%0 Journal Article
%~ Pubmed
%A Tiwari, Alok
%A Saw, Chong
%A Li, Michelle
%A Mohan, Irwin
%A Daly, Tom
%A Swinnen, John
%A Richardson, Arthur
%A So, Simon
%A Young, Noel
%A Vicaretti, Mauro
%A Fletcher, John
%T Use of inferior vena cava filters in a tertiary referral centre in Australia.
%B ANZ Journal of Surgery
%D 2010
%V 80
%N 5
%P 364-7
%@ 1445-2197
%X Introduction: To investigate the use of inferior vena cava (IVC) filters in a tertiary referral centre, looking at indication, types of filters and, with temporary/optional filters, removal rates. Methods: Data was collected from a prospective database of all IVC filters inserted from January 2003 to January 2007. Patients' records and radiological imaging were all reviewed. Results: 66 patients (40 males) had IVC filters inserted during the study period. The median age of the male patients was 57.5 (21-79) years, and females 56 (24-81). There were 49 (74.2%) temporary/optional filters and 17 (25.8%) permanent filters. The most common indication for filter was a contraindication to anticoagulation for both permanent (64.7%) and temporary/optional filters (77.6%). In the temporary/optional filter group, 38 of 49 (77.6%) patients had documented venous thromboembolism, while in the permanent filter group, this was 14 of 17 (82.4%). Of the optional filters, 22 of 49 (45.8%) have been removed. Conclusion: More than half (54.2%) of temporary/optional filters were not removed and with potential for long-term complications. A protocol has now being instituted for vascular surgeons to authorize the insertion of filters and to then be responsible for ensuring their removal.
%Z FOR Codes: 104



%0 Journal Article
%~ Pubmed
%A Tan, Irene
%A Young, Noel
%A Sindhusake, Doungkamol Poppy
%A Boddy, Rachel
%A Bui, Quoc
%A Nagra, Ravinder
%A Reddy, Jyothi
%T Prospective evaluation of selected clinical criteria for cranial computed tomography in non-trauma adult patients.
%B Emergency medicine Australasia : EMA
%D 2009
%V 21
%N 1
%P 43-51
%@ 1742-6723
%X OBJECTIVE: To evaluate the usefulness of previously published criteria by Rothrock et al. and Harris et al. for urgent, cranial CT in non-trauma presentations. METHODS: A prospective, observational study of consecutive adult patients with non-trauma presentations to Westmead Emergency Department, undergoing urgent cranial CT over a period of 2 years and 10 months. Clinical data were assessed to determine the presence of the proposed Rothrock and Harris criteria. Clinically significant findings defined by CT were intracerebral haemorrhage, acute infarction, intracranial infection, acute hydrocephalus, cerebral oedema and malignancy. RESULTS: A total of 1911 patients were studied. Among them, 21.7% (414/1911) of patients had clinically significant findings on CT. Application of the Harris criteria demonstrated a sensitivity of 93.5% (387/414, 95% CI 90.7-95.7) and a false negative rate of 6.5% (27/414, 95% CI 4.3-9.3) with a potential reduction in number of scans by 27.8%. With application of the Rothrock criteria, the possible scan reduction rate was 15% with a sensitivity of 98.8% (409/414, 95% CI 97.2-99.6) and a false negative rate of 1.2% (5/414, 95% CI 0.4-2.8). CONCLUSION: The Harris criteria were not validated by our study. The Rothrock criteria are also not confidently validated, but can be a useful guide for emergency physicians to help prioritize high-risk patients who might have clinically significant cranial CT findings. We have not replicated their very high sensitivity and very low false negative rates.
%Z FOR Codes: 110305



%0 Journal Article
%~ Pubmed
%A Varcoe, Ramon L
%A Mah, Jean
%A Young, Noel
%A So, Simon S
%A Vicaretti, Mauro
%A Swinnen, John
%T Prevalence of carotid stent fractures in a single-center experience.
%B Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists
%D 2008
%V 15
%N 4
%P 485-9
%@ 1526-6028
%X PURPOSE: To assess the prevalence of carotid stent fractures and quantify any associated restenosis or clinical events in a single-center experience. METHODS: Seventy-eight consecutive patients were recorded in a prospective database between 2003 and 2007. Nearly two thirds (51, 65%) were available for follow-up, which included magnified multiplanar radiography and selective duplex ultrasonographic studies to evaluate fracture and restenosis in 53 self-expanding stents (49 open-cell and 4 closed-cell designs). The images were assessed independently by 2 vascular radiologists blinded to the patients' clinical data. RESULTS: There was 1 (1.9%) stent fracture with no associated adverse events or restenosis. Six (11%) stents had an irregular "fish-scale" appearance that was easily confused for fracture and seen only in the open-cell stents. CONCLUSION: Stent fractures do occur in the carotid artery; however, they are rare and, in our experience, have no clinical sequelae. Radiological assessment should be incorporated into clinical and ultrasound surveillance protocols.
%Z FOR Codes: 110201



