bluuebunny/crossref_metadata_2025_split huggingface dataset:
Radiofrequency ablation of idiopathic ventricular tachycardia
Authors: Vohra J. , Shah A. , Hua W. , Gerloff J. , Riters A. 
Published: March 2008

Abstract Background: Radiofrequency ablation (RFA) has been shown to be very effective in the treatment of supraventricular tachycardias and has replaced surgical ablation. Only a few reports of RFA for idiopathic ventricular tachycardia (VT) have appeared in the literature during the last two years. Aim: This paper presents our experience with RFA for idiopathic VT in 19 patients. Material: The age range of patients was 22–60, with a mean of 37.9 years. Twelve out of 19 were females, two patients had cardiac failure due to almost incessant VT while the rest had normal left ventricular function. Twelve patients had VT arising from the right ventricle (RV); of these, nine were from the outflow tract, two from the RV apex, and one from the mid‐anterior RV. Seven patients had VT arising from the left ventricle (LV); of these, five were from the inferobasal portion of the septum and two were from the anterolateral area. Methods: In all patients the diagnostic study and therapeutic RFA were combined in a single procedure. Pacemapping was used to guide die site of RFA in patients with VT arising from the RV. Local activation time (LAT), Purkinje potentials (PP) and pacemapping were used to guide RFA in those patients with LV septal tachycardias. Results: A total of 21 RF procedures were performed in 19 patients and 15 out of 19 patients had successful VT ablation. Ten of the 12 patients with RV tachycardias and all five patients with LV septal (left axis, right bundle branch block) tachycardias were successfully ablated. One patient with mid anterior RV VT required two attempts for successful ablation. One patient with RV outflow tract (RVOT) VT could not be ablated despite two attempts. Two patients with LV tachycardias arising from the antero‐lateral LV could also not be ablated. During a follow up period of two to 16 months none of the successful patients had recurrence of VT The number of RF applications was one to 27, mean 10; fluoroscopy times were four to 75, mean 26.9 minutes. Conclusion: Idiopathic VT frequently arises from the RVOT and inferobasal portion of the LV septum. These tachycardias can be diagnosed on clinical and ECG grounds. RFA for idiopathic VT arising from these areas has a high success rate and this mode of treatment should be considered as a nonpharmacological curative treatment for symptomatic patients. (Aust NZ J Med 1996; 26: 186–194.)
Predictive diagnosis of multiple endocrine neoplasia (MEN 1) in four Australian kindreds
Authors: Grimmond S. M. , Teh B. A. , Hii S. I. , Cardinal J. , Walters M. , Epstein M. , Edwards M. , Hockey A. , Pullan P. T. , Perry‐Keene D. , Boyages S. , Cameron D. , Hayward N. K. 
Published: March 2008

Abstract: Background: Multiple endocrine neoplasia type 1 (MEN 1) is a tumour predisposition syndrome that usually manifests in the first four decades of life. It has an autosomal dominant mode of inheritance which means that any new member of a MEN1 kindred has roughly a 50% chance of developing the disorder during their lifetime. The localisation of the MEN1 gene to a small region of chromosome band llql3 has led to the development of DNA‐based predictive diagnosis for this disease. Aims: To establish a polymerase chain reaction (PCR)‐based system, using simple tandem repeat polymorphisms (STRPs), to predict gene carriers in four Australian MEN 1 kindreds. Funding: This work was supported by the National Health and Medical Research Council of Australia and the Princess Alexandra Hospital Foundation. Methods: Six STRP markers flanking the MEN1 region of chromosome band 11q13 were used to screen individuals for a common haplotype in order to determine carrier status. Results: The accuracy of prediction was calculated to be >95% in informative individuals. Conclusions: DNA‐based presymptomatic detection of affected members of MEN 1 kindreds could facilitate their care and reduce the inconvenience and expense of repeated testing of unaffected members. However, due to occasional recombination events or uninformativeness of markers in certain individuals, carrier status cannot always be predicted.
Hickman catheters: left‐sided insertion, male gender, and obesity are associated with an increased risk of complications
Authors: Craft P. S. , May J. , Dorigo A. , Hoy C. , Plant A. 
Published: March 2008

