Katelaris C.H.,Campbelltown Hospital |
Katelaris C.H.,University of Western Sydney
Medicine Today | Year: 2013
HAE, AAE and ACE inhibitor-induced angioedema are rare forms of angioedema that should be considered in patients with angioedema without urticaria. Although angioedema associated with allergic or chronic idiopathic urticaria generally resolves with antihistamine treatment of the associated urticaria, these other forms have no or poor response to antihistamines, corticosteroids and adrenaline, and require other management. In patients with HAE, danazol and tranexamic acid are appropriate for prophylaxis, and C1 INH concentrates (expensive and not PBS listed), icatibant (PBS listed) and ecallantide (not available in Australia) are appropriate for the treatment of severe episodes. In patients with AAE, treatment of the underlying disease generally relieves symptoms. In patients with ACE inhibitor-induced angioedema, withdrawal of the ACE inhibitor and supportive management is appropriate, with intubation if necessary. Angiotensin receptor antagonists may be used as an alternative when ACE inhibitors are withdrawn.
Milne S.,Paediatric Alied Health Unit |
McDonald J.,Campbelltown Hospital |
Comino E.J.,University of New South Wales
Physical and Occupational Therapy in Pediatrics | Year: 2012
In response to concerns that the Bayley Scales of Infant and Toddler Development III (BSIDIII) underestimate delay in clinical populations, this study explores developmental quotient scores as an alternative to composite scores for these children. One hundred and twenty-two children aged ≤42 months, referred for diagnosis of developmental disability from January 2007 to May 2010, were assessed, and their composite and developmental quotient scores on each scale were compared. Composite scores identified only 22% (cognitive), 27% (motor), and 47.5% (language) of children as having a developmental disability. Developmental quotient scores were significantly lower than composite scores, giving rates of developmental disability of 56.6% (cognitive), 48.4% (motor), and 74.6% (language) and more closely matching both clinical impressions of delay and the proportions of those children who were also delayed on standardized tests of adaptive function. © 2012 Informa Healthcare USA, Inc.
White L.,University of Wollongong |
Halpin A.,Wagga Wagga Base Hospital |
Turner M.,Wagga Wagga Base Hospital |
Wallace L.,Campbelltown Hospital
British Journal of Anaesthesia | Year: 2016
Background Ultrasound is a well-validated adjunct to central venous cannulation; however, previous reviews of ultrasound-guided radial artery cannulation have been inconclusive. The aim of this study was to assess the use of ultrasound in radial artery cannulation in adult and paediatric populations. Methods A systematic search of five major databases for all relevant articles published until November 2015 was conducted. Randomized controlled trials of radial artery cannulation with and without ultrasound guidance were included. All studies were assessed for level of evidence and risk of bias. Studies were grouped in adult and paediatric populations for each outcome. A meta-analysis was performed to analyse the data. Results Eleven randomized controlled trials (six adult and five paediatric) were found. In both the adult and paediatric populations, there was high-level evidence for significantly improved first-attempt success rate and number of attempts with the use of ultrasound guidance. Conclusions This is the first level one systematic review to demonstrate strong evidence for the use of ultrasound guidance in radial artery cannulation in adult and paediatric populations. In the adult population, ultrasound use significantly increased first-attempt success rate, which subsequently resulted in a significant reduction in the number of attempts. The benefits of ultrasound were also shown in the paediatric population, with a significant increase in first-attempt success rate and reduction in the number of attempts. The use of ultrasound as an adjunct to radial arterial cannulation should now be considered best practice. © 2016 The Author 2016. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved.
Jeffery N.N.,Royal Prince Alfred Hospital |
Douek N.,Campbelltown Hospital |
Guo D.Y.,Concord Hospital |
Patel M.I.,University of Sydney
BMC Urology | Year: 2011
Background: Tumor size is a critical variable in staging for renal cell carcinoma. Clinicians rely on radiological estimates of pathological tumor size to guide patient counseling regarding prognosis, choice of treatment strategy and entry into clinical trials. If there is a discrepancy between radiological and pathological measurements of renal tumor size, this could have implications for clinical practice. Our study aimed to compare the radiological size of solid renal tumors on computed tomography (CT) to the pathological size in an Australian population. Methods. We identified 157 patients in the Westmead Renal Tumor Database, for whom data was available for both radiological tumor size on CT and pathological tumor size. The paired Student's t-test was used to compare the mean radiological tumor size and the mean pathological tumor size. Statistical significance was defined as P < 0.05. We also identified all cases in which post-operative down-staging or up-staging occurred due to discrepancy between radiological and pathological tumor sizes. Additionally, we examined the relationship between Fuhrman grade and radiological tumor size and pathological T stage. Results: Overall, the mean radiological tumor size on CT was 58.3 mm and the mean pathological size was 55.2 mm. On average, CT overestimated pathological size by 3.1 mm (P = 0.012). CT overestimated pathological tumor size in 92 (58.6%) patients, underestimated in 44 (28.0%) patients and equaled pathological size in 21 (31.4%) patients. Among the 122 patients with pT1 or pT2 tumors, there was a discrepancy between clinical and pathological staging in 35 (29%) patients. Of these, 21 (17%) patients were down-staged post-operatively and 14 (11.5%) were up-staged. Fuhrman grade correlated positively with radiological tumor size (P = 0.039) and pathological tumor stage (P = 0.003). Conclusions: There was a statistically significant but small difference (3.1 mm) between mean radiological and mean pathological tumor size, but this is of uncertain clinical significance. For some patients, the difference leads to a discrepancy between clinical and pathological staging, which may have implications for pre-operative patient counseling regarding prognosis and management. © 2011 Jeffery et al; licensee BioMed Central Ltd.
Milne S.,Paediatric Allied Health |
McDonald J.,Campbelltown Hospital
Infants and Young Children | Year: 2015
Adaptive function is an essential dimension in the diagnosis of neurodevelopmental conditions in young children, assisting in determining the pattern of intellectual function and the amount and type of support required. Yet, little information is available on the accuracy of currently used adaptive function assessments for preschool children. This study compares the results of 2 commonly used assessments, the Adaptive Behavior Assessment System (ABAS-II) and the Vineland Adaptive Behavior Scales, Second Edition (Vineland-II), on a group of 52 preschoolers referred for investigation of delays in development. Standard scores on the Vineland-II were significantly higher than those on the ABAS-II, but both assessment scores could be used to identify patterns of adaptive functioning that would require support. The amount and type of support required could not be determined by standard scores on either assessment. Greater consistency between scales and grading the level of support required was achieved using age equivalent scores. Age equivalent scores on individual subscales showed motor and preacademic skills that were consistent with developmental level; performance on all other subscales was lower than developmental level. This study supports the use of standard scores to identify significant impairment in adaptive function and age equivalent quotient scores to describe the amount and area of support required. Copyright © 2015 Wolters Kluwer Health, Inc. All Rights Reserved.