bluuebunny/crossref_metadata_2025 huggingface dataset:
ANTICOAGULANTS AND CEREBRAL VENOUS THROMBOSIS
Authors: HALPERN J. P. , MORRIS J. G. L. , DRISCOLL G. L.
Published: March 2008

Three patients with cerebral venous thrombosis are described. The management of this rare condition is discussed and a case is made for using anticoagulant therapy provided the diagnosis is established before cerebral infarction or hemorrhage have occurred.
ARTICULAR CHONDROCALCINOSIS IN A HOSPITAL POPULATION: AN AUSTRALIAN EXPERIENCE
Authors: GORDON T. P. , SMITH M. , EBERT B. , McCREDIE M. , BROOKS P. M.
Published: March 2008

A group of hospital patients aged 55 years or over (53 men, 74 women) were screened for articular chondrocalcinosis (ACC) with high‐resolution radiographs of knees, wrists, hands and pelvis. Two men (4%) aged 79 and 86 years had ACC involving knees, wrists and symphysis pubis. Both had clinical joint disease and radiological osteoarthritis (OA). Eighteen women (24%) had ACC with sites affected including the knees (89%), wrists (39%) and symphysis pubis (44%). Metabolic screening did not reveal any predisposing factors in patients with ACC. Symptoms and signs of joint disease were not significantly more common in women with ACC compared to those without ACC, and 44% of those with knee calcification were clinically asymptomatic and had no evidence of OA radiologically. However, the presence of knee ACC significantly increased the risk for OA in the same knee by a factor of three‐to‐four while knee calcification was associated with the more severe grades of radiographic OA.
IRON OVERLOAD ASSOCIATED WITH CONGENITAL PYRUVATE KINASE DEFICIENCY AND HIGH DOSE ASCORBIC ACID INGESTION
Authors: ROWBOTHAM B. , ROESER H. P.
Published: March 2008

Iron overload is an uncommon complication of untransfused chronic hemolytic anemias. This paper describes only the fourth reported case of erythrocyte pyruvate kinase deficiency and iron overload. Important aspects of this case are the presence of the HLA genotype commonly associated with genetic (idiopathic) hemochromatosis and a history of ingestion of large doses of ascorbic acid. Their roles in the development of iron loading and toxicity are discussed.

A beneficial response to treatment with desferrioxamine was observed before significant iron removal. A mechanism for this action of desferrioxamine is proposed.
ZINC ABNORMALITIES IN FULMINANT HEPATIC FAILURE
Authors: CANALESE J. , POSTON L. , SEWELL R. B. , WILLIAMS R.
Published: March 2008

Abstract: :Zinc is an important trace metal and, in liver disease, abnormal zinc metabolism has been reported. In this study of patients with fulminant hepatic failure progressing to grade IV encephalopathy, plasma zinc concentrations fell during the illness to reach levels significantly below normal; during this time urinary zinc excretion was markedly elevated.
COMPARISON OF NETILMICIN WITH CEFOPERAZONE FOR THE TREATMENT OF SEVERE OR COMPLICATED URINARY TRACT INFECTIONS
Authors: BAILEY R. R. , LYNN K. L. , PEDDIE B. A. , SWAINSON C. P.
Published: March 2008

Abstract: :A randomised trial was undertaken to compare the efficacy and safety of netilmicin and cefoperazone for the treatment of severe or complicated urinary tract infections. Thirty‐two patients completed the study. Fifteen of 16 patients treated with netilmicin and nine of 16 treated with cefoperazone were cured. This difference was statistically significant (p = 0.037). No serious side effects or toxicity occurred with either drug, although five patients developed diarrhea after treatment with cefoperazone. (Aust NZ J Med 1985; 15: 22–26.)
ATRIAL TACHYARRHYTHMIAS AFTER CARDIAC SURGERY: RESULTS OF DISOPYRAMIDE THERAPY
Authors: GAVAGHAN T. P. , CAMPBELL T. J. , FENELEY M. P. , MORGAN J. J.
Published: March 2008

Abstract: :Of 1,247 consecutive patients who underwent cardiac surgery, 297 (24%) developed a post‐operative atrial tachyarrhythmia. Of these patients, 201 were suitable for treatment according to the study protocol. All patients were initially given digoxin 0.75 mg intravenously (i.v.). After two hours, those 156 patients whose atrial arrhythmias persisted were given a 2 mg/kg loading dose of disopyramide (i.v.), followed by a constant i.v. infusion (0.4 mg kg‐1 tr1) or oral therapy (600 mg daily). Within a further 12 hours, 75 patients (48%) reverted to sinus rhythm, 24 within one hour. Thus 120/201 patients (60%) reverted to sinus rhythm within 14 hours of commencing therapy. Reversion rates of those patients with both atrial fibrillation and flutter (AF/AFL) were significantly lower than those with AF (p<0.001) or AFL (p<0.02) alone. A further 70 patients reverted to sinus rhythm in one to 13 (mean four) days on continued drug therapy. Elective cardioversion restored sinus rhythm in six subjects. Atrial arrhythmias persisted in five patients (2.5%) at hospital discharge. Side‐effects of disopyramide were noted in 19% of patients. Urinary retention was common (11.5%). Four patients with atrial flutter developed 1:1 atrioventricular conduction with the disopyramide loading dose. One patient with atrial fibrillation developed ventricular tachycardia during injection of the loading dose of disopyramide, but was successfully cardioverted to sinus rhythm. Two further patients developed significant hypotension (< 90 mmHg systolic). Disopyramide is effective in the treatment of post‐operative atrial tachyarrhythmias, but its routine use in this situation may be associated with an unacceptably high incidence of side‐effects.
INFANTILE COMPLETE HEART BLOCK ASSOCIATED WITH MATERNAL Ro(SS‐A) RIBONUCLEOPROTEIN AUTOANTIBODIES: REPORT OF TWO CASES
Authors: EPSTEIN R. J. , McNEILAGE L. J. , GATENBY P. A. , HENDERSON‐SMART D. J. , WHITTINGHAM S. F. , BASTEN A.
Published: March 2008

Abstract: :Two cases of congenital complete heart block arising during pregnancy were observed in association with a circulating maternal autoantibody to the soluble ribonucleoprotein Ro(SS‐A). Neither mother had clinical evidence of Sjogren's syndrome or systemic lupus erythematosus usually associated with anti‐Ro. However, both had a previous history of first‐trimester abortion and laboratory evidence of autoimmunity, and one gave a history of sialadenitis. Maternal anti‐Ro antibodies may be predictive of infantile heart block when present in pregnant women with overt or suspected multisystem autoimmune disease.
UNUSUAL TRANSFORMATIONS OF RENAL INVOLVEMENT IN SYSTEMIC LUPUS ERYTHEMATOSUS
Authors: YEUNG C. K. , CHAN M. K. , WONG K. L. , NG W. L. , WONG W. S.
Published: March 2008

Abstract: :The clinical course of a woman with systemic lupus erythematosus demonstrated that renal involvement in this disease can change, both in the predominant site of renal injury and in the pattern of glomerular lesions. Over 50 months she had first tubulo‐interstitial lupus nephritis with no glomerular change, then a membranous nephropathy with disappearance of tubulo‐interstitial inflammation, and finally crescentic glomerulonephritis. This case emphasizes the need for close follow‐up of all lupus patients regardless of their initial renal manifestations and pathology.
SULINDAC HEPATOTOXICITY: EFFECTS OF ACUTE AND CHRONIC EXPOSURE
Authors: WOOD L.J. , MUNDO F. , SEARLE J. , POWELL L W
Published: March 2008

Abstract: Sulindac (Clinoril), an anti–inflammatory drug increasingly used in Australia for the treatment of rheumatological conditions, is unpredictably associated with a cholestatic hepatitis. We present three cases of sulindac hepatitis. The first case exemplifies acute sulindac hepatitis, the second, continuously exposed to sulindac for 18 months, had chronic sulindac hepatotoxicity, and in the third case, the long–term histological outcome after cessation of sulindac is described. The clinical, biochemical, and histopathological characteristics are those of a cholestatic hepatitis which resolves on withdrawal of the drug. We report marked anisonucleosis with cytoplasmic invaginations into the nucleus and binuclearity of hepatocytes as additional histological features of sulindac hepatitis. There is no evidence that sulindac hepatitis progresses to irreversible structural liver damage, although nuclear changes may persist for up to two months after cessation of the drug. The clinical and biochemical features of all reported cases of sulindac hepatitis are summarised.
CENTRAL NERVOUS SYSTEM ECHOVIRUS INFECTION IN BRUTON'S X–LINKED HYPOGAMMAGLOBULINEMIA
Authors: R. L. PRENTICE S , A. G. DALGLEISH N , GATENYB P. A. , LOBLAY R. H. , WADE S. , KAPPAGODA N. , BASTEN A.
Published: March 2008

Abstract

A patient with Bruton's X–linked hypogammaglobulinemia, who developed the typical syndrome associated with systemic echovirus 3 infection whilst on routine intramuscular gammaglobulin replacement therapy, is described. Following regular infusions of specific antibody–containing plasma from his spouse, he has shown sustained clinical improvement over a period of two years, and is, therefore, one of the very rare cases with this syndrome to survive for more than a few months,
LONG‐TERM BROMOCRIPTINE THERAPY MAY RESTORE THE INHIBITORY CONTROL OF PROLACTIN RELEASE IN SOME PATIENTS WITH PATHOLOGICAL HYPERPROLACTINEMIA
Authors: HO K. Y. , SMYTHE G. A. , COMPTON P. J. , LAZARUS L.
Published: March 2008

While bromocriptine is effective in controlling hyperprolactinemia, it is not known if bromocriptine therapy can restore the abnormal regulation of prolactin (PRL) release found in patients with pathological hyperprolactinemia. We report 15 hyperprolactinemic patients treated for a mean duration of 5.5 ± 0.6 years (mean ± SE) in whom stimulation tests to assess PRL control mechanisms [thyrotropin releasing hormone (TRH) and metoclopramide] were performed before and at least one month after withdrawal of bromocriptine therapy. The basal PRL level after withdrawal of bromocriptine therapy was significantly lower (p< 0.001) than that before therapy. All patients had blunted PRL stimulatory responses to TRH and metoclopramide (%D́16.0±5.6%) before treatment. After withdrawal of bromocriptine, PRL responses to stimulatory tests were significantly improved in seven patients (termed ‘responders’, %D́ 376 ±55%) but remained unchanged in eight patients (termed ‘non‐responders’, %D́ 9.2 ± 3.0%). Basal PRL levels were significantly lower (p<0.01) in responders (290 ±35 mlU/l) than in non‐responders (10360 ± 6790 mlU/l). Four of the responders have maintained normoprolactinemia and normal stimulated PRL responses for 15 months to three years following cessation of bromocriptine therapy and appear to be in remission. Favourable factors amongst the responders were the female sex, absence of a macroadenoma, and a pre‐treatment PRL level below 3000 mlU/l. PRL stimulation tests performed before therapy could not predict which patients would respond. No relationship was found between duration of therapy, or age at presentation, and improvement after bromocriptine. Our data demonstrate that the inhibitory control of PRL release can be restored in some patients with pathological hyperprolactinemia and suggest that the underlying hypothalamic‐pituitary defect responsible for the pathogenesis of pathological hyperprolactinemia may be corrected by bromocriptine therapy.
EVALUATION OF DOMICILIARY TREATMENT WITH TERBUTALINE BY WET NEBULISATION IN PATIENTS WITH CHRONIC BRONCHITIS AND EMPHYSEMA
Authors: SILINS R. A. , MARLIN G. E.
Published: March 2008

