bluuebunny/crossref_metadata_2025_split huggingface dataset:
Transoesophageal echocardiography in the investigation of stroke: experience in 135 patients with cerebral ischaemic events
Authors: Jones E. F. , Calafiore P. , Donnan G. A. , Tonkin A. M. 
Published: March 2008

Abstract Background: The importance of cardiogenic embolism as a cause of cerebral ischaemic events may be underestimated if potential cardiac sources of embolism remain undetected. Transoesophageal echocardiography (TOE) is more sensitive in detecting such abnormalities than earlier methods and may result in more frequent recognition of cardiogenic embolism. Aims: To establish in an unselected stroke population the prevalence of potential cardiac sources of embolism detectable on TOE and their relationship to atrial fibrillation and carotid stenosis. Methods: One hundred and thirty‐five consecutive patients with cerebral ischaemic events were studied using transthoracic and monoplane transoesophageal contrast echocardiography and carotid Duplex imaging or cerebral angiography. Results: Thirty patients (22%) had atrial fibrillation. In 43 patients (32%), no cardiac source of embolism was identified; in eight echocardiography was normal. At least one potential cardiac source of embolism was identified in 92 patients (68%) with multiple findings in 41; these patients were older (70 ± 9 years vs 61 ± 14 years;P= 0.0001), more frequently in atrial fibrillation (28/92 vs 2/43; p= 0.0017) and more frequently had cortical or large subcortical stroke (71/92 vs 23/43; p = 0.005). Carotid stenoses were detected in 55% of patients, not significantly different in those with and without cardiac abnormalities. Conclusions: When bias in selection of patients is avoided, TOE detects a potential cardiac source of embolism in most patients with cerebral ischaemia, particularly those older and in atrial fibrillation. Multiple cardiac abnormalities and coexistent carotid disease are common. The implication of these findings for prevention of stroke awaits age‐matched controlled studies. (Aust NZ J Med 1993; 23: 477–483.)
Immunoreactive calmodulin in cystic fibrosis kidneys
Authors: Couper R. , Kilbourn J. P. , Bentur L. , Wolf P. 
Published: March 2008

Abstract Aims: To determine whether CF kidneys obtained at autopsy contain normal amounts of calmodulin and whether the presence of immunoreactive calmodulin correlates with nephrocalcinosis. Methods: An immunoperoxidase method was used to stain kidneys obtained from six CF individuals aged three to 27.5 years (mean 15.75 ± 10.2 years) and five individuals who died of chronic debilitating disease aged eight to 17 years (mean 13.6 ± 3.9 years). Calcium staining was undertaken using the von Kossa (silver precipitation) and Alizarin red methods. Results: No quantifiable difference in immunoreactive calmodulin staining was demonstrated in autopsy renal specimens between six CF patients and five chronically diseased controls. Three of six CF patients aged 22.8 ± four years and two of five chronically diseased controls aged eight to 16 years respectively had detectable immunoreactive calmodulin staining. Within the CF group the presence of microscopic nephrocalcinosis did not correlate with immunoreactive calmodulin staining. Background: Microscopic nephrocalcinosis has been detected at autopsy in 35 of 38 (92%) cystic fibrosis (CF) patients. A primary defect of calcium metabolism in the kidney has been postulated. Intracellular calcium and calmodulin (a calcium binding protein) have been shown to be increased in CF tissues. Conclusion: This study does not support the premise that a calmodulin‐dependent defect of intracellular calcium handling contributes to the microscopic nephrocalcinosis seen in CF. (Aust NZ J Med 1993; 23: 484–488.)
The GUSTO Trail: background and baseline characteristics
Authors: Aylward Philip 
Published: March 2008

Abstract:The GUSTO study was designed to test the hypothesis that achieving early sustained patency with a thrombolytic regimen in acute coronary thrombosis would improve mortality. Four regimens were compared. In 41,021 patients randomised, nearly 3000 of these were in Australia and New Zealand. These regimens were streptokinase (SK) with subcutaneous heparin (9841 patients), SK and intravenous heparin (10,410 patients), accelerated tissue plasminogen activator (t‐PA) and intravenous heparin (10,396 patients) and combined SK and t‐PA (10,374 patients). The patients were well matched for baseline characteristics. The mean time to treatment was two hours. The accompanying regimen of investigation and revascularisation was aggressive ‐ 58% receiving angiography (28% in Australia), 15% angioplasty (5% in Australia) and 9% bypass surgery (4% in Australia). The GUSTO trial results should be interpreted in the light of these background observations.
Early thrombolytic treatment in acute coronary thrombosis
Authors: O'Rourke Michael 
Published: March 2008

