bluuebunny/crossref_metadata_2025 huggingface dataset:
The Contribution of Immunopathology to the Diagnosis and Classification of Systemic Lupus Erythematosus: Relationship between Serum Anti‐DNA, Complement and Renal Biopsy Changes
Authors: Rigby R. J. , Dawkins R. L. , Kay P. H. , Matz L. R. , Papadimitriou J. M. , Quintner J. , Haywood E. F.
Published: March 2008

Summary: The contribution of immunopathology to the diagnosis and classification of systemic lupus erythematosus: Relationship between serum anti‐DNA, complement and renal biopsy changes. R. J. Rigby, R. L. Dawkins, P. H. Kay, L R. Matz, J. M. Papadimitriou, J. Quintner and E. F. Haywood, Aust. N.Z. J. Med., 1978, 8, pp. 29–38.

Twenty‐three patients with systemic lupus erythematosus (SLE) were studied in an attempt to define diagnostic laboratory criteria and those features which discriminate between mild and severe renal involvement. Although there was generally a relationship between serum C3 and C4 concentrations, the latter was more commonly below the normal range. An elevated serum anti‐DNA was common and generally associated with a low C4. Renal involvement as indicated by positive glomerular immunofluorescence was almost invariable. Most cases showed mild mesangio‐pro/iferative change, patchy granular immunofluorescence and electron dense deposits predominantly within the mesangium. Those cases with more severe renal involvement were distinguished by a high anti‐DNA and a very low C3, as well as proteinuria and diffuse sub‐endothelial deposits as indicated by the combination of immunofluorescence and electron microscopy. These results suggest that glomerular immunofluorescence and the combination of serum anti‐DNA and C4 are helpful diagnostic criteria.
Contrasting IgE Levels in Acute HBsAg‐positive and Negative Hepatitis
Authors: Charlesworth J. A. , Lennane R. J. , Jones P. , Lawrence S. , Boughton C. R.
Published: March 2008

Serial measurements of serum IgE were performed in 54 patients with acute, uncomplicated hepatitis; 28 had detectable hepatitis B surface antigen (HBsAg). Eight patients with alcoholic cirrhosis were also studied. Acute phase IgE reactivity was examined in two otherwise healthy subjects undergoing routine cholecystectomy. Significant elevation of IgE was found in the patients with hepatitis B and alcoholic cirrhosis. In the former group this abnormality persisted, although to a reduced extent, for at least four weeks after admission. There was no significant association between levels of IgE and SGPT or the persistence of detectable HBsAg. It is suggested that these data either reflect activity of a system mediating liver cell injury or result from an antigenic stimulus that is secondary to preexisting hepatic damage.
Sodium Valproate (Epilim) in Refractory Epilepsy
Authors: Vajda F. J. , McNeil J. J. , Morris P. , Drummer O. , Bladin P. F.
Published: March 2008

This study reports the results of treatment of 18 refractory epileptic patients with sodium valproate used as an adjuvant therapy to their previously prescribed medication. Plasma levels of anticonvulsants were monitored throughout this study. Adverse clinical effects and laboratory screening results were reported. A tentative therapeutic plasma level range related to pre‐dosed blood samples of patients receiving sodium valproate is proposed. In 50%, the proportion of days when fits had occurred diminished significantly during valproate therapy especially when accompanied by significant EEG clearing.
Myoclonus Epilepsy in Two Families–Clinical and Electrographic Studies
Authors: Vignaendra V. , Loh T. G.
Published: March 2008

Summary: Clinical and electrographic findings are described in two unrelated families with myoclonus. Both families had consanguineous marriage in the parents. Family A resembled progressive myoclonus epilepsy of Unverricht and Lundborg. In family B the illness was mild, mental function was normal and infrequent grand mal seizures affected one member only; the illness did not resemble hereditary essential myoclonus, familial myoclonus with ataxia or progressive myoclonus epilepsy (PME).

The diurnal EEG, in affected members of family A, resembled the changes described in PME. In contrast, affected members of family B showed normal alpha rhythms accompanied by numerous epileptic discharges. Some affected members of both families showed eye closure triggered generalised epileptic discharges.

Overnight poly graphic recordings in the probands of the two families showed preservation of normal nocturnal sleep cycles and marked attenuation of myoclonus in sleep. However, the epileptic discharges, though decreased in sleep, were most prominent during REM sleep in the proband of family A and in deep sleep (NREM 3 and 4 and REM) in the proband of family B.

Two affected members from each family showed good control of their myoclonus on clonazepam; clinical improvement was accompanied by marked suppression of epileptic discharges.
Definite Myocardial Infarction in Auckland*
Authors: Fraser G. E.
Published: March 2008

Summary: Definite myocardial infarction in Auckland. G E Fraser, Aust. N.Z. J. Med., 1978, 8, pp 479–490.

40% representative sample of definite myocardial infarctions in Auckland was studied to give incidence figures and data relating to demographic variables, personal characteristics and habits, cardiovascular history, the acute phase and events over the subsequent 28 days.

The incidence results showed figures comparable with other centres in Europe and the USA, as expected from New Zealanders' high consumption of dietary saturated fats and westernized life style.
Occurrence of Large Proximal Splenic Artery Aneurysms in Chronic Liver Disease
Authors: Joske R. A.
Published: March 2008

Summary: Occurrence of large proximal splenic artery aneurysms in chronic liver disease. R. A. Joske, Aust. N.Z. J. Med., 1978, 8, pp. 515–517.

Two cases are reported of large pre‐splenic aneurysms of the splenic artery in patients with chronic liver disease, and three others cited from the literature. Four of the five died from rupture of the aneurysm. All patients were parous females with chronic liver disease, and in four of the five this was known to be present before pregnancy. It is suggested that proximal splenic artery aneurysms in such patients are due to both haemodynamic changes of portal hypertension and the endocrine changes of pregnancy. This concept may lead to early recognition of these lesions, although there are as yet no certain indications for investigation or surgical intervention in asymptomatic patients.
Corrected Transposition of Great Arteries: Diagnosis by Coronary Angiography and Ventriculography
Authors: Vohra J. , Hare W. , Hunt D. , Sloman G.
Published: March 2008

Summary: Corrected transposition of great arteries: Diagnosis by coronary angiography and ventriculography. J. Vohra, W. Hare, D. Hunt and G. Sloman, Aust. N.Z. J. Med., 1978, 8, pp. 523–527.

A patient aged 53, presenting with the clinical picture of congestive cardiomyopathy, was diagnosed as having isolated corrected transposition of great vessels on the basis of the coronary angiographic findings which are discussed in this report.
B Cell Leukaemia Distinguished from Chronic Lymphocytic Leukaemia by Surface Markers
Authors: Forbes I. J. , Zalewski P. D. , Leongi A. S. Y. , Sage R. E. , Dale B. , Cowled P. A.
Published: March 2008

Summary: B cell leukaemia distinguished from chronic lymphocytic leukaemia by surface markers. I. J. Forbes, P. D. Zalewski, A. S. Y. Leong, R. E. Sage, B. Dale and P. A. Cowled, Aust. N.Z. J. Med., 1978, 8, pp. 532–538.

Four cases of lymphocytic leukaemia were distinguished from CLL by surface marker analysis. CLL cells have relatively little Slg and have the mouse erythrocyte receptor. Cells in these cases had denser Slg and lacked the mouse erythrocyte receptor.

The group presented a fairly uniform picture with onset in sixth or seventh decade, very high lymphocyte counts, splenomegaly (gross in three), heavy infiltration of marrow, relative resistance to chemotherapy and response to splenectomy. The lymphocytes were somewhat larger than those usually found in CLL and histological examination showed a quasi‐nodular pattern in lymph nodes with diffuse infiltration of the spleen. Difficulties of classification are discussed.

The addition of surface marker analysis to clinical and morphological parameters allows these cases of B‐lymphocytic leukaemia (mouse erythrocyte‐negative B leukaemia) to be distinguished clearly from chronic lymphocytic leukaemia. The mouse erythrocyte receptor is particularly useful in making this distinction.
The Effect of Westernization on Native Populations. Studies on a Micronesian Community with a High Diabetes Prevalence
Authors: Zimmet P. , Arblaster M. , Thoma K.
Published: March 2008

Summary: The effect of westernization on native populations. Studies on a Micronesian community with a high diabetes prevalence.

A diabetes prevalence study in 1975 on an isolated urbanized Central Pacific island (Nauru) showed rates comparable to the American Pima Indians—the highest yet recorded in the world literature. This paper reports the results of a follow‐up study and the high prevalence has been confirmed. In this survey of 417 people aged ten years and over, 9‐8% were known diabetics. With a plasma glucose of 160 mg/100 ml or over at two hours after a 75 gram oral glucose load as the criterion of diagnosis, diabetes was detected in a further 19‐2%, making a total diabetic population of 29% in the population studied. The prevalence of diabetes was 44% in people aged 20 years and over. A further 7% had borderline diabetes on the basis of a two‐hour plasma glucose of 140–159 mg/100 ml.

Parity did not appear to be a causative factor in relation to the high diabetes prevalence. However, obesity is common in this community and is more marked than that seen in other Pacific or Caucasian communities. The high prevalence of diabetes in this population appears to be related to the inter‐action of environmental factors, such as obesity, with a diabetic genotype. The results confirm the possible detrimental effects of westernization on native populations.
Experience with Large Volume Plasmapheresis in Malignant Paraproteinemia and Immune Disorders
Authors: Isbister J. P. , Biggs J. C. , Penny R.
Published: March 2008

Summary: Experience with large volume plasmapheresis in malignant paraproteinaemia and immune disorders.

Clinical experience with large volume plasmapheresis in a wide range of malignant and immune disorders is described. An average of 4 litres of plasma was exchanged for various colloid and electrolyte solutions. Patient tolerance was good but close medical and nursing supervision in monitoring fluid balance and adverse reactions to replacement fluids is necessary.

Plasmapheresis has been established to be of benefit in immunoproliferative diseases when complicated by hyperviscosity, and may also have a place in other cases with haemostatic or renal impairment. Autoantibodies, alloantibodies and immune complexes can be removed by plasmapheresis, but the effect is usually transient and the procedure should be combined with immunosuppressive therapy in most cases. The removal of blocking factors in disseminated malignant melanoma is an experimental procedure at present, but initial results have been encouraging.
Chronic Cough and Haemoptysis due to a Nematode, “Syngamus Laryngeus”
Authors: Birrell D. J. , Moorhouse D. E. , Gardner M. A. H. , May C. S.
Published: March 2008

Summary: Chronic cough and haemoptysis due to a nematode, Syngamus laryngeus.

A case of bronchial infection with Syngamus laryngeus (Gapeworm) in a 42‐year‐old woman is described. Following presentation with chronic cough, haemoptysis and weight loss, a pair of worms was removed at bronchoscopy, with resolution of symptoms.
A Testosterone‐Secreting Adrenal Cortical Adenoma
Authors: Smith H. C. , Posen S. , Clifton‐Bligh P. , Casey J.
Published: March 2008

Summary: A testosterone‐secreting adrenal cortical adenoma.

