bluuebunny/crossref_metadata_2025 huggingface dataset:
Autoreactive platelet antibody in post transfusion purpura
Authors: Minchinton R. M. , Cunningham I. , Cole‐Sinclair M. , Van der Weyden M. , Vaughan S. , McGrath K. M.
Published: March 2008

Abstract Post transfusion purpura in a DR3, DRw52 positive, P1A1 negative woman rapidly responded to high‐dose intravenous gammaglobulin therapy. Using the platelet immunofluorescence test (PIFT) high titre IgG and IgM alloantibodies were detected in the patient's acute serum. These alloantibodies had P1A1 specificity and the patient's serum produced a broad, 100 kDa band on Western Blot with P1A1 positive platelets. Acute phase serum also contained an IgG antibody which reacted in the PIFT with the patient's own platelets, and P1A1 negative platelets. When tested by Western Blot with P1A1 negative and Glanzmann's Thrombasthenia platelets, the acute serum produced bands at 180 and 200 kDa. The autoreactive antibody was not detected once the platelet count returned to normal. These findings provide evidence for the hypothesis that the mechanism of autologous platelet destruction in PTP is autoimmune.
The gastrointestinal manifestations of AIDS
Authors: Edwards P. , Thompson I. L. , Wodak A. , Penny R. , Cooper D. A.
Published: March 2008

Abstract Gastrointestinal disease in AIDS is common and is due to opportunistic infections, aggressive malignancy and possible direct HIV enteropathy. Disabling gastrointestinal symptoms are prominent both in patients with established AIDS and in patients with earlier stages of HIV infection. We report the cases of 160 patients with AIDS who underwent gastroenterological investigations at St Vincent's Hospital, Sydney, between November 1983 to October 1987. Of these, 127 had the diagnosis of AIDS established prior to referral and 33 patients had the diagnosis of AIDS established as a result of gastroenterological investigations. Diarrhoea and weight loss (88%) were the most frequent reasons for undertaking gastroenterological investigations. Swallowing disorders (47%), abdominal pain (20%), oral and perianal disease (74%) and evidence of hepatobiliary disease were the other major indications for investigation. In 90% of cases there was evidence of concurrent and active gastrointestinal disease at two or more sites within the alimentary tract. Results from this series reveal a wide range of infectious pathogens: viral (Cytomegalovirus, Herpes simplex), bacterial (Mycobacterium avium intracellulare) and parasitic (Crypiosporidium, Isospora belli). Kaposi's sarcoma and non‐Hodgkin's lymphoma were the only malignancies detected in this series. Gastrointestinal disease associated with HIV infection is common, and contributes significantly to its overall morbidity and mortality. Moreover, chronic diarrhoea, weight loss and malnutrition may also contribute to the overall immunodeficiency.
Heterogeneity of adverse hepatic reactions to tetrahydroaminoacridine
Authors: Ames D. J. , Bhathal P. S. , Davies B. M. , Fraser J. R. E. , Gibson P. R. , Roberts S.
Published: March 2008

Abstract Of 14 patients taking tetrahydroaminoacridine (THA) for the trial treatment of Alzheimer's disease, five developed mildly abnormal liver function tests. Four asymptomatic patients with persistently abnormal serum transaminase levels underwent liver biopsy, in order to determine the nature of the hepatic lesions. One subject had granulomatous hepatitis while three showed focal, predominantly centrilobular, liver cell necrosis and mild fatty change. One of the latter showed both tissue and peripheral blood eosinophilia. The liver function tests of the fifth patient, who was symptomatic, became normal after reduction of the dose of THA so he did not undergo biopsy. These findings suggest that the pathogenic mechanisms for THA‐induced liver injury are heterogeneous ranging from hypersensitivity reactions to direct injury, and including combinations of the two. Patients receiving THA for treatment of Alzheimer's disease need regular monitoring of liver function.
The effect of ageing on autonomic nervous system function
Authors: Ingall T. J. , McLeod J. G. , O'Brien P. C.
Published: March 2008

Abstract We studied 76 healthy subjects (five‐85 years) with a number of invasive and non‐invasive tests of autonomie function. Age related effects were found with the tests of predominantly vagal cardiovascular function. However, there were no age related effects found with the tests of predominantly sympathetic cardiovascular function. The age of the subject should be taken into consideration when evaluating tests of autonomic function and each laboratory should establish its own control values.
Cardiovascular reflexes from cardiac sensory receptors
Authors: Ludbrook J.
Published: March 2008

Abstract The mammalian heart, especially its left ventricle, is densely innervated by sensory nerves. One set of these travels to the brainstem in the vagus nerves; the other to the spinal cord in sympathetic nerves. Excitation of vagal cardiac afferents, especially unmyelinated afferents from the left ventricle, cause a reflex bradycardia and fall in blood pressure and, under some conditions, a massive release of AVP. The sympathetic afferents convey the sensation of cardiac pain, but innocuous stimuli may cause a reflex tachycardia and rise in blood pressure.

Both sympathetic and vagal cardiac afferents can be excited by mechanical distension of the heart (mechanoreceptors), and by a variety of foreign and endogenous chemical substances (chemosensitive receptors). It is not yet clear whether the effective natural stimulus to these receptors is mechanical, or through the chemical products of myocardial metabolism. Neither is it clear whether information from the heart exerts a minute‐to‐minute regulatory effect on the circulation, or whether it has a purely defensive role in the face of extreme disturbances of cardiac function.

Cardiogenic reflexes are also thought to be the cause of haemodynamic and humoral disturbances that occur in clinical conditions such as myocardial ischaemia or infarction, left ventricular outflow obstruction, and acute reduction in central blood volume as well as during coronary angiography.
Long‐term nasal CPAP does not ameliorate obstructive sleep apnoea
Authors: Rolfe Isobel , Olson L. G. , Saunders N. A.
Published: March 2008

Fifty‐seven patients with obstructive sleep apnoea (OSA) were treated for at least six months with nasal continuous positive airway pressure (CPAP). At follow‐up, sleep studies were performed in which CPAP was not used for the first half of the night. We compared the severity of OSA at follow‐up without CPAP to the severity of OSA during the patient's initial diagnostic study. Apnoea and hypopnoea index (AHI) fell from 41.4 ± 7.5 (mean ±95% CI) to 34.8 ± 7.9 (p= 0.06 by Wilcoxon test) and minimum oxygen saturation rose from 71.6 ± 3.2 to 78.5 ± 2.6 (p<0.001). Some of this change may have been due to reduced REM sleep in the follow‐up study (10.5±2.1% Total Sleep Time vs 7.4±2.4% TST, p<0.05). Long‐term nasal CPAP was not associated with any reduction of obesity (BMI before CPAP 31.9 ± 1.0, after CPAP 31.7 ± 1.0 (p= 0.39). Systolic arterial pressure fell (before CPAP 143.0 ±4.5 mmHg, after CPAP 136.3 ± 4.6, p < 0.05) but diastolic pressure did not (before CPAP 88.5 ± 3.0 mmHg, after CPAP 85.6 ±2.9 mmHg, p = 0.11). We concluded that the effect of CPAP treatment for six or more months was a small fall in AHI and a small rise in minimum Sa02, but that this would be of marginal clinical significance, and may be artefactual. (Aust NZ J Med 1991; 21: 235–238.)
Reproducibility of synovial fluid examination for crystals
Authors: McGill N. W. , York H. F.
Published: March 2008

Abstract A quality assurance survey of synovial fluid examination for crystals was performed at six teaching hospitals. Aliquots of 12 different fluids (three with no crystals, one with betamethasone crystals, four with calcium pyrophosphate dihydrate (CPPD) crystals and four with monosodium urate monohydrate [urate] crystals) were examined by all six laboratories. Four laboratories performed well (10 or more correct out of 12) but two did poorly (50% or less correct). False positive crystal identification occurred in eight of 72 samples, but all false positive reports were from two laboratories. CPPD and urate crystals were missed in seven of 24 (29%) and five of 24 (21%) samples respectively.

The standard of synovial fluid examination for crystals in Sydney teaching hospitals is not uniform and in some cases appears unsatisfactory.
Painful sciatic neuropathy following cardiac surgery
Authors: Kempster P. , Byrne E. , Gates P. , Wilson A.
Published: March 2008

Abstract Ten patients developed bilateral asymmetrical lower limb sensori‐motor or motor deficits associated with prominent causalgic pain after cardiac surgery. The clinical and electrophysiological abnormalities indicated bilateral proximal sciatic nerve lesions, although in several cases the distinction from a diffuse ischaemic axonopathy was difficult to make. This pattern of post‐cardiac surgery peripheral neurological dysfunction has not been previously described but is likely to relate either to the intra‐operative posturing technique for access to the saphenous veins and/or the upright posture used to nurse patients in the immediate post‐operative period and is in keeping with the previously demonstrated susceptibility of peripheral nerves to pressure palsy during cardiac surgical procedures.
Acute Barmah Forest polyarthritis
Authors: Nash P. , Harrington T.
Published: March 2008

Abstract More than 60 arboviruses have been isolated in Australia with the human pathogenicity of the majority yet to be determined. Recent reports outline extensive clinical and sub‐clinical infection occurring in Eastern Australia by such agents as Ross River and Barmah Forest viruses.2.3 We describe the clinical features of two patients with an acute polyarthritis associated with serological evidence of acute Barmah Forest virus infection to alert physicians to this form of viral polyarthritis and highlight the need to consider this agent when confronted with patients with an acute ‘viral‐type’ polyarthritis in whom serology for Ross River virus is negative.
Fulminant metoclopramide induced neuroleptic malignant syndrome rapidly responsive to intravenous dantrolene
Authors: Henderson A. , Longdon P.
Published: March 2008

Abstract We report a case of fulminant neuroleptic malignant syndrome in a man aged 70 developing within 12 hours of starting six‐hourly intravenous metoclopramide. The muscle rigidity and hyperpyrexia were unresponsive to intravenous benztropine but resolved within one hour of intravenous dantrolene 2 mg/kg. Within six hours the patient had a partial relapse which resolved completely following further intravenous dantrolene 2 mg/kg. This case demonstrates that the rapid effect of intravenous dantrolene can be life saving in fulminant neuroleptic malignant syndrome.
The use of a low molecular weight heparinoid (Org 10172) for extracorporeal procedures in patients with heparin dependent thrombocytopenia and thrombosis
Authors: Rowlings P. A. , Mansberg R. , Rozenberg M. C. , Evans S. , Murray B.
Published: March 2008

We report two cases of heparin induced thrombocytopenia (HIT), in patients who required anticoagulation for extracorporeal procedures (haemodialysis and cardiopulmonary bypass) one associated with recurrent thrombosis of the artificial circuits. Resolution of thrombocytopenia and successful anticoagulation were achieved using a low molecular weight heparinoid (LMWH) Org 10172. Anticoagulation was monitored using estimations of plasma anti‐factor Xa activity.

These cases demonstrate that LMWH provides safe and effective anticoagulation in patients in whom unfractionated heparin has caused HIT.
First and second complete remissions in a HIV positive patient following remission induction therapy for acute non‐lymphoblastic leukaemia
Authors: Mansberg R. , Rowlings P. A. , Yip M‐Y , Rozenberg M. C.
Published: March 2008

A small number of patients positive for the human immunodeficiency virus (HIV) have been reported as developing acute non‐lymphoblastic leukaemia (ANLL) and none has achieved remission despite attempts at treatment.

We report on a 34‐year‐old HIV positive heterosexual intravenous drug user who presented with ANLL (FAB classification M5, Monoblastic) and entered remission following one cycle of cytosine arabinoside and daunorubicin according to the 7‐3 protocol of the Australian Leukaemia Study Group (ALSG). This was followed by consolidation of 5‐2 as per ALSG and one cycle of maintenance with low dose cytosine arabinoside. Ten months after remission, he relapsed but achieved a second remission with the ALSG 7‐3‐7 protocol (7‐3 plus etoposide) followed by consolidation with 5‐2‐5. He remained HIV positive but showed little progression towards the acquired immunodeficiency syndrome despite the intense immunosuppression. The duration of his second remission was five months. The patient died of septicaemia during the third attempt at remission induction 18 months after diagnosis.

We conclude that HIV seropositivity is not an absolute contraindication to aggressive chemotherapy in those patients who develop ANLL.
Standardised initial warfarin treatment: evaluation of initial treatment response and maintenance dose prediction by randomised trial, and risk factors for an excessive warfarin response
Authors: Doecke C. J. , Cosh D. G. , Gallus A. S.
Published: March 2008

We report a comparison of warfarin treatment outcomes in 172 inpatients in two general hospitals randomly assigned to commence warfarin therapy by one of two methods; the first where warfarin dosage was determined using a flexible dose induction protocol, and the other where dosage was prescribed empirically by resident medical staff.

The mean INR for each treatment day, the mean time to reach a therapeutic level of INR, the mean maintenance dose and the mean time to reach maintenance dose were not significantly different between the protocol and empirical treatment groups. Although the mean observations of warfarin effect were similar between the two groups, there were more patients with excessive warfarin effect (INR > 4.0) during empirical treatment. In addition, age and identified complicating factors such as interfering drugs, heart failure or alcohol abuse were significant predictors of excessive warfarin effect, regardless of treatment group. The protocol dose administered on day 4 of treatment, which has been used as a determinant of maintenance dose, predicted maintenance dose to within lmg in 57/83 patients (69%, 95% confidence interval: 59–79%).

We conclude that as a method for safely and effectively initiating warfarin therapy, this protocol at least matches the empirical prescribing skills of medical staff in a teaching hospital.
Pulmonary infiltrates and eosinophilia associated with sulphasalazine administration
Authors: Panayiotou B.N.
Published: March 2008

A case of blood eosinophilia with pulmonary infiltrates associated with sulphasalazine therapy in a patient with ulcerative colitis is described. These manifestations resolved when sulphasalazine was ceased and recurred with rechallenge. The failure of recurrence after treatment with mesalazine (5‐aminosalicylic acid in a sustained release preparation) suggests that sulphapyridine is the component responsible for this reaction.
Can the response to interferon treatment be predicted in patients with chronic active hepatitis C?
Authors: Lin R. , Schoeman M. N. , Craig P. I. , Bilous M. , Grierson J. , McDonald J. A. , Batey R. G. , Farrell G. C.
Published: March 2008

Twenty‐one of 40 patients with chronic non‐A, non‐B hepatitis (37 anti‐HCV positive) were randomised to receive interferon α2b (3 million units subcutaneously thrice weekly for 24 weeks) and then to be observed for six months. Among the other 19 patients (controls) randomised to be observed without treatment for 12 months, eight have subsequently been treated with interferon for six months. One treated patient and three controls were lost to follow‐up. A return to normal serum alanine aminotransferase levels which lasted until the end of the treatment period occurred in 18 (64%) of the 28 patients given interferon (and in 13 of 21 (62%) randomised to treatment), but only in one of the 16 untreated controls (p < 0.001). Multivariant analysis indicated that, compared with the ten nonresponders, the 18 patients who responded to interferon were more likely to have acquired infection by intravenous drug abuse than by blood transfusion (p < 0.05), and were more likely to have histologically less severe chronic liver disease (p < 0.01). Thus, all 13 patients with less severe liver disease histologically responded to interferon, but only five of 15 patients with cirrhosis or bridging fibrosis responded. Among 17 responders followed for more than four months, five (28%) are still in remission a median of 13 months (range four months to 24 months) after stopping interferon. The characteristics which favoured a response during treatment also appeared to distinguish those who experienced sustained post‐treatment remission. Thus, five of 12 patients with less severe chronic hepatitis C histologically appear to have a sustained remission of disease activity after treatment for six months with interferon, whereas none of five patients with cirrhosis or bridging fibrosis has had a sustained remission after interferon treatment. It is proposed that continued treatment with interferon may be required for long‐term suppression of chronic active hepatitis C among patients with bridging fibrosis or cirrhosis, but one course of interferon may provide a lasting response in 40% of patients with less severe disease.
Left ventricular energy in mitral regulation: a preliminary report
Authors: MacIsaac Andrew L. , McDonald G. , Kirsner Richard C.G. , Graham Sandra A. , Tanzer Dindne
Published: March 2008

