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Issue

Vol 124 No 1345: 04 November 2011

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Issue Summary

SUMMARY

Secondary prevention of vertebral fractures in a large New Zealand District Health Board

Katherine Bloomfield, Joe Singh

Osteoporosis is a common medical condition affecting many New Zealand older adults. Vertebral fractures are a common manifestation of osteoporosis and strongly predict future fractures. Medications proven to help prevent further fractures are available, yet this audit shows many patients with prior fractures presenting to Waitemata District Health Board were not adequately treated. This appeared particularly so for men with prior fractures.

SUMMARY

Review of 100 consecutive microvascular free flaps

Ryan Gao, Stanley Loo

Free flap surgery is an integral part of modern day plastic surgery. The operation involves the transfer of tissue, along with its blood supply from the original (donor) location to another (recipient) location. Free flaps are extremely versatile and they can be performed for a variety of reasons including reconstructing a breast following breast cancer surgery; coverage of a defect following tumour resections from the head and neck region and coverage of exposed bones following repair of fractures. After decades of refinement of surgical techniques and improved perioperative management, success rates of more than 90% have widely been reported in the international literature. This study showed that free flap reconstructions in our regional plastics and reconstruction centre have an excellent success rate (96%); and the results are comparable to international literature.

SUMMARY

Outcomes of patients with untreated severe aortic stenosis in real-world practice

Suresh Perera, Namal Wijesinghe, Elene Ly, Gerard Devlin, Sanjeevan Pasupati

Aortic stenosis once symptomatic can be debilitating and deadly. We attempted to assess the burden of this disease in New Zealand using Waikato Hospital as a reference centre. We found about half our patients referred for surgical aortic valve replacement are declined surgery. During our follow-up (34 months) 73% of patients were dead who were declined from surgery compared to 18% of operated patients. Also the surgically declined patients were significantly debilitated with symptoms leading to poor quality of life and required more hospital stay utilising the health dollar.

SUMMARY

Emergency peripartum hysterectomy: a 10-year review in a tertiary obstetric hospital

Tze Yoong Wong

According to the World Health Organization (WHO) postpartum haemorrhage (bleeding after a woman has just given birth) accounts for one-quarter of maternal deaths worldwide. There are occasions when an emergency peripartum hysterectomy (EPH) is necessary to remove the uterus, in order to control these haemorrhages. Although it is a life-saving procedure, this study found that EPH is itself associated with considerable maternal morbidity. This study also found that the most common indication for an EPH is abnormal placental implantation where the placenta is too close to the cervix or goes through the uterus lining, as a result of a previous caesarean delivery. It is hoped that this study will alert medical practitioners to this indication so that they will be more vigilant about the placental implantation in women with previous caesareans antenatally e.g. scans to determine placental site, and the medical team and woman can prepare and plan ahead of the delivery if this problem arises.

SUMMARY

Colonic self-expanding metal stents (SEMS) in acute large bowel obstruction

Mohammad I Khan, Adrian Claydon

Colonic self-expanding metal stents are increasing used in the management of acute large bowel obstruction, both as a bridge to surgery and as a definitive palliative measure in patients unfit for surgery. We describe our experience from a New Zealand hospital and compare our data with that already published in literature. Our technical and clinical success rates were 90% and 88% respectively. The procedure was palliative in 15 patients and as a bridge to elective surgery in 13 cases. Procedure-related mortality was 7%. It was because of one early and one late perforation. The average length of stay post procedure was 2 days. Mean survival post stent insertion in the palliative group was 2.4 months and for those with a bridge to surgery was 14 months. Conclusion Our results support the data published from international centres in terms of deployment of SEMS in patients with acute large bowel obstruction, both as a bridge to surgery and as a definitive palliative measure.

SUMMARY

Temporal trends and clinical characteristics of spontaneous intracerebral haemorrhage in the Waikato region of New Zealand: a hospital-based analysis

James Irwin, Peter Wright, Paul Reeve

This study investigated intracerebral haemorrhage (ICH) or sudden bleeding within the brain detected in the hospitals of the Waikato region of New Zealand between 1999 and 2008. 653 episodes of ICH were identified. Observed ICH has increased in incidence in our hospitals over the past 10 years. Increasing availability of neuroimaging, increasing numbers of elderly, and increasing warfarin (a blood thinner used in heart conditions)-associated ICH were likely contributors to this observed increase. Radiological evidence of extension of intraventricular bleed, warfarin use, lobar location of bleed, and increasing age correlated with poorer survival. This data will be available for comparison with future studies to assess trends in incidence, patient characteristics and outcome in ICH.

ALL ARTICLES
SUMMARY

Secondary prevention of vertebral fractures in a large New Zealand District Health Board

Katherine Bloomfield, Joe Singh

Review of 100 consecutive microvascular free flaps

Ryan Gao, Stanley Loo

NZMJ publication dates for 2012

Binge drinking is patterned by demographic and socioeconomic position in New Zealand: largest national survey to date

Santosh Jatrana, Kristie Carter, Sarah McKenzie, Nick Wilson

Cleveland Clinic's Current Clinical Medicine (2nd edition; William D Carey)

Lutz Beckert

Medical image. An unusual cause of nonresponsive chronic dyspnoea

Prem P Gupta, Dipti Agarwal

Outcomes of patients with untreated severe aortic stenosis in real-world practice

Suresh Perera, Namal Wijesinghe, Elene Ly, Gerard Devlin, Sanjeevan Pasupati

Sudden unexpected infant death—no more “stunned amazement”!

Nick Baker Cheap Uggs

Eliminating tobacco point of sale displays: removing the retail detail from the devil

Janet Hoek, Anne Jones, Richard Edwards, Ninya Maubach, Julian Crane, Ben Youdan; for the ASPIRE2025 collaboration

Potential social and psychological consequences of the Rena incident: lessons from an international perspective

Sarb Johal, Ron Chambers, Susan Collins, Ian de Terte, Dianne Gardner, Bruce Glavovic, Lucy Johnston, A Nuray Karanci, Maureen F Mooney, Douglas Paton, David Johnston

Banning pharmaceutical sponsorship: is ethical apartheid the right road ahead?

Lance Gravatt

Emergency peripartum hysterectomy: a 10-year review in a tertiary obstetric hospital

Tze Yoong Wong

Consensus Statement on the Role of the Doctor in New Zealand

“Punching above its weight”: why New Zealand must maintain leadership in global health

Judith McCool, Chris Bullen

New Zealand is not an island when it comes to global health policy engagement

Don Matheson, Belinda Loring

Playing with ‘The Public Health’

Peter W Moller

Incarceration of an inguinal hernia post urinary catheterisation

Phil T Davey, Eunice J Minford

Improving Emergency Department performance at Christchurch Hospital: an update

Michael W Ardagh

Medical image. Xanthogranulomatous pyelonephritis

Habib U Ugg Boots Online Rehman

Hypnosedative access and risk of harm

David B Menkes, Lucy M Shieffelbien, Mark Huthwaite

Revised status of PSA testing in the early detection and treatment of prostate cancer

David S Lamb, Brett Delahunt, John N Nacey

End-of-term review of the New Zealand Government’s response to climate change: a public health perspective

Nick Wilson, Ralph Chapman, Philippa Howden-Chapman

Colonic self-expanding metal stents (SEMS) in acute large bowel obstruction

Mohammad I Khan, Adrian Claydon

Dominion Notes: Otaki Sanatorium

Temporal trends and clinical characteristics of spontaneous intracerebral haemorrhage in the Waikato region of New Zealand: a hospital-based analysis

James Irwin, Peter Wright, Paul Reeve

Ralph Marcus Lawson (Toby) Whitlock

Colonoscopy—a rare cause of pancreatitis

Manar Khashram, Frank A Frizelle

Thames Hospital

Roger M Ridley-Smith

SUMMARY

Secondary prevention of vertebral fractures in a large New Zealand District Health Board

Katherine Bloomfield, Joe Singh

Osteoporosis is a common medical condition affecting many New Zealand older adults. Vertebral fractures are a common manifestation of osteoporosis and strongly predict future fractures. Medications proven to help prevent further fractures are available, yet this audit shows many patients with prior fractures presenting to Waitemata District Health Board were not adequately treated. This appeared particularly so for men with prior fractures.

SUMMARY

Review of 100 consecutive microvascular free flaps

Ryan Gao, Stanley Loo

Free flap surgery is an integral part of modern day plastic surgery. The operation involves the transfer of tissue, along with its blood supply from the original (donor) location to another (recipient) location. Free flaps are extremely versatile and they can be performed for a variety of reasons including reconstructing a breast following breast cancer surgery; coverage of a defect following tumour resections from the head and neck region and coverage of exposed bones following repair of fractures. After decades of refinement of surgical techniques and improved perioperative management, success rates of more than 90% have widely been reported in the international literature. This study showed that free flap reconstructions in our regional plastics and reconstruction centre have an excellent success rate (96%); and the results are comparable to international literature.

SUMMARY

Outcomes of patients with untreated severe aortic stenosis in real-world practice

Suresh Perera, Namal Wijesinghe, Elene Ly, Gerard Devlin, Sanjeevan Pasupati

Aortic stenosis once symptomatic can be debilitating and deadly. We attempted to assess the burden of this disease in New Zealand using Waikato Hospital as a reference centre. We found about half our patients referred for surgical aortic valve replacement are declined surgery. During our follow-up (34 months) 73% of patients were dead who were declined from surgery compared to 18% of operated patients. Also the surgically declined patients were significantly debilitated with symptoms leading to poor quality of life and required more hospital stay utilising the health dollar.

SUMMARY

Emergency peripartum hysterectomy: a 10-year review in a tertiary obstetric hospital

Tze Yoong Wong

According to the World Health Organization (WHO) postpartum haemorrhage (bleeding after a woman has just given birth) accounts for one-quarter of maternal deaths worldwide. There are occasions when an emergency peripartum hysterectomy (EPH) is necessary to remove the uterus, in order to control these haemorrhages. Although it is a life-saving procedure, this study found that EPH is itself associated with considerable maternal morbidity. This study also found that the most common indication for an EPH is abnormal placental implantation where the placenta is too close to the cervix or goes through the uterus lining, as a result of a previous caesarean delivery. It is hoped that this study will alert medical practitioners to this indication so that they will be more vigilant about the placental implantation in women with previous caesareans antenatally e.g. scans to determine placental site, and the medical team and woman can prepare and plan ahead of the delivery if this problem arises.

SUMMARY

Colonic self-expanding metal stents (SEMS) in acute large bowel obstruction

Mohammad I Khan, Adrian Claydon

Colonic self-expanding metal stents are increasing used in the management of acute large bowel obstruction, both as a bridge to surgery and as a definitive palliative measure in patients unfit for surgery. We describe our experience from a New Zealand hospital and compare our data with that already published in literature. Our technical and clinical success rates were 90% and 88% respectively. The procedure was palliative in 15 patients and as a bridge to elective surgery in 13 cases. Procedure-related mortality was 7%. It was because of one early and one late perforation. The average length of stay post procedure was 2 days. Mean survival post stent insertion in the palliative group was 2.4 months and for those with a bridge to surgery was 14 months. Conclusion Our results support the data published from international centres in terms of deployment of SEMS in patients with acute large bowel obstruction, both as a bridge to surgery and as a definitive palliative measure.

SUMMARY

Temporal trends and clinical characteristics of spontaneous intracerebral haemorrhage in the Waikato region of New Zealand: a hospital-based analysis

James Irwin, Peter Wright, Paul Reeve

This study investigated intracerebral haemorrhage (ICH) or sudden bleeding within the brain detected in the hospitals of the Waikato region of New Zealand between 1999 and 2008. 653 episodes of ICH were identified. Observed ICH has increased in incidence in our hospitals over the past 10 years. Increasing availability of neuroimaging, increasing numbers of elderly, and increasing warfarin (a blood thinner used in heart conditions)-associated ICH were likely contributors to this observed increase. Radiological evidence of extension of intraventricular bleed, warfarin use, lobar location of bleed, and increasing age correlated with poorer survival. This data will be available for comparison with future studies to assess trends in incidence, patient characteristics and outcome in ICH.

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