%0 Journal Article
%A Guo, Y
%A Piza, M
%A Gubin, G L
%A Dorsch, N
%A Young, Noel
%A Wong, K P
%T Neurological complications of cerebral angiography performed for hospital inpatients
%B Journal Hong Kong College of Radiologists
%D 2007
%C Hong Kong
%I Scientific Communications International Ltd.
%V 10
%N 
%P 9-15
%@ 1029-5097
%X 
%Z FOR Codes: 110320



%0 Journal Article
%~ Pubmed
%A Dorsch, N W C
%A Young, N
%A Kang, A
%A Ly, S
%T Ns09 detection and follow-up of aneurysms by cta.
%B ANZ Journal of Surgery
%D 2007
%V 77 Suppl 1
%N 
%P A53
%@ 1445-1433
%X Purpose To analyse usefulness of CTA in detecting aneurysms in subjects with a family history, and in follow-up of patients with known aneurysms. Methodology From 1997 to 2004, 286 adults with a family history of cerebral aneurysms were investigated by a spiral CT angiogram of the Circle of Willis. Their age range was 20-76, and 192 were female. Over a similar period 119 patients with 138 known aneurysms, described as Group 1, and another 84 with a past history of SAH and aneurysm treatment (Group 2), were followed by serial CTAs for up to 97 months, median 36 months. Results Of those with a family history, 193 had one CTA and the other 93 averaged 2.8 studies. Aneurysms were found in 15.4%, with 56 detected in 44 patients. There were multiple aneurysms in 12 of the 44 (27%); 80% of the aneurysms were under 7mm in diameter and 93% less than 13mm; 39% were on the MCA - all findings similar to other literature. In the 119 group 1 patients there were initially 120 aneurysms. During follow-up 18 more developed, a rate of 5% per year. Of these 138, 99 remained stable, 29 enlarged (21%), and nine became smaller. One aneurysm ruptured, a rupture rate of 0.28% per year. In group 2 patients, 75 aneurysms were found on the initial CTA in the 84 patients. Subsequent studies showed 19 new aneurysms for a total of 94 - annual development rate 7.5%. Four aneurysms ruptured in the study period, equivalent to 1.7% annually. Conclusions CTA is useful for relatives of aneurysm patients, for subjects with unruptured aneurysms, and for patients with past aneurysmal SAH. As others have shown, in this last group new aneurysms develop more often, they grow faster, they rupture more often, and they rupture at smaller size.



%0 Journal Article
%~ Pubmed
%A Nawawi, O
%A Young, N
%A So, S
%T Superselective coil embolization in gastrointestinal haemorrhage: early experience.
%B Journal of Medical Imaging and Radiation Oncology
%D 2006
%V 50
%N 1
%P 21-6
%@ 0004-8461
%X This is a retrospective study to evaluate our early experience of using selective microcoil embolization in patients who had gastrointestinal (GI) haemorrhage. From December 2002 to December 2003, six patients with GI haemorrhage (upper GI, n = 1; lower GI, n = 5) underwent superselective microcoil embolization. Microcatheters were used to carry out embolizations in branches of the superior mesenteric artery. Microcoils were used in five patients and a combination of microcoils and embolospheres was used in one patient. Technical success (bleeding target devascularization) was achieved in all patients who showed active bleeding at the time of angiography. Two patients had recurrent bleeding within 24 h of embolization, of which one (16.7%) died. The other patient did not require active intervention as bleeding was minimal and resolved with conservative management. Satisfactory clinical success (no rebleeding after 30 days) was achieved in five patients. No clinical signs and symptoms of bowel ischaemia occurred in these patients. Follow-up colonoscopy carried out in two patients did not show any signs of ischaemia in the affected bowel segments. Superselective microcoil embolization is an effective and safe method of controlling and arresting bleeding in GI haemorrhage.
%Z FOR Codes: 110320



%0 Journal Article
%~ Isi
%A Elton, C.
%A Riaz, A. A.
%A Young, N.
%A Schamschula, R.
%A Papadopoulos, B.
%A Malka, V.
%T Accuracy of computed tomography in the detection of blunt bowel and mesenteric injuries.
%B British Journal of Surgery
%D 2005
%C UK
%I John Wiley & Sons Ltd.
%V 92
%N 8
%P 1024-1028
%@ 0007-1323
%X 



%0 Journal Article
%~ Pubmed
%A Eftekhar, Kathy
%A Young, Noel
%A Fletcher, John
%A Bester, Lourens
%A Wong, Louise
%A Puttaswamy, Vikram
%T Clinical efficacy of metal stents for the treatment of focal abdominal aortic stenosis.
%B Journal of Medical Imaging and Radiation Oncology
%D 2004
%V 48
%N 1
%P 17-20
%@ 0004-8461
%X Seven patients (four women and three men) who underwent primary stenting of infrarenal abdominal aortic stenosis over a 4-year period are reported. The patients ranged between 44 and 77 years of age. All were referred for treatment of disabling claudication. Self-expanding stents with balloon assistance were used. A single complication, a retroperitoneal haematoma, requiring surgical intervention occurred in one patient. Patients had either complete resolution of symptoms (five of seven) or a substantial decrease in their claudication symptoms. Primary stenting is a safe and effective treatment for severe abdominal aortic stenosis.



%0 Journal Article
%~ Pubmed
%A Gradinscak, Denis J
%A Young, Noel
%A Jones, Yvette
%A O'Neil, Dianne
%A Sindhusake, Doungkamol
%T Risks of outpatient angiography and interventional procedures: a prospective study.
%B AJR. American journal of roentgenology
%D 2004
%V 183
%N 2
%P 377-81
%@ 0361-803X
%X OBJECTIVE: The purpose of this study was to evaluate complications in diagnostic and interventional angiographic procedures performed on outpatients. MATERIALS AND METHODS: Data were collected prospectively for 2,683 procedures performed on an outpatient basis in 2,248 patients from the period March 1997 to March 2002. Patients were assessed by nursing or medical staff within 2-4 hr of the procedure and again via telephone 24-48 hr after the procedure. The collected data were summarized on the basis of procedure type into four main groupings: aortofemoral studies, cerebral studies, interventional procedures, and other studies. Complication frequency distribution was determined for each procedure type. An interim summary of complication rates was prepared for the period March 1997 to June 1999. Statistical analysis using a two-tailed z-test for the comparison of two proportions was performed to determine if a significant difference existed in the rates of complications from data collected before and after the June 1999 summary. RESULTS: Ninety-one percent of cases completed follow-up. In total, 561 complications were identified in 2,436 cases (23%). Most complications consisted of either local pain or puncture site hematoma and bruising. No deaths occurred. In the 1,128 diagnostic aortofemoral studies performed, 211 complications (19%) occurred. In the 359 cerebral studies, 87 complications (24%) occurred. The 441 interventional procedures resulted in 146 complications (33%). In the remaining 508 procedures, 117 complications (23%) occurred. Major complications in each group are presented. CONCLUSION: We observed a low incidence of complications requiring further treatment or resulting in a permanent deficit. The rates are comparable to published data from similar studies and practice standards guidelines. A statistically significant improvement was seen in the total complication rate between the periods March 1997-June 1999 and July 1999-March 2002 (p = 0.01).



%0 Journal Article
%~ Pubmed
%A Young, N
%A Yeghiaian-Alvandi, R
%A Chin, Y S
%T Use of endovascular metal stents to alleviate malignant superior vena cava syndrome.
%B Internal Medicine Journal
%D 2003
%V 33
%N 11
%P 542-4
%@ 1444-0903
%X 
%Z FOR Codes: 110399



