bluuebunny/crossref_metadata_2025 huggingface dataset:
INTERACTIONS BETWEEN NON‐STEROIDAL ANTI‐INFLAMMATORY DRUGS AND ANTIHYPERTENSIVES AND DIURETICS
Authors: Davis A. , Day R. O. , Begg E. J.
Published: March 2008

Non‐steroidal anti‐inflammatory drugs (NSAIDs) may increase blood pressure and antagonise the effects of antihypertensive agents, they can cause salt and water retention and an increase in extracellular volume. NSAIDs also cause a decrease in prostaglandin synthesis in blood vessel walls which removes a direct vasodilatory influence and also increases the vascular response to vasoconstrictor stimuli. The hypotensive effects of frusemide and captopril are due in part to their stimulation of prostaglandin synthesis. Hence the antagonism of the hypotensive effect of these agents is probably due to NSAID‐induced inhibition of prostaglandin synthesis. However, the interactions of NSAIDs with the other antihypertensive agents may not be related to inhibition of antihypertensive‐induced release of prostaglandin but to independent and opposing actions of the NSAIDs on the various physiological mechanisms which regulate blood pressure. Clinicians should remain alert to these potential drug interactions. (Aust NZ J Med 1986; 16: 537–546.)
TREATMENT OF ACUTE RENAL ALLOGRAFT REJECTION WITH A MONOCLONAL ANTIBODY TO A T CELL ANTIGEN (HuLy‐m2)
Authors: D'APICE A. J. F. , THURLOW P. J. , IHLE B. U. , LOVERING E. K. , McKENZIE I.F.C.
Published: March 2008

Abstract The progress of five patients with recurrent renal allograft rejection who were treated with anti‐HuLy‐m2 (anti‐T cell subset monoclonal antibody) is described. The therapy was without significant side effects and all patients responded to therapy with a diminution of OKT3+ and HuLy‐m1+ (= E‐RFC) peripheral blood lymphocytes. Three of the five patients had improvement in renal rejection. One patient demonstrated long term improvement in renal function, in another two patients renal function improved temporarily, and the remaining two patients had no significant benefit from anti‐HuLy‐m2 therapy. This limited trial has demonstrated the potential value of a monoclonal anti‐T cell antibody, reactive with a subset of T cells, for immunotherapy of renal rejection in patients previously treated with anti‐rejection therapy.
HEPATITIS B IN AUSTRALIA: DETERMINANTS OF INTRAFANIILY SPREAD
Authors: WILLIAMS S. J. , CRAIG P. I. , LIDDLE C. , BATEY R. G. , FARRELL G. C.
Published: March 2008

Abstract Strategies for the control of hepatitis B virus (HBV) infection rely on information about the modes of spread and the numbers of ‘at risk’ individuals in particular community subgroups. This study prospectively examined 377 family and household contacts of 145 patients with HBV infection to determine the incidence of and factors determining intrafamily spread. Two hundred and forty were contacts of 68 Asian patients and 137 were contacts of 77 Caucasian patients. Serological examination of all contacts demonstrated that 161 (43%) had HBV markers including 60 (16%) who were HBsAg positive. HBV transmission within families was greater if the index case was Asian rather than Caucasian (ρ<0.001), had an HBsAg positive mother rather than an HBsAg positive father (ρ<0.01), was HBeAg positive rather than HBeAg negative (ρ<0.002), and had chronic rather than acute HBV infection (ρ< 0.001). However birthplace, family size, and the activity of the liver disease of the index case did not influence HBV transmission. Within Asian families, the risk of non‐sexual and non‐vertical transmission of hepatitis B appeared to be as high as 18% and continued after the first three years of life. It is concluded that hepatitis B prevention programmes should include vaccination of families of chronic HBV carriers, particularly those from endemic regions such as Asia.
A COMPARISON OF SINGLE AND MULTIPLE INTRAVENOUS INFUSIONS OF 3‐AMINO‐1‐HYDROXYPROPYLIDENE‐1, 1‐BISPHOSPHONATE (APD) IN THE TREATMENT OF HYPERCALCEMIA OF MALIGNANCY
Authors: YATES A. J. P. , MURRAY R. M. L. , JERUMS G. J. , MARTIN T. J.
Published: March 2008

Abstract Following rehydration with intravenous saline, 27 patients with hypercalcemia of malignancy were treated with a total of 32 courses of 3‐amino‐1‐hydroxypropylidene‐1, 1‐biphosphonate (APD) given by slow intravenous infusion. Twelve treatments consisted of daily infusions of APD for between two and six days whereas single‐dose APD was used in 20 treatments. Mean albumin‐adjusted serum calcium fell to the upper end of the reference range at seven days from the start of treatment, both in multiple‐dose and in single‐dose treatment groups. No relationship between total dose of APD and hypocalcemic response was observed. However, second treatments with APD following recurrence of hypercalcemia in five patients were significantly less effective than the original therapy, suggesting that resistance to APD may develop. Multiple‐dose and single‐dose intravenous APD treatments appear to be equally effective in the acute management of hypercalcemia of malignancy.
MOLECULAR STUDIES OF HYPOXANTHINE‐GUANINE PHOSPHORIBOSYLTRANSFERASE MUTATIONS IN SIX AUSTRALIAN FAMILIES
Authors: GORDON R. B. , EMMERSON B. T. , STOUT J. T. , CASKEY C. T.
Published: March 2008

Abstract Genomic deoxyribonucleic acid (DNA) was isolated from six hemizygotes and five heter‐ozygotes from unrelated families exhibiting the full clinical spectrum of hypoxanthine‐guanine phosphoribosyltransferase (HPRT) deficiency. The DNA was digested with the restriction endonucleases, Bam H1, Pst 1 and Taq 1, previously found to be useful in demonstrating restriction fragment length polymorphism (RFLP) at the HPRT locus of the X‐chromosome. DNA blotting experiments using a full length HPRT‐cDNA probe, have revealed RFLPs in three families which may prove useful for the diagnosis of HPRT deficiency and the determination of heterozygosity. Total ribonucleic acid (RNA) was also extracted from our 11 subjects and analysed by Northern blotting for the presence of HPRT‐messenger (mRNA). Apparently normal HPRT‐mRNA was demonstrated in all the hemizygotes and heterozygotes for partial HPRT deficiency. In the families with complete HPRT deficiency (Lesch‐Nyhan syndrome), the heterozygotes had normal HPRT‐mRNA. However, one hemizygote had a complete absence of message for HPRT, while the other hemizygote had considerably reduced amounts of this message.
ANTIBODY PATTERNS IN THE SEROLOGICAL DIAGNOSIS OF ACUTE LYMPHADENOPATHIC TOXOPLASMOSIS
Authors: JOHNSON A. M. , GU Q. M. , ROBERTS H.
Published: March 2008

Abstract Sera from six patients at various stages of acute lymphadenopathic toxoplasmosis were tested using nine different types of test currently available for the serological diagnosis of the disease. A diagnosis was made on positive serology in three of the patients. The antibody patterns of two of these patients were studied over a period of six months and the third was studied over two months. A diagnosis was made on lymph node morphology in the other three cases. Two serum samples were tested from each of these patients. The results obtained suggest that a rationalisation of the types of test used should be encouraged and that an enzyme‐linked immunosorbent assay (ELISA) for parasite‐specific IgG and an antibody class capture ELISA for parasite‐specific IgM are sufficient to confirm the diagnosis of acute lymphadenopathic toxoplasmosis.
METHYL TERTIARY BUTYL ETHER CHOLELITHOLYSIS OF CALCULI IN THE GALLBLADDER AND BILE DUCTS*
Authors: CARRICK J. , DOUST B. , COLEMAN M. , BYRNES D. , HUGH T. B. , BORODY T. J.
Published: March 2008

Abstract Recent use of the cholelitholytic agent, methyl tertiary butyl ether (MTBE) has demonstrated its efficacy in the dissolution of cholesterol calculi. In three patients with retained stones in the bile duct, MTBE was instilled and aspirated through a T tube to effect dissolution. Stones dissolved completely in two patients, while in the third, partial dissolution permitted instrumental extraction through the T tube tract. In this third patient, dissolution of gallbladder stones in vitro was relatively slow. Patients tolerated the procedure well and there were no major complications. There was no evidence of duodenal inflammation in two patients who underwent duodenoscopy and biopsy before and after treatment. Four patients with cholesterol cholelithiasis underwent direct gallbladder perfusion with MTBE. The mean size of the gallstones was 0.8 cm (range 0.25–1.75 cm) and the mean number of stones per patient was four (range 1–13 stones). MTBE was instilled via a percutaneous gallbladder catheter inserted under local anesthesia with X‐ray control. In three patients, the stone dissolution appeared to be complete after three to six hours of treatment. In the fourth patient, catheter displacement led to termination of dissolution therapy. Follow‐up ultrasonograms in two patients demonstrated residual debris not visualised on the immediate post‐dissolution films. Complications occurred in two patients and included catheter dislodgement and bile leakage after catheter withdrawal. Biliary perfusion with MTBE is a therapeutic option in patients with retained stones in whom instrumental retrieval has failed. It may also have a role in selected patients with symptomatic stones in the gallbladder.
ASYMPTOMATIC CEREBELLAR VENOUS ANGIOMA
Authors: HANKEY G. J. , GUBBAY S. S. , CHAKERA T. M. H. , KHANGURE M. S.
Published: March 2008

Abstract In contrast to the scarcity of recorded cases of radiologically studied venous angiomas, venous angiomas are the most common of the four basic types of congenital intracranial vascular malformations encountered incidentally at autopsy. Their clinical significance remains unclear. When symptomatic, they are associated mainly with hemorrhage or mechanical pressure on cranial nerves by anomalously enlarged veins, however, it is, as yet, impossible to predict what course an asymptomatic cerebellar venous angioma will take. The risks of surgery appear to exceed those of the natural history of the disorder.

The following two cases of asymptomatic cerebellar venous angioma are recorded because of the rarity of the condition's diagnosis and the possibility of controversy in its conservative management.
NIFEDIPINE HEPATITIS
Authors: SHAW D. R. , MISAN G. M. H. , JOHNSON R. D.
Published: March 2008

Abstract An 80‐year‐old woman developed acute hepatitis following her first exposure to nifedipine. This adverse effect was characterised by fever, chills, anorexia, nausea, liver tenderness, hepatitic liver function tests and peripheral blood eosinophilia. On liver biopsy the portal tracts were expanded with a mixed inflammatory cell infiltrate rich in eosinophils. The potential for the occurrence of this adverse effect must increase with the current expansion of indications for the use of nifedipine.
HYPOKALEMIC PERIODIC PARALYSIS OF THYROTOXIC ORIGIN
Authors: McHUTCHISON J. G. , MELICK R. A. , WARK J. D.
Published: March 2008

Abstract A 50‐year‐old Vietnamese man suffered recurrent episodes of hypokalemic periodic paralysis during treatment for thyrotoxicosis. Suspected precipitants of the paralysis were oral prednisolone, strenuous exertion and poor compliance with medications. Propranolol prevented the periodic paralysis. Control of the thyrotoxicosis was complicated by a florid skin reaction attributed to carbimazole, and was ultimately achieved using radioiodine.
OCCURRENCE AND DISTRIBUTION OF HEPATITIS B INFECTION IN THE ABORIGINAL POPULATION OF WESTERN AUSTRALIA
Authors: HOLMAN C. D. J. , QUADROS C. F. , BUCENS M. R. , REID P. M.
Published: March 2008

