Westmead Public Hospital

Westmead, Australia

Westmead Public Hospital

Westmead, Australia

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Nguyen D.T.,University of Sydney | Nguyen D.T.,Westmead Public Hospital | Bhaskaran A.,Westmead Public Hospital | Bhaskaran A.,University of Sydney | And 11 more authors.
Physiological Measurement | Year: 2015

Recent studies showed that regional pulmonary perfusion can be reliably estimated using electrical impedance tomography (EIT) with the aid of hypertonic saline based contrast enhancement. Building on these successful studies, we studied contrast EIT for pulmonary perfusion defect caused by an artificially induced pulmonary embolism (PE) in a large ovine model (N = 8, 78 ± 7.8 kg). Furthermore, the efficacy of a less invasive contrast bolus of 0.77 ml kg-1 of NaCl 3% was compared with a more concentrated bolus of 0.13 ml kg-1 of NaCl 20%. Prior to the injection of each contrast bolus injection, ventilation was turned off to provide a total of 40 to 45 s of apnoea. Each bolus of impedance contrast was injected through a catheter into the right atrium. Pulmonary embolisation was performed by balloon occlusion of part of the right branch of the pulmonary trunk. Four parameters representing the kinetics of the contrast dilution in the lung were evaluated for statistical differences between baseline and PE, including peak value, maximum uptake, maximum washout and area under the curve of the averaged contrast dilution curve in each lung. Furthermore, the right lung to left lung (R2L) ratio of each the aforementioned parameters were assessed. While all of the R2L ratios yielded significantly different means between baseline and PE, it can be concluded that the R2L ratios of area under the curve and peak value of the averaged contrast dilution curve are the most promising and reliable in assessing PE. It was also found that the efficacy of the two types of impedance contrasts were not significantly different in distinguishing PE from baseline in our model. © 2015 Institute of Physics and Engineering in Medicine.


Cerimagic S.,University of New South Wales | Cerimagic S.,University of Sydney | Cerimagic S.,University of Technology, Sydney | Ahmadi N.,Westmead Public Hospital | And 3 more authors.
International Journal of Human Rights in Healthcare | Year: 2015

Purpose – The purpose of this paper is to examine ethnic Australian urological cancer patients and the positive life changes that those patients report after cancer diagnosis. Design/methodology/approach – A sample of 50 Australian urological cancer patients of ethnic origin were chosen to participate in this study. One-on-one semi structured interviews were conducted with the patients. Findings – Cancer diagnosis often serves as an impetus for making positive lifestyle changes. Most (98 per cent) of this study’s participants reported that they made positive lifestyle changes following a diagnosis of cancer. Those positive lifestyle changes include: greater appreciation of health and life (100 per cent); improved diet (94 per cent); closer relationships with family and friends (90 per cent); more frequent visits to the doctor for check-ups (74 per cent); increased physical activity (48 per cent); starting a new hobby (36 per cent); greater knowledge about their health in general (32 per cent) and increased spirituality (22 per cent). Research limitations/implications – The limitation of this study is the small sample of patients with ethnic diversity specific to western Sydney. Larger multicentre studies across Australia are required to confirm the findings. Additionally, this study focused on positive life changes, because 98 per cent of the participants reported positive lifestyle changes after diagnosis. However, there are related negative health behaviour changes, which this study has not addressed in depth. Furthermore, a comparison between positive life changes of ethnic Australian patients’ against the experience of post cancer diagnosis of non-ethnic Australian patients could investigate this issue further and possibly provide further insight. Originality/value – The majority (98 per cent) of the participants report positive lifestyle changes following urological cancer diagnoses. The patient population of predominantly elderly (84 per cent), males (90 per cent) differs from the current literate which states that positive lifestyle changes (posttraumatic growth) are mainly found to be significantly correlated to being female, younger and non-white and greater event severity. © 2015, © Emerald Group Publishing Limited.


Perotti V.,Westmead Public Hospital | Dexter M.,Westmead Public Hospital
Journal of Clinical Neuroscience | Year: 2010

This study describes a patient with post-partum collapse secondary to pituitary apoplexy with bilateral carotid artery occlusion. A 29-year-old female, post delivery of a healthy child, presented with a Glasgow Coma Scale score of 3, fixed dilated pupils, complete ophthalmoplegia, and bilateral compression of the internal carotid arteries. These symptoms were due to a giant pituitary macroadenoma. She underwent a craniotomy and subsequently survived with minor cognitive deficits and functional vision. Bilateral carotid occlusion caused by pituitary apoplexy is rare, yet survival with only minor deficits is possible. © 2010 Elsevier Ltd. All rights reserved.


Hall G.,Westmead Public Hospital | Hall G.,Royal North Shore Hospital | Clarkson A.,Royal North Shore Hospital | Shi A.,Royal North Shore Hospital | And 8 more authors.
Pathology | Year: 2010

Aims: Currently, testing for mismatch repair deficiency in colorectal cancers is initiated by performing immunohistochemistry with four antibodies (MLH1, PMS2, MSH2 and MSH6). If any one of these stains is negative the tumour is considered microsatellite unstable and, if clinical circumstances warrant it, the patient is offered genetic testing for Lynch's syndrome. Due to the binding properties of the mismatch repair heterodimer complexes, gene mutation and loss of MLH1 and MSH2 invariably result in the degradation of PMS2 and MSH6, respectively, but the converse is not true. We propose that staining for PMS2 and MSH6 alone will be sufficient to detect all cases of mismatch repair deficiency and should replace routine screening with all four antibodies. Methods: The electronic database of the department of Anatomical Pathology, Royal North Shore Hospital, Sydney, Australia, was searched for all colorectal carcinomas on which a four panel immunohistochemical microsatellite instability screen was performed. An audit of the slides for concordant loss of MLH1-PMS2 and MSH2-MSH6 was then undertaken. Unusual or discordant cases were reviewed and, in some cases, re-stained to confirm the staining pattern. Results: Of 344 cases of colorectal cancer which underwent four antibody immunohistochemistry, 104 displayed loss of at least one mismatch repair protein. Of these, 100% showed concordant mismatch repair loss (i.e., loss of MLH1 and PMS2 or loss of MSH2 and MSH6). The four discordant cases comprised two single negative cases (1 MSH6 negative/MSH2 positive case, 1 PMS2 negative/MLH1 positive) and two triple negative (both MLH1/PMS2/MSH6 negative). The microsatellite instability (MSI) group showed a relatively high median age (69.3 years) due to the departmental policy of testing all cases with possible MSI morphology regardless of age. Conclusions: The sensitivity and specificity of a two panel test comprised of PMS2 and MSH6, compared to a four panel test, is 100%. No false negatives or positives were identified. We conclude that the two panel test should replace a four panel protocol for immunohistochemical screening for mismatch repair deficiency. © 2010 Royal College of Pathologists of Australasia.


Paik J.Y.,Royal North Shore Hospital | Hall G.,Westmead Public Hospital | Clarkson A.,Royal North Shore Hospital | Lee L.,St Vincents Hospital | And 5 more authors.
Human Pathology | Year: 2011

Recent studies have demonstrated a high frequency of detection of Merkel cell polyomavirus in Merkel cell carcinoma. However, most of these studies are from European or North American centers that have relatively low sun exposure and may have a higher incidence of virus-driven oncogenesis compared with the highly sun-exposed but predominantly fair-skinned Australian population. We performed immunohistochemistry for Merkel cell polyomavirus on 104 cases of Merkel cell carcinoma and 74 cases of noncutaneous small cell-undifferentiated carcinoma from 3 major Australian centers. Nineteen (18.3%) cases of Merkel cell carcinoma showed positive staining for Merkel cell polyomavirus versus 1 (1.3%) of small cell-undifferentiated carcinoma. All 15 cases (14.3%) of Merkel cell carcinoma with areas of mixed squamous differentiation showed negative staining. We found positive staining in only 3 (7.7%) of 39 Merkel cell carcinoma from the head and neck (the most sun-exposed area) versus 16 (24.6%) of 65 of tumors from other sites (P <.05). Our findings support the concept of a Merkel cell polyomavirus-driven and a non-Merkel cell polyomavirus-driven (primarily sun-dependent) pathway in Merkel cell carcinoma carcinogenesis, with the latter being significantly more frequent in Australia and in mixed squamous-Merkel cell carcinoma (which is also more frequent in Australia). Although immunohistochemistry for Merkel cell polyomavirus seems to be highly specific in all populations, the low incidence of Merkel cell polyomavirus-positive Merkel cell carcinoma in a highly sun-exposed population limits its diagnostic utility in this setting. © 2011 Elsevier Inc.


Currently, testing for mismatch repair deficiency in colorectal cancers is initiated by performing immunohistochemistry with four antibodies (MLH1, PMS2, MSH2 and MSH6). If any one of these stains is negative the tumour is considered microsatellite unstable and, if clinical circumstances warrant it, the patient is offered genetic testing for Lynchs syndrome. Due to the binding properties of the mismatch repair heterodimer complexes, gene mutation and loss of MLH1 and MSH2 invariably result in the degradation of PMS2 and MSH6, respectively, but the converse is not true. We propose that staining for PMS2 and MSH6 alone will be sufficient to detect all cases of mismatch repair deficiency and should replace routine screening with all four antibodies.The electronic database of the department of Anatomical Pathology, Royal North Shore Hospital, Sydney, Australia, was searched for all colorectal carcinomas on which a four panel immunohistochemical microsatellite instability screen was performed. An audit of the slides for concordant loss of MLH1-PMS2 and MSH2-MSH6 was then undertaken. Unusual or discordant cases were reviewed and, in some cases, re-stained to confirm the staining pattern.Of 344 cases of colorectal cancer which underwent four antibody immunohistochemistry, 104 displayed loss of at least one mismatch repair protein. Of these, 100 showed concordant mismatch repair loss (i.e., loss of MLH1 and PMS2 or loss of MSH2 and MSH6). The four discordant cases comprised two single negative cases (1 MSH6 negative/MSH2 positive case, 1 PMS2 negative/MLH1 positive) and two triple negative (both MLH1/PMS2/MSH6 negative). The microsatellite instability (MSI) group showed a relatively high median age (69.3 years) due to the departmental policy of testing all cases with possible MSI morphology regardless of age.The sensitivity and specificity of a two panel test comprised of PMS2 and MSH6, compared to a four panel test, is 100%. No false negatives or positives were identified. We conclude that the two panel test should replace a four panel protocol for immunohistochemical screening for mismatch repair deficiency.

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