Monash Medical Centre Research Articles

Failure of eculizumab to correct paroxysmal cold hemoglobinuria

Dear Editor, Paroxysmal cold hemoglobinuria (PCH) is a rare cause of intravascular hemolytic anemia in which an antibody against the P antigen develops and hemolysis ensues via a pathway involving thermally dependent complement binding. Previously an association of syphilis due to crossreactivity of antibody, PCH has since predominantly become a disease of childhood following varicella-zoster virus infection. The childhood form is typically acute, selflimiting, and steroid-responsive. Rare cases of PCH in adults have been described in association with chronic lymphocytic leukemia and lymphoma but never previously with myeloma [1]. We describe a case of steroid-refractory PCH in a patient with myeloma that was only partially corrected with eculizumab, a monoclonal antibody against C5 complement. A 51-year-old Nigerian man with Stage III ISS IgA kappa multiple myeloma in very good partial response following treatment with bortezomib, thalidomide, cyclophosphamide, and dexamethasone was admitted to our hospital with severe hemolytic anemia. At admission, lactate dehydrogenase (LDH) was elevated at 543 U/L (100–200 U/L); bilirubin, 164 μmol/L (<20 μmol/L); and hemoglobin was 60 g/L (125–175 g/L). Initial transfusion requirement were 2 to 4 U of red blood cells per day to achieve a target hemoglobin 60–80 g/L. PCH was diagnosed with the Donath–Landsteiner test following positive urinary hemosiderin on day 21 of admission. No complement C3 was detected on his red cells at diagnosis. Blood film was significant for rosette formation of erythrocytes around neutrophils and erythrophagocytosis by neutrophils (Fig. 1). Syphilis serology and cerebrospinal fluid treponemal PCR were negative. Being refractory to oral prednisolone and cyclophosphamide (1 g/m), he received standard induction with eculizumab 600 mg weekly for 4 weeks [2]. Urinary hemosiderin became negative by day 36; however, hemolysis continued albeit at reduced rate, and was finally controlled following a single dose of intravenous cyclophosphamide 4 g/m. The patient became transfusionindependent 31 days post high-dose cyclophosphamide and hemoglobin returned to normal reference range (136 g/L) at 10 weeks, with normalization of LDH at 9 weeks. This is the first reported case of eculizumab use for treatment of PCH. Failure of eculizumab to control hemolysis in this patient suggests that extravascular clearance of red cells in PCH may be induced by earlier components of complement and opsonization with anti-P antibodies. Moreover, the observation of neutrophil erythG. P. Gregory (*) : S. Opat :H. Quach : J. Shortt :H. Tran Department of Clinical Hematology, Monash Medical Centre, Clayton, VIC, Australia e-mail: g.gregory@alfred.org.au

Whole Brain Radiotherapy and Ara-C In Consolidation Post High-Dose Methotrexate Is Important In Establishing Durable Disease Control In the Treatment of Primary CNS Lymphoma: A Single Centre Observational Study

AbstractAbstract 1776While the survival benefits of high-dose methotrexate (MTX) based chemotherapy for primary central nervous system lymphoma (PCNSL) are well documented, the place for adjunctive cytarabine, and whole brain radiotherapy (WBRT) in consolidation remains uncertain. Due to the potential significant risk of treatment delayed neurotoxicity, the delivery of WBRT is often omitted at the physician's discretion in the treatment of PCNSL, especially in elderly patients. In the absence of randomised control trials comparing survival outcomes between patients receiving high dose MTX with or without WBRT in consolidation, we performed a retrospective study assessing the impact of these treatment modalities and other prognostic factors on the overall survival in a heterogeneously treated population with PCNSL.Forty-five patients with newly diagnosed PCNSL were identified at Monash Medical Centre, Australia between 1995 and 2009. Twenty patients were treated with palliative intent and were removed from analysis. The remaining 25 patients had a median age of 59 (range 31–79). Twenty-four patients had diffuse large B cell lymphoma, one T-cell lymphoma. Positive CSF cytology for lymphoma was found in 4 patients. All actively treated patients received chemotherapy; 16 patients received high-dose MTX-based combination chemotherapy, 5 patients received single-agent high-dose MTX, and 3 other. Eleven patients (median age 48, range 31–79) received WBRT in consolidation. The median dose of RT delivered was 39.6 Gy (range 20–45 Gy).After a median follow up of 2.1 years (range 0.3 – 11.6 years), the 5 year PFS was 27% and 5 year OS was 40% for all patients in the actively treated group. On univariate analysis, Age <60 years at diagnosis was significantly associated with both increased in PFS (p=0.002) and OS (p=0.04). Patients who received WBRT in consolidation tended to have a longer PFS (5 year PFS 49% vs. 12% p=0.098) compared to patients who did not receive WBRT. However, OS in both groups were similar (5 year OS 47% (consolidation WBRT) vs. 42%, p=0.31). Importantly, no relapses were observed in patients receiving WBRT who survived 2.7 years. Although formal neuropsychiatric assessment was not performed, examination of the records identified no significant cognitive impairment in survivors. Adjunctive cytarabine was associated with improved OS (p<0.001), however use of cytarabine was correlated with age<60 (Fishers exact test). Nonetheless, on multivariate analysis, the use of cytarabine was the only covariate associated with improved PFS and OS (p<0.001, Cox regression).Conclusion. The potential of cure in a proportion of patients as a result of initial therapy is suggested in this single centre experience by the plateau in the PFS and OS curve. This study underscores the potential role of both WBRT and AraC in consolidation after high dose MTX-based chemotherapy, in establishing durable disease control, and supports such an approach particularly in young patients with good performance status. The lack of overt neurotoxicity associated with moderate dose radiotherapy is of particular interest; although long-term formal cognitive assessments are lacking in this case. Disclosures:No relevant conflicts of interest to declare.

Renal Vein Leiomyosarcoma

We describe a 66 year old female who presented with abdominal pain. Histology confirmed what was suggested by surgeon and radiologist to indeed be a leiomyosarcoma, originating from the renal vein. Authors: Mr Mark Frydenberg , Associate Professor Dept of Surgery Monash University , Chairman Dept of Urology , Monash Medical Centre , Southern […]

Report from the 4th annual Society of Cardiac Computed Tomography Japan Forum

Report from the 4th annual Society of Cardiac Computed Tomography Japan Forum

New Vistas on Parkinson’s disease

European Journal of NeurologyVolume 17, Issue 4 p. 519-520 New Vistas on Parkinson’s disease G. L. Willis, G. L. Willis The Bronowski Clinic, The Bronowski Institute of Behavioural Neuroscience, Coliban Medical Centre, Kyneton, Vic. Monash University Department of Psychological Medicine, School of Psychology, Psychiatry and Psychological Medicine, Monash Medical Centre, Clayton, Vic.Search for more papers by this authorS. M. Armstrong, S. M. Armstrong The Bronowski Clinic, The Bronowski Institute of Behavioural Neuroscience, Coliban Medical Centre, Kyneton, Vic. Brain Sciences Institute, Swinburne University of Technology, Hawthorn, Vic., Australia(e-mail: [email protected])Search for more papers by this author G. L. Willis, G. L. Willis The Bronowski Clinic, The Bronowski Institute of Behavioural Neuroscience, Coliban Medical Centre, Kyneton, Vic. Monash University Department of Psychological Medicine, School of Psychology, Psychiatry and Psychological Medicine, Monash Medical Centre, Clayton, Vic.Search for more papers by this authorS. M. Armstrong, S. M. Armstrong The Bronowski Clinic, The Bronowski Institute of Behavioural Neuroscience, Coliban Medical Centre, Kyneton, Vic. Brain Sciences Institute, Swinburne University of Technology, Hawthorn, Vic., Australia(e-mail: [email protected])Search for more papers by this author First published: 15 March 2010 https://doi.org/10.1111/j.1468-1331.2009.02852.xCitations: 4Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article.Citing Literature Volume17, Issue4April 2010Pages 519-520 RelatedInformation

When managing established osteonecrosis of the jaw, don't forget the not‐infrequent chronic refractory pain

Internal Medicine JournalVolume 40, Issue 3 p. 243-244 When managing established osteonecrosis of the jaw, don't forget the not-infrequent chronic refractory pain P. Poon, P. Poon McCulloch House, Monash Medical Centre, Southern Health and Department of Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, AustraliaSearch for more papers by this authorK. Jackson, K. Jackson McCulloch House, Monash Medical Centre, Southern Health and Department of Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, AustraliaSearch for more papers by this authorT. Platt, T. Platt McCulloch House, Monash Medical Centre, Southern Health andSearch for more papers by this author P. Poon, P. Poon McCulloch House, Monash Medical Centre, Southern Health and Department of Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, AustraliaSearch for more papers by this authorK. Jackson, K. Jackson McCulloch House, Monash Medical Centre, Southern Health and Department of Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, AustraliaSearch for more papers by this authorT. Platt, T. Platt McCulloch House, Monash Medical Centre, Southern Health andSearch for more papers by this author First published: 15 March 2010 https://doi.org/10.1111/j.1445-5994.2010.02166.xCitations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume40, Issue3March 2010Pages 243-244 RelatedInformation

Initial Australasian experience with portal-enteric drainage in simultaneous pancreas-kidney transplantation

Pancreas-kidney transplantation is currently the most effective method to re-establish euglycaemia in insulin-dependent diabetics with associated renal failure. The standard technique employed has been bladder drainage of exocrine secretions coupled with systemic venous drainage ('systemic-bladder' (SB) drainage). The more physiological technique, enteric exocrine with portal venous drainage ('portal-enteric' (PE) drainage), has been utilized sparingly in the past as a result of fears of technical complications. This paper compares the Monash Medical Centre experience with both techniques. A total of 68 simultaneous pancreas-kidney transplantations were performed at Monash Medical Centre from 1991 until 2004. The first 37 received SB drainage. Since March 2001, 27 have received PE drainage. This retrospective study compared the SB group (n= 37) with the PE group (n= 27), with a 2-year follow-up, examining a number of surgical outcomes. Two-year patient (94.3 versus 96.0%), kidney (89.2 versus 85.2%), pancreas (77.9 versus 71.4%) and event-free (73.0 versus 67.7%) survivals were all similar between the SB and PE groups, respectively. Although surgery took longer in PE subjects (4 h : 47 min ± 0:48 versus 5 h : 16 min ± 1:00; P= 0.045), less intraoperative transfusions were required (1.3 ± 1.43 versus 0.52 ± 0.90; P= 0.024). Length of hospital stay and time to insulin independence were similar. Pancreas graft thrombosis rates were similar (10.8% SB versus 7.4% PE, P= 0.497). PE drainage is a safe and viable method for pancreas transplantation, which can be performed with excellent outcomes. An increased rate of complications with PE drainage has not been demonstrated in this series.

Problems with sleep, eating, and adherence to therapy are common among children with cystic fibrosis

Ward C, Massie J, Glazner J, Sheehan J, Canterford L, Armstrong D, et al. Problem behaviors and parenting in preschool children with cystic fibrosis. Arch Dis Child 2009;94:341-7. Among children with cystic fibrosis (CF), how common are problems with sleep, eating, and adherence to therapy, or behavioral problems? Is there an association with different parenting styles (harsh, inconsistent, overprotective)? Cross-sectional survey. CF outpatient clinics at Royal Children's Hospital (Melbourne), Monash Medical Centre (Melbourne) and Sydney Children's Hospital, Australia. A total of 117 (of 139 eligible) caregivers of children aged 6 months to 5 years. Surveys of behavior, sleep, eating, and adherence to therapy. Child externalizing and internalizing behaviors, sleep, eating, and adherence with therapy. Problems were common with child sleep (small problem: 31.6%; moderate/large problem: 21.9%), eating (32.4%), and adherence with physiotherapy (50.4%). Compared with normative data, sleep and mealtime problems were more prevalent. Caregivers reported high rates of symptoms indicating depression (33.3%), anxiety (16.4%), and stress (34.2%). Harsh parenting was associated with internalizing behaviors (adjusted OR 3.9, 95% CI 1.16 to 13.17, P = .03). Problems with sleeping, eating and physiotherapy adherence were common in preschool children with CF. Caregivers reported high rates of symptoms indicative of mental health problems. Harsh parenting was associated with internalizing problems. An intervention targeting child problem behaviors and parental mental health would be appropriate for CF families.

7024 Phase Ib dose-finding trial of intravenous (i.v.) panobinostat (PAN) with docetaxel (DOC) and prednisone (PRED) in patients (pts) with castration resistant prostate cancer (CRPC)

Rapid care protocols developed to reduce in-hospital delay times in the assessment of acute stroke patients are now common in Emergency Departments. Correct triage identification and prioritisation is vital to instigate this process and increase the eligibility of patients for acute stroke treatments.We set out to examine triage assessments of acute stroke patients and investigate factors associated with the instigation of rapid care protocols (allocation of triage category 1 or 2) for acute stroke patients presenting within 2 h of symptom onset.A retrospective assessment of emergency department records was undertaken for stroke patients presenting to three hospitals in Melbourne over six months in 2010.798 patients were included in the study. Among acute stroke patients who presented within 2 h (n = 185), 173 (94%) were identified as stroke at triage with 10 cases identified as “altered conscious state”. In all cases not identified as stroke the patient was diagnosed with intracerebral haemorrhage. 132 cases (71%) were allocated a triage category 1 or 2. Facial weakness (p = 0.002) and presentation to Monash Medical Centre (p = <0.001), were significantly associated with triage category 1 or 2.Virtually all acute stroke patients were identified at triage, however 30% were not allocated an urgent triage category (1 or 2). Further education strategies may be required to develop awareness of rapid care protocols for acute stroke patients among triage nurses and ensure the uniform application of Acute Stroke Guidelines and local rapid care pathways.

Protein C concentrate in preterm neonates with sepsis

1.Department of Pediatrics, Division of Neonatology, J.W. Goethe-University Hospital Frankfurt, Germany2.University of Colorado Health Sciences Center, Denver, CO, USA3.MonashNewborn,MonashMedicalCentreandTheRitchieCentreforBabyHealthResearch,MonashInstituteofMedicalResearch,MonashUniversity,Melbourne,AustraliaCorrespondenceAlex Veldman, M.D., Monash Newborn, MonashMedical Centre, 246 Clayton Rd, Clayton,Melbourne, VIC 3168, Australia.Tel: +61-3-9594-5155 |Fax: +61-3-9594-6115 |Email: alex.veldman@med.monash.edu.auReceived12 February 2009; revised 28 April 2009;accepted 3 June 2009.DOI:10.1111/j.1651-2227.2009.01404.x

Human Umbilical Cord Mesenchymal Stem Cells Reduce Fibrosis of Bleomycin-Induced Lung Injury

Acute respiratory distress syndrome is characterized by loss of lung tissue as a result of inflammation and fibrosis. Augmenting tissue repair by the use of mesenchymal stem cells may be an important advance in treating this condition. We evaluated the role of term human umbilical cord cells derived from Wharton's jelly with a phenotype consistent with mesenchymal stem cells (uMSCs) in the treatment of a bleomycin-induced mouse model of lung injury. uMSCs were administered systemically, and lungs were harvested at 7, 14, and 28 days post-bleomycin. Injected uMSCs were located in the lung 2 weeks later only in areas of inflammation and fibrosis but not in healthy lung tissue. The administration of uMSCs reduced inflammation and inhibited the expression of transforming growth factor-beta, interferon-gamma, and the proinflammatory cytokines macrophage migratory inhibitory factor and tumor necrosis factor-alpha. Collagen concentration in the lung was significantly reduced by uMSC treatment, which may have been a consequence of the simultaneous reduction in Smad2 phosphorylation (transforming growth factor-beta activity). uMSCs also increased matrix metalloproteinase-2 levels and reduced their endogenous inhibitors, tissue inhibitors of matrix metalloproteinases, favoring a pro-degradative milieu following collagen deposition. Notably, injected human lung fibroblasts did not influence either collagen or matrix metalloproteinase levels in the lung. The results of this study suggest that uMSCs have antifibrotic properties and may augment lung repair if used to treat acute respiratory distress syndrome.

A challenge to the claims that fludarabine and cyclophosphamide is the new standard treatment for chronic lymphocytic leukaemia

Internal Medicine JournalVolume 39, Issue 4 p. 269-271 A challenge to the claims that fludarabine and cyclophosphamide is the new standard treatment for chronic lymphocytic leukaemia I. Haines, I. Haines Cabrini Health, Department of Medicine, Monash University,Search for more papers by this authorP. Elliott, P. Elliott Alfred Hospital andSearch for more papers by this authorR. Stanley, R. Stanley Cabrini Health, Monash Medical Centre, Melbourne, Victoria, AustraliaSearch for more papers by this author I. Haines, I. Haines Cabrini Health, Department of Medicine, Monash University,Search for more papers by this authorP. Elliott, P. Elliott Alfred Hospital andSearch for more papers by this authorR. Stanley, R. Stanley Cabrini Health, Monash Medical Centre, Melbourne, Victoria, AustraliaSearch for more papers by this author First published: 21 April 2009 https://doi.org/10.1111/j.1445-5994.2009.01905.xCitations: 2Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Citing Literature Volume39, Issue4April 2009Pages 269-271 RelatedInformation

Evolution of the complications of laparoscopic hysterectomy after a decade: A follow up of the Monash experience

A retrospective review of medical records was performed to assess the incidence and types of significant complications encountered during laparoscopic hysterectomy which would affect the use of a laparoscopic approach versus other routes of hysterectomy. A total of 526 consecutive patients' medical data between January 1994 and August 2007 were reviewed. Two hundred and thirty-two laparoscopic-assisted vaginal hysterectomies and 294 total laparoscopic hysterectomies were performed at Monash Medical Centre, a Melbourne tertiary public hospital, and three Melbourne private hospitals, by or under the supervision of three surgeons. Sixteen significant complications occurred. There were two cases of ureteric fistula, two bladder injuries, two bowel obstructions, four postoperative haematomas, one case of a bladder fistula, four conversions to laparotomy and one superficial epigastric artery injury. Inpatient stay ranged from two to six days. Our complication and inpatient stay rates are consistent with the previously reported rates, although there has been a reduction of incidence of visceral injuries with experience and introduction of new equipment.

Implementation Issues for Mobile-Wireless Infrastructure and Mobile Health Care Computing Devices for a Hospital Ward Setting

mWard is a project whose purpose is to enhance existing clinical and administrative decision support and to consider mobile computers, connected via wireless network, for bringing clinical information to the point of care. The mWard project allowed a limited number of users to test and evaluate a selected range of mobile-wireless infrastructure and mobile health care computing devices at the neuroscience ward at Southern Health's Monash Medical Centre, Victoria, Australia. Before the project commenced, the ward had two PC's which were used as terminals by all ward-based staff and numerous multi-disciplinary staff who visited the ward each day. The first stage of the research, outlined in this paper, evaluates a selected range of mobile-wireless infrastructure.

Problem behaviours and parenting in preschool children with cystic fibrosis

Background:Problems with sleep, eating and adherence to therapy may adversely affect health outcomes in children with cystic fibrosis (CF). Data on the prevalence of such problems, associated parenting styles and...

Thrombosis in the critically ill neonate: incidence, diagnosis, and management

Among children, newborn infants are most vulnerable to development of thrombosis and serious thromboembolic complications. Amongst newborns, those neonates who are critically ill, both term and preterm, are at greatest risk for developing symptomatic thromboembolic disease. The most important risk factors are inflammation, DIC, impaired liver function, fluctuations in cardiac output, and congenital heart disease, as well as exogenous risk factors such as central venous or arterial catheters. In most clinically symptomatic infants, diagnosis is made by ultrasound, venography, or CT or MRI angiograms. However, clinically asymptomatic vessel thrombosis is sometimes picked up by screening investigations or during routine imaging for other indications. Acute management of thrombosis and thromboembolism comprises a variety of approaches, including simple observation, treatment with unfractionated or low molecular weight heparin, as well as more aggressive interventions such as thrombolytic therapy or catheter-directed revascularization. Long-term follow-up is dependent on the underlying diagnosis. In the majority of infants, stabilization of the patients' general condition and hemodynamics, which allows removal of indwelling catheters, renders long-term anticoagulation superfluous. Nevertheless, in certain types of congenital heart disease or inherited thrombophilia, long-term prophylaxis may be warranted. This review article focuses on pathophysiology, diagnosis, and acute and long-term management of thrombosis in critically ill term and preterm neonates.

Nursing Rounds—A collaborative approach to improvements in emergency care

Monash Medical Centre boasts a busy Emergency Department located on the outskirts of Melbourne. The integration of Nursing Rounds (NR) is a direct response to results of an audit identifying a high proportion of nursing charts lacked adequate levels of documentation. The NR have has provided an opportunity for communication, clinical teaching and provides incite into current issues facing staff on the floor. The NR team are able to address staff concerns, documentation, patient care concerns, provide positive and constructive feed back, clinical teaching and encourage self directed learning. The reviews are held Monday through to Friday mornings. The department is split into seven work areas and the NR team visit every work station. A number of nursing charts, at each station, are selected and talked through with the staff, identifying the plan of care for the patient. Self-directed learning objectives and individual learning needs and expectations are identified. Opportunities exist to assess our model of nursing care, identify future strategies and a commitment to encourage a collaborative approach with moving forward with future developments in practice. A comparative audit of documentation and a survey to assess staff satisfaction with the NR has been conducted 6 months post-implementation identifying significant improvements. The audit provided staff the opportunity to provide suggestions for possible modifications/improvements to the rounds that will continue to provide a satisfying experience and improve care delivery. Consideration will be given to extend the information for other disciplines to join the group, i.e. care coordination team.

Urinary Symptoms Before and After Female Urethral Diverticulectomy—Can We Predict De Novo Stress Urinary Incontinence?

We assessed preoperative and postoperative urinary symptoms, and determined risk factors for de novo stress urinary incontinence after transvaginal urethral diverticulectomy. We reviewed the case records of 25 consecutive women who had transvaginal urethral diverticulectomy. Urinary symptoms were documented before and after surgery with a structured history and examination pro forma. Demographic, clinical and imaging parameters were reviewed to determine any association with preoperative and postoperative symptoms as well as possible risk factors for postoperative stress urinary incontinence. The most common presenting symptoms were urinary urgency and frequency (60%), and dyspareunia (56%). On physical examination the most common findings were a tender anterior vaginal wall mass (88%) and urethral discharge (40%). At a mean followup of 15.1 +/- 14.9 months (median 12) the rate of urgency-frequency symptoms and dyspareunia decreased significantly from 60% to 16% and from 56% to 8%, respectively. All the patients who had urge incontinence were cured of this symptom after the operation. De novo stress urinary incontinence developed in 4 patients (16%) postoperatively, and it was mild and only necessitated surgical treatment in 1 patient. A diverticulum larger than 30 mm and proximal urethral location were significant factors (p <0.05) for the development of de novo stress urinary incontinence. Irritative bladder symptoms are common in woman with urethral diverticulum and usually resolve after surgical excision. Stress urinary incontinence developed immediately after the operation, and had a significant association with a proximal urethral location and ultrasonically measured size greater than 30 mm.

What's hanging around your neck? Pathogenic bacteria on identity badges and lanyards

To determine whether identity badges and lanyards worn by health care workers (HCWs) are capable of harbouring potentially pathogenic bacteria. Cross-sectional study of 71 HCWs (59 clinical ward staff and 12 infection control staff) at Monash Medical Centre, a university teaching hospital. Samples from lanyards, identity badge surfaces and connections (eg, clips, keys, pens) were cultured. The study was conducted from July to August 2006. Presence of pathogenic bacteria on identity badges and lanyards; differences in bacterial counts on items carried by nurses and doctors. A total of 27 lanyards were identified with pathogenic bacteria, compared with 18 badges. Analysing lanyards and badges as a combined group, seven had methicillin-resistant Staphylococcus aureus, 29 had methicillin-sensitive S. aureus (MSSA), four had Enterococcus spp and five had aerobic gram-negative bacilli. Lanyards were found to be contaminated with 10 times the median bacterial load per area sampled compared with identity badges. There were no significant differences between nurses and doctors in total median bacterial counts on items carried, but doctors had 4.41 times the risk of carrying MSSA on lanyards (95% CI, 1.14-13.75). Identity badges and lanyards worn by HCWs may be contaminated with pathogenic bacteria, which could be transmitted to patients. In view of this finding we suggest appropriate infection control interventions.

INFANT OUTCOME AFTER ANTENATAL STEROIDS IN PRETERM PREGNANCIES WITH ABSENT UMBILICAL END-DIASTOLIC FLOW

INTRODUCTION: Absence of the end-diastolic flow (EDF) is associated with adverse neonatal outcome. Administration of β-methasone to women with a pregnancy complicated by absent EDF is associated with the transient return of EDF in up to 70% of cases. OBJECTIVE: We aimed to compare the hospital outcome of preterm infants for whom the absent EDF returned after antenatal administration of β-methasone with those for whom the absent EDF did not return. METHODS: At Monash Medical Center, 80 pregnant women with absent EDF were given 2 intramuscular 11.4-mg doses of β-methasone 24 hours apart. In the majority of pregnancies, EDF returned after β-methasone treatment. The preterm infants born to these 80 pregnant women had their hospital outcome ascertained retrospectively. Statistical analysis was performed by using the χ2 and Mann-Whitney rank-sum tests. RESULTS: The 51 infants for whom the EDF returned were compared with the 29 for whom the EDF did not return. There were no significant differences in their gestational age, birth weight, or resuscitation and ventilation needs. The former group was less acidotic at birth (mean pH: 7.4 vs 7.3 [P &amp;lt; .05]; and mean base excess: −3 vs −5 mmol/L [P &amp;lt; .05]). There was no significant difference in the incidence of respiratory disease, intraventricular hemorrhage, necrotizing enterocolitis, and mortality rates. CONCLUSIONS: Preterm infants born after return of an absent EDF after the administration of antenatal β-methasone were less acidotic at birth, but their hospital morbidity and mortality rates were not significantly improved compared with those for whom the absent EDF did not return.