• A 76 year old female diagnosed with cystic fibrosis

      O’Brien, ME; Murphy, DM; Plant, BJ (Irish Medical Journal, 2014-09)
      The diagnosis of Cystic Fibrosis (CF) requires a high clinical suspicion in patients presenting at all ages. Early recognition permits referral to a specialist centre and may reduce the morbidity and mortality associated with CF. We report the case of the oldest patient in Ireland diagnosed with CF at 76 years of age and highlight the clinical features of her presentation.
    • Abnormalities of contrast sensitivity and electroretinogram following sevoflurane anaesthesia.

      Iohom, G; Gardiner, C; Whyte, A; O'Connor, G; Shorten, G; Cork University Hospital and University College Cork, Department of Anaesthesia, and Intensive Care Medicine, Cork, Ireland. (2012-02-03)
      BACKGROUND AND OBJECTIVE: We tested the hypothesis that disturbances of the visual pathway following sevoflurane general anaesthesia (a) exist and persist even after clinical discharge criteria have been met and (b) are associated with decreased contrast sensitivity. METHODS: We performed pattern and full-field flash electroretinograms (ERG) in 10 unpremedicated ASA I patients who underwent nitrous oxide/sevoflurane anaesthesia. ERG and contrast sensitivity were recorded preoperatively, immediately after discharge from the recovery room and 2 h after discontinuation of sevoflurane. The time at which the Post Anaesthesia Discharge Score first exceeded 9 was also noted. Data were analysed using paired, one-tailed t-tests and Pearson's correlation coefficient. RESULTS: On the full-field photopic ERG, b-wave latency was greater at each postoperative time point (31.6+/-1.1 and 30.8+/-1.1 ms) compared to preoperatively (30.1+/-1.1 ms, P < 0.001 and P = 0.03, respectively). Oscillatory potential latencies were greater on discharge from the recovery room compared with preanaesthetic values (23.1+/-3.1 vs. 22.4+/-3.3 ms, P = 0.01) and returned to baseline by 2 h after emergence from anaesthesia. Also at 2 h after emergence from anaesthesia: (a) P50 latency on the pattern ERG was greater than at baseline (81.5+/-17.9 vs. 51.15+/-22.6ms, P = 0.004); (b) N95 amplitude was less compared to preanaesthetic values (2.6+/-0.5 vs. 3.3+/-0.4 microV, P = 0.003) and (c) contrast sensitivity was less compared to baseline values (349+/-153 vs. 404+/-140, P = 0.048). A positive correlation was demonstrated between contrast sensitivity and both N95 amplitude and b-wave latency (r = 0.99 and r = -0.55 at significance levels of P < 0.005 and P < 0.05, respectively). CONCLUSIONS: Postoperative ERG abnormalities and associated decreases in contrast sensitivity are consistently present in patients who have undergone nitrous oxide/sevoflurane anaesthesia. These abnormalities persist beyond the time at which standard clinical discharge criteria have been met.
    • Accidental human poisoning with a veterinary tranquilliser.

      Cummins, F H; Cork University Hospital, Cork, Ireland. cumminsfergal@hotmail.com (2012-02-03)
    • Accidental shotgun injuries sustained in game-shooting.

      O'Sullivan, S T; O'Shaughnessy, M; O'Connor, T P; Department of Plastic & Reconstructive Surgery, Cork University Hospital,, Ireland. (2012-02-03)
    • ACE up the sleeve - are vascular patients medically optimized?

      Coveney, A P; O'Brien, G C; Fulton, G J; Department of Vascular Surgery, Cork University Hospital, National University of Ireland, Cork, Ireland. acoveney@gmail.com (2011-03)
      While almost all arteriopaths receive some form of antiplatelet and statin in line with clinical evidence, ACE inhibitors and beta-blockers appear to be under-prescribed in this arteriopathic population. We conclude that opportunity exists for vascular surgeons to embrace recent guidelines and lead the way in both surgical and medical optimization of arteriopathic patients through improving links with primary care physicians or taking greater responsibility themselves for the medical as well as the surgical care of their arteriopathic patients.
    • Acquired generalised neuromyotonia, cutaneous lupus erythematosus and alopecia areata in a patient with myasthenia gravis.

      O'Sullivan, S S; Mullins, Gerard M; Neligan, Aidan; McNamara, Brian; Galvin, Roderick J; Department of Neurology and Neurophysiology, Cork University Hospital, Wilton,, Cork, Ireland. sosulliv@ion.ucl.ac.uk (2012-02-03)
      We describe a patient with the diagnoses of acquired neuromyotonia, cutaneous lupus erythematosus and alopecia areata, occurring many years after a thymectomy for myasthenia gravis associated with a thymoma. We review the current literature on autoimmune conditions associated with myasthenia gravis and thymectomy. To our knowledge, this combination of multiple autoimmune conditions has not been reported previously.
    • Actinomyces pyogenes septic arthritis in a diabetic farmer.

      Lynch, M; O'Leary, J; Murnaghan, D; Cryan, B; Department of Medical Microbiology, Cork University Hospital, Wilton, Ireland. (2012-02-03)
      We report a case of septic arthritis and osteomyelitis of the left ankle due to Actinomyces pyogenes in a diabetic farmer. Few confirmed human cases of A. pyogenes infection have been reported, partly because of inadequate identification of this bacterium. Bacteriological characteristics of the organism, which resembles Arcanobacterium haemolyticum, are described with a review of previous case reports.
    • Activated endothelial interleukin-1beta, -6, and -8 concentrations and intercellular adhesion molecule-1 expression are attenuated by lidocaine.

      Lan, Wei; Harmon, Dominic C; Wang, Jiang H; Shorten, George D; Redmond, Paul H; Academic Department of Surgery, Cork University Hospital, University College,, Cork, Ireland. dweilan@hotmail.com (2012-02-03)
      Endothelial cells play a key role in ischemia reperfusion injury. We investigated the effects of lidocaine on activated human umbilical vein endothelial cell (HUVEC) interleukin (IL)-1beta, IL-6, and IL-8 concentrations and intercellular adhesion molecule-1 (ICAM-1) expression. HUVECs were pretreated with different concentrations of lidocaine (0 to 0.5 mg/mL) for 60 min, thereafter tumor necrosis factor-alpha was added at a concentration of 2.5 ng/mL and the cells incubated for 4 h. Supernatants were harvested, and cytokine concentrations were analyzed by enzyme-linked immunosorbent assay. Endothelial ICAM-1 expression was analyzed by using flow cytometry. Differences were assessed using analysis of variance and post hoc unpaired Student's t-test where appropriate. Lidocaine (0.5 mg/mL) decreased IL-1beta (1.89 +/- 0.11 versus 4.16 +/- 1.27 pg/mL; P = 0.009), IL-6 (65.5 +/- 5.14 versus 162 +/- 11.5 pg/mL; P < 0.001), and IL-8 (3869 +/- 785 versus 14,961 +/- 406 pg/mL; P < 0.001) concentrations compared with the control. IL-1beta, IL-6, and IL-8 concentrations in HUVECs treated with clinically relevant plasma concentrations of lidocaine (0.005 mg/mL) were similar to control. ICAM-1 expression on lidocaine-treated (0.05 mg/mL) HUVECs was less than on controls (198 +/- 52.7 versus 298 +/- 50.3; Mean Channel Fluorescence; P < 0.001). Activated endothelial IL-1beta, IL-6, and IL-8 concentrations and ICAM-1 expression are attenuated only by lidocaine at concentrations larger than clinically relevant concentrations.
    • Activated human neutrophils release hepatocyte growth factor/scatter factor.

      McCourt, M; Wang, J H; Sookhai, S; Redmond, H P; Department of Surgery, Professorial Unit, Cork University Hospital, Cork,, Ireland. (2012-02-03)
      BACKGROUND: Hepatocyte growth factor or scatter factor (HGF/SF) is a pleiotropic cytokine that has potent angiogenic properties. We have previously demonstrated that neutrophils (PMN) are directly angiogenic by releasing vascular endothelial growth factor (VEGF). We hypothesized that the acute inflammatory response can stimulate PMN to release HGF. AIMS: To examine the effects of inflammatory mediators on PMN HGF release and the effect of recombinant human HGF (rhHGF) on PMN adhesion receptor expression and PMN VEGF release. METHODS: In the first experiment, PMN were isolated from healthy volunteers and stimulated with tumour necrosis factor-alpha (TNF-alpha), lipopolysaccharide (LPS), interleukin-8 (IL-8), and formyl methionyl-leucyl-phenylalanine (fMLP). Culture supernatants were assayed for HGF using ELISA. In the second experiment, PMN were lysed to measure total HGF release and HGF expression in the PMN was detected by Western immunoblotting. Finally, PMN were stimulated with rhHGF. PMN CD 11a, CD 11b, and CD 18 receptor expression and VEGF release was measured using flow cytometry and ELISA respectively. RESULTS: TNF-alpha, LPS and fMLP stimulation resulted in significantly increased release of PMN HGF (755+/-216, 484+/-221 and 565+/-278 pg/ml, respectively) compared to controls (118+/-42 pg/ml). IL-8 had no effect. Total HGF release following cell lysis and Western blot suggests that HGF is released from intracellular stores. Recombinant human HGF did not alter PMN adhesion receptor expression and had no effect on PMN VEGF release. CONCLUSIONS: This study demonstrates that pro-inflammatory mediators can stimulate HGF release from a PMN intracellular store and that activated PMN in addition to secreting VEGF have further angiogenic potential by releasing HGF.
    • Activated protein C attenuates acute ischaemia reperfusion injury in skeletal muscle.

      Dillon, J P; Laing, A J; Cahill, R A; O'Brien, G C; Street, J T; Wang, J H; Mc Guinness, A; Redmond, H P; Department of Academic Surgery and Orthopaedics, Cork University Hospital and, National University of Ireland, Cork, Ireland. dillionjp@o2.ie (2012-02-03)
      Activated protein C (APC) is an endogenous anti-coagulant with anti-inflammatory properties. The purpose of the present study was to evaluate the effects of activated protein C in the setting of skeletal muscle ischaemia reperfusion injury (IRI). IRI was induced in rats by applying rubber bands above the levels of the greater trochanters bilaterally for a period of 2h followed by 12h reperfusion. Treatment groups received either equal volumes of normal saline or activated protein C prior to tourniquet release. Following 12h reperfusion, muscle function was assessed electrophysiologically by electrical field stimulation. The animals were then sacrificed and skeletal muscle harvested for evaluation. Activated protein C significantly attenuated skeletal muscle reperfusion injury as shown by reduced myeloperoxidase content, wet to dry ratio and electrical properties of skeletal muscle. Further in vitro work was carried out on neutrophils isolated from healthy volunteers to determine the direct effect of APC on neutrophil function. The effects of APC on TNF-alpha stimulated neutrophils were examined by measuring CD18 expression as well as reactive oxygen species generation. The in vitro work demonstrated a reduction in CD18 expression and reactive oxygen species generation. We conclude that activated protein C may have a protective role in the setting of skeletal muscle ischaemia reperfusion injury and that this is in part mediated by a direct inhibitory effect on neutrophil activation.
    • Activation of hemostasis and decline in cognitive function in older people.

      Stott, David J; Robertson, Michele; Rumley, Ann; Welsh, Paul; Sattar, Naveed; Packard, Christopher J; Shepherd, James; Trompet, Stella; Westendorp, Rudi G J; de Craen, Anton J M; et al. (2010-03)
      Older patients with increased markers of thrombin generation (d-dimer and prothrombin fragment 1+2) are at increased risk for cognitive decline and deterioration in ability to perform activities of daily living. This is likely attributable to increased risk of cerebral ischemic damage (including covert disease) associated with prothrombotic states.
    • Acute cardiac failure in neuroleptic malignant syndrome.

      Sparrow, Patrick; Murnaghan, Dermot; Kearney, Peter; Hogan, John; Sheppard, Mary N; Department of Cardiology, Cork University Hospital, Cork, Ireland., patsparrow@doctors.net.uk (2012-02-03)
      We present a case of rapid onset acute cardiac failure developing as part of neuroleptic malignant syndrome in a 35-year-old woman following treatment with thioridazine and lithium. Post mortem histology of cardiac and skeletal muscle showed similar changes of focal cellular necrosis and vacuolation suggesting a common disease process.
    • Acute exertional peroneal compartmental syndrome following prolonged horse riding.

      Nicholson, P; Devitt, A; Stevens, M; Mahalingum, K; Department of Orthopaedic Surgery, Cork University Hospital, Ireland. (2012-02-03)
    • Acute nursing care of the older adult with fragility hip fracture: An international perspective (Part 2)

      Maher, Ann Butler; Meehan, Anita J; Hertz, Karen; O'Sullivan, Mary P (Elsevier, 2012-10-23)
      The second part of this paper provides those who care for orthopaedic patients with evidence-supported international perspectives about acute nursing care of the older adult with fragility hip fracture. Developed by an international group of nurse experts and guided by a range of information from research and clinical practice, it focuses on nurse sensitive quality indicators during the acute hospitalisation for fragility hip fracture. Optimal care for the patient who has experienced such a fracture is the focus. This includes (in the first, earlier, part): Pain Delirium and in this part Pressure Ulcers Fluid Balance/Nutrition Constipation/Catheter Associated Urinary Tract Infection Vigilant nursing assessment and prompt intervention may prevent the development of the complications we discuss. If they do occur and are identified early on, they may resolve with appropriate and timely nursing management. This “tool kit” has been developed under the auspices of the International Collaboration of Orthopaedic Nursing (ICON) a coalition of national associations of orthopaedic nursing (www.orthopaedicnursing.org).
    • Acute stroke care: are we getting the basics right?

      Barry, P; O'Mahony, D; Liston, R; Cork University Hospital. (2012-02-03)
    • Acute superior vena caval syndrome with airway obstruction following elective mediastinoscopy.

      Power, C K; Buggy, D; Keogh, J; Department of Anaesthetics, Cork University Hospital, Wilton, Ireland. (2012-02-03)
      A 47-year-old female patient had a subclinical superior vena caval syndrome which developed into the 'full blown' acute condition when she was placed into the left lateral position after mediastinoscopy. She developed airway obstruction requiring urgent re-intubation and subsequent admission to the intensive care unit. This subclinical condition might have been suspected pre-operatively if closer attention had been paid to the history, physical examination and review of the computerised axial tomography scan: she had a history of intermittent dysponea, wheeze and cough which was worse on waking and improved as the day progressed, she had a positive Pemberton's sign and the computerised axial tomography scan showed that the lesion was encroaching on the superior vena cava.
    • Adalimumab therapy-a double-edged sword?

      O'Leary, Donal Peter; Myers, Eddie; Moran, Sarah; Browne, Tara-Jane; Harney, Sinead; Kirwan, William O; Department of Colo-rectal Surgery, Cork University Hospital, Wilton, Cork, Ireland, Olearypeter83@hotmail.com. (Springer, 2011-12)
    • Addison disease in patients treated with glucocorticoid therapy.

      Cronin, C C; Callaghan, N; Kearney, P J; Murnaghan, D J; Shanahan, F; Department of Medicine, Cork University Hospital, Ireland. (2012-02-03)
      Acute adrenal crisis in patients with unrecognized chronic adrenocortical failure is difficult to diagnose and potentially fatal. We describe 2 patients with acute adrenal crisis whose diagnoses were hindered because of concomitant glucocorticoid treatment. Acute adrenal insufficiency is primarily a state of mineralocorticoid deficiency. Prednisolone and prednisone, the most frequently prescribed anti-inflammatory corticosteroid agents, have minimal mineralocorticoid activity. Several conditions that may be treated with pharmacological glucocorticoids are associated with an increased risk of Addison disease. An acute adrenal crisis, against which concurrent glucocorticoid therapy does not confer adequate protection, may develop in such patients.
    • Addition of inhaled long-acting beta2-agonists to inhaled steroids as first line therapy for persistent asthma in steroid-naive adults and children.

      Ni Chroinin, Muireann; Greenstone, Ilana; Lasserson, Toby J; Ducharme, Francine M; Division of Children's Services, Cork University Hospital, Cork, Ireland. (2009)
      In steroid-naive patients with mild to moderate airway obstruction, the combination of ICS and LABA does not significantly reduce the risk of patients with exacerbations requiring rescue oral corticosteroids over that achieved with a similar dose of ICS alone. However, it significantly improves lung function, reduces symptoms and marginally decreases rescue ss2-agonist use. Initiation of a higher dose of ICS is more effective at reducing the risk of exacerbations requiring rescue systemic corticosteroids, and of withdrawals, than combination therapy. Although children appeared to respond similarly to adults, no firm conclusions can be drawn regarding combination therapy in steroid-naive children, given the small number of children contributing data.