Pilgrim C.H.C.,Alfred Hospital |
McIntyre R.,Frankston Hospital |
Bailey M.,Alfred Hospital |
Bailey M.,Monash University
Diseases of the Colon and Rectum | Year: 2010
Purpose: There is little evidence regarding the prevalence or incidence of parastomal hernia, but it is thought to be common. Repair of parastomal hernia can be troublesome, and methods of repair need to be validated based on reduced incidence following surgery. The true rate of parastomal herniation needs to be determined prospectively, and risk factors for developing such hernias need to be more clearly defined. Methods: To determine prevalence and associated risk factors, prospective data were collected regarding initial stoma surgery, presence of parastomal hernia, and comorbidities. Results: Ninety patients were prospectively audited. For stomas formed at emergency or elective surgery, regardless of surgical indication, the overall rate of parastomal hernia was 33%. Aperture size and patient age were independently predictive of parastomal hernia in multivariate analysis. For every millimeter increase in aperture size, the risk of developing a hernia increased by 10% (odds ratio, 1.10 (CI, 1.03-1.18); P = .005). For every additional year of patient age, the risk of developing a hernia increased by 4% (odds ratio, 1.04 (CI, 1.00 -1.08); P = .04). There was a significantly higher prevalence of hernia following sigmoid colostomy than following ileostomy (45.9% vs. 22%; P < .05). The hernia rate was higher but did not reach statistical significance in patients with disseminated malignancy, body mass index >35 kg/m2, diabetes, prostate hypertrophy, ascites, or chronic constipation. Conclusion: This study of carefully and prospectively collected data shows the prevalence of parastomal herniation to be 33%. This rate was higher with larger aperture size and increased age in multivariate analysis. © 2009 The ASCRS.
Haji D.L.,Frankston Hospital |
Haji D.L.,University of Melbourne |
Royse A.,Royal Melbourne Hospital |
Royse C.F.,Royal Melbourne Hospital
EMA - Emergency Medicine Australasia | Year: 2013
There is increased realisation of the emerging role of point-of-care transthoracic echocardiography (TTE) as 'ultrasound-assisted examination', given the low sensitivity of clinical examination for cardiovascular pathologies and the time-critical nature of these pathologies. There is evidence that point-of-care TTE provides higher accuracy in patient assessment and management, with potential prognostic impact by assessing the severity of cardiac dysfunction and response to treatment. Point-of-care TTE is increasingly used by non-cardiologists, as a diagnostic, screening or monitoring tool. The literature shows that TTE identifies new clinical findings, and conversely can accurately rule out clinically important pathologies. Recent reports have examined more advanced ultrasound devices and patients in the critical care settings of emergency medicine, intensive care and anaesthesia. The diagnostic capability of new portable devices is improving rapidly and outdating its predecessors, thereby improving confidence in echocardiography findings. © 2012 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.
Mirbagheri N.,Frankston Hospital |
Dark J.,Academic Surgical Unit |
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.
Branch T.,University Orthopedics |
Lavoie F.,Hopital Notre Dame |
Guier C.,Private Practice |
Lording T.,Frankston Hospital |
And 2 more authors.
Knee Surgery, Sports Traumatology, Arthroscopy | Year: 2015
Purpose: The purpose of this study was to compare the biomechanical characteristics and patient outcomes after either isolated intraarticular ACL reconstruction or intraarticular reconstruction with lateral extra-articular tenodesis. In addition, we aimed to evaluate biomechanical parameters of the entire uninjured, contralateral knee as a baseline during the analysis. Methods: Eighteen patients were evaluated at an average of 9.3 years after ACL reconstruction. Twelve patients had an intraarticular reconstruction (BTB), and six had an additional lateral extraarticular procedure (BTB/EAR). Patients were selected for the additional procedure by the operating surgeon based on clinical and radiological criteria. At the time of review, each patient was assessed using subjective patient questionnaires, manual laxity testing, and instrumented laxity testing. Each knee was also evaluated using a robotic lower leg axial rotation testing system. This system measured maximum internal and external rotations at 5.65 Nm of applied torque and generated load deformation curves and compliance data. Pointwise statistical comparisons within each group and between groups were performed using the appropriate paired or unpaired t test. Features were extracted from each load deformation curve for comparative analysis. Results: There were no significant differences between the two groups with respect to the patient satisfaction scores or to laxity testing (manual or instrumented). Robotic testing results for within-group comparisons demonstrated a significant reduction in maximum external rotation (8.77°) in the reconstructed leg when compared to the healthy leg (p < 0.05) in the BTB/EAR group, with a non-significant change in internal rotation. The slope of the curve at maximum internal rotation was also significantly greater in the reconstructed legs for the BTB/EAR group (p < 0.05), indicating reduced endpoint compliance or a harder endpoint. Finally, the leg that received the extra-articular tenodesis had a trend towards a reduced total leg axial rotation. Conversely, patients in the BTB group demonstrated no significant differences between their legs. For between-group comparisons, there was a significant increase in maximum internal rotation in the healthy legs in the BTB/EAR group compared with the healthy legs in the BTB group (p < 0.05). If the injured/reconstructed legs were compared, the significant difference at maximum internal rotation disappeared (p < 0.10). Similarly, the healthy legs in patients in the BTB/EAR group had a significantly more compliant or softer endpoint in internal rotation, greater maximum internal rotation, and more internal rotation at torque 0 in their healthy legs compared with the healthy legs in the BTB group (p < 0.05). These same differences were not noted in the reconstructed knees. The only identifiable significant difference between the injured/reconstructed legs was rotation at 0 torque (p < 0.05). Conclusions: In this group of patients who were at an average of 9 years from surgery, the addition of a lateral extra-articular reconstruction to a standard bone–tendon–bone intraarticular ACL reconstruction does reduces internal rotation of the tibia with respect to the femur when compared to intraarticular reconstruction alone. It appears that the selection process for inclusion into the BTB/EAR group included an increase in total axial rotation of the healthy knee during the examination along with a decrease in endpoint stiffness at maximum internal rotation. Level of evidence: II. © 2015, The Author(s).
Tiruvoipati R.,Frankston Hospital |
Botha J.,Frankston Hospital |
Peek G.,East Midlands Congenital Heart Center
Journal of Critical Care | Year: 2012
The mortality and morbidity of patients with severe acute respiratory distress syndrome (ARDS) remains high despite the advances in intensive care practice. The low-tidal-volume ventilation strategy (ARDS net protocol) has been shown to be effective in improving survival. Unfortunately, however, some patients have such severe ARDS that they cannot be managed with the ARDS net strategy. In these patients, rescue therapies such as high-frequency ventilation, prone ventilation, nitric oxide, and extracorporeal membrane oxygenation (ECMO) are considered. The CESAR trial has shown that an ECMO-based protocol improved survival without severe disability as compared with conventional ventilation. The recent increased incidence of severe respiratory failure due to H1N1 influenza pandemic has led to an increased use of ECMO. Although several reports showed ECMO use to be encouraging, some scepticism remains. In this article, we reviewed the usefulness of ECMO in patients with severe ARDS in the light of current evidence. © 2012.