Australasian Medical Journal
Not a member yet
1482 research outputs found
Sort by
High flexion total knee arthroplasty using short posterior flange of femoral component mid-term results
Get PDFBackgroundHigh-flexion designs for total knee arthroplasty were introduced and promoted greater and safer knee flexion. However, early loosening of the femoral component related to the deep flexion was reported with high incidence.AimsContrary to conventional high-flexion designs, another femoral component was designed to allow high flexion by shortening the length of posterior condylar flange of femoral component. Authors evaluated the outcomes of high flexion total knee arthroplasty using short posterior flange of femoral component at least 3 years after the operation and to assess the occurrence of periprosthetic osteolysis and loosening.Methods Of the patients who underwent total knee arthroplasty using short posterior flange of femoral component between August 2011 and November 2014, 65 patients (94 knees) were enrolled. Knee Society Knee score, Knee Society Function score, maximal flexion angle were evaluated. Relationship between postoperative maximal flexion and radiographic factors including posterior tibial slope and femoral condylar offset was analyzed. Also, the occurrence of periprosthetic osteolysis and loosening was assessed.Results The maximal flexion was improved at the final follow-up (
Multislice computed tomography angiography in the diagnosis of patients with suspected aortic dissection: A single centre experience
Get PDFBackgroundComputed tomography angiography (CTA) is widely used as the preferred imaging modality in the diagnosis of aortic dissection with high diagnostic value. However, high radiation dose associated with CTA remains a concern, especially for young patients. Little research is available regarding the correlation between age groups and CT dose values.AimsTo investigate the clinical performance of CTA in diagnosing aortic dissection and determine the correlation between age groups and corresponding CT dose values based on a single centre experience.MethodsA total of 204 patient records were retrospectively reviewed for analysis of the CTA examinations over a period of 12 months. CTA findings regarding the type and extent of aortic dissection were analysed, while radiation dose values in terms of volume CT dose index (CTDIvol) and dose length product (DLP) were compared between different age groups (70 years).ResultsOf 204 patients, 170 had abnormal CTA findings with Stanford type A dissection diagnosed in 38 cases and type B dissection in the remaining 132 cases. There were significant differences in CTDIvol and DLP dose values between age groups (p=0.039-0.048) with the groups 31-40 years old having the highest radiation dose than other groups. The mean effective dose for all patients is 11.18mSv.ConclusionCTA is an accurate imaging modality for diagnosis of aortic dissection; however, reduction of radiation dose is necessary, especially for younger patients due to direct correlations between patient’s age and corresponding dose values
Emergency general surgery models in Australia: A cross-sectional study
Get PDFBackgroundEmergency general surgery (EGS) patients experience superior outcomes when cared for within an acute surgical unit (ASU) model. However, the EGS structures in most Australian hospitals remain unknown.AimsThis study aimed to describe the national spectrum of EGS models.Methods Surgical staff were contacted in all Australian public hospitals of medium (> 2,000 patient separations per-annum) or greater peer group. Primary outcomes were incidence of each EGS model. Secondary outcomes were the relationship of EGS model to objective hospital variables, and qualitative reasons for choice of model. An ASU allocated a general surgeon solely to EGS patients for ≥50 per cent of business hours. A Hybrid model did not have this feature, but provided either a doctor-in-training rostered solely to EGS for ≥50 per cent of business hours, or ≥2 protected theatre half-day EGS lists per week.Results One hundred and nineteen of 120 eligible hospitals participated (99 per cent). Sixty-four hospitals (54 per cent) reported utilising hybrid model. ASU implementation was significantly more common amongst hospitals of greater peer group (p < 0.0001), bed number (p < 0.0001), surgeon pool (p=0.0003) and trauma service sophistication (p=0.0002). Leading reported drivers for ASU commencement were aims to improve EGS patient care and decrease after-hours operating, while common barriers against ASU uptake were insufficient EGS patient load or surgeon on-call pool.ConclusionASU or Hybrid models of care for EGS patients may be more widespread than currently reported. Introduction of such structures is heavily dependent on hospital and staff size, trauma subspecialisation and EGS patient throughput