Domiciliary treatment with terbutaline by wet nebulisation (5 mg, four times daily) was compared with placebo in a double‐blind study over four consecutive periods, each of seven days duration, in eight patients with severe airflow limitation due to chronic bronchitis and emphysema. Lung function tests performed at the conclusion of each treatment period showed small but significant improvements in FEVT before and after 500 μg of terbutaline by metered dose inhaler (MDI), with reductions in functional residual capacity and residual volume for terbutaline compared with placebo. Morning and evening peak expiratory flow rate recordings were greater and there was a significant reduction in the use of terbutaline by MDI during the terbutaline treatment. Three patients were unable to complete the placebo treatment because of excessive symptoms. Analysing all individual results, only one patient appeared not to benefit from nebulised terbutaline, while the preference rating for the other seven patients was significantly in favour of terbutaline.
OPTIC NERVE INVOLVEMENT IN GRAVES‘ OPHTHALMOPATHY: A CASE REPORT AND REVIEW
Authors: DUNNE J. W. , EDIS R. H.
Published: March 2008

Optic neuropathy in Graves' disease is an uncommon, but potentially treatable cause of disabling visual loss. Optic nerve damage is probably secondary to compression by swollen extraocular muscles at the apex of the orbit. The visual loss is usually bilateral and insidiously progressive, although accelerated visual loss, fluctuations in vision, and features mimicking orbital cellulitis may occur. Ocular congestive symptoms and proptosis have no direct relationship to the severity of visual loss. Early diagnosis is facilitated by orbital CT scanning. Oral corticosteroids and radiotherapy, alone or in combination, are the primary modalities of medical treatment. Surgical decompression of the orbit can be used where medical approaches have failed
PREGNANCY AFTER RENAL TRANSPLANTATION
Authors: O'DONNELL D. , SEVITZ H. , SEGGIE J. L. , MEYERS A. M. , BOTHA J. R. , MYBURGH J. A.
Published: March 2008

During the 13 year period 1971 to 1984 there were 38 pregnancies in 21 renal transplant patients at the Johannesburg Hospital. Twenty‐two ended with live births and included two sets of twins; there were nine spontaneous abortions, six therapeutic abortions, and one stillbirth. Maternal complications were mild in the majority but five patients suffered deterioration in renal function, two undergoing transplant nephrectomy as a result of this. There were seven neonatal deaths, including both sets of twins; death was due to prematurity in six and congenital malformation (diaphragmatic hernia) in one. A further infant had congenital pyloric stenosis which was corrected surgically.

Pregnancies were analysed according to whether or not their outcome was successful. Those with a successful outcome had less exposure to warfarin during pregnancy (p = 0.0025) and showed a tendency towards lower immunosuppressive doses of prednisone and azathioprine although these did not reach significance.

Although these results indicate an unhappy prognosis for both the mother and fetus, two redeeming features are to be noted. Pregnancy outcome improved markedly in the latter years, possibly owing to non‐exposure to warfarin, less immunosuppression, and improvement in neonatal care, and four of the five mothers who suffered deterioration in renal function were notoriously unco‐operative in their medical care.

Pregnancy can only be recommended in the transplanted patient who has stable renal function, is compliant in taking of medications, and whose graft is of such age that the immunosuppressive drug dose is minimal. Warfarin should be avoided. (Aust NZ J Med 1985; 15: 320–325.)
CHLAMYDIAL ENDOCARDITIS
Authors: DIMMITT S. B. , PEARMAN J. W. , WOOLLARD K. V.
Published: March 2008

Echocardiography diagnosis of a case of endocarditis, subsequently proven to be due to a chlamydial organism, is described. Early echocardiographic diagnosis guided initial medical management and directed urgent surgical intervention when the patient deteriorated. Reported cases of chlamydial endocarditis are reviewed. (Aust NZ J Med 1985; 15: 340–342.)
TAKAYASU'S DISEASE ASSOCIATED WITH GENERALISED AMYLOIDOSIS
Authors: GRAHAM A. N. , DELAHUNT B. , RENOUF J. J. , AUSTAD W. I.
Published: March 2008

A case of Takayasu's disease in a young Caucasian female is described. The major complications which developed over the ten year course of the disease include nephrotic syndrome, severe refractory hypertension, aortic valve regurgitation associated with aneurysmal dilatation of the ascending aorta, and recurrent congestive heart failure. Amyloid deposits have been demonstrated in the aorta, atrial appendage, aortic valve, and renal cortex.

The association of amyloidosis and Takayasu's disease is discussed. (Aust NZ J Med 1985; 15: 343–345.)
REPRODUCIBILITY OF HYPERVENTILATION OF COLD DRY AIR IN CHILDREN WITH CYSTIC FIBROSIS
Authors: CHAY O. M. , SLY P. D. , OLINSKY A.
Published: March 2008

Abstract Wheezing is a significant problem in some patients with cystic fibrosis. Currently available tests are not reliable at determining whether this wheezing is due to co‐existent asthma or to the underlying pulmonary disease. The reproducibility of hyperventilation of cold dry air (HVCDA) was studied over eight days in 11 children with cystic fibrosis. A group with mild lung disease were selected to minimize the variability due to underlying pulmonary disease. Fifty‐six per cent of subjects had consistent responses to HVCDA. A test of reroducibilit was performed on the respiratory heat exchange, the percentage fall in FEV1 after HVCDA and the ratio of these two (R). Respiratory heat exchange was found to be highly reproducible with a reproducibility co‐efficient of 0.97. The percentage fall in FEV1 after HVCDA and R were not reproducible over the eight‐day period. Hyperventilation of cold dry air did not give reproducible results in children with cystic fibrosis, suggesting that a single test may not be suitable for judging bronchial lability. (Aust NZ J Med 1986; 16: 644–647.)
ADMISSION THYROID FUNCTION TESTING IN ELDERLY PATIENTS
Authors: SCOTT M. A. , KIDD B. L. , CROXSON M. S. , EVANS M. C.
Published: March 2008

Abstract The free thyroxine indeg (FTI) was measured in 307 elderly patients admitted to two geriatric units. The initial FTI was abnormal in 41 (13.3%), ieing raised in 27 and low in 14 patients. On further testing, these abnormalities were found to be either transient or of no clinical significance in 36 of the 41 patients (88%). Only five of the 307 patients (1.6%) were finally treated for previously undiagnosed thyroid disease and of these three improved (1%). Thyroid disease identified by routine screening, and not suspected from the history and clinical findings, was present in only two patients (0.7%). In view of these findings we suggest that thyroid screening is no more justified in the elderly than in younger hospitalised patients. (Aust NZ J Med 1986; 16: 699–702.)
HISTIOCYTIC NECROTIZING LYMPHADENITIS (KIKUCHI'S DISEASE)
Authors: MA D. D. F. , HOLLIS R. R. , DELBRIDGE L.
Published: March 2008

Abstract We report a typical case of histiocic necrotizing lymphadenitis. To our knowledge, this is the first reported case in Australasia. Histiocytic necrotizing lymphadenitis (Kikuchi's disease) is a distinct disorder originally reported in Japan. It commonly affects young females and involves mainly cervical lymph nodes. The condition is benign. The etiology of histiocytic necrotizing lymphadenitis and its distinction from other causes of benign and malignant lymphadenopathies are discussed. The clinical importance of this disorder is that, histopatholoaicallv. it could be misdiagnosed as malignant lymphoma and therefore patients may receive irkorrect treatment. (Aust NZ J Med 1986; 16: 711–713.)
CURRENT CONCEPTS IN THE ETIOPATHOGENESIS AND TREATMENT OF SYSTEMIC LUPUS ERYTHEMATOSUS (SLE)
Authors: MANOLIOS N. , SCHRIEBER L.
Published: March 2008

Abstract Systemic lupus erythematosus is an autoimmune disorder that occurs spontaneously in humans and mice. Genetic factors play an important role in the predisposition to and expression of disease. Environmental factors augment the expression of illness and in the absence of normal control mechanisms may provide the stimulus to autoimmunity. Sex hormones modulate the immune response and tend to modify disease expression. Disordered immune regulation may be due to a primary or secondary abnormality in cellular, cytokine, and/or humoral function.

Therapy for SLE is directed towards suppression of exaggerated immunological and inflammatory activity. This review will re‐evaluate current therapy and describe newer approaches including the use of pharmacological, hormonal, immunological, dietary, and physical modalities. (Aust NZ J Med 1986; 16: 729–743.)
SUCCESSFUL TOTAL CORRECTION OF FALLOT'S PENTALOGY IN THE SEVENTH DECADE OF LIFE
Authors: BETT J. H. N. , STAFFORD E. G.
Published: March 2008

Abstract The patient described had correction of Fallot's pentalogy at the age of 61 and has been asymptomatic for a further five years. Survival with this disorder to this age is extremely rare, and successful surgery for cyanotic congenital heart disease in the seventh decade of life has apparently not been reported previously.
BOOK REVIEW
Authors: Silink M.
Published: March 2008

PAEDIATRIC NEUROENDOCRINOLOGY. Edited by Derek Gupta, with Patrizia Borrelli and Andrea Attanasio
HEPATITIS AND NEUTROPENIA SECONDARY TO GOLD THIOMALATE THERAPY FOR RHEUMATOID ARTHRITIS
Authors: SMITH M. D.
Published: March 2008

Abstract A 37 year old female with rheumatoid arthritis developed clinical and biochemical evidence of hepatitis after receiving 80 mg of sodium aurothiomalate. Inadvertent rechallenge with sodium aurothiomalate led to recurrence of the biochemical abnormalities and a profound neutropenia and eosinophilia.
BOOK REVIEW
Authors: Alpers J. H.
Published: March 2008

BRONCHIAL ASTHMA, MECHANISMS AND THERAPEUTICS. Second Edition. Edited by Earle B. Weiss, Maurice S. Segal, and Myron Stein. Little, Brown & Co.
GlARDlA INFECTION CAUSES VITAMIN B12 DEFICIENCY
Authors: CORDINGLEY F. T. , CRAWFORD G. P. M.
Published: March 2008

Abstract A patient presented with hematological evidence of vitamin B12 deficiency. The Schilling test performed suggested intestinal malabsorption and further investigation revealed heavy infestation with Giardia lamblia. Specific treatment of the giardiasis with tinidazole resulted in correction of the abnormalities in vitamin B12 absorption. These findings, together with the absence of other causes of vitamin B12 deficiency, suggest that giardiasis should be considered as a cause of vitamin B12 deficiency.
BOOK REVIEW
Authors: Alpers J. H.
Published: March 2008

PRACTICAL MANAGEMENT OF ASTHMA. By Tim Clark and John Rees
BOOK REVIEW
Authors: Calvert G. D.
Published: March 2008

PREVENTIVE TREATMENT OF ATHEROSCLEROSIS. Consulting Editor David H. Blankenhorn
COMPLICATIONS ASSOCIATED WITH INDWELLING VENOUS HICKMAN CATHETERS IN PATIENTS WITH HEMATOLOGICAL DISORDERS
Authors: HARVEY M. P. , TRENT R. J. , JOSHUA D. E. , RAMSEY‐STEWART G. , STOREY D. W. , KRONENBERG H.
Published: March 2008

Abstract During a 28 month period, 77 Hickman catheters were inserted in 66 patients with hematological disorders. Complete follow‐up was possible for 72 catheter insertions. Catheters remained in situ for a median period of 77 days (range 5–474 days). Fourteen (19%) catheters required removal because of complications which included sepsis, blockage, or displacement. Catheter‐related infection was the major complication and Staphylococcus epidermidis and diphtheroids (Corynebacterium species) were the organisms most commonly isolated.
TREATMENT OF MINERALOCORTICOID‐RESISTANT RENAL HYPERKALEMIA WITH HYPERTENSION (TYPE II PSEUDOHYPOALDOSTERONISM)
Authors: WAYNE V. S. , STOCKIGT J. R. , JENNINGS G. L.
Published: March 2008

