• Atraumatic bilateral inferior pubic rami fractures in a young female: a rare case

      Raval, Pradyumna; Khan, Khalid S.; Department of Orthopaedic Surgery, Our Lady of Lourdes Hospital, Drogheda, County Louth, Ireland (Springer-Verlag, 2014-06)
    • Bite injuries to the hand - review of the literature.

      Raval, Pradyumna; Khan, Wasim; Haddad, Behrooz; Narayan Mahapatra, Anant; Department of Orthopaedic Surgery, Our Lady of Lourdes Hospital, Drogheda, County Louth, Ireland. University College London Institute of Orthopaedics & Musculoskeletal Sciences, Royal National Orthopaedic Hospital, Stanmore, UK (2014-04)
      Patients presenting to the emergency department with bite injuries to the hand sustain them through a number of causes including domesticated as well as stray animal bites, and human bites commonly sustained as a result of violence. The nature of the injuries sustained can be very deceptive. A small tooth mark on the exterior can be a fulminant infection in the tissues deeper down. Tendon injuri es, fractures of the metacarpals and phalanges and management of the wound are critical issues faced by a surgeon in dealing with such patients. Similarly the less common bite injuries to the hand, often with disastrous and sometimes fatal complications, d o also present to the emergency department. A high incidence of suspicion is needed in dealing with these injuries effectively. In our article we discuss the common as well as uncommon causes of bite injuries to the hand and their management. In addition to reviewing the literature to ascertain the management of such injuries, we also discuss interesting and rare case reports.
    • 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.
    • Clinical report: Maternity Department

      Our Lady of Lourdes Hospital, Drogheda (1981)
    • The comparative palliative care needs of those with heart failure and cancer patients.

      O'Leary, Norma; Our Lady of Lourdes Hospital, Drogheda, Co. Louth and Our Lady's Hospital, Navan,, Co. Meath. HSE Northeast, Dublin, Ireland. normaoleary@hse.ie (2012-02-01)
      PURPOSE OF REVIEW: Patients with heart failure seem particularly suited to palliative care having needs that fall within the prototypical palliative care domains. Despite this there is still much debate as to who should respond to these needs and when. RECENT FINDINGS: Since the early 1990s many studies have been published outlining the unmet needs of patients with heart failure. However, there have been limitations to these studies and they have not guided professionals as to how to respond. More recently comparative studies using cancer as the reference have explored similarities and highlighted differences in need between heart failure and cancer patients. These studies are useful for informing future service development. SUMMARY: Patients with heart failure have variable needs and variable disease trajectories. A targeted response to these needs is required. Palliative triggers or transitions should be recognized by professionals caring for patients with heart failure. It is unlikely that either specialist palliative care or medical specialists working in isolation will be sufficiently experienced to respond to these needs. Research is required to determine the effectiveness of different collaborative approaches; heart failure specialist care aligned with palliative care consultancy or heart failure-oriented palliative care services.
    • Congenital diaphragmatic hernia surveillance

      Chukwu, J; Cunney, R; Molloy, E (Irish Medical Journal, 2014-09)
      Congenital Diaphragmatic Hernia (CDH) is a rare congenital disorder as a result of deficient development of the diaphragm with resultant herniation of abdominal viscera into the thoracic cavity, mal-development of the alveoli and pulmonary vessels 1,2 . The incidence of CDH â ranges from 1 in 2,000 to 1 in 15,000 births 3 . Due to the legislation in Ireland against termination of pregnancy it was suggested that there may be an increased incidence of CDH. There is no mandatory reporting of CDH cases in the Republic of Ireland (ROI) and Northern Ireland (NI). Voluntary case reporting to the Irish Paediatric Surveillance Unit (IPSU) started in January 2010.
    • 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.
    • Evaluating the impact of ISO 15189 on an Irish histopathology laboratory

      O’Connor, Linda; Malkin, Alison; Carroll, Breffnie (THE BIOMEDICAL SCIENTIST, 2016-09)
      Accreditation is the acknowledgement that the laboratory has reached and maintains a certain standard of quality. Pre-accreditation, quality standards in hospital laboratories were perceived to exist but were undocumented. The difference post-accreditation is having to prove that this standard of quality actually exists and is maintained. An Irish hospital laboratory is recognised as accredited when an accreditation body such as the Irish National Accreditation Body (INAB) inspects or audits the hospital laboratory and grants it accreditation status.
    • 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.
    • Genomic and oncoproteomic advances in detection and treatment of colorectal cancer.

