bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Elite Seniors Study
Authors: Nair B. , Hughes J. , Basta M. , Hardy D. , Crooks R. , Finucane P. , Fletcher P. , Silberberg J. 
Published: March 2008

Abstract Background: A descriptive study of self‐reported healthy elderly in Newcastle was undertaken for an adequate understanding of the normal characteristics of the elderly. Aims: We sought to determine the frequency of abnormal clinical, laboratory and echocardiographic findings in a self‐reported healthy elderly population. Methods: Volunteers aged greater than 75 years were recruited from active members of the region's bowling clubs. Forty‐five subjects with no self‐reported vascular or cardiac disease underwent clinical, laboratory and echocardiography assessment. Results: Minor cardiovascular abnormalities were frequently detected. Echocardiography correspondingly found a high frequency of haemodynamically insignificant degenerative valvular lesions. Doppler left ventricular filling pattern of abnormal relaxation was a universal finding. Conclusion: There is a high prevalence of age‐related echo‐Doppler abnormalities in the self‐reported healthy elderly with important implications for the interpretation of echo‐Doppler studies.
Bile acid malabsorption in HIV infected patients with chronic diarrhoea
Authors: Cramp M. E. , Hing M. C. , Marriott D. J. , Freund J. , Cooper D. A. 
Published: March 2008

Abstract Aims: To look for the presence of bile acid malabsorption in HIV infected patients with chronic diarrhoea and determine whether bile sequestering agents may have a role in palliating this common problem. Methods: Nineteen HIV infected patients with chronic diarrhoea (duration >one month) poorly controlled on conventional treatment were investigated using the seven day retention of 75seleno‐23‐homocholic acid taurine (SeHCAT) as a measure of bile acid loss from the enterohepatic circulation. Patients with evidence of bile acid malabsorption were offered cholestyramine. Results: Sixteen (84%) had evidence of bile acid malabsorption (<15% retention at seven days). Ten of the 16 patients with bile acid malabsorption had terminal ileal biopsies ‐six had ileitis and four normal histology, suggesting that malabsorption is not always related to terminal ileitis. Thirteen patients with bile acid malabsorption have been treated with cholestyramine and 11 have reported a symptomatic response. Conclusions: Bile acid malabsorption can be demonstrated in some cases of HIV associated chronic diarrhoea and we suggest a therapeutic trial of a bile sequestering agent in patients whose symptoms are not well controlled using conventional anti‐diarrhoeal agents.
Carboplatin dosing based on measurement of renal function — experience at the Peter MacCallum Cancer Institute
Authors: Millward M. J. , Webster L. K. , Toner G. C. , Bishop J. F. , Rischin D. , Stokes K. H. , Johnston V. K. , Hicks R. 
Published: March 2008

Abstract Background: Carboplatin is used in treating many types of cancer. Because renal excretion is the major variable determining the pharmacokinetics of this drug, a dosing formula based on glomerular filtration rate (GFR) has been proposed and is being increasingly used in carboplatin dosing. This method of dosing is critically dependent on accurate measurement of GFR. Aims: To report the experience at a single major oncology centre of carboplatin dosing based on GFR, and comparisons of different methods of measuring renal function for use in this dosing method. Methods: An initial group of patients (n=24) was studied where GFR was measured by Cr51EDTA clearance and compared to Tc99mDTPA clearance, measured 24 hour urine creatinine clearance and the Cockcroft and Gault formula. The carboplatin area under the plasma concentration versus time curve (AUC) was calculated using total platinum measured in a single blood sample assayed by flameless atomic absorption spectrophotometry. A subsequent patient group (n=16) was then studied using Tc99mDTPA clearance to measure GFR. Results: Carboplatin dosing using Cr51EDTA clearance to measure GFR was accurate (<25% difference between planned and measured AUC) in 87% of samples. Estimation of renal function using the Cockcroft and Gault formula correlated with Cr51EDTA clearance only in patients with GFR <100 mL/minute. The measured 24 hour urine creatinine clearance did not correlate with Cr51EDTA clearance. Using Tc99mDTPA clearance to measure GFR, carboplatin dosing was accurate in 81% of samples. Across a GFR range of 42–239 mL/minute, the Cr51EDTA and Tc99mDTPA clearances were closely correlated (r=0.98, slope of regression line=1.02). Conclusions: Carboplatin dosing using a pharmacological formula based on GFR produces accurate targeting of the carboplatin AUC. Tc99mDTPA clearance can be used to measure GFR instead of Cr51EDTA clearance, which is both more convenient and has potential cost savings. Estimates of renal function using the Cockcroft and Gault formula or measured 24 hour creatinine clearance are insufficiently accurate to use for carboplatin dosing.
Radiofrequency catheter ablation of left ventricular tachycardia in the normal heart
Authors: Hellestrand K. J. , Whalley D. W. 
Published: March 2008

