bluuebunny/crossref_metadata_2025_split huggingface dataset:
Thymic hyperplasia in adults following chemotherapy for malignancy
Authors: Simmonds P. , Silberstein M. , McKendrick J. 
Published: March 2008

Abstract
Background:
The accuracy of the assessment of patients with malignant disease and of their response to chemotherapy has been significantly improved with the routine availability of computerized tomography (CT) scanning. CT abnormalities, however, may be non‐specific, especially after chemotherapy. Rebound enlargement of the thymus gland after chemotherapy induced atrophy is one cause of an abnormal thoracic CT scan on re‐staging.
Aims:
This phenomenon has previously been reported mainly in relation to the treatment of lymphoma and germ cell cancers. This paper highlights the occurrence of thymic hyperplasia after chemotherapy in these and other tumour types.
Methods:
We discuss five cases including three patients with malignancies other than lymphoma in whom thymus enlargement occurred during or after intensive chemotherapy.
Results:
Clear identification of the nature of CT abnormalities after chemotherapy, particularly in the mediastinum, is required prior to embarking on further anti‐cancer treatments. (Aust NZ J Med 1993; 23: 264–267.)
Duplicate reporting of AIDS cases between two neighbouring countries
Authors: Kaldor J. , Carlson R. , Dickson N. , McDonald A. 
Published: March 2008

Abstract
Aims:
To measure the extent and characteristics of cases of duplicate notification of diagnoses of Acquired Immunodeficiency Syndrome (AIDS) between Australia and New Zealand.
Methods:
Cases of AIDS notified to the national AIDS registries in both Australia and New Zealand were identified, using date of birth and a name code. Cases determined to have been notified to both registries were analysed with respect to exposure category, country of birth and country of death.
Results:
Twenty‐six cases of AIDS were determined to be common to both representing 1.1 % of cases notified to the Australian registry and 11.1 % of cases notified to the New Zealand registry. Exposure to HIV was attributed to male homosexual contact for all cases, and a history of injecting drug use was reported more frequently to the Australian registry for the cases in common. For the majority of cases notified to both registries, country of birth was recorded as New Zealand. Deaths following AIDS were reported as occurring in both countries with equal frequency.
Repair of the anterior mitral leaflet*
Authors: Alvarez J. M. , Gray D. , Choong C. , Deal C. W. 
Published: March 2008

Abstract
Background:
Repair rather than replacement of the diseased mitral valve has been the goal of the cardiac surgeon. Although well accepted for posterior leaflet pathology, a diseased anterior leaflet was believed by some to be irreparable.
Aims:
To assess the result of reconstructive mitral valve surgery involving the anterior mitral leaflet in a selected group of patients.
Methods:
Twenty consecutive patients with degenerative (19), ischaemic (one) and congenital/ calcific mitral regurgitation were evaluated. There were five females and 15 males with a mean age of 62 ± 12 years (41–75 years). The technique used to repair these valves included chordal transposition, leaflet plication commissuroplasty and a new technique we call leaflet repositioning. Result: There were no deaths, follow‐up is complete with mean follow‐up of 31 ± five months (two‐102) months. All patients have had 2DE and 13 TOE as well. There have been no reoperations due to failure of the repair, 95% of patients are in NYHA Class HI post operative, while 15% have significant residual regurgitation. (Aust NZ J Med 1993; 23: 279–284.)
Impact of a national educational campaign to reduce patient delay in possible heart attack
Authors: Bett N. , Aroney G. , Thompson P. 
Published: March 2008

Abstract:In 1989 the National Heart Foundation (NHF) of Australia's Heart Week campaign was directed towards encouraging those with symptoms of possible myocardial infarction (MI) to seek help as promptly as possible.To evaluate its effect, three surveys were conducted of patients admitted to 22 coronary care units (CCUs). Two (335 and 221 patients) preceded and one (253 patients) followed the public education campaign. During the third survey a subset of patients were asked why they delayed, how long they thought one should wait before seeking help, whether they were aware of the media campaign and whether this had influenced their behaviour.Overall, only 42% of 809 patients sought help within one hour (median delay 1.2 hours). The median time of arrival and the proportion of patients arriving within one, two and four hours was not altered after this campaign. Those who admitted to having been aware of the campaign sought help no more promptly. The Heart Week campaign could not be shown to have produced any clinically important change in patient delay. Future campaigns will need to be modified in the light of this experience. (Aust NZ J Med 1993; 23: 157–161.)
Chronic liver disease in asymptomatic hepatitis C antibody positive blood donors
Authors: Hardiman R. P. , Shaw D. R. , Brooy J. T. La , Rozen L. , de Boer W. B. , Rowland R. , Beardsley A. M. , Gowans E. J. 
Published: March 2008

Abstract:The risks of acquisition of hepatitis C infection, the histological spectrum of liver disease, and the presence of viraemia were investigated in anti‐hepatitis C virus (HCV) antibody positive blood donors. All 357 (0.64%) blood donors to the South Australian Red Cross Transfusion Service found to have anti‐HCV antibody during the first seven months of testing in 1990 were assessed, and 70 (19.6%) were found to have elevated alanine transaminase levels. These subjects were referred for participation in the study; 31 presented for enrolment.Sixteen (52%) of the 31 patients had previously used intravenous drugs, four (13%) had been transfused, two (6%) had a history of occupational exposure to blood, and three (10%) had tattoos and ear‐piercing as possible risk factors for acquisition of hepatitis C. There was no history of parenteral exposure in six (16%). None of these donors had clinical evidence of liver disease, but in all 24 of the 31 who had a liver biopsy there was histological evidence of significant liver damage. Twelve had evidence of chronic active hepatitis. All 24 subjects biopsied were viraemic as judged by the presence of HCV RNA in serum. (Aust NZ J Med 1993; 23: 176–180.)
Role of T‐cell antigen receptors in rheumatic disease
Authors: Li Z. G. , Manolios N. 
Published: March 2008

Abstract:The initiation and perpetuation of many rheumatic diseases is believed to be mediated by specific T‐cells activated by an unknown antigenic peptide present on the surface of antigen presenting cells (APC). The T‐cell antigen receptor (TCR) plays a central role in the recognition of antigen and subsequent T‐cell activation. It is thought that a selective TCR repertoire may contribute to the immunopathogenesis of certain inflammatory rheumatic diseases. In this review recent progress in our understanding of TCR usage and their role in a variety of rheumatic diseases will be discussed. In addition, novel immunotherapeutic strategies based on a better understanding of the molecular mechanisms of antigen recognition will be reviewed. (Aust NZ J Med 1993; 23: 205–212.)
Evaluation of mitral valve repair by intraoperative transoesophageal echocardiography
Authors: Kalman J. M. , Buxton B. B. , Jones E. F. , Tonkin A. M. , Lubicz S. , Calafiore P. 
Published: March 2008

Abstract Background: Mitral valve repair is the procedure of choice in the surgical management of mitral regurgitation. Intraoperative confirmation of successful repair is essential to the effectiveness of this procedure. Aims: The aims of this study were: (a) to compare intraoperative transoesophageal echocardiography (TOE) with the surgeon's assessment of valve competence; (b) to assess the impact of routine intraoperative imaging on the hospital echocardiography laboratory. Methods: Eighty‐six consecutive patients undergoing mitral valve repair formed the study population. Valve competence following repair was assessed intraoperatively by: TOE; saline insufflation of the flaccid left ventricle; and evaluation of the pulmonary capillary wedge pressure for the presence of a significant V wave. Results: TOE demonstrated successful valve repair (≤ 1 + residual regurgitation) in 75 patients (87%) and detected significant residual regurgitation (≥3 +) in seven (8.2%). The mechanism of regurgitation was also clearly shown. Of these seven patients, four underwent immediate valve replacement, two had successful revision of the initial repair and one required valve replacement one week later. In all seven patients the valve repair had been assessed as successful by saline testing and only one had a post‐repair V wave 10 mmHg above the mean pulmonary capillary wedge pressure. In 30 non‐selected patients the imaging equipment was required in theatre for 43 ± 18 minutes. Conclusions: TOE is currently the most sensitive method for detection and quantitation of residual mitral regurgitation following valve repair. Evaluation can be performed within a similar time to that required for one complete transthoracic study and can usually be performed with minimal disruption to the hospital echocardiography laboratory. (Aust NZ J Med 1993; 23: 463–469.)
Coronary artery surgery in the elderly: long‐term follow‐up
Authors: Ruygr P. N. , Kerr A. R. , Agnew T. M. , Graham K. J. , Coverdale H. A. , Whitlock R. M. L. 
Published: March 2008

Abstract Background: There has been controversy concerning the indications for coronary artery surgery in the elderly, particularly in countries where health resources are restricted. Aims: To assess the results of coronary artery bypass grafting (CABG) in a large group of elderly subjects with regard to initial risks and long term follow‐up. Methods: Ninety‐six consecutive patients aged 70 years or older underwent isolated CABG between January 1981 and December 1985. Long term follow‐up was obtained in 94 (98%). Results: The mean age was 71.6 years (70–78) and mean duration of follow‐up 73 months. Seventy (73%) were male. In 80 cases the myocardial score was > 10. In 22 of 90 who had left ventricular angiography the ejection fraction was < 50%. Hospital survival was 96% and the five year survival 77%. It was not influenced by gender, myocardial score, ejection fraction or age at the time of operation. The status of survivors was reviewed in 1991. Of the 55 long term survivors 35 (64%) were free of angina. Eight (15%) and ten (18%) were in the Canadian Cardiovascular Society Angina classes 1 and 2 respectively. Seventeen patients (31%) had symptoms of heart failure with 14 (25%) in NYHA class 2 and 3 (5%) in class 3. Eight patients (15%) had survived a cerebrovascular event during follow‐up. There were 35 late deaths (37%). Sixteen of these were cardiac, 18 due to other causes and one unknown. (Aust NZ J Med 1993; 23: 489–493.)
A comparison between estimates of GFR using [99m– Tc]DTPA clearance and the approximation of Cockcroft and Gault
Authors: Cochran M. , John A. St 
Published: March 2008

Abstract Background: The formula of Cockcroft and Gault, relating age, weight, sex and plasma creatinine is widely used to estimate glomerular function. Its ability to predict [99mTc]DTPA clearance, an accepted measure of GFR, is therefore of interest. Aim: To test prospectively the reliability of the formula in predicting the [99mTc]DTPA clearance in subjects with normal and sub‐normal renal function. Methods: The 24 hour creatinine clearance (Ccr), the derived clearance using the formula (Cder), and the [99mTc]DTPA clearance have been compared in 47 male and 47 female subjects, aged between 15 and 71 years. Obese and non‐obese subjects (males >90 kg, females >80 kg body weight) were considered separately. Results: Across the range of [99mTc]DTPA clearance studied (14 to 125 mL/minute), in non‐obese subjects, both Ccr and Cder were correlated similarly with [99mTc]DTPA clearance in males and females. In obese subjects as a group, Cder was also closely correlated with [99mTc]DTPA clearance but the scatter of data was wider. Among non‐obese subjects, correlations were high between either Ccr or Cder and [99mTc]DTPA clearance values < 101 mL/minute but were not significant at [99mTc]DTPA clearance values > 100 mL/minute. For [99mTc]DTPA clearance values between 14 and 100 mL/minute, Cder was a more direct and more precise predictor of [99mTc]DTPA clearance [DTPA clearance = 1.01(Cder) + 2.34, with 95% confidence limits of ± 18 mL/minute] than of Ccr [Ccr= 1.34(CderC)‐ 10.86, confidence limits ±28 mL/minute]. Conclusion: For very mild through to moderate renal failure, the formula of Cockcroft and Gault can evidently be used as a reasonable estimate of GFR. (Aust NZ J Med 1993; 23: 494–497.)
A comparison between enalapril and captopril on insulin sensitivity in normotensive healthy volunteers
Authors: Pratt M. C. , Lewis‐Barned N. J. , Walker R. J. 
Published: March 2008

Abstract Background: Captopril has been shown to improve insulin sensitivity in insulin resistant hypertensive individuals and enalapril has been shown to improve insulin sensitivity in a small group of healthy volunteers, but there has been no direct comparison of the effects of the different angiotensin converting enzyme inhibitors (ACEIs) on insulin sensitivity in either insulin sensitive or insulin insensitive populations. Aim: To compare the impact of two different ACEIs (captopril and enalapril) on insulin mediated glucose uptake in normotensive, non‐obese, insulin sensitive subjects. Method: A single blind cross‐over study comparing captopril (6.25 mg twice daily) and enalapril (5 mg once daily) for 28 days with a 28 day washout period between drugs. Insulin mediated glucose uptake was measured by means of the euglycaemic hyperinsulinaemic clamp at the start and completion of each period of drug therapy. Results: Both drugs resulted in elevations of fasting insulin levels (mean difference ± SEM for combined data, 2.7 ± 1.8; p < 0.05) and a reduction in insulin mediated glucose uptake (mean difference for combined data, ‐ 0.72 ± 0.37 mg/kg1 minute‐1; p= 0.056). Results were similar for both agents and suggest a class effect. Conclusions: The increase in fasting insulin levels, and reduction in insulin mediated glucose uptake in this study are in contrast to findings in obese and hypertensive subjects, and indicate that studies of insulin sensitivity of ACEIs in non‐obese, normotensive subjects are inappropriate for predicting likely effects in clinical practice. (Aust NZ J Med 1993; 23: 652–655.)
Prevention of heart disease by subcutaneous desferoxamine in patients with thalassaemia major
Authors: Richardson M. E. , Matthews R. N. , Alison J. F. , Menahem S. , Mitvalsky J. , Byrt E. , Harper R. W. 
Published: March 2008

Abstract Background: Cardiac siderosis from transfused iron remains the major cause of death in thalassaemia major, despite iron chelation therapy with desferrioxamine. Aims: Our aim was to determine the nature and extent of cardiac involvement and its relationship to desferrioxamine use in a group with thalassaemia major. Methods: We reviewed 76 patients with thalassaemia major and performed multiple logistic regression to analyse factors affecting cardiac involvement. Factors studied included: patient sex, age, haemoglobin, serum ferritin, total transfusions, liver iron, duration of desferrioxamine use, electrocardiograms, echocardiograms and compliance to desferrioxamine treatment. Results: Thirty‐seven patients developed heart disease. They were older (p < 0.001), began desferrioxamine later (p < 0.001), had more liver iron (p= 0.014), higher serum ferritin levels (p= 0.023) and received more blood (p = 0.018). Compared to those with optimal compliance the odds of developing heart disease were increased 10.7 times in fair compilers (p <0.001) and 5.1 times in poor compilers (p= 0.016). However, there was no significant difference between those with fair and poor compliance. After multivariate analysis only compliance (p= 0.02) and age at desferrioxamine onset (p= 0.004) remained significant. Compliance was inversely related to liver iron (p< 0.001), serum ferritin (p< 0.001) and age at desferrioxamine commencement (p< 0.001). Conclusions: We conclude that late commencement of desferrioxamine and noncompliance are associated with greater iron loading and an increased riskof heart disease. (Aust NZ J Med 1993; 23: 656–661.)
Capillary blood glucose measurements in hospital inpatients using portable glucose meters
Authors: Phillipou G. , Seaborn C. J. , Hooper J. , Phillips P. J. 
Published: March 2008

Abstract Background: The use of portable glucose meters by nursing staff to perform bedside capillary blood glucose measurements is standard practice in the management of diabetic hospital inpatients. Few studies, however, have examined the practical limitations or the cost of this technology. Aim: To investigate the performance and cost of capillary blood glucose measurements using portable glucose meters in a hospital inpatient population being managed for diabetes mellitus. Methods: The setting was a 500 bed metropolitan University Teaching hospital, with 22 meters (Glucometer‐M) in routine use by about 450 accredited nursing staff. The Glucometer‐M was also compared with an operator‐independent meter (Hemocue) to assess the effect of operator bias on the overall efficacy and cost of the programme. Results: Retrospective analysis of Glucometer‐M reagent strips and comparison of measurements (n = 72) with the Hemocue revealed a marked operator bias which diminished accuracy and increased costs. The significant proportion of low haematocrits (< 30%) in the hospital population limited the applicability of the Glucometer‐M which only operates reliably over the haematocrit range 35–50%. The excess of blood glucose measurements was highlighted by both a hospital ward audit and the frequency which exceeded that of routine electrolyte assays. Conclusions: Reliable bedside estimation of capillary blood glucose levels in hospitals requires a meter which is accurate, has negligible operator bias, is largely unaffected by haematocrit, and has insignificant risk of cross‐contamination. At present only the Hemocue fulfils these specifications. Irrespective of meter choice, it is necessary to develop criteria for glucose measurements and monitor adherence. (Aust NZ J Med 1993; 23: 667–671.)
Strokes and net clinical benefit
Authors: White Harney 
Published: March 2008

Abstract:The need for careful assessment of stroke incidence in a trial comparing highly effective thrombolytic regimens was recognised in the design of the GUSTO trial. There was a gradation of stroke incidence from 1.22% in the streptokinase (SK) and subcutaneous heparin group, to 1.4% in the SK and intravenous heparin group, 1.55% in the tissue plasminogen activator (t‐PA) and intravenous heparin group and 1.64% in the combination t‐PA and SK group. The concept of net clinical benefit was developed to balance the adverse effect of stroke with the benefit of mortality reduction. On this analysis, the net clinical benefit favoured the accelerated t‐PA regimen over the SK regimens. (Aust NZ J Med 1993; 23: 737–738.) Key words: Myocardial infarction, thrombolysis, heparin therapy, stroke, net clinical benefit.
Reperfusion injury, stunning and myocardial viability
Authors: Tonkin Andrew , Chan Robert 
Published: March 2008

Abstract:Recent experimental data suggest that current thrombolytic strategies may not yet have achieved their full potential for myocardial salvage. In fact, reperfusion may result in microvascular and myocardial cellular injuries. These may translate into transient loss of contractile function (‘myocardial stunning’), and possibly contribute to the ultimate extent of myocardial necrosis. A number of imaging modalities are now available to detect the presence and amount of these dysfunctional but viable myocardial segments. Myocardial reperfusion experiments using animal models have studied possible mechanisms responsible for reperfusion injury. These may help in the search for novel pharmacological and other adjunctive approaches which may overcome potential adverse effects of reperfusion. (Aust NZ J Med 1993; 23: 756–759.)
New thrombolytic strategies
Authors: van de Werf Frans 
Published: March 2008

Abstract:Recent angiographic studies after thrombolytic therapy have shown that the rates of effective coronary reperfusion (TIMI grade 3) is still quite low with currently available thrombolytic regimens. Approaches to improving thrombolytic efficacy include the development of mutants oft‐PA, recombinant staphylokinase and conjugations of thrombolytic agents to monoclonal antibodies targeted to components of the thrombus. The development of more potent conjugative antithrombolysis therapy includes newer antiplatelet agents and selective thrombin inhibitors such as hirudin and Hirulog. Clinical trials of these new approaches are now underway and hold hope for improvement of reperfusion efficacy in coronary thrombolysis.
Hirudin and Hirulog
Authors: White Harvey 
Published: March 2008

Abstract:A brief outline is presented of a proposed trial of Hirulog versus heparin after thrombolytic therapy with streptokinase (SK). The lower patency rates achieved with SK compared with tissue plasminogen activator (t‐PA) suggest that a potent thrombin specific agent may be more important for SK than for t‐PA therapy. This study will involve more than 400 patients with two dose levels of Hirulog. Endpoints will be angiographic patency, and ST segment monitoring showing evidence of coronary reperfusion.
The cost‐effectiveness of treatment of supraventricular arrhythmias related to an accessory atrioventricular pathway: comparison of catheter ablation, surgical division and medical treatment
Authors: Weerasooriya H. Rukshen , Murdock C. J. , Harris A. H. , Davis M. J. E. 
Published: March 2008

Abstract Background: Treatment alternatives for patients with incapacitating supraventricular arrhythmias related to an accessory atrioventricular pathway include transcatheter radiofrequency (RF) ablation, surgical division and long‐term antiarrhythmic therapy (medical). Aim: The aim of this study was to compare in terms of cost and efficacy, transcatheter, surgical and medical treatment of patients with incapacitating supraventricular arrhythmias resulting from an accessory pathway. Methods: The study population consisted of 52 patients who underwent transcatheter RF ablation (20 consecutive patients), surgical treatment (20) and medical treatment (12). Two types of economic analysis were used. In all groups, a resource based costing method was used and in the medical and surgical treatment groups, a diagnostic related group (DRG) based costing method was used. Results: Eighteen out of 20 (90%) patients who underwent catheter ablation remained asymptomatic during 8.4 ±1.6 months of follow‐up. All surgically treated patients remained asymptomatic during 54 ± 15 months of follow‐up. Only one of the 12 patients in the medical treatment group remained completely free of symptoms during the mean 58 ±23 month follow‐up period. The mean cost (1992 Australian dollars) per patient, calculated on the basis of actual resources used (with a DRG based costing given in brackets), was $2746 ±$800 for catheter ablation, $12141 ±$4465 ($12880 ±$3998) for surgical treatment and $1713 ±$748 ($1967 ±$33) for medical treatment. The total cost of management over 20 years is estimated to be: $2911 for catheter ablation, $17467 for surgery and $4959 for medical treatment. Conclusions: In the long term transcatheter RF ablation is the most cost‐effective treatment strategy for patients with incapacitating supraventricular arrhythmias related to an accessory pathway.