New Plymouth, New Zealand
New Plymouth, New Zealand

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PubMed | Auckland City Hospital, Taranaki Base Hospital and Waikato Hospital
Type: Journal Article | Journal: Injury | Year: 2016

Plain radiographs still play a role in management of extraarticular scapular neck fractures. Glenopolar angle (GPA) is one of the radiograph measurements that is used to determine the necessity for surgery. Our aim was to establish reliability of GPA on plain radiograph in patients with extraarticular scapular neck fractures.We performed a multicentre retrospective study including all patients with extraarticular scapular neck fractures with available imaging between 2006 and 2012. We excluded intra-articular glenoid fractures, scapular blade fractures, acromion fractures, and scapular spine fractures. We compared GPA on plain radiograph with three dimensional computed tomography (3D CT) measurement, as well as contribution of radiograph rotational error, glenoid inclination, and medial shortening of glenoid fragment towards GPA measurement.One hundred patients met the inclusion criteria. The mean difference between the GPA measurements on radiographs and 3D CT was 6.10.85 (95% confidence interval) as an absolute value. In terms of contribution to GPA values, GPA changed by one degree with ten degrees of radiograph rotational error, three degrees of glenoid inclination, and three millimetres of glenoid fragment medial shortening.Plain radiograph can provide a clinician with a reasonable estimation of the GPA. Glenoid inclination has a greater influence on GPA compared to medial shortening.


Richmond B.I.,Taranaki Base Hospital | Richmond B.I.,Middlemore Hospital | Hadlow S.V.,Taranaki Base Hospital | Lynskey T.G.,Taranaki Base Hospital | And 2 more authors.
Clinical Orthopaedics and Related Research | Year: 2013

Background: Bone mineral density (BMD) in the proximal tibia decreases after TKA and is believed to be a factor in implant migration and loosening. Unicompartmental knee arthroplasty (UKA) is a less invasive procedure preserving knee compartments unaffected by degeneration. Finite element studies have suggested UKA may preserve BMD and that implants of differing stiffnesses might differentially affect BMD but these notions have not been clinically confirmed. Questions/purposes: We therefore asked whether (1) proximal tibial BMD decreases after UKA, and (2) a cemented metal tibial component with a mobile polyethylene (PE) bearing would have greater BMD loss than a cemented PE tibial component. Methods: We prospectively followed 48 patients who underwent 50 UKAs using one of two implants: one with a cemented metal tibial baseplate and a mobile PE insert (n = 26) and one with a cemented all-PE tibial component (n = 24). In followup we assessed pain and function (Oxford Knee Score, SF-12, The Knee Society Score©) and radiographs. BMD changes were assessed using quantitative CT osteodensitometry performed postoperatively and at 1 and 2 years after the index procedure. Results: Mean cancellous BMD decreased 1.9% on the medial side and 1.1% on the lateral side. Mean cortical BMD was static, decreasing 0.4% on the medial side and increasing 0.5% on the lateral side. The greatest observed difference between implants for any region was 3.7%. There were no differences in pain or functional outcome scores. Conclusions: BMD was preserved 2 years after UKA with no major differences seen between implant types. © 2013 The Association of Bone and Joint Surgeons®.


Pandit S.,Taranaki Base Hospital | Frampton C.,Otago Medical School | Stoddart J.,Taranaki Base Hospital | Lynskey T.,Taranaki Base Hospital
International Orthopaedics | Year: 2011

Purpose: The aim of this study was to report normal values of the tibial tuberosity-trochlear groove distance (TTTG) in males and females and assess the reliability of MRI in measuring TTTG. Methods: Patients presenting with a suspected meniscus injury without any patellofemoral or ligamentous instability, and arthroscopically normal cruciate ligaments and patellofemoral joints were included in the study. K-PACS© was used for MRI analysis and was performed by three observers blinded to each others' measurements. Results: One hundred patients (57 males, 43 females) were recruited from 2006-2010. The mean TTTG in males was 9.91 mm (95% CI 8.9-10.8 mm) and in females 10.04 mm (95% CI 8.9-11.1). The coefficient of variation was <10% for both intra and inter-observer analysis. Conclusions: The normal TTTG distance is 10 ± 1 mm with MRI being a reliable method of measurement. Literature supports a high degree of variability in reporting TTTG. This study establishes normal TTTG values, which will help in the assessment and treatment of patellofemoral disorders. © 2011 Springer-Verlag.


Primhak R.,Taranaki Base Hospital
Paediatrics and Child Health (United Kingdom) | Year: 2013

This review provides an overview of acute and chronic upper airway obstruction. Glottic or subglottic obstruction affects the airway when it is a single channel. This is potentially life-threatening and presents with stridor and/or respiratory distress. Supraglottic airway obstruction generally affects the nasal or nasopharyngeal airway and tends to predominantly affect breathing during sleep. There are a number of different causes for each of these clinical problems.In acute glottic or subglottic obstruction, management consists of a rapid assessment and the establishment of a secure airway when the obstruction is life-threatening. Thereafter the management will be targeted on the underlying condition. In supraglottic airway obstruction it is important to recognize that symptoms may be subtle and a high index of suspicion is needed, particularly when there are co-morbidities which make sleep-disordered breathing more likely. In severe supraglottic obstruction causing significant sleep-disordered breathing adenotonsillectomy is usually the treatment of choice, but other measures including non-invasive continuous positive airway pressure (CPAP) or ventilation may be necessary if this is unhelpful. © 2012 Elsevier Ltd.


Lance S.,Taranaki Base Hospital | White C.,Taranaki Base Hospital
New Zealand Medical Journal | Year: 2015

AIMS: Faecal calprotectin (FC) is a recognised marker for excluding inflammatory bowel disease (IBD). However, it is often not used appropriately. This audit aimed to identify the rate of its use of in Taranaki, along with attempting to assess how appropriately it is used and overall utility. METHODS: A list of FCs performed in Taranaki from July 2013 to December 2013 was obtained. Notes were examined, identifying the indication, its outcome, and a decision made whether or not the test added any benefit. RESULTS: 206 patients were identified. A large number (n=75) were excluded due to inadequate clinical information. Of the remaining 131 patients, 37% (n=49) did not benefit. 22% (n=29) avoided further investigation with a negative result. 91% of patients with previously known IBD avoided invasive investigation with a negative result. There was a strong correlation between very high levels (>500mg/g) and a diagnosis of IBD (88%), as well as a strong correlation between lower levels (<200mg/g) and excluding IBD (86%). CONCLUSIONS: FC remains useful to exclude IBD, and can assist in patients with established disease. However, in a significant percentage, the test adds no value. The absolute level of FC may also assist diagnosis. More research is needed, and more education is recommended. © 2015 NZMA.


Zhanje F.T.,Taranaki Base Hospital
New Zealand Medical Journal | Year: 2013

Peripartum cardiomyopathy (PPCM) is a dilated cardiomyopathy in which left ventricular systolic dysfunction and symptoms of heart failure occur between the late stages of pregnancy and the early postpartum period. It is relatively uncommon. In this case report I describe the development of PPCM in the first pregnancy of a woman of older maternal age. © NZMA.


Alexander Aiken C.G.,Taranaki Base Hospital
Journal of Clinical and Diagnostic Research | Year: 2013

To establish how controversies in understanding acid base balance arose, the literature on acid base balance was reviewed from 1909, when Henderson described how the neutral reaction of blood is determined by carbonic and organic acids being in equilibrium with an excess of mineral bases over mineral acids. From 1914 to 1930, Van Slyke and others established our acid base principles. They recognised that carbonic acid converts into bicarbonate all non-volatile mineral bases not bound by mineral acids and determined therefore that bicarbonate represents the alkaline reserve of the body and should be a physiological constant. They showed that standard bicarbonate is a good measure of acidosis caused by increased production or decreased elimination of organic acids. However, they recognised that bicarbonate improved low plasma bicarbonate but not high urine acid excretion in diabetic ketoacidosis, and that increasing pCO2 caused chloride to shift into cells raising plasma titratable alkali. Both indicate that minerals influence pH. In 1945 Darrow showed that hyperchloraemic metabolic acidosis in preterm infants fed milk with 5.7 mmol of chloride and 2.0 mmol of sodium per 100 kcal was caused by retention of chloride in excess of sodium. Similar findings were made but not recognised in later studies of metabolic acidosis in preterm infants. Shohl in 1921 and Kildeberg in 1978 presented the theory that carbonic and organic acids are neutralised by mineral base, where mineral base is the excess of mineral cations over anions and organic acid is the difference between mineral base, bicarbonate and protein anion. The degree of metabolic acidosis measured as base excess is determined by deviation in both mineral base and organic acid from normal.


Hayat A.,Taranaki Base Hospital
The New Zealand medical journal | Year: 2013

We report a peritoneal dialysis-related peritonitis infection with Rothia mucilaginosa (R. mucilaginosa), a Gram-positive germ belonging to the normal flora of the human oral cavity. Successful treatment was achieved by intraperitoneal administration of cephazolin. This case report illustrates the potential virulence of R. mucilaginosa in patients on peritoneal dialysis. We propose to routinely perform specific staining and prolonged culturing techniques for unusual germs such as R. mucilaginosa in patients with peritoneal dialysis-related peritonitis.


Hopkins C.J.,Taranaki Base Hospital
Internal Medicine Journal | Year: 2014

Background: Reporting of antibiotic consumption in hospitals is a crucial component of antibiotic stewardship, but data from Australasian secondary hospitals are scarce. The hypothesis of this audit is that antibiotic consumption in secondary hospitals would be lower than in tertiary centres. Aims: The study aims to present the first published audit of antibiotic consumption from a secondary hospital in New Zealand compared with two tertiary centres. Methods: Hospital population-level data were retrospectively accessed to identify all systemic antibiotics dispensed to adult inpatients at Taranaki District Health Board during 2011. Consumption was calculated in defined daily doses per 100 inpatient-days and per 100 admissions, stratified by drug class. Comparison was against published data from two tertiary centres. Results: Total consumption was lower, but that of high-risk antibiotic classes was higher than both tertiary centres. The relative consumption of lincosamides was 4.0 and 2.6 times higher than the two tertiary centres, with an associated 14% incidence of Clostridium difficile associated diarrhoea within 3 months. Conclusion: Our secondary hospital appears to consume the wrong types of antibiotic rather than too much. Data from all Australasian hospitals, stratified by clinical service area and hospital level, are required for clinically relevant benchmarking. © 2014 Royal Australasian College of Physicians.


Sarvepalli R.,Taranaki Base Hospital | Kyle S.M.,Taranaki Base Hospital
New Zealand Medical Journal | Year: 2010

Omental torsion is a rare cause of acute abdomen which often required surgical intervention. Preoperative diagnosis by clinical examination alone is almost never possible. Increasing use of CT is making it possible to diagnose this preoperatively. An adult male case is presented that highlights these points. ©NZMA.

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