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Hogarty J, Jassal K, Ravintharan N, Adhami M, Yeung M, Clements W, Fitzgerald M, Mathew JK. Twenty-year perspective on blunt traumatic diaphragmatic injury in level 1 trauma centre: Early versus delayed diagnosis injury patterns and outcomes. Emerg Med Australas 2023; 35:842-848. [PMID: 37308166 DOI: 10.1111/1742-6723.14255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/25/2023] [Accepted: 05/14/2023] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Blunt traumatic diaphragmatic injury (TDI) is typically associated with severe trauma and concomitant injuries. It is a diagnostic challenge in the setting of blunt trauma and can be easily overlooked especially in the acute phase often dominated by concurrent injuries. METHODS A retrospective review was conducted of patients with blunt-TDI identified from a level 1 trauma registry. Variables associated with early versus delayed diagnosis as well as non-survivor and survivor groups were collected to examine factors associated with delayed diagnosis. RESULTS A total of 155 patients were included (mean age 46 ± 20, 60.6% male). Diagnosis was made <24 h in 126 (81.3%), and >24 h in 29 (18.7%). Of the delayed diagnosis group, 14 (48%) were diagnosed >7 days. Overall, 27 (21.4%) patients had a diagnostic initial CXR and 64 (50.8%) had a diagnostic initial CT. Fifty-eight (37.4%) patients were diagnosed intraoperatively. Of the delayed diagnosis group, 22 (75.9%) had no initial signs on CXR or CT, 15 (52%) of this group had persistent pleural-effusions/elevated-hemidiaphragm leading to further investigation and diagnosis. No significant difference in survival was observed between early and delayed diagnoses, no clinically significant injury patterns to predict delayed diagnoses were noted. CONCLUSION The diagnosis of TDI is challenging. Without frank signs of herniation of abdominal contents on CXR or CT, the diagnosis is often not made on initial imaging. In patients with the evidence of blunt traumatic injury in the lower-chest/upper-abdomen, a high degree of clinical suspicion should be held and follow-up CXRs/CTs arranged.
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Affiliation(s)
- Joseph Hogarty
- Alfred Health Trauma Service, Alfred Hospital, Melbourne, Victoria, Australia
| | - Karishma Jassal
- Alfred Health Trauma Service, Alfred Hospital, Melbourne, Victoria, Australia
- National Trauma Research Institute, Alfred Hospital, Melbourne, Victoria, Australia
| | | | | | - Meei Yeung
- Alfred Health Trauma Service, Alfred Hospital, Melbourne, Victoria, Australia
- National Trauma Research Institute, Alfred Hospital, Melbourne, Victoria, Australia
| | - Warren Clements
- National Trauma Research Institute, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Mark Fitzgerald
- Alfred Health Trauma Service, Alfred Hospital, Melbourne, Victoria, Australia
- National Trauma Research Institute, Alfred Hospital, Melbourne, Victoria, Australia
| | - Joseph K Mathew
- Alfred Health Trauma Service, Alfred Hospital, Melbourne, Victoria, Australia
- National Trauma Research Institute, Alfred Hospital, Melbourne, Victoria, Australia
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2
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Hogarty JP, Jones ME, Jassal K, Hogarty DT, Mitra B, Udy AA, Fitzgerald MC. Review article: Early steroid administration for traumatic haemorrhagic shock: A systematic review. Emerg Med Australas 2023; 35:6-13. [PMID: 36347522 PMCID: PMC10100146 DOI: 10.1111/1742-6723.14129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/10/2022] [Indexed: 11/11/2022]
Abstract
Haemorrhagic shock after trauma is a leading cause of death worldwide, particularly in young individuals. Despite advances in trauma systems and resuscitation strategies, mortality from haemorrhagic shock has not declined over the previous two decades. A proportion of shocked trauma patients may experience a deficiency of cortisol relative to the severity of their injury. The benefit of exogenous steroid administration in patients suffering haemorrhagic shock as a result of injury is unclear. A systematic review of four databases (Ovid Medline, Ovid Embase, Cochrane, Scopus) was undertaken. Inclusion and exclusion criteria were pre-determined and two reviewers independently screened the articles with disagreements arbitrated by a third reviewer. The primary outcome variable was 28-day mortality. Quality of studies were assessed using the Cochrane-risk-of-bias (RoB 2) tool. Of the 2919 studies yielded by the search strategy, 1274 duplicates were removed and 1645 screened on title and abstract. After the full text of 33 studies were assessed, two articles were included. Both studies were over 30 years old with small numbers of participants and with primary outcomes not including mortality. Of the data available, no statistically significant difference in mortality was detected. Hospital length of stay, reversal of shock or adverse events were not reported. Both studies were at risk of bias. There are no high quality or recent studies in the English literature investigating the use of steroids for haemorrhagic shocked trauma patients. PROSPERO: CRD42021239656.
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Affiliation(s)
- Joseph P Hogarty
- Trauma Service, The Alfred Hospital, Melbourne, Victoria, Australia.,National Trauma Research Institute, Melbourne, Victoria, Australia
| | - Morgan E Jones
- Trauma Service, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Karishma Jassal
- Trauma Service, The Alfred Hospital, Melbourne, Victoria, Australia.,National Trauma Research Institute, Melbourne, Victoria, Australia
| | - Daniel T Hogarty
- Trauma Service, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Biswadev Mitra
- Trauma Service, The Alfred Hospital, Melbourne, Victoria, Australia.,National Trauma Research Institute, Melbourne, Victoria, Australia.,Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Andrew A Udy
- Department of Hyperbaric and Intensive Care Medicine, The Alfred Hospital, Melbourne, Victoria, Australia.,Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Mark C Fitzgerald
- Trauma Service, The Alfred Hospital, Melbourne, Victoria, Australia.,National Trauma Research Institute, Melbourne, Victoria, Australia
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3
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Jassal K, Koohestani A, Kiu A, Strong A, Ravintharan N, Yeung M, Grodski S, Serpell JW, Lee JC. Artificial Intelligence for Pre-operative Diagnosis of Malignant Thyroid Nodules Based on Sonographic Features and Cytology Category. World J Surg 2023; 47:330-339. [PMID: 36336771 PMCID: PMC9803749 DOI: 10.1007/s00268-022-06798-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Current diagnosis and classification of thyroid nodules are susceptible to subjective factors. Despite widespread use of ultrasonography (USG) and fine needle aspiration cytology (FNAC) to assess thyroid nodules, the interpretation of results is nuanced and requires specialist endocrine surgery input. Using readily available pre-operative data, the aims of this study were to develop artificial intelligence (AI) models to classify nodules into likely benign or malignant and to compare the diagnostic performance of the models. METHODS Patients undergoing surgery for thyroid nodules between 2010 and 2020 were recruited from our institution's database into training and testing groups. Demographics, serum TSH level, cytology, ultrasonography features and histopathology data were extracted. The training group USG images were re-reviewed by a study radiologist experienced in thyroid USG, who reported the relevant features and supplemented with data extracted from existing reports to reduce sampling bias. Testing group USG features were extracted solely from existing reports to reflect real-life practice of a non-thyroid specialist. We developed four AI models based on classification algorithms (k-Nearest Neighbour, Support Vector Machine, Decision Tree, Naïve Bayes) and evaluated their diagnostic performance of thyroid malignancy. RESULTS In the training group (n = 857), 75% were female and 27% of cases were malignant. The testing group (n = 198) consisted of 77% females and 17% malignant cases. Mean age was 54.7 ± 16.2 years for the training group and 50.1 ± 17.4 years for the testing group. Following validation with the testing group, support vector machine classifier was found to perform best in predicting final histopathology with an accuracy of 89%, sensitivity 89%, specificity 83%, F-score 94% and AUROC 0.86. CONCLUSION We have developed a first of its kind, pilot AI model that can accurately predict malignancy in thyroid nodules using USG features, FNAC, demographics and serum TSH. There is potential for a model like this to be used as a decision support tool in under-resourced areas as well as by non-thyroid specialists.
