Publications by authors named "Yuigi Yuminaga"

19 Publications

  • Page 1 of 1

Quantifying the Effect of Location Matching on Accuracy of Multiparametric Magnetic Resonance Imaging Prior to Prostate Biopsy-A Multicentre Study.

Eur Urol Open Sci 2020 Jul 12;20:28-36. Epub 2020 Aug 12.

Department of Urology, St Vincent's Hospital Melbourne, Victoria, Australia.

Background: Multiparametric magnetic resonance imaging (mpMRI) has shown promise to improve detection of prostate cancer over conventional methods. However, most studies do not describe whether the location of mpMRI lesions match that of cancer found at biopsy, which may lead to an overestimation of accuracy.

Objective: To quantitate the effect of mapping locations of mpMRI lesions to locations of positive biopsy cores on the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of mpMRI.

Design Setting And Participant: We retrospectively identified patients having mpMRI of the prostate preceding prostate biopsy at three centres from 2013 to 2016. Men with targetable lesions on imaging underwent directed biopsy in addition to systematic biopsy. We correlated locations of positive mpMRI lesions with those of positive biopsy cores, defining a match when both were in the same sector of the prostate. We defined positive mpMRI as Prostate Imaging Reporting and Data System (PI-RADS) score ≥4 and significant cancer at biopsy as grade group ≥2.

Outcome Measurements And Statistical Analysis: Sensitivity, specificity, PPV, and NPV were calculated with and without location matching.

Results And Limitations: Of 446 patients, 247 (55.4%) had positive mpMRI and 232 (52.0%) had significant cancer at biopsy. Sensitivity and NPV for detecting significant cancer with location matching (both 63.4%) were decreased compared with those without location matching (77.6% and 73.9%, respectively). Of the 85 significant cancers not detected by mpMRI, most were of grade group 2 (64.7%, 55/85).

Conclusions: We report a 10-15% decrease in sensitivity and NPV when location matching was used to detect significant prostate cancer by mpMRI. False negative mpMRI remains an issue, highlighting the continued need for biopsy and for improving the standards around imaging quality and reporting.

Patient Summary: The true accuracy of multiparametric magnetic resonance imaging (mpMRI) must be determined to interpret results and better counsel patients. We mapped the location of positive mpMRI lesions to where cancer was found at biopsy and found, when compared with matching to cancer anywhere in the prostate, that the accuracy of mpMRI decreased by 10-15%.
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http://dx.doi.org/10.1016/j.euros.2020.07.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8317842PMC
July 2020

Growth and renal function dynamics of renal oncocytomas on active surveillance.

BJU Int 2021 May 28. Epub 2021 May 28.

Division of Surgery and Interventional Science, University College London.

Objectives: To study the natural history of renal oncocytomas and address indications for intervention by determining how growth associates with renal function over time, the reasons for surgery and ablation, and disease-specific survival.

Patients And Methods: Retrospective cohort of consecutive patients with renal oncocytoma on active surveillance reviewed at the Specialist Centre for Kidney Cancer at Royal Free London NHS Foundation Trust (2012 to 2019). Comparison between groups was tested using the Mann-Whitney U and the Chi-square tests. A mixed-effects model with a random intercept for patient was used to study the longitudinal association between tumour size and estimated glomerular filtration rate (eGFR).

Results: Longitudinal data from 98 patients with 101 lesions was analysed. Most patients were male (68.3%), median age was 69 years (IQR 13). The median follow-up was 29 months (IQR 26). Most lesions were small renal masses, 24% measured over 4 cm. Over half (64.4%) grew at a median rate of 2 mm per year (IQR 4). No association was observed between tumour size and eGFR over time (p=0.871). Nine lesions (8.9%) were subsequently treated. Two deaths were reported, neither were related to the diagnosis of renal oncocytoma.

