Fisher J.,Monash Health |
Fisher J.,Monash University |
Taori G.,Dandenong Hospital |
Braitberg G.,Monash Health |
And 3 more authors.
Clinical Toxicology | Year: 2014
Background. Methylene blue inhibits the nitric oxide-cyclic guanosine monophosphate (NO-cGMP) pathway, decreasing vasodilation and increasing responsiveness to vasopressors. It is reported to improve haemodynamics in distributive shock from various causes including septicaemia and post-cardiac surgery. Reports of use in overdose are limited. We describe the use of methylene blue to treat a case of refractory distributive shock following a mixed drug poisoning. Case details. A 41-year-old male presented following reported ingestion of 18 g extended-release quetiapine, 10 g controlled-release carbamazepine, 240 mg fluoxetine, 35 g enteric-coated sodium valproate and 375 mg oxazepam. He was comatose and intubated on presentation. Progressive hypotension developed. Echocardiogram revealed a hyperdynamic left ventricle, suggesting distributive shock. The patient remained hypotensive despite intravenous fluid boluses, escalating vasopressor infusions. Arterial blood gas revealed metabolic acidaemia and high lactate. Methylene blue was administered as loading-dose of 1.5 mg/kg and continuous infusion (1.5 mg/kg/h for 12 h, then 0.75 mg/kg/h for 12 h) resulting in rapid improvement in haemodynamic parameters and weaning of vasopressors. Serum quetiapine concentration was 18600 ng/mL (30-160 ng/mL), collected at the time of peak toxicity. Conclusion. Severe quetiapine poisoning produces hypotension primarily from alpha-adrenoreceptor antagonism. Methylene blue may have utility in the treatment of distributive shock resulting from poisoning refractory to standard vasopressor therapy. © 2014 Informa Healthcare USA, Inc.
Egerton-Warburton D.,Monash Medical Center Clayton |
Egerton-Warburton D.,Monash University |
Povey K.,Dandenong Hospital
EMA - Emergency Medicine Australasia | Year: 2013
Objective: The study aims to determine if slow intravenous infusion of metoclopramide reduces the incidence of acute drug-induced akathisia (DIA) compared with intravenous bolus. Methods: A prospective, double-blind, double dummy trial of adult patients requiring intravenous metoclopramide in the ED. Participants were randomised to receive either: metoclopramide 20mg as a bolus and normal saline infusion over 15min, or normal saline bolus and metoclopramide 20mg infused over 15min. Patients were assessed for DIA using the Prince Henry Akathisia Rating Scale before treatment was commenced and at 20, 40 and 60min post. Nausea was assessed with a visual analog scale. Results: Of 210 participants assessed for eligibility, 206 were randomised and 205 were included in the final analysis. Participant characteristics and indication for metoclopramide were well matched between the treatment groups. Overall, incidence of DIA was 26 out of 205 participants (12.68%, 95% confidence interval [CI] 8.09-17.3). DIA occurred in 11 out of 103 (10.68%, 95% CI 4.61-16.74%) in the bolus group, and in 15 out of 102 (14.71%, 95% CI 7.71-21.70%) in the infusion group (P = 0.67). Severe DIA occurred in six patients in each group. The mean age of patients experiencing DIA was 34 years (interquartile range 29-40) and 42 years (interquartile range 40-45) in those without akathisia (P = 0.04). Nausea reduction was equivalent in both groups. Conclusion: The incidence of DIA and reduction in nausea is unaffected by the rate of administration of intravenous metoclopramide 20mg. © 2013 The Authors. EMA © 2013 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.
Bergin S.M.,Dandenong Hospital |
Brand C.A.,Royal Melbourne Hospital |
Colman P.G.,Royal Melbourne Hospital |
Campbell D.A.,Monash University
Journal of Foot and Ankle Research | Year: 2011
Background: Information describing variation in health outcomes for individuals with diabetes related foot disease, across socioeconomic strata is lacking. The aim of this study was to investigate variation in rates of hospital separations for diabetes related foot disease and the relationship with levels of social advantage and disadvantage.Methods: Using the Index of Relative Socioeconomic Disadvantage (IRSD) each local government area (LGA) across Victoria was ranked from most to least disadvantaged. Those LGAs ranked at the lowest end of the scale and therefore at greater disadvantage (Group D) were compared with those at the highest end of the scale (Group A), in terms of total and per capita hospital separations for peripheral neuropathy, peripheral vascular disease, foot ulceration, cellulitis and osteomyelitis and amputation. Hospital separations data were compiled from the Victorian Admitted Episodes Database.Results: Total and per capita separations were 2,268 (75.3/1,000 with diabetes) and 2,734 (62.3/1,000 with diabetes) for Group D and Group A respectively. Most notable variation was for foot ulceration (Group D, 18.1/1,000 versus Group A, 12.7/1,000, rate ratio 1.4, 95% CI 1.3, 1.6) and below knee amputation (Group D 7.4/1,000 versus Group A 4.1/1,000, rate ratio 1.8, 95% CI 1.5, 2.2). Males recorded a greater overall number of hospital separations across both socioeconomic strata with 66.2% of all separations for Group D and 81.0% of all separations for Group A recorded by males. However, when comparing mean age, males from Group D tended to be younger compared with males from Group A (mean age; 53.0 years versus 68.7 years).Conclusion: Variation appears to exist for hospital separations for diabetes related foot disease across socioeconomic strata. Specific strategies should be incorporated into health policy and planning to combat disparities between health outcomes and social status. © 2011 Bergin et al; licensee BioMed Central Ltd.
Singh T.,Dandenong Hospital |
Schenberg M.,Monash University
Annals of the Royal College of Surgeons of England | Year: 2013
INTRODUCTION Oral squamous cell carcinoma (SCC) can present with a wide range of clinical appearances. Consequently, an oral SCC, particularly in its early stage, may not be considered suspicious by a clinician, thereby delaying diagnosis. Delayed diagnosis of an oral SCC could result in more advanced disease at the time of treatment, leading to more extensive and costly treatment, greater morbidity and poorer survival. The aim of this study was to identify cases of oral SCC treated at Southern Heath (Melbourne, Australia) with a history of prediagnosis dental treatment, and to determine the delay between dental treatment and appropriate surgical assessment of the oral SCC. METHODS: Patients were identified from the head and neck tumour database at Southern Health who met the inclusion criteria and relevant data were recorded. RESULTS: Twelve patients met the inclusion criteria and 83% of cases involved the mandible. Dental extraction was the most common prediagnosis treatment performed (75%). The average delay from dental treatment to surgical assessment was just over eight weeks and all patients were found to have stage IV disease. Most patients had received extensive surgical resections (83%), neck dissections (75%) and adjunctive therapy (83%). CONCLUSIONS: Oral SCC can sometimes be difficult to diagnose, which can result in more extensive treatment and greater morbidity. Health professionals and patients need to be aware that non-healing oral lesions, even after dental treatment such as a dental extraction, need to be considered as suspicious and an appropriate surgical referral should be made.
De Silva I.M.,Dandenong Hospital |
Teague J.A.,Cabrini Medical Center |
Blake W.E.,Dandenong Hospital |
Blake W.E.,Cabrini Medical Center
Journal of Plastic, Reconstructive and Aesthetic Surgery | Year: 2013
Since 1995, the association between Anaplastic Large Cell Lymphoma (ALCL) and breast implant capsules has been of increasing concern. Up to 40 cases have been reported worldwide. The majority of cases favour an indolent course, similar to that of primary cutaneous ALCL, with a 10-year survival rate of greater than 90%. Many recommendations have been made for diagnosis, treatment and adjuvant therapy but the issue of reconstruction post capsulectomy and removal of implants has not yet been addressed. We present a case report and management option. © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons.
Mee M.J.,Monash Medical Center |
Egerton-Warburton D.,Monash Medical Center |
Meek R.,Dandenong Hospital
EMA - Emergency Medicine Australasia | Year: 2011
Objective: To describe the treatment and assessment of emergency department nausea and vomiting (EDNV) in Australasia by Fellows of the Australasian College for Emergency Medicine (FACEM). To determine the influence of various factors on FACEM anti-emetic choice. To compare the influence of drug effectiveness, side effects, cost and pharmacy directives on adult EDNV anti-emetic choice between FACEM choosing the two most common first-line agents. Methods: A cross-sectional survey of all FACEM practising in Australasian ED was conducted by mail-out in February 2009. Results: Of all FACEM surveyed 48.7% (532/1092) responded. The most common first-line drugs for adult EDNV were metoclopramide (87.3%, 453/519), 5HT3 antagonists (7.9%, 41/519) and prochlorperazine (2.3%, 12/519). For paediatric EDNV, the most common first-line agents were 5HT3 antagonists (86.2%, 307/356), metoclopramide (6.7%, 24/356) and promethazine (5.1%, 18/356). For most FACEM anti-emetic choice was highly influenced by perceived drug efficacy (96.1%) and side effects (82.5%), and 32.9% of FACEM were highly influenced by drug cost. Few FACEM reported ED anti-emetic protocols for adults (13.0%) or children (16.7%) in their ED. FACEM seldom used scales or tools to measure EDNV severity in adult (2.5%) or paediatric (3.4%) patients. Conclusions: Fellows of the Australasian College for Emergency Medicine anti-emetic choice in Australasian ED has been described. The main influences on anti-emetic choice were patient age, perceived drug efficacy and drug side-effect profiles. © 2011 The Authors. EMA © 2011 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.
Lundine K.M.,Dandenong Hospital |
Davis G.,Austin Hospital and Cabrini Hospital |
Rogers M.,Austin Hospital and Cabrini Hospital |
Staples M.,Cabrini Hospital |
Quan G.,Austin Hospital
Journal of Clinical Neuroscience | Year: 2014
Anterior cervical discectomy and fusion (ACDF) is a widely accepted surgical treatment for symptomatic cervical spondylosis. Some patients develop symptomatic adjacent segment degeneration, occasionally requiring further treatment. The cause and prevalence of adjacent segment degeneration and disease is unclear at present. Proponents for motion preserving surgery such as disc arthroplasty argue that this technique may decrease the "strain" on adjacent discs and thus decrease the incidence of symptomatic adjacent segment degeneration. The purpose of this study was to assess the pre-operative prevalence of adjacent segment degeneration in patients undergoing ACDF. A database review of three surgeons' practice was carried out to identify patients who had undergone a one- or two-level ACDF for degenerative disc disease. Patients were excluded if they were operated on for recent trauma, had an inflammatory arthropathy (for example, rheumatoid arthritis), or had previous spine surgery. The pre-operative MRI of each patient was reviewed and graded using a standardised methodology. One hundred and six patient MRI studies were reviewed. All patients showed some evidence of intervertebral disc degeneration adjacent to the planned operative segment(s). Increased severity of disc degeneration was associated with increased age and operative level, but was not associated with sagittal alignment. Disc degeneration was more common at levels adjacent to the surgical level than at non-adjacent segments, and was more severe at the superior adjacent level compared with the inferior adjacent level. These findings support the theory that adjacent segment degeneration following ACDF is due in part to the natural history of cervical spondylosis. © 2013 Elsevier Ltd. All rights reserved.
Mirbagheri N.,Frankston Hospital |
Dark J.,Dandenong Hospital |
Skinner S.,University of Melbourne
Techniques in Coloproctology | Year: 2013
Background Stoma closure is associated with high wound infection rates. The aim of this study was to evaluate risk factors for infection rates in such wounds, with particular emphasis on assessing the importance of the stomal wound closure technique. Methods A retrospective analysis of 142 patients who had undergone ileostomy or colostomy closure between 2002 and 2011 was performed. Postoperative outcome as measured by wound infection rate was recorded. Three different closure techniques were identified: primary closure (PC), primary closure with Penrose drain (PCP) and purse-string circumferential wound approximation technique (PSC). Other factors such as age, sex, ASA score, type of prophylactic antibiotics used, diabetes, smoking and obesity were also analysed. All other techniques were excluded. Results Our series consisted of 142 stomal closures (90 ileostomy and 52 colostomy closures). The patients had a median age of 63.5 years with an interquartile range of 50.1-73.2 years. The overall wound infection rate was 10.7 %. PC, PCP and PSC were associated with wound infection rates of 17.9, 10.5 and 3.6 %, respectively. Compared to PSC, PC and PCP were associated with significantly higher wound infection rates (p = 0.027 and p = 0.068, respectively). Obesity was a significant risk factor for wound infection (p = 0.024). Use of triple-agent antibiotics prophylactically had a protective effect on the infection rate (p = 0.012). Conclusions To reduce stomal wound closure infection rates, we recommend institution of closure techniques other than PC with or without a drain. Risk factors such as obesity should be addressed, and prophylactic triple antibiotics should be administered. © Springer-Verlag Italia 2012.
Marom L.,Dandenong Hospital
Diabetes Research and Clinical Practice | Year: 2010
Background: An electronic literature search was conducted to determine suitability of insulin pumps for people with type 1 diabetes who have visual impairment. Methods: Ovid MEDLINE and CINAHL databases as well as the Internet were searched. Search terms used were insulin pump therapy, continuous subcutaneous insulin infusion, blindness, vision disorders, visually impaired persons and low vision. Only two relevant articles were identified regarding accessibility issues for insulin pump use by vision-impaired people with diabetes. Results: Insulin pumps currently available do not have features that are sufficiently compatible with severely visually impaired people. None have speech output, user guides in Braille or accessible diabetes software for personal computers and only one pump has good visual display characteristics. Conclusions: As serious health consequences can result from improper use of insulin pumps, industry should design pumps with features that can be safely and easily accessed by people with severe vision loss. © 2010 Elsevier Ireland Ltd.
Matera J.T.,Frankston Hospital |
Egerton-Warburton D.,Monash Medical Center |
Meek R.,Dandenong Hospital
EMA - Emergency Medicine Australasia | Year: 2010
Objectives: To survey Fellows of the Australasian College for Emergency Medicine (FACEMs) in order to describe current ultrasound (US) usage during central venous catheter (CVC) placement and to compare practice and opinions between FACEMs routinely using US and those not.Methods: Descriptive and analytical cross-sectional electronic survey of all FACEMs. Baseline variables including hospital type, US availability, frequency of CVC insertion, US usage and technique are presented descriptively. US practice and opinions on usage are compared between routine and non-routine users.Results: Responses were obtained from 486 (42.4%) of 1146 FACEMs emailed. Whereas 88.5% of respondents had US available and 70% had done an US course, only 37% routinely used US for CVC placement. Completion of an US course and performance of >11 CVC per year were strongly associated with routine US use (odds ratio 10.0 [5.5-18.4] and 2.6 [1.7-3.9], respectively). Common barriers to more frequent US use were not having completed an US course (20%) and US-guided CVC placement taking too long (18%). Eighty-five per cent of FACEMs agreed that there should be ED access to US and US training but only 34% thought its use should be mandatory.Conclusions: We found that only 37% of FACEM respondents routinely used US to guide placement of CVCs and a number of barriers to more frequent use are identified. Practices and opinions regarding US use differed significantly between routine and non-routine users. © 2010 The Authors. EMA © 2010 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.