bluuebunny/crossref_metadata_2025_split huggingface dataset:
The causes of sporadic and ‘senile’ chorea
Authors: Warren J. D. , Firgaira F. , Thompson E. M. , Kneebone C. S. , Blumbergs P. C. , Thompson P. D. 
Published: March 2008

Abstract Background: Although ‘senile’ chorea is commonly listed in the differential diagnosis of chorea, the condition is poorly defined. Indeed, the existence of such an entity is debated. There are few contemporary prospective studies of sporadic chorea in the elderly. Methods: Detailed prospective study of patients presenting with undiagnosed chorea over a three year period to a Movement Disorder Clinic. Results: Twelve patients, aged 50 to 89 years, were identified. The final diagnoses were Huntington's disease, confirmed on genetic testing in six, antiphospholipid antibody syndrome in two, and hypocalcaemia, tardive dyskinaesia and basal ganglia calcification in each of the three remaining cases. Only one patient remained undiagnosed despite extensive investigation. Conclusions: The majority of patients with ‘senile’ chorea actually have Huntington's disease even in the absence of a family history. Rarer causes of chorea still need to be considered in the elderly when Huntington's disease has been excluded by DNA analysis.
Smoking habits and cessation programme in an Australian teaching hospital
Authors: Jones T. E. , Crocker H. , Ruffin R. E. 
Published: March 2008

Abstract Background: Data on prevalence of cigarette smoking by hospital employees are limited in Australia, but anecdotal evidence suggests that many health sector employees continue to smoke despite abundant evidence regarding the harmful effects of this habit. Nicotine is an addictive drug and arguably this should be known better in the health industry than in any other industry. Despite having this knowledge at their disposal, health sector employers rarely provide assistance to employees, relying instead on restrictive policies to reduce smoking in the workplace. Methods: To assist employees to quit smoking, we instituted a medium intensity Stop Smoking Programme, run by a clinical pharmacist offering nicotine patches and support on a weekly basis. A principal aim of the service was to redress the imbalance between the availability of cigarettes and the most effective nicotine replacement therapy, the trandermal nicotine patch. Following 18 months operation of this service, we surveyed hospital employees to ascertain smoking rates and views on smoking cessation in this South Australian teaching hospital. Results: In the first 18 months of operation, 111 staff members availed themselves of the service. At the first follow up period (three months), 21 were not contactable, 29 were successful in not smoking and 61 were still smoking. Six of the 29 who were not smoking at three months resumed smoking by six months, and a further four resumed smoking by 12 months. At the time of this report, 12 of the remaining 19 non smokers had completed two years since quitting and a further three of these had resumed regular smoking by this time. The cost of providing the service was modest at approximately $180.00 per known successful quitter. Results from the survey showed that 12.4% of hospital employees were regular smokers. Smoking prevalence was not equally distributed with female employees being twice as likely to smoke as their male counterparts and employees in the catering department having the highest smoking prevalence (23.8%). Conclusions: Although the prevalence of cigarette smoking by employees of this teaching hospital is lower than for the general community, health sector employers can reduce smoking prevalence further by providing assistance to their employees to quit smoking. The Stop Smoking Programme we describe is effective and could be replicated by other hospitals and similar organisations.
Mycobacterial lymphadenitis in eastern Sydney
Authors: Wark P. , Goldberg H. , Ferson M. , Mckenzie D. , Lau E. , Rivas K. 
Published: March 2008

