bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effect of Cimetidine on Gastrin Release in Ulcer Disease
Authors: Korman M. G. , Hansky J. , Waugh J.
Published: March 2008

Summary: The effect of cirnetidine on gastrin release in ulcer disease. M. G. Korman. J. Hansky and J. Waugh, Aust. N.Z. J. Med., 1979, 9, pp. 367–369.

The effect of a single dose of 400 mg of the H2‐receptor antagonist cimetidine on protein meal stimulated immunoreactive gastrin was assessed in ten patients with gastric ulcer and ten patients with duodenal ulcer. In gastric ulcer patients, serum gastrin (mean±SE) rose from 34±2·2 pmol∖l‐1 to a peak of 80±5·0 pmol∖l‐1 at 45 minutes without and from 36±2·2 to 107±8·0 pmol∖l‐1 at 60 minutes with cimetidine; in duodenal ulcer it rose from 26±3·0 to 47±5·1 pmol∖l‐1 at 45 minutes without and 26±3·2 to 52±5·1 pmol∖l‐1 at 60 minutes with cimetidine. Integrated gastrin responses in gastric ulcer were 4900±800 pmol∖l‐1 720 minutes without and 7000±900 pmol∖l‐1 720 minutes with cimetidine and 1560±300 pmol∖l‐1 720 minutes without and 2620±400 pmol∖l‐1 720 minutes with cimetidine in duodenal ulcer patients. These gastrin increases after cimetidine are comparable to those achieved with continuous intragastric neutralisation with alkali.
Improvement of Left Ventricular Function in Alcoholic Cardiomyopathy Documented by Serial Gated Cardiac Pool Scanning*
Authors: Hung J. , Harris P. J. , Kelly D. T. , Richmond D. R. , Hutton B. F. , Bautovich G.
Published: March 2008

Summary: lmpravement of left ventricular function in alcoholic cardiomyopathy documented by serial gated cardiac pool scanning. J. Hung, P. J. Harris, D. T. Kelly. D. R. Richmond, B. F. Hutton and G. Bautovich, Aust. N.Z. J. Med., 1979, 9, pp. 420–422.

Serial gated cardiac blood pool scans showed a gradual return to normal left ventricular function over ten months in a 44‐year‐old patient who presented initially with severe alcoholic congestive cardiomyopathy. The clinical signs of left ventricular failure abated considerably before myocardial function improved objectively on gated blood pool scanning.
HLA Patterns in Australian Patients with Insulin Dependent Diabetes Mellitus (IDDM)
Authors: Zimmet P. , Kiely P. , Cross R. , Court J. , Bornstein J.
Published: March 2008

Summary: HLA antigens were determined in 169 Australian patients with insulin dependent diabetes mellitus (IDDM). HLA‐B8 (47·9% v. 23·8%) and B15 (18·9% v. 8·2%) were significantly more frequent in the IDDM patients than in 1460 controls. The relative risks for developing IDDM in people carrying these antigens were 2·94 and 2·59 respectively. Carriers of the B8/B15 genotype had a relative risk of 5·48. These HLA associations in Australian IDDM patients are similar to those reported in other predominantly Caucasian populations.
Chronic Recurrent Ventricular Tachycardia—An Electrophysiological Study*
Authors: Ross D. L. , Vohra J. K. , Hunt D. , Sloman J. G.
Published: March 2008

Summary: Electrophysiological techniques were used to study 17 patients with chronic recurrent ventricular tachycardia. Twelve of the patients had coronary disease, while eight had pre‐existing intraventricular conduction defects. The site of origin of the tachycardia as deduced by analysis of the QRS morphology correlated well with the electrocardiographic evidence of the site of the old infarction.

Ventricular tachycardia was induced by pacing techniques in eight patients while it occurred spontaneously during the study in two others. In only four of the eight patients in whom tachycardia was induced, could the arrhythmia be reinduced; the arrhythmia could not be reproduced in one, while reproducibility was not assessed in the remaining three. Tachycardia was terminated by pacing techniques in six patients and by DC cardioversion in four. Ventricular tachycardia was initiated with a run of “torsade de pointes” in four patients. Ventricular tachycardias with varying morphology were observed in three patients. Electrophysiological study was of significant benefit in patient management in 14 of the 17 patients, particularly those with pre‐existing intraventricular conduction defects, undocumented tachycardia or undocumented syncope.
Does Viral Hepatitis Cause Aplastic Anaemia?
Authors: Bennett N. McK. , Lucas C. R.
Published: March 2008

Summary: The sera of six of seven patients with aplastic anaemia following “hepatitis” admitted to Fairfield Hospital, Melbourne, since 1954 were examined for serological evidence of infection by HAV or HBV, with negative results. We conclude that at present there is insufficient evidence to presume that infection with any of the hepatitis viruses predisposes to aplastic anaemia.
Primary Type I Hyperlipoproteinaemia—A Metabolic and Family Study
Authors: Potter J. M. , Macdonald W. B.
Published: March 2008

Summary: Primary Type I Hyperlipoproteinaemia is the rarest phenotype of the inherited hyperlipidaemias. A study of the plasma lipids, lipoprotein distribution and apoprotein concentrations has been carried out in a propositus and in three generations of her immediate family, as has associated post heparin lipolytic activity (PHLA). The propositus presented in infancy with spontaneous bruising and abdominal pain. She has gross chylomicronaemia in the presence of depressed PHLA, which is due to deficiency of lipoprotein lipase. Apo Al and B levels are depressed in concert with low density and high density lipoproteins. Introduction of alow fat diet has resulted in loss of symptoms but plasma lipids remain abnormal. Within her immediate family, six of nine members have depressed PHLA. Two such members have elevated plasma triglycerides, one associated with hypercholesterolaemia and peripheral vascular disease. Low PHLA in this family is then associated with different lipoprotein phenotypes.
Spinal Canal Stenosis in Adult with Hypophosphataemic Vitamin D‐resistant Rickets
Authors: Cartwright D. W. , Latham S. C. , Masel J. P. , Yelland J. D. N.
Published: March 2008

Summary: A case is described of a 55‐year‐old male with hypophosphataemic vitamin D‐resistant rickets, who presented with long‐standing back pain and paraesthesiae in both legs considered to be due to osteoid encroachment on an already narrow spinal canal. Marked symptomatic improvement has followed extensive lumbar laminectomy.
Human Tumour Immunology
Authors: Nelson D. S.
Published: March 2008

Summary: Many human cancer cells appear to differ from their normal counterparts in ways that are recognisable by the immune system of the host or patient. The specificities of these differences, however, and the nature, extent and significance of the host responses to them are often not very clear. Disturbances of the immune system generally contribute little to the occurrence, progression and clinical features of common malignant diseases. The present value of immunological monitoring of cancer patients is rather limited. Immunotherapy remains an experimental mode of treatment, the results of which are often disappointing. Current studies of the host‐tumour relationship in experimental animals and man suggest, however, that a wholly pessimistic view is not justified.
Serum Immune Complexes and Disease
Authors: Woodroffe A. J. , Foldes M. , McKenzie P. E. , Thompson A. J. , Seymour A. E. , Clarkson A. R.
Published: March 2008

Summary: The solid phase Clq radioimmunoassay was used to detect immune complexes in sera from patients with systemic lupus erythematosus (14/25), rheumatoid arthritis (4/5), vasculitis (5/15), infective endocarditis (2/2), acute rheumatic fever (2/3), pre‐eclamptic toxaemia (0/14), lung cancer (3/7), glomerulonephritis (26/98) and renal transplant patients (0/5). The best correlation with disease activity was seen in systemic lupus erythematosus and infective endocarditis where serial immune complex determinations were clearly of value in monitoring therapy. The findings in primary glomerulonephritis indicate only a limited usefulness of the assay in that serum immune complexes were detected in a minority (22/73) of patients with glomerular immune deposits. In particular the data do not support a role for Clq fixing immune complexes in the pathogenesis of membranous glomerulonephritis or in pre‐eclamptic toxaemia.
High Density and Low Density Lipoproteins in Chronic Renal Failure Before and After Renal Transplantation
Authors: Gibson J. C. , Savdiet E. , Simons L. A. , Stewart J. H. , Mahonytt J. F.
Published: March 2008

Summary: The hyperlipoproteinaemia accompanying chronic renal failure and renal transplantation has been re‐examined in terms of the apoprotein (apo A and apo B) moieties of the high density (HDL) and low density (LDL) lipoproteins. Hypertriglyceridaemia is prevalent in chronic uraemia and is not corrected by haemodialysis or renal transplantation. Hypercholesterolaemia is characteristic only of renal allograft recipients. Apo A levels are reduced in undialyzed uraemics and remain low during haemodialysis, as well as in patients with renal allografts of less than six months duration. In renal transplant recipients of greater than one year duration, apo A levels are normalized. The normalization of apo A level is related to the stability of graft function, as determined by sequential analysis of 15 renal transplant recipients. Apo B levels are normal in uraemic and dialyzed patients, but are elevated in long term transplant recipients. Unlike apo A levels, this alteration does not appear to reflect the restoration of kidney function.
The Effects of Dietary Fibre on Glucose Tolerance in Healthy Males
Authors: Wahlqvist M. L. , Morris M. J. , Littlejohn G. O. , Bond A. , Jackson R. V. J.
Published: March 2008

Summary: Previous studies have shown that the addition of non‐absorbable carbohydrate (NAC) to test meals decreases the glucose and insulin response both in normal and diabetic subjects. However, these studies appear to have used bran in the basic test meal without a knowledge of the effect of bran itself or of the added NAC alone. In the present investigation bran alone, pectin alone, guar alone and pectin with guar have been studied. Guar alone added to the test meal significantly lowered blood glucose at 90 minutes. Pectin alone did not have a significant effect. Pectin and guar together resulted in a blood glucose lower at 30 minutes and greater at 120 minutes. No significant changes in insulin response were noted to our study. It appears that NAC alters the glucose response to a given meal, but the extent to which this occurred in the present study was less than in previous studies. The differences may reflect synergism between bran and other NAC's to lower blood glucose response after a meal.
False Positive and Negative Hemoccult Reactions on a Normal Diet and Effect of Diet Restriction
Authors: Bassett M. L. , Goulston K. J.
Published: March 2008

Summary: False positive and negative hemoccult reactions on a normal diet and effect of diet restriction. M. L. Bassett and K. J. Goulston, Aust. N.Z. J. Med. 1980, 10. pp. 1–4.

The reliability of Hemoccult, a guaiacimpregnated slide for detecting faecal occult blood, was assessed on both normal and restricted diets. Two‐hundred‐and‐twenty‐five faecal samples were obtained from 40 patients on a normal diet, and 115 samples from 20 patients on a restricted diet. A single Hemoccult I test was performed on each sample. Faecal blood was quantitated by 51Cr red cell labelling. On a normal diet, the false positive rate was 11%. This reduced to 2% on a high fibre diet free of red meat and raw fruit and vegetables. This false positive rate is lower than has been previously reported for other: more widely‐used, occult blood tests. The overall false negative rate was 48%; this diminished with increasing faecal blood loss.
Hepatitis A Outbreak in a Residential School
Authors: Boughton C. R. , Hawkes R. A. , Lehmann N. I. , Grohmann G. S.
Published: March 2008

Summary: Hepatitis A outbreak in a residential school. C. R. Boughton, R. A. Hawkes, N. I. Lehmann and G. S. Grohmann, Aust. N.Z. J. Med., 1980, 10, pp. 4–6.

