bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does the emergency room electrocardiogram identify patients with suspected myocardial infarction who are at low risk of acute complications?
Authors: Bell M. R. , Montarello J. K. , Steele P. M. 
Published: March 2008

Abstract To determine the early morbidity of patients admitted to the coronary care unit (CCU) with inconclusive evidence of acute myocardial infarction, the prognostic value of the emergency room electrocardiogram (ECG) was examined prospectively in a blinded fashion in 410 patients presenting with acute chest pain. One hundred and forty one patients (34.4%) had an ECG that was normal, showed ST segment changes < 1 mm, or was unchanged from a previous recording (group 1). The remaining patients (65.6%, group 2) had ECGs considered abnormal.Thirty‐nine patients in group 1 and 226 in group 2 had confirmed infarction. There was one CCU death in group 1 (0.7%) versus 27 (10.0%) in group 2 (p<0.001) and the overall hospital mortality for group 1 was 2.1% versus 13.0% in group 2 (p< 0.001). Twenty‐eight patients (19.9%) from group 1 suffered complications in the CCU versus 155 (57.6%) from group 2 (p< 0.001). No life‐threatening arrhythmias occurred in group 1 versus occurrence in 47 patients (17.5%) in group 2 (p< 0.001). The need for acute intervention was also less for group 1 versus group 2 patients, 14 (9.9%) and 85 (31.6%) respectively (p<0.001) with no patient requiring electrical cardioversion in group 1.It is concluded that the emergency room ECG can reliably identify a group of low risk patients presenting with suspected myocardial infarction and so help in establishing priority for admission to the CCU. Furthermore, the risk‐benefit of thrombolytic therapy in these low risk patients appears unacceptable.
Optic disc oedema and diabetes mellitus: a case report with review
Authors: West P. D. , De Wytt C. N. , Strakosch C. R. 
Published: March 2008

AbstractOptic disc oedema is a neurological complication of diabetes mellitus. Typically, the patient is a young diabetic with minimal symptomatology but severe bilateral optic disc oedema discovered on routine eye examination. It is a relatively benign condition which on occasion can result in a residual visual deficit, but requires no specific intervention and represents a subgroup of anterior ischaemic optic neuropathy (AION). We present a patient with insulin dependent diabetes and asymptomatic bilateral optic disc oedema, with a brief review of the syndrome and its pathogenesis. (Aust NZ J Med 1991; 21: 248–250.)
Low dose erythropoietin in maintenance haemodialysis: improvement in quality of life and reduction in true cost of haemodialysis
Authors: Harris D. C. H. , Lawrence S. , Chapman J. R. , Roger S. D. , Stewart J. H. 
Published: March 2008

Abstract Human recombinant erythropoietin (r‐HuEPO) improves quality of life in patients on maintenance haemodialysis, but the haemoglobin (Hb) level necessary to achieve this improvement is unknown. In this study, quality of life, functional capacity and symptoms of 28 haemodialysis patients with an initial Hb of 67 ±2 (mean ± SEM) g/L were assessed after 0, 6 and 12 months of r‐HuEPO, the dose of which was titrated to achieve a stable Hb of between 90 and 100 g/L.At six and 12 months Hb was 97 ± 2 and 93+2 g/L, and mean r‐HuEPO dose between three and six, and between nine and 12 months was 88 ± 6 and 62 ± 9 U/kg/week intravenously respectively. There was a significant improvement in level of activity and satisfaction with various aspects of life, and a reduction in fatigue, weakness, dyspnoea, angina and restless legs. Patients were able to walk 50% further in six minutes. The improvement in quality of life and function was similar to that reported from other centres whose target Hb was between 100 and 120 g/L, and where the r‐HuEPO dose was 75% higher than in this study.Costs of r‐HuEPO therapy were assessed. The drug itself costs $A3681/yr/patient, to which was added the estimated cost of additional dialyses and medications, bringing the total to $A5177/yr/patient. There was, however, a reduction in both hospitalisation by 8.3 days/yr/patient and medical consultation by 3.9 hours/yr/patient. Five patients commenced full‐time work, one took up full‐time study aimed at finding work, three transferred to home haemodialysis and six fewer patients drew social security benefits. The net cost saving from using low dose r‐HuEPO was more than $A1,000/yr/patient.
A randomised double‐blind trial of cyclosporin and azathioprine in refractory rheumatoid arthritis
Authors: Ahern M. J. , Harrison W. , Hollingsworth P. , Bradley J. , Laing B. , Bayliss C. 
Published: March 2008

