Australasian Medical Journal
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Feasibility of the use of touch imprint cytology for the assessment of axillary lymph nodes in breast cancer in the rural setting
Get PDFBackgroundSentinel lymph node (SLN) biopsy for the assessment of axillary lymph nodes (ALN) is the gold standard in the management of breast cancer. Patients with a positive SLN will undergo an axillary clearance on a later date. Intra-operative assessment of the SLN is a valuable tool and often performed using Frozen section (FS) in certain tertiary centres. Most rural centres do not have access to this facility due to lack of resources. As patients often travel long distances for specialist treatments within the rural networks, having access to an easy-to-perform intra-operative SLN assessment tool is invaluable.AimsThe aim of this study was to assess the feasibility and sensitivity of TIC and if it can be applied in the rural setting in assessment of SLN in invasive breast cancer.Methods100 patients with newly diagnosed breast cancer were recruited in this cross-sectional study. The management of these patients was not altered in any manner. SLNs were assessed intra-operatively by TIC prior to being sent for formal histological (FH) analysis. We compared the intra-operative TIC assessment with the formal histopathology. This gave an indication of whether TIC assessment was comparable to alternative intra-operative SLN assessment.ResultsFrom the 100 patients selected, seventeen patients were found to be true positive, and 78 were found to be true negative. This gave TIC assessment a positive predictive value (PPV) of 0.89 and a Negative predictive value (NPV) of 0.96. The limitations of TIC were its lack of sensitivity with micrometastasis. ConclusionOur trial was limited by the small number of patients enrolled. TIC lacks the sensitivity in assessing micrometastasis and therefore we do not recommend its use in the intra-operative assessment of SLN
Time for Australia to revisit antipsychotic use in dementia in residential aged care
Get PDFBackgroundResearch shows that antipsychotic medication is over used and inappropriately prescribed in residential aged care settings. New research suggests trial periods of only two weeks, not twelve weeks, may be sufficient to determine response to treatment.AimThis brief report outlines the necessary research and changes to policy and practice in Australian residential aged care facilities to achieve best practice for antipsychotic use.ConclusionExperts concur that change is required in antipsychotic use. New findings provide the impetus for further research and robust policy regarding evaluation of antipsychotic use
Isthmocele: An important sequelae of caesarean section - report of three cases and mini review
Get PDFAn isthmocele appears as a fluid-filled pouch-like defect in the anterior uterine wall at the site of a prior caesarean section, and ranges in prevalence from 19 per cent to 84 per cent, a direct relation to the increase in caesarean sections performed worldwide. It is the result of incomplete healing of the isthmic myometrium after a low transverse uterine incision performed for caesarean section. Although mostly asymptomatic, it may cause menstrual abnormalities, chronic pelvic pain, and secondary infertility. Scar tissue dehiscence, scar pregnancy, and abnormally adherent placenta are some of the obstetric complications associated with this defect. Diagnosis of the defects can be made with transvaginal ultrasound (TVUS), saline infused sonohysterogram (SIS), hysterosalpingogram, hysteroscopy, and magnetic resonance imaging (MRI). Surgical treatment of an isthmocele is still a controversial issue but it should be offered to symptomatic women or asymptomatic patient who desires future pregnancy. When surgery is the treatment choice, laparoscopy guided by hysteroscopy, or hysteroscopy alone are the best options depending on the isthmocele's characteristics and surgeon expertise.We would like to present a mini-review of the topic with contribution of three cases
Two relatives female patients with primary malignant phyllodes sarcoma and primary stromal sarcoma of breast
Get PDFThe primary sarcoma of breast is a rare malignant tumor, which develops from the mesenchymal tissue of mammary gland. It represents less than 1% of all malignant diseases of breast. The incidence is about 17 new cases per 1 000 000 women. The etiology of that disease is unknown. The main method of treatment is the surgical excision with includes ";;;;safety-margin";;;; of healthy-looking tissues. We present a 57-year-old woman with probably familial, primary, malignat phyllodes sarcoma
Appropriate management of traumatic dental injuries at the hospital emergency department provides a positive impact on patient outcomes
Get PDFThe objective of this case study is to highlight the importance of medical doctors’ management of acute dental trauma. Correct diagnosis and treatment techniques are essential for an optimal long-term prognosis of restored function and aesthetics for the patient. The aim of correct management of acute traumatic dental injuries (TDI) to permanent teeth is to protect patients from inaccurate diagnosis, poor treatment by clinicians and to stabilize the condition before referring to a dentist for permanent dental care. This case shows that appropriate management of acute dental injuries by the emergency doctor prevented the loss of teeth at an earlier age
Rates of clarithromycin resistance in Helicobacter pylori sampled from healthy subjects in Cheonan, Korea
Get PDFBackgroundThe increasing use of the standard triple therapy for eradication of Helicobacter pylori (H. pylori) has led to an increase in the prevalence of strains resistant to existing drugs, thereby lowering the success rate of eradication therapies.AimsThis study aimed at promoting effective eradication therapy by investigating the H. pylori infection rate, incidence of clarithromycin resistance, and types of mutations.Methods Using a PCR kit that amplifies a gene site known to be resistant to antibiotics in H. pylori, the resistance gene retention rate is determined and analyzed using various methods. The rapid urease test (RUT) was performed on patients undergoing routine health exams in Cheonan, and residual specimens were analyzed through DPO-based multiplex PCR to examine point mutations of the 23S rRNA gene, a gene responsible for clarithromycin resistance in H. pylori.Results The statistical program R was used for data analysis. Data are presented as medians and ranges. A chi-square test was used to analyze the categorical data. A p-valu
Epidemiology of frequent admitters of cardiovascular diseases in urbanizing Pune population
Get PDFBackgroundIschemic heart disease is known to be prevalent in Indian populationAimsTo study the prevalence of CVDs in Pune population and to elucidate comorbidities and the risk factors associated with frequently admitted CVD patients.MethodsA descriptive cross-sectional study was carried out for a period of five years (2011–2015) in Pune India. Data was retrieved from Life Line software at Bharti Hospital. ICD-10 was followed throughout the study. Comorbidities and risk factors were estimated in frequent CVD admitters. For estimation of oxidative stress, antioxidant marker enzymes were estimated from plasma samples of CVD patients. Chi-square test was employed for the study of association in proportions. Kruskal-Wallis test was performed to test significance of difference. ResultsAmong 939 cardiac patients, MI represented as the most common CVD especially in men (38.79 per cent). Higher level of Lipid peroxidation was reported in MI (14.43±1.82) than IHD (13.06±2.23), HCM (7±1.47) and control (2.44±0.74) (p < 0.001). MI patients show higher comorbidities and increased risk of developing complications. Glutathione reductase (U/mg) was decreased in MI (1.76±0.2) and HCM (1.8±0.3) patients than IHD (2.14±0.4) and Control samples (2.17±0.3) (p < 0.05). ConclusionMI is more often observed in frequent admitters of CVDs. IHD patients show higher comorbidities than other CVDs in this population. Oxidative stress was found to be more in MI than other cardiac disorders
Lymph node involvement and the role of lymphadenectomy in patients with advanced ovarian cancer
Get PDFBackgroundOvarian carcinoma (OC) is one of the most common types of cancer diagnosed in women and its clinical significance is reflected in the leading place it holds in the morbidity and mortality rates among women diagnosed with cancer. The evaluation of lymph node involvement by the oncosurgeons is a pivotal step towards proper disease staging and adjuvant therapeutic choices, towards optimal treatment outcomes.AimsThe aim of this study was to investigate the lymph node metastases and patient characteristics in women with advanced OC (FIGO II-IV).MethodsThe study includes 58 patients with advanced OC (FIGO II-IV) operate in our clinic for the period 2004-2012. The patients were analysed with respect to age, FIGO stage, histological type and tumour grading, type of surgical verification of lymph nodes (biopsy, pelvic and/or para- aortic lymphadenectomy), results from histopathological reports describing the extent of lymphatic involvement, localization of lymph node metastases, and presence of ascites.ResultsLymph node metastases were found in 56.7 per cent of the patients. 24.1 per cent of the patients had micrometastases in lymph nodes that were not initially detected on both pre- operative diagnostic imaging and intraoperative inspection. ConclusionThe only reliable method for initial/early detection of lymphatic metastases in patients with OC is the surgical, through lymphadenectomy, with subsequent histological evaluation
Weather and its effects on RSV A and B infections in infants and children in Korea
Get PDFBackgroundThe epidemic patterns of respiratory syncytial virus (RSV) infection and the factors determining its seasonality are not well studied in the local society of South Korea.AimsThis study aims to investigate the prevalence of RSV infection in hospitalized children and its relationship with climate change in Cheonan, Korea.Methods This retrospective study included 2,484 children (aged 0–14 years) who were hospitalized for respiratory tract infections documented RSV test at a tertiary hospital in Cheonan between December 2006 and February 2014. Daily temperature and humidity data during the period were obtained from the Korea Meteorological Administration.Results In total, 752 (30 per cent) showed tested positive for RSV infection, and the prevalence was noted to be higher during November and December. RSV A and RSV B were less likely to be detected simultaneously (0.4 per cent). RSV A was more likely to be detected during lower temperatures, lower wind speeds, and shorter daylight hours, and RSV B during lower daily precipitation and higher humidity. RSV infection was predominantly prevalent between November and April. The infection rate of RSV peaked every other year in Korea. Air temperature was associated with the epidemics of RSV infection.ConclusionFurther understanding of the effect of climate on RSV infection will help in timely prevention using immunoprophylaxis or future vaccines