bluuebunny/crossref_metadata_2025_split huggingface dataset:
Video push enteroscopy in the investigation of small bowel disease: defining clinical indications and outcomes
Authors: Shackel N. A. , Bowen D. G. , Selby W. S. 
Published: March 2008

Abstract Background: Push enteroscopy is a new technique for investigation of the small intestine. The clinical indications are still being defined. It also offers the potential for therapeutic intervention in suitable cases. Aims: To evaluate further the role of push enteroscopy in the diagnosis and treatment of patients with suspected or known small bowel disease. Methods: A prospective record was kept of all patients having enteroscopy at Royal Prince Alfred Hospital between March 1995 and July 1997. The procedure was performed 73 times in 68 patients. Indications and diagnoses were noted. The outcome in patients with obscure gastrointestinal bleeding or anaemia in whom a vascular lesion was treated with a heater probe was also determined. Results: Enteroscopy was performed in 23 patients for gastrointestinal bleeding of obscure origin. An active or possible bleeding source was found in 13 (57%). The commonest of these was jejunal angiodysplasia. In the 21 patients with chronic iron deficiency anaemia a lesion was found in ten (48%). The majority of these were in the stomach, as described by others. The diagnostic yield in the 16 patients having enteroscopy for known or suspected small bowel disease was 56%. One patient underwent balloon dilatation of a postoperative jejunal stricture. Eleven patients with obscure bleeding or anaemia had ablation of a vascular lesion with a heater probe. Transfusion requirements fell after this procedure, particularly in those with active bleeding at the time of the examination. In five of the 11 no further transfusions were required in over six months of follow‐up. Conclusions: The most common indications for enteroscopy are obscure gastrointestinal bleeding, chronic anaemia and known or suspected small bowel disease. A positive result can be expected in over 50% of patients. The treatment of vascular lesions via the enteroscope has a significant impact of subsequent transfusion requirements. (Aust NZ J Med 1998; 28: 198–203.)
Short duration therapy for Helicobacter pylori in Western Australia: the impact of metronidazole resistance
Authors: Forbes G. M. , Coombs G. W. , Collins B. J. , Robins P. D. , McCullough C. A. 
Published: March 2008

Abstract: Background: Limited Australian data are available on either short duration therapy for Helicobacter pylori infection, or the impact of metronidazole resistance on the outcome of treatment. Aim: To compare the efficacy of two treatment regimens and determine the influence metronidazole resistance has on clearing H. pylori infection. Methods: Eighty patients with H. pylori infection proven at upper gastrointestinal endoscopy, none of whom had previously received therapy for H. pylori, were randomised to one week therapy with either bismuth subcitrate one tablet qid, tetracycline 500 mg qid and metronidazole 400 mg tds (BTM), or lansoprazole 30 mg bd, amoxycillin 500 mg qid and metronidazole 400 mg tds (LAM). Effectiveness of therapy was measured by C14‐urea breath test at six weeks. Results: On an intention‐to‐treat basis, clearance of infection was achieved in 17 of 32 (53%; 95% CI: 35–71%) evaluable patients receiving BTM and 32 of 46 (70%, 54–182%) patients receiving LAM (p=0.16). Metronidazole resistance was found in 32 of 65 (49%) patients in whom H. pylori was isolated by culture. On a per‐protocol basis, of patients who had metronidazole sensitive strains of H. pylori 23 of 24 (96%) cleared infection after therapy with either BTM or LAM, compared with 14 of 24 (58%) who were metronidazole resistant (p=0.004). Clarithromycin resistance was not found in 45 patients tested. Conclusions: In Western Australia clearance rates H. pylori infection, after one week of BTM or LAM, are lower than in other published series. The high incidence of metronidazole resistance is the main determinant of our relatively poor eradication rates.
Long term follow‐up of CEOP in the treatment of HIV related non‐Hodgkin's lymphoma (NHL)
Authors: Davis A. J. , Goldstein D. , Milliken S. 
Published: March 2008

Abstract: Background: The development of non‐Hodgkin's lymphoma (NHL) in AIDS conveys a poor prognosis with less than 10% of patients surviving beyond two years. These tumours are generally aggressive and often require systemic chemotherapy to bring about effective palliation. Aims: To report on the long term follow‐up of patients with HIV related NHL treated with CEOP chemotherapy. Methods: This is a retrospective analysis of a group of 18 patients treated at two institutions between October 1990 and 1992 with modified CEOP chemotherapy. Doses were calculated using cyclophosphamide 750 mg/m2, epirubicin 50 mg/m2, vincristine 2 mg and prednisone 75–100 mg Xfive days, however initial doses of cyclophosphamide and epirubicin were modified to 50–75% of calculated dose. Results: Seventeen of the 18 patients were male, one female; age range 26–79 (median 36 years); seven with immunoblastic, three Burkitt's, one Ki‐1 (anaplastic), six diffuse large cell, and one mixed large and small cell. Eight patients (44%) achieved a complete remission, with seven patients (39%) achieving a partial remission, for an overall response rate of 83% (95% CI=59–96%). Survival ranged from three‐35 months (median nine months). Interestingly, four patients (22%) survived more than two years (median 31 months), three remaining in complete remission at the time of death. Generally therapy was well tolerated and toxicity was manageable. Conclusions: CEOP is an effective, tolerable and safe regimen and our long term follow‐up suggests that there is a small sub‐population of patients with HrV and lymphoma who may have a better prognosis and as such would clearly benefit from systemic chemotherapy as a means of prolonging survival and not simply palliation.
Identification of incident fractures: the Geelong Osteoporosis Study
Authors: Pasco J. A. , Henry M. J. , Gaudry T. M. , Nicholson G. C. , Kotowicz M. A. 
Published: March 2008

AbstractBackground: Complete fracture ascertainment is critical for fracture cost estimates and planning for future health care facilities. Virtually complete ascertainment is possible for hip fractures because they nearly always require hospitalisation.Aims: To validate the use of radiological reports as a resource for ascertaining fracture cases, using hip fracture as a model.Methods: Hip fracture rates obtained from radiological reports were compared with rates obtained from hospital discharge summaries of medical records using International Classification of Diseases‐9 (ICD‐9) codes 820.0–820.9 and 733.1 over a three‐year period.Results: Hip fracture cases numbered 589 using radiological reports and 585 using medical records. Discharge summaries failed to identify 15 cases ascertained through radiology reports whereas 11 cases ascertained through medical records were not identified from X‐ray reports. The age‐specific incidence rates for radiological ascertainment were within the 95% confidence limits of the rates derived from medical records.Conclusions: Among a population of patients generally admitted to hospital for treatment of their fracture, we were able to identify more cases from radiological reports than from medical records. Incidence rates for hip fracture were comparable using the two methods. Radiological reports provide a valuable resource for identifying incident fractures. This method of case ascertainment would be suitable for identifying both major and minor fractures in regions with self‐contained health services where access to all radiological reports is possible.
Osteolymphoma (primary bone lymphoma): an Australian review of 70 cases
Authors: Christie D. R. H. , Barton M. B. , Bryant G. , Cheuk R. , Gebski V. , Hornsey J. , Lonergan D. , MacLeod C. , Pratt G. , Roos D. , Shannon J. , Thornton D. , Wirth A. 
Published: March 2008

AbstractBackground: To examine prognostic factors, treatment outcomes and design future studies for Osteolymphoma (OL) – also known as primary bone lymphoma.Methods: Between 1979 and 1993, 70 patients with OL were treated in nine Australian centres. The effect of patient‐, tumour‐, and treatment‐related factors on local control, distant disease‐free survival and overall survival were assessed by multivariate analysis.Results: Most patients (94%) received radiotherapy (RT) (median dose 40 Gy) and 56% received chemotherapy. Multifocal disease was present in 20% of patients. The five year rates of overall survival and local control were 59% and 82%. Although there was a trend towards better results with the addition of chemotherapy, on multivariate analysis, there were no factors identified which appeared to impact upon overall and disease‐free survival. Among the distant recurrences, there was a high proportion in bone (33%). Six patients suffered pathological fractures after treatment.Conclusion: High rates of local control were achieved by RT, but the overall survival remains relatively poor, worse than nodal lymphoma. The natural history of the disease suggests that OL may be a distinct entity, different to nodal lymphomas, so the results of clinical trials in nodal lymphoma may not be relevant to OL. Prospective studies could define the outcome of combined modality therapy and set a benchmark for testing further proposals, as well as improving our knowledge of the clinical features of OL.
Opinion of New Zealand physicians on management of acute ischaemic stroke: results of a national survey
Authors: Ardern‐Holmes S. L. , Raman R. , Anderson N. E. , Charleston A. J. , Bennett P. 
Published: March 2008

Abstract Background: Randomised trials have evaluated various treatments for acute ischaemic stroke, but it is unclear how the results of these studies are used in everyday practice. Aims: To obtain the opinions of physicians on the management of acute ischaemic stroke. Methods: A questionnaire was sent to 368 New Zealand Fellows of the Royal Australasian College of Physicians. The survey included questions about the availability of hospital services for stroke patients, management of acute ischaemic stroke and opinion on the efficacy of treatments used in acute ischaemic stroke. Results: Of the 293 physicians who responded to the questionnaire, 171 managed patients in the first week after stroke. Forty‐seven per cent of these physicians were general physicians. Ninety‐five per cent usually managed these patients in a general medical ward. Only five physicians admitted patients to an acute stroke unit and only 57% considered acute stroke units were beneficial. Aspirin was usually or sometimes used for patients with acute ischaemic stroke by 92% of physicians, intravenous heparin by 43%, low‐dose subcutaneous heparin by 41%, low‐molecular‐weight heparin by 25% and tissue‐plasminogen activator (t‐PA) by 3%. Two thirds considered that aspirin was definitely beneficial, but most were uncertain about the efficacy of intravenous heparin, low‐dose subcutaneous heparin, low‐molecular‐weight heparin and t‐PA. Sixty‐two per cent were prepared to begin aspirin and 21% subcutaneous heparin before computerised tomography (CT). Twenty‐three per cent used anti‐hypertensive treatment in the first few hours after an ischaemic stroke. Conclusions: Several common deficiencies in the management of acute ischaemic stroke were identified. The widespread lack of stroke units, use of aspirin and heparin before CT, and lowering of blood pressure after an acute ischaemic stroke differed from accepted guidelines. Many physicians used heparin despite lack of evidence from randomised trials that it is beneficial. The development of stroke units and the appoint‐ment of physicians with a special interest in the management of stroke may improve the management of patients with acute stroke. (Aust NZ J Med 1999; 29: 324–330.)
Sympathetic activation and the role of beta‐blockers in chronic heart failure
Authors: Krum H. 
Published: March 2008

AbstractChronic heart failure (CHF) is associated with activation of the sympathetic nervous system. This activation provides short term haemodynamic support to the failing myocardium, but may be deleterious over longer periods as chronic catecholamine excess appears to contribute to disease progression and increased mortality in this condition.Therefore, blockade of sympathetic activation represents a logical, if somewhat counter‐intuitive, approach to the management of the patient with systolic CHF. Pharmacological approaches to blockade of this system include inhibition of central sympathetic outflow (using central sympatholytics, e.g. rilmenidine, moxonidine), blockade of the catecholamine biosynthetic pathway (dopamine beta hydroxylase antagonists) and blockade of the cardiac effects of sympathetic activation (beta‐adrenoceptor blocking agents).Beta‐blockers have now been extensively studied in patients with symptomatic CHF of the New York Heart Association (NYHA) Class II and III severity. Provided beta‐blocker therapy is carefully up‐titrated from sub‐therapeutic doses and given for at least three to four months, these agents have been associated with favourable long term haemodynamic, functional and mortality outcomes. Furthermore, beta‐blockers delay disease progression in CHF by reversing the pathological myocardial remodelling process that accompanies the disease.Non‐selective beta‐adrenoceptor blocking drugs appear to be of particular benefit in CHF therapy. Myocardial β2 receptors are down‐regulated to a lesser extent than β1 receptors in CHF, therefore blockade of the β2 receptor sub‐type may assume greater importance in inhibiting the deleterious effects of sympathetic activation on the myocardium in this disease.Newer agents that possess additional vasodilator properties (carvedilol, bucindolol, nebivolol) may be useful in overcoming the initial negative inotropy of the beta‐blocking component of the drug, however, it is unlikely that vasodilation contributes greatly to long term clinical benefits.Drugs such as carvedilol are also anti‐oxidant, anti‐protiferative and have anti‐endothelin: actions; the clinical significance of these properties is yet to be determined.Unanswered questions remain regarding the use of beta‐blockers in heart failure. Ongoing studies are further examining mechanisms underlying the clinical benefits of these agents as well as their therapeutic potential in NYHA Class IV patients, heart failure post‐myocardial infarction and patients with asymptomatic left ventricular dysfunction.
New thrombolytic drugs
Authors: Thomson A. 
Published: March 2008

AbstractThrombolytic drugs reduce mortality from myocardial infarction and research is focused on newer drugs with improved clinical efficacy. The ideal thrombolytic drug should be effective in dissolving fresh and older thrombi, be rapid in its action with complete dissolution of the thrombus, be able to be given as a bolus and be safe without hypotensive or allergic or immunogenic reactions.The types of agents being developed fall into five broad categories:• mutants or variants of single chain urokinase type plasminogen activator;• mutants or variants of tissue type plasminogen activator;• recombinant chimaeric plasminogen activators;• conjugates of plasminogen activators and anti‐fibrin monoclonal antibodies;• compounds derived from haemophagous animals.Within the mutant and variant groups there may be single point mutations which increase the half life or deletion of various amino acid sequences to increase resistance to plasma protease inhibitors or cause more selective binding to fibrin. The recombinant chimaeric plasminogen activators are designer drugs where the kringle regions, the growth hormone domain region, the finger domain region and the serine protease part of the molecules are all cleaved and recombined in various ways to improve potency.The conjugates of plasminogen activators and anti‐fibrin and monoclonal antibodies improve the targeting of the agent to fibrin clot. Monoclonal antibodies are commonly used against the seven aminoterminal residues of the beta chain of fibrin. These are cross linked and bound to plasminogen activators.A variety of substances from haemophageous animals are currently being studied including salivary plasminogen activator from vampire bats, venom from southern copperhead snakes and staphylokinase from bacteria.Currently available thrombolytic agents have many limitations, but the novel thrombolytic agents have yet to be tested in clinical trials. With few exceptions, they all act via the plasminogen system and it may be in the future that combinations of anti‐platelet and thrombolytic agents may prove to be more efficacious than thrombolytics and aspirin alone.
Troponin and other cardiac markers: role in management of acute coronary syndromes
Authors: Ohman E. M. 
Published: March 2008

AbstractMany adjuncts to the traditional history, physical examination, and baseline ECG have been developed to improve the differential diagnosis of acute coronary syndromes in the Emergency Department (ED). These include serial ECGs, continuous ST‐segment monitoring, and serum markers of myocardial necrosis. In general, the serum markers of coronary ischaemia, particularly the troponins, provide the most information toward initial and later risk stratification. Serial marker measures not only increase the sensitivity and negative predictive value for acute infarction (thus reducing hospital costs) but also can add to prognostic ability. More importantly, a positive marker result indicates an increased risk of an early event, which could allow earlier intervention and thus a better outcome.
Treatment of metastatic breast cancer with continuous infusional 5 fluorouracil
Authors: Karapetis C. S. , Patterson W. K. , Pittman K. B. , Kotasek D. , Sage R. E. 
Published: March 2008

Abstract Background: Single agent continuous infusional 5 fluorouracil (CI‐5FU) via a central venous catheter (CVC) is usually reserved for breast cancer patients who have previously failed one or more chemotherapy regimens. The patients are usually heavily pre‐treated with later stage disease. Previously published studies of CI‐5FU have reported response rates as high as 54%. It is considered an approach with an acceptable side effect profile in such patients. Aims: To evaluate the efficacy and toxicity of CI‐5FU in previously treated metastatic breast cancer. Methods: A retrospective review of advanced breast cancer patients treated with CI‐5FU between October 1992 and October 1996 was performed. Response to treatment, toxicity, CVC complications and patient survival were analysed. Results: Twenty‐four patients with metastatic breast cancer were treated with CI‐5FU. All had received previous chemotherapy, including 19 patients (79%) with prior 5FU exposure and eight patients (33%) who had previous high dose chemotherapy with autologous stem cell transplantation. The median duration of CI‐5FU treatment was 3.1 months. Nineteen patients had evaluable disease, three (16%) of whom demonstrated a partial response and four patients had stable disease. There were no complete responses. All responses occurred in soft tissue sites with no objective evidence of response in liver or bone metastases. The survival rate at one year was 21% (five of 24) and the median survival of all patients was 6.1 months. Five patients (21%) stopped treatment due to treatment related morbidity (two CVC complications and three CI‐5FU side effects). Diarrhoea, nausea, and palmar‐plantar erythrodysaesthesia were the major side effects of chemotherapy. CVC complications requiring intervention, the most notable of which were infection and thrombosis, occurred in 11 patients (46%). There were no treatment related deaths. Conclusions: Single agent CI‐5FU has modest activity in women with previously treated advanced breast cancer. The efficacy is lower than in previously published series. This may reflect patient selection factors. The toxicity was mainly related to CVC complications. Important issues relating to quality of life need to be objectively measured in future studies of CI‐5FU.
Severity of liver disease in hepatitis C infection contracted through injecting drug use
Authors: Ostapowicz G. , Bell S. J. , Desmond P. V. 
Published: March 2008

