• A case of congenital solitary Langerhans cell histiocytoma.

      Ricciardo, Bernadette; Irvine, Alan; McDermott, Michael; Ryan, John; Collins, Sinead; Department of Dermatology, Our Lady of Lourdes Hospital, Drogheda, Dublin,, Ireland. berniricciardo@yahoo.com.au (2012-02-01)
      A newborn baby boy was referred to the Paediatric Dermatology Unit with a solitary asymptomatic nodule overlying his right nasolabial fold. Complete physical examination, full blood count, serum chemistry, liver function tests and baseline imaging were unremarkable. Histopathological examination showed an atypical dermal infiltrate of mononuclear cells that stained positive with CD1a and S100. A diagnosis of congenital solitary Langerhans cell histiocytoma was made. The lesion completely resolved by 4 months of age. The baby is now 15 months old and repeat systemic evaluation has remained normal.
    • Cow-related trauma: a 10-year review of injuries admitted to a single institution.

      Murphy, Colin G; McGuire, Ciara M; O'Malley, Natasha; Harrington, Paul; Department of Orthopaedics, Our Lady of Lourdes Hospital Drogheda, Co. Louth,, Ireland. cmurphy@rcsi.ie (2012-02-01)
      INTRODUCTION: Bovine-related injuries to farmers are common in rural communities. Many injuries are significant requiring hospital admission and surgery. We reviewed all cattle-related injuries admitted to a regional trauma centre over 10 years and detail the nature of the injuries. METHOD: A retrospective review was undertaken, using hospital inpatient coding system (HIPE) to identify patients admitted following cow-related trauma for the last 10 years. From retrieved charts mechanism of injury was identified, demographics recorded and Injury Severity Score (ISS) and Trauma Injury Severity Score (TRISS) calculated based on the injuries sustained. RESULTS: 47 patients were identified, with a median age of 53 years. 4 injuries occurred in children, and 12 in patients over 65 years old. Three-quarters of those injured were male. Kicking was the most common mechanism of injury (n=21), but charge/head-butt injuries and trampling injuries were associated with more serious injury scores. 72% of patients were admitted under Orthopaedics as their primary care team, 25% under General Surgeons, with one patient admitted medically. Mean ISS score was 6.9 (range 1-50). 41 operative interventions were performed on 30 patients during their admission. 6.3% of patients required admission to Intensive Care with a mean length of stay of 12.3 days (range 2-21 days). There was no mortality. CONCLUSION: Cow-related trauma is a common among farming communities and is a potentially serious mechanism of injury that appears to be under-reported in a hospital context. Bovine-related head-butt and trampling injuries should be considered akin to high-velocity trauma.
    • Dual diagnosis of sarcoidosis and lymphoma.

      Brady, B; Kamel, D; Kiely, J; Hennessy, B; Department of Medical Oncology, Our Lady of Lourdes Hospital, Drogheda, Co. Louth, Ireland. bernadettebrady@gmail.com (2013-06)
      Sarcoidosis is a multisystem granulomatous disease of unknown origin with pulmonary and extrapulmonary manifestations. Worldwide it is most often diagnosed in the third and fourth decades and most often affects Swedish, Danish and black patients. The association between malignancy and sarcoidosis has not been conclusively proven. Cancer can eventually occur in patients who have an established diagnosis of sarcoidosis for example, in sarcoidosis-lymphoma syndrome. Sarcoidosis can also subsequently develop in an oncology patient. There are multiple obstacles to confirming epidemiologically the linkage between sarcoidosis and malignancy. Histological verification and clinical acumen are needed to avoid misdiagnosis. The 18 fluorodeoxyglucose (18-FDG) PET has failed to provide a non invasive diagnostic method to differentiate neoplasia from benign sarcoid lesions and tissue diagnosis is essential before commencing a new therapeutic intervention in patients with lymphoma.
    • Fixation of ankle syndesmotic injuries: comparison of tightrope fixation and syndesmotic screw fixation for accuracy of syndesmotic reduction.

