Vos L.J.,Cairns Hospital |
Robertson T.,Pathologist |
Binotto E.,Cairns Hospital
Communicable diseases intelligence quarterly report | Year: 2016
Haycocknema perplexum is a rare cause of parasitic myositis, with all cases of human infection reported from Australia. This case involved an 80-year-old Queensland wildlife carer, who presented with muscle weakness, mild eosinophilia and creatine kinase elevation. This case supports an association with native animal contact and highlights the debilitating nature of this infection.
Starmer G.,Cairns Hospital |
Schrale R.,Townsville Hospital
Rural and Remote Health | Year: 2016
Acute coronary syndromes (ACS) are life-threatening medical emergencies that require urgent treatment, posing particular challenges for systems of health care in regional and remote parts of the world characterised by large distances and widely dispersed populations and healthcare facilities. Northern Australia is such an environment. The prevalence of cardiovascular risk factors, coronary artery disease and ACS (myocardial infarction and unstable angina) in northern Australia is amongst the highest in Australia. Despite the high burden of disease, appropriate healthcare services to address these important health challenges have been inadequate. The Australian Commission on Safety and Quality in Health Care has released a Clinical Care Standard for Acute Coronary Syndromes and the National Heart Foundation of Australia has developed an ACS Capabilities Framework, which together define minimum standards of care regardless of the patient's location. Strategies such as uniform state-wide ACS clinical pathways provide guidance on how evidence-based care can be provided in a range of geographical settings and to all populations, including Indigenous Australians. The continuing evolution of cardiac catheter laboratories in Townsville, Cairns, Mackay and Darwin has facilitated improved treatment for ACS in northern Australia, and has supported the development of region-wide, integrated, multidisciplinary pathways of care. Systems of care in ACS require consideration of the perspectives of the patient (from symptom onset to long-term secondary prevention of further events), the health system ('dissolving' traditional regional silos of care to enable a higher critical mass, greater cooperation, better communication and improved efficiency) and healthcare disciplines and services (including ambulance, retrieval, local health centres and local hospitals, tertiary centres, cardiac rehabilitation and general practice). © James Cook University 2016.
Judge D.,Cairns Hospital |
Krause V.,Director Center for Disease Control Northern Territory
Communicable diseases intelligence quarterly report | Year: 2016
BACKGROUND AND OBJECTIVE: To describe the clinical characteristics, risk factors, diagnostic modalities, treatments, subsequent outcomes and complications of Multidrug-resistant tuberculosis (MDR-TB) cases residing in the Northern Territory.METHODS: A retrospective case series was conducted of all patients treated for MDR-TB in the Northern Territory between 1 January 2004 and 31 December 2013. This is the first study to analyse data relating to the subset of MDR-TB cases treated in the Northern Territory. Cases were identified by the Northern Territory Centre for Disease Control (NT CDC): the public health unit responsible for the management of tuberculosis in the Northern Territory. Outcome measures included patient demographics, diagnostics, HIV status, treatment methods, outcomes, and complications.RESULTS AND CONCLUSIONS: Six MDR-TB cases were treated in the Northern Territory; 5 of these were notified by the NT CDC during the study period (1.5% of all Northern Territory TB notifications). The median age of all 6 patients was 31 years (range 21 to 50 years), sex distribution was equal and all were born overseas. Country of birth in a World Health Organization (WHO) high burden MDR-TB country and previous treatment were most highly correlated with a current diagnosis of MDR-TB. Access to rapid drug susceptibility testing reduced the time to effective therapy from 45 to 27 days. Five patients met criteria for the WHO outcome term 'treatment success'. The median length of treatment for the 5 patients treated in Australia was 623 days (537 to 730 days). Side effects to therapy were common and serious. The incidence of MDR-TB in the Northern Territory is similar to other Australian states. Rapid drug susceptibility testing reduces the time to effective therapy. Treatment regimens are complex, toxic and have serious resource implications for health care providers. Successful treatment outcomes are possible with coordinated TB control programs. Commun Dis Intell 2016;40(3):E334-E339.
Parkinson B.,Cairns Hospital |
Gogna R.,Coventry University |
Robb C.,Coventry University |
Thompson P.,Coventry University |
Spalding T.,Coventry University
Knee Surgery, Sports Traumatology, Arthroscopy | Year: 2015
Purpose: The aim of this study was to define the normal ACL central tibial footprint position and describe a standardised technique of measuring tibial tunnel location on 3D CT for anatomic single-bundle ACL reconstruction. Methods: The central position of the ACL tibial attachment site was determined on 76 MRI scans of young individuals. The central footprint position was referenced in the anterior–posterior (A–P) and medial–lateral (M–L) planes on a grid system over the widest portion of the proximal tibia. 3D CT images of 26 young individuals had a simulated tibial tunnel centred within the bony landmarks of the ACL footprint, and the same grid system was applied over the widest portion of the proximal tibia. The MRI central footprint position was compared to the 3D CT central footprint position to validate the technique and results. Results: The median age of the 76 MRI subjects was 24 years, with 32 females and 44 males. The ACL central footprint position was at 39 (±3 %) and 48 (±2 %), in the A–P and M–L planes, respectively. There was no significant difference in this position between sexes. The median age of the 26 CT subjects was 25.5 years, with 10 females and 16 males. The central position of the bony ACL footprint was at 38 (±2 %) and 48 (±2 %), in the A–P and M–L planes, respectively. The MRI and CT central footprint positions were not significantly different in relation to the medial position, but were different in relation to the anterior position (A–P 39 % vs. 38 %, p = 0.01). The absolute difference between the central MRI and CT reference positions was 0.45 mm. Conclusions: The ACL’s normal central tibial footprint reference position has been defined, and the technique of measuring tibial tunnel location with a standardised grid system is described. This study will assist surgeons in evaluating tibial tunnel position in anatomic single-bundle ACL reconstruction. Level of evidence: III. © 2015 European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA)
Ismail I.,Gold Coast University Hospital |
Neuen B.L.,St Vincents Hospital |
Mantha M.,Cairns Hospital
BMJ Case Reports | Year: 2015
Metachronous metastatic disease may develop in up to 50% of patients with renal cell carcinoma (RCC) who have undergone a presumably curative radical nephrectomy. We describe a case of small bowel obstruction secondary to a solitary jejunal RCC metastasis affecting a 66-year-old man with a history of RCC, which was treated 19 years earlier by right radical nephrectomy. The patient underwent successful laparotomy and wide margin resection of the affected small bowel with end-to-end anastomosis. A subsequent staging CT revealed no other metastases. To our knowledge, only eight cases of isolated small bowel metastasis from RCC have been reported. Of these, only one previous report referred to a longer time interval to small bowel metastasis than our case. The case highlights that isolated bowel metastasis should be considered as a possible aetiology of small bowel obstruction, even in patients with a distant history of presumably curative cancer treatment. Copyright 2015 BMJ Publishing Group. All rights reserved.
News Article | December 1, 2016
A female snorkeller is lucky to be alive after suffering heart failure following an Irukandji jellyfish sting in far north Queensland. The 39-year-old Victorian woman was snorkelling off Fitzroy Island last Friday when she was stung on the neck by the deadly, thumbnail-sized jellyfish. The tourist, Ayllie White, told the Courier-Mail: “All of a sudden, I felt what I thought was sea mites and a tingling sensation.” “Five minutes later, I got this searing pain across my neck. And then quite quickly after that, the other symptoms, which were much scarier [started], were just really heavy limbs, struggling to breathe and a tightness across my chest.” White made it to shore, where she received first aid treatment before being flown to hospital where she went into heart failure. She was diagnosed with takotsubo cardiomyopathy, or broken heart syndrome, which is a weakening of the left ventricle. She spent two days in intensive care at Cairns Hospital after her heart slowed to a quarter of its capacity before being discharged on Wednesday, Queensland Ambulance Service said. The latest episode follows speculation that Irukandji may be to blame for a spate of recent deaths on the reef. A 60-year-old British man died while diving on Agincourt reef, 100km north of Cairns in mid-November. In the same week, two French tourists died on the reef. Jacques Goron, 76, and Danielle Franck, 74, died within minutes of each other while snorkelling at Michaelmas Cay, also near Cairns. Both had pre-existing medical conditions and it is believed both suffered heart attacks. An Australian cardiologist has speculated whether they were stung by Irukandji jellyfish. The Irukandji is one of the world’s most venomous creatures. Its toxin can send the body into cardiac arrest within 20 minutes. In 2002, a 58-year-old British tourist Richard Jordan was believed to have been the first person to have died after being stung by an Irukandji. He was stung whilst swimming off Hamilton Island, in north Queensland’s Whitsundays, and the sting aggravated a pre-existing heart condition and blood pressure causing cerebral haemorrhage.
Schuller P.J.,Cairns Hospital |
Newell S.,Cairns Hospital |
Strickland P.A.,Cairns Hospital |
Barry J.J.,Cairns Hospital
British Journal of Anaesthesia | Year: 2015
Background: The bispectral index (BIS) monitor is a quantitative electroencephalographic (EEG) device that iswidely used to assess the hypnotic component of anaesthesia, especiallywhen neuromuscular blocking drugs are used. It has been shown that the BIS is sensitive to changes in electromyogram(EMG) activity in anaesthetized patients. A single study using an earlier version of the BIS showed that decreased EMG activity caused the BIS to decrease even in awake subjects, to levels that suggested deep sedation and anaesthesia. Methods: We administered suxamethonium and rocuronium to 10 volunteers who were fully awake, to determine whether the BIS decreased in response to neuromuscular block alone. An isolated forearm technique was used for communication during the experiment. Two versions of the BIS monitor were used, both of which are in current use. Sugammadex was used to antagonise the neuromuscular block attributable to rocuronium. Results: The BIS decreased after the onset of neuromuscular block in both monitors, to values as low as 44 and 47, and did not return to pre-Test levels until after the return of movement. The BIS showed a two-stage decrease, with an immediate reduction to values around 80, and then several minutes later, a sharp decrease to lower values. In some subjects, there were periods where the BIS was <60 for several minutes. The response was similar for both suxamethonium and rocuronium. Neither monitor was consistently superior in reporting the true state of awareness. Conclusions: These results suggest that the BIS monitor requires muscle activity, in addition to an awake EEG, in order to generate values indicating that the subject is awake. Consequently, BIS may be an unreliable indicator of awareness in patients who have received neuromuscular blocking drugs. © 2015 The Author . Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved.
Ismail I.,Cairns Hospital |
Mudge D.W.,University of Queensland
Journal of Medical Case Reports | Year: 2015
Introduction: Congenital duodenal diverticula are a rare anomaly. The discovery of one in association with an ingested foreign body has only been reported on one previous occasion. In this challenging presentation, the presence of the coin led to the correct diagnosis. Patients with congenital duodenal anomalies may present a number of associated abnormalities. Interestingly, after the discovery of his intraluminal duodenal diverticulum, we searched and found that our patient presented a number of associated pathologies, as described in the literature. Case presentation: Our patient was a 36-year-old man, Caucasian, a kidney transplant recipient who presented with abdominal pain, vomiting and fever after an episode of pancreatitis. Because of a history of behavioral problems associated with intellectual impairment, including a compulsion to swallow coins during childhood, an abdominal radiograph was performed. Surprisingly, the radiograph revealed a radiopaque shadow in the central abdominal area. The findings of the ultrasound examination and computed tomography scan were suggestive of dilated biliary and pancreatic ducts. We performed an endoscopic retrograde cholangiopancreatography, which led to confirmation of the suspected coin above an obstructing intraluminal duodenal diverticulum with associated biliary ductal dilation. Upon retrieval of the coin, it was found to be a 1975 copper two-cent piece out of circulation in Australia for a large number of years. Conclusions: Foreign body retention in the gastrointestinal tract in an adult could be a sign of underlying mechanical pathology. Intraluminal duodenal diverticulitis can have a varied presentation, including life-threatening complications. Awareness should be raised of the conditions associated with congenital duodenal anomalies in adults, including renal, hepatobiliary and cardiac defects, many of which were present in our case. © 2015 Ismail and Mudge.
Killen J.P.,Cairns Hospital |
Brenninger V.L.,Royal North Shore Hospital
Nephrology | Year: 2014
Background Long-term haemodialysis patients may be at risk of hydrosoluble vitamin deficiencies. This study aimed to test the hypothesis that in patients with serum B12 < 300 pmol/L, intramuscular hydroxocobalamin reduces erythropoietin requirements whilst maintaining haemoglobin concentrations (Hb). Methods Study design was prospective, non-randomized, open label, with single group assignment. In 61 patients hydroxocobalamin 1000 μg was given weekly for 3 weeks and erythropoietin dose adjusted to target a Hb of 11-12 g/L. The primary outcome was the change in erythropoietin requirements at 2 years. Secondary outcomes included assessment of change in biochemical or clinical parameters. Results The erythropoietin dose reduced from 11 000 ± 7000 (10 000) IU to 5000 ± 6000 (3000) IU per week (P < 0.001) with no change in Hb 116 ± 16 (117) g/L before and after 114 ± 15 (113) g/L (P = 0.488) hydroxocobalamin supplementation. Serum albumin rose from 35 ± 4 (35) g/L to 36 ± 4 (36) g/L (P = 0.03). A significant rise in red cell folate (RCF) and serum vitamin B12 levels was observed. Serum ferritin rose despite a reduction in intravenous iron usage and no significant change in c-reactive protein or transferrin saturation. Conclusions In HD patients with B12 < 300 pmol/L, following treatment with hydroxocobalamin there was reduced erythropoietin requirements, maintained Hb and a small but significant rise in the serum albumin. RCF may be low in haemodialysis patients with metabolic cobalamin deficiency and rises significantly after supplementation. Hydroxocobalamin supplementation may have the potential to reduce the cost of anaemia management. Summary at a Glance The contribution of vitamin B12 (cobalamin) deficiency towards the anaemia of dialysis patients is an under recognized problem. This study examines the effect of administration of hydroxycobalamin over 2 years to those on haemodialysis with B12 < 300 pmol/L, and reported a reduction in erythropoietin-stimulating agent requirements. © 2014 Asian Pacific Society of Nephrology.
Ward E.W.,Cairns Hospital |
Sean McManus M.,Cairns Hospital
Canadian Journal of Anesthesia | Year: 2014
Purpose: This report describes the management of a life-threatening tracheal obstruction due to a thymoma in the anterior mediastinum and the use of a guidewire to facilitate intubation. Clinical features: Anesthetic management of patients presenting with large anterior mediastinal masses is always challenging. Catastrophic complications can occur after loss of consciousness due to compression of the airway, heart, or great vessels. Intrathoracic airway compression may become complete with a life-threatening inability to ventilate the lungs. We discuss the management of this case presenting to a regional centre prior to transfer to a tertiary care facility and point out current recommendations for pre-induction assessment and airway management in similar cases. Conclusion: Confirmed guidewire placement prior to induction enabled intubation in a setting without cardiothoracic backup capabilities. © 2014 Canadian Anesthesiologists' Society.