bluuebunny/crossref_metadata_2025 huggingface dataset:
ISCHEMIC HEPATITIS: CLINICAL FEATURES, DIAGNOSIS AND PROGNOSIS
Authors: GIBSON P. R. , DUDLEY F. J.
Published: March 2008

Nineteen episodes of ischemic hepatitis were diagnosed by hepatitic liver function tests and characteristic liver pathology in 17 patients.

All patients had an acute illness associated with a likely fall in cardiac output although only five episodes were associated with documented hypotension. Right ventricular failure was severe in only four, mild in six, and absent in nine whilst left ventricular failure was clinically apparent in 16.

The hepatitic illness was usually mild. No patient died as a direct result of hepatic damage, prognosis depending on the underlying cardiac or systemic disease. Liver function tests were characterised by a marked rise in serum transaminase levels with a parallel increase in serum lactic dehydrogenase of hepatic origin and a short time course of the enzyme elevation lasting 3 to 11 days.

It is concluded that ischemic hepatitis (a) is' caused by poor hepatic perfusion associated with an acute fall in cardiac output; (b) is usually a subclinical illness with little influence on prognosis, and (c) may be accurately differentiated from viral hepatitis on clinical and biochemical criteria alone.
SPECIFICITY OF PSYCHOLOGICAL PROFILES OF IRRITABLE BOWEL SYNDROME PATIENTS
Authors: WELCH G. W. , STACE N. H. , POMARE E. W.
Published: March 2008

The aim of the study was to investigate the specificity of psychological profiles in female Irritable Bowel Syndrome (IBS) patients by a comparison with a gastrointestinal patient control group and with a normal population control group. The results showed that the IBS patients scored significantly higher than the normal population sample on three test scales: Anxiety, Phobic and Somatisation. Our results thus support the conclusion of earlier authors that a moderate degree of psychoneurotic disorder exists amongst IBS patients. However, the patient control group also scored significantly higher than the normal control group on two factors (Phobic and Somatisation), and the comparison between the IBS group and the patientcontrol group did not reveal any significant differences. It is suggested that attention to the psychological needs of both IBS and other gastrointestinal disease patients should form an important part of the management strategy, particularly in the former — where a consistently clear benefit for any particular therapy has yet to be shown.
CRANIAL ARTERITIS A TWENTY‐YEAR REVIEW OF CASES
Authors: KOOREY D. J.
Published: March 2008

Thirty‐five cases of cranial arteritis in an Australian population have been analysed. The female to male ratio was 2.2:l and the average age of onset was 71 years. Eighty‐five percent of patients suffered headache and this was most frequently temporal or bitemporal. Polymyalgia rheumatica (40%), permanent visual loss (29%) and jaw claudication (26%) were common, six patients complained of diplopia and four gave a past history of thyroid disease.

The temporal artery was clinically abnormal in only 69% of cases but biopsy was positive in 26 of 28 specimens examined. Sixty‐seven percent of patients had ESR's greater than 60 mmlh.

The average duration of prednisone therapy was 22 months. Side effects of steroids were observed in seven of 19 patients followed up. The importance of starting steroid therapy as soon as the condition is suspected clinically is emphasised by the case of one patient who lost vision while awaiting temporal artery biopsy.
CHOLESTYRAMINE INDUCED HYPERCHLOREMIC METABOLIC ACIDOSIS
Authors: EAVES E. R. , KORMAN M. G.
Published: March 2008

The first reported case, in an adult, of cholestyramine induced hyperchloremic metabolic acidosis is a 70 year old female with a two year history of primary biliary cirrhosis confirmed by histologic and immunologic criteria. After taking cholestyramine II sachets twice daily for two months she presented with lethargy, confusion and drowsiness. Examination revealed confusion, jaundice, signs of chronic liver disease, portal hypertension and hepatic encephalopathy. Laboratory investigations confirmed a metabolic acidosis (pH 7.15) and hyperchloremia. Multiple cultures failed to reveal sepsis and a urinary pH of 4.85 together with tests of renal acidification, excluded renal tubular acidosis. She received 600 mEq of sodium bicarbonate intravenously over 36 hours by which time her mentation, electrolytes and pH were normal. It is presumed that her hyperchloremic metabolic acidosis was secondary to cholestyramine because of (i) the similarity to pediatric reports; (ii) the rapid and lasting response to intravenous sodium bicarbonate; (iii) the absence of another etiology; (iv) normal serum potassium, chloride and bicarbonate despite continued spironolactone therapy after recovery.
RESPIRATORY SYNCYTIAL VIRUS AND HEART BLOCK –CAUSE AND EFFECT?
Authors: MENAHEM S. , UREN E. C.
Published: March 2008

Abstract: :A child aged 3 years who developed a respiratory syncytial virus infection is described. His admission was complicated by the development of an irregular pulse. He initially had a variable first or second degree heart block with transient electrocardiographic evidence suggestive of pericarditis and/or myocarditis and later developed complete heart block. He has remained asymptomatic for the past four years. A search for other causes of the heart block proved negative. It is tempting to suggest an association between the acute RSV infection and the development of the heart block But such an association at this stage remains speculative
RAPIDLY PROGRESSIVE FATAL PULMONARY INFILTRATION BY LYMPHOMA
Authors: KENNEDY P. , JOSHUA D. E. , BUCK M. , KRONENBERG H.
Published: March 2008

Abstract: :Two patients with diffuse lymphoma, one diffuse large cell and the other diffuse mixed, large and small cell, developed an illness characterised by a high swingeing fever and a pulmonary infiltrate. In both patients there was clinical evidence of chemotherapy‐induced tumour response elsewhere at the time lung infiltrates progressed. Blood and sputum cultures, bronchial washings, and, in one case, trans‐bronchial lung biopsy did not establish a diagnosis and there was progressive clinical deterioration. Post mortem examination showed widespread involvement of both lungs with lymphoma. The differential diagnosis of fever and pulmonary infiltrates in patients with diffuse lymphoma is discussed, in particular the possibility of this being due to rapidly progressive lymphom
INTERMITTENT CLAUDICATION: A DOUBLE–BLIND CROSSOVER TRIAL OF PENTOXIFYLLINE
Authors: GALLUS A. S. , GLEADOW F. , DUPONT P. , WALSH J. , MORLEY A A. , WENZEL A. , ALDERMAN M. , CHIVEHS D.
Published: March 2008

Abstract: The influence of the xanthine derivative pentoxifylline (‘Trental’ or BL191; Hoechst–Roussel) on exercise tolerance was measured in 38 subjects with stable, severe to moderately severe, intermittent claudication who completed a randomised, double–blind, placebo controlled, cross–over clinical trial. Patients received placebo tablets or 400 mg slow–release pentoxifylline tablets (‘Trental 400’) twice a day for one week, followed by three times daily for seven weeks, and then crossed over to receive the alternate preparation for another eight weeks.

Claudication distance and walking distance were measured on a treadmill before starting treatment and again at four–week intervals during the trial. At the same times, red blood cell filterability, plasma fibrinogen concentration and blood viscosity, resting and post–ischemic calf muscle blood flow, and the resting and post–exercise ankle/brachial systolic pressure ratio were also measured.

In this study, the observed effects of pentoxifylline treatment were no greater than those of placebo, even though serum levels of pentoxifylline and its hydroxy–metabolite were within the anticipated range. This was shown by a ‘therapeutic effect ratio’ of 0.98 for treadmill claudication distance and 0.96 for treadmill walking distance after within–patient analysis at the end of the cross–over (where a ratio of 1.0 means the test drug and placebo effects are identical). These ratios have 95% confidence limits of 0.72–1.34 and 0.74–1.25, respectively.
ANALYSIS OF ALLERGEN–SPECIFIC IgE RESPONSES IN 341 ALLERGIC PATIENTS. ASSOCIATIONS BETWEEN ALLERGENS AND BETWEEN ALLERGEN GROUPS AND CLINICAL DIAGNOSES
Authors: KRILIS S. , BALDO B. A. , BASTEN A.
Published: March 2008

Abstract: An allergic population of 341 patients was studied using 14 different allergen extracts in skin prick tests and radioallergosorbent tests (RAST) in an attempt to identify important allergen sources in the Sydney area and to examine relationships between these diagnostic methods and a number of clinical parameters. A computer based statistical analysis of the data revealed that: (a) male patients showed a significantly higher frequency of skin test reactivity to extracts of house dust and the house dust mite Dermatophagoides farinae; (b) the incidence of positive prick test reactions declined with age; (c) cross–reactive allergenic determinants were found in taxonomically–related extracts (e.g. between different house dust mites, pollens, and fungi); (d) a clear correlation emerged between relative potency using a histamine standard and RAST score which supports the continued use of histamine as a standard in skin prick testing; and (e) important associations between certain allergens and clinical diagnosis emerged (e.g. positive skin test reactions to house dust mites and epithelia but not pollens were associated with asthma).
INSULIN SECRETION AND IMMUNO‐GENETIC MARKERS IN DIABETICS WITH SECONDARY FAILURE‘ OF ORAL HYPOGLYCEMIC AGENTS
Authors: COLMAN P. G. , HARRISON L. C. , TAIT B. D.
Published: March 2008

‘Secondary failure’ of oral hypoglycemics, in non‐insulin dependent diabetics, has been attributed to dietary non‐compliance, inadequate drug dosage, metabolic stress, or true drug failure. Progressive loss of beta cell function is a suggested mechanism for true drug failure but on the basis of little documented evidence. In view of this, we have measured basal and glucagon‐stimulated C‐peptide levels, human leukocyte antigen (HLA) types, and islet cell antibodies in 20 non‐insulin dependent diabetics with ‘secondary failure’ of oral agents.

There were 16 females and four males with a mean ideal body weight of 1.30 units and mean duration of diabetes of 9.5 years. Fasting insulin (mean ± SD: 15.1 ± 10.6 mU/l) and fasting C‐peptide (2.3 ± 1.2 μg/l) were normal or slightly elevated in all but one patient. Mean C‐peptide increased from 2.3 ± 1.2 μg/l to 3.5 ± 2.2 μg/l (152% over basal) 6 minutes after 1 mg i.v. glucagon. In 15 patients the C‐peptide response was greater than 130% of basal. Islet cell cytoplasmic antibodies were detected in only two patients. The distribution of HLA types was not significantly different from a control population, with no increase in DR3 or DR4.

Thus, absolute insulin deficiency is uncommon in non‐insulin dependent diabetics with ‘secondary failure’ of oral hypoglycemic agents and such patients do not exhibit the immuno‐genetic markers of insulin‐dependent diabetes.
THE DIAGNOSTIC CHALLENGE OF EUTHYROID HYPERTHYROXINEMIA
Authors: STOCKIG J. R. , BARLOW J. W.
Published: March 2008

In euthyroid hyperthyroxinemia high levels of thyroxine (T4) may be either transient or persistent, associated with high, normal, or low levels of tri‐iodothyronine (T3). Euthyroid hyperthyroxinemia may occur: (i) as a response to abnormal plasma binding (thyroxine binding globulin, albumin, prealbumin, or autoantibodies), (ii) because of hormone resistance, (iii) after exposure to drugs such as amiodarone, cholecystographic contrast agents, or propranolol, (iv) during acute psychiatric illness or stress, and (v) in hyperemesis gravidarum. In some instances the cause of persistent hyperthyroxinemia still remains obscure.

