bluuebunny/crossref_metadata_2025 huggingface dataset:
THROMBO‐EMBOLISM AND INCREASED PLATELET ADHESIVENESS IN POST‐SPLENECTOMY THROMBOCYTOSIS
Authors: HIRSH J. , MCBRIDE J. A. , DACIE J. V.
Published: September 2017

Platelet count data have been obtained from patients suffering from various types of hereditary hæmolytic anæmia, sideroblastic anæmia and thalassæmia, and from hæmatologically normal controls. One‐third of the patients studied had been subjected to splenectomy. Patients with persistent anæmia after splenectomy developed post‐splenectomy thrombocytosis. The percentage of platelets which were adhesive was increased after splenectomy irrespective of whether anæmia and thrombocytosis persisted.

Six of the 25 patients with persistent post‐splenectomy thrombocytosis developed thrombo‐embolic complications. On the other hand, signs or symptoms of thrombo‐embolism were not observed in any of 21 patients who had normal platelet counts after splenectomy, or in 72 patients suffering from similar disorders who had not been subjected to splenectomy. The cause of the high incidence of thrombo‐embolic complications in patients with continuing anæmia after splenectomy is not completely understood, but it seems likely that thrombocytosis and increased platelet adhesiveness may play a part.
ŒSOPHAGEAL MOTILITY STUDIES
Authors: HANSKY J.
Published: September 2017

A study has been made of the propulsive and pressure characteristics of the œsophagus and its sphincters in eight normal subjects and in 65 patients with œsophageal symptoms, by means of water‐filled, open‐ended tubes connected to external strain gauge transducers.

The patterns of ordered and disordered œsophageal motility have generally conformed to those found by others. The results suggest that this method of investigation permits a precise diagnosis of neuromuscular disorders of the œsophagus, and is a useful ancillary aid in the differentiation of those disorders from suspected organic obstruction.

Of the 65 patients with symptoms, 14 had hiatus hernia, 11 diffuse spasm, seven achalasia, seven scleroderma, four obstructive dysphagia and the remainder normal motility.
TOXOPLASMOSIS: AN EPIDEMIOLOGICAL STUDY
Authors: JENNIS F.
Published: September 2017

Sera received from subjects suspected of toxoplasmosis were examined for hæmagglutinating antibodies and compared with sera from an apparently normal population.

In cases of chorio‐retinitis, a significantly higher than normal proportion of positive results was demonstrated in all age groups. The results also suggest that in children and young adults infection with Toxoplasma may be a far from rare cause of disease of the reticulo‐endothelial system.
A CHROMOSOME ABNORMALITY ASSOCIATED WITH MACROGLOBULINÆMIA
Authors: BLAKE M. N.
Published: September 2017

Examination of serum from an adult male patient with lymphosarcoma showed the presence of two macroglobulins and a large amount of cryoglobulin.

Chromosome studies on peripheral blood leucocytes, cultured prior to any treatment, showed that of 110 cells analysed, 21 contained an extra chromosome of abnormal morphology. All the abnormal chromosomes were large; 18 showed a submedian centromere, the remaining three a median centromere.

A biometric comparison of the arm lengths of these abnormal chromosomes with the corresponding measurements for the 1–3 and 4–5 groups, and the four longest chromosomes of the X+ (6–12) group, suggests that the abnormal chromosome was not related to the normal number 2 pair, as previously suggested by reports of similar cases.
THE CLINICAL SIGNIFICANCE OF PLASMA THYROID‐STIMULATING ACTIVITY IN HYPERTHYROIDISM
Authors: HOFFMANN M. JOHN , HETZEL BASIL S.
Published: September 2017

The long‐acting thyroid stimulator (LATS) measured by the method of McKenzie was detected in 36 of 60 cases of untreated hyperthyroidism—a figure comparable with that in other reported series.

An association was found between LATS and several clinical features. There was a definite correlation between LATS and the occurrence of exophthalmos. The mean LATS level of 433% in 13 exophthalmic patients was significantly greater than the mean of 230% in 50 patients without exophthalmos (P<0·02. There was also a significantly higher level of LATS (P<0·05) in 34 patients who had a visible goitre (323%) than in 24 without visible goitre (184%). Sixteen patients who eventually had a recurrence of hyperthyroidism after therapy were found to have a significantly higher mean LATS level (411%) than 34 subjects who remained well (182%) (P<0·01).

No correlation could be found between plasma LATS level and (a) thyroid 131I turnover, (b) the plasma level of protein‐bound iodine and (c) the presence of a significant titre of antibodies to thyroglobulin in the patient's blood (Tanned red‐cell titre 1/2500).

The association between LATS and pretibial myxœdema was demonstrated by two patients who both had elevated plasma levels of LATS and unequivocal pretibial myxœdema when first examined. Follow‐up studies over the ensuing three years demonstrated resolution of the pretibial myxœdema concurrently with disappearance of LATS from the plasma of one patient, and increasingly severe pretibial myxœdema associated with an increasing plasma level of LATS in the other.

