bluuebunny/crossref_metadata_2025 huggingface dataset:
SPONTANEOUS DISSECTION OF THE INTERNAL CAROTID ARTERY
Authors: KILPATRICK C. , SAGE M. R. , BURNS R.
Published: March 2008

Abstract: Spontaneous dissection of the internal carotid artery has been considered a relatively rare cause of carotid artery occlusion. It is postulated this condition may not be uncommon and that some cases are not recognised.

The condition is characterised by typical clinical and radiological features which should suggest the diagnosis. Despite these suggestive features it appears that recognition of this condition is not widespread and the diagnosis may not be made.

Three cases of spontaneous dissection are reported. The clinical and radiological features will be emphasised and pathogenesis and treatment discussed.
PERHEXILENE NEUROPATHY: A REPORT OF TWO CASES
Authors: LORENTZ I. T. , SHORTALL M.
Published: March 2008

Abstract: Two cases of sensory‐motor neuropathy attributed to perhexilene maleate are described. The clinical and pathological features of perhexilene neuropathy are discussed. The use of perhexilene should be tempered with caution. Nerve conduction studies may be useful in confirming early neuropathy.
POST‐OBSTRUCTIVE DIURESIS
Authors: JONES B. F. , NANRA R. S.
Published: March 2008

Abstract: A patient with post‐obstructive diuresis is described. Inappropriate losses of salt and water occurred, with urine volume exceeding half the glomerular filtration rate. Additionally, excessive urinary excretion of potassium, bicarbonate, calcium, phosphate, magnesium and urate took place in the presence of subnormal blood levels. Transient proteinuria was also observed. This case demonstrates that serious electrolyte disturbances can occur after relief of urinary tract obstruction and the evidence suggests these may be due to disordered proximal tubule function.
SMALL AIRWAYS DISEASE
Authors: BEREND N.
Published: March 2008

Over the last 10 years the non‐specific term “small airways disease” has been applied to a number of histologic lesions seen in the peripheral airways of smokers. It is becoming recognized that airway inflammation is the most important of these lesions. This pathology may be the precursor to the subsequent development of emphysema and is an important cause of the functional abnormality in smokers. A current hypothesis is that small airways disease may be detected early in the smoking careers of subjects who later develop chronic respiratory disability. In these individuals particularly, complete cessation of smoking should be the primary therapeutic goal. With the recent development of special tests to assess small airways function, the presence of small airways disease can be detected in asymptomatic smokers who may have normal routine lung function tests. However, most of the tests to assess airway function are also influenced by other physiological factors such as loss of elastic recoil. We await the results of long term epidemiological studies to confirm the above hypothesis that early small airways disease leads to chronic disability. Without such confirmatory evidence, the routine use of these special tests cannot at present be advocated.
LOWER RESPIRATORY TRACT SYMPTOMS IN QUEENSLAND SCHOOLCHILDREN THE QUESTIONNAIRE: ITS RELIABILITY AND VALIDITY
Authors: MITCHELL C. , MILES J.
Published: March 2008

Respiratory symptoms and ventilatory function were recorded on 4549 Queensland schoolchildren. Previously parents of 67 children on two occasions showed that key questions on wheezy breathing and productive cough were reliable, with agreement of responses in 97% and 91% of subjects. These two questions divided the children into four main groups: Group A, those children with attacks of asthma or of wheezy breathing; Group B, those with attacks of cough with sputum; Group AB, those with both symptoms; and Group N, those with neither symptom.

The validity of the questionnaire was examined by relating question responses to ventilatory function expressed as normalized residuals. Mean (±SD) normalized FEF 25–75 residuals for the major groups were: N, 0 ± 1.00; B, ‐0.10±1.00; A, ‐ 0.26 ±1.10; and AB, ‐0.50±1.07. In subjects with wheeze, residuals distinguished subjects on a basis of frequency of wheeze, total number of attacks, and the association with breathlessness.

The proportion of eight year olds in each group (N, B, A and AB) was 44%, 33%, 2.6%, and 20.5% respectively; and of twelve year olds, 52%, 28%, 2.7%, and 18.1%. These results contrast with those of a comparable survey of Tasmanian seven year olds where the proportion was 51%, 33%, 1.8%, and 14.4% respectively.
PLESIOMONAS SHIGELLOSES SEPTIC ARTHRITIS COMPLICATING RHEUMATOID ARTHRITIS
Authors: GORDON D. L. , PHILPOT C. R. , McGUIRE C.
Published: March 2008

A patient with severe seropositive rheumatoid arthritis and hepatic cirrhosis developed septic arthritis of his knees. Plesiomonas shigelloides was isolated from joint fluid, blood, and also from the gut. The patient's joint symptoms responded to treatment with oral trimethoprim‐sulphamethoxazole, but he died of uncontrolled gastrointestinal bleeding five days later.
PATHOLOGIC FRACTURE DUE TO SEVERE OSTEOMALACIA FOLLOWING LOW‐DOSE DIPHOSPHONATE TREATMENT OF PAGET'S DISEASE OF BONE
Authors: EVANS R. A. , HILLS E. , DUNSTAN C. R. , WONG S. Y. P.
Published: March 2008

Ethane‐l‐hydroxy‐l, l‐diphosphonate (EHDP) 5 mg/kg body weight/day was administered to a patient suffering from Paget's disease of bone. After 150 days of treatment, when the plasma alkaline phosphatase was 40% of initial, he suffered a pathologic fracture of his Pagetic right patella, which was found to have osteomalacia of extreme severity. An iliac crest bone biopsy, following double tetracycline labels, also showed severe osteomalacia of Pagetic bone. Osteoclast acid phosphatase activity was reduced, as occurs in diphosphonate‐treated rats. The patient's history included two previous pathologic fractures of Pagetic bone and unusual sensitivity to EHDP. It might be prudent to perform needle bone biopsy in order to exclude osteomalacia in EHDP‐treated _ patients with these clinical manifestations.
CEREBRAL ABSCESS: MANIFESTATION OF PULMONARY ARTERIOVENOUS MALFORMATIONS
Authors: FENELEY M. P. , BURNS M. W.
Published: March 2008

