Wiley
0004-8291
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Involvement of the Skin and Subcutaneous Tissue in Azotaemic Hyperparathyroidism
Tập 2 Số 2 - Trang 142-147 - 1972
Acute stroke outcome: effects of stroke type and risk factors Abstract: We studied 925 consecutive patients hospitalised with acute stroke to determine how stroke type, age, gender and risk factors influence acute, in‐hospital outcome. Stroke types included carotid territory cortical or large subcortical infarction (52%), vertebrobasilar infarction (12%), lacunar infarction (11%), intracerebral haemorrhage (16%), and subarachnoid haemorrhage (9%). Mean age (mean ± 1 SD) was 66 ± 15 years, but patients with cerebral infarction were older than those with cerebral haemorrhage. The prevalence of hypertension, diabetes mellitus and cardiac disease increased with age across all stroke types, while the prevalence of smoking decreased with age. Mortality was 19% overall, but varied significantly between stroke types, highest in intracerebral haemorrhage (34%), and lowest in lacunar infarction (1%). Age had a marked adverse effect on mortality, independent of stroke type, the probability of death increasing by 3 ± 0.5% per year from 20–92 years, whereas gender had no effect. Cardiac disease and diabetes were independent adverse prognostic factors (Odds Ratios 1.6 and 1.5 respectively). Cerebral haemorrhage, age, cardiac disease and diabetes all independently worsen acute stroke outcome. (Aust NZ J Med 1992; 22: 30–35.)
Tập 22 Số 1 - Trang 30-35 - 1992
INTERMITTENT CLAUDICATION: A DOUBLE–BLIND CROSSOVER TRIAL OF PENTOXIFYLLINE Abstract: The influence of the xanthine derivative pentoxifylline (‘Trental’ or BL191; Hoechst–Roussel) on exercise tolerance was measured in 38 subjects with stable, severe to moderately severe, intermittent claudication who completed a randomised, double–blind, placebo controlled, cross–over clinical trial. Patients received placebo tablets or 400 mg slow–release pentoxifylline tablets (‘Trental 400’) twice a day for one week, followed by three times daily for seven weeks, and then crossed over to receive the alternate preparation for another eight weeks.Claudication distance and walking distance were measured on a treadmill before starting treatment and again at four–week intervals during the trial. At the same times, red blood cell filterability, plasma fibrinogen concentration and blood viscosity, resting and post–ischemic calf muscle blood flow, and the resting and post–exercise ankle/brachial systolic pressure ratio were also measured. In this study, the observed effects of pentoxifylline treatment were no greater than those of placebo, even though serum levels of pentoxifylline and its hydroxy–metabolite were within the anticipated range. This was shown by a ‘therapeutic effect ratio’ of 0.98 for treadmill claudication distance and 0.96 for treadmill walking distance after within–patient analysis at the end of the cross–over (where a ratio of 1.0 means the test drug and placebo effects are identical). These ratios have 95% confidence limits of 0.72–1.34 and 0.74–1.25, respectively.
Tập 15 Số 4 - Trang 402-409 - 1985
THE SYDNEY AIDS PROJECT: DEVELOPMENT OF ACQUIRED IMMUNODEFICIENCY SYNDROME IN A GROUP OF HIV SEROPOSITIVE HOMOSEXUAL MEN Abstract: The Sydney AIDS Project is a prospective immunoepidemiological study of 996 homosexual/bisexual men enrolled between February 1984 and January 1985. By January 1987, 32 of 386 homosexual men who were seropositive at enrolment in the study had developed AIDS, yielding a crude progression rate of between 2.8% and 4.2% per annum. Of these subjects, 23 (72%) developed AIDS within 12 months of enrolment. In univariate analysis, the only lifestyle differences between seropositive subjects who progressed to AIDS and those that did not progress were less frequent oral sex activity and more use of marijuana in the three months prior to enrolment. In multivariate analysis, seropositive subjects who progressed to AIDS were more likely to have a lower percentage of CD4+ cells, a higher percentage of CD8+ cells and to have used marijuana in the three months prior to enrolment than the seropositive subjects who did not progress. No HIV seropositive subject who was asymptomatic and had normal T‐cell subsets at enrolment had developed AIDS by January 1987. Persistent generalised lymphadenopathy was not associated with progression to AIDS. Although there are a number of lifestyle factors that may be associated with HIV infection, this study did not implicate most of these in the progression of HIV seropositive subjects to end‐stage AIDS. We conclude that antecedent changes in T‐cell subsets are associated with progression to AIDS and we emphasise the prognostic value of enumeration of T‐cell subsets in HIV seropositive persons. (Aust NZ J Med 1988; 18: 8–15).
Tập 18 Số 1 - Trang 8-15 - 1988
Mitochondrial Myopathy with Cardiomyopathy, Lactic Acidosis and Response to Prednisone and Thiamine Summary Clinical, biochemical and pathological findings are described in a 23‐year‐old male with a mitochondrial myopathy who had a high‐output circulatory state and cardiomyopathy which resulted in cardiac insufficiency 11 years before presentation of the skeletal myopathy. Venous lactate levels were elevated and severe lactic acidosis developed at one stage of the illness. Electron microscopy of muscle tissue showed various mitochondrial abnormalities and accumulation of neutral lipids which was confirmed histochemically and by thin‐layer chromatography. Marked improvement in the myopathy occurred after commencement of prednisone and thiamine and was maintained following withdrawal of these drugs. The metabolic defect in this case has not been defined, but an abnormality in the Kreb's cycle or cytochrome chain with secondary over‐production of lactate and lipid accumulation in muscle is postulated.
Tập 10 Số 6 - Trang 660-664 - 1980
A controlled trial of a killed Haemophilus influenzae vaccine for prevention of acute exacerbations of chronic bronchitis Abstract Sixty‐four patients with chronic bronchitis with a history of recurrent respiratory tract infections were admitted to a double‐blind randomised controlled study in which the efficacy of an oral vaccine containing killed Haemophilus influenzae in preventing acute exacerbations of chronic bronchitis was compared with placebo. Patients given vaccine developed fewer acute infective episodes. Although the numbers of patients who required antibiotic therapy in the two groups were not significantly different, the number of antibiotic prescriptions given to the vaccinated group of patients was significantly less than that required by the control group. A reduction in colonisation with Haemophilus influenzae occurred in the active group, which was maximal 14 weeks after the onset of the study. (Aust NZ J Med 1991; 21: 427–432.)
Tập 21 Số 4 - Trang 427-432 - 1991
MANTLE IRRADIATION FOR STAGE I AND STAGE II HODGKIN'S DISEASE – RESULTS OF A 10 YEAR EXPERIENCE Abstract: One hundred and thirty patients with Stage I and II supradiagphragmatic Hodgkin's disease treated with mantle irradiation alone at the Peter MacCallum Hospital, Melbourne between 1968–1977 were analysed retrospectively. The median followup was 7.4 years with a minimum of three years.There were 64 clinically staged (CS) and 66 pathologically staged (PS) patients. The major difference between the two groups was the transdiaphragmatic relapse which occurred in 33% of CS patients, and 7.5% in PS patients. The actuarial five year relapse free survival (RFS) was 48% for CS patients and 67% for PS patients, but the five year overall survival was 90% for both groups, reflecting the impact of salvage treatment. Avid attention must be given to radiotherapy techniques to minimise local treatment failures. High grade nodular sclerosis Hodgkin's disease is associated with poor RFS even after adjustment has been made for stage and constitutional symptoms (p < 0.003). Further studies will be made on this group of patients who may benefit from combined modality treatment. For PS I and II patients mantle irradiation gives a five year RFS of 67%, thus offering potential for cure in these patients.
Tập 13 Số 2 - Trang 135-140 - 1983
Allergic bronchopulmonary fungal disease caused by Bipolaris and Curvularia Abstract Allergic bronchopulmonary fungal disease (ABPFD) usually manifests in asthmatics as allergic bronchopulmonary aspergillosis. In a few instances other fungi have been implicated. Serological testing in Western Australia between 1979 and 1986 revealed precipitins to Bipolaris and Curvularia species in 40 of 503 patients tested. Eight of these were patients with ABPFD due to Bipolaris and/or Curvularia and are reported here.Geographical location appeared to be significant as seven of eight of those with ABPFD (and at least 18 of 40 with positive serology) were living in the more remote and sub‐tropical northern part of the state. ABPFD due to fungi other than Aspergillus species may be more common than previously recognised and further epidemiological assessment is warranted. (Aust NZ J Med 1991; 21: 871–874.)
Tập 21 Số 6 - Trang 871-874 - 1991
THE NEUROLOGICAL FEATURES OF EARLY AND ‘LATENT’ HUMAN IMMUNODEFICIENCY VIRUS INFECTION Abstract Neurological manifestations of unknown cause occurring in patients who become or are HIV antibody positive with presumed normal immune function have been described recently. This report adds a further six cases, all of whom had normal CD4 + cell counts either throughout the period of observation or after the episode of seroconyersion. Three had an acute presentation, two in the context of documented seroconversion consisting of one of the following: an encephalitis, an ataxia, and confusion with neuralgic amyotrophy. Three had a subacute disorder occurring at a later phase of HIV infection but before opportunistic infections or neoplasms, and marked by a static mild cognitive deficit. This report extends the range of abnormalities that may be seen at seroconversion and documents the presence of a non‐progressive cognitive deficit occurring in the latent phase of HIV infection.
Tập 19 Số 6 - Trang 700-705 - 1989
The Aetiology of the Sudden Infant Death Syndrome: Current Ideas on Breathing and Sleep and Possible Links to Deranged Thiamine Neurochemistry Summary: The aetiology of the sudden infant death syndrome: Current ideas on breathing and sleep and possible links to deranged thiamine Neurochemistry.The sudden infant death syndrome (SIDS) is now the commonest cause of death between one week and one year of age in most western countries. An asphyxia/ death, with unrecognised hypoxic episodes during sleep in the preceding weeks, has been postulated from autopsy evidence for both acute and chronic hypoxia; the evidence includes Po2 values, intra‐thoracic distribution of petechiae, pulmonary arteriolar and right ventricular hypertrophy. Long‐term monitoring of infants resuscitated from a “near miss” SIDS demonstrates sleep apnoea, sometimes associated with episodic collapse and obstruction of the upper airway. Physiological studies in healthy babies and animals highlight factors leading to vulnerability to asphyxia in different phases of sleep. In REM‐sleep (rapid‐eye‐movement), inhibition of intercostal muscle activity leads to: inspiratory collapse of the rib‐cage, impaired reflex compensation for airway obstruction, overall lung‐deflation with reduction of O2 ‐stores and rapid hypoxaemia during apnoea. In REM‐sleep, breathing efforts are not augmented by hypercapnia and the defense against asphyxia depends on reflex responses to hypoxia. Sleep apnoea sometimes occurs in infants with a rare congenital defect of brain thiamine triphosphate. This draws attention to many similarities of modern SIDS and other infantile syndromes reported historically which involve deranged thiamine neurochemistry. Sudden unexpected deaths occur in apparently thriving infants of asymptomatic thiamine deficient mothers. Other similarities include: a peak incidence at 2–4 months of age; precipitation often by minor febrile episodes; seasonal and familial risk factors, with increased risk in twins; many common findings at autopsy. Although asymptomatic maternal thiamine deficiency is common in western communities ingesting high carbohydrate diets containing various thiamine antagonists, the effect on infant thiamine stores has received little attention. Future research is needed to evaluate SIDS incidence after identification and elimination of low thiamine states. Defective neural control of breathing during sleep should be evaluated in relation to thiamine‐neurochemistry, particularly to the leaky blood‐brain barrier, to glutamate and GAB A, to sympathetic denervation and to defective vagal reflexes of the lungs and larynx.
Tập 8 Số 3 - Trang 322-336 - 1978