• A UK NEQAS ISH multicenter ring study using the Ventana HER2 dual-color ISH assay.

      Bartlett, J M S; Campbell, Fiona M; Ibrahim, Merdol; O'Grady, Anthony; Kay, Elaine; Faulkes, Catherine; Collins, Nadine; Starczynski, Jane; Morgan, John M; Jasani, Bharat; et al. (2011-01)
      We performed a multicenter assessment of a new HER2 dual-color chromogenic in situ hybridization (CISH) test and herein report on concordance of CISH data with fluorescence in situ hybridization (FISH) data and intraobserver and interlaboratory scoring consistency. HER2 results were evaluated using duplicate cores from 30 breast cancers in 5 laboratories using the Ventana HER2 dual-color ISH assay (Ventana Medical Systems, Cambridgeshire, England) and in 1 central laboratory using a standard FISH assay. Overall 93.3% of cases were successfully analyzed by CISH across the 5 participating laboratories. There was excellent concordance (98.0% overall) for diagnosis of HER2 amplification by CISH compared with FISH. Intraobserver variability (7.7%) and intersite variability (9.1%) of absolute HER2/chromosome enumeration probe 17 ratios were tightly controlled across all participating laboratories. The Ventana HER2 dual-color ISH assay is robust and reproducible, shows good concordance with a standard FISH assay, and complies with requirements in national and international guidelines for performance of ISH-based diagnostic tests.
    • Ultrasound-guided core biopsy: an effective method of detecting axillary nodal metastases.

      Solon, Jacqueline G; Power, Colm; Al-Azawi, Dhafir; Duke, Deirdre; Hill, Arnold D K; Department of Surgery, Beaumont Hospital, Dublin, Ireland; Department of Surgery,, Royal College of Surgeons in Ireland, Dublin, Ireland. (2012-02-01)
      BACKGROUND: Axillary nodal status is an important prognostic predictor in patients with breast cancer. This study evaluated the sensitivity and specificity of ultrasound-guided core biopsy (Ax US-CB) at detecting axillary nodal metastases in patients with primary breast cancer, thereby determining how often sentinel lymph node biopsy could be avoided in node positive patients. STUDY DESIGN: Records of patients presenting to a breast unit between January 2007 and June 2010 were reviewed retrospectively. Patients who underwent axillary ultrasonography with or without preoperative core biopsy were identified. Sensitivity, specificity, positive predictive value, and negative predictive value for ultrasonography and percutaneous biopsy were evaluated. RESULTS: Records of 718 patients were reviewed, with 445 fulfilling inclusion criteria. Forty-seven percent (n = 210/445) had nodal metastases, with 110 detected by Ax US-CB (sensitivity 52.4%, specificity 100%, positive predictive value 100%, negative predictive value 70.1%). Axillary ultrasonography without biopsy had sensitivity and specificity of 54.3% and 97%, respectively. Lymphovascular invasion was an independent predictor of nodal metastases (sensitivity 60.8%, specificity 80%). Ultrasound-guided core biopsy detected more than half of all nodal metastases, sparing more than one-quarter of all breast cancer patients an unnecessary sentinel lymph node biopsy. CONCLUSIONS: Axillary ultrasonography, when combined with core biopsy, is a valuable component of the management of patients with primary breast cancer. Its ability to definitively identify nodal metastases before surgical intervention can greatly facilitate a patient's preoperative integrated treatment plan. In this regard, we believe our study adds considerably to the increasing data, which indicate the benefit of Ax US-CB in the preoperative detection of nodal metastases.
    • Ultraviolet radiation and immunosuppression.

      Murphy, G M; Department of Dermatology, Beaumont & Mater Misericordiae Hospital, Dublin, Ireland. gmurphyoffice@eircom.net (2009-11)
      Ultraviolet (UV) radiation is a complete carcinogen. The effects of UV radiation are mediated via direct damage to cellular DNA in the skin and suppression of image surveillance mechanisms. In the context of organ transplantation, addiction of drugs which suppress the immune system add greatly to the carcinogenicity of UV radiation. This review considers the mechanisms of such effects.
    • Unilateral facial palsy in an infant: an unusual presentation of familial multiple cerebral cavernous malformation.

      Zakaria, Zaitun; Kaliaperumal, Chandrasekaran; Caird, John; Sattar, Mohammad; Department of Neurosurgery, Beaumont Hospital, Dublin, Ireland. (2012)
      Cerebral cavernous malformation (CCM) in infants tends to have genetic predisposition. These cavernomas have a progressive course of events and associated neurological symptoms with increase in age. They most commonly present with seizure and syndrome of increased intracranial pressure comprising of headache, vomiting and focal neurological signs. We describe a case of a 7-month-old infant who presented with an acute onset of right facial paralysis with a background of familial CCM. The CT and MRI scan revealed fresh haemorrhage in the right cerebellar and pontine cavernomas with surrounding oedema and no evidence of obstructive hydrocephalus. These two cavernomas re-bled in a week duration causing episodes of incessant crying and irritability. After discussing the pros and cons of treatment, owing to stable clinical status, the patient is currently been managed conservatively.
    • An unusual case of cancer of the urachal remnant following repair of bladder exstrophy.

      Fanning, D M; Sabah, M; Conlon, P J; Mellotte, G J; Donovan, M G; Little, D M; Department of Urology and Transplantation, Beaumont Hospital, Dublin 9, Ireland, deirdre.fanning@ucd.ie. (2009-03-18)
      INTRODUCTION: We report the first case of cancer of the urachal remnant following repair of bladder exstrophy, in a renal transplant recipient. METHOD: A retrospective review of this clinical case and the associated literature were performed. CONCLUSION: This unusual case highlights two very rare entities. Bladder exstrophy has an incidence of 1 in 50,000 newborns, whereas urachal cancer accounts for less than 1% of all bladder tumours.
    • An unusual case of cancer of the urachal remnant following repair of bladder exstrophy.

      Fanning, D M; Sabah, M; Conlon, P J; Mellotte, G J; Donovan, M G; Little, D M; Department of Urology and Transplantation, Beaumont Hospital, Dublin 9, Ireland. , deirdre.fanning@ucd.ie (2012-02-01)
      INTRODUCTION: We report the first case of cancer of the urachal remnant following repair of bladder exstrophy, in a renal transplant recipient. METHOD: A retrospective review of this clinical case and the associated literature were performed. CONCLUSION: This unusual case highlights two very rare entities. Bladder exstrophy has an incidence of 1 in 50,000 newborns, whereas urachal cancer accounts for less than 1% of all bladder tumours.
    • An unusual cause of methaemoglobinaemia.

      Conway, R; Browne, P; O'Connell, P; Department of Rheumatology, Beaumont Hospital, Beaumont, Dublin 9. richardconway@physicians.ie (2009-06)
      Methaemoglobinaemia is a rare condition characterised by increased quantities of haemoglobin in which the iron of haem is oxidised to the ferric (Fe3+) form. Clinically the condition presents with cyanosis and low oxygen saturations on pulse oximetry but normal oxygen saturation on arterial blood gas analysis. Most cases are acquired and are frequently drug related. We present a case of methaemoglobinaemia which presented to our hospital.
    • Update on vascular disrupting agents for cancer therapy

      Korpanty, Grzegorz; Brekken, Rolf A (2011-07)
    • The use and limitations of SMS reminders to improve outpatient attendance rates

      Sheil, F; Davis, S; Lowery, AJ; Hill, ADK (Irish Medical Journal, 2014-06)
      Missed appointments and non-attendance at outpatient clinics are a major cause of inefficiency in the health service. It is estimated that this problem currently costs the Health Service Executive (HSE) up to 33 million annually; each individual non-attendance costs 80 and adds a burden to lengthening waiting lists and a potential delay in assessment and treatment of the non-attending patient. Outpatient Breast Services are currently under particular pressure with a 60% increase in referrals to the Symptomatic Breast Units (SBU) since services were centralised under the auspices of the NCCP in 2007 1 .
    • The use of a camera-enabled mobile phone to triage patients with nasal bone injuries.

      Barghouthi, Taleb; Glynn, Fergal; Speaker, Richard-Benjamin; Walsh, Michael; Department of Otolaryngology and Head and Neck Surgery, Beaumont Hospital, Dublin, Ireland. talebbarghouthi@gmail.com (2012-03)
      To identify the accuracy of a camera-enabled mobile phone in assessing patients with nasal bone injuries and to determine if treatment in the form of manipulation of the nasal bones and therefore outpatient attendance was necessary.
    • Use of e-learning to enhance medical students' understanding and knowledge of healthcare-associated infection prevention and control.

      O'Neill, E; Stevens, N T; Clarke, E; Cox, P; O'Malley, B; Humphreys, H; Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland. eoneill@rcsi.ie (2011-12)
      An online infection prevention and control programme for medical students was developed and assessed. There was a statistically significant improvement (P<0.0001) in the knowledge base among 517 students after completing two modules. The majority of students who completed the evaluation were positive about the learning experience.
    • Use of movable high-field-strength intraoperative magnetic resonance imaging with awake craniotomies for resection of gliomas: preliminary experience.

      Leuthardt, Eric C; Lim, Chris C H; Shah, Manish N; Evans, John A; Rich, Keith M; Dacey, Ralph G; Tempelhoff, Rene; Chicoine, Michael R; Department of Neurological Surgery, Washington University, St. Louis, Missouri 63110, USA. (2011-07)
      Awake craniotomy with electrocortical mapping and intraoperative magnetic resonance imaging (iMRI) are established techniques for maximizing tumor resection and preserving function, but there has been little experience combining these methodologies.
    • Use of surveillance data for prevention of healthcare-associated infection: risk adjustment and reporting dilemmas.

      O'Neill, Eoghan; Humphreys, Hilary; Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland. (2009-08)
      Healthcare-associated or nosocomial infection (HCAI) is of increasing importance to healthcare providers and the public. Surveillance is crucial but must be adjusted for risk, especially when used for interhospital comparisons or for public reporting.
    • Using social media to increase accessibility to online teaching resources

      O’Kelly, B; McHugh, S; McHugh, T; Fady, N; Boyle, E; Hill, ADK (Irish Medical Journal, 2015-09)
      The key learning points of Surgical Grand Rounds (SGR) are often not accessible at times of exam revision for students. We sought to use Twitter as an online teaching repository. A SGR Twitter profile was created. 23 SGR presentations were made accessible on Twitter over a 3 month period. 93 students were invited to complete a questionnaire assessing usage of the repository. 84 (90%) in total responded, of these, 25 (80.6%) felt that the online provision of SGR through twitter was “useful”. The majority (71%) felt that the online content was easily accessible. The novel use of social media is a useful adjunctive educational tool in accessing an online repository of SGR presentations.
    • The utility of 99mTc-sestamibi scintigraphy in the localisation of parathyroid adenomas in primary hyperparathyroidism.

      Glynn, N; Lynn, N; Donagh, C; Crowley, R K; Smith, D; Thompson, C J; Hill, A D K; Keeling, F; Agha, A; Division of Endocrinology, Beaumont Hospital, RCSI Medical School, Dublin 9, Ireland. (2011-03)
      There are conflicting data in the literature about the sensitivity of sestamibi scintigraphy in parathyroid tumour localisation in primary hyperparathyroidism (PHPT).
    • The utility of 99mTc-sestamibi scintigraphy in the localisation of parathyroid adenomas in primary hyperparathyroidism.

      Glynn, N; Lynn, N; Donagh, C; Crowley, R K; Smith, D; Thompson, C J; Hill, A D K; Keeling, F; Agha, A; Division of Endocrinology, Beaumont Hospital, RCSI Medical School, Dublin 9,, Ireland. (2012-02-01)
      BACKGROUND: There are conflicting data in the literature about the sensitivity of sestamibi scintigraphy in parathyroid tumour localisation in primary hyperparathyroidism (PHPT). AIM: We aimed to evaluate the overall sensitivity of this modality in parathyroid tumour localisation and to determine clinical and biochemical factors which influence sensitivity of this method. METHODS: We performed a retrospective review of 57 patients with a biochemical diagnosis of PHPT who had sestamibi scintigraphy performed. RESULTS: The sensitivity of sestamibi scanning was 56% in whole group and 63% in those without nodular thyroid disease. Among the patients with confirmed single gland disease (biochemical cure after surgical removal of a single adenoma), sensitivity was 71%. A positive scan was associated with younger age, greater adenoma weight and higher pre-operative serum calcium. Concordance between the sestamibi and neck ultrasonography was 92% accurate in pre-operative tumour localisation. CONCLUSION: Sestamibi scintigraphy was more likely to be positive in younger patients without nodular thyroid disease who have larger parathyroid adenomas with more severe hyperparathyroidism.
    • Utilization of resource leveling to optimize ERCP efficiency.

      Hendrick, L M; Harewood, G C; Patchett, S E; Murray, F E; University College Dublin School of Medicine, Dublin, Ireland. (2011-03)
      Optimizing endoscopy efficiency is becoming increasingly important. This study profiled ERCP availability and assessed resource leveling as a strategy to enhance efficiency.