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Intern Med J [journal]
- Portal Hypertension - Pathophysiology, Diagnosis and Management. [JOURNAL ARTICLE]
- Intern Med J 2014 Sep 17.
Portal hypertension is an important complication of liver disease, although other conditions may also be implicated. As a result of elevated pressures within the portal vein a number of complications can arise including the development of oesophageal and gastric varices, ascites, hepatic encephalopathy as well as complications secondary to circulatory dysfunction such as hepatorenal syndrome, portopulmonary syndrome and hepatopulmonary syndrome. This review outlines the pathogenesis and diagnosis of portal hypertension and outlines the management of these various important clinical sequelae. The management of oesophageal and gastric varices is particularly important and both the emergency management together with prophylactic management of this condition are described.
- A Possible Role of Serum Uric Acid as a Marker of Metabolic Syndrome. [JOURNAL ARTICLE]
- Intern Med J 2014 Sep 16.
The association between serum uric acid (SUA) levels and metabolic syndrome (MetS) has recently been reported in several cross-sectional and longitudinal studies. We investigated SUA as a biomarker to predict future development of MetS in healthy Korean men without diabetes or hypertension and determined the optimal cut-off levels of SUA.A retrospective cohort study was conducted using data from healthy men who received a general health check-up in 2003. A total of 1809 participants free of MetS, diabetes, and hypertension were enrolled. Participants were classified into three groups based on SUA levels: group 1 (< 5.5 mg/dl), group 2 (5.5-6.9 mg/dl), and group 3 (≥ 7.0 mg/dl).During 13802 person-years of follow-up, 127 participants developed MetS. After adjusting for multiple associated parameters, SUA was significantly associated with incident MetS (hazard ratios comparing groups 2 and 3 vs. group 1, 2.45 and 3.47, respectively; P < 0.001). In receiver operating characteristic curve analysis, the optimal cut-off level for SUA to predict the development of MetS was 6.5 mg/dl.Our results indicate that an increased level of SUA, even within the normal range, is associated with future development of MetS in healthy middle-aged men.
- High Proportion of Rare and Compound EGFR Mutations in an Australian Population of Non-Squamous NSCLC. [JOURNAL ARTICLE]
- Intern Med J 2014 Sep 16.
EGFR mutation positivity in primary non-small cell lung cancer (NSCLC) may confer increased sensitivity to EGFR tyrosine kinase inhibitor (TKI) therapy with improved progression free survival over EGFR wild-type tumours. Some mutation subtypes may not confer such TKI sensitivity. The incidence of rare and compound subtypes in the Australian lung cancer population is not fully defined.The aim of the study was to audit the incidence of EGFR mutation in serial cases of primary non-squamous NSCLC presenting to two multidisciplinary team meetings in metropolitan Sydney for incidence, type of mutation and phenotypic association with mutation positivity.Serially presenting cases of primary non-squamous NSCLC were tested for EGFR mutation. The cases presented to either of two multidisciplinary team meetings in metropolitan Sydney and were referred for EGFR mutation testing on the basis of non-squamous NSCLC histopathology. Samples from the two sites were analysed for EGFR mutation at one of three different laboratories, each using a slightly different assay. Data on phenotypic characteristics, smoking history and clinic-pathological features of the tumour were collected.There is a relatively high incidence of EGFR mutation in non-squamous NSCLC in a series of patients drawn from two metropolitan MDMs in Sydney at a rate of 23.8%. A high proportion of rare and compound EGFR mutations were identified (6/32 mutation positive cases, 18.8%).The incidence of EGFR mutation may be higher in Australian populations than in other populations of predominantly European origin. Rare and compound EGFR mutations may occur and may have implications for treatment that differ from classically activating mutations.
- Enteral tube feeding of patients with acute stroke: When does the risk of diarrhoea increase? [JOURNAL ARTICLE]
- Intern Med J 2014 Sep 16.
We aimed to evaluate the relationship between the length of time acute stroke patients underwent enteral tube feeding (ETF) and episodes of diarrhoea, and to investigate the temporal cut-off point at which diarrhoea risk increases.An observational, retrospective study was conducted on patients with acute stroke admitted to a Stroke Centre. Patients undergoing ETF (ETF group) and those not undergoing ETF (control group) were analysed and matched by age and stroke severity. Data regarding demographic and clinical variables were recorded. The analysis was conducted using a receiver operating characteristic curve (ROC) and multivariate analyses.A total of 130 inpatients were included (age 75.08±11.53 years, 56.2% men). The ETF group had higher diarrhoea frequency (27.7% vs. 6.2%, p=.001). The length of time on ETF was associated with diarrhoea development (odds ratio [OR], 1.12 increment per day; CI 95% 1.05-1.18; p<.001), after adjusting for confounders. The ROC curve showed 7 days on ETF as a cut-off point for diarrhoea risk. Seven days or more on ETF was independently associated with diarrhoea (OR, 6.26; 95% CI 1.66-23.62; p=.007), whereas less than 7 days was not, when compared with the control group (OR, 0.38; 95% CI 0.04-3.91; p=.413).The length of time on ETF is associated with diarrhoea development in patients with acute stroke, demonstrating a temporal cut-off point. Seven days or longer on ETF is related to the occurrence of diarrhoea, whereas less than 7 days on ETF does not show this effect.
- The consultant physician and his role in team medicine. [Letter]
- Intern Med J 2014 Sep; 44(9):936.
- Sudden cardiac death complicating acute myocardial infarction following synthetic cannabinoid use. [Letter]
- Intern Med J 2014 Sep; 44(9):934-6.
- A case of iatrogenic Cushing syndrome and apparent mineralocorticoid excess presenting with accelerated hypertension and proteinuria. [Letter]
- Intern Med J 2014 Sep; 44(9):932-4.
- Association of heme oxygenase-1 gene promoter polymorphism and blood pressure in an Iranian population. [Letter]
- Intern Med J 2014 Sep; 44(9):931-2.
- Severe cardiomyopathy revealing antineutrophil cytoplasmic antibodies-negative eosinophilic granulomatosis with polyangiitis. [Journal Article]
- Intern Med J 2014 Sep; 44(9):928-31.
Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare form of systemic vasculitis in which cardiac involvement is frequent and severe, and accounts for half of EGPA-related deaths. ANCA-positive EGPA differs from ANCA-negative EGPA in that the former is significantly associated with renal involvement, peripheral neuropathy and biopsy proven vasculitis, whereas the latter is associated with cardiac involvement. Herein, we report a case of EGPA with myocarditis in a woman, who was successfully treated with steroids and cyclophosphamide. This report highlights the importance of diagnosing cardiac involvement in EGPA early, especially in ANCA-negative patients.