Princess Alexandria Hospital

Brisbane, Australia

Princess Alexandria Hospital

Brisbane, Australia

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Chadban S.,Royal Prince Alfred Hospital | Eris J.,Royal Prince Alfred Hospital | Russ G.,Royal Adelaide Hospital | Campbell S.,Princess Alexandria Hospital | And 10 more authors.
Nephrology | Year: 2013

Aim Cyclosporine (CsA), dosed to achieve C2 targets, has been shown to provide safe and efficacious immunosuppression when used with a mycophenolate and steroids for de novo kidney transplant recipients. This study examined whether use of enteric-coated mycophenolate sodium (EC-MPS) together with basiliximab and steroids would enable use of CsA dosed to reduced C2 targets in order to achieve improved graft function. Methods Twelve-month, prospective, randomized, open-label trial in de novo kidney transplant recipients in Australia. Seventy-five patients were randomized to receive either usual exposure (n = 33) or reduced exposure (n = 42) CsA, EC-MPS 720 mg twice daily, basiliximab and corticosteroids. Results There was no significant difference in mean Cockcroft-Gault CrCl (creatinine clearance) (60.2 ± 17.6 mL/min per 1.73 m2 vs 63.2 ± 24.3, P = 0.64 for usual versus reduced exposure respectively) at 6 months. There was no significant difference between treatment groups in the incidence of treatment failure defined as biopsy proven acute rejection, graft loss or death (secondary endpoint: 30.3% full exposure vs 35.7% reduced exposure). At 12 months the incidence of overall adverse events was the same in both groups. Conclusion This exploratory study suggests de novo renal transplant patients can safely receive a treatment regimen of either full or reduced exposure CsA in combination with EC-MPS, corticosteroids and basiliximab, with no apparent difference in efficacy or graft function during the first year after transplant. © 2012 The Authors. Nephrology © 2012 Asian Pacific Society of Nephrology.


Johnston C.I.,The University of Notre Dame Australia | O'Leary M.A.,University of Newcastle | Brown S.G.A.,University of Western Australia | Currie B.J.,Royal Darwin Hospital | And 62 more authors.
PLoS Neglected Tropical Diseases | Year: 2012

Background: Death adders (Acanthophis spp) are found in Australia, Papua New Guinea and parts of eastern Indonesia. This study aimed to investigate the clinical syndrome of death adder envenoming and response to antivenom treatment. Methodology/Principal Findings: Definite death adder bites were recruited from the Australian Snakebite Project (ASP) as defined by expert identification or detection of death adder venom in blood. Clinical effects and laboratory results were collected prospectively, including the time course of neurotoxicity and response to treatment. Enzyme immunoassay was used to measure venom concentrations. Twenty nine patients had definite death adder bites; median age 45 yr (5-74 yr); 25 were male. Envenoming occurred in 14 patients. Two further patients had allergic reactions without envenoming, both snake handlers with previous death adder bites. Of 14 envenomed patients, 12 developed neurotoxicity characterised by ptosis (12), diplopia (9), bulbar weakness (7), intercostal muscle weakness (2) and limb weakness (2). Intubation and mechanical ventilation were required for two patients for 17 and 83 hours. The median time to onset of neurotoxicity was 4 hours (0.5-15.5 hr). One patient bitten by a northern death adder developed myotoxicity and one patient only developed systemic symptoms without neurotoxicity. No patient developed venom induced consumption coagulopathy. Antivenom was administered to 13 patients, all receiving one vial initially. The median time for resolution of neurotoxicity post-antivenom was 21 hours (5-168). The median peak venom concentration in 13 envenomed patients with blood samples was 22 ng/mL (4.4-245 ng/mL). In eight patients where post-antivenom bloods were available, no venom was detected after one vial of antivenom. Conclusions/Significance: Death adder envenoming is characterised by neurotoxicity, which is mild in most cases. One vial of death adder antivenom was sufficient to bind all circulating venom. The persistent neurological effects despite antivenom, suggests that neurotoxicity is not reversed by antivenom. © 2012 Johnston et al.


Gingras M.-C.,Baylor College of Medicine | Covington K.R.,Baylor College of Medicine | Chang D.K.,University of Glasgow | Chang D.K.,Royal Infirmary | And 198 more authors.
Cell Reports | Year: 2016

The ampulla of Vater is a complex cellular environment from which adenocarcinomas arise to form a group of histopathologically heterogenous tumors. To evaluate the molecular features of these tumors, 98 ampullary adenocarcinomas were evaluated and compared to 44 distal bile duct and 18 duodenal adenocarcinomas. Genomic analyses revealed mutations in the WNT signaling pathway among half of the patients and in all three adenocarcinomas irrespective of their origin and histological morphology. These tumors were characterized by a high frequency of inactivating mutations of ELF3, a high rate of microsatellite instability, and common focal deletions and amplifications, suggesting common attributes in the molecular pathogenesis are at play in these tumors. The high frequency of WNT pathway activating mutation, coupled with small-molecule inhibitors of β-catenin in clinical trials, suggests future treatment decisions for these patients may be guided by genomic analysis. © 2016 The Authors.


