Prince of Wales HospitalNSW

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Prince of Wales HospitalNSW

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Watt S.C.,Liverpool and Macarthur Cancer Therapy CentresNSW | Watt S.C.,University of Sydney | Watt S.C.,Ingham Institute for Applied Medical Research | Vinod S.K.,Liverpool and Macarthur Cancer Therapy CentresNSW | And 14 more authors.
Medical Dosimetry | Year: 2016

Target volume matching using cone-beam computed tomography (CBCT) is the preferred treatment verification method for lung cancer in many centers. However, radiation therapists (RTs) are trained in bony matching and not soft tissue matching. The purpose of this study was to determine whether RTs were equivalent to radiation oncologists (ROs) and radiologists (RDs) in alignment of the treatment CBCT with the gross tumor volume (GTV) defined at planning and in delineating the GTV on the treatment CBCT, as may be necessary for adaptive radiotherapy. In this study, 10 RTs, 1 RO, and 1 RD performed a manual tumor alignment and correction of the planning GTV to a treatment CBCT to generate an isocenter correction distance for 15 patient data sets. Participants also contoured the GTV on the same data sets. The isocenter correction distance and the contoured GTVs from the RTs were compared with the RD and RO. The mean difference in isocenter correction distances was 0.40 cm between the RO and RD, 0.51 cm between the RTs, and RO and 0.42 cm between the RTs and RD. The 95% CIs were smaller than the equivalence limit of 0.5 cm, indicating that the RTs were equivalent to the RO and RD. For GTV delineation comparisons, the RTs were not found to be equivalent to the RD or RO. The alignment of the planning defined GTV and treatment CBCT using soft tissue matching by the RTs has been shown to be equivalent to those by the RO and RD. However, tumor delineation by the RTs on the treatment CBCT was not equivalent to that of the RO and RD. Thus, it may be appropriate for RTs to undertake soft tissue alignment based on CBCT; however, further investigation may be necessary before RTs undertake delineation for adaptive radiotherapy purposes. © 2016 American Association of Medical Dosimetrists.


Gooden H.,University of Sydney | Tiller K.,Prince of Wales HospitalNSW | Mumford J.,Australasian Gastro Intestinal Trials Group | White K.,University of Sydney
Cancer Forum | Year: 2016

Pancreatic cancer is acknowledged as one of the most challenging diseases in the 21st century. Despite the recent focus on research and novel therapies, by 2030 pancreatic cancer is projected to be the second leading cause of cancer death after lung cancer. With incidence and mortality rising against the trend in other cancers, the importance of a whole team approach to achieve best quality of life and care is critical. Recent Australian research has reported significant unmet needs for psychosocial and supportive care for people affected by pancreatic cancer. Nihilism has been identified as a problem in pancreatic cancer that affects clinicians, patients, carers and families. This can lead to loss of hope and people becoming disengaged from care, resulting in increased distress, poor quality of life and signs of demoralisation. Meaning-centred therapies can help with reducing demoralisation, improving existential wellbeing, increasing dignity and legacy building. Effective interventions can ease the existential distress that is often experienced at end of life and help family members during the grieving process. Essential in providing optimal care for patients and caregivers is timely and appropriate discussions about the importance of palliative care in managing symptoms and improving quality of life. Early integration of psychosocial and supportive care is recommended to achieve best quality of life and relieve suffering.


Espinoza A.,University of Wollongong | Petasecca M.,University of Wollongong | Fuduli I.,University of Wollongong | Howie A.,St George Hospital Cancer Care CentreNSW | And 5 more authors.
Medical Physics | Year: 2015

