• Obesity, metabolic syndrome and esophageal adenocarcinoma: epidemiology, etiology and new targets.

      Ryan, Aoife M; Duong, Michelle; Healy, Laura; Ryan, Stephen A; Parekh, Niyati; Reynolds, John V; Power, Derek G; Department of Nutrition, Food Studies & Public Health, New York University, New York, NY 10044, USA. aoife.ryan1@gmail.com (2011-08)
      Rates of distal and junctional adenocarcinomas are increasing in Western countries.
    • Ocular coherence tomographic examination of postoperative foveal architecture after scleral buckling vs vitrectomy for macular off retinal detachment.

      Gibran, S K; Cleary, P E; Department of Ophthalmology, Cork University Hospital, Cork, Ireland., syedgibran@yahoo.com (2012-02-03)
      AIMS: This pilot study uses Optical Coherence Tomography (OCT) imaging to compare the difference in foveal architecture after successful retinal detachment (RD) surgery by scleral buckling or pars plana vitrectomy (PPV). METHODS: Prospective recruitment of patients with macular off RDs. Detachment surgery was undertaken by scleral buckling, external drainage, and air injection (group 1) or by PPV (group 2). Postoperatively patients had clinical examinations and OCT at 1, 3, 6, and 12 months. If abnormalities persisted, a further OCT was obtained at 18 months. RESULTS: Retinal reattachment, including clinical macular reattachment, was achieved in all cases within 24 h postoperatively. In group 1 (n=22), postoperative OCT showed persistent foveal detachment in 63% of cases (n=14) at 1 and 3 months. At 6 and 12 months, 36% (n=8) and 9% (n=2) had a persistent foveal detachment, respectively, and at 18 months, foveal detachment eventually. In group 2 (n=21), postoperative OCT showed an attached fovea in all cases; however, foveal thickening suggesting intraretinal oedema was present in all cases. The oedematous appearance of retina on OCT settled in 1-3 months. No foveal abnormality was seen at 6 and 12 months postoperatively. CONCLUSIONS: A high proportion of patients with successful retinal reattachment surgery by scleral buckling had foveal detachments postoperatively. No cases who had PPV had foveal detachments; however, transient retinal oedema was evident in all cases. The aetiology of these changes is unknown and warrants further investigation, as there is the potential of a long-term effect on vision.
    • Ocular injury in hurling.

      Flynn, T H; Fennessy, K; Horgan, N; Walsh, B; O'Connell, E; Cleary, P; Beatty, S; Cork University Hospital, Cork, Ireland. tomhenry75@hotmail.com (2012-02-03)
      OBJECTIVES: To describe the clinical characteristics of ocular injuries sustained in hurling in the south of Ireland and to investigate reasons for non-use of protective headgear and eye wear. METHODS: Retrospective review of the case notes of 310 patients who attended Cork University Hospital or Waterford Regional Hospital between 1 January 1994 and 31 December 2002 with ocular injuries sustained during a hurling match. A confidential questionnaire on reasons for non-use of protective headgear and eye wear was completed by 130 players. RESULTS: Hurling related eye injuries occurred most commonly in young men. Fifty two patients (17%) required hospital admission, with hyphaema accounting for 71% of admissions. Ten injuries required intraocular surgical INTERVENTION: retinal detachment repair (5); macular hole surgery (1); repair of partial thickness corneal laceration (1); repair of globe perforation (1); enucleation (1); trabeculectomy for post-traumatic glaucoma (1). Fourteen eyes (4.5%) had a final best corrected visual acuity (BCVA) of <6/12 and six (2%) had BCVA <3/60. In the survey, 63 players (48.5%) reported wearing no protective facemask while playing hurling. Impairment of vision was the most common reason cited for non-use. CONCLUSIONS: Hurling related injury is a significant, and preventable, cause of ocular morbidity in young men in Ireland. The routine use of appropriate protective headgear and faceguards would result in a dramatic reduction in the incidence and severity of these injuries, and should be mandatory.
    • The opinion of the general practitioner toward clinical management of patients with psychogenic nonepileptic seizures.

      O'Sullivan, S S; Sweeney, B J; McNamara, B; Department of Neurology/Neurophysiology, Cork University Hospital, Wilton, Cork, , Republic of Ireland. seansosullivan@hotmail.com (2012-02-03)
      OBJECTIVE: The purpose of this work was to assess the opinion of general practitioners (GPs) regarding the diagnosis of psychogenic nonepileptic seizures (PNES) and the role they feel they should play in the management of the disorder. METHODS: Patients with PNES were identified from hospital records. Seizure and patient characteristics were recorded. Their GPs were surveyed regarding their understanding of the diagnosis and ongoing management of PNES. RESULTS: Twenty-three patients were identified over a 3-year period as having been diagnosed with PNES. Sixty-five percent of GPs agreed with the diagnosis, and when asked to grade their understanding of the diagnosis (poor = 1, excellent = 10), the mean score was 5.7 (+/-SD 2.3). Thirty-five percent of GPs felt psychological input was of benefit to their patients. Fifty-two percent of GPs felt comfortable following up these patients, either with or without neurology outpatient services. CONCLUSIONS: PNES remains a difficult disease to manage. There is a high level of uncertainty regarding the optimum management of PNES among primary care physicians, for which further education is needed.
    • Opioid toxicity as a cause of spontaneous urinary bladder rupture.

      Galbraith, John G; Butler, Joseph S; McGreal, Gerard T; Department of Surgery, Mercy University Hospital Cork, Ireland. johng442@hotmail.com (Elsevier, 2011-02)
    • Opioid-induced delay in gastric emptying: a peripheral mechanism in humans.

      Murphy, D B; Sutton, J A; Prescott, L F; Murphy, M B; Cork University Hospital, Wilton, Cork City, Ireland. (2012-02-03)
      BACKGROUND: Opioids delay gastric emptying, which in turn may increase the risk of vomiting and pulmonary aspiration. Naloxone reverses this opiate action on gastric emptying, but it is not known whether this effect in humans is mediated by central or peripheral opiate antagonism. The importance of peripheral opioid receptor antagonism in modulating opioid-induced delay in gastric emptying was evaluated using methylnaltrexone, a quaternary derivative of the opiate antagonist naltrexone, which does not cross the blood-brain barrier. METHODS: In a randomized, double-blind, crossover placebo-controlled study, 11 healthy volunteers were given either placebo (saline), 0.09 mg/kg morphine, or 0.09 mg/kg morphine plus 0.3 mg/kg methylnaltrexone on three separate occasions before ingesting 500 ml deionized water. The rate of gastric emptying was measured by two methods: a noninvasive epigastric bioimpedance technique and the acetaminophen absorption test. RESULTS: The epigastric bioimpedance technique was sufficiently sensitive to detect opioid-induced changes in the rate of gastric emptying. The mean +/- SD time taken for the gastric volume to decrease to 50% (t0.5) after placebo was 5.5 +/- 2.1 min. Morphine prolonged gastric emptying to (t0.5) of 21 +/- 9.0 min (P < 0.03). Methylnaltrexone given concomitantly with morphine reversed the morphine-induced delay in gastric emptying to a t0.5 of 7.4 +/- 3.0 (P < 0.04). Maximum concentrations and area under the concentration curve from 0 to 90 min of serum acetaminophen concentrations after morphine were significantly different from placebo and morphine administered concomitantly with methylnaltrexone (P < 0.05). No difference in maximum concentration or area under the concentration curve from 0 to 90 min was noted between placebo and methylnaltrexone coadministered with morphine. CONCLUSIONS: The attenuation of morphine-induced delay in gastric emptying by methylnaltrexone suggests that the opioid effect is mediated outside the central nervous system. Methylnaltrexone may have the potential to decrease the side effects of opioid medications, which are mediated peripherally, while maintaining the central analgesia effect of the opioid.
    • Optimisation of an epileptiform activity detector for ambulatory use

      Thomas, E. M.; Kelleher, D.; Lightbody, G.; Nash, D.; McNamara, B.; Marnane, W. P. (2010)
    • Orthopaedic admissions due to sports and recreation injuries.

      Delaney, R A; Falvey, E; Kalimuthu, S; Molloy, M G; Fleming, P; Department of Trauma & Orthopaedics, Cork University Hospital, Wilton, Cork. radelaney@partners.org (2009-02)
      The health benefits of exercise may be attenuated by sports and recreation related injury (SRI). Though the majority of SRI are mild and self-limiting, a significant number are serious and require orthopaedic intervention. The aims of this study were to assess the burden of these serious injuries on the orthopaedic inpatient service, and to investigate potential target areas for injury prevention. All 1,590 SRI seen in the ED over a 3-month period were analysed using the Patient Information Management System to determine which patients received inpatient orthopaedic care. The medical records of those 63 patients who required inpatient care under orthopaedics were reviewed and data collected on demographic features, history, operative procedure and theatre resources, and length of hospital stay. Data were analyzed using SPSS. SRI accounted for 12.3% of all ED presentations. The principal activities resulting in injury requiring orthopaedic care were soccer, hurling and informal play e.g. trampoline. Falls made up 37% of the overall mechanism of injury but 68% of the injuries severe enough to require operative management. Most operative procedures were performed as part of a routine day trauma list but 20% were performed out of hours. This group of injuries places a significant burden on a busy trauma service. Injury prevention measures such as public education regarding falls in sport may have a role in reducing this burden.
    • Osteochondroma development subsequent to traumatic hip dislocation.

      Laing, A J; Dillon, J P; Suiluman, B; Mulcahy, D; Department of Orthopedic Surgery, Cork University Hospital, Cork, Ireland. (2012-02-03)
    • Osteosarcoma: A rare cause of painful enlargement of the hallux.

      Sproule, J A; Kennedy, C; Mulcahy, D M; Department of Trauma and Orthopaedic Surgery, Cork University Hospital, Wilton Road, Cork, Ireland. (Elsevier, 2011-12)
      Malignant osseous and soft-tissue tumors of the foot are rare. We report a case of osteosarcoma in the proximal phalanx of the hallux in a 45-year-old man. In patients with foot-related symptoms, a high index of suspicion for pedal osteosarcoma is required. Delayed or inappropriate diagnosis may compromise limb-sparing surgery and survivorship.
    • Ostial left main coronary stenosis in a frequent flyer.

      O'Sullivan, John F; McFadden, Eugene (2009-05-15)
      A 52 year old gentleman presented with chest pain, after a long distance flight from India; he had made long haul flights every 2 weeks over the last 5 years as part of his job. His ECG revealed T wave inversion in leads V1-3. Cardiac biomarkers including troponin were negative; we proceeded to exercise stress testing (EST). This revealed 2 mm ST depression at 2 min of the standard Bruce protocol, associated with chest pain. He was taken immediately to the coronary catheterization laboratory; engagement of the left main caused pressure damping with 6 French, then 5 French diagnostic Judkins left 4 catheters. An ostial left main stenosis was seen; the right and left coronary trees otherwise had no significant stenoses. He had normal LV function. He underwent inpatient CABG 7 days later.
    • An outcomes assessment of intra-articular calcaneal fractures, using patient and physician's assessment profiles.

      Kennedy, J G; Jan, W M; McGuinness, A J; Barry, K; Curtin, J; Cashman, W F; Mullan, G B; Department of Orthopaedic Surgery, Cork University Hospital, Wilton, Cork,, Ireland. jgk1@hotmail.com (2012-02-03)
      Thirty-six patients with intra-articular displaced calcaneal fractures were examined to determine both physician- and patient-based outcomes. Three groups were selected. Group A was treated with open reduction and internal fixation, group B was treated with open reduction internal fixation and supplemental bone graft augmentation and the patients in group C were treated with plaster cast immobilisation and no formal operative treatment. All cohorts were well matched for age, sex and severity of injury. Patients were evaluated using both the American Foot and Ankle Society Scoring System (AFASS) and the short form 36 (SF-36). Minimum time to follow up was 4 years. No significant difference was observed between the three groups with regards to pain and functional outcomes using the AFASS score (P>0.05). No difference was observed between the three groups using the SF-36 score (P>0.1). A statistically significant difference was observed, using radiological criteria, between both groups A and B when compared to the non-operative group C. The rate of wound infection in groups A and B was 31.5%. No correlation was found between the SF-36 score and the AFASS score. No correlation was found between the radiological score and either the SF-36 or the AFASS score. This study has found that the conservative treatment of calcaneal fractures can produce satisfactory outcomes with lower morbidity than surgically treated fractures.
    • Ovarian cancer mimicking recurrence at colorectal anastomosis: report of a case.

      Reardon, C M; Kavanagh, E G; Sabah, M; Kirwan, W O; Department of Surgery, Cork University Hospital, Cork City, Ireland. (2012-02-03)
      PURPOSE: The aim of this article is to emphasize the increased risk of developing metachronous ovarian tumors after resection of rectal cancer. METHOD AND RESULTS: We report the case of a postmenopausal female patient who, five years after anterior resection, developed a primary ovarian malignancy that invaded a rectal anastomosis and in so doing mimicked a recurrence of a Dukes A rectal cancer. To our knowledge, such an occurrence has not been described previously in the literature. CONCLUSION: This case illustrates the possible benefits of routine prophylactic oophorectomy at the time of colorectal cancer resection.
    • Oxidative and inflammatory status in Type 2 diabetes patients with periodontitis.

      Allen, Edith M; Matthews, John B; O' Halloran, Domhnall J; Griffiths, Helen R; Chapple, Iain L; Department of Restorative Dentistry, Cork University Dental School and Hospital, Wilton, Ireland. e.allen@ucc.ie (2011-10)
      To determine the impact of periodontitis on oxidative/inflammatory status and diabetes control in Type 2 diabetes.
    • Paediatric analgesia in an Emergency Department.

      Hawkes, C; Kelleher, G; Hourihane, J; Cork University Hospital, Wilton, Cork. cphawkes@gmail.com (2012-02-03)
      Timely management of pain in paediatric patients in the Emergency Department (ED) is a well-accepted performance indicator. We describe an audit of the provision of analgesia for children in an Irish ED and the introduction of a nurse-initiated analgesia protocol in an effort to improve performance. 95 children aged 1-16 presenting consecutively to the ED were included and time from triage to analgesia, and the rate of analgesia provision, were recorded. The results were circulated and a nurse initiated analgesia protocol was introduced. An audit including 145 patients followed this. 55.6% of patients with major fractures received analgesia after a median time of 54 minutes, which improved to 61.1% (p = 0.735) after 7 minutes (p = 0.004). Pain score documentation was very poor throughout, improving only slightly from 0% to 19.3%. No child had a documented pain score, which slightly improved to 19.3%. We recommend other Irish EDs to audit their provision of analgesia for children.
    • Paediatric ride-on mower related injuries and plastic surgical management.

      Laing, T A; O'Sullivan, J B; Nugent, N; O'Shaughnessy, M; O'Sullivan, S T; Department of Plastic and Reconstructive Surgery, Cork University Hospital, Wilton, Cork, Ireland. terezelaing@yahoo.com (2011-05)
      Lawnmower related injuries cause significant morbidity in children and young teenagers. The 'ride-on' mowers which are more powerful than the 'walk behind' mowers are becoming increasingly popular. The incidence and severity of injuries from either type of lawnmower appears to be steadily rising as is the burden placed on local plastic surgical and emergency services in managing the care of these patients. The aims of the study were to demonstrate changing trends in lawnmower-related injuries to children presenting to a single unit over a ten-year period and to identify any association between injury severity and machine subtype ('ride-on' versus 'walk-behind'). Hospital databases, theatre records and medical case notes were reviewed retrospectively of all patients under the age of 16 treated for lawnmower related injuries over a 10 year period from July 1998 to June 2008. Data gathered included patient demographics, injury site and severity, management (type and number of surgical procedures), length of hospital stay and outcome. Injury severity score was also calculated for each case. Controlling for estimated regional population changes, there was a significant increase in the number of ride-on mower related accidents in the time period 2003-2008, compared to the time period 1998-2003. Ride-on injuries had significantly higher injury severity scores, longer hospital stays and were more likely to involve amputations as compared with walk-behind injuries. Children can sustain significant injuries with unsafe lawnmower use. The current study demonstrates the increasing incidence of ride-on mower related injuries in children and identifies a greater morbidity associated with such injuries. Such presentations place intense demands on local plastic surgical services.
    • Palliative gastrostomy in the setting of voluminous ascites.

      O'Connor, Owen J; Diver, Elizabeth; McDermott, Shaunagh; Covarrubias, Diego A; Shelly, Martin J; Growdon, Whitfield; Hahn, Peter F; Mueller, Peter R; 1 Department of Radiology, Massachusetts General Hospital , Boston, Massachusetts. (2014-07)
      We report the indications, methods, and complications of percutaneous gastrostomy/gastrojejunostomy (G/GJ) in patients with voluminous ascites.
    • Parental And Clinician Views Of Consent In Neonatal Research

      O’Shea, N; Doran, K; Ryan, C A; Dempsey, E (Irish Medical Journal, 2018-03)
      Informed consent is an obligatory requirement for research participation1. The process of informed consent states that certain measures must be followed to ensure a research participant has made an informed decision about their participation in a research study2,3. Consent for research should be voluntary, informed, and understood by the consenting individual who must also be competent to do so. In the case of neonatal research informed consent is acquired from parent(s)/guardian(s) of a patient.
    • Parental patterns of use of over the counter analgesics in children

      Garvey, AA; Hawkes, CP; Ryan, CA; Kelly, M (Irish Medical Journal, 2013-05)
    • Pathogenesis of and unifying hypothesis for idiopathic pouchitis.

      Coffey, J Calvin; Rowan, Fiachra; Burke, John; Dochery, Neil G; Kirwan, William O; O'Connell, P Ronan; School of Medicine and Medical Sciences University College Dublin, St Vincent's University Hospital, Dublin, Ireland. calvincoffey@hotmail.com (2009-04)
      Ileal pouch-anal anastomosis is the procedure of choice in the surgical management of refractory ulcerative colitis. Pouchitis affects up to 60% of patients following ileal pouch-anal anastomosis for ulcerative colitis. It overlaps significantly with ulcerative colitis such that improvements in our understanding of one will impact considerably on the other. The symptoms are distressing and impinge significantly on patients' quality of life. Despite 30 years of scientific and clinical investigation, the pathogenesis of pouchitis is unknown; however, recent advances in molecular and cell biology make a synergistic hypothesis possible. This hypothesis links interaction between epithelial metaplasia, changes in luminal bacteria (in particular sulfate-reducing bacteria), and altered mucosal immunity. Specifically, colonic metaplasia supports colonization by sulfate-reducing bacteria that produce hydrogen sulfide. This causes mucosal depletion and subsequent inflammation. Although in most cases antibiotics lead to bacterial clearance and symptom resolution, immunogenetic subpopulations can develop a chronic refractory variant of pouchitis. The aims of this paper are to discuss proposed pathogenic mechanisms and to describe a novel mechanism that combines many hypotheses and explains several aspects of pouchitis. The implications for the management of both pouchitis and ulcerative colitis are discussed.