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Melbourne, Australia

Lim B.,Royal Melbourne Hospital | Smith A.,University of Melbourne | Chandu A.,Western Hospital
Journal of Oral and Maxillofacial Surgery | Year: 2010

Purpose: To determine whether the treatment of oral leukoplakia with potassium-titanyl-phosphate (KTP) lasers versus CO2 lasers results in lower recurrence rates. Materials and Methods: Retrospective data were collected from the records of 30 patients (mean age 75.6 years) with 35 primary oral leukoplakia who had their lesions ablated by KTP laser, and 45 patients (mean age 59.9 years) with 59 primary oral leukoplakia who had CO2 laser treatment. The recurrence rates of lesions between these 2 groups was then compared. Results: A statistically significant (P = .049) reduction in recurrence rates for those patients treated with KTP lasers versus CO2 lasers was found. Conclusion: The use of KTP lasers for the treatment of oral leukoplakia may result in lower recurrence rates than when using CO2 lasers. Crown Copyright © 2010. Source

Bourke V.C.,Central Coast Area Health Service | Bourke B.M.,Central Coast Area Health Service | Beiles C.B.,Western Hospital
European Journal of Vascular and Endovascular Surgery | Year: 2016

Objectives The aim was to analyse a prospective, consecutive series of awake carotid endarterectomy (CEA) patients undergoing, when possible, pre- and postoperative diffusion-weighted magnetic resonance imaging brain scans (DWI). Methods All CEA patients from June 23, 2006, to January 13, 2012, were prospectively entered in the study. CEA was performed under regional cervical block. Only patients demonstrating shunt dependence were shunted. Before August 7, 2008, all longitudinal endarterectomy had been performed with a vein patch. From that date all CEA were eversions without a patch, except shunted patients who were vein patched. DWI was performed 2 days before and 5 days after (3 Tesla). Scans were reported by MRI-trained radiologists. Logistic regression analysis (LRA) identified predictive variables for MRI changes using backward stepwise elimination of variables with p >.05. Results There was a total of 295 consecutive CEA. There were no deaths but four clinical strokes (1.4 %); 89 excluded from DWI leaving 206; of these 27 (13%) developed new DWI lesions including four of 57 (7%) in the asymptomatic group and 23 of 149 (15%) symptomatic patients. Nineteen of the 206 (9.2%) were shunted. LRA showed that shunt dependence was highly associated with new DWI lesions: odds ratio (OR) 6.43; 95% confidence interval (CI) 2.3-17.9; p <.001. Both the vein patched, non-shunted group (OR.25; CI 0.09-0.72; p =.010) and the eversion (all non-shunted and all non-patched) group (OR 0.05; CI 0.01-0.22; p <.001) were associated with a low risk of new lesions, with the eversion group a lower risk than the patched group. Conclusions One in every eight CEA patients developed new DWI lesions (rate doubled in symptomatic patients). Shunt dependence in conscious CEA patients is highly associated with the development of new DWI lesions compared with non-shunted patients. For non-shunted patients the new lesion risk is low, and in those patients the risk in the eversion group is lower than in the patched group. © 2015 European Society for Vascular Surgery. Source

Anpalahan M.,Western Hospital | Gibson S.,National Ageing Research Institute
European Journal of Internal Medicine | Year: 2012

Aims: To determine the prevalence and clinical significance of carotid sinus syndrome (CSS) and vasovagal syncope (VVS), the two common types of Neurally Mediated Syncope (NMS), in a cohort of older patients with unexplained falls. Methods: Patients presenting with unexplained and accidental falls were identified from 200 consecutive admissions of falls in patients aged 65 years and older admitted to the Rapid Assessment Medical Unit (RAMU) in a teaching hospital. A sample of unexplained and accidental fallers underwent carotid sinus massage (CSM) and tilt table testing (TTT) as per a standardised protocol. Baseline characteristics, clinical variables and the prevalence of NMS were compared between the two groups. Results: Falls were unexplained in 26% of patients. The prevalence of NMS was 24% (5/21) among patients with unexplained falls who underwent assessment for NMS, whereas it was nil (0/17) in patients with accidental falls (P = 0.050). The prevalence of previous falls was significantly higher in patients with unexplained falls (P = 0.0025), but all other baseline characteristics were similar between the two groups. Conclusion: Falls are unexplained in a significant number of older patients presenting to acute hospitals. The assessment of unexplained fallers for NMS is clinically important as this may be aetiologically related in nearly a quarter of these patients. © 2011 European Federation of Internal Medicine. Source

Travers R.,Western Hospital
International Journal of Rheumatic Diseases | Year: 2015

Aim: Sir Benjamin Collins Brodie (1783-1862) was a London surgeon who investigated joint disease by observation and morbid anatomy in the first half of the 19th century. His descriptions of inflammatory joint disease have been referred to in the past, but only in a fragmentary way. This study aimed to provide more detail than previously, allowing for a new appreciation of his contributions. Methods: The authors used the first (1818), third (1834) and fifth (1850) editions of his book, Pathological and Surgical Observations on the Diseases of Joints, to provide his description of reactive arthritis, rheumatoid arthritis and ankylosing spondylitis. Results: Brodie's descriptions are admirably clear. He describes reactive arthritis in the first edition of his book more completely than authors before him and even Reiter a century later. He recognised that the conjunctivo-urethral-synovial syndrome can occur independently of gonorrhoea, that there are often repeated attacks, and that irits is a complication - the first indication that this syndrome might be part of what we now call seronegative spondyloarthritis. The fifth edition (1850) has among the earliest descriptions in English of ankylosing spondylitis and rheumatoid arthritis. Conclusion: Brodie's understanding of rheumatic diseases, and his willingness to pass this knowledge on, demands that he be widely recognised as a pioneer rheumatologist. International Journal of Rheumatic Diseases © 2015 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd185 June 2015 10.1111/1756-185X.12646 Milestone Milestone © 2015 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd. Source

Ye M.J.,Western Hospital | Ye M.J.,University of Melbourne | Ye J.M.,University of Melbourne
Dermatology Research and Practice | Year: 2014

Pyoderma gangrenosum (PG) is a rare dermatological disorder characterised by the rapid progression of a painful, necrolytic ulcer. This study retrospectively identified patients who were admitted and treated for PG during a 10-year period (2003-2013). Twenty-three patients were included in this study, 16 women and seven men. The mean age at initial admission was 62.8 years (range 30 to 89 years). Lesions were localised to lower limb in 13 patients, peristomal region in four, breast in three, and upper limb in one, and two patients had PG at multiple sites. The variants of PG noted were ulcerative (18), bullous (2), vegetative (2), and pustular (1). Associated systemic diseases were observed in 11 patients (47.8%). Systemic therapies were initiated in 21 patients while two patients received topical treatments. The mean length of hospital stay was 47 days (range 5 to 243 days) and five patients died during their admissions. Seven patients required readmissions for exacerbations of their PG. Our study showed that patients admitted for treatment of PG had high morbidity and mortality. This study also highlights the importance of early and aggressive treatment of patients admitted with PG as well as treating associated systemic diseases and wound infections. © 2014 Mingwei Joel Ye and Joshua Mingsheng Ye. Source

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