2024 |
Lott N, Douglas JL, Magnusson M, Gani J, Reeves P, Connah D, et al., 'Should intermittent pneumatic compression devices be standard therapy for the prevention of venous thromboembolic events in major surgery? Protocol for a randomised clinical trial (IMPOSTERS)', BMJ OPEN, 14 (2024)
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2024 |
Thomas J, Jerome A, Marr G, De Boo DW, Gani J, 'Surgeons versus radiologists: do we care what they think?', ANZ Journal of Surgery, 94 103-107 (2024) [C1]
Backgrounds: Acute surgical care nowadays usually involves access to urgent imaging. There is a paucity of data on how often the images or radiologist reports of these images are ... [more]
Backgrounds: Acute surgical care nowadays usually involves access to urgent imaging. There is a paucity of data on how often the images or radiologist reports of these images are used by the surgical team. We aimed to identify the rates and timeliness of radiology images and report viewing for acute surgical admissions in an Australian tertiary university teaching hospital. Methods: We utilized a data set comprising radiological studies completed at our institute during a one-month period. Investigations were classified by modality and whether images or reports were available ¿in-hours¿ or ¿after-hours¿. The time taken from imaging to reports available for viewing by the surgical team was calculated using timestamps derived from electronic hospital systems. Spearman's rho test was used to assess correlation between the Study Ascribable Time and time to view an image or report. Results: Of 40 042 investigations, 1156 (3%) satisfied study criteria. Both images and reports were viewed in 82% (n = 950/1156) of cases. CT scans had the shortest median time for image (14 min, IQR 4¿47 min) and report (25 min, IQR 8¿68 min) viewing. CT (95%, n = 410/430) and MRI (95%, n = 38/40) scans had the highest proportion of both images and reports viewed, regardless of whether the scan was completed ¿in-hours¿ or ¿after-hours¿. X-ray reports were viewed least often (73%). Conclusion: This study demonstrates a high level of viewing of acute surgical radiological imaging and reports by surgical teams. The ¿simpler¿ the study the less likely the radiology report will be viewed.
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2024 |
Deeming S, Dolja-Gore X, Gani J, Carroll R, Lott N, Attia J, et al., 'Optimal antiseptic skin preparation agents for minimizing surgical site infection following surgery: cost and cost-effectiveness analysis', BJS Open, 8 (2024)
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2023 |
Holmes M, Rugendyke A, Ming YJ, Howley P, Gani J, Pockney P, 'Getting back home after emergency laparotomy: how many never make it?', ANZ Journal of Surgery, 93 2433-2438 (2023) [C1]
Background: Emergency laparotomy (EL) is performed on about 15 500 patients in Australia each year. Aside from mortality there is significant concern about the possibility that pr... [more]
Background: Emergency laparotomy (EL) is performed on about 15 500 patients in Australia each year. Aside from mortality there is significant concern about the possibility that previously independent patients discharged after EL will become reliant on long-term dependent care. This study aimed to establish the proportion of patients not returning to their pre-admission residence, a proxy for dependent care, following EL. Methods: Data were collected on all adult patients who underwent EL across four Australian hospitals over 2 years. A total of 113 data points were collected including pre-hospital residence, discharge destination, mortality and place of residence at 90 and 365 days. Results: A total of 782 patients underwent EL, the mean age was 64 years. Pre-admission, 95.5% of patients were living in their own home. Inpatient mortality was 7.0% and at discharge 72.4% of patients returned directly back to their pre-hospital residence. At 90 days, mortality was 10.5%, and 87% of patients had returned to their pre-hospital residence, including all patients under 70 years of age. By 365 days, overall mortality was 16.8%, and only 1.5% of patients (all aged >70 years) had not returned to their pre-hospital residence. Conclusion: Patients who survive 90 and 365 days following EL nearly all return to their pre-hospital residence, with only a very small proportion of previously independent patients entering dependent care. This should help inform shared decision-making regarding emergency laparotomy in the acute setting.
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Nova |
2023 |
Lott N, Smith S, Gani J, Reeves P, 'Intermittent pneumatic compression devices: time to reassess the evidence', ANZ JOURNAL OF SURGERY, 93 812-814 (2023)
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2023 |
Lott N, Senanayake T, Carroll R, Gani J, Smith SR, 'Venous thromboembolic prophylaxis: current practice of surgeons in Australia and New Zealand for major abdominal surgery.', BMC Surg, 23 265 (2023) [C1]
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Nova |
2023 |
Ming YJ, Howley P, Holmes M, Gani J, Pockney P, Hunter Emergency Laparotomy Collaborator Group, 'Combining sarcopenia and ASA status to inform emergency laparotomy outcomes: could it be that simple?', ANZ J Surg, 93 1811-1816 (2023) [C1]
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Nova |
2023 |
Smith S, Abuhassanian I, Attia J, Carroll R, Lott N, Hampton J, Gani J, 'Antiseptic Skin Agents to Prevent Surgical Site Infection After Clean Implant Surgery: Subgroup Analysis of the NEWSkin Prep Trial.', Surg Infect (Larchmt), 24 818-822 (2023) [C1]
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Nova |
2023 |
Ajitsaria P, Lott N, Baker A, Lacey J, Magnusson M, Douglas JL, et al., 'Protocol paper for SMART OPS: Shared decision-making Multidisciplinary Approach - a Randomised controlled Trial in the Older adult Population considering Surgery', BMJ OPEN, 13 (2023)
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2022 |
Ming YJ, Howley P, Holmes M, Gani J, Pockney P, 'Sarcopenia 'made simple' and outcomes from emergency laparotomy.', ANZ J Surg, 92 3198-3203 (2022) [C1]
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Nova |
2022 |
Smith SR, Gani J, Carroll R, Lott N, Hampton J, Oldmeadow C, et al., 'Antiseptic Skin Agents to Prevent Surgical Site Infection After Incisional Surgery', Annals of Surgery, 275 842-848 (2022) [C1]
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Nova |
2022 |
Knight SR, Shaw CA, Pius R, Drake TM, Norman L, Ademuyiwa AO, et al., 'Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study', The Lancet Global Health, 10 e1003-e1011 (2022) [C1]
Background: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility charact... [more]
Background: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study¿a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58¿5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23¿0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research.
