Topics
Vascular diseases
The epidemiology of haemodialysis catheter infections in Australia, 2016–20: a prospective cohort study
The health burden of haemodialysis CVC infections in Australia is substantial, particularly among adults under 70 years of age
Benjamin Lazarus · Kevan R Polkinghorne · Martin P Gallagher · Jayson Catiwa · Nicholas A Gray · Sarah Coggan · Kathryn R Higgins · Girish Talaulikar · Stephen P McDonald AM · Sradha Kotwal
30/60/90 National stroke targets and stroke unit access for all Australians: it's about time
Australia’s stroke treatment performance has stagnated. A well targeted national quality improvement effort is required
For the 30/60/90 National Stroke Targets Taskforce
A summary of the 2023 Society of Obstetric Medicine of Australia and New Zealand (SOMANZ) hypertension in pregnancy guideline
The 2023 SOMANZ guideline presents significant updates on evidence-based recommendations for screening, prevention and management of hypertensive disorders of pregnancy
Renuka Shanmugalingam · Helen L Barrett · Amanda Beech · Lucy Bowyer · Tim Crozier · Amanda Davidson · Marloes Dekker Nitert · Kerrie Doyle · Luke Grzeskowiak · Nicole Hall · Hicham Ibrahim Cheikh Hassan · Annemarie Hennessy · Amanda Henry · David Langsford · Vincent WS Lee · Zachary Munn · Michael J Peek · Joanne M Said · Helen Tanner · Rachel Taylor · Meredith Ward · Jason Waugh · Linda LY Yen · Ellie Medcalf · Katy JL Bell · Deonna Ackermann · Robin Turner · Angela Makris
PEG‐GCSF‐induced aortitis in a patient with breast cancer: distinguishing between infective and immune‐mediated aortitis
A 64-year-old woman presented with non-neutropenic fever and back pain one day after the first cycle of neoadjuvant chemotherapy
Luigi Zolio · Prudence A Francis · Nava Ferdowsi
Catheter‐related superior vena cava syndrome: an increasing problem
A 16-year-old female patient with cystic fibrosis developed recurrent pleural effusions, facial plethora and prominent chest wall veins
John J Harvey · John I Vrazas · Elhamy Bekhit · Chris Barnes · Philip J Robinson
Australian evidence‐based guidelines for the prevention and management of diabetes‐related foot disease: a guideline summary
Despite the large national DFD burden, Australian regions implementing guideline-based care have demonstrated large reductions in their regional DFD burdens and costs
Peter A Lazzarini · Anita Raspovic · Jenny Prentice · Robert J Commons · Robert A Fitridge · James Charles · Jane Cheney · Nytasha Purcell · Stephen M Twigg
Hypertensive retinopathy in the paediatric setting
A 12-year-old girl presented to a general practitioner with a two-day history of progressively worsening blurry vision
Nandini Singh · Kanika Chaudhri · Caroline Catt
Controversies in the management of proximal deep vein thrombosis
Future studies should focus on patient selection for interventional therapy, best practices for stent surveillance, and long term anticoagulation
Jana‐Lee Moss · Frederikus A Klok · Uyen G Vo · Toby Richards
Reducing the number of unplanned returns to hospital after treatment for peripheral artery disease
Improved, integrated care for older patients with complex medical needs could avert some modifiable causes of readmission
Bethany Stavert · Sarah Aitken
Angiosarcoma presenting as unexplainable unilateral leg pain and purpuric toes
An older man presented with increasing pain the in right leg over 3 months, with no relief after femoral artery stenting
Genevieve Ho · Dedee F Murrell
Isolated superior ophthalmic vein thrombosis
A 62-year-old man presented with left eye swelling and 3 weeks of intermittent epiphora without visual disturbance
Douglas Dunn · Sebastian Brown · Sartaj Sandhu · Domit Azar
Paradoxical embolism through patent foramen ovale as a cause of myocardial infarction
A 42-year-old man presented with acute onset substernal chest pain
Naim Mridha · Eloise Ward · Samual Hayman · Arun Dahiya · Sandhir Prasad
A case of central Horner syndrome after haemorrhagic stroke
A 75-year-old man presented with right hemiparesis secondary to a left thalamic haemorrhage
Julia Lim · Yi Chao Foong
Epipericardial fat necrosis: chest pain in a young pregnant woman
A 28-year-old woman at 16 weeks’ gestation presented to the emergency department with a 2-day history of severe, worsening left- sided pleuritic chest pain
Rohan V Navani · Claudia Ashkar · Harry Gibbs
A curious case of finger pain
A 65-year-old man from a rural town presented with severe left- hand pain on a background of previously diagnosed Buerger disease
Warren Clements · Heather K Moriarty
May–Thurner syndrome: an overlooked cause of venous thromboembolism
