bluuebunny/crossref_metadata_2025 huggingface dataset:
RESULTS OF A TECHNIQUE OF MITRAL VALVE REPAIR
Authors: BRADY P. W. , DEAL C. W. , ANGUS G.
Published: March 2008

Abstract A particular technique for mitral repair of the posterior leaflet prolapse of the mitral valve has been used at Royal North Shore Hospital over a 15‐year period. The anatomical details, complications and results of repair, as well as mortality, are reviewed in a group of 49 patients.

Surgery in this group was performed with three peri‐operative deaths. Three patients required re‐operation due to the failure of repair; one patient within one month of surgery and the others at 6.5 and 9 years. All patients improved symptomatically following mitral repair.

This series demonstrates that the repair of posterior leaflet prolapse can be performed in all patient age groups with low mortality and morbidity rates. A low incidence of re‐operation for failure of repair and other complications related to valve surgery can be anticipated. (Aust NZ J Med 1987; 17: 491–494)
USEFULNESS OF ESTIMATING INDIVIDUAL PHARMACOKINETIC DATA FOR AMINOGLYCOSIDE THERAPY IN SERIOUSLY ILL PATIENTS
Authors: DENARO C. P. , RAVENSCROFT P. J.
Published: March 2008

Abstract This study proposes the use of individual pharmacokinetic parameters to predict effective dosages of aminoglycosides for patients with serious infections. Parameters were calculated for 51 patients using a one‐compartment model. This model required a trough and three postinfusion aminoglycoside concentrations from each patient, as well as least squares linear regression. A total of 56 dosing regimens (37 gentamicin, 19 tobramycin) were predicted from these parameters and the efficacy of this approach was examined by comparing the predicted peak (8 mg/l) and trough (1.5 mg/l) concentrations with the observed peak and trough concentrations measured 24 h later. Aminoglycoside concentrations in serum were measured using a fluorescence polarisation immunoassay.

Parameters varied widely, as the following ranges demonstrate: Volume of distribution 0.16–0.52 Ukg; clearance 0.04–0.17 I/kg/h; half‐life 1.l‐5.3 h. The doses predicted ranged from 3.2–16.9 mg/kg/day, with an average of 8.6 (standard deviation [SD] 3.4) mg/kg/day. The measured peak (mean 7.5; SD 1.6) and trough (mean 1.95; SD 0.57) concentrations closely approximated the predicted levels. The equations used underestimated trough concentrations mainly because of aminoglycoside accumulation. The changing pharmacokinetic parameters for each patient meant that regular drug assays were still required to fine‐tune the dosing regimen. Two patients (4%) developed significant nephrotoxicity. Ototoxicity was not assessed.

We conclude that individual pharmacokinetic data for aminoglycoside therapy can be used effectively to predict dosages for desired concentrations in seriously ill patients. The dose required was on average 1.5–2 times the normal recommended dosage. (Aust NZ J Med 1987; 17: 526–531).
AUTOIMMUNE HEMOLYTIC ANEMIA: CURRENT CONCEPTS
Authors: GIBSON JOHN
Published: March 2008

Autoimmune hemolytic anemia (AIHA) is one end of a spectrum of clinical and serological disorders resulting from an autoimmune attack against red cells. Although the etiology of this disorder is far from firmly established, the pathogenesis of red cell destruction by the effector mechanisms of the immune system is well characterised and correlates well with the clinical and serological features of this disorder. Direct antiglobulin test (DAGT) negative AIHA, production crises, AIHA in children and following alpha methyldopa therapy are subgroups of AIHA which have recently been described or more clearly defined and understood. The addition of high dose immunoglobulin and danazol as well as the potential use of more novel approaches to the traditional triad of corticosteroids, splenectomy and immunosuppressive agents has expanded and increased the flexibility of the therapeutic options in this disorder.
CARDIAC ARREST – A MANIFESTATION OF 5‐FLUOROURACIL CARDIOTOXICITY
Authors: MILLWARD M. J. , GANJU V. , BUCK M.
Published: March 2008

We report a case of cardiac arrest occurring during an infusion of 5‐fluorouracil where electrocardiograms suggested coronary artery spasm as the underlying event. Treatment with vasodilators and diltiazem, proved effective. This clinical presentation of 5‐fluorouracil cardiotoxicity has not previously been described.
THE EFFECT OF DIETS CONTAINING FISH AND FISH OILS ON DISEASE RISK FACTORS IN HUMANS
Authors: GIBSON R. A.
Published: March 2008

Fish and fish oils are rich in omega 3 polyunsaturated fatty acids which are capable of acting as both a source of active eicosanoids and as inhibitors of synthesis of eicosanoids from arachidonic acid by a variety of human cells. There is an extensive literature on the role of omega 3 polyunsaturates in ameliorating the risk factors associated with coronary heart disease, including both atherosclerotic and thrombotic factors. In addition, there is a limited number of studies which report the results of trials testing the effects of fish oils on other clinical conditions including diabetes, arthritis, migraine and psoriasis. There appears to be sufficient evidence to suggest that patients at risk from heart disease could benefit from low doses (1–6 g/day) of fish oil in conjunction with a prudent diet.
EOSINOPHILIC ENTERITIS – A RECENT NORTH QUEENSLAND EXPERIENCE
Authors: CROESE T. J.
Published: March 2008