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2022 |
Adamina M, Ademuyiwa A, Adisa A, Bhangu AA, Bravo AM, Cunha MF, et al., 'The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study', COLORECTAL DISEASE, 24 708-726 (2022) [C1]
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2022 |
Lott N, Robb F, Nolan E, Attia J, Reeves P, Gani J, Smith S, 'Efficacy of intermittent compression devices for thromboembolic prophylaxis in major abdominal surgery: a systematic review and meta-analysis', ANZ JOURNAL OF SURGERY, 92 2926-2934 (2022) [C1]
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Nova |
2021 |
Glasbey JC, Nepogodiev D, Simoes JFF, Omar O, Li E, Venn ML, et al., 'Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study', Journal of Clinical Oncology, 39 66-78 (2021) [C1]
PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aim... [more]
PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19¿free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19¿free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19¿free surgical pathways. Patients who underwent surgery within COVID-19¿free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19¿free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score¿matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19¿free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19¿free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks.
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Nova |
2021 |
Knight SR, Shaw CA, Pius R, Drake TM, Norman L, Ademuyiwa AO, et al., 'Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries', LANCET, 397 387-397 (2021) [C1]
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2021 |
Ming JY, Holmes M, Pockney P, Gani J, '677 Quick, Simple and just as Effective Comparing PM:L3 Ratio to NELA, P-POSSUM and NSQIP Scores for Emergency Laparotomy', British Journal of Surgery, 108 (2021)
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2021 |
Ming JY, Holmes M, Gani J, Pockney P, '678 Can patients have their old life back? Using PM:L3 ratio to predict discharge destination of emergency laparotomy survivors', British Journal of Surgery, 108 (2021)
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2021 |
McLean KA, Kamarajah SK, Chaudhry D, Gujjuri RR, Raubenheimer K, Trout I, et al., 'Death following pulmonary complications of surgery before and during the SARS-CoV-2 pandemic', BRITISH JOURNAL OF SURGERY, 108 1448-1464 (2021) [C1]
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Nova |
2021 |
Glasbey JC, Nepogodiev D, Simoes JFF, Omar OM, Venn ML, Evans JP, et al., 'Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic', Colorectal Disease, 23 732-749 (2021) [C1]
Aim: This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases... [more]
Aim: This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic. Method: This was an international cohort study of patients undergoing elective resection of colon or rectal cancer without preoperative suspicion of SARS-CoV-2. Centres entered data from their first recorded case of COVID-19 until 19 April 2020. The primary outcome was 30-day mortality. Secondary outcomes included anastomotic leak, postoperative SARS-CoV-2 and a comparison with prepandemic European Society of Coloproctology cohort data. Results: From 2073 patients in 40 countries, 1.3% (27/2073) had a defunctioning stoma and 3.0% (63/2073) had an end stoma instead of an anastomosis only. Thirty-day mortality was 1.8% (38/2073), the incidence of postoperative SARS-CoV-2 was 3.8% (78/2073) and the anastomotic leak rate was 4.9% (86/1738). Mortality was lowest in patients without a leak or SARS-CoV-2 (14/1601, 0.9%) and highest in patients with both a leak and SARS-CoV-2 (5/13, 38.5%). Mortality was independently associated with anastomotic leak (adjusted odds ratio 6.01, 95% confidence interval 2.58¿14.06), postoperative SARS-CoV-2 (16.90, 7.86¿36.38), male sex (2.46, 1.01¿5.93), age >70¿years (2.87, 1.32¿6.20) and advanced cancer stage (3.43, 1.16¿10.21). Compared with prepandemic data, there were fewer anastomotic leaks (4.9% versus 7.7%) and an overall shorter length of stay (6 versus 7¿days) but higher mortality (1.7% versus 1.1%). Conclusion: Surgeons need to further mitigate against both SARS-CoV-2 and anastomotic leak when offering surgery during current and future COVID-19 waves based on patient, operative and organizational risks.
