Topics
Digestive system diseases
Enhancing hepatitis C treatment in the custodial setting: a national roadmap
Even in settings with well developed infrastructure, few potentially eligible prisoners get hepatitis C treatment
Michael M Mina MB ChB(Hons), MRCP, MIPH(Hons) · Paul J Clark MB BS(Hons), PhD, FRACP · Holly M Beasley BSc, PostGradDip (IntHealth) · Lilie Herawati MD, MPH · Tony G Butler MSc, PhD · Andrew R Lloyd MB BS, MD, FRACP
Investigating iron deficiency anaemia
To the Editor: The response of Sievert and colleagues for the Gastroenterological Society of Australia1 to an article on iron deficiency anaemia in a young woman2 missed the point. In the absence of menorrhagia, dietary deficiency of iron is extraordinarily rare unless the individual is a vegan. The young woman presented with a haemoglobin level of 61 g/L and was treated with iron supplements over a ...
Terry D Bolin
Investigating iron deficiency anaemia
To the Editor: The Gastroenterological Society of Australia (GESA) response1 to the anonymous father’s heartfelt account of the suffering and ultimate death of his daughter, misdiagnosed on a number of occasions by general practitioners and medical specialists, was, in my view, inadequate. The young woman certainly warranted a colonoscopy, if not at presentation then certainly after 6 months of unsuccessful iron replacement therapy. Sievert and colleagues should ...
Randolph S Williams
Investigating iron deficiency anaemia
In reply: We appreciate the interest of Bolin and Williams regarding our article.1 We agree that further investigation of iron deficiency anaemia was indicated in this patient, as her clinical presentation of severe, unexplained anaemia is clearly articulated in the Gastroenterological Society of Australia recommendations as requiring such diagnostic investigation, as stated in our article. Colonoscopy would have been the most appropriate investigation. Williams states ...
William Sievert · Barbara A Leggett · Finlay A Macrae
Nature and outcomes of the increased incidence of colorectal malignancy after liver transplantation in Australasia
Objectives: To examine whether incidence of colorectal malignancy is increased in Australasian liver transplant recipients compared with the general population of Australia, and to assess the characteristics and outcomes of colorectal malignancy in this patient group.Design, setting and patients: Data on patients who underwent orthotopic liver transplantation (OLTx) and had a diagnosis of de-novo colorectal malignancy after transplantation during the period ...
Deborah J Verran MB ChB, FRACS · Marie H Mulhearn BAppSc (Nursing), GradDipHPEd · Pamela J Dilworth RN · Glenda A Balderson BSc · Stephen Munn MB ChB, FRACs · John W Chen MB BS, FRACS, PhD · Michael A Fink MB BS, FRACS · Michael D Crawford MB BS, FRACS, MMed · Geoffrey W McCaughan MB BS, PhD, FRACP
Novel insights into the pathology of upper gut symptoms: new syndromes, new diseases
The importance of gut microflora in human health and immunity is just beginning to be realised.
Nicholas J Talley MB BS(Hons), MD, PhD · Marjorie M Walker BMedSci, BM BS, FRCPath
Treatment outcomes for Indigenous and non-Indigenous inmates with hepatitis C in New South Wales prisons
New South Wales prisons data add to previous findings which show that Indigenous and non-Indigenous Australians achieve similar hepatitis C treatment outcomes.
Jeffrey J Post · Andrew R Lloyd · Denise Monkley
Khat-associated hepatitis
We report a case of khat-associated hepatitis in a 32-year-old Somali man living in Australia. This is the first case of hepatoxicity related to khat ingestion reported in Australia.Clinical recordA 32-year-old Somali man with no prior medical history presented to the emergency department with a 1-week history of dark urine, pruritus and jaundice, on a background of a month of malaise and reduced appetite. He ...
Malcolm P Forbes MB BS · Ashok S Raj MB ChB, FRACP · Jennifer Martin MB ChB, FRACP, PhD · Guy Lampe MB BS, FRCPA · Elizabeth E Powell FRACP, FRCP, PhD
Modifying the gluten-free threshold for foods: first do no harm
To the Editor: The gluten-free (GF) diet for people with coeliac disease (CD) is complex, costly, and compliance with the diet is variable. Coeliac Australia, with the Australian Food and Grocery Council, are lobbying to increase the mandated gluten threshold for GF foods.1 The situation in Australia since 1995 has been that there must be “no detectable gluten” in foods labelled “gluten free”. The proposed new ...
