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| 1 | Treatment of hemorrhoids: A survey of surgical practice in Australia and New Zealand显示文摘BACKGROUND Hemorrhoidal disease is the most common anorectal disorder.Hemorrhoids can be classified as external or internal,according to their relation to the dentate line.External hemorrhoids originate below the dentate line and are managed conservatively unless the patient cannot keep the perianal region clean,or they cause significant discomfort.Internal hemorrhoids originate above the dentate line and can be managed according to the graded degree of prolapse,as described by Goligher.Generally,low-grade internal hemorrhoids are effectively treated conservatively,by non-operative measures,while high-grade internal hemorrhoids warrant procedural intervention.AIM To determine the application of clinical practice guidelines for the current management of hemorrhoids and colorectal surgeon consensus in Australia and New Zealand.METHODS An online survey was distributed to 206 colorectal surgeons in Australia and New Zealand using 17 guideline-based hypothetical clinical scenarios.RESULTS There were 82 respondents(40%)to 17 guideline-based scenarios.Nine(53%)reached consensus,of which only 1(6%)disagreed with the guidelines.This was based on low quality evidence for the management of acutely thrombosed external hemorrhoids.There were 8 scenarios which showed community equipoise(47%)and they were equally divided for agreeing or disagreeing with the guidelines.These topics were based on low and moderate levels of evidence.They included the initial management of grade I internal hemorrhoids,grade III internal hemorrhoids when initial management had failed and the patient had recognised risks factors for septic complications;and finally,the decision-making when considering patient preferences,including a prompt return to work,or minimal post-operative pain.CONCLUSION Although there are areas of consensus in the management of hemorrhoids,there are many areas of community equipoise which would benefit from further research. | George E Fowler Javariah Siddiqui Assad Zahid Christopher John Young | 2019 | World Journal of Clinical Cases2019，7，22： | 8 |
| 2 | Low ADAMTS-13 in plavix induced thrombotic thrombocytopenic purpura显示文摘Thrombotic thrombocytopenia purpura(TTP) was fi rst described in 1924 as a 'pathologic alteration of the microvasculature, with detachment or swelling of the endothelium, amorphous material in the sub-endothelial space, and luminal platelet aggregation leading to compromise of the microcirculation'. Ticlopidine induced TTP has been highly associated with autoimmune induced reduction in ADAMTS-13 activity. These findings, to a lesser extent, have also been found in clopidogrel induced TTP. We report a case of clopidogrel associated TTP in a patient that presented with acute stroke, renal failure, and non-ST elevation myocardial infarction. | Long Bao Cao Christopher Jones Assad Movahed | 2013 | World Journal of Clinical Cases2013，1，1： | 2 |
| 3 | How to decide on stent insertion or surgery in colorectal obstruction?显示文摘Colorectal cancer is one of the most common cancers in western society and malignant obstruction of the colon accounts for 8%-29% of all large bowel obstructions. Conventional treatment of these patients with malignant obstruction requiring urgent surgery is associated with a greater physiological insult on already nutritionally replete patients. Of late the utility of colonic stents has offered an option in the management of these patients in both the palliative and bridge to surgery setting. This has been the subject of many reviews which highlight its efficacy, particulary in reducing ostomy rates, allowing quicker return to oral diet, minimising extended post-operative recovery as well as some quality of life benefits. The uncertainity in managing patients with malignant colonic obstructions has lead to a more cautious use of stenting technology as community equipoise exists. Decision making analysis has demonstrated that surgeons' favored the use of stents in the palliative setting preferentially when compared to the curative setting where surgery was preferred. We aim to review the literature regarding the use of stent or surgery in colorectal obstruction, and then provide a discourse with regards to the approach in synthesising the data and applying it when deciding the appropriate application of stent or surgery in colorectal obstruction. | assad zahid christopher john young | 2016 | World Journal of Gastrointestinal Surgery2016，8，1： | 1 |
| 4 | A model of cerebellar computations for dynamical state estimation显示文摘 | Hoffman L F Christopher Assad | 2001 | Autonomous Robots2001，11，3： | 1 |
| 5 | Coumadin ridge: An incidental finding of a left atrial pseudotumor on transthoracic echocardiography显示文摘Coumadin ridge is a normal anatomic variant that is occasionally found in the left atrium. It can present as a linear or nodular mass which can undulate with cardiac motion and if particularly prominent, can easily be mistaken for a tumor or thrombus. Careful evaluation and consideration of the common variants discussed in this review can help limit misdiagnosis, as well as unnecessary workup and treatment. We present a case of coumadin ridge that was found on a patient using two-dimensional transthoracic echocardiography. | Aadil Mubeen Lodhi Tin Nguyen Christopher Bianco Assad Movahed | 2015 | World Journal of Clinical Cases2015，3，9： | 1 |
| 6 | Hypothesized summative anal physiology score correlates but poorly predicts incontinence severity显示文摘AIM To explore the relationship between such a construct and an existing continence score.METHODS A retrospective study of incontinent patients who underwent anal physiology(AP) was performed. AP results and Cleveland Clinic Continence Scores(CCCS) were extracted. An anal physiology score(APS) was developed using maximum resting pressures(MRP), anal canal length(ACL), internal and external sphincter defects and pudendal terminal motor latency. Univariate associations between each variable, APS and CCCS were assessed. Multiple regression analyses were performed.RESULTS Of 508(419 women) patients, 311 had both APS and CCCS measured. Average MRP was 51 mm Hg(SD23.2 mm Hg) for men and 39 mm Hg(19.2 mm Hg) for women. Functional ACL was 1.7 cm for men and 0.7 cm for women. Univariate analyses demonstrated significant associations between CCCS and MRP(P = 0.0002), ACL(P = 0.0006) and pudendal neuropathy(P < 0.0001). The association between APS and CCCS was significant(P < 0.0001) but accounted for only 9.2% of the variability in CCCS. Multiple regression showed that the variables most useful in predicting CCCS were external sphincter defect, pudendal neuropathy and previous pelvic surgery, but only improving the scores predictive ability to 12.5%.CONCLUSION This study shows that the ability of AP tests to predict continence scores improves when considered collectively, but that a constructed summation model before and after multiple regression is poor at predicting the variability in continence scores. | Christopher J Young Assad Zahid Cherry E Koh Jane M Young | 2017 | World Journal of Gastroenterology2017，23，31： | 0 |
| 7 | Atrium of stone:A case of confined left atrial calcification without hemodynamic compromise显示文摘Dystrophic cardiac calcification is often associated with conditions causing systemic inflammation and when present,is usually extensive,often encompassing multiple cardiac chambers and valves.We present an unusual case of dystrophic left atrial calcification in the setting of end stage renal disease on hemodialysis diagnosed by echocardiography and computed tomography.Significant calcium deposition is confined within the walls of the left atrium with no involvement of the mitral valve,and no hemodynamic effects. | Christopher Jones Aadil Mubeen Lodhi Long Bao Cao Arjun Kumar Chagarlamudi Assad Movahed | 2014 | World Journal of Clinical Cases2014，2，5： | 0 |
| 8 | Colorectal surgeon consensus with diverticulitis clinical practice guidelines显示文摘AIM To determine the application of clinical practice guidelines for the current management of diverticulitis and colorectal surgeon specialist consensus in Australia and New Zealand.METHODS A survey was distributed to 205 colorectal surgeons in Australia and New Zealand, using 22 hypothetical clinical scenarios.RESULTS The response rate was 102(50%). For 19 guidelinebased scenarios, only 11(58%) reached consensus(defined as > 70% majority opinion) and agreed with guidelines; while 3(16%) reached consensus and did not agree with guidelines. The remaining 5(26%) scenarios showed community equipoise(defined as less than/equal to 70% majority opinion). These included diagnostic imaging where CT scan was contraindicated, management options in the failureof conservative therapy for complicated diverticulitis, surgical management of Hinchey grade 3, proximal extent of resection in sigmoid diverticulitis and use of oral mechanical bowel preparation and antibiotics for an elective colectomy. The consensus areas not agreeing with guidelines were management of simple diverticulitis, management following the failure of conservative therapy in uncomplicated diverticulitis and follow-up after an episode of complicated diverticulitis. Fifty-percent of rural/regional based surgeons would perform an urgent sigmoid colectomy in failed conservative therapy of diverticulitis compared to only 8% of surgeons city-based(Fisher's exact test P = 0.016). In right-sided complicated diverticulitis, a greater number of those in practice for more than ten years would perform an ileocecal resection and ileocolic anastomosis(79% vs 41%, P < 0.0001).CONCLUSION While there are areas of consensus in diverticulitis management, there are areas of community equipoise for future research, potentially in the form of RCTs. | Javariah Siddiqui Assad Zahid Jonathan Hong Christopher John Young | 2017 | World Journal of Gastrointestinal Surgery2017，9，11： | 0 |
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