bluuebunny/crossref_metadata_2025 huggingface dataset:
Coronary artery disease in Asians
Authors: Rajadurai J. , Arokiasamy J. , Pasamanickam K. , Shatar A. , Lin O. Mei
Published: March 2008

From available studies, there appears to be a racial preponderance of coronary artery disease (CAD) among Indians when compared to other ethnic groups. We found that this racial difference exists even in a young Asian population with premature atherosclerosis. In this small series, these racial differences could not be explained by the commonly known risk factors for coronary artery disease – smoking, hypertension, diabetes and hypercholesterolaemia, findings similar to those found in older patients elsewhere. Only fasting triglyceride levels were significantly higher among young Indians compared to non Indians (p <0.02) although the importance of this finding as a risk factor for CAD remains controversial. The majority of these young patients were treated medically and their one year survival was good.
A mucosal barrier of gastric surfactant identified in the human stomach
Authors: Hills B. A.
Published: March 2008

Using a special furation procedure avoiding glutaraldehyde, an oligolamellar lining has been demonstrated by electronmicroscopy on the luminal surface of the human stomach and, with more lamellations, on the epithelial surfaces of oxyntic ducts and parietal cells.

These results indicate that, in the human stomach, there is indeed a gastric mucosal barrier consisting of a multi‐laminated structure of surface‐active phospholipid (SAPL). This gastric surfactant is probably produced in parietal cells and surface mucus cells in which lamellar bodies and some prominent multi‐focal lamellated agglomerates of SAPL were prevalent. These findings of a gastric mucosal barrier similar in structure and function to a very thin polyethylene liner are compatible with previous information about the hydrophobicity of the gastric mucosa, the clinical correlation of hydrophobicity with peptic ulceration and the action of barrier breakers (including Helicobacterpylorr). It is speculated that the administration of exogenous gastric surfactant in various forms may be effective for inexpensive long‐term maintenance of the ulcer patient treated acutely by more conventional means.
Biological markers of alcoholism
Authors: Whelan GREG
Published: March 2008

The roles of two categories of biological markers — those relating to alcohol consumption and those relating to the risk of developing alcohol related problems ‐ are reviewed. Platelet Mono‐amino oxidase levels are low in individuals with a strong inheritance of their drinking problem (Cloninger Type II alcoholics).

Elevated gamma‐glutamyl transpeptidase (GGT) levels identify regular heavy drinkers with a sensitivity between 40–60%. Mean corpuscular volume (MCV) has a high specificity (95%) and is useful in detecting regular heavy drinkers in the ambulatory care population if other causes of an elevated MCV can be included.

Currently there are no laboratory tests with adequate sensitivity to be used as screening tests for alcoholism. (Aust NZ J Med 1992; 22: 209–213.)
The role of dipyridamole in addition to low dose aspirin in the prevention of occlusion of coronary artery bypass grafts
Authors: Agnew T. M. , Brandt P. W. T. , French J. K. , Kerr A. R. , Neutze J. M. , Webber B. J. , Whitlock R. M. L. , Rutherford J. D.
Published: March 2008

One hundred and one subjects were randomised to receive either aspirin 100 mg or aspirin 100 mg + dipyridamole 300 mg daily before undergoing coronary bypass surgery. The drugs were commenced at least 36 hours before operation and patients were followed for one year. There were three perioperative deaths and 37 withdrawals, of which 14 were drug related (aspirin four, aspirin + dipyridamole ten). Cineangiocardiograms at nine weeks and one year showed vein graft patency rates of 93% and 87% for subjects treated with aspirin alone; and 90% and 89% in those who received aspirin + dipyridamole. During the follow‐up period 14% of 232 coronary lesions in the aspirin treated group advanced by more than two grades compared with 15% of 315 lesions in the aspirin + dipyridamole group.

The study did not establish superiority of one regimen over another in terms of graft patency or progress of lesions in native vessels. However, low dose aspirin was better tolerated than combination therapy. (Aust NZ J Med 1992; 22: 665ndash;670.)
Medical care and case fatality from myocardial infarction and coronary death in Newcastle and Perth
Authors: Dobson A. J. , Jamrozik K. D. , Hobbs M. , Heller R. F. , Steele P. L. , Parsons R. , Thompson P.
Published: March 2008

Coronary mortality rates are significantly higher in Newcastle than Perth. In this paper we examine the extent to which this might be due to differences in medical treatment and case fatality.

Population‐based disease registers were used to identify all cases of non‐fatal definite myocardial infarction (MI) and coronary death in people aged 25–64 years in the study populations between July 1988 and June 1990.

Case fatality (at 28 days from onset of symptoms) was not significantly different between the centres. Thrombolytic therapy was used for one third of all hospitalised events in both centres. Other drugs of proven benefit were, however, used more often in Perth than in Newcastle. For example, during hospitalisation 74% of patients in Perth received β‐blockers compared with 41% in Newcastle (difference=33%, 95% confidence interval (CI): 28%, 37%) and 85% of patients in Perth compared with 72% in Newcastle received aspirin (difference313%, 95% CI: 9%, 17%). Median lengths of stay in a coronary care unit (CCU) and total hospital stay were one day shorter in Perth.

