School of Medicine Publications - UQ eSpace

Trends in utilization of hospital beds by older patients in Australia

Gray, L. C. og Yeo, M. A. og Duckett, S. — 2007-08-23T00:00:00Z

Trepopnoea due to positional narrowing of the left main bronchus

2007-08-13T00:00:00Z

TRH stimulation test and depression

2008-08-28T00:00:00Z

A thyrotropin-releasing hormone (TRH) stimulation test was performed in 52 male inpatients with major depressive disorder. Twenty-nine percent of the 52 subjects had a delta thyroid-stimulating hormone (ΔTSH) < 5 μU/ml. The cerebrospinal fluid (CSF) amine metabolites, 3-methoxy-4-hydroxyphenylglycol (MHPG), homovanillic acid (HVA), and 5-hydroxyindoleacetic acid (5HIAA), were measured in 29 subjects, and a dexamethasone suppression test (DST) was performed in 48 subjects. Of the three CSF amine metabolites, only MHPG correlated significantly with baseline TSH and none correlated with ΔTSH. The baseline TSH correlated positively with the TSH response at 30 minutes. Neither baseline TSH nor ΔTSH correlated with cortisol levels before or after dexamethasone. The correlation between CSF MHPG and serum TSH suggests a relationship between central norepinephrine and baseline TSH.

TRH stimulation test and sleep measures in depression

2008-08-28T00:00:00Z

Triage of referrals to outpatient hepatology services: an ineffective tool to prioritise patients?

2012-12-23T00:25:57Z

Trial of a mobile phone method for recording dietary intake in adults with type 2 diabetes: evaluation and implications for future applications

2011-10-16T00:00:00Z

Trial-of-antibiotic algorithm for the diagnosis of tuberculosis in a district hospital in a developing country with high HIV prevalence

2007-08-13T11:46:59Z

OBJECTIVE: To evaluate a diagnostic algorithm for pulmonary tuberculosis based on smear microscopy and objective response to trial of antibiotics. SETTING: Adult medical wards, Hlabisa Hospital, South Africa, 1996-1997. METHODS: Adults with chronic chest symptoms and abnormal chest X-ray had sputum examined for Ziehl-Neelsen stained acid-fast bacilli by light microscopy. Those with negative smears were treated with amoxycillin for 5 days and assessed. Those who had not improved were treated with erythromycin for 5 days and reassessed. Response was compared with mycobacterial culture. RESULTS: Of 280 suspects who completed the diagnostic pathway, 160 (57%) had a positive smear, 46 (17%) responded to amoxycillin, 34 (12%) responded to erythromycin and 40 (14%) were treated as smear-negative tuberculosis. The sensitivity (89%) and specificity (84%) of the full algorithm for culture-positive tuberculosis were high. However, 11 patients (positive predictive value [PPV] 95%) were incorrectly diagnosed with tuberculosis, and 24 cases of tuberculosis (negative predictive value [NPV] 70%) were not identified. NPV improved to 75% when anaemia was included as a predictor. Algorithm performance was independent of human immunodeficiency virus status. CONCLUSION: Sputum smear microscopy plus trial of antibiotic algorithm among a selected group of tuberculosis suspects may increase diagnostic accuracy in district hospitals in developing countries.

Trials (and tribulations) of biocompatible peritoneal dialysis fluids

2012-07-09T09:51:00Z

Trials and tribulations of recruiting 2,000 older women onto a clinical trial investigating falls and fractures: Vital D study

2011-09-11T00:00:00Z

Trichomonas vaginalis is associated with pelvic inflammatory disease in women infected with human immunodeficiency virus

2007-08-13T00:00:00Z

We assessed the association between the causative agents of vaginal discharge and pelvic inflammatory disease (PID) among women attending a rural sexually transmitted disease clinic in South Africa; the role played by coinfection with human immunodeficiency virus type 1 (HIV-1) was studied. Vaginal and cervical specimens were obtained to detect Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, and bacterial vaginosis. HIV-1 infection was established by use of serum antibody tests. A total of 696 women with vaginal discharge were recruited, 119 of whom had clinical PID. Patients with trichomoniasis had a significantly higher risk of PID than did women without trichomoniasis (P = .03). PID was not associated with any of the other pathogens. When the patients were stratified according to HIV-1 status, the risk of PID in HIV-1-infected patients with T. vaginalis increased significantly (P = .002); no association was found in patients without HIV-1. T. vaginalis infection of the lower genital tract is associated with a clinical diagnosis of PID in HIV-1-infected women.

Tricuspid regurgitation and right ventricular function after mitral valve surgery with or without concomitant tricuspid valve procedure

2012-11-20T08:25:38Z

Trigeminal Sensory Neuropathy Induced by Interferon-Alpha Therapy

2004-05-19T00:00:00Z

We report a case of trigeminal sensory neuropathy apparently induced by therapy with interferon-alpha. Interferon-alpha is used in the treatment of a variety of malignancies and chronic viral infections and has been reported to cause neurological complications such as somnolence, cognitive dysfunction and psychiatric disturbance.

Triggers of acute cardiovascular events and potential preventive strategies: Prophylactic role of regular exercise

Franklin, Barry A. og Lavie, Carl J. — 2012-03-13T00:00:00Z

There is now considerable evidence to suggest that acute myocardial infarction, sudden cardiac death, and stroke can be triggered by physical, chemical, and psychological stressors, including heavy physical exertion and situations that create heightened emotional stress. The increased risk appears to be largely limited to a susceptible subset of the population, that is, individuals with known or occult cardiovascular (CV) disease. In this article, we summarize the evidence supporting the impact of selected triggers in the pathogenesis of acute CV events, as well as the potential role of various preventive strategies, especially regular exercise training and improvements in cardiorespiratory fitness to reduce the CV risk imposed by various triggers.

Triple therapy for advanced squamous cell cancer of the head and neck

2010-11-23T00:00:00Z

This study presents the results of treatment for Stage III and IV squamous cell carcinoma of the head and neck at the Princess Alexandra Hospital and Queensland Radium Institute, Brisbane. Patients were treated using a programme of sequential chemotherapy, surgery and radiotherapy. Between 1980 and 1988, 116 patients commenced the programme and 85 completed the treatment as planned. The Price-Hill regimen of chemotherapy was used until 1986 after which time it was replaced by cisplatin/5-fluorouracil (5FU). Two courses were usually given achieving an overall response rate of 36% (12% complete response). Cisplatin/5FU produced an overall response rate of 56% compared with 24% for the Price-Hill regimen. Radical surgical resections were performed using a free flap reconstruction in the majority of patients. Radiotherapy fields usually covered the primary site and both cervical lymph node areas to a dose of 50–60 Gy in 5–6 weeks. The lengthy treatment was generally well tolerated although there were two chemotherapy and two peri-operative deaths. The overall actuarial survival for the 85 patients completing the triple therapy was 60%. These patients were analysed in more detail for possible prognostic factors.

Tropical diseases

Pearn, J. H. — 2008-06-10T00:00:00Z

Tropical emergency medicine: Features of falciparum malaria, snakebite and marine envenomations

Pearn, J. H. — 2008-06-10T00:00:00Z

Troponin: A risk-defining biomarker for emergency department physicians

Cullen, Louise — 2011-09-18T00:16:58Z

Troponin-I concentration 72 h after myocardial infarction correlates with infarct size and presence of microvascular obstruction

