bluuebunny/crossref_metadata_2025 huggingface dataset:
Some Observations on the Immunological Status in Scleroderma (Progressive Systemic Sclerosis)
Authors: Barnett A. J. , Cauchi M. N. , Hosking C. S. , Sharp A. H.
Published: March 2008

Summary: Some observations on the immunological status in scleroderma (progressive systemic sclerosis). A. J. Barnett, M. N. Cauchi, C. S. Hosking and A. H. Sharp, Aust. N.Z. J. Med., 1978, 8, pp. 622–627.

A variety of tests were performed to determine the immune status of a group of patients with scleroderma (progressive systemic sclerosis). Sera of 11 of 35 patients showed autoantibodies by an immuno‐fluorescent technique. There was no significant difference between the C3 and C4 components of complement in 12 patients tested and laboratory controls. IgM levels were raised in 24 of 34 sera. Four of ten patients showed some deficiency of phagocytic function in the leucocyte iodination test. B cell and T cell numbers were normal in the eight patients tested. Reactivity to mitogens was usually normal in ten patients tested with a deficient response to one of the three mitogens in two patients. In skin reactivity tests in 23 patients, only one was anergic to all of the four antigens tested. It is concluded that although some immune abnormalities are common in scleroderma there is no consistent abnormality in any of the tests used. This does not exclude the possibility that immune factors may be involved in systemic manifestations of the disease, or that there may be some subtle specific abnormality not revealed by the tests performed.
Carpal Tunnel Syndrome, Diabetes and Pyridoxal
Authors: McCann V. J. , Davis R. E.
Published: March 2008

Summary: Carpal tunnel syndrome, diabetes and pyridoxal. V. J. McCann and R. E. Davis, Aust. N.Z. J. Med, 1978, 8, pp. 638–640.

Serum pyridoxal concentrations were estimated in 13 patients who had both diabetes and carpal tunnel syndrome. The clinical features and response to treatment in these patients did not differ from that seen in non‐diabetic patients with this syndrome. No significant difference in mean serum pyridoxal concentrations was noted between diabetics with carpal tunnel syndrome, diabetics without neuropathy, and normal subjects.

These results indicate that carpal tunnel syndrome in diabetics is distinct from polyneuropathy in that it is not associated with a reduction in serum pyridoxal levels which is a feature of diabetic polyneuropathy.
Histopathology in Giardiasis: A Correlation with Diarrhoea
Authors: Duncombe V. M. , Bolin T. D. , Davis A. E. , Cummins A. G. , Crouch R. L.
Published: March 2008

Summary: There is controversy both in regard to the severity of small bowel mucosal damage attributable to giardiasis and to the causal relationship of these changes to the associated diarrhoea. In this series of 17 consecutive patients with giardiasis, small bowel histology and diarrhoea were independently assessed and compared. Disaccharidase assays were performed in 16 of these patients and a repeat biopsy obtained in seven cases. On histological examination the villous architecture varied from normal to sub‐total villous atrophy. When these changes were compared with the severity of diarrhoea, a direct correlation was obtained, the more severe symptoms being associated with the more severe villous changes. Repeat biopsy after treatment demonstrated improvement in the histology which correlated with improvement in diarrhoea. Lactase activity was low in all patients with moderate or severe diarrhoea as well as in some patients with mild diarrhoea, two of whom had normal histology. This series demonstrates the occurrence of a spectrum of mucosal changes in giardiasis and supports the concept that these changes mediate the diarrhoea associated with this gut parasite.
Serial Exercise Thallium Myocardial Perfusion Scanning and Exercise Electrocardiography in the Diagnosis of Coronary Artery Disease*
Authors: Dunn R. F. , Kelly D. T. , Bailey I. K. , Uren R. , McLaughlin A.
Published: March 2008

Summary: Serial exercise thallium‐201 myocardial perfusion scanning (exercise and 4‐hour redistribution) was compared to rest and exercise electrocardiography (ECG) for the detection of coronary artery disease in 125 patients with known or suspected coronary artery disease. All patients underwent coronary arteriography and 108 were found to have significant coronary artery lesions.

The serial exercise thallium scan was significantly more sensitive than rest and exercise ECG in detecting coronary artery disease (94% v. 83% P <0.01). The sensitivity of a reversible thallium perfusion scan abnormality and a positive exercise ECG for detecting exercise induced myocardial ischaemia in coronary artery disease was similar (69% v. 63%). The exercise thallium scan complemented the exercise EGG, and the sensitivity of the combined test was significantly greater than the exercise ECG alone (84% v. 63% P<0.001).

The specificity for coronary artery disease of the exercise ECG was 65% and that of the exercise thallium‐201 myocardial perfusion scan was 82% (P = NS).

Thallium‐201 myocardial perfusion scanning complements the rest and exercise ECG in the non‐invasive detection of coronary artery disease.
Haemoglobin A1 in Diabetes Mellitus
Authors: Bartley P. C. , Hambling T. E.
Published: March 2008

Summary: Haemoglobin A1 in diabetes mellitus. P. C. Bartley and T. E. Hambling

HbA1 was measured by a rapid method in a routine hospital laboratory. The normal range of 5·0–8·5% compares favourably with other studies. Patients with uncontrolled diabetes had levels of HbA1 of up to 20·5% while well controlled patients had levels of HbA1 in the normal range. The level of HbA1 is relatively stable in normal subjects and does not correlate with age, sex or weight. There was a correlation (p < 0·001) with a 1–2 hour postprandial, post‐insulin blood sugar in insulin dependent diabetics. There was a relationship between type of therapy and HbA1 level at presentation. From the study of two ketoacidotic patients, it is apparent that the level of HbA1 decreases about six weeks after the decrease in blood sugar. It is concluded that the measurement of HbA1 is a useful adjunct in the assessment of diabetic control.
An Outbreak of Acute Methyl Alcohol Intoxication
Authors: Naraqi S. , Dethlefs R. F. , Slobodniuk R. A. , Sairere J. S.
Published: March 2008

