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Abeysuriya S.D.,Queen Elizabeth Medical Center
Communicable diseases intelligence | Year: 2010

A 4-year-old fully immunised male presented to a regional hospital in the West Kimberley with fever and lethargy. Blood cultures yielded serogroup B Neisseria meningitidis, resistant to benzylpenicillin (minimum inhibitory concentration (MIC) 1.0 mg/L). The patient was treated with intravenous ceftriaxone and made a complete recovery. Although invasive N. meningitidis isolates with reduced penicillin susceptibility are not uncommon in Australia, this is the first report of a benzylpenicillin-resistant isolate (MIC > 0.5 mg/L) causing invasive disease. As benzylpenicillin is currently recommended as first line empiric and definitive therapy for invasive meningococcal disease, the emergence of penicillin-resistant N. meningitidis disease is of concern and emphasises the importance of ongoing surveillance for antimicrobial resistance. Source


Shaw R.J.,University of Liverpool | Dhanda J.,Queen Elizabeth Medical Center
British Journal of Oral and Maxillofacial Surgery | Year: 2011

Osteoradionecrosis (ORN) is a serious condition following treatment for head and neck cancer with serious associated morbidity and mortality. While the use of hyperbaric oxygen (HBO) in treating established osteoradionecrosis has been standard practice in many units for years, the evidence base for this remains remarkably weak. The published evidence has been made even more controversial by trial protocols that do not use HBO as it is generally advocated. This review describes the classification, incidence, and treatment of ORN, and explores the available published evidence with particular emphasis on randomised trials of treatment with HBO. © 2010 The British Association of Oral and Maxillofacial Surgeons. Source


Lo W.B.,Queen Elizabeth Medical Center | Ellis H.,Guys
Neurosurgery | Year: 2010

The circle of Willis is one of the most famous eponymous structures in human anatomy. There is no doubt Thomas Willis at Oxford accurately demonstrated the anastomotic arterial supply at the base of the brain. However, this eponymous name does not reveal the history of the discovery of the ramification, nor does it give credit to the anatomists and artists who have contributed to the understanding of this clinically important structure. This article first traces the story of the discovery of the circle of Willis. Willis's contribution and innovative approaches are then discussed. Finally, despite Willis's not being the first to describe the circle, we explain why he still deserves to retain the eponymous title. The earlier description of the vasculature at the base of the brain was fixated on a nonexistent structure, at least not in humans, named the rete mirabile. The more scientific study of the blood supply to the brain took place during the Renaissance period, which culminated in the work of Thomas Willis in the 17th century. Copyright © 2010 by the Congress of Neurological Surgeons. Source


Pateria P.,Western Australian Liver Transplant Service | De Boer B.,University of Western Australia | De Boer B.,Queen Elizabeth Medical Center | MacQuillan G.,University of Western Australia
Best Practice and Research: Clinical Gastroenterology | Year: 2013

Drug and substance abuse remains a major medical problem. Alcohol use, abuse and dependence are highly prevalent conditions. Alcohol related liver disease can present as simple steatosis, steatohepatitis, alcoholic hepatitis or liver cirrhosis. Paracetamol hepatotoxicity secondary to accidental or deliberate overdose is another common problem. While the adverse cardiovascular, neurological, renal and psychiatric consequences of various illicit substance abuses are widely studied and publicized, less attention has been directed towards possible hepatotoxic effects. Illicit drug abuse can cause a range of liver abnormalities ranging from asymptomatic derangement of liver function tests to fulminant hepatic failure. This article reviews the epidemiology, risk factors, clinical manifestations, pathogenesis, investigations, management and prognostic factors of alcohol related liver disease and paracetamol hepatotoxicity as well as the current knowledge pertaining to hepatotoxicity of the more commonly used illicit substances including cannabis, amphetamine type stimulants, cocaine, khat chewing and complementary and alternate medicine. © 2013 Published by Elsevier Ltd. All rights reserved. Source


Knight D.R.,University of Western Australia | Riley T.V.,University of Western Australia | Riley T.V.,Queen Elizabeth Medical Center
Applied and Environmental Microbiology | Year: 2013

Recently, Clostridium difficile has been isolated from a wide variety of animals, particularly production animals, mainly cattle and pigs. Concurrently, the incidence of C. difficile infection (CDI) in humans has increased in the community, with some suggestions that food-borne transmission of C. difficile is occurring. Interestingly, sheep and lambs appear not to have been investigated for carriage/ colonization with C. difficile. The aim of this project was to determine the prevalence of carriage of C. difficile in sheep and lambs in Australia by culturing fecal samples. A total of 371 sheep and lamb fecal samples were received in seven batches from three different geographic areas in eastern Australia and two in Western Australia. The overall rate of detection in sheep and lambs was low (4.0%); however, carriage/colonization in lambs (6.5%) was statistically significantly higher than that in sheep (0.6%) (P=0.005). Seven distinct PCR ribotype patterns were observed, three of which were known international ribotypes (UK 056 [n=1],UK101 [n=6], and UK137 [n=2]), while the remainder were unable to be matched with our available reference library. This low rate of carriage/colonization in Australian ovines suggests they are unlikely to be a major source/reservoir of human infections. © 2013, American Society for Microbiology. Source

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