      Naqvi, Gohar A; Cunningham, Patricia; Lynch, Bernadette; Galvin, Rose; Awan, Nasir; Department of Trauma and Orthopaedics, Our Lady of Lourdes Hospital, Drogheda, Ireland. drgoharabbas@hotmail.com (2012-12)
      Ankle syndesmotic injuries are complex and require anatomic reduction and fixation to restore the normal biomechanics of the ankle joint and prevent long-term complications.
    • Glomus tumour of the thumb in a child with neurofibromatosis: a case report.

      Leonard, Michael; Harrington, Paul; Department of Orthopaedic Surgery, Our Lady of Lourdes, Drogheda, Ireland., mikeleonard77@gmail.com (2012-02-01)
      This case report is unique in reporting the occurrence of a glomus tumour in a child with neurofibromatosis-1 (NF-1) and serves to support the link between neurofibromatosis-1 and glomus tumours.
    • Interobserver and intraobserver reliability and validity of the Vancouver classification system of periprosthetic femoral fractures after hip arthroplasty.

      Naqvi, Gohar A; Baig, Shakoor A; Awan, Nasir; Department of Trauma and Orthopaedics, Our Lady of Lourdes Hospital, Drogheda, Co., Louth, Republic of Ireland. (2012-06)
      The Vancouver classification system of periprosthetic fractures has been revalidated in this study, using the radiographs of 45 patients. Three consultants and 3 trainees reviewed the radiographs independently, on 2 separate occasions, at least 2 weeks apart. Interobserver and intraobserver agreement and validity were analyzed, using weighted κ statistics. The mean κ value for interobserver agreement was found to be 0.69 (0.63-0.72) for consultants and 0.61 (0.56-0.65) for the trainees, both representing substantial agreement. Intraobserver κ values ranged from 0.74 to 0.90, showing substantial agreement. Validity analysis of 37 type B cases revealed 81% agreement within B1, B2, and B3 subgroups with a κ value of 0.68 (substantial agreement). This study has reconfirmed the reliability and validity of the Vancouver classification while it also emphasizes the intraoperative assessment of implant stability.
    • Irish neonatal mortality statistics for 2004 and over the past 17 years: how do we compare internationally?

      Fleming, P; Clarke, T; Gormally, S M; Department of Neonatology and Paediatrics, Our Lady of Lourdes Hospital,, Drogheda, Co Louth. (2012-02-01)
      In the past 17 years neonatal mortality survey has provided important data on the trends in deaths of all live born infants born in Southern Ireland who are greater than 500 g birth weight and who die within the first 28 days of life. The aims of this study were to report neonatal mortality data for Southern Ireland for 2004, to examine trends in neonatal mortality over the past 17 years and compare Irish Neonatal Mortality rates to other countries around the world. The neonatal mortality rate for 2004 was 2.9/1000 with a corrected NMR of 1.9/1000. The response rate to the survey was 100%. Prematurity is now the leading cause of neonatal mortality representing a change from previous years. Deaths related to asphyxia have remained largely unchanged. When compared to international figures Ireland compares favourably to other countries around the world.
    • Minimally-invasive treatment of high velocity intra-articular fractures of the distal tibia.

      Leonard, M; Magill, P; Khayyat, G; Our Lady Of Lourdes Hospital, Drogheda, Co. Louth, Ireland., mikeleonard77@gmail.com (2012-02-01)
      The pilon fracture is a complex injury. The purpose of this study was to evaluate the outcome of minimally invasive techniques in management of these injuries. This was a prospective study of closed AO type C2 and C3 fractures managed by early (<36 hours) minimally invasive surgical intervention and physiotherapist led rehabilitation. Thirty patients with 32 intra-articular distal tibial fractures were treated by the senior surgeon (GK). Our aim was to record the outcome and all complications with a minimum two year follow-up. There were two superficial wound infections. One patient developed a non-union which required a formal open procedure. Another patient was symptomatic from a palpable plate inferiorly. An excellent AOFAS result was obtained in 83% (20/24) of the patients. Early minimally invasive reduction and fixation of complex high velocity pilon fractures gave very satisfactory results at a minimum of two years follow-up.
    • Necrotizing fasciitis of the lower extremity: a case report and current concept of diagnosis and management.