Conclusion: Natural history data from the largest active surveillance cohort of renal oncocytomas to date show that renal function does not seem to be negatively impacted by growing oncocytomas, and confirms clinical outcomes are excellent after a median follow up of over 2 years. Active surveillance should be considered the gold standard management of renal oncocytomas up to 7cm.
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http://dx.doi.org/10.1111/bju.15499DOI Listing
May 2021

Ga-PSMA PET/CT versus CT and bone scan for investigation of PSA failure post radical prostatectomy.

Asian J Urol 2021 Apr 10;8(2):170-175. Epub 2020 Feb 10.

Nepean Urology Research Group, Nepean Hospital, Penrith New South Wales, Australia.

Objective: To evaluate the use of Gallium-68 prostate-specific membrane antigen positron emission tomography/computed tomography (Ga-PSMA PET/CT), compared with conventional CT abdomen/pelvis (CTAP) and whole body single photon emission CT bone scan (BS), for detection of local or distant metastasis following biochemical failure/recurrence in post-prostatectomy patients.

Methods: We conducted a review of our prospectively maintained, institutional database to identify 384 patients with post-prostatectomy biochemical failure/recurrence who underwent PSMA PET/CT, CTAP and BS from February 2015 to August 2017 in Nepean Hospital, tertiary referral centre. The results of the three imaging modalities were analysed for their ability to detect local recurrence and distant metastases. PSMA PET/CT and CTAP imaging were separately performed on the same day and the BS was performed within several days (mostly in 24 h). Difference in detection rates was determined between the modalities and the Chi square test was used to determine significance.

Results: A total of 384 patients were identified with a median prostate-specific antigen (PSA) of 0.465 ng/mL (interquartile range =0.19-2.00 ng/mL). Overall, PSMA PET/CT was positive for 245 (63.8%) patients whereas CTAP and BS were positive in 174 patients (45.3%). A total of 98 patients (25.5%) had local or distant metastasis detected on PSMA only, while 20 patients (5.2%) had recurrences detected on CTAP but not on PSMA PET/CT.

Conclusion: The use of PSMA PET/CT has a higher detection rate of predicted local or distant metastasis compared to CTAP and BS in the staging of patients with biochemical recurrences after radical prostatectomy.
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http://dx.doi.org/10.1016/j.ajur.2020.02.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8099644PMC
April 2021

Long Pulse-Width Setting Improves Holmium-YAG Laser Lithotripsy - Enhanced Fragmentation and Retropulsion Characteristics of Renal Calculi in a Novel In-Vivo Setting.

Surg Technol Int 2020 Nov;37:168-170

Nepean Urology Research Group (NURG), Kingswood, NSW, Australia, Nepean Clinical School, University of Sydney, Kingswood, NSW, Australia.

The aim of this novel in vivo study was to characterize the effect of short pulse-width versus long pulse-width Holmium-YAG laser lithotripter settings on retropulsion and fragmentation in a real-life setting. A prospective, crossover study was conducted at a tertiary teaching hospital in NSW, Australia. Patients who underwent flexible ureteroscopy with laser lithotripsy for renal calculi in 2018 were included. All patients underwent flexible ureteroscopy using a Flexor® 10.7/12 French ureteric access sheath (Cook Medical LLC, Bloomington, IN, USA) and lithotripsy with a 30W Holmium-YAG laser (Rocamed, Monaco). Thirty-two renal calculi were subjected to 1 min of laser treatment using both short and long pulse-width settings. Using 5-point, operator-assessed Likert scales, the level of retropulsion and fragmentation efficacy were assessed. There was significantly less retropulsion and improved stone fragmentation (p<0.001) using the long pulse-width compared to the short pulse-width setting. Regardless of stone size, in vivo renal calculi lithotripsy with a long pulse-width significantly improves the efficacy of lithotripter treatment.
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November 2020

Segmental testicular infarction, a rare complication of epididymo-orchitis.

Urol Case Rep 2020 Sep 15;32:101246. Epub 2020 May 15.

Nepean Urology Research Group, Kingswood, NSW, 2747, Australia.

