ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1994.tb02168.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractBackground: Laparoscopy is an old technique that is frequently used by gastroenterologists in America and Germany. With modern equipment it is now possible to perform this technique under local anaesthesia.Aim: To evaluate the usefulness and safety of laparoscopic liver biopsy.Methods: Liver biopsy was routinely performed by laparoscopy under local anaesthetic and sedation. A standard 5 mm laparoscope was used and a pneumoperitoneum induced with nitrous oxide.Results: Two hundred consecutive patients were laporoscoped and underwent liver biopsy. In five patients the liver could not be visualised due to adhesions. Two patients had bleeds related to the procedure. Twenty‐five patients had malignancy diagnosed by guided biopsy. Eight of these had been missed by ultrasound prior to paparoscopy. Cirrhosis was diagnosed laparoscopically in 72 patients. Histology was unable to confirm this diagnosis in four patients.Conclusion: Laparoscopy can be performed safely and comfortably on patients with local anaesthetic and sedation. The visualisation of the liver can add valuable information to liver biops

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1994.tb02169.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractBackground: Alpha‐1‐antitrypsin is the body's major inhibitor of human neutrophil elastase, a powerful proteolytic enzyme capable of degrading the common tissue components. There are over 70 genetic variants of alpha‐1‐antitrypsin, with the Z allele being of greatest clinical relevance. Individuals homozygous for this allele (approximately one in 2500 in Caucasians) have low serum alpha‐1‐antitrypsin levels (10–20% of normal) and are predisposed to emphysema, especially if they smoke. Much rarer are mutations which result in the complete or almost complete absence of alpha‐1‐antitrypsin in the serum.Aim: To determine the cause of complete absence of alpha‐1‐antitrypsin in a patient who at age 27 years had both emphysema and idiopathic cardiomyopathy.Methods: Molecular biology techniques were used to sequence the alpha‐1‐antitrypsin gene. Allele specific amplification was used to show the presence of the mutations in other family members.Results: Investigation showed that the proband was homozygous for the Pi Null Bellingham variant of alpha‐1‐antitrypsin due to the mutation Lys 217 (AAG) to Stop (TAG). His grandmother was heterozygous for Pi Null Bellingham and the additional rare variant P Lowell, Asp 256 (GAT) to Val (GTT), a variant that also results in alpha‐1‐antitrypsin deficiency.Conclusion: Patients with complete absence of alpha‐1‐antitrypsin develop premature emphysema not having smoked or after only minimal exposure, and much earlier than the more common Pi Z individuals who have the usual f

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1994.tb02170.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractBackground: Despite an increasing prevalence of childhood asthma, few studies have quantified the strength of associations between asthma and its aetiological factors.Aims: To quantify the risk factors associated with childhood asthma and to investigate the characteristics of children most at risk.Methods: We studied a population sample of 1339 schoolchildren aged eight‐11 years living in Sydney, NSW. Questionnaires were used to measure respiratory illness, histamine inhalation test to measure airway hyperresponsiveness (AHR), skin prick tests to measure atopy and ELISA assay to measure house dust mite allergen (Der p I) levels. ‘Current asthma’ was defined as the presence of wheeze in the previous year and AHR.Results: The meanDer pI level in 72 homes was 22.5 μg/gm dust which is high compared to suggested thresholds of 2 μg/gm for sensitisation and 10 μg/gm for exacerbation of symptoms. Sensitisation to house dust mites was the most important risk factor for current asthma (odds ratio 7.0, 95% CI 9.4, 22.2). Sensitisation to ryegrass was of minor importance (odds ratio 2.0, 95% CI 1.4, 3.1). The presence of AHR was strongly related to the degree of sensitisation to house dust mite allergen and children with skin wheals greater than 4 mm had frequent morbidity caused by asthma.Conclusions: To reduce the high prevalence of childhood asthma in NSW, it is imperative that we design interventions which recognise that house dust mite allergens are a dominant risk factor and that children with large skin wheal reactions to this allergen are most at risk for severe illness including disturbed sleep, days missed from school and urgent medical a

