• Small cell cervical cancer: an unusual finding at cholecystectomy.

      Boyle, Emily; Nzewi, Emeka; Khan, Iqbal; Al-Akash, Musallam; Crotty, Paul; Neary, Paul C; Department of Surgery, Adelaide and Meath Hospital incorporating the National, Children's Hospital, Tallaght, Dublin 24, Ireland. emboyle@rcsi.ie (2012-02-01)
      BACKGROUND: Small cell carcinoma of the cervix is a rare cancer, comprising less than 3% of all cervical neoplasms. It uniformly has a poor prognosis, and has a high mortality even with early stage disease. It can metastasise rapidly and metastatic sites include lung, liver, brain, bone, pancreas and lymph nodes. CASE: Here, we report the case of a 60-year-old woman with no symptoms of cervical pathology who developed post-renal failure following a laparoscopic cholecystectomy. The cause was bilateral ureteric obstruction from metastatic small cell cervical cancer and metastases were subsequently found on her gallbladder specimen. CONCLUSION: This is an unusual presentation of small cell cervical cancer and demonstrates the aggressive nature of this disease.
    • SMART phones and the acute respiratory patient.

      Gleeson, L; Alam, J; Lane, S; Department of Respiratory Medicine, AMNCH, Tallaght, Dublin 24. gleesole@tcd.ie (Iirish Medical Journal (IMJ), 2012-05)
      Definition of Respiratory Failure using PaO2 alone is confounded when patients are commenced on oxygen therapy prior to arterial blood gas (ABG) measurement. Furthermore, classification of Respiratory Failure as Type 1 or Type 2 using PaCO2 alone can give an inaccurate account of events as both types can co-exist. 100 consecutive presentations of acute respiratory distress were assessed initially using PaO2, and subsequently PaO2/FiO2 ratio, to diagnose Respiratory Failure. Respiratory Failure cases were classified as Type 1 or Type 2 initially using PaCO2, and subsequently alveolar-arterial (A-a) gradient. Any resultant change in management was documented. Of 100 presentations, an additional 16 cases were diagnosed as Respiratory Failure using PaO2/FiO2 ratio in place of PaO2 alone (p = 0.0338). Of 57 cases of Respiratory Failure, 22 cases classified as Type 2 using PaCO2 alone were reclassified as Type 1 using A-a gradient (p < 0.001). Of these 22 cases, management changed in 18.
    • Snowboard, wakeboard, dashboard? Isolated fracture of the lateral process of the talus in a high-speed road traffic accident.

      Ng, Evangeline Shimei; O'Neill, Barry James; Cunningham, Laurence Patrick; Quinlan, John Francis; Department of Trauma and Orthopaedics, The Adelaide and Meath Hospital Incorporating the National Childrens Hospital, Dublin, Ireland. (2013)
      We present a 23-year-old man who sustained an isolated fracture of the lateral process of the talus (LPT) in a head-on vehicle collision at a combined speed of 200 km/h. The driver of the other vehicle sustained fatal injuries at the scene. The LPT was openly reduced and fixed with successful outcome at 3 months. This case is unusual in the method of injury, in particular in relation to the isolated relatively minor injury sustained.
    • Social networking patterns/hazards among teenagers.

      Machold, C; Judge, G; Mavrinac, A; Elliott, J; Murphy, A M; Roche, E; Department of Paediatrics, Trinity Centre for Health Sciences, AMNCH, Tallaght, Dublin 24. macholdc@tcd.ie (Irish Medical Journal, 2012-05)
      Social Networking Sites (SNSs) have grown substantially, posing new hazards to teenagers. This study aimed to determine general patterns of Internet usage among Irish teenagers aged 11-16 years, and to identify potential hazards, including; bullying, inappropriate contact, overuse, addiction and invasion of users' privacy. A cross-sectional study design was employed to survey students at three Irish secondary schools, with a sample of 474 completing a questionnaire. 202 (44%) (n = 460) accessed the Internet using a shared home computer. Two hours or less were spent online daily by 285(62%), of whom 450 (98%) were unsupervised. 306 (72%) (n = 425) reported frequent usage of SNSs, 403 (95%) of whom were Facebook users. 42 (10%) males and 51 (12%) females experienced bullying online, while 114 (27%) reported inappropriate contact from others. Concerning overuse and the risk of addiction, 140 (33%) felt they accessed SNSs too often. These patterns among Irish teenagers suggest that SNS usage poses significant dangers, which are going largely unaddressed.
    • Solar urticaria successfully treated with intravenous immunoglobulin.

      Hughes, R; Cusack, C; Murphy, G M; Kirby, B; Department of Dermatology, The Adelaide and Meath Hospital, Incorporating the, National Children's Hospital Tallaght, Dublin, Ireland. (2012-02-01)
      Idiopathic solar urticaria (SU) is a rare, debilitating photodermatosis, which may be difficult to treat. First-line treatment with antihistamines is effective in mild cases, but remission after phototherapeutic induction of tolerance is often short-lived. Other treatment options include plasma exchange, photopheresis and cyclosporin. We present two cases of severe, idiopathic SU, which were resistant to conventional treatment. Both patients achieved remission after administration of intravenous immunoglobulin (IVIg) and have remained in remission at 13 months and 4 years, respectively. There are only two case reports of successful treatment of solar urticaria with IVIg. In our experience IVIg given at a total dose of 2 g/kg over several 5-day courses about a month apart is an effective treatment option for severe idiopathic SU. It is also generally safe, even if certainly subject to significant theoretical risks, such as induction of viral infection or anaphylaxis.
    • Sonographic appearance of metallic ureteric stents.

      Snow, Aisling; Buckley, Orla; Torreggiani, William C (Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 2009-02)
    • A sonographic spectrum of psoriatic arthritis: "the five targets".

      Gutierrez, Marwin; Filippucci, Emilio; De Angelis, Rossella; Filosa, Giorgio; Kane, David; Grassi, Walter; Cattedra di Reumatologia, Università Politecnica delle Marche, Jesi, Ancona, Italy. dr.gmarwin@gmail.com (Clinical rheumatology, 2010-02)
      Ultrasound is a rapidly evolving technique that is gaining an increasing success in the assessment of psoriatic arthritis. Most of the studies have been aimed at investigating its ability in the assessment of joints, tendons, and entheses in psoriatic arthritis patients. Less attention has been paid to demonstrate the potential of ultrasound in the evaluation of skin and nail. The aim of this pictorial essay was to show the main high-frequency grayscale and power Doppler ultrasound findings in patients with psoriatic arthritis at joint, tendon, enthesis, skin, and nail level.
    • Sources of pre-admission medication information: observational study of accuracy and availability.

      Fitzsimons, Michelle; Grimes, Tamasine; Galvin, Mairead (2011-12)
      To identify the accessibility of sources of pre-admission medication (PAM) information, to quantify agreement between the PAM list and the 'gold-standard' PAM list (GS-PAML) and to categorise disagreements.
    • Spinal subdural abscess.

      McCabe, John J; Murphy, Raymond P; Department of Neurology, Adelaide and Meath Incorporating National Children’s Hospital, Dublin, Ireland. mccabej1@tcd.ie (2013-02)
    • Spontaneous spinal epidural abscess.

      Ellanti, P; Morris, S; Department of Trauma Orthopaedics, AMNCH, Tallaght, Dublin 24. prasad.ellanti@gmail.com (Irish Medical Journal (IMJ), 2011-10)
      Spinal epidural abscess is an uncommon entity, the frequency of which is increasing. They occur spontaneously or as a complication of intervention. The classical triad of fever, back pain and neurological symptoms are not always present. High index of suspicion is key to diagnosis. Any delay in diagnosis and treatment can have significant neurological consequences. We present the case of a previously well man with a one month history of back pain resulting from an epidural abscess.
    • Steroid allergy in patients with inflammatory bowel disease.

      Malik, M; Tobin, A-M; Shanahan, F; O'Morain, C; Kirby, B; Bourke, J; Department of Dermatology, South Infirmary--Victoria University Hospital, Cork, Ireland. mohsinmalik66@yahoo.com (The British journal of dermatology, 2007-11)
      Background: Contact allergy to a steroid enema leading to worsening of inflammatory bowel disease (IBD) has recently been reported. This study was designed to look for evidence of steroid allergy in patients with IBD.
    • Steroid swapping between friends: adrenal suppression secondary to psoriasis treatment.

      Hughes, R; Gibney, J; Kirby, B (Irish journal of medical science, 2009-06)
    • Subacute cutaneous lupus erythematosus presenting as poikiloderma.

      Hughes, R; Loftus, B; Kirby, B; Department of Dermatology, Adelaide and Meath Hospital, Tallaght, Dublin,, Ireland. (2012-02-01)
      Subacute cutaneous lupus erythematosus (SCLE) is a recognised variant of lupus erythematosus (LE), which accounts for 10-15% of all cases of cutaneous LE, occurring most commonly in young to middle-aged white women. Diagnosis is based on the detection of anti-Ro/SS-A antibodies in the skin and serum, characteristic clinical and histological cutaneous involvement, and relatively mild systemic involvement. Several unusual variants of SCLE have been reported including erythrodermic SCLE, SCLE with vitiligo-like lesions, acral SCLE and bullous SCLE. Poikoilodermatous SCLE is a recognised but rare variant of SCLE. There are currently only two case reports, comprising five individual cases, in the literature. We present a case of SCLE in which the main clinical findings were an extensive photodistributed poikilodermatous rash and alopecia.
    • Subtrochanteric Femur Fractures in an Irish Trauma Centre over 9 years: How the Impact of Hospital Coding on Diagnosis of Subtrochanteric Femur Fractures Leads to Inaccurate Occurrence Rates

      Coveney, EI; Harriz, E; Gibney, B; Quinlan, JF (Irish Medical Journal, 2018-06)
      Our aim was to assess the occurrence rates of subtrochanteric femur fractures in an orthopaedic tertiary referral centre and to assess the correlation of patient’s actual diagnosis with national hospital inpatient enquiry data.
    • Successful Use of Alternative Anticoagulants in the Management of Heparin-induced Thrombocytopenia with Thrombotic Complications: Report of 5 cases and review of literature.

      Alkindi, Salam; Smith, Owen P; Enright, Helen; Department of Haematology, Sultan Qaboos University Hospital, Muscat, Oman; (Sultan Qaboos University medical journal, 2011-08)
      Heparin is one of the most frequently used anticoagulants. It is easy to use, but can be associated with life-threatening side effects. One of these is heparin-induced thrombocytopenia syndrome (HITS), which develops in about 3-5% of patients exposed to heparin and is associated with thrombosis in 1% of cases. We report here the successful treatment of five patients with HITS who were treated with alternative anticoagulants namely danaparoid or hirudin. The median time between their exposure to heparin and onset of symptoms and or signs was 10.2 days (range 7-14 days). Platelet counts decreased to a mean of 38.4 x 10(9) /l (12-82 x 10(9)/l). All five patients had evidence of thrombosis; four patients had clinical and radiological evidence of pulmonary emboli, one patient had confirmed deep vein thrombosis (DVT) and one patient had extensive skin necrosis of the thighs and abdomen. Platelet aggregation test were positive in two patients, inconclusive in one patient and negative in two patients. Two patients were anticoagulated with danaparoid and three with hirudin until their platelet counts returned to normal between 4 and 14 days (average 6 days) following the recognition of the syndrome. Our patients had significant morbidity, but no mortality. Immediate withdrawal of heparin is of paramount importance and introduction of alternative anticoagulant is necessary in the presence of thrombosis.
    • The surgical importance of an axillary arch in sentinel node biopsy.

      Ridgway, P F; Collins, A M; McCready, D R; Department of Surgery, Trinity College Dublin at the Adelaide and Meath Hospital, Tallaght, Dublin 24, Ireland. ridgwayp@tcd.ie (2011-03)
      When Carl Langer described the aberrant axillary arch in 1846 its relevance in sentinel node biopsy (SNB) surgery could not have been contemplated. The authors define an incidence and elucidate relevance of the arch in SNB of the axilla.
    • Surgical instruction for general practitioners: how, who and how often?

      Collins, Anne M; Ridgway, Paul F; Hassan, Mohammed S U; Chou, Christy W K; Hill, Arnold D; Kneafsey, Brian; Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland. (J Plast Reconstr Aesthet Surg, 2010-07)
      Educational programmes, designed to meet the training needs of General Practitioners (GPs) performing minor surgical procedures, have previously been shown to increase their surgical workload. The change in the level of competence following these programmes has not been assessed. The aims of this study were two-fold: to evaluate the vertical mattress suture for construct validity and to assess the impact of plastic surgery training on the surgical skill of GPs. Thirty non-consultant hospital doctors and 27 self-selected GPs were included. Using a modified objective structured assessment of technical skills (OSATS) scoring system, construct validity of the vertical mattress suture was confirmed. The median total OSATS score was 16 points (26.7%) in the novice group (medical registrars), 38.5 points (64.2%) in the intermediate group (surgical SHOs) and 59 points (98.3%) in the expert group (surgical registrars, p<0.001, Kruskal-Wallis test). Objective assessment in the GP group immediately following practical instruction revealed a median overall improvement of 31.7% (19 points) in total OSATS scores (p<0.001, Friedman non-parametric test, F). At six months follow-up all course participants had improved compared to their baseline. A median overall improvement of 13 points (21.7%) was noted (p<0.001, F). However, the majority (80%, n=20) had deteriorated from the standard set immediately after the course with a median overall reduction in total OSATS scores of six points (10%, p=0.001, F). Plastic surgery training is immediately efficacious in improving the technical proficiency of GPs. Through objective assessment of a standardised suture task we demonstrated a low rate of educational decay of 10% over a six-month period.
    • Surveillance of gastric intestinal metaplasia for the prevention of gastric cancer.

      O'Connor, Anthony; McNamara, Deirdre; O'Moráin, Colm A; Department of Gastroenterology and Clinical Medicine, Adelaide and Meath Hospital incorporating the National Children's Hospital/Trinity College, Belgard Road, Tallaght, Dublin, Ireland, D24. (2013)
      Adenocarcinoma of the stomach is the second leading cause of cancer related death in the world. Gastric intestinal metaplasia (GIM) is a recognised premalignant condition of the stomach. It has been described as occurring in up to one in five patients in western countries. Although there is a definite risk of progression from GIM to cancer, published guidelines and statements differ as to the utility and structure of surveillance programs for this condition.
    • A survey of patients' attitudes to clinical research.

      Desmond, A; Stanton, A; Maher, V; Crean, P; Feely, J; Sullivan, P; Boehringer Ingelheim Ireland Ltd, Sandyford Business Estate, Dublin 18. audreydesmond@yahoo.co.uk (Irish medical journal, 2011-04)
      Every year hundreds of patients voluntarily participate in clinical trials across Ireland. However, little research has been done as to how patients find the experience. This survey was conducted in an attempt to ascertain clinical trial participants' views on their experience of participating in a clinical trial and to see and how clinical trial participation can be improved. One hundred and sixty-six clinical trial participants who had recently completed a global phase IV cardiovascular endpoint clinical trial were sent a 3-page questionnaire. Ninety-one (91%) respondents found the experience of participating in a clinical trial a good one with 85 (84.16%) respondents saying they would recommend participating in a clinical trial to a friend or relative and eighty-five (87.63%) respondents feeling they received better healthcare because they had participated in a clinical trial.
    • Survey of the management of acute asthma in children.

      Widger, J; Elnazir, B (Irish medical journal, 2009-12)
      Acute asthma is one of the most common reasons for children presenting to the emergency department. International guidelines for the management of acute paediatric asthma are widely available. In this study we examined how acute asthma in children is managed across hospitals in Ireland and compared Irish practice with standard international guidelines. We surveyed 54 paediatricians across 18 centres in Ireland. A total of 30 (55.5%) individual paediatricians across 17 (94%) centres replied. The majority of centres had a written protocol for the management of acute asthma. A large number of centres use MDI and spacer devices in acute management although doses used varied widely. Only 29% of centres had written asthma action plans available from the emergency department and 53% had plans available from the ward. Irish practice is largely inline with established guidelines. A national asthma strategy could further help to improve asthma care.