• Sacral insufficiency fractures: an easily overlooked cause of back pain in the ED.

      Galbraith, John G; Butler, Joseph S; Blake, Simon P; Kelleher, Gemma; Department of Emergency Medicine, Cork University Hospital, Cork, Ireland. johng442@hotmail.com (2011-03)
      Sacral insufficiency fractures are an important and treatable cause of severe back pain. Despite publication of several case reports since its original description in 1982, awareness of these injuries remains inadequate in emergency medicine. Most patients are elderly women presenting with intractable lower back pain. Postmenopausal osteoporosis is the most significant risk factor. Marked sacral tenderness is common. Neurologic impairment is rarely detectable. Routine radiography of the spine and pelvis is usually inconclusive. Computed tomography remains the diagnostic modality of choice. Treatment is usually conservative.
    • Safety and tolerability of tegaserod in patients with chronic constipation: pooled data from two phase III studies.

      Quigley, Eamonn M M; Wald, Arnold; Fidelholtz, James; Boivin, Michel; Pecher, Eckhard; Earnest, David; Alimentary Pharmabiotic Centre, Department of Medicine, Cork University Hospital,, Wilton, Cork, Ireland. e.quigley@ucc.ie (2012-02-03)
      BACKGROUND & AIMS: Studies show that tegaserod effectively relieves the symptoms of chronic constipation/idiopathic constipation (CC). This pooled analysis assessed the safety and tolerability of tegaserod in a large dataset of CC patients. METHODS: Adverse event (AE) data were pooled from 2 double-blind, placebo-controlled phase III trials of 12 weeks' duration. Post hoc analysis was conducted for the most frequent AEs (incidence, >or=3%). RESULTS: Eight hundred eighty-one, 861, and 861 patients received tegaserod 6 mg twice a day, 2 mg twice a day, or placebo, respectively. Most AEs were mild/moderately severe. AE incidence was similar for the tegaserod 6 mg and 2 mg twice a day (57.1% and 56.3%, respectively) and placebo groups (59.6%) and most frequent in the gastrointestinal system (tegaserod 6 mg twice a day, 25.8%; 2 mg twice a day, 22.5%; placebo, 24.6%). Headache, the most common AE, was slightly more frequent in the placebo group (tegaserod 6 mg twice a day, 11.0%; 2 mg twice a day, 10.1%; placebo, 13.2%). Diarrhea (generally transient and resolved with continued treatment) was the only AE with a statistically significant difference between groups (tegaserod 6 mg twice a day 6.6% vs placebo 3.0%, P=.0005). Serious AE incidence (1.4% overall) was comparable across treatment groups, although abdominal surgery was less common in the combined tegaserod (0.5%) than the placebo group (1.0%). Discontinuation as a result of AEs was slightly higher in tegaserod 6 mg twice a day patients (5.7%; 2 mg twice a day, 3.3%; placebo, 3.7%), mainly because of diarrhea. Laboratory and electrocardiogram parameters were comparable across groups. CONCLUSIONS: Tegaserod is well tolerated by patients with CC during 12 weeks of treatment.
    • Salicylic acid burn induced by wart remover: a report of two cases.

      Tiong, W H C; Kelly, E J; Department of Plastic and Reconstructive Surgery, Cork University Hospital, Cork, Ireland. willhct@yahoo.com (2009-02)
    • Salmonella tel-el-kebir and terrapins.

      Lynch, M; Daly, M; O'Brien, B; Morrison, F; Cryan, B; Fanning, S; Department of Medical Microbiology, Cork University Hospital, Wilton, Ireland. (2012-02-03)
      OBJECTIVES: An outbreak of Salmonella tel-el-kebir occurring over a 6-month period is described in this report. This is the first outbreak of S. tel-el-kebir in the reported literature. METHODS: S. tel-el-kebir was isolated from human faecal samples using conventional laboratory methods. RESULTS: Eight patients had S. tel-el-kebir isolated from faeces. All patients were owners of, or in close contact with, pet terrapins. The terrapins were purchased in the same pet shop, where they were imported from America. The epidemiological link with these pets was confirmed, as S. tel-el-kebir was isolated from cloacal swabs from the terrapins, and from terrapin water. Molecular biology studies using DNA amplification fingerprinting (DAF) gave identical fingerprint patterns for all human and terrapin isolates. CONCLUSIONS: Salmonellosis associated with exotic pets is a re-emerging disease in the 1990s, and measures to reduce this are discussed.
    • Sarcoidosis in Ireland: regional differences in prevalence and mortality from 1996-2005.

