ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb137773.x

出版商:Wiley    

年代:1993

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb137774.x

出版商:Wiley    

年代:1993

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb137775.x

出版商:Wiley    

年代:1993

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb137776.x

出版商:Wiley    

年代:1993

数据来源: WILEY

摘要:

ObjectiveTo define the epidemiological and clinical characteristics of human brucellosis, which is being detected in increasing numbers of patients in Queensland.Design and settingThirty‐four cases of brucellosis diagnosed according to standard clinical and microbiological criteria were studied either retrospectively or prospectively over a two‐year period from October 1989 to October 1991.ResultsCases were assessed by means of standard laboratory investigations and a questionnaire documenting clinical symptoms, occupation and recreational activities, treatment and response, relapse rate and complications. Blood cultures taken from 11 patients were positive forBrucella suis;in three others,Brucella suiswas cultured from other sites. In the 12 months before diagnosis, all affected individuals were involved in the killing and slaughter of feral pigs. Most infections occurred in rural Queensland but six were contracted in metropolitan Brisbane from feral pig abattoirs. All patients responded to appropriate antibiotic therapy; the relapse rate was 66% in those treated for less than four weeks. Complications (multiple splenic abscesses, epididymitis, cervical lymphadenitis and septic arthritis) occurred in four patients, who were ill for more than one month before diagnosis.ConclusionsBrucellosis due toBrucella abortusis a disappearing disease in Australia as a result of effective eradication programs in cattle. However, the disease is re‐emerging in Queensland because of recreational and occupational exposure to feral pigs infected withBrucella suis.The population at risk is increasing as the lucrative export industry based on field‐shot feral pigs expands.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb137777.x

出版商:Wiley    

年代:1993

数据来源: WILEY

摘要:

ObjectivesTo determine the current immune status of high‐risk populations of New South Wales and Victoria to the arboviral pathogens, Murray Valley encephalitis (MVE) and Kunjin (KUN) viruses, which are associated with Australian encephalitis (AE), and Ross River (RR) and Kokobera (KOK) viruses which are associated with polyarthritis. Further, to estimate seroconversion rates to these viruses in high‐risk populations over the 10‐year period 1981‐1991.Design and study populationBlood was taken from 2873 permanent residents, children and adults from previously identified high‐risk areas in western NSW and northern Victoria. Samples were tested by the haemag‐glutination‐inhibition (HI) test for antibodies to the four viruses. All sera were also tested for MVE and KUN antibodies by the more specific neutralisation test (NT). Ninety‐five of the subjects had been seronegative when sampled 10 years previously.ResultsAge standardised prevalence rates for flavivirus HI antibodies (MVE, KUN, KOK) ranged from 66% (Bourke) to 15% (Forbes), and were similar to those observed 10 years previously. However, specific NT antibodies to MVE and KUN were uncommon in all districts except Bourke, indicating a very high level of susceptibility to Australian encephalitis, should a fresh epidemic occur. Whereas KUN virus seems enzootic in NSW and Victoria, MVE did not appear to have been present since the last outbreak in 1974, even in Bourke. Flavivirus antibody rates (as detected by the broadly reactive HI test) greatly exceeded those specifically attributable to MVE and KUN (NT test) or KOK, leading to the speculation that unidentified flaviviruses are responsible for most human infections. Ross River virus antibody prevalence rates exceeded those of flaviviruses in all districts, ranging from 72% (Bourke) to 25% (Cohuna), and were uniformly higher than those observed in 1981. Ten‐year seroconversion rates in seronegative panels were 8.5% for flaviviruses and 24.2% for RR virus, and are broadly consistent with the cross‐sectional study.ConclusionsAlthough flavivirus and alphavirus infections have occurred at a “steady rate” in western NSW and northern Victoria, there is a general lack of immunity to the agents of Australian encephalitis in all centres except Bourke. This needs to be considered in public health policy in these areas.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb137778.x

出版商:Wiley    

年代:1993

数据来源: WILEY

摘要:

The offer to determine carrier status for cystic fibrosis (CF) was made to the 230 descendants of a couple who were presumed to carry the ΔF508 mutation. “Cascade testing” was employed, in which the mutation is followed from the oldest generation down. Compliance was over 75% and family members were relieved of the anxiety engendered by uncertainty. In one couple considering having a family, both partners were found to be carriers.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb137779.x

出版商:Wiley    

年代:1993

数据来源: WILEY

摘要:

ObjectiveTo review the results of uncomplicated coronary artery bypass graft surgery and to identify factors which influence operative mortality (OM) and postoperative myocardial infarction (PMI).DesignAn analysis of the outcome in patients having coronary artery bypass graft surgery for the first time from 1978 to 1990 inclusive.SettingThe Cardiothoracic Surgery Unit at the Royal Adelaide Hospital.ParticipantsTwelve thousand and twenty‐two patients had coronary artery bypass graft surgery only. Complete data were available for 12 003 patients.ResultsThere was an overall mortality rate of 0.99% and a postoperative myocardial infarction rate of 1.34%. Older patients and women had a higher operative mortality rate. Both unstable angina and poor ventricular function increased the mortality rate. The only significant operative factor was the perfusion time. There was a more than 16‐fold increase in mortality in patients who had an average bypass time (48 minutes) compared with those whose bypass time was 100 minutes or more (0.63% v. 10.3%). The PMI rate changed over the study period, and was also influenced by the presence of unstable angina and the duration of bypass: unstable angina doubled the rate from 0.86% to 1.91 %, and with an average bypass time the PMI rate was 0.56% whereas with a bypass time of 100 minutes or more the rate increased to 7.7%.ConclusionsThe outcome after coronary artery bypass graft surgery is strongly dependent on the perfusion time and the presence of unstable angina. Older patients and women are more likely to die during the operation.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb137780.x

出版商:Wiley    

年代:1993

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb137781.x

出版商:Wiley    

年代:1993

数据来源: WILEY

摘要:

ObjectiveTo survey the use of computer‐assisted instruction (CAI) in undergraduate medical student education in Australia.Setting and designA postal questionnaire survey of medical school deans, and department heads, in all Australian medical schools.Results90% of deans, and 88% of department heads responded to the questionnaires. There were considerable variations between departments and faculties in the use of CAI. Overall, 36% of departments were using CAI and 65% of those not currently using it were either developing CAI or would like to introduce it into their teaching programs. Some medical faculties had well‐developed policies for CAI, and provided considerable resources, while others did not. Some departments had large numbers of student work stations (up to 64), and multiple teaching packages (up to 200). CAI packages were generally thought to be popular with students, and to have improved the standard of learning.ConclusionThis form of teaching is currently undergoing rapid expansion, but in an uncoordinated manner that is likely to lead to greatly increased overall development costs.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1993.tb137782.x

出版商:Wiley    

年代:1993

数据来源: WILEY