It is concluded that there is a significant relation between the plasma LATS level and various clinical features of hyperthyroidism. These data indicate the importance of LATS in relation to the pathogenesis of the disease. Recent chemical studies indicate that LATS belongs to the 7S globulins. These findings indicate that thyrotoxicosis, exophthalmos and pretibial myxœdema may result from disordered immunological mechanisms.
A FAMILY WITH ALPORT'S SYNDROME OF HEREDITARY NEPHRITIS AND DEAFNESS
Authors: WOOD TREVOR J. , KNIGHT L. W.
Published: September 2017

A family is reported, in which four of the six siblings are affected by a nephropathy and two of these siblings are deaf. This fulfils the criteria for a diagnosis of Alport's syndrome. The renal lesion in this family appears to be indistinguishable from chronic glomerulonephritis, and the clinical manifestation of this nephropathy was as bouts of hæmaturia since childhood. The two affected males were more severely affected than the females, the eldest male having died at the age of 25 years from chronic renal failure. The more unusual manifestations of this syndrome—namely, the ocular and mental changes or the amino aciduria—were not present in this family.
NEONATAL THYROTOXICOSIS: REPORT OF THREE CASES INVOLVING FOUR INFANTS
Authors: HOFFMANN M. J. , HETZEL B. S. , MANSON J.
Published: September 2017

Four cases of neonatal hyperthyroidism are described. The condition was shown to be transient and associated with thyrotoxicosis in the mothers of the patients.

Assays for long‐acting thyroid stimulator (L.A.T.S.) were performed on plasma samples from the neonatal hyperthyroid subjects and their mothers. It was shown that L.A.T.S. was present in all the patients and the mothers, and that it disappeared in the neonate after a few weeks. It is concluded that L.A.T.S. is the pathogenetic agent responsible for the hyperthyroidism by passage across the placenta from the maternal circulation. This finding is consistent with recent chemical evidence that L.A.T.S. is a 7S gamma globulin.
THYROID FUNCTION IN PATIENTS WITH EXOPHTHALMOS PRECEDING THYROTOXICOSIS
Authors: HUDSON BRYAN , BREIDAHL HARALD
Published: September 2017

Eight patients are described who showed the classical ocular manifestations of Graves' disease but none of the other clinical manifestations of hyperthyroidism. In all cases there was an elevated level of PB131I in the plasma after the administration of a tracer dose of 131I, and, in three cases studied, the uptake of 131I by the thyroid was not suppressed by the administration of triiodothyronine. The possible mechanisms are discussed.
ABO BLOOD GROUP, SECRETOR STATUS AND GASTRIC SECRETION
Authors: DENBOROUGH M. A.
Published: September 2017

The gastric secretion of acid and pepsin was measured in 93 healthy young male volunteers and related to ABO blood group and secretor status.

No evidence for an increased secretion of gastric acid and pepsin in group O individuals or non‐secretors was found. The implications of these findings are discussed.
CHRONIC LUNG DISEASE IN THE TERRITORY OF PAPUA AND NEW GUINEA—AN EPIDEMIOLOGICAL STUDY
Authors: WOOLCOCK ANN J. , BLACKBURN C. R. B.
Published: September 2017

A preliminary epidemiological survey of natives in the Eastern and Western Highlands of the Territory of Papua and New Guinea shows that chronic lung disease is common.

The disease is more frequently seen in natives aged over 30 years, appears to be restrictive in the early stages but to produce obstruction as well in the later stages, and appears to lead to cor pulmonale. The cause is not known, but repeated infections appear to be an important factor.

A definitive epidemiological study is planned to investigate the incidence, nature, cause and course of chronic lung disease and to define its relationship to cor pulmonale. The plan of this study is outlined.
CYTOGENETIC STUDIES IN CHRONIC GRANULOCYTIC LEUKÆMIA
Authors: DOUGAN L. , ONESTI P. , WOODLIFF H. J.
Published: September 2017

A review of the literature shows that the Philadelphia (Ph1) chromosome is present in cells from a majority of patients with chronic granulocytic leukæmia, including 19 presented here. An adequate explanation has been found for the failure to demonstrate the Ph1 chromosome in all but four cases in the literature. The Ph1 chromosome has only rarely been reported in other myeloproliferative disorders, and never in other conditions. The positivity in the myeloproliferative disorders is discussed and the probability that the few reported cases are atypical examples of chronic granulocytic leukæmia is considered. The diagnostic value of cytogenetic studies in prognosis and therapy is considered. The conclusion is reached that such studies are of definite but limited value.

Theoretical implications of the Ph1 chromosome are discussed with particular reference to the stem cell, leucopoiesis and chromosome 21, the inter‐relationship of the myeloproliferative disorders and the pathogenesis of chronic granulocytic leukæmia.
STUDIES ON DEFICIENCY AND ABSORPTION OF FOLATES IN PATIENTS ON ANTICONVULSANT DRUGS
Authors: IBBOTSON R. N. , DILENA BEVERLEY A. , HORWOOD M.
Published: September 2017

The incidence of macrocytosis and low serum folate levels has been estimated in 115 mental hospital patients on anticonvulsant drug therapy and in 48 mental hospital control patients. Low serum folate levels were found in 36·1% of the patients treated with anticonvulsants.

Of the patients on anticonvulsants, 14·6% had red cell macrocytosis, and the incidence of macrocytosis was significantly higher in female than in male patients.

The mental hospital patients not on anticonvulsants who were used as controls had mean serum folate values significantly below that of the normal, non‐hospitalized controls. Attention is drawn to the influence of the diet on normal folate ranges, which must be taken into account during their assessment. The fact that a combination of factors is probably necessary to produce a frank megaloblastic change in anticonvulsant‐drug‐treated patients could account for the relative infrequency of megaloblastosis among these patients. It is believed that, in case of anticonvulsant drug therapy, a borderline folate diet often interacts with the mild drug folate inhibition.

Folic acid absorption tests, carried out on 19 patients on anticonvulsant therapy with subnormal folate levels, showed slightly decreased absorption values at two hours after the oral test dose but no difference at three hours. The significance of these findings is discussed, and attention is drawn to possible mechanisms of mild malabsorption of folates in patients on anticonvulsant drugs.
ATROPHIC GASTRITIS IN THE AGED
Authors: ANDREWS G. R. , HANEMAN BEN , ARNOLD B. J. , BOOTH J. COOPER , TAYLOR KENNETH
Published: September 2017

The incidence of gastritis and the correlation of this finding with the presence of circulating parietal cell antibodies and gastric secretory function was studied in 24 asymptomatic subjects aged over 6o years. A gastric biopsy examination, a maximal histamine‐stimulation test, a test for parietal cell antibody and a Schilling test were performed on each subject. The biopsy specimens were examined by histological and histochemical methods. The gastric juice was assayed for acid and intrinsic factor content, and the serum iron and vitamin B12 levels were measured.

All but one subject showed some degree of chronic atrophic gastritis. Close correlation was found between gastric secretory function, the histological changes in the gastric mucosa and the reduction in specialized cells demonstrated on histochemical examination. Two subjects presented a “pre‐pernicious anæmia” picture with gross reduction in intrinsic factor secretion, a degree of malabsorption of vitamin B12 but no evidence of vitamin B12 deficiency; a very similar case not included in the series is described to illustrate the diagnostic problem which may occur with hæmatological evidence of vitamin B12 deficiency as a result of atrophic gastritis. Serum iron levels were reduced in some cases with severe atrophic gastritis. Antibodies to parietal cells occurred with increasing frequency as the changes in the gastric mucosa became more marked.

Atrophic gastritis is a common finding in the “normal” aged male even in the absence of gastrointestinal symptoms, and a clinical picture simulating early pernicious anæmia may occur as a result of “normal ageing” of the gastric mucosa.
A STUDY OF CORTISOL METABOLISM IN PATIENTS WITH CHRONIC ASTHMA
Authors: DWYER J. , LAZARUS L. , HICKIE J. B.
Published: September 2017

The mortality rate in asthma is rising and, in our hospital, the majority of deaths occur during episodes of status asthmaticus in steroid‐treated patients. Clinical observations have indicated that relatively large doses of cortisol are necessary to treat acute episodes of asthma in the long‐term‐steroid‐treated patient. Studies on 10 patients indicate that the plasma cortisol response to the intravenous injection of cortisol is less than normal in steroid‐treated patients, and that this reduced response is associated with a lack of clinical improvement.

A good clinical response in steroid‐treated patients does not occur until the plasma cortisol level is at least 100 µg. per 100 ml. Studies of cortisol metabolism in the case of these 10 patients demonstrate an increased rate of removal of cortisol. The metabolic clearance rate of cortisol is higher than in normal subjects and in non‐steroid‐treated asthmatic patients. The metabolic clearance rate of cortisol is not affected by the administration of ACTH, but is reduced in steroid‐treated patients who are simultaneously receiving æstrogen therapy. These studies indicate the need to administer an initial relatively large dose of cortisol to steroid‐treated asthmatic patients in status asthmaticus.
THE ABO SYSTEM IN MILK AND SALIVA
Authors: DENBOROUGH M. A. , DOWNING H. J. , MCCREA MARY G.
Published: September 2017

In a study of the ABO system in milk and saliva, the following observations were made:

Isoagglutinins were found in 91·6% of milk samples and in 62·7% of saliva specimens.

Anti‐B isoagglutinins were present in greater amounts in group O individuals than in group A, both in milk and in saliva.

Blood group substance A specificity was poorly expressed in milk, and B specificity was virtually not expressed at all.

Less H substance was found in milk than in saliva in group O individuals, but more H substance was found in group A and B individuals in milk than in saliva.

The possible physiological, clinical and genetic significance of these observations is discussed.
HYPOFIBRINOGENÆMIA IN ACUTE LEUKÆMIA WITH EXTENSIVE FIBRINOUS PERICARDITIS
Authors: HIRSH J. , EKERT H. , TAFT L. I. , COLEBATCH J. H. , SPENSLEY J. C.
Published: September 2017

A case of acute myeloid leukæmia and hypofibrinogenæmia is described. The hypofibrinogenæmia was associated with decreased levels of factor V and factor VIII, but there was no increase in fibrinolytic activity. The clinical course was marked by a severe hæmorrhagic diathesis and evidence of cardiac tamponade. At autopsy there was extensive fibrinous pericarditis. It is suggested that the extensive pericardial fibrin deposition might have contributed to the coagulation abnormality observed.
DISACCHARIDASE DEFICIENCY IN REGIONAL ENTERITIS
Authors: FIDDES P. J. , BAUME PETER
Published: September 2017

A man aged 32 years was found to have lactase deficiency in histologically normal jejunal and ileal mucosa, together with regional enteritis affecting the terminal ileum. The diseased ileum exhibited deficiencies of lactase, sucrase and maltase, and there was mucosal destruction. The remainder of the small intestine exhibited isolated lactase deficiency, a diffuse small intestinal defect the relationship of which to regional enteritis is uncertain.
CLINICAL, PHYSIOLOGICAL AND PATHOLOGICAL OBSERVATIONS IN A CASE OF PROGRESSIVE AUTONOMIC NERVOUS SYSTEM DEGENERATION ASSOCIATED WITH HOLMES‐ADIE SYNDROME AND PERIPHERAL NEUROPATHY
Authors: FREWIN D. B. , GILMORE H. R. , HO J. Q. K. , SCROOP G. C.
Published: September 2017

The case history is reported of a woman aged 40 years who presented with weight loss, postural hypotension and paræsthesia in the hands and feet. The diagnosis of widespread autonomic nervous system degeneration with associated peripheral neuropathy and Holmes‐Adie syndrome was made from the results of a series of clinical and physiological tests.

