• ACP Journal Club. An intensive lifestyle intervention increased remission from type 2 diabetes in overweight adults.

      Kyithar, Ma P; Dinneen, Sean F; Galway Roscommon University Hospitals Group, Galway, Ireland. (2013-05-21)
    • Acute calcific tendinitis of the finger--a case report.

      Ali, S N; Kelly, J L; The Department of Plastic Surgery, Stoke Mandeville Hospital Aylesbury, Buckinghamshire HP21 8AL, England. (2004-07)
      Acute calcific tendinitis of the hand is rare and often misdiagnosed as infection, fracture or periarthritis. It frequently occurs in peri-menopausal women and is caused by deposits of hydroxyapatite crystals. We describe acute calcific tendinitis of the flexor digitorum superficialis insertion in an elderly man taking oral anticoagulants. The differential diagnoses and recommended treatment are discussed.
    • The Airtraq as a rescue airway device following failed direct laryngoscopy: a case series.

      Maharaj, C H; Costello, J F; McDonnell, J G; Harte, B H; Laffey, J G; Department of Anaesthesia, Clinical Sciences Institute, National Centre for Biomedical Engineering Sciences, National University of Ireland, Galway, Ireland. (2007-06)
      We report the successful use of the Airtraq as a rescue device following failed direct laryngoscopy, in patients deemed at increased risk for difficult tracheal intubation. In a series of seven patients, repeated attempts at direct laryngoscopy with the Macintosh blade, and the use of manoeuvres to aid intubation, such as the gum elastic bougie placement, were unsuccessful. In contrast, with the Airtraq device, each patient's trachea was successfully intubated on the first attempt. This report underlines the utility of the Airtraq device in these patients.
    • Alcohol-attributable mortality in Ireland.

      Martin, Jennifer; Barry, Joe; Goggin, Deirdre; Morgan, Karen; Ward, Mark; O'Suilleabhain, Tadhg; Department of Public Health, Merlin Park, Galway, Ireland. Jennifer.martin@hse.ie (2010)
      The study aim was to calculate Irish alcohol-attributable fractions (AAFs) and to apply these measurements to existing data in order to quantify the impact of alcohol on mortality.
    • The analgesic efficacy of transversus abdominis plane block after abdominal surgery: a prospective randomized controlled trial.

      McDonnell, John G; O'Donnell, Brian; Curley, Gerard; Heffernan, Anne; Power, Camillus; Laffey, John G; Department of Anaesthesia and Intensive Care Medicine, University College Hospital, Galway, Ireland. (2007-01)
      The transversus abdominis plane (TAP) block is a novel approach for blocking the abdominal wall neural afferents via the bilateral lumbar triangles of Petit. We evaluated its analgesic efficacy in patients during the first 24 postoperative hours after abdominal surgery, in a randomized, controlled, double-blind clinical trial.
    • Anterior thigh pain - A case report.

      De Burca, Neasa; Physiotherapy Department, University Hospital Galway, Ireland. neasa.deburca1@hse.ie (2011-06)
    • Association between anxiety and depression symptoms with resistant hypertension and central hemodynamics: A pilot study.

      Mermerelis, A; Kyvelou, S-M; Vellinga, A; Papageorgiou, C; Stefanadis, C; Douzenis, A (Elsevier, 2016)
      The hypothesis that symptoms of anxiety and depression contribute to the development of hypertension has been controversial. Rutledge and Hogan found that the risk of developing hypertension is approximately 8% higher among people with psychological distress compared to those with minimal distress. People suffering from either severe depression or anxiety were two to three times more likely to develop hypertension. The aim of the present pilot study was to compare the prevalence of anxiety and depression in patients with resistant HTN (rHTN) who underwent renal denervation (RDN) versus medical management alone. An additional aim was to assess possible associations with central hemodynamics using the cardio-ankle vascular index (CAVI). The study included 34 patients who lacked a comorbid mental health disorder, had rHTN and were a mean age of 58.3 ± 11.2 years. Twenty-four hour ambulatory blood pressure monitoring (24 hABPM) was conducted in all patients, and they were divided into the following groups: group I (n = 20) underwent RDN and group II (n = 14) was treated with medical management alone. The mean office SBP and DBP measurements for group I were 163 mmHg and 92 mmHg, respectively; for group II, they were 159 mmHg and 91 mmHg, respectively. There was no significant difference in the duration of hypertension (10.1 vs 9.4 years, p = NS) or in the familial burden. Finally, there was no difference in the number of antihypertensive medications in the two groups (5.1 vs 5.5, p = NS). The evaluation of anxiety disorder was performed with the Hospital Anxiety Depression Scale (HADS)3,4. The Beck Depression Inventory (BDΙ) was used to evaluate depression5. Both scales consist of a simple, yet reliable, self-assessment screening questionnaire. For the HADS scale, a score of ≥11 is thought to indicate a significant case of psychological morbidity. The BDI is a 21-item self-report depression inventory that measures depressive symptoms. For each item, the score ranges from 1 to 4. The total score is obtained by summing the scores on each of the 21 questions. CAVI was measured with a Vasera VS-1500 (Fukuda Denshi, Tokyo, Japan) vascular screening device. Descriptive and univariate comparisons were made using SPSS (version 20.0). Due to the low number of subjects in each group, only non-parametric tests were used (Spearman for correlations, Mann-Whitney U-test for comparison of groups and Chi square for categorized comparisons). A p-value of 0.05 was set as the cut-off for significance. The HADS and BDI scores were highly correlated in the entire group [correlation coefficient (CC) = 0.787, p = 0.0001] as well as separately in each of the two groups [group I (CC) = 0.825, p = 0.0001 and group II (CC) = 0.779, p = 0.0001, respectively]. When comparing HADS and BDI scores between the two groups, no significant difference was identified. Comparing CAVI results, CAVIR, but not CAVIL, was significantly higher in group I (p = 0.02). In group II, there seems to be a negative correlation between the CAVIR, CAVIL and HADS scores [CAVIR-HADS CC = -0.597, p = 0.024; CAVIL-HADS CC = -0.668, p = 0.009] This small pilot study showed that there is a significant correlation between the two scores in the total population; however, patients treated with RDN are not different from those with medical management alone. A negative association was also noted between the anxiety scoring scale and CAVIR and CAVIL in patients treated with medical management alone. A previous study documented a lack of difference in the prevalence of panic, anxiety and depression between patients with rHTN and non-resistant controls. In agreement with our study, the prevalence of anxiety and depression was high in the two groups of patients with rHTN; however, the RDN made no difference in the total impact of the two modalities, which is in contrast with previous results. To the best of our knowledge, this report describes the first attempt to associate the arterial stiffness using the CAVI with anxiety and depression in this population. In a previous study, there was an association between an increased arterial stiffness, autonomic disbalance and depression in a young hypertensive population. The present study is a small pilot study that highlights the higher prevalence of depression and anxiety in patients with resistant hypertension, as well as a negative association with central hemodynamics. However, because the sample is small, acquisition of a larger sample size with the continuation of this study might reveal stronger correlations in the future.
    • Clinical efficacy and cost per quality-adjusted life years of pararenal endovascular aortic aneurysm repair compared with open surgical repair.

      Sultan, Sherif; Hynes, Niamh; Western Vascular Institute, Department of Vascular and Endovascular Surgery, University College Hospital Galway, Newcastle Road, Galway, Ireland. sherif.sultan@hse.ie (Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists, 2011-04)
      To gauge the efficacy of applying commercially-available endografts to pararenal endovascular abdominal aortic aneurysm (AAA) repair compared with open surgical repair (OSR).
    • Clofarabine in the treatment of poor risk acute myeloid leukaemia.

      Krawczyk, Janusz; Ansar, Naeem; Swords, Ronan; Murphy, Tracy; MacDonagh, Barry; Meenaghan, Teresa; Hayden, Patrick; Hayad, Amjad; Murray, Margaret; O'Dwyer, Michael; et al. (2010-09)
      Clofarabine is a second generation nucleoside analogue. It inhibits DNA repair and activates the mitochondrial apoptotic pathway leading to cell death. In vitro clofarabine has demonstrated synergy with daunorubicin and Ara-C and in phase II clinical trials has shown promising activity in poor risk Acute myeloid leukaemia (AML) patients. In our institution over a 24 month period 22 AML patients (11 M, 11 F) with poor risk features, deemed unsuitable for standard therapy, were treated with clofarabine, alone (eight patients) or in combination (14 patients) for up to three cycles of treatment. The median age was 67.5 years (24-76) with 16 patients > 60 years. At the time of treatment 18 patients had active AML. Four patients intolerant of standard induction received clofarabine as consolidation. The overall response rate (ORR) for the 18 patients with active AML was 61%, nine patients (50%) achieving a complete response (CR). Induction and consolidation were well tolerated with no unexpected toxicities. Predictably, all patients developed grade 4 neutropenia but the median duration was only 20 days (17-120). Induction mortality was acceptable at 17%. In conclusion, clofarabine (alone or in combination) is active in poor risk AML with an acceptable safety profile and should be considered a potential option in poor risk AML patients.
    • Comparison of Macintosh, Truview EVO2, Glidescope, and Airwayscope laryngoscope use in patients with cervical spine immobilization.

      Malik, M A; Maharaj, C H; Harte, B H; Laffey, J G; Department of Anaesthesia, Clinical Sciences Institute, Galway University Hospitals, Galway, Ireland. (2008-11)
      The purpose of this study was to evaluate the effectiveness of the Pentax AWS, Glidescope, and the Truview EVO2, in comparison with the Macintosh laryngoscope, when performing tracheal intubation in patients with neck immobilization using manual in-line axial cervical spine stabilization.
    • A comparison of tracheal intubation using the Airtraq or the Macintosh laryngoscope in routine airway management: A randomised, controlled clinical trial.

      Maharaj, C H; O'Croinin, D; Curley, G; Harte, B H; Laffey, J G; Department of Anaesthesia, University College Hospital, Galway, Ireland. (2006-11)
      The Airtraq laryngoscope is a novel single use tracheal intubation device. We compared the Airtraq with the Macintosh laryngoscope in patients deemed at low risk for difficult intubation in a randomised, controlled clinical trial. Sixty consenting patients presenting for surgery requiring tracheal intubation were randomly allocated to undergo intubation using a Macintosh (n = 30) or Airtraq (n = 30) laryngoscope. All patients were intubated by one of four anaesthetists experienced in the use of both laryngoscopes. No significant differences in demographic or airway variables were observed between the groups. All but one patient, in the Macintosh group, was successfully intubated on the first attempt. There was no difference between groups in the duration of intubation attempts. In comparison to the Macintosh laryngoscope, the Airtraq resulted in modest improvements in the intubation difficulty score, and in ease of use. Tracheal intubation with the Airtraq resulted in less alterations in heart rate. These findings demonstrate the utility of the Airtraq laryngoscope for tracheal intubation in low risk patients.
    • Demographics, nature and treatment of orthopaedic trauma injuries occurring in an agricultural context in the West of Ireland.

      Byrne, F J; Waters, P S; Waters, S M; Hynes, S; Ní Thuairisg, C P; O'Sullivan, M; Department of Orthopaedics and Trauma Surgery, Merlin Park Hospital, Galway, Ireland. fergbyrne@gmail.com (2011-03)
      Farming is a major industry in the West of Ireland. This prospective study examined the age profile, nature and treatment of orthopaedic injuries occurring in agricultural surroundings presenting at the Orthopaedic Unit of Merlin Park Hospital, Galway.
    • Does topical wound oxygen (TWO2) offer an improved outcome over conventional compression dressings (CCD) in the management of refractory venous ulcers (RVU)? A parallel observational comparative study.

      Tawfick, W; Sultan, S; Western Vascular Institute (WVI), Department of Vascular and Endovascular Surgery, University College Hospital Galway (UCHG), Galway, Ireland. wael.tawfick@hse.ie (European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery, 2009-07)
      Topical wound oxygen (TWO(2)) may help wound healing in the management of refractory venous ulcers (RVU). The aim of this study was to measure the effect of TWO(2) on wound healing using the primary end-point of the proportion of ulcers healed at 12 weeks. Secondary end-points were time to full healing, percentage of reduction in ulcer size, pain reduction, recurrence rates and Quality-Adjusted Time Spent Without Symptoms of disease and Toxicity of Treatment (Q-TWiST).
    • Double paddle free fibular flap for reconstruction of the composite facial tumour in patient with Fanconi's anaemia.

      Alkaabi, Malaka; Regan, Padraic J; Kelly, Jack; Mc Cann, Patrick J; Ismael, Thamir S (2009-11)
    • Drop weld thermal injuries to the middle ear.

      Keogh, I J; Portmann, D; Academic Department of Oto-Rhino-Laryngology, National University of Ireland Galway, Newcastle Road, Galway, Ireland. ivanj.keogh@hse.ie (Revue de laryngologie - otologie - rhinologie, 2009)
      Drop weld injuries to the tympanic membrane and middle ear caused by hot sparks or molten slag are a rare but significant injury. Steel workers and welders who are regularly exposed to flying sparks and molten metal slag are predisposed. This type of transtympanic thermal injury occurs when the slag literally drops into the external auditory canal and burns through the tympanic membrane. A spectrum of severity of injury occurs which includes chronic tympanic membrane perforation, chronic otorrhoea, facial nerve injury and deafness. Chronic tympanic membrane perforation is the most common sequelae and is perhaps one of the most challenging of all perforations to repair The combination of direct thermal injury and foreign body reaction results in continuing or recurrent suppuration. The foreign body reaction is due to the embedding of metal slag in the promontorial mucosa. We present a case of drop weld injury to the left tympanic membrane, resulting in chronic middle ear inflammation, otorrhoea and tympanic perforation. CAT scan clearly demonstrated a metallic promontorial foreign body with localised bone erosion. We emphasise the importance of removing these foreign bodies and recommend a cartilage reinforced underlay tympanoplasty technique to repair these perforations. Transtympanic thermal trauma is a preventable occupational injury, which is best, avoided by earplugs and increased awareness.
    • Dual-energy X-ray absorptiometry diagnostic discordance between Z-scores and T-scores in young adults.

      Carey, John J; Delaney, Miriam F; Love, Thomas E; Cromer, Barbara A; Miller, Paul D; Richmond, Bradford J; Manilla-McIntosh, Martha; Lewis, Steven A; Thomas, Charles L; Licata, Angelo A; et al. (Journal of clinical densitometry : the official journal of the International Society for Clinical Densitometry, 2009)
      Diagnostic criteria for postmenopausal osteoporosis using central dual-energy X-ray absorptiometry (DXA) T-scores have been widely accepted. The validity of these criteria for other populations, including premenopausal women and young men, has not been established. The International Society for Clinical Densitometry (ISCD) recommends using DXA Z-scores, not T-scores, for diagnosis in premenopausal women and men aged 20-49 yr, though studies supporting this position have not been published. We examined diagnostic agreement between DXA-generated T-scores and Z-scores in a cohort of men and women aged 20-49 yr, using 1994 World Health Organization and 2005 ISCD DXA criteria. Four thousand two hundred and seventy-five unique subjects were available for analysis. The agreement between DXA T-scores and Z-scores was moderate (Cohen's kappa: 0.53-0.75). The use of Z-scores resulted in significantly fewer (McNemar's p<0.001) subjects diagnosed with "osteopenia," "low bone mass for age," or "osteoporosis." Thirty-nine percent of Hologic (Hologic, Inc., Bedford, MA) subjects and 30% of Lunar (GE Lunar, GE Madison, WI) subjects diagnosed with "osteoporosis" by T-score were reclassified as either "normal" or "osteopenia" when their Z-score was used. Substitution of DXA Z-scores for T-scores results in significant diagnostic disagreement and significantly fewer persons being diagnosed with low bone mineral density.
    • The effects of normalizing hyperhomocysteinemia on clinical and operative outcomes in patients with critical limb ischemia.

      Waters, Peadar S; Fennessey, Paul J; Hynes, Niamh; Heneghan, Helen M; Tawfick, Wael; Sultan, Sherif; Western Vascular Institute, University College Hospital Galway, Ireland. (Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists, 2012-12)
      To assess the outcome of patients with medically treated hyperhomocysteinemia (HHC) requiring intervention for critical limb ischemia (CLI).
    • The effects of the European Working Time Directive on surgical training: the basic surgical trainee's perspective.

      Kelly, B D; Curtin, P D; Corcoran, M; Department of Urology, Galway University Hospital, Galway, Republic of Ireland., Drbriankelly@hotmail.com (2012-01-31)
      BACKGROUND: On the 1 August 2009, the implementation of European Working Time Directive became European law and was implemented in Galway University Hospital (GUH). AIMS: The aim of the study is to ascertain the opinion of the 25 surgical SHOs in GUH on the effect of the implementation of an EWTD compliant roster had on the quality of their training. METHODS: A questionnaire was circulated to all 25 surgical SHOs. RESULTS: Twenty-two (88%) SHOs report a reduction in the quality of their training. 18 (72%) report a reduction in the development of their operative skills. The SHOs believed the EWTD Rotas would encourage Irish graduates to train abroad. CONCLUSIONS: Surgical training faces a challenge with the implementation of EWTD Rotas. Major changes need to be made to the surgical training structure to train surgeons to the highest standard and to retain Irish-trained surgeons in the Irish healthcare system.
    • Endotracheal intubation in patients with cervical spine immobilization: a comparison of macintosh and airtraq laryngoscopes.

      Maharaj, Chrisen H; Buckley, Elma; Harte, Brian H; Laffey, John G; Department of Anaesthesia, University College Hospital, Galway, Ireland. (2007-07)
      The Airtraq laryngoscope (Prodol Ltd., Vizcaya, Spain) is a novel single-use tracheal intubation device. The authors compared ease of intubation with the Airtraq and Macintosh laryngoscopes in patients with cervical spine immobilization in a randomized, controlled clinical trial.
    • Endovascular repair of early rupture of Dacron aortic graft--two case reports.

      Sultan, Sherif; Heskin, Leonie; Oaikhinan, Kenneth; Hynes, Naimh; Akhter, Yousaf; Courtney, Donald; Western Vascular Institute, Department of Vascular and Endovascular Surgery, University College Hospital, Galway, Ireland. sherifsultan@esatclear.ie (Vascular and endovascular surgery, 2005)
      Complications after open aortic surgery pose a challenge both to the vascular surgeon and the patient because of aging population, widespread use of cardiac revascularization, and improved survival after aortic surgery. The perioperative mortality rate for redo elective aortic surgery ranges from 5% to 29% and increases to 70-100% in emergency situation. Endovascular treatment of the postaortic open surgery (PAOS) patient has fewer complications and a lower mortality rate in comparison with redo open surgical repair. Two cases of ruptured abdominal aortic aneurysm (AAA) were managed with the conventional open surgical repair. Subsequently, spiral contrast computer tomography scans showed reperfusion of the AAA sac remnant mimicking a type III endoleak. These graft-related complications presented as vascular emergencies, and in both cases endovascular aneurysm repair (EVAR) procedure was performed successfully by aortouniiliac (AUI) stent graft and femorofemoral crossover bypass. These 2 patients add further merit to the cases reported in the English literature. This highlights the crucial importance of endovascular grafts in the management of such complex vascular problems.