Renal tubular acidosis in pediatrics: A review article
Get PDFBackgroundRenal tubular acidosis was first defined by the incapacity to lower urinary pH below 5.5, normal GFR associated with hyperchloremia and a normal plasma anion gap, and later the definition added tubular impairment in the bicarbonate reabsorption.AimsTo provide an overview of types, diagnosis and management of renal tubular acidosis. The study focuses on syndromes found in Saudi Arabia. Methods This study is a review article about renal tubular acidosis. It is composed of an extensive research in pubmed, uptodate, BMJ, Cochrane.Results There are different hypothesis and genetic play a role in renal tubular acidosis. Treatment varies from each type, but with proper treatment promotes normal growth development.ConclusionThis study is an overview of renal tubular acidosis. It provides a comprehensive summary to interns, residents and consultants in the medical field
Favourable outcome of thrombotic thrombocytopenic purpura despite delayed presentation
Get PDFDelayed presentation of thrombotic thrombocytopenic purpura (TTP). We report a female patient presenting with a headache and dizziness for two weeks, her past medical history is notable for epistaxis otherwise unremarkable. On examination she was pale with a tinge of jaundice. She was vitally stable, other systems were unremarkable. A peripheral blood smear showed evidence of microangiopathic haemolytic anaemia (MAHA) and thrombocytopenia. No evidence of organ dysfunction. Plasma exchange and corticosteroids were started with dramatic response. This case illustrates the efficacy of plasmapheresis in late TTP
Assessment of knowledge and awareness of Vitamin D among physicians and students of healthcare
Get PDFBackgroundVitamin D deficiency is now considered to be a widespread epidemic. A poor level of knowledge and an inadequate level of awareness are two of the main risk factors for vitamin D deficiency.AimsThis study aimed to assess the level of awareness and knowledge about vitamin D deficiency and identify factors associated with the level of awareness among healthcare workers and healthcare professional students.MethodsFrom September 2017 to March 2018, a self-administered questionnaire was used to collect data among physicians and students of healthcare in Jeddah, Saudi Arabia.Results Of 529 participants, 320 (60.5 per cent) were students and 209 (39.5 per cent) were healthcare workers. The overall mean knowledge scores (maximum score=35) were 20.0±5.5 (58.8 per cent) among healthcare workers and 15.9±5.5 (46.8 per cent) among students. Most healthcare workers and healthcare professional students stated that vitamin D is used to treat bone disease and rickets (96.2 per cent and 89.4 per cent, respectively), maintain calcium and phosphate levels (95.2 per cent and 87.8 per cent, respectively), and strengthen immunity (68.3 per cent and 60.9 per cent, respectively). Most healthcare workers (94.7 per cent) and students (91.5 per cent) stated that osteoporosis is a result of vitamin D deficiency.Less than half of healthcare workers (38.3 per cent) and less than quarter of healthcare professional stated that vitamin D reduces the risk of diabetes. Only 13.1 of healthcare professional and 11.6 per cent of healthcare professional stated that vitamin D reduces the risk of premature birth. However, less than one-third of workers and one-fifth of students were aware of the correct dose.ConclusionThis study highlighted the lack of knowledge regarding vitamin D deficiency among healthcare professional students and healthcare workers in Jeddah, Saudi Arabia. There was a significant association between the level of knowledge and position. More continuing medical education programs and campaigns need to be implemented to raise awareness about the condition
An evaluation of irregular antibody profile in voluntary blood donors and blood transfusion recipients
Get PDFBackgroundUnexpected antibodies can develop in multiple transfused patients as well as in healthy donors who were either transfused or pregnant previously. This unexpected alloantibodies can complicate transfusion process, cross matching of blood and can occasionally cause severe transfusion reactions if a large amount of plasma or whole blood is transfused as in massive transfusion and in paediatric patients. AimsThe purpose of this study was to screen and identify irregular/unexpected antibodies in voluntary blood donors and blood transfusion recipients in and around Gangtok and to provide compatible blood and prevent transfusion reactions due to such antibodies.Methods A prospective cross-sectional study was carried out in a total of 2415 samples from voluntary blood donors and transfusion recipients and tested for the screening and identification of unexpected antibodies for the period of 2 years from 1st September, 