bluuebunny/crossref_metadata_2025 huggingface dataset:
A Procedure for Comprehensive Analysis of Neutral Urinary Steroids in Endocrine Investigations
Authors: Phillipou G. , Seamark R. F. , Cox L. W.
Published: March 2008

Summary: A reliable and practical procedure for the quantitation of approximately 25 neutral urinary steroids is described. Its application to the clinical investigation of various endocrine disorders including adrenocortical hyperfunction, congenital adrenal hyperplasia, dysmenorrhoea, hirsutism and the Stein‐Leventhal syndrome is discussed.
Hormonal Profile, Blood Sugar Control and HLA Patterns in Long‐term Insulin Dependent Diabetes with and without Vascular Disease
Authors: Larkins R. G. , Martini F. I. R. , Heding L. G. , Tait B. D.
Published: March 2008

Summary: Hormonal profile, blood sugar control and HLA patterns in long‐term insulin dependent diabetes with and without vascular disease. R. G. Larkins, F. I. R. Martin, L. G. Heding and B. D. Tait, Aust. N.Z. J. Med., 1978, 8, pp. 465–471.

Nineteen insulin dependent diabetics with onset at 30 years of age or less and duration of diabetes of greater than 25 years were divided into two groups on the basis of the presence or absence of clinically evident vascular disease. The patients without vascular disease were characterised by a later mean age of onset, lower fasting growth hormone concentration, and a lower frequency of the unusual HLA pattern B8 without A1 compared to the diabetics with vascular complications. The level of blood glucose control assessed over the last 15 years, insulin antibody titres, plasma glucagon levels and plasma cholesterol did not differ between the two groups. Residual beta cell activity was found in only one of the 19 patients.

Although this study does not exclude an effect of the degree of blood glucose control or persistence of beta cell function in the early stages of diabetes on the subsequent development of vascular disease, it suggests that genetic factors, age of onset and plasma growth hormone levels may be more important.
Sudden Death in Auckland
Authors: Fraser G. E.
Published: March 2008

Summary: Sudden death in Auckland. G. E Fraser, Aust. N Z. J. Med., 1978, 8, pp 490–499.

A representative sample of all sudden cardiac deaths occurring in Auckland in one year is reported. Data describing demographic variables, personal characteristics and habits, previous symptoms, prodromal symptoms, the acute phase and post mortem results, is presented. Incidence values are very close to those of other similar communities. The syndrome of “sudden death” probably defines a heterogenous group of cases. Deaths were significantly more common in the cooler months, and in the lowest social class. Some evidence is presented consistent with the hypothesis that a high alcohol intake is associated with sudden death. No differences were found between cases dying within five minutes and those dying later but within 24 hours, considering several variables. Myocardial fibrosis at post mortem was a common finding. The role of the coronary ambulance is briefly discussed.
Iatrogenic Fluorosis
Authors: Grennar D. M. , Palmer D. G. , Malthus R. S. , Matangi M. F. , de Silva R. T. D.
Published: March 2008

Summary: Iatrogenic fluorosis. D. M. Grennan, D. G. Palmer, R. S. Malthus, M. F. Matangi and R. T. D. de Silva, Aust. N.Z. J. Med., 1978, 8, pp. 528–531.

A 69‐year‐old spinster presented with a history of generalised bone pains in September 1977. She was asthmatic and had been treated with 60 mg sodium fluoride and three Calcium Sandoz tablets daily for three years in an attempt to minimize steroid‐induced osteoporosis. She was subsequently found to have fluorosis as shown by radiological osteosclerosis in vertebrae and pelvis with histological. changes of osteomalacia on bone biopsy and a high bone fluoride content. A trial regimen for osteoporosis which is currently being assessed in various centres includes fluoride along with supplementary calcium and Vit D to prevent the production of osteomalacia which may occur with the fluoride salt alone. The case described here emphasises the potential toxicity of therapeutic dosages of fluoride when prescribed with calcium alone and emphasises the need for careful clinical and biochemical monitoring in all patients receiving therapeutic dosages of fluoride.
Effect of Surgical Stress on Serum Thyroid Hormones in Hyperthyroidism
Authors: Engler D. , Donaldson E. B. , Stockigt J. R.
Published: March 2008

Summary: Effect of surgical stress on serum thyroid hormones in hyperthyroidism.

The effect of elective non‐thyroidal surgery on serum total and free triiodothyronine (T3), reverse T3 and thyroxine (TJ has been studied in one patient with mild, untreated typical hyperthyroidism, one with mild T3 toxicosis and in four euthyroid patients. The high T3 level of typical hyperthyroidism became normal post‐operatively, decreasing to 47% of the mean pre‐operative level 24 hours after surgery, while total reverse T3 doubled. In euthyroid subjects T3 decreased to 57 ± 6 (SEM)% of the preoperative level 24 hours after surgery, associated with a doubling of reverse T3. The patient with T3 toxicosis, whose surgical stress was less severe, showed a 17% decrease in T3 without change in reverse T3. Because the inverse post‐operative changes in T3 and reverse T3 described in euthyroid subjects also occur in typical hyperthyroidism, measurement of serum T3 may be diag‐nostically unreliable after surgical stress.
Radionuclide Imaging to Assess Myocardial Damage during Open Heart Surgery
Authors: Kelly D. T. , Harris P. J. , Bautovichi G. , McLaughlin A. , Crocker E. , Baird D. K.
Published: March 2008

Summary: Radionuclide imaging to assess myocardial damage during open heart surgery.

