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Auckland, New Zealand

Murgatroyd S.E.,Middlemore Hospital | Frampton C.M.A.,University of Otago | Wright M.S.,Auckland Hospital
Journal of Arthroplasty | Year: 2014

This study assessed the early outcomes of total hip arthroplasty compared with body mass index (BMI). 5357 hip arthroplasties were evaluated. Oxford Scores, revision for any reason and other factors including American Society of Anaesthesiology scores, length of surgery and cementation of components were analyzed. Both a high and a low BMI predicted for worse Oxford Hip Scores. Obese and morbidly obese patients had significantly lower six month Oxford Scores than healthy patients, the lowest survival, were younger than all other groups and had greater proportions with fully un-cemented prostheses. At this early stage, the results show that outcome and early revision are statistically and clinically poorer for obese patients. © 2014. Source

To review local CT colonography (CTC) data with regard to demographics, and both colonic and extracolonic findings. To improve performance by identifying any deficiencies that need to be addressed, in relation to a literature review of the current status of CTC. A retrospective observational analysis was conducted of all the patients undergoing CTC for the 3-year period from 9 August 2007 - 12 August 2010 (n=302) conducted at a single site: Greenlane Hospital (ADHB outpatients). In total, 12 of the 302 patients (4%) were found to have cancer, 24 polyps (8%), and 111 diverticular disease (37%). 21 patients (7%) were referred on for optical colonoscopy following their CTC, and 34 patients (11%) had follow-up recommendations resulting from extracolonic findings, including 24 recommendations for further imaging. A trend towards under-representation of both Māori and Pacific Island groups undergoing CTC, and over-representation of Asians was identified. This study has reported on the experience of CT colonography at Greenlane Hospital over a 3-year period. It has provided important local data on rates of detection of colonic pathology. Māori and Pacific Islanders need encouragement from primary health practitioners to present for bowel examination. Source

Wade K.R.,University of Auckland | Robertson P.A.,Auckland Hospital | Broom N.D.,University of Auckland
European Spine Journal | Year: 2011

The disc nucleus is commonly thought of as a largely unstructured gel. However, exactly how the nucleus integrates structurally with the endplates remains somewhat ambiguous. The purpose of this study was to investigate whether a substantial level of structural/mechanical cohesion does, in fact, exist across the nucleus-endplate junction. Vertebra-nucleus-vertebra samples were obtained from mature ovine lumbar motion segments and subjected to a novel technique involving circumferential transverse severing (i.e. ring-severing) of the annulus fibrosus designed to eliminate its strain-limiting influence. These samples were loaded in tension and then chemically fixed in order to preserve the stretched nucleus material. Structural continuity across the nucleus-endplate junctions was sufficient for the samples to support, on average, 20 N before tensile failure occurred. Microscopic examination revealed nucleus fibres inserting into the endplates and the significant level of load carried by the nucleus material indicates that there is some form of structural continuity from vertebra to vertebra in the central nucleus region. © Springer-Verlag 2011. Source

Veres S.P.,Dalhousie University | Robertson P.A.,Auckland Hospital | Broom N.D.,University of Auckland
Spine | Year: 2010

Study Design. Mechanically induced disruption and subsequent microscopic investigation of lumbar intervertebral discs following a previously published testing protocol, but using a much higher rate of loading. Objective. To explore if loading rate affects the internal disruption mechanics of lumbar intervertebral discs. Summary of Background Data. The failure mechanics of some bone-ligament-bone constructs vary with the rate of tensile load application. Like many ligaments, recent reports indicate that the mechanical response of the disc wall varies with strain-rate. It is possible that the internal failure mechanics of the disc wall also varies with strain-rate. Methods. Nuclear pressurization was used to deliver sudden pressure impulses directly to the nucleus of ovine lumbar motion segments. Pressure impulses were delivered to 12 neutrally positioned motion segments, and 15 motion segments held at 7° flexion. Aside from loading rate, testing was conducted in the same manner as 2 previously published studies that employed a gradual nuclear pressurization regime. Following testing, the internal damage resulting to each disc was analyzed using micro-CT and serial microscopy in tandem. Results. Radial tears of the medioposterior disc wall were the most frequent cause of disc failure. In most cases, radial tears involved a combination of anular and endplate disruption: Neutrally positioned discs frequently suffered tears within the superior cartilaginous endplate adjacent to the transition zone and/or inner anulus. Flexed discs frequently suffered tears adjacent to the outer anulus at the cartilaginous/vertebral endplate junction, or within the vertebral endplate. Both groups frequently suffered endplate tears adjacent to the mid anulus at the inferior cartilaginous/vertebral endplate junction. Conclusion. The internal morphologies of the disc disruptions created in this study using high strain-rate impulse pressurization differed significantly from those documented previously for both neutrally positioned and flexed discs subjected to gradual low strain-rate pressurization. These morphologic differences show that the internal failure mechanics of lumbar intervertebral discs vary with the rate of internal radial load application. © 2010, Lippincott Williams & Wilkins. Source

Goh J.E.L.,Auckland Hospital | Sadler L.,National Womens Health | Rowan J.,National Womens Health
Diabetic Medicine | Year: 2011

Aims To compare maternal and neonatal outcomes in women with gestational diabetes treated with diet, metformin and/or insulin in routine clinical practice in a single centre. Methods We analysed prospectively collected data from the National Women's Health database for all women with gestational diabetes who delivered between January 2007 and December 2009. Since June 2007, women requiring medication have been given a choice of either metformin or insulin treatment, except women with a fetal abdominal circumference less than the 10th percentile, who were not offered metformin. Results There were 1269 women with gestational diabetes; treatment was diet in 371, insulin in 399 and metformin in 465 (249 metformin alone, 216 metformin and insulin). Women treated with metformin and/or insulin had significantly higher BMIs compared with those in the diet group (P<0.001) and had a higher fasting glucose at diagnosis (p<0.001). Women treated with insulin had higher rates of Caesarean delivery (45.6% insulin, 37% metformin, 34% diet, P=0.02) than women treated with metformin or diet. They also had higher rates of preterm births (19.2% insulin, 12.5% metformin, 12.1% diet, P=0.005), customized large-for-gestational-age infants (18.5% insulin, 12.5% metformin, 12.4% diet, P=0.02), neonatal admissions (18.7% insulin, 12.7% metformin, 14.0% diet, P=0.04) and neonatal intravenous dextrose use (11.1% insulin, 5.1% metformin, 7.4% diet, P=0.004). Neonatal outcomes were similar between diet- and metformin-treated women. Conclusions In routine practice, use of metformin in gestational diabetes was associated with fewer adverse outcomes compared with insulin, but baseline differences between treatment groups may have contributed to this. © 2011 The Authors. Diabetic Medicine © 2011 Diabetes UK. Source

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