• Radiation protection to the eye and thyroid during diagnostic cerebral angiography: a phantom study.

      Shortt, C P; Malone, L; Thornton, J; Brennan, P; Lee, M J; Department of Radiology, Beaumont Hospital, Dublin, Ireland. (2008-08)
      We measured radiation doses to the eye and thyroid during diagnostic cerebral angiography to assess the effectiveness of bismuth and lead shields at dose reduction. Phantom head angiographic studies were performed with bismuth (study 1) and lead shields (study 2). In study 1 (12 phantoms), thermoluminescent dosimeters (TLD) were placed over the eyes and thyroid in three groups: (i) no shields (four phantoms); (ii) anterior bismuth shields (four phantoms) and (iii) anterior and posterior bismuth shields (four phantoms). In a second study (eight phantoms), lead shields were placed over the thyroid only and TLD dose measurements obtained in two groups: (i) no shielding (four phantoms) and (ii) thyroid lead shielding (four phantoms). A standard 4-vessel cerebral angiogram was performed on each phantom. Study 1 (bismuth shields) showed higher doses to the eyes compared with thyroid (mean 13.03 vs 5.98 mSv, P < 0.001) and a higher eye dose on the X-ray tube side. Overall, the use of bismuth shielding did not significantly reduce dose to either eyes or thyroid in the measured TLD positions. In study 2, a significant thyroid dose reduction was found with the use of lead shields (47%, mean 2.46 vs 4.62 mSv, P < 0.001). Considerable doses to the eyes and thyroid highlight the need for increased awareness of patient protection. Eye shielding is impractical and interferes with diagnostic capability. Thyroid lead shielding yields significant protection to the thyroid, is not in the field of view and should be used routinely.
    • Radical cystectomy in the octogenarian population: a single centre experience

      Raheem, Omer A.; Kamel, Mohamed H.; Leung, Peter; Shields, William P.; Connolly, Stephen S.; Zimmerman, Antonio J.; Mohan, Ponnusammy; Hickey, David P. (2011)
    • Radiological abnormalities associated with Aspergillus colonization in a cystic fibrosis population.

      McMahon, Michelle A; Chotirmall, Sanjay Haresh; McCullagh, Brian; Branagan, Peter; McElvaney, N G; Logan, P M; Department of Radiology, Nottingham University Hospitals, Derby Road, Nottingham NG7 2UH, UK. mmcm75@yahoo.com (2012-03)
      To determine if sputum colonization with Aspergillus species in patients with cystic fibrosis (PWCF) correlates with radiological abnormalities and/or a reduction in pulmonary function (FEV1).
    • Randomised clinical trial: a 'nudge' strategy to modify endoscopic sedation practice.

      Harewood, G C; Clancy, K; Engela, J; Abdulrahim, M; Lohan, K; O'Reilly, C; Department of Gastroenterology & Hepatology, Beaumont Hospital Dublin, Dublin, Ireland. Royal College of Surgeons of Ireland Medical School, Dublin, Ireland. (2011-05-17)
      Background  In behavioural economics, a 'nudge' describes configuration of a choice to encourage a certain action without taking away freedom of choice. Aim  To determine the impact of a 'nudge' strategy - prefilling either 3 mL or 5 mL syringes with midazolam - on endoscopic sedation practice. Methods  Consecutive patients undergoing sedation for EGD or colonoscopy were enrolled. On alternate weeks, midazolam was prefilled in either 3 mL or 5 mL syringes. Preprocedure sedation was administered by the endoscopist to achieve moderate conscious sedation; dosages were at the discretion of the endoscopist. Meperidine was not prefilled. Results  Overall, 120 patients received sedation for EGD [59 (5 mL), 61 (3 mL)] and 86 patients were sedated for colonoscopy [38 (5 mL), 48 (3 mL)]. For EGDs, average midazolam dose was significantly higher in the 5-mL group (5.2 mg) vs. 3-mL group (3.3 mg), (P < 0.0001); for colonoscopies, average midazolam dose was also significantly higher in the 5-mL group (5.1 mg) vs. 3-mL group (3.3 mg), (P < 0.0001). There was no significant difference in mean meperidine dose (42.1 mg vs. 42.8 mg, P = 0.9) administered to both colonoscopy groups. No adverse sedation-related events occurred; no patient required reversal of sedation. Conclusions  These findings demonstrate that 'nudge' strategies may hold promise in modifying endoscopic sedation practice. Further research is required to explore the utility of 'nudges' in impacting other aspects of endoscopic practice.
    • Randomised clinical trial: a 'nudge' strategy to modify endoscopic sedation practice.

      Harewood, G C; Clancy, K; Engela, J; Abdulrahim, M; Lohan, K; O'Reilly, C; Department of Gastroenterology & Hepatology, Beaumont Hospital Dublin, Dublin,, Ireland. harewood.gavin@gmail.com (2012-02-01)
      BACKGROUND: In behavioural economics, a 'nudge' describes configuration of a choice to encourage a certain action without taking away freedom of choice. AIM: To determine the impact of a 'nudge' strategy - prefilling either 3mL or 5mL syringes with midazolam - on endoscopic sedation practice. METHODS: Consecutive patients undergoing sedation for EGD or colonoscopy were enrolled. On alternate weeks, midazolam was prefilled in either 3mL or 5mL syringes. Preprocedure sedation was administered by the endoscopist to achieve moderate conscious sedation; dosages were at the discretion of the endoscopist. Meperidine was not prefilled. RESULTS: Overall, 120 patients received sedation for EGD [59 (5mL), 61 (3mL)] and 86 patients were sedated for colonoscopy [38 (5mL), 48 (3mL)]. For EGDs, average midazolam dose was significantly higher in the 5-mL group (5.2mg) vs. 3-mL group (3.3mg), (P<0.0001); for colonoscopies, average midazolam dose was also significantly higher in the 5-mL group (5.1mg) vs. 3-mL group (3.3mg), (P<0.0001). There was no significant difference in mean meperidine dose (42.1mg vs. 42.8mg, P=0.9) administered to both colonoscopy groups. No adverse sedation-related events occurred; no patient required reversal of sedation. CONCLUSIONS: These findings demonstrate that 'nudge' strategies may hold promise in modifying endoscopic sedation practice. Further research is required to explore the utility of 'nudges' in impacting other aspects of endoscopic practice.
    • Rapid effects of 17beta-estradiol on epithelial TRPV6 Ca2+ channel in human T84 colonic cells.

      Irnaten, Mustapha; Blanchard-Gutton, Nicolas; Harvey, Brian J; Molecular Medicine Laboratories, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland. mirnaten@rcsi.ie (2008-11)
      The control of calcium homeostasis is essential for cell survival and is of crucial importance for several physiological functions. The discovery of the epithelial calcium channel Transient Receptor Potential Vaniloid (TRPV6) in intestine has uncovered important Ca(2+) absorptive pathways involved in the regulation of whole body Ca(2+) homeostasis. The role of steroid hormone 17beta-estradiol (E(2)), in [Ca(2+)](i) regulation involving TRPV6 has been only limited at the protein expression levels in over-expressing heterologous systems. In the present study, using a combination of calcium-imaging, whole-cell patch-clamp techniques and siRNA technology to specifically knockdown TRPV6 protein expression, we were able to (i) show that TRPV6 is natively, rather than exogenously, expressed at mRNA and protein levels in human T84 colonic cells, (ii) characterize functional TRPV6 channels and (iii) demonstrate, for the first time, the rapid effects of E(2) in [Ca(2+)](i) regulation involving directly TRPV6 channels in T84 cells. Treatment with E(2) rapidly (<5 min) enhanced [Ca(2+)](i) and this increase was partially but significantly prevented when cells were pre-treated with ruthenium red and completely abolished in cells treated with siRNA specifically targeting TRPV6 protein expression. These results indicate that when cells are stimulated by E(2), Ca(2+) enters the cell through TRPV6 channels. TRPV6 channels in T84 cells contribute to the Ca(2+) entry/signalling pathway that is sensitive to 17beta-estradiol.
    • Rapid effects of 17beta-estradiol on TRPV5 epithelial Ca2+ channels in rat renal cells.

      Irnaten, Mustapha; Blanchard-Gutton, Nicolas; Praetorius, Jeppe; Harvey, Brian J; Molecular Medicine Laboratories, Royal College of Surgeons in Ireland, Beaumont Hospital, PO Box 9063, Dublin 9, Ireland. irnatenm@yahoo.fr (2009-08)
      The renal distal tubules and collecting ducts play a key role in the control of electrolyte and fluid homeostasis. The discovery of highly calcium selective channels, Transient Receptor Potential Vanilloid 5 (TRPV5) of the TRP superfamily, has clarified the nature of the calcium entry channels. It has been proposed that this channel mediates the critical Ca(2+) entry step in transcellular Ca(2+) re-absorption in the kidney. The regulation of transmembrane Ca(2+) flux through TRPV5 is of particular importance for whole body calcium homeostasis.In this study, we provide evidence that the TRPV5 channel is present in rat cortical collecting duct (RCCD(2)) cells at mRNA and protein levels. We demonstrate that 17beta-estradiol (E(2)) is involved in the regulation of Ca(2+) influx in these cells via the epithelial Ca(2+) channels TRPV5. By combining whole-cell patch-clamp and Ca(2+)-imaging techniques, we have characterized the electrophysiological properties of the TRPV5 channel and showed that treatment with 20-50nM E(2) rapidly (<5min) induced a transient increase in inward whole-cell currents and intracellular Ca(2+) via TRPV5 channels. This rise was significantly prevented when cells were pre-treated with ruthenium red and completely abolished in cells treated with siRNA specifically targeting TRPV5.These data demonstrate for the first time, a novel rapid modulation of endogenously expressed TRPV5 channels by E(2) in kidney cells. Furthermore, the results suggest calcitropic effects of E(2). The results are discussed in relation to present concepts of non-genomic actions of E(2) in Ca(2+) homeostasis.
    • A rare case of minimal deviation adenocarcinoma of the uterine cervix in a renal transplant recipient.

      Fanning, D M; Gulmann, C; Hickey, D P; Little, D M; Department of Urology and Transplantation, Beaumont Hospital, Dublin 9, Ireland. , fanningdee@yahoo.co.uk (2012-02-01)
      INTRODUCTION: We report the first described case of minimal deviation adenocarcinoma of the uterine cervix in the setting of a female renal cadaveric transplant recipient. MATERIALS AND METHODS: A retrospective review of this clinical case was performed. CONCLUSION: This rare cancer represents only about 1% of all cervical adenocarcinoma.
    • A rare case of minimal deviation adenocarcinoma of the uterine cervix in a renal transplant recipient.

      Fanning, D M; Gulmann, C; Hickey, D P; Little, D M; Department of Urology and Transplantation, Beaumont Hospital, Dublin 9, Ireland, fanningdee@yahoo.co.uk. (2009-02-03)
      INTRODUCTION: We report the first described case of minimal deviation adenocarcinoma of the uterine cervix in the setting of a female renal cadaveric transplant recipient. MATERIALS AND METHODS: A retrospective review of this clinical case was performed. CONCLUSION: This rare cancer represents only about 1% of all cervical adenocarcinoma.
    • Rare case of primary spinal ependymomatosis occurring in a 26-year-old man: a case report.

      Kaliaperumal, Chandrasekaran; Suttner, Nigel; Herron, Brian; Choudhari, Kishor A; National centre for Neurosurgery, Beaumont Hospital, Dublin-9, Republic of Ireland. (2009)
      The authors report a rare case of primary spinal ependymomatosis in a young adult man. Multiple primary ependymomatous lesions were seen on magnetic resonance imaging and no anaplasia was identified on the surgical-pathological analysis. The aetio-pathological mechanism and surgical significance of this rare occurrence is discussed.
    • A rare case of recurrent urachal adenocarcinoma of the bladder

      Sullivan, JF; Fanning, DM; Cheema, I; Creagh, T (Irish Medical Journal, 2013-05)
      Urachal carcinoma is a rare, aggressive malignancy accounting for less than 1% of bladder neoplasms. These tumours are usually adenocarcinomas and occur at the dome or anterior wall of the bladder. They often escape early clinical detection, growing for prolonged periods prior to diagnosis, resulting in local invasion and systemic spread before therapeutic intervention is initiated. We present the case of a recurrent urachal carcinoma in a young female.
    • Rate of familial amyotrophic lateral sclerosis: a systematic review and meta-analysis.

      Byrne, Susan; Walsh, Cathal; Lynch, Catherine; Bede, Peter; Elamin, Marwa; Kenna, Kevin; McLaughlin, Russell; Hardiman, Orla; Deparment of Neurology, Beaumont Hospital, Beaumont Rd, Dublin 9, Ireland., suabyrne@gmail.com (2012-02-01)
      BACKGROUND: The population rate of familial amyotrophic lateral sclerosis (FALS) is frequently reported as 10%. However, a systematic review and meta-analysis of the true population based frequency of FALS has never been performed. METHOD: A Medline literature review identified all original articles reporting a rate of FALS. Studies were grouped according to the type of data presented and examined for sources of case ascertainment. A systematic review and meta-analysis of reported rates of FALS was then conducted to facilitate comparison between studies and calculate a pooled rate of FALS. RESULTS: 38 papers reported a rate of FALS. Thirty-three papers were included in analysis and the rate of FALS for all studies was 4.6% (95% CI 3.9% to 5.5%). Restricting the analysis to prospective population based registry data revealed a rate of 5.1% (95% CI 4.1% to 6.1%). The incidence of FALS was lower in southern Europe. There was no correlation between rate of FALS and reported SOD1 mutation rates. CONCLUSION: The rate of FALS among prospective population based registries is 5.1% (CI 4.1 to 6.1%), and not 10% as is often stated. Further detailed prospective population based studies of familial ALS are required to confirm this rate.
    • Rate of familial amyotrophic lateral sclerosis: a systematic review and meta-analysis.

      Byrne, Susan; Walsh, Cathal; Lynch, Catherine; Bede, Peter; Elamin, Marwa; Kenna, Kevin; McLaughlin, Russell; Hardiman, Orla; Deparment of Neurology, Beaumont Hospital, Dublin, Ireland. (2010-11-03)
      Background The population rate of familial amyotrophic lateral sclerosis (FALS) is frequently reported as 10%. However, a systematic review and meta-analysis of the true population based frequency of FALS has never been performed. Method A Medline literature review identified all original articles reporting a rate of FALS. Studies were grouped according to the type of data presented and examined for sources of case ascertainment. A systematic review and meta-analysis of reported rates of FALS was then conducted to facilitate comparison between studies and calculate a pooled rate of FALS. Results 38 papers reported a rate of FALS. Thirty-three papers were included in analysis and the rate of FALS for all studies was 4.6% (95% CI 3.9% to 5.5%). Restricting the analysis to prospective population based registry data revealed a rate of 5.1% (95% CI 4.1% to 6.1%). The incidence of FALS was lower in southern Europe. There was no correlation between rate of FALS and reported SOD1 mutation rates. Conclusion The rate of FALS among prospective population based registries is 5.1% (CI 4.1 to 6.1%), and not 10% as is often stated. Further detailed prospective population based studies of familial ALS are required to confirm this rate.
    • Recurrent tongue swelling: an unusual manifestation of allergic contact dermatitis.

      Moran, B; Murphy, G M; Department of Dermatology, Beaumont Hospital, Dublin, Ireland. benvonmoran@gmail.com (2009-02)
    • Recurring pulmonary hamartomas: cause for concern?

      Coleman, N; Chotirmall, SH; Forman, E; McCullagh, B; Broe, P; Royston, D; O’Neill, S (Irish Medical Journal (IMJ), 2013-10)
      We report the case of a well-controlled female asthmatic who developed â multiple pulmonary hamartomasâ on three separate occasions over a period of 25 years that necessitated surgical resection. To our knowledge, this is the first report of recurrent hamartomas in a single individual necessitating multiple thoracotomies.
    • Recurring themes arising during medical research ethics committee

      Kelleher, E; Stanton, A; Vale, G; Smith, D (Irish Medical Journal, 2013-06)
      A standard application form for the ethical review of health-related research studies has recently been adopted by many Irish medical research ethics committees. In order to assess the impact of the new form, we reviewed all comments made by the Beaumont Hospital Ethics Committee during two six-month periods, immediately prior to adoption of the new form (2010), and soon afterwards (2011). Neither volume nor comment type differed significantly between the two observation periods. Participant documentation (information leaflets and consent forms) accounted for the largest proportion of comments (2010; 44%, 2011; 37%). Other common areas prompting queries were study administration (7%), design (12%) and procedures (13%), participant selection and recruitment (8%), and lastly data protection (9%). Because of these findings, the standard operating procedures of the committee have been revised â use of provided template participant documentation is strongly encouraged, and a â Recurring Review Themesâ checklist is highlighted to all applicants.
    • Reducing risks: have the changing antiepileptic drug prescribing habits in pregnancy resulted in an improvement in pregnancy outcomes between 1995 and 2010?

      Kinney, M O; Morrow, J I; Bannon, F; Irwin, B; Hunt, S; Russell, A; Smithson, W; Parsons, L; Robertson, I; Morrison, P J; et al. (2011-08)
      Purpose: The risk of major congenital malformations (MCM) with in utero exposure to valproate used in monotherapy (6.2%; 95% CI 4.1–7.8) or in polytherapy (7.8%; 95%CI 5.6–10.7) has previously been shown to be greater than the risk due to exposure to carbamazepine (2.6%; 95%CI 1.9–3.5) or lamotrigine (2.3%; 95%CI 1.6–3.2). (Morrow JI, et al. J Neurol Neurosurg Psychiatry 2006; 77:193–198) The awareness of this association has increased over the past 10–15 years. This current study sought to assess the impact on prescribing habits and onMCMrate. Method: An analysis of the UK Epilepsy and Pregnancy register, which now encompasses more than 8000 registrations, allows for review of prescribing habits and for calculation ofMCMrates from 1995 to 2010. Results: There was no change in the ratio of monotherapy, polytherapy and no drug exposures, but sodium valproate prescription fell from 31.2 to 23.25% of monotherapy exposures during the study period. This was associated with a trend towards reducing MCM in the pregnancies of women with epilepsy from 4.3% (95% CI 3.5–5.4%) to 3.2% (95%CI 2.6–3.9%). Conclusion: The MCM rate has fallen by approximately a quarter during the study period, this equates to 26 less children born with MCM per annum. Given the spectrum of MCMs seen with valproate and their cost to the Health Service this may represent an extrapolated direct health cost saving in the order of £2–3 million per annum in the UK.
    • The referral and complete evaluation time study.

      Gilligan, Peadar; Winder, Stephen; Ramphul, Navin; O'kelly, Patrick; Departments of aEmergency bInformation Technology cNephrology, Beaumont Hospital, Dublin, Ireland. peadargilligan@beaumont.ie (2010-12)
      It has been suggested that inefficiency in the delivery of care in emergency departments (EDs) may contribute to their overcrowding. Specifically the duplication of work by the on take teams of the assessment already performed by the ED doctor has been identified as a possible contributor to prolonged waits for a hospital bed for those requiring admission. Anything that prolongs an individual patient's processing time will contribute to overcrowding.
    • Referral letters to the emergency department: is the medication list accurate?

      McCullagh, M; O'Kelly, P; Gilligan, P (Irish Medical Journal, 2015-02)
      Medication errors are common when patients transfer across healthcare boundaries. This study was designed to investigate the quality of information on medicines provided by general practitioners (GPs) on emergency department (ED) referral letters. A convenience sample of referral letters to the ED of a teaching hospital was reviewed. The medication list and/or patient's drug allergy status were noted. Medicines reconciliation including patient (or carer) interview was conducted to determine the patient's actual home medication list. This was compared with the GP list and any discrepancies were identified and addressed. A total of 92 referral letters were included in the analysis of which 60 were computer-generated and 32 were hand-written. GPs provided dose and frequency of administration information in 47 (51%) of the letters sampled i.e. 44 (71%) computer-generated versus 3 (10%) hand-written; p < 0.001. In addition, the patient was taking their medicines exactly as per the GP list in 20 (22%) of cases. The patient's drug allergy status was documented in 13 (14%) of the letters.