• Bare necessities? The utility of full skin examination in the COVID-19 era.

      O'Connor, C; Gallagher, C; O'Connell, M; Bourke, J; Murphy, M; Bennett, M (2021-03-18)
      Full skin examination (FSE) may improve the detection of malignant melanoma (MM). The objective of this study was to assess the safety of targeted lesion examination (TLE) compared with FSE in our Pigmented Lesion Clinic (PLC). Patients attending the PLC were randomized in a 2 : 1 ratio to FSE (intervention) or TLE (standard care). Demographic details and risk factors were documented, and the time taken to perform FSE and TLE was noted. Of 763 participants, 520 were assigned to FSE and 243 were assigned to TLE. On average, FSE took 4.02 min and TLE took 30 s to perform. Of the 520 participants assigned to FSE, 37 (7.1%) had incidental findings, of whom 12 patients (2.3%) had additional lesions biopsied. No additional melanomas were detected that would have been missed by use of the standard protocol. This study suggests that in low-risk patients referred to a PLC with a lesion of concern, the possibility of missing incidental cutaneous malignancies using lesion-directed examination is low.
    • Distance as a Barrier to Melanoma Care

      McCarthy, S; Feeley, K; Murphy, M; Bourke, J F (2019-08-01)
      Our aim was to review cases of melanoma diagnosed histologically in UHK in 2016 and to compare them to cases of melanoma nationally and in Kerry. Methods For each patient we recorded age, Breslow depth, and shortest distance to travel by car and travelling time (without traffic) to the South Infirmary Victoria University Hospital (SIVUH) from their primary residence (calculated using Google maps™ (2018)). Results 20 cases of invasive melanoma were diagnosed in UHK in 2016. Of the 20 cases, 9 (45%) presented at a very advanced stage with a Breslow depth of greater than 4mm. A further 7 (35%) cases had a depth of 1.5-4mm. These patients with invasive melanoma had a mean age of 72.5 (±15). The mean shortest distance to travel from the patient’s primary residence to the SIVUH was 114.8km (±15.5) taking an average of 102 minutes (±14.6) by car. Conclusion Cases of melanoma diagnosed locally in UHK presented at an advanced stage compared to the national average. We suspect that the long distances to travel to the SIVUH pigmented lesion clinic is a barrier for these patients.
    • Skin Cancer Awareness Amongst Irish Golfers

      McCarthy, Siobhan; Paul, Lyndsey; O’Connell, Michael (Irish Medical Journal, 2017-09)
      The aim of this study was to assess skin cancer awareness and identify the UV protective measures used by golfers within the Munster region of Ireland.
    • Critical Airway Compromise due to a Massive Vagal Schwannoma

      McDermott, AM; Sadadcharam, M; Manning, BJ; Sheahan, P (Irish Medical Journal, 2016-05)
      We describe the case of a 37-year-old man with a slowly enlarging neck lump and compressive symptoms. He presented to a separate institution 10 years prior where an observational approach was advocated. Following preoperative investigations and embolization, an 11cm vagal schwannoma was excised and vagus nerve was sacrificed. Although conservative management is appropriate for a select patient population, surgical excision is treatment of choice for cervical neurogenic tumours and paraganglionomas and must be considered in young patients or rapidly expanding tumours to avoid compressive symptoms, as in this case.
    • Changing paradigms for oropharynx cancer: swinging of pendulum back towards surgery

      Sheahan, P (Irish Medical Journal, 2015-07)
      The oropharynx, extending from the soft palate to the level of the epiglottis, and containing the palatine tonsils and base of tongue (BOT), is a common site for Head and Neck cancer. Squamous cell carcinoma (SCC) comprises the overwhelming majority of cases. Traditional aetiological factors for oropharynx SCC (OPSCC) are smoking and alcohol consumption. In recent years, human papilloma virus (HPV) type 16 has emerged as the major cause of an ever increasing number of cases 1 . Over the last two decades, there has been a dramatic surge in the incidence of OPSCC. Figures obtained by the Irish National Cancer Registry show an increase from 50 cases per year in 1994 to over 100 cases per year in 2012. This recent rise in OPSCC incidence is almost exclusively related to an increase in HPV related cancers. In the United States, between 1988 and 2004, HPV related OPSCC showed a 225% increase, while HPV-negative OP SCC showed a 50% decline, attributed to decreased prevalence of smoking 1 .
    • Initial results from the newborn hearing screening programme in Ireland.

