• 11beta-hydroxysteroid dehydrogenase type 1 regulates glucocorticoid-induced insulin resistance in skeletal muscle.

      Morgan, Stuart A; Sherlock, Mark; Gathercole, Laura L; Lavery, Gareth G; Lenaghan, Carol; Bujalska, Iwona J; Laber, David; Yu, Alice; Convey, Gemma; Mayers, Rachel; Hegyi, Krisztina; Sethi, Jaswinder K; Stewart, Paul M; Smith, David M; Tomlinson, Jeremy W; Centre for Endocrinology, Diabetes and Metabolism, Institute of Biomedical Research, School of Clinical & Experimental Medicine, University of Birmingham, Birmingham, U.K. (Diabetes, 2009-11)
      Glucocorticoid excess is characterized by increased adiposity, skeletal myopathy, and insulin resistance, but the precise molecular mechanisms are unknown. Within skeletal muscle, 11beta-hydroxysteroid dehydrogenase type 1 (11beta-HSD1) converts cortisone (11-dehydrocorticosterone in rodents) to active cortisol (corticosterone in rodents). We aimed to determine the mechanisms underpinning glucocorticoid-induced insulin resistance in skeletal muscle and indentify how 11beta-HSD1 inhibitors improve insulin sensitivity.
    • Abdominal CT findings in small bowel perforation.

      Ward, E; Killeen, R; Campbell, N; Torreggiani, W C (The British journal of radiology, 2009-06)
    • Accuracy of whole-body low-dose multidetector CT (WBLDCT) versus skeletal survey in the detection of myelomatous lesions, and correlation of disease distribution with whole-body MRI (WBMRI).

      Gleeson, T G; Moriarty, J; Shortt, C P; Gleeson, J P; Fitzpatrick, P; Byrne, B; McHugh, J; O'Connell, M; O'Gorman, P; Eustace, S J; Department of Radiology and Diagnostic Imaging, Mater Misericordiae University Hospital, Eccles St., Dublin 7, Ireland. tadhggleeson@hotmail.com (Skeletal radiology, 2009-03)
      The aim of the study is to assess the feasibility of whole-body low-dose computed tomography (WBLDCT) in the diagnosis and staging of multiple myeloma and compare to skeletal survey (SS), using bone marrow biopsy and whole-body magnetic resonance imaging (WBMRI; where available) as gold standard.
    • Accurate intra-articular knee joint injection in the obese? 'Fat Chance!'-A clinical lesson and recommendations for secondary referral.

      McGarry, James G; Livingston, Kerr; Daruwalla, Zubin J; Department of Orthopaedic Surgery, Tallaght Hospital, Dublin, Ireland. (2011-04-12)
      Abstract Corticosteroid joint injections are perceived as being an effective treatment for symptomatic knee osteoarthritis, with a very low risk of complications. While the procedure is often performed in secondary care by orthopaedic surgeons and rheumatologists (and trainees in either specialty), the role of general practitioners (GPs) in chronic disease management has long existed with joint injections also frequently performed in primary care. The perception that serious complications from corticosteroid knee joint injections are rare and that their benefits in treating symptomatic knee osteoarthritis significantly outweigh the risks has not been well addressed. We present a case of a 71-year-old obese female who presented to her general practitioner (GP) with worsening left knee pain and radiographic changes consistent with osteoarthritis. She was administered a corticosteroid joint injection, which gave minimal relief, and over the next few days resulted in worsening severe pain, erythema and swelling. She returned to the GP who commenced oral antibiotics and referred her to casualty. A large knee abscess was diagnosed and intravenous antibiotics were commenced. The patient was admitted under the orthopaedic surgeons with her treatment consisting of multiple surgical procedures over a prolonged duration. Although lengthy, her postoperative recovery was unremarkable. Based on this case report and our review of the literature, we highlight the potential complications associated with corticosteroid knee joint injections and suggest certain patients for whom we would recommend secondary referral before any intervention in primary care.
    • Acetabular fractures following rugby tackles: a case series.

      Good, Daniel W; Leonard, Michael; Lui, Darren; Morris, Seamus; McElwain, John P; Department of Trauma Orthopaedics and Reconstructive Pelvic and Acetabular Surgery, Adelaide and Meath Incorporating the National Childrens Hospital, Tallaght, Dublin 24, Ireland. goodd@tcd.ie. (Journal of medical case reports, 2011)
      Rugby is the third most popular team contact sport in the world and is increasing in popularity. In 1995, rugby in Europe turned professional, and with this has come an increased rate of injury.
    • ACTH deficiency, higher doses of hydrocortisone replacement, and radiotherapy are independent predictors of mortality in patients with acromegaly.

      Sherlock, M; Reulen, R C; Alonso, A Aragon; Ayuk, J; Clayton, R N; Sheppard, M C; Hawkins, M M; Bates, A S; Stewart, P M; Centre for Endocrinology, School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TH, United Kingdom. (The Journal of clinical endocrinology and metabolism, 2009-11)
      A number of retrospective studies report that patients with acromegaly have increased morbidity and premature mortality, with standardized mortality ratios (SMR) of 1.3-3. Many patients with acromegaly develop hypopituitarism as a result of the pituitary adenoma itself or therapies such as surgery and radiotherapy. Pituitary radiotherapy and hypopituitarism have also been associated with an increased SMR.
    • Acute pulmonary admissions following implementation of a national workplace smoking ban.

      Kent, Brian D; Sulaiman, Imran; Nicholson, Trevor T; Lane, Stephen J; Moloney, Edward D; Department of Respiratory Medicine, Adelaide and Meath Hospital, Dublin, Ireland. brian.kent@ucd.ie (2012-09)
      The implementation of workplace smoking bans has contributed to a significant reduction in the incidence of acute coronary syndrome admissions, but their influence on adult acute pulmonary disease admissions is unclear. We sought to assess the impact of a national smoking ban on nationwide admissions of individuals of working age with acute pulmonary illness.
    • Acute serum amyloid A induces migration, angiogenesis, and inflammation in synovial cells in vitro and in a human rheumatoid arthritis/SCID mouse chimera model.

      Connolly, Mary; Marrelli, Alessandra; Blades, Mark; McCormick, Jennifer; Maderna, Paola; Godson, Catherine; Mullan, Ronan; FitzGerald, Oliver; Bresnihan, Barry; Pitzalis, Costantino; Veale, Douglas J; Fearon, Ursula; Dublin Academic Medical Centre, University College Dublin, Dublin, Ireland. (Journal of immunology (Baltimore, Md. : 1950), 2010-06-01)
      Serum amyloid A (A-SAA), an acute-phase protein with cytokine-like properties, is expressed at sites of inflammation. This study investigated the effects of A-SAA on chemokine-regulated migration and angiogenesis using rheumatoid arthritis (RA) cells and whole-tissue explants in vitro, ex vivo, and in vivo. A-SAA levels were measured by real-time PCR and ELISA. IL-8 and MCP-1 expression was examined in RA synovial fibroblasts, human microvascular endothelial cells, and RA synovial explants by ELISA. Neutrophil transendothelial cell migration, cell adhesion, invasion, and migration were examined using transwell leukocyte/monocyte migration assays, invasion assays, and adhesion assays with or without anti-MCP-1/anti-IL-8. NF-kappaB was examined using a specific inhibitor and Western blotting. An RA synovial/SCID mouse chimera model was used to examine the effects of A-SAA on cell migration, proliferation, and angiogenesis in vivo. High expression of A-SAA was demonstrated in RA patients (p < 0.05). A-SAA induced chemokine expression in a time- and dose-dependent manner (p < 0.05). Blockade with anti-scavenger receptor class B member 1 and lipoxin A4 (A-SAA receptors) significantly reduced chemokine expression in RA synovial tissue explants (p < 0.05). A-SAA induced cell invasion, neutrophil-transendothelial cell migration, monocyte migration, and adhesion (all p < 0.05), effects that were blocked by anti-IL-8 or anti-MCP-1. A-SAA-induced chemokine expression was mediated through NF-kappaB in RA explants (p < 0.05). Finally, in the RA synovial/SCID mouse chimera model, we demonstrated for the first time in vivo that A-SAA directly induces monocyte migration from the murine circulation into RA synovial grafts, synovial cell proliferation, and angiogenesis (p < 0.05). A-SAA promotes cell migrational mechanisms and angiogenesis critical to RA pathogenesis.
    • Added Value of Stroke Protocol MRI Following Negative Initial CT in the Acute Stroke Setting