No single investigation (including free hormone measurement and the response of thyrotropin to its releasing hormone) can distinguish all of these entities from true hyperthyroidism. Hence, re‐evaluation in cases of diagnostic uncertainty should begin with clinical reassessment. Techniques are now available to identify easily some causes of euthyroid hyperthyroxinemia, allowing us to recognise patients and relatives who are at risk of inappropriate treatment. Because measurement of serum T4 remains the key investigation for diagnosis of thyroid dysfunction, it is important to appreciate the full range of conditions that compromise its specificity
DISABLING NEUROLOGICAL COMPLICATIONS OF AMIODARONE
Authors: ANDERSON N. E. , LYNCH N. M. , O'BRIEN K. P.
Published: March 2008

Five patients developed neurological symptoms during treatment with amiodarone for intervals ranging between five and 40 months. In each case the daily maintenance dose did not exceed 600 mg. The neurological manifestations included gait ataxia, tremor, polyneuropathy, and myopathy. In all five patients, the neurological symptoms were severe and disabling. In one patient with a myopathy, there was no improvement after amiodarone was withdrawn. The neurological side effects of amiodarone may be disabling and are not always reversible with drug withdrawal. Neurological complications may arise during treatment with usual maintenance doses. (Aust NZ J Med 1985; 15: 300–304.)
BODILY HABITUS AND MITRAL VALVE PROLAPSE
Authors: HICKEY A. J. , NARUNSKY L. , WILCKEN D. E. L.
Published: March 2008

We investigated the hypothesis that patients with idiopathic mitral valve prolapse (MVP) have distinctive anthropometric characteristics as part of an ill‐defined connective tissue abnormality. In 100 consecutive patients with MVP identified at echocardiography, 56 women and 44 men (age range 28–78 years), we compared measurements of height, weight, arm span, upper and lower body segments, anteroposterior chest diameter, anteroposterior chest diameter/height index, body mass index, and metacarpal index with those from an age and sex matched control group. We also compared the frequency of thoracic asymmetry in MVP patients and controls. Both male and female MVP patients had lower body mass indices than their controls (p<0.01 and p<0.001, respectively). Women with MVP were lighter than their controls (p< 0.001) and the same trend was seen in men (p = 0.14). There were no significant differences with any of the other measurements or in the frequency of thoracic asymmetry. We conclude that patients of both sexes with idiopathic MVP are leaner than control subjects but do not otherwise have a specific bodily habitus or an increased frequency of thoracic cage abnormalities. The findings do not support the hypothesis of an underlying generalised connective tissue abnormality but raise the interesting question of why MVP patients should be lean. (Aust NZ J Med 1985; 15: 326–330.)
HOUSE DUST MITES AND SKIN TESTS IN DIFFERENT AUSTRALIAN LOCALITIES
Authors: GREEN W. F. , WOOLCOCK A. J. , STUCKEY M. , SEDGWICK C. , LEEDER S. R.
Published: March 2008

Abstract Dermatophagoides mite concentrations in household dust have been measured in three Australian towns with contrasting geographical features, climate, and degree of urbanisation. Mite allergen skin tests on school children living in these areas showed that the prevalence of positive reactions varied with mite concentrations.

In Belmont, D. farinae as well as D. pteronyssinus were present in some of the dust samples.

Skin test weals were larger in Busselton than in either Wagga Wagga or Belmont.

The importance and practical implications of these findings are discussed. (Aust NZ J Med 1986; 16: 639–643.)
THE PREVALENCE RATE OF RESPIRATORY SYMPTOMS IN SCHOOLCHILDREN FROM TWO SOUTH AUSTRALIAN RURAL COMMUNITIES
Authors: CROCKETT A. J. , SCHEMBRI D. A. , RUFFIN R. E. , ALPERS J. H.
Published: March 2008

Abstract The respiratory symptoms and respirator function of 680 schoolchildren from two rural areas of South Australia were studied. the initial results of this prospective, longitudinal study showed that the cumulative prevalence of asthma and/or wheezy breathing was 27.4% in the Burra population and 23.1% in the Kingston population. The cumulative prevalence of one or more attacks of asthma/wheezy breathing amongst Burra (38.8%) and Kingston (23%) children aged up to 8 years was significantly higher than that reported for urban Melbourne children (11%, p <0.01). The combined South Australian group reported a cumulative prevalence of asthmdwheezy breathing alone of 10% which was significantly higher than the cumulative prevalence rates in three previous studies reported in Australia (1.8%, 2.6%, 2.7%, p <0.01).

The highest overall cumulative prevalence of bronchitislloose or productive cough occurred in the 12 year old Burra children (41.5%). Burra girls had the highest prevalence of bronchitis/loose or productive cough (36.8%) compared to other groups studied at both locations.

The parental smoking rate (60.4% in Burra, 57.4% in Kingston) is much higher than the national figure reported by the Bureau of Statistics in 1977 (35.9%).

The prevalence of asthmdwheezy breathing is much higher in the South Australian cohort compared to the Queensland and Tasmanian cohorts studied using the same questionnaire.

Predicted respiratory function parameters using initial algorithms are similar to those reported for urban Australian children. (Aust NZ J Med 1986; 16: 653–657.)
HEMODYNAMIC AND PLASMA RENlN RESPONSES TO TREATMENT OF A RENAL ARTERIOVENOUS MALFORMATION
Authors: KERR P. G. , SHERIDAN W. P. , KELLY W. , MYERS K. , JOHNSTON C. I.
Published: March 2008

Abstract We report a case of a right renal arteriovenous malformation with high output cardiac failure and hypertension which was cured by nephrectomy. Hemodynamic findings pre‐and post‐operatively are presented. Plasma renin activity (PRA), both from peripheral venous and renal vein samples, was assessed. The fall in PRA associated with nephrectomy lends support to the suggestion that the renin‐angiotensin system plays a role in the hypertension in these patients.
PREDICTION OF REMISSION INDUCTION IN CHILDHOOD ACUTE MYELOID LEUKEMIA
Authors: SMITH P. J. , LIHOU M. G.
Published: March 2008

