bluuebunny/crossref_metadata_2025_split huggingface dataset:
RESEARCH IN CHOICE OF MEDICAL SPECIALITY: A REVIEW OF THE LITERATURE 1977–87
Authors: MOWBRAY R. M. 
Published: March 2008

AbstractStudies of the factors which influence the selection of a specialty in medicine represent a major theme in research in medical education. The journal literature in this area is reviewed for the last ten years under the headings of:Reasons for choice of specialtyTiming and consistency of choiceExpectations of financial successAttitudes and choice of specialtyPredictive methodsEffect of the curriculumAcademic performancePsychiatry as a career choiceGeneral differencesPersonality factorsIt is concluded that there are a number of inadequacies in the investigations reported in this field. The research is not based on any theoretical model, focuses on only one or a few of the many possible factors and uses different study populations. Greater consistency and applicability of the findings could be achieved by a central organisation conducting appropriately designed multivariate studies using defined populations at a large number of centres.
A RANDOMISED TRIAL OF EMPIRICAL ANTIBIOTIC THERAPY IN FEBRILE NEUTROPENIC PATIENTS WITH HEMATOLOGICAL DISORDERS: CEFTAZIDIME VERSUS AZLOCILLIN PLUS AMIKACIN
Authors: GIBSON J. , DATE L. , JOSHUA D. E. , YOUNG G. A. R. , WILSON A. , BENN R. , BENSON W. , ILAND H. , VINCENT P. C. , KRONENBERG H. 
Published: March 2008

AbstractOne hundred and two patients with neutropenia (<1 × 109/L) secondary to primary hematological disorders or chemotherapy for hematological malignancies were prospectively randomised, upon the development of fever or other signs of infection, to receive empirical antibiotic treatment with either ceftazidime (± flucloxacillin) (n = 52) or azlocillin plus amikacin (± flucloxacillin) (A&A, n = 50). The two groups were equivalent with respect to clinical and laboratory parameters prior to antibiotic therapy and flucloxacillin was added to approximately 25% of the patients in each group on the clinical suspicion of Gram positive infection. When assessed at 96 hours, the complete response rates were 59.6% for the ceftazidime treated patients and 44% for A&A treated patients. Partial response rates were 17% and 20% respectively. This difference was not statistically significant. Eight patients died whilst on the trial, three of those initially randomised to ceftazidime and five initially randomised to A&A. Moderate to severe hypokalemia was encountered significantly less often in the ceftazidime treated group (p< 0.01), whilst other parameters of toxicity were equivalent. No primary or acquired resistance to ceftazidime was encountered. Separate analysis of those patients who did not receive flucloxacillin yielded identical results.We conclude that ceftazidime (±flucloxacillin) is as efficacious as azlocillin plus amikacin (±flucloxacillin) in the empirical antibiotic management of such patients and is associated with a lower incidence of moderate to severe hypokalemia.
LONG TERM EFFICACY OF TRANSVENOUS CATHETER ABLATION OF THE ATRIOVENTRICULAR JUNCTION FOR REFRACTORY SUPRAVENTRICULAR TACHYCARDIA
Authors: MURDOCK C. J. , DAVIS M. J. E. , COPE G. D. , MEWS G. C. 
Published: March 2008

AbstractTwenty‐four patients who underwent transvenous catheter ablation of the atrioventricular (A‐V) junction between November 1982 and February 1987 were followed from 18–72 months (mean 47.9) to assess the long term efficacy and safety of the procedure. All had severely symptomatic supraventricular tachyarrhythmias refractory to standard treatment. Atrioventricular conduction was abolished in 23 patients, 22 having permanent pacemakers implanted. Conduction has recovered, though it is modified, in one patient who is asymptomatic on digoxin. Four patients have died; one suddenly 20 months following the procedure, one of progressive heart and liver failure due to hemochromatosis, and two of a stroke. Four patients have had complications related to permanent pacing; one patient has required generator replacement and one patient ventricular lead replacement, one patient had asystole and one patient had a pacemaker‐related tachycardia. Two patients remain symptomatic but improved by the procedure. Seventeen patients are free of their original symptoms, 11 having no intervening morbid events.These results demonstrate that patients with severely symptomatic supraventricular tachyarrhythmias may gain long term symptomatic relief from the procedure, but permanent pacing is a cause of significant morbidity and there is a small incidence of late sudden cardiac death.
ANGIOGRAPHICALLY DEMONSTRATED ARTERIAL SPASM IN A CASE OF BENIGN SEXUAL HEADACHE AND BENIGN EXERTIONAL HEADACHE
Authors: SILBERT P. L. , HANKEY G. J. , PRENTICE D. A. , APSIMON H. T. 
Published: March 2008

AbstractBenign headaches related to sexual activity and exertion are being recognised with increasing frequency. We wish to report a case of benign sexual headache (Type 2) and benign exertional headache, occurring sequentially in the same patient. Multiple areas of cerebral arterial spasm were demonstrable on angiography. This observation would support the concept that benign sexual headache (Type 2) and benign exertional headache may have a similar pathophysiology.
PRIMARY CEREBRAL LYMPHOMA: PRESENTATION OF EIGHT CASES AND REVIEW OF THE LITERATURE
Authors: BOADLE D. J. , TATTERSALL M. H. N. 
Published: March 2008

AbstractEight cases of primary cerebral lymphoma (PCL) are presented, being the largest Australian series of this rare condition reported to date. The clinical, radiological, anatomical and histological features were found to be comparable with those of patients reported in other series between 1954 to 1986. The precise treatment of PCL remains undetermined due to its rarity and apparent heterogeneity. Whole brain irradiation forms the basis of therapy although the role of prophylactic spinal irradiation, surgery and chemotherapy have not been defined. Response to corticosteroids and chemotherapy has been documented. Reported cases associated with the acquired immune deficiency syndrome (AIDS) are discussed. With an anticipated increase in the numbers of cases of AIDS, the incidence of related PCL will also increase. Large, multicentric trials are required to further delineate optimal treatment.
HISTOPLASMOSIS IN THE ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS)
Authors: RAWLINSON W. D. , PACKHAM D. R. , GARDNER F. J. , MacLEOD C. 
Published: March 2008

AbstractThis case report describes a 50‐year‐old man from South America with AIDS who developed disseminated histoplasmosis with focal lymph node involvement. Treatment with ketoconazole was initially successful. Six weeks after cessation of ketoconazole he died of what was thought to be relapse of histoplasmosis.
HYPERCALCEMIA AND LIPOID PNEUMONIA
Authors: GREENAWAY T. M. , CATERSON I. D. 
Published: March 2008

AbstractA 49‐year‐old man with an 11 year history of NIDDM presented hypercalcemic and with acute on chronic renal failure. His only symptoms were mild anorexia and nausea. Four years previously he had been diagnosed as haying lipoid pneumonia, with classical histological findings. On this admission, serum parathyroid hormone was suppressed and 1,25 dihydroxyvitamin D levels elevated. The cause of his hypercalcemia presumably was ectopic 1 hydroxylation of 25 hydroxyvitamin D in the chronic granulomata in his lungs. It should be emphasised that any chronic granulomatous disease, and not just sarcoidosis, may be a cause of hypercalcemia.
THE INFLUENCE OF AGE AND DIETARY FAT IN AN ANIMAL MODEL OF SUDDEN CARDIAC DEATH
Authors: McLENNAN P. L. , ABEYWARDENA M. Y. , CHARNOCK J. S. 
Published: March 2008

Abstract:The influence of dietary fat on myocardial vulnerability to arrhythmia was examined using coronary artery occlusion and reperfusion in the anesthetised rat as a whole animal model of ventricular fibrillation and sudden cardiac death. Animals were fed a reference (REF) diet alone or supplemented 12% by weight with tuna fish oil (TFO) (rich in n‐3 fatty acids), sunflower seed oil (SSO) (rich in n‐6 fatty acids) or sheep perirenal fat (SF) (rich in saturated fatty acids). Feeding periods of 6, 12, and 18 months and a total of 108 rats were used. The incidence of ventricular fibrillation in occlusion was reduced from 46% of REF animals to 6% and 21% in TFO and SSO groups respectively and increased to 68% in the SF‐fed rats. The incidence of ventricular tachycardia was also reduced by TFO and SSO. The incidence of fibrillation on reperfusion of acutely ischemic myocardium (15 minutes occlusion) was significantly reduced by TFO only (12%, REF = 50%, SSO = 30%, SF = 70%). Severity of arrhythmias increased with age as did the extent of dietary influence. Mortality from fibrillation which only occurred in rats aged 12 months or older (REF = 13%) was increased by SF (43%) mainly in reperfusion (38%) but did not occur in TFO or SSO. These results indicate the potential benefit of dietary modification to include a higher proportion of polyunsaturated fat especially fish oil in reducing risk of sudden cardiac death. It is suggested that, in addition to their effects on atherosclerosis or thrombosis, dietary fats can directly influence myocardial vulnerability to arrhythmic stimuli through incorporation into myocardial membranes. (Aust NZ J Med 1989; 19: 1–5.)
INFECTIOUS DIARRHEA IN CHILDREN UNDERGOING BONE‐MARROW TRANSPLANTATION
Authors: BLAKEY J. L. , BARNES G. L. , BISHOP R. F. , EKERT H. 
Published: March 2008

Abstract:Fecal flora of 12 children undergoing bone‐marrow transplantation was monitored prospectively using comprehensive microbiological techniques. Diarrhea developed at least once in ten of the 12 children (83%), and a total of 24 episodes were recorded. Recognised gut pathogens were isolated from 11/21 (52%) diarrheal episodes where fecal specimens were obtained. Enteric pathogens identified included viral pathogens in 19% (rotaviruses, ‘enteric’ adenoviruses), parasites in 19% (cryptosporidium, Giardia lamblia) and cytotoxic C. difficile (14%). Excretion of clostridial species (including cytotoxin negative C. difficile, C. innocuum) occurred in 90% of diarrheal episodes when no enteric pathogen was identified. These results suggest that infection is often responsible for diarrhea associated with bone‐marrow transplantation. Prophylaxis against enteric infection might reduce the morbidity and mortality associated with severe diarrhea in bone‐marrow transplanted children. (Aust NZ J Med 1989; 19: 31–36.)
HYPOKALEMIA WITH NEPHROCALCINOSIS: A VARIANT OF BARTTER'S SYNDROME
Authors: WANG C. W. , SIMPSON I. J. 
Published: March 2008

AbstractA 28‐year‐old male presented with profound hypokalemia and was found to have a variant of Bartter's syndrome with nephrocalcinosis, hypercalciuria, normal distal fractional reabsorption of chloride and normal sodium delivery to the distal tubule. (Aust NZ J Med 1989; 19: 58–60).
Autologous bone marrow transplantation for acute myeloid leukaemia in remission: a preliminary report
Authors: Bradstock K. F. , Posen J. , Kabral A. , Hughes W. G. , Koutts J. , Robertson T. I. , Lee C. H. , Castaldi P. A. 
Published: March 2008

AbstractAutologous bone marrow transplantation, using unpurged cryopreserved autologous marrow, was performed on ten adult patients with acute myeloid leukaemia in remission. Seven patients were in first chemotherapy‐induced remission of their disease, while three were in later remission. Patients ages ranged from 24 to 52 years, with a median of 38.5 years. Conditioning therapy consisted of oral busulphan 16 mg/kg over four days and intravenous cyclophosphamide 60 mg/kg on two days. Bone marrow cells were thawed and infused two days later. All patients showed signs of marrow engraftment, however this was delayed in comparison with patients receiving allogeneic transplants. All patients developed fever requiring antibiotic therapy and one patient died of overwhelming sepsis. Another patient died of hepatic veno‐occlusive disease two months after transplant. Serious, but non‐fatal, hepatic complications occurred in two other patients. One patient, transplanted in third remission, relapsed 16 months post‐autograft. No other relapses have been seen, with one second remission patient remaining leukaemia‐free at 24 months, and six first remission patients in continuing remission 11 to 23 (median 20) months post transplant. These encouraging results require confirmation in a randomised clinical trial comparing autologous marrow transplantation versus standard chemotherapy.
Bacterial colonisation of the respiratory tract in chronic bronchitis
Authors: Butt H. L. , Clancy R. L. , Cripps A. W. , Murree‐Allen K. , Saunders N. A. , Sutherland D. C. , Hensley M. J. 
Published: March 2008

AbstractOne hundred and nine subjects with chronic bronchitis were studied prior to winter and without clinical infection, to determine baseline patterns of bacterial colonisation. Qualitative analysis of cultures of oropharyngeal swabs showed little difference from age matched normal controls (17) except for growth of small numbers of Gram negative coliforms in the chronic bronchitic group. Quantitation of bacteria colonising the oropharynx showed small numbers (mean of 105 cfu/ml), with no particular bacteria dominating. Haemophilus influenzae was present in 7.3% of throat swabs from chronic bronchitic patients, but the organism was always less than 10% of the total count. Quantitation of bacteria in sputum showed significantly higher numbers (mean 107 cfu/ml). H. influenzae was detected in 25.7% of available specimens, and when present constituted > 90% of the total count.Biotyping of H. influenzae isolates demonstrated a separate colonisation of the upper and lower respiratory tracts.
Complications and causes of death in B cell chronic lymphocytic leukaemia: a long term study of 105 patients
Authors: Robertson T. I. 
Published: March 2008

AbstractThe complications and causes of death of 105 patients with B cell chronic lymphocytic leukaemia followed for a median period of 5.5 years are described. Infection and secondary primary malignant tumours were the most common complications and also caused most deaths. S. pneumoniae, S. aureus, S. haemolyticus, E. coli and the zoster‐varicella virus accounted for most infections and the lungs, skin and urinary tract were the sites affected. Even trivial infections were potentially serious. Haemolytic anaemia and vascular complications were also common. Older patients tended to have a shorter survival than the mean for the group whereas younger patients fared better. The mean survival was 6.2 years. Analysis confirmed the prognostic value of Rai staging. Advancing disease increased the liability to major infection. Light bone marrow infiltration five years post diagnosis indicated a good prognosis and preservation of normal immunoglobulin levels seemed beneficial. Immunoglobulin deficiency is the factor that correlates best with the frequency, severity and pattern of infection. Early stage disease provides a distinct benefit and there may be advantages in prompt diagnosis, regular assessment by immunoglobulin levels and bone marrow pattern and treatment on the first evidence of advancing disease. Fresh symptoms should be investigated in their own right because of the likelihood of second tumours.
Cryptococcosis in a renal unit
Authors: Kong N. C. T. , Suleiman A. B. , Shaariah W. , Wong Y. H. , Morad Z. 
Published: March 2008

AbstractCryptococcosis is a known opportunistic infection in immunosuppressed hosts. We report our experience of all cases presenting to our Department between December 1975 and September 1988. Eight post‐renal transplant patients and three systemic lupus erythematosus (SLE) patients were affected. All were receiving treatment with steroids, in association with either azathioprine or cyclosporin. The diagnosis of cryptococcal meningitis was initially based on a positive cerebrospinal fluid (CSF) cryptococcal antigen, by latex agglutination test, and subsequently confirmed by cultures. Common clinical presentations, in descending order of frequency, included headaches, fever, mental confusion, epilepsy and papilloedema. Meningism was not a prominent feature. CT brain scans were obtained in eight patients and one showed a focal lesion and one showed cerebral atrophy. Four patients also had an abnormal chest X‐ray (CXR) and one had disseminated cryptococcosis. Amphotericin and 5‐fluorocytosine were the mainstay of therapy, although ketoconazole alone was subsequently used in three selected patients with cure. Four early deaths occurred in patients with delayed diagnosis and treatment, usually in association with other severe concurrent infections. We conclude that awareness of cryptococcosis is essential in immunocompromised hosts presenting with headaches with, or without, mental confusion or fever.
Cervical cord compression due to ossified posterior longitudinal ligament associated with diffuse idiopathic skeletal hyperostosis
Authors: Yusof Zurkumai B. , Pratap R. C. 
Published: March 2008

AbstractWe describe a case of cervical cord compression due to ossified posterior longitudinal ligament in association with diffuse idiopathic skeletal hyperostosis, in a young female. Characteristic CT findings are described.
Necrobacillosis‐primary anaerobic septicaemia due to Fusobacterium necrophorum
Authors: Golledge C. L. , Beaman M. H. , Weeramanthri T. , Riley T. V. 
Published: March 2008

AbstractNecrobacillosis is a severe septicaemic illness caused by an anaerobic Gram‐negative bacillus, Fusobacterium necrophorum. It occurs predominantly in young people and is characterised by oropharyngeal infection and subsequent metastatic complications, frequently involving the lungs and/or large joints. We report four recent cases in previously healthy young men, describing the clinical features of the disease (including autopsy findings), and the problems associated with diagnosis and treatment.
Familial hypocalciuric hypercalcaemia and pancreatitis: no causal link proven
Authors: Stuckey B. G. A. , Gutteridge D. H. , Kent G. N. , Reed W. D. 
Published: March 2008

AbstractA case of a patient with pancreatitis and familial hypocalciuric hypercalcaemia is presented and the literature linking FHH and pancreatitis is reviewed. The case for a causal link between the two conditions is not proven and seems unlikely. In view of this we strongly challenge the recommendation of total parathyroidectomy in such cases.
Physicians’ approaches to continuing education
Authors: Newble D. I. , Whelan G. , Hejka E. J. 
Published: March 2008

AbstractA questionnaire survey was conducted of a random sample of 308 physicians to determine their actual and preferred approach to continuing education. Demographic data raised questions about the possible influence of the undergraduate institution attended, the future impact of the growing proportion of women physicians and the effect of increasing subspecialisation.The average physician spends eight‐nine hours a week on educational activities and 2.5–4.0 hours a week teaching. Unstructured ad hoc reading and postgraduate activities predominate over methods based on specific, individual needs or on current patient problems. The educational desirability of this is questioned. Physicians are avid attenders at conferences with 10–15% being at a national or international meeting in any one survey week.It appears physicians would prefer to use a wider range of educational activities including more refresher courses and innovative methods. By comparison, Canadian physicians showed similar, but more strongly evident, preferences.These findings have important implications for the College. It appears physicians need to be better informed about potentially more effective learning methods and account ought to be taken of their preference for methods which are not currently widely available.
Splenomegaly—an insensitive sign of portal hypertension
Authors: Gibson P. R. , Gibson R. N. , Ditchfield M. R. , Donlan J. D. 
Published: March 2008

AbstractThe prevalence of splenomegaly associated with portal hypertension was examined in a consecutive population of III patients who had portal hypertension diagnosed using specific endoscopie, sonographic, and Doppler signs. Splenic size was measured objectively via its cranio‐caudal length on coronal section using ultrasound and by clinical examination. Sonographically, 52% of patients had a definitely large spleen and 35% a spleen less than one standard deviation from the normal mean, while a further 13% had equivocal splenomegaly. Only 52% of patients had splenomegaly on clinical assessment. Splenomegaly was less common in patients with alcoholic (41% definite, 15% equivocal) than in those with non‐alcoholic liver disease (66% definite, 17% equivocal, p= 0.02) and splenic length was significantly smaller in alcoholic patients (12.7±0.5cm) compared to patients with either non‐alcoholic liver disease (15.0±0.6cm, p= 0.003) or portal hypertension due to vascular occlusive diseases (16.5 ± 2.0 cm, p= 0.006). Splenomegaly, whether assessed sonographically or clinically, is an insensitive sign of portal hypertension and its absence cannot be used as a negative predictor of the presence of portal hypertension in patients with chronic liver disease.
Methylprednisolone in multiple sclerosis exacerbation: changes in CSF parameters
Authors: Anderson T. J. , Donaldson I. MacG , Shear J. M. , George P. M. 
Published: March 2008

AbstractTwenty‐six patients with multiple sclerosis (MS) received a total of 45 courses of intravenous methylprednisolone daily for seven days, for acute neurological deterioration. Changes in CSF parameters and clinical status following methylprednisolone were determined and first and repeat courses were compared. There were significant reductions in CSF IgG, CSF albumin, serum IgG and serum albumin levels and CSF IgG synthesis rate in the first and repeat treatment groups. CSF IgG index fell significantly with initial methylprednisolone treatment but not with subsequent courses. Oligoclonal bands disappeared in three patients. Definite clinical improvement followed 30 methylprednisolone courses, possible improvement followed six and no change followed seven. Clinical response was not predicted by pre‐treatment CSF IgG synthesis status and did not correlate with its degree of reduction.
Management of fibrosing alveolitis with polymyositis dermatomyositis
Authors: Maccioni F. J. , Colebatch H. J. H. 
Published: March 2008

AbstractA 38‐year‐old man with polymyositis‐dermatomyositis developed acute life‐threatening fibrosing alveolitis. We report a two year follow‐up of this patient, during which control of alveolitis was obtained using prednisolone, and was maintained with the addition of cyclophosphamide. Relapse of myositis responded to increased prednisolone. Serial measurements of vital capacity and transfer factor assisted management of alveolitis, but changes in vital capacity preceded changes in transfer factor, and were more convenient to perform during frequent outpatient review.
Medroxyprogesterone induced Cushing's syndrome
Authors: Learoyd Diana , McElduff Aidan 
Published: March 2008

AbstractA 74‐year old female taking medroxyprogesterone acetate (MPA) presented with Cushing's syndrome together with low serum cortisol and plasma ACTH and an impaired response to synthetic ACTH (Synacthen, CIBA). When the medroxyprogesterone therapy was ceased the cushingoid features resolved and serum cortisol, ACTH and ACTH responsiveness all returned to normal. The MPA was acting as an exogenous glucocorticoid causing Cushing's syndrome.