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Meadowbrook, Australia

Remedios M.,Sandford Jackson Building | Jones D.,Logan Hospital | Kerlin P.,Sandford Jackson Building
Drugs | Year: 2011

Eosinophilic oesophagitis (EE) is a clinico-pathological entity recognized with increased frequency in children and adults. It is an atopic disease involving ingested and inhaled allergens. A pathological eosinophilic infiltrate is diagnosed by finding ≥15 eosinophils per high-powered field on oesophageal mucosal biopsies. This infiltrate may result in a narrowed oesophageal lumen. It does not involve the stomach or duodenum. Children commonly present with abdominal pain, vomiting and dysphagia. Presentation in adults is with dysphagia, heartburn, chest pain or impaction of a food bolus in the oesophagus. There is often a history of allergy (asthma, hay fever, eczema). A male predominance (70 in adults) is unexplained. Distinctive endoscopic features are linear furrows, mucosal rings and white papules, and the narrowed lumen may be appreciated. Although EE and gastro-oesophageal reflux disease are separate entities, there is a significant overlap of the conditions. Treatment options include nonpharmacological approaches including an elimination or elemental diet, and or medications, chiefly with corticosteroids. The topical administration of fluticasone propionate has been demonstrated to improve symptoms and mobilize the pathological infiltrate of eosinophils. There has been a variable effect with the leukotriene receptor antagonist montelukast and promising early results with mepolizumab, a monoclonal antibody against interleukin-5. The long-term efficacy of topical corticosteroids has not been well studied and most patients experience recurrent symptoms when treatment is completed. Currently, repeated short courses of topical corticosteroids are utilized. Acid suppression by a proton pump inhibitor may be considered in view of the overlap between EE and gastro-oesophageal reflux disease. © 2011 Adis Data Information BV. All rights reserved. Source

Torbey M.J.,Logan Hospital
Journal of Obstetrics and Gynaecology Research | Year: 2014

Vaginal pessaries are generally considered a safe and effective form of management for pelvic organ prolapse. Serious complications such as rectovaginal fistula can develop with or without regular follow-up. This case report describes the rapid development over a 10-week period of a large rectovaginal fistula in a 75-year-old woman, despite routine follow-up and replacement of her cube pessary. Currently, there is a lack of evidence-based guidelines for pessary care and, in particular, the frequency of pessary replacement. Intervals for pessary replacements vary greatly and are often based on the manufacturer's recommendations. This case highlights the rapidity at which serious complications can develop and also represents the first reported case of a cube pessary-induced rectovaginal fistula. © 2014 The Author. Journal of Obstetrics and Gynaecology Research © 2014 Japan Society of Obstetrics and Gynecology. Source

Wysocki A.P.,Logan Hospital
World Journal of Gastroenterology | Year: 2010

The ultimate reason why pancreatologists have strived to establish definitions for inflammatory pathologies of the pancreas is to improve patient care. Although the Atlanta Classification has been used for around for 17 years, considerable misunderstanding of the key elements of the nomenclature still persists. While a recent article by Stamatakos et al aimed to deal with an entity not clearly defined in the 1993 document, it is replete with factual and conceptual errors as well as contradictory statements. © 2010 Baishideng. Source

Watson V.,Logan Hospital
BMJ Case Reports | Year: 2015

Pituitary apoplexy is a rare event in which the pituitary gland undergoes infarction or haemorrhage, most commonly in the setting of an underlying tumour. We report on apoplexy of an undiagnosed pituitary adenoma precipitated both by physiological enlargement of the pituitary in pregnancy and prophylactic anticoagulation from a history of deep vein thrombosis. The haemorrhage was managed conservatively without significant complications. Copyright 2015 BMJ Publishing Group. All rights reserved. Source

Huxtable S.,Logan Hospital | Palmer M.,Logan Hospital
European Journal of Clinical Nutrition | Year: 2013

Background/objectives: A Protected Mealtimes Programme (PMP) encourages staff, volunteers and visitors to assist patients and cease non-urgent clinical activity during mealtimes. Given the limited evidence available establishing the efficacy of PMP, we compared mealtime interruptions, mealtime assistance received and nutrient intakes before and after PMP implementation in adult inpatients on acute wards. Subjects/methods: Data collected on patients at main meals before and after PMP implementation included the following: diet code, level of assistance required and received and by whom, time available to consume the meal, position of the patient and tray during eating, type of interruption and by whom and proportion of foods and drinks consumed. Outcomes pre- and post-PMP implementation were compared using χ2, independent samples t-tests and logistic regression analyses. Results: Over two years, 1632 inpatient mealtime observations were conducted (65 (18) years, 51% M). Similar proportions of patients received mealtime assistance when required (∼84%, P=0.928). Feeding assistance nearly doubled post-PMP implementation (15-29%, P=0.002). Interruptions by nursing staff increased by 8% post-PMP implementation (P<0.001) and represented 61% of all interruptions. Interruptions were less likely to occur pre-PMP implementation (odds ratio, 0.403, 95% confidence interval, 0.301-0.539). Mealtime energy and protein intakes were not changed post-PMP (P=0.979, P=0.482, respectively). Conclusions: The PMP increased nursing staff availability at mealtimes and feeding assistance, but also increased mealtime interruptions. This may explain the lack of change in patient energy and protein consumption. Strategies promoting adherence with PMP implementation, such as nurse ward champions or nursing staff driving PMP implementation, may be required to maximise the benefits of protected mealtimes. © 2013 Macmillan Publishers Limited. Source

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