ORCID Profile
0000-0002-8066-9278
Current Organisation
University of Adelaide
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Publisher: Elsevier BV
Date: 07-2015
DOI: 10.1016/J.OPHTHA.2015.04.002
Abstract: To analyze the TNM stage, management, and recurrence rates of patients with histologically confirmed squamous cell carcinoma (SCC) of the eyelid. Retrospective case series from 3 Australian centers. A total of 254 cases of eyelid SCC from 254 patients (median age, 73 years range, 28-102 years 159 were male). Tumors were staged according to The American Joint Committee on Cancer 7th edition TNM criteria for eyelid carcinoma. Outcomes and recurrence rates according to TNM stage at presentation. A total of 25 cases (9.8%) were recurrent tumors. TNM classifications were as follows: T1N0M0, 74 patients (29.1%) T2aN0M0, 92 patients (36.2%) T2bN0M0, 50 patients (19.7%) T3aN0M0, 31 patients (12.2%) T3bN0M0, 5 patients (2.0%) T2bN0M1, 1 patient (0.4%) and T3bN1M1, 1 patient (0.4%). Perineural invasion (PNI) was present histologically in 8.3% of cases. Treatment modalities included Mohs microsurgery (31.1%), wide local excision (WLE) with paraffin section control (21.7%), WLE with frozen-section control (19.3%), and excision without margin control (24.4%). Three cases did not receive treatment. Median follow-up was 40 months (range, <1-132 months). Local recurrence occurred in 17 treated patients (6.8%). The recurrence rate was 5.3% (12/226 patients) for primary tumors and 20% (5/25 patients) for recurrent tumors (P = 0.019). Four patients (1.6%) died of their disease during follow-up. Higher T stage was significantly associated with both PNI (P = 0.035) and local recurrence (P < 0.001). We could not identify a T-stage threshold below which there was no risk of recurrence, as evidenced by 3 T1 primary tumors that recurred. Higher T stage was significantly associated with local recurrence, and recurrent tumors had a 4-fold increased risk of further recurrence compared with primary tumors. Therefore, it may be reasonable to consider sentinel lymph node biopsy or close nodal surveillance and follow-up for patients with recurrent or high T-stage tumors. Of note, we could not identify a T-stage threshold below which there was no risk of recurrences therefore, clinicians should be aware of the potential for low T-stage tumors to recur.
Publisher: Wiley
Date: 29-06-2017
DOI: 10.1111/AJD.12550
Publisher: Elsevier BV
Date: 02-2015
DOI: 10.1016/J.AJO.2014.10.029
Abstract: To describe the surgical technique for endoscopic medial orbital fat decompression in type 1 (lipogenic) Graves orbitopathy and report outcomes. Retrospective interventional case review. We reviewed 108 patients (206 orbits) with inactive, type 1 Graves orbitopathy without diplopia, who underwent endoscopic medial orbital fat decompression solely for proptosis reduction. Following endoscopic transethmoid medial orbital wall decompression, extraconal and intraconal orbital fat was removed with a low-suction cutting instrument. All patients were followed up for at least 12 months. Surgical time, preoperative and postoperative Hertel exophthalmometry, incidence of postoperative diplopia within 30-degree visual field in the primary gaze, and other complications were analyzed. The mean surgical time was 97.7 ± 16.7 minutes (67-136 minutes). The mean follow-up was 16.0 ± 4.2 months (12-24 months). Preoperative and postoperative proptosis values at final review were 21.1 ± 2.3 mm (17-26 mm) and 13.0 ± 0.9 mm (12-15 mm), respectively (P < .001). Median reduction in proptosis was 8.0 mm with mean of 8.2 ± 1.8 mm (4-11 mm). Symmetry to within 2 mm was achieved in 106 of 108 patients (98.1%). Twenty-five of 108 patients (23.1%) had diplopia within 30-degree visual field of the gaze, and 23 of these had complete resolution within 3 months, while the remaining 2 patients required squint surgery. Endoscopic medial orbital fat decompression may be an effective technique for proptosis in selected patients with type 1 Graves orbitopathy and is associated with a low rate of surgically induced diplopia.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2016
DOI: 10.1161/CIRCEP.116.004378
Abstract: Although adiposity is increasingly recognized as a risk factor for atrial fibrillation (AF), the importance of epicardial fat compared with other adipose tissue depots remains uncertain. We sought to characterize and compare the associations of AF with epicardial fat and measures of abdominal and overall adiposity. We conducted a meta-analysis of 63 observational studies including 352 275 in iduals, comparing AF risk for 1-SD increases in epicardial fat, waist circumference, waist/hip ratio, and body mass index. A 1-SD higher epicardial fat volume was associated with a 2.6-fold higher odds of AF (odds ratio, 2.61 95% confidence interval [CI], 1.89–3.60), 2.1-fold higher odds of paroxysmal AF (odds ratio, 2.14 95% CI, 1.45–3.16) and, 5.4-fold higher odds of persistent AF (odds ratio, 5.43 95% CI, 3.24–9.12) compared with sinus rhythm. Likewise, a 1-SD higher epicardial fat volume was associated with 2.2-fold higher odds of persistent compared with paroxysmal AF (odds ratio, 2.19 95% CI, 1.66–2.88). Similar associations existed for postablation, postoperative, and postcardioversion AF. In contrast, associations of abdominal and overall adiposity with AF were less extreme, with relative risks per 1-SD higher values of 1.32 (95% CI, 1.25–1.41) for waist circumference, 1.11 (95% CI, 1.08–1.14) for waist/hip ratio, and 1.22 (95% CI, 1.17–1.27) for body mass index. Strong and graded associations were observed between increasing epicardial fat and AF. Moreover, the strength of associations of AF with epicardial fat is greater than for measures of abdominal or overall adiposity. Further studies are needed to assess the mechanisms and clinical relevance of epicardial fat.
