ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1991.tb00443.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

AbstractThe clinical characteristics, perioperative complications and medium term outcome were analysed for patients undergoing emergency coronary artery bypass surgery (CABG) following failed coronary angioplasty (PTCA).Seven hundred and twenty PTCAs were performed from June 1981 to June 1989, of which 30 (4.2%) resulted in CABG within four hours of PTCA. The perioperative course and follow‐up were compared to 30 patients undergoing elective CABG, matched retrospectively for age, sex, month of operation and number of grafts.The emergency group had a tendency to more post operative bleeding, but no increased incidence of early reoperation for bleeding, and had a high incidence of periprocedural Q wave infarction (20% vs 3%, p<0.05). The emergency group had shorter bypass time and decreased use of the internal mammary artery (7% vs 50%, p<0.05). There was one in‐hospital death in the emergency group.We conclude that patients with failed PTCA requiring emergency CABG are more likely than an elective group to have post operative bleeding but no increased risk of early reoperation, and have a higher incidence of perioperative Q wave infarction.There is significant difference in operative technique between emergency and elective coronary bypass groups (greater use of the internal mammary artery in the elective group), but not in hospital mortality. Rapid successful surgical revascularisation after failed PTCA resulted in medium term outcome similar to that of patients undergoing elective coronary surgery. (Aust NZ J Med 1991; 21: 211

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1991.tb00444.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

AbstractA retrospective audit of the medical records and respiratory function data of 186 subjects placed on long term continuous home oxygen therapy between 1979 and 1988 was undertaken. Kaplan‐Meier survival curves were constructed for subjects with Chronic Obstructive Airways Disease (COAD) and Interstitial Lung Disease (ILD).There was an almost twofold greater mortality rate for COAD subjects at 12 months when compared to the Medical Research Council Working Party (MRC) and the Nocturnal Oxygen Therapy multicentre clinical trials (NOTT). However, the mean values of the baseline physiological parameters were similar to these major studies of long term oxygen therapy.Survival of ILD patients was significantly less than COAD patients (p<0.001). Within both disease categories, females survived significantly longer than males. Within the COAD category the observed sex difference was not abolished when the data was controlled for age, Pco2, Po2and pack‐years (as an estimate of total cigarette consumption). However, prior smoking history appeared to modify the male‐female difference in COAD survival.These are the first Australian survivorship data for patients on long term oxygen therapy. The more adverse survival figures compared with the overseas studies may reflect the co‐existence of other diseases. (Aust NZ J Med 1991; 21: 2

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1991.tb00445.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

AbstractSixty‐six volunteers who considered themselves to have wheat dust‐related respiratory disease, were reviewed from a farming community. A spectrum of disease was described ranging from a mild allergic rhinitis limited to periods of wheat dust exposure through to perennial asthma in which wheat dust was but one of several precipitating factors. Approximately half of those with asthma had symptoms limited to times of wheat dust exposure. Results of a limited survey of farmers showed patterns of symptoms similar to those in the volunteer group. Most subjects were atopic with elevated IgE levels, and had positive skin prick tests to environmental allergens. All but one of 65 subjects tested had a positive RAST test to wheat dust antigen. It is concluded that wheat dust associated respiratory tract disease is a significant problem in Australian farming communities, that a particular pattern of asthma can be described, and that IgE mediated reactions contribute to this disease pattern. (Aust NZ J Med 1991; 21: 211

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1991.tb00446.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

AbstractIsoelectric focusing and immunofixation allow the detection of abnormal immunoglobulin bands in the cerebrospinal fluid (CSF). In normal subjects, the immunoglobulins in the CSF are derived from serum. In inflammatory disorders of the nervous system, there may be intrathecal immunoglobulin synthesis usually seen as oligoclonal bands confined to the CSF. Monoclonal immunoglobulin bands in the CSF are not common. We surveyed 1490 CSF samples, and found that a total of nine had a monoclonal immunoglobulin band and that in three this was not present in the serum. Of these three, one patient had chronic inflammatory demyelinating polyneuropathy and the antibody may have been secreted by lymphocytes which had infiltrated the nervous system. The other patients had either lymphoma or lymphomatoid granulomatosis within or adjacent to the nervous system and the monoclonal immunoglobulin was probably secreted by B lymphocytes within those lesions. (Aust NZ J Med 1991; 21: 227–229