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Affiliation(s)
- Karishma Jassal
- grid.1623.60000 0004 0432 511XMonash University Endocrine Surgery Unit, The Alfred Hospital, 55 Commercial Road, Melbourne, VIC 3004 Australia ,grid.1002.30000 0004 1936 7857Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia
| | - Afsanesh Koohestani
- grid.1623.60000 0004 0432 511XMonash University Endocrine Surgery Unit, The Alfred Hospital, 55 Commercial Road, Melbourne, VIC 3004 Australia ,grid.1002.30000 0004 1936 7857Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia
| | - Andrew Kiu
- grid.1002.30000 0004 1936 7857Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia
| | - April Strong
- grid.1002.30000 0004 1936 7857Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia
| | - Nandhini Ravintharan
- grid.1002.30000 0004 1936 7857Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia
| | - Meei Yeung
- grid.1623.60000 0004 0432 511XMonash University Endocrine Surgery Unit, The Alfred Hospital, 55 Commercial Road, Melbourne, VIC 3004 Australia ,grid.1002.30000 0004 1936 7857Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia
| | - Simon Grodski
- grid.1623.60000 0004 0432 511XMonash University Endocrine Surgery Unit, The Alfred Hospital, 55 Commercial Road, Melbourne, VIC 3004 Australia ,grid.1002.30000 0004 1936 7857Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia
| | - Jonathan W. Serpell
- grid.1623.60000 0004 0432 511XMonash University Endocrine Surgery Unit, The Alfred Hospital, 55 Commercial Road, Melbourne, VIC 3004 Australia ,grid.1002.30000 0004 1936 7857Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia
| | - James C. Lee
- grid.1623.60000 0004 0432 511XMonash University Endocrine Surgery Unit, The Alfred Hospital, 55 Commercial Road, Melbourne, VIC 3004 Australia ,grid.1002.30000 0004 1936 7857Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia
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4
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Jassal K, Ravintharan N, Prabhakaran S, Grodski S, Serpell JW, Lee JC. Preoperative serum calcitonin may improve initial surgery for medullary thyroid cancer in patients with indeterminate cytology. ANZ J Surg 2022; 92:1428-1433. [PMID: 35412008 PMCID: PMC9321997 DOI: 10.1111/ans.17690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 02/01/2022] [Accepted: 02/14/2022] [Indexed: 12/18/2022]
Abstract
BACKGROUND Medullary thyroid cancer (MTC) is rare, with poorer outcomes than differentiated thyroid cancer. We aimed to identify areas for improvement in the pre-operative evaluation of patients with possible MTC in a high-volume endocrine surgery unit in accordance with current practice guidelines. We hypothesised that the selective use of serum calcitonin (sCT) as a biomarker for possible MTC could guide the extent of initial surgical management. METHODS We recruited MTC patients between 2000 and 2020 from the Monash University Endocrine Surgery Unit database. Demographics, tumour characteristics, pre-operative evaluation, operative management, and outcomes were analysed. RESULTS Of 1454 thyroid cancer patients, 43 (3%) had MTC. Pre-operatively, 36 (84%) patients with MTC confirmed on cytology (28, 65%), elevated sCT (6, 14%) or RET mutation (2, 4%). Of these 36 patients, 31 (86%) had optimal extent of thyroidectomy and lymph node dissection (LND). Five (14%) had less than total thyroidectomy due to nerve injury. Thirty-four patients had compartmental LND. In the 12 (27%) patients with indeterminate or non-diagnostic cytology, 5 had elevated sCT and were managed as above. None of the remaining seven had LND, thus potentially suboptimal surgery. CONCLUSION Our findings reflect the rarity of MTC, and the challenges of pre-operative diagnosis. The addition of sCT may improve surgical planning in patients with indeterminate cytology.
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Affiliation(s)
- Karishma Jassal
- Monash University Endocrine Surgery Unit, Alfred Hospital, Melbourne, Victoria, Australia
| | - Nandhini Ravintharan
- Monash University Endocrine Surgery Unit, Alfred Hospital, Melbourne, Victoria, Australia
| | - Swetha Prabhakaran
- Monash University Endocrine Surgery Unit, Alfred Hospital, Melbourne, Victoria, Australia
| | - Simon Grodski
- Monash University Endocrine Surgery Unit, Alfred Hospital, Melbourne, Victoria, Australia.,Department of Surgery, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Jonathan W Serpell
- Monash University Endocrine Surgery Unit, Alfred Hospital, Melbourne, Victoria, Australia.,Department of Surgery, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - James C Lee
- Monash University Endocrine Surgery Unit, Alfred Hospital, Melbourne, Victoria, Australia.,Department of Surgery, Central Clinical School, Monash University, Melbourne, Victoria, Australia
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5
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Wagner K, Jassal K, Lee JC, Ban EJ, Cameron R, Serpell J. Challenges in diagnosis and management of a spiradenocarcinoma: a comprehensive literature review. ANZ J Surg 2021; 91:1996-2001. [PMID: 33522696 DOI: 10.1111/ans.16626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/15/2021] [Accepted: 01/18/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Spiradenocarcinoma is a rare skin adnexal neoplasm that may behave aggressively. It is often associated with a benign slow-growing spiradenoma that has undergone malignant transformation. Given the paucity of cases in the literature, there is a lack of consensus on treatment. METHODS The terms 'malignant spiradenoma' or 'spiradenocarcinoma' were systematically used to search the PubMed, MEDLINE and Google Scholar databases. A total of 182 cases of spiradenocarcinoma were identified as eligible for this comprehensive literature review. RESULTS Spiradenocarcinoma was commoner in older age and Caucasian race. In most cases, surgical excision for local disease is the mainstay of treatment. Lymph node dissection is usually reserved for those with suspected or confirmed lymph node metastases. High rates of local recurrence (20.8%), metastasis (37.4%) and mortality (19.1%) were identified, prompting some authors to suggest regular follow up including chest X-rays and liver function tests. CONCLUSIONS Patients with spiradenocarcinoma may benefit from a magnetic resonance imaging and fluorodeoxyglucose-positron emission tomography/computed tomography to establish the extent of disease. We recommend wide local excision as the treatment of choice to achieve surgical margins of ≥1 cm, with node resection to be determined on a case-to-case basis. Regular follow up is important given the high rate of local recurrence, metastasis and mortality. This should include an examination of the regional lymph nodes. Further research is required to refine an evidence-based approach to spiradenocarcinoma.
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Affiliation(s)
- Katy Wagner
- Monash University Endocrine Surgery Unit, Alfred Hospital, Melbourne, Victoria, Australia
| | - Karishma Jassal
- Monash University Endocrine Surgery Unit, Alfred Hospital, Melbourne, Victoria, Australia
| | - James C Lee
- Monash University Endocrine Surgery Unit, Alfred Hospital, Melbourne, Victoria, Australia.,Department of Surgery, Central Clinical School, Monash University, The Alfred Centre, Melbourne, Victoria, Australia
| | - Ee-Jun Ban
- Monash University Endocrine Surgery Unit, Alfred Hospital, Melbourne, Victoria, Australia.,Department of Surgery, Central Clinical School, Monash University, The Alfred Centre, Melbourne, Victoria, Australia
| | - Rhoda Cameron
- Department of Pathology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Jonathan Serpell
- Monash University Endocrine Surgery Unit, Alfred Hospital, Melbourne, Victoria, Australia.,Department of Surgery, Central Clinical School, Monash University, The Alfred Centre, Melbourne, Victoria, Australia
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6
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Langmaid T, Jassal K, Meher-Homji Z, Lee JC, Serpell J, Yeung M, McMahon J, Grodski S. Disseminated nocardiosis with adrenal abscess masquerading as metastatic adrenal cancer in an immunocompetent adult. ANZ J Surg 2020; 91:E396-E398. [PMID: 33137243 DOI: 10.1111/ans.16423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 10/17/2020] [Accepted: 10/20/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Tess Langmaid
- Department of General Surgery, Breast and Endocrine Unit, Alfred Hospital, Melbourne, Victoria, Australia
| | - Karishma Jassal
- Department of General Surgery, Breast and Endocrine Unit, Alfred Hospital, Melbourne, Victoria, Australia.,Monash University Endocrine Surgery Unit, Alfred Hospital, Melbourne, Victoria, Australia
| | - Zaal Meher-Homji
- Department of Infectious Diseases, Alfred Hospital, Melbourne, Victoria, Australia
| | - James C Lee
- Department of General Surgery, Breast and Endocrine Unit, Alfred Hospital, Melbourne, Victoria, Australia.,Monash University Endocrine Surgery Unit, Alfred Hospital, Melbourne, Victoria, Australia
| | - Jonathan Serpell
- Department of General Surgery, Breast and Endocrine Unit, Alfred Hospital, Melbourne, Victoria, Australia.,Monash University Endocrine Surgery Unit, Alfred Hospital, Melbourne, Victoria, Australia
| | - Meei Yeung
- Department of General Surgery, Breast and Endocrine Unit, Alfred Hospital, Melbourne, Victoria, Australia.,Monash University Endocrine Surgery Unit, Alfred Hospital, Melbourne, Victoria, Australia
| | - James McMahon
- Department of Infectious Diseases, Alfred Hospital, Melbourne, Victoria, Australia
| | - Simon Grodski
- Department of General Surgery, Breast and Endocrine Unit, Alfred Hospital, Melbourne, Victoria, Australia.,Monash University Endocrine Surgery Unit, Alfred Hospital, Melbourne, Victoria, Australia
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7
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Sun S, Ravintharan N, Jassal K, Nandurkar R, Yesul K, Boo E, Smit DV, Fitzgerald M. COVID-19 pandemic consciousness: droplet contamination and aerosolization during pleural decompression. ANZ J Surg 2020; 90:2588-2591. [PMID: 33030221 PMCID: PMC7675369 DOI: 10.1111/ans.16388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/22/2020] [Accepted: 09/24/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Sunjuri Sun
- Alfred Health Trauma Service, Alfred Hospital, Melbourne, Victoria, Australia
| | | | - Karishma Jassal
- Alfred Health Trauma Service, Alfred Hospital, Melbourne, Victoria, Australia.,National Trauma Research Institute, Alfred Hospital, Melbourne, Victoria, Australia
| | - Rohan Nandurkar
- Alfred Health Trauma Service, Alfred Hospital, Melbourne, Victoria, Australia
| | - Kim Yesul
- National Trauma Research Institute, Alfred Hospital, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Ellaine Boo
- Alfred Health Trauma Service, Alfred Hospital, Melbourne, Victoria, Australia.,National Trauma Research Institute, Alfred Hospital, Melbourne, Victoria, Australia
| | - De Villiers Smit
- National Trauma Research Institute, Alfred Hospital, Melbourne, Victoria, Australia.,Alfred Emergency and Trauma Centre, Alfred Hospital, Melbourne, Victoria, Australia
| | - Mark Fitzgerald
- Alfred Health Trauma Service, Alfred Hospital, Melbourne, Victoria, Australia.,National Trauma Research Institute, Alfred Hospital, Melbourne, Victoria, Australia
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8
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Chen RJ, Gillespie C, Jassal K, Read MD, Lee JC. Urgent surgical presentations during the coronavirus pandemic: an Australian perspective. ANZ J Surg 2020; 90:1547-1549. [PMID: 32924299 DOI: 10.1111/ans.16219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/22/2020] [Accepted: 07/22/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Reuben J Chen
- Department of Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Carla Gillespie
- Department of Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Karishma Jassal
- Department of General Surgery, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Matthew D Read
- Department of Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - James C Lee
- Department of General Surgery, The Alfred Hospital, Melbourne, Victoria, Australia.,Department of Surgery, Central Clinical School, Monash University, Melbourne, Victoria, Australia
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9
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Chen RJ, Gillespie C, Jassal K, Lee JC, Read M. Delayed presentation of breast necrotising fasciitis due to COVID-19 anxiety. ANZ J Surg 2020; 90:1485-1487. [PMID: 32536015 PMCID: PMC7323344 DOI: 10.1111/ans.16102] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 06/09/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Reuben J Chen
- Department of Surgery, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Carla Gillespie
- Department of Surgery, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Karishma Jassal
- Department of General Surgery, Alfred Hospital, Melbourne, Victoria, Australia
| | - James C Lee
- Department of General Surgery, Alfred Hospital, Melbourne, Victoria, Australia.,Department of Surgery, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Matthew Read
- Department of Surgery, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, St Vincent's Hospital, Melbourne, Victoria, Australia
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10
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Yang TWW, Ban EJ, Lee JC, Serpell J, Jassal K. Blunt abdominal trauma resulting in ovarian mucinous cystadenoma rupture. ANZ J Surg 2020; 91:197-198. [PMID: 32510752 DOI: 10.1111/ans.16045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 05/19/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Tze Wei Wilson Yang
- Department of General Surgery, Breast and Endocrine Unit, Alfred Hospital, Melbourne, Victoria, Australia
| | - Ee-Jun Ban
- Department of General Surgery, Breast and Endocrine Unit, Alfred Hospital, Melbourne, Victoria, Australia
| | - James C Lee
- Department of General Surgery, Breast and Endocrine Unit, Alfred Hospital, Melbourne, Victoria, Australia
| | - Jonathan Serpell
- Department of General Surgery, Breast and Endocrine Unit, Alfred Hospital, Melbourne, Victoria, Australia
| | - Karishma Jassal
- Department of General Surgery, Breast and Endocrine Unit, Alfred Hospital, Melbourne, Victoria, Australia
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11
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V K, Osman S, Jassal K, Sarkar B, Singh S, Giri U, T G. EP-1774: Utilization Of Osld As The Quality Control Indicator For In-Vivo Measurements In Tbi Treatment. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)32083-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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12
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Abstract
Chylothorax caused by blunt trauma is extremely rare. We present a case of bilateral massive chylothorax post blunt trauma and a review of the literature regarding the identification and management of this rare diagnosis. An eighteen-year-old male was involved in a motor vehicle crash where he sustained multiple injuries including a right, moderate to large, haemopneumothorax, a small left haemopneumothorax, left T8, T9, L1 and L2 acute transverse process fractures and fractures of bilateral 11th ribs. An intercostal catheter was inserted on the right side which initially drained blood-stained fluid however milky colour fluid was noted to be draining 11 h post insertion. Further imaging revealed a left pleural effusion causing a mediastinal shift where, once drained, also revealed a chylothorax. The patient was managed conservatively with bilateral intercostal catheters and a no fat/low-fat diet. The patient was discharged day seven post removal of bilateral intercostal catheters.
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Affiliation(s)
- Christina Kozul
- Department of Trauma, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
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13
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Sarkar B, Manikandan A, Jassal K, Ganesh T, Munshi A, Mohanti B, Pradhan A. SU-F-J-126: Influence of Six Dimensional Motions in Frameless Stereotactic Dosimetry Incorporating Rotational Shifts as Equivalent Translational Shifts: A Feasibility Study for Elekta-BrainLAB Stereotactic System. Med Phys 2016. [DOI: 10.1118/1.4956034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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14
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Kaur H, Kumar S, Sarkar B, Ganesh T, Giri U, Jassal K, Rathinamuthu S, Gulia G, Gopal V, Mohanti B, Munshi A. SU-F-T-327: Total Body Irradiation In-Vivo Dose Measurements Using Optically Stimulated Luminescence (OSL) NanoDots and Farmer Type Ion Chamber. Med Phys 2016. [DOI: 10.1118/1.4956512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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15
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Giri U, Sarkar B, Munshi A, Kaur H, Jassal K, Rathinamuthu S, Kumar S, Ganesh T, Mohanti B. SU-F-T-422: Detection of Optimal Tangential Partial Arc Span for VMAT Planning in IntactLeft-Breast Treatment. Med Phys 2016. [DOI: 10.1118/1.4956607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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16
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Jassal K, Sarkar B, Ganesh T, Kaur H, Giri U, Mohanti B, Munshi A. SU-F-T-343: Dosimetric Investigation for Fluence Smoothing On VMAT Plans in Monaco for Head - Neck Cancers. Med Phys 2016. [DOI: 10.1118/1.4956528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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17
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Kumar S, Sarkar B, Kaur H, Rathinamuthu S, Giri U, Jassal K, Ganesh T, Munshi A, Mohanti B, Krishnankutty S, Sathiya J. SU-F-P-50: Performance Evaluation of Optically Stimulated Luminescence (OSL) NanoDots in Therapy and Imaging In-Vivo Dose Measurement During Patient Treatment. Med Phys 2016. [DOI: 10.1118/1.4955757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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18
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Jassal K, Sarkar B, Mohanti B, Roy S, Ganesh T, Munshi A, Chougule A, Sachdev K. SU-E-T-77: A Statistical Approach to Manage Quality for Pre-Treatment Verification in IMRT/VMAT. Med Phys 2015. [DOI: 10.1118/1.4924438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Biplab S, Soumya R, Paul S, Jassal K, Munshi A, Giri U, Kumar V, Roy S, Ganesh T, Mohanti B. SU-E-T-190: First Integration of Steriotactic Radiotherapy Planning System Iplan with Elekta Linear Accelerator. Med Phys 2014. [DOI: 10.1118/1.4888520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Ganesh T, Paul S, Munshi A, Sarkar B, Krishnankutty S, Sathya J, George S, Jassal K, Roy S, Mohanti B. SU-E-J-39: Comparison of PTV Margins Determined by In-Room Stereoscopic Image Guidance and by On-Board Cone Beam Computed Tomography Technique for Brain Radiotherapy Patients. Med Phys 2014. [DOI: 10.1118/1.4888091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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21
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Sarkar B, Roy S, Paul S, Munshi A, Roy S, Jassal K, Ganesh T, Mohanti BK. SU-E-T-226: Junction Free Craniospinal Irradiation in Linear Accelerator Using Volumetric Modulated Arc Therapy : A Novel Technique Using Dose Tapering. Med Phys 2014. [DOI: 10.1118/1.4888556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Sarkar B, Jassal K, Sureka C. SU-E-T-83: Validation and Testing of Performance of a Novel Phantom Specially Designed for Volumetric Modulated Arc Therapy MU/dose Verification. Med Phys 2013. [DOI: 10.1118/1.4814518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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23
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Janardhan N, Bhardwaj A, Kataria T, Surendran J, Vikraman S, Karthick KP, Jassal K. SU-GG-T-222: Angular Response Correction Factors for ImRT MatriXX in Rotational Beam Radiotherapy. Med Phys 2010. [DOI: 10.1118/1.3468612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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