2009-03-16T13:51:40Z

Objectives: The aim of this study was to use late gadolinium hyper-enhancement cardiac magnetic resonance (LGE-CMR) imaging to determine if a 72-h troponin-I measurement would provide a more accurate estimation of infarct size and microvascular obstruction (MVO) than serial creatine kinase (CK) or early troponin-I values. Methods: LGE-CMR was performed 3.7±1.4 days after medical treatment for acute ST elevation or non-ST elevation myocardial infarction. Infarct size and MVO were measured and correlated with serum troponin-I concentrations, which were sampled 12 h and 72 h after admission, in addition to serial CK levels. Results: Ninety-three patients, of whom 71 had received thrombolysis for ST elevation myocardial infarction, completed the CMR study. Peak CK, 12-h troponin-I, and 72-h troponin-I were related to infarct size by LGE-CMR (r = 0.75, p<0.0001; r = 0.56, p = 0.0003; r = 0.62, p<0.0001 respectively). Serum biomarkers demonstrated higher values in the group with MVO compared with those without MVO (Peak CK 3085±1531 vs 1471±1135, p<0.001; 12-h troponin-I 58.3±46.9 vs 33.4±40.0, p = 0.13; 72-h troponin-I 11.5±9.9 vs 5.5±4.6, p<0.005). The correlation between the extent of MVO and 12-h troponin-I was not significant (r = 0.16), in contrast to the other serum biomarkers (peak CK r = 0.44, p<0.0001; 72-h troponin-I r = 0.46, p = 0.0002). Conclusion: A single measurement of 72-h troponin-I is similar to serial CK measurements in the estimation of both myocardial infarct size and extent of MVO, and is superior to 12-h troponin-I measurements.

Trouble with a shunt: Alcohol and spastic paraparesis

2010-12-06T00:00:00Z

TRPV4 related skeletal dysplasias: a phenotypic spectrum highlighted byclinical, radiographic, and molecular studies in 21 new families

2011-08-21T00:00:00Z

Tryptophan and 5-Hydroxytryptophan for depression

2010-07-30T00:00:00Z

BACKGROUND: 5 Hydroxytryptophan (5-HTP) and tryptophan are so-called natural alternatives to traditional antidepressants, used to treat unipolar depression and dysthymia. OBJECTIVES: To determine whether 5-HTP and tryptophan are more effective than placebo, and whether they are safe to use to treat depressive disorders in adults. SEARCH STRATEGY: Trials were searched in computerized general (Medline, Psychlit, and Embase) and specialized databases (Cochrane Controlled Clinical Trials Register, Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trial Register); by checking reference lists of relevant articles; by handsearching relevant specialist journals; and by contacting relevant authors where appropriate. Publications in all languages were sought. SELECTION CRITERIA: Trials were included if they were randomized, included patients with unipolar depression or dysthymia, compared preparations of 5-HTP or tryptophan with placebo, and included clinical outcomes assessed by scales assessing depressive symptoms. DATA COLLECTION AND ANALYSIS: Data was extracted independently by the three reviewers, onto data collection forms. Inclusion criteria were applied to all potential studies independently and a coefficient of agreement (Kappa) was calculated for them. Disagreement was resolved by reaching consensus. Trial quality was scored according to risk of bias. Analysis for 5-HTP and tryptophan were combined due to the small number of included trials. MAIN RESULTS: 108 trials were located using the specified search strategy. Of these, only two trials, involving a total of 64 patients, were of sufficient quality to meet inclusion criteria. The available evidence suggests these substances were better than placebo at alleviating depression (Peto Odds Ratio 4.10; 95% confidence interval 1.28-13.15; RD 0.36; NNT 2.78). However, the evidence was of insufficient quality to be conclusive. REVIEWER'S CONCLUSIONS: A large number of studies appear to address the research questions, but few are of sufficient quality to be reliable. Available evidence does suggest these substances are better than placebo at alleviating depression. Further studies are needed to evaluate the efficacy and safety of 5-HTP and tryptophan before their widespread use can be recommended. The possible association between these substances and the potentially fatal Eosinophilia-Myalgia Syndrome has not been elucidated. Because alternative antidepressants exist which have been proven to be effective and safe the clinical usefulness of 5-HTP and tryptophan is limited at present

Tsunami lung : A necrotising pneumonia in survivors of the Asian tsunami

Allworth, A. M. — 2011-11-28T12:25:52Z

Tubercular serpiginous-like choroiditis presenting as multifocal serpiginoid choroiditis

2013-03-13T10:27:16Z

Tuberculosis and health sector reform: experience of integrating tuberculosis services into the district health system in rural South Africa

Wilkinson, D — 2007-08-13T00:00:00Z

SETTING: Hlabisa health district, South Africa. OBJECTIVE: To describe the integration of a vertical tuberculosis control programme into an emerging 'horizontal' district health system, within the context of health sector reform. DESIGN: Descriptive account of the process of integration of the programme into the health system. RESULTS: A highly 'vertical' system of delivering tuberculosis treatment (with poor programme outcomes) was converted into a (horizontal' team, integrated within the district health system, that used available resources such as village clinics and community health workers, with improved programme outcomes. CONCLUSIONS: In some settings at least, integration of tuberculosis 'programmes' into the district health system as tuberculosis 'teams' is feasible, and may produce highly cost-effective outcomes.