%0 Journal Article
%~ Pubmed
%A Lee, David
%A Chitturi, Shivakumar
%A Kench, James
%A George, Jacob
%A Fuller, Steven
%A Bradstock, Ken
%A Lin, Rita
%A Wong, Kai Ping
%A Young, Noel
%T Transjugular liver biopsy effecting changes in clinical management.
%B Journal of Medical Imaging and Radiation Oncology
%D 2003
%V 47
%N 2
%P 117-20
%@ 0004-8461
%X Although transjugular liver biopsies are frequently performed in patients with impaired blood coagulation, their impact on effecting changes in clinical management has not been assessed. We reviewed our experience with 43 consecutive transjugular liver biopsies performed over 3 years (1998-2000) at Westmead Hospital, Sydney, Australia. The technical success, procedural complication rates and subsequent management of these patients were ascertained from the medical case records. Forty-two (28 men) patients were studied. The indications for liver biopsy were as follows: assessment of hepatitis/cirrhosis status (n = 21), evaluation of liver dysfunction following bone marrow transplantation (n = 19) and miscellaneous (n = 2). All liver biopsies were performed with a Cook 20-G transjugular cutting needle device. Adequate histological samples were obtained in 42 (98%) of the 43 biopsies performed. The pre-biopsy diagnoses were confirmed by histology in 28 cases (65%). A change in clinical diagnosis was observed in 12 (28%) patients, and there were changes to subsequent management in all 12 patients. Four patients developed procedural complications, including small neck haematomas in two patients and a self-limiting biliary fistula in one. The only major complication was an extracapsular bleed from a hepatic laceration. This patient required emergency surgery but recovered. Transjugular liver biopsies can be effectively and safely performed in high-risk patients with impaired coagulation. They aid accurate histological appraisal of liver dysfunction in these patients and influence clinical decision-making.
%Z FOR Codes: 110320



%0 Journal Article
%~ Pubmed
%A Young, Noel
%A Chi, Ka-Kit
%A Ajaka, Joe
%A McKay, Lesa
%A O'Neill, Diane
%A Wong, Kai Ping
%T Complications with outpatient angiography and interventional procedures.
%B Cardiovascular and interventional radiology
%D 2002
%V 25
%N 2
%P 123-6
%@ 0174-1551
%X PURPOSE: To prospectively identify the complications, and rates of complication, in outpatient angiography and interventional procedures. METHODS: There were 1050 consecutive patients, 646 men and 404 women, aged 17-89 years, with a total of 1239 procedures studied in a 2-year period, 1997 to 1999. RESULTS: There were 560 cases of aorto-femoral angiography, resulting in 124 complications (22%), with pain or hematoma in 110. There were 206 cases of neck and cerebral angiography, resulting in 51 complications (25%), with pain and hematoma in 34, transient ischemic attack in 2 and cerebrovascular accident in 1. There were 197 interventional procedures, with 177 being balloon dilatations, resulting in 68 complications (35%), with 2 having hematomas and 1 having hematoma/abscess requiring active treatment. There were 276 cases having various "other" procedures (e.g., renal angiography), resulting in 65 complications (24%), with pain and hematoma in 61. No procedure-related death occurred. Eighteen cases (1.5%) had significant complications, with contrast allergy in eight. CONCLUSION: Outpatient angiography and intervention are relatively safe, with low significant complication rates.
%Z FOR Codes: 110201



%0 Journal Article
%~ Pubmed
%A Young, N
%A Dorsch, N W
%A Kingston, R J
%A Markson, G
%A McMahon, J
%T Intracranial aneurysms: evaluation in 200 patients with spiral CT angiography.
%B European radiology
%D 2001
%V 11
%N 1
%P 123-30
%@ 0938-7994
%X The goal of this study was to assess the usefulness of spiral CT angiography (CTA) with three- dimensional reconstructions in defining intracranial aneurysms, particularly around the Circle of Willis. Two hundred consecutive patients with angiographic and/or surgical correlation were studied between 1993 and 1998, with CTA performed on a GE HiSpeed unit and Windows workstation. The following clinical situations were evaluated: conventional CT suspicion of an aneurysm; follow-up of treated aneurysm remnants or of untreated aneurysms; subarachnoid haemorrhage (SAH) and negative angiography; family or past aneurysm history; and for improved definition of aneurysm anatomy. Spiral CTA detected 140 of 144 aneurysms, and an overall sensitivity of 97%, including 30 of 32 aneurysms 3 mm or less in size. In 38 patients with SAH and negative angiography, CTA found six of the seven aneurysms finally diagnosed. There was no significant artefact in 17 of 23 patients (74%) with clips. The specificity of CTA was 86% with 8 false-positive cases. Spiral CTA is very useful in demonstrating intracranial aneurysms.
%Z FOR Codes: 110320