Geoffrey M Forbes
Iron deficiency anaemia in a young woman: a plea for early investigation
A tragic case of delayed diagnosis prompts a question from the patient’s father: are current guidelines appropriate and correctly interpreted in practice?
Anonymous
Investigating iron deficiency anaemia
Persistent unexplained iron deficiency should always be investigated, but iron deficiency is common and colorectal cancer rare in young women — the risks of investigation must be balanced against the risks of serious pathologyWe would like to express our sympathy to the family and to acknowledge the tragedy of the circumstances in regard to the death of their 29-year-old family member from metastatic colon cancer. To ...
for the Gastroenterological Society of Australia
Emergency surgery model improves outcomes for patients with acute cholecystitis
To the Editor: Reducing the time from presentation to cholecystectomy in patients with acute cholecystitis has been shown to benefit patients (eg, by reducing the duration of patient discomfort before surgery) and to be cost-effective.1-3 Benefits have also been shown for performing cholecystectomy during the index admission for gallstone pancreatitis.4 Geelong Hospital (in regional Victoria) introduced daily general surgery emergency theatre sessions in February 2011. We ...
Daniel P McGlade · David A Watters · Douglas A Stupart
19th century haemorrhoid diathermy clamp
To the Editor: In London in the late 1960s, one of my chiefs regularly used a diathermy clamp (Med J Aust 2012; 197: 193) for the management of third and fourth degree piles. The patient was anaesthetised, placed in the lithotomy position, and draped. Meanwhile, the clamp was brought to red heat on a Bunsen burner in a side room and fetched into theatre by ...
William E M Renton-Power
Identifying and prioritising gaps in colorectal cancer trials research in Australia
There is a mismatch between the high proportion of registered trials in advanced colorectal cancer and the areas of priority identified. The development of specific trials in these priority areas depends on the availability of funding and the existence of plausible interventions likely to improve patient outcomes.
Rachel F Dear MB BS, PhD, FRACP · Alexandra L Barratt MB BS, MPH, PhD · Alison Evans PhD · John Simes MD, PhD · John Newsom BA · Dan Kent GDM · Sally Crossing BEc · Catherine Holliday PhD · Eva Segelov MB BS, FRACP, PhD · George Hruby MB ChB · Martin HN Tattersall MD
This pioneering spirit
Next year, it will be 200 years since Blaxland, Lawson and Wentworth crossed Australia’s Great Dividing Range, opening up the lands beyond to European exploration and settlement. Last century, other pioneering Australians cleared the way towards better health with discoveries and developments as diverse as penicillin (Florey), lithium (Cade) and Helicobacter pylori (Marshall and Warren), and as courageous as life-saving heart surgery (Chang) and our bold ...
Ann Gregory · Ruth Armstrong
Treating Crohn’s disease: at “deep” remission and exploring beyond
A new treatment target includes mucosal healing as well as clinical remissionIn the late 1990s, controlled trials confirmed the efficacy of tumour necrosis factor-alpha (TNF-α) antibodies in treating active Crohn’s disease, signalling a major breakthrough in treatment. TNF-α monoclonal antibody therapy has since been shown to lead to significant improvements in quality of life and symptom control and a decrease in the need for surgery ...
Crispin Corte MB BS, BSc(Med), FRACP · Warwick S Selby MB BS, MD, FRACP
Australia’s first liver–intestinal transplant
With the completion of the first liver–intestinal transplant in Australia in July 2010, the Austin Hospital in Victoria became one of only 35 active centres worldwide to offer this life-saving procedure to patients with irreversible intestinal failure and associated life-threatening complications of parenteral nutrition.Clinical recordA 32-year-old man was initially referred to our centre in 2005 after the progression of multiple complications of long-term parenteral nutrition (PN) for ...
Mayur Garg MB BS, FRACP · Robert M Jones MB BS, FRACS · Darius Mirza MB BS, FRCS, MS · Bao Zhong Wang MB BS, FRACS · Michael A Fink MB BS, FRACS · Graham Starkey MB BS, FRACS · Rhys B Vaughan MB BS, FRACP, PhD · Adam G Testro MB BS(Hons), FRACP, PhD
Listeria monocytogenes infection in Crohn’s disease treated with adalimumab
Clinical record A 58-year-old man with a history of Crohn’s disease presented to the emergency department of a peripheral hospital in March 2011. He had been ill for the past day, with confusion, fluctuating expressive dysphasia, frontal headache and fever, preceded by 12 hours of lethargy and myalgia. The patient had been diagnosed with Crohn’s disease 2 years earlier after a colonoscopy for profuse bloody stools, which revealed extensive ...
Kaspar J Willson MB BS, BMedSci · Antony Jacob MB BS, MRCP(UK) · Mohit P Shetti MB BS, MD(Med), DNB(Med) · Rajesh Bhatia MB BS, FRACP · Kwang Yee MB BS(Hons), FRACP · William Osler MBChB, FRACP
Pancreatic cancer: surgical management and outcomes after 6 years of follow-up
To the Editor: Speer and colleagues’ recent article concerning pancreatic cancer outcomes makes sobering reading.1 Notwithstanding the results of surgery being in line with other case series, they found a somewhat high rate (nearly 40%) of positive resection margins in patients undergoing surgery with curative intent. The authors also cite evidence from other studies indicating benefit from a small number of surgeons each performing a ...
Andrew A Thomson
Is the end of chronic hepatitis C virus infection in sight?
Direct antiviral agents may hold the key to eradication, but only if they reach those who will benefitIn this issue of the Journal, Dore outlines the astonishing recent progress in the treatment of hepatitis C virus (HCV) infection,1 largely triggered by the approval in 2011 by regulatory bodies, both overseas and in Australia, of the first ...
Geoffrey W McCaughan MB BS, PhD, FRACP
The changing therapeutic landscape for hepatitis C
The next decade will be a crucial period in the public health response to hepatitis C virus (HCV) infection. The rapid development of direct-acting antiviral therapy for HCV infection has brought considerable optimism to the HCV sector, with the realistic hope that therapeutic intervention will soon be more effective and offer shorter treatment duration. ...
Gregory J Dore MPH, PhD, FRACP
Hepatitis C treatment outcomes in Australian clinics
Objective: To determine hepatitis C (HCV) treatment effectiveness and predictors of response in the “real-world” Australian clinic setting. Design, setting and participants: Patients with chronic HCV, who were HCV-treatment-naive at enrolment, and were then treated with standard therapy (pegylated interferon-α plus ribavirin), were recruited prospectively through a national network of 24 HCV clinics ...
Heather F Gidding MAppEpid, PhD · Matthew G Law PhD · Janaki Amin PhD · George Ostapowicz BMed, MD, FRACP · Martin Weltman PhD, FAChAM, FRACP · Graeme A Macdonald MB BS, PhD, FRACP · Joe J Sasadeusz MB BS, PhD, FRACP · Paul AW Haber MD, FRACP, FAChAM · Jacob George MB BS, PhD, FRACP · Gregory J Dore MPH, PhD, FRACP
Modelling antiviral treatment to prevent hepatitis C infection among people who inject drugs in Victoria, Australia
Objectives: To develop a mathematical model to project the potential impact of hepatitis C virus (HCV) treatment on HCV infection prevalence among people who inject drugs (PWID). Design and setting: An existing model of HCV transmission among PWID was parameterised using data from Victoria, Australia, including specific parameter estimates of the number ...
Margaret E Hellard PhD, FRACP, FAFPHM · Rebecca Jenkinson BEng(Geol), MEpid, PhD · Peter Higgs BSW, MA, PhD · Mark A Stoové BaAppSci(Hons), GradDip(Ed), PhD · Rachel Sacks-Davis BA BSc(Hons[Arts]) · Judy Gold BBiomedSci(Hons), PhD · Matthew Hickman MSc, PhD, FFPH · Peter Vickerman DPhil, BSc · Natasha K Martin PhD
Pancreatic cancer: surgical management and outcomes after 6 years of follow-up
Objective: To describe the management and outcomes of a population-based cohort of patients with pancreatic cancer in Victoria, Australia.Design, setting and patients: Retrospective study based on questionnaires completed from medical histories of patients diagnosed with pancreatic cancer during 2002–2003 in Victoria who were identified from the Victorian Cancer Registry and followed up ...
Antony G Speer BE, MB BS, FRACP · Vicky J Thursfield BSc, GradDip(ApplStats) · Yvonne Torn-Broers BA(Hons) · Michael Jefford MB BS, PhD, FRACP
Accidental ingestion of plastic from takeaway containers — food for thought
To the Editor: We read with interest the case report by Guirgis and colleagues. Recently, we examined a 62-year-old man with a 20-day history of dysphagia with solids and odynophagia. He did not recall ingesting any foreign body, and his medical history and physical examination were unremarkable.
Athanasios Sioulas · Dimitrios Polymeros · Ioannis S Papanikolaou · Konstantinos Triantafyllou