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2021 |
Glasbey JC, Omar O, Nepogodiev D, Minaya-Bravo A, Bankhead-Kendall BK, Fiore M, et al., 'Preoperative nasopharyngeal swab testing and postoperative pulmonary complications in patients undergoing elective surgery during the SARS-CoV-2 pandemic', BRITISH JOURNAL OF SURGERY, 108 88-96 (2021) [C1]
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2021 |
Glasbey JC, Ademuyiwa A, Adisa A, AlAmeer E, Arnaud AP, Ayasra F, Azevedo J, 'Effect of COVID-19 pandemic lockdowns on planned cancer surgery for 15 tumour types in 61 countries: an international, prospective, cohort study', LANCET ONCOLOGY, 22 1507-1517 (2021) [C1]
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2021 |
Wiadji E, Mackenzie L, Reeder P, Gani JS, Carroll R, Smith S, et al., 'Utilization of telehealth by surgeons during the COVID 19 pandemic in Australia: lessons learnt', ANZ JOURNAL OF SURGERY, 91 507-514 (2021) [C1]
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Nova |
2021 |
Wiadji E, Mackenzie L, Reeder P, Gani JS, Ahmadi S, Carroll R, et al., 'Patient perceptions of surgical telehealth consultations during the COVID 19 pandemic in Australia: Lessons for future implementation', ANZ JOURNAL OF SURGERY, 91 1662-1667 (2021) [C1]
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Nova |
2020 |
Whitcher S, Magnusson M, Gani J, Oldmeadow C, Pockney PG, 'Comparison of colonic neoplasia detection rates in patients screened inside and outside the National Bowel Cancer Screening Program', Medical Journal of Australia, 212 275-276 (2020) [C1]
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Nova |
2020 |
Fenton M, Gani J, Pockney P, 'Adverse Events After Inpatient Colonoscopy in Octogenarians: Patient Selection Key for Colonoscopies', JOURNAL OF CLINICAL GASTROENTEROLOGY, 54 484-484 (2020)
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2020 |
Feng D, Petschack L, Marr G, Gani J, 'Surgeon Preference May Be More Important Than Models of Care When It Comes to Early Laparoscopic Cholecystectomy Rates for Acute Cholecystitis', Journal of Surgery, 8 228-232 (2020) [C1]
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Nova |
2020 |
Eliezer DD, Holmes M, Sullivan G, Gani J, Pockney P, Gould T, et al., 'High-Risk Emergency Laparotomy in Australia: Comparing NELA, P-POSSUM, and ACS-NSQIP Calculators', Journal of Surgical Research, 246 300-304 (2020) [C1]
Background: The National Emergency Laparotomy Audit (NELA) highlights the importance of identifying high-risk patients due to the potential for significant morbidity and mortality... [more]
Background: The National Emergency Laparotomy Audit (NELA) highlights the importance of identifying high-risk patients due to the potential for significant morbidity and mortality. The NELA risk prediction calculator (NRPC) was developed from data in England and Wales and is one of several calculators available. We seek to determine the utility of NRPC in the Australian population and compare it with Portsmouth Physiological and Operative Severity Score for the enumeration of mortality and Morbidity (P-POSSUM) and American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) calculators. Methods: A retrospective review of all emergency laparotomies undertaken at four Australian centers was performed between January 2016 and December 2017. Data extracted from patient records were used to calculate NRPC, ACS-NSQIP, and P-POSSUM scores for 30-day mortality risk. The sensitivity of NRPC was assessed using the NELA high-risk cohort score of =10% and this was compared with the other two calculators. Results: There were 562 (M = 261, mean age = 66 [±17] y) patient charts reviewed in the study period. 59 patients died within 30 d (10.5%). NRPC was able to identify 52 (sensitivity = 88.1%) of these as being within the high-risk group. Using the NELA high-risk cutoff, NRPC identified 52 deaths of 205 (25.4%) high-risk patients, P-POSSUM identified 46 of 245 (18.8%), and ACS-NSQIP identified 46 of 201 (22.9%). Using the McNemar test, no significant difference was noted between NRPC and P-POSSUM (P = 0.07) or NRPC and ACS-NSQIP (P = 0.18). Conclusions: In the Australian context, the NRPC is a highly sensitive and useful tool for predicting 30-day mortality in high-risk emergency laparotomy patients and is comparable with P-POSSUM and ACS-NSQIP calculators.