Laboratory investigation failed to disclose a cause for the degenerative changes, and symptomatic treatment with 9‐alpha fluorohydrocortisone and digitalis was commenced in an effort to combat the patient's postural hypotension. On this régime there was transient improvement in her clinical state, but over a period of six months her general condition gradually deteriorated and she eventually died.

At autopsy, widespread amyloid infiltration of the sympathetic ganglia, peripheral nerves, heart and alimentary canal was found, and this appears to have been the pathological basis for the clinical and physiological findings.
LEFT VENTRICULAR VOLUME IN MAN: THE RELATION TO HEART RATE AND TO END‐DIASTOLIC PRESSURE
Authors: WILCKEN D. E. L.
Published: September 2017

Resting left ventricular end‐diastolic and end‐systolic volumes were measured by means of a dye‐dilution method in 37 patients, nine with normal cardio‐vascular systems, nine with mitral stenosis, nine with aortic valve disease, and 10 with other conditions. Ventricular volumes were related to heart rate and to the simultaneously measured end‐diastolic pressure. Evidence is presented to indicate that the method is capable of detecting changes in ventricular size, and is not affected by changes in heart rate over the range studied.

In the normal subjects there was a significant inverse relationship between heart rate and end‐diastolic volume. There was a direct relationship between the ratio of end‐systolic volume to end‐diastolic volume and heart rate, and an inverse relationship between stroke volume and heart rate. The mean systolic size of the ventricle was smaller at faster heart rates. Such a relationship would tend to minimize increases in myocardial energy expenditure with increases in heart rate.

The patients with mitral stenosis had smaller left ventricular volumes than the normal subjects, but the end‐diastolic pressures were also smaller, which finding was consistent with similarity of ventricular distensibility in the two groups. Evidence for an abnormally stiff left ventricle was found in one of the four patients with severe aortic stenosis, in one patient with cardiomyopathy, and in two of the three patients with extreme obesity. The third patient had clinically unsuspected high output left ventricular failure. Evidence for a flabby ventricle was found in two patients with cardiomyopathy and in one patient with predominantly ischæmic heart disease.

It seems likely that variations in ventricular stiffness occur during the progression of left ventricular disease and contribute importantly to the production of symptoms, because of effects on left atrial and pulmonary capillary pressures.
URINARY EXCRETION OF TITRATABLE ACID AND ITS RELATIONSHIP TO URINARY pH AND INORGANIC PHOSPHORUS EXCRETION
Authors: GYÖRY A. Z. , NEGRIN A. , EDWARDS K. D. G.
Published: September 2017

The relationship between urinary pH, titratable acid (T.A.) and inorganic phosphorus (I.P.) excretion was examined in a group of 81 hospital out‐patients and some normal volunteers, who presented for one‐day renal function testing. Although the patients had a variety of renal diseases, with glomerular filtration rates ranging from 7 to 146 ml. per minute per 1·73 sq. m., a strictly linear relationship was found between the “ratio of urinary T.A. over urinary I.P.” and urinary pH, expressed by the following equation: urinary T.A./urinary I.P. = 4·2409‐0·5678 × urinary pH. From this relationship it was deduced that abnormalities of urinary T.A. excretion in these patients were mainly dependent on abnormalities of either urinary I.P. excretion, or urinary pH, or both. For any given level of urinary pH, variations in urinary T.A. excretion were caused mainly by variations in urinary I.P. excretion. The theoretically derived sigmoid titration curve of a buffer with a pK′ of 7·20 most closely fitted the experimentally determined regression line, especially between urinary pH values of 6·0 and 8·0 units ; this was consistent with the behaviour of phosphoric acid at 25° C., the temperature of titration. The standard error of the method for deriving urinary I.P. excretion from urinary pH and urinary T.A. excretion measured titrimetrically was 5% ; and this was considered sufficient to allow its use in clinical biochemistry as a screening procedure for urinary I.P. excretion, as part of a one‐day renal function testing system.
LIVER DISEASE IN PREGNANCY, WITH PARTICULAR EMPHASIS ON THE CHOLESTATIC SYNDROMES
Authors: MISTILIS STEVEN P.
Published: September 2017

This review is primarily concerned with the ætiology, pathology, clinical features, differential diagnosis, pathogenesis and treatment of obstetric cholestasis and pruritus of pregnancy. The exact mechanism of the pruritus, jaundice and deranged biochemical state in these disorders is discussed in the light of advances in our understanding of bile salt metabolism and a recent and more acceptable concept of the pathogenesis of cholestasis. The incidence, ætiology and clinical features of cholestasis following oral contraceptives are outlined in detail, and the relationship of these changes to the cholestatic syndrome in the third trimester is discussed. Other hepatic disorders which appear to be related to pregnancy are also briefly reviewed. Biochemical derangements of hepatic function in pregnant women without underlying hepatic disease are considered in detail.
THYMOMA PRESENTING WITH POLYSEROSITIS AND THE LUPUS ERYTHEMATOSUS SYNDROME
Authors: SINGH B. N.
Published: September 2017

For systemic lupus erythematosus aud thymoma to occur simultaneously is rare. Such an association in a woman aged 61 years is described. She presented with polyserositis and was found on radiological examination to have progressive enlargement of the mediastinum. An inoperable thymoma of the epithelial‐cell type was demonstrated at thoracotomy and treated with radiotherapy.

The diagnosis of systemic lupus erythematosus was established with appropriate serological tests, but no abnormalities of peripheral blood, erythrocyte sedimentation rate or serum proteins were noted during a two‐year period of observation.

The possible mechanisms involved in the immunological aspects of thymic disease' are briefly discussed.
THE PHYSIOLOGICAL SIGNIFICANCE OF KINEKARD
Authors: LOWE THOMAS E.
Published: September 2017

The name “kinekard” has been given to a fraction that can be prepared from blood plasma by gel‐filtration on polyacrylamide followed by ion‐exchange chromatography on D.E.A.E.‐methacrylate. Kinekard has a powerful inotropic action on cardiac muscle and a pressor action on the arterial circulation. Some evidence is presented that the inotropic and pressor activities of kinekard are independent of each other. In contrast to having a stimulatory action on cardiac and vascular muscle, kinekard is inhibitory to alimentary canal and uterine muscle.

Comparison of the properties of kinekard with those of other vasoactive substances shows that the active principle(s) is not a catecholamine, bradykinin, angiotensin, vasopressin or glucagon. No species specificity in source or action of kinekard has been noted.

The active principle(s) has not been isolated, but the data suggest that it is a polypeptide with a molecular weight 4,000 to 8,000. It may be, however, that kinekard is a complex of several active principles, some stimulatory and others inhibitory.

The plasma concentration of kinekard in man has been determined in a large number of subjects both with respect to inotropic and pressor activity. In healthy people there is only a small variation between individuals, and the concentration is very stable over long periods. In illness marked deviations above and below the normal range occur. Study of the plasma concentration in different regions of the body and in disease states suggests that kinekard originates in the liver either de novo or by an action of the liver on a precursor.

It is concluded that kinekard is a complex entity present in the plasma of all species so far examined which appears to be of importance to the body economy.
FAILURE OF POTENT ANTACID THERAPY TO HASTEN HEALING IN CHRONIC GASTRIC ULCERS
Authors: BAUME PETER E. , HUNT JOHN H.
Published: September 2017

Healing of gastric ulcers in 28 outpatients was measured over a three‐week treatment period. Fifteen patients were treated with an agent (aluminium hydroxide tablets) incapable of elevating the pH of gastric juice, while the other thirteen received large doses of a drug (calcium carbonate) thought to be capable of elevating gastric juice pH.

Healing was slightly greater (P=0·12) in patients treated with the ineffective agent but was not impressive in either group. There was no evidence that either treatment exerted a significant effect on gastric ulcer healing, and the results did not support the widely held belief that antacids hasten the healing of gastric ulcers.
BLOOD‐CELL CYCLES IN POLYCYTHÆMIA VERA
Authors: MORLEY ALEC
Published: September 2017

Two patients with polycythæmia vera were studied in order to determine whether blood‐cell cycles were present. Neutrophil and platelet cycles were found in one and a reticulocyte cycle in the other. The findings suggest that control of cell production by the marrow is partly retained in polycythæmia vera. In contrast to the findings in chronic granulocytic leukæmia, no evidence was found for slowed cellular maturation.
ON THE PRESENCE OF IMMUNOREACTIVE GROWTH HORMONE IN A BRONCHOGENIC CARCINOMA
Authors: CAMERON D. P. , BURGER H. G. , DEKRETZER D. M. , CATT K. J. , BEST J. B.
Published: September 2017

Radioimmunoassay and immunohistochemical techniques have been used to demonstrate the presence of immunoreactive human growth hormone (IRHGH) in a bronchogenic carcinoma. While the patient had the clinical manifestations of osteoarthropathy, the role of IRHGH in the pathogenesis of this condition is not established.
GENERALIZED CYTOMEGALOVIRUS INFECTION IN A PATIENT WITH LUPOID HEPATITIS
Authors: ROBSON G. S. , MACKAY I. R.
Published: September 2017

A woman aged 18 years had an acute “multisystem disease” of which the major impact was on the liver; the LE cell test was positive. The subsequent course of the illness was that of “autoimmune” lupoid hepatitis: serological tests for antinuclear and smooth muscle antibody were positive, and continued treatment with prednisolone was necessary. Splenectomy was required for thrombocytopenia with bruising. Liver biopsy during the illness showed quiescent hepatitis and no virus inclusions in liver cells. After seven years of illness and two years of treatment with azathioprine, a fatal febrile illness occurred with sharp deterioration of liver function. Autopsy revealed inclusions of cytomegalovirus in liver cells and many other tissues.

