bluuebunny/crossref_metadata_2025 huggingface dataset:
LIFE THREATENING CARDIAC TAMPONADE COMPLICATING A CASE OF SERONEGATIVE RHEUMATOID ARTHRITIS
Authors: SMITH M. D. , ROBERTS‐THOMSON P. J. , GEDDES R.
Published: March 2008

We report the complication of cardiac tamponade occurring secondary to a pericardial effusion in a patient with persistently seronegative rheumatoid arthritis. The frequency and presenting features of this potentially life threatening complication of rheumatoid arthritis are reviewed and management of this complication is discussed.
A FATAL CASE OF LEGIONNAIRES‘ DISEASE IN AN IMMUNOCOMPROMISED PATIENT
Authors: WILSON R. D. , McPETRIE R. A. , PRITCHARD R. C.
Published: March 2008

A 65‐year‐old woman presented with an autoimmune hemolytic anemia and was subsequently diagnosed as having malignant lymphoma. Cytotoxic chemotherapy was followed by the development of fatal Legionnaires' disease, confirmed by isolation of L. pneumophila serogroup 6 from pleural and lung aspirate specimens. This is believed to be the first reported isolation of serogroup 6 L. pneumophila in Australia. (Aust NZ J Med 1984; 14: 59–60.)
FATAL VENO‐OCCLUSIVE DISEASE OF THE LIVER ASSOCIATED WITH HERBAL TEA CONSUMPTION AND RADIATION
Authors: FEIGEN M.
Published: March 2008

A case is presented of fatal veno‐occlusive disease of the liver in a patient undergoing treatment by whole abdomen irradiation for carcinoma of the ovary. She had also been exposed to herbal tea and chemotherapy, each of which may cause veno‐occlusive disease in its own right. Interaction of these agents is postulated and should be considered before submitting patients to combination treatment. (Aust NZ J Med 1984; 14: 61–62.)
INTERNATIONAL TRENDS IN CARDIOVASCULAR DISEASE— IMPLICATIONS FOR PREVENTION AND TREATMENT*
Authors: ROSE G.
Published: March 2008

Stroke mortality is declining fast in many countries (this decline being due, in part, to treatment), with implications for medical care and for coronary disease incidence, but in some European countries rates are rising. Coronary mortality is decreasing fast in some countries, probably because of a fall in incidence; dietary and other life‐style changes are likely to be involved, but lack of systematic monitoring inhibits firm conclusions. In other countries with comparable medical care the rates have not declined, and in eastern Europe and sections of developing populations they are rising fast. Some implications are discussed.
SMOKING WITHDRAWAL PROGRAMME: BASELINE INDICATORS OF SMOKING EXPOSURE AND BIOCHEMICAL MONITORING OF SUCCESSFUL OUTCOME
Authors: PUDDEY I. B. , VANDONGEN R. , BEILIN L. J. , UKICH A. W. , ENGLISH D. R.
Published: March 2008

Sixty‐four subjects Who participated in a smoking withdrawal programme were analysed with respect to the relative usefulness of biochemical and hematological indices of smoking exposure. Plasma thiocyanate was found to be the best biochemical correlate of baseline cigarette consumption when compared to salivary thiocyanate or expired air carbon monoxide. Both plasma and salivary thiocyanate also correlated significantly with depth of inhalation per cigarette but not with any other questionnaire index of smoking exposure. After six weeks of successful smoking cessation all three indices fell significantly. Plasma thiocyanate proved the most sensitive biochemical index for monitoring ultimate outcome, accurately dichotomizing 90% of subjects as successful or unsuccessful in their attempts to stop smoking. The use of all three variables allowed accurate classification of 96% of subjects. White cell count, red cell count and hemoglobin also correlated significantly with baseline cigarette consumption and a significant decrease in these hematological indices occurred consequent to successful smoking cessation. However, these hematological changes were not as sensitive as biochemical indices in monitoring successful outcome.
PRE‐HOSPITAL EMERGENCY CARE: EVALUATION OF AN AUSTRALIAN SYSTEM
Authors: BJORKLÜND P. , O'ROURKE M. F.
Published: March 2008

The efficacy of the Sydney ambulance paramedic service in dealing with out‐of‐hospital cardiac and other emergencies was examined. The outcome of 182 cases (from a total of 1,799 casualty calls) treated by a paramedic service was compared with the outcome of 104 similar cases (from a total of 2,376 calls) treated by a general duties service. There were 33 cases of cardiac arrest in the general duties group; resuscitation was attempted in 12 and none survived. There were 49 cases of cardiac arrest in the paramedic group; resuscitation was attempted in 21 cases and 4 survived. There were 35 cases of suspected myocardial infarction in the general duties group; 7 died compared with 58 cases and 4 deaths, in the paramedic group (mortality 20%, cf. 7%; difference not significant). The increased cost of a paramedic call, less than half of an entire hospital day, appears justified by better results.
BETA‐BLOCKERS AFTER MYOCARDIAL INFARCTION
Authors: ROSE G.
Published: March 2008

Excellent recent trials have demonstrated beyond reasonable doubt that beta‐blockade started during convalescence from confirmed myocardial infarction reduces mortality in the next year or two by about a quarter. Similar confidence does not extend to the mechanisms of action, choice of drug, defining treatment criteria in relation to severity and age, or to the duration of treatment.
THE FALL IN MORTALITY FROM ISCHEMIC HEART DISEASE IN AUSTRALIA: HAS SURVIVAL AFTER MYOCARDIAL INFARCTION IMPROVED?
Authors: MARTIN C. A. , HOBBS M. S. T. , ARMSTRONG B. K.
Published: March 2008

Trends in mortality and survival after myocardial infarction (MI) were studied by use of computerised death and hospital discharge records for 25 to 64 year old residents of the Perth Statistical Division between 1971 and 1979. Highly significant falls in ischemic heart disease (IHD) mortality rates were found for men (18%) and women (29%) but 4, 26 and 52 week survival after hospital admission for MI remained constant at around 88%, 84% and 81% respectively. Further, as 75% of all IHD deaths between 1971 and 1979 occurred before the victim was admitted to hospital, the survival of those receiving treatment would have had to be greatly improved to influence total mortality from IHD appreciably.

