• 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.
    • Maternal post natal hospital readmission-trends and association with mode of delivery.

      Ade-Conde, J A; Alabi, O; Higgins, S; Visvalingam, G; Our Lady of Lourdes Hospital, Drogheda, Co Louth. tunjitola@yahoo.com (2012-02-01)
      The aim of this study is to examine the trend in maternal postnatal readmission within six weeks of discharge from childbirth hospitalisation. It is a retrospective review of the maternity computer records system, patient's clinical notes and HIPE data base. All women who delivered babies weighing > 500 g and/ > or = 24 weeks gestational age at Our Lady of Lourdes Hospital, Drogheda, Ireland from 1st January 2005 to 31st December 2008 who were re-hospitalised within six weeks of discharge from hospital following child birth were included in the study. A total of 15782 women were delivered over the four year study period. Of these, 236 were readmitted. A series of chi-square analysis were conducted to assess the difference in readmission rates between the year 2008 86 (2.03%) and the years 2005-51(1.46%), 2006-39 (1.01%) and 2007-60 (1.42%). The readmission rate was found to be significantly higher in 2008 compared with the three preceding years. Complications of Caesarean section and secondary postpartum haemorrhage following spontaneous vaginal delivery constitute the major indications for readmission.
    • 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.
    • Modes of death in neonatal intensive care units.

      Finan, E; Bolger, T; Gormally, S M; Dept of Neonatology, Our Lady of Lourdes Hospital, Drogheda, Co. Louth. (2006-04)
      With the ever-increasing availability of aggressive medical treatment and technical support, neonatologists are offered an increasing ability to prolong life. While "end-of-life" decisions within NICUs have been studied internationally, there is limited data available for Ireland. Through the auspices of the Irish Faculty of Paediatrics 2002 Neonatal Mortality Ouestionnaire, decisions made around the time of death in Irish Neonatal Intensive Care Units were examined. The overall response rate to the questionnaire was 96% (n=25). One hundred and eighty seven deaths were reported for 2002. Information pertaining to the mode of death was available in 53% of cases. Seventy seven percent of those paediatricians who answered this question, reported either withdrawing or withholding treatment in babies thought to have a hopeless outcome, with the greatest proportion of these deaths occurring in premature infants (n=30) and babies with congenital defects (n=40).
    • 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.
    • The outcome of laparoscopic cholecystectomy by ultrasonic dissection.

      Sasi, Walid; Department of Surgery, Our Lady of Lourdes Hospital Drogheda, Ireland. (2010-04)
      Electrocautery remains the main energy form used for dissection in laparoscopic cholecystectomy. However, due to its many risks the search continues for safer and more efficient forms of energy. This chapter assesses the outcomes of dissection using ultrasonic energy as compared to monopolar electrocautery during laparoscopic cholecystectomy. Studies included are trials of prospectively randomized adult patients with symptomatic gallstone disease subject either ultrasonic or monopolar electrocautery dissection during laparoscopic cholecystectomy. Seven trials were included in this review, with a total patient number of 695 randomized to two dissection methods: 340 in the electrocautery group and 355 in the ultrasonic group. Ultrasonic dissection is shown to be superior to monopolar electrocautery in laparoscopic cholecystectomy. Disadvantages include a difficult maneuvering technique and overall cost. Appropriate training programs may be implemented to overcome the first disadvantage, and it might be argued that given the combined cost of factors associated with standard clip and cautery technique, cost issues may be outweighed by the benefits of ultrasonic dissection. However, this necessitates further cost-benefit analysis.
    • Peripheral nerve field stimulation for pruritus relief in a patient with notalgia paraesthetica.

      Ricciardo, Bernadette; Kumar, Sandeep; O'Callaghan, James; Boyce, Zachary; Department of Dermatology, Our Lady Of Lourdes Hospital, Drogheda, Louth,, Ireland. berniricciardo@yahoo.com.au (2012-02-01)
      This case study is presented to exemplify the application of peripheral nerve field stimulation in the treatment of recalcitrant notalgia paraesthetica. The patient was a 60-year-old woman with severe and disabling notalgia paraesthetica. The itch persisted despite the use of several medications - topical and oral. Following a successful trial of peripheral nerve field stimulation with a temporary electrode, two subcutaneous electrodes were inserted into the affected area with a battery implanted subcutaneously in her right buttock. The patient was reviewed at 5 months post implantation. She reported a greater than 85% improvement in her itch. She also reported a major improvement in her quality of life, with particular improvement in her ability to sleep through the night. This case illustrates the possible utilization of peripheral nerve field stimulation in the treatment of notalgia paraesthetica, which is a common yet poorly understood and treated condition. Replication and controlled studies are required to determine the general applicability of this approach.
    • 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.
    • Point of Care Echocardiography in an Irish Critical Care Unit

      Kuriakose, D; O’Mahony, R; Rooplalsingh, R; McCanny, P; Colreavy, F; Our Lady of Lourdes Hospital, Drogheda, Connolly Hospital, Blanchardstown, Co. Dublin, The Prince Charles Hospital, Rode Road, Chermside, QLD AUS, Liverpool Hospital, Liverpool, New South Wales 2170, Australia, Consultant Intensivist, Mater Misercordiae University Hospital, Eccles Street, Dublin 7 (Irish Medical Journal, 2018-09)
      Transthoracic echocardiography (TTE) has become an established component of critical care monitoring1-5 .Traditionally performed by Cardiology Services, either cardiac physiologists or cardiology doctors, a major limitation has been availability of these personnel on a 24 hour /7 day per week basis to the critical care area. As a result performance of TTE examinations has moved beyond the traditional users and now involves critical care doctors. Definition of the competencies required for basic level critical care echocardiography has provided a practical roadmap to Intensivists involved in echocardiography training. We introduced a basic level echocardiography training course into our critical care unit and it was the aim of this study to evaluate the impact of echocardiography training on clinical practice.
    • Point of Care Echocardiography in an Irish Critical Care Unit

      Kuriakose, D; O’Mahony, R; Rooplalsingh, R; McCanny, P; Colreavy, F; 1. Our Lady of Lourdes Hospital, Drogheda 2. Connolly Hospital, Blanchardstown, Co. Dublin 3. The Prince Charles Hospital, Rode Road, Chermside, Aus 4. Liverpool Hospital, Liverpool, New South Wales, Aus 5. Mater Misercordiae University Hospital, Dublin (Irish Medical Journal, 2018-10)
      We sought to evaluate the clinical impact of a 6 month transthoracic echocardiography (TTE) teaching programme in a critical care unit.
    • Prenatal diagnosis of chorionicity in twins.

      Hassan, T; O'Coigligh, S; Higgins, S; Our Lady of Lourdes, Drogheda, Co Louth. tayyabahassan@hotmail.com (2012-02-01)
      The aim of this audit was to assess the accuracy of transabdominal ultrasound scan in predicting chorionicity in twin pregnancies in our unit. The presence or absence of lambda sign, T-sign, dividing membrane thickness and number of placentae were used to determine chorionicity. We retrospectively analysed these antenatal markers in 268 sets of twins delivered over a 5 year period and compared it with the postpartum placental histology and neonatal gender. Of 268 twin deliveries, 204 (76%) had both chorionicity and placental histology to compare. 67 of 84 (80%) were correctly diagnosed antenatally as monochorionic and 137 of 151 (91%) as dichorionic. In 31 cases (15%) the ultrasound diagnosis of chorionicity didn't match placental histology. Seventeen were thought to be monochorionic antenatally but were confirmed dichorionic on placental histology. Overall chorionicity was correctly diagnosed in 171/204 (84%) using transabdominal ultrasound scan (USS) in all trimesters. However the sensitivity and specificity of USS was much higher for dichorionic twins when carried out before 14 weeks of gestation.
    • 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.
    • Proteomic classification of breast cancer.

      Kamel, Dalia; Brady, Bernadette; Tabchy, Adel; Mills, Gordon B; Hennessy, Bryan; Department of Medical Oncology, Our Lady of Lourdes Hospital, Drogheda, Ireland. dsskamel@hotmail.com (2012-11)
      Being a significant health problem that affects patients in various age groups, breast cancer has been extensively studied to date. Recently, molecular breast cancer classification has advanced significantly with the availability of genomic profiling technologies. Proteomic technologies have also advanced from traditional protein assays including enzyme-linked immunosorbent assay, immunoblotting and immunohistochemistry to more comprehensive approaches including mass spectrometry and reverse phase protein lysate arrays (RPPA). The purpose of this manuscript is to review the current protein markers that influence breast cancer prediction and prognosis and to focus on novel advances in proteomic classification of breast cancer.
    • Pulmonary embolism following isolated upper limb injury: a rare complication

      Raval, Pradyumna; Burke, Neil; Harrington, Paul (Springer, 2012-12)
    • A quality improvement approach to reducing the caesarean section surgical site infection rate in a regional hospital

      O’ Hanlon, M; McKenna, C; Carton, E; Diviney, D; Costello, MR; O’Sullivan, L; Fitzsimons, J; Toland, L; Dornikova, G; Curran, R; et al. (Iris Medical Journal, 2016-09)
      Surgical site infection (SSI) rates are used extensively by hospitals as a basis for quality improvement. A 30 day post-discharge SSI programme for caesarean section operations has been implemented in Our Lady of Lourdes Hospital since 2011. It has been shown that skin antisepsis and antibiotic prophylaxis are key factors in the prevention of SSI. Using quality improvement methodology, an infection prevention bundle was introduced to address these two factors. Skin antisepsis was changed from povidone-iodine to chlorhexidine-alcohol. Compliance with choice of antibiotic prophylaxis increased from 89.6% in 2014 to 98.5% in 2015. Compliance with timing also improved. The SSI rate of 7.5% was the lowest recorded to date, with the majority of SSIs (64%) diagnosed after hospital discharge. The level of variation was also reduced, however the continued presence of variation and possibility of lower infection rates from the literature imply that further improvements are required.
    • A Quality Improvement Approach to Reducing the Caesarean section Surgical Site Infection Rate in a Regional Hospital

      O’ Hanlon, M; McKenna C; Carton, E; Diviney, D; Costello, MR; O’Sullivan, L; Fitzsimons, J; Toland, L; Dornikova, G; Curran, R; et al. (Irish Medical Journal, 2016-09)
      Surgical site infection (SSI) rates are used extensively by hospitals as a basis for quality improvement. A 30-day post-discharge SSI programme for Caesarean section operations has been implemented in Our Lady of Lourdes Hospital since 2011. It has been shown that skin antisepsis and antibiotic prophylaxis are key factors in the prevention of SSI. Using quality improvement methodology, an infection prevention bundle was introduced to address these two factors. Skin antisepsis was changed from povidone-iodine to chlorhexidine-alcohol. Compliance with choice of antibiotic prophylaxis increased from 89.6% in 2014 to 98.5% in 2015. Compliance with timing also improved. The SSI rate of 7.5% was the lowest recorded to date, with the majority of SSIs (64%) diagnosed after hospital discharge. The level of variation was also reduced. However, the continued presence of variation and possibility of lower infection rates from the literature imply that further improvements are 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.