bluuebunny/crossref_metadata_2025 huggingface dataset:
Do thermoregulatory reflexes pass through the hypothalamus?– studies of chronic hypothermia due to hypothalamic lesion
Authors: Johnson R. H. , Delahunt J. W. , Robinson B. J.
Published: March 2008

Abstract A 38‐year‐old man presented with chronic hypothermia. He also had evidence of hypothalamo‐pituitary dysfunction and CT scans showed a discrete hypothalamic lesion. Thermoregulatory impairment was found although there was normal circulatory control of blood pressure. Reflex vasodilatation could be initiated when hypothermia was present and also in response to raised body temperature. Shivering was initiated reflexly but did not otherwise occur. These observations imply that thermoregulatory reflexes are independent of central thermoregulatory mechanisms and do not pass through the hypothalamus.
Sweet's syndrome associated with sideroblastic anaemia
Authors: Duggan C. J. , Willsteed E. M. , McCrossin I. D. , Ma D. D. F.
Published: March 2008

Abstract Previous reports have noted an association between Sweet's syndrome (acute febrile neutrophilic dermatosis) and leukaemia, and less commonly other haematological abnormalities. We report a previously unrecognised association between Sweet's syndrome (SS) and sideroblastic anaemia (myelodysplastic syndrome—refractory anaemia with ring sideroblasts). Both patients were males and one had prominent extracutaneous features of SS. Bone marrow cytogenetic studies were normal in this latter patient and neither patient showed progression to leukaemia.
Studies on an unusual von Willebrand's variant – type IID
Authors: Exner T. , Hill P. , Cleland J. , Berry E.
Published: March 2008

Abstract We describe a man and his daughter from a large New Zealand family with the extremely rare variant von Willebrand's (VW) disease type IID. These two patients had a severe bleeding history following minor surgery and displayed easy bruising. However, routine laboratory screening tests and factor VIII studies were essentially normal except for slightly reduced ristocetin cofactor activity and prolonged skin bleeding times.

Although lacking higher molecular weight forms of VW antigen in common with VW type II's the patients' multimer patterns were clearly different from types IIA and IIB. Instead of showing the characteristic ‘triplet’ pattern in each multimer band the patients gave a single prominent band with faint satellite bands different in mobility to those in normals. Von Willebrand factor from the patients' platelets gave a similar abnormal pattern.

DDAVP failed to correct the bleeding time in either patient and multimer analysis confirmed that there was no increase in the higher molecular weight VWF antigen.
Lack of airway response to nasal irritation in normal and asthmatic subjects
Authors: Levi C. R. , Tyler G. R. , Olson L. G. , Saunders N. A.
Published: March 2008

Abstract Twenty two subjects (10 normals, nine asthmatics and three who had suggestive histories for asthma but normal bronchial histamine challenges) underwent nasal challenges with logarithmic incremental doses of histamine or saline on alternate days. Nasal resistance (measured by posterior rhinometry), and forced expiratory volume in one second (FEV1) were assessed after each dose of nasal histamine or placebo. After each nasal challenge (maximum nasal dose of 250 μg of histamine or doubling of nasal resistance) bronchial responsiveness was measured with a bronchial histamine challenge. Despite significant changes in nasal resistance with nasal histamine (p < 0.01) there was no significant change in the forced expiratory volume in one second, or in bronchial responsiveness. We were unable to demonstrate nasobronchial reflexes initiated by acute irritation of the nasal mucosa with histamine in either normal subjects or in those with mild to moderate asthma.
The influence of dialect group on peptic ulcer frequency amongst the Chinese in Singapore
Authors: Kang J. Y. , Yap I. , Labrooy S. J. , Guan R. , Tay H. H. , Lim K. P. , Math M. V.
Published: March 2008

Abstract In Singapore, peptic ulcer is more common amongst Chinese than amongst Malays or Indians. Earlier work has suggested that, amongst female Chinese, Cantonese women are more susceptable to ulcer disease when compared to females of other dialect groups. The aim of the present study was to confirm or refute this possibility. The dialect group distribution of 897 Chinese patients with peptic ulcer (duodenal ulcer 601, gastric ulcer 296) was compared with that of non‐ulcer dyspepsia patients and 1602 general medical patients attending the same medical units. The proportion of various dialect groups (including Cantonese) was similar in all patient groups. The proportion of ulcer patients presenting with haemorrhage was also similar in the different dialect groups. We conclude that no major dialect differences exist in peptic ulcer frequency amongst the Chinese in Singapore.
Pituitary apoplexy presenting as aseptic meningitis without visual loss or ophthalmoplegia
Authors: Reutens D. C. , Edis R. H.
Published: March 2008

Abstract Clinical and spinal fluid evidence of aseptic meningitis were the sole features at presentation in a patient with pituitary apoplexy. Visual impairment and bitemporal field defects developed later. Necrosis within a chromophobe adenoma was found at surgical decompression of the sella.
Acute ileotyphlitis as a complication of cytotoxic drug treatment of a non‐seminomatous germ cell tumor of the testis
Authors: Beadle G. F.
Published: March 2008

Abstract A case of acute ileotyphlitis is reported in a man treated with cytotoxic drugs for metastatic non‐seminomatous germ cell tumor of the testis. This case illustrates the variable features of acute ileotyphlitis and highlights the importance of clinical awareness in order to establish the diagnosis and commence treatment immediately.
Preventive strategies in management of acute myocardial infarction
Authors: Carroll G. , O'Rourke M. , Feneley M.
Published: March 2008

Abstract Recent studies on pathogenetic mechanisms, supplemented by findings in clinical trials point the way to a logical approach to acute evolving myocardial infarction. This is designed in the earliest stage to limit infarction through reduction in myocardial oxygen demands, improvement in collateral blood supply and dissolution of coronary thrombus, to prevent in a later stage coronary reocclusion through administration of antiplatelet agents, and then to prevent infarct expansion through reduction in ventricular wall tension throughout the period of repair. Application of such an approach holds the promise of reducing infarct size and all the complications of infarction, as well as short and long‐term mortality. The approach is active and aggressive, and contrasts with the approach applied a decade ago, where infarction was accepted as inevitable and therapies were reserved for managing its complications.
At medium term follow‐up (3.4 ± 2.4 years, range two months to eight years) there was one late death in each group, and seven patients in each group had return of angina or congestive heart failure. Twenty‐one patients in the emergency group and 22 patients in the elective group were asymptomatic on no cardiac medications
Authors: Celermajer D. S. , Zeng G. E. , Bailey B. P. , Bernstein L. , Beetson R. , Hughes C. F.
Published: March 2008

The clinical characteristics, perioperative complications and medium term outcome were analysed for patients undergoing emergency coronary artery bypass surgery (CABG) following failed coronary angioplasty (PTCA).

Seven hundred and twenty PTCAs were performed from June 1981 to June 1989, of which 30 (4.2%) resulted in CABG within four hours of PTCA. The perioperative course and follow‐up were compared to 30 patients undergoing elective CABG, matched retrospectively for age, sex, month of operation and number of grafts.

The emergency group had a tendency to more post operative bleeding, but no increased incidence of early reoperation for bleeding, and had a high incidence of periprocedural Q wave infarction (20% vs 3%, p < 0.05). The emergency group had shorter bypass time and decreased use of the internal mammary artery (7% vs 50%, p<0.05). There was one in‐hospital death in the emergency group.

We conclude that patients with failed PTCA requiring emergency CABG are more likely than an elective group to have post operative bleeding but no increased risk of early reoperation, and have a higher incidence of perioperative Q wave infarction.

There is significant difference in operative technique between emergency and elective coronary bypass groups (greater use of the internal mammary artery in the elective group), but not in hospital mortality. Rapid successful surgical revascularisation after failed PTCA resulted in medium term outcome similar to that of patients undergoing elective coronary surgery. (Aust NZ J Med 1991; 21: 211–216.)
Home oxygen therapy: an audit of survival
Authors: Crockett A.J. , Alpers J.H. , Moss J.R.
Published: March 2008

A retrospective audit of the medical records and respiratory function data of 186 subjects placed on long term continuous home oxygen therapy between 1979 and 1988 was undertaken. Kaplan‐Meier survival curves were constructed for subjects with Chronic Obstructive Airways Disease (COAD) and Interstitial Lung Disease (ILD).

There was an almost twofold greater mortality rate for COAD subjects at 12 months when compared to the Medical Research Council Working Party (MRC) and the Nocturnal Oxygen Therapy multicentre clinical trials (NOTT). However, the mean values of the baseline physiological parameters were similar to these major studies of long term oxygen therapy.

Survival of ILD patients was significantly less than COAD patients (p < 0.001). Within both disease categories, females survived significantly longer than males. Within the COAD category the observed sex difference was not abolished when the data was controlled for age, Pco2, Po2 and pack‐years (as an estimate of total cigarette consumption). However, prior smoking history appeared to modify the male‐female difference in COAD survival.

These are the first Australian survivorship data for patients on long term oxygen therapy. The more adverse survival figures compared with the overseas studies may reflect the co‐existence of other diseases. (Aust NZ J Med 1991; 21: 217–221.)
Wheat dust‐associated respiratory disease in a farming community
Authors: Clancy R. L. , Saunders N. A. , Ruhno J. , Wrigley C. , Scicchitano R. , Walsh B. , Cripps A. W. , Sutherland D. C. , Hensley M. J.
Published: March 2008

Sixty‐six volunteers who considered themselves to have wheat dust‐related respiratory disease, were reviewed from a farming community. A spectrum of disease was described ranging from a mild allergic rhinitis limited to periods of wheat dust exposure through to perennial asthma in which wheat dust was but one of several precipitating factors. Approximately half of those with asthma had symptoms limited to times of wheat dust exposure. Results of a limited survey of farmers showed patterns of symptoms similar to those in the volunteer group. Most subjects were atopic with elevated IgE levels, and had positive skin prick tests to environmental allergens. All but one of 65 subjects tested had a positive RAST test to wheat dust antigen. It is concluded that wheat dust associated respiratory tract disease is a significant problem in Australian farming communities, that a particular pattern of asthma can be described, and that IgE mediated reactions contribute to this disease pattern. (Aust NZ J Med 1991; 21: 211–215.)
XY female athlete with Olympic potential
Authors: Hill P. T. , Stepanas A. V.
Published: March 2008

We report a 16‐year‐old phenotypic female with XY pure gonadal dysgenesis. A dysgerminoma was found in one of the dysgenetic gonads stressing the importance of prophylactic gonadectomy. Her case presents a difficult problem because as a member of a national junior training squad, she had the potential for competing at international level where her genetic sex could be a profound liability. (Aust NZ J Med 1991; 21: 242–243.)
Complete response of a transitional cell carcinoma of the renal pelvis to leucovorin/5 fluorouracil chemotherapy
Authors: Bonaventura A. , Stewart J. F.
Published: March 2008

A 56‐year‐old female underwent treatment with leucovorin and 5‐fluorouracil for extensive metastatic moderately differentiated transitional cell carcinoma (TCC) of the renal pelvis. This resulted in a complete response for 20 + months. This combination has not been reported before in TCCs of the urinary tract and requires further exploration. (Aust NZ J Med 1991; 21: 244–245.)
Salmonella empyema in a patient with lymphoma
Authors: Cistulli P. A. , Barnes D. J. , Young G. A. R.
Published: March 2008

Salmonella empyema occurred in a patient with non‐Hodgkin's lymphoma. He was successfully managed with a combination of antibiotics and surgery. (Aust NZ J Med 1991; 21: 246–247.)
Diclofenac hepatitis
Authors: Sallie R. W. , Quinlan M. F. , McKenzie T. , Shilkin K. B. , Reed W. D.
Published: March 2008

We report five cases of biopsy‐proven hepatitis developing between six and 20 weeks after administration of diclofenac. In one patient jaundice had previously developed following use of ibuprofen. In another the clinical, biochemical and histopathological features were those of chronic active hepatitis and treatment with corticosteroids was required. All patients recovered from their liver injury without sequelae. Resolution of symptoms occurred between three and 12 weeks following cessation of the drug, while liver function tests returned to normal between seven and 16 weeks after drug withdrawal, except in the patient with chronic active hepatitis who remained biochemically abnormal for eight months. Three of the five patients developed transient circulating autoantibodies, suggesting immune mechanisms may be important in the pathogenesis of this injury. The incidence of severe hepatic dysfunction related to the use of diclofenac appears low and is probably in the order of one case per 50–100,000 prescriptions. (Aust NZ J Med 1991; 21: 251–255.)
Chronic myeloid leukaemia treated by allogeneic bone marrow transplantation from histocompatible sibling donors – an invariably fatal malignancy rendered highly curable
Authors: Szer J. , Sheridan W. P.
Published: March 2008

Abstract Twenty‐eight patients aged 16–50 years with chronic myeloid leukaemia (CML) underwent allogeneic bone marrow transplantation (BMT) using human leukocyte antigen (HLA)‐identical sibling donors. Of the 28 patients, 21 were in chronic phase, five were in accelerated phase and two were in blast phase at the time of BMT. Twenty‐three of the patients survived more than 63–2187 days after BMT, 21 in continuous complete remission and two with haemato‐logic relapse of CML. Two patients died of interstitial pneumonitis and one died of relapsed CML, cerebral aspergillosis and cytomegalovirus enterocolitis.

The overall probability of survival at six years was 78%± 9% (mean ± standard error) and of disease free survival 66 ± 11%. For patients transplanted in chronic phase, the survival probability was 90 ± 6%, while all of the patients undergoing BMT in chronic phase within the first year after diagnosis were alive with a relapse‐free survival of 88 ± 12%. The actuarial probability of occurrence of acute graft‐versus‐host disease (GVHD) was 57 ± 9%, while for Grades II and III GVHD it was 28 ±9%. Chronic GVHD occurred in 18 of 25 patients at risk. The majority of patients had a Karnofsky performance score at latest follow‐up of at least 90% (range 50–100). We conclude that allogeneic BMT is effective, curative therapy for CML and that BMT performed earlier in the natural history of the disease is associated with the best outcome. (Aust NZ J Med 1991; 21: 408–413.)
Oat bran and cholesterol reduction: evidence against specific effect
Authors: Bremer J. M. , Scott R. S. , Lintott C. J.
Published: March 2008

Abstract Most placebo‐controlled studies testing the hypo‐cholesterolaemic action of oat bran have compared high fibre against low fibre diets. To determine whether oat bran had greater cholesterol‐lowering action than another source of fibre (wheat bran) we compared the effect of breads of similar total fibre content containing either oat bran or additional wheat bran. Twelve hyperlipidaemic subjects (38–66 years) were stabilised on lipid‐lowering diets for at least three months prior to the study. Subjects were given each type of bread for four‐week periods in a single‐blind, cross‐over design.

Cholesterol, triglyceride and LDL‐cholesterol levels did not change significantly during the oat and wheat bread periods. HDL‐cholesterol rose equivalently but only to a just significant level during the oat bran diet. Body weights, lipids and lipoprotein parameters were not significantly different between the two diet periods. Both diet treatments lowered serum cholesterol approximately 4%.

We conclude that this oat bran bread consumed as part of a lipid‐correcting diet did not influence lipoproteins to any greater extent than wheat bread of similar total fibre content. (Aust NZ J Med 1991; 21: 422–426.)
Successful treatment of two patients with gastric antral vascular ectasia ‘watermelon stomach’ using endoscopic Nd‐YAG laser therapy
Authors: Brennan F. N. , Cowen A. E. , Laurence B. H.
Published: March 2008

Abstract Two patients with gastric antral vascular ectasia –‘watermelon stomach’– successfully treated with endoscopic Nd‐YAG laser are described. This condition is an uncommon cause of iron deficiency anaemia due to chronic blood loss and is usually managed by antrectomy. Endoscopic therapy with Nd‐YAG laser offers an effective and safe alternative to surgery particularly in the elderly poor‐risk patient. (Aust NZ J Med 1991; 21: 439–441.)
Cure of Salmonella hadar endovascular infection with medical therapy
Authors: Grey A. B. , Thomas M.G. , Simpson I.J.
Published: March 2008