As case fatality was similar, the differences in mortality rates can be attributed mainly to differences in attack rates. Greater use of cardio‐active drugs in Perth apparently did not result in improved short‐term outcome although potential long‐term benefits cannot be judged yet. (Aust NZ J Med 1993; 23: 12–18.)
Sheehan's syndrome: clinical profile, pituitary hormone responses and computed sellar tomography
Authors: Dash R. J. , Gupta V. , Suri S.
Published: March 2008

Twenty patients with the typical clinical presentation of Sheehan's syndrome were studied. All had a severe degree of hypopituitarism. The circulating mean basal levels of thyroid hormones, Cortisol and prolactin were significantly lower (p< 0.05 to <0.02) compared to those in 50 age matched controls. The provoked pituitary responses to combined pituitary stimulation in 13 patients were markedly lower (p <0.02 to <0.001) than those in ten age matched control subjects. Sellar computed tomography revealed an empty sella in all the patients; partial in five and complete in the remaining. A secondary empty sella is considered a characteristic finding in the classical form of Sheehan's syndrome. (Aust NZ J Med 1993; 23: 26–31.)
Cost effectiveness of radiofrequency catheter ablation in the treatment of symptomatic supraventricular tachyarrhythmias
Authors: Kertes P. J. , Kalman J. M. , Tonkin A. M.
Published: March 2008

Abstract Background: The recent advent of radiofrequency (RF) catheter ablation as a curative therapy for supraventricular tachyarrhythmias has challenged the role of long term drug treatment, which is essentially a palliative therapy. To date, however, no data have been published on the cost‐effectiveness of RF ablation as compared with drug treatment in the Australian setting.

Aims: The study aimed to compare actual and projected costs of these two treatment options in a consecutive group of patients having RF ablation as treatment for symptomatic tachyarrhythmias.

Methods: The cost effectiveness of RF catheter ablation was assessed in 26 patients having RF ablation, using a hypothetical model of continued drug therapy in the same group of patients. A ‘cost saving’ criterion was used for cost effectiveness. Actual costs for the RF ablation and for continued drag therapy were based on data from medical records and from the answers to a detailed patient questionnaire. Analysis included costs of prior diagnostic electrophysiology (EP) study (17/26 patients), general anaesthesia (GA: 20/26 patients), post‐ablation echocardiography (10/26 patients), and late follow‐up EP study (7/26 patients). The in‐hospital stay for the RF ablation was two days in all cases, and no patient required implantation of a permanent pacemaker. The RF ablation procedure was successful in 23/26 patients (88.5%) with late recurrence of tachycardia in one patient. After a median follow‐up of nine months, 22/26 patients no longer require antiarrhythmic drug therapy.

Results: The mean per patient cost of RF ablation was $4067 in the study group. This reduces to $2546 if prior EP study and GA are excluded. The mean per patient cost of continued medical therapy was $700 per year. Extrapolating over 20 years and allowing for an annual 5% inflation factor, RF ablation becomes cost saving in 5.5 years (3.8 years if prior EP and GA are excluded). Over 20 years, continued drag therapy would be four to five times more expensive than RF ablation in the patient study group. We consider RF ablation to be a cost‐effective alternative to long term drug therapy in patients with supraventricular tachyarrhythmias.
Radiofrequency catheter ablation for paroxysmal supraventricular tachycardia: a report of 135 procedures
Authors: Sathe S. , Vohra J. , Chan W. , Wong J. , Gerloff J , Riters A. , Hall R. , Hunt D.
Published: March 2008

Background:
Paroxysmal Supraventricular Tachycardia (PSVT) is a common condition which until recently has been treated with anti‐arrhythmic drugs or surgery. Radiofrequency (RF) catheter ablation is a new mode of treatment which provides a cure of this condition. Aims:To present our early experience of RF catheter ablation for PSVT.

Methods:
One hundred and thirty‐five procedures were performed in 117 patients. The diagnostic study and therapeutic catheter ablation were performed as a combined electrophysiological procedure in 74 patients (63%). In 58 patients (50%), PSVT was due to Atrio‐ventricular junctional (nodal) re‐entrant tachycardia (AVJRT). Twenty‐five of the 58 patients underwent a fast pathway ablation while 33 had ablation of their slow pathway. The mean number of radio‐frequency pulses delivered was ten for a mean duration of 25 seconds.

Radiofrequency ablation of accessory pathways was attempted in 58 patients; pathways were left‐sided in 29 patients, postero‐septal in 21, midseptal in five, Mahaim connection in two, antero‐septal in one and right free wall in one patient. One patient with incessant automatic atrial tachycardia also underwent a successful RF ablation.

Results:
Using RF ablation cure of PSVT was achieved in 90% of patients. Cure of AVJRT was achieved in 95% (55/58) of patients using either fast or slow pathway ablation. Only one patient required permanent pacemaker implantation for Mobitz type I AV block following fast pathway ablation. The overall success rate for ablation of accessory pathways was 85%. There is an operator learning curve for this procedure suggested by the fact that the success rate for accessory pathway ablation at first attempt was 63% in the first 29 patients and 93% in the remaining 29. There was no significant morbidity or mortality during or after the procedure. In a mean follow‐up of nine months in the patients with successful ablation only two patients with AVJRT had a recurrence of documented PSVT. Both these patients had successful repeat RF ablation. Catheter ablation using radiofrequency energy is an effective and safe therapeutic option for patients with symptomatic PSVT. (Aust NZ J Med 1993; 23: 317–324.)
Lipid, lipoprotein and apolipoprotein distributions in an elderly New Zealand population
Authors: Lintott C. J. , Sainsbury R. , Hanger H. C. , Frampton C. , Scott R. S.
Published: March 2008

:The aim of this study was to determine the lipid, lipoprotein and apolipoprotein distribution in an ambulant elderly New Zealand population, and to consider the association between these and other variables (including body mass index, diabetes mellitus, and smoking history) with the prevalence of manifest macrovascular disease in a cross‐section analysis.

