bluuebunny/crossref_metadata_2025 huggingface dataset:
HUMAN CRYPTOSPORIDIOSIS IN NORTH QUEENSLAND
Authors: CRUICKSHANK R. , ASHDOWN L. , CROESE J.
Published: March 2008

:During a 12‐month period, feces from 780 persons from the Townsville region were evaluated by the Kinyoun acid‐fast strain, and 36 (4.6%) immunocompetent patients were found to have Cryptosporidium oocysts. Twenty‐five index cases were identified; 13 (8.6%) cases from 151 patients were from Palm Island, an isolated Aboriginal community in the wet tropics and 12 (1.9%) cases from 629 patients were from the dry tropics of Townsville. All 11 secondary cases were associated with a person‐to‐person outbreak in the nursery of a Townsville day‐care centre. Infection occurred mainly in two distinct age groups: the under five‐year‐old (27 cases), and the 25 to 35‐year‐old (six cases). A prodrome of dry cough, rhinorrhea and vomiting often preceded symptoms of fever, weight loss, abdominal pain, persistent cough and vomiting, and acute diarrhea with frequent, non‐bloodstained, watery, mucous stools. Although 13 patients were hospitalised because of their illness, the infection was self‐limiting and all 36 patients recovered with symptomatic treatment. Cryptosporidium was the third most commonly identified enteric pathogen after Rotavirus and Giardia. Infection did not appear to depend on seasonal variation and no animal or environmental sources of infection were identified. Cryptosporidiosis in immunocompetent persons is endemic and common in North Queensland and routine investigations for this parasite in symptomatic patients are warranted.
HIGH INCIDENCE OF EARLY LEUKEMIC RELAPSE IN PATIENTS GIVEN CYCLOSPORIN AND T CELL DEPLETED HLA‐IDENTICAL SIBLING MARROW TRANSPLANTS FOR ACUTE LEUKEMIA IN FIRST REMISSION*
Authors: ATKINSON K. , BlGGS J. , DODDS A. , CONCANNON A. , DOWNS K. , ASHBY M. , McKENZlE I. F. C.
Published: March 2008

:Twelve patients with acute nonlymphoblastic leukemia (ANL, n = 6) or acute lymphoblastic leukemia (ALL, n = 6) in first complete remission received cyclophosphamide 120 mg/kg and total body irradiation (TBI) 12 Gy followed by HLA‐identical sibling marrow that had been depleted of T cells by incubation with anti‐CD2 (with or without anti‐CD8) monoclonal antibody and rabbit complement. These 12 patients were compared historically to 25 patients with ANL (n = 15) or ALL (n = 10) in first remission given cyclophosphamide 120 mg/kg and TBI 12 Gy followed by non‐T cell depleted HLA‐identical sibling marrow for parameters of relapse and survival. Thirty‐six of the 37 patients received cyclosporin as post transplant prophylaxis for graft‐versus‐host disease (GVHD). All surviving patients have been followed for a minimum of one year from transplant. The actuarial rate of leukemic relapse in the T‐depleted group was 62% compared to 37% in the non‐depleted group (p< 0.02). Additionally, relapse occurred significantly earlier post transplant in the T‐depleted recipients (p = 0.012). Actuarial survival at two years post transplant was 24% for the T‐depleted recipients and 41 % at six years post transplant for the non‐depleted recipients (not significant, p = 0.37). We have previously shown that GVHD is less severe in patients given T cell depleted transplants. Taken together, these findings suggest that (under the protocol conditions used) a graft‐versus‐leukemia effect is not separable from a GVHD effect in man. More effective anti‐leukemia therapy must be devised before the benefit of T cell depletion can be applied to patients with ANL or ALL receiving HLA‐identical sibling marrow transplants in first remission. (Aust NZ J Med 1988; 18: 587–593).
ASSESSMENT OF AORTOCORONARY BYPASS GRAFT PATENCY BY INTRA‐ARTERIAL DIGITAL SUBTRACTION ANGIOGRAPHY COMPARED TO SELECTIVE GRAFT ANGIOGRAPHY
Authors: GRIGG L. E. , HUNT D. , CHAN W. , THOMSON K.
Published: March 2008

The value of digital subtraction angiography (DSA), in assessing aortocoronary bypass graft patency, was evaluated by studying 22 consecutive patients with 54 aortocoronary saphenous vein bypass grafts, who had postoperative angina pectoris. Each patient underwent selective graft angiography and non‐gated DSA. The DSA consisted of a run of 15 to 20 frames, taken at 2.3 frames per second during injection of diluted contrast in the ascending aorta, performed after a test exposure was made.

Thirty‐two of the 54 grafts (59%) were patent. Thirty of the 32 grafts were seen to be patent by both selective graft angiography and DSA. In addition, a further two grafts were found to be patent on DSA, but were not able to be selectively catheterised and were not seen on the conventional aortogram. Selective graft angiography revealed four tight proximal graft stenoses, of which one only was seen on DSA; and poor distal run‐off in five grafts, two of which showed up as late filling grafts on DSA.

In summary, the accuracy of intra‐arterial DSA in assessment of bypass graft patency was excellent. All grafts seen to be patent on selective graft angiography were also seen by DSA alone and in addition two grafts which could not be selectively catheterised were found to be patent. However, in patients with postoperative chest pain, selective graft angiography is probably required as non‐gated intra‐arterial DSA does not provide sufficient information to assess graft stenoses, distal flow and the native coronary vessels.
AUTOIMMUNE CARDIOLIPIN‐BINDING ANTIBODIES IN ORAL ANTICOAGULANT PATIENTS
Authors: EXNER T. , KOUTTS J.
Published: March 2008

In a routine clinic of patients taking regular oral anticoagulant therapy (warfarin, n= 140) 14% were found to have elevated levels (>4 SD above normal) of anticardiolipin antibody (ACA) assessed by a well standardised enzyme linked immunosorbent assay (ELISA).

