Murdoch D.,The Prince Charles Hospital
Minerva cardioangiologica | Year: 2015
Transcatheter aortic valve implantation (TAVI) is the new standard of care for selected patients with severe symptomatic aortic stenosis who are at high risk for surgical aortic valve replacement (AVR), or are inoperable. Multicentre randomised controlled trials have demonstrated equivalent or superior clinical outcomes for TAVI compared to AVR in carefully selected patient cohorts. A number of important limitations were observed with early generation TAVI valves and their delivery systems, and rapid evolution of the technology continues. The Lotus Valve System aims to address a number of these limitations - it is repositionable and retrievable, and has an adaptive seal to prevent paravalvular aortic regurgitation. Early clinical outcomes for the Lotus Valve System have recently been published with promising results in terms of paravalvular regurgitation and repositionability.
Chan B.A.,Royal Brisbane and Womens Hospital |
Chan B.A.,University of Queensland |
Hughes B.G.M.,Royal Brisbane and Womens Hospital |
Hughes B.G.M.,University of Queensland |
Hughes B.G.M.,The Prince Charles Hospital
Translational Lung Cancer Research | Year: 2015
In recent years, there has been a major paradigm shift in the management of non-small cell lung cancer (NSCLC). NSCLC should now be further sub-classified by histology and driver mutation if one is known or present. Translational research advances now allow such mutations to be inhibited by either receptor monoclonal antibodies (mAb) or small molecule tyrosine kinase inhibitors (TKI). Whilst empirical chemotherapy with a platinum-doublet remains the gold standard for advanced NSCLC without a known driver mutation, targeted therapy is pushing the boundary to significantly improve patient outcomes and quality of life. In this review, we will examine the major subtypes of oncogenic drivers behind NSCLC as well as the development of targeted agents available to treat them both now and in the foreseeable future. © Translational lung cancer research. All rights reserved.
Mao X.,Central South University |
Tay G.H.,The Prince Charles Hospital |
Godbolt D.B.,The Prince Charles and Holy Spirit Hospital |
Crawford R.W.,The Prince Charles Hospital |
Crawford R.W.,Queensland University of Technology
Journal of Arthroplasty | Year: 2012
The incidence of pseudotumor formation has been reported to be 1% in patients with metal-on-metal resurfacing arthroplasties. This complication is not exclusive to these patients. We report a case of pseudotumor formation secondary to femoral head-neck corrosion after a metal-on-polyethylene uncemented total hip arthroplasty. © 2012 Elsevier Inc.
Moore J.P.R.,The Prince Charles Hospital |
Fraser J.F.,The Prince Charles Hospital
Annals of Thoracic Surgery | Year: 2010
Cardiac tamponade is defined as a life-threatening, slow or rapid compression of the heart due to the pericardial accumulation of fluid, pus, thrombus or gas as a result of effusion, trauma, or myocardial rupture. We describe the case of a lady who developed classic signs of cardiac tamponade immediately after an open hiatus hernia repair. Computed tomographic imaging revealed extrapericardial hernia recurrence causing cardiac compression. We believe this is the first such reported case. We conclude that cardiac tamponade from acute recurrence of hiatus hernia must be considered in the unstable postoperative patient and that the definition of cardiac tamponade is expanded to include extrapericardial pathologies. © 2010 The Society of Thoracic Surgeons.
Holloway J.W.,University of Southampton |
Yang I.A.,the Prince Charles Hospital |
Yang I.A.,University of Queensland |
Holgate S.T.,University of Southampton
Journal of Allergy and Clinical Immunology | Year: 2010
Allergic diseases are complex genetic diseases resulting from the effect of multiple genetic and interacting environmental factors on their pathophysiology. Recent years have seen considerable progress in unraveling the contribution of these factors to an individual subject's susceptibility to, subsequent development of, and severity of disease. This has resulted in increasing insight into novel areas of allergic disease pathophysiology, for example the significant role played by locally acting tissue susceptibility factors like epithelial/epidermal barrier function and remodeling, such as filaggrin, ADAM33, and GSDML/ORMDL3, in patients with atopic dermatitis and asthma. Furthermore, studies of gene-environment interactions and Mendelian randomization approaches have led to increased insight into the importance of environmental triggers for allergic disease. Studies of the timing of action of genetic variants in determining disease susceptibility have highlighted the importance of in utero development and early life in determining susceptibility to allergic disease. In the future, genetic discoveries in allergic disease will potentially lead to better endophenotyping, prognostication, prediction of treatment response, and insights into molecular pathways to develop more targeted therapy for these conditions. © 2010 American Academy of Allergy, Asthma & Immunology.
Clarke A.,The Prince Charles Hospital
European Journal of Clinical Nutrition | Year: 2016
Background/objectives:Post-operative atrial fibrillation (POAF) is a frequent complication of cardiac surgery. Oxidative stress and reduced antioxidant function have major roles in its development. Selenium is a key to normal antioxidant function, and levels are often low before cardiac surgery. This study investigated whether low preoperative selenium levels were associated with POAF in cardiac surgical patients.Subjects/methods:Using the Society of Thoracic Surgeons (STS) Mortality risk score, 50 patients having primary coronary artery bypass grafts (CABG) surgery were divided into two groups: (i) low-risk group (STS ⩽0.5%; n=26) and (ii) intermediate-risk group (STS ⩾2.0%; n=24). Plasma levels of selenium, glutathione peroxidase (GPx) and malondialdehyde (MDA) were measured in all patients at anaesthetic induction, after aortic cross-clamp removal, 3 h post cardiopulmonary bypass and on post-operative days 1 and 5. Multiple logistic regression was used to assess whether selenium levels were associated with POAF development.Results:Seventeen patients developed POAF (14 patients in the intermediate-risk group and 3 patients in the low-risk group). Preoperative selenium was lower in patients who developed POAF compared with those with normal sinus rhythm (0.73±0.16 vs 0.89±0.13 μmol/l, P=0.005), and this was independently associated with POAF (PR 0.32; 95% confidence credible interval (95%cI) 0.06–0.85, P=0.016). Regardless of POAF, preoperative selenium was lower in the intermediate-risk patients than in the low-risk patients (0.77±0.15 vs 0.89±0.14 μmol/l; P=0.004).Conclusions:Intermediate-risk patients with low preoperative selenium levels may be at a greater risk of developing POAF following CABG. This raises the question of whether selenium supplementation in select cardiac surgical patients may reduce their POAF risk.European Journal of Clinical Nutrition advance online publication, 13 July 2016; doi:10.1038/ejcn.2016.125. © 2016 Macmillan Publishers Limited
Sivakumar B.,The Prince Charles Hospital
Journal of orthopaedic surgery (Hong Kong) | Year: 2012
To evaluate the utility of blood cultures in the assessment of early postoperative fever in hip fracture patients with no other indicators of sepsis. 101 blood cultures were drawn on postoperative days 0 to 5 to investigate 84 febrile episodes in 31 women and 30 men (mean age, 80 years) whose body temperature measured via the tympanic route was ≥ 38 oC. Culture results of these 61 patients were divided into culture-positive and culture-negative groups for comparison. Of the 101 blood cultures, only 2 were positive: one was obtained 5 days after dynamic hip screw fixation, and the other 4 days after hemiarthroplasty. Both blood cultures grew coagulase-negative staphylococcal species, which were deemed to be skin contaminants not requiring change of patient management. 44 of these patients were treated with oral or intravenous antibiotics for a period of time. The risk of bacteraemia in patients with postoperative fever but no other symptoms of infection is low. Routine procurement of blood cultures in such patients is ineffective and of limited utility.
Lee J.C.,The Prince Charles Hospital
Australian family physician | Year: 2013
Coronary artery disease (CAD) remains a major health concern and the leading cause of death in Australia. Effective assessment of patients for possible CAD is a common problem in general practice. Non-invasive tests such as myocardial perfusion scans (MPS), exercise stress tests (ESTs) and stress echocardiography (using exercise or dobutamine as the stressor, as appropriate) can provide useful diagnostic and prognostic information. This brief review discusses the role of MPS in the evaluation of CAD.
Lawrence P.,The Prince Charles Hospital
Nursing in critical care | Year: 2011
The aim of this review was to critically analyse recent research that has investigated ventilator care bundle (VCB) use, with the objective of analysing its impact on ventilator-associated pneumonia (VAP) outcomes. The VCB is a group of four evidence-based procedures, which when clustered together and implemented as an 'all or nothing' strategy, may result in substantial clinical outcome improvement. VAP is a nosocomial lung infection associated with endotracheal tube use in ventilated patients. Since the VCB was introduced there have been several studies that have reported significant VAP rate reductions. A comprehensive search for research, published between 2004 and 2009, was conducted using Medline and PubMed. Key words were used to identify English language studies reporting VCB implementation within adult intensive care units (ICU) and associated clinical outcomes. Studies that implemented bundle variations that did not include all four elements were excluded. Because of the limitations of the observational designs used in the studies retrieved, a definitive causal relationship between VCB use and VAP reduction cannot be stated. However, the evidence to date is strongly indicative of a positive association. Several studies reported the use of additional VCB elements. In these cases it is difficult to establish which elements are related to the measured outcomes. Further research is recommended to establish baseline outcome measures using the four-element VCB, before adding further processes singly, as well as research investigating the effect of audit and feedback on VCB compliance and its effect on clinical outcomes. A reduction in VAP is associated with VCB use. The evidence to date, whilst not at the highest experimental level, is at the highest ethically permissible level. In the absence of contradictory research, the current evidence suggests that use of the VCB represents best practice for all eligible adult ventilated patients in ICU. © 2011 The Authors. Nursing in Critical Care © 2011 British Association of Critical Care Nurses.
Richards C.,The Prince Charles Hospital
Journal of orthopaedic surgery (Hong Kong) | Year: 2010
A 2-stage revision total hip replacement (THR) is the standard treatment for a chronically infected THR with severe metadiaphyseal bone loss. A long-stem cemented prosthesis as part of a temporary articular spacer is commonly used during the first-stage procedure. Nonetheless, this option is expensive and can pose difficulties for patients with a small medullary canal. A construct using an antibiotic cement-loaded Kuntscher nail cemented with a highly polished Exeter stem has been devised and used in 4 patients.