bluuebunny/crossref_metadata_2025_split huggingface dataset:
Computerised tomography does not predict N2 disease in patients with lung cancer
Authors: Cole P. H. , Roszkowski A. , Firouz‐Abadi A. , Dare A. 
Published: March 2008

Abstract Background: Mediastinal node involvement in primary lung cancer determines the staging and prognosis of the patient, and as these nodes can be seen on the computerised tomography (CT) scan of the chest it is a temptation to diagnose malignant involvement if the nodes appear enlarged. However, initial experience with mediastinal node mapping at lung resection demonstrated this extrapolation to be unreliable and misinterpretation of enlarged nodes on CT may lead to misdiagnosis and prejudice the patient's management. Aim: To demonstrate that the sensitivity, specificity, and accuracy of the CT to detect malignant mediastinal nodes is too low to use size of node on CT as representative of malignant involvement. Methods: One hundred and fifty‐three sequential patients with resectable lung cancer were studied with preoperative CT. Two radiologists determined the preoperative T and N status from these studies with nodes of 1.5 cm or larger diagnosed abnormal. These results were compared to the results of subsequent node mapping performed after lung resection. Results: Sensitivity was found to be 26% specificity to be 81% and overall accuracy 69%– too low to justify the diagnosis of N2 disease on size of 1.5 cm or larger. CT is not a valid means of diagnosing malignant involvement of mediastinal nodes. (Aust NZ J Med 1993; 23: 688–691.)
Issues raised by GUSTO
Authors: White Harvey 
Published: March 2008

Abstract:The GUSTO trial raises several questions including the role of heparin in thrombolysis. The need for intravenous versus subcutaneous heparin with streptokinase (SK) has not been clarified in this trial. It is more likely that the superiority of tissue plasminogen activator (t‐PA) was due to its accelerated administration rather than the accompanying heparin. Despite the improvement in survival, much is still to be achieved in obtaining optimal reper‐fusion rates. (Aust NZ J Med 1993; 23: 739–741.)
Post thrombolysis management
Authors: Harris Phillip 
Published: March 2008

Abstract:Strategies for the evaluation of the post infarction patient need revision in the light of recent findings from thrombolytic trials, and the availability of more effective methods for detecting myocardial viability. A strategy based on determining the risk of re‐occlusion from vessel anatomy at coronary angiography and determining the area of myocardium at risk based on sequential analysis of ST segment elevation is discussed. (Aust NZ J Med 1993; 23: 760–762.)
Sclerosing cholangitis in children with inflammatory bowel disease
Authors: Ong J. C. , O'Loughlin E. V. , Kamath K. R. , Dorney S. F. A. , de Silva M. , Gaskin K. J. 
Published: March 2008

Abstract Background: Primary sclerosing cholangitis (PSC) with inflammatory bowel disease (IBD) has been rarely reported in children. Aim: To describe the clinical presentation, sequential liver function test abnormalities, radiological bile duct anomalies and liver histology in four children with PSC and IBD. Methods: Over a period of 18 years, four of 130 patients with IBD developed abnormal liver function tests. Three of the four patients had ulcerative colitis and the other Crohn's disease. All four patients had baseline and follow‐up liver function tests, percutaneous transhepatic cholangiography and a needle biopsy of the liver. Results: The four patients at presentation had minimal symptoms or signs of liver disease. All had elevation of serum transaminases, gamma glutamyl transferase and/or alkaline phosphatase. Three had the typical onion skin fibrosis of bile ducts. Percutaneous transhepatic cholangiography demonstrated irregularity and beading of the hepatic and common bile ducts in three patients. The other with normal cholangiography had fibrosing cholangitis on liver biopsy and was considered to have small duct disease. Conclusions: We conclude that yearly biochemical assessment of liver function should be performed on all children with IBD, and if abnormal should raise the suspicion of PSC. The latter diagnosis can be confirmed by liver biopsy and cholangiography.
Diagnostic laparoscopy and liver disease: experience of 200 cases
Authors: Crantock L. R. F. , Dillon J. F. , Hayes P. C. 
Published: March 2008

Abstract Background: Laparoscopy is an old technique that is frequently used by gastroenterologists in America and Germany. With modern equipment it is now possible to perform this technique under local anaesthesia. Aim: To evaluate the usefulness and safety of laparoscopic liver biopsy. Methods: Liver biopsy was routinely performed by laparoscopy under local anaesthetic and sedation. A standard 5 mm laparoscope was used and a pneumoperitoneum induced with nitrous oxide. Results: Two hundred consecutive patients were laporoscoped and underwent liver biopsy. In five patients the liver could not be visualised due to adhesions. Two patients had bleeds related to the procedure. Twenty‐five patients had malignancy diagnosed by guided biopsy. Eight of these had been missed by ultrasound prior to paparoscopy. Cirrhosis was diagnosed laparoscopically in 72 patients. Histology was unable to confirm this diagnosis in four patients. Conclusion: Laparoscopy can be performed safely and comfortably on patients with local anaesthetic and sedation. The visualisation of the liver can add valuable information to liver biopsy.
Idiopathic right ventricular tachycardia: electrophysiology and response to catheter ablation
Authors: Kuchar D. L. , West P. , Thorburn C. 
Published: March 2008

Abstract Background: Ventricular tachycardia (VT) originating in the right ventricle may be seen in the absence of structural heart disease. Although this is thought to be associated with a benign course, it may cause intolerable symptoms and be difficult to control with antiarrhythmic drugs. Aims: To assess the value of radiofrequency ablation of right ventricular tachycardia and to characterise the clinical and electrophysiologic features predictive of successful ablation. Methods: Nine patients (aged 20–49 years) with clinical VT underwent cardiac map ing which were identified in these patients. Ablation of VT was defined as suppression of VT at the time of hospital discharge. Results: Five patients had successful ablation of the tachycardia focus with long term suppression of the arrhythmia. Patients with successful ablation were characterised by inability to induce VT with extrastimuli, a distinct VT morphology with a rS pattern in lead 1, right axis deviation, facilitation of VT with isoprenaline and site of origin in the lateral outflow tract. During VT, an earlier site of presystolic activation was found in successful patients compared with unsuccessful ablations. Right ventricular tachycardia in patients without structural heart disease is a heterogeneous disorder with varied clinical and electrophysiologic features. Successful ablation ofVT may be predicted by consideration of these variables.
Cholesterol and cardiovascular disease: basic science
Authors: Barter Philip 
Published: March 2008

Abstract:Cholesterol is a normal constituent of blood plasma and of cell membranes in every tissue of the body. It is transported in plasma as a component of lipoproteins. Increased concentrations of specific lipoprotein fractions, namely low density lipoproteins (LDL) and intermediate density lipoproteins (IDL), have been implicated both in vitro and in vivo as causes of atherosclerosis. The mechanism by which these lipoproteins initiate atherosclerosis is unknown, although there is growing evidence that it involves interactions between lipoproteins and cells within the artery wall, setting in train complex reactions which lead ultimately to the fully developed lesion.
Cholesterol and non‐cardiovascular disease: basic science
Authors: Sullivan David 
Published: March 2008

Abstract:Cholesterol metabolism is of fundamental biological importance. This review examines the role of cholesterol metabolism in relation to non‐cardiovascular disease (non‐CVD). Particular attention is paid to the question of whether or not low levels of cholesterol may have harmful effects on cell function or lead to pathological processes. Many in vitro phenomena have been demonstrated at levels of cholesterol which are very low in comparison to physiological conditions. Nevertheless, low cholesterol is more favourable than high cholesterol for most aspects of cell function. There is no evidence that any catastrophic cellular response or pathological process occurs due to exposure of organisms to low cholesterol. On the other hand, the inflammatory process is a powerful and consistent cause of decreased cholesterol levels. This, together with other confounding factors, appears to explain a major component of the association between low cholesterol levels and non‐CVD.
Phase II study of high dose epirubicin in combination with cyclophosphamide in patients with advanced breast cancer
Authors: Levi J. A. , Tattersall M. H. , Beith J. M. , Bell D. , Snyder R. D. , Wheeler H. 
Published: March 2008

Abstract Background: Combination chemotherapy for metastatic breast cancer will palliate symptoms in the majority of patients but only a small percentage will have prolonged survival. Higher doses of doxorubicin lead to increased response rates in breast cancer and early studies have shown that epirubicin could be tolerated in higher doses with less relative toxicity than doxorubicin. Aims: This study was initiated to assess the dose of epirubicin that could be tolerated by escalating its dose while maintaining a fixed dose of cyclophosphamide. Simultaneously tumour response rate, spectrum of toxicities, duration of response and overall survival in patients with metastatic breast cancer were assessed. Methods: Patients with metastatic breast cancer commenced chemotherapy with a starting dose of epirubicin of 120 milligram per metre squared (mg/m2) and cyclophosphamide 600 mg/m2. The dose of epirubicin was to be escalated or reduced depending on toxicity. Results: Forty female patients were entered into this study and three patients withdrew because of toxicity. Overall tumour response rate was 75% with 27.5% of patients obtaining a complete response. Median time to progressive disease was 35 weeks and median overall survival was 48 weeks, with median survival for complete responders being 103 weeks. Thirty‐one (77%) patients completed five or more courses of treatment. Haematological toxicity was the main side effect and 70% of patients required a dose reduction. No patients were eligible for a dose escalation. One patient died as a consequence of neutropenic sepsis. Four (10%) patients had treatment ceased because of decrease in left ventricular ejection fraction and one patient died as a consequence of heart failure. Four patients remain alive. Conclusions: High dose epirubicin combined with cyclophosphamide is an effective treatment regimen for metastatic breast cancer obtaining higher overall response rates with increased percentage complete responses compared to conventional dose chemotherapy. Although toxicity was increased, high dose chemotherapy was well tolerated and mortality associated with treatment was not increased. No dose escalations of epirubicin were possible and a dose of 90mg/m2 of epirubicin would be the maximum dose when used in combination with cyclophosphamide. Further trials are required to determine the influence of this high dose therapy on survival duration and whether comparable benefits can be achieved with shorter durations of therapy. (Aust NZ J Med 1995; 25: 474–478.)
The accuracy of hospital records and death certificates for acute myocardial infarction
Authors: Boyle C. A. , Dobson A. J. 
Published: March 2008

Abstract Background: In Australia information on the incidence of acute myocardial infarction (AMI) is available from routinely collected morbidity and mortality data. Given that these data are used for monitoring AMI it is important to assess their quality. Aims: This paper examines the accuracy of the hospital records and death certificates. Methods: Morbidity and mortality data were compared with the Newcastle heart disease register which is part of the WHO MONICA Project for 1986–1991 and sensitivity and positive predictive values calculated. Results: For non‐fatal AMI the hospital diagnostic coding had sensitivity of 78.9% (95% confidence interval [CI] 77.1%‐80.7%), and positive predictive value of 65.6% (95% CI 63.7%‐67.4%). Sensitivity was higher for men than for women and decreased with increasing age. Sensitivity was higher in those with no history of either AMI or other ischaemic heart disease (IHD), higher in current smokers than ex‐smokers or never smokers, and lower in those with a self‐reported history of high blood pressure. Sensitivity also varied among hospitals. Positive predictive value varied only with hospital.Both sensitivity and positive predictive value were high for death certificate data — 89.9% (95% CI 88.4%‐91.3%) and 96.0% (95% CI 95.1%‐97.0%), respectively. Conclusions: Although the mortality data appear to be quite accurate, the hospital data alone are not accurate enough to be used to estimate rates or trends of heart attacks. Additional data are required in order to determine numbers of non‐fatal AMIs accurately. (Aust NZ J Med 1995; 25: 316–323.)
Directional coronary atherectomy for lesions of the proximal left anterior descending artery: initial clinical results, complications and histopathological findings
Authors: Sankardas M. A. , Cameron J. , McEniery P. , Garrahy P. , Aroney C. , Dare A. , Holt G. , Bett N. 
Published: March 2008

Abstract Background: Directional coronary atherectomy is a percutaneous technique which extends the role of balloon angioplasty to bulky eccentric coronary lesions. Aims: To report the early experience, clinical results, complications and histopathological findings of directional coronary atherectomy (DCA) in proximal left anterior descending artery (LAD) stenosis. Methods: Study of 25 lesions in 24 patients on whom directional atherectomy was performed on the proximal LAD artery with the Simpson coronary atherectomy device. Results: Twenty‐five procedures were performed on 24 patients with stenosis in the proximal LAD artery. There were 21 males and three females with a mean age of 56.5 years. Sixteen patients presented with stable angina and eight with unstable angina. Eight patients had previous myocardial infarction (MI). Angiographic success was obtained in 24 of 25 lesions (96%). The mean lesion length was 13.1 ± 3.7 mm and the mean LAD artery diameter was 3.6 ± 0.5 mm. Minimal luminal diameter improved from 0.9 ± 0.4 mm to 3.0 ± 0.5 mm and the percentage diameter stenosis reduced from 75 ± 12% to 16 ± 9%. Complications included acute occlusion in one patient, non‐Q MI in three patients, local vascular complications in one patient and side‐branch loss in one patient. Histology demonstrated fibrous cap of atherosclerotic plaque in 100%, media and internal elastic lamina in 28% and intimal hyperplasia in 100% of restenotic lesions and 27% of native lesions. Restenosis rates in angiographically restudied patients was 27%. The mean minimal luminal diameter at follow‐up was 2.3 ± 0.9 mm and the mean percentage diameter stenosis was 35 ±21%. Conclusion: From this initial study, we conclude that DCA is an effective and safe procedure for the treatment of large proximal LAD lesions. DCA provides a large luminal diameter and a ‘smoother’ angiographic appearance compared to coronary angioplasty. Acute complication rates are low and restenosis rates were comparable with percutaneous transluminal coronary balloon angioplasty.
Alpha‐1‐antitrypsin PLowell: a normally functioning variant present in low concentration
Authors: Cook L. , Burdon J. , Brenton S. , Janus E. D. , Knight K. 
Published: March 2008

Abstract Background: Alpha‐1‐antitrypsin deficiency is associated with a high risk for the development of emphysema, particularly for phenotype Pi ZZ, which is both deficient and an abnormal inhibitor of the powerful proteolytic enzyme, human neutrophil elastase. The rare variant PLowell is also expressed at abnormally low levels, but its anti‐elastase activity has not been described. Aim: To study the anti‐elastase activity of alpha‐1‐antitrypsin PLowdl and compare it to the common M, S and Z proteins. Method: Alpha‐1‐antitrypsin from a female patient aged 75 years with the rare genotype PLoweU NullBcllingham was studied for its ability to inhibit human neutrophil elastase in a time dependent manner. Results: PLoweii has near normal function as an inhibitor of human neutrophil elastase with an association rate constant of 7.4 X 106 M'V1 at 25 °C, similar to that of M and S. Conclusion: Alpha‐1‐antitrypsin PL is associated with a severe deficiency of alpha‐1‐antitrypsin similar to Z, but unlike that protein it has near normal function as an anti‐elastase.
Immune surveillance and autoantigen recognition in the central nervous system
Authors: Sedgwick JONATHAN D. 
Published: March 2008

Abstract:The central nervous system (CNS) is considered to be a severely disadvantaged site for the elicitation of immune responses. First, there is no specialised lymphatic drainage. Second, both glia and neuronal cells normally do not express appreciable levels of major histocompatibility complex molecules. Third, the vasculature of the CNS is, at least in most places, lined by endothelial cells that have tight junctions and form a barrier (the blood‐brain barrier) against most molecules and cells present in the circulation. Fourth, the cells most important in the initiation of immune responses, the leucocyte dendritic cell, are not present. Nevertheless, the existence of inflammatory diseases of this tissue, occurring naturally as in multiple sclerosis or in animals after peripheral immunisation with CNS autoantigens, indicates that the immune system can access and recognise antigens in this site. How this is achieved has become clearer in recent years and primarily seems to involve extravasation of activated but not resting T cells across the blood‐brain barrier, and recognition of antigen on macrophage‐like perivascular cells, rather than cells within the CNS parenchyme such as astrocytes or microglia. The processes involved in immunological patrolling of the CNS and development of autoimmune inflammatory disease are reviewed.
Cytotoxic lymphocyte‐mediated immunotherapy
Authors: Smyth MARK J. , Kershaw MICHAEL H. 
Published: March 2008

Abstract:Cytotoxic CD8+ T cells and NK cells play a role in the elimination of some viruses, graft rejection, antitumour responses, immuno regulation and some autoimmune diseases. The central importance of these cells in each of these immune responses and the therapeutic potential they offer, when effectively targeted, has justified continued interest in their Junction. Molecular biology has dominated the recent study of cytotoxic lymphocyte function, allowing the characterisation of recognition structures on cytotoxic lymphocytes, the definition of two distinct mechanisms of cytotoxicity and the determination of their relevance in vivo. Biological and genetic experimental approaches which exploit the targeted cytolytic activity of lymphocytes are now being developed for immunotherapy. A greater knowledge of the biology of cytotoxic lymphocytes when adoptively transferred, the development of engineered monoclonal antibodies and the characterisation of novel endogenous tumour cell antigens, has us on the brink of using these cells to greater therapeutic advantage. This article reviews ongoing efforts to characterise the mechanism of action of cytotoxic lymphocytes and outlines the progression of approaches designed to enhance the anti‐tumour activity of these cells.
Understanding the pathogenesis of type 2 diabetes: can we get off the metabolic merry‐go‐rounds?
Authors: Proietto JOSEPH , Rosella GENNARO , Andrikopoulos SOFIANOS , Thorburn ANNE 
Published: March 2008

Abstract:The aetiology of non‐insulin‐dependent diabetes mellitus (NIDDM) is not known. The concordance of NIDDM in identical twins and differences in the prevalence rate of NIDDM between different racial groups suggest a genetic cause. Hyperglycaemia in established diabetes is caused by a combination of hepatic insulin resistance, impaired peripheral (muscle and fat) glucose uptake and a defect in glucose‐mediated insulin secretion. However, it is not known if these defects are all inherited or if one can cause the others. This uncertainty is due to the fact that hyperglycaemia per se can cause defects in insulin action and insulin secretion that resemble those found in NIDDM. Furthermore the elevated free fatty acid (FFA) levels found when NIDDM is associated with obesity are known to cause both peripheral and hepatic insulin resistance. Recently we have demonstrated the mechanism by which elevated FFA levels can cause hepatic insulin resistance. However, we also have evidence that the converse holds in that genetically engineered hepatic insulin resistance in a transgenic rat model leads to obesity. Thus an understanding of the pathogenesis of NIDDM is complicated by the fact that hyperglycaemia and obesity can be both causes and consequences of insulin resistance. To overcome these difficulties, studies in young, euglycaemic diabetes‐prone subjects have been conducted. Results suggest that there may be different causes for NIDDM in different racial groups.
Primary hyperaldosteronism: A missed diagnosis in ‘essential hypertensives’?
Authors: Brown M. A. , Cramp H. A. , Zammit V. C. , Whitworth J. A. 
Published: March 2008

Abstract Background: It has been recognised recently that primary hyperaldosteronism may be more common than previously thought, the frequency of diagnosis being improved by screening using a plasma aldosterone concentration to renin activity ratio. Aims: To determine the frequency of primary hyperaldosteronism, screening with both plasma aldosterone to renin concentration (PRC) and activity (PRA) ratios, in normokalaemic subjects previously diagnosed as having essential hypertension. Methods: Plasma potassium, aldosterone and PRCs and PRA and blood pressure (BP) were measured in 74 hypertensive subjects previously diagnosed by one physician as having essential hypertension. A normal range for plasma aldosterone/renin ratios was determined in 147 control subjects.Hypertensive subjects with elevated aldosterone/renin ratios were further assessed for primary hyperaldosteronism using saline loading and fludrocortisone suppression. Those in whom plasma aldosterone concentration exceeded 140 pmol/L after suppression tests underwent adrenal vein sampling for measurement of aldosterone and Cortisol concentrations as well as adrenal CT scanning to diagnose the cause of primary hyperaldosteronism. The main outcome measures were a diagnosis of aldosterone producing adenoma or bilateral adrenal hyperplasia based upon adrenal vein sampling. Results: Four subjects (5%) had an elevated plasma aldosterone to renin ratio using PRC and six (8%) using PRA. Two subjects (2.7%) in this selected population had primary hyperaldosteronism, both of whom had BP > 160/110 mmHg at the time of testing. Conclusions: The frequency of normokalaemic primary hyperaldosteronism appears to be greater than previously thought, though the true incidence in the general population of hypertensive subjects remains unknown. The sensitivity of diagnosis (but not specificity) may be improved by measurement of the plasma aldosterone/renin ratio and PRC is at least as adequate as PRA for this process.