:
Stress‐responsive microRNAs in Populus
Authors: Lu Shanfa , Sun Ying‐Hsuan , Chiang Vincent L.
Published: March 2008

MicroRNAs (miRNAs), a group of small non‐coding RNAs, have recently become the subject of intense study. They are a class of post‐transcriptional negative regulators playing vital roles in plant development and growth. However, little is known about their regulatory roles in the responses of trees to the stressful environments incurred over their long‐term growth. Here, we report the cloning of small RNAs from abiotic stressed tissues of Populus trichocarpa (Ptc) and the identification of 68 putative miRNA sequences that can be classified into 27 families based on sequence homology. Among them, nine families are novel, increasing the number of the known Ptc‐miRNA families from 33 to 42. A total of 346 targets was predicted for the cloned Ptc‐miRNAs using penalty scores of ≤2.5 for mismatched patterns in the miRNA:mRNA duplexes as the criterion. Six of the selected targets were validated experimentally. The expression of a majority of the novel miRNAs was altered in response to cold, heat, salt, dehydration, and mechanical stresses. Microarray analysis of known Ptc‐miRNAs identified 19 additional cold stress‐responsive Ptc‐miRNAs from 14 miRNA gene families. Interestingly, we found that individual miRNAs of a family responded differentially to stress, which suggests that the members of a family may have different functions. These results reveal possible roles for miRNAs in the regulatory networks associated with the long‐term growth of tree species and provide useful information for developing trees with a greater level of stress resistance.
Epidemic Polyarthritis: A Cytological, Viroiogical and Immunochemical Study
Authors: Clarris B. J. , Doherty R. L. , Fraser J. R. E. , French E. L. , Muirden K. D.
Published: March 2008

Summary: Epidemic polyarthritis: A cytological, viroiogical and immunochemical study. B. J. Clarris, R. L Doherty, J. R. E. Fraser, E. L French and K. D. Muirden, Aust. N.Z. J. Med., 1975, 5, pp. 450–457.
The Relationship of Red Cell Membrane Lipid Content to Red Cell Morphology and Survival in Patients with Liver Disease*
Authors: Powell Lawrie W. , Halliday June W. , Knowles Brian R.
Published: March 2008

Summary: The relationship of red blood cell (RBC) membrane lipid content to RBC morphology and survival was studied in patients with liver disease. An increase in RBC cholesterol and phospholipid was detected in most patients with hepatocellular disease or cholestatic jaundice but the alteration in RBC lipid content did not correlate with RBC survival. The main abnormality of RBC morphology observed was the presence of macrocytes and target cells. In a small proportion of patients (approximately 3%) with severe hepatocellular disease, significant numbers of severely deformed (“spur”) cells were seen. In these patients haemolysis was moderately severe and the RBC lipid profile showed increased membrane cholesterol without a concomitant increase in phospholipids. It is concluded that only in patients with “spur” cell anaemia do the morphological alterations lead to premature removal of cells from the circulation. The cause of the shortened RBC survival in jaundiced patients without “spur” cells remains to be determined.
Nutrition in the Australian Aborigines—Effects of the fortification of white flour
Authors: Kamien M. , Woodhill Joan M. , Nobile Silvia , Cameron Pat , Rosevear Pam
Published: March 2008

Summary: The nutritional status of 66 part Aborigines was re‐examined in 1974—with particular reference to blood levels of haemoglobin and vitamins—after white bread fortified with iron and the vitamins B1 and PP (niacin) had been available for six and a half months to the population of Bourke, New South Wales. The results found in 1971 and 1974 are compared. A significant improvement from deficient to acceptable blood levels of vitamins B1 and B6 was found in 44% and 52% of the subjects respectively. This is attributed to the consumption of fortified bread since the levels of the other vitamins had remained either unchanged or worsened. The biochemical improvement in vitamin B6 is attributed to the sparing effect of vitamin PP on vitamin B6 requirement because the conversion of tryptophan to niacin is impaired in vitamin B6 deficiency. Iron deficiency anaemia in children had decreased by 50% but this could have been due to many other factors besides the iron which had been added to the bread. Clinically there was a marked decrease in angular stomatitis and skin xerosis which could be related to the biochemical improvement of the two B‐vitamins and a decrease in active trachoma and suppurative otitis media probably due to intensive treatment received since 1971. The results of this study and the extent of biochemical vitamin B1 and B6 deficiency found in other groups, indicate that fortification of bread may be of benefit to the community as a whole.
Hydralazine and Beta‐Blockade in Refractory Hypertension with Characterization of Acetylator Phenotype
Authors: Hunyor S. N.
Published: March 2008

Summary: Hydralazine and beta‐blockade in refractory hypertension with characterization of acetylator phenotype.
Hepatitis B in Australian Aborigines and Torres Strait Islanders: Geographical, Age and Familial Distribution of Antigen Subtypes and Antibody
Authors: Barrett E. Judith
Published: March 2008

Summary: Hepatitis B in Australian Aborigines and Torres Strait Islanders: Geographical, age and familial distribution of antigen subtypes and antibody.
Analysis of Two‐Category Data from Small Independent Samples
Authors: Lee James
Published: March 2008

Summary: Analysis of two‐category data from small independent samples. James Lee Aust. N.Z J. Med., 1976, 6, pp. 141–146.

An exact probability test for the comparison of cure‐rate (or any other 2‐category response variable) among three treatments is presented in detail. Extension of the method to larger contingency tables is also shown. It is suggested that the exact method should be used if the sample size for a particular investigation is small and/or when the chisquare test gives a probability level near borderline statistical significance.
Immediate Hypersensitivity: A Clinical Review*
Authors: Woolcock Ann J.
Published: March 2008

Summary: Immediate hypersensitivity: A clinical review. Ann J. Woolcock, Aust N.Z. J. Med., 1976, 6, pp. 158–167.

Diseases in which immediate hypersensitivity (IH) reactions occur, (asthma, allergic rhinitis and eczema) are very common in Australia although their overall prevalence is unknown. Until recently the clinical investigation of IH has been undertaken almost exclusively by allergists using scratch tests. The discovery of IgE by Ishizaka et al.1 in 1966 resulted in a rapid increase in the understanding of the processes involved in IH reactions and, although much remains unclear, respiratory physicians, immuno/ogists and epidemiologists are becoming increasingly involved in investigating the IH reactivity of individuals and populations.

In this review the immunological basis of IH reactions is briefly presented; the role of skin tests in their assessment is evaluated and the relationship between IH and clinical allergic disease is discussed in terms of patient management.
Renin Unresponsiveness and the Effects of Oxprenolol, Methyldopa and Spironolactone in Patients with Essential Hypertension
Authors: Thomas G. W. , Ledingham J. G. G. , Beilin L. J. , Yeates K. M.
Published: March 2008

Summary: Renin unresponsiveness and the effects of oxprenolol, methyldopa and spironolactone in patients with essential hypertension.

Plasma renin activity (PRA), supine, erect and post‐frusemide (1 mg/kg IV) was studied in 51 patients with previously untreated essential hypertension and their age‐and sex‐matched normotensive controls. Supine PRA, and the rise in PRA in response to the erect posture and frusemide, were significantly less in hypertensives compared to controls. When the hypertensives were arbitrarily divided into lower, mid, and upper subgroups according to supine PRA, the renin responsiveness was similar in each subgroup but significantly less in hypertensives compared to controls, subdivided in the same way. This does not support the existence of a separate “low renin” subgroup. The low supine PRA and reduced response to stimulation appears to be a feature of patients with essential hypertension.

Thirty‐nine of these hypertensives entered a double‐blind cross‐over drug trial of oxprenolol, methyldopa and spironolactone. All three drugs were equally effective in lowering the systolic and diastolic blood pressures in all three renin subgroups. Spironolactone caused a greater fall in systolic pressure in the lower renin group than in the other groups. Oxprenolol was the best tolerated drug, with only 5% of patients withdrawing due to side‐effects compared to 13% on spironolactone and 29% on methyldopa.
Transient Global Amnesia–A Review of 213 Cases from the Literature
Authors: Rollinson R. D.
Published: March 2008

Summary: Transient global amnesia–A review of 213 cases from the literature. R D. Rollinson, Aust. N.Z. J. Med., 1978, 8, pp. 547–549.

TGA is a clearly recognisable clinical syndrome with many and varied aetiologies, the most ubiquitous being transient cerebral ischaemia. This entity is probably much more common than the literature suggests, many patients not coming to the attention of a physician due to the transient nature of the isolated memory defect and the risk of recurrence being low. It is of interest that many of the original patients described tended to be the more prominent members of the community, e.g. physicians and relatives of physicians, perhaps suggesting that the occurrence of TGA in such a person is less likely to pass unnoticed. In the differential diagnosis one should include the following: transient cerebral ischaemia, epilepsy, migraine, temporal lobe encephalitis, psychogenic fugues, post‐traumatic, and rarely cerebral neoplasms.
Brain Atrophy and Intellectual Impairment in Heavy Drinkers—A Clinical, Psychometric and Computerized Tomography Study
Authors: Cala L. A. , Jones B. , Mastaglia F. L. , Wiley B.
Published: March 2008

Summary: Brain atrophy and intellectual impairment in heavy drinkers–A clinical, psychometric and computerized tomography study.

The frequency of cerebral and cerebellar atrophy was assessed by computerized tomography (CT) in 26 heavy drinkers. Findings were correlated with clinical deficits, with the results of psychometric testing using the Wechsler Adult Intelligence Scale (WAIS), and with the alcoholic history and nutritional status. Cerebral atrophy was present in 19 cases (73%), 16 of whom also had cerebellar atrophy. There was a good correlation between the degree of cerebral hemisphere atrophy and age and length of drinking history, but a poor correlation between neurological deficits and atrophy. Impairment of visuo‐spatial and visuo‐motor functions with sparing of other non‐dominant hemisphere functions and of verbal skills was the characteristic pattern found with the WAIS in 18 subjects; four showed a more global depression of intellectual function. The degree of cerebral hemisphere atrophy correlated significantly with the impairment of non‐dominant hemisphere functions but not with total IQ.
Compartmental Shift of Potassium—A Result of Sympathomimetic Overdose
Authors: McCleave D. J. , Phillips P. J. , Vedig A. E.
Published: March 2008

Summary: Compartmental shift of potassium—A result of sympathomimetic overdose.

A 17‐year‐old youth was admitted with a serum potassium concentration of 1 ‐8mmol/l after taking an overdose of pseudoephedrine and choline theophyllinate. Apart from tachycardia, tachypnoea and ankle clonus, examination was normal as was the initial electrocardiograph. The hypokalaemia resolved, but there was an overall positive potassium balance of only 13 mmol. This suggests that the sympathomimetics provoked a compartmental shift of potassium perhaps indirectly by inducing hyperg/ycaemia and hyperinsulinaemia, as well as directly. Other factors known to affect body potassium distribution were excluded. The fact that features commonly associated with hypokalaemia could not be demonstrated may be explained by a normal body potassium content.

Severe hypokalaemia caused by a compartmental shift occurs with large doses of sympathomimetics as well as in periodic paralysis.
The Association of Chronic Active Hepatitis with Pyoderma Gangrenosum
Authors: Marshall A. W. , Slonim J. M. , Smallwood R. A. , Fraser K. J.
Published: March 2008

Summary: The association of chronic active hepatitis with pyoderma gangrenosum. A. W. Marshall, J. M. Slonim, R. A. Smallwood and K. J. Fraser, Aust. N.Z. J. Med., 1978, 8, pp. 656–658.

This report deals with a 25‐year‐old man with chronic active hepatitis and cirrhosis who developed the rare complication of pyoderma gangrenosum which improved rapidly following the commencement of prednisolone.
Limitation of Work Performance in Normal Adult Males in the Presence of Beta‐Adrenergic Blockade
Authors: Anderson S. D. , Bye P. T. P. , Perry C. P. , Hamor G. P. , Theobald G. , Nyberg G.
Published: March 2008

Summary: The effect on work performance of a single oral dose of the cardio‐selective beta‐adreno‐receptor blocking agent, metoprolol, was compared with an equipotent dose of the non‐selective agent, propranolol, in the same subjects. A number of biochemical and physiological variables including heart rate, oxygen consumption, ventilation, lactate, free fatty acid and glucose levels were measured.

Following exercise in the presence of both active drugs, subjects complained of excessive leg fatigue. For the group there was a significant reduction in the total work performed and the maximum heart rate achieved on both drugs.

There was a significant correlation between plasma levels of metoprolol, reduction in total work performed and reduction in maximum heart rate. By contrast, after propranolol, there was a wide variation in work performed at a time when the reduction in maximum heart rate was similar for all subjects. This suggests for propranolol that a reduction in heart rate alone is an inappropriate guide to the impairment of work performance.

There was a fall in the circulating level of free fatty acids at the end of exercise in the presence of both drugs and it is possible that this biochemical variable contributed to the decrease in work performance.
A Randomized Study of Factor VIII or Prothrombin Complex Concentrate Infusions in Children with Haemophilia and Antibodies to Factor VIII
Authors: Ekert H. , Price D. A. , Lane J. L. , Dean F. L.
Published: March 2008

Summary: In four children with haemophilia A and antibodies to factor VIII, 18 bleeding episodes were randomized for treatment with factor VIII concentrate (30 units/kg) and 18 for treatment with a prothrombin‐complex concentrate (prothrombinex) given in a dose of 30 units of factor IX/kg. Treatment with prothrombinex was associated with a better clinical response, a significantly greater shortening of the kaolin partial thromboplastin time and significantly lower incidence of post‐infusion increase of levels of factor VIII antibodies. Although treatment with factor VIII concentrate was clinically successful in 15 episodes, treatment failures occurred in three instances leading to parental request for withdrawal from study in two families.
Multiple Myeloma—Prognosis, Treatment and Survival in an Eight Year Study
Authors: Colls B. M. , Darlow B. A.
Published: March 2008

Summary: Data are presented from an unselected group of 76 patients with multiple myeloma, diagnosed over an eight year period in Christ‐church. The median survival time was 31 months from commencement of treatment. The median survival of patients with Bence Jones proteinuria (29 months) was significantly shorter than those without this feature (47 months). Patients with lambda proteinuria had a median survival of 25·5 months and those with kappa proteinuria 32 months, but this difference was not statistically significant.

The correlation of presenting anaemia, azotaemia or hypoalbuminaemia with a bad prognosis was confirmed.

Immunosuppression of nonmyeloma immunoglobulins in patients with IgA or IgG myeloma was associated with a significantly worse median survival.

Chemotherapy was discontinued in 11 patients at a variable period after one year of remission. In six cases the disease did not relapse, but relapse occurred in four cases and in three of these control could not be reasserted. One patient developed acute myeloblastic leukaemia five months after treatment was discontinued.
Exchange of Cadaveric Kidneys for Transplantation in Australia and New Zealand*
Authors: Hardie I. R. , Clunie G. J. A.
Published: March 2008

Summary: In the period from March 1970 to April 1978, 176 kidneys from 137 cadaver donors were exchanged, on the basis of HLA matching, between transplant centres throughout Australia and New Zealand. The kidneys were preserved by simple ice storage or machine perfusion, and transported by air in chipped ice. Total ischaemia times ranged from 3·5 to 28·6 hours and immediate function occurred in 52% of cases. Graft survival was 62% at one year, 51% at three years and 47% at five years, the corresponding patient survival rates being 86%, 74% and 71%. An average of 1·4 antigens mismatched was achieved, and 59% of recipients received kidneys with zero or one antigen mismatched. These kidneys survived better than those with two or more antigens mismatched, the difference being 12% at one year, and rising to more than 20% at five years. The results confirm the practicability and potential value of the Organ Sharing Scheme, and indicate that effective sharing of kidneys on the basis of zero HLA mismatches could substantially improve the current success rate of clinical cadaveric renal transplantation.
High‐dose Methotrexate Therapy—An Area of Uncertainty*
Authors: Paxton J. W.
Published: March 2008

Summary: A brief review of our present knowledge of the pharmacology and the pharmacokinetics of high‐dose methotrexate (MTX) therapy is presented. Although this drug has been in use for 30 years, there are many areas of uncertainty regarding the mode of action of its selective cytotoxicity, the degree of plasma protein binding, the renal toxicity, pharmacokinetics and extent of metabolism after a high dose.

During the last decade, high‐dose methotrexate followed by citrovorum factor (CF) rescue has become a popular mode of cancer treatment, especially for osteogenic sarcoma, even though there is a lack of definitive evidence in man supporting the superiority of the high dose over more conventional doses. The rationale for the administration of these high doses and the necessity of citrovorum factor rescue to prevent toxicity are discussed.

Even with citrovorum factor rescue and the recommended routine hydration and alkalinisation of the patient, a 6% mortality rate is still encountered with this therapy. It is to be hoped that the relative safety of these high‐dose regimens will be increased in the future with the greater availability of a rapid, precise assay for monitoring methotrexate during and after infusion as an indication of impending toxicity and the discovery of more efficient rescue agents (such as thymidine?).

More research is required to determine the optimal methotrexate regimens with regard to the many variables which are associated with this therapy. Bearing in mind the high cost of high‐dose MTX therapy and the increased risk of severe toxicity, further comparative trials against the conventional‐dose regimens are essential to establish whether high‐doses do offer additional clinical advantages.
Alcohol Consumption and Hypertension—The Evidence from Hazardous Drinking and Alcoholic Populations
Authors: Ashley M. J. , Rankin J. G.
Published: March 2008

Summary: To provide an enhanced perspective to observations of an association between moderate alcohol consumption and hypertension, information on the frequency of hypertension in heavy drinking and alcoholic populations was reviewed. Hypertension was found more often in ambulatory heavy drinkers and alcoholics than in more moderate drinkers and abstainers. This hypertensive state appeared to be at least partially reversible upon cessation of drinking. Additional investigation is needed to define the level of consumption associated with an increased risk of hypertension, the dose response pattern, and the determinants of irreversibility. Alcohol‐related hypertension may constitute a risk factor for cardiovascular disease, thus contributing to the excess mortality experienced by heavy drinking populations. In view of the steady increase in per capita alcohol consumption which characterizes many affluent societies further clarification of this relationship is an urgent public health research priority.
Sudden, Unexpected Death and Wernicke's Encephalopathy: A Complication of Prolonged Intravenous Feeding
Authors: Harper C. G.
Published: March 2008

Summary: Sudden, unexpected death and Wernicke's encephalopathy: A complication of prolonged intravenous feeding. C. G. Harper, Aust. N.Z. J. Med., 1980, 10, pp. 230–235.

Wernicke's encephalopathy (WE) is thought to be largely confined to the alcoholic population. However, another “at risk” group of patients has been identified. Three patients maintained on prolonged intravenous feeding died suddenly and unexpectedly from acute WE. Six similar cases from the recent literature are reviewed. Six of these nine cases died as a result of this disease. Neuropathological examinations showed a prominent haemorrhagic component of the acute WE. Six patients did not exhibit any of the classical signs of WE
New Methods to Separate Artifacts from Normal and Defective Breathing Patterns in Different Sleep‐states, if Infants are Monitored at Home
Authors: Jeffery H. , Cunningham R. A. , Cubis A. , Read D. J. C.
Published: March 2008

Abstract: Respiratory and cardiac monitoring was undertaken in the home for seven months in an infant at increased risk for cot‐death (SIDS). The infant was a surviving non‐identical twin of a SIDS sibling.

In hospital, clinical and cardio‐respiratory studies during sleep were normal. Analysis of eleven 24‐hour tape‐recordings showed that many of the alarms at home were the result of technical problems. Suspected apnoeas were identified initially from an oscilloscopic display of the original waveforms and from a compressed‐record and histogram of the computed breath‐to‐breath intervals. Expanded pen‐recordings confirmed some, but not all, of these suspected apnoeas (> 15s). The results indicate (i) the importance of verifying apnoeic episodes; (ii) the value of 24‐h compressed recordings for identifying and timing the sleep cycles and their possible relationships to breathing defects; (iii) the need for improved instrumentation; (iv) the dangers of evaluating clinical prognosis or research from parental diaries
THE ROLE OF HEPATITIS B VIRUS IN THE ETIOLOGY OF HEPATOCELLULAR CARCINOMA IN AUSTRALIA
Authors: DALGLEISH A. G. , WOODS R. L. , LEVI J. A. , RAGHAVAN D. , McCAUGHAN G. W. , TATTERSALL M. H. N.
Published: March 2008

:Fifty‐three patients with Hepatocellular Carcinoma (HCC) from three Sydney teaching hospitals were examined for possible evidence of Hepatitis B virus (HBV) infection. Hepatitis Surface Antigen (HBsAg) was positive in 38% of those in whom it was sought, a higher incidence than previously reported in an Australian series. A further 13 patients had antibody to Hepatitis B core (Anti‐HBC), but negative HBsAg, confirming past exposure to HBV. Where serum was available evidence of HBV infection was obtained in 62% of patients. It is argued that the incidence of HBV infection may be shown to be higher still with the advent of new technology as applied to HBV assays and tissue stains. The need to be aware of the growing evidence of a strong association between Hepatitis B virus and the development of HCC is stressed and the clinical implications are discussed. (Aust NZ J Med 1983; 13: 605–607.)
COLLAGENOUS COLITIS: A RECENTLY RECOGNISED REVERSIBLE CLINICOPATHOLOGICAL ENTITY
Authors: EAVES E. R. , WALLIS P. L. , McINTYRE R. L. E. , KORMAN M. G.
Published: March 2008

:A case of collagenous colitis is reported in an 86 year old man who presented with watery diarrhea. This case differs from previous reports in that five of the six reported cases involved women, mostly in their mid‐forties, and that previously the collagenous band has been demonstrated in the mucosa of the left side of the colon only. This case is the first report to demonstrate the collagenous band in the right side of the colon as well as the left, and is the thickest band reported to date. In keeping with the two reported cases with follow‐up, the subepithelial collagenous band was shown to have disappeared three months after the initial biopsy with a corresponding clinical improvement after symptomatic treatment only. The diagnosis needs to be considered in all patients presenting with watery diarrhea, and can only be confirmed after rectal or colonic biopsy. (Aust NZ J Med 1983; 13: 630–632.)
SODIUM CROMOGLYCATE AS A PRESSURISED AEROSOL (VICROM) IN EXERCISE‐INDUCED ASTHMA
Authors: SCHOEFFEL R. E. , ANDERSON S. D. , LINDSAY D. A.
Published: March 2008

Abstract: We investigated the effect of sodium cromoglycate (SCG), delivered as a pressurised aerosol, in a dose of 2 or 4 mg in 15 patients known to have exercise‐induced asthma (EIA).

All patients had a fall in peak expiratory flow rate (PEFR) greater than 20% of the pre‐exercise level following placebo (Range 21.1 to 74.7%). When an identical exercise test was performed after 2 mg of SCG aerosol, nine of the 15 patients had falls in PEFR less than 50% of the value observed on placebo. Of the remaining six patients, four had greater than 50% protection afforded by 4 mg of SCG. Of the 15 patients, 12 had falls in PEFR less than 11% after either 2 or 4 mg of SCG aerosol.

The dose of aerosol SCG required to inhibit EIA is only 10 to 20% of that delivered by conventional spinhaler. The apparent superiority of the pressurised aerosol may be due to its site of deposition in the airways.
ABSENCE STATUS: A REPORT OF TWO CASES
Authors: YEO P. T. , WODAK J. , ROE C. J. , GILLIGAN B. S.
Published: March 2008

Two known epileptics presented with abnormal behaviour. One was inattentive, aggressive and ataxic. The other carried out quite complex, though purposeless activity. EEG's revealed that the patients' behavioural abnormalities were due to uncontrolled seizures. Absence Status is an uncommon condition and its various manifestations can lead to delays in its recognition and treatment. It should be considered as a possible diagnosis in any patient who presents with recurring episodes of confusion.
TRENDS IN CIGARETTE CONSUMPTION IN AUSTRALIA
Authors: WOODWARD S. D.
Published: March 2008

Historical trends are presented showing an increase in total cigarette consumption but a fall in the number of adult male smokers. The prevalence of smoking among children appears to have increased. The role of tobacco advertising and reduced cigarette prices are discussed. The need to prevent children from taking up smoking is emphasised, and recent data show that the earlier a child begins to smoke, the higher will be the subsequent daily cigarette consumption.
ASSESSMENT OF THE IMPACT OF CORONARY ARTERY SURGERY ON MORTALITY AFTER RECOVERY FROM MYOCARDIAL INFARCTION
Authors: THOMPSON P. L. , VANDONGEN Y. K. , ECCLES J. L. , KLERK N. H. DE
Published: March 2008

Death rates over a nine year period were studied in 1,232 survivors of myocardial infarction. From 1973 to 1981, the 29 to 365 day case fatality rate in 28 day survivors dropped from 13.3% to 3.2%. This down‐trend in case fatality was highly significant, averaging 14.3% in each year. After adjustment for changes in age and severity of infarction, using a prognostic score derived from the Perth Coronary Register (the PCR score), the estimated decline was still 12.2% in each year. During the nine years, the rate of coronary surgery in the post‐infarction year rose from 1.5% to 12.0%. Overall, the surgically treated cases had a lower case fatality rate (1.6%) than the medically treated cases (7.7%). However, the surgical cases had a better prognosis at the time of infarction than the medical cases. When the severity of infarction (PCR score) and year of admission were considered, coronary surgery in the post‐infarction year had no independent effect on outcome.
COMPARISON OF DELAYED TYPE HYPERSENSITIVITY AND T SUBSETS IN RANDOM AND HOMOSEXUAL POPULATIONS IN WESTERN AUSTRALIA
Authors: GRIMSLEY G. , LATTIMORE M. , DAWKINS R. L.
Published: March 2008

Random and homosexual populations were tested for delayed type hypersensitivity (DTH) (Multitest) reactivity and T cell subsets. In the random population DTH reactivity was stronger in males irrespective of age. Reactivity in the homosexuals was generally even stronger especially with respect to tuberculin. As a group, male homosexuals had low OKT 4/8 ratios when compared with sex and age matched controls. Analysis of DTH and T cell subset results in the random group showed an association between anergy and low OKT 4/8 ratios. It is concluded that homosexuals demonstrate some alteration of cell mediated immunity and therefore may be at risk of various infections.
LIDOCAINE AND THE REDUCTION OF POST‐VENOGRAPHIC PAIN
Authors: OCKELFORD P. A. , POWERS P. J. , HULL R. D. , McLAUGHLIN D. , STRASBERG Z. , GENT M. , HIRSH J.
Published: March 2008

Venography remains the standard method for the diagnosis of deep venous thrombosis but it is invasive and frequently causes discomfort. A randomised double‐blind study was performed to determine the efficacy of lidocaine in reducing pain and discomfort associated with venography. Sixty patients undergoing ascending venography received 40 mg of lidocaine (2 ml of 2% lidocaine mixed with 50 ml of contrast medium) in one leg and saline in the other. Assessment of pain was by a standard questionnaire administered by an investigator unaware of the sequence of administration of lidocaine or saline placebo. Twenty‐four patients reported no difference in pain or discomfort between the two limbs. Of the 36 patients experiencing an overall difference in pain between the two legs, 12 reported more pain in the leg receiving lidocaine and 24 reported more pain in the leg receiving saline (p = 0.023). There were no significant side effects attributable to lidocaine. These results indicate that lidocaine is beneficial in reducing pain and discomfort associated with venography.
ASBESTOSIS AND CRYPTOGENIC FIBROSING ALVEOLITIS: A RADIOLOGICAL AND FUNCTIONAL COMPARISON
Authors: COOKSON W. O. C. M. , MUSK A. W. , GLANCY J. J.
Published: March 2008

This study compares the relationship between lung function and radiological abnormality in 46 subjects with asbestosis and 38 subjects with cryptogenic fibrosing alveolitis. Radiographs were graded separately by two observers according to the 1980 International Labour Organisation criteria for classification of the pneumoconioses. The correlation between the transfer factor of the lungs and the radiographic profusion of small parenchymal opacities was found to be greater in subjects with asbestosis than in subjects with cryptogenic fibrosing alveolitis. At any level of radiological profusion transfer factor was higher in cases with asbestosis than in cases with fibrosing alveolitis. As pleural thickening is seen commonly in asbestosis and may influence lung volumes and the ratio of transfer factor to effective alveolar volume, the results of these measurements were compared only in the cases showing absent or minimal pleural thickening. Both of these variables were higher in the subjects with asbestosis. The results indicate that despite pathological, functional and radiographic similarities, lung function for a given degree of radiographic parenchymal abnormality is better in subjects with asbestosis than in subjects with cryptogenic fibrosing alveolitis, and that changes in the plain chest x‐ray appearances in asbestosis correlate more closely with the results of lung function tests.
SHEATH IMPACTION AS A CAUSE OF DEFECTIVE INTRA‐AORTIC BALLOON PUMP ACTION IN MAN
Authors: O'ROURKE M. F. , JOHNSTON R. , KEOGH A.
Published: March 2008

Abstract: :Intra‐aortic balloon counterpulsation became ineffective in a 63 inch (160 cm) 14 year old girl while console operation proceeded almost normally. The problem was simulated in a hydraulic model of the aorta and could be reproduced when the proximal end of the balloon engaged in the introducing sheath. Measurements of the balloon catheter and sheath against the patient indicated that such engagement had occurred during counterpulsation. The* findings provide an explanation for apparent catheter ‘kinkage’ in other patients where there was difficulty running the Kontron console in automatic mode. Problems are preventable by total or partial withdrawal of the inserting sheath.
RIGHT VENTRICULAR INFARCTION, BRADYARRHYTHMIAS, AND CARDIOGENIC SHOCK: IMPORTANCE OF ATRIAL OR ATRIOVENTRICULAR SEQUENTIAL PACING
Authors: ABRAHAM K. A. , BROWN M. A. , NORRIS R. M.
Published: March 2008

Abstract: :We report two patients with inferior myocardial infarction, complicated by bradyarrhythmia, hypotension, and clinical evidence of right ventricular infarction. Conventional therapy of volume expansion and inotropic support was insufficient to maintain an adequate blood pressure. Sequential atrioventricular (AV) pacing for AV block (Case 1) or atrial pacing for junctional bradycardia (Case 2) resulted in immediate and sustained improvement in blood pressure and clinical indices of perfusion. We recommend consideration of these pacing modes in patients with inferior infarction with evidence of right ventricular infarction, bradyarrhythmia, and cardiogenic shock. The likely mechanism of improvement is by restoration of atrial transport with consequent improvement in ventricular function.
THE EFFECT OF CIGARETTE SMOKING ON GASTRIC ACID SECRETION AND GASTRIC MUCOSAL BLOOD FLOW IN MAN
Authors: FLETCHER D. R. , SHULKES A. , HARDY K. J.
Published: March 2008

Abstract: Smoking leads to a higher incidence of peptic ulcer and delays healing of those ulcers. Possible mechanisms include increased gastric acid secretion, reduced gastric mucosal blood flow, and reduced duodenal bicarbonate production. In six subjects we determined the effect of one hour of cigarette smoking on gastric mucosal blood flow (14C–aminopyrine clearance), acid secretion (triple lumen perfused oro–gastric tube), and plasma levels of gastrin and pancreatic polypeptide. Smoking reduced acid secretion from a median of 433 (range 160–707) μmol/min to 166 (47–340) μmol/min (p < 0.05) and blood flow from 66 (40–70) ml/min to 36 (22–58) ml/min (p<0.05). There was no change in plasma gastrin and the small rise in pancreatic polypeptide would be insufficient to affect duodenal bicarbonate production.

We conclude that cigarette smoking decreased gastric acid secretion and gastric mucosal blood flow. The increased incidence of gastric ulcers seen in smokers may be related to this reduction in gastric mucosal blood flow.
CARDIAC TAMPONADE FOLLOWING INFARCTION: MANAGEMENT WITH PERICARDIOCENTESIS AND SURGERY
Authors: LIMAYE S. B. , STUBBERFIELD J.
Published: March 2008

Abstract: Four patients with cardiac tamponade following myocardial infarction are presented. Diagnostic clinical features and the role of echocardiography are discussed. Pericardiocentesis resulted in rapid improvement in clinical state but frequently tamponade recurred. Surgery was undertaken in three patients and two have survived long term.

If promptly recognised, tamponade following myocardial infarction may be treated.
THE EFFECT OF INSPIRATORY RESISTIVE TRAINING ON EXERCISE CAPACITY IN OPTIMALLY TREATED PATIENTS WITH SEVERE CHRONIC AIRFLOW LIMITATION
Authors: McKEON J. L. , TURNER J. , KELLY C. , DENT A. , ZIMMERMAN P. V.
Published: March 2008

Abstract This study was designed to determine whether inspiratory resistive training could improve the exercise performance of patients with severe chronic airflow limitation who had already received optimum conventional therapy with bronchodilators and physiotherapy. Eighteen patients were studied. Ten patients were trained with an inspiratory resistance device for six weeks and eight patients used a placebo device. Psychological factors, likely to influence exercise capacity, were taken into account. Although there was no significant increase in maximum inspiratory pressure in the ten trained subjects, inspiratory muscle endurance was improved. Exercise performance, as assessed by progressive cycle exercise, stair climbing, 12 minute walking distance and treadmill walking did not change significantly in either group.

It was concluded that inspiratory muscle training, using a currently available technique, produced no additional improvement in exercise capacity beyond that achieved by conventional bronchodilator and rehabilitation therapy. (Aust NZ J Med 1986; 16: 648–652.)
A POSSIBLE RELATIONSHIP BETWEEN MIGRAINE AND CORONARY ARTERY SPASM
Authors: WAYNE V. S.
Published: March 2008

Abstract Five patients, all women in their 50s and all with a documented history of migraine headaches, had ischemic chest pains investigated. Four patients had angina primarily occurring at rest, with documented ischemic electrocardiographic changes during pain in all five. Three subjects sustained myocardial infarction, one shortly after taking ergotamine tartrate for an acute attack of migraine. Subsequent coronary angiography in all five subjects revealed no evidence of atherosclerotic coronary artery disease, suggestive of spasm as the cause of ischemia.

In subjects with known migraine, the occurrence of chest pain may represent coronary artery spasm, and should be investigated with concurrent electrocardiographs, as these two clinical entities may be related as part of a generalised vasospastic disorder. The use of ergot preparations should be contraindicated in such patients, as exacerbation of chest pain and frank myocardial infarction may result. These chest pains responded favourably to calcium channel blockers. (Aust NZ J Med 1986; 16: 708–710.)
CHRONIC LEAD NEPHROPATHY IN QUEENSLAND: ALTERNATIVE METHODS OF DIAGNOSIS
Authors: CRASWELL P. W. , PRICE J. , BOYLE P. D. , HEAZLEWOOD V. J. , BADDELEY H. , LLOYD H. M. , THOMAS B. J. , THOMAS B. W. , WILLIAMS G. M.
Published: March 2008

Abstract Indices of past lead absorption were measured and compared in patients with chronic renal failure from many causes, including some with chronic lead nephropathy. X‐ray fluorescence (XRF) yielded finger bone lead concentrations by a new in vivo method. These correlated significantly with excess urinary lead following calcium di‐sodium EDTA (ethylenediamine tetra‐acetate) and erythrocyte lead concentration.

Discriminant function analysis demonstrated that the patients in the study could be separated into two groups without any reference to the EDTA lead excretion test using the following variables, all of which contributed significantly to the discrimination. In order of importance, these were: a childhood history of acute lead poisoning, a history of gout, a family history of gout and detectable XRF finger bone lead.

Although the XRF finger bone lead measurement is convenient and non‐invasive, its lack of sensitivity (48%) limits its usefulness as a screening test for chronic lead nephropathy.
SUDDEN DEATH DUE TO PAINLESS SPASM IN NEAR NORMAL CORONARY ARTERIES
Authors: CROZIER I. , STEWART D. , IKRAM H.
Published: March 2008

Abstract Two cases of resuscitated sudden cardiac death are described; one was due to ventricular fibrillation and the other to ventricular asystole. In both cases the underlying etiology was painless coronary spasm and no fixed coronary disease.
EVALUATION OF THERAPEUTIC DECISIONS IN PATIENTS WITH SUSPECTED PULMONARY EMBOLISM AND A LOW PROBABILITY LUNG SCAN: APPLICATION OF BAYES' THEOREM
Authors: OCKELFORD P. A. , RUTLAND M.
Published: March 2008

Abstract Three hundred and one consecutive lung scans were reviewed to determine the frequency of the different ventilation perfusion scan patterns and their use in the management of suspected pulmonary embolism. Based on the original report, an accurate diagnosis was possible in 99 patients (33%). Within this group pulmonary embolism was excluded by a normal lung scan in 35 (12%), and confirmed in 64 (21%) patients having a high probability pattern. There were 194 (64%) patients with a low probability scan, but in only 24 of these (12%) was venous thromboembolism objectively confirmed or excluded by additional investigations. Although the low probability scan is non‐specific, the scan result was used as the sole objective test to determine therapy in 170 patients (56%). The clinical decision was to withhold anticoagulants in 143 patients and to treat 27 patients. Probability estimates using Bayes' Theorem have been applied to evaluate these management decisions.
CRYSTAL SHEDDING IN SEPTIC ARTHRITIS: CASE REPORTS AND IN VIVO EVIDENCE IN AN ANIMAL MODEL
Authors: GORDON T. P. , REID C. , ROZENBILDS M. A. M. , AHERN M.
Published: March 2008

Abstract Two cases of coexisting septic and crystalline joint disease are reported. In one patient polyarticular septic artaritis occurred simultaneously with gout and pseudogout. In a second patient septic arthritis preceded the appearance of calcium pyrophosphate dihydrate (CPPD) crystals in the joint fluid, supporting an earlier postulate that lysosomal enzymes released during sepsis lead to shedding of crystals from cartilage and synovium into the joint space. This sequence was demonstrated in a rat air pouch model of synovium, in which CPPD crystals embedded in facsimile synovial tissue were released after injection of pyogenic bacteria. Coexisting septic arthritis should always be considered when crystals are identified in inflamed joints, particularly in elderly patients with concurrent infections.
BOOK REVIEW
Authors: Mahar L. J.
Published: March 2008

CURRENT THERAPY IN CARDIOVASCULAR DISEASE 1984–1985. By Nicholas J. Fortuin
IMMUNOLOGICAL RECONSTITUTION IN A PATIENT WITH SEVERE COMBINED IMMUNE DEFICIENCY USING NON‐SIBLING BONE MARROW DEPLETED OF T CELLS WITH HuLy‐m1
Authors: ROBERTON D. M. , GEORGIOU G. M. , TIEDEMANN K. , HOSKING C. S. , FERRANTE A. , TOOGOOD I. , McKENZlE I. F. C.
Published: March 2008

Abstract An infant with severe immune deficiency received bone marrow from an HLA‐A, ‐B, ‐DR matched, mixed leucocyte reaction non‐reactive first cousin. The donor marrow was fractionated on a discontinuous Percoll gradient and before infusion was treated with the anti‐human T lymphocyte antibody, HuLy‐m1, and rabbit serum as a source of complement. Methotrexate was given during the following two weeks. A rise in the peripheral blood lymphocyte count, indicating engraftment, occurred six weeks after transplantation. There was no clinical evidence of graft versus host disease (GVHD). Engraftment has been sustained for one year and the patient is in normal health and has normal in vitro immunological function. In vitro treatment of human marrow with HuL‐m1 allows stable engraftment and may be useful in attempting to diminish or prevent GVHD.
APLASTIC ANEMIA: ANALYSIS OF TWO METHODS OF TREATMENT
Authors: Dodds A. J. , Atkinson K. , Biggs J. C. , Concannon A. J. , Gillett A. , Penny R. , Raphael H.
Published: March 2008

Between 1981 and 1985, 27 patients with aplastic anemia have been treated by immunosuppression with antilymphocyte globulin and prednisolone or allogeneic bone marrow transplantation. Fifteen have undergone bone marrow transplantation and have an actuarial survival at 54 months of 65%± 12% (95% confidence limits). There have been four deaths from graft rejection, septicemia (two), and graft‐versus‐host disease. Twelve have received antilymphocyte globulin and have an actuarial survival at 56 months of 67%± 21 %. Five of these now have a normal blood count and two have had good partial responses and are self supporting. Of the five non‐responders, three survived, two with persistent aplasia and one after allogeneic bone marrow transplantation. Two are dead, one of hemorrhage and one after mismatched bone marrow transplantation. In this study antilymphocyte globulin produced survival equivalent to bone marrow transplantation although only 58% of patients had a response to the antilymphocyte globulin. The advantages and disadvantages of these two methods of treatment are discussed. (Aust NZ J Med 1986; 16: 470–474.)
CEREBRAL ANEURYSMS AND THE ←MISSED→ HEMORRHAGE
Authors: Dorsch N. W. C.
Published: March 2008

Eleven patients are described in whom a warning subarachnoid hemorrhage, preceding severe or fatal rupture of an intracranial aneurysm, was misdiagnosed; a 12th had a successful outcome from surgery after a single hemorrhage. Erroneous labels included meningitis, migraine, hysteria, tension, and head and neck injury. The vital importance of diagnosing an aneurysm before a major rupture occurs is emphasised. Apart from the ‘warning leak’, other signs may be due to the location or expansion of an aneurysm, which should alert doctors to the diagnosis. (Aust NZ J Med 1986; 16: 486–490.)
HYPOTHALAMIC/PITUITARY SARCOIDOSIS
Authors: SCOTT I. A. , STOCKS A. E. , SAINES N.
Published: March 2008

Abstract A patient is described with combined pulmonary and central nervous system sarcoidosis, including hypothalamic/pituitary involvement. Formal pituitary challenge testing was performed before steroid treatment and again eight months later. Diabetes insipidus, hyperprolactinemia, and anterior pituitary hormone deficiencies were demonstrated and did not improve significantly in response to steroids. Hypothalamic/pituitary involvement is a rare complication of sarcoidosis, the incidence of which may be under‐reported.
THE DEVELOPMENT OF CUSHING'S SYNDROME FROM A PREVIOUSLY SILENT PITUITARY TUMOUR
Authors: COOPER M. E. , MURRAY R. M. L. , KALNINS R. , WOODWARD J. , JERUMS G.
Published: March 2008

Abstract A 60 year old woman originally presented with headache. Investigations revealed a pituitary tumour and endocrine investigations at that time showed normal plasma Cortisol levels. Seven years after removal of this tumour, the patient developed the clinical and biochemical features of Cushing's disease. Immunoperoxidase staining of the original tumour was positive for adrenocor‐ticotrophic hormone. This report suggests that immunocytochemistry may have an important role in the routine evaluation of pituitary tumours.
REFRACTORY ASCITES PRECIPITATED BY OBSTRUCTIVE UROPATHY
Authors: WOOD L. J. , DUDLEY F. J.
Published: March 2008

Abstract A case is presented where a patient's cirrhotic ascites was refractory to conventional treatment and where the usual factors which precipitate refractory ascites were excluded. We believe that this patient's apparently refractory ascites was precipitated by an obstructive uropathy, as evidenced by dramatic diuresis, natriuresis, and return to diuretic sensitivity following relief of the obstruction.
SERUM FRUCTOSAMINE AS A SCREENING METHOD FOR DIABETES MELLITUS IN PATIENTS WITH SUSPECTED ACUTE MYOCARDIAL INFARCTION
Authors: KYLE C. , BAKER J. , METCALF P. , JOHNSON R. , NORRIS R.
Published: March 2008

Abstract It is important to identify diabetic patients in a coronary care population because they have a higher risk of suffering congestive heart failure, dysrhythmias and death following myocardial infarction. In order to determine the most efficient screening method for diabetes, we compared fructosamine and glucose measurements on admission blood specimens from 256 consecutive patients. Of 15 (5.9%) known diabetic patients, 12 had glucose results >7.8 mmol/l and nine had fructosamine levels >2.87 mmol/l. However, elevated glucose results were also found in a high proportion (49.2%) of patients with no previous history of diabetes. We performed glucose tolerance tests in 107 patients after discharge to determine the frequency of false‐positive observations. Fructosamine yielded five (4.6%) false‐positive results, whereas plasma glucose yielded 47 (43.9%) false‐positive observations. We conclude that serum fructosamine provides a more specific screening method for diabetes in this population because the results are unaffected by stress hyperglycemia. (Aust NZ J Med 1987; 17: 467–471.)