• A journey taken when developing a new neurovascular assessment tool

      Murphy, Siobhan; Conway, Col; McGrath, Niamh B.; Leary, Breda O’; P. O’Sullivan, Mary; Powell, Anne (2009-02)
    • Koebner phenomenon of the ear canal skin.

      Young, O; Murphy, M; Fitzgibbon, J; O'Sullivan, P; Department of Otolaryngology, South Infirmary/Victoria Hospital, Old Blackrock Road, Cork, Ireland. oyoung@rcsi.ie (2009-02)
      The Koebner phenomenon originally described the appearance of psoriatic lesions in the uninvolved skin of patients with psoriasis as a consequence of trauma. We describe a case of concurrent lichen planus and sarcoidosis in the auditory canal, which represents an unusual manifestation of the Koebner phenomenon. This is the first case of concurrent lichen planus and sarcoidosis in the head and neck region and highlights the need for biopsy to allow accurate histopathological diagnosis and treatment.
    • Lack of correlation between calcium intake and serum calcium levels in stable haemodialysis subjects.

      Byrne, Fiona N; Kinsella, Sinead; Murnaghan, Dermot J; Kiely, Mairead; Eustace, Joseph A; Department of Nutrition and Dietetics, Cork University Hospital, Cork, Ireland. (Karger, 2009)
      The relationship between calcium intake and serum calcium level in hemodialysis patients is poorly understood.
    • Laparoscopic cholecystectomy in adult cystic fibrosis.

      McGrath, D S; Short, C; Bredin, C P; Kirwan, W O; Rooney, E; Meeke, R; Department of Medicine, Cork University Hospital. (2012-02-03)
      Two female patients with Cystic Fibrosis, attending the Adult Regional Cystic Fibrosis centre at the Cork University Hospital, were investigated for upper abdominal pain and found to have gallstones at ultrasonography. Laparoscopic cholecystectomy was performed successfully and, without complication, in both patients.
    • Laparoscopic-assisted appendicectomy (LAA): a novel advance on an established procedure.

      Khan, Z; Mofidi, R; Redmond, H P; Department of Academic Surgery, Cork University Hospital, Wilton, Ireland., zaib@eircom.net (2012-02-03)
    • Laryngotracheal disruption in a child following airbag deployment.

      Murphy, Adrian; Seigne, Patrick; O'Sullivan, Iomhar; Cusack, Stephen; Department of Emergency Medicine, Cork University Hospital, Cork, Ireland. adrianmurphy06@eircom.net (2010-05)
    • Late presentation of developmental dysplasia of the hip.

      Gul, R; Coffey, J C; Khayyat, G; McGuinness, A J; Department of Orthopaedic and Trauma Surgery, Cork University Hospital, Ireland. , rehangul@hotmail.com (2012-02-03)
      BACKGROUND: A neonatal screening programme for developmental dysplasia of the hip (DDH) is ongoing in Cork. Despite early screening, infants continue to present at later ages with DDH. The impact of late diagnosis is significant. Established DDH causes significant morbidity and may have major medicolegal implications. AIM: To identify the reasons for the late presentation of DDH in the presence of a screening programme. METHODS: In a retrospective study all cases of late DDH presenting from 1988 to 2000 were identified using inpatient database. RESULTS: Forty-nine cases of DDH were diagnosed. The mean age of diagnosis was 14.8 months (range 6-47). Multiple risk factors were identified in four patients only. More than one risk factor was identified in 10 patients. CONCLUSION: Despite screening, children continue to present with late DDH. In this study, only 14 patients had multiple risk factors and only four patients had more than two risk factors, highlighting the low incidence of suspicion in this patient group.
    • Late-onset ophthalmoplegic migraine in a patient with previous childhood abdominal migraine.

      O'Sullivan, S S; O'Regan, K N; Tormey, P; Galvin, R J; Neurology Department, Cork University Hospital, Wilton, Ireland., seansosullivan@hotmail.com (2012-02-03)
    • Lawnmower injuries in children.

      Nugent, Nora; Lynch, Jenny B; O'Shaughnessy, Michael; O'Sullivan, Sean T; Department of Plastic Surgery, Cork University Hospital, Wilton, Cork, Ireland., nnugent@rcsi.ie (2012-02-03)
      OBJECTIVE: Power lawnmowers can pose significant danger of injury to both the operator and the bystander, from direct contact with the rotary blades or missile injury. Our objective was to review our experience with paediatric lawnmower-associated trauma, and the safety recommendations available to operators of power lawnmowers. METHODS: The patient cohort comprised paediatric (<16 years of age) patients treated for lawnmower-associated trauma, by the plastic surgery service, between 1996 and 2003. These patients were identified retrospectively. Age at the time of injury, location and extent of bony and soft tissue injuries sustained, treatment instituted and clinical outcome were recorded. Brochures and instruction manuals of six lawnmower manufacturers were reviewed, and safety recommendations noted. RESULTS: Fifteen patients were identified. The majority of injuries occurred from direct contact with the rotary blades (93%); the remaining child sustained a burn injury. Fourteen children (93%) required operative intervention. Seven patients (46%) sustained injuries resulting in amputation, two of whom had major limb amputations. All children, except the burns patient, underwent wound debridement and received antibiotic therapy. Reconstructive methods ranged from primary closure to free tissue transfer. Many patients required multiple procedures. In all instruction manuals, instructions to keep children and pets indoors or out of the yard when mowing were found. CONCLUSIONS: Lawnmower injuries can be devastating, particularly in children. Many victims have lasting deformities as a result of their injuries. Awareness of and stringent adherence to safety precautions during use of power lawnmowers can prevent many of these accidents.
    • Leptin predicts diabetes but not cardiovascular disease: results from a large prospective study in an elderly population.

      Welsh, Paul; Murray, Heather M; Buckley, Brendan M; de Craen, Anton J M; Ford, Ian; Jukema, J Wouter; Macfarlane, Peter W; Packard, Chris J; Stott, David J; Westendorp, Rudi G J; et al. (2009-02)
      To clarify the association of circulating levels of leptin with risk for cardiovascular disease (CVD) events and new-onset diabetes in men and women.
    • Leptospirosis: a globally increasing zoonotic disease.

      Rock, Clare; Brady, Deirdre; Forde, Patrick; Lucey, Patricia; Horgan, Mary; Department of Infectious Diseases, Cork University Hospital, Cork, Ireland. clarerock@hotmail.com (2010)
      A 27-year-old previously healthy man was admitted to the intensive care unit with severe jaundice, dyspnoea with haemoptysis, anaemia, thrombocytopenia and acute renal injury. He had no recent history of foreign travel but had been building a shed in his back garden in Cork, Ireland, for the preceding week. The patient's history, clinical observations, haematological and radiological results were all consistent with icteric leptospirosis or Weil's disease. This was confirmed on serological testing. He completed 7 days intravenous ceftriaxone and made a complete recovery. While endemic in tropical climates, leptospirosis incidence is increasing in temperate climates. Recent cases seen in temperate climates can be severe, particularly with pulmonary manifestations. The report of this case serves to increase awareness of this re-emerging potentially fatal infectious disease.
    • Less stress, more success? Oncological implications of surgery-induced oxidative stress.

      O'Leary, D P; Wang, J H; Cotter, T G; Redmond, H P; Department of Academic Surgery, Cork University Hospital, Cork, Ireland. donaloleary@rcsi.ie (2013-03)
      Reactive oxygen species (ROS) possess important cell signalling properties. This contradicts traditional thought which associated ROS activity with cell death. Emerging evidence clearly demonstrates that ROS signalling acts as a key regulator in tumour cell survival and in the cellular processes required for tumour cells to successfully metastasise and proliferate. The discovery of the nicotinamide adenine dinucleotide phosphate (NADPH) oxidase (Nox) family of enzymes in the last decade has unravelled much of the mystery surrounding how ROS are generated. Tumour cells are now known to express Nox enzymes which produce ROS required for cellular signalling. Activation of Nox enzymes occurs via interaction with proinflammatory cytokines and growth factors, all of which are released following surgical trauma. As our understanding of the signalling capabilities of ROS grows, the oncological implications of ROS activity are gradually being revealed. Nox-derived ROS are known to play a central role in each step of the metastatic cascade including invasion, adhesion, angiogenesis and proliferation. This article describes how surgery creates a ROS-rich environment, which facilitates redox signalling, and also examines the role played by Nox enzymes in this process. The authors then explore current knowledge of the oncological implications of surgery-induced redox signalling, and discuss current and future therapeutic strategies targeted at ROS and Nox enzymes in cancer patients.
    • Lessons from sudden infant death syndrome.

      Kearney, P J; Department of Paediatrics and Child Health, Cork University Hospital, University , College Cork. (2012-02-03)
    • Lessons learned using Snodgrass hypospadias repair.

      O'Connor, K M; Kiely, E A; Dept of Urology, Cork University Hospital. oconnorkevinm@eircom.net (2012-02-03)
      BACKGROUND: This is a review of our experience with the Snodgrass technique for distal hypospadias repair and we point to lessons learned in improving results. METHODS: We reviewed all patients who underwent Snodgrass hypospadias repair for distal hypospadias over a four-year period by a single surgeon. Chart review followed by parental telephone interview was used to determine voiding function, cosmesis and complication rate. RESULTS: Thirty children and three adults were identified. Age at surgery ranged from seven months to 39 years. The urinary stream was straight in 94%, and 97% reported a good or satisfactory final cosmetic outcome. One patient (3.3%) developed a urethral fistula and 21% developed meatal stenosis which required general anaesthetic. CONCLUSION: The Snodgrass urethroplasty provides satisfactory cosmetic and functional results. High rates of meatal stenosis initially encountered have improved with modifications to technique which include modified meatoplasty and routine meatal dilatation by the parents.
    • The ligase chain reaction as a primary screening tool for the detection of culture positive tuberculosis.

      O'Connor, T M; Sheehan, S; Cryan, B; Brennan, N; Bredin, C P; Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland., terryoconnor@eircom.net (2012-02-03)
      BACKGROUND: The ligase chain reaction Mycobacterium tuberculosis assay uses ligase chain reaction technology to detect tuberculous DNA sequences in clinical specimens. A study was undertaken to determine its sensitivity and specificity as a primary screening tool for the detection of culture positive tuberculosis. METHODS: The study was conducted on 2420 clinical specimens (sputum, bronchoalveolar lavage fluid, pleural fluid, urine) submitted for primary screening for Mycobacterium tuberculosis to a regional medical microbiology laboratory. Specimens were tested in parallel with smear, ligase chain reaction, and culture. RESULTS: Thirty nine patients had specimens testing positive by the ligase chain reaction assay. Thirty two patients had newly diagnosed tuberculosis, one had a tuberculosis relapse, three had tuberculosis (on antituberculous therapy when tested), and three had healed tuberculosis. In the newly diagnosed group specimens were smear positive in 21 cases (66%), ligase chain reaction positive in 30 cases (94%), and culture positive in 32 cases (100%). Using a positive culture to diagnose active tuberculosis, the ligase chain reaction assay had a sensitivity of 93.9%, a specificity of 99.8%, a positive predictive value of 83.8%, and a negative predictive value of 99.9%. CONCLUSIONS: This study is the largest clinical trial to date to report the efficacy of the ligase chain reaction as a primary screening tool to detect Mycobacterium tuberculosis infection. The authors conclude that ligase chain reaction is a useful primary screening test for tuberculosis, offering speed and discrimination in the early stages of diagnosis and complementing traditional smear and culture techniques.
    • The limping child: an algorithm to outrule musculoskeletal sepsis.

      Delaney, R A; Lenehan, B; O'sullivan, L; McGuinness, A J; Street, J T; Department of Trauma and Orthopaedics, Cork University Hospital, Cork, Ireland., Delaney.ruth@gmail.com (2012-02-03)
      BACKGROUND: The acutely limping child presents a significant diagnostic challenge. AIM: The purpose of this study was to create a clinically useful algorithm to allow exclusion of 'musculoskeletal sepsis' as a differential diagnosis in the child presenting with limp. METHODS: Data were collected on all 286 limping children admitted to our centre over a 3-year-period. Using logistic regression analysis, the predictive model was constructed, to exclude infection. RESULTS: Duration of symptoms, constitutional symptoms, temperature, white cell count and ESR were significantly different in children with musculoskeletal infection (P < 0.05). Multivariate analysis demonstrated that when all three variables of duration of symptoms >1, <5 days; temperature >37.0 degrees C; and ESR >35 mm/h were present, the predicted probability of infection was 0.66, falling to 0.01 when none were present. CONCLUSION: This multivariate model enables us to rule out musculoskeletal infection with 99% certainty in limping children with none of these three presenting variables.
    • Lipomatosis: an unusual side-effect of cytotoxic chemotherapy?

      Cronin, Patricia A; Myers, Eddie; Redmond, H Paul; O'Reilly, Seamus; Kirwan, William O (2010-05)
    • Lisfranc injuries: patient- and physician-based functional outcomes.

      O'Connor, P A; Yeap, S; Noel, J; Khayyat, G; Kennedy, J G; Arivindan, S; McGuinness, A J; Department of Orthopaedic Surgery, Cork University Hospital, Wilton, Ireland., paoconn@indigo.ie (2012-02-03)
      The purpose of this study was to assess functional outcome of patients with a Lisfranc fracture dislocation of the foot by applying validated patient- and physician-based scoring systems and to compare these outcome tools. Of 25 injuries sustained by 24 patients treated in our institution between January 1995 and June 2001, 16 were available for review with a mean follow-up period of 36 (10-74) months. Injuries were classified according to Myerson. Outcome instruments used were: (a) Medical Outcomes Study 36-Item Short Form Health Survey (SF-36), (b) Baltimore Painful Foot score (PFS) and (c) American Orthopedic Foot and Ankle Society (AOFAS) mid-foot scoring scale. Four patients had an excellent outcome on the PFS scale, seven were classified as good, three fair and two poor. There was a statistically significant correlation between the PFS and Role Physical (RP) element of the SF-36.
    • Listeria Meningitis in an Immunocompetent Child: Case Report and Literature Review

      McCarthy, K.N; Leahy, T.R; Murray, D.M (Irish Medical Journal, 2019-05)
      Listeria monocytogenes is a facultatively anaerobic Gram-positive bacillus that is an unusual cause of illness among immunocompetent individuals1. Infection with listeria is most commonly encountered in pregnancy, the neonatal period, and in immunocompromised patients2. Risk factors include food-borne exposures, particularly to soft cheeses and delicatessen meats, and life stock exposure3. Meningitis is the most frequently encountered clinical syndrome. L. monocytogenes accounts for 20% of cases of meningitis in neonates and in those >60 years and is the most common cause of meningitis among immunocompromised individuals1. Listeriosis is a rare disease in Ireland with a crude incidence rate of 0.41 per 100,000 which is lower than the EU average of 0.48 per 100,000 4.
    • Local anaesthetic toxicity in a pregnant patient undergoing lignocaine-induced intravenous regional anaesthesia.

      Coleman, M; Kelly, D J; Department of Anaesthesia and Intensive Care, Cork University Hospital, Ireland. (2012-02-03)
      A pregnant patient at 38 weeks' gestation developed symptoms of local anaesthetic toxicity following intravenous regional anaesthesia (IVRA) for hand surgery, using a standard dose of lignocaine. Reports suggest that a number of factors, both physiological and pharmacological, combine to increase the likelihood of local anaesthetic (LA) toxicity in pregnancy despite employment of a conventional "safe" IVRA technique. It is suggested that for IVRA, pregnant patients are premedicated with a benzodiazepine, the tourniquet time is increased and the concentration of LA is decreased to reduce the risks of LA toxicity.