bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mechanism of stroke complicating cardiopulmonary bypass surgery
Authors: Rankin J. M. , Silbert P. L. , Yadava O. P. , Hankey G. J. , Stewart‐Wynne E. G. 
Published: March 2008

Abstract Background: Stroke is a devastating complication of cardiopulmonary bypass (CPB) surgery which occurs in 1 to 5% of cases. Strategies to reduce its incidence require a knowledge of the underlying pathology and aetiology. Aims: To determine the incidence, pathology and aetiology of stroke complicating CPB. Methods: Prospective review of clinical, operative and cranial CT scan findings in all cases of stroke complicating CPB procedures in our institution over an 18 month period. Results:. Twenty‐one (1.6%, 95% CI 0.9–2.3%) cases of stroke were identified from 1336 CPB procedures. Cranial CT scan, performed in all but one patient, was normal in three patients or consistent with ischaemic stroke in 17 patients. There were no cases of haemorrhagic infarction or intracerebral haemorrhage. It was difficult to differentiate embolic and borderzone infarcts in two cases. After considering the clinical, operative and CT scan features together, 12 (57%, 95% CI 36–78%) of the cases were felt to be embolic in origin and nine (43%, 95% CI 22–64%) due to hypoperfusion in a borderzone. Conclusions: This study demonstrates that stroke remains an important complication of CPB procedures with an incidence in our series of 1.6%. The pathologic type of stroke is predominantly ischaemic in nature due to either cerebral embolism or borderzone infarction. Strategies for stroke prevention in patients undergoing CPB should be targeted primarily at these two mechanisms.
Asthma severity and morbidity in a population sample of Sydney school children: Part I – Prevalence and effect of air pollutants in coastal regions
Authors: Gray E. J. , Peat J. K. , Mellis C. M. , Harrington J. , Woolcock A. J. 
Published: March 2008

Abstract Background: In two regions of Sydney where sewage treatment facilities with high temperature sludge burning incinerators are installed, there was concern that the resultant emissions were causing a local increase in symptoms of asthma and other allergic diseases. Aim: To investigate whether living in a region with high temperature sludge burning incinerators was associated with an increased prevalence of childhood asthma or allergy. Methods: We studied 713 children aged eight‐12 years in two regions close to incinerators and 626 children in a control region with no sludge burning incinerator. We measured respiratory illness in the previous year by questionnaire, airway hyper‐responsiveness (AHR) by histamine inhalation test, and atopy by skin prick tests. ‘Current asthma’ was defined as AHR and recent wheeze. Results: Recordings of oxides of nitrogen and sulphur, hydrogen sulphide, ozone and particulates during the study period showed that the level of pollutants did not vary in any major way between the study regions and the control region. The prevalence of current asthma, atopy, symptom frequency or any category of severity of asthma illness was not significantly different between the control and study regions. Conclusions: This suggests that factors other than intermittent or industrial air pollutants are responsible for the high prevalence of asthma symptoms, asthma medication use, asthma morbidity and AHR in the study of children.
Simultaneous transplantation of the heart and kidney
Authors: Savdie E. , Keogh A. M. , Macdonald P. S. , Spratt P. M. , Graham A. M. , Golovsky D. , Strieker P. D. , Spicer T. , Hayes J. M. , Crozier J. , Rainer S. 
Published: March 2008

Abstract Background: Multiple organ transplants have become frequent. Combined heart‐and‐kidney grafting has been reported recently and we have pursued this in selected cases. Aims: To devise a protocol for simultaneous heart‐and‐kidney transplantation, review our clinical experience with the procedure and the causes of cardiac and renal disease in this group. Methods: Seven patients with advanced cardiac failure (LV ejection fraction < 0.29 units; five with IDCM), and chronic renal failure (serum creatinine > 375 μmol/L) due to a variety of causes, were accepted for combined heart‐and‐kidney transplantation. Four males, of mean age 33 years, underwent the procedure. Each received his organs from a single cadaveric donor with ABO blood group compatibility and a negative ‘current’ lymphocytotoxic cross‐match, but without regard to HLA‐antigen matching. Cardiac ischaemic time averaged 3 hours 40 minutes, the renal first warm time was 0 minutes in all cases, and renal cold and second warm ischaemic times averaged 5 hours 17 minutes and 52 minutes respectively. The heart was grafted first and the kidney second in a procedure which averaged seven hours. Immunosuppression was achieved by induction with antithymocyte globulin, thence steroids, azathioprine and cyclosporin A. Results: No patient required post‐operative dialysis. One patient had early urological complications requiring operative correction, but no serious opportunistic infections were observed. Early cardiac rejection on biopsy (ISHT grade 3a) was seen in three patients at four‐ten weeks and responded promptly to increased steroids, but severe steroid‐resistant rejection of both heart and kidney contemporaneously occurred in one of these three at 19 months and required a course of muromonab‐CD3. All four patients developed hypertension. Mean creatinine clearance was 1.23 ± 0.22 mL/second (74±13 mL/minute) at last follow‐up. All four recipients were alive, well and rehabilitated 5, 20, 28 and 35 months after grafting. Two patients died while waiting for the double procedure and another patient eventually died after being taken off the dual waiting list and receiving a renal transplant only. Conclusions: In experienced hands, combined heart‐and‐kidney transplantation is feasible and offers a compelling therapeutic solution in the treatment of advanced cardiac and renal failure. IDCM is a frequent cause of the heart failure in this group. (Aust NZ J Med 1994; 24: 554–560.)
Epidemiology of hypothermia: fatalities and hospitalisations in New Zealand
Authors: Taylor N. A. S. , Griffiths R. F. , Cotter J. D. 
Published: March 2008

Background: Hypothermia occurs within domestic and non‐residential settings. Most epidemiological data originate from the northern hemisphere, with little data being generally available concerning cases from New Zealand and Australia. Aims: The National Health Statistics Centre (New Zealand) records hospital discharges and deaths. This study isolated hypothermia cases, to quantify its incidence and identify risk groups. Methods: The morbidity and mortality files for the years 1979‐86 (cases = 3,808,717) and 1977‐86 (cases = 259,325; respectively) were searched by three investigators. Results: Hypothermia hospitalisations were identified (6.9 per 100,000 per year). There were 176 deaths from hypothermia, representing 0.07% of the 259,325 deaths from all causes for the same period (0.537 per 100,000 people per year); of these fatalities, 72.2% were classified as domestic, and 27.8% as non‐residential; of the domestic fatalities, 86.6% were 65 + years and 35.5% of these were male. Within the non‐residential category, 75.5% were aged 13–65, of which 94.6% were male. The hospitalisation incidence was 12.7 times the fatality incidence, with the majority of hospitalisations being of domestic origin (88.4% of total), and occurring mostly within the lower and upper age extremes. Neonatal domestic hypothermia accounted for 72.6% of all domestic hospitalisations, and the elderly constituted 72.0% of the remaining cases. The proportion of New Zealand fatalities caused by hypothermia was 0.067%; lower than reported in the United Kingdom. Conclusions: The two main non‐neonatal groups contributing to cases of hypothermia were males aged 13–65 years, and the elderly. In the aged, the proportion of hypothermia‐related deaths was no different from that associated with other disorders, however, the case‐fatality ratio was three times greater, highlighting the need for improving prevention and management strategies. (Aust NZ J Med 1994; 24: 705–710.)
Septic arthritis: a second decade of experience
Authors: Youssef P.P. , York J. R. 
Published: March 2008

Abstract Aims: To review the diagnostic features, treatment and outcomes of all cases of septic arthritis presenting to a major Australian rheumatology unit, between 1982 and 1991. These were compared with the previous decade's experience Methods: The medical records of all cases of septic arthritis presenting to the Combined Centre for Rheumatic Diseases, The Rachel Forster Hospital between 1982 and 1991 were reviewed and compared with the experience of the previous decade (1971–1981). Results: Twenty‐seven episodes of septic arthritis were diagnosed in 27 patients. There were 18 females and nine males. The average age was 62 (21–83) with three patients less than 30. Their rheumatological diagnoses were: rheumatoid arthritis (RA) in 15, osteoarthritis in five, gout in two, and one each of mixed connective disease, sarcoid, tenosynovitis of the forearm, seronegative spondyloarthropathy, and non specific polyarthritis. Eleven patients were on oral corticosteroids. Four patients had intra‐articular injections within two months of the onset of the septic episode. Sixteen out of 19 aspirates on the wards were positive. The organisms identified were Staphylococcus aureus in ten (one multiply resistant S. aureus (MRSA), Streptococcus four, Mycobacterium three (one atypical), two Pseudomonas and one each of Citrobacter, Enterobacter, Gram negative bacillus. Five patients did not have a causative organism identified. The site of involvement and the causative organisms were similar in both decades. All patients received intravenous antibiotics for at least two weeks and oral antibiotics for at least another four weeks. Twenty‐two per cent had regular aspirations on the wards and 26% had surgical drainage performed. Only 59% of all joints returned to good hnction. Fifty per cent of infected arthroplasties required arthrodesis and only a third of these returned to acceptable function. Conclusion: Septic arthritis in subjects with previous rheumatic disease continues to have a poor prognosis, especially in cases of infected arthroplasties. There has been no change in the types of causative organisms or sites of involvement over the last two decades.
Catheter ablation of the atrioventricular node using radiofrequency energy
Authors: Wong J. , Vohra J. , Chan W. , Sathe S. , Hall R. , Mond H. , Hunt D. 
Published: March 2008

Abstract: Background: Catheter ablation of the atrioventricular (AV) junction using stored direct current (DC) energy from a standard DC Cardioverter defibrillator was first reported in 1982. Since then many patients have been treated using this procedure for refractory supraventricular arrhythmias, usually atrial fibrillation and flutter. Undesirable thermal effects such as barotrauma and arcing are largely responsible for complications associated with the use of DC energy. This report details our experience of catheter ablation of the AV junction using radiofrequency (RF) energy in a series of 30 consecutive patients. Methods: RF ablations were performed using steerable Mansfield (Webster Laboratories) 4 mm tipped electrodes and locally assembled RF energy delivery system. Results: The procedure was successful in 27/30 (90%) patients using RF energy, while three patients required DC energy to achieve successful AV junction ablation. General anaesthesia was required in nine patients, six of whom required this for cardioversion to sinus rhythm so that an adequate His Bundle spike could be recorded and three for DC ablation. Dual chamber permanent pacemakers with automatic mode switching were implanted in four patients who had paroxysmal atrial fibrillation or flutter and the remainder had ventricular rate responsive pacemakers. Conclusions: In patients with drug refractory paroxysmal atrial fibrillation and flutter and in patients with established atrial fibrillation where control of the ventricular rate is difficult, catheter ablation of the AV junction using RF energy is a safe and effective procedure with a high success rate.
Percutaneous transluminal coronary angioplasty: clinical and quality of life outcomes one year later
Authors: McKenna K. T. , McEniery P. T. , Maas F. , Aroney C. N. , Bett J. H. N. , Cameron J. , Holt G. , Hossack K. F. 
Published: March 2008

Background: The quality of life status of patients prior to and following percutaneous transluminal coronary angioplasty (PTCA) has not been comprehensively investigated.Abstract: Aim: This study was carried out to determine the effect that PTCA has on patients' quality of life. Methods: Data on 209 patients were collected one day pre‐PTCA and at a mean of two and 11 months post‐PTCA. Data on symptomatic status, functional capacity, life satisfaction and psychological well‐being were analysed quantitatively. Clinical outcomes, patient perception of PTCA and employment status wee analysed by descriptive statistics. Results: Highly significant improvement in all quality of life measures was found at the early follow‐up (p < .001). This improvement was sustained at the late follow‐up. At the late follow‐up, 58% of patients felt that PTCA had been very beneficial to their health and well‐being, and 79% of workers had returned to work. PTCA was primarily successful in 91% of vessels dilated. There were no procedural‐related deaths, 12 patients (6%) developed acute occlusion and three patients (1.5%) experienced myocardial infarction (MI). A symptomatic restenosis rate of 16% was found, including 19 patients (9%) requiring repeat PTCA and 14 (7%) undergoing coronary artery bypass grafting (CABG). Conclusion: These findings suggest that, after PTCA, the majority of patients experienced improved quality of life which was sustained one year later.
Identification and genotyping of hepatitis C virus in injectable and oral drug users in New Zealand
Authors: Woodfield D. G. , Harness M. , Rix‐Trott K. , Tsuda F. , Okamoto H. , Mayumi M. 
Published: March 2008

