• Kikuchi-Fujimoto disease--an unusual mimicker?

      Scully, Diarmaid F; Walsh, Ceara; Eskander, Hala F; Kane, David; Department of Rheumatology, Adelaide and Meath incorporating the National Children's Hospital, Tallaght, Dublin 24, Ireland. discully@tcd.ie. (2013)
      We describe the case of a 27-year-old Chinese female diagnosed with Kikuchi-Fujimoto disease in Ireland. It principally occurs in Asian populations, but is being increasingly reported in non-Asian populations. This rare, benign disease may potentially be misdiagnosed as lymphoma, and has an association with the subsequent development of systemic lupus erythematosus. Clinicians and pathologists need to be aware of the clinical and histological features of this rare disorder to avoid misdiagnosis.
    • L-2-hydroxyglutaric aciduria diagnosed in an adult presenting with acute deterioration.

      Saidha, Shiv; Murphy, Sinead; McCarthy, Peter; Mayne, Philip D; Hennessy, Michael (Journal of neurology, 2010-01)
    • Lack of significant metabolic abnormalities in mice with liver-specific disruption of 11β-hydroxysteroid dehydrogenase type 1.

      Lavery, Gareth G; Zielinska, Agnieszka E; Gathercole, Laura L; Hughes, Beverly; Semjonous, Nina; Guest, Phillip; Saqib, Khalid; Sherlock, Mark; Reynolds, Gary; Morgan, Stuart A; et al. (Endocrinology, 2012-07)
      Glucocorticoids (GC) are implicated in the development of metabolic syndrome, and patients with GC excess share many clinical features, such as central obesity and glucose intolerance. In patients with obesity or type 2 diabetes, systemic GC concentrations seem to be invariably normal. Tissue GC concentrations determined by the hypothalamic-pituitary-adrenal (HPA) axis and local cortisol (corticosterone in mice) regeneration from cortisone (11-dehydrocorticosterone in mice) by the 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1) enzyme, principally expressed in the liver. Transgenic mice have demonstrated the importance of 11β-HSD1 in mediating aspects of the metabolic syndrome, as well as HPA axis control. In order to address the primacy of hepatic 11β-HSD1 in regulating metabolism and the HPA axis, we have generated liver-specific 11β-HSD1 knockout (LKO) mice, assessed biomarkers of GC metabolism, and examined responses to high-fat feeding. LKO mice were able to regenerate cortisol from cortisone to 40% of control and had no discernible difference in a urinary metabolite marker of 11β-HSD1 activity. Although circulating corticosterone was unaltered, adrenal size was increased, indicative of chronic HPA stimulation. There was a mild improvement in glucose tolerance but with insulin sensitivity largely unaffected. Adiposity and body weight were unaffected as were aspects of hepatic lipid homeostasis, triglyceride accumulation, and serum lipids. Additionally, no changes in the expression of genes involved in glucose or lipid homeostasis were observed. Liver-specific deletion of 11β-HSD1 reduces corticosterone regeneration and may be important for setting aspects of HPA axis tone, without impacting upon urinary steroid metabolite profile. These discordant data have significant implications for the use of these biomarkers of 11β-HSD1 activity in clinical studies. The paucity of metabolic abnormalities in LKO points to important compensatory effects by HPA activation and to a crucial role of extrahepatic 11β-HSD1 expression, highlighting the contribution of cross talk between GC target tissues in determining metabolic phenotype.
    • Laparoscopic colonic resection in inflammatory bowel disease: minimal surgery, minimal access and minimal hospital stay.

      Boyle, E; Ridgway, P F; Keane, F B; Neary, P; Division of Colorectal Surgery, Minimally Invasive Surgery Tallaght, Adelaide, Ireland. (Colorectal disease : the official journal of the Association, 2008-11)
      Laparoscopic surgery for inflammatory bowel disease (IBD) is technically demanding but can offer improved short-term outcomes. The introduction of minimally invasive surgery (MIS) as the default operative approach for IBD, however, may have inherent learning curve-associated disadvantages. We hypothesise that the establishment of MIS as the standard operative approach does not increase patient morbidity as assessed in the initial period of its introduction into a specialised unit, and that it confers earlier postoperative gastrointestinal recovery and reduced hospitalisation compared with conventional open resection.
    • Laparoscopic nephrectomy: initial experience with 120 cases.

      Cheema, I A; Manecksha, R P; Murphy, M; Flynn, R; Urology Department, The Adelaide and Meath Hospital, Tallaght, Dublin 24., ijazacheema@hotmail.com (2012-02-01)
      Laparoscopic nephrectomy for both benign and malignant diseases of kidney is increasingly being performed. We report our experience with the first 120 consecutive laparoscopic nephrectomy performed in our hospital. It is the retrospective analysis of a prospectively maintained database of 4 years period. The parameters examined included age, gender, indications, operative time, blood loss, intraoperative and post operative complications. Mean age of surgery was 59 years (rang 19-84years). The indications for surgery included solid renal masses (71 patients), non-functioning kidneys (43), and collecting system tumours (6). The mean operating time was 132 minutes (range 75-270), average blood loss was 209 ml (range 0-1090) and average hospital stay was 4.7days (range 2-20). Bleeding, bowel injury and poor progression of laparoscopic procedure were the reasons in 7 (5.8%) cases converted to open surgery. There was 1 (0.8%) perioperative mortality. Eight (6.6%) patients developed post operative complications. Laparoscopic nephrectomy has inherent benefits and may be considered an alternate therapeutic option for kidney diseases with acceptable morbidity
    • Laparoscopic pelvic sling placement facilitates optimum therapeutic radiotherapy delivery in the management of pelvic malignancy.

      Joyce, M; Thirion, P; Kiernan, F; Byrnes, C; Kelly, P; Keane, F; Neary, P; Division of Colorectal Surgery, Minimally Invasive Surgery, The Adelaide and, Meath Hospital, Tallaght, Dublin 24, Ireland. mylesjoyce@eircom.net (2012-02-01)
      BACKGROUND: Radiotherapy has a significant role in the management of pelvic malignancies. However, the small intestine represents the main dose limiting organ. Invasive and non-invasive mechanical methods have been described to displace bowel out of the radiation field. We herein report a case series of laparoscopic placement of an absorbable pelvic sling in patients requiring pelvic radiotherapy. METHODS: Six patients were referred to our minimally invasive unit. Four patients required radical radiotherapy for localised prostate cancer, one was scheduled for salvage localised radiotherapy for post-prostatectomy PSA progression and one patient required adjuvant radiotherapy post-cystoprostatectomy for bladder carcinoma. All patients had excessive small intestine within the radiation fields despite the use of non-invasive displacement methods. RESULTS: All patients underwent laparoscopic mesh placement, allowing for an elevation of small bowel from the pelvis. The presence of an ileal conduit or previous surgery did not prevent mesh placement. Post-operative planning radiotherapy CT scans confirmed displacement of the small intestine allowing all patients to receive safely the planned radiotherapy in terms of both volume and radiation schedule. CONCLUSION: Laparoscopic mesh placement represents a safe and efficient procedure in patients requiring high-dose pelvic radiation, presenting with unacceptable small intestine volume in the radiation field. This procedure is also feasible in those that have undergone previous major abdominal surgery.
    • Laparoscopic repair of postoperative perineal hernia.

      Ryan, Stephen; Kavanagh, Dara O; Neary, Paul C; Department of Colorectal Surgery, The Adelaide and Meath Hospital incorporating the National Children's Hospital, 24 Dublin, Ireland. (Case reports in medicine, 2010)
      Perineal hernias are infrequent complications following abdominoperineal operations. Various approaches have been described for repair of perineal hernias including open transabdominal, transperineal or combined abdominoperineal repairs. The use of laparoscopic transabdominal repair of perineal hernias is not well-described. We present a case report demonstrating the benefits of laparoscopic repair of perineal hernia following previous laparoscopic abdominoperineal resection (APR) using a nonabsorbable mesh to repair the defect. We have demonstrated that the use of laparoscopy with repair of the pelvic floor defect using a non absorbable synthetic mesh offers an excellent alternative with many potential advantages over open transabdominal and transperineal repairs.
    • Laparoscopic resection for low rectal cancer: evaluation of oncological efficacy.

      Moran, Diarmaid C; Kavanagh, Dara O; Nugent, Emmeline; Swan, Niall; Eguare, Emmanuel; O'Riordain, Diarmuid; Keane, Frank B V; Neary, Paul C; Division of Colorectal Surgery, Minimally Invasive Surgery, AMNCH, Tallaght, Dublin, 24, Ireland. morandiarmaid@gmail.com (International journal of colorectal disease, 2011-09)
      Laparoscopic resection of low rectal cancer poses significant technical difficulties for the surgeon. There is a lack of published follow-up data in relation to the surgical, oncological and survival outcomes in these patients.
    • Laparoscopic retrieval of a peritoneal mouse.

      Kavanagh, Dara O; Moran, Diarmaid; Flynn, Robert; Neary, Paul C; Division of Colorectal Surgery, Departments of Colorectal Surgery and Urology, Adelaide and Meath Incorporating the National Children's Hospital, Tallaght, Dublin 24, Ireland. (Case reports in medicine, 2010)
      A 67-year-old Caucasian male was referred by the urology service with a history of incomplete bowel emptying. He complained of tenesmus. MRI scan suggested a leiomyoma lying anterior to the rectum. He underwent examination under anaesthesia and attempted endorectal ultrasound and biopsy. However, the lesion seemed to migrate cranially and was impalpable. At laparoscopy, a mobile, unattached, 5.5 × 5 × 3.5, cream-coloured 'egg was retrieved from the retrovesical space. Histology confirmed a hyalinised fibrocollagenous lesion lined with mesothelium. A comprehensive review of the literature is presented.
    • Laparoscopic right hemicolectomy for intestinal intussuception.

      Kiernan, F; Joyce, M; Byrnes, C K; Keane, F; Neary, P; Division of Minimally Invasive Surgery, Department of General Surgery, Adelaide and Meath Hospital, Tallaght, Dublin 24, Ireland. fionamaireadkiernan@yahoo.co.uk (Irish journal of medical science, 2012-09)
      Adult intussusception is rare and usually associated with carcinoma in 50% of the cases. These have traditionally been managed using an open technique. We herein describe a laparoscopic extended right hemicolectomy in a 62-year-old lady with an intussuception secondary to a transverse colonic tumor.
    • Laparoscopic staging and cancer management

      Conlon KC,; Gallagher T. (McGraw-Hill Medical, 2012)
    • Laparoscopic surgery for complicated diverticular disease: a single-centre experience.

      Royds, J; O'Riordan, J M; Eguare, E; O'Riordan, D; Neary, P C; Minimally Invasive Surgery Unit, Division of Colorectal Surgery, AMNCH, Tallaght Hospital, Dublin 24, Ireland. roydsj@gmail.com (Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, 2012-10)
      The role of laparoscopic surgery in the management of patients with diverticular disease is still not universally accepted. The aim of our study was to evaluate the results of laparoscopic surgery for diverticular disease in a centre with a specialist interest in minimally invasive surgery.
    • Laparoscopic surgery for rectal cancer: a single-centre experience of 120 cases.

      Good, Daniel W; O'Riordan, James M; Moran, Diarmaid; Keane, Frank B; Eguare, Emmanuel; O'Riordain, Diarmuid S; Neary, Paul C; Minimally Invasive Surgical Unit, Division of Colorectal Surgery, Adelaide and Meath Incorporating the National Childrens Hospital, Tallaght, Dublin 24, Ireland. goodd@tcd.ie (International journal of colorectal disease, 2011-10)
      For colorectal surgeons, laparoscopic rectal cancer surgery poses a new challenge. The defence of the questionable oncological safety tempered by the impracticality of the long learning curve is rapidly fading. As a unit specialising in minimally invasive surgery, we have routinely undertaken rectal cancer surgery laparoscopically since 2005.
    • Large cell neuroendocrine carcinoma of the ampulla of Vater.

      Beggs, Rachel E; Kelly, Michael E; Eltayeb, Omer; Crotty, Paul; McDermott, Ray; Ridgway, Paul F; Department of Surgery, The Adelaide and Meath Hospital, Dublin Incorporating the National Children's Hospital, Dublin, Ireland. (2012-09)
      Large cell neuroendocrine carcinomas of the ampulla of Vater are rare and confer a very poor prognosis despite aggressive therapy. There are few case reports of large cell neuroendocrine carcinomas of the ampulla of Vater in the literature and to date no studies have been done to establish optimal management. We describe a pooled case series from published reports of neuroendocrine carcinomas of the ampulla of Vater including a case which presented to our institution.
    • Large primary splenic cyst: A laparoscopic technique.

      Geraghty, M; Khan, I Z; Conlon, K C; Department of Surgery, Professorial Surgical Unit, Trinity College Dublin and Adelaide, Meath and National Children's Hospital, Tallaght, Dublin 24. (Journal of minimal access surgery, 2009)
      Splenic cysts are rare lesions with around 800 cases reported in the world literature. Traditionally splenectomy was the treatment of choice. However, with the recognition of the important immunological function of the spleen, new techniques to preserve splenic function have been developed. This case emphasizes that in selected cases splenic preservation is appropriate.
    • Lateral views and subungual soft-tissue chondromas.

      Connolly, Maureen; Intzedy, Laszlo; Collins, Chris; de Berker, David A R (Journal of the American Academy of Dermatology, 2008-02)
    • Left atrial appendage occlusion in non-valvular atrial fibrillation.

      McCabe, Dominick J H; Kinsella, Justin A; Tobin, W Oliver; Department of Neurology, Adelaide and Meath Hospital, Dublin, incorporating the, National Children's Hospital, Trinity College Dublin, Dublin 24, Ireland., dominick.mccabe@amnch.ie (2012-02-01)
    • Left-dominant arrhythmogenic cardiomyopathy: an under-recognized clinical entity.

      Sen-Chowdhry, Srijita; Syrris, Petros; Prasad, Sanjay K; Hughes, Siân E; Merrifield, Robert; Ward, Deirdre; Pennell, Dudley J; McKenna, William J; Inherited Cardiovascular Disease Group, The Heart Hospital, London, United Kingdom. srijita@aol.com (Journal of the American College of Cardiology, 2008-12-16)
      We sought to investigate the clinical-genetic profile of left-dominant arrhythmogenic cardiomyopathy (LDAC).
    • Leukocytosis in women with polycystic ovary syndrome (PCOS) is incompletely explained by obesity and insulin resistance.

      Phelan, N; O'Connor, A; Kyaw Tun, T; Correia, N; Boran, G; Roche, Hm; Gibney, J; Departments of Endocrinology and Diabetes, Adelaide and Meath Hospital, Tallaght, Dublin 24, Ireland. (Clinical endocrinology, 2012-06-20)
      OBJECTIVES: Low-grade chronic inflammation predicts cardiovascular outcomes and is observed in women with polycystic ovary syndrome (PCOS). Whether this is entirely a cause or consequence of insulin resistance (IR) is unknown. METHODS: Seventy pairs of women with and without PCOS, matched for age, BMI and IR (HOMA, QUICKI and Avignon index), were generated from a larger cohort of 103 women with and 104 BMI-matched women without PCOS. Women with PCOS were studied in the follicular phase of the menstrual cycle. White cell count (WCC), high-sensitivity CRP (hsCRP) and a series of 12 cytokines and growth factors were measured. These inflammatory markers were also compared between women with PCOS and 10 normal women studied in the follicular, peri-ovulatory and luteal stages. RESULTS: When all subjects were compared, WCC (6.75 x 10(9) vs 5.60 x 10(9) g/l, p<0.005), hsCRP (4.04 vs 2.90 mg/l, p<0.05), and IL-6 (1.11 vs 0.72 pg/ml, p<0.05) were greater in women with PCOS. Pair-matching for IR eliminated between-group differences in hsCRP and cytokines but did not alter the difference in WCC (6.60 x 10(9) vs 5.60 x 10(9) g/l, p<0.005). WCC was greater in PCOS compared to normal women at all stages of the menstrual cycle. CONCLUSIONS: Low-grade inflammation occurs in PCOS. Increased hsCRP and cytokines are associated with IR but increased WCC is observed even when IR is accounted for. The explanation for this and its clinical significance is unknown. © 2012 Blackwell Publishing Ltd.
    • Liaison neurologists facilitate accurate neurological diagnosis and management, resulting in substantial savings in the cost of inpatient care.

      Costelloe, L; O'Rourke, D; Monaghan, T S; McCarthy, A J; McCormack, R; Kinsella, J A; Smith, A; Murphy, R P; McCabe, D J H; Department of Neurology, The Adelaide and Meath Hospital, Dublin, Incorporating, the National Children's Hospital, Trinity College Dublin, Tallaght, Dublin 24,, Ireland. (2012-02-01)
      BACKGROUND: Despite understaffing of neurology services in Ireland, the demand for liaison neurologist input into the care of hospital inpatients is increasing. This aspect of the workload of the neurologist is often under recognised. AIMS/METHODS: We prospectively recorded data on referral and service delivery patterns to a liaison neurology service, the neurological conditions encountered, and the impact of neurology input on patient care. RESULTS: Over a 13-month period, 669 consults were audited. Of these, 79% of patients were seen within 48 h and 86% of patients were assessed by a consultant neurologist before discharge. Management was changed in 69% cases, and discharge from hospital expedited in 50%. If adequate resources for neurological assessment had been available, 28% could have been seen as outpatients, with projected savings of 857 bed days. CONCLUSIONS: Investment in neurology services would facilitate early accurate diagnosis, efficient patient and bed management, with substantial savings.