Thirty‐three patients have been investigated in Townsville between 1983 and 1987 with eosinophilic enteritis. All were Caucasian and had been well prior to this illness. Twenty‐six had similar presentations with episodic and transient abdominal pain often with features of small bowel obstruction. Four patients presented with pain and diarrhoea, two with chronic diarrhoea and one with recurrent melena. All patients at some stage during their illness developed high peripheral blood eosinophil counts, mean value 2096/mm3. Nine patients had laparotomies. The disease typically involved a short segment of ileum or jejunum with thickening and induration. The histology of the four resected specimens demonstrated a transmural inflammation with edema and an intense eosinophilic infiltrate. A solitary adult hookworm was identified in one patient adherent to the mucosa of the resected bowel. Each of the 19 patients treated with antihelminthic drugs responded promptly. Recovery was accompanied by a return to normal peripheral blood eosinophil counts. This paper reports an unusual form of eosinophilic enteritis thought due to a parasitic infection. The diagnosis should be considered in patients from North Queensland presenting with abdominal pain and eosinophilia. Laparotomy should be delayed pending a trial of conservative therapy with mebendazole.
FAMILIAL RESTRICTIVE CARDIOMYOPATHY
Authors: ARONEY CON , BETT NICHOLAS , RADFORD DOROTHY
Published: March 2008

The cases of a father and daughter with idiopathic restrictive cardiomyopathy are described. In contrast to other forms of cardiomyopathy, this type is rarely familial.
FIFTY YEARS OF MIGRAINE RESEARCH
Authors: Lance James W.
Published: March 2008

The prevalence of ice‐pick pains and ice‐cream headache in migrainous patients and their localisation to the habitual site of migraine headache, suggest that segments of the central pain pathways remain hyperexcitable between spontaneous attacks. Excessive afferent stimulation (flashing lights, noise, strong perfumes) or hypothalamic changes resulting from emotion, stress or the operation of some internal clock may set in motion brainstem mechanisms, including spontaneous unilateral or bilateral discharge of pain pathways.

Studies in the experimental animal have shown that certain monoaminergic brainstem nuclei can influence the cerebral circulation unilaterally and that they and the trigeminal system can induce a reflex dilatation of the external carotid circulation. Descending pathways from the same brainstem nuclei cause the adrenal gland to secrete noradrenaline, which in turn can release serotonin from blood platelets. Free serotonin may become adsorbed to the arterial wall, thus increasing sensitivity to pain, augmenting afferent input and adding a pulsating quality to migrainous pain.

Both neural and vascular components of migraine implicate monoamines, specifically noradrenaline and serotonin, as neurotransmitters and humoral agents. The recent pharmacological classification of serotonin (5HT) receptors indicates that agonists of a subset of the 5HT1 receptor and antagonists of 5HT2 receptors are most likely to be helpful in the treatment of migraine.
SOME URINARY TRACT DISEASE IN AUSTRALIAN ABORIGINAL INPATIENTS IN 1980
Authors: ASSUMPCAO C.
Published: March 2008

Four hundred and ninety‐three patients were admitted to the Royal Darwin Hospital in 1980 with urinary tract disease. Aboriginals had an increased incidence (p < 0.005) of urinary tract infection and glomerulonephritis (p < 0.001) compared with non Aboriginals. Aboriginals with post‐streptococcal glomerulonephritis tended to grow Group A Beta hemolytic streptococci from their skins, non Aboriginals tended to grow it from their throats. Aboriginals had a lower incidence of urolithiasis (p<O.OOl). There was no difference in the incidence of benign prostatic hypertrophy between the two populations.
LACK OF CROSS SENSITIVITY BETWEEN CAPTOPRIL AND ENALAPRIL
Authors: JACKSON B. , MAHER D. , MATTHEWS P. G. , McGRATH B. P. , JOHNSTON C. I.
Published: March 2008

Oral inhibitors of angiotensin converting enzyme (ACE) now have an established place in the treatment of hypertension and heart failure. Captopril, the first of these agents, was initially used in high doses and was associated with adverse effects including proteinuria, skin rash and taste disturbance. We report 11 patients who developed side effects during captopril therapy (proteinuria two, rash four, taste disturbance four and taste disturbance with rash one) who were subsequently treated with enalapril, a second generation angiotensin converting enzyme inhibitor. Proteinuria did not recur in either patient, skin rash resolved in all five cases and taste disturbance resolved in four of five duringenalaprii therapy. We conclude that the side effects of proteinuria, skin rash and taste disturbance are consequences of captopril idiosyncrasy rather than inhibition of the angiotensin converting enzyme. The reported incidence of these side effects with the current recommended dosage of captopril is low.
ARTICULAR MANIFESTATIONS OF ACROMEGALY
Authors: PODGORSKI M. , ROBINSON B. , WEISSBERGER A. , STIEL J. , WANG S. , BROOKS P. M.
Published: March 2008

Forty‐five patients with acromegaly or gigantism were reviewed for musculoskeletal abnormalities. Abnormalities of peripheral joints occurred in 74% of the patients and spinal involvement in 47%, leading to significant morbidity. Joint abnormalities most frequently affected the large joints (hips, knees and shoulders) but the wrist and hand were also involved. The radiological features of acromegalic arthropathy are described, including vertical widening of the hip joint, enthesopathy and osteophytosis. A favourable response to treatment is associated with a less severe arthropathy and a good functional outcome.
ENCEPHALOPATHY FOLLOWING CISPLATIN, BLEOMYCIN AND VINBLASTINE THERAPY FOR NON‐SEMINOMATOUS GERM CELL TUMOUR OF TESTIS
Authors: HITCHINS R. N. , THOMSON D. B.
Published: March 2008

A 22‐year‐old man developed severe encephalopathy, grand mal seizures and visual disturbance after combination chemotherapy with cisplatin, vinblastine and bleomycin for metastatic testicular carcinoma. After excluding treatable causes, only supportive management was given, and the symptoms and signs resolved over several months. We suggest a clinical syndrome of encephalopathy, seizures and visual disturbance represents a rare toxicity of cisplatin‐based therapy. Given the wide spread usage of cisplatin, this should be drawn once again to the attention of medical oncologists.
WISKOTT‐ALDRICH SYNDROME IN IDENTICAL TWINS: ABNORMALITY OF CD4 AND CD8 POSITIVE LYMPHOCYTES
Authors: FORSYTH K. , SESHADRI R. , MATTHEWS C. , HEDDLE R.
Published: March 2008

