Palmerston North, New Zealand
Palmerston North, New Zealand

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Murdoch B.,Broadway Surgical Clinic | Buchanan J.,Middlemore Hospital | Cliff J.,Palmerston North Hospital
International Journal of Oral and Maxillofacial Surgery | Year: 2014

Alloplastic total temporomandibular joint replacement (TMJ TJR) has been performed in New Zealand utilizing the TMJ Concepts patient-fitted system since 2000. The data analysed in this study were collected retrospectively from questionnaires sent to all maxillofacial surgeons in New Zealand who had implanted TMJ Concepts devices between 2000 and 2011. A total of 63 devices were implanted in 42 patients (13 males, 29 females) during this 12-year period. The primary indication for TMJ TJR was end-stage joint disease resulting from ankylosis and arthritis. The mean age of the patients was 47 years (range 7-80 years). The most common complication reported was transient facial nerve impairment in 4.8% of the patients. Objective results, measured as the maximal incisional opening, improved by a mean of 17.3 mm (P < 0.01); 90% of patients reported improved quality of life. New Zealand oral and maxillofacial surgeons have concluded that TMJ TJR using the TMJ Concepts prosthesis is a reliable treatment option for the management of end-stage TMJ disease. © 2013 Published by Elsevier Ltd on behalf of International Association of Oral and Maxillofacial Surgeons. All rights reserved.


Sato K.,University of Florida | Roesl C.,Massey University | Pollock N.,Palmerston North Hospital | Stowell K.M.,Massey University
Anesthesiology | Year: 2013

Background: Mutations within the gene encoding the skeletal muscle calcium channel ryanodine receptor can result in malignant hyperthermia. Although it is important to characterize the functional effects of candidate mutations to establish a genetic test for diagnosis, ex vivo methods are limited because of the low incidence of the disorder and sample unavailability. More than 250 candidate mutations have been identified, but only a few mutations have been functionally characterized. Methods: The human skeletal muscle ryanodine receptor complementary DNA was cloned with or without a diseaserelated variant. Wild-type and mutant calcium channel proteins were transiently expressed in human embryonic kidney-293 cells expressing the large T-antigen of simian virus 40, and functional analysis was carried out using calcium imaging with fura-2 AM. Six human malignant hyperthermia-related mutants such as R44C, R163C, R401C, R533C, R533H, and H4833Y were analyzed. Cells were stimulated with a specific ryanodine receptor agonist 4-chloro-m-cresol, and intracellular calcium mobility was analyzed to determine the functional aspects of mutant channels. Results: Mutant proteins that contained a variant linked to malignant hyperthermia showed higher sensitivity to the agonist. Compared with the wild type (EC50 = 453.2 μm, n = 18), all six mutants showed a lower EC50 (21.2-170.4 μm, n = 12-23), indicating susceptibility against triggering agents. Conclusions: These six mutations cause functional abnormality of the calcium channel, leading to higher sensitivity to a specific agonist, and therefore could be considered potentially causative of malignant hyperthermia reactions. Copyright © 2013, the American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins.


Machin S.E.,Palmerston North Hospital | Mukhopadhyay S.,Norwich University
Menopause International | Year: 2011

Pelvic organ prolapse is a common condition affecting a large number of women. Incidence increases after the menopause. Age, parity and obesity are the most consistently reported risk factors. Many women can be asymptomatic of prolapse but common symptoms include a sensation of a bulge or fullness in the vagina or urinary, bowel or sexual dysfunction. Management depends upon symptoms and the type and grade of the prolapse as well as any associated medical co-morbidities. Management options include expectant, conservative or surgical approaches. Up to 10% of women having a surgical procedure for prolapse will require a second procedure. It is, therefore, important to consider lifestyle modifications such as weight loss and conservative measures including pelvic floor muscle training, topical estrogens and pessaries as initial management options.


