Auckland, New Zealand
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Carroll S.C.,Greenlane Clinical Center | Ng S.G.J.,Waikato Public Hospital
British Journal of Ophthalmology | Year: 2010

Background/aim: To describe the features and outcomes of orbital blowout fracture surgery in children and adolescents <20 years old. Methods: Retrospective chart review of consecutive patients undergoing orbital blowout fracture surgery at a tertiary referral hospital. Results: A single surgeon performed all surgeries between October 2000 and April 2008. All patients had symptoms and signs of orbital soft tissue entrapment and radiographical evidence of orbital blowout fractures involving the orbital floor and/or medial wall. The characteristics and outcomes of 19 consecutive patients undergoing surgery are presented. The median delay from injury to surgery was 7 (range 0e113) days, with 13 cases having late surgery (>72 h post-injury). The median follow-up was 2 months. Two patients had follow-up of less than 1 week. One patient required subsequent strabismus surgery. Of the remaining 16 patients, none had significant diplopia postoperatively. There was a trend to longer recovery times with increasing delay to surgery. Conclusion: Previous series suggest that significant delays between injury and surgery lead to poorer outcomes in young patients with orbital blowout fractures. The data from this series show that despite delays, excellent outcomes can be obtained.


Chow K.,Waikato Hospital | Mora J.,Greenlane Clinical Center
Journal of Glaucoma | Year: 2012

PURPOSE: To evaluate the practice patterns in the use of glaucoma drainage devices (GDD) and cyclodestruction among consultant ophthalmologists in Australia and New Zealand. MATERIALS AND METHODS: A 22-part questionnaire regarding GDD implantation and cyclodestruction practices was sent to all ophthalmologists registered with the Royal Australian and New Zealand College of Ophthalmologists in 2008 by post or e-mail. RESULTS: Sixty-six percent of 872 questionnaires were returned, of these, 14% were from glaucoma subspecialists. Ten percent of all respondents performed GDD implantations. Molteno drains were the most popular device (69%). The most commonly recognized indications for GDD implantation were a history of 2 failed trabeculectomies (85%), neovascular glaucoma (71%), iridocorneal endothelial syndrome (55%), and uveitic glaucoma (52%). Only a minority of surgeons used intraoperative mitomycin C (38%) or 5-fluorouracil (26%) when implanting GDD. Cyclodestruction had been performed by 20% of all respondents. External diode cyclophotocoagulation was the most preferred treatment mode (73%). Sixty-seven percent treated 180 degrees of the ciliary body during initial treatment. Fifty-five percent treated only the earlier untreated area during retreatment. Only 11% of surgeons who performed cyclodestruction agreed that the indications for cyclodestruction are expanding. CONCLUSIONS: A wide range of practice patterns for GDD implantation and cyclodestruction exist among Australian and New Zealand ophthalmologists. This likely reflects a paucity of good evidence to guide practice. The Australasian indications for GDD implantation were moderately different from the reported practice in America. Well-designed clinical trials are needed to better define the indications and best practice for these 2 important glaucoma treatment modalities. © 2012 Lippincott Williams & Wilkins, Inc.


Azariah S.,Greenlane Clinical Center
New Zealand Medical Journal | Year: 2010

Aim: As there is no New Zealand data, an audit of patients treated for syphilis at Auckland Sexual Health Service (ASHS) was undertaken to see if management conformed to guidelines and was achieving acceptable outcomes. Methods: Cases were initially identified from laboratory data and were categorised as being either infectious or non-infectious according to clinical and laboratory criteria. Management was compared to recommendations from ASHS treatment guidelines and treatment outcome was assessed by serological response. Results: 109 cases of syphilis were identified including 9 with HIV infection (8%). Men who had sex with men were much more likely to be diagnosed with infectious syphilis than heterosexuals (p<0.0001). Fifty-one percent of infectious cases (n=35) were asymptomatic. Ninety-four percent (n=103) of cases were treated with antibiotic regimens appropriate for their clinical stage. Discrepancy in management occurred most often in the early latent and unknown duration categories. Ninety-eight cases (90%) completed the full 12 months serological follow-up period and 97% (n=92) of those had an adequate serological response to treatment. There were no treatment failures in patients with HIV infection. Conclusion: Current care of patients with syphilis at Auckland Sexual Health Service is achieving acceptable outcomes. Criteria for diagnosing infectious syphilis cases need to be standardised as it has implications for management and disease surveillance. MSM are a major risk group for acquisition of infectious syphilis and regular serological screening is recommended as a large proportion will be asymptomatic. ©NZMA.


Oliphant J.,Greenlane Clinical Center | Perkins N.,Greenlane Clinical Center
New Zealand Medical Journal | Year: 2011

Aim To review cases of genital warts diagnosed at Auckland Sexual Health Service (ASHS) and to document any change following the introduction of the human papillomavirus (HPV) vaccination. The national HPV immunisation programme, using the quadrivalent vaccine Gardasil, commenced on 1 September 2008. The publically funded programme provides for the ongoing vaccination of girls in year 8 with an initial catch-up programme for young women born after 1 January 1990 until the end of 2010. Monitoring rates of diagnosis of genital warts should provide the earliest clinical indicator of a population response to the vaccine. Method The proportion of new clients attending ASHS who were diagnosed with genital warts from 1 January 2007 to 31 December 2008 was compared to the proportion diagnosed from 1 January 2009 to 30 June 2010. Results 40,793 new clients attended the ASHS between 2007 and June 2010 and genital warts were diagnosed in 3125 (7.7%). Genital warts were diagnosed in 9.2% of new clients in 2007 decreasing to 6.6% for the first 6 months of 2010. Analysis of the subgroup of clients under the age of 20 years, found genital warts in males decreased from 11.5% in 2007 to 6.9% in 2010 while in females the rates decreased from 13.7% to 5.1% over the same time period. In comparison, the rates decreased from 7.5% in 2007 to 5.9% in 2010 for females aged 20 years and over. Thus there was evidence of a significant difference, in the pre to post vaccination era, in the proportion of female clinic visits for genital warts in those aged less than 20 years and those aged 21 years or older (p=0.02) and further a borderline significant difference for males aged less than 20 years (p=0.05). Conclusion A significant decline in the incidence of genital warts in the target population suggests an early response to the HPV vaccination programme with some evidence of an effect for males aged less than 20 years. © NZMA.


Dai S.,Greenlane Clinical Center | Chow K.,Greenlane Clinical Center | Vincent A.,Greenlane Clinical Center | Vincent A.,University of Auckland
Clinical and Experimental Ophthalmology | Year: 2011

Background: To evaluate the efficacy of wide-field digital retinal imaging for retinopathy of prematurity screening. Design: Retrospective study in a quaternary public neonatal intensive care unit. Participants: A total of 108 premature infants screened for retinopathy of prematurity. Methods: Retrospective chart and photo review were performed on participants screened by both serial wide-field digital retinal imaging and concurrent binocular indirect ophthalmoscopy. Review of captured digital photos was performed independently by a masked reader. Using the binocular indirect ophthalmoscopy findings as the gold standard, the efficacy of wide-field digital retinal imaging in detecting treatment-requiring retinopathy of prematurity, defined as type 1 prethreshold disease, was determined. Main Outcome Measures: Sensitivity and specificity of wide-field digital retinal imaging in detecting treatment-requiring retinopathy of prematurity. Results: Treatment-requiring retinopathy of prematurity was detected in 11 infants by both binocular indirect ophthalmoscopy examination and telemedicine images taken at the same visit. Wide-field digital retinal imaging has a sensitivity of 100% (95% CI: 76.2-100%) and a specificity of 97.9% (95% CI: 93.4-99.7%) in detecting infants with treatment-requiring retinopathy of prematurity. Positive and negative predictive values of wide-field digital retinal imaging were 84.6% (95% CI: 57.8-97.3%) and 100% (95% CI: 96.9-100%), respectively. Conclusions: Wide-field digital retinal imaging is accurate, reliable and efficient in detecting treatment-requiring retinopathy of prematurity. Incorporating wide-field digital retinal imaging with telemedicine in standard retinopathy of prematurity management can potentially improve delivery, accessibility, quality and cost of retinopathy of prematurity care. © 2010 The Authors. Clinical and Experimental Ophthalmology © 2010 Royal Australian and New Zealand College of Ophthalmologists.


Azariah S.,Greenlane Clinical Center
New Zealand Medical Journal | Year: 2012

Aim Primary care practitioners need practical guidance on how to best manage partner notification for bacterial sexually transmitted infections. This paper reviews published literature on partner notification to determine whether there is good evidence to support the introduction of patient delivered partner therapy for the management of bacterial STI in New Zealand. Method A search of CINAHL, Medline and Cochrane databases was carried out using the search terms partner notification, contact tracing, sexually transmitted infections, sexually transmitted diseases, chlamydia, gonorrhoea and trichomoniasis. After review of the abstracts the identified papers were included in the review if they addressed the research question. Results Most people diagnosed with a bacterial STI would prefer to notify their sexual contacts themselves; therefore health practitioners need to feel competent to discuss and facilitate this process for their patients. Clinicians and patients are prepared to consider the use of patient delivered partner therapy with reservations however there is little evidence to support the effectiveness of this intervention even if it were legal under current New Zealand prescribing law. Conclusion Training of practice nurses, the use of partner notification cards and implementation of systems to improve documentation of management of index cases are all practical ways of achieving better partner notification outcomes in primary care within existing legal frameworks. © NZMA.


Chan P.L.,Greenlane Clinical Center
The New Zealand medical journal | Year: 2012

Vertebral fractures are the most common osteoporotic fracture and predict subsequent fracture and mortality. We undertook an audit (Auckland City Hospital, Auckland, New Zealand) to determine whether targeted assessment for incidental vertebral fractures on computed tomography (CT) examinations of the chest or abdomen in older people would detect previously unidentified vertebral fractures. In 175 consecutive patients aged >65 years, sagittal images of the spine were obtained by reformatting data from CT examinations of the chest or abdomen. Vertebral fractures were assessed using a semi-quantitative technique. The prevalence of vertebral fractures was 13%, with 41 vertebral fractures identified in 22 patients; 12/22 (55%) had vertebral fracture mentioned in the formal CT report, and 2/12 patients with contemporaneous plain films had vertebral fracture mentioned in the X-ray report. The vertebral fracture was newly identified in 17 (77%) patients, but vertebral fracture and osteoporosis were each listed in the relevant discharge summary or clinic letter for only 14% of patients, and only 31% of patients with fracture subsequently received osteoporosis treatment. In summary, assessing sagittal spine images reformatted from CT examinations of the chest or abdomen detects previously unidentified vertebral fractures, offering an undervalued opportunity to assess fracture risk and intervene with treatments that prevent fractures and reduce mortality.


Kim D.D.W.,Greenlane Clinical Center | Holdaway I.M.,Greenlane Clinical Center
Pituitary | Year: 2012

Acquired central diabetes insipidus (CDI) often occurs abruptly after a cranial event causing hypothalamic or pituitary damage. We present a case of a patient with pre-existing and clinically unapparent CDI which was unmasked after renal transplantation. A 60 year old woman with end-stage renal failure due to autosomal dominant polycystic kidney disease (ADPKD) underwent renal transplantation. She was noted to be markedly polyuric and polydipsic after the transplant. A fluid deprivation test was unequivocally positive for CDI, and desmopressin treatment resulted in immediate symptom relief. Neuroimaging revealed a midline defect in the region of the hypothalamus. She had a history of an intracerebral aneurysm that had ruptured, requiring extensive neurosurgery many years previously. This case demonstrates a rare instance of pre-existing but clinically unapparent CDI unmasked by renal transplantation. It is likely that renal failure due to ADPKD disguised her CDI prior to transplantation. A previous intracerebral insult from an aneurysmal bleed is the likely cause of her vasopressin deficiency. © 2010 Springer Science+Business Media, LLC.


Background Although multiple studies have confirmed Mycoplasma genitalium as a cause of nongonococcal urethritis in men, there is less evidence of its pathogenicity in women. Our aims were to determine the prevalence of M. genitalium in a sample of women attending a sexual health clinic and to assess whether there was any association between the detection of M. genitalium and a diagnosis of cervicitis in this population. Methods: A cross-sectional study recruited women who required screening for sexually transmissible infections. Endocervical swabs to detect the presence of M. genitalium were taken in addition to routine testing for Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis. Data were collected on demographics, sexual behaviour, clinical symptoms and the presence of clinical or microscopic cervicitis. Results: The prevalence of M. genitalium was 8.4% (n≤22, 95% confidence interval (CI): 5.4-12.5%) in the study sample of 261 women. There was an association between the finding of cervical contact bleeding (odds ratio OR): 5.45; 95% CI: 1.93-15.42, P≤0.001) and microscopic cervicitis (OR: 2.64; 95% CI: 0.95-7.34, P≤0.06) and the presence of M. genitalium when compared with women with no diagnosed infection; however, the latter finding was not statistically significant. Conclusions: Although the prevalence of M. genitalium was high at 8.4%, the overall lack of any association between the findings of cervicitis and the detection of M. genitalium support the conclusion that cervicitis has poor clinical utility as an indicator for the presence of M. genitalium infection. © CSIRO 2013.


This meta-analysis is aimed to determine the efficacy of quetiapine for the treatment of behavioural and psychological symptoms of dementia (BPSD). Our electronic search included MEDLINE (1950-2009), Cochrane Central Register of Controlled Trials and PsychINFO. We also did a hand search of the International Psychogeriatric Association poster presentations and checked the National trial registry data bases from USA, UK, RSA, Holland, Australia and New Zealand. We included double-blinded randomised placebo-controlled trials studies that measured BPSD with the Neuropsychiatric Inventory (NPI). The Clinical Global Impression of Change scale (CGI-C) was our secondary outcome. Six sets of data were included in this meta-analysis. Patients receiving quetiapine improved when compared to placebo with a weighted mean difference of - 3.05 (95% CI: -6.10, -0.01) and -0.31 (95% CI: -0.54, -0.08) respectively on the NPI score and CGI-C score. This meta-analysis found that quetiapine is statistically more efficacious than placebo in the treatment of BPSD as measured by the NPI and CGI-C. However, improvement is of a small magnitude and observable clinical significance is questionable.

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