• Preoperative information needs of children undergoing tonsillectomy.

      Buckley, Aoife; Savage, Eileen; General Operating Theatres, South Infirmary Victoria University Hospital, Cork,, Ireland. buckley_aoife@hotmail.com (2012-02-01)
      AIMS AND OBJECTIVES: To identify the information needs of children undergoing tonsillectomy with reference to content of information, method of delivery, information providers and timing of information provision. BACKGROUND: Tonsillectomy can be anxiety provoking for children and preoperative preparation programmes are long recognised to reduce anxiety. However, few have been designed from the perspectives of children and to date little is known about how best to prepare children in terms of what to tell them, how to convey information to them, who can best provide information and what is the best timing for information provision. DESIGN: A qualitative descriptive study. METHOD: Data were collected from nine children (aged 6-9) using interviews supported by a write and draw technique. Data were coded and categorised into themes reflecting content, method, providers and timing of information. RESULTS: Children openly communicated their information needs especially on what to tell them to expect when facing a tonsillectomy. Their principal concerns were about operation procedures, experiencing 'soreness' and discomfort postoperatively and parental presence. Mothers were viewed as best situated to provide them with information. Children were uncertain about what method of information and timing would be most helpful to them. CONCLUSION: Preoperative educational interventions need to take account of children's information needs so that they are prepared for surgery in ways that are meaningful and relevant to them. Future research is needed in this area. RELEVANCE TO CLINICAL PRACTICE: Practical steps towards informing children about having a tonsillectomy include asking them what they need to know and addressing their queries accordingly. Child-centred information leaflets using a question and answer format could also be helpful to children.
    • Acute suppurative neonatal parotitis: Case report.

      Khan, Sardar U; O'Sullivan, Peter G; McKiernan, John; Department of Otorhinolaryngology-Head and Neck Surgery, South Infirmary-Victoria, University Hospital, Cork, Ireland. sardarent@hotmail.com (2012-02-01)
      Neonatal suppurative parotitis is very rare. One review of the English-language literature spanning 35 years found only 32 cases. Most cases are managed conservatively with antibiotic therapy; early antibiotic treatment reduces the need for surgery. The predominant organism is Staphylococcus aureus. We report a new case of neonatal suppurative parotitis in a 3-week-old boy. The patient was diagnosed on the basis of parotid swelling, a purulent exudate from a Stensen duct, and the growth of pathogenic bacteria in culture. He responded well to 9 days of intravenous antibiotic therapy. We also discuss the microbiologic and clinical patterns of this disease.
    • Establishing a temporal bone laboratory: considerations for ENT specialist training.

      Fennessy, B G; O'Sullivan, P; Department of ENT, South Infirmary and Victoria Hospital, Cork, Ireland., bfennessy@rcsi.ie (2012-02-01)
      Cadaveric temporal bone dissection in a temporal bone laboratory is a vital component in training safe, competent otorhinolaryngologists. Recent controversies pertaining to organ retention have resulted in a more limited supply of temporal bones. Consequently, current trainees are dissecting far fewer bones than their consultants. We discuss the establishment of a temporal bone laboratory in the Department of Anatomy in the University College Cork, from the timely preparation and preservation of the tissue to its disposal. Comparisons are drawn between our experience and that of the United States training schemes. The temporal bone laboratory in Cork is the only one in existence in Ireland. The exposure and experience obtained by registrars rotating through Cork, has resulted in noticeable improvements in their operative abilities. The temporal bone laboratory remains a core component to training. It is hoped that this article may facilitate other units overcoming obstacles to establish a temporal bone laboratory.
    • The benefits of hypopharyngeal packing in nasal surgery: a pilot study.

      Fennessy, B G; Mannion, S; Kinsella, J B; O'Sullivan, P; Department of ENT, South Infirmary and Victoria Hospital, Old Blackrock Road,, Cork, Ireland. bfennessy@rcsi.ie (2012-02-01)
      BACKGROUND: Hypopharyngeal packs are used in nasal surgery to reduce the risk of aspiration and postoperative nausea and vomiting. Side effects associated with their use range from throat pain to retained packs postoperatively. AIM: To evaluate, as a pilot study, postoperative nausea/vomiting and throat pain scores for patients undergoing nasal surgery in whom a wet or dry hypopharyngeal pack was placed compared with patients who received no packing. METHODS: A randomized, double-blind prospective trial in a general ENT unit. RESULTS: The study failed to show a statistically significant difference between the three groups in terms of their postoperative nausea/vomiting and throat pain scores at 2 and 6 h postoperatively. This is the first study in which dry packs have been compared with wet and absent packs. CONCLUSION: Based on our findings, the authors recommend against placing hypopharyngeal packs for the purpose of preventing postoperative nausea and vomiting.
    • Methotrexate information booklet study 2008.

      Mohammad, A; Kilcoyne, A; Bond, U; Regan, M; Phelan, M; Department of Rheumatology, South Infirmary Victoria University Hospital, Cork,, Ireland. ausafmohammad@gmail.com (2012-02-01)
      INTRODUCTION: I n order to assess the value of using the methotrexate information booklet, we conducted a single blind prospective controlled trial of the patients attending two rheumatology services. METHODS: The active-arm (n=40) used the MTX information booklet for the patients' education and the control-arm (n=38) did not. Patients' interviews were conducted over a 6-month period using an MTX-questionnaire. RESULTS: The entire active-arm patients (100%) were taking folic-acid and 32 (80%) knew the reason why they were taking folic-acid vs. [30 (79%) and 10 (26%) in the control-arm]. In the active-arm 35 (88%) knew the reason for their monthly blood tests vs. 18 (47%) in the control-arm. The entire active-arm was aware of the need for contraception use and MTX-side effects vs. 23 (60%) and 15 (40%) in the control-arm respectively. CONCLUSIONS: The use of the MTX information booklet in our cohort improved their understanding of the treatment.
    • Thyroid Tubercle of Zuckerkandl: importance in thyroid surgery.

      Sheahan, Patrick; Murphy, Matthew S; Department of Otolaryngology-Head & Neck Surgery, South Infirmary Victoria, University Hospital, Cork, Ireland. sheahan.patrick@sivuh.ie (2012-02-01)
      OBJECTIVE: The Tubercle of Zuckerkandl (TZ), which is the remant of the lateral thyroid process, is an important anatomic structure that serves as a reliable landmark for the recurrent laryngeal nerve in thyroid surgery. Furthermore, removal of the TZ is critical for the adequate performance of a total thyroidectomy. However, there is little mention of the TZ in surgical textbooks or papers. METHODS: Prospective observational study of 138 consecutive thyroid surgeries. The presence of the TZ, its size, and relationship to the recurrent laryngeal nerve, were recorded. RESULTS: A total of 211 thyroid lobes were included in the study. The TZ was identified in 61.1% of all thyroid lobes. The median size was 8 mm (range = 3-40 mm). A TZ was more commonly identified on the right (69.6%) than on the left side (53.2%) (P = .02). The recurrent laryngeal nerve was found deep to the TZ in 98.4% of cases. CONCLUSIONS: A TZ is present in the majority of thyroid lobes. Awareness of the TZ is critical in performing an adequate total thyroidectomy, and is very useful as a landmark for the recurrent laryngeal nerve.
    • Improved malignant melanoma prognosis at a consultant-delivered multidisciplinary pigmented lesion clinic in Cork.

      Field, S; Deady, S; Fitzgibbon, J; Murphy, M; Comber, H; Dermatology Department, South Infirmary-Victoria University Hospital, Old, Blackrock Road, Cork. sineadfield@hotmail.com (2012-02-01)
      Early detection and excision is the only effective treatment for malignant melanoma. To assess the effect of a consultant-delivered, rapid-access pigmented lesion clinic (PLC) established at the South Infirmary-Victoria University Hospital (SIVUH), we analyzed melanoma tumour-stage prior to (1998-2002) and after (2003-2007) the advent of the PLC. Patients attending SIVUH had a greater proportion of early-stage tumours (65.3%) compared to the rest of Cork (51.2%), County Cork as a whole (56.7%) and all of Ireland (57.4%). The proportion of SIVUH males with early-stage tumours was statistically significantly higher than the rest of County Cork (chi2 = 11.23, P < 0.05). The proportion of patients > 50y with early-stage tumours was also statistically significantly higher than the rest of County Cork (chi2 = 18.88, P < 0.05), the whole of County Cork (chi2 = 7.84, P < 0.05) and all of Ireland (chi2 = 9.67, P < 0.05). We believe that the early detection and improved prognosis of Cork melanoma patients is at least partly due to the PLC.
    • Antegrade deligation of iatrogenic distal ureteric obstruction utilising a high pressure balloon dilatation technique.

      Rajendran, Simon; Hodgnett, Philip; O'Hanlon, Deirdre; Curtain, Andrew; Murphy, Micheal; Department of Surgery, South Infirmary Victoria University Hospital, Cork,, Ireland. simonrajendran@gmail.com (2012-02-01)
      BACKGROUND: Iatrogenic trauma is the leading cause of ureteric injury with an incidence in abdominal and pelvic surgery varying between 0.4 and 2.5%. CASE: We report a case of ureteric obstruction caused by a haemostatic clip. There was associated rupture of the ureter proximal to the clip with intra-peritoneal leakage of urine. The patient was unfit for surgery and was managed by a novel procedure of endoluminal balloon deligation. CONCLUSION: Ureteric injuries are rare but potentially serious complications. They require prompt diagnosis and management depends on the patients' clinical condition, extent of injury and interval from injury to diagnosis. We have successfully demonstrated a new technique to treat ureteric obstruction caused by a haemostatic clip with associated ureteral rupture in a patient unfit for surgery.
    • Guidelines for the management of contact dermatitis: an update.

      Bourke, J; Coulson, I; English, J; Department of Dermatology, South Infirmary, Victoria Hospital, Cork, Ireland. (2012-02-01)
      These guidelines for management of contact dermatitis have been prepared for dermatologists on behalf of the British Association of Dermatologists. They present evidence-based guidance for investigation and treatment, with identification of the strength of evidence available at the time of preparation of the guidelines, including details of relevant epidemiological aspects, diagnosis and investigation.
    • Acute compartment syndrome and the role of regional anesthesia.

      Mannion, Stephen; Capdevila, Xavier; Department of Anaesthesiology, South Infirmary-Victoria University Hospital,, Cork, Ireland. Mannionstephen@gmail.com (2012-02-01)
    • Increased occurrence of cardiovascular events and comorbidities in a general rheumatology cohort.

      Mohammad, A; Hartery, K; Bond, U; Phelan, M; Department of Rheumatology, South Infirmary Victoria University Hospital, Cork,, Ireland. ausafmohammad@gmail.com (2012-02-01)
      BACKGROUND: To identify cardiovascular and other comorbidities in a general rheumatology cohort. METHODS: Interviews/retrospective chart audits were conducted on 1,000 patients attending rheumatology outpatient clinics of a university teaching hospital. Comorbidities were classified using the Charlson comorbidity index (Ambrose et al. in Ir J Med Sci 178(1):53-55, 2009). RESULTS: Mean age 58 +/- 15.3 years, mean BMI 26. Of the patients, 400 (40%) were diagnosed with dyslipidemia and hypertension (p = 0.002), 160 (16%) with obesity and 80 (8%) with hypothyroidism. Overall 160 (16%) patients were diagnosed with coronary heart disease (CHD). Of these, 120 (75%) had RA (p = 0.001), 100 (63%) were male, mean age 60 +/- 15.8 years, 120 (75%) had dyslipidemia and BMI > 30 (p = 0.002), 112 (70%) were smokers (p = 0.002), 40 (25%) were diagnosed with diabetes mellitus and 20 (12%) with hypothyroidism. CONCLUSIONS: The increased prevalence of these comorbidities may serve as a reminder to the rheumatologists that many of their patients will have coexistent disease of which they need to be aware to properly plan their management.
    • The prevalence of vitamin D deficiency in consecutive new patients seen over a 6-month period in general rheumatology clinics.

