Australian and New Zealand Journal of Medicine 

About: Australian and New Zealand Journal of Medicine is an academic journal. The journal publishes majorly in the area(s): Myocardial infarction & Population. Over the lifetime, 3949 publications have been published receiving 45877 citations.

Does colchicine work? The results of the first controlled study in acute gout.

Abstract: We have performed the first controlled study of colchicine in acute gout, to determine its efficacy and toxicity, and to define the natural history of acute gout. Two-thirds of colchicine-treated patients improved after 48 hours, but only one-third of the patients receiving placebo demonstrated similar improvement. The colchicine-treated patients responded earlier; significant differences from placebo were shown after 18-30 hours. All patients given colchicine developed diarrhea after a median time of 24 hours (mean dose of colchicine 6.7 mg). This side effect occurred before relief of pain in most patients.

Atrial fibrillation and mortality in an elderly population.

Abstract: Prospective data from Busselton, Western Australia, collected during triennial surveys from 1966-81 with follow-up of subjects to 1983, showed that atrial fibrillation (AF) was frequent in elderly people and associated with increased mortality. Of 1770 people aged over 60 years, 40 were in atrial fibrillation when first seen and a further 47 developed it during follow-up. Atrial fibrillation was positively associated with angina, history of a myocardial infarction and left bundle branch block. Relative mortality in those with atrial fibrillation compared with those without it, was 1.92 for all causes, 1.82 for death from cardiovascular causes (excluding stroke) and 3.78 for deaths from stroke, after adjustment by proportional hazards regression for confounding effects of age, sex, history of a myocardial infarction, an abnormal electrocardiogram, angina, cholesterol level systolic blood pressure and Quetelet's Index (weight/height2). The excess relative mortality declined with increasing age for both women and men. This raised relative mortality remained constant with time from the first detection of AF for all causes and cardiovascular causes but appeared to increase with time from detection for stroke death. The risk of death from stroke was greatest in the younger women. The observed risk of death from stroke in patients with AF suggests that anticoagulant use should be considered in selected patients.

Application of the Poincaré plot to heart rate variability: a new measure of functional status in heart failure.

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 ofa 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 variability. Methods : We used the Poincare 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, p<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 Poincare plot 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. (Aust NZ J Med 1995 ; 25 : 18-26.)

Prevalence of lupus anticoagulant and anticardiolipin antibodies in a healthy population

Abstract: This study was designed to explore the incidence of lupus anticoagulant (LA) and anticardiolipin antibodies (ACA) and their relationship to each other in a healthy population of 499 blood donors. Plasma samples were tested for LA activity and IgG, IgM and polyvalent ACA. Prolongation of the kaolin clotting time of a mixture of 80% normal plasma and 20% test plasma compared to the normal (dKCT) was used to detect LA activity. A normal distribution of dKCT was found with the mean 3.5 seconds +/- SD 10.6 seconds. Forty subjects (8%) were greater than 10% of the normal control; among these, 18 (3.6%) were outside the 95% confidence limits. The median age (29.3) and sex (M = 12, F = 28) of the 40 subjects with prolonged KCT were significantly different (p less than 0.001) from the group as a whole, younger females predominating. The frequency distribution of IgG, IgM and polyvalent ACA was skewed and the majority did not have detectable levels. ACA concentration falling within 95% of the population group were regarded as normal. Applying this definition, abnormal IgG ACA was greater than 4.33 U/ml, IgM ACA greater than 3.55 U/ml and polyvalent ACA greater than 4.55 U/ml with a prevalence of 4.6%, 4.6% and 5.6% respectively. Of the subjects with positive ACA of any class there was no significant association with either age or sex or the presence of LA. Only three plasma samples had both activities. Neither ACA nor LA were associated with antinuclear antibodies (ANA) or rheumatoid factor (Rh factor). Thus, in a healthy population LA is found predominantly in younger females and neither LA or ACA appear to identify subjects with other autoimmune parameters such as ANA or Rh factor or, for that matter, each other.

Chronic Idiopathic Thrombocytopenic Purpura

Abstract: Tuberculosis is known to be common in new Asian immigrants, but less well known is the continuing high risk in British-born Asians and immigrants of 15 years' standing. One possible explanation is that immigrants may return to their home countries for visits in a state of relatively low resistance. West Indians and Asians born in Britain develop asthma more frequently and at an earlier age than those born in their country of origin. S Jackson (Birmingham) analysed Hospital Activity Analysis returns and showed that bronchitis and bronchial carcinoma are under-represented among West Indians despite similar smoking habits. According to D Addy (Birmingham), while tuberculosis may occur after a long interval in Britain, malaria in Asian children is confined to those who have entered the country within the previous 12 months. In children the clinical features of malaria, such as fever and pallor, are often not dramatic and may easily be missed. Perinatal morbidity and mortality are greater among Asians than whites and appear to be associated with a lower birth weight, but attempts to identify those mothers particularly likely to produce high-risk babies have not been altogether successful. The high rate of increase in self-poisoning in both immigrant groups, but particularly West Indians, presumably reflects the stresses of these communities in adjusting to life in Birmingham.