Rational approach to diagnosis and management of blunt scrotal trauma.

Objectives: To provide a rational approach to the diagnosis and management of blunt scrotal trauma to aid clinicians in the selection of patients for surgical exploration.

Methods: We performed a retrospective evaluation of the medical records of 44 patients from two metropolitan tertiary referral hospitals. A total of 29 patients were recruited from July 1, 1993 to June 30, 2003 at one institution and an additional 15 patients from February 1, 1991 to January 31, 1999 at the second.

Endorectal magnetic resonance imaging staging of prostate cancer.

Background: There are important treatment and prognostic implications in distinguishing between organ-confined prostate cancer that has spread locally outside the capsule and that which has spread into the seminal vesicles. This study is the first Australian study to report local accuracy for the locoregional staging of prostate cancer with endorectal magnetic resonance imaging (MRI).

Methods: From July 2002 to December 2005, 129 patients were referred for endorectal MRI for all indications.

Implementation of a first presentation psychosis clinical pathway in an area mental health service: the trials of a continuing quality improvement process.

Objectives: The aim of this study was to describe the process of improving early psychosis services in a generic Victorian adult area mental health service from 1998 to 2004 and to give consideration to whether to implement a first presentation psychosis clinical pathway and how that should be done.

Method: A description will be given of the quality improvement process and practical difficulties in the sequential implementation of guidelines then pathways for early psychosis.

Results: We experienced many of the commonly reported difficulties in quality improvement and implementation of evidence-based practice in real clinical settings.

Vascular pulsatility in patients with a pulsatile- or continuous-flow ventricular assist device.

Objective: We sought to investigate differences in indices of pulsatility between patients with normal ventricular function and patients with heart failure studied at the time of implantation with continuous-flow or pulsatile-flow left ventricular assist devices.

Methods: Eight patients with normal ventricular function and 22 patients with heart failure were studied. A high-fidelity aortic and left ventricular pressure catheter was inserted retrograde through the aortic valve into the left ventricle, and transit-time flow probes were placed on the aorta and device outflow graft.

Renal tract calculi: comparison of stone size on plain radiography and noncontrast spiral CT scan.

Background And Purpose: Noncontrast spiral CT (NCCT) has emerged as the investigation of choice in patients presenting with renal-tract calculi. As management guidelines are based on stone size measured on plain radiography of the kidneys, ureters, and bladder (KUB), it is important to assess the accuracy of stone size measured on NCCT compared with KUB films.

Patients And Methods: The NCCT and KUB studies obtained from 24 patients (27 stones) presenting to the emergency department at a major metropolitan hospital were analyzed randomly and independently by two urologists and one uroradiologist.

Hemodynamic effects of partial ventricular support in chronic heart failure: results of simulation validated with in vivo data.

Objective: Current left ventricular assist devices are designed to provide full hemodynamic support for patients with end-stage failing hearts, but their use has been limited by operative risks, low reliability, and device-related morbidity. Such concerns have resulted in minimum use of left ventricular assist devices for destination therapy. We hypothesize that partial circulatory support, which could be achieved with small pumps implanted with less-invasive procedures, might expand the role of circulatory support devices for treatment of heart failure.

Traumatic intramyocardial left ventricular dissection: a case report.

In this report, we present an unusual case of a patient who sustained and survived an intramyocardial dissecting hematoma with subacute ventricular rupture complicating a motor vehicle accident. In conclusion, we report on the diagnosis, management, and prior literature of this highly unusual and often lethal condition.

Metformin is an AMP kinase-dependent growth inhibitor for breast cancer cells.

Recent population studies provide clues that the use of metformin may be associated with reduced incidence and improved prognosis of certain cancers. This drug is widely used in the treatment of type 2 diabetes, where it is often referred to as an "insulin sensitizer" because it not only lowers blood glucose but also reduces the hyperinsulinemia associated with insulin resistance. As insulin and insulin-like growth factors stimulate proliferation of many normal and transformed cell types, agents that facilitate signaling through these receptors would be expected to enhance proliferation.

Improved technique to diagnose a patent foramen ovale during left ventricular assist device insertion.

Diagnosis of a patent foramen ovale prior to left ventricular assist device placement can be quite difficult, and if missed may result in a significant hypoxemia due to a right to left shunt. We describe a simple and precise way to increase the diagnostic accuracy of patent foramen ovale detection prior to initiating cardiopulmonary bypass for left ventricular assist device placement.

Iliocaval arteriovenous fistula presenting with multiple organ failure.

Iliac arteriovenous fistulas are an uncommon condition, which may be spontaneous or traumatic in nature. Such fistulas classically present with a triad of high-output cardiac failure, pulsatile abdominal mass with a bruit and unilateral leg ischaemia or venous congestion. We describe a case of an iliocaval fistula secondary to rupture of a common iliac artery aneurysm, with an unusual presentation of multiple organ failure, masquerading as sepsis.

Development and early testing of a simple subcutaneous counterpulsation device.

The intra-aortic balloon pump has been widely and successfully used as a treatment for cardiac dysfunction, but it only has short-term applications. To overcome this limitation, a superficial counterpulsation device (CPD) is being developed to provide extended counterpulsation support to promote myocardial recovery. The CPD is a valveless, monoport, pneumatically driven, 40-ml sac that is intended to be implanted in a pacemaker-type pocket in the subclavian fossa.

Simple mechanical aortic valve closure in ventricular assist device recipients.

Patients with mechanical aortic valves that develop refractory heart failure may require left ventricular assist devices. These patients have an increased risk of postoperative thromboembolic events due to intermittent valve opening. Previously described techniques to address this problem can result in a significantly increased ischemic time.

Unusual presentation of perirenal lung metastases.

Lung cancer is not commonly known to metastasize to the perirenal space, with only five such cases previously published. We present an unusual case of perirenal lung metastases manifesting as diffuse perinephric stranding which to our knowledge has not been described before.

Endovascular treatment of arterial mesenteric ischaemia: a retrospective review.

Mesenteric ischaemia is a condition that has traditionally been managed surgically. It poses a challenging diagnostic and therapeutic problem, particularly in the acute setting. We review a small series of eight patients managed with endovascular techniques for either acute or chronic mesenteric ischaemia at The Royal Melbourne Hospital, from 1997 to 2002.

Left ventricular volume reduction surgery: The 4th International Registry Report 2004.

Background And Methods: An international registry of left ventricular volume reduction (LVVR) procedures, including partial left ventriculectomy, has been expanded, updated, and refined to include 568 cases voluntarily reported from 52 hospitals in 12 countries.

Results: Gender, age, ventricular dimension, ethnology, myocardial mass, presence or absence of mitral regurgitation, as well as transplant indication, had little effect on event-free survival, which was defined as either absence of death or ventricular failure requiring mechanical assist or transplantation. Poor preoperative patient condition such as New York Heart Association classification IV, depressed contractility and decompensation requiring an emergency procedure were associated with reduced event-free survival.

A prospective evaluation of treatment with Selective Internal Radiation Therapy (SIR-spheres) in patients with unresectable liver metastases from colorectal cancer previously treated with 5-FU based chemotherapy.

Background: To prospectively evaluate the efficacy and safety of Selective Internal Radiation (SIR) spheres in patients with inoperable liver metastases from colorectal cancer who have failed 5FU based chemotherapy.

Methods: Patients were prospectively enrolled at three Australian centres. All patients had previously received 5-FU based chemotherapy for metastatic colorectal cancer.

Are registered dietitians adequately prepared to be hospital foodservice directors?

Objective: To determine perceived importance of selected competencies for the role of hospital foodservice director and explore whether registered dietitians (RDs) are perceived competent in these areas.

Design: Data were collected through a mailed questionnaire.

Subjects: A random sample of 500 hospital foodservice directors and 500 hospital executives to whom the directors report.

Transcatheter closure of patent foramen ovale after left ventricular assist device implantation: intraoperative decision making.

The presence of a patent foramen ovale in patients with heart failure can be missed during echocardiography despite the use of provocative maneuvers. Implantation of a left ventricular assist device in these patients can result in right-to-left shunting and hypoxemia. We report the use of a percutaneous atrial septal defect closure device as an alternative to surgical closure.

Gene-expression changes induced by Feline immunodeficiency virus infection differ in epithelial cells and lymphocytes.

Infection of cats with Feline immunodeficiency virus (FIV) is an important model for understanding comparative lentivirus biology. In vivo, FIV infects lymphocytes and monocyte/macrophages, but in vitro infection is commonly investigated in epithelial Crandell-Reese Feline Kidney (CRFK) cells. In this study, the transcriptional responses of CRFK cells and primary lymphocytes to infection with FIV 34TF, a cloned subtype A virus, and FIV USgaB01, a biological subtype B isolate, were determined.

Matrix metalloproteinase-activated doxorubicin prodrugs inhibit HT1080 xenograft growth better than doxorubicin with less toxicity.

Matrix metalloproteinase (MMP)-activated prodrugs were formed by coupling MMP-cleavable peptides to doxorubicin. The resulting conjugates were excellent in vitro substrates for MMP-2, -9, and -14. HT1080, a fibrosarcoma cell line, was used as a model system to test these prodrugs because these cells, like tumor stromal fibroblasts, expressed several MMPs.

Prospective study of treatment with selective internal radiation therapy spheres in patients with unresectable primary or secondary hepatic malignancies.

Aim: To prospectively evaluate the efficacy and safety of Selective Internal Radiation (SIR) Spheres (Sirtex Medical, Sydney, NSW, Australia) in patients with unresectable primary or secondary hepatic malignancies.

Methods: We report our experience of SIR sphere therapy at three Australian centres. Patients with previously untreated colorectal cancer (CRC) received concurrent 5FU, other patients with CRC received 5-FU at investigator discretion and all other patients received SIR spheres alone.

Octreotide induced prolongation of colonic transit increases faecal anaerobic bacteria, bile acid metabolising enzymes, and serum deoxycholic acid in patients with acromegaly.

Background: Acromegalic patients have slow colonic transit, increased rates of deoxycholic acid formation, and an increased prevalence of cholesterol gall stones, especially during long term octreotide treatment. However, the effects of this prolonged large bowel transit time on the numbers of faecal anaerobes and the activities of the enzyme systems which biotransform conjugated cholic acid into unconjugated deoxycholic acid (cholylglycine hydrolase and 7alpha-dehydroxylase) are unknown.

Methods: Therefore, in 10 non-acromegalic controls, 11 acromegalic patients not treated with octreotide, and 11 acromegalics on long term (8-48 months) octreotide (100-200 mug three times daily subcutaneously), we measured large bowel transit time and, in freshly voided faeces, the activities of the two bile acid metabolising enzymes, and related the results to the proportion of deoxycholic acid in fasting serum.

Acute presentations of renal artery stenosis in three patients with a solitary functioning kidney.

Renal artery stenosis can present uncommonly in the acute state as flash pulmonary oedema and hypertensive encephalopathy. We present three such cases in patients with a solitary functioning kidney, with successful management via renal artery angioplasty and stent insertion.