ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1994.tb04415.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1994.tb04416.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Abstract:Background:Gallium‐67 (67Ga) scintigraphy has been reported to be of limited value in staging lymphoma patients. However, recent technical advances in radionuclide imaging have potentially enhanced the usefulness of this method.Aims:The purposes of this study were to determine the current: (1) sensitivity and specificity and (2) impact on clinicians' treatment decisions of67Ga scans performed at a teaching hospital.Methods:There were 46 newly presenting patients with lymphoma (13 with Hodgkin's disease (HD) and 33 with non‐Hodgkin's lymphoma [NHL]). Planar67Ga scans were performed up to eight days following injection of 300 MBq (8 mCi) with images interpreted by consensus of two blinded observers; sensitivity and specificity were determined on a lesion by lesion basis in comparison to computed tomography (CT) scans, palpation of peripheral lymph nodes and abdominal lymphangiograms (n = 5). The contribution of67Ga scans to clinicians' treatment decisions was also independently assessed by an experienced oncologist.Results:Gallium‐67 scan sensitivity and specificity were 80% and 96% for HD and 59% and 98% for NHL. Initial treatment plans were modified in three individuals (7%; 95% confidence intervals = 3–10%) due to lesions on the67Ga scan not prospectively detected or considered equivocal on other tests.Conclusions:Only a small proportion of newly diagnosed lymphoma patients benefit from staging with state of the art planar high dose67Ga

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1994.tb04417.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Abstract:Background:Catheter ablation of the atrioventricular (AV) junction using stored direct current (DC) energy from a standard DC Cardioverter defibrillator was first reported in 1982. Since then many patients have been treated using this procedure for refractory supraventricular arrhythmias, usually atrial fibrillation and flutter. Undesirable thermal effects such as barotrauma and arcing are largely responsible for complications associated with the use of DC energy. This report details our experience of catheter ablation of the AV junction using radiofrequency (RF) energy in a series of 30 consecutive patients.Methods:RF ablations were performed using steerable Mansfield (Webster Laboratories) 4 mm tipped electrodes and locally assembled RF energy delivery system.Results:The procedure was successful in 27/30 (90%) patients using RF energy, while three patients required DC energy to achieve successful AV junction ablation. General anaesthesia was required in nine patients, six of whom required this for cardioversion to sinus rhythm so that an adequate His Bundle spike could be recorded and three for DC ablation. Dual chamber permanent pacemakers with automatic mode switching were implanted in four patients who had paroxysmal atrial fibrillation or flutter and the remainder had ventricular rate responsive pacemakers.Conclusions:In patients with drug refractory paroxysmal atrial fibrillation and flutter and in patients with established atrial fibrillation where control of the ventricular rate is difficult, catheter ablation of the AV junction using RF energy is a safe and effective procedure with a high success rate.

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1994.tb04418.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Background:The quality of life status of patients prior to and following percutaneous transluminal coronary angioplasty (PTCA) has not been comprehensively investigated.Abstract:Aim:This study was carried out to determine the effect that PTCA has on patients' quality of life.Methods:Data on 209 patients were collected one day pre‐PTCA and at a mean of two and 11 months post‐PTCA. Data on symptomatic status, functional capacity, life satisfaction and psychological well‐being were analysed quantitatively. Clinical outcomes, patient perception of PTCA and employment status wee analysed by descriptive statistics.Results:Highly significant improvement in all quality of life measures was found at the early follow‐up (p<.001). This improvement was sustained at the late follow‐up. At the late follow‐up, 58% of patients felt that PTCA had been very beneficial to their health and well‐being, and 79% of workers had returned to work. PTCA was primarily successful in 91% of vessels dilated. There were no procedural‐related deaths, 12 patients (6%) developed acute occlusion and three patients (1.5%) experienced myocardial infarction (MI). A symptomatic restenosis rate of 16% was found, including 19 patients (9%) requiring repeat PTCA and 14 (7%) undergoing coronary artery bypass grafting (CABG).Conclusion:These findings suggest that, after PTCA, the majority of patients experienced improved quality of life which was sustained

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1994.tb04419.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Abstract:Background:Recent data indicate that the prevalence of genetic haemochromatosis (GH) is greater than previously recognised and suggest that this disease is underdiagnosed.Aims:To determine the prevalence of GH in a rheumatology clinic population.Methods:Over a 12 month period 339 consecutive patients, mean age 67.0 years, attending a rheumatology clinic were screened for iron overload.Results:Twenty three patients had elevated initial screening tests (transferrin saturation [Tf %]>55% ferritin>500 μg/L). Repeat fasting Tf % and ferritin concentrations were obtained in 20 of these patients. Twelve patients had persistently elevated results, and of these patients four had liver biopsy tissue hepatic iron indices consistent with GH. One patient in the group had the diagnosis established by liver biopsy just before the screening commenced. Thus, the prevalence of GH in this population was 1.5% ‐ five times that anticipated for the general population. Three of the patients with GH presented with an arthropathy which was not characteristic of the disease. The increased prevalence of GH in this group of patients with peripheral arthropathy provides an excellent justification for the routine screening of patients with peripheral arthritis for the exclusion of iron overlo

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1994.tb04420.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Abstract:Background:Bone marrow transplantation (BMT) is usually the only procedure offering cure for children with life‐threatening immune deficiency disorders, but compatible sibling donors are frequently unavailable.Aims and Methods:To examine the outcome of HLA non‐identical T‐cell‐depleted BMT carried out between April 1985 and May 1992 in 11 patients with primary immunodeficiency diseases and to seek prognostic factors.Results:Eight patients achieved sustained engraftment, one after a second BMT. One further patient engrafted transiently, but rejected the graft five months later. Acute graft‐versus‐host disease (GVHD) grade II was seen in one and chronic GVHD was seen in three children. Seven patients survived beyond six months, six with donor T cell and five with donor B cell engraftment. At present, five patients (46%) are alive with immune reconstitution at a median follow‐up of 14 months (range 6 to 78 months). The major factor associated with outcome was the presence of any infection within one week of BMT (p= 0.01). The presence of lung infection also tended to be a poor prognostic factor (p>= 0.06) but did not reach significance, presumably because of the small sample size. HLA non‐identical (parental) T‐cell depleted BMT plays an important role in the cure of children with immunodeficiencies who do not have an identical sibling donor. Survival can be further improved if the diagnosis of immunodeficiency disease is made early and BMT undertaken before significant infections occur.Conclusions:The availability of T‐cell depleted haploidentical parental bone marrow transplant can be anticipated to improve outcome significantly for children with severe immunodeficiency, especially w

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1994.tb04421.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Abstract:Background:Emergency coronary artery bypass grafting (CABG) has previously been the only option in the treatment of refractory abrupt vessel closure complicating percutaneous transluminal coronary angioplasty (PTC A), and has been associated with high rates of morbidity and mortality. Intracoronary stenting now provides an alternative to emergency CABG.Aim:To assess our initial experience with emergency coronary artery stenting as a new technique.Methods:Retrospective case study review with clinical and angiographic follow‐up.Results:The Gianturco‐Roubin (GR) stent was deployed in 13 patients in whom PTCA was complicated by abrupt vessel closure refractory to standard balloon techniques. Indications for PTCA were unstable angina (six), stable angina (six) and acute myocardial infarction (MI) (one). The arteries stented included left anterior descending (LAD) artery lesions (eight) and right coronary artery lesions (five). Two patients required urgent CABG, one due to failed stent deployment and one for inadequate control of vessel dissection. In seven of the stented patients the creatine kinase rose to greater than twice the upper limit or normal. Three patients had subacute thrombotic occlusion at seven to 19 days post stent deployment, managed with intravenous thrombolysis or repeat PTCA. At seven months follow‐up, 11 patients were free of angina, two patients had Canadian Heart Association class II angina and there were no deaths. Eleven patients had repeat angiography at mean six months post stent. Five patients had evidence of restenosis managed with repeat PTCA in four and CABG in one.Conclusions:The GR stent is an effective alternative to urgent CABG in the treatment of refractory abrupt vessel closure complicating

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1994.tb04422.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Abstract:Background:The outcome of patients with end‐stage renal failure (ESRF) and spinal cord injury or disease has not been clearly documented.Methods:Fifty patients (two groups: 25 ‐ spinal cord injury, 25 ‐ SB) were identified retrospectively by questionnaire to individual renal units. Additional information was obtained from the Australia and New Zealand Dialysis and Transplant Registry. Dialysis and transplant history, degree of disability and cumulative survival with integrated treatment were compared between the two groups.Results:Haemodialysis was the most common form of treatment (75.8% of total treatment time in the spinal cord injury group and 66.1% in the SB group). Home or self‐care dialysis for a period of more than six months was achieved in 68% of patients in each group. Ten year cumulative survival with integrated treatment was statistically better in the SB group (p<0.01). In the 42% of all patients who underwent renal transplantation cumulative patient survival was 94% at one year and 82% at five years, with allograft survival being 73% and 70% respectively. In conclusion ESRF and spinal cord injury or SB has a good prognosis in the longer term with an integrated approach to treatment.Aims:The aim of this study was to define the prognosis and social consequences for patients with spinal cord injury or spina bifida (SB) treated for ESRF in Australia and New Zealand from 1970

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1994.tb04423.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Abstract:Background:There is a growing body of evidence to indicate that the gastric mucosa is protected against the back‐diffusion of acid by a physical barrier comprising surface‐active phospholipid (SAPL) otherwise known as gastric surfactant on account of its similarity to pulmonary surfactant in composition and behaviour.Aims:To determine whether this form of mucosal protection might extend into the oesophagus to offer some degree of protection against the reflux of gastric contents.Methods:Oesophageal epithelium was tested for the same hydrophobicity which is characteristically imparted to gastric mucosa by SAPL. A morphological study was also performed to visualise any barrier, purposely avoiding conventional fixatives for electron microscopy which destroy hydrophobic surfaces.Results:Oesophageal epithelium in the vicinity of the cardiac sphincter was found to be appreciably hydrophobic, although not as hydrophobic as gastric mucosa. This hydrophobicity was eliminated by bile salts selected as a known ‘barrier breaker’ and one which reacts with any lining of SAPL. The morphological study revealed much evidence of SAPL, especially that lining epithelial cells, while its source is probably the lamellar bodies also visualised.Conclusions:These findings indicate a physical barrier of oesophageal surfactant which could offer some degree of protection against gastro‐oesophageal reflux but one which is particularly prone to attac

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1994.tb04424.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY