• Brain activation predicts treatment improvement in patients with major depressive disorder.

      Samson, Andrea C; Meisenzahl, Eva; Scheuerecker, Johanna; Rose, Emma; Schoepf, Veronika; Wiesmann, Martin; Frodl, Thomas; Department of Psychiatry, School of Medicine & Trinity College Institute of, Neuroscience, Integrated Neuroimaging, The Adelaide and Meath Hospital, incorporating the National Children's Hospital (AMNCH), & St. James's Hospital,, Trinity College, Dublin, Ireland. andrea.samson@stanford.edu (2012-02-01)
      Major depressive disorder (MDD) is associated with alterations in brain function that might be useful for therapy evaluation. The current study aimed to identify predictors for therapy improvement and to track functional brain changes during therapy. Twenty-one drug-free patients with MDD underwent functional MRI twice during performance of an emotional perception task: once before and once after 4 weeks of antidepressant treatment (mirtazapine or venlafaxine). Twelve healthy controls were investigated once with the same methods. A significant difference between groups was a relative greater activation of the right dorsolateral prefrontal cortex (dlPFC) in the patients vs. controls. Before treatment, patients responding better to pharmacological treatment showed greater activation in the dorsomedial PFC (dmPFC), posterior cingulate cortex (pCC) and superior frontal gyrus (SFG) when viewing of negative emotional pictures was compared with the resting condition. Activations in the caudate nucleus and insula contrasted for emotional compared to neutral stimuli were also associated with successful treatment. Responders had also significantly higher levels of activation, compared to non-responders, in a range of other brain regions. Brain activation related to treatment success might be related to altered self-referential processes and a differential response to external emotional stimuli, suggesting differences in the processing of emotionally salient stimuli between those who are likely to respond to pharmacological treatment and those who will not. The present investigation suggests the pCC, dmPFC, SFG, caudate nucleus and insula may have a key role as a biological marker for treatment response and predictor for therapeutic success.
    • Cardiovascular prevention guidelines in daily practice: a comparison of EUROASPIRE I, II, and III surveys in eight European countries.

      Kotseva, Kornelia; Wood, David; De Backer, Guy; De Bacquer, Dirk; Pyörälä, Kalevi; Keil, Ulrich; Department of Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London, London, UK. (Lancet, 2009-03-14)
      The first and second EUROASPIRE surveys showed high rates of modifiable cardiovascular risk factors in patients with coronary heart disease. The third EUROASPIRE survey was done in 2006-07 in 22 countries to see whether preventive cardiology had improved and if the Joint European Societies' recommendations on cardiovascular disease prevention are being followed in clinical practice.
    • Cardiovascular risk age: concepts and practicalities.

      Cooney, Marie Therese; Vartiainen, Erkki; Laatikainen, Tiina; De Bacquer, Dirk; McGorrian, Catherine; Dudina, Alexandra; Graham, Ian; Department of Cardiology, Adelaide Meath Hospital, Dublin, Ireland. (2012-06)
      A young person with many risk factors may have the same level of risk as an older person with no risk factors. Thus a high-risk 40-year-old may have a risk age of 60 years or more. The aim of the study was to derive a generic equation for risk age, construct risk age charts, and explore the hypothesis that risk age is similar regardless of the cardiovascular disease (CVD) end point used.
    • Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomised controlled trial.

      Ederle, Jörg; Dobson, Joanna; Featherstone, Roland L; Bonati, Leo H; van der Worp, H Bart; de Borst, Gert J; Lo, T Hauw; Gaines, Peter; Dorman, Paul J; Macdonald, Sumaira; et al. (Lancet, 2010-03-20)
      Stents are an alternative treatment to carotid endarterectomy for symptomatic carotid stenosis, but previous trials have not established equivalent safety and efficacy. We compared the safety of carotid artery stenting with that of carotid endarterectomy.
    • A changing trend in the management of patients with newly diagnosed Crohn's disease.

      Qasim, A; Ullah, N; Crotty, P; Swan, N; Breslin, N; Ryan, B; Torreggiani, W; Eguare, E; Neary, P; O'Connor, H; et al. (2012-02-01)
      BACKGROUND: Epidemiologic shift with rising incidence of Crohn's disease (CD) has been reported in recent studies. AIMS: To determine disease behaviour and therapeutic interventions undertaken in newly diagnosed patients with CD. METHODS: Patients diagnosed with CD between January 2006 and June 2008 were included. Disease type, location, degree of involvement and type of therapeutic interventions were recorded. RESULTS: A total of 78 patients were included. Colonic, ileo-colonic, terminal ileal and isolated small bowel disease were present in 37, 27, 9 and 5 patients, respectively. Disease phenotype was inflammatory, stenosing and fistulising in 42, 30 and 6 patients, respectively. Surgery was required in 22 patients, including right hemicolectomy (n = 8), subtotal colectomy (n = 4), segmental colonic resection (n = 2), segmental small bowel resection (n = 2), appendectomy (n = 2) and perianal surgery (n = 4). Fourteen patients underwent surgery at the time of diagnosis. Laparoscopic surgery was performed in 14 patients. CONCLUSIONS: A significant proportion of newly diagnosed patients with CD underwent surgical intervention on their first admission to hospital. This may signify a changing trend in the management approach.
    • Charcot-Marie-Tooth disease: frequency of genetic subtypes and guidelines for genetic testing.

