ORCID Profile
0000-0002-8370-5510
Current Organisation
Royal Brisbane and Women's Hospital
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Publisher: Wiley
Date: 11-08-2022
DOI: 10.1111/IMJ.15556
Abstract: The electroencephalogram (EEG) is a common diagnostic tool used to investigate patients for various indications including seizure disorders. To investigate factors that predict the presence of epileptiform abnormalities on EEG and review the common indications for ordering an EEG. We retrospectively reviewed all routine adult EEG performed in a hospital over a 6‐month period. Data collated included patient demographics, clinical indication for EEG, setting in which EEG was performed, activation procedures utilised, history of epilepsy, and whether the patient was on antiepileptic medication. Our primary objective was to evaluate the factors that were predictive of an EEG with epileptiform abnormalities. Two hundred and thirty‐nine routine EEG were included with indications, including first seizure (25.9%), known epilepsy (25.1%), cognitive change (15.9%), syncope (15.0%), movement disorder (6.7%), psychogenic non‐epileptic events (5.4%), unresponsiveness/intensive care unit (4.6%) and psychiatric presentation (1.3%). Most (48.1%) EEG were normal 8.9% of the EEG demonstrated epileptiform abnormalities. Using multivariate logistic regression, three variables proved significant in predicting an EEG with epileptiform abnormalities. Any seizure as an indication (first seizure or seizure in known epileptic), increasing patient age, and EEG conducted in an inpatient setting and within 48 h of seizure event were all statistically more likely to yield epileptiform abnormalities on EEG. Our findings suggest that careful selection of patients based on appropriate indications for EEG referral would likely improve the yield of an EEG. Depending on the indication, a normal EEG result can be of similar usefulness to an abnormal EEG demonstrating epileptiform abnormalities.
Publisher: Elsevier BV
Date: 08-2010
DOI: 10.1016/J.IJROBP.2009.07.006
Abstract: To analyze which patient-, tumor-, and treatment-related factors may influence outcome after (90)Y radioembolization ((90)Y-RE) for hepatocellular carcinoma (HCC). Seventy-two consecutive patients with advanced HCC treated with (90)Y-RE were studied to detect which factors may have influenced response to treatment and survival. Median overall survival was 13 months (95% confidence interval, 9.6-16.3 months). In univariate analysis, survival was significantly better in patients with one to five lesions (19 vs. 8 months, p = 0.001) and in patients with alpha-fetoprotein 52 UI/mL, and their survival in the multivariate analysis was significantly worse (hazard ratio, 4.7 95% confidence interval, 13-1.73) (p = 0.002). Yttrium-90 radioembolization results in control of target lesions in the majority of patients with HCC but does not prevent the development of new lesions. Survival of patients treated with (90)Y-RE seems to depend largely on factors related to the aggressiveness of the disease (number of nodules, levels of alpha-fetoprotein, and presence of microscopic disease).
Publisher: Springer Science and Business Media LLC
Date: 03-11-2018
Publisher: Springer Science and Business Media LLC
Date: 13-05-2015
Publisher: Wiley
Date: 2008
DOI: 10.1002/CNCR.23339
Abstract: To the authors' knowledge, liver damage after liver radioembolization with yttrium90-labeled microspheres has never been studied specifically. Using a complete set of data recorded prospectively among all patients without previous chronic liver disease treated by radioembolization at the authors' institution from September 2003 to July 2006, patterns of liver damage were identified and possible risk factors were analyzed. In all, 20% of patients developed a distinct clinical picture that appeared 4 to 8 weeks after treatment and was characterized by jaundice and ascites. Veno-occlusive disease was the histologic hallmark observed in the most severe cases. This form of sinusoidal obstruction syndrome was not observed among patients who never received chemotherapy or in those in whom a single hepatic lobe was treated. Relevant to treatment planning, a possible risk factor was a higher treatment dose in relation to the targeted liver volume. A transjugular intrahepatic stent shunt improved liver function in 2 patients with impending liver failure, although 1 of them eventually died from it. Radioembolization of liver tumors, particularly after antineoplastic chemotherapy, may result in an uncommon but potentially life-threatening form of hepatic sinusoidal obstruction syndrome that presents clinically with jaundice and ascites.
