bluuebunny/crossref_metadata_2025_split huggingface dataset:
Total hip arthroplasty in the young arthritic patient
Authors: Bleasel J. F. , York J. R. , Korber J. , Tyer H. D. D. 
Published: March 2008

Abstract Background: Hip disease is a major cause of immobility and pain in children and young adults with inflammatory arthritides. Total hip arthroplasty (THA) has previously been avoided in young patients because of the concern about durability of the prosthesis and the need for multiple revisions. There are now, however, growing reports of the success of such procedures in improving mobility and relieving pain in the young patient with severe hip disease. In this study we aimed to determine the clinical and radiological results in patients with inflammatory arthritides who had undergone THA before the age of 35 years. Methods: Twenty‐one patients who had undergone a total of 38 hip arthroplasties were identified. Patients' hips were scored both pre‐operatively and at follow‐up using the scoring system of the Hospital for Special Surgery, which allots a score for pain, walking, motion and muscle power, and function. Complications were noted and follow‐up X‐rays were compared to postoperative films to assess radiological loosening. Results: The mean age at operation was 24 years, and the mean follow‐up was 8.6 years. The results in terms of pain relief, mobility, movement and functional capacity were good. Revision was required in 13 hips (34%). This was mostly due to the failure of resurfacing prostheses. Radiological loosening was evident in a further six hips, five of which were asymptomatic. Conclusions: THA can dramatically improve the quality of life of the young patient with arthritis. The main concern is the likely need for multiple revisions, with progressive loss of bone stock.
Narcolepsy in Hong Kong Chinese ‐ a preliminary experience
Authors: Wing Y.‐K. , Chiu H.F.K. , Ho C. K. W. , Chen C.‐N. 
Published: March 2008

Abstract Background: Narcolepsy is a sleep disorder of unknown aetiology. Despite the widely reported strong association with HLA DR2 among different ethnic groups and their varying prevalence rates, there has never been any series of laboratory documented narcolepsy in Chinese. Aims: To report the preliminary experience with Chinese narcoleptic patients and their HLA typing. Methods: The records of 342 patients who presented to our sleep laboratory for various sleep problems from 1986 to 1992 were examined. Both clinical and polysomnographic data were analysed. The criteria for a diagnosis of narcolepsy is based on shortened mean sleep latency of less than 5 minutes and presence of rapid eye movement (REM) sleep in two or more of the five 20‐minute naps during multiple sleep latency test (MSLT). Results: There were five narcoleptic patients documented resulting in an overall laboratory prevalence of 1.5% or 2.3% of patients presenting with hypersomnia. All patients were HLA DR2 positive. Conclusion: There is 100% association with HLA DR2 in Hong Kong Chinese narcoleptic patients. Based on the laboratory prevalence, the prevalence rate of narcolepsy among Hong Kong Chinese population is estimated to be within the range of four in 10,000 to one in 100,000.
The role of high dose 67‐gallium scintigraphy in staging untreated patients with lymphoma
Authors: Larcos G. , Farlow D. C. , Antico V. F. , Gruenewald S. M. , Boyages J. 
Published: March 2008

Abstract: Background: Gallium‐67 (67Ga) scintigraphy has been reported to be of limited value in staging lymphoma patients. However, recent technical advances in radionuclide imaging have potentially enhanced the usefulness of this method. Aims: The purposes of this study were to determine the current: (1) sensitivity and specificity and (2) impact on clinicians' treatment decisions of 67Ga scans performed at a teaching hospital. Methods: There were 46 newly presenting patients with lymphoma (13 with Hodgkin's disease (HD) and 33 with non‐Hodgkin's lymphoma [NHL]). Planar 67Ga scans were performed up to eight days following injection of 300 MBq (8 mCi) with images interpreted by consensus of two blinded observers; sensitivity and specificity were determined on a lesion by lesion basis in comparison to computed tomography (CT) scans, palpation of peripheral lymph nodes and abdominal lymphangiograms (n = 5). The contribution of 67Ga scans to clinicians' treatment decisions was also independently assessed by an experienced oncologist. Results: Gallium‐67 scan sensitivity and specificity were 80% and 96% for HD and 59% and 98% for NHL. Initial treatment plans were modified in three individuals (7%; 95% confidence intervals = 3–10%) due to lesions on the 67Ga scan not prospectively detected or considered equivocal on other tests. Conclusions: Only a small proportion of newly diagnosed lymphoma patients benefit from staging with state of the art planar high dose 67Ga imaging.
Efficacy of drug intervention for lipids in the prevention of coronary artery disease
Authors: Howes Laurence G. , Simons Leon A. 
Published: March 2008

Abstract: Meta‐analysis of the benefit of drug intervention in hypercholesterolemia has produced conflicting conclusions, dependent upon which studies were included or which outcomes were considered. We have approached this question by considering coronary artery disease (CAD) outcomes, fatal and non‐fatal, in studies considered to be pivotal ‐ those of sufficient size and duration and those achieving sufficient cholesterol reduction to be likely to have a statistically significant outcome. In parallel, we have reviewed all the published angiographic trials of adequate design (randomised and controlled). In four pivotal primary prevention studies, CAD morbidity was reduced in the range 19–45%. CAD mortality was reduced significantly in one of these studies. Women were included in only one study and they did not exhibit the favourable outcome observed in men. In four pivotal secondary prevention studies, CAD morbidity was reduced in the range 5–36%. CAD mortality was significantly reduced in two studies. In eight angiographic intervention studies, lipid intervention was associated with consistently more evidence of regression or stable coronary disease. These studies also yielded suggestive evidence of improved clinical outcome. We conclude that drug intervention to lower cholesterol levels effectively reduces CAD morbidity and mortality in men already suffering from CAD (and may do so in women). Treatment is similarly effective in men with hypercholesterolemia having no prior history of CAD. We lack evidence of the value of treatment in the elderly or in women having no prior CAD.
Cholesterol reduction and death from noncoronary causes: evidence from randomised controlled trials*
Authors: MacMahonf Stephen 
Published: March 2008

Abstract:An overview of randomised trials of cholesterol reduction (26 trials, 50,000 patients, net cholesterol reduction ˜10%) provides clear evidence of a reduction in the incidence of coronary heart disease (CHD) after just a few years of treatment. Overall, the observed reduction in CHD death (9%± 3) was only half as large as the reduction in non‐fatal myocardial infarction (19%±4), 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 9%, the expected reduction in total deaths was about 5–6%. 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 individually 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 suggest that the small excesses of noncoronary deaths observed in the cholesterol reduction trials may have occurred by chance. Evidence from ongoing longer‐term studies of treatments producing larger cholesterol reductions will be useful in further delineating the effects, if any, of such treatments on non‐coronary mortality.
Application of the Poincaré plot to heart rate variability: a new measure of functional status in heart failure
Authors: Kamen P. W. , Tonkin A. M. 
Published: March 2008

Abstract Background: Conventional methods of quantifying heart rate variability using summary statistics have shown that decreased variability is associated with increased mortality in heart failure. However, many patients with heart failure have arrhythmias which make the ‘raw’ heart rate variability data less suitable for the use of summary statistical measures. Aims: To examine the clinical potential of a new measure of heart rate variability data, presented by the Poincare plot pattern, as an adjunct to the summary statistical measures of R‐R interval Methods: We used the Poincaré plot pattern to display beat‐to‐beat heart rate variability data from a group of 23 patients with heart failure and compared them with data collected from 20 healthy age‐matched control subjects. The data, which consisted of 2000 consecutive R‐R intervals, were gathered over 20–40 minutes while the subjects rested supine in a quiet darkened room. Results: The morphological classification scheme proposed reflected the functional status of patients in heart failure. There was a significant difference (chi‐square = 27.5, df = 6, ρ < 0.0001) in the different pattern types between patients with NYHA Class I and II compared to patients with NYHA Class III and IV. All healthy subjects displayed a ‘cluster’ type of pattern characterised by normally distributed data. Sixteen of the 23 patients in heart failure also produced data which were normally distributed but the remaining seven produced data which required careful filtering to make them suitable for analysis using summary statistics, but which could be analysed by the Poincare plot. Conclusions: The Poincaréot pattern is a semi‐quantitative tool which can be applied to the analysis of R‐R interval data. It has potential advantages in that it allows assessment of data which are grossly non‐Gaussian in distribution, and is a simple and easily implemented method which can be used in a clinical setting to augment the standard electrocardiogram to provide ‘real time’ visualisation of data.
Writing to referring doctors after a new patient consultation
Authors: Tattersall M. H. N. , Monaghan H. , Griffin A. , Scatchard K. , Dunn S. M. , Butow P. N. 
Published: March 2008

Abstract Background: There are no Australasian data on the preferred information content of letters from consultant physicians to referring doctors. Aims: To survey referring general practitioners (GPs) and specialists concerning their preferences for letters from a consultant physician after a new patient consultation to include different categories of information. To investigate the information content of letters written by one medical oncologist to referring doctors after a new patient consultation and contrast with that of individualised letters written to patients. Methods: Fifty‐five referring GPs and 53 specialists were sent a questionnaire seeking their views on the information content of letters from consultant physicians. Ninety‐four letters after a new patient consultation were selected at random and analysed for their information content, and compared with 182 individualised letters sent to patients. Results: Referring doctors wanted letters to contain details of diagnosis, clinical findings, test results and recommended future tests, treatment options, side effects and prognosis. Letters to referring doctors contained 19 items of information (range 8–33), while letters to patients contained a mean of 5.6 ‘salient’ points (range 5–7). Both letters almost always stated the diagnosis, the presenting history and recommended treatment. Letters to patients more commonly presented information about prognosis, further tests, and explanation of symptoms than letters to doctors. In contrast, letters to referring doctors contained more information concerning the past medical, family, and drug history, clinical findings and test results. Conclusions: Letters sent by a consultant oncologist are not well tailored to the information needs of the referring clinician. Summary letters sent to patients may be modified to include information required by referring doctors. (Aust NZ J Med 1995; 25; 479–482.)
Radiation exposure to patient and operator during radiofrequency ablation for supraventricular tachycardia
Authors: Kovoor P. , Uther J. B. , Ricciardello M. , Ross D. L. , Collins L. 
Published: March 2008

Abstract Background: Radiofrequency (RF) ablation has become the primary method of treatment for supraventricular tachycardia and often requires prolonged fluoroscopy times. Aim: To quantitate radiation exposure to patient and operator during RF ablation for supraventricular tachycardia. Methods: Thermoluminescent dosemeters were used to monitor radiation at seven sites. Positions were: patient's thyroid, left scapula, T9 vertebra, right scapula and L4‐L5 vertebra and the operator's thyroid and left hand. Monitoring was performed during 22 procedures. Of the patients studied 10 (45%) had atrioventricular junctional re‐entry tachycardia (AVJRT) and 12 (55%) had accessory pathway tachycardia. Results: The median fluoroscopy times (minutes) and inter‐quartile ranges were 46 (39–65) for AVJRT, 55 (52–60) for left free wall accessory pathway (LFW), 107 (89–140) for septal and 166 (128–176) for RFW pathways. The mean radiation doses (mGy) to the chest wall were 50 for AVJRT, 47 for LFW, 87 for septal and 151 for RFW pathways. The mean radiation to the chest wall of the patient per case was found to be 3.9 times that reported for diagnostic cardiac catheter‐isation and 1.5 times that reported for angioplasty. Conclusions: Radiofrequency ablation is associated with significant irradiation of the patient and operator. All precautions should be taken to decrease this exposure. If eye irradiation is assumed to be equal to that to the thyroid, more than 45 procedures per month by a single operator (using ceiling‐suspended lead glass shielding) may result in exceeding the recommended dose limit to the eye. (Aust NZ J Med 1995; 25; 490–495.)
Clinico‐pathological study of cytomegalovirus (CMV) in AIDS autopsies: under‐recognition of CMV pneumonitis and CMV adrenalitis
Authors: Dore G. J. , Marriott D. J. , Duflou J. A. 
Published: March 2008

