ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1996.tb00593.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.tb00594.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

AbstractBackground:Oxidative modification of low density lipoprotein (LDL) may play a role in the pathogenesis of atherosclerosis. Ingestion of vitamin E in high dosage has been shown to reduce the susceptibility of LDL to copper‐induced oxidation, as assessedex vivo.Aim:To determine a minimum dose of supplementary vitamin E which will significantly reduce the susceptibility of LDL to oxidation.Methods:A single centre, double‐blind, parallel placebo‐controlled trial. Healthy volunteers (totaln=42) were randomised to receive placebo, 500, 1000 or 1500 IU/day of vitamin E (D‐α‐tocopherol) for a period of six weeks. Primary outcomes were change in lag time or oxidation rate to copper‐induced LDL oxidation. Secondary outcomes were changes in plasma vitamin E levels and clinical tolerance.Results:Lag time to LDL oxidation was significantly prolonged and oxidation rate significantly slowed at all dose levels of vitamin E, indicating a threshold effect from 500 IU/day. Compared to placebo, the median prolongation in lag time on 500 IU/day was 26%, on 1000 IU/day 24% and on 1500 IU/day 35%. The corresponding slowing in oxidation rates was 14%, 19% and 25% respectively. The per cent change in plasma vitamin E concentration was highly correlated with the change in lag time (r=0.61, p<0.001) and oxidation rate (r=−0.55,p<0.001). Vitamin E was generally well tolerated.Conclusions:Vitamin E in a dose of 500 IU/day will significantly reduce the susceptibility of LDL to oxidation. Whether or not this treatment will consistently reduce the future incidence of coronary artery disease will only be answered by further c

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1996.tb00595.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

AbstractBackground:The influence of diet in asthma control remains unclear. However, there is likely to be a wide gap between patient perceptions and the probable actual role. Some 20–60% of people with asthma report food as a trigger factor while approximately 2.5% react to double‐blind placebo‐controlled challenges. The aim of this study was to determine: the frequency, type and sources of dietary advice being offered to patients, the prevalence of dietary modification, whether dietary changes were perceived to be of benefit and the type and sources of food/beverage reactions that people perceive they have experienced.Method:A self‐administered ‘food and asthma’ questionnaire was developed and mailed to 156 consecutive Alfred Hospital Asthma and Allergy Clinic patients registered on a computer database.Results:The completed questionnaire response rate was 86.5%. Dietary advice had been offered to 47% of respondents while 61% had tried to modify their diet. Dietary restriction was the most common dietary modification. Where dietary restriction had occurred 79% of respondents perceived that this had improved their asthma control. A doctor was the most common source of dietary advice. Seventy‐three per cent reported that food induced asthma.Conclusion:We confirmed that patients with asthma perceived diet to be important in their asthma control and that dietary modification is common despite its lack of objective basis. The influence of diet and asthma requires more research, evaluation and clini

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1996.tb00596.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

AbstractBackground:The permeability of the alveolar‐capillary barrier to an inhaled aerosol of technetium99mlabelled diethylenetriamine penta‐acetate (99mTc‐DTPA) is used as an index of alveolar epithelial injury. Permeability is greatly increased in active smokers.Aims:To determine the effect of sidestream smoke inhalation on permeability as this has not been described previously.Methods:We measured lung clearance of inhaled99mTc‐DTPA aerosol in 20 normal nonsmoking subjects before and after exposure to one hour's sidestream smoke inhalation.Results:Measured carbon monoxide (CO) levels rose to a maximum of 23.5±6.2 ppm (mean ±D) from baseline values of 0.6± 1.3 (p<0.001) and plasma cotinine levels to a maximum of 9.5± 4.5 nmol/L (mean ± SD). The half time (T1/2 in minutes) for99mTc‐DTPA clearance rose from baseline 69.1± 15.6 (mean ± SD) to 77.4± 17.8 (p<0.05) after smoke exposure. No effect of99mTc‐DTPA scanning or of sidestream smoke was demonstrated on lung function.Conclusions:We conclude that low level sidestream smoke inhalation decreases99mTc‐DTPA clearance acutely in humans. The mechanism of this unexpected result is not established but may include differences in constituents between sidestream and mainstream smoke, alterations in pulmonary microvascular blood flow, or changes in surfactant due to an acute ph

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1996.tb00597.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

AbstractBackground:Microalbuminuria has been shown to be associated with cardiovascular mortality in type 2 diabetic subjects. It is unclear to what extent this is due to the increased prevalence of other cardiac risk factors.Aims:To examine the relationship of urine albumin excretion to cardiovascular mortality and to determine its status as an independent risk factor.Methods:In a prospective longitudinal study from 1986–1999 we followed 666 type 2 diabetic subjects from a diabetes outpatient service. Cardiovascular risk factors including urine albumin concentration were measured at study entry. Cox proportional hazards regression was used to determine risk factors for mortality. The hazard ratios of microalbuminuria and macroalbuminuria for all cause, cardiovascular and coronary heart disease mortality were determined after accounting for other cardiac risk factors including blood pressure, glycated haemoglobin, total cholesterol, HDL cholesterol, triglycerides, urea, smoking, body mass index, patient age and disease duration.Results:The prevalence of urine albumin of 30–300 mg/L at study entry was 31.7%. A total of 167 deaths occurred (80 from cardiovascular disease). Mortality hazard ratios in subjects with urine albumin of 30–300 mg/L as compared to<30 mg/L, adjusted for age, sex and other cardiovascular risk factors were 1.77 (95% CI 1.22–2.57,p=0.002) for all causes, 2.34 (95% CI 1.38–3.99,p=0.002) for cardiovascular and 1.78 (95% CI 0.97–3.26,p=0.061) for coronary heart disease (CHD) mortality. Other factors significantly associated with cardiovascular mortality included diastolic blood pressure, HDL cholesterol and glycated haemoglobin. Total cholesterol and log triglyceride were significantly associated with CHD mortality. Disease duration, age at diagnosis, smoking and body mass index were not related to cardiovascular or CHD mortality.Conclusions:We confirm microalbuminuria as an independent predictor of mortality in type 2 diabetes despite its association with a number of conventional cardiovascular r

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1996.tb00598.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

AbstractBackground:There has been a sustained increase in incidence of meningococcal disease throughout Australia since 1987. In south western Sydney the incidence is higher than the national rate and a cluster of cases occurred in 1991 resulting in a widespread vaccination programme.Aims:To investigate the clinical demographics of patients with meningococcal disease treated in south western Sydney, and to differentiate meningococcal strains to understand better the epidemiology in this urban setting. In addition, to investigate whether delays in diagnosis of meningococcal disease and institution of appropriate treatment were occurring.Methods:Retrospective classification of notified cases as meningitis, septicaemia, meningitis/septicaemia, and other syndromes. Clinical information recorded to establish patterns of disease, delays in diagnosis and appropriate treatment, and outcome. Microbiological classification of organisms isolated by serogroup, serotype and subtype.Results:Meningococcal disease primarily affects young children in winter months in south western Sydney, with a secondary peak of incidence in the 15–20 year old age group. 20.7% presented with meningitis only, 22.4% with septicaemia only, and 53.4% with meningitis/septicaemia. There was a delay in diagnosis and institution of appropriate treatment of more than two hours in 21/58 (36.2%) patients including three of the six who died. No patient had received a parenteral antibiotic prior to coming to hospital ‐ 18.9% had received an oral antibiotic. The use of antibiotics before diagnostic lumbar puncture decreased the number of positive CSF cultures. However, in all but one patient with negative cultures there was other microbiological evidence of meningococcal disease. The mortality rate was highest (30.8%) in patients with septicaemia only, 6.5% in patients with meningitis/septicaemia and 0% in patients with meningitis only.Serogroup C was the predominant organism in all age groups. The predominant serotype was 2b (80% of serogroup C isolates). Subtypes were more variable but P1.2 occurred in 66.7% of serogroup C strains.Conclusions: There is a need for more education in our Health Area to improve the time taken to diagnose and institute appropriate treatment. The predominance of serogroup C is unusual in urban Australia where national data show serogroup B organisms predominate. Meningococci of phenotype C:2b:Pl.2 have continued to cause disease in our Health Area for the past five years. This phenotype is uncommon in other areas of Austra

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1996.tb00599.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

AbstractBackground:It has been recognised recently that primary hyperaldosteronism may be more common than previously thought, the frequency of diagnosis being improved by screening using a plasma aldosterone concentration to renin activity ratio.Aims:To determine the frequency of primary hyperaldosteronism, screening with both plasma aldosterone to renin concentration (PRC) and activity (PRA) ratios, in normokalaemic subjects previously diagnosed as having essential hypertension.Methods:Plasma potassium, aldosterone and PRCs and PRA and blood pressure (BP) were measured in 74 hypertensive subjects previously diagnosed by one physician as having essential hypertension. A normal range for plasma aldosterone/renin ratios was determined in 147 control subjects.Hypertensive subjects with elevated aldosterone/renin ratios were further assessed for primary hyperaldosteronism using saline loading and fludrocortisone suppression. Those in whom plasma aldosterone concentration exceeded 140 pmol/L after suppression tests underwent adrenal vein sampling for measurement of aldosterone and Cortisol concentrations as well as adrenal CT scanning to diagnose the cause of primary hyperaldosteronism. The main outcome measures were a diagnosis of aldosterone producing adenoma or bilateral adrenal hyperplasia based upon adrenal vein sampling.Results:Four subjects (5%) had an elevated plasma aldosterone to renin ratio using PRC and six (8%) using PRA. Two subjects (2.7%) in this selected population had primary hyperaldosteronism, both of whom had BP>160/110 mmHg at the time of testing.Conclusions:The frequency of normokalaemic primary hyperaldosteronism appears to be greater than previously thought, though the true incidence in the general population of hypertensive subjects remains unknown. The sensitivity of diagnosis (but not specificity) may be improved by measurement of the plasma aldosterone/renin ratio and PRC is at least as adequate as PRA for this process.

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1996.tb00600.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

AbstractBackground:While use of thrombolytic therapy in the management of acute myocardial infarction has become accepted practice in major teaching hospitals, its use in peripheral metropolitan hospitals has not been well accepted.Aim:To evaluate the use of thrombolytic therapy in the management of acute myocardial infarction in the Emergency Department (ED) of a peripheral metropolitan hospital.Methods:A mixed prospective and retrospective observational study of 69 patients with acute myocardial infarction, who received thrombolytic therapy during a three year period, was conducted in a community based ED.Results:Demographic data, door to drug interval, complications occurring during administration of thrombolytics and subsequent interhospital transfer were recorded. The mean door to drug interval in 1992 was 79.7 minutes (95% CI: 50.7 to 109.1) and by 1994 this had fallen to 25.6 minutes (95% CI: 18.9 to 32.3). Hypotension (22%) was the most common complication of therapy observed and cardiac arrest occurred in two cases (3.2%). A single episode of hypotension and vomiting were the only complications that occurred during interhospital transfer. There were no deaths during therapy or transfer.Conclusion:Thrombolytic therapy can be undertaken in the EDs of peripheral metropolitan hospitals in a safe and timely manner. There is little justification for routine medical escorts in the clinically stable post thrombolysis patient.

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1996.tb00601.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.tb00602.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY