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Vincents, Australia

Haar K.,University of Sydney | Haar K.,Robert Koch Institute | Romani L.,University of New South Wales | Filimone R.,Ministry of Health | And 7 more authors.
International Journal of Dermatology | Year: 2014

Background: Scabies has been estimated to affect approximately 300 million people worldwide each year. Scabies rates are high and pose a significant public health problem in Fiji. Community-based comparison treatment trials have not been undertaken. We estimated scabies prevalence and compared the efficacy and tolerability of mass drug administration (MDA) of benzyl benzoate lotion (BB) or oral ivermectin (IVM) in two villages in Fiji. Methods: A prospective MDA trial was undertaken in two Fijian villages, comparing three daily applications of BB with single dose IVM or permethrin cream for those aged under two years. The therapies were offered to all community members regardless of the presence of scabies or its symptoms. The difference in prevalence was measured before and after the intervention and absolute risk reduction (ARR) and relative risk (RR) calculated. Results: In the BB group, there were 572 eligible participants, of whom 435 (76%) enrolled and 201 (46%) returned for follow-up. In the IVM group, there were 667 eligible participants, of whom 325 (49%) enrolled and 126 (39%) returned. Scabies prevalence was lower after the intervention in both groups. It fell from 37.9 to 20.0% (ARR 18.0%; RR 0.52) in the BB group and from 23.7 to 9.5% (ARR 14.2%; RR 0.40) in the IVM group. Conclusions: Our study provides proof of principle that MDA for scabies can reduce scabies prevalence at the community level, and that there was no significant difference in this trial between BB and oral IVM. © 2013 The Authors. Source

Chia P.-L.,St Vincents Hospital Sydney | Subbiah R.N.,St Vincents Hospital Sydney | Subbiah R.N.,University of New South Wales | Kuchar D.,St Vincents Hospital Sydney | Walker B.,St Vincents Hospital Sydney
Heart Lung and Circulation | Year: 2012

We present a case of ventricular tachycardia with clinical features suggestive of arrhythmogenic right ventricular cardiomyopathy. However, endomyocardial biopsy revealed non-caseating granulomas diagnostic of cardiac sarcoidosis. © 2011 Australasian Society of Cardiac and Thoracic Surgeons and the Cardiac Society of Australia and New Zealand. Source

Stoita A.,St Vincents Hospital Sydney | Earls P.,St. Vincents Hospital | Williams D.,St Vincents Hospital Sydney
ANZ Journal of Surgery | Year: 2010

Background: Solid pseudopapillary tumour (SPT) is a rare tumour of the pancreas with low malignant potential affecting mainly young women difficult to diagnose preoperatively. The aim of this study is to describe the endoscopic ultrasound (EUS) features and utility of EUS-guided fine needle aspiration (FNA) in diagnosing these tumours. Methods: A retrospective analysis of SPTs identified in a tertiary institution EUS database between April 2002 and April 2009 was performed. Medical records, imaging, EUS features, cytology and histology specimens were reviewed. Patients were followed up until April 2009. Results: Seven cases of SPTs were indentified out of 2400 EUS performed. All patients were females with a mean age of 41 years (range 22-69). The tumours were solitary with a mean diameter of 2.9 cm (range 2-4.3 cm). Five tumours were located in the body and tail of the pancreas and two in the neck. All lesions were hypoechoic, heterogenous and well circumscribed, with five having a cystic component and two having a calcified rim. FNA using a 22-gauge needle was performed in six cases with no complications. A preoperative diagnosis of SPT based on cytology was obtained in 5/6 cases (83%). Surgical resection was done in six cases with confirmation of SPT and no metastatic disease. Conclusion: EUS-guided FNA is a minimally invasive, safe and reliable way of diagnosing SPT by providing characteristic cytological specimens. Definitive preoperative diagnosis leads to targeted and minimally invasive surgical resection. © 2010 Royal Australasian College of Surgeons. Source

Saxena A.,University of New South Wales | Bester L.,St Vincents Hospital Sydney | Shan L.,University of New South Wales | Perera M.,University of New South Wales | And 3 more authors.
Journal of Cancer Research and Clinical Oncology | Year: 2014

Introduction: The management of unresectable, chemorefractory colorectal cancer liver metastases (CRCLM) is a clinical dilemma. Yttrium-90 (Y90) radioembolization is a potentially safe and effective treatment for patients with CRCLM who have failed conventional chemotherapy regimens. Methods: A systematic review of clinical studies before November 2012 was performed to examine the radiological response, overall survival and progression-free survival of patients who underwent Y90 radioembolization of unresectable CRCLM refractory to systemic therapy. The secondary objectives were to evaluate the safety profile of this treatment and identify prognostic factors for overall survival. Results: Twenty studies comprising 979 patients were examined. Patients had failed a median of 3 lines of chemotherapy (range 2-5). After treatment, the average reported value of patients with complete radiological response, partial response and stable disease was 0 % (range 0-6 %), 31 % (range 0-73 %) and 40.5 % (range 17-76 %), respectively. The median time to intra-hepatic progression was 9 months (range 6-16). The median overall survival was 12 months (range 8.3-36). The overall acute toxicity rate ranged from 11 to 100 % (median 40.5 %). Most cases of acute toxicity were mild (Grade I or II) (median 39 %; range 7-100 %) which resolved without intervention. The number of previous lines of chemotherapy (≥3), poor radiological response to treatment, extra-hepatic disease and extensive liver disease (≥25 %) were the factors most commonly associated with poorer overall survival. Conclusion: Y90 radioembolization is a safe and effective treatment of CRCLM in the salvage setting and should be more widely utilized. © 2013 Springer-Verlag. Source

Smialkowski A.O.,St Vincents Hospital Sydney | Huilgol R.L.,St Vincents Hospital Sydney
Annals of Vascular Surgery | Year: 2014

Background To evaluate percutaneous endovascular repair of popliteal artery aneurysms (PAAs) using self-expanding covered stent grafts. Methods A retrospective record review of consecutive patients who underwent percutaneous endovascular PAA repair across 2 Australian centers between April 2009 and May 2012 was performed. Results We report 16 patients (mean age: 77.3; 93% men) with PAA in 20 limbs who underwent percutaneous endovascular repair using self-expanding covered stent grafts. The mean aneurysm diameter was 3 cm (range: 2-5.1 cm). Ultrasound-guided percutaneous antegrade access was used in all cases: 16 superficial femoral artery punctures and 4 common femoral artery punctures. The mean number of runoff vessels per limb was 1.84 (42%, 1 vessel; 32%, 2 vessels; and 26%, 3 vessels). Technical success was 100%. A mean number of 1.82 stents were deployed in each limb (range: 1-3). The mean stent diameter was 8.84 (range: 6-13). The median follow-up time was 12 months (range: 0-24 months). Primary patency of 85% and secondary patency of 90% were achieved in our study. The limb loss and mortality rate were 5% both in a patient with an undiagnosed prothrombotic condition. Puncture site complications were seen in 1 patient (5%) who had a bleeding diathesis. Conclusions Percutaneous endovascular repair of PAA using self-expanding stent grafts can be safely performed and achieved good results achieved in most patients. © 2014 Elsevier Inc. All rights reserved. Source

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