ORCID Profile
0000-0002-9684-4691
Current Organisations
Austin Health
,
University of Melbourne
Does something not look right? The information on this page has been harvested from data sources that may not be up to date. We continue to work with information providers to improve coverage and quality. To report an issue, use the Feedback Form.
Publisher: Baishideng Publishing Group Inc.
Date: 2015
DOI: 10.4254/WJH.V7.I1.93
Publisher: Wiley
Date: 15-12-2007
DOI: 10.1111/J.1440-1746.2006.04422.X
Abstract: The gap between the demand for liver transplantation and organ donation rates has a major impact on waiting list mortality. Understanding the risk factors that predict liver transplant waiting list death may help optimize organ allocation policy and reduce waiting list deaths. We analyzed risk factors associated with waiting list mortality in the Liver Transplant Unit Victoria for the period 1988 through 2004. The mean annual waiting list mortality for the period examined was 10.2% (10.6% for adult and 6.4% for pediatric patients). Factors associated with waiting list death included female sex, fulminant hepatic failure, primary non-function, blood group O, more urgent United Network for Organ Sharing (UNOS)-derived medical status, a Child-Turcotte-Pugh (CTP) score >or=11, a model for end-stage liver disease (MELD) score >or=20, and a pediatric end-stage liver disease score >or=20. UNOS-derived medical status, CTP class, and MELD score were significant at the multivariate level. Disease severity scores, such as MELD, predict the risk of liver transplantation waiting list mortality. Use of such scores in organ allocation in Australian liver transplant units may result in reduced waiting list mortality.
Publisher: JOP. Journal of the Pancreas
Date: 2013
Abstract: Factors affecting length of hospital stay after uncomplicated pancreaticoduodenectomy have not been reported. We hypothesized that patients undergoing uncomplicated pancreaticoduodenectomy treated by fast track recovery program would have a shorter length of hospital stay compared to those managed by a standard program. Patients without surgical or medical complications following pancreaticoduodenectomy managed by fast track or standard protocols, between 2005 and 2011, were identified and prognostic predictors for length of hospital stay determined. Forty-one patients treated by pancreaticoduodenectomy had no medical or surgical complications during this period. Of these patients, 20 underwent fast track recovery program compared to 21 who underwent standard care. Patients in the standard group were more likely to have a feeding jejunostomy tube (P .001), pylorus preserving procedure (P=0.001) and a nasogastric tube in place longer than 24 hours postoperatively (P .001). The median postoperative length of stay was shorter in the fast track recovery program group (8 days, range: 7-16 days) versus 14 days, range: 8-29 days P .001). There were three readmissions in the fast track recovery program related to abdominal pain and none in the standard group. The overall length of stay, accounting for readmissions, still remained significantly shorter in the fast track recovery program group (median 9 days, range: 7-17 days versus median14 days, range: 8-29 days P .001). There were no significant differences in discharge destination between groups. On multivariate analysis, the only factor independently associated with postoperative discharge by day 8 was fast track recovery program (OR: 37.1, 95% CI: 4.08-338 P .001). Fast track recovery program achieved significantly shorter length of stay following uncomplicated pancreaticoduodenectomy.
Publisher: Informa UK Limited
Date: 23-01-2015
DOI: 10.3109/00365521.2014.953572
Abstract: It remains unclear whether radiofrequency ablation (RFA) provides comparable outcomes to surgical resection (SR). We, therefore, compared survival outcomes of RFA to SR in patients with early stage and very early stage hepatocellular carcinoma (HCC). A multicenter retrospective analysis was performed in patients from five academic hospitals with Barcelona Cancer of the Liver Clinic (BCLC) stages 0-A HCC having RFA or SR as primary therapy. From 2000-2010, 146 patients who received treatment with RFA (n = 96) or SR (n = 52) were identified. In BCLC A patients with ≤5 cm HCC, there was a trend of lower overall survival after RFA compared with SR (3- and 5-year survival: 62% and 37% vs. 66% and 62% respectively p = 0.11). By multivariate analysis, RFA was an independent predictor of poor survival (hazard ratio = 2.26 95% confidence interval: 1.02-5.03 p = 0.04). In ≤3 cm HCC (n = 109), the 3- and 5-year survivals in RFA and SR groups were 66% and 39%, and 69% and 59%, respectively, with no difference in the median survival (p = 0.41). Local recurrence was significantly higher after RFA compared to SR in HCC ≤5 cm (p = 0.006) with a trend of lower recurrence-free survival (p = 0.06) after RFA in HCC ≤3 cm. There were fewer major complications after RFA (2% vs. 8%). While SR is superior to RFA for the management of early stage BCLC A disease with ≤5 cm HCC, both appear effective as first-line treatment options for Western patients with small ≤3 cm tumors. Although safer than SR, RFA is associated with higher rates of tumor recurrence and local disease progression. Further prospective randomized controlled trials are warranted to compare these two modalities.
Publisher: Wiley
Date: 03-09-2012
DOI: 10.1111/J.1445-2197.2012.06202.X
Abstract: Acute acalculous cholecystitis (AAC) is traditionally described in the setting of critical illness, where the diagnosis is based on clinical assessment and imaging criteria. Very few studies have assessed the features and outcomes of AAC in patients treated by cholecystectomy. Patients with histologically confirmed acute cholecystitis treated in a specialized unit in a tertiary hospital between 2005 and 2011 were identified from prospectively maintained database. Retrospective review of data was undertaken and patients with AAC were compared with those patients with acute cholecystitis and confirmed gallstones. AAC was identified in 35 of 412 (8.5%) patients with acute cholecystitis. These patients were older (69 years versus 61 years P = 0.004) and were more likely to be febrile (46% versus 21% P = 0.001) and hypotensive (23% versus 5% P < 0.001) at initial presentation. There was a higher incidence of chronic obstructive airways disease (COAD) in the AAC group (26% versus 6% P < 0.001). Other co-morbidities were similar among the groups. Operative outcomes were similar between the groups. There were no overall differences in postoperative complications between AAC and calculous acute cholecystitis patients (17% versus 16% P = 0.063). However, the postoperative length of stay was higher in the AAC group (5 days versus 3 days P = 0.026). AAC more commonly occurs in older patients and those with COAD. The operative outcomes and complications of AAC treated by cholecystectomy are similar to cases of acute calculous cholecystitis.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2013
Publisher: Frontiers Media SA
Date: 2006
DOI: 10.1111/J.1432-2277.2005.00237.X
Abstract: Innovation may be required for satisfactory arterial reconstruction in liver transplantation, particularly when the vessels obtained from the donor are inadequate. We have used a composite graft of donor iliac artery and recipient inferior mesenteric vein (IMV) between the infrarenal aorta and donor hepatic artery. Postoperative liver function was satisfactory, with normal daily duplex ultrasound scans for the first 2 weeks. At 4 years follow up, graft function is normal, a duplex ultrasound scan shows normal arterial flow and no dilatation of the composite graft, and a magnetic resonance angiogram reveals no evidence of dilatation or thrombosis of the composite graft. This is one of the few reported cases in which a composite graft has been used to arterialize the allograft in liver transplantation. A composite graft of iliac artery and IMV provided a satisfactory outcome in this patient and may be a valuable addition to the arterial grafts available to the liver transplant surgeon.
Publisher: Frontiers Media SA
Date: 30-05-2012
DOI: 10.1111/J.1432-2277.2012.01501.X
Abstract: Nonanastomotic biliary strictures (NAS) cause significant morbidity post liver transplantation. Timing of stricture development varies considerably, but the relationship between timing of stricture onset and aetiology has not been fully elucidated. Database analysis was performed on all adult patients undergoing liver transplantation between 1st January 1990 and 31st May 2008. Diagnosis of NAS required demonstration on at least two radiological studies. Early NAS were defined as developing 1 year post transplant (minimum 10-year follow-up). Ninety-six of 397 patients developed NAS (24%) 54 were early-onset NAS (56%) and 42 late-onset NAS (44%). Primary sclerosing cholangitis (PSC) was the only risk factor for NAS overall (P = 0.001). However, when patients with PSC were excluded, older donor age was a significant risk for NAS (P = 0.003). Early-onset NAS were associated with advanced donor age (P = 0.02), high MELD score (P = 0.001) and ABO-identical grafts (P = 0.02), whereas late-onset NAS were associated with PSC (P = 0.0008), bilio-enteric anastomosis (P = 0.006) and tacrolimus (P = 0.0001). Advanced donor age is a significant risk for NAS in patients without PSC. Importantly, aetiology of NAS varies depending on time to stricture development, suggesting early-onset and late-onset NAS may have different pathogenesis.
Publisher: Wiley
Date: 09-04-2015
DOI: 10.1111/ANS.12585
Abstract: Portal vein resection (PVR) with pancreatectomy is now accepted practice in cases with involvement by tumour. We present our experience of this procedure with particular emphasis on morbidity and survival. A retrospective case-control analysis of a prospectively maintained database between 2004 and 2012 was undertaken. A total of 17 patients had pancreatic resections with PVR for cancer and were compared with 17 patients with identical tumour type and stage who underwent pancreatic resection without PVR next in chronological order. Information obtained included patient demographics, radiological and histological evidence of major vein involvement and post-operative morbidity. Disease- and recurrence-free survival were calculated using Kaplan-Meier curves. Procedures associated with PVR included pancreatico-duodenectomy in 11 and total pancreatectomy in six. Three patients underwent pancreatic resection as a re-operation. Pathological staging showed 2× T2N0, 5× T3N0, 1× T1N1, 2× T2N1 and 7× T3N1 tumours. Seven PVR patients (41%) had post-operative morbidity Clavien 3 and 4, compared with none in no-PVR group, but rates of Clavien 1 and 2 complications were similar. Six PVR patients developed PV thrombosis (35%), all with significant clinical consequences. Comparing the PVR group with the no-PVR group, there was significantly reduced median overall survival in (13.8 versus 43.1 months P = 0.028) and recurrence-free survival (7.5 months versus 39.7 P = 0.004). Survival of patients after pancreatectomy with PVR was reduced and morbidity was high compared with no-PVR. Delayed portal vein thrombosis due to recurrence was common. Routine post-operative anticoagulation may be indicated in this group.
Publisher: Wiley
Date: 28-04-2015
DOI: 10.1111/MEDU.12687
Publisher: Wiley
Date: 13-09-2013
DOI: 10.1111/TID.12134
Abstract: Hepatitis C virus (HCV) recurrence post liver transplant is universal, with a subgroup of patients developing rapid hepatic fibrosis. Various clinical definitions of rapid fibrosis (RF) have been used to identify risks for rapid progression, but their comparability and efficacy at predicting adverse outcomes has not been determined. Retrospective data analysis was conducted on 100 adult patients with HCV who underwent liver transplantation at a single center. We measured year 1 fibrosis progression (RF defined as METAVIR F score ≥ 1 at 1-year liver biopsy), time to METAVIR F2-stage fibrosis, and fibrosis rate (calculated using liver biopsies graded by METAVIR scoring F0-4 fibrosis rate = fibrosis stage/year post transplant). RF was defined as ≥ 0.5 units/year. Multivariate analysis revealed that donor age and peak HCV viral load were significant risks for RF, when fibrosis rate was used to define RF. Advanced donor age was a risk for rapid progression to F2-stage fibrosis, whereas genotype 2 or 3 HCV infection was protective. Fibrosis rate had the strongest correlation with time to cirrhosis development (P < 0.0001, r = -0.76) and was the most accurate predictor of rapid graft cirrhosis (P < 0.0001, area under the curve 0.979, sensitivity 100%, specificity 94%). Different measures of RF progression identify different risks for RF and are not directly comparable. Fibrosis rate was the most accurate predictor of rapid graft cirrhosis.
Publisher: Elsevier BV
Date: 08-2011
Publisher: Wiley
Date: 09-09-2010
DOI: 10.1111/J.1365-2044.2010.06478.X
Abstract: We conducted a prospective study of non-cardiac surgical patients aged 70 years or more in 23 hospitals in Australia and New Zealand. We studied 4158 consecutive patients of whom 2845 (68%) had pre-existing comorbidities. By day 30, 216 (5%) patients had died, and 835 (20%) suffered complications 390 (9.4%) patients were admitted to the Intensive Care Unit. Pre-operative factors associated with mortality included: increasing age (80-89 years: OR 2.1 (95% CI 1.6-2.8), p < 0.001 90+ years: OR 4.0 (95% CI 2.6-6.2), p < 0.001) worsening ASA physical status (ASA 3: OR 3.1 (95% CI 1.8-5.5), p < 0.001 ASA 4: OR 12.4 (95% CI 6.9-22.2), p < 0.001) a pre-operative plasma albumin < 30 g.l⁻¹ (OR: 2.5 (95% CI 1.8-3.5), p < 0.001) and non-scheduled surgery (OR 1.8 (95% CI 1.3-2.5), p < 0.001). Complications associated with mortality included: acute renal impairment (OR 3.3 (95% CI 2.1-5.0), p < 0.001) unplanned Intensive Care Unit admission (OR 3.1 (95% CI 1.9-4.9), p < 0.001) and systemic inflammation (OR 2.5 (95% CI 1.7-3.7), p < 0.001). Patient factors often had a stronger association with mortality than the type of surgery. Strategies are needed to reduce complications and mortality in older surgical patients.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2005
DOI: 10.1002/LT.20428
Abstract: Minimization of death while waiting for liver transplantation involves accurate prioritization according to clinical status and appropriate allocation of donor livers. Clinical judgment in the Liver Transplant Unit Victoria (LTUV) was compared with Model for End-Stage Liver Disease (MELD) in a retrospective analysis of the LTUV database over the 2-year period August 1, 2002, through July 31, 2004. A total of 1,118 prioritization decisions occurred. Decisions were concordant in 758 (68%), comparing priorities assigned by clinical judgment with those assigned by MELD, P < 0.01. A total of 263 allocation decisions occurred. Decisions were concordant in 190 (72%) and 203 (77%) of the cases, comparing donor liver allocation with prioritization by MELD and clinical judgment, respectively. Of the 52 patients allocated a liver, only 23 would have been allocated on the basis of MELD while 29 had been prioritized on the waiting list in the week prior to transplantation. A total of 10 patients died on the waiting list in the 2-year period (annual adult waiting list mortality is 9.3%). Patients who subsequently died waiting were 3 times as likely to be prioritized by MELD as clinical judgment (29% vs. 9%, respectively). One half (3 of 6) of the patients who could have received a donor liver but who died waiting would have been allocated the organ on the basis of MELD. In conclusion, an allocation process based on MELD rather than clinical judgment would significantly alter organ allocation in Australia and may reduce waiting list mortality.
Publisher: Wiley
Date: 09-2021
DOI: 10.1111/CTR.14419
Abstract: Blood removed from organs during deceased donor organ procurement is routinely discarded but is a potential resource for donor‐specific transfusion (DST) in subsequent liver transplantation (LT). This study retrospectively analyses the impact of DST on intraoperative bank blood product usage, long‐term graft, and patient survival, as well as frequency of rejection post‐LT. A total of 992 adult LT performed from 1993 to 2018 in a single quaternary center were included. Intraoperative blood product usage, patient, and graft survival, as well as acute and chronic rejection were assessed in patients who received blood retrieved from the organ donor, the “donor blood” (DB) group ( n = 437) and patients who did not, the “no donor blood” (NDB) group ( n = 555). Processing of DB ensured safe levels of potassium, magnesium, and insulin. There were fewer units of bank red blood cells transfusion required in the DB group compared to NDB group (2 vs. 4 units, P = .01). Graft survival was significantly superior in the DB group (10‐year survival 75% vs. 69%, respectively, P = .04) but DST was not an independent predictor of graft survival. There was no significant difference in patient survival or rejection between the groups. There was no difference in treated, biopsy‐proven rejection between the two groups. This is the first large‐cohort study assessing long‐term outcomes of intraoperative DST in LT. The collection of organ donor blood and subsequent use in LT recipients appeared feasible with appropriate quality checks ensuring safety. DST resulted in a reduction in the use of packed red blood cells. There was no difference in the rate of rejection or graft or patient survival.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2013
Publisher: Springer Science and Business Media LLC
Date: 16-11-2013
DOI: 10.1007/S12664-012-0274-1
Abstract: Patients with peri ullary cancers may not be suitable for curative resection due to locally advanced disease, metastases, or poor health. Biliary stenting and surgical bypass are utilized for symptom control, but the true benefit of one technique over the other is not clear. A retrospective analysis of case records was undertaken of patients with peri ullary (pancreatic head/uncinate process, distal bile duct, and ulla of Vater and surrounding duodenum) malignancy treated between June 2004 and June 2010 in a tertiary center by palliative biliary stenting or palliative surgical bypass. Of the 69 patients included in the analysis, combined biliary and gastric bypass was performed on 28, while 41 underwent biliary stent (metallic, n = 39) insertion. Patients undergoing stenting were significantly older and less likely to be offered chemotherapy than those from the surgical bypass group. Overall, there were significantly more complications in the stent insertion group (85 %) than the surgical bypass group (36 %) (p = 0.003). The stent group required significantly more subsequent procedures than the surgical bypass group. Metal stent obstruction occurred in 16 of 39 (41 %) patients, with a median stent patency of 224 days. The overall median survival of patients in this study was 7 months with no significant difference between the groups (p = 0.992). The presence of metastases at presentation was the only independent factor associated with decreased survival. There was no survival difference between stenting vs. surgical bypass for palliation of peri ullary cancer. There was, however, a high rate of stent occlusion and need for repeat procedures in patients treated by metal stenting, suggesting that stenting may be best suited to patients predicted as having the shortest survival.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 25-09-2022
DOI: 10.1002/HEP4.2089
Abstract: Although there are several established international guidelines on the management of hepatocellular carcinoma (HCC), there is limited information detailing specific indicators of good quality care. The aim of this study was to develop a core set of quality indicators (QIs) to underpin the management of HCC. We undertook a modified, two‐round, Delphi consensus study comprising a working group and experts involved in the management of HCC as well as consumer representatives. QIs were derived from an extensive review of the literature. The role of the participants was to identify the most important and measurable QIs for inclusion in an HCC clinical quality registry. From an initial 94 QIs, 40 were proposed to the participants. Of these, 23 QIs ultimately met the inclusion criteria and were included in the final set. This included (a) nine related to the initial diagnosis and staging, including timing to diagnosis, required baseline clinical and laboratory assessments, prior surveillance for HCC, diagnostic imaging and pathology, tumor staging, and multidisciplinary care (b) thirteen related to treatment and management, including role of antiviral therapy, timing to treatment, localized ablation and locoregional therapy, surgery, transplantation, systemic therapy, method of response assessment, and supportive care and (c) one outcome assessment related to surgical mortality. Conclusion : We identified a core set of nationally agreed measurable QIs for the diagnosis, staging, and management of HCC. The adherence to these best practice QIs may lead to system‐level improvement in quality of care and, ultimately, improvement in patient outcomes, including survival.
Publisher: Wiley
Date: 20-04-2012
Publisher: AMPCo
Date: 11-2013
DOI: 10.5694/MJA13.10102
Abstract: To examine whether incidence of colorectal malignancy is increased in Australasian liver transplant recipients compared with the general population of Australia, and to assess the characteristics and outcomes of colorectal malignancy in this patient group. Data on patients who underwent orthotopic liver transplantation (OLTx) and had a diagnosis of de-novo colorectal malignancy after transplantation during the period 1985-2011 were obtained from the Australia and New Zealand Liver Transplant Registry, and these data were compared with colorectal malignancy data from the Australian Institute of Health and Welfare. Time from OLTx to diagnosis of colorectal malignancy, stage of colorectal malignancy at diagnosis, patient survival, and standardised incidence ratio (SIR) for colorectal malignancy. Forty-eight of 3735 recipients (1.3%) were diagnosed with colorectal malignancy at a median of 7.3 years after OLTx. More advanced colorectal malignancy (regional or metastatic disease) was evident at diagnosis in 20 of the 48 patients these patients tended to be younger than patients with less advanced malignancy (P = 0.01) and diagnosed sooner after OLTx (P = 0.005). Despite treatment predominantly with surgery, 19 of the 48 patients died from the malignancy. The overall SIR for colorectal malignancy liver transplant recipients compared with the general population of Australia was 2.80 (95% CI, 2.06-3.71). The incidence of colorectal malignancy is increased in liver transplant recipients in comparison with the general population. Of concern is the tendency for advanced malignancy to be diagnosed in younger patients. These data highlight the importance of considering whether specific guidelines for colorectal malignancy screening in the Australasian adult liver transplant population are needed.
Publisher: Wiley
Date: 04-2023
DOI: 10.1002/JGH3.12879
Abstract: Hepatocellular carcinoma (HCC) is an aggressive primary malignancy of the liver and is the third most common cause of cancer‐related global mortality. There has been a steady increase in treatment options for HCC in recent years, including innovations in both curative and non‐curative therapies. These advances have brought new challenges and necessary improvements in strategies of disease monitoring, to allow early detection of HCC recurrence. Current serological and radiological strategies for post‐treatment monitoring and prognostication and their limitations will be discussed and evaluated in this review.
Publisher: Wiley
Date: 08-2014
DOI: 10.1111/ANS.12313
Abstract: The independent influence of advanced age on outcomes in contemporary series treated by early cholecystectomy is undetermined. Elderly patients, aged 80 years and older, with histology proven acute cholecystitis treated by cholecystectomy on initial presentation between 2005 and 2011 were compared to all others. In total, 411 patients had histologically proven acute cholecystitis, of whom 71 (17%) were aged 80 years and older. Elderly patients were more likely to have ischaemic heart disease, underlying diabetes and chronic renal failure. There was greater conversion from laparoscopic to open surgery in the elderly (21% versus 7% P = 0.001). Elderly patients were more likely to have gangrenous cholecystitis (44% versus 31% P = 0.033) and common bile duct stones (27% versus 17% P = 0.048). Elderly patients had more complications (31% versus 13% P < 0.001), a higher mortality rate (4% versus 1% P = 0.038) and a longer median post-operative length of stay (7 days versus 3 days P < 0.001). Age ≥ 80 (P = 0.004) was an independent risk factors for complications. Age 80 years and older is independently associated with increased morbidity following cholecystectomy for treatment acute cholecystitis at initial presentation.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 19-02-2016
DOI: 10.1002/HEP.28267
Abstract: Hepatocellular carcinoma (HCC) incidence is rising rapidly in many developed countries. Primary epidemiological data have invariably been derived from cancer registries that are heterogeneous in data quality and registration methodology many registries have not adopted current clinical diagnostic criteria for HCC and still rely on histology for classification. We performed the first population‐based study in Australia using current diagnostic criteria, hypothesizing that HCC incidence may be higher than reported. Incident cases of HCC (defined by American Association for the Study of Liver Diseases diagnostic criteria or histology) were prospectively identified over a 12‐month period (2012‐2013) from the population of Melbourne, Australia. Cases were captured from multiple sources: admissions to any of Melbourne's seven tertiary hospitals attendances at outpatients and radiology, pathology, and pharmacy services. Our cohort was compared to the Victorian Cancer Registry (VCR) cohort (mandatory notified cases) for the same population and period, and incidence rates were compared for both cohorts. There were 272 incident cases (79% male median age: 65 years) identified. Cirrhosis was present in 83% of patients, with hepatitis C virus infection (41%), alcohol (39%), and hepatitis B virus infection (22%) the commonest etiologies present. Age‐standardized HCC incidence (per 100,000, Australian Standard Population) was 10.3 (95% confidence interval [CI]: 9.0‐11.7) for males and 2.3 (95% CI: 1.8 to 3.0) for females. The VCR reported significantly lower rates of HCC: 5.3 (95% CI: 4.4 to 6.4) and 1.0 (95% CI: 0.7 to 1.5) per 100,000 males and females respectively ( P 0.0001). Conclusions: HCC incidence in Melbourne is 2‐fold higher than reported by cancer registry data owing to under‐reporting of clinical diagnoses. Adoption of current diagnostic criteria and additional capture sources will improve registry completeness. Chronic viral hepatitis and alcohol remain leading causes of cirrhosis and HCC. (H epatology 2016 :1205–1212)
Publisher: Wiley
Date: 30-08-2007
DOI: 10.1111/J.1445-2197.2007.04258.X
Abstract: We reviewed our experience to determine the role of resectional surgery in metastatic melanoma to the abdomen. An observational study of 25 patients at the Austin Hospital, Melbourne from 1997 to 2005. The median survival after abdominal resectional surgery was 8.3 (range 0.4-41.1) months. Fourteen patients who underwent resection with curative intent (extra-abdominal disease controlled and complete macroscopic clearance of abdominal disease) had improved survival compared with 11 patients who underwent palliative resection (12 month survival, 89 vs 10%, respectively, P < 0.0001). Survival was also superior in patients with up to two metastases compared with more than two (P = 0.0001) and in patients with serum albumin of at least 35 g/L (P = 0.0031). Intent of surgery (curative vs palliative) was the only factor significant on multivariate analysis (P = 0.001). Of patients with preoperative symptoms, 87% had resolution of these symptoms. Operative morbidity was 12%, and 30-day mortality was 4%. In a highly selected group of patients with intra-abdominal melanoma metastases, resection of intra-abdominal metastases with curative intent resulted in prolonged survival compared with patients who underwent palliative resection. Those who underwent palliative resection had good relief of symptoms with minimal morbidity.
Publisher: Springer Science and Business Media LLC
Date: 30-10-2014
DOI: 10.1007/S00268-013-2309-X
Abstract: Surgical site infections (SSI) are a significant cause of postoperative morbidity. Pressurized pulse irrigation of subcutaneous tissues may lower infection rates by aiding in the debridement of necrotic tissue and reducing bacterial counts compared to simply pouring saline into the wound. A total of 128 patients undergoing laparotomy extending beyond 2 h were randomized to treatment of wounds by pressurized pulse lavage irrigation (<15 psi) with 2 L normal saline (pulse irrigation group), or to standard irrigation with 2 L normal saline poured into the wound, immediately prior to skin closure (standard group). Only elective cases were included, and all cases were performed within a specialized hepatobiliary and pancreatic surgery unit. There were 62 patients managed by standard irrigation and 68 were managed by pulse irrigation. The groups were comparable in most aspects. Overall there were 16 (13 %) SSI. Significantly fewer SSI occurred in the pulse irrigation group [4 (6 %) vs. 12 (19 %) p = 0.032]. On multivariate analysis, the use of pulse irrigation was the only factor associated with a reduction in SSI with an odds ratio (OR) of 0.3 [95 % confidence interval (95 % CI) 0.1-0.8 p = 0.031]. In contrast, hospital length of stay of greater than 14 days was associated with increased infections with an OR of 7.6 (95 % CI 2.4-24.9 p = 0.001). Pulse irrigation of laparotomy wounds in operations exceeding 2 h duration reduced SSI after major hepatobiliary pancreatic surgery. (Australian New Zealand Clinical Trials Registry, ACTRN12612000170820).
Publisher: Wiley
Date: 09-2015
DOI: 10.1111/ANS.13243
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-11-2022
DOI: 10.1002/LT.26329
Abstract: Introduction of universal access to direct-acting antiviral (DAA) therapy for hepatitis C virus (HCV) in Australia and New Zealand on March 1
Publisher: Wiley
Date: 18-09-2013
No related grants have been discovered for Michael Fink.