The rare occurrence of Wiskott‐Aldrich syndrome (WAS) in identical twin brothers without a preceding family history of the disease is described. Investigation into the nature of the lymphocyte abnormality in the surviving twin suggests that the frequency of T cell clone forming cells is markedly decreased. Further analysis of the T cell clones showed a deficiency of CD8 positive cytotoxic/suppressor cells. This alteration may be an underlying mechanism in the development of some of the clinical manifestations of WAS
DISSEMINATED TUBERCULOSIS COMPLICATED BY THE HEMOPHAGOCYTIC SYNDROME
Authors: BROWETT P. J. , VARCOE A. R. , FRASER A. G. , ELLIS‐PEGLER R. B.
Published: March 2008

A 43‐year‐old Polynesian presented with fever, abnormal liver function tests, bilateral pulmonary infiltrates, and a progressive neutropenia and thrombocytopenia. Bone marrow examination showed extensive and striking hemophagocytosis which raised the diagnosis of malignant histiocytosis. Mycobacterium tuberculosis was subsequently cultured from both urine and bone marrow. Hemophagocytosis is now a recognised association of several infections and we draw attention to this finding, particularly as the confident exclusion of malignancy can be very difficult and management is obviously very different.
NON CAMPYLOBACTER PYLORI SPIRAL ORGANISMS IN THE GASTRIC ANTRUM
Authors: LEE A. , ECKSTEIN R. P. , FEVRE D. I. , DICK E. , KELLOW J. E.
Published: March 2008

Colonisation of the human gastric antrum with non Campylobacter pylori spiral organisms is described. A moderately severe histological gastritis was present despite the fact that these organisms, in contrast to C. pylori, were not closely associated with the epithelial cell surface. Although in vitro culture of the organisms was unsuccessful, in vivo culture was achieved in the mouse stomach. Further study of these spiral organisms should provide important clues to the role of bacteria in upper gastrointestinal disease.
PATHOPHYSIOLOGY OF PORTAL HYPERTENSION AND IMPLICATIONS FOR ITS PHARMACOLOGICAL CONTROL
Authors: GIBSON P. R. , DUDLEY F. J.
Published: March 2008

Bleeding from esophageal varices complicating portal hypertension is a major cause of morbidity and mortality in patients with chronic liver disease. Therapy has been directed towards obliteration of esophageal varices (endoscopic sclerotherapy, transhepatic sclerosis, or esophageal transection) or decompression of the portal vascular bed by the creation of surgical portasystemic shunts. The use of pharmacological agents to lower portal venous pressure (PVP) was for many years limited to intravenous or intraarterial vasopressin in the setting of acute variceal hemorrhage. However, since Lebrec et al.,1 reported the favourable effect of propranolol on PVP and on the incidence of rebleeding from the upper gastrointestinal tract in patients with portal hypertension,2 there has been an increasing interest in the potential use of a number of pharmacological agents in the short and long term management of patients with portal hypertension. The purpose of such therapy would be to reduce the incidence of complications of portal hypertension. These may include upper gastrointestinal bleeding, ascites via reduced ascitic fluid formation, and even portasystemic encephalopathy via improvement of hepatic perfusion and reduction of collateral shunting of blood.
CYCLOSPORIN A IN THE TREATMENT OF CHILDHOOD GLOMERULONEPHRITIS
Authors: JAMES R. W. , BURKE J. R. , PETRIE J. J. B. , RIGBY R. J. , WILLIAMS M.
Published: March 2008

Seven children with steroid resistant nephrotic syndrome (focal segmental sclerosis in six, mesangial proliferation in one) were treated with Cyclosporin A for 12 weeks. Five of these children were also resistant to cyclophosphamide. All patients had normal renal function. Cyclosporin was started at 8mg/kg/day then increased until a trough blood level of 100–300 ng/ml (HPLC) was achieved. Three of the seven patients achieved complete remission, and the other four had a significant reduction in their proteinuria (p < 0.05). In the three patients who achieved complete remission, relapse of proteinuria occurred within six weeks of ceasing Cyclosporin. All patients experienced some impairment in renal function with mean creatinine clearance decreasing from 12919 to 9113 ml/min/1.73m2 (p < 0.05). One child was subsequently treated with Cyclosporin for 12 months. He remains in remission with a repeat renal biopsy showing no evidence of nephrotoxicity.

One other child with steroid sensitive minimal change nephrotic syndrome who had severe steroid toxicity was treated with a lower dose (5mg/kg/day) for 12 months. She remained in remission off steroids, but relapsed 16 weeks after Cyclosporin was ceased. A renal biopsy after 12 months showed no nephrotoxicity. Cyclosporin should be considered in steroid resistant nephrotic syndrome, and in children with minimal change disease who show signs of steroid toxicity and short remission period after cyclophosphamide. Serial renal biopsies are recommended with prolonged therapy.
INFERIOR PETROSAL SINUS SAMPLING IN ACROMEGALY
Authors: CROCK P. A. , GILFORD E. J. , HENDERSON J. K. , CUMMINS J. , CALENTI A. J. , BEST J. D. , ALFORD F. P.
Published: March 2008

