摘要:

SummaryAnalgesic abuse, renal parenchymal disease and carcinoma of the kidney or ureter. J. F. Mahony, B. G. Storey, R. C. Ibahez and J. H. Stewart, Aust. N.Z. J. Med., 1977, 7, pp. 463–469.In a consecutive series of 88 cases of carcinoma of the kidney and upper urinary tract seen at one hospital, 31 had malignant urothelial tumours of the renal pelvis or ureter. Forty‐two per cent of these transitional‐cell carcinomas occurred in patients with renal papillary necrosis following upon prolonged and heavy analgesic ingestion. Other possible aetiological factors were heavy cigarette smoking (61% of cases), long standing urinary obstruction or infection (23%) and possible occupational exposure (6%); in only four cases (13%) was there no identifiable aetiological factor. Those cases with analgesic nephropathy were characterised by renal functional impairment, hypertension and interstitial nephritis, but there was no difference in the clinical behaviour or pathological appearances of the tumours in the two groups.The clinical and experimental evidence that certain metabolites of phenacetin are carcinogenic is rev

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1977.tb03366.x

出版商:Blackwell Publishing Ltd    

年代:1977

数据来源: WILEY

摘要:

SummaryCigarette smoking in a cohort of Sydney schoolchildren: 1971–1974. S. R. Leeder, J. K. Peat, A. J. Woolcock and C. R. B. Blackburn, Aust. N.2. J. Med., 1977, 7, pp. 470–475.Cigarette smoking habits of a cohort of Sydney schoolchildren aged 12.13 years in 1971 have been recorded for four years. Smoking prevalence increased steadily over those years, 2–3% of boys and 0–5% of girls smoking 20 or more cigarettes a week at age 12.7 years in 1971, rising to 23‐6% of boys and 17‐6% of girls by age 15‐6 years in 1974. A substantial increase in smoking prevalence in children aged 156 years was found in 1974 compared with a similarly aged group studied by the National Health and Medical Research Council (Australia) Subcommittee on Smoking in 1968.1Quite a few children changed their smoking habits during the study. Children who changed or left schools smoked more than children who remained at the one school. Attacks of asthma or bronchitis were not related to smoking except that girls who were very heavy smokers reported more of these illnesses in 1974. No changes in lung function could be attributed to smoking by age 14‐6 years. New approaches to smoking need to be evaluated in view of its rising prevalence, especially among older

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1977.tb03367.x

出版商:Blackwell Publishing Ltd    

年代:1977

数据来源: WILEY

摘要:

Summary:Thiamine status in alcoholism. Beverley Wood, Kerry J. Breen and D. G. Penington, Aust. N.Z. J. Med., 1977, 7, pp. 475–484.The erythrocyte transketolase assay was used to seek biochemical evidence of thiamine deficiency in 265 alcoholic persons attending an inner city Australian hospital. Fifty patients were found to have recent vitamin therapy and were excluded from further study. Wernicke's encephalopathy was diagnosed in 24 subjects (11.3%). The thiamine pyrophosphate (TPP) effect was elevated in only 13 of the 24 patients with Wernicke's encephalopathy; a much closer correlation was observed with erythrocyte transketolase activity which was depressed in 21 persons with this diagnosis. Low erythrocyte transketolase activity (32.6%) was more frequently seen than an elevated TPP effect (24‐7%) in the overall group of 215 subjects. Of 47 patients with a low erythrocyte transketolase activity which failed to return to normal after the addition of TPP in vitro, only ten patients had liver disease. Twelve patients with Wernicke's encephalopathy studied following thiamine hydrochloride in vivo showed complete biochemical response despite the presence of biopsy proven severe liver disease in two patients and the lack of response of low erythrocyte transketolase activity to TPP in vitro in eleven of the twelve patients. Fiftyfive patients were studied before and after thiamine in vivo. Seventeen of these subjects had severe liver disease but only two of the 17 had low ETKA which failed to respond to TPP in vitro; both responded biochemically to thiamine hydrochloride in vivo. In the remaining 38 patients without evidence of severe liver disease, 14 had low ETKA which failed to return to normal with TPP in vitro; three of these failed to respond biochemically to thiamine hydrochloride in vivo. These data indicated that apparent deficiency of erythroc yte apotransketolase was infrequently linked with the presence of liver disease and that liver disease did not appear to interfere with the biochemical response to thiamine in vivo. Urinary thiamine excretion measured in 79 subjects did. not correlate with any means of expression of the transketolase assay or with clinical thiamine deficiency. It was concluded that the TPP effect was frequently misleading in subjects with gross thiamine deficiency (Wernicke'S encephalopathy) and it was suggested that erythrocyte transketolase activity may be the best parameter to use in assessing thiamine status with the erythrocyte transketolase assay. Finally, it is postulated that severe thiamine deficiency per se may lead to deficiency of erythrocyte apotransketolase which has been previously ascribed to liver dam

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1977.tb03368.x

出版商:Blackwell Publishing Ltd    

年代:1977

数据来源: WILEY

摘要:

SummaryThe effect of ethyl alcohol on striated muscle: some clinical and pathological observations. J. C. Walsh and A. B. Conomy, Aust. N.Z. J. Med. 1977, 7, pp. 485–490.Electrophysiological and pathological studies have been performed on three patients with recurrent focal swelling of the calf muscles simulating deep venous thrombosis, and in a patient with both cardiomyopathy and skeletal muscle disease. In all patients there were elevated CPK levels, histological evidence of an acute myopathy, heavy alcohol intake prior to the development of symptoms, and improvement in hospital with the cessation of alcohol consumption. These patients illustrate a form of alcoholic muscle disease which may be more common than generally realise

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1977.tb03369.x

出版商:Blackwell Publishing Ltd    

年代:1977

数据来源: WILEY

摘要:

Summary:The role of echocardiography in the assessment of chronic aortic regurgitation. H. J. Paoloni, D. E. L. Wilcken and M. J. Dadd, Aust. N.Z. J. Med. 1977, 7, pp. 491 ‐496.Thirty‐two patients with aortic regurgitation were assessed clinically and with echocardiography and were compared with 45 patients who proved to have normal cardiovascular function. When compared with normal subjects, patients with moderate and with severe aortic regurgitation had increased diastolic left ventricular internal dimensions determined by echocardiography –50 ± 0–3 cm (normal), 5‐5 ± 0–6 cm (moderate) and 6‐4 ± 0–6 cm (severe), (mean ± SD), respectively. In patients with aortic regurgitation and with “good” left ventricular function as demonstrated at angiography, left ventricular inward wall movement during systole was increased so that, as compared with the normal subjects, fractional shortening was higher in both moderate and severe aortic regurgitation– 34 ± 4% (normal), 39 ± 5% (moderate) and 40 ± 4% (severe) (mean ± SD), respectively. In patients with aortic regurgitation and impaired left ventricular function as demonstrated at angiography, there was reduced left ventricular wall motion shown with echocardiography; left ventricular internal diastolic dimensions were increased (6‐5 ± 0–5 cm) and fractional shortening was greatly reduced (22 ± 7%).Echocardiography allows a non‐invasive assessment of the severity of aortic regurgitation based on left ventricular size and extent of systolic shortening and identifies patients with aortic regurgitation and diminished left ventricular function. Sequential studies may detect changes in left ventricular function, thereby assisting in the accura

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1977.tb03370.x

出版商:Blackwell Publishing Ltd    

年代:1977

数据来源: WILEY

摘要:

SummaryPhysiological responses to maximal exercise in a normal Australian population. Comparative values in patients with anatomically defined coronary artery disease. A. F. Calvert, L. Bernstein and I. K. Bailey, Aust. N.Z. J. Med., 1977, 7, pp. 497–506.Maximum work capacities, heart rate and blood pressure responses were obtained from 200 male and 124 female, clinically normal subjects aged 16–62 years. Exercise was performed on a bicycle ergometer with workload increments of 100 kpm/min each minute to the limit of tolerance. Maximum work capacity (W.Max) for men related most closely to age and height (P<0005, r=06), with weight an insignificant additional correlate (P<0–1). Regression equation for W.Max (men) =15‐4 height (cm) – 11‐8 age (years) – 961(± 220 SE) kpm/min. W.Max for women related to age and weight (P<0005, r = 0.67). Regression equation for W.Max (women) = 5‐4 weight (kg) –10 age (years) + 785 (± 137 SE) kpm/min. Maximum heart rate (HR.Max) was only age related. HR.Max (men) = 201 – 0.6 age (±12 SE)/min and HR.Max (women) = 192 – 0–7 age (±12 SE)/min. Blood pressure rise from rest to maximum exercise averaged 60/9 and 38/10 mmHg for men and women respectively.A nomogram for predicting normal maximum work capacities and heart rates is presented.Maximum work capacities and development of ischaemic ST segment changes with bicycle exercise were evaluated in WO patients with angiographically proven coronary artery disease. W.Max related primarily to the severity of disease, with reductions to 70%, 61% and 50% of predicted values in single, double and triple coronary disease respectively. When performance was limited by angina values were 6–11% lower, and when limited by fatigue or dyspnoea, 7–9% higher than the mean values for each coronary artery disease group.Ischaemic ST segment changes occurred in 77% of patients without previous infarction, and 58% of post infarct subjects. Both intra and post exercise ECG monitoring proved essential since diagnostic ST changes were confined to exercise in 25% of patients, and to