      Nicholson, T T; Plant, B J; Henry, M T; Bredin, C P; Interstitial Lung Disease Clinic, Department of Respiratory Medicine, Cork University Hospital, Wilton, Cork, Ireland. tnicholson@physicians.ie (2010-07)
      Sarcoidosis is a common multisystem disease of unknown cause and Ireland is among the countries with the highest reported prevalence of disease worldwide. Despite this, reports on the geographical distribution of disease and differences in mortality due to sarcoidosis within Northern Ireland (NI) and the Republic of Ireland (ROI) are currently lacking.
    • Scalp abscess--a cautionary tale.

      Nugent, Nora F; Murphy, Michael; Kelly, Jason; Department of Plastic Surgery, Cork University Hospital, Wilton, Cork, Ireland. noranugent@gmail.com (Elsevier, 2010-08)
      Transcranial extension of frontal sinus infection is a rare, but not eradicated entity. We present a 21-year-old male, in whom a persistent scalp abscess heralded the discovery of skull vault osteomyelitis and extradural abscesses secondary to frontal sinusitis. Patients with prolonged or unusual symptoms with a history of sinusitis or trauma warrant further investigation as they may have developed serious intracranial complications. Urgent management, both surgical and antimicrobial, is indicated in such scenarios.
    • Schistosomiasis of the spinal cord presenting as progressive myelopathy. Case report.

      Kamel, Mahmoud Hamdy; Murphy, Martin; Kelleher, Michael; Aquilina, Kristian; Lim, Chris; Marks, Charles; Department of Neurosurgery, Cork University Hospital, Cork, Ireland., mahmoudhandy@yahoo.com (2012-02-03)
      The authors report on a case of schistosomiasis of the spinal cord in an individual returning to Ireland after a 25-year residence in Africa, where the infection affects approximately 200 million people.
    • Sciatica as a presenting feature of thyroid follicular adenocarcinoma in a 79-year-old woman.

      Ogbodo, Elisha; Kaliaperumal, Chandrasekaran; Keohane, Catherine; Bermingham, Niamh; Kaar, George; Department of Neurosurgery, Cork University Hospital, Cork, Ireland. (2011)
      The authors describe an unusual case of metastatic thyroid follicular adenocarcinoma presenting with sciatica in a 79-year-old woman. The primary thyroid tumour was undiagnosed until this clinical presentation. The patient gave a short history of back pain and right-sided sciatica, which was progressive and nocturnal in nature. Neuroimaging revealed an enhancing intradural mass lesion, which was completely excised through a right L1-L3 hemilaminectomy. Histopathological examination of the excised tissue revealed a follicular thyroid carcinoma. Subsequent metastatic investigation revealed a heterogeneously attenuating mixed solid cystic mass in a retrosternal thyroid gland, with multiple solid pulmonary nodules suggestive of metastatic disease. She opted for palliative radiotherapy for the primary thyroid cancer and made remarkable postoperative improvement. The authors conclude that surgical treatment of solitary metastatic lesion may produce good symptomatic relief irrespective of patient's age and primary pathology, while emphasising the need for detailed clinical evaluation of patients with 'red flag' symptoms.
    • Screening for CRLF2 overexpression in adult acute lymphoblastic leukemia.

      Haslam, K; Kelly, J; Morris, T; Connaghan, G; Gilligan, O; Browne, P; Langabeer, S E (2011-12)
    • Second trimester hepatic rupture in a 35 year old nulliparous woman with HELLP syndrome: a case report.