Abstract: Background: Hepatitis C virus infections are known to be common in injectable drug users (IDU) both in New Zealand and overseas. Little is known of the hepatitis C genotype frequency in this population. Aims: To confirm the high incidence of hepatitis C virus infections in IDU and compare this with the frequency in oral drug users (ODU) as well as identify the pattern of hepatitis C genotypes present. Methods: Use was made of an experimental nucleocapsid assay as well as a conventional anti‐HCV assay. HCV‐RNA was identified using a polymerase chain reaction (PCR) technique and a variation of this method was used for HCV genotyping. Results: Seventy‐four per cent of IDU were reactive for anti‐HCV in both types of assay. PCR testing detected several more reactive samples. Dominant genotypes were Types I and V, but Type IV was not detected. Mixed infections were noted in some patients. There was a low frequency of anti‐HCV in ODU. Conclusions: Hepatitis C virus infections are a problem in IDU in New Zealand, and additional public health measures may be required. The distribution of genotypes of HCV‐RNA are similar to those seen in other Western countries.
Short and long term results of coronary angioplasty in patients over 75 years
Authors: Richardson M. , Pitney M. R. , Gibbons F. , Cope G. D. , Cumpston G. N. , Mews G. C. 
Published: March 2008

Abstract: Aims: This report reviews the outcome of percutaneous transluminal coronary angioplasty (PTCA) on patients aged 75 years or over at this institution, in order to provide statistics that may be useful in managing elderly patients. Methods: All elderly patients undergoing PTCA between January 1984 and December 1990 were included. Data concerning the PTCA procedure and short term (hospital stay) outcome were compared to those of all patients less than 75 years who underwent PTCA during the same period. Long term outcome was obtained for all surviving elderly patients. Results: One hundred and eleven procedures were performed on patients over 75 years, compared to 3183 procedures on patients under 75. The incidence of PTCA in the elderly increased to 6.7% of all procedures in 1990. Elderly patients were more symptomatic (97% vs 79% in patients under 75 years had Canadian Cardiovascular Society grade 3 or 4 angina), more frequently had the procedure performed urgently (39% vs 14%) and often (67%) had risk factors for PTCA (3 vessel disease, significant left ventricular dysfunction, or a complicating medical illness). Primary success rates (86%vs 90% in patients under 75 years), urgent coronary artery bypass grafting (1.8%vs 1.9%) and Q wave infarction (1.8%vs 1.0%) were similar in the two age groups. In the elderly, procedural difficulties requiring non standard equipment were common (61%), and in‐hospital mortality was increased (4.5%vs 0.7%). Additionally, three patients died after discharge resulting in a 30 day mortality of 7.2%. A favourable long term outcome was obtained in 50% of patients at a mean follow up of 20 months. Unfavourable or neutral outcome was due to one or more of the following; death (16%), coronary artery bypass grafting (19%), acute myocardial infarction (7.5%) or significant residual angina (17%). Conclusions: Highly symptomatic patients over 75 years constitute a high risk group for PTCA, with approximately half obtaining a favourable long term outcome.
Scleroderma and augmentation mammoplasty ‐ a causal relationship?
Authors: Englert H. J. , Brooks P. 
Published: March 2008

Abstract: Background: The studies implicating a causal relationship between silicone and scleroderma, other autoimmune diseases, and fibromyalgia‐like symptoms have been largely descriptive with absence of appropriate controls and no consideration of potential confounders.This case control study of augmentation mammoplasty and scleroderma represents an attempt to answer these deficiencies. Aims: To compare the frequency and temporal relationship of augmentation mammoplasty in interviewed and deceased cases and interviewed controls. To determine the frequencies of exposure to non‐augmentation mammoplasty silicone, and to determine the frequencies of mastectomy and breast lumpectomy in interviewed cases and controls. Methods: Scleroderma cases and age‐stratified general practice controls were interviewed using a prepilotted telephone questionnaire. Self‐reported date/s of augmentation mammoplasty were ascertained, as were dates of onset of first and second scleroderma symptom/s and scleroderma diagnosis, where relevant. Comparison of socioeconomically adjusted rates was expressed in terms of rate ratios. Results: Augmentation mammoplasty rates were comparable between interviewed cases and controls. No augmentation mammoplasty procedures were documented in deceased scleroderma patients' medical records. Rates of exposure to non‐mammoplasty silicone, mastectomy and breast lumpectomy were comparable in interviewed cases and controls. Conclusions: This study failed to demonstrate an association between silicone breast implantation and the subsequent development of scleroderma, to a relative risk level as low as 4.5 with 90% power.
Low cholesterol and risk of non‐coronary mortality
Authors: Simes R. John 
Published: March 2008

Abstract:Based on a systematic review of over 20 cohort studies, a clear association exists, for both men and women, between particularly low cholesterol levels and the rate of non‐coronary mortality. The excess in women appears mainly confined to non‐cancer causes, particularly respiratory and digestive diseases, while there is also an excess of deaths from cancer seen in men with low cholesterol levels. Higher mortality rates from trauma, haemorrhagic stroke and cirrhosis have also been observed.Much of this association is known to be as a consequence of the disease with a fall in cholesterol levels seen after developing a variety of inflammatory diseases. However, the excess risk of non‐coronary heart disease deaths is still apparent by excluding deaths within five years suggesting that effect‐cause is not the only explanation. Confounding still remains the most likely explanation for the association with an underlying chronic disease or risk factor causing both the low cholesterol and the fatal event. However, there is still the possibility that some of the increased risk is due to the low cholesterol. This makes it important that appropriately controlled trials of both drug and dietary interventions demonstrate net clinical benefit among those with low levels of coronary risk before cholesterol‐lowering strategies are adopted more widely in these groups.
Smoking‐related beliefs and behaviour among adults with asthma in a representative population sample
Authors: Wakefield M. , Ruffin R. , Campbell D. , Roberts L. , Wilson D. 
Published: March 2008

Abstract Background: Smoking and exposure to environmental tobacco smoke are inadvisable for adults with asthma. Aims: To determine the smoking prevalence and daily smoking rate of asthmatics and compare smoking‐related beliefs and behaviours among smokers with and without asthma. To compare beliefs of asthmatics about passive smoking and asthma, how many are exposed at home and what they do when they are exposed, with people who do not have asthma. Methods: A representative population survey of 3019 South Australian adults aged 15 years and older interviewed in their own homes in late 11992. Results: Twenty‐eight per cent of asthmatics were smokers; mean daily smoking rate was 17.6. Asthmatics had similar patterns of smoking, readiness to quit and quit attempt histories as people without asthma. More than 40% of smokers with asthma did not perceive that smoking had greatly affected their health, over half did not believe they were at risk in future and two‐thirds did not think future health problems would be serious. Among non‐smokers, despite being more convinced of the effects of passive smoking on asthma, and being more concerned about exposure, those with asthma were no more likely to take protective action in response to actual or imminent exposure than those without asthma. One in ten non‐smokers with asthma were exposed to smoking at home. Conclusions: The smoking habits of adults with asthma are cause for concern, with many asthmatic smokers perceiving they are not personally at risk from their smoking. Health education principles should be used by health professionals caring for asthmatic smokers to guide the selection and delivery of smoking cessation strategies. Prevailing restrictions on indoor smoking play an important role in protecting the respiratory health of non‐smokers with asthma.