Abstract Endovascular infection due to salmonellae is an uncommon condition with an extremely poor prognosis. We describe a patient with endovascular infection due to Salmonella hadar who was cured by prolonged medical treatment with third generation cephalosporin and fluoroquinolone antibiotics. (Aust NZ J Med 1991; 21: 442–443.)
An unusual cutaneous lymphoma with B and T cell characteristics showing gallium‐67 positive benign thymic hyperplasia following intensive chemotherapy
Authors: Young G. A. R. , Grace J. , Williams B. G. , Trent R. J. , McLaughlin A. F. , McCaughan B.
Published: March 2008

Abstract This case illustrates two interesting features. Firstly it describes an unusual cutaneous lymphoma in an adolescent girl. This lymphoma showed features of B and T cell lineages with rearrangements of both immunoglobulin heavy chain and T cell /3 chain genes. Secondly it describes the development of gallium‐67 citrate (67Ga) scan positive benign thymic hyperplasia, 15 months after diagnosis and three months after cessation of intensive chemotherapy. (Aust NZ J Med 1991; 21: 447–450)
Multiple cardiac papillary fibroelastomas and rheumatic heart disease
Authors: Kalman J. M. , Vernon‐Roberts E. , Lubicz S. , Calafiore P. , Brennan J.B.
Published: March 2008

Abstract A case of severe rheumatic mitral stenosis was found to have multiple echodense masses attached to the ventricular surface of the mitral valve and papillary muscle at preoperative 2‐dimensional echocardiography. Subsequent surgery involved mitral valve replacement and excision of the masses. Complete excision was confirmed by intraoperative transoesophageal echocardiography. Histologic examination of the surgical specimens showed typical papillary fibroelastomas. This is the first case report of multiple papillary fibroelastomas in association with rheumatic valvular disease demonstrated by 2‐dimensional echocardiography.
Single institutional experience with non‐seminomatous germ cell tumours of the testis: local perspectives on a curable cancer
Authors: Rosenthal M. A. , Stuart‐Harris R. C. , Tiver K. W. , Langlands A. O. , Kefford R. F.
Published: March 2008

Abstract We have reviewed 77 patients with Non‐seminomatous germ cell tumour of the testis (NSGCTT) treated at a single institution. A residual mass following definitive treatment occurred in 16 patients (35%), 13 of whom had a resection of the mass, yielding active tumour in only one patient. Nine patients (12%) relapsed including four of the 14 with Stage I disease who were treated by orchidectomy alone. Four relapses occurred at more than two and a half years after primary treatment. Relapse prior to the development of clinical symptoms or signs was evident in three of nine patients; in two patients by routine imaging and one with elevated routine serum markers. Three of the nine patients who relapsed had elevated serum markers. Two patients died from disease but there were four treatment‐related deaths (7%). Overall, 64 patients (83%) remain disease free at the time of follow‐up. A further seven (9%) have been lost to follow‐up but were disease‐free at a minimum of 26 months after diagnosis. This study confirms features of this disease including the excellent prognosis when adequately treated. However, it also reveals the problems of late or marker negative relapses, the implementation of an observation policy in Stage I disease and treatment related mortality in young men. (Aust NZ J Med 1991; 21: 857–862.)
Differences in the symptoms of men and women with obstructive sleep apnoea
Authors: Ambrogetti A. , Olson L. G. , Saunders N. A.
Published: March 2008

Abstract In order to determine whether the clinical features of obstructive sleep apnoea (OSA) are the same in men and women we reviewed the records of 22 women with OSA. The women were matched with 44 men of similar age (±5 years) and frequency of respiratory events (15/hr, 16–40/hr, 41–70/hr and >70/hr). The degree of daytime somnolence was similar in men and women. Women are more likely than men to complain of morning fatigue and morning headache, and less likely to report restless sleep or to have been told of apnoea during sleep. Difficulty initiating sleep (DIS) was twice as common in women as in men (p < 0.05). Most of these differences were also seen when women and men who snored but did not have OSA were compared. Arterial hypertension was less common in women (3/22) than in men (18/44), (p < 0.001). More striking than the differences between men and women in the prevalence of single symptoms was the existence of a subgroup of women (9/22) with no complaint of either apnoea, choking arousals or restless sleep, and normal blood pressure, complaining only of fatigue and morning headache, and in three cases DIS as well. We concluded that OSA may be commoner in women than previous reports suggest, and that the clinical features may be misleading in women. (Aust NZ J Med 1991; 21: 863–866.)
Recombinant alpha‐2b interferon in patients with malignant carcinoid tumour
Authors: Basser R. L. , Lieschke G.J. , Sheridan W. P. , Fox R. M. , Green M. D.
Published: March 2008