      Kelly, J; Ryan, Dj; O'Brien, N; Kirwan, Wo; Department of Surgery, Cork University Hospital, Wilton, Cork, Ireland. justinjoshkelly@gmail.com. (2009)
      The HELLP syndrome (haemolysis, elevated liver blood tests and low platelets) is a serious complication in pregnancy characterized by haemolysis, elevated liver enzymes and low platelet count occurring in 0.5 to 0.9% of all pregnancies and in 10-20% of cases with severe preeclampsia. Hepatic capsular rupture is a rare yet dramatic complication of HELLP syndrome. The majority of cases occur in multiparous women over the age of 30. Classically it presents with acute onset right upper quadrant pain in the presence of constitutional symptoms such as vomiting and pyrexia. However, symptoms and signs are usually non specific. Spontaneous hepatic rupture can be preceded by signs of hypovolaemic shock; yet the diagnosis is infrequently made prior to emergent laparotomy. We present the case of a 35 year old nulliparous woman with a second trimester gestational hepatic rupture associated with HELLP syndrome. We briefly discuss the aetiology, diagnostic difficulties and treatment options associated with this rare presentation.
    • Seizure burden and neurodevelopmental outcome in neonates with hypoxic-ischemic encephalopathy.

      Kharoshankaya, Liudmila; Stevenson, Nathan J; Livingstone, Vicki; Murray, Deirdre M; Murphy, Brendan P; Ahearne, Caroline E; Boylan, Geraldine B (Developmental Medicine & Child Neurology, 2016-12)
      To examine the relationship between electrographic seizures and long-term outcome in neonates with hypoxic-ischemic encephalopathy (HIE).
    • Selection of symptomatic patients with Crohn's disease for abdominopelvic computed tomography: role of serum C-reactive protein.

      Desmond, Alan N; O'Regan, Kevin; Malik, Neera; McWilliams, Sebastian; O'Neill, Siobhan; Quigley, Eamonn M; Shanahan, Fergus; Maher, Michael M; Alimentary Pharmabiotic Centre, University College Cork, National University of Ireland and Cork University Hospital, Cork, Ireland. (2012-11)
      Results of previous studies have shown that repeated abdominopelvic computed tomography (CT) examinations can lead to substantial cumulative diagnostic radiation exposure in patients with Crohn's disease (CD). Improved selection of patients referred for CT will reduce unnecessary radiation exposure. This study examines if serum C-reactive protein (CRP) concentration predicts which symptomatic patients with CD are likely to have significant disease activity or disease complications (such as abscess) detected on abdominopelvic CT.
    • Selective endoscopy in management of ingested foreign bodies of the upper gastrointestinal tract: is it safe?

      O'Sullivan, S T; McGreal, G T; Reardon, C M; Hehir, D J; Kirwan, W O; Brady, M P; Department of Surgery, Cork University Hospital, Ireland. (2012-02-03)
      During a four-year period, 308 patients presented following ingestion of foreign bodies. Ingestion was accidental in 272 cases (88.3%) and deliberate in the remainder. Symptoms at presentation included dysphagia, odynophagia, nausea and vomiting, chest pain and pharyngeal discomfort. Sixty-eight patients were asymptomatic. A policy of expectant management and selective endoscopy was employed. Following initial assessment 202 patients (65.6%) were discharged without treatment, 30 (9.7%) of whom were later reviewed as outpatients and did not require admission. Forty-nine patients (16%) were admitted for treatment; 27 had oesophagoscopy, five bronchoscopy and two had foreign body extraction with direct laryngoscopy. In nine patients who were endoscoped, no foreign body was identified. Twenty-seven others were referred to the otorhinolaryngology service in another hospital. There were no deaths in the group and morbidity was 1.2%. We conclude that a policy of selective endoscopy is safe and effective in the management of patients following ingestion of foreign bodies.
    • Self-management education for cystic fibrosis.

      Savage, Eileen; Beirne, Paul V; Ni Chroinin, Muireann; Duff, Alistair; Fitzgerald, Tony; Farrell, Dawn; Catherine McAuley School of Nursing & Midwifery Brookfield Health Sciences Complex, University College Cork, Cork, Ireland. (2011)
      Self-management education may help patients with cystic fibrosis and their families to choose, monitor and adjust treatment requirements for their illness, and also to manage the effects of illness on their lives. Although self-management education interventions have been developed for cystic fibrosis, no previous systematic review of the evidence of effectiveness of these interventions has been conducted.
    • Sensitivity and specificity of a two-question screening tool for depression in a specialist palliative care unit.

      Payne, Ann; Barry, Sandra; Creedon, Brian; Stone, Carol; Sweeney, Catherine; O' Brien, Tony; O' Sullivan, Kathleen; Cork University Hospital, Cork, Ireland. dannann@eircom.net (2012-02-03)
      OBJECTIVES: The primary objective in this study is to determine the sensitivity and specificity of a two-item screening interview for depression versus the formal psychiatric interview, in the setting of a specialist palliative in-patient unit so that we may identify those individuals suffering from depressive disorder and therefore optimise their management in this often-complex population. METHODS: A prospective sample of consecutive admissions (n = 167) consented to partake in the study, and the screening interview was asked separately to the formal psychiatric interview. RESULTS: The two-item questionnaire, achieved a sensitivity of 90.7% (95% CI 76.9-97.0) but a lower specificity of 67.7% (95% CI 58.7-75.7). The false positive rate was 32.3% (95% CI 24.3-41.3), but the false negative rate was found to be a low 9.3% (95% CI 3.0-23.1). A subgroup analysis of individuals with a past experience of depressive illness, (n = 95), revealed that a significant number screened positive for depression by the screening test, 55.2% (16/29) compared to those with no background history of depression, 33.3% (22/66) (P = 0.045). CONCLUSION: The high sensitivity and low false negative rate of the two-question screening tool will aid health professionals in identifying depression in the in-patient specialist palliative care unit. Individuals, who admit to a previous experience of depressive illness, are more likely to respond positively to the two-item questionnaire than those who report no prior history of depressive illness (P = 0.045).
    • Sentinel lymph node biopsy: is it possible to reduce false negative rates by excluding patients with nodular melanoma?

      Corrigan, M A; Coffey, J C; O'Sullivan, M J; Fogarty, K M; Redmond, H P; Department of Academic Surgery, Cork University Hospital, Ireland., mark@surgent.ie (2012-02-03)
      OBJECTIVE: The aim of this study was to review the outcome of sentinel lymph node biopsy (SLNB) in patients with melanoma and to delineate whether patients with nodular melanoma are more likely to develop nodal recurrence despite negative SLNB. METHODS: Consecutive patients with cutaneous melanoma undergoing SLNB were identified from a departmental database between 1997 and 2005. Factors including demographic data, site, histological subtype, depth and outcome were examined. RESULTS: Of 131 patients, 103 were node negative and eligible for study. The median age was 53 (16-82) years with 46 patients being male (45%) and 57 female (55%). Primary melanoma sites included lower limb (49; 48%), upper limb (29; 28%), head (12; 11%), trunk (7; 7%) and back (6; 6%). The median Breslow thickness was 2mm. Superficial spreading accounted for 43% of melanoma with nodular accounting for 42%. Median follow-up was 40 (3-90) months. Of 20 relapses, seven recurred in the same nodal basin, three were satellite recurrences, one recurred with both satellite and nodal lesions simultaneously, and nine experienced haematogenous spread. Of the eight patients who developed recurrence in the same nodal basin, four were of nodular histological subtype (p=NS). All of the three patients with satellite lesions had nodular melanoma histologically (p=0.02). When nodal and satellite recurrences were combined, eight of 11 were histologically nodular (p=0.01). CONCLUSIONS: This study indicates that lymphatic recurrence occurs more often in SLNB negative patients with nodular melanoma. Further evaluation of the inclusion criteria for sentinel node biopsy is warranted.
    • Sentinel nodes are identifiable in formalin-fixed specimens after surgeon-performed ex vivo sentinel lymph node mapping in colorectal cancer.

