bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reoperation for recurrent coronary artery disease – a ten year experience
Authors: Horton D. A. , Hicks R. G. 
Published: March 2008

Abstract:The need for reoperation caused by recurrence of coronary artery disease is becoming increasingly common. Although reoperation is more difficult and time‐consuming, with careful surgical technique it can be carried out with the same mortality as that described by many units for primary coronary artery bypass grafting (1.2 – 2.0%). In the 172 patients described here, who had coronary artery reoperations between 1981 and 1990, there were two in‐hospital deaths (1.2%). There were three postoperative bleeds which required return to theatre. No patient suffered a postoperative neurological deficit or postoperative myocardial infarction. These reoperations comprised 6.9% of the 2497 coronary artery operations carried out in the same period. Follow‐up disclosed eight late deaths, from five‐62 months after operation; all survivors claim to be symptomatically improved. Consideration should be given to the potential problems of reoperation when carrying out primary myocardial revascularisation.
Clinical experience with surgery for paroxysmal supraventricular tachycardia: a report of 103 cases
Authors: Vohra J. , Sathe S. , Tatoulis J. , Fenelon T. , Chan W. , Hamer A. , Kertes P. , Graham D. , Riter A. , Hunt D. 
Published: March 2008

Abstract:One‐hundred‐and‐three patients underwent surgery for paroxysmal supraventricular tachycardia (PSVT). In eighty‐three patients (81%), PSVT was due to an accessory atrioventricular pathway (Group I) and in 20 (19%) to Atrioventricular Junctional (AV nodal) Reentrant Tachycardia (AVJRT:Group II). Initial surgery successfully divided 77 of 83 accessory pathways, including 58 of 60 left free wall pathways, 12 of 15 posteroseptal pathways, six of seven right free wall pathways and one anteroseptal pathway. Twenty patients had successful surgery for AVJRT. Surgery was performed with low morbidity and no early or late mortality in either group. One patient in each group required permanent pacemaker implantation. Immediate (within one week) postoperative electrophysiological study using epicardial wires was performed in 96% of patients and repeat electrophysiological study six months later was possible in 65/103 (63%) patients. Patients with surgery for accessory pathways were followed‐up for a mean 34 ± 23 months, while those with surgery for AVJRT for a mean of 13 ± seven months. No patient with successful surgery has had a clinical recurrence of PSVT. Thus the results indicate that surery is a safe and curative therapy for patients with PSVT. (Aust NZ J Med 1992; 22: 134–138.)
Taming demons: the reduction of harm resulting from use of illicit drugs
Authors: Wodak ALEX 
Published: March 2008

Abstract:Restricting availability is the major response to illicit drugs in most Western countries including Australia. Prohibition may reduce harm when the drug in question is in low demand, controls are difficult to subvert, and when similar drugs are less toxi; or unavailable. However, the health, social and economic costs of supply reduction are substantial and increasing for both injecting drug users and the general community. Population adjusted mortality of heroin users has doubled in Australia in the last decade. The possible impact of supply reduction policy on the spread of HIV infection among IDUs is an important but largely neglected consideration. The effectiveness of supply restriction policy in decreasing the availability of drugs or in reducing drug‐related harm is unlikely to be increased significantly by more vigorous implementation of supply reduction or adoption of new technology. Conversely, on the basis of existing data, greater availability of HIV prevention measures attractive to the target population (including especially drug treatment such as methadone maintenance) is likely to be effective and cost‐effective. The costs and benefits of innovative methods of providing currently illicit drugs to those who are determined to use them requires careful evaluation and comparison with existing policies. Policy on illicit drugs in most countries including Australia is still dominated by concern about drug use rather rhan focused on the need to reduce drug‐related problems which is the agreed aim of national drug policy. (Aust NZ 3 Med 1992; 22: 204–208.)
Brief and early intervention: experience from studies of harmful drinking
Authors: Saunders JOHN B. , Foulds KIM 
Published: March 2008

Abstract:Brief and early interventions represent an innovative strategy for the prevention of harm from alcohol and other drugs. The pioneering study of early intervention, undertaken by Kristenson et al. (1983) as part of a preventive medicine programme, demonstrated the efficacy of this approach for problem drinking. Subsequent studies have confirmed these findings. Brief and early interventions have been shown to be effective in a wide range of health care settings, including hospital wards and outpatient clinics, general practice, private health screening facilities and community‐based health screening programmes.What is required now is the ascertainment of the most effective settings for brief and early interventions and the incentives needed for incorporation into routine practice. (Aust NZ J Med 1992; 22: 224–230.)
Autosomal dominant polycystic kidney disease (ADPKD)—mechanisms of cyst formation and renal failure*
Authors: Geberth E. Ritz S. , Zeier M. , Gebert S. , Waldherr R. 
Published: March 2008

Abstract:None of the hypotheses proposed so far to explain cyst formation in autosomal dominant polycystic kidney disease (ADPKD) is entirely satisfactory, e.g. the theory of tubular obstruction by intraluminal polyps or dilatation of nephron segments as a consequence of abnormal compliance of the basement membrane. Recent in vitro studies show that (i) synthesis of basement membrane material is abnormal and that (ii) the direction of transepithelial resorptive flux into a secretory mode is reversed as a consequence of faulty insertion of Na, K‐ATP'ase into the luminal membrane.It remains unclear why cystic transformation of a few percent of nephrons should cause endstage renal failure. Our clinical and experimental studies do not provide evidence to support some hypotheses proposed in the past, i.e. that renal parenchyma is compressed by expanding cysts and that glomeruli are overperfused. Our histological studies show that progression to endstage renal failure is associated with (i) progressive arteriolar lesions (out of proportion to the vascular lesions seen in extrarenal vascular beds; and (ii) progressive interstitial fibrosis. It appears that fibroblasts in ADPKD are particularly sensitive to platelet derived growth factor (PDGF) which is secreted by epithelial cells of the cyst wall in a paracrine fashion.In contrast to previous opinion, which was presumably skewed by ascertainment bias, it appears that not all, and perhaps not even a majority, of ADPKD patients progress to endstage renal failure. Factors related to progression are gender, family history and hypertension. Both abnormal sodium excretion and inappropriate renin secretion play a role in the genesis of hypertension. Elevated blood pressure, albeit within the normotensive range, is demonstrable even in prepubertal children. The involvement of renin in renal vasoconstriction of normotensive ADPKD patients suggests a particular role of ACE inhibitors in the management of these patients.
Visualisation of arterial structure in vivo with intravascular ultrasound
Authors: Jeremy R. , Huang Hui , Hasche E. , Waugh R. , Sinclair E. , Bailey B. , Brieger D. 
Published: March 2008

Abstract Background: Contrast angiography provides a silhouette of the arterial lumen, but does not give information about arterial wall structure. Catheter‐tip ultrasound transducers can now provide a cross‐sectional image of the arterial wall. This study examined the pathological correlation of intravascular ultrasound images and the accuracy of ultrasound measurements of vascular geometry. Methods: Intravascular ultrasound images were obtained with a mechanically rotated catheter‐tip transducer and recorded on videotape. Initial validation studies were performed in fresh, postmortem arterial specimens, which were filled with saline at physiological pressures. Ultrasound images at specific sites were compared with the pathological findings at that site and measurements of luminal diameter were compared with corresponding angiographic measurements. Subsequently, intravascular ultrasound was employed to examine the aorta, ilio‐femoral and coronary arteries in patients undergoing balloon angioplasty. Results: The pathological correlations showed that intravascular ultrasound can detect early initial thickening and mild atherosclerotic lesions that do not result in luminal deformation. Ultrasound images provided definition of calcified, fibrotic and lipid‐filled lesions. Ultrasound measurements of luminal diameter correlated well with pathology measurements (r = 0.93), as did ultrasound measurements of plaque area (r = 0.89). The in vivo studies demonstrated that intravascular ultrasound can define atheroma lesions not evident on contrast angiography and permits detailed evaluation of the results of interventions such as balloon angioplasty. Conclusions: Intravascular ultrasound provides a unique window upon arterial structure and pathology in humans. Ultrasound images allow accurate measurements of vascular geometry and define early atheromatous lesions that are not evident with angiography.
The effect of pregnancy on the epilepsies: a study of 37 pregnancies
Authors: Kilpatrick C. J. , Hopper J. L. 
Published: March 2008

Abstract Background: Although studies have assessed the effect of pregnancy on epilepsy, usually the types of epilepsy are not differentiated and most have not included a control group, despite the natural history of epilepsy including fluctuations in seizure frequency. Aims: To assess the effect of pregnancy on seizure frequency and compare this with changes in seizure frequency in non‐pregnant patients. In addition, the relationship between seizure frequency during pregnancy and epilepsy type, seizure frequency prior to pregnancy and duration of epilepsy will be assessed. Methods: Seizure frequency was assessed retrospectively in 37 pregnancies from 24 women by comparing the seizure number for the nine‐month period prior to pregnancy with the number during the pregnancy. An increase in frequency was defined as a 50% or greater increase in the number of seizures. Twenty‐four non‐pregnant women, matched for age and epilepsy type, were included to assess fluctuations in control. Results: In 41% of pregnant women, there was an increase in seizure frequency, in 51% no change and in 8% improvement. In the control group, 24% had an increase, 65% no change and 11% improvement. There was no correlation between seizure frequency during pregnancy and epilepsy type and seizure frequency prior to pregnancy, but those with longer duration of epilepsy were more likely to deteriorate (p < 0.05). Alterations in anticonvulsants to reduce the risk of teratogenicity was a common identifiable cause of deterioration in control. Conclusions: Significant random fluctuations in epileptic control occur, but pregnancy may have a deleterious effect on epilepsy, particularly when appropriate therapy is withdrawn to reduce teratogenicity.
Percutaneous transhepatic measurement of the pressure gradient between the portal and hepatic veins
Authors: Gibson P. R. , Firkin A. G. , Hebbard G. S. , Bhathal P. S. , Gibson R. N. 
Published: March 2008

Abstract Background: Knowledge of the portal pressure may be of value in the assessment of patients with chronic liver disease but its measurement is problematic. Aims: To evaluate the ease and safety of percutaneous transhepatic measurement of the pressure gradient between the portal and hepatic veins and to determine directly the need for an internal zero. Methods: Sixty‐one patients undergoing liver biopsy for suspected liver disease had pressures in branches of portal and hepatic veins measured using a flexible 22G (Chiba) needle. Results: The procedure was successful in all patients, took less than ten minutes in most, and was associated with minimal discomfort. Post‐procedure morbidity was similar to that of liver biopsy. Portal pressure using an external zero (either puncture site or sternal angle) was inaccurate compared with pressures obtained using the generally accepted gold standard internal zero, hepatic venous pressure, and led to incorrect classification of the presence or absence of portal hypertension in at least 10% of patients. Variations in hepatic venous pressure were not predictable on clinical grounds. The only histopathological feature predictive of portal hypertension was cirrhosis, 20 of 25 patients with and four of 36 patients without cirrhosis having portal hypertension. Of routine biochemical and haematological tests, only plasma albumin and platelet count jointly (and negatively) predicted hepatic venous pressure gradient on multiple regression analysis (R2= 0.40). Conclusions: The use of an internal zero is essential for accurate measurement of portal pressure and this can be achieved safely using the percutaneous, transhepatic route in patients with well compensated liver disease.
Aconitine poisoning following the ingestion of Chinese herbal medicines: a report of eight cases
Authors: Chan T. Y. K. , Tomlinson B. , Critchley J. A. J. H. 
Published: March 2008

Abstract
Background:
Traditional Chinese medicines often contain ‘chuanwu’ and ‘caowu’, the roots of certain Aconitum species which are thought to have an anti‐inflammatory effect in many conditions. Excessive amounts of these materials, which contain diterpene alkaloids particularly aconitine, can produce toxic effects and occasional fatalities.
Aims:
This study was conducted to document the adverse effects related to these herbal medicines which resulted in hospital admission and to determine the outcome in these patients.
Methods:
A retrospective survey was conducted of patients admitted to the Prince of Wales Hospital, Hong Kong with suspected adverse effects from Chinese herbal medicines containing chuanwu or caowu over a two year period from 1989 to 1991.
Results:
Eight patients were identified with features of mild to moderate intoxication including nausea and vomiting, paraesthesiae or numbness in the mouth and extremities, hypotension and ventricular extrasystoles. The management of aconitine poisoning is essentially supportive and in‐hospital observation with ECG monitoring should be continued for at least 24 hours because of the risk of cardiovascular collapse and ventricular arrhythmias. The medical profession and general public should be alerted to the potential toxicity of these herbs and their usage should be controlled by legislation in Hong Kong as it is in some other countries. (Aust NZ J Med 1993; 23: 268–271.)
Unrelated volunteer bone marrow transplantation: initial experience at St Vincent's Hospital, Sydney
Authors: Atkinson K. , Downs K. , Dodds A. J. , Marshall G. , Concannon A. J. , Wilson F. , Milliken S. , Staniforth D. 
Published: March 2008

Abstract Background: Only 30% of patients with leukaemia have an HLA‐compatible family member able to act as a marrow donor. The recent development of volunteer bone marrow donor registries has supplied HLA‐matched donors for a number of such individuals. Aims: To define the problem and outcome of the first cohort of patients given HLA‐matched unrelated volunteer bone marrow transplants at St Vincent's Hospital, Sydney. Methods: Post transplant outcome of patients with advanced leukaemia given HLA‐identical unrelated donor marrow transplants was compared to that of patients transplanted concurrently from HLA‐identical sibling donors, in terms of survival, leukaemia‐free survival, incidence and severity of acute graft‐versus‐host disease (GVHD), duration of neutropenia, incidence of infection and duration of transplant hospitalisation. Results: Sixteen patients with advanced leukaemia and without a histocompatible family member donor received unrelated donor bone marrow transplants. Actuarial survival at two years post transplant was 30%. Actuarial survival of 23 recipients of HLA‐identical sibling bone marrow transplants with advanced leukaemia transplanted during the same time period was 17% (not significant). Actuarial disease free survival at two years was 30% and 13% respectively. Three of five long term survivors of the unrelated transplants had chronic myeloid leukaemia in blastic transformation at the time of transplant; thus blastic transformation should not preclude consideration of unrelated marrow transplantation. Recipients of unrelated allografts had a higher incidence of acute GVHD which occurred earlier and with greater severity than in recipients of sibling allografts, a longer duration of post transplant neutropenia (24 days to reach 0.5 × 109/L versus 19.5, p= 0.07), a higher frequency of infection in the first 100 days post transplant (p= 0.0004) and a longer duration of transplant hospitalisation (p= 0.04). Transplant‐related complications were the commonest cause of death in the unrelated donor recipients, while leukaemic recurrence was the commonest single cause of death in the HLA‐identical sibling recipients. Improvements are needed in prophylaxis of infection and in prevention and treatment of acute GVHD in recipients of unrelated donor transplants. Nevertheless, this modality provides curative treatment for patients with otherwise incurable haematological malignancies and should no longer be considered experimental. (Aust NZ J Med 1993; 23: 450–457.)
Historical assessment of risk factors in screening for osteopenia in a normal Caucasian population
Authors: Elliot J. R. , Ayling E. , Gilchrist N. L. , Turner J. , Wells J. E. , Sainsbury R. 
Published: March 2008

Abstract Background: Bone mineral density (BMD) can predict fracture, however, the common use of historical risk factors to predict low BMD is unproven. Aims: To identify significant historical risk factors for osteopenia. To establish predicting equations for BMD and test their ability to identify those who should be referred for BMD scanning. Methods: Three hundred and twenty female and 131 male volunteers underwent questionnaire assessment of risk factors and BMD by dual photon absorptiometer at hip and spine. Significant risk factors (P < 0.05) were used to construct a linear regression model to predict BMD. This was cross validated on a second sample of 107 females and 131 males selected from the electoral roll analysing the ability to detect those subjects with BMD in the lower third of the age matched normal range. Results: In women lower BMD at the spine was associated with increased age, decreased weight, smoking, and delayed menarche. Lower femoral BMD was associated with increased age, decreased weight, family history, inactivity, and smoking. In men lower BMD at the lumbar spine was associated with lower weight, and inactivity. Lower BMD at the femur was associated with increased age, decreased weight, family history, and low calcium intake. When cross validated on the second sample, the models produced sensitivity of 86–89% and sensitivity of 25–46%. Referring those with these risk factors could save 10–23% on scanning. Measuring BMD at the site in question remains the only accurate way of assessing an individual's risk of osteopenia. (Aust NZ J Med 1993; 23: 458–462.)
Sequential changes in the bone marrow trephine biopsy in B‐cell chronic lymphocytic leukaemia
Authors: Robertson T. I. , Byth K. 
Published: March 2008

Abstract Background: Trephine biopsy of the bone marrow is integral to both diagnosis and prognosis in B‐cell lymphocytic leukaemia (B‐CLL), but its usefulness would be enhanced by more information on the type, degree and rate of change that occur over time in histologic pattern and lymphocytic infiltration. Aims: To investigate these changes by serial trephine biopsy in totally untreated patients, in treatment‐free intervals in treated patients and during intervals of treatment. Methods: In 82 patients with predominantly early B‐CLL observed for a median of 65 months (13–331), 309 trephine biopsies were carried out, a median of three (two to eight) per patient. The biopsies were classified into nodular, interstitial, mixed and diffuse patterns. Lymphocytic infiltration was subjectively graded into minimal (< 20%), intermediate (20–50%) and majority (> 50%) categories and all changes were compared. Results: Intensity of infiltration increased through this histologic range, as did the relative risk of death. Survival of patients with > 50% involvement was significantly poorer than those with < 50%. Changes in both lymphocyte numbers and pattern occurred slowly in early disease but quickened as the leukaemia advanced. Under treatment, lymphocytes decreased but the histology did not alter significantly. Examining the marrow for disease progression should be part of regular follow‐up. It may help identify the minority of patients with early disease which will run a more active course and in whom early therapy may yet be indicated. We recommend biopsy at two‐yearly intervals in early disease, more frequently as the leukaemia advances. The minimal, intermediate and majority classification in addition to the histologic pattern is a useful grading. (Aust NZ J Med 1993; 23: 470–476.)
How vancomycin is used in Australasia – A survey
Authors: Duffull S. B. , Chambers S. T. , Begg E. J. 
Published: March 2008

Abstract Background: Vancomycin serum concentrations have been monitored over the last 30 years in an attempt to avoid dose‐dependent toxicity and enhance efficacy. Current literature recommendations for peak and trough concentrations are usually in the range of 20–40 mg/L and 5–10 mg/L, respectively. Literature recommendations regarding the time at which peak concentrations are measured are highly variable, ranging from immediately after the end of the infusion to three hours post‐dose. Aims: To identify how vancomycin dosing is being monitored and assess variability in the current practice. Methods: A survey of microbiology departments and infectious disease physicians in major Australasian hospitals was undertaken. The variability in the current practice was assessed by fitting mean recommendations to a two compartment Bayesian model. Results: Of the 83 (70%) who replied 71 (86%) monitored vancomycin concentrations. Fifty‐four percent targeted peak concentrations within the range of 20–40 mg/L, and 73% targeted trough concentrations ≤ 10 mg/L. The time of sampling of peak concentrations varied considerably ranging from immediately (12%) to 120 minutes (12%) post‐infusion (median 30 minutes [40%]). The concentration‐time curves resulting from three sets of mean recommendations (“peaks' drawn at: 0, 30 and 120 minutes aiming for a concentration of 35 mg/L with a trough concentration of 10 mg/L) were modelled using a two compartment Bayesian programme. The predicted true peak (maximum) concentrations ranged from 30 to 86 mg/L, despite aiming for identical target concentrations, indicating marked variation in the actual dosing practice. Conclusions: There is thus considerable variation in the practice of vancomycin therapeutic monitoring which has a major effect on dosing. The main contributing factor is the variable timing of sampling peak concentrations. (Aust NZ J Med 1993; 23: 662–666.)