Abstract Background: Radiofrequency (RF) catheter ablation is a safe and effective cure for many forms of supraventricular tachycardia. Its efficacy in the cure of right ventricular outflow tract tachycardia, and some forms of left ventricular tachycardia in patients with left ventricular dysfunction, has also been shown. In contrast limited data are available to assess the role of RF catheter ablation in treating idiopathic left ventricular tachycardia (ILVT), an unusual form of tachycardia occurring in patients without demonstrable heart disease. Aim: To examine the efficacy and safety of RF catheter ablation in patients with ILVT. Methods: Three patients without structural heart disease and with recurrent drug‐refractory ILVT (right bundle branch block and left axis morphology) underwent electrophysiologic study (EPS) to initiate and localise the site of origin of their VT. RF catheter ablation of the VT focus was performed, with success being defined as failure to reinduce VT during incremental infusion of isoprenaline. Results: In all three patients VT was inducible by rapid right atrial pacing and/or programmed ventricular stimulation, and could be terminated by intravenous verapamil. RF catheter ablation was successful in all patients. The site of successful ablation was common to each patient and was localised to the infero‐apical aspect of the left ventricular septum. It was characterised by the recording of the earliest presystolic ‘P’ potential during both sinus rhythm and induced ILVT. No complications occurred during the procedure. During follow‐up periods ranging from six to 12 months there were no symptomatic or documented episodes of recurrent ILVT. Conclusions: We conclude that ILVT can be safely and effectively cured by RF catheter ablation.
An audit of third generation cephalosporin prescribing in a tertiary care hospital
Authors: LeMire M. , Wing L. , Gordon D. L. 
Published: March 2008

Abstract Background: There is increasing resistance to commonly used antibiotics, including third generation cephalosporins, and an increasing cost burden. Aims: To assess the appropriateness of prescribing of third generation cephalosporin antibiotics in a tertiary teaching hospital. Methods: Prescriptions of third generation cephalosporins (ceftriaxone, cefotaxime and ceftazidime) to inpatients were identified prospectively by the Hospital Pharmacy Department for a six week period during May‐June 1994. Clinical data and indications were obtained from patient records and, when necessary, by interviewing the prescriber and by patient assessment. Criteria for appropriate prescribing were according to nationally accepted criteria outlined in the 1994–95 Antibiotic Guidelines handbook.All inpatients who were prescribed a third generation cephalosporin at Flinders Medical Centre for the duration of the audit period were eligible. This included medical, surgical, paediatric, obstetric and gynaecology inpatients. Results: Sixty‐five per cent of prescriptions for third generation cephalosporins were judged appropriate, 31% inappropriate and 4% doubtful. Inappropriate use was found particularly in the treatment of respiratory tract infections and abdominal sepsis, and in surgical prophylactic use. Conclusion: Third generation cephalosporin prescribing in a tertiary care teaching hospital is frequently inappropriate, as judged against widely available Australian guidelines.
Five year leukaemia‐free survival of 72% and 77% for early stage acute and chronic myeloid leukaemia treated by HLA‐identical sibling bone marrow transplantation
Authors: Atkinson K. , Downs K. , Dodds A. , Concannon A. , Milliken S. 
Published: March 2008

Abstract: Background: HLA‐identical sibling bone marrow transplantation is an accepted treatment for patients with acute myeloid leukaemia (AML) and chronic myeloid leukaemia (CML). We have recently reported improving results in HLA‐identical sibling transplant over the ten year period 1981‐1990. In this report we described the outcome in patients transplanted at St Vincent's Hospital, Sydney between 1989 and 1993. Aims: To determine the leukaemia‐free survival, transplant‐related mortality rate, and relapse rate for patients with AML or CML given HLA‐identical sibling marrow transplants between 1989 and 1993. Methods: Sixty‐two patients with AML or CML received high dose busulphan/cyclophos‐phamide chemotherapy followed by infusion of T replete, HLA‐identical sibling bone marrow. Cyclosporin/short methotrexate was utilised as prophylaxis for graft‐versus‐host disease, ganciclovir as prophylaxis for cytomegalovirus disease and cotrimoxazole as prophylaxis for Pneumocystis carinii pneumonia. Low dose intravenous heparin was used as prophylaxis for hepatic veno‐occlusive disease. Results: The five year disease‐free survival for patients with AML transplanted in first complete remission was 72% and for those with CML transplanted in first chronic phase was 77%. The relapse rate for AML transplanted in first complete remission was 15% and for CML in first chronic phase 0%. The transplant‐related mortality for AML transplanted in first complete remission was 16% and for CML transplanted in first chronic phase 23%. In contrast, the disease‐free survival, relapse rate and transplant‐related mortality for patients with AML transplanted outside first complete remission and for CML transplanted beyond first chronic phase was 17%, 57% and 57% respectively. Conclusions: The outcome for patients transplanted for early AML or early CML continues to improve and exceeds that obtainable by conventional therapy. The salvage rate is so low for patients transplanted in later stages of AML or CML that all patients less than 55 years of age with these diseases, who have a HLA‐identical sibling donor, should be offered bone marrow transplantation early in their disease course.
A cost‐effectiveness analysis of enalapril maleate in the management of congestive heart failure in Australia
Authors: Butler J. R. G. , Fletcher P. J. 
Published: March 2008

AbstractBackground: This study is motivated by the results of the SOLVD treatment trial (N Engl J Med 1991; 325: 293‐302) which demonstrated the clinical efficacy of enalapril in the treatment of congestive heart failure but did not undertake an economic evaluation of enalapril therapy.Aims: To undertake a cost‐effectiveness analysis of enalapril maleate versus placebo, in conjunction with conventional treatment, in the management of congestive heart failure in Australia.Methods: The published results from the SOLVD treatment trial are used to estimate the increase in survival, and the reduction in the number of hospitalisations, arising from the use of enalapril in the management of congestive heart failure. The costs of enalapril therapy are estimated using Australian data on the drug and non‐drug costs of enalapril therapy and the costs of hospitalisation.Results: Enalapril therapy increases mean survival in heart failure patients by 1.68 to 1.80 months. The average additional drug and non‐drug cost of enalapril therapy is estimated to be $1890 over a four year period, against which must be offset cost savings from a reduction in hospitalisations of $2060 to $2140. On balance, therefore, enalapril is cost saving, reducing health care costs for a congestive heart failure patient on average by SI70 to $250 over a four year period. This value is sensitive to estimates of cost offsets and of improved survival which can result in either a net cost saving with enalapril of approximately $1200 per patient or a net additional cost of up to $3000 per patient (over four years) or greater than $20,000 per life‐year saved.Conclusions: The addition of enalapril to conventional management of congestive heart failure in Australia should improve survival and may provide a net reduction in treatment costs compared with conventional management alone.
Prevalence of Helicobacter pylori infection in different ethnic groups in New Zealand children and adults
Authors: Fraser A. G. , Scragg R. , Metcalf P. , McCullough S. , Yeates N. J. 
Published: March 2008

