bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of lovastatin on serum lipid profile in the treatment of dyslipoproteinaemia in uraemic patients on continuous ambulatory peritoneal dialysis
Authors: Li Philip K. T. , Leung C. B. , Mak T. W. L. , Lui S‐ F‐ , Chiu K. , Lam C. W. K. , Mak G. Y. K. , Lai K. N.
Published: March 2008

Background:
Dyslipoproteinaemia is an important risk factor for cardiovascular disease in uraemic patients on continuous ambulatory peritoneal dialysis (CAPD). Lovastatin is an HMG Coenzyme A reductase inhibitor which is useful in treating non‐uraemic patients with hypercholesterolaemia.

Aims:
We conducted a single blind cross‐over study versus placebo in 10 CAPD patients to examine the effect of lovastatin (20–40 mg) on the serum lipid profile and its safety in uraemic patients.

Methods:
Treatment phases were of eight weeks' duration. Each four weeks' measurements were made of serum total cholesterol (TC), triglyceride (TG), HDL‐cholesterol (HDL‐C), LDL‐cholesterol (LDL‐C), VLDL‐cholesterol (VLDL‐C), Apolipoprotein Al & B (Apo Al & Apo B) and Lipoprotein (a). After eight weeks, lovastatin significantly reduced TC by 29% from 6.7 ± 0.3 (mean±S.E.M.) to 4.8±0.1 mmol/L, LDL‐C by 41% from 4.6±0.3 to 2.7±0.1 mmol/L and Apo B by 32% from 116±7 to 78±3 mg/dl (p<0.01). HDL‐C increased by 8% froml.2±0.1 to 1.3 ±0.2 mmol/L after eight weeks' therapy (p<0.05). TG decreased by 18% from 1.9 ±0.4 to 1.6 ±0.3 mmol/L (p< 0.05). There was no significant difference in changes of other lipid profiles between placebo and drug. No adverse effects of the drug were noted during treatment and the liver function and muscle enzymes were not significantly altered by either drug therapy or placebo.

Results:
Lovastatin appears to be a safe and useful drug in effectively treating dyslipoproteinaemia in CAPD patients. (Aust NZ J Med 1993; 23: 252–257.)
Decreased uptake of L‐cystine by duodenal brush border membrane vesicles from patients with cystinuria
Authors: Furlong T. J. , Stiel D.
Published: March 2008

Background:
The pathophysiology of cystinuria remains unclear. Decreased absorption of L‐cystine across brush border membranes of small intestinal and renal proximal tubular epithelial cells is likely but has not been directly demonstrated.

Aims:
To compare the rates of L‐cystine transport by isolated duodenal brush border membranes of normal individuals and patients with cystinuria.

Methods:
Distal duodenal biopsies were taken from normal individuals and patients with cystinuria. Brush border membrane vesicles (BBMV) were prepared using magnesium aggregation and differential centrifugation and the rates of L‐cystine transport into the vesicles measured using a rapid filtration technique.

Results:
Rates of L‐cystine transport by BBMV from patients with cystinuria were reduced at 5 minute (p = 0.003) and 30 minute (/> = 0.053). Time points, indicating that L‐cystine absorption across brush border membranes is abnormal in cystinuria. (Aust NZ J Med 1993; 23: 258–263.)
Thymic hyperplasia in adults following chemotherapy for malignancy
Authors: Simmonds P. , Silberstein M. , McKendrick J.
Published: March 2008

Background:
The accuracy of the assessment of patients with malignant disease and of their response to chemotherapy has been significantly improved with the routine availability of computerized tomography (CT) scanning. CT abnormalities, however, may be non‐specific, especially after chemotherapy. Rebound enlargement of the thymus gland after chemotherapy induced atrophy is one cause of an abnormal thoracic CT scan on re‐staging.

Aims:
This phenomenon has previously been reported mainly in relation to the treatment of lymphoma and germ cell cancers. This paper highlights the occurrence of thymic hyperplasia after chemotherapy in these and other tumour types.

Methods:
We discuss five cases including three patients with malignancies other than lymphoma in whom thymus enlargement occurred during or after intensive chemotherapy.

Results:
Clear identification of the nature of CT abnormalities after chemotherapy, particularly in the mediastinum, is required prior to embarking on further anti‐cancer treatments. (Aust NZ J Med 1993; 23: 264–267.)
Duplicate reporting of AIDS cases between two neighbouring countries
Authors: Kaldor J. , Carlson R. , Dickson N. , McDonald A.
Published: March 2008

Aims:
To measure the extent and characteristics of cases of duplicate notification of diagnoses of Acquired Immunodeficiency Syndrome (AIDS) between Australia and New Zealand.

Methods:
Cases of AIDS notified to the national AIDS registries in both Australia and New Zealand were identified, using date of birth and a name code. Cases determined to have been notified to both registries were analysed with respect to exposure category, country of birth and country of death.

Results:
Twenty‐six cases of AIDS were determined to be common to both representing 1.1 % of cases notified to the Australian registry and 11.1 % of cases notified to the New Zealand registry. Exposure to HIV was attributed to male homosexual contact for all cases, and a history of injecting drug use was reported more frequently to the Australian registry for the cases in common. For the majority of cases notified to both registries, country of birth was recorded as New Zealand. Deaths following AIDS were reported as occurring in both countries with equal frequency.
Repair of the anterior mitral leaflet*
Authors: Alvarez J. M. , Gray D. , Choong C. , Deal C. W.
Published: March 2008

Background:
Repair rather than replacement of the diseased mitral valve has been the goal of the cardiac surgeon. Although well accepted for posterior leaflet pathology, a diseased anterior leaflet was believed by some to be irreparable.

Aims:
To assess the result of reconstructive mitral valve surgery involving the anterior mitral leaflet in a selected group of patients.

Methods:
Twenty consecutive patients with degenerative (19), ischaemic (one) and congenital/ calcific mitral regurgitation were evaluated. There were five females and 15 males with a mean age of 62 ± 12 years (41–75 years). The technique used to repair these valves included chordal transposition, leaflet plication commissuroplasty and a new technique we call leaflet repositioning.

Result: There were no deaths, follow‐up is complete with mean follow‐up of 31 ± five months (two‐102) months. All patients have had 2DE and 13 TOE as well. There have been no reoperations due to failure of the repair, 95% of patients are in NYHA Class HI post operative, while 15% have significant residual regurgitation. (Aust NZ J Med 1993; 23: 279–284.)
Impact of a national educational campaign to reduce patient delay in possible heart attack
Authors: Bett N. , Aroney G. , Thompson P.
Published: March 2008

:In 1989 the National Heart Foundation (NHF) of Australia's Heart Week campaign was directed towards encouraging those with symptoms of possible myocardial infarction (MI) to seek help as promptly as possible.

To evaluate its effect, three surveys were conducted of patients admitted to 22 coronary care units (CCUs). Two (335 and 221 patients) preceded and one (253 patients) followed the public education campaign. During the third survey a subset of patients were asked why they delayed, how long they thought one should wait before seeking help, whether they were aware of the media campaign and whether this had influenced their behaviour.

Overall, only 42% of 809 patients sought help within one hour (median delay 1.2 hours). The median time of arrival and the proportion of patients arriving within one, two and four hours was not altered after this campaign. Those who admitted to having been aware of the campaign sought help no more promptly. The Heart Week campaign could not be shown to have produced any clinically important change in patient delay. Future campaigns will need to be modified in the light of this experience. (Aust NZ J Med 1993; 23: 157–161.)
Chronic liver disease in asymptomatic hepatitis C antibody positive blood donors
Authors: Hardiman R. P. , Shaw D. R. , Brooy J. T. La , Rozen L. , de Boer W. B. , Rowland R. , Beardsley A. M. , Gowans E. J.
Published: March 2008

:The risks of acquisition of hepatitis C infection, the histological spectrum of liver disease, and the presence of viraemia were investigated in anti‐hepatitis C virus (HCV) antibody positive blood donors. All 357 (0.64%) blood donors to the South Australian Red Cross Transfusion Service found to have anti‐HCV antibody during the first seven months of testing in 1990 were assessed, and 70 (19.6%) were found to have elevated alanine transaminase levels. These subjects were referred for participation in the study; 31 presented for enrolment.

Sixteen (52%) of the 31 patients had previously used intravenous drugs, four (13%) had been transfused, two (6%) had a history of occupational exposure to blood, and three (10%) had tattoos and ear‐piercing as possible risk factors for acquisition of hepatitis C. There was no history of parenteral exposure in six (16%). None of these donors had clinical evidence of liver disease, but in all 24 of the 31 who had a liver biopsy there was histological evidence of significant liver damage. Twelve had evidence of chronic active hepatitis. All 24 subjects biopsied were viraemic as judged by the presence of HCV RNA in serum. (Aust NZ J Med 1993; 23: 176–180.)
Role of T‐cell antigen receptors in rheumatic disease
Authors: Li Z. G. , Manolios N.
Published: March 2008

:The initiation and perpetuation of many rheumatic diseases is believed to be mediated by specific T‐cells activated by an unknown antigenic peptide present on the surface of antigen presenting cells (APC). The T‐cell antigen receptor (TCR) plays a central role in the recognition of antigen and subsequent T‐cell activation. It is thought that a selective TCR repertoire may contribute to the immunopathogenesis of certain inflammatory rheumatic diseases. In this review recent progress in our understanding of TCR usage and their role in a variety of rheumatic diseases will be discussed. In addition, novel immunotherapeutic strategies based on a better understanding of the molecular mechanisms of antigen recognition will be reviewed. (Aust NZ J Med 1993; 23: 205–212.)
Evaluation of mitral valve repair by intraoperative transoesophageal echocardiography
Authors: Kalman J. M. , Buxton B. B. , Jones E. F. , Tonkin A. M. , Lubicz S. , Calafiore P.
Published: March 2008

Background: Mitral valve repair is the procedure of choice in the surgical management of mitral regurgitation. Intraoperative confirmation of successful repair is essential to the effectiveness of this procedure.

Aims: The aims of this study were: (a) to compare intraoperative transoesophageal echocardiography (TOE) with the surgeon's assessment of valve competence; (b) to assess the impact of routine intraoperative imaging on the hospital echocardiography laboratory.

Methods: Eighty‐six consecutive patients undergoing mitral valve repair formed the study population. Valve competence following repair was assessed intraoperatively by: TOE; saline insufflation of the flaccid left ventricle; and evaluation of the pulmonary capillary wedge pressure for the presence of a significant V wave.

Results: TOE demonstrated successful valve repair (≤ 1 + residual regurgitation) in 75 patients (87%) and detected significant residual regurgitation (≥3 +) in seven (8.2%). The mechanism of regurgitation was also clearly shown. Of these seven patients, four underwent immediate valve replacement, two had successful revision of the initial repair and one required valve replacement one week later. In all seven patients the valve repair had been assessed as successful by saline testing and only one had a post‐repair V wave 10 mmHg above the mean pulmonary capillary wedge pressure. In 30 non‐selected patients the imaging equipment was required in theatre for 43 ± 18 minutes.

Conclusions: TOE is currently the most sensitive method for detection and quantitation of residual mitral regurgitation following valve repair. Evaluation can be performed within a similar time to that required for one complete transthoracic study and can usually be performed with minimal disruption to the hospital echocardiography laboratory. (Aust NZ J Med 1993; 23: 463–469.)
Coronary artery surgery in the elderly: long‐term follow‐up
Authors: Ruygr P. N. , Kerr A. R. , Agnew T. M. , Graham K. J. , Coverdale H. A. , Whitlock R. M. L.
Published: March 2008

Background: There has been controversy concerning the indications for coronary artery surgery in the elderly, particularly in countries where health resources are restricted.

Aims: To assess the results of coronary artery bypass grafting (CABG) in a large group of elderly subjects with regard to initial risks and long term follow‐up.

Methods: Ninety‐six consecutive patients aged 70 years or older underwent isolated CABG between January 1981 and December 1985. Long term follow‐up was obtained in 94 (98%).

Results: The mean age was 71.6 years (70–78) and mean duration of follow‐up 73 months. Seventy (73%) were male. In 80 cases the myocardial score was > 10. In 22 of 90 who had left ventricular angiography the ejection fraction was < 50%. Hospital survival was 96% and the five year survival 77%. It was not influenced by gender, myocardial score, ejection fraction or age at the time of operation. The status of survivors was reviewed in 1991. Of the 55 long term survivors 35 (64%) were free of angina. Eight (15%) and ten (18%) were in the Canadian Cardiovascular Society Angina classes 1 and 2 respectively. Seventeen patients (31%) had symptoms of heart failure with 14 (25%) in NYHA class 2 and 3 (5%) in class 3. Eight patients (15%) had survived a cerebrovascular event during follow‐up. There were 35 late deaths (37%). Sixteen of these were cardiac, 18 due to other causes and one unknown. (Aust NZ J Med 1993; 23: 489–493.)
A comparison between estimates of GFR using [99m– Tc]DTPA clearance and the approximation of Cockcroft and Gault
Authors: Cochran M. , John A. St
Published: March 2008

Background: The formula of Cockcroft and Gault, relating age, weight, sex and plasma creatinine is widely used to estimate glomerular function. Its ability to predict [99mTc]DTPA clearance, an accepted measure of GFR, is therefore of interest.

Aim: To test prospectively the reliability of the formula in predicting the [99mTc]DTPA clearance in subjects with normal and sub‐normal renal function.

Methods: The 24 hour creatinine clearance (Ccr), the derived clearance using the formula (Cder), and the [99mTc]DTPA clearance have been compared in 47 male and 47 female subjects, aged between 15 and 71 years. Obese and non‐obese subjects (males >90 kg, females >80 kg body weight) were considered separately.

Results: Across the range of [99mTc]DTPA clearance studied (14 to 125 mL/minute), in non‐obese subjects, both Ccr and Cder were correlated similarly with [99mTc]DTPA clearance in males and females. In obese subjects as a group, Cder was also closely correlated with [99mTc]DTPA clearance but the scatter of data was wider. Among non‐obese subjects, correlations were high between either Ccr or Cder and [99mTc]DTPA clearance values < 101 mL/minute but were not significant at [99mTc]DTPA clearance values > 100 mL/minute. For [99mTc]DTPA clearance values between 14 and 100 mL/minute, Cder was a more direct and more precise predictor of [99mTc]DTPA clearance [DTPA clearance = 1.01(Cder) + 2.34, with 95% confidence limits of ± 18 mL/minute] than of Ccr [Ccr= 1.34(CderC)‐ 10.86, confidence limits ±28 mL/minute].

Conclusion: For very mild through to moderate renal failure, the formula of Cockcroft and Gault can evidently be used as a reasonable estimate of GFR. (Aust NZ J Med 1993; 23: 494–497.)
A comparison between enalapril and captopril on insulin sensitivity in normotensive healthy volunteers
Authors: Pratt M. C. , Lewis‐Barned N. J. , Walker R. J.
Published: March 2008

Background: Captopril has been shown to improve insulin sensitivity in insulin resistant hypertensive individuals and enalapril has been shown to improve insulin sensitivity in a small group of healthy volunteers, but there has been no direct comparison of the effects of the different angiotensin converting enzyme inhibitors (ACEIs) on insulin sensitivity in either insulin sensitive or insulin insensitive populations.

Aim: To compare the impact of two different ACEIs (captopril and enalapril) on insulin mediated glucose uptake in normotensive, non‐obese, insulin sensitive subjects.

Method: A single blind cross‐over study comparing captopril (6.25 mg twice daily) and enalapril (5 mg once daily) for 28 days with a 28 day washout period between drugs. Insulin mediated glucose uptake was measured by means of the euglycaemic hyperinsulinaemic clamp at the start and completion of each period of drug therapy.

Results: Both drugs resulted in elevations of fasting insulin levels (mean difference ± SEM for combined data, 2.7 ± 1.8; p < 0.05) and a reduction in insulin mediated glucose uptake (mean difference for combined data, ‐ 0.72 ± 0.37 mg/kg1 minute‐1; p= 0.056). Results were similar for both agents and suggest a class effect.