Abstract :Fifty‐two patients with severe rheumatoid arthritis (RA) from four Australian centres were randomised to receive cyclosporin A (CSA) (n = 25) or azathioprine (AZA) (n = 27) for six months. Initial mean doses of CSA and AZA were 4.2 mg/kg and 1.7 mg/kg respectively. The mean doses of CSA and AZA at six months were 3.4 mg/kg and 1.9 mg/kg. Assessments of side‐effects and outcomes of benefit were made monthly by independent, blinded observers. Both treatment groups exhibited statistically significant improvement in standard outcome parameters when compared with baseline values. However, there were no statistically significant differences in these parameters between the two groups.There was a mean increase in serum creatinine concentration associated with CSA; no persons were withdrawn from the study for this reason. Seven CSA recipients (three gastrointestinal symptoms, two neurological symptoms, two other) and 12 AZA recipients (six gastrointestinal symptoms, four inefficacy, two other) withdrew from treatment prematurely. Seven CSA recipients became hypertensive and four required anti‐hypertensive therapy. Adverse events not requiring cessation of therapy were more commonly seen among CSA patients.In this group of severely affected patients with RA both cyclosporin and azathioprine were effective therapies. CSA toxicities were predictable and manageable but required close monitoring. (Aust NZ J Med 1991; 21: 844–849.)
Hepatitis C virus infection in haemodialysis patients
Authors: Roger S. D. , Crewe E. , Cunningham A. , Harris D. C. H. 
Published: March 2008

Abstract:Antibody to hepatitis C has been variously detected in 1‐20% of haemodialysis patients in recent studies from overseas. To determine the frequency of antibodies to the C100‐3 protein of the hepatitis C virus (anti‐HCV) a cross‐sectional study was performed in 60 patients on maintenance haemodialysis in Western Sydney. Six patients (10%) were anti‐HCV seropositive. Four of the six anti‐HCV positive patients were also hepatitis B core antibody positive, compared with nine of 54 anti‐HCV negative patients (p < 0.05). All anti‐HCV positive patients had received multiple blood transfusions. Serum alanine aminotransferase (ALT) was not useful as a screening test. Recent evidence suggests that anti‐HCV seropositivity underestimates infectivity.
Oesophageal intramural pseudodiverticulosis—always benign?
Authors: Evans P. R. 
Published: March 2008

Abstract:Oesophageal intramural pseudodiverticulosis is a rare condition that presents with dysphagia. The diagnosis is usually not apparent endoscopically and careful radiological evaluation is required. Previous reports suggest a benign course with good response of dysphagia to oesophageal dilatation and complications have not been described. Two cases are reported, one in whom life threatening haemorrhage developed following dilatation, and one complicated by a retro‐oesophageal collection. It is possible that oesophageal intramural pseudodiverticulosis results in an increased propensity to trauma and even perforation.
Intermittent subcutaneous apomorphine injection treatment for Parkinsonian motor oscillations
Authors: Kempster P. A. , Iansek R. , Larmour I. 
Published: March 2008

Abstract:Eight patients with severe Parkinsonian motor oscillations have been treated with the dopamine receptor agonist apomorphine by intermittent subcutaneous self‐injection as an adjunct to oral anti‐Parkinsonian medication. The dopamine receptor antagonist domperidone was also given by mouth to prevent nausea. Six patients remain on chronic treatment (mean period 6.5 months) with improved control of motor function in each case. Four have had major enhancement of their quality of life. Benefits of this treatment stem from the training of patients to use intelligent behaviour to administer a promptly acting and effective pharmacological agent, thereby exercising a degree of direct control over previously unpredictable variations in motor performance.
The early diagnosis of acute myocardial infarction
Authors: Foy S. G. , Kennedy I. C. S. , Ikram H. , Low C. J. S. , Shirlaw T. M. , Crozier I. G. 
Published: March 2008

