• Paediatric cyclical Cushing's disease due to corticotroph cell hyperplasia.

      Noctor, E; Gupta, S; Brown, T; Farrell, M; Javadpour, M; Costigan, C; Agha, A (BioMed Central, 2015-06)
      Cushing's disease is very rare in the paediatric population. Although uncommon, corticotroph hyperplasia causing Cushing's syndrome has been described in the adult population, but appears to be extremely rare in children. Likewise, cyclical cortisol hypersecretion, while accounting for 15 % of adult cases of Cushing's disease, has only rarely been described in the paediatric population. Here, we describe a very rare case of a 13-year old boy with cyclical cortisol hypersecretion secondary to corticotroph cell hyperplasia.
    • Palliative care in amyotrophic lateral sclerosis: a review of current international guidelines and initiatives.

      Bede, Peter; Oliver, David; Stodart, James; van den Berg, Leonard; Simmons, Zachary; O Brannagáin, Doiminic; Borasio, Gian Domenico; Hardiman, Orla; Trinity College, Dublin, Ireland. bedepeter@hotmail.com (2011-04)
      Amyotrophic lateral sclerosis (ALS) is a relentlessly progressive neurodegenerative condition. Optimal management requires a palliative approach from diagnosis with emphasis on patient autonomy, dignity and quality of life.
    • Pandemic H1N1 (2009) and renal failure: the experience of the Irish national tertiary referral centre.

      O Brien, F J; Jairam, S D; Traynor, C A; Kennedy, C M; Power, M; Denton, M D; Magee, C; Conlon, P J; Department of Nephrology, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland., Frankjobrien@physicians.ie (2012-02-01)
      INTRODUCTION: H1N1 influenza A, was first described in April 2009. A significant cohort of patients from this outbreak developed acute respiratory distress syndrome or pneumonia. H1N1 has since been transmitted across the world. Little has been described on the renal complications of this illness. METHODS: A retrospective review of all patients admitted to our institution with H1N1 infection was carried out from July to November 2009. Renal biochemistry, need for renal replacement therapy and hospital outcome was recorded. RESULTS: Thirty-four patients with H1N1 were admitted. Average length of admission was 10 days (3-84). Eleven patients (32%) developed acute kidney injury (AKI) as defined by the RIFLE criteria (creatinine range 120-610). Four patients required renal replacement therapy, for a range of 10-52 days. Seven patients developed AKI that responded to volume resuscitation. The commonest cause of AKI was sepsis with acute tubular necrosis. CONCLUSION: This study highlights the significance and frequency of renal complications associated with this illness.
    • Pandemic H1N1 (2009) and renal failure: the experience of the Irish national tertiary referral centre.

      O Brien, F J; Jairam, S D; Traynor, C A; Kennedy, C M; Power, M; Denton, M D; Magee, C; Conlon, P J; Department of Nephrology, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland. Frankjobrien@physicians.ie (2011-03)
      H1N1 influenza A, was first described in April 2009. A significant cohort of patients from this outbreak developed acute respiratory distress syndrome or pneumonia. H1N1 has since been transmitted across the world. Little has been described on the renal complications of this illness.
    • Panton Valentine leukocidin MSSA leading to multi-organ failure.

      Low, T B; Harty, L; Murray, M; Andrews, C; O'Neill, S J; Department of Respiratory Medicine, RCSI Education & Research Center, Smurfit Building, Beaumont Hospital, Dublin 9. teckboonlow1@rcsi.ie (2009-06)
      We report a case of a 15-year-old boy who developed multiple organ failure secondary to a sport injury leading to infection with a Panton Valentine Leukocidin (PVL) secreting Community-Acquired Methicillin Sensitive Staphylococcus Aureus (CA MSSA). Aggressive antibiotic therapy eventually led to recovery.
    • Parallel imaging enhanced MR colonography using a phantom model.

      Morrin, Martina M; Pedrosa, Ivan; McKenzie, Charles A; Farrell, Richard J; Bloch, Nicolas; Solazzo, Stephanie; Ngo, Long; Goldberg, Shraga N; Rofsky, Neil M; Department of Radiology, Beaumont Hospital, Dublin, Ireland. mmorrin@rcsi.ie (2008-09)
      To compare various Array Spatial and Sensitivity Encoding Technique (ASSET)-enhanced T2W SSFSE (single shot fast spin echo) and T1-weighted (T1W) 3D SPGR (spoiled gradient recalled echo) sequences for polyp detection and image quality at MR colonography (MRC) in a phantom model. Limitations of MRC using standard 3D SPGR T1W imaging include the long breath-hold required to cover the entire colon within one acquisition and the relatively low spatial resolution due to the long acquisition time. Parallel imaging using ASSET-enhanced T2W SSFSE and 3D T1W SPGR imaging results in much shorter imaging times, which allows for increased spatial resolution.
    • Partial status epilepticus - rapid genetic diagnosis of Alpers' disease.

      McCoy, Bláthnaid; Owens, Cormac; Howley, Rachel; Ryan, Stephanie; King, Mary; Farrell, Michael A; Lynch, Bryan J; Departments of Neurology, Children's University Hospital, Temple Street, Dublin 1, Ireland. (2011-11)
      We describe four children with a devastating encephalopathy characterised by refractory focal seizures and variable liver dysfunction. We describe their electroencephalographic, radiologic, genetic and pathologic findings. The correct diagnosis was established by rapid gene sequencing. POLG1 based Alpers' disease should be considered in any child presenting with partial status epilepticus.
    • Patient and surgeon factors are associated with the use of laparoscopy in appendicitis.

      McCartan, D P; Fleming, F J; Hill, A D K; Department of Surgery, Beaumont Hospital, Royal College of Surgeons in Ireland,, Dublin, Ireland Division of Colorectal Surgery, Department of Surgery, University, of Rochester Medical Center, Rochester, New York, USA. (2012-02-01)
      Aim The use of a minimally invasive approach to treat appendicitis has yet to be universally accepted. The objective of this study was to examine recent trends in Ireland in the surgical management of acute appendicitis. Method Data were obtained from the Irish Hospital In-Patient Enquiry system for patients discharged with a diagnosis of appendicitis between 1999 and 2007. An anonymous postal survey was sent to all general surgeons of consultant and registrar level in Ireland to assess current attitudes to the use of laparoscopic appendectomy. Results The use of laparoscopic appendectomy increased throughout the study and was the most common approach for appendectomy in 2007. Multivariate analysis revealed age under 50 years (OR = 1.51), female sex (OR = 2.84) and residence in high-density population areas (OR = 4.15) as predictive factors for undergoing laparoscopic appendectomy in the most recent year of the study. While 97% of surgeons reported current use of laparoscopy in patients with acute right iliac fossa pain, in most cases it was selective. Surgeons in university teaching hospitals (42 of 77; 55%) were more likely to report using laparoscopic appendectomy for all cases of appendicitis than those in regional (six of 23; 26%) or general (13 of 53; 25%) hospitals (P = 0.048). Conclusion This study has demonstrated a significant increase in laparoscopic appendectomy, yet a variety of patient and surgeon factors contribute to the choice of procedure. Differences in the perception of benefit of the laparoscopic approach amongst surgeons appears to be an important factor in determining the operative approach for appendectomy.
    • Patient Safety in Interventional Radiology: A CIRSE IR Checklist.

      Department of Academic Radiology, Beaumont Hospital, Dublin 9, Ireland,, mlee@rcsi.ie. (2012-02-01)
      Interventional radiology (IR) is an invasive speciality with the potential for complications as with other invasive specialities. The World Health Organization (WHO) produced a surgical safety checklist to decrease the morbidity and mortality associated with surgery. The Cardiovascular and Interventional Society of Europe (CIRSE) set up a task force to produce a checklist for IR. Use of the checklist will, we hope, reduce the incidence of complications after IR procedures. It has been modified from the WHO surgical safety checklist and the RAD PASS from Holland.
    • Patients' perceptions of services and preferences for care in amyotrophic lateral sclerosis: A review.

      Foley, Geraldine; Timonen, Virpi; Hardiman, Orla; Department of Occupational Therapy, National Neuroscience Centre, Beaumont, Hospital , Dublin. (2012-02-01)
      Abstract Service providers and service users often have different perspectives on health and social care services. We have undertaken a systematic review of empirical data between 1988 and March 2011 relating to ALS service users' perspectives on health and social care services. Forty-seven texts were extracted and a narrative synthesis conducted. Few studies have explored ALS patients' experiences in relation to their satisfaction with services. Our review showed that ALS patients expect dignified care but they are often dissatisfied with health care services and have unmet expectations of their care. Most studies of decision-making and preferences for care have focused on end-of-life intervention. Various factors influence preferences for care from the service user perspective and people with ALS may adjust their use of services as they negotiate change. In conclusion, further research on the timeliness of services to meet changing needs of service users is required. The service user experience of allied health care services prior to end-of-life care also warrants investigation. Service providers need to support people with ALS as they negotiate feelings of acceptance and independence. Research to identify the key parameters of the ALS patient experience of services is required.
    • Patientsmate©: the implementation and evaluation of an online prospective audit system.

      McHugh, Seamus Mark; Loh, Kah Poh; Corrigan, Mark Anthony; Sheikh, Athar; Lehane, Elaine; Hill, Arnold David Konrad; Research fellow, General Surgery, Department of Surgery, Beaumont Hospital, Dublin, Ireland and Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland Medical Student, Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland Specialist Registrar in General Surgery, Department of Surgery, Beaumont Hospital, Dublin, Ireland and Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland Senior Registrar in General Surgery, Department of Surgery, Beaumont Hospital, Dublin, Ireland Lecturer in Research, Department of Nursing, University College Cork, Cork, Ireland Professor of Surgery, Department of Surgery, Beaumont Hospital, Dublin, Ireland and Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland. (2010-11-18)
      Introduction  Inaccuracy in Hospital Inpatient Enquiry (HIPE)/Casemix-based data has been reported as high as 26%. This results in financial waste and makes effective audit impossible. We aimed to develop a novel web-based outcome audit system. Methods  A web-based online audit system, Patientsmate©, was developed using an integrated database system written in the programme language PHP. Data were inputted by the surgical team responsible for the patients care. A prospective comparison study of the new Patientsmate© and the standard HIPE systems, was performed over a 1-month period and involving two general surgical teams in April 2010. In addition, a Likert-scale based questionnaire was designed and hosted within the Patientsmate© system. A focus group of those clinicians directly involved in data accessing and input were then invited to complete the questionnaire in order to assess usability of the system. Results  During the study period there were a total of 108 patients and 88 procedures. Our study confirms the accuracy of clinician derived data, with the Patientsmate© system more accurately recording number of patients (83% vs. 80.6%), number of procedures (85.2% vs. 68.1%) and hospital day case rate (52% vs. 47.1%). Inputting data using Patientsmate© for a single patient took 6-7 minutes. Of those using the system, 75% reported feeling comfortable after using it once only and 100% were satisfied with the layout of the online interface. Conclusion  The Patientsmate© system allows for increased accuracy in outcome-based data as compared with the HIPE system, facilitating audit, financial savings and the appropriate allocation of services.
    • PCR ribotype prevalence and molecular basis of macrolide-lincosamide-streptogramin B (MLSB) and fluoroquinolone resistance in Irish clinical Clostridium difficile isolates.

      Solomon, Katie; Fanning, Seamus; McDermott, Sinead; Murray, Sean; Scott, Louise; Martin, Alan; Skally, Mairead; Burns, Karen; Kuijper, Ed; Fitzpatrick, Fidelma; et al. (2011-09)
      Antimicrobial use is recognized as a risk factor for Clostridium difficile infection (CDI) and outbreaks. We studied the relationship between PCR ribotype, antimicrobial susceptibility and the genetic basis of resistance in response to exposure to antimicrobial agents.
    • PEA3/ETV4-related transcription factors coupled with active ERK signalling are associated with poor prognosis in gastric adenocarcinoma

      Keld, R; Guo, B; Downey, P; Cummins, R; Gulmann, C; Ang, Y S; Sharrocks, A D (2011-06-28)
      Background: Transcription factors often play important roles in tumourigenesis. Members of the PEA3 subfamily of ETS-domain transcription factors fulfil such a role and have been associated with tumour metastasis in several different cancers. Moreover, the activity of the PEA3 subfamily transcription factors is potentiated by Ras-ERK pathway signalling, which is itself often deregulated in tumour cells. Methods: Immunohistochemical patterns of PEA3 expression and active ERK signalling were analysed and mRNA expression levels of PEA3, ER81, MMP-1 and MMP-7 were determined in gastric adenocarcinoma samples. Results: Here, we have studied the expression of the PEA3 subfamily members PEA3/ETV4 and ER81/ETV1 in gastric adenocarcinomas. PEA3 is upregulated at the protein level in gastric adenocarcinomas and both PEA3/ETV4 and ER81/ETV1 are upregulated at the mRNA level in gastric adenocarcinoma tissues. This increased expression correlates with the expression of a target gene associated with metastasis, MMP-1. Enhanced ERK signalling is also more prevalent in late-stage gastric adenocarcinomas, and the co-association of ERK signalling and PEA3 expression also occurs in late-stage gastric adenocarcinomas. Furthermore, the co-association of ERK signalling and PEA3 expression correlates with decreased survival rates. Conclusions: This study shows that members of the PEA3 subfamily of transcription factors are upregulated in gastric adenocarcinomas and that the simultaneous upregulation of PEA3 expression and ERK pathway signalling is indicative of late-stage disease and a poor survival prognosis.
    • Penile incarceration secondary to a penile ring device.

      Fanning, Deirdre Mary; Department of Urology, Beaumont Hospital, Dublin, Ireland. (2011-06-30)
    • Perceptions of medication safety among patients with inflammatory bowel disease.

      Cullen, Garret; Donnellan, Fergal; Long, Syapiq; Forry, Mary; Murray, Frank E; Department of Gastroenterology, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland. garret.cullen@ucd.ie (2010-09)
      The aim of this study was to assess attitudes towards and knowledge of medication safety in inflammatory bowel disease (IBD). IBD patients frequently require long-term treatment with potentially toxic medications. Techniques are employed to improve patient awareness of medication safety, but there are sparse data on their effectiveness.
    • Perceptions of the risks of continuation and cessation of maintenance therapy among patients with inflammatory bowel disease

      Kevans, D; Zeb, F; Boland, K; Forry, M; Godwin, N; Harewood, G; Patchett, S; Murray, F E (2011-02)
    • Percutaneous antegrade ureteric stent removal using a rigid alligator forceps.

      Given, M F; Geoghegan, T; Lyon, S M; McGrath, F; Lee, M J; Department of Radiology, Beaumont Hospital, Dublin, Ireland. givenmark@hotmail.com (2008-12)
      To evaluate the safety and efficacy of percutaneous antegrade ureteric stent removal using a rigid alligator forceps. Twenty patients were included in our study. Indications for ureteric stent insertion included stone disease (n = 7), malignancy (n = 8) and transplant anastomotic strictures (n = 5). Stent retrieval was carried out for proximal stent placement/migration in seven patients and encrustation in the remaining 13. Twenty-two stents were successfully retrieved in 20 patients. There was one technical failure (5%). There were no major complications. We had four minor complications, which included nephrostomy site pain (n = 2), periprocedural sepsis (n = 1) and a small urinoma (n = 1). All patients settled with conservative management. Percutaneous radiologically guided antegrade ureteric stent removal with an alligator forceps is safe and effective, particularly when initial surgical removal has failed.
    • Percutaneous balloon dilatation of stenotic calyceal diverticular infundibula in patients with recurrent urinary tract infections.

      Keeling, Aoife N; Wang, Tim T; Lee, Michael J; Department of Academic Radiology, Beaumont Hospital, Beaumont Road, Dublin 9,, Ireland. (2012-02-01)
      AIM: Renal calyceal diverticula are usually detected as incidental findings on intravenous pyelograms (IVPs) and rarely manifest any clinical signs or symptoms. However, they can interfere with patient's quality of life in a number of instances causing pain, recurrent urinary tract infections (UTIs), abscess, systemic sepsis and calculus formation. The purpose of this study was to review the clinical indications, procedure technique and clinical outcome in all patients referred to Interventional Radiology for the percutaneous management of renal calyceal diverticula. MATERIALS AND METHODS: A retrospective review of all patients treated with percutaneous balloon dilatation of calyceal diverticular infundibula in the Interventional Radiology Department over a 10-year period was performed. Data collected included clinical details, laboratory indices, IVP and CT findings, procedure details and clinical outcome. RESULTS: A total of three patients were treated over the course of the study period. All patients were young females who presented as a result of recurrent urinary tract infections. The calyceal diverticula were diagnosed incidentally on routine IVPs, with CT eloquently confirming the plain film findings in two cases. Technical procedure success was achieved in all cases, avoiding surgical intervention. Clinical follow-up revealed no further UTIs following dilatation. CONCLUSION: Fluoroscopic guided percutaneous balloon dilatation of renal calyceal diverticular infundibula following direct diverticular puncture is a safe and well tolerated method to reduce UTI and potentially avoid future stone formation.
    • Percutaneous balloon dilatation of stenotic calyceal diverticular infundibula in patients with recurrent urinary tract infections.

      Keeling, Aoife N; Wang, Tim T; Lee, Michael J; Department of Academic Radiology, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland. (2011-02)
      Renal calyceal diverticula are usually detected as incidental findings on intravenous pyelograms (IVPs) and rarely manifest any clinical signs or symptoms. However, they can interfere with patient's quality of life in a number of instances causing pain, recurrent urinary tract infections (UTIs), abscess, systemic sepsis and calculus formation. The purpose of this study was to review the clinical indications, procedure technique and clinical outcome in all patients referred to Interventional Radiology for the percutaneous management of renal calyceal diverticula.
    • Performance of an automated, remote system to detect vocal fold paralysis.

      Wormald, Robert N; Moran, Rosalyn J; Reilly, Richard B; Lacy, Peter D; Department of Otolaryngology-Head and Neck Surgery, Beaumont Hospital, Dublin, Ireland. (2008-11)
      The aim of this project was to evaluate the diagnostic accuracy of an automated, remote system for correctly identifying vocal fold paralysis.