• 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.
    • Distribution of lymph node metastases in esophageal carcinoma [TIGER study]: study protocol of a multinational observational study.

      Hagens, Eliza R C; van Berge Henegouwen, Mark I; van Sandick, Johanna W; Cuesta, Miguel A; van der Peet, Donald L; Heisterkamp, Joos; Nieuwenhuijzen, Grard A P; Rosman, Camiel; Scheepers, Joris J G; Sosef, Meindert N; et al. (2019-07-04)
      Background: An important parameter for survival in patients with esophageal carcinoma is lymph node status. The distribution of lymph node metastases depends on tumor characteristics such as tumor location, histology, invasion depth, and on neoadjuvant treatment. The exact distribution is unknown. Neoadjuvant treatment and surgical strategy depends on the distribution pattern of nodal metastases but consensus on the extent of lymphadenectomy has not been reached. The aim of this study is to determine the distribution of lymph node metastases in patients with resectable esophageal or gastro-esophageal junction carcinoma in whom a transthoracic esophagectomy with a 2- or 3-field lymphadenectomy is performed. This can be the foundation for a uniform worldwide staging system and establishment of the optimal surgical strategy for esophageal cancer patients. Methods: The TIGER study is an international observational cohort study with 50 participating centers. Patients with a resectable esophageal or gastro-esophageal junction carcinoma in whom a transthoracic esophagectomy with a 2- or 3-field lymphadenectomy is performed in participating centers will be included. All lymph node stations will be excised and separately individually analyzed by pathological examination. The aim is to include 5000 patients. The primary endpoint is the distribution of lymph node metastases in esophageal and esophago-gastric junction carcinoma specimens following transthoracic esophagectomy with at least 2-field lymphadenectomy in relation to tumor histology, tumor location, invasion depth, number of lymph nodes and lymph node metastases, pre-operative diagnostics, neo-adjuvant therapy and (disease free) survival. Discussion: The TIGER study will provide a roadmap of the location of lymph node metastases in relation to tumor histology, tumor location, invasion depth, number of lymph nodes and lymph node metastases, pre-operative diagnostics, neo-adjuvant therapy and survival. Patient-tailored treatment can be developed based on these results, such as the optimal radiation field and extent of lymphadenectomy based on the primary tumor characteristics.
    • 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.
    • The effect of inclement weather on ankle fracture management in an Irish trauma unit.

      O'Neill, B J; Kelly, E G; Breathnach, O C; Keogh, P; Kenny, P J; O'Flanagan, S J; Department of Trauma and Orthopaedics, Connolly Hospital Blanchardstown, Blanchardstown, Dublin 15, Ireland. barryoneill1922@gmail.com (2013-09)
      Ireland is unfamiliar with extreme weather conditions. Such conditions occurred in winter 2009-2010 and 2010-2011, with much of the country being affected by snow and ice. We reviewed the effect that these conditions had on the treatment of ankle fractures in our trauma unit.
    • Elective surgery: a comparison of in-patient versus day surgery practices in Ireland.

      Meshkat, B; Cowman, S; Gethin, G; Higgins, P; Ryan, K; Mulligan, E; Department of Surgery, Connolly Hospital Blanchardstown, Blanchardstown, Dublin 15, Ireland. b_meshkat@hotmail.com (2013-06)
      Currently, there is a paucity of research which has assessed practices at the point of care for day surgery patient.
    • Endoscopic assessment of inflammatory bowel disease: colonoscopy/esophagogastroduodenoscopy.

      Chan, Grace; Fefferman, David S; Farrell, Richard J; Gastroenterology Department, Connolly Hospital Blanchardstown, Dublin, Republic of Ireland. (2012-06)
      Endoscopy plays an important role in the initial diagnosis of IBD, including the evaluation of disease severity, activity, and extent. The implications of complete mucosal healing further confirm the function of endoscopy in the follow-up of IBD patients. The use of therapeutic endoscopy, for example stricture dilatation, can avoid the need for bowel resection. Modalities such as capsule endoscopy, EUS, NBI, CE, and other emerging techniques are likely to have an increasing role in the management of IBD, particularly in the area of dysplasia surveillance and treatment.
    • Endothelial progenitor cells in mothers of low-birthweight infants: a link between defective placental vascularization and increased cardiovascular risk?

      King, Thomas F J; Bergin, David A; Kent, Etaoin M; Manning, Fiona; Reeves, Emer P; Dicker, Patrick; McElvaney, Noel G; Sreenan, Seamus; Malone, Fergal D; McDermott, John H; et al. (2013-01)
      Offspring birthweight is inversely associated with future maternal cardiovascular mortality, a relationship that has yet to be fully elucidated. Endothelial progenitor cells (EPCs) are thought to play a key role in vasculogenesis, and EPC numbers reflect cardiovascular risk.
    • Excision and primary closure of pilonidal sinus disease: worthwhile option with an acceptable recurrence rate.

