bluuebunny/crossref_metadata_2025 huggingface dataset:
Historical assessment of risk factors in screening for osteopenia in a normal Caucasian population
Authors: Elliot J. R. , Ayling E. , Gilchrist N. L. , Turner J. , Wells J. E. , Sainsbury R.
Published: March 2008

Background: Bone mineral density (BMD) can predict fracture, however, the common use of historical risk factors to predict low BMD is unproven.

Aims: To identify significant historical risk factors for osteopenia. To establish predicting equations for BMD and test their ability to identify those who should be referred for BMD scanning.

Methods: Three hundred and twenty female and 131 male volunteers underwent questionnaire assessment of risk factors and BMD by dual photon absorptiometer at hip and spine. Significant risk factors (P < 0.05) were used to construct a linear regression model to predict BMD. This was cross validated on a second sample of 107 females and 131 males selected from the electoral roll analysing the ability to detect those subjects with BMD in the lower third of the age matched normal range.

Results: In women lower BMD at the spine was associated with increased age, decreased weight, smoking, and delayed menarche. Lower femoral BMD was associated with increased age, decreased weight, family history, inactivity, and smoking. In men lower BMD at the lumbar spine was associated with lower weight, and inactivity. Lower BMD at the femur was associated with increased age, decreased weight, family history, and low calcium intake. When cross validated on the second sample, the models produced sensitivity of 86–89% and sensitivity of 25–46%. Referring those with these risk factors could save 10–23% on scanning. Measuring BMD at the site in question remains the only accurate way of assessing an individual's risk of osteopenia. (Aust NZ J Med 1993; 23: 458–462.)
Sequential changes in the bone marrow trephine biopsy in B‐cell chronic lymphocytic leukaemia
Authors: Robertson T. I. , Byth K.
Published: March 2008

Background: Trephine biopsy of the bone marrow is integral to both diagnosis and prognosis in B‐cell lymphocytic leukaemia (B‐CLL), but its usefulness would be enhanced by more information on the type, degree and rate of change that occur over time in histologic pattern and lymphocytic infiltration.

Aims: To investigate these changes by serial trephine biopsy in totally untreated patients, in treatment‐free intervals in treated patients and during intervals of treatment.

Methods: In 82 patients with predominantly early B‐CLL observed for a median of 65 months (13–331), 309 trephine biopsies were carried out, a median of three (two to eight) per patient. The biopsies were classified into nodular, interstitial, mixed and diffuse patterns. Lymphocytic infiltration was subjectively graded into minimal (< 20%), intermediate (20–50%) and majority (> 50%) categories and all changes were compared.

Results: Intensity of infiltration increased through this histologic range, as did the relative risk of death. Survival of patients with > 50% involvement was significantly poorer than those with < 50%. Changes in both lymphocyte numbers and pattern occurred slowly in early disease but quickened as the leukaemia advanced. Under treatment, lymphocytes decreased but the histology did not alter significantly. Examining the marrow for disease progression should be part of regular follow‐up. It may help identify the minority of patients with early disease which will run a more active course and in whom early therapy may yet be indicated. We recommend biopsy at two‐yearly intervals in early disease, more frequently as the leukaemia advances. The minimal, intermediate and majority classification in addition to the histologic pattern is a useful grading. (Aust NZ J Med 1993; 23: 470–476.)
How vancomycin is used in Australasia – A survey
Authors: Duffull S. B. , Chambers S. T. , Begg E. J.
Published: March 2008

Background: Vancomycin serum concentrations have been monitored over the last 30 years in an attempt to avoid dose‐dependent toxicity and enhance efficacy. Current literature recommendations for peak and trough concentrations are usually in the range of 20–40 mg/L and 5–10 mg/L, respectively. Literature recommendations regarding the time at which peak concentrations are measured are highly variable, ranging from immediately after the end of the infusion to three hours post‐dose.

Aims: To identify how vancomycin dosing is being monitored and assess variability in the current practice.

Methods: A survey of microbiology departments and infectious disease physicians in major Australasian hospitals was undertaken. The variability in the current practice was assessed by fitting mean recommendations to a two compartment Bayesian model.

Results: Of the 83 (70%) who replied 71 (86%) monitored vancomycin concentrations. Fifty‐four percent targeted peak concentrations within the range of 20–40 mg/L, and 73% targeted trough concentrations ≤ 10 mg/L. The time of sampling of peak concentrations varied considerably ranging from immediately (12%) to 120 minutes (12%) post‐infusion (median 30 minutes [40%]). The concentration‐time curves resulting from three sets of mean recommendations (“peaks' drawn at: 0, 30 and 120 minutes aiming for a concentration of 35 mg/L with a trough concentration of 10 mg/L) were modelled using a two compartment Bayesian programme. The predicted true peak (maximum) concentrations ranged from 30 to 86 mg/L, despite aiming for identical target concentrations, indicating marked variation in the actual dosing practice.

Conclusions: There is thus considerable variation in the practice of vancomycin therapeutic monitoring which has a major effect on dosing. The main contributing factor is the variable timing of sampling peak concentrations. (Aust NZ J Med 1993; 23: 662–666.)
Managing asthma in accident and emergency departments: an assessment in non teaching hospitals
Authors: Jayasuriya R. , Westley‐Wise V. , Dunn T. , Nydam K. , Jeffs D.
Published: March 2008

Background: The management and follow‐up of asthma patients presenting at Accident and Emergency (A&E) departments have mostly been studied in children's hospitals or specialised teaching hospitals.

Aims: To study the adequacy of assessment, treatment and follow‐up of patients presenting at A&E departments in non‐teaching hospitals.

Methods: A twenty‐five per cent sample of presentations to A&E departments in all public hospitals in the Illawarra for one year was selected for a case note audit. Information on demographics, assessment, management and referral was extracted from the A&E case notes and medical records of cases with documentation of a final diagnosis of asthma. Chi square and Fischer's Exact tests were used for comparisons among hospitals.

Results: Of 359 presentations with a final diagnosis of asthma, 88% were self referred and only 5% were first presentations. Objective measures of airways obstruction was not documented in 34% of admissions and 48% of nonadmissions. There was no documented follow‐up in 28% of cases. The assessment and management of asthma in A&E was significantly poorer in smaller hospitals.

Conclusion: Evidence of high use of A&E as a primary care facility by asthma patients was found in the study. There is a need to implement protocols to optimise assessment and treatment of asthma in smaller hospitals. (Aust NZ J Med 1993; 23: 672–677.).
Interferon alpha and doxorubicin in malignant mesothelioma: a phase II study
Authors: Upham J.W. , Musk A.W. , van Hazel G. , Byrne M. , Robinson B.W.S.
Published: March 2008

Background: Malignant mesothelioma is a tumour which is generally resistant to chemotherapy. While the addition of interferon to chemotherapy improves response rates in some other malignancies, such a combination has not been evaluated in the treatment of mesothelioma.

Aims: To assess the anti‐tumour effects and toxicity of interferon‐alpha combined with doxorubicin in the treatment of pleural mesothelioma.

Methods: Twenty five patients (mean age 54 ± 11 years) were enrolled in a phase II study. All patients had a confirmed histological diagnosis, measurable tumour, a life expectancy of at least three months, and no prior chemotherapy or interferon. Interferon alpha‐2a, 9 × 106 U sc daily, was administered together with doxorubicin 25 mg per m2 i.v. weekly, for 12 weeks. Response status was assessed by tumour measurements on clinical examination and thoracic CT scans before and after treatment.

Results: A partial response was observed in four patients (16%; 90% CI, 8–30%), 11 remained stable, while six had progressive disease. Four patients withdrew within the first month because of toxicity. The median survival of all patients was 11 months (95% CI, 3–19). Dose modification as a result of toxicity was required in all patients. Lethargy, weight loss, leukopenia and vomiting were the most common side effects.

Conclusions: The combination of interferon‐alpha and doxorubicin showed only modest activity and was associated with significant toxicity. It cannot be recommended in the treatment of malignant pleural mesothelioma. (Aust NZ J Med 1993; 23: 683–687.)
Adult congenital heart disease: principles and management guidelines: Part II
Authors: Wilson N. J. , Neutze J. M.
Published: March 2008

Part 1 of this article (Aust NZ J Med 1993; 23: 498–503) discussed the concept of a new medical group of young adults with repaired congenital heart defects. Medical and life issues for these individuals include career prospects, insurability, pregnancy and contraception, genetic counselling, appropriate exercise, risks of non‐cardiac surgery, and the need for infective endocarditis prophylaxis.

Most adults with congenital heart disease lead remarkably normal lives but need intermittent medical follow‐up, some as inpatients. Medical management guidelines are discussed in Part II of this review by highlighting important individual lesions.
Mortality results in GUSTO
Authors: van de Werf Frans
Published: March 2008

The mortality results for the four arms of the GUSTO trial are presented. The 30 day mortality results were as follows: streptokinase (SK) and subcutaneous heparin (n=9796), 7.2%, SKand intravenous heparin (n=10,377) 7.4%, accelerated tissue plasminogen activator (t‐PA) and intravenous heparin (n = 110,344) 6.3%, and combined SK and t‐PA (n=10,328) 7.9%. This is a relative risk reduction of 14% for the accelerated t‐PA regimen compared with the two SK regimens equivalent to an absolute risk reduction of ten lives saved per 1000 patients treated. Predefined subgroups who showed a greater benefit with t‐PA versus SK were patients under the age of 75, anterior infarct location and those treated within four hours of onset of symptoms. (Aust NZ J Med 1993; 23: 000‐000.)
Repeat thrombolysis
Authors: Cross David
Published: March 2008

Since 20% of patients with myocardial infarction (MI) have had a previous infarction, and reinfarction within one year after infarction occurs in 9% of cases, it is important to clarify the role of repeat thrombolysis.

After streptokinase (SK) administration, IgG antibodies rise to a peak at two weeks and slowly fall over the next 12 months, but 50% of patients still have antibody levels sufficient to neutralise a standard dose of SK up to four years after initial SK administration. On this evidence, SK or anistreplase should not be readministered, except perhaps in the first two to three days after initial treatment. The efficacy of tissue plasminogen activator (t‐PA) and urokinase is not affected by prior treatment with SK. (Aust NZ J Med 1993; 23: 749–752.)
The role of angioplasty in acute myocardial infarction
Authors: Ross Allan
Published: March 2008

The role of primary angioplasty versus thrombolytic therapy for the treatment of coronary thrombosis has been the subject of recent randomised trials. They have shown a higher early patency rate after angioplasty with no differences in later patency. Recurrent ischaemia was more frequent after thrombolysis, but the one study that examined myocardial salvage showed no difference. There were fewer intracerebral bleeds in the angioplasty group, but owing mostly to much higher than usual stroke occurrence in the thrombolysis group.