Abstract In 1986, the prevalences of hepatitis B surface antigen (HBsAg), and other serological markers of infection with hepatitis B virus in the Western Australian adult Aboriginal population, were estimated using a stratified random sample of 1 150 subjects. When the estimates were standardised to the age and sex distribution of the total population of aborigines aged 12 years or over, the prevalence of HBsAg was 7% (95% confidence interval 6–9%). The prevalence of any marker, that is HBsAg andlor hepatitis surface antibody (anti‐HBs), was 49% (44–54%). The follow‐up blood specimens obtained from three‐fifths of the antigenemic subjects indicated that 96% (88–99%) were hepatitis B carriers. Male subjects had twice the prevalence of HBsAg (10%; 7–13%) when compared with females (4%; 3–6%). However, there was only a modest elevation of the prevalence of any marker in men (53%) compared with women (46%). There was evidence that the prevalence of HBsAg increased with age, but this was not the case with any marker. Geographically, there was substantial variation in hepatitis B infection rates. The Eastern Goldfields region had the highest prevalence (HBsAg 12%; any marker 66%), followed by the Kimberley, Pilbara and Central regions (HBsAg 74%; any marker 56–59%). The lowest rates were evident in Perth and the South West (HBsAg 3–5%; any marker 23–25%). The highest prevalence of markers in any discrete community was observed in the desert people of Warburton (HBsAg 22%; any marker 85%). These data indicate that, according to World Health Organisation criteria, the aboriginal population of Western Australia has an intermediate to high risk of infection with hepatitis B. (Aust NZ J Med 1987; 17: 518–525).
CHEMOTHERAPY FOR SMALL CELL LUNG CANCER: INPUCTION AND REINDUCTION WITH VOCA
Authors: STUART‐HARRIS R. , RAGHAVAN D. , FOX R. H. , PERETZ G. , CROMBIE C. , TERIANA N. , YOUNG I. , BYE P. , TIVER K. , GREEN D.
Published: March 2008

Abstract Sixty‐five patients with small cell lung cancer were treated with VP16, vincristine, cyclophosphamide, and doxorubicin (VOCA) intravenously at three‐week intervals. Patients with limited disease received four cycles with responders receiving radiation to the primary site and prophylactic cranial irradiation. Patients with extensive disease received chemotherapy only. Of 59 patients evaluable for chemotherapy response, eight (14%) achieved complete remission and 30 (51%) partial remission. Major side‐effects included myelosuppression, alopecia, nausea, and vomiting. Reinduction with VOCA at relapse yielded objective or subjective response in four of seven patients.

This regimen is active in small cell lung cancer and was well tolerated by patients. Reinduction of resDonse was Dossible in a small number of Datients retreated and mav provide useful palhation for those who relapse when treatment is discontinued.
LUPOID THROMBOCYTOPENIA
Authors: FIRKIN B. G. , PFUELLER S. , BUCHANAN R. R. C. , RYAN P.
Published: March 2008

Abstract Lupoid thrombocytopenia is herein defined as a disorder in which patients with throm‐bocytopenia have a positive Hep 2 antinuclear antibody. Although these patients may have other clinical or laboratory findings consistent with systemic lupus erythematosus, they do not satisfy the revised diagnostic criteria set down by the American Rheumatism Association (1982). In all other respects they have similar findings to patients with idiopathic thrombocytopenic purpura. Six patients are described with their clinical and laboratory features. It is proposed that this disorder should be distinguished from other forms of autoimmune thrombocytopenia including that associated with systemic lupus erythematosus.
DOES COLCHICINE WORK? THE RESULTS OF THE FIRST CONTROLLED STUDY IN ACUTE GOUT
Authors: AHERN M. J. , REID C. , GORDON T. P. , McCREDlE M. , BROOKS P. M. , JONES M.
Published: March 2008

Abstract We have performed the first controlled study of colchicine in acute gout, to determine its efficacy and toxicity, and to define the natural history of acute gout.

Two‐thirds of colchicine‐treated patients improved after 48 hours, but only one‐third of the patients receiving placebo demonstrated similar improvement. The colchicine‐treated patients responded earlier; significant differences from placebo were shown after 18–30 hours.

All patients given colchicine developed diarrhea after a median time of 24 hours (mean dose of colchicine 6.7 mg). This side effect occurred before relief of pain in most patients.
ENPROSTIL AND RANITIDINE: COMPARATIVE EFFICACY AND SAFETY IN PATIENTS WITH DUODENAL ULCER
Authors: MACKINNON M. , ALP M. , AUSTAD W. I. , BYRNES D. , COWEN A. , DUGGAN J. , PIROLA R. , THOMAS M. , WARD M.
Published: March 2008

Abstract This randomised, double‐blind, double‐dummy, multiclinic study of duodenal ulcer healing compared the efficacy and safety of enprostil with ranitidine. The six week trial admitted 164 patients with endoscopically demonstrated duodenal ulcer. Ratings of symptoms and adverse events were collated from patients' daily diaries, and endoscopy was repeated to verify healing after four weeks and, if appropriate, after six weeks. Medication used was enprostil (35 μg capsule) or ranitidine hydrochloride (150 mg tablet) with matching placebos twice daily. After six weeks, 81 % of patients treated with enprostil and 95% of those treated with ranitidine had healed ulcers, a statistically significant difference (p = 0.007). There were no differences between treatment groups for the number of days until the daytime ulcer pain completely ceased. Night‐time ulcer pain ceased significantly earlier in the group receiving ranitidine (p = 0.019) and was less severe during the week before the last visit (p = 0.001); daytime pain for ranitidine users was also less severe (p = 0.020) during this week. Mild to moderate adverse experiences were reported by 44% of enprostil and 35% of ranitidine patients. There were no severe adverse events.

In conclusion, both enprostil and ranitidine were found to be safe and effective in the treatment of duodenal ulcer. However, the ranitidine regimen used in this trial produced better results than the enprostil regimen.
ACUTE SCLERODERMA IN STABLE MIXED CONNECTIVE TISSUE DISEASE: TREATMENT BY PLASMAPHERESIS
Authors: CRAPPER R. M. , DOWLING J. P. , MACKAY I. R. , WHITWORTH J. A.
Published: March 2008

Abstract This report describes a case of stable mixed connective tissue disease (MCTD) with development of acute scleroderma with hypertension, oliguric renal failure, microangiopathic hemolytic anemia, and pulmonary infiltrates. The renal histology in the acute episode was that of scleroderma with intimal sclerosis and ‘onion skinning’ of vessels and glomerular ischemic injury but with no evidence of damage by immune complexes either histologically or by immunofluorescence. Improvement occurred after treatment with plasmapheresis, cyclosphamide, and captopril with return of near normal renal function.
ONCOGENJC HYPOPHOSPHATEMIC OSTEOMALACIA ASSOCIATED WITH A GIANT CELL TUMOUR OF A TENDON SHEATH
Authors: PROWSE M. , BROOKS P. M.
Published: March 2008

Abstract We report a case of oncogenic hypophosphatemic osteomalacia, a rare form of osteomalacia, secondary to a diffuse giant cell tumour of tendon sheath. Possible pathogenic factors are discussed in the light of previously described clinical and experimental observations.
PALM ISLAND RECONSIDERED. WAS IT COPPER POISONING?
Authors: PROCIV P.
Published: March 2008

Abstract The clinical features of the ‘Palm Island mystery disease’ cannot be explained on the basis of toxocariasis, nor do they correlate with the known manifestations of algal toxicity. A detailed review of acute and chronic copper poisoning in humans and laboratory animals supports this as a possible explanation for the epidemic. The mechanisms involved in copper intoxication are discussed briefly, and a scenario is proposed to explain the occurrence and pathogenesis of the outbreak.
PULMONARY MANIFESTATIONS OF THE ACQUIRED IMMUNODEFICIENCY SYNDROME
Authors: GIBSON P. G. , BRYANT D. H. , HARKNESS J. , MUNRO V. F. , PENNY R. , COOPER D. A.
Published: March 2008

Abstract Between 1983 and 1985, 71 patients with the acquired immunodeficiency syndrome (AIDS) were evaluated. Pulmonary manifestations were present in 42 patients (59%). Pneumocystis carinii pneumonia (PCP) was the most common pulmonary manifestation, present in 32 patients (45%). Other pulmonary findings were cytomegalovirus pneumonia (one patient), Candida pneumonia (one patient), cryptococcal pneumonia (one patient), bacterial pneumonia (three patients), nonspecific pneumonitis (three patients), Kaposi's sarcoma (one patient), and non‐Hodgkin's lymphoma (one patient). The presenting features of PCP were reviewed and in seven patients the chest X‐ray and blood gases were normal at the time of diagnosis of PCP. Bronchoscopy was a safe and useful technique for obtaining specimens for diagnosis promptly, and a combination of samples obtained by bronchial washings/brushings and transbronchial biopsy was found to give a higher diagnostic yield than any single sample. Drug side‐effects were common during therapy, requiring change of therapy in 16 patients. At one month after diagnosis 16% of patients with PCP had died. PCP is a common pulmonary manifestation in patients with AIDS which is treatable and has an initially favourable outcome.
CORONARY PROGNOSTIC INDEX FOR THE CHINESE
Authors: WOO K.S.
Published: March 2008

Abstract A coronary prognostic index (CPI) for the prediction of mortality of patients with acute myocardial infarction (AMI) has been constructed with data from 644 Chinese patients in Hong Kong. According to this CPI, patients with AMI could be divided into subgroups with increasing hospital mortality from 1.6% to 100%, depending on their ages, blood pressure, heart size, serum urea level, positions and types of infarcts, the presence of pulmonary congestion and cardiac dysrythmia in the initial three days. This simple and convenient CPI could be useful for the objective assessment and stratification of AMI in the Chinese, as well as in many other developing countries in the Asian‐Pacific region.
THE SEROLOGICAL RESPONSE TO THE PHENOLIC GLYCOLIPID OF MYCOBACTERIUM LEPRAE IN AUSTRALIAN AND NEPALI LEPROSY PATIENTS
Authors: BRITTON W. J. , GARSIA R. J. , BASTEN A.
Published: March 2008

Abstract Antibodies to the species‐specific phenolic glycolipid (PGL‐1) of Mycobacterium leprae and a crude M. leprae sonicate were measured by ELISA in sera from newly diagnosed and treated leprosy patients from Sydney and Nepal. IgM anti‐PGL‐1 antibodies were present in 88–90% of untreated patients at the lepromatous pole of the clinical spectrum and 35–55% of those at the tuberculoid pole. In treated patients with either form of the disease, IgM anti‐PGL‐1 antibodies were within the normal range or minimally elevated. In contrast, high levels of IgG anti‐PGL‐1 antibodies were detected in both treated and untreated patients. Neither IgM nor IgG anti‐PGL‐1 antibodies were elevated in sera from Mantoux negative controls and only one out of 15 sera from patients with untreated tuberculosis contained significant amounts of antibody. Comparison of the data from the anti‐PGL‐1 assay with the antibody response to a crude M. leprae sonicate revealed that the latter assay yielded more variable results and discriminated less well between lepromatous and tuberculoid subjects and between untreated patients and those on therapy. Thus the IgM anti‐PGL‐1 response signifies the presence of active disease, particularly in multi‐bacillary cases, and has the potential to be used not only to monitor the response of these patients to therapy, but also to detect subclinical leprosy in high‐risk groups such as the relatives of patients with lepromatous disease.
MANAGEMENT OF HUMAN IMMUNODEFICIENCY VIRUS‐INDUCED THROMBOCYTOPENIA IN HEMOPHILIA
Authors: KELLNER S. V. , McGRATH K. M. , STREET A. M.
Published: March 2008

Abstract Three patients with severe hemophilia and Human Immunodeficiency Virus (HIV) infection seropositive for virus antibody, presented with thrombocytopenia. Treatment with prednisolone, danazol (in one patient) and intravenous gammaglobulin, produced only transient responses. In one case, danazol treatment resulted in a rash, fever and a further fall in platelet count. The use of combined intravenous gammaglobulin and splenectomy successfully resulted in sustained elevation of platelet counts in all three patients. These counts have remained elevated at eight months, ten months and 17 months after operation.
NON‐HODGKIN'S LYMPHOMA AS A CAUSE OF HYPOADRENALISM
Authors: CHUNG H. T. , WONG K. L. , LIANG R. H. S. , LOKE S. L. , LAI C. L. , LIU H. W. , TSO W. K. , CHAN S. C. H. , LAM K. S. L.
Published: March 2008

Abstract Non‐Hodgkin's lymphoma which presents as adrenocortical insufficiency is rare, however, it should be a well‐recognised entity because, in addition to specific chemotherapy or radiotherapy, it needs hormonal replacement. We report a patient with diffuse histiocytic lymphoma, who had remission for seven years and relapsed with Addisonian crisis.
IMPROVED TREATMENT RESULTS FOR LYMPHOBLASTIC LYMPHOMA IN ADOLESCENTS AND ADULTS USING A DOXORUBICIN‐BASED (APO) PROTOCOL
Authors: BRADSTOCK K. F. , KOUTTS J. , STANTON A. , LEE C. H. , ROBERTSON T. I. , CASTALDI P. , KAMATH S. , CARTER J. , GREENBERG M.
Published: March 2008

A multi‐drug chemotherapy (APO) protocol incorporating doxorubicin was used to treat 12 patients (median age 19 years) with lymphoblastic lymphoma. The APO protocol consisted of intensive induction and consolidation phases, prophylactic CNS treatment, and 24 months of maintenance therapy. Eleven patients had an anterior mediastinal mass, while T cell markers were found on the lymphoma cells in eight of the nine cases tested. Two patients had initial CNS involvement, with one also having bone marrow replacement. Complete remission was obtained in all patients, with no deaths due to treatment toxicity. There have been four relapses, one in the patient with initial CNS and leukemic disease, two in abdominal sites, and in the mediastinum in one patient. With a median follow‐up time of 30 months from diagnosis, 67% of patients remain alive in first remission. These results indicate that the APO protocol provides a highly effective approach to the management of this high grade lymphoma in adolescents and adults.
CIRCADIAN RHYTHMS IN PATIENTS WITH ABDOMINAL PAIN SYNDROMES
Authors: ROBERTS‐THOMSON I. C. , KNIGHT R. E. , KENNAWAY D. J. , PANNALL P. R.
Published: March 2008

:Circadian rhythms for Cortisol, 6‐sulphatoxy melatonin and core body temperature were compared in control subjects and patients with functional abdominal pain. There were 20 patients with biliary pain after cholecystectomy, ten with biliary pain without cholecystectomy and 14 with irritable bowel syndrome. Rhythms were determined by urine collections at intervals of 4 h for 48 h and by overnight monitoring of core body temperature using the Vitalog system. Data were fitted to a sine curve to yield the time of maximal urinary excretion/lowest temperature and the amplitude of each rhythm. Urinary excretion of free Cortisol was similar in patients and control subjects. For urinary 6‐sulphatoxy melatonin, the timing (phase) of rhythms was similar in patients and controls but those with pain had a lower urinary excretion of 6‐sulphatoxy melatonin (p<0.05) and a rhythm of lower amplitude (p<0.02). The amplitude of the temperature rhythm was also lower in patients with biliary pain with and without prior cholecystectomy (p<0.05). Functional abdominal pain is associated with 6‐sulphatoxy melatonin and temperature rhythms of low amplitude, presumably because of suppression of circadian oscillators.
EFFECTS OF PHYSICAL ACTIVITY ON RISK FACTORS FOR CORONARY HEART DISEASE IN PREVIOUSLY SEDENTARY WOMEN: A FIVE‐YEAR LONGITUDINAL STUDY
Authors: SEDGWICK A. W. , DAVIDSOND A. H. , TAPLIN R. E. , THOMAS D.W.
Published: March 2008

:Fitness, weight, blood‐pressure, and lipids were measured in 290 women joining a fitness programme. Five years later, 110 (38%) had remained active, and the others had become sedentary again. The net effect of being active was to increase fitness by 18% and to reduce weight by 1.9 kg, diastolic blood pressure by 3 mmHg, and triglycerides by 0.15 mmol/L‐1. After controlling for age, weight and fitness, physical activity accounted for 1 % and 3% of the variance of changes in systolic and diastolic blood pressure respectively, and was not associated with changes in lipids. Change in fitness accounted for only 1% of change in diastolic blood pressure. More 'active women gave up smoking than ‘inactive’ (70%versus 10%). Hypertensive women were more sensitive to changes in weight and fitness than normotensive women. It was concluded that physical activity and change in fitness were only weakly related to changes in blood pressure and were unrelated to changes in lipids. (Aust NZ J Med 1988; 18: 600–605)
DYSTONIA AND INTRACEREBRAL CALCIFICATION: PSEUDOHYPOPARATHYROIDISM PRESENTING IN AN ELEVEN‐YEAR‐OLD GIRL
Authors: SIEJKA S. J. , KNEZEVIC W. V. , PULLAN P. T.
Published: March 2008

:Pseudohypoparathyroidism is an uncommon cause of movement disorders. We describe the case of an otherwise well 11‐year‐old girl, who presented with dystonia and was subsequently shown to have the classical metabolic abnormalities of pseudohypoparathyroidism. Cranial computerised tomographic scanning (CT scanning) showed intracerebral calcification of the basal ganglia and frontal lobes. (Aust NZ J Med 1988; 18: 607–609)
THE P300 EVENT RELATED POTENTIAL COMPONENT IN THE DIAGNOSIS OF DEMENTIA
Authors: SARA G. , KRAIUHIN C. , GORDON E. , LANDAU P. , JAMES L. , HOWSON A. , MEARES R.
Published: March 2008

