ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb121244.x

出版商:Wiley    

年代:1991

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb121245.x

出版商:Wiley    

年代:1991

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb121246.x

出版商:Wiley    

年代:1991

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb121247.x

出版商:Wiley    

年代:1991

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb121248.x

出版商:Wiley    

年代:1991

数据来源: WILEY

摘要:

ObjectiveTo determine the operative morbidity and mortality of carotid endarterectomy in South Australia.DesignThis was a prospective study on consecutive patients already selected independently by their treating clinicians for carotid endarterectomy. Patients were assessed before and after the operation by independent neurologists.Setting and participantsThe study involved all patients undergoing carotid endarterectomy in South Australia in public and private hospitals over the 20‐months period of the study. All vascular surgeons agreed to participate.InterventionTwo hundred and thirty‐nine carotid endarterectomies were performed on 223 patients, always as primary procedures.Main outcome measuresPatient characteristics, angiographic findings and indications for surgery were documented before the operation by neurologists who then carried out postoperative assessments and determined neurological status at discharge. Follow‐up at six and twelve months was by letter and telephone enquiry to general practitioners or direct to patients.ResultsThe perioperative death and stroke rate was 6.3% including one stroke after angiography and before endarterectomy. Fourteen patients (5.9%) had strokes after the operation and three died as a result (1.3%). Three patients had reversible ischaemic neurological deficits. In 58 asymptomatic patients, operative morbidity was 3.4%. However, in 42 patients who had had a stroke before the operation, there were seven who had operative complications (16.7%). Neurological complication rates for individual surgeons varied from 0 to 13.8%. In the subsequent 12 months, follow‐up of 214 patients revealed nine additional deaths (three known to be caused by stroke, four not caused by stroke and two of unknown cause) and six more cerebral infarctions (involVing both operated and unoperated sides), an annual mortality plus stroke morbidity rate of 4.2%‐5.1%.ConclusionsThe morbidity and mortality of carotid endarterectomy in South Australia is acceptable by world standards but is high in the subgroup with a preceding stroke. In this audit, carotid endarterectomy had an average risk at least equal to one year of untreated carotid artery disease and did not diminish the expected stroke and death incidence after one year.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb121249.x

出版商:Wiley    

年代:1991

数据来源: WILEY

摘要:

ObjectiveA clinical and microbiological review of cases of subdural and epidural empyema.Design, setting, patientsA 10‐year retrospective review of patients with subdural and epidural empyema in all Brisbane hospitals with neurosurgical units. 10 this period there were 14 cases.ResultsThe paranasal sinuses were the primary focus in 8 of the 14 cases, the middle ear in 3 and a surgical or traumatic wound in 2. One case occurred as a complication of Haemophilus influenzae meningitis. Streptococcus, particularly Streptococcus milleri, were the causative organisms in all cases of sinus origin, most of which occurred in the second decade of life. An intracranial collection was considered in the differential diagnosis within 24 hours of admission in all 3 cases of otic origin but in only 2 of the 10 sinus or post‐traumatic cases. The most common initial diagnosis was viral or partially‐treated bacterial meningitis (8 of 13 cases). The initial computed tomographic (CT) scan was not diagnostic in 3 of 11 patients. No patient Was successfully treated without surgery, and all 3 deaths in the series were associated with delayed surgery.ConclusionsSubdural and epidural empyema is an uncommon condition. The majority of the cases in this series were associated with sinusitis, and Streptococcus milleri was the commonest organism identified. The condition remains a diagnostic challenge; CT scanning cannot be relied upon although the use of intravenous contrast arid more modern scanners has improved the diagnostic yield. Surgical drainage and early aggressive antimicrobial therapy are essential to avoid significant morbidity and mortality.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb121250.x

出版商:Wiley    

年代:1991

数据来源: WILEY

摘要:

ObjectiveTo evaluate the volume used and the indications for use of the human albumin solutions, stable plasma protein solution and normal serum albumin, in Victorian metropolitan teaching hospitals.DesignThe Victorian Drug Usage Advisory Committee conducted a prospective audit by means of a questionnaire in three major Melbourne teaching hospitals over a three month period. All bottles of the human albumin solutions issued were numbered and a questionnaire regarding indications for use was completed for each patient treated with either product.Outcome measuresThe results were compared with the recommendations of the Australasian Society of Blood Transfusion to determine whether usage was appropriate, and the number of bottles used was analysed for each hospital and each major indication.ResultsThe survey was comprehensive (84% of the forms were returned) and demonstrated that these products are used for appropriate clinical categories, for example, hypovolaemia, hypoalbuminaemia, and not for inappropriate indications, such as nutritional support or wound healing. There was however a marked variation in the level of usage for a given indication between the three hospitals.ConclusionsThis variation reflected a considerable difference in unit policy regarding the use of these products in preference to crystalloid or synthetic colloid solutions. The variation suggests the need for more specific guidelines for the use of these products in defined clinical settings.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb121251.x

出版商:Wiley    

年代:1991

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb121252.x

出版商:Wiley    

年代:1991

数据来源: WILEY

摘要:

ObjectiveTo describe the epidemiology of domestic swimming pool drowning and near drowning in Brisbane and to examine the efficacy of a broad range of preventive options, including pool fences.DesignA prospective, hospital‐based, injury surveillance system to describe the epidemiology of drowning and near‐drowning and a community survey to describe pool fencing.SettingThe surveillance questionnaire was completed at presentation in the Emergency Department by the parent, nurse and doctor. Personal interviews in households that were randomly selected by means of a stratified sampling scheme provided the pool fencing description.ParticipantsAll 139 children suffering from an immersion injury resulting in presentation at a hospital in the catchment area of The Mater Children's Hospital were included. There were 204 households with a swimming pool in the 1024 households interviewed in the community survey.ResultsThe 100 domestic pool drownings and near‐drownings were equivalent to 15.5 incidents per year per 100 000 children aged 0‐13 years and 64.9 per year per 100000 for the critical 1‐3 years age group. Of 72 children who gained unintended access to a domestic pool, 88.9% were less than 3 years of age and 52.8% were less than 2 years. All 10 of the children who drowned and five who were severely brain damaged (age range, 12‐32 months) were in this group. The risk of a drowning or near‐drowning involving unintended access to an unfenced pool is 3.76 times higher than the risk associated with a fenced pool (95% confidence limits for relative risk: 2.14, 6.62).ConclusionsPool fences are an effective method of preventing child drownings and near‐drownings. This effectiveness can be further improved if compliance with gate closure can be enhanced. This should be emphasised in health promotion accompanying the introduction of universal pool fencing.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1991.tb121253.x

出版商:Wiley    

年代:1991

数据来源: WILEY