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Vo J, Hayler R, Tyler A, Verschuer K. Chronic constipation and abdominal distension in a patient with adult Hirschprung's disease and bilateral ovarian teratomas. J Surg Case Rep 2024; 2024:rjae227. [PMID: 38638925 PMCID: PMC11026061 DOI: 10.1093/jscr/rjae227] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 03/22/2024] [Indexed: 04/20/2024] Open
Abstract
Hirschprung's disease is a congenital disorder characterized by aganglionic bowel, usually diagnosed in infancy. Here, we present a unique case of Hirschprung's disease diagnosed in a 29-year-old female with acute on chronic constipation. As part of her work up, a computerized tomography of her abdomen and pelvis revealed large, bilateral dermoid cysts. A diagnostic and therapeutic colonoscopy allowed manual disimpaction and decompression of her bowel, as well as biopsy attainment. Histopathology revealed absence of ganglionic cells on haematoxylin and eosin stain and calretinin immunostaining. This case underscores the diagnostic challenges of Adult Hirschprung's disease and how this impacts patient quality of life, as well as the work up and management of concurrent causes abdominopelvic conditions.
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Affiliation(s)
- Jessica Vo
- Department of Obstetrics and Gynaecology, St George Hospital, Gray St George Hospital, Kogarah, Sydney, NSW, Australia
- Faculty of Women’s Health, St George and Sutherland Clinical School (University of New South Wales), St George Hospital, Gray St, Kogarah, Sydney, NSW, Australia
| | - Raymond Hayler
- Department of Surgery, St George Hospital, Gray St, Kogarah, Sydney, NSW, Australia
- Faculty of Medicine & Health, St George and Sutherland Clinical School (University of New South Wales), St George Hospital, Gray St, Kogarah, Sydney, NSW, Australia
- Faculty of Medicine and Health, Macquarie University, Technology Pl, Macquarie Park, Sydney, NSW, Australia
| | - Alex Tyler
- Department of Surgery, Shoalhaven District Memorial Hospital, Scenic Dr, Nowra, NSW, Australia
| | - Kurt Verschuer
- Department of Surgery, Shoalhaven District Memorial Hospital, Scenic Dr, Nowra, NSW, Australia
- Department of Surgery, Goulburn Base Hospital, 130 Goldsmith St, Goulburn, NSW, Australia
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Gao Y, Jhamb S, Hayler R, Trickett C, Kwok A. Actinomyces as a rare cause of appendicitis: a case report. J Surg Case Rep 2024; 2024:rjae195. [PMID: 38572291 PMCID: PMC10984727 DOI: 10.1093/jscr/rjae195] [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] [Received: 02/19/2024] [Accepted: 03/09/2024] [Indexed: 04/05/2024] Open
Abstract
Actinomycosis remains a rare and often underdiagnosed cause of appendicitis with only 10% of cases diagnosed prior to surgery. It is an important cause to consider particularly in the setting of an indolent infection with nonspecific symptoms. We present a 22 years old male who presented with 3 weeks history of lower abdominal pain who underwent laboratory investigations and imaging studies suggestive of acute appendicitis. He underwent an emergency laparoscopic caecectomy with histopathology of the specimen suggestive of actinomycosis. He recovered well postoperatively and was discharged home with a prolonged course of oral penicillins. Preoperative diagnosis of actinomycosis is uncommon and accounts for ~10% of cases. Definitive diagnosis is usually through histopathology or tissue/fluid culture. Treatment usually involves a combination of surgical resection and antibiotic therapy with a success rate of >90%.
