bluuebunny/crossref_metadata_2025 huggingface dataset:
LARGE LUNGS AFTER CHILDHOOD ASTHMA: A CONSEQUENCE OF ENLARGED AIRSPACES
Authors: GREAVES I. A. , COLEBATCH H. J. H.
Published: March 2008

Abstract: The long–term effects of asthma on lung volume were investigated in 18 asthmatic patients during periods of remission from airway obstruction; ten had developed asthma in childhood (before 8 years of age) and eight after the age of 18 years. Subjects whose asthma began in childhood had an increased total lung capacity (TLC) on average; adult–onset asthmatics had normal mean lung volumes. Exponential analysis of static pressure–volume curves in these subjects showed that the childhood–onset asthmatics had lungs of increased distensibility, while adult–onset asthmatics had lungs of normal distensibility. In a further ten adults selected for having had asthma in the past and an increased vital capacity, all had developed asthma in childhood, had lungs of increased distensibility and an increased TLC. Increased distensibility and an increased TLC were closely associated within individuals. The close relationship between distensibility and the size of peripheral air spaces demonstrated in mammalian lungs, suggests that asthma in childhood may increase TLC and distensibility because of an increase in the size of peripheral airspaces.
NEEDLE MUSCLE BIOPSY: WILL IT MAKE OPEN BIOPSY OBSOLETE?
Authors: PAMPHLETT R. , HARPER C. , TAN N. , KAKULAS B. A.
Published: March 2008

Seventy‐five needle muscle biopsies have been performed in this department over the past two years. Adequate biopsies were obtained in 69 cases. In 40 cases a variety of neuromuscular conditions was seen, broadly categorised as necrotizing myopathy (10), neurogenic atrophy (7), metabolic myopathy (5), vasculitis (2), normal muscle (7), and non‐specific changes (9). Twenty‐nine cases were for muscular dystrophy carrier detection. There were no complications associated with the procedure.

The technique is simple and quick, and can be performed on outpatients or in the ward. Needle biopsy is the method of choice for sampling skeletal muscle in most patients, although open biopsy is still indicated for certain conditions.
LONG‐TERM MONOTHERAPY OF ANGINA PECTORIS WITH DILTIAZEM
Authors: HOSSACK K. F. , POOL P. E. , SEAGREN S. C. , DAY B. , BRUCE R. A.
Published: March 2008

Eighteen patients with exertional angina were treated with diltiazem (360 mg/day). Serial exercise testing was performed and the results were compared to evaluations when patients were receiving placebo at the initiation and termination of the study. Serial exercise tests indicated significant improvement in duration of exercise (+ 18%, p < 0.001), time to 1 mm ST depression (+ 32%, p < 0.005), and time to angina (+ 46%, p<0.001) when patients were receiving diltiazem. During diltiazem treatment, there was a significant reduction in myocardial oxygen demand as indicated by the change in submaximal pressure rate product. This may contribute to the beneficial effect of diltiazem in patients with exertional angina. The reduction in pressure rate product was due primarily to a change in heart rate. This study provides evidence that diltiazem is an effective long‐term monotherapy for angina; no evidence of drug tachyphylaxis was apparent after a total of 16 months treatment with diltiazem.
SAFETY OF THRICE‐WEEKLY RIFAMPICIN FOR TUBERCULOSIS IN SOUTH‐EAST ASIAN REFUGEES
Authors: MUKERJEE C. M. , MCKENZIE D. K.
Published: March 2008

The incidence and types of adverse reactions to rifampicin (in combination with isoniazid, pyrazinamide, and ethambutol) have been studied in 86 South‐East Asian refugees treated for tuberculosis in Australia. Most patients received daily therapy initially (mean 3.5 months) followed by supervised thrice‐weekly treatment (mean 4.6 months). Minor adverse reactions occurred with similar frequencies during daily (5%) and intermittent (5%) treatment but in no case was modification of rifampicin dosage required. Withdrawal of pyrazinamide was necessary in two patients (2.3%) with clinical hepatitis.
ROLE OF CARBON MONOXIDE DIFFUSING CAPACITY IN THE EARLY DETECTION OF MAJOR BLEOMYCIN‐INDUCED PULMONARY TOXICITY
Authors: BELL M. R. , MEREDITH D. J. , GILL P. G.
Published: March 2008

Fifteen patients with malignant teratoma and twelve with squamous cancer of the head and neck received treatment with bleomycin. Routine measurements of carbon monoxide diffusing capacity (DL00) were performed. Both groups showed a gradual fall of similar magnitude in their DL00 measurements during treatment. No patient in the group with squamous cancer developed clinical or radiological evidence of major pulmonary toxicity.

Two of the teratoma patients suffered fatal pulmonary toxicity and their DLCO measurements before any signs of major pulmonary toxicity were no different from the measurements of those patients who remained free of major clinical toxicity.

The two patients who died both showed a sustained reduction in renal function during chemotherapy which may have been a major risk factor in the development of severe clinical toxicity.

The magnitude of the decline in DLCO in this series was not a useful predictor of those patients who developed severe and radiological toxicity.
GOLD‐INDUCED BONE MARROW APLASIA: SUCCESSFUL TREATMENT WITH ANTITHYMOCYTE GLOBULIN
Authors: McGIRR E. E. , MANOHARAN A. , WEGMAN E. , EDMONDS J. P.
Published: March 2008

A patient receiving gold treatment for rheumatoid arthritis developed sudden severe pancytopenia secondary to bone marrow aplasia. She required extensive hematological support but was unsuitable for bone marrow transplantation.

Although early use of large doses of a chelating agent did not change the hematological parameters, subsequent use of antithymocyte globulin has been associated with substantial hematological improvement.
A REPORT OF THREE CASES OF YERSINIA REACTIVE ARTHRITIS
Authors: HAZELTON R. A. , SEYMOUR G. J. , CROSS S. M. , COPE J. , DOUGLAS W. A. C.
Published: March 2008

Three cases of reactive arthritis associated with Yersinia enterocolitica bowel infection are reported. In one case Y. enterocolitica was cultured from stools while all three exhibited a significant increase in serum antibody titres to Y. enterocolitica. These are believed to be the first reports of Yersinia reactive arthritis in Australia. Synovial membrane biopsy in one case revealed a mixed inflammatory cell infiltrate the appearance of which was quite dissimilar to that of rheumatoid arthritis (RA). Mononuclear cells of the peripheral blood, but not the synovial fluid from another patient had reduced functional activity compared to RA patients as determined by response to phytohemagglutinin stimulation and allogeneic responses. Large numbers of HLA‐DR and acid phosphatase positive macrophages were also found in the synovial fluid of this patient. The reason for joint involvement in Y. enterocolitica reactive arthritis is unknown and further work is necessary. (Aust NZ J Med 1985; 15: 331–335.)
ACUTE HYPERSENSITIVITY TO INGESTED PROCESSED POLLEN
Authors: PRICHARD M. , TURNER K. J.
Published: March 2008

Ingestion of commercially processed honeybee‐collected pollen produced potentially fatal consequences in a 19 year old asthmatic male. Symptoms of sore throat, facial itch and swelling, difficulty in breathing and stridor lasted for approximately two hours and was followed by clinical respiratory distress with widespread wheeze on auscultation of his chest. RAST and skin test data suggest that these complications appear to be mediated by IgE antibodies directed against the processed pollen, but not bee venom. Consumption of processed pollen by atopic individuals is, therefore, a potentially hazardous procedure with little therapeutic benefit. (Aust NZ J Med 1985; 15: 346–347.)
THE CHOICE OF ULCER HEALING AGENT INFLUENCES DUODENAL ULCER RELAPSE RATE AND LONG‐TERM CLINICAL OUTCOME
Authors: McLEAN A. J. , HARRISON P. M. , IOANNIDES‐DEMOS L. , BYRNE A. J. , MCCARTHY P. , DUDLEY F. J.
Published: March 2008

The mode of pharmacological healing influences subsequent ulcer relapse. Duodenal ulcer relapse following healing and withdrawal of active therapy has been studied in 18 prospectively randomised comparative studies involving cimetidine and alternative healing agents. Most studies (eleven of the 18) showed comparative agents with a lower (> 10%) incidence of relapse than cimetidine while a minority (seven of the 18) showed equal (±10%) relapse. The probability of this distribution occurring by chance is less than 1:1000 (p = 0.0005, sign test).

In three of the 11 published comparative studies the relapse rate was significantly higher in those who had previously received cimetidine (p<0.05, two‐sided significance test). This was despite the fact that most of the individual studies were small and required a substantial difference in results for the 5% significance level to be reached.

Paired comparative incidences of relapse at six months were converted to relapse rates (percentage of healed population relapsing monthly), average rates for comparative agents were 8.05±2.7% while those for cimetidine were 16.9±4.4% (x±SEM, n = 5); cimetidine relapse rates derived from non‐comparative trials were 17.0 ± 1.9% (x± SEM, n = 7). Higher relapse rates translate into larger numbers of patients at risk and in need of active therapy.

These results are of biological and clinical significance. Differences in relapse must reflect beneficial effects of one group of agents on the ulcer diathesis or adverse effects of the comparator, cimetidine. Each alternative reflects negatively on cimetidine as an antiulcer medication; however, confirmation of adverse effects would force radical review of most current therapy of ulcer disease. Research into ulcer therapeutics must emphasise both the relapse and the healing potential of pharmacological agents. (Aust NZ J Med 1985; 15: 367–374.)
THE EXTRACRANIAL–INTRACRANIAL BYPASS STUDY: HOW WILL THE OUTCOME AFFECT US?
Authors: DONNAN G. A. , BLADIN P. F. , WOODWARD J. M.
Published: March 2008

Extracranial‐intracranial bypass is now a commonly performed procedure in centres with a high level of neurosurgical and vascular expertise. Bypass of surgically inaccessible stenoses or occlusions appears to be a logical technique to prevent future stroke but there is much uncertainty about the clinical indications for surgery and even the natural history of the lesions being bypassed. To answer these questions, the International EC/IC Bypass Study was set up in 1977 with relatively broad entry criteria. The data will be analysed in June 1985 and if the results support the use of bypass as a means of preventing subsequent stroke, the procedure should become firmly established. However, if the results are negative, or inconclusive, rather than discard the procedure, subsets of higher risk patients should be sought, in particular using newer methods of assessing cerebral perfusion and metabolism. (Aust NZ J Med 1985; 15: 386–391.)

ECAC bypass represents a remarkable technological advance and may be an important means of preventing stroke in selected individuals. It is one of the few procedures in medicine being evaluated stringently in terms of efficacy early in its development. The results of the multicentre EC/IC bypass study are being eagerly awaited around the world. If the study shows that bypass is beneficial, the procedure will become firmly established as a legitimate form of stroke prophylaxis. If the study is negative, rather than discard the procedure altogether, we should re‐examine the indications for surgery, particularly in the light of new technologies capable of sensitive assessments of cerebral perfusion and metabolism.
PROTEIN LOADING TEST BEFORE AND AFTER KIDNEY DONATION
Authors: CHAN M. K.
Published: March 2008

Abstract Renal response to a 60 g protein load was investigated in 33 normal subjects in terms of creatinine clearance and urinary protein excretion. The test was repeated in 10 of these subjects six months after donor nephrectomy. Creatinine clearance and urinary protein excretion increased significantly one and two hours after ingestion of the protein load (in the form of casein mixture); the change in urinary protein excretion correlated significantly with the change in creatinine clearance (p <0.0001). Plasma urea, calcium, and phosphate concentrations increased after protein ingestion, while plasma creatinine and uric acid decreased. Six months after donor nephrectomy the creatinine clearance had decreased but baseline protein excretion had increased.

The pre‐nephrectomy renal response to protein ingestion (i.e. increase in creatinine clearance and urinary protein excretion) did not predict creatinine clearance of the kidney after donor nephrectomy. After donor nephrectomy, the single kidney was able to increase creatinine clearance after a protein load, although qualitativel the response was different from that obtained with two kidneys in situ. (Aust NZ J Kned 1986; 16: 691–694.)
PARANEOPLASTIC OPTIC NEURITIS AND EXTERNAL OPHTHALMOPLEGIA
Authors: WATERSTON J. A. , GILLIGAN B. S.
Published: March 2008

Abstract A 58 year old man developed bilateral optic neuritis and external ophthalmopleia nine months before presentation with a small cell carcinoma of the lung. There was no evidence of central nervous system metastases and his ocular symptoms responded to corticosteroid therapy. (Aust NZ J Med 1986; 16: 703–704.)
CAROTID SINUS HYPERSENSITIVITY IN ELDERLY NURSING HOME PATIENTS
Authors: MURPHY A. L. , ROWBOTHAM B. J. , BOYLE R. S. , THEW C. M. , FARDOULYS J. A. , WILSON K.
Published: March 2008

Abstract Fourteen of 100 geriatric nursing home patients were shown to have evidence of carotid sinus hypersensitivity. The incidence of syncope and falls was noted in prospective follow‐up over 33 months. Falls were classified as either simple or complicated by laceration or fracture. Patients experienced simple falls at similar rates whether carotid sinus hypersensitivity was present or absent. For patients with carotid sinus hypersensitivity, the risk of a laceration was increased more than twofold, that of fracture more than threefold, and that of syncope tenfold. Carotid sinus hypersensitivity warrants greater attention as a contributory factor to serious falls and syncope in the elderly, and its importance may have been underestimated in the past.
A PHASE Ml STUDY OF CYTOSINE ARABINOSIDE, DAUNORUBICIN, AND VP16–213 IN ADULT PATIENTS WITH ACUTE NON‐LYMPHOCYTIC LEUKEMIA
Authors: BISHOP J. F. , JOSHUA D. E. , LOWENTHAL R. M. , KRONENBERG H. , WHITESIDE M. G. , COBCROFT R. , DODDS A. , WOLF M. , MANOHARAN A.
Published: March 2008

Abstract The combination cytosine arabinoside (ara‐C), daunorubicin, and VP16–213 was studied in 28 patients with acute non‐lymphocytic leukemia to define the toxicity of the combination and assess its efficacy. Of 21 previously untreated patients, 16 (76%) achieved a complete response (CR) with the median remission duration not reached but exceeding 25 weeks. For CR patients, the median number of days with neutrophils < 500/μI was 19. The median survival for patients with CR is 60 weeks. Two of seven previously treated patients achieved CR for 11 weeks and in excess of 36 weeks, respectively. At the initial VP16–213 dose of 100 mg m‐2 per day for seven days, severe stomatitis was seen in 38% of courses but was less with dose reduction to 75 mg m‐2 per day for seven days. Other toxicity was similar to previous experience with ara‐C and daunorubicin alone.
ARBOVIRUS INFECTION IN A MURRAY VALLEY COMUNITY
Authors: FRASER J. R. E. , CHRISTIE D. G. , GUST I. D. , WHITE (dec.) J. , LEACH R. , MACAULAY E. D. , AHERN A. P. , ALEXANDER (dec.) J. , JONES J. M. , LUNG D. Y. L. , MOORE F. M. , MOYSEY C. D. , PHILLIPS P. J. , PRYOR I.
Published: March 2008

Abstract Serum antibodies to Ross River virus and Murray Valley encephalitis virus were measured during 1974–1975 in residents of Echuca, an urban Murray Valley community. A representative group of volunteers was obtained by random selection of households. The prevalence of antibodies to both viruses increased progressively with age. Prevalence was equal in both sexes for both viruses in all age groups, indicating that the risk of infection was mainly determined by geography rather than by personal activities. Antibody levels remained unchanged in the following year when there was no disease activity in the area. The stability of antibody levels permitted retrospective estimates of mean rates of infection. These were approximately 0.4% per annum for both viruses when age was used as the index for years of exposure. With allowance for other factors, the best estimate for both virus infections is probably closer to 1%. The morbidity rate for Ross River virus infection appeared to be low. It is concluded that infection with Ross River virus and with Murray Valley encephalitis‐related viruses is endemic in the Murray Valley.
COMBINED SPIRONOLACTONE AND CONVERTING‐ENZYME INHIBITOR THERAPY FOR REFRACTORY HEART FAILURE
Authors: IKRAM H. , WEBSTER M. W. I. , NICHOLLS M. G. , LEWIS G. R. J. , RICHARDS A. M. , CROZIER I. G.
Published: March 2008

Abstract Three cases are described of severe congestive heart failure which failed to respond to digitalis, high doses of loop diuretics, and converting‐enzyme inhibitors. The addition of spironolactone produced a substantial diuresis associated with clinical and radiological improvement in each case. Although a reversible deterioration in renal function was observed, this drug combination represents a therapeutic option in end‐stage heart failure.
PRIMARY ALDOSTERONISM DUE TO A MALIGNANT OVARIAN TUMOUR
Authors: JACKSON B. , VALENTINE R. , WAGNER G.
Published: March 2008

Abstract The case of a woman with autonomous aldosteronism, hypertension, and malignant ovarian tumour is reported. Hormone studies revealed high plasma aldosterone levels, and low plasma renin concentration. Following surgical removal of a malignant sex cord stromal tumour, the hyperaldosteronism regressed, and the hypertension improved. Subsequently the tumour recurred, as did hyperaldosteronism.
MITOCHONDRIAL MYOPATHIES. A CLINICO‐PATHOLOGICAL STUDY OF CASES WITH AND WITHOUT EXTRA‐OCULAR MUSCLE INVOLVEMENT
Authors: MECHLER F. , MASTAGLIA F. L. , SERENA M. , JENKISON M. , JOHNSON M. A. , FAWCETT P. R. W. , HUDGSON P. , WALTON J. N.
Published: March 2008

Abstract The clinical and pathological features of 28 patients with mitochondrial myopathy were reviewed. The cases were divided into a group with involvement of the extra‐ocular muscles alone or with limb muscle involvement, and a group with a facioscapulohumeral syndrome or generalised weakness without extra‐ocular muscle involvement. Cardiac and central nervous system manifestations occurred particularly in the first group which included six patients with multisystemic features and two with the complete Kearns‐Sayre syndrome. Diabetes mellitus occurred in the second group only. Quantitative histology on limb muscle biopsies showed a higher proportion of fibres with abnormal mitochondrial aggregates in the second group. No one type of mitochondrial inclusion or other ultrastructural change was specific for either group of cases. The findings illustrate the clinical heterogeneity of cases of mitochondrial myopathy and the lack of specificity of any of the myopathological changes for different subgroups of patients.
A COMPARATIVE DOUBLE‐BLIND TRIAL OF THE EFFECTIVENESS AND ANTIGENICITY OF SEMISYNTHETIC HUMAN INSULIN AND PURIFIED PORCINE INSULIN IN NEWLY TREATED DIABETIC SUBJECTS
Authors: LARKINS R. G. , ZAJAC J. , SAUNDERS R. , READ A. , HOPPER J. L.
Published: March 2008

Abstract A double‐blind comparative trial of the effectiveness and antigenicity of semisynthetic human insulin (Novo) and highly purified (Monocomponent) porcine insulin was performed over a 12 month period in 20 diabetic subjects newly treated with insulin. Human insulin was shown to be indistinguishable from porcine insulin of comparable purity with respect to plasma glucose and glycosylated hemoglobin levels and insulin dose requirements. Human insulin was no less antigenic than porcine insulin; significant IgG‐associated insulin binding activity was detected in six of the ten patients in the human insulin treated group and four of the ten patients in the porcine insulin treated group. In all patients, the binding activity was of low capacity. No adverse reactions to human insulin were noted.

It is concluded that semisynthetic human insulin, like purified porcine insulin, is safe and effective. Although there may be advantages for human insulin in the setting of insulin allergy, this study does not indicate that human insulin has advantages over purified porcine insulin with respect to elicitation of antibodies of the IgG class.
BOOK REVIEWS
Authors: Rawling Peter
Published: March 2008

Book reviewed in this article:

CLOSED HEAD INJURY: PSYCHOLOGICAL, SOCIAL, AND FAMILY CONSEQUENCES. Edited by D. Neil Brooks
BOOK REVIEWS
Authors: Yeomans Neville D.
Published: March 2008

Book reviewed in this article:

FLEXIBLE SIGMOIDOSCOPY. By Ronald M. Katon, Emmet B. Keefe and Clifford S. Melnyk
MYCOBACTERIUM GASTRI PERITONITIS IN A PATIENT UNDERGOING CONTINUOUS AMBULATORY PERITONEAL DIALYSIS
Authors: LINTON I. M. , LEAHY S.I. , THOMAS G. W.
Published: March 2008

Abstract This report documents a case of peritonitis due to Mycobacterium gastri in a 28 year old woman on continuous ambulatory peritoneal dialysis. She presented with persistent abdominal pain and clear peritoneal drainage fluid which contained increased numbers of lymphocytes. The diagnosis was made by identification of acid‐fast bacilli in peritoneal fluid and within a peritoneal biopsy specimen, and culture of Mycobacterium gastri from peritoneal fluid. Treatment with rifampicin and ethambutol and removal of the Tenckhoff catheter has proved effective. The case highlights the importance of searching for slow growing organisms in apparently ‘aseptic’ peritonitis in peritoneal dialysis patients.
LASER PHOTORADIATION THERAPY FOR TRACHEOBRONCHIAL AMYLOID
Authors: THOMPSON P. J. , RYAN G. , LAURENCE B. H.
Published: March 2008

Abstract Tracheobronchial amyloid is uncommon and has a high morbidity and mortality. In the past, progressive airways obstruction has been treated with bronchoscopic resection but benefit has been limited. We report the successful use of a laser to treat this condition and the responses of amyloid tissue to laser photoirradiation.
IPSILATERAL MOTOR SEIZURES
Authors: CHAND R. PRATAP
Published: March 2008

Abstract A patient presented with elementary partial motor seizures on the same side as the cerebral lesion. A cerebral computerised tomographic scan showed a right medial frontal atrophic lesion and an electroencephalogram showed seizure discharges from the same region. The clinical significance and pathophysiology of ipsilateral seizures are discussed.
BOOK REVIEW
Authors: Raghavan Derek
Published: March 2008

THE MOLECULAR BASIS OF CANCER. Edited by Peter B. Farmer and John M. Walker
HYPOTHYROIDISM AND GRAVES' DISEASE AFTER MANTLE IRRADIATION: A FOLLOW UP STUDY
Authors: MORTIMER R. H. , HILL G. E. , GALLIGAN J. P. , BRANSDEN A. I. , TYACK S. A. , ROESER H. P.
Published: March 2008

Abstract Fifty of 66 patients whose thyroid function had previously been assessed 7–139 months after irradiation for Hodgkin's disease were re‐evaluated 35 ± 3 months later. They could be divided into three groups: those whose thyroid function had been normal in the first study (N= 26), those who had had asymptomatic impaired thyroid reserve (N= 19), and those in whom evidence of Graves' disease had developed (N= 5).

The 26 patients who had been euthyroid when first studied had developed significant increases in mean throid‐stimulating hormone (TSH) levels basal and following thyrotrophin releasing hormone) without changes in mean free thyroxine index (FTI). In three of these patients, each studied within six years of irradiation, basal TSH had risen to hypothyroid levels. There were no significant changes in mean FTI or basal and peak TSH in 19 patients who had demonstrated impaired thyroid reserve in the first study. The cumulative incidence of impaired thyroid reserve in the total cohort is now 30/66 (45%) but only one of these 30 has developed clinical hypothyroidism. Five patients developed evidence of Graves' disease. Two patients with thyrotoxicosis and one with euthyroid Graves' disease were found in the initial study. On re‐evaluation, a third patient had developed frank thyrotoxicosis and another euthyroid Graves' disease, giving a cumulative incidence of Graves' disease of 5/66 (7%). Three of these five were HLA‐DR3 and three had measurable thyrotrophin binding inhibiting immunoglobulins. We conclude that impaired thyroid reserve continues to develop within six years of mantle irradiation in adults but once established appears to remain stable. There also appears to be a high incidence of Graves' disease after mantle irradiation.
BOOK REVIEW
Authors: McGrath K. M.
Published: March 2008

HAEMOPHILIC BLEEDING. EARLY MANAGEMENT AT HOME. By A. Aronstam
CHARACTERISATION OF THE HOST RESPONSE TO PLASMODIUM FALCIPARUM INFECTION. I. CEREBRAL MALARIA
Authors: COWEN N. L. , CLANCY R. L. , STACE J. , CRIPPS A. W.
Published: March 2008

Abstract Cerebral malaria is a major form of complicated malaria consequent upon cerebral damage associated with endothelial cell necrosis. We have used assays of Plasmodium falciparum growth inhibition in vitro to study serum inhibitory factors in patients with cerebral malaria. Serum from children with cerebral malaria inhibited parasite growth in a non‐synchronised 72‐hour assay to a greater extent than did sera from immune adults or asymptomatic children (p < 0.001). The high level of non‐specific inhibition of parasite growth was particularly evident when sera were tested against three P. falciparum isolates, and contrasted with the inhibitory effect of sera from non‐malaria febrile controls. In this study, serum from patients with cerebral malaria was more inhibitory than serum from the other groups (p < 0.001) and its between‐isolate variation, when tested against a panel of P. falciparum isolates in growth assays, was significantly less than that of the other groups tested (p < 0.005). These results are consistent with the hypothesis of toxin‐induced endothelial cell damage, with the sequence of pathogenic events involving host‐derived serum factors capable of damaging P. falciparum.
ANTERIOR ST SEGMENT DEPRESSION IN INFERIOR MYOCARDIAL INFARCTION: EFFECT ON COMPLICATIONS AND LONG‐TERM SURVIVAL
Authors: STAFFORD A. N. , LLOYD B. L. , THOMPSON P. L.
Published: March 2008

Abstract The effect of anterior ST segment depression in inferior myocardial infarction on early complications and long‐term prognosis was studied. A modification of the Minnesota Code was used for grading the extent of ST segment depression in leads V2 to V4 on the first hospital electrocardiogram. In 267 patients with acute inferior myocardial infarction, 107 had isoelectric anterior ST segments, 84 had minor ( 0.5 mm) depression, and 76 had major (> 0.5 mm) depression. Patients with anterior ST segment depression had higher serum enzyme levels, higher Norris coronary pronostic indices, and more frequent cardiac failure during the acute stages, but similar 28 day case fatality rate (11.1%) compared with patients without anterior ST segment depression (12.6%). In the subsequent four years total cardiac death rates were not significantly different and the pattern of survival was not influenced, but there was a higher fatal re‐infarction rate in patients with major anterior ST segment depression. Thus, anterior ST segment depression in inferior myocardial infarction was associated with more severe infarction in the early phase but was not a reliable marker of high risk after recovery. Selection of patients for further investigation should not be based on this observation alone.
BOOK REVIEW
Authors: Alpers J. H.
Published: March 2008

MANUAL OF CLINICAL PROBLEMS IN PULMONARY MEDICINE. Second edition. Edited by Richard A. Bordow and Kenneth M. Moser
IN VITRO FUNCTION OF A T‐CELL CHRONIC LYMPHOCYTIC LEUKEMIA WITH SUPPRESSOR CELL PHENOTYPE
Authors: CROSIER P. S.
Published: March 2008

Abstract Surface membrane studies of cells from a atient with T‐cell chronic lymphocytic leukemia T‐CLL) showed that they had an OKT3+, OKT4‐‐, OKT8+ phenotype which IS consistent with tbe phenotype of normal circulating peripheral blood suppressorlcytotoxic T‐lymphocytes. The cells were HLA‐DR', anti‐Tac‐, Smlg‐ and E rosette+. Parallel studies in vitro showed that the T‐CLL cells had a marked suppressive effect on both the mixed lymphocyte culture (MLC) proliferative response and the activation of cytotoxic T‐lymphocytes. The T‐CLL cells failed to respond or stimulate in MLC and were not directly cytotoxic to allogeneic peripheral blood lymphocyte targets. Both the suppression of the MLC and the cytotoxic responses depended on the presence of the T‐CLL cells and not T‐CLL culture supernatants. The T‐CLL cells did not suppress the production of polyclonal antibody and did not produce interleukin‐2 to levels above normal control lymphocytes.
IgA KAPPA MULTIPLE MYELOMA AND LYMPHADENOPATHY SYNDROME ASSOCIATED WITH AIDS VIRUS INFECTION
Authors: THOMAS M. A. B. , IBELS L. S. , WELLS J. V. , ISBISTER J. P. , COOPER D. A. , McMAHON C.
Published: March 2008

Abstract A 29 year old homosexual male presented with acute renal failure caused by acute myeloma. Subsequent investigation demonstrated antibody to the AIDS‐associated virus human T‐cell lymphotropic virus III, (HTLV‐III/LAV/ARV). The association between lymphadenopathy syndrome and multiple myeloma is discussed.
SHlGELLA DYSENTERlAE TYPE 1 ENTEROCOLITIS
Authors: CALDWELL G. R. , REISS‐LEVY E. A. , de CARLE D. J. , HUNT D. R.
Published: March 2008

Abstract Shigella dysenteriae tpe 1 is much more virulent than Shigella flexneri and sonnei which are endemic in Australia. This report describes a 22 year old woman who acquired Shigella dysenteriae type 1 whilst travelling in India. During the course of her illness, she developed severe enteroco‐litis for which a subtotal colectomy was performed. The illness resembled fulminant ulcerative colitis and its infectious nature was difficult to establish because several fecal cultures failed to grow the pathogen. Her infection was complicated by shigella bacteremia, disseminated intravascular coagulation, and renal cortical necrosis which requires continued hemodialysis.
INHIBITION OF COMPLEMENT‐MEDIATED SOLUBILISATION OF ANTIGEN‐ANTIBODY COMPLEXES BY SERUM FACTOR(S) IN PATIENTS WITH VARIOUS CONNECTIVE TISSUE DISEASES
Authors: Webb J. , Zoma A. , Cobb S. , Veitch J. , Whaley K.
Published: March 2008

Control of immune complex formation is important to limit disease resulting from their deposition in tissues. Any inhibition of immune complex solubilisation is thus significant in the pathogenesis of immune complex diseases. More than half of our patients with various rheumatic connective tissue diseases were demonstrated to have serum inhibition of immune complex solubilisation (12/16 rheumatoid arthritis, 22/37 systemic lupus erythematosus, 16/29 primary Sjogren's syndrome, and eight of nine with mixed connective tissue disease). This serum inhibitory activity did not correlate well with serum levels of IgM rheumatoid factor or circulating immune complexes, and its nature remains to be elucidated. (Aust NZ J Med 1986; 16: 445–451.)
REITER'S SYNDROME: CHRONICITY OF SYMPTOMS AND EMPLOYMENT
Authors: Hart H. H. , Mcguigan L. E. , Gow P. J. , Grigor R. R.
Published: March 2008

To assess the chronicity of symptoms and long term prospects for employment in patients with Reiter's syndrome, a follow‐up study of 111 patients was performed. Ninety‐eight patients were available for follow‐up; these had a mean disease duration of 7.9 years (range two months to 39 years). At follow‐up, 55 patients had symptomatic joints and 26 objective evidence of synovitis, but only seven had chronic joint deformity. Seven patients fulfilled criteria for ankylosing spondylitis. Ninety‐three patients were in functional class I or II, 86 patients were working, 26 had changed employment, and 11 were unemployed because of the disease. No prognostic features of value were identified. The tissue antigen HLA B27 was associated significantly with anterior uveitis and radiological sacroiliitis. (Aust NZ J Med 1986; 16: 452–456.)
THE IMMUNOCHEMICAL CHARACTERISATION OF CIRCULATING IMMUNE COMPLEX CONSTITUENTS IN CANDIDA ALBICANS OSTEOMYELITIS BY ISOELECTRIC FOCUSING, IMMUNOBLOT, AND IMMUNOPRINT
Authors: NEALE T. J. , MUIR J. C. , DRAKE B.
Published: March 2008

Abstract Circulating immune complexes present in the serum of a patient with systemic lupus erythematosus, end‐stage renal failure, and thoracic vertebral Candida albicans osteomyelitis were sequentially analysed by isoelectric focusing, immunoblotting, and immunoprinting. Candida antigens (including mannoproteins), Clq and C3 complement components, and specific anti‐Candida antibody were detected within polyethylene glycol precipitated complexes. An antigen of 47K molecular weight was amongst those demonstrated by polyacrylamide gel electrophoresis to be present within the complexes. It has been proposed elsewhere that a serologic response to a 47K protein is predictive of recovery from Candida albicans infection. Free antibody had specificity for Candida antigens ranging in molecular weight from 18K to more, than 100K including a 47K component. The analytical techniques employed allowed rapid and precise identification of the components of one particular immune complex system and will be widely applicable to the dissection of other diverse systems.
ADULT HENOCH‐SCHÖNLEIN NEPHRITIS
Authors: FAULL R. J. , AARONS I. , WOODROFFE A. J. , CLARKSON A. R.
Published: March 2008

Abstract A retrospective study was performed of all patients at the Royal Adelaide Hospital over a ten‐year period with biopsy proven Henoch‐Schonlein nephritis. The records of 27 patients were examined, with emphasis on clinical and histopathological presentation, treatment and outcome. A scheme for assessing glomerular histology is presented, and severity correlated with prognosis of the disease. At presentation unfavourable prognostic indicators were acute renal impairment, crescents in greater than 20% of glomeruli, and severe glomerular histological lesions. Four patients died as a result of the disease, and 20 of the patients had evidence of continued renal abnormality at follow‐up. Adult Henoch‐Schénlein nephritis is a potentially catastrophic disease, and requires careful assessment at presentation.
CHRONIC ALCOHOLIC PROXIMAL WASTING: PHYSIOLOGICAL, MORPHOLOGICAL AND BIOCHEMICAL STUDIES IN SKELETAL MUSCLE
Authors: TROUNCE I. , BYRNE E. , DENNETT X. , SANTAMARIA J. , DOERY J. , PEPPARD R.
Published: March 2008

Abstract Electromyography, muscle histochemistry and assay of all glycolytic enzymes, phosphorylase, glycogen, carnitine and several mitochondrial marker enzymes in skeletal muscle (vastus lateralis) were carried out in two groups. One group comprised chronic alcoholic patients with prominent proximal wasting, the other was an alcoholic group with normal neuromuscular examination. Biochemical results were compared with data from control groups with normal muscle histology and with non‐alcohol related type 2b fibre atrophy. Either 2b atrophy factor or 2b variability coefficient were increased in all wasted alcoholic patients, with normal values in alcoholics without wasting. Electromyography studies were usually normal in proximal muscles, although several patients had mild distal neuropathies. A significant fall in activity of phosphorylase and all glycolytic enzymes was found in wasted alcoholics with reference to normal controls. In the non‐ethanolic 2b atrophy group the activity of several glycolytic enzymes was also significantly lower, but for each enzyme the mean activity was not depressed to the same extent as in the wasted alcoholic group. Muscle glycogen, carnitine, and mitochondrial marker enzyme activities (isocitrate dehydrogenase, monoamine oxidase, cytochrome oxidase) were normal in alcoholics with proximal wasting. It is concluded that there is no deficiency of mitochondrial marker enzymes in wasted alcoholics and that a significant depression in glycogenolytic and glycolytic enzyme activity is seen which is explained in part, but probably not fully, by 2b fibre atrophy.
A HIGH FREQUENCY OF INHERITED DEFICIENCY OF COMPLEMENT COMPONENT C4 IN DARWIN ABORIGINES
Authors: RANFORD P. , HAY J. , SERJEANTSON S. W. , DUNCKLEY H.
Published: March 2008

Abstract A high frequency of serum complement component C4A deficiency may explain the higher prevalence and greater severity of systemic lupus erythematosus reported in Australian Aborigines. Inherited deficiencies of serum complement components C4A, C4B, and C2 were examined in two Australian Aboriginal populations from Darwin and Alice Springs and compared with the prevalence of complement deficiencies in white Australian blood donors. The frequency of C4A deficiency alleles was 29% in Darwin Aborigines compared with 12% in Alice Springs and 17% in Canberra blood donors. Partial C4B deficiency was also higher in Darwin Aborigines than in the other populations. Inherited deficiency of serum complement component C2 was not observed.
VENO‐OCCLUSIVE DISEASE OF THE LIVER FOLLOWING CHEMOTHERAPY WITH MITOMYCIN C AND DOXORUBICIN
Authors: CRAFT P. S. , PEMBREY R. G.
Published: March 2008

Abstract A 54‐year‐old woman with metastatic breast cancer developed veno‐occlusive disease of the liver following chemotherapy with mitomycin C and doxorubicin. The dose of mitomycin C received by this patient was much lower than that previously described to cause this complication. As both these drugs are used widely physicians should be aware of this complication.
A MATCHED PAIRS COMPARISON OF CYCLE ERGOMETRY AND TREADMILL EXERCISE TESTING IN THE EVALUATION OF CORONARY HEART DISEASE
Authors: CALVERT A. F. , PATER G. , PYE D. , MANN J. , CHALMERS D. , AYRES B.
Published: March 2008

Abstract In 105 patient pairs, matched for sex, aged within a ten‐year range and with closely similar coronary disease, the sensitivity and specificity of treadmill testing using the Bruce Protocol was compared to cycle ergometry using the 100 kpm/min (16 W/min) increment protocol, and found to be similar. The parameters of use were ST segment depression (sensitivity of 52% for treadmill and 61% for cycle), test angina (65% and 61%), significant work impairment (66% and 68%) and impaired blood pressure response (31% and 20%). The sensitivity was increased (treadmill to 84%, cycle to 89%) if the four parameters were grouped, and abnormality in any one of them was regarded as a positive test.

The equivalent severity of coronary disease resulted in more severe work impairment on the cycle than on the treadmill. The mean work level of the treadmill group was 80%, and of the cycle group, 61% of their respective, nomographically predicted, normal values. The difference was similar for the zero. sinale and multivessel disease aroum. This difference should be recognised when comparing the two techniques. (xust NZ J Med 1987; 17: 472–478).
ARE HIGH BLOOD SUGAR LEVELS IN THE ELDERLY IGNORED?
Authors: CHALMERS J. , BEAVEN D. W. , SAINSBURY R.
Published: March 2008

Abstract In a survey of 530 patients, aged 75 years and older, who were admitted to a general teaching hospital in Christchurch, 60 (11.3%) were known diabetics. One hundred and seventy‐six other patients (33.2%) had a last measured laboratory blood glucose level of >7.8 mmol/l, of whom 27 people (5.1% of all patients) had significant hyperglycemia (over 11 mmol/l).

The Geriatric Assessment and Rehabilitation Unit (ARU) and acute general medical wards of the Princess Margaret Hospital made little use of the specialised Diabetes Services for help in managing known or newly diagnosed diabetics. The mean in‐hospital laboratory blood glucose value for all diabetics was an unphysiological value of 12.2 mmol/l, compared with a community mean of 4.9 mmol/l and hyperglycemia persisted after resolution of acute medical problems. ARU diabetic patients had significantly lower blood glucose values than those achieved by physicians in acute medical wards. Prescribed medications such as steroids or diuretics contributing to insulin resistance were rarely modified.

It is concluded that 16.4% of elderly patients had significant hyperglycemia or poorly managed diabetes mellitus, and that both general and geriatric physicians underestimated both the severity and consequences of elevated blood sugars in older patients in a regional New Zealand community with a ‘high’ diabetes profile. (Aust NZ J Med 1987; 17: 485–490).
DECREASED INCIDENCE OF ADVERSE INFUSION REACTIONS IN HYPOGAMMAGLOBULINEMIC CHILDREN RECEIVING LOW pH INTRAVENOUS IMMUNOGLOBULIN
Authors: ROBERTON D. M. , HOSKING C. S. , EFTHlMlOU H. , WRIGHT S. , UPTON H. , COLGAN T. , HARTMAN L. , SCHIFF P.
Published: March 2008

Abstract Eighteen patients (ages eight months to 20 years) with disorders of immunoglobulin and antibody production received infusions of two preparations of intravenous immunoglobulin in a blind crossover trial. The incidence and severity of immediate adverse infusion reactions was significantly lower with low pH immunoglobulin; ten patients (56%) experiencing immediate reactions with the standard preparation and only one patient experiencing an immediate reaction with the low pH preparation (p<0.01). Infusion times were significantly less with the low pH preparation p0.02 and patient tolerance, determined by visual analogue scores, was significantly better than with the standard preparation (p<0.01). However, the incidence of delayed reactions (44%) was the same for both infusions. (Aust NZ J Med 1987; 17: 495–500).
SYPHILITIC ANEURYSM OF THE RIGHT SUBCLAVIAN ARTERY PRESENTING WITH HEMOPTYSIS
Authors: BOUNDY K. , BIGNOLD L. P.
Published: March 2008

Abstract A 40‐year‐old Australian Aboriginal female presented with hemoptysis in association with a right upper zone pulmonary and mediastinal mass. Several syphilitic infections in the patient had been documented during the previous 16 years. Death was due to a large hemoptysis, and autopsy revealed that the mass in the chest was a right subclavian artery aneurysm which had ruptured into the lung parenchyma. (Aust NZ J Med 1987; 17: 533–535.)
ACUTE TUBULAR NECROSIS COMPLICATING BILATERAL RETROGRADE PYELOGRAPHY
Authors: WHALLEY D. W. , IBELS L. S. , ECKSTEIN R. P. , ALEXANDER J. H. , SMITH R. D.
Published: March 2008

Abstract Acute renal failure following retrograde pyelography is a rare occurrence. The mechanisms reported have focused upon urinary tract obstruction either at an intrarenal or ureteric kevel. This report describes the first biopsy‐proven case of acute tubular necrosis complicating retrograde pyelography. We propose the etiology to be direct tubular toxicity resulting from pyelolymphatic reflux of contrast. (Aust NZ J Med 1987; 17: 536–538).
HIGH DOSE INTRAVENOUS GAMMAGLOBULIN IN COOMBS POSITIVE HEMOLYTIC ANEMIA
Authors: MITCHELL C. A. , VAN DER WEYDEN M. B. , FIRKIN B. G.
Published: March 2008

Abstract Four patients with warm type autoimmune hemolytic anemia who failed to respond to steroid therapy received high dose intravenous gammaglobulin (0.2–0.4 g/kg daily) for five days. In one patient hemolysis occurred in association with non‐Hodgkin's lymphoma and in the others the cause of the hemolysis was not established; two patients had prior splenectomy. A response to gammaglobulin therapy, demonstrable by a rise in or stabilisation of hemoglobin levels, a decrease in elevated serum bilirubin and lactate dehydrogenase levels, or prolongation of a shortened red cell (51Cr) survival, was observed in three patients. In two of these patients the effect of gammaglobulin therapy was temporary but allowed for splenectomy to proceed in one patient, without blood transfusion. The third patient continued to improve after cessation of gammaglobulin treatment. These findings suggest that high dose intravenous gammaglobulin may temporarily ameliorate hemolysis in some individuals with warm type immune hemolytic anemia, and may be a useful adjunct to steroids immediately before splenectomy.
JUVENILE RHEUMATOID ARTHRITIS IN AUCKLAND: A LONG TERM FOLLOW‐UP STUDY WITH PARTICULAR REFERENCE TO UVEITIS
Authors: McGILL N. W. , GOW P. J.
Published: March 2008

Abstract Although features of juvenile rheumatoid arthritis (JRA) have been well described in British, American, and to a lesser extent Australian communities we can find no previous study of the clinical characteristics of this disease in a New Zealand population or indeed in any population containing Polynesians.

In a follow‐up study of 55 Auckland residents with juvenile rheumatoid arthritis, current information was obtained for 78% of the study group with a mean interval from disease onset to follow up of 9.3 years. The outcome for the group as a whole was excellent although patients with a polyarticular course, regardless of onset subtype, had a poorer outcome with respect to both ongoing disease activity and functional disability. Polynesian patients were represented in all onset subtypes in proportion to their frequency in the general community and there was no recognisable influence of race on the course of the disease.

Despite careful ophthalmological examination only one case of mild uveitis was detected, a much lower incidence than in British and American reports.
THE EFFICACY OF NEDOCROMIL SODIUM (TILADE®) IN ASTHMA
Authors: RUFFIN R. E. , RUBINFELD A. R. , ALPERS J. H. , CZARNY D. , PAIN M. C. F. , BOWES G.
Published: March 2008

Abstract Nedocromil sodium is a new antiasthmatic drug with properties similar to sodium cromoglycate. We examined the efficacy of nedocromil sodium compared to placebo in 71 asthmatic patients in a three‐centre double‐blind parallel group study over 12 weeks. During the study the patients' maintenance inhaled corticosteroids were progressively withdrawn. Nedocromil sodium had an advantage over placebo in the number of withdrawals related to uncontrolled asthma, 14 and 24 respectively (p= 0.03). Changes in symptom scores, peak flow rates and bronchodilator use favoured nedocromil sodium occasionally during the study. The unusual taste of the active drug was reported frequently. Nedocromil sodium is more efficacious than placebo in asthma maintenance, but does not replace inhaled corticosteroids.
CHRONIC EOSINOPHILIC PNEUMONIA IN A PATIENT WITH ATAXIA TELANGIECTASIA
Authors: ZAGAMI A. S. , COLEBATCH H. J. H. , WAKEFIELD D.
Published: March 2008

Abstract The first reported case of chronic eosinophilic pneumonia in a patient with ataxia telangiectasia is described. The patient displayed the immunoglobulin deficiencies and abnormalities of lymphocyte numbers characteristic of ataxia telangiectasia. Treatment with corticosteroids led to a dramatic recovery. The proposed pathogenetic mechanisms of chronic eosinophilic pneumonia are discussed in the light of the immunological abnormalities associated with ataxia telangiectasia.
MALASSEZIA FURFUR FUNGEMIA AS A TREATABLE CAUSE OF OBSCURE FEVER IN A LEUKEMIA PATIENT RECEIVING PARENTERAL NUTRITION
Authors: MIDDLETON C. , LOWENTHAL R. M.
Published: March 2008

Abstract We describe a 46‐year‐old man with acute non‐lymphocytic leukemia (ANLL) and Crohn's disease who, while receiving total parenteral nutrition (TPN), developed a protracted febrile illness with thrombocytopenia, pulmonary infiltrates and jaundice. Malassezia furfur, a lipophilic fungus, was identified from blood culture on lipid‐enriched media. The patient improved rapidly with cessation of TPN and removal of his central venous catheter. M. furfur may cause a severe illness in immunosuppressed patients receiving TPN.