Outbreaks of hepatitis A occurred sequentially in two wards for children in a residential institution for the mentally retarded in Sydney. Twenty‐six of 47 children were initially susceptible to hepatitis A. In the first ward affected, 77 of 13 susceptible children (85%), and in the second ward, four of 13 susceptible (31%), were infected. Of the 15 showing serological evidence of infection, five (33%) were clinically jaundiced.
Coronary Artery Spasm: Use of Ergonovine in Diagnosis *
Authors: Freedman S. B. , Dunn R. F. , Bernstein L. , Richmond D. R. , O'Neill G. , Kelly D. T.
Published: March 2008

Summary: Coronary artery spasm: Use of ergo ovine in diagnosis. S. B. Freedman, R. F. Dunn, L. Bernstein, D. R. Richmond, G. O'Neill and D. T. Kelly, Aust. N.Z. J. Med., 1980, 10, pp. 6–11.

Ergo ovine male ate was administered to 69 patients with chest pain but without significant coronary artery disease (<70% luminal diameter obstruction) to determine whether coronary artery spasm could be provoked. Coronary artery spasm was seen at angiography, or inferred from ECG or thallium myocardial perfusion scan changes. The test was positive in 76 patients: all five patients with documented variant angina (Group A); ten of the 19 patients with suspected variant angina (Group 6); one of the 11 patients with exercise‐induced chest pain (Group C); and none of the 34 patients with atypical chest pain (Group D). Patients with a positive test usually smoked, complained of recurrent nocturnal or early morning chest pain, showed ST changes during spontaneous chest pain and had minor degrees of fixed coronary obstruction (30–70%), when compared to those with a negative test. The only major side effect of the test was transient ventricular tachycardia which occurred in three patients and was reverted by sublingual and paranormal nitroglycerine.
The Effects of Body Weight on Serum Cholesterol, Serum Triglycerides, Serum Urate and Systolic Blood Pressure*
Authors: Brennan P. J. , Simpson J. M. , Blacket R. B. , McGilchrist C. A.
Published: March 2008

Summary:The effects of body weight on serum cholesterol, serum triglycerides, serum urate and systolic blood pressure. P. J. Brennan, J. M. Simpson, R. B. Blacket and C. A. McGilchrist,Aust. N.Z. J. Med., 1980,10, pp. 15–20.

The effects of body weight and age on serum cholesterol, serum triglycerides, serum urate and systolic blood pressure were examined in 600 male and 400 female blood donors aged 20 to 49 years. In the men significant correlations with body mass index were found for all four variables in each decade. In the women below 40 only the correlation with blood pressure was significant. In the fifth decade the correlations resembled those in the men, save for triglycerides. After adjusting for weight, age had no independent influence on the prevalence of hypertriglyceridaemia or hypertension in either sex. In men the effect of body weight on the prevalence of hypercholesterolaemia was age dependent. Age influenced hyper‐uricaemia independently of weight. In women only serum cholesterol was affected by age after allowing for weight. There was marked clustering of high values of the four variables in the heavier men and women and this increased with age. The leanest men and women were remarkably free of high values.
3,3‘ Diiodothyronine: Serum Concentration and Production in Normal and Abnormal Thyroid States
Authors: Corcoran J. M. , Eastman C. J.
Published: March 2008

Summary: 3,3‘ diiodothyronine: serum concentration and production in normal and abnormal thyroid states. J. M. Corcoran and C. J. Eastrnan, Aust. N.Z. J. Med., 1980, 10, pp. 32–38.

This study reports the details of a specific, sensitive radioimmunoassay for 3,3′ diiodothyronine (3,3'T2) in human serum and the results obtained from measurement of serum 3,3'T2 concentrations in normal humans and in patients with a variety of thyroidal and non thyroidal diseases. This assay permits measurement of 3,3'T2 in unextracted serum with a sensitivity of 10 to 20 pmolll and intraassay and interassay coefficients of variation of 3% and 9% respectively.

Normal serum concentrations of 3,3'T2 in healthy, euthyroid adults ranged from 10 to 140 pmolll in males and from 8 to 196 pmolll in females. Mean levels were not significantly different. In women taking oral contraceptives serum 3,3'T2 concentrations ranged from 48 to 218 pmolll with a mean of 133 pmolll which was significantly higher than the normal female group (P <0.001): Mean serum 3,3'T2 concentrations were increased in hyperthyroid and decreased in hypothyroid patients, however, there was considerable overlap of individual results with normal subjects. Serum 3,3'T, levels in sick euthyroid patients were mostly below assay sensitivity. By contrast serum 3,3'T2 levels in cord blood were significantly higher than in normal adults with a range of 173 to 405 pmolll and mean of 287 pmolll. Serial studies performed on hypo‐thyroid patients given either L‐T3 (60 μg/day) or L‐reverse T3 (120 μg/day) in divided dosage revealed significant rises in serum 3,3'T2 levels.

These results demonstrated extrathyroidal conversion of both T3 and reverse T3 to 3,3'T2 in peripheral tissues.

Data obtained from kinetic studies of 3,3'T2 metabolism in normal adults revealed a mean metabolic clearance rate of 175 ± 112 I/day (range 110–276 I/day), and a mean half life of 8.3±1.0 hours. These data are consistent with an average daily production rate of 15.75 nmollday.

It is concluded that 3,3'T2 is a normal constituent of human serum and is derived from peripheral mono deiodination of both T3 and reverse T3. The biological significance of this metabolite has not yet been determined.
Apparent Insulin Resistance due to Abnormal Enzymatic Insulin Degradation: A New Mechanism for Insulin Resistance
Authors: McElduff A. , Eastman C. J. , Haynes S. P. , Bowen K. M.
Published: March 2008

Summary: Apparent insulin resistance due to abnormal enzymatic insulin degradation: A new mechanism for insulin resistance. A. McElduff, C. J. Eastman, S. P. Haynes and K. M. Bowen. Aust. N.Z. J. Med., 1980, 10, pp. 56–61.

A 16–year‐old girl presented with severe, prolonged insulin resistance. Insulin antibodies, initially thought to be responsible for the insulin resistance, were suppressed using monocomponent insulin and immunosuppressive therapy; however insulin resistance persisted. Insulin kinetic studies suggested abnormal metabolism of a bolus injection of 125insulin and the reappearance in the circulation of radioactive products, demonstrated by chromatography to be of different molecular weight to insulin. These products were of similar molecular weight to material obtained by incubating125/insulin with protease. Trasylol significantly reduced the patient's insulin requirements and normalised the disappearance of125/ insulin from the circulation. Prolonged treatment with Trasylol resulted in a fall in insulin requirement to non “insulin resistance” levels. The insulin requirement remained static when Trasylol was ceased. We propose abnormally rapid insulin degradation to be a new mechanism of resistance to insulin therapy.
Clinical Settings in Pseudomembranous Colitis
Authors: Goulston S. J. M. , McGovern V. J.
Published: March 2008

Summary: Clinical settings in pseudomembranous colitis. S. J. M. Goulston and V. J. McGovern, Aust. N.Z. J. Med., 1980, 10, pp. 139–145.

Renewed interest in pseudomembranous colitis (PMC) has occurred in recent years due to an increased incidence following the introduction of the antibiotics clindamycin and lincomycin. However, the disease was well known before the antibiotic era. In this paper the histopathological features are re‐emphasised and the similarity to early amoebic colitis is stressed. From a background of 32 patients, some unusual clinical settings are described. These consist of an association with renal transplantation; the demonstration of the lesion on the mucosal surface of rectal polypi and metaplastic bladder mucosa; its occurrence in an area of isolated ileum presenting as a “blind loop syndrome”: and examples suggesting that this disease can exist for quite long periods of time or may recur several times in the same patient
Free Insulin, C‐Peptide and Glucagon Profiles in Insulin Dependent Diabetes Mellitus
Authors: Scott R. S. , Espiner E. A. , Donald R. A. , Ellis M. J.
Published: March 2008

Summary: Free insulin, C‐peptide and glucagon profiles in insulin dependent diabetes mellitus. R. S. Scott, E. A. Espiner, R. A. Donald and M. J. Ellis, Aust. N.Z. J. Med., 1980, 10, pp. 146–150.

Glucose and hormone profiles, including plasma levels of glucagon, GH, total insulin, free immunoreactive and biologically active insulin were determined by hourly sampling in two groups of insulin dependent diabetics. The five patients in Group I were recently diagnosed and still had residual β‐cell function. The other six in Group II had disease of longer duration, had developed insulin antibodies, and were non‐secretors of C‐peptide. All patients were studied while receiving their usual maintenance doses of Semilente mono‐component insulin (Novo). Daily insulin requirements were 25.6 ± 4 U in Group I and 52.2 ±7 U in Group II. The glucose profiles were similar in the periprandial periods but over the whole 24‐hour period control was more unstable in the patients of Group II and during the period 2400–0200 h plasma glucose fell to low levels (minimum plasma glucose 1.5–3.0 mmol/l). Free insulin levels rose to peak levels over a similar time course but then fell more slowly in the Group II subjects. These patients had higher free, biologically active insulin and lower glucagon levels which were coincident in time with the early morning hypoglycaemia. These observations suggest that raised free insulin levels in the setting of an impaired counter‐regulatory glucagon response are one of the factors contributing to glucose instability in long‐standing diabetics
Is the Incidence of Deep Vein Thrombosis Following Myocardial Infarction Decreasing?
Authors: Pitney W. R. , Hickey A. , Gopinath A. , Dean S.
Published: March 2008

Summary: Is the incidence of deep vein thrombosis following myocardial infarction decreasing? W. R. Pitney, A. Hickey, A. Gopinath and S. Dean, Aust. N.Z. J. Med., 1980, 10, pp. 167–171.

A trial was undertaken to compare the effectiveness of the antiplatelet drug, flurbiprofen, and subcutaneous heparin in the prevention of deep vein thrombosis following acute myocardial infarction. The original aim of the study could not be fulfilled as the incidence of isotopically‐determined venous thrombosis in the group of control patients was only 9.5%. The incidence in all three groups was too low to assess the effectiveness of flurbiprofen prophylaxis. It is suggested that the low incidence may be related to the recent practice of early physiotherapy and ambulation in coronary care units. The patients who developed venous thrombosis were, on average, a little older than those who did not. No differences were observed in blood viscosity, plasma antithrombin III concentration or mean coronary prognostic index. The low incidence of venous thrombosis following acute myocardial infarction suggests a need to reassess the practice of prophylactic anticoagulant therapy in this condition
Shortened Cardiac Rehabilitation: A Three Year Experience
Authors: Jelinek V. M. , Ziffer R. W. , McDonald I. G. , Hale G. S.
Published: March 2008

Summary: Shortened cardiac rehabilitation: A three year experience. V. M Jelinek, R. W. Ziffer, I. G. McDonald and G S. Hale, Aust N.Z.J. Med., 1980, 10, pp. 171–175.

One‐hundred‐and‐twenty‐four (19%) of patients with acute myocardial infarction seen in a three year period from 1975 to 1978 were considered low risk patients suitable for rapid mobilisation, early discharge, and early exercise testing. Their mean long term Norris Prognostic Index was 3.2; the mean date of discharge was 9.6 days, and the mean date of exercise testing was 10.5 days. There were seven deaths and nine non‐fatal recurrenf myocardial infarctions in a mean follow up time of 14.2 months. These events were best predicted by a history of angina prior to myocardial infarction or radiological cardiomegaly detected in the CCU. Altogether 98 (80%) of the patients returned to work at a median time of six weeks after their infarct. The nett effect of the team activity has been to reduce the need for referral to the National Heart Foundation Assessment Centre from an average of 15 patients per year to an average of two per year
Dual Presentation of Polycythaemia Vera and Lymphatic Leukaemia
Authors: Januszewicz E. , Firkin F. C.
Published: March 2008

Summary: Dual presentation of polycythaemia Vera and lymphatic leukaemia. E. Januszewicz and F. C. Firkin, Aust. N.Z. J. Med., 1980, 10, pp. 209–211.

A case is described in which polycythaemia Vera was found to co‐exist with chronic lymphatic leukaemia at the time of presentation. This case can be added to five other reported cases of an association between polycythaemia Vera and well‐differentiated lymphocytic neoplasia, and adds further emphasis to the tendency for dual presentation, which has now occurred in all but one of these cases. One explanation is that the association is due to chance, but the tendency for dual presentation raises the possibility that the overall picture reflects neoplastic involvement of stem cells with capacity to differentiate into the lymphoid as well as the erythroid, myeloid and megakaryocytic series
Current Trends in the Management of Myasthenia Gravis: Plasmapheresis and Immunosuppressive Therapy
Authors: Pollard J. D. , Basten A. , Hassall J. E. , Kronenberg H. , Cobcroft R. , Dawkins R.
Published: March 2008

Summary: Current trends in the management of myasthenia gravis: Plasmapheresis and immunosuppressive therapy. J. D. Pollard, A. Basten, J. E. Hassall, H. Kronenberg, R. Cobcroftand R. Dawkins, Aust. N.Z. J. Med., 1980, 10, pp. 212–217.

In recent years a considerable body of evidence has accumulated to demonstrate autoimmune mechanisms in myasthenia gravis. This evidence has important implications for the aetiology, diagnosis and management of the disease

The primary abnormality in myasthenia gravis is related to the presence of antibody which reacts with the acetylcholine receptor. Measurement of this IgG antibody in the serum has become the most reliable diagnostic adjunct to the edrophonium test, and in an individual patient, the level of the serum antibody relates closely to the clinical indices. In cases of myasthenia where control with anticholinesterase drugs is unsatisfactory, methods to lower the antiacetylcholine receptor antibody are indicated: these may include thymectomy, immunosuppressive therapy or plasmapheresis

Two patients with very severe disease are described in whom all types of therapy were used and in whom survival depended ultimately on the use of plasmapheresis. These patients illustrate the importance of receptor antibody in the clinical manifestations of myasthenia gravis and in its management
Sudden Death in Young Females with Floppy Mitral Valve Syndrome
Authors: Mair W. J.
Published: March 2008

Summary: Sudden death in young females with floppy mitral valve syndrome. W. J. Mair, Aust. N.Z. J. Med., 1980, 10, pp. 221–223.

Three cases of sudden death in young females with clinical and pathological features of the floppy mitral valve syndrome are presented. Two patients had a history of syncopal attacks and were found to have intermittent cardiac arrhythmias, in addition to auscultatory findings consistent with mitral valve prolapse. The third patient had complained of attacks of giddiness associated with tachycardia. Sudden, unexpected death in all three cases resulted in coronial autopsies being performed. The clinical and autopsy findings are presented and discussed.
The Importance of Suspecting Sleep Apnoea as a Common Cause of Excessive Daytime Sleepiness: Further Experience from the Diagnosis and Management of 19 Patients
Authors: Coverdale S. G. M. , Read D. J. C. , Woolcock A. J. , Schoeffel R. E.
Published: March 2008

Summary: Over an 18 month period, 19 patients were referred for assessment of excessive daytime sleepiness and/or loud snoring. Respiratory studies during sleep were performed in 14 of these patients with additional features such as disturbed sleep, observed apnoea during sleep, morning headache, mental and personality changes, hypertension and cardiac failure.

Nocturnal respiratory studies undertaken for periods of 4–8 hours confirmed a diagnosis of the Sleep Apnoea Syndrome in eight patients. In these patients apnoeas, lasting from 30–144 seconds, occurred frequently during sleep (from 35–291 episodes per patient).

In one severely affected patient, tracheostomy abolished all symptoms. The use of conservative therapy such as weight loss, protriptyline or a neck collar, highlighted the inadequacies of current medical treatment. Awareness of the symptom complex and potential complications of the Sleep Apnoea Syndrome is important because the diagnosis may easily be missed if the patient presents with one or two isolated complaints.
The Effect of a Selective Beta Adrenergic Blocking Agent on Ventricular Arrhythmias in the First Year Following Myocardial Infarction*
Authors: Federman J. , Whitford J. A. , Anderson S. T. , Pitt A.
Published: March 2008

Summary: Fifty‐five patients with recent acute myocardial infarction entered a single‐blind cross‐over trial to assess the effect of oral practolol 200 mg twice daily on the incidence and nature of ventricular arrhythmias in the first year following myocardial infarction. Patients had 24‐hour Hotter electrocardiogram tape monitoring at two weeks following infarction and at three‐monthly intervals for one year.

Twenty‐six patients completed the full year of the trial with 12% of tape recordings technically unsatisfactory. A total of 46 periods of comparison of the action of practolol versus placebo therapy were available in thirty patients.

Whilst receiving the selective beta adrenergic blocking agent, practolol, there was a significant reduction in the percentage of studied hours during which salvos of ventricular premature beats occurred (P < 0·025), however the percentage of patients in whom salvos were recorded was unchanged. The incidence of all other ventricular arrhythmias was not reduced in the practolol group. When the effect of practolol was related to the site of infarction, anterior or inferior, there was no significant reduction in the incidence of ventricular arrhythmias.
Effect of Propranolol on the Renin Response to Frusemide in Man
Authors: Vandongen R. , Barden A. , Tunney A.
Published: March 2008

Summary: The response of plasma renin activity (PRA) to frusemide, 40 mg given intravenously, was examined before and after oral propranolol 160 mg daily for seven days in normal and hypertensive subjects. Although basal PRA was reduced in many cases, the increase following frusemide was essentially unaltered by propranolol therapy. Evidence is presented that adequate beta adrenoceptor blockade was attained in these studies. Increasing the dose of propranolol to 240 mg daily for seven days in two subjects did not alter renin responsiveness to frusemide. Stimulation of renin release by oral frusemide, examined in one subject, was also unaltered by propranolol therapy. These findings indicate that enhancement of renin activity associated with diuretic use may not be prevented by concurrent propranolol administration. Limitation of the hypotensive action of combined beta blocker‐diuretic therapy can therefore be expected. The fact that the renin stimulating effect of frusemide is preserved during beta blockade indicates that this procedure can be used in the investigation of hypertension even in those patients in whom discontinuation of beta blocking treatment may be undesirable.
Mitral Valve Vegetations in Bacterial Endocarditis Resembling Left Atrial Myxoma
Authors: Nicholson M. R. , Roche A. H. G. , Kerr A. R. , Long S.
Published: March 2008

Summary: A patient with Staphylococcus aureus endocarditis is reported whose echocardiogram closely resembled that found in left atrial myxoma. Because of severe mitral incompetence, the valve was replaced using cardiopulmonary bypass and at operation a large 3 cm friable vegetation was found attached to the posterior leaflet of the mitral valve. Histological examination showed changes typical of bacterial endocarditis with no evidence of myxoma.
Hydrothorax with Peritoneal Dialysis: Radionuclide Detection of a Pleuro‐peritoneal Connection
Authors: Adam W. R. , Arkles L. B. , Gill G. , Meagher E. J. , Thomas G. W.
Published: March 2008

Summary: Unilateral hydrothorax occurring during peritoneal dialysis is well described and has been presumed to be secondary to a pleuro‐peritoneal communication. Diagnosis of these communications usually requires invasive procedures. A non‐invasive method of confirmation of abnormal pleuro‐peritoneal communication using radionuclide scanning is outlined.

The occurrence of this complication has usually meant cessation of this type of dialysis. However, this patient illustrates that continuation of peritoneal dialysis is possible.
Type I Hyperlipoproteinaemia and Recurrent Scrotal Pain
Authors: Simons L. A. , Grigor W. , Martin H. C. O. , Gibson J. C. , Gunn A. P.
Published: March 2008

Summary: A three‐year‐old boy is described with type I hyperlipoproteinaemia in association with recurrent scrotal pain and hepatosplenomegaly. His parents are consanguinous and it is likely that he is homozygous for an autosomal recessive trait, characterised by the absence of plasma lipoprotein lipase following intravenous injection of heparin. Studies have been performed in a number of first degree relatives, but the findings are inconclusive. He has responded well to a low fat diet with dramatic reductions in elevated plasma triglyceride concentrations.
The Diagnosis of Exocrine Pancreatic Disease: The Present Position Reviewed
Authors: Waller S. L.
Published: March 2008

Summary: In this paper, recent advances in the diagnosis of pancreatic disease are reviewed, together with older methods currently in use. The clinical role of these techniques in the diagnosis of pancreatic disease is discussed with particular reference to symptomatology and prognosis of the various pancreatic disorders. Likely future developments in this field are considered.
Coma and Hypothermia in Wernicke's Encephalopathy
Authors: Donnan G. A. , Seeman E.
Published: March 2008

Summary: Two patients who developed Wernicke's Encephalopathy with subsequent hypothermia are described. Both patients responded rapidly to thiamine administration and one later had hypothalamic‐pituitary function tests performed. This patient demonstrated depressed TSH response to TRH and a sluggish early Cortisol response to adequate hypoglycaemia compared to 17 control subjects.

These findings may suggest that previously described hypothalamic‐pituitary abnormalities in chronic alcoholics may be mediated via thiamine deficiency and may also reflect hypothalamic damage contributing to the hypothermic state.

The importance of intravenous thiamine administration in cases of coma of unknown aetiology is emphasised.
Erythrocyte Phosphoglycerate Kinase Deficiency: Enzymatic and Oxygen Binding Studies
Authors: Dodgsor S. J. , Lee C. S. , Holland R. A. B. , O'Sullivan W. J. , Vowels M. R.
Published: March 2008

Summary Enzyme and oxygen transport studies have been made on seven members of a kindred with red cell deficiency of phosphoglycerate kinase (PGK), an enzyme known to be linked to the X‐chromosome. The two affected males were children, had little detectable PGK activity and had severe neurological damage. Both had moderate haemolytic anaemia complicated by the occurrence of haemolytic crises. Red cell ATP levels were substantially decreased in both subjects. However, they had more than double the normal level of 2,3‐diphosphoglycerate (2,3‐DPG) in their ted cells, associated with a rightward shift in their oxygen‐haemoglobin equilibrium curves. This shift in the curve was sufficient to permit oxygen delivery to most body tissues, including the brain, at better tensions than normal, except during a haemolytic crisis.

Two of the three known heterozygotes were aged over 70. They had moderate haemolytic anaemia, considerable reduction of red cell PGK activity (19% and 35% of normal, respectively), and considerable increase in red cell 2,3‐DPG with rightward shifting of the oxygen‐haemoglobin equilibrium curve. The other known heterozygote was aged 22 and showed little abnormality in her blood oxygen transport.
Variant Angina—Correlation of Clinical, Electrocardiographic and Angiographic Features: Results of Medical and Surgical Management
Authors: Saltups A.
Published: March 2008

Summary Angiographic coronary artery disease (CAD) was correlated with clinical features, electrocardiographic (ECG) findings and the results of medical management or aortocoronary bypass in 42 patients with angina at rest associated with transient ST segment elevation (variant angina).

Patients were divided into three sub‐sets based on the coronary arteriographic findings. On the basis of > 75% luminal diameter narrowing, 28 patients had multiple vessel, ten had single vessel and four had minimal (< 50% narrowing) CAD. The angiographic sub‐sets did not differ significantly in age, sex, coronary risk factors, time from onset of rest pain to coronary angiography, or in the presence of arrhythmias during ischaemic episodes. Patients with multiple vessel CAD more commonly had prior coronary events (P < 0·01), an abnormal baseline ECG (P < 0·05) or both (P < 0·001). These features did not distinguish patients with single vessel from those with minimal CAD. ST elevation in the inferior leads during episodes of myocardial ischaemia was more common (P < 0·005) in patients with minimal CAD.

Twenty‐four patients with multiple vessel and six with single vessel CAD underwent aortocoronary by‐pass surgery and relief of variant angina was achieved in all 25 long‐term survivors during an average follow‐up period of 36 months. Twelve patients (four of each subset) were treated medically. Among those with multiple vessel CAD, the small medically treated numbers precluded valid comparison of medical and surgical results. Patients with single vessel CAD followed for an average period of 17 months compared unfavourably with the operated group. Calcium antagonists or nitrates controlled variant angina in patients with minimal CAD followed for an average of 27 months.
Rifampicin Associated Renal Dysfunction During Antituberculous Therapy
Authors: Need A. G. , Phillips P. J. , Chiu F. T. S. , Clarkson A. R.
Published: March 2008

Summary Intermittent rifampicin therapy has been reported to commonly cause a flu‐like illness with chills and fever sometimes associated with acute renal failure.

This report describes a fourth case of partially reversible insidious renal damage associated with continuous rifampicin therapy and provides evidence that it is not the result of light chain proteinuria as previously suggested. A retrospective review of data relating to renal function in 89 tuberculous patients indicated that increased plasma urate concentration was commonly associated with ethambutol therapy.
Mitochondrial Myopathy with Cardiomyopathy, Lactic Acidosis and Response to Prednisone and Thiamine
Authors: Mastaglia F. L. , Thompson P. L. , Papadimitriou J. M.
Published: March 2008

Summary Clinical, biochemical and pathological findings are described in a 23‐year‐old male with a mitochondrial myopathy who had a high‐output circulatory state and cardiomyopathy which resulted in cardiac insufficiency 11 years before presentation of the skeletal myopathy. Venous lactate levels were elevated and severe lactic acidosis developed at one stage of the illness. Electron microscopy of muscle tissue showed various mitochondrial abnormalities and accumulation of neutral lipids which was confirmed histochemically and by thin‐layer chromatography. Marked improvement in the myopathy occurred after commencement of prednisone and thiamine and was maintained following withdrawal of these drugs. The metabolic defect in this case has not been defined, but an abnormality in the Kreb's cycle or cytochrome chain with secondary over‐production of lactate and lipid accumulation in muscle is postulated.
Cerebrospinal Fluid Involvement in Patients with Adult Acute Leukaemia and Non‐Hodgkin's Lymphoma
Authors: Gordon S. , Raik E. , Hewitt B. , Moore P.
Published: March 2008

Summary: One hundred and thirty‐four cases of adult acute leukaemia and 212 cases of non‐Hodgkin's lymphoma treated by the Combined Haematology Division of Sydney Hospital over a four year period were reviewed to establish the incidence of central nervous system (CNS) involvement. The sole diagnostic criterion considered was positive cerebro‐spinal fluid (CSF) cytology. The detected incidences of 21% and 5.2% respectively in long term surviving adults with leukaemia and those with non‐Hodgkin's lymphoma are similar to other series.

Unusual findings were the relatively low incidence of involvement in acute myelo‐monocytic leukaemia and unexpectedly high incidence in diffuse poorly differentiated lymphocytic lymphoma.

Cytocentrifugation using the Cytospin has proved to be a useful technique in detecting small numbers of abnormal cells in the CSF.
Deep Venous Thrombosis after Strokes in Chinese
Authors: Tso S. C.
Published: March 2008

Summary: In 35 Chinese patients suffering from strokes resulting in hemiparesis or hemiplegia, deep venous thrombosis, as detected with 125/‐fibrinogen scan, occurred in the paralysed leg in five and in the normal leg in one. The total incidence of 17% was lower than that reported in the West. No clinical evidence of pulmonary embolism was seen. This report represents an objective confirmation of the low incidence of venous thrombosis in the Chinese.
The Radionuclide Assessment of Left Ventricular Function Using Graded Exercise in Normal Subjects*
Authors: Kalff V. , Kelly M. J. , Jennings G. L. , Lirn Y. L. , Anderson S. T. , Korner P. I. , Harper R. W. , Pitt A.
Published: March 2008

Summary: In 20 normal volunteers, two minute equilibrium gated blood pool scanning (GBPS) was used to assess left ventricular function during rest and three stages of graded supine exercise on a bicycle ergometer. The three work loads were individualised for each subject from a previously performed exercise test and corresponded to mild, moderate and severe stress. The short imaging time was validated against standard GBPS.

With exercise all subjects increased their left ventricular ejection fraction and in the majority, most of this rise occurred with the lowest work load. This change was predominantly due to a marked fall in end‐systolic volume. The end‐diastolic volume initially fell, then at peak exercise returned to baseline values. The major change in stroke volume occurred at peak exercise.
Multiple Myeloma Presenting as Recurrent Obstructive Uropathy
Authors: Waugh D. A. , Ibels L. S.
Published: March 2008

Summary: A 51‐year‐old patient who presented with a four‐day history of abdominal pain was found to have unilateral ureteral obstruction and an intracalyceal radiolucent filling defect on radiological studies. Further investigation of this was refused by the patient but ten days later a repeat intravenous pyelogram showed persistence of the initial intracalyceal filling defect and ureteral obstruction in the contra‐lateral kidney along with multiple intracalyceal radiolucent filling defects. Subsequent investigation led to a diagnosis of kappa light chain myeloma.

The diagnosis of multiple myeloma should be considered in patients presenting with unexplained radiolucent filling defects.
Oral Histoplasmosis Treated With Miconazole
Authors: Nicholls M. , Robertson T. I. , Jennis F.
Published: March 2008

Summary: A case of localised histoplasmosis of the gingivae, with no osseous involvement is described in a 50‐year‐old man. The diagnosis was based on histology, growth on culture and a positive histoplasmin latex test. Therapy was commenced with intravenous amphotericin but was changed to intravenous miconazole because of serious immediate side effects and the development of marked renal impairment and moderate suppression of erythropoiesis. Rebiopsy of the gingival margin showed therapy to be effective. No source of the infection could be traced.
Lymphocytic Lymphoma Presenting with Peripheral Bony Manifestations and with Massive Renal Infiltration Responsive to BACOP Combination Therapy
Authors: Ruse W. , Barry A. L.
Published: March 2008

Summary: A 26‐year‐old man with diffuse lymphocytic lymphoma presented with painful peripheral bone involvement and with acute renal failure associated with massive lymphomatous renal infiltration. Renal function returned to near normal following combination chemotherapy with bleomycin, adriamycin, cyclophos‐phamide, vincristine and prednisolone (BACOP).
Clinical Features and Natural Mortality of Chronic Active Hepatitis in Hong Kong
Authors: Lam K. C. , Lai C. L. , Chan W. C.
Published: March 2008

Abstract: To study the clinical picture and survival of chronic active hepatitis (CAH) in Hong Kong, the records of 298 non‐alcoholic patients with histologically proven CAH were reviewed. The male :female ratio was 3:l. The mean age (±SD) on presentation was 47.3 (±13.1) years. The liver was shrunken and the mean mass (± SD) at autopsy was 887 gm (± 266) compared to 1343 gm (± 172) in cases without liver disease. The spleen was enlarged to 2 to 20 cm below the left costal margin in 98% of cases. The survival graph showed an annual mortality of approximately 13%, without a tendency to flatten out within ten years of diagnosis. Survival was best in patients presenting with splenomegaly alone, average in those presenting with ascites or gastrointestinal haemorrhage and worst in those presenting with hepatic decompensation. The modes of death were significantly correlated with the chief complaints on first presentation (P < 0.001). The study documented the clinical aspects of CAH in Hong Kong and amplified the differences reported among CAH patients between Australia and Asia.
Use of Captopril in the Diagnosis of Renal Hypertension
Authors: McGrath B. P. , Matthewst P. G. , Johnston C. I.
Published: March 2008

Abstract: 1. The effects of a single 25 mg oral dose of captopril on blood pressure, heart rate and circulating renin, angiotensin I, angiotensin II, bradykinin and catecholamine levels were examined in untreated patients with essential (n = 10, Group I), accelerated (n = 6, Group II) and renal hypertension (n = 8, Group III) studied on a normal sodium diet.

2. Mean blood pressure fell only slightly in Group I patients, (113 ± 3 to 109 ± 3 mmHg at 60 minutes) but a greater fall was observed in Group II (153 ± 8 to 135 ± 11 mmHg) and a marked fall in Group III, (136 ± 3 to 114 ± 5 mmHg). There were no significant changes in heart rate in any group.

3. Plasma angiotensin II levels were significantly reduced 30 minutes after captopril in all three groups and returned toward resting values after four hours. The falls in plasma angiotensin II levels were accompanied by reciprocal increases in blood angiotensin I and plasma renin, but blood bradykinin and plasma catecholamine concentrations remained unchanged.

4. Resting plasma renin levels showed considerable overlap in the three groups and the mean renin values were not significantly different in the three groups. After captopril a marked rise in plasma renin concentration (>2.5 ng/ml/hr) was observed in seven patients in Group III, including all six patients with renovascular disease. In contrast, none of the patients with essential hypertension and only one patient with accelerated hypertension had such an increase. Determination of the acute renin and blood pressure responses to converting enzyme inhibition with a single oral dose of captopril appears to be useful in identifying patients with renovascular hypertension.