      Naqvi, G A; Malik, S A; Jan, W; Department of Orthopaedics, Our Lady of Lourdes Hospital, Drogheda, Republic of, Ireland. drgoharabbas@hotmail.com (2012-02-01)
      Necrotizing fasciitis is a severe soft tissue infection characterized by rapidly progressing necrosis, involving subcutaneous tissues. This rare condition carries high mortality rate and require prompt diagnosis and urgent treatment with radical debridement and antibiotics. We describe a case of 21-year old man who presented with the history of trivial injury to the knee. Initially he was admitted and treated for septic arthritis but later was diagnosed as necrotizing fasciitis which was successfully treated with no ill effects what so ever from this devastating condition. This rare condition has been reported in literature but still early diagnosis, which is a key for successful treatment, remains a challenge.
    • Pharmacological management of co-morbid conditions at the end of life: is less more?

      McLean, S; Sheehy-Skeffington, B; O'Leary, N; O'Gorman, A; Specialist Palliative Care Service, Dochas Centre, Our Lady of Lourdes Hospital, Drogheda, Co. Louth, Ireland. smclean81@yahoo.com (2013-03)
      Co-morbid conditions (CMCs) are present in over half of patients with cancer over 50 years of age. As life-limiting illnesses progress, the benefits and burdens of treatments for CMCs become unclear. Relevant issues include physiological changes in advanced illness, time-to-benefit of medications, burden of medications, and psychological impact of discontinuing medications. Optimal prescribing is unclear due to lack of evidence.
    • Pneumomediastinum following high pressure air injection to the hand.

      Kennedy, J; Harrington, P; Department of Orthopaedics, Our Lady of Lourdes Hospital, Drogheda, Co Louth., getjimkennedy@gmail.com (2012-02-01)
      We present the case of a patient who developed pneumomediastinum after high pressure air injection to the hand. To our knowledge this is the first reported case of pneumomediastinum where the gas injection site was the thenar eminence. Fortunately the patient recovered with conservative management.
    • Preventing unintentional injury in children and adolescents--the importance of local injury data collection.

      O'Carroll, C; Egleston, C; Nicholson, A J; Department of Paediatrics and Emergency Medicine, Our Lady of Lourdes Hospital,, Drogheda, Co Louth. (2012-02-01)
      We sought to prospectively study all injuries in children and adolescents up to 16 years of age presenting to a regional Emergency Department (ED), to ascertain detailed injury patterns and to use this data to recommend injury prevention priorities. Electronic injury surveillance was prospectively collected over a 10 year period (1997-2007) in a hospital with a paediatric catchment population of 75,000 in a region with pockets of high social deprivation. All fatalities were obtained from data provided by the Central Statistics Office (CSO). Over a 10 year period, there were 31 fatalities, 5,408 admissions and 40,817 new attendances due to injury. Males outnumbered females in a 3:2 ratio. Of all injuries 24,317 (60%) occurred at home. Peak injury presentation time was in the evening between 18:00 and 20:00. Minor injuries (bruises, minor head injuries, lacerations and sprains) accounted for 32,456 (80%) of total. Fractures resulting from high falls (n=1,194) tended to result from bunk beds, staircases, horses, walls and playground equipment. Burns (n=630) involved hot liquids (tea, coffee), hot bath water, hot cooking oil and hot cooking plates. Pedestrian injuries (n=251) were predominantly 'dart outs' in urban areas. Car passenger injuries (n=869) showed low rates of documented car restraint use. Poisonings (n= 1,153) were predominantly medicinal products. Cyclist injuries (n=477) indicated low documented use of appropriate helmet wear. Prevention priorities should focus on home injuries, hot liquid burn and scald injuries and high falls from walls, beds and playground equipment. To prevent road-related injuries and deaths, further legislation, urban planning and greater police enforcement is required.
    • Referral patterns of patients with liver metastases due to colorectal cancer for resection.

      Al-Sahaf, O; Al-Azawi, Dhafir; Al-Khudairy, Ammar; Fauzi, Mohammad Z; El-Masry, Sherif; Gilen, Peter; Department of General Surgery, Our Lady of Lourdes Hospital, Drogheda, Co.,, Louth, Ireland. Usama_sahaf70@hotmail.com (2012-02-01)
      INTRODUCTION: Colorectal carcinoma accounts for 10% of cancer deaths in the Western World, with the liver being the most common site of distant metastases. Resection of liver metastases is the treatment of choice, with a 5-year survival rate of 35%. However, only 5-10% of patients are suitable for resection at presentation. AIMS: To examine the referral pattern of patients with liver metastases to a specialist hepatic unit for resection. METHODOLOGY: Retrospective review of patient's charts diagnosed with colorectal liver metastases over a 10-year period. RESULTS: One hundred nine (38 women, 71 men) patients with liver metastases were included, mean age 61 years; 79 and 30 patients had synchronous and metachronus metastases, respectively. Ten criteria for referral were identified; the referral rate was 8.25%, with a resection rate of 0.9%. Forty two percent of the patients had palliative chemotherapy; 42% had symptomatic treatment. CONCLUSION: This study highlights the advanced stage of colorectal cancer at presentation; in light of modern evidence-based, centre-oriented therapy of liver metastasis, we conclude that criteria of referral for resection should be based on the availability of treatment modalities.
    • Reversal of Hartmann's procedure following acute diverticulitis: is timing everything?

      Fleming, Fergal J; Gillen, Peter; Surgical Professorial Unit, Department of Surgery, Our Lady of Lourdes Hospital, , Drogheda, Co Louth, Ireland. fjfleming@rcsi.ie (2012-02-01)
      BACKGROUND: Patients who undergo a Hartmann's procedure may not be offered a reversal due to concerns over the morbidity of the second procedure. The aims of this study were to examine the morbidity post reversal of Hartmann's procedure. METHODS: Patients who underwent a Hartmann's procedure for acute diverticulitis (Hinchey 3 or 4) between 1995 and 2006 were studied. Clinical factors including patient comorbidities were analysed to elucidate what preoperative factors were associated with complications following reversal of Hartmann's procedure. RESULTS: One hundred and ten patients were included. Median age was 70 years and 56% of the cohort were male (n = 61). The mortality and morbidity rate for the acute presentation was 7.3% (n = 8) and 34% (n = 37) respectively. Seventy six patients (69%) underwent a reversal at a median of 7 months (range 3-22 months) post-Hartmann's procedure. The complication rate in the reversal group was 25% (n = 18). A history of current smoking (p = 0.004), increasing time to reversal (p = 0.04) and low preoperative albumin (p = 0.003) were all associated with complications following reversal. CONCLUSIONS: Reversal of Hartmann's procedure can be offered to appropriately selected patients though with a significant (25%) morbidity rate. The identification of potential modifiable factors such as current smoking, prolonged time to reversal and low preoperative albumin may allow optimisation of such patients preoperatively.
    • Tightrope fixation of ankle syndesmosis injuries: clinical outcome, complications and technique modification.

      Naqvi, Gohar A; Shafqat, Aseer; Awan, Nasir; Department of Orthopaedics, Our Lady of Lourdes Hospital, Drogheda, Ireland. drgoharabbas@hotmail.com (2012-06)
      Ankle syndesmotic injuries are complex and require anatomic reduction and fixation. Tightrope fixation is a relatively new technique and we present the largest series of syndesmosis fixation using Arthrex Tightrope™ (Naples, FL, USA).
    • Traumatic posterior dislocation of the hip in a 3-year-old child.

      Forde, James C; Khan, Khalid S; Awan, Nasir; Department of Trauma and Orthopaedics, Our Lady of Lourdes Hospital, Drogheda,, County Louth, Ireland. fordejames@yahoo.com (2012-02-01)
      We report the case of a traumatic posterior dislocation of the hip in a 3-year-old boy. After a fall in the garden, the boy was brought to our emergency department where an x-ray confirmed a posterior dislocation of his right hip. A successful prompt reduction was performed in the operating room under general anesthesia. This uncommon injury represents an orthopedic emergency and requires prompt reduction to lessen the risk of complications including avascular necrosis of the femoral head.