2014 to 31st August, 2016 in Blood Bank of Tertiary care hospital, Central Referral Hospital, Sikkim. Results The positive screening rates for unexpected antibodies were found to be 1.48 per cent in donors (n=1999); and 3.03 per cent in blood transfusion recipients (n=416). Antibodies against the Kell system were the most frequent (Anti-Kpa- 32.1 per cent; Anti-K- 27.7 per cent), followed by antibodies against Lutherium system (Lua-22.73 per cent), against Rh system (Anti-Cw-22.73 per cent; Anti-E -18.18 per cent) and so on. ConclusionSince clinically significant antibodies are frequently detected in our donor as well as transfusion recipient samples, screening and identification of unexpected antibody is a must and the need of the hour. Knowledge of such alloantibodies is essential not only in the multitransfused patients but in all hospital patients who require or may require transfusion. This study not only helps in selecting appropriate RBC products for transfusion but also avoids unnecessary delays in provision of blood in case of emergencies or surgical complications
Quantitative assessment of 3D printing model accuracy in delineating the normal heart anatomy based on in vitro phantom experiments
Get PDFBackgroundAlthough the diagnosis of heart disease has improved with the rapid development of scanning techniques such as computed tomography (CT), magnetic resonance imaging (MRI) and echocardiography, there are still limitations in diagnosing patients with congenital heart disease (CHD) due to its complex morphology.AimsThe aim of this study is to use a preserved pig heart for conducting phantom experiments and creating a highly accurate 3D model using 3D printing technique. Methods Palatinate pig hearts were used in the phantom experiments to investigate the accuracy of the 3D printed model in comparison with the CT images and 3D segmentation files as well as the real object of the pig’s heart.Results Eight comparisons and scatter plots were generated from six different datasets consisting of pig heart, 3D printed model, two standard tessellation language (STL) files and two CT images data. A strong correlation (r=0.99) was noted in each scatter plot while pig heart and 3D printed model averaging 0.21mm in difference.ConclusionThis study has shown that the 3D model which was printed with a pig heart has high accuracy in replicating normal cardiac anatomy
Modern surgical treatment of malignant skin melanoma: A brief literature overview
Get PDFBackgroundMalignant melanoma (MM) of the skin is a rare, highly malignant tumour, affecting younger age. Its incidence rate has been rising as compared to all malignant neoplasms – 5 per cent of all newly diagnosed cancers in men, and 6 per cent of those in women.AimsThe aim of the literature review is the present the contemporary tendencies in the surgical treatment and monitoring of patients with malignant melanoma of the skin.Methods Systematic Literature Review Made By Google and Science Direct.com Search Engines. Publications and guidelines in English, including the newest aspects in the overall care of patients with malignant melanoma of the skin. Information for the indications and contraindications of performing a sentinel biopsy.Results The study established that the most modern surgical treatment of a malignant melanoma of the skin includes: primary tumour biopsy, sentinel biopsy of the regional lymph nodes with wide re-excision of the affected area, usually with a radius of 2cm, and the removal of local recurrences, lymph and distant organ metastases. When it comes to monitoring, it has to be done according to the contemporary worldwide guidelines.ConclusionSuccessful treatment of skin MM is in direct correlation to keeping up with the most modern tendencies
Primary cutaneous adenoid-cystic carcinoma of thigh found accidentally and presenting with the clinical picture of small pigmented (dark brown) cutaneous fibroma
Get PDFThe primary cutaneous adenoid-cystic carcinoma represents a very rare neoplasm - less than 100 similar cases are reported in the literature until now. It affects persons of middle age or elder the female is involved a little more often the local relapses are observed in about half of the cases and it metastasizes most frequently in the regional lymph nodes and lungs.We present a case of a 31-year-old woman with primary adenoid-cystic carcinoma of skin which was treated for a pigmented cutaneous fibroma. This required reoperating the patient.The clinical manifestation of primary cutaneous adenoid-cystic carcinoma may imitate benign pigmented cutaneous fibroma. The final diagnosis of this disease is made by a pathologist based on the pathomorphological exam and immunohistochemistry. The basic method for treatment in these cases is the extensive local excision in a radius of 2cm from the lesion to avoid the risk of local relapse