• Radiation exposure from diagnostic imaging among patients with gastrointestinal disorders.

      Desmond, Alan N; McWilliams, Sebastian; Maher, Michael M; Shanahan, Fergus; Quigley, Eamonn M; Department of Gastroenterology, Cork University Hospital, Cork, Ireland. alanndesmond@gmail.com (2012-03)
      There are concerns about levels of radiation exposure among patients who undergo diagnostic imaging for inflammatory bowel disease (IBD), compared with other gastrointestinal (GI) disorders. We quantified imaging studies and estimated the cumulative effective dose (CED) of radiation received by patients with organic and functional GI disorders. We also identified factors and diagnoses associated with high CEDs.
    • Radiation exposure in gastroenterology: improving patient and staff protection.

      Ho, Immanuel K H; Cash, Brooks D; Cohen, Henry; Hanauer, Stephen B; Inkster, Michelle; Johnson, David A; Maher, Michael M; Rex, Douglas K; Saad, Abdo; Singh, Ajaypal; et al. (Nature Publishing Group, 2014-08)
      Medical imaging involving the use of ionizing radiation has brought enormous benefits to society and patients. In the past several decades, exposure to medical radiation has increased markedly, driven primarily by the use of computed tomography. Ionizing radiation has been linked to carcinogenesis. Whether low-dose medical radiation exposure will result in the development of malignancy is uncertain. This paper reviews the current evidence for such risk, and aims to inform the gastroenterologist of dosages of radiation associated with commonly ordered procedures and diagnostic tests in clinical practice. The use of medical radiation must always be justified and must enable patients to be exposed at the lowest reasonable dose. Recommendations provided herein for minimizing radiation exposure are based on currently available evidence and Working Party expert consensus.
    • Radiographic findings after pubic symphysiotomy: mean time to follow-up of 41.6 years.

      Galbraith, John G; Murphy, Kevin P; Baker, Joseph F; Fleming, Pat; Marshall, Nina; Harty, James A; Department of Trauma and Orthopaedic Surgery (J.G.G., J.F.B., P.F., and J.A.H.) and Department of Radiology (K.P.M. and N.M.), Cork University Hospital, Wilton, Cork, Ireland. E-mail address for J.A. Harty: jaharty@hotmail.com. (2014-01-01)
      Pubic symphysiotomy is a rarely performed procedure in which the pubic symphysis is divided to facilitate vaginal delivery in cases of obstructed labor. Recently, many obstetricians have shown renewed interest in this procedure. The purpose of this paper is to report the long-term radiographic findings for patients who had undergone pubic symphysiotomy compared with the radiographic appearance of a group of age-matched and parity-matched controls.
    • Radiologic imaging in cystic fibrosis: cumulative effective dose and changing trends over 2 decades.

      O'Connell, Oisin J; McWilliams, Sebastian; McGarrigle, AnneMarie; O'Connor, Owen J; Shanahan, Fergus; Mullane, David; Eustace, Joseph; Maher, Michael M; Plant, Barry J; Cork Adult Cystic Fibrosis Center, Cork University Hospital, Cork, Ireland. (2012-06)
      With the increasing life expectancy for patients with cystic fibrosis (CF), and a known predisposition to certain cancers, cumulative radiation exposure from radiologic imaging is of increasing significance. This study explores the estimated cumulative effective radiation dose over a 17-year period from radiologic procedures and changing trends of imaging modalities over this period.
    • Radiological features of progressive tumoral calcinosis in chronic renal failure.

      Hodnett, P; Moore, M; Kinsella, S; Kelly, D; Plant, W D; Maher, M M; Radiology Department, Cork University Hospital, Cork, Ireland., phodnett@eircom.net (2012-02-03)
      We present the case of a young adult patient with chronic renal failure who developed painful subcutaneous nodules after failed renal transplant and recommencing dialysis. These nodules were juxta-articular in location and initially located over both shoulders. Radiological evaluation suggested tumoral calcinosis. The patient was placed on a strict dialysis and dietary regimen but was suboptimally compliant with same. The patient developed progressive disease with an increase in size and number of juxta-articular calcified soft-tissue masses. However, 6 months following a second renal transplant clinical and radiological follow up demonstrated marked resolution both in symptomatology and radiographic findings. We present the plain radiographic, CT and MRI findings which demonstrate the typical radiological features of tumoral calcinosis. We correlate these findings with clinical course and histological findings following surgical excision of one of these masses.
    • Radiological management of patients with urinary obstruction following urinary diversion procedures: technical factors, complications, long-term management and outcome. Experience with 378 procedures.