Abstract:Latex agglutination for serum myoglobin (Rapitex™) was compared with the initial ECG for the early diagnosis of acute myocardial infarction. Forty patients suspected of myocardial infarction were prospectively evaluated by initial electrocardiogram and Rapitex™ serum myoglobin. The initial ECG was categorised into one of three groups: Group 1 had ST segment elevation of at least 1 mm in a limb lead or 2 mm in a precordial lead (with or without Q waves); Group 2 had abnormalities other than those seen in Group 1; and Group 3 had no particular abnormalities present that is, a normal ECG. Myocardial infarction was confirmed by a rise in creatine kinase to greater than or equal to twice the upper limit of normal for our laboratory range and with a CKMB fraction of greater than 6%. Nineteen of 40 patients sustained myocardial infarction; nine ECG group 1, six ECG group 2, and four ECG group 3. Eleven of the 19 patients with myocardial infarction had positive serum myoglobin agglutination. The initial ECG was the most predictive of a subsequent rise in CK (p = 0.003), while Rapitex™ serum myoglobin determination was the least predictive (p= 0.8517). We conclude that the Rapitex™ serum myoglobin test offers little diagnostic or economic advantage over the initial electrocardiogram.
Phenelzine associated peripheral neuropathy—clinical and electrophysiologic findings
Authors: Goodheart R. S. , Dunne J. W. , Edis R. H. 
Published: March 2008

Abstract:Phenelzine associated sensorimotor peripheral neuropathy is reported in two patients. Symptoms were predominantly sensory, and improvement occurred after withdrawal of phenelzine. Electrophysiologic findings were consistent with an axonal process.
Alpha 1‐antitrypsin deficiency and pancreatitis in a juvenile
Authors: Edmunds S. E. J. , Wilkinson M. L. 
Published: March 2008

Abstract:An 18‐year‐old female with PiSZ phenotype alpha 1‐antitrypsin deficiency presented with pancreatitis and a pancreatic pseudocyst. There were no other causative factors. Deficiency of alpha 1‐antitrypsin may predispose to pancreatitis or exacerbate existing pancreatic disease.
Medical informatics—an Australian perspective
Authors: Hannan T. 
Published: March 2008

Abstract:Computers, like the X‐ray and stethoscope1can be seen as clinical tools, that provide physicians with improved expertise in solving patient management problems. As tools they enable us to extend our clinical information base, and they also provide facilities that improve the delivery of the health care we provide.Automation (computerisation) in the health domain will cause the computer to become a more integral part of health care management and delivery before the start of the next century. To understand how the computer assists those who deliver and manage health care, it is important to be aware of its functional capabilities and how we can use them in medical practice.The rapid technological advances in computers over the last two decades2–4has had both beneficial and counterproductive effects on the implementation of effective computer applications in the delivery of health care. For example, in the 1990s the computer hobbyist is able to make an investment of less than $ 10,000 on computer hardware that will match or exceed the technological capacities of machines of the 1960s. These rapid technological advances, which have produced a quantum leap in our ability to store and process information, have tended to make us overlook the need for effective computer programmes which will meet the needs of patient care.As the 1990s begin, those delivering health care (eg, physicians, nurses, pharmacists, administrators.) need to become more involved in directing the effective implementation of computer applications that will provide the tools for improved information management, knowledge processing, and ultimately better patient care.
Genes, gender and geometry and the prolapsing mitral valve
Authors: Wilcken David E. L. 
Published: March 2008

AbstractMitral Valve Prolapse (MVP) is usually a variant of normal occurring in about 4% of the population. Complications are relatively uncommon, but false associations due to ascertainment bias have had a potential for iatrogenic harm. Adverse outcomes which do occur in a subset of MVP subjects are considered here in relation to the contributions of genes, gender and geometry.There are definite associations between MVP and several dominantly inherited connective tissue abnormalities; it occurs in 85% of adults with Marfan syndrome. All these contribute to a very small proportion of the MVP population. A larger less easily characterised group with dominant inheritance and some features of a connective tissue disorder awaits DNA studies for identification. For most MVP subjects our data define significant family aggregation consistent with polygenic inheritance; the likelihood of a first degree relative having MVP is about two and a half times the population average.There is a higher prevalence in young women than in men—5% versus 3%; this has also been demonstrated for floppy mitral valve (MV) at autopsy. MVP complications of chordal rupture, severe mitral regurgitation and infective endocarditis are, however, two to three times more common in men, are age related and evident after the age of 50 years. Higher blood pressure in men may contribute to this in accordance with a response‐to‐injury hypothesis to explain progressive valve changes.Leaflet, annulus and left ventricular size differences and septal changes are geometric variants with a potential for increasing tension‐related valve injury. Changes in excised floppy valves are consistent with ongoing repair in response to repetitive leaflet and chordal injury involving enhanced type III collagen gene expression and proteoglycan synthesis. This myxomatous change constitutes the final common pathway to serious mitral regurgitation and the rare occurrence of sudden death. The response‐to‐injury concept has implications for treatment to minimise progressive changes.
The APO A, B, a of coronary risk: back to kindergarten
Authors: Wilcken David E. L. , Wang Xing Li L. , Dudman Nicholas P. B. 
Published: March 2008

AbstractApproximately 1% of the population have a dominantly inherited lipid disorder predisposing to premature vascular disease. Apolipoproteins (Apo) B, and Al, the carrier proteins for the atherogenic low density lipoprotein (LDL) and the protective high density lipoprotein (HDL) cholesterol respectively are markers for these disorders, as is Apo(a), the unique carrier protein for lipoprotein(a). We assessed changes in these apolipoproteins during the first 12 years of life, aiming to detect young families with inherited dyslipidaemia and implement early prevention. Among 1032 consecutively born babies in whom levels were measured within their first week and at a mean age of 8.5 months, the Apo B/Al ratio and Apo(a) both tracked closely (p<0.01 and <0.0001). High B/Al ratios (>95 percentile) identified two families with familial hypercholesterolaemia, and infants with high Apo B identified two families with hyperapolipoprotein B. Apo(a) levels increased twofold between the first week and 8.5 months and were highly correlated (r = 0.73, p < 0.0001). Levels at 8.5 months were not different from parental values and were closely correlated with them. We then assessed school children aged eight to 12 years. In a pilot study (n—1400) we have established normal apolipoprotein values and distribution patterns and defined the 95th percentile for each. This study is continuing and parents of children with high levels are being recalled (with their children) for lipid measurements. Our findings indicate that our approach is feasible and has wide acceptance, and that measuring Apo B/A 1 and Apo(a) in childhood identifies families at increased cardiovascular risk. We have yet to assess the efficacy of our family‐based coronary prevention programme.
Trials and tribulations: the ISIS experience
Authors: Sleight Peter 
Published: March 2008

AbstractThe ISIS trials group has grown slowly over the last ten years and now includes about 1000 collaborating hospitals worldwide.The original stimulus came from the thesis of a research student, Salim Yusuf, a newly qualified Rhodes Scholar from India. Yusuf s thesis (begun in 1976) examined methods of measuring infarct size quantitatively and paved the way to a preliminary trial of i.v. atenolol in 477 patients in Manchester and Oxford.Richard Peto was consulted about the statistical aspects of a trial design and pointed out that most clinical trials at that time were hopelessly inadequate in size to have the power reliably to ascertain the value of moderate but medically worthwhile treatments in many common conditions. We thus developed much larger collaboration, which still continues to grow.Dr Rory Collins joined the Oxford Cardiac Department and the CTSU in 1981 and now is the coordinator of the ISIS trials, and co‐director with Richard Peto of the CTSU.Simple trials answer the questions rapidly and effectively. The mechanics of the trial do not hinder patient entry by participating doctors and nurses.The trials are mainly funded by industry, with ‘priming’ grants from the British Heart Foundation. Once the protocol is agreed the funding companies have no further input. The trials are planned and supervised by an international steering committee. Sir Richard Doll chairs the data monitoring committees.A brief overview of the three completed trials will be given, together with some peeps behind the scenes!
The push, the pull and the periphery
Authors: Oakley Celia M. 
Published: March 2008

AbstractIf the failing left ventricle could be given an effective push, other approaches to the treatment of heart failure would not be needed. We have inotropes only for short‐term parenteral use. We have no safe inotrope for chronic oral use. The effect of digitalis is only feeble and the phosphodiesterase inhibitors seem to increase mortality from sudden death.Diuretics are dramatic for acute pulmonary oedema and the mainstay for chronic fluid retention but do not improve the pump and by reducing blood volume stimulate the renin angiotensin system leading to vasoconstriction, further fluid retention and hypokalaemia. Nitrates drop pre‐load without reducing blood volume but tolerance is a problem and stroke volume does not increase.Reduction of afterload helps the failing ventricle to empty, the pull and output increases. The angiotensin converting enzyme inhibitors (ACEI) are now the cornerstone of heart failure treatment, reducing mortality in severe heart failure (CONSENSUS) and superior to standard vasodilator therapy (V‐HeFT‐2) at improving the survival of patients with mild to moderate heart failure. ACEI can reduce the incidence of ventricular ectopy and probably do this through improving left ventricular function, from decreasing sympathetic tone, reducing myocardial oxygen demand or increasing serum potassium but ACEI did not dimmish the incidence of sudden death in the SOLVD trial despite reducing mortality.Disappointingly little improvement in exercise tolerance and persistence of chronic fatigue in heart failure concentrated attention on the periphery. That the changes found in skeletal muscles are consequent upon the combination of inability to increase perfusion on exercise together with the effects of chronic inactivity are beyond question (though it has been suggested otherwise). Retraining by suitable daily exercise has been shown to improve exercise tolerance in chronic stable heart failure with restoration of lost oxidative fast muscle fibres and capillary network. Rest is no longer the order of the day.
Exercise testing? not at all
Authors: Jelinek Michael 
Published: March 2008

AbstractThe traditional approach to the ambulatory patient with suspected or definite coronary disease is to evaluate the clinical features, to perform non‐invasive tests for myocardial ischaemia, and to proceed, if necessary, to coronary angiography and coronary revascularisation. However, when the results of the exercise tests are discordant with the clinical classifications they are usually misleading as diagnostic tools. When the exercise lest is used to assist prognostication, the information provided overlaps with that available to the clinician and only the presence of ST segment depression is an independent prognosticator. The amount of ST segment shift has been found to be an inferior prognosticator to the severity of disease seen on a coronary angiogram and the latter allows for appropriate decisions to be made regarding coronary angioplasty or bypass surgery. A more appropriate use of exercise testing is as a gate for coronary angiography if there is real doubt or the nature of the chest pain or as an aid in therapeutic decisions if the coronary angiography interpretation is difficult.
Accuracy of a portable interpretive ECG machine in diagnosis of acute evolving myocardial infarction
Authors: O'Rourke M. F. , Cook A. , Carroll G. , Gallagher D. , Hall J. 
Published: March 2008

Abstract:From a study of 526 patients having automatic ECG analysis, criteria were established which diagnosed acute evolving Q wave myocardial infarction with 71% sensitivity and 98% specificity. Specificity was 100% when patients with known previous Q wave infarction were excluded. In pre‐hospital practice the high sensitivity and specificity were maintained. This method appears appropriate, when other criteria are met, for paramedic‐initiated pre‐hospital thrombolysis with remote supervision of a cardiologist by telephone. (Aust NZ J Med 1992; 22: 9–13.)
Acute stroke outcome: effects of stroke type and risk factors
Authors: Lefkovits J. , Davis S. M. , Rossiter S. C. , Kilpatrick C. J. , Hopper J. L. , Green R. , Tress B. M. 
Published: March 2008

Abstract:We studied 925 consecutive patients hospitalised with acute stroke to determine how stroke type, age, gender and risk factors influence acute, in‐hospital outcome. Stroke types included carotid territory cortical or large subcortical infarction (52%), vertebrobasilar infarction (12%), lacunar infarction (11%), intracerebral haemorrhage (16%), and subarachnoid haemorrhage (9%). Mean age (mean ± 1 SD) was 66 ± 15 years, but patients with cerebral infarction were older than those with cerebral haemorrhage. The prevalence of hypertension, diabetes mellitus and cardiac disease increased with age across all stroke types, while the prevalence of smoking decreased with age. Mortality was 19% overall, but varied significantly between stroke types, highest in intracerebral haemorrhage (34%), and lowest in lacunar infarction (1%). Age had a marked adverse effect on mortality, independent of stroke type, the probability of death increasing by 3 ± 0.5% per year from 20–92 years, whereas gender had no effect. Cardiac disease and diabetes were independent adverse prognostic factors (Odds Ratios 1.6 and 1.5 respectively). Cerebral haemorrhage, age, cardiac disease and diabetes all independently worsen acute stroke outcome. (Aust NZ J Med 1992; 22: 30–35.)