Two cases in which cerebral abscess was the initial presenting feature of pulmonary arteriovenous malformations are reported. Cerebral abscess recurred in one patient. The pulmonary malformations were multiple and bilateral in both cases. One patient had associated features of hereditary hemorrhagic telangiectasia. Surgical resection of the largest malformations was performed in both cases. Cerebral abscess did not recur in either case post‐operatively, though this may not have been due to surgical intervention.
MYOCLONUS FOLLOWING SEVERE ASTHMA: CLONAZEPAM RELIEVES
Authors: CHEE Y. C. , POH S. C.
Published: March 2008

Three cases of severe asthma requiring mechanical ventilatory support after sudden cardiorespiratory collapse developed myoclonus following the hypoxemic insult. They were unable to stand, walk or feed themselves because of these jerky involuntary movements which were worse on intention. Oral clonazepam in varying doses up to 8 mg daily improved the myoclonus remarkably such that they were able to perform these functions unaided.
COMPLICATIONS OF CHRONIC GLUE (TOLUENE) ABUSE IN ADOLESCENTS
Authors: DEVATHASAN G. , LOW D. , TEOH P. C. , WAN S. H. , WONG P. K.
Published: March 2008

Recently there has been an alarming increase in the number of schoolchildren sniffing glue (toluene). The medical complications seen in 18 boys, aged 14 to 18 years, include physical and mental dependence, pulmonary hypertension with cor pulmonale, restrictive lung defect, encephalopathy, peripheral neuropathy and high frequency, continuous discharges (neuromyotonia) on electromyogram.

Glue sniffing took place in small groups and abusers sniffed directly from cans containing glue. Lower socio‐economic status, overcrowding, lack of attention by working parents, school failure and easy availability of the glue were commonly cited associated factors.
RISK FACTORS IN AUSTRALIANS: NATIONAL HEART FOUNDATION'S RISK FACTOR PREVALENCE STUDY, 1980
Authors: HODGE R. L.
Published: March 2008

The National Heart Foundation's Risk Factor Prevalence Survey in 1980 is described. Results for the prevalence of hypertension, smoking, hyperlipidemia, obesity and inactivity from the 1980 survey are presented. A second study was conducted in 1983 and a third is planned for 1986 or later. These surveys provide unique data on risk factors in Australians, and hold the prospect of determining trends which may be relevant to overall mortality trends in cardiovascular disease.
HEPATITIS B INFECTION AMONG STD CLINIC PATIENTS IN SYDNEY
Authors: CHRISTOPHER P. J. , CREWE E. B. , MAILER P. T. , MURPHY A. M.
Published: March 2008

Evidence of current or past infection with hepatitis B has been studied in 809 patients attending clinics for sexually transmitted diseases in Sydney by assaying serological markers. Prevalence rates were 13.9% among male heterosexuals; 13.5% among female heterosexuals; 30.7% among female prostitutes; 64.3% among male homosexuals and 47.1% among male bisexuals. The prevalence was 80% for male homosexuals aged 36 years or more. Vaccination should be considered for persons at high risk of sexual transmission of hepatitis B, and it is the immunization of this group that is likely to have a major impact on this disease.
FAMILIAL MYOPATHY ASSOCIATED WITH MARFANOID FEATURES AND MULTICORES
Authors: JOYCE D. A. , MASTAGLIA F. L. , OJEDA V. J. , SPAGNOLO D. V.
Published: March 2008

The cases of a mother and son with a slowly progressive generalised myopathy and Marfanoid features are described. Muscle biopsies showed atrophy, type 1 fibre preponderance, excessive variation in fibre size and shape, and multiple foci of myofibrillar disorganisation with loss of oxidative enzyme activity of the type found in multicore disease.
CULTURE NEGATIVE INFECTIVE ENDOCARDITIS
Authors: ABRAHAM A. K. , NEUTZE J. M. , MacCULLOCH D. , CORNERE B.
Published: March 2008

Twenty cases of culture negative infective endocarditis admitted to the Cardiology Department of Green Lane Hospital from 1959 to 1980 out of a total of 265 cases (7.5%), were analysed retrospectively. Cases were included only when adequate proof of endocarditis was available at surgery or postmortem. Indiscriminate use of antibiotics before taking blood cultures was the most common association with failure to obtain positive cultures, seen in 16 of the 20 patients described. Failure to obtain positive cultures in four cases was attributed to inadequate bacteriologic techniques before 1967. Where no antibiotics were given prior to collecting blood cultures and bacteriologic techniques were adequate, proven culture negative endocarditis was virtually unknown. When antibiotics have been given, repeated blood cultures are recommended following withdrawal of antibiotics for at least four days.
SUBACUTE PULMONARY HYPERTENSION DUE TO CARCINOMATOUS MICROEMBOLISM
Authors: RAPER R. F. , ROGLEFF B. R. A. , VANDENBERG R. A.
Published: March 2008

A 43 year old female was admitted to hospital with severe pulmonary hypertension and cardiogenic shock. She had a two week history of dyspnea only. Resuscitative measures proved unsuccessful and she died ten hours after admission. Post mortem examination indicated that the pulmonary hypertension and right ventricular failure were due to endarteritis secondary to widespread carcinomatous microembolisation from adenocarcinoma of the lung.
GlANT CELL ARTERlTlS DIAGNOSED FOLLOWING ARM CLAUDICATION
Authors: PETRIE J. P. , SHEPPEARD H.
Published: March 2008

A patient is described whose initial symptoms, though suggestive of polymyalgia rheumatica, were attributed to psoriatic arthritis, and whose subsequent development of claudication of the left arm led to the biopsy proven diagnosis of giant cell arteritis. Attention is drawn to widespread arterial involvement by giant cell arteritis which, though uncommon, must be considered in all patients with ischemic limb pain. In addition, the consequences of overlooking polymyalgia rheumatica as an early manifestation of giant cell arteritis are outlined.
EFFECTIVE ORAL TREATMENT OF SEVERE PAGET'S DISEASE OF BONE WITH APD (3‐AMINO‐I‐HYDROXYPROPYLIDENE‐1,1‐BISPHOSPHONATE); A COMPARISON WITH COMBINED CALCITONIN + EHDP (1 ‐HYDROXYETHYLIDENE‐1,1 ‐BISPHOSPHONATE)
Authors: FRASER T. R. C. , IBBERTSON H. K. , HOLDAWAY I. M. , RUTLAND M. , KING A. , DODD G. , WATTIE D. J.
Published: March 2008

Ten patients with severe Paget's disease of bone and serum alkaline phosphatase (SAP) >900 IU/I were treated for six months with the oral diphosphonate APD, (3‐amino‐1‐hydroxypropylidene‐1,1‐bisphosphonate). By the end of the treatment period there was a reduction in the log mean urine hydroxyproline (uHP) and the log mean SAP of 92% and 87% respectively. In four patients both SAP and uHP fell to within the normal range and remained normal for at least six months after therapy was stopped. Bone scintigraphy showed a fall in 99mTc‐MDP uptake in sites of active Paget's disease in all patients and histomorphometry showed no increase in osteoid. Repair of radiological osteolytic lesions was observed in 6/6 patients and progression of tibial osteolytic wedges was arrested in 5/5 patients and reversed in four. This improvement persisred six months after completion of therapy but further wedge progression occurred in one patient whose urine HP remained elevated.

There were no serious effects though five patients complained of nausea. The clinical and biochemical responses to APD were equivalent to those observed in the same patients during a previous six month course of combined therapy with human calcitonin (CT) + EHDP except that there was additional biochemical and radiological evidence of bone healing. This study confirms PAD as an effective treatment of severe Paget's disease of bone.
MUTATION FREQUENCY IN NURSES AND PHARMACISTS WORKING WITH CYTOTOXIC DRUGS
Authors: CHRYSOSTOMOU A. , SESHADRI R. , MORLEY A. A.
Published: March 2008

Individuals occupationally exposed to cytotoxic drugs may be at risk owing to the effects of these agents on DNA. As an index of DNA damage, in vivo mutations were measured in lymphocytes from 24 oncology nurses or pharmacists and 24 matched controls. Mutation frequency was significantly increased in exposed individuals and appeared to be related to duration of exposure. However, the overall magnitude of the increase was small and its biological significance remains to be determined.
RENAL FAILURE IN INFANCY DUE TO OVER‐PRODUCTION OF URATE
Authors: BATCH J. A. , RIEK R. P. , GORDON R. B. , BURKE J. R. , EMMERSON B. T.
Published: March 2008

This report concerns a three month old infant who was failing to thrive. Renal insufficiency was demonstrated and attributed to aortic coarctation. However, surgical correction of the coarctation failed to correct the renal insufficiency completely and disproportionate hyperuricemia was noted. Excessive urinary excretion of uric acid was found and a moderate deficiency (6% of normal) of hypoxanthine‐guanine phosphoribosyltransferase (HGPRT) was demonstrated. When the urate over‐production was corrected with allopurinol, renal function returned to normal and the child became well. The importance of over‐production of urate and the resultant excessive urinary excretion of uric acid as a treatable cause of acute or persistent renal insufficiency is stressed.
IMMUNOCHEMICAL DETECTION OF FECAL OCCULT BLOOD
Authors: McDonald C. A. , BURFORD Y. , YUEN A. C. , WALLS R. S. , GOULSTON K. J.
Published: March 2008

An immunochemical test for fecal occult blood has been evaluated. It has been found to be specific for human hemoglobin and to be reproducible, accurate and four times more sensitive than chemical occult blood tests. Storage of prepared slides at ‐20°C prevented reduction in sensitivity. To determine the effect of blood from the upper gastrointestinal tract, six volunteers ingested 100 ml of their own blood. Positive chemical, but no positive immunochemical tests were produced. In 20 healthy subjects, challenge with red meat and vegetables with high peroxidase content increased the positivity rate of chemical tests but had no effect on the positivity rate of the immunochemical test.

The immunochemical method for fecal occult blood has advantages over chemical testing in that it IS specific for human blood and for lower gut bleeding. Its increased sensitivity should result in a high detection rate of colorectal neoplastic lesions. However, this same increased sensitivity may also reduce its effectiveness in bowel cancer screening because of positive results in patients with trivial blood loss from non‐neoplastic colonic sources.
LOW MOLECULAR WEIGHT IgM IN B CELL LYMPHOPROLIFERATIVE DISORDERS
Authors: ROBERTS‐THOMSON P. J. , JONES D. N. , KOH L. Y. , NEOH S. H. , THOMAS M. , BRADLEY J.
Published: March 2008

Circulating low molecular weight (LMW) IgM was demonstrated in five of 38 patients with B cell lymphoproliferative disorders. These five patients all had malignant disease and could be subdivided into two groups. In the first group were three patients, each with an associated serum IgM paraprotein; two had Waldenstrom's macroglobulinemia. and one lymphocytic lymphoma. The two patients of the second group did not have IgM paraproteins; one had lymphocytic lymphoma and one chronic lymphocytic leukemia. Both these patients also had acquired C1 esterase inhibitor deficiency, a previously recognised association with circulating LMW IgM. None of the 16 patients with benign IgM macroglobulinemia had circulating LMW IgM. In those positive sera with LMW IgM this moiety contributed between 10.5% and 37.5% of the total IgM. There was no apparent association between LMW IgM and total IgM levels, kappallambda typing or the presence of Bence Jones proteinuria. but rheumatoid factor, immune complexes and cryoglobulins occurred in many of the sera which contained LMW IgM. Pokeweed mitogen stimulated peripheral blood mononuclear cells from two patients with circulating LMW IgM secreted considerable quantities of this moiety in vitrobut this did not occur in two patients with benign IgM macroglobulinemia.

