• Radical pancreaticoduodenectomy for benign disease.

      Kavanagh, D O; O'Riain, C; Ridgway, P F; Neary, P; Crotty, T C; Geoghegan, J G; Traynor, O; Liver Unit, St Vincent's University Hospital, Elm Park, Dublin. dara_kav@hotmail.com (The Scientific World Journal, 2008)
      Whipple's procedure is the treatment of choice for pancreatic and periampullary malignancies. Preoperative histological confirmation of malignancy is frequently unavailable and some patients will subsequently be found to have benign disease. Here, we review our experience with Whipple's procedure for patients ultimately proven to have benign disease. The medical records of all patients who underwent Whipple's procedure during a 15-year period (1987-2002) were reviewed; 112 patients underwent the procedure for suspected malignancy. In eight cases, the final histology was benign (7.1%). One additional patient was known to have benign disease at resection. The mean age was 50 years (range: 30-75). The major presenting features included jaundice (five), pain (two), gastric outlet obstruction (one), and recurrent gastrointestinal haemorrhage (one). Investigations included ultrasound (eight), computerised tomography (eight), endoscopic retrograde cholangiopancreatography (seven; of these, four patients had a stent inserted and three patients had sampling for cytology), and endoscopic ultrasound (two). The pathological diagnosis included benign biliary stricture (two), chronic pancreatitis (two), choledochal cyst (one), inflammatory pseudotumour (one), cystic duodenal wall dysplasia (one), duodenal angiodysplasia (one), and granular cell neoplasm (one). There was no operative mortality. Morbidity included intra-abdominal collection (one), anastomotic leak (one), liver abscess (one), and myocardial infarction (one). All patients remain alive and well at mean follow-up of 41 months. Despite recent advances in diagnostic imaging, 8% of the patients undergoing Whipple's procedure had benign disease. A range of unusual pathological entities can mimic malignancy. Accurate preoperative histological diagnosis may have allowed a less radical operation to be performed. Endoscopic ultrasound-guided fine needle aspirate (EUS-FNA) may reduce the need for Whipple's operation in benign pancreaticobiliary disease in the future.
    • The radiological diagnosis and treatment of renal angiomyolipoma-current status.

      Halpenny, D; Snow, A; McNeill, G; Torreggiani, W C; Department of Radiology, Adelaide and Meath Hospitals Incorporating the National Childrens Hospital, Tallaght, Dublin, Ireland. (Clinical radiology, 2010-02)
      Angiomyolipomas (AMLs) are the most common benign renal neoplasm and are often discovered incidentally. Due to both an increase in the use of imaging, as well as advances in imaging technology, they are being increasing identified in the general population. As these lesions are benign, there is good evidence that the majority of them can be safely followed up without treatment. However, there is an increasing wealth of information available suggesting there are individuals with AMLs where prophylactic treatment is indicated to prevent complications such as haemorrhage. In such cases, treatment with radiological interventional techniques with subselective particle embolization has superseded surgical techniques in most cases. Even in emergency cases with catastrophic rupture, prompt embolization may save the patient with the additional benefit of renal salvage. Confident identification of a lesion as an AML is important as its benign nature obviates the need for surgery in most cases. The presence of fat is paramount in the confirmatory identification and characterization of these lesions. Although fat-rich AMLs are easy to diagnose, some lesions are fat poor and it is these cases where newer imaging techniques, such as in-phase and out-of-phase magnetic resonance imaging (MRI) may aid in making a confident diagnosis of AML. In this paper, we comprehensively review the imaging techniques in making a diagnosis of AML, including features of both characteristic lesions as well as atypical lesions. In addition, we discuss current guidelines for follow-up and prophylactic treatment of these lesions, as well as the increasing role that the interventional radiologist has to play in these cases.
    • Radiology Encyclopaedia

      Buckley, O; Torreggiani, W (2012-11-20)
    • Randomized clinical trial of the benefit of laparoscopy with closure of loop ileostomy.