To the Editor: The recent article by Akram and Sadashiv1 presents a timely and most welcome opportunity to enhance awareness, in the medical community at large, of the investigation and treatment options for proximal deep vein thrombosis (DVT) of the lower extremity. Diagnosis of lower extremity DVT is generally made or confirmed with duplex ultrasound assessment. Standards in Australia and New Zealand state that duplex ultrasound for DVT should determine the proximal extent of the thrombus, as well as identify structures causing extrinsic compression that may have contributed to the thrombosis.2 This information assists the clinician in determining the need to consider specific treatments, such as venous stenting for May–Thurner syndrome or placement of a caval filter in cases where there is a free‐floating thrombus in the inferior vena cava. Duplex ultrasound can play a key role in the diagnosis of May–Thurner syndrome.3 Technical factors, such as the presence of bowel gas, may inhibit ultrasonographic views of the abdominal and pelvic vasculature, and may therefore prevent attainment of the required information. Further, clinical experience in vascular surgery services in Australia and overseas has shown that, despite the above‐mentioned standards, it is common for there to be no attempt to obtain adequate proximal views during ultrasound DVT scans. Clinicians should therefore be wary of the limitations of ultrasound DVT scans and consider alternate imaging modalities such as computed tomography venography in cases where ultrasound has yielded inadequate information. Clinicians should also be aware of the potential of clot removal therapies such as catheter‐directed thrombolysis to improve long term outcomes for patients with proximal lower extremity DVT, whether or not May–Thurner syndrome is identified as a predisposing factor. Recent studies have reported improvements in the incidence and/or severity of post‐thrombotic syndrome in patients receiving catheter‐directed thrombolysis compared with those treated with anticoagulation alone.4,5 The appropriateness of catheter‐directed thrombolysis for some patients is acknowledged in the relevant guidelines,6 although patient selection remains a topic of debate. Lower extremity DVT is a common condition encountered in both inpatient and community settings. Due to technical considerations and quality variations, ultrasound DVT scans do not always yield adequate information to determine the optimal therapeutic approach. In such situations, consultation with a vascular specialist is strongly encouraged.
Trevor MY Kwok
Advances in stroke medicine
To the Editor: Reperfusion therapies in acute ischaemic stroke have become well recognised in recent years. The article by Campbell1 summarises current practice and addresses the benefits and challenges of several reperfusion therapies, but it misses one key prevention strategy. Carotid stenosis is a significant cause of ischaemic stroke — it is present in about 20% of patients with stroke2 — and can lead to the formation of thromboembolism or haemodynamic failure from hypoperfusion.3 Multidisciplinary care is vital to the management of acute stroke, and carotid endarterectomy is a safe and effective procedure that significantly reduces the risk of stroke and improves perfusion to the brain.4 Carotid endarterectomy plays an important role as reperfusion therapy in acute ischaemic stroke and is integral clinical practice in the management of stroke.5
Suk Cheng · Toby Richards
Propylthiouracil‐induced vasculitis in carbimazole‐refractory Graves disease
A 59- year- old woman with carbimazolerefractory Graves disease presented with fever and extensive necrotising rash 2 weeks after commencing propylthiouracil therapy
Brian Lam · Alexander Yuile · Suran L Fernando
A rare red eye: cavernous sinus dural arteriovenous fistula masquerading as conjunctivitis and sinusitis
A 77-year-old woman with a background of hypertension, diet-controlled type 2 diabetes and bilateral cataract surgery was referred by her GP to the emergency department
Stuart Campbell · Emma Hack · Babu Philip
Advances in stroke medicine
Reperfusion therapies for ischaemic stroke have transformed the prognosis for long term disability, but maximising patient benefit requires increased community recognition and faster treatment
Bruce CV Campbell
Reversal of dabigatran with idarucizumab in hyperacute stroke: a new paradigm?
A 68- year- old man presented with hyperacute stroke one hour after symptom onset
Amy Ting · Abhay R Venkat · Yash Gawarikar · Ronak Patel
Carotid sinus hypersensitivity
55- year- old otherwise healthy woman presented with the first episode of syncope
Vahid Moosavi · Mohammad Paymard
Hereditary haemorrhagic telangiectasia
A 52-year-old woman presented with symptomatic iron deficiency anaemia …
Varitsara Mangkorntongsakul · Cecily J Forsyth
