bluuebunny/crossref_metadata_2025 huggingface dataset:
Good long‐term outcome following surgical repair of post‐infarction ventricular septal defect
Authors: Ellis C. J. , Parkinson G. F. , Jaffe W. M. , Campbell M. J. , Kerr A. R.
Published: March 2008

Background: A post‐infarction ventricular septal defect (VSD) is a serious complication of a myocardial infarction with 90% of patients dying by two months, in published series. Urgent surgical repair improves the prognosis.

Aims: To assess the Green Lane Hospital experience over a ten year period, especially with regard to hospital mortality and long‐term follow up.

Methods: A retrospective case note review of all 35 consecutive patients undergoing post‐infarct VSD repair from 1981 to 1990. Long‐term follow up was obtained in all but one patient (97%).

Results: Twenty‐one male and 14 female patients presented with a mean age of 67 years (range 51–75). All were in NYHA class 3 or 4, 14 (40%) were in cardiogenic shock. Following urgent surgical repair, 30 day mortality was 3i% (11 patients). A further three patients died at two, 33 and 39 months; one patient was lost to follow up. At a mean follow up of 61 months (range 16–111), 15 patients were in NYHA class 1 or 2, five in NYHA class 3 or 4. For the whole group (n= 35) the actuarial survival was 66% at one year, 62% at three years and 58% at nine years.

Conclusion: Post‐infarct VSD surgery is of major prognostic benefit with patients obtaining a good long‐term outcome. (Aust NZ J Med 1995; 25: 330–336.)
Radiofrequency catheter ablation of atrial tachycardia
Authors: Wang L. , Weerasooriya H. R. , Davis M. J. E.
Published: March 2008

Background: Atrial tachycardia is a relatively uncommon arrhythmia which usually responds poorly to antiarrhythmic drug therapy. Transcatheter radiofrequency (RF) ablation is a new therapeutic modality for patients with atrial tachycardia.

Aim: This study analyses our early experience with the treatment of atrial tachycardia by this technique.

Methods: Thirteen consecutive patients (age 13–63 years) with 15 drug‐refractory atrial tachycardia foci were treated with RF catheter ablation. Atrial tachycardia was mapped by seeking the earliest atrial activation in the right atrium in eight patients and in the left atrium in five.

Results: Tachycardias were abolished in nine (69%) patients, including two sinoatrial re‐entrant tachycardias and seven automatic atrial tachycardias, after 9±10 (range, one to 28) pulses of RF current. Six of these ablated atrial tachycardia foci were right sided and three were on the left. One patient had three separate right atrial tachycardia foci; one was eliminated. Tachycardia recurred after two weeks in one patient with apparently successful ablation of sinoatrial re‐entrant tachycardia. One patient with successful ablation of a right atrial tachycardia developed cardiac tamponade requiring surgical intervention.

Conclusion: This study demonstrates that atrial tachycardia arising from diverse sites can be eliminated by RF catheter ablation.
Primary spontaneous pneumothorax treated by video assisted thoracoscopic surgery – results of intermediate follow up
Authors: Yim A. P. C. , Ho J. K. S. , Lai C. K. W. , Chan H. S.
Published: March 2008

Background: Primary spontaneous pneumothorax (PSP) is a common clinical condition associated with high recurrence if no definitive treatment is given and could be life threatening if left untreated. The best treatment for this condition, however, remains controversial.

Aims: A prospective study of patients with PSP treated by video assisted thoracoscopic surgery (VATS) after a mean follow up of 16 months.

Methods: Between September 1992 and April 1994, 114 VATS procedures were performed on 110 patients with PSP (including four patients with bilateral presentation) by one surgical team from a single institution. Mechanical pleurodesis with Marlex mesh was performed on all patients. In addition, apical bullae were identified in 100 cases (88%) and these were resected.

Results: There was no mortality. The median hospital stay was three days. The procedure was well accepted by patients and this was reflected subjectively in a visual analogue scale and objectively in the requirement of postoperative analgesia. Complications included one wound infection, one bleeding, eight persistent air leaks over ten days. We had two failures with recurrence of pneumothorax occurring one week and two months postoperatively (mean follow up of 16 months). Late morbidity with intercostal neuropathy was identified in nine patients but only two of them required oral analgesics.

Conclusion: VATS is a quick and effective treatment for PSP. We currently recommend VATS for patients with recurrent spontaneous pneumothorax, as well as first time pneumothoraces associated with tension, bilaterality, frequent travelling, unreliable follow up and persistent air leak over three days.
Regulation of the immune response – lessons from transgenic models
Authors: de St Groth BARBARA FAZEKAS
Published: March 2008

Generation of the immune antigen receptor repertoire by means of semi‐random recombination requires a mechanism for ensuring that self reactivity is constrained. A model is presented which accounts not only for the generation of self tolerance during ontogeny but also for regulation of tolerance and immunity in peripheral immune responses. The model proposes a hierarchy of immune regulation in which antigen presenting cells (APCs) determine the responses of T cells and T cells those of B cells. APCs respond to environmental triggers such as microbes, particulate antigen and tissue injury by becoming highly immunogenic for T cells. At other times, APCs can either be non‐stimulatory or tolerogenic, depending on their environment. The model suggests that during ontogeny T and B cells mature in a tolerogenic environment in the thymus and bone marrow, thus ensuring that immunological tolerance results from early contact with self antigen.
Target cell apoptosis induced by cytotoxic T cells and natural killer cells involves synergy between the pore‐forming protein, perforin, and the serine protease, granzyme B
Authors: Trapani JOSEPH A.
Published: March 2008

Cytotoxic lymphocytes (CL) comprise two effector cell populations with the ability to eliminate unwanted or harmful cells. Cytotoxic T cells (CTLs) demonstrate both an exquisite specificity and memory in recognising target cell oligopeptides presented within the groove of major histocompatibility complex class I antigens. By contrast, natural killer (NK) cells mediate ‘innate’ immunity against virus‐infected cells and surveillance against neoplastic transformation, and do not require presensitisation. Despite recognising target cells in very different ways, CTLs and NK cells both utilise a pore‐forming protein, perforin, and a battery of serine proteases as a principal means of inflicting cell death. The action of both types of CL results in death by apoptosis. Recently, we and others have accumulated evidence that perforin and serine proteases synergistically trigger an endogenous pathway of programmed cell death that results in dissolution of the nuclear membrane, chromatin condensation and DNA fragmentation. These changes are secondary to inappropriate activation of p34cdc2, a kinase whose activation and migration from the cytoplasm to the nucleus normally controls a cell's entry into mitosis. Therefore, CL may exert their actions through the derangement of cell cycle control. The downstream molecular targets of perforin/granzyme‐mediated apoptosis (especially the physiological ligand/substrate of granzyme B) are still unclear, though candidate molecules with homology to products of cell death genes found in primitive organisms such as the nematode, C. elegans, are currently under investigation.
Mechanisms of drug resistance in malaria
Authors: Cowman ALAN F.
Published: March 2008

Plasmodium falciparum causes the most severe form of human malaria which directly results in over two million deaths per year. As there is not yet a useful vaccine against this disease the major form of treatment and control is the use of chemotherapeutic agents. Unfortunately the parasite has managed to devise mechanisms that allow it to evade the action of almost all the antimalarials in our arsenal.

The antifolate drugs include the dihydrofolate inhibitors pyrimethamine and proguanil as well as the sulfones and sulfonamides. These antimalarials act on enzymes in the folate pathway. The mechanism of resistance to these compounds involve mutations in the target enzyme that decrease the affinity of binding of the drug.

A second major group of antimalarials include the quinine‐like compounds. Quinine was one of the first compounds used to treat malaria and the related drug chloroquine is the most important antimalarial. Mefloquine and halofantrine were developed in response to major problems with the spread of chloroquine resistance. Chloroquine resistance is due to the ability of the parasite to decrease the accumulation of the drug in the cell. The exact mechanism that allows this is still under investigation although at least one protein has been identified that affects the accumulation of this important antimalarial.
The cbl oncogene: a novel substrate of protein tyrosine kinases
Authors: Langdon WALLACE Y.
Published: March 2008

The cbl oncogene was first identified as part of a transforming retrovirus which arose in a mouse pre‐B cell lymphoma. Its protein product, p120cbl, is cytoplasmic and has several distinctive domains including a highly basic region, a RING finger motif and a large proline‐rich domain. A mutation to cbl in the 70Z/3 pre‐B cell lymphoma produces an oncogenic protein which exhibits a marked enhancement of tyrosine phosphorylation. Parallel studies have demonstrated that P120cbl is a substrate of protein tyrosine kinases activated by engagement of the T cell antigen receptor and that cbl is phosphorylated by oncogenic forms of the Abl tyrosine kinase. These studies also demonstrated a constitutive association between cbl and the SH3 domains of the Grb2 and Nek adaptor proteins in a range of haemopoietic cell lines. More recently it has been found that cbl is rapidly phosphorylated following stimulation of the EGF receptor, Fey receptor, c‐Kit receptor and CSF‐1 receptor. A genetic analysis in Caenorhabditis elegans has identified a cbl homologue, called sli‐1, that negatively regulates the LET‐23 tyrosine kinase receptor. These characteristics indicate a central role for cbl in the regulation of intracellular signals that are mediated by growth factors and antigenic stimuli which activate protein tyrosine kinases.
Patients' perceptions of food‐induced asthma
Authors: Woods R. K. , Weiner J. , Abramson M. , Thien F. , Walters E. H.
Published: March 2008

Background: The influence of diet in asthma control remains unclear. However, there is likely to be a wide gap between patient perceptions and the probable actual role. Some 20–60% of people with asthma report food as a trigger factor while approximately 2.5% react to double‐blind placebo‐controlled challenges. The aim of this study was to determine: the frequency, type and sources of dietary advice being offered to patients, the prevalence of dietary modification, whether dietary changes were perceived to be of benefit and the type and sources of food/beverage reactions that people perceive they have experienced.

Method: A self‐administered ‘food and asthma’ questionnaire was developed and mailed to 156 consecutive Alfred Hospital Asthma and Allergy Clinic patients registered on a computer database.

Results: The completed questionnaire response rate was 86.5%. Dietary advice had been offered to 47% of respondents while 61% had tried to modify their diet. Dietary restriction was the most common dietary modification. Where dietary restriction had occurred 79% of respondents perceived that this had improved their asthma control. A doctor was the most common source of dietary advice. Seventy‐three per cent reported that food induced asthma.

Conclusion: We confirmed that patients with asthma perceived diet to be important in their asthma control and that dietary modification is common despite its lack of objective basis. The influence of diet and asthma requires more research, evaluation and clinical attention.
Microalbuminuria in Type 2 diabetes: an independent predictor of cardiovascular mortality
Authors: Beilin J. , Stanton K. G. , McCann V. J. , Knuiman M. W. , Divitini M. L.
Published: March 2008

Background: Microalbuminuria has been shown to be associated with cardiovascular mortality in type 2 diabetic subjects. It is unclear to what extent this is due to the increased prevalence of other cardiac risk factors.

Aims: To examine the relationship of urine albumin excretion to cardiovascular mortality and to determine its status as an independent risk factor.

Methods: In a prospective longitudinal study from 1986–1999 we followed 666 type 2 diabetic subjects from a diabetes outpatient service. Cardiovascular risk factors including urine albumin concentration were measured at study entry. Cox proportional hazards regression was used to determine risk factors for mortality. The hazard ratios of microalbuminuria and macroalbuminuria for all cause, cardiovascular and coronary heart disease mortality were determined after accounting for other cardiac risk factors including blood pressure, glycated haemoglobin, total cholesterol, HDL cholesterol, triglycerides, urea, smoking, body mass index, patient age and disease duration.

Results: The prevalence of urine albumin of 30–300 mg/L at study entry was 31.7%. A total of 167 deaths occurred (80 from cardiovascular disease). Mortality hazard ratios in subjects with urine albumin of 30–300 mg/L as compared to <30 mg/L, adjusted for age, sex and other cardiovascular risk factors were 1.77 (95% CI 1.22–2.57, p=0.002) for all causes, 2.34 (95% CI 1.38–3.99, p=0.002) for cardiovascular and 1.78 (95% CI 0.97–3.26, p=0.061) for coronary heart disease (CHD) mortality. Other factors significantly associated with cardiovascular mortality included diastolic blood pressure, HDL cholesterol and glycated haemoglobin. Total cholesterol and log triglyceride were significantly associated with CHD mortality. Disease duration, age at diagnosis, smoking and body mass index were not related to cardiovascular or CHD mortality.

Conclusions: We confirm microalbuminuria as an independent predictor of mortality in type 2 diabetes despite its association with a number of conventional cardiovascular risk factors.
Symptomatic Human Immunodeficiency Virus (HIV) infection in Papua New Guinea
Authors: Seaton R. A. , Wembri J. P. , Armstrong P. , Ombiga J. , Naraqi S. , Kevau I.
Published: March 2008

Background: Human Immunodeficiency Virus (HIV) infection was first detected in Papua New Guinea (PNG) in 1987. By August 1995 a total of 323 persons had been diagnosed as HIV antibody positive nationwide and seroprevalence rates were climbing. This study was prompted by a lack of data on the clinical syndromes associated with HIV infection in Melanesian adults.

Aims: To describe the clinical and epidemiological features of symptomatic HIV infection in adult Melanesians.

Methods: A largely retrospective study of patients was admitted to the medical wards of the Port Moresby general hospital between January 1990 and September 1995. Clinical records of patients with antibody to HIV were studied and clinical, laboratory and epidemiological data were recorded.

Results: Seventy patients were studied and the majority were young, urban dwelling adults from a variety of social groups. The sex distribution was even. Common clinical syndromes associated with HIV infection were chronic diarrhoea (47.8%), wasting (94.2%) and oropharyngeal candidiasis (68.7%). Tuberculosis was suspected in 68.6% and cryptococcal meningitis was detected in 8.6% including one patient with Cryptococcus. neoformans var. gattii infection. There was a high mortality (53%) in patients admitted to hospital.

Conclusions: Patients with HIV infection in PNG present to hospital late in their disease course. Clinical syndromes are similar to those observed in Africa and mortality on first admission is high. The major mode of transmission is heterosexual and sexually transmitted diseases and promiscuity are probably important factors in facilitating spread.
A prospective study of the gastroenterological causes of iron deficiency anaemia in a General Hospital
Authors: Bampton P. A. , Holloway R. H.
Published: March 2008

Background: Current practice is to investigate routinely both upper and lower gastrointestinal tracts in patients with unexplained iron deficiency anaemia.

Aims: To determine the efficacy of this approach and whether the use of more stringent biochemical criteria for iron deficiency, symptoms, or a positive immunochemical faecal human haemoglobin (FHH) influenced the findings of the investigations and could help target investigations more efficiently.

Methods: Eighty patients were studied prospectively, 51 who had ‘definite’ iron deficiency anaemia (low ferritin and transferrin saturation) and 29 with ‘probable’ iron deficiency anaemia (either low ferritin or transferrin saturation). Patients underwent a standardised symptom assessment and testing for FHH, upper endoscopy with small bowel biopsy and colonoscopy, and a small bowel series if upper endoscopy and colonoscopy were negative.

Results: Lesions potentially causative for iron deficiency anaemia were found in 54/80 (60%) of patients. Five patients (7%) had lesions in both upper and lower tracts. Small bowel biopsy was abnormal in one of 80 patients and small bowel series one of 25 patients. Significant lesions in either the upper or lower gastrointestinal tract were found in 14/20 patients with positive FHH and 25/47 with negative FHH. Symptoms, use of non‐steroidal anti‐inflammatory drugs and classification of patients into ‘definite’ and ‘probable’ iron deficiency did not influence yield of investigations or site of lesions found.

Conclusions: Gastrointestinal lesions are common in patients with unexplained iron deficiency anaemia. Neither symptoms nor presence of FHH predict the presence or site of detectable lesions and neither testing for FHH nor more stringent biochemical criteria for iron deficiency alters clinical decision making. The findings support the routine performance of both upper endoscopy and colonoscopy in the investigation of patients with unexplained iron deficiency anaemia, however routine investigation of the small bowel is of questionable value.
Detection of carriers of haemophilia A: use of bioassays and restriction fragment length polymorphisms (RFLP)
Authors: Rudzki Z. , Sheffield L. J. , Rodgers S. E. , Lloyd J. V.
Published: March 2008

Abstract Background: Haemophilia A is a sex‐linked bleeding disorder carried by unaffected females. Currently, the two main methods used for the determination of carrier status in women from families with haemophilia A are bioassays and DNA‐based assays using restriction fragment length polymorphisms (RFLP).

Aim: The aim of this paper was to assess the current usefulness of these two methods.

Methods: Bioassays measured factor VIII coagulation activity by a two‐stage coagulation assay and von Willebrand antigen by immunoelectrophoresis. RFLP were determined with two intragenic probes (pi 14 and p486) and two linked probes (Stl4 and DX13). Data were analysed using a Bayesian analysis to allow for all possible recombination events. We also incorporated an estimate for the risk of mosaicism into calculations in isolated haemophilia families. Both bioassays and RFLP were used to determine carrier status in 63 women, 31 from known haemophilia families and 32 from families of isolated cases. The techniques were assessed for their ability to classify the patients as normal (p<0.2) or carrier (p>0.7). Where applicable, intron 22 inversion was also tested.

Results: In the known families, six women could not be classified after bioassay, but all could be classified by RFLP. Of the 32 women from families of isolated cases, eight were unclassified by bioassay and 12 were not definitely classified using RFLP. However, RFLP was useful in determining that a recent mutation had occurred in six of the eight families in which DNA from the grandparents was available.

Conclusion: For diagnosis of carriers of haemophilia, RFLP is the preferred method in familial haemophilia, but is less useful in isolated haemophilia.
Cost effectiveness of day stay versus inpatient radiofrequency (RF) ablation for the treatment of supraventricular tachyarrhythmias
Authors: Weerasooriya H. R. , Harris A. H. , Davis M. J. E.
Published: March 2008

Abstract Background: It is well established that radiofrequency (RF) ablation is the most cost effective treatment strategy for patients with supraventricular tachycardia. Previous cost estimates assumed at least an overnight stay following RF ablation. Day stay RF ablation however appears to be a safe alternative.

Aims: The aim of this study was to compare day stay and inpatient catheter ablation in terms of cost, efficacy and safety.

Methods: This was a retrospective cost effectiveness analysis. The study population consisted of 25 consecutive patients who underwent day stay RF ablation and 25 consecutive patients who underwent inpatient RF ablation (historical controls). Economic analysis was based upon a detailed clinical costing.

Results: The mean overall cost per patient of inpatient RF ablation in 1994 Australian dollar values is $2354 (SD, $642) compared with $1876 (SD, $595) for day stay RF ablation (p<0.01). Day stay RF ablation is a cost effective alternative to inpatient RF ablation.
Feed us nutrition: final year medical students' perceptions of nutrition medical education
Authors: Warden R. A. , Lettoof A‐L. , Wallis B. J. , Porteous J. E.
Published: March 2008

Background: Nutrition is recognised as an integral aspect of Australian medical education. Since medical students will learn more of a subject they consider important, there is a need for their perceptions of nutrition to be investigated.

Aims: To identify final year medical students' perceptions about nutrition and its inclusion in their medical course, and to compare priority nutrition topics identified with those previously identified by Faculty and General Practitioners (GPs) who teach in the undergraduate curriculum.

Methods: A cross‐sectional survey of all final year medical students attending the University of Newcastle was conducted, using a distributed questionnaire, comprising three sections: demographics, perceptions about nutrition and its inclusion in the medical course, and a listing of 38 major nutrition topics. Main outcome measures were: interest in nutrition, and whether it should be included in the undergraduate medical curriculum; rated importance of listed nutrition topics; comparison between students and Faculty and GPs. Frequency distributions and Chi square analyses were used to compare group responses.

Results: Seventy‐one per cent of the students were interested in nutrition and 94% believed it should be included in the medical curriculum. More than 60% of the students nominated 21 of the 38 topics essential or important. Thirteen of these topics were also highly rated by Faculty and GPs, although Faculty and GPs rated more topics as essential or important.

Conclusions: Newcastle medical students are interested in nutrition and believe it should be included in their medical curriculum. This may be due to their clinical exposure and the educational milieu of the University of Newcastle Medical School. Exposure to nutrition in their undergraduate education appears to be an important determinant for priority designated nutrition topics.
Alcohol intake and survival in the elderly: a 77 month follow‐up in the Dubbo study
Authors: Simons L. A. , McCallum J. , Friedlander Y. , Simons J.
Published: March 2008

Background: A prospective study in non‐institutionalised Australian elderly aged 60 years and over commenced in Dubbo, NSW in 1988.

Aim: To examine the relationship between all‐causes mortality and alcohol intake.

Methods: The data were derived from a community‐based sample comprising 1236 men and 1569 women followed for a median period of 77 months. Regular alcohol intake was reported by 78% of men and 52% of women. Eighty‐seven per cent of men and 44% of women primarily drank beer.

Results: Death occurred in 305 men and 236 women, 34% and 39% respectively from coronary heart disease (CHD). In a proportional hazards model, the hazard ratio (HR) for all‐causes mortality in male drinkers, compared with abstainers, was 0.75 at one‐seven drinks/week, 0.76 at eight‐14 drinks/week, 0.69 at 15–28 drinks/week and 0.49 at >28 drinks/week (p<0.04), an inverse relationship. In female drinkers, HR was 0.78 at one‐seven drinks/week, 0.49 at eight‐14 drinks/week (p<0.04) and 0.62 at 15–28 drinks/week, potentially a U shaped relationship. The effect on all‐causes mortality could not be attributed to a differential effect of beer versus wine/spirit intake. Although the mortality rate was lower in those taking any alcohol compared with abstainers, those taking any alcohol exhibited an increased proportion of deaths due to cancer at the expense of a reduced proportion of CHD and stroke deaths.

Conclusions: Alcohol intake in the Dubbo elderly appears to be independently associated with a significant increase in life expectancy. Mechanisms underlying the effect may emerge at a longer interval of follow‐up.
Rheumatic manifestations of the myelodysplastic syndromes: A comparative study
Authors: Chandran G. , Ahern M. J. , Seshadri P. , Coghlan D.
Published: March 2008

Background: The myelodysplastic syndromes (MDS) are a group of common haematological disorders that increase in incidence age. Case reports have suggested an arthritis associated with myelodysplasia. This comparative study reviews patients with myelodysplasia and patients with a myeloproliferative disorder (MPD) as the control group.

Aim: To document the rheumatological manifestations in patients with MDS and to determine if there is an association between MDS and an inflammatory arthritis/ vasculitis.

Methods: Between July 1990 and July 1995 all patients with a known diagnosis of MDS and MPD attending the Haematology clinics of two teaching hospitals were reviewed. There were 87 MDS patients and 86 MPD patients identified. Twenty‐six of the MDS patients and 28 of the MPD patients attended a clinical review by a single examiner. A history of joint symptoms, skin rashes, family and drug history was obtained. Physical examination and serology were routinely performed. The case notes of the remaining patients were reviewed by a single observer. Approval was obtained from the Ethics Committee at both hospitals.

Results: The two patient groups were matched for sex and age. There were equal numbers of patients with osteoarthritis, rheumatoid arthritis and crystal arthritis in the two groups. The significant finding was the presence of a seronegative inflammatory arthritis in five patients in the MDS group. One patient had both a seronegative arthritis and a cutaneous leukocytoclastic vasculitis, and another a cutaneous leukocytoclastic vasculitis only. These rheumatic manifestations were not seen in the MPD group. Five of six patients were treated with prednisolone and responded impressively. The rheumatological symptoms preceded the diagnosis of MDS in two of the six cases.

Conclusions: A seronegative arthritis is an associated finding in MDS. The artiiritis can precede the development of the bone marrow disorder, and can be a guide to the diagnosis of this haematological disorder in elderly patients presenting with an inflammatory arthritis and cytopenias.
An audit of long‐term octreotide therapy for acromegaly
Authors: Cheung N. W. , Taylor L. , Boyages S. C.
Published: March 2008

Abstract Background: Octreotide has been successfully used for the treatment of acromegaly, but little long‐term data are available.

Aims: To determine the long‐term efficacy and safety of octreotide in the treatment of acromegaly.

Methods: Twenty‐seven patients with acromegaly were treated with octreotide in a non randomised study. Six patients had not had previous surgery or radiotherapy, and were treated with octreotide alone. Symptoms of acromegaly, IGF‐I levels, growth hormone suppression by glucose, pituitary tumour size, and side effects were monitored. The median duration of treatment was 44 months (range six‐102).

Results: Symptom control was excellent. Twenty (74%) patients had a reduction of IGF‐I into the normal range. IGF‐I levels fell after one year from 94.2±6.1 nmol/L (mean±SEM) to 50.0±2.7 nmol/L (p<0.0001). Ten of 13 (77%) patients had normal IGF‐I levels after four years. These reductions have persisted for up to nine years of octreotide therapy. The GH response to glucose was normalised in 14 of 16 (88%) subjects. Eleven of 25 (44%) patients had a reduction in pituitary gland height. Side effects were common, but usually of a minor nature. Cholelithiasis occurred in 39% of patients. Two patients ceased octreotide because of side effects.

Conclusions: We conclude that octreotide is an effective and safe long‐term treatment for acromegaly. It is a useful adjunct to surgery, and may be offered as sole therapy for patients with smaller adenomas.
Fasting and post‐methionine homocysteine levels in a healthy Australian population
Authors: Silberberg J. , Finucane P. , Crooks R. , Guo X. W. , Fryer J. L. , Xie J. , Wlodarczyk J. , Dudaman N. , Nair B.
Published: March 2008

Abstract Background: Plasma homocysteine (H[e]) is frequently measured in patients with occlusive vascular disease, but levels vary between populations and between laboratories.

Aims: We sought to derive reference values for an Australian population over a wide age range.

Methods: We measured plasma H(e) in the fasting state and after methionine loading in 116 volunteers selected at random from the Hunter districts of the New South Wales electoral roll and in 49 apparently healthy, active subjects recruited from the region's lawn bowling clubs. Reference ranges were derived for born sexes, in three age strata. We collaborated with two international laboratories in standardising our results.

Results: Mean fasting H(e) levels were approximately 2.7 μ.mol/L higher in men than women, at all ages (95% CI for the difference, 1.2 to 4.1 μmol/L). Levels increased with age (approximately 1.0 μmol/L/decade, 95% CI 0.5 to 1.5) and were correlated with serum creatine (r=0.48), serum folate (r=−0.30), red cell folate (r=−0.25) and serum B12 (r=−0.31) (all p<0.001). These results are similar to those reported in other populations.

Conclusions: We have defined reference ranges for a typical Australian population, following careful laboratory standardisation. H(e) levels must be interpreted with regard to age, sex, renal function and vitamin B12 and folate status.
Community acquired pneumonia in north eastern Australia ‐ a hospital based study of Aboriginal and non‐Aboriginal patients
Authors: Thompson J. E.
Published: March 2008

Abstract Background: Although the most important organism causing community acquired pneumonia continues to be Streptococcus pneumoniae, the frequency of other pathogens varies considerably across the world.1‐4

Aims: To look for the causes of community acquired pneumonia (CAP) in north east Australia. To examine the differences between Aboriginal and non‐Aboriginal subjects with emphasis on prevalence, risk factors, causative organisms and prognosis.

Methods: The records of 200 consecutive patients admitted to Cairns Hospital during 1992 with a diagnosis of pneumonia were studied.

Results: Aboriginal patients made up half the numbers admitted, but only 13% of the population. More Aboriginal adults died than non‐Aboriginal adults, but no child died. Heavy alcohol use, chronic lung disease and diabetes mellitus were the commonest risk factors for Aborigines (alcohol, chronic lung disease and cancer for non‐Aboriginal subjects).

S. pneumoniae, followed by Haemophilus influenzae were the most common pathogens found. Both were sensitive to amoxycillin. The yield of definite pathogens was low. Staphylococcal and melioidosis pneumonia were confined to Aboriginal patients. Chlamydia, legionella and Mycoplasma pneumoniae were not identified.
Lymphocytopenia in a hospital population ‐ what does it signify?
Authors: Castelino D. J. , McNair P. , Kay T. W. H.
Published: March 2008

Abstract Background: Lymphocytopenia is a common finding in hospital patients especially since the advent of automated differential leukocyte counters. The causes and significance of lymphocytopenia are generally poorly understood. There has been no large‐scale study of its significance for 25 years. The HIV epidemic, and the recently described idiopathic CD4+T‐lymphocytopenia have raised interest in this finding.

Aims: To describe the spectrum of lymphocytopenia in an adult teaching hospital and investigate its clinical significance.

Methods: Using the available computer facilities, patients with significant lymphocytopenia (<0.6X109/L) were identified over a 102 day period and diagnoses, operations and medication lists obtained. Where necessary, patient histories were examined to supplement the above information. If feasible, previous and subsequent lymphocyte counts were checked to establish if the lymphocytopenia were temporary or longstanding.

Results: One thousand and forty‐two patients were identified, with a mean age of 59.6 years, of whom 563 were male, and 757 were inpatients. Thirty‐six patients were pancytopenic. We checked previous and subsequent counts for 698 patients and found 45 patients who were consistently lymphocytopenic, some for more than ten years. Thirty‐four patients with previously normal counts remained lymphocytopenic throughout follow up, while 457 had at least one subsequent lymphocyte count >1×107L. We found only one patient who was suspected of having idiopathic CD4+T‐lymphocytopenia. Patients fell into several categories (with some overlap): bacterial/fungal sepsis (250), post‐operative (228), corticosteroid therapy (definite 159, suspected 53, inhaled steroids alone 14), malignancy (174 definite, six probable), cytotoxic therapy and/or radiotherapy (90), trauma or haemorrhage (86), transplants (73–38 renal and 35 bone marrow), ‘viral infections’ (26) and HIV infection (13). Thirty‐four patients died within the study period.

Conclusions: Lymphocytopenia in hospital patients is most frequently reversible, and due to acute illness, notably sepsis and trauma (including surgery). Malignancy, with or without chemotherapy, and steroid use are also common causes, but HIV infection is a relatively uncommon cause in our hospital.
Instrument performance in bone density testing at five Australian centers
Authors: Khan K. M. , Henzell S. L. , Broderick C. , Prince R. L. , Saul A. , Lornman J. , Wark J. D.
Published: March 2008

Abstract Aims: To assess the in vitro precision and accuracy of bone mineral densitometry (BMD) within and between locations at five Australian centres.

Methods: Using a multicentre reliability study the accuracy and short‐ and long‐term precision of dual‐energy X‐ray absorptiometry (DXA) in vitro was compared on five instruments. Measures were performed using pencil beam mode on four Hologic QDR‐2000 densitometers and one Hologic QDR‐1000/W (Hologic Inc, Waltham, MA).

Results: Short‐term precision of bone mineral density measurement was less than 0.5% for spine phantoms (n=10 for each centre, mean intrasite coefficient of variation [CV] 0.39±0.09% [SD]) and for hip phantoms (n=10 for each centre, mean intrasite coefficient of variation [CV] 0.34±0.10% [SD]). Between‐centre measurement (n=10 for each phantom) of a single spine phantom and a single hip phantom (specified mineral contents ‐ 58.5 g and 38.6 g, respectively) revealed ranges of bone mineral content of 57.7‐58.1 g (all‐point CV=0.52%) and 37.1–37.8 g (all‐point CV=0.70%), respectively. When results from pairs of machines were compared there were statistically different mean BMD results for the majority of the ten possible pairings for both spine and hip measurements. Each study centre measured in vitro stability of phantom BMD measurements over a one year period (n=45–283, median 157 for spine; and n=0–262, median 38, for hip); CVs ranged from 0.38 to 0.53% for the spine measurements and from 0.38 to 0.54% for the hip measurements. The mean all‐point accuracy of the spine phantom measurements was 99.1% and the hip phantom measurements was 96.7%.

Conclusions: Across a number of instruments DXA demonstrates in vitro all‐point precision of 0.5% for the spine phantom and 0.7% for the hip phantom. The instrument demonstrates accuracy of greater than 99% at the spine and 96% at the hip. This finding has clinical, research and quality control implications.
‘Normal’ lung function in rural Australian Aborigines*
Authors: Veale A. J. , Peat J. K. , Salome C. M. , Woolcock A. J. , Thompson J. E.
Published: March 2008

Abstract Background: Although lung diseases are a leading cause of premature mortality in Australian Aborigines, little is known about normal lung function in these people.

Aim: To develop models for ‘normal’ spirometric function in rural Australian Aborigines.

Method: A cross‐sectional population‐based study of four rural Aboriginal communities was performed in Queensland, Northern Territory and South Australia, Australia. We studied 261 children aged seven‐19 years and 332 adults aged 20–80 years who were free of symptoms and had no clinical signs of chronic lung disease. The outcome measures were forced expiratory volume in one second (FEVj) and forced vital capacity (FVC). Multiple linear regression was used to develop models for FEVj and FVC and comparisons were made with Caucasians and indigenous people from other countries.

Results: The Aboriginal people studied had FEVi and FVC values that were lower (20% and 30% respectively) than those found in Caucasians of the same height, age and gender. As a consequence, they had relatively high FEVi/FVC ratios. Those studied also had forced expiratory volumes that were lower than those found in African Americans and other indigenous peoples.

Conclusions: Apparently healthy rural Aboriginal people have low forced expiratory volumes when contrasted with Caucasians and indigenous peoples such as African Americans. More research is required to determine if this is ‘normal’ or a product of the suboptimal environment into which many Aboriginal people are born.
The value of the lipid‐laden macrophage index in the assessment of aspiration pneumonia
Authors: Adams R. , Ruffin R. , Campbell D.
Published: March 2008

Abstract Background: A semi‐quantitative index of lipid‐laden macrophages on broncho‐alveolar lavage (BAL) has been reported to be highly sensitive but only moderately specific for aspiration in adults. There has been little published literature evaluating this technique since the original report.

Aims: To assess the value of a lipid‐laden macrophage index (LLMI) of greater than 100 to confirm the clinical diagnosis of aspiration in patients with abnormal radiological investigations.

Methods: Prospective evaluation of 80 adult patients with abnormal radiology was undertaken using BAL and the LLMI. A diagnosis of aspiration was made prior to bronchoscopy if the patient had one or more of: clinically witnessed aspiration, positive barium swallow or speech pathology assessment; or an upper gastrointestinal endoscopy showed severe reflux oesophagitis and the patient had a history consistent with aspiration.

Results: Eighteen patients were diagnosed with aspiration. Of these, 17 had an index >100, and one had an index of 94 (mean 157, 99% CI 127–187, range 94–238). Of the other 62 subjects, seven had an index >100 (mean 46, 99% CI 22–70, range 0–303). There was a significant difference between index scores for the two groups (p=0.002). For aspiration, an index >100 had a sensitivity of 94% and a negative predictive value of 98%. The specificity was 89%, with a positive predictive value of 71%.

Conclusions: The LLMI is a sensitive indicator for aspiration causing radiological lung disease in adults. Its lack of specificity means it cannot be the sole means of diagnosis, but it can allow better targeting of other investigations in those patients in whom bronchoscopy is undertaken to investigate radiological abnormalities.
Risk factors for repeat attendance at hospital emergency departments among adults and children with asthma
Authors: Wakefield M. , Staugas R. , Ruffin R. , Campbell D. , Beilby J. , McCaul K.
Published: March 2008

Background: Acute asthma attacks are frequent causes of attendance at hospital Emergency Departments (EDs) and a subgroup of these patients repeatedly present for such treatment.

Aims: This study sought to characterise patients who were repeat attenders at EDs, to assist the targetting of appropriate future interventions aimed at reducing avoidable presentation.

Methods: A cross‐sectional survey was undertaken of patients presenting with an asthma attack to the EDs of six teaching hospitals in Adelaide, South Australia between 14 May and 30 June 1994. Patients were interviewed within six weeks of their attendance about aspects of their asthma history, severity, medications, self‐management, attitudes and environment. Repeat attenders, defined as two or more visits over the course of the preceding year, were compared with those who reportedly attended on one occasion only, using logistic regression analyses.

Results: Sixty‐two per cent of 272 patients aged under 15 years and 40% of 165 patients aged 15 years or more reported having attended two or more times over the course of the preceding year. Among adults, the variables independently associated with repeat attendance principally related to asthma severity. Among children, repeat attendance was associated with parental attitudinal variables relating to appraisal of their child's asthma severity, management of asthma attacks and parental worry.

Conclusions: The factors underlying repeated presentations at EDs differ between adults and children and interventions to minimise avoidable presentation will require different emphasis for these patient subgroups.
High density lipoprotein (HDL) particle composition in patients with end stage renal failure (ESRF) on chronic dialysis
Authors: Lee P. , O'Neal D. , Murphy B. , Best J.
Published: March 2008

Background: Hypertriglyceridaemia, low high density lipoprotein (HDL) cholesterol level and reduced LDL particle size are the major features of uraemic dyslipidaemia. They are also found in the Insulin Resistance Syndrome.

Aim: To examine alterations in HDL composition in patients on chronic dialysis and their relationship with insulin resistance.

Methods: HDL particle size was determined in 33 patients on chronic haemodialysis (HD), 27 on chronic ambulatory peritoneal dialysis (CAPD) and 32 control non‐diabetic subjects (C) without renal disease by non‐denaturing 3–30% polyacrylamide gradient gel electrophoresis. A weighted HDL particle size score was calculated taking into account both HDL particle size and percentage total HDL protein concentration of each HDL band of the individual. lipid and apolipoliprotein concentrations were determined in HDL2 and HDL3 particles obtained by sequential ultracentrifugation. In a subset of 24 control subjects and 22 subjects on HD, insulin sensitivity was also determined by an intravenous glucose tolerance test (IVGTT).

Results: HDL particles were found to be more triglyceride enriched and apoAI depleted in subjects on HD even though plasma triglyceride level was highest in patients on CAPD. Five subpopulations of HDL particles were identified by gradient gel electrophoresis in all subjects combined. In the subgroup of subjects who underwent IVGTT, the weighted HDL particle size score correlated positively with HDL cholesterol level 0=0.6, p<0.0005), LDL particle size (r=0.47, p>0.001), and insulin sensitivity (r=0.48, p<0.001), and negatively with plasma triglyceride level (r=‐0.37, p<0.01).

Conclusions: We conclude that even though HDL cholesterol is reduced to a similar level in subjects on both forms of dialysis for end stage renal failure, abnormalities of HDL composition are more marked in subjects on HD. Reduction in HDL particle size is linked with insulin resistance and accompanies reduction in LDL particle size and hypertriglyceridaemia.
The use of pamidronate in hypertrophic pulmonary osteoarthropathy (HPOA)
Authors: Speden D. , Nicklason F. , Francis H. , Ward J.
Published: March 2008

Background: Hypertrophic pulmonary osteoarthropathy (HPOA) secondary to bronchogenic carcinoma can be associated with severe, disabling pain which is not always responsive to conventional treatment.

Aim: To report on the use of pamidronate to control resistant pain in HPOA in three cases.

Methods: A retrospective review of reported pain, chest X‐ray and radionuclide bone scans was made.

Results: Pain relief was achieved in all three cases together with reduced radiolabel uptake in two cases.

Conclusions: Pamidronate appears to be an effective therapy for HPOA. Further investigation is warranted.
Hyperprolactinaemia in males
Authors: Walsh J. P. , Pullan P. T.
Published: March 2008

Background: The literature suggests that men with prolactinomas typically present with pressure effects of large pituitary tumours and/or the clinical features of hypogonadism. A definitive study of the clinical features of hyperprolactinaemia in males is, however, lacking.

Aims: To identify the clinical, biochemical and radiological features of hyperprolactinaemia in males.

Methods: Retrospective review of tlie case notes of 53 adult males with prolactinoma or idiopathic hyperprolactinaemia diagnosed 1980–1995.

Results: The mean age of the patients was 41 years (range 19–75). The presenting symptom was endocrine in nature in 57% of patients (loss of libido/potency 47%, gynaecomastia 6%, galactorrhoea 2%, sparse beard growth 2%), pressure effects of pituitary tumour in 28% (headache 13%, visual loss 13%, diplopia 2%), while 15% of patients presented incidentally. On physical examination, galactorrhoea was present in 8% of patients, gynaecomastia in 23
Haemopoietic stem cell transplantation in Australia, 1992–95: a report from the Australian Bone Marrow Transplant Recipient Registry
Authors: Atkinson K. , Nivison‐Smith I. , Hawkins T.
Published: March 2008

Background: Bone marrow and blood stem cell transplantation is increasingly utilised in Australia. The Australian Bone Marrow Transplant Recipient Registry was founded in 1991 to record this activity.

Aim: To describe allogeneic and autologous bone marrow and blood stem cell transplantation in Australia during 1992‐95.

Methods: Each bone marrow transplant programme in each State of Australia has been invited to contribute information to the Registry and all do. A single information sheet is compiled by the data manager in each programme when a marrow transplant is performed and mailed to the Registry office. An annual follow‐up sheet is then mailed from the Registry to the contributing centre at the anniversary of each individual transplant.

Results: Australia‐wide, haemopoietic cell transplants have increased in number from 478 in 1992 to 681 in 1995. The number of hospitals contributing registrations to the Australian Bone Marrow Transplant Registry has increased from 20 in 1992 to 25 in 1995. The main reason for the increased number of transplants is an increase in the number of autologous blood stem cell transplants including an increase in the number of staged autologous blood stem cell transplants. The most common indication for a single autologous transplant in 1995 was non‐Hodgkin's lymphoma and for a staged autologous transplant was breast cancer. The commonest indication for an allogeneic family member transplant in 1995 was acute myeloid leukaemia and for an allogeneic unrelated donor transplant, acute lymphoblastic leukaemia. The three year actuarial overall survival for patients receiving a haemopoietic stem cell transplant between 1992 and 1994 was 54% with a median follow‐up time of 2.04 years. Recurrence of the underlying malignant disease was the main cause of death during both the first and second year post transplant after both allogeneic (13.3% and 8.3%) and autologous (22.1% and 11.8%) transplantation. Treatment‐related mortality was 13.1% after allogeneic transplantation and 3.3% after autologous transplantation.