bluuebunny/crossref_metadata_2025_split huggingface dataset:
A PCR‐based method of screening individuals of all ages, from neonates to the elderly, for familial hyperaldosteronism type I
Authors: Stowasser M. , Gartside M. G. , Gordon R. D. 
Published: March 2008

Abstract Aim: Unless specifically treated (glucocorticoids in low doses), Familial Hyperaldosteronism Type I (FH‐I) may result in early death from stroke. We report the successful application of a rapid, polymerase chain reaction (PCR)‐based method of detecting the ‘hybrid’ 11β‐hydroxylase (11β‐OHase)/aldosterone synthase (AS) gene as a screening test for FH‐I. Methods:‘Long‐PCR’ was used to amplify, concurrently, a 4 kb fragment of AS gene (both primers AS‐specific) and a 4 kb fragment of the hybrid gene (5' primer 11β‐OHase‐specific, 3' primer AS‐specific) from DNA extracted from blood either collected locally or transported from elsewhere. Sample collection and transport were straightforward. This 4 kb fragment contains all the currently recognised hybrid gene ‘crossover’ points. Results: Within a single family, long‐PCR identified all 21 individuals known to have FH‐I. Hypertension was corrected in all 11 treated with glucocorticoids. Nine with normal blood pressure are being closely followed for development of hypertension. Long‐PCR cord blood analysis excluded FH‐I in three neonates born to affected individuals.Long‐PCR newly identified two other affected families: (1) a female (60 years) with a personal and family history of stroke and her normotensive daughter (40 years), and (2) a female (51 years) previously treated for primary aldosteronism with amiloride, her two hypertensive sons (14 and 16 years) and her hypertensive mother (78 years).No false negative or false positive results have yet been encountered. At least seven other centres have successfully performed this test. Conclusion: Long‐PCR is a reliable method of screening individuals of all ages for FH‐I.
Socio‐economic disadvantage, quality of medical care and admission for acute severe asthma
Authors: Kolbe J. , Vamos M. , Fergusson W. 
Published: March 2008

Abstract Background: In asthma, socio‐economic and health care factors may operate by a number of mechanisms to influence asthma morbidity and mortality. Aim: To determine the quality of medical care including the patient perception of the doctor‐patient relationship, and the level of socio‐economic disadvantage in patients admitted to hospital with acute severe asthma. Methods: One hundred and thirty‐eight patients (15–50 years) admitted to hospital (general ward or intensive care unit) with acute asthma were prospectively assessed using a number of previously validated instruments. Results: The initial subjects had severe asthma on admission (pH=7.3±0.2, PaCO2=7.1 ±5.0 kPa, n=90) but short hospital stay (3.7±2.6 days). Although having high morbidity (40% had hospital admission in the last year and 60% had moderate/severe interference with sleep and/or ability to exercise), they had indicators of good ongoing medical care (96% had a regular GP, 80% were prescribed inhaled steroids, 84% had a peak flow meter, GP measured peak flow routinely in 80%, 52% had a written crisis plan and 44% had a supply of steroids at home). However, they were severely economically disadvantaged (53% had experienced financial difficulties in the last year, and for 35% of households the only income was a social security benefit). In the last year 39% had delayed or put off GP visit because of cost. Management of the index attack was compromised by concern about medical costs in 16% and time off work in 20%. Conclusion: Patients admitted to hospital with acute asthma have evidence of good quality on‐going medical care, but are economically disadvantaged. If issues such as financial barriers to health care are not acknowledged and addressed, the health care services for asthmatics will not be effectively utilised and the current reductions in morbidity and mortality may not be maintained.
Adult acute leukaemia ‐ a retrospective study of 66 consecutive patients
Authors: Shapiro J. , Brown S. , Briggs P. , Stanley R. , Griffiths J. , Brodie G. , Richardson G. 
Published: March 2008

Abstract Background: Advances in therapy and supportive care have improved the outlook for many patients with acute leukaemia, however elderly patients have increased treatment‐related toxicity and shorter survival. Most clinical trials have selected patient populations with young median ages and it is therefore difficult to apply results to the general population where the majority of patients presenting with acute leukaemia are over 60 years. There is little information in the literature guiding appropriate treatment of these patients. Aims: To determine the relationship between age, treatment received, and outcome in patients presenting with acute leukaemia. Methods: A retrospective analysis was performed on all patients presenting to Prince Henry's Hospital and Monash Medical Centre with acute myeloid leukaemia (AML) or acute lymphocytic leukaemia (ALL) during a five year period. Results: Sixty‐six patients (51 ‐ AML, 15 ‐ ALL) presented with acute leukaemia between March 1989 and April 1994. Median patient age was 63 years; 32% of patients received supportive therapy only; 86% of patients with ALT, and 58% of patients with AML commencing remission‐induction chemotherapy entered a complete remission. Median survival for patients receiving only supportive therapy was three months. Median survival in patients under 55 years was almost twice as long as patients over 55 years receiving similar treatment (AML ‐ eight vs four months p=0.023; ALL ‐ 3.5 vs seven months p=0.029). Conclusions: Median survival for acute leukaemia is inversely proportional to age. Applying results from selected series to elderly patients with acute leukaemia is inappropriate.
Exercise vascular responses in health and disease
Authors: Thomson Helen 
Published: March 2008

Abstract In normal subjects during exercise, there is vasoconstriction of non‐exercise resistance vessels and an increase in blood pressure. We have investigated patients with vasovagal syncope with structurally normal hearts and patients with hypertrophic cardiomyopathy compared with normal controls and found a failure of vasoconstriction in both patients with vasovagal syncope and hypertrophic cardiomyopathy compared with normals and this has been associated with exercise hypotension. An association between exercise hypotension and sudden death has previously been reported in hypertrophic cardiomyopathy. We speculate that in patients with vasovagal syncope and structurally and electrically normal hearts, exercise hypotension is well tolerated, but in patients with structurally abnormal hearts, exercise hypotension can have catastrophic consequences.
The importance of the autonomic nervous system in health and disease*
Authors: Sleight Peter 
Published: March 2008

AbstractBaroreceptor control of the circulation is now generally thought to be concerned only with short term buffering of changes in arterial pressure, rather than with long term setting of pressure levels. This paper reviews evidence to the contrary, which suggests that impairment of the baroreflex, either by local changes in the carotid sinus or by environmental or genetic influences working through cortical modulation of the reflex gain, may have an important influence on long term arterial pressure.Further interest in the baroreflex has been revived by the demonstration in several large studies that autonomic control, measured either by baroreflex sensitivity (BRS) or heart rate variability (HRV), is a powerful independent prognostic factor, which adds to other clinical measures of risk stratification in patients with left ventricular damage, or who have survived a myocardial infarction.The inter‐relationships are complex, poorly understood, and subject to many confounding factors. Nevertheless, BRS and HRV are promising techniques. Further understanding holds out the hope of new therapeutic approaches to these patients.
Interventional management of acute myocardial infarction (AMI)
Authors: Bett John H. Nicholas 
Published: March 2008

AbstractThe best way to limit infarct size and improve survival in patients with early heart attacks is to restore as quickly as possible patency in the infarct‐related artery and blood flow to the threatened myocardium. The value of thrombolytic therapy and aspirin has been shown in large clinical trials. A regimen of accelerated recombinant tissue plasminogen activator is more effective than those using streptokinase. In older patients, there is a greater risk of haemorrhagic stroke; nevertheless, thrombolytic treatment saves more lives because the mortality of myocardial infarction (MI) is higher.Thrombolytic therapy fails to restore blood flow sufficiently rapidly or completely in nearly one‐fifth of patients. Its efficacy, therefore, has been compared with immediate or direct angioplasty (PTCA). If it can be done promptly enough, PTCA is superior in preventing recurrent ischaemia and the combined outcome of death or non‐fatal reinfarction, and is associated with a lesser risk of intracranial haemorrhage. It may also be cheaper because patients spend less time in hospital and fewer of them require late revascularisation. PTCA should be considered for patients with cardiogenic shock or for those in whom there is a contraindication to thrombolytic therapy.The benefits of prompt treatment have been reduced by excessive delay in reaching hospital and door‐to‐needle time.After fibrinolysis, coronary angiography and PTCA may be reserved for those with spontaneous angina or exercise‐induced ischaemia.
Diabetic ketoacidosis in adults at Auckland Hospital, 1988–1996
Authors: Bagg W. , Sathu A. , Streat S. , Braatvedt G. D. 
Published: March 2008

Abstract Background: Diabetic ketoacidosis (DKA) is associated with significant morbidity and mortality. Recent evidence suggests that patients with both type 1 and type 2 diabetes can develop DKA. Aim: To review the experience in managing patients admitted to Auckland Hospital with DKA over an eight year period. Methods: A retrospective chart review was undertaken to identify patients with a discharge code of DKA admitted to Auckland Hospital between May 1988 and October 1996. Results: One hundred and twenty‐five patients were identified who met the defined criteria for DKA. The in‐patient mortality for the group was 2.4%. Thirteen patients (10.4%) probably had type 2 diabetes. Thirty‐eight (30.4%) patients were admitted to the Department of Critical Care Medicine (DCCM) ‐ these patients had a significantly lower systolic blood pressure and arterial pH, together with a significantly higher admission blood glucose and longer duration of insulin infusion than those not admitted to DCCM. Following their index admission 25% of patients were readmitted to hospital with DKA during the study period. Errors in insulin self‐administration that contributed to admission to hospital with DKA were identified in 61% of the patients with known diabetes. Conclusions: Patients with DKA in this study spent about a week in hospital and a significant proportion were admitted to the DCCM. In spite of this the overall mortality was low. Many of these patients were readmitted to hospital with DKA. A small number of patients with DKA may have type 2 diabetes and may not need long term insulin therapy. More effort on patient education regarding insulin use with illness, may prevent admission to hospital with DKA.
A phase II study of liposomal doxorubicin in the treatment of HIV‐related Kaposi's sarcoma
Authors: Newell M. , Milliken S. , Goldstein D. , Lewis C. , Boyle M. , Dolan G. , Ryan S. , Cooper D. A. 
Published: March 2008

Abstract Objectives: To evaluate the toxicity and clinical efficacy of liposomal encapsulated doxorubicin (DOX‐SL) in the treatment of HIV‐related Kaposi's sarcoma (KS). Methods: DOX‐SL 20–40mg/m2 was administered by intravenous infusion over 30–60 minutes every two weeks. Toxicity was assessed in all patients and response assessed in patients who completed two or more cycles of therapy. Results: Twenty‐five patients with KS were enrolled. Nine had received previous KS chemotherapy but only one prior anthracycline therapy. Eighteen patients had CD4 counts <50/mm3. Eight had pulmonary and/or visceral KS. A total of 191 cycles were given, median 6, range 1–33. Twenty patients completed two or more cycles and were considered evaluable for efficacy. A defined response occurred in 11 patients, nine achieving a partial response and two a complete response. The median duration of response was 120 days and the median time to disease progression was 187 days. Acute toxicity was minimal, except in one patient who had generalised erythema, hypotension and diaphoresis within ten minutes of starting DOX‐SL infusion. Grade 3 or 4 neutropenia occurred in 13.6 and 3.7% of cycles respectively. Neutropenic sepsis secondary to drug therapy was not reported. Alopecia and gastrointestinal symptoms were mild and infrequent. No cardiac toxicity was seen. Nine/25 patients developed HIV‐associated illnesses while on study (three Pneumocystis carinii pneumonia, two systemic Cytomegalovirus infection, three cryptosporidiosis, one Mycobacterium avium intracellulare‐(MAC) infection). Median survival in the evaluable patients was 219 days. Conclusions: DOX‐SL is an effective and well tolerated palliative therapy in AIDS‐related KS.
Percutaneous transseptal mitral valvotomy‐progress report
Authors: McCredie R. M. , Hill A. T. , Allan R. M. , Black I. W. 
Published: March 2008

Abstract Background: Percutaneous transseptal mitral valvotomy (PTMV) has been established as an alternative to surgery in the treatment of mitral stenosis. Aim: To review our experience in the first 200 attempted PTMV procedures in patients with mitral stenosis, and the short and medium term follow‐up. Methods: PTMV was attempted on 200 occasions in 189 patients with significant mitral stenosis between May 1988 and May 1994. There were 156 females and 33 males, mean age 53.5 years (range 14 to 83 years). Six patients were pregnant at the time of the procedure. Results: Valve split was achieved at the initial attempt in 183/189 procedures (97%). Clinical improvement of at least one New York Heart Association (NYHA) functional class was achieved in 172/189 patients (91%). The mean mitral valve gradient (mean±SD) decreased from 11.5±5.1 mmHg to 4.9±4.1 mmHg, mean cardiac output rose from 3.9±1.1 L/minute to 4.4±1.4 L/minute and mean calculated mitral valve area increased from 1.0±0.3 cm2 to 2.1±0.9 cm2. Ten patients developed clinically significant mitral incompetence requiring surgical mitral valve replacement. There were two transient cerebral embolic events. Small atrial septal defects were detected echocardio‐graphically in 42 patients, but none has been a clinical problem. There were no early deaths; there were 11 late deaths, four of which were non‐cardiac. Twenty patients have had repeat PTMV for re‐stenosis, four to 67 months after the first. Conclusions: PTMV provides significant haemodynamic and clinical improvement with low risk and should be considered the treatment of choice in patients with mitral stenosis.
Plasma leptin in relation to regional body fat in older New Zealand women
Authors: Taylor R. W. , Goulding A. 
Published: March 2008

Abstract Background: Leptin is the protein product of the obesity (ob) gene and is produced in adipose tissue. Plasma leptin values are highly correlated with total body fat mass but less is known concerning relationships of leptin with regional adiposity. Aim: To investigate associations between leptin and dual energy X‐ray absorptiometry (DEXA) measures of regional body fat deposition in older New Zealand women. Methods: Body composition was measured in 80 women aged 40 to 79 years (20 in each decade) using DEXA. Height and weight were measured by conventional anthropometry. Plasma leptin concentrations were assayed by radioimmunoassay. Results: Leptin was strongly correlated (p<0.001) with weight (r=0.751), body mass index (r=0.782), total fat mass (r=0.854) and % fat mass (r=0.813). A statistical model with trunk fat (kg) and leg fat (kg) as the independent variables showed that trunk fat accounted for 72.1% of the variance in plasma leptin with leg fat explaining only a further 1.6% of the variance. No relationships were found between leptin and age, height, lean tissue mass or menopausal status (p>0.05). Conclusions: We conclude that trunk fat explains more of the variance in circulating leptin concentrations than leg fat, suggesting that the propensity to leptin resistance may be increased in women with higher central adiposity.
Management of patients with diabetes after heart attack: A population‐based study of 1982 patients from a heart disease register
Authors: Lim L. L‐Y. , Tesfay G. M. , Heller R. F. 
Published: March 2008

Abstract Background: Previous studies examining the management of patients with diabetes after acute myocardial infarction (AMI) have been based on clinical studies under experimental conditions. We used data from a population‐based heart disease register to document differences in the management after AMI between patients with and without diabetes. Hypothesis: There were no differences in the prescription rates of aspirin, beta blockers, streptokinase, ACE inhibitors and calcium channel blockers between patients with and without diabetes admitted to hospital with AMI. Methods: A retrospective study of 268 patients with, and 1714 patients without, diabetes discharged from hospital with ‘definite’ AMI between August 1988 and March 1994. Results: The prescription rates of all five drug classes increased between 1988 and 1994 both for patients with and without diabetes. Patients with diabetes were significantly less likely to have been prescribed aspirin (76%vs 85%), beta blockers (41%vs 53%) and streptokinase (25%vs 43%) but more likely to have been prescribed ACE inhibitors (47%vs 29%) and calcium channel blockers (50%vs 40%). The differences in prescription rates were statistically significant after controlling for age, sex, history of ischaemic heart disease, smoking status, educational level and disease severity. Conclusion: Patients with diabetes were less likely to have been prescribed three of the five drug classes where evidence points to a beneficial effect after AMI. Further work is needed to identify the reasons for the disparity between management of patients with and without diabetes, and to develop effective strategies to increase the implementation of best practice guidelines in the management of patients with diabetes after AMI.
Can we improve on front‐loaded alteplase (r‐TPA)?
Authors: Aylvoard Philip 
Published: March 2008

AbstractThe method of administration of alteplase has evolved since its introduction to clinical practice in the late 1980s. The initial dosage regimen of a graded administration of 100 mg was replaced by the front‐loaded weight adjusted regimen, the efficacy of which was demonstrated in the GUSTO 1 trial.Double bolus administration was shown to achieve superior TIMI 3 patency of the infarct related artery in a small angiographic study, but the COBALT trial failed to show equivalence and indeed showed a slightly higher mortality and incidence of stroke, so cannot be recommended.Reteplase, a deletion mutant of alteplase, also showed superior efficacy in achieving coronary patency but no clinical superiority in outcomes in the 15,000 patient GUSTO 3 trial. The case of administration of reteplase, however, has some attraction as an alternative to alteplase. Trials of newer agents based on further modifications of alteplase are ongoing, but at present the front‐loaded alteplase regimen remains the standard for clinical practice.
New antiplatelet agents
Authors: White Harvey D. , French John K. , Ellis Christopher J. 
Published: March 2008

AbstractAspirin is an established therapy for the management of acute myocardial infarction (AMI) and unstable angina. Secondary prevention with chronic aspirin therapy is also indicated for patients with stable angina.Aspirin inhibits cyclo‐oxygenase‐I, a key enzyme in the biosynthetic pathway leading to the production of thromboxane A2. It therefore inhibits only one of the many activation pathways leading to platelet aggregation. Other antiplatelet agents that have also been evaluated in clinical trials include ticlopidine and clopidogrel, which inhibit adenosine diphosphate‐mediated platelet aggregation, but these agents are known to be effective against only one of the 90 known agonists that stimulate platelet aggregation.The final common pathway for platelet aggregation involves the glycoprotein IIb/IIIa receptor combining with fibrinogen. Several inhibitors of the glycoprotein IIb/IIIa receptor have been developed and have an important role as adjunctive therapy in angioplasty. Recent trials have been performed in patients with unstable angina, and trials of adjunctive therapy are currently underway in patients receiving thrombolysis for AMI, and for secondary prevention.These drugs have various different features, including specificity for blockade of the glycoprotein IIb/IIIa receptor, half life, duration of the haemostatic effect and potential for antigenicity. Recently concluded and ongoing trials of both intravenous and oral agents are expected to provide further support for the introduction of these agents into clinical management of patients with acute coronary syndromes.
Issues in extrapolating from clinical trials to clinical practice and outcomes
Authors: Tonkin Andrew M. 
Published: March 2008

AbstractExtrapolation of clinical trial results to clinical practice requires consideration of whether the trial patients were representative of clinical practice, whether the trial therapy studied was optimal, whether the sample size was adequate, and the impact of adjunctive treatments.In thrombolytic trials in particular, regional variations in attitudes to coronary angiography may have affected outcomes. Clinical trial results need to be interpreted in the light of the cost effectiveness of the application.The assessment of clinical outcomes depends on interplay between the structure and process of care, patient factors and chance. Large standardised databases are necessary to assess clinical practice and outcomes.
Staphylococcal bacteraemia: the hospital or the home? A review of Staphylococcus aureus bacteraemia at Concord Hospital in 1993
Authors: O'Kane G. M. , Gottlieb T. , Bradbury R. 
Published: March 2008

Abstract: Aims: To examine the risk factors for, and the complications and mortality of, Staphylococcus aureus bacteraemia. Methods: A retrospective case review of patients with S. aureus bacteraemia in 1993 diagnosed at the Concord Repatriation General Hospital, Sydney. Results: Of 104 cases reviewed, 32 were due to methicillin resistant S. aureus (MRSA), 73 were due to methicillin sensitive S. aureus (MSSA) and one was a dual infection. Twenty‐eight of the bacteraemias were community‐acquired, including one case of MRSA, and 76 were hospital‐acquired; 38% had an implanted prosthetic device or graft. The average age (68 years), incidence of underlying diseases and hospitalisation in the past month (26%) did not differ between MRSA and MSSA groups. MRSA was more likely in patients with recent broad‐spectrum antibiotic use (53%vs 0, p<.01). Vascular access was the commonest source of sepsis (61 %) but in community‐acquired cases the source was unknown in 50%. Use of central line access was more predictive of MRSA infection (75%vs 49%, p=.018). In hospital‐acquired infection, MRSA sepsis occurred later in the course of the admission (26 days vs eight days, p<.01). Directly attributable mortality was highest in MRSA and community‐acquired MSSA infection (9% and 11%) compared with hospital‐acquired MSSA infection (1%). Conclusions: Nosocomial S. aureus bacteraemia, particularly MRSA, is a major source of preventable morbidity, which could be addressed by improved infection control of MRSA, antibiotic use and attention to central line catheter use.