Peter Blumbergs - Academia.edu (original) (raw)

Papers by Peter Blumbergs

Spine, 1997

... The Pathologic Effects of Intrathecal Betamethasone. Latham, Jeremy M. MA, BM, BCh, FRCS, FRC... more ... The Pathologic Effects of Intrathecal Betamethasone. Latham, Jeremy M. MA, BM, BCh, FRCS, FRCS (Ed); Fraser, Robert D. MB, BS, MD, FRACS; Moore, Robert J. MSc, PhD; Blumbergs, Peter C. MB, BS, FRACP, FRCPA; Bogduk, Nikolai MD, PhD. Article Outline. Collapse Box ...

APLAR Journal of Rheumatology, 2007

To review the epidemiology of dermatomyositis (DM) in South Australia (SA) and to compare it with... more To review the epidemiology of dermatomyositis (DM) in South Australia (SA) and to compare it with other Australian states and New Zealand (NZ).

Internal Medicine Journal, 2012

There is a paucity of literature on the patterns and predictors of mortality in idiopathic inflam... more There is a paucity of literature on the patterns and predictors of mortality in idiopathic inflammatory myopathies (IIM). To determine the patterns and predictors of mortality in a South Australian cohort of patients with biopsy-proven IIM. The living/deceased status (and for deceased patients the causes of death) of patients with histologically determined IIM was determined from the Births, Deaths and Marriages Registry. Standardised mortality ratios (SMR) were generated compared with the age/gender matched South Australian population. The effect of presence/absence of the components of the Bohan and Peter criteria on risk ratios (RR) for mortality was determined. The effect of comorbidities and autoantibodies on mortality was investigated. The SMR for mortality in IIM was 1.75 and was significantly increased in all disease subgroups, being highest in patients with dermatomyositis (2.40). Dominant causes of death were cardiovascular disease (31%), infections (22%) and malignancy (11%). Risk factors for death were age at time of biopsy (hazard ratio 1.05), ischaemic heart disease (RR 2.97, P < 0.0001), proximal weakness at diagnosis (RR 1.8, P= 0.03), definite diagnosis of IIM per the Bohan and Peter criteria (RR 2.14, P < 0.0001), and the absence of autoantibodies (RR 1.9, P < 0.001). Patients with IIM are at 75% increased risk for mortality, and cardiovascular diseases account for the commonest causes of death. This study suggests a thorough cardiovascular evaluation of these patients is indicated, and raises the possibility that targeted interventions such as the use of aspirin or statins may improve outcomes in IIM.

International Journal of Rheumatic Diseases, 2013

Aim: To describe the epidemiology of biopsy-proven idiopathic inflammatory myopathies (IIM) in So... more Aim: To describe the epidemiology of biopsy-proven idiopathic inflammatory myopathies (IIM) in South Australia (SA).

The New Zealand medical journal, Jan 27, 2011

To report the neuro-ophthalmic manifestations and outcomes in patients with pituitary apoplexy. R... more To report the neuro-ophthalmic manifestations and outcomes in patients with pituitary apoplexy. Retrospective chart review. 23 patients were identified (17 men, mean age 54.1 years (range 23-86 years). The onset was abrupt in 22 patients; one patient had a subclinical presentation. Headache was the commonest presenting symptom (82.6%, 19/23). Neuro-ophthalmic manifestations were present in more than three-quarters of the patients (82.6%, 19/23). At presentation, 55 % (11/20), 47.6 % (10/21) and 60.9 % (14/23) of the patients had reduced visual acuity, field defects and cranial nerve palsies respectively. Management was conservative in 4 patients and surgical in 18 patients; one patient died shortly after presentation. The median follow up period was 10.5 months (22 patients, range 0.2-168 months). At final follow up, improvement was present in 100% of the patients with reduced acuity (8/8) and ocular palsy (13/13) and 81.8% of patients with field deficits (9/11). Age, sex, presence ...

Journal of Clinical Neuroscience, 2010

70-year-old man with right-sided C4 radiculopathy due to a VA loop. This man was treated with dec... more 70-year-old man with right-sided C4 radiculopathy due to a VA loop. This man was treated with decompression of the loop through right C3 and C4 hemilaminectomies and a facetectomy. 4 Horgan et al. elected to conservatively treat their patient who presented with cervical radiculopathy secondary to a right VA loop at the C4/5 level. 5 Our patient had complex left-sided VA loops at the C2/3 and C4 levels. His symptoms were clearly related to cervical motion, especially during extension and flexion. We performed a posterior cervical fusion from C2 to C6 in order to eliminate the motion at these levels. A direct decompression and reconstruction carried a higher risk of complications because he had a hypoplastic right VA. Posterior fusion resulted in complete resolution of his symptoms of vertebrobasilar insufficiency and an improvement in his radiculopathy.

American Journal of Ophthalmology, 2001

Pathological changes are reported in the anterior visual pathways of a 41 year old man with compl... more Pathological changes are reported in the anterior visual pathways of a 41 year old man with complex partial seizures treated with vigabatrin who developed bilateral visual field constriction. There was peripheral retinal atrophy with loss of ganglion cells and loss of nerve fibres in the optic nerves, chiasm, and tracts. No evidence of intramyelinic oedema was seen. These findings suggest that the primary site of injury lies within the ganglion cells in the retina. The degree of atrophy seen would suggest that the visual field loss is irreversible. (J Neurol Neurosurg Psychiatry 2001;70:787-789)

Journal of Cerebral Blood Flow & Metabolism, 2009

Brain edema and swelling is a critical factor in the high mortality and morbidity associated with... more Brain edema and swelling is a critical factor in the high mortality and morbidity associated with traumatic brain injury (TBI). Despite this, the mechanisms associated with its development are poorly understood and interventions have not changed in over 30 years. Although neuropeptides and neurogenic inflammation have been implicated in peripheral edema formation, their role in the development of central nervous system edema after brain trauma has not been investigated. This study examines the role of the neuropeptide, substance P (SP), in the development of edema and functional deficits after brain trauma in rats. After severe diffuse TBI in adult male rats, neuronal and perivascular SP immunoreactivity were increased markedly. Perivascular SP colocalized with exogenously administered Evans blue, supporting a role for SP in vascular permeability. Inhibition of SP action by administration of the neurokinin-1 (NK 1 ) antagonist, N-acetyl-L-tryptophan, at 30 mins after trauma attenuated vascular permeability and edema formation. Administration of the NK 1 antagonist also improved both motor and cognitive neurologic outcomes. These findings suggest that SP release is integrally linked to the increased vascular permeability and edema formation after brain trauma, and that treatment with an NK 1 receptor antagonist reduces edema and improves neurologic outcome.

Journal of Neurotrauma, 2011

Previous studies have demonstrated that the compound N-acetyl-L-tryptophan (NAT) reduces brain ed... more Previous studies have demonstrated that the compound N-acetyl-L-tryptophan (NAT) reduces brain edema and improves functional outcome following traumatic brain injury (TBI). In this study we examined whether this effect was mediated via the neurokinin-1 receptor, and whether there was an effect on axonal injury. We also explored whether the compound was effective, even when administered at delayed time points. Male Sprague-Dawley rats were subject to acceleration-induced, diffuse TBI and administered NAT, its inactive D-enantiomer, or saline vehicle. In contrast to NAT (2.5 mg/kg), the inactive D-enantiomer was ineffective at improving rotarod motor performance after TBI. NAT also improved cognitive outcome as assessed by the Morris water maze and novel object recognition tests, and reduced axonal injury at 5 and 24 h after TBI as assessed by amyloid precursor protein immunohistochemistry. However, efficacy of the membrane-impermeable NAT was limited to administration within 5 h, whereas administration of a form of NAT, L-732,138 (47 mg/kg), in which a trifluoromethyl benzyl ester group has been added, making it highly lipid soluble and able to cross the intact blood-brain barrier, significantly improved motor outcome, even when administration was delayed by as much as 12 h. We conclude that the neuroprotective effects of NAT are receptor-mediated, and that administration of the membrane-permeable form of the compound can be effective even up to 12 h after TBI.

This study was designed to determine whether long-term (2 years) brain exposure to mobile telepho... more This study was designed to determine whether long-term (2 years) brain exposure to mobile telephone radiofrequency (RF) fields produces any astrocytic activation as these glia react to a wide range of neural perturbations by astrogliosis. Using a purpose-designed exposure system at 900 MHz, mice were given a single, far-field whole body exposure at a specific absorption rate of 4 W/kg on five successive days per week for 104 weeks. Control mice were sham-exposed or freely mobile in a cage to control any stress caused by immobilization in the exposure module. Brains were perfusion-fixed with 4% paraformaldehyde and three coronal levels immunostained for glial fibrillary acidic protein (GFAP). These brain slices were then examined by light microscopy and the amount of this immunomarker quantified using a color deconvolution method. There was no change in astrocytic GFAP immunostaining in brains after long-term exposure to mobile telephony microwaves compared to control (sham-exposed or freely moving caged mice). It was concluded that long-term (2 years) exposure of murine brains to mobile telephone RF fields did not produce any astrocytic reaction (astrogliosis) detectable by GFAP immunostaining. Bioelectromagnetics 36:245–250, 2015.

Permanent proximal MCAO in the sheep results in space-occupying cerebral edema, raised ICP and mo... more Permanent proximal MCAO in the sheep results in space-occupying cerebral edema, raised ICP and mortality similar to human malignant MCA stroke. This animal model may prove useful for pre-clinical testing of anti-edema therapies that have shown promise in rodent studies.

Brain Research, 2012

The amyloid precursor protein (APP) increases following traumatic brain injury (TBI), although th... more The amyloid precursor protein (APP) increases following traumatic brain injury (TBI), although the functional significance of this remains unclear largely because the functions of the subsequent APP metabolites are so different: Aβ is neurotoxic whilst sAPPα is neuroprotective.

Pediatric and Developmental Pathology, 2006

Journal of Clinical Neuroscience, 2012

Non-accidental head injury (NAHI), also termed the ''shaken baby syndrome'', is a major cause of ... more Non-accidental head injury (NAHI), also termed the ''shaken baby syndrome'', is a major cause of death and severe neurological dysfunction in children under three years of age, but it is debated whether shaking alone is sufficient to produce brain injury and mortality or whether an additional head impact is required. In an attempt to resolve this question, we used a lamb model of NAHI since these animals have a relatively large gyrencephalic brain and weak neck muscles resembling those of a human infant. Three anaesthetised lambs of lower body weight than others in the experimental group died unexpectedly after being shaken, proving that shaking alone can be lethal. In these lambs, axonal injury, neuronal reaction and albumin extravasation were widely distributed in the hemispheric white matter, brainstem and at the craniocervical junction, and of much greater magnitude than in higher body weight lambs which did not die. Moreover, in the eyes of these shaken lambs, there was damage to retinal inner nuclear layer neurons, mild, patchy ganglion cell axonal injury, widespread Muller glial reaction, and uveal albumin extravasation. This study proved that shaking of a subset of lambs can result in death, without an additional head impact being required.

The Medical journal of Australia

This is thought to be the first report of the use of interferon therapy by intraventricular admin... more This is thought to be the first report of the use of interferon therapy by intraventricular administration in adult-onset subacute sclerosing panencephalitis. A 22-year-old female patient with subacute sclerosing panencephalitis was treated for three months with interferon by the intraventricular route and methisoprinol (inosiplex) by mouth. There was no obvious clinical improvement during this time, and the cerebrospinal-fluid measles antibody titre remained elevated. The lack of effect of therapy could be attributed partly to the patient's age and to the rapidly progressive deterioration in her condition before treatment. No significant side-effects were associated with this therapy. Further trials of these medications in adult-onset subacute sclerosing panencephalitis are indicated.

Australian Veterinary Journal

To assess the effect of impact with a nonpenetrating captive bolt pistol in pigs by studying the ... more To assess the effect of impact with a nonpenetrating captive bolt pistol in pigs by studying the resulting traumatic brain injury (TBI) and to compare the pathological changes with those found previously in the brains of sheep using a similar experimental paradigm. The unrestrained heads of six, anaesthetised, 7- to 8-week-old, Large White pigs were impacted in the temporal region with a nonpenetrating captive bolt pistol. Four hours postimpact, brains were perfusion-fixed with 4% paraformaldehyde. Coronal sections from six levels along the brain were cut and stained with haematoxylin and eosin and immunohistochemically for amyloid precursor protein, a sensitive marker of axonal injury (AI) in the brain after trauma. TBI in pigs was characterised only by very mild AI, whereas AI in sheep after captive bolt impact to the same head region was much more severe and widely distributed and often associated with vascular damage such as contusions, subarachnoid and intraparenchymal haemorrhage. TBI in pigs was much less severe than in sheep after non-penetrating mechanical impact of similar magnitude, confirming the importance of interspecies differences in determining an appropriate physical method of euthanasia.

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Pediatric and Developmental Pathology

Oncology

Primary central nervous system (CNS) lymphoma appears to be on the increase. This increase is rea... more Primary central nervous system (CNS) lymphoma appears to be on the increase. This increase is real rather than due to changes in nosology, physician awareness or increase in high-risk groups. Diagnostic guidelines appear to be well defined and widely accepted. We report 9 cases of primary CNS lymphoma seen at our institution over a 5-year period. The clinical presentation was variable, but consisted mostly of headache, motor dysfunction, and memory and behavioural disturbance. Surgery is of value for diagnosis. In general, surgical decompression is not recommended. Glucocorticoids and radiotherapy appear effective in the short term. The role of chemotherapy is uncertain.

Acta neurochirurgica. Supplement

Amyloid precursor protein (APP) has been shown to accumulate in traumatically injured axons as ea... more Amyloid precursor protein (APP) has been shown to accumulate in traumatically injured axons as early as 1 hour after injury. This accumulation may be due to interruption of fast axoplasmic transport and/or upregulation of APP synthesis. The aim of this study was to examine the neuronal cell body response to head impact using APP immunostaining in a focal non-missile head impact model. Ten anaesthetised and ventilated 2 year old Merino ewes were subjected to graded impact in the left temporal region by captive bolt. 2 hours after impact the brain was perfused fixed with formaldehyde. The tissue was mounted in paraffin, sectioned and stained with a monoclonal antibody to APP and standard H&E stain. APP positivity was semi-quantitated using a modification of our previously described sector scoring system [1]. Widespread neuronal APP positivity was found in the cerebral hemispheres and brain stem distant from the site of focal injury in all 10 animals. The most prominent APP positivity ...