• Tailored diagnostics: a proposal.

      O'Neill, Siobhan B; Maher, Michael M; O'Reilly, Seamus (2011-07-10)
    • Tamoxifen and Potent CYP2D6 Inhibitors: A Potentially Lethal Interaction

      Battley, JE; O’Connor, M; Barron, TI; O’Reilly, S (Irish Medical Journal, 2015-06)
      Tamoxifen has a well-established role in the management of oestrogen-receptor positive breast cancer halving the 5-year recurrence risk of early stage breast cancer, reducing mortality and controlling metastasis. It is an inactive pro-drug which is activated by the hepatic cytochrome P450 system.
    • Teaching and learning spinal anaesthesia: anaesthetists' attitudes.

      Breen, Dorothy; Shorten, George; Bogar, Lajos; Aboulafia, Annette; Department of Anaesthesia and Intensive Care, Cork University Hospital, Ireland. dorothybreen@financialcontroller.ie (2010-12)
      To identify the determinants of learning for one medical procedural skill, spinal anaesthesia, by eliciting the opinions of anaesthetists in Ireland and Hungary. This objective is one component of a research project, Medical Competence Assessment Procedure (MedCAP) funded by the EU Leonardo da Vinci Lifelong Learning Programme.
    • Technical knockout: when is traumatic brain injury “just” a concussion?

      O’Halloran, P J; Johnson, A (Irish Medical Journal, 2016-05)
      While cricket is an unlikely source of concussion, the fierce contagion of media coverage surrounding Rugby and Gaelic Football has led to difficulties in deciphering real from perceived risk. The surge in public interest has forced this young science to mature quickly. The principles of managing head injury have not changed, but there is now a greater awareness that concussion is a traumatic brain injury (TBI). Concussion is a poorly understood, historical term, used to describe a low velocity injury causing brain “shaking.” This results in a nebulous cluster of non-specific symptoms. The most recent attempt to redefine the term was in 2012 (Zurich). The key features of concussion involve the transmission of an impulsive force to the head, the rapid onset of transient, spontaneously resolving neurological impairment, and clinical symptoms that may or may not involve loss of consciousness1
    • Technical note: the humeral canal approach to the brachial plexus.

      Frizelle, H P; Department of Anesthesia, Cork University Hospital, Wilton, Ireland., hpfiiz@indigo.ie (2012-02-03)
      Many variations to the axillary approach to the brachial plexus have been described. However, the success rate varies depending on the approach used and on the definition of success. Recent work describes a new approach to regional anaesthesia of the upper limb at the humeral/brachial canal using selective stimulation of the major nerves. This report outlines initial experience with this block, describing the technique and results in 50 patients undergoing hand and forearm surgery. All patients were assessed for completeness of motor and sensory block. The overall success rate was 90 percent. Motor block was present in 80 percent of patients. Completion of the block was necessary in 5 patients. Two patients required general anaesthesia. The preponderance of ulnar deficiencies agrees with previously published data on this technique. No complications were described. Initial experience confirms the high success rate described using the Dupre technique. This technically straightforward approach with minimal complications can be recommended for regional anaesthesia of the upper limb.
    • Technological progress in radiation therapy for brain tumors

      Vernimmen, Frederik Jozef; Rock, Kathy (Journal of Cancer Therapy, 2014-01)
      To achieve a good therapeutic ratio the radiation dose to the tumor should be as high as possible with the lowest possible dose to the surrounding normal tissue. This is especially the case for brain tumors. Technological ad- vancements in diagnostic imaging, dose calculations, and radiation delivery systems, combined with a better un- derstanding of the pathophysiology of brain tumors have led to improvements in the therapeutic results. The widely used technology of delivering 3-D conformal therapy with photon beams (gamma rays) produced by Li-near Accelerators has progressed into the use of Intensity modulated radiation therapy (IMRT). Particle beams have been used for several decades for radiotherapy because of their favorable depth dose characteristics. The introduction of clinically dedicated proton beam therapy facilities has improved the access for cancer patients to this treatment. Proton therapy is of particular interest for pediatric malignancies. These technical improvements are further enhanced by the evolution in tumor physiology imaging which allows for improved delineation of the tumor. This in turn opens the potential to adjust the radiation dose to maximize the radiobiological effects. The advances in both imaging and radiation therapy delivery will be discussed.
    • Telephone Follow-Up of Mild Traumatic Brain Injury; A Feasibility Study

      Underwood, S.; Campbell, S.; Deasy, C. (Irish Medical Journal, 2019-09)
      This study investigates the prevalence of Post-Concussion Syndrome (PCS) one-year post-injury in patients that were treated for Mild Traumatic Brain Injury (mTBI) in the Clinical Decision Unit (CDU) of Cork University Hospital’s (CUH) Emergency Department.
    • Temporal artery biopsy is not required in all cases of suspected giant cell arteritis.

