bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of 7 and 12 Day Bone Marrow CFUc Culture in Adult Acute Non Lymphoblastic Leukaemia*
Authors: Hill R. S. , Postlewaight B. F. , Blacklock H. A. , Matthews J. R. D.
Published: March 2008

Abstract: Bone marrows from 17 patients with acute non‐lymphoblastic leukaemia (ANLL) were serially cultured on semisolid agar during periods of intensive remission induction chemotherapy and during remission.

Of 12 patients achieving remission, six showed recovery of 7 and 12 day colony forming units (CFUc) culture to normal. However, in four of the six patients, recovery was short‐lived with reappearance of typically leukaemic culture patterns while still in remission by bone marrow and peripheral blood criteria.

In individual patients, serial 7 day cultures frequently showed persisting or recurring leukaemia‐associated patterns while 12 day cultures were normal.

This study confirms the heterogeneity observed in the cultural characteristics of the CFUc in acute non lymphoblastic leukaemia. Bone marrow cultures in patients with ANLL following intensive remission induction chemotherapy appear to provide a more reliable indication of persisting leukaemia or early relapse if they are interpreted earlier at 7 days.
A COMPARISON OF LOW DOSE LEVAMISOLE and PENICILLAMINE IN RHEUMATOID ARTHRITIS
Authors: CLEMENS L. E. , ANSELL B. M. , BERNSTEIN R. M. , HALL M. A. , McCAULEY D.
Published: March 2008

Levamisole (150 mg once weekly) was compared with penicillamine (250 mg daily) in a single blind independent observer study in 28 patients with rheumatoid arthritis over twelve months. Fifty percent (8/16) of patients stopped levamisole, five within three months of starting, while only two of twelve stopped penicillamine. In those patients able to tolerate treatment for twelve months, both regimes produced a significant and comparable reduction in disease activity, with the onset of action of penicillamine occurring at three months compared with six to nine months for levamisole. Radiological progression of disease occurred in both groups.

Levamisole in low dose may improve parameters of disease activity in rheumatoid arthritis but poor patient tolerance, slow onset of action and failure to prevent radiological progression limit its usefulness. (Aust NZ J Med 1983; 13: 578–582.)
RATIONALISATION OF THERAPY IN SEVERE EPILEPSY
Authors: ROMAN E. J. , LAMBERT J. B. , BUCHANAN N. , BARRAH N.
Published: March 2008

Anticonvulsant therapy in 18 institutionalised adult epileptic persons was rationalised.

The mean number of drugs administered was reduced from 3.2 to 2.0 per patient with improvement of seizure control in 11 patients and either no alteration or a mild deterioration of seizure control in seven patients. In this latter group however, there was an improvement in cerebellar signs andlor mentation associated with the reduction in drug therapy. It is proposed that even in patients with apparently severe epilepsy, whilst monotherapy may not be achieved, a significant reduction in the number of medications administered may be. Moreover medication can be effectively administered twice daily. (Aust NZ J Med 1983; 13: 601–604.)
NEUROLOGICAL TOXICITY ASSOCIATED WITH VIDARABINE (ADENINE ARABINOSIDE) THERAPY
Authors: COLLIGNON P. J. , SORRELL T. C.
Published: March 2008

Disorientation, myoclonic jerks, generalised rigidity and tremor developed in a young woman while on treatment with vidarabine for disseminated cutaneous varicella. Residua were still present 11 months later. She had normal renal function and was being treated with relatively low dose vidarabine therapy. A possible drug interaction with allopurinol is described.
DIPHOSPHONATES AND PAINFUL FEET
Authors: EVANS R. A. , MACDONALD D.
Published: March 2008

Abstract: Localised foot pain occurred in four patients with Paget's disease of bone or myositis ossificans who were treated with disodium etidronate (EHDP) in a dose of 10 to 20 mg/kg body weight/day for four to six months. There was localised tenderness and sometimes slight swelling at the painful areas. Bone x‐rays were normal, but bone scans showed increased uptake of the isotope at these areas. The pain persisted for several weeks, causing considerable difficulty in walking. The symptoms were most likely due to diphosphonate‐induced stress fractures. These cases emphasise the importance of administering EHDP in low dosage for short periods only.
A COMPARISON OF “CARRIER SCREENING” OF HEMOPHILIA BY THE RATIO OF FACTOR VIII COAGULANT ACTIVITY OR ANTIGEN TO FACTOR VIII RELATED ANTIGEN
Authors: EKERT H. , DEAN F.
Published: March 2008

Abstract: The ratio of factor VIII coagulant activity (VIIIC) or antigen (VIIICAg) to that of factor VIII related antigen (VIIIRAg) was measured in 15 normals, 21 obligatory and 23 possible carriers of hemophilia. Factor VIII coagulant was measured on fresh plasma samples whereas antigenic properties were measured on frozen and thawed samples. In obligatory carriers only, the mean level of VIIICAg was significantly lower than VIIIC and there was a tendency for low VIIICAg levels to be associated with raised VIIIRAg levels. Using both ratios, 13 obligatory carriers were outside the normal tolerance ellipse. In possible carriers, neither ratio showed superior discriminating power. In reference laboratories that perform carrier studies on stored or transported specimens, measurement of VIIICAg/VIIIRAg is a suitable test for diagnosis of carriers.
CONTINUOUS AMBULATORY PERITONEAL DIALYSIS (CAPD): AN ESTABLISHED TREATMENT FOR ENDSTAGE RENAL FAILURE
Authors: THOMSON N. M. , ATKINS R. C. , HUMPHERY T. J. , AGAR J. McD. , SCOTT D. F.
Published: March 2008

Abstract: This paper is a study of 117 patients with endstage renal failure, treated by continuous ambulatory peritoneal dialysis (CAPD) over periods of 1–56 months. The study has shown CAPD to be an effective form of dialysis with a number of advantages over intermittent peritoneal dialysis and hemodialysis (better control of salt and water status, hypertension and anemia, steady state biochemistry and greater ease of self‐dialysis). Peritoneal clearance and ultrafiltration have remained adequate in all but a few patients. Hypoproteinemia, poor nutrition, obesity and abdominal herniae have been problems in a small percentage of patients. Hyperlipidemia has developed in half the patients but improved with diet. Peritonitis remains the major barrier to the more widespread use of CAPD, although its incidence can be considerably reduced by use of better connectors, bacterial filters and choice of patients.
ADRIAMYCIN COMBINATIONS AS SALVAGE THERAPY IN ADVANCED MOPP‐RESISTANT HODGKIN'S DISEASE
Authors: OLVER I. N. , WOLF M. M. , BISHOP J. F. , DING J. C. , COOPER I. A. , MATTHEWS JANE
Published: March 2008

Thirty one patients with advanced MOPP‐resistant Hodgkin's disease were treated with adriamycin, bleomycin, vinca alkaloid and prednisolone (ABVP). Sixteen patients received vinblastine, seven received vincristine and in eight VM26 was substituted for the vinca. Of 28 patients evaluable for response 17 (61%) achieved an objective response with five (18%) complete responders. Response was significantly inferior in patients receiving VM26. Patients with a prolonged interval since previous chemotherapy had a greater chance of complete response (p<0.02) as did those with previous complete response to MOPP therapy (p<0.05). Response to treatment did not affect overall survival (p= 0.8) although relapse free survival was significantly longer for those achieving complete response (p<0.01). The regimen produced minimal gastrointestinal toxicity, but significant myelosuppression. ABVP is a well tolerated salvage therapy in advanced MOPP‐resistant Hodgkin's disease. (Aust NZ J Med 1983; 13: 369–373.)
HEPATOSPLENIC SCHISTOSOMIASIS IN A SOUTH‐EAST ASIAN REFUGEE CHILD IN SOUTH AUSTRALIA
Authors: SOUTHWOOD T. , DAVIDSON G. P. , PHILLIPS G. E. , RICE M.
Published: March 2008

This report documents a case of hepatosplenic schistosomiasis in a South‐East Asian refugee boy who presented with malaise, abdominal distension, and was found to have massive splenomegaly and esophageal varices. The diagnosis was confirmed by liver biopsy and he was treated with a highly efficacious schistosomicide, Praziquantel. The case highlights the possible occurrence in Australia of non‐endemic tropical diseases in immigrants.
CAUDA EQUINA LESION DUE TO THOROTRAST
Authors: FREILICH D.
Published: March 2008

Thorotrast (Thorium dioxide) has been used in the past as a radiological contrast medium. Its use resulted in serious side‐effects, often after a delay of many years. There was an increased incidence of tumours and blood dyscrasias. Meningeal fibrosis, hydrocephalus and progressive lesions of the cauda equina have followed its injection into the sub‐arachnoid spaces. A patient with such a cauda equina lesion is reported.
COMPUTED TOMOGRAPHY OF INTRAPERITONEAL MALIGNANCY
Authors: EPSTEIN R. J. , OLIVER B. , MACINTOSH P. K. , LEVI J. A.
Published: March 2008

A review of 205 abdominal computed tomographic (CT) scans in 83 patients with gastric or ovarian neoplasms was performed in order to assess their contribution to management. Assessment of scan accuracy was based on results of invasive procedures, clinical data, and double‐blind re‐reporting. Scans appeared to be of greater value in patients with ovarian rather than gastric neoplasms (p< 0.001), and in patients undergoing clinically‐indicated rather than routine scans (p< 0.001). No clinical benefit accrued from the use of pre‐treatment scans. Overall accuracy of scanning was judged to be significantly greater for the ovarian than the gastric group (p< 0.001), while concordance of scan reports with re‐reporting was also greater in the ovarian group (p<0.001). The data indicate the inherent limitations of the CT scan and the high degree of subjectivity in its interpretation, particularly when used in the follow‐up of patients with known or suspected recurrent gastric cancer. CT scanning remains a potentially useful adjunct to clinical assessment of patients with intraperitoneal malignancy, but should not be regarded as obviating the need for clinical judgement in management decisions.
HOW “REPRESENTATIVE” ARE SUBJECTS ATTENDING A CORONARY RISK FACTOR SCREENING PROGRAMME?
Authors: SIMONS L. A. , SIMONS J.
Published: March 2008

Coronary risk factors were compared in two groups of subjects aged 25–64 years. One group voluntarily, and at no cost, attended a risk factor screening clinic (n = 3844), while the second group represented a population sample drawn from the metropolitan Sydney electoral roll (n = 1394). Older subjects were over‐represented in the screening clinic compared with the electoral roll sample. Hypercholesterolemia was more prevalent in the screening clinic in older females, while hypertension and current cigarette smoking were less prevalent in the screening clinic in older subjects of both sexes. Obesity was less prevalent in the screening clinic in older males. A voluntary screening programme may generate a unique and possibly unreproducible population sample.
SUBACUTE HEART RUPTURE AND HEMOPERICARDIUM FOLLOWING ACUTE MYOCARDIAL INFARCTION: REPORT OF SUCCESSFUL TREATMENT AND TEN YEAR FOLLOW‐UP
Authors: WINDSOR H. M. , O'ROURKE M. F. , FENELEY M. P.
Published: March 2008

Hemopericardium complicating acute myocardial infarction generally has a poor prognosis. Two cases of this complication, one due to subacute rupture of the free left ventricular wall, are reported. Both patients are still alive and well ten years after urgent surgical intervention. Good long‐term results are possible in this condition if diagnosis and surgical intervention are not delayed.
FULMINANT HEPATIC FAILURE DUE TO ALLOPURINOL
Authors: RAPER R. , IBELS L. , LAUER C. , BARNES P. , LUNZER M.
Published: March 2008

