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Samarasekera N.,University of Edinburgh | Salman R.A.S.,University of Edinburgh | Huitinga I.,Netherlands Institute for Neuroscience | Klioueva N.,Netherlands Institute for Neuroscience | And 4 more authors.
The Lancet Neurology | Year: 2013

Brain banks are used to gather, store, and provide human brain tissue for research and have been fundamental to improving our knowledge of the brain in health and disease. To maintain this role, the legal and ethical issues relevant to the operations of brain banks need to be more widely understood. In recent years, researchers have reported that shortages of high-quality brain tissue samples from both healthy and diseased people have impaired their efforts. Closer collaborations between brain banks and improved strategies for brain donation programmes will be essential to overcome these problems as the demand for brain tissue increases and new research techniques become more widespread, with the potential for substantial scientific advances in increasingly common neurological disorders. © 2013 Elsevier Ltd.

Hsu C.C.,The Alfred Hospital
Cochrane database of systematic reviews (Online) | Year: 2010

BACKGROUND: Pulmonary arteriovenous malformations are abnormal direct connections between the pulmonary artery and pulmonary vein which result in a right-to-left shunt. They are associated with substantial morbidity and mortality mainly from the effects of paradoxical emboli. Potential complications include stroke, cerebral abscess, pulmonary haemorrhage and hypoxaemia. Embolisation therapy is a form of treatment based on the occlusion of the feeding arteries to a pulmonary arteriovenous malformation and can prevent many of these debilitating and life-threatening complications. OBJECTIVES: To determine the efficacy and safety of embolisation therapy in people with pulmonary arteriovenous malformations including a comparison with surgical resection and different embolisation devices. SEARCH STRATEGY: We searched the Cystic Fibrosis and Genetic Disorders Group's Trials Registers (last searched 07 September 2009). We also searched the following databases: the Australian New Zealand Clinical Trials Registry; ClinicalTrials.gov; International Standard Randomised Controlled Trial Number Register; International Clinical Trials Registry Platform Search Portal (last searched 22 November 2009). We checked cross-references and searched references from review articles. Finally, we contacted manufacturers and specialised centres for unpublished and ongoing trials. SELECTION CRITERIA: Trials in which individuals with pulmonary arteriovenous malformations were randomly allocated to embolisation therapy compared to no treatment, surgical resection or a different embolisation device. Studies identified for potential inclusion were independently assessed for eligibility by two authors, with excluded studies further checked by a third author. DATA COLLECTION AND ANALYSIS: No trials were identified. As this was the case, no analysis was performed. MAIN RESULTS: There were no randomised controlled trials identified. AUTHORS' CONCLUSIONS: Currently there are no randomised controlled trials to support or refute embolisation therapy for treatment of pulmonary arteriovenous malformations. However, randomised controlled trials are not always feasible on ethical grounds. Observational studies suggest that embolisation therapy reduces mortality and morbidity compared to no treatment in patients. A standardised approach to reporting with long-term follow up through registry studies can help to strengthen the evidence base for embolisation therapy in the absence of randomised controlled trials. Future viable randomised controlled trials may compare different embolisation devices against each other.

Adams N.,The Alfred Hospital
EMA - Emergency Medicine Australasia | Year: 2014

Current conventions for the writing of medical scientific papers impede clear communication of scientific research results. This article discusses the reasons for this and how to ameliorate them. © 2014 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Seneviratne U.,The Alfred Hospital | Seneviratne U.,Monash Medical Center
Epilepsy and Behavior | Year: 2010

Fyodor Dostoevsky is a great Russian writer who had epilepsy. As a consequence, there are many references to seizure-related phenomena in his work. His epilepsy syndrome has been a focus of debate. The goal of this article is to delineate his epilepsy syndrome based on a semiological description of seizures, which could be considered one of the most reliable pieces of circumstantial evidence available. It was hypothesized that seizure-related descriptions in his books were based on his own personal experience. The semiology of seizures and related phenomena was compiled from Dostoevsky's own work, his letters to family and friends, and reminiscences of his wife and friend. Those descriptions were analyzed in detail to elicit localizing and lateralizing features of seizures. On the basis of this evidence, it was postulated that Dostoevsky had a partial epilepsy syndrome most probably arising from the dominant temporal lobe. © 2010.

• To examine the effect of oral anticoagulation (OA) on the prevalence and inpatient management of haematuria in a contemporary Australian patient cohort. • Patients across all inpatient units who had diagnosis-related group (DRG) coding for haematuria were identified from April 2010 to September 2011. • A retrospective chart review was performed to identify the type of anticoagulation (if any), requirement for bladder irrigation or blood transfusion, length of stay (LOS) and cause of haematuria. • Patients for whom the anticoagulation status was uncertain were excluded from analysis. • Statistical significance was determined by Pearson's chi-square tests and Student's t-tests. • In all, 335 admissions with DRG coding for haematuria were identified from hospital records, of which 268 admissions had clear documentation of anticoagulation. There were 118 emergency admissions and 150 elective admissions for day case cystoscopy. The mean age of the patients was 66 years and the male:female ratio was 5:1. In all, 123 admissions were for patients on some form of anticoagulation (46%). • Patients were on anticoagulation in 53% of the 118 emergency admissions for gross haematuria. These comprised patients on aspirin (28%), clopidogrel (4%), warfarin (10%), combined aspirin and warfarin (1%) and combined aspirin and clopidogrel (10%). • The use of OA was a significant predictor of the need for intervention among the 118 emergency admissions (86% vs 62%, P = 0.003). • In particular, dual antiplatelet therapy in the form of aspirin and clopidogrel was associated with an increased requirement for bladder irrigation (92%) when compared with patients on other forms of anticoagulation (84%) or none at all (62%, P = 0.01). • The mean LOS for patients admitted to hospital with haematuria was 5.6 days. Patients on warfarin had a statistically significant longer LOS than the other groups (13.7 vs 4.5 days, P < 0.001). A cause for haematuria was identified in 120 of the 234 patients (51%). Of these, the most common was benign prostatic hyperplasia (21%), followed by bladder urothelial carcinoma (17%). • In our cohort of patients, about half of all admissions with haematuria were for patients on some form of OA. • OA use increased the need for intervention, especially for patients on dual antiplatelet therapy. © 2012 THE AUTHORS. BJU INTERNATIONAL © 2012 BJU INTERNATIONAL.

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