ORCID Profile
0000-0002-0927-3721
Current Organisations
Univeristy of Sydney
,
University of New South Wales
,
University of Oxford
,
University of Toronto
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Publisher: Wiley
Date: 08-2008
DOI: 10.1111/J.1445-2197.2008.04616.X
Abstract: The best operation for high anal fistulas is difficult to nominate because they have varying cure and incontinence rates. The objective of this study was to quantify the relative importance of the outcomes of cure, continence and other quality-of-life (QOL) factors. A questionnaire was sent in October 2006 to patients with anal fistulas and to colorectal surgeons. Participants were asked to nominate up to five QOL domains. They were also asked to choose between two treatment options (with different cure and continence rates). Seventy-five of 134 (56%) surgeons and 28 of 199 (14%) patients replied. Comparing draining and cutting setons, surgeons (57 of 71, six neutral) favoured the former and patients (15 of 27, four neutral) preferred the latter. Comparing mucosal advancement flap with cutting seton, both surgeons (71 of 75, four neutral) and patients (13 of 26, two neutral) preferred the former. There was greater uncertainty among surgeons when comparing draining seton (23) and mucosal advancement flap (33), with 18 neutral. Patients preferred the mucosal advancement flap (19) to draining seton (three) and four were neutral. In direct questioning of objectives, surgeons nominated continence, leakage, pain, cure and sepsis as the five most important QOL factors. Patients nominated independent activity, pain, continence, psychological health and leakage as their five factors. Functional impairment and QOL do not necessarily correlate. The development of a validated specific QOL scale for patients with anal fistulas would be important to compare the results of different treatment options. This scale should include social and psychological factors in addition to the physical outcomes.
Publisher: Wiley
Date: 11-2001
Publisher: Spandidos Publications
Date: 24-07-2012
Abstract: Signal transducer and activator of transcription 3 (STAT3) regulates many critical functions in human normal and malignant tissues, such as differentiation, proliferation, survival, angiogenesis and immune function. Constitutive activation of STAT3 is implicated in a wide range of human cancers. As such, STAT3 has been studied as a tumour therapeutic target. This review aimed principally to summarise the updated research on STAT3 inhibition studies and their therapeutic potential in solid tumours. Recent literature associated with STAT3 inhibition was reviewed through PubMed and Medline database, followed by critical comparison and analysis. Constitutive activation of STAT3 has been identified as abnormal and oncogenic. The pathway of STAT3 activation and signal transduction identifies 3 approaches for inhibition: modulating upstream positive or negative regulators, regulating RNA (DN-STAT3, anti-sense RNA, siRNA and microRNA) or targeting STAT3 protein at different domains. The last approach using small molecule STAT3 inhibitors has been the most examined so far with both preclinical and clinical studies. Targeting STAT3 using a specific inhibitor may be a useful cancer treatment approach, with the potential for a broad clinical impact.
Publisher: Wiley
Date: 1988
DOI: 10.1177/014860718801200115
Abstract: Conventional long chain triglyceride (LCT) was compared with a new emulsion containing 50% medium chain triglyceride (5% MCT/5% LCT) in a randomized cross-over trial of 10 days duration. Plasma concentrations of albumin, prealbumin, the complement components C3 and C4, and prothrombin times measured daily at 8 am, before lipid infusion, showed no progressive change during the 10 days of the trial, nor in each separate 5-day period when LCT or MCT/LCT was infused. Aspartate transaminase and alkaline phosphatase activities were similar over the two periods. There was a significant increase (compared with preinfusion levels) in C3 and C4 levels after 5 hr of either lipid infusion. Nitrogen balance was improved, and plasma bilirubin levels were lower on the regimen containing MCT/LCT.
Publisher: Springer Science and Business Media LLC
Date: 09-07-2001
DOI: 10.1007/S00268-001-0069-5
Abstract: A significant number of patients with liver metastases from colorectal cancer (CRC) achieve 5-year survival after liver resection. Increased expression of genetic markers in the primary tumor are known to predict outcome after colonic resection, but the predictive value of such markers after resection of hepatic metastases is unknown. The objective of this study was to evaluate whether DNA content and multiple genetic markers, separately or expressed together, can predict patient outcome (liver recurrence and survival) after resection of hepatic metastases. We studied the paraffin-embedded liver tissue of 71 consecutive patients who had undergone a potentially curative resection of hepatic metastases from CRC. Using DNA flow cytometry and immunohistochemical staining techniques we determined the DNA content and the level of co-expression of seven tumor-associated proteins: proliferating cellular nuclear antigen (PCNA), epidermal growth factor receptor (EGFr), p53, c-erbB-2, H-ras, c-myc, and nm23. Three endpoints (liver recurrence, cancer specific, overall survival) were correlated with these tumor markers. The 5-year overall survival of the group was 31.2%. There was no correlation detected between the DNA aneuploidy and overall or cancer-specific survival. Similarly, expression of the in idual tumor-associated proteins did not predict survival. Patients whose tumors co-expressed multiple markers had survivals similar to those whose tumors expressed fewer markers. However, a significant difference in hepatic recurrence was found between the p53-positive and p53-negative patients (p = 0.007), with marker-negative tumors having decreased recurrence. In conclusion, this study demonstrates that the DNA content and genetic markers c-myc, c-erbB-2, EGFr, H-ras, p53, PCNA, and nm23 do not predict survival after potentially curative resection of hepatic metastases from CRC. However, the immunoreactivity of p53 may be an important marker of local recurrence in the liver, which may be useful if re-resection of metastatic liver tumors is considered a viable management option in this disease.
Publisher: American Association for Cancer Research (AACR)
Date: 04-2023
DOI: 10.1158/1078-0432.22488651
Abstract: Supplementary Methods
Publisher: Wiley
Date: 05-1999
DOI: 10.1046/J.1440-1622.1999.01569.X
Abstract: To identify risk factors for local recurrence and overall survival in patients with extremity soft tissue sarcoma. A retrospective study was performed of all patients with extremity soft tissue sarcoma treated at the Combined Surgical Oncology Clinic in the Institute of Oncology at Prince of Wales Hospital between 1972 and 1992. Variables analysed included clinical presentation, patient characteristics, tumour characteristics, treatment factors and outcome. One hundred and nineteen patients were eligible for the study. The most common type of presentation was with a painless mass, usually in the thigh. Local control rates at 5 and 10 years were 75% and 73%. Local control was higher in patients who had more radical surgery and in those who received adjuvant radiotherapy. Tumour size and high grade were independent risk factors for poorer survival. Patients over 50 had poorer survival than younger patients and those who presented with recurrent tumours also tended to have poor survival compared to patients presenting de novo. The respective 5- and 10-year survival rates were 65% and 62%. This study suggests that local control of extremity soft tissue sarcoma is improved by radical surgery and by the addition of radiotherapy when more conservative procedures are used. Overall survival appeared to be largely determined by patient (age, recurrent presentation) and tumour characteristics (grade, size).
Publisher: American Association for Cancer Research (AACR)
Date: 04-2023
DOI: 10.1158/1078-0432.22488654
Abstract: Supplementary Figures S1-S13
Publisher: Wiley
Date: 09-11-2019
DOI: 10.1111/ANS.14827
Abstract: Current surgical practice often leads to excision of all papillary lesions of the breast diagnosed on percutaneous biopsy. This study aims to identify a subset of patients with papillary lesions who may be able to avoid surgery. Between January 2000 and December 2015, 157 cases of papillary lesions with complete surgical excision pathology results were reviewed retrospectively to compare the clinical, imaging and pathology features. Of these, 50 patients with benign papillary lesions without atypia and 19 patients with benign papillary lesions with atypia on needle biopsy were analysed to determine the rate of upgrade to malignancy after surgery. Of the 50 patients with benign papillary lesions without atypia on biopsy, two (4%) were upgraded to low grade ductal carcinoma in situ after surgical excision. Both these patients had suspicious features on imaging. Of the 19 patients with papillary lesions with atypia diagnosed on needle biopsy, eight (42%) were upgraded to malignancy after surgery. The differences between benign, atypical and malignant papillary lesions were further compared. Malignant lesions were more suspicious radiologically (P = 0.001), more likely to have architectural distortion (P = 0.001), more peripherally located (P = 0.001) and were larger in size (P = 0.01). Patients diagnosed with malignant lesions were also older (P = 0.001). Younger patients diagnosed with small central benign papillary lesions without atypia on needle biopsy, and without suspicious imaging, may be managed conservatively with surveillance.
Publisher: Wiley
Date: 25-10-2010
DOI: 10.1111/J.1445-2197.2010.05339.X
Abstract: The use of a continuous local anaesthesia infusion after laparotomy may reduce opioid requirements and facilitate earlier return of bowel function, independent mobilization and hospital discharge. We performed a double-blinded, randomized controlled trial on 55 patients who underwent laparotomy. Patients were randomly allocated to receive a continuous infusion of either 0.2% ropivacaine or normal saline into their midline abdominal wound at the fascial level. The end points of the study were: total opioid requirements at 24 and 48 h time to first flatus, bowel movement and independent ambulation length of hospital stay complications and daily mean patient-reported pain scores at rest and movement. The two treatment groups were well controlled for factors that influence analgesia requirements, including age, weight, length of wound incision and type of operation. Patients allocated to ropivacaine infusion used, on average, 32 mg less morphine at 48 h (95% confidence interval 7, 57 P= 0.01). This was highly statistically significant after adjusting for age, gender and type of operation (P= 0.0006). Ropivacaine infusion was associated with a significantly decreased time to independent mobilization (P= 0.02), time to first flatus (P= 0.02) and reduced post-operative ileus (2/28 versus 9/27, χ(2) = 5.89, P= 0.02). There was no significant effect of ropivacaine infusion on time to first bowel movement (P= 0.94) nor length of hospital stay (P= 0.77). Local anaesthesia infusion at the fascial plane provides effective analgesia. This improves patient recovery through earlier return to bowel function and mobilization.
Publisher: Oxford University Press (OUP)
Date: 08-1984
Abstract: The nitrogen sparing effect of glucose loading at either 1 mg kg−1 min−1 or 5 mg kg−1 min−1 from the evening before surgery was compared with similar glucose infusions commenced after elective surgery. Thirty-two patients undergoing abdominal surgery of moderate severity were studied. Glucose at 5 mg kg−1 min−1 reduced urea excretion compared with glucose at 1 mg kg−1 min−1. The timing of the carbohydrate infusion was not critical in altering the overall extent of the protein sparing at either rate. High dose glucose infusions markedly reduced overall urea and 3-methylhistidine excretion. This implies a reduction in protein breakdown. A pre-operative high dose infusion of glucose may in particular improve protein synthesis for the first 24 h after surgery.
Publisher: Oxford University Press (OUP)
Date: 17-08-2005
DOI: 10.1002/BJS.5139
Abstract: Intraoperative diagnosis of breast cancer metastases in axillary sentinel nodes is desirable to avoid a second operation for lymphadenectomy. Imprint or touch-preparation cytology is a popular technique that has high specificity and a wide range of sensitivity. A systematic search of electronic databases was performed. Included articles were assessed for methodological and reporting quality. Random-effects model pooled estimates of sensitivity and specificity were calculated. Single-variable and multivariable meta-regression analyses were performed for predictors of sensitivity. Thirty-one studies were included all were of good methodological quality but reporting quality varied. Pooled sensitivity of imprint cytology was 63 (95 per cent confidence interval (c.i.) 57 to 69) per cent and specificity was 99 (95 per cent c.i. 98 to 99) per cent. Pooled sensitivity for macrometastases was 81 per cent and that for micrometastases 22 per cent. Mean or median primary tumour size (P = 0·004), the prevalence of metastases (P = 0·103) and the proportion of micrometastases (P = 0·022) were significant risk factors in single-variable meta-regression analysis. Only the proportion of micrometastases remained significant in multivariable analysis. Frozen sectioning had better sensitivity than imprint cytology in three of four direct comparisons. Imprint cytology is simple and rapid, and has good sensitivity for macrometastases. The significance of poor sensitivity for micrometastases will be determined by trials investigating their natural history.
Publisher: Wiley
Date: 08-2003
DOI: 10.1046/J.1445-2197.2003.02707.X
Abstract: Equestrian activities are associated with a high rate of injury. Attempts to reduce the incidence and severity of injury require accurate characterization of risk factors and pattern of injury. The present study was performed to analyse the injuries seen at an Australian centre where a large number of equestrian injuries present. Data were collected prospectively over a 3 year period on all equestrian injuries presenting to the Prince of Wales -Hospital complex. These data were compared against and combined with retrospectively collected data over the preceding 3 years at the same centre. Two hundred and twenty-one injured equestrians presented (181 consented) in the prospective period of the study, and 208 presented in the retrospective period. Overall, 81% of riders were wearing a helmet at the time of their injury. Helmet use was associated with a significantly lower admission rate (27% vs 55% P < 0.0001, from combined data). Recreational equestrians had a higher admission rate than professional equestrians, and had a significantly higher head and spine injury rate than the professional group. Rate of helmet use increased from 72% in the retrospective group to 91% in the more recent prospective group, and total admissions decreased from 43% to 14%. Significant and serious injuries are associated with equestrian activities, with the higher risk group being recreational equestrians, and riders not using a helmet. The pattern of injury favours head and spine in recreational and non-helmeted riders, and extremities for professional and helmeted riders. Helmet use is still not universal among riders, although an increase in its use may be contributing to an overall reduction in admission rate. Facial and spinal injuries still occurred in helmeted patients.
Publisher: American Association for Cancer Research (AACR)
Date: 07-10-2022
DOI: 10.1158/1078-0432.CCR-22-1206
Abstract: Advanced-stage mucinous ovarian carcinoma (MOC) has poor chemotherapy response and prognosis and lacks biomarkers to aid stage I adjuvant treatment. Differentiating primary MOC from gastrointestinal (GI) metastases to the ovary is also challenging due to phenotypic similarities. Clinicopathologic and gene-expression data were analyzed to identify prognostic and diagnostic features. Discovery analyses selected 19 genes with prognostic/diagnostic potential. Validation was performed through the Ovarian Tumor Tissue Analysis consortium and GI cancer biobanks comprising 604 patients with MOC (n = 333), mucinous borderline ovarian tumors (MBOT, n = 151), and upper GI (n = 65) and lower GI tumors (n = 55). Infiltrative pattern of invasion was associated with decreased overall survival (OS) within 2 years from diagnosis, compared with expansile pattern in stage I MOC [hazard ratio (HR), 2.77 95% confidence interval (CI), 1.04–7.41, P = 0.042]. Increased expression of THBS2 and TAGLN was associated with shorter OS in MOC patients (HR, 1.25 95% CI, 1.04–1.51, P = 0.016) and (HR, 1.21 95% CI, 1.01–1.45, P = 0.043), respectively. ERBB2 (HER2) lification or high mRNA expression was evident in 64 of 243 (26%) of MOCs, but only 8 of 243 (3%) were also infiltrative (4/39, 10%) or stage III/IV (4/31, 13%). An infiltrative growth pattern infers poor prognosis within 2 years from diagnosis and may help select stage I patients for adjuvant therapy. High expression of THBS2 and TAGLN in MOC confers an adverse prognosis and is upregulated in the infiltrative subtype, which warrants further investigation. Anti-HER2 therapy should be investigated in a subset of patients. MOC s les clustered with upper GI, yet markers to differentiate these entities remain elusive, suggesting similar underlying biology and shared treatment strategies.
Publisher: Wiley
Date: 04-1993
DOI: 10.1111/J.1445-2197.1993.TB00382.X
Abstract: The role of frozen section (FS) thyroid histology is controversial, some finding it helpful and others finding it inaccurate and of little assistance. The FS and subsequent permanent histology diagnosis were analysed retrospectively in 241 patients, 23 of whom were subsequently shown to have carcinoma. FS correctly identified five (22%) of these, deferred the diagnosis in three (13%) and made an incorrect benign diagnosis in 15 (65%). This impaired accuracy was attributed to the high proportion (13/23) of follicular neoplasms, which are difficult to categorize on FS. No false positive diagnoses were made in the 218 patients with benign disease. The possibility of a benign FS diagnosis being converted to malignant was 6.2%. The result of the FS affected management in that all five patients with the diagnosis of cancer underwent immediate contralateral surgery, but only seven of 18 in the negative FS group had further surgery when permanent histology demonstrated carcinoma, despite equivalent risk factors for poor prognosis in each group. This study suggests that the interpretation of FS and risk factors, in particular the tendency to interpret most follicular neoplasms as benign rather than defer decision, may be improved if pathologists and surgeons interested in thyroid disease are involved in the management of patients with thyroid nodules. Although FS remains flawed it is helpful in a small proportion of cases where it allows immediate contralateral surgery.
Publisher: Springer Science and Business Media LLC
Date: 02-2004
DOI: 10.1007/S00428-003-0931-Y
Abstract: The insulin-like growth factor (IGF) signal transduction system involves receptors, ligands and binding proteins (IGFBPs) that have been shown to have mitogenic and distinct anti-apoptotic effects on malignant cell lines of both epithelial and mesenchymal origin. Expression of the IGF signal system might be a mechanism by which human soft-tissue sarcomas (STS) obtain a proliferative advantage over normal adjacent tissues. IGFBP2, one of at least six different binding proteins identified to date, is secreted by most sarcoma cell lines and appears to be involved in cell proliferation and transformation. Circulating levels of this protein are markedly increased in malignancy. We have assessed 46 adult STS specimens of low, intermediate and high pathological grade of malignancy for the immunohistochemical expression of IGFBP2, IGF1, IGF2, IGF1 receptor-alpha and -beta (IGF1Ralpha/beta). The protein expression was measured by quantitative color video image analysis and semi-quantitative evaluation, and the measurements correlated well (Spearman, P<0.001). Using both methods, significant differences in expression of IGFBP2 among each of the three grades, expression of IGF2 between intermediate and high grade, and expression of IGF1Rbeta between low-intermediate and low-high grade were observed (Dunnett test, P<0.05). Multiple regression analysis for both quantitative and semi-quantitative data confirmed the significance of the relationship and independence of the proteins, except IGF2. We concluded that IGFBP2 and IGF1Rbeta are independent predictors of the malignant potential of adult STS.
Publisher: Wiley
Date: 09-1999
DOI: 10.1046/J.1440-1622.1999.01653.X
Abstract: Indirect laryngoscopy (IDL) is often performed prior to thyroid surgery to detect pre-existing vocal cord pathology. A retrospective chart review of 201 patients undergoing thyroid surgery at the Prince of Wales Hospital was undertaken in order to study the patterns of pre-operative and postoperative voice changes and IDL findings. A total of 9% of patients had pre-operative voice symptoms, and 22% of this group had abnormalities detected on pre-operative IDL. Of 160 documented IDL, 4% revealed vocal cord pathology in asymptomatic patients, including an asymptomatic recurrent laryngeal nerve palsy. Indirect laryngoscopy remains a useful but flawed pre-operative screening tool for patients with voice symptoms, but the literature suggests that more advanced phoniatric tests will provide superior diagnostic sensitivity. The role of routine pre-operative laryngoscopy for asymptomatic patients is of debatable value.
Publisher: Elsevier BV
Date: 02-2012
DOI: 10.1016/J.EJVS.2011.11.002
Abstract: The aim of this study was to create an ovine arteriovenous fistula (AVF) model which would closely replicate a human forearm fistula and use this to quantify the degree of intimal hyperplasia in those created with the U-Clip compared to a conventional sutured anastomosis. Twenty AVFs were created in 10 Border Leicester-Merino sheep between the superficial femoral artery and vein of each hind limb. On one side the U-Clip and on the other a continuous polypropylene suture was used to perform the anastomosis. The animals were sacrificed at 2 (n = 3), 4 (n = 4), 6 (n = 3) weeks and histological slices were taken of each AVF in cross section to determine the intimal media area per unit length (IMA/L). Intimal hyperplasia (IH) was observed at all time points with one AVF found occluded with thrombus at the time of harvest. The IMA/L was significantly lower in the U-Clip groups by 24% at 2 weeks, 32% at 4 weeks and 23% at 6 weeks (Two-way ANOVA, p = 0.019, observed power = 0.825, time or side p ≥ 0.766, type p = 0.001 Paired t-test, p < 0.001 between matched anastomotic types). Time taken to perform the anastomosis was similar between the two anastomotic techniques (Polypropylene 14(8-18) vs. U-Clip 15.3(11-23) min p = 0.47). This ovine AVF model results in IH similar to that seen in a human AVF. The IH that occurs with the U-Clip is less than that of continuous polypropylene suture.
Publisher: Springer Science and Business Media LLC
Date: 02-1986
DOI: 10.1007/BF01656088
Publisher: American Association for Cancer Research (AACR)
Date: 04-2023
DOI: 10.1158/1078-0432.22488651.V1
Abstract: Supplementary Methods
Publisher: Wiley
Date: 02-2002
Publisher: Wiley
Date: 2009
DOI: 10.1111/J.1445-2197.2008.04790.X
Abstract: The provision of acute surgical care in the public sector is becoming increasingly difficult because of limitation of resources and the unpredictability of access to theatres during the working day. An acute‐care surgical service was developed at the Prince of Wales Hospital to provide acute surgery in a more timely and efficient manner. A roster of eight general surgeons provided on‐site service from 08.00 to 18.00 hours Monday to Friday and on‐call service in after‐hours for a 79‐week period. An acute‐care ward of four beds and an operating theatre were placed under the control of the rostered acute‐care surgeon (ACS). At the end of each ACS roster period all patients whose treatment was undefined or incomplete were handed over to the next rostered ACS. Patient data and theatre utilization data were prospectively collected and compared to the preceding 52‐week period. Emergency theatre utilization during the day increased from 57 to 69%. There was a 11% reduction in acute‐care operating after hours and 26% fewer emergency cases were handled between midnight and 08.00 hours. There was more efficient use of the entire theatre block, suggesting a significant cultural change. Staff satisfaction was high. On‐site consultant‐driven surgical leadership has provided significant positive change to the provision of acute surgical care in our institution. The paradigm shift in acute surgical care has improved patient and theatre management and stimulated a cultural change of efficiency.
Publisher: Springer Science and Business Media LLC
Date: 06-2000
Abstract: Hypomagnesemia after total thyroidectomy has not been studied extensively. Our anecdotal experience suggests that it may be important in some patients after thyroid excision. The hypomagnesemic hypocalcemic syndrome has been described in other disease states in which a state of functional hypoparathyroidism exists. This study was designed to determine the incidence of hypomagnesemia after total thyroidectomy and relate it to hypocalcemia and symptoms during the postoperative period. A prospective study of all patients undergoing total thyroidectomy between September 1994 and July 1996 was performed. Patient data, thyroid function, retrosternal extension, initial versus reoperative surgery, operative details, parathyroid resection, and pathology were recorded. Calcium, magnesium, electrolytes, blood count, liver function tests, and albumin were measured prior to surgery and twice daily during the postoperative period. Fifty patients underwent total thyroidectomy: 68% were hypocalcemic, 72% were hypomagnesemic, and 36% were symptomatic during the postoperative period. Hypomagnesemia and gender were associated with hypocalcemia. Volume of fluid and neck dissection were associated with low magnesium levels. Hypomagnesemia and parathyroid resection were risk factors for symptoms after thyroidectomy. No patients developed permanent hypoparathyroidism. Transient hypocalcemia and hypomagnesemia occur frequently after total thyroidectomy. The etiology of this phenomenon is probably multifactorial. Patients are more likely to be symptomatic when both cations are low, and attempting to correct only hypocalcemia may prolong symptoms. It is important to monitor both calcium and magnesium levels after total thyroidectomy and to correct deficiencies to facilitate prompt resolution of symptoms.
Publisher: Wiley
Date: 2007
DOI: 10.1002/JSO.20636
Publisher: Wiley
Date: 28-01-2021
DOI: 10.1111/ANS.16584
Abstract: Metastatic cutaneous squamous cell carcinoma to the axilla is uncommon, with limited data to guide management. We sought to assess the outcomes of patients with this condition after surgery and radiotherapy. A retrospective cohort study of patients treated at two Australian hospitals from 1994 through 2016 was performed. A total of 74 patients were identified, including 48 treated curatively with surgery‐plus‐radiotherapy and 15 with surgery alone. Compared with patients treated with surgery alone, a higher proportion of patients treated with surgery‐plus‐radiotherapy had lymph nodes larger than 6 cm (53% versus 8%, P = 0.012) and multiple adverse histopathological features (75% versus 47%, P = 0.04). The groups had similar 5‐year disease‐free survival (45% versus 46%) and overall survival (51% versus 48%). Presence of multiple positive lymph nodes was associated with reduced disease‐free survival (hazard ratio 4.57, P = 0.01) and overall survival (hazard ratio 3.53, P = 0.02). Regional recurrence was higher in patients treated with surgery alone (38% versus 22%, P = 0.22) and patients with lymph nodes larger than 6 cm (34% versus 10%, P = 0.03). All recurrences occurred within 2 years following treatment. Combined‐modality therapy for metastatic cutaneous squamous cell carcinoma to the axilla is recommended for high‐risk patients, although outcomes remain modest. The key period for recurrence is within 2 years following treatment.
Publisher: Wiley
Date: 06-2006
DOI: 10.1111/J.1445-2197.2006.03764.X
Abstract: There are research requirements for trainees to be eligible to present for their final examinations (Fellowship of Royal Australasian College of Surgeons, FRACS). One option is the presentation of a paper or poster at a meeting of which abstracts are subject to review and selection. This includes presentation at the annual Registrars' Papers Day (RPD) in New South Wales. There has been some debate surrounding whether research requirements are fulfilled by presentation at such meetings. Publication in a peer-reviewed journal should be the ultimate aim. A high publication rate will validate the quality of the meeting. All abstracts submitted to the RPD in 1998 and 1999 were analysed. A Medline search was performed in 2005 to identify publication of these presentations in a peer-reviewed journal. Variables of the study that were potentially predictive of subsequent publication were analysed. This included type of presentation, surgical specialty, clinical or laboratory-based study, study design (prospective or retrospective) and s le size. Chi-squared test with Yates' continuity correction was used to compare two independent proportions and significance was set at P < 0.05. The publication rates were: oral presentations 50% (17/34), poster presentations 39% (9/23) and rejected presentations 20% (2/10). The mean and median time to publication was 23.8 and 21.0 months. Prospective design was the only variable identified to have a statistically significant effect on the publication rate (P < 0.002). The most common publishing journal was the Australian and New Zealand Journal of Surgery (12 of 26). Overall consistency (author and study s le consistency) from presentation to publication was 32%. The overall 46% publication rate of this state-based trainees-organized meeting compares favourably with international meetings. The research requirement of the Royal Australasian College of Surgeons (RACS), which includes presentation at the RPD in New South Wales, produces good quality papers for publication.
Publisher: Wiley
Date: 2017
DOI: 10.1111/ANS.13808
Publisher: Springer Science and Business Media LLC
Date: 22-08-2014
DOI: 10.1007/S00432-014-1803-3
Abstract: PTEN is an essential tumour suppressor gene which encodes a phosphatase protein that antagonises the PI3K/Akt/mTOR antiapoptotic pathway. Impairment of this tumour suppressor pathway potentially becomes a causal factor for development of malignancies. This review aims to assess current understanding of mechanisms of dysfunction involving the PI3K/PTEN/Akt/mTOR pathway linked to tumorigenesis and evaluate the evidence for targeted therapy directed at this signalling axis. Relevant articles in scientific databases were identified using a combination of search terms, including "malignancies", "targeted therapy", "PTEN", and "combination therapy". These databases included Medline, Embase, Cochrane Review, Pubmed, and Scopus. PI3K/PTEN expression is frequently deregulated in a majority of malignancies through genetic, epigenetic, and post-transcriptional modifications. This contributes to the upregulation of the PI3K/Akt/mTOR pathway which has been the focus of intense clinical studies. Targeted agents aimed at this pathway offer a novel treatment approach in a variety of haematologic malignancies and solid tumours. Compared to single-agent use, greater response rates were obtained in combination regimens, supporting further investigation of suitable drug combinations in a broad spectrum of malignancies. Activation of the PI3K/PTEN/Akt/mTOR pathway is implicated both in the pathogenesis of malignancies and development of resistance to anticancer therapies. Therefore, PI3K/Akt/mTOR inhibitors are a promising therapeutic option, in association with systemic cytotoxic and biological therapies, to enable sustained clinical outcomes in cancer treatment. Therapeutic strategies could be tailored according to appropriate biomarkers and patient-specific mutation profiles to maximise benefit of combination therapies.
Publisher: Elsevier BV
Date: 05-2015
DOI: 10.1016/J.AJIC.2015.01.007
Abstract: Over the last decade, there has been a slow shift toward the more active engagement of patients and families in preventing health care-associated infections (HCAIs). This pilot study aimed to examine the receptiveness of hospital patients toward a new empowerment tool aimed at increasing awareness and engagement of patients in preventing HCAI. Patients from the surgical department were recruited and randomized into 2 groups: active and control. Patients in the active arm were given an empowerment tool, whereas control patients continued with normal practices. Pre- and postsurveys were administered. At the baseline survey, just over half of the participants were highly willing to assist with infection control strategies. Participants were significantly more likely to be willing to ask a doctor or nurse a factual question then a challenging question. After discharge, 23 of the 60 patients reported discussing a health concern with a staff member however, only 3 participants asked a staff member to wash their hands. Our results suggest that patients would like to be more informed about HCAIs and are willing to engage with staff members to assist with the prevention of infections while in the hospital setting. Further work is going to need to be undertaken to ascertain the best strategies to promote engagement and participation in infection control activities.
Publisher: American Association for Cancer Research (AACR)
Date: 04-2023
DOI: 10.1158/1078-0432.22488645
Abstract: Supplementary Tables S1-S11
Publisher: Elsevier BV
Date: 02-1988
Publisher: Elsevier BV
Date: 10-1989
DOI: 10.1016/0022-4804(89)90141-8
Abstract: Leucine and glucose turnover were measured using simultaneous infusions of [13C]leucine and [2H]glucose before and during an infusion of Na DL-hydroxybutyrate (Na DL-HB) in overnight-fasted patients the day before and 3 days after total hip replacement. The ketone body infusion before surgery resulted in a significant increase in plasma leucine concentration and leucine turnover, while glucose concentration and turnover decreased. Surgery increased leucine turnover. Ketone body infusion after surgery caused a further increased leucine turnover while turnover fell as before surgery. We suggest that exogenous ketone bodies decrease hepatic glucose production and probably stimulate a rise in protein synthesis above breakdown leading to a decreased nitrogen excretion as observed by other investigators. Despite the metabolic adaptation to trauma, this response was not affected by surgery.
Publisher: International Society of Endovascular Specialists
Date: 10-2012
Publisher: Wiley
Date: 24-10-2011
Publisher: American Association for Cancer Research (AACR)
Date: 04-2023
DOI: 10.1158/1078-0432.22488645.V1
Abstract: Supplementary Tables S1-S11
Publisher: Wiley
Date: 30-04-2000
DOI: 10.1046/J.1440-1622.2000.01801.X
Abstract: The standard surgical treatment of the axilla in patients with early breast cancer is about to undergo a radical change. Although axillary dissection is an excellent procedure for both staging and local control, particularly in the clinically positive axilla, it has considerable morbidity and may understage a significant proportion of patients, because it will usually miss micrometastases that can occur in approximately 10% of 'node negative' patients. An increasing number of patients whose tumours are either non-invasive (ductal carcinoma in situ DCIS), micro-invasive, tubular cancers or low-grade T1a tumours without lymphovascular invasion may be spared axillary surgery because the risk of axillary disease is 0-3%. Many studies, both prospective trials and large retrospective series, show that axillary radiotherapy alone provides similar local control rates to axillary dissection in patients with clinically negative axillas. Primary treatment of the axilla with radiotherapy alone, however, does not allow appropriate staging. Sentinel lymph node biopsy is being increasingly used in patients with breast cancer to provide this information. When a sentinel node is identified it is equal to or better than axillary dissection for staging the axilla and, if the node is positive, it will help select patients who should then proceed to further axillary surgery or axillary radiotherapy. Although sentinel lymph node biopsy is being rapidly adopted in many centres worldwide, the results of randomized controlled trials are needed before it can be recommended as the standard of care.
Publisher: SAGE Publications
Date: 02-02-2016
Abstract: Purpose: To evaluate and characterize debris retrieved from the cerebral embolic protection devices (EPDs) used during carotid artery stenting (CAS) and compare debris size, volume, tissue types, cellular composition, and protein biomarker expression in symptomatic and asymptomatic patients. Methods: Distal protection filters were retrieved from 22 consecutive patients (mean age 71.6 years, range 52–85 16 men) undergoing elective CAS between July 2012 and February 2014 for % internal carotid artery stenosis (mean 85.4%±10.3%). Six patients were symptomatic. The debris within each EPD was visually characterized using stereomicroscopy and then processed for histology and immunohistochemistry. Biomarkers were immunohistochemically measured to evaluate plaque stability [matrix metalloproteinase-9 (MMP-9)], inflammation [glycoprotein CD68 and interleukin-6 (IL-6)], or phenotype [smooth muscle (SM)-actin and type IV collagen]. The immunohistochemical results were measured using semiquantitative grading criteria based on both staining intensity and distribution in the s les. Results: Macroscopic debris was visible in 5/22 EPDs 3 of the 5 filters came from symptomatic patients. Microscopic debris was detected in all filters and ranged in size from 0.01 to 8.57 mm 2 . Debris consisted of calcified, fibrous, and necrotic tissue, as well as fibrin and foam cells with no significant difference between the symptomatic and asymptomatic groups. There was no association between the degree or type of embolic material and stenosis severity, carotid tortuosity, calcium grade, soft plaque, or arch type. Symptomatic patients had a larger volume of debris (8.24 vs 0.58 mm 3 , p .01), mean particle size (1.30 vs 0.32 mm 2 , p .001), and expression of biomarkers IL-6 (2.17 vs 0.81, p .05), CD68 (2.00 vs 0.38, p .01), SM-actin (1.00 vs 0.25, p=0.055), type IV collagen (1.17 vs 0.25,p=0.082), and MMP-9 (1.00 vs 0.06, p .05). Conclusion: Histological analysis revealed particulate embolization in all EPDs used during CAS. Symptomatic patients had a larger volume of embolic debris, mean particle size, and the biomarkers associated with inflammation, necrotic core, and diminished fibrous cap.
Publisher: Wiley
Date: 15-06-2009
DOI: 10.1002/JSO.21163
Abstract: The quality of surgical outcomes for cancer patients is influenced by multiple factors that must be addressed by both a systemic and an in idual surgeon approach. In Australia, like many other countries, changes to the health care system via both federal and state government health care quality agencies are likely to positively impact outcomes for surgical patients. Surgical audit is an important component of quality surgical practice and the most successful surgical audit in Australia is the National Breast Cancer Audit, run by the Royal Australasian College of Surgeons. The audit has helped to document the standard of breast cancer surgery in Australia and New Zealand and in the process identified areas for improvement.
Publisher: Impact Journals, LLC
Date: 17-02-2016
Publisher: American Association for Cancer Research (AACR)
Date: 04-2023
DOI: 10.1158/1078-0432.C.6532782.V1
Abstract: AbstractPurpose: Advanced-stage mucinous ovarian carcinoma (MOC) has poor chemotherapy response and prognosis and lacks biomarkers to aid stage I adjuvant treatment. Differentiating primary MOC from gastrointestinal (GI) metastases to the ovary is also challenging due to phenotypic similarities. Clinicopathologic and gene-expression data were analyzed to identify prognostic and diagnostic features. Experimental Design: Discovery analyses selected 19 genes with prognostic/diagnostic potential. Validation was performed through the Ovarian Tumor Tissue Analysis consortium and GI cancer biobanks comprising 604 patients with MOC ( i n /i = 333), mucinous borderline ovarian tumors (MBOT, i n /i = 151), and upper GI ( i n /i = 65) and lower GI tumors ( i n /i = 55). Results: Infiltrative pattern of invasion was associated with decreased overall survival (OS) within 2 years from diagnosis, compared with expansile pattern in stage I MOC [hazard ratio (HR), 2.77 95% confidence interval (CI), 1.04–7.41, i P /i = 0.042]. Increased expression of i THBS2 /i and i TAGLN /i was associated with shorter OS in MOC patients (HR, 1.25 95% CI, 1.04–1.51, i P /i = 0.016) and (HR, 1.21 95% CI, 1.01–1.45, i P /i = 0.043), respectively. i ERBB2 /i (HER2) lification or high mRNA expression was evident in 64 of 243 (26%) of MOCs, but only 8 of 243 (3%) were also infiltrative (4/39, 10%) or stage III/IV (4/31, 13%). Conclusions: An infiltrative growth pattern infers poor prognosis within 2 years from diagnosis and may help select stage I patients for adjuvant therapy. High expression of i THBS2 /i and i TAGLN /i in MOC confers an adverse prognosis and is upregulated in the infiltrative subtype, which warrants further investigation. Anti-HER2 therapy should be investigated in a subset of patients. MOC s les clustered with upper GI, yet markers to differentiate these entities remain elusive, suggesting similar underlying biology and shared treatment strategies. /
Publisher: Anticancer Research USA Inc.
Date: 11-2016
DOI: 10.21873/ANTICANRES.11160
Abstract: Sarcoma carries a poor prognosis prompting the need for targeted therapies aimed at deregulated signaling pathways. These include the PI3K/Akt/mTOR pathway commonly up-regulated in malignancies attributed to loss of PTEN expression. However, PTEN status and activation state of PI3K/Akt/mTOR pathway have not been comprehensively studied in sarcoma. The aims of this study were to characterise PTEN and Akt expression in a panel of sarcoma cell lines and then to examine mTOR inhibition using ridaforolimus. PTEN genomic expression was analyzed using Sanger sequencing. PTEN, total Akt (tAkt) and phosphorylated Akt (pAkt) expression were quantified with western blot analysis. Antiproliferative effects of treatment regimens were designed using Chou & Talalay's isobologram and determined with crystal violet assay. Four cell lines had wild-type PTEN (exons 2 to 8), with normal protein expression. The GCT cell line had a missense mutation in exon 6 (C>T), associated with loss of PTEN protein expression. Increased pAkt expression was found in all cell lines following epidermal growth factor (EGF) stimulation, indicating that wild-type PTEN expression in four cell lines did not inhibit constitutive activation of PI3K/Akt/mTOR pathway. Nonetheless, all cell lines demonstrated sensitivity to ridaforolimus within a clinically relevant dose-range (half-maximal inhibitory concentration (IC PTEN mutation is rare in sarcoma cell lines and constitutive activation of PI3K/Akt/mTOR is independent of PTEN status.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-1999
DOI: 10.1097/00000658-199908000-00007
Abstract: To assess the significance of the expression of five protein markers (nm23, p53, c-erbB-2, u-PA, and VEGF) to the development of metastasis in colorectal cancer. The metastatic cascade is a complex multistep process involving several genetic alterations, angiogenesis activation, and tissue proteolysis. Although the prognosis of colorectal cancer depends on the stage of the tumor, the development of metastasis is difficult to predict. Paraffin-embedded specimens of 58 patients who underwent surgery for colorectal cancer were retrospectively analyzed by immunohistochemistry, and the coexpression of these protein markers was related to patient outcome. The risk of developing liver secondaries was correlated with the expression of nm23 protein (p < 0.0001) this was also the case in those patients with Dukes' stage B showing positive nm23 immunostaining (p = 0.006). The determination of the number of positive markers or the cumulative intensity score did not improve the predictive value over and above that of nm23 protein alone. Expression of nm23 protein is correlated with the risk of developing liver metastasis. Its evaluation alone may help to determine which patients who have undergone apparently curative resection of a colorectal cancer have an increased risk of liver recurrence, especially those with Dukes' stage B tumors who might be considered for adjuvant chemotherapy.
Publisher: Mary Ann Liebert Inc
Date: 12-1995
Abstract: The laparoscopic diagnosis and repair of an unusual diaphragmatic hernia are described. Extensive radiological assessment failed to demonstrate the injury, which was diagnosed by laparoscopy 5 weeks after the initial presentation. The diaphragmatic tear was adjacent to the costal margin and was repaired using a novel percutaneous technique. The place of laparoscopy in blunt abdominal trauma is discussed.
Publisher: The Korean Society for Vascular Surgery
Date: 31-12-2019
Publisher: Wiley
Date: 31-10-2013
DOI: 10.1111/AJCO.12125
Abstract: Retroperitoneal sarcomas (RPSs) are large, rare tumors. The role of core biopsy for retroperitoneal masses identified by preoperative imaging is unclear and we report the safety and accuracy of core biopsies at a specialized sarcoma unit in Sydney, Australia. A retrospective analysis of a prospectively collected database was performed to identify the safety and accuracy of core biopsies in patients who were confirmed to have RPS. Twenty-two patients underwent biopsies with no recorded morbidity or tumor seeding. RPS was correctly identified in 82%. Median follow-up was 19 months. We demonstrate that core biopsy is safe and can identify RPSs.
Publisher: Wiley
Date: 12-10-2010
DOI: 10.1111/J.1445-2197.2010.05526.X
Abstract: The operating theatre is a complex place. There are many potential factors which can interfere with surgery and predispose to errors. Optimizing the operating theatre environment can enhance surgeon performance, which can ultimately improve patient outcomes. These factors include the physical environment (such as noise and light), human factors (such as ergonomics), and surgeon-related factors (such as fatigue and stress). As in idual factors, they may not affect surgical outcome but in combination, they may exert a significant influence. The evidence for some of these working environment factors are examined in idually. Optimizing the operating environment may have a potentially more significant impact on overall surgical outcome than improving in idual surgical skill.
Publisher: Wiley
Date: 04-01-2022
DOI: 10.1111/ANS.17449
Abstract: The aim of the study was to assess the robotic colorectal surgery (RCS) learning curve of an experienced surgeon. A retrospective review of 117 consecutive patients who underwent total RCS at a single institution between October 2018 and July 2021 was performed. Patient demographics, surgery indications, operation type, intraoperative data, histopathology, morbidity and mortality, and length of stay were analysed. Cumulative summation technique (CUSUM) was used to construct a learning curve of surgeon console and total operation times (SCT and TOT). There was no open conversion, positive resection margin and mortality in the study population. There were four Clavien‐DIndo grade III complications and one local recurrence. The range for SCT was 18–855 min (mean 214, median 211) and TOT was 68–937 min (mean 302, median 291). The SCT CUSUM graph identified change in slope at cases 44 and 88, which ided the learning curve into three distinct phases. Patient demographics were similar through the three phases. There was proportionally more cancer cases performed in the first phase ( P = 0.001). The mean SCT was significantly higher in Phase 2 when compared with Phases 1 and 3 ( P = 0.03). The failure rate was similar through the three phases. There was a non‐significant steady decline in LOS over the three phases, from 6.9 to 6.1 days. Experienced colorectal surgeons can perform robotic surgery safely, even on patients with high complexity early in the learning curve. Audit of patient outcome should be an important component of learning curve assessment.
Publisher: Informa UK Limited
Date: 1998
Publisher: Wiley
Date: 09-2006
DOI: 10.1177/0148607106030005451
Abstract: We describe a delayed case of Horner's syndrome after the use of a peripherally inserted central line. Central vein thrombosis, a well-recognized complication of central venous access, led to temporary injury to the sympathetic tract in the neck. Presentation of Horner's syndrome with central venous access in place should be further investigated to rule out central vein thrombosis.
Publisher: Hindawi Limited
Date: 2014
DOI: 10.1155/2014/236482
Abstract: Objective . We investigate the prevalence of human papillomavirus (HPV) in oesophageal squamous cell carcinoma (OSCC) tissues compared to oesophageal tissue from healthy controls, in an Australian cohort. Methods . We conducted a hospital-based case-control study of 99 patients with OSCC and 100 healthy controls to examine the presence of HPV DNA. Paraffin tissues were tested using the PapType high-risk HPV detection and genotyping kit and with INNO-LiPA HPV Genotyping Extra. The biopsy s les were tested for HPV using a PCR-ELISA method based on the L1 consensus primer set PGMY09-PGMY11. Results . HPV DNA of the oncogenic genotype 16 was detected in 1/99 case specimens, a rate of 1010 per 100,000 (95% CI: 30–5500). All control specimens were negative for HPV. Significantly higher rates of smoking, other aerodigestive cancers, and mortality were seen among cases than controls. A pooled analysis of this study and the only other Australian case-control study found that 9/321 cases and 0/155 controls were positive for HPV. The pooled odds ratio for HPV being a risk factor for OSCC was 9.35 (95% CI: 0.47–190.33). Conclusion . Our results suggest that in this multifactorial cancer HPV may be an additional risk factor although a larger, better powered study is needed.
Publisher: Springer Science and Business Media LLC
Date: 20-06-2005
Publisher: Wiley
Date: 06-1999
DOI: 10.1046/J.1440-1622.1999.01441.X
Abstract: Patients who are discharged earlier from hospital frequently require support from professional and unpaid carers at home after discharge. Hospitals save money per patient by discharging earlier, but it is not known whether the costs to community services and unpaid caters outweigh the savings to the hospital. We prospectively studied the total costs, patient satisfaction, time off work and pain scores of 224 patients who underwent elective herniorrhaphy or laparoscopic cholecystectomy and who lived locally before and after re-engineering the elective surgical service. The components of the re-engineered surgical service were a peri-operative unit, pre-admission anaesthetic assessment based on self-reported questionnaires, day of surgery admissions, enhanced patient education, clinical pathways, and post-acute care. The patients treated through the re-engineered surgical service had a significantly shorter length of stay (LOS) (mean LOS: 2.2 vs 3.2 days P < 0.001) but neither they nor their carers required more time off work. Significant determinants of time off work were smoking, heavy lifting at work and a higher pain score at day 7. Patients treated through the re-engineered surgical service recorded significantly higher satisfaction with their treatment. The cost saving to the hospital outweighed the cost of increased services provided in the community, so that the overall cost of providing treatment was over $200 less per patient through the re-engineered service. This study demonstrates that changes in care provision that result in shorter LOS and greater cost effectiveness may better meet patients' needs than existing systems.
Publisher: Springer Science and Business Media LLC
Date: 17-06-2009
DOI: 10.1007/S00432-009-0622-4
Abstract: Targeted therapy refers to anticancer treatment which specifically targets key molecules of cancer cells and/or neovascular cells, aiming to thus interfere with processes of tumorigenesis, cancer progression and metastasis. The epidermal growth factor receptor (EGFR) was the first receptor to be proposed for targeted cancer therapy, having been found to be commonly overexpressed in a range of solid tumors and play a role in cancer cell proliferation, apoptosis, angiogenesis, invasion and metastasis. Despite successful development of EGFR-targeted pharmacological agents, clinical and molecular studies have indicated several limitations to the broad application of this treatment as a monotherapy. Novel combination treatments which might optimize the effect of EGFR inhibition have, therefore, been investigated. Research conducted into the mechanisms of action and synergy of these combination treatments is likely to enhance the role of the EGFR target in future cancer treatment.
Publisher: Springer Science and Business Media LLC
Date: 05-1998
Abstract: The function and prognostic significance of the nm23 gene is controversial in colorectal cancer (CRC). The aim of this study was to determine if nm23 protein expression correlated with the subsequent development of liver metastasis. Paraffin-embedded sections of 30 metastasizing CRC primaries and their subsequently resected liver secondaries were compared with those of 28 nonmetastasizing CRCs, 20 adenomas, and 20 cases of normal colonic mucosa. Expression of nm23 protein, assayed by immunohistochemistry, was measured using a standard semiquantitative scaling system and compared with a microcomputerbased color video image analysis (VIA). There was good correlation between color VIA and semiquantitative evaluation of nm23 immunoreactivity, confirming the validity of quantitative analysis (Pearson's r = 0.88 p < 0.001). Metastasizing CRC primaries and secondaries overexpressed nm23 protein when compared with the other clinical groups, particularly nonmetastasizing CRC (Student's t-test, p < 0.001). Furthermore, more nm23 immunoreactivity was associated with a higher risk of death from CRC (log-rank test, p = 0.002). These results suggest that overexpression of nm23 is highly associated with liver metastases from CRC and reduced survival.
Publisher: Elsevier BV
Date: 05-2006
DOI: 10.1016/J.EJSO.2006.01.012
Abstract: To measure epidermal growth factor receptor (HER1/EGFR) expression in a range of soft tissue sarcoma (STS) patient s les. HER1/EGFR expression was examined by immunohistochemistry in archival tissues of 46 STS patients. HER1/EGFR was positively expressed in 36/46 of STS s les distributed among different histological types. The levels of HER1/EGFR in STS tumour tissues in positive s les were higher compared to those in nearby normal tissues. HER1/EGFR is significantly expressed in soft tissue sarcomas, which is a finding reflected in other series. The significance of this finding for targeted therapy is as yet unknown.
Publisher: Wiley
Date: 07-2002
DOI: 10.1046/J.1445-2197.2002.02424.X
Abstract: There are many clinical situations in which immune suppression or deficiency occurs. This may lead to healing impairment. The aim of the present study was to characterize the effect of T lymphocyte deficiency on wound healing, and on -platelet-derived growth factor (PDGF), bFGF (basic fibroblast growth factor) and insulin-like growth factor-1 (IGF-1) expression, using an animal model. Nude and normal 10-12-week-old male BALB/c mice were given standard dermal incisions and killed at 1, 2, 4 or 6 weeks postinjury. The pelts were harvested and the wounds cut (perpendicularly) into strips for analysis. Strips from each animal were tested mechanically or processed for histological assessment and immunohistochemical detection of PDGF, bFGF and IGF-1 and colour video image analysis. The data were assessed by analysis of variance (anova). The interaction between species and time resulted in statistically significant differences in mechanical properties. Wound peak load was higher in nude mice at weeks 1 and 2 postinjury, but lower in nude mice at week 6 postinjury. Colour video image analysis demonstrated that the expression of bFGF and IGF-1 was greater in nude mice at week 1 postinjury (P < 0.05). The mechanical data suggest that the overall effect of the T lymphocyte system on wound healing is initially inhibitory and later stimulatory. This may be associated with corresponding differences in wound growth factor expression.
Publisher: Springer Science and Business Media LLC
Date: 20-05-2010
Publisher: Elsevier BV
Date: 12-1998
Publisher: Elsevier BV
Date: 09-2005
Publisher: Wiley
Date: 02-2022
DOI: 10.1111/ANS.17492
Publisher: Wiley
Date: 06-04-2011
DOI: 10.1002/JSO.21942
Abstract: To evaluate the distribution and scope of surgical research in Australia relating to malignant diseases in the field of surgery. Surgical publications relating to adult malignant diseases originating from Australia were identified from a systematic literature examination using PubMed during a 12-year period between 1998 and 2009. The origin of the article, journal impact factor (IF), type of research and its subspecialty discipline were recorded. Over a 12-year period, 1,132 papers were published in various journals at a median annual rate of 98 papers. Four hundred eighty-five (43%) papers arose from institutions in New South Wales, 225 (20%) papers from Victoria, 150 (13%) papers from South Australia, 106 (9%) papers from Western Australia, and 77 (7%) papers from Queensland. The mean IF was 3.22 (SD = 2.5). Papers were most commonly published in journals including the ANZ Journal of Surgery (n = 237, 21%), Annals of Surgical Oncology (n = 50, 4%), British Journal of Surgery (n = 38, 3%), and Diseases of the Colon and Rectum (n = 36, 3%). The mean IF of papers published per year ranged from 2.55 to 3.87. The most number of papers were published in the fields of urological oncology (n = 103, 9%), hepatopancreaticobiliary oncology (n = 144, 13%), breast oncology (n = 174, 15%), and colorectal oncology (n = 222, 20%). Bibliometric findings of this review suggest that there is a growth in high scientific research publications in the field of surgical oncology in Australia, indicating an interest in this discipline. This research trend may impact on the national research strategy for clinical cancer control.
Publisher: American Association for Cancer Research (AACR)
Date: 04-2023
DOI: 10.1158/1078-0432.22488654.V1
Abstract: Supplementary Figures S1-S13
Publisher: Wiley
Date: 03-03-2016
Abstract: Local control for extremity soft tissue sarcomas (STS) requires surgery combined with radiotherapy, usually given pre-operatively or post-operatively. The modified Eilber protocol, a neoadjuvant chemoradiation regimen, has been reported with excellent local control rates. This retrospective single-centre study compared outcomes for patients treated with the modified Eilber protocol with those treated with standard adjuvant radiotherapy. Patients with a diagnosis of extremity STS were retrospectively reviewed from the Prince of Wales Hospital Sarcoma Database from 1995 to 2012. Sixty-three patients underwent curative surgery with either neoadjuvant Eilber chemoradiotherapy (Eilber) or adjuvant radiotherapy (Adjuvant). Twenty-nine patients were treated with modified Eilber protocol. Thirty-four patients received adjuvant radiotherapy. Three patients (10%) in the Eilber group and five patients (15%) in the Adjuvant group developed local recurrence (P = 0.87). Major acute wound complications were noted in four patients in each group (P = 0.55). One patient (3.4%) in the Eilber group developed Grade 3 or 4 late toxicities after 1 year compared with nine patients (27%) in the Adjuvant group (P = 0.02). Neoadjuvant chemoradiation (Eilber protocol) provided similar rates of local control when compared with adjuvant radiotherapy. Acute wound complication rates were similar but there was less severe late toxicity in the Eilber group.
Publisher: Elsevier BV
Date: 03-2015
DOI: 10.1016/J.EJVS.2014.12.025
Abstract: This study sought to compare the local tissue response and subsequent volume of intimal hyperplasia (IH) that develops throughout the maturation of an arteriovenous fistula created using continuous/interrupted polypropylene with that of a novel, metal-alloy, penetrating anastomotic clip device. Forty-six fistulae were created in 23 sheep under a paired design using the nitinol U-Clip (n = 23) in one hind limb and continuous (n = 20) or interrupted (n = 3) polypropylene suture for the other. Animals were killed at 4 (n = 3), 14 (n = 3), 28 (n = 10), 42 (n = 3), and 180 (n = 4) days. Histological sections were evaluated for quantitative histology and immunohistochemistry. Compared with continuous polypropylene, U-Clip specimens demonstrated less intima-media area per unit length (IMA/L), proliferating cells, and tissue necrosis at all time points (MANOVA, F = 9.8-24.1, all p ≤ .005 observed power >82%). Specifically, values of IMA/L were reduced by 5% (p = .97), 37% (p = .02), 33% (p < .01), 9% (p = .42), and 14% (p = .22) at the time points of 4, 14, 28, 42, and 180 days respectively. Proliferating cells were reduced by 75% (p < .01), 72% (p = .03), 76% (p = .03), 27% (p = .31), and 60% (p = .01) and tissue necrosis by 67% (p < .01), 58% (p = .02), 40% (p = .33), 21% (p = .43), 77% (p = .11). In a 28-day comparison between U-Clip and interrupted polypropylene the U-Clip group demonstrated a 4% (p = .65) reduction in IMA/L, 74% (p < .01) in proliferating cells and 49% (p < .05) in tissue necrosis. These results provide evidence of reduced local tissue necrosis, proliferating cells, and IH, favouring arteriovenous fistulae created using the U-Clip anastomotic device over conventional polypropylene suture techniques most evident over the first 4 weeks.
Publisher: Springer Science and Business Media LLC
Date: 04-08-2013
DOI: 10.1007/S00432-013-1482-5
Abstract: Anoikis ('homelessness' in Greek) is a form of apoptosis following the detachment of cells from the appropriate extracellular matrix (Chiarugi and Giannoni in Biochem Pharmacol 76:1352-1364, 2008). Resistance to anoikis is a critical mediator of metastasis in cancer by enabling cancer cells to survive during invasion and transport in the blood and lymph. Numerous regulators and mechanisms of anoikis in human cancer have been proposed to date. Consequently, the identification of key regulators of anoikis that can be targeted to at least partially restore anoikis sensitivity in cancer cells is important in the development of therapies to treat metastatic cancer. A literature search focusing on the regulators of anoikis in human cancer was performed on the Medline, Embase and Scopus databases. Mcl-1, Cav-1, Bcl-(xL), cFLIP, 14-3-3ζ and Bit1 appear to regulate anoikis in human cancer by participating in the intrinsic apoptotic pathway, extrinsic apoptotic pathway or caspase-independent pathways. Mcl-1, Cav-1, Bcl-(xL), cFLIP and 14-3-3ζ are suppressors of anoikis, and their upregulation confers anoikis resistance to cancer cells. Bit1 is a promoter of anoikis and is downregulated to confer anoikis resistance in metastatic cancer. Anoikis is a complex process involving the crosstalk between different signalling pathways. The dysregulated expression of key regulators of anoikis that participate in these signalling pathways promotes anoikis resistance in human cancer. These regulators of anoikis might therefore be the targets for developing therapies to overcome anoikis resistance in metastatic cancer.
Publisher: Wiley
Date: 26-02-2003
DOI: 10.1002/JSO.10210
Abstract: Certain pathophysiological markers may be helpful in selecting further therapies for patients with resected colorectal cancer (CRC). The aim of this study was to determine whether expression of proteins of the plasminogen activation system (PAS), which are important in tumor spread and growth, can predict outcome of human CRC. Protein expression of the PAS, including urokinase-type plasminogen activator (uPA) and its receptor (uPAR), plasminogen (Plg), and plasminogen activator inhibitors-1 and -2 (PAI-1 and PAI-2), was determined in the colonic tissue s les of 56 patients with resected primary CRC by quantitative immunohistochemistry and correlated with clinicopathological parameters and patient outcome. Overexpression of uPA (t-test, P < 0.001), uPAR (P < 0.001) and PAI-1 (P = 0.031) was significantly associated with liver metastatic CRC tumors. Higher uPA or uPAR expression level was significantly correlated with overall survival (OS log-rank, P = 0.001 and P < 0.0001) and cancer-specific survival (CSS P = 0.001 and P < 0.0001) after the first CRC resection. The predictive value of both uPA and uPAR in liver metastasis, OS and CSS was independent from other parameters (multivariate Cox regression: all P < 0.001). uPA and uPAR may be independent predictors of liver metastasis, patient overall survival and cancer-specific survival after resection of colorectal tumors.
Publisher: Informa UK Limited
Date: 09-2016
DOI: 10.2147/OTT.S94745
Publisher: American Association for Cancer Research (AACR)
Date: 02-2011
DOI: 10.1158/1078-0432.CCR-10-2050
Abstract: Purpose: Reactivation of p53 tumor suppressor activity in diseases such as soft-tissue sarcoma is considered an attractive means of targeted therapy. By systematically assessing alterations affecting the p53 pathway, we aimed to (a) classify sarcoma subtypes, (b) define a potential role in malignancy, and (c) identify potential patient biomarkers in this heterogeneous disease. Experimental Design: We have mapped mutational events in a panel of 192 benign or malignant bone and soft-tissue sarcomas. Analyses included TP53 and CDKN2A mutational and SNP status, MDM2 and MDM4 lification and MDM2 SNP309 status. Results: We found an inverse relationship between MDM2 lification and TP53 mutations, with a predominantly wild-type CDKN2A background. A high rate of point mutations in TP53 was observed uniquely in leiomyosarcoma, osteosarcoma, and MFH. Both MDM2 and MDM4 were also lified in a subtype-specific manner, which was frequently seen as a co lification event. We have also analyzed the risk allele frequencies for MDM2 SNP309, and show that the G allele was strongly associated with both liposarcomas and MDM2 lification. Conclusions: Our data emphasize the critical role of p53 inactivation in sarcomagenesis, whereby different pathway alterations may be related to the heterogeneity of the disease. Moreover, we observed a strong association of malignancy with TP53 mutation, or MDM2 lification and the presence of a G allele in SNP309, especially in lipoma versus liposarcoma. We propose, therefore, that MDM2 markers along with TP53 sequencing should be considered as patient biomarkers in clinical trials of sarcomas using MDM2 antagonists. Clin Cancer Res 17(3) 416–26. ©2010 AACR.
Publisher: Wiley
Date: 03-1999
DOI: 10.1046/J.1440-1622.1999.01518.X
Abstract: Breast cancer is a common disease in our community and its incidence is increasing. As a result of the improvements in community awareness and introduction of screening, patients are being diagnosed with earlier breast cancer and with a higher incidence of pre-invasive disease. Improvements in radiology, often coupled with minimally invasive diagnostic modalities, have lessened the requirement for open diagnostic biopsies and also reduced the number of operations for benign breast disease. An audit of the surgical workload at Prince of Wales/Prince Henry Hospitals and Tamworth Base Hospital was conducted to document and compare the above changes in the metropolitan and rural settings. This study was conducted between 1987 and 1996 to assess the effect of screening and improved technology over a 10-year period. The study found that a high percentage of malignant lesions are being diagnosed by fine-needle aspiration biopsy (FNAB) with a corresponding reduction in open biopsy rate at the Prince of Wales Hospital. There is a smaller percentage of benign operations in both settings with a reduction of equal proportion. The reporting of the pathology specimens has markedly improved at both institutions. There has been a reduction in the number of patients having modified radical mastectomy and there has been a corresponding increase in breast conservation surgery especially at the Prince of Wales/Prince Henry Hospitals, although there was an unexpectedly high incidence of breast conservation surgery at Tamworth Base Hospital in 1987. In 1996 the rates of breast conservation surgery were the same in both hospitals. There are minimal differences in the quality of surgical care being offered to patients at the Tamworth Base Hospital compared with the Prince of Wales Hospital and both institutions are within reach of the accepted best management practices available.
Publisher: Wiley
Date: 09-08-2012
DOI: 10.1111/J.1743-7563.2012.01555.X
Abstract: Esophageal cancer (EC) is responsible for almost half a million deaths worldwide annually and has a multifactorial etiology, which may account for its geographical variation in incidence. In the last 30 years the potential of human papillomaviruses (HPV) as oncogenes or co-factors in the tumorigenic process of esophageal squamous cell carcinoma (ESCC) has been widely studied. While the etiology of HPV in cervical and certain other anogenital and aerodigestive cancers has been established, results regarding its role in EC have been largely inconclusive. A causal association can be evaluated only with a case-control study, where normal controls are compared to ESCC cases for the presence of HPV. We reviewed all studies investigating ESCC tissue for HPV DNA and identified 139 that met our inclusion criteria, of which only 22 were case-control studies. Our results support previous findings of higher levels of HPV detection in high-risk ESCC regions than in areas of low risk. In addition, we confirm that the role of HPV in ESCC remains unclear, despite an accumulation of studies on the subject. The variations in investigative technique, study design and s le types tested may account for the lack of consistency in results. There is a need for a meta-analysis of all case-control studies to date, and for large, well-designed case-control studies with adequate power to investigate the association. The potential benefits of prophylactic HPV vaccines could be evaluated if HPV is identified as an etiological factor in EC, highlighting the need for further research in this area.
Publisher: American Association for Cancer Research (AACR)
Date: 04-2023
DOI: 10.1158/1078-0432.C.6532782
Abstract: AbstractPurpose: Advanced-stage mucinous ovarian carcinoma (MOC) has poor chemotherapy response and prognosis and lacks biomarkers to aid stage I adjuvant treatment. Differentiating primary MOC from gastrointestinal (GI) metastases to the ovary is also challenging due to phenotypic similarities. Clinicopathologic and gene-expression data were analyzed to identify prognostic and diagnostic features. Experimental Design: Discovery analyses selected 19 genes with prognostic/diagnostic potential. Validation was performed through the Ovarian Tumor Tissue Analysis consortium and GI cancer biobanks comprising 604 patients with MOC ( i n /i = 333), mucinous borderline ovarian tumors (MBOT, i n /i = 151), and upper GI ( i n /i = 65) and lower GI tumors ( i n /i = 55). Results: Infiltrative pattern of invasion was associated with decreased overall survival (OS) within 2 years from diagnosis, compared with expansile pattern in stage I MOC [hazard ratio (HR), 2.77 95% confidence interval (CI), 1.04–7.41, i P /i = 0.042]. Increased expression of i THBS2 /i and i TAGLN /i was associated with shorter OS in MOC patients (HR, 1.25 95% CI, 1.04–1.51, i P /i = 0.016) and (HR, 1.21 95% CI, 1.01–1.45, i P /i = 0.043), respectively. i ERBB2 /i (HER2) lification or high mRNA expression was evident in 64 of 243 (26%) of MOCs, but only 8 of 243 (3%) were also infiltrative (4/39, 10%) or stage III/IV (4/31, 13%). Conclusions: An infiltrative growth pattern infers poor prognosis within 2 years from diagnosis and may help select stage I patients for adjuvant therapy. High expression of i THBS2 /i and i TAGLN /i in MOC confers an adverse prognosis and is upregulated in the infiltrative subtype, which warrants further investigation. Anti-HER2 therapy should be investigated in a subset of patients. MOC s les clustered with upper GI, yet markers to differentiate these entities remain elusive, suggesting similar underlying biology and shared treatment strategies. /
Publisher: Wiley
Date: 16-08-2010
DOI: 10.1111/J.1445-2197.2010.05430.X
Abstract: Surgical trainees' operating theatre (OT) experiences significantly influence their ability to attain key professional competencies. A measure of trainees' satisfaction with this learning environment would allow recognition of characteristics of highly successful teaching venues and threats to trainee development. Our study aimed to validate the Surgical Theatre Educational Environment Measure (STEEM) and use it to explore Australasian surgical trainees' satisfaction with OT learning. In a cross-sectional study, the STEEM was distributed electronically to all 1500 Royal Australasian College of Surgeons trainees in Australia and New Zealand. Trainee satisfaction was gauged using Likert-type items, an overall satisfaction measure and content analysis of free-text comments. The STEEM's psychometric properties were evaluated using exploratory factor analysis. Three hundred fifty-six responses were received. The STEEM's original subscales were not supported by the data empirically grounded subscales were identified for further analysis. Most trainees were satisfied with their OT environment and satisfaction was higher in senior than junior trainees. Trainees' relationship with their supervisor correlated most strongly with overall satisfaction. Less positively, only half of trainees report discussing their operative role with their supervisor prior to surgery. The a priori STEEM subscales could not be replicated by factor analysis. We developed an empirically grounded instrument capable of identifying areas of trainee concern. The majority of trainees reported high levels of satisfaction. The revised instrument has potential to complement other sources of information to facilitate surgical supervisors' difficult task of optimizing trainees' compatibility with their OT learning environments.
Publisher: Wiley
Date: 09-2002
DOI: 10.1046/J.1445-2197.2002.02508.X
Abstract: Small bowel obstruction is common in clinical practice and is most often due to adhesions. The aim of this study was to determine the significance of colon cancer presenting as a small bowel obstruction at a single institution and to find out whether routine colonoscopy was necessary in patients who had spontaneous resolution of their small bowel obstruction. A retrospective review of the medical records of patients presenting with small bowel obstruction from 1995 to 2000 at the Prince of Wales Hospital was performed. The clinical outcomes were obtained from the medical records and the clinical notes of each surgical consultant. Over the study period, 251 patients presented with small bowel obstruction. The mean age at presentation was 63.8 years (range 21-95 years). A total of 149 patients (59.4%) were treated conservatively with an average hospital stay of 4.6 days (range 1-20 days). Another 100 patients (39.8%) were treated operatively with a mean time from presentation to operation of 2.2 days (range <24 h-14 days). The remaining two patients (0.8%) were managed palliatively because of known metastatic disease. At laparotomy, 13 patients (13%) had a colon cancer identified. A further three patients were identified to have a colon cancer on follow up colonoscopy. However, only one of the three patients had had a previous laparotomy, that is, only 0.7% (1/149) of patients with a spontaneously resolved small bowel obstruction (presumably secondary to adhesions) had actually had colon cancer. The overall incidence of small bowel obstruction secondary to colon cancer is significant at 6.4%. However, as the incidence of colon cancer in patients who had had a previous laparotomy and spontaneous resolution of their obstruction was very low at 0.7%, routine colonoscopy does not seem warranted.
Publisher: Wiley
Date: 05-1992
DOI: 10.1111/J.1445-2197.1992.TB07209.X
Abstract: The value of bioelectrical impedance (BI) as an index of body composition was assessed in 32 patients with gastric carcinoma, 20 with advanced disease. Bioelectrical impedance was compared with standard nutritional parameters: weight, body mass index (BMI), albumin, transferrin and triceps skinfold thickness. There was no correlation between BI and these parameters with the exception of weight and BMI in the male patients. Clinical assessment of nutrition on the other hand correlated well with the standard parameters. Although BI may be a useful adjunct to the routine assessment of nutritional status in normal subjects, its use in clinical patients should be treated with caution, particularly in those with advanced gastrointestinal malignancy.
Publisher: Springer Science and Business Media LLC
Date: 06-02-2010
DOI: 10.1007/S00432-010-0792-0
Abstract: Chemotherapy is administered only to patients with advanced cancers, typically to modest avail. Hence, the search for innovative approaches to treat cancer is growing rapidly. One such approach involves targeting molecular pathways identified as encouraging tumor growth and maintenance, particularly the type 1 insulin-like growth factor (IGF-1) and its receptor (IGF-1R) pathway that is important in conferring chemoresistance. This study focuses on IGF-1R targeted therapy, which will enhance chemotherapy efficacy, through reviewing recent literature from PubMed and Medline databases. This review examines data and strategies addressing an approach conquering chemoresistance through the combination of IGF-1R targeted therapy and chemotherapy in cancer patients, as well as the mechanisms by which IGF-1R acts as a target. This will impact on future research on treatment selection, thereby improving patient prognosis.
Publisher: Wiley
Date: 04-2018
DOI: 10.1111/ANS.14354
Publisher: Wiley
Date: 11-03-2000
DOI: 10.1046/J.1440-1622.2000.01791.X
Abstract: Increasing recognition of the need for training in teaching skills for clinical teachers has coincided with data that registrars and residents conduct much 'on the job' teaching as part of their routine work. While attention has been devoted to training consultants, support for the teaching role of the junior staff has been relatively neglected. The aim of the present report is to describe the teaching experiences of surgical registrars and the impact of a registrar teaching workshop. A half-day programme combining presentation and discussion of surgical teaching with practical skills sessions was designed for surgical registrars at Prince of Wales Hospital. The programme included observation and feedback of brief teaching simulations at the bedside of volunteer patients to newly commenced clinical students, and small group sessions on clinic and operating theatre teaching. A pre-workshop questionnaire sought information about the registrars' own teaching, and a survey 3 months after the workshop determined if any changes to teaching practice had occurred. The registrars were generally moderately to very confident with their teaching ability but more than 75% felt that they were more confident after the workshop. Only three of 39 registrars had received any instruction aimed at improving their teaching skills, yet 34/39 had taught either on the ward, in the clinics or in the operating room. Follow-up after 3 months revealed that most registrars were enjoying their teaching tasks more, and half had increased their teaching since the workshop and began discussing teaching with their surgical colleagues. The present project demonstrates that relatively brief interventions focused on skill development may enhance the confidence and enjoyment of junior clinical teachers and increase the frequency of 'teaching on the run'.
Publisher: Public Library of Science (PLoS)
Date: 24-07-2013
Publisher: Elsevier BV
Date: 04-2017
DOI: 10.1038/GIM.2016.130
Abstract: Increasingly, women newly diagnosed with breast cancer are being offered treatment-focused genetic testing (TFGT). As the demand for TFGT increases, streamlined methods of genetic education are needed. In this noninferiority trial, women aged <50 years with either a strong family history (FH+) or other features suggestive of a germ-line mutation (FH-) were randomized before definitive breast cancer surgery to receive TFGT education either as brief written materials (intervention group (IG)) or during a genetic counseling session at a familial cancer clinic (usual-care group (UCG)). Women completed self-report questionnaires at four time points over 12 months. A total of 135 women were included in the analysis, all of whom opted for TFGT. Decisional conflict about TFGT choice (primary outcome) was not inferior in the IG compared with the UCG (noninferiority margin of -10 mean difference = 2.45 95% confidence interval -2.87-7.76 P = 0.36). Costs per woman counseled in the IG were significantly lower (AUD$89) compared with the UCG (AUD$173 t(115) = 6.02 P < 0.001). A streamlined model of educating women newly diagnosed with breast cancer about TFGT seems to be a cost-effective way of delivering education while ensuring that women feel informed and supported in their decision making, thus freeing resources for other women to access TFGT.Genet Med 19 4, 448-456.
Publisher: Wiley
Date: 07-2009
Publisher: Springer Science and Business Media LLC
Date: 28-07-2012
Publisher: American Association for Cancer Research (AACR)
Date: 02-2011
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Philip Crowe.