Abstract Prediction of clinical response to induction treatment was studied in a group of 16 children and adolescents with acute myeloid leukemia (AML) by a colony inhibition assay. Samples from ten of 16 patients formed colonies in agar and cells were available from nine of these ten for further study. The system correctly predicted the response of eight of the nine patients (89%) with a confidence level of greater than 80% in all cases and thus produced useful results in half of the series of 16 children. The incorrect prediction occurred in a child whose leukemia had a very low plating efficiency and who relapsed soon after achieving remission. While this methodology requires further development and assessment, it shows great promise in aiding in the selection of appropriate chemotherapy for individual patients with AML.
CELLULOSE PHOSPHATE AND CHLOROTHIAZIDE IN CHILDHOOD IDIOPATHIC HYPERCALCIURIA
Authors: BURKE J. R. , COWLEY D. M. , MOTTRAM B. M. , BUCKNER P.
Published: March 2008

Abstract A calcium loading test performed on seven of eight children with idiopathic hypercalciuria identified the hyperabsorptive form of hypercalciuria in five and renal hypercalciuria in one. The type of hypercalciuria was not identified in the other patient. Three children presented with hematuria without calculus formation. Chlorothiazide reduced the urinary calcium excretion level in two of six patients to the normal range. The addition of cellulose phosphate to chlorothiazide reduced the urinary calcium excretion level to the normal range in those four patients who showed an incomplete response to chlorothiazide alone. There was clinical improvement with cellulose phosphate in another child whose symptoms did not disappear after chlorothiazide had reduced urinary calcium level to the normal range. Cellulose phosphate is effective in children with recurrent stone formation who have shown inadequate response to chlorothiazide.
THE ACUTE BIOCHEMICAL EFFECTS OF FOUR PROPRIETARY CALCIUM PREPARATIONS
Authors: REID I. R. , SCHOOLER B. A. , HANNAN S. F. , IBBERTSON H. K.
Published: March 2008

Abstract Changes in serum and urine biochemical indices have been studied in ten normal subjects in the four hours following the ingestion of four proprietary calcium supplements. Each was taken in a dose containing 1 gram of elemental calcium. The four preparations were ranked according to the amount of calcium absorbed in the order Spar‐Cal and Calcium Sandoz> Os‐Cal> Ossopan.

There were no significant differences between the four preparations in the changes in parathyroid hormone (PTH) and urine hydroxyproline levels. For this reason, the four results from each subject were averaged. Following the calcium load there was a reduction in mean PTH from 0.16 ± 0.01 to 0.10 ± 0.02 μg/l (p<0.001) and a decline in urine hydroxyproline/creatinine ratio from 20 ± 1 to 17 ± 1 (p<0.02), suggesting that bone resorption responds immediately to dietary calcium intake.

There was a rise in urine sodium excretion which correlated with the indices of calcium absorption (r= 0.63, p<0.01) but not with the sodium content of the calcium preparations. This effect could be important, particularly in elderly patients on borderline sodium intakes.
NAILFOLD CAPILLAROSCOPY: A BLINDED STUDY OF ITS DISCRIMINATORY VALUE IN SCLERODERMA, SYSTEMIC LUPUS ERYTHEMATOSUS, AND RHEUMATOID ARTHRITIS
Authors: Mcgill N. W. , Gow P. J.
Published: March 2008

The appearances of the nailfold capillaries can be used to distinguish between various connective tissue diseases. In a study of 30 patients (10 with scleroderma, nine with systemic lupus erythematosus, and 11 with rheumatoid arthritis), photographs were taken of the eight nailfolds of each patient (thumbs excluded) and then coded. Each of the photographs was later analysed by a rheumatology registrar and an attempt was made to predict the patient's diagnosis using only the appearance of the nailfold. The diagnostic specificity and sensitivity were 89% and 80%, respectively.

The results indicate that nailfold capillaroscopy, performed by a relatively inexperienced observer, can accurately distinguish between patients with scleroderma and those with systemic lupus erythematosus or rheumatoid arthritis. (Aust NZ J Med 1986; 16: 457–460.)
EFFECTS OF ENALAPRIL AND HYDROCHLOROTHIAZIDE ON BLOOD PRESSURE, RENIN–ANGIOTENSIN SYSTEM, AND ATRIAL NATRIURETIC FACTOR IN ESSENTIAL HYPERTENSION: A DOUBLE BLIND FACTORIAL CROSS‐OVER STUDY
Authors: Chalmers J. P. , Wing L. M. H. , West M. J. , Bune A. J. C. , Elliott J. M. , Morris M. J. , Cain M. D. , Graham J. R. , Southgate D. O.
Published: March 2008

The hypotensive and hormonal effects of the angiotensin converting enzyme (ACE) inhibitor enalapril (10 mg twice daily) were compared with those of hydrochlorothiazide (25 mg twice daily), with the two drugs in combination and with placebo in 21 patients with essential hypertension. For each patient there were four randomised double‐blind treatment phases, each of four weeks' duration, which comprised a 2 times 2 factorial experiment.
ADULT ONSET STILL'S DISEASE OR COXSACKIE POLYARTHRITIS?
Authors: Roberts‐Thomson P. J. , Southwood T. R. , Moore B. W. , Smith M. D. , Ahern M. J. , Geddes R. A. , Hill W. R.
Published: March 2008

The clinical manifestations and laboratory findings of two patients with a presumptive diagnosis of coxsackie B4 virus infection are described. A striking feature was the similarity with adult onset Still's disease, with spiking fever, evanescent macular rash, and severe polyarthritis. This latter feature persisted for many weeks and required steroids to control the symptoms. Review of the literature has supported the proposition that many cases of adult onset Still's disease may be due to coxsackie B4 or other viral infection and it is suggested that these agents should be actively sought in future cases. (Aust NZ J Med 1986; 16: 509–511.)
ANATOMICAL AND ECHOCARDIOGRAPHY CORRELATIONS IN THE NORMAL HEART
Authors: Calder A. L. , Robinson P. J. , Roche A. H. G.
Published: March 2008

Knowledge of the normal intracardiac structures and their variations is essential for interpretation of two‐dimensional echocardiography. The anatomical features seen in the standard echocardiography views have been demonstrated in normal heart specimens.

