bluuebunny/crossref_metadata_2025_split huggingface dataset:
A prospective study of the gastroenterological causes of iron deficiency anaemia in a General Hospital
Authors: Bampton P. A. , Holloway R. H. 
Published: March 2008

Abstract Background: Current practice is to investigate routinely both upper and lower gastrointestinal tracts in patients with unexplained iron deficiency anaemia. Aims: To determine the efficacy of this approach and whether the use of more stringent biochemical criteria for iron deficiency, symptoms, or a positive immunochemical faecal human haemoglobin (FHH) influenced the findings of the investigations and could help target investigations more efficiently. Methods: Eighty patients were studied prospectively, 51 who had ‘definite’ iron deficiency anaemia (low ferritin and transferrin saturation) and 29 with ‘probable’ iron deficiency anaemia (either low ferritin or transferrin saturation). Patients underwent a standardised symptom assessment and testing for FHH, upper endoscopy with small bowel biopsy and colonoscopy, and a small bowel series if upper endoscopy and colonoscopy were negative. Results: Lesions potentially causative for iron deficiency anaemia were found in 54/80 (60%) of patients. Five patients (7%) had lesions in both upper and lower tracts. Small bowel biopsy was abnormal in one of 80 patients and small bowel series one of 25 patients. Significant lesions in either the upper or lower gastrointestinal tract were found in 14/20 patients with positive FHH and 25/47 with negative FHH. Symptoms, use of non‐steroidal anti‐inflammatory drugs and classification of patients into ‘definite’ and ‘probable’ iron deficiency did not influence yield of investigations or site of lesions found. Conclusions: Gastrointestinal lesions are common in patients with unexplained iron deficiency anaemia. Neither symptoms nor presence of FHH predict the presence or site of detectable lesions and neither testing for FHH nor more stringent biochemical criteria for iron deficiency alters clinical decision making. The findings support the routine performance of both upper endoscopy and colonoscopy in the investigation of patients with unexplained iron deficiency anaemia, however routine investigation of the small bowel is of questionable value.
Detection of carriers of haemophilia A: use of bioassays and restriction fragment length polymorphisms (RFLP)
Authors: Rudzki Z. , Sheffield L. J. , Rodgers S. E. , Lloyd J. V. 
Published: March 2008

Abstract Background: Haemophilia A is a sex‐linked bleeding disorder carried by unaffected females. Currently, the two main methods used for the determination of carrier status in women from families with haemophilia A are bioassays and DNA‐based assays using restriction fragment length polymorphisms (RFLP). Aim: The aim of this paper was to assess the current usefulness of these two methods. Methods: Bioassays measured factor VIII coagulation activity by a two‐stage coagulation assay and von Willebrand antigen by immunoelectrophoresis. RFLP were determined with two intragenic probes (pi 14 and p486) and two linked probes (Stl4 and DX13). Data were analysed using a Bayesian analysis to allow for all possible recombination events. We also incorporated an estimate for the risk of mosaicism into calculations in isolated haemophilia families. Both bioassays and RFLP were used to determine carrier status in 63 women, 31 from known haemophilia families and 32 from families of isolated cases. The techniques were assessed for their ability to classify the patients as normal (p<0.2) or carrier (p>0.7). Where applicable, intron 22 inversion was also tested. Results: In the known families, six women could not be classified after bioassay, but all could be classified by RFLP. Of the 32 women from families of isolated cases, eight were unclassified by bioassay and 12 were not definitely classified using RFLP. However, RFLP was useful in determining that a recent mutation had occurred in six of the eight families in which DNA from the grandparents was available. Conclusion: For diagnosis of carriers of haemophilia, RFLP is the preferred method in familial haemophilia, but is less useful in isolated haemophilia.
Cost effectiveness of day stay versus inpatient radiofrequency (RF) ablation for the treatment of supraventricular tachyarrhythmias
Authors: Weerasooriya H. R. , Harris A. H. , Davis M. J. E. 
Published: March 2008

Abstract Background: It is well established that radiofrequency (RF) ablation is the most cost effective treatment strategy for patients with supraventricular tachycardia. Previous cost estimates assumed at least an overnight stay following RF ablation. Day stay RF ablation however appears to be a safe alternative. Aims: The aim of this study was to compare day stay and inpatient catheter ablation in terms of cost, efficacy and safety. Methods: This was a retrospective cost effectiveness analysis. The study population consisted of 25 consecutive patients who underwent day stay RF ablation and 25 consecutive patients who underwent inpatient RF ablation (historical controls). Economic analysis was based upon a detailed clinical costing. Results: The mean overall cost per patient of inpatient RF ablation in 1994 Australian dollar values is $2354 (SD, $642) compared with $1876 (SD, $595) for day stay RF ablation (p<0.01). Day stay RF ablation is a cost effective alternative to inpatient RF ablation.
Feed us nutrition: final year medical students' perceptions of nutrition medical education
Authors: Warden R. A. , Lettoof A‐L. , Wallis B. J. , Porteous J. E. 
Published: March 2008

Abstract Background: Nutrition is recognised as an integral aspect of Australian medical education. Since medical students will learn more of a subject they consider important, there is a need for their perceptions of nutrition to be investigated. Aims: To identify final year medical students' perceptions about nutrition and its inclusion in their medical course, and to compare priority nutrition topics identified with those previously identified by Faculty and General Practitioners (GPs) who teach in the undergraduate curriculum. Methods: A cross‐sectional survey of all final year medical students attending the University of Newcastle was conducted, using a distributed questionnaire, comprising three sections: demographics, perceptions about nutrition and its inclusion in the medical course, and a listing of 38 major nutrition topics. Main outcome measures were: interest in nutrition, and whether it should be included in the undergraduate medical curriculum; rated importance of listed nutrition topics; comparison between students and Faculty and GPs. Frequency distributions and Chi square analyses were used to compare group responses. Results: Seventy‐one per cent of the students were interested in nutrition and 94% believed it should be included in the medical curriculum. More than 60% of the students nominated 21 of the 38 topics essential or important. Thirteen of these topics were also highly rated by Faculty and GPs, although Faculty and GPs rated more topics as essential or important. Conclusions: Newcastle medical students are interested in nutrition and believe it should be included in their medical curriculum. This may be due to their clinical exposure and the educational milieu of the University of Newcastle Medical School. Exposure to nutrition in their undergraduate education appears to be an important determinant for priority designated nutrition topics.
Alcohol intake and survival in the elderly: a 77 month follow‐up in the Dubbo study
Authors: Simons L. A. , McCallum J. , Friedlander Y. , Simons J. 
Published: March 2008

Abstract Background: A prospective study in non‐institutionalised Australian elderly aged 60 years and over commenced in Dubbo, NSW in 1988. Aim: To examine the relationship between all‐causes mortality and alcohol intake. Methods: The data were derived from a community‐based sample comprising 1236 men and 1569 women followed for a median period of 77 months. Regular alcohol intake was reported by 78% of men and 52% of women. Eighty‐seven per cent of men and 44% of women primarily drank beer. Results: Death occurred in 305 men and 236 women, 34% and 39% respectively from coronary heart disease (CHD). In a proportional hazards model, the hazard ratio (HR) for all‐causes mortality in male drinkers, compared with abstainers, was 0.75 at one‐seven drinks/week, 0.76 at eight‐14 drinks/week, 0.69 at 15–28 drinks/week and 0.49 at >28 drinks/week (p<0.04), an inverse relationship. In female drinkers, HR was 0.78 at one‐seven drinks/week, 0.49 at eight‐14 drinks/week (p<0.04) and 0.62 at 15–28 drinks/week, potentially a U shaped relationship. The effect on all‐causes mortality could not be attributed to a differential effect of beer versus wine/spirit intake. Although the mortality rate was lower in those taking any alcohol compared with abstainers, those taking any alcohol exhibited an increased proportion of deaths due to cancer at the expense of a reduced proportion of CHD and stroke deaths. Conclusions: Alcohol intake in the Dubbo elderly appears to be independently associated with a significant increase in life expectancy. Mechanisms underlying the effect may emerge at a longer interval of follow‐up.
Rheumatic manifestations of the myelodysplastic syndromes: A comparative study
Authors: Chandran G. , Ahern M. J. , Seshadri P. , Coghlan D. 
Published: March 2008

Abstract Background: The myelodysplastic syndromes (MDS) are a group of common haematological disorders that increase in incidence age. Case reports have suggested an arthritis associated with myelodysplasia. This comparative study reviews patients with myelodysplasia and patients with a myeloproliferative disorder (MPD) as the control group. Aim: To document the rheumatological manifestations in patients with MDS and to determine if there is an association between MDS and an inflammatory arthritis/ vasculitis. Methods: Between July 1990 and July 1995 all patients with a known diagnosis of MDS and MPD attending the Haematology clinics of two teaching hospitals were reviewed. There were 87 MDS patients and 86 MPD patients identified. Twenty‐six of the MDS patients and 28 of the MPD patients attended a clinical review by a single examiner. A history of joint symptoms, skin rashes, family and drug history was obtained. Physical examination and serology were routinely performed. The case notes of the remaining patients were reviewed by a single observer. Approval was obtained from the Ethics Committee at both hospitals. Results: The two patient groups were matched for sex and age. There were equal numbers of patients with osteoarthritis, rheumatoid arthritis and crystal arthritis in the two groups. The significant finding was the presence of a seronegative inflammatory arthritis in five patients in the MDS group. One patient had both a seronegative arthritis and a cutaneous leukocytoclastic vasculitis, and another a cutaneous leukocytoclastic vasculitis only. These rheumatic manifestations were not seen in the MPD group. Five of six patients were treated with prednisolone and responded impressively. The rheumatological symptoms preceded the diagnosis of MDS in two of the six cases. Conclusions: A seronegative arthritis is an associated finding in MDS. The artiiritis can precede the development of the bone marrow disorder, and can be a guide to the diagnosis of this haematological disorder in elderly patients presenting with an inflammatory arthritis and cytopenias.
An audit of long‐term octreotide therapy for acromegaly
Authors: Cheung N. W. , Taylor L. , Boyages S. C. 
Published: March 2008

Abstract Background: Octreotide has been successfully used for the treatment of acromegaly, but little long‐term data are available. Aims: To determine the long‐term efficacy and safety of octreotide in the treatment of acromegaly. Methods: Twenty‐seven patients with acromegaly were treated with octreotide in a non randomised study. Six patients had not had previous surgery or radiotherapy, and were treated with octreotide alone. Symptoms of acromegaly, IGF‐I levels, growth hormone suppression by glucose, pituitary tumour size, and side effects were monitored. The median duration of treatment was 44 months (range six‐102). Results: Symptom control was excellent. Twenty (74%) patients had a reduction of IGF‐I into the normal range. IGF‐I levels fell after one year from 94.2±6.1 nmol/L (mean±SEM) to 50.0±2.7 nmol/L (p<0.0001). Ten of 13 (77%) patients had normal IGF‐I levels after four years. These reductions have persisted for up to nine years of octreotide therapy. The GH response to glucose was normalised in 14 of 16 (88%) subjects. Eleven of 25 (44%) patients had a reduction in pituitary gland height. Side effects were common, but usually of a minor nature. Cholelithiasis occurred in 39% of patients. Two patients ceased octreotide because of side effects. Conclusions: We conclude that octreotide is an effective and safe long‐term treatment for acromegaly. It is a useful adjunct to surgery, and may be offered as sole therapy for patients with smaller adenomas.
Fasting and post‐methionine homocysteine levels in a healthy Australian population
Authors: Silberberg J. , Finucane P. , Crooks R. , Guo X. W. , Fryer J. L. , Xie J. , Wlodarczyk J. , Dudaman N. , Nair B. 
Published: March 2008

Abstract Background: Plasma homocysteine (H[e]) is frequently measured in patients with occlusive vascular disease, but levels vary between populations and between laboratories. Aims: We sought to derive reference values for an Australian population over a wide age range. Methods: We measured plasma H(e) in the fasting state and after methionine loading in 116 volunteers selected at random from the Hunter districts of the New South Wales electoral roll and in 49 apparently healthy, active subjects recruited from the region's lawn bowling clubs. Reference ranges were derived for born sexes, in three age strata. We collaborated with two international laboratories in standardising our results. Results: Mean fasting H(e) levels were approximately 2.7 μ.mol/L higher in men than women, at all ages (95% CI for the difference, 1.2 to 4.1 μmol/L). Levels increased with age (approximately 1.0 μmol/L/decade, 95% CI 0.5 to 1.5) and were correlated with serum creatine (r=0.48), serum folate (r=−0.30), red cell folate (r=−0.25) and serum B12 (r=−0.31) (all p<0.001). These results are similar to those reported in other populations. Conclusions: We have defined reference ranges for a typical Australian population, following careful laboratory standardisation. H(e) levels must be interpreted with regard to age, sex, renal function and vitamin B12 and folate status.
Community acquired pneumonia in north eastern Australia ‐ a hospital based study of Aboriginal and non‐Aboriginal patients
Authors: Thompson J. E. 
Published: March 2008

Abstract Background: Although the most important organism causing community acquired pneumonia continues to be Streptococcus pneumoniae, the frequency of other pathogens varies considerably across the world.1‐4 Aims: To look for the causes of community acquired pneumonia (CAP) in north east Australia. To examine the differences between Aboriginal and non‐Aboriginal subjects with emphasis on prevalence, risk factors, causative organisms and prognosis. Methods: The records of 200 consecutive patients admitted to Cairns Hospital during 1992 with a diagnosis of pneumonia were studied. Results: Aboriginal patients made up half the numbers admitted, but only 13% of the population. More Aboriginal adults died than non‐Aboriginal adults, but no child died. Heavy alcohol use, chronic lung disease and diabetes mellitus were the commonest risk factors for Aborigines (alcohol, chronic lung disease and cancer for non‐Aboriginal subjects).S. pneumoniae, followed by Haemophilus influenzae were the most common pathogens found. Both were sensitive to amoxycillin. The yield of definite pathogens was low. Staphylococcal and melioidosis pneumonia were confined to Aboriginal patients. Chlamydia, legionella and Mycoplasma pneumoniae were not identified.
Lymphocytopenia in a hospital population ‐ what does it signify?
Authors: Castelino D. J. , McNair P. , Kay T. W. H. 
Published: March 2008

Abstract Background: Lymphocytopenia is a common finding in hospital patients especially since the advent of automated differential leukocyte counters. The causes and significance of lymphocytopenia are generally poorly understood. There has been no large‐scale study of its significance for 25 years. The HIV epidemic, and the recently described idiopathic CD4+T‐lymphocytopenia have raised interest in this finding. Aims: To describe the spectrum of lymphocytopenia in an adult teaching hospital and investigate its clinical significance. Methods: Using the available computer facilities, patients with significant lymphocytopenia (<0.6X109/L) were identified over a 102 day period and diagnoses, operations and medication lists obtained. Where necessary, patient histories were examined to supplement the above information. If feasible, previous and subsequent lymphocyte counts were checked to establish if the lymphocytopenia were temporary or longstanding. Results: One thousand and forty‐two patients were identified, with a mean age of 59.6 years, of whom 563 were male, and 757 were inpatients. Thirty‐six patients were pancytopenic. We checked previous and subsequent counts for 698 patients and found 45 patients who were consistently lymphocytopenic, some for more than ten years. Thirty‐four patients with previously normal counts remained lymphocytopenic throughout follow up, while 457 had at least one subsequent lymphocyte count >1×107L. We found only one patient who was suspected of having idiopathic CD4+T‐lymphocytopenia. Patients fell into several categories (with some overlap): bacterial/fungal sepsis (250), post‐operative (228), corticosteroid therapy (definite 159, suspected 53, inhaled steroids alone 14), malignancy (174 definite, six probable), cytotoxic therapy and/or radiotherapy (90), trauma or haemorrhage (86), transplants (73–38 renal and 35 bone marrow), ‘viral infections’ (26) and HIV infection (13). Thirty‐four patients died within the study period. Conclusions: Lymphocytopenia in hospital patients is most frequently reversible, and due to acute illness, notably sepsis and trauma (including surgery). Malignancy, with or without chemotherapy, and steroid use are also common causes, but HIV infection is a relatively uncommon cause in our hospital.
Instrument performance in bone density testing at five Australian centers
Authors: Khan K. M. , Henzell S. L. , Broderick C. , Prince R. L. , Saul A. , Lornman J. , Wark J. D. 
Published: March 2008

Abstract Aims: To assess the in vitro precision and accuracy of bone mineral densitometry (BMD) within and between locations at five Australian centres. Methods: Using a multicentre reliability study the accuracy and short‐ and long‐term precision of dual‐energy X‐ray absorptiometry (DXA) in vitro was compared on five instruments. Measures were performed using pencil beam mode on four Hologic QDR‐2000 densitometers and one Hologic QDR‐1000/W (Hologic Inc, Waltham, MA). Results: Short‐term precision of bone mineral density measurement was less than 0.5% for spine phantoms (n=10 for each centre, mean intrasite coefficient of variation [CV] 0.39±0.09% [SD]) and for hip phantoms (n=10 for each centre, mean intrasite coefficient of variation [CV] 0.34±0.10% [SD]). Between‐centre measurement (n=10 for each phantom) of a single spine phantom and a single hip phantom (specified mineral contents ‐ 58.5 g and 38.6 g, respectively) revealed ranges of bone mineral content of 57.7‐58.1 g (all‐point CV=0.52%) and 37.1–37.8 g (all‐point CV=0.70%), respectively. When results from pairs of machines were compared there were statistically different mean BMD results for the majority of the ten possible pairings for both spine and hip measurements. Each study centre measured in vitro stability of phantom BMD measurements over a one year period (n=45–283, median 157 for spine; and n=0–262, median 38, for hip); CVs ranged from 0.38 to 0.53% for the spine measurements and from 0.38 to 0.54% for the hip measurements. The mean all‐point accuracy of the spine phantom measurements was 99.1% and the hip phantom measurements was 96.7%. Conclusions: Across a number of instruments DXA demonstrates in vitro all‐point precision of 0.5% for the spine phantom and 0.7% for the hip phantom. The instrument demonstrates accuracy of greater than 99% at the spine and 96% at the hip. This finding has clinical, research and quality control implications.
‘Normal’ lung function in rural Australian Aborigines*
Authors: Veale A. J. , Peat J. K. , Salome C. M. , Woolcock A. J. , Thompson J. E. 
Published: March 2008

Abstract Background: Although lung diseases are a leading cause of premature mortality in Australian Aborigines, little is known about normal lung function in these people. Aim: To develop models for ‘normal’ spirometric function in rural Australian Aborigines. Method: A cross‐sectional population‐based study of four rural Aboriginal communities was performed in Queensland, Northern Territory and South Australia, Australia. We studied 261 children aged seven‐19 years and 332 adults aged 20–80 years who were free of symptoms and had no clinical signs of chronic lung disease. The outcome measures were forced expiratory volume in one second (FEVj) and forced vital capacity (FVC). Multiple linear regression was used to develop models for FEVj and FVC and comparisons were made with Caucasians and indigenous people from other countries. Results: The Aboriginal people studied had FEVi and FVC values that were lower (20% and 30% respectively) than those found in Caucasians of the same height, age and gender. As a consequence, they had relatively high FEVi/FVC ratios. Those studied also had forced expiratory volumes that were lower than those found in African Americans and other indigenous peoples. Conclusions: Apparently healthy rural Aboriginal people have low forced expiratory volumes when contrasted with Caucasians and indigenous peoples such as African Americans. More research is required to determine if this is ‘normal’ or a product of the suboptimal environment into which many Aboriginal people are born.
The value of the lipid‐laden macrophage index in the assessment of aspiration pneumonia
Authors: Adams R. , Ruffin R. , Campbell D. 
Published: March 2008

Abstract Background: A semi‐quantitative index of lipid‐laden macrophages on broncho‐alveolar lavage (BAL) has been reported to be highly sensitive but only moderately specific for aspiration in adults. There has been little published literature evaluating this technique since the original report. Aims: To assess the value of a lipid‐laden macrophage index (LLMI) of greater than 100 to confirm the clinical diagnosis of aspiration in patients with abnormal radiological investigations. Methods: Prospective evaluation of 80 adult patients with abnormal radiology was undertaken using BAL and the LLMI. A diagnosis of aspiration was made prior to bronchoscopy if the patient had one or more of: clinically witnessed aspiration, positive barium swallow or speech pathology assessment; or an upper gastrointestinal endoscopy showed severe reflux oesophagitis and the patient had a history consistent with aspiration. Results: Eighteen patients were diagnosed with aspiration. Of these, 17 had an index >100, and one had an index of 94 (mean 157, 99% CI 127–187, range 94–238). Of the other 62 subjects, seven had an index >100 (mean 46, 99% CI 22–70, range 0–303). There was a significant difference between index scores for the two groups (p=0.002). For aspiration, an index >100 had a sensitivity of 94% and a negative predictive value of 98%. The specificity was 89%, with a positive predictive value of 71%. Conclusions: The LLMI is a sensitive indicator for aspiration causing radiological lung disease in adults. Its lack of specificity means it cannot be the sole means of diagnosis, but it can allow better targeting of other investigations in those patients in whom bronchoscopy is undertaken to investigate radiological abnormalities.