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1.
Neuroepidemiology ; 51(3-4): 123-127, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30092562

RESUMO

BACKGROUND: Failure to recognise acute stroke may result in worse outcomes due to missed opportunity for acute stroke therapies. Our study examines factors associated with stroke misdiagnosis in patients admitted to a large comprehensive stroke centre. METHODS: Retrospective review comparing 156 consecutive stroke patients misdiagnosed in emergency department (ED) with 156 randomly selected stroke controls matched for age, gender, language spoken and stroke subtype for the period 2014-2016. RESULTS: There were 141 ischemic and 15 hemorrhagic misdiagnosed strokes (median age: 77 years, male:female = 1.3: 1). Symptom resolution, altered mental status, nausea/vomiting, dizziness and vertigo favored misdiagnosis (p < 0.05). Hemiparesis and dysarthria favored an accurate diagnosis (p < 0.05). Misdiagnosed patients were more commonly triaged into a lower ED category (62 vs. 42%, p = 0.001), clinically assessed as Face, Arm, Speech and Time (FAST) - negative (78 vs. 22%, p < 0.001) and underwent delayed CT imaging (median 4.1 vs. 1.5 h, p < 0.001). Misdiagnosed patients were more likely to have posterior circulation stroke (PCS; 39 vs. 22%, p = 0.01) and be admitted under non-neurological services (35 vs. 11%, p < 0.001) with worse discharge outcomes including increased mortality. CONCLUSIONS: Patients with stroke misdiagnosis were commonly FAST-negative with nonspecific symptoms including altered mental status, dizziness and nausea/vomiting often associated with PCS. Improved diagnostic accuracy may increase access to acute therapies.


Assuntos
Isquemia Encefálica/diagnóstico , Ataque Isquêmico Transitório/diagnóstico , Acidente Vascular Cerebral/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Erros de Diagnóstico , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco
2.
JOP ; 12(4): 372-6, 2011 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-21737899

RESUMO

CONTEXT: Post-ERCP pancreatitis is the most common complication of endoscopic retrograde cholangiopancreatography (ERCP). A simple method of predicting patients who are at risk of developing post-ERCP pancreatitis is needed to allow those at low risk to be discharged on the same day of their procedure. The aim of this study was to confirm that 4-hour post-ERCP serum amylase level is predictive of post-ERCP pancreatitis. PATIENTS: A study of 886 ERCPs performed at a single centre was conducted. MAIN OUTCOME MEASURE: Four-hour amylase level was recorded, along with patient demographics, procedural details, presence of pancreatogram, and morbidity and mortality. RESULTS: Pancreatitis occurred in 4.4% of ERCPs. Hyperamylasaemia was found to be predictive of post-ERCP pancreatitis, with other risk factors being a younger age and pancreatogram. Hyperamylasaemia was also predictive of post-ERCP pancreatitis in the subgroup of patients who had undergone pancreatogram. CONCLUSIONS: The 4-hour amylase level is a useful measure in the prediction of post-ERCP pancreatitis. Patients who have undergone pancreatogram should be admitted if 4-hour amylase level is greater than 2.5 times the upper limit of reference. Patients who have not undergone pancreatogram should be admitted if 4-hour amylase level is greater than 5 times the upper limit of reference.


Assuntos
Amilases/sangue , Colangiopancreatografia Retrógrada Endoscópica , Pancreatite/sangue , Pancreatite/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pancreatite/etiologia , Período Pós-Operatório , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
3.
J Hand Surg Am ; 36(10): 1585-91, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21855233

RESUMO

PURPOSE: Revascularized or replanted digits may fail because of vessel thrombosis. Off-label use of botulinum toxin type A injected subcutaneously has been used successfully in limited case series to treat vasospastic disorders. Botulinum toxin type B (BTX-B) is thought to have an earlier onset of action than type A in certain settings. We used a rat model to determine the ability of BTX-B to decrease vasospasm and prevent thrombosis after acute vessel division and anastomotic repair. METHODS: We transected and immediately repaired the bilateral femoral arteries and veins of 25 rats via microscopic technique. We measured each vessel's diameter before transection. Each rat had 1 leg randomly assigned to receive BTX-B; the contralateral side received normal saline. We separated the animals into 5 groups. Each group underwent vasospastic stress at a different time point (12, 24, 48, 72, and 120 h) after the anastomoses and treatment with BTX-B or saline. Vasospastic stress included a lower extremity cold temperature challenge and systemic treatment with phenylephrine. After vasospastic stress, we reopened the wounds and recorded vessel thrombosis and diameter. RESULTS: Vessel thrombosis rate was lower in the BTX-B-treated group of vessels compared with those receiving placebo. Thrombosis rate was 8% for BTX-B-treated arteries versus 68% for saline-treated arteries. Thrombosis rate was 20% for BTX-B-treated veins versus 76% for saline-treated veins. Overall vessel thrombosis rate was significantly lower for BTX-B at all time points except at 120 hours when no thrombotic events occurred for either group. Average increase in diameter for BTX-B-treated vessels was significantly greater than that for the controls regardless of patency. CONCLUSIONS: BTX-B prevented or reduced the incidence of thrombosis after acute vessel anastomosis in this rat model at all time points less than 120 hours compared with placebo. The average final vessel diameter throughout the series of BTX-B-treated vessels was significantly larger than in the control group. CLINICAL RELEVANCE: The use of BTX-B may improve the success rate of microvascular anastomoses by being protective against vasospastic stress and subsequent thrombosis.


Assuntos
Toxinas Botulínicas/farmacologia , Trombose/prevenção & controle , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Anastomose Cirúrgica/efeitos adversos , Animais , Toxinas Botulínicas Tipo A , Temperatura Baixa , Artéria Femoral/cirurgia , Veia Femoral/cirurgia , Microtecnologia , Fenilefrina/farmacologia , Ratos , Ratos Sprague-Dawley , Estresse Fisiológico , Trombose/etiologia , Vasoconstrição/efeitos dos fármacos , Vasoconstritores/farmacologia
4.
Neuroepidemiology ; 35(1): 53-8, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20431303

RESUMO

BACKGROUND: It is important to establish the validity of diagnostic coding in administrative datasets used in stroke and transient ischemic attack (TIA) research. This study examines the accuracy of emergency department (ED) TIA diagnosis and final diagnostic coding after hospital admission. METHODS: Using administrative datasets, we identified all patients with an ED TIA diagnosis (435.9; ICD-9) admitted to Liverpool Hospital from January 2003 to December 2007. ED and hospital admission records were matched and final diagnosis codes (ICD-10-AM) recorded. All records were expertly reviewed to determine coding validity. RESULTS: 570 patients were admitted with an ED TIA diagnosis. According to ICD-10-AM coding, 46% had TIA, 29% stroke and 25% TIA mimic diagnoses. Expert review determined final diagnoses of TIA in 51.4%, stroke in 26.1% and TIA mimic in 22.5% of the patients. The positive predictive value of a final TIA diagnosis (ICD-10-AM) was 88.2% when subjected to expert review. TIA mimic disorders diagnosed after admission included serious conditions. CONCLUSIONS: Half of the emergency diagnoses retained a TIA diagnosis after hospital admission. In the setting of neurological admission there were small percentage differences between coded final diagnosis for TIA, stroke and mimic and diagnoses at expert review. Admission of ED TIA cases permitted identification of TIA mimics with serious conditions requiring non-TIA management.


Assuntos
Ataque Isquêmico Transitório/diagnóstico , Acidente Vascular Cerebral/diagnóstico , Bases de Dados Factuais , Diagnóstico Diferencial , Serviço Hospitalar de Emergência , Feminino , Humanos , Classificação Internacional de Doenças , Masculino , New South Wales
5.
Arthroscopy ; 26(9): 1189-94, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-20691561

RESUMO

PURPOSE: We compared the Bristow procedure with a conjoined tendon transfer to investigate the role of the sling alone in restoring anterior translation in a simple soft-tissue instability model without bony defects. METHODS: Ten matched cadaveric shoulder pairs were randomly assigned to receive a Bristow procedure or a conjoined tendon transfer alone. Specimens were tested in a simple soft-tissue model with low load simulating anterior translation of the glenohumeral joint. The conditions (intact, cut, and repaired) and treatments (Bristow and conjoined tendon transfer alone) were compared for anteroposterior translation. RESULTS: Anterior translation increased from 3.4 +/- 0.6 mm (mean +/- SEM) to 12.0 +/- 1.3 mm after the cut and decreased to 5.2 +/- 0.7 mm with the Bristow procedure. Anterior translation increased from 2.8 +/- 0.4 mm to 12.2 +/- 1.9 mm after the cut and decreased to 4.9 +/- 0.5 mm after conjoined tendon transfer alone. Although the repair increased the stability of the glenohumeral joint as reflected in significantly decreased anterior translation, anterior translation in the repaired joint was significantly greater than that in the intact condition for both procedures (P < .05). There were no significant differences in anterior translation between the 2 treatments at any test stage. CONCLUSIONS: There was no difference between the Bristow procedure and conjoined tendon transfer alone in restoring anteroposterior translation in a simple soft-tissue shoulder instability model with low load and no bony defect. CLINICAL RELEVANCE: Further investigation of the described conjoined tendon procedure should be done to evaluate the procedure with significant bony defects.


Assuntos
Instabilidade Articular/cirurgia , Articulação do Ombro/cirurgia , Tendões/transplante , Idoso , Idoso de 80 Anos ou mais , Cadáver , Complacência (Medida de Distensibilidade) , Feminino , Humanos , Ligamentos Articulares/cirurgia , Masculino , Pessoa de Meia-Idade , Distribuição Aleatória , Suporte de Carga
6.
Epilepsy Behav ; 16(3): 475-8, 2009 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-19775939

RESUMO

This study was designed (1) to compare the prevalence of emergency department (ED) presentations in Western Zone Sydney South West Area Health Service (WZS) between 1998-2002 and 2003-2007 for epilepsy (including status epilepticus (SE) and convulsions), hospital admission rates, and proportion of first seizure presentations; and (2) to compare these data with those for New South Wales (NSW) and Australia-wide figures. Using health department data sets, we found 19,834 presentations to WZS EDs between 1998 and 2007 (24.85/10,000 population/year). When the periods 2003-2007 and 1998-2002 in WZS are compared, ED presentations fell by 3% (P=0.03) and hospital admissions fell by 6% (P=0.001). The prevalence of ED presentations for seizures in NSW did not change (P=0.92), but hospital admissions fell by 3% (P<0.0001). When 1999/2000-2002/2003 was compared with 2003/2004-2006/2007, the prevalence of hospital admissions in Australia fell by 1% (P=0.0002). Rates of presentation for epilepsy in WZS have fallen over the last decade. Most presentations were first seizures rather than recurrences. The reason for this is speculative, but may reflect improved levels of education and health care delivery.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Convulsões/epidemiologia , Adolescente , Adulto , Austrália/epidemiologia , Criança , Pré-Escolar , Feminino , Sistemas de Informação Hospitalar/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Convulsões/classificação , Fatores de Tempo , Adulto Jovem
7.
ANZ J Surg ; 88(1-2): 82-86, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27457275

RESUMO

BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) is a complex therapeutic procedure that is complicated by pancreatitis in 3-5% of cases. The aim of this study is to determine whether a 4-h post-ERCP serum lipase level is superior to the serum amylase level in predicting the occurrence of post-ERCP pancreatitis (PEP). METHODS: We performed a retrospective review of prospectively collected data on 543 consecutive patients undergoing therapeutic ERCP at a single centre. Serum lipase and amylase levels were measured at 4-h post-procedure and were recorded as a factor of the upper limit of normal: amylase factor (AF) and lipase factor (LF). Sensitivity and specificity were compared using receiver-operating characteristics and the Youden index (YI). RESULTS: A total of 506 procedures were considered for analysis. PEP occurred in 19 patients (3.8%). A LF of <10 was useful for the exclusion of PEP with a sensitivity of 100% and a specificity of 94%, YI = 0.94. In contrast, an AF <3 yielded a sensitivity of 79% and specificity of 94%, YI = 0.73. CONCLUSION: Serum lipase measured at 4-h post-ERCP better excludes PEP than serum amylase measured at the same time point. Patients with a LF <10 may be safely considered for same-day discharge.


Assuntos
Amilases/sangue , Doenças Biliares/cirurgia , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Lipase/sangue , Pancreatite/etiologia , Complicações Pós-Operatórias/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Biliares/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pancreatite/sangue , Pancreatite/diagnóstico , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/diagnóstico , Estudos Retrospectivos , Sensibilidade e Especificidade , Fatores de Tempo , Adulto Jovem
8.
ANZ J Surg ; 77(11): 1013-7, 2007 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-17931269

RESUMO

BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) is an important procedure for the investigation and management of pancreaticobiliary disease. There is a recognized potential for significant morbidity, and a number of studies have identified patient and operator risk factors for the development of complications, including small case volume. We look at the outcomes of ERCP from a single operator at a rural centre and compare these with published figures. METHOD: Findings from 700 consecutive ERCP were collected prospectively between August 1997 and May 2006. Patients were included on an intention to treat basis, and all predetermined morbidity criteria were recorded. RESULTS: Five hundred and forty-four therapeutic and 156 diagnostic ERCP were included in the study. There were a total of 40 complications (5.71%), with three cases of ERCP-specific mortality (0.4%). The success of therapeutic intervention was 94.3%. CONCLUSIONS: The importance of comparing personal audit to published prospective studies has been emphasized. This has provided quality assurance finding, confirming that comparable success rates, morbidity and mortality are possible in a low-volume rural centre with an operator who has been properly trained and has ongoing ties with a tertiary hepatobiliary unit, a dedicated and skilled local team and suitable patient selection.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Colangiopancreatografia Retrógrada Endoscópica/mortalidade , Colangiopancreatografia Retrógrada Endoscópica/normas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Serviços de Saúde Rural/organização & administração , População Rural , Resultado do Tratamento , Vitória
9.
Case Rep Med ; 2013: 808751, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23956753

RESUMO

Torsion of the gallbladder is an uncommon condition that may present as an acute abdomen. Its preoperative diagnosis can often be challenging due to its variable presentation, with specific sonographic signs seen infrequently. We describe, to our knowledge, the first case of torsion of a wandering gallbladder following a colonoscopy in a 69-year-old female who presented with acute abdominal pain after procedure. This was discovered intraoperatively, and after a subsequent cholecystectomy, she had an uncomplicated recovery.

11.
Med J Aust ; 189(1): 9-12, 2008 Jul 07.
Artigo em Inglês | MEDLINE | ID: mdl-18601633

RESUMO

OBJECTIVE: To compare outcomes at 28 days and 1 year between patients admitted to hospital and those discharged after presenting to the emergency department (ED) with transient ischaemic attack (TIA). DESIGN AND SETTING: All TIA presentations to EDs in a large metropolitan and rural region of Sydney and its surroundings, New South Wales, between 2001 and 2005 were extracted from state health department databases and followed up over 1 year. Admission and discharge data and subsequent TIA or stroke presentations were identified. MAIN OUTCOME MEASURES: TIA recurrence or stroke. RESULTS: Of 2535 presentations to an ED with TIA during the 5-year period, 1816 patients were admitted to hospital (71.6%) and 719 were discharged from the ED (28.4%). At 28 days, the discharged group had significantly higher rates of recurrence than the admitted group for all events (TIA or stroke) (5.3% v 2.3%, P < 0.001), stroke (2.1% v 0.7%, P = 0.002), and recurrent TIA (3.2% v 1.6%, P = 0.01). During the 29-365-day follow-up period, there was no significant difference between the discharged and admitted groups for all events (4.2% v 5.1%; P = 0.37), stroke (1.3% v 2.5%; P = 0.06) or recurrent TIA (2.9% v 2.6%; P = 0.65). CONCLUSION: Patients with an ED diagnosis of TIA may benefit from admission to hospital through a reduced risk of early stroke.


Assuntos
Serviço Hospitalar de Emergência , Ataque Isquêmico Transitório/complicações , Acidente Vascular Cerebral/etiologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Fatores de Risco
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