Energy exchange based on Newtonian principles is the‐most appropriate way to express the function of any pump ‐ including the heart. Using information obtained at cardiac catheterisation, we have measured the total work energy (ET) of the left ventricle (LV) (mean 1.63 J) in patients with severe mitral regurgitation (mean regurgitant fraction 0.66). ET was approximately‐84% above normal. Of the regurgitant energy (RE)(mean 0.95 J), on average, ¾ (73.6%)was‐kinetic (KE) and ¼ (23‐4%) potential (PE). Both components represent wasted LV energy, the Kinetic energy associated with the lost as heat, the potential energy responsible for a fix in Left Atrial (LA) pressure. The‐amount of PE as a percentage of total regurgitant Energy (RE) varied considerably from, one patient to another (10.5% to 54.4%) Hence, colour flow mapping which detects‐only KE of turbulent jet flow must underestimate LV energy loss and, because of patient to patient variation, cannot consistently reflect severity of regurgitation. Measurements of PE correlate well with wedge P‐wave height. Corresponding non‐invasive estimates were made using sphygmodynamometer‐calibrated indirect carotid pulse tracings and echocardiographic measurements. These were not significantly different from the invasive measurements. Unfortunately, the calculation of PE is indirect and invlves subtraction, so that measurements for individual patients were not accurate enough, for clinical use. Paxt of the non‐invasive calculation involved an estimate of left atrial pressure based on the blood pressure measurement and Doppler velocity of regurgitation; this should be a useful measurement in itself. Measurement of ET, an index of both volume and pressure overload (reflecting peripheral resistance changes), should be tested in serial studies as a predictor of left ventricular‐failure in severe mitral regurgitation. Non‐invasive measurements would be useful to follow patients with acute severe mural regurgitation: Non‐invasive PE measurements are currently not reliable enough but an indirect measurement of left atrial pressure would be very useful.
Lowering cholesterol: effects on trauma death, cancer death and total mortality
Authors: MacMahon Stephen
Published: March 2008

Randomised trials of cholesterol reduction (26 trials, 50 000 patients, net cholesterol reduction ∼10%) have demonstrated a clear reduction in the incidence of coronary heart disease (CHD) after just a few years of treatment. Overall, the reduction in CHD death was only half as large as the reduction in non‐fatal myocardial infarction (MI), although both were statistically significant (2P < 0.005). In these trials, 60% of all deaths were from CHD, and since treatment reduced these by about 10%, the expected reduction in total deaths was about 6%. This expected reduction falls within the 95% confidence interval of the observed effect of cholesterol reduction on total mortality in these trials. There were small excesses of deaths from cancer and deaths from trauma among patients allocated active treatment. However, in no single trial, nor in the trials collectively, were these increases statistically significant. Furthermore, the increases did not appear to be specific to any one agent nor were the increases consistent between trials of the same agent. These observations are consistent with the hypothesis that the small excesses of cancer and trauma deaths observed in the cholesterol reduction trials occurred by chance.
RSI revisited: evidence for psychological and physiological differences from an age, sex and occupation matched control group
Authors: Helme R. D. , LeVasseur S. A. , Gibson S. J.
Published: March 2008

The present study sought to examine psychological characteristics and function of primary afferent nociceptive mechanisms, as indexed by capsaicin‐induced flare responses, in subjects suffering from RSI (n = 72) and in pain free control volunteers (n=69). After completing a battery of psychological tests including the McGill Pain Questionnaire, Visual Analogue Scale and Word Descriptor Scale for pain, the Profile of Mood States, Illness Behaviour Questionnaire and Multidimensional Health Locus of Control, the neurogenic flare response was assessed on the right and left forearms and across the trapezius at the shoulder. When compared to controls RSI subjects displayed higher levels of mood disturbance and some abnormal patterns of illness behaviour. A reduction in flare size was observed in the pain affected limb of RSI subjects, but an increased response occurred in sites reported as unaffected by clinical pain. Multiple regression analysis revealed that the severity of clinical pain was strongly associated with the magnitude of reduction in flare size. Collectively, these findings provide objective evidence of altered nociceptor mechanisms in RSI subjects, and are consistent with the view that this chronic pain syndrome involves somatic pathophysiology. However, a strong conviction regarding the somatic basis of their symptoms, and a denial of psychological factors may have contributed to the more severe affective disturbance and greater subjective emphasis on the presence of pain. (Aust NZ J Med 1992; 22: 23–29.)
Current concepts on monoclonal gammopathies
Authors: Kyle R. A.
Published: March 2008

This is a review of the monoclonal gammopathies, including a discussion of cause. The role of T lymphocytes and B lymphocytes is presented. The recognition of a monoclonal protein in the serum and urine is presented in detail.