Purpose: High dose rate (HDR) brachytherapy is a treatment method that is used increasingly worldwide. The development of a sound quality assurance program for the verification of treatment deliveries can be challenging due to the high source activity utilized and the need for precise measurements of dwell positions and times. This paper describes the application of a novel phantom, based on a 2D 11×11 diode array detection system, named magic phantom (MPh), to accurately measure plan dwell positions and times, compare them directly to the treatment plan, determine errors in treatment delivery, and calculate absorbed dose. Methods: The magic phantom system was CT scanned and a 20 catheter plan was generated to simulate a nonspecific treatment scenario. This plan was delivered to the MPh and, using a custom developed software suite, the dwell positions and times were measured and compared to the plan. The original plan was also modified, with changes not disclosed to the primary authors, and measured again using the device and software to determine the modifications. A new metric, the positiontime gamma index, was developed to quantify the quality of a treatment delivery when compared to the treatment plan. The MPh was evaluated to determine the minimum measurable dwell time and step size. The incorporation of the TG-43U1 formalism directly into the software allows for dose calculations to be made based on the measured plan. The estimated dose distributions calculated by the software were compared to the treatment plan and to calibrated EBT3 film, using the 2D gamma analysis method. Results: For the original plan, the magic phantom system was capable of measuring all dwell points and dwell times and the majority were found to be within 0.93 mm and 0.25 s, respectively, from the plan. By measuring the altered plan and comparing it to the unmodified treatment plan, the use of the positiontime gamma index showed that all modifications made could be readily detected. The MPh was able to measure dwell times down to 0.067±0.001 s and planned dwell positions separated by 1 mm. The dose calculation carried out by the MPh software was found to be in agreement with values calculated by the treatment planning system within 0.75%. Using the 2D gamma index, the dose map of the MPh plane and measured EBT3 were found to have a pass rate of over 95% when compared to the original plan. Conclusions: The application of this magic phantom quality assurance system to HDR brachytherapy has demonstrated promising ability to perform the verification of treatment plans, based upon the measured dwell positions and times. The introduction of the quantitative positiontime gamma index allows for direct comparison of measured parameters against the plan and could be used prior to patient treatment to ensure accurate delivery. © 2015 American Association of Physicists in Medicine.


De Sousa S.M.C.,Garvan Institute of Medical Research | De Sousa S.M.C.,Garvan Institute of ResearchNSW | Haghighi K.S.,St Vincents Hospital | Haghighi K.S.,Prince of Wales HospitalNSW | And 5 more authors.
Pancreas | Year: 2016

Herein, we report the first case of concomitant nesidioblastosis, pancreatic neuroendocrine tumor, and intraductal papillary mucinous neoplasia. The combination is significant as each of these pathological entities is independently very rare. The patient was a 33-year-old man who presented with symptomatic hyperinsulinemic hypoglycemia and no risk factors for pancreatic disease. Abdominal imaging showed an isolated 12 mm pancreatic lesion, whilst selective arterial calcium stimulation testing demonstrated multiple territories of insulin excess. He proceeded to subtotal pancreatectomy. Histopathology revealed an endocrine microadenoma, α and β cell nesidioblastosis, and multifocal intraductal papillary mucinous neoplasia. The endocrine microadenoma and nesidioblastosis stained for insulin, suggesting both likely contributed to hypoglycemia. Glucagon immunohistochemistry was also positive, though there were no clinical features of glucagon excess. Hypoglycemia resolved postoperatively. This case and other evidence from the literature suggest that hyperplasia and neoplasia may occur sequentially in the pancreas, and that endocrine and exocrine tumorigenesis may be linked in some individuals. Further study is required to identify a unifying mechanism, and to elucidate potential ramifications in the management of patients with pancreatic neoplasms. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.


Gunasingam N.,St Vincents Hospital | Perczuk A.,Prince of Wales HospitalNSW | Talbot M.,St George Hospital | Kaffes A.,Royal Prince Alfred Hospital | Saxena P.,Royal Prince Alfred Hospital
Journal of Gastroenterology and Hepatology (Australia) | Year: 2016

Achalasia is a primary esophageal motility disorder. It is the absence of peristalsis in the esophageal body and inability of the lower esophageal sphincter to relax, which characterizes this rare condition. Its features typically include dysphagia, regurgitation, chest pain, and weight loss. The ultimate goal in treating achalasia is to relieve the patient's symptoms, improve esophageal emptying, and prevent further dilatation of the esophagus. Current treatment modalities targeted at achalasia include pharmacological therapy, endoscopic therapy, and surgery. This review focuses on the current therapeutic options and explores the role of peroral endoscopic myotomy in the management armamentarium. © 2016 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd


Buckley C.,Queensland Childrens Medical Research Institute | Buckley C.,University of Queensland | Trembizki E.,Queensland Childrens Medical Research Institute | Trembizki E.,University of Queensland | And 16 more authors.
Journal of Antimicrobial Chemotherapy | Year: 2016

Objectives: The objective of this study was to develop a real-time PCR method for specific detection of the gonococcal GyrA amino acid 91 locus directly in clinical samples so as to predict Neisseria gonorrhoeae ciprofloxacin susceptibility. Methods: The real-time PCR assay, GyrA91-PCR, was designed using two probes, one for detection of the WT S91 sequence and the other for detection of the S91F alteration. The performance of the assay was initially assessed using characterized N. gonorrhoeae isolates (n = 70), a panel of commensal Neisseria and Moraxella species (n = 55 isolates) and clinical samples providing negative results by a commercial N. gonorrhoeae nucleic acid amplification test (NAAT) method (n = 171). The GyrA91-PCR was then applied directly to N. gonorrhoeae NAAT-positive clinical samples (n = 210) from the year 2014 for which corresponding N. gonorrhoeae isolates with susceptibility results were also available. Results: The GyrA91-PCR accurately characterized the GyrA 91 locus of all 70 N. gonorrhoeae isolates (sensitivity = 100%, 95% CI = 94.9%-100%), whereas all non-gonococcal isolates and N. gonorrhoeae NAAT-negative clinical samples gave negative results by the GyrA91-PCR (specificity = 100%, 95% CI = 98.4%-100%). When applied to the 210 N. gonorrhoeae NAAT-positive clinical samples, the GyrA91-PCR successfully characterized 195 samples (92.9%, 95% CI = 88.5%-95.9%). When compared with the corresponding bacterial culture results, positivity by the GyrA91-PCR WT probe correctly predicted N. gonorrhoeae susceptibility to ciprofloxacin in 161 of 162 (99.4%, 95% CI = 96.6%-99.9%) samples. Conclusions: The use of a PCR assay for detection of mutation in gyrA applied directly to clinical samples can predict ciprofloxacin susceptibility in N. gonorrhoeae. © The Author 2015. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.


Knopman A.A.,Macquarie University | Knopman A.A.,Westmead HospitalNSW | Wong C.H.,University of Sydney | Wong C.H.,Westmead Hospital and The Childrens Hospital at WestmeadNSW | And 14 more authors.
Epilepsy and Behavior | Year: 2015

We examined the relationship between baseline neuropsychological functioning and 18-fluorodeoxyglucose positron emission tomography (FDG-PET) in intractable mesial temporal lobe epilepsy (MTLE). We hypothesized relationships between dominant temporal lobe hypometabolism and verbal memory and between nondominant temporal lobe hypometabolism and nonverbal memory in line with the lateralized material-specific model of memory deficits in MTLE. We also hypothesized an association between performance on frontal lobe neuropsychological tests and prefrontal hypometabolism. Thirty-two patients who had undergone temporal lobectomy for treatment of MTLE and who completed both presurgical FDG-PET and comprehensive neuropsychological investigations with widely used standardized measures were included. Age-adjusted composite measures were calculated for verbal memory, nonverbal memory, relative material-specific memory, IQ, executive function, attention/working memory, and psychomotor speed. Fluorodeoxyglucose positron emission tomography was analyzed with statistical parametric mapping (SPM) to identify hypometabolism relative to healthy controls. Pearson's correlation was used to determine the relationship between regions of hypometabolism and neuropsychological functioning. Dominant temporal lobe hypometabolism was associated with relatively inferior verbal memory, while nondominant temporal lobe hypometabolism was associated with inferior nonverbal memory. No relationship was found between performance on any frontal lobe measures and prefrontal hypometabolism. Statistical parametric mapping-quantified lateralized temporal lobe hypometabolism correlates with material-specific episodic memory impairment in MTLE. In contrast, prefrontal hypometabolism is not associated with performance on frontal lobe measures. We suggest that this is because frontal lobe neuropsychology tests may not be good measures of isolated frontal lobe functioning. © 2015 Elsevier Inc.


Waggel S.E.,George Washington University | Lipnicki D.M.,Center for Healthy Brain Ageing | Delbaere K.,Falls and Balance Research Group | Kochan N.A.,Center for Healthy Brain Ageing | And 11 more authors.
International Journal of Geriatric Psychiatry | Year: 2015

Objective Neuroticism has been reported as both a risk factor for cognitive decline and a characteristic that increases in parallel with the development of mild cognitive impairment (MCI) and dementia. However, the evidence for these associations is inconclusive, and whether effects are stronger for particular cognitive domains is unknown. We investigated these issues and determined if associations differ among different components of neuroticism. Methods A neuroticism scale (NEO-FFI) and neuropsychological test battery were administered to 603 older adults without dementia, with 493 of these reassessed two years later. Diagnoses of MCI and dementia (at follow-up) were made, and global cognition and performance in six cognitive domains quantified. The neuroticism components were negative affect, self-reproach, and proneness to psychological distress. Results For the whole sample, neuroticism scores remained stable between baseline (15.3±7.0) and follow-up (15.5±7.0), as did all neuroticism component scores. However, there were declines in global cognition (p<0.05) and particular cognitive domains (p<0.001). Higher neuroticism was associated with poorer cognition cross-sectionally (p<0.01), but did not predict cognitive decline. For 43 participants who developed incident MCI or dementia, there were increases in neuroticism (15.3±6.4 to 17.1±8.3, p<0.05) and negative affect (p<0.05). Declines in all cognitive measures except executive function were associated with increases in neuroticism and component scores (p<0.05). Conclusions Late-life cognitive decline is associated with an increase in neuroticism scores. However, associations vary between different cognitive domains and components of neuroticism. An increase in neuroticism or negative affect scores may be a sign of MCI or dementia. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.


Padmanabhan S.,Prince of Wales HospitalNSW | Wagstaff A.,Prince of Wales HospitalNSW | Tung V.,Prince of Wales HospitalNSW | Tung V.,University of New South Wales | And 5 more authors.
Diabetes Research and Clinical Practice | Year: 2014

We recorded gestational weight gain (GWG) and change in body mass index (BMI) at 28 weeks gestation in 343 vs. 339 women with and without gestational diabetes (GDM). GDM was associated with a greater increment in BMI, but not with increased GWG in kilograms. © 2014.


Lavee O.,Prince of Wales HospitalNSW | Kidson-Gerber G.,Prince of Wales HospitalNSW
Obstetric Medicine | Year: 2015

Inherited bleeding disorders have the potential to cause bleeding complications during pregnancy, childbirth and the postpartum period as well as effect fetal outcomes. There is an evolving understanding of the need for specialised and individualised care for affected women during these times. The aim for each patient is to estimate the risk to mother, fetus and neonate; to implement measures to minimise these risks; and to anticipate complications and develop contingencies for these scenarios. This includes accurate diagnosis, preconceptual care, prenatal diagnostic options, antenatal care, delivery and postpartum care as well as care of an affected neonate. An understanding of the physiologic haemostatic changes associated with pregnancy as well as the scope of defects, inheritance and management of inherited bleeding disorders is paramount when caring for these women. Collaborative and prospective management in conjunction with haematology services underpins the approach advocated. This review draws on the available literature, and outlines the principles of care for women with inherited bleeding disorders before, during and after pregnancy, as well as their babies, based on both available data and collective clinical experience. © 2016, © The Author(s) 2016.

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