We conclude that LMW IgM is found in the malignant but riot the benign forms of B cell lymphoproliferative disorders and is frequently associated with other serological abnormalities. The basic abnormality causing defective IgM polymerisation in these disorders is obscure.
SUBACUTE SCLEROSING PANENCEPHALITIS (SSPE): A REPORT OF 16 CASES
Authors: ROBBINS S. J. , APPLETON B. , FIUMARA F. , BURKE C.
Published: March 2008

Sixteen cases of subacute sclerosing panencephalitis (SSPE) were diagnosed at the Royal Children's and Mater Misericordiae Children's Hospitals in Brisbane from September 1974 to June 1983. Although the incidence of the disease with regard to age at onset, previous exposure to measles virus, and longevity was similar to that reported in the United States and Europe, the frequency of the illness was substantially higher in the present study. The high frequency of the disease in Queensland appears to reflect a relatively low level of immunity to measles virus in the population at risk.
OBSTRUCTIVE AZOOSPERMIA AFTER A SECOND RENAL TRANSPLANT: AN AVOIDABLE CAUSE OF INFERTILITY
Authors: HANDELSMAN D. J.
Published: March 2008

A case of obstructive azoospermia and infertility after renal transplantation is presented. Vasec‐tomies were performed incidental to insertion of a renal allograft on each side and were not amenable to vasovasostomy owing to retraction of the proximal vasal stump. The desirability of spermatic cord preservation in younger men undergoing renal transplantation is discussed.
ENDOSCOPIC SPHINCTEROTOMY OF THE PAPILLA OF VATER: AN ANALYSIS OF 300 CASES
Authors: ROBERTS‐THOMSON I. C.
Published: March 2008

Endoscopic sphincterotomy was performed on 300 patients with biliary and/or pancreatic disease during the period 1978–1983. The most frequent indications were choledocholithiasis after cholecystectomy (59%), choledocholithiasis without cholecystectomy (17%) and presumed motility disorders of the sphincter of Oddi (15%). In choledocholithiasis, stones passed spontaneously or were extracted from the bile duct in 147 of 164 patients (90%) in whom the outcome was determined by cholangiography immediately after stone extraction or by a second retrograde cholangiogram. In presumed motility disorders, only 51% of patients have shown sustained improvement in symptoms. Complications were uncommon (5%) but included bleeding from the margins of the incision, pancreatitis, cholangitis and an entrapped Dormia basket; no patient died. Duodenal diverticula were more frequent (p<0.005) in patients with bile duct stones after cholecystectomy (28%) than in patients in whom retrograde cholangiography did not reveal stones (9%) but the presence of diverticula did not influence the outcome of the procedure. Endoscopic sphincterotomy is a safe and effective procedure of particular relevance to elderly patients with choledocholithiasis after cholecystectomy and to high‐risk patients with choledocholithiasis without cholecystectomy.
CHRONIC IDIOPATHIC MEGADUODENUM IN A FAMILY
Authors: EAVES E. R. , SCHMIDT G. T.
Published: March 2008

Abstract: :This paper reports a family in which idiopathic megaduodenum occurred. The index case was a 17 year old male with lifelong steatorrhea, episodic vomiting of food consumed days before, offensive belching, and recurrent abdominal pain and distention. The diagnosis was made by a barium meal examination, but only after a failed small bowel biopsy suggested some anatomical abnormality. Direct questioning about family “ft members then revealed that his father, aged 43 years, had similar symptoms and a subsequent barium meal confirmed the diagnosis. Screening of the family revealed megaduodenum in the 20 year old sister who was totally asymptomatic and had normal fecal fat levels but an abnormal breath test. The remainder of the family members were asymptomatic and had normal radiology. This family, in which idiopathic megaduodenum occurred in three of six members, is reported because it illustrates some of the features of idiopathic megaduodenum and chronic idiopathic intestinal pseudo‐obstruction. It also demonstrates the need to investigate the families of apparent sporadic cases. Such investigation may uncover additional symptomatic and asymptomatic individuals who may be presenting diagnostic difficulty, and who, by virtue of an early diagnosis, may be spared unnecessary surgery.
LEGIONELLA PNEUMOPHILA AND WATER TEMPERATURES IN AUSTRALIAN HOSPITALS
Authors: PEEL M. M. , HARKNESS J. L. , CALWELL J. M. , ROUCH G. J. , CHRISTOPHER P. J.
Published: March 2008

Abstract: Thirty‐four samples of warm waters from 12 psychiatric centres in Victoria and New South Wales were examined for legionellae by guinea‐pig inoculation. Legionella pneumophila was isolated from 20 of the samples collected from ten of the establishments investigated. The detected prevalence proportion of L. pneumophila in waters of temperatures 36 to 43oC was 0.9 (18/20), whereas the prevalence in waters of temperatures 45 to 54.2oC was 0.14 (2/14). The two ‘positive’ waters within the latter range showed evidence of low numbers of L pneumophila. No significant antibody titres to relevant serogroups were detected in the 112 exposed residents tested from seven psychiatric hospitals in New South Wales.

The findings show that the temperature range with the greatest prevalence of L. pneumophila in warm waters is 36 to 43oC. The presence of legionellae in these warm water‐distribution systems contrasts with their absence from the water‐distribution systems of Victorian hospitals in an earlier survey and underlines the value and simplicity of the usual Australian practice of maintaining hospital hot water temperatures at about 70oC in the control of L pneumophila.
ASTHMA DUE TO INSECTICIDE SENSITIVITY
Authors: BRYANT D. H.
Published: March 2008

Abstract: :Two patients are reported in whom asthma was precipitated by exposure to synthetic organophosphorous insecticides. Investigation showed no evidence of systemic poisoning or cholinesterase inhibition and indicated that the asthmatic reactions may have been due to a sensitivity response. The mechanism of this response is unknown but it was inhibited by corticosteroids in one patient. A history of insecticide exposure was obtained from the affected patients only after careful questioning and indicates the need for awareness that sensitivity to insecticides may precipitate asthma and that little exposure is necessary to elicit a response
NUTRITIONAL STATUS IN HOSPITAL INPATIENTS: IMPLICATIONS FOR NUTRITIONAL SUPPORT SERVICES
Authors: B. WOOD D. , LO L. , J. CLEARY C , BONTOFT J. , KELLEHER D. , BURNS E. , THIEN C
Published: March 2008

Abstract: In a population of 473 inpatients, a profile of nutritional status from obesity to marasmickwashiokor was observed. Thirty–two per cent of the population were overweight or obese (n = 153), forty–five per cent were of normal weight (n = 211), 8% were at risk of protein–energy malnutrition (n = 39), and 15% (n = 70) had grades of protein–energy malnutrition from marasmus to marasmic–kwashiokor. The implications for improved nutritional support services for hospitalised patients are discussed.
TREATMENT OF REFRACTORY ASCITES IN PATIENTS WITH LIVER DISEASE
Authors: WOOD L. J. , WILLETT I. R. , DUDLEY F. J.
Published: March 2008

“When the liver is full of fluid and this overflows into the peritoneal cavity so that the belly becomes full of fluid, death occurs” ‐ Hippocrates.
WEGENER'S GRANULOMATOSIS: CLINICAL FEATURES AND OUTCOME IN SEVENTEEN PATIENTS
Authors: LITTLEJOHN G. O. , RYAN P. J. , HOLDSWORTH S. R.
Published: March 2008

Seventeen patients with Wegener's granulomatosis are reviewed. Eleven males and six females, with a mean age of 46.9± 4.5 years, were followed for 35.7 ± 9.0 months. Mean duration from time of onset of symptoms to diagnosis was 8.5 ±3.1 months. Constitutional symptoms (100%), lower respiratory tract involvement (93%), renal involvement (87%), and upper respiratory tract involvement (80%) were the most frequent clinical manifestations. Arthritis (60%), dermal vasculitis (60%), and inflammatory ocular disease (40%) were also common. Elevated ESR (94%), anemia (70%), and lymphopenia (77%) were frequent laboratory findings prior to treatment. Five patients had renal failure at presentation and two patients progressed from no renal involvement at presentation to renal failure at diagnosis, while five patients progressed from renal involvement without impairment at diagnosis to end‐stage renal failure. Seven patients died; six of these deaths were related to active Wegener's granulomatosis. The patients with a severe systemic vasculitis, and renal involvement had a poor outcome while predominant respiratory disease had a good prognosis.
GLUE SNIFFING NEUROPATHY
Authors: KING P. J. L. , MORRIS J. G. L. , POLLARD J. D.
Published: March 2008

Three young men are described in whom a severe, subacute, predominantly motor peripheral neuropathy resulted from the deliberate inhalation of glue vapour. Weakness began after several years of daily glue sniffing and was marked in proximal as well as distal muscles. Muscle wasting was prominent at the time of presentation. Deterioration continued for several weeks after glue sniffing ceased. Peripheral nerve conduction was markedly slow and there was extensive denervation in the muscles. Characteristic changes were seen on sural nerve biopsy. The habit of glue sniffing is now widespread amongst Australian adolescents and this factor should be considered when any young person presents with a peripheral neuropathy. (Aust NZ J Med 1985; 15: 293–299.)
CHRONIC RELAPSING MYALGIA (? POST VIRAL): CLINICAL, HISTOLOGICAL, AND BIOCHEMICAL STUDIES
Authors: BYRNE E. , TROUNCE I. , DENNETT X.
Published: March 2008

Two patients with persistent myalgia characterised by onset after an ill‐defined systemic illness, marked fluctuations in the severity of the symptoms, and normal neuromuscular examination with the exception of variable muscle tenderness on deep palpation, may have a forme fruste of myalgic encephalomyelitis. Differentiation from psychogenic muscle pain is important in management. Muscle histology revealed non‐specific Type II fibre atrophy. Mitochondrial respiration was assayed polarographically in intact organelles in vitro and revealed a mild depression of State 3 respiration rates with Site I and Site II substrates. (Aust NZ J Med 1985; 15: 305–308.)
THE INFLAMMATORY RESPONSE IN THE SYNOVIUM OF A PATIENT WITH ROSS RIVER ARBOVIRUS INFECTION
Authors: HAZELTON R. A. , HUGHES C. , AASKOV J. G.
Published: March 2008

Ross River virus has been incriminated in the etiology of many sporadic and epidemic cases of polyarthritis in Australia and the Pacific. Both synovium and synovial exudate fluid recovered from the knee of an epidemic polyarthritis patient showed a predominantly mononuclear leucocyte infiltrate. Infectious virus could not be recovered from the synovial exudate. Functional natural killer cells were detected in the synovial fluid. Their level of cytotoxic activity was similar to that detected in the peripheral circulation. (Aust NZ J Med 1985; 15: 336–339.)
THE CATECHOLAMINE RESPONSE TO ACUTE MYOCARDIAL INFARCTION: EFFECT OF EARLY ADMINISTRATION OF SOTALOL
Authors: McGRATH B. , ARNOLDA L. , SALTUPS A.
Published: March 2008

Abstract Thirty‐five patients with suspected acute myocardial infarction were studied in a randomised controlled trial to determine whether the catecholamine response to myocardial infarction was altered by administration of the beta blocker, sotalol, given within six hours of the onset of chest pain. Myocardial infarction evolved in 30 patients (15 placebo‐treated, 15 sotalol‐treated) and was associated with markedly increased plasma and urine noradrenaline and adrenaline levels. Intravenously administered sotalol was well tolerated and produced significant acute falls in blood pressure and heart rate. The reduction in heart rate was maintained in the sotalol group with once‐daily therapy. Plasma levels of both catecholamines showed slow but very similar falls in the two groups, the decline being evident earlier for adrenaline than for noradrenaline. This was also reflected in the pattern of catecholamine excretion: significant falls in adrenaline but not noradrenaline excretion were seen on day 2 in both groups. Although mean plasma and urinary catecholamine levels tended to be higher in the sotalol group throughout the study, the differences between the sotalol and placebo groups for the changes in plasma or urinary catecholamines with time were not statistically significant. Episodes of ventricular tachycardia occurred in 68% of the patients on day 1 and 27% of patients on day 2. More patients in the sotalol group experienced episodes of ventricular tachycardia (sotalol 89% placebo 54%) but this difference was not statistically significant. Infarct size as assessed by cumulated release of creatine kinase was similar in sotalol (184±21 IU/I) and placebo (199±24 IU/I) groups and correlated with day 1 adrenaline excretion (r = 0.40, n = 30, p 0.05). Early administration of sotalol did not appear to confer any significant benefits in the acute phase of myocardial infarction.
THE PREVALENCE OF ARRHYTHMIAS IN HYPERTROPHIC CARDIOMYOPATHY: ROLE OF AMBULATORY MONITORING AND SIGNAL‐AVERAGED ELECTROCARDIOGRAPHY
Authors: GAVAGHAN T. P. , KELLY R. P. , KUCHAR D. L. , HICKIE J. B. , CAMPBELL T. J.
Published: March 2008

Abstract Hypertrophic cardiomyopathy (HCM) is associated with a high incidence of supraventricular and ventricular arrhythmias. The presence of ventricular tachycardia (VT) in patients with HCM has been associated with a high risk of sudden death. Forty‐seven patients with HCM (31 male, 16 female, mean age 47 years) underwent continuous 24‐hour ambulatory electrocardiographic (ECG) monitoring. High grade ventricular arrhythmias (modified Lown class 3, 4a, 4b) were found in 20 patients (43%) with VT in 11 (24%). In each case the arrhythmia was asymptomatic. Supraventricular arrhythmias were detected in 16 patients (34%). Signal‐averaged electrocardiography in 27 patients showed late potentials in three of 11 patients with repetitive ventricular arrhythmias and was negative in 15 of 16 patients without these arrhythmias. In conclusion, asymptomatic high grade ventricular and supraventricular arrhythmias are common in HCM and are readily detected with continuous electrocardiographic monitoring. Sinal‐averaged ECG has low sensitivit for the detection of subclinical VT in patients with HCM. (Aust NZ J Med 1986; 16: 666–670.)
SPINAL CORD COMPRESSION IN MULTIPLE MYELOMA: WHO GETS IT?
Authors: WOO E. , YU Y. L. , NG M. , HUANG C. Y. , TODD D.
Published: March 2008

Abstract Of 97 Chinese patients with multiple myeloma seen over a 12‐year period, 23.7% were found to have cauda equina or spinal cord compression (SCC). Predictive features for SCC include paraprotein type, hemoglobin level, and the extent of bone lesion at initial hematological diagnosis. A discriminant function derived from this analysis can be used to predict the likelihood of SCC with 79% accuracy. It is postulated that when the cortex is more involved than the medulla in a vertebra, it will predispose to SCC while hemopoiesis is relatively preserved.

Our patients presented late with advanced neurological deficit so that treatment was unsatisfactory. It is emphasised that early recognition of back pain and neurological symptoms is essential, as any delay would jeopardise the chance of neurological recovery. (Aust NZ J Med 1986; 16: 671–675.)
MANAGEMENT OF SPLENECTOMY FAILURES IN CHRONIC IMMUNE THROMBOCYTOPENIC PURPURA: ROLE OF ACCESSORY SPLENECTOMY
Authors: GIBSON J. , RICKARD K. A. , BAUTOVICH G. , MAY J. , KRONENBERG H.
Published: March 2008

Abstract Accessory splenic tissue was demonstrated in four of eight patients with chronic immune thrombocytopenic purpura investigated following post‐splenectomy relapses. Time from initial splenectomy to relapse of thrombocytopenia ranged from immediately to eight years and post‐splenectomy changes were present on the peripheral blood films of all patients at time of relapse. Three scanning techniques were employed to demonstrate and localise residual splenic tissue. Conventional 99mTc scans were positive in three of the four patients whilst 99mTc‐heat damaged red cell scans and computerised tomographic scans were each positive in three out of three patients including the one patient in whom a conventional 99mTc scan was negative. Histological confirmation of splenic tissue was obtained in all cases with the weights of the accessory spleens ranging from 0.6 g to 2 g. Two patients responded to accessory splenectomy and, without immunosuppressive therapy, have remained well with normal platelet counts for over four years. There was no correlation between length of initial remission and the response to removal of the accessory spleen. The presence of a functioning accessory spleen should be considered in all patients with chronic ITP who fail to respond to, or relapse following, initial splenectomy. (Aust NZ J Med 1986; 16: 695–698.)
BOOK REVIEW
Authors: Darveniza Paul
Published: March 2008

NEUROCA RDIOLOG Y. THE INTERRELA TIONSHIPS BETWEEN D YSFUNCTION IN THE NERVOUS AND CARDIOVASCULAR SYSTEMS. By John Walton
BALLOON DILATATION PULMONARY VALVULOPLASTY IN PULMONARY STENOSIS
Authors: McCREDlE R. M. , SWINBURN M. J. , LEE C. L. , WARNER G.
Published: March 2008

Abstract Balloon valvuloplasty was used to treat congenital pulmonary valve stenosis in 13 patients, 11 with isolated pulmonary stenosis, one associated with complex univentricular heart and tricuspid atresia, and one associated with tetralogy of Fallot.

A balloon catheter was introduced through the pulmonary valve over a guidewire positioned in the distal pulmonary artery and inflated for 15 seconds on two or three occasions to 3 to 5 atmospheres and rapidly deflated.