There was a higher incidence of raised ACA in patients being treated for thrombotic episodes (9/47 = 19%) than in cases with heart valve replacements (8/75 = 11%). Furthermore, the highest ACA titres were in younger patients with thromboses scheduled for short‐term anticoagulant treatment. Borderline DNA binding studies, together with some positive ANA results, suggested autoimmune etiology in the minority of these cases. Lupus anticoagulant was strongly detectable in only one such patient.

The ACA were predominantly IgG (14/17) and did not appear to compromise the conditions of patients while on anticoagulant therapy. Raised ACA may be a highly significant marker for an acquired prothrombotic state.
USE OF A DNA PROBE IN THE DIAGNOSIS OF ADULT POLYCYSTIC KIDNEY DISEASE
Authors: SAVIGE J. A. , PATRIKIOS V. , ALDRED P. , KINCAID‐SMITH P.
Published: March 2008

Adult polycystic kidney disease (APKD) is one of the most common inherited diseases in man. A diagnosis based on the demonstration of renal cysts with ultrasonography or computerised tomography may be inconclusive in early adulthood, the crucial years before child‐bearing is complete. Here we describe the improved diagnostic probability that is possible using genetic linkage studies.

A 24‐year‐old woman, whose father and younger sister were affected by APKD, was demonstrated to have a single cyst in each kidney. These findings were insufficient for a diagnosis of APKD1 and for this reason genetic linkage studies were undertaken. DNA was extracted from peripheral blood leukocytes from the presenting individual, and her immediate and extended family; the DNA was cut with the restriction enzyme PvuII, electrophoresed in a 0.7% agarose gel and blotted onto nitrocellulose before probing with a 32P‐labelled 4 kb fragment. This contained DNA from the hypervariable region (3′ hypervariable region, 3′HVR) that is linked to the gene for APKD on the short arm of chromosome 16 and has been used in other family studies by Reeders et al.2 We correlated the findings on Southern blotting with ultrasound evidence of APKD and found that the disease segregated with a 7.0 kb fragment in the presenting individual's father and sister. She was shown to have inherited this allele also; the use of this technique thus increased the probability of her having APKD from 50% to 96.5%.3
MYCOBACTERIUM BOVIS AS AN OCCUPATIONAL HAZARD IN ABATTOIR WORKERS
Authors: ROBINSON P. , MORRIS D. , ANTIC R.
Published: March 2008

Five cases of bovine tuberculosis occurred in a two year period in South Australia, which represents a higher incidence than in previous years. All five patients had a history of employment in an abattoir (although four different abattoirs were involved) and four of the cases had pulmonary or pleural TB. A voluntary survey of one of the abattoirs was conducted which discovered the fifth case of active pulmonary TB.

We suggest that bovine TB should be considered an occupational hazard in abattoir workers, and that suitable pre‐employment screening programmes for workers be established. The transmission of disease in these cases is almost certainly by inhalation causing pulmonary TB and is therefore different from the ‘classic’ form of bovine TB transmitted by ingestion of infected milk and resulting in extrapulmonary disease.
DIFFUSE HISTIOCYTIC LYMPHOMA: THE 20‐YEAR EXPERIENCE OF AN AUSTRALIAN TEACHING HOSPITAL
Authors: BURROW J. N. C. , WRIGHT J. , JUTTNER C. A. , CROWLEY K. S. , KIMBER R. J.
Published: March 2008

There is a paucity of information regarding the natural history and treatment outcome of diffuse histiocytic lymphoma (DHL) in Australia. Case records from 80 patients treated for DHL at the Royal Adelaide Hospital between 1965 and 1985 were reviewed to determine treatment outcome and prognostic information. Pathological review of biopsy specimens confirmed the correct diagnosis in 78 patients.

The Ann Arbor staging criteria were unsatisfactory for prognostic purposes. We identified three prognostic groups: Localised disease (82% five‐year survival), Advanced disease marrow negative (36% five‐year survival), and Advanced disease marrow positive (11 % five‐year survival). An elevated plasma lactate dehydrogenase (LDH) and calcium (Ca++) predicted a poorer outcome; no patient with a LDH > 500 IU achieved longterm survival (p < 0.001). Survival was identical for patients reclassified histologically as intermediate grade or high grade (Working Formulation).

Localised disease was associated with a good prognosis (82% five‐year survival) regardless of treatment modality. The outcome of patients with advanced disease has markedly improved over the last two decades, particularly with the introduction of combination chemotherapy containing doxorubicin in 1974 (p < 0.005). Using these regimens, complete remission was achieved in 65% of patients, with a 39% five‐year survival.
RENAL DISEASE IN DIABETICS—WHICH PATIENTS HAVE DIABETIC NEPHROPATHY AND WHAT IS THEIR OUTCOME?*
Authors: LYNN K. L. , FRENDIN T. J. , WALKER R. J. , BAILEY R. R. , SWAINSON C. P.
Published: March 2008

From August 1974 to January 1985, 53 patients (26 men; seven Maoris) mean age 45 (SD 15) years, with diabetes mellitus for a mean of 12 (SD nine) years had a renal biopsy and were followed. Indications for biopsy were nephrotic syndrome (24), proteinuria (23), renal impairment (five) and hematuria (one). Mean plasma creatinine concentration was 0.22 (SD 0.18) mmol/L and protein excretion 3.4 (SD 2.5) g/24 h. Diabetic nephropathy was demonstrated in 39 patients and significantly associated with retinopathy and insulin dependent diabetes mellitus (IDDM). Of the 39 patients followed for 25.7 (SD 22.8) months, 18 had died (nine myocardial infarction, six uremia, two sepsis, one stroke) and nine had begun dialysis. The five‐year cumulative renal survival was 28%. The presence of the nephrotic syndrome and the plasma creatinine concentration at presentation were the best predictors of survival. Diabetics with IDDM of 20 years duration, retinopathy and heavy proteinuria, who survive the other complications of their disease, are likely to have diabetic nephropathy requiring renal replacement therapy.
TRACHEAL PAPILLOMATOSIS TREATED WITH Nd‐YAG LASER RESECTION
Authors: HUNT J. M. , PIERCE R. J.
Published: March 2008

We report a case of tracheal papillomatosis in a 69‐year‐old woman who presented with stridor and functional evidence of large airway obstruction. She was successfully treated by endobronchial resection using a Neodymium Yag laser. This provided lasting symptomatic relief of dyspnea. Respiratory papillomatosis is a disease predominantly of the childhood larynx and its presentation with predominant tracheal involvement late in life is extremely uncommon. Laser therapy provides an extremely effective treatment modality for this condition.
POSITIVE RESPONSE TO EDROPHONIUM IN DEATH ADDER (ACANTHOPHIS ANTARCTICUS) ENVENOMATION
Authors: HUDSON B. J.
Published: March 2008

A 20‐year‐old Papua New Guinean male developed neuromuscular paralysis following a bite by a death adder (Acanthophis antarcticus). Ptosis persisted despite otherwise effective anti‐venom therapy. The ptosis clinically resembled myasthenia gravis and improved after intravenous edrophonium. The role of anticholinesterase drugs in snake bite management is discussed.
CLINICAL IMPLICATIONS OF ELECTROPHYSIOLOGY STUDY FINDINGS IN PATIENTS WITH CHRONIC BIFASCICULAR BLOCK AND SYNCOPE
Authors: TWIDALE NICHOLAS , AYRES BRONTE F. , HEDDLE WILLIAM r. , TONKIN ANDREW M.
Published: March 2008

Electrophysiology study was performed in 93 patients with bifascicular block and unexplained syncope. Clinical evidence of organic heart disease was present in 33 (35%). Electrophysiological abnormalities were detected in 45 patients (48%). Of these, 36 had distal conduction disease, including 28 with an HV interval > 55 ms (mean 76.4 ms), and eight who developed infraHisian block following either intravenous procainamide (four) or atrial pacing (four). Sick sinus syndrome was evident in six patients and a further two had carotid sinus hypersensitivity. Sustained monomorphic ventricular tachycardia (VT) was induced in only three patients, two of whom also had prolonged HV interval.

Among the 93 patients, 45 had therapy which was guided by positive findings at electrophysiology study (Group 1). Of these, 42 received permanent pacemakers, two were treated with combined permanent pacing and antiarrhythmic drug therapy, and one was treated with antiarrhythmic drug alone. In addition, eight patients without electrophysiologic abnormalities were treated empirically by pacing (Group 2). Finally, 40 patients without electrophysiologic abnormalities received no specific therapy (group 3). At a mean follow‐up of 39 months (range two‐125 months), recurrence of syncope had occurred in 4% of Group 1 patients, and 25% of Group 3 patients (p < 0.05). No patient in Group 2 had had recurrence. Total mortality was 40%, including 47% of patients in Group 1, 25% of Group 2, and 35% of Group 3. Death was sudden in seven patients.

We concluded that among patients with bifascicular block and syncope, therapy directed by findings at electrophysiology study was associated with symptomatic improvement, but mortality was not significantly influenced. Patients with no electrophysiological abnormality have a high recurrence of syncope which may relate either to undetected bradyarrhythmia or ventricular tachycardia. These results highlight some limitations in current assessment, including, for programmed ventricular stimulation, significant differences in both stimulation protocols and the definition of ventricular tachycardia.
ANTIBODIES TO HIV ARE PRODUCED WITHIN THE CENTRAL NERVOUS SYSTEM OF ALL SUBJECTS WITH ALL CATEGORIES OF HIV INFECTION
Authors: LLOYD A. , ROBERTSON P. , WAKEFIELD D. , DWYER J. M.
Published: March 2008

Anti‐HIV antibodies were found in the cerebrospinal fluid of all 41 subjects tested whose serum contained these antibodies. To ensure that locally produced antibody was being detected, a sensitive assay was used to demonstrate the integrity of the blood‐brain barrier. Antibodies to ubiquitous adenovirus group antigens were sought, simultaneously, in CSF and serum. A lack of adenovirus antibodies in CSF of subjects seropositive for adenovirus was required before CSF anti‐HIV antibodies could be considered to be produced within the central nervous system.

Of the 41 subjects tested eight were asymptomatic, eight were clinically well but had persistent lymphadenopathy, 14 were immunodeficient arid had constitutional symptoms (AIDS‐related complex or ARC) and 11 had AIDS. Ofigoclonal banding was detected in the CSF of 16 subjects and a pleocytosis was present in 24. Neither finding clustered with a particular stage of infection. It appears that HIV infection of T lymphocytes and the central nervous system occurs simultaneously, early in the course of the infection. All HIV infected subjects are at risk of developing primary neurological as well as immunological sequelae. Currently poorly understood resistance factors must protect both lymphocytes and nervous system tissue from damage by the HIV virus, as to date, the majority of infected subjects have not become immunodeficient or developed neurological disease.
ADVANCES IN REPRODUCTIVE MEDICINE: AUSTRALIAN CONTRIBUTIONS
Authors: Burger Henry G. , Buckler Helen M. , Baker H. W. Gordon , Healy David L. , Kovacs Gabor T.
Published: March 2008

Reproductive medicine encompasses a variety of disorders resulting from disturbed gonadal function. Such disorders affect all age groups, and their rational therapy depends on comprehensive understanding of the physiology of the hypothalamo‐pituitary‐gonadal axis and of the pathophysiological disturbances which may occur. In a deliberately selective manner, this review has highlighted Australian contributions which include: new knowledge of the physiology of inhibin; approaches to the management of male infertility; the use of gonadotrophins and gonadotrophin releasing hormone in ovulation induction; new advances in our understanding of the patho‐physiology and management of the polycystic ovarian syndrome; the use of superactive GnRH agonists in the management of disorders such as uterine fibroids and also the use of parenteral estradiol and testosterone replacement in women suffering from sexual dysfunction at the menopause.