With less than 800 patients in all the studies, no final conclusions can yet be drawn about effects on mortality and larger studies are needed. Primary angioplasty is an option when operators are skilled and the procedure can be done quickly. (Aust NZ J Med 1993; 23: 753–755.)
ISIS 5 possibilities
Authors: Hunt David
Published: March 2008

There are five major therapeutic groups for possible evaluation in the ISIS 5 trial. They include intravenous beta‐blocking agents, glucose‐insulin‐potassium (GIK) therapy, newer anticoagulant and antithrombotic agents (hirudin and Hirulog), newer thrombolytic drugs such as recombinant plasminogen activator (r‐PAJ and surfactant and emulsifying agents such as Rheothrx. Many pilot studies are underway. Selection of agents will depend on the scientific interest of collaborating hospitals as well as the agent's safety and efficacy.
Acute treatment of paroxysmal tachycardia by adenosine
Authors: Ho K.Y. , Wilson N. J. , Smith W. M.
Published: March 2008

Background: Adenosine has proven efficacy in clinical trials and in the electrophysiological laboratory for the treatment of paroxysmal tachycardia.

Aims: To evaluate the efficacy and safety of adenosine administered in a clinical setting by non‐consultant staff.

Methods: Incremental doses of adenosine were administered intravenously to five children and 32 adults during 39 episodes of paroxysmal tachycardia in a clinical setting. Structural heart disease was present in 43% of patients.

Results: Of 35 episodes of narrow complex tachycardia, adenosine terminated 26 of 28 episodes of supraventricular re‐entrant tachycardia (SVRT), one episode of ectopic atrial tachycardia, and induced transient atrioventricular block to reveal atrial arrhythmias in four. Termination of SVRT occurred at a mean (SD) dose of 9.2 (4.0) mg in adults and 0.09 (0.04) mg/kg in children, but two patients had later spontaneous reinitiation of SVRT. Two patients with narrow complex tachycardia who failed to respond to adenosine were subsequently found to have ventricular tachycardia. Adenosine was therapeutic or diagnostic in three of four episodes of broad complex tachycardia. Overall, by intention to treat by the clinician, adenosine was therapeutic or diagnostic in 34 of 39 episodes (87%). Breathlessness (26%), chest tightness (18%) and flushing (18%) occurred transiently. There were no episodes of hypotension. Adenosine was given safely to 15 patients in whom verapamil was considered contraindicated.

Conclusions: Adenosine is a safe treatment for both narrow and broad complex tachycardias; usually effective for the former and diagnostic for the latter.
A comparison of hepatitis C virus (HCV) RNA and – antibody as markers of infection and predictors of infectivity
Authors: Beardsley A. M. , LaBrooy J. T. , Rozen L. , Gowans E. J.
Published: March 2008

Background: The diagnosis of hepatitis C virus (HCV) infection currently relies on the detection of antibody to HCV (anti‐HCV). However, anti‐HCV positivity may indicate past infection, current infection or possibly non‐specific reactivity. For confirmation of current infection the virus needs to be assayed directly and this is possible by the polymerase chain reaction (PCR).

Aims: The aims were to compare HCV RNA and anti‐HCV as markers of infection in two groups of individuals: (i) a heterogeneous group with suspected HCV infection and (ii) a small group of blood and bone marrow donors, and their respective recipients.

Methods: Serum samples were tested for alanine aminotransferase (ALT) as part of a liver function screen, for anti‐HCV by ELISAII, and HCV RNA was detected by PCR. Single round and nested PCR was performed using primers designed from the sequence of the 5′‐untranslated region of the HCV genome.

Results: Of the 36 subjects in the heterogeneous group, 19/22 anti‐HCV‐positive patients with chronic non‐A non‐B hepatitis (NANBH) were viraemic, and the majority (17/19) demonstrated elevated ALT. However, HCV RNA was undetected in seven anti‐HCV‐positive patients, four of whom suffered autoimmune hepatitis Type I and three were low risk blood donors. Of the remaining subjects (seven/36) who were anti‐HCV‐negative, three/seven were HCV‐RNA‐positive and included two with acute post‐transfusion (PT) NANBH and a recent needlestick victim who contracted HCV. In the second group, four individuals (donors), including a mother with a history of drug use, were implicated in transmission to three recipients. ALT levels were normal in all donors but raised in two of the recipients. PCR determined which of two anti‐HCV‐negative blood donors was infectious, confirmed transmission between a bone marrow donor and recipient, and indicated that anti‐HCV detected in a newborn child represented passive transfer of antibody.

Conclusions: Anti‐HCV detected by ELISA II is a useful marker of chronic HCV infection, particularly in association with raised ALT. However, HCV RNA is a superior marker of acute HCV infection, a more reliable predictor of infectivity and is more specific.
Seroprevalence of hepatitis A antibodies among residents of a centre for people with developmental disabilities
Authors: Bell J. C. , Crewe E. B. , Capon A. G.
Published: March 2008

Abstract Background: In February 1993,11 cases of hepatitis A virus (HAV) were identified in permanent residents of a centre for young people with developmental disabilities.

Aims: To define the extent of the outbreak in the centre, to determine the seroprevalence of hepatitis A antibodies (anti‐HAV) in permanent residents, and to ascertain risk factors for serological evidence of HAV infection.

Methods: A cross‐sectional serological survey of 270 permanent residents, aged eight to 40 years, in a centre for people with developmental disabilities, was conducted in western Sydney. Using a radioimmunoassay technique, sera were tested for anti‐HAV (IgM and total antibody). We used logistic regression to determine risk factors for presence of anti‐HAV.

Results: Blood samples were collected from 259 permanent residents (96%). Serological testing revealed anti‐HAV in 128 residents tested (49%). Presence of anti‐HAV was associated with living in specific residential units, and with residents' age and length of stay at the centre, but was not associated with reported behavioural factors.

Conclusions: More than half of the residents of the centre were susceptible to HAV infection. Behavioural characteristics of the residents and their close contact with each other make HAV transmission difficult to control. HAV vaccine should be promoted in communities at risk, such as those with developmental disabilities. (Aust NZ J Med 1994; 24: 365–367.)
Accuracy of reported family history of heart disease: The impact of ‘don't know’ responses
Authors: Silberberg J. , Wlodarczyk J. , Hensley M. , Ray C. , Alexander H. , Basta M. , Hughes J.
Published: March 2008

Abstract Background: Usual ‘Yes/No’ definitions of a family history of heart disease do not allow for ‘Don't know’ responses. In some families, misclassification of family history may result if these are not considered.

Aims: To study the accuracy of family history reporting and the impact of ‘Don't know’ responses.

Methods: We compared reported family history of coronary heart disease (CHD) and cancer among 360 deceased relatives of 59 probands with ‘gold standard’ diagnoses recorded on official death certificates.

Results: For first degree relatives, sensitivity of reporting was 81% for CHD, 86% for any heart disease and 60% for cancer, while for second degree relatives, sensitivity was 73%, 69% and 90%, respectively. When ‘Don't know’ responses were classified as ‘No’, sensitivity in first degree relatives was not affected, but in second degree relatives, it fell to 49%, 41% and 60%, respectively. Specificities were unchanged. These data show that in families where information beyond first degree relatives is considered, failing to account for ‘Don't know’ responses is likely to lead to misclassification of family history of CHD. (Aust NZ J Med 1994; 24: 386–389.)
Rates of progression to end stage renal failure in nephropathy secondary to Type 1 and Type 2 diabetes mellitus
Authors: Bruce R. , Williams L. , Cundy T.
Published: March 2008

Abstract Background: Diabetic nephropathy is now the commonest single cause of end‐stage renal failure (ESRF) in New Zealand.

Aims: To investigate differences in the natural history of established nephropathy in Type 1 and 2 diabetes.

Methods: Retrospective analysis of the rate of progression to ESRF in 17 subjects with Type 1 diabetes (predominantly European) compared to 29 subjects with Type 2 diabetes (all Polynesian). The rate of decline of renal function was determined from serial creatinine measurements (median 5, range 3–8) during progression of chronic renal failure to end stage. Glomerular filtration rate (GFR) was estimated from creatinine measurements using the Cockcroft Gault equation, and the regression slope of these measurements against time was used to determine rate of change of renal function.

Results: GFR fell significantly more rapidly in the group with Type 2 diabetes than in those with Type 1 diabetes: median 1.7 (interquartile range 1.2 to 2.3) mL min‐1 month‐1 vs 1.1 (interquartile range 0.4 to 1.5) mL min‐1 month‐1, p = 0.017. During the study period the mean reduction in diastolic blood pressure in subjects with Type 1 diabetes (15 mmHg) was greater than that in the Type 2 subjects (8 mmHg), but the stage at which antihypertensives were commenced was similar in the two groups. Glycaemic control was worse in the subjects with Type 1 diabetes (p < 0.005). The differences in blood pressure control were not significant on analysis of covariance which indicated that ethnicity was the major determinant of the different rates of decline of GFR between the groups. We conclude that in subjects with diabetic nephropathy the rate of progression to ESRF is more rapid in Polynesians with Type 2 diabetes than in Europeans with Type 1 diabetes. This could contribute to the apparent excess of Type 2 diabetic subjects of Polynesian origin on renal replacement programmes in New Zealand. (Aust NZ J Med 1994; 24: 390–395.)
Phase II study of glycosylated recombinant human granulocyte colony‐stimulating factor after HLA‐identical sibling bone marrow transplantation
Authors: Lickliter J. D. , Roberts A. W. , Grigg A. P.
Published: March 2008

Background: The lengthy period of neutropenia which follows allogeneic bone marrow transplantation (BMT) results in significant morbidity and some mortality. Recombinant human granulocyte colony‐stimulating factor (rhuG‐CSF) effectively reduces neutropenia and morbidity when given after autologous BMT, but has not been adequately investigated in allografts.

Aims: To assess the tolerability, safety and efficacy of rhuG‐CSF after allogeneic BMT.

Methods: rhuG‐CSF was administered to 13 adult patients with haematological malignancies after HLA‐identical sibling BMT. Five μg/kg of rhuG‐CSF was given daily by subcutaneous bolus injection, commencing four hours after marrow infusion and continuing until the neutrophil count was ≥ 1.0 × 109/L on three consecutive days. Graft‐versus‐host disease (GVHD) prophylaxis was cyclosporin and short‐course methotrexate (days 1, 3, 6 and 11). Prophylactic intravenous (IV) antibiotics were administered from the onset of neutropenia. The control group consisted of patients with comparable diagnoses, transplanted before and after the current study using identical supportive care and GVHD prophylaxis policies.

Results: Although time to recovery of the neutrophil count to >0.1 × 109/L was similar, the rhuG‐CSF‐treated patients experienced accelerated recovery to > 0.5 × 109/L, which occurred at a median of 15 days (range 11–21) after marrow infusion in study patients compared to 18.5 days (range 14–41) in the controls (p = 0.04). No significant differences were detected in any of the indices of transplant‐related morbidity examined, including the number of days of fever, the incidence of culture‐positive infections, the usage of antibiotics, the requirement for parenteral nutrition and IV morphine, the maximum severity of mucositis and GVHD, and the day of discharge.

Conclusion: Within the context of this study, rhuG‐CSF had limited impact on the clinical outcome of HLA‐identical sibling BMT. (Aust NZ J Med 1994; 24: 541–546.)
Sheepskins and bedding in childhood, and the risk of development of bronchial asthma
Authors: Flannery E. M. , Herbison G. P. , Hewitt C. J. , Holdaway M. D. , Jones D. T. , Sears M. R.
Published: March 2008

Background: Sheepskin bedding might increase house dust mite exposure and so explain some of the increasing prevalence or severity of childhood asthma.

Methods: Relationships between use of different types of bedding, and diagnoses of asthma, symptoms of wheezing, skin prick test evidence of house dust mite sensitivity, and airway responsiveness to methacholine, were examined retrospectively in a birth cohort of children followed longitudinally to age 15 years.

Results: In the whole cohort, no associations were identified to suggest a causal relationship between use of any type of bedding and development of features of asthma. Although not an a priori hypothesis, we noted that among children with a family history of atopic disease, those who were house dust mite sensitive were more likely to have used an innerspring mattress (29.6% vs 10.2% who had not used an innerspring mattress, ρ= 0.005).

Conclusion: In this subgroup, increased airway responsiveness and mite sensitivity were significantly associated with use of innerspring mattresses, although whether this is a causal or secondary association is not certain. Use of a sheepskin in the bed in early childhood was not an additional risk factor for the development of asthma. (Aust NZ J Med 1994; 24: 687–692.)
Trends in the incidence of end‐stage renal failure due to hypertension and vascular disease in Australia, 1972–1991
Authors: Stewart J. H. , Disney A. P. S. , Mathew T. H.
Published: March 2008

Background: Despite the known protective effects upon renal function of lowering blood pressure in primary chronic renal disease, diabetes and malignant hypertension, the number of patients entering dialysis and transplantation programmes with renal failure due to hypertension or vascular disease remains high.

Aims: To analyse the trends in incidence of arteriopathic end‐stage renal failure.

Methods: Calculation of mean annual age‐ and sex‐specific rates (by decade) and truncated age‐standardised rates for entry into Australian end‐stage renal failure programmes in the period 1972–1991. Statistical analysis by chi‐squared test, assuming a Poisson distribution of cases.

Results: End‐stage renal failure attributed primarily to hypertension or vascular disease fell to less than half its former level over the period of observation in persons aged 15–54 years. This change has occurred only in the diagnostic category ‘malignant hypertension’. Trends in persons aged 55 years and over are more difficult to analyse because of changing criteria for entry into renal failure programmes, but there has been no indication of any fall in incidence.

Conclusions: The aetiology and pathology of arteriopathic renal failure is diverse, with different patterns in young and old adults. The formerly common pathology in young adults is largely preventable by modern antihypertensive therapy, while arteriopathic renal disease in older persons is not. (Aust NZ J Med 1994; 24: 696–700.)
Asthma severity and morbidity in a population sample of Sydney schoolchildren: Part II ‐ Importance of house dust mite allergens
Authors: Peat J. K. , Tovey E. , Gray E. J. , Mellis C. M. , Woolcock A. J.
Published: March 2008

Background: Despite an increasing prevalence of childhood asthma, few studies have quantified the strength of associations between asthma and its aetiological factors.

Aims: To quantify the risk factors associated with childhood asthma and to investigate the characteristics of children most at risk.

Methods: We studied a population sample of 1339 schoolchildren aged eight‐11 years living in Sydney, NSW. Questionnaires were used to measure respiratory illness, histamine inhalation test to measure airway hyperresponsiveness (AHR), skin prick tests to measure atopy and ELISA assay to measure house dust mite allergen (Der p I) levels. ‘Current asthma’ was defined as the presence of wheeze in the previous year and AHR.

Results: The mean Der p I level in 72 homes was 22.5 μg/gm dust which is high compared to suggested thresholds of 2 μg/gm for sensitisation and 10 μg/gm for exacerbation of symptoms. Sensitisation to house dust mites was the most important risk factor for current asthma (odds ratio 7.0, 95% CI 9.4, 22.2). Sensitisation to ryegrass was of minor importance (odds ratio 2.0, 95% CI 1.4, 3.1). The presence of AHR was strongly related to the degree of sensitisation to house dust mite allergen and children with skin wheals greater than 4 mm had frequent morbidity caused by asthma.

Conclusions: To reduce the high prevalence of childhood asthma in NSW, it is imperative that we design interventions which recognise that house dust mite allergens are a dominant risk factor and that children with large skin wheal reactions to this allergen are most at risk for severe illness including disturbed sleep, days missed from school and urgent medical attention.
Anti‐neutrophil cytoplasmic antibodies (ANCA) in myelodysplasia and other haematological disorders
Authors: Savige J. A. , Chang L. , Smith C. L. , Duggan J. C.
Published: March 2008

Background: Anti‐neutrophil cytoplasmic antibodies (ANCA) are typically associated with small vessel vasculitides. They are also found in situations where other autoantibodies are common, sometimes after infections and possibly in individuals who have received multiple blood transfusions.

Aims: The aim of this study was to determine the incidence of ANCA in a variety of haematological disorders, where these predisposing factors may be at work.

Methods: Sera from patients with myelodysplasia (n= 26), acute myeloid leukaemia (AML) (n= 3), and myeloproliferative (n= 25) or lymphoproliferative syndromes (n= 16) were screened for ANCA using a crude neutrophil cytoplasmic extract ELISA and indirect immunofluorescent examination of normal peripheral blood neutrophils. Positive results were confirmed by ELISAs for anti‐proteinase 3, anti‐myeloperoxidase or anti‐elastase antibodies.

Results: ANCA were demonstrated in two patients with myelodysplasia, both with chronic myelomonocytic leukaemia and greater than 5% blasts in the bone marrow. Both of these individuals were infected at the time that ANCA were demonstrated and other autoantibodies were present. One of these individuals had never had evidence of any vasculitis; the other probably developed myelodysplasia after treatment with cyclophosphamide for Wegener's granulomatosis. ANCA were demonstrated in one individual with AML secondary to myelodysplasia. ANCA were also found in a patient with lymphoma in whom autoantibodies against red cells and platelets were already noted. ANCA were demonstrated in one further individual with lymphomatoid granulomatosis, a condition that resembles Wegener's granulomatosis clinically and histologically, but which is treated as a lymphoma. No ANCA were present in any of the patients with myeloproliferative syndromes.

Discussion: ANCA probably occur secondary to immune dysregulation in myelodysplasia and the lymphoproliferative conditions and they are not necessarily associated with the presence of a vasculitis.
Aspirin reduces the incidence of colonic carcinoma in the dimethylhydrazine rat animal model
Authors: Davis A. E. , Patterson F.
Published: March 2008

Background: Epidemiological studies in humans suggest that regular use of non‐steroidal anti‐inflammatory drugs (NSAIDs) especially aspirin significantly decreases the risk of developing colorectal cancer.

Aims: The purpose of this study was to investigate the effect of aspirin on colonic carcinogenesis using the dimethylhydrazine (DMH) colonic cancer model in rats.

Methods: Groups of animals were given daily doses of aspirin either 0, 5, 30 or 60 mg/kg for 18 weeks. Half of each group also received 18 × 30 mg/kg/wk injections of DMH.

Results: Aspirin at doses of 5, 30 or 60 mg/kg/dy had a progressive effect on the reduction of tumour numbers and the percentage of tumours greater or equal to 5 mm in diameter. Aspirin at doses of 30 and 60 mg/kg/dy significantly reduced tumour incidence.

Conclusion: These findings support the epidemiological studies in humans. The rat DMH model would appear to be suitable for investigating the mechanism of action of aspirin in reducing colonic tumour formation.
Screening for genetic haemochromatosis in a rheumatology clinic
Authors: Olynyk J. , Hall P. , Ahern M. , Kwiatek R. , Mackinnon M.
Published: March 2008

Background: Recent data indicate that the prevalence of genetic haemochromatosis (GH) is greater than previously recognised and suggest that this disease is underdiagnosed.

Aims: To determine the prevalence of GH in a rheumatology clinic population.

Methods: Over a 12 month period 339 consecutive patients, mean age 67.0 years, attending a rheumatology clinic were screened for iron overload.

Results: Twenty three patients had elevated initial screening tests (transferrin saturation [Tf %] > 55% ferritin > 500 μg/L). Repeat fasting Tf % and ferritin concentrations were obtained in 20 of these patients. Twelve patients had persistently elevated results, and of these patients four had liver biopsy tissue hepatic iron indices consistent with GH. One patient in the group had the diagnosis established by liver biopsy just before the screening commenced. Thus, the prevalence of GH in this population was 1.5% ‐ five times that anticipated for the general population. Three of the patients with GH presented with an arthropathy which was not characteristic of the disease. The increased prevalence of GH in this group of patients with peripheral arthropathy provides an excellent justification for the routine screening of patients with peripheral arthritis for the exclusion of iron overload.
HLA non‐identical T‐cell‐depleted bone marrow transplantation for primary immunodeficiency diseases
Authors: Giri N. , Vowels M. , Ziegler J. B. , Ford D. , Lam‐Po‐Tang R.
Published: March 2008

Background: Bone marrow transplantation (BMT) is usually the only procedure offering cure for children with life‐threatening immune deficiency disorders, but compatible sibling donors are frequently unavailable.

Aims and Methods: To examine the outcome of HLA non‐identical T‐cell‐depleted BMT carried out between April 1985 and May 1992 in 11 patients with primary immunodeficiency diseases and to seek prognostic factors.

Results: Eight patients achieved sustained engraftment, one after a second BMT. One further patient engrafted transiently, but rejected the graft five months later. Acute graft‐versus‐host disease (GVHD) grade II was seen in one and chronic GVHD was seen in three children. Seven patients survived beyond six months, six with donor T cell and five with donor B cell engraftment. At present, five patients (46%) are alive with immune reconstitution at a median follow‐up of 14 months (range 6 to 78 months). The major factor associated with outcome was the presence of any infection within one week of BMT (p= 0.01). The presence of lung infection also tended to be a poor prognostic factor (p> = 0.06) but did not reach significance, presumably because of the small sample size. HLA non‐identical (parental) T‐cell depleted BMT plays an important role in the cure of children with immunodeficiencies who do not have an identical sibling donor. Survival can be further improved if the diagnosis of immunodeficiency disease is made early and BMT undertaken before significant infections occur.

Conclusions: The availability of T‐cell depleted haploidentical parental bone marrow transplant can be anticipated to improve outcome significantly for children with severe immunodeficiency, especially when diagnosed early.
Experience with the Gianturco‐Roubin stent for abrupt vessel closure complicating percutaneous transluminal coronary angioplasty
Authors: Carey L. , Cameron J. , Aroney C. , Bett N. , Holt G. , Mahononda N. , McEniery P.
Published: March 2008

Background: Emergency coronary artery bypass grafting (CABG) has previously been the only option in the treatment of refractory abrupt vessel closure complicating percutaneous transluminal coronary angioplasty (PTC A), and has been associated with high rates of morbidity and mortality. Intracoronary stenting now provides an alternative to emergency CABG.

Aim: To assess our initial experience with emergency coronary artery stenting as a new technique.

Methods: Retrospective case study review with clinical and angiographic follow‐up.

Results: The Gianturco‐Roubin (GR) stent was deployed in 13 patients in whom PTCA was complicated by abrupt vessel closure refractory to standard balloon techniques. Indications for PTCA were unstable angina (six), stable angina (six) and acute myocardial infarction (MI) (one). The arteries stented included left anterior descending (LAD) artery lesions (eight) and right coronary artery lesions (five). Two patients required urgent CABG, one due to failed stent deployment and one for inadequate control of vessel dissection. In seven of the stented patients the creatine kinase rose to greater than twice the upper limit or normal. Three patients had subacute thrombotic occlusion at seven to 19 days post stent deployment, managed with intravenous thrombolysis or repeat PTCA. At seven months follow‐up, 11 patients were free of angina, two patients had Canadian Heart Association class II angina and there were no deaths. Eleven patients had repeat angiography at mean six months post stent. Five patients had evidence of restenosis managed with repeat PTCA in four and CABG in one.

Conclusions: The GR stent is an effective alternative to urgent CABG in the treatment of refractory abrupt vessel closure complicating PTCA.
The prognosis for end‐stage renal failure in spinal cord injury and spina bifida ‐ Australia and New Zealand, 1970–1991*
Authors: Patrickf G. M. , Mahony J. F. , Disney A. P. S.
Published: March 2008

Background: The outcome of patients with end‐stage renal failure (ESRF) and spinal cord injury or disease has not been clearly documented.

Methods: Fifty patients (two groups: 25 ‐ spinal cord injury, 25 ‐ SB) were identified retrospectively by questionnaire to individual renal units. Additional information was obtained from the Australia and New Zealand Dialysis and Transplant Registry. Dialysis and transplant history, degree of disability and cumulative survival with integrated treatment were compared between the two groups.

Results: Haemodialysis was the most common form of treatment (75.8% of total treatment time in the spinal cord injury group and 66.1% in the SB group). Home or self‐care dialysis for a period of more than six months was achieved in 68% of patients in each group. Ten year cumulative survival with integrated treatment was statistically better in the SB group (p < 0.01). In the 42% of all patients who underwent renal transplantation cumulative patient survival was 94% at one year and 82% at five years, with allograft survival being 73% and 70% respectively. In conclusion ESRF and spinal cord injury or SB has a good prognosis in the longer term with an integrated approach to treatment.

Aims: The aim of this study was to define the prognosis and social consequences for patients with spinal cord injury or spina bifida (SB) treated for ESRF in Australia and New Zealand from 1970 to 1991.
A review of observational studies on the relationship between cholesterol and coronary heart disease
Authors: Calvert G. Dennis
Published: March 2008

The likelihood that an association observed in epidemiological studies is one of cause and effect is often evaluated using criteria first put forward by Bradford Hill. The evidence on whether abnormal concentrations of cholesterol and lipoproteins in the blood plasma cause coronary heart disease (CHD) is considered using Bradford Hill's criteria. Evidence from observational studies, backed by evidence from clinical, animal and laboratory studies, leaves no doubt that a high plasma cholesterol concentration is a cause of CHD.
A prospective study of screening upper gastrointestinal (GI) endoscopy prior to and after bone marrow transplantation (BMT)
Authors: Forbes G. M. , Rule S. A. J. , Herrmann R. P. , Davies J. M. , Collins B. J.
Published: March 2008

Background: Upper gastrointestinal (GI) endoscopic abnormalities are common in symptomatic bone marrow transplant (BMT) recipients but the incidence of occult gastrointestinal disease in these patients is unknown.

Aims: To examine the role of screening upper GI endoscopy before and after BMT.

Methods: Endoscopy was performed routinely on allogeneic (n = 24) and autologous (n = 17) BMT patients before transplant and at 30 and 120 days after transplant.

Results: Twenty‐one of 41 patients (51%) had an endoscopic abnormality on one or more occasions which necessitated a change in treatment. These abnormalities were present in ten of 41 (24%) pre‐transplant endoscopies, ten of 32 (31%) endoscopies at day 30 after BMT, and in seven of 22 (32%) day 120 endoscopies. Abnormalities included mucosal erosions or ulcers (n = 22 endoscopies), infections (n = 5) or previously undiagnosed GI graft‐versus‐host disease (n = 3). Mucosal erosions or ulcers were present in eight of 28 endoscopies despite regular anti ulcer drug therapy.

Conclusions: Screening upper GI endoscopy before and after BMT is generally safe and detects a high yield of significant GI abnormalities. However, it remains to be demonstrated that treatment of these lesions will improve the clinical outcome in BMT recipients without GI symptoms.
Autologous blood stem cell transplantation for haematological malignancy: treatment‐related mortality of 2%
Authors: Atkinson K. , Dodds A. , Milliken S. , Concannon A. , Fay K. , Harris M. , Flecknoe‐Brown S. , Lind D. , McKinley R. , Rutovitz J. , Rosenfeld D. , Harvey M. , Downs K. , Flattery D. , Song J. , Green A. , Quigley V. , Hawkins T.
Published: March 2008

Abstract Background: Lengthy remission or cure has remained elusive for patients with many of the common haematological malignancies. Thus high dose chemotherapy followed by autologous haemopoietic stem cell transplantation is being increasingly utilised in these diseases.

Aim: To assess the safety of high dose chemotherapy and autologous stem cell transplantation in haematological malignancy.

Methods: Forty‐eight patients with haematological malignancy were given high dose chemotherapy followed by an infusion of previously cryopreserved autologous peripheral blood stem cells with (patients with acute myeloid leukaemia [AML]) or without (patients with acute lymphoblastic leukaemia [ALL], chronic myeloid leukaemia, non‐Hodgkin's lymphoma, Hodgkin's disease and myeloma) autologous bone marrow.

Results: All patients except one had sustained engraftment. The median (range) number of days to attain a neutrophil count of 0.5 × 109/L was 12 (10–42) and a platelet count of 20 × 109/L unsupported by platelet transfusions was 15 (eight to 155). Other than oropharyngeal mucositis and febrile neutropenia, morbidity was low. Two patients had haemorrhagic cystitis, one hepatic veno‐occlusive disease and one interstitial pneumonitis; all resolved. The treatment‐related mortality was 2% ‐ a single patient with AML died of failure of sustained engraftment.

Conclusions: Autologous blood stem cell transplantation to support high dose chemotherapy is a relatively safe procedure and its efficacy is currently being explored in a wide range of haematological malignancies. (Aust NZ J Med 1995; 25; 483–489.)
Acute renal failure following cardiac surgery: incidence, outcomes and risk factors
Authors: Mangos G. J. , Horton D. , Brown M. A. , Trew P. , Chan W. Y. L. , Whitworth J. A.
Published: March 2008

Background: Acute renal failure (ARF) is a recognised complication following cardiac surgery, but the incidence varies widely in the published literature and there are no Australian data available to help predict the risks of ARF in patients with pre‐existing renal disease.

Aim: To determine the incidence, outcome and risk factors for ARF following cardiac surgery.

Methods: A retrospective case control analysis of 903 consecutive patients who had cardiac surgery (795 CABG, 68 valve/septal surgery, 40 combined valve/CABG) in 1992‐93. ARF was defined as doubling of serum creatinine concentration (Cr) to >0.13mmol/L if serum Cr was <0.13 mmol/L pre‐operatively, or else a rise in serum Cr of 2:0.10 mmol/L after cardiac surgery. For each subject with ARF, two case control subjects were matched for date of surgery, surgeon, age, sex, type of surgery and pre‐operative serum Cr to permit analysis of the influence of preoperative factors (hypertension, diabetes mellitus, left ventricular systolic dysfunction) and for the comparison of cardiopulmonary bypass time upon the development of ARF. Subsidiary endpoints were mortality, need for dialysis and length of hospital stay.

Results: ARF developed in only 1.1% of patients with ‘normal’ pre‐operative renal function (creatinine 0.13 mmol/L) and none required dialysis. ARF developed in 16%of those with impaired pre‐operative renal function, 20% of whom required dialysis. Mortality from ARF was 13%. The risk of ARF rose from 10.4% in those with pre‐operative serum Cr 0.14‐0.20 mmol/L to 36.8% if the serum Cr was >0.20 mmol/L (p< 0.01). Mortality was higher (4.2%vs 0.7%, p< 0.01) and length of hospital stay longer (14.5 vs nine days [median], p< 0.001) in those with impaired pre‐operative renal function. ARF was more likely in those over 65 years, if valve surgery was included and where there was prolonged cardiopulmonary bypass time.

Conclusions: These data confirm that ARF following cardiac surgery is uncommon without preoperative impairment of renal function but currently carries a mortality rate of 13%. Impaired renal function alone is associated with higher mortality and prolonged hospital stay. Studies to prevent ARF in this setting should focus on the high risk subsets described in this study.
Leptomeningeal and brain biopsy in chronic meningitis
Authors: Anderson N. E. , Willoughby E. W. , Synek B. J. L.
Published: March 2008

Background: The cause is not found in one third of patients presenting with chronic meningitis. Biopsy of the leptomeninges and brain is often recommended in these patients, but the value of a biopsy is uncertain.

Aims: To review the results of leptomeningeal and brain biopsies and their effect on diagnosis and management in patients with chronic meningitis, if the diagnosis was uncertain after clinical assessment, lumbar puncture and radiological investigations.

Methods: The clinical features, investigations and the results of leptomeningeal and brain biopsies were reviewed retrospectively in 25 patients presenting with chronic meningitis between 1967 and 1990.

Results: The biopsy identified the cause of the chronic meningitis in five patients (neoplastic meningitis in three, tuberculous meningitis in one, granulomatous angiitis in one). In 17 patients the biopsy was abnormal but it did not identify the cause (non‐gran‐ulomatous lymphocytic meningitis in eight, granulomatous meningitis in two, non‐specific abnormalities in seven). In two patients the biopsy was normal and in one patient the tissue was used only for culture. The results of the biopsy led to a beneficial change in treatment in two patients but did not influence management in the other patients.

Conclusions: A leptomeningeal and brain biopsy was of limited practical value in diagnosis and management in most patients with chronic meningitis.