Abstract Background: Cytomegalovirus (CMV) is a common cause of morbidity in human immunodeficiency virus (HIV) infected patients, predominantly when severe immunosuppression has occurred. Although CMV infection of the retina and gastrointestinal tract is well recognised as causing substantial morbidity, the significance of infection at other sites, in particular the lungs and adrenal glands is unclear. Aims: To assess the extent of CMV infection in postmortem examinations performed on HIV‐infected patients. To estimate the degree of concordance between clinical and postmortem findings and the effect of prior diagnosis and/or treatment of CMV infection. Methods: The postmortem examination findings and clinical records of 25 consecutive HIV‐infected patients who underwent a complete autopsy were examined. Results: CMV infection was demonstrated in 19 patients (76%) at postmortem examination, with the most common sites of infection being the adrenal glands (56%) and lungs (44%). Concordance between clinical diagnosis of CMV infection and postmortem findings was low with only five of 19 patients (26%) having an antemortem diagnosis. No patient with CMV infection of the lungs or adrenal glands had a clinical diagnosis made, despite four patients having florid CMV pneumonitis at postmortem examination; in three the probable cause of death. Conclusion: CMV infection is a common postmortem finding in HIV‐infected patients but the concordance between clinical diagnosis and autopsy findings is low. CMV appears to be a significant pathogen in HIV‐related respiratory disease. (Aust NZ J Med 1995; 25: 503–506.)
Determinants of severity of left ventricular dysfunction in Australian men and women with coronary disease aged 65 years or less
Authors: Wang X. L. , McCredie R. M. , Tam C. , Wilcken D. E. L. 
Published: March 2008

Abstract Background: The degree of left ventricular (LV) impairment is an important determinant of long term outcome in patients with coronary artery disease (CAD). Aim: We aimed to determine variables predictive of the severity of LV dysfunction in men and women aged 65 years or less with CAD, and to quantitate their contributions. Methods: We documented atherogenic variables and extent of LV impairment and CAD severity at angiography in 521 consecutively studied men and women aged 65 years or less (381 males and 140 females). We assessed severity from an LV impairment score (Green Lane) and the ejection fraction. We related severity to quantitative and categorical variables which included the severity of angina (no angina, stable and unstable angina). Results: The LV impairment score correlated closely (negatively) with the ejection fraction (r = ‐0.783, p= 0.0001). There were eight variables independently predictive of the severity of LV impairment assessed by the LV score. The variables in descending order of relative importance in predicting the LV scores were past history of myocardial infarction (MI), number of significantly diseased vessels (> 50% luminal obstruction), life‐time smoking dose, log‐triglycerides, total cholesterol to HDL‐C ratio, hypertension, age and Body Mass Index (BMI). They were all positive relationships. Together they correctly classified the LV scores of 52.6% of the patients. Gender was not an independent contributor to the LV score when other variables were controlled. When the contributions to the variance in LV scores of past history of MI (15.4%) and number of significantly diseased vessels (2.6%) were controlled, life‐time smoking dose independently explained 2.1% (p0.01) of the variance. The LV impairment score was 55% higher in heavy smokers than in non‐smokers (p = 0.01). When we compared patients with stable and unstable angina, LV scores are higher and ejection fraction lower in the unstable angina patients consistent with them having a greater degree of LV dysfunction. Conclusion: We conclude that variables other than a history of MI and CAD severity contribute significantly to the variance of the degree in LV impairment in CAD patients among which the life‐time smoking dose, triglycerides, TC/HDL‐C, hypertension and increased BMI are all relevant to prevention, and that patients with unstable vs stable angina usually have more impaired LV function. (Aust NZ J Med 1995; 25; 309–315.)
The role of bronchoscopy in the diagnosis and treatment of pulmonary disease in HIV‐infected patients
Authors: Lewin S. R. , Hoy J. , Crowe S. M. , McDonald C. F. 
Published: March 2008