      Quinn, Edel Marie; Kearney, David E; Kelly, Justin; Keohane, Catherine; Redmond, Henry Paul; Department of Academic Surgery, Cork University Hospital, Wilton, Cork, Ireland. edelquinn@rcsi.ie (2012-07)
      Temporal artery biopsy (TAB) is performed during the diagnostic workup for giant cell arteritis (GCA), a vasculitis with the potential to cause irreversible blindness or stroke. However, treatment is often started on clinical grounds, and TAB result frequently does not influence patient management. The aim of this study was to assess the need for TAB in cases of suspected GCA.
    • Testicular dislocation after scrotal trauma.

      O'Donnell, C; Kumar, U; Kiely, E A; Department of Urology, Cork University Hospital, Ireland. (2012-02-03)
    • Testing haptic sensations for spinal anesthesia.

      Kulcsár, Zsuzsanna M; Lövquist, Erik; Fitzgerald, Anthony P; Aboulafia, Annette; Shorten, George D; Department of Anaesthesia and Intensive Care Medicine, Cork University Hospital, Wilton, Cork, Ireland. zsuzsanna.kulcsar@gmail.com (2011-01)
      Having identified key determinants of teaching and learning spinal anesthesia, it was necessary to characterize and render the haptic sensations (feeling of touch) associated with needle insertion in the lower back. The approach used is to match recreated sensations (eg, "pop" through skin or dura mater) with experts' perceptions of the equivalent clinical events.
    • Tetomilast.

      O'Mahony, Seamus; Cork University Hospital, Wilton, Cork, Ireland. omahonys3@shb.ie (2012-02-03)
      Otsuka is developing a once-daily oral formulation of the phosphodiesterase-4 inhibitor tetomilast for the potential treatment of ulcerative colitis (phase III) and chronic obstructive pulmonary disease (phase II).
    • Therapeutic implications of manipulating and mining the microbiota.

      Shanahan, Fergus; Department of Medicine, Alimentary Pharmabiotic Centre, Clinical Science Building, Cork University Hospital and University College Cork, Cork, Ireland. f.shanahan@ucc.ie (2009-09-01)
      The gut microbiota is increasingly recognized as a health asset but occasionally is a contributor to the pathogenesis of both gastrointestinal and certain extra-intestinal disorders. This is driving research interest, the pace of which has been greatly facilitated by new molecular technologies for studying mixed microbial populations, including the non-cultivable sector. In addition, it appears that elements of a modern lifestyle such as diet, domestic hygiene, urbanization, antibiotic usage and family size, may represent proxy markers of environmental influence on the composition of the microbiota colonizing the host in early life. While manipulation of the microbiota has become a therapeutic strategy in certain clinical disorders, the prospect of mining host-microbe-dietary interactions for novel drug discovery may become an even more intriguing reality.
    • Therapies aimed at the gut microbiota and inflammation: antibiotics, prebiotics, probiotics, synbiotics, anti-inflammatory therapies.

      Quigley, Eamonn M M; Department of Medicine, Alimentary Pharmabiotic Centre, Cork University Hospital, University College Cork, Clinical Sciences Building, Cork, Ireland. e.quigley@ucc.ie (2011-03)
      Several recent observations have raised the possibility that disturbances in the gut microbiota and/or a low-grade inflammatory state may contribute to symptomatology and the etiology of irritable bowel syndrome (IBS). Consequent on these hypotheses, several therapeutic categories have found their way into the armamentarium of those who care for IBS sufferers. These agents include probiotics, prebiotics, antibiotics, and anti-inflammatory agents.
    • Thoracic paravertebral block using real-time ultrasound guidance.

      O Riain, Seosamh C; Donnell, Brian O; Cuffe, Tracy; Harmon, Dominic C; Fraher, John P; Shorten, George; Department of Anaesthesia, Mid-Western Regional Hospitals, Dooradoyle, Limerick, Ireland. seosamh.oriain@hse.ie (2010-01-01)
      We developed a technique for ultrasound-guided paravertebral block, which was subsequently applied in the clinical setting.
    • Thoracic vasculitis presenting as surgical problems.

      Jansen, Michael; Saleh, Sheikh; Bolster, Margot; O'Donnell, Aonghus; Ahern, Thomas; Spence, Liam; Sheppard, Mary N; Burke, Louise; Department of Histopathology, Cork University Hospital, Wilton, Cork, Eire, Ireland. jansmichael@gmail.com (2010-01)
      We present four patients with vasculitis manifesting with unusual clinical or pathological features, generating surgical problems. Two cases presented with pulmonary hypertension, with investigations and radiological evidence prompting clinical suspicion of pulmonary thrombo-embolic disease. First case, with an antecedant history of Wegener's granulomatosis (WG), demonstrated following "embolectomy", WG involving the large pulmonary elastic arteries. The second case of inoperable "pulmonary thrombo-embolic disease" was subsequently found at limited post mortem to have giant cell arteritis, which affected widespread small peripheral pulmonary arterial vessels. The other two cases were of aortitis occurring in the background of immune-mediated disease, which had been treated with aggressive immunosuppression regimens. The first of these was a case of Cogan's syndrome complicated by descending aortitis, a rarely reported phenomenon, with co-existent acute endocarditis of the aortic valve leaflets. Most cases of endocarditis in this context occur secondary to and in continuity with ascending aortitis. That this case, and a case of ascending aortitis occurring in the context of relapsing polychondritis occurred in the face of aggressive immunosuppression with an apparent clinical response, underscores the need to not accept a clinical picture at face value. This has implications for clinical management, particularly in the follow-up of surgical prosthetic devices such as grafts which may be used in these cases. All four cases emphasise the continued importance of histology and the post-mortem examination in elucidating previously undetected or unsuspected disease.
    • Tim-4 inhibition of T-cell activation and T helper type 17 differentiation requires both the immunoglobulin V and mucin domains and occurs via the mitogen-activated protein kinase pathway.

      Cao, Wei; Ryan, Michelle; Buckley, Deirdre; O'Connor, Rosemary; Clarkson, Michael R; Immunology, Moffitt Cancer Center Department of Biochemistry Department of Renal Medicine, Cork University Hospital, University College Cork, Ireland. (2011-06)
      Emerging experimental data suggest an important role for the T-cell immunoglobulin mucin 1 (Tim-1):Tim-4 pathway in autoimmune and alloimmune responses in vivo. Using a Tim-4 ectodomain human IgG Fc fusion protein we studied the role of Tim-4 in T-cell activation, signalling and differentiation responses in vitro. We demonstrate that Tim-4Fc can inhibit naive and pre-activated T-cell activation, proliferation and cytokine secretion via a Tim-1-independent pathway. Tim-4 contains immunoglobulin variable (IgV) and mucin domains; to identify which domain accounts for the inhibitory effect novel Tim-4 fusion proteins containing either the IgV or mucin domain were generated. We demonstrate that both IgV and mucin domains are required for the inhibitory effects and that they are mediated at least in part by inhibition of extracellular signal-regulated kinase pathway activity. Given the emerging interest in the role of the Tim family in T helper type 17 (Th17) cells, which play an important role in autoimmune disease and transplantation tolerance, our data show that Tim-4Fc can prevent polarization of CD4(+) T cells to the Th17 phenotype. Collectively, our results highlight an inhibitory role for Tim-4Fc in vitro, which we propose is mediated by a receptor other than Tim-1. In addition, this study provides new insights into the role of Tim-4Fc in regulating Th17 immune responses and may open a new avenue for autoimmune therapy.
    • Tissue viral load variability in chronic hepatitis C.

      Fanning, L; Loane, J; Kenny-Walsh, E; Sheehan, M; Whelton, M; Kirwan, W; Collins, J K; Shanahan, F; Department of Medicine, Cork University Hospital, National University of Ireland. (2012-02-03)
      OBJECTIVE: Liver biopsy is regarded as the gold standard for assessing disease activity in chronic hepatitis C, but sampling error is a potential limitation. Whether sampling variability applies equally to viral load assessment as it does to histology is uncertain. To examine this, we compared viral load between right- and left-lobe biopsy specimens from patients infected with hepatitis C virus (HCV). METHODS: Bilobe biopsies were taken from 16 patients who were serum positive for HCV RNA by reverse transcription-polymerase chain reaction. Genotype was identified by reverse line probe hybridization. There was an absence of competing risk factors for infectious and other liver diseases in this patient group. Histology and hepatic viral load were assessed blindly. None of the patients had received antiviral therapy at the time of study. RESULTS: Detection of HCV in right and left lobes was concordant with serum positivity in all cases. The viral load between lobes was highly correlated (p = 0.0003, r = 0.79). In contrast, the histological activity indices of inflammation and fibrosis/cirrhosis were poorly correlated between lobes (p = 0.038, r = 0.60, and p = 0.098, r = 0.50, respectively). CONCLUSION: Hepatic viral load variability does not suffer from the same degree of heterogeneity of sampling variability as does histology.
    • Tolerization with BLP down-regulates HMGB1 a critical mediator of sepsis-related lethality.

      Coffey, J Calvin; Wang, Jiang Huai; Kelly, Ray; Romics, Laszlo Jr; O'Callaghan, Adrian; Fiuza, Carmen; Redmond, H Paul; Department of Academic Surgery, University College Cork (UCC)/National University, of Ireland (NUI), Cork University Hospital, Cork, Ireland. (2012-02-03)
      Tolerization with bacterial lipoprotein (BLP) affords a significant survival benefit in sepsis. Given that high mobility group box protein-1 (HMGB1) is a recognized mediator of sepsis-related lethality, we determined if tolerization with BLP leads to alterations in HMGB1. In vitro, BLP tolerization led to a reduction in HMGB1 gene transcription. This was mirrored at the protein level, as HMGB1 protein expression and release were reduced significantly in BLP-tolerized human THP-1 monocytic cells. BLP tolerance in vivo led to a highly significant, long-term survival benefit following challenge with lethal dose BLP in C57BL/6 mice. This was associated with an attenuation of HMGB1 release into the circulation, as evidenced by negligible serum HMGB1 levels in BLP-tolerized mice. Moreover, HMGB1 levels in peritoneal macrophages from BLP-tolerized mice were reduced significantly. Hence, tolerization with BLP leads to a down-regulation of HMGB1 protein synthesis and release. The improved survival associated with BLP tolerance could thus be explained by a reduction in HMGB1, were the latter associated with lethality in BLP-related sepsis. In testing this hypothesis, it was noted that neutralization of HMGB1, using anti-HMGB1 antibodies, abrogated BLP-associated lethality almost completely. To conclude, tolerization with BLP leads to a down-regulation of HMGB1, thus offering a novel means of targeting the latter. HMGB1 is also a mediator of lethality in BLP-related sepsis.
    • Topacheous gout as a rare cause of spinal stenosis in the lumbar region. Case report.

      Kelly, Joseph; Lim, Chris; Kamel, Mahmoud; Keohane, Catherine; O'Sullivan, Michael; Cork University Hospital, Cork, Ireland. (2012-02-03)
      Despite the fact that gout is a common metabolic disorder, because its involvement of the axial skeleton is rare the diagnosis is often delayed, even in patients with long-standing gout who present with neurological deficits. The authors report the case of a woman with a history of extensive gout, emphasizing the clinical, radiological, and pathological features of a lumbar spinal stenosis.
    • Topical amethocaine (Ametop) is superior to EMLA for intravenous cannulation. Eutectic mixture of local anesthetics.

      Browne, J; Awad, I; Plant, R; McAdoo, J; Shorten, G; Department of Anaesthesia and Intensive Care Medicine, Cork University Hospital, and University College Cork, Wilton, Ireland. (2012-02-03)
      PURPOSE: A eutectic mixture of local anesthetics (EMLA) is commonly used to provide topical anesthesia for intravenous (i.v.) cannulation. One of its side effects is vasoconstriction, which may render cannulation more difficult. A gel formulation of amethocaine (Ametop) is now commercially available. The aim of this study was to compare EMLA and Ametop with regard to the degree of topical anesthesia afforded, the incidence of vasoconstriction and the ease of i.v. cannulation. METHODS: Thirty two ASA I adult volunteers had a #16 gauge i.v. cannula inserted on two separate occasions using EMLA and Ametop applied in a double blind fashion for topical anesthesia. Parameters that were recorded after each cannulation included visual analogue pain scores (VAPS), the presence of vasoconstriction and the ease of cannulation, graded as: 1 = easy, 2 = moderately difficult, 3 = difficult and 4 = failed. RESULTS: The mean VAPS +/- SD after cannulation with Ametop M was 12+/-9.9 and with EMLA was 25.3+/-16.6 (P = 0.002). Vasoconstriction occurred after EMLA application on 17 occasions and twice after Ametop (P = 0.001). The grade of difficulty of cannulation was 1.44+/-0.88 following EMLA and 1.06+/-0.25 with Ametop (P = 0.023). CONCLUSIONS: Intravenous cannulation was less painful following application of Ametop than EMLA. In addition, Ametop caused less vasoconstriction and facilitated easier cannulation. Its use as a topical anesthetic agent is recommended, especially when i.v. access may be problematic.