In view of the diagnostic value of bilateral simultaneous inferior petrosal sinus sampling (BSIPSS) in localising preoperatively the site of the microadenoma in pituitary dependent Cushing s disease, the clinical value of BSIPSS was evaluated in five acromegalic patients with equivocal or negative pituitary CT scans. Intersinus GH gradients were obtained for all patients (range 1.6–4.2) but in only one case was the gradient correctly localised to the side of the tumour. Gradients of several other pituitary hormones, particularly prolactin (range 1.6–4.0), also demonstrated gradients parallel to the GH intersinus gradients. Despite the paradoxical intersinus GH gradients, the surgeon was able to readily identify the tumour at the time of surgery. Thus BSIPSS is of little assistance to the surgeon for the preoperative radiological evaluation in acromegaly and these results caution against the universal adoption of the BSIPSS technique in the radiological assessment of all secretory pituitary microadenomas.
THE EFFECT OF HISTAMINE CHALLENGE ON PLATELET COUNT AND PLATELET ACTIVATION
Authors: DUGGAN C. J. , PARMENTIER M. D. , CASTLE W. D. , BEREND N.
Published: March 2008

There is conflicting evidence of platelet involvement in asthmatic bronchoconstriction. We sought direct evidence of platelet activation and indirect evidence of platelet sequestration following histamine challenge (HC) in 14 asthmatics and seven non asthmatic control subjects. Peripheral platelet counts and levels of β thromboglobulin (BTG) were measured immediately before and following HC in the 21 subjects. There were no significant differences in the platelet counts or BTG levels, before or after HC, within or between the two groups. These results do not support platelet activation or accumulation in the lungs occurring immediately following histamine induced bronchoconstriction in asthmatics.
VENTILATORY RESPONSES TO HYPOXIA AND HYPERCAPNIA IN ASTHMATICS WITH PREVIOUS RESPIRATORY FAILURE
Authors: TOWN G. I. , ALLAN C.
Published: March 2008

The ventilatory response to hypoxia and the ventilatory and mouth occlusion pressure response to hypercapnia was measured in 13 subjects who had previously developed respiratory failure or respiratory arrest during an acute asthma attack, In 11 of 12 subjects tested there was a normal response to hypercapnia. Six of the 13 subjects had an impaired response to hypoxia. Impaired hypoxic responsiveness may Contribute to the early onset of hypercapnic respiratory failure during acute severe asthma.
PROTEINURIA, GLOMERULOMEGALY AND FOCAL GLOMERULOSCLEROSIS IN A GROSSLY OBESE MAN WITH OBSTRUCTIVE SLEEP APNEA SYNDROME
Authors: BAILEY R. R. , BURRY A. F. , LYNN K. L. , DRENNAN C.
Published: March 2008

A grossly obese (149 kg) man with the sleep apnea syndrome was found to have proteinuria and a supernormal glomerular filtration rate. Renal histology showed glomerulomegaly and focal glomerulosclerosis. It is suggested that obesity may induce glomerular hyperfiltration and in turn glomerulosclerosis.
THE ENDOGENOUS NITROVASODILATOR PRODUCED BY THE VASCULAR ENDOTHELIUM
Authors: DUSTING G. J. , HIGGS E. A. , MACDONALD P. S. , MONCADA S.
Published: March 2008

The calibre of blood vessels and the tone of the vascular smooth muscle are determined not only by innervation, circulating hormones and metabolic factors, but also by local mediators generated in the vascular wall. Prostacyclin is produced mainly by the endothelium; it was the first endothelium‐derived mediator that aroused widespread attention, for it is a powerful vasodilator and inhibitor of platelet aggregation.1 More recently it was discovered that the vascular endothelium produced another potent humoral agent which is responsible for the vasodilator action of many endogenous substances. This substance is endothelium‐derived relaxing factor (EDRF).
GUILLAIN‐BARRÉ SYNDROME AND RELATED CONDITIONS IN VICTORIAN TEACHING HOSPITALS 1980–84
Authors: STOREY E. , COOK M. , PEPPARD R. , NEWTON‐JOHN H. , BYRNE E.
Published: March 2008

Cases of Guillain‐Barré syndrome, its variants, and chronic inflammatory demyelinating neuropathy presenting during the period 1980–84 were identified through computer‐based record systems. Case notes were examined, and cases that did not meet standard criteria for diagnosis were excluded. A hundred and ten patients were identified, giving an annual adult incidence rate of 0.9/100,000 and a male:female ratio of 1.3:1. The majority of cases developed severe tetraparesis, but unusual presentations included the Miller‐Fisher variant, paraplegia, and bibrachial involvement. There was wide variation in peak disability, ranging from ambulant with weakness (32%), through bedfast but without significant respiratory involvement (29%), to respiratory involvement requiring admission to an intensive care unit (38%). Of those discharged directly home, the average hospital stay for those less than 50 years was 27 days, whilst that for those over 50 was 49 days. CSF protein was measured in 87 patients, and was ≥0.6 g/L in 76% of these. Nerve conduction studies were performed in 52 patients, and were abnormal in 90% of these. Guillain‐Barré syndrome and allied conditions represent a major drain on health resources, and the need to provide adequate plasmapheresis facilities for patients early in the course of severe disease is stressed.
ACUTE LEAD ARSENATE POISONING
Authors: TALLIS G. A.
Published: March 2008

Three cases of acute lead arsenate poisoning which occurred in South Australia during a 12 month interval are described. The case reports demonstrate a number of features of the characteristic clinical syndrome which may follow ingestion of lead arsenate. The recommended management is immediate gastric lavage and subsequent chelation therapy with calcium EDTA and dimercaprol. Early gastric lavage may prevent significant lead absorption. However, arsenic acid (produced in the stomach when lead arsenate reacts with hydrochloric acid) is relatively water soluble and prompt gastric lavage is unlikely to prevent extensive arsenic absorption. It remains controversial as to whether chelation with dimercaprol prevents arsenical neuropathy.
CHLOROQUINE ABUSE AND HEART BLOCK IN AFRICANS
Authors: IHENACHO H. N. C. , MAGULIKE E.
Published: March 2008

Twelve of 30 Africans with heart block gave a history of chronic chloroquine abuse. Eleven of these had evidence of chloroquine retinopathy whereas four of the 18 nonabusers had abnormal ophthalmologic findings, thought to be senile changes. The chronic chloroquine abusers were all male and were younger (mean age 51.6 years) than the non‐abusers (mean age 61.2), nine of whom were female. Serum chloroquine levels were not helpful diagnostically.

In the absence of other etiological factors, chronic chloroquine toxicity is important in the causation of heart block in Africans. (Aust NZ J Med 1989; 19: 17–21.)
CUTANEOUS VASCULITIS DUE TO CYCLOPHOSPHAMIDE THERAPY FOR CHRONIC LYMPHOCYTIC LEUKEMIA
Authors: GREEN R. MALCOLM , SCHAPEL GRAHAM J. , SAGE ROBERT E.
Published: March 2008

A 55‐year‐old male with chronic lymphocytic leukemia developed a skin eruption after receiving oral cyclophosphamide. Subsequent rechallenge with parenteral cyclophosphamide led to recurrence of the skin lesions, which on biopsy were shown to be vasculitic in nature. (Aust NZ J Med 1989; 19: 55–57.)
Endometrial adenocarcinoma presenting as pituitary apoplexy
Authors: Lieschke G. J. , Tress B. , Chambers D.
Published: March 2008

The novel combination of disseminated primary endometrial adenocarcinoma and a symptomatic pituitary metastasis presenting as pituitary apoplexy is described for the first time. Pituitary apoplexy is an unusual manifestation of metastatic pituitary disease. The more common clinical features of pituitary metastases and an approach to their management are discussed. The usefulness of magnetic resonance imaging in assessing the base of skull is emphasised.
Comparison of methods of assessment of renal function in patients with cancer treatedwith cisplatin, carboplatin or methotrexate
Authors: Robinson B. A. , Atkinson C. H. , Frampton C. M. , Fitzharris B. M. , Colls B. M.
Published: March 2008

In patients with cancer treated with cisplatin, carboplatin or methotrexate creatinine clearance calculated using the Cockcroft‐Gault formula was compared with measured clearance and with the glomerular filtration rate. In 106 patients the average squared difference for calculated and 24 hour urine creatinine clearance was 0.288, n = 606; and for calculated creatinine clearance and glomerular filtration rate (measured using diethylenetriaminepenta‐acetic acid, DTPA), 0.212, n = 34.

On 35 of 606 occasions (6%) in 18 patients (17%), the calculated clearance overestimated the 24‐hour urine creatinine clearance when it was less than 1 mL/s. In all but one patient, this was explained by factors leading to renal impairment (seven patients) or overestimation of clearance (ascites in two patients) or by an isolated low value for 24‐hour urine creatinine clearance (eight patients). Declining renal function with increasing total dose of cisplatin was detected by both calculated and 24‐hour urine creatinine clearance in patients with germ cell tumours.

Derivation of an equation to predict creatinine clearance showed a linear association with plasma creatinine concentration, patient age, weight and gender. Variability in cancer patients was similar to that in the original Cockcroft‐Gault study. Calculation of creatinine clearance can be used in cancer patients to monitor treatment with renally‐eliminated chemotherapy agents.
Clinical benefit of transdermal glyceryl trinitrate when used with an eight hour patch‐free period
Authors: Whalley D. W. , Hellestrand K. J.
Published: March 2008

The 24‐hour application of transdermal nitrate patches has been associated with rapid development of therapeutic tolerance. Recent reports suggest maintenance of clinical benefit by introducing a daily patch‐free period. This study investigates, by means of serial treadmill testing, the efficacy of a new transdermal delivery system when used with an eight hour patch‐free period in 16 subjects with chronic stable angina. Concomitant antianginal therapy was permitted. After demonstration of exercise test reproducibility and nitrate responsiveness, subjects entered a double‐blind randomised placebo‐controlled crossover trial comprising one week of active nitroglycerin patches (10mg/24hrs) and one week of an identical placebo patch. Exercise tests were conducted four hours after patch application on the last day of each of the treatment arms. Daily angina frequency and nitroglycerin consumption were also monitored.

There was significant improvement in total exercise duration (16.5%), time to onset of angina (26%), time to 1mm ST depression (22%), and peak heart rate blood pressure product with active patch application. Angina frequency was reduced during the week of active therapy. These results demonstrate the additional efficacy of intermittent transdermal nitroglycerin in a group of subjects with continuing angina despite therapy with beta‐blockers and calcium antagonists.
Effects of an ethyl ester preparation of fish oils (HIMEGAR) on lipids and lipoproteins in hyperlipidaemia
Authors: Simons L. A. , Parfitt A. , Simons J. , Balasubramaniam S.
Published: March 2008

Clinical trials were conducted to assess the utility of HimegaR in the management of hyperlipidaemia. Himega is an ethyl ester concentrate from fish oil containing at least 50% n‐3 fatty acid and minimal cholesterol. In Study 1, 13 subjects with primary hypertriglyceridaemia consumed Himega or a triglyceride‐based fish oil in a randomised, double‐blind crossover study for 12 weeks. Nine subjects took 2 g/day of n‐3 fatty acid but four subjects with marked hypertriglyceridaemia took 4 g/day. Plasma triglycerides were reduced by approximately 50% with either product. There was a very similar effecton all lipid and lipoprotein parameters, including an 18% increase in LDL cholesterol and23% increase in serum apolipoprotein B. In Study 2, nine subjects with primary hypercholesterolaemia took 2 g/day of n‐3 fatty acid (Himega) or placebo (olive oil) in a randomised, double‐blind crossover study for nine weeks. Plasma cholesterol was reduced by 6%, without significant change in LDL. cholesterol. Fish oils in the form of ethyl esters or triglyceride are assimilated to a similar degree and lead to equivalent triglyceride‐lowering in hypertriglyceridaemia, while simultaneously increasing LDL particle numbers. Himega does not reduce LDL levels in hypercholesteraemia, despite being a product with minimalcholesterol content.
Covert self poisoning with brodifacoum, a ‘superwarfarin’
Authors: Wallace S. , Worsnop C. , Paull P. , Mashford M. L.
Published: March 2008

The clinical course of a patient poisoned with the ‘superwarfarin’ brodifacoum and a method for estimation of plasma levels is described. It was characterised by prolonged depression of Vitamin K‐dependent clotting factors poorly responsive to Vitamin K administration.
An overview of bilateral synchronous inferior petrosal sinus sampling (BSIPSS) in the pre‐operative assessment of Cushing's disease
Authors: Boolell M. , Gilford E. , Arnott R. , McNeill P. , Cummins J. , Alford F.
Published: March 2008

This study examines the role of bilateral synchronous inferior petrosal sinus sampling (BSIPSS) in resolving two major issues in the pre‐operative assessment of Cushing's disease, namely proof of pituitary dependent disease and accurate lateralisation of tumour within the pituitary. BSIPSS was technically successful in 16 of 20 patients. The central to peripheral ACTH gradients, supporting the diagnosis of pituitary dependent disease, was <2.0 (2.0–27.2) in all patients with histologically proven ACTH‐secreting pituitary tumours and in those who remained in remission following pituitary surgery. In addition, BSIPSS accurately localised the site of the tumour within the pituitary in 13 of the 16 technically satisfactory studies and thus contributed to the outcome of surgical treatment. In contrast CT scan demonstrated a definite tumour in only two patients.
Antacid‐induced phosphate depletion syndrome presenting as nephrolithiasis
Authors: Harmelin D. L. , Martin F. I. R. , Wark J. D.
Published: March 2008

A 29‐year‐old insulin‐dependent diabetic woman developed phosphate depletion, nephrolithiasis and bilateral ureteric obstruction due to antacid abuse. Unlike previous descriptions of chronic phosphate depletion, myalgia, weakness and bone pain were absent. Biochemical features included hypophosphataemia, hypercalciuria, hypophosphaturia, elevated plasma 1,25‐dihydroxyvitamin D and low plasma intact parathyroid hormone. These abnormalities were corrected when antacid ingestion was reduced and phosphate intake supplemented. Wepropose that phosphate depletion secondary to antacid abuse caused 1α‐hydroxylase activation and elevation of the plasma 1,25‐dihydroxyvitamin D level, leading to marked hypercalciuria. Once diagnosed, antacid abuse is a readily reversible cause of hypercalciuria and renal stones. Moreover, antacid‐induced phosphate depletion may present with nephrolithiasis in the absence of musculoskeletal symptoms. This report is intended to draw attention to this important cause of renal stone disease.
Aspirin concurrently administered with ranitidine does not delay healing of duodenal ulcer
Authors: Misra S. P. , Kumar N. , Anand B. S.
Published: March 2008

Sixty‐nine patients with endoscopically diagnosed duodenal ulcer were randomised to either Group I or Group II. Group I patients (n= 35) received tablet ranitidine 150 mg twice daily along with tablet aspirin 600 mg three times a day while Group II patients received only tablet ranitidine 150 mg twice daily. Eight patients (four in each group) dropped out of the trial but were included in the final analysis as failure of treatment. At the end of four weeks 51.4% ulcers healed in Group I compared to 58.8% in Group II. The difference between the two groups was not significant. There was also no statistical difference in the time required for relief of pain, number of patients relieved of pain and the complication rate. It is concluded that aspirin concurrently administered with ranitidine is safe and does not delay the healing of uncomplicated duodenal ulcers.
Pulmonary toxicity following MOPP chemotherapy
Authors: Millward M. J. , Cohney S. J. , Byrne M. J. , Ryan G. F.
Published: March 2008

Pulmonary toxicity is a well recognised side effect of anticancer agents particularly bleomycin, cyclophosphamide, methotrexate, and busulphan.1 In contrast this problem has been infrequently reported following MOPP (nitrogen mustard, vincristine, prednisolone, procarbazine) chemotherapy for Hodgkin's disease and has been attributed principally to the procarbazine.2–8 We report a further instance of MOPP associated pulmonary toxicity. This case and a review of previously published cases indicate that MOPP chemotherapy may be associated with the development of permanent lung damage as well as an acute reversible hypersensitivity lung disease.
Endobronchial resection with the Nd‐YAG laser – Two years experience in an Australian unit
Authors: Pierce R. J. , Mestitz H. , Simpson L. W. , Daniel F. J.
Published: March 2008

Abstract In a two year period 44 endobronchial resections using the Neodymium‐YAG laser have been performed in 28 patients. The majority of cases had either bronchogenic carcinoma (57%) or metastatic carcinoma (18%) involving the bronchial tree. Adenoid cystic carcinoma, benign tumours, lymphoma, tracheal papillomatosis, Wegener's granulomatosis and benign stricture comprised the other cases. Rigid bronchoscopy and general anaesthesia were used in the majority. Symptomatic improvement of dyspnoea when relief of bronchial obstruction occurred was marked in ten of 17 cases, moderate in four and absent in three. Haemoptysis was markedly improved in two of three cases and obstructive pneumonias resolved in one of two cases. Significant respiratory function improvement was observed in Raw (most sensitive), FEV1, FVC and TLC. Laser treatment restored the lumen to normal calibre in 52% (including all patients with tracheal lesions), to greater than half normal in 28% and to less than half normal in 20% of cases. Re‐expansion of a collapsed lung or lobe occurred in seven of eight patients. In six of these patients laser treatment was the initial therapy resulting in immediate re‐expansion and symptomatic relief prior to further therapy. In patients with bronchogenic carcinoma the mean time to retreatment or death was 72 days. For metastatic carcinoma this was 60 days. Two early deaths (3 hours, 36 hours) due to respiratory failure occurred in patients with very severe bilateral bronchial obstruction too advanced for effective clearance. Other complications included laryngeal oedema requiring prolonged intubation (1), bronchospasm (1), atrial fibrillation (1), and acute pulmonary oedema (1). Laser treatment provides effective palliation for bronchial obstruction and haemoptysis in selected proximal endobronchial cancers.
Electrical ablation of posteroseptal accessory pathways
Authors: Vohra J. , Strathmore N. , Kertes P. , Hunt D.
Published: March 2008

Abstract Electrical ablation of a posteroseptal accessory pathway by delivery of direct current electrical energy at the coronary sinus ostium was attempted in six patients.