      Murphy, Sinead M; Laura, Matilde; Fawcett, Katherine; Pandraud, Amelie; Liu, Yo-Tsen; Davidson, Gabrielle L; Rossor, Alexander M; Polke, James M; Castleman, Victoria; Manji, Hadi; et al. (Journal of neurology, neurosurgery, and psychiatry, 2012-07)
      Charcot-Marie-Tooth disease (CMT) is a clinically and genetically heterogeneous group of diseases with approximately 45 different causative genes described. The aims of this study were to determine the frequency of different genes in a large cohort of patients with CMT and devise guidelines for genetic testing in practice.
    • Chest pain in an 18-year-old man: "didn't I tell you I was sick?".

      Dudina, A; Leong, T; Cooney, M T; Foley, B; Graham, I (Irish medical journal, 2009-06)
    • Churg-Strauss syndrome and leukotriene antagonist use: a respiratory perspective.

      Nathani, N; Little, M A; Kunst, H; Wilson, D; Thickett, D R; Department of Thoracic Medicine, City Hospital, Dudley Road, Birmingham B18 7QH, UK. n.nathani@nhs.net (Thorax, 2008-10)
      Churg-Strauss syndrome (CSS) is a rare granulomatous small vessel vasculitis that occurs against a background of longstanding asthma. Leukotriene antagonists (LTAs) are used in the management of asthma and may facilitate a reduction in steroid dosage. Reports of the development of CSS in patients with asthma following the initiation of LTA therapy suggest either a causal association or an unmasking of latent CSS as steroid doses fall. We have undertaken a systematic review to establish whether evidence of a drug induced syndrome exists.
    • Chylous ascites post open cholecystectomy after severe pancreatitis.

      Cheung, Cherry X; Kelly, Michael E; El Tayeb, Omer; Torregianni, William C; Ridgway, Paul F; Department of Surgery, Adelaide and Meath Incorporating the National Children's Hospital, Tallaght, Dublin, Ireland. cheungx@tcd.ie (2012-05)
      Chylous ascites a rare complication post cholecystectomy. There are to our knowledge only 3 reported cases in the literature. We describe a case of chylous ascites post open cholecystectomy in a patient with recent severe pancreatitis. We propose a potential relationship between acute biliary pancreatitis and the development of chylous ascites.
    • Cinacalcet reduces plasma intact parathyroid hormone, serum phosphate and calcium levels in patients with secondary hyperparathyroidism irrespective of its severity.

      Frazão, J M; Messa, P; Mellotte, G J; Geiger, H; Hagen, E C; Quarles, L D; Kerr, P G; Baños, A; Dehmel, B; Urena, P; et al. (2011-09)
      To evaluate the relationship between the severity of secondary hyperparathyroidism (SHPT) - defined in terms of baseline plasma intact parathyroid hormone (iPTH) level - and the magnitude of response to cinacalcet.
    • Clinical and genetic characterization of families with arrhythmogenic right ventricular dysplasia/cardiomyopathy provides novel insights into patterns of disease expression.

      Sen-Chowdhry, Srijita; Syrris, Petros; Ward, Deirdre; Asimaki, Angeliki; Sevdalis, Elias; McKenna, William J; The Heart Hospital, University College London, United Kingdom. (Circulation, 2007-04-03)
      According to clinical-pathological correlation studies, the natural history of arrhythmogenic right ventricular dysplasia/cardiomyopathy is purported to progress from localized to global right ventricular dysfunction, followed by left ventricular (LV) involvement and biventricular pump failure. The inevitable focus on sudden death victims and transplant recipients may, however, have created a skewed perspective of a genetic disease. We hypothesized that unbiased representation of the spectrum of disease expression in arrhythmogenic right ventricular dysplasia/cardiomyopathy would require in vivo assessment of families in a genetically heterogeneous population.
    • Comments regarding 'Infrainguinal bypass for peripheral arterial occlusive disease: when arms save legs'.

      Egan, B M; The Adelaide and Meath Hospital, Department of Vascular Surgery, Tallaght, Dublin, Ireland. bridget.egan1@gmail.com (European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery, 2012-01)
    • Common variation in the vitamin D receptor gene and risk of inflammatory bowel disease in an Irish case-control study.

      Hughes, David J; McManus, Ross; Neary, Paul; O'morain, Colm; O'sullivan, Maria; Department of Clinical Medicine, Adelaide and Meath Hospital, Dublin, Ireland. (2012-02-01)
      OBJECTIVE: Vitamin D may protect against the development of inflammatory bowel disease (IBD). Several preliminary studies in separate geographical locations suggest that these effects may be partly mediated by genetic variants of the vitamin D receptor (VDR). The data, however, are yet to be confirmed in large European cohorts. This study aimed to determine if common VDR polymorphisms affected IBD risk in an Irish population. MATERIALS AND METHODS: The study was based on a cohort of 1359 Irish participants. Frequencies of the common VDR gene polymorphisms rs2228570 (FokI), rs1544410 (BsmI), rs7975232 (ApaI), and rs731236 (TaqI) were determined using allele-specific PCR in a case-control analysis of 660 patients with IBD and 699 controls. Unconditional logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between these variants and risk of IBD. RESULTS: There was no statistically significant effect observed on IBD risk for any of the four VDR polymorphisms tested. Furthermore, no significant differences were observed in susceptibility when the population was stratified by sex or IBD subtype (Crohn's disease or ulcerative colitis). Notably, however, there was an increased risk observed for both IBD and ulcerative colitis associated with heterozygote carriage of the FokI allele that approached significance (OR=1.21, 95% CI=0.95-1.53, P=0.12 and OR=1.36, 95% CI=0.98-1.89, P=0.06, respectively), this merits further investigation. CONCLUSION: This study indicates that there is no major effect for common variation in the VDR gene alone on predisposition to IBD in the Irish population.
    • A comparative study of faecal occult blood kits in a colorectal cancer screening program in a cohort of healthy construction workers.

      Shuhaibar, M; Walsh, C; Lindsay, F; Lee, N; Walsh, P; O'Gorman, P; Boran, G; McLoughlin, R; Qasim, A; Breslin, N; et al. (2012-02-01)
      BACKGROUND: The incidence of colorectal cancer (CRC) has been increasing. We evaluated uptake rates and outcomes of faecal immunochemical test (FIT) and Guaiac test (gFOBT) kits as part of a two-step CRC screening. METHODS: A 3-year CRC screening program for a defined population of construction workers was conducted. Those satisfying the inclusion criteria were provided with gFOBT or FIT kits. Individuals testing positive were invited for a colonoscopy. RESULTS: A total of 909 faecal testing kits were distributed. Age range was 53-60 years. Compliance rate was higher for FIT (58.3%) as compared to gFOBT (46.7%) (p = 0.0006). FIT detected adenomatous polyps and CRC in 37.5 and 25%, respectively, whereas; gFOBT detected 23.5 and 18%. Colonoscopies were normal in 53 and 25% tested positive by gFOBT and FIT, respectively (p = 0.016). CONCLUSION: The FIT was more cost-effective when compared with gFOBT with higher return rate, sensitivity and specificity. A comparative study of faecal occult blood kits in a CRC screening program in a healthy cohort of construction workers.
    • Comparison of semi-automated and manual measurements of carotid intima-media thickening.

      Mac Ananey, Oscar; Mellotte, Greg; Maher, Vincent; Tallaght Hospital (Hindawi Publishing Corporation, 2014)
      Carotid intima-media thickening (CIMT) is a marker of both arteriosclerotic and atherosclerotic risks. Technological advances have semiautomated CIMT image acquisition and quantification. Studies comparing manual and automated methods have yielded conflicting results possibly due to plaque inclusion in measurements. Low atherosclerotic risk subjects (n = 126) were recruited to minimise the effect of focal atherosclerotic lesions on CIMT variability. CIMT was assessed by high-resolution B-mode ultrasound (Philips HDX7E, Phillips, UK) images of the common carotid artery using both manual and semiautomated methods (QLAB, Phillips, UK). Intraclass correlation coefficient (ICC) and the mean differences of paired measurements (Bland-Altman method) were used to compare both methodologies. The ICC of manual (0.547 ± 0.095 mm) and automated (0.524 ± 0.068 mm) methods was R = 0.74 and an absolute mean bias ± SD of 0.023 ± 0.052 mm was observed. Interobserver and intraobserver ICC were greater for automated (R = 0.94 and 0.99) compared to manual (R = 0.72 and 0.88) methods. Although not considered to be clinically significant, manual measurements yielded higher values compared to automated measurements. Automated measurements were more reproducible and showed lower interobserver variation compared to manual measurements. These results offer important considerations for large epidemiological studies.
    • Comparison of the predictive performance of eGFR formulae for mortality and graft failure in renal transplant recipients.

      He, Xiang; Moore, Jason; Shabir, Shazia; Little, Mark A; Cockwell, Paul; Ball, Simon; Liu, Xiang; Johnston, Atholl; Borrows, Richard; Department of Clinical Pharmacology, Barts and The London School of Medicine and Dentistry, London, United Kingdom. (Transplantation, 2009-02-15)
      To date, efforts have focused on assessing estimated glomerular filtration rate (eGFR) formulae against measured GFR. However, a more appropriate clinical gold standard is one conveying a defined clinical disadvantage. In renal transplantation, these measures are mortality and graft failure.
    • Complete clinical response to neoadjuvant chemotherapy in a 54-year-old male with Askin tumor.

      Mulsow, J; Jeffers, M; McDermott, R; Geraghty, J; Rothwell, J; Department of Surgery, Adelaide and Meath Hospital, Tallaght, Dublin, Ireland., jmulsow@rcsi.ie (2012-02-01)
      Askin tumor is a tumor of the thoracopulmonary region that most commonly affects children and adolescents. These rare tumors are a form of primitive neuroectodermal tumor and typically carry a poor prognosis. Treatment is multimodal and consists of a combination of neoadjuvant chemotherapy, radical resection, and adjuvant chemo- and radiotherapy or all of the above. Surgery is advocated in most cases. We report a case of Askin tumor in a 54-year-old male who showed rapid and complete response to neoadjuvant chemotherapy. This allowed potentially radical surgery to be avoided. At one-year follow-up he remains disease-free.
    • Complex rectal polyps: other treatment modalities required when offering a transanal endoscopic microsurgery service.

      Joyce, Myles R; Eguare, Emmanuel; Kiernan, Fiona; Swan, Niall; Crotty, Paul; Neary, Paul; Keane, Frank B V; Division of Colorectal Surgery, The Adelaide & Meath Hospital, Tallaght, Dublin 24, Ireland. mylesjoyce@eircom.net (2011-09)
      Complex rectal polyps may present a clinical challenge. The study aim was to assess different treatment modalities required in the management of patients referred for transanal endoscopic microsurgery.
    • Compliance with McDonald criteria and red flag recognition in a general neurology practice in Ireland.

      Albertyn, Christine; O'Dowd, Sean; McHugh, John; Murphy, Raymond; Department of Neurology, Adelaide and Meath Hospital, Tallaght, Dublin, Ireland. , christinealbertyn@yahoo.com (2012-02-01)
      BACKGROUND: The revised McDonald criteria aim to simplify and speed the diagnosis of multiple sclerosis (MS). An important principle of the criteria holds there should be no better explanation for the clinical presentation. In Miller et al.'s consensus statement on the differential diagnosis of MS, red flags are identified that may suggest a non-MS diagnosis. OBJECTIVE: All new patients with a practice diagnosis of MS were assessed for compliance with McDonald criteria. The group of patients not fulfilling criteria was followed up to assess compliance over time. At the end of the follow-up period, red flags were sought in the group of patients who remained McDonald criteria negative. METHODS: Clinical notes and paraclinical tests were examined retrospectively for compliance with McDonald criteria and for the presence of red flags. RESULTS: Sixty-two patients were identified, with two lost to follow-up. Twenty-six (42%) patients fulfilled criteria at diagnosis. After 53 months follow-up, 47 (78%) patients fulfilled criteria. In the 13 (22%) patients who remain McDonald criteria negative, a total of 20 red flags were identified, ranging from one to six per patient. Alternative diagnoses were considered and further investigations performed in 10 patients with no significantly abnormal results. CONCLUSION: Twenty-two percent of patients still do not fulfill McDonald criteria after 53 months. Dissemination in time was not proven in the majority of patients and the lack of follow-up neuroimaging was an important factor in this. Red flags may be useful in identifying alternative diagnoses, but the yield was low in our cohort.
    • Computer use in school: its effect on posture and discomfort in schoolchildren.

      Kelly, Grace; Dockrell, Sara; Galvin, Rose; Department of Physiotherapy, School of Medicine, Trinity Centre for Health Sciences, Trinity College Dublin, Ireland. (2009)
      The aim of the study was to investigate the posture and musculoskeletal discomfort of secondary school students while working at computers in school. Students (n = 40) were observed while working at a computer during their designated computer class. The Rapid Upper Limb Assessment Tool (RULA) was used to assess posture. A Body Discomfort Chart (BDC) and Visual Analogue Scale (VAS) were used to record the area(s) and intensity of musculoskeletal discomfort, if any, experienced by the students at the beginning and end of the computer class. None of the students' posture was in the acceptable range (Action Level 1) according to RULA. The majority (65%) were in Action Level 2, 30% were in Action Level 3, and 5% were in Action Level 4. There was a statistically significant increase in reported discomfort from the beginning to the end of the computer class. Longer class length (80 minutes) did not result in greater reporting of discomfort than shorter class length (40 minutes).