ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1995.tb01888.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.tb01889.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.tb01890.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

AbstractBackground: Acute renal failure (ARF) is a recognised complication following cardiac surgery, but the incidence varies widely in the published literature and there are no Australian data available to help predict the risks of ARF in patients with pre‐existing renal disease.Aim: To determine the incidence, outcome and risk factors for ARF following cardiac surgery.Methods: A retrospective case control analysis of 903 consecutive patients who had cardiac surgery (795 CABG, 68 valve/septal surgery, 40 combined valve/CABG) in 1992‐93. ARF was defined as doubling of serum creatinine concentration (Cr) to>0.13mmol/L if serum Cr was0.20 mmol/L (p<0.01). Mortality was higher (4.2%vs0.7%,p<0.01) and length of hospital stay longer (14.5vsnine days [median],p<0.001) in those with impaired pre‐operative renal function. ARF was more likely in those over 65 years, if valve surgery was included and where there was prolonged cardiopulmonary bypass time.Conclusions: These data confirm that ARF following cardiac surgery is uncommon without preoperative impairment of renal function but currently carries a mortality rate of 13%. Impaired renal function alone is associated with higher mortality and prolonged hospital stay. Studies to prevent ARF in this setting should focus on the high risk subsets de

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1995.tb01891.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

AbstractBackground:The death rate from cardiovascular disease in Tasmania has been among the highest in Australian States for a number of years. The North‐West (NW) and Northern regions of Tasmania account for most of the increased mortality.Aims:To determine the prevalence of cardiovascular risk factors in the North and NW regions of Tasmania and to ascertain whether any differences are consistent with the regional patterns of mortality for ischaemic heart disease (IHD) within the State.Methods:The design of the study was almost identical to the previous National Heart Foundation (NHF) Risk Factor Prevalence Survey conducted in 1989. The subjects, aged 20–69 years, were randomly selected from the Electoral Roll with 1146 subjects participating in the North and 1219 in the NW. Subjects answered a detailed questionnaire and then underwent a brief physical examination with venipuncture for blood lipids. Hobart data from the NHF Risk Factor Prevalence Survey in 1989 were used as an estimate of risk factor prevalence in the Southern region.Results:In both males and females, mean systolic blood pressure was significantly higher in the NW than the South which was in turn higher than the North. Mean serum cholesterol levels in males were higher in the NW than the North. Smoking behaviour was similar in males and females in all regions. Males and females in the NW and North were more inactive than those in the South. Similar proportions in all regions were on either ‘no specific’ or ‘fat modified’ diets. Body mass index in males and females was higher in the NW and North but waist to hip ratios failed to show a consistent trend.Conclusions:While the NW has an unfavourable risk factor profile compared with the South, the North does not. The risk factor data are broadly consistent with, but unlikely to be sufficient to explain fully, the regional differences in mortality from IHD. (Aust NZ J Med 1995; 2

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1995.tb01892.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

AbstractBackground:Upper gastrointestinal (UGI) bleeding is a relatively common and potentially fatal complication of coronary artery bypass graft (CABG) surgery. However, little is known of this problem, including its incidence, predisposing factors and safety of endoscopy in these patients.Aim:To document the incidence, site, predisposing factors and outcome of UGI bleeding following CABG surgery. Also, to assess the safety of UGI endoscopy in these patients.Method:Retrospective study of UGI haemorrhage following CABG at one institution between 1976 and 1991.Results:Fifty‐five of 10,573 patients (0.5%) suffered a major UGI haemorrhage (as defined by need for transfusion or presence of melaena or haematemesis associated with hypotension). Of 51 patients undergoing endoscopy or laparotomy, 42 (82%) bled from duodenal ulceration. Five patients bled from gastric ulcers and one each from oesophagitis and Mallory Weiss tear. Nine patients underwent endoscopic therapy, which initially arrested haemorrhage in eight patients. However, three patients rebled and required surgery. Eight patients underwent surgery as initial therapy, resulting in an overall surgical rate of 20%. One patient died due to multi system failure following surgery. There were no complications from endoscopy. Patients who bled were more likely to have received inotropic support post‐operatively prior to the haemorrhage (p<0.05) and tended to be older than controls (mean age 65.6 yearsvs58.7 years,p<0.01). Twenty‐one of the patients (38%) who bled had a past history of peptic ulceration or dyspepsia compared with 9% of controls (p<0.001). Seven (12.5%) had previously bled from peptic ulceration. Patients who bled were less likely to have received H2‐receptor antagonists in the perioperative period than controls (4%vs20%,p<0.05).Conclusion:Upper GI haemorrhage following CABG is relatively frequent. It is usually secondary to duodenal ulceration. Endoscopy is a safe procedure in this patient group. Mortality did not differ between index patients who suffered a UGI haemorrhage and controls undergoing CABG who did no

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1995.tb01893.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

AbstractBackground:Chronic gastrointestinal (GI) symptoms are believed to be common in the general population, but Australian data are lacking. A valid instrument is required to assess GI symptoms adequately and determine their prevalence in the community.Aims:To test the feasibility, reliability and concurrent validity of a self‐report Bowel Symptom Questionnaire (BSQ) as a measure of GI symptoms, and obtain preliminary data on the prevalence of symptoms in an Australian population‐based sample.Methods:Outpatients (n= 63), volunteers (n= 163) and a random sample (n= 99) of the Penrith population, Sydney, completed the BSQ. Feasibility was evaluated in 264 subjects. Reliability was measured by a test‐retest procedure (n= 43), while concurrent validity was documented by comparing self‐report data with an independent interview (n= 20). The response rate in the population mail survey was 68%. Prevalence data on bowel symptoms in the community sample (n= 99) were age and gender standardised to the Australian population.Results:The majority of subjects found the BSQ easy to complete (97%) and understand (97%); 90% completed the questionnaire in half an hour or less. Reliability (median kappa 0.70, interquartile range 0.20) and concurrent validity (median kappa 0.79, interquartile range 0.26) of GI symptoms were both very acceptable. The internal consistency of all GI symptom scales was good (Cronbach's Alpha range 0.51‐0.74). The prevalence of the irritable bowel syndrome (defined as abdominal pain and disturbed defaecation based on two or more of the Manning criteria) was 17.2% (95% CI: 10–25%).Conclusions:The BSQ was well accepted and easy to understand; it provided reliable and valid data on GI symptoms and should prove useful in large scale epidemiological studies in Australia. (Aust NZ J Med 1995; 2

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1995.tb01894.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

AbstractBackground:The degree of left ventricular (LV) impairment is an important determinant of long term outcome in patients with coronary artery disease (CAD).Aim:We aimed to determine variables predictive of the severity of LV dysfunction in men and women aged 65 years or less with CAD, and to quantitate their contributions.Methods:We documented atherogenic variables and extent of LV impairment and CAD severity at angiography in 521 consecutively studied men and women aged 65 years or less (381 males and 140 females). We assessed severity from an LV impairment score (Green Lane) and the ejection fraction. We related severity to quantitative and categorical variables which included the severity of angina (no angina, stable and unstable angina).Results:The LV impairment score correlated closely (negatively) with the ejection fraction (r = ‐0.783,p= 0.0001). There were eight variables independently predictive of the severity of LV impairment assessed by the LV score. The variables in descending order of relative importance in predicting the LV scores were past history of myocardial infarction (MI), number of significantly diseased vessels (>50% luminal obstruction), life‐time smoking dose, log‐triglycerides, total cholesterol to HDL‐C ratio, hypertension, age and Body Mass Index (BMI). They were all positive relationships. Together they correctly classified the LV scores of 52.6% of the patients. Gender was not an independent contributor to the LV score when other variables were controlled. When the contributions to the variance in LV scores of past history of MI (15.4%) and number of significantly diseased vessels (2.6%) were controlled, life‐time smoking dose independently explained 2.1% (p0.01) of the variance. The LV impairment score was 55% higher in heavy smokers than in non‐smokers (p =0.01). When we compared patients with stable and unstable angina, LV scores are higher and ejection fraction lower in the unstable angina patients consistent with them having a greater degree of LV dysfunction.Conclusion:We conclude that variables other than a history of MI and CAD severity contribute significantly to the variance of the degree in LV impairment in CAD patients among which the life‐time smoking dose, triglycerides, TC/HDL‐C, hypertension and increased BMI are all relevant to prevention, and that patients with unstablevsstable angina usually have more impaired LV function. (Aust NZ J Med 199

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1995.tb01895.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

AbstractBackground:In Australia information on the incidence of acute myocardial infarction (AMI) is available from routinely collected morbidity and mortality data. Given that these data are used for monitoring AMI it is important to assess their quality.Aims:This paper examines the accuracy of the hospital records and death certificates.Methods: Morbidity and mortality data were compared with the Newcastle heart disease register which is part of the WHO MONICA Project for 1986–1991 and sensitivity and positive predictive values calculated.Results:For non‐fatal AMI the hospital diagnostic coding had sensitivity of 78.9% (95% confidence interval [CI] 77.1%‐80.7%), and positive predictive value of 65.6% (95% CI 63.7%‐67.4%). Sensitivity was higher for men than for women and decreased with increasing age. Sensitivity was higher in those with no history of either AMI or other ischaemic heart disease (IHD), higher in current smokers than ex‐smokers or never smokers, and lower in those with a self‐reported history of high blood pressure. Sensitivity also varied among hospitals. Positive predictive value varied only with hospital.Both sensitivity and positive predictive value were high for death certificate data — 89.9% (95% CI 88.4%‐91.3%) and 96.0% (95% CI 95.1%‐97.0%), respectively.Conclusions:Although the mortality data appear to be quite accurate, the hospital data alone are not accurate enough to be used to estimate rates or trends of heart attacks. Additional data are required in order to determine numbers of non‐fatal AMIs accurately. (Aust NZ J Med

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1995.tb01896.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

AbstractBackground:Although spacer devices are frequently used for aerosol therapy in asthma, the commonly used spacers have undergone little controlled evaluation, and their relation to nebuliser therapy is unclear.Aims:The aims of this study were to compare three delivery methods (Breath‐A‐Tech spacer, Volumatic spacer and jet nebuliser) for the administration of salbutamol to reverse acute histamine induced airway narrowing in asthma (Study 1); and to assess asthma control during two weeks use of inhaled therapy via Volumatic or Breath‐A‐Tech spacer (Study 2).Methods:A randomised double‐blind cross‐over comparison was conducted. In Study 1, 27 adults with stable asthma who were currently using pressurised metered dose inhaler therapy attended for three study days. On each study day subjects inhaled doubling doses of histamine and were randomised to receive: (a) salbutamol 200 μg via Breath‐A‐Tech spacer and placebo 200 μg via Volumatic spacer; (b) placebo two puffs via Breath‐A‐Tech spacer and salbutamol 200 μg via Volumatic spacer; or (c) salbutamol 1 mg in 2 mL saline via jet nebuliser. FEV and FEF 25–75% were measured at two minute intervals for 20 minutes. In Study 2, subjects were randomised to use regular asthma medication by Volumatic or Breath‐A‐Tech spacers and recorded symptoms and peak expiratory flow (PEF) in a daily diary.Results:Lung function improved from a baseline FEV, of 51% predicted to 72% after salbutamol inhalation from each of the delivery systems. The spacers and nebulisers produced the same maximum improvement in FEVi, however, lung function improved more rapidly when salbutamol was delivered by spacer. There was no difference in asthma control comparing inhaler use via Breath‐A‐Tech with Volumatic spacer over two weeks use. Subject preference favoured the Breath‐A‐Tech spacer (72%vs4%).Conclusions:The Volumatic and Breath‐A‐Tech spacer devices are effective delivery systems in asthma and may offer a more rapid respon

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1995.tb01897.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY