Chandran S.,Austin Health |
Chandran S.,University of Melbourne |
Parker F.,Austin Health |
Vaughan R.,Austin Health |
And 9 more authors.
Gastrointestinal Endoscopy | Year: 2015
Background: Colonoscopy and polypectomy can prevent up to 80% of colon cancer; however, a significant adenoma miss rate still exists, particularly in the right side of the colon. Objective: To assess whether retroflexion in the right side of the colon significantly improves theadenoma detection rate (ADR) over forward-view assessment. Design: Multicenter prospective cohort study. Setting: Three tertiary care public and 2 private hospitals. Patients: A total of 1351 consecutive adult patients undergoing elective colonoscopy. Intervention: Withdrawal from the cecum was performed in the forward view initially and identified polyps removed. Once the hepatic flexure was reached, the cecum was reintubated and the right side of the colon was assessed in the retroflexed view to the hepatic flexure. Main Outcome Measurements: ADR in the retroflexed view when compared with forward-view examination of the right side of the colon. Results: Retroflexion was successful in 95.9% of patients, with looping the predominant (69.6%) reason for failure. Forward-view assessment of the right side of the colon identified 642 polyps, of which 531 were adenomas yielding a polyp and ADR of 28.57% and 24.64%, respectively. Limitations: Observational study. Conclusion: Right-sided retroflexion was successful in most of our cohort with a statistically signi ficant but small increase in ADR. Right-sided retroflexion is safe when performed by experienced endoscopists with no adverse events observed in this cohort. (Clinical trial registration: Australian New Zealand Clinical Trials Registry, ACTRN12613000424707.) Copyright © 2015 by the American Society for Gastrointestinal Endoscopy.
Woodford R.,Monash Medical Center |
Ranasinghe W.,Monash Medical Center |
Ranasinghe W.,Launceston General HospitalTAS |
Aw H.C.,Monash Medical Center |
And 2 more authors.
BJU International | Year: 2016
Objective To investigate the incidence and mortality trends of upper tract urothelial cancers (UTUC) in Victoria over the last decade. Patients and Methods Age-adjusted incidence and mortality rates were calculated for UTUC. These were identified using data from the Victorian Cancer Registry from 2001 until 2011 based on histological diagnoses. Age at diagnosis, sex and demographical location were compared. Results The age-standardised incidence of UTUC remained stable from 2001 to 2011. There were 278 deaths from UTUC over this period with an overall 5-year survival rate of 32%. There was no significant difference in survival between 2001-06 and 2007-11 (30% vs 36%, respectively). Lower age at diagnosis was associated with a significant improvement in survival (P = 0.01). Sex and geographical location appeared to have no effect on survival. Conclusion The 5-year survival rates for UTUC in Victoria are poor, particularly in comparison to worldwide data. In contrast to worldwide trends, the incidence of UTUC appears to be stable. No significant improvement in 5-year survival rates over the short study period was identified. These findings highlight the difficulties in managing this rare yet deadly malignancy. © 2016 The Authors.
Field K.M.,Royal Melbourne Hospital |
Simes J.,University of Sydney |
Simes J.,Royal Prince Alfred HospitalNSW |
Nowak A.K.,Sir Charles Gairdner Hospital |
And 50 more authors.
Neuro-Oncology | Year: 2015
Background. The optimal use of bevacizumab in recurrent glioblastoma (GBM), including the choice of monotherapy or combination therapy, remains uncertain. The purpose of this study was to compare combination therapy with bevacizumab monotherapy. Methods. This was a 2-part randomized phase 2 study. Eligibility criteria included recurrent GBM after radiotherapy and temozolomide, no other chemotherapy for GBM, and Eastern Cooperative Oncology Group performance status 0-2. The primary objective (Part 1) was to determine the effect of bevacizumab plus carboplatin versus bevacizumab monotherapy on progression-free survival (PFS) using modified Response Assessment in Neuro-Oncology criteria. Bevacizumab was given every 2 weeks, 10 mg/kg; and carboplatin every 4 weeks, (AUC 5). On progression, patients able to continue were randomized to continue or cease bevacizumab (Part 2). Secondary endpoints included objective radiological response rate (ORR), quality of life, toxicity, and overall survival (OS). Results. One hundred twenty-two patients (median age, 55y) were enrolled to Part 1 from 18 Australian sites. Median follow-up was 32 months, and median on-treatment time was 3.3 months. Median PFS was 3.5 months for each arm (hazard ratio [HR]: 0.92, 95% CI: 0.64-1.33, P =. 66). ORR was 14% (combination) versus 6% (monotherapy) (P =. 18). Median OS was 6.9 (combination) versus 7.5 months (monotherapy) (HR: 1.18, 95% CI: 0.82-1.69, P =. 38). The incidence of bevacizumab-related adverse events was similar to prior literature, with no new toxicity signals. Toxicities were higher in the combination arm. Part 2 data (n = 48) will be reported separately. Conclusions. Adding carboplatin resulted in more toxicity without additional clinical benefit. Clinical outcomes in patients with recurrent GBM treated with bevacizumab were inferior to those in previously reported studies. © 2015 The Author(s) 2015.
Omari S.,University of Tasmania |
Omari S.,Jordan University of Science and Technology |
Khalafallah A.,University of Tasmania |
Khalafallah A.,Launceston General HospitalTAS |
And 3 more authors.
Mediterranean Journal of Hematology and Infectious Diseases | Year: 2011
Anemia is a common finding in lymphoma. There are few data available regarding the erythropoietin (EPO) levels in conjunction with ferritin in lymphoma patients. We prospectively evaluated 55 patients diagnosed with malignant lymphoma during the period between November 2006 and March 2008 at the King Abdullah University Teaching Hospital, Jordan. Our data showed that 74.4% of lymphoma patients were anemic. Furthermore, serum EPO and ferritin levels were higher in lymphoma patients compared with the healthy controls (P=0.001). The observed versus predicted EPO ratio showed also significantly higher levels in anemic lymphoma patients compared to healthy controls (p=0.03). There was an improvement in the Hb level in lymphoma patients who were treated with at least 3-cycles of chemotherapy as compared with newly-diagnosed patients. An adequate increase of EPO levels was observed in anemic lymphoma patients and notably associated with higher ferritin levels and improvement of Hb (p<0.001). Our findings suggest that ferritin estimation in lymphoma patients may predict the level of erythropoiesis and possibly the degree of anemia. Further studies to confirm these findings are warranted.
Keung C.,Launceston General HospitalTAS |
Hebbard G.,Royal Melbourne Hospital
Australian Prescriber | Year: 2016
If there are no features of serious disease, suspected gastro-oesophageal reflux disease can be initially managed with a trial of a proton pump inhibitor for 4–8 weeks. This should be taken 30–60 minutes before food for optimal effect. Once symptoms are controlled, attempt to withdraw acid suppression therapy. If symptoms recur, use the minimum dose that controls symptoms. Patients who have severe erosive oesophagitis, scleroderma oesophagus or Barrett’s oesophagus require long-term treatment with a proton pump inhibitor. Lifestyle modification strategies can help gastro-oesophageal reflux disease. Weight loss has the strongest evidence for efficacy. Further investigation and a specialist referral are required if there is no response to proton pump inhibitor therapy. Atypical symptoms or signs of serious disease also need investigation. © 2016, Australian Government Publishing Service. All rights reserved.
El-Ansary D.,University of Melbourne |
Aitken J.,Launceston General HospitalTAS |
Zalucki N.,Launceston General HospitalTAS |
Hardikar A.,Launceston General Hospital and Royal Hobart HospitalTAS
International Journal of Therapy and Rehabilitation | Year: 2015
Background: Postoperative sternal complications after cardiac surgery remain a significant problem that increases hospital length of stay and cost of care, delays recovery, and impairs function. While the majority of patients with sternal instability can be successfully treated with sternal debridement and rewiring, this may not be an option for all patients who present with acute or persistent instability. Methods: This clinical case reports an interdisciplinary approach to the clinical assessment and conservative management of a complex patient with multiple co-morbidities and persistent sternal instability following three open-heart procedures for coronary revascularisation. It presents new and innovative diagnosis of sternal instability and monitoring of sternal healing using real-time ultrasound, as well as clinical management, with a sternal brace (QualiBreath, Chiaverano, 10010-Torino, Italy). Results: With the QualiBreath in situ, the patient reported a significant reduction in pain with activity (2/10), uninterrupted sleep and improved confidence in completing everyday tasks. On physical examination, there was minimal sternal motion on palpation (Sternal Instability Scale grade 1). Conclusions: A conservative interdisciplinary team approach to the management of patients who present with persistent sternal instability is recommended. © MA Healthcare Limited 2014.