bluuebunny/crossref_metadata_2025_split huggingface dataset:
ACUTE LITHIUM TOXICITY—CHOREA, HYPERCALCEMIA AND HYPERAMYLASEMIA
Authors: MATSIS P. P. , FISHER R. A. , TASMAN‐JONES C. 
Published: March 2008

AbstractLithium is widely used in the management of patients with manic depressive illnesses. It is a valuable drug with a good safety record but occasionally causes severe disorders. A 71‐year‐old woman is described who previously had a good response to lithium carbonate treatment of a manic depressive illness. Because the patient appeared depressed and withdrawn, lithium carbonate dosage was increased. The development of confusion and choreiform movements precipitated hospital admission. The symptoms were relieved when lithium was stopped but recurred with the reinstitution of lithium. Spontaneous choreiform movements were again relieved on lithium withdrawal. Associated with the abnormal movements were alterations in the serum calcium concentrations, a rise in the parathyroid hormone concentration and a rise in the serum amylase concentration without features of acute pancreatitis.SUMMARYThis patient presents uncommon complications of therapy with lithium carbonate. Hypercalcemia is a well reported complication of lithium therapy and the associated raised parathyroid hormone may be due to modification of the threshold of parathyroid tissue to calcium under the influence of lithium. Chorea in lithium toxicity is uncommon and is not yet fully explained. Hyperamylasemia has not been previously reported. We suggest that in patients having long‐term lithium therapy that periodic checks of the serum calcium, parathyroid hormone and amylase levels should be undertaken.
TRANSESOPHAGEAL ELECTROCARDIOGRAPHY AND ATRIAL PACING IN ACUTE CARDIAC CARE: DIAGNOSTIC AND THERAPEUTIC VALUE
Authors: TWIDALE N. , ROBERTS‐THOMSON P. , TONKIN A. M. 
Published: March 2008

Abstract:The utility of transesophageal electrocardiography using a bipolar ‘pill electrode’ was assessed in 17 consecutive patients with tachycardia presenting to our casualty department. Standard 12‐lead electrocardiography showed regular narrow QRS tachycardia in 12 patients, and five patients had wide QRS tachycardia. Esophageal atrial electrogram recordings were obtained in 14 patients (82%), and these were helpful in determining the mechanism of tachycardia in 11 patients (78%). Of these 11, seven patients fulfilled criteria for atrioventricular junctional (AVJ) tachycardia based on measurement of the minimum interval between the onset of ventricular depolarisation and earliest atrial (esophageal) activity. One of these patients had presented with a wide QRS tachycardia. The other four patients were diagnosed as having ventricular tachycardia (VT) following diagnosis of AV dissociation. Atrial overdrive pacing, via the pill electrode, successfully reverted four of the nine patients (44%) with narrow QRS tachycardia but no patient with VT. Esophageal recording during tachycardia is a simple, relatively non‐invasive technique which is helpful in suggesting the mechanism of tachycardia both in patients with narrow and wide QRS tachycardia, and may have a therapeutic role in patients with AVJ tachycardia. (Aust NZ J Med 1989; 19: 11–15.)
ACUTE LYMPHOBLASTIC LEUKEMIA IN CHINESE ADULTS IN HONG KONG
Authors: CHENG P. N. M. , TSO S. C. , CHAN T. K. , TODD D. , LAWTON J. W. M. , HO F. C. S. 
Published: March 2008

Abstract:Forty‐four previously untreated Chinese adult patients with acute lymphoblastic leukemia (ALL) were treated with vincristine, adriamycin and prednisone with or without L‐asparaginase. The clinical features and prognostic factors were similar to those reported in Caucasian series. Overall complete remission (CR) rate was 52%. Duration of first remission and overall median survival were nine and 12 months respectively. The addition of L‐asparaginase did not improve CR rate or duration of remission and was associated with clotting dysfunction and other adverse reactions. Factors associated with a higher CR rate include age < 40 years, blast count < 10 times 109/1 and CALLA+phenotype at presentation. Sex, platelet count and FAB morphology did not affect CR rate.Bone marrow relapse occurred in 11 patients and was associated with short survival after relapse (median two months; mean two months; range 0.5–7 months). Central nervous system relapse occurred in four patients and was compatible with relatively long survival after relapse (median 13 months; mean 12 months; range 6–12 + months).The poor CR rate and short median survival in this study could not be adequately explained by an increase in risk factors and is likely to be due to what is currently regarded as suboptimal chemotherapy. (Aust NZ J Med 1989; 19: 37–43.)
THE EFFECTS OF LONG TERM GLICLAZIDE ADMINISTRATION ON INSULIN SECRETION AND INSULIN SENSITIVITY
Authors: MA A. , KAMP M. , BIRD D. , HOWLETT V. , CAMERON D. P. 
Published: March 2008

Abstract:Gliclazide (80 mg bd) was administered to nine subjects with type 2 (non insulin dependent) diabetes inadequately controlled on diet only. Twenty‐four hour glucose, insulin and c‐peptide profiles were obtained before and after one week and four months of therapy. Insulin sensitivity was assessed by euglycemic hyperinsulinemic clamp before and after four months of treatment. Twenty‐four hour glucose levels were significantly lowered after one week and four months. Insulin secretion, as assessed by the areas under the insulin and c‐peptide curves, was enhanced after one week. The increase was most noted during the day in response to meals. The enhancement was maintained after four months of treatment with the increase in the postabsorptive phase becoming significant. Glucose utilisation rate was significantly increased at four months. It is concluded that both acute and prolonged gliclazide therapy directly or indirectly 1) enhances both meal stimulated and post absorptive insulin secretion and 2) increases insulin sensitivity. The relative contribution of each to improved diabetic control has not been established. (Aust NZ J Med 1989; 19: 44–49.)
AN APPRAISAL OF CARDIOVASCULAR STANDARDS FOR AUSTRALIAN CIVILIAN FLYING LICENCES
Authors: VOHRA J. , PLOWRIGHT R. 
Published: March 2008

Abstract:This paper summarises recommendations drawn up at a meeting of a group of Cardiologists and Aviation Medical personnel to review cardiovascular standards for Australian Civil Flying Licences.Major recommendations were in the field of ischemic heart disease which remains the commonest cause of disqualification. The panel recommended consideration of coronary risk factors and increased attention to the high risk group as a preventive measure for loss of licence. Licensing, with appropriate safeguards and continued supervision, was considered permissible in carefully selected subjects with ischemic heart disease. Guidelines were also drawn up for various licence categories for subjects with valvular heart disease, cardiac arrhythmias, implanted pacemakers, cardiomyopathy and hypertension. (Aust NZ J Med 1989; 19: 76–82.)
Randomised controlled trial of recombinant human interferon ‐αA for chronic active hepatitis B
Authors: Williams S. J. , Craig P. I. , Cooksley W. G. E. , Bye W. A. , Bilous M. , Grierson J. M. , Nightingale B. N. , Burnett L. , Hensley W. J. , Batey R. G. , Farrell G. C. 
Published: March 2008

AbstractThe efficacy of interferon treatment for Australian patients with chronic active hepatitis B (CAH‐B) was assessed by a three‐centre randomised controlled trial in Sydney and Brisbane. Thirty patients (29 with histologically‐proven CAH‐B with and without cirrhosis and one with chronic persistent hepatitis) were allocated to receive either thrice weekly intramuscular injections of recombinant human leucocyte interferon ‐αA (either 2.5, 5.0 or 10.0 million units/m2) for six months followed by 12 months of observation, or to be observed for 18 months without active treatment. Three of 23 treated patients but none of seven controls underwent clinical, biochemical and histological resolution of their disease with loss of HBsAg, HBeAg and HBV‐DNA from serum. An additional six treated and two control patients underwent a sustained partial remission of their disease. This was characterised by resolution of symptoms and serum aminotransferase abnormalities in association with seroconversion from HBeAg positive to negative, loss of HBV‐DNA from serum but persistent hepatitis B surface antigenaemia. In such patients, there was significant improvement in histological appearances but some necroinflammatory activity remained and fibrosis was unchanged. Although total response rates were similar in treated and control subjects, they appeared to occur earlier after interferon treatment.Treatment with interferon was associated with predictable but minor side effects that usually did not necessitate dose reduction and rarely compromised the patient's life style. Interferon is thus a feasible treatment for CAH‐B. Complete responses occurred only in treated patients and partial responses appeared to occur earlier in treated than in untreated patients. However, differences in the partial response rate at 18 months were not significant and seroconversion from HBeAg positive to negative was not associated with complete histological resolution of disease activity. Hence, while interferon is a promising agent for treatment of CAH‐B, efforts must continue to define more optimal treatment regimes and to identify those patients most likely to respond to this agent.
Pathology of fatal acute myocardial infarction in the Chinese
Authors: Woo K. S. 
Published: March 2008