Abstract Background: Semipermanent tunnelled silicone rubber Hickman catheters are widely used to provide durable central venous access for patients with cancer or haematological disease. Aims: To document the frequency and severity of Hickman catheter related adverse events and to identify predisposing factors. Methods: A retrospective review was undertaken of 153 sequential Hickman catheters inserted into patients receiving treatment for cancer or haematological disease. All Hickman catheters were inserted percutaneously in a radiology department under local anaesthesia and fluoroscopic control. The exact position of the catheter tip was determined by reviewing post‐insertion radiographs. Results: The median duration of catheter use was 55 days (range one‐650). Complications led to the removal of 32% of catheters. Exit site infection complicated 22% of catheters, septicaemia 7%, migration or dislodgment 7%, and venous thrombosis 8%. Complications were more common in male patients (exit site infection and catheter loss), in patients with acute leukaemia (septicaemia) and in obese patients (catheter migration). Left sided catheters caused more venous thrombosis and were more likely to malfunction or block. Left sided catheters required removal more frequently than right sided catheters. Termination of the Hickman catheter within the high superior vena cava (SVC) resulted in loss of function earlier when compared to termination with the low SVC or right atrium (RA). Conclusions: Right‐sided Hickman catheters terminating in the low SVC/RA offer the best chance of durable function. The use of subcutaneously tunnelled catheters in obese patients poses unique problems with catheter migration. Vigilance in the placement and care of Hickman catheters remains essential.
Relationship of non‐specific airway hyper‐responsiveness (AHR) to measures of peak expiratory flow (PEF) variability
Authors: Kolbe J. , Mercer‐Fenwick J. , Richards G. , Rea H. 
Published: March 2008

Abstract Background: The relationship between airway hyper‐responsiveness (AHR) and clinical asthma remains controversial and unclear. Aims: To test the hypothesis that serial measures of variability of peak expiratory flow rate (PEF) correlate with serial measures of AHR, and to determine which mathematical expression of variability provides the best correlation. Methods: A longitudinal study over 180 days of 20 atopic, moderately severe asthmatics was undertaken. A diary of medication use and morning and evening PEFR before and after (3 agonist was kept and AHR (PD20 histamine) was measured at three‐weekly intervals. Using group data (128 sets) In PD20 was correlated with various measures of PEF variability over 9 days.Results:Within the group there was a weak but highly statistically significant correlation between AHR and measures of PEF variability ‐ the strongest correlation being with mean morning PEF. Within individual subjects, however, the correlation was not a consistent finding and only four patients had a statistically significant relationship (p<0.05) between AHR and mean morning PEF. Conclusions: These results suggest that while PEF variability may reflect AHR for the purposes of epidemiologic studies, it is unlikely to be useful as a simple ‘non‐invasive’ means of assessing AHR in individual patients. More complex measures of PEF variability do not have an advantage over simpler measures such as mean morning PEF.
Diabetes, mortality and coronary heart disease in the prospective Dubbo study of Australian elderly
Authors: Simons L. A. , Friedlander Y. , McCallum J. , Simons J. 
Published: March 2008

Abstract Background: A prospective study of Australian elderly living in Dubbo has shown that diabetes is a significant predictor of all‐causes mortality and coronary heart disease (CHD). Aim: To examine and contrast clinical and socio‐demographic predictors of these outcomes in those with and without diabetes. Methods: The data are derived from a community‐based sample of subjects 60 years and older followed over 62 months since 1988. Of 1155 men and 1472 women, 9.2% and 6.9% respectively manifested diabetes at baseline, based on history or fasting hyper‐glycaemia. Results: In the presence of diabetes, all‐causes mortality was increased twofold in both sexes, CHD incidence was increased twofold in men and threefold in women, stroke incidence was increased twofold in women but little changed in men. Proportional hazards models were derived separately for persons with and without diabetes and risk factors differentially predictive in diabetes were sought. Significant predictors of death in diabetes were old age and current smoking. Those factors differentially predictive were ‘being married’ (Relative Risk [RR] 1.60 with diabetes and 0.69 without diabetes) and higher body mass index (BMI) (RR 1.03 with diabetes and 0.79 without diabetes). Significant predictors of CHD in diabetes were old age, prior CHD, severe hypertension, low HDL cholesterol and self‐rated health. Those factors differentially predictive were higher body mass index (RR 1.14 vs 0.83) and physical disability (RR 0.69 vs 1.55). Differential predictions with regard to BMI may relate in part to excess CHD and mortality at low BMI in non‐diabetic subjects. Conclusion: The vascular disease burden of diabetes in the elderly has been confirmed, especially in women. A number of conventional risk factors are contributing to this burden and may be amenable to treatment.
Transdiaphragmatic pressure in young adult Singaporean subjects ‐ normal values and a comparison between different respiratory manoeuvres
Authors: Chan CHOONG‐CHEE , Cheong TUCK‐HONG , Wang YEE‐TANG , Poh SOO‐CHUAN 
Published: March 2008

Abstract: Background: Most published normal values for transdiaphragmatic pressure (Pdi) have been from Caucasian subjects and there is no universal agreement regarding the most appropriate manoeuvre for assessing Pdi. Aims: The aims of our study were to obtain normal values and to compare the different manoeuvres used to assess Pdi in normal young Singaporean adults. Methods: Twenty‐four normal subjects (23 Chinese, one Indian) were studied by measuring Pdi during maximal sniffs from functional residual capacity (sniff Pdi), maximal inspiration to total lung capacity (Pdi TLC) and maximal static inspiratory efforts from residual volume (Pdi PImax). Results: Mean values±SD for sniff Pdi, Pdi TLC and Pdi PImax were 101.8±31.7, 46.8±26.4 and 83.5±35.5 cm H20 respectively. Sniff Pdi was significantly higher than Pdi TLC (p<0.001) and Pdi PImax (p=0.005). Pdi PImax was significantly higher than Pdi TLC (p<0.001). Males had significantly higher values for sniff Pdi (p=0.026) and Pdi PImax (p=0.022) than females. There was a significant correlation between the different methods of recording Pdi. Sniff Pdi had the highest values, least between‐ and within‐subject variation and most consistent pattern of respiratory muscle recruitment with the lowest proportion of negative gastric pressure (Pg) values (p<0.001). Conclusions: Therefore, sniff Pdi may be better than Pdi TLC and Pdi PImax in assessing diaphragm function. Also, our subjects seemed to have lower sniff Pdi and Pdi PImax, and higher Pdi TLC compared with Caucasian subjects.
Assessment of left ventricular function after radiofrequency and direct current atrioventricular node ablation
Authors: Wong J. , Vohra J. , Chan W. , Mond H. G. , Lichtenstein M. , Kritharides L. , Warren R. J. 
Published: March 2008

Abstract Background: There is limited information available regarding the effect of catheter ablation of the antioventricular (AV) junction on left ventricular (LV) function. Both deterioration and improvement in LV function have been reported following direct current (DC) ablation of the AV junction. The deterioration of LV function following DC ablation of the AV junction may be due to the ccompanying barotrauma, DC arcing and direct coagulation, or even the effects of chronic ventricular pacing. If this deterioration of LV function was a result of the accompanying effects of DC shock, the use of radiofrequency ablation (RF) should not result in deterioration of LV function. Aim: To study LV function before and after different methods of AV junction ablation and in patients with chronic ventricular pacing without AV junction ablation. Material: This study assessed LV function in patients following RF ablation, low energy DC ablation of the AV junction and compared the results with our previously reported finding in patients who had AV junction ablation using high energy DC shock. A group of patients undergoing permanent single chamber ventricular pacemaker implantation without AV junction ablation were selected as controls. Methods: All patients were paced in the ventricle at 110 beats/minute during LV function assessment by radionuclide angiography. Global LV function and segmental wall motion abnormalities were assessed before, immediately following and three months after ablation. Results: In the high energy DC ablation group, a fall in global LV function (50±3.0% to 43±3.0%, p=0.02) and impairment of segmental wall motion were detected. Low energy DC ablation resulted in segmental wall motion impairment similar to high energy DC but without affecting global ejection fraction (47.0%±6.7 to 45.5%±3.1, p>0.05). Neither RF ablation (44.0%±3.3 to 45.3%±3.5, p>0.05), nor chronic pacing (46.7%±4.9 to 47.0%±2.9 p>0.05) had any effect on global or segmental LV function. Conclusions: Low energy DC or RF ablation of the AV junction does not affect global LV ejection fraction. The deterioration of global LV function after high energy DC shock ablation appears to be related to the accompanying effects of DC energy and not to the effects of chronic ventricular pacing.
Maternal selenium levels and Sudden Infant Death Syndrome (SIDS)
Authors: McGlashan N. D. , Cook S. J. , Melrose W. , Martin P. L. , Chelkowska E. , von Witt R. J. 
Published: March 2008

Abstract Background: The possibility is tested that low anti‐oxidant status and/or low levels of selenium (Se) might predispose to Sudden Infant Death Syndrome (SIDS). Aim: This study was undertaken to collect evidence on the Se status of pregnant and non‐pregnant women and newborn babies and to establish whether babies who later died of cot death had significantly divergent levels of blood Se at birth. Methodology: Aliquots of blood were collected from all newly pregnant mothers in Tasmania and from the cords of all newborn babies. These were analysed for Se and glutathione peroxidase (GPx) content and compared by season and with non‐pregnant, age standardised blood donors in three areas of Tasmania and three mainland Australian States. Results: Cot death babies' cordbloods were not significantly different in Se or GPx‐status, in this small sample, from those of other babies, nor was a seasonal variation in these parameters demonstrated among 390 randomly selected Tasmanian mothers. Mothers‐to‐be showed a decrease in enzyme levels during pregnancy and Tasmanian blood donors had significantly lower levels than donors from other States. Conclusion: While no evidence can safely be drawn about a relationship between Se or GPx‐status and SIDS, this study provides base level measures for populations showing that Tasmanian residents have low levels of these anti‐oxidants.
The clinical spectrum of necrotising fasciitis. A review of 15 cases
Authors: Jarrett P. , Rademaker M. , Duffill M. 
Published: March 2008

Abstract Background: Necrotising fasciitis represents a spectrum of disease which ranges from fulminant through acute to subacute varieties. While fulminating necrotising fasciitis is a well recognised entity the subacute variety is not. Aim: To assess six years' experience of necrotising fasciitis at Waikato Hospital. Method: Cases of necrotising fasciitis were identified from discharge statistics for the period 1990–1995. Records were reviewed for clinical features, predisposing factors, microbiology, histology, treatment and outcome. Results: Fifteen cases were identified of which ten were female. The average age was 55 years (range of 15–92 years). One patient presented with fulminant, eight with acute and six with subacute necrotising fasciitis. Significant blister formation was noted in eight cases. Risk factors were identified in 14 patients including trauma, renal impairment, diabetes mellitus, and various drugs including diclofenac (four patients), naproxen (one patient) and prednisone (two patients).Group A beta haemolytic streptococcus (GABHS) was identified in ten cases. Swab or tissue cultures had the highest yield for isolating the organism. Blood cultures grew GABHS in only three of 12 cases.Eight patients (53%) died. Of the survivors all but one patient required debridement and skin grafting. Conclusions: Necrotising fasciitis is a clinical spectrum of disease. It affects a wide age group and can have associated morbidities. It is often a fatal disease. Early recognition, high dose antibiotics and surgical debridement are important in the management of the entire spectrum of necrotising fasciitis.
The decline in asthma hospitalisations in persons aged 0–34 years in New Zealand
Authors: Kemp T. , Pearce N. 
Published: March 2008

Abstract Aims: Hospitalisation rates for asthma for the 0–14 year and five‐34 year age ranges have been examined from 1969 to 1993 to determine whether the rise observed between the 1960s and 1980s has continued into the 1990s. Results: In the 0–14 age range, hospitalisations peaked in 1986 then fell by 18.7% by 1993. There was a corresponding rise in hospitalisation rates for acute bronchitis/ bronchiolitis and it is possible that the fall in asthma hospitalisations in this age range is at least partly explained by diagnostic transfer. On the other hand, the trends in the five‐34 age range appear unlikely to be explained by diagnostic transfer. The rate peaked in 1986 and fell by 34.7% by 1993, with most of the decline occurring after 1989. This in part parallels the trends in mortality in this age range, which saw a sudden fall in the death rate in 1989. Conclusions: New Zealand is not only benefiting from a marked fall in asthma deaths, but is also benefiting from a marked decline in asthma hospitalisations in young adults, and probably also in children.
Orthostatic blood pressure control and ageing*
Authors: Wing Lindon M. H. , Tonkin Anne L. 
Published: March 2008

AbstractReflex haemodynamic responses to orthostatic stress are attenuated with ageing, the extent of attenuation increasing with advancing age. In 15–20% of individuals aged >65 years, the attenuation may be so marked that there is an excessive fall of blood pressure (BP) on assumption of the upright posture, sufficient on occasions to cause symptomatic cerebral hypoperfusion ‐ this is known as ‘ageing‐related’ orthostatic hypotension (AOH), a major risk factor for morbidity and mortality. Comparison of the cardiovascular responses to a variety of physiological and pharmacological stresses in healthy young and elderly subjects and in those with AOH suggests that the predominant site of the ageing‐related change in cardiovascular reflex function is in the central connections of the arterial baroreflex, affecting particularly the BP buffering response. There is no evidence for ageing‐related impairment of the efferent limb of the baroreflex, i. e. there is no significant ageing change in sympathetic vasomotor function or cardiac drive. Ageing‐related impairment of baroreflex function also does not appear to result from either attenuation of arterial compliance or the presence of systolic hypertension, despite the epidemiological association between systolic hypertension and AOH. Better understanding of this important problem has the potential to improve the health of all elderly people.
The current status of thrombolytic therapy
Authors: Aylward Philip 
Published: March 2008

AbstractFibrinolytic therapy substantially reduces mortality from acute myocardial infarction. Patient selection is, however, important. The patient must present within 12 hours of the onset ofischaemic symptoms, have definite ECG changes of ST elevation or left bundle branch block and no contraindications. The major contraindications are those for risk of an intracerebral bleed, recent stroke, intracranial tumour or risk of a major systemic bleed. Age and hypertension are not contraindications but may modify the regimen used.Heparin is required with recombinant tissue plasminogen activator but is optional with streptokinase.The recent COBALT trial suggests that the accelerated weight related t‐PA regimen given over 90 minutes is more satisfactory than double bolus t‐PA. However, inpatients under 75 years of age, the two regimens were equivalent.For patients suffering acute myocardial infarction, practitioners should now individualise choice of therapy, rather than give the same cocktail to all patients. The choice of regimen will depend on the cardiac risk, the stroke risk, the bleeding risk and the cost.
Idiopathic steroid responsive chronic lymphocytic meningitis—clinical features and long‐term outcome in 17 patients
Authors: Charleston A. J. , Anderson N. E. , Willoughby E. W. 
Published: March 2008

Abstract Background: Some patients with chronic lymphocytic meningitis appear to respond to corticosteroid treatment, but investigations fail to identify the cause. The use of corticosteroids in patients with chronic meningitis is controversial and the long term outcome is unclear. Aim: To review the long term outcome in 17 patients with the syndrome of idiopathic steroid responsive chronic lymphocytic meningitis. Methods: Review of patients' records and examination of surviving patients 1.5 to 17.5 years (median 8.8 years) after presentation. Results: The cause of the steroid responsive chronic meningitis was found during follow up in two of the 17 patients: Wegener's granulomatosis and multiple sclerosis in one patient each. A cause was not found in the other 15 patients. Seven of these patients eventually recovered and corticosteroids were withdrawn after six weeks to six years without a recurrence of symptoms. Four patients improved transiently, but died six months to 26 years after starting treatment; in two, steroids were withdrawn a few weeks before death. Four patients had active chronic meningitis and reduction in the dose of corticosteroids was associated with a recurrence of symptoms. Leptomeningeal and brain biopsy in eight patients showed non‐specific abnormalities which were not helpful in the diagnosis. Conclusions: A subgroup of patients with idiopathic chronic lymphocytic meningitis responds to corticosteroids. Leptomeningeal biopsy and long term follow up seldom identify the underlying cause in these patients. Steroid treatment must be undertaken with caution, even after infective causes of chronic meningitis have been excluded.