bluuebunny/crossref_metadata_2025_split huggingface dataset:
Can the response to interferon treatment be predicted in patients with chronic active hepatitis C?
Authors: Lin R. , Schoeman M. N. , Craig P. I. , Bilous M. , Grierson J. , McDonald J. A. , Batey R. G. , Farrell G. C. 
Published: March 2008

Abstract:Twenty‐one of 40 patients with chronic non‐A, non‐B hepatitis (37 anti‐HCV positive) were randomised to receive interferon α2b (3 million units subcutaneously thrice weekly for 24 weeks) and then to be observed for six months. Among the other 19 patients (controls) randomised to be observed without treatment for 12 months, eight have subsequently been treated with interferon for six months. One treated patient and three controls were lost to follow‐up. A return to normal serum alanine aminotransferase levels which lasted until the end of the treatment period occurred in 18 (64%) of the 28 patients given interferon (and in 13 of 21 (62%) randomised to treatment), but only in one of the 16 untreated controls (p < 0.001). Multivariant analysis indicated that, compared with the ten nonresponders, the 18 patients who responded to interferon were more likely to have acquired infection by intravenous drug abuse than by blood transfusion (p < 0.05), and were more likely to have histologically less severe chronic liver disease (p < 0.01). Thus, all 13 patients with less severe liver disease histologically responded to interferon, but only five of 15 patients with cirrhosis or bridging fibrosis responded. Among 17 responders followed for more than four months, five (28%) are still in remission a median of 13 months (range four months to 24 months) after stopping interferon. The characteristics which favoured a response during treatment also appeared to distinguish those who experienced sustained post‐treatment remission. Thus, five of 12 patients with less severe chronic hepatitis C histologically appear to have a sustained remission of disease activity after treatment for six months with interferon, whereas none of five patients with cirrhosis or bridging fibrosis has had a sustained remission after interferon treatment. It is proposed that continued treatment with interferon may be required for long‐term suppression of chronic active hepatitis C among patients with bridging fibrosis or cirrhosis, but one course of interferon may provide a lasting response in 40% of patients with less severe disease.
Left ventricular energy in mitral regulation: a preliminary report
Authors: MacIsaac Andrew L. , McDonald G. , Kirsner Richard C.G. , Graham Sandra A. , Tanzer Dindne 
Published: March 2008

AbstractEnergy exchange based on Newtonian principles is the‐most appropriate way to express the function of any pump ‐ including the heart. Using information obtained at cardiac catheterisation, we have measured the total work energy (ET) of the left ventricle (LV) (mean 1.63 J) in patients with severe mitral regurgitation (mean regurgitant fraction 0.66). ET was approximately‐84% above normal. Of the regurgitant energy (RE)(mean 0.95 J), on average, ¾ (73.6%)was‐kinetic (KE) and ¼ (23‐4%) potential (PE). Both components represent wasted LV energy, the Kinetic energy associated with the lost as heat, the potential energy responsible for a fix in Left Atrial (LA) pressure. The‐amount of PE as a percentage of total regurgitant Energy (RE) varied considerably from, one patient to another (10.5% to 54.4%) Hence, colour flow mapping which detects‐only KE of turbulent jet flow must underestimate LV energy loss and, because of patient to patient variation, cannot consistently reflect severity of regurgitation. Measurements of PE correlate well with wedge P‐wave height. Corresponding non‐invasive estimates were made using sphygmodynamometer‐calibrated indirect carotid pulse tracings and echocardiographic measurements. These were not significantly different from the invasive measurements. Unfortunately, the calculation of PE is indirect and invlves subtraction, so that measurements for individual patients were not accurate enough, for clinical use. Paxt of the non‐invasive calculation involved an estimate of left atrial pressure based on the blood pressure measurement and Doppler velocity of regurgitation; this should be a useful measurement in itself. Measurement of ET, an index of both volume and pressure overload (reflecting peripheral resistance changes), should be tested in serial studies as a predictor of left ventricular‐failure in severe mitral regurgitation. Non‐invasive measurements would be useful to follow patients with acute severe mural regurgitation: Non‐invasive PE measurements are currently not reliable enough but an indirect measurement of left atrial pressure would be very useful.
Lowering cholesterol: effects on trauma death, cancer death and total mortality
Authors: MacMahon Stephen 
Published: March 2008

AbstractRandomised trials of cholesterol reduction (26 trials, 50 000 patients, net cholesterol reduction ∼10%) have demonstrated a clear reduction in the incidence of coronary heart disease (CHD) after just a few years of treatment. Overall, the reduction in CHD death was only half as large as the reduction in non‐fatal myocardial infarction (MI), although both were statistically significant (2P < 0.005). In these trials, 60% of all deaths were from CHD, and since treatment reduced these by about 10%, the expected reduction in total deaths was about 6%. This expected reduction falls within the 95% confidence interval of the observed effect of cholesterol reduction on total mortality in these trials. There were small excesses of deaths from cancer and deaths from trauma among patients allocated active treatment. However, in no single trial, nor in the trials collectively, were these increases statistically significant. Furthermore, the increases did not appear to be specific to any one agent nor were the increases consistent between trials of the same agent. These observations are consistent with the hypothesis that the small excesses of cancer and trauma deaths observed in the cholesterol reduction trials occurred by chance.
RSI revisited: evidence for psychological and physiological differences from an age, sex and occupation matched control group
Authors: Helme R. D. , LeVasseur S. A. , Gibson S. J. 
Published: March 2008

Abstract:The present study sought to examine psychological characteristics and function of primary afferent nociceptive mechanisms, as indexed by capsaicin‐induced flare responses, in subjects suffering from RSI (n = 72) and in pain free control volunteers (n=69). After completing a battery of psychological tests including the McGill Pain Questionnaire, Visual Analogue Scale and Word Descriptor Scale for pain, the Profile of Mood States, Illness Behaviour Questionnaire and Multidimensional Health Locus of Control, the neurogenic flare response was assessed on the right and left forearms and across the trapezius at the shoulder. When compared to controls RSI subjects displayed higher levels of mood disturbance and some abnormal patterns of illness behaviour. A reduction in flare size was observed in the pain affected limb of RSI subjects, but an increased response occurred in sites reported as unaffected by clinical pain. Multiple regression analysis revealed that the severity of clinical pain was strongly associated with the magnitude of reduction in flare size. Collectively, these findings provide objective evidence of altered nociceptor mechanisms in RSI subjects, and are consistent with the view that this chronic pain syndrome involves somatic pathophysiology. However, a strong conviction regarding the somatic basis of their symptoms, and a denial of psychological factors may have contributed to the more severe affective disturbance and greater subjective emphasis on the presence of pain. (Aust NZ J Med 1992; 22: 23–29.)
Current concepts on monoclonal gammopathies
Authors: Kyle R. A. 
Published: March 2008

Abstract:This is a review of the monoclonal gammopathies, including a discussion of cause. The role of T lymphocytes and B lymphocytes is presented. The recognition of a monoclonal protein in the serum and urine is presented in detail.The frequency of benign and malignant monoclonal gammopathies is provided. A long‐term follow‐up of 241 patients with apparently benign monoclonal gammopathy is examined closely. In this series, multiple myeloma, macroglobulinaemia, amyloidosis, or related disorders developed in 22% of the 241 patients with long‐term disease. The median duration from the recognition of the monoclonal protein until the development of serious disease was approximately eight to ten years.The differentiation of benign from malignant monoclonal gammopathics is examinad in detail. The point is made that paticnu must be folld indefinitely because malignancy may develop more than 20 years later. The association of monoclonal gammopathies with other apparently unrelated diseases discussed. (Aust NZ J Med 1992; 22: 291–302.)
Culture‐positive tuberculosis in Western Australia
Authors: Pang S. C. , Clayton A. S. , Harrison R. H. 
Published: March 2008