Abstract:It is now accepted that the earliest event in acute myocardial infarction is coronary occlusion caused by fissuring of an atherosclerotic plaque, with resultant platelet deposition on the mural flaw and build up of thrombus within the lumen. The symptoms generated are caused by myocardial isckaemia, as first described by Herrick and Levine some 80 years ago. If occlusion is not relieved, irreversible damage (infarction) begins in the ischaemic region within 30 minutes, is half completed by 2.5 hours, and is virtually completed by six hours.Thrombolysis is now accepted therapy for acute evolving myocardial infarction, but in most cases such therapy is not commenced for four hours after symptom onset, when most of the irreparable damage has already been done and when the potential for benefit has fallen substantially. The average time to thrombolysis in GUSTO worldwide, however, was two hours and, in Australia, 2.8 hours. Only patients who could be submitted to thrombolysis within six hours of the onset of pain were included.The results of thrombolytic therapy in acute thrombosis are likely to be improved if delays are minimised. This requires education of the public in the symptoms of this condition, and on the actions to take if such symptoms arise. It also requires expeditious transfer to hospital (or appropriate treatment outside) and above all it requires expeditious assessment and treatment when patients arrive in hospital. Use of the diagnosis “myocardial infarction‘ for such patients implies that irreversible damage has already occurred and serves as a disincentive for the speedy, aggressive management that is logical and appropriate for dissolution of the offending coronary thrombus. (Aust NZ J Med 1993; 23: 742–744.)
LATE assessment of thrombolytic efficacy with alteplase (rt‐PA) six‐24 hours after onset of acute myocardial infarction
Authors: Bett J. H. Nick 
Published: March 2008

Abstract:Conflicting results on the benefit of thrombolytic therapy administered six to 24 hours after the onset of myocardial infarction (Ml) led to the LA TE trial. Five thousand seven hundred and eleven patients were treated with recombinant tissue plasminogen activator (t‐PA) or placebo, treatment was begun between six and 24 hours after the onset of infarction. For patients treated within 12 hours, there was a relative reduction in 35 day mortality of 25%, but no benefit for those treated at 12 to 24 hours. The benefits were confined to those whose treatment was begun within three hours of admission to hospital.These results widen the window for effective treatment from six to 12 hours after the onset of infarction, but emphasise the need for expeditious treatment when the diagnosis of MI is suspected. (Aust NZ J Med 1993; 23: 745–748.)
GUSTO II Trail
Authors: Aylward Philip 
Published: March 2008

Abstract:The GUSTO II trial will investigate the role of antithrombin therapy in acute coronary syndromes, comparing standard doses of heparin with the specific antithrombin agent recombinant hirudin. The two drugs will be compared as primary therapy in patients with unstable angina or patients with myocardial infarction (MI) unsuitable for thrombolysis, and as post thrombolysis treatment in patients who fulfil standard criteria for thrombolysis therapy. A total of 12,000patients will be studied in a global, multifactorial trial.
Transjugular intrahepatic portosystemic stent‐shunt (TIPSS) for variceal haemorrhage: initial results in 28 patients
Authors: Duggan A. , Waugh R. C. , Perkins K. W. , Gallagher N. D. , Selby W. S. 
Published: March 2008

Abstract Background: Endoscopic sclerotherapy is an effective form of treatment of bleeding varices in patients with cirrhosis. However, the mortality in patients who rebleed is high. Recently, trans‐jugular intrahepatic portosystemic stent‐shunt (TIPSS) has been developed as an alternative to surgical shunt formation in patients who have failed sclerotherapy. Aim: To review the early experience with TIPSS at a teaching hospital. Methods: Twenty‐eight patients underwent TIPSS on 30 occasions between September 1991 and June 1993 for bleeding oesophageal or gastric varices. The majority had alcoholic liver disease. Results: TIPSS was performed successfully in all patients. Immediate control of bleeding was achieved, but one patient rebled within 24 hours. Complications related to the procedure occurred in 30%, but no patient died from these. Thirty‐day mortality was 11% (three of 28), two patients dying from progressive liver failure and one from sepsis. A further three patients died from six weeks to two months following TIPSS, due to liver failure in one, spontaneous bacterial peritonitis in the second and in the third after a fall. This represents an overall mortality of 21%. Three patients have rebled at mean follow‐up of 11.3 months. One of these had repeat TIPSS while the other two had balloon dilatation of the stent with control of bleeding. Four patients developed mild chronic encephalopathy which was readily controlled with medical therapy. Conclusions: TIPSS is an effective means for control of bleeding from oesophageal and/or gastric varices not responding to other methods. Further follow‐up is required with regard to rates of rebleeding, encephalopathy and survival.
Transjugular intrahepatic portal‐systemic shunts (TIPS) – initial experience and clinical outcome
Authors: Hebbard G. S. , Fitt G. , Thomson K. R. , Angus P. W. , Jones R. , Sewell R. B. , Gibson P. R. , Hennessy O. 
Published: March 2008

Abstract Background: The clinical role of the transjugular intrahepatic portal‐systemic shunt (TIPS) has not been fully defined. Aims: To determine the technical results of TIPS and the clinical outcome of patients undergoing the procedure. Methods: Retrospective audit of the results of the first 31 procedures performed in Melbourne. Results: Thirty procedures were performed for variceal haemorrhage, one procedure was for ascites. The aetiology of the liver disease was cirrhosis due to alcohol in 20, cryptogenic in five, chronic viral infection in four, and autoimmune chronic active hepatitis in one. Nodular regenerative hyperplasia was present in one patient. Seventy‐seven per cent of procedures were considered successful based on the angiographic demonstration of shunt patency at the end of the procedure. The in‐hospital mortality in all patients undergoing TIPS was 45% and was 42% in patients undergoing technically successful TIPS. Only age could be identified as predictive of death in hospital. In patients leaving hospital, we found a rebleeding rate of 57% with one patient dying of bleeding, one requiring balloon tamponade and two requiring variceal sclerotherapy. Hepatic trauma was documented in six cases, shunt thrombosis in four cases, stent displacement in two cases and severe hepatic encephalopathy in one case. Conclusions: TIPS has the potential to decompress the portal venous system, but the procedure is technically complex and should be performed in the knowledge that mortality and morbidity can be relatively high, particularly in patients whose condition is poor.
The influence of clinical problems, age and social support on outcomes for elderly persons referred to regional aged care assessment teams
Authors: Cape R. D. T. , Gibson S. J. 
Published: March 2008

Abstract Background: Aged Care Assessment Teams (ACATs) have been established throughout Australia during the past seven years. Early studies of their effect have concentrated on their impact on the rate of institutionalisation of disabled elderly, the clinical characteristics of referred cases and the relationship between disability and recommended care plan. Aims: The aim of this study was to explore the relationship between age, clinical features and social characteristics of AC AT subjects with outcomes at 12 months after assessment. Methods: The examination of an arbitrary sample of persons referred to ACATs over a year by one generalist geriatrician with follow‐up of all cases by the three ACATs associated with the study was carried out. All analyses were performed on raw data presented as categorical variables in the form of contingency tables. Results: The sample included 324 subjects who suffered from 2030 clinical problems with a mean of 6.5 per person aged 75 or over and 5.5 for those under 75. Cardiovascular and neurological disease were the commonest source of problems. Study of accommodation outcome at 12 months, for those subjects who survived this period revealed that, in the older group, over 60% of subjects with neurological disease were resident in nursing homes while the majority of all other groups remained in the community, as did two‐thirds of those aged under 75. Admission to a nursing home was independent of social support for older subjects with neurological disease, but it played a significant role in those with cardiopulmonary or musculoskeletal disease. Conclusions: The study demonstrates that for one‐year survivors there is an increased likelihood of admission to a nursing home of people aged 75 or over with neurological disease, while those under 75 were more likely to remain at home. The association was independent of whether spouse, family or friends were living with the subject. (Aust NZ J Med 1994; 24: 378–385.)
Peak expiratory flow meters (PEFMs) – who uses them and how and does education affect the pattern of utilisation?
Authors: Garrett J. , Mitchell E. , Fenwick J. Mercer , Rea H. , Taylor G. 
Published: March 2008