Abstract A 16 year old girl with the rare syndrome characterised by hypertension, hyperkalemia, and acidosis was treated with a range of drugs, including thiazides, frusemide, and beta‐adrenoceptor antagonists. None of the agents normalised the hypertension and biochemical abnormalities. Best results were obtained with methyclothiazide in full dosage, which normalised the blood pressure, serum potassium level, and bicarbonate level in the face of increased plasma renin activity. Empirical treatment with thiazides is the most satisfactory method for long term management.
RESPONSE OF REFRACTORY ANEMIA TO LOW‐DOSE CYTOSINE ARABINOSIDE
Authors: GALLO J. H. , ROZENBERG M. C.
Published: March 2008

Abstract Two elderly patients with transfusion‐dependent refractory anemia due to myelodysplastic syndromes were treated with a course of low‐dose subcutaneous cytosine arabinoside in an attempt to reduce their transfusion requirements. Following treatment, they required no transfusions for over six months. The treatment was well tolerated, but was associated with initial myelosuppression.
BOOK REVIEW
Authors: Cunningham Clare
Published: March 2008

BEHAVIOURAL TREATMENTS WITH CHILDREN. By Roger Morgan
BOOK REVIEW
Authors: Whitworth Judith A.
Published: March 2008

WOMEN PHYSICIANS. Careers, Status, and Power. By Judith Lorber
COMPLEMENT AND IMMUNE COMPLEX DISEASES
Authors: WEBB J. , WHALEY K.
Published: March 2008

Abstract Research during the past decade has led to a much greater understanding of the activation and control, as well as a more complete delineation, of the complement system of proteins. There has been definiton of the roles of individual components in modulation of immune complex formation, the deposition of which leads to tissue injury in the autoimmune connective tissue diseases. The ability of serum to render immune complexes more soluble is complement‐mediated and appears to be an important protective mechanism against immune complex diseases. Inherited deficiencies and production of non‐functional variants of complement components, decreased synthesis, hypercatabolism, and the presence of serum inhibitors may all contribute to the reduced immune complex solubilisation which has been found in the connective tissue diseases. More work is required to define further the role of complement and immune complexes in the basic pathogenesis of these diseases.
BOOK REVIEW
Authors: Shann Frank
Published: March 2008

CLINICAL REVIEWS IN PEDIA TRIC INFECTIOUS DISEASE. Edited by John D. Nelson and George H. McCracken
CALCIUM METABOLISM AND OSTEOPOROSIS IN CORTICOSTEROID‐TREATED POSTMENOPAUSAL WOMEN
Authors: NEED A. G. , PHILCOX J. C. , HARTLEY T. F. , NORDIN B. E. C.
Published: March 2008

Abstract Osteoporosis is a common complication of corticosteroid therapy and it is associated with both decreased bone formation and increased bone resorption. We have measured radiocalcium absorption and the fasting urinary calciumkreatinine and hydroxy‐prolinekreatinine ratios in 30 postmenopausal women receiving prednisolone therapy and compared the patients with normal spine radiographs (N= 14) with those whose spine radiographs showed osteoporosis (N=16). The osteoporotic cases had lower radiocalcium absorption (p < 0.001), higher fasting urinary calcium (p < 0.05), and higher fasting urinary hydroxyproline excretion (p < 0.001). As calcium absorption has a positive effect on calcium balance and urinary calcium a negative effect, the difference between these two variables was calculated in each case. This derived variable (radiocalcium absorption—fasting urinary calciumkreatinine) disclosed a greater difference between the osteoporotic and normal groups (p < 0.0001) than either variable alone.
CYTOPHAGIC PANNlCULITIS
Authors: MARCH L. M. , WEBB J. , ECKSTEIN R. P.
Published: March 2008

Abstract A 60 year old woman developed generalised erythema nodosum‐like lesions together with hectic fever, lymphadenopathy, and hepatitis. Biopsies revealed lobular panniculitis with a benign histiocytic infiltrate and prominent phagocytosis in subcutaneous sites, lymph nodes, and bone marrow. All immunological, serological, and culture studies were negative, apart from throat isolation of herpes simplex. The patient responded to high‐dose corticosteroids. The case illustrates the differential diagnosis of lobular panniculitis, with histiocytic infiltrate and cytophagocytosis. These combined features are consistent with the recently described syndromes of cytophagic panniculitis and virus‐associated hemophagocytic syndrome.
THE IMPACT OF LEUKEMIA STATUS AT THE TIME OF HLA‐IDENTICAL SIBLING MARROW TRANSPLANTATION ON SUBSEQUENT COMPLICATION RATE AND SURVIVAL OF ADULTS WITH ACUTE LEUKEMIA
Authors: Atkinson K. , Biggs J. C. , Concannon A. , Dodos A. , Raphael H. , Ashby M. , Mapley D. , Andrews K.
Published: March 2008