Abstract:Notifications of 485 patients with culture‐positive tuberculosis (TB) in Western Australia from 1980 to 1989 inclusive have been analysed. In 478 (98.6%) the disease was caused by Mycobacterium tuberculosis hominis and in seven (1.4%) M. bovis. Most (78.5%) of the disease was pulmonary with 4.3% pleural and 17.2% extrapulmonary. The annual incidence decreased from 4.6 per 100 000 in 1980 to 2.5 in 1985 steadying thereafter around 3.3. The Aborigines had over four times the average incidence of the non‐Aboriginal Australians but less than a quarter that of the Asians. In a total 297 migrants, 51% of 253 with data available had been in Australia for over five years. Initial drug resistance was found in 48 patients giving an overall rate of 9.9%. In 32 (66.7%), resistance was against a single drug, mainly isoniazid and in 11 (22.9%) against two drugs, predominantly isoniazid and streptomycin. The most disturbing finding was the occurrence of multiple‐drug resistance including both isoniazid and rifampicin in five immigrants (10.4%). This study has provided useful baseline TB data, raised important issues such as chemoprophylaxis and drug resistance, and clearly indicates that the campaign against TB is far from over. Continual surveillance, monitoring and regular evaluation of existing policies should be maintained. (Aust NZ J Med 1992; 22: 109–113.)
Death certification and coding for ischaemic heart disease in Tasmania
Authors: Sexton P. T. , Jamrozik K. , Walsh J. M. 
Published: March 2008

Abstract:Official records show that the rates of mortality from ischaemic heart disease (IHD) in Tasmania have been the highest of all the Australian states for most of the past decade. This study assesses the accuracy of the official Tasmanian mortality data for IHD in 1987 and 1988 for males aged 25 to 74 years using routinely available clinical and pathological data supplemented by information from the attending doctor. Our findings show that a death officially coded to ICD 9 rubrics 410–414 (IHD) in Tasmania has 94% sensitivity and a positive predictive value of 90% for fatal definite acute myocardial infarction or possible coronary death as defined by the WHO. Comparison of our results with those of two earlier studies undertaken in Australian mainland centres indicates that differences in the official statistics for coronary mortality between Tasmania and the mainland states reflect true differences in the risk of coronary death. While the results from three Australian studies suggest that the routine system of death certification is reasonably accurate, careful monitoring of death certification and coding practices need to be undertaken regularly in all states of Australia if secular changes in regional patterns of coronary mortality are to be regarded as credible. (Aust NZ J Med 1992; 22: 114–118.)
Complications and failure of anticoagulation therapy in the treatment of venous thromboembolism in patients with disseminated malignancy
Authors: Chan A. , Woodruff R. K. 
Published: March 2008

Abstract:Thirty‐one patients with malignancy, anticoagulated for the treatment of venous thromboembolism (VTE) are reported. Complications of treatment included major bleeding (35%), redevelopment of VTE whilst on therapeutic levels of anticoagulants (13%) and recurrent VTE following cessation of anticoagulant (42%). Forty‐two per cent of patients died within three months of initiating anticoagulant therapy. The cause of death was progressive malignancy, except in one patient who died of anticoagulant‐related bleeding. The high incidence of bleeding is frequently associated with over‐anticoagulation and indicates the need for improved monitoring. The frequent recurrence of VTE is associated with chronic disseminated intravascular coagulation, for which warfarin is ineffective and heparin is indicated. (Aust NZ J Med 1992; 22: 119–122.)
Thyroid involvement in multiple myeloma
Authors: Patel R. , Bayliss E. , Trotter J. 
Published: March 2008

Abstract:Involvement of the thyroid gland by plasma cell neoplasms is a rare occurrence. Two modes of presentation are described; firstly as part of disseminated myeloma and secondly, as an isolated plasma cell neoplasm of the thyroid as the only evidence of disease. We wish to describe two cases of thyroid involvement as part of disseminated disease. (Aust NZ J Med 1992; 22: 139–141.)
Preventing the medical sequelae of alcohol abuse
Authors: Batey ROBERT G. 
Published: March 2008

Abstract:Excessive alcohol use is responsible for a significant amount of medical harm in the Australian community. It is not appropriate to suggest that alcohol use should be eliminated but it is important that we take steps to minimise harm produced by intake of inappropriate amounts ? of this drug. Many alcohol related problems are irreversible once established and thus it is imperative that information be made available to the public and to health care workers to help minimise problems before they become permanently established. It is suggested that harm niay be minimised by a number of strategies that include measures to:1. Prevent the desire or need to drink excessively.2. Prevent the ingestion of excessive amounts of alcohol.3. Prevent the effects of excessive intake by protecting susceptible tissues.4. Treating tissue damage early to prevent progressive injury.Early detection and intervention must play an increasing role in any attempt to minimise alcohol related problems. (Aust NZ J Med 1992; 22: 214–219.)
Clinical aspects of malignant mesothelioma in Australia
Authors: Driscoll T. R. , Thompson R. , Baker G. J. , Ferguson D. A. , Daniels S. , Leigh J. , Lee J. 
Published: March 2008

Abstract:Australia is currently experiencing an epidemic of malignant mesothelioma. The clinical aspects of malignant mesothelioma were investigated in 295 Australian patients as part of a national study of the disease. Most patients were male (91%), with the mean age at diagnosis being 64 years. The predominant cell type was epithelial (38%) and the majority of primary tumours arose from the pleura (94%). Mean survival was poor (17.6 months from first symptom; 11.8 months from diagnosis). Patients with a pleural primary tumour were more likely to present with dyspnoea, chest pain and cough; to have a pleural effusion diagnosed radiologically; and to have metastatic spread. Patients with a peritoneal primary tumour were more likely to present with weight loss, loss of appetite, abdominal pain and ascites; to have radiologic evidence of asbestos exposure; and to have spread along a needle track created during a diagnostic tap. A minority of patients had past thoracic conditions, or radiologic findings, specifically related to previous asbestos exposure. About one fifth of patients had no known asbestos exposure. Forty‐one per cent of subjects received some form of chemotherapy, radiotherapy and/or surgery, but no formal disease staging had been documented for any patient. Proper controlled trials of secondary and tertiary treatments in malignant mesothelioma are now needed. (Aust NZ J Med 1993; 23: 19–25.)
Trial of an intervention to reduce chronic benzodiazepine use among residents of aged‐care accommodation
Authors: Gilbert A. , Innes J. M. , Owen N. , Sansom L. 
Published: March 2008

Abstract Background: Many residents of aged‐care accommodation are chronic users of benzodiazepines. This pattern of use contradicts current guidelines and may adversely affect residents. It was hypothesised that a lasting reduction in benzodiazepine use could be achieved through a programme which involved prescribers, residents and caregivers in the change process. Aim: To demonstrate that an intervention which involved education and relaxation training for patients, and education of prescribers and caregivers, could reduce levels of chronic benzodiazepine use among residents of an aged‐care facility. Methods: Two aged‐care facilities from metropolitan Adelaide were chosen; one received the intervention, the other was a no‐intervention comparison. Pre‐test, post‐test and follow‐up interviews were conducted with 60 residents: 27 from the intervention setting and 33 from the comparison setting. Residents at the intervention setting were provided with relaxation skills training, and their medical practitioners and caregivers were provided with information about alternative strategies for managing sleep disturbance. Outcome measures were: the proportion of residents using benzodiazepines, total medication use, cognitive performance, emotional responsiveness, subjective health and sleep ratings and an index of well‐being. Results: The proportion of participants in the intervention condition who used benzodiazepines declined significantly (from 70% to 35%); the reduction was maintained over the subsequent three months. No adverse consequences were associated with cessation of benzodiazepine use; there was improvement in emotional responsiveness among those who ceased benzodiazepine use. This structured intervention strategy is a useful approach for reducing levels of chronic benzodiazepine use among residents of aged‐care accommodation.
Retention and survival of hostel residents – a 12 year study
Authors: Lefroy R. B. , Hobbs M. S. T. , Hyndman J. 
Published: March 2008

Abstract Background: The admission of a proportion of disabled people to hostels is inevitably followed by their transfer to nursing homes. Our hypothesis was that such admissions are justified in terms of quality of life and the cost to the community, notwithstanding the necessity of subsequent transfer. Aims: To test this hypothesis by measuring the retention and survival times of residents in hostel and in nursing home; to consider the relevance of these factors to the future policy of the two institutions. Methods: A retrospective study was made of 159 residents admitted over a period of 12 years to a hostel with 32 places. Times spent in the hostel and in the nursing home were recorded. Probabilities of survival in hostel and in nursing home were calculated according to the Kaplan‐Meier method. Comparison with the expected survival of a matched cohort of the total population was determined. Estimation was made, using the SAS software package, of the likely number of places needed in nursing homes for residents following transfer. Results: Although the majority of hostel residents eventually needed nursing home care, a worthwhile proportion of their total institutional time (approximately two‐thirds) was spent in the hostel. Ongoing support from the personnel in a geriatric service is likely to increase retention time in the hostel. Because of the ultimate outcome for the majority of residents, planning for hostel care should include consideration of places needed in nursing homes.
Trends in the terminal care of cancer patients: South Australia, 1981–1990
Authors: Hunt R. , Bonett A. , Roder David 
Published: March 2008

Abstract
Background:
The increasing numbers of cancer patients, the high costs of terminal care, and the development of palliative care services have led to a growing interest in patterns of terminal cancer care. These patterns are relevant to the formulation and evaluation of health services policy.
Aims:
To investigate trends in the place of death of South Australian cancer patients between 1981 and 1990, and to examine associations of socio‐demographic and clinical variables with the place of death.
Methods:
Data relating to 2715 deaths attributed to cancer in 1990 were extracted from the Central Cancer Registry. To assess trends, these data were directly standardised to the age‐sex distribution of cancer deaths in 1981 and 1985 which were investigated in a previous study. Unconditional logistic regression was used to investigate predictors of place of death.
Results:
The proportion of deaths which occurred in major metropolitan public hospitals decreased from 40% in 1981 to 28% in 1990. Conversely, the proportion which occurred in hospice units increased from 5% to 20% over the same period. There was a decline in the proportion of deaths which occurred in private hospitals, but there was no significant change in the proportion which occurred in country hospitals or nursing homes. The proportion of deaths at home remained around 14%. Associated with place of death were age, sex, type of malignancy, survival time from diagnosis to death, Aboriginality, and area of residence. Further research to assess the clinical appropriateness of terminal care patterns is suggested. (Aust NZ J Med 1993; 23: 245–251.)
Systemic lupus erythematosus in Australian Aborigines: high prevalence, morbidity and mortality
Authors: Anstey N. M. , Bastian I. , Dunckley H. , Currie B. J. 
Published: March 2008

Abstract Background: Racial differences occur in the incidence of systemic lupus erythematosus (SLE). It has been suggested that SLE occurs at a higher prevalence and with greater severity in Aboriginal Australians, but because of the small, widely distributed population base, this has not been well documented. Aims: To confirm and document the clinical impression of an increased prevalence and severity of systemic lupus erythematosus (SLE) in Aboriginal Australians, and to identify prognostic indicators. Methods: Top End Northern Territory (NT) Aborigines with SLE on 1 January 1984 or diagnosed thereafter were followed until 1 January 1991. Epidemiological, clinical and serological data were collected. Results: Prevalence on 1 January 1991 estimated at 1:1900, at least twice the estimated prevalence in non‐Aboriginal Australians. High frequencies of renal disease (62% with proteinuria > 0.5 g/day) and autoantibodies to the Sm antigen (29%) were identified, contributing to the high mortality. Five year survival rate was 60%, with 67% of deaths resulting from infection. Conclusions: There is a high prevalence of SLE in NT Aborigines. In view of probable under‐recognition of mild cases the true prevalence is likely to be even higher. Although morbidity and mortality may have been overestimated for the same reason, both were found to be high. Improved living conditions and health care delivery may improve prognosis. (Aust NZ J Med 1993; 23: 646–651.)