A 58‐year‐old Chinese woman was admitted to hospital with a presumed hypersensitivity reaction to allopurinol. Her illness was characterised by high fever, eosinophilia, exfoliative dermatitis and jaundice. She developed fulminant hepatic failure and septicemia with a fatal outcome. Clinical details are presented and the possible relationship of allopurinol hypersensitivity to renal impairment is discussed. (Aust NZ J Med 1984; 14: 63–65.)
NEWER ASPECTS OF REGULATION OF HUMAN GRANULOCYTE FUNCTION
Authors: VADAS M. A.
Published: March 2008

The regulation of granulocyte function by cell‐derived factors is emphasised in this review. The most important of these cell‐derived factors belongs to a class of substances known as colony stimulating factors (CSF) so named because they stimulate the maturation of progenitor cells into clumps or “colonies” of mature cells. CSF mediated regulation of granulocytes is likely to be important for the two reasons (i) the site of CSF production can determine the site of granulocyte activation and (ii) the type of CSF produced can determine the type of granulocyte activated. Blood mononuclear cells were found to be a good source of granulocyte activating material suggesting that interaction between these two cell types is important in vivo. The potential clinical use of CSF‐like substances is discussed. (Aust NZ J Med 1984; 14: 71–74.)
ALCOHOL AND ISCHEMIC HEART DISEASE: A REVIEW
Authors: ROHAN T. E.
Published: March 2008

Evidence from epidemiological studies suggests that consumption of alcohol at moderate levels might be protective against IHD. The alcohol‐IHD relationship appears to be U‐shaped, so that the risk of IHD associated with moderate levels of alcohol consumption is lower than that for abstainers and heavy drinkers. However, the effects of alcohol upon the risk of IHD must be examined in the context of its overall effects upon health. When this is done, the potential benefits are not clear‐cut. This paper reviews the epidemiological evidence relating to the alcohol‐IHD association, considers the mechanisms by which alcohol might exert its effects upon IHD risk, and suggests some avenues for future research in this area. (Aust NZ J Med 1984; 14: 75–80).
TRENDS IN ISCHEMIC HEART DISEASE MORTALITY AND MORBIDITY IN PERTH STATISTICAL DIVISION
Authors: HOBBS M. S. T. , HOCKEY R. A. , MARTIN C. A. , ARMSTRONG B. K. , THOMPSON P. L.
Published: March 2008

Trends in mortality from Ischemic Heart Disease (IHD) and other principal causes of death, and in hospital admission rates for Acute Myocardial Infarction (AMI) have been studied in residents aged 35–64 years of the Perth Statistical Division for the period 1968–1982. Death rates were based on data abstracted from official statistics or computer tapes of unit death records. Hospital admission rates were derived from the computer tapes of the Western Australian Hospital Inpatient Survey, 1968–1982.

Since 1968, mortality from IHD has fallen in the Perth Statistical Division in both males and females by 30% and 33%, respectively. This fall has occurred principally in deaths occurring out‐of‐hospital and has been accompanied by similar fails in mortality from other vascular diseases and in total mortality. Hospital admission rates for Acute Myocardial Infarction (AMI) in the Perth Statistical Division have fallen since 1971 by 17% in males and 27% in females. These findings taken together suggest that the improvement in IHD mortality in Western Australia has been due mainly to a fall in the incidence of acute manifestations of IHD (sudden death and AMI), rather than improvements in case fatality. The possible underlying mechanisms responsible for this are discussed.
DIETARY FATS AND BLOOD PRESSURE
Authors: MARGETTS B. M. , BEILIN L. J. , ARMSTRONG B. K. , VANDONGEN R.
Published: March 2008

The blood pressure lowering effect of elevating the dietary polyunsaturatedlsaturated (PIS) ratio has been assessed in a randomised, controlled trial in normotensive volunteers. Subjects were allocated either to a control group who ate a low PIS ratio diet throughout, or to one of two experimental groups who ate a high P/S ratio diet for one of two six week experimental periods. There were significant changes in estimated dietary P/S ratio and measured changes in plasma fatty acids and buccal mucosal cell phospholipids. Changes in blood pressure were not related to changes in P/S ratio. There were no changes in other factors which may have confounded the relationship between blood pressure and PIS ratio change. This study suggests that PIS ratio change, without changing other nutrients, does not affect blood pressure in normotensive subjects.
ALCOHOL AND HYPERTENSION
Authors: ARKWRIGHT P. , BEILIN L. J. , VANDONGEN R. , ARMSTRONG B.K. , MASAREI J. R. L.
Published: March 2008

The nature of the association between alcohol consumption and blood pressure has been studied in 491 working men in Western Australia. The effect of alcohol on systolic blood pressure was seen to be independent of obesity, age, cigarette smoking, coffee or tea consumption, educational attainment or personality type. Ex‐heavy drinkers had similar blood pressures to teetotallers. Men drinking the equivalent of three or more glasses of beer a day had a 10.4% prevalence of hypertension compared with 2.6% in teetotallers while the most introverted tertile of non‐smoking drinkers had a 22% prevalence of hypertension. Possible mechanisms by which repeated alcohol ingestion might lead to hypertension are discussed in the light of hernodynamic and biochemical studies in pairs of drinkers and teetotallers.
TRANSVENOUS ABLATION OF ATRIOVENTRICULAR CONDUCTION FOR REFRACTORY OR MALIGNANT SUPRAVENTRICULAR ARRHYTHMIAS
Authors: DAVIS M. J. E. , MEWS G. C. , COPE G. D.
Published: March 2008

In nine patients with recurrent disabling supraventricular arrhythmia refractory to, or intolerant of, multiple drug combinations, and two patients with Wolff‐Parkinson‐White (WPW) syndrome and documented malignant atrial fibrillation, transvenous ablation of atrioventricular (AV) conduction, utilising synchronised unipolar DC shocks delivered by catheter to the AV node‐His bundle or to the accessory AV pathway, was attempted. One to two 200–300 J discharges produced complete heart block in all of the nine patients, with markedly improved symptomatic status at one to ten month follow‐up including the one patient with recovery of modified AV conduction. Single 100–150 J shocks ablated pre‐excitation for five to fifteen minutes in the two WPW patients without subsequent modification of accessory pathway conduction. There were no complications. This simple technique has great potential and may supplant some open‐heart procedures. With refinement it may be possible to slow rather than to ablate AV‐His conduction, to ablate conduction via accessory AV pathways permanently and to interrupt ventricular re‐entrant circuits.
AUTOIMMUNE THYROID DISEASE AND GIANT CELL ARTERITIS: A REVIEW, CASE REPORT AND EPIDEMIOLOGICAL STUDY
Authors: NICHOLSON G. C. , GUTTERIDGE D. H. , CARROLL W. M. , ARMSTRONG B. K.
Published: March 2008

A 75‐year‐old man with the simultaneous onset of Graves' disease and giant cell arteritis is described. Although there have been few previous reports of simultaneous onset, literature review and a retrospective study of the records of this hospital suggest that the association of Graves' disease and the polymyalgia rheumatica‐giant cell arteritis syndrome is not simple coincidence. The patient's course was complicated by cerebral infarction secondary to either arterial thrombo‐embolism or arteritis.
CONGENITAL HEPATIC FIBROSIS ASSOCIATED WITH MALLORY BODIES AND COPPER RETENTION
Authors: EVANS J. , HARRIS O. , DETH A. G. VAN
Published: March 2008

New observations are described in a case of congenital hepatic fibrosis. Histochemical stains of liver tissue for copper (rhodanine) and copper associated protein (orcein) were positive and hepatic copper concentration, measured by atomic absorption spectroscopy, was markedly elevated being 550 μg/g dry weight (NR <30 μg/g dry weight). Mallory bodies were observed in several areas in liver sections. These observations have not been previously recorded in congenital hepatic fibrosis. Increased hepatic copper concentration in this case may have contributed to the production of liver damage. Hepatic copper concentration should be specifically measured in other patients with congenital hepatic fibrosis.
THE INTERACTIONS OF BODY WEIGHT, AGE, CIGARETTE SMOKING AND HORMONE USAGE WITH BLOOD PRESSURE AND PLASMA LIPIDS IN AN AUSTRALIAN COMMUNITY
Authors: SIMONS L. A. , SIMONS J. , JONES A. S.
Published: March 2008

The predicted variation of blood pressure and plasma lipid levels, based on association with body weight, age, cigarette smoking and oral contraceptive usage, was examined in 47 000 self‐referred subjects who attended a community programme for coronary risk factor screening. In both sexes, blood pressure and plasma lipid (cholesterol and triglyceride) levels were positively correlated with age and body mass index (BMI, kg/m2). Plasma triglyceride concentrations were positively correlated with cigarette smoking. Partial correlation analysis showed age and BMI to be independently correlated with blood pressure and plasma lipids. Plasma cholesterol and triglyceride levels were correlated with each other independently of the effects of age and BMI. Multiple regression analysis showed age to be a more powerful predictor of blood pressure and plasma lipid levels in females than in males, while BMI was a more powerful predictor of blood pressure and plasma lipid levels in males than in females. Current cigarette smoking did not contribute to the prediction of blood pressure or plasma cholesterol level in either sex, but did predict a 10% higher plasma triglyceride level in both sexes. Oral contraceptive usage did not contribute to the prediction of plasma cholesterol level in multiple regression analysis, but did predict higher plasma triglyceride and blood pressure levels. In view of the high prevalence of overweight people in the Australian community, weight reduction would probably be associated with a significant fall in the risk of coronary heart disease, particularly in males.
PEER REVIEW OF UTILISATION OF MEDICAL BEDS AT FLINDERS MEDICAL CENTRE
Authors: POPPLEWELL P. Y. , CHALMERS J. P. , BURNS R. J. , MILLER C. D. J. , MULLINS P. G.
Published: March 2008

A clinical audit of all medical inpatients was undertaken and the appropriateness of admissions and of length of stay was assessed from a clinical viewpoint on 4 separate days within an 11 day period. In addition, the mode of entry to hospital, length of stay of patients, occupancy rate, and the vacancy interval were analysed for all medical patients during the preceding three months.

The mean length of stay of medical patients in hospital during this 3 month period was 5.6 days, with an occupancy rate of 93% and a vacancy interval of 0.43 days. Seventy‐four percent of all medical inpatients were admitted through the Accident and Emergency Department (A&E). The short length of stay, high occupancy rate and low vacancy interval indicated that bed usage in the medical wards was efficient.

A total of 493 reviews was carried out on 294 individual patients. In 87% of cases, both admission to hospital and length of stay were appropriate on clinical grounds alone. The number of patients whose admission to hospital (11), or length of stay (27) was not justified on medical grounds alone was 38 (13% of total patients). These patients were elderly, or had complex social and psychological problems contributing to their illness. It was concluded that stricter control of admissions or length of stay was unlikely to make a significant number of beds available for other admissions.
VENTILATORY CONTROL IN TWO ASTHMATICS RESUSCITATED FROM RESPIRATORY ARREST*
Authors: OLSON L. G. , SAUNDERS N. A.
Published: March 2008

Two female patients revived from fulminant attacks of asthma are described. Ventilatory responses to asphyxia in these patients were 0.70 ± 0.10 I min‐1% SaO2‐1 and 0.64 ± 0.21 I min‐1% SaO2‐1 (mean ± SEM), respectively. These values were significantly less than the responses of seven normal female subjects (1.54 ± 0.11 I min‐1% SaO2‐1 mean ± SEM; p<0.01). Ventilatory responses to hypercapnia of the two patients were in the low normal range. Dopamine‐receptor blockade with prochlorperazine significantly increased the ventilatory response to asphyxia in normal subjects (p<0.05 or less for each subject) but did not alter the depressed responses in the asthmatic patients. In one patient, naloxone in a dose of 400 μg reversed the decreased ventilatory responsiveness; the response to asphyxia was increased from 0.72 I min‐1% SaO‐1 to 1.80 I min‐1% SaO2‐1 (p<0.01) and the response to hypercapnia was increased from 0.90 I min‐1 mmHg‐1 to 4.80 I min‐1 mmHg‐1 (p<0.01). Naloxone had no effect in the second asthmatic patient nor in five normal subjects. Defective chemoreceptor responses to chemical stimuli may play a role in sudden death from asthma; endogenous opioids may mediate this disorder of ventilatory control.
ADVANCED BREAST CANCER: RESPONSE TO HIGH DOSE ORAL MEDROXYPROGESTERONE ACETATE
Authors: HEDLEY D. , DALGLEISH A. , RAGHAVAN D. , TATTERSALL M. H. N. , COATES A. , FOX R.
Published: March 2008

We treated 105 patients with advanced breast cancer, using the progestational agent medroxyprogesterone acetate (MPA), 200 mg orally tds in a non‐randomised trial. In general they were a poor risk population, since 78 had received prior endocrine therapy (21 more than one type) and 58 prior chemotherapy. Treatment was well tolerated. Side effects included weight gain, muscle cramps, fine tremor and fluid retention, but these were usually mild, resolved if the dose of drug was reduced, and only one patient stopped treatment because of toxicity. Seventeen patients died within six weeks of starting MPA, and disease progression occurred in a further 58. Nine have had stable disease for periods ranging from two to 11 months, and there were 21 who showed disease regression. Response to treatment continues in 13 of these patients, and at the time of writing the median duration of response is 10 months. Response rates were similar in pre‐ and post‐menopausal patients.

The dose of MPA was doubled to 400 mg tds in 16 patients whose disease had progressed on 200 mg tds, but no additional responses were seen in this group. Seven out of 24 (29%) patients who had not received prior endocrine therapy responded to high dose oral MPA, a response rate similar to that seen following other hormonal manipulations, but because the drug also has activity against hormone‐resistant tumours and is well tolerated, it should have a role in the treatment of advanced breast cancer.
SERUM AMYLASE, ISOAMYLASE AND LIPASE IN ACUTE ALCOHOLISM
Authors: D'EMDEN M. C. , WONG L. , HARRIS O. D.
Published: March 2008

Hyperamylasemia is found in asymptomatic alcoholics. The aim of this study was to document the incidence of elevations of serum amylase and lipase in asymptomatic alcoholics and to evaluate the contribution of salivary isoamylase to the total serum amylase. One hundred and three patients with acute alcohol withdrawal were studied. Total serum amylase was elevated in 7 patients (6.8%) of whom 4 (57%) showed elevation of salivary isoamylase. Elevated lipase levels were found in 11 patients (10.7%) but correlation of lipase levels with either amylase or isoamylase levels was poor. Thus there was a low but significant incidence of hyperamylasemia which resulted from an elevated salivary isoamylase in the majority of cases. Lipase determination did not assist in defining the origin of the hyperamylasemia and correlated poorly with the other enzymes. It is probably more sensitive than amylase in reflecting the toxic effects of alcohol on the pancreas
CURATIVE TREATMENT OF BLEEDING ESOPHAGEAL VARICES SECONDARY TO A SPLENIC ARTERIO‐VENOUS FISTULA
Authors: CURRAN D. H. , McCAUGHAN G. , WAUGH R. , STEPHEN M.
Published: March 2008

A 59 year old female, who presented with abdominal pain, diarrhea, and ascites, developed major bleeding from esophageal varices. Celiac angiography demonstrated a splenic arterio‐venous fistula with early filling of an enlarged splenic vein and esophageal varices (pre‐sinusoidal extra hepatic portal hypertension). The patient underwent splenectomy and resection of the fistula with resultant disappearance of the varices and presenting symptoms.
CLINICAL EVALUATION OF THE “GTRIOLEIN BREATH TEST: A CRITICAL ANALYSIS
Authors: BUTLER R. N. , GEHLING N. J. , LAWSON M. J. , GRANT A. KERR
Published: March 2008

Twenty‐two hospital patients without gastrointestinal symptoms and fourteen patients with clinically suspected fat malabsorption were studied using the 14C‐Triolein Breath Test and three day fecal fat estimation. The 14C‐Triolein Breath Test was 100% sensitive and 86% specific for fat malabsorption. Three day fecal fat estimations were 86% sensitive and 91% specific. These data confirm the high sensitivity and specificity obtained using the 14C‐Triolein Breath Test. The speed and convenience of the 14C‐Triolein Breath Test plus acceptable sensitivity and specificity make this a practical screening test to detect fat malabsorption.
THE PULMONARY ALVEOLAR MACROPHAGE
Authors: McLENNAN G. , DeYOUNG N.
Published: March 2008

