bluuebunny/crossref_metadata_2025 huggingface dataset:
THE THYROID AND CALCIUM HOMEOSTASIS IN MAN : EVALUATION BY CALCIUM INFUSION
Authors: IBBERTSON H. K. , ROCHE A. H. G. , PYBUS J.
Published: September 2017

Nine normal subjects, and five patients with primary thyroid failure, were infused with calcium gluconate solution (0.6 mEq of calcium per kilogram of body weight) for three hours. Serum calcium and magnesium levels were measured during the next 24 hours. The mean rise in serum calcium level in both treated and untreated patients with thyroid failure was significantly greater than the mean control levels after the fourth hour, and the elevation persisted at 24 hours. No additional abnormality was seen in subjects who also lacked parathyroid tissue, although in one patient with primary hypoparathyroidism alone a similar rise was seen. There were no significant changes in serum magnesium level in any of the patients studied.

The results suggest that thyrocalcitonin normally acts in man to restore the serum calcium to normal after its experimental elevation. The clinical implications of this are discussed.
SOME CLINICAL AND CHEMICAL MANIFESTATIONS OF ALCOHOL‐INDUCED HYPERLIPÆMIA
Authors: NESTEL P. J.
Published: September 2017

Some of the clinical features and the values of the plasma lipids of 10 subjects with alcohol‐induced hyperlipæmia are presented. The finding of lactescence in samples of fasting plasma from subjects who had been drinking heavily led to the establishment of the diagnosis.

The presenting symptoms were abdominal pain in seven cases, coronary heart disease in two and recurrent xanthomatosis in one cases. Pancreatitis was found in three cases, marked hepatomegaly subsiding rapidly after admission of the subjects to hospital in seven, and transient hyperglycæmia in four. The very high concentrations of plasma triglyceride and cholesterol fell rapidly when alcohol intake was stopped. The frequency of finding and the pathogenesis of this disorder are discussed.
SMALL BOWEL TUMOURS
Authors: MIDDLETON W. R. J.
Published: September 2017

Primary tumours of the small bowel have been reviewed over a 16 year period; 58 tumours were found in 55 patients.

The sex incidences were equal, and the peak age at presentation was in the seventh decade. Sixteen (28%) of the tumours were benign and 42 (72%) malignant. Carcinoma accounted for 57% of the malignant growths, and carcinoid for 29%. The average duration of symptoms was 21·4 months and 7·8 months for benign and malignant tumours respectively.

Forty‐nine of the 58 tumours caused symptoms, and 14 of these (29%) presented as surgical emergencies. Benign tumours usually cause obstructive symptoms, whereas malignant tumours frequently present with weight loss, anæmia or changed bowel habit in addition to pain and vomiting.

Diagnostic methods and their shortcomings are considered. Clinical suspicion is the most important single factor in making the diagnosis.
AN EVALUATION OF SCREENING PROCEDURES IN THE DIAGNOSIS OF RENO‐VASCULAR HYPERTENSION
Authors: MORGAN TREFOR , STEPHEN D. , MCRAE J. , COOREY G. , SANDS JOHN
Published: September 2017

A functional renal artery stenosis was present in 15 of 166 hypertensive patients examined. The relative values of clinical criteria, an assessment of renal length, the results of intravenous pyelography, the response to angiotensin infusion and the results of 203Hg‐labelled “Neohydrin” renal scan and and accumulation tests in identifying these patients were compared. No test was found to be an ideal screening procedure, but the most satisfactory was the rapid sequence and water load intravenous pyelogram.

Retrograde arteriography should not be performed on all hypertensive patients.
AN ASSESSMENT OF RED CELL SURVIVAL IN IDIOPATHIC UNCONJUGATED HYPERBILIRUBINÆMIA (GILBERT'S SYNDROME) BY THE USE OF RADIOACTIVE DIISOPROPYLFLUOROPHOSPHATE AND CHROMIUM
Authors: POWELL L. W. , BILLING BARBARA H. , WILLIAMS H. S.
Published: September 2017

Red cell survival was determined in 20 patients with idiopathic unconjugated hyperbilirubinæmia without overt signs of hæmolysis (Gilbert's syndrome) by means of a double isotope technique with the use of diisopropylfluorophosphate (DF32P) and chromium (51Cr) simultaneously. Red cell life span was significantly reduced in 42% of patients. However, the degree of hæmolysis was not sufficient to produce hyperbilirubinæmia in persons with normal hepatic function. The incidence of familial involvement in patients with reduced red cell survival was not significantly different from that in patients with normal red cell survival. Similarly, there was no difference between the groups with respect to symptomatology, age of onset of jaundice, or results of laboratory investigations.

It is concluded that the hyperbilirubinæmia in this syndrome is more likely to be due to a defect in hepatic handling of bilirubin than to compensated hæmolysis. This defect appears to occur whether or not there is a reduced red cell survival. It remains to be shown why some patients with this syndrome have a reduced red cell survival while others do not.
PERNICIOUS ANIEMIA: INCIDENCE AND SIGNIFICANCE OF CIRCULATING ANTIBODIES TO INTRINSIC FACTOR AND TO PARIETAL CELLS
Authors: UNGAR BERTA , WHITTINGHAM SENGA , FRANCIS C. M.
Published: September 2017

Intrinsic factor antibody was present in 54% and parietal cell antibody in 91% of 95 patients (26 men and 69 women) with Addisonian pernicious anæmia.

The incidence of intrinsic factor antibody of 82% in 17 patients tested more than 10 years after diagnosis was significantly higher than the incidence of 47% in 78 patients tested within 10 years of diagnosis. The incidence of parietal cell antibody showed no significant variation with the duration of diagnosed pernicious anæmia.

It is suggested that given sufficient time all patients with pernicious anæmia may develop detectable circulating antibody to intrinsic factor.
PROBLEMS OF THE SYNDROME OF FAMILIAL MULTIPLE ENDOCRINE ADENOMAS
Authors: STOCKS A. E.
Published: September 2017

A study is presented of two families with the syndrome of multiple endocrine adenomas (MEA).

In the literature, only 21% of reported patients had affected relatives, which is much less than expected in a disorder thought to be inherited as an autosomal dominant. It is suggested that many isolated cases result from spontaneous mutations which are not transmitted further.

An attempt is made to define the limits of the syndrome, and it is proposed that involvement of any two of the following structures be required for the diagnosis of MEA: pituitary, parathyroids, and pancreatic islets.

A simple scheme for the investigation of relatives of patients with MEA is presented, and the problems of management of these difficult cases are discussed.
INSULIN SENSITIVITY AND 131I INSULIN METABOLISM IN JUVENILE‐TYPE DIABETICS
Authors: MARTIN F. I. R. , STOCKS A.E.
Published: September 2017

1. The acute response of blood glucose levels to insulin, and the half‐time of disappearance and degree of protein binding of 131I‐labelled insulin as determined by electrophoresis, have been studied in 43 insulin‐dependent diabetics with disease of long duration. Of the patients studied, 21 (50%) had a blood glucose response to insulin which was within normal limits. The remaining 22 patients were insensitive, showing both a delay in response and a significantly decreased rate of fall of blood glucose levels after insulin administration.

2. A weak correlation was observed between insulin sensitivity and both the half‐time of disappearance and the degree of protein binding of radioactive insulin, but no relationship was found between any of these parameters and the somatic index, the degree of “brittleness” of individual patients, the dose of insulin required or the duration of diabetes.

3. It is proposed that there may be two populations of juvenile‐type diabetics, one sensitive and one insensitive to the acute effects of insulin, which cannot adequately be explained by the effects of heterologous antibody formation on injected insulin.
THE TREATMENT OF ACTIVE CHRONIC HEPATITIS WITH 6‐MERCAPTOPURINE AND AZATHIOPRINE
Authors: MISTILIS STEVEN P. , BLACKBURN C. R. B.
Published: September 2017

6‐Mercaptopurine (6‐MP) or azathioprine was given to 17 patients with active chronic hepatitis. In eight cases toxic reactions were observed, and these included anorexia, jaundice, hepatic coma, thrombocytopenia and leukopenia. Toxicity appeared to be related to both the dose of the drug and the severity of the underlying liver disease, assessed by the extent of parenchymal necrosis. Although 100 to 125 mg. of 6‐MP is well below the accepted toxic dose in leukæmia, it appears to be excessive for many patients with active chronic hepatitis.

6‐MP or azathioprine at a lower dose range was used in 14 cases for periods of up to four and a half years with complete freedom from toxicity. Our data suggest that at the present time 6‐MP or azathioprine is the drug of choice for patients in whom complications to steroids develop, or when “control” of the disease cannot be achieved with steroid therapy. Although the clinical and biochemical indices of activity can be more adequately “controlled”, and the time spent in hospital markedly reduced when compared with steroid treated cases, drug therapy does not appear to be effective in altering long‐term survival or arresting the progressive fibrosis in the liver. Used judiciously in the dose levels indicated, azathioprine and 6‐MP appear to be the most effective drugs to suppress the activity of active chronic hepatitis, and are free of complications when used for long periods of time.
EFFECT OF ADRENALINE ON BLOOD KININ LEVELS IN CARCINOID SYNDROME AND IN NORMAL SUBJECTS
Authors: MASHFORD M. L. , ZACEST R.
Published: September 2017

Three cases are briefly discussed in which the carcinoid syndrome was confidently diagnosed. In two cases there were elevated resting levels of bradykinin in the arterial blood, and in all three the level rose in association with an increase in the vascular symptoms. In two cases adrenaline infusion caused flushing, at the height of which the bradykinin level in the arterial blood was higher than the resting concentration. This contrasts with the findings in six subjects not suffering from the carcinoid syndrome, in whom adrenaline infusion caused a fall in arterial blood bradykinin levels.
PAPILLARY FIBROMYXOMA OF THE PULMONARY VALVE
Authors: CAMPBELL C. B.
Published: September 2017

A papillary fibromyxoma of the pulmonary valve, discovered incidentally at autopsy, is recorded. It consisted of a pedunculated papillary growth containing fibrous and myxomatous tissue in similar proportions. The lesion was vascular and contained a mucopolysaccharide extractable with hyaluronidase.
KURU : THE ENDOCRINE STATUS
Authors: BUTTFIELD I. H. , HETZEL B. S. , HORNABROOK R. W.
Published: September 2017

SUMMARY

Investigations of thyroid and adrenal cortical function have been carried out on subjects suffering from kuru in the Australian‐administered Territory of Papua and New Guinea. Determinations of radioiodine uptake at 24 hours by 15 subjects revealed a level of 66±12% compared to one of 65±12% for 24 control subjects. These findings are consistent with the wide prevalence of iodine deficiency in the New Guinea highlands. Determinations of plasma protein bound iodine levels revealed levels of 6·4±2·2 µg. per 100 ml. in nine subjects with kuru and 5·1±0·1 µg. per 100 ml. in seven control subjects.

