Vincents, Australia
Vincents, Australia

Time filter

Source Type

Brew B.J.,University of New South Wales | Brew B.J.,St Vincents Hospital Sydney | Brew B.J.,St Vincents Center For Applied Medical Research | Chan P.,Queen Elizabeth Hospital
Current Neurology and Neuroscience Reports | Year: 2014

The introduction of combined antiretroviral therapy (cART) has dramatically reduced the risk of central nervous system opportunistic infection and severe dementia secondary to HIV infection in the last two decades. However, a milder form of HIV-associated neurocognitive disorder (HAND) remains prevalent in the cART era and has a significant impact on patients' quality of life. In this review, we outline updated research findings on investigating and monitoring cognitive impairment in HAND patients. The outcomes of recent research on the pathogenesis of HAND and how it overlaps with neurodegenerative diseases are discussed. Lastly, there is a brief discussion of the results of clinical trials using a brain-penetrating cART regimen. © 2014 Springer Science+Business Media.


Gillis J.,Childrens Hospital at Westmead | Tobin B.,St Vincents Hospital Sydney
Pediatric Critical Care Medicine | Year: 2011

Objective: To argue that pediatric intensive care physicians have difficulties in responding to parental questions about prognostic certainty, and that this constitutes a failure in their professional responsibility to parents. Conclusions: These difficulties arise from three sources: 1) the structure and organization of contemporary intensive care, 2) the neglect of prognostication, and 3) the failure to distinguish scientific certainty from practical certainty. It is proposed that an understanding of these issues will enable physicians to respond to the parental question "How certain are you, doctor?" with more authenticity and sincerity. Copyright © 2011 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.


Saxena A.,St Vincents Hospital Sydney | Saxena A.,St George Hospital | Kapoor J.,St George Hospital | Meteling B.,St Vincents Hospital Sydney | And 2 more authors.
Annals of Surgical Oncology | Year: 2014

Introduction. There are a paucity of data on the treatment of unresectable, chemoresistant breast cancer liver metastases (BRCLM) with yttrium-90 (Y90) radioembolization. Methods. Forty patients underwent resin-based Y90 radioembolization for unresectable, chemoresistant BRCLM between 2006 and 2012 in a single institution. All patients were followed up with imaging studies at regular intervals as clinically indicated until death. Radiologic response was evaluated with the Response Criteria in Solid Tumors criteria. Clinical toxicities were prospectively recorded as per the National Cancer Institute Common Toxicity Criteria. Survival was calculated by the Kaplan-Meier method and potential prognostic variables were identified on univariate and multivariate analysis. Results. Follow-up was complete in all patients. The median follow-up was 11.2 (range 0.6-30.5) months and the median survival after Y90 radioembolization was 13.6 months, with a 24-month survival of 39 %. On imaging follow-up of 38 patients who survived beyond 1 month of treatment, a complete response (CR) to treatment was observed in two patients (5 %), partial response (PR) in 10 patients (26 %), stable disease (SD) in 15 patients (39 %), and progressive disease (PD) in 11 patients (29 %). Two factors were associated with an improved survival on multivariate analysis: CR/PR to treatment (vs. SD vs. PD; p < 0.001) and chemotherapy after radioembolization (vs. no chemotherapy; p = 0.004). Sixteen patients (40 %) developed clinical toxicity after treatment; all complications were minor grade I/II and resolved without active intervention. Conclusion. This study provides supportive evidence of the safety and efficacy on Y90 radioembolization for the treatment of unresectable, chemoresistant BRCLM. Further prospective investigation is required to assess the suitability of this treatment in this population. © 2013 Society of Surgical Oncology.


Sewell W.A.,St Vincents Hospital Sydney | Sewell W.A.,University of New South Wales | Sewell W.A.,Garvan Institute of Medical Research | Smith S.A.B.C.,St Vincents Hospital Sydney
Pathology | Year: 2011

Technological advances in flow cytometry include increasingly sophisticated instruments and an expanding range of fluorochromes. These advances are making it possible to detect an increasing number of markers on a single cell. The term polychromatic flow cytometry applies to such systems that detect five or more markers simultaneously. This review provides an overview of the current and future impact of polychromatic flow cytometry in the clinical laboratory. The use of multiple markers has several advantages in the diagnosis and monitoring of haematological malignancies. Cell populations can be analysed more comprehensively and efficiently, and abnormal populations can be distinguished more readily when normal counterparts are present. Polychromatic flow cytometry is particularly useful in the evaluation of plasma cells, and the role of flow cytometry in the assessment of plasma cell disorders is reviewed in depth. There is improved sensitivity in the assessment of small populations, which is critical in the evaluation of minimal residual disease. Flow cytometry can also play a role in assessment of circulating tumour cells in carcinoma. Introduction of polychromatic flow cytometry is a complex process with many challenges including design of antibody panels and instrument compensation. Developments in data analysis are required to realise the full benefits of the other technical advances. Standardisation of protocols may reduce interlaboratory variation. While the complexity of polychromatic flow cytometry creates challenges, it has substantial potential to improve clinical analysis. © 2011 Royal College of Pathologists of Australasia.


Saxena A.,St George Hospital | Bester L.,St Vincents Hospital Sydney | Shan L.,St George Hospital | Perera M.,St George Hospital | 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.


Saxena A.,St Vincents Hospital Sydney | Saxena A.,St George Hospital | Meteling B.,St Vincents Hospital Sydney | Kapoor J.,St George Hospital | And 3 more authors.
Annals of Surgical Oncology | Year: 2015

Introduction: We report the largest series to date on the safety and efficacy of yttrium-90 (90Y) radioembolization for the treatment of unresectable, chemorefractory colorectal cancer liver metastases (CRCLM).Methods: A total of 302 patients underwent resin-based 90Y radioembolization for unresectable, chemorefractory CRCLM between 2006 and 2013 in Sydney, Australia. All patients were followed up with imaging studies at regular intervals until death. Radiologic response was evaluated with the response criteria in solid tumors criteria. Clinical toxicities were prospectively recorded. Survival was calculated by the Kaplan–Meier method, and potential prognostic variables were identified on univariate and multivariate analysis.Results: Median follow-up in the complete cohort was 7.2 months (range 0.2–72.8), and the median survival after 90Y radioembolization was 10.5 months with a 24-month survival of 21 %. On imaging follow-up of 293 patients who were followed up beyond 2 months, complete response to treatment was observed in 2 patients (1 %), partial response in 111 (38 %), stable disease in 96 (33 %), and progressive disease in 84 (29 %). Four factors were independently associated with a poorer prognosis: extensive tumor volume, number of previous lines of chemotherapy, poor radiological response to treatment, and low preoperative hemoglobin. One hundred fifteen (38 %) developed clinical toxicity after treatment; most complications were minor (grade I/II) and resolved without active intervention.Conclusions: 90Y radioembolization is a safe and effective treatment for unresectable, chemorefractory CRCLM. © 2014, Society of Surgical Oncology.


Young A.M.,St Vincents Hospital Sydney
Nuclear Medicine Communications | Year: 2013

INTRODUCTION: Answers to common nuclear medicine radiation safety questions often involve the consideration of dose rates from injected patients and the inverse square law. For staff, lead aprons are available as an option, although they are not routinely used and their effectiveness varies depending on the isotope. New tests and procedures have been introduced at this hospital, including PET and Y microsphere implantation, which have required a review and investigation of their potential impact on staff doses. To answer these questions and to account for the recently introduced technologies and procedures, a study was conducted to measure and demonstrate the level of effectiveness of the department's lead aprons and to simulate patient dose rate measurements and estimations by obtaining measurements from water phantoms filled with these isotopes. MATERIALS AND METHODS: A calibrated survey meter was used to measure dose rates at varying distances from water phantoms filled with Tc, Ga, I, F and Y. Thermoluminescence dosimeters attached to an anthropomorphic phantom with a lead apron were used to assess the effectiveness of the lead aprons available within the department. An uncollimated detector from a gamma camera was used to observe the changes to the energy spectrum in the presence of the lead apron. RESULTS: The results from the dose rate measurements demonstrated an overestimation by the inverse square law at close distances. This overestimation can be in excess of four times the measurements made within this study. The use of a lead apron was shown to reduce doses by varying degrees depending on the isotope used. A 64.5% dose reduction was observed when shielding against Tc with diminishing effectiveness against the remaining isotopes. The results for Y suggest that using a lead apron could result in dose escalation at shallow depths. CONCLUSION: A table of conversion factors, independent of the isotope, was generated for the estimation of dose rates from injected patients at various distances. An isotope-specific conversion table was also generated. The effectiveness of the lead aprons within the department was also successfully measured and assessed and recommendations were passed on to staff regarding their use. © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Teng I.,University of New South Wales | Spigelman A.,St Vincents Hospital Sydney
Familial Cancer | Year: 2014

Genetic testing for susceptibility for common cancers is widely available. Thus, doctors have a role in identifying and referring patients who would benefit from a consultation with a specialist in genetics. This study aims to assess doctors' referral rates, knowledge and attitudes towards cancer genetic testing, broken down by specialty (gastrointestinal, breast/ovarian, other specialties and General Practitioners-GPs). A 4-page questionnaire was mailed out to the GPs of all patients seen in 2012 in the Hereditary Cancer Clinic of St. Vincent's Hospital Sydney (n = 128) and all the specialists in St. Vincent's Hospital Sydney that might refer to the HCC (n = 33). 50 questionnaires were returned (31 %). Most doctors had referred a patient for cancer genetic testing (90 %). The average proportion of patients referred was 1 in 68.5 patients with breast/ovarian specialists referring the most, followed by gastrointestinal specialists and GPs. There was suboptimal knowledge of cancer genetic testing amongst doctors. Breast/ovarian specialists were most knowledgeable, followed by gastrointestinal specialists, other specialists and GPs. There were indications of inappropriate referral amongst doctors. Most (77.6 %) doctors were willing to receive further information on cancer genetics. Nearly all (94 %) doctors believe that it is their duty to inform an individual at high risk for hereditary cancer that cancer genetic counselling and testing is available. The majority of doctors have positive attitudes towards cancer genetic testing. Defective knowledge scores, however, indicate that doctors need further training or tools to enable them to refer patients appropriately for cancer genetic testing. © 2013 Springer Science+Business Media.


Smialkowski A.O.,St Vincents Hospital Sydney | Huilgol R.L.,St Vincents Hospital Sydney | Huilgol R.L.,Wagga Wagga Base Hospital
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.


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.

Loading St Vincents Hospital Sydney collaborators
Loading St Vincents Hospital Sydney collaborators