      Smith, Fraser McLean; Coffey, John Calvin; Khasri, Nurul Mod; Walsh, Miriam Fiona; Parfrey, Nollaig; Gaffney, Eoin; Stephens, Richard; Kennedy, M John; Kirwan, William; Redmond, H Paul; et al. (2012-02-03)
      BACKGROUND: In recent years, the technique of sentinel lymph node (SLN) mapping has been applied to colorectal cancer. One aim was to ultrastage patients who were deemed node negative by routine pathologic processing but who went on to develop systemic disease. Such a group may benefit from adjuvant chemotherapy. METHODS: With fully informed consent and ethical approval, 37 patients with primary colorectal cancer and 3 patients with large adenomas were prospectively mapped. Isosulfan blue dye (1 to 2 mL) was injected around tumors within 5 to 10 minutes of resection. After gentle massage to recreate in vivo lymph flow, specimens were placed directly into formalin. During routine pathologic analysis, all nodes were bivalved, and blue-staining nodes were noted. These later underwent multilevel step sectioning with hematoxylin and eosin and cytokeratin staining. RESULTS: SLNs were found in 39 of 40 patients (98% sensitivity), with an average of 4.1 SLNs per patient (range, 1-8). In 14 of 16 (88% specificity) patients with nodal metastases on routine reporting, SLN status was in accordance. Focused examination of SLNs identified occult tumor deposits in 6 (29%) of 21 node-negative patients. No metastatic cells were found in SLNs draining the three adenomas. CONCLUSIONS: The ability to identify SLNs after formalin fixation increases the ease and applicability of SLN mapping in colorectal cancer. Furthermore, the sensitivity and specificity of this simple ex vivo method for establishing regional lymph node status were directly comparable to those in previously published reports.
    • Separation of Hepatitis C genotype 4a into IgG-depleted and IgG-enriched fractions reveals a unique quasispecies profile.

      Moreau, Isabelle; O'Sullivan, Hilary; Murray, Caroline; Levis, John; Crosbie, Orla; Kenny-Walsh, Elizabeth; Fanning, Liam J; Department of Medicine, Molecular Virology Diagnostic & Research Laboratory,, Clinical Sciences Building, Cork University Hospital, Cork, Ireland., i.moreau@ucc.ie (2012-02-03)
      BACKGROUND: Hepatitis C virus (HCV) circulates in an infected individual as a heterogeneous mixture of closely related viruses called quasispecies. The E1/E2 region of the HCV genome is hypervariable (HVR1) and is targeted by the humoral immune system. Hepatitis C virions are found in two forms: antibody associated or antibody free. The objective of this study was to investigate if separation of Hepatitis C virions into antibody enriched and antibody depleted fractions segregates quasispecies populations into distinctive swarms. RESULTS: A HCV genotype 4a specimen was fractionated into IgG-depleted and IgG-enriched fractions by use of Albumin/IgG depletion spin column. Clonal analysis of these two fractions was performed and then compared to an unfractionated sample. Following sequence analysis it was evident that the antibody depleted fraction was significantly more heterogeneous than the antibody enriched fraction, revealing a unique quasispecies profile. An in-frame 3 nt insertion was observed in 26% of clones in the unfractionated population and in 64% of clones in the IgG-depleted fraction. In addition, an in-frame 3 nt indel event was observed in 10% of clones in the unfractionated population and in 9% of clones in the IgG-depleted fraction. Neither of these latter events, which are rare occurrences in genotype 4a, was identified in the IgG-enriched fraction. CONCLUSION: In conclusion, the homogeneity of the IgG-enriched species is postulated to represent a sequence that was strongly recognised by the humoral immune system at the time the sample was obtained. The heterogeneous nature of the IgG-depleted fraction is discussed in the context of humoral escape.
    • Septic arthritis due to Actinomyces pyogenes.

      Nicholson, P; Kiely, P; Street, J; Mahalingum, K; Department of Orthopaedic Surgery, Cork University Hospital, Ireland. (2012-02-03)
    • Septic arthritis of the adult ankle joint secondary to Salmonella enteritidis: a case report.

      Munigangaiah, Sudarshan; Khan, Hamid; Fleming, Pat; Dolan, Mark A; Department of Trauma and Orthopaedic Surgery, Cork University Hospital, Wilton, Cork, Ireland. drsudarshan79@yahoo.com (Elsevier Ltd., 2011-09)
      Salmonella septic arthritis in healthy individuals is a rare phenomenon. However, septic arthritis of the native adult ankle joint in healthy patients has not been previously described in the published data. This is a case report of a 70-year-old farmer who presented with a 2-week history of a painful, swollen right ankle and an inability to bear weight. He had no history of ankle injury or any predisposing conditions. Joint aspirations were positive for Salmonella enteritidis that was successfully treated with right ankle arthrotomy and washout, along with a 6-week course of intravenous antibiotic therapy.