Category: Articles

Categories
Case Reports

IVC thrombosis: An unusual complication of metastatic prostate cancer

Figure 1. Contrast enhanced abdominal CT scan: coronal section. This image demonstrates the ovoid hypodense filling defect in the IVC distal to the renal veins. The thrombus is expanding the cava (red circle). Note also the hypodense metastatic deposit in the liver (green circle).

Figure 1. Contrast enhanced abdominal CT scan: coronal section. This image demonstrates the ovoid hypodense filling defect in the IVC distal to the renal veins. The thrombus is expanding the cava (red circle). Note also the hypodense metastatic deposit in the liver (green circle).

This case report identifies an IVC thrombosis in a patient with stage IV prostate cancer. The case demonstrates hypercoagulability as one of the many complications of malignancy. The patient presented clinically with bilateral pitting oedema to the groin and into the scrotum with dilated superficial abdominal veins. The prostate cancer was aggressive and unresponsive to anti-androgen therapy and brachytherapy. The latest staging CT and bone scans revealed diffuse disseminated disease and a caval thrombus. He is now receiving chemotherapy as an outpatient and unfortunately his prognosis is unfavourable.

Categories
Case Reports

Intra-vitreal bevacizumab in patients with Juvenile Vitelliform Dystrophy (Best Disease)

Figure 1. Right fundus of Case One, eighteen months prior to the time of presentation with decreased left visual acuity. A vitelliform macular lesion typical of Best disease is present.

Figure 1. Right fundus of Case One, eighteen months prior to the time of presentation with decreased left visual acuity. A vitelliform macular lesion typical of Best disease is present.

Juvenile Vitelliform Dystrophy (Best disease) is a degenerative macular condition that is genetically inherited. In recent years monoclonal antibodies have been employed to help prevent the decline in vision associated with macular fluid. This report documents the use of intra-vitreal bevacizumab in two siblings (aged thirteen and fifteen) with Best Disease. This work studies the changes observed in visual acuity and macular oedema over a 39 and nineteen week period respectively.

Categories
Review Articles

Human papillomavirus in head and neck squamous cell carcinoma

Background: Head and neck squamous cell carcinoma (HNSCC) is a significant global health burden. Approximately 25 percent of HNSCC cases are caused by human papillomavirus (HPV). These particular cancers of viral aetiology have been found to have distinct characteristics in regards to presentation, treatment and prognosis. Current advances in vaccinology have the capability to drastically decrease the incidence of HPV-positive HNSCC. Methods: A literature review was undertaken through MEDLINE/PubMED/Ovid databases. The terms “HPV,” “HNSCC,” “carcinogenesis,” “treatment,” “prognosis” and “vaccine” were searched. Only studies published in English were considered with 65 articles selected and analysed. Preference was given to studies published in the last ten years. Results: The incidence of HPV-positive HNSCC is increasing. Infection with HPV can result in cancer through the expression of oncogenic proteins which disrupt normal cellular turnover. Aggressive treatment is often undertaken causing significant morbidity in many patients. A proportion of patients die from this disease, suggesting that these cancers have a considerable impact on society. Conclusion: Human papillomavirus is an infectious agent that is likely transmitted through skin-to-skin contact. The virus integrates into the DNA of the host with the high oncogenic risk genotypes, HPV 16 and 18 being strongly linked to HPV-positive HNSCC development. Prevention through vaccination against these genotypes is currently an option for all individuals. The cervical cancer vaccines immunise non-exposed females against HPV 16 and 18. Vaccination of both males and females will prevent HPV-positive HNSCC.

Categories
Review Articles

Management of infertility in the setting of polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is a common endocrine disorder which affects a significant number of premenopausal women in Australia. PCOS has long-term clinical implications which can lead to decreased quality of life and psychological morbidity. A major contributing factor to this is the impact of PCOS on a woman’s fertility. However, there are a number of treatment modalities that may be used to treat PCOS-related infertility and with appropriate treatment, a woman’s prognosis with regards to PCOS-related infertility can be excellent.

Categories
Review Articles

Acute blood loss in children

Hypovolaemia is the leading cause of circulatory failure in children. Effective fluid resuscitation is a mainstay of patient management and is dependent on accurate detection of blood loss or volume depletion. Calculation of blood volume in children is based on age, weight and clinical physiology and the estimation of the volume of blood lost requires interpretation of the history and orthostatic vital signs, especially heart rates. Administration of fluids following these calculations will also be discussed.

Categories
Review Articles

Balance and gait stability following sports-related concussion

Background: Concussion is an injury that is associated with many sports, in particular ice hockey, martial arts and the various codes of football. Concussion alters the stability of a person and as stability is vital when playing sports, the consequences of undiagnosed and untreated concussions are enormous. Aim: To look at various methods used to assess posture and stability in athletes, and their use in making safe return to play decisions after a sport-induced concussion. Methods: A search was conducted through PubMed, using the terms ‘concussion’ and ‘sport.’ Article titles were initially screened by the author and if the title seemed to be relevant to the purpose of the review, the abstract of the article was then screened for relevance. Results: Concussion negatively impacts upon an athlete’s cognitive and motor functioning. Cognitive testing has previously been assessed and is currently used; however it has been shown that cognitive function may return before motor functioning. The time taken to recover the motor component is usually between three to ten days; however, this varies considerably between athletes. Balance and gait testing are a means of objectively assessing the stability of an athlete and have proved to be particularly useful in monitoring the recovery of an athlete after suffering concussion. Conclusion: Balance and gait testing are means of objectively assessing the stability of an athlete. Although their use is applicable to many situations, they have proved to be of particular usefulness in monitoring the recovery of an athlete after suffering concussion. Through their use, the subjectivity of the assessment is being eliminated, ensuring informed and supported decision-making regarding the safe return to play.

 

Categories
Review Articles

Early impact of rotavirus vaccination

Background: Rotavirus is the most common cause of severe gastroenteritis in children and two vaccines to prevent rotavirus infection have been licensed since 2006. The World Health Organisation recommends the inclusion of rotavirus vaccination of infants in all national immunisation programs. Aim: To review current literature evaluating the global impact of rotavirus immunisation programs over the first two years of their implementation. Methods: A MEDLINE search was undertaken to identify relevant observational studies. Results: Eighteen relevant studies were identified which had been carried out in eight countries. Introduction of the vaccine was associated with a reduction in all-cause gastroenteritis hospitalisation rates of 12- 78% in the target group and up to 43% in older groups ineligible for the vaccine. Hospitalisation rates for confirmed rotavirus cases ranged between 46-87% in the target group. Mortality from all-cause gastroenteritis was reduced by 41% and 45% in two countries studied. Conclusions: Early research evaluating rotavirus immunisation programs suggests significant decreases in diarrhoeal disease rates extending beyond the immunised group. Further monitoring will allow vaccine performance to be optimised and for the long-term effect of vaccination programs to be assessed.

Categories
Original Research Articles

Emergency Department management and referral of self-harm patients

Aim: To outline the socio-demographic characteristics, the means of arrival, management and referral pathways for mental health presentations to the Emergency Department (ED) where the main reason for presentation is self-harm. Methods: A retrospective study conducted in a metropolitan hospital in Sydney. Sampled data were collected from mental health presentations to the ED for the month of May in 2005, 2006 and 2007. The data collected included patient demographics as well as management, referral and follow-up outcomes. Results: There were 606 patients in the sampled data (99.3% of all mental health presentations). The gender distribution of the patient cohort was 63:37 (male n=380 and female n=226) and the average age was 36 ± 16.7 years. Two hundred and three (33.5%) patients had self-harmed and 403 (66.5%) had other mental health problems. Self-harm patients’ mode of arrival included ambulance (38.4%), self-presentations (36.5%), police (14%), and other. Self-harmers were mainly admitted to Psychiatric Emergency Care Centre (PECC) (28%) or discharged home (51.7%). More than one third (35.5%) of self-harm patients did not receive adequate follow-up. Conclusion: Important variations between self-harm patients and other mental health patients were identified in their management and referral outcomes from the ED. Clinicians need to ensure that optimal patient care is provided through appropriate follow-up of every self-harm patient post-discharge from hospital.

 

Categories
Original Research Articles

Exploring barriers to the provision of palliative care in Australia

Palliative care provides assistance for people living with a terminal medical condition, for which the primary goal of treatment is improving quality of life. There are numerous barriers to the provision of palliative care. There is little research into barriers to the provision of palliative care and little with an Australian context. This research explores barriers to palliative care in Australia through questionnaires and interviews with stakeholders. One hundred and one questionnaires were given to South East Palliative Care (SEPC) community nursing and allied health staff, general practitioners and aged care facility staff. Five interviews were conducted with representatives from SEPC, Palliative Care Australia and two aged care facilities. Most agreed that palliative care was essential in the community, hospital and aged care setting. Four major themes were identified from interviews: 1.) Education & stigma barriers; 2.) Communication barriers; 3.) Aged care barriers; and 4.) General practice barriers. Inadequate prescriptions of pain medication were a significant issue. These themes were supported by questionnaire data, with 25.6% identifying education and 28.2% identifying resources as major barriers. Knowledge of palliative care was poor in both aged care staff and GPs, only 8.3% and 38.5% respectively answering all palliative care questions correctly, compared to 64.2% amongst SEPC staff. The study addresses a deficit in previous research, identifying barriers to palliation in aged care. The data collected has potential for further research or interventional approaches to improve the provision of palliative care for Australians.

Categories
Original Research Articles

Maternal attitudes towards breast and bottle feeding in a regional community

Background: Based on research demonstrating the many benefits of breastfeeding, it is recommended babies be exclusively breastfed from birth to at least six months of age. However, despite these known benefits, many women choose to bottle feed or cease breastfeeding before six months. Aim: To survey women in order to determine factors associated with their attitudes and choice to bottle feed or breastfeed their children, with the aim of identifying areas to target education to improve breastfeeding rates or duration. Methods: Anonymous surveys were distributed to a convenience sample of 106 adult female patients selected from a suburban general practice. MS-Excel and Epi Info 3.5.3 software package were used for data management. Chi square was used for analysis. Results: The response rate was 94.3% (n=100). There were trends suggesting an association between income and the respondents’ choices (p=0.26); and income and the respondents’ mothers’ choices (p=0.51). Respondents were significantly more likely to choose the feeding method their own mother used (p=0.01). Discussion: Income and respondents’ mothers’ choice regarding breastfeeding were identified as factors possibly associated with respondents’ attitudes and choice. Hence awareness of individual family dynamics may assist in targeting prenatal education to help increase rates of breastfeeding. A large proportion of respondents chose to bottle feed and also believed that the bottle was as good as breastfeeding. The needs of this group also need to be met. Conclusion: To increase breastfeeding rates, individualised prenatal education as well as supporting women through their breastfeeding problems is a likely requirement.