Abstract Background: Helicobacter pylori infection is a major risk factor for peptic ulcer disease and gastric cancer. A study of patients with dyspepsia attending for gastroscopy showed significant differences in H.pylori seropositivity between ethnic groups. Aims: To determine the prevalence of H.pylori in children and adults in the community in different ethnic groups and to identify risk factors for infection. Methods: Serum samples (324) were randomly selected from a cross‐sectional survey of 11–12 year old school children with a high proportion of Maori and Pacific Island groups. Serum samples (579) were randomly selected from a cross‐sectional workforce survey of 5677 participants aged 40–64 years. Serum samples were tested for H.pylori IgG. Results: The percentage seropositivity in 11–12 year old children was European 7%, Maori/part Maori 21%, all Pacific Island groups 48% and for the workforce survey 35.8%, 57.4% and 73.2% respectively. Compared with Europeans the increased relative risk of seropositivity for H.pylori in Maori and Pacific Island participants was significant after adjusting for age and socio‐economic status (1.43 [1.13, 1.80] and 1.76 [1.43, 2.18]) respectively. The relative risk of H.pylori infection significantly increased with age, lower socio‐economic status and lower household income, but was not significantly associated with gender, alcohol or cigarette use. Conclusions: The high seroprevalence of H.pylori in Maori and Pacific Island groups is consistent with the differences in incidence of gastric cancer. H.pylori continues to be a common infection in Maori and Pacific Island school children. Ethnicity appears to be a risk factor for H.pylori independent of socio‐economic status.
Apolipoprotein E genotyping in Alzheimer's disease in an Australian sample
Authors: Yang J. G. , Poropat R. A. , Brooks W. S. , Broe G. A. , Nicholson G. A. 
Published: March 2008

Abstract Background: Several previous studies have reported an increased frequency of the E4 allele of the gene for Apolipoprotein (APOE4) in both familial and sporadic Alzheimer's disease (AD). We report the results of a study of this association in an Australian clinic‐based sample. Aim: To investigate the relationship between APOE4 frequency and AD in an Australian clinic‐based sample and compare the results with previous studies. Methods: Subject DNA was PCR amplified, enzymatically digested with Hhal and the resulting fragments electrophoretically separated. The genotypes were ascertained according to the resulting fragment sizes and the resulting allele frequencies analysed by calculating a z‐statistic for comparison of two proportions. Results: The frequency of the APOE4 allele was 53% in the AD group and 11% in the control group. This difference is statistically significant. There was no significant difference in E4 allele frequencies between AD subjects with a family history and those without. At least one E4 allele was found in 26/30 (87%) of AD patients and 10/50 (20%) of controls. The allele frequencies of the control subjects used in this study were found to be consistent with those of several previous studies. Conclusion: The frequency of the APOE4 allele was significantly higher in AD subjects than in unaffected controls. This provides further evidence of an association between APOE4 and both familial and sporadic AD.
Home and hospital intravenous therapy for two acute infections: an early study
Authors: Montalto M. , Dunt D. 
Published: March 2008

Abstract Aim: To study the severity, treatment and outcome of patients with cellulitis and pyelonephritis treated with intravenous antibiotics in either a hospital in the home unit (HHU) or traditional inpatient beds. Method: Retrospective case reviews were used. All patients with cellulitis and pyelonephritis from January 1995 until January 1996 who were assessed as appropriate for HHU care were included. Each HHU case was included. The traditional in‐hospital group was defined as patients who had been assessed as suitable for HHU, but who did not enter the HHU for non‐clinical reasons. Background variables were: patient age; patient gender; prior treatment with antibiotics; temperature on presentation; creatinine on presentation; leucocyte count on presentation; parenteral medication used; and pre‐existent conditions. Outcome variables were: number of days until febrifuge; total duration of stay; duration of in‐hospital stay; duration of HHU stay; patient incidents; and status at discharge. Results: The two groups exhibited similarities on patient and condition characteristics, although differences in the types of antibiotics used were found. A positive clinical outcome was achieved in every patient. In‐hospital duration of stay was briefer in the HHU groups. Discussion: These early results are encouraging for home intravenous therapy. Further studies, controlled trials if possible, are now required to establish these findings more definitively.
Activity and toxicity of docetaxel (Taxotere®) in women with previously treated metastatic breast cancer
Authors: Shapiro J. D. , Millward M. J. , Rischin D. , Davison J. D. , Michael M. , Francis P. A. , Ganju V. , Toner G. C. 
Published: March 2008

Abstract Background: Metastatic breast cancer is a major cause of cancer death in Australian women. Docetaxel is a new cytotoxic drug that has shown promise in the treatment of metastatic breast cancer in patients who have previously received other chemotherapy, particularly an anthracycline, and has recently been approved for marketing in Australia. Aim: To report the first Australian experience with docetaxel in a group of women with metastatic breast cancer. Methods: Patients with progressive metastatic breast cancer who had previously received other chemotherapy were treated with docetaxel 75 mg/m2 or 100 mg/m2 given as a one hour infusion every three weeks. All patients received oral dexamethasone for five days starting 24 hours prior to docetaxel as prophylaxis against fluid retention. The patients' response to docetaxel and toxicity were assessed by standard criteria. Results: Twenty‐six patients were treated. The major toxicity was neutropenia with 92% of patients experiencing at least one episode of grade 4 (absolute neutrophil count <0.5X109/L) neutropenia. Hospital admission for febrile neutropenia occurred in 44% of patients with one death from sepsis. Cumulative fluid retention was observed but in only one patient was it dose‐limiting. Apart from alopecia, other toxicities were infrequent and rarely serious. In 23 patients assessable for response, there were 11 partial responses (48%). Three other patients whose disease could not be assessed for response had clinical improvement. The median survival of all patients treated was eight months. Conclusions: The response rate observed with docetaxel is comparable to that seen in trials in the United States and Europe and confirms the high activity of this new cytotoxic agent. Neutropenia is the major toxicity, and consideration should be given to the use of prophylactic oral antibiotics or colony stimulating factors to try and prevent febrile episodes. Clinicians will need to balance the benefits, toxicities, and cost of docetaxel in determining the appropriateness of its use in their patients.
The natural history of left ventricular wall thickening in hypertrophic cardiomyopathy
Authors: Semsarian C. , French J. , Trent R. J. , Richmond D. R. , Jeremy R. W. 
Published: March 2008

Abstract Background: Hypertrophic cardiomyopathy (HCM) is associated with mutations of genes coding for major sarcomeric proteins, but the mechanism of hypertrophy is unknown. As hypertrophy may not develop until adolescence, an altered response to physiological growth stimuli may regulate the hypertrophy process. Aims: This study examined the relationship between age and changes in left ventricular (LV) wall thickness in patients with HCM. Methods: Forty‐three patients who had definite electrocardiographic and echocardiographic evidence of HCM were studied with serial 2D and M‐mode echocardiograms at least two years apart (mean interval 5.5±3.0 years). LV cavity dimensions, septal and posterior wall thicknesses, and LV mass indices were compared with data from an age‐ and gender‐matched control group. Results: In patients with HCM aged ten to 20 years (n=9), there was an increase in septal wall thickness during the study period from 15.9±6.2 mm to 19.3 ± 2.1 mm (p<0.01). This increase (3.4±2.5 mm) greatly exceeded the change in septal thickness observed in the control group between the ages often and 20 years (0.8±0.3 mm, p<0.01). There was a lesser increase in posterior wall thickness from 9.8±2.1 mm to 11.5±3.5 mm (p=0.07). In patients with HCM aged 21–40 years (n=11), there was also an increase in septal wall thickness during the study period from 16.0±2.2 mm to 17.8±3.0 mm (p<0.05), but no change in septal thickness in the control group. In contrast, the patients aged >40 years (w=23) showed no significant change in either septal or posterior wall thickness during the study period. LV mass index increased in the ten to 20 years age group from 128 ±24 g/m2 to 164±20 g/m2 (p=0.01), but this increase was not observed in the older age groups. Conclusions: LV hypertrophy is progressive, particularly in the septum, during adolescence and early adult life in patients with HCM. As progressive hypertrophy may continue after somatic growth has ceased, an abnormal myocardial response to physiological growth regulators is less likely to be the principal stimulus to hypertrophy. Gene‐gene interactions, changes in haemodynamic load or environmental factors may modulate the development of hypertrophy. Serial measurements of ventricular wall thickness in the first two decades of life, and probably until the fourth decade of life are advisable in patients suspected of having HCM.