Conclusions: The increase in fasting insulin levels, and reduction in insulin mediated glucose uptake in this study are in contrast to findings in obese and hypertensive subjects, and indicate that studies of insulin sensitivity of ACEIs in non‐obese, normotensive subjects are inappropriate for predicting likely effects in clinical practice. (Aust NZ J Med 1993; 23: 652–655.)
Prevention of heart disease by subcutaneous desferoxamine in patients with thalassaemia major
Authors: Richardson M. E. , Matthews R. N. , Alison J. F. , Menahem S. , Mitvalsky J. , Byrt E. , Harper R. W.
Published: March 2008

Background: Cardiac siderosis from transfused iron remains the major cause of death in thalassaemia major, despite iron chelation therapy with desferrioxamine.

Aims: Our aim was to determine the nature and extent of cardiac involvement and its relationship to desferrioxamine use in a group with thalassaemia major.

Methods: We reviewed 76 patients with thalassaemia major and performed multiple logistic regression to analyse factors affecting cardiac involvement. Factors studied included: patient sex, age, haemoglobin, serum ferritin, total transfusions, liver iron, duration of desferrioxamine use, electrocardiograms, echocardiograms and compliance to desferrioxamine treatment. Results: Thirty‐seven patients developed heart disease. They were older (p < 0.001), began desferrioxamine later (p < 0.001), had more liver iron (p= 0.014), higher serum ferritin levels (p= 0.023) and received more blood (p = 0.018). Compared to those with optimal compliance the odds of developing heart disease were increased 10.7 times in fair compilers (p <0.001) and 5.1 times in poor compilers (p= 0.016). However, there was no significant difference between those with fair and poor compliance. After multivariate analysis only compliance (p= 0.02) and age at desferrioxamine onset (p= 0.004) remained significant. Compliance was inversely related to liver iron (p< 0.001), serum ferritin (p< 0.001) and age at desferrioxamine commencement (p< 0.001).

Conclusions: We conclude that late commencement of desferrioxamine and noncompliance are associated with greater iron loading and an increased riskof heart disease. (Aust NZ J Med 1993; 23: 656–661.)
Capillary blood glucose measurements in hospital inpatients using portable glucose meters
Authors: Phillipou G. , Seaborn C. J. , Hooper J. , Phillips P. J.
Published: March 2008

Background: The use of portable glucose meters by nursing staff to perform bedside capillary blood glucose measurements is standard practice in the management of diabetic hospital inpatients. Few studies, however, have examined the practical limitations or the cost of this technology.

Aim: To investigate the performance and cost of capillary blood glucose measurements using portable glucose meters in a hospital inpatient population being managed for diabetes mellitus.

Methods: The setting was a 500 bed metropolitan University Teaching hospital, with 22 meters (Glucometer‐M) in routine use by about 450 accredited nursing staff. The Glucometer‐M was also compared with an operator‐independent meter (Hemocue) to assess the effect of operator bias on the overall efficacy and cost of the programme.

Results: Retrospective analysis of Glucometer‐M reagent strips and comparison of measurements (n = 72) with the Hemocue revealed a marked operator bias which diminished accuracy and increased costs. The significant proportion of low haematocrits (< 30%) in the hospital population limited the applicability of the Glucometer‐M which only operates reliably over the haematocrit range 35–50%. The excess of blood glucose measurements was highlighted by both a hospital ward audit and the frequency which exceeded that of routine electrolyte assays.

Conclusions: Reliable bedside estimation of capillary blood glucose levels in hospitals requires a meter which is accurate, has negligible operator bias, is largely unaffected by haematocrit, and has insignificant risk of cross‐contamination. At present only the Hemocue fulfils these specifications. Irrespective of meter choice, it is necessary to develop criteria for glucose measurements and monitor adherence. (Aust NZ J Med 1993; 23: 667–671.)
Strokes and net clinical benefit
Authors: White Harney
Published: March 2008

The need for careful assessment of stroke incidence in a trial comparing highly effective thrombolytic regimens was recognised in the design of the GUSTO trial. There was a gradation of stroke incidence from 1.22% in the streptokinase (SK) and subcutaneous heparin group, to 1.4% in the SK and intravenous heparin group, 1.55% in the tissue plasminogen activator (t‐PA) and intravenous heparin group and 1.64% in the combination t‐PA and SK group. The concept of net clinical benefit was developed to balance the adverse effect of stroke with the benefit of mortality reduction. On this analysis, the net clinical benefit favoured the accelerated t‐PA regimen over the SK regimens. (Aust NZ J Med 1993; 23: 737–738.) Key words: Myocardial infarction, thrombolysis, heparin therapy, stroke, net clinical benefit.
Reperfusion injury, stunning and myocardial viability
Authors: Tonkin Andrew , Chan Robert
Published: March 2008

Recent experimental data suggest that current thrombolytic strategies may not yet have achieved their full potential for myocardial salvage. In fact, reperfusion may result in microvascular and myocardial cellular injuries. These may translate into transient loss of contractile function (‘myocardial stunning’), and possibly contribute to the ultimate extent of myocardial necrosis. A number of imaging modalities are now available to detect the presence and amount of these dysfunctional but viable myocardial segments. Myocardial reperfusion experiments using animal models have studied possible mechanisms responsible for reperfusion injury. These may help in the search for novel pharmacological and other adjunctive approaches which may overcome potential adverse effects of reperfusion. (Aust NZ J Med 1993; 23: 756–759.)
New thrombolytic strategies
Authors: van de Werf Frans
Published: March 2008

Recent angiographic studies after thrombolytic therapy have shown that the rates of effective coronary reperfusion (TIMI grade 3) is still quite low with currently available thrombolytic regimens. Approaches to improving thrombolytic efficacy include the development of mutants oft‐PA, recombinant staphylokinase and conjugations of thrombolytic agents to monoclonal antibodies targeted to components of the thrombus. The development of more potent conjugative antithrombolysis therapy includes newer antiplatelet agents and selective thrombin inhibitors such as hirudin and Hirulog. Clinical trials of these new approaches are now underway and hold hope for improvement of reperfusion efficacy in coronary thrombolysis.
Hirudin and Hirulog
Authors: White Harvey
Published: March 2008

A brief outline is presented of a proposed trial of Hirulog versus heparin after thrombolytic therapy with streptokinase (SK). The lower patency rates achieved with SK compared with tissue plasminogen activator (t‐PA) suggest that a potent thrombin specific agent may be more important for SK than for t‐PA therapy. This study will involve more than 400 patients with two dose levels of Hirulog. Endpoints will be angiographic patency, and ST segment monitoring showing evidence of coronary reperfusion.
The cost‐effectiveness of treatment of supraventricular arrhythmias related to an accessory atrioventricular pathway: comparison of catheter ablation, surgical division and medical treatment
Authors: Weerasooriya H. Rukshen , Murdock C. J. , Harris A. H. , Davis M. J. E.
Published: March 2008

Background: Treatment alternatives for patients with incapacitating supraventricular arrhythmias related to an accessory atrioventricular pathway include transcatheter radiofrequency (RF) ablation, surgical division and long‐term antiarrhythmic therapy (medical).

Aim: The aim of this study was to compare in terms of cost and efficacy, transcatheter, surgical and medical treatment of patients with incapacitating supraventricular arrhythmias resulting from an accessory pathway.

Methods: The study population consisted of 52 patients who underwent transcatheter RF ablation (20 consecutive patients), surgical treatment (20) and medical treatment (12). Two types of economic analysis were used. In all groups, a resource based costing method was used and in the medical and surgical treatment groups, a diagnostic related group (DRG) based costing method was used.

Results: Eighteen out of 20 (90%) patients who underwent catheter ablation remained asymptomatic during 8.4 ±1.6 months of follow‐up. All surgically treated patients remained asymptomatic during 54 ± 15 months of follow‐up. Only one of the 12 patients in the medical treatment group remained completely free of symptoms during the mean 58 ±23 month follow‐up period. The mean cost (1992 Australian dollars) per patient, calculated on the basis of actual resources used (with a DRG based costing given in brackets), was $2746 ±$800 for catheter ablation, $12141 ±$4465 ($12880 ±$3998) for surgical treatment and $1713 ±$748 ($1967 ±$33) for medical treatment. The total cost of management over 20 years is estimated to be: $2911 for catheter ablation, $17467 for surgery and $4959 for medical treatment.

Conclusions: In the long term transcatheter RF ablation is the most cost‐effective treatment strategy for patients with incapacitating supraventricular arrhythmias related to an accessory pathway.
Heterogeneity in the phenotypic expression of the mutation in the mitochondrial tRNALeu (UUR) gene generally associated with the MELAS subset of mitochondrial encephalomyopathies
Authors: Jean‐Francois M. J. B. , Lertrit P. , Berkovic S. F. , Crimmins D. , Morris J. , Marzuki S. , Byrne E.
Published: March 2008

Background: Point mutations in the mitochondrial (mt) genome underlie a number of neurological disorders. Some are well defined including the myoclonus epilepsy ragged red fibre syndrome (MERRF) and the mitochondrial encephalopathy lactic acidosis stroke like episode syndrome (MELAS). However, other clinical phenotypes are less distinctive and mitochondrial studies are often included in the workup in complex neurological syndromes of uncertain aetiology.

Aims: We investigated 27 consecutive patients with varied clinical phenotypes referred to our laboratory for mtDNA studies to determine the incidence of recognised point mutations in a patient group with a range of phenotypes including many where mt disease was possible but did not fall into a classical syndrome.

Methods: The recognised point mutations were detected by amplification of the appropriate DNA fragment by PCR followed by restriction‐endonuclease digestion of the normal and mutant species.

Results: The A‐G base substitution mutation at nucleotide (nt)3243 in the tRNALeu gene of mtDNA which is present in the majority of cases of MELAS syndrome, was detected in four cases, only one of whom had typical MELAS symptoms. Their clinical manifestations ranged from mild deafness to a mixture of chronic progressive external ophthalmoplegia symptoms (CPEO) and stroke like episodes. The nt3243 mutation was also identified in one of seven mtDNA deletion negative CPEO cases.

Conclusions: The presentation of the mtDNA mutation at nt3243 appears therefore to be quite variable with some mild phenotypes as well as severe phenotypes observed. In general, the chance of finding a mitochondrial point mutation in a patient with an atypical clinical phenotype is small.
Second malignant neoplasms in patients with Hodgkin's disease
Authors: Robinson B. A. , Fitzharris B. M. , Colls B. M. , Atkinson C. H.
Published: March 2008

Abstract Aim: To determine the incidence of second malignant neoplasms in patients treated for Hodgkin's disease.

Methods: The records were reviewed of all patients receiving primary treatment for Hodgkin's disease at the Oncology Service, Christchurch Hospital from 1969 to 1992. Second malignant neoplasms presenting at least six months after the diagnosis of Hodgkin's disease were noted and the cumulative risk estimated.

Results: Twenty‐two second malignant neoplasms developed in 20 of the 209 patients. The risk was 5.6 ± 3.8% (CI) at five years, 11.4 ± 6.2% at ten years, and 21.7 ± 11.2% at 15 years and continued to increase thereafter. Thirteen patients have died of their second malignancy, including two of a third malignancy, while four have been followed for less than one year. Three leukaemias (CML, 1; acute non lymphocytic leukaemia, 2), three lymphomas and 16 solid tumours developed. The risk was greater after six or more cycles of MOPP‐like chemotherapy and after radiation doses exceeding 30 Gray. The risk was less after laparotomy and splenectomy (p = 0.0205).

Conclusions: In view of the significant risk of a second neoplasm in survivors of Hodgkin's disease follow up should continue beyond ten years, after which time second malignancies were more likely than recurrence. Efforts should continue to minimise the carcinogenicity of therapy while preserving efficacy. (Aust NZ J Med 1994; 24: 368–373.)
Trends in bacterial infections in febrile neutropenic patients: 1986–1992
Authors: Gibson J. , Johnson L. , Snowdon L. , Joshua D. , Young G. , MacLeod C. , Benn R. , Iland H. , Vincent P. , Kronenberg H.
Published: March 2008

Abstract Background: Bacterial infection is a major cause of morbidity and mortality in neutropenic patients.

Aims: (1) To review patterns and trends in bacterial infections in three cohorts of febrile neutropenic patients managed by a single unit over a seven year period. (2) To relate any changes to the use of central venous (Hickman's) catheters and high‐dose cytosine arabinoside chemotherapy.

Methods: Retrospective review of the results of initial bacteriological work‐up performed on 344 episodes of febrile neutropenia. The three cohorts were 1986–87 (n= 102), 1989–90 (n= 92) and 1991–92 (n= 150).

Results: (1) The ratio of gram‐negative to gram‐positive bacteraemias fell from 1.36 in the first cohort to 1.05 in the second and 0.40 in the third (p= 0.03). There was a fall in both percentage and number of gram‐negative isolates coupled with a rise in the frequency of gram‐positive isolates. (2) Coincidentally there was a rise in the frequency of positive cultures from Hickman catheter entry wounds and an increasing frequency of simultaneous isolation of the same organism from the catheter entry site and the blood. The types of organisms isolated from catheter entry wounds showed a trend towards fewer gram‐negative and more gram‐positive. (3) A relationship was observed between the use of high‐dose cytosine arabinoside chemotherapy and the incidence of bacteraemia (p= 0.025) but not with the change in types of organisms.

Conclusions: Over seven years we have documented a major change in the types of infections, particularly bacteraemias, seen in febrile neutropenic patients. In our institution the more widespread use of intravenous catheters and high‐dose cytosine arabinoside chemotherapy have been identified as two possible contributing factors. (Aust NZ J Med 1994; 24: 374–377.)
Does beclomethasone dipropionate suppress dehydroepiandrosterone sulphate in postmenopausal women?
Authors: Smith B. J. , Dickeson J. , Buxton J. R. , Heller R. F.
Published: March 2008

Abstract Background: Patients with chronic obstructive airways disease and asthma are at special risk of developing osteoporosis. Previous research has indicated that adrenal androgen levels in postmenopausal women are suppressed by short term high dose inhaled corticosteroids. Such an effect, if sustained, may be a causative factor for long term bone loss. We tested the hypothesis that postmenopausal women receiving ≥1 mg/day inhaled beclomethasone dipropionate, long term, have suppressed dehydroepiandrosterone sulphate levels when compared to postmenopausal controls.

Methods: As part of a larger study, we studied 36 postmenopausal subjects, recruited from regional pharmacies and a hospital chest clinic, who had been receiving treatment for asthma. Subjects were selected if they were receiving ≥1 mg/day inhaled beclomethasone dipropionate (n= 27) or receiving no beclomethasone dipropionate (n= 9). The two groups were compared for dehydroepiandrosterone sulphate levels, age and potential confounders.

Results: Mean dehydroepiandrosterone sulphate levels were 35% lower in the high dose beclomethasone dipropionate group than the control group (p<0.01).

Conclusions: This is the first report of suppression of dehydroepiandrosterone sulphate in postmenopausal women receiving long term inhaled beclomethasone dipropionate. Further research is needed to clarify whether or not there is any associated clinically important adverse effect on bone density. (Aust NZ J Med 1994; 24: 396–401.)
A pseudoepidemic of Mycobacterium chelonae: contamination of a bronchoscope and autocleaner
Authors: Campagnaro R. L. , Teichtahl H. , Dwyer B.
Published: March 2008

Background: At fibreoptic bronchoscopy the potential exists for contamination of bronchoscopes and microbiological specimens. Patients may also be cross infected with acid fast bacilli (AFB). During a five month period, 12 bronchial wash specimens of 65 patients undergoing bronchoscopy, one bronchoscope and an autocleaner, were contaminated with the AFB, Mycobacterium chelonae (MCH).

Aim: To eradicate AFB contamination of bronchoscopy specimens by identifying sources of contamination and modifying disinfection procedures.

Methods: To identify the source of contamination, samples for AFB culture were taken from three bronchoscopes, the autocleaner and water taps. To eradicate MCH contamination, the bronchoscopes were soaked in 2% glutaraldehyde overnight and flushed with 70% alcohol. Disinfection procedures were altered by using sterile water and containers in cleaning. Autocleaner use was discontinued.

Results: The autocleaner, one bronchoscope and 12 bronchial wash specimens were contaminated with MCH. All contaminants had similar electrophoretic banding on probing of their DNA fragments, suggesting a common clone of origin. After the alterations in disinfection procedures and despite prolonged soaking in 2% glutaraldehyde, three further contaminated wash specimens were isolated from one bronchoscope. Only after ethylene oxide sterilisation of this bronchoscope was the contamination overcome. Since then no further MCH contamination has occurred. No patient required treatment and there has been no clinical evidence of mycobacterial disease.

Conclusion: To avoid contamination of bronchoscopy specimens with MCH, use of autocleaners should be discouraged and sterile water and containers used in cleaning procedures. If MCH contamination occurs in this setting, the bronchoscope and dismantled valve mechanism should undergo ethylene oxide sterilisation. (Aust NZ J Med 1994; 24: 693–695.)
Initial and long‐term results of percutaneous transluminal balloon angioplasty for chronic total occlusions: an analysis of 184 procedures
Authors: Sathe S. , Alt C. , Black A. , Manolas E. , Warren R. , Valentine P.
Published: March 2008

Background: Coronary angioplasty, although of proven use in partial occlusion, has not been shown to be of similar benefit in chronic total occlusion.

Aims: To assess the utility of coronary angioplasty in chronically totally occluded vessels in patients undergoing angioplasty and to determine the success of TIMI‐I flow before angioplasty compared to those patients with TIMI‐O flow.

Methods: A group of 178 consecutive patients (from 1984 to 1992), who underwent angioplasty of a chronic occlusion, were analysed. There were 136 males and 42 females with a mean age of 56.9 years.

Results: Initial technical success was achieved in 65%. Patients with TIMI‐I flow before angioplasty had a higher chance of success (700%) compared to those with TIMI‐O flow (53%), p < 0.04. During hospitalisation six patients suffered myocardial infarction (MI), two required surgery and one patient died. During a mean follow‐up of 2.8 years the overall survival rate was 95% for the group as a whole. Freedom from coronary surgery was significantly greater in patients with successful angioplasty (93%) than those without (66%, p < 0.002). The above two populations also showed a significant difference in the incidence of angina (35%vs 56%, p < 0.0003). However, the incidence of MI (6%vs 5%, p > O.5) and cardiac survival (98%vs 94%, p > 0.l) did not differ significantly in the two groups. Restenosis occurred in 63% of the 95 patients (82%) who returned for follow‐up angiography. Eighteen of the 59 patients (28%) with restenosis had a reocclusion.

Conclusion: The success rate for angioplasty of chronic total occlusions is acceptable. Long‐term clinical benefit in patients with successful angioplasty is suggested by the high freedom from angina and the lesser need for coronary surgery. No major impact on either the incidence of MI or cardiac survival was noted when patients who had coronary surgery were included, although it must be emphasised that the sample size in this study was insufficient to detect a difference in these outcome variables.
Oesophageal surfactant: evidence for a possible mucosal barrier on oesophageal epithelium
Authors: Hills B. A.
Published: March 2008

Background: There is a growing body of evidence to indicate that the gastric mucosa is protected against the back‐diffusion of acid by a physical barrier comprising surface‐active phospholipid (SAPL) otherwise known as gastric surfactant on account of its similarity to pulmonary surfactant in composition and behaviour.

Aims: To determine whether this form of mucosal protection might extend into the oesophagus to offer some degree of protection against the reflux of gastric contents.

Methods: Oesophageal epithelium was tested for the same hydrophobicity which is characteristically imparted to gastric mucosa by SAPL. A morphological study was also performed to visualise any barrier, purposely avoiding conventional fixatives for electron microscopy which destroy hydrophobic surfaces.

Results: Oesophageal epithelium in the vicinity of the cardiac sphincter was found to be appreciably hydrophobic, although not as hydrophobic as gastric mucosa. This hydrophobicity was eliminated by bile salts selected as a known ‘barrier breaker’ and one which reacts with any lining of SAPL. The morphological study revealed much evidence of SAPL, especially that lining epithelial cells, while its source is probably the lamellar bodies also visualised.

Conclusions: These findings indicate a physical barrier of oesophageal surfactant which could offer some degree of protection against gastro‐oesophageal reflux but one which is particularly prone to attack by bile.
Predictors of survival after cerebral infarction: importance of cardiac factors
Authors: Friedman P.
Published: March 2008

Background: Stroke is the third leading cause of death in much of the developed world. There are two approaches to lowering mortality from stroke: reducing the incidence of stroke and reducing case fatality rate.

Aims: To determine factors, identified at presentation, that were predictive of mortality in elderly persons with acute cerebral infarction.

Methods: A consecutive series of 215 elderly persons admitted to hospital with acute cerebral infarction, confirmed by computerised tomography, were followed for an average of one year. A proportional hazards model was used to identify predictors of mortality.

Results: The following variables were identified on univariate analysis as predictors of death: raised serum creatinine, interstitial oedema on chest radiograph, low score on the Mini‐Mental State Examination, atrial fibrillation, advanced age, cardiomegaly, raised leucocyte count, pulmonary venous congestion and homonymous hemianopia. Interstitial oedema was the most powerful predictor of death among the four measures of cardiac status. Two successful multivariate models included: 1) interstitial oedema, serum creatinine, age and homonymous hemianopia; 2) serum creatinine and Mini‐Mental State Score. Further studies are required to assess the relationship between elevated serum creatinine and poor survival following stroke.
Review of dietary intervention studies: effect on coronary events and on total mortality
Authors: Truswell A. Stewart
Published: March 2008

The perfect randomised controlled dietary prevention trial of coronary heart disease has never been done. The best we can do is to look at all the trials together. Dietary trials should be separated from drug trials because they have different characteristics. Fourteen dietary trials which had disease or death as the end point are collected in this review for a metaanalysis. Three of the trials had two parts (male/female or low fat/increased fish), making a total of 17 trials. All were randomised trials, except the Finnish mental hospital trial which was a 12‐year crossover in two hospitals. The trials were primary or secondary, diet only or multifactorial; numbers of subjects range from 52 to 57,460. For total deaths the ratio of intervention/control in all 17 trials is 0.94 (significantly less than 1.00) and for coronary events the pooled odds ratio is 0.87. But in the seven trials with most effective cholesterol lowering the odds ratios are 0.89 for all deaths and 0.70 for coronary events. There is thus no indication of excess all causes mortality in the dietary trials

Four recent secondary prevention trials had angiographic end points. There were a total of 275 subjects; trials were in Holland, USA, Germany and UK. In all trials plasma cholesterol was effectively lowered and coronary narrowing regressed a little, or progressed less in the diet group but significantly compared with controls. These angiographic trials strongly support the results of the major prevention trials.

Lastly, a set of ten trials with fish oil after coronary angioplasty are reviewed. In some there appeared to be lower rates of restenosis, but not in all. The mechanism here is different from the major trials with plasma cholesterol‐lowering diets for longer periods.
Declining cardiovascular disease incidence and environmental components
Authors: Lloyd Brian L.
Published: March 2008

After rising for many years in the mid‐to‐late 1960s the mortality from ischaemic heart disease (IHD) began to decline in many countries. This represents a decline in both out‐of‐hospital (community) and hospital deaths. Non‐fatal myocardial infarction (MI) has also declined. A literature review was conducted to examine lifestyle and environmental factors contributing to the decline. Half of the decline is attributable to changes in lifestyle and in the known major risk factors. Changes in nutrition appear relevant to the decline, in particular an increased ratio of polyunsaturated to saturated fat intake and a reduced saturated fat intake overall. There is little evidence to support a role of changing alcohol consumption, changing coffee consumption, changing exercise levels or reduction in excess weight in the declining incidence of IHD. While the benefit of smoking cessation is a clear one, its impact on the differing trends in various countries is not clear. Socio‐economic factors appear to influence the rate and extent of decline in IHD in different groups and may help explain some of the regional differences in IHD incidence. Reductions in blood pressure within the ‘normal range’ which may occur with lifestyle changes may also be an important contributor.
A quantification of alcohol‐related mortality in New Zealand
Authors: Scragg R.
Published: March 2008

Background: There are no published New Zealand (NZ) studies on alcohol drinking and total mortality, despite its importance to alcohol health policy.

Aims: To estimate the proportion of NZ deaths caused or prevented by alcohol drinking.

Methods: The proportion of current alcohol drinkers from recent NZ surveys, and pooled relative risks from a review of the international literature on alcohol and mortality, were used to calculate disease‐specific population attributable risks. The number of deaths caused (or prevented) by alcohol were calculated for 1987 New Zealand deaths. Person‐years of life lost (or saved) were calculated using recent NZ life tables.

Results: The association between alcohol and total mortality was related to age. Alcohol was estimated to have caused 3.0% of all deaths among 0–14 year olds and 20.1% of deaths among 15–34 year olds, mostly from road injuries. In contrast, alcohol was estimated to have prevented 0.5% of all deaths among 35–64 year olds and 3.4% of deaths among >65 year olds due to its protective effect against coronary heart disease. For all age groups, alcohol was estimated to have prevented 1.5% of deaths. However, the number of person‐years of life lost among ages less than 35 years was greater than those saved in the older age groups, so that alcohol was estimated to have caused the loss of 9525 person‐years of life for all ages combined.

Conclusions: The adverse effects of alcohol on total mortality are confined to age groups less than 35 years. Public health policy to minimise deaths from alcohol should be concentrated on this group.
Finding solutions to the rural doctor shortage: the roles of selection versus undergraduate medical education at Newcastle
Authors: Rolfe I. E. , Pearson S.‐A. , O'Connell D. L. , Dickinson J. A.
Published: March 2008

Abstract Background: Australia has a rural doctor shortage. Proposed solutions have included both increasing the medical student admissions from rural areas and modifying the curriculum content of rural medicine.

Aim: To examine the differences between doctors who chose to practise in rural areas and those who chose urban areas after graduation from the University of Newcastle medical school.

Methods: A cross‐sectional survey of 331 graduates who had completed at least their intern year was undertaken in 1990, using a mailed self‐report questionnaire.

Results: A 75% response rate was achieved from those completing their degree before 1987 (N = 217). Twenty‐two per cent of respondents were employed in a rural area and the great majority of these doctors were in general practice. Those from earlier graduating years, those from rural backgrounds (relative risk [RR] 2.5,95% confidence interval [CI]: 1.4–4.4), and those who chose an undergraduate rural general practice attachment in their final year (RR = 3.0,95% CI: 1.3–7.3) were more likely to become rural doctors. However, there was a tendency for those who chose an undergraduate rural rotation in year 3 not to be more likely to become rural doctors (RR = 0.7, 95% CI: 0.4–1.2). The most frequent reasons given for working in rural areas related to lifestyle, whereas work related reasons were given more often for those who chose urban practices.

Conclusion: Our data suggest that the rural doctor shortage would be improved by medical school admission policies favouring students from rural areas, and by encouraging rural placements towards the end of undergraduate training. (Aust NZ J Med 1995; 25: 512–517.)