Segmental infarction of the testicle secondary to epididymo-orchitis is a rare condition which can be difficult to diagnose and can lead to loss of the testis. We report a case of a 72-year-old man who presented with two weeks of worsening pain of his left testis despite oral antibiotic treatment for epididymo-orchitis. A testicular ultrasound initially revealed a suspected intra-testicular abscess. Despite intravenous antibiotics, his symptoms worsened. A repeat ultrasound demonstrated an increase in size of the lesion and a decision was made to take him to theatre. Intra-operative findings instead revealed a segmental area of testicular infarction requiring debridement.
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http://dx.doi.org/10.1016/j.eucr.2020.101246DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7256310PMC
September 2020

Single use versus reusable digital flexible ureteroscopes: A prospective comparative study.

Int J Urol 2019 10 25;26(10):999-1005. Epub 2019 Aug 25.

Nepean Urology Research Group, Sydney, New South Wales, Australia.

Objectives: To compare the performance and surgical outcomes of two different single-use digital flexible ureteroscopes with a reusable video flexible ureteroscope.

Methods: Patients undergoing retrograde flexible ureteroscopy at Nepean Hospital, Sydney, Australia, were included in this study. Three different flexible ureteroscopes were used in this study: (i) single-use digital LithoVue (Boston Scientific, Marlborough, MA, USA); (ii) single-use digital PU3022A (Pusen, Zhuhai, China); and (iii) reusable digital URF-V2 (Olympus, Tokyo, Japan). Visibility and maneuverability was rated on a 5-point Likert scale by the operating surgeon. Operative outcomes and complications were collected and analyzed.

Results: A total of 150 patients were included in the present study. Of these, 141 patients had ureteroscopy for stone treatment, four for endoscopic combined intrarenal surgery and five for diagnostic/tumor treatment. There were 55 patients in the LithoVue group, 31 in the PU3022A group and 64 patients in the Olympus URF-V2 group. The URF-V2 group had higher visibility scores than both the single-use scopes and higher maneuverability scores when compared with the PU3022A. The LithoVue had higher visibility and maneuverability scores when compared with the PU3022A. There were no differences in operative time, rates of relook flexible ureteroscopes, scope failure or complication rates observed.

Conclusions: Single-use digital flexible ureteroscopes have visibility and maneuverability profiles approaching that of a reusable digital flexible ureteroscope. Single-use flexible ureteroscopes achieve similar clinical outcomes to the more expensive reusable versions.
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http://dx.doi.org/10.1111/iju.14091DOI Listing
October 2019

Evaluation of the accuracy of multiparametric MRI for predicting prostate cancer pathology and tumour staging in the real world: an multicentre study.

BJU Int 2019 08 25;124(2):297-301. Epub 2019 Feb 25.

Gosford Hospital and Gosford Private Hospital, Gosford, NSW, Australia.

Objectives: To assess the accuracy of multiparametric magnetic resonance imaging (mpMRI) for the detection of significant prostate cancer in men undergoing radical prostatectomy (RP) in an Australian multicentre setting, and to assess concordance between mpMRI and RP for local tumour staging and index lesion locations.

Patients And Methods: Men who underwent mpMRI within 12 months of RP between January 2013 and August 2016 at three Australian sites were included (Central Coast, NSW, St Vincents Hospital, Melbourne, Vic., and Bendigo Hospital, Vic.). The results of mpMRI were compared with the final RP specimen to analyse the performance of mpMRI for significant prostate cancer detection, index lesion localization, prediction of T3 disease and lymph node metastasis. A comparison between mpMRI cases performed using the technical and reporting specifications of Prostate Imaging Reporting and Data System (PI-RADS) version 1 and version 2 was also performed. Data analysis was performed using spss 24.0.

Results: A total of 235 cases were included for analysis. mpMRI PI-RADS score ≥3 had a 91% sensitivity and 95% positive predictive value (PPV) for significant prostate cancer at RP. The overall concordance between index lesion location on mpMRI and RP specimen was 75%. The sensitivity for predication of significant prostate cancer was higher in the PI-RADS version 2 cases compared with PI-RADS version 1 (87-99%; P = 0.005). Index lesion concordance was higher in the PI-RADS version 2 group (68% vs 91%; P = 0.002). mpMRI had a 38% sensitivity, 95% specificity, 90% PPV and 57% negative predictive value for extraprostatic disease. Sensitivity for prediction of T3 disease improved from 30% to 62% (P = 0.008) with PI-RADS version 2.

Conclusions: In patients undergoing RP, an abnormal mpMRI is highly predictive (95% PPV) of significant prostate cancer, with an index lesion concordance of 75%. There has been a significant improvement in accuracy after the adoption of PI-RADS version 2 technical specifications and reporting criteria; however; further study is required to determine if this is attributable to improved experience with mpMRI or changes in the PI-RADS system.
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http://dx.doi.org/10.1111/bju.14696DOI Listing
August 2019

Does magnetic resonance imaging-guided biopsy improve prostate cancer detection? A comparison of systematic, cognitive fusion and ultrasound fusion prostate biopsy.

Prostate Int 2018 Sep 2;6(3):88-93. Epub 2017 Nov 2.

Department of Urology, Gosford District Hospital and Gosford Private Hospital, Gosford, Australia.

Background: The increase in the use of multiparametric magnetic resonance imaging for the detection of prostate cancer has led to the rapid adoption of MRI-guided biopsies (MRGBs). To date, there is limited evidence in the use of MRGB and no direct comparisons between the different types of MRGB. We aimed to assess whether multiparametric MRGBs with MRI-US transperineal fusion biopsy (FB) and cognitive biopsy (CB) improved the management of prostate cancer and to assess if there is any difference in prostate cancer detection with FB compared with CB.

Methods: Patients who underwent an MRGB and a systematic biopsy (SB) from June 2014 to August 2016 on the Central Coast, NSW, Australia, were included in the study. The results of SB were compared with MRGB. The primary outcome was prostate cancer detection and if MRGB changed patient management.

Results: A total of 121 cases were included with a mean age of 65.5 years and prostate-specific antigen 7.4 ng/mL. Seventy-five cases (62%) had a Prostate Imaging and Reporting Data System 4-5 lesions and 46 (38%) had a Prostate Imaging and Reporting Data System 3 lesions. Fifty-six cases underwent CB and 65 underwent FB.Of the 93 patients with prostate cancer detected, 19 men (20.5%) had their management changed because of the MRGB results. Eight men (9%) had prostate cancer detected on MRGB only and 12 men (13%) underwent radical prostatectomy or radiotherapy based on the MRGB results alone.There was a trend to a higher rate of change in management with FB compared with CB (29% vs. 18%).

Conclusions: This is one of the first Australian studies to assess the utility of MRGB and compare FB with CB. MRGB is a useful adjunct to SB, changing management in over 20% of our cases, with a trend toward FB having a greater impact on patient management compared with CB.
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http://dx.doi.org/10.1016/j.prnil.2017.10.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6104474PMC
September 2018

A Rare Case of Ureteral IgG4 Disease Masquerading as Urothelial Carcinoma.

Urology 2018 Aug 22;118:e1-e2. Epub 2018 May 22.

Department of Urology, Nepean Hospital, Nepean Urology Research Group, Kingswood, NSW, Australia; The University of Sydney and Macquarie University Hospital, The University of Sydney, Sydney, Australia.

The present paper described a rare case of ureteral IgG4-related disease (IgG4-RD) that mimicked urothelial carcinoma. An otherwise healthy patient presented with computed tomography, ureteroscopic, and biopsy findings that were suspicious of urothelial carcinoma. The patient received a right nephroureterectomy. Histopathology showed ureteral IgG4-RD, without evidence of urothelial carcinoma. Accurate diagnosis of this rare entity should be based on clinical, biochemical, and histopathological findings.
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http://dx.doi.org/10.1016/j.urology.2018.05.019DOI Listing
August 2018

Multi-centre, prospective evaluation of the Seldinger technique for difficult male urethral catheter insertions by non-urology trained doctors.

BJU Int 2017 11 5;120 Suppl 3:21-27. Epub 2017 Sep 5.

Department of Urology, Gosford District Hospital, Gosford, NSW, Australia.

Objective: To evaluate the safety and effectiveness of the Seldinger technique by non-urology trained (NUT) doctors for difficult male indwelling urinary catheter (IDC) insertions.

Patients And Methods: In all, 115 patients and 57 participating NUT doctors were recruited by the urologist or urology registrar, when contacted in regards to failed IDC insertion. The successful passage of an IDC by the NUT doctors using the Seldinger technique with a straight, hydrophilic guidewire was assessed in our prospective, multicentre evaluation. Instruction of this technique was via bedside teaching by the urology registrar or via video media.

Results: The 115 patients, involving 57 NUT doctors, were prospectively evaluated across four sites; 93% (107/115) of cases had successful placement of an IDC with the Seldinger technique by a NUT doctor. No complications with the Seldinger technique were recorded. In 80 patients (69.6%), the technique was successfully performed by a NUT doctor without attendance by a urologist or urology registrar, with instruction provided from video media or prior bedside teaching by the urology registrar.

Conclusions: Our study is the first to validate the safety and effectiveness of the Seldinger technique for difficult male IDC insertion performed by NUT doctors. This technique can be taught via video education and thus has important implications for health services where urological support is not readily available.
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http://dx.doi.org/10.1111/bju.13928DOI Listing
November 2017

Rare case of a massive staphylococcal prostatic abscess presenting as an ischio-rectal abscess.

ANZ J Surg 2019 Apr 27;89(4):438-440. Epub 2017 Jul 27.

Nepean Urology Research Group, Nepean Hospital, Sydney, New South Wales, Australia.

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http://dx.doi.org/10.1111/ans.14112DOI Listing
April 2019

Chronic peritoneal inflammation and nodules masquerading as peritoneal carcinomatosis in Birt-Hogg-Dube syndrome.

ANZ J Surg 2019 01 3;89(1-2):E37-E38. Epub 2017 May 3.

Department of Urology, Gosford District Hospital and Gosford Private Hospital, Gosford, New South Wales, Australia.

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http://dx.doi.org/10.1111/ans.13967DOI Listing
January 2019

Comparison of cost of care for tethered versus non-tethered ureteric stents in the management of uncomplicated upper urinary tract stones.

ANZ J Surg 2017 Jun 30;87(6):505-508. Epub 2017 Mar 30.

Urology Department, Westmead Hospital, Sydney, New South Wales, Australia.

Background: Many surgeons use a stent after ureteroscopic lithotripsy (URSL). For short-term stenting purposes, a surgeon has the choice of either a tethered or a non-tethered stent. Stents may be associated with complications that entail an additional cost to their use. There is a paucity of data on the direct healthcare cost of using stent type after either primary or secondary URSL.

Methods: We retrospectively reviewed medical records for patients who underwent URSL for uncomplicated urolithiasis between January 2013 and December 2013 at two tertiary referral hospitals. Costs data was sourced from the costing department with complete data available for 134 patients. The overall medical care cost was estimated by computing the cost of surgery, stent-related emergency department presentations, re-admissions and stent removal.

Results: A total of 113 patients had tethered stents and 21 had non-tethered stents, with similar age and gender composition between the two groups and complications rates. The mean cost of URSL and stent placement was A$3071.7 ± A$906.8 versus A$3423.8 ± A$808.4 (P = 0.049), mean cost of managing complications was A$309.4 ± A$1744.8 versus A$31.3 ± A$98.9 (P = 0.096), mean cost of out-patient clinic stent removal was A$222.5 ± A$60 versus A$1013.6 ± A$75.4 (P < 0.001) for endoscopic stent removal, overall mean cost of care was A$3603.6 ± A$1896.7 versus A$4468.1 ± A$820.8 (P = 0.042) for tethered and non-tethered stents, respectively.

Conclusion: It is cheaper to use a tethered ureteric stent compared with non-tethered stents for short-term stenting after uncomplicated URSL, with a mean cost saving of A$864.5.
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http://dx.doi.org/10.1111/ans.13945DOI Listing
June 2017

Volume-outcome relationship in penile cancer treatment: a population based patterns of care and outcomes study from Australia.

BJU Int 2016 Oct;118 Suppl 3:35-42

Cancer Research Division, NSW Cancer Council, Sydney, Australia.

Objectives: To study the patterns of care of penile cancer diagnosed in the state of New South Wales (NSW) over a 10 year period and determine factors that are associated with differences in survival.

Patients And Methods: All invasive penile cancer diagnosed between 2001 and 2009 in NSW, Australia, were identified from the Central Cancer Registry. Records of treatment from the Admitted Patient Data Collection and deaths from the Registry of Births Deaths and Marriages were electronically linked. Predictors of receiving an inguinal lymph node dissection (ILND) were analysed using multivariable logistic regression. Survival analyses were performed with Kaplan-Meier and Cox proportional hazards models.

Results: A total of 220 men were diagnosed with penile cancer over the 10 years from 69 centres. The median number of penile operations performed over 10 years was <4. Radical penile surgery (partial or total penectomy) was performed in 70% of the cases and the proportion of patients receiving radical surgery increased over time (P = 0.015). Only 53/220 men with invasive penile cancer received an ILND. Younger age and higher stage were the only factors that predicted whether ILND was performed. Overall survival (OS) was predicted by age, stage, marital status and co-morbidity status. Low centre volume decreased OS by 37% (HR 0.63 [95% CI: 0.40-0.97]). For men who received ILND, low centre volume decreased OS by 60% (HR 0.40 [95% CI: 0.19-0.85]).

Conclusions: There is a decreasing trend for the use of conservative penile surgery and median centre volumes for penile cancer surgery in NSW are low. A decrease in overall survival is observed in men treated in lower volume surgery centres.
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http://dx.doi.org/10.1111/bju.13626DOI Listing
October 2016

Re: Transrectal ultrasound-guided biopsy sepsis and the rise in carbapenem antibiotic use.

ANZ J Surg 2016 Apr;86(4):316

Gosford Hospital, Gosford, New South Wales, Australia.

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http://dx.doi.org/10.1111/ans.13467DOI Listing
April 2016

Rapidly growing massive pleomorphic rhabdomyosarcoma of the bladder presenting with bladder outlet obstruction.

ANZ J Surg 2018 Mar 17;88(3):E208-E209. Epub 2015 Sep 17.

Department of Urology, Gosford District Hospital, Gosford, New South Wales, Australia.

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http://dx.doi.org/10.1111/ans.13319DOI Listing
March 2018

Simultaneous endovascular repair of an iatrogenic carotid-jugular fistula and a large iliocaval fistula presenting with multiorgan failure: a case report.

J Med Case Rep 2012 Jan 24;6:33. Epub 2012 Jan 24.

Department of Vascular Surgery, Royal North Shore Hospital Sydney, St Leonards 2065, Australia.

Introduction: Iliocaval fistulas can complicate an iliac artery aneurysm. The clinical presentation is classically a triad of hypotension, a pulsatile mass and heart failure. In this instance, following presentation with multiorgan failure, management included the immediate use of an endovascular stent graft on discovery of the fistula.

Case Presentation: A 62-year-old Caucasian man presented to our tertiary hospital for management of iatrogenic trauma due to the insertion of a central venous line into his right common carotid artery, causing transient ischemic attack. Our patient presented to a peripheral hospital with fever, nausea, vomiting, acute renal failure, acute hepatic dysfunction and congestive heart failure. A provisional diagnosis of sepsis of unknown origin was made. There was a 6.5 cm×6.5 cm right iliac artery aneurysm present on a non-contrast computed tomography scan. An unexpected intra-operative diagnosis of an iliocaval fistula was made following the successful angiographic removal of the central line to his right common carotid artery. Closure of the iliocaval fistula and repair of the iliac aneurysm using a three-piece endovascular aortic stent graft was then undertaken as part of the same procedure. This was an unexpected presentation of an iliocaval fistula.

Conclusion: Our case demonstrates that endovascular repair of a large iliac artery aneurysm associated with a caval fistula is safe and effective and can be performed at the time of the diagnostic angiography. The presentation of an iliocaval fistula in this case was unusual which made the diagnosis difficult and unexpected at the time of surgery. The benefit of immediate repair, despite hemodynamic instability during anesthesia, is clear. Our patient had two coronary angiograms through his right femoral artery decades ago. Unusual iatrogenic causes of iliocaval fistulas secondary to previous coronary angiograms with wire and/or catheter manipulation should be considered in patients such as ours.
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http://dx.doi.org/10.1186/1752-1947-6-33DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3277481PMC
January 2012

Polyarteritis nodosa presenting with bilateral testicular swelling and complicated by unilateral facial nerve palsy.

Korean J Urol 2011 May 24;52(5):364-7. Epub 2011 May 24.

Department of Urology, Royal North Shore Hospital, Sydney, Australia.

Polyarteritis nodosa (PAN) is a systemic necrotizing vasculitis that is generally restricted to medium-sized vessels. Here we describe the first case of a patient in which a bilateral testicular mass was a presenting symptom and the diagnosis was made on the basis of testicular histopathology. A 53-year-old Asian man presented with a history of constitutional symptoms and testicular swelling. Scrotal ultrasound revealed two avascular, bilateral, intratesticular lesions. The bilateral testicular abscess was treated without improvement. The patient developed left seventh cranial nerve palsy during his admission. The clinical changes made vasculitis or a related disorder more likely and the patient underwent a right testicular biopsy. Histopathology demonstrated features of transmural inflammation and fibrinoid necrosis of medium-sized vessel walls, consistent with PAN. This case illustrates the difficulty in diagnosing polyarteritis nodosa with isolated bilateral testicular swelling and the delay in the diagnosis. After 9 months of follow-up, no relapse had occurred and the patient's testosterone level was on the lower side of normal.
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http://dx.doi.org/10.4111/kju.2011.52.5.364DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3106172PMC
May 2011

Using the ISBAR handover tool in junior medical officer handover: a study in an Australian tertiary hospital.

Postgrad Med J 2011 May 10;87(1027):340-4. Epub 2011 Feb 10.

Royal North Shore Hospital, St Leonards, New South Wales, Australia.

Background: Despite being essential to patient care, current clinical handover practices are inconsistent and error prone. Efforts to improve handover have attracted attention recently, with the ISBAR tool increasingly utilised as a format for structured handover communication. However, ISBAR has not been validated in a junior medical officer setting.

Objective: To assess the effect of the ISBAR handover tool on junior medical officer (JMO) handover communication in an Australian hospital.

Methods: JMOs who participated in after-hours handover during an 11 week clinical term from June to August 2009 were recruited. After-hours handover was audiotaped, and JMOs completed a survey to assess current handover perception and practice. JMOs then participated in a 1 h education session on handover and use of the ISBAR handover tool, and were encouraged to handover using this method. Following the education session, participants were surveyed to measure perceived changes in handover with use of ISBAR, and handover was again audiotaped to assess differences in information transfer and duration.

Results: Following the introduction of ISBAR, 25/36 (71%) of JMOs felt there was an overall improvement in handover communication. Specifically, they perceived improvement in the structure and consistency of handover, they felt more confident receiving handover, and they believed patient care and safety were improved. Audio-tape data demonstrated increased transfer of key clinical information during handover with no significant effect on handover duration.

Conclusions: Use of the ISBAR tool improves JMO perception of handover communication in a time neutral fashion. Consideration should be given to the introduction of ISBAR in all JMO handover settings.
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http://dx.doi.org/10.1136/pgmj.2010.105569DOI Listing
May 2011
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