Summary: An outbreak of acute methyl alcohol intoxication occurred in Port Moresby, Papua New Guinea, in March 1977. Twenty‐eight young men attended a drinking party and drank methyl alcohol. The amount consumed by each individual ranged from an equivalent of 60–600 ml of pure methanol. Three had prior ethanol ingestion. All 28 became ill 8–36 hours after drinking and were hospitalized. The most commonly observed clinical syndromes were: acute metabolic acidosis, severe visual impairment and acute pancreatitis. Four died within 72 hours after admission to the hospital. All had severe metabolic acidosis and visual impairment and three pancreatitis. Of 24 who recovered, 16 showed no residual complications, six had bi‐lateral visual impairment and two had difficulty in speech as well as visual impairment. A three month follow‐up examination showed no change in the findings. Coma, seizures and prolonged acidosis were poor prognostic signs. The estimated amount of consumed methanol and the rapidity of the appearance of signs of toxicity following methanol ingestion did not seem to influence the outcome of poisoning. The treatment of acute methyl alcohol intoxication in centres where dialysis is not available is discussed.
Acute Non‐lymphocytic Leukaemia in the Third Trimester of Pregnancy
Authors: Manoharan A. , Leyden M. J.
Published: March 2008

Summary: A 28‐year‐old woman with acute myeloblastic leukaemia was effectively treated with cytosine arabinoside and 6‐thioguanine during the third trimester of pregnancy and a complete remission achieved. A normal infant was delivered at term. The patient survived for 27 months and the baby is now 2½ years old with normal physical and mental development.

The literature on management of acute non‐lymphocytic leukaemia during the second and third trimester of pregnancy is reviewed and it is concluded that effective combination chemotherapy improves fetal survival.
Immune Complexes in Diabetes Mellitus
Authors: Charlesworth J. A. , Campbell L. V. , Quin J. , Lazarus L. , Macdonald G. J.
Published: March 2008

Summary: Immune complexes in diabetes mellitus. J. A. Charlesworth, L. V. Campbell, J. Quin, L. Lazarus and G. J. Macdonald, Aust. N.Z. J. Med., 1979, 9, pp. 370–373.

Sera from 86 well controlled diabetics were examined for the presence of immune complexes. Thirty‐six patients were receiving standard insulins, 19 monocomponent preparations, 24 oral hypoglycaemic agents and seven dietary restriction alone. Three methods were used to detect complexes: measurement of complement components, a Clq binding assay (BA) and the Raji cell radioimmunoassay (RIA). Complement components were normal in all patients. Eleven (31%) of the group on standard insulins had a positive Raji cell RIA; none had an abnormal Clq‐BA. One patient on monocomponent therapy had a mildly positive Raji cell RIA; Clq‐BA was negative in each patient of this group. Thirteen (54%) of the patients on oral hypoglycaemic agents were positive on one or both assays while one patient on diet alone was abnormal on both assays. These data show that immune complex production is common in both insulin‐requiring and non‐insulin‐requiring diabetics and that this phenomenon is strikingly less frequent in patients on mono‐component insulins. Such observations could bear relevance to the pathogenesis of microvascular complications in diabetes.
The Cardiovascular System in Paget's Disease of Bone and the Response to Therapy with Calcitonin and Diphosphonate
Authors: Henley J. W. , Croxson R. S. , Ibbertson H. K.
Published: March 2008

Summary: The cardiovascular system in Paget's disease of bone and the response to therapy withcalcitonin and diphosphonate. J. W. Henley, R. S. Croxson and H. K. Ibbertson, Aust. N.Z. J. Med., 1979, 9, pp. 390–397.

The cardiovascular status of 39 patients with Paget's disease of bone was studied before and after treatment with porcine calcitonin or diphosphonate (disodium etidronate).

Cardiovascular abnormalities were detected in 32 patients. Systemic hypertension was present in four, ischaemic heart disease in five, cardiac enlargement in ten and evidence of valvular and/or arterial calcification in 14.

Before treatment the cardiac index was elevated in 27 of 39 patients (69%) and there was a significant direct correlation with the serum alkaline phosphatase (r = 0·68, P < 0·001), urine total hydroxyproline (r = 0·51, P<0·001) and percentage skeletal involvement (r = 0·51, P<0·001). After 24 weeks' treatment with either diphosphonate or calcitonin, there was a fall in cardiac index in 17 of 18 patients; the mean reduction being 12·7% for the calcitonin group and 27% for the diphosphonate treated patients. There was a rise in mean arterial pressure and peripheral resistance in both groups (P< 0·025) and a fall in cardiothoracic ratio (P<0·005) but no change in heart rate.

In 17 patients studied 24 weeks after the end of therapy, similar, though less marked changes were observed. The cardiac index was lower than the pretreatment value in all eight diphosphonate treated patients but cardiac index and biochemical indices were higher than basal levels in three of nine patients who had received calcitonin.

This study confirms a high incidence of cardiovascular complications and an increased cardiac output in most patients with moderate or severe Paget's disease of bone. There was a significant correlation between these abnormalities, the biochemical indices of disease activity and the radiological evidence of skeletal disease.

Treatment with either diphosphonate or calcitonin caused partial or complete biochemical remission and a reduction in cardiac index in most patients studied.
Bundle Branch Block after Myocardial Infarction—A Long Term Follow‐up*
Authors: Woo K. S. , Norris R. M.
Published: March 2008

Summary: Bundle branch block after myocardial infarction‐a long term follow‐up. K. S. Woo and R. M. Norris. Aust. N.Z. J. Med., 1979,9, pp. 411–416.

Fifty‐two patients with myocardial infarction complicated by bundle branch block (27 RBBB and 25 LBBB) survived the hospital period (1967–1972), and were followed up to December 1976. Actuarial survival curves revealed a worse mortality up to five years (P < 0·05) for LBBB (68%) than for RBBB (33%). All deaths occurred in the first four years.

In RBBB, additional hemiblock (seven patients) did not increase the risk of heart block nor worsen the prognosis—one death in seven patients (14%) compared to eight in 20 patients with isolated RBBB (40%).

The previous literature on long term survival of BBB was reviewed. Recommended treatment for BBB, a marker of severe myocardial damage, includes antiarrhythmic prophylaxis for anteroseptal infarction with RBBB, aneurysmectomy in selected subsets of patients, and possibly prevention of RBBB or its complications by treatment for reduction of infaret size during the very early phase after onset of infarction.
Necrotising Enterocolitis Associated with Invasion by Clostridium septicum Complicating Cyclic Neutropaenia
Authors: Bignold L. P. , Harvey H. P. B.
Published: March 2008

Summary: Necrotising enterocolitis associated with invasion by clostridium septicurn complicating cyclic neutropaenia. L. P. Bignold and H P B. Harvey, Ausf. N.Z. J. Med., 1979, 9, pp. 426–429.

A fatal case of necrotising enterocolitis complicating cyclic neutropaenia in a 17‐year‐old boy is reported. The episode of enterocolitis was characterised by fulminant, generalised peritonitis associated with necrosis and gas formation in the wall of the ileum and caecum. Clostridium septicum was grown from pre‐mortem blood cultures and Gram positive bacilli typical of this organism were present in histological sections of the bowel wall. Necrotising enterocolitis in this and previously reported cases of cyclic neutropaenia resembles the agranulocytic form of intestinal necrosis which occasionally complicates leukaemia.
A Study of Synovial Fluid and Cytology in Arthritis Associated with Herpes Zoster
Authors: Cunningham A. L. , Fraser J. R. E. , Clarris B. J. , Hobbs J. B.
Published: March 2008

Summary: A study of synovial fluid and cytology in arthritis associated with herpes zoster. A. L. Cunningham, J. R. E. Fraser, B. J. Clarris and J. B. Hobbs, Aust. N.Z. J. Med., 1979, 9, pp. 440–443.

A case of herpes zoster complicated by acute arthritis with effusions is described. The white cell count in the synovial fluid was low, with a predominance of neutrophils. The synovium showed superficial deposits of fibrin, slight intimal hyperplasia, and subintimal polymorph infiltration. Varicella virus was not detected by culture or electron microscopy, but varicella antigen was demonstrated in the cytoplasm of macrophages in the effusion. Other findings did not determine whether the antigen had appeared in the joint from circulating immune complexes, or following synovial phagocytosis or proliferation of virus.
Inhibitory Epilepsy
Authors: Sinniah D. , Lin H. P. , Loh T. G.
Published: March 2008

Summary: Inhibitory epilepsy. D. Sinniah, H. P. Lin and T. G. Loh, Aust. N.Z. J. Med., 1979, 9, pp. 448–450.

Unlike post‐epileptic paralysis, inhibitory epilepsy is rare and not well known. Differentiation between the two phenomena is usually difficult because both may have associated seizures. A satisfactory physiological explanation has yet to be advanced to account for the paralysis. The present is a report of such a case together with the results of electro‐encephalographic, electromyographic and nerve conduction studies both during and after an attack of paralysis. The results suggest that inhibitory impulses originating from higher centres acting on the upper motor neurone itself leaving the anterior horn cell and possibly the upper motor neurone input to the gamma efferents switched off, are probably responsible for the paralysis.
Crohn's Disease: A Review of 122 Cases
Authors: Selby W. S. , Kater R. M. H. , Heap T. R. , Gallagher N. D.
Published: March 2008

Summary: One‐hundred‐and‐twenty‐two patients with Crohn's disease were admitted to Royal Prince Alfred Hospital from 1966 to 1977. Thirty‐seven had disease confined to small bowel, 37 to colon and 48 had combined small and large bowel involvement. The disease was twice as common in females as in males. Pain was the major symptom in patients with small bowel disease and was associated with diarrhoea if both small and large bowel were involved. Disease confined to the colon most commonly produced diarrhoea with bleeding. Perianal disease occurred more often in patients with colonic disease. Systemic complications were also more frequent in the group with disease confined to colon, and these complications were often multiple. Medical treatment with corticosteroids, salazopyrine or azathioprine, was generally unsuccessful. One in two patients required surgery, usually in the form of resection. Following resection, recurrence occurred in more than one half of the patients but was less frequent in those with colonic disease. Three‐quarters of patients with a recurrence required a further resection, emphasising the unsatisfactory long‐term results of surgery in this disease.
A Comparison of Nontransmural and Transmural MyocardiaI Infarction
Authors: Boxall J. , Saltups A.
Published: March 2008

Summary: A comparison of nontransmural and transmural myocardial infarction. J. Boxall and A. Saltups, Aust. N.Z. J. Med., 1980, 10, pp. 176–179.

This report compares the past history, hospital course and follow‐up of 70 patients with nontransmural myocardial infarction compared to 259 patients with transmural myocardial infarction

The pre‐infarction history in the two groups is similar with respect to angina and infarction. The hospital course for non‐transmural myocardial infarction is not a guide for future cardiac events and the post‐hospital prognosis in the two groups is similar. Nontransmural myocardial infarction has a lower hospital mortality (P<0.05). Patients in whom nontransmural myocardial infarction is a first coronary event have a lower incidence of subsequent angina (P< 0.05).

The study demonstrates that myocardial infarction without development of q waves does not have an unfavourable long term outlook when compared to transmural infarction. This finding is contrary to reports which suggest a poor prognosis and recommend early coronary anteriography with a view to aorto‐coronary bypass in patients with nontransmural infarction
Neuralgic Amyotrophy: Criteria for Diagnosis and a Clinical with Electromyographic Study of 21 Cases
Authors: Devathasan G. , Tong H. I.
Published: March 2008

Summary: Neuralgic amyotrophy: criteria for diagnosis and a clinical with electromyographic study of 21 cases. G. Devathasan and H. I. Tong, Aust. N.Z. J. Med., 1980, 10, pp. 188–191.

Twenty‐one cases of neuralgic amyotrophy referred for diagnosis and for electromyography were studied. The criteria used for diagnosis included pain, wasting and paralysis of shoulder girdle muscles, the absence of a compressive or traumatic lesion, spontaneous full or partial recovery and electromyographic findings of denervation or reduced numbers of functioning motor units of the muscles involved. Pain was usually sudden in onset and preceded paralysis. The commonest muscles involved were the deltoid, supraspinatus, infraspinatus and biceps. Sensory changes were minimal. Recovery was the rule and repeat electromyogram after full clinical recovery was normal. The common diagnostic difficulties were excluding poliomyelitis in children, trauma in adults and cervical spondylosis in the elderly. The atypical manifestations need to be recognised in this condition, the aetiology of which is unknown in the majority of cases
Prospective Angiographic Assessment of Factors Affecting Early Patency of Saphenous Vein‐Coronary Artery Bypass Grafts
Authors: Higginbotham M. , Hunt D. , Stuckey J. , Sloman G.
Published: March 2008

Summary: Between November 1977 and September 1978, early post‐operative angiography was performed in 50 of 53 consecutive patients undergoing coronary artery bypass surgery. An average of 2–4 grafts per patient were applied. The overall patency rate was 82% and was not affected by the degree of proximal native vessel stenosis. Grafts to circumflex marginal vessels had a significantly lower (P < 0·05) patency rate (72%) than grafts to the left anterior descending (84%) and its diagonal branches (85%), or to the right coronary artery (90%). Ten single grafts were applied and all were patent. Forty‐nine of the 50 patients had at least one patent graft. Fifty‐three per cent of the grafts were considered of excellent quality and 25% patent but of fair quality only. There was a 100% patency rate for vessels of 2 mm diameter or more, which is significantly better (P < 0·01) than for vessels of 1–2 mm diameter (78%) or for vessels of less than 1 mm diameter (50%). There was a suggestion of a lower patency rate (74%) for vessels with evidence of distal disease, compared with vessels without such disease (85%). An assessment of the overall quality of the recipient vessel was made, taking both diameter and disease into account. This showed improved results for better quality vessels in terms of graft patency (P < 0·1) and graft quality (P < 0·05).
Cardiac Tamponade: Accurate Diagnosis by Radionuclide Angiography
Authors: Uren R. F. , Mclaughlin A. F. , Cormack J.
Published: March 2008

Summary: This study was performed to define the signs of cardiac tamponade on radionuclide angiography.

The first pass studies were performed on a large field gamma camera, using a bolus of technetium pertechnetate.

Three hundred and seventy‐two studies were analysed. Cardiac tamponade requiring surgical intervention was present at the time in 28 studies

The diagnostic signs of cardiac tamponade on radionuclide angiography were:

(1) Right ventricular compression—sensitivity 82%, specificity 97%, predictive value of a positive result 72%, predictive value of a negative result 99%, and

(2) Right atrial compression—sensitivity 21%, specificity 99%, predictive value of a positive result 75%, predictive value of a negative result 94%.

Cardiac tamponade can be accurately diagnosed on radionuclide angiography and thus indicate those pericardial effusions which require urgent drainage.
The Value of Exercise Electrocardiography and Exercise Thallium‐201 Myocardial Perfusion Scanning in Determining the Presence of Single Vessel Coronary Artery Obstruction
Authors: Dunn R. F. , Freedman B. , Bailey I. K. , Uren R. F. , Kelly D. T.
Published: March 2008

Summary: In 39 patients with single vessel coronary artery disease and no previous myocardial infarction, exercise thallium‐207 myocardial perfusion scanning and 12 lead exercise electrocardiography (ECG) were compared to see how reliably each method identified the site of coronary artery obstruction. Significant (≥ 70% diameter) stenosis was present in the left anterior descending (LAD) coronary artery in 21 patients, in the right coronary artery (RCA) in 14 patients and in the left circumflex (LCX) in four patients. Thallium defects on the scan in the septa1 (SEPT), anteroseptal (ANT SEPT) and anterior (ANT) segments correlated (P < 0.0005) with LAD disease and defects in the inferior (INF), posteroinferior (POST INF), and posterior (POST) segments correlated (P < 0.0005) with RCA or LCX disease. Exercise induced ST segment elevation in VI and/or AVL correlated with LAD disease. The site of ischaemic ST depression did not correlate with disease in any vessel. ST segment depression in leads L2, 3, AVF (67%) and in leads V4–6 (67%) was most sensitive for detecting patients with LAD disease and ST depression in leads V4–6 was most sensitive (56%) for detecting patients with RCA or LCX disease but neither differentiated LAD from RCAILCX disease.