As a result of 12 procedures in these six patients, the posteroseptal accessory pathway was successfully ablated in one patient. Retrograde conduction only was affected in a further three patients, abolishing paroxysmal supraventricular tachycardia in two and reducing the tachycardia rate in one. One of the six patients developed coronary sinus perforation requiring prompt pericardial aspiration.

The procedure is complicated, time consuming, of limited efficacy and coronary sinus perforation is a significant risk. Surgery remains the preferred option as a curative procedure for arrhythmias due to posteroseptal accessory pathway.
Disseminated histoplasmosis presenting as penile ulcer
Authors: Jayalakshmi P. , Goh K. L. , Soo‐Hoo T. S. , Daud A.
Published: March 2008

Abstract A 59‐year‐old Chinese man presented with a three month history of penile ulcers and abdominal pain. Syphilis and a gastric malignancy were diagnosed clinically. Biopsy of the genital and stomach ulcers revealed histiocytic granulomata containing numerous intracellular fungal bodies. Histoplasma capsulatum was subsequently cultured from the penile ulcer. Antifungal therapy was instituted. However the patient's general condition deteriorated rapidly and he died within two weeks of admission. A post‐mortem liver biopsy showed numerous intracellular fungi.
Streptococcus zooepidemicus cellulitis and bacteraemia in a renal transplant recipient
Authors: McKeage M. J. , Humble M. W. , Morrison R. B. I.
Published: March 2008

Abstract A case of a renal transplant recipient with Streptococcus zooepidemicus (Lancefield group C) cellulitis and bacteraemia is described. Human infections with this organism are very rare and this is the first case report of cellulitis caused by S. zooepidemicus. While animals are the reservoir for most human infections, a source was not defined in this patient.
Does the emergency room electrocardiogram identify patients with suspected myocardial infarction who are at low risk of acute complications?
Authors: Bell M. R. , Montarello J. K. , Steele P. M.
Published: March 2008

Abstract To determine the early morbidity of patients admitted to the coronary care unit (CCU) with inconclusive evidence of acute myocardial infarction, the prognostic value of the emergency room electrocardiogram (ECG) was examined prospectively in a blinded fashion in 410 patients presenting with acute chest pain. One hundred and forty one patients (34.4%) had an ECG that was normal, showed ST segment changes < 1 mm, or was unchanged from a previous recording (group 1). The remaining patients (65.6%, group 2) had ECGs considered abnormal.

Thirty‐nine patients in group 1 and 226 in group 2 had confirmed infarction. There was one CCU death in group 1 (0.7%) versus 27 (10.0%) in group 2 (p<0.001) and the overall hospital mortality for group 1 was 2.1% versus 13.0% in group 2 (p< 0.001). Twenty‐eight patients (19.9%) from group 1 suffered complications in the CCU versus 155 (57.6%) from group 2 (p< 0.001). No life‐threatening arrhythmias occurred in group 1 versus occurrence in 47 patients (17.5%) in group 2 (p< 0.001). The need for acute intervention was also less for group 1 versus group 2 patients, 14 (9.9%) and 85 (31.6%) respectively (p<0.001) with no patient requiring electrical cardioversion in group 1.

It is concluded that the emergency room ECG can reliably identify a group of low risk patients presenting with suspected myocardial infarction and so help in establishing priority for admission to the CCU. Furthermore, the risk‐benefit of thrombolytic therapy in these low risk patients appears unacceptable.
An unusual case of variegate porphyria with possible homozygous inheritance
Authors: Coakley J. , Blake D. , Hawkins R. , Nordmann Y. , Crinis N. , Sloan L. , McManus J. , Connelly J.
Published: March 2008

Abstract We report an unusual case of variegate porphyria in a young girl with epilepsy, mental retardation and premature adrenarche. Symptoms of porphyria commenced about the age of 12 years and death occurred about 18 months later. The patient had very low protoporphyrinogen oxidase activity in her cultured fibro‐blasts. Both parents had half the normal activity of this enzyme in lymphocytes and are heterozygous for the abnormal gene for variegate porphyria. Therefore, it is possible that the patient was a homozygous variant. Anticonvulsant therapy and low hepatic 5α reductase activity were probably other contributing factors to the severity of the condition in this patient.
Fits, confusion and peripheral neuropathy in a young woman
Authors: Crimmins D. , Marks J. , McLeod J. G. , Morris J. G. L.
Published: March 2008

A 34‐year‐old high school teacher presented at Westmead Hospital in September 1987 with the following history. She had been perfectly well until June 1986. At that time she had an episode of horizontal diplopia which lasted for several minutes. A few days later her husband saw her having a fit while asleep. Her limbs shook, she bit her tongue and she was incontinent of urine. Thereafter she continued to have fits, always at night while asleep. Her husband also described episodes in which, while cooking the family meal, she looked vacant for a few minutes. She was referred to a neurologist. No abnormalities were found on physical examination. Visual evoked potentials, MRI head scan and cranial CT scan with contrast were normal. Examination of the CSF showed no cells, no growth on culture, normal total protein and polyclonal gammaglobulin on electrophoresis.
Optic disc oedema and diabetes mellitus: a case report with review
Authors: West P. D. , De Wytt C. N. , Strakosch C. R.
Published: March 2008

