• Gastric applications of electrical field stimulation.

      Hogan, Aisling M; Gallagher, Tom K; Kennelly, Rory; Baird, Alan W; Winter, Desmond C; Department of General Surgery, Institute of Clinical Outcomes Research and, Education (iCORE), St Vincent's University Hospital, Dublin, Ireland., Aislinghogan@yahoo.com (2012-02-01)
      Advances in clinical applications of electricity have been vast since the launch of Hayman's first cardiac pacemaker more than 70 years ago. Gastric electrical stimulation devices have been recently licensed for treatment of gastroparesis and preliminary studies examining their potential for use in refractory obesity yield promising results.
    • Gastrointestinal Erdheim-Chester disease

      Tevlin, R; Cahalane, AM; Larkin, JO; Treacy, A; Connaghan, D; Winter, DC (Irish Medical Journal, 2014-05)
      We report a rare case of Erdheim-Chester Disease, a non-Langerhans cell histiocytosis. A 60-year old female presented with a seven-month history of vague abdominal symptoms. A large retroperitoneal mass was detected on computed tomography (CT), but multiple CT-guided biopsy samples were inconclusive. Laparoscopy revealed a mass in the distal ileum, which was resected. Histology and immuno-histochemistry supported a diagnosis of Erdheim-Chester Disease.
    • Gastrointestinal perforation in metastatic carcinoma: a complication of bevacizumab therapy.

      Collins, D; Ridgway, P F; Winter, D C; Fennelly, D; Evoy, D; Department of Surgery, St Vincent's University Hospital, Elm Park, Dublin 4,, Dublin, Ireland. daniellecollins@rcsi.ie (2012-02-01)
    • Genetic variation in DNMT3B and increased global DNA methylation is associated with suicide attempts in psychiatric patients

      Murphy, T. M.; Mullins, N.; Ryan, M.; Foster, T.; Kelly, C.; McClelland, R.; O'Grady, J.; Corcoran, E.; Brady, J.; Reilly, M.; et al. (Genes, Brain and Behavior, 2012-09)
      Recently, a significant epigenetic component in the pathology of suicide has been realized. Here we investigate candidate functional SNPs in epigenetic-regulatory genes, DNMT1 and DNMT3B, for association with suicide attempt (SA) among patients with co-existing psychiatric illness. In addition, global DNA methylation levels [5-methyl cytosine (5-mC%)] between SA and psychiatric controls were quantified using the Methylflash Methylated DNA Quantification Kit. DNA was obtained from blood of 79 suicide attempters and 80 non-attempters, assessed for DSM-IV Axis I disorders. Functional SNPs were selected for each gene (DNMT1; n =7, DNMT3B; n =10), and genotyped. A SNP (rs2424932) residing in the 3 UTR of the DNMT3B gene was associated with SA compared with a non-attempter control group (P =0.001; Chi-squared test, Bonferroni adjusted P value=0.02). Moreover, haplotype analysis identified a DNMT3B haplotype which differed between cases and controls, however this association did not hold after Bonferroni correction (P =0.01, Bonferroni adjusted P value=0.56). Global methylation analysis showed that psychiatric patientswith a history of SA had significantly higher levels of global DNA methylation compared with controls (P =0.018, Student’s t -test). In conclusion, this is the first report investigating polymorphisms in DNMT genes and global DNA methylation quantification in SA risk. Preliminary findings suggest that allelic variability in DNMT3B may be relevant to the underlying diathesis for suicidal acts and our findings support the hypothesis that aberrant DNA methylation profiles may contribute to the biology of suicidal acts. Thus, analysis of global DNA hypermethylation in blood may represent a biomarker for increased SA risk in psychiatric patients.
    • The genetics of obstructive sleep apnoea.

      Kent, Brian D; Ryan, Silke; McNicholas, Walter T; Pulmonary and Sleep Disorders Unit, St Vincent's University Hospital, Dublin,, Ireland. (2012-02-01)
      PURPOSE OF REVIEW: Obstructive sleep apnoea syndrome (OSAS) is a highly prevalent disorder associated with reduced quality of life and adverse cardiovascular and metabolic sequelae. Recent years have seen an intensification of the research effort to establish the genetic contribution to the development of OSAS and its sequelae. This review explores emerging evidence in this field. RECENT FINDINGS: A genetic basis for sleep-disordered breathing has been demonstrated for discrete disorders such as Treacher-Collins and Down syndromes, but the picture is less clear in so-called idiopathic OSAS. A degree of heritability appears likely in some of the intermediate phenotypes that lead to OSAS, particularly craniofacial morphology. However, only sparse and often contradictory evidence exists regarding the role of specific polymorphisms in causing OSAS in the general population. Similarly, investigations of the cardiovascular sequelae of OSAS have in general failed to consistently find single causative genetic mutations. Nonetheless, evidence suggests a role for tumour necrosis factor-alpha polymorphisms in particular, and large-scale family studies have suggested shared pathogenetic pathways for the development of obesity and OSAS. SUMMARY: As with other common disorders, OSAS is likely to result from multiple gene-gene interactions occurring in a suitable environment. The application of modern genetic investigative techniques, such as genome-wide association studies, may facilitate new discoveries in this field.
    • Geriatric Medicine in the Emergency Department

      Tan, KM; Lannon, R; O’Keeffe, L; Barton, D; Ryan, J; O’Shea, D; Hughes, G (Irish Medical Journal, 2012-09)
    • Giant desmoid tumour of the thorax following latissimus dorsi and implant breast reconstruction: case report and review of the literature

      Collins, AM; Granahan, AM; Healy, DG; Lawlor, CA; O’Neill, SP (Irish Medical Journal, 2017-03)
      The case of a giant thoracic desmoid tumour in a 44-year-old woman, who presented two years following a breast reconstruction with a latissimus dorsi (LD) flap and implant, is reported. Clinical findings included a rapidly growing, painless mass. Computed tomography (CT) suggested skin and intercostal soft tissue invasion. The tumour was resected en bloc with the LD muscle, implant capsule and underlying rib segments. The resultant thoracic and abdominal wall defects were reconstructed with Dualmesh® and polypropylene meshes respectively. There was no evidence of recurrence at thirty-six months follow-up.
    • Giant right atrial myxoma: characterization with cardiac magnetic resonance imaging.

      Ridge, Carole A; Killeen, Ronan P; Sheehan, Katherine M; Ryan, Ronan; Mulligan, Niall; Luke, David; Quinn, Martin; Dodd, Jonathan D; Department of Radiology, St. Vincent's University Hospital, Elm Park, Dublin 4,, Ireland. c.ridge@st-vincents.ie <c.ridge@st-vincents.ie> (2012-02-01)
      A 53-year-old woman presented to the emergency department with a 2-week history of dyspnoea and chest pain. Computed tomography pulmonary angiography was performed to exclude acute pulmonary embolism (PE). This demonstrated a large right atrial mass and no evidence of PE. Transthoracic echocardiography followed by cardiac magnetic resonance imaging confirmed a mobile right atrial mass. Surgical resection was then performed confirming a giant right atrial myxoma. We describe the typical clinical, radiologic, and pathologic features of right atrial myxoma.
    • Gitelman's syndrome: a rare presentation mimicking cauda equina syndrome.

      Quinlan, C S; Walsh, J C; Moran, A-M; Moran, C; O'Rourke, S K; Department of Orthopaedic Surgery, St. Vincent's University Hospital, Elm Park,, Dublin 4, Ireland. christinequinlan@rcsi.ie (2012-02-01)
      We describe a case of bilateral weakness of the lower limbs, sensory disturbance and intermittent urinary incontinence, secondary to untreated Gitelman's syndrome, in a 42-year-old female who was referred with presumed cauda equina syndrome. On examination, the power of both legs was uniformly reduced, and the perianal and lower-limb sensation was altered. However, MRI of the lumbar spine was normal. Measurements of serum and urinary potassium were low and blood gas analysis revealed metabolic alkalosis. Her symptoms resolved following potassium replacement. We emphasise the importance of measurement of the plasma and urinary levels of electrolytes in the investigation of patients with paralysis of the lower limbs and suggest that they, together with blood gas analysis, allow the exclusion of unusual causes of muscle weakness resulting from metabolic disorders such as metabolic alkalosis.
    • Glucagon-like peptide-1 (GLP-1) - a key regulator of innate immune function with clinical efficacy in a range of inflammatory diseases

      Hogan, Andrew (2012-06)
      American Diabetes Association Annual Meeting in Philadelphia in June 2012
    • Glucagon-like peptide-1 analogue therapy for psoriasis patients with obesity and type 2 diabetes: a prospective cohort study.

      Ahern, T; Tobin, A-M; Corrigan, M; Hogan, A; Sweeney, C; Kirby, B; O'Shea, D; Obesity Research Group, and Dermatology Research Group, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland. (Journal of the European Academy of Dermatology and Venereology : JEADV, 2012-06-13)
      Background  Diabetes and obesity are more prevalent amongst psoriasis patients as is disturbance of the innate immune system. GLP-1 analogue therapy considerably improves weight and glycaemic control in people with type 2 diabetes and its receptor is present on innate immune cells. Objective  We aimed to determine the effect of liraglutide, a GLP-1 analogue, on psoriasis severity. Methods  Before and after 10 weeks of liraglutide therapy (1.2 mg subcutaneously daily) we determined the psoriasis area and severity index (PASI) and the dermatology life quality index (DLQI) in seven people with both psoriasis and diabetes (median age 48 years, median body mass index 48.2 kg/m(2) ). We also evaluated the immunomodulatory properties of liraglutide by measuring circulating lymphocyte subset numbers and monocyte cytokine production. Results  Liraglutide therapy decreased the median PASI from 4.8 to 3.0 (P = 0.03) and the median DLQI from 6.0 to 2.0 (P = 0.03). Weight and glycaemic control improved significantly. Circulating invariant natural killer T (iNKT) cells increased from 0.13% of T lymphocytes to 0.40% (P = 0.03). Liraglutide therapy also effected a non-significant 54% decrease in the proportion of circulating monocytes that produced tumour necrosis factor alpha (P = 0.07). Conclusion  GLP-1 analogue therapy improves psoriasis severity, increases circulating iNKT cell number and modulates monocyte cytokine secretion. These effects may result from improvements in weight and glycaemic control as well as from direct immune effects of GLP-1 receptor activation. Prospective controlled trials of GLP-1 therapies are warranted, across all weight groups, in psoriasis patients with and without type 2 diabetes.
    • The Golden State of healthcare reform: ethnoeconomic origins of outcome imbalance.

      Winter, Des; Department of Surgery, Institute for Clinical Outcomes Research and Education, (iCORE), St Vincent's University Hospital, Elm Park, Dublin, Ireland., winterd@indigo.ie (2012-02-01)
    • Guideline promotion increases prescription of bone protection with steroids in hospitalised patients

      Harty, L; Clare, J; Finnerty, D; Van Der Kamp, S.; Kennedy, F; Callanan, I; McKenna, MJ; FitzGerald, O (Irish Medical Journal, 2015-07)
      Guidelines for the prevention of glucocorticoid (GC) induced osteoporosis (GIOP) were implemented in a level 5 Irish Hospital with cross sectional audit of inpatient prescribing undertaken before and after. Prior to guideline implementation, elemental calcium (Ca) with Vitamin D (VitD) was prescribed for 11/66 (17%) of patients on GCs with 2/66 (3%) also receiving bisphosphonate (BP) therapy. Subsequent to guideline implementation, Ca with VitD was prescribed for 19/55 (35%) of patients on GCs with 11/55 (20%) also receiving BP therapy, representing a 2 and 6 fold respective increase. Internal promotion of guidelines is an effective strategy for healthcare improvement but needs refinement with or without repetition to achieve better patient outcomes.
    • Headshop heartache: acute mephedrone 'meow' myocarditis.