Several studies have suggested that delays in the latency of the P300 ERP component are highly sensitive and specific to dementia and that ERP measurements may become a useful clinical tool in aiding diagnosis. This study examines the sensitivity of P300 measurements to dementia and addresses several methodological issues that limit previous research. Twenty‐four patients with dementia diagnosed according to ICD‐10 criteria were compared with 100 normal controls, 31 of whom were older than 60. An auditory oddball paradigm was employed to elicit the P300. Mean P300 latency did not differ significantly between the two groups. When individual subjects were examined only 13% of patients with dementia fell outside the two standard error band of the regression of P300 latency on age derived from controls. Thus, this study has not demonstrated clinically useful abnormalities of the P300 component in dementia.
HERPES SIMPLEX AND DUODENAL ULCER PATHOLOGY
Authors: WEGMAN E. A. , CROUCH R. L. , BOLIN T. D. , DAVIS A. E.
Published: March 2008

An association between Herpes simplex Virus 1 (HSV‐1) and duodenal ulcer disease has been suggested. Duodenal ulcers, like HSV‐1 lesions, exhibit periodicity in recurrence. Several of the presently available anti‐ulcer agents may have an antiviral action. Antibody titres in some studies have shown selective increases to HSV‐1 in duodenal ulcer patients. The aim of this study was to determine whether a real association exists between HSV‐1 and endoscopically proven duodenal ulcer or duodenal erosive disease. In a prospective study, 27 patients with either duodenal ulcer (16) or duodenal erosions (11) were studied in order to attempt isolation of HSV‐1. Acute and convalescent sera were also taken and examined by an enzyme linked‐immunoabsorbent assay system for antibody titres to HSV‐1. Duodenal biopsies from a further 26 patients with duodenal ulcer or erosive disease were also examined retrospectively for HSV‐1 by the immunoperoxidase technique.

In no case of either duodenal ulcer or duodenal erosive disease was HSV‐1 isolated by any of the above methods, nor was a relationship demonstrated by acute or convalescent HSV‐1 antibody titres. Hence, this study does not support an association between HSV‐1 and duodenal ulcer or erosive disease.
NEUROPSYCHIATRIC MANIFESTATIONS OF SYSTEMIC LUPUS ERYTHEMATOSUS
Authors: BUCHBINDER R. , HALL S. , LITTLEJOHN G. O. , RYAN P. F. J.
Published: March 2008

Forty‐six episodes of major neuropsychiatric manifestations of systemic lupus erythematosus occurring in 35 patients over a ten‐year period were reviewed. The frequency of central nervous system SLF was lower than that reported from overseas referral centres. Glucocorticosteroid treatment did not precipitate psychiatric problems in this group. Whilst neuropsychiatric recovery was the rule, such features indicated a subgroup of SLE with high short‐term mortality.
THE ROLE OF PERCUTANEOUS LUNG ASPIRATION IN THE BACTERIOLOGICAL DIAGNOSIS OF PNEUMONIA IN ADULTS
Authors: BARNES D. J. , NARAQI S. , IGO J. D.
Published: March 2008

In a prospective study of 175 adults with acute pneumonia, percutaneous lung aspiration (PLA) was performed in 144 in an attempt to obtain a bacteriological diagnosis. Positive cultures were obtained from PLA in 90/144 cases (62.5%). The most common organisms isolated were Streptococcus pneumoniae (60%) gram‐negative bacilli including Hemophilus influenzae (26%) and Staphylococcus aureus (11%). In 39% of those patients with positive PLA cultures, the same organism was isolated on blood cultures. Complications of PLA were uncommon, with hemoptysis in 4% and chest wall hematoma in 0.7% of patients. The incidence of post‐aspirate pneumothorax was not determined in this study. PLA was found to be a safe and effective method of obtaining a bacteriological diagnosis in adult patients with pneumonia.
DIABETIC AMYOTROPHY: REASSESSMENT OF THE CLINICAL SPECTRUM
Authors: LEEDMAN P. J. , DAVIS S. , HARRISON L. C.
Published: March 2008

Diabetic amyotrophy is a syndrome whose recognition may be difficult or delayed. We reviewed thirteen patients with this disorder, all of whom had significant proximal lower limb wasting and weakness as the predominant feature and eleven of whom had pain in the affected limbs. Significant weight loss was common. In nine patients the deficits were largely or totally reversible. Important variations from the classical features were observed. Only five patients displayed asymmetric proximal lower limb wasting, weakness and pain, motor deficits in the remainder being either unilateral or bilateral and symmetrical. The shoulder girdle and arms were also involved in two patients. Proximal limb pain was not invariable, a distal sensory peripheral neuropathy was common, and diabetic control at diagnosis was likely to be good. No prognostic factors were identified. Thus, not all patients with diabetic amyotrophy exhibit the classically‐described features. Other than careful clinical examination, a thorough bilateral electromyographic and nerve conduction study remains the most helpful diagnostic test. Appreciation of the clinical spectrum and context of diabetic amyotrophy should facilitate its differentiation from other disorders, including other forms of diabetic neuropathy.
INCIDENCE AND OUTCOME OF MULTIPLE MYELOMA IN WESTERN AUSTRALIA, 1960 TO 1984
Authors: NANDAKUMAR A. , ENGLISH D. R. , DOUGAN L. E. , ARMSTRONG B. K.
Published: March 2008

All patients diagnosed with multiple myeloma in Western Australia have been registered since 1960; 337 men and 280 women were registered in the period 1960–84. During this period there was a 25% increase in incidence. Age adjusted incidence rates rose from 2.34 per 100 000 person years in men and 1.64 in women during the decade 1960–69 to 2.95 in men and 1.92 in women in 1980–84. Overall, the incidence was 1.36 times higher in men than in women (95% confidence interval 1.16–1.59).

Survival from multiple myeloma improved substantially during the period. In 1960–69, median survival for both sexes was six months, in 1970–79 it was 19 months, and in 1980–84 median survival in men was 43 months while in women it was at least five years.
A PAROXYSMAL OCULAR MOTILITY DISORDER IN MULTIPLE SCLEROSIS
Authors: TODMAN D. H.
Published: March 2008

A 24‐year‐old woman with multiple sclerosis had frequent episodes of an ocular motility disorder and a crossed corticospinal tract deficit. This symptom complex illustrates a distinctive form of paroxysmal disorder in multiple sclerosis.
ECTOPIC PANCREAS AND CYSTIC FIBROSIS
Authors: DAWSON K. P.
Published: March 2008

The case is reported of an infant with cystic fibrosis and duodenal obstruction relieved by surgery and caused by an affected submucosal ectopic pancreas in the third part of the duodenum.
ACUTE THROMBOTIC OBSTRUCTION OF A MITRAL VALVE PROSTHESIS: THE ROLE OF THROMBOLYTIC THERAPY
Authors: FITZPATRICK M. A. , IKRAM H. , ILSLEY C.
Published: March 2008

An acute thrombotic occlusion of a mitral prosthesis in a hemodynamically compromised patient was successfully lysed with intravenous streptokinase. Unfortunately, the patient had a major cerebral embolus, from which she died several days later. A review of the current literature reveals that thrombolytic therapy successfully relieves the obstructing thrombus in 73% of cases, while it is partially successful in another 16% allowing deferral of surgical repair to a more optimal time. Mortality from thrombolytic therapy is 14% while hemorrhage or cerebral emboli occur in a further 11%. Reports of surgical intervention have shown an operative mortality rate of 25%, in those fit to undergo surgery. If hemodynamically unstable patients unfit for surgery are included on an intention to treat basis, overall mortality is 42%. Thus, thrombolytic therapy should be considered primarily in those compromised patients who have a thrombotic occlusion of a valvular prosthesis with a greater risk of operative mortality. Low dose, prolonged infusions should be favoured over rapid, high concentration infusions currently employed for coronary thrombolysis, as the latter regime could have contributed to the fatal cerebral embolus in our patient.
TRANSJUGULAR LIVER BIOPSY ‐ AN AUSTRALIAN EXPERIENCE
Authors: STEADMAN C. , TEAGUE C. , HARPER J. , HAYES P. , NATHAN N. , HARRIS O. , KERLIN P.
Published: March 2008

During the four year period 1983‐87 transjugular liver biopsy was performed on 67 patients (M43, F24) aged 17–79 yr (mean 45.6 yr). Standard percutaneous biopsy was contraindicated by coagulation disorders (95%) often with ascites (17%). Biopsies were taken using a specially modified Ross trans‐septal needle passed into hepatic veins under fluoroscopic guidance. Hepatic tissue samples were obtained from the initial biopsy in 62 (93%) patients. In 30 consecutive transjugular biopsies a mean area of 38.2 mm2 per section (0.9–100mm2) was available for histology compared with an area of 15.9 mm2 (9.3–48.8 mm2) in 50 consecutive percutaneous biopsies. Improved techniques of sample washing, sieving and fixation optimised separation of hepatic tissue from blood clot and fibrin. Four patients experienced significant complications but no deaths occurred. Individual diagnoses were changed in 17 patients as a result of biopsy findings. This study confirms the efficacy and relative safety of the transjugular approach in obtaining liver biopsies from patients with contraindications to standard percutaneous techniques.
DOPPLER ECHOCARDIOGRAPHIC DETERMINATION OF AORTIC VALVE AREA USING THE CONTINUITY EQUATION
Authors: BOWMAN L. K. , CRANNEY G. B. , HOPKINS A. P. , WICKS J. , WALSH W. F.
Published: March 2008

The noninvasive measurement of aortic valve area by use of the continuity equation has been proposed as an accurate method for determining the severity of aortic stenosis. In 32 patients (mean age 64±14 years) with proven aortic stenosis and without significant regurgitation, aortic valve areas derived by the Gorlin equation from cardiac catheterisation data were compared with valve areas calculated from the continuity equation using Doppler echocardiography.

There was a close correlation between Doppler and catheter derived aortic valve areas (r = 0.87, SEE = 0.17 cm2). The interobseryer error for aortic valve area measurement in 20 patients was 9.0 ± 6.8%. The specificity of this method for critical aortic stenosis (aortic valve area less than 0.75 cm2) was 73% and the sensitivity 88%.

We conclude that in an adult, predominantly elderly population with calcific aortic stenosis, this Doppler echocardiographic method is reproducible and can be used accurately to derive aortic valve area.
A CLINICAL MODEL FOR PREDICTING SURVIVAL FOLLOWING ACUTE MYOCARDIAL INFARCTION IN PATIENTS WITHOUT CARDIOGENIC SHOCK: A MULTIVARIATE (COX) ANALYSIS
Authors: BARIN E. , LISTER V. J. , JONES M. P. , NELSON G. I. C.
Published: March 2008

A multivariate predictive model for early (six‐month) survival based on Cox's proportional‐hazards regression model was developed using data collected prospectively from 317 consecutive patients admitted with acute myocardial infarction to a coronary care unit (CCU). Of these, 63 (19.8%) died within the follow‐up period. Patients with cardiogenic shock were excluded from the study. Variables associated with survival were sought from clinical, historical, electrocardiographic and radiographic variables recorded at the time of admission. On multivariate analysis, a stepwise selection procedure identified four variables which described the probability of survival for the six‐month follow‐up. These were: age, upper lung crepitations, marginal and also definite radiographic cardio‐megaly on an anteroposterior radiograph. With this combination of clinical variables alone, using a survival probability partition value of 80%, the model had a sensitivity of 67% and a specificity of 75%. However, the model's predictive accuracy for death was 40%, compared to a predictive accuracy for survival of 90%. This clinical model is most useful for early discrimination of those patients at low risk of death within six months of CCU admission. Other predictive tests for premature death would need to exceed these discriminatory criteria to justify their cost and risks.
THE METABOLISM OF C3 AND C4 IN PATIENTS WITH IMMUNE COMPLEXES AND NORMAL COMPLEMENT LEVELS
Authors: CHARLESWORTH J. A. , PEAKE P. W. , GOLDING J. , PUSSELL B. A. , TIMMERMANS V. , WICKS I. , WAKEFIELD D.
Published: March 2008

The metabolism of the complement proteins, C3 and C4 was examined in two groups of patients with a high incidence of detectable immune complexes but normal levels of complement components. The specific aim was to ascertain whether significant ongoing complement activation occurred in these patients. Eleven patients with rheumatoid arthritis (RA), 11 with infection and 11 control subjects were studied. Each received approximately 10 uCi 125I.C4 and 2.5 uCi 131I.C3 by intravenous injection. Analysis of turnover data showed that there was significant hypercatabolism of both C3 and C4 in the two study groups compared to controls. Plasma production of C4 was normal for both groups (despite the presence of C4 null alleles in six out of 11 of the RA group), while C3 production was significantly elevated in both RA and infection (p < 0.01 and p < 0.001 respectively). Patients with infection showed a significant increase in extravascular/intravascular distribution of both proteins. The data show that immune complex formation is associated with accelerated turnover of complement proteins, irrespective of co‐existing tissue damage or changes in the serum concentration of complement components. The findings suggest that both activation of complement and maintenance or enhancement of protein synthesis are important for the efficient processing of immune complexes in vivo.
PLATELET AGGREGATING ACTIVITY IN THE PLASMA OF PATIENTS WITH ESTABLISHED THROMBOSIS
Authors: JACKSON S. P. , SALEM H. H.
Published: March 2008

This study examines the incidence and significance of novel plasma derived platelet aggregating activity (PAA) in 190 consecutive patients admitted to the medical wards of a general hospital. Seventy five patients (39%) demonstrated this activity. The incidence was highest in patients with a history of thrombosis (52%) or in those with a heightened thrombotic tendency, for example, patients with diabetes or hypertension. In contrast, platelet aggregating activity was observed in six out of 62 patients (approximately 10%) in whom a current or past medical history of thrombosis could not be elicited and in only two out of 72 healthy volunteers examined (3%).

A high frequency of PAA was also noted in a small group of patients with idiopathic thrombocytopenia and patients who had previously received, platelet transfusions. In these patients, this activity presumably reflects the presence of antiplatelet antibodies.

A good correlation between the presence of plasma derived platelet aggregating activity and the phenomenon of spontaneous platelet aggregation was observed. The platelet aggregating activity was not heparin dependent, but was completely abolished by EDTA (5 mM) and benzamidine (8 mM), or by pretreating the platelets with aspirin. A synergistic response was observed with subaggregatory concentrations of thrombin and adrenalin.

Our results suggest that the presence of this platelet aggregating activity may provide a marker for vascular thrombosis. Furthermore we postulate that this plasma derived activity may be partly responsible for platelet hyperactivity previously observed in patients with thromboembolic disorders.
HEMORRHAGIC MYOCARDIAL INFARCTION COMPLICATED BY FREE WALL‐RUPTURE: A CASE ASSOCIATED WITH UNUSUAL CLINICAL FEATURES FOLLOWING INTRAVENOUS THROMBOLYTIC THERAPY
Authors: TWIDALE N. , HENRY L. , MORPHETT A. , TONKIN A. M.
Published: March 2008

A patient is described who developed a systolic murmur soon after she was administered intravenous thrombolytic therapy for acute myocardial infarction. She died and autopsy revealed extensive hemorrhagic myocardial infarction and a free‐wall rupture. A review of the literature suggests that this may be an unusual complication of thrombolytic therapy.
LYMPHOMATOID GRANULOMATOSIS PRESENTING AS A PROGRESSIVE CERVICAL CORD LESION
Authors: COLLINS S. , HELME R. D.
Published: March 2008

A 50‐year‐old male presented with symptoms of a progressive spinal cord lesion over two and a half months. Investigations, including myelography, CT scan and magnetic resonance imaging (MRI), did not show cord compression although the MRI scan demonstrated thickening of the posterior cervical meninges. CSF examination revealed pleocytosis, increased total protein and cells suggestive of a lymphoproliferative disorder. Open lung biopsy of an asymptomatic toft mid‐zone mass was diagnostic of lymphomatoid granulomatosis. We believe this to be a case of lymphomatoid granulomatosis presenting as a progressive cervical myelopathy.
LATE‐ONSET POST‐HEMIPLEGIC HEMIDYSTONIA: CT AND ANGIOGRAPHIC FINDINGS
Authors: HANKEY G. J. , SADKA M.
Published: March 2008

A 27‐year‐old woman is described who suffered an acute left hemiplegia at the age of three years and 20 years later she noted the onset of unilateral left limb dystonic movements. Her cranial CT scan showed an area of low density, consistent with longstanding infarction, in the right lentiform nucleus. Cerebral angiography demonstrated aneurysmal dilatation of the terminal portion of the right internal carotid artery, minor irregularity of the lenticulostriate branches of the right middle cerebral artery (suggestive of Moya Moya disease) and occlusion of the right anterior cerebral artery. The dystonic movements improved with levodopa therapy. Clinico‐radiological correlation in this case supports recent evidence for a disruption of pathways between the caudate nucleus, lentiform nucleus and thalamus in the pathophysiology of hemidystonia.
MALIGNANT LYMPHOMA IN A RENAL TRANSPLANT PATIENT ON CYCLOSPORIN A THERAPY
Authors: WALKER R. J. , TILLER D. J. , HORVATH J. S. , DUGGIN G. G.
Published: March 2008

Cyclosporin A has been associated with an apparent increased incidence of non Hodgkins lymphoma, most often in conjunction with multiple immunosuppressive agents. We report a patient who developed a non Hodgkins lymphoma arising in the right tonsillar fossa six months following renal transplantation. The development of the lymphoma was associated with seroconversion for the Epstein Barr capsid antigen and nuclear antigen. The patient was receiving cyclosporin A alone as immunosuppression.