Abstract Background: Pulmonary disease is the most common reason for presentation and the major cause of death in HIV‐infected patients. There has been an evolution in the optimal approach to the investigation of a pulmonary infiltrate in HIV‐infected patients since the introduction of induced sputum for the diagnosis of Pneumocystis carinii pneumonia (PCP). Aims: To evaluate the usefulness of flexible fibreoptic bronchoscopy (FFB), bronchoalveolar lavage (BAL), transbronchial biopsy (TBB) and bronchial brushings (BB) in the diagnosis of pulmonary disease in HIV‐infected patients and to examine the effect of FFB on changes in therapy and survival. Methods: The histories of all HIV‐infected patients referred to Fairfield Hospital for FFB between January 1990 and June 1993 were examined retrospectively. Results: Forty‐two FFB were performed on 41 patients (40 male and one female). Definitive diagnoses made at FFB included Kaposi's sarcoma (KS) (n= 9), invasive aspergillosis (n= 5), PCP (n= 4), Mycobacterium avium complex (MAC) pneumonia (n= 2), cytomegalovirus (CMV) pneumonia (n= 1), Cryptococcus neoformans pneumonia (n= 1), microsporidium (n= 1) and Pseudomonas aeruginosa pneumonia (n= 1). TBB and BB did not provide a diagnosis for diseases not seen macro‐scopically at FFB or diagnosed by BAL. FFB findings altered diagnosis in 21/42 (50%) presentations and changed therapy in 26/42 (62%) cases. Conclusions: FFB together with BAL altered the working diagnosis and changed therapy in a significant number of patients. TBB and BB should not be routinely performed in all patients as these procedures are of limited value in this setting.
Validation of the Banff criteria for acute rejection in renal transplant biopsies
Authors: Dittmer I. D. , Zwi L. J. , Collins J. F. 
Published: March 2008

Abstract Background: The histological criteria for the diagnosis of mild acute rejection in renal transplant biopsies have not been well defined. Aim: To ascertain the value of the Banff criteria for transplant biopsy reporting, particularly for the diagnosis of acute rejection, and the ‘borderline’ category. Methods: We compared two systems of histological assessment in 23 transplant biopsy specimens and compared histological diagnoses to separately defined clinical diagnoses. The histological criteria applied were those of the recently described Banff criteria which were compared with our traditional diagnostic method for each specimen. Results: We found the Banff diagnoses more closely related to the clinical outcome than the system of histological diagnosis that we had previously been using. Conclusions: We conclude that the Banff criteria more accurately reflect the clinical situation.
Comparison of Chemcard Cholesterol test and laboratory cholesterol measurements
Authors: Gan I. E. T. , Schier G. M. 
Published: March 2008

Abstract Background: The Chemcard cholesterol test has been designed to estimate cholesterol levels in patients in General Practitioners' surgeries. The patients displaying elevated cholesterol levels may then be referred for a more accurate test at a recognised laboratory. Aims: To compare the accuracy of the Chemcard cholesterol procedure with a standardised laboratory procedure for estimating cholesterol levels. Methods: The Chemcard cholesterol procedure was applied to 200 subjects from the community, who were enrolled in a cardiovascular risk assessment programme. Results: The correlation coefficient between the paired measurements was 0.83. The Chemcard cholesterol procedure gave slightly higher results than did the laboratory procedure as shown by the mean (± standard deviation) difference between the two methods of 0.16 ± 0.58 mmol/L. Conclusions: The poor agreement between the two methods and the potential misclassi‐fication by Chemcard suggests that the Chemcard is not a reliable test system. The high level of risk group misclassification found in this study refutes the manufacturer's claims and does not eliminate the need for formal laboratory cholesterol measurement.
Aldosterone and its mechanism of action: more questions than answers
Authors: Fuller PETER J. 
Published: March 2008

Abstract:The physiology of the steroid hormone, aldosterone is well defined. The molecular events that mediate this response remain to be elucidated. Aldosterone binds to a specific mineralocorticoid receptor (MR) in sodium transporting epithelia. The structural determinants of ligand‐binding have been explored through the analysis of steroid resistance syndromes, however, the molecular basis of resistance to aldosterone, pseudo‐hypoaldosteronism remains an enigma. Cortisol also binds MR, access is however restricted by the enzyme 11β‐hydroxysteroid dehydrogenase. The MR induces specific genes which regulate apical amiloride‐sensitive epithelial sodium channels; the finding of activating mutations in Liddles syndrome (pseudoaldosteronism) has emphasised their key role. Such mechanisms may apply not only to the peripheral effects of aldosterone but also to the central regulation of blood pressure.