News Article | November 29, 2016
Site: www.prweb.com

AxioMed is pleased to announce the success of the first viscoelastic Freedom cervical case in Australia. Dr. Richard Laherty of Queensland Neurosurgery & Spine Surgery completed the procedure on Monday, November 28th at the Princess Alexandria Hospital in Brisbane, Australia. The procedure was performed on a 47-year-old male patient suffering from degenerative disc disease with radiculopathy, as a result of degenerative cervical discs at levels C5-7. The patient failed conservative treatments prior to undergoing surgery. The AxioMed viscoelastic disc is a next-generation disc replacement that restores natural disc height, lordosis, stability, and motion in the human spine. AxioMed was approved in September to market and sell their viscoelastic cervical and lumbar Freedom total disc replacements in Australia by the Therapeutic Goods Administration. Dr. Richard Laherty spoke to the advantages of the AxioMed cervical disc after the operation: “The Freedom cervical disc is extremely easy to implant and has a great anatomical fit for restoring disc height and lordosis in the cervical spines of my patients. I am excited to have this viscoelastic technology that mimics the natural motion of a healthy human disc, and to make this solution available to my patients. It will provide a faster surgical recovery time and increase a patient’s overall health and satisfaction.” AxioMed CEO Dr. Kingsley Chin explained how an experience like Dr. Laherty’s aligns with AxioMed’s vision: “AxioMed believes it can replicate the success of total joint restoration in the spine with our innovative and advanced viscoelastic total disc replacements with a high degree of patient satisfaction.” Dr. Chin added, “With the addition of the lateral lumbar technique, we expect AxioMed to be the worldwide leader in disc replacement surgery.” Dr. Laherty currently practices general neurosurgery with a special interest in minimally invasive surgical techniques for management of complex spine conditions. Dr. Laherty graduated from University of Queensland and completed postgraduate fellowship training at Princess Alexandra Hospital, Brisbane and St. Vincents and Concorde Hospitals in Sydney. He is extensively involved in both research and training young neurosurgeons in the latest technologies via his roles at both Princess Alexandra Hospital and the University of Queensland. About AxioMed Founded in 2001, AxioMed (http://www.axiomed.com/) began its journey of exhaustively proving the Freedom® Disc through clinical studies in the USA and Europe, research, development and testing. In 2014, KICVentures recognized the disc’s enormous potential and acquired the company into their healthcare portfolio. AxioMed owns an exclusive viscoelastic material license on its proprietary Freedom Disc technology.


Yang L.,University of Queensland | Tan L.,Pindara Private Hospital | Lau Q.,University of Queensland | Jayalath R.,Princess Alexandria Hospital
World Neurosurgery | Year: 2016

Background Pleomorphic adenoma is a benign neoplastic tumor of the salivary gland. Salivary gland tumors in the intracranial cavity are generally restricted to the pituitary gland and sellar region. To our knowledge, there has been only 1 previous case report of a primary central nervous system pleomorphic adenoma outside of the sellar region. In that case report of a posterior fossa pleomorphic adenoma, typical myxochondroid stroma was not identified on histology, and its pathogenesis was not explored. Case Description A 71-year-old woman presented with a 6-week history of occipital headache and unsteadiness. Contrast-enhanced computed tomography and magnetic resonance imaging studies revealed a solitary large posterior fossa tumor in the left cerebellopontine angle measuring 47 × 43 × 45 mm. The tumor resulted in moderate hydrocephalus and significant mass effect with compression of the pons and medulla. She underwent a stereotactic right ventriculoperitoneal shunt insertion followed by a stereotactic craniotomy and complete excision of the tumor. The operation went uneventfully, and the patient had an uncomplicated recovery. Histopathologic examination revealed a benign pleomorphic adenoma (benign salivary gland tumor) with a classic appearance comprising an admixture of ductal epithelial cells, myoepithelial elements, and nodules of myxochondroid stroma. No extracranial source has been identified despite extensive investigation and 8 years of follow-up. Conclusions This case study illustrates a classic primary central nervous system pleomorphic adenoma in an unusual intracranial site. Its pathogenesis is postulated to involve salivary gland heterotopia. © 2016


Campbell K.L.,Princess Alexandria Hospital | Campbell K.L.,University of Queensland | Rossi M.,Princess Alexandria Hospital | Rossi M.,University of Queensland
Renal Society of Australasia Journal | Year: 2014

Dietary modification has long been considered a modifiable risk factor for the progression of chronic kidney disease (CKD) and a key management strategy in end-stage kidney disease. This review will focus on the history of the reoccurring focus on dietary components of salt and protein, as well as the impact of consumer behaviour moving towards convenience foods, on intake of phosphate and sugar in the form of fructose. The latest evidence in CKD supports diets low in sodium, discourages strict diets low in protein and presents a strong case to turn the cycle of eating habits back to basics, in a bid to lower processed food intake and improve the health outcomes of our CKD patients.


Henson A.,Princess Alexandria Hospital
Renal Society of Australasia Journal | Year: 2014

Acute kidney injury associated with multiple myeloma does not resolve with traditional haemodialysis, often resulting in stage five chronic kidney disease and permanent dialysis, which is an additional burden for patients with an uncertain future. The porous membrane of the high cut-off (HCO) haemodialysis filter is showing promising results in reducing levels of free light chains in serum and hence reverting acute kidney injury. This article focusses on the HCO haemodialysis treatment from a nursing perspective, outlining treatment frequency, anticoagulant and dialysate changes and the instigation of cytotoxic precautions. Experience gained with HCO filters has resulted in a protocol maximising patient safety and ensuring consistency in practice.


Butterfield R.,Liverpool Hospital | Stedman W.,Princess Alexandria Hospital | Herod R.,Liverpool Hospital | Aneman A.,Liverpool Hospital | Aneman A.,University of New South Wales
Anaesthesia and Intensive Care | Year: 2015

Surgery for upper gastrointestinal malignancy carries a high postoperative mortality and morbidity risk. The importance of preoperative physiological reserve and intraoperative events in determining clinical outcomes is recognised in the Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) score that comprises variables relevant to both phases. Whether adding variables linked to ICU admission characteristics improves the predictive capacity of POSSUM is unclear, especially in an Australian/New Zealand healthcare context. This study aimed to evaluate the predictive capacity of the POSSUM score for 30-day mortality and in-hospital morbidity in 80 patients undergoing resection of oesophageal (28%), gastric (26%) or pancreatic (46%) malignancies and admitted to ICU. The 30-day mortality was 8.8% and 65% of patients developed some postoperative complication. Receiver operating characteristics generated an area under the curve (95% CI) to predict mortality by Portsmouth POSSUM of 0.87 (0.77 to 0.93) and morbidity by POSSUM of 0.67 (0.55 to 0.77). Multiple regression analysis including biochemical variables and vital signs on admission to ICU identified renal function parameters, fluid balance and need for cardiorespiratory support beyond the first postoperative day as independent factors associated with mortality and morbidity (in addition to the POSSUM score) but the inclusion of these variables in a logistic regression model did not significantly improve the predictive capacity for mortality (to area under the curve 0.93 [0.85 to 0.97]) or morbidity (to area under the curve 0.67 [0.55 to 0.78]). In conclusion, the POSSUM score provides clinically useful predictive capacity in patients undergoing surgery for upper gastrointestinal malignancies. The incorporation of ICU admission variables to the pre- and intraoperative POSSUM variables did not significantly enhance the precision.


PubMed | Princess Alexandria Hospital, Liverpool Hospital and University of New South Wales
Type: Journal Article | Journal: Anaesthesia and intensive care | Year: 2015

Surgery for upper gastrointestinal malignancy carries a high postoperative mortality and morbidity risk. The importance of preoperative physiological reserve and intraoperative events in determining clinical outcomes is recognised in the Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) score that comprises variables relevant to both phases. Whether adding variables linked to ICU admission characteristics improves the predictive capacity of POSSUM is unclear, especially in an Australian/New Zealand healthcare context. This study aimed to evaluate the predictive capacity of the POSSUM score for 30-day mortality and in-hospital morbidity in 80 patients undergoing resection of oesophageal (28%), gastric (26%) or pancreatic (46%) malignancies and admitted to ICU. The 30-day mortality was 8.8% and 65% of patients developed some postoperative complication. Receiver operating characteristics generated an area under the curve (95% CI) to predict mortality by Portsmouth POSSUM of 0.87 (0.77 to 0.93) and morbidity by POSSUM of 0.67 (0.55 to 0.77). Multiple regression analysis including biochemical variables and vital signs on admission to ICU identified renal function parameters, fluid balance and need for cardiorespiratory support beyond the first postoperative day as independent factors associated with mortality and morbidity (in addition to the POSSUM score) but the inclusion of these variables in a logistic regression model did not significantly improve the predictive capacity for mortality (to area under the curve 0.93 [0.85 to 0.97]) or morbidity (to area under the curve 0.67 [0.55 to 0.78]). In conclusion, the POSSUM score provides clinically useful predictive capacity in patients undergoing surgery for upper gastrointestinal malignancies. The incorporation of ICU admission variables to the pre- and intraoperative POSSUM variables did not significantly enhance the precision.

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