Rosenberg H.,Saint Barnabas Medical Center | Pollock N.,Palmerston North Hospital | Schiemann A.,Massey University | Bulger T.,Palmerston North Hospital | Stowell K.,Massey University
Orphanet Journal of Rare Diseases | Year: 2015

Abstract Malignant hyperthermia (MH) is a pharmacogenetic disorder of skeletal muscle that presents as a hypermetabolic response to potent volatile anesthetic gases such as halothane, sevoflurane, desflurane, isoflurane and the depolarizing muscle relaxant succinylcholine, and rarely, in humans, to stressors such as vigorous exercise and heat. The incidence of MH reactions ranges from 1:10,000 to 1: 250,000 anesthetics. However, the prevalence of the genetic abnormalities may be as great as one in 400 individuals. MH affects humans, certain pig breeds, dogs and horses. The classic signs of MH include hyperthermia, tachycardia, tachypnea, increased carbon dioxide production, increased oxygen consumption, acidosis, hyperkalaemia, muscle rigidity, and rhabdomyolysis, all related to a hypermetabolic response. The syndrome is likely to be fatal if untreated. An increase in end-tidal carbon dioxide despite increased minute ventilation provides an early diagnostic clue. In humans the syndrome is inherited in an autosomal dominant pattern, while in pigs it is autosomal recessive. Uncontrolled rise of myoplasmic calcium, which activates biochemical processes related to muscle activation leads to the pathophysiologic changes. In most cases, the syndrome is caused by a defect in the ryanodine receptor. Over 400 variants have been identified in the RYR1 gene located on chromosome 19q13.1, and at least 34 are causal for MH. Less than 1 % of variants have been found in CACNA1S but not all of these are causal. Diagnostic testing involves the in vitro contracture response of biopsied muscle to halothane, caffeine, and in some centres ryanodine and 4-chloro-m-cresol. Elucidation of the genetic changes has led to the introduction of DNA testing for susceptibility to MH. Dantrolene sodium is a specific antagonist and should be available wherever general anesthesia is administered. Increased understanding of the clinical manifestation and pathophysiology of the syndrome, has lead to the mortality decreasing from 80 % thirty years ago to <5 % in 2006. © 2015 Rosenberg et al.


Schiemann A.H.,Massey University | Durholt E.M.,Massey University | Pollock N.,Palmerston North Hospital | Stowell K.M.,Massey University
British Journal of Anaesthesia | Year: 2013

BackgroundMalignant hyperthermia (MH) is a potentially fatal pharmacogenetic disorder in which intracellular calcium homeostasis in the skeletal muscle of susceptible individuals is disrupted upon exposure to halogenated anaesthetics. While MH is linked to the ryanodine receptor (RYR1) on chromosome 19 and the α1S subunit of the voltage-dependent L-type calcium channel (CACNA1S) on chromosome 1, mutations have been found in only 50-70% of patients, and subsequently, there is a need for a more powerful screening tool.MethodsGenomic DNA capture and next-generation sequencing was used to screen 32 genes involved in excitation-contraction coupling, skeletal muscle calcium homeostasis, or immune response in two MH patients. Lymphoblastoid cell lines were used to functionally characterize candidate RYR1 mutations in one family.ResultsSequence analysis revealed two putative causative mutations in RYR1 in one patient. Segregation analysis and functional analysis support a causative role of the detected variants. The amount of Ca2+ released after stimulation with 4-chloro-m-cresol from B lymphocytes of the MH-susceptible patients in the family was significantly greater compared with that of Ca2+ released from cells of an MH-negative family member. In the other patient, no causative mutations were identified in the 32 genes screened.ConclusionsIn this study, we successfully demonstrate the use of genomic DNA capture and next-generation sequencing for identification of putative mutations causing MH. We also suggest that whole exome sequencing may be necessary to identify MH causing mutations in patients where no mutations in RYR1 and CACNA1S have been identified thus far. © The Author [2012]. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved.