Abstract Seventeen patients with malignant carcinoid tumour, ten of whom had the malignant carcinoid syndrome, were treated with recombinant alpha‐2b interferon by subcutaneous injection (3 MU per dose) three times per week for a median of 12 weeks (range 4–48). No objective tumour responses were observed; however, there was a greater than 50% reduction in 24‐hour urinary 5‐hydroxyindolacetic acid (5‐HIAA) excretion in four often patients (40%) with elevated pretreat‐ment levels. Five often patients (50%) with flushing, five of seven patients (71%) with diarrhoea and both patients with wheezing experienced relief of symptoms. Three of four patients (75%) with weight loss as their only problem experienced weight gain. Responses occurred within the first eight weeks of treatment, but were generally of short duration. Toxicity occurred in all patients, and consisted mainly of fever, chills, anorexia, fatigue and weight loss. Four patients ceased therapy due to toxic reactions. Although interferon has activity against carcinoid tumours, its benefits are short‐lived and toxicity limits its use with increasing dose. Patients with carcinoid syndrome appear to achieve the best therapeutic response, and it is likely that low doses (9–20 million IU weekly) are as effective as higher doses (36–72 million IU weekly). (Aust NZ J Med 1991; 21: 875–878.)
Primary leiomyosarcoma of the heart: a rare cause of obstruction of the left ventricular outflow tract
Authors: Fox J. P. , Freitas E. , McGifgin D. C. , Firouz‐Abadi A. A. , West M. J.
Published: March 2008

Abstract Primary cardiac tumours are rare and frequently only diagnosed post‐mortem. Recent improvements in non‐invasive imaging techniques have led to an increasing number being diagnosed in life, allowing surgical resection.

We report a primary leiomyosarcoma presenting with obstruction of the left ventricular outflow tract. (Aust NZ J Med 1991; 21: 881–883.) Key words: Cardiac tumour, leiomyosarcoma, obstruction to left ventricular outflow.
Severe constipation as the presenting complaint of phaeochromocytoma
Authors: Williams A. J. K. , Palmer K. R.
Published: March 2008

Abstract Phaeochromocytoma is a rare tumour which may present with gastrointestinal features. We report two patients who presented with severe constipation and were found to have a malignant phaeochromocytoma. Both patients deteriorated following barium contrast radiology. In the first patient, constipation improved following pharmacological manipulation with a and β adrenoreceptor antagonists. The diagnosis of phaeochromocytoma must be considered in a constipated patient with the features of catecholamine excess. (Aust NZ J Med 1991; 21: 888–890.)
Frusemide antagonises exercise‐induced but not histamine‐induced bronchospasm
Authors: Feather I. R. , Olson L. G.
Published: March 2008

Frusemide has recently been shown to antagonise exercise‐induced bronchospasm, an action attributed to blockade of chloride channels in the bronchial epithelium. In order to test the hypothesis that frusemide non‐specifically antagonises bronchospasm, we tested the bronchial reactivity to inhaled histamine in ten subjects aged 22 to 35 years, after nebulising 30 mg of frusemide, and after nebulising the frusemide vehicle (water at pH 9.1). The geometric mean (histamine PD20) after inhalation of the solution was 0.6 μmol and after frusemide was 0.45/μmol. The mean difference in PD PD20 between control and frusemide was – 0.50 μmol (frusemide test more reactive) but this change was not statistically significant. We conclude that nebulised frusemide does not antagonise histamine‐induced bronchospasm, and that the ability of frusemide to block exercise‐induced bronchospasm may be specific to that stimulus.
Diabetic end stage renal failure – the Wellington experience 1975–1988
Authors: Thompson T. J. , Fisher M. , Hatfield P. J. , Morrison R. B. I. , Neale T. J.
Published: March 2008

Since the late 1970s patients with diabetic nephropathy have formed an increasing proportion of new entrants to the Hospital renal dialysis and transplantation programme, reaching 28% for the three year period to December 1988. Between 1 January 1975 and 31 December 1988, 87 diabetic patients were accepted for treatment. Fifty‐one per cent were European, predominantly type I diabetics. Maori (9% of the total reference population) accounted for a disproportionately high 47% due to an over‐representation by type II diabetic patients (34 of 41 Maori). These findings cannot be explained by the higher prevalence in Maori of type II diabetes but appear to be due to a more prevalent and/or aggressive diabetic renal lesion in this group. On commencing treatment, nearly all patients had retinopathy and the majority had evidence of peripheral vascular disease, hypertension and neuropathy. CAPD was the initial mode of renal replacement therapy in 70% of patients. Overall patient survival was 77% at one year and 42% at three years, and survival on CAPD was 76% and 37% at one and three years, respectively. Patient survival on transplantation was 63% at one year and 58% at three years. Graft survival was 51% at one year and 46% at three years. Although the short term outlook for diabetic patients on renal replacement therapy is encouraging, longer term survival compared to non‐diabetic patients is poor. Vascular disease is the major cause of death and an important factor in patient morbidity.
Transfusion associated graft‐versus‐host disease after cardiac surgery: response to antithymocyte‐globulin and corticosteroid therapy
Authors: Prince M. , Szer J. , van der Weyden M. B. , Pedersen J. S. , Holdsworth R. F. , Whyte G.
Published: March 2008

A 63‐year‐old patient developed graft‐versus‐host disease (GVHD) after the transfusion of stored, random donor red cell concentrates with coronary artery surgery. The disease was characterised by skin rash, fever, diarrhoea, hepatic dysfunction, pancytopenia and the acquisition of cells bearing human leukocyte antigens of a blood donor. Clinical and histologic improvements were noted with antithymocyte‐globulin and corticosteroid therapy, as seen in some patients with acute GVHD following allogeneic bone marrow transplantation, but the pancytopenia failed to resolve prior to a fatal cerebral haemorrhage. Early aggressive immunosuppressive therapy may be beneficial for transfusion‐associated GVHD but strategies for its prevention, by limitation of the use of homologous blood need to be addressed.
Early and late results of surgery for Wolff‐Parkinson‐White syndrome
Authors: Rosenfeldt F. L. , Muller D. , Harper R. , Shardey G. C. , Broughton A.
Published: March 2008

Surgical treatment for accessory atrioventricular connections was performed in 60 patients with Wolff‐Parkinson‐White syndrome between 1981 and 1986. The initial procedure successfully divided 69 of 73 pathways identified preoperatively, including 39 of 40 left free wall pathways, 23 of 24 posteroseptal pathways, six of seven right free wall pathways, and one of two anteroseptal pathways. Three additional pathways were identified for the first time during follow‐up. The primary procedure was successful in curing 53 (88%) of the 60 patients and in dividing 69 (91%) of the total of 76 pathways. Subsequent procedures increased the overall clinical cure rate to 97%. The surgery was performed with low morbidity and no perioperative or late mortality. Patients were followed‐up for a mean of 6.4 years (range four to nine years). No patient showed clinical or electrocardiographic evidence of recurrence of a pathway which had been divided surgically. We conclude that regardless of pathway site, surgical treatment carries a low risk and has a high probability of avoiding lifelong antiarrhythmic therapy.
Mitral valve palpitations
Authors: Oakley Celia M.
Published: March 2008

Few disorders ever provoked more interest and controversy than mitral valve prolapse (MVP). Past echocardiographic over‐diagnosis led to it becoming a whipping boy for otherwise unexplained chest pain, palpitation, arrhythmias and emboli. Surgical centres reported a high incidence of endocarditis and severe regurgitation.

Most investigators who have studied the prevalence of arrhythmias in MVP have concluded that they are more common in this syndrome than in the general population and that there is a causal rather than a fortuitous relationship. However, the prevalence of arrhythmias in reported studies is probably higher than in unselected MVP patients.

Multiple ventricular premature beats, ventricular tachycardia and sudden death have been reported. Suggested mechanisms have included a focal cardiomyopathy with incoordinate contraction and relaxation, QRS dispersion, a long QT, traction on papillary muscles by prolapsed leaflets, interference with the blood supply of the papillary muscles, stimulation of the endocardium by the chordae and diastolic depolarisation of muscle fibres in redundant leaflets with triggered repetitive automaticity. MVP has been associated with pre‐excitation giving rise to atrioventricular re‐entry tachycardia. Autonomic dysfunction and a hyperadrenergic state has been claimed and this may also be responsible for supraventricular arrhythmias including atrioventricular nodal re‐entry tachycardia, flutter and fibrillation. Electrophysiological studies have yielded contradictory results which may be due to the heterogeneity of the patients studied and variability of the mechanisms.

Whatever the true prevalence, arrhythmias in MVP are usually benign. Syncope and sudden death are rare. Anti‐arrhythmic therapy is only warranted in patients with frequent and distressing symptoms shown to be due to the arrhythmias or when arrhythmias are judged potentially life threatening. Beta‐blockers are particularly helpful in the syndrome.
Optimising plasma lipids: public intervention versus high risk management
Authors: Nestel Paul J.
Published: March 2008

A public health strategy carries more constraints than a high risk strategy because it targets both low risk and high risk individuals; this requires cautious intervention and hence achieves only a modest reduction in risk. Nevertheless, a modest population‐wide fall in the concentrations of atherogenic lipoproteins leads to substantial numbers of preventible heart attacks and deaths.

Other strategic considerations are to lower non‐lipid cardiovascular risks (hypertension, clotting tendency) and to prevent other diet‐related disease (such as cancer) through interventions which lower plasma lipids. The major nutritional changes which achieve this are optimising energy balance, reducing total fats and saturated fatty acids and increasing plant foods which are rich sources of unsaturated fatty acids, fibre and antioxidants. Each of these contributes to optimising the low density lipoprotein (LDL) concentration.

Antioxidants (vitamins C and E mainly) may inhibit LDL oxidation. The strategy for lowering plasma triglyceride, especially in the context of atherogenic lipoprotein phenotypes, is mainly through energy balance, reduced saturated fat and alcohol. Correcting overweight especially in those with abdominal obesity, may normalise raised plasma triglyceride, low high density lipoprotein (HDL), abnormal LDL and even glucose intolerance and hypertension, which may be associated.

The scientific basis for the lipid optimising effects of the different nutrients will be discussed.
Cholesterol and coronary heart disease mortality
Authors: Sleight Peter
Published: March 2008

The epidemiological relation between increased levels of blood cholesterol and increased risk of future heart disease is clear, both within and between countries. These strong relationships have led to the adoption of consensus statements in most countries which recommend measures such as the reduction of dietary saturated fat/an increase in the polyunsaturated/saturated ratio and other dietary and sometimes drug methods to reduce serum cholesterol. There is controversy as to whether these measures should be targeted at individuals with high levels of cholesterol or whether there should be a public health approach to the whole population.

The public and medical debate has become more heated since the data from intervention trials are conflicting. Taken overall the trials do appear to show reduction in risk of coronary which is stronger for non fatal, compared with fatal coronary events. Meta analysis suggests that increasing benefit accrues from larger reductions and also longer reductions in cholesterol by intervention. However, individual trials frequently show variable results and some, especially the recent 15 year follow up of a Finnish five year intervention (by diet, cholesterol lowering and blood pressure lowering drugs) was strikingly adverse—although the total number of events was not large.

Total mortality is much harder to influence and the sum of the available trials is hopelessly inadequate in size to address these questions.

As a result confusion abounds and is unlikely to be clarified by the present on going trials. The need for more data is clear. The pilot study for the Oxford Cholesterol Study will be presented as a prelude for a proposed main study in about 20 000 high risk individuals.
Remodelling of the heart after myocardial infarction
Authors: White Harvey D.
Published: March 2008

In the first few hours after the onset of coronary occlusion the infarct zone stretches due to myocyte slippage. Subsequently the noninfarct zone develops volume overload hypertrophy with series addition of new sarcomeres and fibre elongation.

Dilatation is detrimental as it increases ventricular wall stress and oxygen demand, and re‐entry of electrical impulses may be influenced by stretching of the ischaemic scar resulting in ventricular fibrillation.

Left ventricular remodelling and dilatation is a progressive process which begins early and continues in the months after infarction. The major determinants of the extent of remodelling are infarct size and patency of the infarct‐related artery.

Late reperfusion may reverse initial infarct dilatation and decrease left ventricular volumes by inducing calcium‐activated contracture of the actomyosin complex. Expansion may also be inhibited by acceleration of healing, splinting of the infarct zone by salvage of subepicardial cells, and blood in the coronary arteries and veins supporting the infarct zone.

End‐systolic volume is the strongest predictor of long‐term prognosis after infarction. A number of therapies including thrombolysis, angiotensin‐converting enzyme (ACE) inhibition and nitrates have been shown to decrease left ventricular dilatation. The optimal time for commencement, dose, duration and the effects of combinations of therapy are yet to be determined.
The importance of assessing time‐course behaviour of abnormal ST/T changes after exercise
Authors: Barlow Clifford W. , Friedman Brian M. , Barlow John B. , Soicher Evan R.
Published: March 2008

Routine stress electrocardiography has been criticised for yielding too many so‐called 'false‐positive' results because ST/T changes that develop during and after exercise are prevalent. Recent studies in our institution indicate, however, that the time‐course behaviour patterns of these ST/T configurational ‘abnormalities’ after exercise are different from those reflecting myocardial ischaemia due to epicardial coronary artery disease (CAD). Time‐course analysis increases the predictive value of exercise testing and has dramatically decreased the number of asymptomatic subjects or symptomatic patients at low risk of having CAD being subjected to coronary arteriography in our institution.

Our method of assessing post‐exercise time course patterns of abnormal ST/T are described in detail. Ischaemic ST/T abnormalities have late onset, early offset or early onset, late offset whereas those ST/T changes associated with normal epicardial coronary arteries have late onset, late offset or early onset, early offset post‐exercise time course patterns.
Heart failure: to digitalise or not? The view against
Authors: White Harvey D.
Published: March 2008

Despite extensive clinical experience the role of digoxin is still not well defined. In patients with atrial fibrillation digoxin is beneficial for ventricular rate control. For patients in sinus rhythm and heart failure the situation is less clear.

Digoxin has a narrow therapeutic:toxic ratio and concentrations are affected by a number of drugs. Also, digoxin has undesirable effects such as increasing peripheral resistance and myocardial demands, and causing arrhythmias.

There is a paucity of data from well‐designed trials. The trials that are available are generally small with limitations in design and these show variation in patient benefit. More convincing evidence is required showing that digoxin improves symptoms or exercise capacity. Furthermore, no trial has had sufficient power to evaluate mortality. Pooled analysis of the effects of other inotropic drugs shows an excess mortality and there is a possibility that digoxin may increase mortality after myocardial infarction (MI).

Angiotensin‐converting enzyme (ACE) inhibitors should be used first as they are safer, do not require blood level monitoring, modify progression of disease, relieve symptoms, improve exercise tolerance and reduce mortality.

Caution should be exercised in using digoxin until large mortality trials are completed showing either benefit or harm. Until then digoxin should be considered a third‐line therapy.
Mortality in systemic lupus erythematosus: active disease is the most important factor
Authors: Cohen M. G. , Li E. K.
Published: March 2008

Although systemic lupus erythematosus (SLE) no longer has the very poor prognosis that it had 50 years ago, there remains a significant mortality. We were able to determine the causes of death in 27 of the 29 patients with SLE who died over the period 1985 to 1989. This represents one and five year mortality of six and 24% respectively. In common with other studies, sepsis was a major factor, being implicated in the deaths of 37% of our patients. However, sepsis (i) occurred almost exclusively in patients with active SLE; (ii) often occurred after prolonged hospitalisation; and (iii) was a terminal event in otherwise fatal SLE in several patients. Overall, active disease was determined to be a cause of death in 67% of the patients. An unexpected observation was the finding that active cardiopulmonary disease accounted for 37% of deaths. Although late mortality from degenerative vascular disease is being increasingly reported with the modern prolonged SLE survivorship, it was identified in only one patient. We conclude that active disease remains the most important factor in mortality in SLE. (Aust NZ J Med 1992; 22: 5–8.)
Amiodarone pulmonary toxicity — three unusual manifestations
Authors: McNeil K. D. , Firouz‐Abadi A. , Oliver W. , Zimmerman P. V.
Published: March 2008

Amiodarone is very useful treatment for refractory arrhythmias. However, it has a wide profile of adverse effects involving a number of organ systems. Pulmonary toxicity is the most serious of these side effects and often limits its clinical use.

Three patients with unusual forms of amiodarone pulmonary toxicity are described. One had extensive unilateral alveolar disease, another pleural effusion, and in a third the pulmonary infiltrate improved with oral corticosteroids despite continuation of amiodarone therapy. Extensive unilateral alveolar disease and resolution of the pulmonary toxicity with corticosteroids despite continuing with amiodarone have not been previously reported. Pleural effusion has been noted only rarely. With the increasing use of amiodarone, pulmonary toxicity is likely to occur more frequently and it is important to be aware of its less common manifestations. (Aust NZ J Med 1992; 22: 14–18.)
Isolated hepatitis B core antibody — can response to hepatitis B vaccine help elucidate the cause?
Authors: McIntyre A. , Nimmo G. R. , Wood G. M. , Tinniswood R. D. , Kerlin P.
Published: March 2008

The finding of a positive hepatitis B core antibody (anti‐HBc) in the absence of hepatitis B surface antigen (HBsAg) or fiepatitis B surface antibody (anti‐HBs) is relatively uncommon. This finding is known to occur during the ‘window period’ of acute hepatitis B between loss of HBsAg and the appearance of anti‐HBs. It may also occur with active infection or following resolution. The aim of this study was to determine if response to hepatitis B vaccination would allow the separation of these subgroups of patients with isolated anti‐HBc. Seventeen patients with persistent isolated core antibody were vaccinated and serum obtained at 2,4 and 8 weeks. Results were compared with a seronegative control group. Six subjects (35%) but no control patients (p = 0.016) responded with a titre of>50mIU/mL at two weeks, suggesting an anamnestic response due to prior infection and immunity. A further seven subjects (41%) finally seroconverted (anti‐HBs titre > 10mIU/mL) thus excluding chronic infection and suggesting initial false positive results. Only two subjects did not respond to a full course of vaccination, but neither they nor any other subjects were positive for HBV DNA. These results indicate that hepatitis B vaccination and subsequent measurement of anti‐HBs will identify evidence of past infection in the form of an anamnestic response in up to one third of the patients and will also exclude chronic infection on the grounds of a normal vaccine response in a majority of the remainder. (Aust NZ J Med 1992; 22: 19–22.)
Investigation of pleural effusion: the role of bronchoscopy
Authors: Upham J. W. , Mitchell C. A. , Armstrong J. G. , Kelly W. T.
Published: March 2008

To assess the place of bronchoscopy in the investigation of pleural effusion, 245 patients presenting during a two year period were reviewed. Of the 46 patients who had bronchoscopy, a positive yield was obtained in 13, though in five of these a second pleural aspiration was also diagnostic. Bronchoscopy was more likely to be diagnostic in patients presenting with a cough (12/24) than in those with no cough (1/22) (p<0.001), and in those whose chest X‐ray revealed significant radiological abnormalities such as hilar enlargement, lung mass or persisting consolidation (12/29), than in those without such changes (1/17) (p<0.01).

Bronchoscopy has a limited role in the investigation of pleural efision. The presence or absence of cough, and the appearance of the chest X‐ray, are both important considerations when planning the investigation of an undiagnosed pleural effusion. (Aust NZ J Med 1992; 22: 41–43)
Late presentation and development of nephrocalcinosis in primary hyperoxaluria
Authors: Irish A. B. , Doust B.
Published: March 2008

A case of primary hyperoxaluria type 1 with complete deficiency of alanine:glyoxalate aminotransferase that first manifested at the age of 59 with irreversible acute on chronic renal failure is reported. Nephrocalcinosis, initially absent, developed rapidly after renal failure evolved. The possible role of hypovolaemia and contrast nephrotoxicity in precipitating the clinical onset is discussed. Primary hyperoxaluria should be considered in patients of any age presenting with unexplained renal failure, and appropriate systemic pathology of oxalosis. (Aust NZ J Med 1992; 22: 48–50.)
Microscopic polyarteritis presenting with chest infections and acute appendicitis
Authors: Li Philip K. T. , Lai F. M. , KO G. T. C. , Lai K. N.
Published: March 2008

We describe a 38‐year‐old male with antineutrophil cytoplasmic auto‐antibody (ANCA) positive microscopic polyarteritis who presented with recurrent chest infections, lung haemorrhage, renal insufficiency and acute appendicitis. Appendectomy was followed by resolution of abdominal symptoms and the surgical specimen revealed vasculitis of the serosal vessels. A renal biopsy was performed because of impaired renal function and this revealed focal necrotising glomerulonephritis with absence of immune deposits. Chest infections were treated with antibiotics resulting in partial clinical response, but pulmonary symptoms relapsed and a complete resolution was achieved only after plasma exchange and the administration of cyclophosphamide. Our observation emphasises the protean manifestations of microscopic polyarteritis and the relationship between ANCA and disease activity. (Aust NZ J Med 1992; 22: 56–59.)
The safety and economic advantages of day case electrophysiologic studies
Authors: May C. D. , Davis M. J. E.
Published: March 2008

Electrophysiologic Studies (EPS) have been performed as ‘day case’ procedures in selected patients at Royal Perth Hospital since April 1987. Previously, EPS had involved hospitalisstion for two to ten days. During the 51 month period to June 1991, 484 EPS were performed in total. of these, 153 (105 males and 48 females aged 46±31y) wen day case procedures.

Studies were baseline in 60 cases and included drug evaluation in 30. Sixty‐one additional studies were performed solely to evaluate therapy. Twenty‐one patients required cardioversion. One hundred and fifty one patients were discharged on the same day and two required prolonged observation.

The financial cost savings to the hospital for day case EPS is estimated to be $115 per patient and to the community potentially a further $108 per patient. This study demonstrates that in selected patients undergoing elective EPS, day case management is a safe and economic alternative to hospital admission.