The discussion is concerned with cytomegalovirus as a cause of liver disease in adults, “latent” cytomegalovirus infection, and the degree to which immunosuppressive therapy in this case predisposed to the fatal illness due to cytomegalovirus.
POST‐PARTUM RENAL FAILURE. ? THE GENERALIZED SHWARTZMAN REACTION
Authors: CLARKSON A. R. , MEADOWS R. , LAWRENCE J. R.
Published: September 2017

Three cases of post‐partum acute renal failure are described, the clinical and pathological features of which are identical to those previously reported. Renal failure accompanied by micro‐angiopathic hremolytic anæmia occurred after a non‐specific prodromal illness early in the puerperium. The features of the disease closely resemble those of thrombotic thrombocytopenic purpura and the hæmolytic uræmic syndrome of children and adults. The similarity of the hæmatological and histological features to their counterparts in the generalized Shwartzman reaction (GSR) is striking. Pregnancy predisposes humans to the GSR, a modification of which may play a part in the pathogenesis of this disease. The prognosis in the cases described and those previously reported is bad because of the irreversible nature of the renal and other pathological changes. Heparin therapy may be of value if given early but clinical recognition of the condition may not occur soon enough.
EPIDEMIOLOGY OF ALCOHOLIC CIRRHOSIS
Authors: WILKINSON PATRICIA , SANTAMARIA JOSEPH N. , RANKIN JAMES G.
Published: September 2017

Seventy‐seven alcoholic patients, 54 men and 23 women, had cirrhosis of the liver when they first attended the Alcoholism Clinic at St Vincent's Hospital, Melbourne, between July, 1964, and June, 1968. During this period 800 chronic alcoholics, 663 men and 137 women, attended the clinic. Cirrhosis was thus diagnosed twice as often in women as in men.

The case histories of the 77 cirrhotic patients were reviewed, and information was collected about socio‐economic status and drinking habits. This information was compared with that obtained from a sample of 220 patients‐‐all those who attended the Alcoholism Clinic between July, 1966, and June, 1967. Most of the cirrhotic patients were beer drinkers, as are the majority of Australian alcoholics. Relatively more cirrhotics were habitual excessive drinkers. The cirrhotic patients did not drink more heavily, but they had drunk excessively for longer when their cirrhosis was diagnosed. Cirrhotic women, however, had drunk excessively for a significantly shorter time than cirrhotic men.

No difference was found in the incidence of either social isolation or clinical peripheral neuropathy between cirrhotic and alcoholic patients, or between male and female cirrhotics. Cirrhosis was not commoner among the lower socio‐economic groups. These findings were interpreted as suggesting that nutrition did not play an important part in the causation of the liver disease.

Women appear to be more susceptible than men to cirrhosis of the alcoholic, and unremitting habitual excess more damaging than intermittent alcohol abuse. Some undetermined predisposition must also exist, since the disease is still sporadic even when these factors operate.
THE EFFECT OF GIARDIA LAMBLIA INFESTATION ON THE GASTRO‐INTESTINAL TRACT
Authors: ALP M. H. , HISLOP I. G.
Published: September 2017

Five patients with Giardia Iamblia infestation are presented, all of whom showed evidence of malabsorption. Marked mucosal damage, found in two cases, was reversible within four weeks of commencement of mepacrine therapy. One patient, who failed to respond to this therapy, was treated successfully with a course of metronidazole. The pathogenesis of malabsorption in Giardia Iamblia infestation is discussed. It is suggested that the malabsorption results from mucosal damage consequent on a “toxic effect” exerted by the organism.

Giardia Iamblia infestation is common in Australia. A careful search for the parasite is recommended in patients who have experienced abdominal pain and diarrhœa, particularly where there is evidence of malabsorption.
GASTRO‐INTESTINAL BLEEDING: THE ROLE OF VITAMIN C
Authors: HANSKY J. , ALLMAND FIONA
Published: September 2017

During a three‐year period, 93 patients selected at random, who were admitted to hospital with either hæmatemesis or melrena, had a detailed dietary history taken; these dietary factors were compared with a group of hospital patients (matched by age and sex) with non‐gastro‐intestinal diseases. The 93 patients with gastro‐duodenal bleeding were further subdivided on the basis of radiological studies, using barium, endoscopy or laparotomy into 37 patients with duodenal ulcer, 12 patients with gastric ulcer, nine patients with hiatus hernia, four patients with gastric carcinoma, and 31 patients in whom the site or source of bleeding remained undetermined.

Thirty‐four of the 93 patients with gastro‐duodenal bleeding had a vitamin C intake of under 50 mg per day, whereas only 14 of the control group had a similarly low intake. In the group of those with bleeding, a history of excessive intake of analgesics was obtained in 17 patients, only three of whom had a low vitamin C intake.

This preliminary study indicates that vitamin C deficiency may be an important factor in the genesis of gastro‐intestinal hremorrhage, particularly in the group in which no cause for the bleeding is found.
Effects of Intravenous Alcohol on Motility of the Duodenum and of the Sphincter of Oddi
Authors: Pirola R. C. , Davis A. E.
Published: September 2017

Normal subjects were given a constant infusion of secretin and consecutive 5‐minute samples of duodenal aspirate were collected. Tests in which bile was present in duodenal aspirate were discarded. In 8 subjects, intravenous alcohol caused a significant reduction in volume without a fall in bicarbonate concentrations. In 3 subjects, intravenous dextrose did not cause a fall in volumes of aspirate. These findings indicate that intravenous alcohol causes obstruction to pancreatic outflow, presumably as a result of contraction of the sphincter of Oddi.

In view of the functional and anatomical connections between the duodenal and sphincteric musculature, the effects of intravenous alcohol on duodenal motility were studied by combined electromanometric and cineradiologic techniques. Intravenous alcohol in eleven normal subjects caused a significant increase in duodenal motility, whereas intravenous dextrose had no effect.

It is postulated that alcohol has a systemic effect leading to obstruction to pancreatic outflow and that this is one factor in the production of alcoholic pancreatitis.
Anaemia and Temporary Erythroblastopaenia in Children
Authors: Lovric V. A.
Published: September 2017

Over a period of 7 years, 12 patients were seen at the Royal Alexandra Hospital for Children with a symptomatic normocytic, normochromic anaemia and reticulocytopaenia. The initial bone marrow aspirates revealed erythroblastopaenia as the only abnormality.

