bluuebunny/crossref_metadata_2025 huggingface dataset:
Coronary Risk Factors in a Rural Community Which Includes Aborigines: lnverell Heart Disease Prevention Programmed
Authors: Simons L. , Whish P. , Marr B. , Jones A. , Simons J.
Published: March 2008

Abstract: A coronary risk factor screening and referral service was established in Inverell, New South Wales, in July 1978. In non‐Aboriginal subjects, there was an increasing prevalence of coronary risk factors with age (hyperlipi‐daemia, hypertension and obesity), except for cigarette smoking which showed a reverse trend. Allowing for minor differences in sampling, the average level of plasma chalesterol, blood pressure and cigarette smoking in rural Inverell closely resembled that in Sydney. However, Inverell subjects of both sexes were consistently more overweight at all ages. Aboriginal subjects of both sexes showed an increased prevalence of hypertriglyceri‐daemia and cigarette smoking compared with non‐Aboriginal subjects, whilst hypertension and obesity were also more prevalent in the Aboriginal females. High coronary risk Inverell subjects sustained significant improvements in serum cholesterol, cigarette smoking and body weight levels over one year of follow‐up. Community‐wide control of hypertension was initially unsatisfactory and this remained so.
Atrial Fibrillation and Arterial Embolism in Hyperthyroidism
Authors: Hurley D. M. , Hunter A. N. , Hewett M. J. , Stockigt J. R.
Published: March 2008

Abstract: Atrial fibrillation or flutter was present in 70 of 381 patients with uncontrolled hyperthyroidism; return to stable sinus rhythm occurred in 39 with antithyroid and anti‐arrhythmic treatment. One third of the patients who reverted did so in the first week of treatment while still hyperthyroid. As expected, reversion was more likely in younger patients, and in those with arrhythmia of recent onset, without evidence of other heart disease. Eight patients with arrhythmia had proven (five) or probable (three) major arterial embolic episodes. Four of these eight patients died. Embolism tended to occur at an early stage, during uncontrolled hyperthyroidism, in patients with both atrial fibrillation and cardiac failure. These findings suggest that prophylactic anticoagulation may be appropriate in this high risk group, although more extensive studies are necessary before effective prevention of embolism can be claimed.
Immune Complexes in Acute Pancreatitis
Authors: Fey A. , Smart C. , Duggan J. M. , Major G. A. C. , Clancy R.
Published: March 2008

Abstract: Immune complexes were detected in the sera of ten of 22 patients with acute pancreatitis using a Clq deviation assay. Five of these were positive using a second technique. There was no correlation between immune complexes and clinical or aetiological features of the pancreatitis. Two patients with immune complexes developed a benign and transient pancreatic polyarthritis. Immune complexes may provide one common path in the sequence of pathogenic events that lead to pancreatitis.
Presentation of Pulmonary Tuberculosis
Authors: Holmes P. , Faulks L.
Published: March 2008

Abstract: A study was made of the presenting features of 700 consecutive Australian patients with pulmonary tuberculosis. A clinical diagnosis of pulmonary tuberculosis was suspected at the time of first presentation in only 52 patients and the initial provisional diagnosis was that of a non‐tuberculous chest condition in a further 32 patients. In another 16 there was a delay in diagnosis because pulmonary tuberculosis was suspected only after chest X‐rays were taken for screening purposes—for example, prior to elective surgery, A non‐cavitating lesion in an upper lobe was the radiological appearance most often associated with failure to suspect tuberculosis at the time of presentation, The most common symptoms or change in pre‐existing chest complaints were cough (55), loss of weight (52) and shortness of breath (43) followed by fever or night sweats (23) and haemoptysis (10) while 16 were asymptomatic.
Pneumonia with Bacteraemia Due to Escherichia Coli
Authors: Packham D. R. , Sorrell T. C.
Published: March 2008

Abstract: Pneumonia due to Escherichia coli (E. coli) has a reported mortality of up to 70 per cent. Most infections are associated with underlying disease, and follow bacteraemia from a genitourinary or gastrointestinal source.

This report describes two patients with bacteraemic E. coli pneumonia, presumed secondary to aspiration of E. coli from the oropharynx. Both patients presented a rapidly progressive illness with hypotension. Response of the pneumonia to early, appropriate antimicrobial therapy, was complete.

Our cases are discussed with particular reference to clinical features of the infection and choice of antimicrobial therapy.
Anti Platelet Agents for Strokes and Myocardial Infarction: A Critical Appraisal of Recent Clinical Trials*
Authors: Castaldi P. A.
Published: March 2008

Abstract: Attempts at prevention of arterial thrombosis with platelet inhibitors have been the subject of a number of major trials in recent years. These trials were prompted by earlier observations that aspirin takers seemed to fare better after acute myocardial infarction and were further stimulated by the recent growth of knowledge about the role of vascular and platelet prostaglandins. The trials have sought to establish that aspirin (ASA), sulphinpyrazone and dipyridamole may prevent thrombosis in the form of recurrence of transient ischaemic attack (TIA) and stroke or reduce the recurrence rate and mortality after acute myocardial infarction. No single trial has provided conclusive evidence although there is a strong suggestion of some benefit from ASA. With further understanding of PG metabolism and the effects of inhibitors new approaches are likely to emerge in the near future.
Quality Assurance in Hospital Medicine: A Report
Authors: Legge D. G. , Hutton P. A.
Published: March 2008

Abstract: The Austin Division of Medicine Quality Assurance Programme evaluates the quality of care through reviews of admissions, discharges, deaths, and of outpatient attendances, and through special topic surveys and reviews prepared by providers of care from inside and outside the Division. The main focus of the programme is on the technical quality of medical services although the personal dimension is also discussed. The evaluation of quality of care creates pressures for improvement, primarily through continuing education and by increased administrative awareness of clinical priorities.
Significance, Mechanisms and Control of Renal Ammoniagenesis
Authors: Adam W. R.
Published: March 2008

Abstract: Ammonia is quantitatively the major buffer for hydrogen ion in the urine. Further, the excretion of ammonia can be varied by acid base status and is therefore of homeostatic importance. Acid base status exerts its effect on ammonia excretion both directly and also via an effect on renal ammonia production from glutamine. The mechanism of the effect of acid base status on glutamine deamidation and deamination is uncertain.

