• 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.
    • A patient with a rare leukodystrophy related to lamin B1 duplication.

      Molloy, A; Cotter, O; van Spaendonk, R; Sistermans, E; Sweeney, B; Department of Neurology, Cork University Hospital, Wilton, Cork. a.molloy@st-vincents.ie (2012-06)
      The hereditary leukodystrophies are rare disorders caused by molecular abnormalities leading to destruction of or failure of development of central white matter. For almost 30 years there has been increasing recognition of later onset Autosomal Dominant Leukodystrophy (ADLD). We report the first genetically confirmed case of lamin B1 duplication causing ADLD from Ireland.
    • The pattern of plasma sodium abnormalities in an acute elderly care ward: a cross-sectional study.

      O'Connor, K A; Cotter, P E; Kingston, M; Twomey, C; O'Mahony, D; South Munster Geriatric Training Scheme, Dept of Geriatric Medicine, Cork, University Hospital, Wilton, Cork. (2012-02-03)
      INTRODUCTION: The combination of ageing, illness, and medications can lead to hyponatraemia or hypernatraemia. AIMS: To describe the distribution of plasma sodium levels in older patients admitted to hospital. METHODS: We carried out a hospital based cross-sectional study examining 1,511 serum sodium concentrations ([Na+]) among 336 elderly patients and attempted to elucidate the cause(s) of the abnormal serum [Na+]. RESULTS: The study population had a mean age of 81.4. Ninety-two (27.4%) patients had hyponatraemia and seven patients (2.1%) had hypernatraemia during their hospitalisation. The distribution of [Na+] results was towards the lower end of the normal range. The mortality rate of patients with hyponatraemia was 14.1% and that of patients with normal serum [Na+] was 8.9%. Six patients with hypernatraemia died in hospital. Lower respiratory tract infection and medication accounted for the majority of cases. CONCLUSIONS: Deranged [Na+] is common among elderly patients admitted to hospital.
    • Pattern recognition: a true clinician's pearl in rheumatology.

      Haroon, Muhammad; Harney, Sinead; Ryan, John G; Department of Rheumatology, Cork University Hospital, Cork, Ireland. mharoon301@hotmail.com (2011-06)
    • Patterns of referral and treatment of undescended testis: a 12-year experience in a single centre.

      Golabek, T; Kiely, E; Department of Urology, Cork University Hospital, Wilton, Cork, Republic of Ireland. elementare@op.pl (2010-12)
      It is now recommended that orchidopexy be performed by 18 months.
    • Peanut allergy.

      Hourihane, Jonathan O'B; Department of Paediatrics and Child Health, Clinical Investigations Unit, Cork University Hospital, University College Cork, Wilton, Cork, Ireland. J.Hourihane@ucc.ie (2011-04)
      Peanut allergy may affect up to 2% of children in some countries, making it one of the most common conditions of childhood. Peanut allergy is a marker of a broad and possibly severe atopic phenotype. Nearly all children with peanut allergy have other allergic conditions. Peanut accounts for a disproportionate number of fatal and near fatal food-related allergies. Families with a child or children with peanut allergy can struggle to adapt to the stringent avoidance measures required. Although oral induction of tolerance represents the cutting edge of peanut allergy management, it is not yet ready for routine practice.
    • Pelvic girdle sepsis in childhood. An illustrative case of the difficulty in diagnosis.

      Street, John; Lenehan, Brian; Mulcahy, David; McGuinness, Anthony; Department of Trauma and Orthopaedics, Cork University Hospital, Cork, Ireland., hrb_street@yahoo.com (2012-02-03)
      The child who presents with fever, limp and hip pain will often undergo multiple diagnostic procedures before a definitive diagnosis is made. We describe a diagnostically challenging case of a 14-year-old boy presenting with an atraumatic painful limp and pyrexia. Eventually the diagnosis of obturator internus muscle abscess with associated ischial osteomyelitis was made. Of the 19 previous cases reported, four children had associated osteomyelitis and were of an older age. Symptomatology varies, clinical examination is non-specific and the diagnosis can be difficult. Haematological indices are more predictive than in cases of classical osteomyelitis or septic arthritis. Subtle features on conventional radiography and isotope bone scanning should not be overlooked while CT and MRI may be complementary in diagnosis.
    • Penetrating ectopic peptic ulcer in the absence of Meckel's diverticulum ultimately presenting as small bowel obstruction.

      Hurley, Hilary; Cahill, Ronan A; Ryan, Paul; Morcos, Ashraf I; Redmond, Henry P; Kiely, Helen M; Department of Surgery, Cork University Hospital, Wilton, Cork, Ireland. (2012-02-03)
      We report here how a heterotopic penetrating peptic ulcer progressed to cause small bowel obstruction in a patient with multiple previous negative investigations. The clinical presentation, radiographic features and pathological findings of this case are described, along with the salient lessons learnt. The added value of wireless capsule endoscopy (WCE) in such circumstances is debated.
    • Percutaneous extraction of entrapped infective transvenous pacing lead.

      Memon, Rizwan Aziz; Buckley, John; O'Donnell, Angus; Department of Cardiothoracic Surgery, Cork University Hospital, Cork, Republic of, Ireland. rizwanazizmenon@hotmail.com (2012-02-03)
      A 57-year-old woman had an entrapped infected transvenous pacing lead successfully removed percutaneously with a Dormier basket under fluoroscopy, thus avoiding a major surgical procedure.
    • Percutaneous vertebroplasty in osteoporosis, myeloma and Langerhans' cell histiocytosis.

      Kevane, B; Ryder, D Q; Gilligan, O; Department of Haematology, Cork University Hospital, Wilton, Cork. barrykevane@hotmail.com (2012-01-09)
      This review aims to assess the effectiveness of percutaneous vertebroplasty as a treatment for the severe refractory pain associated with vertebral fracture, in a group of patients with fractures secondary to either osteoporotic or neoplastic disease. A retrospective review of 20 patients treated with percutaneous vertebroplasty in Cork University Hospital up until March 2007 was carried out and a questionnaire was prepared and distributed. Prior to vertebroplasty, patients had been symptomatic with severe pain for a mean of 20.9 weeks. Of those thirteen whom replied to a postal questionnaire, 12 (92.3%) reported pain relief and this improvement occurred within 7 days in 9 (81.8%). This was associated with decreased analgesic requirements, as determined on chart review. Prior to the procedure only 5 (38.4%) were independently mobile and this figure rose to 10 (76.9%) afterwards, occurring within one week in the majority. Subjective outcomes were better in the group of patients with neoplasm-induced fractures.
    • Perianal hidradenoma papilliferum occurring in a male: a case report.

      Loane, J; Kealy, W F; Mulcahy, G; Department of Pathology, Cork University Hospital, Ireland. (2012-02-03)
      Hidradenoma papilliferum is a rare apocrine gland tumour, described only once previously in a male. We present the second such case.
    • Perinatal hepatic infarction in twin-twin transfusion.

      O'Sullivan, M J; Dempsey, E M; Kirwan, W O; Ryan, C A; Academic Department of Surgery, University College, Cork and Cork University, Hospital, Ireland. (2012-02-03)
      We report a case of a twin pregnancy which was complicated by a twin-twin transfusion in which the recipient twin was noted to have an intra-abdominal echogenic mass. This twin died at two days of age of hepatic infarction. The donor twin was healthy at birth, at thirty weeks' gestation, and did not have any subsequent problems. Fetal intra-abdominal echogenicity may be a marker of hepatic infarction.
    • Perinatal mortality in Ireland annual report 2012

      Manning, E; Greene, RA; Meaney, S; Corcoran, P; UCC (National Perinatal Epidemiology Centre, Department of Obstetrics and Gynaecology, UCC, 5th Floor, Cork University Maternity Hospital, Wilton, Cork, Ireland, 2014)
      This is the second national clinical audit on perinatal mortality in Ireland using the NPEC data collection tool and classification system. Anonymised data were reported by the 20 Irish maternity units on a total of 485 perinatal deaths occurring in 2012 and arising from 71,755 births of at least 24 weeks gestation or at least 500g birthweight. Stillbirths, early neonatal and late neonatal deaths accounted for 304 (62.7%), 141 (29.1%) and 40 (8.2%) of the 485 deaths, respectively. The perinatal mortality rate was 6.2 per 1,000 births in 2012; corrected for congenital malformation, the rate was 4.1 per 1,000 births; the stillbirth rate was 4.2 per 1,000 births; and, the early neonatal death rate was 2.0 per 1,000 live births. International comparisons are hampered by variation in definitions, availability of screening programmes for congenital anomalies and national legislation on abortion. Nevertheless, the Irish perinatal mortality rates compare favourably with those of countries in the UK and Europe. The year 2012 is the fifth year the NPEC has reported national perinatal mortality rates and while this period is too short to establish trends, it is promising that the observed rates have decreased by approximately 10%.
    • Perinatal mortality in Ireland: annual report 2014

      Corcoran, P.; Manning, E.; O’Farrell, I.B.; McKernan, J.; Meaney, S.; Drummond, L.; de Foubert, P.; Greene, R.A.; National Perinatal Epidemiology Centre (National Perinatal Epidemiology Centre. University College Cork, 2016-06)
    • Perioperative acute renal failure.

      Mahon, Padraig; Shorten, George; Department of Anaesthesia, Cork University Hospital, Wilton, Cork, Ireland., rsimahon@hotmail.com (2012-02-03)
      PURPOSE OF REVIEW: Recent biochemical evidence increasingly implicates inflammatory mechanisms as precipitants of acute renal failure. In this review, we detail some of these pathways together with potential new therapeutic targets. RECENT FINDINGS: Neutrophil gelatinase-associated lipocalin appears to be a sensitive, specific and reliable biomarker of renal injury, which may be predictive of renal outcome in the perioperative setting. For estimation of glomerular filtration rate, cystatin C is superior to creatinine. No drug is definitively effective at preventing postoperative renal failure. Clinical trials of fenoldopam and atrial natriuretic peptide are, at best, equivocal. As with pharmacological preconditioning of the heart, volatile anaesthetic agents appear to offer a protective effect to the subsequently ischaemic kidney. SUMMARY: Although a greatly improved understanding of the pathophysiology of acute renal failure has offered even more therapeutic targets, the maintenance of intravascular euvolaemia and perfusion pressure is most effective at preventing new postoperative acute renal failure. In the future, strategies targeting renal regeneration after injury will use bone marrow-derived stem cells and growth factors such as insulin-like growth factor-1.