      Maher, M M; Rizzo, S; Kalra, M; Mc Sweeney, S E; Arellano, R; Hahn, P; Gervais, D; Mueller, P; Department of Radiology, University College Cork, Cork University Hospital, Cork,, Ireland. m.maher@ucc.ie (2012-02-03)
      We aimed to assess management by interventional radiology techniques of patients with urinary diversion procedures (UD) complicated by urinary obstruction (UO). A 12-year electronic database of interventional cases was searched for urinary access in patients with UD. Patients' records were assessed for aetiology of obstruction, indication for procedure, types of interventional radiology, complications and outcome. Management issues included frequency of visits for catheter care, type of catheter placement and technical problems associated with catheter maintenance. Three hundred and seventy eight procedures were carried out in 25 patients (mean age 70 years; Male : Female ratio 13:12). Indications for UD were malignancy (n = 22) and neuropathic bladder (n = 3). UD included ileal conduits (n = 17), cutaneous ureterostomy (n = 3 (2 patients)) and sigmoid colon urinary conduit (n = 6). In most patients, catheters were placed antegradely through nephrostomy tract, but subsequent access was through the UD. Twenty of 25 patients had unilateral stents where as 5 had bilateral stents (8-10- Fr pigtail catheters (20-45 cm in length)). The mean number of procedures including catheter changes was 15 +/- 4 per patient and 331 of 378 procedures (87 %) were carried out as outpatients. Since catheter placement, 11 patients required hospital admission on 22 occasions for catheter-related complications. Ureteric strictures in patients with UD can be successfully managed by interventional radiology.
    • A randomised controlled trial of absorbable versus non-absorbable sutures for skin closure after open carpal tunnel release.

      Theopold, C; Potter, S; Dempsey, M; O'Shaughnessy, M; Department of Plastic and Reconstructive Surgery, Cork University Hospital, Wilton, Cork, Republic of Ireland. theopold@doctors.org.uk (2012-05)
      We compared the aesthetic outcome of scars after closure of open carpal tunnel incisions with either absorbable 4-0 Vicryl Rapide or non-absorbable 4-0 Novafil. Patients were recruited in a randomized controlled trial and scars were scored at 6 weeks using a modified Patient and Observer Scar Assessment Scale. Scores demonstrated differences only for pain, vascularity and cross-hatching between both groups, though none of these were statistically significant. The dissolving and falling out of Vicryl Rapide was significantly more comfortable than removal of 4-0 Novafil sutures, assessed on a numerical analogue scale. There was no difference in infection rate between both study groups, supporting overall the use of Vicryl Rapide for the closure of palmar hand incisions, in light of the convenience and cost savings associated with absorbable sutures.
    • Randomized controlled trial of supervised patient self-testing of warfarin therapy using an internet-based expert system.

      Ryan, F; Byrne, S; O'Shea, S; Pharmaceutical Care Research Group, University College Cork, Cork, Ireland. (2009-08)
      Increased frequency of prothrombin time testing, facilitated by patient self-testing (PST) of the International Normalized Ratio (INR) can improve the clinical outcomes of oral anticoagulation therapy (OAT). However, oversight of this type of management is often difficult and time-consuming for healthcare professionals. This study reports the first randomized controlled trial of an automated direct-to-patient expert system, enabling remote and effective management of patients on OAT.
    • The range of excursion of flexor tendons in Zone V: a comparison of active vs passive flexion mobilisation regimes.