Apart from its homeostatic role in health and disease alterations in renal ammonia production may assume pathological importance in potassium depletion and uric acid urolithiasis.
Vasoactive Peptides and Hypertension: Role of Angiotensin Converting Enzyme
Authors: Johnston C. I. , Iansek R. , Millari J. A. , McGrath B. P. , Matthews P. G.
Published: March 2008

Abstract: Angiotensin converting enzyme plays a key role in the hormonal regulation of blood pressure. It is responsible for the production of the vasconstrictor hormonal peptide angiotensin II as well as the destruction of the vasodilator peptide bradykinin. Recently, orally active specific inhibitors of angiotensin converting enzyme have become available. Captopril (SQ14225) blocks angiotensin I and potentiates bradykinin effects in vitro and in vivo. In man it leads to a fall in endogenous plasma angiotensin II, a rise in blood angiotensin I and renin, but no change in blood bradykinin can be detected.

In sodium deplete normal subjects it lowers the blood pressure, but in sodium replete subjects it is without effect. Similarly, it will acutely lower blood pressure in renovascular and accelerated hypertension but not in essential hypertension. The acute hypotensive effect of captopril may therefore be due to inhibition of the renin‐angiotensin system.

However, in the long term, it is effective in lowering the blood pressure in patients with essential hypertension, especially when combined with a diuretic. This suggests that the long‐term hypotensive effect differs from the short term effect, and involves mechanisms other than inhibition of the renin‐angiotensin
Nephritogenic Immune Reactions Involving Immune Complex Formation in the Circulation and in situ within the Kidney
Authors: Wilson C. S. , Neale T. J. , Holdsworth S. R.
Published: March 2008

Abstract: The circulating immune complex (IC) mechanism of renal and vascular injury is now well established based on observations in experimental serum sickness in animals and detection of circulating and localized IC of known antigen and antibody content in glomerulonephritis (GN) in man Studies continue on the factors responsible for formation and vascular deposition of circulating IC Utilization of assays to detect circulating IC has revealed that some patients with chronic presumed IC GN have no unusual amount of circulating IC. The possibility that nephritic indviduals may handle relatively normal amounts of circulating IC in a nephritogenic fashion points out the need to study host and genetic factors in the development of IC GN Observations in experimental animals have demonstrated the nephritogenic potential of the direct reaction of antibody with antigens, either structural in nature or planted within the glomerulus fn a discontinuous pattern This suggests that some GN previously thought to be from deposition of Circulating IC by the pattern of irregular Ig accumulation on immunofluorescence study might be the product of a direct reaction of antibody with glomerular capillary wall antigens Models of such reactions involving nonclassic glomerular basement membrane (GBM)
Anti‐Basement Membrane Antibodies in Immunologic Renal Disease
Authors: Wilson C. B. , Holdsworth S. R. , Neale T. J.
Published: March 2008

Abstract: Anti‐basement membrane antibodies are now being associated with an increasing spectrum of disease, including Goodpasture's syndrome, rapidly progressive and occasionally milder forms of glomerulo‐nephritis (GN), tubulointerstitial nephritis, pulmonary damage, and potentially other forms of tissue injury. We have developed a radioimmunoassay to detect circulating anti‐glomerular basement membrane (GBM) antibodies. The antigens for this assay are derived from the noncollagenous portion of the GBM remaining after collagenase digestion. After immunoabsorptive purification, the major antigens precipitated by human anti‐GBM antibodies can be characterized by polyacrylamide gel electrophoresis (PAGE) into an unresolved high molecular weight fraction and two antigenic peaks of 54,000 and 27,000 daltons. The noncollagenous nature of the antigenic material has been confirmed by amino acid analysis. The radiolabelled antigen has proven useful in detecting circulating anti‐GBM antibodies in over 500 patients. The assay is of use in monitoring the activity of disease and judging the patient's response to therapy. It is also useful in determining the timing of renal transplantation, if required. Differences in antigenic content of glomerular and tubular basement membranes (TBM) have been noted between individuals. These antigenic differences. under certain circumstances, can lead to the induction of anti‐basement membrane antibody responses after transplantation.
Cell‐Mediated Immunity in Glomerulonephritis
Authors: Thomson N. M. , Kraft N. , Atkins R. C.
Published: March 2008

Abstract: In about 30% of cases of glomerulonephritis. there is little or no evidence that humoral immunity has a role in the pathogenesis of the disease. There is now mounting evidence that cell‐mediated immunity (CMI) plays a role in this group of glomerulonephritides, particularly in minimal lesion glomerulonephritis. Moreover, there is some evidence that CMl may also augment injury in glomerulonephritis, primarily induced by a humoral mechanism.
Genetic Regulation and Development of Alcohol Dehydrogenases in the Mouse
Authors: Holmes R. S.
Published: March 2008

Abstract: Alcohol dehydrogenase (ADH) of mouse tissues was investigated using electrophoretic zymogram methods. ADH activity is widely distributed in mouse tissues and exists as at least two genetic isozymes, designated A2 and C2, which are predominantly localised in liver and stomach respectively. Electrophoretic and activity variants of ADH‐C2 among inbred strains of mice have been used to localise the gene encoding this enzyme (Adh‐3) and a closely linked temporal locus (Adh‐3‐t) on chromosome 3 of this organism. Recent developmental studies on ADH isozymes in the mouse have been reviewed.
Cytology of Synovial Effusions in Epidemic Polyarthritis
Authors: Fraser J. R. E. , Cunningham A. L. , Clarris B. J. , Aaskov J. G. , Leach R.
Published: March 2008

Abstract: Examination of synovial fluid in eight patients with epidemic polyarthritis following Ross River virus infection showed cell counts ranging from 1,500 to 13,800 per mm3. Stained smears were notable for a paucity of neutrophils and high proportions of monocytes and vacuolated macrophages, which were further characterised by light and electron microscopy. Ross River virus antigen was detected by specific immunofluorescence in monocytes and macrophages of four cases early in the course of the illness, but intact virus was not identified by electron microscopy or cell culture. No cell‐associated C3 component of complement or immunoglobulin of IgM or IgG class was detected in any cell‐type. These findings indicate that cell counts and simple smears may be useful in the early diagnosis of suspected epidemic polyarthritis, and provide further information pertinent to the pathogenesis of this disease.
Antibodies Against Double‐stranded RNA in Patients with Rheumatoid Arthritis, Osteoarthrosis and Paget's Disease of Bone
Authors: Kalmakoff J. , Maskill W. J. , Thongkrajai P. , Palmer D. G.
Published: March 2008

Abstract: Using a liquid phctse radioimmunoassay to detect antibodies to 3H‐labelled double‐stranded RNA the premise that rheumatoid arthritis and Paget's disease of the bone may be associated with a chronic virus disease was examined. About 33% of patients with rheumatoid arthritis had antibody levels above the normal range and 11%had antibody levels below the normal range of controls (blood bank donors). The low binding activities were

attributed to the action of a nuclease that degraded the dsRNA. Some patients with Paget's disease of bone had higher binding activities than the normal range and similar binding activity was also found in patients with osteoarthrosis. The increase in antibodies to double‐stranded RNA did not correlate with increasing age.
Graft‐Versus‐Host Disease in Consecutive Patients with Acute Myeloid Leukaemia Treated with Blood Cells from Normal Donors
Authors: Lowenthal R. M. , Menon C. , Challis D. R.
Published: March 2008

Abstract: Two consecutive patients with acute myeloid leukaemia (AML) developed severe probable graft‐versus‐host disease (GVHD) following transfusion of blood products from normal donors. In one patient the AML had arisen de novo, while in the other it occurred four years after the patient developed non‐Hodgkin's lymphoma (NHL) and was treated with radiotherapy and combination cytotoxic chemotherapy. Both patients received anti‐leukaemic treatment with doxorubicin and cytosine arabinoside and intensive haematological supportive care with transfusions of red cell, white cell and platelet concentrates obtained from normal donors. Clinically the GVHD in each patient was manifest by a severe erythematous rash, ifftractable diarrhoea and abnormalities in the liver function tests. On pathological examination the skin in each case showed the typical changes of GVHD. Both patients died. There have been few previous reports of GVHD occurring after accidental engraftment of immunosuppressed patients undergoing therapy for acute leukaemia. Our experience suggests that it may occur more often than has hitherto been recognised.

At present there is controversy concerning the possible anti‐leukaemic effects of granulocyte transfusions. Until the relative importance of the benefits and deleterious effects of cells with the potential for engraftment is determined by further studies, we recommend the routine irradiation of all cellular blood products intended for administration to acute leukaemia patients undergoing intensive cytoreductive chemotherapy.
Acanthocytosis and Haemolytic Anaemia Due to the McLeod Blood Group
Authors: Woodruff R. K. , Wiley J. S. , Bell W. R. , McPherson A. J. , Ford D. S.
Published: March 2008

Abstract: A fourteen‐year‐old boy presenting with marked acanthocytosis of the red blood cells and a compensated haemolytic anaemia was shown to have the McLeod blood type. Only three other individuals have been reported as having this abnormality of the Kell blood group system without evidence of chronic granulo‐matous disease.

Serological typing for the McLeod phenotype should be undertaken in males with unexplained acanthocytosis, and CPK estimation may provide a screening test for this condition.
Shoshin Beriberi
Authors: Sambrook P. N. , Dalton W. R.
Published: March 2008

Abstract: A case of probable Shoshin Beriberi heart disease is described. The patient developed persistent low cardiac output failure despite treatment with thiamine. Although rarely reported in Australia, Beriberi heart disease may be more common than is supposed and should be considered in alcoholic patients presenting with acute cardiac failure.
The Glomerular Sieve and the Mechanisms of Proteinuria
Authors: Ryan G. B.
Published: March 2008

Abstract: The glomerular capillary wall acts as a sieve, allowing the passage of water and small solutes but holding up circulating macro‐molecules the size of albumin or larger. Recent studies indicate that such macromolecules are held up at the level of the endothelial fenestrae by a functional barrier which depends critically upon the maintenance of normal haemo‐dynamic conditions. The effectiveness of this barrier probably relates to molecular sieving phenomena across the basement membrane, perhaps in conjunction with the formation of a concentration‐polarisation layer beneath the endothelium, and possibly in association with charge effects. Accordingly, proteinuria may result not only from structurat damage to the capillary wall in glomerular disease but also from general or local changes in glomerular blood flow or ultrafiltration flux, causing disturbances in the functional barrier at the endothelial fenestrae. Because it appears that the epithelial layer offers the major restriction to water flux across the wall, protein leakage at sites of focal loss bf the epithelial layer (as found in a variety of human and experimental proteinuric states) may result from a focal “blow‐out” of ultrafiltration flux, thereby dis rupting the functional barrier at the endothelial fenestrae and dragging macromolecules across to the urinary space.
Lymphokine Production by Peripheral Blood teucocytes: Quantitation of T‐cell Growth Factor Activity for Assessment of Immune Response Capability*
Authors: Warren H. S. , Pembrey R. G.
Published: March 2008

Abstract: Mitogen stimulation of as few as 200,000 human peripheral blood leucocytes (PBL) in 0.2 ml volumes produces highly active lymphokine supernatants. The lymphokine activity measured is T‐cell growth factor. Under optimum conditions of PHA‐P concentration, serum source and concentration, and time, activity is detectable to a dilution of between 1/250 and 1/700 for lymphokine supernatants from PBL of normal donors. Lymphokine supernatants prepared from PBL of donors previously treated with the immuno‐suppressive regimes of radiotherapy and/or chemotherapy had activities that were between 13% and 66% of normal controls. Lymphokine production as a quantitative measure of immune capability is discussed.
Anti‐Digoxin Antibody in Digoxin Intoxication
Authors: Anderson D. , Penny R. , O'Rourker M. F.
Published: March 2008

Abstract: This study was conducted to investigate the action of anti‐digoxin antibody in digoxin intoxication. Anti‐digoxin antibody was raised in sheep and administered to six dogs following intravenous infusion of digoxin (0.04 or 0.16mg/kg body weight), either as whole serum or as partially purified gamma globulin. Plasma and urine digoxin levels, both bound and free, were determined on serial samples. Myocardial samples were analysed for digoxin content. Comparisons were made with six dogs given digoxin but no antibody. The results indicate that anti‐digoxin antibody is effective through inactivation of digoxin in myocardium and removal of digoxin from myocardium into plasma. Loss of digoxin in urine is not responsible for toxicity reversal.
Effect of Naturally Occurring Dietary Fibre in Western Foods on Blood Glucose
Authors: Simpson R. W. , McDonald J. , Wahlqvist M. , Balazs N. , Dunlop M.
Published: March 2008

Abstract: The aim of this study is to evaluate the short term effect of naturally occurring dietary fibre (mainly cellulose and hemicelluloses) in the Western diet on carbohydrate absorption. Two equicaloric test meals were designed, each containing the same amount and types of absorbable carbohydrate and similar proportions of fat and protein. One meal was composed of salad vegetables and apple and the other of simple sugars and starch added to a gelatine and cream cheese base. Thirteen normals and 12 maturity onset diabetics consumed both test meals and neither group showed any reduction in the post‐prandial blood glucose levels or immunoreactive insulin concentrations on the fibre containing meal. Thus naturally occurring dietary fibre in unrefined foods commonly consumed in Australia does not attenuate carbohydrate absorption in short term studies.
Comparison of Ipratropium Bromide and Salbutamol by Aerosolized Solution
Authors: Jenkins C. R. , Chow C. M. , Fisher B. L. , Marlin G. E.
Published: March 2008

Abstract: lpratropium bromide (0,125 mg, 0.25 mg and 0.5 mg) and salbutamol (5 mg) by aerosolized solution produced equivalent peak broncho‐dilatation between one and two hours after administration to ten patients with chronic partially reversible airways obstruction. The duration of action of the two higher doses of ipratropium bromide (0.25 mg—6 hours; 0.5 mg— 5 hours) was significantly greater than salbutamol (4 hours). FVC increases with both drugs and saline were greater than FEV, increases which may indicate dilatation of small peripheral airways or removal of bronchial mucus from these sites after coughing. A dose of 0.25 mg ipratropium bromide as an aerosolised solution is recommended for clinical use.
Radiation Veno‐Occlusive Liver Disease
Authors: Rowland R. , Pieterse A. S. , Kimber R. J. , Ward G.
Published: March 2008

Abstract: Two fatal cases of veno‐occlusive disease (VOD) of the liver following whole‐abdominal irradiation for malignant lymphoma are described. This occurred despite a radiotherapy programme designed to reduce the toxic effect of irradiation to the liver. The clinical picture of rapid weight gain, progressive ascites, jaundice, raised alkaline phos‐phatase and thrombocytopenia following abdominal radiotherapy should alert the clinician to the possibility of irradiation induced VOD.
Prostaglandins, Slow‐reacting Substances (Leukotrienes) and the Lung
Authors: Seale J. P.
Published: March 2008

Abstract: Prostaglandins (PGs) are synthesised from arachidonic acid in human lung tissue and their effects on bronchial smooth muscle have suggested a possible role in the pathogenesis of airflow obstruction in asthmatic subjects, who are exquisitely sensitive to inhalation of PGF2α. More recently it has become evident that the endoperoxides, which are unstable intermediates in the biosynthesis of PGs, may be converted to thromboxane A2 which is more potent than PGF2α in animal experimental models of airflow obstruction. Prostacyclin which is released by the lung into the circulation inhibits platelet aggregation but appears to have minimal effect on broncho‐motor tone. Non‐steroidal anti‐inflammatory drugs such as aspirin and indomethacin prevent the formation of PGs and throm‐boxanes by inhibiting the cyclooxygenase enzyme which converts arachidonic acid to the endoperoxides. The failure of indomethacin to prevent allergen‐induced and exercise‐induced asthma mitigates against a direct involvement of cyclooxygenase products. However experiments with human lung tissue in vitro have shown increased antigen‐induced release of slow‐reacting substance of anapbylaxis (SRS‐A) in the presence of indomethacin. Since SRS‐A is a potent broncho‐constrictor it is possible that an enhanced release of SRS‐A, in subjects pre‐treated with indornethacin, was contributing to their continued bronchoconstriction following antigen or exercise challenge. A similar mechanism may be involved in aspirin‐sensitive asthmatics. The recent discovery that SRS‐A is a lipoxygenase product of arachidonic acid has emphasised the importance of this alternative pathway for the metabolism of arachidonic acid. The structure of SRS‐A has been identified as leukotriene D and chemically pure leukotrienes have been synthesised to enable detailed studies of their role in the patho‐pbysiology of asthma and other lung diseases. It should now be possible to develop leukotriene synthesis inhibitors and receptor antagonists for clinical use.
ADRENOMYELONEUROPATHY–CLINICAL and BIOCHEMICAL DIAGNOSIS
Authors: BERKOVIC S. F. , ZAJAC J. D. , WARBURTON D. J. , MERORY J. R. , FELLENBERG A. J. , POULOS A. , POLLARO A. C.
Published: March 2008

:Adrenomyeloneuropathy (AMN) is an X‐linked storage disease of very‐long‐chain fatty acids that presents as primary adrenocortical failure combined with spastic paraparesis and peripheral neuropathy. This disorder was diagnosed in three unrelated adult males. Definitive diagnosis was made by finding elevated very‐long‐chain fatty acids in plasma and skin biopsy samples. Biochemical characterisation of this disease has elucidated its genetics, clarified its relationship with adrenoleukodystrophy of children and other phenotypic variants, and allowed heterozygote identification, accurate genetic counselling and prenatal diagnosis. (Aust NZ J Med 1983; 13: 594–600.)
INSULIN SECRETORY CAPACITY IN NEWLY DIAGNOSED NON‐INSULIN DEPENDENT DIABETICS
Authors: BARNETT A. H. , LIVESEY J. , SCOTT R. S. , SMITH J.
Published: March 2008

Plasma insulin was measured fasting and after iv glucose in fifteen newly diagnosed non‐grossly obese non‐insulin dependent diabetics. Two‐thirds had normal fasting insulin (< 13 mU/L) and all had sub‐normal responses to iv glucose. There was no significant correlation between fasting or stimulated insulin concentrations and body weight. Six subjects with totally “flat” response to iv glucose were tested after a standard 4MJ meal and after 75 g oral glucose. They now showed normal profiles of later phase insulin release to the meal test or oral glucose and a significant increase in early phase insulin concentration, but this response was still blunted when compared with control subjects.

We conclude that for non‐grossly obese NIDDs (1) insulin deficiency is a common and important disorder and (2) there may be a loss of beta cell sensitivity to blood glucose with retention of sensitivity to gut mediated factors. (Aust NZ J Med 1983; 13: 621–624.)
HUMAN INSULIN1
Authors: LARKINS RICHARD G.
Published: March 2008

Two methods of synthesis of human insulin have been developed to the stage of commercial production. One entails synthesis of human insulin by bacteria (“biosynthetic” human insulin) and one entails the conversion of pork insulin into human insulin by an amino acid substitution (“semisynthetic” human insulin). Both forms of human insulin have been shown to be safe, and to have similar efficacy and pharmacokinetics to purified pork insulin. Human insulin given by subcutaneous injection has been shown to elicit antibody formation in man, although the extent of this may be slightly less than in the case of purified pork insulin, and is certainly less than in the case of beef insulin and beef‐pork combinations. The clinical significance of these differences in immunogenicity is doubtful. However there are rare defined situations, such as allergy to pork insulin and antibody‐mediated insulin resistance where human insulin has been shown to have advantages over purified pork insulin.

Bacterial synthesis of insulin provides an assured supply for the world's future needs, and it is conceivable that further technological refinement may make bacterial synthesis cheaper than extraction and purification of animal insulins. However, current evidence provides no basis for recommending human rather than purified animal insulin for the routine management of insulin dependent diabetes.
APLASTIC ANEMIA IN ASSOCIATION WITH GOLD THERAPY FOR RHEUMATOID ARTHRITIS
Authors: GIBSON J. , McGIRR E. E. , YORK J. , KRONENBERG H.
Published: March 2008

Abstract: Over a ten year period five patients developed aplastic anemia in association with gold therapy for rheumatoid arthritis. None of these patients was suitable for bone marrow transplantation due to the lack of a compatible sibling. Four patients with severe aplastic anemia died, despite intensive haemopoietic support and trials of gold chelating agents. Survival ranged from 22 to 103 days (mean 55 days) with death in each case being due to a combination of bleeding and infection. The remaining patient with moderate aplasia survived, recovering over a period of two to three years.
ASYMPTOMATIC COLONIC CARCINOMA REVEALED BY INVESTIGATION OF STREPTOCOCCUS BOVIS BACTEREMIA
Authors: KEWAL N. , WILKINSON R. K. , SENEVIRATNE B. I. B. , SENEVIRATNE E. M. E.
Published: March 2008

Abstract: A case of bacteremia in a patient with a prosthetic aortic valve is reported. The identification of streptococcus bovis as the causative organism and its known association with gastrointestinal disease led to investigations which revealed carcinoma of the sigmoid colon in an asymptomatic patient. The association of colonic lesions with S. bovis bacteremia is briefly reviewed.
AN INTRODUCTION TO CLINICAL DECISION ANALYSIS: BONE MARROW TRANSPLANTATION FOR APLASTIC ANEMIA
Authors: BUCHANAN J. G.
Published: March 2008

Abstract: Clinical decision analysis is a systematic and rigorously logical approach to medical decision making under conditions of uncertainty. The structuring of a clinical problem in a decision analytic framework enables the clinician to focus on one aspect of a complex decision at a time without losing sight of the whole. The concepts of clinical decision analysis are explained and the technique is applied to compare bone marrow transplantation with supportive care for the treatment of a patient with severe aplastic anemia. The advantages and disadvantages of clinical decision analysis are discussed. The technique is intended to complement, but not replace, clinical judgement.
DIAGNOSTIC CUES IN GASTROENTEROLOGY
Authors: BALLA J. I. , GREENBAUM D. S. , ROTHERT M. L. , BLACK N. A.
Published: March 2008

Abstract: Twenty seven gastroenterologists (15 physicians and 12 surgeons) were studied to capture their policy in the usage and weighting of cues in making a diagnosis. This was a relatively small sample and on account of possible sampling bias only tentative generalisations will be made. Five case vignettes, each consisting of four to eight cues, were used. Subjects were asked to give their percentage likelihood estimates of various diagnostic possibilities after each cue. This gave an indication of their perception of the significance of various cues in relationship to each diagnosis. There were marked variations in cue weighting by these experts, and in particular, most individuals were far off the mean regarding the weighting of certain clinical features, thus displaying idiosyncratic behaviour in these instances. As may be expected, there were differences in disease prevalence estimates between physicians and surgeons. Early information had an overwhelming effect on the final diagnosis. In most cases the expert relied on a few critical cues rather than on a pattern to make a diagnosis.

In view of the strong influences of early diagnostic formulations, these findings confirm the need for doctors to learn to use and collect accurate factual information on prevalence rates and on the most significant critical cues for various disease processes.

The study highlights some of the problems faced by novices in learning from experts who may teach them contradictory information about what are the most significant factors in coming to a diagnosis.
THE VALUE OF THE AUTOPSY IN MEDICAL AUDIT–A COMBINED CLINICAL and PATHOLOGICAL ASSESSMENT OF 100 CASES
Authors: POUNDER D. J. , ROWLAND R. , HOROWITZ M. , REID D. P.
Published: March 2008

Abstract: We retrospectively reviewed 100 consecutive autopsies performed at the Royal Adelaide Hospital in 1979. The review was made jointly by a clinician, surgical pathologist and forensic pathologist. The mean patient age was 64.5 years. Sixteen percent of premortem anatomical diagnoses were not confirmed at autopsy. Autopsy revealed 171 new anatomical diagnoses. Of these, 33 diagnoses in 27 patients were important in relation to the cause of death and if known premortem would have altered therapy and possibly outcome in two patients. In 11 cases the missed major diagnoses should have been entertained on the basis of available clinical data. Of the 19 sudden deaths, the cause of death was not included in the clinical differential diagnosis in seven cases. Autopsy resulted in a substantial change in the death certification of 43 cases. The data indicate that the autopsy has a great deal to offer in correcting clinical diagnoses and effecting scientific discipline for clinicians.
VENTRICULAR STANDSTILL DESPITE NORMAL ELECTROPHYSIOLOGY STUDY: A FURTHER POSSIBLE INDICATION FOR PACING
Authors: TONKIN A. M. , HEDDLE W. F.
Published: March 2008

Abstract: Permanent pacing has usually been indicated for the treatment of organic disease of the sinus node or specific cardiac conducting tissue. We report three patients in whom profound syncope was apparently related to intense, transient autonomic dysfunction. Although ventricular standstill was documented in all three, detailed electrophysiology study, responses to graded Valsalva manoeuvres and carotid sinus massage, and repeated observations after cardiac autonomic blockade by IV atropine (0.03 mg/Kg) and propranolol (0.15 mg/Kg) were essentially normal. Permanent ventricular (VVI) pacing has controlled symptoms in all three, over follow‐up period of 20 to 26 months. These observations suggest that transient autonomic imbalance may be a cause of undiagnosed cardiac syncope. This is neither excluded by normal electrophysiology study nor by normal responses to usual provocative autonomic interventions
SUCCESSFUL TREATMENT OF ACUTE DAPSONE INTOXICATION USING CHARCOAL HEMOPERFUSION
Authors: ENDRE Z. H. , MACDONALD G. J. , CHARLESWORTH J. A. , WOODBRIDGE L.
Published: March 2008

Abstract: A 22 year old female was admitted to hospital two hours after ingesting 4 g of dapsone. Over the next 15 h she developed progressive hemolysis and methemoglobinemia. Charcoal hemoper‐fusion and sequential dialysis were performed because of the serious risk of fatality following such a massive dose of dapsone. Charcoal hemoperfusion led to rapid clearing of dapsone from the circulation. This resulted in clinical improvement and controlled the progression of hemolysis and methemoglobinemia.
RENAL COMPLICATIONS OF CYTOTOXIC THERAPY
Authors: HEALY H. G. , CLARKSON A. R.
Published: March 2008

Abstract: The expanding use of cytotoxic drugs in cancer therapy has resulted in a confusing and increasingly frequent array of severe renal complications. This article reviews the nephrotoxicity and other renal and urological complications of commonly used drugs and the clinical setting in which they are prescribed. Emphasis is placed on the mechanisms, prevention and treatment of renal damage.
CORRELATIONS BETWEEN FIBROBLAST ANDROGEN RECEPTOR LEVELS and CLINICAL FEATURES IN ABNORMAL MALE SEXUAL DIFFERENTIATION and INFERTILITY
Authors: WARNE G. L. , GYORKI S. , RISBRIDGER G. P. , KHALID B. A. K. , FUNDER J. W.
Published: March 2008

Androgen receptor binding of radiolabelled methyltrienolone (3H‐R1881) was determined in cultured genital skin fibroblasts from 17 normal male controls and from 65 males with genital abnormalities. Analysis of the results was performed with patients grouped according to the predominant clinical features. Of 16 patients with complete male pseudohermaphroditism, 12 had androgen receptor (AR) deficiency, one had “receptor‐positive” Testicular Feminization, and in three, alternative diagnoses were established (17ahydroxylase deficiency; 20,22‐desmolase deficiency; mixed gonadal dysgenesis). In contrast, only four of 16 patients investigated for ambiguous genitalia (phallus intermediate between male and female, perineal urethra) showed AR deficiency. Borderline or slightly low AR levels were found in each of four boys in whom the sole abnormality was micropenis. In 26 boys with penile hypospadias, however, only one had low AR. Very low levels of AR (levels comparable to those seen in complete Testicular Feminization) were found in two of three men with infertility associated with abnormally high serum testosterone levels.
TUBERCULOUS PERITONITIS IN CHRONIC RENAL FAILURE MANAGED BY CONTINUOUS AMBULATORY PERITONEAL DIALYSIS
Authors: McKERROW K. J. , NEALE T. J.
Published: March 2008

Continuous ambulatory peritonea! dialysis (CAPD) is being increasingly used to treat chronic renal failure in New Zealand. Peritonitis due in particular to gram positive organisms remains the major complication. Three of 92 CAPD patients trained in the Wellington Renal Unit had tuberculous peritonitis, a previously rarely reported complication. Gram positive or Gram negative bacterial infections preceeded or followed isolation of Mycobacterium tuberculosis. Differential peritoneal fluid leucocyte counts were not predictive of tuberculous infection and total leucocyte counts remained elevated in tuberculous patients treated for other concurrent bacterial peritonitides. Systemic toxicity was not encountered in these patients, symptoms being confined almost entirely to the peritoneum. CAPD was continued during treatment with anti‐tuberculous therapy, in all three patients. However, peritoneal pain on dialysis fluid in‐flow necessitated temporary hemodialysis management in two. Anti‐tuberculous chemoprophylaxis may be prudent in the at‐risk Polynesian patient with chronic renal failure who is being considered for CAPD management.
FINE NEEDLE ASPIRATION CYTOLOGY IN THE MANAGEMENT OF LYMPHOMA
Authors: RUSSELL J. , ORELL S. , SKINNER J. , SESHADRI R.
Published: March 2008

The use of fine needle aspiration (FNA) cytology in the management of patients with lymphadenopathy was investigated. The cases of non‐Hodgkin's lymphoma were classified using the Kiel classification, which is based strictly on cytological criteria. Of the 59 cases of biopsy confirmed lymphoma, FNA of nodes showed lymphoma in 53 (90%), no definite diagnosis in five (8%), and false negative diagnosis in one (2%). During the follow‐up of patients FNA was positive in seven of the eight cases with a suspected recurrence which was later confirmed by lymph node biopsy. Results suggest that FNA is useful on the initial presentation of a patient with lymphadenopathy. If the diagnosis is unequivocal it helps in planning staging procedures and in selecting involved nodes for biopsy. In some cases with intra‐abdominal disease it may obviate laparotomy. However, because false negative diagnoses do occur and because cytological classification of lymphoma is not always accurate FNA should not replace lymph node biopsy at initial presentation, but it can be used as the only investigation to confirm suspected recurrence.
DELTA ASSOCIATED HEPATITIS IN AUSTRALIA
Authors: WILLIAMS G. V. , COSSART Y. E.
Published: March 2008

Hepatitis B associated delta infection was found in Australian born narcotics users, patients with cirrhosis and hepatoma from Italy and Greece and in south east Asian immigrants. About 9% of patients with chronic hepatitis B were found to have intranuclear delta antigen in liver biopsies with immunofluorescence or anti‐delta antibody in serum by radioimmunoassay. Delta may have been imported from southern Europe and Asia and a reservoir of delta infection may exist in narcotics users. Anti‐delta was not found in hemophiliacs despite exposure to hepatitis B.

Delta occurs in Australia and causes acute and particularly chronic hepatitis in addition to that caused by hepatitis B.
FAMILIAL HEPATOCELLULAR CARCINOMA AND HEPATITIS B ANTIGENEMIA IN A NEW ZEALAND CHINESE FAMILY
Authors: SCOBIE B. , WOODFIELD D. G. , FONG R.
Published: March 2008

Primary hepatocellular carcinoma (HCC), is reported in three and probably a fourth member of a New Zealand Chinese family, with a high carrier rate of HBsAg. Hepatitis B virus (HBV) markers and HLA tissue types were analysed in the three generations of the expanded family of 35. Twenty‐one of the three generations were positive for one or more serum HBV markers, including six of the 18 children. Intrafamilial spread of HBV was seen in four of the eight families. Tissue types did not correlate with HBV status. The two propositi of the four with HCC studied and four of six siblings were positive for HBsAg: both propositi had identical HLA haplotypes, including Bw46/DRw9. Evidence is as yet insufficient that this haplotype may represent a disease susceptibility gene for HCC. Other family members at risk will be those positive for HBsAg and/or anti HBC, but those with Bw46/DRw9 will be monitored with special interest.
INTRAVENOUS RANITIDINE HAS NO HEMODYNAMIC EFFECTS IN SUBJECTS WITH NORMAL LUNG FUNCTION AND PATIENTS WITH CHRONIC OBSTRUCTIVE AIRWAY DISEASE
Authors: CHOW J. S. F. , WANG R. Y. C. , WONG P. H. C. , CHEN W. W. C. , LAI C. L.
Published: March 2008

Ten patients with Chronic Obstructive Airway Disease (COAD) and five subjects with duodenal ulcers and normal lung function were given 50 mg ranitidine as a single intravenous bolus injection. Hemodynamic responses were continuously monitored. There were no significant alterations in systemic and pulmonary pressures, systemic and total pulmonary vascular resistances or cardiac output. Continuous ECG recordings did not reveal arrhythmias.

Ranitidine does not appear to cause any significant disturbance of hemodynamic function in COAD patients. This contrasts with alterations in hemodynamics previously observed following administration of cimetidine.
POLYARTERITIS NODOSA AFFECTING THE SPINAL CORD ARTERIES
Authors: OJEDA V. J.
Published: March 2008

Necrotising arteritis was found in the spinal arterial branches of the lumbar spinal cord and in skeletal muscles, bones, peripheral nerves, and most viscera, except lungs and brain, of a 41‐year‐old female who died after a protracted illness finally characterized by severe paralysis due to progressive peripheral neuropathy. Spinal cord vascular involvement in polyarteritis nodosa (PAN) is rarely reported despite the high incidence of neurological complications of this disease.
ORAL MUCOSAL COMPLICATIONS IN CANCER CHEMOTHERAPY
Authors: BARRETT A. P.
Published: March 2008

Complications involving the oropharyngeal mucosa occur commonly in patients receiving chemotherapy for cancer. This communication presents a classification and description of the principal changes encountered, and suggests guidelines for their management.
THE ASSESSMENT OF RESPONSE TO THERAPY OF BONE METASTASES IN BREAST CANCER
Authors: ROSSLEIGH M. A. , LOVEGROVE F. T. A. , REYNOLDS P. M. , BYRNE M. J. , WHITNEY B. P.
Published: March 2008

Serial bone scans, x‐rays and records of bone pain were reviewed in order to determine the relative contributions of these parameters in the assessment of response of bone metastases to treatment. Twenty‐seven patients with abnormal bone scans due to metastatic breast cancer were studied. Ten of the patients showed an early temporary flare on bone scan including five with apparent new lesions. Confirmation that such new lesions did not denote progressive disease was provided by subsequent improvement in symptoms and reduction in intensity and number of lesions on a follow‐up bone scan, without any change in systemic therapy. Serial x‐rays were found to be unreliable as a sole method for assessing response to therapy or disease progression, as in only seven of the 27 patients could a definitive radiological assessment of response be made. In only one patient did x‐rays improve the accuracy of the scan by distinguishing between a healing flare and progressive disease. In contrast, this distinction was made in seven of the 10 patients on the basis of improvement in bone pain at the time of the flare. The other 3 patients had no bone pain prior to therapy or at the time of the flare. Tentative response criteria incorporating bone scan, x‐ray and symptoms are suggested. The criteria incorporate recognition of the fact that new lesions appearing on a bone scan within six months of initiation of therapy may comprise part of a healing flare response.
SERUM ANGIOTENSIN CONVERTING ENZYME IN CROHN'S DISEASE, ULCERATIVE COLITIS AND PEPTIC ULCERATION
Authors: D'ONOFRIO G. M. D. , LEVITT S. , ILETT K. F.
Published: March 2008

Serum angiotensin converting enzyme (ACE) activities were determined in patients with different types of inflammatory disease of the gastrointestinal tract. in patients with peptic ulcer, and in healthy volunteer subjects. ACE activity in serum was measured by its in vitro ability to cleave hippuric acid from the synthetic tripeptide hippuryl‐L‐histidyl‐L‐leucine. The hippuric acid so formed was quantified by high performance liquid chromatography and results are expressed as nmol hippuric acid producedlml plasma/min. ACE activity was 27.4 ± 7.7 (mean ± SD, n = 37) in control subjects and was not related to age or sex. Compared to controls, patients with ulcerative colitis had similar ACE values (26.5 ± 7.7, n = 16) while, surprisingly, there was a significant (p<0.01) increase in the enzyme in those with active peptic ulcers (33.8 ± 8.8, n = 21) irrespective of whether the site of ulceration was gastric or duodenal. In a mixed group of patients with active and inactive Crohn's disease, ACE activity (24.8 ± 7.2, n = 19) was not different from controls. However, ACE activity was significantly (p<0.02) depressed in active Crohn's disease (19.8 ± 7.3, n= 8) compared to either control subjects or patients with inactive disease (28.4 ± 6.3, n = 9). There was wide inter‐patient variability in ACE levels and hence the diagnostic value of random measurements of this enzyme in Crohn's disease is limited.
INTRA‐AORTIC BALLOON ECG ARTEFACT
Authors: ADAMS P. C. , NICHOLSON M. R.
Published: March 2008

Patients undergoing intra‐aortic balloon counter pulsation (IABP) for acute life threatening cardiac disease usually have abnormal electrocardiograms (ECGs) and are prone to arrhythmias and conduction disturbances. We report a patient in whom movement of the electrocardiographic lead to the left leg by the balloon catheter caused artefact simulating a conduction disturbance and arrhythmia.
GUILLAIN‐BARRE SYNDROME AND PEMPHIGUS FOLIACEUS ASSOCIATED WITH D‐PENICILLAMINE THERAPY
Authors: KNEZEVIC W. , MASTAGLIA F. L. , QUINTNER J. , ZILKO P. J.
Published: March 2008

The Guillain‐Barre syndrome and pemphigus foliaceus occurred simultaneously in a patient on long‐term treatment with D‐penicillamine. It is proposed that both conditions may have developed as a result of a disturbance of immunoregulation caused by D‐penicillamine.