Abstract Background: Injecting drug use (IDU) is currently the most common route of hepatitis C virus (HCV) transmission in Australia and many other Western countries. Most reports on the natural history of HCV have examined populations that included patients from all risk groups, but it is possible that this increasingly important subgroup is different. Aims: To assess the severity of liver disease in individuals who acquired HCV through IDU. Methods: Three hundred and forty‐six patients with confirmed HCV infection and a history of IDU, who had had a liver biopsy performed were recruited from a liver clinic. Demographic data, liver function tests and hepatitis B serology were obtained on all patients. A detailed drug use history and HCV viral studies were also available in a subgroup of 142 patients. Results: Mean age of the group was 34 years and 73% were male. Mean duration of HCV infection was 14.6 years. Forty one per cent were infected with genotype 3a, 19%– 1a, 17%– 1 (nonsubtypable), 14%– 1b and 4%– 2b. Cirrhosis was present in 12% of patients. Patients with cirrhosis (38 years) were older than those with chronic hepatitis (34 years; p=0.0003) and had a longer duration of infection (17.2 vs 14.3 years; p=0.003). On multivariate analysis, however, patient age was the only factor independently associated with cirrhosis (odds ratio 4.2; 95% confidence interval 1.4‐12.6). Conclusion: While cirrhosis is less common in this group than in other HCV infected populations, its prevalence may increase as these patients are followed over a longer period of time.
Systemic sclerosis prevalence and mortality in Sydney 1974‐88
Authors: Englert H. , Small‐McMahon J. , Davis K. , O'Connor H. , Chambers P. , Brooks P. 
Published: March 2008

Abstract Background: Systemic sclerosis prevalence and mortality estimates have demonstrated wide variability. The sole Australian study published to date demonstrated high prevalence rates when compared to overseas estimates. The prevalence and mortality findings reported in this paper derive from a larger study which addressed the distribution and determinants of systemic sclerosis within Sydney. Aims: To determine systemic sclerosis prevalence and mortality rates within Sydney over 15 years, 1974–88. Methods: Cases were ascertained from multiple sources including death certificates, hospitals, physicians, vascular surgeons' and dermatologists' private practices, a systemic sclerosis self‐help group and private medical laboratories. Results: Overall, 715 cases were identified. Females comprised 77% (95%CI:74–80) of cases. Disease of the limited subtype accounted for 79% (95%CI: 76–82) of all systemic sclerosis, being relatively more frequent in living than deceased cases, and in females than males. Crude prevalence estimates appeared to rise between 1975 (4.52/100,000 95%CI:3.75–5.29/100,000) and 1988 (8.62/100,000 95%CI:7.64–9.60/100,000) as did estimates of diffuse disease. However, diffuse disease prevalence, when expressed as a proportion of total disease prevalence, showed no significant temporal change. Although crude mortality rates also showed apparent temporal increases (0.24/100,000 in 1975 to 0.80/100,000 in 1988) standardised mortality rates showed less convincing trends (0.41/100,000 in 1976 and 0.40/100,000 in 1988). Death certificate‐derived mortality rates provided relatively large underestimates of total mortality. However, these underestimates were relatively constant over time. Conclusions: This study has demonstrated systemic sclerosis prevalence and mortality rates comparable to overseas estimates, consistently higher prevalence and mortality rates in females than males, proportionally higher rates of diffuse disease in males than females and in deceased cases than living cases, a diffuse: limited disease ratio apparently