The frequency of benign and malignant monoclonal gammopathies is provided. A long‐term follow‐up of 241 patients with apparently benign monoclonal gammopathy is examined closely. In this series, multiple myeloma, macroglobulinaemia, amyloidosis, or related disorders developed in 22% of the 241 patients with long‐term disease. The median duration from the recognition of the monoclonal protein until the development of serious disease was approximately eight to ten years.

The differentiation of benign from malignant monoclonal gammopathics is examinad in detail. The point is made that paticnu must be folld indefinitely because malignancy may develop more than 20 years later. The association of monoclonal gammopathies with other apparently unrelated diseases discussed. (Aust NZ J Med 1992; 22: 291–302.)
Culture‐positive tuberculosis in Western Australia
Authors: Pang S. C. , Clayton A. S. , Harrison R. H.
Published: March 2008

Notifications of 485 patients with culture‐positive tuberculosis (TB) in Western Australia from 1980 to 1989 inclusive have been analysed. In 478 (98.6%) the disease was caused by Mycobacterium tuberculosis hominis and in seven (1.4%) M. bovis. Most (78.5%) of the disease was pulmonary with 4.3% pleural and 17.2% extrapulmonary. The annual incidence decreased from 4.6 per 100 000 in 1980 to 2.5 in 1985 steadying thereafter around 3.3. The Aborigines had over four times the average incidence of the non‐Aboriginal Australians but less than a quarter that of the Asians. In a total 297 migrants, 51% of 253 with data available had been in Australia for over five years. Initial drug resistance was found in 48 patients giving an overall rate of 9.9%. In 32 (66.7%), resistance was against a single drug, mainly isoniazid and in 11 (22.9%) against two drugs, predominantly isoniazid and streptomycin. The most disturbing finding was the occurrence of multiple‐drug resistance including both isoniazid and rifampicin in five immigrants (10.4%). This study has provided useful baseline TB data, raised important issues such as chemoprophylaxis and drug resistance, and clearly indicates that the campaign against TB is far from over. Continual surveillance, monitoring and regular evaluation of existing policies should be maintained. (Aust NZ J Med 1992; 22: 109–113.)
Death certification and coding for ischaemic heart disease in Tasmania
Authors: Sexton P. T. , Jamrozik K. , Walsh J. M.
Published: March 2008

Official records show that the rates of mortality from ischaemic heart disease (IHD) in Tasmania have been the highest of all the Australian states for most of the past decade. This study assesses the accuracy of the official Tasmanian mortality data for IHD in 1987 and 1988 for males aged 25 to 74 years using routinely available clinical and pathological data supplemented by information from the attending doctor. Our findings show that a death officially coded to ICD 9 rubrics 410–414 (IHD) in Tasmania has 94% sensitivity and a positive predictive value of 90% for fatal definite acute myocardial infarction or possible coronary death as defined by the WHO. Comparison of our results with those of two earlier studies undertaken in Australian mainland centres indicates that differences in the official statistics for coronary mortality between Tasmania and the mainland states reflect true differences in the risk of coronary death. While the results from three Australian studies suggest that the routine system of death certification is reasonably accurate, careful monitoring of death certification and coding practices need to be undertaken regularly in all states of Australia if secular changes in regional patterns of coronary mortality are to be regarded as credible. (Aust NZ J Med 1992; 22: 114–118.)
Complications and failure of anticoagulation therapy in the treatment of venous thromboembolism in patients with disseminated malignancy
Authors: Chan A. , Woodruff R. K.
Published: March 2008

Thirty‐one patients with malignancy, anticoagulated for the treatment of venous thromboembolism (VTE) are reported. Complications of treatment included major bleeding (35%), redevelopment of VTE whilst on therapeutic levels of anticoagulants (13%) and recurrent VTE following cessation of anticoagulant (42%). Forty‐two per cent of patients died within three months of initiating anticoagulant therapy. The cause of death was progressive malignancy, except in one patient who died of anticoagulant‐related bleeding. The high incidence of bleeding is frequently associated with over‐anticoagulation and indicates the need for improved monitoring. The frequent recurrence of VTE is associated with chronic disseminated intravascular coagulation, for which warfarin is ineffective and heparin is indicated. (Aust NZ J Med 1992; 22: 119–122.)
Thyroid involvement in multiple myeloma
Authors: Patel R. , Bayliss E. , Trotter J.
Published: March 2008

Involvement of the thyroid gland by plasma cell neoplasms is a rare occurrence. Two modes of presentation are described; firstly as part of disseminated myeloma and secondly, as an isolated plasma cell neoplasm of the thyroid as the only evidence of disease. We wish to describe two cases of thyroid involvement as part of disseminated disease. (Aust NZ J Med 1992; 22: 139–141.)
Preventing the medical sequelae of alcohol abuse
Authors: Batey ROBERT G.
Published: March 2008

Excessive alcohol use is responsible for a significant amount of medical harm in the Australian community. It is not appropriate to suggest that alcohol use should be eliminated but it is important that we take steps to minimise harm produced by intake of inappropriate amounts ? of this drug. Many alcohol related problems are irreversible once established and thus it is imperative that information be made available to the public and to health care workers to help minimise problems before they become permanently established. It is suggested that harm niay be minimised by a number of strategies that include measures to:

1. Prevent the desire or need to drink excessively.

2. Prevent the ingestion of excessive amounts of alcohol.

3. Prevent the effects of excessive intake by protecting susceptible tissues.

4. Treating tissue damage early to prevent progressive injury.

Early detection and intervention must play an increasing role in any attempt to minimise alcohol related problems. (Aust NZ J Med 1992; 22: 214–219.)
Clinical aspects of malignant mesothelioma in Australia
Authors: Driscoll T. R. , Thompson R. , Baker G. J. , Ferguson D. A. , Daniels S. , Leigh J. , Lee J.
Published: March 2008

Australia is currently experiencing an epidemic of malignant mesothelioma. The clinical aspects of malignant mesothelioma were investigated in 295 Australian patients as part of a national study of the disease. Most patients were male (91%), with the mean age at diagnosis being 64 years. The predominant cell type was epithelial (38%) and the majority of primary tumours arose from the pleura (94%). Mean survival was poor (17.6 months from first symptom; 11.8 months from diagnosis). Patients with a pleural primary tumour were more likely to present with dyspnoea, chest pain and cough; to have a pleural effusion diagnosed radiologically; and to have metastatic spread. Patients with a peritoneal primary tumour were more likely to present with weight loss, loss of appetite, abdominal pain and ascites; to have radiologic evidence of asbestos exposure; and to have spread along a needle track created during a diagnostic tap. A minority of patients had past thoracic conditions, or radiologic findings, specifically related to previous asbestos exposure. About one fifth of patients had no known asbestos exposure. Forty‐one per cent of subjects received some form of chemotherapy, radiotherapy and/or surgery, but no formal disease staging had been documented for any patient. Proper controlled trials of secondary and tertiary treatments in malignant mesothelioma are now needed. (Aust NZ J Med 1993; 23: 19–25.)
Trial of an intervention to reduce chronic benzodiazepine use among residents of aged‐care accommodation
Authors: Gilbert A. , Innes J. M. , Owen N. , Sansom L.
Published: March 2008

Abstract Background: Many residents of aged‐care accommodation are chronic users of benzodiazepines. This pattern of use contradicts current guidelines and may adversely affect residents. It was hypothesised that a lasting reduction in benzodiazepine use could be achieved through a programme which involved prescribers, residents and caregivers in the change process.

Aim: To demonstrate that an intervention which involved education and relaxation training for patients, and education of prescribers and caregivers, could reduce levels of chronic benzodiazepine use among residents of an aged‐care facility.

Methods: Two aged‐care facilities from metropolitan Adelaide were chosen; one received the intervention, the other was a no‐intervention comparison. Pre‐test, post‐test and follow‐up interviews were conducted with 60 residents: 27 from the intervention setting and 33 from the comparison setting. Residents at the intervention setting were provided with relaxation skills training, and their medical practitioners and caregivers were provided with information about alternative strategies for managing sleep disturbance. Outcome measures were: the proportion of residents using benzodiazepines, total medication use, cognitive performance, emotional responsiveness, subjective health and sleep ratings and an index of well‐being.

Results: The proportion of participants in the intervention condition who used benzodiazepines declined significantly (from 70% to 35%); the reduction was maintained over the subsequent three months. No adverse consequences were associated with cessation of benzodiazepine use; there was improvement in emotional responsiveness among those who ceased benzodiazepine use. This structured intervention strategy is a useful approach for reducing levels of chronic benzodiazepine use among residents of aged‐care accommodation.
Retention and survival of hostel residents – a 12 year study
Authors: Lefroy R. B. , Hobbs M. S. T. , Hyndman J.
Published: March 2008

Abstract Background: The admission of a proportion of disabled people to hostels is inevitably followed by their transfer to nursing homes. Our hypothesis was that such admissions are justified in terms of quality of life and the cost to the community, notwithstanding the necessity of subsequent transfer.

Aims: To test this hypothesis by measuring the retention and survival times of residents in hostel and in nursing home; to consider the relevance of these factors to the future policy of the two institutions.

Methods: A retrospective study was made of 159 residents admitted over a period of 12 years to a hostel with 32 places. Times spent in the hostel and in the nursing home were recorded. Probabilities of survival in hostel and in nursing home were calculated according to the Kaplan‐Meier method. Comparison with the expected survival of a matched cohort of the total population was determined. Estimation was made, using the SAS software package, of the likely number of places needed in nursing homes for residents following transfer.

Results: Although the majority of hostel residents eventually needed nursing home care, a worthwhile proportion of their total institutional time (approximately two‐thirds) was spent in the hostel. Ongoing support from the personnel in a geriatric service is likely to increase retention time in the hostel. Because of the ultimate outcome for the majority of residents, planning for hostel care should include consideration of places needed in nursing homes.
Trends in the terminal care of cancer patients: South Australia, 1981–1990
Authors: Hunt R. , Bonett A. , Roder David
Published: March 2008

Background:
The increasing numbers of cancer patients, the high costs of terminal care, and the development of palliative care services have led to a growing interest in patterns of terminal cancer care. These patterns are relevant to the formulation and evaluation of health services policy.

Aims:
To investigate trends in the place of death of South Australian cancer patients between 1981 and 1990, and to examine associations of socio‐demographic and clinical variables with the place of death.

Methods:
Data relating to 2715 deaths attributed to cancer in 1990 were extracted from the Central Cancer Registry. To assess trends, these data were directly standardised to the age‐sex distribution of cancer deaths in 1981 and 1985 which were investigated in a previous study. Unconditional logistic regression was used to investigate predictors of place of death.

Results:
The proportion of deaths which occurred in major metropolitan public hospitals decreased from 40% in 1981 to 28% in 1990. Conversely, the proportion which occurred in hospice units increased from 5% to 20% over the same period. There was a decline in the proportion of deaths which occurred in private hospitals, but there was no significant change in the proportion which occurred in country hospitals or nursing homes. The proportion of deaths at home remained around 14%. Associated with place of death were age, sex, type of malignancy, survival time from diagnosis to death, Aboriginality, and area of residence. Further research to assess the clinical appropriateness of terminal care patterns is suggested. (Aust NZ J Med 1993; 23: 245–251.)
Systemic lupus erythematosus in Australian Aborigines: high prevalence, morbidity and mortality
Authors: Anstey N. M. , Bastian I. , Dunckley H. , Currie B. J.
Published: March 2008

Background: Racial differences occur in the incidence of systemic lupus erythematosus (SLE). It has been suggested that SLE occurs at a higher prevalence and with greater severity in Aboriginal Australians, but because of the small, widely distributed population base, this has not been well documented.

Aims: To confirm and document the clinical impression of an increased prevalence and severity of systemic lupus erythematosus (SLE) in Aboriginal Australians, and to identify prognostic indicators.

Methods: Top End Northern Territory (NT) Aborigines with SLE on 1 January 1984 or diagnosed thereafter were followed until 1 January 1991. Epidemiological, clinical and serological data were collected.

Results: Prevalence on 1 January 1991 estimated at 1:1900, at least twice the estimated prevalence in non‐Aboriginal Australians. High frequencies of renal disease (62% with proteinuria > 0.5 g/day) and autoantibodies to the Sm antigen (29%) were identified, contributing to the high mortality. Five year survival rate was 60%, with 67% of deaths resulting from infection.

Conclusions: There is a high prevalence of SLE in NT Aborigines. In view of probable under‐recognition of mild cases the true prevalence is likely to be even higher. Although morbidity and mortality may have been overestimated for the same reason, both were found to be high. Improved living conditions and health care delivery may improve prognosis. (Aust NZ J Med 1993; 23: 646–651.)
Computerised tomography does not predict N2 disease in patients with lung cancer
Authors: Cole P. H. , Roszkowski A. , Firouz‐Abadi A. , Dare A.
Published: March 2008

Background: Mediastinal node involvement in primary lung cancer determines the staging and prognosis of the patient, and as these nodes can be seen on the computerised tomography (CT) scan of the chest it is a temptation to diagnose malignant involvement if the nodes appear enlarged. However, initial experience with mediastinal node mapping at lung resection demonstrated this extrapolation to be unreliable and misinterpretation of enlarged nodes on CT may lead to misdiagnosis and prejudice the patient's management.

Aim: To demonstrate that the sensitivity, specificity, and accuracy of the CT to detect malignant mediastinal nodes is too low to use size of node on CT as representative of malignant involvement.

Methods: One hundred and fifty‐three sequential patients with resectable lung cancer were studied with preoperative CT. Two radiologists determined the preoperative T and N status from these studies with nodes of 1.5 cm or larger diagnosed abnormal. These results were compared to the results of subsequent node mapping performed after lung resection.

Results: Sensitivity was found to be 26% specificity to be 81% and overall accuracy 69%– too low to justify the diagnosis of N2 disease on size of 1.5 cm or larger. CT is not a valid means of diagnosing malignant involvement of mediastinal nodes. (Aust NZ J Med 1993; 23: 688–691.)
Issues raised by GUSTO
Authors: White Harvey
Published: March 2008

The GUSTO trial raises several questions including the role of heparin in thrombolysis. The need for intravenous versus subcutaneous heparin with streptokinase (SK) has not been clarified in this trial. It is more likely that the superiority of tissue plasminogen activator (t‐PA) was due to its accelerated administration rather than the accompanying heparin. Despite the improvement in survival, much is still to be achieved in obtaining optimal reper‐fusion rates. (Aust NZ J Med 1993; 23: 739–741.)
Post thrombolysis management
Authors: Harris Phillip
Published: March 2008

Strategies for the evaluation of the post infarction patient need revision in the light of recent findings from thrombolytic trials, and the availability of more effective methods for detecting myocardial viability. A strategy based on determining the risk of re‐occlusion from vessel anatomy at coronary angiography and determining the area of myocardium at risk based on sequential analysis of ST segment elevation is discussed. (Aust NZ J Med 1993; 23: 760–762.)
Sclerosing cholangitis in children with inflammatory bowel disease
Authors: Ong J. C. , O'Loughlin E. V. , Kamath K. R. , Dorney S. F. A. , de Silva M. , Gaskin K. J.
Published: March 2008

Background: Primary sclerosing cholangitis (PSC) with inflammatory bowel disease (IBD) has been rarely reported in children.

Aim: To describe the clinical presentation, sequential liver function test abnormalities, radiological bile duct anomalies and liver histology in four children with PSC and IBD.

Methods: Over a period of 18 years, four of 130 patients with IBD developed abnormal liver function tests. Three of the four patients had ulcerative colitis and the other Crohn's disease. All four patients had baseline and follow‐up liver function tests, percutaneous transhepatic cholangiography and a needle biopsy of the liver.

Results: The four patients at presentation had minimal symptoms or signs of liver disease. All had elevation of serum transaminases, gamma glutamyl transferase and/or alkaline phosphatase. Three had the typical onion skin fibrosis of bile ducts. Percutaneous transhepatic cholangiography demonstrated irregularity and beading of the hepatic and common bile ducts in three patients. The other with normal cholangiography had fibrosing cholangitis on liver biopsy and was considered to have small duct disease.

Conclusions: We conclude that yearly biochemical assessment of liver function should be performed on all children with IBD, and if abnormal should raise the suspicion of PSC. The latter diagnosis can be confirmed by liver biopsy and cholangiography.
Diagnostic laparoscopy and liver disease: experience of 200 cases
Authors: Crantock L. R. F. , Dillon J. F. , Hayes P. C.
Published: March 2008

Background: Laparoscopy is an old technique that is frequently used by gastroenterologists in America and Germany. With modern equipment it is now possible to perform this technique under local anaesthesia.

Aim: To evaluate the usefulness and safety of laparoscopic liver biopsy.

Methods: Liver biopsy was routinely performed by laparoscopy under local anaesthetic and sedation. A standard 5 mm laparoscope was used and a pneumoperitoneum induced with nitrous oxide.

Results: Two hundred consecutive patients were laporoscoped and underwent liver biopsy. In five patients the liver could not be visualised due to adhesions. Two patients had bleeds related to the procedure. Twenty‐five patients had malignancy diagnosed by guided biopsy. Eight of these had been missed by ultrasound prior to paparoscopy. Cirrhosis was diagnosed laparoscopically in 72 patients. Histology was unable to confirm this diagnosis in four patients.

Conclusion: Laparoscopy can be performed safely and comfortably on patients with local anaesthetic and sedation. The visualisation of the liver can add valuable information to liver biopsy.
Idiopathic right ventricular tachycardia: electrophysiology and response to catheter ablation
Authors: Kuchar D. L. , West P. , Thorburn C.
Published: March 2008

Background: Ventricular tachycardia (VT) originating in the right ventricle may be seen in the absence of structural heart disease. Although this is thought to be associated with a benign course, it may cause intolerable symptoms and be difficult to control with antiarrhythmic drugs.

Aims: To assess the value of radiofrequency ablation of right ventricular tachycardia and to characterise the clinical and electrophysiologic features predictive of successful ablation.

Methods: Nine patients (aged 20–49 years) with clinical VT underwent cardiac map ing which were identified in these patients. Ablation of VT was defined as suppression of VT at the time of hospital discharge.

Results: Five patients had successful ablation of the tachycardia focus with long term suppression of the arrhythmia. Patients with successful ablation were characterised by inability to induce VT with extrastimuli, a distinct VT morphology with a rS pattern in lead 1, right axis deviation, facilitation of VT with isoprenaline and site of origin in the lateral outflow tract. During VT, an earlier site of presystolic activation was found in successful patients compared with unsuccessful ablations. Right ventricular tachycardia in patients without structural heart disease is a heterogeneous disorder with varied clinical and electrophysiologic features. Successful ablation ofVT may be predicted by consideration of these variables.
Cholesterol and cardiovascular disease: basic science
Authors: Barter Philip
Published: March 2008

Cholesterol is a normal constituent of blood plasma and of cell membranes in every tissue of the body. It is transported in plasma as a component of lipoproteins. Increased concentrations of specific lipoprotein fractions, namely low density lipoproteins (LDL) and intermediate density lipoproteins (IDL), have been implicated both in vitro and in vivo as causes of atherosclerosis. The mechanism by which these lipoproteins initiate atherosclerosis is unknown, although there is growing evidence that it involves interactions between lipoproteins and cells within the artery wall, setting in train complex reactions which lead ultimately to the fully developed lesion.
Cholesterol and non‐cardiovascular disease: basic science
Authors: Sullivan David
Published: March 2008

Cholesterol metabolism is of fundamental biological importance. This review examines the role of cholesterol metabolism in relation to non‐cardiovascular disease (non‐CVD). Particular attention is paid to the question of whether or not low levels of cholesterol may have harmful effects on cell function or lead to pathological processes. Many in vitro phenomena have been demonstrated at levels of cholesterol which are very low in comparison to physiological conditions. Nevertheless, low cholesterol is more favourable than high cholesterol for most aspects of cell function. There is no evidence that any catastrophic cellular response or pathological process occurs due to exposure of organisms to low cholesterol. On the other hand, the inflammatory process is a powerful and consistent cause of decreased cholesterol levels. This, together with other confounding factors, appears to explain a major component of the association between low cholesterol levels and non‐CVD.