      Haroon, Muhammad; Bond, Ursula; Quillinan, Niamh; Phelan, Mark J; Regan, Michael J; Arthritis and Osteoporosis Centre, Department of Rheumatology, South, Infirmary-Victoria University Hospital, Cork, Ireland. mharoon301@hotmail.com (2012-02-01)
      The objectives of this study are to assess: (a) the prevalence of vitamin D deficiency among new patients attending rheumatology outpatient departments, (b) the age profile of these low vitamin D patients and (c) whether any diagnostic category had a particularly high number of vitamin D-deficient patients. All new patients seen consecutively in general rheumatology clinics between January to June 2007 inclusive were eligible to partake in this study, and 231 out of 264 consented to do so. Parathyroid hormone, 25-hydroxyvitamin D, creatinine, calcium, phosphate, albumin and alkaline phosphatase levels were measured. We defined vitamin D deficiency as /=65 and 78% of patients aged
    • Occupational allergic contact dermatitis to HBTU [(o-benzotriazole-10yl)-N,N,N',N,-tetramethyluronium hexafluorophosphate].

      McAleer, Maeve A; Bourke, Breeda; Bourke, Johnny; Department of Dermatology, South Infirmary-Victoria University Hospital, Old, Blackrock Road, Cork, Ireland. (2012-02-01)
    • Awareness of diabetes complications in an Irish population.

      O'Sullivan, E P; Bhargava, A; O'Callaghan, M; Buckley, U; De Faoite, T; Moynihan, K; Thabit, H; Walsh, C H; Sreenan, S; Department of Diabetes and Endocrinology, South Infirmary Victoria University, Hospital, Cork, Ireland. eoinposullivan@yahoo.i.e (2012-02-01)
      BACKGROUND: Patients' awareness of the increased cardiovascular risk associated with their diabetes is poorly documented. AIM: The aim of this study was to assess the awareness of diabetes complications among patients with diabetes in Ireland. METHODS: Patients attending diabetes outpatient clinics in two teaching hospitals in different regions of the country were invited to complete a questionnaire. RESULTS: A total of 258 (59.3% male) patients completed the questionnaire; mean age 57.8 years. On questioning, 53.5% reported cardiovascular disease as a potential complication of diabetes, with awareness rates of 61.2, 17.1, 16.3 and 12% for retinopathy, stroke, peripheral vascular disease and amputation, respectively. Disappointingly, less than half of respondents felt that improvements in diet and exercise could potentially reduce their cardiovascular risk. CONCLUSIONS: Awareness of cardiovascular risk and knowledge of effective measures to reduce this were low in our study and an alternative means of education may need to be considered.
    • Occupational allergic contact dermatitis to olanzapine.

      Lowney, Aoife C; McAleer, Maeve A; Bourke, Johnny; Dermatology Department, South Infirmary-Victoria University Hospital, Old, Blackrock Road, Cork, Ireland. (2012-02-01)
    • A study of needle stick injuries among non-consultant hospital doctors in Ireland.

      O'Connor, M B; Hannon, M J; Cagney, D; Harrington, U; O'Brien, F; Hardiman, N; O'Connor, R; Courtney, K; O'Connor, C; Department of Medicine, South Infirmary, Victoria University Hospital, Old, Blackrock Road, Cork, Ireland. mortimeroconnor@gmail.com (2012-02-01)
      INTRODUCTION: NCHDs are exposed to a great number of blood-borne infections. Needle stick injuries are possibly the main route of acquiring such infections from a non-consultant hospital doctors (NCHDs) perspective. This study examines NCHDs experiences surrounding needle stick injuries. METHODS: A cross-sectional self-administered anonymous questionnaire survey was conducted on 185 NCHDs working in a clinical setting among seven teaching hospitals in Ireland. Implied consent was obtained. The data was analysed using Excel spreadsheets. Ethical approval was received. RESULTS: A response rate of 85.4% (158/185) was achieved. Findings of the study are shown in the manuscript table. CONCLUSIONS: A needle stick injury (NI) history is greater among surgical NCHDs than medical NCHDs. The level of disposable glove usage is worryingly poor. Training in sharps handling and dealing with a NI needs to be addressed. HIV is the blood-borne infection most fear of being contracting as a consequence of a NI.
    • Non-Hodgkin lymphoma presenting as bilateral tonsillar hypertrophy: case report.

      Khan, Sardar U; Kenefick, Cyril; O'Leary, Gerard; Lucey, James J; Department of Otorhinolaryngology-Head and Neck Surgery, South Infirmary-Victoria, University Hospital, Cork, Ireland. sardarent@hotmail.com (2012-02-01)
      We describe the case of a 57-year-old man who was referred to us with persistent sore throat, dysphagia, and enlarged tonsils. He had not responded to earlier treatment with antibiotic therapy and other routine measures. In view of the persistent nature of the patient's symptoms and the tonsillar hypertrophy, we decided to perform a tonsillectomy and to send the excised specimens for pathologic analysis. Histologic evaluation identified non-Hodgkin lymphoma in both tonsils. The patient was treated with postoperative chemo- and radiotherapy, and he was free of symptoms during 18 months of follow-up. To the best of our knowledge, only 4 cases of bilateral non-Hodgkin lymphoma of the tonsils have been reported in the English-language literature. We also discuss the importance of histologic analysis of excised tonsil tissue in selected cases.
    • Peristomal allergic contact dermatitis to stoma-adhesive paste containing monobutyl ester/maleic acid of polymethylvinylether (Gantrez 425) but not to Isopropyl ester/maleic anhydride of polymethylvinylether (Gantrez 335).

      Field, Sinead; O'Sullivan, Carmel; Murphy, Michelle; Bourke, John F; Dermatology Department, South Infirmary-Victoria University Hospital, Cork,, Ireland. sineadfield@hotmail.com (2012-02-01)
    • The impact of total laryngectomy: the patient's perspective.

      Noonan, Brendan J; Hegarty, Josephine; School of Nursing and Midwifery, University College Cork, South, Infirmary-Victoria University Hospital, Cork, Ireland. b.noonan@ucc.ie (2012-02-01)
      PURPOSE/OBJECTIVES: To describe the experiences of patients who had total laryngectomy from their perspective. RESEARCH APPROACH: Descriptive, qualitative study.Setting: Participants' homes or investigator's hospital office. PARTICIPANTS: 10 patients after total laryngectomy. METHODOLOGIC APPROACH: Data were collected by semistructured, open-ended interviews during a period of six months, with an interview topic guide built on the framework of the literature review. Data were analyzed with descriptive content analysis. Trustworthiness of the study was enhanced through the use of verbatim quotations, audible data analysis trail, and a reflexive approach. MAIN RESEARCH VARIABLES: Patients' experiences of undergoing total laryngectomy. FINDINGS: Patients who have undergone a total laryngectomy report difficulties and concerns that are largely functional and psychological. The functional difficulties reported included descriptions of altered swallow, excess phlegm, speech difficulties, weak neck muscles, and altered energy levels. The psychological concerns reported included descriptions of depression, regrets, and personal resolve. CONCLUSIONS: As a group, patients experience a broad range of problems well after completion of treatment, reinforcing the need for rehabilitation management for prolonged periods after surgery. INTERPRETATION: Nurses are suitably positioned to support this group of patients across the disease management trajectory, from the initial preoperative period to the postoperative period and through to the rehabilitative period and beyond.
    • Type 1 hypersensitivity reaction to carboxymethylcellulose following intra-articular triamcinolone injection.

      Field, Sinead; Falvey, Eanna; Barry, Josephine; Bourke, John; Dermatology Department, South Infirmary-Victoria University Hospital, Cork,, Ireland. sineadfield@hotmail.com (2012-02-01)