The cause of this condition remains uncertain. However, all children fully recovered within a few weeks after diagnosis. A single course of steroid therapy was given to 3 children, whilst the remainder received no therapy. Recurrence was observed in one child only. Thus, on clinical and haematological grounds, differentiation from Gasser's series could be made.

Failure to recognize this syndrome will lead to a number of unnecessary investigations. Furthermore, a life‐long iatrogenic diagnostic label may be given in error for a benign, self‐limiting condition in childhood.
Lactose Intolerance in Australian‐born Chinese
Authors: Bolin T. D. , Davis A. E.
Published: September 2017

Controversy exists over the aetiology of primary lactase deficiency, which may be either a genetic defect or an adaptive phenomenon. The incidence of lactose intolerance in a group of Australian‐born Chinese was 56% compared to an incidence of 95–100% in Chinese resident in Australia and indigenous Chinese in Singapore. The lower incidence of intolerance in Australian‐born Chinese suggested that an environmental rather than a genetic factor was operative and this appeared to be a high intake of lactose in the tolerant subjects.
Hypertension and Severe Hyperkalaemia Associated with Suppression of Renin and Aldosterone and Completely Reversed by Dietary Sodium Restriction
Authors: Gordon Richard D. , Geddesj Robin A. , Pawseynl Charles G. K. , O'Halloran Michael W.
Published: September 2017

A 10‐year‐old girl presenting with short stature had hypertension, severe hyperkalaemia (8.5 mEq/litre), mild acidaemia (arterial pH, 7.30) and periodic paralysis. It was postulated that the basic defect was a renal tubular avidity for sodium at a site proximal to the action of aldosterone, resulting in expansion of blood volume which in turn caused suppression of renin and of aldosterone and “escape” from relentless sodium retention. Plasma volume was increased, plasma renin activity undetectable, the urinary excretion of aldosterone very low and the renal tubule responsive to endogenous and exogenous aldosterone. The hypothesis was tested by appropriate balance studies including demonstration of renal tubular avidity for sodium despite low levels of aldosterone. Correction of all abnormalities followed prolonged dietary sodium restriction which brought about elevation of renin and aldosterone to normal levels. Correction of the hyperkalaemia or of the acidaemia while maintaining strict sodium balance did not correct the other abnormalities. Arterial pressor hypersensitivity to the stimulus of cold and to infused angiotensin and norepinephrine was reduced to normal when dietary sodium was restricted, associated with a return of blood pressure to normal levels. Following institution of dietary sodium restriction, attacks of muscle paralysis ceased and growth rate increased. The components of this syndrome are opposite to those found accompanying another rare congenital renal lesion associated with severely disturbed renin‐aldosterone physiology, and usually referred to as “Bartter's Syndrome”.
Cushing's Syndrome — A Review of the Response to Treatment in 42 Patients
Authors: Taft Pincus , Martin F. I. R. , Melick Roger
Published: September 2017

The course after treatment of 42 patients suffering from Cushing's syndrome is reviewed, the follow‐up period being from twelve months to twelve years. In 30 instances the syndrome was due to bilateral adrenal hyperplasia, in five to adrenal carcinoma, in four to unilateral adenoma, and in three to non‐endocrine carcinoma. Treatment was mainly by adrenal resection—total in the hyperplasia group, unilateral for the adenoma patients.

During the follow‐up period 16 patients (38%) have died. These include all eight with carcinoma and eight of the 30 suffering from adrenal hyperplasia.

Whilst most of the 26 survivors can be regarded subjectively as being in good health, only ten patients have no clinical abnormality. Hypertension has persisted in nine patients and diabetes in two. Eleven patients have presumed pituitary dysfunction: six of these have pituitary tumours, while a further five have pigmentation only at present. Growth has been interrupted in the two children treated. The psychiatric changes, where present, improved slowly after treatment and three deaths in the hyperplasia group were due to suicide within six months of treatment.
Polyarteritis Nodosa: The Natural History of a Spontaneously Occurring Model in Outbred Mice
Authors: Wigley R. D. , Couchman K. G. , Maulel Rachel
Published: September 2017

Spontaneous arteritis resembling the chronic form of the human disease polyartiritis nodosa occurred in up to 60% of outbred PN mice. The lesions were similar in histology and distribution to peri‐arteritis nodosa as described by Kussmaul and Maier, the marked round cell infiltration occurring in 80% of mice at 18 months being the main difference from the human disease. Perivascular cuffing of renal vessels invariably preceded the arteritis, the frequency of which did not appear to be influenced by lymphoma, chronic virus pneumonia or amyloidosis. There was a significant association with antinuclear antibodies and a low incidence of red cell antibody, but no evidence of haemolytic anaemia. The possibility that this disease is due to a chronic virus infection is discussed.
Involvement of Bulbar Muscles in Thyrotoxic Myopathy
Authors: Joasoo Aet , Murray I. P. C. , Steinbeck A. W.
Published: September 2017

Twelve cases of thyrotoxic myopathy, with involvement of bulbar muscles, are reported. It appears likely that this manifestation of thyrotoxicosis is not as uncommon as has previously been suggested.
The Spectrum of Protein Calorie Malnutrition in Adolescents
Authors: Caughey J. E.
Published: September 2017

