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Wollongong, Australia

Trajkovski T.,St. Michaels Hospital | Pinsker E.,St. Michaels Hospital | Cadden A.,Wollongong Hospital | Daniels T.,St. Michaels Hospital
Journal of Bone and Joint Surgery - Series A | Year: 2013

Background: Preoperative talar varus deformity increases the technical difficulty of total ankle replacement and is associated with an increased failure rate. Deformity of >20° has been reported to be a contraindication to arthroplasty. We determined whether clinical outcomes of total ankle replacement in patients with ankle arthritis and preoperative talar varus deformity of ge;10° were comparable with those of patients with varus deformity of <10°. Methods: Thirty-six ankles with preoperative coronal-plane tibiotalar varus deformity of ge;10° (''varus'' group) and thirtysix prospectively matched ankles with varus deformity of <10° (''neutral'' group) underwent total ankle replacement. Preoperative and postoperative evaluations included AOFAS (American Orthopaedic Foot & Ankle Society) ankle-hindfoot scores, Ankle Osteoarthritis Scale (AOS) scores, Short Form (SF)-36 scores, and radiographic measurements of coronalplane deformity. Results: The cohorts were similar with respect to age, sex, operatively treated side, body mass index, and components used, and the mean duration of clinical follow-up was 34.7 months. Eighteen (50%) of the ankles in the varus group had a preoperative varus deformity of ge;20°. Patients in the varus group underwent more ancillary procedures during the index surgery to achieve a plantigrade foot. The AOFAS score improved by a mean of 57.2 points in the varus group and 51.5 points in the neutral group. The AOS pain and disability component scores decreased significantly in both groups. The improvement in AOS and SF-36 scores did not differ significantly between the groups at the time of the final follow-up. Tibiotalar deformity improved significantly toward a normal weight-bearing axis in the varus group. Thirteen ankles in the varus group and six in the neutral group underwent additional procedures at a later date. Conclusions: Satisfactory results can be achieved in patients with varus malalignment of ge;10°, which should not be considered a contraindication to total ankle replacement. Complication rates can be reduced by utilizingmeticulous surgical technique and taking care to address all causes of the varus deformity, particularly through osteophyte debridement, correction of cavus deformity, and soft-tissue balancing. Level of Evidence: Prognostic Level I. See Instructions for Authors for a complete description of levels of evidence. © 2013 BY THE JOURNAL OF BONE AND JOINT SURGERY, INCORPORATED.

Huber D.,Wollongong Hospital
Wounds UK | Year: 2013

Approximately 25% of heel and ankle pressure injuries begin in the operating theatre. These injuries can be prevented simply by offloading, but elevating the heel can cause other problems, mainly popliteal vein compression. Elevating the heel and allowing the knee to drop back unsupported, will result in popliteal vein compression in 64% of patients who are supine and anaesthetised. Popliteal vein compression increases the likelihood of deep vein thrombosis and can be overcome by flexing the knee around 5°. It must be done without putting pressure in the popliteal fossa.

Georgiou C.,University of Wollongong | Georgiou C.,Wollongong Hospital
BJOG: An International Journal of Obstetrics and Gynaecology | Year: 2010

Objective To investigate the proposed mechanism by which intrauterine balloons achieve their tamponade effect of creating an 'intrauterine pressure that is greater than the systemic arterial pressure'. Design To determine the intraluminal pressures within a Bakri balloon during the establishment of a positive 'tamponade test' in the management of postpartum haemorrhage. To correlate these intraluminal pressures with contemporaneous readings of blood pressure recordings as documented from the operating theatre anaesthetic charts. Setting An obstetric unit (approximately 2400 births) in Wollongong, New South Wales, Australia. Sample Two women in whom first-line uterotonics were unsuccessful and who required a Bakri balloon to control postpartum haemorrhage secondary to an atonic uterus. Methods A DigiMano (Netech Corporation, Farmingdale, NY, USA) pressure recorder was attached via a three-way tap to a Bakri balloon. Anaesthetic charts of the two cases were reviewed retrospectively. Main outcome measures Intraluminal pressure readings were recorded after each 50-ml aliquot of normal saline had been insufflated into the balloon whilst the next aliquot was being prepared. Results There is a curvilinear relationship between the intraluminal pressure and the balloon volume. The pressure does not exceed the systolic blood pressure of the patient at the time of establishment of a positive tamponade test. Conclusions The intraluminal pressure within the tamponade balloon does not exceed the systolic blood pressure of the patient when a positive tamponade test is established. © 2009 RCOG BJOG An International Journal of Obstetrics and Gynaecology.

Cadden A.R.,Wollongong Hospital
Seminars in Musculoskeletal Radiology | Year: 2012

Total ankle replacement is becoming a more popular option in the treatment of end-stage ankle arthritis. Appropriate imaging plays an important role in surgical planning, considering the overall foot alignment for optimal outcomes after surgery. Preoperative imaging includes weightbearing views of the foot and ankle, as well as an adjunct computed tomography scan. Imaging the painful ankle postsurgery often involves multiple modalities to define the underlying pathology and determine the appropriate management. Suggested imaging sequences are discussed. Copyright © 2012 by Thieme Medical Publishers, Inc.

Balli E.P.,Aristotle University of Thessaloniki | Venetis C.A.,Aristotle University of Thessaloniki | Miyakis S.,Aristotle University of Thessaloniki | Miyakis S.,Wollongong Hospital
Antimicrobial Agents and Chemotherapy | Year: 2014

Limited therapeutic options exist for the treatment of vancomycin-resistant Enterococcus (VRE) bacteremia; the most commonly used are daptomycin and linezolid. We attempted a systematic review and meta-analysis of the comparative efficacy of those two agents. Studies comparing daptomycin to linezolid treatment for VRE bacteremia, published until August 2012, were identified from the MEDLINE, EMBASE, CENTRAL, ISI Web of Science, and SCOPUS databases. All comparative studies on patients older than 18 years of age that provided mortality data were considered eligible for this systematic review and meta-analysis. he primary outcome of the meta-analysis was 30-day all-cause mortality. Ten retrospective studies including 967 patients were identified. Patients treated with daptomycin had significantly higher 30-day all-cause mortality (odds ratio [OR], 1.61; 95% confidence interval [CI], 1.08 to 2.40) and infection-related mortality (OR, 3.61; 95% CI, 1.42 to 9.20) rates than patients treated with linezolid. When data from all 10 studies were combined, overall mortality was also significantly increased among patients treated with daptomycin (OR, 1.41; 95% CI, 1.06 to 1.89). These findings were confirmed when odds ratios adjusted for potential confounders were pooled. Relapse rates among patients treated with daptomycin were also higher (OR, 2.51; 95% CI, 0.94 to 6.72), although this difference did not reach statistical significance. Adverse event rates were not significantly different between the two groups. Notwithstanding the absence of randomized prospective data, available evidence suggests that mortality rates may be higher with daptomycin than with linezolid among patients treated for VRE bacteremia. Copyright © 2014, American Society for Microbiology. All Rights Reserved.

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