The contributions of Australian medicine have been significant.
TREATMENT OF IMPOTENCE BY INTRAPENILE INJECTIONS OF PAPAVERINE AND PHENOXYBENZAMINE: A DOUBLE BLIND, CONTROLLED TRIAL
Authors: KEOGH E. J. , EARLE C. M. , CARATI C. J. , WISNIEWSKI Z. S. , TULLOCH A. G. S. , LORD D. J. , WATTERS G. R.
Published: March 2008

The efficacy of papaverine and phenoxybenzamine as a pharmacological treatment of impotence was compared in a double blind, crossover, placebo controlled trial. Thirty‐four impotent men received intra‐cavernosal injections of papaverine (60 mg), phenoxybenzamine (6 mg) or normal saline (10 ml) at monthly intervals. Observations by EJK up to 45 minutes after injection demonstrated that papaverine caused full erections in 35% of men and partial erections in 62%. Phenoxybenzamine injection resulted in full erections in 20% of men and 62% had partial erections. The differences were not significant. Despite 82–97% of patients attaining some degree of erection in the clinical setting only six of the patients decided to use this mode of treatment for more than three months. Sexual function during the month after injection was better with either drug when compared with placebo.
GIANT CELL ARTERITIS AND AMYLOIDOSIS
Authors: CID MARIA‐CINTA
Published: March 2008

Delahunt et al., ‘recently’ published a very interesting and well documented case of Takayasu's disease associated with amyloidosis.1, 2 The probable AA type of amyloid substance in their case, as well as the lack of any other chronic process able of producing secondary amyloidosis, strongly suggest a causal relationship between both diseases.
LONG‐TERM EFFECTS OF MEGAVOLTAGE RADIOTHERAPY IN ACROMEGALY
Authors: LAM K. S. L. , WANG C. , CHOI P. , MA J. T. C. , YEUNG R. T. T.
Published: March 2008

The progress of 41 Chinese patients with acromegaly treated with megavoltage radiotherapy was reviewed after a mean follow‐up of 4.5 (one‐ten) years. Nine received prior surgery. Radiotherapy was delivered by a 3‐field technique to a total of 4000–5000 cGy in 25 fractions. By life table analysis successful treatment of growth hormone (GH) hypersecretion, as defined by a mean GH concentration of 10 mu/L, could be expected in 6, 11, 26, 64 and 67% of the patients after one, two, five, eight and ten years respectively. Median intervals before achieving a mean GH level of 10 mu/L were 6.6 and 8.6 years following radiotherapy with the higher (4500–5000 cGy) and lower (4000 cGy) doses respectively, suggesting a tendency towards earlier response following radiotherapy with the higher dose. The prevalence of acquired hypopituitarism in patients followed up for over five years was 40% for gonadotrophins, 30% for TSH and 20% for ACTH deficiency respectively. In the majority of patients, acquired hypopituitarism was not apparent within five years after radiotherapy. No mortality or major side effects were noted following radiotherapy. In 34 patients on long‐term bromocriptine treatment, mean GH concentrations were normalised in 26.5% of patients. We conclude that with judicious selection of patients and use of adjunctive medical therapy, megavoltage radiotherapy remains a safe and satisfactory form of treatment for acromegaly especially if expert transphenoidal surgery is not readily available.
MAGNETIC RESONANCE IMAGING IN POSTERIOR CIRCULATION INFARCTION: IMPACT ON DIAGNOSIS AND MANAGEMENT
Authors: DAVIS S. M. , DONNAN G. A. , TRESS B. M. , KIERS L. , DOWLING R. , ROSSITER S. C.
Published: March 2008

To compare the diagnostic yield of magnetic resonance imaging (MRI) with computed tomography (CT) in posterior circulation infarction, we used proton MRI with a 0.3 Tesla magnet and a 3rd generation CT scanner in 25 patients. Age‐matched controls were compared in a blinded fashion. Seventeen patients (68%) showed relevant pathology on MRI not seen on CT, 11 with normal CT and six with more extensive lesions, chiefly in the brain stem.

Evidence of abnormal vertebrobasilar blood flow was seen in 8/25 (32%) of patients, suggested by vascular high intensity signals on MRI. Two tissue and one flow abnormality were seen in the control group. MRI provides additional information concerning infarct site, extent and pathogenesis in posterior circulation infarction.
STREPTOCOCCUS PYOGENES PNEUMONIA WITH ABSCESS FORMATION
Authors: McINTYRE H. D. , ARMSTRONG J. G. , MITCHELL C. A.
Published: March 2008

A 30‐year‐old female with mild asthma presented with high fever, hypotension, pleuritic chest pain, vomiting and diarrhea. Chest radiograph showed consolidation of the right upper lobe, and S. pyogenes was cultured from blood and sputum. Following initial rapid recovery the patient relapsed ten days after antiobiotics were ceased, with rapid development of a large abscess cavity. Clinical improvement occurred following reinstitution of treatment including intravenous penicillin. Progressive radiological resolution eventuated during outpatient follow‐up. This case demonstrates that S. pyogenes pneumonia may occur without an antecedent viral infection or major predisposing condition, cause rapid cavitation despite antiobiotic therapy and resolve satisfactorily with prolonged penicillin therapy.
SERONEGATIVE ARTHRITIS ASSOCIATED WITH SEROLOGICAL EVIDENCE OF YERSINIA INFECTION IN AUSTRALIA
Authors: WAKEFIELD D. , STAHLBERG T. , FRESTON J. , BUCKLEY R.
Published: March 2008

Infection due to yersinia enterocolitica is a common antecedent illness in patients with reactive arthritis in Scandinavia, but appears to be less frequent in other countries. In order to examine the frequency of yersinia infection in patients with seronegative arthritis in Australia we examined 22 patients, 15 with ankylosing spondylitis (AS) and seven with Reiter's syndrome (RS). A sensitive ELISA assay was used to detect serum antibodies to the most common serotypes. Six patients (29%) had positive yersinia serology, all were HLA B27 and four had a history of diarrhea preceding the onset of their disease. Four patients with positive yersinia serology had AS and two had RS. Antibodies were directed against Y. enterocolitica biotype 0:3 in three cases, Y. enterocolitica 0:9 in two cases and Y. enterocolitica 0:8 in one subject. Twenty‐nine control subjects (13 HLA B27) had no serum antibodies to yersinia.

