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Kogarah, Australia

Schembri G.P.,Royal North Shore Hospital | Miller A.E.,Royal North Shore Hospital | Smart R.,St George Hospital
Seminars in Nuclear Medicine | Year: 2010

When considering the investigation of the patient with possible pulmonary embolism, one needs to balance the likelihood of disease and the diagnostic utility of the test against the risks associated with the investigation. Both computed tomography pulmonary angiography (CTPA) and the ventilation/perfusion (V/Q) scan involve exposure to ionizing radiation. The effect of low-level ionizing radiation remains an issue of some controversy. CTPA delivers a greater effective dose and, in particular, greater doses to breast tissue, than the V/Q scan (typically 10-70 mGy for CTPA vs <1.5 mGy for V/Q to breast). Since breast tissue is particularly radiosensitive in younger women, the V/Q study has an advantage over CTPA in this group. In the pregnant patient, fetal exposure has been raised as a concern. In fact, there is typically only low fetal exposure from either study (<1 mGy). The CTPA does deliver less fetal exposure, particularly in the first trimester, but the difference between CTPA and V/Q scan is small when compared with the difference in dose to maternal breast from the 2 investigations. The "as low as reasonably achievable" (ie, ALARA) principle favors the use of V/Q scans in young women, assuming the diagnostic power of the 2 tests is comparable. CTPA requires a contrast injection that can cause adverse reactions in a small number of patients. No significant risk, however, has been demonstrated with the radiopharmaceuticals involved in V/Q scans. © 2010 Published by Elsevier Inc. All rights reserved. Source


Wiseman T.,St George Hospital | Foster K.,University of Sydney | Curtis K.,University of Sydney
Injury | Year: 2013

Aim: To investigate the state of knowledge on the relationship between physical trauma and mental health in patients admitted to hospital with traumatic physical injury. Background: Adults who sustain traumatic physical injury can experience a range of mental health problems related to the injury and subsequent changes in physical health and function. However early screening and identification of mental health problems after traumatic physical injury is inconsistent and not routine during the hospital admission process for the physically injured patient. Methods: Integrative review methods were used. Data were sourced for the period 1995-2010 from EMBASE, CINAHL, MEDLINE and PsycINFO and hand searching of key references. Abstracts were screened by 3 researchers against inclusion/exclusion criteria. Forty-one papers met the inclusion criteria. Data were retrieved, appraised for quality, analysed, and synthesised into 5 main categories. Results: Forty-one primary research papers on the relationship between mental health and traumatic physical injury were reviewed. Studies showed that post-traumatic stress disorder, depression and anxiety were frequent sequelae associated with traumatic physical injury. However, these conditions were poorly identified and treated in the acute hospital phase despite their effect on physical health. Conclusion: There is limited understanding of the experience of traumatic physical injury, particularly in relation to mental health. Greater translation of research findings to practice is needed in order to promote routine screening, early identification and referral to treatment for mental health problems in this patient group. © 2012 Elsevier Ltd. All rights reserved. Source


Craig P.I.,St George Hospital
Digestive Endoscopy | Year: 2012

Aim: To review the published work concerning the role of biliary stenting for chronic pancreatitis-related strictures. Methods: A case study in which multiple plastic stents are used to manage a chronic pancreatitis biliary stricture is presented, and the published work reviewed. Results: There has been a gradual evolution in the endoscopic management of distal biliary strictures secondary to chronic pancreatitis. Most early series used single (usually 10 F) plastic stents for varying time periods. Long-term stricture resolution occurred in only approximately 25% of patients and stent-related complications were high if stent exchanges were not performed routinely every 3-4 months. Recent studies using multiple (≥3) 10 F stents placed sequentially every few months for approximately 12 months have resulted in resolution of biliary strictures in up to 90% of patients. In general, the use of both uncovered and partially covered self-expandable metal stents for biliary strictures due to chronic pancreatitis have been disappointing due to problems with epithelial hyperplasia involving the uncovered portions of the self-expandable metal stents resulting in late stent occlusion and other problems. Similarly, early published data does not at this stage support the routine use of fully covered self-expandable metal stents because of unacceptable stent-related complications. Conclusion: Chronic pancreatitis-related biliary strictures should be managed initially with sequentially-placed multiple 10 F plastic stents for approximately 12 months. © 2012 Japan Gastroenterological Endoscopy Society. Source


Sebaratnam D.F.,St George Hospital | Murrell D.F.,University of New South Wales
Dermatologic Clinics | Year: 2011

Bullous systemic lupus erythematosus (BSLE) is a rare bullous dermatosis in patients with systemic lupus erythematosus. It is characterized by clinical and histologic features, resembling either bullous pemphigoid or dermatitis herpetiformis, and a heterogeneous immunologic profile, characterized by autoimmunity to components of type VII collagen, much like epidermolysis bullosa acquisita. As understanding of the pathology of this interesting dermatologic condition has evolved, so too have criteria and profiling of BSLE. The distinct clinical, histologic, and immunologic features of BSLE represent a unique bullous disease phenotype. © 2011 Elsevier Inc. Source


Intong L.R.A.,St George Hospital | Murrell D.F.,University of New South Wales
Dermatologic Clinics | Year: 2010

The definitive diagnosis of inherited epidermolysis bullosa is best made with positive immunofluorescence antigenic mapping, transmission electron microscopy, and epidermolysis bullosa-related monoclonal antibody studies. However, immunofluorescence microscopy is faster and easier as compared with electron microscopy for subtyping epidermolysis bullosa. The severity of the disease varies with the structural protein involved. A proper diagnosis should be made as soon as possible, and skin biopsies help with diagnosis. This article describes the technique of skin biopsy. © 2010 Elsevier Inc. Source

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