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1977.tb03371.x

出版商:Blackwell Publishing Ltd    

年代:1977

数据来源: WILEY

摘要:

Summary:Electromyographic (EMG) study in thyrotoxic periodic paralysis. K. Puvanendran, J. S. Cheah and P. K. Wong, Aust. N.Z. J. Med., 1977, 7, pp. 507–510.Thyrotoxic periodic paralysis (TPP) is produced by a different metabolic disorder than familial periodic paralysis.1,2In the familial disorder, a myopathic cause is well known, but although electromyography can be used to demonstrate the site of the lesion in TPP, such studies are rare in the medical literature and the results are conflicting.In this report, EMG studies were carried out on eight Chinese patients with thyrotoxic periodic paralysis during the attack and the results compared with studies repeated during a remission. Most cases showed a myopathic pattern during an attack of paralysis which disappeared during remission. The myopathic changes noted were a decrease in duration of muscle action potentials, an increase in po/yphasic potentials, a satisfactory interference pattern with reduced amplitude and a reduced amplitude of the evoked muscle action potential on nerve stimulation.Peripheral nerve function was normal in the cases studied.It is concluded that the weakness in TPP is myopathic and that the peripheral nerve function during paralysis is norma

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1977.tb03372.x

出版商:Blackwell Publishing Ltd    

年代:1977

数据来源: WILEY

摘要:

Summary:Demonstration of surgical portasystemic venous shunts by scintisplenoportography. F. J. Dudley, C. L. Wong and L. M. Dugdale, Aust. N.Z. J. Med., 1977, 7, pp. 511–514.Scintisplenoportography (SSP) was used to assess shunt patency in 15 patients with surgically created portasystemic venous shunts and proved to be a simple, safe and accurate technique for demonstrating the patency of both mesocaval “H” grafts and distal lienorenal shunts. SSP was as accurate as angiography in confirming shunt patency but was simpler to perform and resulted in less radiation exposure to the patient. The direction and distribution of blood flow within the splanchnic venous system was different to that obtained by angiography. It is postulated that SSP may well reflect portal haemodynamics more accurately than angiography. In patients with patent mesocaval “H” grafts SSP demonstrated the complete diversion of splanchnic venous blood through the shunt into the systemic venous circulation. This suggests that the mesocaval “H” graft is haemodynamica/ly similar to other side to side port

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1977.tb03373.x

出版商:Blackwell Publishing Ltd    

年代:1977

数据来源: WILEY

摘要:

Summary:Jejuno‐gastric intussusception – gastroscopic diagnosis. C. C. Varley and N. H. Dyer, Aust. N.Z. J. Med., 1977, 7, pp. 515–517.A case of acute jejuno‐gastric intussusception diagnosed at gastroscopy is described. The patient had undergone a Polya gastrectomy eight years previously. Other reported cases have been discovered by radiology or at surgery. Endoscopy is the method of choice to diagnose this uncommon, but important co

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1977.tb03374.x

出版商:Blackwell Publishing Ltd    

年代:1977

数据来源: WILEY

摘要:

Summary:Allopurinol associated hypersensitivity reactions: cutaneous and renal manifestations. H. L. Chan, G. Ku and 0. T. Khoo, Aust. N.Z. J. Med., 1977, 7, pp. 518–522.Five patients developed fever, “toxaemia”, severe skin reactions and eosinophilia, three to six weeks after commencing allopurinol therapy. The presenting feature in these patients was an extensive erythema, progressing to an exfoliative dermatitis, sometimes with oral mucous membrane involvement. One patient developed toxic epidermal necrolysis. The clinical course in two patients was complicated by acute renal failure which necessitated dialysis.The clinical and laboratory features support an acute hypersensitivity mechanism in these allopurinol associated reactions, in agreement with previous studies. Patients with chronic renal failure appear particularly prone to severe, potentially fatal reactions. If these patients need allopurinol, a lower dose than would be normally required should be

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1977.tb03375.x

出版商:Blackwell Publishing Ltd    

年代:1977

数据来源: WILEY