The results of this study indicate that preceding yersinia infection occurs in a significant (p < 0.05; compared to controls) proportion of patients with HLA B27 related seronegative arthropathies.
SEVERE HYPOKALEMIC RHABDOMYOLYSIS DUE TO INGESTION OF LIQUORICE DURING RAMADAN
Authors: ACHAR K. N. , ABDUO T. J. , MENON N. K.
Published: March 2008

A 62‐year‐old man was admitted with severe hypokalemia following ingestion of a modest amount of liquorice during the Islamic holy month of Ramadan. Hypokalemia was associated with typical electrocardiographic changes, marked acid‐base disturbance and complicated by rhabdomyolysis. All abnormalities improved with normalisation of serum potassium. The serum creatine kinase isoenzymes (CK‐total and MB) returned to normal over a prolonged period. The potential danger of ingesting liquorice even in small amounts over short periods, and the role of concomitant diuretic therapy with the additional factor of fasting during Ramadan in precipitating hypokalemia during liquorice ingestion are discussed.
REHABILITATION FOR STROKE SURVIVORS—A REVIEW
Authors: FLICKER LEON
Published: March 2008

With the growing advent of rehabilitation units designed particularly for the needs of the stroke patient, a need has arisen for the evaluation of these units. In particular, several questions have to be asked
REGIONAL CEREBRAL BLOOD FLOW MEASUREMENTS IN THE DIAGNOSIS OF DEMENTIA
Authors: ZURYNSKI Y. , SINGER A. , KRAIUHIN C. , GORDON E. , DORSCH N. , LANDAU P. , HOWSON A. , MEARES R.
Published: March 2008

The Xenon‐133 regional cerebral blood flow technique (rCBF) was used to assess cortical perfusion in a group of 15 elderly patients (mean age = 79.1, SD = 8.7) with a probable diagnosis of Dementia of the Alzheimer type (DAT). Nine had mild DAT and six were in the moderate stages of DAT. These patients were compared with 15 age and sex matched normal elderly controls (mean age = 75.1, SD = 5.6). RCBF was measured in each patient and control at rest with eyes closed. The DAT patients had significantly lower mean global CBF than normal controls (t = ‐4.63, p< 0,0001). In addition, a further 15 normal elderly subjects aged 60 to 92 were assessed and combined with the original 15 to allow calculation of a normal range of rCBF for elderly individuals. Seventy‐three per cent of the DAT patients fell below the lower limit of the normal range (39.3 ‐ 59.3 ISI units). These results show the possible usefulness of rCBF as an aid in the diagnosis of early DAT.
EARLY AND LATE RESULTS OF BALLOON VALVULOPLASTY FOR SEVERE AORTIC STENOSIS
Authors: WARREN R. J. , HUNT D. , BLACK A. J. , SUMMERS P.
Published: March 2008

Abstract Balloon aortic valvuloplasty has been used as treatment for selected patients with severe aortic stenosis. We report our experience of 11 procedures, performed on ten patients between October 1987 and June 1988.

The peak aortic systolic gradient was reduced by 53% from 77 ± 22 to 37 ±14 mmHg (p < 0.0001) whilst cardiac output did not change significantly (4.1 ± 1.7 to 3.8 ± 1.6 L/min). Aortic valve area was increased by 50%, from 0.4 ± 0.2 to 0.6 ± 0.2 cm2 (p < 0.0001). Initial symptomatic improvement was achieved in eight patients. Echocardiographically demonstrated aortic regurgitation did not increase after valvuloplasty. There were no deaths during the procedure, no embolic events and no femoral artery complications.

The mean follow‐up for survivors was 9 ± 3 months. Five patients died and three had symptom recurrence at an average of 13 weeks (six–24 weeks). Only two patients reported a continued improvement in symptoms.

Balloon aortic valvuloplasty produced a small increase in aortic valve area and a satisfactory initial clinical response, but there was a high incidence of symptom recurrence. The procedure may have a role in the short‐term palliation of severely symptomatic patients who are unable to have aortic valve replacement.
CONNECTIVE TISSUE DISEASE MIMICKING MULTIPLE SCLEROSIS
Authors: PENDER M. P. , CHALK J. B.
Published: March 2008

Abstract Systemic lupus erythematosus, primary Sjögren's syndrome and systemic sclerosis may be associated with acute transverse myelitis and chronic relapsing neurological syndromes mimicking multiple sclerosis in the same individuals and/or their relatives. We now present three cases which suggest that there is a wide spectrum of connective tissue disorders mimicking multiple sclerosis and acute disseminated encephalomyelitis. These cases demonstrate that the diagnosis of multiple sclerosis should be kept under constant review by searching for the development of connective tissue disorders in the patients or their relatives.
ACUTE NECROTISING MYOPATHY ASSOCIATED WITH AMIODARONE THERAPY
Authors: CLOUSTON P. D. , DONNELLY P. E.
Published: March 2008

