ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb121304.x

出版商:Wiley    

年代:1991

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb121305.x

出版商:Wiley    

年代:1991

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb121306.x

出版商:Wiley    

年代:1991

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb121307.x

出版商:Wiley    

年代:1991

数据来源: WILEY

摘要:

ObjectivesTo report the experience of the Australian National Liver Transplant Unit with patients with fulminant hepatic failure and to describe the role of liver transplantation. Patients: Twenty‐seven patients presented with acute or subacute fulminant hepatic failure during the period from January, 1986, to March, 1990. Twenty‐two had acute arid five had subacute fulminant hepatic failure. The causes were hepatitis B in 10 patients, presumed non‐A, non‐B {NANB) hepatitis in eight patients, drug‐induced hepatic damage in five patients, and Wilson's disease in four patients. There were 13 males and 14 females. Ages were 2–43 years (mean, 23). Twenty patients (74%) were in grade IV encephalopathy on presentation.ResultsSix patients (22%) began to improve soon after admission and went on to full recovery. Spontaneous recovery was more frequent in patients with drug‐induced hepatic damage (four patients [80%]) and was less frequent in those with hepatitis B (one patient [10% and NANB hepatitis (one patient [12%. The other 21 patients (78%) were considered for orthotopic liver transplantation. Eight (30%) were judged to be unsuitable and went. on to early death. Thirteen (48%).were suitable for transplantation. Of these five (19%) died before a liver donor became available and eight (30%) received liver grafts and went. on to full recovery. Overall, 14 patients (52%) survived and 13 (48%) died. Patients with Wilson's disease (four [100% were most suitable for orthotopic liver transptantatlon whereas eight (44%) of those with hepatitis B or NANB hepatitis were unsuitable. Of the eight patients receiving liver grafts one. had hepatitis B, three had NANB hepatitis and four had Wilson's disease. Five were in grade IV encephalopathy at the time of operation. The mean waiting time for transplantation was 6.4 days. Five patients received ABO blood group compatible grafts and three received ABO incompatible grafts. Of the latter group, two subsequently required secondary orthotopic liver transplantation with ABO compatible grafts. All eight patients who received transplants are alive and well 3–24 months after the operation. No patient has any neurological sequelae.ConclusionsOrthotopic liver transplantation is a preferred option. for patients with fulminant hepatic failure whose condition is not responding to conservative management. ABO incompatible livers transplanted in emergency circumstances may prove lifesaving either by functioning successfully or by providing time during which ABO compatible grafts become available. Despite the availability of liver transplantation, many patients with fulminant hepatic failure in Australia still die, some before hepatic transplantation can be undertaken. Early referral of patients with fulminant hepatic failure to established centres with liver transplantation programmes is required.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb121308.x

出版商:Wiley    

年代:1991

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb121309.x

出版商:Wiley    

年代:1991

数据来源: WILEY

摘要:

To test the premise that asthma in children is treated erratically and often inappropriately, we studied the medical records of children with asthma presenting to the emergency department of a paediatric teaching hospital over a 12‐month period. Four hundred and twenty‐two patients (10% of those eligible) were selected; they ranged in age from 5 months to 17 years with a mean age of 5.4 years and a male to female ratio of 1.6:1. Eighty‐six per cent of patients were self referred and 53% had a documented history of asthma. Thirty‐seven per cent of patients were not taking medication at the time of presentation and 19% had been prescribed antibiotics. Documentation of physical findings in the medical record was generally inconsistent. For the vast majority of patients the treatment given was a nebuIised β‐agonist, with 30% receiving oral corticosteroids. Seventy‐six per cent of patients were able to be discharged from the emergency department, but 10% of these patients re‐presented during the same attack. When discharged, 98% of patients were taking β‐agonists, 23.5% theophylline and 29% corticosteroids (usually a short oral course). For over one‐third of patients attending the emergency department no documented follow‐up arrangements were made. The poor documentation of severity and the variability of treatment of asthma among physicians, both in the community and in the emergency department, is cause for concern. There is a need for further education of health professionals in the appropriate assessment, documentation and treatment of asthma in children.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb121310.x