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1994.tb02171.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractBackground: Coronary angioplasty, although of proven use in partial occlusion, has not been shown to be of similar benefit in chronic total occlusion.Aims: To assess the utility of coronary angioplasty in chronically totally occluded vessels in patients undergoing angioplasty and to determine the success of TIMI‐I flow before angioplasty compared to those patients with TIMI‐O flow.Methods: A group of 178 consecutive patients (from 1984 to 1992), who underwent angioplasty of a chronic occlusion, were analysed. There were 136 males and 42 females with a mean age of 56.9 years.Results: Initial technical success was achieved in 65%. Patients with TIMI‐I flow before angioplasty had a higher chance of success (700%) compared to those with TIMI‐O flow (53%),p<0.04. During hospitalisation six patients suffered myocardial infarction (MI), two required surgery and one patient died. During a mean follow‐up of 2.8 years the overall survival rate was 95% for the group as a whole. Freedom from coronary surgery was significantly greater in patients with successful angioplasty (93%) than those without (66%,p<0.002). The above two populations also showed a significant difference in the incidence of angina (35%vs56%,p0.l) did not differ significantly in the two groups. Restenosis occurred in 63% of the 95 patients (82%) who returned for follow‐up angiography. Eighteen of the 59 patients (28%) with restenosis had a reocclusion.Conclusion: The success rate for angioplasty of chronic total occlusions is acceptable. Long‐term clinical benefit in patients with successful angioplasty is suggested by the high freedom from angina and the lesser need for coronary surgery. No major impact on either the incidence of MI or cardiac survival was noted when patients who had coronary surgery were included, although it must be emphasised that the sample size in this study was insufficient to detect a difference in these outc

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1994.tb02172.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractBackground: Anti‐neutrophil cytoplasmic antibodies (ANCA) are typically associated with small vessel vasculitides. They are also found in situations where other autoantibodies are common, sometimes after infections and possibly in individuals who have received multiple blood transfusions.Aims: The aim of this study was to determine the incidence of ANCA in a variety of haematological disorders, where these predisposing factors may be at work.Methods: Sera from patients with myelodysplasia (n= 26), acute myeloid leukaemia (AML) (n= 3), and myeloproliferative (n= 25) or lymphoproliferative syndromes (n= 16) were screened for ANCA using a crude neutrophil cytoplasmic extract ELISA and indirect immunofluorescent examination of normal peripheral blood neutrophils. Positive results were confirmed by ELISAs for anti‐proteinase 3, anti‐myeloperoxidase or anti‐elastase antibodies.Results: ANCA were demonstrated in two patients with myelodysplasia, both with chronic myelomonocytic leukaemia and greater than 5% blasts in the bone marrow. Both of these individuals were infected at the time that ANCA were demonstrated and other autoantibodies were present. One of these individuals had never had evidence of any vasculitis; the other probably developed myelodysplasia after treatment with cyclophosphamide for Wegener's granulomatosis. ANCA were demonstrated in one individual with AML secondary to myelodysplasia. ANCA were also found in a patient with lymphoma in whom autoantibodies against red cells and platelets were already noted. ANCA were demonstrated in one further individual with lymphomatoid granulomatosis, a condition that resembles Wegener's granulomatosis clinically and histologically, but which is treated as a lymphoma. No ANCA were present in any of the patients with myeloproliferative syndromes.Discussion: ANCA probably occur secondary to immune dysregulation in myelodysplasia and the lymphoproliferative conditions and they are not necessarily associated with the presence of a vas

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1994.tb02173.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractBackground: Breast cancer is the commonest form of cancer in Australian women. Although approximately 50% of women with breast cancer achieve long term survival by current management methods, recurrent or metastatic disease is generally incurable. In addition, women with Stage II disease with>10 positive axillary lymph nodes and also women with locally advanced disease (Stage III) have a poor survival even with adjuvant therapy.Aims: To assess the toxicity and efficacy of high‐dose chemotherapy with autologous peripheral blood stem cell (PBSC) transplantation in women with both metastatic and poor prognosis primary breast cancer.Methods: Twenty‐eight women with either metastatic (15) or poor prognosis (13) primary breast cancer were enrolled in the study between November 1988 to January 1993. PBSC were harvested using high‐dose cyclophosphamide (Cy) with or without granulocyte‐colony stimulating factor (G‐CSF) and a myeloablative regimen of Cy, melphalan and carboplatin (CMCp) was used in the transplantation phase.Results: Optimum numbers of stem cells were harvested in 85% of patients. The use of five G/m2Cy plus G‐CSF resulted in better PBSC yields and a significant reduction in haematologic morbidity when compared to mobilisation with Cy alone. Twenty‐two women underwent 23 PBSC transplants (PBSCT). There have been two early deaths due to sepsis. The predominant morbidities observed following high dose chemotherapy and transplantation have been nausea, mucositis and diarrhoea. The median number of days to discharge following infusion of PBSC was 15 (range 11–21). At a median follow up time of 1.1 years (range 0 months‐3.6 years), 8/22 (36%) evaluable patients remain alive and disease free while 14/22 (64%) have relapsed or progressed or died.Conclusion: High‐dose chemotherapy and autologous PBSCT is a potentially highly effective treatment of women with metastatic and poor prognosis primary breast cancer. Randomised studies are required to compare this form of therapy to more standard forms of treatme