A virilizing, gonadotrophin ‐responsive adrenal cortical adenoma was removed from a 54‐year‐old woman. Following removal of the tumour, which contained and secreted androgens and estradiol, serum gonado‐trophins rose to menopausal levels and the patient experienced menopausal symptoms. Pre‐operative attempts to localize the source of androgens were unsuccessful.
An Evaluation of Five Years Experience with a Physicians Workshop
Authors: Newble D. I.
Published: March 2008

Summary: An evaluation of five years experience with a Physicians Workshop.

This paper reports five years experience with a new type of continuing education programme for practising physicians. The continued development and the organisation of the programme is described. A high proportion of the hospital's physicians have regularly attended and participated. Annual questionnaire surveys have shown a high degree of satisfaction with the programme and the majority of physicians give it a high priority in their continuing educational activities. The features which appear to be responsible for the success of the programme include the variety of the format, the quality of the presentations, the active participation by all physicians and the fact that the activities are specifically aimed at the practising physician rather than physician trainees.
Serum Pyridoxal Concentrations in Patients with Diabetic Neuropathy
Authors: McCann V. J. , Davis R. E.
Published: March 2008

Summary: Serum pyridoxal concentrations in patients with diabetic neuropathy.

Serum pyridoxal (vitamin B6) concentrations were measured in 50 patients with significant diabetic neuropathy. There were 24 males and 26 females with a mean age of 58·2 years and a mean duration of diabetes of 9·8 years. The level of pyridoxal was significantly lower in these patients when compared with randomly selected diabetic patients matched for age and sex without clinical evidence of neuropathy. There was no significant difference in the duration of the diabetes between the two groups. The results indicate an association between pyridoxal deficiency and neuropathy in diabetic patients.
Treatment of Amenorrhoea, Galactorrhoea and Hypogonadism with Bromocriptine*
Authors: Donald R. A. , Espiner E. A. , Livesey J. H.
Published: March 2008

Summary: Treatment of amenorrhoea, galactorrhoea and hypogonadism with bromocriptine.

The effect of bromocriptine administration was studied in 34 patients, whose presenting symptoms included amenorrhoea, galactorrhoea, infertility, dyspareunia, delayed puberty, and impotence. Two patients were found to have raised plasma prolactin values during investigation for acromegaly. With the exception of three individuals all patients had hyperprolactinaemia. Pituitary fossa enlargement or asymmetry was reported in 16 patients and one patient had primary hypothyroidism.

Virtually all patients complained of side effects when first starting bromocriptine but only two patients were unable to tolerate prolonged therapy with doses which ranged from 5–40 mg daily. A single oral dose of 2·5 mg resulted in a greater than 50% reduction in plasma prolactin within five hours in 22 of 26 patients. Over the course of one month, five patients with significant pituitary fossa enlargement appeared to show less rapid suppression of plasma prolactin than five patients without fossa enlargement. At two months this trend was still evident but eventually all patients showed acceptable control of plasma prolactin, with the exception of one patient who required pituitary surgery.

Galactorrhoea ceased in 13 of 15 patients, menstrual periods resumed in ten of 13 patients, two patients becoming pregnant first. Potency returned and puberty proceeded in two hypogonadal males. Six of the nine patients requesting treatment for infertility became pregnant. It is concluded that bromocriptine provides effective treatment for galactorrhoea, amenorrhoea or gonadal disorders when there is associated hyperprolactinaemia.
Association of Sick Sinus and Lown‐Ganong‐Levine Syndromes*
Authors: Tonkin A. M. , Heddle W. F. , Robinson M. A.
Published: March 2008

Summary: Association of sick sinus and Lown‐Ganong‐Levine syndromes.

A 38‐year‐old woman presented with syncopal attacks for 27 years. The electro‐physiology techniques which enabled the diagnosis of both sinus node dysfunction (sick sinus syndrome) and presence of an atrionodal bypass tract (Lown‐Ganong‐Levine syndrome) are illustrated.
Transient Metastatic Calcification in Primary Hyperparathyroidism
Authors: Cooper R. A. , Riley J. W. , Middleton W. R. J. , Wiseman J. C. , Hales I. B.
Published: March 2008

Summary: Transient metastatic calcification in primary hyperparathyroidism.

Metastatic calcification has been visualised on bone scan in many hypercalcaemic states. This report illustrates the phenomenon occurring in a patient with primary hyperparathyroidism and its subsequent disappearance after therapy.
Pharmacokinetics of Non‐Steroidal Anti‐Inflammatory Agents
Authors: Champion G. D. , Graham G. G.
Published: March 2008

Summary: Pharmacokinetics of non‐steroidal anti‐inflammatory agents. G. D. Champion and G. G. Graham, Aust. N.Z. J. Med., 1978, 8, Suppl. 1, pp 94–100.