Sato K.,Massey University | Pollock N.,Palmerston North Hospital | Stowell K.M.,Massey University
Anesthesiology | Year: 2010

Background: Malignant hyperthermia is associated with mutations within the gene encoding the skeletal muscle ryanodine receptor, the calcium channel that releases Ca from sarcoplasmic reticulum stores triggering muscle contraction, and other metabolic activities. More than 200 variants have been identified in the ryanodine receptor, but only some of these have been shown to functionally affect the calcium channel. To implement genetic testing for malignant hyperthermia, variants must be shown to alter the function of the channel. A number of different ex vivo methods can be used to demonstrate functionality, as long as cells from human patients can be obtained and cultured from at least two unrelated families. Because malignant hyperthermia is an uncommon disorder and many variants seem to be private, including the newly identified H4833Y mutation, these approaches are limited. Methods: The authors cloned the human skeletal muscle ryanodine receptor complementary DNA and expressed both normal and mutated forms in HEK-293 cells and carried out functional analysis using ryanodine binding assays in the presence of a specific agonist, 4-chloro-m-cresol, and the antagonist Mg2+. Results: Transiently expressed human ryanodine receptor proteins colocalized with an endoplasmic reticulum marker in HEK-293 cells. Ryanodine binding assays confirmed that mutations causing malignant hyperthermia resulted in a hypersensitive channel, while those causing central core disease resulted in a hyposensitive channel. Conclusions: The functional assays validate recombinant human skeletal muscle ryanodine receptor for analysis of variants and add an additional mutation (H4833Y) to the repertoire of mutations that can be used for the genetic diagnosis of malignant hyperthermia. Copyright © 2010, the American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins.


Guidera A.K.,Palmerston North Hospital | Stegehuis H.R.,Palmerston North Hospital
New Zealand Medical Journal | Year: 2010

Aim: To present four cases of button battery nasal foreign bodies that were referred to an otolaryngology department over a 6-month period. Methods: Four cases are presented and discussed with a review of current literature. Results: Four children aged 2-4 years who were referred to an otolaryngology department over about 6 months were found to have a button battery in their nose. While there was mucosal damage in all the noses the likelihood of a septal perforation developing appears to be related to the time interval between insertion and removal. The two patients who did not develop a septal perforation had the battery removed after about 90 minutes and 3 days. The two patients who did develop a perforation had the battery removed after 4 hours and 24 hours. Battery thickness may also be important as the patient who had the battery removed at 3 days had a 2 mm thick battery whereas the other three all had a 5 mm thick battery. Discussion: As button batteries are ubiquitous it is imperative that consumers and medical practitioners are aware of the risks they pose if placed in the nose, and also elsewhere in the body. Conclusion: As early removal of a button battery is likely to decrease the chances of a septal perforation developing a nasal foreign body should be considered to be a button battery until proven otherwise. ©NZMA.


Martin D.K.,Palmerston North Hospital
EMA - Emergency Medicine Australasia | Year: 2011

Objective: The aim of the present study was to determine the reasons for which patients with minor injury attend the ED, comparing those who have and have not self-administered analgesia. Secondary outcomes were to quantify the proportion of patients who present without having taken analgesia, to describe the reasons why analgesia was not taken, and to compare pain scores between the two groups. Methods: Prospective observational study of adult patients with minor injury presenting to the Emergency Department of Palmerston North Hospital, Palmerston North, New Zealand. Participants answered a questionnaire about their analgesic usage and reasons for ED attendance. Results: Four hundred and seventy-three patients were enrolled, of which 63.9% had not self-administered analgesia. The most common primary reasons for ED attendance were for diagnosis (49.6%), and for treatment (31.3%). Patients who had not self-administered analgesia were significantly less likely to be seeking analgesia than those who had (22.8% vs 39.2% [P < 0.001]). They were also less likely to want an X-ray (31.8% vs 46.8% [P= 0.001]) and had a significantly lower pain score than those who had taken analgesia (47.2 vs 59.8, [P < 0.001]). They were significantly more likely to have come primarily for treatment (35.8% vs 23.1% [P= 0.017]). The most commonly cited reasons for not taking analgesia were 'didn't have any handy' (31.0%), or 'didn't have time' (27.4%). Conclusion: The majority of patients who attend ED with minor injury have not taken analgesia. They come primarily for diagnosis and treatment, and often believe that their condition is too urgent to stay at home and take analgesia. Pain is usually not their main concern. © 2011 The Author. EMA © 2011 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.


Al-Herz F.,Palmerston North Hospital
The New Zealand medical journal | Year: 2012

Oesophagectomy is a complex procedure associated with a significant morbidity and mortality rate. There is very little published data from New Zealand, with no published data from a non-Tertiary New Zealand hospital. We aimed to evaluate the outcomes of oesophagectomy at a single provincial hospital in New Zealand. Retrospective review of clinical records of all patients who underwent oesophagectomy at Palmerston North Hospital (a level II provincial New Zealand public hospital) between 1993 and 2010 was performed. Demographic data, operative details, postoperative recovery parameters, survival data, pathological data, and details of adjuvant treatment were collected. Data from all 68 patients who underwent oesophagectomy were included. Mean age was 63.6 plus or minus 10.9 years, and 69% of patients were male. Mean operating time was 438.37 plus or minus 101.8 min, and mean intraoperative blood loss was 934.5 plus or minus 790.2 ml. Median intensive care unit stay was 7 (1-29) days, and total day stay was 17.5 (4-60) days. Tracheostomy was performed in 20 patients (29.4%). Anastomotic leak occurred in 7 patients (10.3%), chylothorax in 6 patients (8.8%) and cardiopulmonary complications in 34 patients (50.0%). The all cause in-hospital mortality rate was 4.4%. Overall survival at 30 days was 98.5%, at 1 year was 78.3% and at 5 years was 30.3%. Survival outcomes of oesophagectomy in this provincial New Zealand hospital are comparable to published series from national and international tertiary centres.


Losco G.,Palmerston North Hospital | Keedle L.,Palmerston North Hospital | King Q.,Palmerston North Hospital
BJU International | Year: 2013

Objective :To assess whether the penile cuff non-invasive urodynamic test serves as an effective diagnostic tool for predicting outcomes prior to disobstructive surgery for men presenting with voiding lower urinary tract symptoms. Patients with proven urodynamic obstruction do better after surgery. The current gold standard, invasive pressure-flow studies, imposes cost, resource demand, discomfort and inconvenience to patients. Patients and Methods : Patients undergoing surgery for prostatic obstruction at Palmerston North Hospital had pre-operative non-invasive urodynamics and completed an International Prostate Symptom Score (IPSS). Catheterised patients were excluded. • Two months post-operatively they completed a further IPSS score. An improvement of seven or greater was defined as a clinically successful outcome. Results were compared with the outcome predicted by the nomogram supplied with the urodynamic device. Results: Data was obtained for 62 patients with mean age 70 years (range 49 to 86 years; SD 9 years). Follow-up was complete for all patients. Thirty-eight patients underwent transurethral resection and 24 holmium laser enucleation of the prostate.Mean IPSS score was 21 (range 5 to 35; SD 6) pre-operatively and 11 (range 1 to 31; SD 9) post-operatively. Thirty-five patients were predicted obstructed and 27 not obstructed. 94% of those predicted obstructed had a successful outcome (p <0.01). 70% predicted as not obstructed did not have a successful outcome after surgery (p <0.01). Conclusion :The penile cuff test is an exciting adjunct in the decision to proceed to surgery for prostatic obstruction. Patients predicted to be obstructed have an excellent likelihood of a good surgical outcome, yet 30% of those shown not to be obstructed will still do well. Whilst numbers in our study are small, outcomes compare favourably with published results on invasive urodynamic methods. © 2013 BJU International.

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