The pulmonary alveolar macrophage (PAM) occupies a unique environment, with exposure to both the atmosphere and the blood stream. This position enables the PAM to perform its primary role of protecting the lung from inhaled, potentially damaging, agents. The effects of long term cigarette smoking on the human PAM appear to be functionally minimal when the cells are studied as a group, but the marked recruitment of PAM's which occurs in smokers leads to a greater potential for PAM helpful and/or damaging activity within the lung. The traditional role of phagocytosis is not a global function of the unstimulated human PAM. Of increasing importance for the understanding of pulmonary disease is the ability of the PAM to modulate lymphocyte, polymorphonuclear leukocyte and fibroblast activity. These functions are primarily for the defence of the lung but often produce temporary or permanent lung damage. Subclassification of the human PAM based upon functional heterogeneity may lead to a better understanding of the role of this cell.
ALVEOLAR TYPE I AND TYPE II CELLS
Authors: WARD H. E. , NICHOLAS T. E.
Published: March 2008

The alveolar epithelium comprises two main cell types: the alveolar type I and alveolar type II cell. The type I cell is a complex branched cell with multiple cytoplasmic plates that are greatly attenuated and relatively devoid of organelles; these plates represent the gas exchange surface in the alveolus. On the other hand, the type II cell acts as the “caretaker” of the alveolar compartment. It responds to damage of the vulnerable type I cell by dividing and acting as a progenitor cell for both type I and type II cells. In addition, it synthesises, stores and releases pulmonary surfactant into the alveolar hypophase, where it acts to optimise conditions for gas exchange.
THE MORPHOGENESIS AND CLASSIFICATION OF DIFFUSE INTERSTITIAL LUNG DISEASES: A CLINCCOPATHOLOGICAL APPROACH, BASED ON TISSUE REACTION PATTERNS
Authors: HENDERSON D. W.
Published: March 2008

This account gives a clinicopathological overview and classification of diffuse interstitial lung diseases, emphasising the interstitial pneumonias. The morphogenesis and progression of fibrosing alveolitis are discussed in relation to the normal cellular and extracellular components of the pulmonary interstitium, with the alveolar macrophage playing a pivotal role. So‐called desquamative interstitial pneumonia is considered to represent an early steroid‐responsive cellular exudative phase of fibrosing alveolitis, most of the intra‐alveolar cells being macrophages rather than type II pneumocytes. The distinction between fibrosing alveolitis and diffuse alveolar damage, and their possible pathogenetic relationships to each other, are also discussed. Throughout this presentation it is stressed that inflammatory interstitial disorders such as the “desquamative” alveolopathies constitute stereotyped patterns of tissue reaction to a variety of injurious agents, which should always be taken into account in reaching a definitive clinicopathological diagnosis, especially in fibreoptic biopsies where histomorphological discriminants may not be present because of the small amount of tissue sampled.
PULMONARY ASBESTOSIS — AN EXAMPLE OF INDUSTRIAL DIFFUSE LUNG DISEASE
Authors: MUSK A. W. , HENDERSON D. W.
Published: March 2008

This account reviews the clinical and pathological features of asbestosis, with a brief comment on the incidence of asbestosis in workers exposed occupationally to Western Australian crocidolite at Wittenoom Gorge. In keeping with common usage, the term “asbestosis” is restricted to pulmonary parenchymal fibrosis — with or without associated visceral pleural fibrosis — related to inhalation of asbestos fibres, thereby excluding parietal pleural fibrous plaques. The mechanisms underlying the development of the interstitial fibrosis are incompletely understood, but they appear to involve complex interactions of asbestos with alveolar macrophages, fibroblasts, lymphocytes and the complement system.
MECHANICAL PROPERTIES OF THE LUNG IN DIFFUSE INTERSTITIAL LUNG DISEASE
Authors: FINUCANE K. E. , PRICHARD M. G.
Published: March 2008

To define the mechanical properties of the lungs in diffuse interstitial lung disease (DILD) the static deflation volume‐pressure (VP) and maximum expiratory flow‐volume characteristics were measured in 18 patients with DILD including 14 with biopsy confirmation.

Elastic recoil, defined by the position of the VP curve, was increased in 12, normal in four and decreased in two patients. The distensibility of inflatable lung, defined by the constant K of a single exponential fitted to the VP data, was decreased in 10 of the 12 with increased recoil and increased in the two with decreased recoil. Those with a normal or increased pulmonary distensibility smoked more than those with decreased distensibility (p<0.05).

Maximum expiratory flow rates (MEFR) were decreased at any elastic recoil pressuce in 12 patients; when corrected for lung size MEFR were decreased in seven patients, six of whom were smokers.

These results show that in DILD a decreased pulmonary distensibility is common but not invariable, that an increased elastic recoil reflects both loss of lung units and decreased distensibility of inflatable units and that an increased flow resistance is common. Co‐existent emphysema could explain a normal or increased pulmonary distensibility in DILD. The increased flow resistance is due in part to fibrosis and loss of lung units with functional loss of the attendant airways. Decreased MEFR, despite correction for lung size, in seven subjects suggests that structural narrowing of airways, due to cigarette smoking andlor bronchiolar involvement by the disease, also contributes to an increased flow resistance in some patients with DILD.
SERUM PANCREATIC ISOAMYLASE ESTIMATION BY THE INHIBITOR METHOD AS A DIAGNOSTIC TEST FOR CHRONIC PANCREATITIS
Authors: TAIT A. D. , MANOLIOS K. , DUNCOMBE V. M. , DAVIS A. E.
Published: March 2008

The diagnosis of chronic pancreatitis is often difficult to establish and may involve invasive diagnostic procedures. Serum pancreatic isoamylase has been estimated by the inhibitor method in controls and in 38 patients with known chronic pancreatitis in order to evaluate its use as a diagnostic test. The mean pancreatic isoamylase in those with chronic pancreatitis (68 ± 77 IU/l) was significantly lower (p <0.005) than in controls (113 ± 60 IU/I). The diagnostic sensitivity of pancreatic isoamylase was 50% (compared to total amylase 9%) and had a specificity of 95%. Stimulation tests with cholecystokinin and secretin failed to increase the sensitivity of the test. A low value of pancreatic isoamylase strongly supports a diagnosis of chronic pancreatitis and may obviate the need for further investigation.
CLOSTRIDIUM DIFFICILE COLITIS
Authors: ROCCA J. M. , PIETERSE A. S. , ROWLAND R. , HECKER R. , RICH G. E.
Published: March 2008

We reviewed all rectal biopsies performed on patients with proven C. difficile infection between 1977 and 1982 (36 patients). All patients were symptomatic and all had received antibiotic treatment recently, the commonest antibiotic treatment being ampicillin or amoxycillin. There was poor correlation between the histological appearances and the severity of symptoms.

