Barreto S.G.,Modbury Hospital |
Saccone G.T.P.,Flinders Medical Center
Pancreatology | Year: 2012
Background: Pain management of many pancreatic diseases remains a major clinical concern. This problem reflects our poor understanding of pain signaling from the pancreas. Objectives: This review provides an overview of our current knowledge, with emphasis on current pain management strategies and recent experimental findings. Methods: A systematic search of the scientific literature was carried out using EMBASE, PubMed/MEDLINE, and the Cochrane Central Register of Controlled Trials for the years 1965-2011 to obtain access to all publications, especially randomized controlled trials, systematic reviews, and meta-analyses exploring pain and its management in disease states such as acute pancreatitis (AP), chronic pancreatitis (CP) and pancreatic cancer (PC). Results: Over the last decade, numerous molecular mediators such as nerve growth factor and the transient receptor potential (TRP) cation channel family have been implicated in afferent nerve signaling. More recent animal studies have indicated the location of the receptive fields for the afferent nerves in the pancreas and shown that these are activated by agents including cholecystokinin octapeptide, 5- hydroxytryptamine and bradykinin. Studies with PC specimens have shown that neuro-immune interactions occur and numerous agents including TRP cation channel V1, artemin and fractalkine have been implicated. Experimental studies in the clinical setting have demonstrated impairment of inhibitory pain modulation from supraspinal structures and implicated neuropathic pain mechanisms. Conclusions: Our knowledge in this area remains incomplete. Characterization of the mediators and receptors/ion channels on the sensory nerve terminals are required in order to facilitate the development of new pharmaceutical treatments for AP and CP. Copyright © 2012, IAP and EPC. Published by Elsevier India, a division of Reed Elsevier India Pvt. Ltd.
Shrikhande S.V.,The Surgical Center |
Barreto S.G.,Modbury Hospital
Indian Journal of Surgery | Year: 2012
Carcinoma of the pancreas remains a malignancy with a generally dismal outcome owing to the delayed presentation of the disease. To date, surgery affords the best outcomes when a complete resection can be achieved. Improvements in imaging, surgical techniques and adjuvant therapies are perceived advancements in the management of this cancer. This article reviews the latest evidence in terms of the diagnosis and management of pancreatic cancer. © 2011 Association of Surgeons of India.
Grace R.F.,Vila Central Hospital |
Tang W.,Modbury Hospital |
Namel E.,Vila Central Hospital
Anaesthesia and Intensive Care | Year: 2015
'Ketofol', the single-syringe combination of ketamine and propofol (50 mg of ketamine and 90 mg of propofol in a 10 ml syringe) is becoming increasingly popular for short procedures, progressively replacing the more traditional use of ketamine and diazepam in some settings. This audit examined the haemodynamic, emergence and other characteristics of ketofol administration in 42, otherwise fit, women undergoing bilateral post-partum tubal ligation at Vila Central Hospital in Vanuatu. The combination of ketamine and propofol had no clinically important adverse haemodynamic effects. Wake-up from ketofol was favourable, with low rates of nausea and minimal emergence delirium. However, 43% of patients required airway support. For short procedures such as post-partum tubal ligation in fit patients, ketofol appears to have minimal adverse haemodynamic effects and favourable emergence characteristics.
Solanki N.S.,Royal Adelaide Hospital |
Barreto S.G.,Modbury Hospital |
Saccone G.T.P.,Flinders University
Pancreatology | Year: 2012
Background: The co-existence of diabetes mellitus (DM) in patients with acute pancreatitis (AP) is linked to poor outcomes. Four large epidemiological studies have suggested an aetiological role for DM in AP. The exact nature of this role is poorly understood. Objective: To analyse the available clinical and experimental literature to determine if DM may play a causative role in AP. Methods: A systematic search of the scientific literature was carried out using EMBASE, PubMed/MEDLINE, and the Cochrane Central Register of Controlled Trials for the years 1965e2011 to obtain access to all publications, especially randomized controlled trials, systematic reviews, and meta-analyses exploring the mechanisms of pathogenesis of AP in patients with DM. Results: No clinical studies could be identified directly providing pathogenetic mechanisms of DM in the causation of AP. The available data on DM and its associated metabolic changes and therapy indicate that hyperglycaemia coupled with the factors influencing insulin resistance (tumour necrosis-a, NFk B, amylin) cause an increase in reactive oxygen species generation in acinar cells. Conclusions: Complex pathogenetic connections exist between AP and factors involved in the development and therapy of DM. Insulin resistance and hyperglycaemia, hallmarks of DM, are important factors linked to the susceptibility of diabetics to AP. Given the high morbidity associated with an attack of AP in a diabetic patient, targeting these two aspects by therapy may help not only to reduce the risk of development of AP, but may also help reduce the severity of an established attack in a diabetic patient. Copyright © 2012, IAP and EPC. Published by Elsevier India, a division of Reed Elsevier India Pvt. Ltd.
Morse L.P.,Modbury Hospital |
McGuire D.T.,Modbury Hospital |
Bain G.I.,University of Adelaide
Techniques in Hand and Upper Extremity Surgery | Year: 2014
The most common site of ulnar nerve compression is within the cubital tunnel. Surgery has historically involved an open cubital tunnel release with or without transposition of the nerve. A comparative study has demonstrated that endoscopic decompression is as effective as open decompression and has the advantages of being less invasive, utilizing a smaller incision, producing less local symptoms, causing less vascular insult to the nerve, and resulting in faster recovery for the patient. Ulnar nerve transposition is indicated with symptomatic ulnar nerve instability or if the ulnar nerve is located in a "hostile bed" (eg, osteophytes, scarring, ganglions, etc.). Transposition has previously been performed as an open procedure. The authors describe a technique of endoscopic ulnar nerve release and transposition. Extra portals are used to allow retractors to be inserted, the medial intermuscular septum to be excised, cautery to be used, and a tape to control the position of the nerve. In our experience this minimally invasive technique provides good early outcomes. This report details the indications, contraindications, surgical technique, and rehabilitation of the endoscopic ulnar nerve release and transposition. Copyright © 2013 by Lippincott Williams & Wilkins.