Technetium 99m Pyrophosphate imaging before and after open heart surgery was performed in 38 patients to estimate the incidence of peri‐operative infarction. Positive images were present pre‐operatively in 11 of 30 patients with coronary artery disease. In three patients the images changed from negative to positive and in two this was thought to be due to infarction produced at operation. The high incidence of positive pre‐operative images emphasises that many patients with evolving myocardial infarction, unstable angina or severe heart failure are now operated upon without delay. Because many patients have positive images before surgery pre‐operative and post‐operative images must be compared to assess myocardial damage due to surgery.
Testicular Damage Due to Cytotoxic Drugs and Recovery after Cessation of Therapy
Authors: Roeser H. P. , Stocks A. E. , Smith A. J.
Published: March 2008

Summary: Testicular damage due to cytotoxic drugs and recovery after cessation of therapy.

Testicular function was assessed in 32 patients who received standard chemotherapy regimens for disseminated lymphomas. Thirty‐one had evidence of germ cell damage, as assessed by the finding of azoospermia and/or high plasma levels of follicle‐stimulating hormone (FSH). In addition, five patients had persistently low plasma testosterone levels associated in three with elevated plasma luteinising hormone (LH) levels.

Reproductive function did not recover in any patient while chemotherapy continued. Cessation of therapy was possible in 16 patients with prolonged remissions of disease. Among these, recovery of germinal epithelium differed greatly between the cyclophosphamide / vincristine / prednisone treated group and the mustine I procarbazine / vincristine/prednisone treated group. Seventy per cent of the former patients had evidence of recovery after 34 months of follow‐up while only one (17%) of the latter had begun to recover at 52 months post‐therapy. Serial measurement of plasma FSH levels proved useful in predicting likely recovery of spermatogenesis.
A Quantitative Review of the Performance of Implanted Cardiac Pacemakers, Medtronic Model No. 5944
Authors: Thompson G. H. , Black J. L. , Collins D. W. K.
Published: March 2008

Summary: A quantitative review of the performance of implanted cardiac pacemakers, Medtronic Model No. 5944.

One of the service functions of the Sir Charles Gairdner Hospital Department of Biophysics since 1972 has been the routine performance testing of pacemakers implanted by the Hospital's Cardiologists. This service was set up to measure pacemaker pulse parameters with a view to detecting battery depletion. It was also found to be of great help in showing lead insulation deterioration, intermittent capture and movement of the catheter tip within the right ventricle, information that is frequently of help to the Cardiologists in planning acute or elective pacemaker replacement.
The Problem Family and Community Medicine
Authors: Dax E. Cunningham , Hagger Rona
Published: March 2008

Summary: The problem family and community medicine.

The characteristics of problem families are described and especially their dependency upon the social services.

They are of increasing importance to community medicine since as shown by the literature their members form 5—10% of the total population and use from 50–80% of the total social and corrective services.

The social pathology of 16 root and 110 sub‐families was investigated; enquiries have also been made into the family dynamics and especially child rearing, learning problems and ill health. Infections, injuries and childhood disorders are particularly frequent.

There are administrative advantages in regarding these families as socially handicapped.
Whipple's Disease Involving the Pericardium: Pathological Confirmation During Life
Authors: Vlietstra R. E. , Lie J. T. , Kuhl W. E. , Danielson G. K. , Roberts M. K.
Published: March 2008

Summary: Whipple's disease involving the pericardium: Pathological confirmation during life. R. E. Vlietstra, J. T. Lie, W. E. Kuhl, G. K. Danielson and M. K. Roberts, Aust. N.Z. J. Med., 1978, 8, pp. 649–651.

Cardiac involvement in Whipple's disease has been a frequent autopsy finding but is rarely recognized clinically. We report here a patient, a 63‐year‐old man, in whom Whipple's disease was diagnosed in 1974, based on a seven‐year history of arthralgia, one‐year history of weight loss and steatorrhea, and diagnostic small bowel biopsy. Despite complete regression of all joint and bowel symptoms following a prolonged course of tetracycline therapy, the patient developed incapacitating congestive heart failure and signs of constrictive pericarditis, for which a thoracotomy and pericardectomy was performed. Histologic examination revealed fibrous pericarditis with mononuclear infiltrates, including PAS‐positive histiocytes. The characteristic bacilliform bodies were identified by electron microscopy in the resected pericardium. This to our knowledge is the first such demonstration during life of Whipple's disease involving the heart.
Membranous Glomerulonephritis Associated with Sarcoidosis*
Authors: Mariani A. F. , Clifton S. , Davies D. J. , Dawborn J. K. , Fitzgerald J. E. , Ihle B. U. , Niall J. F. , Ryan G. B.
Published: March 2008

Summary: Two patients with sarcoidosis involving pulmonary hilar lymph nodes developed the nephrotic syndrome. Renal biopsy in both cases showed membranous glomerulonephritis. In one patient, there was an associated renal vein thrombosis.
Difficulties in the Use of D‐Penicillamine in the Treatment of Rheumatoid Arthritis
Authors: Stockman A. , Richter D. , Barraciough D. , Muirden K. D. , Macdonal I. , Kincaid‐Smith P.
Published: March 2008

Summary: The difficulties encountered in administering D‐penicillamine to 40 patients with rheumatoid arthritis (RA) over a six to 24 month period are recorded. Side‐effects were frequent. Proteinuria occurred in 13 patients (33%) mainly in the fourth to the sixth month. Renal biopsies were performed in six patients and all showed light microscopy abnormalities. Electron microscopy performed in five patients revealed subepithelial deposits in all and in addition some had mesangial and subendothelial deposits. Seven patients (17.5%) developed eight episodes of thrombocytopaenia which was quickly reversed on cessation of treatment or reduction in dosage.