Determinations of plasma cortisol levels revealed a normal figure of 15·7±6·1 µg. per 100 ml. in 13 subjects with kuru, while 15 control subjects showed an elevation of cortisol levels‐24·1±5·4 µg. per 100 ml.—probably as a result of stress.

Determinations of urine levels of 17‐oxosteroid gave figures of 6·2±2·2 mg. per day in 10 subjects with kuru, and of 5·4±2·2 mg. per day in seven control subjects ; the urine levels of 17‐oxogenic steroids were respectively 8·3±6·7 mg. per day and 9·0±4·0 mg. per day.

Determinations of the response to metyrapone revealed no difference between subjects with kuru and control subjects. The results of a water excretion test were also normal in four subjects with kuru. It is concluded that both thyroid and adrenal cortical function are normal in kuru.
EXPERIENCES WITH LEFT ATRIAL MYXOMA
Authors: NEILSON GRAEME H.
Published: September 2017

Four cases of left atrial myxoma discovered in the course of 159 mitral commissurotomies are described. Mitral valve disease was mimicked closely in every case, both clinically and hæmodynamically.

Hæmodynamic data are presented for three cases, including one in which the myxoma was removed.

The diagnosis should be suspected in mitral disease of recent or sudden onset with constitutional symptoms or systemic embolism, especially with sinus rhythm. The classical description of syncope on change of posture occurs only in 18% of patients. It was not a feature of any of these cases.

Left atrial myxoma is best shown by angiography with injection into the pulmonary artery.
THE ELECTROPHORETIC INDEX : A PARAMETER OF THYROID FUNCTION
Authors: TAYLOR KATHLEEN , WINIKOFF DORA
Published: September 2017

The capacity of serum thyroxine‐binding globulin (T.B.G.) and albumin to bind added radiothyroxine in vitro has been utilized as a diagnostic test of thyroid function.

After electrophoresis on cellulose acetate, the ratio of radioactivity in the α1‐ to α2 globulin zone to the total radioactivity present in the protein area, expressed as a percentage, is termed the electrophoretic index (E. I.).

The normal range of values lies between 61% and 75% (mean, 68·9±3·86). The hyperthyroid range is below the lower limit (mean, 54·9±6·03), while hypothyroid values are above the upper limit (mean, 79·8±2·90). The E.I. for normal pregnancy is invariably over 80%.

The clinical conditions under which the E.I. is most contributory to correct diagnosis, in the presence of conflicting protein bound iodine and resin uptake results, include treated thyroid disease and suspected thyroid dysfunction in which there is a high blood level of iodine as a result of laboratory contamination, the use of X‐ray media or the intake of iodine preparations.

In the case of those patients who have an abnormal binding capacity of T.B.G. because of changes in the protein pattern which are either inherent, disease‐induced, or the result of the intake of drugs or hormones, the estimation of the E.I. is of value in establishing the underlying cause.

A knowledge of the E.I. is also helpful in the detection of hypothyroidism in early infancy, and its use gives consistently reliable results in the diagnosis of thyrotoxicosis coinciding with pregnancy.
RESPIRATORY DEATH AFTER RENAL HOMOTRANSPLANTATION
Authors: BALE PATRICIA M. , LE QUESNE D. M. , STEWART J. H.
Published: September 2017

Renal transplantation from the father was performed on a girl aged 16 years. Apart from a controlled episode of rejection, the graft functioned well. Dyspnœa and cyanosis with alveolar‐capillary block developed 73 days after transplantation and progressed to death 10 days later.

At autopsy, thrombi were found in pulmonary and small systemic vessels, and their age coincided with the duration of symptoms. Although Pneumocystis carinii was found in the lungs, it was greatly concentrated in infarcts. The evidence suggests that pulmonary thrombi are an important feature of “transplantation pneumonia”.
CHRONIC LYMPHOCYTIC LEUKEMIA IN A CHILD PRESENTING AT THE AGE OF TWO YEARS AND EIGHT MONTHS
Authors: CASEY T. P.
Published: September 2017

Chronic lymphatic leukæmia in childhood is a rare condition. A case is reported in which the condition was diagnosed in a child aged two years and eight months, although it had probably been present before this. The pancytopenia improved and a considerable increase in leukæmic lymphocytosis took place after splenectomy. The child remains well on chlorambucil treatment three years after the initial presentation.
PULMONARY CRYPTOCOCCOSIS IN SOUTH AUSTRALIA
Authors: RICHARDSON J. P.
Published: September 2017

Twelve cases of pulmonary cryptococcosis occurring over a 10‐year period in South Australia (which has a population of approximately one million) are reported. All lesions were resected surgically.

A significantly large proportion of these patients were of Australian Aboriginal stock.

Eight cases were complicated by the presence of cryptococcal meningitis.

Meningo‐encephalitis appears to be the most significant clinical complication of the disease, and was the cause of two deaths in this series.

Surgical resection of the pulmonary lesion is recommended to prevent infection or reinfection of the central nervous system by hæmatogenous spread. No mortality nor morbidity can be ascribed to pulmonary resection in this series.

Provided meningeal infection can be controlled initially by chemotherapy, subsequent resection of a residual pulmonary lesion may cure the patient of cryptococcosis.
ANTIBODY TO GASTRIC INTRINSIC FACTOR IN BLOOD DONORS AND HOSPITAL PATIENTS
Authors: UNGAR BERTA
Published: September 2017

Antibody to gastric intrinsic factor was detected in the serum of five of 700 hospital patients (0·7%) aged over 50 years, but in none of 400 hospital patients aged below 50 years and in none of 500 blood donors aged below 60 years. Four of these five patients were further investigated : all four had latent pernicious anæmia and two of the patients had extremely low serum levels of vitamin B12 (30 and 60 pg. per millilitre).

