摘要:

Summary:Glucose absorption during peritoneal dialysis is increased when solutions of high glucose concentration and high dialysis exchange rates are used. These conditions also favour maximum fluid removal. Optimum efficiency for removal of urea and related compounds is achieved when a well placed catheter allows good peritoneal drainage and high volume exchanges. Under these conditions concentrated solutions are rarely required. High glucose concentrations should not be used to compensate for technical problems which prevent adequate drainage.Hyperglycaemia is a constant risk of peritoneal dialysis and reflects an underlying carbohydrate intolerance. However, the condition is often precipitated by the stress of operation or severe infection or the exhibition of corticosteroids or diuretics. Increased glucose loads in the form of intravenous glucose solutions or peritoneal dialysis solutions of high glucose concentration may also contribute. Hyperglycaemia may be a severe and even fatal complication which can only be avoided by constant awareness and surveillance.

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1973.tb03951.x

出版商:Blackwell Publishing Ltd    

年代:1973

数据来源: WILEY

摘要:

Summary:Corticotrophin was substituted for corticosteroid in 42 patients with chronic asthma, including 22 children, for one of three reasons:(a) to correct growth retardation,(b) to improve control of asthma, and(c) to facilitate withdrawal of corticosteroid in patients believed not to require this form of treatment.The effects of corticotrophin substitution were assessed in terms of each of these indications, and the rate of recovery of HPA function was studied in all cases.The substitution of corticotrophin for corticosteroid in children was usually followed by an increase in growth rate; this was observed more frequently when the degree of growth retardation was less severe. Corticotrophin only occasionally controlled asthma more effectively than corticosteroid, and did not facilitate the withdrawal of corticosteroid where this was indicated. Recovery of HPA function after the withdrawal of corticosteroid was slow and occasionally incomplete, despite the substitution of corticotrophin, and in only on case in two did it return to normal within 12 months.It seems that there is little to be gained from the substitution of corticotrophin for corticosteroid in patients with chronic asthma, except in the case of children with retarded growth.

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1973.tb03952.x

出版商:Blackwell Publishing Ltd    

年代:1973

数据来源: WILEY

摘要:

Summary:Atrioventricular block (A‐V block) was documented in 150 (13.8%) of 1083 patients with acute myocardial infarction. Those with A‐V block differed significantly from the remainder, being older, having higher peak levels of serum lactic dehydrogenase and a greater incidence of left ventricular failure and of death in hospital.These differences were due mainly to the inclusion of 90 patients with complete heart block (CHB). Among those patients whose CHB complicated anterior infarction there was a significantly greater incidence of previous infarction.Lesser grades of A‐V block and right bundle branch block (RBBB) commonly heralded the onset of CHB, which occurred more frequently in those with inferior infarction.Markers of death in those with CHB were anterior infarction, RBBB, and a slow subsidiary pacemaker with a wide ventricular complex. Pacing is recommended for all patients with CHB and for those with RBBB; the reasons for this are presented in d

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1973.tb03953.x

出版商:Blackwell Publishing Ltd    

年代:1973

数据来源: WILEY

摘要:

Summary:Seventy patients with right bundle‐branch block (RBBB), comprising 6% of 1083 patients with acute myocardial infarction, were admitted to our coronary care unit (CCU) over a five‐year period. Thirty‐eight of them died in hospital. Their prognosis was not altered significantly by the presence of complete heart block (CHB), bilateral bundle‐branch block or the site of infarction and serum enzyme levels. Hospital mortality was lower (p<0.015) among eight patients with transient RBBB of whom one died. The high mortality appeared to be due mainly to extensive infarction.All 32 survivors were followed from two to 50 months and 15 have died. Four patients who had had bilateral bundle‐branch block or CHB died suddenly. Although no sudden deaths occurred in those with RBBB alone the mortality at six, 12 and 18 months did not differ significantly from patients with bilateral bundle‐branch block.Of the 17 patients still alive eleven have persistent RBBB, one has bilateral bundle‐branch block, one has required permanent pacing for Stokes‐Adams attacks and four have a QRS complex of normal duration.The late sudden deaths suggest that permanent pacing may have a place in the management of patients with bilateral bundle‐branch block sur

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1973.tb03954.x

出版商:Blackwell Publishing Ltd    

年代:1973

数据来源: WILEY

摘要:

Summary:A three‐year follow‐up of 244 patients admitted to a coronary‐care unit is described. The cases were the hospital survivors of 300 patients who had originally been assessed by a coronary prognostic index (CPI) for short‐term survival. They were followed firstly, in order to check the findings from an earlier group of patients on whom a second CPI for three years survival had been formulated. Secondly, it had previously been established that acute prognosis was improved by treatment in the coronary‐care unit for a group of these patients, and it was therefore important to check their long‐term survival. Thirdly, the data provided an opportunity for assessing the effect of arrhythmias during acute myocardial infarction on subsequent survival.The previous findings were confirmed that age, radiological evidence of cardiomegaly and left ventricular failure, and previous myocardial infarction, are all relevant to three year survival. Late mortality was also higher in hypertensive patients, and in those who had suffered anterior transmural infarction. Mortality was well predicted by the CPI for three year survival, and there was no significant difference in mortality from the earlier study. There was no evidence that any arrhythmia during the acute stage of the illness influenced late mortality independently of the ot

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1973.tb03955.x

出版商:Blackwell Publishing Ltd    

年代:1973

数据来源: WILEY

摘要:

Summary:Some characteristics of 70 men who had experienced myocardial infarction or angina pectoris between 28 and 40 years of age have been compared with those of a normal Australian population at Busselton.The coronary men were on average slightly shorter. Their weight at maturity had been the same and when first seen after infarction, at a mean age of 36.9 years, their weight was also the same as Busselton men of the same age. At infarction they were slightly heavier than Busselton men. In 30 percent of coronary men relative body weight at infarction was greater than 120 according to the Davenport standards. At Busselton where slightly different standards were used 20 per cent of healthy men aged 30–39 had relative body weight of 120 or more.The coronary men had hypercholesterolaemia and hyperuricaemia and their dissimilarity from Busselton men was highly significant. The coronary men also had hypertriglyceridaemia and half of them smoked excessively.The incidence of hypertension was no greater in coronary men than in Busselton men. Oral glucose tolerance tests revealed a possibly higher incidence of frank diabetes mellitus than could have occurred by chance. It was possible that a minor degree of carbohydrate intolerance was present in many of the non‐diabetic subjects.There was evidence of family aggregation for in half the men there was a family history of coronary heart disease, often fatal, usually in the father or less frequently in the mother before the age of 65.Serum cholesterol correlated significantly with serum triglycerides and the latter correlated with serum uric acid and body build. The predominant lipoprotein phenotypes were types 2a and 2b which were three times as common as type 4. The findings demonstrate the very strong association between hypercholesterolaemia and coronary heart disease in young people. Collateral evidence indicates that it is the prime determinant of accelerated atherogenesis in the first half of life. The higher the serum cholesterol the sooner the disease is likely to appear. Hypercholesterolaemia may be due in part to genetic predisposition but a high intake of saturated fat and cholesterol is the most important cause.The high prevalence of gout and hyperuricaemia and their lack of correlation with hypercholesterolaemia raises once again the question whether they are independent risk factors in coronary heart disease.The evidence from young coronaries supports the case for population screening for serum cholesterol. Evidence from other studies indicates that this should begin early in life. The Inter‐Society Commission in the United States has concluded that there is a strong case for reform of the national diet for all age groups. We suggest that the least that should be done is to identify those at greatest risk at the earliest possible age and to offer them corrective dietary educ

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1973.tb03956.x

出版商:Blackwell Publishing Ltd    

年代:1973

数据来源: WILEY

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1973.tb03957.x

出版商:Blackwell Publishing Ltd    

年代:1973

数据来源: WILEY

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1973.tb03958.x

出版商:Blackwell Publishing Ltd    

年代:1973

数据来源: WILEY

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1973.tb03959.x

出版商:Blackwell Publishing Ltd    

年代:1973

数据来源: WILEY

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1973.tb03960.x

出版商:Blackwell Publishing Ltd    

年代:1973

数据来源: WILEY