出版商:Wiley    

年代:1991

数据来源: WILEY

摘要:

ObjectivesTo identify the preferences of rural Australians for health care services and to relate their attitudes towards health care services in general and preventive health care services in particular to their sociodemographic characteristics and their degree of geographic access to available services.DesignBoth an interview and a delivery‐and‐collection questionnaire survey were conducted. The method of paired comparisons was used to determine the structure of preferences for a set of health care services.SettingThe study area comprised the small rural settlement of Nyngan, and the surrounding farming lands in the Bogan Shire, New South Wales.ParticipantsA random sample of 20% of residents was surveyed in October 1989. Ma;n outcome measures: In the absence of any studies on the attitudes of rural Australians towards health care services, no a priori hypotheses were formulated. Both the rank order of preferences and a preference interval shOWing the “distance” between the preferences were calculated.ResultsThe results show the overwhelming importance attributed to curative medical services compared to those oriented to preventive health care. In particular, the services provided by the doctor are indisputably the most highly valued of all health care services. The attitudes of rural residents to particular preventive services varied, with those’ services most relevant to immediate needs being the ones most highly valued.ConclusionsThe felt need for health care among country people centres on the adequate provision of doctors and hospitals; preventive services which address the longer‐term health care needs of country people may best be prOVided by closely integrating them with curative medical services.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb121311.x

出版商:Wiley    

年代:1991

数据来源: WILEY

摘要:

ObjectiveTo explore the risk of inducing a coagulation defect in cardiac surgery patients by the reinfusion of mediastinal blood.DesignTen patients who underwent coronary artery surgery were prospectively studied for the haematological effects of reinfusion of blood drained from the chest drain tubes after the operation by a Sorenson autologous transfusion system.SettingSurgery was performed at a private hospital and patient selection was made at the time of reinfusion.PatientsNine patients had primary coronary artery surgery and one had a reoperation. Main outcome measures: Blood samples were taken from the patients before reinfusion, one hour after reinfusion, and 24 hours later as well as from the collected blood. Measurements were made of the haemoglobin content, white cell and platelet counts, fibrinogen and fibrinogen degradation produets, D‐dimer, antithrombin III and plasma haemoglobin content. Estimations were also made of the prothrombin time, the thrombin clotting time and the activated partial thromboplastin time. The hypothesis to be tested by this study was that the reinfusion of mediastinal blood after the operation did not cause any significant disturbance of the patient's blood clotting profile.ResultsAn average of 535 mL (range, 400–950 mL) was reinfused after a period of three hours drainage (range, 45 minutes to 5 hours). While the initial patient samples contained a raised plasma haemoglobin level (0.19 gIL) significantly related to the cardiopulmonary bypass time (P<0.001), these were free of fibrinogen degradation products except for a sample from one patient who had a reoperation. The blood drained by the Sorenson system was lower in haemoglobin content (7.7 g/dL), and had a significant content of fibrinogen degradation products(147 mg/L) and D‐dimer (6.4 mg/L) together with reduced clotting factors when compared with the patients’ blood. After reinfusion, the patient sample showed evidence of altered coagulation with mildly increased clotting times (activated partial thromboplastin time 57 s, thrombin clotting time 123 s), the extent of which was related to the volume reinfused (P<0.001), but 24 hours later, these effects had all disappeared. All samples were sterile in aerobic and anaerobic culture media.ConclusionWe conclude that the Sorenson system of retrieval of mediastinal blood after cardiac surgery provides a safe and simple method of blood conservation provided that the volume of reinfusion is not excessive.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb121312.x

出版商:Wiley    

年代:1991

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb121313.x

出版商:Wiley    

年代:1991

数据来源: WILEY