During exercise induced ischaemia, the site of ST segment depression on the 12 lead exercise ECG will not identify the area of ischaemia in patients with single vessel disease but thallium defects will. In contrast to ST depression, ST elevation in V1 and/or AVL may identify LAD stenosis.
RELAPSE OF HERPES SIMPLEX ENCEPHALITIS AFTER ACYCLOVIR THERAPY
Authors: KNEZEVIC W. , CARROLL W. M.
Published: March 2008

Acyclovir is a new and well tolerated anti‐viral agent whose role in the treatment of herpes simplex encephalitis (HSE) is still being evaluated. Although relapse of adenosine arabinoside treated HSE has been documented, this paper describes the recurrence of encephalitis after treatment with the recommended course of Acyclovir. A more extended course of Acyclovir produced a rapid and sustained improvement with minimal residual neurological deficit. We emphasise the need for more prolonged treatment and an awareness of the possibility of relapse when using Acyclovir for HSE.
MULTIPLE MYELOMA WITH RENAL FAILURE A CASE FOR INTENSIVE TREATMENT
Authors: HARRIS D. C. H. , IBELS L. S. , RAVICH R. B. M. , ISBISTER J. P. , WELLS J. V.
Published: March 2008

Abstract: A series of nine consecutive patients with multiple myeloma and renal failure is presented. All patients were treated with urinary alkalinisation with sodium bicarbonate and/or acetazolamide, diuresis with saline, mannitol and/or furosemide, pulse melphalan and prednisone and, where indicated, allopurinol and aluminium hydroxide. A substantial and sustained improvement in renal function has been achieved in all nine patients. Of five patients with a urea more than 25 mmol/L at presentation, the median survival to date is 64 weeks. Of these patients only one has died – not from renal failure but pneumonia, eighteen months after presentation. The others are alive and well. The results confirm the effectiveness of these measures in both improving renal function and prolonging survival, and suggest a more optimistic prognosis for patients with multiple myeloma and renal failure.
M‐MODE ECHOCARDIOGRAPHY: REPRODUCIBILITY OF SERIAL LEFT VENTRICULAR MEASUREMENTS IN SUBJECTS WITH NORMAL VENTRICLES and PATIENTS WITH CONGESTIVE CARDIOMYOPATHY
Authors: MACMAHON S. W. , HICKEY A. J. , WILCKEN D. E. L.
Published: March 2008

Abstract: Serial measurements of left ventricular short axis dimensions were made to determine reproducibility in ten normal subjects and in ten patients with congestive cardiomyopathy without asynergic wall motion, conduction abnormalities, or arrhythmias, three echocardiograms were performed over a period of three weeks in each subject. In the congestive cardiomyopathy group, mean coefficients of variation for diastolic and systolic left ventricular dimensions (LVIDd, LVIDs) and fractional shortening (FS) were 3.5%, 4.3% and 10.3% respectively. In the normal subjects they were slightly less; LVIDd (2.2%), LVIDs (3.1 %) and FS (8.0%) but the difference was not statistically significant. Coefficients of variation for calculated diastolic and systolic volumes in the normal ventricle group (Teichholz formula) were 5.0% and 7.1% respectively and for ejection fraction, stroke volume and cardiac output 5.8%, 9.8% and 11.8%.

The results demonstrate that M‐mode echocardiography is a reliable technique for serial quantitative studies of left ventricular dimensions in both normal subjects, and in selected patients with congestive cardiomyopathy. M‐mode echocardiography may be used to assess the responses of patient groups but not of individual patients to interventions which change ventricular volume and cardiac output in subjects with normal left ventricles in whom good quality endocardial echoes are recorded.
COMPLEMENT ALLOTYPING IN SLE: ASSOCIATION WITH C4A NULL
Authors: CHRISTIANSEN F. T. , DAWKINS R. L. , UKO G. , McCLUSKEY J. , KAY P. H. , ZILKO P. J.
Published: March 2008

Abstract: Immunogenetic factors are important in systemic lupus erythematosus (SLE) and deficiency of a number of complement components is often associated with a lupuslike illness. The complement components Bf, C2 and C4 are encoded within the human major histocompatibility complex (MHC) and are polymorphic. A study of HLA and Bf and C4 polymorphism in 43 patients with SLE was undertaken firstly, to determine whether partial deficiency of C2 and C4 may predispose to disease and secondly, because it may allow the better definition of important supratypes associated with the disease and which may include the relevant disease gene(s).

An increased frequency of C4A null alleles has been shown in SLE, with a minimal estimated C4A null gene frequency of 0.32 versus 0.20, but no case of partial C2 deficiency was identified. These results may indicate a direct role for partial C4 deficiency or that C4A null may be a marker for an important supratype which includes the relevant disease gene(s).
CEREBROVASCULAR DISEASE IN WESTERN AUSTRALIA: AN ANALYSIS OF STROKE TYPE and ASSOCIATED RISK FACTORS
Authors: THOMPSON P. D.
Published: March 2008

Abstract: The stroke types and major risk factors in 356 patients with cerebrovascular disease were examined. Large artery thrombosis accounted for 53% of strokes, cerebral embolism for 22%, lacunes for 14% and intracerebral hemorrhage for 11%. Hypertension, detected in two‐thirds of patients, was the major risk factor. The sex distribution varied with age, the major change being an increase in the number of females affected in older age groups. The extent of systemic vascular disease was greatest in patients with thrombo‐embolic infarction.
INTRAVENOUS METHYLPREDNISOLONE PULSE THERAPY IN MINIMAL CHANGE NEPHROTIC SYNDROME
Authors: YEUNG C. K. , WONG K. L. , NG W. L.
Published: March 2008

The effectiveness of intravenous methylprednisolone pulses in 20 mg/kg/day for three consecutive days was compared with a more conventional oral prednisone regime in inducing remission in adult patients presenting with first episodes of minimal change nephrotic syndrome. Methylprednisolone was significantly less effective and failed to induce remission in six of nine patients within two weeks of treatment, while the oral prednisone regime was uniformly effective in all eight patients within five weeks. Of the six non‐responders to methylprednisolone five subsequently remitted with oral prednisone, and one with cyclophosphamide. Except for one patient in the oral prednisone group who had acute gastritis with bleeding, no serious side‐effect was seen with either treatment regimes.
SEROTYPES IN PNEUMOCOCCAL DISEASE A TEN YEAR STUDY IN AUSTRALIA 1970 THROUGH 1979
Authors: HANSMAN D.
Published: March 2008