      O'Connor, A; O'Sullivan, P G; Behan, L; Norman, G; Murphy, B; Department of Otolaryngology, South Infirmary Victoria University Hospital, Cork, Ireland, aoconnor@rcsi.ie. (2013-03-02)
      INTRODUCTION: Hearing screening programmes aim to detect hearing loss in the neonate. The Health Service Executive (HSE) South was the first phase of a national roll-out of a neonatal hearing screening programme in Ireland, going live on 28 April 2011. RESULTS: Over 11,738 babies have been screened for permanent childhood hearing impairment (PCHI) during the first 12 months. The percentage of eligible babies offered hearing screening was 99.2 %. Only 0.2 % (n = 25) of those offered screening declined. 493 (4 %) were referred for immediate diagnostic audiological assessment. The average time between screen and diagnostic audiology appointment was 2 weeks. 15 (1.3/1,000) babies have been identified with a PCHI over the 12-month period. 946 (4 %) babies screened were admitted to the neonatal intensive care unit (NICU) for >48 h. The prevalance of PCHI is 7.3/1,000 in the NICU population compared to 0.6/1000 in the well baby population. 214 (1.8 % of total babies screened) had a clear response in the screening programmes, but were deemed to be at risk of an acquired childhood hearing impairment. These babies will be reassessed with a diagnostic audiology appointment at 8-9 months of age. To date, there is one case of acquired hearing impairment through this targeted follow-up screen. Of the 15 cases of PCHI identified, 8 (53 %) of these had one or more risk factors for hearing loss and 7 (37 %) were admitted to the NICU for >48 h. Four babies were referred for assessment at the National Cochlear Implant Centre.
    • Irish patients knowledge and perception of Anaesthesia

      Smith, A; Mannion, S (Irish Medical Journal, 2013-02)
    • Herpes zoster infection, vaccination and immunocompromised rheumatology patients.

      O'Connor, Mortimer B; Phelan, Mark J; Department of Rheumatology, South Infirmary Victoria University Hospital, Cork, Ireland. mortimeroconnor@gmail.com (2013-01)
      Varicella is a self-limiting and relatively mild disease of childhood, although it is frequently more severe and complicated among the immunocompromised rheumatology patients on immunomodulator therapies. In addition, future reactivation of the dormant virus in dorsal root ganglia may cause herpes zoster infection, which can be very debilitating. In this manuscript, we discuss the nature of this infection along with its potential vaccine especially among rheumatology patients.
    • Second toe swelling: Nora's lesion or glomus tumour, case report and literature review.

      Mohammad, A; Kilcoyne, A; Blake, S; Phelan, M; Department of Rheumatology and Radiology, South Infirmary Victoria University Hospital, Cork, Ireland. ausafmohammad@gmail.com (2012-09)
      We report a rare case of bizarre parosteal osteochondromatous proliferation (BPOP, Nora's lesion) of the right second toe in a 60-year-old man who presented with painful, bluish and bulbous swelling of the right second toe without any break in the skin.
    • The prevalence and genotype of human papillomavirus on cervical samples from an Irish female population with external genital warts.

      Cremin, Suzanne M; Menton, John F; Canier, Lydie; Horgan, Mary; Fanning, Liam J; STI Clinic, Infirmary, South Victoria University Hospital, Cork, Ireland. suzannem.cremin@hse.ie (2012-07)
      The aim of this study was to determine the cervical genotype profile of females who presented to an STI Clinic with external genital warts (EGW); and to determine the potential vaccine coverage prior to the uptake of the HPV vaccines. Sixty-one cervical scrapings were taken from females aged 18-35 y who had external genital warts or a history of external genital warts. The resulting 50 samples that were positive for HPV-DNA were subjected to genotype identification. Forty-six of these samples had detectable genotypes by LIPA analysis and most (78%, 36/46) had multiple low risk (LR) and high risk (HR) genotypes on the cervix. Twenty-five of these samples (54%) had more than 1 HR genotype. Of the 36 patients who had any HR genotypes, 18 (50%) were identified to have the most oncogenic HPV genotypes, namely 16 and 18. Three of these samples had both 16 and 18 on the cervix. The presence of multiple HR genotypes on the majority of cervical samples from a self-referred population of females with EGW is presented. This study is of importance since persistent HR-HPV is the necessary risk factor in the development of precancerous and cancerous lesions of the cervix. Gardisil, the quadrivalent HPV vaccine would have been useful in the prevention of 28% (13/46) of these infections.
    • Risk factors for recurrent laryngeal nerve neuropraxia postthyroidectomy.

      Sheahan, Patrick; O'Connor, Ann; Murphy, Matthew S; Department of Otolaryngology-Head & Neck Surgery, South Infirmary Victoria University Hospital, Cork, Ireland. sheahan.patrick@sivuh.ie (2012-06)
      Despite preservation of the recurrent laryngeal nerve (RLN), transient vocal cord paralysis (VCP) occurs after 1.2% to 10.9% of thyroidectomies. The objective of this study was to study risk factors for transient VCP after thyroidectomy.
    • Sun exposure and the use of sunscreen among rheumatology inflammatory arthropathy patients receiving anti-tumor necrosis factor therapy.

      McKeogh, John; O'Connor, Mortimer B; Bond, Ursula; Swan, Joan; Phelan, Mark J; Medicine, South Infirmary Victoria University Hospital, Cork, Ireland. (2012-06)
    • Safety of body piercings for rheumatology patients on immunosuppressive medications.

      O'Connor, M B; Phelan, M J (Irish Medical Journal (IMJ), 2012-05)
    • Comparison of incidence of postoperative seroma between flapless and conventional techniques for thyroidectomy: a case-control study.

      Sheahan, P; O'Connor, A; Murphy, M S; Department of Otolaryngology-Head & Neck Surgery, South Infirmary Victoria University Hospital, Cork, Ireland. sheahan.patrick@sivuh.ie (2012-04)
      The incidence of seroma after thyroidectomy has been reported between 1.3% and 7%. We hypothesised that a flapless thyroidectomy technique would reduce the incidence of seroma.
    • Eccrine porocarcinoma arising within an area of Bowen disease.

      Lowney, A C; Mc Aleer, M A; O'Connor, K; Fitzgibbon, J F; Bourke, J F; Department of Dermatology, South Infirmary Victoria University Hospital, Cork, Ireland. aoifelowney@gmail.com (2012-03)
      Summary Very little is known about the aetiology of eccrine porocarcinoma (EP), a rare malignant sweat-gland tumour. Most reported cases have arisen de novo, or from a benign eccrine poroma. We report an unusual case, in which eccrine porocarcinoma arose at the exact site of pre-existing Bowen disease (BD).
    • Koebner phenomenon of the ear canal skin.

      Young, O; Murphy, M; Fitzgibbon, J; O'Sullivan, P; Department of Otolaryngology, South Infirmary/Victoria Hospital, Old Blackrock, Road, Cork, Ireland. oyoung@rcsi.ie (2012-02-01)
      The Koebner phenomenon originally described the appearance of psoriatic lesions in the uninvolved skin of patients with psoriasis as a consequence of trauma. We describe a case of concurrent lichen planus and sarcoidosis in the auditory canal, which represents an unusual manifestation of the Koebner phenomenon. This is the first case of concurrent lichen planus and sarcoidosis in the head and neck region and highlights the need for biopsy to allow accurate histopathological diagnosis and treatment.
    • Intravenous cidofovir for resistant cutaneous warts in a patient with psoriasis treated with monoclonal antibodies.

      McAleer, M A; Bourke, J; Department of Dermatology, South Infirmary-Victoria University Hospital, Cork,, Co. Cork, Ireland. (2012-02-01)
      Human papilloma virus is a common and often distressing cutaneous disease. It can be therapeutically challenging, especially in immunocompromised patients. We report a case of recalcitrant cutaneous warts that resolved with intravenous cidofovir treatment. The patient was immunocompromised secondary to monoclonal antibody therapy for psoriasis.
    • An unusual rash in a neonate. X-linked dominant ichthyosis (XLDI).

      Moriarty, B; Bourke, J F; Fitzgibbon, J; Irvine, A D; Department of Dermatology, South Infirmary, Victoria Hospital, Cork, Ireland., blaithinl@hotmail.com (2012-02-01)
    • Osteonecrosis following alcohol, cocaine, and steroid use.

      Ziraldo, Laura; O'Connor, Mortimer B; Blake, Simon P; Phelan, Mark J; Department of Medicine, South Infirmary-Victoria University Hospital, Cork,, Ireland. (2012-02-01)
      Alcohol, steroids and cocaine have all been shown to be independent risk factors for osteonecrosis when taken in excess. Here we present a case of a young girl who developed debilitating osteonecrosis secondary to low doses of alcohol, steroids and cocaine. We feel it is important to highlight to those caring for such patients of the potential devastating complication of these three agents.
    • Local IgE production in nonatopic nasal polyposis.

      Sheahan, Patrick; Ahn, Chadwick N; Harvey, Richard J; Wise, Sarah K; Mulligan, Ryan M; Lathers, Deanne M R; Schlosser, Rodney J; Department of Otolaryngology-Head and Neck Surgery, South Infirmary Victoria, University Hospital, Cork, Ireland. (2012-02-01)
      INTRODUCTION: Chronic rhinosinusitis with nasal polyposis (CRSwNP) represents an eosinophilic T-helper 2 inflammatory response. Local production of IgE within nasal polyps (NPs) has been demonstrated, suggesting a role for local IgE in the pathogenesis of NP in atopic CRS patients. We hypothesized that local IgE specific to inhalant allergens may also play a role in the genesis of NP in nonatopic CRS patients. METHODS: Sinus and inferior turbinate tissue was obtained from nonatopic CRSwNP patients (n = 7), chronic rhinosinusitis without nasal polyps (CRSsNP) patients (n = 15), and healthy controls (n = 9) at the time of surgery. ImmunoCAP analysis (Phadia AB, Portage, MI) for 14 common inhalant antigens was performed on tissue homogenates to determine the antigen-specific response. RESULTS: Total IgE levels did not differ in sinus or turbinate tissue between CRSwNP, CRSsNP, or control patients. CRSwNP sinus tissue had higher levels of specific IgE for cockroach and plantain (p = .03) than other groups and elevated Alternaria IgE levels when compared with CRSsNP sinus tissue (p < .05). No significant differences were found for any of the other antigen-specific IgE levels. Fifty-seven percent of CRSwNP polyps demonstrated a polyclonal IgE response, whereas the other 43% had no demonstrable antigen-specific IgE. In contrast, only 17% of CRSsNP patients demonstrated a polyclonal response within sinus tissue, whereas 67% had no detectable antigen-specific IgE. There was no significant difference in levels of IgE in inferior turbinate tissue between the groups (p > .05). CONCLUSIONS: Localized mucosal IgE specific to common inhalant allergens appears to play a role in a subset of CRSwNP patients without evidence of systemic atopy.