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Item Metadata only 5-ASA decreases colonic sulfide formation: implications for ulcerative colitis.(1996) Roediger, W.; Duncan, A.Experimental evidence suggests that anionic sulfide (SH-) may be implicated in the pathogenesis of ulcerative colitis. Sulfides are formed in the colon by sulfate-reducing bacteria acting on sulfate or sulfur amino acids. Experiments were designed to test whether the most useful drug for ulcerative colitis, 5-aminosalicylic acid (5ASA) or salicylazosulfapyridine (SASP) could suppress sulfide formation from sulfur amino acids by anaerobic bacteria grown in batch culture. Neither 5-ASA or SASP altered acetate formation, a universal indicator of fermentation. Both agents very significantly reduced sulfide formation by anaerobic bacteria of the human colon grown in batch culture. Such an action of 5-ASA/SASP may reduce the injurious action of sulfide on the colonie epithelial cell barrier of the colon and help to prevent attacks of colitis. Keywords: 5-aminosalicylic acid, colon, sulfides, ulcerative colitis, fermentation.Item Metadata only A 2a/1b full-length p7 inter-genotypic chimeric genome of hepatitis C virus is infectious in vitro(Academic Press Inc, 2007) Haqshenas, G.; Dong, X.; Ewart, G.; Bowden, S.; Gowans, E.The p7 protein of hepatitis C virus (HCV) functions as an ion channel in planar lipid bilayers, and its function is vital for the virus life cycle. In this study, we replaced either the entire or partial p7 of genotype 2a (strain JFH1), an HCV strain that replicates and produces virus progeny in vitro, with the corresponding regions of the p7 protein from genotype 1b (Australian isolate, HCV-A). Compared to wild type, the chimeric viruses reached their peak of infectivity with a delay but they produced a comparable titer to the wild type virus and the progeny viruses were able to infect naive permissive cells. Amantadine treatment of wild type and chimeric viruses reduced the virus titers by about 50% and 45%, respectively. Therefore, in this study, for the first time, we demonstrated that genotype 2a (JFH1 strain) genome encoding a full-length genotype 1b p7 gene produces infectious particles in vitro. These chimeric viruses are valuable instruments for comparative studies of the p7 proteins.Item Metadata only A blinded randomized controlled trial evaluating the efficacy of chitosan gel on ostial stenosis following endoscopic sinus surgery(American Rhinologic Society, 2013) Ha, T.; Valentine, R.; Moratti, S.; Robinson, S.; Hanton, L.; Wormald, P.BACKGROUND Stenosis of sinus ostia following endoscopic sinus surgery (ESS) is the most common reason for revision surgery. Chitosan-dextran (CD) gel has been shown to be an effective hemostatic agent; however, its effects on ostial stenosis are unknown. This study aims to quantify the effect of CD gel on circumferential scarring following ESS. METHODS A prospective, blinded, randomized, controlled trial was conducted in 26 patients undergoing ESS. Measurements of neo-ostia were taken using a standard-sized measuring probe. CD gel was applied unilaterally, while contralateral sides received no gel. Ostial diameters were measured by a blinded observer at 2, 8, and 12 weeks postoperation. Sinus ostial areas calculated as a proportion of the original were compared for each ostium at each time point. RESULTS Intraoperative ostial areas were comparable for CD gel and control sides (38 mm2 vs 39 mm2, 131 mm2 vs 120 mm2, and 203 mm2 vs 193 mm2, in frontal, sphenoid, and maxillary ostia, respectively; p > 0.05). CD gel significantly improved sinus ostial patency. The largest difference was seen when ostial areas at 12 weeks were compared with their corresponding baseline areas (66% vs 31% frontal, p < 0.001; 85% vs 47% sphenoid, p < 0.001; and 74% vs 54% maxillary ostia, p = 0.002). The difference between raw ostial areas reached statistical significance in sphenoid (p < 0.001) and maxillary (p = 0.01), but not in frontal ostia (p > 0.05) at 12 weeks. CONCLUSION CD gel produced significantly less stenosis of all neo-ostia following ESS and may reduce the necessity for revision surgery in patients with chronic rhinosinusitis.Item Metadata only A blinded, randomized, controlled study on the effect of buffered 0.9% and 3% sodium chloride intranasal sprays on ciliary beat frequency(Lippincott Williams & Wilkins, 2005) Wabnitz, D.; Wormald, P.Background
There are conflicting reports regarding the effect of intranasal saline sprays on the various components of the mucociliary clearance system. This study evaluates the effect of normal saline and hypertonic saline on the ciliary beat frequency (CBF).Methods
Eight healthy volunteers were randomized to receive 0.9% saline spray to one nostril and 3.0% saline spray to the other. Ciliated cells were collected, and the CBF was calculated using computerized microphotometry.Results
Although neither solution significantly altered the CBF from baseline measurements, there was a significant difference between the CBFs of the two solutions at 5 minutes postadministration (9.1 Hz with 0.9% saline, 10.1 Hz with 3.0% saline, P < .05). This was a transient effect and was not seen when cells were examined at 60 minutes postadministration.Conclusion
The administration of hypertonic saline results in a significantly faster CBF 5 minutes after administration. This effect is not seen 60 minutes after administration.Item Metadata only A case of an extrahepatic biliary tract fibro-adenoma in a 35-year-old woman(BLACKWELL SCIENCE, 1998) Frewin, C.; Robertson, G.; Roberts-Thomson, I.; Maddern, G.Item Metadata only A checklist for components of operating room suites(Taylor & Francis AS, 2003) Patkin, M.Planning an operating room (OR) is a complex process, and it is common to find that essential items are overlooked. A checklist may be one measure for preventing this. An example of this is presented.Item Metadata only A chest injury in an isolated geo-politically sensitive area: Questions in management(J E M S Communications, 2001) Rahdon, R.; Bridgewater, F.; Harris, M.AbstractThe reported case of a stab wound to the chest occurred in an isolated area with no specialized surgical care available. The need for transport and specifically by air, introduced particular questions in management. On a humanitarian basis and in line with its mandate, the Peace Monitoring Group, a United Nations endorsed entity in Bougainville, Papua New Guinea, provided transport to a facility with an appropriate standard of care. The questions of need for patient evacuation and chest drainage, with the timing of this maneuver are considered.Item Metadata only A chimeric GB virus B encoding the hepatitis C virus hypervariable region 1 is infectious in vivo(Soc General Microbiology, 2007) Haqshenas, G.; Dong, X.; Netter, H.; Torresi, J.; Gowans, E.Two GB virus B (GBV-B) chimeric genomes, GBV-HVR and GBV-HVRh (with a hinge), containing the coding region of the immunodominant hypervariable region 1 (HVR1) of the E2 envelope protein of Hepatitis C virus (HCV) were constructed. Immunoblot analysis confirmed that HVR1 was anchored to the GBV-B E2 protein. To investigate the replication competence and in vivo stability of in vitro-generated chimeric RNA transcripts, two naïve marmosets were inoculated intrahepatically with the transcripts. The GBV-HVR chimeric genome was detectable for 2 weeks post-inoculation (p.i.), whereas GBV-HVRh reverted to wild type 1 week p.i. Sequencing analysis of the HVR1 and flanking regions from GBV-HVR RNA isolated from marmoset serum demonstrated that the HVR1 insert remained unaltered in the GBV-HVR chimera for 2 weeks. Inoculation of a naïve marmoset with serum collected at 1 week p.i. also resulted in viraemia and confirmed that the serum contained infectious particles. All animals cleared the infection by 3 weeks p.i. and remained negative for the remaining weeks. The chimera may prove useful for the in vivo examination of any HCV HVR1-based vaccine candidates.Item Metadata only A combined modality approach to the management of oesophageal cancer(W B SAUNDERS CO LTD, 1997) Smithers, B.; Devitt, P.; Jamieson, G.; Bessell, J.; Gotley, D.; Gill, P.; Neely, M.; Joseph, D.; Yeoh, E.; Burmeister, B.; Denham, J.This study aims to update the experience of multimodality approaches in the management of oesophageal cancer that have been adopted in several Australian and New Zealand hospitals. Between 1984 and 1985, 92 patients received pre-operative radiotherapy (30-36 Gy over 3 weeks) and one of two chemotherapy regimes (one or two courses of i.v. cisplatin 80 mg/m2 plus a 4-5 day continuous i.v. of fluorouracil 5-800 mg/m2/day) concurrently prior to surgery. Eighty-two patients (89%) underwent resection as planned. Operative specimens were microscopically free of residual tumour in 18 patients. Eight patients (9%) had treatment-related deaths: seven from surgery and one due to pre-operative chemoradiation. The Kaplan-Meier 5-year cause-specific survival estimates were 32.9 +/- 7.8% for the 58 patients with squamous cancer and 0% for the 32 with adenocarcinoma. Complete pathological response to the pre-operative regime was more common in females and was associated with a survival advantage. Five-year cause-specific survival expectation in patients who experienced a complete pathological response was 71.5 +/- 12.4%, whereas it was only 15.9 +/- 5.6% in patients who had residual cancer in their surgical specimens. Although less toxic the pre-operative regime utilizing only one cycle of chemotherapy was no less efficacious either in producing a complete pathological response or in terms of survival expectation. This uncontrolled pilot study has produced encouraging long-term results, especially for patients with squamous carcinoma that experienced a complete response to pre-operative synchronous chemoradiotherapy. A randomized controlled study comparing surgery alone with (one cycle) chemoradiation followed by surgery is now underway.Item Metadata only A comparative study of miniplates used in the treatment of mandibular fractures(Ovid Technologies (Wolters Kluwer Health), 1996) Edwards, T.; David, D.The purposes of this study were to investigate the differences in mechanical properties of major miniplating systems used for noncompression miniplate osteosynthesis of mandibular fractures and to determine whether these properties influence treatment outcome. The study was conducted in two parts. First, six of the major miniplate systems currently used at the Royal Adelaide Hospital were subjected to bending tests at the University of Adelaide Engineering Department to quantify the relative stiffness of each plate. Second, a prospective sample of patients presenting with mandibular fractures was analyzed. These patients were treated with a variety of the miniplating systems. The results of treatment as a whole were compared to identify any direct benefit consequent on the miniplate selected. While significant differences in stiffness were identified between the plating systems, no significant differences in treatment outcome were identified, between the noncompression plates employed. Since no observable benefits have been identified by choice of miniplate, selection should be based on surgical preference, biocompatibility, CT compatibility and unit cost. Because of the variations in materials, design, properties, CT compatibility, and unit cost, it is important not to regard all miniplates as equal and interchangeable.Item Metadata only A comparative study of three methods of nasal irrigation(Lippincott Williams & Wilkins, 2004) Wormald, P.; Cain, T.; Oates, L.; Hawke, L.; Wong, I.Objective
To assess the effectiveness of three methods of nasal irrigation on distributing saline to the nasal cavity and paranasal sinuses.Design
: A prospective, cross-over study.Materials and methods
Twelve subjects (9 patients with chronic sinusitis after functional endoscopic sinus surgery and 3 healthy controls) underwent nasal irrigation with normal saline containing Technetium 99m sulfur colloid. The distribution of radioactivity was assessed on each subject after three different irrigation techniques: metered nasal spray, nebulization with RinoFlow, and nasal douching while kneeling with the head on the floor.Results
The nasal cavity was well irrigated by all three techniques. Compared with the other two methods, douching was significantly more effective in penetrating the maxillary sinus (P = .036) and frontal recess (P = .003). The sphenoid and frontal sinuses were poorly irrigated by all three techniques.Conclusion
Nasal douches are more effective in distributing irrigation solution to the maxillary sinus and frontal recess. This should be the method of choice for irrigating these areas.Item Metadata only A comparison of primary oesophageal squamous epithelial cells with HET-1A in organotypic culture(Editions Scientifiques Medicales Elsevier, 2010) Underwood, T.; Derouet, M.; White, M.; Noble, F.; Moutasim, K.; Smith, E.; Drew, P.; Thomas, G.; Primrose, J.; Blaydes, J.Background Information. Carcinoma of the oesophagus is the sixth leading cause of cancer death in the western world and is associated with a 5-year survival of less than 15%. Recent evidence suggests that stromal-epithelial interactions are fundamental in carcinogenesis. The advent of co-culture techniques permits the investigation of cross-talk between the stroma and epithelium in a physiological setting. We have characterized a histologically representative oesophageal organotypic model and have used it to compare the most commonly used squamous oesophageal cell line, HET-1A, with primary oesophageal squamous cells for use in studies of the oesophageal epithelium in vitro. Results. When grown in an organotypic culture with normal fibroblasts, the oesophageal carcinoma cell lines OE21 (squamous) and OE19 (adenocarcinoma) morphologically resembled the tumour of origin with evidence of stromal invasion and mucus production, respectively. However, HET-1A cells, which were derived from normal squamous oesophageal cells, appeared dysplastic and failed to display evidence of squamous differentiation. By comparison with primary oesophageal epithelial cells, the HET-1A cells were highly proliferative and did not express the epithelial markers E-cadherin or CK5/6 (casein kinase 5/6), or the stratified epithelial marker Delta Np63, but did express the mesenchymal markers vimentin and N-cadherin. Conclusion. Studies of epithelial carcinogenesis will benefit from culture systems which allow manipulation of the stromal and epithelial layers independently. We have developed an organotypic culture using primary oesophageal squamous cells and fibroblasts in which a stratified epithelium with a proliferative basal layer that stains strongly for Delta Np63 develops. This model will be suitable for the study of the molecular events in the development of Barrett's oesophagus. The most commonly used normal oesophageal squamous cell line, HET-1A, does not have the characteristics of normal oesophageal squamous cells and should not be used in models of the normal oesophageal epithelium. Until more representative cell lines are available, future studies in oesophageal cancer will be reliant on the availability and manipulation of primary tissue.Item Metadata only A comparison of subcutaneous morphine and Fentanyl in hospice cancer patients(Dept. of Anesthesiology, University of Wisconsin, 1999) Hunt, R.; Fazekas, B.; Thorne, D.; Brooksbank, M.This study compares subcutaneous (s.c.) morphine and fentanyl with respect to pain control and side effects using a 6-day randomized, double-blind, cross-over design. Results were obtained from 23 patients (12 males and 11 females: mean age of 70.5 years) who could tolerate morphine. Thirteen patients were randomized to receive morphine for the first 3 days followed by fentanyl; 10 received fentanyl first followed by morphine. There were no significant differences in the scores for pain between the two drugs, suggesting that fentanyl is equally efficacious and the conversion ratio of morphine 10 mg: fentanyl 150 micrograms is appropriate. Patients had more frequent bowel movements during days 4-6 while on the fentanyl arm [t-test, df (22), P = 0.015]. Other measures for nausea, delirium, and cognitive function showed no differences between the two drugs. This study highlights the need to further assess the role of various opioids in hospice patients, and emphasizes the requirement for sensitive and simple cognitive tests in this population.Item Metadata only A comparison of women with breast cancer who do and do not seek support from the Internet(Australian Psychological Soc, 2003) Winefield, H.; Coventry, B.; Pradhan, M.; Harvey, E.; Lambert, V.The Internet potentially allows people with health concerns to obtain not only expert information about illnesses and diseases but also peer support. A postal survey of women with breast cancer (N = 78) investigated characteristics associated with their use of the Internet for information and support. Current users of the Internet were younger and reported less adequate family support and poorer mental health compared with those who were not using the net and not interested in using it. Family support differences in net use groups remained significant after controlling for age. The connection between net use and lower family support needs more exploration, and the findings have important implications for web-based health educators.Item Metadata only A critical analysis of reasons for improved survival from invasive cutaneous melanoma(Kluwer Academic Publ, 2003) Luke, C.; Coventry, B.; Foster-Smith, I.; Roder, D.Objective: To determine the extent to which increases in survival from melanoma are explained by changes in thickness, level, histological type, site of lesion, and sociodemographic characteristics. Methods: Analyses of changes in survival among 9519 South Australians with melanoma reported to the State's population-based cancer registry during the 1980–2000 diagnostic period, using proportional hazards regression to adjust for thickness, level and other characteristics. Results: Lower survivals applied for thicker lesions, deeper Clark levels, lesions on the trunk and scalp/neck, and for older cases and males. After adjusting for these characteristics, the relative risk (95% confidence limits) of case fatality for the 1994–2000 diagnostic period was 0.79 (0.63, 0.99), when compared with the 1980–1986 baseline. Prior to adjusting, the relative risk for these cases was 0.58 (0.47, 0.72). An unexpected finding was a secular change for deeper Clark levels within Breslow thickness categories. Conclusions: Approximately half the survival increase was not explained by changes in thickness, level, lesion site, and age and sex. Other possible contributors warranting further study include changes in ulceration, nodal or more distant site involvement, treatment gains and changes in tumour biology. The trend for deeper Clark levels within Breslow thickness categories requires independent confirmation.Item Metadata only A decision aid for predicting non-sentinel node involvement in women with breast cancer and at least one positive sentinel node(Churchill Livingstone, 2004) Farshid, G.; Pradhan, M.; Kollias, J.; Gill, P.Background: Several clinical trials are re-evaluating the management of the axilla after sentinel node (SN) biopsy. Approximately 50–70% of patients with positive SN have no further nodal involvement. Estimates of the risk of non-sentinel node (NSN) involvement would aid decisions regarding further axillary surgery. Methods: Clinical and pathological variables for 82 breast cancer patients with metastasis to at least one SN, were used to find independent predictors of the status of NSNs. Results: NSN metastases were found in 46.3% of patients. In a regression model patient age, proportion of SN replaced by metastasis and number of SNs were independent predictors of NSN status. Conclusion: Data available after SN biopsy allow estimation of the risk of NSN metastases among patients with positive SNs. Individualised estimates of the risk of NSN involvement may facilitate discussions regarding the trade off between the likely benefits of further axillary surgery and the morbidity of this procedure.Item Metadata only A further modification of fundoplication - 90° anterior fundoplication(Springer-Verlag, 2002) Krysztopik, R.; Jamieson, G.; Devitt, P.; Watson, D.BACKGROUND: Laparoscopic Nissen fundoplication is the most widely applied procedure for the surgical treatment of gastroesophageal reflux. However, it can be followed by adverse outcomes, including dysphagia and "wind-related" problems. To reduce the likelihood of side effects, we have progressively modified this procedure to an anterior 90° partial fundoplication. METHODS: The procedure entails posterior hiatal repair, posterior esophagopexy, accentuation of the angle of His, and construction of a 90° anterior partial fundoplication. Clinical follow-up was performed prospectively using a standardized questionnaire. RESULTS: From February 1999 to June 2001, 83 patients underwent 90° anterior fundoplication for gastroesophageal reflux disease. In 45 the procedure was chosen because of specific patient or surgeon preference, and in 38 it was performed within the context of an ongoing randomized trial. Operating time ranged from 20 to 140 minutes (median, 52 min), and all but one of the procedures were completed laparoscopically. One patient experienced a major postoperative complication--small bowel injury from Veress needle. Follow-up extends up to 2 years (median, 1 year). Two patients have undergone further surgery, both for recurrent reflux. Control of reflux has been acceptable, with a reduction in heartburn symptom scores and high overall satisfaction. Postoperative dysphagia measured using a visual analog scale was less following surgery compared with preoperative scores. Eighty-two percent of patients could belch normally 3 and 12 months after surgery. CONCLUSIONS: Ninety-degree anterior fundoplication achieves good control of reflux and a low incidence of side effects. To further evaluate its potential, we are currently undertaking a prospective randomized trial.Item Metadata only A guide to multi-centre ethics for surgical research in Australia and New Zealand(Wiley-Blackwell, 2011) Boult, M.; Fitzpatrick, K.; Maddern, G.; Fitridge, R.Background: This paper describes existing inconsistencies as well as the disparate processes and logistics required when obtaining ethics approval in Australia and New Zealand in order to initiate a multi-centre bi-national surgical trial. Methods: The endovascular aortic aneurysm repair trial is a large multi-centre trial that aims to obtain pre- and post-operative data from patients in hospitals across Australia and New Zealand. As the trial was research based, ethics applications were submitted to all hospitals where surgeons wished to be involved in the trial. Results: Few ethics committees have embraced attempts to simplify the application process for multi-centre trials. There was limited mutual review between Human Research Ethics Committees necessitating the submission of multiple applications. Though the use of the National Ethics Application Form in ethical review is increasing, some Human Research Ethics Committees do not accept it in its entirety; many require site-specific applications or sections of the Common Application Form modules. Conclusions: Queensland, New South Wales and New Zealand were the easiest systems to prepare, submit and lodge ethics applications because of their understanding and accommodation of reviewing multi-centred trials. The time, expense and complexity of obtaining ethics approval for multi-centre research projects are impediments to their establishment and reduce the time available for research. Australia is working to implement a system named the Harmonisation of Multi-centre Ethical Review to ease the process of obtaining multi-centre ethics clearance. Our experience suggests there will be some teething problems with implementation and acceptance.Item Metadata only A historical perspective: reviewing the evolution of the surgical management of groin hernias(Churchill Livingstone, 1997) Bridgewater, F.Item Metadata only A human nasal explant model to study Staphylococcus aureus biofilm in vitro(American Rhinologic Society, 2013) Cantero Cajas, D.; Cooksley, C.; Jardeleza, C.; Bassiouni, A.; Jones, D.; Wormald, P.; Vreugde, S.Background
Staphylococcus aureus (S. aureus) biofilm has been associated with severe and recalcitrant cases of chronic rhinosinusitis (CRS). However, its role in the pathophysiology of this condition is not completely understood. This study aims to develop a sinonasal tissue explant model to analyze the interaction of S. aureus biofilm with the mucosa in vitro.Methods
Sinonasal tissue samples from 5 control patients undergoing pituitary surgery were cultured with and without S. aureus biofilm in vitro. Confocal scanning laser microscopy (CSLM) using the Live/Dead BacLight stain and histology were performed on the tissue explants after 24 hours of biofilm challenge. Measurements of IL-6, at both the messenger RNA (mRNA) level (using quantitative reverse-transcriptase polymerase chain reaction [qRT-PCR]) and the protein level (using enzyme-linked immunosorbent assay [ELISA]), were undertaken to evaluate biofilm-mucosa interaction.Results
Viability of the explants after 24 hours was confirmed by CSLM and histology. Although light microscopy failed to identify S. aureus biofilms, its presence was confirmed in the biofilm-challenged samples by CSLM. IL-6 mRNA transcript levels were 4.9-fold upregulated in biofilm-treated tissue compared to controls (p = 0.0485). A similar trend was observed at the protein level (p = 0.0313).Conclusion
The sinonasal tissue explant is a viable and functional model capable of analyzing direct biofilm-mucosal interactions and can advance our understanding of the role played by S. aureus biofilm in sinus inflammation. Our model suggests that S. aureus biofilms in the initial phase of growth are not inert bystanders but elicit an immune response in the sinonasal mucosa.