During the ten year period 1970 through 1979, pneumococci from 1205 episodes of pneumococcal disease affecting children and adults in Australia were studied. These included 188 cases of bacteremic pneumonia (85% in adults), 103 cases of primary bacteremia (50% adults), 201 cases of meningitis (69% children), 13 cases of osteomyelitis and/or arthritis, and 13 cases of peritonitis. Otitis media (403 cases), conjunctivitis and sinusitis were predominant amongst 672 localised infections. Of 36 serotypes of pneumococci met with, the leading types were 19, 14, 6, 3 and 9: type 14 predominated in children with primary bacteremia, bacteremic pneumonia or meningitis, type 9 in adults with bacteremic pneumonia, and types 3 and 7 in adults with meningitis. In otitis media types 19 and 3 predominated, in conjunctivitis types 19 and 6, and in sinusitis types 6 and 19. For bacteremic and meningeal infections the current (United States) vaccine provides 83% cover, deletion of the rare (in Australia) types 2, 12 and 25 and the substitution of types 11,15 and 33 would increase cover by 5% to 88%.
ACUTE NONSPECIFIC CARDITIS WITH ADVANCED HEART BLOCK IN MALAYSIANS
Authors: CHIN K. , SINGHAM K. T. , ANUAR M.
Published: March 2008

Acute nonspecific carditis with advanced heart block is rare. We observed nine cases with complete heart block and one with Mobitz type II block over an eight and a half year period. Temporary cardiac pacing was instituted in all while permanent pacing was required in six patients. No death was recorded.
EMPYEMA DUE TO BETA‐LACTAMASE‐PRODUCING H. INFLUENZAE TYPE b COMPLICATING SEVERE LARYNGO‐PHARYNGITIS and CERVICAL CELLULITIS
Authors: ALLEN R. K. A. , FAULKS L. W.
Published: March 2008

A 70‐year‐old woman presented to hospital with an acute life‐threatening cervical cellulitis and laryngopharyngitis followed by pneumonia. Despite a month's treatment with intravenous antibiotics including cephamandole she developed a bacteremic empyema due to a beta‐lactamase producing H. influenzae. Subsequent treatment with chloramphenicol and surgical drainage was curative. The same pathogen was later isolated from her grandson's throat. Chloramphenicol is recommended as the drug of choice in such cases.
TYPE 1 HYPERLIPOPROTEINEMIA PRESENTING AS SUDDEN DEATH IN INFANCY
Authors: POTTER J. M. , HILTON J. M. N.
Published: March 2008

A routine post‐mortem investigating sudden death in an eight week old male infant revealed gross Type I hyperlipoproteinemia (triglyceride concentration 825 mmol/L). Death was attributed to generalized cerebral anoxia. Study of the family revealed the parents were first cousins both of whom had depressed postheparin lipolytic activity, as did five out of seven of the remainder of the family members tested. This family is a notable example of deficiency of extrahepatic lipoprotein lipase.
MORPHOLOGICAL AND BIOCHEMICAL CONFIRMATION OF GRAY PLATELET SYNDROME IN TWO SIBLINGS
Authors: BERNDT M. C. , CASTALDI P. A. , GORDON S. , HALLEY H. , McPHERSON V. J.
Published: March 2008

A case report is presented of Gray Platelet syndrome in siblings. The absence of platelet α‐granules in these patients was confirmed by electron microscopy and by analysis of the platelet protein profile using SDS‐polyacrylamide gel electrophoresis. This was further confirmed by quantitation of individual α‐granule protein constituents. The results in these two patients are compared with those of the four reported patients with this syndrome.
SERUM LIPID AND APOLIPOPROTEIN A AND B LEVELS IN FAMILIAL HYPERCHOLESTEROLEMIA
Authors: CRAIG I. H. , POULIS P. , HILL G.
Published: March 2008

Serum lipid and apolipoprotein A (apo A) and B (apo B) levels were studied in a family with familial hypercholesterolemia (FH), which comprised two heterozygous parents, five heterozygous children, one homozygote and one normal child. Lipid levels were compared with those of age‐ and sex‐matched normal controls.

All subjects with FH had total serum cholesterol and low density lipoprotein‐cholesterol (LDL‐C) levels greater than the 90th percentile value for the reference range. High density lipoprotein‐cholesterol (HDL‐C) levels were less than the corresponding 13th percentile in heterozygous subjects. The homozygous child had grossly elevated levels of LDL‐C and apo B, and very low levels of HDL‐C and apo A.

The most powerful discriminating variable between normal, heterozygous and homozygous family members was the LDL‐C/HDL‐C ratio.
AMIODARONE THERAPY FOR LIFE THREATENING OR REFRACTORY CARDIAC ARRHYTHMIAS
Authors: JOHNS J. A. , FEDERMAN J. , HARPER R. W. , ANDERSON S. T. , CURRIE P. J. , PITT A.
Published: March 2008

Amiodarone was used in 40 patients with life‐threatening or refractory tachyarrhythmias. Eighteen patients had recurrent ventricular tachycardia of whom 13 had suffered a cardiac arrest. Control has been excellent or good in 17 of these 18 patients during an average follow‐up period of 10 months. A further 22 patients had supraventricular arrhythmias, including three with Wolff‐Parkinson‐White syndrome and paroxysmal atrial fibrillation. In 20 of these control has been excellent or good. The mean daily maintenance dose of amiodarone was 300 mg for patients with ventricular tachyarrhythmias and 200 mg for those with supraventricular tachyarrhythmias. Side‐effects were common and included corneal microdeposits, skin rash and discolouration, alteration in thyroid function, and symptomatic bradycardia. Serious adverse effects were uncommon however and necessitated discontinuation of the drug in only two patients. Amiodarone did not appear to precipitate or exacerbate cardiac failure in any patient although many had severe left ventricular dysfunction. We conclude that amiodarone is effective in the therapy of life‐threatening or refractory cardiac arrhythmias.
DECLINING MORTALITY RATES FROM ISCHEMIC HEART DISEASE IN AUSTRALIA
Authors: LEEDER S. R. , GIBBERD R. W. , DOBSON A. J. , LLOYD D. M.
Published: March 2008

