bluuebunny/crossref_metadata_2025_split huggingface dataset:
ACUTE THROMBOTIC OBSTRUCTION OF A MITRAL VALVE PROSTHESIS: THE ROLE OF THROMBOLYTIC THERAPY
Authors: FITZPATRICK M. A. , IKRAM H. , ILSLEY C. 
Published: March 2008

AbstractAn acute thrombotic occlusion of a mitral prosthesis in a hemodynamically compromised patient was successfully lysed with intravenous streptokinase. Unfortunately, the patient had a major cerebral embolus, from which she died several days later. A review of the current literature reveals that thrombolytic therapy successfully relieves the obstructing thrombus in 73% of cases, while it is partially successful in another 16% allowing deferral of surgical repair to a more optimal time. Mortality from thrombolytic therapy is 14% while hemorrhage or cerebral emboli occur in a further 11%. Reports of surgical intervention have shown an operative mortality rate of 25%, in those fit to undergo surgery. If hemodynamically unstable patients unfit for surgery are included on an intention to treat basis, overall mortality is 42%. Thus, thrombolytic therapy should be considered primarily in those compromised patients who have a thrombotic occlusion of a valvular prosthesis with a greater risk of operative mortality. Low dose, prolonged infusions should be favoured over rapid, high concentration infusions currently employed for coronary thrombolysis, as the latter regime could have contributed to the fatal cerebral embolus in our patient.
TRANSJUGULAR LIVER BIOPSY ‐ AN AUSTRALIAN EXPERIENCE
Authors: STEADMAN C. , TEAGUE C. , HARPER J. , HAYES P. , NATHAN N. , HARRIS O. , KERLIN P. 
Published: March 2008

Abstract:During the four year period 1983‐87 transjugular liver biopsy was performed on 67 patients (M43, F24) aged 17–79 yr (mean 45.6 yr). Standard percutaneous biopsy was contraindicated by coagulation disorders (95%) often with ascites (17%). Biopsies were taken using a specially modified Ross trans‐septal needle passed into hepatic veins under fluoroscopic guidance. Hepatic tissue samples were obtained from the initial biopsy in 62 (93%) patients. In 30 consecutive transjugular biopsies a mean area of 38.2 mm2 per section (0.9–100mm2) was available for histology compared with an area of 15.9 mm2 (9.3–48.8 mm2) in 50 consecutive percutaneous biopsies. Improved techniques of sample washing, sieving and fixation optimised separation of hepatic tissue from blood clot and fibrin. Four patients experienced significant complications but no deaths occurred. Individual diagnoses were changed in 17 patients as a result of biopsy findings. This study confirms the efficacy and relative safety of the transjugular approach in obtaining liver biopsies from patients with contraindications to standard percutaneous techniques.
DOPPLER ECHOCARDIOGRAPHIC DETERMINATION OF AORTIC VALVE AREA USING THE CONTINUITY EQUATION
Authors: BOWMAN L. K. , CRANNEY G. B. , HOPKINS A. P. , WICKS J. , WALSH W. F. 
Published: March 2008

Abstract:The noninvasive measurement of aortic valve area by use of the continuity equation has been proposed as an accurate method for determining the severity of aortic stenosis. In 32 patients (mean age 64±14 years) with proven aortic stenosis and without significant regurgitation, aortic valve areas derived by the Gorlin equation from cardiac catheterisation data were compared with valve areas calculated from the continuity equation using Doppler echocardiography.There was a close correlation between Doppler and catheter derived aortic valve areas (r = 0.87, SEE = 0.17 cm2). The interobseryer error for aortic valve area measurement in 20 patients was 9.0 ± 6.8%. The specificity of this method for critical aortic stenosis (aortic valve area less than 0.75 cm2) was 73% and the sensitivity 88%.We conclude that in an adult, predominantly elderly population with calcific aortic stenosis, this Doppler echocardiographic method is reproducible and can be used accurately to derive aortic valve area.
A CLINICAL MODEL FOR PREDICTING SURVIVAL FOLLOWING ACUTE MYOCARDIAL INFARCTION IN PATIENTS WITHOUT CARDIOGENIC SHOCK: A MULTIVARIATE (COX) ANALYSIS
Authors: BARIN E. , LISTER V. J. , JONES M. P. , NELSON G. I. C. 
Published: March 2008

Abstract:A multivariate predictive model for early (six‐month) survival based on Cox's proportional‐hazards regression model was developed using data collected prospectively from 317 consecutive patients admitted with acute myocardial infarction to a coronary care unit (CCU). Of these, 63 (19.8%) died within the follow‐up period. Patients with cardiogenic shock were excluded from the study. Variables associated with survival were sought from clinical, historical, electrocardiographic and radiographic variables recorded at the time of admission. On multivariate analysis, a stepwise selection procedure identified four variables which described the probability of survival for the six‐month follow‐up. These were: age, upper lung crepitations, marginal and also definite radiographic cardio‐megaly on an anteroposterior radiograph. With this combination of clinical variables alone, using a survival probability partition value of 80%, the model had a sensitivity of 67% and a specificity of 75%. However, the model's predictive accuracy for death was 40%, compared to a predictive accuracy for survival of 90%. This clinical model is most useful for early discrimination of those patients at low risk of death within six months of CCU admission. Other predictive tests for premature death would need to exceed these discriminatory criteria to justify their cost and risks.
THE METABOLISM OF C3 AND C4 IN PATIENTS WITH IMMUNE COMPLEXES AND NORMAL COMPLEMENT LEVELS
Authors: CHARLESWORTH J. A. , PEAKE P. W. , GOLDING J. , PUSSELL B. A. , TIMMERMANS V. , WICKS I. , WAKEFIELD D. 
Published: March 2008

AbstractThe metabolism of the complement proteins, C3 and C4 was examined in two groups of patients with a high incidence of detectable immune complexes but normal levels of complement components. The specific aim was to ascertain whether significant ongoing complement activation occurred in these patients. Eleven patients with rheumatoid arthritis (RA), 11 with infection and 11 control subjects were studied. Each received approximately 10 uCi 125I.C4 and 2.5 uCi 131I.C3 by intravenous injection. Analysis of turnover data showed that there was significant hypercatabolism of both C3 and C4 in the two study groups compared to controls. Plasma production of C4 was normal for both groups (despite the presence of C4 null alleles in six out of 11 of the RA group), while C3 production was significantly elevated in both RA and infection (p < 0.01 and p < 0.001 respectively). Patients with infection showed a significant increase in extravascular/intravascular distribution of both proteins. The data show that immune complex formation is associated with accelerated turnover of complement proteins, irrespective of co‐existing tissue damage or changes in the serum concentration of complement components. The findings suggest that both activation of complement and maintenance or enhancement of protein synthesis are important for the efficient processing of immune complexes in vivo.
PLATELET AGGREGATING ACTIVITY IN THE PLASMA OF PATIENTS WITH ESTABLISHED THROMBOSIS
Authors: JACKSON S. P. , SALEM H. H. 
Published: March 2008

AbstractThis study examines the incidence and significance of novel plasma derived platelet aggregating activity (PAA) in 190 consecutive patients admitted to the medical wards of a general hospital. Seventy five patients (39%) demonstrated this activity. The incidence was highest in patients with a history of thrombosis (52%) or in those with a heightened thrombotic tendency, for example, patients with diabetes or hypertension. In contrast, platelet aggregating activity was observed in six out of 62 patients (approximately 10%) in whom a current or past medical history of thrombosis could not be elicited and in only two out of 72 healthy volunteers examined (3%).A high frequency of PAA was also noted in a small group of patients with idiopathic thrombocytopenia and patients who had previously received, platelet transfusions. In these patients, this activity presumably reflects the presence of antiplatelet antibodies.A good correlation between the presence of plasma derived platelet aggregating activity and the phenomenon of spontaneous platelet aggregation was observed. The platelet aggregating activity was not heparin dependent, but was completely abolished by EDTA (5 mM) and benzamidine (8 mM), or by pretreating the platelets with aspirin. A synergistic response was observed with subaggregatory concentrations of thrombin and adrenalin.Our results suggest that the presence of this platelet aggregating activity may provide a marker for vascular thrombosis. Furthermore we postulate that this plasma derived activity may be partly responsible for platelet hyperactivity previously observed in patients with thromboembolic disorders.
HEMORRHAGIC MYOCARDIAL INFARCTION COMPLICATED BY FREE WALL‐RUPTURE: A CASE ASSOCIATED WITH UNUSUAL CLINICAL FEATURES FOLLOWING INTRAVENOUS THROMBOLYTIC THERAPY
Authors: TWIDALE N. , HENRY L. , MORPHETT A. , TONKIN A. M. 
Published: March 2008

AbstractA patient is described who developed a systolic murmur soon after she was administered intravenous thrombolytic therapy for acute myocardial infarction. She died and autopsy revealed extensive hemorrhagic myocardial infarction and a free‐wall rupture. A review of the literature suggests that this may be an unusual complication of thrombolytic therapy.
LYMPHOMATOID GRANULOMATOSIS PRESENTING AS A PROGRESSIVE CERVICAL CORD LESION
Authors: COLLINS S. , HELME R. D. 
Published: March 2008

AbstractA 50‐year‐old male presented with symptoms of a progressive spinal cord lesion over two and a half months. Investigations, including myelography, CT scan and magnetic resonance imaging (MRI), did not show cord compression although the MRI scan demonstrated thickening of the posterior cervical meninges. CSF examination revealed pleocytosis, increased total protein and cells suggestive of a lymphoproliferative disorder. Open lung biopsy of an asymptomatic toft mid‐zone mass was diagnostic of lymphomatoid granulomatosis. We believe this to be a case of lymphomatoid granulomatosis presenting as a progressive cervical myelopathy.
LATE‐ONSET POST‐HEMIPLEGIC HEMIDYSTONIA: CT AND ANGIOGRAPHIC FINDINGS
Authors: HANKEY G. J. , SADKA M. 
Published: March 2008

AbstractA 27‐year‐old woman is described who suffered an acute left hemiplegia at the age of three years and 20 years later she noted the onset of unilateral left limb dystonic movements. Her cranial CT scan showed an area of low density, consistent with longstanding infarction, in the right lentiform nucleus. Cerebral angiography demonstrated aneurysmal dilatation of the terminal portion of the right internal carotid artery, minor irregularity of the lenticulostriate branches of the right middle cerebral artery (suggestive of Moya Moya disease) and occlusion of the right anterior cerebral artery. The dystonic movements improved with levodopa therapy. Clinico‐radiological correlation in this case supports recent evidence for a disruption of pathways between the caudate nucleus, lentiform nucleus and thalamus in the pathophysiology of hemidystonia.
MALIGNANT LYMPHOMA IN A RENAL TRANSPLANT PATIENT ON CYCLOSPORIN A THERAPY
Authors: WALKER R. J. , TILLER D. J. , HORVATH J. S. , DUGGIN G. G. 
Published: March 2008

AbstractCyclosporin A has been associated with an apparent increased incidence of non Hodgkins lymphoma, most often in conjunction with multiple immunosuppressive agents. We report a patient who developed a non Hodgkins lymphoma arising in the right tonsillar fossa six months following renal transplantation. The development of the lymphoma was associated with seroconversion for the Epstein Barr capsid antigen and nuclear antigen. The patient was receiving cyclosporin A alone as immunosuppression.
ENDOSCOPIC SCLEROTHERAPY FOR ESOPHAGO‐GASTRIC VARICES: A CRITICAL REAPPRAISAL
Authors: SARIN S. K. 
Published: March 2008

AbstractAmongst the many non‐surgical techniques for the treatment of variceal bleeding, endoscopic sclerotherapy (EST) has shown great promise. EST can successfully obliterate esophageal varices and prevent variceal rebleeding. It is also very effective in the control of active bleeding from esophageal varices. The technique of EST is simple and can be carried out with a conventional, forward viewing, flexible endoscope and a teflon injector. Weekly intravariceal injections of an aqueous sclerosant are prefer‐rable. Though complications of EST in experienced hands are low, prophylactic EST at present should be advocated only to patients at high risk of bleeding. While controversy exists, most reports indicate that EST improves survival of patients with portal hypertension who have bled from esophageal varices. With regular follow‐up endoscopics, recurrence of varices and bleeding from them can be substantially reduced. Sclerotherapy may successfully obliterate gastric varices in some patients either following EST for esophageal varices or by direct gastric variceal injections. For the long‐term management of portal hypertension, combination of pharmacotherapy before as well as after eradication of esophageal varices, needs proper evaluation.
SERUM THYMIDINE KINASE AS A MARKER OF DISEASE ACTIVITY IN PATIENTS WITH MULTIPLE MYELOMA
Authors: BROWN R. D. , IOANNIDIS R. A. , JOSHUA D. E. , KRONENBERG H. 
Published: March 2008

AbstractSerum thymidine kinase (STK) levels have recently been used to detect tumour regression and progression in a number of hematological malignancies. In this study, patients with myeloma were monitored longitudinally for STK and several other potentially useful tumour markers to determine which laboratory parameters are the most useful for differentiating between stable and progressive disease. STK was determined by radioenzyme assay, lymphocyte surface markers were analysed by flowcytometry, plasma cell labelling index (LI) by immunofluorescence with anti BU‐1, serum B2‐microglobulin (SB2M) by radioimmunoassay and M proteins by radial immunodiffusion. Detailed multiparameter longitudinal investigations of 5 patients and ongoing studies of 70 other patients suggest that STK is a more reliable marker of progressive disease than either SB2M, LI, M‐protein or CD10 positive lymphocytes. A rise in STK during the emergence of progressive disease at least paralleled and usually preceded any change in the other parameters which often did not change at all. All samples from patients with progressive disease (n = 29) had a STK above the normal range (0–5U/I) whereas 76% of patients in clear stable disease had a STK within the normal range. All samples (n = 34) from patients with light chain isotype suppression (LCIS) had STK values of less than 12 U/L and 82% of samples (n = 33) from patients without LCIS had a STK above the normal range (0–5U/L). The correlation between STK and LI was r = 0.65; p < 0.001 (n = 21). The radioenzyme assay for STK is simple, reproducible and a valuable tool for monitoring patients with myeloma and when used in conjunction with other clinical and laboratory investigations, aids in the separation of patients with stable myeloma from patients whose disease is progressive.
FIBRILLARY GLOMERULONEPHRITIS – A REPORT OF TWO CASES
Authors: PERRY G. J. , WYNDHAM R. N. , LIN B. P. C. , KALOWSKI S. 
Published: March 2008

AbstractTwo patients with an uncommon form of glomerulonephritis are described. The main clinical features were hematuria and proteinuria associated with normal renal function. The glomerular lesions consisted of mesangial hypercellularity and capillary wall thickening. Immunofluorescence was positive for IgG and C3 in both cases. Widespread deposition of microfibrils (mean diameters 17.0 nm and 18.4 nm) within mesangial areas and capillary basement membranes was seen on electron microscopy. Congo red staining for amyloid was negative. In both patients there was no evidence of underlying disease or extra‐glomerular involvement and hence the disorder appeared to represent a primary glomerulonephritis.
PROGNOSIS OF PATIENTS WHO PRESENT WITH AN EPISODE OF MYELOPATHY OF UNKNOWN ORIGIN IN MALAYSIA: A RETROSPECTIVE STUDY OF 52 PATIENTS
Authors: TAN C. T. 
Published: March 2008

AbstractFifty‐four per cent of 52 patients presenting to the University of Malaya Medical Centre with a myelopathy for which appropriate investigations uncovered no definite etiology, subsequently developed clinically definite or probable multiple sclerosis. In the subgroup of patients with a presentation indicative of acute/subacute transverse myelopathy, 14 or 52% also went on to develop clinically definite or probable multiple sclerosis, a far higher proportion than previously recorded in the literature. This finding is probably a further manifestation of racial difference in the behaviour of multiple sclerosis. For the group as a whole, the only factor which appeared to be associated with an increased risk of developing multiple sclerosis was female sex; 67% of 33 female patients went on to develop multiple sclerosis after a mean follow‐up period of 5.5 years. Other factors such as age of onset, racial composition, level of spinal cord involvement, presence of fever and CSF finding were found not to be important.
IMMUNE HEMOLYSIS AFTER AN ABO MISMATCHED RENAL TRANSPLANT
Authors: PERKINS A. C. , RICHARDS V. L. , GIBSON J. , JOSHUA D. E. , JOHNSON J. R. , KRONENBERG H. 
Published: March 2008

AbstractWe describe a case of immune hemolysis due to anti‐B occurring in a blood group B patient 16 days after a cadaveric renal transplantation from a blood group O donor. Transfusional support was initially required and the direct antiglobulin test (DAT) remained positive for 80 days. Cyclosporin A (CSA), which was used for rejection prophylaxis in this case, has unique immunosuppressive capabilities which protects transplanted organs from rejection, but which might permit this type of ‘graft versus host’ reaction.
INITIAL CHEMOTHERAPY FOLLOWED BY SURGERY IN MALIGNANT THYMOMA
Authors: MACKINTOSH J. F. , HAWSON G. A. T. , MATAR K. S. , JOHNSTON N. G. 
Published: March 2008

AbstractInitial combination chemotherapy with cisplatinum, adriamycin and cyclophosphamide was given prior to surgery in a young woman with an unresectable malignant thymoma. Complete remission was achieved following three cycles of chemotherapy. Subsequent thymectomy revealed no evidence of residual malignancy. Prolonged remissions following cisplatin‐based chemotherapy have recently been achieved in metastatic thymoma. Initial chemotherapy should now be considered prior to surgery or radiotherapy in those patients presenting with very bulky or unresectable disease.
DETECTION OF REARRANGEMENT WITHIN THE BREAKPOINT CLUSTER REGION OF CHROMOSOME 22 IN THE DIAGNOSIS OF CHRONIC MYELOID LEUKEMIA
Authors: HUTCHINS C. , CASEY G. , WHITE D. , MOORE S. , RUDZKI Z. , KIMBER R. 
Published: March 2008

AbstractChronic myeloid leukemia (CML) is characterised by the presence of a Philadelphia (Ph) chromosome in approximately 95% of patients. Molecular analysis has shown that the Ph chromosome translocation breakpoints are clustered within 5.8kb on chromosome 22 (breakpoint cluster region or bcr). This has facilitated the diagnosis of CML by nucleic acid hybridisation using probes specific for the bcr to detect DNA rearrangement in this region. Forty patients diagnosed with CML, including four with variant Ph chromosome translocations and three with normal karyotypes were analysed for rearrangement within the bcr. All except one patient with Ph negative CML had rearrangement within the bcr. In contrast, none of the patients diagnosed with other hematological disorders such as the myelodysplastic or myeloproliferative syndromes (16 patients), acute myeloid leukemia (AML) (six patients), acute lymphoblastic leukemia (ALL) (five patients), including Ph positive ALL (two patients), showed rearrangement within the bcr. Analysis for rearrangement within the bcr is useful in the diagnosis of CML, especially when cytogenetic analysis is unsuccessful or in patients with normal karyotypes or variant Ph chromosome translocations.
ASSESSMENT OF A Psti POLYMORPHISM OF THE APOLIPOPROTEIN‐AI GENE IN AUSTRALIAN PATIENTS WITH CORONARY ARTERY DISEASE
Authors: DOROW D. S. , BURKE J. , GODING J. W. 
Published: March 2008

AbstractIn 1986 Ordovas et al.,1 reported that a polymorphism in the 3' flanking region of the apolipoprotein Al gene was strongly associated with premature coronary artery disease. This polymorphism affects a restriction site for the endonuclease Pstl, resulting in the identification of a 3.3 kb band, rather than the more common 2.2 kb band, when genomic blots of Pstl digested human DNA are probed with an apolipoprotein Al gene probe. In a study population of 88 patients with severe coronary artery disease before the age of 60, 28 (32%) carried the 3.3 kb allele, which was found in only five (4%) of 123 randomly chosen control subjects. In the present study, we have assessed the prevalence of this polymorphism in coronary artery disease patients and outpatients with abnormal lipid levels at the Alfred Hospital, Melbourne, and in normal volunteers. The 3.3 kb allele was present in 7–12% of subjects in these populations, and showed no association with coronary artery disease.
THE NEUROLOGICAL FEATURES OF EARLY AND ‘LATENT’ HUMAN IMMUNODEFICIENCY VIRUS INFECTION
Authors: BREW B. J. , PERDICES M. , DARVENIZA P. , EDWARDS P. , WHYTE B. , BURKE W. J. , GARRICK R. , O'SULLIVAN D. , PENNY R. , COOPER D. A. 
Published: March 2008

AbstractNeurological manifestations of unknown cause occurring in patients who become or are HIV antibody positive with presumed normal immune function have been described recently. This report adds a further six cases, all of whom had normal CD4 + cell counts either throughout the period of observation or after the episode of seroconyersion. Three had an acute presentation, two in the context of documented seroconversion consisting of one of the following: an encephalitis, an ataxia, and confusion with neuralgic amyotrophy. Three had a subacute disorder occurring at a later phase of HIV infection but before opportunistic infections or neoplasms, and marked by a static mild cognitive deficit. This report extends the range of abnormalities that may be seen at seroconversion and documents the presence of a non‐progressive cognitive deficit occurring in the latent phase of HIV infection.
HYPERVISCOSITY SYNDROME SECONDARY TO RHEUMATOID ARTHRITIS
Authors: BACH L. A. , BUCHANAN R. R. C. , SCARLETT J. D. , FRASER K. J. 
Published: March 2008

AbstractA woman with longstanding seropositive rheumatoid arthritis presented with the insidious onset of a hyperviscosity syndrome. This responded to plasma exchange and corticosteroids. Plasma exchange was complicated by severe bleeding which was associated with disturbances of coagulation and of platelet function related to the marked increase in plasma immunoglobulins.
LEFT HEART INVOLVEMENT WITH CARDIAC SHUNT COMPLICATING CARCINOID HEART DISEASE
Authors: MILLWARD M. J. , BLAKE M. P. , HUNG J. , GIBSON P. , BYRNE M. J. 
Published: March 2008

AbstractThe manifestations of carcinoid heart disease are usually right heart failure due to pulmonary and tricuspid valve disease and sometimes high output failure due to peripheral vasodilation. Recently there has been one case report of progressive central cyanosis due to right to left shunting through a patent foramen ovale.1 We present a similar case where such a shunt developed and was also complicated by significant valvular disease affecting the left side of the heart.