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1994.tb02174.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractBackground: Hip disease is a major cause of immobility and pain in children and young adults with inflammatory arthritides. Total hip arthroplasty (THA) has previously been avoided in young patients because of the concern about durability of the prosthesis and the need for multiple revisions. There are now, however, growing reports of the success of such procedures in improving mobility and relieving pain in the young patient with severe hip disease. In this study we aimed to determine the clinical and radiological results in patients with inflammatory arthritides who had undergone THA before the age of 35 years.Methods: Twenty‐one patients who had undergone a total of 38 hip arthroplasties were identified. Patients' hips were scored both pre‐operatively and at follow‐up using the scoring system of the Hospital for Special Surgery, which allots a score for pain, walking, motion and muscle power, and function. Complications were noted and follow‐up X‐rays were compared to postoperative films to assess radiological loosening.Results: The mean age at operation was 24 years, and the mean follow‐up was 8.6 years. The results in terms of pain relief, mobility, movement and functional capacity were good. Revision was required in 13 hips (34%). This was mostly due to the failure of resurfacing prostheses. Radiological loosening was evident in a further six hips, five of which were asymptomatic.Conclusions: THA can dramatically improve the quality of life of the young patient with arthritis. The main concern is the likely need for multiple revisions, with progressive loss of

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1994.tb02175.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractBackground: Epidemiological studies in humans suggest that regular use of non‐steroidal anti‐inflammatory drugs (NSAIDs) especially aspirin significantly decreases the risk of developing colorectal cancer.Aims: The purpose of this study was to investigate the effect of aspirin on colonic carcinogenesis using the dimethylhydrazine (DMH) colonic cancer model in rats.Methods: Groups of animals were given daily doses of aspirin either 0, 5, 30 or 60 mg/kg for 18 weeks. Half of each group also received 18 × 30 mg/kg/wk injections of DMH.Results: Aspirin at doses of 5, 30 or 60 mg/kg/dy had a progressive effect on the reduction of tumour numbers and the percentage of tumours greater or equal to 5 mm in diameter. Aspirin at doses of 30 and 60 mg/kg/dy significantly reduced tumour incidence.Conclusion: These findings support the epidemiological studies in humans. The rat DMH model would appear to be suitable for investigating the mechanism of action of aspirin in reducing colonic tumour forma

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1994.tb02176.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractBackground: Narcolepsy is a sleep disorder of unknown aetiology. Despite the widely reported strong association with HLA DR2 among different ethnic groups and their varying prevalence rates, there has never been any series of laboratory documented narcolepsy in Chinese.Aims: To report the preliminary experience with Chinese narcoleptic patients and their HLA typing.Methods: The records of 342 patients who presented to our sleep laboratory for various sleep problems from 1986 to 1992 were examined. Both clinical and polysomnographic data were analysed. The criteria for a diagnosis of narcolepsy is based on shortened mean sleep latency of less than 5 minutes and presence of rapid eye movement (REM) sleep in two or more of the five 20‐minute naps during multiple sleep latency test (MSLT).Results: There were five narcoleptic patients documented resulting in an overall laboratory prevalence of 1.5% or 2.3% of patients presenting with hypersomnia. All patients were HLA DR2 positive.Conclusion: There is 100% association with HLA DR2 in Hong Kong Chinese narcoleptic patients. Based on the laboratory prevalence, the prevalence rate of narcolepsy among Hong Kong Chinese population is estimated to be within the range of four in 10,000 to one in 100,00

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1994.tb02177.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY