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Tauranga, New Zealand

De Carvalho B.R.,Tauranga Hospital
Japanese Journal of Radiology

Abstract Calcific myonecrosis is a rare entity with only 57 cases reported in the English literature to date. It is a late complication of compartment syndrome of the limb and results in characteristic muscle necrosis with central liquefaction and peripheral calcification. This series presents a further two cases and consolidates the diagnostic features and treatment modalities described in the literature. © Japan Radiological Society 2012. Source

Cornu J.-N.,University Paris - Sud | Ahyai S.,Universitatsklinikum Hamburg Eppendorf | Bachmann A.,University of Basel | De La Rosette J.,University of Amsterdam | And 6 more authors.
European Urology

Context A number of transurethral ablative techniques based on the use of innovative medical devices have been introduced in the recent past for the surgical treatment of benign prostatic obstruction (BPO). Objective To conduct a systematic review of the literature and a meta-analysis of available randomized controlled trials (RCTs), and to evaluate the efficacy and safety of transurethral ablative procedures for BPO. Evidence acquisition A systematic literature search was performed for all RCTs comparing any transurethral surgical technique for BPO to another between 1992 and 2013. Efficacy was evaluated after a minimum follow-up of 1 yr based on International Prostate Symptom Score, maximum flow rate, and postvoid residual volume. Efficacy at midterm follow-up, prostate volume, perioperative data, and short-term and long-term complications were also assessed. Data were analyzed using RevMan software. Evidence synthesis A total of 69 RCTs (8517 enrolled patients) were included. No significant difference was found in terms of short-term efficacy between bipolar transurethral resection of the prostate (B-TURP) and monopolar transurethral resection of the prostate (M-TURP). However, B-TURP was associated with a lower rate of perioperative complications. Better short-term efficacy outcomes, fewer immediate complications, and a shorter hospital stay were found after holmium laser enucleation of the prostate (HoLEP) compared with M-TURP. Compared with M-TURP, GreenLight photoselective vaporization of the prostate (PVP) was associated with a shorter hospital stay and fewer complications but no different short-term efficacy outcomes. Conclusions This meta-analysis shows that HoLEP is associated with more favorable outcomes than M-TURP in published RCTs. B-TURP and PVP have resulted in better perioperative outcomes without significant differences regarding efficacy parameters after short-term follow-up compared with M-TURP. Further studies are needed to provide long-term comparative data and head-to head comparisons of emerging techniques. Patient summary Bipolar transurethral resection of the prostate, photovaporization of the prostate, and holmium laser enucleation of the prostate have shown efficacy outcomes comparable with conventional techniques yet reduce the complication rate. The respective role of these new options in the surgical armamentarium needs to be refined to propose tailored surgical treatment for benign prostatic obstruction relief. © 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved. Source

Davis C.,Tauranga Hospital | Boddington D.,Tauranga Hospital
Heart Lung and Circulation

Introduction The cardiac effects of many illegal substances (cocaine, methadone) have previously been well described [1,2]. However the association between synthetic cannabis and cardiac arrest is less well documented. Here we describe an out-of-hospital cardiac arrest in a previously healthy 16-year-old female associated with the use of inhaled synthetic cannabis. Methods An electronic systematic search of online databases PubMed and Embase was performed using keywords, ''synthetic cannabis death'' and ''cardiac arrest''. Results In this case study a previously healthy 16-year-old had a cardiac arrest after synthetic cannabis use. Despite extensive investigations no other cause for her arrest was found. To the best of our knowledge there has been one previous case report of cardiac arrest following synthetic cannabis use in a 56-year-old man [3]. Conclusions This case report augments the relationship between synthetic cannabis and cardiac arrest in the medical community. More awareness surrounding the risk of synthetic cannabinoids is warranted. © 2015 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Source

Vincent M.W.,Tauranga Hospital | Gilling P.J.,Tauranga Hospital
World Journal of Urology

Introduction: Lower urinary tract symptoms (LUTS) are a common complaint and although can be adequately managed with medication, surgery remains the mainstay of treatment. Transurethral resection has been the reference ‘gold standard’, but due to its complications and issues with larger volume prostates, many alternatives have been developed and assessed. Holmium laser enucleation of the prostate (HoLEP) has shown excellent efficacy, durability and safety and has become an important alternative that has gained guideline approval.Results: HoLEP has been shown to have outcomes that are equivalent or better than TURP in both urodynamic measurements and symptom scores. Its outcomes have been proven to be durable and cost-effective. HoLEP has fewer and less serious complications when compared to the current reference standard, its use also allows earlier removal of catheter and hospital discharge. Appropriate mentoring reduces many of the issues associated with the steep learning curve, thus removing the main hurdle to its widespread adoption as the surgical treatment of choice for LUTS due to benign prostatic hyperplasia (BPH).Conclusions: HoLEP fulfils all of the requirements as an alternative/replacement for TURP and open prostatectomy, with equivalent outcomes and reduced complications. With improvements in the learning curve, it could now be considered the true gold standard surgical treatment for BPH. HoLEP has come of age. © 2014, Springer-Verlag Berlin Heidelberg. Source

It has been well demonstrated that Maori have the poorest health status of any ethnic group in New Zealand. The aim of this study was to determine whether there are any differences between Maori and non-Maori patients in the severity of their arthritis preoperatively and in their postoperative functional outcomes following primary total hip and knee arthroplasty surgery. Secondary objectives were to compare general and mental health scores and to determine whether the intervention rate for Maori arthroplasty patients is appropriate. We compared preoperative and postoperative (1 and 5 year) Oxford and WOMAC scores, general health (SF-12 PH) and mental health (SF-12 MH) scores in all public patients who underwent primary total hip and knee arthroplasty surgery in our region between 2005 and 2009. Maori patients are younger at the time of surgery, have higher ASA scores and worse preoperative function. They also have worse postoperative outcomes and smaller overall improvements following surgery when comparing their preoperative with postoperative scores. In terms of general health, Maori and non-Maori had similar SF-12 PH scores but worse SF-12 MH scores both pre- and postoperatively. Maori patients are younger, have worse general and mental health and worse preoperative function compared with non-Maori patients. Both absolute and differential scores show that Maori patients also have worse postoperative outcomes compared with non-Maori patients. These differences are likely clinically significant and ongoing education and effort is required in order to achieve earlier intervention rates and improve postoperative outcomes for Maori patients. Source

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