      Nicholson, Patrick J; Quinn, Martin J; Dodd, Jonathan D; Department of Cardiology, St Vincent's University Hospital, Dublin, Ireland. (2012-02-01)
    • Health-related qualify of life, angina type and coronary artery disease in patients with stable chest pain.

      Rieckmann, Nina; Neumann, Konrad; Feger, Sarah; Ibes, Paolo; Napp, Adriane; Preuß, Daniel; Dreger, Henryk; Feuchtner, Gudrun; Plank, Fabian; Suchánek, Vojtěch; et al. (2020-05-14)
      Background: Health-related quality of life (HRQoL) is impaired in patients with stable angina but patients often present with other forms of chest pain. The aim of this study was to compare the pre-diagnostic HRQoL in patients with suspected coronary artery disease (CAD) according to angina type, gender, and presence of obstructive CAD. Methods: From the pilot study for the European DISCHARGE trial, we analysed data from 24 sites including 1263 patients (45.9% women, 61.1 ± 11.3 years) who were clinically referred for invasive coronary angiography (ICA; 617 patients) or coronary computed tomography angiography (CTA; 646 patients). Prior to the procedures, patients completed HRQoL questionnaires: the Short Form (SF)-12v2, the EuroQoL (EQ-5D-3 L) and the Hospital Anxiety and Depression Scale. Results: Fifty-five percent of ICA and 35% of CTA patients had typical angina, 23 and 33% had atypical angina, 18 and 28% had non-anginal chest discomfort and 5 and 5% had other chest discomfort, respectively. Patients with typical angina had the poorest physical functioning compared to the other angina groups (SF-12 physical component score; 41.2 ± 8.8, 43.3 ± 9.1, 46.2 ± 9.0, 46.4 ± 11.4, respectively, all age and gender-adjusted p < 0.01), and highest anxiety levels (8.3 ± 4.1, 7.5 ± 4.1, 6.5 ± 4.0, 4.7 ± 4.5, respectively, all adjusted p < 0.01). On all other measures, patients with typical or atypical angina had lower HRQoL compared to the two other groups (all adjusted p < 0.05). HRQoL did not differ between patients with and without obstructive CAD while women had worse HRQoL compared with men, irrespective of age and angina type. Conclusions: Prior to a diagnostic procedure for stable chest pain, HRQoL is associated with chest pain characteristics, but not with obstructive CAD, and is significantly lower in women.
    • Hedgehog signaling and therapeutics in pancreatic cancer.

      Kelleher, Fergal C; Department of Medical Oncology, St Vincent's University Hospital, Dublin,, Ireland. fergalkelleher@hotmail.com (2012-02-01)
      OBJECTIVE: To conduct a systematic review of the role that the hedgehog signaling pathway has in pancreatic cancer tumorigenesis. METHOD: PubMed search (2000-2010) and literature based references. RESULTS: Firstly, in 2009 a genetic analysis of pancreatic cancers found that a core set of 12 cellular signaling pathways including hedgehog were genetically altered in 67-100% of cases. Secondly, in vitro and in vivo studies of treatment with cyclopamine (a naturally occurring antagonist of the hedgehog signaling pathway component; Smoothened) has shown that inhibition of hedgehog can abrogate pancreatic cancer metastasis. Thirdly, experimental evidence has demonstrated that sonic hedgehog (Shh) is correlated with desmoplasia in pancreatic cancer. This is important because targeting the Shh pathway potentially may facilitate chemotherapeutic drug delivery as pancreatic cancers tend to have a dense fibrotic stroma that extrinsically compresses the tumor vasculature leading to a hypoperfusing intratumoral circulation. It is probable that patients with locally advanced pancreatic cancer will derive the greatest benefit from treatment with Smoothened antagonists. Fourthly, it has been found that ligand dependent activation by hedgehog occurs in the tumor stromal microenvironment in pancreatic cancer, a paracrine effect on tumorigenesis. Finally, in pancreatic cancer, cells with the CD44+CD24+ESA+ immunophenotype select a population enriched for cancer initiating stem cells. Shh is increased 46-fold in CD44+CD24+ESA+ cells compared with normal pancreatic epithelial cells. Medications that destruct pancreatic cancer initiating stem cells are a potentially novel strategy in cancer treatment. CONCLUSIONS: Aberrant hedgehog signaling occurs in pancreatic cancer tumorigenesis and therapeutics that target the transmembrane receptor Smoothened abrogate hedgehog signaling and may improve the outcomes of patients with pancreatic cancer.
    • Hedgehog signaling and therapeutics in pancreatic cancer.