The population sample was randomly selected from the age/sex register of a large urban medical centre in Christchurch, New Zealand. A total of 369 subjects (participation rate 69%) aged 65 years and older were screened for manifest macrovascular disease, diabetes mellitus, smoking status, height and body weight. Levels of plasma total cholesterol, triglycerides, HDL cholesterol, apolipoproteins AI and B, glucose, glycated haemoglobin and fibrinogen were measured. Three way analysis of variance (ANOVA) was used to compare continuous variables across age/sex/macrovascular disease groups.

Females had significantly higher levels of total and HDL cholesterol, apolipoproteins AI and B than males. Body mass index showed a significant decrease with increasing age.

Macrovascular disease was manifest in 24% of males, and in 26% of females. No direct correlation was seen between any of the measured continuous variables and the presence of macrovascular disease, except for fibrinogen (P<0.05). No significant association was seen between macrovascular disease and smoking status, nor with a diagnosis of diabetes. In females, the frequency of macrovascular disease was significantly higher amongst those with low (<1.00 mmol/L) levels of HDL. (Aust NZ J Med 1993; 23: 162–167.)
Changing results of HLA‐identical sibling bone marrow transplantation in patients with haematological malignancy during the period 1981–1990
Authors: Atkinson K. , Marshall G. , Biggs J. C. , Wilson F. , Concannon A. J. , Young S. , Dodds A. J. , Ashby M. , Milliken S. , Morgan G. , Downs K. , Harkness J.
Published: March 2008

:During the years 1981‐90 inclusive 227 patients with haematological malignancy received an HLA‐identical sibling first transplant at St Vincent's Hospital, Sydney. Recipients with acute leukaemia in first remission or chronic myeloid leukaemia in first chronic phase were analysed as good risk, and those beyond these stages, as poor risk patients. Good risk patients transplanted in the years 1986‐90 (n= 52) showed improved actuarial survival (74%) compared to those (n= 58) transplanted during 1981‐85 (37%, p= 0.01). There was a suggestion that leukaemia‐free survival was also improved in those transplanted during the later time period (62% versus 36%, p= 0.07). In contrast, poor risk patients transplanted during 1986‐90 (n=55) appeared to have worse leukaemia‐free survival (15%) compared to those transplanted during 1981‐85 (n= 62) (22%, p = 0.09). The incidence of acute graft‐versus‐host disease (GVHD) grades I‐IV in all patients was 94% in those transplanted during 1981‐85 (n=120) and 86% in those transplanted during 1986‐90 (n=107) (p= 0.002). The incidence of acute GVHD grades II‐IV was 37% during 1981‐83, 20% during 1984‐86, and 28% during 1987‐90 (p= 0.1). The decrease in incidence and severity of acute GVHD correlated with the introduction of the cyclosporin/short methotrexate regimen in our practice. The incidence of cytomegalovirus (CMV) pneumonitis was 18% in 1981‐85, and 11% in 1986‐90 (p= 0.09). In 1989 and 1990 no cases of CMV pneumonitis occurred. The decrease in incidence of CMV pneumonitis correlated with the introduction of prophylactic ganciclovir. The reduction of the transplant‐related complications acute GVHD and CMV pneumonitis has resulted in improved survival for good risk patients, but not for bad risk patients. (Aust NZ J Med 1993; 23: 181–186.)
A comparative study of radionuclide venography and contrast venography in the diagnosis of deep venous thrombosis
Authors: Kilpatrick T. K. , Lichtenstein M. , Andrews J. , Gibson R. N. , Neerhut P. , Hopper J.
Published: March 2008

Background: The value of the radionuclide blood pool venogram in detecting deep venous thrombosis (DVT) has to date been inadequately evaluated. This is despite its lower complication rate than the gold standard of contrast X‐ray venography.

Aims: To compare the relative accuracy and inter observer variability of radionuclide blood pool and X‐ray contrast venography as well as evaluate previous literature on radionuclide venography.

Methods: Prospective comparison of radionuclide and contrast venography was performed in 39 patients. Sensitivity and specificity of radionuclide venography were compared to contrast venography and confidence intervals were measured using standard error calculations. A meta‐analysis of previous studies was also performed.

Results: Significant inter observer variation in reports was present in both radionuclide (37%) and contrast (22%) venograms. Using consensus reports sensitivity of radionuclide venography was 87% compared to contrast venography and specificity was 83%. These results are similar to those obtained in previous studies. Furthermore, sensitivity in specificity in the proximal veins were 90% and 92% respectively which were superior to sensitivity and specificity in the distal veins where it was 74% and 90% respectively.

Conclusion: The radionuclide venogram appears accurate in the proximal veins and in excluding but not diagnosing distal venous thrombosis. (Aust NZ J Med 1993; 23: 641–645.)
Cryptococcus neoformans in tropical northern Australia: predominantly variant gattii with good outcomes
Authors: Fisher D. , Burrow J. , Lo D. , Currie B.
Published: March 2008

Background: Infection with Cryptococcus neoformans is common in the Northern Territory of Australia. Disease is life threatening and treatment is prolonged and often complicated by the need for surgery and difficulties with medical therapy.

Aims: To document incidence, demography, risk factors, clinical features and outcomes of infection and to determine differences between gattii and neoformans varieties.

Methods: Case records of all patients (n= 35) diagnosed with cryptococcal infection at the Royal Darwin Hospital between 1976 and 1992 were reviewed retrospectively. Current status of patients was ascertained. Variety identification of isolates was determined by growth in canavanine‐glycine‐bromthymol blue agar.

Results: Of the 35 patients, 23 had meningitis, ten had pneumonia, one had a dermal infection and one had fungaemia with no obvious focus. Twelve (52%) meningitis cases and two (20%) pneumonia cases had no predisposing disease. Thirteen (57%) meningitis cases had concomitant pulmonary cryptococcosis. Twenty‐nine patients were Aboriginal and six were Caucasian, with a relative risk for Aboriginals compared with non‐Aboriginals of 20.6 (95% CI 8.6–49.5). Arnhem‐land was the commonest location of infection, with an annual incidence in Aboriginals of 0.14/1000. Fourteen (78%) of 18 isolates tested were C. neoformans var. gattii. Management was characterised by the frequent need for adjunctive surgery and prolonged or repeat courses of systemic antifungal therapy. Despite this, long‐term outcomes are encouraging with a mortality of 14% overall and 9% in meningitis patients. The river red gum (Eucalyptus camaldulensis) has a limited distribution in Arnhemland and ongoing studies are seeking alternative environmental sources of C. neoformans var. gattii. (Aust NZ J Med 1993; 23: 678–682.)
Mechanism of stroke complicating cardiopulmonary bypass surgery
Authors: Rankin J. M. , Silbert P. L. , Yadava O. P. , Hankey G. J. , Stewart‐Wynne E. G.
Published: March 2008

Background: Stroke is a devastating complication of cardiopulmonary bypass (CPB) surgery which occurs in 1 to 5% of cases. Strategies to reduce its incidence require a knowledge of the underlying pathology and aetiology.

Aims: To determine the incidence, pathology and aetiology of stroke complicating CPB.

Methods: Prospective review of clinical, operative and cranial CT scan findings in all cases of stroke complicating CPB procedures in our institution over an 18 month period.

Results:. Twenty‐one (1.6%, 95% CI 0.9–2.3%) cases of stroke were identified from 1336 CPB procedures. Cranial CT scan, performed in all but one patient, was normal in three patients or consistent with ischaemic stroke in 17 patients. There were no cases of haemorrhagic infarction or intracerebral haemorrhage. It was difficult to differentiate embolic and borderzone infarcts in two cases. After considering the clinical, operative and CT scan features together, 12 (57%, 95% CI 36–78%) of the cases were felt to be embolic in origin and nine (43%, 95% CI 22–64%) due to hypoperfusion in a borderzone.

Conclusions: This study demonstrates that stroke remains an important complication of CPB procedures with an incidence in our series of 1.6%. The pathologic type of stroke is predominantly ischaemic in nature due to either cerebral embolism or borderzone infarction. Strategies for stroke prevention in patients undergoing CPB should be targeted primarily at these two mechanisms.
Asthma severity and morbidity in a population sample of Sydney school children: Part I – Prevalence and effect of air pollutants in coastal regions
Authors: Gray E. J. , Peat J. K. , Mellis C. M. , Harrington J. , Woolcock A. J.
Published: March 2008

Background: In two regions of Sydney where sewage treatment facilities with high temperature sludge burning incinerators are installed, there was concern that the resultant emissions were causing a local increase in symptoms of asthma and other allergic diseases.

Aim: To investigate whether living in a region with high temperature sludge burning incinerators was associated with an increased prevalence of childhood asthma or allergy.

Methods: We studied 713 children aged eight‐12 years in two regions close to incinerators and 626 children in a control region with no sludge burning incinerator. We measured respiratory illness in the previous year by questionnaire, airway hyper‐responsiveness (AHR) by histamine inhalation test, and atopy by skin prick tests. ‘Current asthma’ was defined as AHR and recent wheeze.

Results: Recordings of oxides of nitrogen and sulphur, hydrogen sulphide, ozone and particulates during the study period showed that the level of pollutants did not vary in any major way between the study regions and the control region. The prevalence of current asthma, atopy, symptom frequency or any category of severity of asthma illness was not significantly different between the control and study regions.

Conclusions: This suggests that factors other than intermittent or industrial air pollutants are responsible for the high prevalence of asthma symptoms, asthma medication use, asthma morbidity and AHR in the study of children.
Simultaneous transplantation of the heart and kidney
Authors: Savdie E. , Keogh A. M. , Macdonald P. S. , Spratt P. M. , Graham A. M. , Golovsky D. , Strieker P. D. , Spicer T. , Hayes J. M. , Crozier J. , Rainer S.
Published: March 2008

Background: Multiple organ transplants have become frequent. Combined heart‐and‐kidney grafting has been reported recently and we have pursued this in selected cases.

Aims: To devise a protocol for simultaneous heart‐and‐kidney transplantation, review our clinical experience with the procedure and the causes of cardiac and renal disease in this group.

Methods: Seven patients with advanced cardiac failure (LV ejection fraction < 0.29 units; five with IDCM), and chronic renal failure (serum creatinine > 375 μmol/L) due to a variety of causes, were accepted for combined heart‐and‐kidney transplantation. Four males, of mean age 33 years, underwent the procedure. Each received his organs from a single cadaveric donor with ABO blood group compatibility and a negative ‘current’ lymphocytotoxic cross‐match, but without regard to HLA‐antigen matching. Cardiac ischaemic time averaged 3 hours 40 minutes, the renal first warm time was 0 minutes in all cases, and renal cold and second warm ischaemic times averaged 5 hours 17 minutes and 52 minutes respectively. The heart was grafted first and the kidney second in a procedure which averaged seven hours. Immunosuppression was achieved by induction with antithymocyte globulin, thence steroids, azathioprine and cyclosporin A.

Results: No patient required post‐operative dialysis. One patient had early urological complications requiring operative correction, but no serious opportunistic infections were observed. Early cardiac rejection on biopsy (ISHT grade 3a) was seen in three patients at four‐ten weeks and responded promptly to increased steroids, but severe steroid‐resistant rejection of both heart and kidney contemporaneously occurred in one of these three at 19 months and required a course of muromonab‐CD3. All four patients developed hypertension. Mean creatinine clearance was 1.23 ± 0.22 mL/second (74±13 mL/minute) at last follow‐up. All four recipients were alive, well and rehabilitated 5, 20, 28 and 35 months after grafting. Two patients died while waiting for the double procedure and another patient eventually died after being taken off the dual waiting list and receiving a renal transplant only.

Conclusions: In experienced hands, combined heart‐and‐kidney transplantation is feasible and offers a compelling therapeutic solution in the treatment of advanced cardiac and renal failure. IDCM is a frequent cause of the heart failure in this group. (Aust NZ J Med 1994; 24: 554–560.)
Epidemiology of hypothermia: fatalities and hospitalisations in New Zealand
Authors: Taylor N. A. S. , Griffiths R. F. , Cotter J. D.
Published: March 2008

Background: Hypothermia occurs within domestic and non‐residential settings. Most epidemiological data originate from the northern hemisphere, with little data being generally available concerning cases from New Zealand and Australia.

Aims: The National Health Statistics Centre (New Zealand) records hospital discharges and deaths. This study isolated hypothermia cases, to quantify its incidence and identify risk groups.

Methods: The morbidity and mortality files for the years 1979‐86 (cases = 3,808,717) and 1977‐86 (cases = 259,325; respectively) were searched by three investigators.

Results: Hypothermia hospitalisations were identified (6.9 per 100,000 per year). There were 176 deaths from hypothermia, representing 0.07% of the 259,325 deaths from all causes for the same period (0.537 per 100,000 people per year); of these fatalities, 72.2% were classified as domestic, and 27.8% as non‐residential; of the domestic fatalities, 86.6% were 65 + years and 35.5% of these were male. Within the non‐residential category, 75.5% were aged 13–65, of which 94.6% were male. The hospitalisation incidence was 12.7 times the fatality incidence, with the majority of hospitalisations being of domestic origin (88.4% of total), and occurring mostly within the lower and upper age extremes. Neonatal domestic hypothermia accounted for 72.6% of all domestic hospitalisations, and the elderly constituted 72.0% of the remaining cases. The proportion of New Zealand fatalities caused by hypothermia was 0.067%; lower than reported in the United Kingdom.

Conclusions: The two main non‐neonatal groups contributing to cases of hypothermia were males aged 13–65 years, and the elderly. In the aged, the proportion of hypothermia‐related deaths was no different from that associated with other disorders, however, the case‐fatality ratio was three times greater, highlighting the need for improving prevention and management strategies. (Aust NZ J Med 1994; 24: 705–710.)
Septic arthritis: a second decade of experience
Authors: Youssef P.P. , York J. R.
Published: March 2008

Aims: To review the diagnostic features, treatment and outcomes of all cases of septic arthritis presenting to a major Australian rheumatology unit, between 1982 and 1991. These were compared with the previous decade's experience

Methods: The medical records of all cases of septic arthritis presenting to the Combined Centre for Rheumatic Diseases, The Rachel Forster Hospital between 1982 and 1991 were reviewed and compared with the experience of the previous decade (1971–1981).

Results: Twenty‐seven episodes of septic arthritis were diagnosed in 27 patients. There were 18 females and nine males. The average age was 62 (21–83) with three patients less than 30. Their rheumatological diagnoses were: rheumatoid arthritis (RA) in 15, osteoarthritis in five, gout in two, and one each of mixed connective disease, sarcoid, tenosynovitis of the forearm, seronegative spondyloarthropathy, and non specific polyarthritis. Eleven patients were on oral corticosteroids. Four patients had intra‐articular injections within two months of the onset of the septic episode. Sixteen out of 19 aspirates on the wards were positive. The organisms identified were Staphylococcus aureus in ten (one multiply resistant S. aureus (MRSA), Streptococcus four, Mycobacterium three (one atypical), two Pseudomonas and one each of Citrobacter, Enterobacter, Gram negative bacillus. Five patients did not have a causative organism identified. The site of involvement and the causative organisms were similar in both decades. All patients received intravenous antibiotics for at least two weeks and oral antibiotics for at least another four weeks. Twenty‐two per cent had regular aspirations on the wards and 26% had surgical drainage performed. Only 59% of all joints returned to good hnction. Fifty per cent of infected arthroplasties required arthrodesis and only a third of these returned to acceptable function.