Anatomical variants such as a prominent Eustachian valve of the inferior vena cava in the right atrium and fibromuscular strands or ‘heart strings’ traversing the left ventricular cavity are frequently visualised on the two‐dimensional echocardiograms.
THE ROLE OF BRONCHOALVEOLAR LAVAGE IN THE DIAGNOSIS OF SUSPECTED OPPORTUNISTIC PNEUMONIA
Authors: ABRAMSON M. J. , STONE C. A. , HOLMES P. W. , TAI E. H.
Published: March 2008

Abstract We report 50 immunocompromised patients with pulmonary infiltrates who underwent fibreoptic bronchoscopy, including bronchoalveolar lavage, on 56 occasions. The underlying diseases were mostly lymphoma, leukemia, other malignancies and renal failure. The commonest immunodeficiency factors were chemotherapy, steroids and neutropenia. A positive diagnosis could be made from analysis of the bronchoalveolar lavage on 59% (33/56) occasions. This was a comparable yield to transbronchial lung biopsy 57% (16/27), and superior to proximal airways wash 24% (13/55), or bronchial brushings 29% (10/34). Open lung biopsy added additional diagnostic information in three of the four cases in which it was performed. The most common final diagnoses were bacterial, viral or Pneumocystis carinii pneumonia and recurrent malignancy. We conclude that bronchoalveolar lavage is a safe procedure with a high diagnostic yield in the immunocompromised host with suspected opportunistic pneumonia.
ISOLATION OF HIV FROM AUSTRALIAN PATIENTS WITH AIDS, AIDS RELATED CONDITIONS AND HEALTHY ANTIBODY POSITIVE INDIVIDUALS*
Authors: NEATE E. V. , PRINGLE R. C. , JOWETT J. B. M. , HEALEY D. S. , GUST I. D.
Published: March 2008

Abstract The Fairfield Hospital experience with isolation of HIV from peripheral blood leucocytes, cerebrospinal fluid and semen is described. To date HIV has been isolated from single specimens of blood from 45% of patients with AIDS, 35% of patients with lymphadenopathy syndrome AIDS‐related complex or ARC and 14% of asymptomatic antibody positive individuals. HIV was recovered from peripheral blood leucocytes in the presence of phytohemagglutinin and interleukin‐2. The presence of virus in the supernatant fluid was detected using reverse transcriptase and immunofluorescence assays. Supernatants with borderline activity were confirmed by infection of a continuous cell line. (Aust NZ J Med 1987; 17: 461–466).
LUPUS AND NON‐LUPUS CUTANEOUS MANIFESTATIONS IN SYSTEMIC LUPUS ERYTHEMATOSUS
Authors: WEINSTEIN C. , MILLER M. H. , AXTENS R. , LITTLEJOHN G. O. , DOREVITCH A. P. , BUCHANAN R.
Published: March 2008

Abstract Mucocutaneous manifestations occur frequently in systemic lupus erythematosus (SLE). Common non‐lupus dermatoses may be confused with lupus rashes, with important clinical consequences. A study of 84 consecutive patients with SLE was performed to determine the comparative frequency of lupus and non‐lupus mucocutaneous abnormalities, the comparative sensitivity of routine histology and immunofluorescence in the diagnosis of lupus rashes, and the association of skin manifestations with other clinical and serological features. Thirty‐five patients had dermatoses attributable to SLE (mean 3.7 per patient) and 58 had derrnatoses which were not directly attributable to SLE (mean 2.1 per patient), highlighting the need for accurate diagnosis of skin rashes in SLE patients. Routine histology confirmed the clinical diagnosis of typical cutaneous lupus in 100% of malar lupus rashes and in approximately 90% of subacute cutaneous and discoid lupus rashes. Direct immunofluorescence of the affected skin provided supportive evidence of cutaneous lupus in 60% of malar lupus rashes and approximately 50% of subacute cutaneous and discoid lupus rashes. This reaffirmed the poor sensitivity of immunofluorescence, compared with routine histology, in the diagnosis of lupus rashes. The association of subacute cutaneous lupus with anti‐Ro antibodies was confirmed. (Aust NZ J Med 1987; 17: 501–506).
PLASMA CONCENTRATIONS OF UNBOUND VALPROATE AND THE MANAGEMENT OF EPILEPSY
Authors: KILPATRICK C. J. , BURY R. W. , FULLINFAW R. O. , MOULDS R. F. W.
Published: March 2008

Abstract The range of protein binding of valproate and the use of unbound and total plasma concentrations of the drug were studied in an outpatient population of 70 epileptics. The unbound fraction of plasma valproate ranged from 4.2% to 11.7% with a median of 7.1%. A non‐linear relationship was found between unbound and total plasma valproate concentrations and was best described by a cubic regression (r2= 0.88). This concentration dependent protein binding was also demonstrated by a linear relationship between total plasma valproate concentration and unbound fraction (r= 0.46). As expected, there was no correlation across the patient population between plasma concentrations of valproate and seizure frequency. In an individual patient, however, plasma valproate levels usually correlated with change in clinical status, although this correlation was no better for unbound levels than total levels. There were only three patients in whom unbound valproate levels correlated better with clinical effect than total levels, whereas there were six patients in whom total levels correlated better than unbound levels. It is therefore concluded that monitoring sodium valproate therapy with unbound concentrations is rarely helpful and the routine use of unbound valproate levels cannot be advocated.
TREATMENT OF HAIRY CELL LEUKEMIA WITH INCREASING DOSES OF RECOMBINANT ALPHA A INTERFERON
Authors: HOLMES R. , WHITESIDE M G. , SCHWARZ M. A. , FIRKIN F. C.
Published: March 2008

