ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb93951.x

出版商:Wiley    

年代:1991

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb93952.x

出版商:Wiley    

年代:1991

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb93953.x

出版商:Wiley    

年代:1991

数据来源: WILEY

摘要:

Objective:To evaluate the clinical complications and diagnostic problems of chorionic villus sampling.Design:A pragmatic retrospective analysis.Setting:Tertiary obstetric referrals mostly to private practice; sampling carried out at Royal Prince Alfred Hospital; diagnostic analysis usually at Oliver Latham Laboratory, or the Clinical Immunology Research Centre, Royal Prince Alfred Hospital, New South Wales.Patients:1500 women in the first trimester of pregnancy requesting prenatal diagnosis because of a risk of chromosomal or inherited genetic disorder in the fetus.Interventions:Ultrasound‐guided passage of a catheter into the chorion through the cervix.Main outcome measures:Incidence of unintended abortion, preterm births, low weight infants and discrepant karyotypes.Results:There were 42 unintended abortions (3.0%), about 0.4% higher than the background abortion rate in women of similar age. Abortion did not occur more frequently in women with vaginal bleeding earlier in that pregnancy. Rates of preterm births and birth of low birthweight infants did not differ from the general population. A second diagnostic test was required in 68 women (4.5%). Mosaicism and tetraploidy were usually confined to the chorion.Conclusion:Chorionic villus sampling is an acceptable diagnostic test. Amniocentesis should be offered to patients who show mosaicism or tetraploidy.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb93954.x

出版商:Wiley    

年代:1991

数据来源: WILEY

摘要:

Objective:To assess the first year of operation of a palliative care service in a general teaching hospital.Design, setting, patients:A retrospective analysis of 241 terminally ill patients referred to the Austin Hospital Palliative Care Service during its first year of operation.Main outcome measures:The occurrence and relief of pain, the occurrence and management of social and psychological problems, involvement of allied health services and the place of death.Main results:Unrelieved pain was the most frequent medical problem but, with appropriate medical management as well as input from other members of the multidisciplinary team, all patients achieved satisfactory pain control. The occurrence and severity of social and psychological problems was greater than expected. Most of the patients were discharged home and referred to domiciliary palliative care services; one‐quarter of patients were able to die at home, one‐third died in an inpatient hospice, and the remainder died in hospital.Conclusions:The Service was able to achieve most of its stated aims and has generated a much improved appreciation of the palliative care needs of patients with terminal illness and their families within the Hospital. A multidisciplinary approach to the management of terminally ill patients is crucial, and this Service has been successful despite limited staffing because of the willing involvement of other Units and Services in the Hospital. The difficulties inherent in the evaluation of a palliative care program (quality of life, cost‐effectiveness) are discussed.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb93955.x

出版商:Wiley    

年代:1991

数据来源: WILEY

摘要:

Objective:To use meta‐analysis to estimate the benefits of drug treatment to lower cholesterol levels in the primary and secondary prevention of coronary heart disease (CHD) events.Data sources:MEDLINE search from 1967 to 1990; bibliographies of review articles.Study selection:Nine trials met the entry criteria: they were monofactorial, randomised and controlled.Data extraction:Two independent, un‐blinded observers.Data synthesis:The odds ratio (and 95% CI) for death from CHD was 0.85 (0.64, 1.14) in primary prevention and 0.84 (0.75, 0.95) in secondary prevention studies when calculated by the method of Peto. The event rate in the secondary prevention studies was higher than that in the primary prevention studies, and the absolute risk reduction achieved by therapy in the former (3.2%) was much higher than that in the latter (0.1%). The number of subjects needing to be treated to prevent one death from CHD was 38 in secondary prevention and 675 in primary prevention. Results with the method of DerSimonian and Laird were similar.Conclusions:The benefits of cholesterol lowering to prevent death from CHD are substantially greater in the secondary prevention setting than in primary prevention.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb93956.x

出版商:Wiley    

年代:1991

数据来源: WILEY

摘要:

Objective:To estimate the number of coronary heart disease (CHD) events arising from the primary and secondary prevention populations of middle‐aged Australian men, and the potential impact in each setting of lipidlowering therapy on death from CHD.Design:Analysis based on results of a meta‐analysis of drug trials to lower cholesterol levels and data from the Hunter Region Heart Disease Prevention Programme.Main outcome measure:Death from CHD.Results:Over a five‐year period, 1520 fatal CHD events would be expected in a population of 100 000 men aged 35 to 69 years. Approximately 52% would arise from subjects already known to suffer from CHD. We predict that treating everyone in the secondary prevention group who has a blood cholesterol level of>5.2 mmol/L (approximately 5000 subjects) would prevent 118 deaths, compared with 51 deaths prevented by treating those in the primary prevention group who have cholesterol levels of>6.2 mmol/L (approximately 30 000 subjects). The outcome is maintained in several sensitivity analyses.Conclusions:The majority of persons in whom death from CHD might be prevented by treatment to lower cholesterol levels can be identified by targeting subjects for secondary prevention. Therapy in the secondary prevention setting is much more efficient than in primary prevention.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb93957.x

出版商:Wiley    

年代:1991

数据来源: WILEY

摘要:

Objectives:To identify and surgically treat correctable inguinal injuries in athletes with chronic groin pain and to assess the results of surgical treatment.Design:Sixty‐four athletes presented between March 1987 and January 1990 for treatment of chronic groin pain in which surgical exploration of the inguinal canal was considered necessary. Follow‐up was performed by questionnaire.Main outcome measure:Patient self‐assessment of the success of the operation, including postoperative pain, ability to return to active sport and any further treatment required.Results:Sixty‐four athletes were treated. Australian Rules footballers predominated (46/64, 72%). Eight athletes had bilateral groin pain. Fifty‐nine (92%) reported an incipient onset of pain. The most common operative finding was of a substantially deranged posterior wall of the inguinal canal which was evident in 61/72 instances (85%). Apparent splitting of the conjoint tendon was found in 19 instances (26%) and previously occult indirect inguinal hernias were discovered in six (8%). Repair of the posterior wall of the inguinal canal was by the standard Bassini repair and Tanner slide or by plication of the transversalis fascia followed by a nylon darn. Follow‐up by questionnaire of the 64 athletes revealed that 40 athletes (62.5%) considered themselves cured and had returned to competitive sport. Twenty athletes (31.3%) were partially satisfied with the results of their operation, and also able to return to active sport. Three athletes (4.7%) were dissatisfied with the operative result. One patient was lost to follow‐up.Conclusion:The most common finding in athletes with chronic groin pain was a deficiency of the posterior wall of the inguinal canal. Surgical exploration and repair of the posterior wall of the inguinal canal in athletes with chronic debilitating groin pain achieved excellent or good relief of pain in 93.8% of athletes and improved physical performance.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb93958.x

出版商:Wiley    

年代:1991

数据来源: WILEY

摘要:

Objective:To review a group of Australian women presenting to a reproductive endocrinologist with acne and investigate how many had androgen excess and how they had responded to endocrinological therapy.Design:All patients referred to me over a 12 month period were included in the study and investigated in a standard manner. Medical therapy was given in a non‐randomised manner based on clinical and biochemical evidence.Setting:Most patients were referred to my private practice, but all public patients seen over this period were also included.Patients:Subjects were women who presented with acne. Some were also hirsute and/or had menstrual irregularities. The total group consisted of 157 subjects. Patients with thyroid disease, hyperprolactinaemia, and late‐onset congenital adrenal hyperplasia, and menopausal women were excluded, and the final study group consisted of 90 subjects.Interventions:Women presenting with acne but no hirsutism and an elevated level of dehydroepiandrosterone sulphate were treated with low‐dose dexamethasone. All other subjects were treated with ethinyloestradiol and cyproterone acetate.Main outcome measures:(i) The diagnosis of polycystic ovary syndrome and (ii) the effect of endocrinological therapy on their acne.Results:Of the 90 subjects presenting with acne, 67 (74%) were found to have the polycystic ovary syndrome. In all cases the acne was substantially reduced by treatment. All 30 subjects who had previously failed to respond to standard dermatological preparations were successfully treated with combined ethinyioestradiol and cyproterone acetate therapy.Conclusions:The polycystic ovary syndrome is commonly found amongst women complaining of acne. Some patients will not have excess body hair, obesity or ?menstrual irregularities. Among women with resistant acne, not responding to conventional treatments, the polycystic ovary syndrome is very common. Treatment with ethinyloestradiol and cyproterone acetate is an extremely effective, safe and well tolerated therapy for these women.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb93959.x

出版商:Wiley    

年代:1991

数据来源: WILEY

摘要:

Objective:To determine the validity of parental report of vaccination as a measure of a child's measles immunisation status.Design:Cross‐sectional survey.Setting:Four 24‐hour medical centres in western Sydney.Patients:Parents of children aged 12–36 months were approached in the clinic waiting room. Of the 160 parents approached, 137 agreed to be interviewed and a successful venepuncture to yield a 2 mL blood sample was achieved with 128 children.Main outcome measures:Measles IgG antibody, determined by means of an indirect ELISA, was compared with parental report of measles vaccination status by McNemar's χ2test.Results:Parental report significantly overestimates the immunisation status of children. Eighty‐four per cent of the parents in the sample stated that their child had been vaccinated, but only 74% were immune (95% confidence interval, 65%–81%). A positive predictive value of 84% meant that only 84% of children who were reported to have been vaccinated were immune to measles. Further, of all those who were not immune to measles, only one half would have been identified by asking the parents. Failed seroconversion may have accounted for up to 70% of cases of non‐immunity in children reported to have been vaccinated.Conclusions:Parental report is limited as a measure of a child's measles immunisation Status.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb93960.x

出版商:Wiley    

年代:1991

数据来源: WILEY