Ischemic heart disease is the major cause of death in Australia. Australian attack and mortality rates from this disease are high compared with most other countries. Over the last thirty years there have been remarkable changes in heart disease death rates which rose from the 1950's until around 1965–7 and then declined by about 40% over the period 1965–7 to 1980–81. Although the pattern of this decline was similar for most age groups and both sexes it varied among subgroups of the population defined by country of birth, geographic region and occupation. For example, Australian‐born men initially had higher death rates than immigrants and they experienced relatively greater declines; Perth and Adelaide (with low initial rates) had similar declines to Sydney and Brisbane (with high rates); professionals (with the lowest rates) had the greatest decline among occupational groups.

While the decline in mortality is encouraging the cause is still unclear so control programmes must proceed, to some extent, by guesswork. If the subpopulations with high mortality can achieve rates comparable with subpopulations with low rates further substantial decline in heart disease mortality is possible.
VEGETARIAN DIETS, LIPIDS AND CARDIOVASCULAR RISK
Authors: MASAREI J. R. L. , ROUSE I. L. , LYNCH W. J. , ROBERTSON K. , VANDONGEN R. , BEILIN L. J.
Published: March 2008

Vegetarian diets produce moderate but appreciable changes in serum lipid levels. A six‐weeg intervention study in which other aspects of life‐style were kept constant showed that levels of total cholesterol, LDL‐cholesterol and HDL‐cholesterol fell 0.22, 0.19 and 0.07 mmol/l, respectively, while triglyceride levels increased non‐significantly 0.12 mmol/l. The ratio of total cholesterol to HDL‐cholesterol did not change. A comparison of grous of habitual vegetarians and omnivores matched for other aspects of lifestyle showed rather larger differences in atherogenic lipid levels: 0.71 and 0.67 mmol/l for total— and LDL—cholesterol; the difference in HDL‐C levels was 0.04 mmol/l; triglyceride was 0.19 mmol/l greater in vegetarians. 92% of the variation in intakes of major nutrients was accounted for by three derived factors; changes in levels of most of the lipids were associated in each case with one of the factors. The resultant falls in the levels of total‐and LDL‐cholesterol in people adopting a vegetarian diet probably contribute to a reduction in cardiovascular risk.
MULTIPLE RISK FACTOR INTERVENTION IN CARDIOVASCULAR DISEASE
Authors: MAGNUS P.
Published: March 2008

This paper describes multiple risk factor intervention, its rationale and the form it takes, referring to recent intervention trials and the issues arising from their approaches and outcomes. Some questions relevant to intervention are raised and some guesses made as to future directions and opportunities.
DIAGNOSIS AND MANAGEMENT OF ACUTE MYOCARDITIS AIDED BY SERIAL MYOCARDIAL BIOPSY
Authors: FENELEY M. P. , GAVAGHAN T. P. , RALSTON M. , HICKIE J. B. , BARON D. W.
Published: March 2008

Two cases in which right ventricular endomyocardial biopsy established a definitive pathologic diagnosis of acute myocarditis are presented. Both patients presented with severe left ventricular dysfunction, atrial flutter and an intraventricular conduction defect. lmmunofluorescent and immunoperoxidase examination of the biopsy specimens suggested a humoral immune mechanism in one case and a cell‐mediated immune mechanism in the other. Substantial improvement in cardiac function followed treatment with prednisolone and azathioprine in both cases. Significant regression of the myocardial inflammatory changes was documented by a further endomyocardial biopsy in each case following clinical improvement.
FAMILIAL DEFICIENCY OF ANTITHROMBIN 111: EVIDENCE FOR HETEROGENEITY EXISTING WITHIN THE FAMILY
Authors: D'SOUZA S. , EKERT H.
Published: March 2008

An Australian family with familial antithrombin Ill (AT III) deficiency is described. The deficiency inherited in an autosomal co‐dominant manner is characterised by proportionate reduction in antigenically and biologically measured AT III. Some members with AT Ill deficiency have had major venous thromboses, and the deficiency has possibly been the cause of death in two individuals in the family. Heterogeneity was observed in laboratory and clinical findings in this family.
ACUTE EPlGLOTTlTlS IN CHILDHOOD: REPORT OF AN INCREASED INCIDENCE IN VICTORIA
Authors: SLY P. D. , LANDAU L. I. , WAGENER J. S.
Published: March 2008

The incidence of acute epiglottitis treated in Melbourne, Australia at the Royal Children's Hospital (RCH) has increased from an average of 14 cases per year during 1975–79 to 49 cases per year during 1980–81. Less marked increases have occurred for H. influenzae meningitis and bacteremia and H. influenzae(untyped) isolation from respiratory tract cultures. A review of 171 cases of acute epiglottitis showed no significant differences between the 1975–79 and 1980–81 patients with respect to sex, age, seasonal incidence, prodromal length, prodromal symptoms, geographical location, polymorpho‐nuclear cell count, or disease severity. Patients treated in 1980–81 had fewer complications (12% versus 22%, p<0.02), and a shorter hospital stay (3.0 versus3.3 days, p<0.003). The increased incidence of H. influenzaetype b infections may be due to an increased bacterial presence within our community.
THE EFFECT OF DIHYDROERGOTAMINE ON VENOUS DISTENSIBILITY AND BLOOD PRESSURE IN IDIOPATHIC ORTHOSTATIC HYPOTENSION
Authors: BELLAMY G. R. , HUNYOR S. N.
Published: March 2008

