Nelson, New Zealand
Nelson, New Zealand

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In 2012 the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) published an updated guideline for the diagnosis of Coeliac disease, allowing symptomatic individuals with appropriate serology and HLA genotype to be diagnosed without a small bowel biopsy. This retrospective study aimed to assess the applicability of this guideline to children in New Zealand. Children less than 16 years of age investigated for coeliac disease with small bowel biopsy in Christchurch Hospital between January 2010 and December 2012 were identified. The results of those with tissue transglutaminase IgA (tTG) levels greater than 50 units (10 times upper limit of normal), positive endomysial antibodies and HLA DQ2/DQ8 were used to calculate sensitivity and specificity. Data from 160 children was available: 70 had biopsy-confirmed Coeliac disease, and 90 had negative biopsies. Limited data precluded application of the guidelines to all patients. Using only tTG data, levels above 50 units provided a sensitivity of 67% and a specificity of 92%. Specificity increased to 97% when limited EMA and HLA DQ2/DQ8 data was added. Despite limited data, applying the ESPGHAN guidelines in the Christchurch paediatric population over this period produced a high specificity (97%). Prospective studies are now required to confirm these findings. © Science and Education Publishing.


Escott A.B.,University of Auckland | Pochin R.S.,Nelson Hospital
Ear, Nose and Throat Journal | Year: 2016

Tracheal perforation is a rare postoperative complication of total thyroidectomy. While previously documented cases have been reported in the anterior aspect of the trachea after a total thyroidectomy, we report what we believe is the first documented case of a perforation in the posterior aspect of the trachea. Our patient was a 29-year-old woman who presented with symptoms of tracheal impingement in the context of a right-sided goiter that subsequent investigation found to be three benign colloid nodules. Fourteen days after her total thyroidectomy, she presented with surgical emphysema surrounding the wound. Computed tomography identified a 2.5-mm defect in the right posterior lateral trachea, posterior to the cartilaginous ring. The defect failed to seal spontaneously, and after 48 hours, the patient remained symptomatic. During reexploration, the defect was successfully repaired with a myovascular transposition flap in conjunction with Tisseel tissue-bonding agent. This technique has the potential to be applied in future intraoperative and postoperative cases of tracheal perforation. © 2016 Vendome Group, LLC All rights reserved.


Law C.J.,Anglesea Hospital | Jacobson G.M.,University of Waikato | Kluger M.,Waitemata District Health Board | Chaddock M.,Waitemata District Health Board | And 2 more authors.
British Journal of Anaesthesia | Year: 2014

Background Our hypothesis was that deep anaesthesia, as estimated by a low target bispectral index (BIS) of 30-40, would result in less postoperative pain than that achieved at a conventional depth of anaesthesia. Methods We undertook a randomized double-blind controlled study at two tertiary teaching hospitals in New Zealand (2010-1) recruiting 135 adult patients ASA I-II presenting for non-emergent surgery under general anaesthesia requiring tracheal intubation. Anaesthesia was maintained with desflurane and a multimodal analgesia regimen comprising fentanyl infusion, i.v. paracetamol, and parecoxib. Patients were randomly assigned to either a low BIS (30-40) group or a high BIS (45-60) group. Desflurane concentrations were titrated to achieve these targets. Postoperative pain was assessed by: the pain on awakening (0-10, verbal rating scale, VRSawake) in the post-anaesthetic care unit; pain on activity at 20-24 h after operation (VRSd1A); and the rate of morphine patient-controlled analgesia (PCA) usage over the first 24 h. Results There was no statistically significant difference between the two groups for any of the pain scores. The median [inter-quartile range (IQR)] VRSawake was 4.0 (0-8) for the low and 4.0 (0-8) for the high BIS groups (P=0.56). The median (IQR) VRSd1A was 3.0 (1-5) for the low and 3.0 (1.5-4.5) for the high BIS groups (P=0.83). The median PCA morphine consumption in the low BIS group was 0.61 mg h-1 (0.04-1.5) vs 0.43 mg h-1 (0-1.59) in the high BIS group (P=0.98). Conclusions We conclude that there is no clinically useful analgesic effect of a deep anaesthesia regimen. © The Author [2013].


Deacon A.,Nelson Hospital
New Zealand Medical Journal | Year: 2013

Aims To review the management of acute gallstone disease at a provincial New Zealand centre and compare to current national/international practice. Methods All patients presenting to Nelson Hospital with acute gallstone-related pathology were identified from the study period. The first presentation within the audit period was defined as the index admission. Length of stay and interventions were recorded. Waiting lists were compared. Results Between January 2004 to December 2010, 390 patients were admitted with acute gallstone-related pathology to Nelson Hospital. The index cholecystectomy rate was 17% (57/329) after exclusion of 61 ineligible patients; 158/329 patients subsequently underwent elective cholecystectomy, with patients waiting a median time of 97 days (range 7-1922). There were 132 Emergency Department visits (median one (range 0-8)), and 59 readmissions with acute gallstone-related pathology for those waiting for cholecystectomy. Of the 37 admitted with gallstone pancreatitis, 11 underwent cholecystectomy within 2 weeks of index admission. Waiting lists remained unchanged over time. Conclusions Nelson Hospital has a low rate of index cholecystectomy. High numbers of patients represent to the emergency department or are readmitted whilst waiting for definitive surgery. Patients presenting with gallstone pancreatitis fail to receive treatment in accordance with international management guidelines. © NZMA.


Stewart R.A.H.,Green City | Stewart R.A.H.,University of Auckland | Kerr A.J.,Middlemore Hospital | Whalley G.A.,University of Auckland | And 9 more authors.
European Heart Journal | Year: 2010

AimsLeft ventricular (LV) hypertrophy and abnormal non-invasive measures of LV diastolic function are common in patients with severe aortic stenosis (AS) but their prognostic importance is uncertain. This study aimed to determine whether tissue Doppler measures of LV systolic and/or diastolic function or echocardiographic LV hypertrophy are useful for risk stratifying asymptomatic patients with severe calcific AS. Methods and resultsOne hundred and eighty-three initially asymptomatic patients with moderate or severe AS (valve area mean 0.96 ± SD 0.3 cm2) and a normal LV ejection fraction were followed for median 31 (IQR 14-40) months. Peak systolic (S′) and diastolic (E′) mitral annular velocities and LV mass were measured by echocardiography at baseline and during follow-up. During follow-up 106 (58) patients suffered symptomatic deterioration, including three sudden deaths and one resuscitated cardiac arrest. Peak aortic velocity (for 0.5 m/s increase HR = 1.43, 95 CI 1.25, 1.64, P < 0.0001) and aortic valve area (-0.1 cm 2/m2 HR = 1.23, 95 CI 1.12, 1.35, P = 0.004) at baseline were most strongly associated with symptomatic deterioration. After peak aortic velocity adjustment neither LV mass index nor any measure of LV systolic or diastolic function was associated with symptomatic deterioration (P > 0.2 for all). ConclusionIn patients with calcific AS who have a normal LV ejection fraction the severity of stenosis is the most important correlate of symptomatic deterioration. Tissue Doppler measures of LV systolic and diastolic function and LV mass provide limited predictive information after accounting for the severity of stenosis. © 2010 The Author.


We describe three cases of tutu berry (Coriaria arborea) ingestion resulting in tonic-clonic seizures in two individuals and mild symptoms in the third. Tutu poisoning in humans appears to be a rare occurrence; the last reported case in the medical literature being over 40 years ago. We review the literature on tutu poisoning and recommend extending the period of observation for poisoned individuals from 8 hours to 12 hours or longer. We also recommend that prophylactic benzodiazepine use should be considered in those with mild to moderate symptoms of poisoning.


Plummer C.,St Vincents Hospital | Spring P.J.,Concord Repatriation General Hospital | Marotta R.,St Vincents Hospital | Chin J.,St Vincents Hospital | And 5 more authors.
Mitochondrion | Year: 2013

Multiple Symmetrical Lipomatosis (MSL) is an unusual disorder characterized by the development of axial lipomas in adulthood. The pathoetiology of lipoma tissue in MSL remains unresolved. Seven patients with MSL were followed for a mean period of 12. years (8-20 years). All patients had cervical lipomas ranging from subtle lesions to disfiguring masses; six patients had peripheral neuropathy and five had proximal myopathy. Myoclonus, cerebellar ataxia and additional lipomas were variably present. All patients showed clinical progression. Muscle histopathology was consistent with mitochondrial disease. Five patients were positive for mtDNA point mutation m.8344A. >. G, three of whom underwent lipoma resection - all samples were positive for uncoupling protein-1 mRNA (unique to brown fat). Lipoma from one case stained positive for adipocyte fatty-acid protein-2 (unique to brown fat and immature adipocytes). This long-term study hallmarks the phenotypic heterogeneity of MSL's associated clinical features. The clinical, genetic and molecular findings substantiate the hypothesis that lipomas in MSL are due to a mitochondrial disorder of brown fat. © 2013 Elsevier B.V. and Mitochondria Research Society.


Everts R.J.,Nelson Hospital | Barnett T.,Medlab. South | Lahood B.R.,Nelson Hospital
New Zealand Medical Journal | Year: 2011

Aim: To determine the accuracy of preliminary results of conjunctival swab culture and to evaluate the utility of preliminary and final conjunctival swab culture results in the routine management of conjunctivitis. Methods: We prospectively identified 164 conjunctival swabs from adults and children over 3 weeks of age and compared preliminary (next day) with final culture results. We modelled the would-be effect on treatment and clinical outcome of three strategies (indiscriminant, delayed and targeted) for management of acute conjunctivitis. Results: In total, 54 of 164 (33%) samples yielded significant bacterial growth. Compared to final culture, preliminary culture had a sensitivity of 86%, positive predictive value of 98% and specificity of 99%. Modelling showed that an indiscriminant approach to management (all patients given topical antibacterial treatment, no swabs taken) was the most effective at reducing symptoms but led to substantial unnecessary use of topical antibacterial treatment. Modelling showed that a delayed treatment strategy (patients start topical antibacterial treatment only if not improving satisfactorily after 2 days, no swabs taken) was the least effective at reducing symptoms and lead to moderate unnecessary use of topical antibacterial treatment. The targeted treatment strategy (topical antibacterial treatment given to those with clinical predictors of bacterial infection on day 0, positive preliminary culture results on day 1 and positive final culture results on day 2) was highly effective at reducing symptoms and potentially the least wasteful of topical antibacterial treatment. Conclusion: Preliminary (next day) conjunctival swab culture results are highly predictive of the final result and could be used by practitioners to guide prescription of topical antibacterial treatment. ©NZMA.


Munro A.,Nelson Hospital
The New Zealand medical journal | Year: 2013

To assess the utility of a decision rule for determining short-term risk in syncope patients presenting to the Emergency Department (ED) of Nelson Hospital (Nelson, New Zealand). Sixty-eight of 83 eligible syncope patients who presented to the ED with syncope were consecutively enrolled. Follow-up for an adverse event within 7 days of index presentation was performed. Actual event rate was compared with the prediction tool known as the San Francisco Syncope Rule (SFSR). Sensitivity and specificity for the SFSR was 83% (95% Confidence Interval (CI) of 44-97%) and 82% (95%CI 71-91%) respectively. There was a negative predictive value of 98% (95% CI 90-99%). Positive and negative likelihood ratios were 4.7 (95% CI 2.5-9.0) and 0.2 (95% CI 0.03-01.22) respectively. Syncope patients who present to the ED with no obvious cause and who are being considered for discharge may benefit from application of the SFSR for short-term risk assessment.


Sussex P.V.,Nelson Hospital | Thomson W.M.,University of Otago | Fitzgerald R.P.,University of Otago
Gerodontology | Year: 2010

Objective: The aim of this study was to obtain a deeper understanding of the social factors driving New Zealand's historic 'epidemic of edentulism' and how they operated. Method: In-depth, semi-structured interviews with 31 older New Zealanders were analysed using applied grounded theory. Results: Universal factors present in the data were: (a) the way in which New Zealand society accepted and indeed encouraged edentulism without stigma for those who had a 'sub-optimal' natural dentition; (b) how the predominant patterns of dental care utilisation (symptomatic and extraction-based) were often strongly influenced by economic and social disadvantage; and (c) the way in which lay and professional worldviews relating to 'calcium theory' and dental caries were fundamental in decisions relating to the transition to edentulism. Major influences were rural isolation, the importance of professional authority and how patient-initiated transitions to edentulism were ultimately facilitated by an accommodating profession. Conclusion: The combined effects of geography, economics, the dental care system and the professional culture of the day, in the context of contemporary (flawed) understandings of oral disease, appear to have been the key drivers. These were supported (in turn) by a widespread acceptance by the profession and society alike of the extraction/denture philosophy in dealing with oral disease. © 2009 The Gerodontology Society and John Wiley & Sons A/S.

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