Optic disc oedema is a neurological complication of diabetes mellitus. Typically, the patient is a young diabetic with minimal symptomatology but severe bilateral optic disc oedema discovered on routine eye examination. It is a relatively benign condition which on occasion can result in a residual visual deficit, but requires no specific intervention and represents a subgroup of anterior ischaemic optic neuropathy (AION). We present a patient with insulin dependent diabetes and asymptomatic bilateral optic disc oedema, with a brief review of the syndrome and its pathogenesis. (Aust NZ J Med 1991; 21: 248–250.)
Controlled release levodopa/carbidopa (Sinemet CR4) in Parkinson's disease – an open evaluation of efficacy and safety
Authors: Bulling M.T. , Wing L.M.H. , Burns R.J.
Published: March 2008

Abstract Twenty patients with moderately severe Parkinson's disease entered an open study of the efficacy and safety of a slow release preparation containing levodopa 200mg and carbidopa 50mg per tablet (‘Sinemet CR4’). Following an initial four week baseline stabilisation period on conventional ‘Sinemet’ tablets, the patients were transferred to ‘Sinemet CR4’ and observed at intervals over the next 12 months. Fifteen patients completed the full year observation period. When compared with the baseline period, treatment with ‘Sinemet CR4’ was associated with longer periods of functional improvement and less fluctuation of response following each dose. The median (range) dose frequency was reduced from three (three‐12) to two (two‐seven) times daily (p< 0.001) on ‘Sinemet CR4’ although median (range) total daily dose of levodopa was increased from 700 (375–2525) to 800 (400–2800) mg without any increase in adverse effects. Three patients developed peripheral neuropathy while receiving Sinemet CR4, but the association with this therapy is unclear. Overall ‘Sinemet CR4’ allowed a longer dosage interval and provided more stable control of disease manifestations than conventional ‘Sinemet’. (Aust NZ J Med 1991; 21: 397–400.)
Renal failure due to cholesterol emboli
Authors: Fraser I. , Ihle B. , Kincaid‐Smith P.
Published: March 2008

Abstract Renal failure due to cholesterol embolisation is an uncommonly recognised condition. It is usually associated with severe aortic atherosclerosis and in most cases follows a vascular event, such as angiography, vascular surgery, or aneurysm rupture. We report nine patients, all males, who presented to our unit. Six patients survived the initial event, although two died six and eight weeks later. This report emphasises that, although this condition has a high mortality, long term survival is not a rare event. (Aust NZ J Med 1991; 21: 418–421.)
A controlled trial of a killed Haemophilus influenzae vaccine for prevention of acute exacerbations of chronic bronchitis
Authors: Tandon M. K. , Gebski V.
Published: March 2008

Abstract Sixty‐four patients with chronic bronchitis with a history of recurrent respiratory tract infections were admitted to a double‐blind randomised controlled study in which the efficacy of an oral vaccine containing killed Haemophilus influenzae in preventing acute exacerbations of chronic bronchitis was compared with placebo. Patients given vaccine developed fewer acute infective episodes. Although the numbers of patients who required antibiotic therapy in the two groups were not significantly different, the number of antibiotic prescriptions given to the vaccinated group of patients was significantly less than that required by the control group. A reduction in colonisation with Haemophilus influenzae occurred in the active group, which was maximal 14 weeks after the onset of the study. (Aust NZ J Med 1991; 21: 427–432.)
Arrhythmogenic right ventricular dysplasia
Authors: Fatkin D. , Thorburn C. , Hickie J. , Kuchar D.
Published: March 2008

Abstract A 23‐year‐old man presented with recurrent exercise‐induced ventricular tachycardia (VT), complicated by systemic embolisation. Catecholamine ‐ sensitive VT was reproduced on exercise testing and programmed electrical stimulation, displaying features suggestive of enhanced automaticity as well as re‐entry. Both 2D‐echocardiography and gated heart pool scan showed localised dyskinetic bulging in the right ventricle. A diagnosis of arrhythmogenic right ventricular dysplasia was made. This condition should be excluded in all young patients with otherwise unexplained ventricular arrhythmias. (Aust NZ J Med 1991; 21: 451–453.)
POEMS syndrome, osteosclerotic myeloma and Castleman's disease: a case report
Authors: Bosco J. , Pathmanathan R.
Published: March 2008

Abstract Peripheral neuropathy, organomegaly, endocrinopathy, monoclonal gammopathy and skin changes are often the presenting features of the POEMS syndrome. Approximately 50% of these are associated with osteosclerotic myeloma, a rare variant of multiple myeloma and some with Castlemanapos;s disease, an unusual lympho‐proliferative disorder. The underlying pathogenetic mechanisms have not been elucidated but amelioration of symptoms with the disappearance of the M‐component suggests possible etiopathogenic mechanisms. We present a 40‐year‐old woman with manifestations of all three disorders. (Aust NZ J Med 1991; 21:454–456.).
Multi‐drug resistant tuberculosis in migrants
Authors: Pang S. C. , Gill J. S.
Published: March 2008

Abstract Between 1986 and 1989 three Vietnamese migrants presented at the Perth Chest Clinic with multiple‐drug resistant tuberculosis of the lungs. This resistance was to both rifampicin and isoniazid in addition to other antituberculous drugs. Although all three had a long history of past intermittent treatment for tuberculosis and extensive active disease, they were not detected in spite of what should have been adequate premigration screening. This report is 1o alert those medical personnel concerned with the process of migrant health screening and surveillance. The implications of such multi‐drug resistant disease on tuberculosis control in Australia is also briefly discussed. (Aust NZ J Med 1991; 21: 457–459.)