      Gargan, ML; Kok, HK; Kearney, J; Collins, R; Coughlan, T; O’Neill, D; Ryan, D; Torreggiani, W; Doody, O (Irish Medical Journal, 2015-12)
      The aim of the study was to determine the added value of stroke protocol MRI following negative initial CT brain in the acute stroke setting. A retrospective study was performed over a 6 month period in a tertiary referral stroke centre. Patients were selected from the stroke and radiology databases. Inclusion criteria: clinical stroke syndrome, negative initial CT with subsequent MRI study with diffusion weighted sequences. Ninety two patients were reviewed and 73 (M:F of 39:34, mean age 62.1 – 14.0 years) met the inclusion criteria. Twenty MRI studies (27.4%) were positive for acute/ subacute ischaemia in the setting of a normal initial CT. The average time interval between initial CT and MRI brain imaging was 4.7 – 2.6 days. Whilst CT continues to be the first line imaging investigation for acute stroke, MRI has substantial added value following negative initial CT in the diagnosis of stroke.
    • The addition of ondansetron to a oral rehydration protocol for children with acute gastroenteritis

      Mullarkey, C; Crowley, E; Martin, C (Irish Medical Journal (IMJ), 2013-10)
      This study describes the introduction of Ondansetron to an established waiting room Oral Rehydration Therapy (ORT) for Emergency Department (ED) children with acute gastroenteritis, and evaluates its impact on intravenous fluid administration and admissions. Children who failed initial ORT while waiting further medical assessment received Ondansetron and ORT reattempted. Data collected over a six week period in 2009 was compared to a similar period in 2008 when children received ORT without an anti-emetic. Outcome measures included intravenous fluid administration, admission. Rates of IVF administration reduced by 19% [88/215 (40.9%) in 2008, 51/234 (21.7%) in 2009, p < 0.0001] with a 1.6% reduction in admission rates [31/215 (14.41%) vs 30/234(12.82%) p=0.62]. Thirty four patients received Ondansetron, 79% were successfully rehydrated orally. The addition of Ondansetron to our established ORT programme has successfully reduced rates of IVF administration and admissions in children with gastroenteritis.
    • The Adelaide and Meath Hospital, incorporating the National Children's Hospital ("The Hospital") report to the Minister for Health and Children on management, reporting and control, service provision and the financial position of the hospital in the context of the recent merger of the base hospitals and the move to the new hospital at Tallaght.

      Deloitte & Touche (Deloitte & Touche, 1998-12-03)
      The Adelaide and Meath Hospital, incorporating the National Children's Hospital, ("AMINCH") is established under a Charter as amended by an Order passed by both houses of the Oireachtas in July 1996. AMINCH came into being on I August 1996. AMINCH reflects the merger of the three separate entities of the Adelaide Hospital. the Meath Hospital and the National Children's Hospital, each of which had in its own right a long tradition of providing hospital services in the Dublin area. AMINCH has operated from the new hospital in Tallaght since 21 June 1998. The Charter under which AMINCH is established is derived from the Charter of the former Adelaide Hospital. It sets down the religious character of the Hospital and provides for a multi-denominational and pluralist approach to the provision of services in the Hospital.
    • Adelaide Hospital annual report for the year ended 31st December 1989. the 150th year of the hospital.

      Adelaide Hospital. (Adelaide Hospital., 1990)
      Everyone, who was in the Hospital on 11th March, 1989, received a flower to mark the day on which the Hospital first opened 150 years ago. We had arranged to give each patient, each member of staff, and each visitor a single bloom to mark in a personal way the celebration of the 150th Anniversary of the Adelaide. Later, we had a more formal celebration with the Service of Thanksgiving at Christ Church Cathedral on 7th May, 1989. His Grace Dr. Donald Caird, Archbishop of Dublin, preached the sermon in which he spoke of the past and of the future at Tallaght. The Annual Service in Birr was a particularly splendid occasion this year-His Grace, Dr. Robin Eames. Archbishop of Armagh, preached the sermon, and the choir of St. Patrick's Cathedral, Dublin, led us in worship.
    • Adelaide Hospital annual report for the year ended 31st December 1993.

      Adelaide Hospital. (Adelaide Hospital, 1994)
      1993 finally saw resolution of the major difficulties regarding the management structure for the new Adelaide and Meath Hospital at Tallaght. The Minister for Health, Mr. Brendan Howlin, made it clear to the hospital that resolution of this issue was an extremely high priority for him. For this reason, the Board of Management acquiesced to his request that negotiations be resumed under the Chairmanship of Prof. David Kennedy and Mr. David Kingston. This time, it was evident that the political will existed to resolve the difficult outstanding issues and the working party issued heads of agreement on the 19th May, 1993. These Heads of Agreement guarantee the place of the new Hospital as a focus for Protestant participation in the Health Services while confirming freedom of conscience and the free profession and practice of religion by all within the institution. The structure of the new Board of Management is such that six representatives will be appointed by the Adelaide Hospital Society, six by the Meath Hospital or its successor, and three by the National Children's Hospital or its successor. Each of these three bodies shall include at least one senior medical representative holding an appointment within the hospital in its nomination to the Board. In addition, the Minister for Health shall be requested to appoint six persons to the Board on receipt of nominations from the President of the hospital. The Minister shall further be requested to appoint a person on the nomination of the local Health Authority and a representative of Trinity College, Dublin. These recommendations meet with the approval of the Department of Health.
    • Adelaide Hospital annual report for the year ended 31st December 1995.

      Adelaide Hospital. (Adelaide Hospital., 1996)
      The prospect of 1995 was an optimistic, if challenging, one for the Board of Management. The final ratification of the Charter of the Adelaide & Meath Hospital, Dublin (incorporating the National Children's Hospital) by all three Boards of Management within the MANCH Group was tantalisingly close, but considerable effort was still required to ensure that this was achieved. The agreed draft was finally submitted to Government in August, 1995 and subject to approval by the office of the Attomey General and the Houses of the Oireachtas will take legal effect early in 1996. In tandem with Charter negotiations, much other work was done to assure a prosperous future for the Adelaide Hospital Society. A primary object of the Society is to support through charitable donations and other means, the Adelaide & Meath Hospital, Dublin (incorporating the National Children's Hospital) after the transfer of the Adelaide to the new hospital at Tallaght. The Cy pres scheme was approved by the High Court on 13th February, 1995. The effect of this was to separate the Adelaide Hospital Society, its property and other assets, from the Adelaide Hospital (Incorporated).
    • Adherence to colorectal polyp surveillance guidelines: is there a 'scope' to increase the opportunities for screening?

      O'Connor, Anthony; Keane, Ruth-Anne; Egan, Brian; Lee, Nikki; O'Connor, Humphrey; Qasim, Asghar; Ryan, Barbara; Breslin, Niall; McNamara, Deirdre; O'Morain, Colm; Department of Gastroenterology, Adelaide and Meath Hospital incorporating the, National Children's Hospital/Trinity College Dublin, Ireland. oconna12@tcd.ie (2012-02-01)
      Colorectal polyps are usually asymptomatic and are found opportunistically. Individuals with adenomata are at increased risk for cancer and therefore guidelines exist for surveillance of these lesions including those of the British Society of Gastroenterology (BSG). Deviation from these guidelines is common and increases the workload of endoscopy. We examined those individuals waiting for endoscopy for polyp surveillance to see whether strict adherence to BSG guidelines could facilitate opportunities for screening. A total of 413 patients with earlier colonic polyps were examined, of whom 50 patients were excluded based on having alternative indications for surveillance, 179 (49.3%) were appropriately scheduled for surveillance and 184 patients (55.9%) were scheduled incorrectly. Seventy-nine patients (30%) could have been discharged; of these, 59 had hyperplastic polyps. Of the remaining 105 inappropriate triages under surveillance at the wrong interval, seven patients were scheduled for too infrequent surveillance and 98 were too frequent. A total of 284 patients with adenomatous polyps were under surveillance of whom 11 patients (3.8%) were in the high-risk category and all were appropriately scheduled, and 75 patients (26.4%) were in the intermediate-risk category, of whom 48 were appropriately scheduled, 20 were incorrectly triaged as high risk and seven were triaged as low risk. A total of 198 (69.7%) patients were in the low-risk category, 117 of these were correctly triaged, 15 were incorrectly triaged as high risk and 66 were classified as intermediate risk. Over a five-year period, 318 unnecessary colonoscopies are being performed. On the basis of the data obtained from a population-based colorectal screening programme using immunohistochemical-faecal occult blood testing in our department another 1516 patients could be screened annually without requiring any additional endoscopy resources, if strict adherence to guidelines was assured.
    • Adipophilin distribution and colocalization with lipid droplets in skeletal muscle.

      Shaw, Christopher S; Sherlock, Mark; Stewart, Paul M; Wagenmakers, Anton J M; Exercise Metabolism Research Group, School of Sport and Exercise Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK. c.s.shaw@bham.ac.uk (Histochemistry and cell biology, 2009-05)
      Intramyocellular lipids (IMCL) are stored as discrete lipid droplets which are associated with a number of proteins. The lipid droplet-associated protein adipophilin (the human orthologue of adipose differentiation-related protein) is ubiquitously expressed and is one of the predominant lipid droplet-proteins in skeletal muscle. The aim of this study was to investigate the subcellular distribution of adipophilin in human muscle fibres and to measure the colocalization of adipophilin with IMCL. Muscle biopsies from six lean male cyclists (BMI 23.4 +/- 0.4, aged 31 +/- 2 years, W (max) 346 +/- 8) were stained for myosin heavy chain type 1, IMCL, adipophilin and mitochondria using immunofluorescence and viewed with widefield and confocal fluorescence microscopy. The present study shows that like IMCL, the adipophilin content is ~twofold greater in type I skeletal muscle fibres and is situated in the areas between the mitochondrial network. Colocalization analysis demonstrated that 61 +/- 2% of IMCL contain adipophilin. Although the majority of adipophilin is contained within IMCL, 36 +/- 4% of adipophilin is not associated with IMCL. In conclusion, this study indicates that the IMCL pool is heterogeneous, as the majority but not all IMCL contain adipophilin.
    • Adrenal incidentalomas: a disease of modern technology.

      Das, J P; McDermott, J; Torreggiani, W C (Irish Medical Journal (IMJ), 2011-09)
    • Adriamycin and Dexamethasone is superior to VAD-type chemotherapy: the use of a novelstatistical methodology in the PAD Ireland Trial

      Morris, C; O’Dwyer, M; Popat, R; Drake, M; Quinn, M; McGuigan, T; Cook, G; Yong, K; Leahy, M; Murray, M; Enright, H; McCloy, M; O’Gorman, P; O’Shea, T; Verghis, R; Oakervee, H; Cavenagh, J (2011)
    • Adult growth hormone deficiency

      Aragon-Alonso, A; Sherlock, M; Toogood, AA (Oxford University Press, 2010)