      Panchal, J; Mehdi, S; O'Donoghue, J M; O'Sullivan, S T; O'Shaughnessy, M; O'Connor, T P; Department of Plastic Surgery, Cork University Hospital, Ireland. (1997-10)
      A number of early postoperative mobilisation regimes have been developed in an attempt to increase tendon excursion and gliding and thereby reduce formation of adhesions following repair of flexor tendons. Early active flexion mobilisation regimes are becoming more popular, and have replaced early passive flexion regimes in many centres. The aim of the present study was: (a) to determine the range of excursion of flexor tendons in Zone V, and (b) to compare the excursion ranges between active (Belfast) and passive (modified Duran) flexion mobilisation regimes postoperatively. This was done (a) in two cadavers, and (b) in two patients intraoperatively, and postoperatively at 10 days, 3 weeks and 6 weeks. With passive flexion, the mean tendon excursion in Zone V in cadavers was 1 mm for flexor digitorum superficialis (FDS), flexor digitorum profundus (FDP) and flexor pollicis longus (FPL) tendons respectively. With simulated active flexion, the mean tendon excursion was 14 mm, 10 mm and 11 mm respectively. The mean tendon excursion in clinical cases intraoperatively following passive flexion was 2 mm for FDS, FDP and FPL respectively; following simulated active flexion it was 10 mm, 11 mm and 11 mm for FDS, FDP and FPL respectively. On the tenth day following repair, the mean excursions of FDS, FDP and FPL were 1 mm, 4 mm and 4 mm on passive flexion as compared to 3 mm, 10 mm and 12 mm on active flexion respectively. Three weeks postoperatively, the mean excursions of FDS, FDP and FPL tendons were 1 mm, 2 mm and 1 mm on passive flexion as compared to 5 mm, 15 mm on active flexion respectively. Six weeks postoperatively, the mean excursions of FDS, FDP and FPL tendons were 9 mm, 7 mm and 4 mm on passive flexion as compared to 12 mm, 33 mm and 20 mm on active flexion respectively. These results demonstrate an increased excursion of repaired flexor tendons in Zone V following an active flexion mobilisation regime as compared to a passive flexion mobilisation regime.
    • Rapid intraoperative parathyroid hormone assay--more than just a comfort measure.

      Hanif, F; Coffey, J C; Romics, L Jr; O'Sullivan, K; Aftab, F; Redmond, H P; Department of Surgery, National University of Ireland, Cork, and Cork University , Hospital, Cork, Ireland. (2012-02-03)
      BACKGROUND: Minimally invasive radio-guided parathyroidectomy (MIRP) has been embraced as an acceptable therapeutic approach to primary hyperparathyroidism. Preoperative sestamibi scanning has facilitated this technique. Here we evaluate the addition of a rapid intraoperative parathyroid hormone (iPTH) assay for patients undergoing MIRP. METHODS: A series of 51 patients underwent sestamibi localization of parathyroid glands followed by MIRP for primary hyperparathyroidism. Using peripheral venous samples, iPTH levels were measured prior to gland excision, as well as post-excision at 5, 10, and 15 minutes, taking a 50% reduction in iPTH level as indicative of complete excision. Next, changes in serum iPTH were compared with preoperative and postoperative changes in serum calcium, as well as levels of intraoperative ex-vivo radiation counts taken by hand-held gamma probe. RESULTS: In this series, a drop of greater than 50% in iPTH levels was observed in 94% of patients (n=48). Moreover, a significant drop in iPTH occurred within 10 minutes of excision in the majority (n=42) of cases (P<0.004). Changes in iPTH were comparable with the therapeutic reduction in calcium levels, as well as with the change in intraoperative ex-vivo gamma counts. CONCLUSIONS: This study demonstrates that the addition of an iPTH assay to MIRP provides a quick and reliable intraoperative diagnostic modality in confirming correct adenoma removal. Moreover, it precludes the requirement of frozen section.
    • Rapid on-site evaluation of axillary fine-needle aspiration cytology in breast cancer.

      O'Leary, D P; O'Brien, O; Relihan, N; McCarthy, J; Ryan, M; Barry, J; Kelly, L M; Redmond, H P; Department of Surgery, Cork University Hospital, Cork, Ireland. donaloleary@rcsi.ie (2012-06)
      Axillary ultrasonography (AUS) and fine-needle aspiration cytology (FNAC) can establish axillary lymph node status before surgery, although this technique is hampered by poor adequacy rates. To achieve consistently high rates of FNAC adequacy, rapid on-site evaluation (ROSE) of FNAC samples was introduced.
    • Rapid recurrence of pulmonary hypertension following cessation of nifedipine.

      Gallagher, M M; Hart, C M; Vaughan, C J; Fennell, W H; Department of Cardiology, Cork University Hospital, Ireland. (2012-02-03)
      In a young woman with primary pulmonary hypertension, treatment with low-dose nifedipine resulted in resolution of symptoms and of tricuspid regurgitation. On withdrawal of nifedipine, symptomatic pulmonary hypertension recurred within 48 hours and was controlled by reintroduction of low-dose nifedipine.
    • A rare cause of testicular pain: thrombosis of the pampiniform

      Tanner, R; Twomey, M; Maher, MM; Fitzgerald, E; O’Connor, J (Irish Medical Journal, 2016-01)
      Testicular pain is a common presentation in the emergency department. The cause includes a wide array of differentials. This report highlights a case of thrombosis of the pampiniform plexus as a rare cause of testicular pain. Doppler ultrasound should be the first line investigation. Symptomatic relief with anti-inflammatory medication should be sufficient for management.
    • Re-challenge with Etanercept in patients with Etanercept-induced Neutropenia.