:Since July 1984, eight patients with advanced hairy cell leukemia have received treatment with recombinant alpha A interferon. At commencement of interferon, seven patients had progressive cytopenia, and one was in leukemic phase (>20times109/L circulating hairy cells). All patients had had previous splenectomy. Interferon was administered subcutaneously. The initial dose was 3times106 U/day, continued until peripheral counts stabilised. Subsequently, patients received 6times106 U/day, 9times106 U/day, and finally 12 times 106 U/day. The dose increases proceeded every 8–12 weeks, as tolerated. Seven patients had an objective response. There were four complete remissions, two partial remissions, and one minor response. Complete remission was documented only in patients on at least 6 times 106 U/day for 12 weeks. The median time to complete remission was 40 weeks (range 35–53). Normalisation of peripheral blood counts preceded histologic marrow improvement. The median times for response (platelets ≤ 100 times 109L, hemaglobin > 12 gm/dL, neutrophils < 1.5 times 109/L), were six to eight and 17 weeks, respectively. Toxicity included myelosuppression during the first four weeks of therapy. With increasing doses of interferon, myelosuppression did not recur. A transient, mild, flu‐like syndrome affected all patients. Two patients developed asymptomatic transaminitis at doses >6 times 106 U/day. This resolved with dose reduction. In one case impotence was reported during the first four weeks of each interferon level. One patient discontinued after two weeks due to an exacerbation of systemic vasculitis. The median duration of treatment for the seven responding patients is 78 weeks (range 30–156). All remain on interferon without disease progression. This report confirms a high remission rate, which may reflect a dose‐response phenomenon for long‐term treatment with alpha interferon in hairy cell leukemia. (Aust NZ J Med 1988; 18: 557–562).
MALIGNANT SYSTEMIC MASTOCYTOSIS
Authors: JANE S. M. , SUTHERLAND R. , SALEM H. H.
Published: March 2008

:Malignant systemic mastocytosis is a rare disorder, a subgroup of the mast cell neoplasms. Its clinical and histological diagnosis is often difficult, especially in patients without cutaneous involvement. We report an unsuspected case who underwent laparotomy complicated by life‐threatening hypotension consistent with vasoactive mediator release from mast cells. The subsequent use of two chemotherapy regimens is detailed and both induced transient reduction in disease bulk. (Aust NZ J Med 1988; 18: 610–612)
LONG‐TERM CLINICAL AND ANGIOGRAPHIC RESULTS FOLLOWING PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY
Authors: GRIGG L. E. , VALENTINE P. A. , MANOLAS E. G. , FLOWER D. J. , HUNT D.
Published: March 2008

The long‐term results of percutaneous transluminal coronary angioplasty were evaluated in our first 42 patients, who had initial successful angioplasty and no restenosis on angiogram performed four months after angioplasty. Evaluation included repeat follow‐up angiogram performed approximately two years after angioplasty in 22 of the 42 patients.

All 42 patients had single vessel disease with severe angina pectoris refractory to medical treatment before angioplasty; at a mean follow‐up of 28 months after angioplasty, 37 (88%) were asymptomatic. No patient died or underwent coronary artery bypass graft surgery during the follow‐up period, although three patients (7%) suffered a myocardial infarction due to occlusion of a nondilated artery. In the 22 cases studied at a mean of 28 months after angioplasty, angiogram showed that successful coronary artery dilatation remained in all cases, with no deterioration of a dilated lesion between the four and 28 month angiograms. Progression of atherosclerosis, however, did occur in five of the 22 patients (23%), with development of either stenosis or occlusion of a non‐dilated vessel.

This study suggests that the development of restonsis between four and 28 months after percutaneous transluminal coronary angioplasty is unlikely. The results suggest an excellent long‐term prognosis after angioplasty, in patients who have no evidence of restenosis at four months after an initially successful dilatation.
PREVALENCE OF RESPIRATORY SYMPTOMS, BRONCHIAL HYPERRESPONSIVENESS AND ATOPY IN SCHOOLCHILDREN LIVING IN THE VILLAWOOD AREA OF SYDNEY
Authors: HURRY V. M. , PEAT J. K. , WOOLCOCK A. J.
Published: March 2008

Respiratory symptoms, bronchial hyperresponsiveness (BHR) and atopic status were measured in 1 217 schoolchildren, aged 8 to 12 years, living in the Villawood area of the city of Sydney. The findings are compared to those from studies previously conducted, using identical protocols, in the inland town of Wagga Wagga and in the coastal town in Belmont, NSW.

There was a higher prevalence of respiratory symptoms in Villawood and Wagga Wagga (40%) than in Belmont (29%). The prevalence of BHR was 15% in Villawood and Belmont and 20% in Wagga Wagga. However, the distribution of severity of BHR was similar in each study town, reflecting the same pattern of responsiveness. The percentage of children who were atopic was higher in Villawood (44%) than in inland Wagga Wagga (39%) or coastal Belmont (40%). Children in the three areas differed in their reactions to the predominant allergen groups. There were more children who were reactive to grass pollens in the inland area and more children who were reactive to house dust mites in the coastal area. Children in Villawood had a high prevalence of reactivity both to house dust mites and to grass pollens.

The Villawood children who were born in Australia had a higher prevalence of respiratory symptoms, of BHR and of atopy than the foreign‐born children.
DAY CASE CARDIAC CATHETERISATION — A SAFE AND ECONOMIC ALTERNATIVE
Authors: MURDOCK CHALLON J. , IRELAND MARK A. , DAVIS MICHAEL J. E. , PLATELL MARK
Published: March 2008

Cardiac catheterisation, as a day procedure, has been performed at the Royal Perth Hospital since November 1985. During the 23 month period from November 1985 to September 1987, there have been 1398 day procedures carried out. One hundred and twelve patients (8%) required overnight admission as a consequence of the procedure — 39 patients for routine observation, 41 patients for minor hemorrhage from the brachial arteriotomy or femoral artery puncture site; 12 patients for severe angina: three patients with reversible ischemic neurological deficits; two patients with stroke; four patients with transient brachial artery occlusion; two patients with arrhythmias and eight patients for miscellaneous reasons. One patient discharged on the day of the procedure required subsequent re‐admission for treatment of an acute myocardial infarction. There were no deaths. The financial cost saving to the hospital in real terms is estimated to be £41.50 per patient and to the community a further saving of £25 per patient due to a reduction in sick leave. The minimum total cost saving to the taxpayer for the 1,285 patients managed as day cases was £85,000.