      McHugh, Seamus M; O'Donnell, Jill; Gillen, Peter; Dept. of Surgery, Our Lady of Lourdes Hospital, Drogheda, County Louth, Ireland. , seamusmchugh@rcsi.ie (2012-02-01)
      AIMS: We will examine the latest advances in genomic and proteomic laboratory technology. Through an extensive literature review we aim to critically appraise those studies which have utilized these latest technologies and ascertain their potential to identify clinically useful biomarkers. METHODS: An extensive review of the literature was carried out in both online medical journals and through the Royal College of Surgeons in Ireland library. RESULTS: Laboratory technology has advanced in the fields of genomics and oncoproteomics. Gene expression profiling with DNA microarray technology has allowed us to begin genetic profiling of colorectal cancer tissue. The response to chemotherapy can differ amongst individual tumors. For the first time researchers have begun to isolate and identify the genes responsible. New laboratory techniques allow us to isolate proteins preferentially expressed in colorectal cancer tissue. This could potentially lead to identification of a clinically useful protein biomarker in colorectal cancer screening and treatment. CONCLUSION: If a set of discriminating genes could be used for characterization and prediction of chemotherapeutic response, an individualized tailored therapeutic regime could become the standard of care for those undergoing systemic treatment for colorectal cancer. New laboratory techniques of protein identification may eventually allow identification of a clinically useful biomarker that could be used for screening and treatment. At present however, both expression of different gene signatures and isolation of various protein peaks has been limited by study size. Independent multi-centre correlation of results with larger sample sizes is needed to allow translation into clinical practice.
    • 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.
    • Incidence of central line related/associated bloodstream infections in an acute hospital

      O’Hanlon, M; Dornikova, G; Curran, R; Staunton, M; Woolhead, A; Kennedy, M; Tinsley, A; Shepherd, E; Doherty, T (Irish Medical Journal, 2014-09)
      Bloodstream infection related to a central venous catheter in the intensive care unit is a substantial clinical and economic problem. The aim of the study was to examine the incidence of central line related bloodstream infections and central line associated bloodstream infections in Our Lady of Lourdes Hospital, Drogheda, during a six month period, using an active patient based prospective surveillance method. CLRBSI rate in ICU/HDU was 0.93/1000 central line days. There was no CLABSI identified in the studied time period. However, further interventions are needed, particularly with CVC care bundle. Also, the implementation of 2% chlorhexidin in 70% isopropylalcohol use for skin asepsis, which is recommended by the Irish national guidelines, would be beneficial.
    • 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.
    • Isolated dislocation of pisiform in an 11-year-old, following a horse bite: a rare injury

      Raval, Pradyumna; Saeed, Nauman; Narayan Mahapatra, Anant; Our Lady of Lourdes Hospital (Springer, 2013-01)
    • Localized plaques on the sacral area of a child.

      Fallon, J; Jones, B; Egan, C A; Department of Dermatology, Our Lady of Lourdes Hospital, Drogheda, Ireland., eur@health.ie (2012-02-01)
    • Management of chronic symphysis pubis pain following child birth with spinal cord stimulator.

      Idrees, Ahsan; Department of Anaesthesia & Pain, Our Lady of Lourdes Hospital, Drogheda, Ireland. (2012-01)
      The case of a 39 year old woman who had diastasis of pubic symphysis following childbirth and later developed severe chronic neuropathic pain and disability is presented. She received extensive surgical and medical treatment for 6 years with no improvement of symptoms. The VNRS (Visual Numerical Rating Scale) pain score was 7/10 or more most of the time. This was quite disabling in terms of her quality of life. A spinal cord stimulator was inserted after failure of other modalities of pain management which resulted in dramatic improvement in the quality of life measured with SF-36 questionnaire. Her pain score became 0/10 VNRS and she was free from opioids and psychotropic medications within 3 months post insertion. Spinal cord stimulator can be considered for the management of pain due to diastasis of pubic symphysis, not amenable to other therapies.