As the age and sex composition of persons hospitalised for MI and the proportion of MI victims hospitalised did not change during the study period it would seem that improved survival after hospital admission for MI did not contribute to the fall in IHD deaths between 1971 and 1979.
DIETARY MODIFICATION OF PLATELET AND RENAL PROSTAGLANDINS
Authors: CROFT K. D. , BEILIN L. J. , MAHONEY D. P. , VANDONGEN R. , CODDE J. P.
Published: March 2008

The effects of specific types of dietary fats on prostanoid biosynthesis, platelet function and the cardiovascular system are reviewed. Studies examining the influence of dietary modification of prostanoid synthesis on blood pressure regulation in normotensive and Goldblatt hypertensive rats showed that while dietary supplementation with either sunflower or linseed oil at 40% of energy respectively stimulated and inhibited tissue prostanoids in virro and urinary PGE2 excretion in vivo, the development of 1 kidney, 1 clip hypertension was not altered in parallel. Rats on both oil rich diets did however, show an average lower blood pressure than animals on a standard diet. In order to minimise possible non‐specific effects of large amounts of dietary fats, the effects on prostanoid metabolism of different oils at 5, 20 and 40% of energy in the diet were studied. While as little as 5% dietary supplements alter fatty acid and prostanoid synthesis in platelets, it appears that higher levels (at least 20%) are required to alter significantly renal prostaglandin metabolism.
GENETIC, FAMILIAL AND RACIAL INFLUENCES ON BLOOD PRESSURE CONTROL SYSTEMS IN MAN
Authors: GRIM C. E. , LUFT F. C. , WEINBERGER M. H. , MILLER J. Z. , ROSE R. J. , CHRISTIAN J. C.
Published: March 2008

This paper reviews investigations by the Indiana University Medical Centre Hypertension Research Centre into genetic influences on blood pressure control systems in man. Our studies have used the families of adult identical twins to partition the relationships of age, sex and body size to the genetic contribution to blood pressure variability.

These studies provide little evidence for environmental influence on the familial aggregation of blood pressure and suggest that at least 63% of the variability is due to genetic factors. Studies on the renin‐angiotensin‐aldosterone system and on the kidney's ability to excrete sodium were also undertaken in identical and fraternal twins, as well as in black and white subjects, and provided unequivocal evidence of genetic control. Studies in first degree relatives of patients with essential hypertension have demonstrated higher plasma renin levels and a decreased ability to excrete a sodium load when compared to first degree relatives of normotensive subjects. Blacks in the U.S.A. have a decreased ability to excrete a sodium load and a greater rise in blood pressure with sodium loading than do whites.

We suggest that the heritability of blood pressure is directly related to a genetic influence on the level of renin and that this increase in renin level results in subtle increases in angiotensin II. These chronic elevations of angiotensin II directly increase blood pressure and decrease the kidney's ability to excrete sodium by either a direct renal effect or indirectly by stimulating aldosterone‐dependent sodium retention.
A COMPARISON OF INTRAVENOUS AND INTRACORONARY STREPTOKINASE IN ACUTE MYOCARDIAL INFARCTION
Authors: WOOLLARD K. V. , MEWS G. C. , COPE G. D. , CUMPSTON N. , IRELAND M. A. , DAVIS M. J. E. , BLACK A. J. , TAYLOR R. R.
Published: March 2008

A randomised study of intravenous and intracoronary streptokinase therapy was carried out in 20 subjects with acute myocardial infarction and angiographically confirmed complete obstruction of the associated coronary artery. Two dose levels of therapy were used. Although more recanalisations occurred with intracoronary than intravenous therapy at the low dose levels, overall there was not a significant difference between the two groups; one million IU intravenously over 20 minutes recanalised four of five arteries. While seven of nine recanalisations with intracoronary therapy occurred within an hour, only two of five with intravenous therapy did so. Hence prolonged angiographic observation is necessary to document recanalisation with intravenous therapy adequately. Nevertheless, the time disadvantage of large dose intravenous therapy is not great and it may yet prove as effective as, and more practical than, intracoronary therapy.
RELATIONSHIPS BETWEEN PHYSICAL FITNESS AND RISK FACTORS FOR CORONARY HEART DISEASE IN MEN AND WOMEN
Authors: SEDGWICK A. W. , DAVIDSON A. H. , TAPLIN R. E. , THOMAS D. W.
Published: March 2008

The aim of the study was to examine the cross‐sectional relationships between physical fitness and risk factors for coronary heart disease (CHD). Measurements were made of fitness (defined as predicted maximal oxygen uptake), blood pressure, total cholesterol, triglycerides, and glucose in 1500 healthy men and women aged 20 to 65 years. After controlling for the effects of age, physique, smoking, alcohol use and stress, by multiple regression analyses, it was found that fitter men had lower blood pressure, cholesterol, and triglycerides than less fit men, and fitter women had lower blood pressure than less fit women. However, these fitness/risk factor relationships were seen as weak trends, probably of minor clinical importance. It is emphasised that such cross‐sectional data should not be interpreted as support for the popular claim that people who increase their fitness can expect to improve their CHD risk factor status.
HYPOFIBRINOGENEMIA DUE TO INCREASED FIBRINOLYSIS IN TWO PATIENTS WITH ACUTE PROMYELOCYTIC LEUKEMIA
Authors: CHAN T. K. , CHAN G. T. C. , CHAN VIVIAN
Published: March 2008