Conclusion: Septic arthritis in subjects with previous rheumatic disease continues to have a poor prognosis, especially in cases of infected arthroplasties. There has been no change in the types of causative organisms or sites of involvement over the last two decades.
Catheter ablation of the atrioventricular node using radiofrequency energy
Authors: Wong J. , Vohra J. , Chan W. , Sathe S. , Hall R. , Mond H. , Hunt D.
Published: March 2008

Background: Catheter ablation of the atrioventricular (AV) junction using stored direct current (DC) energy from a standard DC Cardioverter defibrillator was first reported in 1982. Since then many patients have been treated using this procedure for refractory supraventricular arrhythmias, usually atrial fibrillation and flutter. Undesirable thermal effects such as barotrauma and arcing are largely responsible for complications associated with the use of DC energy. This report details our experience of catheter ablation of the AV junction using radiofrequency (RF) energy in a series of 30 consecutive patients.

Methods: RF ablations were performed using steerable Mansfield (Webster Laboratories) 4 mm tipped electrodes and locally assembled RF energy delivery system.

Results: The procedure was successful in 27/30 (90%) patients using RF energy, while three patients required DC energy to achieve successful AV junction ablation. General anaesthesia was required in nine patients, six of whom required this for cardioversion to sinus rhythm so that an adequate His Bundle spike could be recorded and three for DC ablation. Dual chamber permanent pacemakers with automatic mode switching were implanted in four patients who had paroxysmal atrial fibrillation or flutter and the remainder had ventricular rate responsive pacemakers.

Conclusions: In patients with drug refractory paroxysmal atrial fibrillation and flutter and in patients with established atrial fibrillation where control of the ventricular rate is difficult, catheter ablation of the AV junction using RF energy is a safe and effective procedure with a high success rate.
Percutaneous transluminal coronary angioplasty: clinical and quality of life outcomes one year later
Authors: McKenna K. T. , McEniery P. T. , Maas F. , Aroney C. N. , Bett J. H. N. , Cameron J. , Holt G. , Hossack K. F.
Published: March 2008

Background: The quality of life status of patients prior to and following percutaneous transluminal coronary angioplasty (PTCA) has not been comprehensively investigated.

Aim: This study was carried out to determine the effect that PTCA has on patients' quality of life.

Methods: Data on 209 patients were collected one day pre‐PTCA and at a mean of two and 11 months post‐PTCA. Data on symptomatic status, functional capacity, life satisfaction and psychological well‐being were analysed quantitatively. Clinical outcomes, patient perception of PTCA and employment status wee analysed by descriptive statistics.

Results: Highly significant improvement in all quality of life measures was found at the early follow‐up (p < .001). This improvement was sustained at the late follow‐up. At the late follow‐up, 58% of patients felt that PTCA had been very beneficial to their health and well‐being, and 79% of workers had returned to work. PTCA was primarily successful in 91% of vessels dilated. There were no procedural‐related deaths, 12 patients (6%) developed acute occlusion and three patients (1.5%) experienced myocardial infarction (MI). A symptomatic restenosis rate of 16% was found, including 19 patients (9%) requiring repeat PTCA and 14 (7%) undergoing coronary artery bypass grafting (CABG).

Conclusion: These findings suggest that, after PTCA, the majority of patients experienced improved quality of life which was sustained one year later.
Identification and genotyping of hepatitis C virus in injectable and oral drug users in New Zealand
Authors: Woodfield D. G. , Harness M. , Rix‐Trott K. , Tsuda F. , Okamoto H. , Mayumi M.
Published: March 2008

Background: Hepatitis C virus infections are known to be common in injectable drug users (IDU) both in New Zealand and overseas. Little is known of the hepatitis C genotype frequency in this population.

Aims: To confirm the high incidence of hepatitis C virus infections in IDU and compare this with the frequency in oral drug users (ODU) as well as identify the pattern of hepatitis C genotypes present.

Methods: Use was made of an experimental nucleocapsid assay as well as a conventional anti‐HCV assay. HCV‐RNA was identified using a polymerase chain reaction (PCR) technique and a variation of this method was used for HCV genotyping.

Results: Seventy‐four per cent of IDU were reactive for anti‐HCV in both types of assay. PCR testing detected several more reactive samples. Dominant genotypes were Types I and V, but Type IV was not detected. Mixed infections were noted in some patients. There was a low frequency of anti‐HCV in ODU.

Conclusions: Hepatitis C virus infections are a problem in IDU in New Zealand, and additional public health measures may be required. The distribution of genotypes of HCV‐RNA are similar to those seen in other Western countries.
Short and long term results of coronary angioplasty in patients over 75 years
Authors: Richardson M. , Pitney M. R. , Gibbons F. , Cope G. D. , Cumpston G. N. , Mews G. C.
Published: March 2008

Aims: This report reviews the outcome of percutaneous transluminal coronary angioplasty (PTCA) on patients aged 75 years or over at this institution, in order to provide statistics that may be useful in managing elderly patients.

Methods: All elderly patients undergoing PTCA between January 1984 and December 1990 were included. Data concerning the PTCA procedure and short term (hospital stay) outcome were compared to those of all patients less than 75 years who underwent PTCA during the same period. Long term outcome was obtained for all surviving elderly patients.

Results: One hundred and eleven procedures were performed on patients over 75 years, compared to 3183 procedures on patients under 75. The incidence of PTCA in the elderly increased to 6.7% of all procedures in 1990. Elderly patients were more symptomatic (97% vs 79% in patients under 75 years had Canadian Cardiovascular Society grade 3 or 4 angina), more frequently had the procedure performed urgently (39% vs 14%) and often (67%) had risk factors for PTCA (3 vessel disease, significant left ventricular dysfunction, or a complicating medical illness). Primary success rates (86%vs 90% in patients under 75 years), urgent coronary artery bypass grafting (1.8%vs 1.9%) and Q wave infarction (1.8%vs 1.0%) were similar in the two age groups. In the elderly, procedural difficulties requiring non standard equipment were common (61%), and in‐hospital mortality was increased (4.5%vs 0.7%). Additionally, three patients died after discharge resulting in a 30 day mortality of 7.2%. A favourable long term outcome was obtained in 50% of patients at a mean follow up of 20 months. Unfavourable or neutral outcome was due to one or more of the following; death (16%), coronary artery bypass grafting (19%), acute myocardial infarction (7.5%) or significant residual angina (17%).

Conclusions: Highly symptomatic patients over 75 years constitute a high risk group for PTCA, with approximately half obtaining a favourable long term outcome.
Scleroderma and augmentation mammoplasty ‐ a causal relationship?
Authors: Englert H. J. , Brooks P.
Published: March 2008

Background: The studies implicating a causal relationship between silicone and scleroderma, other autoimmune diseases, and fibromyalgia‐like symptoms have been largely descriptive with absence of appropriate controls and no consideration of potential confounders.

This case control study of augmentation mammoplasty and scleroderma represents an attempt to answer these deficiencies.

Aims: To compare the frequency and temporal relationship of augmentation mammoplasty in interviewed and deceased cases and interviewed controls. To determine the frequencies of exposure to non‐augmentation mammoplasty silicone, and to determine the frequencies of mastectomy and breast lumpectomy in interviewed cases and controls.

Methods: Scleroderma cases and age‐stratified general practice controls were interviewed using a prepilotted telephone questionnaire. Self‐reported date/s of augmentation mammoplasty were ascertained, as were dates of onset of first and second scleroderma symptom/s and scleroderma diagnosis, where relevant. Comparison of socioeconomically adjusted rates was expressed in terms of rate ratios.

Results: Augmentation mammoplasty rates were comparable between interviewed cases and controls. No augmentation mammoplasty procedures were documented in deceased scleroderma patients' medical records. Rates of exposure to non‐mammoplasty silicone, mastectomy and breast lumpectomy were comparable in interviewed cases and controls.

Conclusions: This study failed to demonstrate an association between silicone breast implantation and the subsequent development of scleroderma, to a relative risk level as low as 4.5 with 90% power.
Low cholesterol and risk of non‐coronary mortality
Authors: Simes R. John
Published: March 2008

Based on a systematic review of over 20 cohort studies, a clear association exists, for both men and women, between particularly low cholesterol levels and the rate of non‐coronary mortality. The excess in women appears mainly confined to non‐cancer causes, particularly respiratory and digestive diseases, while there is also an excess of deaths from cancer seen in men with low cholesterol levels. Higher mortality rates from trauma, haemorrhagic stroke and cirrhosis have also been observed.

Much of this association is known to be as a consequence of the disease with a fall in cholesterol levels seen after developing a variety of inflammatory diseases. However, the excess risk of non‐coronary heart disease deaths is still apparent by excluding deaths within five years suggesting that effect‐cause is not the only explanation. Confounding still remains the most likely explanation for the association with an underlying chronic disease or risk factor causing both the low cholesterol and the fatal event. However, there is still the possibility that some of the increased risk is due to the low cholesterol. This makes it important that appropriately controlled trials of both drug and dietary interventions demonstrate net clinical benefit among those with low levels of coronary risk before cholesterol‐lowering strategies are adopted more widely in these groups.
Smoking‐related beliefs and behaviour among adults with asthma in a representative population sample
Authors: Wakefield M. , Ruffin R. , Campbell D. , Roberts L. , Wilson D.
Published: March 2008

Background: Smoking and exposure to environmental tobacco smoke are inadvisable for adults with asthma.

Aims: To determine the smoking prevalence and daily smoking rate of asthmatics and compare smoking‐related beliefs and behaviours among smokers with and without asthma. To compare beliefs of asthmatics about passive smoking and asthma, how many are exposed at home and what they do when they are exposed, with people who do not have asthma.

Methods: A representative population survey of 3019 South Australian adults aged 15 years and older interviewed in their own homes in late 11992.

Results: Twenty‐eight per cent of asthmatics were smokers; mean daily smoking rate was 17.6. Asthmatics had similar patterns of smoking, readiness to quit and quit attempt histories as people without asthma. More than 40% of smokers with asthma did not perceive that smoking had greatly affected their health, over half did not believe they were at risk in future and two‐thirds did not think future health problems would be serious. Among non‐smokers, despite being more convinced of the effects of passive smoking on asthma, and being more concerned about exposure, those with asthma were no more likely to take protective action in response to actual or imminent exposure than those without asthma. One in ten non‐smokers with asthma were exposed to smoking at home.

Conclusions: The smoking habits of adults with asthma are cause for concern, with many asthmatic smokers perceiving they are not personally at risk from their smoking. Health education principles should be used by health professionals caring for asthmatic smokers to guide the selection and delivery of smoking cessation strategies. Prevailing restrictions on indoor smoking play an important role in protecting the respiratory health of non‐smokers with asthma.
Asthma management and mode of acquisition of inhaled bronchodilators
Authors: Comino E. J. , Henry R. L. , Mitchell C. A. , Bauman A. , Monaco R.
Published: March 2008

Abstract Background: Controversy has existed about the benefits and disadvantages associated with the availability of inhaled bronchodilators over the counter (OTC).

Aims: To compare sociodemographic features, use of preventive medications, use of medical services and control of asthma in adults who purchased inhaled bronchodilators OTC with those who purchased on prescription (script).

Methods: A cross‐sectional telephone survey of 772 adults 18 years and over who used inhaled bronchodilators for their asthma. Symptoms, asthma medications, and management practices were determined by a structured questionnaire administered by trained telephone interviewers.

Results: Two hundred and thirty adults purchased their bronchodilator OTC and 542 on script. OTC purchasers were more likely to be male (OR: 1.5), have had tertiary education (1.5) and be in paid employment (2.8); they were less likely to report frequent symptoms (wheeze, nocturnal symptoms or EIA more than once a week) (0.71); were less likely to use preventive medications more than twice a day (0.57) and were less likely to have consulted a general practitioner in the previous year (0.38). However, poor control of asthma symptoms was evident in both OTC and script groups. Forty per cent of the OTC group who had symptoms more than two to three times a week and 34% of the script group were not using preventive medication.

Conclusions: Undertreatment and suboptimal management of asthma were apparent in both OTC and script groups. (Aust NZ J Med 1995; 25: 496–502.)
Infections during severe primary undernutrition and subsequent refeeding: paradoxical findings
Authors: Murray M. J. , Murray A. B. , Murray N. J. , Murray M. B.
Published: March 2008

Abstract Background: Our earlier uncontrolled observations during primary famine and subsequent refeeding did not suggest that severe undernutrition inevitably increases vulnerability to infection. Some infections appeared suppressed by famine but reactivated by refeeding.

Aims: To examine prospectively the occurrence of infections in a large cohort of primary famine victims before and during refeeding.

Methods: From 1973 to 1993,4382 famine victims aged 14 or more with an estimated weight loss greater than 25% were weighed and examined for infection before and after one, two, three and four weeks of refeeding. In 137, serum C‐reactive protein was measured in an effort to detect latent asymptomatic infections before and after two weeks of refeeding. Refeeding diets included wheat, sorghum, millet, ghee and milk powder.

Results: Mean weight loss ±SD was 28.7 ± 2.3%. Before refeeding overt infections were found in 4.9%, an incidence rising to 29.1% at two weeks of refeeding and declining after four. Those developing infections gained more weight at two weeks, 4.63 ± 0.81 kg, than those never infected, 3.94 ± 0.76 (p = < 0.001 t test). C‐reactive protein levels confirmed the presence of latent infections before refeeding.

Conclusions: Severe undernutrition can suppress certain infections, mostly those due to intracellular pathogens and especially P. falciparum. Refeeding reactivates suppressed infection and can increase vulnerability to certain new infections especially of viral origin. Those gaining weight the most rapidly may be at greatest risk. Refeeding with foods alien to local culture could play a role in reactivating latent infections. Our findings may be limited to severe undernutrition and not apply to lesser forms or secondary undernutrition in hospital patients. These studies were done during charitable provision of medical care to famine victims. (Aust NZ J Med 1995; 25; 507–511.)
Initial validation of a bowel symptom questionnaire* and measurement of chronic gastrointestinal symptoms in Australians
Authors: Talley N. J. , Newman P. , Boyce P. M. , Paterson K. J. , Owen B. K.
Published: March 2008

Background: Chronic gastrointestinal (GI) symptoms are believed to be common in the general population, but Australian data are lacking. A valid instrument is required to assess GI symptoms adequately and determine their prevalence in the community.

Aims: To test the feasibility, reliability and concurrent validity of a self‐report Bowel Symptom Questionnaire (BSQ) as a measure of GI symptoms, and obtain preliminary data on the prevalence of symptoms in an Australian population‐based sample.

Methods: Outpatients (n= 63), volunteers (n= 163) and a random sample (n= 99) of the Penrith population, Sydney, completed the BSQ. Feasibility was evaluated in 264 subjects. Reliability was measured by a test‐retest procedure (n= 43), while concurrent validity was documented by comparing self‐report data with an independent interview (n= 20). The response rate in the population mail survey was 68%. Prevalence data on bowel symptoms in the community sample (n= 99) were age and gender standardised to the Australian population.

Results: The majority of subjects found the BSQ easy to complete (97%) and understand (97%); 90% completed the questionnaire in half an hour or less. Reliability (median kappa 0.70, interquartile range 0.20) and concurrent validity (median kappa 0.79, interquartile range 0.26) of GI symptoms were both very acceptable. The internal consistency of all GI symptom scales was good (Cronbach's Alpha range 0.51‐0.74). The prevalence of the irritable bowel syndrome (defined as abdominal pain and disturbed defaecation based on two or more of the Manning criteria) was 17.2% (95% CI: 10–25%).

Conclusions: The BSQ was well accepted and easy to understand; it provided reliable and valid data on GI symptoms and should prove useful in large scale epidemiological studies in Australia. (Aust NZ J Med 1995; 25: 302–308.)