bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dendritic cell immunotherapy for patients with metastatic renal cell carcinoma: University of Tokyo experience
Authors: Azuma Takeshi , Horie Shigeo , Tomita Kyoichi , Takahashi Tsuyoshi , Tanaka Yuji , Kashiwase Koichi , Nieda Mie , Takeuchi Takumi , Ohta Nobutaka , Shibata Yoichi , Hirai Hisamaru , Kitamura Tadaichi 
Published: March 2003

AbstractBackground : Dendritic cells (DC) are the most potent antigen‐presenting cells and induce host antitumor immunity through the T‐cell response. A clinical study of immunotherapy using cultured DC loaded with tumor antigen, for patients with metastatic renal cell carcinoma (RCC) was performed.Methods : Dendritic cells were generated by culturing monocytes from peripheral blood for 7 days in the presence of granulocyte–macrophage colony‐stimulating factor and interleukin‐4. On day 6 the DC were pulsed with lysate from autologous tumor as the antigen and with keyhole limpet hemocyanin (KLH) as immunomodulator. The patients were given four doses of lysate‐pulsed DC by intradermal injection with a 2‐week interval between doses. Clinical effect and immune response were, respectively, evaluated by radiological examination and delayed‐type hypersensitivity (DTH) test.Results : Three patients were enrolled and the immunotherapy was well tolerated without significant toxicity. The vaccination induced a positive DTH reaction to tumor lysate in two patients and to KLH in all patients. Clinical responses consisted of one case of no change and two cases of progression of disease. However, we did not see a significant reduction of tumor volume in any case.Conclusion : Dendritic cell vaccination can safely induce an immunological response against RCC. Further trials are needed to fully evaluate its efficacy.
Fertility reduced by immunization with p84: A human sperm‐coating antigen in the mouse
Authors: Sato Itaru , Mukai Toshiji 
Published: March 2003

Background: p84 is an 84‐kDa protein with the ABO (H) antigenic epitope, and it is also a member of the family of sperm‐coating antigens. In order to investigate whether the antibodies against p84 reduce fertility in mice, p84 and lactotransferrin (Lf), whose N‐terminal sequence is similar to that of p84, were injected into female mice.Results: When p84 was used as the immunogen, the fertilization ratio was 37.5% lower than that of female mice immunized with no antigen (control group;P < 0.01). When Lf was used as the immunogen, there was no significant difference in the fertilization ratio between the Lf and control groups. Sera from female mice immunized with these antigens showed no agglutination against human erythrocytes, suggesting that the ABO(H) determinant site on p84 is not the factor reducing fertility. Although the titer of antibody (IgG) against p84 in serum from female mice immunized with p84 was generally higher than that against Lf, the titer was not related to the reduction of fertility.Conclusion: We conclude that an injection of p84 can reduce the fertility of female mice by inducing antibodies against p84. Our results suggest that the antibodies may act to inhibit the sperm–egg interaction, and that the binding site is the carbohydrate chain of p84, excluding the ABO (H) antigenic epitope, rather than the p84 protein itself. (Reprod Med Biol 2002;1: 35–39)
Myasthenia gravis with thymoma is more common in the Maori and Pacific Island populations in New Zealand
Authors: Fink J. N. , Wallis W. E. , Haydock D. A. 
Published: March 2003

Abstract Background: The association of myasthenia gravis (MG) with thymoma is well recognized. Our clinical impression has been that MG associated with thymoma may be more common in patients of Polynesian descent than in other races. Aim: To determine the influence of ethnicity on the association of MG with thymoma in our population. Method: Review of all cases of thymectomy performed at Greenlane Hospital in Auckland for the 20‐year period from June 1978 to June 1998. Results: There were 103 thymectomies performed in the study period. Fifty‐five thymomas were identified, 15 in subjects of Maori or Pacific Island ethnicity and 40 in subjects of other races, predominantly Caucasian. Ten of 15 Maori or Pacific Island subjects with thymoma had MG (67%), compared with 15 of 40 subjects of other races (37.5%, P = 0.05). The mean age of Maori or Pacific Island subjects with thymoma and MG was 42.5 years, compared with 56.3 years in subjects from other races (P = 0.06). All five Maori and Pacific Island subjects with invasive thymoma had MG, whereas only four of 15 subjects (27%) from other races with invasive tumours had MG (P < 0.01). The overall incidence of thymoma and the proportion of thymomas that were invasive did not differ between the ethnic groups. Conclusions: Myasthenia gravis with thymoma occurs more frequently among Maori or Pacific Island people than in other racial groups in our population. This is due to an increase in the proportion of cases with thymoma who have MG in this group, while the overall frequency of cases of thymoma is similar between groups. MG with thymoma in the Maori or Pacific Island populations also presents at a younger age and is more often associated with tumour invasion. (Intern Med J 2001; 31: 206–210)
Early Australian experience with infliximab, a chimeric antibody against tumour necrosis factor‐α, in the treatment of Crohn’s disease: is its efficacy augmented by steroid‐sparing immunosuppressive therapy?
Authors: Mortimore M. , Gibson P. R. , Selby W. S. , Radford‐Smith G. L. , Florin T. H. J. ,   THE INFLIXIMAB USER GROUP
Published: March 2003

Abstract Background: Tumour necrosis factor‐α (TNF‐α) plays an important role in the pathology of Crohn’s disease. Infliximab, a chimeric antibody against TNF‐α, has been shown in controlled clinical trials to be effective in two‐thirds of patients with refractory or fistulating Crohn’s disease. The factors that determine a clinical response in some patients but not others are unknown. Aims: To document the early Australian experience with infliximab treatment for Crohn’s disease and to identify factors that may determine a beneficial clinical response. Methods: Gastroenterologists known to have used infliximab for Crohn’s disease according to a compassionate use protocol were asked to complete a spreadsheet that included demographic information, Crohn’s disease site, severity, other medical or surgical treatments and a global clinical assessment of Crohn’s disease outcome, judged by participating physicians as complete and sustained (remission for the duration of the study), complete but unsustained (remission at 4 weeks but not for the whole study) or partial clinical improvement (sustained or unsustained). Results: Fifty‐seven patients were able to be evaluated, with a median follow‐up time of 16.4 (4–70) weeks, including 23 patients with fistulae. There were 21 adverse events, including four serious events. Fifty‐one patients (89%) had a positive clinical response for a median duration (range) of 11 (2–70) weeks. Thirty patients (52%) had a remission at 4 weeks, 10 of whom had remission for longer than 12 weeks. Forty‐two per cent of fistulae closed. Sustained remission (P = 0.065), remission at 4 weeks (P = 0.033) and a positive clinical response of any sort (P = 0.004) were more likely in patients on immunosuppressive therapy, despite there being more smokers in this group. Conclusion: This review of the first Australian experience with infliximab corroborates the reported speed and efficacy of this treatment for Crohn’s disease. The excellent response appears enhanced by the concomitant use of conventional steroid‐sparing immunosuppressive therapy. (Intern Med J 2001; 31: 146–150)
Prevalence survey of multiple sclerosis in the Australian Capital Territory
Authors: Simmons R. D. , Hall C. A. , Gleeson P. , Everard G. , Casse R. F. , O'Brien E. D. 
Published: March 2003

Abstract Aim: This study sought to obtain an estimate of the prevalence of multiple sclerosis (MS) in the Australian Capital Territory (ACT), a largely urban region that differs climatically and socioeconomically from other Australian cities examined in previous MS surveys. Methods: Prevalence day was chosen to coincide with the 1996 National Census. All ACT neurologists’ records for the previous 5 years were examined and cases of MS were classified according to the published diagnostic criteria of Rose et al. and Poser et al. Results: By the criteria of Rose et al., as used in previous Australian surveys of MS, prevalence was 79.9/100 000 (95% confidence interval (CI) = 63.4–99.2) for females, 32.8 (22.7–46.2) for males and 56.7 (43.1–74.1) for all people, standardized to the 1996 population. Standardized to the 1981 population for direct comparison with 1981 surveys in New South Wales, the prevalence of MS in the ACT was still unexpectedly high, particularly for females. Using the criteria of Poser et al., the prevalence of MS standardized to the 1996 population was 70.6/ 100 000 (95% CI = 58.4–85.3) for females, 28.0 (20.3–37.8) for males and 49.5 (42.2–58.2) for all people. There was evidence from a relatively short duration of disease in the ACT sample that some persons with long‐standing MS had been missed in the survey and therefore that the prevalence of MS observed in the ACT was an underestimate. Conclusions: The survey found an unexpectedly high prevalence of MS in the ACT. Possible reasons for this are discussed. There was no evidence that the advent of magnetic resonance imaging had increased the numbers of persons diagnosed with MS in the present survey. (Intern Med J 2001; 31: 161–167)
Factors influencing the uptake of technologies to minimize perioperative allogeneic blood transfusion: an interview study of national and institutional stakeholders
Authors: Treloar C. J. , Hewitson P. J. , Henderson K. M. , Harris G. , Henry D. A. , McGrath K. M. 
Published: March 2003

Abstract Background: Alternatives to allogeneic blood transfusion exist and are being used to varying extents in Australian hospitals. Evidence on effectiveness and cost‐effectiveness is generally inconclusive and provides a suboptimal basis for policy development. Aim: To describe the influences on uptake of transfusion technologies as perceived by national and institutional stakeholders. Methods: Qualitative interview study. Interview transcripts were coded and analysed independently by at least two researchers. Participants had opportunity to comment on their transcript and the manuscript. Results: A total of 71 interviews were conducted with representatives of the media, specialist medical societies, consumer special interest groups, the Australian Red Cross Blood Service (ARCBS), government, private health insurers, technology manufacturers, prominent clinicians in the area and a sample of clinicians drawn from hospitals with variable use of blood‐saving technologies. Technical advances and acceptance of lower transfusion triggers were identified as the main influences on the decrease in use of allogeneic blood transfusion in the past decade. Participants indicated that patients were most aware and supportive of autologous predonation. Participants noted that ‘enthusiasts’ were involved in educating about the need for alternatives, negotiating resourcing and maintaining the use of a technology. Funding mechanisms were seen as main barriers to use of alternatives. A discrepancy was noted in the rigour of evaluation and regulation of pharmaceuticals and devices/procedures. Conclusions: Uptake of blood transfusion technologies by institutions was dependent mostly on funding arrangements and the presence of an ‘enthusiast’. Critical review of the evidence for effectiveness or cost‐effectiveness of these technologies was rarely mentioned. Opportunities exist for evidence‐based medicine principles to play a greater role in policy decisions in this area. (Intern Med J 2001; 31: 230–236)
Randomized controlled trial of two cigarette quit programmes in coronary care patients after acute myocardial infarction
Authors: Feeney G. F. X. , McPherson A. , Connor J. P. , McAlister A. , Young R. M. , Garrahy P. 
Published: March 2003

Abstract Background: Tobacco cessation after acute myocardial infarction (AMI) substantially improves outcome but how effective individual programmes are needs to be established. To date, few studies have examined this factor. Aims: To assess the outcome of two smoking cessation programmes after AMI. Methods: One hundred and ninety‐eight current smokers admitted to coronary care with an AMI participated in a randomized controlled study comparing two outpatient tobacco interventions, the Stanford Heart Attack Staying Free (SF) programme and a Usual Care (UC) programme. Results: Log–rank analyses revealed that patients in the SF programme were retained longer (P < 0.001) and had higher cotinine validated abstinence rates (P < 0.001) compared with patients in the UC programme. Twelve months after intervention, 39% of the SF programme compared with 2% of the UC programme demonstrated cotinine validated tobacco cessation, representing a significant reduced relapse rate in the SF programme (χ2, P < 0.001). Conclusions: The SF smoking cessation programme initiated in hospital can significantly reduce smoking rates at 12 months after myocardial infarction. Although superior to the UC quit programme, Australian outcomes were lower than the American programme originators’ published outcomes. (Intern Med J 2001; 31: 470–475)
Evaluation of clinical guidelines for the management of Staphylococcus aureus bacteraemia
Authors: Blyth C. C. , Darragh H. , Whelan A. , O’Shea J. P. , Beaman M. H. , McCarthy J. S. 
Published: March 2003

Abstract Background: While treatment guidelines have been developed to guide the management of Staphylococcus aureus bacteraemia, there is a need to validate these guidelines in different clinical settings and to relate the effect of compliance to clinical outcome. Aims: To assess the impact of adherence to treatment guidelines on clinical outcome and to explore the role of transoesophageal echocardiography (TOE) in risk stratification. Methods: We undertook a 2‐year mixed retrospective and prospective study of all cases of S. aureus bacteraemia at Fremantle Hospital, documenting the clinical and microbiological features of each case, the results of echocardiography, adherence with published clinical guidelines and clinical outcome. Results: Failure to comply with guidelines was observed in 41% (38 of 93) of cases, the majority receiving abbreviated treatment. An
increased rate of relapse was observed among patients who received inadequate therapy (5/38 vs 1/55; P = 0.04). Ten of 28 eligible patients underwent TOE and the test led to significant changes in management in two of those cases. Conclusions: While non‐adherence with clinical guidelines was associated with an increased risk of relapse, the role of TOE in risk stratification was limited by factors including cost, limited acceptance of the test and the need for prolonged therapy for other indications. (Intern Med J 2002; 32: 224−232)
Doctors’ beliefs on the use of antithrombotic therapy in atrial fibrillation: identifying barriers to stroke prevention
Authors: Peterson G. M. , Boom K. , Jackson S. L. , Vial J. H. 
Published: March 2003

Abstract Aims: To assess the attitudes of Australian doctors towards the use of antithrombotic drug therapy for stroke prevention in patients with non‐valvular atrial fibrillation (AF), and investigate the barriers to prescribing warfarin. Methods: A postal survey was undertaken among approximately 10% of all registered general practitioners (GPs), cardiologists and physicians in Australia. The anonymous questionnaire used case scenarios to assess doctors’ knowledge of current guidelines for the therapeutic management of AF and sought opinions on potential barriers to the use of anticoagulation. Results: Completed questionnaires were received from 711 doctors (30% response rate). The GPs performed better than the cardiologists and other specialists in estimating the risk of stroke in case scenarios. However, the cardiologists were more likely to select the recommended treatment, with GPs being more hesitant to use anticoagulation and tending to underestimate its reported benefit for stroke prevention in non‐valvular AF. The GPs were also more likely to overestimate the reported risk of major bleeds with warfarin. In contrast, over one‐third of the cardiologists went as far as to give warfarin to a low‐risk patient and they were more likely to overestimate the reported benefit of aspirin and warfarin in AF. Only half the doctors correctly classified a patient without a previous stroke (but with other risk factors) as being at high risk. Increased experience as a registered medical practitioner was generally related to a poorer performance on classifying patients according to the risk of stroke. The principal barriers to the use of anticoagulation were nominated as: (i) active gastrointestinal bleeding, (ii) previous intracranial haemorrhage, (iii) alcoholism, (iv) a history of daily falls, (v) liver disease, (vi) severe anaemia and (vii) concurrent use of non‐steroidal anti‐inflammatory drugs. Conclusion: There is scope for improvement in doctors’ knowledge about the appropriate use of antithrombotic drug therapy in non‐valvular AF and awareness of the results of recent clinical trials. Compilation and dissemination of clear guidelines and focused education on some of the other risk factors (apart from previous stroke or transient ischaemic attacks) in patients with non‐valvular AF are important strategies for targeting barriers to the use of anticoagulation for stroke prevention. (Intern Med J 2002; 32: 15–23)
Renin‐angiotensin system inhibition: how much is too much of a good thing?
Authors: Campbell D. J. 
Published: March 2003

Abstract Inhibitors of the renin‐angiotensin system (RAS) are valuable therapeutic agents for a wide range of clinical conditions. Increasingly, consideration is being given to the combination of angiotensin‐converting enzyme (ACE) inhibitors and angiotensin‐II receptor (AR) antagonists to obtain more complete inhibition of the RAS than can be achieved by either agent alone. Beta‐blockers also inhibit the RAS by inhibiting renin secretion. Whereas the combination of an ACE inhibitor and AR antagonist represents dual RAS inhibition, the combination of both of these agents with beta‐blocker therapy represents triple RAS inhibition. Animal studies indicate that complete blockade of the RAS produces adverse effects. Moreover, post‐hoc analysis of the recent Valsartan Heart Failure Trial study suggests that the combination of ACE inhibitor and AR antagonist therapies may have an adverse effect in heart failure when combined with beta‐blocker therapy. There is therefore a need for caution in the combination of ACE inhibition and AR antagonism, particularly in patients receiving beta‐blockers, until the impact of this strategy is evaluated. (Intern Med J 2002; 32: 616−620)
Postdural puncture headache is not an age‐related symptom in children: a prospective, open‐randomized, parallel group study comparing a22‐gauge Quincke with a 22‐gauge Whitacre needle
Authors: Kokki Hannu , Salonvaara Marjut , Herrgård Eila , Onen Pekkariik 
Published: March 2003

SummaryMany reports have shown a low incidence of postdural puncture headache (PDPH) and other complaints in young children. The objective of this open‐randomized, prospective, parallel group study was to compare the use of a cutting point spinal needle (22‐G Quincke) with a pencil point spinal needle (22‐G Whitacre) in children. We studied the puncture characteristics, success rate and incidence of postpuncture complaints in 57 children, aged 8 months to 15 years, following 98 lumbar punctures (LP). The patient/parents completed a diary at 3 and 7 days after LP. The response rate was 97%.The incidence of PDPH was similar, 15% in the Quincke group and 9% in the Whitacre group (P=0.42). The risk of developing a PDPH was not dependent on the age (r < 0.00, P=0.67). Eight of the 11 PDPHs developed in children younger than 10 years, the youngest being 23‐months‐old.
Paediatric head injury: incidence, aetiology and management
Authors: Hiu Lam W. , Mackersie Angela 
Published: March 2003

SummaryTrauma is the commonest cause of hospital admission in children. Head injuries are present in 75% of children with trauma and 70% of all traumatic deaths are due to the head injury. The mechanism of brain injury is examined, resulting from the effects of the primary insult and secondary ischaemic damage. Therapeutic interventions will be discussed with specific emphasis on outcome studies. However, institution of adequate oxygen delivery and haemodynamic stability in the child at the earliest moment remains the most important aspect of the management plan.
Quality of sedation during mechanical ventilation
Authors: Playfor S.D. , Thomas David A. , Choonara Imti , Jarvis Anita 
Published: March 2003

SummaryThe aim of the study was to determine the quality of sedation in ventilated patients on a general paediatric intensive care unit (PICU), including those treated with infusions of neuromuscular blocking agents. Twenty‐eight ventilated children on a PICU had their level of sedation determined using an arousability scale dependent upon the response to tracheal suction. Observed levels of sedation were then compared to a predetermined desired level of sedation. A total of 81 assessments were performed and 90% were considered satisfactory. Thirty‐two of these assessments were performed in 15 children following the temporary discontinuation of infusions of neuromuscular blocking agents; 97% of these assessments were considered satisfactory. A regime of continuous intravenous midazolam and morphine with additional oral sedation using chloral hydrate and antihistamines when required provides a satisfactory level of sedation for the majority of children ventilated on a PICU, including those treated with infusions of neuromuscular blocking agents.
A comparison of four methods for assessing oropharyngeal leak pressure with the laryngeal mask airway (LMA™) in paediatric patients
Authors: Lopez‐Gil M , Brimacombe J , Keller C 
Published: March 2003

Background: This study compares four tests for assessing oropharyngeal leak pressure with the laryngeal mask airway (LMA™). We tested the hypothesis that the oropharyngeal leak pressure and interobserver reliability differs between tests. Methods: Eighty paralysed anaesthetized paediatric patients (weight 10–30 kg) were studied with the intracuff pressure set at 60 cmH2O. Four different oropharyngeal leak pressure tests were performed in random order on each patient by two observers blinded to each other’s measurements. Test 1 involved detection of an audible noise. Test 2 involved detection of endtidal CO2 in the oral cavity. Test 3 involved observation of the aneroid manometer dial as the pressure increased and noting the airway pressure at which the dial reaches stability. Test 4 involved detection of an audible noise by neck stethoscopy. Results: The mean oropharyngeal leak pressure was 12.5 cmH2O and was similar between tests. The intraclass correlation coefficient was 0.99 for all tests and was classed as excellent. Conclusions: We conclude that all four tests provide accurate and reliable information about oropharyngeal leak pressure in children.
A prospective randomized controlled study of the efficacy of ketamine for postoperative pain relief in children after adenotonsillectomy
Authors: Aspinall R L , Mayor A 
Published: March 2003

Background: Adenotonsillectomy is commonly needed by children with obstructive sleep apnoea syndrome. This population is at high risk of life threatening airway obstruction in the postoperative period.Methods: Fifty children were studied to test the efficacy of an alternative analgesic to the use of opioids in providing analgesia in the immediate postoperative period. Patients were randomized to receive either 0.1 mg·kg–1morphine or 0.5 mg·kg–1ketamine at induction.Results: Ketamine was as effective as morphine with no additional side‐effects.Conclusions: Ketamine is a safe and effective alternative to morphine to provide analgesia in the immediate postoperative period after tonsillectomy.