bluuebunny/crossref_metadata_2025_split huggingface dataset:
Transfusion associated graft‐versus‐host disease after cardiac surgery: response to antithymocyte‐globulin and corticosteroid therapy
Authors: Prince M. , Szer J. , van der Weyden M. B. , Pedersen J. S. , Holdsworth R. F. , Whyte G. 
Published: March 2008

Abstract:A 63‐year‐old patient developed graft‐versus‐host disease (GVHD) after the transfusion of stored, random donor red cell concentrates with coronary artery surgery. The disease was characterised by skin rash, fever, diarrhoea, hepatic dysfunction, pancytopenia and the acquisition of cells bearing human leukocyte antigens of a blood donor. Clinical and histologic improvements were noted with antithymocyte‐globulin and corticosteroid therapy, as seen in some patients with acute GVHD following allogeneic bone marrow transplantation, but the pancytopenia failed to resolve prior to a fatal cerebral haemorrhage. Early aggressive immunosuppressive therapy may be beneficial for transfusion‐associated GVHD but strategies for its prevention, by limitation of the use of homologous blood need to be addressed.
Early and late results of surgery for Wolff‐Parkinson‐White syndrome
Authors: Rosenfeldt F. L. , Muller D. , Harper R. , Shardey G. C. , Broughton A. 
Published: March 2008

Abstract:Surgical treatment for accessory atrioventricular connections was performed in 60 patients with Wolff‐Parkinson‐White syndrome between 1981 and 1986. The initial procedure successfully divided 69 of 73 pathways identified preoperatively, including 39 of 40 left free wall pathways, 23 of 24 posteroseptal pathways, six of seven right free wall pathways, and one of two anteroseptal pathways. Three additional pathways were identified for the first time during follow‐up. The primary procedure was successful in curing 53 (88%) of the 60 patients and in dividing 69 (91%) of the total of 76 pathways. Subsequent procedures increased the overall clinical cure rate to 97%. The surgery was performed with low morbidity and no perioperative or late mortality. Patients were followed‐up for a mean of 6.4 years (range four to nine years). No patient showed clinical or electrocardiographic evidence of recurrence of a pathway which had been divided surgically. We conclude that regardless of pathway site, surgical treatment carries a low risk and has a high probability of avoiding lifelong antiarrhythmic therapy.
Mitral valve palpitations
Authors: Oakley Celia M. 
Published: March 2008

AbstractFew disorders ever provoked more interest and controversy than mitral valve prolapse (MVP). Past echocardiographic over‐diagnosis led to it becoming a whipping boy for otherwise unexplained chest pain, palpitation, arrhythmias and emboli. Surgical centres reported a high incidence of endocarditis and severe regurgitation.Most investigators who have studied the prevalence of arrhythmias in MVP have concluded that they are more common in this syndrome than in the general population and that there is a causal rather than a fortuitous relationship. However, the prevalence of arrhythmias in reported studies is probably higher than in unselected MVP patients.Multiple ventricular premature beats, ventricular tachycardia and sudden death have been reported. Suggested mechanisms have included a focal cardiomyopathy with incoordinate contraction and relaxation, QRS dispersion, a long QT, traction on papillary muscles by prolapsed leaflets, interference with the blood supply of the papillary muscles, stimulation of the endocardium by the chordae and diastolic depolarisation of muscle fibres in redundant leaflets with triggered repetitive automaticity. MVP has been associated with pre‐excitation giving rise to atrioventricular re‐entry tachycardia. Autonomic dysfunction and a hyperadrenergic state has been claimed and this may also be responsible for supraventricular arrhythmias including atrioventricular nodal re‐entry tachycardia, flutter and fibrillation. Electrophysiological studies have yielded contradictory results which may be due to the heterogeneity of the patients studied and variability of the mechanisms.Whatever the true prevalence, arrhythmias in MVP are usually benign. Syncope and sudden death are rare. Anti‐arrhythmic therapy is only warranted in patients with frequent and distressing symptoms shown to be due to the arrhythmias or when arrhythmias are judged potentially life threatening. Beta‐blockers are particularly helpful in the syndrome.
Optimising plasma lipids: public intervention versus high risk management
Authors: Nestel Paul J. 
Published: March 2008

