Referral Centre In Australia Research Articles

Non-tuberculous mycobacterial bone and joint infections - a case series from a tertiary referral centre in Australia.

Non-tuberculous mycobacteria (NTM) are rare causes of bone and joint infection (BJI) and there is limited evidence on which to base management decisions. This study describes 1 year of experience from a multi-disciplinary BJI team which collects data on all cases reviewed at a tertiary referral centre in Queensland, Australia. The database was interrogated for all cases in which NTM were recovered from operative samples. Individual chart review was performed to collect the details of each case. A total of seven cases were managed between 1st February 2021 and 28th February 2022, comprising one patient with chronic osteomyelitis, three with fracture-related infections, two with prosthetic joint infections, and one with infection of a synthetic ligament graft. In contrast to pulmonary NTM infections, most patients were clinically well and immunocompetent, and most infections were propagated by direct inoculation. Time to diagnosis was unknown in three patients, with 1, 2, 2, and 5 months for the remaining four. Rapid growing NTM were diagnosed on routine cultures and specific mycobacterial cultures were confirmatory. Management was characterized by multiple stage surgical procedures and prolonged antimicrobial regimens. Antimicrobial complications were common; however, all patients were infection free at their latest follow up. Despite the inherent limitations, these results suggest that routinely ordering mycobacterial culture is of low yield. There is potential for shorter-term oral antimicrobial treatments. Prospective research is required to optimize treatment regimens and durations.

Practice Variations in the Diagnosis and Treatment of Pulmonary Embolism.

Venous thromboembolism is responsible for a significant burden of disease worldwide. Despite the publication of multiple international guidelines, anecdotal evidence suggests significant clinical variation exists in the diagnostic and management pathways of pulmonary embolism (PE). We conducted a retrospective cohort study using electronic medical records to examine clinical variation in patients admitted to a tertiary referral center in Australia with a diagnosis of PE between November 2018 and January 2020. Three hundred cases met the inclusion criteria; we found variation in rates of compression ultrasonography, acute investigation of the right ventricle, and planning of repeat imaging at specialist follow-up. Guidelines do not address the use of compression ultrasonography in already diagnosed PE, are conflicting in their recommendation for acute investigation of the right ventricle, and recommend repeat imaging only if there are persistent symptoms at the time of specialist follow-up. The variations we found in this study may in part be due to physician preference or due to the paucity of evidence for some of these diagnostic practices. Robust future studies are required to guide the use of these investigations in PE.

Results of a Novel, Nonsurgical Bone-Conduction Hearing Aid for the Treatment of Conductive Hearing Loss in Australian Children.

To determine and compare the benefits a novel adhesive bone-conduction system and a conventional bone-conduction hearing aid (BCHA) on a softband for children with conductive hearing loss. Prospective, single-subject randomized, crossover trial. Tertiary referral center in Australia. Eight children aged from 4 to 17 years with conductive hearing loss. Rehabilitative with participants using the novel adhesive bone-conduction aid and a BCHA. Aided thresholds, as well as speech perception in quiet, unaided and aided with the novel adhesive bone-conduction aid and BCHA on a softband. For the six older children, speech in noise testing was also conducted. The mean unaided four frequency average hearing levels was 48 dB HL for air conduction, 10.5 dB HL for bone conduction, with a mean air-bone gap in the aided ear of 37.5 dB HL.Four-frequency average hearing level aided thresholds were 20.2 dB for the novel device and 19.8 dB for the BCHA, with no significant difference between the devices. Aided monosyllabic word scores improved from an average of 45% in the unaided condition to 81.6 and 85% for the novel adhesive and BCHA devices, respectively. Aided speech in noise performance improved, on average, by 1.6 dB SNR when wearing the BCHA and the novel adhesive device, with no significant difference in performance between the two devices. The novel device provided equivalent performance to the BCHA on all measures and can be considered as an alternative device for pediatric patients with conductive hearing loss.

Testicular Torsion: An Analysis of Rural Geography and Socioeconomic Status

ObjectivesTesticular torsion is a time-critical, organ-threatening diagnosis requiring prompt surgical intervention for successful salvage of the organ. In Australia, 28% of individuals live in rural and remote areas and face barriers to health care such as greater distance, lower socioeconomic status, (SES), and limited health infrastructure. We hypothesize that these barriers would delay intervention and access to surgical care, and lead to higher orchidectomy rates.ObjectivesA 12-year retrospective audit was conducted at a large rural referral center in Australia, focusing on patients undergoing scrotal exploration for testicular torsion. Primary outcomes were orchidectomy rate, time to operation, and ultrasound (US) and their relationship with patient distance, SES, age, and peripheral hospital attendance. Data on SES for geographic postcodes was obtained from the Australian Government Socio-Economic Indexes for Areas 2016. Statistical analysis was performed using IBM SPSS Statistics software, and a P value < 0.05 was considered significant.ResultsThe study involved 107 patients, of whom 46% had left-sided pathology. The median age of the patients was 14 years. Median SES was in the 37% to 41% centile range, median distance from travelled was 62 kilometers, and median time to operation from triage was 194 minutes. Of the patients, 34 attended a peripheral hospital. No significant risk factors for orchidectomy were identified. US was used in 65% of cases, with torsion detected in 50% of those cases, and orchidectomy performed in 11 patients. US had a sensitivity of 86.1% and specificity of 52.9%.ConclusionDespite significant differences in geographical distance, SES, age, and access to health care, patients in rural and remote areas of Australia experienced equivalent outcomes in testicular torsion management. Testicular torsion was safely managed at a central referral center using a peripheral hospital catchment in rural and remote areas of Australia, despite significant time delays due to greater distance or lower SES.

Re-thinking congenital piriform aperture stenosis: Modern imaging demonstrates narrowing of the full nasal cavity length

ObjectiveMeasure the width of the nasal cavity in cases of piriform aperture stenosis using computerised tomography scans. MethodsRetrospective study performed at a paediatric tertiary referral centre in Australia. Comparison nasal cavity widths (measured on computerised tomography scans in the axial plane) at the piriform aperture, choana and points 25, 50 and 75% along the length of nasal cavity, between cases with piriform aperture stenosis and controls. ResultsIn cases of piriform aperture stenosis the piriform aperture along with the nasal cavity is statistically significantly narrower than controls, measured at 25, 50 and 75% along the distance between the piriform aperture and the choana. ConclusionThis modern imaging review has illustrated the need for a change in the treatment paradigm for neonates with this condition, suggesting the need for further investigation of techniques that treat narrowing beyond the aperture.

MRI sliding sign: Using MRI to assess rectouterine mobility in pelvic endometriosis.

Surgical excision of deep infiltrating endometriosis (DIE) is complex and associated with morbidity. Diagnostic imaging plays an important role in the preoperative workup. We sought to determine the utility of single sagittal T2-weighted MRI motion sequence in the preoperative assessment of pelvic mobility in patients with endometriosis. An observational study at a single tertiary public referral centre in Australia. Eighty-one MRI studies from 1 May 2019 to 3 December 2019, were enrolled. Studies were included if they were performed to stage endometriosis, including a T2-weighted motion series, adequately covering a uterus, cervix and rectum. Fifty-seven studies met inclusion criteria. The reference standard was a contemporaneous transvaginal ultrasound (TVUS) reporting on pelvic organ mobility. Three subspecialist radiologists were then blindly asked to identify, on the cine loop: rectouterine immobility, superficial endometriosis (pelvic bowel adhesions), rectosigmoid Deep Infiltrating Endometriosis (DIE). Fleiss' Kappa assessed interobserver agreement. Consensus MRI sensitivity and specificity were estimated against the reference standard (TVUS). Median age was 35 years (range 19-51). Forty-three cases had a contemporaneous TVUS; 14 reporting a sliding sign, 29 with fixed pelves. Interobserver agreement was 'substantial' (k = 0.79) for absent MRI sliding sign and 'almost perfect' (k = 0.90) for absence of DIE. Consensus MRI had 90% sensitivity (95% CI 73-98%) for pelvic immobility at TVUS (absent sliding sign). Interobserver agreement and consensus MRI sensitivity were higher for adhesions and immobility than normal findings. An MRI motion sequence can identify patients with pelvic adhesions and immobility, helping determine surgical difficulty when TVUS is not diagnostic.

Survival in borderline resectable and locally advanced pancreatic cancer is determined by the duration and response of neoadjuvant therapy

BackgroundPancreatic cancer is the 8th commonest cancer and the 5th commonest cause of cancer-related death in Australia, with a 9% average 5-year survival. This study aims to investigate the effects of neoadjuvant treatment on overall survival (OS) and recurrence-free survival (RFS) in borderline resectable (BRPC) and locally advanced (LAPC) pancreatic adenocarcinoma followed by curative resection. Materials and methodsProspectively-collected demographic, medical, surgical and pathological data of patients with BRPC and LAPC treated with both neoadjuvant therapy (NAT) and surgery at a single tertiary referral centre in Australia were reviewed and analysed. ResultsBetween 2012 and 2018, 60 patients, 34 with BRPC and 26 with LAPC, were treated with NAT followed by curative resection. The commonest neoadjuvant chemotherapy regimens were Gemcitabine + Abraxane (51.7%) and FOLFIRINOX (35.0%), with 48.3% of patients additionally receiving neoadjuvant radiotherapy. Median RFS was 30 months and median OS was 35 months. On multivariable analysis, inferior OS was predicted by enlarged loco-regional lymph nodes on initial computed tomography (p = 0.032), larger tumour size post-NAT (p = 0.006) and Common Terminology Criteria for Adverse Events post-NAT toxicity greater than grade 2 (p = 0.015). LAPC patients received more neoadjuvant chemotherapy (p = 0.008) and radiotherapy (p = 0.021) than BRPC and achieved a superior pathological response (p = 0.010). ConclusionPatients who respond to NAT likely have a favourable disease biology and will progress well following resection. It is these patients who should be selected for more aggressive upfront management, and those with resistant disease should be spared from high-risk surgery.

Assessment of von Willebrand disease and pregnancy outcomes at regional Australian hospitals.

von Willebrand disease (vWD) is a heterogeneous hereditary bleeding disorder and is associated with risk of primary postpartum haemorrhage (PPH). An observational study at a tertiary referral centre in Australia of 16 women with 23 deliveries with a median age of 27.5years (range, 21-39; IQR=9). Median gestational age at delivery was 39weeks (range, 35-41; IQR=1.1). All cases had type 1 vWD, apart from one case with type 2. Patients were managed in combined obstetrics and haematology clinics. PPH occurred in ten deliveries (44%). Intravenous desmopressin was administered in 6 cases, and IV human vWF was administered in 4 cases. Two cases with mild vWD had received oral tranexamic acid. The median Apgar score at 1 and 5min was 9 (IQR=1.0), while the median Apgar score at 10min was 10.0 (IQR=0.0). One case required transfusion of blood products postdelivery. There were no other significant complications observed. vWD was associated with a high incidence of primary PPH. Individualised treatment to restore haemostasis, according to the severity of the disease, could achieve as possible, normal haemostasis with favourable outcomes for both mothers and their infants. Further studies to confirm our findings are warranted.

Selective serotonin reuptake inhibitor or serotonin-norepinephrine reuptake inhibitors and epidemiological characteristics associated with prenatal diagnosis of congenital heart disease.

Identify early pregnancy associations of congenital heart disease (CHD) in a multiethnic cohort. This retrospective observational cohort study compared the general obstetric population to women who gave birth at a referral centre in Australia between 2012 and 2017, after 20 weeks' of gestation, with a pregnancy affected by CHD. We defined mood disorder and anxiety as a history of self-reported or medically diagnosed anxiety, depression, postpartum depression or bipolar disorder. We compared epidemiological factors between 30 842 general obstetric patients and 470 obstetric patients with a foetus affected by CHD. Multivariate analysis showed independent associations between CHD and use of selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) in the first trimester (relative risk [RR] 4.14, 95% CI 2.58-6.65), history of anxiety or mood disorder with no SSRI/SNRI first trimester (RR 2.20, 95% CI 1.77-2.74), folate and/or pregnancy multivitamin use in the first trimester (RR 0.69, 95% CI 0.55-0.87) and increased risk with maternal age >40 years (RR 2.30, 95% CI 1.57-3.38). Our data show maternal mood disorders with and without SSRI or SNRI use, maternal age >40 years and lack of multivitamin/folate use to be independently associated with CHD in pregnancy.

Clinical progression and outcome of individuals with and without swallowing impairment following non-traumatic subarachnoid haemorrhage: A retrospective cohort study

Purpose: To establish the clinical profiles of individuals with and without dysphagia following non-traumatic subarachnoid haemorrhage (SAH), and to further describe the clinical progression and outcome of dysphagia within the acute phase for those individuals with dysphagia.Method: Retrospective chart review of 250 patients consecutively admitted with non-traumatic SAH to a major, tertiary neurosurgery referral centre in Australia over a three-year period. Clinical information associated with usual clinical care was collected for the duration of the acute hospital admission. Characteristics of participants with dysphagia (n = 73/250) were further analysed to evaluate dysphagia progression and recovery.Result: Participants with dysphagia took 10.93 times longer to commence oral intake following admission than those without dysphagia (p < 0.01). Those with dysphagia took approximately 12.86 times longer to reach total oral feeding than those without dysphagia (p < 0.01). There was no statistically significant difference between groups for time to SLP referral (p = 0.549) or commencement of supplemental feeding (p = 0.256). Safe management of thin fluids occurred for >50% of participants by weeks 2 and 3 following admission, with 75.34% of participants with dysphagia resuming thin fluids by discharge. Safe management of full diet took slightly longer with 32.88% of participants resuming unmodified diet by week 3. By discharge, only 53.42% of participants resumed a full diet.Conclusion: The clinical progression and recovery of dysphagia within the acute phase following non-traumatic SAH can be protracted for some patients, necessitating ongoing speech-language pathology (SLP) input after discharge. The study findings will enhance SLP assessment processes, management focuses and guide prognostic decision making for this population.

Retrospective review of CT brain image quality, diagnostic adequacy and radiation dose in a paediatric population imaged at a non-paediatric tertiary hospital.

Minimising radiation exposure in paediatric imaging examinations whilst maintaining acceptable diagnostic quality continues to present a challenge. The aims of this study were to assess institutional compliance of paediatric CT brain (CTB) examinations performed in an adult hospital with ARPANSA radiation dose recommendations and to compare qualitative CTB diagnostic acceptability with objective imaging parameters and radiation dose. A retrospective review of 115 consecutive paediatric CTB examinations was undertaken at an adult tertiary referral centre in Australia over a 2-year period. Dose length product (DLP) was compared with the ARPANSA standards. CTB image quality was subjectively classified by two neuroradiologists independently, with discordant results resolved by consensus. Objective assessment of image quality included measurements of signal-to-noise (SNR) and contrast-to-noise ratios (CNR) of grey and white matter. All patient scans complied with ARPANSA DLP recommendations; however, 10 out of 115 scans were classified as being of diagnostically suboptimal image quality. These scans had significantly lower mean DLP values compared with diagnostically adequate examinations (105.1 vs 379.2 mGy.cm; P<0.0001). CTB scans of adequate diagnostic quality, when compared to suboptimal scans, had significantly higher CNR (1.8 vs 1.1; P<0.0001) and SNR in grey (7.1 vs 4.6; P<0.0001) and white matter (5.6 vs 3.8; P<0.0001). All CTB examinations in this series complied with the ARPANSA DLP recommendations; however, 9% were of suboptimal diagnostic image quality. While it is important to minimize unnecessary radiation exposure, our results suggest that excessively low DLP values can lead to suboptimal diagnostic image quality.

Thrombocytopenia post Transcatheter Aortic Valve Insertion: Clinical and Prognostic Significance

ABSTRACT Background: Transcatheter aortic valve insertion (TAVI) has revolutionized the management of aortic stenosis in patients at high surgical risk. Major thrombocytopenia has previously been assessed as a predictor of short- and long-term mortality. This study aimed at identifying the predictors and prognostic value of major thrombocytopenia post TAVI. Methods: Patients who underwent TAVI at a metropolitan quaternary referral centre in Australia over an 8-year period were included. Primary outcomes included 30-day and 1-year mortality. Secondary outcomes included Bleeding Academic Research Consortium (BARC) minor, major and life-threatening bleeding. Baseline characteristics and platelet counts were collected retrospectively. Results: A total of 331 consecutive patients were included in the analysis. The only predictor of major thrombocytopenia was pre-procedural platelet count (p < 0.01). Patients who had major thrombocytopenia post TAVI had increased 30-day mortality (OR 4.37, 95% CI 1.35–14.16, p = 0.014) but this did not extend to 1-year mortality (OR1.67, 95 CI 0.64–4.36, p = 0.29). Patients with major thrombocytopenia had an increased rate of major and life-threatening bleeding (OR 2.01, 95% CI 1.2–2.4, p = 0.01). Conclusion: Thrombocytopenia post TAVI is common and may contribute to worse short-term outcome. Larger studies into the mechanism and prevention of thrombocytopenia post TAVI are warranted.

Incidence and Risk Factors for Dysphagia Following Non-traumatic Subarachnoid Hemorrhage: A Retrospective Cohort Study.

The aim of the study is to investigate dysphagia incidence and establish factors which may reliably predict dysphagia risk in individuals presenting with non-traumatic subarachnoid hemorrhage (SAH). A retrospective chart audit of 250 patients (151 females and 99 males) consecutively admitted with non-traumatic SAH to a major, tertiary neurosurgery referral center in Australia was conducted. Demographics, medical, and surgical information, along with speech-language pathology (SLP) assessment data were collected. Differences between dysphagic and non-dysphagic groups were evaluated using t tests, χ2, and Fisher's exact tests. Univariate and multivariate logistic regression analysis was performed to establish factors associated with dysphagia risk. A total of 31.6% of participants were identified with dysphagia during acute inpatient admission based on SLP, medical officer, and/or nursing staff reports. Individuals with dysphagia had significantly (p < 0.01) higher World Federation of Neurological Surgeons (WFNS) grading scores, were more likely to have an aneurysmal cause, were more likely to have secondary complications such as vasospasm, hydrocephalus, or new ischemia, were older, and had longer intubation and intensive care unit (ICU) periods than those without dysphagia. Dysphagia risk was significantly associated (p < 0.01) with age > 57.5years, ICU length of stay > 7.5days, length of intubation > 1.5days, need for tracheostomy, vasospasm, and new stroke. Dysphagia is highly prevalent following non-traumatic SAH, and significantly associated with a number of factors. Established risk factors will improve current knowledge, promote early identification of dysphagia, and inform SLP referral criteria and management of this patient cohort.

Outpatient parenteral antibiotic therapy in a suburban tertiary referral centre in Australia over 10years.

Outpatient parenteral antibiotic therapy (OPAT) is a widely accepted and safe therapeutic option for carefully selected patients. This study reviewed the practice of an OPAT service in a large Australian tertiary teaching hospital in Western Sydney over a 10-year period. Data were retrieved from a prospectively maintained electronic database which included information on patient demographics, clinical diagnosis, microbiological identity, antimicrobial therapy, complications and readmissions. Data were analysed using descriptive statistics. There were 3435 referrals made to the service between January 2004 and June 2014, amounting to 25,289 antibiotic days. The most frequent referral was for Skin and Soft Tissue Infections (SSTIs), 61.28%, followed by Bone and Joint Infections (BJIs), 15.30%. The most common organism identified was methicillin-sensitive Staphylococcus aureus. Readmission was uncommon (5.15%), with the highest rate of readmission noted for Cardiovascular System Infections (16.67%) followed by BJIs (10.31%). Line infection, aseptic thrombophlebitis and drug hypersensitivity or reaction were the cause of 68.55% of all complications. There was a decline in line-related complications throughout the study period. OPAT service is in increasing demand in Australia, providing a significant relief in in-hospital days. Growth in referrals was seen not only with SSTIs and BJIs, but also a diverse range of other infective entities with limited literature in its treatment in an OPAT setting. This study highlights the need to improve data collection, develop risk stratification strategies and standardisation of OPAT services in Australia.

Fall in thyroid stimulating hormone (TSH) may be an early marker of ipilimumab-induced hypophysitis.

Hypophysitis develops in up to 19% of melanoma patients treated with ipilimumab, a cytotoxic T-lymphocyte antigen-4 antibody. Early detection may avert life-threatening hypopituitarism. We aimed to assess the incidence of ipilimumab-induced hypophysitis (IH) at a quaternary melanoma referral centre, and to determine whether cortisol or thyroid stimulating hormone (TSH) monitoring could predict IH onset. We performed a retrospective cohort study of ipilimumab-treated patients at a quaternary melanoma referral centre in Australia. The inclusion criteria were patients with metastatic or unresectable melanoma treated with ipilimumab monotherapy, and cortisol and TSH measurements prior to ≥ 2 infusions. The main outcomes were IH incidence and TSH and cortisol patterns in patients who did and did not develop IH. Of 78 ipilimumab-treated patients, 46 met the study criteria and 9/46 (20%) developed IH at a median duration of 13.0weeks (range 7.7-18.1) following ipilimumab initiation. All patients whose TSH fell ≥ 80% compared to baseline developed IH, and, in 5/9 patients with IH, TSH fell prior to cortisol fall and IH diagnosis. Pre-cycle-4 TSH was significantly lower in those who developed IH (0.31 vs. 1.73mIU/L, P = 0.006). TSH fall was detected at a median time of 9.2 (range 7.7-16.4) weeks after commencing ipilimumab, and a median of 3.6 (range of- 1.4 to 9.7) weeks before IH diagnosis. There was no difference in TSH between the groups before cycles 1-3 or in cortisol before cycles 1-4. TSH fall ≥ 80% may be an early marker of IH. Serial TSH measurement during ipilimumab therapy may be an inexpensive tool to expedite IH diagnosis.

374P - A review of single agent and combination immunotherapy-induced colitis from a tertiary referral centre in Australia

374P - A review of single agent and combination immunotherapy-induced colitis from a tertiary referral centre in Australia

Predictors and outcomes of acute pancreatitis in critically ill patients presenting to the emergency department of a tertiary referral centre in Australia.

To provide a current review of the clinical characteristics, predictors and outcomes in critically ill patients presenting to the ED with acute pancreatitis and subsequently admitted to an intensive care unit (ICU) of a tertiary referral centre in Australia. A retrospective single-centre study of adult patients admitted with pancreatitis. Severe acute pancreatitis defined by Bedside Index of Severity in Acute Pancreatitis (BISAP) score ≥2. Eighty-seven patients fulfilled criteria for inclusion during the study period, representing 0.9% of all ICU admissions. The median age of patients was 54. Survival was independent of patients' age, sex, aetiology and comorbidities. Mortality was 30.8% for both inpatient referrals to the ICU and for direct referrals via the ED. Higher mortality was identified among patients requiring mechanical ventilation (74.2 vs 24.6% in survivors; P < 0.0001), vasopressor support (85.7 vs 33.8% in survivors; P < 0.0001) or renal replacement therapy (60 vs 16.9% in survivors; P < 0.002). BISAP score surpasses Ranson's and Acute Physiological and Chronic Health Examination (APACHE) II scores in discriminating between survivors and non-survivors among unselected patients with acute pancreatitis admitted to ICU, whereas APACHE II discriminates better in the cohort admitted from ED. Severe acute pancreatitis is associated with high mortality. Aetiology and comorbidity did not predict adverse outcomes in this population. BISAP score is non-inferior to APACHE II score as a prognostic tool in critically ill patients with acute pancreatitis and could be used to triage admission. Evidence of persistent organ dysfunction and requirements for organ support reliably identify patients at high-risk of death.

Part of the Solution and Part of the Problem-Report on the Ureteric Stent Use in a Tertiary Referral Center in Australia

Background: The aim of the study is to comprehensively report on a single tertiary referral centre experience with the use of ureteric stents, assess complication burden and determine risk factors to further inform institutional practice. Materials and methods: The retrospectively analysed cohorts include 529 patients treated over a 12 months period. Data regarding details of the index pathology, stent characteristics and complications were collected retrospectively. Results: Most stents (58.9%) were used in the context of stone surgery. Stent encrustation occurred in 14.5% of patients and sepsis in 4.3%. There was a statistically significant difference be-tween the complications of the stents removed after 90 days (76.3% of encrustations, 26.8% positive urine cultures) and the rest of the cohort. Overall, 7.6% of patients re-presented to the emergency department due to stent related complications (pain, haematuria, sepsis) and 2.4% required early stent removal. At our institution, we managed to avoid forgotten stents and catastrophic complications. Conclusions: Stent complications are the complex outcome of interplay between the foreign body and the collecting system environment, influenced by the nature and timing of surgery. Longer stent dwelling times are associated with increased complications rates. Planning definitive management and stent extraction needs to take into account the statistically significant differences between the subgroups with significant co-morbidities.

HIV and renal cell carcinoma: Experience in an Australian statewide HIV center.

To report on the presentation, management and outcomes of renal cell carcinoma (RCC) among people with human immunodeficiency virus (HIV). We retrospectively reviewed patients with HIV and RCC in a statewide HIV referral center in Australia. Patients' medical records were reviewed to collect data on the HIV parameters at the time of RCC diagnosis, as well as presentation, management and outcomes of RCC. Seven patients with HIV and RCC were included in the current study. The median age at RCC diagnosis was 56 years (range: 44-62 years). At RCC diagnosis, six patients were on combination antiretroviral therapy (ART), and five had virological suppression. Three patients were symptomatic at presentation, while the rest were diagnosed incidentally. Two patients had metastatic RCC at diagnosis. All five patients with clinically localized RCC had radical/partial nephrectomies, of which two patients with pT3a disease developed recurrence (pulmonary and bone) at 5 and 30 months postnephrectomies. One patient with metastatic RCC was treated with vascular endothelial growth factor (VEGF) inhibitors while continuing on ART. Four patients died of RCC at a median of 9 months (range: 4-16 months) following diagnosis of metastatic disease. Three patients were alive at a median follow-up of 16 months (range: 10-80 months). Our experience suggests that patients with HIV should be offered all treatment options in the same manner as the general population, taking into account their prognosis from HIV. Curative surgery should be considered for localized RCC. Potential drug interactions between ART drugs and targeted therapies for metastatic RCC need to be considered.

Trends in diabetic ketoacidosis presentations at a major rural referral centre in Australia

Trends in diabetic ketoacidosis presentations at a major rural referral centre in Australia