Download live surgery… - Westmead Private Hospital

GPNews
Westmead Private Hospital
Cnr Mons & Darcy Road Westmead NSW 2145
Issue 2
June 2014
02 8837 9000
LIVE SURGERY…
Advanced Single Site
Robotic Hysterectomy
Inside
• Parking Improvements
• New $1.6m Operating Theatre
• $1.4m 3D Micrscope
• New Specialists Join the Team
Westmead GP news
1
GPNews
In this issue
2
A Message from the CEO Tim Daniel
3
News from Westmead Private Hospital
4
Zeiss ‘Pentero 900’ 3D Microscope
5Husband & Wife Receive Cochlear Implant on the same day
at Westmead Private
5
NOGIN – Neuro Oncology Information Network
PRODUCTION & MATERIAL
6
Dr Faruque Riffat…A concise approach to the hoarse voice
8
Cathetorisation Laboratory: Interventional Neuro-Radiology
The Westmead Private & WSPOIC GP News is
produced by the WESTMEAD PRIVATE Hospital
Marketing Department
9 New Endoscopes for our Urologists- Series 190 Gastroscope
9
The gift to swallow restored for Anthony Whitefield
10
A/Prof Carsten Palme investigates Thyroid Nodular Disease
11
Westmead Private Car Parking Improvements
11
Referrals for Infusion Treatment at WSPOIC
12
New specialists to join the team
FOR FEEDBACK, ENQUIRIES AND MATERIAL
SUBMISSION PLEASE CONTACT
Melissa MacIvor
T: (02) 8837 9000
E: [email protected]
If you do not wish to receive this newsletter or
other marketing materials please contact the
Marketing Department
T: 0428 317 781
A MESSAGE FROM THE CEO Tim Daniel
Welcome to Westmead Private Hospital’s second edition of
‘Medical Matters’. This issue will showcase some of the amazing
outcomes our patients have recently experienced, from the
couple who had cochlear implants, to the patient who received
the first POEM procedure in Australia. We will also highlight
some of the new pieces of equipment our surgeons now have
access to. I am proud that Westmead Private is continually
securing advanced pieces of equipment and undertaking new
procedures.
Despite Westmead Private providing an inspiring record of
medical firsts across many fields, we have one thing that is
consistent in our hospital and that is our outstanding staff,
surgeons and medical clinicians. Dedication and team spirit
recedes through our hospital as our staff work tirelessly day in
and day out to provide an individualised top quality service to
every patient. This issue will present to you some of our current
specialists including our Neuro-radiology team, ENT Surgeons
and Neurosurgeons. We are also delighted to introduce you to
some of the new specialists that have joined the team.
Westmead Private has recently had some significant changes
take place which have further improved the operation of our
hospital. We have just completed a $3m project to put in a
new high tech operating theatre which takes us to a total of 12
theatres. We have also significantly improved our on-site parking,
which has freed up over 100 spaces for patients and visitors and
improved our accessibility.
2
Westmead GP news
As a hospital we are even more focused than ever this year on
providing educational opportunities to our catchment area of
GP’s. You will find some articles within this newsletter, written
by our specialists that provide tips for you in your everyday GP
practice on ‘what to look out for’ and ‘when to refer’. Additionally,
alongside our already well-established GP education program
which runs 5 times a year, our new GP Liaison Officer
will continue to carry out GP ‘lunch and
learn’ sessions with our specialists to
GP practices in the local area.
I would like to thank you all for your
continued support of our hospital and
we look forward to working and
supporting you throughout 2014.
Yours Sincerely,
Tim Daniel
Chief Executive Officer
NEWS FROM WPH
NEW
STATE-OF-THE-ART
THEATRE
We are thrilled to announce the opening of Westmead Private Hospital 12th
operating theatre. This brand new high tech theatre equipped with the latest
surgical technologies will provide our surgeons and patients with gold-class
surgical care. This new 67m2 operating theatre will be primarily utilised
by our Neurosurgeons who require additional space for their advanced
equipment. However, this will then free up additional theatre time for all of our
other surgical specialists. This renovation, alongside our further expansion
plans over the new twelve to eighteen months, will cement our hospital as a
fantastic medical facility, providing top-end surgical technology.
LIVE SURGERY
STREAMED TO AGES CONFERENCE
Westmead Private Hospital was pleased to recently welcome Dr Devin Garza,
from the USA. Dr Garza is an internationally known leader in Gynaecology
robotic surgery and teaches surgeons in the USA to learn best practices
in safety and surgical techniques in robotic surgery.
Dr Garza moderated surgery performed by Dr Felix Chan (Gynaecological
Oncology Surgeon) & A/Prof Harry Merkur (Gynaecologist) during a live
surgery education forum for the Australian Gynaecological Endoscopy and
Surgery Annual Scientific Meeting (AGES).
The doctors performed the live surgery; both the standard and the more
advanced single site robotic hysterectomy, at Westmead Private Hospital
which was streamed live to the International conference held at the Hilton
Hotel in Sydney on Friday 28th March.
Gynaecologists from all over Australia and New Zealand attended the
conference to learn about the new generation robotic technology and the
benefits to their patients. This forum allowed the specialists to discuss the
new technology and to enhance their array of surgical options.
Dr Chan said “I am delighted to be able to assist others in their learning
curve; it is very fulfilling to be involved in the next generation technology”.
With today’s ever changing technology it is evident that surgeons have signed
up for a lifetime of learning.
For the patients involved the benefits for them having this surgery include:
• Minimal scarring
• Low blood loss
• Short hospital stay
• Minimal pain
• Fast recovery
• High patient satisfaction
A/Prof Harry Merkur, Dr Devin Garza and Dr Felix Chan
Dr Felix Chan
Suite 32, 1a Ashley Lane
WESTMEAD, NSW, 2145
T: (02) 9635 9655
F: (02) 9635 9688
A/Prof Harry Merkur
6 Kempsey Street,
BLACKTOWN, NSW, 2145
T: (02) 9622 8000
F: (02) 9622 8686
Westmead GP news
3
ZEISS ‘PENTERO 900’
3D MICROSCOPE
The BLUE 400 fluorescence will help in improving tumour
resection rates. It is used in conjunction with the Gliolan
drug, which accumulates at the glioblastoma site and
fluoresces under the blue light of the micro scope.
The Infrared IR800 fluorescence is used to assist in
vascular Neurosurgery. Essentially the IR800 helps
visualize blood flow.
In addition to the microscope, WMP is the first Hospital
in Australia to adopt the new Trenion 3D camera system.
Traditional video has always been limited in its ability to
show depth. The Trenion 3D camera has dual cameras
on both light paths (left and right), these signals are run
simultaneously into the 3D screen and with the assistance
of the 3D glasses you will get image clarity like no other.
The 3D recording is part of the Trenion system and the
videos taken with the Trenion will be world class videos for
any conferences or live surgery sessions run at the hospital.
Westmead Private Hospital is pleased to announce the
arrival of the latest Zeiss ‘Pentero 900’ microscope, with
the 3D Imaging component. Our Neurosurgeons and
ENT surgeons are delighted that they can now utilise the
newest model of this high-tech microscope at our facility.
The ‘PENTERO 900’ microscope is a unique surgical
visualization platform that offers advanced functionality
to meet the most demanding microsurgical applications.
It is equipped with all the latest technologies including
foldable, rotatable binoculars, integrated HD camera, and
recording plus the latest “Infrared 800” and “BLUE400”
fluorescence technologies.
Westmead Private Hospital:
Specialist ENT Surgeons
“Westmead Private Hospital is very fortunate to be one
of the first hospitals in the world to benefit from the new
High Definition 3D video recording system attached to
this microscope. This allows us to beam 3D HD images
live to other surgeons within the hospital and at external
conferences in Sydney or anywhere in the world. We can
also record all of our operations in 3D HD, to be used as
an invaluable educational resource for trainee surgeons,
through the Royal Australasian College of Surgeons
and The University of Sydney”. Said Dr Narinder Singh, ENT
Surgeon at Westmead Private Hospital
Dr Narinder Singh, ENT Surgeon at Westmead Private,
Westmead Private Hospital:
Neurosurgeons
Dr Alan Cheng
(02) 9763 1111
Dr Gordon Dandie
(02) 9635 1938
A/Prof Melville Da Cruz
(02) 9635 1737
Dr Mark Dexter
(02) 9633 1900
A/Prof Carsten Palme
Dr Suchitra
Paramaesvaran
Dr Faruque Riffat
1300 552 665
Dr Andrew Kam
(02) 9633 1013
(02) 4737 3396
Jacqueline McMaster
(02) 9633 1013
(02) 9633 2133
Dr Gemma Olsson
(02) 9633 1900
Dr Nardiner Singh
(02) 9680 8800
Dr Philip Yeung
(02) 9281 8556
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Westmead GP news
HUSBAND & WIFE RECEIVE COCHLEAR IMPLANT
ON THE SAME DAY AT WESTMEAD PRIVATE HOSPITAL
For Tim and Natalie Nobes to hear the words “I love
you” for the first time, was made a reality after 21 years
of marriage. On 19th February A/Prof Melville DaCruz,
ENT Surgeon at Westmead Private Hospital performed
cochlear implant surgery on the couple, the first time
he had ever undertaken the operation on a married
couple on the same day.
Tim Daniel, CEO of Westmead Private Hospital said, “It’s
an absolute privilege for us to play our part in this truly
remarkable surgery and is just another great example
of the outstanding medical intervention which is being
performed at Westmead Private Hospital“
For Tim, 44 who was born prematurely and is profoundly
deaf and Natalie, 44 who is profoundly deaf from Rubella
the decision to have the implants has been a long time
coming. Some 5 years ago Natalie’s mother gave them
some information on cochlear implants, but it wasn’t
until recently when they saw the successes from friends
and the advancement in technology that they have
decided to undertake the procedure together.
With the recent release of the MED-EL RONDO®
system, which combines the traditional audio processor
components such as the coil, control unit and battery
pack into one single unit, and making it the world’s
first single-unit processor for cochlear implants, the
Nobes thought it was time for action. The RONDO® is
a breakthrough in hearing implant technology being
a compact all-in-one unit and can therefore be worn
discretely under the hair.
For Tim and Natalie’s three children Laura (18), Ryan (17)
and Emily (12) dinner time conversation is now a whole
lot better since the implants were switched on 3 weeks
after the implant surgery.
Tim and Natalie Nobes with A/Prof Melville Da Cruz
EURO ONCOLOGY
NOGIN NINFORMATION
NETWORK
NOgIN is a Brain Tumour Support Group that meets
bi-monthly to provide education to patients and family
on contemporary issues. This group was developed as
a joint initiative between Clinical Nurse Consultants at
Westmead Private and Westmead Hospital. The aim of
this group is to reduce the physical and emotional impact
associated with the diagnosis and ongoing treatment
of a brain tumour. An array of speakers present at the
meetings on very useful topics in an easy to understand
language. Topics include current treatment and research,
management of seizures, lifestyle, and emotional/
psychological issues.
To find out more about NOgIN and to view the dates
and times for the 2014 NOgIN program visit ; www.
westmeadprivate.com.au/Our-Services or contact our
Clinical Nurse Consultant on the number below.
Emma Everingham
Clinical Nurse Consultant, Westmead Private Hospital
Phone: (02) 8837 8926
Fax: (02) 8837 8940
Email: [email protected]
Westmead GP news
5
DR FARUQUE RIFFAT...
A CONCISE APPROACH TO THE HOARSE VOICE
Assessment of Dysphonia to identify malignancy
and diagnosing the benign pathologies that afflict the
larynx. Some key questions in my mind are:
1.Any recent upper respiratory infections? Even
a minor viral URTI can cause sufficient abnormality of
the delicate mucosal folds of the larynx or exacerbate
pre-existing pathology
2.Are there any associated sinister upper aerodigestive tract symptoms? In the region of
the larynx and hypopharynx, malignancies cause
symptoms such as dysphagia, odynophagia,
haemoptysis or referred otalgia
3.Smoking and alcohol history? The risk of
malignancy is proportional to the pack year smoking
history. Alcohol has a synergistic effect. Smoking can
also cause a range of benign laryngeal pathology
that can be treated such as hyperkeratosis, Reinke’s
oedema (Fig 1) as well as lung cancers that can lead to
recurrent laryngeal nerve palsy leading to breathiness
4.Pattern of symptoms? Excessive voice use with
occupational demands can create vocal strain.
Anxiety/Depression and public speaking fears are
often associated with muscle tension. Reflux generally
creates an episodic pattern, and is usually worse in
the morning. Sudden onset after excessive strain (eg.
football spectator) can indicate an acute haemorrhage
into the vocal cord
5.Voice demand of patient? Are there occupational
factors that are associated with risk of developing
benign nodules (teacher, lawyers, doctors, singers,
salespeople) and what are the occupational voice
needs of the patient
6.Presence of laryngopharyngeal reflux? Silent
extra-oesophageal acid reflux can cause a range
of symptoms ranging from globus, irritation, throat
clearing, “phlegminess” and dysphonia
7.Any associated chest disease? The use of steroid
inhalers for COPD can cause laryngeal candidiasis.
Persistent cough from reflux, COPD or post-nasal drip
from rhinosinusitis can cause vocal cord microtrauma.
Lung cancer, TB or thoracic surgery can cause
recurrent laryngeal nerve palsy which can manifest as
breathy dysphonia
8.Thyroid disease and surgery? Myxedema can
cause deposits of proteoglycans that thicken the vocal
cords manifesting as a deep hoarse dysphonia and
thyroid surgery is a risk factor for vocal cord palsy
6
Westmead GP news
9.
ny associated neurological symptom?
A
Conditions such as a CVA, multiple sclerosis, motor
neurone disease can cause bulbar dysfunction
which results in centrally mediated vagal dysfunction
10.Recent intubation? This can be associated with
vocal cord granuloma and scarring/indentation
disrupting the mucosal wave and cricoarytenoid unit
dysfuction
11.Impact on the patient’s quality of life?
Assessment of the impact of the condition on the
patient’s psychological, social and occupational
demands. Motivation to seek treatment and pursue
speech therapy if required
Examination
Speech Therapy
Begin with a general vocal assessment. This involves the
patient uttering a sentence in their normal voice projection.
It is crucial at this stage to identify if possible the dysphonia
is breathy of hoarse. Breathiness indicates air escape
within the larynx. It signifies a range of conditions
where the mobility of vocal cords is affected (eg
recurrent laryngeal nerve palsy). Hoarseness
indicates pathology of the mucosal fold and where
the vocal wave is affected (eg malignancy, Reinke’s
oedema, nodules) Fig 2.
1.Speech therapy has a crucial role in treating the
aetiology of vocal pathology (eg nodules), treating
the effect of vocal pathology on the function of the
patient (eg. muscle tension dysphonia) and training in
compensatory techniques (eg supraglottic swallow for
cord palsy)
After this I move on to a systematic physical examination of
the patient in the following order:
1.Examination of nose and nasopharynx including
nasendoscopy Are there polyps or any evidence of
post-nasal drip? Is there significant crusting or septal
perforation heralding Wegener’s (Fig 3)?
2.Examination of oropharynx Is there candidiasis? Is
there another sinister ulcer/lesion?
3.Examination of the larynx Direct per-nasal or peroral laryngoscopy to assess mucosal fold, mobility and
pyriform fossa. Complete assessment for malignancy
and reflux. Analysis of vocal cord mobility and glottis
closure (eg presbylarynx in old age leading to atrophy
and air escape) or vocal cord palsy
4.A thorough examination of all nodal regions of
the neck and the thyroid gland
Treatment Options
Vocal Hygiene
1.I take every opportunity to educate my patients about
vocal hygiene, including projection, breath control and
avoidance of shouting
2.Maintain adequate hydration , this is crucial to the
lubrication of the cords
Surgery
1.Laser Treatment. The carbon dioxide and KTP lasers
have revolutionised the endoscopic management of
benign and malignant laryngeal conditions. I routinely
offer this for pre-malignant and malignant pathology as
the oncological outcomes are identical to radiotherapy
(RT) and it keeps the options of radiotherapy open for
future use
The laser is also very useful for a range of benign
conditions such as Reinke’s oedema, granulomas and
webs
2.Coblation Treatment. This is a radiofrequency based
technique which I utilise for benign conditions such as
polyps and papillomas
3.Injection and Thyroplasty Techniques. These
techniques offer a very effective treatment for breathy
dysphonia due to volume loss in the cords (eg age
atrophy) or for vocal cord palsy. Depending on the
aetiology and the expected prognosis the appropriate
implant materials can be injected or inserted into the
vocal cord
Once the history and examination are completed, an
accurate diagnosis can be made in the vast majority of
patients. Unless a malignancy is suspected a biopsy under
general anaesthetic or further imaging is not required. In
some cases stroboscopy may be required in a setting of a
voice clinic.
3.Complete smoking cessation including discussion of
quitting techniques and medications
4. Reduction of caffeine (drying effect)
Treatment of Laryngopharygeal Reflux
1.General dietary and lifestyle modifications for reflux
including avoiding alcohol and spicy meals
2.Initial double dose proton-pump inhibitor for 3 months
followed by maintenance once daily
3.Judicious use of prokinetics (domperidone) and
alginates
4.Consider fundoplication for treatment refractory reflux
in consultation with gastroenterology and upper GI
surgery colleagues
Figure 1:
Reike’s
Oedema
Figure 2:
Early vocal
cord cancer
Figure 3:
Nasal
septal
Perforation
Dr Faruque Riffat BSc, MSc,
MBBS (Hons 1 UNSW), FRACS (Oto)
ENT Surgeon
Suite 104, 151 Hawkesbury Road, Westmead, NSW, 2145
Fax: (02) 9676 6708
Phone: (02) 9633 2133
Website: www.drfriffat.com
Westmead GP news
7
CATHETORIZATION LABORATORY:
INTERVENTIONAL Neuro-Radiology
Westmead Private Hospital is lucky to
have a fantastic Interventional Radiology
team, specialising specifically in NeuroRadiology, located on site. They work
closely with our Catheterization Laboratory
team and Neurosurgical team to provide
a comprehensive and multi-disciplinary
approach to managing varied patient
cases.
Visit this link to see some of the team in
action in Westmead Private’s Cath Lab:
http://www.youtube.com/
watch?v=Fs_W5cQF_l4
Dr Ken Faulder
MBBS, FRANZCR, AMIS
Dr Ken Faulder is a Radiologist
with specialist skills in
Interventional Neuro-Radiology.
He finished training as a
specialist radiologist at Royal
North Shore Hospital in 1999. He has gained interventional
radiology training both nationally and internationally, with Dr
Faulder commencing an INR fellowship at Royal North Shore
Hospital and completing it at Mt Sinai Hospital, New York.
Dr Faulder has extensive experience in interventional NeuroRadiology, with special interests including cerebral aneurysm and
AVM embolisation, intracranial stenting, internal carotid artery
stenting, acute stroke treatment and petrosal sinus sampling.
Westmead Specialist Centre, Suite 6, 16-18 Mons Road,
Westmead NSW 2145
Fax: (02) 8580 5208
Ph: 1300 553 339
Website: www.sevs.com.au
Dr Brendan Steinfort
MBBS, FRANZCR
Dr Brendan Steinfort is a
Radiologist with specialist
skills in Interventional NeuroRadiology. He completed
training as a specialist
radiologist at Royal North Shore Hospital and in 2005 he went
on to complete an interventional neuroradiology fellowship and
then undertook a second fellowship at The National Hospital
of Neurology & Neurosurgery, Queens Square London in
diagnostic Neuro Radiology and interventional Neuro-Radiology.
Dr Steinfort has extensive experience in Neuro-Radiology,
interventional Neuro-Radiology and general interventional
radiology, with special interests in neurovascular disease including:
cerebral aneurysm, AVM and dural AV Fistulas embolisation,
intracranial stenting and internal carotid artery stenting.
Westmead Specialist Centre, Suite 6, 16-18 Mons Road,
Westmead NSW 2145
Phone: 1300 553 339 Fax: (02) 8580 5208
Website: www.sevs.com.au
8
Westmead GP news
NEW ENDOSCOPES FOR OUR UROLOGISTS –
Series 190 Gastroscope
We have recently added to our equipment at Westmead
Private Hospital a new video endoscope, with ultrasound
guidance technology. The new scope provide amazing
imaging quality never seen before. Our Urologists have
been busy using ultra-sound in their diagnostic procedures.
Ultrasound guided biopsies of the prostate is now a very
common procedure appearing on our operating lists.
The use of ultrasound guidance, particularly by Dr. Howard
Lau, in partial nephrectomy both open and laparoscopic
procedures, allows us to be even more particular in just
how much tissue needs to be removed from the kidney
when dealing with kidney cancer. Our kidney patients are
now keeping more and more of their own kidney and its
function following cancer diagnosis.
On March 5th the first P.O.E.M. procedure but also the
first in all of Australia was carried out. Professor Bourke,
with Professor Paul Focker from Germany supporting and
encouraging, conducted our first Per-Oral Endoscopic
Myotomy. The patients story is shown below.
THE GIFT TO SWALLOW RESTORED FOR
ANTHONY WHITEFIELD
AT WESTMEAD PRIVATE HOSPITAL,
A FIRST IN AUSTRALIA
On 5th March, 79 year old Anthony Whitefield underwent
ground breaking endoscopic surgery performed by
Professor Michael Bourke, Gastroenterologist to help
him swallow. For the past 8-10 years Anthony has had
trouble swallowing due to a spastic disorder of the lower
oesophageal sphincter called Achalasia. So bad were his
symptoms that his weight plummeted to less than 49kgs.
Anthony underwent Per-Oral Endoscopic Myotomy
(POEM) at Westmead Private Hospital, one of the very
first POEM procedures to be performed in Australia.
POEM involves creating a submucosal tunnel in the
oesophageal wall and then selectively dividing individual
muscle fibres deep in the oesophageal wall, particularly
at the level of the lower oesophageal sphincter,
thereby releasing the obstruction. The tunnel is then
closed endoscopically with clips to avoid a leak of
swallowed luminal contents into the chest outside of the
oesophagus.
Professor Bourke was supported by Professor
Paul Fockens, a world authority in POEM from the
Netherlands.
Anthony was on a light diet for a week and then
progressed back to a normal diet over time, which he
has not enjoyed for quite some time. In particular he is
looking forward to a seafood feast with his four children,
10 grandchildren and 1 great grandchild when he is fully
recovered.
Tim Daniel, CEO of Westmead Private Hospital said, “It’s
an absolute privilege for us to play our part in this truly
remarkable endoscopic surgery with all of its minimally
invasive advantages.”
Westmead GP news
9
A/PROF CARSTEN PALME
INVESTIGATES THYROID NODULAR DISEASE
Thyroid nodules are common in the general community. They are present on clinical examination in approximately
5% of patients. The incidence of subclinical disease however is much higher due to the widespread use of imaging
when evaluating a variety of head and neck complaints. Thyroid nodular disease is most common in women with
a ratio of greater than 3:1. Nearly 50% over the age of 50 years will have detectable nodules on high resolution
ultrasonography. The aetiology is varied and commonly includes iodine deficiency, immune disorders, and both
benign and malignant neoplasms. The incidence of primary malignancy in clinically detectable thyroid nodules
is 5% to 20%. The majority of thyroid cancers are well differentiated and foremost include papillary (80%) and
follicular (10%) variants. The death rate of thyroid cancer is fortunately low and associated with more aggressive
histologic subtypes including medullary and anaplastic carcinoma.
Identifying Patients
with Thyroid Nodules
The high incidence of both
clinically and importantly
incidentally discovered thyroid
nodules place a significant
Symptoms include: pain, difficulty
burden on the primary care
swallowing or breathing
physician especially given the
fact that the majority will be benign. A clear and robust
approach is required to identify those patients which require
prompt specialist care. A concise history and comprehensive
examination is paramount in the assessment of all thyroid
nodules. It is important to identify risk factors for malignancy
such as extremes of age, male gender, ionizing radiation
exposure and a positive family history. A rapidly growing
nodule, associated with lateral neck lymphadenopathy
and or changes in airway, voice and swallow are clinical
features that may be associated with an underlying thyroid
cancer. In addition to careful physical examination of the
neck, all patients require thorough inspection of the upper
aerodigestive tract. This can be achieved with the use of
laryngeal mirrors, rigid endoscopes or fiberoptic flexible
nasendoscopes.
How to Investigate Thyroid Nodules
Fortunately the majority of patients do not have signs
of significant local invasion or metastatic disease
on presentation. It is important to perform routine
investigations in all patients with thyroid nodular disease
which include simple thyroid function tests, evaluation of
thyroid autoantibodies and importantly high resolution
ultrasonography. There are certain imaging features such
as the presence of speckled microcalcification, irregular
tumour borders and increased vascularity that may heighten
concerns of an underlying thyroid cancer. However the gold
standard investigation for any thyroid nodule greater than
1 cm or smaller with suspicious features is an ultrasound
guided fine needle aspiration biopsy (FNA) by an experienced
cytopathologist. Standard reporting of the cytology includes;
malignant, benign, atypical, indeterminate or inadequate
sample.
10
Westmead GP news
Management of Thyroid Nodular Disease
The management of thyroid nodular disease requires a
multidisciplinary approach. The team includes foremost the
primary care physician, the endocrinologist, an experienced
thyroid surgeon, a thyroid cytopathologist and radiologist
with an interest in neck ultrasonography. Ultimate decision
on treatment depends on a combination of patient, tumour
and investigational
factors. Indications
for surgery include
significant upper
aerodigestive
tract compromise
including airway
obstruction,
proven malignancy
or atypical FNA
or overactivity. The extent of surgery may include a total
or hemithyroidectomy with possible lymph node dissection
depending on the clinical setting. Benign FNAs can be
managed with repeat imaging and or biopsy. Inadequate or
indeterminate FNAs should be repeated.
In summary the management of thyroid nodular disease
represents a major challenge given the significant incidence
in the general community and the possibility for a
malignant aetiology. A successful outcome requires a clear
understanding of certain patient, tumor and investigational
risk factors. The standard approach consists of a
comprehensive history and physical examination, appropriate
investigations and a multidisciplinary team. Definitive
treatment includes close observation or surgical exploration.
A/Prof Carsten E Palme
Otolaryngology Head & Neck Surgery
Suite 3, Westmead Private Hospital,
Cnr of Mons & Darcy Rds,
Westmead, NSW, 2145
Ph: 1300 552 665
Fax: (02) 8089 1025
Website: www.carstenpalme.com
Westmead Private
The care you need,
when you need it
Now with increased on-site parking for patients and visitors
In our ongoing efforts to meet the growing healthcare needs of our local community and maintain our excellent
reputation for quality healthcare, our latest completed redevelopment includes the addition of
a state-of-the-art fully integrated theatre while also increasing the spaces available for patient & visitor parking.
Westmead Private Hospital…you’re in safe hands!
www.westmeadprivate.com.au
Cnr Mons & Darcy Rds,
Westmead NSW 2145
Referrals For
Infusion Treatments at
Did you know?
Western Sydney Private Oncology & Infusion Centre (WSPOIC)
specialises in the care and support of patient’s infusion
therapy, including cytotoxic therapies for the treatment or
management of chronic illness or cancer. WSPOIC offers a
vast range of Infusion treatments for patients on-site, and the
pathway for patient referral to our centre is extremely easy.
Some of the treatments and procedures performed at our
centre are;
•
•
•
•
•
Iron Infusions
Blood Transfusions
Specialist Drug Infusions
– Neurology
– Rheumatology
– Gastroenterology
– Endocrinology
Ports, Piccs and Hickman’s care and pathology collection
Cancer Treatment
– Chemotherapy
– Monoclonal
•
•
•
•
•
•
Haematology Treatments
Immune/Enzyme Deficiency Treatments
IV Therapy
– Rehydration Infusions
Phlebotomy/Venesection
BCG Bladder Treatment- Urological patients
Peritoneal Chemotherapy
WSPOIC opened in August 2013 and is equipped with the
newest state-of-the-art equipment and the latest technologies
in infusion therapy. Please visit our website to view our ezi-find
directory for a full list of specialists accredited at our centre.
www.westernsydneyoncology.com.au
Western Sydney Private Oncology & Infusion Centre
Westmead Specialist Centre
Level 2, 16-18 Mons Road
WESTMEAD NSW 2145
Ph: 02 8837 9800
Fax: 02 8837 9845
Westmead GP news
11
NEW SPECIALISTS TO JOIN THE TEAM AT
WESTMEAD PRIVATE HOSPITAL
Obstetrician and Gynaecologist:
Dr Jyothi Marry MBBS, Dip. O&G, FRANZCOG
Dr Jyothi Marry is an experienced female specialist Obstetrician and Gynaecologist and is a Fellow
of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (FRANZCOG).
Jyothi received extensive training in Auckland, Westmead and Liverpool hospitals, and has received
advanced fellowship training in laparoscopic and pelvic surgery. She is RANZCOG Training Co-ordinator
for Sydney South West Local Health District and also received the Associate Dean’s teaching award. Dr
Marry is multilingual and can also speak Hindi and Telugu. She is a Conjoint Lecturer at the University of
New South Wales. She has been awarded the Best Overall Conjoint Teacher by UNSW in 2013 and also
Associate Dean’s teaching award.
Phone: 02 8677 7417
Fax: 02 8677 7046
Gastroenterologist:
Dr Purnima Bhat M.B, B.S. (Qld) FRACP Ph.D
Dr Purnima Bhat graduated in medicine at the University of Queensland before training in
Gastroenterology and Hepatology in Melbourne, where she obtained her specialist qualifications and
certification in Endoscopy in 2000. She subsequently obtained her PhD from the University of Melbourne
followed by post-doctoral training in microscopy and immunology in the Frazer lab in Brisbane. She has
been studying the behaviour of immune cells in cancers, particularly bowel cancers, and is currently a
Senior Researcher at the Australian National University. She is the author of many scientific publications
and regularly speaks at national and international conferences. Dr Bhat has a particular interest in the
development of bowel cancers and their prevention in patients.
Phone: 02 9629 2884
Email: [email protected]
Cardiologist:
Dr Ajita Kanthan MBBS (USyd), BMedSc, FRACP, FCSANZ, PhD (Usyd)
Dr Ajita Kanthan completed his undergraduate medical training at the University of Sydney in 2000 and
physicians training (specialising in adult cardiology) at Westmead Hospital in 2008. After undertaking
a PhD also at Westmead Public Hospital, he obtained sub-speciality training in the management of
inherited diseases under the supervision of Professor Silvia Priori in Italy and in device implantation and
electrophysiology/ablations at Monash HEART (Monash Medical Centre). He is a visiting medical officer
at Blacktown and Mt Druitt Hospitals, and is accredited at Westmead Private Hospital.
Dr Kanthan has an interest in pacemaker, defibrillator and loop recorder implantation as well as
electrophysiology, ablations and inherited disease of the heart
Phone: 02 9633 5658
Fax: 02 9893 9616
General Physician:
Dr Martin Cullen MBBS, FRACP
Dr Martin Cullen will be working as a consultant physician at Westmead Private Hospital, managing the
complex medical issues of inpatients as needed pre and post operatively as well as admitting patients
requiring hospital treatment for acute medical problems. Dr Cullen has a BSc (Hons) MBBS and is a
Fellow of the College of Intensive Care as well as a Fellow of the Royal Australasian College of Physicians.
He is a Staff Specialist in Intensive Care at Westmead Hospital and works as a VMO Intensivist in Gosford
Hospital and the Shoalhaven Hospital.
When Dr Cullen is not working as an Intensivist he practices as a specialist Physician. He works in rural
NSW doing General Medicine clinics and has an interest in Indigenous Health. His other interests include
infectious diseases, acute care medicine, perioperative medicine and the use of ultrasound in Intensive
Care.
Phone: 0418 615 836
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Westmead GP news
Fax: 02 9845 9395