Biomedical subjects

A K House

Publications and source records attributed to A K House.

At least 19 recordsLinked to original sources

PubMed2006

Matrix metalloproteinase mRNA expression in canine anal furunculosis lesions.

Although the aetiology of anal furunculosis (AF) in dogs is poorly understood, there is evidence for an underlying immune dysfunction. This is illustrated by the presence of a T helper type 1 cytokine mRNA profile in AF lesions and the clinical response to ciclosporin therapy. Expression of MMPs 2, 9 and 13 were evaluated in AF lesional biopsies by real-time quantitative RT-PCR. There was significantly increased expression of both MMP-9 and MMP-13 mRNA in AF biopsies compared to controls (p<0.001) but no significant difference in MMP-2 mRNA expression. Since MMP-9 and MMP-13 are primarily produced by macrophages, these data suggest that ulceration could be the result of aberrant activation of this cell type in the tissues. It is feasible that such pathological macrophage activity occurs in response to interferon-gamma secreted by T helper type 1 cells. This could explain why the lesions resolve following treatment with the immunosuppressive drug ciclosporin.

Animals↗

PubMed2005

Unusual vascular ring anomaly associated with a persistent right aortic arch in two dogs.

An unusual vascular ring anomaly consisting of a persistent right aortic arch and a left ligamentum arteriosum extending from the main pulmonary artery to an aberrant left subclavian artery and left aortic arch remnant complex was identified in a German shepherd dog and a great Dane. The left subclavian artery and left aortic arch remnant complex originated at the junction between the right distal aortic arch and the descending aorta and coursed dorsal to the oesophagus in a cranial direction. The attachment of the ligamentum arteriosum to the aberrant left subclavian artery was approximately 5 cm cranial to the point of origin of the aberrant left subclavian artery and left aortic arch remnant complex from the descending aorta in both dogs. This anomaly observed in both dogs is similar to an anomaly reported in humans, in which a persistent right aortic arch is found in conjunction with an aberrant left subclavian artery and a left aortic arch remnant (Kommerell's diverticulum). Surgical ligation and division of the left ligamentum arteriosum in both dogs, along with division of the left subclavian artery in the great Dane, resulted in resolution of clinical signs in both of the dogs in this report.

Animals↗

PubMed2005

Localised mid-jejunal volvulus following intussusception and enteroplication in a dog.

Ileocolic intussusception was successfully treated surgically by partial enterectomy and enteroplication in an 11-month-old, male neutered German shepherd dog. Segmental intestinal volvulus was identified in the same dog two months later and was managed successfully by a second partial enterectomy. The dog made an uneventful recovery and was free of clinical disease six months after the second surgery. Both conditions are reviewed in this case report and a possible relationship between these two episodes in this dog is discussed.

Anastomosis, Surgical↗

PubMed2004

Aciclovir or ganciclovir universal prophylaxis of cytomegalovirus infection in liver transplantation: an economic analysis.

BACKGROUND: Cytomegalovirus (CMV) following orthotopic liver transplantation can result in significant morbidity and mortality. Prophylaxis with oral aciclovir (ACV) or ganciclovir (GCV) for all transplant recipients (universal prophylaxis) may be beneficial, but which agent is more cost-effective is unknown. METHODS: A single centre, retrospective study of all patients who had OLT at the Western Australian Liver Transplantation Service was performed. Patients received ACV from 1992 to 1998, and GCV from 1999 to 2001. A comparative cost-effectiveness analysis for the two groups was performed based on the mean total cost of the number of cases of CMV infection and disease as the clinical end-point. RESULTS: The ACV group comprised of 55 patients and there were 24 in the GCV group. The incidence of CMV disease was 7% and 4% for the ACV and GCV groups, respectively (P > 0.05). For CMV infection it was 16% and 8%, respectively (P > 0.05). GCV prevented more cases of CMV infection and disease than ACV but at an incremental cost of dollars A20,000 (dollars US10,172) per case prevented. Overall, ACV was more cost-effective than GCV by dollars A2200 (dollars US1119) per person. The cost benefit of ACV was derived principally through a reduced pharmaceutical cost. Both agents were well tolerated without development of antiviral resistance. CONCLUSIONS: Universal prophylaxis of CMV infection-following liver transplantation with aciclovir is more cost-effective than with ganciclovir.

Acyclovir↗

PubMed2002

Rural residents' utilisation of health and visiting specialist health services.

INTRODUCTION AND OBJECTIVES: The purpose of the study was to identify the demographic and health service characteristics impacting on rural residents' utilisation of health and visiting specialist services in Western Australia. METHOD: Focus group discussions were held with an age-stratified, randomly selected group of forty-eight residents in four rural Western Australian towns between May and June 2000. RESULTS: Discussions revealed a preference to use local health services for basic care and to travel for the treatment of major or severe illnesses. The focus group participants supported visiting specialist services, indicating a willingness to use them for consultations, diagnostic and minor procedures. Utilisation of visiting services was conditional on the provision of information on specialist reputation, service outcomes, integration of the service into local facilities, and recommendation by the local general practitioner. CONCLUSION: Numerous factors influence the service-seeking behaviour of rural patients. These factors need to be recognised and considered in the design and promotion of resident and visiting specialist services if the migration for health care is to be rationalised.

Journal Article↗

PubMed2001

Adult-to-adult living donor liver transplantation for fulminant hepatic failure.

The outcome of fulminant hepatic failure without timely liver transplantation is poor. We describe a 19-year-old woman with fulminant hepatic failure due to acute hepatitis B infection who received a living donor liver transplant from her sister. The donor's recovery was uneventful, allowing hospital discharge on Day 6. Two months after transplantation the recipient developed a biliary stricture requiring surgery. One year after transplantation, her liver function was normal.

Adult↗

PubMed2001

Costs of accessing surgical specialists by rural and remote residents.

INTRODUCTION: Access to surgical specialist services by rural and remote residents in Australia is limited. Little information is available on the cost to rural residents of accessing specialist treatment. The aim of the present study was to define the personal costs incurred by country patients in Western Australia when accessing specialist surgical services in a rural or metropolitan setting. METHODS: A random sample of 50 patients who attended a visiting rural surgical service between December 1998 and February 1999 inclusive was recruited. In a structured telephone interview patients were asked 40 non-clinical questions relating to their recent specialist consultation. The cost of accessing these services was determined from time lost from work, distance and travel expenses. The same formula was then applied to estimate the cost of attending a base metropolitan hospital. The need for an accompanying person was determined from a subset of 16 patients who had transferred to metropolitan specialist consultation in the previous 12 months. Average waiting list times for consultations and common surgical procedures for the visiting service were compared with those for a metropolitan-based service. RESULTS: An estimated saving of AU$1,077 was made per specialist consultation when accessing a local rather than a metropolitan service. Savings were observed in travel time, distance travelled, lost income, provision of an escort and waiting time. CONCLUSION: The present study shows that the personal costs and difficulties incurred by rural and remote residents when accessing specialist treatment can be reduced if a visiting specialist service is available.

Adult↗

PubMed2000

Improving basic surgical skills for final year medical students: the value of a rural weekend.

BACKGROUND: Hospitals employing medical graduates often express concern at the inexperience of new interns in basic surgical skills. In self assessment questionnaires, our senior medical students reported little clinical procedural experience. A practical skills workshop was staged in order to set learning goals for the final study year. This gave the students an opportunity to learn, revise and practice basic surgical techniques. METHOD: The Bruce Rock rural community sponsored a surgical camp at the beginning of the academic year. Ninety-five (80%) of the class registered at the workshop, which rotated them through teaching modules, with private study opportunities and the capacity to cater for varied skill levels. Eight teaching stations with multiple access points were provided, and ten mock trauma scenarios were staged to augment the learning process. RESULTS: The teaching weekend was rated by students on an evaluative entrance and exit questionnaire. Sixty-five (73%) students returned questionnaires. They recorded significant improvement (P < 0.05) in their ability to handle the teaching stations. All students had inserted intravenous lines in practice prior to the camp, so the rating change in intravenous line insertion ability was not statistically significant. CONCLUSIONS: The weekend retreat offers students a chance to focus on surgical skills, free from the pressures of a clinical setting or the classroom. The emphasis was on the value of practice and primary skills learning. Students endorsed the camp as relevant, practical and an enjoyable learning experience for basic surgical skills.

Cardiopulmonary Resuscitation↗

PubMed1999

Gastric carcinomas with microsatellite instability: clinical features and mutations to the TGF-beta type II receptor, IGFII receptor, and BAX genes.

The replication error phenotype (RER+) represents an important new form of genetic alteration characterized by widespread instability in repetitive nucleotide sequences. The aim of this study was to compare the features of RER+ gastric tumours with those of RER+ colonic tumours. RER status was determined by analysis of size alterations in the BAT-26 mononucleotide repeat microsatellite. Twelve of 121 (10 per cent) gastric carcinomas from a low-incidence region were found to be RER+. BAT-26 instability was associated with tumours showing an absence of nodal invasion ( p=0.009) and with a trend for improved prognosis. These tumours were more frequent in older, female patients. Frameshift mutations in mononucleotide repeat sequences within the transforming growth factor-beta receptor II (RII), insulin-like growth factor II receptor (IGFIIR), and BAX genes were observed in 83, 33, and 25 per cent, respectively, of RER+ tumours. Only 1/12 (8 per cent) RER+ tumours contained a p53 gene mutation compared with 29/109 (27 per cent) RER- tumours. RER+ gastric carcinomas therefore share several important features with RER+ colonic tumours, including less frequent nodal invasion, improved prognosis, a similar frequency of mutation in growth control genes containing repetitive nucleotide sequences, and a low frequency of mutation of the p53 tumour suppressor gene.

Aged↗

PubMed1999

Banff schema for grading liver allograft rejection: utility in clinical practice.

An accurate and functional system for grading acute liver allograft rejection is important for patient management, research, and communication. The Banff schema is a consensus document designed to provide an internationally accepted standard for this purpose. The aim of this study is to determine if application of the Banff schema would significantly alter the grading of acute liver allograft rejection compared with the Birmingham system. One hundred twenty-four post-liver transplantation biopsies performed by the Western Australian Liver Transplantation Service between 1992 and 1997 were retrospectively analyzed by a pathologist and a hepatologist. Each was supplied with a brief clinical history before applying the Banff and Birmingham criteria. Results were compared with each other and to the diagnosis made at the time of the biopsy, which was based on the European grading system. Rejection was diagnosed by the reviewers in 61 of 124 biopsy specimens according to the criteria of Snover. The Banff schema and Birmingham system agreed on the grade of rejection in 22 of the 61 biopsy specimens. The Banff schema elevated the grade of rejection in 39 specimens by an increment of one. In no instance did the Banff schema reduce the grade. Comparison between the Banff schema and diagnosis made at the time of biopsy showed agreement in 39 specimens, whereas the Banff schema elevated the grade in 15 specimens and reduced the grade in 23 specimens. In comparison to the Birmingham system, the Banff schema elevated the grade of liver allograft rejection in the majority of biopsy specimens, and this has the potential to alter clinical management with the adoption of the Banff schema or if the systems are used interchangeably.

Adolescent↗

PubMed1999

TP53 gene mutation status in pretreatment biopsies of oesophageal adenocarcinoma has no prognostic value.

Identification of markers which help to predict response to treatment and overall survival at the time of diagnosis would assist in the management of patients with oesophageal adenocarcinoma. In the present study we investigated the prognostic significance of mutations to the TP53 tumour suppressor gene in a large, consecutive series of oesophageal adenocarcinomas. The incidence of TP53 mutation determined by molecular analysis of endoscopic biopsy specimens was 36% (49/135). No statistically significant difference was observed in patient survival according to the TP53 status of the tumour biopsy. The median survival time for patients with mutation was 12 +/- 1 months compared with 14 +/- 2 months for patients with TP53. These results demonstrate that mutation of the TP53 gene is not a useful predictive marker for patient survival in oesophageal adenocarcinoma.

Adenocarcinoma↗

PubMed1999

Asymptomatic carotid artery stenosis associated with peripheral vascular disease: a prospective study.

This study aimed to determine the prevalence of symptomless internal carotid artery stenosis in consecutive patients presenting with peripheral vascular disease. Duplex ultrasound screening of the carotid arteries was used to determine the degree of stenosis. Co-morbidities were recorded together with age, sex and tobacco use. Internal carotid artery stenosis of > 50% was found in 35% of patients. Among these there was > or = 70% stenosis in 18% of patients and of this group 5% had an occluded carotid vessel at first presentation. Males presented with peripheral vascular disease and associated carotid stenoses at a younger age than females. Male smokers had a higher prevalence of stenosis (P = 0.036) but all smokers had developed stenoses 3-5 years before non-smokers. Females with abdominal aortic aneurysms had a greater prevalence of carotid stenosis (P = 0.037), and male aneurysmal disease diminished stenosis prevalence (P = 0.023). Men with an elevated serum creatinine were more likely to have a stenosis (P = 0.019), but not women. The other co-morbidities were not specifically associated with carotid artery stenosis.

