• Acid suppression increases rates of Barrett's esophagus and esophageal injury in the presence of duodenal reflux.

      Department of Surgery, Royal College of Surgeons, Connolly Hospital,, Blanchardstown, Dublin, Ireland. (2012-01-31)
      BACKGROUND: The contribution of gastric acid to the toxicity of alkaline duodenal refluxate on the esophageal mucosa is unclear. This study compared the effect of duodenal refluxate when acid was present, decreased by proton pump inhibitors (PPI), or absent. METHODS: We randomized 136 Sprague-Dawley rats into 4 groups: group 1 (n = 33) were controls; group 2 (n = 34) underwent esophagoduodenostomy promoting "combined reflux"; group 3 (n = 34) underwent esophagoduodenostomy and PPI treatment to decrease acid reflux; and group 4, the 'gastrectomy' group (n = 35) underwent esophagoduodenostomy and total gastrectomy to eliminate acid in the refluxate. Esophaguses were examined for inflammatory, Barrett's, and other histologic changes, and expression of proliferative markers Ki-67, proliferating cell nuclear antigen (PCNA), and epidermal growth factor receptor (EGFR). RESULTS: In all reflux groups, the incidence of Barrett's mucosa was greater when acid was suppressed (group C, 62%; group D, 71%) than when not suppressed (group B, 27%; P = 0.004 and P < .001). Erosions were more frequent in the PPI and gastrectomy groups than in the combined reflux group. Edema (wet weight) and ulceration was more frequent in the gastrectomy than in the combined reflux group. Acute inflammatory changes were infrequent in the PPI group (8%) compared with the combined reflux (94%) or gastrectomy (100%) groups, but chronic inflammation persisted in 100% of the PPI group. EGFR levels were greater in the PPI compared with the combined reflux group (P = .04). Ki-67, PCNA, and combined marker scores were greater in the gastrectomy compared with the combined reflux group (P = .006, P = .14, and P < .001). CONCLUSION: Gastric acid suppression in the presence of duodenal refluxate caused increased rates of inflammatory changes, intestinal metaplasia, and molecular proliferative activity. PPIs suppressed acute inflammatory changes only, whereas chronic inflammatory changes persisted.
    • ACTH-secreting bronchial carcinoid: a diagnostic and therapeutic challenge.

      McDermott, J H; Thabit, H; Hickey, N; Thompson, C; Gaffney, E; Young, V; Sreenan, S; Department of Endocrinology, Royal College of Surgeons, Connolly Hospital Blanchardstown, Dublin 15, Ireland. John.McDermott1@mailc.hse.ie (2008-09)
      We describe a case of Cushing's syndrome due to ectopic ACTH secretion, where the only potential source on conventional imaging was a tiny benign-appearing lung nodule, which failed to take up radiolabelled octreotide.
    • Acute hospital, community, and indirect costs of stroke associated with atrial fibrillation: population-based study.

      Hannon, Niamh; Daly, Leslie; Murphy, Sean; Smith, Samantha; Hayden, Derek; Ní Chróinín, Danielle; Callaly, Elizabeth; Horgan, Gillian; Sheehan, Orla; Honari, Bahman; et al. (2014-10-30)
      No economic data from population-based studies exist on acute or late hospital, community, and indirect costs of stroke associated with atrial fibrillation (AF-stroke). Such data are essential for policy development, service planning, and cost-effectiveness analysis of new therapeutic agents.
    • Are boys and girls that different? An analysis of traumatic brain injury in children.

      Collins, Niamh C; Molcho, Michal; Carney, Peter; McEvoy, Linda; Geoghegan, Lourda; Phillips, Jack P; Nicholson, Alf J (2013-08)
      The Phillips Report on traumatic brain injury (TBI) in Ireland found that injury was more frequent in men and that gender differences were present in childhood. This study determined when gender differences emerge and examined the effect of gender on the mechanism of injury, injury type and severity and outcome.
    • Are we prepared for a growing population? Morbid obesity and its implications in Irish emergency departments.

      Emergency Medicine Registrar, Connolly Hospital, Blanchardstown, Dublin,, Leinster, Ireland. (2012-01-31)
      Two percent of the Irish population is morbidly obese with this figure expected to rise significantly. This survey aimed to establish the present logistical capacity of Irish emergency departments (EDs) to adequately cater for the bariatric patients. A telephone survey was carried out of 37 health service executive EDs over a 5-day period in October 2008. Questions were posed to the departmental lead nurse regarding facilities (Supplemental digital content 1). No ED had adequate facilities. Two of 37 units questioned had on-site hoists designed to lift patients of more than 170 kg. Four departments had rapid access to mattresses within the hospital and three of these four had access to beds and trolleys for weighing patients. Two percent of the Irish population is morbidly obese with this figure expected to rise significantly to more than 150 kg. One department had access to commodes, chairs, wheelchairs and trolleys from inpatient services. All departments had extra-wide blood pressure cuffs and 12 had a difficult airways trolley. Necessary infrastructure and equipment for bariatric patients is deficient in the majority of Irish EDs.
    • Association between Sleep Disruption and Levels of Lipids in Caucasians with Type 2 Diabetes.

      Wan Mahmood, Wan Aizad; Draman Yusoff, Mohd Shazli; Behan, Lucy Ann; Di Perna, Andrea; Kyaw Tun, Tommy; McDermott, John; Sreenan, Seamus; Department of Endocrinology and Diabetes, Royal College of Surgeons in Ireland, Connolly Hospital, Blanchardstown, Dublin 15, Ireland. (2013-08-29)
      Aim. To investigate the association between sleep quality and duration with lipid and glycaemic control in Caucasian subjects with type 2 diabetes. Methods. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) in 114 type 2 diabetes (T2DM) subjects. Comparisons were made between subjects with different sleep quality and sleep duration. Hierarchical multiple regression analyses were used to determine contributors to metabolic parameters. Results. Subjects with poor sleep quality (PQ; PSQI ≥ 6) had higher systolic blood pressure, glycated haemoglobin, urine albumin : creatinine ratio (UAC), total cholesterol (TC), and triglycerides (TG) (P < 0.05 for all) compared to those with good sleep quality (GQ; PSQI ≤ 5). Long sleep duration (LSD) subjects had higher TC and short sleep duration (SSD) subjects had higher TG compared to those with medium sleep duration. Sleep duration and PSQI score were independent predictors of TC and low-density lipoprotein cholesterol (LDL), contributing to 14.0% and 6.1% of the total variance, respectively. Conclusions. In this Caucasian T2DM population, PQ is associated with adverse cardiovascular risk markers, and long and short sleep disruptions have an independent negative impact on lipids. Sleep assessment should be included as part of a diabetes clinic review.
    • Barriers to exercise in obese patients with type 2 diabetes.

      Egan, A M; Mahmood, W A W; Fenton, R; Redziniak, N; Kyaw Tun, T; Sreenan, S; McDermott, J H; Department of Endocrinology and Diabetes Mellitus, Connolly Hospital, Blanchardstown, Dublin 15, Ireland. aoife.egan@gmail.com (2013-07)
      Although regular exercise is a critical component of the management of type 2 diabetes, many patients do not meet their exercise targets. Lack of exercise is associated with obesity and adverse cardiovascular outcomes.
    • Basic surgical training in Ireland: the impact of operative experience, training program allocation and mentorship on trainee satisfaction.

      O'Sullivan, K E; Byrne, J S; Walsh, T N; RCSI Department of Surgery, Connolly Hospital, Blanchardstown, Dublin 15, Ireland, kaosulli@tcd.ie. (2013-12)
      Application to the Irish basic surgical training (BST) program in Ireland has decreased progressively over the past 5 years. We hypothesised that this decline was secondary to dissatisfaction with training correlated with reduced operative experience and lack of mentorship among BSTs.
    • A case of spontaneous hypoglycaemia and impaired glucose tolerance in the same patient.

      Thabit, Hood; Healy, M L; Royston, Derval; Broe, Patrick; Scarramuzzi, N; Walsh, Thomas N; Sreenan, Seamus; Department of Endocrinology, Connolly Hospital, Blanchardstown, Dublin, Ireland. , hoodeenee@gmail.com (2012-01-31)
      We present a rare case of an insulin-like growth factor-2 (IGF-2)-secreting tumour of the thorax. This patient demonstrated the combination of fasting hypoglycaemia and impaired glucose tolerance on oral glucose tolerance testing, which has not been previously described in this condition. A review of the literature of IGF-2-secreting intrathoracic tumours is presented here.
    • Central arteriovenous anastomosis for the treatment of patients with uncontrolled hypertension (the ROX CONTROL HTN study): a randomised controlled trial.

      Lobo, Melvin D; Sobotka, Paul A; Stanton, Alice; Cockcroft, John R; Sulke, Neil; Dolan, Eamon; van der Giet, Markus; Hoyer, Joachim; Furniss, Stephen S; Foran, John P; et al. (2015-01-22)
      Hypertension contributes to cardiovascular morbidity and mortality. We assessed the safety and efficacy of a central iliac arteriovenous anastomosis to alter the mechanical arterial properties and reduce blood pressure in patients with uncontrolled hypertension.
    • Chemoradiotherapy, with adjuvant surgery for local control, confers a durable survival advantage in adenocarcinoma and squamous cell carcinoma of the oesophagus.

      Bass, G A; Furlong, H; O'Sullivan, K E; Hennessy, T P J; Walsh, T N; Royal College of Surgeons in Ireland, Department of Surgery, Connolly Hospital, Dublin 15, Ireland. Electronic address: garybassmd@gmail.com. (2014-04)
      Oesophageal cancer usually presents with systemic disease, necessitating systemic therapy. Neo-adjuvant chemoradiotherapy improves short-term survival, but its long-term impact is disputed because of limited accrual, treatment-protocol heterogeneity and a short follow-up of randomised trials.
    • Clinical characteristics, management, and control of permanent vs. nonpermanent atrial fibrillation: insights from the RealiseAF survey.

      Murin, Jan; Naditch-Brûlé, Lisa; Brette, Sandrine; Chiang, Chern-En; O'Neill, James; Steg, P Gabriel; 5Connolly/Mater Hospitals/Royal College of Surgeons in Ireland, Dublin, Ireland. (PLoS ONE, 2014)
      Atrial fibrillation can be categorized into nonpermanent and permanent atrial fibrillation. There is less information on permanent than on nonpermanent atrial fibrillation patients. This analysis aimed to describe the characteristics and current management, including the proportion of patients with successful atrial fibrillation control, of these atrial fibrillation subsets in a large, geographically diverse contemporary sample.
    • Collagenous colitis as a possible cause of toxic megacolon.

      Fitzgerald, S C; Conlon, S; Leen, E; Walsh, T N; Department of Surgery, Connolly Hospital, Blanchardstown, Dublin, Ireland. ktsfitz@hotmail.com (2009-03)
      Collagenous colitis is a microscopic colitis characterized by normal appearing colonic mucosa on endoscopy. It is regarded as a clinically benign disease which rarely results in serious complications. We report a case of toxic megacolon occurring in a patient with collagenous colitis. This is the first reported case of toxic megacolon occurring in this subset of patients.
    • Connolly Hospital Blanchardstown: strategic plan

      Connolly Hospital, Blanchardstown (2005)
    • Consultant and trainee attitudes towards supervision of operative procedures in the UK and Ireland

      O’Neill, BJ; Rankn, KS; Banks, LN; Daruwall, ZJ; Sprowson, AP; Robinson, DP; Reed, MR; Kenny, PJ (Irish Medical Journal, 2014)
      The e-logbook is used to monitor progression through training and to assess training within teaching units. We document consultant and trainee opinions with regards to supervision status, and to inform guidelines for trainees and trainers using the e-logbook. A questionnaire was sent to consultants and trainees in the UK and Ireland. Eight theatre scenarios were described and respondents were asked to state what they felt was the appropriate supervision status for the trainee. Significantly more consultants in the UK use the e-logbook than those based in Ireland (58.5%:14.5%). There were differences in consensus response to the scenarios between consultants and trainees, and between Irish and UK based surgeons. We have documented the opinions of consultants and trainees from across the UK and Ireland with regards to supervision status for trainees under certain theatre situations. This information should support formal guidelines for all users of the logbook.
    • Correlation of intra-articular osseous measurements with posterior cruciate ligament length on MRI scans.

      Orakzai, S H; Egan, C M; Eustace, S; Kenny, P; O'flanagan, S J; Keogh, P; Department of Orthopaedics, Connolly Hospital Blanchardstown, Dublin, Republic of Ireland. sajjadho@yahoo.com (2010-01)
      Six patients with a clinical diagnosis of chronic posterior cruciate ligament (PCL) rupture, based on a positive posterior drawer test, had a normal appearance of the PCL on an MRI scan. It is postulated that the PCL had been ruptured but healed in a lengthened state. 12 volunteers with no history of knee trauma underwent an MRI scan of the knee. In this control group (n = 12), there was a close correlation between the lateral femoral condylar width in the sagittal plane and the PCL length, with a ratio of 2:1 (95% confidence interval (CI) = 1.817-2.095). In the clinically abnormal group (n = 6), the ratio was 1.49:1 (95% CI = 1.206-1.782) (p< 0.0005). In conclusion, the ratio of the lateral femoral condylar width in the sagittal plane to the PCL length is a useful index for diagnosing PCL attenuation and lengthening in the presence of a normal morphological MR appearance.
    • Creation of an iliac arteriovenous shunt lowers blood pressure in chronic obstructive pulmonary disease patients with hypertension.

      Faul, John; Schoors, Danny; Brouwers, Sofie; Scott, Benjamin; Jerrentrup, Andreas; Galvin, Joseph; Luitjens, Sandra; Dolan, Eamon (2014-01-28)
      Vasodilators are used with caution in patients with chronic obstructive pulmonary disease (COPD). We have developed a device for percutaneous arteriovenous shunt creation in the iliac region to increase cardiac output and oxygen delivery for patients with COPD. Although this device does not cause significant blood pressure changes in normotensive patients with COPD, we hypothesized that arteriovenous shunt creation might cause vasodilator effects in hypertensive patients because of a reduction in vascular resistance.
    • Dietary nitrate supplementation in COPD: An acute, double-blind, randomized, placebo-controlled, crossover trial.

      Kerley, Conor P; Cahill, Kathleen; Bolger, Kenneth; McGowan, Aisling; Burke, Conor; Faul, John; Cormican, Liam (2014-12-19)
      The acute consumption of dietary nitrate has been shown to improve exercise capacity in athletes, healthy adults and subjects with peripheral vascular disease. Many COPD patients have reduced exercise capacity. We hypothesized that acute nitrate consumption might increase incremental shuttle walk test (ISWT) distance in COPD subjects.
    • Does Impaired Gallbladder Function Contribute to the Development of Barrett's Esophagus and Esophageal Adenocarcinoma?

      Nassr, Ayman O; Gilani, Syeda Nadia Shah; Atie, Mohammed; Abdelhafiz, Tariq; Connolly, Val; Hickey, Neil; Walsh, Thomas Noel; Department of Surgery, Academic Centre, Connolly Hospital, Blanchardstown, Dublin 15, Ireland. (2011-06)
      Esophageal adenocarcinoma is aetiologically associated with gastro-esophageal reflux, but the mechanisms responsible for the metaplasia-dysplasia sequence are unknown. Bile components are implicated. Impaired gallbladder function may contribute to duodenogastric reflux (DGR) and harmful GERD.
    • The effect of an inhaled corticosteroid on glucose control in type 2 diabetes.

      Faul, John L; Wilson, Sandra R; Chu, James W; Canfield, James; Kuschner, Ware G; Department of Respiratory Medicine, Connolly Hospital, Dublin, Ireland. (2009-06)
      OBJECTIVE: To determine the effect of inhaled corticosteroid (ICS) therapy on glucose control in adults with type 2 diabetes mellitus and coexisting asthma or chronic obstructive pulmonary disease (COPD). DESIGN: A prospective randomized, double-blind, double-dummy placebo-controlled, crossover investigation of inhaled steroids and oral leukotriene blockers. SETTING: A United States Department of Veterans Affairs Health Care System outpatient setting. PARTICIPANTS: Adults with type 2 diabetes and asthma or COPD. METHODS: Subjects (n=12) were randomized to receive either inhaled fluticasone propionate (440 microg twice daily) and oral placebo, or inhaled placebo and oral montelukast (10 mg/day). After 6 weeks, subjects were switched to the opposite therapy for 6 weeks. The primary outcome measure was the change in the percentage of glycosylated hemoglobin (%HbA1c) at 6 weeks relative to the baseline value. RESULTS: Ten patients completed the study. The difference between the mean within-subject changes in %HbA1c associated with 6-week periods of fluticasone and the mean changes associated with montelukast therapy was small but statistically significant (mean difference=0.25; P<0.025). Neither fluticasone nor oral montelukast therapy for 6 weeks led to a significantly different mean % HbA1c compared with the relevant baseline (mean differences=0.11 and -0.14, respectively). CONCLUSION: The absence of a clinically significant within-subject difference in the changes in %HbA1c associated with fluticasone versus oral montelukast therapy, or between either therapy or baseline does not warrant recommending changes in therapy for asthma or diabetes in patients with these co-morbid conditions. However, we suggest that clinicians carefully monitor blood glucose control when diabetic patients initiate ICS, especially with higher dosages.