Between March 1981 and March 1985, 76 patients with acute leukemia were treated with cyclophosphamide (120 mg/kg), 12 or 14 Gy total body irradiation, and an HLA‐identical sibling marrow transplant. Forty‐seven patients had acute non‐lymphoblastic leukemia (ANLL) and 29 had acute lymphoblastic leukemia (ALL). Forty‐one were transplanted during first remission and 28 during or after first relapse of their disease. An additional six patients were transplanted because their leukemia was refractory to conventional cytotoxic chemotherapy, and one was transplanted as initial therapy. Actuarial 42 month survival for those transplanted during first remission was 47% and for those transplanted in first relapse or later it was 22% (p = 0.02). There was no difference in either group between those with ANLL and those with ALL. Two of the six patients with refractory leukemia are alive more than 22 and more than 15 months after the transplant. The incidence of acute graft‐versus‐host disease and interstitial pneumonitis was 90% and 39%, respectively, for the first remission group, and 96% and 37% for those transplanted in first relapse or later. There was no significant difference in transplant‐related mortality between the two groups (29% and 43%, respectively). The leukemia recurrence rate, however, was 13% for those transplanted in first remission and 67% for those transplanted in first relapse or later (p = 0.0003). Thus, the major factor determining the incidence of leukemia recurrence and survival after transplant was the status of the leukemia at the time of transplantation. These findings indicate that adults with acute leukemia who have an HLA‐identical sibling should be transplanted in first remission, and that transplant‐related mortality must be reduced urgently. (Aust NZ J Med 1986; 16: 462–469.)
PREVALENCE OF HEMOCHROMATOSIS IN A RANDOM SAMPLE OF ASYMPTOMATIC MEN*
Authors: Elliott R. , Lin B. P. C. , Dent O. F. , Tait A. , Smith C. I.
Published: March 2008

The prevalence of hemochromatosis was studied in 343 randomly selected male World War II veterans aged 58 years and older. Those men with a serum ferritin level of greater than 700 μg/l or a transferrin saturation of greater than 55% underwent liver biopsy. Hepatic iron concentration was assessed histochemically and by atomic absorption spectrophotometry. Histology was assessed blindly by one histopathologist. Of 21 veterans biopsied, four men had hemochromatosis, confirmed by venesection response, and the remaining biopsies all showed some histological abnormality. All four men with hemochromatosis had a transferrin saturation of greater than 55% while only three of the four had a serum ferritin level over 700 μg/l. The prevalence of hemochromatosis detected in this sample was 1.2%, which is higher than that suggested by overseas studies.
A DOSE‐RANGING STUDY OF THE ANTIPLATELET EFFECT OF ENTERIC COATED ASPIRIN IN MAN
Authors: HERD C. M. , RODGERS S. E. , LLOYD J. V. , BOCHNER F. , DUNCAN E. M. , TUNBRIDGE L. J.
Published: March 2008

Abstract Enteric coated aspirin was given to eight human volunteers in escalating doses (20, 40,60,80,100 mg daily), each dose being given over two weeks. In addition, to measure the maximum effect of aspirin, each volunteer was given two single doses of 600 mg of soluble aspirin. At the end of each dosing interval we measured platelet aggregation and thromboxane formation in response to four aggregating agents and to whole blood coagulation. The doses of aspirin required to inhibit platelet aggregation in response to various stimuli were: for collagen 60–80 mg, for adenosine diphosphate and adrenaline 60 mg, and for arachidonate 40 mg. For maximum inhibition of thromboxane formation the doses were: for collagen greater than 100 mg, for adenosine diphosphate and adrenaline 60 mg, for arachidonate 80 mg, and for whole blood coagulation 100 mg. Different aspirin doses are required to inhibit the responses to different stimuli. Furthermore, for some stimuli, inhibition of thromboxane generation may require more aspirin than is required for inhibition of aggregation. The clinical implications of these findings are uncertain since we do not know which stimuli are important in arterial thrombosis in man.
CLINICAL ASPECTS OF INFECTION WITH YERSINIA ENTEROCOLITICA IN ADULTS
Authors: FEENEY G. F. X. , KERLIN P. , SAMPSON J. A.
Published: March 2008

Abstract Yersinia enterocolitica was isolated from the feces of 29 patients over a three‐year period following the introduction of a selective culture medium. Y. enterocolitica was the third most common enteric pathogen after Campylobacter jejuni and Salmonella in this series of 3795 specimens from a predominantly adult population. The isolation rate of Y. enterocolitica was 0.9% and this represented 15.8% of positive cultures. The usual symptoms of Yersinia infection were diarrhea (93%) and abdominal pain (72%), often associated with tenderness in the right iliac fossa and fever. Fourteen patients required admission to hospital and four came to surgery for possible appendicitis. Acute terminal ileitis and mesenteric lymphadenitis were noted in each case. Two patients who were HLA‐B27 positive had a reactive arthritis as their dominant complaint. In conclusion, Y. enterocolitica has emerged as a common cause of diarrhea in adults. It is an important cause of symptoms resembling those of acute appendicitis and is occasionally complicated by reactive arthritis.
ENHANCED PREDICTION OF MAJOR CARDIAC EVENTS AFTER MYOCARDIAL INFARCTION USING EXERCISE RADIONUCLIDE VENTRICULOGRAPHY
Authors: KUCHAR D. L. , FREUND J. , YEATES M. , SAMMEL N.
Published: March 2008

Abstract Exercise radionuclide ventriculography (RVG) was performed 7–12 days after acute myocardial infarction (Ml) in 153 patients to assess its value in identifying those at risk of serious recurrent cardiac events. In addition to electrocardiogram (ECG) features of the exercise test, clinical and hemodynamic features were also considered: the exercise test was abnormal if there was a fall in blood pressure of 10 mmHg or more, development of angina, or inability to complete three minutes of exercise. RVG was used to measure left ventricular ejection fraction and to assess wall motion at rest and at peak exercise. After a median follow‐up of 14 months, there were 18 cardiac events: six deaths and 12 patients with recurrent Ml. In addition, 18 patients underwent coronary artery bypass surgery; the decision to perform surgery was predicted by ST segment depression or a fall in blood pressure during exercise (p<0.005).

The sensitivity of the exercise test for identifying patients with a cardiac event increased progressively as additional parameters were considered in a cumulative fashion; hence, ST depression identified 28% of patients with events, whereas addition of clinical and hemodynamic parameters increased this to 61%. The addition of RVG increased the sensitivity further to 88%, but with a specificity of 50%. Although exercise‐induced ST depression of up to 1 mm did not predict outcome significantly, a positive exercise RVG did predict cardiac events: 17% of patients with a positive test had an event, compared with 6% of those with a normal study (p<0.05).

Exercise testing, using conventional ECG criteria alone, is an insensitive method of identifying patients at risk of recurrent Ml or death when performed within two weeks of Ml. The addition of clinical and hemodynamic variables, and the use of RVG, improves the prognostic value of exercise testing.
MENINGITIS DUE TO BRANHAMELIA CATARRHALIS
Authors: O'NEILL J. H. , MATHIESON P. W.
Published: March 2008

Abstract We report a case of Branhamella catarrhalis meningitis which was unusual in that the patient was a healthy immunocompetent adult, the onset was subacute, and the cerebrospinal fluid pleocytosis was predominantly lymphocytic. Following treatment with intravenous penicillin, recovery was complete apart from residual cortical dysarthria.
INTESTINAL PSEUDO‐OBSTRUCTION IN PHEOCHROMOCYTOMA
Authors: KHAFAGI F. A. , LLOYD H. M. , GOUGH I. R.
Published: March 2008

Abstract Intestinal pseudo‐obstruction is a rare complication of pheochromocytoma. We describe a 39 year old man with a large right adrenal pheochromocytoma and extremely high catecholamine levels, who developed pseudo‐obstruction which responded promptly to intravenous phentolamine infusions. This case supports the concept that this complication is attributable to high circulating levels of catecholamines, acting by direct and indirect inhibition of gastrointestinal motility.
CYTOSINE ARABINOSIDE IN THE TREATMENT OF T‐CELL ACUTE LYMPHOBLASTIC LEUKEMIA
Authors: WILEY J. S. , WOODRUFF R. K. , JAMIESON G. P. , FIRKIN F. C. , SAWYER W. H.
Published: March 2008

Abstract The place of cytosine arabinoside (araC) in the treatment of T‐cell acute lymphoblastic leukemia was studied by measuring nucleoside transport sites and the conversion of araC to its triphosphate (araCTP) in lymphoblasts from the peripheral blood of two patients, who were then treated with araC. Equilibrium binding of 3H‐nitrobenzylmercaptopurine riboside (3H‐NBMPR), a specific ligand of the nucleoside transporter, gave 16 510 to 29 400 sites/cell for T‐lymphoblasts on presentation or early in relapse compared with 2730 ± 1570 sites/cell for non‐T‐lymphoblasts. Accumulation of araCTP from tyM araC was four times greater in T‐cell than non‐T‐cell lymphoblasts. One patient was treated with araC (100 mg/m2 daily × 7 days, continuous intravenously) at the time of her first leukemic relapse and complete remission was achieved with this single agent. When this patient relapsed and developed advanced disease the T lymphoblasts showed a 75% reduction in their ability to accumulate araCTP which paralleled a reduction in 3H‐NBMPR binding. The second patient achieved complete remission with araC given in low dose (15 mg twice daily by subcutaneous injection) for 21 days at the time of a localised relapse in the mediastinum and pleura. These studies suggest that araC may have a place in the therapy of early stage T‐lymphoblastic disease.
EVIDENCE AGAINST AN IMMUNOGENETIC BASIS FOR DIABETES IN CHRONIC PANCREATITIS
Authors: COLMAN P. G. , BEGLEY C. G. , TAIT B. D. , ROBERTS‐THOMSON I. C. , HARRISON L. C.
Published: March 2008

Abstract A possible immunogenetic basis for diabetes in chronic pancreatitis was explored by studying 19 patients with both disorders, most of whom required treatment with insulin. In contrast to patients with insulin‐dependent (Type 1) diabetes, patients with diabetes and chronic pancreatitis had residual beta cell function but blunted C‐peptide responses to intravenous glucagon, absence of circulating islet cell antibodies, and HLA‐DR types similar to control subjects and patients with chronic pancreatitis without diabetes. Diabetes complicating chronic pancreatitis is therefore not associated with the biochemical or immunogenetic markers characteristic of Type 1 diabetes.
CHIASMAL APOPLEXY DUE TO INTRACHIASMATIC VASCULAR MALFORMATION RUPTURE
Authors: KHANGURE M. S. , HANKEY G. J.
Published: March 2008

Abstract Hemorrhage from an intrinsic vascular malformation of the optic chiasm (chiasmal apoplexy) is an uncommon cause of sudden visual loss with chiasmal visual field defects.

This paper describes one case of sudden visual loss with an anterior chiasmal visual field defect due to rupture of an intrachiasmatic venous angioma and contrasts it with the clinical presentation of a case of hemorrhage from an intrachiasmatic arteriovenous malformation causing severe headache and a less apoplectic onset of visual symptoms.

The variable clinical presentation and the accuracy of high resolution post‐contrast cranial CT scan in the diagnosis of intrachiasmal hemorrhage is highlighted.
Tc‐99m TERTIARY BUTYL ISONITRILE: A PRELIMINARY CLINICAL STUDY OF A NEW MYOCARDIAL IMAGING AGENT IN PATIENTS WITH CHEST PAIN
Authors: CHATTERTON B. E. , BAKER R. J. , MAHAR L. J. , STEELE P. M.
Published: March 2008

Abstract Tc‐99m is a preferred agent for nuclear imaging. Tc‐99m tertiary butyl isonitrile (Tc‐99m‐TBI) is the first of a family of lipophilic cations which allow effective imaging of the human myocardium. Twenty‐one patients scheduled for coronary angiography for the investigation of their chest pain were studied after injections of this tracer given during exercise, and on a separate visit, at rest. Despite high uptake in the liver and transiently in the lungs, high quality gated images were obtained allowing the assessment of both myocardial uptake and wall motion. The findings corresponded closely with angiographic and ventriculographic assessment of coronary artery disease and myocardial infarction. Redistribution of Tc‐99m‐TBI was shown to occur in ischemic myocardium analogous to that occurring with thallium‐201 (TI‐201). Similar agents with more favourable properties may well replace TI‐201 as the myocardial imaging agent of choice in the near future.
EXTRAPULMONARY TUBERCULOSIS A CONTINUING PROBLEM IN AUSTRALIA
Authors: DWYER DOMINIC E. , MacLEOD COLIN , COLLIGNON PETER J. , SORRELL TANIA C.
Published: March 2008

Abstract Extrapulmonary tuberculosis (TB) remains a major health problem in Australia, with 24.3% of all new tuberculosis notifications in 1984 of extrapulmonary origin. We have reviewed our recent experience to assess the epidemiology and clinical features that may allow the earlier recognition and treatment of patients at risk for this disease. From 1980–1985, 51 cases of extrapulmonary TB were identified at Westmead Hospital. Thirty‐eight patients were born outside Australia, mainly in South‐East Asia and Europe. The commonest sites of disease were the lymph nodes, genitourinary tract, pleura and bone. Tuberculous lymphadenitis occurred predominantly in South‐East Asians, whilst genitourinary tract disease was confined to Caucasians.