Abstract We report a patient who developed an acute painful proximal myopathy associated with the use of amiodarone. The temporal course, the presence of amiodarone related hypothyroidism and neuropathy, as well as the patient's improvement on drug withdrawal were consistent with a drug reaction. Muscle biopsy demonstrated an acute necrotising myopathy. The mechanism for this reaction is unclear.
GLOMERULONEPHRITIS, PULMONARY HEMORRHAGE AND ANEMIA ASSOCIATED WITH CAMPYLOBACTER JEJUNI INFECTION
Authors: ANDREWS P. I. , KAINER G. , YONG L. C. J. , TOBIAS V. H. , ROSENBERG A. R.
Published: March 2008

A 5‐year‐old girl suffered Campylobacter jejuni enteritis. Over the ensuing weeks she developed glomerulonephritis, pulmonary hemorrhage and anemia. Renal biopsy revealed immune‐complex mediated, crescentic glomerulonephritis. Campylobacter jejuni antigen was identified in the glomeruli suggesting a causal role of Campylobacter jejuni in the disease process.
LEUCOGYROPHANA PINASTRI, A WOOD DECAY FUNGUS AS A PROBABLE CAUSEOF AN EXTRINSIC ALLERGIC ALVEOLITIS SYNDROME
Authors: STONE C. A. , JOHNSON G. C. , THORNTON J. D. , MACAULEY B. J. , HOLMES P. W. , TAI E. H.
Published: March 2008

Two patients were suspected of having extrinsic allergic alveolitis due to exposure to an agent in their home environment. On inspection of their houses, fungal decay was evident in the floorboards, and fungal spores were found deposited on many surfaces. The decay fungus was later identified as Leucogyrophana pinastri. Using an extract of the fruiting bodies and mycelium of this fungus, precipitating antibodies were identified in the sera of both patients. Based on the known exposure by the two patients to these small spores, the absence of a likely alternative allergen, the similarity between these two cases, and the positive precipitin test results, L pinastri was considered to be the most likely cause of extrinsic allergic alveolitis in our cases.
BLADDER CONTROL ‐ A SIMPLE SELF‐HELP GUIDE. Richard J. Millard.
Authors: Walker Rowan ti.
Published: March 2008

BLADDER CONTROL ‐ A SIMPLE SELF‐HELP GUIDE. Richard J. Millard.
TREATMENT OF MALIGNANCY‐ASSOCIATED HYPERCALCEMIA WITH NORETHISTERONE: A CASE REPORT
Authors: ANDERSON CRAIG S. , OLWENY CHARLES L. M. , NEED ALLAN G.
Published: March 2008

Hypercalcemia is a common cause of morbidity in cancer patients. The mechanism of malignancy‐associated hypercalcemia includes increased bone resorption and decreased renal calcium clearance which also occur in primary hyperparathyroidism. Norethisterone can inhibit bone resorption and has recently been shown to be effective treatment for mild hyperparathyroidism in post menopausal women. We report the successful use for the first time of norethisterone (5 mg daily) in a case of malignancy‐associated hypercalcemia after other standard agents failed. (Aust NZ J Med 1989; 19: 51–54.)
Mortality associated with ischaemic hepatitis
Authors: Hickman Peter E. , Potter Julia M.
Published: March 2008

Twenty‐nine patients of 18,000 inpatient admissions over a six‐month period developed ischaemic hepatitis accompanied by peak aspartate aminotransferase (AST‐EC 2.6.1.1) activity greater than 1,000 U/L. Seventeen of these 29 patients died either during or shortly after the episode of ischaemic hepatitis, with an overall mortality of 58.6%. Mortality was not due in any of the cases to the hepatitis but rather the underlying cause. Ischaemic hepatitis was the commonest cause of an AST activity greater than 1,000 U/L in this hospital population (29 of 52 patients i.e. 56%). This condition is more common than generally appreciated and is associated with a poor prognosis.
Arbovirus infection in humans in NSW: Seroprevalence and pathogenicity of certain Australian bunyaviruses
Authors: Boughton C. R. , Hawkes R. A. , Naim H. M.
Published: March 2008

A sero epidemiological study was carried out on human sera from all regions of New South Wales for the presence of antibodies to nine bunyaviruses viz Aino, Akabane, Belmont, Gan Gan, Kowanyama, Mapputta, Peaton, Tinaroo, Trubanaman and the orbivirus Corriparta. Neutralising antibodies were found in titres up to 1280 to Gan Gan and to 640 to Trubanaman viruses, prevalences 4.7% and 1.4% respectively. Neutralisation titres up to 40 were found to Belmont, Aino, Peaton and Corriparta viruses but the significance of these is uncertain since they may represent either non‐specific inhibitors or cross reacting antibodies to related but currently unknown viruses. No antibodies were found to Akabane, Kowanyama, Mapputta or Tinaroo viruses in New South Wales sera.

Gan Gan virus appeared to be pathogenic for man being associated with an acute epidemic polyarthritic like illness. Trubanaman virus is suspected of being pathogenic. This is the first report of the pathogenicity of these Australian bunyaviruses.
Chronic non‐A, non‐B hepatitis: lack of correlation between biochemical and morphological activity, and effects of immunosuppressive therapy on disease progression
Authors: Schoeman M. N. , Craig P. I. , Liddle C. , Bate R. G. , Bilous M. , Farrell G. C. , Grierson J.
Published: March 2008

A study was made of 52 patients considered to probably have chronic non‐A, non‐B hepatitis who were seen during an eight‐year period at Westmead Hospital, Sydney. The patients were followed for a median of 28 months to assess the natural history of the disease and, in a small number of patients, the effect of immunosuppressive therapy on disease progression was examined. In 94% of cases, infection appeared to have been acquired by a parenteral route; the remainder were sporadic infections. Fifty‐six per cent of the patients had mild constitutional symptoms and the remainder were asymptomatic. Similarly, 54% of patients had no signs of chronic liver disease and none exhibited signs of hepatic decompensation. Liver biopsies were performed in 42 patients; chronic active hepatitis with or without cirrhosis was present in 90%. However, neither the presence of symptoms nor the degree of biochemical abnormality were predictive of disease severity as determined histologically. Among eight patients treated with corticosteroids (with or without azathioprine), six underwent follow‐up liver biopsy. Quantitative analysis of inflammatory and fibrotic changes indicated significant (p < 0.01) progression of histological severity during a median 33 months (range 7–98 months) between biopsies with cirrhosis developing in four instances. In contrast, among the seven untreated patients rebiopsied after a median of 16.0 months (range 11–37 months) there was no overall change in histological severity and only one patient developed cirrhosis. It is concluded that histological assessment is required in all patients suspected of having chronic non‐A, non‐B hepatitis as other means of assessment are unreliable. At present, immunosuppressive therapy cannot be recommended for patients with this form of chronic viral hepatitis; as well as being unhelpful, such treatment may accelerate disease progression.
The ‘shrinking lungs syndrome’—an infrequently recognised feature of systemic lupus erythematosus
Authors: Stevens W. M. R. , Burdon J. G. W. , Clemens L. E. , Webb J.
Published: March 2008

Two cases of the ‘Shrinking Lungs Syndrome’ in patients with systemic lupus erythematosus are described to highlight an infrequently recognised feature of this condition. Respiratory muscle weakness, improved by steroid therapy, was demonstrated in each patient and considered to be the mechanismunderlying the respiratory symptoms.
Non‐obstructive apical hypertrophic cardiomyopathy—Emergence of clinical features within three years in a Chinese
Authors: Woo K. S. , Ho David T. W.
Published: March 2008

A Chinese engineer presented with non‐specific palpitation, atypical chest pain and normal electrocardiogram both at rest and during exercise, was documented to develop electrocardiographic evidence of left ventricular hypertrophy and abnormal isotopic cardiac scintigraphy during stress test within a period of three years. His echocardiogram remained unremarkable. Cardiac catheterisation and cineventriculogram confirmed the presence of apical hypertrophic cardiomyopathy, without any outflow tract obstruction or coronary artery disease. This case, together with 14 others detected recently in Hong Kong, will arouse the existence of this form of hypertrophic cardiomyopathy in the Chinese. The emergence of all diagnostic features in this patient within a short time will support an aetiological hypothesis that apical hypertrophic cardiomyopathy can be acquired in patients with genetic predisposition.
Seasonal, regional and secular variations of cardiovascular and cerebrovascular mortality in New Zealand
Authors: Douglas A. S. , Russell D. , Allan T. M.
Published: March 2008

Numbers of deaths from coronary heart disease (CHD) and cerebrovascular disease (CVD) were available for five years (1980–84) in the North and South Islands of New Zealand; estimated death rates were determined, and age correction made.

There was a major seasonal variation by month in coronary and cerebrovascular deaths in both sexes and both islands, with a zenith in June/July/August (winter) and a nadir in December/January/February (summer).

There was a less obvious, and less complete, linear trend, with declining secular (annual) mortality over the five years. This was more obvious in North Island but not proven in South Island.

After standardising for age, coronary mortality rates (but not cerebrovascular mortality rates), were significantly higher in South Island than in North Island. Mortality from both CHD and CVD was significantly higher in males than in females.
Geographical distribution of cancers of the kidney and urinary tract and analgesic nephropathy in Australia and New Zealand
Authors: McCredie M. , Coates M. S. , Ford J. M. , Disney A. P. S. , Auld J. J. , Stewart J. H.
Published: March 2008

Age‐standardised incidence rates for cancers of the renal parenchyma, renal pelvis and bladder and for end‐stage renal failure due to analgesic nephropathy for the years 1982–83 were compared between the Australian states and New Zealand, and within New South Wales (NSW), to determine whether these rates paralleled the previous prevalence of consumption of phenacetin‐containing analgesics. Whereas little variation was seen within Australasia in respect of the incidence of cancer of the renal parenchyma and bladder, both cancer of the renal pelvis and end‐stage renal failure due to analgesic nephropathy had higher incidence rates amongst women in NSW and Queensland than in the other states or New Zealand. Within NSW, the average annual incidence rates during 1973–82 for renal pelvic cancer in the Hunter region of 1.3 (m) and 1.6 (f) per 100,000 were the highest in the state. These high incidence rates coincided with areas known to have had a high prevalence of consumption of compound analgesics containing phenacetin. In an international comparison with populations which had published incidence rates for each of the periods 1973–77 and 1978–82, the rate for cancer of the renal pelvis in women was highest in both time periods in NSW and had increased absolutely at a faster rate.
Pneumothorax: treatment by small‐lumen catheter aspiration
Authors: Markos J. , McGonigle P , Phillips M. J.
Published: March 2008

To assess the efficacy of simple aspiration as a treatment for pneumothorax, 40 consecutive pneumothoraces (28 spontaneous, 12 iatrogenic, all estimated at 20% collapse on visual inspection of the chest X‐ray) in 38 symptomatic patients were treated initially by small‐lumen catheter (SLC) aspiration. SLC aspiration avoided the need for large‐lumen intercostal catheter (LIC) underwater drainage in 28 cases (70%) ‐ 20 of 28 spontaneous and eight of 12 iatrogenic pneumothoraces. Outcome was not predicted by clinical variables or pneumothorax size, whereas an initial aspirate volume of 4 L (n = 33) was predicable of success in 28 cases (85%). Minor local subcutaneous emphysema and vasovagal reactions were encountered infrequently but with similar frequency to LIC drainage. No episodes of re‐expansion pulmonary oedema occurred. The results confirm previous reports of the efficacy of simple aspiration as a treatment for spontaneous or iatrogenic pneumothorax. Initial treatment by SLC aspiration is recommended for all but life‐threatening presentations of pneumothorax. Although not encountered in this study, the potential risk of re‐expansion pulmonary oedema suggests that patients should be observed closely for four hours after aspiration.
The Dubbo study: an Australian prospective community study of the health of elderly
Authors: Simons L. A. , McCallum J. , Simons J. , Powell I. , Ruys J. , Heller R. , Lerba C.
Published: March 2008