A range of histological appearances was observed: normal (8%), congestion and edema (8%), nonspecific colitis (3%), infective colitis (28%) and pseudomembranous colitis (53%) (PMC). Most cases of PMC showed ‘early’ features, involving predominantly the surface epithelium, where attenuation and inflammation, intraepithelial microabscesses, and small eruptive lesions were seen. Recognition of these features, in the context of an acute infective‐type colitis, may lead to early diagnosis of C. difficile colitis.
THE MOLECULAR AND HEMATOLOGICAL HETEROGENEITY OF ALPHA THALASSEMIA
Authors: TRENT R. J. , YAKAS J. , BROCK P. E. , KRONENBERG H.
Published: March 2008

A study of genotypes in ? thalassemia and their corresponding hematological phenotypes has shown that α+ thalassemia is the most frequent type encountered in a Sydney population. Phenotypes of heterozygous α+ thalassemia (αα/−α) in adults or children differ little from normal and so the disorder is difficult to identify. In contrast, Hb Bart's (γ4) is a useful marker for αα/−α in cord blood samples. Abnormal phenotypes are present in homozygous α+ thalassemia (−α/−α), heterozyous α° thalassemia (αα/–) and non‐deletional α thalassemia. Therefore, detection by routine hematological studies should be possible. A less severe phenotype in‐α/‐α compared to αα/—was found which is interesting since 2 α globin genes are lost in both instances.
REVERSIBLE PARASYMPATHETIC DYSAUTONOMIA FOLLOWING STINGING ATTRIBUTED TO THE BOX JELLY FISH (CHIRONEX FLECKERI)
Authors: CHAND R. PRATAP , SELLIAH K.
Published: March 2008

Following a box jelly fish sting, a 52 year old Chinese fisherman developed acute abdominal distension, inability to pass urine and failure of erection.

Examination revealed gaseous abdominal distension and a distended urinary bladder. Absence of lachrimation and absence of changes in the R‐R interval in the ECG during breathing and carotid sinus massage gave further evidence of parasympathetic dysautonomia. The patient made a complete recovery. The case highlights the occurrence of reversible parasympathetic dysautonomia following box jelly fish sting.
ABORIGINAL HEALTH—CURRENT STATUS
Authors: THOMSON N.
Published: March 2008

An analysis of the limited available data confirms that the health status of Australia's Aborigines remains much worse than that of non‐Aboriginal Australians.

Despite significant improvements over the past decade Aboriginal fetal and infant mortality is still approximately three times that of non‐Aborigines. Aboriginal life expectancy remains at least twenty years less than that of the total Australian population.

Levels of Aboriginal hospitalisation have declined markedly, but remain well in excess of overall levels, particularly for infants and children.

For Aborigines, the reduced overall impact of the communicable diseases has been balanced by a worsening of the “lifestyle” diseases, particularly hypertension, coronary heart disease and diabetes mellitus. Alcohol abuse plays an important role in these diseases, and in the level of accidents and violence amongst Aborigines.

The current patterns require a reassessment of Aboriginal health priorities, with more attention being directed at the health problems of Aboriginal adults. Special Aboriginal health programs need to be expanded, and integrated with broad wide‐ranging programs aimed at alleviating Aboriginal social inequality.
NON‐HODGKIN'S LYMPHOMA INVOLVING THE CENTRAL NERVOUS SYSTEM
Authors: WOLF M. M. , COOPER I. A. , OLVER I. N. , LIEW K. H. , DING J C , MADIGAN J P
Published: March 2008

Abstract: :In 44 out of 758 patients (5.8%) with non‐Hodgkin's lymphoma presenting between 1971 and 1982, the central nervous system (CNS) was involved. Patients with a diffuse histology had a 7.6% (34/449) incidence of CNS involvement compared to 3.9% (10/257) for patients with nodular lymphoma. In 63% of patients there was evidence of progressive systemic lymphoma at the time of diagnosis of CNS disease and in 23% CNS relapse occurred in clinical remission. Bone marrow was involved in 34% of patients at diagnosis and in 52% at some time prior to the onset of CNS complications. Cerebrospinal fluid cytology was positive in 63% and an elevated protein level was found in 95% of patients. The median length of survival of the 44 patients was only 3.2 months, but patients who responded to treatment of CNS lymphoma survived significantly longer than those who showed no response or progressed on therapy. Complete response to CNS treatment was achieved in five patients, of whom none relapsed in the CNS and two are long‐term disease‐free survivors. CNS prophylaxis appears justified for patients with lymphoblastic lymphoma, Burkitt's tumour, and diffuse undifferentiated lymphoma, who are at high risk of developing CNS complications. Patients with diffuse histiocytic, and diffuse poorly differentiated lymphocytic, lymphoma who have bone marrow involvement may also benefit from CNS prophylaxis.
A CASE OF HERPES ZOSTER ASSOCIATED ENCEPHALITIS TREATED WITH ACYCLOVIR
Authors: BOWMAN R. V. , LYTHALL D. A. , WYTT C. N. DE
Published: March 2008

Abstract: The case of a 67 year old male who developed severe encephalitis associated with herpes zoster ophthalmicus is described. Encephalitis occurred in the absence of cutaneous dissemination and recovery followed treatment with Acyclovir.
INTRAVENOUS PULSE METHYL PREDNISOLONE IN THE SUCCESSFUL TREATMENT OF SEVERE SARCOID POLYNEUROPATHY WITH PULMONARY INVOLVEMENT
Authors: ALLEN R. K. A. , MERORY J.
Published: March 2008

Abstract: :Severe widespread sarcoid polyneuropathy with associated pulmonary involvement was treated successfully in a 26 year old man using ‘pulse’ methyl prednisolone. After he had failed to respond clinically to a two months course of high‐dose oral prednisolone, a regimen of intravenous methyl prednisolone 1 g once a week for eight weeks was instituted, along with 10 mg prednisolone orally daily. Neurological improvement began after the third dose with complete remission achieved after the eighth week. More than 12 months after cessation of treatment he remains in good health with no clinical or laboratory evidence of sarcoidosis.
PRIMARY HYPOTHYROIDISM AND ESSENTIAL HYPERNATREMIA IN A PATIENT WITH HISTIOCYTOSIS X
Authors: MA J. T. C. , LAM K. S. L. , WANG C. , YEUNG R. T. T. , HO F. C. S.
Published: March 2008

Abstract: :A 27 year old woman with histiocytosis X had an unusual initial presentation with features of primary hypothyroidism and a goitre. Diagnosis was made by lung and thyroid biopsies. Endocrine tests showed the presence of hypopituitarism and a discrete suprasellar mass, consistent with hypothalamic histiocytosis X, was demonstrated by computerised tomography. Radiotherapy and chemotherapy arrested the clinical progression of the disease.
CHARCOAL HEMOPERFUSION TREATMENT OF SEVERE THEOPHYLLINE TOXICITY
Authors: KELLY W. J. W. , PARKIN W. G.
Published: March 2008

Abstract: :A 38 year old man was admitted eight hours after taking ten grams of theophylline. The plasma concentration of theophylline on admission was 732 fjmol/l. In view of the patient's continuing clinical deterioration, charcoal hemoperfusion was undertaken. This led to a rapid fall in plasma theophylline concentrations and improvement in clinical signs. It is suggested that characoal hemoperfusion has a role in the severely theophylline toxic patient in whom standard conservative measures are failing. The patient's hyperglycemia, metabolic acidosis, and hypokalemia are discussed.
ACUTE AND CHRONIC VIRAL HEPATITIS REVISITED†
Authors: SHERLOCK S.
Published: March 2008

Abstract: :Hepatitis A is an acute fecal‐spread disease without chronicity. Gamma immunoglobulin is preventative. Eventually a vaccine will be used for those in developed countries, who have not acquired antibody in childhood.

Hepatitis B is a blood‐borne disease which can lead to chronic hepatitis, cirrhosis, and liver cancer. It is carried worldwide by many millions, especially in South‐East Asia, the Pacific, Africa, and Southern Europe. Australian Aboriginals have a very high carrier rate. It also affects drug abusers, many partner homosexuals, and hospital workers in contact with blood. A safe vaccine is effective and particularly valuable for babies born to carrier mothers. Treatment of chronic hepatitis depends on whether the patient is in the replicative (‘e’ antigen positive) stage, where anti‐viral therapy might be considered, or in the integrated (‘e’ antibody positive) stage where a trial of corticosteroids may be justifiable.

Non‐A, non‐B hepatitis is a diagnosis of exclusion. There is no diagnostic test and no proven therapy. There are probably at least four types, parenteral short and long incubation and enteric sporadic and epidemic.
OPIOID BIOLOGY: THE NEXT SET OF QUESTIONS
Authors: COPOLOV D. L.
Published: March 2008

Abstract: :A range of biologically different opioid peptides are synthesised as components of three distinct precursors, pro‐opiomelanocortin, proenkephalin, and prodynorphin. They interact with a number of receptors which have so far been characterised as mu, delta, kappa, sigma, and epsilon. It is unclear which ligands bind to which receptors under physiological circumstances, but preferential in vitro interactions include enkephalins with delta receptors, dynorphin with kappa receptors, and /?‐endorphin with epsilon receptors. Post‐translational processing determines which of several opioid products are produced from each precursor, but the identity of the enzymes involved and regulation of processing is unknown.

Opioid involvement in the neuroendocrine and cardiovascular systems is reviewed. Naloxone‐sensitive opioid mechanisms are implicated in the control of gonadotrophin and adrenocorticotropic hormone secretion and in the hypotension of various types of shock. The investigation of possible dynorphin involvement in neurohypophysial function is taking place because vasopressin and dynorphin A (1–8) have been shown to coexist in the neurosecretory vesicles of magnocellular neurons.
PLASMA OSTEOCALCIN IN MAN
Authors: MELICK R. A. , FARRUGIA W. , QUELCH K. J.
Published: March 2008

Abstract: A radioimmunoassay for bovine osteocalcin has been developed. Human osteocalcin reacted identically with the bovine standard, allowing the use of this assay to measure human plasma osteocalcin. Levels were determined in 212 healthy subjects (124 men, 88 women) with an age range of 20 to 66 years. The distribution of these was skewed to the right, with the mean being 14.7 ng/ml (range 4 to 40) and the geometric mean 12.2 ng/ml. There was no alteration with age and no difference between males and females. High levels were found in chronic renal failure, Paget's disease of bone, and in primary hyperparathyroidism with severe bone disease, and there was a significant positive correlation of osteocalcin with plasma alkaline phosphatase. Low levels were found in pregnancy. Evidence is presented which suggests that the high levels measured probably reflect intact osteocalcin and not immunoreactive fragments.

Our data are compared with those reported by others. Areas of disagreement are noted and discussed.