      Gilani, S N S; Furlong, H; Reichardt, K; Nasr, A O; Theophilou, G; Walsh, T N; Academic Centre RCSI, Connolly Hospital, Blanchardstown, Dublin 15, Ireland., drnadiagilani7@hotmail.com (2012-01-31)
      BACKGROUND: Treatment of pilonidal sinus disease is controversial. Many claim policy of marsupialisation and healing by secondary intention. This is demanding in terms of nursing care and time lost from work. AIMS: To examine outcome of excision and primary closure of chronic pilonidal disease on recurrence rate and patient's daily activities. PATIENTS AND METHODS: One hundred and fourteen consecutive elective patients who had excision and primary closure of pilonidal sinus disease were reviewed. The demographic data and the post-operative outcome were studied. RESULTS: The recurrence of pilonidal sinus was noted in 9% of patients, wound breakdown occasioning delayed healing in 9%, patients able to drive by day 16 on average. The mean time to return to work was 20.5 days; duration of analgesia, 2.4 days; and duration of antibiotic treatment, 4.7 days. CONCLUSION: Excision and primary closure of chronic pilonidal sinus has low recurrence rate with early return to activities. Primary closure appears to be a cost-effective option for uncomplicated pilonidal sinus disease.
    • Executive Function and Diabetes Mellitus - A Stone Left Unturned?

      Dept. of Endocrinology, Royal College of Surgeons in Ireland, Connolly Hospital, , Blanchardstown, Dublin 15, Ireland. diabetes.centre@hse.ie. (2012-01-31)
      Diabetes mellitus (DM) is a chronic medical condition that is dependent upon patients self-caring and managing their condition to achieve optimal control. Adherence to medical therapy, making decisions related to lifestyle changes, and self-treating hypoglycaemia for example, require planning and organisational skills that are under the control of a specific domain of cognitive function known as executive function. Executive function has been shown by functional imaging studies such as magnetic resonance imaging to be under the influence of the frontal and prefrontal cortical system. It is now recognised that even in subjects with apparently normal cognition, DM may be associated with impaired executive function (IEF). The exact cause of IEF in DM is still not fully understood. However cerebral microvascular disease and chronic dysglycaemia have been postulated as possible factors contributing to functional neuronal dysfunction leading to IEF. IEF may adversely affect patients' abilities to self-manage their diabetes care, potentially cause worsening glycaemic control and difficulty managing risk factors. Several bedside assessment tools to screen for IEF are currently available and have been shown to correlate with functional status. However, more studies are needed to validate these tests against diabetes self-care assessment tools. Until then, clinicians and healthcare workers managing patients with DM should be aware of the potential for IEF in their patients as specific behaviour and education intervention may be needed to help manage patients with diabetes and IEF.
    • Extending the reach of stapled anastomosis with a prepared OrVil™ device in laparoscopic oesophageal and gastric cancer surgery.

      Salih, Abdelmonim E A; Bass, Gary A; D'Cruz, Yvonne; Brennan, Robert P; Smolarek, Sebastian; Arumugasamy, Mayilone; Walsh, Thomas N; Department of Surgery, Connolly Hospital, Blanchardstown, Dublin 15, Ireland, monim.salih@yahoo.ie. (2014-08-27)
      The introduction of minimally invasive surgery and the use of laparoscopic techniques have significantly improved patient outcomes and have offered a new range of options for the restoration of intestinal continuity. Various reconstruction techniques have been described and various devices employed but none has been established as superior. This study evaluates our experience with, and modifications of, the orally inserted anvil (OrVil™).
    • Factors predicting suicidal ideation in the preceding 12 months among patients attending a community psychiatric outpatient clinic.

      Anyansi, Tochukwu E; Agyapong, Vincent I O; Department of Psychiatry, Connolly Hospital, Dublin, Ireland. (2013-06)
      Predictive factors are used to alert the clinician to the necessity of carrying out a suicide risk assessment in those patients whose demographic and clinical characteristics suggest the possibility of suicide.
    • Future bed needs of James Connolly Memorial Hospital: Report of the Hospital Review Group.

      James Connolly Memorial Hospital Review Group. (James Connolly Memorial Hospital, 2000-08)
      In April 1999, a hospital group at James Connolly Memorial Hospital (JCMH) was convened to discuss and study the future bed needs at the hospital. The reasons for this review were due to concerns of a) high occupancy, b) increasing emergency admissions and the knock-on effect on elective work, c) catchment area growth without matching resources and d) the possible change in referral patterns of GPs in favour of JCMH after the new hospital is opened in 2003 and the need for appropriate apportionment of resources. The overall remit of the hospital study group was: 1. To understand the current concerns and future predictions in regard to bed needs at JCMH. 2. To conduct this work in phases with full ownership of relevant groups in the hospital. 3. To produce a report. 4. To discuss findings and recommendations/options with Senior Managers in the Eastern Regional Health Authority and the Dept of Health and Children.
    • Global DNA methylation is altered by neoadjuvant chemoradiotherapy in rectal cancer and may predict response to treatment - A pilot study.

      Tsang, J S; Vencken, S; Sharaf, O; Leen, E; Kay, E W; McNamara, D A; Deasy, J; Mulligan, E D; Department of Surgical Research, Connolly Hospital & RCSI, Blanchardstown, Dublin, Ireland. Electronic address: julianst@yahoo.com. (2014-07-28)
      In rectal cancer, not all tumours display a response to neoadjuvant treatment. An accurate predictor of response does not exist to guide patient-specific treatment. DNA methylation is a distinctive molecular pathway in colorectal carcinogenesis. Whether DNA methylation is altered by neoadjuvant treatment and a potential response predictor is unknown. We aimed to determine whether DNA methylation is altered by neoadjuvant chemoradiotherapy (CRT) and to determine its role in predicting response to treatment.
    • Heart rate awareness in patients with chronic stable heart failure. A multi-center observational study.

      Moran, D; Buckley, A; Daly, K; Meaney, B; Curtin, R; O'Neill, J O; Colwella, N; Mahon, N; Murphy, N; O'Hanlon, R; et al. (2014-08-23)
      We assessed adherence to European Society of Cardiology heart rate guidelines (i.e. heart rates less than 70bpm) in patients with chronic stable heart failure. We also investigated the percent of patients on target doses of rate controlling drugs.
    • Hip and low back pain in the presence of femoral anteversion. A case report.

      Tansey, Paula; Physiotherapy Department, Connolly Hospital, Blanchardstown, Dublin 15, Ireland. Electronic address: paula.tansey@hse.ie. (2014-04-16)
      A change in hip morphology, such as femoral anteversion may be a factor in patients with lower quadrant pain. This case study highlights the importance of angle of torsion assessment and consideration of a patient's individual angle in designing rehabilitation programs. A patient who had a four year history of hip pain and a one year history of low back pain, in the presence of femoral anteversion is presented. She was successfully treated by altering her lower limb position as well as performing exercises in this alignment.
    • Identifying factors that influence the ‘6-hour target’ in the Emergency Department by applying Regression Analysis.

      Borhan, F; Borhan, N; Ahmed, S; Varghese, L; O’Conor, E (Irish Medical Journal, 2018-02)
      To determine factors within the Emergency Department (ED) that have maximum influence on the ‘6-hour target’.
    • Imaging of gunshot injuries in a West Dublin teaching hospital: a ten year review

      Murphy, I; Lavelle, L; Ni Mhurchu, E; McCarthy, R; Heffernan, E; Connolly Hospital (Irish Medical Journal, 2014-09)
      There has been an increase in gun-related crime in Ireland over the last decade to gangland violence, especially in west Dublin. This places a burden on hospital services not previously encountered. The aim of this study was to examine the demographics of gunshot injuries presenting to a Dublin teaching hospital, and the impact on radiology over a ten year period. A total of 65 gunshot injuries were seen. Mortality for high velocity wounds was much higher (10/23, 43%) than for low-velocity shotgun injuries (2/34, 6%).
    • Imitation, the greatest form of flattery?

      Murphy, A; Parihar, V; Shahin, A; Farrell, R (Irish Medical Journal, 2016-01)
      A recent interesting case at our institution reminded us to remain cognisant of the oldest known venereal disease; known as the great imitator , syphilis is a sexually transmitted infection caused by the spirochete Treponema pallidum
    • Impact of antihypertensive combination and monotreatments on blood pressure variability: assessment by old and new indices. Data from a large ambulatory blood pressure monitoring database.

      Parati, Gianfranco; Dolan, Eamon; Ley, Ludwin; Schumacher, Helmut (2014-06)
      High 24-h ambulatory blood pressure (ABP) variability is associated with poor cardiovascular outcomes. We analysed a large ABP monitoring database containing data from hypertensive patients treated with telmisartan/amlodipine combination or various monotherapies with the aim of quantifying the 24-h distribution of blood pressure (BP) reduction by treatment through the smoothness index and of developing and testing a new treatment-on-variability index (TOVI) to quantify the effects of treatment on both mean BP and BP variability.