bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reproducibility of brachial ultrasonography and flow‐mediated dilatation (FMD) for assessing endothelial function
Authors: Hardie K. L. , Kinlay S. , Hardy D. B. , Wlodarczyk J. , Silberberg J. S. , Fletcher P J. 
Published: March 2008

Abstract Background: High‐resolution brachial artery ultrasonography is used to study vasodilator response induced by physiologic reactive hyperaemia. We examined the reproducibility of measuring flow‐mediated dilatation (FMD) on two occasions. Aims: To determine the degree of variability of this technique in our vascular laboratory for the design of clinical research studies. Methods: Nineteen subjects were studied on two separate occasions using an Acuson 128 ultrasound device and a 7.0 MHz linear array transducer. Reactive hyperaemia was induced in the brachial artery by inflation and release of a blood pressure cuff. Nitrate‐induced dilatation was assessed in 11 of the 19 subjects. Measurements were made by two observers blinded to subject details. Results: The 11 subjects given sublingual GTN during the first ultrasound study had a mean nitrate‐induced dilatation of 20.7% (sd 9.6). The mean vessel diameter of 3.78 mm (sd 0.7) at rest and 3.89 mm (sd 0.7) during reactive hyperaemia yielded a mean FMD of only 3.0% (sd 2.7). The mean difference in FMD within‐observers was 0.13% (sd 2.07), between‐observers 0.06% (sd 2.17) and between‐studies was 0.57% (sd 6.83). Conclusions: The reproducibility of FMD measured by brachial artery ultrasound was poor and likely to render the measurements inaccurate for clinical research in our hands. Between‐study variation contributed the largest proportion of total study variability. We suggest that investigators using this technique conduct their own careful reproducibility studies in order to avoid the misinterpretation of ‘negative’ studies.
Cross‐reactivity to porcine factor VIII of factor VIII inhibitors in patients with haemophilia in Australia and New Zealand
Authors: Lloyd J. V. , Street A. M. , Berry E. , McPherson J. , Ekert H. , Lammi A. , McWhirter W. R. , Duncan E. M. , Maxwell E. L. , Rowell J. , Baker R. I. , Leahy M. F. , Jupe D. 
Published: March 2008

Abstract Background: Inhibitory antibodies which neutralise factor VIII develop in 10–20% of individuals with inherited haemophilia A and rarely as autoantibodies in normal individuals to cause acquired haemophilia. The antibodies are directed against human factor VIII but cross‐react to varying degrees with porcine factor VIII. Porcine factor VIII can be used for treatment in individuals with low cross‐reactivity. Aims: To determine the cross‐reactivity of factor VIII inhibitors between human factor VIII and porcine factor VIII, in a population of patients with inherited and acquired haemophilia A. Also, to determine whether patients with inherited haemophilia and inhibitors have a higher incidence of factor VIII gene inversion in intron 22. Methods: Samples and data sheets from 43 patients with inherited and ten with acquired haemophilia were submitted from hospitals in Australia and New Zealand. Inhibitor levels to human and porcine factor VIII were measured by the Bethesda method in 39 with inherited and nine with acquired haemophilia A. Results: Of 39 patients with inherited haemophilia A, cross‐reactivity was 0% in 17 patients,1–19% in six, 20–39% in 11 and 40–80% in five. In six of nine patients with acquired haemophilia cross‐reactivity was 7%. In inherited severe haemophilia A, the frequency of the intron 22 inversion was not greater in 37 study patients than in 28 patients without an inhibitor. Conclusions: Many patients in Australia and New Zealand with inhibitors to human factor VIII presently show a low or absent level of cross‐reactivity to porcine factor VIII. These may respond to treatment with this concentrate at least in the short term. There remains a group of patients with high cross‐reactivity who will respond only to recombinant factor Vila or prothrombin complex concentrates.
Is a standard regime for anticoagulation with heparin in unstable angina adequate?*
Authors: Duffy M. , Kelly A. M. , Bau S. , Rosengarten P. 
Published: March 2008

Abstract Aim: To establish the proportion of patients with unstable angina in whom adequate anticoagulation is achieved using a standard regime of intravenous heparin. Method: A prospective series of 108 Emergency Department attendees over a six‐month period with a clinical diagnosis of unstable angina for whom anticoagulation with heparin was prescribed were included in the study. The standard regime was a 5000 unit bolus followed by an intravenous infusion of 1000 units per hour (1200 units if the patient's weight was greater than 80 kg), with subsequent adjustments being made by reference to a nomogram. The activated partial thromboplastin time (APTT) was measured at six and 12 hours after treatment began. Two commonly used criteria for adequate heparinisation were compared: 1. APTT greater than 1.5 times control and 2. APTT in the range 60–85 seconds. Results: There were valid data for 90 patients at six hours and 79 at 12 hours. Compared to the criterion for adequate anticoagulation of APTT greater than 1.5 times the control, 25% of patients were subtherapeutic at six hours and 12% at 12 hours. Compared to the criterion APTT greater than 60 seconds, 53% of patients were subtherapeutic at 6 hours and 47% at 12 hours. At 6 hours, 26% of patients were over‐anticoagulated as defined as APTT greater than 85 seconds. This had reduced to 13% by 12 hours. Conclusions: In the context of recent research suggesting that an APTT of greater than 1.5 times the control is sufficient to reduce complications in unstable angina, our results demonstrate that a standard regime of heparinisation will achieve this goal in the majority of patients within 6 hours of starting heparin therapy. However, if an APTT of 60–85 seconds is the goal, this standard regime is inadequate.
Asthma prevalence, morbidity and management practices in South Australia, 1992–1995
Authors: Adams R. , Ruffi R. , Wakefield M. , Campbell D. , Smith B. 
Published: March 2008

Abstract Background: The Spring South Australian Health Omnibus Survey (SSAHOS) has been used to monitor trends in asthma prevalence, asthma morbidity and asthma management practices between 1992 and 1995. Aims: To determine if self‐reported asthma prevalence and availability of asthma action plans were increasing. To identify deficiencies in asthma management and opportunities for intervention. Methods: Representative population survey by trained interviewers using a multistage, systematic, clustered area sample of 4200 households in South Australia where people aged 15 years or more are living. Results: Over 3000 interviews were conducted each year. Between 1992 and 1995 the self‐reported prevalence of asthma in those aged 15 years or more increased significantly from 15.7% to 20.3% (p<0.0005), and the prevalence of current asthma increased from 9.3% to 11.4% (p<0.05). The self‐reported availability of individual asthma action plans increased from 21.9% in 1992 to 42.2% in 1995 p<0.0005). In 1992, 21% had a nebuliser at home, and 10.5% had a peak flow meter. In 1993, 61.4% were using preventive medications, and 35% thought bronchodilators were ‘;preventer’ medications. In 1994 and 1995, between 12.5% and 15.6% had nocturnal awakening weekly or more often, and 31.4% had morning asthma symptoms weekly or more often. Between 20.1% and 20.8% had lost days from usual activities during the last year. Those on incomes below $20,000 had more symptoms, had more admissions to hospital, and required more medication than those on higher incomes. Conclusions: Self‐reported asthma prevalence has increased. There remains a gap between current asthma management and that recommended by the National Asthma Campaign.
Establishing a programme for continuous ambulatory infusion chemotherapy
Authors: Cox K. , Murray B. , Visintin L. , White G. , Kovac S. , Storey D. , Childs A. , Findlay M. , Kelleher H. 
Published: March 2008

Abstract Background: The development of venous access devices (VADs) and portable infusion pumps has enabled chemotherapy to be administered continuously within the home environment. Aim: The objective of this study was to describe the experience of establishing an ambulatory chemotherapy programme for patients receiving protracted infusions (PVIs) of 5‐fluorouracil (5‐FU). Methods: The files of all patients receiving PVI 5‐FU as a component of their treatment for gastrointestinal malignancy were reviewed. The types of VADs, infusion pump systems and their management were documented. Information packages and education programmes were developed for patients. Results: Seventy‐four patients with gastrointestinal cancer were studied. At the end of the review period the Portacath was the preferred VAD, while both pumps used were found to have advantages and disadvantages. The choice of pump was decided more by patient preference than systematic differences in performance of the pumps. Conclusions: The findings in this review confirm that, with close attention to the potential pitfalls of ambulatory chemotherapy, an acceptable service can be provided.
Ten‐year follow‐up of a cohort with rheumatic heart disease (RHD)
Authors: Carapetis J. R. , Walker A. R. , Kilburn C. J. , Currie B. J. , MacDonald K. T. 
Published: March 2008

Abstract Background: Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) occur at among the highest rates in the world in Aboriginal Australians of the Northern Territory. Aims: To follow‐up a previously‐described cohort of Aboriginal children with RHD, in order to understand better the outcome of ARF and RHD in this population, and to identify areas where the impact of these diseases might be lessened Methods and results: Of a cohort of 33 children seen between 1980 and 1984, 27 survived until July, 1984. Twenty‐five of the survivors were followed up for a mean of 10.6 years to a mean age of 24.1 years. The two deaths during follow‐up were both due to RHD. Six people underwent valve replacement surgery; all were clinically healthy when last seen. Complications included two thromboembolic events and two episodes of endocarditis. Deterioration of RHD severity was associated with ARF recurrences (relative risk 3.6; 95% CI 1.7–7.6), and resolution of RHD was associated with having only mild valve lesions initially (risk difference 0.58; 95% CI 0.30 to 0.86). During follow‐up, valve lesions tended either to resolve or to become more complex and severe, with a higher proportion of aortic valve lesions and multiple valve lesions. Of seven children with suspected past ARF, excluded from the original cohort because of normal cardiac findings at the time, three developed RHD, including one who died due to RHD and two with moderate or severe valve lesions. Conclusions: In Aboriginal Australians, poor outcomes of RHD are common, and are associated with ARF recurrences and early onset of more severe valve lesions. A coordinated ARF and RHD control programme is needed in this region, using a centralised register of patients, and concentrating on strategies to improve adherence to secondary prophylaxis regimens, better clinical care (including newer surgical techniques) and education of patients, families, and health staff.
Factors influencing the outcome of donor marrow transplantation in adults from less than ideal donors: experience from two Australian centres
Authors: Grigg A. , Morton J. , Durrant S. , Bardy P. , Szer J. 
Published: March 2008

Abstract Background: This paper reports the results of 78 marrow transplants in two Australian hospitals between 1991 and 1996, using unrelated (n=54) or mismatched related (n=24) donors. Twenty‐six patients received granulocyte‐macrophage colony stimulating factor (GM‐CSF) post‐transplant as part of a phase II study. Fifty‐four patients (74%) had advanced disease. Aims: To identify factors associated with a superior outcome post‐transplant, to evaluate the effect of GM‐CSF on engraftment and other transplant parameters, and to compare the overall results with those of published series. Methods: Review of patient records, a Medline search of the relevant literature and appropriate statistical analysis. Results: The probability of overall survival and event‐free survival (EFS) at three years was 35 ±6% and 22±6% respectively. Pre‐transplant factors significantly associated with an inferior EFS were advanced disease, poorer performance status and age >30 years. The EFS in patients with standard risk disease was 51 ±13%versus 10±5% in patients with advanced disease, p<.0001. Severe acute graft‐versus‐host disease was also associated with a poorer outcome. Neutrophil engraftment was faster in patients who received GM‐CSF but there was no difference in any other transplant parameters. Conclusions: These results are consistent with reported series elsewhere and suggest that an extended family or unrelated donor transplant should generally be limited to patients with a good performance status and early phase but otherwise incurable haematological disease.
Experience with the use of continuous positive airway pressure (CPAP) therapy in the emergency management of acute severe cardiogenic pulmonary oedema
Authors: Kelly A.‐M. , Georgakas C. , Bau S. , Rosengarten P. 
Published: March 2008

Abstract Background: Acute pulmonary oedema (APO) is a frequent cause of respiratory failure and a common reason for presentation to emergency departments (EDs). To date, no paper has been published on the application of continuous positive airway pressure (CPAP) therapy for a large broad‐based patient group. Aim: To report our experience with the use of CPAP in severe APO oedema, with particular reference to safety, intubation rates and impact on EDs' resources. Method: A retrospective chart review was undertaken of 75 patients with acute severe pulmonary oedema who were treated with adjuvant CPAP in an urban teaching hospital ED. Results: Three patients (4%) required subsequent endotracheal intubation and mechanical ventilation. The average duration of CPAP was 1.9 hours. Eighty nine per cent of patients experienced no adverse events while being treated with CPAP. Five patients failed to tolerate the tight fitting mask necessitating removal of CPAP, three patients experienced arrhythmias related to underlying cardiac disease and two patients experienced mild transient hypotension. Seventy one per cent of patients were discharged from the ED to general medical wards. The in‐hospital mortality for patients treated with CPAP was 15%. Conclusion: This series has demonstrated that CPAP therapy delivered via a face mask for the treatment of acute severe APO is safe and effective when applied to a broad range of patients. We recommend the use of CPAP therapy for all suitable patients presenting in severe APO irrespective of age or underlying pulmonary disease.
Multiple cycles of aggressive chemotherapy prior to autologous peripheral stem cell transplantation for lymphoma
Authors: Goss G. , Szer J. , Basser R. , Fox R. , Grigg A. 
Published: March 2008

Abstract Background: Based on in vitro evidence of synergy between certain chemotherapeutic agents and of improved efficacy of cytotoxics administered as continuous infusions we devised a novel chemotherapy regimen for use in patients with lymphoma. Aims: To assess the efficacy and tolerability of this regimen alone and in combination with autologous stem cell transplantation (ASCT) in patients with relapsed or refractory lymphoma. Methods: The regimen consisted of cytosine arabinoside and etoposide given as five day continuous infusions, bolus doses of methotrexate and cyclophosphamide and four days of oral dexamethasone (MADEC), together with prophylactic G‐CSF. Fifty‐one patients aged 17 to 65 years (median 43) were treated; 34 had intermediate or high grade non‐Hodgkin's lymphoma and 17 had Hodgkin's disease. Patients with responsive disease received a second cycle. Results: Eleven patients (22%) achieved a complete response and 19 patients (38%) achieved a partial response, eight of whom were gallium negative. Previous chemosensitivity was highly predictive for response; minimal response was seen in patients with primary refractory disease. The probability of survival and event‐free survival at 40 months for the entire group is 46% (±8% SEM) and 26±8% respectively. Thirty‐one patients proceeded to ASCT; the probability of survival of the transplanted group is 65 ± 11 % at 40 months. The regimen caused significant myelosuppression. The majority of cycles were complicated by febrile neutropenia and the requirement for platelet and red cell transfusions. Non‐haematological toxicity was predominantly mucositis and was generally mild. Conclusions: MADEC is a highly active regimen in patients with relapsed lymphoma. Patients responding to MADEC who proceed to ASCT have a good chance of achieving a durable remission.
Radiofrequency catheter ablation in symptomatic ventricular arrhythmia
Authors: Raungratanaamporn O. , Nutakul T. , Chotinaiwattarakul C. , Sriyaphai W. , Chaithiraphany S. , Bhuripanyo K. , Mahanonda N. , Hongvisitgul C. , Kangkagate C. 
Published: March 2008

Abstract Background: Radiofrequency catheter ablation (RFCA) is an effective method to cure both supraventricular and ventricular arrhythmia (VA) in certain centres. Aim: To assess the results of RFCA in VA at Siriraj Hospital. Method: Electrophysiologic study, mapping, using both earliest endocardial activation and pace mapping, and ablation were performed. Results: Thirty patients with symptomatic VA underwent RFCA. The mean age was 44 years. Eight patients had underlying heart disease (two prolapsed mitral valve, three myocarditis, two dilated cardiomyopathy and one mitral stenosis). Thirty‐six morphologies of VA were detected from the study. Thirty‐three morphologic tachycardias attempted were successfully ablated; 17, 10 and six were right VT, left VT and premature ventricular contraction (PVC), respectively. Failure of ablation occurred in one patient with left VT. Only minor complications occurred in this study.There was no difference in cycle length and endocardial activation time between right and left VT. 12/12 identical pace mapping was more easily performed in right VT than in left VT The fluoroscopic and procedure times in left VT were significantly longer than in right VT.Relapse occurred in six patients. Re‐ablation was successfully performed in four patients, giving a final success rate of 93%.
Low‐risk febrile neutropenia in a medical oncology unit
Authors: Leong D. C. S. , Kinlay S. , Ackland S. , Bonaventura A. , Stewart J. F. 
Published: March 2008

Abstract Background: Febrile neutropenia occurring in patients receiving chemotherapy for solid tumours or lymphoma is usually of short duration, and therefore may have a better outcome compared to patients with acute leukaemia or patients receiving myeloablative chemotherapy. Aims: To review retrospectively the outcomes for febrile neutropenia occurring in patients of the Medical Oncology Unit at our institution, and to identify factors associated with worse outcome, particularly prolonged admission or death. Methods: We reviewed 102 episodes of febrile neutropenia occurring in 85 patients treated between 1992 and 1994. Demographic factors, tumour‐related factors and clinical aspects of the episodes were correlated with outcome. Results: The median age was 60 years (range, 18–87), with 56 (55%) episodes occurring in females. Twenty‐eight (27%) episodes occurred in patients with lymphoma, with the remaining 74 (73%) occurring in patients with solid tumours. At presentation, the median absolute neutrophil count (ANC) was 0.14×109/L with a median duration of significant neutropenia (ANC<0.5×10 9/L) of three days. The median duration of fever was two days. Twenty‐nine (28%) episodes had positive cultures; of these 11 had bacteraemia. Forty‐four (43%) episodes were classified as unexplained fevers. The remaining 29 episodes were associated with clinically documented infection but negative cultures. There was a high treatment success rate (81%) with first‐line empirical antibiotics. Of 19 treatment failures, 13 were due to the necessity for antibiotic modification; the other six patients died from infection. Factors associated with a worse outcome (including prolonged admission and death) include: diagnosis of lymphoma; increasing number of chemotherapy courses; early onset of neutropenia; pneumonia; severe hypotension; and multiple co‐morbidities. Conclusions: Febrile neutropenia in adult patients with solid tumours or lymphoma is associated with a relatively good outcome, possibly due to the short duration of neutropenia. A future prospective study to validate the risk factors indentified in this study would be useful for defining patients at low risk for the adverse outcomes examined, in whom less intensive management for this condition may be possible.
Spinal cord excitatory amino acid receptors and plasma catecholamine autonomic responses in the conscious rabbit
Authors: Huang Wen , Hoffmann Nancy V. , West Malcolm J. 
Published: March 2008

AbstractIntrathecal administration of the specific glutamate subtype receptor agonist NMDA (N‐methyl‐D‐aspartate), or the non‐NMDA receptor agonist AMPA (alpha‐amino‐3‐hydroxy‐5‐methyl‐4‐isoxazoleproprionic acid), at the level of the lower thoracic spinal cord in the conscious rabbit, produces increased levels of plasma norepinephrine and a rise in blood pressure. These responses are specifically inhibited with prior intrathecal administration of the NMDA receptor antagonist AP‐5 (2‐amino‐5‐phosphonovaleric acid) or non‐NMDA receptor antagonist DNQX (6, 7‐dinitroquinoxaline‐2, 3‐dione), respectively. In contrast, arterial baroreflex activation induced by transient hypotension following intravenous sodium nitroprusside increases levels of plasma norepinephrine which are inhibited with intrathecal APS, but not DNQX. The experiments are consistent with glutamate acting as a neurotransmitter in the spinal cord influencing control of sympathetic nerve function via activation of spinal cord NMDA and non‐NMDA subtype receptors. The results support previous work suggesting that baroreflex function is predominantly mediated by spinal NMDA receptors and that spinal glutamate receptors are important in baroreflex control of the circulation.
Cholesterol and atherosc lerosis
Authors: Kroon Paulus A. 
Published: March 2008

AbstractCholesterol is an essential component of cellular membranes, but when present in excess in the circulation, can be deposited in the arterial wall, leading to the formation of atherosclerotic lesions. The principal plasma carrier of cholesterol, low density lipoprotein (LDL), is removed from the circulation by LDL receptors in the liver. This process plays a critical role in regulating plasma LDL levels. The unique structure and composition of the LDL particle makes it particularly susceptible to modification by oxidative reactions. Current evidence suggests that the production of oxidised LDL in the intima, and the removal of oxidised LDL particles by scavenger receptors on macrophages, play a central role in the development and progression of atherosclerotic lesions.