On the positive side, there was significant improvement in most parameters of disease activity at six, 12 and 18 months compared to the pretreatment levels, but the results at two years were less impressive. Reduction in steroid dosage was considerable and was greater than half the mean pretreatment dose after two years but the absence of a control group makes the full significance of these uncertain.

Patients on high and low dosage regimens were compared over a 12 month period of treatment. Although the differences were not statistically significant, withdrawals and side effects were less frequent in the low dose group.
An Appraisal of Rheumatic Valvular Disease in Western Samoa
Authors: Smith W. M.
Published: March 2008

Summary: Rheumatic valvular heart disease appears to be common in Western Samoa, although the exact incidence is unknown. The outcome in 170 known cases since 1974 is reviewed. Thirty‐six patients underwent cardiac surgery overseas, with one operative and four late deaths and a further 32 patients died while on medical treatment. Advanced disease was present in the majority of the surviving medical patients. Mitral stenosis was the most common problem. Thromboembolism appeared to be uncommon despite the absence of anticoagulant therapy. Bacterial endocarditis was also seldom recognised, but was probably under‐diagnosed. At present penicillin prophylaxis is often taken haphazardly and an unknown number of cases receive no treatment at all. A prophylactic programme centred on the screening of schoolchildren is suggested.
Annular Subvalvular Left Ventricular Aneurysm Mimicking a Pericardial Effusion on Echocardiogram
Authors: Hickey A. J. , Braye S.
Published: March 2008

Summary: Annular subvalvular left ventricular aneurysms are a rare form of herniation of the left ventricle, reported usually in negroes. These aneurysms are situated beneath the mitral or aortic valves and extend along the line of the valvular annulus. The aetiology remains speculative but is not associated with coronary artery disease.

Our patient was Caucasian and a review of the literature reveals only four other documented cases in Caucasians. Our case corresponds completely in pathological detail with previous cases. This condition has never been reported in Australia.

The echocardiographic features have not been described before. These are the presence of a large echo free space behind the left ventricle, without an anterior free space. These features are not specific but this type of aneurysm should be considered in the differential diagnosis of a loculated posterior pericardial effusion, along with a large left atrium and a hernia through a patent foramen of Morgagni.1
Abdominal Pain Following Intravenous Benzyl Penicillin Administration
Authors: Robinson P. C. , Steele T. W. , Jolley P. T. , Frewin D. B.
Published: March 2008

Summary: The occurrence of abdominal pain (in three patients) and lower chest pain (in one patient) either during or immediately after the intravenous administration of high doses of benzyl penicillin is reported. All four patients were diagnosed as having bacterial endocarditis and had been receiving between 8 and 18 mega units of the drug per day for 2–3 weeks, when the symptoms were first noticed. A skin rash also appeared in each case, at this time. Both the rash and abdominal pain disappeared when an alternative antibiotic was substituted for the penicillin.
Carbamazepine Therapy Complicated by Nodal Bradycardia and Water Intoxication
Authors: Byrne E. , Wong C. H. , Chambers D. G. , Rice J. P.
Published: March 2008

Summary: A case is reported of water intoxication and cardiac conduction disturbances occurring as a late complication of carbamazepine therapy for trigeminal neuralgia. These uncommon but potentially hazardous complications of therapy are reported because of the wide use of carbamazepine as the agent of choice for trigeminal neuralgia and as an anticonvulsant.
Co‐existing Coeliac and Inflammatory Bowel Disease in a Patient with Turner's Syndrome
Authors: Scobie B. A.
Published: March 2008

Summary: A patient, aged 20, with Turner's syndrome was found to have both coeliac disease and chronic ulcerative colitis. Although a gluten‐free diet restored to normal the jejunal biopsy, persisting diarrhoea was found to be due to coexisting left‐sided ulcerative colitis. A search of the literature revealed only three detailed reports of chronic inflammatory bowel disease in coeliac patients, one of coeliac disease in Turner's syndrome and three of inflammatory bowel disease in Turner's syndrome. Growth failure with coeliac or inflammatory bowel disease in females, may call for a chromosomal study, even in the absence of webbing of the neck. The reason for three uncommon disorders occurring in this patient remains obscure.
Home Blood Pressure Monitoring and Changes in Plasma Catecholamines During Once or Twice Daily Treatment with Atenolol in Patients with Mild Hypertension
Authors: McGrath B. P. , Beilin L. J. , Schofield T. , Benedict C. R. , Barker N. P. , Cooper R.
Published: March 2008

Summary: Home blood pressure monitoring and changes in plasma catecholamines during once or twice daily treatment with atenolol in patients with mild hypertension. B. P. McGrath, L. J. Beilin, T. Schofield, C. R. Benedict, N. P. Barker and R. Cooper, Aust. N.Z. d. Med., 1979, 9, pp. 374–381.

1. The effects of atenolol on diurnal blood pressure control, heart rate and plasma catecholamines were studied in nine hypertensive, six of whom also received diuretics. The patients completed a double‐blind trial in which the effects of once and twice daily administration of atenolol were compared with placebo.

2. Atenolol (100 mg) given once a day produced significant reduction in diurnal blood pressures recorded at home but the effect was slightly less than either 50 mg given twice a day or 200 mg once a day.

3. Effects on heart rate and blood pressure were seen within 36 hours of the first dose, and were near maximal at 72 hours. After cessation of the drug, mean resting heart rate increased gradually and reached pre‐treatment levels five days later, suggesting strong tissue binding of atenolol. Blood pressure increased more slowly over 8–10 days.

4. Plasma noradrenaline levels were increased at rest with atenolol. This argues strongly against the antihypertensive effect of atenolol being due to a reduction of sympathetic nerve activity.

5. Once daily administration of atenolol in this group of patients with mild hypertension produced satisfactory diurnal blood pressure control and beta blockade without “rebound” hypertension on cessation of therapy.
Heparinized Chemotherapy in the Treatment of Disseminated Lung Cancer
Authors: Jamieson G. G. , Angove R. C.
Published: March 2008

Summary: Heparinized chemotherapy in the treatment of disseminated lung cancer. G. G. Jamieson and R. C. Angove, Aust. N.Z. J. Med., 1979, 9, pp. 381–384.

Fourteen patients with inoperable or metastatic carcinoma of the lung were entered in this study. All of them received one or more courses of multiple chemotherapy (cyclophosphamide, 5‐fluorouracil, methotrexate and vincristine) with prior and concurrent heparin ant/coagulation.

No tumour regression was noted in any patient although one patient is alive and well at two years. Five patients developed sudden increase in pleural effusion whilst on heparin therapy and in four of these patients the effusion was a significant factor in their death.
Lymphomatoid Granulomatosis in a Renal Transplant Recipient
Authors: Walter M. , Thomson N. M. , Dowling J. , Fox R. , Atkins R. C.
Published: March 2008

Summary: Lymphomatoid granulomatosis in a renal transplant recipient. M. Walter, N. M. Thomson, J. Dowling. R. Fox and R. C. Atkins, Aust. N.Z. J. Med., 1979, 9, pp. 434–436.

Lymphomatoid granulomatosis is a multisystem disorder of high mortality and characterised by angiocentric and angiodestructive lymphoreticular proliferative and granuiomatous change. A case is described of this disease occurring in a renal transplant patient. The patient underwent a rapid remission of the disease after a course of combined cytotoxic therapy and remains free of disease three years after treatment. This case is the second described renal transplant patient to develop the disease and the first to be successfully treated. It is likely that the disease originated as a consequence of immuno‐suppression similar to the development of lymphomas in allograft recipients.
Disseminated Cryptococcosis with Ocular Involvement
Authors: Kumar R. K. , Lykke A. W. J.
Published: March 2008

Summary: Disseminated cryptococcosis with ocular involvement. R. K. Kurnar and A. W. J. Lykke, Aust. N.Z. J. Med., 1979, 9, pp. 444–447.

A case of disseminated cryptococcosis with extensive ocular involvement is reported. The patient had pulmonary, meningeal, cerebral, cutaneous, lymph node, renal, adrenal and thyroid lesions, as well as granulomatous endophthalmitis.
Natural Killer Cells—A New Cytotoxic Mechanism Against Tumours?
Authors: Hersey P.
Published: March 2008

Summary: Natural killer cells–a new cytotoxic mechanism against tumours? P. Hersey, Aust. N.Z. J. Med., 1979, 9, pp. 464–472.

Lymphoid cells from the blood of most normal human subjects can kill a variety of cultured tumour cells in vitro. The cytotoxic activity of these cells (now referred to as natural killer cells) was initially detected during studies on known cytotoxic cells such as T cells, antibody dependent effector (K) cells and macrophages and was regarded as having no biological importance. Studies over the past few years have suggested, however, that natural killer cells may represent a major surveillance mechanism against tumours in vivo and may be the only cytotoxic mechanism against many tumours when those based on antigen recognition by the “conventional immune” cells fail.

The nature of these cells and their cytotoxic mechanism has received considerable attention, but has so far not been clearly defined. A considerable body of evidence suggests they are of the T cell lineage but if so they are a sub‐population of T cells that develop independently of the thymus. Recent studies suggest that interferon may play a major role in the induction of natural killer activity and this finding promises to be an important advance in our understanding of this cytotoxic mechanism. The level of natural killer cell activity against tumours in both animals and humans appears to be genetically determined and may be linked to genes of the major histocompatibility complex.

Evidence for the biological importance of these cells was suggested by experimental studies where the in vivo susceptibility of animals to tumour growth could be related to the levels of their natural killer cell activity. Conversely, the take of different tumour cells in animals was inversely related to their susceptibility to natural killer cells. Studies on transplantation of bone marrow in animals also indicated that natural killer cell activity may be the predominant mechanism responsible for rejection of these grafts.

Studies of a similar nature in humans are as yet limited but initial results from those on melanoma patients support the view that these cells are also important against tumours in human subjects. No information is yet available as to their importance in rejection of bone marrow grafts in human recipients. NK cells are therefore the latest of the effector cells to be defined after T cells, 6 cells, macrophages and K cells. These studies suggest that measurement of the activity of these cells warrants further attention in patients with tumours and bone marrow transplants and that methods to alter their activity may assume an important role in therapeutic procedures against tumours or in transplantation of bone marrow.
The Detection of Immune Complexes of Different Immunoglobulin Class
Authors: Quin J. W. , Charlesworth J. A. , Macdonald G. J.
Published: March 2008

Summary: Immune complexes were detected in 51 sera from patients with a variety of immunological diseases: 14 systemic lupus erythematosus (SLE); 14 infectious mononucleosis (IM); 12 rheumatoid arthritis (RA) and 11 subacute bacterial endocarditis (SBE). Three methods were used to detect complexes: the fluid—phase Clq binding assay (Clq.BA); the solid—phase Clq binding assay (Clq.SP) and the Raji cell radio‐immunoassay (RIA). Modification of the Clq.SP and the Raji cell RIA by use of monospecific antisera to immunoglobulins G, A and M enabled the class of antibody in the immune complexes to be determined. Antibodies of all three classes were found in each disease, the predominant ones being IgG and IgM in SLE and SBE, IgM and IgA in RA and IgM in IM.
Dihydroergotamine Therapy in Symptomatic Postural Hypotension
Authors: Bajada S.
Published: March 2008

Summary: The clinical response to therapy with dihydroergotamine (DHE) has been evaluated in one patient with idiopathic orthostatic hypotension. The results of tests performed on the autonomic nervous system are recorded, and the evidence for a central defect in postural blood pressure control is presented. Tilt table testing over a two‐month period confirmed the beneficial effect of the medication in preventing profound falls of blood pressure. The dose required (20 mg/day) was higher than previously reported.
Glucagon—New Concepts About an “Old” Hormone
Authors: Alford F. P. , Chisholm D. J.
Published: March 2008

Summary: Recent technical advances have led to a great increase in information regarding the role of glucagon in normal human physiology and in diabetes. In man, physiological actions appear to be limited to stimulation of hepatic glycogenolysis, gluconeogenesis, and possibly ketogenesis. Glucagon plays an important role (with insulin) to maintain basal hepatic glucose output and acts synergistically with catecholamines and Cortisol as a counter‐regulatory hormone in preventing hypoglycaemia. On the other hand glucagon is relatively unimportant (in contrast to insulin) in the assimilation of a glucose or carbohydrate load.

Glucagon secretion is mainly controlled by the nervous system, both sympathetic and parasympathetic. Nervous control of the pancreatic A (glucagon‐releasing) cell is in turn modulated by plasma concentrations of glucose and other substrates and by hormonal influences.

Circulating “glucagon” consists of several different peptides of varying molecular weight and differing biological activity. Also “glucagon” may be secreted by tissues other than the pancreas. Both the liver and kidney are important sites of metabolism of the various “glucagons”.

Glucagon levels are raised in human diabetes mellitus. It appears that the hyper‐glucagonaemia in human diabetes is secondary to the diabetic state, rather than a primary defect of the A cell. Glucagon may accentuate hyperglycaemia and ketogenesis but is not essential for the development of the diabetic state.

A clinical syndrome of excess glucagon production from an islet cell tumour (glucagonoma) has recently been defined. Diabetes, though common, is not always present and the most prominent clinical feature is an unusual skin rash, migratory necrolytic erythema.

Pharmacological doses of glucagon have a wide range of effects in humans. In addition to treating hypoglycaemia, glucagon may be used as an inotropic cardiac stimulant, or to inhibit gastrointestinal motility during endoscopy. Other suggested uses are mainly related to tests of endocrine function.
Patent Ductus Arteriosus in Malaysia
Authors: Singham K. T. , Wong H. O.
Published: March 2008

Summary: Findings are reviewed of isolated Patent Ductus Arteriosus after infancy as seen in 181 patients studied at the University Hospital, Kuala Lumpur, during the period 1967 to 1975. The ages of patients ranged from nine months to 54 years. Eighty‐two patients underwent cardiac catheterization. More than 50% of patients were above ten years of age; the sex ratio was 1 male: 2.93 females. Thirty‐two percent of the patients had significant effort dyspnoea or were in heart failure. The complications noted were elevated pulmonary vascular resistance, Eisenmenger syndrome, bacterial endocarditis and cardiac failure.
The Association of Haemopoietic Dysplasia (Pre‐leukaemia) and Abnormal Cell Clone with Connective Tissue Disease
Authors: Lee C. H. , Liew S. K. , Fleming A. , Lam‐Po‐Tang P. R. L. C. , Rozenberg M. C.
Published: March 2008

Summary: A 68‐year‐old man with haemotological features consistent with haemopoietic dysplasia (pre‐leukaemia) and an abnormal cell clone in the marrow, 46, XY,‐18, + t(13;18) (q11;123), developed acute connective tissue disease characterised by vasculitis, dermal changes, marked muscular weakness and serological features suggesting an autoimmune disturbance. Although four other cases of haemopoietic dysplasia (“pre‐leukaemia”) with unusual connective tissue disease had been reported since the recognition of haemopoietic dysplasia as a distinct entity, a definite association between these two disease states still awaits confirmation by further reports and investigations.
A Case of Paroxysmal Nocturnal Haemoglobinuria Terminating in a Myeloproliferative Syndrome
Authors: Boyd A. W. , Parkin J. D. , Castaldi P. A.
Published: March 2008

Summary: This report discusses the case of a 60‐year‐old man who presented in 1969 with thrombocyto‐penia and mild marrow hypoplasia. A diagnosis of paroxysmal nocturnal haemoglobinuria (PNH), was established. The subsequent course included episodes of overt intra‐vascular haemolysis. Thrombocytopenia reverted on several occasions during Oxymetholone therapy. The terminal phase of the illness was marked by the development of a leukocytosis and densely hypercellular bone marrow with splenomegaly. The features were those of a myeloproliferative disorder, although frank leukaemia did not develop.
Tracheobronchopathia Osteochondroplastica
Authors: Berend N. , Harrison A. C. , Hartnett B. J. S. , Lawson J. , Marlin G. E.
Published: March 2008

Summary: The clinical, pathological and physiological features of two patients suffering from tracheobronchopathia osteochondroplastica (TO) are described. Unequivocal evidence of extrapul‐monary airways obstruction was not able to be obtained by lung function testing, despite extensive central airway involvement in both patients. TO is a rare condition of which there is only one other clinical report from this country. As the bronchoscopic appearance may closely resemble that of endobronchial neoplasm, TO should be remembered in the differential diagnosis of patients with haemoptysis.
Lithium Associated Thyroid Cancer
Authors: Brownlie B. E. W. , Turner J. G. , Millner G. M. B. , Perry E. G. , Ding L.
Published: March 2008

Summary: Lithium associated thyroid cancer. B. E. W. Brownlie, J. G. Turner, G. M. B. Millner, E. G. Perry and L. cling, Aust. N.Z. J. Med., 1980,10, pp. 62–63.

This report documents papillary cell carcinoma of the thyroid occurring in a 55–year‐old woman after three‐and‐a‐half years of lithium therapy. She presented with unilateral thyroid enlargement causing tracheal deviation. There was no clinical suspicion of malignancy and the histological fin clings were totally unexpected.
Coronary Artery Spasm*
Authors: Freedman S. B. , Richmond D. R.
Published: March 2008

Summary: Coronary artery spasm. S. B. Freedman and D. R. Richmond. Aust. N.Z. J. Med., 1980. 10, pp. 69–72.

Variant angina with ST elevation indicates transmural myocardial ischaemia and is due to spasm of a large epicardial coronary artery. Spasm occurs in arteries with varying degrees of fixed obstruction, giving rise to different clinical profiles of variant angina. However, coronary angiography is required to differentiate between those with minor coronary disease, and those with significant (>70%) obstruction. In patients with minor coronary disease or normal arteries, β‐blockers are contraindicated, and treatment with calcium antagonist vasodilators should be commenced after documentation of spontaneous or ergo‐novine induced spasm. Patients with significant fixed coronary obstructions require bypass grafting if technically feasible. The role of coronary spasm is not confined to variant angina, as it causes angina at rest with ST depression, and may also cause myocardial infarction and sudden death.
Labetalol and Propranolol in Mild Hypertensives: Comparison of Blood Pressure and Plasma Volume Effects
Authors: Hunyor S. N. , Bauer G. E. , Ross M. , Larkin H.
Published: March 2008

Summary: Labetalol and propranolol in mild hypertensives: Comparison of blood pressure and plasma volume effects. S. N. Hunyor, G. E. Bauer, M. Ross and H. Larkin, Aust. N.Z. J. Med., 1980, 10, pp. 162–166.

Labetalol administered in a small to moderate dose (first month 400 mg/day, second month average 585 mg/day) was effective in lowering blood pressure (BP) (‐21/‐18 mmHg, recumbent) in 11 of 13 mild essential hypertensives over an eight‐week period, despite a significant (+294 ml) increase in plasma volume. The effect of propranolol (first month 160 mglday, second month average 234 mg/day) was significantly less on both blood pressure (‐9/‐9 mmHg) and plasma volume (+98 ml), although the pre‐propranolol BP was lower and the final BP achieved on the two medications was comparable (labetalol 147/89 mmHg, propranolol 145/89

Six patients who continued labetalol for periods of up to 14 months had persistent plasma volume expansion. Three of these, taking a higher dose of labetalol, developed resistance to the drug's antihypertensive effect. Addition of a diuretic restored antihypertensive efficacy and led to a fall in plasma volume. No such plasma volume expansion was seen in six patients who were followed on long term propranolol therapy

Some plasma volume expansion with the combined alpha‐ beta‐adrenoceptor blocker labetalol may be appropriate to its vasodilator action. Provided this effect is not excessive, it appears not to lead to resistance to its antihypertensive action. Small to moderate doses of labetalol would, therefore, seem effective without concomitant diuretic. Such sole use of labetalol could help minimise orthostatic symptoms which can be a major side effect of combination therapy
Why Does Migraine Improve During a Clinical Trial? Further Results from a Trial of Cervical Manipulation for Migraine
Authors: Parker G. B. , Pryor D. S. , Tupling H.
Published: March 2008

Summary: Why does migraine improve during a clinical trial? Further results from a trial of cervical manipulation for migraine. G. B. Parker, D. S. Pryor and H. Tupling, Aust. N.Z. J. Med., 1980, 10, pp. 192–198.

It is generally accepted that migraine is sensitive to intervention, whether in a treatment situation or in a clinical trial, and a “placebo effect” is often suggested. The influence of a number of non‐specific therapeutic ingredients was examined in a recent six‐month trial of cervical manipulation for migraine, and results of a 20‐month follow‐up are reported. During the trial migraine attacks reduced significantly by 28%, and reduced a further 19% up to the follow‐up period. The possibility of a trial effect, whereby improvement might stem from circumstances of the trial, was dismissed as an explanation for improvement. There was some evidence to suggest that placebo influences made a slight contribution to improvement, with sex, social class and subjects' optimism about the therapist at the initial treatment being weakly associated with initial improvement. The possibility that improvement levels reflected spontaneous improvement in migraine symptoms is suggested. If this possibility proves valid, clinical trials assessing migraine therapies should be designed so as to consider the natural course of migraine. Degree of improvement at follow‐up could be predicted clearly from degree of improvement during the treatment phase and from degree of improvement at the end of the trial. This appears to be important to manipulative therapists who appear to practise without the benefit of valid predictors of response to therapy
HLA B27 Negative Ankylosing Spondylitis—A Rare Condition
Authors: Rudge S. R. , Treadwell B. L. J.
Published: March 2008

Summary: HLA 627 negative ankylosing spondylitis—a rare condition. S. R. Rudge and B. L. J. Treadwell, Aust. N.Z. J. Med., 1980, 10, pp. 227–229.

New strict criteria have recently been suggested for the definition of HLA B27 negative ankylosing spondylitis, which show it to be less common than was previously thought. We report two cases which conform to the new criteria, together with details of family us e use of these criteria in future studies of B27 negative disease is discussed
Prazosin in the Treatment of Severe Chronic Congestive Cardiac Failure*
Authors: Hockings B. E. , Cope G. D. , Clarke G. M. , Taylor R. R.
Published: March 2008

Summary: The acute haemodynamic effects of prazosin 5 mg were investigated in 11 patients with severe chronic congestive cardiac failure. Six patients had their antifailure therapy discontinued while five continued on their usual medication. Two patients were exercised before and after prazosin. Following the drug, pulmonary capillary wedge pressure diminished 7 ± 2(SE) mmHg (P < 0·005) and cardiac index increased 17 ± 6% (P · 0·02). Mean arterial pressure fell in all subjects (‐9 ± 2 mmHg; P < 0·001) and systemic vascular resistance was reduced in all but one (‐19 ± 5%; P < 0·005). There was no significant change in heart rate. Four of the five subjects whose regular medications were continued were evaluated by clinical examination, chest X‐ray, echocardiogram and treadmill stress test, before and after four weeks of prazosin therapy, one subject having died in this time. Two improved, one deteriorated and one remained unchanged. Thus, chronic prazosin therapy benefited individual patients but did not consistently provide long term improvement.
Endocarditis Due to an Atypical Mycobacterium Following Porcine Heart Valve Replacement
Authors: Lombardo J. A. , O'Rourke M. F. , Shanahan M. X. , Harkness J. L.
Published: March 2008

Summary: Following aortic valve replacement with a porcine xenograph, a patient developed endocarditis complicated by a fistula between aorta and right ventricle. The xenograph was replaced by a mechanical valve and the fistula oversewn. No organisms were cultured but acid‐fast bacilli were seen in the aortic wall and excised valve tissue. It is likely that these were contaminants of the porcine prosthesis.
Mycobacterium Fortuitum: An Unsuspected Cause of Synovitis and Osteomyelitis
Authors: Williams G. V.
Published: March 2008

Summary: Two men with progressive synovitis and osteomyelitis of the wrist were found to have infection with Mycobacterium fortuitum. Immunological defects were demonstrated in both cases in association with renal failure and renal transplantation respectively. Failure of appropriate antibiotic therapy to eradicate infection necessitated amputation in one case. M. fortuitum is frequently sensitive to only amikacin or kanamycin. Treatment with amikacin alone was unsuccessful.

This organism is widespread in the environment and may need to be considered in undiagnosed chronic infection in the immunologically suspectible host, as it poses unusual problems in diagnosis and therapy.
The Role of α1 Protease Inhibitor (α1 Antitrypsin) in the Regulation of Immunologic and Inflammatory Reactions
Authors: Breit S. N. , Penny R.
Published: March 2008

Summary: Twenty‐six different alleles have been identified for α1 protease inhibitor (α1 antitrypsin), each designated by a letter of the alphabet. In any individual two alleles co‐dominantly determine the characteristics of α1 protease inhibitor (Pi), including mobility on electrophoresis, serum concentration and acute phase response. Recent evidence has linked some mildly deficient phenotypes of Pi with a variety of chronic immunologic and inflammatory disorders, such as rheumatoid arthritis, juvenile chronic arthritis, systemic lupus erythematosus, ankylosing spondylitis, uveitis, asthma and fibrosing alveolitis, in addition to the well recognised association of severe deficiency with emphysema and chronic liver disease. This disease susceptibility in phenotypes associated with reduced serum levels may be due to alteration in lymphocyte responses, complement activation and leukocyte migration. Pi can also influence the autolytic effects of leukocytic enzymes on tissues and may inhibit some aspects of coagulation and fibrinolysis. Therefore patients with deficient Pi phenotypes are likely to have exaggerated immunologic and inflammatory responses.
Cimetidine and Acute Upper Gastrointestinal Bleeding: A Double‐blind Controlled Trial
Authors: Meredith C. G. , Kennedy M. C. , Wade D. N. , Sweeten M. V. , Byrnes D. J. , Frommer D. J. , Hennessy W. B.
Published: March 2008

Summary Patients presenting with acute upper gastrointestinal bleeding from a variety of lesions were admitted to a prospective double‐blind controlled trial to determine if Cimetidine reduces the severity of bleeding and/or the incidence of rebleeding. During the first 48 hours, the patients received intravenous cimetidine (200 mg four‐hourly) or placebo, and for the following ten days, oral Cimetidine (1 g/24 hr) or placebo. Eighty‐eight patients entered the trial of whom 45 (51%) were in the cimetidine‐treated group. Six of the seven patients requiring surgery for life‐threatening bleeding and four of the six patients who rebled were in the cimetidine‐treated group. This study failed to demonstrate any advantage of using Cimetidine routinely in the treatment of acute upper gastrointestinal bleeding.
Cushing's Syndrome Due to an ACTH‐secreting Adrenal Medullary Tumour
Authors: Hoffman L. , Martin F. I. R. , Buchanan M. R. C. , Butkus A. , Whitworth J. A.
Published: March 2008

Summary A 35‐year‐old man with Cushing's syndrome due to ectopic ACTH production is described. The six‐week history and severe proximal myopathy were highly suggestive of a malignant tumour, but a solitary phaeochromocytoma of the left adrenal gland was the source of ACTH production. The surgical outcome was successful and three months post‐operatively the hypothalamic‐pituitary‐adrenal axis was normal. At 12 months follow‐up he remains well with complete regression of the features of Cushing's syndrome.
Plasma Cholesterol, Triglyceride and Uric Acid in Urban and Rural Communities in Papua New Guinea
Authors: Wyatt G. B. , Griew A. R. , Martin F. I. R. , Campbell D. G.
Published: March 2008

Summary: Fasting plasma cholesterol, triglycerides and uric acid were measured in 109 Melanesian residents of Port Moresby and 71 residents of a Papuan coastal village. Cholesterol and triglyceride levels were low, mean cholesterol 3.74 and 3.70 mM/I and triglycerides 0.64 and 0.59 mM/I respectively in urban and rural residents, with no relation to age or sex. Uric acid was higher in urban men (0.37 mM/I) than either urban women (0.26 mM/I) or rural men and women (0.25 and 0.24 mM/I). The levels of plasma cholesterol found in this study are similar to previous reports of rural populations in Papua New Guinea. The apparent failure of plasma lipids to increase significantly in urbanised residents of Port Moresby who had a significantly higher prevalence of both diabetes mellitus and obesity is unexplained.
A Clinical Evaluation of Serum Angiotensin Converting Enzyme in Sarcoidosis
Authors: Allen R. , Mendelsohn F. A. O. , Csicsmann J. , Weller R. F. , Hurley T. H. , Doyle A. E.
Published: March 2008

Summary: Angiotensin converting enzyme was measured in the serum of 52 patients with sarcoidosis, 67 healthy control subjects and 64 patients with pulmonary and non‐pulmonary diseases. The patients with sarcoidosis were classified on clinical grounds as having active or inactive disease.

In 26 patients with active sarcoidosis not taking corticosteroids the mean serum ACE was significantly higher than in normal controls (P < 0.001). 73% of these patients had elevated serum ACE. Only two out of 12 (17%) patients with inactive sarcoidosis not taking corticosteroids had elevated serum ACE. Serum ACE was normal in patients taking oral corticosteroids for longer than two weeks.

Eighty per cent of patients with active sarcoidosis with radiological evidence of pulmonary parenchymal involvement had an elevated serum ACE compared to 25% in patients with normal chest X‐rays and 60% of those with bilateral hilar lymphadenopathy.

All sarcoid patients with hypercalcaemia had elevated serum ACE whereas only half of those with normal serum calcium had elevated ACE.

In the patients with other thoracic and granulomatous conditions serum ACE was normal or rarely marginally elevated.

Serum ACE appears to be of value in the diagnosis of active sarcoidosis.
Enhanced Bioavailability of Pethidine and Pentazocine in Patients with Cirrhosis of the Liver*
Authors: Pond S. M. , Tong T. , Benowitz N. L. , Jacob P.
Published: March 2008

Summary: We studied the bioavailability and disposition kinetics of pethidine and pentazocine in patients with alcoholic cirrhosis and age‐matched healthy subjects. In the presence of liver disease, the bioavailability of pethidine was 31% and pentazocine 233% greater than in normals. Systemic clearance was approximately half and terminal half‐life double normal for both drugs, whereas volumes of distribution were unchanged. Because of greater bioavailability, oral doses of pethidine and pentazocine should be reduced substantially in patients with cirrhosis. When multiple oral or parenteral doses are required, dosing interval should be lengthened or repeated doses reduced below initial doses because of lower systemic clearance.
Filarial Chyluria Associated Glomerulonephritis and Therapeutic Considerations in the Chyluric Patient
Authors: Waugh D. A. , Alexander J. H. , Ibels L. S.
Published: March 2008

Summary: Two patients with chyluria who were successfully treated by surgical disconnection of the lymphatics from the renal pelvis are reported. One patient also had an associated glomerulonephritis, possibly secondary to filariasis. Although glomerulonephritis associated with filariasis has been reported previously the details of renal biopsies in man have included only light microscopic findings. In this patient immunoflourescent and electron microscopic studies showed mesangial deposits of immunoglobulins and complement which suggests that glomerulonephritis in patients with filariasis may be of an immune complex type.
Effect of Cigarette Smoking on Duodenogastric Reflux of Bile Acids*
Authors: Yeomans N. D. , Williams D. R. , Mackinnon M. A. , McLeish A. R. , Smallwood R. A.
Published: March 2008

Abstract: The possibility that smoking induces duodenogastric reflux was examined in 13 healthy male volunteers. Gastric juice was aspirated for four consecutive 20‐minute periods, and reflux quantitated by measuring total bile acids (TBA), chenodeoxycholic acid (CDCA) and glycocholic acid (GCA) in the juice. One cigarette was smoked during either period 2 or period 3. Amounts of bile acids (μmoles; means ±SEM) refluxing into stomach during the pre‐smoking, smoking, and post‐smoking periods respectively were: TBA—4.5 ± 1.1, 5.4 ± 3.0 and 3.9 ± 1.6; CDCA— 1.7 ± 0.6, 1.5 ± 0.9 and 2.0 ±1.1; GCA—1.8 ± 1.7, 1.1±0.6 and 1.0 ± 0.6. Paired analysis revealed no significant effect of smoking on any of these parameters. These findings, based on quantitative methods, do not confirm those of previous unblinded and semiquanti‐tative studies. We conclude that smoking one cigarette does not provoke duodenogastric reflux.
The Lumbar Spinal Canal in Hypophosphataemic Vitamin D‐resistant Rickets
Authors: Cartwright D. W. , Masel J. P. , Latham S. C.
Published: March 2008

Abstract: Lumbar spine radiographs of 77 adult patients with hypophosphataernic vitamin D‐resistant rickets have been examined and measured in their anteroposterior and transverse dimensions. Comparison of these measurements with those of a group of normal individuals showed the HPR patient group to have narrower spinal canals in both diameters. No differences were found between males and females in either group. The lumbar spinal canal stenosis in adult HPR patients may make them more susceptible to spinal cord compromise from space occupying lesions within the canal, causing back pain and lower limb weakness for which surgical intervention may be indicated.