The natural history of adolescent malnutrition has been studied in boys at school and in hospital in Iran. A spectrum of malnutrition has been demonstrated, ranging from simple growth retardation to severe malnutrition with sexual infantilism, iron‐deficiency anaemia, hepatosplenomegaly, generalised oedema and low serum albumin and zinc levels. Primary malnutrition (simple starvation), together with secondary malnutrition (starvation complicated by infections, geophagia and helminthiasis), is significant aetiologically. It is proposed on the basis of clinical and biochemical studies and the response to high‐protein intake that protein deficiency is the major factor in adolescent malnutrition in Iran.
Single CaO accelerated densification and microstructure control of highly transparent YAG ceramic
Authors: Zhang Le , Zhou Tianyuan , Selim Farida A , Chen Hao
Published: September 2017

In this work, a small amount of CaO single dopant was adopted to realize the densification and microstructure control of fine grained YAG ceramic with excellent optical quality, by a simple solid‐state reaction and one‐step vacuum sintering method. Then, highly transparent YAG ceramics (T = 84.4% at 1064 nm) were obtained just after vacuum sintering at 1820°C for 8 hours. The average grain size was only 2.7 μm, when the total amount of CaO was as low as 0.045 wt%. The effect of CaO on the microstructural evolution and optical property of the as‐fabricated YAG ceramics was systematically investigated in detail. It was found that CaO dopant promoted both densification and grain growth of YAG ceramics when the sintering temperature was lower than 1660°C, however, it dramatically inhibited grain growth when the sintering temperature was further increased.
Hepatitis B virus core‐related antigen levels predict progression to liver cirrhosis in hepatitis B carriers
Authors: Tada Toshifumi , Kumada Takashi , Toyoda Hidenori , Kobayashi Natsuko , Akita Tomoyuki , Tanaka Junko
Published: September 2017

Background and Aim

Several hepatitis B virus (HBV) markers have been identified as risk factors for progression to liver cirrhosis in patients with chronic HBV infection. The predictive impact of HBV markers on progression to cirrhosis in HBV carriers was clarified.

Methods

A total of 529 hepatitis B e antigen seroconverters with fibrosis‐4 (FIB‐4) index ≤ 3.6 not on nucleos(t)ide analogue therapy were included. Univariate and multivariate analyses of associations between HBV markers and progression to cirrhosis were performed. In addition, the hazard ratio (HR) spline curves for continuous HBV markers were compared.

Results

Eighty‐four patients progressed to cirrhosis (FIB‐4 index > 3.6) during the follow‐up period. Hepatitis B surface antigen (HBsAg), HBV DNA, HBV core‐related antigen (HBcrAg), and basal core promoter status, but not genotype and precore status, were significantly associated with progression to cirrhosis in univariate Cox proportional hazards models. Multivariate Cox proportional hazards models adjusted for HBV genotype, HBsAg, HBV DNA, HBcrAg, precore status, and basal core promoter status indicated that HBsAg ≥ 3.0 log IU/mL (HR, 0.53; 95% confidence interval [CI], 0.30–0.94) and HBcrAg ≥ 3.7 log U/mL (HR, 3.28; 95% CI, 1.60–6.75) are independently associated with progression to cirrhosis. In the HR spline curve analysis, HR and 95% CI gradually increased as HBcrAg levels increased. Conversely, HRs and 95% CIs for HBsAg and HBV DNA did not show this tendency as their levels increased.

Conclusions

Elevated HBcrAg levels in HBV carriers increases the risk for progression to cirrhosis. HBcrAg is an excellent predictor of the development of cirrhosis.
Older Adults’ Awareness of Deprescribing: A Population‐Based Survey
Authors: Turner Justin P. , Tannenbaum Cara
Published: September 2017

Objectives

To determine older adults’ awareness of the concept of medication‐induced harm and their familiarity with the term “deprescribing.” Secondary objectives were to ascertain determinants of self‐initiated deprescribing conversations and to identify how older adults seek information on medication harms.

Design

Cross‐sectional population‐based household telephone survey using random‐digit dialling.

Setting

Canada.

Participants

Community‐dwelling adults aged 65 and older (N = 2,665; n = 898 men, n = 1,767 women, mean age 74.9 ± 7.2, range 65–100).

Measurements

Information was gathered on age; sex; awareness of the term “deprescribing”; knowledge and information‐seeking behaviors related to medication harms; and previous initiation of a deprescribing conversation with a healthcare professional. Three targeted classes of potentially inappropriate prescriptions were asked about: sedative‐hypnotics, glyburide, and proton pump inhibitors. Descriptive statistics and regression analyses were used to quantify associations.

Results

Two‐thirds (65.2%, 95% confidence interval (CI) = 63.4–67.0%) of participants were familiar with the concept of medication‐induced harms. Only 6.9% (95% CI = 5.9–7.8%) recognized the term deprescribing; 48% (95% CI = 46–50%) had researched medication‐related harms. Older adults most commonly sought information from the Internet (35.5%, 95% CI = 33.4–37.6%), and from health care professionals (32.2%, 95% CI = 30.1–34.3%). Patient‐initiated deprescribing conversations were associated with awareness of medication harms (odds ratio (OR) = 1.74, 95% CI = 1.46–2.07), familiarity with the term deprescribing (OR = 1.55, 95% CI = 1.13–2.12), and information‐seeking behaviors (OR = 4.57, 95% CI = 3.84–5.45), independent of age and sex.

Conclusion

Healthcare providers can facilitate patient‐initiated deprescribing conversations by providing information on medication harms and using the term “deprescribing.”