Marked improvement in pressure gradients was achieved in eight of the 11 patients with isolated pulmonary valve stenosis and symptoms disappeared in the only patient in this group who was symptomatic. The two patients with complex congenital malformations improved clinically. The procedure was without complication and satisfactory results have been maintained from two to twelve months later.

The procedure offers effective treatment. We believe that pulmonary balloon valvuloplasty should be the initial treatment for isolated severe and moderate pulmonary valve stenosis.
HEPATIC VEIN OCCLUSION (BUDD‐CHIARI SYNDROME): PROBLEMS IN DIAGNOSIS AND MANAGEMENT
Authors: BREEN K. J. , BUTTIGIEG R. , DESMOND P. V. , WHELAN G. , WATSON K. J. R. , GILFORD E.
Published: March 2008

Abstract Seven patients demonstrating the difficulties in diagnosis and management of hepatic vein occlusion are presented. The syndrome may present in an acute form with upper abdominal pain, abdominal swelling, ascites and tender hepatomegaly or in a chronic form, mimicking cirrhotic ascites. The clinical features, predisposing factors, liver scan and liver biopsy may all suggest the condition, but hepatic venography is essential for diagnosis and as a preliminary to treatment. It is suggested that early side to side portacaval anastomosis is the current treatment of choice.
TEN YEAR FOLLOW‐UP OF GASTROINTESTINAL HEMORRHAGE PATIENTS
Authors: DUGGAN J. M.
Published: March 2008

Abstract The mortality and morbidity of the 241 survivors of an acute gastrointestinal hemorrhage treated between 1958 and 1964 are reported. The major purpose of this study was to assess the subsequent risk to life and health of patients presenting with acute upper gastrointestinal bleeding. Patients without dyspepsia and with a negative single contrast barium meal study had an excellent prognosis. Life Table analysis showed that the gastric ulcer patients had a mortality not significantly different from that of the Australian population, with the higher risk of death from ulcer balanced by a lower risk of fatal vascular disease. Duodenal ulcer patients had an increased mortality attributable to a 290% increase in deaths from vascular disease, but only one of the 84 died of an ulcer complication. The association between duodenal ulcer and vascular disease has been present for decades. It is unlikely to be associated with hypertension, diabetes mellitus, diet, stress, or smoking and deserves further study.
DISSEMINATED HISTOPLASMOSIS
Authors: HANKEY G. J. , GULLAND D. L.
Published: March 2008

Abstract The first reported case of disseminated histoplasmosis in Western Australia is described. The diagnosis was delayed because the clinical presentation closely resembled that of tuberculosis, the initial histoplasma serology was negative, and constant severe thrombocytopenia delayed efforts to obtain tissue required for culture and histology. Despite adequate therapy, relapse occurred on one occasion.
BRAIN ABSCESS DUE TO PSEUDOMONAS PSEUDOMALLEI
Authors: LEE M. K. , CHUA C. T.
Published: March 2008

Abstract A brain abscess due to Pseudomonas pseudomallei is presented. Central nervous system involvement in melioidosis is rare and generally occurs in association with disseminated infection. The importance of early diagnosis and prompt treatment with prolonged antibiotic therapy is emphasised.
BARRETT'S ESOPHAGUS: CLINICAL, ENDOSCOPIC, AND HISTOLOGIC SPECTRUM IN FIFTY PATIENTS
Authors: KERLIN P. , D'MELLOW G. , VAN DETH A.
Published: March 2008

Abstract The columnar lined (Barrett's) esophagus is an acquired condition resulting from chronic gastroesophageal reflux. The clinical spectrum of 50 consecutive cases of endoscopically consistent, histologically proven Barrett's esophagus was reviewed. The mean age of patients was 65.9 ± 12.4 (SD) years with only four patients younger than 50 years. The predominant presenting symptoms were dysphagia, heartburn, and regurgitation. At endoscopy, the columnar lined segment extended over 6.5 ± 3.0 cm of the lower esophagus. Specialised columnar (intestinal) epithelium was the most frequent histological type identified. Radiologic or endoscopic evidence of a hiatal hernia was present in the majority. Complications were present at endoscopy in 38 (76%) patients. Reflux esophagitis (56%) was present at the area of the squamo‐columnar junction. Stricture formation (38%) and ulceration (36%) were located either at the squamo‐columnar junction or more distally within the columnar epithelium. Two patients (4%) had adenocarcinoma arising in a segment of Barrett's esophagus at presentation. Treatment included physical measures, dilatation, and cimetidine. Bougienage in 20 patients was successful in alleviating dysphagia but multiple treatment sessions were often necessary. Although esophagitis readily resolved with cimetidine therapy, ulceration was generally resistant to medical therapy. Indeed, by two months, healing was achieved in only five of 12 patients. Endoscopic surveillance of 12 patients who received cimetidine (1 g/day) for at least 12 months showed no regression of the metaplastic mucosa.
COMPARISON OF THE CLINICAL FEATURES AND ILLNESS BEHAVIOUR OF PATIENTS PRESENTING WITH DYSPEPSIA OF UNKNOWN CAUSE (ESSENTIAL DYSPEPSIA) AND ORGANIC DISEASE
Authors: TALLEY N. J. , PIPER D. W.
Published: March 2008