We report a case of severe idiopathic orthostatic hypotension (IOH) documented by direct, continuous, ambulatory blood pressure monitoring. Failure of vasoconstriction and more significantly of venoconstriction in response to upright posture was demonstrated, indicating an autonomic nervous system disorder. The venoconstrictive agent dihydroergotamine (DHE) had little effect in preventing a fall in forearm venous tone with head up tilting but caused a recumbent pressor response leading to side effects. These were noted at a time of low plasma DHE levels indicating denervation hypersensitivity. Difficulties may arise in using DHE to treat severe cases of IOH who have denervation hypersensitivity.
EXTRADURAL CHLOROMA WITH SPINAL COMPRESSION—AN UNUSUAL PRESENTATION OF ACUTE MYELOGENOUS LEUKEMIA
Authors: KELLIE S. J. , WATERS K. D.
Published: March 2008

Chloromas are solid tumours resulting from the localised proliferation of myelogenous leukemia cells, and are frequently responsible for the initial manifestations of acute myelocytic leukemia. We report a patient with a thoracic extradural chloroma whose presentation with acute paraplegia led to the diagnosis of an unsuspected myelocytic leukemia. Early recognition of the etiology of the paraplegia and the underlying systemic involvement with leukemia resulted in an excellent neurological and hematological outcome. The previously described association of the 8:21 chromosomal translocation with a good prognosis is noted in our patient.
LUNG FUNCTION IN DIFFUSE INTERSTITIAL LUNG DISEASE OF UNKNOWN CAUSE
Authors: FINUCANE K. E. , PRICHARD M. G.
Published: March 2008

To examine the role of lung function tests in diagnosis and management of patients with diffuse interstitial lung disease (DILD) we measured total lung capacity (TLC), gas transfer (Tl), lung distensibility and arterial saturation (SaO2) and ventilation during progressive exercise in 24 patients with DILD including 18 with biopsy confirmation. Tl was decreased in all patients, in 21/24 there was progressive hypoxia with exercise, in 12/24 TLC was > 80% predicted and in 6/18 lung distensibility was normal. Tl and the change of SaO2 with work output during exercise were highly correlated (r= ‐ 0.65, p< 0.001). In serial studies, the change of SaO2 with work output altered most with clinical improvement or deterioration. The clinical course and response to treatment was not related to a particular pattern of abnormal function.

These results and those of previous studies indicate that in DILD the most sensitive index of abnormal parenchymal function is Tl, that lung volumes and distensibility may be normal so that the term “restrictive lung disease” can be misleading, that the fall of SaO2 with work output and TI are the most sensitive parameters for assessing severity and following the course of the disease and that lung function alone does not predict outcome.
EXERCISE TESTING IN THE EVALUATION OF DIFFUSE INTERSTITIAL LUNG DISEASE
Authors: ANDERSON S. D. , BYE P. T. P.
Published: March 2008

The cardio‐pulmonary response to incremental and steady‐state bicycte exercise was measured in a group of 22 patients with diffuse interstitial lung disease (DILD). In most patients the lung volumes were less than 80% of their predicted normal value. In 19 patients the uptake of carbon monoxide was less than 60% of the value predicted for the observed lung volume.

Maximum working capacity (wmax) was reduced in 20 patients. Eight patients stopped exercising before they achieved their predicted maximum heart rate. In all patients ventilation (VE) was increased in relation to oxygen consumption. The increase in VE resulted from an increased frequency of breathing.

Exercise induced a decrease in arterial oxygen tension in 11 patients. When 60% oxygen was inspired during exercise the endurance time at 80% Wmax increased from 8.0 ± 5.5 to 13.9 ± 8.7 min. The increase in endurance time related to the extent of desaturation during exercise with air breathing. Oxygen breathing did not improve Wmax.

We conclude that exercise testing in patients with DILD is useful for determining the severity of disease and provides additional information in relation to gas exchange.
PYOGENIC LIVER ABSCESS—A NEGLECTED DIAGNOSIS
Authors: SANDFORD N. L. , BRADBEAR R. A. , POWELL L. W.
Published: March 2008

Twenty‐five patients with pyogenic liver abscess admitted to the Royal Brisbane Hospital between 1970 and 1982 have been reviewed. The mortality rate was 32%; however, all patients who were diagnosed before death survived. In seven patients there was a history of biliary obstruction or biliary surgery of whom six died. The mean age of the patients who died was significantly higher than those surviving and it is suggested that this resulted from overdiagnosis of malignancy in the elderly, some hesitancy in investigating older patients, and a tendency to attribute multiple space‐filling defects to metastatic tumour. If liver biopsy or even exploratory laparotomy have failed to confirm the diagnosis of hepatic abscess the clinician should not discard the possibility. It is concluded that the continuing high mortality from liver abscess is in large part due to lack of clinical awareness and failure in diagnosis rather than to inadequate therapy.
ZINC CONTENT OF RED AND WHITE BLOOD CELLS IN ABORIGINAL CHILDREN
Authors: CHEEK D. B. , HAY H. J. , LATTANZIO L. , NESS D. , LUDWIGSEN N. , SPARGO R.
Published: March 2008

Studies were carried out on erythrocyte, granulocyte and lymphocyte zinc content of aboriginal children at the La Grange settlement in the north‐west area of the Kimberley. Forty‐eight children, 34 boys and 14 girls between 6 and 13 years were studied. Only the boys were investigated for white blood cell (WBC) zinc. Twenty‐five Caucasian children volunteered to give blood for control studies. Two approaches were made concerning zinc analyses, atomic absorption spectroscopy and proton induced x‐ray emission.

It was found that lymphocyte, granulocyte and erythrocyte zinc content were significantly reduced in aboriginal boys aged 6 to 13 years. Since the turnover of white blood cells is relatively fast, it follows that the zinc content of these cells may be a true index of current zinc status confirming previous observations.