Abstract Background: Asthma control may be assisted by educating patients to use peak expiratory flow meters (PEFMs). Aims: To find out the sociodemographic and clinical characteristics of asthmatics attending an Emergency Room (ER) who owned PEFMs. Methods: We undertook a study of 352 asthmatics aged seven to 55 years who attended an ER. The following were analysed: their pattern of peak flow monitoring (PFM), the factors associated with ‘appropriate’ or daily PFM on entry to the study and then prospectively; whether asthma education influenced utilisation and whether there was a reduction in ER use or admissions in those who acquired a PEFM. Results: Those owning a PEFM at entry to the study (54%) had more asthma morbidity (p= 0.0001), had had asthma for longer (p = 0.0001), had seen their medical practitioners more often in the previous nine months (p = 0.0001), were on more asthma medications (p= 0.0001) and were more likely to have been to an Asthma Clinic (p = 0.0001). Those not owning a PEFM were more likely to be of lower social class (p = 0.016) and of Pacific Island origin (p= 0.0001) suggesting that distribution is not ideal and is influenced by disease severity, amount of health care use and sociodemographics. Patients with a self‐management plan (35% of PEFM owners) and those receiving ‘good care’ or management, were more likely to use PFM ‘appropriately’ and to mention PFM in a scenario evaluating their response to worsening asthma control and argues for PEFMs to be distributed only in conjunction with a self‐management plan, and therefore in close association with the patients' medical practitioners.Most patients (75%) appeared to prefer making management decisions based on symptoms rather than on their peak expiratory flow (PEF) and few (16%) performed daily PFM at entry to the study and fewer (6%) nine months later. There was an improvement in the pattern of PFM after education, but the acquisition of a PEFM made no difference to the frequency of ER use or admission, Conclusion: More realistic goals need to be defined in relationship to PFM which may improve patients' acceptance of the strategy, and therefore, hopefully their compliance. Such strategies need to be consistently reinforced over time for them to have an impact on asthma morbidity. (Aust NZ J Med 1994; 24: 521–529.)
Direct mutational analysis in a family with hereditary non‐polyposis colorectal cancer
Authors: Van de Water N. S. , Jeevaratnam P. , Browett P. J. , Stewart S. M. , Lane M. R. , Jass J. R. 
Published: March 2008

Background: It is now known that a proportion of cases of hereditary non‐polyposis colorectal cancer (HNPCC) is caused by mutations in the human homologue of the yeast DNA mismatch repair gene MSH2. A proline to leucine change due to a C to T transition in codon 622 of hMSH2 has been identified in a large HNPCC family of over 240 individuals. Aim: To develop an assay to detect the family‐specific mutation and apply the findings to genetic screening. Methods: The C to T change in codon 622 creates a new Mae I site (CTAG) allowing a simple, non‐radioactive assay to be developed in order to detect this mutation. The assay was applied to affected members of the family and their first degree relatives (siblings and offspring) between the ages of 17 and 77 years, a total of 75 subjects within two generations (IV and V). Results: 13/13 (100%) subjects with cancer were mutation positive, 7/7 (100%) elderly subjects from generation IV and with no evidence of cancer were mutation negative, 23/57 (40%) subjects from generation V were mutation positive and 0/50 (100%) unrelated subjects were mutation negative. Following the demonstration of perfect segregation of the disease with the mutation, family members were invited to receive the results of the test. Sixty‐three (84%) responded within six weeks of receiving the invitation. Genetic screening and counselling members of HNPCC families was perceived as beneficial overall, allowing non‐carriers of the mutant gene (as well as their descendants) to be removed from a programme of colonoscopic surveillance. (Aust NZ J Med 1994; 24: 682–686.)
Bone presentation of non‐Hodgkin's lymphoma: experience at the Royal North Shore Hospital, Sydney; highlighting primary bone lymphoma
Authors: Shannon J. A. , Bell D. R. , Levi J. A. , Wheeler H. R. , Boyle F. M. 
Published: March 2008

