Screening and Management of Hepatocellular Carcinoma: The Australian Perspective

Hepatocellular cancer (HCC) remains relatively uncommon in Australia, however incidence rates have been progressively rising, as in many other western countries, over the last few decades. Currently, chronic hepatitis B (HBV) or hepatitis C (HCV) infections accounts for the majority of primary liver cancers, but as the incidence of HBV declines with the implementation of immunization programs and HCV is eradicated by direct acting anti viral therapies, more cases will be due to metabolic causes such as non-alcoholic fatty liver disease. The cornerstone of management involves identifying potential risk factors and implementing both preventative and therapeutic strategies. As we gain more knowledge about the pathogenesis of HCC, newer agents such as multikinase inhibtors have been developed to target specific pathways and have been shown to delay time to disease progression. Well defined screening, diagnostic and management algorithms will allow for standardisation of protocols and enable classification of patients and treatment modalities offering some prediction of outcome and prognosis. It is anticipated that effective screening and surveillance programs will enable the detection of tumours at an early stage thereby allowing for a wider range of therapeutic options with improved outcomes.     

Scrotal reconstruction: a review and a proposed algorithm

Scrotal reconstruction is a difficult problem following infection, trauma or tumour resection. The focus of classic reconstructive options remains occlusive and aesthetic with little regard for testicular function. The important factors in choosing the right reconstructive option for our patients are age, testicular functional requirements and best aesthetic outcome. We reviewed contemporary options available for reconstruction of the scrotum and their effects on testicular function in an effort to provide an algorithm for scrotal reconstruction. We performed an extensive online search using OVID SP, OVID, Medline, PubMed, CINAHL Plus and Cochrane Library database using keywords “scrotal, scrotum and reconstruction”. The introduction of axial pattern analysis of flaps has led to a flourish of innovative and novel coverage techniques to achieve aesthetic and gross reproductive function. With the emergence of new technology, however, spermatogenesis has moved to the forefront of the field, and a new paradigm shift in reconstruction needs to follow. New studies have re-orientated best practice to include this in the reconstructive ladder, and here, we provide a useful algorithm for scrotal reconstitution that will help reconstructive surgeons in choosing the right option for their patients.     

Insomnia treatment in the third trimester of pregnancy reduces postpartum depression symptoms: A randomized clinical trial

Mental health is an important medical issue in perinatal care, and there is increasing evidence that insomnia during pregnancy is associated with postpartum depression (PPD). Therefore, the present study evaluated the effect of insomnia treatment during the third trimester of pregnancy on PPD symptoms. Fifty-four pregnant women with insomnia were randomly assigned to trazodone, diphenhydramine, or placebo treatment. Sleep quality was measured by actigraphy at baseline, and after 2 and 6 weeks of treatment. In addition, depression was assessed 2 and 6 weeks after delivery. Trazodone and diphenhydramine improved sleep profile compared to placebo after 6 weeks of treatment. Further, depressive symptoms were reduced 2 and 6 weeks after delivery in trazodone and diphenhydramine groups compared to placebo. No differences in depressive symptoms were observed between the trazodone and diphenhydramine groups. These findings indicate that insomnia treatment with trazodone or diphenhydramine during the third trimester of pregnancy may prevent PPD.     

Tolerance of Larger Body Sizes by Young Adults Living in Australia and Hawaii

Identifying the barriers to achieving an appropriate body size is important for health. This study investigated young adults' tolerance of excess weight in other adults. Participants were 172 students (65 male, 107 female) with a mean age of 22.24 years (SD = 1.61). Half the participants resided in Australia, and half in Hawaii. Students from both countries were found to be tolerant of body sizes larger than those recommended for good health. These results help inform our understanding of the factors that may influence weight gain, and have important implications for the worldwide obesity problem and related health issues.     

The moderating effects of intellectual development on core symptoms of autism and PDD-NOS in toddlers and infants

Little research has been conducted on whether deficits in developmental functioning affect the range of core symptoms for autism spectrum disorders (ASD). This study represents a first attempt to determine whether developmental level has an effect on the expression of ASD symptoms in infants and toddlers. Eight hundred and fifty-three infants were evaluated with respect to the nature and extent of their ASD symptoms and developmental functioning. Young children with autism displayed a higher number of symptoms than those with PDD-NOS on all three domains of impairment (social, communication, repetitive behaviors). As expected, children without an ASD evinced far fewer symptoms than both these groups. Developmental level was not found to be a moderator for expression of ASD symptoms for the entire sample, or individual diagnostic groups. Higher developmental level was associated with lower severity of evinced ASD symptoms in the sample.