Two patients with acute promyelocytic leukemia and severe bleeding associated with hypofibrinogenemia were studied. The markedly shortened whole blood clot lysis time and dilute clot lysis time suggested that the defect was an increase in fibrinolysis. Although disseminated intravascular coagulation could not be totally excluded as an alternative mechanism, excessive fibrinolysis was confirmed as the pathogenic cause by the prompt response to the administration of tranexamic acid. The low circulating plasminogen, α2 plasmin inhibitor level and the presence of α2 plasmin inhibitor‐protease complex in both patients suggested that the increased fibrinolysis probably resulted from the liberation of plasminogen activator from the promyelocyte.
HYPOGLYCEMIC EPISODES DURING CONTINUOUS SUBCUTANEOUS INSULIN INFUSION: DECREASED FREQUENCY BUT INCREASED SUSCEPTIBILITY
Authors: CHISHOLM D. J. , KRAEGEN E. W. , HEWETT M. J.
Published: March 2008

There has been concern regarding the susceptibility of patients on continuous subcutaneous insulin infusion (CSII) to hypoglycemic episodes. This study has examined glycemic control, the frequency of hypoglycemic reactions and the counterregulatory response to an IV insulin infusion of 2.4 units per hour in five brittle insulin‐dependent diabetics before and during CSII.

CSll was associated with a significant reduction in glycosylated hemoglobin, standard deviation of blood glucose estimations and daily insulin dosage. The frequency of symptomatic hypoglycemic reactions was reduced (mean 14/4 weeks pre CSII, 5/4 weeks post CSII, p<0.05). However, after CSll the IV insulin infusion caused a more rapid fall in blood glucose from the physiological to the hypoglycemic range while growth hormone and cortisol responses were both reduced (p<0.05) and the deficient glucagon response was not improved.

Thus, although the frequency of reported hypoglycemic reactions was reduced by CSII, susceptibility to hypoglycemia due to excess insulin delivery was enhanced, owing to increased insulin sensitivity and/or additional impairment of the counterregulatory response.
RADIOLOGICALLY‐GUIDED PERCUTANEOUS FINE NEEDLE ASPIRATION BIOPSIES OF ABDOMINAL AND OSSEOUS LESIONS
Authors: PHILIPS J. , WAUGH R. , NG A. B. P.
Published: March 2008

The indications, technique, complications and results of radiologically‐guided percutaneous fine needle aspiration biopsy (FNAB) of abdominal and osseous sites performed over a four and a half year period at an Australian tertiary referral hospital are presented. FNAB provided a positive tissue diagnosis for malignancy in 79% of osseous and 78% of abdominal lesions with no false positive diagnoses in either series. Particular problems encountered and the methods employed to overcome them are discussed.
ALTERNATING SKEW DEVIATION ASSOCIATED WITH MANDRAX OVERDOSAGE
Authors: PAN H. Y. M. , HUANG C. Y.
Published: March 2008

Alternating skew deviation has been described in patients with pretectum and mesodiencephalon lesions. Total external ophthalmoplegia has been reported in patients consequent to oral or intravenous administration of diphenylhydantoin and amitriptyline. This case report presents a patient with alternating skew deviation as a result of Mandrax ingestion.
CONGENITAL ANEURYSM OF THE LEFT ATRIUM: DIAGNOSIS AND MANAGEMENT
Authors: ROBINSON P. J. , NEUTZE J. M. , BRANDT P. W. T. , HILL D. G. , ANDERSON R. J. , RUTLAND M. D.
Published: March 2008

A case of congenital aneurysm of the left atrial appendage is presented and previously reported cases are reviewed. The diagnosis can be strongly suspected with the combination of an unusually prominent left heart border in the chest X‐ray and two‐dimensional echocardiographic findings of a large echo‐free space close to the left atrium. The site of communication must be defined accurately and cardiac catheterisation and angiocardiography should usually be performed. Once the diagnosis is confirmed, surgery is indicated even in the asymptomatic patient because of the risk of systemic embolism.
TWO PATIENTS WITH ABNORMALITIES OF REGIONAL SYMPATHETIC NERVOUS TONE
Authors: O'HEHIR R. , ESLER M. , JENNINGS G. , LEONARD P. , LITTLE P. , JOHNS J. , PANETTA F.
Published: March 2008

The traditional biochemical tests of sympathetic nervous system function used in clinical diagnosis (urine and plasma catecholamine measurements) are indices of “overall” sympathetic nervous activity, and incapable of detecting localised changes in sympathetic tone confined to individual organs. Recently developed radiotracer methods, which enable the pattern of sympathetic nervous dysfunction in disease states to be delineated, were used to detect abnormalities in regional sympathetic nervous system activity in two patients presenting problems in management. In one, the abnormality of sympathetic function was iatrogenic, a post‐sympathectomy denervation of the lower regions of the body, associated with incapacitating postural hypotension. In the other, unexplained persistent sinus tachycardia proved to be due to an increase in sympathetic nervous tone restricted to the innervation of the heart. Knowledge of the underlying sympathetic nervous pathophysiology in these patients influenced the choice of drugs subsequently used in their treatment.
DETERMINANTS OF PATIENT COMPLIANCE, CONTROL, PRESENCE OF COMPLICATIONS, AND HANDICAP IN NON‐INSULIN‐DEPENDENT DIABETES
Authors: PETERSON G. M. , McLEAN S. , SENATOR G. B.
Published: March 2008

Factors affecting patient compliance with diet and medication, clinical control, complications, and handicap were studied in 114 subjects with non‐insulin‐dependent diabetes mellitus who were attending a hospital diabetic clinic. Compliance with diet and hypoglycemic medication was correlated. The perceived importance, and the ease of compliance were the principal correlates of patient compliance. Factors independently related to diabetic control were compliance with diet, and the quality of the patient's diet. Diabetes which was poorly controlled, and which was of several‐years' standing, was more likely to involve complications. Both poor control and the presence of complications contributed to handicap. Increased dietary education and counselling, with emphasis placed on the importance and benefits of compliance with prescribed diets, may improve control, decrease the incidence of complications, and ultimately minimise handicap due to diabetes in non‐insulin‐dependent patients.
ABNORMAL T‐CELL SUBPOPULATIONS IN HEMOPHILIC PATIENTS RECEIVING FACTOR Vlll CONCENTRATES FROM VOLUNTARY DONORS
Authors: WEARNE A. , JOSHUA D. E. , RICKARD K. A. , KRONENBERG H.
Published: March 2008

Recently, Acquired Immune Deficiency Syndrome (AIDS) has been reported in hemophiliacs in the USA, Canada and Spain, and this has caused considerable concern amongst hemophiliacs regarding the use of factor Vlll concentrates. The aim of this study was to determine whether hemophiliacs in Australia have T‐lymphocyte subpopulation changes similar to those observed in patients with AIDS. Factor Vlll produced in Australia is derived from a totally volunteer blood donor system and none of the hemophiliacs in this study had received commercial blood products.

For the hemophiliacs, the T‐helper cell to T‐suppressor cell ratio was 1.1±0.6 (mean ± SD) which was significantly less (p<0.001) than that of the normal age and sex‐matched controls. There was a significant relative (p < 0.001) and absolute (p < 0.05) reduction of the helper cell subsets and a significant relative (p< 0.001) and absolute (p<0.05) increase of the suppressor cell subsets, in the hemophiliacs compared to the normal controls. There appears to be no correlation between the amount of factor Vlll therapy received during the last three years and the T‐cell subset changes. All patients with Christmas disease had T‐cell subsets within the normal range. All patients were negative for the hepatitis B virus antigen, but all were positive for the antibody, indicating that there had been exposure to the hepatitis virus in all cases. Cytomegalovirus titres were uniformly low and immunoglobulin levels were normal.

These findings have been reported from many centres and in view of the absence of the other criteria for AIDS in our hemophiliacs, may only reflect a response to chronic antigenic stimulation. It is of interest that factor IX preparations do not seem to have this effect.
THE CHRONIC AND SEVERE FORMS OF EOSINOPHILIC MENINGITIS
Authors: REID I. R. , WALLIS W. E.
Published: March 2008

Two cases of chronic eosinophilic meningitis (presumed to be due to Angiostrongylus cantonen‐sis) and a third patient with a severe form of this disease are described. Such cases are rare in the published literature. All patients developed their illness in Western Samoa, an area previously thought to be free of the disease. The need to consider eosinophilic meningitis in patients with chronic and severe neurological disease who live in, or have recently come from, endemic areas is emphasised.
ADULT RESPIRATORY DISTRESS SYNDROME: MECHANISMS OF LUNG INJURY*
Authors: SAUNDERS N. A.
Published: March 2008

Lung injury in the adult respiratory distress syndrome (ARDS) may be mediated through a variety of mechanisms and may involve the interaction of a number of systems involved in the inflammatory reaction — complement, granulocytes, prostaglandins and platelets. Studies in animals, involving the infusion of endotoxin, have produced convincing evidence that these agents can cause pulmonary vascular injury and a syndrome resembling human ARDS. Direct evidence of these pathogenic mechanisms in man is lacking, however, but some suggestive clues have emerged in the last few years that support this general scheme.

Secondary lung injury through inappropriate fluid administration, sepsis, oxygen toxicity and barotrauma is potentially avoidable. Improved understanding of the pathophysiology of ARDS and improved hemodynamic monitoring should allow minimising of fluid administration and positive end‐expiratory pressure in the management of these patients without dangerous impairment of cardiac output. Such an approach, combined with the avoidance of colloid in the early stages of the disease, and the use of vasoactive agents to support cardiac output if necessary, should minimise edema formation and barotrauma and maximise tissue oxygenation. Pulmonary sepsis continues to play an important role in ARDS. Patients are frequently infected after the initial pulmonary injury; such patients have a far worse prognosis than those who are not infected. Until ways are established at a cellular level to minimise colonisation of the upper respiratory tract, reliance must be placed on avoidance of cross infection by strict personal hygiene, avoidance of prophylactic antibiotics, and prompt, vigorous treatment of suspected pulmonary infection.
HYPERBARIC OXYGEN THERAPY FOR PYODERMA GANGRENOSUM
Authors: HENG M. C. Y.
Published: March 2008

Hyperbaric oxygen administered systemically has been advocated in the treatment of pyoderma gangrenosum. Owing to the serious potential risks of oxygen toxicity with systemic administration, we have devised a simplified technique for the administration of hyperbaric oxygen topically, and have used this method successfully to treat two patients with pyoderma gangrenosum, in whom the underlying etiology was not apparent, and specific therapy, therefore, not possible. The abundant formation of granulation tissue and the ability of the hyperbaric oxygen to arrest further extension of the ulceration suggests that this form of therapy might become the treatment of choice for all ulcers of the pyoderma gangrenosum type.
RESPIRATORY SYMPTOMS IN TASMANIAN ADOLESCENTS: A FOLLOW UP OF THE 1961 BIRTH COHORT
Authors: GILES G. G. , LICKISS N. , GIBSON H. B. , SHAW K.
Published: March 2008

The 1961 birth cohort of Tasmanians (n= 8410) was initially surveyed in 1968 and was followed up in 1974 for the history and presence of respiratory symptoms and signs. The study was designed to describe and compare the natural histories of wheeze and productive cough. In 1981 a 10% stratified random sample of the original cohort was again followed up and this sample's responses were compared across the three surveys. Wheezing was found to be more persistent than productive cough. Wheezers were twice as likely as coughers to persist with their symptoms to the age of 20. These persistent wheezers represented 3.6% of the cohort available for follow‐up in 1974 (n= 7132). Wheezing was also invariably associated with decreased spirometric performance, particularly FEV at 0.5 s and FEF 25–75. The new wheezers first detected in 1974 had had significantly decreased spirometry measurements in 1968 compared to those of their coughing or symptom‐free peers. An early history of cough was associated with triple the incidence of wheeze in previously asymptomatic children. Hayfever and eczema were associated with persistence of wheeze. A child with either of these diagnoses was four times as likely to persist in wheezing to the age of twenty than a wheezer without atopic complaint. No significant associations could be demonstrated between wheezing and smoking.
“LONG‐TERM” SURVIVAL IN LIGHT‐CHAIN MYELOMA WITH DIALYSIS THERAPY ALONE
Authors: BOYCE N. W. , HOLDSWORTH S. R. , THOMSON N. M. , ATKINS R. C.
Published: March 2008

