摘要:

AbstractBackground:Thrombolytic treatment with streptokinase in acute myocardial infarction has proven to be safe and effective in Caucasian populations with relatively low levels of anti‐streptokinase IgG and streptokinase resistance. Higher levels of antibodies, as seen in previous recipients of streptokinase therapy, cause more adverse reactions and may result in lower efficacy.Aims:To examine the levels of anti‐streptokinase IgG and streptokinase resistance in a population subjected to endemic streptococcal infections.Methods and Results:Thirty Aboriginal adults from a remote community in Northern Australia with endemic streptococcal infections and 15 non‐Aboriginal adults from an urban community without endemic infections participated in this study. Aboriginal adults exhibited levels of anti‐streptokinase IgG and streptokinase resistance that, respectively, were almost 20 and 15 times greater than the values of non‐Aboriginal adults. At least 23% of Aboriginal adults had sufficiently high levels of streptokinase resistance to neutralise a standard 1.5 million unit dose of streptokinase.Conclusions:Aboriginal adults from a remote community had dramatically elevated levels of anti‐streptokinase IgG andin vitrostreptokinase resistance. Prospective studies are needed to assess the clinical relevance of streptokinase resistance in populations from areas with endemic streptococca

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1996.tb02906.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:Background:HLA‐identical sibling bone marrow transplantation is an accepted treatment for patients with acute myeloid leukaemia (AML) and chronic myeloid leukaemia (CML). We have recently reported improving results in HLA‐identical sibling transplant over the ten year period 1981‐1990. In this report we described the outcome in patients transplanted at St Vincent's Hospital, Sydney between 1989 and 1993.Aims:To determine the leukaemia‐free survival, transplant‐related mortality rate, and relapse rate for patients with AML or CML given HLA‐identical sibling marrow transplants between 1989 and 1993.Methods:Sixty‐two patients with AML or CML received high dose busulphan/cyclophos‐phamide chemotherapy followed by infusion of T replete, HLA‐identical sibling bone marrow. Cyclosporin/short methotrexate was utilised as prophylaxis for graft‐versus‐host disease, ganciclovir as prophylaxis for cytomegalovirus disease and cotrimoxazole as prophylaxis forPneumocystis cariniipneumonia. Low dose intravenous heparin was used as prophylaxis for hepatic veno‐occlusive disease.Results:The five year disease‐free survival for patients with AML transplanted in first complete remission was 72% and for those with CML transplanted in first chronic phase was 77%. The relapse rate for AML transplanted in first complete remission was 15% and for CML in first chronic phase 0%. The transplant‐related mortality for AML transplanted in first complete remission was 16% and for CML transplanted in first chronic phase 23%. In contrast, the disease‐free survival, relapse rate and transplant‐related mortality for patients with AML transplanted outside first complete remission and for CML transplanted beyond first chronic phase was 17%, 57% and 57% respectively.Conclusions:The outcome for patients transplanted for early AML or early CML continues to improve and exceeds that obtainable by conventional therapy. The salvage rate is so low for patients transplanted in later stages of AML or CML that all patients less than 55 years of age with these diseases, who have a HLA‐identical sibling donor, should be offered bone marrow transplantat

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1996.tb02907.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

AbstractBackground:The relationship between airway hyper‐responsiveness (AHR) and clinical asthma remains controversial and unclear.Aims:To test the hypothesis that serial measures of variability of peak expiratory flow rate (PEF) correlate with serial measures of AHR, and to determine which mathematical expression of variability provides the best correlation.Methods:A longitudinal study over 180 days of 20 atopic, moderately severe asthmatics was undertaken. A diary of medication use and morning and evening PEFR before and after (3 agonist was kept and AHR (PD20histamine) was measured at three‐weekly intervals. Using group data (128 sets) In PD20was correlated with various measures of PEF variability over 9 days.Results:Within the group there was a weak but highly statistically significant correlation between AHR and measures of PEF variability ‐ the strongest correlation being with mean morning PEF. Within individual subjects, however, the correlation was not a consistent finding and only four patients had a statistically significant relationship (p<0.05) between AHR and mean morning PEF.Conclusions:These results suggest that while PEF variability may reflect AHR for the purposes of epidemiologic studies, it is unlikely to be useful as a simple ‘non‐invasive’ means of assessing AHR in individual patients. More complex measures of PEF variability do not have an advantage over simpler measures such as mean

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1996.tb02908.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

AbstractBackground: A prospective study of Australian elderly living in Dubbo has shown that diabetes is a significant predictor of all‐causes mortality and coronary heart disease (CHD).Aim: To examine and contrast clinical and socio‐demographic predictors of these outcomes in those with and without diabetes.Methods: The data are derived from a community‐based sample of subjects 60 years and older followed over 62 months since 1988. Of 1155 men and 1472 women, 9.2% and 6.9% respectively manifested diabetes at baseline, based on history or fasting hyper‐glycaemia.Results: In the presence of diabetes, all‐causes mortality was increased twofold in both sexes, CHD incidence was increased twofold in men and threefold in women, stroke incidence was increased twofold in women but little changed in men. Proportional hazards models were derived separately for persons with and without diabetes and risk factors differentially predictive in diabetes were sought. Significant predictors of death in diabetes were old age and current smoking. Those factors differentially predictive were ‘being married’ (Relative Risk [RR] 1.60 with diabetes and 0.69 without diabetes) and higher body mass index (BMI) (RR 1.03 with diabetes and 0.79 without diabetes). Significant predictors of CHD in diabetes were old age, prior CHD, severe hypertension, low HDL cholesterol and self‐rated health. Those factors differentially predictive were higher body mass index (RR 1.14vs0.83) and physical disability (RR 0.69vs1.55). Differential predictions with regard to BMI may relate in part to excess CHD and mortality at low BMI in non‐diabetic subjects.Conclusion: The vascular disease burden of diabetes in the elderly has been confirmed, especially in women. A number of conventional risk factors are contributing to this burden and may be amen