      Haroon, Muhammad; Daly, Mary; Harney, Sinead; Department of Rheumatology, Cork University Hospital, Cork, Ireland, mharoon301@hotmail.com. (Springer, 2011-08-05)
      TNF blockers have rarely been associated with haematological complications; however, there are scattered case reports of marked neutropenia with their use and necessitating in their withdrawal. We would like to report a series of five patients who developed neutropenia with etanercept use; however, all these patients were re-challenged with etanercept with a mean follow up of 30 months. These patients developed neutropenia within 2 months of starting etanercept. Two patients were eventually taken off etanercept; one of them needed switching to a different form of TNF blockers, and the second patient is in clinical remission with low-dose corticosteroids. All our patients continued to have mild-moderate degree of neutropenia; however, they are being monitored very closely and they are enjoying complete disease remission. It was interesting to note that none of our patients had increased infections during the re-challenge phase, even though they had grade 2 to grade 4 neutropenia. We have re-challenged these patients without any clinical complications, revealing that patients with mild to moderate neutropenia can be safely exposed to TNF blockers as long as they are monitored with regular cell count checks. Although largely noted to be clinically insignificant in our patient series, the potential of drug-induced neutropenia in causing higher rate of infections do exist. Careful clinical and hematologic monitoring is the best way to recognize this adverse event.
    • Readability level of patient information leaflets for older people.

      Cronin, M; O'Hanlon, S; O'Connor, M; Cork University Hospital, Wilton, Cork, Ireland. (2011-03)
      Limited literacy is associated with a nearly twofold increase in mortality in older patients.
    • Recent trends in chlamydial and gonococcal conjunctivitis among neonates and adults in an Irish hospital.

      Quirke, Michael; Cullinane, Anthony; Department of Ophthalmology, Cork University Hospital, Wilton, Cork, Ireland., mmmquirke@hotmail.com (2012-02-03)
      BACKGROUND: Chlamydia trachomatis and Neisseria gonorrhoeae are two important and frequently overlooked causes of neonatal and adult conjunctivitis. OBJECTIVES AND METHODS: In order to improve primary treatment, prevention, and control of infection caused by these organisms, an analysis of all cases presenting from July 2002 to December 2006 at a major Irish regional teaching hospital was performed. RESULTS: There were 51 cases of conjunctivitis in total. Among neonates and adults, C. trachomatis was the most common cause of conjunctivitis. Of the adult patients, 75% were men. The annual incidence of adult chlamydial conjunctivitis increased yearly from 2002 and correlated with an overall increase in genital chlamydia infection in the region. Neonatal chlamydial conjunctivitis has an overall incidence of 0.65/1000 live births and is continuing to rise annually. In 2006, gonococcal conjunctivitis accounted for 20% of all cases of conjunctivitis caused by sexually transmitted bacteria presenting to our hospital. CONCLUSIONS: The recent increase in the incidence of gonococcal keratitis serves to remind us that this important infection should be borne in mind when treating cases of purulent conjunctivitis. The diagnosis of chlamydial and gonococcal conjunctivitis requires a high index of suspicion and prompt treatment with systemic antibiotics.
    • Recognition and management of Shaken Baby Syndrome

      Nicholson, Alf (Irish Medical Journal, 2016-04)
      Abusive head trauma (previously referred to as Shaken Baby Syndrome) consists of a triad of findings which included subdural haemorrhage, retinal haemorrhages and encephalopathy after receiving a shake injury or blunt trauma to the head. Debate rages regarding the exact mechanism. Previously published reports on abusive head trauma (AHT) highlight the young age of the victims (median 4 months of age), the significant preponderance of male infants (3:1 in most series), the high rate of probable male perpetrators (just over 50%), and relatively high rates of mortality and morbidity
    • Recognition of psychogenic non-epileptic seizures: a curable neurophobia?

      O'Sullivan, S S; Redwood, Rebecca I; Hunt, David; McMahon, Elaine M; O'Sullivan, Suzanne; Cork University Hospital Neurosciences Department, University College Cork, Ireland. sean.osullivan@hse.ie (2013-02)
      Diagnosing psychogenic non-epileptic seizures (PNES) remains challenging. The majority of 'PNES status' cases are likely to be seen in the emergency department or similar non-specialised units, where patients are initially assessed and managed by physicians of varying expertise in neurology.