Cardiac catheterisation can be performed as a day procedure with low morbidity, low mortality and modest cost savings to a major hospital.
A CASE OF POLYMICROBIAL INFECTIVE ENDOCARDITIS INVOLVING NEISSERIA MUCOSA OCCURRING IN AN INTRAVENOUS DRUG ABUSER
Authors: GILES M. W. , ANDREW J. H. , TELLUS M. M.
Published: March 2008

The incidence of polymicrobial endocarditis has increased markedly in recent years, in association with the increasing level of abuse of intravenous drugs. Neisseria mucosa, an upper respiratory tract commensal, is a rare cause of infective endocarditis. We report the first case of polymicrobial infective endocarditis involving Neisseria mucosa occurring in an intravenous drug abuser.
TREATMENT OF RESISTANT WALDENSTROM'S MACROGLOBULINEMIA WITH HIGH DOSE GLUCOCORTICOSTEROIDS
Authors: JANE S. M. , SALEM H. H.
Published: March 2008

We examined the efficacy of high dose glucocorticosteroids in two patients with Waldenstrom's macroglobulinemia resistant to other forms of therapy. Both patients demonstrated marked falls in total protein, paraprotein and viscosity levels, after only short periods on this regimen. There was no significant toxicity. We conclude that high dose dexamethasone may offer significant benefits in the treatment of Waldenstrom's macroglobulinemia.
GASTROINTESTINAL BLOOD LOSS FROM A NEW BUFFERED ASPIRIN (OSTOPRIN): MEASUREMENT BY RADIOCHROMIUM AND HEMOQUANTTM TECHNIQUES
Authors: LYNCH N. M. , McHUTCHISON J. G. , YOUNG G. P. , DEACON M. , ST JOHN D. J. B. , BARRACLOUGH D.
Published: March 2008

Occult gastrointestinal blood loss induced by a new buffered aspirin preparation (Ostoprin, 4.0 g per day) was compared with that from an enteric‐coated aspirin (Ecotrin, 3.9 g per day) in 40 patients with osteoarthritis. Blood loss was measured by the radiochromium method and compared with the HemoQuantTM assay of fecal heme and heme‐derived porphyrins. By radiochromium, mean daily blood loss during the first week of treatment with Ostoprin increased 1.6 ml above basal compared to 0.8 ml above basal with Ecotrin (p= 0.06). When aspirin was ceased, blood loss returned more rapidly towards normal in the Ostoprin group (p < 0.01). By HemoQuant,TM mean fecal hemeporphyrin excretion rose 0.63 mg hemoglobin equivalent per g feces during the first week of treatment by Ostoprin compared with 0.40 mg/g for Ecotrin (p= 0.06). There was a significant linear relationship between the two methods (r = 0.65, p < 0.001). Serum salicylate levels achieved with both preparations were almost identical and encompassed the therapeutic range. HemoQuantTM is sufficiently sensitive to detect low‐level aspirin‐induced bleeding. Ostoprin appears to be a safe alternative to Ecotrin and has similar bioavailability.
ENDOCRINE DYSFUNCTION IN LYMPHOMATOID GRANULOMATOSIS
Authors: LEEDMAN P. J. , MATZ L. R. , PULLAN P.
Published: March 2008

Endocrine abnormalities in lymphomatoid granulomatosis are rare and have never been a major determinant of the clinical course. We describe three patients who illustrate that a wide range of endocrine dysfunction (hypoadrenalism, hypercalcemia, hypothyroidism, diabetes insipidus and hypogonadism) may be encountered in this disorder. Moreover, such endocrine manifestions may be the major feature at presentation, the treatment of which may significantly influence the subsequent clinical outcome.
VERY HIGH DOSE INTRAVENOUS GAMMAGLOBULIN IN THROMBOCYTOPENIA OF PREGNANCY
Authors: GIBSON JOHN , LAIRD PAUL P. , CHILD ANDREW , HARRIS JOHN , JOSHUA DOUGLAS E. , KRONENBERG HARRY
Published: March 2008

A 22‐year‐old woman with severe idiopathic thrombocytopenic purpura, complicating pregnancy, was unresponsive to high‐dose corticosteroids and three separate infusions of high‐dose intravenous immunoglobulin using the conventional schedule of 400 mg/kg/d for five days. A dramatic albeit transient, elevation of her platelet count followed a six day course of very high dose immunoglobulin (1000 mg/kg/d) thus allowing elective lower segment cesarean section to be performed without complications and with the delivery of a live, female infant. Two months later a further course of very high dose gammaglobulin was again effective in raising the patient's platelet count prior to elective splenectomy. No adverse reactions were seen to either infusion.
ASPIRATION BIOPSY OF PALPABLE LYMPH NODES AND THE DIAGNOSIS OF LUNG CARCINOMA
Authors: DUGGAN C. J. , DELOHERY J. F. , PHILIPS J. N.
Published: March 2008

Over a six‐year period at this institution aspiration biopsy of palpable lymph nodes has been used in the diagnosis and follow‐up of 40 primary lung cancers. Small cell carcinoma was the commonest cell type. In the majority of the patients this was the initial diagnosis of lung cancer, however there were patients with recurrence after chemotherapy and after surgical management. Diagnosis and classification of tumour using this simple, rapid and safe procedure negates the need for more invasive and costly investigations.
NUTRITIONAL STATUS OF HOME HEMODIALYSIS PATIENTS
Authors: TALEMAITOGA A. S. , SANDERS B. A. , HINTON D. , LYNN K. L.
Published: March 2008