Adult↗

PubMed1999

The changes seen in balloon-injured porcine femoral arteries following sympathectomy.

On the basis that vasoconstriction may contribute to restenosis following angioplasty, the influence of lumbar sympathectomy on the morphometry of femoral arteries after balloon injury was examined in a pig model. Twenty-six juvenile pigs underwent balloon de-endothelialization of the right femoral artery followed by an open bilateral lumbar sympathectomy (n = 14) or a sham sympathectomy (n = 12). Four weeks later flow was measured in femoral arteries. Animals were then killed and the femoral arteries were perfusion-fixed and harvested. Sympathectomy resulted in a significant (P = 0.04) increase in flow in both the injured (right) and uninjured (left) femoral arteries. Sympathectomy did not inhibit intimal thickening following balloon injury: median (interquartile range) intimal area was 0.4 mm2 (0.3-0.9) in the sympathectomy group versus 0.5 mm2 (0.4-0.9) in the sham group. Sympathectomy did, however, result in a significant (P = 0.02) increase in the lumen area: 1.1 mm2 (0.8-1.8) versus 0.7 mm2 (0.6-0.9). Sympathectomy may reduce vasospasm following angioplasty with the potential for clinical benefit.

Animals↗

PubMed1999

Management of biliary tract complications following liver transplantation.

BACKGROUND: A review of biliary tract complications was performed in 32 patients who underwent liver transplantation by the Western Australian Liver Transplantation Service during a 2-year period. METHODS: A review was made of patient data collected prospectively, and confirmed by retrospective casenote review. RESULTS: A total of 30 patients (31 grafts) survived more than 2 days after transplantation, and of these 28 had an end-to-end biliary anastomosis. Analysis of these 28 patients found that eight of 17 patients with T-tubes had complications: three leaks at T-tube removal; two strictures and leaks; and three strictures. Six of 11 patients without a T-tube had complications: one leak; three strictures and leaks; and two strictures. Predisposing factors were present in eight of the 14 patients with biliary tract complications: hepatic artery stenosis in three; and one each with hepatic artery thrombosis; biliary calculi; donor-recipient bile duct mismatch; severe cellular rejection: and prolonged postoperative hypotension. Acute rejection, steroid-resistant rejection and cytomegalovirus infection were all significantly more common in those patients with biliary tract complications compared with those without. There was no difference in cold ischaemic time or donor age. Twelve of the 14 patients with biliary complications required endoscopic stenting with or without balloon dilation, and eight patients required radiological percutaneous drainage of bile collections. Only one patient required biliary reconstruction and two patients required re-transplantation. One patient died of uncontrolled infection. Of three patients who underwent choledochojejunostomy, biliary leak developed in two patients, both of whom required operative biliary and hepatic repair. One of the three patients died from disseminated Aspergillus infection. The median total hospital stay of patients with biliary complications was 61 days (range: 30-180 days) compared with 33.5 days (range: 22-70 days) for patients without. Of patients with end-to-end biliary anastomosis, 50% had biliary tract complications and more than half of these had predisposing factors. The majority of biliary complications were managed without the need for surgery. CONCLUSION: A total of 50% of patients with end-to-end biliary anastomosis had biliary tract complications. Biliary strictures presented later than leaks, and the majority of these complications were managed without the need for surgery.

Adolescent↗

PubMed1998

Developing visiting surgical services for rural and remote Australian communities.

The University Department of Surgery at Queen Elizabeth II Medical Centre (Perth, Western Australia) has undertaken a pilot project to provide surgical services to country communities where no such service exists. Three surgeons undertake a regular schedule of appointments, and are accompanied by final-year medical students to give them experience with common conditions rarely managed in teaching hospitals. The service is supported by a central administrative office and coordinated by a general practitioner, who negotiates with the regional healthcare providers. Patients are referred by their general practitioner, who may work with the surgeon as anaesthetist or surgical assistant.

Ambulatory Surgical Procedures↗

PubMed1998

Mutation of the transforming growth factor-beta type II receptor gene in right-sided colorectal cancer: relationship to clinicopathological features and genetic alterations.

The presence of inactivating mutations in the transforming growth factor-beta (TGF-beta) type II receptor (RII) gene in the colon cancer suggests that it may behave like a tumour suppressor gene. RII is mutated in the majority of colon tumours exhibiting widespread microsatellite instability, a characteristic generally referred to as the replication error phenotype (RER+). We investigated the association between RII mutations and various clinicopathological variables and genetic alterations in a large series of sporadic adenocarcinomas arising in the proximal colon. RII mutations were found in 17 per cent (36/210) of right-sided tumours and in 86 per cent (32/37) of those displaying RER+. They were associated with the absence of lymph node invasion (P = 0.04), poor histological differentiation (P = 0.006), and with a trend for improved patient survival. Tumours with an RII mutation also showed non-significant trends for a lower incidence of p53 protein overexpression and of p53, K-ras, and APC gene mutation compared with tumours with normal RII. These results indicate that right-sided colorectal tumours containing RII mutations resemble those with the RER+ phenotype in terms of their clinicopathological features and genetic alterations.

Adenocarcinoma↗

PubMed1998

Prognostic factors in elective aortic reconstructive surgery.

BACKGROUND: The present study was carried out to determine the risk factors associated with peri-operative mortality and long-term survival in patients undergoing abdominal aortic reconstructive surgery (ARS). METHODS: A retrospective review was performed of the case notes of all patients having ARS at a university teaching hospital during a 5.5-year period, and their details entered onto a pro forma. RESULTS: A total of 252 patients underwent ARS between July 1989 and December 1994. The peri-operative mortality was 7.5%. The most frequent adverse events were cardiac events, accounting for 8 (42%) of the peri-operative deaths. The risk of a peri-operative cerebrovascular accident was low (n = 3, 1.2%) as was the risk of peri-operative renal failure requiring dialysis (n = 3, 1.2%). Factors independently linked to increased peri-operative mortality included moderate-to-severe hypertension (P = 0.05, odds ratio = 3.54), those with renal impairment (P = 0.05, odds ratio = 2.69), and blood transfusion requirements (P < 0.001, odds ratio = 1.26). Long-term survival was independently shortened by occlusive disease (P = 0.004, hazard ratio = 2.78) and ischaemic heart disease (P < 0.001, hazard ratio = 3.58). CONCLUSIONS: The risks of ARS were significantly increased in patients with severe hypertension, those with renal impairment and those requiring blood transfusion. Long-term survival was shortened for those patients with occlusive aortic disease and ischaemic heart disease. These risk factors should be carefully assessed in each patient before performing elective ARS.

Aorta, Abdominal↗

PubMed1997

Liver transplantation in Western Australia: improved services to an isolated population.

OBJECTIVE: To assess performance of the Western Australian Liver Transplantation Service in the light of debate about whether small transplant centres can produce optimal outcomes. DESIGN: Review of patient data collected prospectively and confirmed by retrospective casenote review. SUBJECTS: All patients referred to the Western Australian Liver Transplantation Assessment Panel. Those who underwent transplantation at the Western Australian Liver Transplantation Service (to June 1996) were compared with those referred to other transplant centres before the elective service was established in July 1994. OUTCOME MEASURES: Numbers of referrals and transplants; characteristics of the transplantation procedure; and patient outcomes. RESULTS: Annual referrals for liver transplant in Western Australia (WA) increased from 12 (1985-1993) to 41 (July 1994-June 1996), with five deaths on the "activated" list before July 1994, but none after. To June 1996, 30 patients had received 31 transplants by the Western Australian Liver Transplantation Service (two emergency transplants in 1992 and 1993, respectively, and 28 elective transplants and one retransplant after June 1994), with median operation time of 5.5 hours (range, 3-10.5), median red cell transfusion of 4 units (range, 0-55) and median hospital stay of 24 days (range, 12-128). There was no severe primary graft dysfunction. Major complications included hepatic artery thrombosis or stenosis (5 patients, one requiring retransplant), biliary stricture not associated with hepatic artery pathology, bile leak and perihepatic abscess (4 each), and cytomegalovirus infection (3). Patient survival was 83% and graft survival 81% at a mean follow-up of 13 months, compared with 86% and 83%, respectively, at one year for WA patients who received transplants elsewhere before July 1994. CONCLUSIONS: Performance of the Western Australian Liver Transplantation Service compares favourably with national and international standards, and WA patients receiving liver transplants have increased dramatically since the service was established. This supports the viability of committed liver transplantation centres with only 10-15 patients a year and argues the need for nationally decentralised services.

Adolescent↗