It is suggested that the presence of circulating intrinsic factor antibody in five of 700 hospital patients could indicate an overall incidence of latent pernicious anæmia in the vicinity of 1% in hospital patients aged over 50 years.
METABOLIC AND HORMONAL STUDIES IN A PATIENT WITH PRIMARY ALDOSTERONISM, PRESENTING WITH ACUTE HYPOKALÆMIC PARESIS INDUCED BY CHLOROTHIAZIDE
Authors: STOKES G. S. , GENTLE JANICE L. , EDWARDS K. D. G. , SCOGGINS B. A. , COGHLAN J. P.
Published: September 2017

Primary aldosteronism was discovered in a woman aged 27 years known to have been hypertensive for four years, and who presented with severe muscular weakness of acute onset after one week's treatment with chlorothiazide. Metabolic studies were carried out at three levels of sodium intake—“ normal ”(84 mEq per day), “ high ”(200 mEq per day) and “ low ”(16 mEq per day)—and also during treatment with desoxycorticosterone acetafe or spironolactone. Sodium loading caused a significant fall in the serum potassium concentration from 4·6 to 3·4 mEq/l., and a significant increase in the urinary potassium excretion from 165 mEq per day to 215 mEq per day. The plasma renin activity was abnormally low, being suppressed under all conditions of testing to a level below the lower limit of sensitivity of the assay used. The plasma aldosterone concentration was consistently high (mean 45, range 18 to 64 mµg. per 100 ml). Removal of an aldosterone‐producing tumour resulted in correction of the abnormal plasma levels of aldosterone and renin, and relief of hypertension and hypokalæmia.
NATURAL HISTORY OF ACTIVE CHRONIC HEPATITIS
Authors: MISTILIS STEVEN P. , SKYRING A. P. , BLACKBURN C. R. B.
Published: September 2017

The aim of the present study was to outline the natural history of active chronic hepatitis. Data from 82 patients, suitably arranged for electronic data processing, relating to the onset, clinical course, liver function, morbidity, mortality, prevalence of endocrine changes and diseases in other organs, L.E. cell phenomenon and tissue antibody reactions, were analysed. Cumulative survival was calculated by the life table method.

The criteria for the diagnosis of active chronic hepatitis are defined and features permitting differentiation from other closely related disorders emphasized. Most patients were females with a peak age incidence of 11 to 30 years. One‐third had an onset identical with viral hepatitis, and two‐thirds had an insidious onset with a variable clinical presentation. The presence or absence of jaundice, hyperglobulinæmia and L.E. cells, the particular age group or sex, multi‐organ involvement, endocrine changes, marked elevation of the SGOT level or abnormal tissue antibody reactions, made little difference to the over‐all clinical picture. Florid signs of hypercorticism were distinctly uncommon in the absence of steroid therapy.

The serum bilirubin content was usually below 10 mg. per 100 ml., the SGOT level rarely exceeded 500 units per millilitre, and hyperglobulinæmia exceeding 7·0 grammes per 100 ml. was found in only nine cases. Hypersplenism was common, and antinuclear factors were frequently detected in patients who had no L.E. cells.

Recurrent episodes of active liver disease, with or without liver failure, punctuated the course. Twentyper centumof patients had an anicteric disease. Hypersplenism was common, even in the absence of cirrhosis. Patients spent 6% to 30% of their time in hospital. The disease became inactive in 41%. In no case could reversibility of disease be documented. All patients eventually developed cirrhosis with or without portal hypertension.

There were 21 deaths. Only six patients have so far survived for 10 years. Fiftyper centumof deaths occurred in the first few years, when the disease was most active. Certain factors appear to influence the prognosis. Cumulative survival was only slightly better than that reported in other forms of cirrhosis.
HYDATID PULMONARY EMBOLISM1
Authors: RICHMOND D. R. , BERNSTEIN L.
Published: September 2017

The clinical features and autopsy findings of a case of ruptured hydatid cyst of the liver, with recurrent pulmonary embolism and terminal anaphylaxis, are described.
NATURAL HISTORY OF ACTIVE CHRONIC HEPATITIS
Authors: MISTILIS STEVEN P.
Published: September 2017

This study was designed to clarify the natural history of active chronic hepatitis in terms of its pathology. One hundred and fifty liver biopsy sections were studied from 82 patients with the disorder. Attention was directed to the diagnostic changes in various stages of the disease, to the histogenesis of cirrhosis and to those changes important in predicting prognosis. The importance of a liver biopsy in diagnosis was assessed and the pathological changes were compared with findings in clinically related disorders such as persistent hepatitis, cryptogenic cirrhosis, primary biliary cirrhosis, acute infectious hepatitis and pericholangitis. An attempt was made to assess the relationship between clinical manifestations and severity of active chronic hepatitis on the one hand, and the type and severity of the histological change on the other. Biopsy changes in treated patients were compared with changes in those who did not receive corticosteroids, azathioprine or 6‐mercaptopurine.

Active chronic hepatitis may be diagnosed from aspiration biopsy specimens, which show the changes of both acute and chronic perilobular hepatitis. The changes appear to be specific and biopsy often provides the only means of diagnosing the disorder. The course of the disease is highly variable and is characterized by repeated episodes of necrosis.·, Necrosis of entire consecutive lobules may account for clinical episodes of spontaneous hepatic coma. Patients with evidence of lobular or submassive necrosis have a subsequent poor prognosis. All patients eventually develop cirrhosis, but over half have histologically active disease during the entire course. In no case could reversibility of the process be demonstrated. There is no justification for previous terminology which divides the disease into sub‐groups, as these appear to be merely clinical variants of the same pathological process.
THE EXCRETION OF FREE NORADRENALINE AND ADRENALINE BY HEALTHY YOUNG SUBJECTS AND BY PATIENTS WITH ESSENTIAL HYPERTENSION
Authors: NESTEL P. J. , DOYLE A. E.
Published: September 2017

The possible relationship between arterial pressure and the excretion of free noradrenaline and adrenaline in the urine was the subject of a study of 58 university students and 33 patients with untreated essential hypertension. The urine was collected during the morning with the subjects fasting, recumbent and undisturbed.

The mean excretion rate of free noradrenaline by the students was 0.94 µg. per hour and by the hypertensives, 1.65 µg. per hour. The mean excretion rates of free adrenaline were 0.47 and 0.73 µg. per hour respectively. Although the difference in catecholamine excretion rates between the two groups was highly significant (P = < 0.01), there was a considerable overlap.

There was a significant correlation with the student group between the excretion of both free noradrenaline and adrenaline and the systolic blood pressure, demonstrating that, in normal subjects, casual blood pressure at rest is partly although not very closely related to catecholamine production. Although catecholamine excretion rates were higher in the hypertensive group, a significant correlation with blood pressure was not found.
LACTOSE INTOLERANCE IN VARIOUS ETHNIC GROUPS IN SOUTH‐EAST ASIA
Authors: BOLIN T. D. , CRANE G. G. , DAVIS A. E.
Published: September 2017

A study to determine the incidence of lactose intolerance in asymptomatic Australian, Chinese and Indian students and a group of New Guinea natives was made. No Australian student had lactose intolerance, but the incidence among a group of 21 Chinese students was 86%. All the eight New Guinea natives studied were affected, as were four of the five Indian students.

The retiology of primary adult lactose intolerance is discussed. An adaptive decline in intestinal lactase activity after weaning is favoured as the probable cause. The socio‐economic implications of milk in food aid programmes are stressed.
A FUNCTIONING MALIGNANT PHÆOCHROMOCYTOMA OCCURRING IN A PATIENT WITH NEUROFIBROMATOSIS
Authors: CAMPBELL C. B. , MORTIMER R. H.
Published: September 2017

A man aged 43 years with von Recklinghausen's neurofibromatosis presented originally with exertional angina. The subsequent development of a metastatic lesion near the left scapula led to the diagnosis of a functioning malignant phæochromocytoma with widespread secondary deposits. Clinical and necropsy findings are reported and pathological features are discussed. The association of neurofibromatosis with phæochromocytomas is well documented, but very few cases with undoubted malignancy have been previously reported.
FIBRINOLYSIS AND OBESITY: THE EFFECT OF WEIGHT REDUCTION
Authors: GRACE C. S.
Published: September 2017

In eight obese subjects the initially low level of fibrinolytic activity increased after significant weight reduction. Reduction to a normal weight resulted in normal fibrinolytic activity, which was maintained when an isocaloric diet was resumed. Subsequent weight gain in two subjects caused a return of fibrinolytic activity to its initially low level. Overall, the ultimate level of fibrinolysis achieved was closely related to the degree of obesity.

The changes in fibrinolysis appeared to be unrelated to changes in plasma levels of fibrinogen, triglyceride, cholesterol, free fatty acids and glucose.
THE PHYSICIAN'S VIEW OF LABORATORY PERFORMANCE
Authors: CAMPBELL D. G. , OWEN J. A.
Published: September 2017

The standard of laboratory performance considered desirable by a group of physicians has been ascertained by means of a questionnaire. The standard requested was, in general, greater than most laboratories are at present able to achieve.
HYPOFIBRINOGENÆMIA WITH A POSSIBLY DEFECTIVE FIBRINOGEN ASSOCIATED WITH FIBRINOLYSIS
Authors: FANTL P.
Published: September 2017

Blood coagulation tests carried out on a patient about to undergo prostatectomy revealed a prolonged plasma‐thrombin coagulation time which was shown to be due to the presence of abnormal fibrinogen in the patient's blood. Details are given of the coagulation studies performed, together with a discussion of the little known group of coagulation deficiencies caused by fibrinogen disorders.
A PLATELET CYCLE IN NORMAL INDIVIDUALS
Authors: MORLEY ALEC
Published: September 2017

Oscillation of the platelet count was found in 4 of 11 normal individuals. This finding suggests that platelet production in at least some normal individuals is controlled by a negative feedback circuit containing a time delay. This type of circuit is known to be capable of stable oscillation. The periods of oscillation were between 21 to 35 days and are similar to those found in cyclical thrombocytopenia. These and previous findings suggest that many physiological parameters might be oscillatory due to the action of normal homeostasis. Periodic disease could then result from the oscillation being rendered more apparent or from the system changing from damped to stable oscillation.
THE HORMONAL RESPONSE TO PHYSICAL EXERCISE
Authors: SUTTON J. R. , YOUNG J. D. , LAZARUS L. , HICKIE J. B. , MAKSVYTIS J.
Published: September 2017

Studies of the hormonal response to physical exercise were performed on young males who were classified as physically fit or unfit. The studies included serial measurements of blood sugar, plasma free fatty acids (FFA), serum growth hormone (HGH), serum insulin, serum glucagon and plasma cortisol levels during and following a 30‐minute period of maximal physical exercise.

The hormonal response in both groups was similar except in the case of HGH. In both groups there was an elevation of HGH level during exercise, but in the fit group HGH returned to basal levels within 30 minutes, whereas in the unfit group the HGH level continued to rise for a further hour before decreasing.

These results confirm that HGH secretion occurs during vigorous muscular exercise, and that in the unfit subject there is a delay in the return of HGH to basal levels following exercise. Studies during submaximal exercise revealed an elevation of HGH only in the unfit group. The possibility of anaerobic metabolites acting as the stimulus for HGH in exercise was investigated by infusion of sodium lactate, which caused a significant elevation of HGH level.

From the above data we conclude that a characteristic of physical fitness is a rapid return of HGH secretion to basal levels following vigorous muscular exercise.
SOME EXPERIMENTAL OBSERVATIONS RELATING TO THE PATHOGENESIS OF RENAL PAPILLARY NECROSIS
Authors: HAM K. N. , TANGE J. D.
Published: September 2017

Renal papillary necrosis was induced in female Wistar rats by a single dose of vinylamine. Damage to the renal papilla invariably ensued and was evident on light microscopy eight hours later. The changes comprised intracellular and extracellular œdema, endothelial damage, and necrosis of interstitial and epithelial cells ; these changes commenced at the tip of the papilla and spread towards but not beyond its base.

The state of the medullary circulation was assessed by using colloidal carbon, which was injected intravenously and allowed to clear from the systemic circulation before tissues were taken for examination. As the lesion progressed, carbon accumulated in vessels, first at the tip and later at the base of the pyramid, and protein in the loops of Henle at the same levels. Extensive carbon labelling of damaged vessels in the early lesion indicated that the circulation continued for a time through this zone. After the histological appearances of necrosis were fully developed, there was no carbon labelling and no circulation could be demonstrated in the damaged tissue. There was no evidence of significant vascular lesions outside the papilla. Intravascular fibrin could not be demonstrated histochemically.

It seems probable that vinylamine damages the cells of the medulla, and that there is severe fluid and protein loss into the interstitial tissue. Such fluid loss, in its turn, is followed by impaction of red cells and further slowing of the already sluggish circulation in the venous limbs of the medullary capillary loops.

In rats allowed to survive for weeks or months, the necrotic papilla sloughed and the adjacent tissue became covered with epithelium. In the cortex, areas of tubular atrophy, tubular dilatation, and scarring alternated with normal tissue. Such areas of cortical damage were often small and focal. These findings suggest that tubular obstruction is not inevitable after loss of the papilla and that other factors may influence the associated renal cortical scarring.

The same general pathological processes determine the occurrence of renal papillary necrosis in various clinical and experimental situations. The observations recorded here suggest that two of these processes are direct local tissue injury and venous circulatory stasis.
EXPERIENCES WITH EMERGENCY PORTA‐CAVAL SHUNT
Authors: HOFFMAN D. C. , JEPSON R. P. , HARRIS J. D.
Published: September 2017

(1) Our experiences with 20 cases of emergency porta‐caval shunt for bleeding cesophageal varices are reviewed.

(2) The difference in behaviour between cryptogenic and alcoholic cirrhotics is outlined, and the need for strict selection in the case of the latter group is emphasized.

(3) It is our view that, if liver function is good, this operation is the preferred emergency treatment for persistent bleeding from cesophageal varices.

(4) For those alcoholics with significantly impaired liver function, no adequate therapy appears available.
PARAPROTEIN PATTERNS IN AUSTRALIA
Authors: PENNY RONALD
Published: September 2017

Seventy‐eight patients with serum and/or urinary paraproteins were studied, and their clinical and immunological features are presented. The clinical manifestations that depend on the biological activity of the paraprotein are emphasized.

The disorders associated with the presence of the paraprotein included myeloma (47 cases), macroglobulinremia (14 cases), amyloidosis (six cases) and various tumours, for example carcinoma, sarcoma, hepatoma (seven cases). The paraproteins were gamma‐G (41 cases), gamma‐A (w cases), gamma‐M (17 cases), gamma‐D (two cases), Bence Jones protein alone (six cases) and diclonal (two cases).

In those patients without myeloma or macroglobulinremia, an abnormal or long‐standing stimulus to the immune system is found in a proportion of cases, and this may be of pathogenetic significance.
AMILORIDE HYDROCHLORIDE, A HYPERCALCIURIC DIURETIC
Authors: JOHNY K. V. , LAWRENCE J. R. , O'HALLORAN M. W.
Published: September 2017

Administration of amiloride hydrochloride, a new potassium‐sparing diuretic, to six healthy volunteers for seven days produced significant hypercalciuria. No consistent interrelationship between the urinary excretion of calcium and magnesium, potassium or phosphorus was demonstrable. Three subjects with marked hypercalciuria showed no significant correlation between urinary calcium and sodium excretion, whereas one with marked hypercalciuria and two others with moderate or no hypercalciuria showed a significant correlation. A direct influence on the renal tubular handling of calcium, perhaps augmented by sodium diuresis, is suggested as a possible explanation for this hypercalciuric effect.
SURVIVAL STUDIES ON A COMMERCIAL PREPARATION OF INTRAVENOUS HUMAN GAMMAGLOBULIN LABELLED WITH 131I
Authors: WELLS J. VIVIAN , PENNY R.
Published: September 2017

The biological activity of a new preparation of human gammaglobulin (HGG) was assessed by performing metabolic protein survival studies with 131I‐labelled HGG(C.S.L.). The subjects included two normal controls and one patient each with cirrhosis, G‐myeloma and hypogammaglobulinæmia.

In addition to IgG, the HGG(C.S.L.) contained 33 mg/100 ml IgM, less than 10 mg/100 ml IgA, and no detectable complement (as C′3) when assessed by immunological techniques.

There were no reactions to the injected 131I‐HGG(C.S.L.), but all subjects showed significantly increased urinary excretion of free 131I in the initial 48 hours of the turnover study. This suggested that a proportion of IgG molecules in the HGG(C.S.L.) had been structurally altered during preparation. The catabolism of HGG(C.S.L.) was abnormally increased in normal controls, with a short half‐life and increased fractional turnover rate.

In hypogammaglobulinæmia, both the plasma half‐life and fractional turnover rate were normal, and further studies and clinical trials on the efficacy of this preparation in this disease are warranted.
Low Density Lipoprotein Peptide Metabolism in Nephrotic Syndrome
Authors: Scott P. J. , White B. M. , Winterbourn Christine C. , Hurley P. J.
Published: September 2017

Using human serum low density lipoprotein labelled in the peptide component with 131I or 125I, turnover studies were carried out in nine patients suffering from nephrotic syndrome with accompanying hyperlipoproteinaemia. Results were compared with data obtained previously in a group of normal subjects, and with similar information from patients whose hyperlipoproteinaemia was associated with syndromes other than nephrosis.

Fractional catabolic rates were normal in the nine patients with nephrotic syndrome and in four patients with diabetes mellitus and hyperlipoproteinaemia. This pattern was similar to that previously described for patients with two forms of primary familial hyperlipoproteinaemia, but differed from the pattern reported for myxoedema in which hyperlipoproteinaemia was associated with a reduced fractional catabolic rate for low density lipoprotein peptide. In hypothyroidism the absolute catabolic rate was within the range observed in normal people, whereas in nephrosis and in primary or familial hyperlipoproteinaemia there was an increase in absolute turnover although the fractional rates were normal.

From analysis of plasma decay curves it was concluded that in nephrotic syndrome, and in myxoedema, the proportion of the total miscible low density lipoprotein pool lying outside the plasma compartment was reduced.
The Occult Thymoma
Authors: Hare W. S. C. , Andrews J. T.
Published: September 2017

Thymomata which are too small to be detected by plain radiography, may be demonstrated by pneumomediastinography, thymic venography, and selenomethionine scanning of the mediastinum. These techniques were valuable in demonstrating a tumour in a woman with myasthenia gravis, leading to thymectomy.
The Measurement of Faecal Chymotrypsin
Authors: Muller L. , Wisniewski Z. S. , Hansky J.
Published: September 2017

Estimation of faecal chymotrypsin in a 24 hour stool specimen in a group of normal control subjects and patients with pancreatic exocrine insufficiency provides a useful, simple and practical screening test for the diagnosis of exocrine pancreatic insufficiency. Normal faecal chymotrypsin levels, especially in the presence of steatorrhoea, rule out the diagnosis of chronic pancreatitis as the cause of malabsorption. This test will not obviate the use of more sophisticated tests such as secretin stimulation but will enable the tests to be performed as confirmatory rather than screening procedures.
Medullary Thyroid Carcinoma
Authors: Johnston C. I. , Martin T. J. , Riddell J.
Published: September 2017

The clinical features of a 45 year old woman with proven medullary carcinoma of the thyroid are described. The disease ran a typical prolonged course over 12 years with local recurrence of the tumour. Generalised spread of the carcinoma was associated with persistent and intractable diarrhoea for which no local bowel pathology could be ascertained. She also had hilar lymphadenopathy and a recurrent bloody malignant pericardial effusion with cardiac tamponade. Biochemical investigations revealed normal thyroid function with no extrathyroidal uptake of a thyroid marker, and normal calcium and phosphorous metabolism. Plasma calcitonin assays showed a grossly elevated level of 8 MRC milli units/ml, which rose after an intravenous infusion of calcium chloride. Biopsy of tumour metastases demonstrated small spindle shaped neoplastic cells arranged in large alveolar groups and amyloid stroma. This case demonstrates many of the typical clinical, biochemical and histological features of the disease and adds further evidence that medullary carcinoma of the thyroid is a tumour not of thyroid tissue but of the parafollicular or C cells of the thyroid which produce calcitonin. Furthermore, pre‐operative assay of plasma calcitonin may be of diagnostic value in cases of thyroid tumours.
Angiokeratoma Corporis Diffusum Universale (Fabry's Disease)
Authors: Duncan Campbell , McLeod Graham M.
Published: September 2017

A 53‐year‐old man with angiokeratoma corporis diffusum universale died after cerebral infarction. He was known to have atrial fibrillation for 11 years. Postmortem examination of the heart showed gross involvement of myocardial cells with lipid deposits. The clinical findings during life and the appearances of the myocardium by both light and electron microscopy are presented.
Selective Deficiency of IgA Immunoglobulins Associated with Carcinoma of the Stomach
Authors: Fraser Kevin J. , Rankin James G.
Published: September 2017

The case record of a patient with carcinoma of the stomach in association with a selective deficiency of IgA immunoglobulins is presented. The significance of this finding is discussed in relation to the aetiology of the tumour and to the length of survival of the patient following its resection.
Abdominal Apoplexy in Rheumatoid Arthritis
Authors: Webb John , Payne W. H.
Published: September 2017

A case of haemoperitoneum due to ruptured middle colic artery aneurysm, a rare complication of necrotising arteritis occurring in rheumatoid arthritis, is described. The types of arteritis which complicate rheumatoid arthritis are briefly discussed.
Electrical Cardiac Pacing in Patients Without Heart Block
Authors: Kiss Z. S. , Smith D. , Sloman G.
Published: September 2017

Six patients with recurrent supraventricular or ventricular arrhythmias unresponsive to conventional medical treatment were selected for a trial of electrical pacing in an attempt to control the arrhythmias. All six patients had disabling symptoms, and had documentation of the arrhythmias. In five of the six patients the trial of pacing, combined with drug therapy was successful. Treatment has continued using an implanted cardiac pacemaker.
In‐Vivo Intestinal Mucosal Uptake of Iron, Body Iron Absorption and Gastric Juice Iron‐Binding in Idiopathic Haemochromatosis
Authors: Powell L. W. , Wilson Elizabeth
Published: September 2017

Normal gastric juice possesses considerable iron‐binding properties. In patients with idiopathic haemochromatosis gastric juice iron‐binding did not differ significantly from normal and venesection therapy resulted in only minor changes in the iron‐binding ability.

In‐vivo intestinal mucosal uptake of iron and body iron absorption (retention) were both significantly increased in patients with haemochromatosis after venesection therapy but the results showed no significant relationship to the degree of gastric juice iron‐binding in either patients with haemochromatosis or normal subjects. Neutralized gastric juice from patients with idiopathic haemochromatosis did not significantly affect intestinal mucosal uptake or body iron absorption in subjects with histamine‐fast achlorhydria when compared with normal, neutralized gastric juice. In four patients with idiopathic haemochromatosis who had not been subjected to venesection treatment, the results for mucosal uptake were within the normal range whereas body iron absorption was significantly increased.

These findings do not support the hypothesis that the increased iron absorption in patients with idiopathic haemochromatosis results from a defect in gastric secretion. On the contrary, they point to a mucosal rather than a luminal abnormality in this disease.
Factors Influencing the Prognosis of the Alcoholic Patient with Cirrhosis
Authors: Rankin James R. , Wilkinson Patricia , Santamaria Joseph N.
Published: September 2017

Seventy seven alcoholic patients, 54 men and 23 women were found to have cirrhosis of the liver when they first attended the Alcoholism Clinic at St. Vincent's Hospital, Melbourne, between July 1964, and June 1968. Seven of these patients were in the terminal phase of their illness and died without leaving hospital. Fourteen patients attended the clinic only briefly and could not be traced subsequently. The remaining 56 alcoholic patients, 40 men and 16 women with histologically proven cirrhosis were followed for periods of from ten to 57 months (mean 31 months). Mortality and morbidity from complications of cirrhosis were correlated with the patients' drinking habits during the period of study, their occupational status and their sex.

Fourteen patients gave up alcohol completely, 17 reduced their alcohol intake, while 25 did not modify their drinking habits. The periods of follow‐up were similar in these three groups and also in men compared with women, and in men of “white‐collar” occupational status compared with “blue‐collar” male workers.

The most important factor influencing the clinical course of cirrhosis in this series of patients was the continued consumption of alcoholic beverages. All but one of the 14 patients who stopped drinking were alive at the end of the study, and had been symptomfree from the time of initial therapy. Eight of the 42 patients who continued to drink had died, and 23 had experienced episodes of jaundice, hepatic encephalopathy, ascites or haemorrhage from oesophageal varices.

Social class also appeared to influence the outcome of established alcoholic cirrhosis. “Blue‐collar” workers presented more often with symptomatic cirrhosis, and subsequently experienced greater morbidity and mortality.

Morbidity and mortality were not significantly different in men and women with alcoholic cirrhosis.

These results suggest that in the patient with alcoholic cirrhosis, where the prognosis for the underlying alcoholism is good, the outlook for cirrhosis is also favourable and vigorous treatment of both conditions is indicated.
Effect of Vagotomy on Serum Gastrin in Patients with Duodenal Ulceration
Authors: Byrnes D. J. , Lazarust L. , Young J. D.
Published: September 2017

The concept of increased vagal activity in patients with duodenal ulceration was investigated by observing the effect of medical and surgical vagotomy on the secretion of gastrin.

Using a radioimmunoassay technique fasting serum levels of gastrin were determined in 41 normal subjects, 40 patients with duodenal ulceration and 16 patients following vagotomy. The effect of atropine on gastrin secretion was observed in a further 2 patients with duodenal ulceration.

The patients with duodenal ulceration were found to have elevated serum levels of gastrin. The 8 patients with “complete” vagotomy had significantly lower serum levels of gastrin than the patients with duodenal ulceration, the patients with an “incomplete” vagotomy or the normal subjects. Post‐vagotomy hypergastrinaemia was associated with a recurrence of ulceration.

The abolition, by medical or surgical vagotomy, of the hypergastrinaemia associated with duodenal ulceration is consistent with the hypothesis of an increased vagal tone in this disease. These studies also suggest that gastrin estimations may be useful in predicting the presence of inadequate vagotomies.
Measurement of Glomerular Filtration Rate using a Single Injection of 51Cr‐Edetic Acid
Authors: Bailey R. R. , Rogers T. G. H. , Tait J. J.
Published: September 2017

A simple method of estimating the glomerular filtration rate using a single injection of 51 Cr‐EDTA is described. The technique, which avoids urine collections, has been found to correlate well with the 24 hour endogenous creatinine clearance over a wide range of renal function. The complex is not attached to erythrocytes or significantly bound to plasma proteins. In non‐oedematous patients equilibration in the body space is completed in under 2 hours, following which an exponential fall in plasma activity occurs.