The influence of clinical problems, age and social support on outcomes for elderly persons referred to regional aged care assessment teams

Abstract Background: Aged Care Assessment Teams (ACATs) have been established throughout Australia during the past seven years. Early studies of their effect have concentrated on their impact on the rate of institutionalisation of disabled elderly, the clinical characteristics of referred cases and the relationship between disability and recommended care plan. Aims: The aim of this study was to explore the relationship between age, clinical features and social characteristics of AC AT subjects with outcomes at 12 months after assessment. Methods: The examination of an arbitrary sample of persons referred to ACATs over a year by one generalist geriatrician with follow-up of all cases by the three ACATs associated with the study was carried out. All analyses were performed on raw data presented as categorical variables in the form of contingency tables. Results: The sample included 324 subjects who suffered from 2030 clinical problems with a mean of 6.5 per person aged 75 or over and 5.5 for those under 75. Cardiovascular and neurological disease were the commonest source of problems. Study of accommodation outcome at 12 months, for those subjects who survived this period revealed that, in the older group, over 60% of subjects with neurological disease were resident in nursing homes while the majority of all other groups remained in the community, as did two-thirds of those aged under 75. Admission to a nursing home was independent of social support for older subjects with neurological disease, but it played a significant role in those with cardiopulmonary or musculoskeletal disease. Conclusions: The study demonstrates that for one-year survivors there is an increased likelihood of admission to a nursing home of people aged 75 or over with neurological disease, while those under 75 were more likely to remain at home. The association was independent of whether spouse, family or friends were living with the subject. (Aust NZ J Med 1994; 24: 378–385.)     

小儿先天性心脏病数据库系统的建立及应用

目的为初步建立国内小儿先天性心脏病(先心病)的诊断及治疗标准,提高数据统计效率,探索构建先天性心脏病数据库系统(congenital heart disease database project,CHDDP)。方法采用Egrid.NeT建立CHDDP,将2006年度2051例次先心病手术(含188例普胸手术)进行统计分析,对比国际知名先天性心脏病数据库系统,结合我国实际情况,对小儿先天性心脏病及常见胸部疾病进行归纳整理。结果CHDDP大大提高了小儿先天性心脏病临床工作效率,同时也可高效地对数据进行统计分析。目前CHDDP已在国内数家先心病治疗单位开始推广,获得一定好评。结论建立CHDDP有助于对国内小儿先心病诊断治疗标准进行统一,加强多中心协作,对于推动我国小儿先心病治疗水平的提高具有重要意义。     

改良Norwood手术临床应用

目的总结改良Norwood手术的临床应用经验。方法2004年7月和2005年3月分别为1例7月龄单心室伴左心室流出道梗阻女婴,采用主肺动脉和主动脉弓下缘直接吻合、主动脉肺动脉人工血管分流完成改良Norwood手术;1例出生13 d左心发育不良综合征新生儿,采用主肺动脉和主动脉弓下缘直接吻合、右心室肺动脉人工血管分流完成改良Norwood手术。结果例1术后平稳,动脉压为85～100/25～40mmHg（1 mm Hg=0．133kPa）,动脉血氧饱和度为0．75～0．85,术后第3d撤离辅助呼吸,第11 d出院。例2术后平稳,动脉压为65～80／40～60mmHg,动脉血氧饱和度为0．67～0．89,术后第12 d撤离辅助呼吸,第28 d出院。结论改良Norwood手术的先进方法和技术,值得在我国推广应用。     

卵圆孔未闭动物模型的建立

目的 探讨采用正常中华小型猪制作卵圆孔未闭动物模型的可行性。方法 中华小型猪11只，选取1只行预实验，10只用于正式实验。全身麻醉下，经股静脉送入Rups-100穿刺针系统，在透视引导下穿刺房间隔卵圆窝，然后对穿刺点行球囊扩张术。预实验动物术后1d处死，正式实验组动物术后21d处死。心脏取材，行病理检查。结果 11只猪均成功行房间隔穿刺和球囊扩张术，并经心房造影证实建立卵圆孔未闭模型。正式实验组动物除1只术中出现心包积液外，其余术中及术后均无并发症。预实验动物于处死后肉眼观房间隔卵圆窝有-0．7cm×0．8cm缺损，光学显微镜下见红细胞聚集。正式实验组动物于处死后观察，7只可见房间隔卵圆窝愈合，3只分别残留0．1cm×0．2cm、0．2cm×0．2cm、0．1cm×0．3cm缺损。正式实验组动物无论卵圆窝是否愈合，光学显微镜下在穿刺点周围均可见不同程度的局灶性心内膜增生和缺失、淋巴细胞聚集、心肌细胞肿胀、坏死和间质纤维化。结论 采用房间隔穿刺和球囊扩张的方法，用中华小型猪建立卵圆孔未闭模型是可行的。     

Cardiovascular malformations and organic solvent exposure during pregnancy in Finland

In order to investigate the possible association between cardiovascular malformations and maternal exposure to organic solvents during the first trimester of pregnancy, 569 cases and 1,052 controls were retrospectively studied. The cases represented all infants with diagnosed cardiovascular malformations born in Finland in 1982-1984, and the controls were randomly selected from all normal births in the country during the same period. All mothers were interviewed approximately 3 months after delivery by a midwife using a structured questionnaire. Exposures to organic solvents at work during the first trimester of pregnancy were slightly more prevalent among the mothers of affected infants (10.4%) than among those of controls (7.8%). Logistic regression analysis of exposure to organic solvents showed an adjusted relative odds ratio of 1.3 (95% confidence interval, 0.8-2.2). In the analysis of ventricular septal defect, exposure to organic solvents showed an adjusted relative odds ratio of 1.5 (95% confidence interval, 1.0-3.7).     

Aplasia cutis congenita of the scalp with large underlying skull defect: a case report

Localised agenesis of the scalp is the most frequent patern in aplasia cutis congenita (ACC), a congenital absence of the skin and occasionally of deeper layers. Several clinical groups are characterised by the location and pattern of skin defects, associated malformations and the mode of inheritance. Death occurs in 20% of cases, secondary to the associated anomalies, to infections or to haemorrhage from ulceration of the sagittal sinus when there is also a defect of the underlying skull. In this latter case, we close the defect by two rotational scalp flaps (Orticochea technique) at birth. A three-dimensional CT study is useful for showing the extent of the skull defect and the deformity of the craniofacial complex and the changes in the bone after treatment.     

Reconstruction of plantar defects

Plantar defects are a challenge for the plastic surgeon; from 1984–1995 59 operations were performed in 57 patients. The radial forearm flap and the latissimus dorsi (LD) flaps were mainly used depending on the amount of tissue loss. Local flaps such as dorsalis pedis and instep flaps were used for smaller defects. The radial forearm flap is ideal in terms of thickness and stability for the sole but limited in its size. The LD flap is a safe procedure especially for severe injuries and osteitis, but has the disadvantage of being bulky and debulking procedures are frequently performed. For nerve reconstruction deep sensibility seems to be sufficient in order to obtain stable postoperative results. In this report the different operative methods are evaluated. Since 1991, the patients were monitored with static and dynamic foot pressure measurements and gait analysis to assess the postoperative result and prevent pressure ulcers, scar irritation and hyperkeratosis. Preoperative investigations may contribute to an optimal schedule for planning and stabilization of the operative regimen.     

先天性心脏病患儿术后多脏器功能障碍的预后分析

目的 探讨小儿先天性心脏病(先心病)术后多脏器功能障碍(MODS)预后情况及其影响因素,为对此类患儿进行针对性护理提供依据.方法 收集先心病术后并发MODS 77例患儿的临床资料.结果 11例放弃治疗出院,66例中44例救治存活,22例死亡.出现时间最早、累及最多的脏器为心脏;病死率最高的为累及中枢神经系统的患儿(57.69%),其次是累及血液系统的患儿(55.56%);患儿的病死率与累及脏器的数量呈显著正相关(P＜0.01).死亡患儿手术体外循环时间和主动脉阻断时间显著长于存活患儿(均P＜0.05),术中意外及术后心肺复苏发生率显著高于存活患儿(均P＜0.05).结论 先心病术后患儿应加强心功能监护,特别是体外循环时间＞120 min,主动脉阻断时间＞60 min及术中发生过意外情况、术后采取过心肺复苏术的患儿;尽早采取有利措施避免其他脏器功能受损是提高患儿存活率的关键.     

Reconstruction of complex and unusual defects of the thoracic wall

Summary From 1981 to. 1989, a total of 13 procedures were performed on 12 patients requiring complex reconstructions of the thoracic wall. The most common cause of these defects was cancer. Muscle flaps remain the treatment of choice for thoracic wall reconstruction and have been used in 10 cases. Microsurgical tissue transfer opens even larger therapeutic perspectives. A team approach is recommended.