Early Australian Experience Research Articles

Early Australian Experience of Robotic Anatomic Pulmonary Resection

Early Australian Experience of Robotic Anatomic Pulmonary Resection

Early Australian experience with intravascular lithotripsy treatment of severe calcific coronary stenosis: IVL in acute/chronic coronary syndromes.

Calcified coronary stenoses are a serious impediment to optimal stent expansion and can lead to stent failure and catastrophic adverse outcomes. We hereby present early Australian experience with intravascular lithotripsy for the treatment of calcific lesions in acute and chronic coronary syndromes. This was a single-centre retrospective study of all patients treated with intravascular lithotripsy (IVL) between October 2019 and June 2021. Patient demographics, procedural variables, and treatment safety/efficacy outcomes were evaluated. During this period, there were 40 patients and 41 coronary lesions with IVL-assisted percutaneous coronary intervention (PCI) (70% male; mean age 72.8±9.5 years). Indications for PCI were acute coronary syndromes in 25 patients (62.5%), and stable angina in 15 patients (37.5%). Upfront IVL usage occurred in 5% of cases with the rest being bailout procedures due to suboptimal initial balloon predilatation or stent underexpansion. Angiographic success (<20% residual stenosis) occurred in 37 cases (92.5%), with mean residual stenosis of 8.25%±8.5%. Two patients experienced procedural complications (5%). IVL appears to be a safe and effective modality in modifying coronary calcium to achieve optimal stent expansion in real-world practice. This device obviates the need for more complex lesion preparation strategies such as rotational or orbital atherectomy.

BASILICA During Valve-in-Valve Transcatheter Aortic Valve Implantation (VIV TAVI): An Early Australian Experience

BASILICA During Valve-in-Valve Transcatheter Aortic Valve Implantation (VIV TAVI): An Early Australian Experience

074 Early australian experience with erenumab for chronic migraine

IntroductionErenumab is available in Australia since October 2018. We review the effectiveness and safety in 2 Australian headache centres.MethodsErenumab (70 mg or 140 mg) was prescribed. We monitored headache days, migraine days, analgesic use, adverse reactions, Headache Impact Test-6 (HIT6) score and Migraine Disability Assessment (MiDAS) score, at baseline and at 3 months. Primary outcomes were reduction in headache and migraine days, and adverse effects. Secondary outcomes were improvement in functional scores and analgesic use.Results65 patients (ages 18–73; mean 44 years) commencing Erenumab were assessed before and after 3 monthly treatments. The duration of chronic migraine (CM) ranged from 1 to 40 years, with 3 to 16 previous failed prophylactic treatments.There was a &gt;50% response in overall headache days and migraine days in 29% (19/65) and 46% (27/59), respectively. There was a modest (10–49%) response in overall headache days and migraine days in 29% (19/65) and 27% (18/59), respectively. There was no improvement in headache days and migraines in 42% (27/65) and 27% (14/59), respectively.At onset, the mean HIT-6 and MiDAS scores were 66 and 65, decreasing after 3 treatments to 59 and 32, respectively. The mean monthly days taking triptan and codeine medications reduced from 9 and 6 days, to 5 and 3 days, respectively.There were few reported side effects.ConclusionThis Australian cohort in tertiary referral refractory migraine patients achieved a significant rate of reduced headache and migraine days with good safety and tolerability.

Early Australian experience in the maintenance of schizophrenia management with 3-monthly paliperidone palmitate.

Objectives:Real-world experience from a 6-month product familiarization programme (PFP) for 3-monthly paliperidone palmitate in schizophrenia maintenance treatment.Methods:Prescribers completed an online questionnaire for each patient at enrolment with further questions at second dose (re-supply) stage and a second survey of their overall experience at the end.Results:Ninety-four patients were enrolled and received a first dose and 23 received a second dose within the 6-month programme; 51.1% had been hospitalised for symptom relapse in the previous 2 years. Reasons for prescribing were convenience of 3-monthly dosing for patients (94.7%) and patient choice (54.6%). Prescribers followed-up at least once-monthly (69.6% cases) and indicated in 48.9% they would consider shared GP care. All patients were satisfied with symptom control and either maintained functioning or showed improvement. Clinicians felt confident with administration and identifying suitable patients and were all ‘satisfied’ or ‘somewhat satisfied’ with efficacy and tolerability. All felt patients’ treatment goals were either ‘met’ (81.3%) or ‘partly met’ (18.7%) and none reported dissatisfaction with relapse prevention.Conclusions:Convenient 3-monthly dosing was preferred by clinicians and patients, and symptoms were adequately managed. This has the potential to improve adherence and lead to better outcomes as patients only need four intramuscular doses per year.

Early Australian experience in robotic sleeve gastrectomy: a single site series.

The use of robotic platforms in bariatric surgery has recently gained relevance. With an increased use of this technology come concerns regarding learning curve effects during the initial implementation phase. The sleeve gastrectomy though may represent an ideal training procedure for introducing the robot into bariatric surgical practice. The present review of the first 10 consecutive robotic sleeve gastrectomy procedures performed in an Australian bariatric programme by a single surgeon describes the evolution of the technique, learning curve and initial patient outcomes. Between 2014 and 2015, robotic sleeve gastrectomies were performed as primary and revisional procedures by a consistent surgeon-assistant team. Technique evolution and theatre set-up were documented. Patient demographics, operative time (robot docking and total operation time), additional operative procedures performed, operative and post-operative complications at 1, 3 and 6 months post-procedure and weight loss achieved at 6 months were retrospectively reviewed from a prospectively maintained database. Ten robotic sleeve gastrectomies were performed without significant operative complications. One patient was treated as an outpatient with oral antibiotics for a superficial wound infection. The median total operative time was 123 min (interquartile range (IQR) 108.8-142.5), with a median incision to docking time of 19 min (IQR 15.0-31.8). Length of stay in hospital was 2-3 days. Median excess weight loss achieved at 6 months was 50% (IQR 33.9-66.5). This study describes a method of safely introducing the da Vinci robot into bariatric surgical practice.

Early Australian Experience With AbsorbTM Bioresorbable Scaffold Technology in “Real-World” Coronary Disease

Introduction: Safety and efficacy of the Absorb™ Bioresorbable Scaffold (ABRS) has been documented in “low-risk” lesions. “Real-world” data is limited and in this context we report the early experience with ABRS from two Australian centres. Methods: Between August 2010 and February 2013, 71 lesions in 44 patients (mean age 63 yrs, 59% male) were treated with ABRS (Clinical Trial 45%, Authorised Prescriber 55%). Diabetes was present in 24% and PCI indication was ACS in 33% of patients. Outcomes were measured in-hospital, day 30, one and two years post-PCI. Procedural details: Lesion location – LAD 38%, RCA 51% and LCX 11%. Lesion complexity – 29% B2/C (AHA/ACC), moderate/severe calcification 14%, CTO 2.8% and long lesions 27%. In total, 68 scaffolds were implanted – average 1.5/pt (range 1–5). Average scaffold length/pt was 34 mm with planned overlap in 27% pts. Multi-vessel ABRS implantation was performed in 6.8% patients. Post-dilatation was performed in all cases. Results: Procedural success was 100%. Device success was 99% – a scaffold could not be advanced in one patient (DES were successfully deployed). A “bailout” DES was needed in one case for a distal edge dissection. To date, 95% of patients have reached 30 days, 30% 12 months and 2% 24 months. There has been no myocardial infarction, cardiac death, scaffold thrombosis or target vessel revascularisation. There was one non-cardiac death at 21 months. Conclusions: This early local experience has demonstrated ABRS therapy to be highly safe and efficacious in complex and real-world disease (including long lesions, multi-vessel disease and CTOs).

Accelerated partial breast irradiation using interstitial high dose rate 192iridium brachytherapy: Early Australian experience and review of the literature

Summary Accelerated partial breast irradiation (APBI) is an evolving new technique of adjuvant irradiation in selected women with early-stage breast cancer. We developed a pilot programme of APBI in 2000 and report end results in seven patients followed for a mean of 42.7 months (range 29-55 months). Good to excellent cosmesis and no loco-regional relapse or systemic metastases have occurred. The literature related to APBI is reviewed.

Riluzole therapy for motor neurone disease: An early Australian experience (1996–2002)

Riluzole is the only therapy proven in clinical trials to prolong survival in patients with motor neurone disease (MND). Prior to its listing by the Australian Pharmaceutical Benefits Advisory Scheme in June 2003, the aim of the present study was to provide Australian patients with MND early access to riluzole and to expand the safety profile data of this therapy. Patients with MND were referred to the programme by neurologists covering the Sydney metropolitan region. To be eligible to receive riluzole, patients had to be aged between 18 and 75 years and have probable or definite MND based on El Escorial criteria, with a disease duration of less than 5 years and a vital capacity greater than 60% before study entry. Patients were prescribed riluzole 50 mg twice daily. Safety data were collected through documentation of adverse events by clinical history in combination with regular laboratory screening. Full blood count, haematocrit, differential white cell counts and serum liver transaminase levels were obtained monthly for 3 months, and then at each 3-monthly visit for 1 year. In total, 25 patients with MND (17 male, 8 female; age range 40–74 years; mean age 59 years) were commenced on riluzole. Of these, 28% had definite MND and the remaining 72% were diagnosed as probable MND, with the majority (84%) having limb-onset MND. At 12 months, 68% of patients continued on riluzole, 16% had died from their disease and 16% ceased riluzole because of side-effects or other reasons, largely disenchantment owing to a perceived lack of efficacy. Haematological and biochemical assays showed no significant alteration during the initial 12-month period. Long-term survival data for patients in the present series suggest a greater benefit for patients who commenced riluzole early in the course of their illness. In conclusion, riluzole was generally tolerated well by Australian patients with MND. Of the few patients who experienced side-effects attributed to riluzole, all were reversible. Issues related to patient perceptions of efficacy highlight the need for patients and treating physicians to maintain realistic expectations of riluzole therapy.

Spinal Anaesthesia—Early Australian Experience

Australia in 1902 was a fledgling colony in its second year of Federation with a population of around 3.7 million. European settlement had been largely confined to the coastal margins of this enormous land mass, although some bold adventurers in search of gold and farmland had struggled their way into the interior Horsham, situated 300 km northwest of Melbourne in the state of Victoria, was founded in June 1849. By 1902 the town, with a population of around 2500, had grown to boast a hospital, two doctors, a pharmacist and a dentist. It was at the Horsham Hospital on January 7, 1902 that Dr Robert Ritchie performed Australia's first recorded spinal anaesthetic. Ritchie performed a lumbar puncture at the L3-4 level, injected 2 ml of 2% cocaine solution and waited for a total of 20 minutes before realising that the sensation the patient was feeling when he pinched him was pressure, not pain. The 78-year-old man with a gangrenous right leg, prostatic obstruction and congestive cardiac failure was laid supine, and had his right leg amputated through the thigh while being administered brandy and water Strychnine injections were administered four hourly postoperatively. The adoption of the technique of spinal anaesthesia spread quickly in Australia despite communication difficulties at that time.

Spinal anaesthesia—early Australian experience

Australia, 1902, a fledgling colony in its second year of Federation with a population of around 3.7 million. European settlement had been largely confined to the coastal margins of this enormous landmass although some bold adventurers in search of gold and farmland had struggled their way into the interior. Horsham, situated 300-km northwest of Melbourne in the state of Victoria, was founded by a Scottish storekeeper in June 1849. By 1902 the town, with a population of around 2500, had grown to boast a hospital, two doctors, a pharmacist and a dentist. It was at the Horsham hospital on a hot summer morning, Tuesday 7 January 1902 that 31-year-old Dr. Robert Ritchie performed Australia's first recorded spinal anaesthetic. Ritchie had never before seen a spinal anaesthetic performed, let alone done one. “As regards the technique of the operation, I learned most from an article in the Lancet…” Ritchie performed a lumbar puncture at the L3–4 level, injected 2 ml of 2% cocaine solution…and waited…and waited…for a total of 20 min: then realized that the sensation the patient was feeling when he pinched him was pressure, not pain. The 78-year-old man with a gangrenous right leg, prostatic obstruction and congestive cardiac failure was laid supine, and had his right leg amputated through the thigh while being administered brandy and water. Strychnine injections were administered four hourly postoperatively. After an agitated first night, “he rapidly regained his former strength, and gave no further cause for anxiety.” Sadly, Robert Ritchie's life was brief, but the adoption of the technique of spinal anaesthesia spread quickly in Australia despite the communication difficulties.

Early Australian experience with infliximab, a chimeric antibody against tumour necrosis factor-alpha, in the treatment of Crohn's disease: is its efficacy augmented by steroid-sparing immunosuppressive therapy? The Infliximab User Group.

Tumour necrosis factor-alpha (TNF-alpha) plays an important role in the pathology of Crohn's disease. Infliximab, a chimeric antibody against TNF-alpha, has been shown in controlled clinical trials to be effective in two-thirds of patients with refractory or fistulating Crohn's disease. The factors that determine a clinical response in some patients but not others are unknown. To document the early Australian experience with infliximab treatment for Crohn's disease and to identify factors that may determine a beneficial clinical response. Gastroenterologists known to have used infliximab for Crohn's disease according to a compassionate use protocol were asked to complete a spreadsheet that included demographic information, Crohn's disease site, severity, other medical or surgical treatments and a global clinical assessment of Crohn's disease outcome, judged by participating physicians as complete and sustained (remission for the duration of the study), complete but unsustained (remission at 4 weeks but not for the whole study) or partial clinical improvement (sustained or unsustained). Fifty-seven patients were able to be evaluated, with a median follow-up time of 16.4 (4-70) weeks, including 23 patients with fistulae. There were 21 adverse events, including four serious events. Fifty-one patients (89%) had a positive clinical response for a median duration (range) of 11 (2-70) weeks. Thirty patients (52%) had a remission at 4 weeks, 10 of whom had remission for longer than 12 weeks. Forty-two per cent of fistulae closed. Sustained remission (P = 0.065), remission at 4 weeks (P = 0.033) and a positive clinical response of any sort (P = 0.004) were more likely in patients on immunosuppressive therapy, despite there being more smokers in this group. This review of the first Australian experience with infliximab corroborates the reported speed and efficacy of this treatment for Crohn's disease. The excellent response appears enhanced by the concomitant use of conventional steroid-sparing immunosuppressive therapy.

Paediatric aphakic epikeratoplasty: early Australian experience.

Epikeratoplasty has been performed on eight eyes of seven patients by one surgeon in Melbourne since March 1988. All cases were contact lens or spectacle intolerant. Standard surgical techniques utilising donor lenticules imported from the United States and including an annular keratectomy were employed for the procedure. An eight-month follow-up is available for the first two cases, aged two and 10 years. The elder of these children has achieved corrected acuity of 6/9 in each eye. Refractive and early visual acuity results are presented for the five other cases which have at least two months of follow-up. The results indicate that in appropriately selected patients, epikeratoplasty offers a safe, effective modality for visual restoration and development in otherwise untreatable aphakic children.