We studied the nutritional status of 32 patients (23 men), aged 50 (SD14) yr, on home hemodialysis (HHD) for one‐138 months. No formal dietary restrictions were imposed. Anthropometric measurements were made using standard techniques, diet assessed by three‐day dietetic diary and interview and plasma concentrations of nutrients were measured. Mean caloric intake was 29.4 (SD 10.7) kcal/kg; 24 (75%) patients had lower energy intakes than recommended for normals. Protein, vitamin C and folate intakes were above recommended minimum safe intakes. Intakes were less than recommended for calcium in four (13%) patients, iron in one (3%) and vitamin B12 in two (6%). One‐third of both sexes had body mass indices (kg/m2) <25th percentile for normals, but none was <80% of ideal bodyweight. Arm muscle circumference was <10th percentile for normals in six men and three women. Triceps skin fold thickness was <10th percentile in four men (17%) and five women (55%). No anthropometric measurements were correlated with energy, protein or fat intake. Biochemical measurements were not useful in predicting protein intake. Neither nutritional intake nor anthropometric measurements were correlated with the duration of HHD. There was little evidence of malnutrition and wasting in this group of well rehabilitated HHD patients.
ATRIAL FIBRILLATION AND MORTALITY IN AN ELDERLY POPULATION
Authors: LAKE F. R. , CULLEN K. J. , de KLERK N. H. , McCALL M. G. , ROSMAN D. L.
Published: March 2008

Prospective data from Busselton, Western Australia, collected during triennial surveys from 1966–81 with follow‐up of subjects to 1983, showed that atrial fibrillation (AF) was frequent in elderly people and associated with increased mortality.

Of 1770 people aged over 60 years, 40 were in atrial fibrillation when first seen and a further 47 developed it during follow‐up. Atrial fibrillation was positively associated with angina, history of a myocardial infarction and left bundle branch block.

Relative mortality in those with atrial fibrillation compared with those without it, was 1.92 for all causes, 1.82 for death from cardiovascular causes (excluding stroke) and 3.78 for deaths from stroke, after adjustment by proportional hazards regression for confounding effects of age, sex, history of a myocardial infarction, an abnormal electrocardiogram, angina, cholesterol level, systolic blood pressure and Quetelet's Index (weight/height2).

The excess relative mortality declined with increasing age for both women and men. This raised relative mortality remained constant with time from the first detection of AF for all causes and cardiovascular causes but appeared to increase with time from detection for stroke death. The risk of death from stroke was greatest in the younger women. The observed risk of death from stroke in patients with AF suggests that anticoagulant use should be considered in selected patients.
RESTORATION OF SPERMATOGENESIS WITH PULSATILE GONADOTROPHIN RELEASING HORMONE THERAPY IN HYPOGONADOTROPHIC HYPOGONADISM OF TRAUMATIC ETIOLOGY
Authors: FOK A. C. K. , TSAKOK F. H. M. , SUM C. F. , CHEAH J. S.
Published: March 2008

Head trauma is one of the rarest reported causes of hypogonadotrophic hypogonadism and treatment of this condition with pulsatile gonadotrophin releasing hormone (GnRH) has not been previously described.

A 36‐year‐old man with azoospermia from hypogonadotrophic hypogonadism following head trauma was given pulsatile GnRH therapy. 10 μg of GnRH was administered every 90 minutes through a subcutaneous catheter in the abdominal wall. After 15 months, the ejaculate contained 34 × 106 spermatozoa/ml of semen.

Prolonged pulsatile GnRH therapy can restore gonadal function in males with hypogonadotrophic hypogonadism of traumatic etiology. Our experience adds to the growing spectrum of hypothalamic disorders causing hypogonadism that is amenable to treatment by this method.
ANTI‐NEURONAL AUTOANTIBODIES AND NEUROLOGICAL PARANEOPLASTIC SYNDROMES
Authors: ANDERSON N. E.
Published: March 2008

‘Remote effects’ of cancer on the nervous system, or paraneoplastic syndromes, are diseases of unknown cause that occur exclusively or with increased frequency in patients with cancer. Several hypotheses have been used to explain the pathogenesis of these disorders. One hypothesis is that the tumour and the nervous system share antigens, so that an autoimmune response generated against the tumour causes the neurological disorder. The best evidence for this hypothesis is found in the Lambert‐Eaton myasthenic syndrome which can be transferred to animals by injecting them with IgG from patients. The identification of autoantibodies against Purkinje cell cytoplasmic protein antigens in patients with paraneoplastic cerebellar degeneration, autoantibodies against neuronal nuclear antigens in patients with paraneoplastic syndromes associated with small cell lung cancer and autoantibodies against retinal ganglion cells in patients with small cell lung cancer and retinal degeneration supports this hypothesis. The possible role of these autoantibodies in the pathogenesis of paraneoplastic neurological disease is discussed.
CHRONIC STRONGYLOIDIASIS IN TASMANIAN VETERANS—CLINICAL DIAGNOSIS BY THE USE OF A SCREENING INDEX
Authors: OLIVER N. W. J. , ROWBOTTOM D. J. , SEXTON P. , GOLDSMID J. M. , BYARD R , TOOTH M. , THOMSON K. S.
Published: March 2008

Abstract Chronic infection with Strongyloides stercoralis presents a diagnostic problem because of the low recovery of the organism from stools and the insensitivity of current serological tests.

Of 150 former Far East POWs, 26 (17%) had S. stercoralis in stools. The clinical features in 18 stool‐positive patients were compared to those in 24 stool‐negative patients and showed that strongyloidiasis was associated with a higher frequency of alteration in bowel habit, upper abdominal discomfort, rash and eosinophilia. On the basis of these features, a screening index was devised which largely separated stool‐positive and stool‐negative patients and led to helpful therapy in three of four patients with compatible symptoms who lacked a definitive diagnosis.

Treatment with thiabendazole appeared to be superior to treatment with mebendazole.