The proportion of Australian population over 60 years has risen progressively over the last 40 years and this growth is projected to continue. Major health problems of the elderly include coronary heart disease, cerebro‐vascular disease, osteoporosis and fracture. The risk factors for coronary heart disease and stroke in middle‐aged subjects have been extensively documented in prospective studies in Australia and elsewhere, and include lipid disorders, hypertension, cigarette smoking, diabetes and family history. Few prospective studies have been targeted exclusively on the elderly and information available with respect to vascular risk factors is fragmentary and contradictory. This is the background to a new prospective study of the health of elderly Australians now under way in Dubbo, NSW. The goals of the Dubbo Study are to identify predictors of mortality, hospitalisation and placement in long‐term care, while specific aims are the study of risk factors for chronic diseases and disability. This report describes the study rationale, reasons for selecting Dubbo as the study site, methods and measures, participation rates and demography. The target population included all non‐institutionalised subjects 60 years and over, domiciled in Dubbo, and is comprised of 1693 males and 2167 females. The attendance rate for an extensive medical and sociological baseline assessment over a 13 months' period was 73% for both sexes. The prospective study is now in place and within three to five years will be generating definitive information in the elderly.
Cot deaths in Canterbury (NZ): lack of association with respiratory virus patterns
Authors: Ford R. P. K. , McCormick H. E. , Jennings L. C.
Published: March 2008

This study was done to see whether any association between SIDS and respiratory viruses might be more obvious in Canterbury where the cot death rate is so high (about seven per thousand live births). The numbers of common respiratory virus identifications for the eight year period July 1981 to June 1989 were analysed for associations with cot death. The identifications were from inpatients at the Christchurch Public Hospital and other community sources in Canterbury. Weak associations were found with respiratory syncytial virus (r = 0.3), influenza A (r = 0.3) and influenza B (r = 0.2). However, the associations are overwhelmed by the effect of the month of the year. A high rate of respiratory virus infection cannot be invoked as the explanation for our high SIDS rate.
Torsade de Pointes associated with perhexiline maleate therapy
Authors: Kerr G. D. , Ingham G.
Published: March 2008

Multiform ventricular tachycardia (torsade de pointes) is a recognised proarrhythmic effect of drugs which prolong the QT interval. A case is now described for the first time where torsade de pointes occurred with the administration of the anti‐anginal agent perhexiline maleate.
Prevalence of lupus anticoagulant and anticardiolipin antibodies in a healthy population
Authors: Shi W. , Krilis S. A. , Chong B. H. , Gordon S. , Chesterman C. N.
Published: March 2008

This study was designed to explore the incidence of lupus anticoagulant (LA) and anticardiolipin antibodies (ACA) and their relationship to each other in a healthy population of 499 blood donors. Plasma samples were tested for LA activity and IgG, IgM and polyvalent ACA. Prolongation of the kaolin clotting time of a mixture of 80% normal plasma and 20% test plasma compared to the normal (dKCT) was used to detect LA activity.

A normal distribution of dKCT was found with the mean 3.5 seconds ±SD 10.6 seconds. Forty subjects (8%) were greater than 10% of the normal control; among these, 18 (3.6%) were outside the 95% confidence limits. The median age (29.3) and sex (M = 12, F = 28) of the 40 subjects with prolonged KCT were significantly different (ρ < 0.001) from the group as a whole, younger females predominating.

The frequency distribution of IgG, IgM and polyvalent ACA was skewed and the majority did not have detectable levels. ACA concentration falling within 95% of the population group were regarded as normal. Applying this definition, abnormal IgG ACA was greater than 4.33 U/ml, IgM ACA greater than 3.55 U/ml and polyvalent ACA greater than 4.55 U/ml with a prevalence of 4.6%, 4.6% and 5.6% respectively. Of the subjects with positive ACA of any class there was no significant association with either age or sex or the presence of LA. Only three plasma samples had both activities. Neither ACA nor LA were associated with antinuclear antibodies (ANA) or rheumatoid factor (Rh factor). Thus, in a healthy population LA is found predominantly in younger females and neither LA or ACA appear to identify subjects with other autoimmune parameters such as ANA or Rh factor or, for that matter, each other.
Anti‐neutrophil cytoplasm antibodies (ANCA)
Authors: Savige J. A. , Davies D. J.
Published: March 2008

Circulating antibodies directed against cytoplasmic constituents of granulocytes and monocytes (anti‐neutrophil cytoplasm antibodies, ANCA) are found in about 80% of active cases of Wegener's granulomatosis and microscopic polyarteritis. Antibodies are detected by indirect immunofluorescence on normal peripheral blood leucocytes, or by ELISA or radio‐immunoassay using a neutrophil cytoplasm extract. There are 2 patterns of staining seen on indirect immuno‐fluorescent examination of leucocytes and a number of different molecules recognised on Western blots. In Wegener's granulomatosis diffusely granular cytoplasmic staining (cANCA) is associated with a 29KD molecule that has recently been identified as neutrophil proteinase 3. A finely granular pattern may also be seen in microscopic polyarteritis. A perinuclear pattern (pANCA) is present in some other cases of segmental necrotising glomerulonephritis and occasionally in rheumatoid arthritis but almost never in Wegener's granulomatosis. This pattern is often associated with the presence of anti‐myeloperoxidase and anti‐elastase antibodies. Levels of anti‐neutrophil cytoplasm antibodies usually reflect disease activity but a pathogenetic role for these antibodies in the development of small vessel vasculitides is, as yet, unproven.