ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1995.tb02819.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1995.tb02820.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1995.tb02821.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

AbstractBackground:Severe heat‐related illness can result in hospitalisation and possibly death. These illnesses are potentially preventable; in Australia high environmental temperatures are common.Aims:To identify (i) possible risk factors for hospital attendance with heat‐related illness during a heat wave, (ii) problems with diagnosis and therapy, (iii) issues in prevention, and (iv) areas for further study.Methods:A retrospective descriptive survey from four major teaching hospitals in Adelaide, South Australia (SA), was conducted during a ten day period of exceptional heat in February 1993, in order to review all emergency department presentations (i.e. deaths, casualty treatment or hospital admissions) with a heat‐related illness as determined by attending doctors' documentation. Demographic, clinical, management and outcome data were collected.Results:Ninety‐four patients were classified as having a heat‐related illness of whom 78% had heat exhaustion. Eighty‐five per cent were age 60 years or over; 20% came from institutional care; 48% lived alone; 30% had poor mobility. Peak presentation followed high daily temperatures for four consecutive days. Severity was related to pre‐existing cognitive impairment, diuretic use and presenting temperature, heart rate, blood pressure, plasma sodium and plasma creatinine. Treatment tended to be non‐standardised. Mortality was 12%. Seventeen per cent required a more dependent level of residential care upon discharge.Conclusion:Problems were identified in accuracy of diagnosis and appropriate intervention. Awareness of the risk factor profile is needed among health workers, to ensure early preventative strategies. Populations to target for future prevention include elderly people (including those in institutional care), patients with cognitive impairment and patients taking diuretics, multiple medication and/or with other severe co‐existing illnesses. Treatment could be

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1995.tb02822.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

AbstractAims:To review the outcome of renal transplantation in small children treated with triple immunosuppression at a single Australian centre.Methods:The medical records of all children under the age of five years undergoing renal transplantation from 1988 were reviewed. The duration of follow‐up was 30 months (range 18–36).Results:Six children received seven renal allografts (five living‐related [LR] and two cadaveric [CD]). They had a median age of 3.75 years (range 1.5–4.9) and weight of 11.6 kg (9.1–14.5) at the time of transplantation. All patients received an immunosuppressive regime involving cyclosporin A, azathioprine and prednisolone. There were no deaths. The only graft lost was a CD graft (severe acute rejection within one week of transplantation). Hypertension occurred in all recipients and usually required more than one antihypertensive drug for treatment. Renal function measured by serum median creatinine concentration (range) was 0.05 mmol/L (0.03–0.11) at three months (n= 6) and 0.10 mmol/L (0.07–0.22) at 30 months (n= 4). Growth estimated from median (range) height standard deviation scores was ‐ 1.97 (‐1.36‐ ‐ 4.04) at three months (n= 6) and ‐ 1.90 (‐ 1.74–2.50) at 30 months (n= 4). No patient was entirely weaned from prednisolone. Cyclosporin A side effects included hirsutism (five patients), gingival hyperplasia (six patients) and nephrotoxicity (three patients).Conclusions:Satisfactory patient and graft survival can be accomplished in this recipient age group. The results compare with other international experience and accumulating Australian experience. Hypertension and poor skeletal growth were consistent observations. The long‐term outcome of renal function using triple immunosuppres

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1995.tb02823.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

AbstractBackground:Atrial tachycardia is a relatively uncommon arrhythmia which usually responds poorly to antiarrhythmic drug therapy. Transcatheter radiofrequency (RF) ablation is a new therapeutic modality for patients with atrial tachycardia.Aim:This study analyses our early experience with the treatment of atrial tachycardia by this technique.Methods:Thirteen consecutive patients (age 13–63 years) with 15 drug‐refractory atrial tachycardia foci were treated with RF catheter ablation. Atrial tachycardia was mapped by seeking the earliest atrial activation in the right atrium in eight patients and in the left atrium in five.Results:Tachycardias were abolished in nine (69%) patients, including two sinoatrial re‐entrant tachycardias and seven automatic atrial tachycardias, after 9±10 (range, one to 28) pulses of RF current. Six of these ablated atrial tachycardia foci were right sided and three were on the left. One patient had three separate right atrial tachycardia foci; one was eliminated. Tachycardia recurred after two weeks in one patient with apparently successful ablation of sinoatrial re‐entrant tachycardia. One patient with successful ablation of a right atrial tachycardia developed cardiac tamponade requiring surgical intervention.Conclusion:This study demonstrates that atrial tachycardia arising from diverse sites can be eliminated by RF catheter

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1995.tb02824.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

AbstractBackground:Pulmonary disease is the most common reason for presentation and the major cause of death in HIV‐infected patients. There has been an evolution in the optimal approach to the investigation of a pulmonary infiltrate in HIV‐infected patients since the introduction of induced sputum for the diagnosis ofPneumocystis cariniipneumonia (PCP).Aims:To evaluate the usefulness of flexible fibreoptic bronchoscopy (FFB), bronchoalveolar lavage (BAL), transbronchial biopsy (TBB) and bronchial brushings (BB) in the diagnosis of pulmonary disease in HIV‐infected patients and to examine the effect of FFB on changes in therapy and survival.Methods:The histories of all HIV‐infected patients referred to Fairfield Hospital for FFB between January 1990 and June 1993 were examined retrospectively.Results:Forty‐two FFB were performed on 41 patients (40 male and one female). Definitive diagnoses made at FFB included Kaposi's sarcoma (KS) (n= 9), invasive aspergillosis (n= 5), PCP (n= 4),Mycobacterium avium complex(MAC) pneumonia (n= 2), cytomegalovirus (CMV) pneumonia (n= 1),Cryptococcus neoformanspneumonia (n= 1), microsporidium (n= 1) andPseudomonas aeruginosapneumonia (n= 1). TBB and BB did not provide a diagnosis for diseases not seen macro‐scopically at FFB or diagnosed by BAL. FFB findings altered diagnosis in 21/42 (50%) presentations and changed therapy in 26/42 (62%) cases.Conclusions:FFB together with BAL altered the working diagnosis and changed therapy in a significant number of patients. TBB and BB should not be routinely performed in all patients as these procedures are of limited value in t

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1995.tb02825.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

AbstractBackground:The clinical presentation, course, and radiological spectrum of bronchiolitis obliterans organising pneumonia (BOOP) is still being characterised to aid differentiation from other causes of organising pneumonia.Aims:To define the clinical presentation, response to therapy, and radiological spectrum of BOOP.Methods:Fifteen cases of BOOP were retrospectively reviewed. The clinical presenting features, treatment and outcome of each patient were determined. Three independent readers and chest X‐rays (CXRs) were blinded. CXRs were scored by a semi‐quantitative method. Modal scores were calculated for type and profusion of opacification of each CXR.Results:The mean age of presentation was 64 years and the median duration of follow‐up was 12.5 months. Thirteen patients received corticosteroid therapy. Outcome was varied. One patient had progressive loss of lung function, five had persisting symptoms with stable abnormal lung function, and nine were asymptomatic with near normal lung function. Five patients had a disease relapse. Symptom length prior to presentation, duration and intensity of treatment were not associated with outcome (ρ= 0.23–0.9). Radiological opacities were alveolar in 73%, large localised infiltrates in 13%, nodular in 20% and mobile in 33% of CXR series. There was no relationship between overall profusion, type of CXR opacities and patient outcome, treatment duration or treatment intensity (ρ= 0.42–1.0).Caonclusions:The clinical spectrum of BOOP includes mild subacute, chronic progressive, and acute life threatening illness. Prognosis and response to treatment is variable. The diversity of radiological findings and clinical presentations should prompt consideration of the diagnosis in patients with undiagnosed respiratory tract symptoms and persisting or varying radiological ab

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1995.tb02826.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

AbstractBackground:Primary spontaneous pneumothorax (PSP) is a common clinical condition associated with high recurrence if no definitive treatment is given and could be life threatening if left untreated. The best treatment for this condition, however, remains controversial.Aims:A prospective study of patients with PSP treated by video assisted thoracoscopic surgery (VATS) after a mean follow up of 16 months.Methods:Between September 1992 and April 1994, 114 VATS procedures were performed on 110 patients with PSP (including four patients with bilateral presentation) by one surgical team from a single institution. Mechanical pleurodesis with Marlex mesh was performed on all patients. In addition, apical bullae were identified in 100 cases (88%) and these were resected.Results:There was no mortality. The median hospital stay was three days. The procedure was well accepted by patients and this was reflected subjectively in a visual analogue scale and objectively in the requirement of postoperative analgesia. Complications included one wound infection, one bleeding, eight persistent air leaks over ten days. We had two failures with recurrence of pneumothorax occurring one week and two months postoperatively (mean follow up of 16 months). Late morbidity with intercostal neuropathy was identified in nine patients but only two of them required oral analgesics.Conclusion:VATS is a quick and effective treatment for PSP. We currently recommend VATS for patients with recurrent spontaneous pneumothorax, as well as first time pneumothoraces associated with tension, bilaterality, frequent travelling, unreliable follow up and persistent air leak over three days.

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1995.tb02827.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

AbstractAbstract Background:Inherited factor V (FV) mis‐sense point mutation has recently been identified as a major cause of familial venous thrombosis. The incidence of this congenital haemostatic disorder in Australia is unknown.Aim:To examine the incidence of this congenital defect in patients with thrombosis attending a haematology clinic.Methods:Individuals investigated or treated for venous and arterial thrombosis over a four month period, as well as those who were on anticoagulant for valvular replacement or arrhythmia were studied for the presence of FV mis‐sense point mutation, FV Q506 (G to A at nucleotide position 1691) by a polymerase chain reaction based test, and activated protein C (APC) resistance using an APTT based coagulation assay.Results:Forty‐five patients with venous thromboembolism (VTE), 20 patients with coronary artery disease and 25 patients with valvular replacement or arrhythmia who were on anticoagulant were examined. The frequency of FV mis‐sense point mutation in these three groups was 26.7%, 15% and 4% respectively. In this study, patients with FV Q506 were of a younger age and had a higher incidence of extensive thrombosis or recurrence as compared to those with the normal factor V gene. This mutation was found in a diverse group of people (four of the 12 patients were of non‐European origin). Nearly 50% of these patients had other risk factors for VTE. The number of patients with a family history of VTE was similar for those with the FV mutation and the normal FV.Conclusion:This study confirms the high incidence of FV Q506 mutation in patients with VTE reported overseas. Several clinical features, i.e young age of onset of VTE, high recurrence rate, diverse ethnic background and importance of associated risk factors are highlighted. The findings in this study also raise the possibility that this mutation may be a risk factor for arterial thrombosis. Large studies are required to substantiate these

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1995.tb02828.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY