Eng Gan | Monash University (original) (raw)

Papers by Eng Gan

Pediatric Research, 1988

A marked tissue-specific increase in erythrocyte adenosine deaminase activity is associated with ... more A marked tissue-specific increase in erythrocyte adenosine deaminase activity is associated with an autosomal dominantly inherited hemolytic anemia.

Advances in Experimental Medicine and Biology

The Medical journal of Australia

Peripheral oedema due to pelvic vein compression is a rare complication of bladder overdistension... more Peripheral oedema due to pelvic vein compression is a rare complication of bladder overdistension. Case reports in the literature are few and all have concerned bladder overdistension in men. We report what we believe to be the first case of peripheral oedema due to an overdistended bladder in an adult woman. Pari passu with the relief of bladder obstruction there was resolution of pelvic vein compression and peripheral oedema.

Cancer Research

Cytidine triphosphate synthetase (CTP synthetase) activity was measured in extracts from normal a... more Cytidine triphosphate synthetase (CTP synthetase) activity was measured in extracts from normal and malignant lymphoid cells. A range of enzyme activities was found in the majority of the lymphoproliferative disorders examined, with acute lymphocytic leukemia, nodular poorly differentiated lymphocytic lymphoma, and diffuse histiocytic (large cell) lymphoma (DHL) types exhibiting the widest ranges. The highest levels occurred in acute lymphocytic leukemia, nodular poorly differentiated lymphocytic lymphoma transforming to DHL, and DHL. In chronic lymphocytic leukemia and diffuse well-differentiated lymphocytic lymphoma, a narrow range was encountered, with individual values falling within that of the controls. The highest CTP synthetase levels in Hodgkin's disease were found in the clinically aggressive lymphocyte-depleted Hodgkin's disease.

American Journal of Otolaryngology, 2015

1. To assess the efficacy of omalizumab therapy in improving sinonasal outcomes in refractory all... more 1. To assess the efficacy of omalizumab therapy in improving sinonasal outcomes in refractory allergic fungal rhinosinusitis (AFRS) patients with moderate or severe asthma. 2. To determine if omalizumab therapy reduces the usage of corticosteroids or antifungal therapy in AFRS patients The clinical charts of patients with AFRS with moderate or severe asthma who received at least three subcutaneous injections of omalizumab therapy between 1st January 2012 and 1st May 2014 were retrospectively reviewed. These patients had undergone bilateral functional endoscopic sinus surgery (FESS) and failed adjunct medical treatments (oral or topical corticosteroids and/or antifungal therapy) prior to omalizumab therapy. Seven patients met the inclusion criteria and were included in this study. The mean age of the patients was 48.14. The average number of subcutaneous omalizumab injections was 7.57 (range 6-11) with a mean dosage of 287mg (range 225-375mg). The mean pre-omalizumab treatment Sino-Nasal Outcome Test-22 (SNOT-22) score was 52.14 while the mean post-omalizumab treatment SNOT-22 score was 35.86 (31% improvement). The mean pre-omalizumab therapy Phillpott-Javer endoscopic score (over the last one year before omalizumab therapy) was 36 while the mean post-omalizumab therapy endoscopic score (from the last clinic visit) was 14 (61% improvement). Omalizumab therapy reduced the dependence of AFRS patients on corticosteroid and antifungal treatments. Omalizumab therapy can be considered as a potential adjunct for the treatment for patients with refractory AFRS with moderate or severe asthma. However, larger prospective studies to confirm the findings of this study will be required.

The Medical journal of Australia, Jan 15, 2001

1. Med J Aust. 2001 Jan 15;174(2):101-2. Does the location of deep venous thrombosis affect the r... more 1. Med J Aust. 2001 Jan 15;174(2):101-2. Does the location of deep venous thrombosis affect the risk of developing postphlebitic syndrome? Villanueva EV, Anderson JN, Gan ET. Monash Institute of Public Health, Monash Medical Centre, Clayton, VIC. ...

European journal of cancer & clinical oncology, 1984

The levels of the purine catabolic enzymes, adenosine deaminase (ADA) and purine nucleoside phosp... more The levels of the purine catabolic enzymes, adenosine deaminase (ADA) and purine nucleoside phosphorylase (PNP), together with the pyrimidine activities, thymidine phosphorylase (TP) and thymidine kinase isozymes (TK) have been determined for cells obtained from solid lymphoid tissue of 38 patients with non-Hodgkin's lymphoma (NHL) and 14 individuals exhibiting benign reactive lymphoid hyperplasia. Within each NHL histological group subtyped according to the Rappaport classification, and in the reactive hyperplasia group, there was considerable variation in these activities. However, higher levels of TK and TP activities occurred in cells of the histologically unfavourable prognostic NHL groups compared with those of favourable histology or reactive hyperplasia. There was an inverse relationship between survival and elevated TK isozyme 1 and TP levels, which was independent of histological classification and clinical staging. These results indicate that, in addition to morpholog...

Expert Review of Endocrinology & Metabolism, 2009

Hereditary hemochromatosis due to homozygosity for the C282Y mutation in the HFE gene product is ... more Hereditary hemochromatosis due to homozygosity for the C282Y mutation in the HFE gene product is the most common autosomal recessive genetic disorder in populations of northern European descent, where it attains a maximum prevalence of approximately one in 200. ...

International Forum of Allergy & Rhinology, 2013

Background: Using the reverse Trendelenburg position (RTP) during functional endoscopic sinus sur... more Background: Using the reverse Trendelenburg position (RTP) during functional endoscopic sinus surgery (FESS) is a safe, simple, and cost-free method that has been found to reduce intraoperative blood loss. However, the critical angle of RTP that produces the least amount of bleeding without compromising surgical technique and safety remains unanswered. The objective of this study was to assess the effects of 5-degree, 10-degree, and 20-degree RTP (5-RTP, 10-RTP, and 20-RTP, respectively) on intraoperative bleeding during FESS.

International Forum of Allergy & Rhinology, 2013

The waiting time for functional endoscopic sinus surgery (FESS) in patients with chronic rhinosin... more The waiting time for functional endoscopic sinus surgery (FESS) in patients with chronic rhinosinusitis with nasal polyposis (CRSwNP) in the Canadian public healthcare system can be lengthy. Many such patients have significant nasal obstruction resulting in a poor quality of life. A simple and safe office-based polypectomy device to debulk nasal polyps allows immediate alleviation of nasal obstruction and better access for topical medications. The aim of this study is to assess the efficacy, safety, and patient tolerability of a vacuum-powered microdebrider in the outpatient clinic setting. The clinical charts of patients with CRSwNP who underwent office polypectomy with a vacuum-powered microdebrider between May 2012 and February 2013 were retrospectively reviewed. These patients were either awaiting surgery or had recurrent polyposis postsurgery that was amenable to office polypectomy. Previously completed procedural and clinical outcomes questionnaires by the patients and surgeon were analyzed. Sixty-eight patients underwent office polypectomy in this case series. Fifty-nine procedures (87%) were successfully completed. Failed complete polyp resections were due to fibrous polyps (n = 7; 10%), device failure (n = 1; 1.5%), and obstruction from a deviated nasal septum (n = 1; 1.5%). There was a 43% improvement in nasal obstruction score and significant reduction in polyp grade postpolypectomy. Majority of patients (n = 66; 97%) reported a comfort level of "fair" to "excellent." Bleeding was "light" in 61 cases (90%). There were no complications encountered. The vacuum-powered microdebrider is a safe, effective, and well-tolerated instrument to resect nonfibrous nasal polyps in the outpatient setting.

International Forum of Allergy & Rhinology, 2014

Budesonide is a potent corticosteroid commonly prescribed for management of inflammation in chron... more Budesonide is a potent corticosteroid commonly prescribed for management of inflammation in chronic rhinosinusitis (CRS). The standard for prescribing budesonide is via impregnated nasal saline irrigation (INSI), although recently the mucosal atomization device (MAD) has emerged as a theoretically superior method of distributing medication into the sinuses. The MAD atomizes medication into small droplets and this is thought to enhance absorption and improve bioavailability. However, no studies have shown whether enhanced absorption and improved bioavailability of budesonide via MAD causes adrenal suppression. The objective of this study is to determine whether budesonide via MAD affects the hypothalamic-pituitary-adrenal (HPA) axis. Twenty CRS patients were recruited from a tertiary rhinology clinic and randomized to take budesonide (1 mg) via MAD or via INSI twice a day for 60 days. The adrenocorticotropic hormone (ACTH) stimulation test and 22-item Sinonasal Outcomes Test (SNOT-22) questionnaire were administered on days 1, 30, and 60 of the study. Plasma budesonide and cortisol levels were simultaneously quantified using a high-performance liquid chromatography-tandem mass spectrometry technique. There was no indication of adrenal suppression in either group (n = 20) based on ACTH stimulation test results nor was there significant plasma budesonide levels detected in either group. Quality of life, as indicated by SNOT-22, did not differ between groups at 60 days (p = 0.404; 95% confidence interval [CI], -37.2 to 15.9), but SNOT-22 scores for patients using MAD did show statistically significant improvement at 60 days compared to baseline (p = 0.02). The MAD is likely a safe and effective method of delivering budesonide to the sinuses in the short term.

International Forum of Allergy & Rhinology, 2013

The Mucosal Atomization Device (MAD) distributes medication throughout the paranasal sinuses for ... more The Mucosal Atomization Device (MAD) distributes medication throughout the paranasal sinuses for patients with chronic rhinosinusitis (CRS). Determining the optimal head position is important to ensure maximal delivery of medication to the sinus cavities. The objective of this work was to determine the effect of the lying-head-back (LHB) and head-down and forward (HDF) position, on the distribution of topical nasal medication via MAD in cadaver specimens. Twenty specimens having received complete functional endoscopic sinus dissection were chosen. The MAD was used to administer 2 mL of fluorescein-impregnated saline solution through the nose in both the LHB and HDF positions. Fluorescein was identified on 11 predetermined anatomical areas using a blue light filter. Three blinded investigators assessed endoscopic images to determine the presence of fluorescein. A total of 440 anatomical locations (n = 20 cadavers) received administration of the fluorescein nasal spray in the LHB or HDF position. LHB position had significantly greater total distribution to all pertinent anatomical sites than the HDF position (76% vs 41%; p < 0.001; 95% confidence interval [CI], 0.26-0.44). The proportion of staining was significantly greater for the ethmoid (p = 0.11; 95% CI, 0.05-0.66), frontal (p < 0.01; 95% CI, 0.20-0.80), and sphenoid sinuses (p = 0.03; 95% CI, 0.07-0.73) when compared to the HDF position. A greater distribution of medication to the sinonasal cavities was observed in the LHB position compared to the HDF position. These areas are of particular clinical relevance in postsurgical patients with refractory CRS.

Scandinavian Journal of Haematology, 1983

The thymidine kinase isoenzyme profile was determined in peripheral blood mononuclear cells and s... more The thymidine kinase isoenzyme profile was determined in peripheral blood mononuclear cells and splenic tissue from 4 patients with hairy cell leukaemia, in order to assess the proliferative state of the hairy cell. The predominance of TK1 activity in all 4 spleens and in 2 out of 3 peripheral blood mononuclear cells examined, indicates that the hairy cell has significant proliferative capacity when compared to the neoplastic cell in other chronic lymphoproliferative disorders. It is suggested, in view of the heterogeneity in peripheral blood mononuclear TK isoenzyme types, that more extensive studies are warranted to examine the relationship between peripheral blood mononuclear TK1 activity and the occurrence of progressive disease in post-splenectomy patients.

Profound advances in our knowledge of hereditary hemochromatosis (HH) during the past 150 years h... more Profound advances in our knowledge of hereditary hemochromatosis (HH) during the past 150 years have resulted in two distinct "iron ages": the pre-HFE gene era and the post-HFE gene era. During these periods, family studies, HLA association studies, and ultimately HFE gene studies in various populations informed us of the genotypic prevalence as well as the clinical and biochemical penetrance of HH. We learned that HH has a highly variable clinical penetrance in susceptible individuals of Northern European ancestry. Further, we now recognize that the natural history of HH is not as discrete as previously believed, because genetic and environmental modifiers of disease penetrance are increasingly identified as influencing the clinical expression of HH.

Cost effectiveness and resource allocation : C/E, 2006

The objective of this paper is to estimate the amount of cost-savings to the Australian health ca... more The objective of this paper is to estimate the amount of cost-savings to the Australian health care system from implementing an evidence-based clinical protocol for diagnosing emergency patients with suspected pulmonary embolism (PE) at the Emergency department of a Victorian public hospital with 50,000 presentations in 2001-2002. A cost-minimisation study used the data collected in a controlled clinical trial of a clinical protocol for diagnosing patients with suspected PE. The number and type of diagnostic tests in a historic cohort of 185 randomly selected patients, who presented to the emergency department with suspected PE during an eight month period prior to the clinical trial (January 2002-August 2002) were compared with the number and type of diagnostic tests in 745 patients, who presented to the emergency department with suspected PE from November 2002 to August 2003. Current Medicare fees per test were used as unit costs to calculate the mean aggregated cost of diagnostic...

Anaesthesia and intensive care, 2005

We report the successful use of r-hirudin (lepirudin) for cardiopulmonary bypass in a 67-year-old... more We report the successful use of r-hirudin (lepirudin) for cardiopulmonary bypass in a 67-year-old man who developed heparin-induced thrombocytopenia type II during heparin treatment of an extensive deep venous thrombosis. Lepirudin was monitored by the modified ecarin clotting time in a "mobile laboratory" set up next to the cardiac theatre, aiming for lepirudin levels of 3.5 to 4.5 microg/ml during bypass.

Liver Transplantation, 2014

Fibrosis in livers with hepatitis C virus (HCV) recurrence after liver transplantation (LT) can b... more Fibrosis in livers with hepatitis C virus (HCV) recurrence after liver transplantation (LT) can be rapidly progressive, and the mechanisms underlying this process are poorly understood. In livers with HCV infections in the non-LT setting, there is a significant relationship between the development of structures known as the ductular reaction (DR), hepatic progenitor cells (HPCs), and fibrosis. This study characterizes the DR, HPCs, and fibrosis associated with HCV recurrence after LT. Immunohistochemistry and confocal microscopy were used to characterize the DR, HPC, and fibrosis in liver biopsy specimens. Key findings were confirmed in a separate, independent cohort. The initial characterization cohort had 194 biopsy samples from 105 individuals with HCV recurrence after LT. The immunophenotype, morphology, and location of the DR were consistent with an HPC origin. The DR correlated with intrahepatic fibrosis (rs = 0.529, P < 0.001) and the number of activated hepatic stellate cells (HSCs; rs = 0.446, P < 0.001). There was an early occurrence of hepatocyte replicative arrest as well as increased hepatocyte proliferation that correlated with the DR (rs = 0.295, P < 0.001). Replicative arrest preceded hepatocyte proliferation in early-stage injury. Hepatocyte proliferation decreased with advanced fibrosis; in contrast, the extent of the DR and the number of activated HSCs continued to increase. In the second cohort of 37 individuals, the DR and the number of HPCs similarly correlated with fibrosis and inflammation after LT. In conclusion, this is the first characterization of the DR in HCV-associated liver injury after LT. There was a significant correlation between the DR and the development of progressive fibrosis in HCV recurrence. These results suggest a pivotal role for both the DR and the HPC responses in the aggressive fibrosis seen with HCV recurrence after LT.

Seminars in Liver Disease, 2011

Advances in our knowledge of hereditary hemochromatosis (HH) over the past 150 years have reveale... more Advances in our knowledge of hereditary hemochromatosis (HH) over the past 150 years have revealed new insights into this common genetic disorder. Meticulous family and HLA association studies followed ultimately by cloning of the HFE gene have dramatically changed our understanding of the natural history and manifestations of HH. Cross-sectional studies demonstrated that HH had a highly variable clinical and biochemical penetrance in susceptible individuals of northern European descent. "State-of-the-art" large longitudinal population studies have accurately defined the natural history. We now recognize that HH is not as discreet an entity as previously thought because genetic and environmental modifiers of disease penetrance are increasingly identified as influencing the clinical course of HH. While phlebotomy remains the cornerstone of therapy, our diagnostic approach has been refined to incorporate new biochemical, genetic, and noninvasive methods that complement more traditional approaches. This review aims to encapsulate this new knowledge in a framework that addresses commonly raised issues relating to the current natural history, diagnosis, and management of HH patients.

PLoS ONE, 2013

Objectives: Hepatic steatosis is associated with an increased risk of developing serious liver di... more Objectives: Hepatic steatosis is associated with an increased risk of developing serious liver disease and other clinical sequelae of the metabolic syndrome. However, visual estimates of steatosis from histological sections of biopsy samples are subjective and reliant on an invasive procedure with associated risks. The aim of this study was to test the ability of a rapid, routinely available, magnetic resonance imaging (MRI) method to diagnose clinically relevant grades of hepatic steatosis in a cohort of patients with diverse liver diseases.

Pediatric Research, 1985

The metabolism o f inosine (Ino) and guanosine (Guo) was studied i n r a t blood and plasma i n v... more The metabolism o f inosine (Ino) and guanosine (Guo) was studied i n r a t blood and plasma i n v i t r o . Nucleoside levels were determined using a modification o f the HPLC method o f Hartwick and Brown 1977). When heparinized whole blood was spiked w i t h Ino and maintained a t room temperature, the level o f Ino declined i n a l i n e a r manner from an i n i t i a l concentrat i o n o f 9.9 t o 1.6 wg/ml a f t e r 60 min., giving a plasma h a l f -l i f e o f 23.7 min. Blood spiked w i t h Guo showed a similar l i n e a r decline i n Guo levels, but i n a f a s t e r manner (11.0 t o 0.1 pg/ml a t 60 min., h a l f -l i f e = 8.9 min.). The decline i n nucleoside concentration was greatly retarded by maintaining blood and plasma on ice. Addition o f dipyridamole (100 nmoles/ml) t o whole blood, t o block nucleoside uptake, retarded the disappearance o f Ino and Guo 1.2 and 2.8-fold, respect i v e l y . Addition o f 8-aminoguanosine (8-AG, 100 nmoles/ml), an i n h i b i t o r o f purine nucleoside phosphorylase (PNP), had a s l i g h t l y greater e f f e c t , increasing the h a l f -l i v e s o f Ino and Guo 2.5 and 4.4-fold, respectively. Dipyridamole and 8-AG had an additive e f f e c t i n whole blood. When r a t plasma was spiked a t room temperature w i t h Ino and Guo ( each a t 1 pg/ml), neither nucleoside was detectable a f t e r 30 min. However, addit i o n o f 8-AG t o spiked r a t plasma t o t a l l y i n h i b i t e d the reduction i n the levels o f each nucleoside f o r a t least 60 min. Thus, membrane transport and especially catabolism by PNP cause disappearance o f Ino and Guo from r a t blood i n v i t r

Pediatric Research, 1988

A marked tissue-specific increase in erythrocyte adenosine deaminase activity is associated with ... more A marked tissue-specific increase in erythrocyte adenosine deaminase activity is associated with an autosomal dominantly inherited hemolytic anemia.

Advances in Experimental Medicine and Biology

The Medical journal of Australia

Peripheral oedema due to pelvic vein compression is a rare complication of bladder overdistension... more Peripheral oedema due to pelvic vein compression is a rare complication of bladder overdistension. Case reports in the literature are few and all have concerned bladder overdistension in men. We report what we believe to be the first case of peripheral oedema due to an overdistended bladder in an adult woman. Pari passu with the relief of bladder obstruction there was resolution of pelvic vein compression and peripheral oedema.

Cancer Research

Cytidine triphosphate synthetase (CTP synthetase) activity was measured in extracts from normal a... more Cytidine triphosphate synthetase (CTP synthetase) activity was measured in extracts from normal and malignant lymphoid cells. A range of enzyme activities was found in the majority of the lymphoproliferative disorders examined, with acute lymphocytic leukemia, nodular poorly differentiated lymphocytic lymphoma, and diffuse histiocytic (large cell) lymphoma (DHL) types exhibiting the widest ranges. The highest levels occurred in acute lymphocytic leukemia, nodular poorly differentiated lymphocytic lymphoma transforming to DHL, and DHL. In chronic lymphocytic leukemia and diffuse well-differentiated lymphocytic lymphoma, a narrow range was encountered, with individual values falling within that of the controls. The highest CTP synthetase levels in Hodgkin's disease were found in the clinically aggressive lymphocyte-depleted Hodgkin's disease.

American Journal of Otolaryngology, 2015

1. To assess the efficacy of omalizumab therapy in improving sinonasal outcomes in refractory all... more 1. To assess the efficacy of omalizumab therapy in improving sinonasal outcomes in refractory allergic fungal rhinosinusitis (AFRS) patients with moderate or severe asthma. 2. To determine if omalizumab therapy reduces the usage of corticosteroids or antifungal therapy in AFRS patients The clinical charts of patients with AFRS with moderate or severe asthma who received at least three subcutaneous injections of omalizumab therapy between 1st January 2012 and 1st May 2014 were retrospectively reviewed. These patients had undergone bilateral functional endoscopic sinus surgery (FESS) and failed adjunct medical treatments (oral or topical corticosteroids and/or antifungal therapy) prior to omalizumab therapy. Seven patients met the inclusion criteria and were included in this study. The mean age of the patients was 48.14. The average number of subcutaneous omalizumab injections was 7.57 (range 6-11) with a mean dosage of 287mg (range 225-375mg). The mean pre-omalizumab treatment Sino-Nasal Outcome Test-22 (SNOT-22) score was 52.14 while the mean post-omalizumab treatment SNOT-22 score was 35.86 (31% improvement). The mean pre-omalizumab therapy Phillpott-Javer endoscopic score (over the last one year before omalizumab therapy) was 36 while the mean post-omalizumab therapy endoscopic score (from the last clinic visit) was 14 (61% improvement). Omalizumab therapy reduced the dependence of AFRS patients on corticosteroid and antifungal treatments. Omalizumab therapy can be considered as a potential adjunct for the treatment for patients with refractory AFRS with moderate or severe asthma. However, larger prospective studies to confirm the findings of this study will be required.

The Medical journal of Australia, Jan 15, 2001

1. Med J Aust. 2001 Jan 15;174(2):101-2. Does the location of deep venous thrombosis affect the r... more 1. Med J Aust. 2001 Jan 15;174(2):101-2. Does the location of deep venous thrombosis affect the risk of developing postphlebitic syndrome? Villanueva EV, Anderson JN, Gan ET. Monash Institute of Public Health, Monash Medical Centre, Clayton, VIC. ...

European journal of cancer & clinical oncology, 1984

The levels of the purine catabolic enzymes, adenosine deaminase (ADA) and purine nucleoside phosp... more The levels of the purine catabolic enzymes, adenosine deaminase (ADA) and purine nucleoside phosphorylase (PNP), together with the pyrimidine activities, thymidine phosphorylase (TP) and thymidine kinase isozymes (TK) have been determined for cells obtained from solid lymphoid tissue of 38 patients with non-Hodgkin's lymphoma (NHL) and 14 individuals exhibiting benign reactive lymphoid hyperplasia. Within each NHL histological group subtyped according to the Rappaport classification, and in the reactive hyperplasia group, there was considerable variation in these activities. However, higher levels of TK and TP activities occurred in cells of the histologically unfavourable prognostic NHL groups compared with those of favourable histology or reactive hyperplasia. There was an inverse relationship between survival and elevated TK isozyme 1 and TP levels, which was independent of histological classification and clinical staging. These results indicate that, in addition to morpholog...

Expert Review of Endocrinology & Metabolism, 2009

Hereditary hemochromatosis due to homozygosity for the C282Y mutation in the HFE gene product is ... more Hereditary hemochromatosis due to homozygosity for the C282Y mutation in the HFE gene product is the most common autosomal recessive genetic disorder in populations of northern European descent, where it attains a maximum prevalence of approximately one in 200. ...

International Forum of Allergy & Rhinology, 2013

Background: Using the reverse Trendelenburg position (RTP) during functional endoscopic sinus sur... more Background: Using the reverse Trendelenburg position (RTP) during functional endoscopic sinus surgery (FESS) is a safe, simple, and cost-free method that has been found to reduce intraoperative blood loss. However, the critical angle of RTP that produces the least amount of bleeding without compromising surgical technique and safety remains unanswered. The objective of this study was to assess the effects of 5-degree, 10-degree, and 20-degree RTP (5-RTP, 10-RTP, and 20-RTP, respectively) on intraoperative bleeding during FESS.

International Forum of Allergy & Rhinology, 2013

The waiting time for functional endoscopic sinus surgery (FESS) in patients with chronic rhinosin... more The waiting time for functional endoscopic sinus surgery (FESS) in patients with chronic rhinosinusitis with nasal polyposis (CRSwNP) in the Canadian public healthcare system can be lengthy. Many such patients have significant nasal obstruction resulting in a poor quality of life. A simple and safe office-based polypectomy device to debulk nasal polyps allows immediate alleviation of nasal obstruction and better access for topical medications. The aim of this study is to assess the efficacy, safety, and patient tolerability of a vacuum-powered microdebrider in the outpatient clinic setting. The clinical charts of patients with CRSwNP who underwent office polypectomy with a vacuum-powered microdebrider between May 2012 and February 2013 were retrospectively reviewed. These patients were either awaiting surgery or had recurrent polyposis postsurgery that was amenable to office polypectomy. Previously completed procedural and clinical outcomes questionnaires by the patients and surgeon were analyzed. Sixty-eight patients underwent office polypectomy in this case series. Fifty-nine procedures (87%) were successfully completed. Failed complete polyp resections were due to fibrous polyps (n = 7; 10%), device failure (n = 1; 1.5%), and obstruction from a deviated nasal septum (n = 1; 1.5%). There was a 43% improvement in nasal obstruction score and significant reduction in polyp grade postpolypectomy. Majority of patients (n = 66; 97%) reported a comfort level of "fair" to "excellent." Bleeding was "light" in 61 cases (90%). There were no complications encountered. The vacuum-powered microdebrider is a safe, effective, and well-tolerated instrument to resect nonfibrous nasal polyps in the outpatient setting.

International Forum of Allergy & Rhinology, 2014

Budesonide is a potent corticosteroid commonly prescribed for management of inflammation in chron... more Budesonide is a potent corticosteroid commonly prescribed for management of inflammation in chronic rhinosinusitis (CRS). The standard for prescribing budesonide is via impregnated nasal saline irrigation (INSI), although recently the mucosal atomization device (MAD) has emerged as a theoretically superior method of distributing medication into the sinuses. The MAD atomizes medication into small droplets and this is thought to enhance absorption and improve bioavailability. However, no studies have shown whether enhanced absorption and improved bioavailability of budesonide via MAD causes adrenal suppression. The objective of this study is to determine whether budesonide via MAD affects the hypothalamic-pituitary-adrenal (HPA) axis. Twenty CRS patients were recruited from a tertiary rhinology clinic and randomized to take budesonide (1 mg) via MAD or via INSI twice a day for 60 days. The adrenocorticotropic hormone (ACTH) stimulation test and 22-item Sinonasal Outcomes Test (SNOT-22) questionnaire were administered on days 1, 30, and 60 of the study. Plasma budesonide and cortisol levels were simultaneously quantified using a high-performance liquid chromatography-tandem mass spectrometry technique. There was no indication of adrenal suppression in either group (n = 20) based on ACTH stimulation test results nor was there significant plasma budesonide levels detected in either group. Quality of life, as indicated by SNOT-22, did not differ between groups at 60 days (p = 0.404; 95% confidence interval [CI], -37.2 to 15.9), but SNOT-22 scores for patients using MAD did show statistically significant improvement at 60 days compared to baseline (p = 0.02). The MAD is likely a safe and effective method of delivering budesonide to the sinuses in the short term.

International Forum of Allergy & Rhinology, 2013

The Mucosal Atomization Device (MAD) distributes medication throughout the paranasal sinuses for ... more The Mucosal Atomization Device (MAD) distributes medication throughout the paranasal sinuses for patients with chronic rhinosinusitis (CRS). Determining the optimal head position is important to ensure maximal delivery of medication to the sinus cavities. The objective of this work was to determine the effect of the lying-head-back (LHB) and head-down and forward (HDF) position, on the distribution of topical nasal medication via MAD in cadaver specimens. Twenty specimens having received complete functional endoscopic sinus dissection were chosen. The MAD was used to administer 2 mL of fluorescein-impregnated saline solution through the nose in both the LHB and HDF positions. Fluorescein was identified on 11 predetermined anatomical areas using a blue light filter. Three blinded investigators assessed endoscopic images to determine the presence of fluorescein. A total of 440 anatomical locations (n = 20 cadavers) received administration of the fluorescein nasal spray in the LHB or HDF position. LHB position had significantly greater total distribution to all pertinent anatomical sites than the HDF position (76% vs 41%; p < 0.001; 95% confidence interval [CI], 0.26-0.44). The proportion of staining was significantly greater for the ethmoid (p = 0.11; 95% CI, 0.05-0.66), frontal (p < 0.01; 95% CI, 0.20-0.80), and sphenoid sinuses (p = 0.03; 95% CI, 0.07-0.73) when compared to the HDF position. A greater distribution of medication to the sinonasal cavities was observed in the LHB position compared to the HDF position. These areas are of particular clinical relevance in postsurgical patients with refractory CRS.

Scandinavian Journal of Haematology, 1983

The thymidine kinase isoenzyme profile was determined in peripheral blood mononuclear cells and s... more The thymidine kinase isoenzyme profile was determined in peripheral blood mononuclear cells and splenic tissue from 4 patients with hairy cell leukaemia, in order to assess the proliferative state of the hairy cell. The predominance of TK1 activity in all 4 spleens and in 2 out of 3 peripheral blood mononuclear cells examined, indicates that the hairy cell has significant proliferative capacity when compared to the neoplastic cell in other chronic lymphoproliferative disorders. It is suggested, in view of the heterogeneity in peripheral blood mononuclear TK isoenzyme types, that more extensive studies are warranted to examine the relationship between peripheral blood mononuclear TK1 activity and the occurrence of progressive disease in post-splenectomy patients.

Profound advances in our knowledge of hereditary hemochromatosis (HH) during the past 150 years h... more Profound advances in our knowledge of hereditary hemochromatosis (HH) during the past 150 years have resulted in two distinct "iron ages": the pre-HFE gene era and the post-HFE gene era. During these periods, family studies, HLA association studies, and ultimately HFE gene studies in various populations informed us of the genotypic prevalence as well as the clinical and biochemical penetrance of HH. We learned that HH has a highly variable clinical penetrance in susceptible individuals of Northern European ancestry. Further, we now recognize that the natural history of HH is not as discrete as previously believed, because genetic and environmental modifiers of disease penetrance are increasingly identified as influencing the clinical expression of HH.

Cost effectiveness and resource allocation : C/E, 2006

The objective of this paper is to estimate the amount of cost-savings to the Australian health ca... more The objective of this paper is to estimate the amount of cost-savings to the Australian health care system from implementing an evidence-based clinical protocol for diagnosing emergency patients with suspected pulmonary embolism (PE) at the Emergency department of a Victorian public hospital with 50,000 presentations in 2001-2002. A cost-minimisation study used the data collected in a controlled clinical trial of a clinical protocol for diagnosing patients with suspected PE. The number and type of diagnostic tests in a historic cohort of 185 randomly selected patients, who presented to the emergency department with suspected PE during an eight month period prior to the clinical trial (January 2002-August 2002) were compared with the number and type of diagnostic tests in 745 patients, who presented to the emergency department with suspected PE from November 2002 to August 2003. Current Medicare fees per test were used as unit costs to calculate the mean aggregated cost of diagnostic...

Anaesthesia and intensive care, 2005

We report the successful use of r-hirudin (lepirudin) for cardiopulmonary bypass in a 67-year-old... more We report the successful use of r-hirudin (lepirudin) for cardiopulmonary bypass in a 67-year-old man who developed heparin-induced thrombocytopenia type II during heparin treatment of an extensive deep venous thrombosis. Lepirudin was monitored by the modified ecarin clotting time in a "mobile laboratory" set up next to the cardiac theatre, aiming for lepirudin levels of 3.5 to 4.5 microg/ml during bypass.

Liver Transplantation, 2014

Fibrosis in livers with hepatitis C virus (HCV) recurrence after liver transplantation (LT) can b... more Fibrosis in livers with hepatitis C virus (HCV) recurrence after liver transplantation (LT) can be rapidly progressive, and the mechanisms underlying this process are poorly understood. In livers with HCV infections in the non-LT setting, there is a significant relationship between the development of structures known as the ductular reaction (DR), hepatic progenitor cells (HPCs), and fibrosis. This study characterizes the DR, HPCs, and fibrosis associated with HCV recurrence after LT. Immunohistochemistry and confocal microscopy were used to characterize the DR, HPC, and fibrosis in liver biopsy specimens. Key findings were confirmed in a separate, independent cohort. The initial characterization cohort had 194 biopsy samples from 105 individuals with HCV recurrence after LT. The immunophenotype, morphology, and location of the DR were consistent with an HPC origin. The DR correlated with intrahepatic fibrosis (rs = 0.529, P < 0.001) and the number of activated hepatic stellate cells (HSCs; rs = 0.446, P < 0.001). There was an early occurrence of hepatocyte replicative arrest as well as increased hepatocyte proliferation that correlated with the DR (rs = 0.295, P < 0.001). Replicative arrest preceded hepatocyte proliferation in early-stage injury. Hepatocyte proliferation decreased with advanced fibrosis; in contrast, the extent of the DR and the number of activated HSCs continued to increase. In the second cohort of 37 individuals, the DR and the number of HPCs similarly correlated with fibrosis and inflammation after LT. In conclusion, this is the first characterization of the DR in HCV-associated liver injury after LT. There was a significant correlation between the DR and the development of progressive fibrosis in HCV recurrence. These results suggest a pivotal role for both the DR and the HPC responses in the aggressive fibrosis seen with HCV recurrence after LT.

Seminars in Liver Disease, 2011

Advances in our knowledge of hereditary hemochromatosis (HH) over the past 150 years have reveale... more Advances in our knowledge of hereditary hemochromatosis (HH) over the past 150 years have revealed new insights into this common genetic disorder. Meticulous family and HLA association studies followed ultimately by cloning of the HFE gene have dramatically changed our understanding of the natural history and manifestations of HH. Cross-sectional studies demonstrated that HH had a highly variable clinical and biochemical penetrance in susceptible individuals of northern European descent. "State-of-the-art" large longitudinal population studies have accurately defined the natural history. We now recognize that HH is not as discreet an entity as previously thought because genetic and environmental modifiers of disease penetrance are increasingly identified as influencing the clinical course of HH. While phlebotomy remains the cornerstone of therapy, our diagnostic approach has been refined to incorporate new biochemical, genetic, and noninvasive methods that complement more traditional approaches. This review aims to encapsulate this new knowledge in a framework that addresses commonly raised issues relating to the current natural history, diagnosis, and management of HH patients.

PLoS ONE, 2013

Objectives: Hepatic steatosis is associated with an increased risk of developing serious liver di... more Objectives: Hepatic steatosis is associated with an increased risk of developing serious liver disease and other clinical sequelae of the metabolic syndrome. However, visual estimates of steatosis from histological sections of biopsy samples are subjective and reliant on an invasive procedure with associated risks. The aim of this study was to test the ability of a rapid, routinely available, magnetic resonance imaging (MRI) method to diagnose clinically relevant grades of hepatic steatosis in a cohort of patients with diverse liver diseases.

Pediatric Research, 1985

The metabolism o f inosine (Ino) and guanosine (Guo) was studied i n r a t blood and plasma i n v... more The metabolism o f inosine (Ino) and guanosine (Guo) was studied i n r a t blood and plasma i n v i t r o . Nucleoside levels were determined using a modification o f the HPLC method o f Hartwick and Brown 1977). When heparinized whole blood was spiked w i t h Ino and maintained a t room temperature, the level o f Ino declined i n a l i n e a r manner from an i n i t i a l concentrat i o n o f 9.9 t o 1.6 wg/ml a f t e r 60 min., giving a plasma h a l f -l i f e o f 23.7 min. Blood spiked w i t h Guo showed a similar l i n e a r decline i n Guo levels, but i n a f a s t e r manner (11.0 t o 0.1 pg/ml a t 60 min., h a l f -l i f e = 8.9 min.). The decline i n nucleoside concentration was greatly retarded by maintaining blood and plasma on ice. Addition o f dipyridamole (100 nmoles/ml) t o whole blood, t o block nucleoside uptake, retarded the disappearance o f Ino and Guo 1.2 and 2.8-fold, respect i v e l y . Addition o f 8-aminoguanosine (8-AG, 100 nmoles/ml), an i n h i b i t o r o f purine nucleoside phosphorylase (PNP), had a s l i g h t l y greater e f f e c t , increasing the h a l f -l i v e s o f Ino and Guo 2.5 and 4.4-fold, respectively. Dipyridamole and 8-AG had an additive e f f e c t i n whole blood. When r a t plasma was spiked a t room temperature w i t h Ino and Guo ( each a t 1 pg/ml), neither nucleoside was detectable a f t e r 30 min. However, addit i o n o f 8-AG t o spiked r a t plasma t o t a l l y i n h i b i t e d the reduction i n the levels o f each nucleoside f o r a t least 60 min. Thus, membrane transport and especially catabolism by PNP cause disappearance o f Ino and Guo from r a t blood i n v i t r