Design and Prototyping of a Novel Triple Lumen Photo-Angioplasty Device: Lumi-Solve-T.

Purpose: A triple lumen iteration of the novel photo-angioplasty drug eluting balloon catheter (DEBc) Lumi-Solve may be compromised by guidewire shadow (GWS)-mediated attenuation of balloon surface drug activation. The current study aimed to design and evaluate a novel triple lumen prototype, designated Lumi-Solve-T, to circumvent these issues.

Methods: Effects of guidewire shadowing (GWS) on vascular smooth muscle cell (VSMC) proliferation was evaluated using the MTT assay.

Tracheal Stent Buckling and In-stent Stenosis: A Proposed Airway Management Algorithm for Airway Obstruction for Patients With Tracheal Stents.

EMERGENCY AIRWAY management strategies for patients with complications due to tracheobronchial stents are of growing interest to anesthesiologists. Although tracheal stenting increasingly is used to manage tracheobronchial stenosis of both benign and malignant conditions, official guidelines for the perioperative airway management of patients with tracheobronchial stents in situ are lacking. Here, the authors discuss the management of airway obstruction from a tracheal stent strut protrusion and in-stent stenosis in a patient with a self-expanding nitinol tracheal stent in situ.

A spontaneous retroperitoneal haemorrhage resulting in abdominal compartment syndrome requiring laparotomy: A case report and proposed management algorithm.

Introduction And Importance: Spontaneous Retroperitoneal Haemorrhage (SRH) is a rare condition, which in its extreme state can result in Abdominal Compartment Syndrome (ACS). The aim of this case report is to provide an overview of the diagnosis and management of SRH and to present an algorithm to inform and guide clinical decision-making in the context of ACS.

Case Presentation: A 74-year-old woman with multiple risk factors for SRH developed a tense abdomen in ICU post-cardiac graft study.

Prognostic role of alpha-fetoprotein in patients with hepatocellular carcinoma treated with repeat transarterial chemoembolisation.

Background: Repeat transarterial chemoembolisation (rTACE) is often required for hepatocellular carcinoma (HCC) to achieve disease control, however, current practice guidelines regarding treatment allocation vary significantly. This study aims to identify key factors associated with patient survival following rTACE to facilitate treatment allocation and prognostic discussion.

Method: Patients with HCC undergoing rTACE at six Australian tertiary centers from 2009 to 2014 were included.

Popliteal pseudoaneurysm after FOLFOX chemotherapy for metastatic colorectal cancer.

Introduction: Popliteal artery aneurysms are a rare occurrence in the general population. We present the case of a male who developed a popliteal artery pseudoaneurysm following chemotherapy for metastatic colorectal cancer.

Case Presentation: A 49-year old male presented with a popliteal artery pseudoaneurysm after completing four two-weekly cycles of FOLFOX chemotherapy.

Low accuracy and confidence in chest radiograph interpretation amongst junior doctors and medical students.

Accurate chest X-ray (CXR) interpretation is an essential skill in clinical practice. Previous studies have shown poor accuracy and confidence rates (CR) of CXR interpretation by junior doctors and medical students. We presented 10 chest radiographs via an online questionnaire to Australian medical students and junior doctors, who were asked to identify the radiographic abnormality from a list of 15 options and to rate their confidence for each answer.

Case report: Iatrogenic brachial artery dissection with complete anterograde occlusion during elective arterial line placement.

Introduction: Brachial arterial catheters provide a more accurate reflection of central aortic arterial pressure compared to their radial counterparts. Although brachial arterial line complications are uncommon, we report a case of a rare iatrogenic brachial artery dissection with complete anterograde occlusion from elective arterial line placement.

Presentation Of Case: A 41-year-old female presented for a right upper and middle lobe resection of a large neuroendocrine lung cancer.

Transjugular biopsy case report of inferior vena cava hepatocellular carcinoma with intracardiac extension.

Background: Diagnosis of hepatocellular carcinoma (HCC) can be established with near certainty by correlating radiological imaging with clinical presentation. However, in the absence of diagnostic certainty, biopsy of liver tissue is mandatory for optimal management. We present our management of a patient with advanced liver disease who presented with an IVC mass extending into the right atrium, with co-existing liver lesions not meeting criteria for an imaging diagnosis of HCC.

Preoperative left hepatic lobe devascularisation to minimize perioperative bleeding in a Jehovah's Witness undergoing left hepatectomy.

Introduction: Major liver resection in a Jehovah's Witness presents unique clinical challenges requiring multimodal blood minimization strategies to reduce perioperative complications. We report a case where complete left hepatic lobe devascularisation was undertaken to minimize bleeding in a Jehovah's Witness undergoing left hepatectomy.

Presentation Of Case: A 65-year-old male Jehovah's Witness presented for open left hepatectomy for a large left-sided hepatocellular carcinoma involving segment IV of the liver.

Postoperative wristwatch-induced compressive neuropathy of the hand: a case report.

Introduction: Postoperative peripheral nerve injuries are well-recognised complications of both surgery and anaesthesia and a leading cause of litigation claims. We present a rare cause of compressive sensory and motor neuropraxia of the median, ulnar and radial nerves of the right hand resulting from a wristwatch that was worn on the first postoperative night following minor surgery. Mechanisms of this compressive neuropathy are discussed, with specific recommendations made regarding the wearing of wristwatches, jewellery and constrictive clothing in the immediate postoperative period.

Missed carotid artery cannulation: a line crossed and lessons learnt.

We report a case of an infusion of intra-aortic propofol after the missed inadvertent placement of a central venous catheter into the right common carotid artery. Radiological imaging revealed bilateral ischaemic infarcts in the posterior fossa and right cerebral artery territories consistent with an embolic source. The potential causes of the neurological injuries sustained in this case are explored.

Validation of a clinical decision rule: chest X-ray in patients with chest pain and possible acute coronary syndrome.

Current literature suggests that a large proportion of chest X-rays (CXRs) performed in emergency department (ED) patients with chest pain and suspected acute coronary syndrome (ACS) are unnecessary. The Canadian ACS Guidelines aim to guide clinicians in the appropriate use of CXR within this patient population. This study determined the prevalence of clinically significant CXR abnormalities and assessed the utility of the guidelines in a population of ED patients with chest pain and suspected ACS.

Incidental maxillary sinus findings in patients referred for head and neck CT angiography.

Background: Maxillary sinus pathology is a common finding on routine CT scans of the head and neck. The purpose of this study was to assess the incidental findings in the maxillary sinus on CT scans in patients who presented for head and neck CT angiography.

Study Design: Images of patients referred for head and neck CT angiography were reviewed over a 5-month period.

Large vessel calcification in Takayasu arteritis.

We report the novel case of a young woman with Takayasu arteritis, with extensive large vessel disease. The case demonstrates that while mechanisms of vascular calcification are poorly understood, inflammation per se might be sufficient to mediate increased mineral stress leading to vessel calcification, even in the absence of renal impairment.

Gallbladder perforation following transarterial chemoembolisation; a rare but serious complication.

Transarterial chemoembolisation (TACE) is the mainstay of treatment for large or multifocal hepatocellular carcinoma (HCC). However, this procedure is not without potential complications. We report the case of a 72-year-old man with cirrhosis with HCC treated by TACE using drug-eluting beads.

Implementation of a clinical prediction tool for pulmonary embolism diagnosis in a tertiary teaching hospital reduces the number of computed tomography pulmonary angiograms performed.

Aim: To evaluate the effect of implementing the Wells score clinical prediction tool (CPT) on rationalising the use of computed tomography pulmonary angiography (CTPA) for diagnosing pulmonary embolism (PE).

Methods: Within a tertiary teaching hospital, a retrospective study was conducted applying Wells score to all CTPA ordered in the first quarter of 2007. Subsequently, an algorithm including Wells score and d-dimer assay was developed to assist clinicians in rationalising their ordering of CTPA.