Vascular Investigation and Management of Ischaemic Stroke

A variety of aetiological factors serve as targets for both treatment and prevention in ischaemic stroke. Research has shifted towards acute therapy and improving the risk / benefit ratio in secondary prevention. Current evidence based practice in ischaemic stroke is discussed in chapter one, and the background to subsequent chapters is introduced. The thesis is then divided into two broad areas that examine mechanisms by which vascular disease may cause ischaemic stroke, and the manner in which vascular risk may be modulated. Chapters two to four highlight controversies in investigation and management. Chapter two addresses a clinical dilemma - essentially whether a carotid lesion ipsilateral to a lacunar stroke should be considered symptomatic. Observational data comparing incidence of lacunar disease contralateral (group 1) or ipsilateral (group 2) to carotid artery disease, and stroke recurrence in patients in whom co-existent lacunar and carotid disease had been identified, were analysed. 32 patients had carotid disease contralateral to their lacunar stroke, compared to 61 patients with ipsilateral lacunar disease. Chi-squared testing indicated a positive association between unilateral lacunar stroke and ipsilateral carotid disease (p=0.003), and a just significant trend towards more severe carotid disease in group 2 (p=0.049). Recurrent ischaemic stroke occurred more commonly in group 2 than group 1, although this difference just failed to reach statistical significance (p=0.059). A positive association therefore exists between lacunar stroke and ipsilateral carotid disease that confers a poor prognosis. Cryptogenic stroke accounts for approximately 30% of ischaemic stroke. Inter-atrial septal abnormalities (patent foramen ovale (PFO) and atrial septal aneurysm) have been proposed as a cause of stroke. Chapter three details a meta-analysis of data examining the relationship between inter-atrial septal abnormalities and stroke. Comparing ischaemic stroke to controls, the odds ratio (OR) associated with PFO for all ages was 1.83 (95% C.I.=1.25-2.66). For atrial septal aneurysm it was 2.35 (1.46-3.77), and for both lesions in conjunction it was 4.96 (2.37-10.39). Homogeneous results were found within the group 55 years (1.27 (0.80-2.01), 3.43 (1.89-6.22) and 5.09 (1.25-20.74) respectively). Comparing cryptogenic stroke patients to patients with known stroke cause, heterogeneous results derived from total group examination (PFO 3.16 (2.30-4.35), atrial septal aneurysm 3.65 (1.34- 9.97), PFO and atrial septal aneurysm 23.26 (5.24-103.20)). In those 55, 3 studies produced heterogeneous results for PFO (2.26 (0.96-5.31)), while no data were available on atrial septal aneurysm prevalence. Meta-analysis therefore demonstrates significant association between both PFO and atrial septal aneurysm and ischaemic stroke in patients 55 years. The climate of uncertainty that surrounds the subject of 'PFO-associated stroke' has led to a wide spectrum of practice amongst specialists, which is examined in chapter four, using a questionnaire. 17% of respondents would investigate for PFO in all cryptogenic stroke patients, while 60% investigate only in those 55 years, and by 33% of respondents for those <55 years (p<0.01 for comparison of proportions). In a patient of any age with recurrent events, less than 5% of respondents would continue to use antiplatelet therapy alone. 45% would use warfarin, and 42% would refer the patient for a corrective procedure. For a patient with a large PFO, 57% (55 years) would refer (p=0.01), and for a patient with concomitant atrial septal aneurysm, 62% (55 years) would refer (p<0.01). A large PFO was felt to be the most important factor in decisions regarding lesion correction. Investigation practice varied considerably amongst specialists. Randomised trial design should reflect management practice in this area. The second part of the thesis reports clinical trials designed to examine the manner in which agents aimed at the modification of vascular risk may act in the acute and subacute phase of ischaemic stroke. The cholesterol- independent effects of statins may explain their efficacy in patients at high vascular risk. (Abstract shortened by ProQuest.)

Stardust melodies: an exhibition of sheet music from the Rare Books Collection 22 June - 5 September 2011

The exhibition was held in the Rare Books Exhibition space, Sir Louis Matheson Library, Monash University from 22 June - 5 September 2011 Opening address given by Dr. Joel Crotty, Senior Lecturer, School of Music, Monash University. Before recordings and radio conveyed the latest popular tunes, sheet music was the means of mass marketing the latest musical vogues and hits: Charles K. Harris's 1892 song, After the Ball, reportedly sold 5 million copies. Sheet music, and illustrated sheet music in particular, preserves an evocative record of our musical, cultural and social past. It is also a repository of personal memories, especially – in the words of the song, "Stardust" – 'the memory of love's refrain'

Cookbooks: the Sandy Michell collection: an exhibition of material from the Monash University Rare Books Collection 22 March - 31 Mat 2011

The exhibition was held in the Rare Books Exhibition space, Sir Louis Matheson Library, Monash University from 22 March - 31 May 2011 Opening address given by Rita Erlich, former editor, The Age Good Food Guide. This exhibition celebrates the gift of valuable seventeenth to nineteenth century French and English cookbooks made by Alexandra (Sandy) Michell, beginning in 1988. The collection has been further developed and expanded to include a fine collection of early Australian cookbooks, and a selection of twentieth century material

20th century poetry: Britain and America: an exhibition from the Rare Books Collection 14 June - 27 September 2013

The exhibition was held in the Rare Books Exhibition space, Sir Louis Matheson Library, Monash University from 14 June - 27 September 2013. Opening address given by Dr. John Hawke, Lecturer, School of English, Communications and Performance Studies. This Rare Books Collection exhibition features T.S. Eliot, the Beat poets, Sylvia Plath and Ted Hughes, among others

In Fairy Land: an exhibition of fairy tale books from the Rare Books Collection 6 March - 7 June 2013

The exhibition was held in the Rare Books Exhibition space, Sir Louis Matheson Library, Monash University from 6 March - 7 June 2013. Opening address given by Dr. Rebecca do Rozarion, Lecturer, School of English, Communications and Performance Studies. This Monash University Library Rare Books Collection exhibition of fairy tale books shows their long history. Items range from early street literature and simple Japanese crepe paper editions to lavish gift books illustrated by famous artists

Men of Stamina, women who Dare: an exhibition of advertising material from the Rare Books Collection 27 March - 5 June 2014

The exhibition was held in the Rare Books Exhibition space, Sir Louis Matheson Library, Monash University from 27 March - 5 June 2014. Opening address given by Gene Bawden, Deputy Head, Design (Communication Design), Faculty of Art Design and Architecture, Monash University. This Rare Books collection exhibition of advertisements and advertising ephemera surprises us as it reveals signs of changing social values in Australia and internationally over time. Thus, each item is an important cultural artefact and social document. The items on display are but a fraction of such material held in Rare Books. The library has been collecting advertising materials and other ephemera since the early 1990's in support of research by social historians

Judging a book by its cover: dust jackets in the Monash University Library Rare Books Collection 26 June - 30 September 2014

The exhibition was held in the Rare Books Exhibition space, Sir Louis Matheson Library, Monash University from 26 June - 30 september 2014. Opening address given by Des Cowley, Rare Printed Collections Manager, State Library of Victoria. This exhibition of dust jackets in the Rare Books Collection shows how these covers have changed from being a simple cover for protection to the main vehicle for advertising a book. From the Edwardian period onwards publishers began to lavish their design effort on the jacket rather than the book cover and we see jacket design start to reflect trends in commercial art. This exhibition includes dust jackets from 1860 to the recent deluxe limited edition Penguin Designer Classics series, and those designed by well-known artists and engravers Salvador Dali, Edward Bawden, John Farleigh, Robert Gibbings, Barnett Freedman, Eric Gill, E. McKnight Kauffer, Sidney Nolan and many more

The body in the library: an exhibition of detective fiction from the Rare Books Collection 15 March - 8 June 2012

The exhibition was held in the Rare Books Exhibition space, Sir Louis Matheson Library, Monash University from 15 March - 8 June 2012 Opening address given by John Loder, author of Australian crime fiction: a bibliography, 1857-1993. Dip into this exhibition of detective fiction from the Rare Books Collection and you will discover not only the delights enjoyed by readers of popular fiction in former times but also some of the key templates of the literature of crime. You will discover anew that crime is an almost irresistible prospect in a book

Books never die: a Rare Books exhibition on the history of the book 14 June - 7 September 2012

The exhibition was held in the Rare Books Exhibition space, Sir Louis Matheson Library, Monash University from 14 June - 7 September 2012 Opening address given by Shane Carmody, Director Development, State Library of Victoria. This exhibition is a celebration of the book over six centuries. Rare Books collects books about books and representative items to show the historical development of book production through the ages

Recent acquisitions 6: an exhibition from the Rare Books Collection 8 December 2011 - 5 March 2012

The exhibition was held in the Rare Books Exhibition space, Sir Louis Matheson Library, Monash University from 8 December 2011 - 5 March 2012 Opening address given by Cathrine Harboe-Ree, University Librarian, Monash University Library. This exhibition is focussed on material acquired since 2009 for the Rare Books Collection. Especially showcased are two significant donations. One is from the firm, Rock Posters, which puts up posters around Melbourne advertising pop concerts and dances; the other is a collection of the works of the poet and novelist Robert Graves donated by retired antiquarian bookseller, Jack Bradstreet