Tuberculosis and malnourished children

Wilkinson, D. — 2010-09-07T13:04:18Z

Tuberculosis control in resource-poor countries: alternative approaches in the era of HIV

De Cock, K.M. og Wilkinson, D. — 2010-09-07T13:01:33Z

WHO projections suggest that the annual number of tuberculosis (TB) cases worldwide will reach 10.2 million by the year 2000. HIV plays a dominant role in this increase in many resource-poor countries. The internationally recommended treatment regimens for TB combine some of the six major antituberculosis drugs: isoniazid, rifampicin, pyrazinamide, ethambutol, streptomycin, and thiacetazone. WHO treatment guidelines give priority to patients according to the nature of their disease and recommend two regimens of 6-8 months duration, the longer regimen incorporating thiacetazone. Recently, WHO has favored a 6-month treatment regimen given as directly observed therapy (DOT). The disadvantages of the standard approach are the heavy workload of smear examinations, the complexity of some drug regimens, and the low rates of therapy completion. With the increasing TB case load in areas of high HIV infection prevalence, laboratories cannot do initial as well as follow-up smear examinations. In Botswana the proportion of smear-positive TB cases declined to 40% in 1992, but the overall proportion of patients who had smears performed had declined (52% in 1992). The multiple regimens in use cause confusion and nonadherence to guidelines. Nonadherence is the major risk factor for the emergence of drug resistance, and low completion rates are the most obvious signs of inadequate control programs. Alternative approaches mean ensuring high completion rates and using the most effective drugs. Regarding diagnosis, research might show that the number of smears could be reduced depending on the initial reading. There is no reason why a rifampicin-based short-course regimen could not replace the multiple regimens now in use. Rifampicin-containing regimens of 62-78 doses given intermittently have been effective and are suitable for use within a DOT program. For prevention of drug resistance, only pills combining different drugs should be used and rifampicin should be limited to the treatment of TB and leprosy.

Tuberculosis control in South Africa - Time for a new paradigm?

Wilkinson, D. og DeCock, K.M. — 2010-09-07T00:00:00Z

Tuberculosis control in South Africa - Time for a new paradigm? Reply

Wilkinson, D. og DeKock, K.M. — 2010-09-07T00:00:00Z

Tuberculosis in children in Australia: Strategies for control

2011-11-03T00:00:00Z

Tuberculosis in children in Queensland Australia 1990-2007: Epidemiological and clinical features

2010-09-21T00:00:00Z

Tuberculosis in Far North Queensland, Australia

Simpson, G. og Knight, T. — 2008-06-10T00:00:00Z

SETTING: Regional thoracic clinic in tropical Australia. OBJECTIVE: To document recent experience with tuberculosis in Far North Queensland, Australia, with particular reference to tuberculosis in indigenous people. METHODS: Retrospective survey of all cases of tuberculosis in Far North Queensland between January 1993 and December 1997. RESULTS: There were 87 cases of tuberculosis; 54 were pulmonary, of which 67% were sputum smear-positive. Crude annual incidence of tuberculosis in indigenous people was 35.9/100 000 population compared to 2.32/ 100 000 in non indigenous people. There were 15 deaths, seven of which were felt to be avoidable. Nine of 11 relapses of previously treated disease occurred in Aboriginals. There were six cases of initial drug resistance, of which four were imported from overseas. Contact tracing identified four active cases of tuberculosis and 102 recently infected contacts. Preventive treatment in infected contacts was completed in only 41%, largely because of poor compliance related to alcohol consumption. CONCLUSION: Tuberculosis remains common in Far North Queensland, with excess cases observed mainly in the indigenous population. Aboriginals are at high risk of both death from and relapse of tuberculosis. Tuberculosis control in indigenous people scattered over such a vast area remains challenging, and the results at present are sub-optimal.

Tuberculosis in malnourished children

Wilkinson, D. — 2010-09-07T13:04:22Z

Tuberculosis in New Zealand

2010-06-30T00:00:00Z

Tuberculosis in New Zealand, 1992–2001: A resurgence

2010-01-20T11:11:51Z

Tuberculosis in the Australian Indigenous population: history, current situation and future challenges

2011-10-19T12:53:36Z

Tuberculosis treatment programmes in low-income countries

Wilkinson, David og Moore, David — 2010-09-07T13:07:28Z

Tubular adenomas with minor villous changes show molecular features characteristic of tubulovillous adenomas

2011-03-13T00:15:47Z

Tubular breast carcinoma: An argument against treatment de-escalation

2012-03-20T12:22:46Z

Tubular enzymes predict acute renal failure (ARF) in the intensive care unit (ICU)

2008-06-06T00:00:00Z

Tubular enzymes predict ARF in the Intensive Care Unit (ICU)

2008-06-06T00:00:00Z

Tularemia transmitted by a squirrel bite

2011-06-16T11:06:14Z

Tumor-derived interleukin-4 reduces tumor clearance and deviates the cytokine and granzyme profile of tumor-induced CD8(+) T cells

2011-11-09T11:44:48Z

Tumor heterogeneity in a follicular carcinoma of thyroid: a study by comparative genomic hybridization

2011-06-22T00:00:00Z

We report a follicular carcinoma of thyroid that showed a range of histologic appearances, with microfollicular, macrofollicular/pseudopapillary, oncocytic, and poorly differentiated areas. We used comparative genomic hybridization to detect the major DNA copy number changes in each component, in order to study the inter-relationships among them. All showed gains in 11q and 17q, suggesting that these were early events in the development of the tumor, and these were the only changes in the follicular component. The other components each showed additional gains and losses, some unique to one component. The oncocytic component showed most changes, including loss on 16q in the region of the E-cadherin gene. This was associated with reduced intensity of immunostaining for E-cadherin specifically in that component. No mutations in the E-cadherin gene were detected in this component. The demonstration that some DNA copy number changes are consistent across each component suggests that they are all clonally related. The additional chromosomal and immunohistochemical heterogeneity across the macrofollicular/pseudopapillary, oncocytic, and poorly differentiated components would be consistent with the emergence of subclones, possibly as part of tumor progression. © 2011 Springer Science+Business Media, LLC.

Tumor necrosis factor-alpha antagonist-induced sarcoidosis

2011-03-14T09:57:15Z

Tumor necrosis factor haplotype analysis amongst schizophrenia probands from four distinct populations in the Asia-Pacific region

2007-08-14T19:31:51Z

Tumor progression in hepatocellular carcinoma: Relationship with tumor stroma and parenchymal disease

2007-08-15T00:00:00Z

Background: Encapsulation in hepatocellular carcinoma is associated with decreased invasiveness and improved survival in several series. Although active fibrogenesis by myofibroblasts has been demonstrated in the capsule, it is unclear if the capsule results from a general increase in peritumoral fibrosis, or an inherently less invasive tumor phenotype. The relationship between collagen deposition within tumor stroma, presence of cirrhosis and invasiveness also needs clarification. Methods: We performed immunohistochemistry for collagens I, III, IV and VI on sections of encapsulated and non-encapsulated hepatocellular carcinoma, arising in cirrhotic and non-cirrhotic livers. Staining was graded semi-quantitatively in tumor stromal elements and adjacent parenchymal sinusoids. The relationship of this staining with encapsulation, cirrhosis, and vascular invasion was analyzed. Results: Formation of a discrete capsular layer was associated with reduced vascular invasion, but not with a pervasive increase in peritumoral fibrosis. Increased collagen I content of tumor stroma and adjacent parenchymal sinusoids was associated with non-encapsulated tumors and vascular invasion. The presence of cirrhosis had little effect on capsule composition. Conclusions: Encapsulation of hepatocellular carcinoma reflects reduced invasiveness, rather than increased peritumoral collagen synthesis, which may instead enhance invasion. Increased intratumoral collagen I protein is also associated with increased tumor invasiveness. Pre-existing cirrhosis has little effect on tumor progression, possibly because the characteristics of cirrhosis are overwhelmed by tumor-induced changes in the adjacent parenchyma.(C) 2003 Blackwell Publishing Asia Pty Ltd.

Tumor-selective toxicity of histone deacetylase inhibitors is due to their targeting cell cycle checkpoint points

2008-03-28T00:00:00Z

Tumors, Malignant: Bronchogenic Carcinoma

2006-04-13T13:48:15Z

Lung cancer is the most devastating, yet preventable, cause of premature cancer mortality and morbidity in the Western world. While death rates for all other major cancers have been stable or declining, the age-adjusted death rate due to lung cancer steadily increased in both men and women during the second half of the twentieth century. Public education and measures to control tobacco smoking have resulted in a steady decline in lung cancer deaths in men, and a stable rate in women in some Western countries during the past decade. The ultimate key to controlling the current prevalence and mortality of lung cancer lies in a global solution to tobacco smoking. Meanwhile, the impact of low dose CT screening in high-risk populations on lung cancer mortality is currently under evaluation. Secondary prevention strategies trialled during the latter part of last century did not reduce the incidence of lung cancer, and discovery of effective new agents for secondary prevention is a priority. Strategies to identify and treat very early disease such as carcinoma in situ and atypical adenomatous hyperplasia need to be more practical. Meanwhile refined clinical staging, reduced surgical morbidity and mortality, strategic application of chemotherapy, and definition of optimal combined modality therapy have contributed to improvements in clinical management and outcomes for individual patients. The outstanding issue in clinical lung cancer management remains the limited effectiveness of current agents and treatment modalities. Despite the development of new treatments targeting specific molecular vulnerabilities, a far more comprehensive understanding of the cell and molecular biology of lung cancer is still required before translational therapies can reach their full potential to make an impact on survival

Tumors, Malignant: Carcinoma, Lymph Node Involvement

2009-03-16T17:01:29Z

Metastasis to mediastinal or hilar lymph nodes by cancer (adenopathic carcinoma) is among the commonest causes of intrathoracic node enlargement in adults. As it represents relatively advanced malignant disease, accurate diagnosis is important, but in this relatively inaccessible location, also challenging. Malignant node involvement by carcinoma must be distinguished from various primary mediastinal tumors including lymphoma, as well as from a wide variety of nonmalignant causes of lymphadenopathy and benign enlargements of mediastinal structures. A diagnostic approach based on knowledge of anatomy, radiology, test characteristics of clinical diagnostic procedures, and pathology is outlined in this article

Tumors, Malignant: Metastases from Lung Cancer

2009-03-16T15:56:35Z

Over half of the patients presenting with lung cancer have metastatic disease. The most common sites of metastatic involvement in lung cancer are regional lymph nodes, brain, bone, liver, and adrenal glands. The international staging system for lung cancer arose from recognition that the presence and extent of metastatic disease has a major impact on survival. N (node) and M (distant metastasis) staging is the most important determinant of treatment outcomes. Guidelines for management recommend algorithms to accurately determine the stage of disease in an individual patient, while balancing the financial cost associated with routinely performing staging investigations on all patients, and the morbidity costs of invasive investigations. Fortunately, technological advances in imaging modalities are providing increasingly reliable means of noninvasive staging for lung cancer. Metastatic disease from lung cancer presents tremendous clinical challenges in palliation of symptoms produced by expanding mass lesions, including pain, dyspnea, and loss of function. The potential of systemic therapy to control symptoms, improve quality of life, and extend survival in extensive stage lung cancer has been demonstrated in clinical trials of chemotherapy in patients with good performance status. Major challenges for the future include realizing a reduction in the proportion of patients presenting with metastatic disease through improved early detection, improving detection of micrometastases and understanding their significance, translating the promise of new biologically targeted therapies to control the development of metastasis, and developing new and better means of symptom palliation.