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Affiliation(s)
- Yijun Gao
- Department of Surgery, The Sutherland Hospital, The Kingsway, Caringbah 2229, NSW, Australia
| | - Shaurya Jhamb
- Department of Surgery, The Sutherland Hospital, The Kingsway, Caringbah 2229, NSW, Australia
| | - Raymond Hayler
- Department of Surgery, St George Public Hospital, Gray Street, Kogarah 2217, NSW, Australia
| | - Chloe Trickett
- Department of Surgery, The Sutherland Hospital, The Kingsway, Caringbah 2229, NSW, Australia
| | - Allan Kwok
- Department of Surgery, The Sutherland Hospital, The Kingsway, Caringbah 2229, NSW, Australia
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Hayler R, Tuft C, Fisher O. Head of pancreas mass with biliary obstruction: an unusual cause. Gut 2024:gutjnl-2024-332268. [PMID: 38519124 DOI: 10.1136/gutjnl-2024-332268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 03/17/2024] [Indexed: 03/24/2024]
Affiliation(s)
- Raymond Hayler
- Department of Surgery, Saint George Hospital, Kogarah, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Colin Tuft
- Department of Respiratory Medicine, Saint George Hospital, Kogarah, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Oliver Fisher
- Department of Surgery, Saint George Hospital, Kogarah, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
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Hayler R, Charters E, Coulson S, Hubert Low TH. Gender differences in perceived speech intelligibility in patients with facial nerve palsy. Int J Speech Lang Pathol 2023:1-6. [PMID: 37907077 DOI: 10.1080/17549507.2023.2259136] [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] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
PURPOSE Facial nerve palsy (FNP) affects physical and social function, including speech. There exists discrepancy between professional and patient perception of appearance following FNP; however, speech differences remain unknown. We aimed to compare ratings of speech intelligibility by different listeners. METHOD Patients were identified through the Sydney Facial Nerve Service. FNP related scoring was obtained using the Sunnybrook Facial Grading System, Sydney Facial Grading Score, Facial Disability Index, and Speech Handicap Index. Intelligibility was scored by a speech-language pathologist, member of the public, and patient using a standardised passage. FNP scoring and intelligibility were compared using interclass coefficients (ICC). RESULT Forty patients were recruited (females = 20). There was no difference in FNP scoring, nor between the frequency or types of phonemic errors. Observers' rating of intelligibility had an ICC of 0.807, compared with 0.266 and 0.344 for patients compared to the member of the public and speech-language pathologist respectively. Observers rated males and females intelligibility similar (p > 0.05), but females rated their intelligibility lower than males (74.5 ± 12.8 vs. 82.5 ± 8.4, p = 0.025). CONCLUSION Patients, particularly females, perceive their speech to be less intelligible than observers. Clinicians should be aware of this discrepancy, which does not correlate with physical function.
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Affiliation(s)
- Raymond Hayler
- Sydney Facial Nerve Service, Chris O'Brien Lifehouse, Sydney, Australia
- Department of Medicine, University of New South Wales, Sydney, Australia
- Faculty of Medicine and Health, Macquarie University, Sydney, Australia
| | - Emma Charters
- Sydney Facial Nerve Service, Chris O'Brien Lifehouse, Sydney, Australia
- Head and Neck Department, Chris O'Brien Lifehouse, Sydney, Australia
| | - Susan Coulson
- Sydney Facial Nerve Service, Chris O'Brien Lifehouse, Sydney, Australia
- School of Physiotherapy, and
| | - Tsu-Hui Hubert Low
- Sydney Facial Nerve Service, Chris O'Brien Lifehouse, Sydney, Australia
- Faculty of Medicine and Health, Macquarie University, Sydney, Australia
- Head and Neck Department, Chris O'Brien Lifehouse, Sydney, Australia
- Sydney Medical School, The University of Sydney, Sydney, Australia
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Cheng E, Shamavonian R, Mui J, Hayler R, Karpes J, Wijayawardana R, Barat S, Ahmadi N, Morris DL. Overall survival and morbidity are not associated with advanced age for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: a single centre experience. Pleura Peritoneum 2023; 8:83-90. [PMID: 37304160 PMCID: PMC10249755 DOI: 10.1515/pp-2022-0202] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/18/2023] [Indexed: 06/13/2023] Open
Abstract
Objectives Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) has enabled better prognosis for patients with peritoneal surface malignancies. However, in older age groups, short -and long-term outcomes are still perceived as poor. We evaluated patients aged 70 and over and determine if age is a predictor of morbidity, mortality and overall survival (OS). Methods A retrospective cohort analysis was performed on CRS/HIPEC patients and categorised by age. The primary outcome was overall survival. Secondary outcomes included morbidity, mortality, hospital and incentive care unit (ICU) stay and early postoperative intraperitoneal chemotherapy (EPIC). Results A total of 1,129 patients were identified with 134 aged 70+ and 935 under 70. There was no difference in OS (p=0.175) or major morbidity (p=0.051). Advanced age was associated with higher mortality (4.48 vs. 1.11 %, p=0.010), longer ICU stay (p<0.001) and longer hospitalisation (p<0.001). The older group was less likely to achieve complete cytoreduction (61.2 vs. 73 %, p=0.004) and receive EPIC (23.9 vs. 32.7 %, p=0.040). Conclusions In patients undergoing CRS/HIPEC, age of 70 and above does not impact OS or major morbidity but is associated with increased mortality. Age alone should not be a limiting factor in selecting CRS/HIPEC patients. Careful multi-disciplinary approach is needed when considering those of advanced age.
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Affiliation(s)
- Ernest Cheng
- Department of Surgery, Peritonectomy and Liver Cancer Unit, St George Hospital, Kogarah, NSW, Australia
- St George Hospital Clinical School, University of New South Wales, Kogarah, NSW, Australia
| | - Raphael Shamavonian
- Department of Surgery, Peritonectomy and Liver Cancer Unit, St George Hospital, Kogarah, NSW, Australia
| | - Jasmine Mui
- Department of Surgery, Peritonectomy and Liver Cancer Unit, St George Hospital, Kogarah, NSW, Australia
- St George Hospital Clinical School, University of New South Wales, Kogarah, NSW, Australia
| | - Raymond Hayler
- Department of Surgery, Peritonectomy and Liver Cancer Unit, St George Hospital, Kogarah, NSW, Australia
- St George Hospital Clinical School, University of New South Wales, Kogarah, NSW, Australia
| | - Josh Karpes
- Department of Surgery, Peritonectomy and Liver Cancer Unit, St George Hospital, Kogarah, NSW, Australia
- St George Hospital Clinical School, University of New South Wales, Kogarah, NSW, Australia
| | - Ruwanthi Wijayawardana
- Department of Surgery, Peritonectomy and Liver Cancer Unit, St George Hospital, Kogarah, NSW, Australia
| | - Shoma Barat
- Department of Surgery, Peritonectomy and Liver Cancer Unit, St George Hospital, Kogarah, NSW, Australia
| | - Nima Ahmadi
- Department of Surgery, Peritonectomy and Liver Cancer Unit, St George Hospital, Kogarah, NSW, Australia
| | - David L. Morris
- Department of Surgery, Peritonectomy and Liver Cancer Unit, St George Hospital, Kogarah, NSW, Australia
- St George Hospital Clinical School, University of New South Wales, Kogarah, NSW, Australia
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Petrides GA, Hayler R, Lee JW, Jankelowitz S, Low TH. Electromyography in the prognostication of recovery in patients with acute peripheral facial nerve palsy: A systematic review. Clin Otolaryngol 2023. [PMID: 37118939 DOI: 10.1111/coa.14072] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 03/26/2023] [Accepted: 04/20/2023] [Indexed: 04/30/2023]
Abstract
OBJECTIVES Needle electromyography (EMG) may be used to characterise the severity of the injury in acute peripheral facial nerve palsy (FNP) to predict recovery and guide management, but its prognostic value and clinical utility remain controversial. The aim of this systematic review was to evaluate the role of EMG to prognosticate the recovery of facial motor function in patients with acute peripheral FNP. DESIGN A comprehensive search strategy was applied in PubMed, Embase, and Web of Science based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The main outcome measure was the accuracy of EMG in predicting long-term facial function at least 6 months following symptom onset. RESULTS Eleven studies were included comprising 3837 participants, with 91.6% of these diagnosed with Bell's palsy (BP). In BP patients, the positive predictive value and negative predictive value for a good outcome based on EMG findings ranged from 82.1% to 100% and 66.7% to 80.5%, respectively, with two out of three studies finding that EMG remained a significant predictor of the outcome on multivariate analysis. Three studies addressed the role of EMG in non-idiopathic FNP with two of these studies supporting EMG to predict prognosis. CONCLUSIONS EMG is a useful tool to gain insight into the likely outcome to guide management decisions and counsel patients on their expectations, particularly in BP. However, given inconsistencies in its application and lack of evidence around non-idiopathic FNP, it should not currently be relied on to predict recovery. Ultimately, its prognostic value and widespread adoption are dependent on the implementation of a clear and standardised protocol in future high-quality studies and routine clinical settings.
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Affiliation(s)
- George Andrew Petrides
- Department of Head and Neck Surgery, Sydney Facial Nerve Service, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - Raymond Hayler
- Department of Head and Neck Surgery, Sydney Facial Nerve Service, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - Jennifer W Lee
- Department of Head and Neck Surgery, Sydney Facial Nerve Service, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - Stacey Jankelowitz
- Department of Neurology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Tsu-Hui Low
- Department of Head and Neck Surgery, Sydney Facial Nerve Service, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Camperdown, New South Wales, Australia
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
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Hayler R, Lockhart K, Barat S, Cheng E, Mui J, Shamavonian R, Ahmadi N, Alzahrani N, Liauw W, Morris D. Survival benefits with EPIC in addition to HIPEC for low grade appendiceal neoplasms with pseudomyxoma peritonei: a propensity score matched study. Pleura Peritoneum 2023; 8:27-35. [PMID: 37020474 PMCID: PMC10067551 DOI: 10.1515/pp-2022-0205] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 02/22/2023] [Indexed: 03/17/2023] Open
Abstract
Abstract
Objectives
Appendiceal cancer is a rare malignancy, occurring in roughly 1.2 per 100,000 per year. Low grade appendiceal neoplasams (LAMN) in particular can lead to pseudomyxoma peritonei (PMP), and respond poorly to systemic chemotherapy. Standard treatment includes cytoreduction surgery (CRS) with addition of heated intraoperative peritoneal chemotherapy (HIPEC). Several centres include early postoperative intraperitoneal chemotherapy (EPIC) however; the literature is mixed on the benefits. We aim to examine the benefits of additional EPIC through a propensity-matched analysis.
Methods
Patients with LAMN with PMP who underwent cytoreductive surgery at St George hospital between 1996 and 2020 were included in this retrospective analysis. Propensity score matching was performed with the following used to identify matched controls; sex, age, American Society of Anesthesiologists (ASA) grade, peritoneal cancer index (PCI) and morbidity grade. Outcomes measured included length of stay and survival.
Results
A total of 224 patients were identified of which 52 received HIPEC alone. Propensity matching was performed to identify 52 matched patients who received HIPEC + EPIC. Those receiving HIPEC + EPIC were younger at 54.3 vs. 58.4 years (p=0.044). There was a median survival benefit of 34.3 months for HIPEC + EPIC (127.3 vs. 93.0 months, p=0.02). Median length of stay was higher in those who received EPIC (25.0 vs. 23.5 days, p=0.028).
Conclusions
In LAMN with PMP, the addition of EPIC to HIPEC with CRS improves overall survival in propensity score matched cases but results in prolonged hospitalisation. The use of EPIC should still be considered in selected patients.
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Affiliation(s)
- Raymond Hayler
- Peritonectomy and Liver Cancer Unit, Department of Surgery , St George Hospital , NSW , Sydney , Australia
- School of Clinical Medicine, St George & Sutherland Campus , UNSW Medicine & Health , Sydney , Australia
- Faculty of Medicine and Health , Macquarie University , Sydney , Australia
| | - Kathleen Lockhart
- Peritonectomy and Liver Cancer Unit, Department of Surgery , St George Hospital , NSW , Sydney , Australia
| | - Shoma Barat
- Peritonectomy and Liver Cancer Unit, Department of Surgery , St George Hospital , NSW , Sydney , Australia
- School of Clinical Medicine, St George & Sutherland Campus , UNSW Medicine & Health , Sydney , Australia
| | - Ernest Cheng
- Peritonectomy and Liver Cancer Unit, Department of Surgery , St George Hospital , NSW , Sydney , Australia
- School of Clinical Medicine, St George & Sutherland Campus , UNSW Medicine & Health , Sydney , Australia
| | - Jasmine Mui
- Peritonectomy and Liver Cancer Unit, Department of Surgery , St George Hospital , NSW , Sydney , Australia
- School of Clinical Medicine, St George & Sutherland Campus , UNSW Medicine & Health , Sydney , Australia
| | - Raphael Shamavonian
- Peritonectomy and Liver Cancer Unit, Department of Surgery , St George Hospital , NSW , Sydney , Australia
| | - Nima Ahmadi
- Peritonectomy and Liver Cancer Unit, Department of Surgery , St George Hospital , NSW , Sydney , Australia
| | - Nayef Alzahrani
- Peritonectomy and Liver Cancer Unit, Department of Surgery , St George Hospital , NSW , Sydney , Australia
- College of Medicine , Imam Muhammad Ibn Saud Islamic University , Riyadh , Kingdom of Saudi Arabia
| | - Winston Liauw
- School of Clinical Medicine, St George & Sutherland Campus , UNSW Medicine & Health , Sydney , Australia
- Department of Medical Oncology , St George Hospital , NSW , Sydney , Australia
| | - David Morris
- Peritonectomy and Liver Cancer Unit, Department of Surgery , St George Hospital , NSW , Sydney , Australia
- School of Clinical Medicine, St George & Sutherland Campus , UNSW Medicine & Health , Sydney , Australia
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Hayler R, Low THH, Fung K, Nichols AC, MacNeil SD, Yoo J. Implantable Doppler Ultrasound Monitoring in Head and Neck Free Flaps: Balancing the Pros and Cons. Laryngoscope 2020; 131:E1854-E1859. [PMID: 33141464 DOI: 10.1002/lary.29247] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 08/01/2020] [Revised: 09/29/2020] [Accepted: 10/23/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVES/HYPOTHESIS Free flap transfer offers a versatile option for reconstruction in head and neck surgery, with success rates over 95%. There remains a substantial re-exploration rate of roughly 5% to 15%, with early recognition of compromise essential to flap survival. Monitoring techniques are highly desirable, with the gold standard being clinical monitoring. The Cook-Swartz Doppler (CSD) probe utilizes Doppler technology to inform clinicians about real-time flow. We aim to describe our adoption of this technology in 100 consecutive free flaps. STUDY DESIGN Prospective case series. METHODS Prospective data were collected from July 2014 to June 2015 on 100 consecutive free flaps performed at a head and neck unit in London, Ontario. All patients had a CSD inserted for arterial and venous monitoring. RESULTS A total of 100 free flaps were performed on 99 patients. Sensitivity was 87.1% and specificity was 85.7%. Positive predictive value was 98.8% and negative predictive value was 33.3%. False-negative and false-positive rate were 1.0% and 12.0%, respectively. The exploration rate was 12%, with no flap loss and two partial debridements. The CSD was helpful in management in 9% of cases and was clinically unhelpful in 11% of cases, with 10 of 11 abnormal signals ignored. There were three unique CSD complications; one retained wire, one pedicle laceration during extraction, and one clot around the probe interrupting signal. CONCLUSIONS The CSD is a helpful adjunct to clinical monitoring but has unique complications, which were not previously described. Pros and cons must be considered for new centers adopting this technology. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E1854-E1859, 2021.
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Affiliation(s)
- Raymond Hayler
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Tsu-Hui Hubert Low
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Head and Neck Department, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - Kevin Fung
- Department of Otolaryngology - Head and Neck Surgery, Western University Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Anthony C Nichols
- Department of Otolaryngology - Head and Neck Surgery, Western University Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - S Danielle MacNeil
- Department of Otolaryngology - Head and Neck Surgery, Western University Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - John Yoo
- Department of Otolaryngology - Head and Neck Surgery, Western University Schulich School of Medicine and Dentistry, London, Ontario, Canada
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Hayler R, Clark J, Croxson G, Coulson S, Hussain G, Ngo Q, Ch'ng S, Low T(H. Sydney Facial Nerve Clinic: experience of a multidisciplinary team. ANZ J Surg 2020; 90:856-860. [DOI: 10.1111/ans.15782] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 01/15/2020] [Accepted: 02/09/2020] [Indexed: 12/23/2022]
Affiliation(s)
- Raymond Hayler
- Sydney Medical SchoolThe University of Sydney Sydney New South Wales Australia
- Sydney Facial Nerve ClinicChris O'Brien Lifehouse Sydney New South Wales Australia
| | - Jonathan Clark
- Sydney Medical SchoolThe University of Sydney Sydney New South Wales Australia
- Sydney Facial Nerve ClinicChris O'Brien Lifehouse Sydney New South Wales Australia
| | - Glen Croxson
- Sydney Facial Nerve ClinicChris O'Brien Lifehouse Sydney New South Wales Australia
| | - Susan Coulson
- Sydney Facial Nerve ClinicChris O'Brien Lifehouse Sydney New South Wales Australia
- School of PhysiotherapyThe University of Sydney Sydney New South Wales Australia
| | - Gazi Hussain
- Sydney Facial Nerve ClinicChris O'Brien Lifehouse Sydney New South Wales Australia
- Department of Plastic, Reconstructive, and Hand SurgeryConcord Hospital Sydney New South Wales Australia
| | - Quan Ngo
- Sydney Facial Nerve ClinicChris O'Brien Lifehouse Sydney New South Wales Australia
- Department of Plastic SurgeryLiverpool Hospital Sydney New South Wales Australia
| | - Sydney Ch'ng
- Sydney Medical SchoolThe University of Sydney Sydney New South Wales Australia
- Sydney Facial Nerve ClinicChris O'Brien Lifehouse Sydney New South Wales Australia
- Institute of Academic SurgeryThe University of Sydney Sydney New South Wales Australia
- Department of Plastic SurgeryRoyal Prince Alfred Hospital Sydney New South Wales Australia
| | - Tsu‐Hui (Hubert) Low
- Sydney Medical SchoolThe University of Sydney Sydney New South Wales Australia
- Sydney Facial Nerve ClinicChris O'Brien Lifehouse Sydney New South Wales Australia
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Jondrevillea C, Hayler R, Feuerstein D. Replacement of zinc sulphate by microbial phytase for piglets given a maize-soya-bean meal diet. ACTA ACUST UNITED AC 2007. [DOI: 10.1079/asc41440077] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AbstractForty-eight pigs, weaned at 27 days of age at an average body weight of 7·55 kg were used in a 19-day experiment to investigate the influence of microbial phytase on zinc utilization and to calculate equivalency values of zinc as sulphate for microbial phytase. Eight experimental diets were formulated: a maize-soya-bean meal basal diet containing 30 mg of zinc per kg supplemented with 10, 25, 40 or 100 mg of zinc from sulphate (ZnSO4, 7H2O) per kg or with 100, 250, 500 or 750 units (U) of microbial phytase (3- phytase from Aspergillus niger, Natuphos ®) per kg. The dietary supplies of calcium and phosphorus were adjusted accounting for the release of these elements by microbial phytase. The copper concentration in the diets was 11 mg/kg. Pigs were given the basal diet for a 7-day adjustment period prior to the 19-day experimental period. At the end of the experiment, bone ash, phosphorus and calcium concentrations as well as plasma and liver copper concentrations were independent of the diet (P> 0·10). The zinc status of piglets was assessed through plasma alkaline phosphatase activity (APA) and zinc concentration, bone zinc concentration and liver zinc concentration. Plasma zinc, plasma APA and bone zinc increased linearly (P< 0·001) and quadratically (P< 0·01,P< 0·001 andP< 0·001, respectively) with zinc added. These parameters also increased linearly (P< 0·001) and quadratically (P< 0·05,P< 0·001 andP< 0·05, respectively) with phytase added. Liver zinc increased quadratically (P< 0·05) with zinc added and tended to increase linearly with phytase added (P= 0·077). Linear and non-linear response equations of indicators of zinc status to zinc added and phytase added were developed and used to calculate zinc equivalency values of phytase. Non-linear models were linear plateau models for zinc added and exponential models for phytase added. Plasma APA, plasma zinc and bone zinc were maximized when zinc added reached 43, 54 and 56 mg/kg of diet, respectively. The mean function of equivalency of zinc as sulphate (Zn, mg/kg of diet) for microbial phytase (Phyt, U per kg of diet) was Zn = 49·9 − 58·3 e−0·00233Phyt. From this equation it is calculated that 250, 500, and 750 U of 3-phytase from Aspergillus niger can avoid the addition of 17, 32 and 40 mg of zinc as sulphate in a piglet diet. Zinc ingested and, in turn, zinc excreted, may be proportionately reduced by almost 0·30 by replacing 30 mg of zinc as sulphate by 500 U of phytase as Natuphos ® in a piglet maize and soya-bean meal diet formulated to contain 100 mg of zinc per kg.
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