Froessler B.,Lyell McEwin Hospital |
Froessler B.,University of Adelaide |
Collingwood J.,Ballarat Base Hospital |
Hodyl N.A.,University of Adelaide |
Dekker G.,Lyell McEwin Hospital
BMC Pregnancy and Childbirth | Year: 2014
Background: Iron deficiency is a common nutritional deficiency amongst women of childbearing age. Peri-partum iron deficiency anaemia (IDA) is associated with significant maternal, fetal and infant morbidity. Current options for treatment are limited: these include oral iron supplementation, which can be ineffective and poorly tolerated, and red blood cell transfusions, which carry an inherent risk and should be avoided. Ferric carboxymaltose is a new treatment option that may be better tolerated.The study was designed to assess the safety and efficacy of iron deficiency anaemia (IDA) correction with intravenous ferric carboxymaltose in pregnant women with mild, moderate and severe anaemia in the second and third trimester.Methods: Prospective observational study; 65 anaemic pregnant women received ferric carboxymaltose up to 15 mg/kg between 24 and 40 weeks of pregnancy (median 35 weeks gestational age, SD 3.6). Treatment effectiveness was assessed by repeat haemoglobin (Hb) measurements and patient report of well-being in the postpartum period. Safety was assessed by analysis of adverse drug reactions and fetal heart rate monitoring during the infusion.Results: Intravenous ferric carboxymaltose infusion significantly increased Hb values (p < 0.01) above baseline levels in all women. Increased Hb values were observed at 3 and 6 weeks post infusion and up to 8 weeks post-infusion. Ferritin values increased significantly after the infusion. Only 4 women had repeat ferritin values post-partum which remained above baseline levels. Fetal heart rate monitoring did not indicate a drug related negative impact on the fetus. Of the 29 (44.6%) women interviewed, 19 (65.5%) women reported an improvement in their well-being and 9 (31%) felt no different after the infusion. None of the women felt worse. No serious adverse effects were found and minor side effects occurred in 13 (20%) patients.Conclusions: Our prospective data is consistent with existing observational reports of the safe and effective use of ferric carboxymaltose in the treatment of iron deficiency anaemia in pregnancy. © 2014 Froessler et al.; licensee BioMed Central Ltd.
PubMed | Monash University, Ballarat Base Hospital, Geelong University Hospital, Royal Melbourne Hospital and 2 more.
Type: Journal Article | Journal: Internal medicine journal | Year: 2016
Guidelines recommend prasugrel or ticagrelor instead of clopidogrel in patients with acute coronary syndromes (ACS) undergoing percutaneous coronary interventions (PCI).We sought to describe the trends in uptake of the newer agents and analyse the clinical characteristics and short-term outcomes of patients treated with clopidogrel, prasugrel or ticagrelor.We analysed the temporal trends of antiplatelet use since the availability of prasugrel (2009-2013) in patients with ACS from the Melbourne Interventional Group registry. To assess clinical characteristics and outcomes, we included 1850 patients from 2012 to 2013, corresponding to the time all three agents were available. The primary outcome was major adverse cardiovascular events (MACE). The safety end-point was in-hospital bleeding.For the period of 2009-2013, the majority of patients were treated with clopidogrel (72%) compared with prasugrel (14%) or ticagrelor (14%). There was a clear trend towards ticagrelor by the end of 2013. Patients treated with clopidogrel were more likely to present with non-ST-elevation ACS, be older, and have more comorbidities. There was no difference in unadjusted 30-day mortality (0.9 vs 0.5 vs 1.0%, P = 0.76), myocardial infarction (2 vs 1 vs 2%, P = 0.52) or MACE (3 vs 3 vs 4%, P = 0.57) between the three agents. There was no difference in in-hospital bleeding (3 vs 2 vs 2%, P = 0.64).Prasugrel and ticagrelor are increasingly used in ACS patients treated with PCI, predominantly in a younger cohort with less comorbidity. Although antiplatelet therapy should still be individualised based on the thrombotic and bleeding risk, our study highlights the safety of the new P2Y12 inhibitors in contemporary Australian practice.
Barker P.J.,Monash University |
Hapuarachchi K.S.,North Shore Hospital |
Ross J.A.,Ballarat Base Hospital |
Sambaiew E.,Lismore Base Hospital |
And 2 more authors.
Clinical Anatomy | Year: 2014
Biomechanical models predict that recruitment of gluteus maximus (GMax) will exert a compressive force across the sacroiliac joint (SIJ), yet this muscle requires morphologic assessment. The aims of this study were to document GMax's proximal attachments and assess their capacity to generate forces including compressive force at the SIJ. In 11 embalmed cadaver limbs, attachments of GMax crossing the SIJ were dissected and their fascicle orientation, length and attachment volume documented. The physiological cross-sectional area (PCSA) of each attachment was calculated along with its estimated maximum force at the SIJ and lumbar spine. GMax fascicles originated from the gluteus medius fascia, ilium, thoracolumbar fascia, erector spinae aponeurosis, sacrum, coccyx, dorsal sacroiliac and sacrotuberous ligaments in all specimens. Their mean fascicle orientation ranged from 32 to 45° below horizontal and mean length from 11 to 18 cm. The mean total PCSA of GMax was 26 cm2 (range 16-36), of which 70% crossed the SIJ. The average maximum force predicted to be generated by GMax's total attachments crossing each SIJ was 891 N (range 572-1,215), of which 70% (702 N: range 450-1,009) could act perpendicular to the plane of the SIJ. The capacity of GMax to generate an extensor moment at lower lumbar segments was estimated at 4 Nm (range 2-9.5). GMax may generate compressive forces at the SIJ through its bony and fibrous attachments. These may assist effective load transfer between lower limbs and trunk. Clin. Anat. 27:234-240, 2014. © 2013 Wiley Periodicals, Inc. Copyright © 2013 Wiley Periodicals, Inc.
PubMed | Goulburn Valley Base Hospital, Monash University, Ballarat Base Hospital, St Vincents Hospital and 6 more.
Type: Journal Article | Journal: British journal of anaesthesia | Year: 2016
Service models for gastrointestinal endoscopy sedation must be safe, as endoscopy is the most common procedure performed under sedation in many countries. The aim of this prospective cohort study was to determine the patient risk profile, and incidence of and risk factors for significant unplanned events, in adult patients presenting for gastrointestinal endoscopy in a group of university-affiliated hospitals where most sedation is managed by anaesthetists.Patients aged18yr presenting for elective and emergency gastrointestinal endoscopy under anaesthetist-managed sedation at nine hospitals affiliated with the University of Melbourne, Australia, were included. Outcomes included significant airway obstruction, hypoxia, hypotension and bradycardia; unplanned tracheal intubation; abandoned procedure; advanced life support; prolonged post-procedure stay; unplanned over-night admission and 30-day mortality.2,132 patients were included. Fifty percent of patients were aged>60yr, 50% had a BMI>27kg mPatients presenting for gastrointestinal endoscopy at a group of public university-affiliated hospitals where most sedation is managed by anaesthetists, had a high risk profile and a substantial incidence of significant unplanned intraoperative events and 30-day mortality.
Johnson D.,Ballarat Base Hospital |
Dutch M.,Royal Melbourne Hospital |
Knott J.,Royal Melbourne Hospital
EMA - Emergency Medicine Australasia | Year: 2016
Objective: EDs have long been considered a potential source of eye and tissue donors, but no specific evidence to support this was identified in the Australian setting. The present study aims to bridge that knowledge gap, by analysing medical and social histories of those who have died over a 5 year period so as to determine donation eligibility in this population. Methods: A retrospective audit was undertaken of all patients who died within the Royal Melbourne Hospital ED between 2010 and 2014. ED records, pharmacy records and electronic medical histories were audited for the presence of eye and tissue donation exclusion criteria and the distribution of these criteria within the target population. Results: Over the 5 year period, of 326 deaths that occurred in the ED, one third was suitable for eye donation (n=106) and one in seven (n=45) for tissue donation. Of the age appropriate patients, five criteria were identified that excluded up to 85% of the population not eligible to donate. These were: haematological malignancies, neurodegenerative conditions, non-haematological malignancies, chronic renal failure and eye disease. Conclusion: The present study has identified a large pool of potential eye and tissue donors; a pool mostly unrecognised by emergency clinicians. An extensive list of exclusion criteria restricts donor potential. However, the present study has identified that only five fundamentally limit donation in the ED population. Utilisation of this knowledge will allow for the development of clinical triggers that will improve identification, and increase realisation, of potential donors. © 2016 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.
Dillon J.P.,Ballarat Base Hospital |
Freedman I.,Ballarat Base Hospital |
Tan J.S.M.,Ballarat Base Hospital |
Mitchell D.,Ballarat Base Hospital |
English S.,Ballarat Base Hospital
Archives of Orthopaedic and Trauma Surgery | Year: 2012
Introduction: Operative treatment for septic pre-patellar bursitis generally involves open debridement in addition to an extended course of intravenous antibiotics. Skin necrosis and wound breakdown are potential complications of this procedure in addition to scar sensitivity and a prolonged recovery. Method: We report endoscopic bursectomy for the treatment of septic pre-patellar bursitis in eight patients over a 3-year period. All patients had microbiological confirmation of an infective process. The average age was 36 years (23-68 years). The average hospital stay was 6 days (4-9 days). Results: No patient had a recurrence or complained of tenderness or hypoaesthesia around their wound. No patient experienced wound complications or skin necrosis. The average return to work time was 18 days (7-22 days). Conclusion: We conclude that endoscopic bursectomy is a safe and effective treatment for septic pre-patellar bursitis with a shortened hospital stay and a quicker return to work than conventional open debridement. © Springer-Verlag 2012.
Dillon J.P.,Ballarat Base Hospital |
Brennan L.,Ballarat Base Hospital |
Mitchell D.,Ballarat Base Hospital
Acta Orthopaedica Belgica | Year: 2012
The optimal form of post-operative analgesia in hip and knee arthroplasty is still debated. Traditionally, patient-controlled analgesia and epidural anaesthesia were used. Potential side-effects such as nausea, confusion, urinary retention, hypotension and immobility have resulted in the emergence of newer techniques that limit opioid use. Peripheral nerve blockade provides excellent analgesia but limits patient ability to ambulate in the immediate post-operative period. Local infiltrative analgesia (LIA) is an emerging technique that has shown to provide superior analgesia, higher patient satisfaction and earlier discharge from hospital when compared to some of the more traditional methods. This review article highlights the advantages of LIA in hip and knee arthroplasty surgery. We describe the technique used, including additional measures that aid early ambulation and discharge from hospital in this cohort of patients. © 2012, Acta Orthopædica Belgica.
Kolk A.,TU Munich |
Schuster T.,TU Munich |
Chlebowski A.,TU Munich |
Lange P.,TU Munich |
And 7 more authors.
European Journal of Nuclear Medicine and Molecular Imaging | Year: 2014
Purpose: Knowledge of the presence and extent of bone infiltration is crucial for planning the resection of potential bone-infiltrating squamous cell carcinomas of the head and neck (HNSCC). Routinely, plain-film radiography, multislice computed tomography (MSCT) and magnetic resonance imaging (MRI) are used for preoperative staging, but they show relatively high rates of false-positive and false-negative findings. Scintigraphy with 99mTc-bisphosphonate has the ability to show increased metabolic bone activity. If combined with anatomical imaging (e.g. (SPECT)/CT), it facilitates the precise localization of malignant bone lesions. The aim of this study was to analyse the indications and advantages of SPECT/CT compared with standard imaging modalities and histology with regard to specificity and sensitivity Methods: A longitudinally evaluated group of 30 patients with biopsy-proven HNSCC adjacent to the mandible underwent 99mTc-bisphosphonate SPECT/CT, MRI, MSCT and conventional radiography before partial or rim resection of the mandible was performed. Bone infiltration was first evaluated with plain films, MSCT and MRI. In a second reading, SPECT/CT data were taken into account. The results (region and certainty of bone invasion) were evaluated among the different imaging modalities and finally compared with histological specimens from surgical resection as the standard of reference. For a better evaluation of the hybrid property of SPECT/CT, a retrospectively evaluated group of 20 additional patients with tumour locations similar to those of the longitudinally examined SPECT/CT group underwent SPECT, MSCT and MRI. To assess the influence of dental foci on the specificity of the imaging modalities, all patients were separated into two subgroups depending on the presence or absence of teeth in the area of potential tumour-bone contact. Results: Histologically proven bone infiltration was found in 17 patients (57 %) when analysed by conventional imaging modalities. SPECT/CT data revealed bone infiltration in two additional patients (7 %), who both showed discrete cortical bone erosion not visible by MSCT or MRI. There were no false-positive or false-negative findings on SPECT/CT. The quality criteria for detecting bone involvement in HNSCC by SPECT/CT were as follows: sensitivity 100 % (lower 95 % confidence interval limit 80 %), specificity 100 % (75 %), positive predictive value 100 % (80 %) and negative predictive value 100 % (75 %). Corresponding data for MRI were 95 % (76 %), 94 % (73 %), 95 % (76 %) and 94 % (73 %), and for MSCT were 89 % (71 %), 100 % (85 %), 100 % (86 %) and 88 % (69 %). In the retrospective evaluation SPECT showed results similar to SPECT/CT. Conclusion: Hybrid SPECT/CT has a high specificity as it can provide additional information about the existence and local extent of malignant bone infiltration of the mandible. Although the sensitivity of conventional SPECT is similar to that of SPECT/CT, the latter provides a much better delineation of the local tumour-bone contact area. Based on this information, surgical intervention of the rim versus partial resection can be planned and performed more precisely. Patient outcome can be improved by avoiding undertreatment and unnecessary or overextended bone resections. © 2014 Springer-Verlag.
PubMed | Ballarat Base Hospital
Type: Journal Article | Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology | Year: 2016
20643 Background: CVAPs are required to deliver infused chemotherapy regimens for patients with poor peripheral venous access. Arm-sited CVAPs are implanted subcutaneously 10-15 mm above the cubital fossa where the basilic vein is cannulated. They do not require subcutaneous tunnelling, avoid chest surgical scars and are an alternative to traditional chest-sited CVAPs. We compared the durability and complication rates of radiologically inserted arm CVAPs to surgically inserted chest CVAPs used to deliver chemotherapy.A retrospective, single institution analysis was performed of all patients (pts) who had a chest CVAP inserted for chemotherapy over a 30-month period, and compared to pts who had an arm CVAP over the following 30-month period, with minimum follow-up of 6 months. The primary endpoint was successful use of the CVAP, defined as completion of planned chemotherapy without a complication prompting removal of the CVAP.49 pts had a chest CVAP (Bard) (median age 59, median insertion duration 277 days). 85 pts had an arm CVAP (Cook) (median age 58, median duration insertion 281 days). The two most common cancers were colorectal (43% of chest CVAPs, 42% of arm CVAPs) and breast (29% of chest CVAPs, 40% of arm CVAPs). The primary endpoint was achieved by most pts, and there was no significant difference between chest and arm CVAPs (92% vs 88%, p=0.242). Infection and thombosis were the major complications that forced removal of CVAPs. The infection rate for chest and arm CVAPS was 6% vs 8% (0.16 vs 0.28 per 1,000 days) and the rate of thrombosis was 6% vs 2% (0.16 vs 0.08 per 1,000 day). 12% of chest CVAPs were removed with a complication at any stage compared with 15% of arm CVAPs (p=0.248). These rates are comparable to those seen in other studies of arm and chest CVAPs.Arm CVAPs appear to be equivalent in durability and complications compared to chest CVAPs for chemotherapy administration in a rural setting. In addition, they may be cosmetically preferable and convenient to insert. No significant financial relationships to disclose.
PubMed | Royal Melbourne Hospital and Ballarat Base Hospital
Type: | Journal: International journal of surgery case reports | Year: 2016
Paragangliomas are rare neoplasms arising from cells of the primitive neural crest. These tumours are often difficult to diagnose and treat. We report a case of a 42 year old female presenting with abdominal pain who had a retroperitoneal tumour situated at the aortic bifurcation. Serum catecholamine levels were normal. Complete resection of the tumour was performed. The histological examination and immunohistochemical analyses concluded the diagnosis of an organ of Zuckerkandl paraganglioma.