Publisher: Elsevier BV
Date: 08-2021
Publisher: Springer Science and Business Media LLC
Date: 20-10-2009
DOI: 10.1007/S00270-009-9717-1
Abstract: We evaluated the feasibility, safety, and efficacy of radioembolization (administered from one or two vascular points) after the redistribution of arterial blood flow in the liver in patients with hepatic neoplasms and arterial anatomic peculiarities (AAP). Twenty-four patients with liver neoplasms and AAP (graded according to Michel's classification) were included in the study. During pretreatment angiographic planning, all extrahepatic vessels that could feed the tumor were embolized and the intrahepatic vessels occluded in order to redistribute blood flow. The distribution of microspheres was initially assessed by using technetium-99m-labeled macroaggregated albumin ((99m)Tc-MAA) from one of two vascular points before the administration of yttrium-90 ((90)Y)-radiolabeled resin microspheres. Perfusion of lesions situated in the redistributed segments (L-RS) and nonredistributed segments (L-NRS) were compared by assessing the distribution of (99m)Tc-MAA by SPECT/CT. Perfusion was graded as normal, reduced, or absent. (90)Y resin microspheres were then injected from the same arterial sites as (99m)Tc-MAA and the tumor response recorded 3 months later. The tumor response in L-RS was compared with that in L-NRS and graded as better, similar, or worse. Among 11 patients with type I AAP in whom mainly vessels in segments I-III or IV were occluded, perfusion of L-RS was graded as similar (n = 7) or reduced (n = 4). Among the remaining 13 patients with AAP types III (n = 3), V (n = 4), VIII (n = 3), and others (n = 3) in which aberrant arteries were occluded, perfusion of L-RS was graded as similar (n = 9), reduced (n = 3), or absent (n = 1). Overall, (99m)Tc-MAA was present in the L-RS of 95.8% patients and the distribution of (99m)Tc-MAA in L-RS and L-NRS were graded as similar in 66.6% of patients. Compared with lesions in the L-NRS, tumor response in L-RS was similar in 23 cases and worse in 1 case. No complications were recorded after the administration of (90)Y resin microspheres. Redistribution of flow in L-RS is feasible and enables a safe and effective delivery of (90)Y resin microspheres that are able to be distributed via intrahepatic collaterals and access the microvasculature of L-RS.
Publisher: Springer Science and Business Media LLC
Date: 05-2018
DOI: 10.1007/S00259-018-4033-0
Abstract: To evaluate the incremental value of FDG-PET over clinical tests in: (i) diagnosis of amyotrophic lateral sclerosis (ALS) (ii) picking early signs of neurodegeneration in patients with a genetic risk of Huntington's disease (HD) and detecting metabolic changes related to cognitive impairment in (iii) ALS and (iv) HD patients. Four comprehensive literature searches were conducted using the PICO model to extract evidence from relevant studies. An expert panel then voted using the Delphi method on these four diagnostic scenarios. The availability of evidence was good for FDG-PET utility to support the diagnosis of ALS, poor for identifying presymptomatic subjects carrying HD mutation who will convert to HD, and lacking for identifying cognitive-related metabolic changes in both ALS and HD. After the Delphi consensual procedure, the panel did not support the clinical use of FDG-PET for any of the four scenarios. Relative to other neurodegenerative diseases, the clinical use of FDG-PET in ALS and HD is still in its infancy. Once validated by disease-control studies, FDG-PET might represent a potentially useful biomarker for ALS diagnosis. FDG-PET is presently not justified as a routine investigation to predict conversion to HD, nor to detect evidence of brain dysfunction justifying cognitive decline in ALS and HD.
Publisher: Springer Science and Business Media LLC
Date: 13-05-2018
DOI: 10.1007/S00259-018-4032-1
Abstract: To assess the clinical utility of 18F-Fluorodeoxyglucose positron emission tomography (FDG-PET) for detection of early signs of neurodegeneration in conditions of increased risk for Alzheimer's disease (AD) as defined by: subjective cognitive decline (SCD), evidence of cerebral amyloid-pathology, apolipoprotein E (APOE) ε4-positive genotype, or autosomal dominant forms of AD (ADAD) in asymptomatic stages. A comprehensive literature search was conducted using the PICO model to extract evidence from relevant studies. An expert panel then voted using the Delphi method on three different diagnostic scenarios. The level of empirical study evidence for the use of FDG-PET to detect meaningful early signs of neurodegeneration was considered to be poor for ADAD and lacking for SCD and asymptomatic persons at risk, based on APOE ε4-positive genotype or cerebral amyloid pathology. Consequently, and consistent with current diagnostic criteria, panelists decided not to recommend routine clinical use of FDG-PET in these situations and to currently mainly reserve it for research purposes. Currently, there is limited evidence on which to base recommendations regarding the clinical routine use of FDG-PET to detect diagnostically meaningful early signs of neurodegeneration in asymptomatic subjects with ADAD, with APOE ε4-positive genotype, or with cerebral amyloid pathology, and in subjects with SCD. Future prospective studies are warranted and in part already ongoing, aiming to assess the added value of FDG-PET in this context beyond research applications.
Publisher: Springer Science and Business Media LLC
Date: 19-05-2018
Publisher: Springer Science and Business Media LLC
Date: 02-05-2018
DOI: 10.1007/S00259-018-4030-3
Abstract: To review literature until November 2015 and reach a consensus on whether automatic semi-quantification of brain FDG-PET is useful in the clinical setting for neurodegenerative disorders. A literature search was conducted in Medline, Embase, and Google Scholar. Papers were selected with a lower limit of 30 patients (no limits with autopsy confirmation). Consensus recommendations were developed through a Delphi procedure, based on the expertise of panelists, who were also informed about the availability and quality of evidence, assessed by an independent methodology team. Critical outcomes were available in nine among the 17 papers initially selected. Only three papers performed a direct comparison between visual and automated assessment and quantified the incremental value provided by the latter. Sensitivity between visual and automatic analysis is similar but automatic assessment generally improves specificity and marginally accuracy. Also, automated assessment increases diagnostic confidence. As expected, performance of visual analysis is reported to depend on the expertise of readers. Tools for semi-quantitative evaluation are recommended to assist the nuclear medicine physician in reporting brain FDG-PET pattern in neurodegenerative conditions. However, heterogeneity, complexity, and drawbacks of these tools should be known by users to avoid misinterpretation. Head-to-head comparisons and an effort to harmonize procedures are encouraged.
Publisher: Elsevier BV
Date: 05-2019
DOI: 10.1016/J.IDH.2018.10.005
Abstract: Urinary tract infections are one of the most common infections encountered in ambulatory care and the inpatient setting. Antibiotic resistance is a growing concern in healthcare worldwide and has been described by the World Health Organisation as one of the key global health issues facing our generation. The objective of this study was to evaluate antibiotic prescribing adherence to national therapeutic guidelines for patients with uncomplicated urinary tract infection. A single centre, retrospective study of patients with uncomplicated urinary tract infections presenting to the Gold Coast University Hospital in May 2015. Infections were categorised according to male cystitis, female cystitis, mild pyelonephritis and severe pyelonephritis, with antibiotic prescribing assessed against the Australian Therapeutic Guidelines. 103 patients met the inclusion criteria, 47 (45.6%) received treatment that adhered to the Australian Therapeutic Guidelines. Eight (7.8%) did not adhere but the decision of non-adherence was justified. 48 (46.6%) received treatment that did not adhere to the Australian Therapeutic Guidelines. The most common reason for non-adherence were incorrect dose followed by incorrect duration. There was a lack of fluoroquinolone use in this study. These results highlight the poor adherence to guidelines in uncomplicated urinary tract infection. Non-adherent duration of treatment is likely contributed by inappropriate number of tablets being dispensed in boxes.
Publisher: Wiley
Date: 20-07-2018
DOI: 10.1111/ENE.13728
Abstract: Recommendations for using fluorodeoxyglucose positron emission tomography ( FDG ‐ PET ) to support the diagnosis of dementing neurodegenerative disorders are sparse and poorly structured. Twenty‐one questions on diagnostic issues and on semi‐automated analysis to assist visual reading were defined. Literature was reviewed to assess study design, risk of bias, inconsistency, imprecision, indirectness and effect size. Critical outcomes were sensitivity, specificity, accuracy, positive/negative predictive value, area under the receiver operating characteristic curve, and positive/negative likelihood ratio of FDG ‐ PET in detecting the target conditions. Using the Delphi method, an expert panel voted for/against the use of FDG ‐ PET based on published evidence and expert opinion. Of the 1435 papers, 58 papers provided proper quantitative assessment of test performance. The panel agreed on recommending FDG ‐ PET for 14 questions: diagnosing mild cognitive impairment due to Alzheimer's disease ( AD ), frontotemporal lobar degeneration ( FTLD ) or dementia with Lewy bodies ( DLB ) diagnosing atypical AD and pseudo‐dementia differentiating between AD and DLB , FTLD or vascular dementia, between DLB and FTLD , and between Parkinson's disease and progressive supranuclear palsy suggesting underlying pathophysiology in corticobasal degeneration and progressive primary aphasia, and cortical dysfunction in Parkinson's disease using semi‐automated assessment to assist visual reading. Panellists did not support FDG ‐ PET use for pre‐clinical stages of neurodegenerative disorders, for amyotrophic lateral sclerosis and Huntington disease diagnoses, and for amyotrophic lateral sclerosis or Huntington‐disease‐related cognitive decline. Despite limited formal evidence, panellists deemed FDG ‐ PET useful in the early and differential diagnosis of the main neurodegenerative disorders, and semi‐automated assessment helpful to assist visual reading. These decisions are proposed as interim recommendations.
Publisher: SAGE Publications
Date: 25-07-2017
Publisher: Springer Science and Business Media LLC
Date: 27-04-2018
DOI: 10.1007/S00259-018-4039-7
Abstract: We aim to report the quality of accuracy studies investigating the utility of [ Seven panellist, four from the European Association of Nuclear Medicine, and three from the European Academy of Neurology, produced recommendations taking into consideration the incremental value of FDG-PET, as added on clinical-neuropsychological examination, to ascertain the aetiology of MCI (AD, FTLD or DLB). A literature search using harmonized population, intervention, comparison, and outcome (PICO) strings was performed, and an evidence assessment consistent with the European Federation of Neurological Societies guidance was provided. The consensual recommendation was achieved based on Delphi rounds. Fifty-four papers reported the comparison of interest. The selected papers allowed the identification of FDG patterns that characterized MCI due to AD, FTLD and DLB. While clinical outcome studies supporting the diagnosis of MCI due to AD showed varying accuracies (ranging from 58 to 100%) and varying areas under the receiver-operator characteristic curves (0.66 to 0.97), no respective data were identified for MCI due to FTLD or for MCI due to DLB. However, the high negative predictive value of FDG-PET and the existence of different disease-specific patterns of hypometabolism support the consensus recommendations for the clinical use of this imaging technique in MCI subjects. FDG-PET has clinical utility on a fair level of evidence in detecting MCI due to AD. Although promising also in detecting MCI due to FTLD and MCI due to DLB, more research is needed to ultimately judge the clinical utility of FDG-PET in these entities.
Publisher: Springer Science and Business Media LLC
Date: 07-05-2018
DOI: 10.1007/S00259-018-4035-Y
Abstract: To assess the clinical utility of FDG-PET as a diagnostic aid for differentiating Alzheimer's disease (AD both typical and atypical forms), dementia with Lewy bodies (DLB), frontotemporal lobar degeneration (FTLD), vascular dementia (VaD) and non-degenerative pseudodementia. A comprehensive literature search was conducted using the PICO model to extract evidence from relevant studies. An expert panel then voted on six different diagnostic scenarios using the Delphi method. The level of empirical study evidence for the use of FDG-PET was considered good for the discrimination of DLB and AD fair for discriminating FTLD from AD poor for atypical AD and lacking for discriminating DLB from FTLD, AD from VaD, and for pseudodementia. Delphi voting led to consensus in all scenarios within two iterations. Panellists supported the use of FDG-PET for all PICOs-including those where study evidence was poor or lacking-based on its negative predictive value and on the assistance it provides when typical patterns of hypometabolism for a given diagnosis are observed. Although there is an overall lack of evidence on which to base strong recommendations, it was generally concluded that FDG-PET has a diagnostic role in all scenarios. Prospective studies targeting diagnostically uncertain patients for assessing the added value of FDG-PET would be highly desirable.
Publisher: Springer Science and Business Media LLC
Date: 09-05-2018
Publisher: Elsevier BV
Date: 08-2010
DOI: 10.1016/J.JVIR.2010.04.012
Abstract: Intraarterial delivery of yttrium-90 ((90)Y)-bound microspheres (ie, radioembolization) is a promising treatment for hepatocellular carcinoma (HCC). An early concern was the "embolic" nature of the microspheres, and their potential to reduce hepatic arterial blood flow in patients with compromised portal blood flow secondary to portal vein thrombosis/occlusion (PVT). In this situation, the risk of liver failure could be enhanced, particularly in patients with cirrhosis who have increased hepatic arterial blood flow. This retrospective analysis was undertaken to assess the safety and clinical benefits of radioembolization with (90)Y resin microspheres in HCC with branch or main PVT. A total of 25 patients presenting with unresectable HCC and compromised portal flow received segmental, lobar, or whole-liver infusion of (90)Y resin microspheres. For the analysis of tumor response, changes in target lesions, appearance of new lesions, and changes in portal vein thrombus were studied. Controlled disease was defined by absence of progression in all these components. Globally, controlled disease was achieved in 66.7% of patients at 2 months and 50% of patients at 6 months. No significant changes were observed in liver-related toxicities according to Common Toxicity Criteria (version 3.0) at 1 and 2 months after treatment. Median survival time was 10 months (95% CI, 6.6-13.3 months). Radioembolization of unresectable HCC and branch or main PVT with (90)Y resin microspheres was associated with minimal toxicity and a favorable median survival time. Further prospective studies are warranted to validate the findings in this clinically challenging patient population.
No related grants have been discovered for Javier Arbizu.