AbstractA public health strategy carries more constraints than a high risk strategy because it targets both low risk and high risk individuals; this requires cautious intervention and hence achieves only a modest reduction in risk. Nevertheless, a modest population‐wide fall in the concentrations of atherogenic lipoproteins leads to substantial numbers of preventible heart attacks and deaths.Other strategic considerations are to lower non‐lipid cardiovascular risks (hypertension, clotting tendency) and to prevent other diet‐related disease (such as cancer) through interventions which lower plasma lipids. The major nutritional changes which achieve this are optimising energy balance, reducing total fats and saturated fatty acids and increasing plant foods which are rich sources of unsaturated fatty acids, fibre and antioxidants. Each of these contributes to optimising the low density lipoprotein (LDL) concentration.Antioxidants (vitamins C and E mainly) may inhibit LDL oxidation. The strategy for lowering plasma triglyceride, especially in the context of atherogenic lipoprotein phenotypes, is mainly through energy balance, reduced saturated fat and alcohol. Correcting overweight especially in those with abdominal obesity, may normalise raised plasma triglyceride, low high density lipoprotein (HDL), abnormal LDL and even glucose intolerance and hypertension, which may be associated.The scientific basis for the lipid optimising effects of the different nutrients will be discussed.
Cholesterol and coronary heart disease mortality
Authors: Sleight Peter 
Published: March 2008

AbstractThe epidemiological relation between increased levels of blood cholesterol and increased risk of future heart disease is clear, both within and between countries. These strong relationships have led to the adoption of consensus statements in most countries which recommend measures such as the reduction of dietary saturated fat/an increase in the polyunsaturated/saturated ratio and other dietary and sometimes drug methods to reduce serum cholesterol. There is controversy as to whether these measures should be targeted at individuals with high levels of cholesterol or whether there should be a public health approach to the whole population.The public and medical debate has become more heated since the data from intervention trials are conflicting. Taken overall the trials do appear to show reduction in risk of coronary which is stronger for non fatal, compared with fatal coronary events. Meta analysis suggests that increasing benefit accrues from larger reductions and also longer reductions in cholesterol by intervention. However, individual trials frequently show variable results and some, especially the recent 15 year follow up of a Finnish five year intervention (by diet, cholesterol lowering and blood pressure lowering drugs) was strikingly adverse—although the total number of events was not large.Total mortality is much harder to influence and the sum of the available trials is hopelessly inadequate in size to address these questions.As a result confusion abounds and is unlikely to be clarified by the present on going trials. The need for more data is clear. The pilot study for the Oxford Cholesterol Study will be presented as a prelude for a proposed main study in about 20 000 high risk individuals.
Remodelling of the heart after myocardial infarction
Authors: White Harvey D. 
Published: March 2008

AbstractIn the first few hours after the onset of coronary occlusion the infarct zone stretches due to myocyte slippage. Subsequently the noninfarct zone develops volume overload hypertrophy with series addition of new sarcomeres and fibre elongation.Dilatation is detrimental as it increases ventricular wall stress and oxygen demand, and re‐entry of electrical impulses may be influenced by stretching of the ischaemic scar resulting in ventricular fibrillation.Left ventricular remodelling and dilatation is a progressive process which begins early and continues in the months after infarction. The major determinants of the extent of remodelling are infarct size and patency of the infarct‐related artery.Late reperfusion may reverse initial infarct dilatation and decrease left ventricular volumes by inducing calcium‐activated contracture of the actomyosin complex. Expansion may also be inhibited by acceleration of healing, splinting of the infarct zone by salvage of subepicardial cells, and blood in the coronary arteries and veins supporting the infarct zone.End‐systolic volume is the strongest predictor of long‐term prognosis after infarction. A number of therapies including thrombolysis, angiotensin‐converting enzyme (ACE) inhibition and nitrates have been shown to decrease left ventricular dilatation. The optimal time for commencement, dose, duration and the effects of combinations of therapy are yet to be determined.
The importance of assessing time‐course behaviour of abnormal ST/T changes after exercise
Authors: Barlow Clifford W. , Friedman Brian M. , Barlow John B. , Soicher Evan R. 
Published: March 2008

AbstractRoutine stress electrocardiography has been criticised for yielding too many so‐called 'false‐positive' results because ST/T changes that develop during and after exercise are prevalent. Recent studies in our institution indicate, however, that the time‐course behaviour patterns of these ST/T configurational ‘abnormalities’ after exercise are different from those reflecting myocardial ischaemia due to epicardial coronary artery disease (CAD). Time‐course analysis increases the predictive value of exercise testing and has dramatically decreased the number of asymptomatic subjects or symptomatic patients at low risk of having CAD being subjected to coronary arteriography in our institution.Our method of assessing post‐exercise time course patterns of abnormal ST/T are described in detail. Ischaemic ST/T abnormalities have late onset, early offset or early onset, late offset whereas those ST/T changes associated with normal epicardial coronary arteries have late onset, late offset or early onset, early offset post‐exercise time course patterns.
Heart failure: to digitalise or not? The view against
Authors: White Harvey D. 
Published: March 2008

AbstractDespite extensive clinical experience the role of digoxin is still not well defined. In patients with atrial fibrillation digoxin is beneficial for ventricular rate control. For patients in sinus rhythm and heart failure the situation is less clear.Digoxin has a narrow therapeutic:toxic ratio and concentrations are affected by a number of drugs. Also, digoxin has undesirable effects such as increasing peripheral resistance and myocardial demands, and causing arrhythmias.There is a paucity of data from well‐designed trials. The trials that are available are generally small with limitations in design and these show variation in patient benefit. More convincing evidence is required showing that digoxin improves symptoms or exercise capacity. Furthermore, no trial has had sufficient power to evaluate mortality. Pooled analysis of the effects of other inotropic drugs shows an excess mortality and there is a possibility that digoxin may increase mortality after myocardial infarction (MI).Angiotensin‐converting enzyme (ACE) inhibitors should be used first as they are safer, do not require blood level monitoring, modify progression of disease, relieve symptoms, improve exercise tolerance and reduce mortality.Caution should be exercised in using digoxin until large mortality trials are completed showing either benefit or harm. Until then digoxin should be considered a third‐line therapy.
Mortality in systemic lupus erythematosus: active disease is the most important factor
Authors: Cohen M. G. , Li E. K. 
Published: March 2008

Abstract:Although systemic lupus erythematosus (SLE) no longer has the very poor prognosis that it had 50 years ago, there remains a significant mortality. We were able to determine the causes of death in 27 of the 29 patients with SLE who died over the period 1985 to 1989. This represents one and five year mortality of six and 24% respectively. In common with other studies, sepsis was a major factor, being implicated in the deaths of 37% of our patients. However, sepsis (i) occurred almost exclusively in patients with active SLE; (ii) often occurred after prolonged hospitalisation; and (iii) was a terminal event in otherwise fatal SLE in several patients. Overall, active disease was determined to be a cause of death in 67% of the patients. An unexpected observation was the finding that active cardiopulmonary disease accounted for 37% of deaths. Although late mortality from degenerative vascular disease is being increasingly reported with the modern prolonged SLE survivorship, it was identified in only one patient. We conclude that active disease remains the most important factor in mortality in SLE. (Aust NZ J Med 1992; 22: 5–8.)
Amiodarone pulmonary toxicity — three unusual manifestations
Authors: McNeil K. D. , Firouz‐Abadi A. , Oliver W. , Zimmerman P. V. 
Published: March 2008

Abstract:Amiodarone is very useful treatment for refractory arrhythmias. However, it has a wide profile of adverse effects involving a number of organ systems. Pulmonary toxicity is the most serious of these side effects and often limits its clinical use.Three patients with unusual forms of amiodarone pulmonary toxicity are described. One had extensive unilateral alveolar disease, another pleural effusion, and in a third the pulmonary infiltrate improved with oral corticosteroids despite continuation of amiodarone therapy. Extensive unilateral alveolar disease and resolution of the pulmonary toxicity with corticosteroids despite continuing with amiodarone have not been previously reported. Pleural effusion has been noted only rarely. With the increasing use of amiodarone, pulmonary toxicity is likely to occur more frequently and it is important to be aware of its less common manifestations. (Aust NZ J Med 1992; 22: 14–18.)
Isolated hepatitis B core antibody — can response to hepatitis B vaccine help elucidate the cause?
Authors: McIntyre A. , Nimmo G. R. , Wood G. M. , Tinniswood R. D. , Kerlin P. 
Published: March 2008