      Kelleher, Fergal C; Department of Medical Oncology, St Vincent's University Hospital, Dublin, Ireland. fergalkelleher@hotmail.com (2011-04)
      To conduct a systematic review of the role that the hedgehog signaling pathway has in pancreatic cancer tumorigenesis.
    • Hepatic iron overload following liver transplantation of a C282y homozygous allograft: a case report and literature review.

      Dwyer, Jeremy P; Sarwar, Shahzad; Egan, Brian; Nolan, Niamh; Hegarty, John; Liver Unit, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland. (2011-11)
      Hereditary haemochromatosis is a common genetic disease associated with progressive iron overload and parenchymal organ damage including liver, pancreas and heart. We report a case of inadvertent transplantation of a liver from a haemochromatosis donor to a 56-year-old Asian female. Progressive iron overload occurred over a 2 year follow up as assessed by liver biopsy and iron studies in the absence of a secondary cause of iron overload, supporting a primary role of liver rather than small intestine in the regulation of iron homeostasis in hereditary haemochromatosis.
    • Hepatic transplantation outcomes for carefully selected cirrhotic patients with hepatocellular carcinoma: experience at a small- to medium-volume centre.

      Qasim, A; Zaman, M B; Maguire, D; Geoghegan, J; Gibney, R; Nolan, N; Traynor, O; Hegarty, J; McCormick, P A; St Vincent's University Hospital, Dublin, Ireland. asgharqasim@yahoo.co.uk (2012-02-01)
      BACKGROUND: Hepatic transplantation outcomes for cirrhotic patients with hepatocellular carcinoma (HCC) at a small- to medium-volume centre are not fully known due to relative novelty of patient selection criteria. AIM: To determine hepatic transplantation outcomes for HCC at a small- to medium-volume centre. Patients and methods Hepatocellular carcinoma patients were listed for transplantation according to the International Guideline and further categorized as those fulfilling or exceeding Milan or University of San Francisco (UCSF) criteria on explanted liver morphology. Outcomes including mortality, retransplantation, and tumour recurrence rate were analysed. RESULTS: Twenty-six patients had HCC and on explanted liver morphology, Milan and UCSF criteria met 15 and 18 patients, respectively. Patients and graft survival at 3 months, 1 and 5 years were 100, 96, 84, and 88, 84, 77%, respectively. Outcomes favoured Milan criteria but did not reach statistical significance. CONCLUSIONS: Hepatic transplantation for HCC at a small-to medium-volume transplant centre had comparable survival outcomes to high-volume centres.
    • Hepatocellular carcinoma complicating cystic fibrosis related liver disease.

      O'Donnell, D H; Ryan, R; Hayes, B; Fennelly, D; Gibney, R G; Department of Radiology, St Vincent's University Hospital, Dublin 4, Ireland., davidhodonnell@hotmail.com (2012-02-01)
      Early diagnosis and treatment of the respiratory and gastrointestinal complications of cystic fibrosis (CF) have led to improved survival with many patients living beyond the fourth decade. Along with this increased life expectancy is the risk of further disease associated with the chronic manifestations of their condition. We report a patient with documented CF related liver disease for which he was under routine surveillance that presented with histologically proven hepatocellular carcinoma (HCC). It is important that physicians are aware of this association as increased vigilance may lead to earlier diagnosis and perhaps, a better outcome.