Australasian Medical Journal
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A successful natural conception and childbirth after embolization of uterine arteriovenous malformation
No full textUterine AV malformation is dreadful condition due to vaginal bleeding. In past the only option was hysterectomy which leads to cessation of reproductive function. Here we are presenting a case where we preserved the reproductive function through Transarterial Embolization (TAE) technique. Post TAE patient resumed average flow regular menses, conceived naturally and delivered by elective caesarean section
CYP3A5 genotyping may reduce the cost of care and guide dosing in paediatric renal transplant recipients treated with tacrolimus
No full textTherapeutic tacrolimus blood levels are often difficult to achieve immediately after transplant. Pharmacogenetic testing is an option to predict the metabolism of tacrolimus; however the clinical benefits of this approach have not been extensively studied. We describe two paediatric renal transplant recipients who were initially treated with a standard dosing equation for tacrolimus, but required increased frequency of therapeutic drug monitoring and multiple dose adjustments leading to increased cost of hospitalization. A novel perspective is that pharmacogenetic testing is appropriate to reduce length of hospitalization and the total cost of care
Oral Candidiasis and Inflammatory Response: a Potential Synergic Contribution to the Onset of Type-2 Diabetes Mellitus
No full textIt is known that fungal pathogens activate cellular immune responses involving several inflammatory molecules. On the other hands, it is well known that diabetic patients show a chronic inflammatory state. In this study, we explore the hypothesis that yeast colonization of the oral cavity directly influences the tendency of an individual to develop type 2 Diabetes. According to this hypothesis, oral yeast colonization may influence the pathway in which the immune response handles subsequent responses to glucose intake. The first part of this work presents data concerning oral Candida carriage in subjects with pre-diabetes, the second part explores the potential role of oral Candida infection, related to inflammatory response in promoting insulin resistance
Treatment of radiation-induced erectile dysfunction with low-intensity extracorporeal shock wave: A case report
Get PDFLow-intensity extracorporeal shock wave therapy is a new treatment in treating vasculogenic erectile dysfunction. We report a case of low-intensity extracorporeal shock wave therapy used for treating radiation-induced erectile dysfunction. A 66-year-old gentleman with dyslipidemia and smoking presented with radiation-induced erectile dysfunction. Six sessions of low-intensity extracorporeal shock wave therapy were administered. Pre-treatment IIEF-5 score was 10 and post-treatment IIEF-5 score at one month was 19. Low-intensity extracorporeal shock wave therapy has the potential to treat radiation-induced erectile dysfunction
A case control study of risk factors of coronary heart disease among patients admitted at tertiary hospital in western India
No full textBackgroundCoronary heart disease (CHD) is a major cause of death in the world. In this study, various risk factors of CHD were explored.AimsTo find out association of CHD with its risk factors in Western India.Methods A 100 cases of first episode of Acute Coronary Syndrome (ACS) patients and 200 age and sex matched controls from medical wards of a government run tertiary care hospital were interviewed through modified WHO STEPS questionnaire along with physical examination and anthropometric measurements. Data was cleaned and analysed through SPSS.Results On bivariate analysis current smoking status [OR=2.906 (1.69–4.98)], BMI [OR=2.6492 (1.49–4.72)], waist circumference [OR=1.7051 (1.01–2.88)] and positive family history [OR=2.0457 (1.07–3.91)] were found to be significantly associated with ACS cases. On multivariate analysis, BMI [OR=2.612 (1.376–4.959)] and current smoking status [OR=3.005 (1.791–5.042)] were found to be significantly associated with ACS cases.ConclusionOut of conventional risk factors, BMI and current smoking status were the only risk factors which had positive association with CHD in this study
Patient age at diagnosis and the clinicopathological features of breast cancer in women
Get PDFBackgroundBreast cancer (BC) is diagnosed commonly in younger Ghanaian women compared to women in western countries.AimsThe aim of this study was to compare the clinico-pathological features of BC in young women (≤39 years) with older women (≥40 years) and draw conclusions.Methods This was a retrospective review (2001–2014).Results Approximately 19.6per cent of the study population were women aged ≤39 years (Group A). Bilateral BCs were commoner in group A compared to B (women aged 40 years or older), [(1.1per cent vs. 0.6per cent), (p=0.002]. About 60.7 per cent of group A had skin involvement compared to 71.3 per cent for B, (p=0.002). About 75.7 per cent of group A women presented with breast lumps after 3 months of onset (late), compared to 70.1 per cent of group B women (p=0.000). The mean size of primary BC for A was 5.6cm compared to 5.1cm for B, (p=0.004). Positive tumour margins were found in 27.7 per cent of BCs in A and 24.2 per cent in B, (p=0.003). Grade 3 tumours were common in group A than B [(35.8 per cent vs. 31.0 per cent), p=0.002]. Approximately, 70.5 per cent group A women had positive nodes compared to 88.8 per cent of group B (p=0.001). Higher TNM stages were found in group A compared to B [(58.1 per cent vs. 51.1 per cent, p=0.033)].ConclusionThe study found that 19.6 per cent of the women were age 39 years or younger. Features of advanced BC were common in younger women. Routine self-breast examination is recommended for all Ghanaian women to enhance early detection and management of neoplastic lesions
Analysis of failed rotator cuff repair – Retrospective survey of revisions after open rotator cuff repair
Get PDFBackgroundRotator cuff defects are frequently occurring shoulder pathologies associated with pain and movement impairment.AimsThe aim of the study was to analyse the pathologies that lead to operative revisions after primary open rotator cuff repair.Methods In 216 patients who underwent primary rotator cuff repair and later required operative revision between 1996 to 2005, pathologies found intraoperatively during the primary operation and during revision surgery were collected, analysed and compared. Results The average age at the time of revision surgery was 54.3 years. The right shoulder (61.6 per cent) was more often affected than the left, males (63.4 per cent) more often than females. At primary operation – apart from rotator cuff repair – there were the following surgical procedures performed: 190 acromioplasty, 86 Acromiclavicular joint resections, 68 tenodesis, 40 adhesiolysis and 1 tenotomy. If an ACJ-resection had been performed in the primary operation, ACJ-problems were rare in revision surgery (p < 0.01). Primary gleno-humeral adhesions were associated with a significant rise in re-tearing rate (p=0.049). Primary absence of adhesions went along with a significant lower rate of adhesions found at revision (p=0.018). Primary performed acromioplasty had no influence on re-tearing rate (p=0.408) or on the rate of subacromial impingement at revision surgery (p=0.709).ConclusionTo avoid operative revision after rotator cuff repair relevant copathologies of the shoulder have to be identified before or during operation and treated accordingly. Therefore, even during open rotator cuff repair, the surgeon should initially start with arthroscopy of the shoulder joint and subacromial space to recognise co-pathologies
The impact of the 2016 World Health Organization classification of tumours of the Central Nervous System upon diagnosis and prognosis
No full textOur Surgical Experience in Desmoid Tumors
No full textBackgroundDesmoid tumour (DT) is a locally aggressive soft tissue tumour which is histologically characterized by fibroblastic proliferation in collagen matrix. They may originate from almost any location, mainly from limbs, abdominal wall and abdominal cavity, and occur more frequently in women of childbearing age.AimsRadical resection is generally considered as the most appropriate treatment for patients with desmoid tumours. Alternative methods of treatment are available for patients with unresectable. Methods Nine patients who had DT pathology between January 2008 and January 2013 in İzmir Katip Çelebi University Atatürk Training and Research Hospital, General Surgery Clinic were included in the study.Results The mean age of the nine patients (three males and six females) was 40.1. Two patients (one male and one female) had been diagnosed with familial adenomatous polyposis (FAP), accompanied by Gardner’s syndrome (GS). Among the desmoid tumours, five (55.6 per cent) were intra-abdominally located, two (22.2 per cent) were located in the anterior abdominal wall, one (11.1 per cent) in limbs, and one (11.1 per cent) in breast.ConclusionSurgical resection in which a sufficient amount of surrounding healthy tissue is removed together with the tumour provides an effective treatment. We believe that, for those tumours which cannot be resected or incompletely resected, addition of Tamoxifen to the therapy will provide favourable results for regression