Abstract:The finding of a positive hepatitis B core antibody (anti‐HBc) in the absence of hepatitis B surface antigen (HBsAg) or fiepatitis B surface antibody (anti‐HBs) is relatively uncommon. This finding is known to occur during the ‘window period’ of acute hepatitis B between loss of HBsAg and the appearance of anti‐HBs. It may also occur with active infection or following resolution. The aim of this study was to determine if response to hepatitis B vaccination would allow the separation of these subgroups of patients with isolated anti‐HBc. Seventeen patients with persistent isolated core antibody were vaccinated and serum obtained at 2,4 and 8 weeks. Results were compared with a seronegative control group. Six subjects (35%) but no control patients (p = 0.016) responded with a titre of>50mIU/mL at two weeks, suggesting an anamnestic response due to prior infection and immunity. A further seven subjects (41%) finally seroconverted (anti‐HBs titre > 10mIU/mL) thus excluding chronic infection and suggesting initial false positive results. Only two subjects did not respond to a full course of vaccination, but neither they nor any other subjects were positive for HBV DNA. These results indicate that hepatitis B vaccination and subsequent measurement of anti‐HBs will identify evidence of past infection in the form of an anamnestic response in up to one third of the patients and will also exclude chronic infection on the grounds of a normal vaccine response in a majority of the remainder. (Aust NZ J Med 1992; 22: 19–22.)
Investigation of pleural effusion: the role of bronchoscopy
Authors: Upham J. W. , Mitchell C. A. , Armstrong J. G. , Kelly W. T. 
Published: March 2008

Abstract:To assess the place of bronchoscopy in the investigation of pleural effusion, 245 patients presenting during a two year period were reviewed. Of the 46 patients who had bronchoscopy, a positive yield was obtained in 13, though in five of these a second pleural aspiration was also diagnostic. Bronchoscopy was more likely to be diagnostic in patients presenting with a cough (12/24) than in those with no cough (1/22) (p<0.001), and in those whose chest X‐ray revealed significant radiological abnormalities such as hilar enlargement, lung mass or persisting consolidation (12/29), than in those without such changes (1/17) (p<0.01).Bronchoscopy has a limited role in the investigation of pleural efision. The presence or absence of cough, and the appearance of the chest X‐ray, are both important considerations when planning the investigation of an undiagnosed pleural effusion. (Aust NZ J Med 1992; 22: 41–43)
Late presentation and development of nephrocalcinosis in primary hyperoxaluria
Authors: Irish A. B. , Doust B. 
Published: March 2008

Abstract:A case of primary hyperoxaluria type 1 with complete deficiency of alanine:glyoxalate aminotransferase that first manifested at the age of 59 with irreversible acute on chronic renal failure is reported. Nephrocalcinosis, initially absent, developed rapidly after renal failure evolved. The possible role of hypovolaemia and contrast nephrotoxicity in precipitating the clinical onset is discussed. Primary hyperoxaluria should be considered in patients of any age presenting with unexplained renal failure, and appropriate systemic pathology of oxalosis. (Aust NZ J Med 1992; 22: 48–50.)
Microscopic polyarteritis presenting with chest infections and acute appendicitis
Authors: Li Philip K. T. , Lai F. M. , KO G. T. C. , Lai K. N. 
Published: March 2008

Abstract:We describe a 38‐year‐old male with antineutrophil cytoplasmic auto‐antibody (ANCA) positive microscopic polyarteritis who presented with recurrent chest infections, lung haemorrhage, renal insufficiency and acute appendicitis. Appendectomy was followed by resolution of abdominal symptoms and the surgical specimen revealed vasculitis of the serosal vessels. A renal biopsy was performed because of impaired renal function and this revealed focal necrotising glomerulonephritis with absence of immune deposits. Chest infections were treated with antibiotics resulting in partial clinical response, but pulmonary symptoms relapsed and a complete resolution was achieved only after plasma exchange and the administration of cyclophosphamide. Our observation emphasises the protean manifestations of microscopic polyarteritis and the relationship between ANCA and disease activity. (Aust NZ J Med 1992; 22: 56–59.)
The safety and economic advantages of day case electrophysiologic studies
Authors: May C. D. , Davis M. J. E. 
Published: March 2008

Abstract:Electrophysiologic Studies (EPS) have been performed as ‘day case’ procedures in selected patients at Royal Perth Hospital since April 1987. Previously, EPS had involved hospitalisstion for two to ten days. During the 51 month period to June 1991, 484 EPS were performed in total. of these, 153 (105 males and 48 females aged 46±31y) wen day case procedures.Studies were baseline in 60 cases and included drug evaluation in 30. Sixty‐one additional studies were performed solely to evaluate therapy. Twenty‐one patients required cardioversion. One hundred and fifty one patients were discharged on the same day and two required prolonged observation.The financial cost savings to the hospital for day case EPS is estimated to be $115 per patient and to the community potentially a further $108 per patient. This study demonstrates that in selected patients undergoing elective EPS, day case management is a safe and economic alternative to hospital admission.
Lipoprotein(a) levels in chronic renal disease states, dialysis and transplantation
Authors: Irish A. B. , Simons L. A. , Savdie E. , Hayes J. M. , Simons J. 
Published: March 2008

Abstract:Lipoprotein(a) is an independent risk factor for cardiovascular disease. Lipoprotein(a) levels were measured in 196 patients (103 Male [M]: 93 Female [F]) with chronic renal diseases and in 116 controls. Median levels of Lipoprotein(a) [Lp(a)] were found to be significantly elevated in patients with untreated chronic renal disease (285, 285 mg/L; M, F; range 30–1675 mg/L) and in those treated with continuous ambulatory peritoneal dialysis (320, 603; M, F; range 50–1450) compared with controls (70, 51; M, F; range 1–750; p<0.01 Males, p<0.001 Females). Lp(a) levels in patients treated by haemodialysis (133, 35; M, F; range 5–685) and renal transplantation (100, 95; MJF; range 10–1700) were not significantly different from controls. Lipoprotein(a) levels correlated inversely with serum albumin in the combined dialysis group (r= ‐034, p < 0.001), and with urinary protein loss in the combined transplant and chronic renal diseases groups (r = 0.29, p <0.01). This correlation of Lp(a) with protein metabolism suggests a similarity with changes in other apolipoprotein‐B containing lipoproteins in nephrosis. These findings may be relevant to the increased risk of atherosclerosis in patients with chronic renal disease and to their optimum mode of renal replacement therapy. (Aust NZ J Med 1992; 22:243–248.)
Co‐existence of coeliac disease and insulin‐dependent diabetes mellitus in children: screening sera using an ELISA test for gliadin antibody
Authors: Gadd S. , Kamath K. Ramanand , Silink M. , Skerritt J. H. 
Published: March 2008

Abstract:The prevalence of coeliac disease in children with insulin‐dependent diabetes mellitus was investigated using a screening test of serum for antigliadin antibody by ELISA. One hundred and eighty (180) unselected diabetic children were screened for IgA and IgG class antigliadin antibodies (AGA); children with either grossly elevated or slightly elevated AGA had small bowel biopsies. The four children with the highest IgA AGA had total villous atrophy. These four children were considered to have unsuspected coeliac disease. The prevalence of coeliac disease in this group of children was one in 45. Anri‐gliadin IgA and IgG tests are suitable for screening children at high risk of having coeliac disease.
Fungal Pseudoallescheria boydii lung infiltrates unresponsive to amphotericin B in leukaemic patients
Authors: Walsh M. , White L. , Atkinson K. , Euno A. 
Published: March 2008

Abstract:The management of patients with acute leukaemia is often complicated by serious fungal infections, especially of the lungs. The outcome of therapy has historically depended on the early use, efficacy and tozicity of amphotericin B. Pseudoalksdttria boydii is an uncommon cause of such infections but as it is more often resistant to amphotericin B. early identification may enable the prompt use of alternative and newer antifungal agents. Here we report our experience and review the literature in three cases of P. boydii infection in patients with kukeamia, showing unique features such as childhood and central nervous system disease, positive blood cultures and response to itraconazole.