Abstract Background: There has been a resurgence of tuberculosis (TB) in the developed world, especially extrapulmonary manifestations, of which lymphadenitis is the most common. We reviewed all cases of mycobacterial lymphadenitis notified in the eastern suburbs of Sydney from 1989 to 1996. Aims: To review all cases of mycobacterial adenitis in eastern Sydney. Methods: This was a retrospective review of the medical records of 54 patients (aged 1.2 to 84 years), recruited from all notifications of TB presenting as lymphadenitis at Prince of Wales, Sydney Children's and St Vincent's Hospitals. Results: There were two distinct groups: Group 1, patients with Mycobacterium tuberculosis (MTB), n=37 (68.5%), Group 2, patients with atypical mycobacteria, n=17 (31.5%). For Group 1, 83.3% were foreign born and 18.9% were positive for the human immunodeficiency virus (HIV). Disease involved single node groups in 73% (the cervical chain was involved in 70.1%). Complete resolution of lymphadenopathy at conclusion of treatment occurred in 73.1%. Outcome was not documented in 13.5%, of the rest; 83.8% completed treatment; 2.7% were lost to follow up before treatment concluded; 2.7% were still being seen at the time of writing and 10.8% died within six months of treatment starting (all were HIV positive). HIV positive patients had more diffuse disease. Group 2 were all Australian born. They comprised children less than six years who were all HIV negative and adults (aged 30–55 years) who were all HIV positive. The children were all treated surgically with 80% having complete resolution of their modes. Those adults with HIV had a mortality of 83.3% during treatment. Conclusions: In eastern Sydney lymphadenitis caused by MTB in the HIV negative population is mostly seen in those who are immigrants. Our large proportion of HIV positive patients tended to have diffuse disease and a high mortality. The reporting of outcomes was poor and in a greater than expected number of outcome and follow up were inadequately documented.
The corrected TIMI frame count. The new gold standard?
Authors: French John K. , Ellis Christopher J. , White Harvey D. 
Published: March 2008

AbstractOver the last decade Thrombolysis in Myocardial Infarction (TIMI) flow grades have been the gold standard for the assessment of efficacy of infarct‐artery reperfusion. However, with the introduction of core angiographic laboratories, the reproducibility of TIMI flow grades has been questioned. The corrected TIMI frame count (CTFC) has been developed as a more reproducible method of quantifying infarct artery blood flow after myocardial infarction (MI). We have utilised the CTFC in two studies to examine infarct‐artery blood flow.In the Hirulog in Early Reperfusion and Occlusion (HERO 1) study, the CTFC was measured at 90–120 minutes after administration of aspirin, streptokinase and either Hirulog or heparin. Only 27% of patients had a normal CTFC (≥27) in the infarct‐related artery. Patients with a prolonged CTFC (>27) had more abnormal left ventricular function (LVF) as measured by the mean chord score in the ‘area at risk’ (‐2.51 vs ‐2.06, p=0.02), on left ventriculography.In a second study, infarct‐artery flow was examined four weeks and one year after MI. At four weeks, only 43% of patients with patent infarct‐related arteries had a ‘normal’ CTFC of ≥27. A prolonged CTFC at four weeks was a univariate predictor of increased reocclusion at one year (p=0.001).CTFCs are frequently abnormal in patent infarct‐related arteries, and predict reocclusion. Whether frame counting is a better predictor of late clinical outcomes than the TIMI flow grade needs to be prospectively examined in large clinical trials.
Pregnancy outcome in systemic lupus erythematosus (SLE): a review of 54 cases
Authors: Johns K. R. , Morand E. F. , Littlejohn G. O. 
Published: March 2008

Abstract: Aim: To compare the pregnancy outcome, in particular gestational age and birth weight in women with systemic lupus erythematosus (SLE) diagnosed before and after pregnancy, and to review data on presence or absence of the antiphospholipid (aPL) antibody and flares of disease activity. Method: Case histories were reviewed of women with a diagnosis of SLE and an obstetric event attending Monash Medical Centre (MMC) over an eight year period (1988–96). Fifty‐four pregnancies in 28 women were studied, with 44 occurring after the diagnosis of SLE (Group 1) and ten prior to the diagnosis of SLE (Group 2). Results: In Group 1 there were 25 live births (63%) with 16 full term and nine premature deliveries, 12 spontaneous abortions, three foetal deaths in utero and four elective terminations. In Group 2 there were seven live births (70%), two spontaneous abortions and one foetal death in utero. The mean gestational age of live births was 35.8 weeks and 39.2 weeks respectively (p<0.001). The mean birth weight of live births was 2448 g and 3030 g respectively (p=0.023). a PL antibodies were positive in eight of 26 women tested with three live births and were negative in 18 of 26 women with 12 live births. Flares of disease activity occurred in 17 of 28 pregnancies. Conclusion: Pregnancy in women with a predisposition to SLE have a high risk of an adverse outcome. Clinical disease confers an additional risk. The mean gestational age and birth weight were significantly less in women with established disease. Mild flares in disease activity resulted in a favourable outcome while renal flares had a worse outcome.
The economic cost of asthma in Singapore
Authors: Chew F‐T. , Goh D. Y‐T. , Lee B‐W. 
Published: March 2008

AbstractBackground: Asthma is a common chronic disorder. In Singapore, it is estimated that 140,000 individuals have current asthma and more than 100 individuals die of this disease annually.Objective: This study estimates the economic cost of asthma, both direct and indirect, to the patient and community.Method: Direct cost estimates were based on all levels of medical care, which included inpatient care, emergency room visits, specialist outpatient and primary healthcare, and medication costs. Indirect costs were estimated from cost of time lost by patients and their families attending to medical needs and the loss of productivity due to absenteeism. These estimates were calculated to the 1992/93 US dollar.Results: The total cost of asthma in Singapore was estimated to be US$33.93 million per annum. This was made up of US$17.22 million in direct costs and US$16.71 million in indirect costs. Inpatient hospitalisation accounted for the largest proportion of direct medical expenditure, approximately US$8.55 million. The loss of productivity from acute asthma accounted for the largest proportion of the indirect costs at US$12.70 million. The cost estimates did not include premature death due to disease. These estimates represent approximately US$238 per asthmatic person per year or US$11.90 per person per year.Conclusion: This study shows that the economic cost of asthma is also considerable in populations outside the Western hemisphere, and justifies the need for a concerted effort to reduce asthma morbidity worldwide.
Influence of angiotensin converting enzyme (ACE) genotype on interpretation of diagnostic tests for serum ACE activity
Authors: Stokes G. S. , Monaghan J. C. , Schrader A. P. , Glenn C. L. , Ryan M. , Morris B. J. 
Published: March 2008

Abstract Background: The discovery that an insertion/deletion (I/D) polymorphism of the angiotensin converting enzyme (ACE) gene influences the circulating concentration of ACE may have implications for the proper use of serum ACE activity measurements in screening for sarcoidosis. Aim: To determine whether the sensitivity of the serum ACE test improves if ACE genotype is taken into account. Methods: A retrospective determination of ACE genotype and clinical diagnosis was done in 54 patients with serum ACE activity above the upper limit of the reference range for the insertion (II) genotype. ACE was measured by radioenzymatic and spectrophotometric techniques, and genotype by PCR. Results: When serum ACE values determined diagnostically were related to the appropriate genotype‐specific reference range, sensitivity and specificity for diagnosis of sarcoidosis were 65–70% and 58% respectively, compared to 47–57% and 77% with a reference range unsegregated for genotype. Conclusion: ACE genotyping may be helpful in determining the diagnostic significance of mildly elevated serum ACE activity in patients with the II and ID genotypes.
Large animal models of heart failure
Authors: Power J. M. , Tonkin A. M. 
Published: March 2008

AbstractCongestive heart failure (HF) is a major focus of medical research. Its incidence has greatly increased in recent decades because of an aging population base and the increasingly successful treatment of other forms of chronic cardiac disease. Relevant large animal models of HF should reflect the complex interactions of cardiac dysfunction, neurohumoral dynamics and peripheral vascular abnormalities found in human HF. A number of large animal models have been developed, especially in dogs, sheep and swine, using naturally occurring HF, or single or combinations of interventions, as instruments to trigger the development of HF.Naturally occurring HF models are not commonly used because of ethical or perceived ethical grounds, however, King Charles Cavalier Spaniel and Yucatan Mini Pig models have been described. Tachycardia induced HF is the most commonly used HF model. Ventricular pacing at 220–240 bpm results in profound low output, biventricular, oedematous failure in two to three weeks. Lower pacing rates result in a more stable, sustainable, lesser degree of failure. Positive features of this model include ‘acceptance’, aetiological relevance to patient tachycardia induced HF, neurohumoral and functional profile similar to most human HF, relatively low cost simple preparation, ability to manipulate the degree of failure with pacing rate, reversibility, reliability and a large amount of published multi species data. Limitations to the use of the model are the rapid onset, the fact that reversibility is only relevant to the tachycardia induced patient HF, the absence of hypertrophy in failure, the diminished plasma atrial natriuretic peptide (ANP) levels, absence of ANP of ventricular origin, and the interference between rapid pacing and therapeutic interventions. Myocardial damage models of HF include those models induced by ischaemia, eg due to coronary occlusion (ligation or aneroid) or intracoronary microembolism, transmyocardial DC shock, toxic cardiomyopathy from adriamycin, doxorubicin or catecholamines. Overload models of HF may be induced by high pressure from aortic constriction, aortic regurgitation, renal artery constriction, pulmonary stenosis or aortocaval shunts, or by induction of mitral regurgitation from chordae or leaflet damage.No single, all‐encompassing, large animal model of HF exists to date. Selection of the type of model to be used should be based primarily on the hypotheses to be tested and secondarily on the available resources and facilities.
Animal models of heart failure
Authors: Arnolda L. F. , Llewellyn‐Smith I. J. , Minson J. B. 
Published: March 2008

AbstractAnimal models of heart failure present homogenous groups of animals all with heart failure produced by a well defined lesion at a particular stage of evolution, in contrast to humans, who present with heart failure of uncertain duration from a wide variety of causes and with marked variation in age and pre‐morbid health and fitness. Animal models of heart failure provide diseased groups of animals in which experimental procedures, not possible in humans, can be evaluated and in which new treatments can be tested before their safety is established in humans. An ideal model should have a common human counterpart and should closely mimic heart failure in humans. Thus the haemodynamic changes should include increased cardiac filling pressures and low cardiac output. There should be evidence of activation of the sympathetic nervous system and increased secretion of hormones such os renin, angiotensin, aldosterone, vasopressin, atrial natriuretic factor and endothelin. The clinical features of the human syndrome such as cardiomegaly, lung and peripheral oedema and decreased exercise tolerance should be present. Lastly, the model should be inexpensive and technically simple to produce and study.This paper reviews some commonly used models of heart failure in relation to the criteria listed above. There is no perfect animal model of heart failure and in practice one should match the model to the purpose of the study.
Walking with its training effects on the fitness and activity patterns of 79–91 year old females
Authors: Hamdorf P. A. , Penhall R. K. 
Published: March 2008

Abstract Background: Information is lacking about the physiological and psychosocial effects of exercise among very old persons. Aim: To investigate the effect of a twice‐weekly, six‐month progressive walking programme on 38 healthy women in their ninth decade, for evidence of the benefits of exercise. Methods: Aerobic fitness, blood pressure, skinfold thickness and habitual activity patterns were studied in a randomised controlled trial. Women were chosen, as this is a group of increasing demographic importance for which studies are lacking. Results: The training group and control group were not significantly different at baseline. However, after six months of progressive exercise the training group showed lower resting (p<0.05) and working (p<0.005) heart rates compared with non‐exercising controls. ANCOVA analyses indicated higher scores for the training group compared with the control group for Maximum Current Activity and Normative Impairment Index (both p<0.001), which are both components of the Habitual Activity Profile. Morale also significantly improved within the training group (p<0.01). Conclusions: These data show the trainability of very old women and the positive impact a low frequency, progressive exercise programme can have on cardiorespiratory fitness and daily living activity patterns. Such improvements are likely to be indicative of an enhanced outlook for independence.
Efficacy, safety and tolerability of anagrelide in the treatment of essential thrombocythaemia
Authors: Mills A. K. , Taylor K. M. , Wright S. J. , Bunce I. , Eliadis P. , Brigden M. C. , Seeley G. , Bashford J. , Olsen T. , Rentoul A. , Kelly C. 
Published: March 2008

Abstract Background: Essential thrombocythaemia (ET) has an associated risk of thrombotic and haemorrhagic complications, which can be minimised by control of the platelet count. Anagrelide selectively lowers the platelet count, however, there is little Australasian experience with its use and scant data on symptom control. Aims: To evaluate the efficacy of anagrelide for platelet reduction and symptom control in a broad cohort of patients with well‐defined ET, and to determine the safety and tolerability in such a population. Methods: Seventeen patients with ET and a platelet count >600X109/L were prospectively enrolled. The evaluable four males and 12 females with a median age of 58 years (range 14–79) included ten patients (63%) previously treated with two or more agents and 12 patients (75%) who had failed other therapies. The median follow‐up was seven months (range 15 days to 36 months). Results: Anagrelide, in an average dose of 1.9 mg/day, reduced the platelet count from a mean of 728X109/L (95% CI 611‐845X109/L) to 412X109/L (95% CI 319‐504X109/L) (p<0.001) and maintained it at this level. Fourteen patients (88%) had a platelet reduction to <600X109/L. All symptomatic patients had improvement in symptoms attributable to thrombocythaemia. There were three haemorrhagic and three thrombotic episodes in a total of three patients (19%), including one death from an intracerebral haemorrhage. Six patients (37%) were removed from therapy due to toxicity after a median of 151 days. Side effects included palpitations, abdominal pain and cough. Conclusions: Anagrelide is efficacious and safe in ET, both for platelet and symptom control. Minor side effects are common, however, tend to occur early and resolve spontaneously in most cases.
Familial risk estimation in systemic sclerosis
Authors: Englert H. , Small‐McMahon J. , Chambers P. , O'Connor H. , Davis K. , Manolios N. , White R. , Dracos G. , Brooks P. 
Published: March 2008

Abstract Background: Familial systemic sclerosis has been rarely reported. Assumptions have therefore been made implying no familial disease aggregation. This study critically challenges the assumption using a methodical population‐based epidemiological approach to quantify the prevalence and characteristics of familial systemic sclerosis. Methods: In this retrospective cohort study the systemic sclerosis prevalence in first degree family members was compared between 715 systemic sclerosis patients (710 families) and 371 randomly ascertained age and gender group‐matched general practice controls (371 families). These data, obtained by telephone questionnaire (living patients) or medical records review (deceased patients and untraceable patients of unknown living status), were validated, where necessary, and expressed in terms of relative risk, absolute risk and population point prevalence. Results: Systemic sclerosis affecting first degree members was validated in ten of 710 families. Reporting of systemic disease in another four more distant family members, and the co‐occurrence of systemic and localised disease in three families was also documented.Observed and expected disease subtype concordance was 80% (44–97%) and 68% respectively and the female predominance among familial cases was similar to that for non‐familial disease. The risk of disease in a subsequent first degree relative was compared to the risk in an initial first degree family member. Its estimated magnitude was wide (11–158). However, use of population prevalence data to determine the expected number of systemic sclerosis patients in the negative cohorts' families suggests the higher estimate is more realistic. Despite the high magnitude, the absolute disease risk in first degree family members remained low – approximating 1%. The population prevalence of familial systemic sclerosis approximated 1.4/million. Conclusions: This study substantially increases the otherwise small list of documented instances of familial systemic sclerosis. More importantly, it quantifies the risk for the first time, ranking it as the disease's most powerful determinant identified to date.