• Facial diplegia and deafness following a fall.

      Saidha, Shiv; Fanning, Noel; Counihan, Timothy J (2010)
    • Factors influencing surgical career choices and advancement in Ireland and Britain.

      Corrigan, Mark A; Shields, Conor J; Redmond, Henry P; Department of Academic Surgery, Cork University Hospital, Cork, Ireland., macorrigan@iformix.com (2012-02-03)
      BACKGROUND: The aim of this study was to analyze the factors that influence the advancement and the career choices of doctors and medical students. METHODS: Using the combined databases of the iformix and surgent websites, 450 doctors and medical students were invited to complete an internet-based survey. Surgent (http://www.surgent.ie) and iformix (http://www.iformix.com) are two free internet services administered by the authors. Surgent is a medical educational website, while iformix facilitates the online submission of abstracts to surgical and medical conferences across Britain and Ireland. The combined database of these two websites is approximately 4500 entries. Four hundred and fifty users represented a 10% sample based on an expected 40%-45% response rate. This was anticipated to yield between 180 and 202 respondents, statistically sufficient to analyze the data. A detailed Likert scale assessed the importance of "academic," "clinical," and "lifestyle" factors in determining career choice and progression. Analysis included descriptive statistics and inferential testing. RESULTS: Fifty percent (N = 222) of surveys were returned; 142 men and 78 women. Thirty-seven percent of respondents were Irish, 28% British, and 35% non-European. Fifteen percent were undergraduates, 4% interns, 12% had 2-4 years of clinical experience, while 69% had completed more than 4 years. Fifty-six percent had decided upon a career in general surgery. Overall, the most important factors for career choice were intellectual challenge (95%), academic opportunities (61%), and research opportunities(54%). Doctors with more than 4 years of experience deemed duration of training (p = 0.002), lifestyle during training (p = 0.02), and stress (0.005) as less important factors when considering career choice. Correlation analyses demonstrated that prestige (p = 0.002), patient relationships (p = 0.006), and advice from friends or family (p = 0.01) were more important influencing factors for interns. In terms of career advancement, 66% of non-Europeans considered family contacts important as opposed to 20% of British and 45% of Irish doctors (p < 0.001). In addition, 47% of females felt gender was important for career advancement as opposed to 31% of males (p = 0.01). CONCLUSIONS: Academic and clinical factors play an important role in career choice. However, it is clear that lifestyle factors predominate in determining an individual's career decisions in surgery.
    • Factors that influence therapeutic outcomes in symptomatic gastroesophageal reflux disease.

      Quigley, Eamonn M M; Department of Medicine, Clinical Sciences Building, Cork University Hospital,, National University of Ireland, Wilton Road, Cork, Ireland. (2012-02-03)
      The term "symptomatic gastroesophageal reflux disease" (GERD) refers to those patients who present with the typical GERD symptoms of heartburn and regurgitation, yet do not have endoscopic evidence of esophagitis. The primary goals of managing symptomatic GERD are to control symptoms and improve quality of life. A clinical assessment of the GERD patient can identify important clinical features, such as atypical and extraesophageal symptoms for which acid-suppressive agents tend to be less effective. Performing an endoscopy can further identify the patient as having nonerosive reflux disease, erosive esophagitis, or Barrett's esophagus-diagnoses which can help determine treatment but may not prove predictive of therapeutic response. Determining acid exposure through pH testing can predict therapeutic response, with those revealing an abnormal acid exposure time being more responsive to acid-suppressive therapy. However, the performance of an endoscopy and pH testing on each patient is clearly not practical. Whereas the natural history of symptomatic GERD is still largely undefined, acid-suppressive therapy appears to be the best approach available for both the short-term and long-term management of this disease.
    • Familial adenomatous polyposis: from bedside to benchside.

      O'Sullivan, M J; McCarthy, T V; Doyle, C T; Department of Pathology, Cork University Hospital, Ireland. (2012-02-03)
      Familial adenomatous polyposis (FAP) is a dominantly inherited cancer-predisposition syndrome with an incidence of between 1:17,000 and 1:5,000. The condition has been causally linked to mutation of the adenomatous polyposis coli (APC) gene located at 5q21. Virtually all mutations in the APC gene are truncating mutations, resulting in loss of function of the APC protein. Spontaneous germline mutation of this gene occurs frequently and accounts for the high incidence of FAP. The gene is somatically mutated at an early point in the colorectal adenoma-carcinoma progression. Somatic mutations of the APC gene are also frequently observed in a variety of other human carcinomas. Isolation of the APC gene has led to the recognition of genotype-phenotype correlations and, together with protein studies, has helped to elucidate the structure and function of the APC protein. This report aims to take the reader from a clinical appreciation to a molecular understanding of FAP.
    • Farmer's lung in Ireland (1983-1996) remains at a constant level.

      McGrath, D S; Kiely, J; Cryan, B; Bredin, C P; Department of Respiratory Medicine, Cork University Hospital, Ireland. (2012-02-03)
      A prospective study was undertaken by the Departments of Respiratory Medicine and Medical Microbiology at the Cork University Hospital, a. to investigate the epidemiology of Farmer's Lung (F.L.) in the Republic of Ireland (pop. 3.5 million), with special reference to the South Western Region of this country (pop. 536,000) and b. to assess any relationship between the prevalence/incidence of F.L. with climatic factors in South West Ireland, between 1983 and 1996. F.L. incidence remained constant throughout the 13 yrs studied both on a national and a regional basis. A significant relationship was also found between total rainfall each summer and F.L. incidence and prevalence over the following yr (p < 0.005) in South-West Ireland. The persistence of F.L. in Ireland at a constant level suggests that farmers' working environment and farm practices need to be improved.
    • Farmer's lung is now in decline.

      Arya, A; Roychoudhury, K; Bredin, C P; Department of Respiratory Medicine, Cork University Hospital, Wilton, Cork. (2012-02-03)
      Farmer's lung incidence in Ireland was constant until 1996, even though hay making methods were revolutionised in late 1980's. We undertook this study to find out the incidence of farmer's lung in Ireland from 1982-2002 and its correlation with rainfall and the effect of changing farm practices. The primary cases of farmer's lung were identified from Hospital in Patients Enquiry (HIPE) unit of the national Economic & Social Research Institute (ESRI) Dublin. Rainfall data were obtained from Met Eireann whereas population, hay production and silage production were obtained from the Central Statistics Office, Dublin. As the farming population is in decline, we used the annual working unit (AWU), which reflects the true population at risk. An AWU is the equivalent of 1800 hours per farm worker per year. The incidence rates were constant from 1982-1996, but from 1997-2002 a marked decline was observed. There was strong positive correlation with hay production (r = 0.81) and strong negative correlation with silage production (r = -0.82). This study indicates that the incidence of farmer's lung is now in decline.
    • The Fas counterattack in vivo: apoptotic depletion of tumor-infiltrating lymphocytes associated with Fas ligand expression by human esophageal carcinoma.

      Bennett, M W; O'Connell, J; O'Sullivan, G C; Brady, C; Roche, D; Collins, J K; Shanahan, F; Department of Medicine, Cork University Hospital, Ireland. (2012-02-03)
      Various cancer cell lines express Fas ligand (FasL) and can kill lymphoid cells by Fas-mediated apoptosis in vitro. FasL expression has been demonstrated in several human malignancies in vivo. We sought to determine whether human esophageal carcinomas express FasL, and whether FasL expression is associated with increased apoptosis of tumor-infiltrating lymphocytes (TIL) in vivo, thereby contributing to the immune privilege of the tumor. Using in situ hybridization and immunohistochemistry, respectively, FasL mRNA and protein were colocalized to neoplastic esophageal epithelial cells in all esophageal carcinomas (squamous, n = 6; adenocarcinoma, n = 2). The Extent of FasL expression was variable, with both FasL-positive and FasL-negative neoplastic regions occurring within tumors. TIL were detected by immunohistochemical staining for the leukocyte common Ag, CD45. FasL expression was associated with a mean fourfold depletion of TIL when compared with FasL-negative areas within the same tumors (range 1.6- to 12-fold, n = 6,p < 0.05). Cell death of TIL was detected by dual staining of CD45 (immunohistochemistry) and DNA strand breaks (TUNEL, terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling). There was a mean twofold increase in detectable cell death among TIL in FasL-positive areas compared with FasL-negative areas (range 1.6- to 2.4-fold, n = 6, p < 0.05). In conclusion, we demonstrate a statistically significant, quantitative reduction of TIL concomitant with significantly increased TIL apoptosis within FasL-expressing areas of esophageal tumors. Our findings suggest Fas-mediated apoptotic depletion of TIL in response to FasL expression by esophageal cancers, and provide the first direct, quantitative evidence to support the Fas counterattack as a mechanism of immune privilege in vivo in human cancer.
    • The "Fas counterattack" is not an active mode of tumor immune evasion in colorectal cancer with high-level microsatellite instability.

      Houston, Aileen M; Michael-Robinson, Julie M; Walsh, Michael D; Cummings, Margaret C; Ryan, Aideen E; Lincoln, Douglas; Pandeya, Nirmala; Jass, Jeremy R; Radford-Smith, Graham L; O'Connell, Joe; et al. (2012-02-03)
      Microsatellite instability (MSI) is an alternative pathway of colorectal carcinogenesis. It is found in 10% to 15% of sporadic colorectal neoplasms and is characterized by failure of the DNA mismatch-repair system. High-level MSI (MSI-H) is associated with tumor-infiltrating lymphocytes (TILs) and a favorable prognosis. Expression of Fas ligand (FasL/CD95L) by cancer cells may mediate tumor immune privilege by inducing apoptosis of antitumor immune cells. The aim of this study was to investigate the relationship between FasL expression and MSI status in primary colon tumors. Using immunohistochemistry, we detected FasL expression in 91 colorectal carcinoma specimens, previously classified according to the level of MSI as MSI-H (n = 26), MSI-low (MSI-L) (n = 29), and microsatellite stable (n = 36). Tumor-infiltrating lymphocyte density was quantified by immunohistochemical staining for CD3. MSI-H tumors were significantly associated with reduced frequency (P = .04) and intensity (P = .066) of FasL expression relative to non-MSI-H (ie, microsatellite stable and MSI-L) tumors. Higher FasL staining intensity correlated with reduced TIL density (P = .059). Together, these findings suggest that the abundance of TILs found in MSI-H tumors may be due to the failure of these tumor cells to up-regulate FasL and may explain, in part, the improved prognosis associated with these tumors.
    • Fatal babesiosis in an asplenic patient.

      Browne, Sarah; Ryan, Yvonne; Goodyer, Matthew; Gilligan, Oonagh; Department of Nephrology, Cork University Hospital, Cork, Ireland. salbrowne@gmail.com (2010-02)
    • Femoral nerve blockade.

      Szucs, Szilard; Morau, Didier; Iohom, Gabriella; Department of Anaesthesia and Intensive Care Medicine, Cork University Hospital, Cork, Ireland. szilard.szucs@yahoo.ie (2010-06)
      Femoral nerve blockade is the most widely performed lower limb block. Methods of femoral nerve blockade are briefly reviewed with particular reference to ultrasound guidance.
    • Fetal heart rate patterns in neonatal hypoxic-ischemic encephalopathy: relationship with early cerebral activity and neurodevelopmental outcome.

      Murray, Deirdre M; O'Riordan, Mairead N; Horgan, Richard; Boylan, Geraldine; Higgins, John R; Ryan, Cornelius A; Department of Paediatrics and Child Health, University College Cork, Cork University Maternity Hospital, Cork, Wilton, Cork, Ireland. d.murray@ucc.ie (Thieme Publications, 2009-09)
      Despite widespread use of fetal heart rate monitoring, the timing of injury in hypoxic-ischemic encephalopathy (HIE) remains unclear. Our aim was to examine fetal heart rate patterns during labor in infants with clinical and electroencephalographic (EEG) evidence of HIE and to relate these findings to neurodevelopmental outcome. Timing of onset of pathological cardiotocographs (CTGs) was determined in each case by two blinded reviewers and related to EEG grade at birth and neurological outcome at 24 months. CTGs were available in 35 infants with HIE (17 mild, 12 moderate, 6 severe on EEG). Admission CTGs were normal in 24/35 (69%), suspicious in 8/35 (23%), and pathological in 3/35 (8%). All CTGs developed nonreassuring features prior to delivery. Three patterns of fetal heart rate abnormalities were seen: group 1, abnormal CTGs on admission in 11/35 (31%); group 2, normal CTGs on admission with gradual deterioration to pathological in 20/35 cases (57%); and group 3, normal CTGs on admission with acute sentinel events in 4/35 (11.5%). The median (interquartile range) duration between the development of pathological CTGs and delivery was 145 (81, 221) minutes in group 2 and 22 (12, 28) minutes in group 3. There was no correlation between duration of pathological CTG trace and grade of encephalopathy (R = 0.09, P = 0.63) or neurological outcome (P = 0.75). However, the grade of encephalopathy was significantly worse in group 3 (P = 0.001), with a trend to worse outcomes. The majority of infants with HIE have normal CTG traces on admission but develop pathological CTG patterns within hours of delivery. More severe encephalopathy was associated with normal admission CTG and acute sentinel events shortly before delivery.
    • Field visit placements: An integrated and community approach to learning in children's nursing.

      Cummins, Ann; McCloskey, Sean; O'Shea, Maria; O'Sullivan, Bebhinn; Whooley, Kay; Savage, Eileen; Catherine McAuley School of Nursing and Midwifery, University College Cork, Ireland. a.cummins@ucc.ie (Elsevier, 2010-03)
      This paper reports on the development of a new initiative, field visit placements towards and integrated and community approach to learning for nursing students. To date, limited literature exists on the potential of community field visits as meaningful learning opportunities for nursing students. Drawing on our experiences, the structure and processes involved in implementing field visits are described in this paper. Students evaluated the field visits positively indicating that they provided a wealth of learning opportunities that enhanced their knowledge and awareness of services available to children and their families in the community. The potential of field visits to promote an integrated and community approach to placements in children's nursing is discussed.
    • The financial implications of falls in older people for an acute hospital.

      Cotter, P E; Timmons, S; O'Connor, M; Twomey, C; O'Mahony, D; Cork University Hospital. pecotter@eircom.net (2012-02-03)
      BACKGROUND: Falls are a common occurrence in older people and frequently lead to hospital admission. There is a current lack of cohesive fall prevention strategies in the Republic of Ireland. AIM: To demonstrate the cost of fall-related admissions to an acute hospital. METHODS: A review of Hospital Inpatient Enquiry (HIPE) data and medical case notes was performed for all fall-related admissions over a one-year period. The cost of fall-related admissions was calculated. In addition a detailed cost analysis was performed to determine the true cost of a hip fracture admission. RESULTS: There were 810 fall-related admissions, resulting in 8,300 acute bed days, and 6,220 rehabilitation bed days, costing euros 10.3 million. Fall-related readmissions resulted in 650 bed-days, bringing the total cost to euros 10.8 million. A typical hip fracture incident admission episode costs euros 14,300. CONCLUSION: Fall-related admissions of olderpeople are a significant financial burden to the health service.
    • Fixation of tibial plateau fractures with synthetic bone graft versus natural bone graft: a comparison study.

      Ong, J C Y; Kennedy, M T; Mitra, A; Harty, J A; Department of Trauma and Orthopaedics, Cork University Hospital, Wilton, Cork, Ireland. josh.cy.ong@gmail.com (2012-06)
      The goal of this study was to determine differences in fracture stability and functional outcome between synthetic bone graft and natural bone graft with internal fixation of tibia plateau metaphyseal defects.
    • Food allergies.

      O'Leary, Paula F G; Shanahan, Fergus; Department of Medicine, Cork University Hospital, Clinical Sciences Building,, Wilton, Cork, Ireland. olearyp1@shb.ie (2012-02-03)
      Adverse reactions to foods are commonly implicated in the causation of ill health. However, foreign antigens, including food proteins and commensal microbes encountered in the gastrointestinal tract, are usually well tolerated. True food allergies, implying immune-mediated adverse responses to food antigens, do exist, however, and are especially common in infants and young children. Allergic reactions to food manifest clinically in a variety of presentations involving the gastrointestinal, cutaneous, and respiratory systems and in generalized reactions such as anaphylaxis. Both IgE-mediated and non-IgE-mediated immune mechanisms are recognized. Important advances in the clinical features underlying specific food hypersensitivity disorders are reviewed.
    • Food contaminant analysis at ultra-high mass resolution: application of hybrid linear ion trap - orbitrap mass spectrometry for the determination of the polyether toxins, azaspiracids, in shellfish.

      Skrabáková, Zuzana; O'Halloran, John; van Pelt, Frank N A M; James, Kevin J; PROTEOBIO (Mass Spectrometry Centre), Cork Institute of Technology, Bishopstown, Cork, Ireland. (Wiley-Blackwell, 2010-10-30)
      The biotoxins, azaspiracids (AZAs), from marine phytoplankton accumulate in shellfish and affect human health by causing severe gastrointestinal disturbance, diarrhea, nausea and vomiting. Specific and sensitive methods have been developed and validated for the determination of the most commonly occurring azaspiracid analogs. An LTQ Orbitrap mass spectrometer is a hybrid instrument that combines linear ion trap (LIT) mass spectrometry (MS) with high-resolution Fourier transform (FT) MS and this was exploited to perform simultaneous ultra-high-resolution full-scan MS analysis and collision-induced dissociation (CID) tandem mass spectrometry (MS/MS). Using the highest mass resolution setting (100,000 FWHM) in full-scan mode, the methodology was validated for the determination of six AZAs in mussel (Mytilus galloprovincialis) tissue extracts. Ultra-high mass resolution, together with a narrow mass tolerance window of ±2 mDa, dramatically improved detection sensitivity. In addition to employing chromatographic resolution to distinguish between the isomeric azaspiracid analogs, AZA1/AZA6 and AZA4/AZA5, higher energy collisionally induced dissociation (HCD) fragmentation on selected precursor ions were performed in parallel with full-scan FTMS. Using HCD MS/MS, most precursor and product ion masses were determined within 1 ppm of the theoretical m/z values throughout the mass spectral range and this enhanced the reliability of analyte identity.For the analysis of mussels (M. galloprovincialis), the method limit of quantitation (LOQ) was 0.010 µg/g using full-scan FTMS and this was comparable with the LOQ (0.007 µg/g) using CID MS/MS. The repeatability data were; intra-day RSD% (1.8-4.4%; n = 6) and inter-day RSD% (4.7-8.6%; n = 3). Application of these methods to the analysis of mussels (M. edulis) that were naturally contaminated with azaspiracids, using high-resolution full-scan Orbitrap MS and low-resolution CID MS/MS, produced equivalent quantitative data.
    • Foot Drop: Looking Beyond Common Peroneal Nerve Palsy – A Neurophysiology Centre Experience

      Yap, SM; McNamara, B (Irish Medical Journal, 2016-04)
      Foot drop is a complex symptom with a considerable range in aetiology, severity and prognosis. We aim to characterise the aetiologies of foot drop and assess the diagnostic contribution of neurophysiologic testing (NCS/EMG). Retrospective review of consecutive referrals of foot drop to the Neurophysiology Department in Cork University Hospital was performed over a two year period (January 2012 to December 2013). Of a total of 59 referrals, common peroneal nerve (CPN) palsy comprised only slightly more than half of cases; 3(5%) have central origin; 3(5%) have motor neuron disease. Six (10%) have diabetes; 7(12%) have cancer; 5(8%) were bilateral. NCS/EMG altered initial working diagnosis in 14 out of 52 (27%) cases whereby initial diagnosis was provided. However one-third of all cases revealed additional coexistent pathology in an anatomic location remote to that of the primary diagnosis. Foot drop with central and proximal localisations are important and under recognised. NCS/EMG is valuable and also reveals additional pathology which warrants investigation
    • Fractalkine in rheumatoid arthritis: a review to date.

      Murphy, G; Caplice, N; Molloy, M; Department of Rheumatology, Cork University Hospital, Wilton, Cork, Ireland., grainne.murphy@ucc.ie (2012-02-03)
      Rheumatoid arthritis (RA) is characterized by the expansion of the synovium, with infiltration of pro-inflammatory cells, neovascularization and an abundance of pro-inflammatory cytokines resulting in tissue destruction and bone erosion. Fractalkine (FKN), a recently described chemokine, possesses chemotactic, angiogenic and adhesive functions that associates it with all of these destructive processes. In this review, we describe the research to date, which implicates FKN and its receptor in the pathogenesis of RA and propose that this molecule may represent a future therapeutic target for RA.
    • Fractured cervical spine and aortic transection.

      Griffin, M J; Harnett, M; Kenefick, P; Department of Anaesthesia and Intensive Care, Cork University Hospital, Wilton,, Ireland. (2012-02-03)
      A 17-year-old victim of a road traffic accident presented. Following investigation diagnoses of fractured first cervical vertebra, aortic transection, diffuse cerebral oedema, fractured right ribs 2-4 and pubic rami were made. Management of this case presented a number of anaesthetic dilemmas: management of the airway, use of cross-clamp vs. shunting or heparinization and bypass, cardiovascular and neurological monitoring, maintenance of cardiovascular stability during and post cross-clamp, minimizing the risk of post-operative renal and neurological dysfunction.
    • From comic relief to real understanding; how intestinal gas causes symptoms.

      Quigley, E M M; Department of Medicine, Cork University Hospital, Ireland. e.quigley@ucc.ie (2012-02-03)
      Gas content and transit appear to conspire with the motor and sensory responses of the gut to produce gas related symptoms, both in normal individuals and especially in patients with irritable bowel syndrome (IBS). In relation to gas in IBS, two questions need to be addressed: do IBS patients produce more gas and what are the relationships between intestinal gas and symptoms? The balance of evidence seems to indicate that distension is a real phenomenon in IBS and that such distension accurately reflects gas content. More problematic is extrapolation of the observations relating symptoms to gas transit and retention.