Background: Primary lymphoma of bone (PLB) is a rare form of extranodal lymphoma. Between 1975 and 1992 39 patients with lymphoma presenting in bone were seen at the Royal North Shore Hospital (RNSH), Sydney. Of these, 12 (31%) had truly localised disease (Stage IE). Aims: Patients were studied retrospectively to determine the prognostic significance of bony involvement per se versus involvement of a single bony site, and to determine the impact of treatment modality on outcome. Methods: The 39 patients were divided into three groups according to extent of disease; single osseous site (Stage IE), multifocal bone, and bone plus visceral and/or nodal disease. Kaplan‐Meier survival curves were constructed, and five year actuarial survival stated. Cox regression analysis was used to determine hazard ratios. Overall survival was used as the end‐point. Results: A trend for better survival was noted with Stage IE disease. Multifocal and disseminated disease appeared to have a poorer outcome when assessed by hazard ratio, with a value of 3 (95% CI 0.87–10.4; ρ= 0.08), compared to unifocal disease. Radiotherapy alone was as effective as combined modality treatment although patient numbers were too small for statistical confirmation. Conclusions: The stage of lymphoma, rather than bony involvement per se, seems to have more prognostic importance. Radiotherapy alone offered equivalent results to combined modality treatment in this series. (Aust NZ J Med 1994; 24: 701–704.)
Absence of alpha‐1‐antitrypsin (Pi Null Bellingham) and the early onset of emphysema
Authors: Cook L. , Janus E. D. , Brenton (néeWatts) S. , Tai E. , Burdon J. 
Published: March 2008

Abstract Background: Alpha‐1‐antitrypsin is the body's major inhibitor of human neutrophil elastase, a powerful proteolytic enzyme capable of degrading the common tissue components. There are over 70 genetic variants of alpha‐1‐antitrypsin, with the Z allele being of greatest clinical relevance. Individuals homozygous for this allele (approximately one in 2500 in Caucasians) have low serum alpha‐1‐antitrypsin levels (10–20% of normal) and are predisposed to emphysema, especially if they smoke. Much rarer are mutations which result in the complete or almost complete absence of alpha‐1‐antitrypsin in the serum. Aim: To determine the cause of complete absence of alpha‐1‐antitrypsin in a patient who at age 27 years had both emphysema and idiopathic cardiomyopathy. Methods: Molecular biology techniques were used to sequence the alpha‐1‐antitrypsin gene. Allele specific amplification was used to show the presence of the mutations in other family members. Results: Investigation showed that the proband was homozygous for the Pi Null Bellingham variant of alpha‐1‐antitrypsin due to the mutation Lys 217 (AAG) to Stop (TAG). His grandmother was heterozygous for Pi Null Bellingham and the additional rare variant P Lowell, Asp 256 (GAT) to Val (GTT), a variant that also results in alpha‐1‐antitrypsin deficiency. Conclusion: Patients with complete absence of alpha‐1‐antitrypsin develop premature emphysema not having smoked or after only minimal exposure, and much earlier than the more common Pi Z individuals who have the usual form of alpha‐1‐antitrypsin deficiency.
Dose intensive therapy with autologous blood stem cell transplantation in breast cancer
Authors: Kotasek D. , Sage R. E. , Dale B. M. , Norman J. E. , Bolton A. 
Published: March 2008

Abstract Background: Breast cancer is the commonest form of cancer in Australian women. Although approximately 50% of women with breast cancer achieve long term survival by current management methods, recurrent or metastatic disease is generally incurable. In addition, women with Stage II disease with > 10 positive axillary lymph nodes and also women with locally advanced disease (Stage III) have a poor survival even with adjuvant therapy. Aims: To assess the toxicity and efficacy of high‐dose chemotherapy with autologous peripheral blood stem cell (PBSC) transplantation in women with both metastatic and poor prognosis primary breast cancer. Methods: Twenty‐eight women with either metastatic (15) or poor prognosis (13) primary breast cancer were enrolled in the study between November 1988 to January 1993. PBSC were harvested using high‐dose cyclophosphamide (Cy) with or without granulocyte‐colony stimulating factor (G‐CSF) and a myeloablative regimen of Cy, melphalan and carboplatin (CMCp) was used in the transplantation phase. Results: Optimum numbers of stem cells were harvested in 85% of patients. The use of five G/m2 Cy plus G‐CSF resulted in better PBSC yields and a significant reduction in haematologic morbidity when compared to mobilisation with Cy alone. Twenty‐two women underwent 23 PBSC transplants (PBSCT). There have been two early deaths due to sepsis. The predominant morbidities observed following high dose chemotherapy and transplantation have been nausea, mucositis and diarrhoea. The median number of days to discharge following infusion of PBSC was 15 (range 11–21). At a median follow up time of 1.1 years (range 0 months‐3.6 years), 8/22 (36%) evaluable patients remain alive and disease free while 14/22 (64%) have relapsed or progressed or died. Conclusion: High‐dose chemotherapy and autologous PBSCT is a potentially highly effective treatment of women with metastatic and poor prognosis primary breast cancer. Randomised studies are required to compare this form of therapy to more standard forms of treatment in breast cancer.