ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb137525.x

出版商:Wiley    

年代:1993

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb137526.x

出版商:Wiley    

年代:1993

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb137527.x

出版商:Wiley    

年代:1993

数据来源: WILEY

摘要:

ObjectiveTo determine the age and sex specific incidence, and case fatality of stroke in Perth, Western Australia.Design and settingA population‐based descriptive epidemiological study.SubjectsAll residents of a geographically defined segment of the Perth metropolitan area (population 138 708) who had a stroke or transient ischaemic attack between 20 February 1989 and 19 August 1990, Inclusive.Main outcome measuresDefinite acute “first‐ever‐in‐a‐lifetime” (first‐ever) and recurrent stroke classified according to standard definitions and criteria.ResultsDuring the 18‐month study period, 536 stroke events occurred among 492 patients, 69% of which were first‐ever strokes. The crude annual event rate for all strokes was 258 (95% confidence interval 231–285) per 100 000, and the overall case fatality at 28 days was 24% (95% CI, 20%–28%). The crude annual incidence for first‐ever strokes was 178 (95% CI, 156–200) per 100 000; 189 (95% CI, 157–221) per 100 000 in males and 166 (95% CI, 136–196) per 100 000 in females. The corresponding rates, age‐adjusted to the “world” population, were 132 (95% CI, 109–155) for males and 77 (95% CI, 60–94) for females.ConclusionsIn contrast to mortality rates for Ischaemic heart disease, the incidence of stroke in Australia appears little different from that for several other Western countries. For both mates and females the incidence of stroke rises exponentially with increasing age. Although the sex‐dependent difference in the risk of stroke is greatest in middle age, males are at greater risk of stroke even among the most elderly. To determine the incidence of stroke accurately, population‐based studies of stroke need exhaustive and overlapping sources of case ascertainment. If only cases admitted to hospital had been used, we would have underestimated the rate of stroke among the most elderly by almost 40%. We estimate that approximately 37 000 people, about 50% of whom are over the age of 75, suffer a stroke each year in Australia.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb137528.x

出版商:Wiley    

年代:1993

数据来源: WILEY

摘要:

ObjectiveTo determine the incidence and case fatality of seven distinct subtypes of stroke in Perth, Western Australia.Design and settingA population‐based descriptive epidemiological study.SubjectsAll residents of a geographically defined segment of the Perth metropolitan area (estimated population 138 708 persons) who had a stroke or transient ischaemic attack between 20 February 1989 and 19 August 1990, Inclusive.Main outcome measuresThe following subtypes of stroke were classified according to standard clinical, radiological and pathological criteria: types of cerebral infarction, namely, large artery (thrombotic) occlusive infarction (LAOI), cerebral embolic infarction (EMBI), lacunar infarction (LACI) and boundary zone infarction (BZI); primary intracerebral haemorrhage (PICH); subarachnoid haemorrhage (SAH); and stroke of undetermined cause.ResultsOver the 18‐month study period 538 stroke events were registered, of which 86% (95% confidence interval, 83%–89%) had a defined “pathological” diagnosis on the basis of computed tomographic scanning, magnetic resonance imaging or necropsy. Cerebral infarction accounted for 71% of cases (95% CI, 68%–75%), PICH 11% (95% CI, 9%–14%) and SAH 4% (95% CI, 2%–5%). The 382 cases of cerebral infarction included LAOI (in approximately 71%), EMBI (15%), LACI (10%) and BZI (5%). While the incidence of all subtypes of stroke Increased with age, there were age and sex differences in their proportional frequency, management and prognosis: patients with PICH, SAH and EMBI were more likely to be admitted to hospital, and these conditions carried the highest early case fatality. Over all, the 28‐day case fatality was 24% (95% CI, 20%–28%), but varied from 0 for LACI and BZI, to 37% (95% CI, 15%–59%) for SAH and 35% (CI, 23%–47%) for PICH.ConclusionsIn this study, we found considerable differences In incidence rates, the effect of age and sex on incidence rates, and prognosis for the different subtypes of stroke. Hospital‐based studies are likely to be selectively biased by emphasising strokes that are severe and require admission to hospital. These data have important implications in the design and evaluation of clinical trials of therapy for stroke.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb137529.x

出版商:Wiley    

年代:1993

数据来源: WILEY

摘要:

ObjectiveTo assess the safety, efficacy and durability of injectable glutaraldehyde cross‐linked (GAX) collagen in the treatment of type 3 female stress incontinence.Design and settingA prospective study of incontinent women attending a private practice for clinical and urodynamic assessment.PatientsFifty women who had had an average of 1.8 previous operations for stress urinary incontinence took part in the study. Each had been diagnosed as having type 3 genuine stress incontinence (poor or nonfunctioning urethral sphincter mechanism in the presence of a bladder neck which is well supported, usually by scar tissue from previous surgery). Subject to a negative skin test for allergy, each patient underwent the implantation of GAX collagen (Contigen), a biocompatible product causing no foreign body reaction.InterventionsThe implant was performed by a short day‐only procedure involving cystoscopically controlled periurethral (71%) or transurethral (29%) injection of Contigen. The aim was to achieve closure of the urethra at the bladder neck and increase resistance to urine loss. Top‐up injections were used as required. The follow‐up period ranged from one to 21 months (mean, 11 months).ResultsOf these first 50 female patients, 41 (82%) were successfully treated. Twenty‐one (42%) were no longer incontinent; 20 (40%) desired no further treatment because their condition was improved; seven (14%) did not respond to treatment and two patients were awaiting top‐up injections. The average number of injections given was 1.9 and the average volume injected was 14.4 mL. There were no allergic reactions or infections. Side effects were temporary and of a minor nature.ConclusionsInjectable GAX collagen appears to be a safe and effective treatment for type 3 stress urinary incontinence. Its durability awaits further follow‐up.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb137530.x

出版商:Wiley    

年代:1993

数据来源: WILEY

摘要:

ObjectivesTo assess the efficacy of nimodipine in preventing delayed ischaemic deficit in aneurysmal subarachnoid haemorrhage.DesignA continuous prospective audit of all patients with aneurysmal subarachnoid haemorrhage admitted to the joint neurosurgery units of Prince Henry's and Alfred hospitals, Melbourne. Patients were divided into two groups — 135 in the pre‐nimodipine group during 1986 to 1989, and 73 in the nimodipine group during 1989 and 1990.Main outcome measuresOutcome was measured according to the Glasgow outcome scale and the incidence of delayed ischaemic deficit was recorded.ResultsA substantial reduction in the overall incidence of poor outcome waa observed, from 37% of patients in the non‐nimodipine group, to 20% in the nimodipine group (P=0.022). Delayed ischaemic deficit occurred in 41% and 21% (P=0.005), and poor outcome due to delayed ischaemic deficit occurred in 18% and 8% (P=0.09) respectively.ConclusionsIn our experience, nimodipine appears to have substantially reduced the incidence of delayed Ischaemic deficits in patients with aneurysmal subarachroid haemorrhage, with a resultant improvement in overall patient outcome.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb137531.x

出版商:Wiley    

年代:1993

数据来源: WILEY

摘要:

ObjectiveTo investigate the role of extracorporeal shock wave lithotripsy using the Dornier MPL9000 lithotripter and adjuvant litholytic therapy in the treatment of symptomatic gallbladder stones.Patients and methodsBetween August 1989 and March 1991, 399 patients had their one to three gallbladder stones fragmented by the Dornier MPL9000 lithotripter. Chenodeoxycholic acid alone was used as adjuvant litholytic therapy in the majority. A minority received a combination of chenodeoxycholic acid and ursodeoxycholic acid or ursodeoxycholic acid alone. Patients who died, had cholecystectomies or failed to complete the treatment program were excluded from analysis, leaving a cohort of 287 patients with a follow‐up of at least 12 months. This cohort comprised 173 patients with single small stones (20 mm or less in diameter), 32 patients with single large stones (21 mm to 30 mm in diameter) and 82 patients with two to three stones.Outcome measuresPatients were followed up by repeated ultrasound examination to monitor the disappearance of fragments from the gallbladder. Stone‐free rates, recurrences and complications of treatment were determined.ResultsThe stone‐free rate 12 months after treatment was 37.6% for patients with a single small stone, 3.1% for patients with a single large stone and 18.3% for patients with two to three stones. Of 70 patients with a single small stone who had become stone free at some time during the 12 months after treatment, five (7.1%) experienced recurrence, as did one of the 16 patients (6.9%) with two to three stones. Some 179 patients (44.9%) experienced biliary colic after lithotripsy. Most attacks were mild. Eleven patients (2.8%) developed cholecystitis and nine (2.3%) became jaundiced. Five patients (1.3%) suffered from pancreatitis, of whom one died from severe necrotising pancreatitis. Treatment mortality was 0.25%. Cholecystectomy was needed in 44 patients (11.9%).ConclusionsOnly about 15%–20% of all patients with symptomatic gallbladder stones are suitable for lithotripsy. In this study, only about 28% were stone free after 12 months. As the gallbladder is not removed, stones may re‐form. Laparoscopic cholecystectomy and open cholecystectomy by comparison will produce a “stone‐free state” in 100% of patients, no matter how many stones are present in the gallbladder, their size, or whether the gallbladder is non‐functioning. Consequently, lithotripsy and litholytic therapy are now reserved for those few patients who are unable to tolerate general anaesthesia and cholecystectomy and those who refuse surgery. Even in centres showing the most favourable results, lithotripsy and litholytic therapy will have at best a minor role to play in the overall management of symptomatic gallbladder atones.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb137532.x

出版商:Wiley    

年代:1993

数据来源: WILEY

摘要:

ObjectiveTo investigate the importance of the urinary calcium:creatinihe ratio as a prognostic marker for pregnancy‐induced hypertension.DesignA prospective study which measured the urinary calcium:creatinine ratio at 20‐30 weeks' gestation. Patients' medical records were examined, blind to all urinary assay results, to determine the development of pre‐eclampsia or gestational hypertension.Setting and subjectsA first‐morning urine sample was collected from 456 normotensive pregnant women, at 20–30 weeks' gestation, attending a hospital maternity outpatients' clinic for routine antenatal care.ResultsThe mean urinary calcium:creatinine ratio for women (n=392) with a normotensive outcome of pregnancy, 0.52 (SD 0.32), was not significantly different from the ratios in those women who developed pre‐eclampsia (n= 16), 0.49 (SD 0.32) or gestational hypertension (n= 48), 0.57 (SD 0.41). Significant risk factors for development of gestational hypertension, as estimated by logistic regression, were mean arterial blood pressure greater than 87.6 mmHg, Caucasian race, non‐smoking and nulliparity.ConclusionsWithin the cohort studied, the calciumxreatinine ratio measured in asymptomatic women at 20–30 weeks' gestation was an unsatisfactory prognostic marker for development of pregnancy‐induced hypertension. The major interpopulation, as well as intrapopulation, variation in calcium levels suggests that previous reported findings may not be readily generalised.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb137533.x

出版商:Wiley    

年代:1993

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb137534.x

出版商:Wiley    

年代:1993

数据来源: WILEY