      Royds, J; O'Riordan, J M; Mansour, E; Eguare, E; Neary, P; Minimally Invasive Surgery Unit, Division of Colorectal Surgery, Adelaide and Meath Hospital incorporating the National Children's Hospital, Tallaght Hospital, Dublin, 24, Ireland. (2013-09)
      The aim was to compare reversal and laparoscopy with standard reversal of loop ileostomy in terms of hospital stay and morbidity in a randomized study.
    • Randomized controlled trial of oral vs intravenous therapy for the clinically diagnosed acute uncomplicated diverticulitis.

      Ridgway, P F; Latif, A; Shabbir, J; Ofriokuma, F; Hurley, M J; Evoy, D; O'Mahony, J B; Mealy, K; Department of Surgery, Wexford General Hospital, Ireland. p.ridgway@imperial.ac.uk (Colorectal disease : the official journal of the Association of Coloproctology, 2009-11)
      Despite the high prevalence of hospitalization for left iliac fossa tenderness, there is a striking lack of randomized data available to guide therapy. The authors hypothesize that an oral antibiotic and fluids are not inferior to intravenous (IV) antibiotics and 'bowel rest' in clinically diagnosed acute uncomplicated diverticulitis.
    • A randomized, double-blind, controlled study of ultrasound-guided corticosteroid injection into the joint of patients with inflammatory arthritis.

      Cunnington, Joanna; Marshall, Nicola; Hide, Geoff; Bracewell, Claire; Isaacs, John; Platt, Philip; Kane, David; Freeman Hospital and Newcastle University, Newcastle upon Tyne, UK. (Arthritis and rheumatism, 2010-07)
      Most corticosteroid injections into the joint are guided by the clinical examination (CE), but up to 70% are inaccurately placed, which may contribute to an inadequate response. The aim of this study was to investigate whether ultrasound (US) guidance improves the accuracy and clinical outcome of joint injections as compared with CE guidance in patients with inflammatory arthritis.
    • Rapid diagnosis of combined multifocal gastrointestinal stromal tumours and coeliac disease in a patient with type 1 neurofibromatosis.

      Hussey, Mary; Holleran, Grainne; McNamara, Deirdre; Department of Gastroenterology, Adelaide and Meath Hospital, Tallaght Hospital, Dublin 24, Ireland. (2013)
    • The RAPID protocol enhances patient recovery after both laparoscopic and open colorectal resections.

      Lloyd, G M; Kirby, R; Hemingway, D M; Keane, F B; Miller, A S; Neary, P; Department of Surgery, Leicester Royal Infirmary, Infirmary Square, Leicester LE1 5WW, UK. GMLloyd@doctors.org.uk (Surgical endoscopy, 2010-06)
      Enhanced recovery after surgery (ERAS) programs can accelerate recovery and shorten the hospital stay after colorectal resections. The RAPID (remove, ambulate, postoperative analgesia, introduce diet) protocol is a simplified ERAS program that consists of a simplified, user-friendly single-page pro forma schedule. This study aimed to evaluate the impact of the RAPID protocol on patients undergoing both laparoscopic and open colorectal resections in two specialized colorectal units.
    • Rapid prototyping in the assessment, classification and preoperative planning of acetabular fractures.

      Hurson, C; Tansey, A; O'Donnchadha, B; Nicholson, P; Rice, J; McElwain, J; The Adelaide and Meath Hospital Incorporating the National Children's Hospital, Talaght, Dublin, Ireland. conorhurson@hotmail.com (Injury, 2007-10)
      To evaluate the use of rapid prototyping in the assessment, classification and preoperative planning of acetabular fractures.
    • A rare case of thyroid metastasis from pancreatic adenocarcinoma.

