ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1993.tb01806.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1993.tb01807.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1993.tb01808.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract:A retrospective analysis of 125 consecutive lupus anticoagulant (LA) positive patients and 125 age, sex matched lupus anticoagulant negative controls is reported with the aims of defining further the clinical spectrum of disease, determining at‐risk subgroups and management strategies. There was no significant difference in the incidence or pattern of complications in those with systemic lupus erythematosus (SLE) and related disorders, and those without SLE. Venous thromboembolism, immune thrombocytopenia, foetal loss, depression and hypertension were statistically more common in the LA group than in the control group. In contrast to previous reports, children aged ten years or less with the LA developed significantly more complications than controls. Patients with the LA secondary to drugs also developed complications, a finding which is also at variance with previous reports. There was a significant difference in the outcome of arterial disease(p<0.04) and venous thromboembolism (p<0.001) when long term anticoagulation was part of the treatment regimen. (Aust NZ J Med 1993; 23: 151–1

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1993.tb01809.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract:In 1989 the National Heart Foundation (NHF) of Australia's Heart Week campaign was directed towards encouraging those with symptoms of possible myocardial infarction (MI) to seek help as promptly as possible.To evaluate its effect, three surveys were conducted of patients admitted to 22 coronary care units (CCUs). Two (335 and 221 patients) preceded and one (253 patients) followed the public education campaign. During the third survey a subset of patients were asked why they delayed, how long they thought one should wait before seeking help, whether they were aware of the media campaign and whether this had influenced their behaviour.Overall, only 42% of 809 patients sought help within one hour (median delay 1.2 hours). The median time of arrival and the proportion of patients arriving within one, two and four hours was not altered after this campaign. Those who admitted to having been aware of the campaign sought help no more promptly. The Heart Week campaign could not be shown to have produced any clinically important change in patient delay. Future campaigns will need to be modified in the light of this experience. (Aust NZ J Med 1993; 23: 157–161

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1993.tb01810.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract:The aim of this study was to determine the lipid, lipoprotein and apolipoprotein distribution in an ambulant elderly New Zealand population, and to consider the association between these and other variables (including body mass index, diabetes mellitus, and smoking history) with the prevalence of manifest macrovascular disease in a cross‐section analysis.The population sample was randomly selected from the age/sex register of a large urban medical centre in Christchurch, New Zealand. A total of 369 subjects (participation rate 69%) aged 65 years and older were screened for manifest macrovascular disease, diabetes mellitus, smoking status, height and body weight. Levels of plasma total cholesterol, triglycerides, HDL cholesterol, apolipoproteins AI and B, glucose, glycated haemoglobin and fibrinogen were measured. Three way analysis of variance (ANOVA) was used to compare continuous variables across age/sex/macrovascular disease groups.Females had significantly higher levels of total and HDL cholesterol, apolipoproteins AI and B than males. Body mass index showed a significant decrease with increasing age.Macrovascular disease was manifest in 24% of males, and in 26% of females. No direct correlation was seen between any of the measured continuous variables and the presence of macrovascular disease, except for fibrinogen (P<0.05). No significant association was seen between macrovascular disease and smoking status, nor with a diagnosis of diabetes. In females, the frequency of macrovascular disease was significantly higher amongst those with low (<1.00 mmol/L) levels of HDL. (Aust NZ J Med 1993; 23: 162–1

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1993.tb01811.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract:Thirty‐seven patients (21 female, 16 male) with Wegener's granulomatosis (WG)were reviewed. Patients were followed for a mean six years after diagnosis; 14 were followed for more than seven years. The clinical features were similar to those in previous studies. In this series, only 13 patients (35%) had renal disease at presentation and the cumulative incidence of renal involvement was 51%. Thirty‐one patients received treatment which included cyclophosphamide (CP). The case fatality rate of the six patients not treated with CP was 83% (five deaths). By contrast, all CP treated patients improved and 21 (68%) had complete remissions. Nine (29%) were in complete remission for a mean 4.9 years after discontinuing all treatment. Two were disease free for over ten years. The actuarial probability of survival for these patients was 97% at one year and 71% at ten years. Only three CP treated patients (10%) progressed to end‐stage renal disease. The case fatality rate was 26% (eight patients) and sepsis was the cause of death in five. Fourteen patients (45%) treated with CP had at least one relapse of vasculitis and seven (23%) had multiple (two or more) relapses. These data indicate that CP is effective in inducing remissions and prolonging survival in patients with WG; however, relapses are frequent. (Aust NZ J Med 1993; 23: 168

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1993.tb01812.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract:The risks of acquisition of hepatitis C infection, the histological spectrum of liver disease, and the presence of viraemia were investigated in anti‐hepatitis C virus (HCV) antibody positive blood donors. All 357 (0.64%) blood donors to the South Australian Red Cross Transfusion Service found to have anti‐HCV antibody during the first seven months of testing in 1990 were assessed, and 70 (19.6%) were found to have elevated alanine transaminase levels. These subjects were referred for participation in the study; 31 presented for enrolment.Sixteen (52%) of the 31 patients had previously used intravenous drugs, four (13%) had been transfused, two (6%) had a history of occupational exposure to blood, and three (10%) had tattoos and ear‐piercing as possible risk factors for acquisition of hepatitis C. There was no history of parenteral exposure in six (16%). None of these donors had clinical evidence of liver disease, but in all 24 of the 31 who had a liver biopsy there was histological evidence of significant liver damage. Twelve had evidence of chronic active hepatitis. All 24 subjects biopsied were viraemic as judged by the presence of HCV RNA in serum. (Aust NZ J Med 1993; 23: 176

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1993.tb01813.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract:During the years 1981‐90 inclusive 227 patients with haematological malignancy received an HLA‐identical sibling first transplant at St Vincent's Hospital, Sydney. Recipients with acute leukaemia in first remission or chronic myeloid leukaemia in first chronic phase were analysed as good risk, and those beyond these stages, as poor risk patients. Good risk patients transplanted in the years 1986‐90 (n= 52) showed improved actuarial survival (74%) compared to those (n= 58) transplanted during 1981‐85 (37%,p= 0.01). There was a suggestion that leukaemia‐free survival was also improved in those transplanted during the later time period (62% versus 36%,p= 0.07). In contrast, poor risk patients transplanted during 1986‐90 (n=55) appeared to have worse leukaemia‐free survival (15%) compared to those transplanted during 1981‐85 (n= 62) (22%,p =0.09). The incidence of acute graft‐versus‐host disease (GVHD) grades I‐IV in all patients was 94% in those transplanted during 1981‐85 (n=120) and 86% in those transplanted during 1986‐90 (n=107) (p= 0.002). The incidence of acute GVHD grades II‐IV was 37% during 1981‐83, 20% during 1984‐86, and 28% during 1987‐90 (p= 0.1). The decrease in incidence and severity of acute GVHD correlated with the introduction of the cyclosporin/short methotrexate regimen in our practice. The incidence of cytomegalovirus (CMV) pneumonitis was 18% in 1981‐85, and 11% in 1986‐90 (p= 0.09). In 1989 and 1990 no cases of CMV pneumonitis occurred. The decrease in incidence of CMV pneumonitis correlated with the introduction of prophylactic ganciclovir. The reduction of the transplant‐related complications acute GVHD and CMV pneumonitis has resulted in improved survival for good risk patients, but not for bad risk pati

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1993.tb01814.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract:Kennedy's disease (X‐linked spinal and bulbar muscular atrophy) is an inherited form of motor neuron disease that may be diagnosed genetically using the polymerase chain reaction (PCR). This form of motor neuron disease principally affects the proximal limb girdle muscles as well as those involved with deglutition and phonation. Onset is usually late, in the fourth to fifth decades of life, and progression is slow. Moderate gynecomastia and testicular atrophy are usually present, suggesting a defect in androgen receptor function. Being inherited in an X‐linked recessive manner, only males are affected, with females as the unaffected carriers.The genetic abnormality that causes Kennedy's disease is an enlargement of the androgen receptor (AR) gene, which is located on the proximal long arm of the X chromosome. In patients with this disease, a region in the gene containing repeated CAG triplet nucleotides is approximately twice the size of that found in normal people. Using PCR to amplify this region of the AR gene, this study confirms this genetic mutation in 12 males from eight different families. All these families live on the east coast of Australia. This mutation was not found in five patients with other forms of motor neuron disease. Twelve heterozygote females, the daughters of affected males and carrier females, have also been identified. In addition, there are 14 asymptomatic and as yet untested sons of carriers, ranging in age from less than one year to over 40 years of age. Each has a 50% chance of inheriting the abnormal gene from his mother and thus developing Kennedy's disease.This study shows that Kennedy's disease may be diagnosed genetically using whole blood, and discusses the ethics of prenatal and presymptomatic testing, particularly in males under 16. (Aust NZ J Med 1993; 23: 187

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1993.tb01815.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY