• Macrolide antibiotics and the airway: antibiotic or non-antibiotic effects?

      Murphy, D M; Forrest, I A; Curran, D; Ward, C; Cork University Hospital, The Department of Respiratory Medicine, Wilton, Cork, Ireland. desmond.murphy@hse.ie (2010-03)
      The macrolides are a class of antibiotics widely prescribed in infectious disease. More recently, there has been considerable interest in potential indications for these agents, in addition to their simple antibacterial indications, in a number of lung pathophysiologies.
    • Maintenance hemodialysis patients have high cumulative radiation exposure.

      Kinsella, Sinead M; Coyle, Joe P; Long, Eva B; McWilliams, Sebastian R; Maher, Michael M; Clarkson, Michael R; Eustace, Joseph A; Department of Nephrology, Cork University Hospital, Wilton, Cork, Ireland. (2010-10)
      Hemodialysis is associated with an increased risk of neoplasms which may result, at least in part, from exposure to ionizing radiation associated with frequent radiographic procedures. In order to estimate the average radiation exposure of those on hemodialysis, we conducted a retrospective study of 100 patients in a university-based dialysis unit followed for a median of 3.4 years. The number and type of radiological procedures were obtained from a central radiology database, and the cumulative effective radiation dose was calculated using standardized, procedure-specific radiation levels. The median annual radiation dose was 6.9 millisieverts (mSv) per patient-year. However, 14 patients had an annual cumulative effective radiation dose over 20 mSv, the upper averaged annual limit for occupational exposure. The median total cumulative effective radiation dose per patient over the study period was 21.7 mSv, in which 13 patients had a total cumulative effective radiation dose over 75 mSv, a value reported to be associated with a 7% increased risk of cancer-related mortality. Two-thirds of the total cumulative effective radiation dose was due to CT scanning. The average radiation exposure was significantly associated with the cause of end-stage renal disease, history of ischemic heart disease, transplant waitlist status, number of in-patient hospital days over follow-up, and death during the study period. These results highlight the substantial exposure to ionizing radiation in hemodialysis patients.
    • The male HPV vaccine.

      O'Connor, M B (2012-01-06)
    • Malignancy-associated gastroparesis: an important and overlooked cause of chronic nausea and vomiting.

      Kelly, Dearbhla; Moran, Carthage; Maher, Michael; O'Mahony, Seamus; Department of Gastroenterology, Cork University Hospital, Cork, Ireland. (2014)
      A 69-year-old woman was referred to a gastroenterology clinic with a 1-year history of protracted nausea and postprandial vomiting. She had a background of gastro-oesophageal reflux disease, irritable bowel syndrome and chronic obstructive pulmonary disease with a significant smoking history. Her laboratory work-up including autoimmune screen, coeliac serology and synacthen test were unremarkable. Upper gastrointestinalendoscopy and CT imaging ruled out mucosal and obstructive causes. Gastric emptying studies demonstrated a delayed gastric emptying consistent with diagnosis of gastroparesis. Concurrently, she underwent a CT of the thorax for unresolved consolidation on her chest X-ray. This revealed a locally advanced primary lung carcinoma. In this context, with all other causes excluded, her gastroparesis was deemed to represent a paraneoplastic phenomenon. Gastroparesis is a frequent, under-recognised and important complication of cancer.
    • Malignant melanoma of the ciliary body presenting as extraocular metastasis in the temporalis muscle.

      Oittinen, Henna Anu-Liisa; O'Shaughnessy, Michael; Cullinane, Anthony B; Keohane, Catherine; Department of Plastic Surgery, Cork University Hospital, Ireland., henna.oittinen@gmx.net (2012-02-03)
    • Management of a refracture of the femoral shaft with a bent intramedullary nail in situ.

      Nicholson, P; Rice, J; Curtin, J; Department of Orthopaedic Surgery, Cork University Hospital, Preston, Ireland. (2012-02-03)
    • Management of adult attention deficit hyperactivity disorder in UK primary care: a survey of general practitioners

      McCarthy, Suzanne; Wilton, Lynda; Murray, Macey; Hodgkins, Paul; Asherson, Philip; Wong, Ian CK (2013-02-22)
      Abstract Background Compared to existing literature on childhood attention deficit hyperactivity disorder (ADHD), little published adult data are available, particularly outside of the United States. Using General Practitioner (GP) questionnaires from the United Kingdom, this study aimed to examine a number of issues related to ADHD in adults, across three cohorts of patients, adults who received ADHD drug treatment in childhood/adolescence but stopped prior to adulthood; adults who received ADHD drug treatment in childhood/adolescence and continued treatment into adulthood and adults who started ADHD drug treatment in adulthood. Methods Patients with a diagnosis of ADHD and prescribed methylphenidate, dexamfetamine or atomoxetine were identified using data from The Health Improvement Network (THIN). Dates when these drugs started and stopped were used to classify patients into the three cohorts. From each cohort, 50 patients were randomly selected and questionnaires were sent via THIN to their GPs. GPs returned completed questionnaires to THIN who forwarded anonymised copies to the researchers. Datasets were analysed using descriptive statistics. Results Overall response rate was 89% (133/150). GPs stated that in 19 cases, the patient did not meet the criteria of that group; the number of valid questionnaires returned was 114 (76%). The following broad trends were observed: 1) GPs were not aware of the reason for treatment cessation in 43% of cases, 2) patient choice was the most common reason for discontinuation (56%), 3) 7% of patients who stopped pharmacological treatment subsequently reported experiencing ADHD symptoms, 4) 58% of patients who started pharmacological treatment for ADHD in adulthood received pharmacological treatment for other mental health conditions prior to the ADHD being diagnosed. Conclusion This study presents some key findings relating to ADHD; GPs were often not aware of the reason for patients stopping ADHD treatment in childhood or adolescence. Patient choice was identified as the most common reason for treatment cessation. For patients who started pharmacological treatment in adulthood, many patients received pharmacological treatment for comorbidities before a diagnosis of ADHD was made.
    • Management of chronic constipation in the elderly.

      Gallagher, Paul F; O'Mahony, Denis; Quigley, Eamonn M M; Department of Geriatric Medicine, Cork University Hospital, Alimentary, Pharmabiotic Centre, University College Cork, Cork, Ireland. (2012-02-03)
      Constipation is a significant healthcare problem in the elderly. However, while undoubtedly common in the elderly, data on the prevalence of constipation in general and of its subtypes vary considerably, depending on the nature of the study population and their location. Furthermore, the complexity of the pathophysiology of constipation in this age group is little appreciated. Assumptions regarding 'age-related changes in colorectal physiology' are, for the most part, not supported by scientific evidence and may serve to distract the clinician from uncovering the contributions of co-morbid diseases and the impact of iatrogenic factors. The evidence base from which one can develop recommendations on the management of constipation in the elderly is, for the most part, slim. This becomes most starkly apparent when one attempts to critically assess specific approaches to management. There is insufficient evidence to support the use of many commonly used laxatives both in the general population and in the elderly. Lifestyle interventions have value for some patients but data are lacking on the benefits of these interventions for patients with chronic constipation. Data in the elderly do not exist for most new pharmacological approaches to constipation. Pending the availability of good data, management of constipation in the elderly should be tailored to each individual's needs and expectations, regardless of age or place of residence. In certain situations, constipation may be complicated by the development of impaction; preventive strategies are important in this context. We urge enrolment of many more elderly individuals with chronic constipation in clinical trials designed to address their particular needs.
    • Management of epilepsy in the community.

      Neligan, A; Renganathan, R; Sweeney, B J; Department of Neuroscience, Cork University Hospital, Cork. aidan60@yahoo.com (2012-02-03)
      We posted a questionnaire on epilepsy to all 375 GPs in Cork and Kerry (population 500,000) The questionnaire consisted of 10 sections, covering areas like GP demographics, initial referral practice following a first seizure, advice given to patients and GP's attitudes towards patients with epilepsy. The main focus of the study was GP awareness of 7 of the newer anti-epileptics and their side effects. There was a response rate of 46.7% (175) and revealed that the majority (87%) initially refer patients to a neurologist for further assessment. The majority of GPs gave patients advice about driving, AED side effects, interaction with the OCP and pregnancy counselling. GP awareness of the newer anti-epileptics is very variable with Gabapentin and Lamotrigine having the highest GP awareness rates. Almost 25% of GPs would initiate treatment following a first time seizure although only 30% would change therapy initiated by a consultant neurologist. Finally the majority of GPs were unhappy with the level of access to neurologists and 95% of GPs felt that the provision of an Epilepsy Clinical Nurse Specialist would help alleviate the problem.
    • Management of malignant pleural effusions.

      Uzbeck, Mateen H; Almeida, Francisco A; Sarkiss, Mona G; Morice, Rodolfo C; Jimenez, Carlos A; Eapen, Georgie A; Kennedy, Marcus P; Department of Pulmonary Medicine, MD Anderson Cancer Center, Houston, Texas, USA. (2010-06)
      Malignant pleural effusions are a common clinical problem in patients with primary thoracic malignancy and metastatic malignancy to the thorax. Symptoms can be debilitating and can impair tolerance of anticancer therapy. This article presents a comprehensive review of pharmaceutical and nonpharmaceutical approaches to the management of malignant pleural effusion, and a novel algorithm for management based on patients' performance status.
    • Massive retroperitoneal ganglioneuroma presenting with small bowel obstruction 18 years following initial diagnosis.

      Cronin, E M P; Coffey, J C; Herlihy, D; Romics, L; Aftab, F; Keohane, C; Redmond, H P; Surgical Professorial Unit, Department of Surgery, Cork University Hospital,, Wilton, Cork, Ireland. (2012-02-03)
      BACKGROUND: Ganglioneuroma is a rare tumour of neural crest origin, which arises from maturation of a neuroblastoma. While previously considered to be non-functioning, they are now known to be frequently endocrinologically active. AIMS AND METHODS: We report a case of a massive retroperitoneal ganglioneuroma presenting with small bowel obstruction in an adult, 18 years after initial diagnosis. Urinary dopamine levels were elevated, but other catecholamines were within normal limits. This is the first report in the English-language literature of a retroperitoneal ganglioneuroma presenting with or causing intestinal obstruction. We also review the metabolic, radiological, and histological features of these tumours. Relevant publications were identified from a Medline search using the MeSH headings 'ganglioneuroma', 'retroperitoneal neoplasms' and 'intestinal obstruction', and also from the reference lists of retrieved articles. CONCLUSIONS: Ganglioneuroma can grow to a massive size and present in a varied manner. It should be included in the differential diagnosis of any large retroperitoneal or mediastinal mass, including those causing bowel obstruction.
    • Mast cells facilitate local VEGF release as an early event in the pathogenesis of postoperative peritoneal adhesions.

      Cahill, Ronan A; Wang, Jiang Huai; Soohkai, Shastri; Redmond, H Paul; Department of Academic Surgery, Cork University Hospital, Ireland., rcahill@rcsi.ie (2012-02-03)
      BACKGROUND: Peritoneal injury sustained at laparotomy may evoke local inflammatory responses that result in adhesion formation. Peritoneal mast cells are likely to initiate this process, whereas vascular permeability/endothelial growth factor (VEGF) may facilitate the degree to which subsequent adhesion formation occurs. METHODS: Mast cell deficient mice (WBB6F1-/-), along with their mast cell sufficient counterparts (WBB6F1+/+), underwent a standardized adhesion-inducing operation (AIS) with subsequent sacrifice and adhesion assessment 14 days later in a blinded fashion. Additional CD-1 and WBB6F1+/+, and WBB6F1-/- mice were killed 2, 6, 12, and 24 hours after operation for measurement of VEGF by ELISA in systemic serum and peritoneal lavage fluid. Two further groups of CD-1 mice underwent AIS and received either a single perioperative dose of anti-VEGF monoclonal antibody (10 mug/mouse) or a similar volume of IgG isotypic antibody and adhesion formation 2 weeks later was evaluated. RESULTS: WBB6F1-/- mice had less adhesions then did their WBB6F1+/+ counterparts (median [interquartile range] adhesion score 3[3-3] vs 1.5[1-2] respectively; P < .003). Local VEGF release peaked 6 hours after AIS in both WBB6F1+/+ and CD-1 mice whereas levels remained at baseline in WBB6F1-/- mice. CD-1 mice treated with a single dose of anti-VEGF therapy during operation had less adhesions than controls (2[1.25-2] vs 3[2.25-3], P = .0002). CONCLUSIONS: Mast cells and VEGF are central to the formation of postoperative intra-abdominal adhesions with mast cells being responsible, either directly or indirectly, for VEGF release into the peritoneal cavity after operation. In tandem with the recent clinical success of anti-VEGF monoclonal antibodies in oncologic practice, our observations suggest an intriguing avenue for research and development of anti-adhesion strategy.
    • Maternal separation as a model of brain-gut axis dysfunction.

      O'Mahony, Siobhain M; Hyland, Niall P; Dinan, Timothy G; Cryan, John F; Alimentary Pharmabiotic Centre, Biosciences Institute, University College Cork, Cork, Ireland. somahony@ucc.ie (Springer, 2011-03)
      Early life stress has been implicated in many psychiatric disorders ranging from depression to anxiety. Maternal separation in rodents is a well-studied model of early life stress. However, stress during this critical period also induces alterations in many systems throughout the body. Thus, a variety of other disorders that are associated with adverse early life events are often comorbid with psychiatric illnesses, suggesting a common underlying aetiology. Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder that is thought to involve a dysfunctional interaction between the brain and the gut. Essential aspects of the brain-gut axis include spinal pathways, the hypothalamic pituitary adrenal axis, the immune system, as well as the enteric microbiota. Accumulating evidence suggest that stress, especially in early life, is a predisposing factor to IBS.
    • Mechanisms driving local breast cancer recurrence in a model of breast-conserving surgery.

      Smith, Myles J; Culhane, Aedin C; Killeen, Shane; Kelly, Maura A; Wang, Jiang H; Cotter, Thomas G; Redmond, Henry P; Department of Academic Surgery, Cork University Hospital, Cork, Ireland., mylessmith@hotmail.com (2012-02-03)
      OBJECTIVE: We aimed to identify mechanisms driving local recurrence in a model of breast-conserving surgery (BCS) for breast cancer. BACKGROUND: Breast cancer recurrence after BCS remains a clinically significant, but poorly understood problem. We have previously reported that recurrent colorectal tumours demonstrate altered growth dynamics, increased metastatic burden and resistance to apoptosis, mediated by upregulation of phosphoinositide-3-kinase/Akt (PI3K/Akt). We investigated whether similar characteristics were evident in a model of locally recurrent breast cancer. METHODS: Tumours were generated by orthotopic inoculation of 4T1 cells in two groups of female Balb/c mice and cytoreductive surgery performed when mean tumour size was above 150 mm(3). Local recurrence was observed and gene expression was examined using Affymetrix GeneChips in primary and recurrent tumours. Differential expression was confirmed with quantitative real-time polymerase chain reaction (qRT-PCR). Phosphorylation of Akt was assessed using Western immunoblotting. An ex vivo heat shock protein (HSP)-loaded dendritic cell vaccine was administered in the perioperative period. RESULTS: We observed a significant difference in the recurrent 4T1 tumour volume and growth rate (p < 0.05). Gene expression studies suggested roles for the PI3K/Akt system and local immunosuppression driving the altered growth kinetics. We demonstrated that perioperative vaccination with an ex vivo HSP-loaded dendritic cell vaccine abrogated recurrent tumour growth in vivo (p = 0.003 at day 15). CONCLUSION: Investigating therapies which target tumour survival pathways such as PI3K/Akt and boost immune surveillance in the perioperative period may be useful adjuncts to contemporary breast cancer treatment.
    • Medial arterial calcification, calcific aortic stenosis and mitral annular calcification in a diabetic patient with severe autonomic neuropathy.

      Cronin, C C; O'Sullivan, D J; Mitchell, T H; Department of Medicine, Cork University Hospital, Ireland. (2012-02-03)
      Medial arterial calcification (Monckeberg's arteriosclerosis) is well described in diabetic patients with autonomic neuropathy. There is also a high prevalence of diabetes mellitus among subjects with calcific aortic stenosis and mitral annular calcification. We describe a diabetic patient with autonomic neuropathy and extensive medial arterial calcification who also had calcification of the aortic valve and of the mitral valve annulus. We propose that autonomic neuropathy may play a role in calcification of these structures at the base of the heart.
    • Medical student knowledge regarding radiology before and after a radiological anatomy module: implications for vertical integration and self-directed learning.

      Murphy, Kevin P; Crush, Lee; O'Malley, Eoin; Daly, Fergus E; O'Tuathaigh, Colm M P; O'Connor, Owen J; Cryan, John F; Maher, Michael M; Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland. (Springer, 2014-08-10)
      To examine the impact that anatomy-focused radiology teaching has on non-examined knowledge regarding radiation safety and radiology as a specialty.
    • Meeting the person, not just the illness--this is who I am.

      O'Brien, Tony; Marymount Hospice and Consultant Physician in Palliative Medicine at Cork University Hospital, Cork, Ireland. ony.OBrien1@hse.ie (2010-06)
      ABSTRACT The importance of developing a therapeutic relationship by meeting advanced disease patients where they are in the trajectory of their illness is described with a case and commentary.
    • Melanoma of unknown origin: a case series.

      Kelly, J; Redmond, H P; Department of Academic Surgery, Cork University Hospital, Cork, Ireland. justinjoshkelly@gmail.com (2010-12)
      The natural history of metastatic melanoma involving lymph nodes, in the absence of a known primary site (cutaneous, ocular or mucosal) has, to date, been poorly defined; and the optimal management of this rare subtype of disease is therefore unclear. Melanomas of unknown primary site (MUP) are estimated to comprise between 3.7 and 6% of all melanomas (Anbari et al. in Cancer 79:1861-1821, 1997).
    • The Melkersson Rosenthal syndrome--a differential diagnosis of facial sarcoidosis.

      McGrath, D S; Doyle, C; Bredin, C P; Department of Respiratory Medicine, Cork University Hospital, Wilton. (2012-02-03)