The non‐steroidal anti‐inflammatory drugs (NSAID) are well absorbed from the gastrointestinal tract. The only known exception is aspirin. The availability of aspirin is 70% or less due to hydrolysis in the gastrointestinal tract or during first pass through the liver. However, the remainder is absorbed as its pharmacologically active metabolite, salicylate. The NSAID are extensively bound to plasma proteins but the clinical significance of interactions between NSAID due to displacement from plasma proteins is not known. The two compartment open model generally describes the disposition of the NSAID. Both the volume of distribution (Vd
ss
) and clearance of NSAID are low, the volume of distribution being below 0.2 1/kg and clearance below 200 ml/minute in most cases. The concentrations of NSAID in synovial fluid increase slowly after single doses then decrease with similar half‐lives to the terminal ha If‐lives in plasma. Nonlinear kinetics with greater than predicted accumulation occurs with salicylate, sulindac sulphide and possibly alclofena. By contrast, at high doses, the accumulation of naproxen and phenylbutazone is less than predicted. Approximately 50% of doses of azapropazone are excreted unchanged but other NSAID are inactivated by hepatic metabolism and little of the NSAID are excreted unchanged in urine. Because of interpatient differences in pharmacokinetics, dosage regimens of NSAID should be individualised.
Increased Active Rosette Formation in Patients with Gastrointestinal Cancer after Enzyme Treatment of Lymphocytes In Vitro*
Authors: Walters B. A. J. , Rutherford J. C. , Wall J. R.
Published: March 2008

Summary: Increased active rosette formation in patients with gastrointestinal cancer after enzyme treatment of lymphocytes in vitro. B. A. J. Walters, J. C. Rutherford and J. R. Wall, Aust. N.Z. J. Med., 1978, 8, pp. 610–614.

Total rosette forming cells (RFC) and active rosette forming cells (ARFC) were estimated in 33 patients presenting with gastrointestinal symptoms suggestive of cancer. When the 33 patients were grouped according to whether they had cancer or not, there was a distinct difference in the percentage of ARFC (P < 0001 Mann‐Whitney Test); patients with cancer having much lower values (mean 11 6 ±4–5) than patients without cancer (mean 27 2 ± 3–6). Total RFC were generally lower in the cancer group (mean 54‐8 ± 8‐3) than the non‐cancer group (mean 71‐9 ± 4–5) a/though the range was greater. After treatment of the lymphocytes with papain, the percentage of ARFC increased. In the non‐cancer group the levels reached a mean of 74‐8 ± 1–8, indicating that the T lymphocyte population (mean 71‐9 ± 4–5) was converted into cells all having high affinity receptors for sheep red blood cells (SRBC). In the cancer group, after papain treatment of the lymphocytes, the percentage of ARFC increased to levels greater than that obtained for total RFC, suggesting a contribution from the null cell population. Serum taken from these patients was shown to produce a decrease in the percentage ARFC obtained from normal, young individuals. Further, this decrease could be partially reversed by papain digestion indicating that serum from cancer patients may contain a factor that masks T
Ultrasound Tomography of the Liver: Non‐invasive Method of Choice for the Differential Diagnosis of Jaundice
Authors: Chu J. M. G. , Cosgrove D. O. , McCready V. R.
Published: March 2008

Summary: Ultrasound tomography of the liver: Non‐invasive method of choice for the differential diagnosis of jaundice. J. M. G. Chu, D. 0. Cosgrove and V. R. McCready, Aust. N.Z. J. Med., 1978, 8, pp. 615–619.

Grey‐scale ultrasound tomography was used to examine the liver and biliary tree of 100 consecutive unselected jaundiced patients in a prospective study. It was successful in differentiating between hepato‐cellular and obstructive jaundice in 94%. It precisely localised the site of obstruction in 75% of those patients with enlargement of the head of the pancreas from either carcinoma or gall‐stones impacted in the Ampulla of Mater. This figure was reduced to 60% when all cases of obstruction were considered.

Cirrhosis and chronic active hepatitis were found to be associated with an abnormal pattern of echoes within the liver. These echoes were stronger and more numerous than normal. This association was not apparent with drug‐induced cholestasis or acute viral hepatitis.

Grey‐scale ultrasound tomography is quick safe and completely non‐invasive. It should be the initial investigation of choice in the differential diagnosis of jaundice. When precise localisation of an obstruction is not possible after a repeat attempt then percutaneous transhepatic cholangiography should be considered.
Low Dose Lithium‐Carbimazole in the Treatment of Thyrotoxicosis
Authors: Hedley J. M. , Turner J. G. , Brownlie B. E. W. , Sadler W. A.
Published: March 2008

Summary: Low dose lithium‐carbimazole in the treatment of thyrotoxicosis. J. M. Hedley, J. G. Turner, B. E. W. Brownlie and W. A. Sadler, Aust. N.Z. J. Med., 1978, 8, pp. 628–630.

Fifteen patients with thyrotoxicosis were treated with low dose sustained release lithium carbonate 400 mg, combined with carbimazoie 40 mg daily, and the therapeutic response was followed over a two week period. This response was compared with that obtained in a similar group of patient treated with carbimazoie alone. Li‐carbimazole treatment brought about a fall in the mean total serum T4 of 57 4% compared with a drop of 328% in patients treated with carbimazoie alone. The mean serum T3 fell by 69‐4% in the Li‐carbimazoie group compared with 47‐3% in the group treated with carbimazoie only. No lithium adverse effects were encountered.
Migraine Attacks and Increased Platelet Aggregability Induced by Oral Contraceptives
Authors: Mazal S.
Published: March 2008

Summary: Migraine attacks and increased platelet aggregability induced by oral contraceptives. S. Mazal, Aust. N.Z. J. Med., 1978, 8, pp. 646–648.

A case where common and complicated migraine attacks appeared during the course of oral contraception is reported. The attacks of complicated migraine also continued to appear after the contraceptives were stopped. Increased platelet aggregability was found at the time when the complicated migraine attacks were frequent and, therefore, treatment with dipyridamole and aspirin was given. At the time when a gradual reduction of the platelet aggregability was observed, a decrease in the frequency, and eventual disappearance of the complicated migraine attacks was simultaneously seen. Causal relationship between increased platelet aggregability and complicated migraine attacks is suggested.
Thromboembolic Complications of Mitral Valve Disease
Authors: Neilson G. H. , Galea E. G. , Hossack K. F.
Published: March 2008

Summary: Five hundred and eighty‐eight patients with mitral valve disease were studied.

The incidence of systemic emboli was found to be higher in patients with pure mitral stenosis (16‐6%) and mixed mitral stenosis and incompetence (19‐4%) than in patients with mitral incompetence (3‐1%).

The patients with mitral stenosis who had episodes of systemic emboli tended to be older than 40 years, with moderate or severe valve lesions, atrial fibrillation and moderate or gross enlargement of the left atrial appendage or left atrium.

The following factors were found to be unrelated to systemic embolism–associated aortic valve disease, sex, smoking habit, history of rheumatism, parity, haemoglobin, blood urea, pulmonary hypertension, duration of antifailure treatment, presence of heart failure, and cardiothoracic ratio.
Gentamicin and Amikacin–An in vitro Comparison using 1000 Clinical Isolates
Authors: Forgan‐Smith W. R. , McSweeney R. J.
Published: March 2008

Summary: The in vitro antimicrobial activities of gentamicin and amikacin against WOO bacteria/ isolates from clinical material were compared. The minimum inhibitory concentrations were determined by an agar dilution technique. Both of these aminoglycoside antibiotics had a similar spectrum of activity, being highly active against most species of aerobic Gram negative bacilli. Gentamicin was more active than amikacin against most species of enterobacteria, Haemophilus influenzae and Staphylococcus aureus but amikacin was more active against a proportion of Klebsiella and Providencia isolates. For most isolates, the differences in activity between gentamicin and amikacin were small, however, amikacin achieves higher serum levels. Most resistant isolates in this survey did not influence patient mortality.
Social Factors and Clinical Disease: A Checklist Data Base for Correlative Analysis
Authors: Stanley J. R. , Lamber R. P. , Buckley J D. , Mackay I. R.
Published: March 2008

Summary: The adequate care of a patient entails consideration of his social and psychological problems in addition to the relevant medical data. To facilitate this integrated approach, a Social Work Indices Checklist (SWIC) is described, and its use in practice is illustrated. A narrative report is generated from a possible 3095 items of information recorded in SWIC.
The Relationship Between the Control of Diabetes Mellitus and Circulating Glycosylated Haemoglobin A1
Authors: Stanton K. G. , Davis R. E.
Published: March 2008

Summary: The mean glycosylated haemoglobin A, level in 200 diabetics, 13‐2%±2–6 (1SD), was nearly twice the level found in 100 non‐diabetics, 7–42%±0–6 (1SD), and overlap between the two populations was minimal. Glycosylated haemoglobin A, levels, fasting and two hour post‐prandial blood glucose concentrations and 24 hour urinary glucose excretion were measured at intervals over a period of 12 weeks in six diabetics requiring stabilisation. A close correlation was found between glycosylated haemoglobin Ay levels and short term parameters of control.
Coxsackie Myocarditis Complicating Treatment of Hodgkin's Lymphoma
Authors: Cohn David
Published: March 2008

Summary: A fatal case of Coxsackie 64 myocarditis complicating treatment of Hodgkin's lymphoma in an adult is reported. The virus was isolated from the myocardium obtained at autopsy and light microscopy confirmed a myocarditis with involvement of the conduction system. Electron‐microscopy showed dense mitochondrial inclusions. Coxsackie myocarditis rarely results in death of affected adults. It is postulated in this case that the treatment of the Hodgkin's lymphoma resulted in B lymphocyte depletion, allowing a more virulent infection to occur with resultant fatal myocarditis.
Immunoglobulin Deposition in the Kidney in Pre‐Eclampsia: Its Significance
Authors: Gallery Eileen D. M. , Gyory A. Z.
Published: March 2008

Summary: Renal biopsies from two patients with classical toxaemia of pregnancy demonstrated heavy deposition of IgG and IgA in a predominantly finely granular pattern. It is suggested that this may be a manifestation of immune complex formation and may provide further evidence for an immunological basis for the renal lesion of this poorly understood disease process.
Repeated Shunt Surgery in a Patient with Portal Hypertension
Authors: Dudley F. J. , Young G. P. , Mclnnes I. E.
Published: March 2008

Summary: A 45‐year‐old male with chronic active hepatitis and portal hypertension had a mesocaval interposition graft performed because of repeated uncontrolled bleeding from oesophageal varices. Acute hepatocellular failure, manifested by Grade IV encephalopathy and severe coagulopathy, developed early in the post‐operative course despite the absence of hepatic necrosis or other precipitating factors. Both encephalopathy and coagulopathy resolved rapidly following ligation of the shunt. Variceal bleeding recurred and nine months later an emergency distal lienorenal shunt was performed. Post‐operatively the shunt was shown to be patent and there has been no encephalopathy or recurrence of variceal bleeding. It is concluded that (1) the splanchnic haemodynamic effects of a mesocaval interposition graft can result in severe hepatocellular failure and this can be reverted by shunt ligation and (2) the distal lienorenal shunt, while effectively reducing the risk of haemorrhage from varices, may be less likely to result in post‐operative encephalopathy than more conventional forms of portal decompressive surgery.
Retroperitoneal Fibrosis, Methysergide and Malignant Lymphoma
Authors: Hurley B. P. , Macarthur E. B. , Utley G. L.
Published: March 2008

Summary: A patient who developed retroperitoneal fibrosis on low dose continuous methysergide therapy is presented. Discontinuing the drug led to rapid clinical improvement but the patient was subsequently found to have disseminated malignant lymphoma. This may have had a synergistic effect with methysergide in producing retroperitoneal fibrosis. The patient had also previously had thyrotoxicosis but no evidence of a continuing autoimmune process was found.
Normal Infant after Treatment of Acute Myeloid Leukaemia in Pregnancy with Daunorubicin
Authors: Lowenthal R. M. , Marsden K. A. , Newman N. M. , Baikie M. J. , Campbell S. N.
Published: March 2008

Summary: Daunorubicin, thioguanine and cytosine arabinoside were administered from the 17th to 34th weeks of pregnancy in a 23‐year‐old patient with acute myeloid leukaemia. The patient went into remission of her leukaemia, and a normal male infant was born after labour was induced in the 40th week. This experience supports the view that modern regimens of anti leukaemic drugs may be administered during the second and third trimesters of pregnancy without harmful effects on the foetus.
Primary Selective Deficiency of Immunoglobulin M
Authors: Thong Y. H. , Maxwell G. M.
Published: March 2008

Summary: Selective deficiency of IgM as a primary disorder is seldom encountered1–3, and the syndrome remains ill‐defined. It is generally accepted that for a diagnosis to be made, the serum IgM level should be consistently below 2 SD of normal, no other immunodeficiencies are present, and it is not secondary to other disease processes. This report of an additional case may provide further insight into this rare disease.
Lymphoblastic Transformation of Ph1 ‐Positive Chronic Myeloid Leukaemia: Therapeutic Implications and Relevance to Haemopoietic Stem Cell Theory
Authors: Woodruff R. , Roberts Marion
Published: March 2008

Summary: A proportion of patients with blast crisis of CML have blast cells identical to those found in common non‐T, non‐B ALL, and whilst this disease is often referred to as lymphoid blast crisis (LBC), evidence is presented that it may in fact arise from a pre‐lymphoid, pre‐myeloid (pluripotential) stem cell. Recently developed membrane and enzyme markers (anti‐ALL antiserum, TdT assay) have provided convenient diagnostic tests for the detection of LBC. The clinical and haemato/ogical features of LBC are reviewed: patients with LBC show a higher response rate to therapy with vincristine and prednisolone, and their survival may be significantly prolonged. The frequent occurrence of meningeal leukaemia suggests the need for prophylactic CNS therapy in LBC patients achieving remission.
Warfarin and Warfarin‐Alcohol Levels in Anticoagulated Patients
Authors: Duffield P. , Duffield A. M. , Kennedy M. , Birkett D. J. , Wade D. N.
Published: March 2008

Summary: The relationship between dosage, prothrombin ratio, and steady‐state plasma concentrations of warfarin and warfarin‐alcohol, were determined in 43 patients regularly attending an anticoagulant clinic.

The warfarin and warfarin‐alcohol concentrations were determined by a gas chromatographic mass spectroscopic (GC/MS) method. A significant correlation was found between the dose and the plasma level of warfarin. There was no significant correlation between the prothrombin ratio and the dose of warfarin, the steady‐state plasma levels of warfarin or warfarin‐alcohol, or the sum of their plasma concentrations.

Measurement of the plasma levels of warfarin and warfarin‐alcohol is likely to be of little help clinically other than to detect failure of compliance or malabsorption.
The Validity of Screening for Hypercholesterolaemia at Different Ages from 2 to 17 Years*
Authors: Boulton T. J. C.
Published: March 2008

Summary: This study was designed to test the proposition that an optimal age for screening for hypercholesterolaemia (HC) might be defined. The samples of children studied included 200 two‐year‐olds, 385 four‐year‐olds, and 230 primary and secondary children aged from eight to 17 years.

The 95th percentile value for total serum cholesterol (TC) was used to define HC in children and to select children for family studies. Four of the 15HC two‐year‐olds had an HC parent with three having a history of early coronary heart disease (CHD). Twenty‐three of the 310 parents sampled had HC, 15 having a family history of early CHD, but only four having an HC child.

Family studies were done on 20 HC four‐year‐olds of whom half had a positive family history of premature coronary heart disease (CHD). Half of each group of parents were HC, but probable familial hypercholesterolaemia (FH) was detected only in three parents, environmental causes accounting for the HC of the others.

Four primary and five secondary school students were HC, and selected for family studies. A positive family history of CHD was present in two of the primary and all of the secondary students, with five of the seven families having one or more HC parent, one having probable FH.

It is proposed that programmes for detecting HC in childhood become valid only from four years of age, and that the presence of a positive family history of early CHD would reduce the proportion of children to be tested to a practical level without significantly impairing the accuracy of the case finding procedure. School entry might provide a suitable time to identify children with HC.
Duration of Action of Pentaerythritol Trinitrate and Nitroglycerine: A Comparison Using Exercise Performance and Haemodynamic Alterations
Authors: Vohra J. , Baker G. , Ross D. , Hunt D. , Sloman G.
Published: March 2008

Summary: The duration of action of pentaerythritol trinitrate (PTN), an organic nitrate for sublingual administration, was compared with that of nitroglycerine (NG) by exercise testing and haemodynamic measurements.

A group of ten patients (exercise study A) with effort induced angina were exercised on a bicycle 15 and 45 minutes after double blind randomised administration of PTN, NG or a placebo. Each patient was exercised on three separate occasions and acted as his own control. The results showed that PTN was effective at 15 and 45 minutes (P = < 0.01 and <0.02) while NG was active at 15 minutes but not at 45 minutes (P = <0.01 and >0.05).

Another group of nine patients (exercise study B) were exercised at 15, 45, 90 and 120 minutes and the exercise performance was significantly improved at 15, 45 minutes (P <0.01), it was better than NG at 90 minutes but did not reach statistical significance (P>0. 05) but did so at 120 minutes (P<0.02).

The longer duration of action of PTN was further confirmed by haemodynamic measurements in 18 patients with chronic congestive cardiac failure who were treated with NG or PTN. The fall in mean right atrial (mRA) and mean pulmonary artery wedge (mPAW) pressure in patients treated with NG was maintained up to 30 minutes while patients who received PTN showed a fall in mPAW following PTN which lasted up to 120 minutes.

We conclude that PTN has a significantly longer duration of action than NG and may have a place in treatment of patients with ischaemic heart disease and cardiac failure where longer acting sublingual nitrates are indicated.
Systemic Lupus Erythematosus Presenting as Post‐partum Chorea
Authors: Thomas D. , Byrne P. D. , Travers R. L.
Published: March 2008

Summary: A case of systemic lupus erythematosus (SLE) is reported in which chorea was the dominant clinical feature, and which presented following a spontaneous mid‐trimester abortion. The diagnosis, natural history and management of this uncommon manifestation of CNS lupus is discussed, as well as the influence of pregnancy on disease activity in SLE.
The Management of Primary Hyperparathyroidism
Authors: Posen S. , Clifton‐Bligh P. , Mason R. S.
Published: March 2008

Summary: With the advent of serum parathyroid hormone assays the diagnosis of hyperparathyroidism has become relatively straightforward. Current unresolved problems comprise the selection of patients for surgery, the pre‐operative localization of lesions and the medical management of patients who, for one reason or another, are unsuitable for surgery.
Verapamil in the Management of Hypertensive Patients
Authors: Lewis G. R. J. , Morley K. D. , Maslowski A. H. , Bones P. J.
Published: March 2008

Summary: The hypotensive action of verapamil given orally was assessed in the outpatient management of patients with raised blood pressure, in a single blind study.

Twenty‐six hypertensive patients on no therapy, 14 on beta blockers and eight on methyldopa were more satisfactorily controlled when verapamil was substituted for the initial drug. There was a marked reduction in the number of side‐effects, and the drug was given in many situations where beta blockade was contra‐indicated.
Limitation of Myocardial Infarct Size: Review of Experimental Basis and Clinical Trials
Authors: Thompson P. L.
Published: March 2008

Summary: Limitation of myocardial injury after coronary occlusion is an exciting, recently recognised, but as yet unconfirmed, possibility in the treatment of myocardial infarction. Review of the experimental basis for the concept indicates that although manipulation of the ST segment of the electrocardiogram is not sufficient proof that myocardial necrosis can be limited, more robust experimental methods have confirmed the efficacy of a variety of interventions in experimental coronary occlusion. The effect of myocardial infarct size in determining acute prognosis and complications has been confirmed in clinical studies though the importance of infarct size lessens after recovery. Reported attempts at limiting myocardial necrosis in patients with myocardial infarction have so far not been sufficiently convincing to merit universal clinical application. Results of large scale randomised trials currently underway are awaited with interest.
Treatment of Acromegaly with Bromocryptine
Authors: Steinbeck K. , Turtle J. R.
Published: March 2008

Summary: Twelve acromegalic patients with clinical and biochemical evidence of active disease were studied whilst on bromocryptine (Sandoz) at a maximum dosage of 10–60 mg. The patients were followed for a period of 9–23 months.

Clinically, ten patients showed a reduction or disappearance of sweating and seven patients had a reduction in soft tissue mass. Of the five patients who had diabetes prior to treatment, three reverted to normal glucose tolerance during treatment.

Biochemically, there was no difference between mean plasma levels of growth hormone (hGH) before and on maximum therapy with bromocryptine. There was a significant difference between fasting plasma hGH before treatment with bromocryptine and following treatment for 9–23 months in five individual patients.

Side effects were not disabling in this series except for a reversible paranoid psychosis in one patient. The overall results are disappointing; although some clinical features improved, plasma hGH levels returned to normal in only three patients. Bromocryptine has a limited place in the management of acromegaly for those patients in whom conventional therapy has been ineffective or is contraindicated.
Treatment of Acromegaly with Bromocriptine
Authors: Wang C. , Chan V. , Yeung R. T. T.
Published: March 2008

Summary: Five men and three women with active acromegaly were treated with bromocriptine. After three months' therapy (30 mglday) mean GH during the day decreased by 50% in six out of eight subjects. In the remaining two subjects (non‐responders) GH was persistently over 100 μg/1. Mean GH during glucose tolerance test were not significantly decreased in three out of the eight subjects, of whom two were the non‐responders. The minimum dose of bromocriptine required to achieve maximum GH suppression ranged from 7·5 to 20 mglday. In contrast, serum prolactin (PRL) throughout the day suppressed significantly in all subjects after 5 mglday bromocriptine.

Decreases in clinical symptoms, hand volume, urinary hydroxyproline and calcium excretion were seen in about half of the subjects. Three of the four subjects with diabetes metlitus showed improvement in glucose tolerance. Although minor side effects were uncommon, one patient died because of massive gastrointestinal haemorrhage from a duodenal ulcer.
Some Properties of the Colony Forming Cell in Adult Acute Leukaemia
Authors: Rickard K. A. , Brown R. D. , Yuen E. , Joshua D. , Wilkinson T. , Kronenberg H.
Published: March 2008

Summary: Variations in the concentration and physical characteristics of the bone marrow derived colony forming cell (CFC) have been studied in patients with acute leukaemia. Two‐hundred‐and‐fifteen marrow samples from 83 patients provide the basis for this analysis.

CFC concentration confirmed the clinical remission/relapse status and yielded some guidelines to prognosis in individual patients while the proportions of CFC in DNA synthesis also proved to be a most reliable indicator of disease status. In remission, CFC concentrations return to normal values whilst on presentation and in the relapse phase of acute leukaemia CFC numbers are reduced. Biophysical profiles of CFC established using albumin density gradient and velocity sedimentation studies also indicated the state of the leukaemic process in individual patients. By applying physical laws to the data obtained from such profiles, the mean volume, diameter, density and mass of CFC were calculated. CFC from leukaemic patients in relapse were up to twice the volume and mass although slightly less dense than CFC from normal patients. The reasons for these changes are explained and discussed.
Plasma Renin Activity and Hypertension in Acute Glomerulonephritis*
Authors: Shahabuddin S. H. , Nor M. M. , Abdullah A. M. , Mosdeen F.
Published: March 2008

Summary: The relationship between plasma renin activity (PRA), plasma volume (PV) and mean arterial pressure (MAP) in children with acute glomerulonephritis was assessed in two groups of patients between the ages of three to six years. One group with normal blood pressure (13 children) and a group with significantly elevated blood pressure (20 children) were compared with a control group of ten normal children.

In patients who developed hypertension (MAP: 113 ± 3 mmHg), the mean PRA was 0±45 ± 0±1 ng/ml/hr, and the mean PV measured in ten of these children was 1526 ± 47±9 ml/M2. In the group of normotensive patients with acute glomerulonephritis (MAP = 79 ± 1±8 mmHg), the mean PRA was 1±6 ± 0±32 ng/ml/hr, the mean PV in four of these patients was 1285±37±6 ml/M2. The children in the control group (MAP = 77± 1±6 mmHg) had a mean PRA of 7±93 ± 0±2 ng/ml/hr and six of these children had a mean PV of 1115 ± 103 ml/M2.

The results showed children who developed hypertension had significantly higher PV lower PRA than children with acute glomerulonephritis who were normotensive and the control subjects. A positive correlation was found between MAP and PV and negative correlation between MAP and PRA. There was no significant difference in MAP, PV and PRA between children with acute glomerulonephritis with normal blood pressure and children in the control group.
The Relevance of 25‐Hydroxycalciferol Measurements in Sera of Patients with Renal Failure*
Authors: Mason R. S. , Moddel D. , McElduff A. , Stewart J. H. , Mahony J. F. , Posen S.
Published: March 2008

Summary: Iliac crest biopsies and serum specimens were obtained from 36 non‐dialyzed uraemic patients. The mean serum 25‐hydroxycalciferol concentration of the patients was lower than that of normal subjects and a significant correlation was found between 25‐hydroxycalciferol values and the severity of osteomalacia. Parathyroid osteopathy was significantly correlated with serum immunoreactive parathyroid hormone but not with serum 25‐hydroxycalciferol values.

While normal serum 25‐hydroxycalciferol concentrations in uraemic patients do not exclude the presence of osteomalacia, a low concentration is virtually diagnostic of this disorder.
Measurement of the End‐Organ Responses to Aldosterone in Man: Diversity of Response and its Possible Biological Significance
Authors: Adam W. R. , Mendelsohn F. A. O.
Published: March 2008

Summary: The renal (potassium and sodium ratios) and rectal (potential difference) response to an infusion of aldosterone were measured in 13 hypertensive subjects. The correlation between these two responses was highly significant though the magnitude of the response varied widely between subjects. The variation in response between subjects showed no correlation with the change in, or maximal plasma level of, aldosterone and was thus thought to reflect a diversity in the end‐organ response to aldosterone between subjects.

Biological significance of the diversity of response is suggested by the closer correlation between aldosterone excretion and aldosterone effect when the individual's particular responsiveness to aldosterone is taken into account. Thus the 24‐hour urine K+/Na+ (as a measure of the aldosterone effect) shows a relatively poor correlation with 24‐hour urine aldosterone excretion (r = 0·63, P > 0·05). Compared with this, the 24‐hour urine K +/N/a+ shows an improved correlation with the product of the 24‐hour urine aldosterone factored by an index of the individual's responsiveness (r = 0·83, P < 0·01).

The diversity of end‐organ responsiveness makes interpretation of “normal” aldosterone levels difficult, and may explain some cases where there is evidence suggestive of hyper‐aldosteronism with “normal” levels of aldosterone. To examine such a possibility, one such case of a patient with hypertension, “normal” but non suppressible aldosterone excretion and episodic hypokalaemia is presented in detail.
Familial Relative Polycythaemia due to Haemoglobin Heathrow
Authors: Beard M. E. J. , Hamer J. W. , Brennan S. O. , Jones J. N. , Sheat J. M. , Maclaurin J. S.
Published: March 2008

Summary: Eleven affected members of a New Zealand family carrying the high oxygen affinity haemoglobin Heathrow are described. The detection of high oxygen affinity abnormal haemoglobins may be difficult as haemoglobin and red cell mass may both fall within the normal range and no abnormality may be detected on haemoglobin electrophoresis or by haemoglobin stability tests. The importance of oxygen affinity studies to establish the diagnosis is emphasized.