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Nova |
2020 |
'Delaying surgery for patients with a previous SARS-CoV-2 infection', BRITISH JOURNAL OF SURGERY, 107 E601-E602 (2020)
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2020 |
Corbetta Machado MJ, Gray A, Cerdeira MP, Gani J, 'Short- and long-term outcomes of percutaneous cholecystostomy in an Australian population', ANZ Journal of Surgery, 90 1660-1665 (2020) [C1]
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Nova |
2020 |
Tan HLE, McDonald G, Payne A, Yu W, Ismadi Z, Tran H, et al., 'Incidence and Management of Hypertriglyceridemia-Associated Acute Pancreatitis: A Prospective Case Series in a Single Australian Tertiary Centre', JOURNAL OF CLINICAL MEDICINE, 9 (2020) [C1]
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Nova |
2019 |
Clarke L, Pockney P, Gillies D, Foster R, Gani J, 'Direct access colonoscopy service for bowel cancer screening produces a positive financial benefit for patients and local health districts', Internal Medicine Journal, 49 729-733 (2019) [C1]
Background: A direct access colonoscopy service (DACS) for the National Bowel Cancer Screening Program has become standard of care in Newcastle public hospitals because of the eff... [more]
Background: A direct access colonoscopy service (DACS) for the National Bowel Cancer Screening Program has become standard of care in Newcastle public hospitals because of the effect it has on time to colonoscopy. Cost-effectiveness has not been studied to date. Aim: The aim of this retrospective study was to analyse the cost-effectiveness of a DACS. Methods: Data were collected for patients referred to DACS between January 2014 and June 2016, and patients who were treated on the normal service pathway in 2013 prior to the introduction of the process. A cost-benefit analysis from the patient¿s and local health district¿s perspective was undertaken. Results: Introduction of the DACS produces a direct financial gain to patients in the form of reduced direct costs. It produces an indirect financial gain in terms of increased productivity if the patient is in work, and of increased leisure time if not in work. The DACS is modest income generating for the local health district, an evaluation which is sensitive to internal policies for distribution of government funding within a district. The DACS increases the availability of outpatient consultations to other patients, which is not a quantifiable economic benefit, but is likely to be an overall health benefit. Conclusion: The introduction of DACS in the public system in Australia is of financial benefit to patients and to the local health service provider. It is likely to produce health benefits to non-screening patients, by means of freeing consultations to be used for other indications.
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Nova |
2019 |
Clarke L, Pockney P, Gillies D, Foster R, Gani J, 'Time to colonoscopy for patients accessing the direct access colonoscopy service compared to the normal service in Newcastle, Australia', Internal Medicine Journal, 49 1132-1137 (2019) [C1]
Background: The 2017 National Bowel Cancer Screening Program report records a median time from positive faecal occult blood test to colonoscopy of 53 days. There is some intrinsic... [more]
Background: The 2017 National Bowel Cancer Screening Program report records a median time from positive faecal occult blood test to colonoscopy of 53 days. There is some intrinsic delay in accessing specialist medical opinion prior to colonoscopy. Aim: To examine the effect of the introduction of a Direct Access Colonoscopy Service (DACS). Methods: Using prospectively maintained databases, patients undergoing normal service (NS) colonoscopy and those referred to DACS were compared. The primary outcome measure was the time from general practitioner (GP) referral to colonoscopy. Secondary outcome measures included the proportion of patients who met the current recommended 30 days from GP referral to colonoscopy, and the proportion of patients who waited longer than 90 days. Results: There were 289 patients in the NS group, and 601 patients who progressed on the DACS pathway. The demographics of both groups were comparable. DACS patients had a median waiting time of 49 days, significantly shorter than NS patients whose median wait was 79 days (P < 0.0001). Approximately 15.1% patients in the DACS group had their colonoscopy within 30 days from GP referral, significantly better than in the NS group (4.5%, P < 0.001). In the NS group, 41.2% patients waited longer than 90 days from GP referral to colonoscopy, compared with 16.3% in the DACS group (P < 0.001). Conclusion: DACS reduces waiting times to colonoscopy and is associated with an increased proportion of patients undergoing colonoscopy in a timely manner.
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Nova |
2019 |
March B, Leigh L, Brussius-Coelho M, Holmes M, Pockney P, Gani J, 'Can CRP velocity in right iliac fossa pain identify patients for intervention? A prospective observational cohort study', Surgeon, 17 284-290 (2019) [C1]
Introduction: Previous studies have shown single CRP measurements at time of presentation to have limited predictive benefit for appendicitis. Our objective was to determine the d... [more]
Introduction: Previous studies have shown single CRP measurements at time of presentation to have limited predictive benefit for appendicitis. Our objective was to determine the diagnostic utility of serial CRP measurements (to determine CRP velocity [CRPv]) in patients with right iliac fossa (RIF) pain. Methods: A single-centre prospective observational study was conducted on adult patients admitted with RIF pain. CRP was measured on admission, at midnight, and the following morning. Appendicitis was diagnosed on histopathology, or diagnostic imaging in non-operatively managed patients. Therapeutic interventions included all appropriate operative procedures and effective non-operative treatment with antibiotics. Logistic regression was used to generate predictors of therapeutic intervention, and then used to create a new risk score incorporating CRPv. Results: 98 of 112 (87.5%) participants had complete CRP data. 58 patients met the criteria for appendicitis (59.2%). Most patients presented with intermediate Modified Alvarado Scores (MAS) 5¿6 (40.8%) or Appendicitis Inflammatory Response Scores (AIRS) 5¿8 (49%). Our risk score had an AUROC of 0.88 (95% CI 0.81¿0.96) in predicting therapeutic intervention. This score was superior to MAS, AIRS, and single admission biomarker measurements. Patients with an increasing CRPv had 14 times the odds (OR 14.07, 95% CI 0.63¿315.2) of complicated appendicitis, and no cases of complicated appendicitis were observed in patients with a flat CRPv. Conclusions: CRP velocity is superior to single CRP at predicting intervention. Our v-Score shows promise as a decision making-aide by predicting the need for surgical intervention in RIF pain. A flat CRPv identifies a group of patients with a very low risk of complicated appendicitis.
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Nova |
2018 |
Rutledge A, Carroll G, Smith S, Gani J, 'Response to Re: How to do it: use of the Alexis wound protector as a laparostomy device', ANZ JOURNAL OF SURGERY, 88 117-118 (2018)
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2017 |
Joshi T, Woodford P, Maiti K, Smith R, Gani J, Acharya S, 'Giant Retroperitoneal Teratoma Associated With Unexpected Postoperative Adrenal Insufficiency: Crh And Acth Secretion From Teratoma?', AACE Clinical Case Reports, 3 e8-e11 (2017)
Objective: To report a case of a giant retroperitoneal teratoma involving the adrenal gland associated with persistent postoperative adrenal insufficiency likely due to the secret... [more]
Objective: To report a case of a giant retroperitoneal teratoma involving the adrenal gland associated with persistent postoperative adrenal insufficiency likely due to the secretion of corticotropin releasing hormone (CRH) and adrenocorticotropic hormone (ACTH) from the teratoma. Methods: We describe the presenting signs and symptoms, investigations, and pathologic features leading to the diagnosis and treatment options. Results: A 29-year-old male was found to have a large retroperitoneal mass arising near the right kidney and adrenal, encasing the dual renal arteries and causing right urinary tract obstruction on computed tomography imaging. Resection of the mass required right nephrectomy and median sternotomy. Microscopy demonstrated a mature teratoma arising from the retroperitoneum. The right adrenal gland was compressed and trapped in the edge of the mass. His postoperative course was complicated by unexpected persistent hypocortisolism requiring cortisol replacement. Subsequent immunostaining was positive for CRH and ACTH, suggesting that the teratoma was secreting CRH and ACTH. Conclusion: This is the first reported case of teratoma associated with CRH and ACTH secretion leading to postoperative adrenal insufficiency. Although extremely rare, the possibility of a teratoma secreting hormones should be kept in mind and appropriate evaluation is recommended pre- and postoperatively. ACTH = adrenocorticotropic hormone; AFP = alphafetoprotein; CRH = corticotropin releasing hormone; CT = computed tomography; RR = reference range
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2017 |
Gani JS, 'How to do it: Use of the Alexis wound protector as a laparostomy device', ANZJSurg, (2017)
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2017 |
Burnett D, Gani JS, 'Routine magnetic resonance imaging is not the panacea to common duct stones', ANZ JOURNAL OF SURGERY, 87 743-744 (2017)
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2016 |
Burnett D, Gani J, 'Response to Re: Single-stage laparoscopic cholecystectomy and intraoperative endoscopic retrograde cholangiopancreatography: is this strategy feasible in Australia?', ANZ JOURNAL OF SURGERY, 86 1069-1069 (2016)
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2016 |
Burmeister EA, Jordan SJ, O'Connell DL, Beesley VL, Goldstein D, Gooden HM, et al., 'Using a Delphi process to determine optimal care for patients with pancreatic cancer.', Asia-Pacific journal of clinical oncology, 12 105-114 (2016) [C1]
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Nova |
2016 |
Wijeratne A, Gani J, 'The use of a pedicalised gallbladder graft to repair a large duodenal defect: a case report and review of the literature.', Internal Medicine Review, 2
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2016 |
March B, Burnett D, Gani J, 'Single-stage laparoscopic cholecystectomy and intraoperative endoscopic retrograde cholangiopancreatography: is this strategy feasible in Australia?', ANZ Journal of Surgery, 86 874-877 (2016) [C1]
Currently in Australasia, concomitant cholecystolithiasis and choledocholithiasis are usually managed with two procedures: laparoscopic cholecystectomy (LC) and pre or postoperati... [more]
Currently in Australasia, concomitant cholecystolithiasis and choledocholithiasis are usually managed with two procedures: laparoscopic cholecystectomy (LC) and pre or postoperative endoscopic retrograde cholangiopancreatography (ERCP). This approach exposes the patient to the risk of complications from the common bile duct stone(s) while awaiting ERCP, the risks of the ERCP itself (particularly pancreatitis) and the need for a second anaesthetic. This article explores the evidence for a newer hybrid approach, single stage LC and intraoperative ERCP (SSLCE) and compares this approach with the commonly used alternatives. SSLCE offers reduced rates of pancreatitis, reduced length of hospital stay and reduced cost compared with the two-stage approach and requires only one anaesthetic. There is a reduced risk of bile leak compared with procedures that involve a choledochotomy, and ductal clearance rates are superior to trans-cystic exploration and equivalent to the standard two-stage approach. Barriers to widespread implementation relate largely to operating theatre logistics and availability of appropriate endoscopic expertise, although when bile duct stones are anticipated these issues are manageable. There is compelling justification in the literature to gather prospective evidence surrounding SSLCE in the Australian Healthcare system.
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Nova |
2014 |
March B, Gillies D, Gani J, 'Appendicectomies performed > 48 hours after admission to a dedicated acute general surgical unit', Annals of the Royal College of Surgeons of England, 96 614-617 (2014)
Introduction: Acute general surgical units (AGSUs) are changing the way in which acute appendicitis is managed. In the AGSU at John Hunter Hospital, some patients wait more than 4... [more]
Introduction: Acute general surgical units (AGSUs) are changing the way in which acute appendicitis is managed. In the AGSU at John Hunter Hospital, some patients wait more than 48 hours from admission to undergo an appendicectomy, usually because they are not unwell enough to precipitate an operation before that time. We analysed this subgroup of appendicectomy patients to determine how effectively they are being managed and how this might be improved. Methods: A retrospective review of prospectively collected data was conducted of all patients who received an appendicectomy while admitted under the AGSU at John Hunter Hospital in the five years between January 2009 and December 2013. Results: A total of 1,039 appendicectomies were performed in the study period, with 81 patients (7.8%) waiting > 48 hours for their operation (delayed appendicectomy group). Overall, the negative appendicectomy (NA) rate was 21.6%; the NA rate in delayed appendicectomies was 50.62% and a non-therapeutic operation occurred in 47% of this group (n=38). No significant difference was found in the incidence of perforation/gangrenous appendicitis between patients having surgery in <48 hours and the delayed appendicectomy groups (11.2% vs 9.9%, p=0.85). A combination of negative diagnostic imaging result, a normal white cell count and normal C-reactive protein (ie a negative 'triple test') was the best predictor of a negative appendicectomy (p=0.0158, negative predictive value: 0.91, 95% confidence interval: 0.59-0.99), in the delayed appendicectomy group. Conclusions: In the delayed appendicectomy group, the incidence of perforation/gangrenous appendicitis was not significantly different from that found in patients having appendicectomy performed sooner. However, the NA and non-therapeutic operation rates were unacceptably high. An appendix triple test can improve diagnostic accuracy significantly without an unacceptable rise in the rates of perforation/gangrenous appendicitis.
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2014 |
Ho YM, Gani J, Draganic BD, Smith SR, 'Bladeless stoma creation using muscle separation technology: a novel technique', TECHNIQUES IN COLOPROCTOLOGY, 18 299-300 (2014) [C3]
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Nova |
2013 |
Gillies D, Lack J, Gani J, Proietto T, 'IDENTIFYING SHORTCOMINGS AND VARIATION IN THE DIAGNOSIS OF COLORECTAL CANCER PATIENTS', ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, 9 148-148 (2013) |
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2013 |
Gani JS, '21st century appendicitis: selecting non-operative winners', ANZ JOURNAL OF SURGERY, 83 6-7 (2013) [C3]
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Nova |
2012 |
Gani J, Lewis K, 'Hepaticocholecystoenterostomy as an alternative to hepaticojejunostomy for biliary bypass', Annals of the Royal College of Surgeons of England, 94 472-475 (2012)
Introduction: Hepaticojejunostomy is the standard biliary bypass technique for periampullary cancer when trial dissection reveals unresectable disease or endoscopic stent placemen... [more]
Introduction: Hepaticojejunostomy is the standard biliary bypass technique for periampullary cancer when trial dissection reveals unresectable disease or endoscopic stent placement is not possible. This anastomosis can be technically demanding and potentially difficult. The simpler technique of hepaticocholecystoenterostomy (HCE) has only previously been reported in very limited numbers and without outcome data. Methods: All patients undergoing HCE for the management of periampullary cancer were identified from a prospectively maintained computerised database of a single surgeon and were reviewed retrospectively. The HCE technique achieves a biliary bypass by two anastomoses, using the gallbladder as a conduit. It involves an anastomosis of the infundibulum of the gallbladder to the common hepatic duct followed by a second anastomosis of the gallbladder fundus to the proximal small bowel. Results: From 1996 to 2010, 30 patients with pancreatic adenocarcinoma required a biliary bypass after a failed trial of Whipple procedure (80%) or failed endoscopic stenting (20%). There were 19 men and 11 women with a mean age of 64.5 years. The mean operative time for HCE alone was 92 minutes. The mean length of hospital stay was nine days. There was a single grade 2 complication (readmission with gastric emptying delay) and a single grade 3 complication (bile leak requiring reoperation). Thirty-day mortality was zero and the mean survival was 12 months (with one patient still alive at the time of writing). There were no readmissions with recurrent biliary obstruction or cholangitis. One patient had developed an incisional hernia by the 24-month follow-up appointment. Conclusions: HCE in periampullary cancer is safe and effective in selected patients. It involves two simple anastomoses with good access rather than one more demanding anastomosis. Morbidity, patency and overall survival are comparable with contemporary published series of hepaticojejunostomy.
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2011 |
Nolan GJ, Bendinelli C, Gani J, 'Laparoscopic drainage of an intramural duodenal haematoma: a novel technique and review of the literature', WORLD JOURNAL OF EMERGENCY SURGERY, 6 (2011)
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2008 |
O'Neill CJ, Gillies DM, Gani JS, 'Choledocholithiasis: Overdiagnosed endoscopically and undertreated laparoscopically', ANZ JOURNAL OF SURGERY, 78 487-491 (2008) [C1]
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2008 |
Gani JS, 'Obesity surgery still does not equal laparoscopic gastric banding', ANZ Journal of Surgery, 78 227 (2008) [C3]
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Nova |
2007 |
Matsushita T, Seah PW, Gani J, 'Giant Morgagni Hernia Causing Cardiac Tamponade', Heart Lung and Circulation, 16 392-393 (2007)
A 57-year-old man presented with worsening symptoms of shortness of breath and chest pain. He was found to have a giant Morgagni hernia with severe compression of his right ventri... [more]
A 57-year-old man presented with worsening symptoms of shortness of breath and chest pain. He was found to have a giant Morgagni hernia with severe compression of his right ventricle on computed tomography scan. The hernia which contained greater omentum, small intestine and transverse colon was urgently repaired through a median sternotomy and laparotomy with a polypropylene mesh. Morgagni hernia is a type of congenital diaphragmatic hernia, which may not be symptomatic until adulthood. Presentation with this degree of right ventricular compression is rare. © 2006 Australasian Society of Cardiac and Thoracic Surgeons and the Cardiac Society of Australia and New Zealand.
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2005 |
Spigelman AD, Gani JS, 'Pylorus-preserving pancreaticoduodenectomy for advanced duodenal disease in familial adenomatous polyposis (letter)', British Journal of Surgery, 92 253-253 (2005) [C3]
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2004 |
Spigelman AD, Gani JS, 'Pylorus-preserving pancreaticoduodenectomy for advanced duodenal disease in familial adenomatous polyposis', British Journal of Surgery, 92 253 (2004) [C1]
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2004 |
Winn RD, Laura S, Douglas C, Davidson PM, Gani JS, 'Protocol-Based approach to suspected appendicitis, incorporating the alvarado score and outpatient antibiotics', ANZ Journal of Surgery, 74 324-329 (2004) [C1]
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2004 |
Kable AK, Gibberd RW, Spigelman AD, 'Re: Complications after discharge for surgical patients', ANZ Journal of Surgery, 74 805-807 (2004) [C3]
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2003 |
MacPherson NE, Gani JS, 'White cell count and appendicitis: the missing link', ANZ Journal of Surgery, 963-965 (2003) [C3] |
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2003 |
Amid P, Gani JS, Zib M, 'Inguinal hernia repair: where to next?', ANZ Journal of Surgery, 352-355 (2003) [C3] |
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2003 |
Levy RD, Barto W, Gani JS, 'Retrospective Study of the Utility of Nuclear Scintigraphic-labelled Red Cell Scanning for Lower Gastrointestinal Bleeding', ANZ Journal of Surgery, 73 205-209 (2003) [C1]
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2003 |
Amid PK, Gani J, Zib M, 'Inguinal hernia repair: Where to next? [1] (multiple letters)', ANZ Journal of Surgery, 73 352-353 (2003)
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2003 |
Holz P, Cottee DB, Gani JS, 'Delayed gastric emptying with octreotide', Anaesthesia and Intensive Care, 31 235 (2003) [C3] |
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2002 |
Zib M, Gani JS, 'Inguinal hernia repair: where to next?', ANZ Journal of Surgery, 72(8) 573-579 (2002) [C1]
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2001 |
Winn R, Douglas C, Gani JS, 'A contolled trial of a protocol drive approach to the management of right iliac fossa (RIF) pain', ANZ Journal of Surgery, 71 GS4 (2001) [C3] |
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2000 |
Gani JS, Oakes L, 'Biliary scoring as a method of selecting patients for cholecystectomy', Australian & New Zealand Journal of Surgery, 70 (9) 644-648 (2000) [C1]
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2000 |
Wills V, Eno L, Walker C, Gani JS, 'Use of an ambulance-based helicopter retrieval service', Australian & New Zealnd Journal of Surgery, 70 (7) 506-510 (2000) [C1]
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2000 |
Zib M, Gani JS, 'Is the evidence for laparoscopic hernia repair good enough?', Australian New Zealand Journal Surgery, 70 898-899 (2000) [C3]
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2000 |
Douglas CD, MacPherson NE, Davidson P, Gani JS, 'Randomised controlled trial of ultrasonography in diagnosis of acute appendicitis, incorporating the Alvarado score', British Medical Journal, 321 919 (2000) [C1]
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2000 |
Zib M, Gani J, Slater GH, Bailey M, 'Is the evidence for laparoscopic hernia repair good enough? [1] (multiple letters)', Australian and New Zealand Journal of Surgery, 70 898-900 (2000)
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1998 |
Puvaneswary M, Gani J, Kalnins IK, 'Glomus vagale presenting as a supraclavicular mass: Magnetic resonance imaging findings', Australasian Radiology, 42 367-369 (1998)
Glomus vagale are rare vascular tumours of the paraganglion cells of the vagus nerve, and they usually occur in the carotid space. Tumours can be familial, multicentric, malignant... [more]
Glomus vagale are rare vascular tumours of the paraganglion cells of the vagus nerve, and they usually occur in the carotid space. Tumours can be familial, multicentric, malignant but rarely hormonally active. A rare case is reported of glomus vagale presenting as a supraclavicular mass.
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1998 |
Gani JS, 'Can sincalide cholescintigraphy fulfil the role of a gall-bladder stress test for patients with gall-bladder stones?', AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY, 68 514-519 (1998)
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1998 |
Draganic B, James A, Booth M, Gani JS, 'Comparative experience of a simple technique for laparoscopic chronic ambulatory peritoneal dialysis catheter placement', AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY, 68 735-739 (1998)
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1997 |
Draganic BD, Gani JS, 'Retained gallstones: A pain in the back', AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY, 67 662-664 (1997)
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1996 |
Hayes C, Ambazidis S, Gani JS, 'Intensive care unit admissions following laparoscopic surgery: What lessons can be learned?', AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY, 66 206-209 (1996)
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1996 |
Draganic BD, Gani JS, 'The incidence of deep venous thrombosis after laparoscopic cholecystectomy', MEDICAL JOURNAL OF AUSTRALIA, 165 402-402 (1996)
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1996 |
Draganic B, Perry R, Gani J, 'Operative cholangiography in the laparoscopic era: A retrospective review of the quality and interpretation of this investigation', AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY, 66 18-21 (1996)
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1995 |
GANI JS, 'MANAGEMENT OF PERFORATION OF THE DUODENUM FOLLOWING ENDOSCOPIC SPHINCTEROTOMY - A PROPOSAL FOR SELECTIVE THERAPY', AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY, 65 284-284 (1995)
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1994 |
DRABBLE EK, GANI JS, DAVIDSON P, WRIGHT JE, 'PARTIAL LACERATION OF THE DISTAL BILE-DUCT AND WEDGE FRACTURE OF L1 CAUSED BY BLUNT TRAUMA - A NEW PERSPECTIVE ON TREATMENT', BRITISH JOURNAL OF SURGERY, 81 120-120 (1994)
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1993 |
COTTERILL GF, FERGUSSON JAE, GANI JS, BURNS GF, 'SCANNING-TUNNELING-MICROSCOPY OF COLLAGEN-I REVEALS FILAMENT BUNDLES TO BE ARRANGED IN A LEFT-HANDED HELIX', BIOCHEMICAL AND BIOPHYSICAL RESEARCH COMMUNICATIONS, 194 973-977 (1993)
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1992 |
STOMSKI FC, GANI JS, BATES RC, BURNS GF, 'ADHESION TO THROMBOSPONDIN BY HUMAN EMBRYONIC FIBROBLASTS IS MEDIATED BY MULTIPLE RECEPTORS AND INCLUDES A ROLE FOR GLYCOPROTEIN-88 (CD36)', EXPERIMENTAL CELL RESEARCH, 198 85-92 (1992)
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1992 |
DRABBLE EM, GANI JS, 'ACUTE GASTROCNEMIUS MYOSITIS - ANOTHER EXTRAINTESTINAL MANIFESTATION OF CROHNS-DISEASE', MEDICAL JOURNAL OF AUSTRALIA, 157 318-320 (1992)
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1991 |
SUGRUE M, GANI J, SARRE R, WATTS J, 'ECTOPIA AND AGENESIS OF THE GALLBLADDER - A REPORT OF 2 SETS OF TWINS AND REVIEW OF THE LITERATURE', AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY, 61 816-818 (1991)
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1991 |
GANI JS, FOWLER PR, STEINBERG AW, WLODARCZYK JH, NANRA RS, HIBBERD AD, 'USE OF THE FISTULA ASSESSMENT MONITOR TO DETECT STENOSES IN ACCESS FISTULAS', AMERICAN JOURNAL OF KIDNEY DISEASES, 17 303-306 (1991)
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1990 |
GANI JS, ANSELINE PF, BISSETT RL, 'EFFICACY OF DOUBLE VERSUS SINGLE GLOVING IN PROTECTING THE OPERATING TEAM', AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY, 60 171-175 (1990)
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1990 |
Gani JS, Burns GF, 'Integrins and accessory adhesion molecules', Today's Life Science, 2 32-36 (1990)
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1989 |
GANI JS, FOWLER PR, STEINBERG AW, NANRA RS, HIBBERD AD, 'USE OF THE FISTULA ASSESSMENT MONITOR TO DETECT STENOSES IN ACCESS FISTULAS', KIDNEY INTERNATIONAL, 36 1167-1167 (1989) |
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1987 |
GANI JS, GILLIES JR, 'CYSTIC ARTERY EROSION - A RARE CAUSE OF UPPER GASTROINTESTINAL HEMORRHAGE', MEDICAL JOURNAL OF AUSTRALIA, 147 260-261 (1987)
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1987 |
GANI JS, MORRISON JM, 'SIMPLE THYROID CYST - CAUSE OF ACUTE BILATERAL RECURRENT LARYNGEAL NERVE PALSY', BRITISH MEDICAL JOURNAL, 294 1128-1129 (1987)
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