bluuebunny/crossref_metadata_2025_split huggingface dataset:
Heterogeneity in the phenotypic expression of the mutation in the mitochondrial tRNALeu (UUR) gene generally associated with the MELAS subset of mitochondrial encephalomyopathies
Authors: Jean‐Francois M. J. B. , Lertrit P. , Berkovic S. F. , Crimmins D. , Morris J. , Marzuki S. , Byrne E. 
Published: March 2008

Abstract Background: Point mutations in the mitochondrial (mt) genome underlie a number of neurological disorders. Some are well defined including the myoclonus epilepsy ragged red fibre syndrome (MERRF) and the mitochondrial encephalopathy lactic acidosis stroke like episode syndrome (MELAS). However, other clinical phenotypes are less distinctive and mitochondrial studies are often included in the workup in complex neurological syndromes of uncertain aetiology. Aims: We investigated 27 consecutive patients with varied clinical phenotypes referred to our laboratory for mtDNA studies to determine the incidence of recognised point mutations in a patient group with a range of phenotypes including many where mt disease was possible but did not fall into a classical syndrome. Methods: The recognised point mutations were detected by amplification of the appropriate DNA fragment by PCR followed by restriction‐endonuclease digestion of the normal and mutant species. Results: The A‐G base substitution mutation at nucleotide (nt)3243 in the tRNALeu gene of mtDNA which is present in the majority of cases of MELAS syndrome, was detected in four cases, only one of whom had typical MELAS symptoms. Their clinical manifestations ranged from mild deafness to a mixture of chronic progressive external ophthalmoplegia symptoms (CPEO) and stroke like episodes. The nt3243 mutation was also identified in one of seven mtDNA deletion negative CPEO cases. Conclusions: The presentation of the mtDNA mutation at nt3243 appears therefore to be quite variable with some mild phenotypes as well as severe phenotypes observed. In general, the chance of finding a mitochondrial point mutation in a patient with an atypical clinical phenotype is small.
Second malignant neoplasms in patients with Hodgkin's disease
Authors: Robinson B. A. , Fitzharris B. M. , Colls B. M. , Atkinson C. H. 
Published: March 2008

Abstract Aim: To determine the incidence of second malignant neoplasms in patients treated for Hodgkin's disease. Methods: The records were reviewed of all patients receiving primary treatment for Hodgkin's disease at the Oncology Service, Christchurch Hospital from 1969 to 1992. Second malignant neoplasms presenting at least six months after the diagnosis of Hodgkin's disease were noted and the cumulative risk estimated. Results: Twenty‐two second malignant neoplasms developed in 20 of the 209 patients. The risk was 5.6 ± 3.8% (CI) at five years, 11.4 ± 6.2% at ten years, and 21.7 ± 11.2% at 15 years and continued to increase thereafter. Thirteen patients have died of their second malignancy, including two of a third malignancy, while four have been followed for less than one year. Three leukaemias (CML, 1; acute non lymphocytic leukaemia, 2), three lymphomas and 16 solid tumours developed. The risk was greater after six or more cycles of MOPP‐like chemotherapy and after radiation doses exceeding 30 Gray. The risk was less after laparotomy and splenectomy (p = 0.0205). Conclusions: In view of the significant risk of a second neoplasm in survivors of Hodgkin's disease follow up should continue beyond ten years, after which time second malignancies were more likely than recurrence. Efforts should continue to minimise the carcinogenicity of therapy while preserving efficacy. (Aust NZ J Med 1994; 24: 368–373.)
Trends in bacterial infections in febrile neutropenic patients: 1986–1992
Authors: Gibson J. , Johnson L. , Snowdon L. , Joshua D. , Young G. , MacLeod C. , Benn R. , Iland H. , Vincent P. , Kronenberg H. 
Published: March 2008

Abstract Background: Bacterial infection is a major cause of morbidity and mortality in neutropenic patients. Aims: (1) To review patterns and trends in bacterial infections in three cohorts of febrile neutropenic patients managed by a single unit over a seven year period. (2) To relate any changes to the use of central venous (Hickman's) catheters and high‐dose cytosine arabinoside chemotherapy. Methods: Retrospective review of the results of initial bacteriological work‐up performed on 344 episodes of febrile neutropenia. The three cohorts were 1986–87 (n= 102), 1989–90 (n= 92) and 1991–92 (n= 150). Results: (1) The ratio of gram‐negative to gram‐positive bacteraemias fell from 1.36 in the first cohort to 1.05 in the second and 0.40 in the third (p= 0.03). There was a fall in both percentage and number of gram‐negative isolates coupled with a rise in the frequency of gram‐positive isolates. (2) Coincidentally there was a rise in the frequency of positive cultures from Hickman catheter entry wounds and an increasing frequency of simultaneous isolation of the same organism from the catheter entry site and the blood. The types of organisms isolated from catheter entry wounds showed a trend towards fewer gram‐negative and more gram‐positive. (3) A relationship was observed between the use of high‐dose cytosine arabinoside chemotherapy and the incidence of bacteraemia (p= 0.025) but not with the change in types of organisms. Conclusions: Over seven years we have documented a major change in the types of infections, particularly bacteraemias, seen in febrile neutropenic patients. In our institution the more widespread use of intravenous catheters and high‐dose cytosine arabinoside chemotherapy have been identified as two possible contributing factors. (Aust NZ J Med 1994; 24: 374–377.)
Does beclomethasone dipropionate suppress dehydroepiandrosterone sulphate in postmenopausal women?
Authors: Smith B. J. , Dickeson J. , Buxton J. R. , Heller R. F. 
Published: March 2008

Abstract Background: Patients with chronic obstructive airways disease and asthma are at special risk of developing osteoporosis. Previous research has indicated that adrenal androgen levels in postmenopausal women are suppressed by short term high dose inhaled corticosteroids. Such an effect, if sustained, may be a causative factor for long term bone loss. We tested the hypothesis that postmenopausal women receiving ≥1 mg/day inhaled beclomethasone dipropionate, long term, have suppressed dehydroepiandrosterone sulphate levels when compared to postmenopausal controls. Methods: As part of a larger study, we studied 36 postmenopausal subjects, recruited from regional pharmacies and a hospital chest clinic, who had been receiving treatment for asthma. Subjects were selected if they were receiving ≥1 mg/day inhaled beclomethasone dipropionate (n= 27) or receiving no beclomethasone dipropionate (n= 9). The two groups were compared for dehydroepiandrosterone sulphate levels, age and potential confounders. Results: Mean dehydroepiandrosterone sulphate levels were 35% lower in the high dose beclomethasone dipropionate group than the control group (p<0.01). Conclusions: This is the first report of suppression of dehydroepiandrosterone sulphate in postmenopausal women receiving long term inhaled beclomethasone dipropionate. Further research is needed to clarify whether or not there is any associated clinically important adverse effect on bone density. (Aust NZ J Med 1994; 24: 396–401.)
A pseudoepidemic of Mycobacterium chelonae: contamination of a bronchoscope and autocleaner
Authors: Campagnaro R. L. , Teichtahl H. , Dwyer B. 
Published: March 2008

Background: At fibreoptic bronchoscopy the potential exists for contamination of bronchoscopes and microbiological specimens. Patients may also be cross infected with acid fast bacilli (AFB). During a five month period, 12 bronchial wash specimens of 65 patients undergoing bronchoscopy, one bronchoscope and an autocleaner, were contaminated with the AFB, Mycobacterium chelonae (MCH). Aim: To eradicate AFB contamination of bronchoscopy specimens by identifying sources of contamination and modifying disinfection procedures. Methods: To identify the source of contamination, samples for AFB culture were taken from three bronchoscopes, the autocleaner and water taps. To eradicate MCH contamination, the bronchoscopes were soaked in 2% glutaraldehyde overnight and flushed with 70% alcohol. Disinfection procedures were altered by using sterile water and containers in cleaning. Autocleaner use was discontinued. Results: The autocleaner, one bronchoscope and 12 bronchial wash specimens were contaminated with MCH. All contaminants had similar electrophoretic banding on probing of their DNA fragments, suggesting a common clone of origin. After the alterations in disinfection procedures and despite prolonged soaking in 2% glutaraldehyde, three further contaminated wash specimens were isolated from one bronchoscope. Only after ethylene oxide sterilisation of this bronchoscope was the contamination overcome. Since then no further MCH contamination has occurred. No patient required treatment and there has been no clinical evidence of mycobacterial disease. Conclusion: To avoid contamination of bronchoscopy specimens with MCH, use of autocleaners should be discouraged and sterile water and containers used in cleaning procedures. If MCH contamination occurs in this setting, the bronchoscope and dismantled valve mechanism should undergo ethylene oxide sterilisation. (Aust NZ J Med 1994; 24: 693–695.)
Initial and long‐term results of percutaneous transluminal balloon angioplasty for chronic total occlusions: an analysis of 184 procedures
Authors: Sathe S. , Alt C. , Black A. , Manolas E. , Warren R. , Valentine P. 
Published: March 2008

Abstract Background: Coronary angioplasty, although of proven use in partial occlusion, has not been shown to be of similar benefit in chronic total occlusion. Aims: To assess the utility of coronary angioplasty in chronically totally occluded vessels in patients undergoing angioplasty and to determine the success of TIMI‐I flow before angioplasty compared to those patients with TIMI‐O flow. Methods: A group of 178 consecutive patients (from 1984 to 1992), who underwent angioplasty of a chronic occlusion, were analysed. There were 136 males and 42 females with a mean age of 56.9 years. Results: Initial technical success was achieved in 65%. Patients with TIMI‐I flow before angioplasty had a higher chance of success (700%) compared to those with TIMI‐O flow (53%), p < 0.04. During hospitalisation six patients suffered myocardial infarction (MI), two required surgery and one patient died. During a mean follow‐up of 2.8 years the overall survival rate was 95% for the group as a whole. Freedom from coronary surgery was significantly greater in patients with successful angioplasty (93%) than those without (66%, p < 0.002). The above two populations also showed a significant difference in the incidence of angina (35%vs 56%, p < 0.0003). However, the incidence of MI (6%vs 5%, p > O.5) and cardiac survival (98%vs 94%, p > 0.l) did not differ significantly in the two groups. Restenosis occurred in 63% of the 95 patients (82%) who returned for follow‐up angiography. Eighteen of the 59 patients (28%) with restenosis had a reocclusion. Conclusion: The success rate for angioplasty of chronic total occlusions is acceptable. Long‐term clinical benefit in patients with successful angioplasty is suggested by the high freedom from angina and the lesser need for coronary surgery. No major impact on either the incidence of MI or cardiac survival was noted when patients who had coronary surgery were included, although it must be emphasised that the sample size in this study was insufficient to detect a difference in these outcome variables.
Oesophageal surfactant: evidence for a possible mucosal barrier on oesophageal epithelium
Authors: Hills B. A. 
Published: March 2008

Abstract: Background: There is a growing body of evidence to indicate that the gastric mucosa is protected against the back‐diffusion of acid by a physical barrier comprising surface‐active phospholipid (SAPL) otherwise known as gastric surfactant on account of its similarity to pulmonary surfactant in composition and behaviour. Aims: To determine whether this form of mucosal protection might extend into the oesophagus to offer some degree of protection against the reflux of gastric contents. Methods: Oesophageal epithelium was tested for the same hydrophobicity which is characteristically imparted to gastric mucosa by SAPL. A morphological study was also performed to visualise any barrier, purposely avoiding conventional fixatives for electron microscopy which destroy hydrophobic surfaces. Results: Oesophageal epithelium in the vicinity of the cardiac sphincter was found to be appreciably hydrophobic, although not as hydrophobic as gastric mucosa. This hydrophobicity was eliminated by bile salts selected as a known ‘barrier breaker’ and one which reacts with any lining of SAPL. The morphological study revealed much evidence of SAPL, especially that lining epithelial cells, while its source is probably the lamellar bodies also visualised. Conclusions: These findings indicate a physical barrier of oesophageal surfactant which could offer some degree of protection against gastro‐oesophageal reflux but one which is particularly prone to attack by bile.
Predictors of survival after cerebral infarction: importance of cardiac factors
Authors: Friedman P. 
Published: March 2008

Abstract: Background: Stroke is the third leading cause of death in much of the developed world. There are two approaches to lowering mortality from stroke: reducing the incidence of stroke and reducing case fatality rate. Aims: To determine factors, identified at presentation, that were predictive of mortality in elderly persons with acute cerebral infarction. Methods: A consecutive series of 215 elderly persons admitted to hospital with acute cerebral infarction, confirmed by computerised tomography, were followed for an average of one year. A proportional hazards model was used to identify predictors of mortality. Results: The following variables were identified on univariate analysis as predictors of death: raised serum creatinine, interstitial oedema on chest radiograph, low score on the Mini‐Mental State Examination, atrial fibrillation, advanced age, cardiomegaly, raised leucocyte count, pulmonary venous congestion and homonymous hemianopia. Interstitial oedema was the most powerful predictor of death among the four measures of cardiac status. Two successful multivariate models included: 1) interstitial oedema, serum creatinine, age and homonymous hemianopia; 2) serum creatinine and Mini‐Mental State Score. Further studies are required to assess the relationship between elevated serum creatinine and poor survival following stroke.
Review of dietary intervention studies: effect on coronary events and on total mortality
Authors: Truswell A. Stewart 
Published: March 2008

Abstract:The perfect randomised controlled dietary prevention trial of coronary heart disease has never been done. The best we can do is to look at all the trials together. Dietary trials should be separated from drug trials because they have different characteristics. Fourteen dietary trials which had disease or death as the end point are collected in this review for a metaanalysis. Three of the trials had two parts (male/female or low fat/increased fish), making a total of 17 trials. All were randomised trials, except the Finnish mental hospital trial which was a 12‐year crossover in two hospitals. The trials were primary or secondary, diet only or multifactorial; numbers of subjects range from 52 to 57,460. For total deaths the ratio of intervention/control in all 17 trials is 0.94 (significantly less than 1.00) and for coronary events the pooled odds ratio is 0.87. But in the seven trials with most effective cholesterol lowering the odds ratios are 0.89 for all deaths and 0.70 for coronary events. There is thus no indication of excess all causes mortality in the dietary trialsFour recent secondary prevention trials had angiographic end points. There were a total of 275 subjects; trials were in Holland, USA, Germany and UK. In all trials plasma cholesterol was effectively lowered and coronary narrowing regressed a little, or progressed less in the diet group but significantly compared with controls. These angiographic trials strongly support the results of the major prevention trials.Lastly, a set of ten trials with fish oil after coronary angioplasty are reviewed. In some there appeared to be lower rates of restenosis, but not in all. The mechanism here is different from the major trials with plasma cholesterol‐lowering diets for longer periods.
Declining cardiovascular disease incidence and environmental components
Authors: Lloyd Brian L. 
Published: March 2008

Abstract:After rising for many years in the mid‐to‐late 1960s the mortality from ischaemic heart disease (IHD) began to decline in many countries. This represents a decline in both out‐of‐hospital (community) and hospital deaths. Non‐fatal myocardial infarction (MI) has also declined. A literature review was conducted to examine lifestyle and environmental factors contributing to the decline. Half of the decline is attributable to changes in lifestyle and in the known major risk factors. Changes in nutrition appear relevant to the decline, in particular an increased ratio of polyunsaturated to saturated fat intake and a reduced saturated fat intake overall. There is little evidence to support a role of changing alcohol consumption, changing coffee consumption, changing exercise levels or reduction in excess weight in the declining incidence of IHD. While the benefit of smoking cessation is a clear one, its impact on the differing trends in various countries is not clear. Socio‐economic factors appear to influence the rate and extent of decline in IHD in different groups and may help explain some of the regional differences in IHD incidence. Reductions in blood pressure within the ‘normal range’ which may occur with lifestyle changes may also be an important contributor.
A quantification of alcohol‐related mortality in New Zealand
Authors: Scragg R. 
Published: March 2008

Abstract Background: There are no published New Zealand (NZ) studies on alcohol drinking and total mortality, despite its importance to alcohol health policy. Aims: To estimate the proportion of NZ deaths caused or prevented by alcohol drinking. Methods: The proportion of current alcohol drinkers from recent NZ surveys, and pooled relative risks from a review of the international literature on alcohol and mortality, were used to calculate disease‐specific population attributable risks. The number of deaths caused (or prevented) by alcohol were calculated for 1987 New Zealand deaths. Person‐years of life lost (or saved) were calculated using recent NZ life tables. Results: The association between alcohol and total mortality was related to age. Alcohol was estimated to have caused 3.0% of all deaths among 0–14 year olds and 20.1% of deaths among 15–34 year olds, mostly from road injuries. In contrast, alcohol was estimated to have prevented 0.5% of all deaths among 35–64 year olds and 3.4% of deaths among >65 year olds due to its protective effect against coronary heart disease. For all age groups, alcohol was estimated to have prevented 1.5% of deaths. However, the number of person‐years of life lost among ages less than 35 years was greater than those saved in the older age groups, so that alcohol was estimated to have caused the loss of 9525 person‐years of life for all ages combined. Conclusions: The adverse effects of alcohol on total mortality are confined to age groups less than 35 years. Public health policy to minimise deaths from alcohol should be concentrated on this group.
Finding solutions to the rural doctor shortage: the roles of selection versus undergraduate medical education at Newcastle
Authors: Rolfe I. E. , Pearson S.‐A. , O'Connell D. L. , Dickinson J. A. 
Published: March 2008

Abstract Background: Australia has a rural doctor shortage. Proposed solutions have included both increasing the medical student admissions from rural areas and modifying the curriculum content of rural medicine. Aim: To examine the differences between doctors who chose to practise in rural areas and those who chose urban areas after graduation from the University of Newcastle medical school. Methods: A cross‐sectional survey of 331 graduates who had completed at least their intern year was undertaken in 1990, using a mailed self‐report questionnaire. Results: A 75% response rate was achieved from those completing their degree before 1987 (N = 217). Twenty‐two per cent of respondents were employed in a rural area and the great majority of these doctors were in general practice. Those from earlier graduating years, those from rural backgrounds (relative risk [RR] 2.5,95% confidence interval [CI]: 1.4–4.4), and those who chose an undergraduate rural general practice attachment in their final year (RR = 3.0,95% CI: 1.3–7.3) were more likely to become rural doctors. However, there was a tendency for those who chose an undergraduate rural rotation in year 3 not to be more likely to become rural doctors (RR = 0.7, 95% CI: 0.4–1.2). The most frequent reasons given for working in rural areas related to lifestyle, whereas work related reasons were given more often for those who chose urban practices. Conclusion: Our data suggest that the rural doctor shortage would be improved by medical school admission policies favouring students from rural areas, and by encouraging rural placements towards the end of undergraduate training. (Aust NZ J Med 1995; 25: 512–517.)
Regional differences in cardiovascular risk factor prevalence in Tasmania: are they consistent with the increased cardiovascular mortality?
Authors: Thomson A. , Watts R. , Rundle S. , Sexton P. , Singh B. B. , Woodward D. 
Published: March 2008

Abstract Background: The death rate from cardiovascular disease in Tasmania has been among the highest in Australian States for a number of years. The North‐West (NW) and Northern regions of Tasmania account for most of the increased mortality. Aims: To determine the prevalence of cardiovascular risk factors in the North and NW regions of Tasmania and to ascertain whether any differences are consistent with the regional patterns of mortality for ischaemic heart disease (IHD) within the State. Methods: The design of the study was almost identical to the previous National Heart Foundation (NHF) Risk Factor Prevalence Survey conducted in 1989. The subjects, aged 20–69 years, were randomly selected from the Electoral Roll with 1146 subjects participating in the North and 1219 in the NW. Subjects answered a detailed questionnaire and then underwent a brief physical examination with venipuncture for blood lipids. Hobart data from the NHF Risk Factor Prevalence Survey in 1989 were used as an estimate of risk factor prevalence in the Southern region. Results: In both males and females, mean systolic blood pressure was significantly higher in the NW than the South which was in turn higher than the North. Mean serum cholesterol levels in males were higher in the NW than the North. Smoking behaviour was similar in males and females in all regions. Males and females in the NW and North were more inactive than those in the South. Similar proportions in all regions were on either ‘no specific’ or ‘fat modified’ diets. Body mass index in males and females was higher in the NW and North but waist to hip ratios failed to show a consistent trend. Conclusions: While the NW has an unfavourable risk factor profile compared with the South, the North does not. The risk factor data are broadly consistent with, but unlikely to be sufficient to explain fully, the regional differences in mortality from IHD. (Aust NZ J Med 1995; 25: 290–296.)