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1991.tb00447.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

AbstractThe aim of this study was to identify differences in the medical management and clinical outcome in a group of elderly patients admitted to a designated geriatric assessment unit (GAU) or to two general medical units (GMUs). A prospective randomised controlled trial was undertaken in 267 patients aged 70 years and over (mean age = 78.3 years). Following discharge from hospital, patients were followed up at three monthly intervals for a total of 12 months. At the time of discharge, no significant differences were found in inpatient management, length of stay, mortality rates, discharge rates to institutional care or utilisation of community services in patients admitted to the GAU and the GMUs. Similarly, no significant differences were found at three, six, nine, and 12 month follow up in case fatality, activities of daily living indices, mental health status, rates of institutional referral and the level of community service support in patients admitted to the GAU and the GMUs studied.These findings do not show any advantage for the unselected 70 + acutely ill elderly patient who is admitted to a designated geriatric assessment unit rather than to a general medical unit. Therefore, an admission policy to GAU, based solely on age 70 + is medically inappropriate and cost‐inefficient. Evidence from other sources suggests that an age cohort of acutely admitted patients beyond 80 years may well have returned more optimistic findings for the GAU. In future, GAUs will require a more selective admission policy to maximise the benefits of their rehabilitative and interdisciplinary approach. (Aust NZ J Med 1991; 21: 230–2

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1991.tb00448.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

AbstractFifty‐seven patients with obstructive sleep apnoea (OSA) were treated for at least six months with nasal continuous positive airway pressure (CPAP). At follow‐up, sleep studies were performed in which CPAP was not used for the first half of the night. We compared the severity of OSA at follow‐up without CPAP to the severity of OSA during the patient's initial diagnostic study. Apnoea and hypopnoea index (AHI) fell from 41.4 ± 7.5 (mean ±95% CI) to 34.8 ± 7.9 (p= 0.06 by Wilcoxon test) and minimum oxygen saturation rose from 71.6 ± 3.2 to 78.5 ± 2.6(p<0.001). Some of this change may have been due to reduced REM sleep in the follow‐up study (10.5±2.1% Total Sleep Time vs 7.4±2.4% TST,p<0.05). Long‐term nasal CPAP was not associated with any reduction of obesity (BMI before CPAP 31.9 ± 1.0, after CPAP 31.7 ± 1.0 (p= 0.39). Systolic arterial pressure fell (before CPAP 143.0 ±4.5 mmHg, after CPAP 136.3 ± 4.6,p<0.05) but diastolic pressure did not (before CPAP 88.5 ± 3.0 mmHg, after CPAP 85.6 ±2.9 mmHg,p =0.11). We concluded that the effect of CPAP treatment for six or more months was a small fall in AHI and a small rise in minimum Sa02, but that this would be of marginal clinical significance, and may be artefactual. (Aust NZ J

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1991.tb00449.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

AbstractIn a nine‐year‐old female, cardiac failure was erroneously attributed to idiopathic cardiomyopathy and cardiac transplantation was planned. The actual cause of cardiac failure was permanent junctional reciprocating tachycardia (PJRT), a rare form of supraventricular tachycardia. The diagnostic error was discovered before transplantation was performed and the arrhythmia was treated surgically. This resulted in return of near normal cardiac function. (Aust NZ J Med 1991; 21: 239

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1991.tb00450.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

AbstractWe report a 16‐year‐old phenotypic female with XY pure gonadal dysgenesis. A dysgerminoma was found in one of the dysgenetic gonads stressing the importance of prophylactic gonadectomy. Her case presents a difficult problem because as a member of a national junior training squad, she had the potential for competing at international level where her genetic sex could be a profound liability. (Aust NZ J Med 1991; 21: 242

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1991.tb00451.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

AbstractA 56‐year‐old female underwent treatment with leucovorin and 5‐fluorouracil for extensive metastatic moderately differentiated transitional cell carcinoma (TCC) of the renal pelvis. This resulted in a complete response for 20 + months. This combination has not been reported before in TCCs of the urinary tract and requires further exploration. (Aust NZ J Med 1991; 21: 244

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1991.tb00452.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY