Internal medicine journal
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Internal medicine journal · Jan 2009
Randomized Controlled Trial Multicenter Study Comparative StudyNephrotoxic effects of iodixanol and iopromide in patients with abnormal renal function receiving N-acetylcysteine and hydration before coronary angiography and intervention: a randomized trial.
The use of contrast agents during coronary intervention can result in nephropathy, particularly in patients with renal dysfunction. We aimed to determine whether the use of iso-osmolar iodixanol is less nephrotoxic than that of low-osmolar iopromide when patients are adequately prehydrated and have received N-acetylcysteine. ⋯ There remains a high incidence of CIN despite prehydration and routine use of N-acetylcysteine in patients with pre-existing renal dysfunction undergoing coronary interventional procedures. Although our study is underpowered, iodixanol was not associated with a statistically significant lower incidence of CIN when compared with iopromide.
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Internal medicine journal · Aug 2008
Multicenter Study Comparative StudyRural Organization of Australian Stroke Teams: Emergency Department project.
Many junior doctors have poor stroke assessment skills. Although major efforts have gone in to changing the attitudes of clinicians to stroke through the development of guidelines and implementation strategies, the most important step may be to make sure that medical schools include appropriate teaching of this important topic in their curricula. The Rural Organization of Australian Stroke Teams Emergency Department (ROASTED) project sought to determine the effectiveness of a practical intervention to improve the assessment and education of stroke knowledge among our junior emergency department doctors. ⋯ This project showed that junior doctors have an inadequate knowledge of stroke and that among our junior emergency department doctors there is a need for the ROASTED intervention and other innovative educational measures.
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Internal medicine journal · Jan 2008
Multicenter StudyDeviation from published guidelines in the management of primary spontaneous pneumothorax in Australia.
There are a several published guidelines recommending treatment pathways for patients with primary spontaneous pneumothorax (PSP). Little is known about how these patients are actually treated in Australia. ⋯ In Australia, there is considerable deviation from published guidelines for the management of PSP. In light of the lack of high-quality evidence to assist in choosing treatment approaches, a randomized controlled trial of management strategies is recommended.
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Internal medicine journal · Aug 2007
Case Reports Multicenter StudyThrombotic microangiopathy from Australian brown snake (Pseudonaja) envenoming.
Australian brown snake (genus Pseudonaja) envenoming causes a venom-induced consumptive coagulopathy (VICC). A proportion of cases go on to develop thrombotic microangiopathy characterized by thrombocytopenia, microangiopathic haemolytic anaemia (MAHA) and acute renal failure (ARF). ⋯ Thrombotic microangiopathy resulting from brown snake bite appears to have a good prognosis and management should focus on early antivenom therapy and supportive care including dialysis. The role of plasmapheresis is yet to be defined.
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Internal medicine journal · Oct 2005
Multicenter Study Comparative StudyOrbital decompression in Graves' orbitopathy: efficacy and safety.
Vision-threatening compressive optic neuropathy occurs in a minority of patients with Graves' orbitopathy. Surgical orbital decompression, systemic glucocorticoids and orbital irradiation are treatment options. Orbital decompression is being performed on an increasing number of patients for other indications such as corneal exposure and disfiguring proptosis. ⋯ Orbital decompression is a safe procedure and effective in improving vision in compressive optic neuropathy. It is effective in reducing proptosis, therefore improving exposure keratopathy and cosmesis. However, new or worsened diplopia is a significant postoperative complication, and subsequent strabismus surgery might be required. This is an important consideration, especially for patients undergoing surgery for non-optic neuropathy indications.