      Kelly, Michael E; Kinsella, John; d'Adhemar, Charles; Swan, Niall; Ridgway, Paul F; Professorial Surgical Unit, Department of Surgery, The Adelaide and Meath, Hospital, Dublin Incorporating the National Children's Hospital Dublin, Ireland. , kellym11@tcd.ie (2012-02-01)
      CONTEXT: Thyroid metastasis from pancreatic adenocarcinoma is extremely rare, with only two previous cases in the literature. We report a case of pancreatic adenocarcinoma metastasising to the thyroid. We review the incidence, diagnosis, and management of this rare occurrence. CASE REPORT: A 38-year-old man with a synchronous 6-month history of thyroid swelling, presented with epigastric pain and signs of obstructive jaundice. He was investigated by abdominal computerised tomography and endoscopic retrograde cholangiopancreatography. The diagnosis of pancreatic neoplasm was made. His thyroid neoplasm was investigated at another tertiary centre and thought to be a papillary neoplasm. He underwent a pancreaticoduodenectomy and recovered well post-operatively. Eight weeks later he had a total thyroidectomy. Histology confirmed that the thyroid mass was both morphologically and immunophenotypically similar to the pancreatic neoplasm. CONCLUSION: This case demonstrates the importance of a full investigation when a patient with suspected neoplastic history presents with a thyroid nodule. We outline the crucial role that immunohistochemistry plays in detecting and classifying primary and secondary thyroid neoplasms. The detection of a solitary thyroid metastasis from pancreatic adenocarcinoma may indicate a poor prognosis, and it is debatable whether resection of the primary should be undertaken when it presents with a solitary metastasis.
    • Re-appearance of an ilio-ilio arteriovenous fistula after endovascular stent grafting demonstrated on MDCT.

      Killeen, R; McNeill, G; Torreggiani, W; Department of Radiology, Adelaide and Meath Hospital Incorporating the National, Children's Hospital, Dublin, Ireland. (2012-02-01)
    • Re-evaluating the Rose approach: comparative benefits of the population and high-risk preventive strategies.

      Cooney, Marie-Therese; Dudina, Alexandra; Whincup, Peter; Capewell, Simon; Menotti, Alessandro; Jousilahti, Pekka; Njølstad, Inger; Oganov, Raphel; Thomsen, Troels; Tverdal, Aage; et al. (European journal of cardiovascular prevention and rehabilitation : official journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology, 2009-10)
      Options for the prevention of cardiovascular disease, the greatest global cause of death, include population preventive measures (the Rose approach), or specifically seeking out and managing high-risk cases. However, the likely benefit of a population approach has been recently questioned.
    • Re: diagnosis of hepatic angiomyolipomata using CT: report of three cases and review of the literature.

      McNeill, G; Halpenny, D; Snow, A; Torreggiani, W C (Clinical radiology, 2009-09)
    • Re: Imaging and management of complications of central venous catheters.

      Ryan, D; Torreggiani, W; Adelaide and Meath Hospital, Tallaght, Dublin, Ireland. Electronic address: daviniaryan@hotmail.com. (2013-08-06)
    • Re: Imaging appearances and endovascular management of uncommon pseudoaneurysms.

      Ward, E; Killeen, R P; Doody, O; Torreggiani, W C (Clinical radiology, 2009-07)
    • Re: Paget's disease of the bone: a review.

      McNeill, Graeme; Halpenny, D; Snow, A; Buckley, O; Torreggiani, William C (Rheumatology international, 2009-08)
    • Re: Pericardial effusion impending tamponade: a look beyond Beck's triad.

      McNeill, Graeme; Halpenny, Darragh; Snow, Aisling; Torreggiani, William C (The American journal of emergency medicine, 2009-06)
    • Re: Reduced radiation exposure with the use of an air retrograde pyelogram during fluoroscopic access for percutaneous nephrolithotomy (from: Lipkin ME, Mancini JG, Zilberman DE, et al. J Endourol 2011;25:563-567).

      McNeill, Graeme J; Halpenny, Darragh; Campbell, Naomi; Manecksha, Rustom; Torregianni, William C (Journal of endourology / Endourological Society, 2012-01)