A history of previous exposure to tuberculosis was obtained in 45% of patients. Fever, sweats and weight loss were noted in less than half of the cases. Changes consistent with old pulmonary disease were found on routine chest X‐ray in 34% of cases. Laboratory confirmation of TB was made in 88% of cases, with typical histopathology in 90% and isolation of Mycobacterium tuberculosis in 69% of specimens submitted for analysis. Drug resistance was confined to isolates from South‐East Asian patients. (Aust NZ J Med 1987; 17: 507–511).
CLINICAL ELECTROPHYSIOLOGY STUDY IN PATIENTS WITH SYNCOPE OF UNDETERMINED ETIOLOGY
Authors: TWIDALE N. , TONKIN A. M.
Published: March 2008

Abstract The periodicity of symptoms in patients who present with syncope restricts the diagnostic value of prolonged electrocardiographic monitoring and furthermore, demonstration of arrhythmias in the absence of symptoms may not enable a firm diagnosis. Because of this, electrophysiology study is often necessary. A series of 89 consecutive patients with syncope of unknown origin is reported, highlighting the value and limitations of this technique. A diagnostic yield of 35% was found, with the majority having abnormalities of atrioventricular conduction. The presence of organic heart disease, 12‐lead electrocardiographic abnormalities and a number of syncopal episodes did not influence the diagnostic utility of electrophysiology study. Patient follow‐up suggested that therapeutic decisions based on the findings of electrophysiology study provide satisfactory symptomatic relief in a high percentage of cases, with a recurrence rate of 25% at mean follow‐up of 14 months. (Aust NZ J Med 1987; 17: 512–517.)
TRANSPLANTATION OF MONOCLONAL ANTIBODY‐PURGED AUTOLOGOUS BONE MARROW FOR TREATMENT OF POOR RISK COMMON ACUTE LYMPHOBLASTIC LEUKEMIA
Authors: BRADSTOCK K. F. , BERGIN M. , DUVAL P. , KABRAL A. , JUTTNER C. , STEVENS M. , DALLA‐POZZA L. , FAVALORO E. J. , KERR A. , ZOLA H.
Published: March 2008

Abstract Two murine monoclonal antibodies, FMC‐8 and WM‐21, reactive with the human leucocyte differentiation antigens CD‐9 (p‐24) and CD‐10 (CALLA), respectively, have been used for purging leukemic cells from remission bone marrow. Nine patients with the common variant of acute lymphoblastic leukemia (c‐ALL) in second or subsequent remission underwent bone marrow harvesting. Bone marrow mononuclear cells underwent lytic incubation in vitro with antibodies FMC‐8 and WM‐21, and rabbit serum as a source of complement, and were then cryopreserved. A mean of 0.90 ± 0.50 times 108 nucleated cells per kilogram of recipient body weight remained after treatment, with 0.38 ± 0.24 times 108 nucleated cells and 8.3 ± 10.3 times 104 CFUGM per kg being recovered on thawing. Seven patients subsequently received marrow‐ablative treatment with high dose cyclophospharnide (120 mg/kg) and fractionated total body irradiation (12 Gy), followed by infusion of antibody‐purged autologous bone marrow. Three deaths due to sepsis occurred within the first 35 days, compounded in one patient by poor marrow engraftment. All other patients engrafted promptly, and four remain in continuous complete remission at 2, 6, 9, and 28 months after transplantation. The procedure carries a substantial risk of early toxicity, but offers a significant chance of prolonged unmain‐tained remission to selected patients with poor prognosis acute lymphoblastic leukemia.
VARIATION IN DEATH CERTIFICATION OF ISCHEMIC HEART DISEASE IN AUSTRALIA AND NEW ZEALAND
Authors: LEITCH D. G. M. , HELLER R. F. , O'CONNOR S. J.
Published: March 2008

Abstract This study was designed to test the hypothesis that the between‐State variation in death rates from ischemic heart disease may be due in part to variation in the manner in which death certificates are completed or the diagnoses on them are assigned numerical codes. Random samples of 75 doctors who had recently completed a death certificate in an Australian State or in Auckland, New Zealand, as well as all doctors who had recently completed a death certificate in the Northern Territory were asked to participate. They were sent a book of 10 actual case histories and asked to complete a death certificate for each case. Seventy per cent of the doctors returned death certificates (range from 64% to 81%). Each certificate was coded by the Australian Bureau of Statistics (ABS) in the doctor's State of residence, or by the New Zealand Health Statistics Centre for Auckland respondents, and then coded again by the federal office of the ABS in Canberra. There was considerable variation in the codes assigned to each case history but systematic variation large enough to account for the variation in between‐State ischemic heart disease death rates was not seen. There was little systematic variation between codes assigned in each State and by the federal ABS office, although a few isolated discrepancies were identified which need attention by the ABS. There was considerable variability in the positioning of diagnoses in parts I and II of the death certificate, and this accounted for much of the variation in assigned causes of death. There appears a need for (i) standardisation of education of students and doctors about death certification practice if the quality of information derived from death certificates is to prove reliable, and (ii) standardisation of the death certificate form.