We report a case of a 59 year old woman who presented in end‐stage renal failure with lambda (A) light‐chain myeloma (LLCM). Despite a large tumour burden, and refusal to accept cytotoxic chemotherapy, she was commenced on continuous ambulatory peritoneal dialysis (CAPO). With dialysis therapy alone she has shown considerable hematological improvement and remains well 18 months after diagnosis. The extremely poor prognosis attributed to light‐chain myeloma is largely due to death from uremia. As the natural history of this disease in patients offered dialysis therapy is unknown, dialysis should not automatically be withheld from patients with LLCM.
ULTRASOUND IN THE ASSESSMENT OF SYNOVIAL THICKENING IN THE HEMOPHILIC KNEE
Authors: WYLD P. J. , DAWSON K. P. , CHISHOLM R. J.
Published: March 2008

Two patients with severe hemophilic arthropathy of the knee were studied using ultrasound. Post‐operative confirmation of the ultrasound findings is presented. The possible role of ultrasound in the assessment and management of joint disease in hemophilia is discussed.
McARDLE'S DISEASE PRESENTING WITH RHABDOMYOLYSIS
Authors: HAINS A. D. B. , PANNALL P. R. , BOURNE A. J. , CAREY W. F. , DISNEY A. P. S. , BLACK A. B. , ALBERTYN L. A.
Published: March 2008

A patient with McArdle's disease is described who presented with rhabdomyolysis following severe exertion. An episode of acute renal failure four years earlier was probably secondary to a combination of myoglobinuria and an intravenous contrast agent.
LOW DOSE CYTARABINE IN ACUTE NON‐LYMPHOBLASTIC LEUKEMIA OR MYELODYSPLASTIC SYNDROME: REPORT OF SIX CASES AND REVIEW OF THE LITERATURE
Authors: VINCENT P. C. , BUCK M. , YOUNG G. A. R. , BENSON W. J.
Published: March 2008

Abstract: :Low dose cytarabine (10 mg m‐2,12 hourly by subcutaneous injection) was used to treat four patients with acute non‐lymphoblastic leukemia, two of whom had failed standard induction chemotherapy, and two patients with refractory anemia with excess blasts in transformation. Following treatment two patients entered complete remission (CR) and two patients had survivals of ten and 18 months in stable partial remission. All patients have died, four of progressive or recurrent leukemia, one of a treatment‐related intracerebral hemorrhage, and one of lung carcinoma while in CR. Our experience, and a review of the literature, suggest that in general low dose cytarabine is well tolerated, although myelosuppression is common and thrombocytopenia can be a major problem. This form of treatment appears to offer a useful alternative to intensive induction chemotherapy in those patients in whom such treatment is usually poorly tolerated, and has the advantage of being able to be given to an outpatient.
SUBCUTANEOUS EMPHYSEMA: A RARE COMPLICATION OF FIBREOPTIC SIGMOIDOSCOPY
Authors: MCCARTHY J. H. , LAURENCE B. H.
Published: March 2008

Abstract: :Fibreoptic sigmoidoscopy is a commonly used technique. However, it is not without complications. We report the rare occurrence of subcutaneous emphysema, mediastinal emphysema, and pneumoperitoneum following routine sigmoidoscopy.
NASAL MUCOSAL INVOLVEMENT IN ULCERATIVE COLITIS
Authors: EASTON L. A.
Published: March 2008

Abstract: :A patient with ulcerative colitis, sclerosing cholangitis, and mouth ulceration, developed an unusual lesion involving the nasal mucosa. This was thought to represent another extra‐intestinal manifestation of inflammatory bowel disease.
NEW CONCEPTS IN MANAGEMENT OF NEUTROPENIA
Authors: FIRKIN F. C.
Published: March 2008

Abstract: :Neutropenia is a life‐threatening sequel of hematological disorders and a dominant factor limiting the dosage of cytotoxic chemotherapy. The role of the neutrophil is of such importance in defence against microbial invasion that measures that modify the behaviour of residual hemopoietic tissue to promote a modest increase in neutrophils, can confer considerable benefit by reducing the frequency and severity of infection. Such a change can be mediated in bone marrow depression by diversion of more progeny of immature precursors into the neutrophil series, or by enhancement of the stimulatory drive operating on neutrophil production. The former effect can be achieved by hypertransfusion of red cells to reduce the demand on the limited precursor population for cells of the erythroid series. The latter effect can be achieved by administration of lithium carbonate. Neutropenia caused by autoimmune injury to the neutrophil series can also be successfully modified by measures which suppress the underlying immune dyscrasia or the function of the reticuloendothelial system. Corticosteroid administration and splenectomy can be helpful in certain specific types of neutropenia. Administration of cyclophosphamide and azathioprine has both mutagenic and marrow suppressive potential, but can induce remissions in severe chronic isolated neutropenia and in systemic lupus erythematosis.
MANAGEMENT OF EXTRA‐SELLAR PITUITARY TUMOURS WITH BROMOCRIPTINE: COMPARISON OF PROLACTIN SECRETING AND NON‐FUNCTIONING TUMOURS USING HALF‐FIELD VISUAL EVOKED POTENTIALS AND COMPUTERISED TOMOGRAPHY
Authors: PULLAN P. T. , CARROLL W. M. , CHAKERA T. M. H. , KHANGURE M. S. , VAUGHAN R. J.
Published: March 2008

To determine whether prolactin secreting and non‐functioning pituitary tumours respond differently in terms of shrinkage to bromocriptine, we prospectively studied ten consecutive patients (five with prolactinomas and five with non‐functioning tumours) complicated by extra‐sellar extensions. No patient had received prior radiotherapy or bromocriptine and the mean dose and duration of bromocriptine treatment were identical in the two groups of patients. Objective evidence of tumour shrinkage was provided by serial half‐field visual evoked potentials (VEPs) and computerised tomography (CT). All five prolactinomas were shown to shrink as assessed by improvement in VEP and four of the five as assessed by CT. In contrast, only one of the five patients with nonfunctioning tumours showed any improvement in VEP or CT. Macroprolactinomas frequently shrink rapidly when treated with bromocriptine, whereas non‐functioning tumours seldom show such a dramatic response.
INITIAL EXPERIENCE WITH PHYSIOLOGICAL PACING
Authors: DAVIS M. J. E. , MEWS G. C. , COPE G. D.
Published: March 2008

Fifty patients, aged 23 to 88 years, with permanent rate‐responsive dual chamber pacemakers were studied prospectively for 14.1 ± 11.4 (S.D.) months after implantation to assess the benefits and complications associated with this technique. In 12 patients the device replaced a ventricular demand pacemaker. Minor complications associated with implantation occurred in one case. Atrial leads required repositioning because of increase in threshold and/or problems of sensing in five cases and ventricular leads in five. There were two patients with symptomatic pacemaker‐related arrhythmias necessitating reprogramming; one patient with pacemaker‐mediated tachycardia and one with pacemaker autoinhibition. Seven patients have died; one suddenly and possibly related to a pacemaker‐triggered arrhythmia. Of 43 living patients, five are now programmed to the ventricular demand mode; two with atrial fibrillation, one with failed atrial lead repositioning, one with persistent sinus tachycardia, and one because of angina pectoris. Thirty‐six of the 43 living patients are asymptomatic and a further six are symptomatically improved. All 12 patients changed from ventricular demand pacing have less symptoms. Rate‐responsive dual chamber pacing is safe and appears to improve symptoms in most cases. Complications are infrequent and usually easily overcome. This mode of pacing should be considered in all patients with normal sinoatrial function in whom a permanent pacemaker is indicated.
CUTANEOUS VASCULITIS FROM MAPROTILINE
Authors: OAKLEY A. M. M. , HODGE L.
Published: March 2008

An 83 year old woman with depression, while receiving maprotiline, developed a vasculitic skin eruption which resolved on discontinuing the drug. Vasculitis has not previously been reported with this drug.
THE USE OF FIBREOPTIC BRONCHOSCOPY WITH STERILE CATHETER IN THE DIAGNOSIS OF PNEUMONIA
Authors: GLANVILLE A. R. , MARLIN G. E. , HARTNETT B. J. S. , YAP J. M. , BRADBURY R.
Published: March 2008

The use of fibreoptic bronchoscopy with sterile catheter sampling of pulmonary secretions was evaluated in 70 patients with a provisional diagnosis of pneumonia. In 37 patients quantitative analysis of the sterile catheter isolates was performed (colony forming units (CFU) per ml). Potential bacterial pathogens were isolated in 37 patients and in the quantitative analysis, 14 of 22 isolates were grown in counts ≤ 103 CFU/ml. Sterile catheter increased the bacterial isolation rate as in only 19 patients blood (2) or sputum (18) cultures yielded the same organisms. Sputum cultures showed a 25% false‐positive rate in patients with no growth from sterile catheter. Quantitative analysis did not yield any further information in patients receiving antibiotics. Atypical or fungal pneumonia was diagnosed in 22 patients, while ten patients had other pathology simulating pneumonia. Sterile catheter sampling of pulmonary secretions at fibreoptic bronchoscopy proved to be a valuable tool in the diagnosis of bacterial pneumonia. (Aust NZ J Med 1985; 15: 309–319.)
NORMAL METABOLISM OF DEBRISOQUINE AND THEOPHYLLINE IN A SLOW TOLBUTAMIDE METABOLISER
Authors: MINERS J. O. , WING L. M. H. , BIRKETT D. J.
Published: March 2008

The metabolism of debrisoquine and theophylline has been studied in a healthy male who was identified as a slow hydroxylator of tolbutamide. Tolbutamide clearance in this subject was threefold lower than the lowest tolbutamide clearance observed in other healthy males and the drug's half‐life was approximately three‐fold longer. Despite this, his ability to 4‐hydroxylate debrisoquine and both N‐demethylate and 8‐hydroxylate theophylline was normal. Along with previously published information the data from this subject suggest that tolbutamide hydroxylation, debrisoquine hydroxylation, theophylline N‐demethylation, and theophylline 8‐hydroxylation involve four distinct isozymes of cytochrome P‐450. Furthermore, this report illustrates the difficulties of using the metabolic clearance of a model drug to predict the ability of an individual to clear a range of metabolised drugs. (Aust NZ J Med 1985; 15: 348–349.)
DIAGNOSIS OF WERNICKE'S ENCEPHALOPATHY
Authors: BREW B. J.
Published: March 2008

Abstract Records of the emergency medical admissions to a large teaching hospital over a one year period were examined for evidence of Wernicke's encephalopathy or Korsakoff's syndrome. It was found that only 0.4% of the population studied had the classical triad of Wernicke's encephalopathy, namely confusion, ophthalmoplegia, and ataxia. If two of these three criteria are allowed in the absence of other causes then 2.2% of the population had this limited Wernicke's encephalopathy or Korsakoff's syndrome. It is concluded that the diagnosis of Wernicke's encephalopathy should not rely on the presence of all three criteria; any two of the three in the absence of other causes will suffice for the diagnosis. (Aust NZ J Med 1986; 16: 676–678.)
CONTINUING EDUCATION AND PEER REVIEW IN INTERNAL MEDICINE (CEPRIME)
Authors: LEGGE D. G. , RICHMOND D. E.
Published: March 2008

Abstract Research in adult education shows that educational initiatives are most effective when they are related to perceived needs. The CEPRIME system was devised as a means of using peer review to reveal the educational needs of physicians. Sixteen physicians volunteered to test the system, by allowing a panel of specialists to review copies of their reports to referring general practitioners. The comments of the reviewers, both commendatory and critical, were referred back to the participants, and their evaluation of the system was sought. Although the method was found to have limitations relating both to the adequacy of the report as a document for review, and to the objectivity and relevance of the comments made about it, the results were such as to encourage further development of CEPRIME as a means of apprising physicians of their specific educational needs. (Aust NZ J Med 1986; 16: 679–685.)
EXPOSURE OF INTRAVENOUS DRUG USERS TO AIDS RETROVIRUS, SYDNEY, 1985
Authors: BLACKER P. , TINDALL S. , WODAK A. , COOPER D.
Published: March 2008

Abstract A survey of a cohort of 200 intravenous (IV) drug users drawn from five drug referral agencies was conducted in Sydney in 1985 and revealed only one heterosexual male with antibodies to AIDS retrovirus (ARV). Contact tracing of sexual and needle‐sharing partners resulted in the referral of a further four out of six at‐risk individuals seropositive for ARV. This study indicates that ARV has now reached the IV drug‐using population and could be spread further among IV drug users by sexual contact and by needle‐sharing. We conclude that exposure to ARV among IV drug users is in its earliest stages in Australia. There is an urgent need to introduce measures such as contact tracing and screening of IV drug users to prevent further spread of ARV in this risk group. (Aust NZ J Med 1986; 16: 686–690.)
SEVERE AUTONOMIC NEUROPATHY IN AMYLOIDOSIS SECONDARY TO RHEUMATOID ARTHRITIS
Authors: McGILL N. W. , TUCK R. , HASSALL J. E.
Published: March 2008

Abstract Autonomic neuropathy, although reported to occur in 15% of patients with AL (primary) amyloidosis, is extremely rare in AA (secondary) amyloidosis. We report a patient with amyloidosis secondary to rheumatoid arthritis in whom autonomic neuropathy resulted in severe and disabling orthostatic hypotension. Extensive amyloid deposits were found throughout the autonomic nervous system. (Aust NZ J Med 1986; 16: 705–707.)
EXERCISE CAPACITY IN CHRONIC RENAL FAILURE PATIENTS MANAGED BY CONTINUOUS AMBULATORY PERITONEAL DIALYSIS
Authors: BEASLEY C. R. W. , SMITH D. A. , NEALE T. J.
Published: March 2008

Abstract Exercise capacity is documented to be poor in patients with end stage renal failure undergoing regular hemodialysis, but there is little information about exercise capacity in patients on continuous ambulatory peritoneal dialysis (CAPD). We studied a group of 18 patients undergoing CAPD, with a variety of cardiorespiratory disorders, using a progressive load treadmill exercise test. The influence of intraperitoneal fluid on work capacity was also assessed. The mean maximum oxygen uptake (VO2max) of the CAPD patients was reduced considerably (14.6 ml kg‐1 min‐1) compared with matched control subjects (33.6 ml kg‐1 min‐1). This corresponded to the difficulty experienced by these patients in carrying out daily activities. There was no significant change in VO2max or in maximum heart rate with the peritoneal cavity full. We conclude that physical fitness is poor in CAPD patients and that the infusion of dialysis fluid into the peritoneal cavity does not affect physical work capacity further.
LONG TERM MANAGEMENT OF HEMORRHAGIC ESOPHAGITIS WITH CIMETIDINE AND OMEPRAZOLE
Authors: HETZEL D. J. , BONNIN M.
Published: March 2008

Abstract We report a patient whose severe recurrent anemia was due to overt and occult hemorrhage from peptic esophagitis. Cimetidine treatment was successful for seven years but dose reduction was followed by intractable hemorrhage which did not respond to H2‐receptor antagonists. Omeprazole therapy produced dramatic remission of symptoms and anemia.
BOOK REVIEW
Authors: Becker G.
Published: March 2008

CHRONIC RENAL DISEASE: Causes, Complications, and Treatment. Edited by Nancy Boucot Cummings and Saulo Klahr
SCLEROMYXEDEMA AND INFLAMMATORY MYOPATHY: A CLINICOPATHOLOGIC STUDY OF THREE PATIENTS
Authors: HARVEY J. M. , ZILKO P.J. , CHEAH P. S. , MASTAGLIA F. L. , OJEDA V. J.
Published: March 2008

Abstract Scleromyxedema (lichen myxedematosus is a rare cutaneous manifestation in patients with idiopathic inflammatory myopathy. The clinical and histological findings in three patients with this association are presented. Two patients had a severe inflammatory polymyopathy which responded incompletely to corticosteroid therapy, while in the third, who developed esophageal carcinoma, the myopathy was relatively mild and the skin changes were the dominant feature. The occurrence of scleromyxedema in patients with inflammatory myopathy appears to carry a poor prognosis.
TWO CONCURRENT EPIDEMICS OF ENTEROVIRAL MENINGITIS IN AN OBSTETRIC NEONATAL UNIT
Authors: REISS‐LEVY E. , BAKER A. , DON N. , CALDWELL G.
Published: March 2008

Abstract A small epidemic of viral infection occurred in a neonatal unit. It involved 11 infants, all of whom recovered. Echovirus 11 was the cause of illness in six infants, coxsackie 83 in four, and one infant had a biphasic illness, due first to echo 11, then to coxsackie B3. The epidemic coincided with a major outbreak of echovirus 11 and a smaller outbreak of coxsackie 83 in the community. Several staff became ill. Five infants were considered to have been infected by perinatal materno‐infant spread, others by cross‐infection. The epidemic ended when the nursery was closed.
THE INTRAVENTRICULAR RESERVOIR IN THE TREATMENT OF NEUROLOGICAL DISEASE SECONDARY TO HEMATOLOGICAL MALIGNANCY: AN EIGHT YEAR EXPERIENCE
Authors: YOUNG G. A. R. , MILLIKEN S. , JURD J. , POULGRAIN P. , VINCENT P. C.
Published: March 2008

Abstract Between 1974 and 1982, 17 patients with central nervous system disease secondary to hematological malignancy had an intraventricular reservoir inserted to monitor their disease and to instil cytotoxic chemotherapy. Two other patients with acute lympho‐blastic leukemia and difficult access to the cerebrospinal fluid had a reservoir inserted to facilitate intrathecal chemotherapy. All 17 patients with established disease showed clinical improvement. Thirteen patients had complete elimination of malignant cells from the cerebrospinal fluid with cytotoxic chemotherapy, and the other four had a reduction in the concentration of malignant cells. Infection and neurotoxicity were found in a significant number of cases. and therefore the good clinical resDonse associated with th; procedure must be weighed carefully against the associated toxicity.
A FAMILIAL SYNDROME OF CARDIAC MYXOMAS, MYXOID NEUROFIBROMATA, CUTANEOUS PIGMENTED LESIONS, AND ENDOCRINE ABNORMALITIES
Authors: WILSHER M. L. , ROCHE A. H. G. , NEUTZE J. M. , SYNEK B. J. L. , HOLDAWAY I. M. , NICHOLSON G. I.
Published: March 2008

Abstract A family syndrome of cardiac myxomas, myxoid neurofibromata, cutaneous pigmented lesions, and endocrine abnormalities is described. Three cases from a family of four are presented. All had cutaneous pigmented lesions. The mother had left and right atrial myxomata, her daughter a left ventricular myxoma, subcutaneous myxoid neurofibromata, and mammary fibroadenosis, and her son has no evidence of cardiac myxoma. Elevated circulating levels of insulin‐like growth factors in the one family member tested raises the possibility of abnormal stimulation of somatic growth and may be linked to development of soft tissue neoplasms in these patients.
RAPID DOPPLER SCREENING TEST FOR INTERNAL CAROTID DISEASE
Authors: Seneviratne B.I.B. , Hughes A. , Jayasinghe L. S. , Hewson D. J.
Published: March 2008

There is increasing evidence that only hemodynamically significant internal carotid lesions (of more than 50% diameter stenosis or occlusion) rather than minor lesions are the precursors of stroke. A Doppler test combining periorbital and direct audible interpretation of internal carotid Doppler signals was performed on 67 patients (134 internal carotids) and the results were compared with those from conventional biplane angiography. The test was 100% sensitive and had a positive predictive value of 91% for hemodynamically significant lesions. Negative predictive value for normal or less than 50% stenosis was 100%. Carotid bifurcation bruits were heard over only 25% of internal carotids with significant stenosis and nearly 60% of bruits were heard over internal carotids with minor disease. The equipment was portable and relatively inexpensive. The test could be performed by vascular technicians in less than 12 minutes with minimal patient discomfort, thus meeting most of the criteria for an ideal non‐invasive screening test. (Aust NZ J Med 1986; 16: 481–485.)
LUNG FUNCTION AND RESPIRATORY MUSCLE STRENGTH AFTER PROPRANOLOL IN THYROTOXICOSIS
Authors: Wang Y. T. , Poh S. C.
Published: March 2008

Thirty‐five thyrotoxic patients were assessed before treatment, after treatment with propranolol, and after antithyroid drugs. The first group of patients (n= 17) performed the following tests at all three assessment points: forced expiratory volume in the first second (FEV,), vital capacity (VC), functional residual capacity (FRC), residual volume (RV), total lung capacity (TLC), maximal mid‐expiratory flow rate (MMFR), diffusing capacity for carbon monoxide (DLCO), and maximum static inspiratory and expiratory mouth pressures (Plmax and PEmax). Arterial blood gas analysis was also performed for the first group of patients. No significant changes were seen either after propranolol or after antithyroid drugs in the FRC, RV, TLC, MMFR, DLCO, or blood gases. The remaining 18 patients, group 2, performed only the FEV1, VC, Plmax, and PEmax tests at each assessment. The only index of respiratory function that improved significantly after propranolol was Plmax (from 46.5 ± 16.5 to 53.2 ± 22 cmH2O, p < 0.01). This suggests that adrenergic excess may play a role in thyrotoxic inspiratory muscle weakness. After antithyroid drugs, Plmax, PEmax, FEV1, and VC all increased significantly as expected. (Aust NZ J Med 1986; 16: 496–500.)
Book Reviews
Authors: O'Rourke M. F.
Published: March 2008

Book reviews in this article

MANUAL OF CARDIAC DRUG THERAPY. By M. Khan.

MANUAL OF CARDIOVASCULAR DIAGNOSIS AND THERAPY. By J. S. Alpert and J. M. Rippe.
HYPERCALCEMIA DURING RESOLUTION OF ACUTE RENAL FAILURE ASSOCIATED WITH RHABDOMYOLYSIS: EVIDENCE FOR SUPPRESSION OF PARATHYROID HORMONE AND CALCITRIOL
Authors: Prince R. L. , Hutchison B. G. , Bhagat C. I.
Published: March 2008

Hypercalcemia during the recovery phase of renal function is a relatively common complication of rhabdomyolysis‐associated acute renal failure. The cause is unclear but it has been suggested recently that both hyperparathyroidism and high levels of calcitriol are implicated. We present evidence which does not support these hypotheses. (Aust NZ J Med 1986; 16: 506–508.)