Abstract The aim of this study was to (1) describe the clinical features of patients with chronic unexplained dyspepsia and compare the symptoms with peptic ulcer and biliary pain, and (2) determine the prevalence of symptoms that may indicate psychoneurotic traits and measure chronic illness behaviour (days lost from work and doctor visits). Studied were: 113 patients with essential dyspepsia, defined as endoscopically confirmed non‐ulcer dyspepsia where gallstones, the irritable bowel syndrome and gastro‐esophageal reflux have been excluded and there is no ascertainable cause for the dyspepsia; 55 patients with dyspepsia and peptic ulceration at endoscopy; and 53 patients with diagnosed biliary pain and cholelithiasis, proven at cholecystectomy. All patients completed a detailed structured history questionnaire in the presence of one investigator. More patients with peptic ulcer than with essential dyspepsia experienced night pain, pain relieved by food, and vomiting, while more patients with essential dyspepsia than with cholelithiasis experienced epigastric pain, lack of radiation of pain, continuous pain, mild to moderate pain, pain before meals, pain relieved by food and antacids, pain aggravated by food and alcohol, and an absence of vomiting (all p < 0.01). Symptoms suggesting psychoneurosis, aerophagy symptoms, and chronic illness behaviour were similar in all groups. We conclude that certain symptoms may be of value in diagnosing the underlying cause of dyspepsia.
CONGENITAL LOBAR EMPHYSEMA REQUIRING SURGERY IN ADULT LIFE
Authors: Mcdonald C. F. , Pierce R. J. , Barter C. E. , Chou S. T. , Daniel F. J.
Published: March 2008

We report a case of congenital lobar emphysema requiring surgery in early adult life to relieve respiratory symptoms of fate onset. Regional lung function studies helped to predict the outcome of surgery which was successful in relieving symptoms. (Aust NZ J Med 1986; 16: 501–505.)
NUTRITIONAL STATUS ON ADMISSION TO A GENERAL SURGICAL WARD IN A SYDNEY HOSPITAL
Authors: ZADOR D. A. , TRUSWELL A. S.
Published: March 2008

Abstract To assess the nutritional status of patients on admission to a general surgical ward in a major teaching hospital in Sydney, we examined 84 men and women. We measured, recorded, and/or calculated: history of weight loss, body mass index (BMI), triceps skinfold, arm muscle circumference, hemoglobin, total lymphocyte count, and plasma albumin level. Measurements were graded normal, borderline, or abnormal and patients were considered malnourished if they had two or more abnormal measurements, three or more borderline measurements, or one abnormal and two borderline measurements. Thirty‐one patients (37%) were found to have one or more measurements below the reference range. Twelve patients (14%) were considered malnourished and of this group more than half were of normal weight or overweight. But if indices of overnutrition are included in a definition of malnutrition then a high BMI was the most common abnormal index of nutritional status. Forty‐six patients (55%) had a BMI of greater than 25, that is, were overweight. This single study showed a higher percentage of overnutrition amongst hospital patients than previous work has indicated and secondly that malnourished patients are not necessarily underweight.
AUSTRALIAN HEMOPHILIAC RECIPIENTS OF VOLUNTARY DONOR BLOOD PRODUCTS LONGITUDINALLY EVALUATED FOR AIDS. A CLINICAL AND LABORATORY STUDY, 1983–1986
Authors: GARSIA R. J. , GATENBY P. A. , BASTEN A. , KENNY D. F. , GALLAGHER K. J. , RICKARD K. A. , GUST I. D. , MASKILL W.
Published: March 2008

Abstract One hundred and sixty‐one Australian patients with hereditary bleeding disorders comprising hemophilia A (120), hemophilia B (18), von Willebrand's disease (16), and seven symptomatic female hemophilia A or B carriers were screened for clinical and serological evidence of exposure to HTLV‐IM/LAV/ARV/HIV infection. During the previous five years (1979–1984) they had been treated almost exclusively with blood products derived from Australian voluntary donors.

The prevalence of HTLV‐III antibodies in 1985 was 45%, with the highest frequency being in those with severe hemophilia A (78%) and the lowest in patients with hemophilia B (6%). Antibody positivity correlated with a reduced absolute T helper (T4) cell numbers and/or an inverted T4:T8 ratio. Lymphadenopathy was detected in 23 subjects but only 13 had an abnormal T cell ratio. Comparison of seropositivity and T4:T8 ratios in 32 patients studied in 1983 and again in 1985 suggested that T4 cell deficiency reflected HTLV‐III exposure rather than being a predisposing factor for infection with the virus. Individual patients showed considerable fluctuation in T cell subsets over a 12 month period of follow‐up, but as a population there was a slight trend with time towards diminishing T4:T8 ratio only in the antibody positive hemophilia A patients of mild to moderate severity.

Three (2%) of the 161 patients screened to date have developed confirmed AIDS with fatal outcome. Following the introduction of rigid exclusion criteria for donors and heat treatment of Australian lyophilised concentrates in late 1984, no antibody negative subjects have seroconverted. To date none of 15 regular sexual partners of antibody positive patients have been consistently seropositive and four clinically well, antibody negative babies have been born to antibody positive fathers.
SERUM IgG SUBCLASSES IN PATIENTS WITH AN INCREASED SUSCEPTIBILITY TO RESPIRATORY TRACT INFECTIONS
Authors: FRENCH M. A. H. , HARRISON G.
Published: March 2008

Abstract Serum IgG subclass concentrations were assayed in 45 patients with chronic respiratory tract infections and 16 patients with recurrent acute respiratory tract infections. Eleven of these 61 patients, all but one with recurrent acute infections, were IgA‐deficient but the remainder had normal or high serum immunoglobulin concentrations.

Only 4% of patients with chronic infections were lgG2‐deficient. The prevalence of lgG2 deficiency amongst patients with recurrent acute infections was greater (31%), but in most cases this appeared to be due to an association with IgA deficiency. Owing to the limits of assay sensitivity it was not possible to determine whether any patient was lgG4‐deficient, but the number of sera with undetectable lgG4 was greater in patients with recurrent acute infections than in controls (37.5%vs 10%, p<0.01), although such patients were mainly those with IgA and lgG2 deficiency. None of the patients had IgGl or lgG3 deficiency; in fact lgG3 concentrations were higher than those of controls in both groups of patients (ρ<0.001) and IgGl concentrations were higher than those of controls in patients with recurrent infections (ρ<0.01). Thus, unequivocal IgG subclass deficiency is uncommon in non‐lgA‐deficient patients, but those with lgG2 deficiency may have an immune defect requiring further investigation.