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1996.tb02909.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Abstract:Background:Most published normal values for transdiaphragmatic pressure (Pdi) have been from Caucasian subjects and there is no universal agreement regarding the most appropriate manoeuvre for assessing Pdi.Aims:The aims of our study were to obtain normal values and to compare the different manoeuvres used to assess Pdi in normal young Singaporean adults.Methods:Twenty‐four normal subjects (23 Chinese, one Indian) were studied by measuring Pdi during maximal sniffs from functional residual capacity (sniff Pdi), maximal inspiration to total lung capacity (Pdi TLC) and maximal static inspiratory efforts from residual volume (Pdi PImax).Results:Mean values±SD for sniff Pdi, Pdi TLC and Pdi PImax were 101.8±31.7, 46.8±26.4 and 83.5±35.5 cm H20 respectively. Sniff Pdi was significantly higher than Pdi TLC (p<0.001) and Pdi PImax (p=0.005). Pdi PImax was significantly higher than Pdi TLC (p<0.001). Males had significantly higher values for sniff Pdi (p=0.026) and Pdi PImax (p=0.022) than females. There was a significant correlation between the different methods of recording Pdi. Sniff Pdi had the highest values, least between‐ and within‐subject variation and most consistent pattern of respiratory muscle recruitment with the lowest proportion of negative gastric pressure (Pg) values (p<0.001).Conclusions:Therefore, sniff Pdi may be better than Pdi TLC and Pdi PImax in assessing diaphragm function. Also, our subjects seemed to have lower sniff Pdi and Pdi PImax, and higher Pdi TLC compared with Caucasian

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1996.tb02910.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

AbstractBackground:There is limited information available regarding the effect of catheter ablation of the antioventricular (AV) junction on left ventricular (LV) function. Both deterioration and improvement in LV function have been reported following direct current (DC) ablation of the AV junction. The deterioration of LV function following DC ablation of the AV junction may be due to the ccompanying barotrauma, DC arcing and direct coagulation, or even the effects of chronic ventricular pacing. If this deterioration of LV function was a result of the accompanying effects of DC shock, the use of radiofrequency ablation (RF) should not result in deterioration of LV function.Aim:To study LV function before and after different methods of AV junction ablation and in patients with chronic ventricular pacing without AV junction ablation.Material:This study assessed LV function in patients following RF ablation, low energy DC ablation of the AV junction and compared the results with our previously reported finding in patients who had AV junction ablation using high energy DC shock. A group of patients undergoing permanent single chamber ventricular pacemaker implantation without AV junction ablation were selected as controls.Methods:All patients were paced in the ventricle at 110 beats/minute during LV function assessment by radionuclide angiography. Global LV function and segmental wall motion abnormalities were assessed before, immediately following and three months after ablation.Results:In the high energy DC ablation group, a fall in global LV function (50±3.0% to 43±3.0%,p=0.02)and impairment of segmental wall motion were detected. Low energy DC ablation resulted in segmental wall motion impairment similar to high energy DC but without affecting global ejection fraction (47.0%±6.7 to 45.5%±3.1,p>0.05).Neither RF ablation (44.0%±3.3 to 45.3%±3.5, p>0.05), nor chronic pacing (46.7%±4.9 to 47.0%±2.9p>0.05)had any effect on global or segmental LV function.Conclusions:Low energy DC or RF ablation of the AV junction does not affect global LV ejection fraction. The deterioration of global LV function after high energy DC shock ablation appears to be related to the accompanying effects of DC energy and not to the effects of chronic ventricular

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1996.tb02911.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

AbstractBackground: This study is motivated by the results of the SOLVD treatment trial (N Engl J Med 1991; 325: 293‐302) which demonstrated the clinical efficacy of enalapril in the treatment of congestive heart failure but did not undertake an economic evaluation of enalapril therapy.Aims: To undertake a cost‐effectiveness analysis of enalapril maleate versus placebo, in conjunction with conventional treatment, in the management of congestive heart failure in Australia.Methods: The published results from the SOLVD treatment trial are used to estimate the increase in survival, and the reduction in the number of hospitalisations, arising from the use of enalapril in the management of congestive heart failure. The costs of enalapril therapy are estimated using Australian data on the drug and non‐drug costs of enalapril therapy and the costs of hospitalisation.Results: Enalapril therapy increases mean survival in heart failure patients by 1.68 to 1.80 months. The average additional drug and non‐drug cost of enalapril therapy is estimated to be $1890 over a four year period, against which must be offset cost savings from a reduction in hospitalisations of $2060 to $2140. On balance, therefore, enalapril is cost saving, reducing health care costs for a congestive heart failure patient on average by SI70 to $250 over a four year period. This value is sensitive to estimates of cost offsets and of improved survival which can result in either a net cost saving with enalapril of approximately $1200 per patient or a net additional cost of up to $3000 per patient (over four years) or greater than $20,000 per life‐year saved.Conclusions: The addition of enalapril to conventional management of congestive heart failure in Australia should improve survival and may provide a net reduction in treatment costs compared with conventional managem

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1996.tb02912.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1996.tb02913.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1996.tb02914.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1996.tb02915.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY