bluuebunny/crossref_metadata_2025_split huggingface dataset:
Late (one month) reversible ischaemia after primary coronary occlusion treated with recombinant tissue plasminogen activator (rTPA)
Authors: Wilkes N. P. F. , Magee M. , Hoschl R. , Nelson G. I. C. 
Published: March 2008

Abstract The incidence of reversible ischaemia was assessed four weeks after primary coronary occlusion in 36 patients who had not required earlier revascularisation after randomisation to receive rTPA (n= 19) or placebo (n= 17). Coronary arteriography was performed at three weeks and thallium scintigraphy with dynamic stress testing at four weeks. Patients were followed for one year without planned intervention in the absence of symptoms. Managing physicians remained blinded to thrombolytic therapy.Patency rate of the infarct related artery at three weeks was greater after rTPA (rTPA 16, placebo 9; p= 0.04). Reversible perfusion defects within infarct related artery territory occurred with similar frequency in both treatment groups (rTPA 7, placebo 8). Multivessel disease was frequent (rTPA 11, placebo 12) but associated with a low incidence of reversible perfusion defects outside infarct related artery territory (rTPA 3, placebo 2). Thallium scintigraphy identified six of seven patients requiring subsequent revascularisation (sensitivity 86%, specificity 59%, negative predictive value 94%). Dynamic stress testing was positive for reversible ischaemia in 28% (rTPA 6, placebo 4) and identified two patients requiring revascularisation (sensitivity 29%, specificity 72%, negative predictive value 81%).The greater patency rate achieved with rTPA at three weeks after primary coronary occlusion was not associated with a significantly greater incidence of reversible perfusion defects at four weeks in patients who had not required prior revascularisation. The absence of reversible perfusion defects at four weeks was associated with a low incidence of revascularisation procedures during one year follow‐up.
A randomised study of outcomes in a defined group of acutely ill elderly patients managed in a geriatric assessment unit or a general medical unit
Authors: Harris R. D. , Chalmers J. P. , Henschke P. J. , Tonkin A. , Popplewell P. Y. , Stewart A. M. , Radford A. J. , O'Brien K. P. , Bond M. J. , Harris M. G. , Turnbull R. J. , Champion G. , Hobbin E. R. , Andrews G. R. 
Published: March 2008

AbstractThe aim of this study was to identify differences in the medical management and clinical outcome in a group of elderly patients admitted to a designated geriatric assessment unit (GAU) or to two general medical units (GMUs). A prospective randomised controlled trial was undertaken in 267 patients aged 70 years and over (mean age = 78.3 years). Following discharge from hospital, patients were followed up at three monthly intervals for a total of 12 months. At the time of discharge, no significant differences were found in inpatient management, length of stay, mortality rates, discharge rates to institutional care or utilisation of community services in patients admitted to the GAU and the GMUs. Similarly, no significant differences were found at three, six, nine, and 12 month follow up in case fatality, activities of daily living indices, mental health status, rates of institutional referral and the level of community service support in patients admitted to the GAU and the GMUs studied.These findings do not show any advantage for the unselected 70 + acutely ill elderly patient who is admitted to a designated geriatric assessment unit rather than to a general medical unit. Therefore, an admission policy to GAU, based solely on age 70 + is medically inappropriate and cost‐inefficient. Evidence from other sources suggests that an age cohort of acutely admitted patients beyond 80 years may well have returned more optimistic findings for the GAU. In future, GAUs will require a more selective admission policy to maximise the benefits of their rehabilitative and interdisciplinary approach. (Aust NZ J Med 1991; 21: 230–234.)
Physician response to screening for hypercholesterolaemia in a coronary care unit
Authors: Cox S. V. , Woodhouse S. 
Published: March 2008

Abstract Hypercholesterolaemia is a known risk factor for coronary artery disease. This study describes a retrospective analysis of 176 patients admitted to the Coronary Care Unit (CCU) in a six month period with an admission fasting serum cholesterol of greater than 5.5 millimoles per litre (mmols/L). The patient records were examined at least six months after hospital discharge to determine what action, if any, was instituted in response to their hypercholesterolaemia.One hundred and thirty‐four (76%) patients had a discharge diagnosis of myocardial ischaemia or infarction. Of the 176 patients, 73 were referred to a dietitian, 31 were given dietary advice by a medical officer, 13 were commenced on lipid‐lowering drugs with nine continuing lipid‐lowering drugs and only 13 patients were referred to this hospital's lipid clinic. Sixty‐nine (39%) received no response to their hypercholesterolaemia.It is likely that our experience is not unique and greater attention to CCU measured lipid results and risk factor modification should be instituted by physicians. (Aust NZ J Med 1991; 21: 401–404.)
Autoantibodies in systemic vasculitis
Authors: Savige J. A. , Gallicchio M. , Chang L. , Parkin J. D. 
Published: March 2008

Abstract We have studied 495 sera that were referred to us from patients suspected on clinical and/or histological grounds to have a small vessel vasculitis. These sera were tested for antibodies against neutrophil cytoplasm antigens (anti‐neutrophil cytoplasm antibodies, ANCA) using assays based on neutrophil acid extract, myeloperoxidase and elastase. Such antibodies are commonly found in Wegener's granulomatosis (WG) and microscopic polyarteritis (MPA), and sometimes in other small vessel vasculitides.One hundred and twenty‐six of these sera (25%) were positive in the acid extract ELISA, 68 (14%) in the assay for anti‐myeloperoxidase antibodies and 35 (16%) in the assay for anti‐elastase antibodies. A total of 166 sera (34%) were positive for antibodies against neutrophil cytoplasm constituents.No ANCA, anti‐myeloperoxidase or anti‐elastase antibodies were detected in 26 convalescent sera from patients either with WG or MPA, or who had previously been positive. The mean time between positive and negative sera was eight weeks (range three weeks to six months) and three out of three who relapsed again developed ANCA of the same specificity as the original sera.Of the 228 sera also tested for anti‐GBM antibodies, 13 (5.7%) were positive. All these contained antibodies against neutrophil cytoplasm constituents (three against the acid extract, eight against myeloperoxidase and two against elastase).Forty‐nine of the 74 sera (66%) tested for ANA were positive. Twenty‐nine (39%) had a speckled and 20 (27%) had a homogeneous pattern. Twenty of these were positive for ANCA or anti‐myeloperoxidase or anti‐elastase antibodies and 29 were negative.ANCA, anti‐myeloperoxidase and anti‐elastase antibodies are common in patients in whom a vasculitis is suspected on clinical and/or histological grounds. The presence of these antibodies correlates with disease activity. Anti‐GBM antibodies and ANA are not uncommon in this group. A single ELISA for ANCA is insufficient to detect all antibodies directed against neutrophil cytoplasm constituents. (Aust NZ J Med 1991; 21: 433–437.)
Allergic bronchopulmonary fungal disease caused by Bipolaris and Curvularia
Authors: Lake F. R. , Froudist J. H. , McAleer R. , Gillon R. L. , Tribe A. E. , Thompson P. J. 
Published: March 2008

Abstract Allergic bronchopulmonary fungal disease (ABPFD) usually manifests in asthmatics as allergic bronchopulmonary aspergillosis. In a few instances other fungi have been implicated. Serological testing in Western Australia between 1979 and 1986 revealed precipitins to Bipolaris and Curvularia species in 40 of 503 patients tested. Eight of these were patients with ABPFD due to Bipolaris and/or Curvularia and are reported here.Geographical location appeared to be significant as seven of eight of those with ABPFD (and at least 18 of 40 with positive serology) were living in the more remote and sub‐tropical northern part of the state.ABPFD due to fungi other than Aspergillus species may be more common than previously recognised and further epidemiological assessment is warranted. (Aust NZ J Med 1991; 21: 871–874.)
Inability to detect circulating anti‐idiotypic antibodies in human anti‐GBM antibody‐mediated disease using a splenic PFC assay
Authors: Savige J. A. , Lockwood C. M. 
Published: March 2008

Abstract:Anti‐idiotypic antibodies are antibodies that are directed against the variable region of the corresponding antibody molecule and have been postulated to have a regulatory role in the immune response. Circulating anti‐idiotypic antibodies have been reported in several antibody‐mediated autoimmune diseases.We have established the following detection system for anti‐idiotypic antibodies in human anti‐glomerular basement membrane (GBM) disease. Spleen cells harvested from BALB/c mice immunised with human GBM were incubated with GBM‐coated sheep red blood cells in the presence of guinea pig complement. Each spleen cell that produced anti‐GBM antibodies resulted in a surrounding plaque where antibodies lysed the GBM‐coated RBC. The number of plaques could be inhibited by the addition of heterologous anti‐idiotypic antibodies to the plaquing mixture. Anti‐idiotypic antibodies were then sought in both acute and convalescent phase sera from patients with anti‐GBM disease and in laboratory staff who repeatedly handled GBM and sera containing anti‐GBM antibodies. Anti‐GBM antibodies were removed from all material before testing and affinity‐purified preparations contained concentrations of IgG corresponding to the range that resulted in inhibition when affinity‐purified rabbit anti‐idiotypic antibody was examined.No anti‐idiotypic antibodies could be demonstrated in any of the sera or IgG preparations examined. We conclude that if circulating anti‐idiotypic antibodies are present in patients with anti‐GBM disease, they must be infrequent, or at concentrations below the limits of detection of this assay (< 1 mcg/mL). The observations of anti‐idiotypic antibodies in other antibody‐mediated diseases need to be confirmed.
Sino‐atrial arrest due to temporal lobe epilepsy
Authors: Joske D. J. L. , Davis M. J. E. 
Published: March 2008

Abstract:A case of sino‐atrial arrest due to temporal lobe epilepsy is described and compared with previously documented such cases in the literature. The rarity of bradycardias and sinus arrest due to arrhythmogenic seizures is discussed, as is the role of prospective ambulatory electroencephalographic and electrocardiographic studies in evaluating this association.
Epidemiological characteristics of Legionella infection in South Australia: implications for disease control
Authors: Cameron S. , Roder D. , Walker C. , Feldheim J. 
Published: March 2008

Abstract:About one third of adults surveyed in South Australia have shown evidence of past silent infection with Legionella pneumophila serogroup 1. However, the annual notification rate for symptomatic disease is only about 0.5 per 100,000 residents in non‐epidemic years. The male to female ratio is 2.5 to one and approximately 50% of cases are at least 60 years of age. Cases have presented more in summer and in the metropolitan areas.Twenty cases of Legionnaires' disease occurred during the summer of 1985‐86. A cooling tower was held to be the principal source with aerosols being dispersed up to three kilometres away during an atmospheric thermal inversion.A subsequent outbreak of 22 L. longbeachae serogroup 1 infections had no marked geographic clustering. The outbreak commenced in spring and cases were distinguished as active gardeners. L. longbeachae was found in garden soil and it is hypothesised that this soil inhabitant can become aerosolised and inhaled during gardening.The potential for primary prevention of Legionnaires' disease is discussed in relation to water‐handling equipment and the need for early precautionary treatment of all community‐acquired pneumonia as suspect Legionnaires' disease is emphasised.
High density lipoproteins, genetic polymorphism for apo A‐I and coronary artery disease
Authors: Simons L. A. , Balasubramaniam S. , Szanto A. , Simons J. , Friedlander Y. , Hickie J. B. , Shine J. 
Published: March 2008

Abstract:HDL cholesterol and apolipoprotein A‐I are associated with the development of coronary artery‐disease (CAD). The presence of a PstI site polymorphism adjacent to the gene encoding apo A‐I (known as P2) has also been shown to be associated with CAD but this relationship is controversial. A case control study was conducted in an Australian population to re‐examine whether the rare P2 allele is associated with CAD. Data were derived from 159 cases of angiographically confirmed CAD and 99 healthy controls. The proportion of CAD cases carrying the P2 allele did not differ significantly from controls (11% versus 9%). In a multiple logistic regression model controlling for the effects of age, country of birth, hypertension and hypotensive drugs, body mass index and lipid variables, the P2 allele failed to predict significantly the presence of CAD (odds ratio 1.83; 95% confidence interval 0.65–5.19).
Survival from pentamidine induced pancreatitis and diabetes mellitus
Authors: Wood G. , Wetzig N. , Hogan P. , Whitby M. 
Published: March 2008

Abstract:Serious and occasionally fatal reactions to pentamidine have been reported and with the increased use of the drug in immunocompromised patients they are likely to become more frequent. We report the development of acute pancreatitis and permanent diabetes mellitus in an AIDS patient treated with intravenous pentamidine for Pneumocystis pneumonia. The literature on pentamidine induced pancreatic damage is reviewed.
Giant cell arteritis associated with pericarditis and large vessel disease
Authors: Stanley D. , Henderson D. , Harris S. 
Published: March 2008

Abstract:Giant cell arteritis is well recognised to affect branches of the external carotid artery and to cause systemic symptoms, but may also involve branches of the aorta producing a clinical syndrome that may be difficult to diagnose. A patient is described who presented with limb ischaemia, pericarditis and systemic symptoms. Treatment with corticosteroids improved the systemic manifestations but not the ischaemia. The patient died of bowel infarction four months after treatment was commenced.
Digital echocardiography in myocardial infarction
Authors: Feigenbaum Harvey 
Published: March 2008

AbstractProbably the most under‐utilised application of echocardiography is in patients with coronary artery disease (CAD). This under‐utilisation is striking since echocardiography can be very valuable in evaluating the natural history and therapy of CAD.One reason why echocardiography is not being utilised to its fullest is because of the reliance on videotape to record and display echocardiograms. This medium is time consuming and inconvenient for clinicians to review studies, it is not ideal for detecting subtle wall motion abnormalities, and videotape is impractical for comparing serial studies. Recording and storing echocardiograms on a digital medium overcomes these difficulties. Digital cine loops of single cardiac cycles provide great versatility. Multiple views or studies can be displayed simultaneously, subtle changes in wall motion are more easily detected and different views, or serial studies, can be readily compared. Such images can be displayed on computers on the ward or in the coronary care unit (CCU) and be available 24 hours a day, seven days a week at the convenience of the clinician. One does not need to find a recording on a two hour videotape, which may be in the ultrasound instrument, and one can view the exam in 30 sec instead of 5 to 10 min.Regional and global left ventricular function is one of the most important manifestations of CAD. With new therapeutic efforts at restoring myocardial function and limiting infant expansion, assessing LV function is more important than ever. Digital echocardiography is an extremely practical and convenient way for clinicians to obtain this information.
Echocardiography in the management of mitral valve prolapse
Authors: Feigenbaum Harvey 
Published: March 2008

AbstractEchocardiography plays a major role in the management of patients with mitral valve prolapse (MVP). The technique has greatly enhanced our understanding of the pathophysiology, epidemiology and natural history. There are major and minor echocardiographic diagnostic criteria for prolapse. Major criteria involve the mitral leaflets and include late systolic posterior displacement on M‐mode, bulging into the left atrium on 2D long‐axis (LAX) view, and thickening and redundancy of the leaflets. Minor criteria include holosystolic posterior prolapse on M‐mode, bowing of the mitral leaflets into the left atrium (LA) in the apical 2D views, and late systolic mitral regurgitation on the Doppler echogram. Any of the major criteria should be sufficient to make the diagnosis. One or two minor criteria without a major sign would be questionable.The degree of thickening and redundancy and the presence and quantitation of mitral regurgitation influence prognosis. Echocardiography is also helpful in identifying complications such as endocarditis and ruptured chordae.An echocardiogram may not be necessary for the diagnosis, but it is helpful for prognosis and as a baseline for possible future changes. The frequency of follow‐up echocardiograms should be determined by clinical findings. When mitral regurgitation is present, then one should follow LA and left ventricular size and function. Transoesophageal echocardiography may be desirable for better definition of vegetations or flail leaflets and is frequently used to monitor surgical repair.
Aspects of active rheumatic carditis
Authors: Barlow John B. 
Published: March 2008

AbstractFulminating active rheumatic carditis has been observed for over 3 decades in this environment with no recent alteration in either the incidence or the pattern of presentation. Patients are black, seldom older than 20 years and are usually in their early teens but may occasionally be as young as five years. Heart failure is prevalent but occurs only when a haemodynamically important left‐sided valve lesion supervenes. Regurgitation is the predominant valve lesion and involves principally the mitral valve. Mitral annular dilatation is the initial pathology and predisposes to lengthening – or rupture – of chordae tendineae and prolapse of the anterior leaflet. The resultant cardiac work‐overload apparently perpetuates the rheumatic activity. Heart failure, whether caused by or associated with active rheumatic carditis, makes surgical management of the valve lesion mandatory as a life‐saving measure. Mitral valve repair, rather than replacement, is the surgical procedure of choice but is not always practicable when the rheumatic activity is fulminant, significant aortic regurgitation associated or the surgeon relatively inexperienced. Aggressive medical therapy for heart failure, which should include vasodilator drugs, provides temporary improvement only. Contrary to ongoing doctrine, treatment with steroid drugs is neither life‐saving nor beneficial. Varying degrees of left ventricular dysfunction are encountered pre‐operatively and may be a sequel of the severe regurgitant valve lesion rather than of a rheumatic ‘myocardial factor’.
Exercise, echocardiography
Authors: Feigenbaum Harvey 
Published: March 2008

AbstractExercise testing is an indispensable component of clinical cardiology. Latent disease or the full extent of a problem may not be apparent on a resting examination. Some form of stress is frequently necessary, especially in patients with coronary disease, to appreciate whether a patient has stress‐induced ischaemia as manifested by exercise‐induced chest discomfort, a drop in blood pressure or electrocardiographic changes of ischaemia. Unfortunately as with every test ECG and clinical monitoring have limitations. Patients may have ischaemia without pain, ECG changes may be non‐specific, a resting abnormal ECG has limited value, and the location and amount of ischaemic muscle is not directly assessed.Monitoring the echocardiogram adds significant additional information to routine stress testing. By visualising the myocardium in the exercising individual, it is possible to assess a fundamental manifestation of ischaemia, regional wall motion abnormalities. This information kelps identify the vessels and the amount of muscle involved. In addition resting wall motion abnormalities may detect clinically silent infarction or hibernating myocardium. Direct visualisation of the exercising heart provides an improved understanding of a patient's cardiac status. The technique is particularly useful in evaluating revascularisation procedures.Advances in instrumentation have reduced or eliminated many of the technical difficulties with obtaining and interpreting exercise echocardiograms. This examination has become an extremely useful adjunct to routine stress testing.
The automatic implantable defibrillator is the most realistic and cost‐effective way of preventing sudden cardiac death
Authors: Uther John F. B. 
Published: March 2008

AbstractJudgement about cost‐effectiveness of medical treatments depends upon the criteria used to define effectiveness. The most rational single criterion is the Quality Adjusted Life Year gained (QALY).Comparisons of cost‐effectiveness of treatments may be made by comparing the dollar costs per QALY. Both the dollar and the QALY comparisons are subject to all errors of biological variable measurement and bias introduced by experimental design seen in other biological experiments. The proper methodology for comparison is the prospective randomised controlled clinical trial. Such trials using the automatic implantable defibrillator (AICD) as prophylaxis against sudden cardiac death (SCD) have not yet been performed.The major underlying cause of SCD is coronary artery disease with previous myocardial infarction (MI) and provocative tests for ventricular arrhythmias are the most powerful predictors of SCD in infarction survivors. AICD implantation carries a mortality of about 2%, and survival after successful implantation is about 89% at one, and 84% at two years. By comparison, infarction survivors with left ventricular ejection fraction <0.4 and inducible slow monomorphic ventricular tachycardia have a survival rate of 70% at one, and 54% at two years, Antiarrhythmic drugs have not proven effective. There is an urgent need to confirm the advantage of the AICD by proper randomised controlled trial
Asthma under‐recognition and under‐treatment in an Australian community
Authors: Bauman A. , Young L. , Peat J. K. , Hunt J. , Larkin P. 
Published: March 2008

Abstract:In a study in south‐western Sydney, we examined asthma symptoms in a random sample of 4239 schoolchildren aged five‐12 years. The prevalence of current wheeze and cough was 17.1% (95% CI 16.0–18.2%). Interviews were conducted with the parents of all 214 symptomatic children from two of the six schools. Only 60% of these children had ever been labelled as asthma, and only 20% were using appropriate asthma treatment. Fewer than 6% had ever had their airway function assessed. There was a socio‐economic difference, with better levels of asthma recognition and management in children attending the school in the more aflluent region. The findings suggest that asthma recognition, assessment and management in the Australian community, as in New Zealand and the UK, may need to be improved. (Aust NZ J Med 1992; 22: 36–40.)