Publisher: Future Medicine Ltd
Date: 11-2015
DOI: 10.2217/FON.15.190
Abstract: Basal cell carcinoma (BCC) is the most common eyelid malignancy however, orbital invasion by periocular BCC is rare, and management remains challenging. Established risk factors for orbital invasion by BCC include male gender, advanced age, medial canthal location, previous recurrences, large tumor size, aggressive histologic subtype and perineural invasion. Management requires a multidisciplinary approach with orbital exenteration remaining the treatment of choice. Globe-sparing treatment may be appropriate in selected patients and radiotherapy and chemotherapy are often used as adjuvant therapies for advanced or inoperable cases, although the evidence remains limited. We aim to summarize the presentation and treatment of BCC with orbital invasion to better guide the management of this complex condition.
Publisher: The Royal Australian College of General Practitioners
Date: 08-2019
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2015
Publisher: Wiley
Date: 09-09-2012
Publisher: Elsevier BV
Date: 06-2015
DOI: 10.1016/J.JACEP.2015.04.004
Abstract: The purpose of this study was to quantify the magnitude of association between incremental increases in body mass index (BMI) and the development of incident, post-operative, and post-ablation atrial fibrillation (AF). Obesity has been estimated to account for one-fifth of all AF and approximately 60% of recent increases in population AF incidence. From a public health perspective, obesity, therefore, is a modifiable risk factor that could be profitably targeted. A systematic review and meta-analysis was conducted. Medline and EMBASE databases were searched for observational studies reporting data on the association between obesity and incident, post-operative, and post-ablation AF. Studies were included if they reported or provided data allowing calculation of risk estimates. Data from 51 studies including 626,603 in iduals contributed to this analysis. There were 29% (odds ratio [OR]: 1.29, 95% confidence interval [CI]: 1.23 to 1.36) and 19% (OR: 1.19, 95% CI: 1.13 to 1.26) greater excess risks of incident AF for every 5-U BMI increase in cohort and case-control studies, respectively. Similarly, there were 10% (OR: 1.10, 95% CI: 1.04 to 1.17) and 13% (OR: 1.13, 95% CI: 1.06 to 1.22) greater excess risks of post-operative and post-ablation AF for every 5-U increase in BMI, respectively. Incremental increases in BMI are associated with a significant excess risk of AF in different clinical settings. For every 5-U increase in BMI, there were 10% to 29% greater excess risks of incident, post-operative, and post-ablation AF. By providing a comprehensive and reliable quantification of the relationship between incremental increases in obesity and AF across different clinical settings, our findings highlight the potential for even moderate reductions in population body mass indexes to have a significant effect in mitigating the rising burden of AF.
Publisher: BMJ
Date: 23-01-2014
Publisher: Springer Science and Business Media LLC
Date: 26-07-2019
Publisher: BMJ
Date: 13-09-2013
DOI: 10.1136/BJOPHTHALMOL-2013-303758
Abstract: To describe the clinical features, management and correlation of the American Joint Committee on Cancer tumour node metastasis (TNM) staging for eyelid carcinoma with outcomes in Japanese patients with sebaceous carcinoma. Multicentre retrospective review of 63 Japanese patients. Tumours were staged using the American Joint Committee on Cancer 7th edition TNM criteria. A distinct mass was the initial presentation in 94% and correct initial diagnosis made in 57% patients. Most tumours (60%) presented at stage T2aN0M0. The remaining TNM stages were: T2bN0M0 (25%) T3aN0M0 (9%) T3bN0M0 (2%) T2bN1M0 (2%) T3bN1M1 (2%). Frozen section controlled excision was performed in 81%. One patient required an orbital exenteration. Median follow-up was 4.2 years. Local recurrence occurred in four patients treated with frozen section controlled excision. Five patients had regional nodal metastases, two of which had T2aN0M0 lesions. T3a tumours and greater were significantly associated with local recurrence but not regional nodal metastasis. One patient died due to disease. One patient is alive with disease, and remaining patients were alive without disease at last follow-up. In this Japanese cohort, an eyelid mass was the main clinical presentation of sebaceous carcinoma. Contrary to previous reports, T2a tumours smaller than 10 mm were associated with regional nodal metastases.
Publisher: American Medical Association (AMA)
Date: 02-2014
DOI: 10.1001/JAMAOPHTHALMOL.2013.6077
Abstract: The literature on Merkel cell carcinoma (MCC) of the eyelid remains scarce, and there has yet to be a study using the most up-to-date TNM staging system for this rare but aggressive tumor. To analyze the TNM stage, management, and outcomes of patients with MCC of the eyelid. Retrospective case series of 21 patients from 5 tertiary referral centers in the United Kingdom and Australia with primary MCC of the eyelid presenting at a median age of 77 years, with median follow-up of 54 months. Tumors were staged according to the American Joint Committee on Cancer, 7th edition, TNM criteria for eyelid carcinoma and MCC. TNM stage, treatment modalities, and clinical outcome. The eyelid carcinoma TNM stages were T2aN0M0 for 5 patients, T2bN0M0 for 7 patients, T3aN0M0 for 4 patients, T3bN0M0 for 3 patients, T2bN1M0 for 1 patient, and T3aN1M0 for 1 patient. The MCC TNM stages were T1N0M0 for 12 patients, T2N0M0 for 7 patients, T1N1M0 for 1 patient, and T2N1M0 for 1 patient. One patient had a sentinel lymph node biopsy, and 8 patients underwent head/neck imaging. Eighteen patients underwent a wide local excision, 12 with a paraffin section and 6 with a frozen section. Two patients underwent Mohs surgery, 1 of whom required an orbital exenteration. Twelve patients (57%) received adjuvant radiotherapy, and 2 patients received chemotherapy. The local recurrence rate was 10%, the regional nodal recurrence rate was 10%, and the distant metastatic recurrence rate was 19%. The lowest T category tumor metastasizing to both regional nodes and distant locations was a T2a (eyelid TNM)/T1 (Merkel TNM) tumor measuring 8 mm. Two patients with T3a (eyelid TNM)/T2 (Merkel TNM) tumors died of metastatic MCC. The majority of patients with MCC of the eyelid present with localized eyelid disease of T category T2 (eyelid TNM)/T1 (Merkel TNM). A wide local excision with margin control remains the mainstay of treatment, whereas the use of radiotherapy is institution specific. Tumors with a low T category are associated with regional nodal and distant metastatic disease. It may therefore be reasonable to consider a sentinel lymph node biopsy or strict regional lymph node surveillance for all MCCs of the eyelid, regardless of T category or size.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2017
DOI: 10.1097/IOP.0000000000000528
Abstract: Orbital schwannomas are rare and despite a variety of external surgical approaches previously utilized, removal of tumors located in the deep orbital apex remains challenging. The endoscopic endonasal approach has been used increasingly for various apical tumours, but few describe this technique for orbital schwannomas. The authors describe 2 cases of orbital schwannoma removed via an endoscopic endonasal assisted approach. The first patient was a 31-year-old Cantonese female who was found to have an 11 × 8 × 8 mm right orbital apical schwannoma which was removed using an endoscopic endonasal sphenoethmoidal approach. The second patient was a 78-year-old white male who had a 28 × 17 × 18 mm orbital schwannoma removed via a transcaruncular and endoscopic endonasal-assisted approach. These findings suggest that the use of an endonasal approach may facilitate the safe removal of selected medially located orbital schwannomas whose posterior margins involve the orbital apex.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-09-2022
Publisher: Wiley
Date: 11-03-2014
DOI: 10.1111/CEO.12298
Abstract: To determine the proportion of different subtypes of periocular BCC in South Australia. Retrospective review. One thousand seven hundred thirteen consecutive periocular basal cell carcinoma (BCC) excision specimens. Histological analysis of consecutive periocular BCC specimens. Date of resection, patient age at resection, gender, tumour location, histological subtype and perineural invasion. From 2006 to 2012, a total of 1713 consecutive periocular BCC excision specimens were analysed. The mean age at resection was 68.8 years (median: 71, range: 21-101). Most specimens (56.4%) were removed from male patients. 52.7% involved the lower eyelid, 29.0% the medial canthus, 10.9% the lateral canthus and 7.5% the upper eyelid. The main histological subtypes identified were nodular (65.7%), infiltrative (17.5%), superficial (12.6%) and micronodular (4.2%). Of the specimens, 25.6% had more than one subtype. The most common subtype combinations were nodular with infiltrative (49.7%), and nodular with superficial (26.0%). The majority of periocular BCC were located on the lower lid and classified histologically as nodular. Infiltrative BCC occurred more frequently than the superficial subtype. As the proportion of mixed BCC containing aggressive subtypes is high, surgical excision with margin control should be considered for periocular BCC.
Publisher: BMJ
Date: 17-02-2022
DOI: 10.1136/BJOPHTHALMOL-2020-318701
Abstract: Limited data are available on glaucoma surgical trends in Australia. Nationwide study of glaucoma surgery in Australia over 17-year period from 2001 to 2018. The Australian Institute of Health, Welfare and Ageing hospitalisation database was used to review age- and gender-specific trends in glaucoma surgeries from 2001 to 2018 in Australian public and private hospitals. Although there was an increase in the absolute number of trabeculectomy procedures from 2926 to 3244 over the 17-year study period, this represented a decline in the age-standardised and gender-standardised number of trabeculectomy procedures from 15.1 to 13.2 procedures per 100 000 persons. However, during this same period, there was a dramatic increase in the number of glaucoma drainage devices (GDD) from 119 to 3262 procedures, representing an age-standardised and gender-standardised increase from 0.6 to 13.3 procedures per 100 000 persons. Negative binomial regression analysis revealed a decrease in trabeculectomy procedures of 1.1% per year, while there was increase in GDD insertions of 16.3% per year (p .001 for both). When stratified by age group, there was a statistically significant interaction in both trabeculectomy and GDD rates by age groups over time (p .001 for both). Trabeculectomy procedures decreased to a greater extent in those aged years, compared with stable or increasing rates in younger age groups. GDD insertion rates demonstrated a progressively greater increase in older compared with younger age groups. Our findings demonstrate changing trends in the surgical management of advanced glaucoma in Australia, likely reflecting updated evidence regarding the role of GDD surgeries.
Publisher: Elsevier BV
Date: 03-2016
DOI: 10.1016/J.AJO.2015.11.032
Abstract: To review the clinical and histologic features of idiopathic dacryoadenitis, and to assess prognostic factors associated with disease recurrence, treatment recalcitrance, and incomplete treatment response. Retrospective interventional case series. setting: Tertiary referral centers. Seventy-nine cases of biopsy-confirmed idiopathic dacryoadenitis. The following data were reviewed: age, sex, laterality, symptom onset, clinical presentation, histopathology, treatment response, and recurrence. Rates of treatment recalcitrance, incomplete treatment response, and recurrence. Idiopathic dacryoadenitis patients had a mean age of 50 years, 57% were female, and 16% of cases were bilateral. Fifty-two percent had inflammation extending to adjacent structures on imaging. Twenty percent were recalcitrant to treatment, 17% had an incomplete treatment response, and 15% of patients had a recurrence during a mean follow-up time of 64 months. Risk factors for an incomplete treatment response were male sex (P = .01) and inflammation extending to extraocular muscle (P = .01). A clinical presentation of "classic" dacryoadenitis was a risk factor for treatment recalcitrance (P = .02). Bilateral cases were younger than unilateral cases (P = .004) and had an increased risk of recurrence (P = .05). Sclerosing cases were associated with an insidious onset of symptoms (P = .009), but neither histopathology nor the speed of symptom onset was associated with a poor prognosis. Thirty-seven percent of idiopathic dacryoadenitis had a poor response to treatment and 15% of cases recurred. The prognostic factors identified in this study have not been reported previously and may inform management.
Publisher: Elsevier BV
Date: 09-2009
DOI: 10.1016/J.HRTHM.2009.06.007
Abstract: Abstract presentation at conferences provides the opportunity to rapidly communicate research findings. The outcome and impact of publications arising from cardiac electrophysiology abstracts are not known. The purpose of this study was to examine the characteristics of abstracts presented at the annual scientific sessions of Heart Rhythm Society (HRS), their publication rate, and the indexed impact of subsequent publications. Two independent database searches (MEDLINE and EMBASE) were performed by cross-referencing authors and keywords from abstracts originally presented at HRS in 2003. ISI Web of Knowledge was accessed for impact factors and citation rates. A total of 790 abstracts were presented, of which 377 (47.7%) resulted in publication of an original article. Median time to publication was 1.39 years (interquartile range [IQR] 0.88-2.30 years), and the median impact factor and citation rate of published articles was 4.14 (IQR 3.48-11.05) and 10 (IQR 4-25), respectively. Experimental research abstract category (odds ratio [OR] 2.03, P <.001), randomized study design (OR 0.53, P = .02), and positive findings (OR 0.80, P = .06) were independently predictive of publication by stepwise logistic regression. Independent predictors of higher citation rates were randomized study design (P = .03) and impact factor of the publishing journal (P <.001). Almost half of all abstracts presented at HRS resulted in publication in journals with a high impact factor. Experimental research abstracts, those with a randomized study design, and those demonstrating positive findings were predictors of subsequent publication. Randomized study design and greater impact factor of the publishing journal were found to predict higher citation rates.
Publisher: Informa UK Limited
Date: 20-06-2016
DOI: 10.1080/01676830.2016.1176208
Abstract: Haemangiopericytomas (HPCs) are rare tumours which infrequently occur in the lacrimal sac. Only 8 cases of lacrimal sac HPC have previously been reported. The authors report 2 additional cases presenting clinically with epiphora and a mass. One case recurred 3 times during an 18-year period. The other case did not recur during 51 months of follow-up. The tumours showed immunohistochemical features consistent with a diagnosis of HPC. The authors recommend wide excision for these tumours and careful long-term follow-up to detect recurrence which is not uncommon.
Publisher: Wiley
Date: 23-05-2018
DOI: 10.1111/AJD.12855
Publisher: Elsevier BV
Date: 09-2013
DOI: 10.1016/J.AJO.2013.05.001
Abstract: To determine the indications for the addition of a transcaruncular approach along with detachment of the medial rectus muscle during the removal of small apical cavernous hemangiomas using an endoscopic transethmoidal approach. Retrospective, noncomparative case series. Multicenter study of 12 patients with apical orbital tumors removed using an endoscopic transethmoidal approach. The decision to detach the medial rectus muscle with the addition of a transcaruncular approach was made during surgery for tumors largely lateral to the medial rectus muscle. Tumors adjacent to the medial orbital wall were removed via an endoscopic transethmoidal approach alone. Seven tumors were removed via an endoscopic transethmoidal approach combined with medial rectus muscle detachment, whereas 5 patients underwent removal without detachment of the medial rectus. All patients had visual impairment. Complete excision of the hemangiomas was achieved in all patients and tumor size ranged from 6 × 5 mm to 20 × 12 mm. The mean postoperative follow-up time was 11.8 ± 4.3 months. At final follow-up, the best-corrected visual acuity improved in 11 patients. Three patients had transient horizontal diplopia resulting from partial paralysis of the medial rectus muscle after detachment during surgery. The endoscopic transethmoidal approach with or without medial rectus detachment is a promising approach for selected small cavernous hemangiomas located at the deep medial orbital apex. Detachment of the medial rectus muscle can be a useful technique for tumors located largely lateral to the medial rectus muscle. Further studies will be required to demonstrate the safety and efficacy of this technique.
Publisher: Wiley
Date: 28-06-2017
DOI: 10.1111/AJD.12539
Publisher: BMJ
Date: 21-04-2022
DOI: 10.1136/BJOPHTHALMOL-2021-321010
Abstract: Optimal utilisation of investigations in glaucoma management remains unclear. We aimed to assess whether a temporal association exists between such testing and management changes. Retrospective observational study using nationwide healthcare insurance claims database. Glaucoma outpatient encounters from patients aged ≥40 years with/without Humphrey visual field (HVF) and/or optical coherence tomography (OCT) were identified. An encounter was considered associated with an intervention if surgery occurred within 90 days, or if medication change or laser trabeculoplasty (LT) occurred within 30 days. 12 669 324 outpatient encounters of 1 863 748 in iduals from 2003 to 2020 were included. HVF and OCT was performed during 32.8% and 22.2% of encounters respectively. Of the 36 763 (0.3%) encounters preceding surgery, 28.1% included HVF, 11.9% had OCT and 8.5% both. 79 181 (0.6%) visits preceded LT, of which 28.2% had HVF, 13.2% OCT and 9.3% both. Of the 515 899 (4.5%) encounters preceding medication changes, 29.1% had HVF, 16.7% OCT and 12.2% both. Compared with encounters with no investigations, those with HVF and/or OCT were associated with a 49% increased odds of a management change (p .001). In multivariate analyses, compared with encounters without investigations, visits with HVF alone had higher odds of subsequent surgery and LT, while HVF and/or OCT were associated with higher odds of medication change (p .001 for all). Glaucoma therapeutic changes occurred following approximately 5% of outpatient encounters. Surgery and LT were more likely to occur following a visit with a HVF rather than an OCT, while either investigation was associated with a higher odds of medication change.
Publisher: Wiley
Date: 10-12-2018
DOI: 10.5694/MJA18.00890
Abstract: To determine whether surgeons and junior doctors intending to pursue careers in surgery are more likely to purchase more expensive vehicles and to replace them sooner than colleagues of similar seniority pursuing non-surgical careers. Survey of practising medical officers at an Australian tertiary referral hospital. Car value proportion of doctors who bought their car new median time to replacement of vehicle. 154 doctors participated in the survey (17% response rate). 49% were interns, residents or unaccredited registrars, 18% were accredited registrars or fellows, and 31% were consultants 40% of respondents were surgical trainees or consultants. 59% of surgical trainees and consultants purchased their car new, compared with 38% of non-surgical doctors (P = 0.013) 52% of doctors in the junior surgeon group purchased their car new, compared with 28% of non-surgeon junior doctors (P = 0.019). Median car value was $16 500 (IQR, $9350-37 000) for surgeons and $8500 (IQR, $4400-14 100) for non-surgeons (P < 0.001) 30% of surgeons owned cars valued at more than $50 000, compared with 6% of non-surgeons (P = 0.025). The median time to replacement was 5-7 years for surgeons and 7-10 years for non-surgeons (P < 0.001). Surgeons more frequently purchase their cars new and replace their cars earlier than non-surgeons, and the median value of their vehicles is higher. These findings were consistent across all levels of seniority.
Publisher: Elsevier BV
Date: 11-2012
DOI: 10.1016/J.AMJCARD.2012.07.011
Abstract: Recent reports have described that hospitalizations for atrial fibrillation (AF) are continuing to increase. Given that hospitalizations are responsible for most of the economic burden associated with AF, the aim of this study was to characterize the impact of age and how changing procedural practices may be contributing to the increasing rates of AF hospitalizations. The annual age- and gender-specific incidence of hospitalizations for AF, electrical cardioversions, electrophysiologic studies, and radiofrequency ablation procedures in Australia were determined from 1993 to 2007 inclusive. Over this 15-year follow-up period spanning almost 300 million person-years, a total of 473,501 hospitalizations for AF were identified. There was a relative increase in AF hospitalizations of 203% over the study period, in contrast to an increase for all hospitalizations of only 71%. Whereas the gender-specific incidence of hospitalizations remained stable, the age-specific incidence increased significantly over the study period, particularly in older age groups. AF hospitalizations associated with electrical cardioversions decreased from 27% to 14% over the study period. Electrophysiologic studies and radiofrequency ablation procedures contributed minimally to the overall increase in AF hospitalizations observed. In conclusion, in addition to the growing prevalence of AF because of the aging population, there is an increasing age-specific incidence of hospitalizations for AF, particularly in older age groups. In contrast, changing procedural trends have contributed minimally to the increasing number of AF-associated hospitalizations. Greater attention to older patients with AF is required to develop strategies to prevent hospitalizations and contain the growing burden on health care systems.
Publisher: Wiley
Date: 08-05-2014
Abstract: Orbital compartment syndrome (OCS) is an ophthalmic emergency that requires urgent surgical decompression to preserve vision. To describe the clinical presentation, management and outcomes for patients with traumatic OCS. Retrospective case series of eight patients with OCS secondary to blunt trauma presenting to the Royal Adelaide Hospital between 2004 and 2013. All patients had acute, painful decrease in visual acuity and proptosis. Common examination findings included a relative afferent pupillary defect, periorbital oedema, ophthalmoparesis and chemosis. All patients underwent surgical decompression in the form of a lateral canthotomy or cantholysis. Three patients who were decompressed within 2 h after injury recovered fully. One patient who sustained a macular hole at the time of injury recovered four lines of Snellen acuity after being decompressed within 1 h. Another patient recovered three lines of Snellen acuity after undergoing decompression at 2.5 h post-injury. The remaining patients had minimal visual recovery, with postoperative visual acuities ranging from hand movements to no perception to light. Of these patients, one was decompressed at 2 h, while the remaining underwent decompression at 4 and 6 h post-injury. Prompt decompression is essential for visual recovery in OCS, which appears maximal if performed within 2 h of injury. All patients presenting with history and examination findings suggestive of OCS should undergo emergency canthotomy and cantholysis prior to any additional investigations to minimise visual loss.
Publisher: Springer Science and Business Media LLC
Date: 15-09-2015
DOI: 10.1007/S10792-015-0127-X
Abstract: An elderly woman was incidentally noted to have a nodular mass on the upper eyelid, whilst under investigation for cataracts. Punch biopsy of this presumed basal cell carcinoma revealed it to be endocrine mucin-producing sweat gland carcinoma (EMPSGC). The tumour extended to the deep dermal layer and comprised solid nests with foci of cystic and papillary change, and additional cytoplasmic and focal extracellular mucin deposits. Immunohistochemistry confirmed epithelial lineage and neuroendocrine differentiation, and adjacent tissue invasion. The tumour was excised completely with Mohs micrographic surgery with no recurrence after 8 months. EMPSGC is a low-grade sweat gland carcinoma with variable neuroendocrine differentiation, a solid, papillary, or cystic growth pattern, and a predilection for the eyelid of elderly women [Am J Surg Pathol 29:1330-1339, 2005]. There have been 54 previously documented cases of EMPSCG. We report an additional case and review the literature.
Publisher: Elsevier BV
Date: 06-2016
DOI: 10.1016/J.AMJCARD.2016.03.042
Abstract: Atrial fibrillation (AF) is common in patients on dialysis. Although randomized trials of anticoagulation for AF have demonstrated striking reductions in stroke, these trials did not recruit patients on dialysis. We thus undertook this systematic review and meta-analysis of observational studies including patients with AF on dialysis that reported associations of anticoagulation use. Twenty studies involving 529,741 subjects and 31,321 patients with AF on dialysis were identified. Anticoagulation was associated with a 45% (95% CI 13% to 88%) increased risk of any stroke, reflecting a nonsignificant 13% (95% CI -4% to 34%) increased ischemic stroke risk and 38% (95% CI 3% to 85%) increased hemorrhagic stroke risk. There was also a 44% (95% CI 38% to 56%) lower risk of any thromboembolism, and a 31% (95% CI 12% to 53%) increased risk of any bleeding but no clear association with cardiovascular death (relative risk 0.99, 95% CI 0.86 to 1.15) or all-cause mortality (relative risk 0.97, 95% CI 0.90 to 1.04). Incident event rates were similar or worse in patients on anticoagulation. In conclusion, these observational analyses provide little supporting evidence of benefit, and instead suggest harm, from anticoagulation in patients on dialysis with AF. These results raise the possibility that the effects of anticoagulation in patients with AF on dialysis may not be similar to the clear benefit of anticoagulation seen in patients with AF without end-stage renal disease. Randomized trials are required to definitively evaluate the safety and efficacy of anticoagulation for AF in the dialysis setting.
Publisher: Elsevier BV
Date: 06-2011
Publisher: American Medical Association (AMA)
Date: 11-2017
Publisher: Elsevier BV
Date: 09-2015
DOI: 10.1016/J.JBIOMECH.2015.05.037
Abstract: Reconstruction of the eyelid remains challenging due to the unique properties of the tarsal plate, which is a fibrocartilagenous structure within the eyelid providing structural support and physical form. There are no previous studies investigating the biomechanical properties of tarsus tissue, which is vital to the success of bioengineered tarsal substitutes. We therefore aimed to determine the biomechanical properties of human tarsus tissue, and used a CellScale BioTester 5000 (CellScale, Waterloo, Canada) to perform uniaxial tensile tests on ten s les of healthy eyelid tarsus. All s les were tested 'fresh' within two hours of harvest. A tensile preload of 50 mN was applied for 10 min before the s le was subjected to uniaxial tension under linear r displacement control. Maximum strain was 30% of the original tissue length and thirty dynamic cycles were performed at a strain rate of 1%/s using a triangular waveform. Of the s les tested, the mean (SD) width was 5.51 mm (1.45 mm) whilst mean thickness was 1.6mm (0.51 mm). The mean toe modulus was 0.14 (0.10) MPa, elastic modulus was 1.73 (0.61) MPa, with an extensibility of 15.8 (2.1)%, and phase angle of 6.4° (2.4)°. After adjusting for the initial tissue slack, the maximum strain ranged from 23.8% to 30.0%. At maximum strain, it was observed that the linear region of the stress-strain curve was reached without the s le slipping out of the cl s. Our results establish a benchmark for native tarsus tissue, which can be used when evaluating tissue engineered tarsal substitutes in the future.
Publisher: Informa UK Limited
Date: 08-01-2018
DOI: 10.1080/01676830.2017.1423359
Abstract: A 39-year-old male developed bilateral periorbital oedema and tense orbits in keeping with orbital compartment syndrome (OCS) shortly after presenting to the emergency department for uncontrollable epistaxis. Bilateral lateral canthotomy and inferior cantholysis was performed within 30 minutes of onset, with the left side further decompressed via superior cantholysis. Computed tomography demonstrated bilateral proptosis and optic nerve stretch, but no intraorbital haemorrhage or haematoma. Laboratory findings were consistent with disseminated intravascular coagulation (DIC) and sepsis of unknown origin. The right visual acuity recovered to 6/6 -2 from counting fingers, but the left eye failed to improve beyond light perception. This unique case of OCS is the first associated with DIC which had no evidence of intraorbital haemorrhage.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2017
DOI: 10.1097/IOP.0000000000000792
Abstract: Bioengineering aims to produce functional tissue replacements to repair defects and has been widely investigated over the past few decades. We aimed to review the available literature on the application of tissue engineering in ophthalmology, with a particular focus on ophthalmic plastic surgery and potential applications for eyelid reconstruction. A literature search was performed on the MEDLINE database using the keywords “bioengineering,” “tissue engineering,” and “ophthalmology.” Articles written in English were included. There is a substantial body of work on tissue engineering of the cornea. Other structures in ophthalmology investigated include the conjunctiva, lacrimal gland, and orbital bone. We also discuss the potential application of tissue engineering in eyelid reconstruction. Tissue engineering represents the future of regenerative and reconstructive medicine, with significant potential applications in ophthalmic plastic surgery.
Publisher: Elsevier BV
Date: 08-2012
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2016
Publisher: Informa UK Limited
Date: 26-04-2017
Publisher: Elsevier BV
Date: 04-2020
Publisher: BMJ
Date: 11-10-2013
Publisher: Springer Science and Business Media LLC
Date: 08-11-2014
DOI: 10.1007/S10384-014-0357-X
Abstract: To characterize the location of orbital blowout fractures in Asian in iduals. This was a retrospective review of 470 consecutive Asian patients with orbital blowout fractures who presented to four tertiary care hospitals in Japan and China. Computed tomography (CT) characterized the location and severity of fractures involving the medial wall, the orbital floor, and/or the maxilloethmoidal strut. A total of 475 orbital blowout fractures were identified. More than one fracture location was involved in 19% of all cases. The medial orbital wall was the most commonly involved location, presenting in 29 cases (61%), of which 204 (43%) were isolated medial blowout fractures. The orbital floor was the second most common location involved, present in 226 cases (48%) with 150 isolated orbital floor fractures (32%), while the maxilloethmoidal strut was involved in 45 cases (9%) with 30 of those being isolated strut fractures (6%). The majority of fractures (62%) were classified as moderately severe, whilst 14% were mild, and 24% were severe. Associated nasal fractures were present in 16% of the cases. Orbital blowout fractures in Japanese and Chinese in iduals occur most commonly in the medial wall. This is in contrast to previous reports on white in iduals, who tend to sustain fractures involving the orbital floor rather than the medial wall.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2017
DOI: 10.1097/IOP.0000000000000630
Abstract: The authors report a case of neurotropic nondesmoplastic melanoma involving the ophthalmic ision of the trigeminal nerve and the cavernous sinus in a patient with recurrent scalp melanoma. This case highlights the importance of earlier diagnosis of local recurrence of melanoma and the rare association of neurotropic melanoma and orbital metastasis.
Publisher: Wiley
Date: 08-2013
DOI: 10.1111/IMJ.12201
Abstract: Implantable cardioverter defibrillators (ICD) have been demonstrated to reduce mortality in survivors of life-threatening arrhythmias (secondary prevention) and in patients at increased risk of sudden cardiac death (primary prevention). Other nations have reported significant increases in ICD use in recent years. To investigate Australian nationwide trends of ICD procedures over a 10-year period (2000-2009). A retrospective analysis of the Australian Institute of Health and Welfare's National Hospital Morbidity Database was performed to determine the annual number of ICD implantation and replacement procedures between 2000 and 2009. Rates were calculated using Australian Bureau of Statistics data on the annual estimated population. Time trends in the yearly procedure number and rate were analysed using negative binomial regression models with comparisons made by age and sex. The number of new ICD implantations increased from 708 to 3198 procedures between 2000 and 2009. Replacement procedures increased from 290 to 1378. The implantation rate (per million) increased from 37.0 to 145.6 and the replacement rate from 15.1 to 62.7. When rates were adjusted for age and sex, the implantation rate increased annually by 15.8% and the replacement rate by 16.6% (P < 0.0001). Procedures occurred most commonly in men (implantations: 80.1% replacements: 78.0%) between ages 70-79. ICD procedures increased significantly in Australia between 2000-2009. Despite these increases, other studies have suggested ICD devices are currently under-utilised. During the study period, males accounted for the majority of ICD procedures. While there are numerous reasons for this, it is not known if device under-use is more common in females.
Publisher: Elsevier BV
Date: 11-2021
DOI: 10.1016/J.SURVOPHTHAL.2021.03.001
Abstract: Anti-vascular endothelial growth factor (anti-VEGF) crunch syndrome describes the progression to tractional retinal detachment following intravitreal anti-VEGF therapy in an eye with proliferative diabetic retinopathy . We reviewed the literature on the anti-VEGF crunch using the PubMed and Cochrane databases. Anti-VEGF crunch typically manifests as sudden vision loss in the affected eye between 1 and 6 weeks following intravitreal anti-VEGF injection, with a mean onset of 13 days. Risk factors for crunch development include the use of a higher anti-VEGF dose and increased severity of diabetic retinopathy with fibrosis. Our review found that intravitreal anti-VEGF, in particular bevacizumab, should be used with caution when treating patients with severe proliferative diabetic retinopathy and pre-existing intraocular fibrosis. In patients where anti-VEGF is used before a planned vitrectomy, we recommend close monitoring for crunch symptoms and proceeding promptly with surgery if there is new or progression of tractional retinal detachment. For eyes with minimal preexisting traction that develop crunch after anti-VEGF treatment, surgeons should proceed to vitrectomy within 7 days. The existing literature on the anti-VEGF crunch is limited by heterogeneity in the way crunch is documented and characterized and the presence of panretinal photocoagulation as a confounding factor. Because of these methodological flaws, the relative frequency of the anti-VEGF crunch cannot be accurately estimated.
Publisher: American Medical Association (AMA)
Date: 08-2017
Publisher: Springer Science and Business Media LLC
Date: 13-06-2015
Publisher: Wiley
Date: 06-02-2020
DOI: 10.1111/CEO.13722
Publisher: Wiley
Date: 27-04-2015
DOI: 10.1111/CEO.12514
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2012
Publisher: Elsevier BV
Date: 07-2013
DOI: 10.1016/J.AMJCARD.2013.03.014
Abstract: Although most of the additional increases in coronary heart disease morbidity and mortality are estimated to occur outside developed regions such as North America and Europe, few nationwide studies have been published of acute myocardial infarction (MI) epidemiology from other regions. We thus sought to expand the global data regarding MI trends. Nationwide trends of incident MI, ST-segment elevation MI (STEMI), and non-ST-segment MI (non-STEMI) were analyzed during a 17-year period in Australia. We identified 714,262 hospitalizations for MI from 1993 to 2010, representing 331,871,389 person-years. During the study period, the age- and gender-adjusted incidence of all MIs increased from 215 to 251 cases per 100,000 person-years, a relative increase of 76% (p <0.0001 for trend). The adjusted incidence of STEMI decreased from 147 to 70 cases per 100,000 person-years, a relative decrease of 30% (p <0.0001 for trend). In contrast, the adjusted incidence of non-STEMI increased from 67 to 182 cases per 100,000 person-years, a relative increase of 315% (p <0.0001 for trend). Age-specific analyses suggested that statistically significant increases in MI incidence were present in those aged <50 and ≥80 years. In conclusion, although it has previously been suggested that declining trends in MI incidence in North American and European reports might be generalizable given the seemingly consistent observations thus far, the present results highlight the possibility that other global populations might have less favorable trends. The incidence of MI in Australia might not be decreasing as rapidly as that seen in other regions and requires additional exploration.
Publisher: Informa UK Limited
Date: 09-07-2018
DOI: 10.1080/01676830.2018.1490438
Abstract: Desmoplasia is the formation of a dense collagenous stroma around a neoplasm. It occurs in a variety of malignancies including squamous cell carcinoma (SCC). While desmoplasia is uncommonly seen in cutaneous SCC, it is an independent risk factor for recurrence and metastasis. We report a case series of desmoplastic SCC in the periorbital region. Seven cases were identified: the median age was 68, four were men. The mean follow-up was 48 months. Two patients (29%) had aggressive local recurrence: one required salvage surgery including orbital exenteration, parotidectomy, and neck dissection to excise involved parotid and cervical lymph nodes the other required repeat excision and adjuvant radiotherapy. Desmoplastic SCC is an uncommon but highly aggressive subtype. In the periorbital region, due to the high risk of orbital invasion, it is potentially sight and life-threatening.
Publisher: Elsevier BV
Date: 07-2013
DOI: 10.1016/J.AMJCARD.2013.03.016
Abstract: Although conferences are important vehicles for discussing scientific findings, the translation of presented research into peer-reviewed manuscripts is a crucial subsequent step in the research process. Given the evolving subspecialization of cardiology, we sought to characterize the temporal and comparative outcomes of abstracts presented at a subspecialty cardiac electrophysiology conference. Abstracts presented at the Heart Rhythm Society conference (1994 through 2006 HRS abstracts) and abstracts presented at the American Heart Association conference (2003 AHA abstracts) were studied. Subsequent publications, impact factors, and citation rates were determined. A total of 3,850 HRS and 1,000 AHA abstracts were studied. More human abstracts were presented at HRS than AHA (p <0.05). Compared with HRS abstracts, more AHA abstracts were published (p <0.001) and had higher impact factors and citation rates (p <0.001 for both). These differences were attributable in part to the greater proportion of human HRS abstracts. Compared with HRS abstracts, electrophysiology-related AHA abstracts were published less (p <0.001), and these publications had similar impact factors (p = 0.38) although greater citation rates (p = 0.001). The number and publication rate of HRS abstracts increased over the 15-year period, as did their publication impact factors and citation rates (p <0.001 for all). In conclusion, there are significant differences between AHA and HRS abstracts. Although AHA abstracts were more likely to be published overall, the publication rate and impact of electrophysiology abstracts presented at both a subspecialty (HRS) and a major cardiovascular conference (AHA) were comparable. There has also been a growth in the number and impact of cardiac electrophysiology abstracts presented at HRS in recent years.
No related grants have been discovered for Michelle Sun.