[Show abstract][Hide abstract] ABSTRACT: This study was undertaken to assess the frequency of development and the stages of evolution of chronic liver disease in patients with renal failure who are chronic carriers of hepatitis B surface antigen. Cirrhosis or chronic active hepatitis developed in five of 21 patients and could not be predicted by the initial histological appearance or by HLA-A and B typing but was associated with the e antigen in four of the five patients. However, the antigen was not a consistent indicator of a poor prognosis, as the four other e antigen positive patients did not develop chronic liver disease during the period of the study. Transmission of hepatitis B to spouses occurred in four cases, was fatal in one instance, and was associated with e antigen in three of the four. Determination of e antigen status in renal unit patients who are carriers of hepatitis B surface antigen may be of value to the patient and his home environment.
[Show abstract][Hide abstract] ABSTRACT: Twenty-three patients with coeliac disease were studied whilst on a normal diet and again after a mean period of 15 months on a gluten-free diet. Serum levels of IgG, IgA and IgM, total haemolytic complement, C3, serum autoantibodies and precipitins to dietary proteins were compared to those in age and sex matched control subjects. There was considerable individual variation, but as a group, patients on a normal diet had significantly raised IgA and low IgM and an increased prevalence of antibody to reticulin, smooth muscle and dietary protein. These abnormalities disappeared during the period of dietary restriction suggesting that they are disease epiphenomena rather than primary pathogenetic factors.
Australian and New Zealand journal of medicine 09/1977; 7(4):349-52.
[Show abstract][Hide abstract] ABSTRACT: The numbers of immunoglobulin (Ig) containing cells in jejunal mucosa were determined in 29 patients with untreated coeliac disease and 28 control subjects. The patients had significantly increased numbers of IgM containing cells. Seven of the patients were studied again after 12 months on a gluten-free diet and showed a significant reduction in the number of IgM containing cells. The increase noted in untreated patients is therefore likely to be a manifestation of the disease rather than a primary abnormality of aetiological significance.
Australian and New Zealand journal of medicine 09/1977; 7(4):353-5.
[Show abstract][Hide abstract] ABSTRACT: This study concerns hepatitis B antigen and antibody, (HBAg and HBAb) auto-antibodies and liver disease in a renal haemodialysis and transplantation unit between February, 1970 and December, 1972. Fourteen per cent of patients on maintenance haemodialysis, 25% of renal transplant recipients, and 5% of the staff were HBAg positive during this period. Three family members of antigen positive patients developed hepatitis; all were either antigen or antibody positive. Both immuno-electro-osmo-phoresis and radio-immuno-assay were used to detect HBAg. No additional carriers were identified among the dialysis or transplant patients by applying the more sensitive technique, although two persons with hepatitis were positive only by RIA. None of the staff members who developed antigen positive hepatitis died, and no one became a carrier. Dialysis patients who had icteric hepatis also cleared the antigen from the serum. Clinical hepatitis did not occur in immunosuppressed graft recipients who were carriers of the ay subtype of the antigen, nor was there histological evidence of liver disease in 18 of 19 of such carriers studied. Moreover, there was no association between long term carriage of the antigen and the presence of the auto-antibodies characteristic of chronic active hepatitis. Rapid reduction of immunosuppression was followed by acute hepatitis in one carrier, while another, whose antigen was of the ad subtype, developed micro-nodular cirrhosis.
Australian and New Zealand journal of medicine 09/1975; 5(4):314-8.
[Show abstract][Hide abstract] ABSTRACT: Serial studies of PHA-induced lymphocyte transformation, serum autoantibodies, immunoglobulins and complement were performed in seventeen patients with hepatitis A and nine patients with hepatitis B. In both types of hepatitis PHA-induced transformation was markedly impaired during the 1st week after the onset of jaundice and there was less marked but prolonged impairment for a further period of 6-10 weeks. A group of eleven subjects with a previous history of hepatitis had values which were similar to those of healthy persons. Serum from patients with hepatitis A and hepatitis B contains an inhibitor of lymphocyte response to PHA. The inhibitor depresses the function of both patients' and normal lymphocytes and is only detectable during the acute phase of the illness. Washing lymphocytes free from autologous serum did not restore the PHA response to normal but the markedly impaired response present during the first 2 weeks of the illness was improved. A serum factor or factors may therefore be responsible for at least part of the impaired response of lymphocytes to PHA during the acute phase of hepatitis but does not appear to account for the more prolonged impairment of the PHA response. The protracted lymphocyte defect is possibly induced by hepatitis virus. The incidence of autoantibodies and the changes in immunoglobulin levels were similar to those reported by other workers.
[Show abstract][Hide abstract] ABSTRACT: The prevalence of Au antigen, autoantibodies and impaired cell-mediated immune responses was studied in 66 patients with Down's sydrome and 66 other mentally retarded patients in a South Australian institution. The antigen was detected in three of the former and none of the latter. This unexpectedly low carrier rate in patients with Down's syndrome was thought to be due either to good hygiene and state of nutrition in the institution or to the high age of which the patients had been admitted to hospital (eight to nine years). Because of the incompleteness of the association between impairment of cell-mediated immunity and antigen carriage, it was thought unlikely that the former was the sole reason for the latter.
The Medical journal of Australia 05/1975; 01(15):468-70. · 2.85 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: : The Weed system of problem oriented medical records has been successfully introduced into a general medical unit without the need for computers or specialised stationery. The change requires an increased time commitment by resident and senior staff and the development of a training programme in case record structuring for new staff. The system is acceptable to resident staff who recognise an improvement in their own training and in patient care. A weekly clinical audit has been an integral part of the system. A quality control procedure has been developed and applied to the management of myocardial infarction. This has involved identification of problem areas and formulation of a unit policy. It is felt that this procedure has resulted in an improvement in the quality of total patient care.
Australian and New Zealand journal of medicine 03/1974; 4(1):23-8.
[Show abstract][Hide abstract] ABSTRACT: A young woman whose serum was positive for hepatitis-associated antigen (H.A.A.) and alpha-fetoprotein developed a malignant hepatoma. Though the light-microscopical appearances of the surrounding liver tissue were normal, electronmicroscope examination of the tumour tissue disclosed both C-virus-like particles and H.A.A. particles. Possibly there was a causal connexion between one of these particles and the hepatoma.