AbstractPost‐mortem examinations were performed on 89 Chinese with fatal acute myocardial infarction, who represented an unselected 45.6% of a series comprising 195 consecutive hospital deaths from acute myocardial infarction in Hong Kong. In 83 patients (93.3%), the acute infarcts were correctly identified, and old infarct scars or patchy fibrosis were found in 21 patients (23.6%). Of the 85 sudden deaths, 33 patients (38.8%) had no definite mechanical complication and therefore could have died of primary arrhythmias, ten patients (11.8%) had rupture in the free ventricular wall with cardiac tamponade. Two other patients had rupture of the interventricular septum and one more patient had rupture of papillary muscle. Evidence of significant coronary atherosclerosis was identified in 94.7% of patients, with one‐vessel disease in 18.7%, two‐vessel disease in 33.3% and three‐vessel disease in 42.7% of patients respectively. Critical lesions were present in left main stem in 8%, left anterior descending artery in 45.3%, circumflex artery in 8% and right coronary artery in 17.3% respectively. Occlusive coronary thrombi were identified in 18.7% of patients. These pathological findings were compared with reports on fatal myocardial infarctions from the western countries.
Hypoxia during bronchoalveolar lavage
Authors: Gibson P. G. , Breit S. N. , Bryant D. H. 
Published: March 2008

AbstractThe aim of this study was to determine the degree and duration of hypoxaemia during bronchoalveolar lavage (BAL) and to examine the effect of supplemental oxygen on this response. Transcutaneous oxygen tension (PO2) was recorded continuously in 22 patients having bronchoscopy alone (Group 1), and during BAL in patients with a variety of connective tissue disorders. Thirty eight of these patients were breathing room air (Group 2) and 28 were given supplemental oxygen (Group 3). The mean fall in PO2 in Group 1 was 12 ±3 mmHg and the PO2 in these subjects rose promptly to the initial value once the bronchoscopy was finished. The mean falls in Groups 2 and 3 were 24±4 and 32±5 mmHg and the mean times taken for the PO2 values to return to baseline after the procedure were 47±9 and 53±10 minutes respectively. The PO2 fell to less than 60 mmHg in 76% of the patients in Group 2 but in only 25% of those in Group 3. It is recommended that supplemental oxygen be given to all patients having BAL during and for one hour after the procedure and that oxygenation be monitored continuously throughout the bronchoscopy. Arterial blood gases should be always measured prior to bronchoscopy and BAL. In those cases where it is not possible to maintain the PaO2 at 70 mmHg or more the procedure should be undertaken with great care and with due consideration of the risk of the hypoxaemia that may occur.
Unusual pulmonary manifestations of pneumocystis carinii infection in immunocompromised patients
Authors: Connor H. , Lavoipierre A. M. 
Published: March 2008

AbstractThree proven cases and one presumed case of Pneumocystis carinii pneumonia are presented in which the radiological appearance mimics tuberculosis.The classic and unusual X‐ray findings of P. carinii pneumonia are discussed.
Sarcocystis infection of human muscle
Authors: Pamphlett R. , O'Donoghue P. 
Published: March 2008

AbstractA 31‐year‐old man with fatigue and muscle aches was found to have protozoan cysts within the most painful muscle upon microscopic examination of biopsy material. Electron microscopic studies revealed the ultra‐structural characteristics of the cysts to conform to those of the genus Sarcocystis. This report represents the first ultrastructural study of human tissue infection with Sarcocystis, which may be a rare cause of muscle aching in humans.
Spontaneous complete remission of chronic myeloid leukaemia following haematological relapse after allogeneic bone marrow transplantation
Authors: Alkam M. , Bradstock K. F. , Hughes W. G. , Watson N. , Bowyer I. 
Published: March 2008

AbstractA 31‐year‐old woman with Philadelphia (Ph) chromosome‐positive chronic myeloid leukaemia (CML) underwent allogenic bone marrow transplantation during accelerated phase. Non‐T‐cell‐depleted marrow from a male sibling mismatched at one Class 2 histocompatibility locus was infused after conditioning with total body irradiation and intravenous cyclophosphamide. Cyclosporin and methotrexate were given for prevention of graft‐versus‐host disease (GVHD). Prompt engraftment occurred with donor karyotype cells, followed by transient moderate acute GVHD. However, by day 60 after BMT, haematological relapse occurred with increasing splenomegaly, leucocytosis, increasing marrow fibrosis, and cytogenetic mosaicism, consisting of 47% donor metaphases with 53% Ph‐positive host metaphases, some containing additional structural changes. Thirty days later further cytogenetic progression was evident. A slowly progressive fungal pneumonia concurrently present was treated with intravenous amphotericin and gradual reduction of cyclosporin. Subsequently, without further cytotoxic chemotherapy, pancytopenia and bone marrow hypoplasia developed, and on day 144 only donor karyotype marrow cells were seen. Chromosomes have remained of donor type on subsequent occasions, and the patient has a normal performance status 25 months after BMT. The patient's course illustrates that factors operating after allogeneic BMT contribute to long‐term control of CML. The factors potentially responsible for this spontaneous remission, after early relapse, are discussed.
Remission of Menetrier's disease associated with ranitidine administration
Authors: Kang J. Y. , Tang K. F. , Goh A. , Sundram F. X. , Seah C. S. 
Published: March 2008

AbstractWe describe a patient with Menetrier's disease in whom acute administration of ranitidine reduced gastric protein loss more effectively than cimetidine or propantheline. Thispatient went into remission following a course of ranitidine. We reviewed the literature on remissions in Menetrier's disease occurring without surgery. More detailed studies of various anti‐secretory agents on individual patients are required to determine whether ornot they are truly efficacious.
Managing hypertension: drugs, life‐style manipulation or benign neglect? Medical, ethical and economic considerations*
Authors: Simpson F. O. 
Published: March 2008

AbstractAntihypertensive drugs have been of major benefit to people with moderate or severe hypertension and have contributed enormously to fundamental physiological knowledge. Antihypertensive therapy in milder hypertension reduces the incidence of stroke by 40% or more, may reduce myocardial infarction and prevents progression to more severe hypertension or heart failure but is being criticised as not cost‐effective. Much of this criticism is based on deductions from inappropriate data. Nevertheless, it is likely that money is in some cases being wasted on the treatment of people who were not truly hypertensive in thefirst place. It is also likely that drug dosage is often unnecessarily high. Clearly it is vital that treatment is delivered as economically as possible.A reduction in the prevalence of hypertension would be the best way to reduce costs. Obesity and a high alcohol intake are associated with a higher blood pressure at any age. A high salt intake throughout life appears to be associated with a rise in blood pressure in the second half of life and may well be the main factor in hypertension. A radical rethinking of the method of pricing of medical care should be considered, so as to provideincentives to people to adopt life‐style measures that lead to avoidance of hypertension (and other cardiovascular risk factors) or, in established hypertension, to a reduction in the need for medication.
The clinical role of transoesophageal echocardiography
Authors: Black I. W. , Hopkins A. , Lee C. L. , Jacobson B. , Walsh W. F. 
Published: March 2008

AbstractThe role of transoesophageal echocardiography (TEE) was evaluated in a consecutive series of 100 procedures performed in 86 patients (age 17–81, mean 56 years). All patients had prior transthoracic echocardiography (TTE). TEE was performed with a 5 MHz phased array transoesophageal transducer with pulsed wave Doppler and colour flow mapping capability. Forty‐four per cent of patients received intravenous sedation and 36% received antibiotic prophylaxis. There were no complications of TEE. The TTE and TEE findings were compared. In patients referred for possible cardiac source of embolism, left atrial thrombi were detected in 8/27 TEE studies but in none of 27 TTE studies. In 12 patients with prosthetic valve dysfunction TEE distinguished prosthetic from periprosthetic regurgitation in 9/12 studies compared to 3/12 with TTE. In 11 patients with suspected aortic dissection TEE correctly detected dissection in all seven cases in which the diagnosis was subsequently confirmed, whereas TTE showed only equivocal findings in two cases. Vegetations were detected by TEE in 4/5 studies in patients with proven native valve endocarditis and by TTEin 2/5. No vegetations were detected by TTE or TEE in five studies in patients with proven prosthetic valve endocarditis. Compared with other investigations there were no false positive TEE studies and one possible false negative study. We conclude that TEE is a safeprocedure which often provides additional clinical information to transthoracic echocardiography.
HLA‐DR RFLP distributions in two groups of Aboriginal Australians
Authors: Davies R. , Pace R. , Jazwinska E. C. , Serjeantson S. W. 
Published: March 2008

AbstractHLA‐DR and ‐DQ typing by restriction fragment length polymorphism (RFLP) in Aboriginal Australians from the Kimberleys and from Coen shows a restricted number of HLA‐DR types in these populations. The polymorphism is essentially limited to DR2, DR4, DRw14 and DRw8. The most common DR.DQ RFLP haplotype in Aborigines shows a novel arrangement of DR and DQ alleles that has important implications for histocompatibility matching if the RFLP patterns reflect functional variation in HLA class II molecules.
Lead intoxication in an anuric patient: management by intraperitoneal EDTA
Authors: Roger S. D. , Crimmins D. , Yiannikas C. , Harris D. C. H. 
Published: March 2008

AbstractTreatment of lead intoxication with intravenous ethylene‐diamine‐tetra‐acetic acid (EDTA) depends on the urinary excretion of chelated lead. This route of excretion was absent in a 48‐year‐old patient with childhood lead exposure and end stage renal failure who developed encephalopathy and a rapidly progressive neuropathy thought to be due to acute lead intoxication. Diagnosis was confirmed by lead chelation with EDTA and neurophysiological studies. EDTA was added by the patient to her chronic ambulatory peritoneal dialysis (CAPD) fluid each week and chelated lead excreted in the dialysate. Intraperitoneal administration of EDTA was 70% as efficient in removing lead as intravenous administration. Four months of home chelation therapy was associated with resolution of the encephalopathy but no improvement in the peripheral neuropathy.
Treatment of severe orthostatic hypotension with the somatostatin analogue octreotide
Authors: Woo J. , Or K. H. , Teoh R. , Nicholls M. G. 
Published: March 2008

AbstractThe long‐acting somatostatin analogue octreotide was used in a patient with severe orthostatic hypotension resistant to conventional treatment. 0.4 ug/kg octreotide given subcutaneously abolished the postural drop in systolic blood pressure for about four hours and was more effective than a combination of fludrocortisone and pindolol.
Longstanding pleural effusion in an elderly man due to non‐Hodgkin's lymphoma (multilobulated nuclear cell type)
Authors: Raina V. , Boyd G. , Soukop M. 
Published: March 2008

AbstractA 68‐year‐old man presented with left sided pleural effusion. Investigations were suggestive of non‐Hodgkin's lymphoma of multilobulated nuclear cell type. Symptomatic treatment by repeated thoracic aspiration was carried out every three to four months over nine years, after which the patient developed left axillary lymphadenopathy and a chest wall mass. Biopsy of the mass revealed multilobulated B cell lymphoma. Complete remission including disappearance of the pleural fluid was achieved with combination chemotherapy. Pleural effusion was the only clinical feature of lymphoma for nine years and this has not been described before.
Practical management of diabetic ketoacidosis and hyperosmolar coma
Authors: Hamblin P. S. , Topliss D. J. , Stockigt J. R. 
Published: March 2008

AbstractIn diabetic ketoacidosis (DKA) and particularly in hyperosmolar coma, rapid normalisation of the measured extracellular fluid abnormalities cannot be equated with optimal management. In both disorders there are complex imbalances between extra‐ and intracellular compartments that are best corrected in a series of rational steps, based on an understanding of pathophysiology. Fluid administration in DKA can generally be divided into three successive phases: (i) a short period of rapid isotonic saline infusion, (ii) slower infusion of isotonic saline with potassium chloride, and (iii) glucose‐potassium infusion until oral food intake is well established. In severe cases, there is a definite place for judicious use of isotonic sodium bicarbonate in small amounts. While insulin infusion is desirable, intramuscular insulin remains a satisfactory alternative. Biochemical monitoring is mandatory and management must be reviewed and modified every three to four hours on the basis of the clinical and biochemical response.In the management of hyperosmolar coma, insulin and fluid therapy are more conservative, with the aim of achieving complete rehydration and normoglycaemia only after 36 to 72 hours. Pulmonary complications and the effects of tissue ischaemia, as well as thromboembolic events, remain important causes of death in both disorders. The frequent recurrences of DKA that occur in a group of psychiatrically‐unstable young patients remain an unsolved problem.