• Just as the twig is bent, the tree's inclined: lessons from the future of surgical education.

      Winter, Desmond C; Institute for Clinical Outcomes Research and Education (iCORE) and Department of , Surgery, St Vincent's University Hospital, Dublin, Ireland. winterd@indigo.ie (2012-02-01)
    • Juvenile folliculotropic and ichthyosiform mycosis fungoides.

      Ryan, C; Whittaker, S; D'Arcy, C; O'Regan, G M; Rogers, S; Department of Dermatology, St Vincent's University Hospital, Elm Park, Dublin,, Ireland. caitrionaryan80@hotmail.com (2012-02-01)
      Ichthyosiform mycosis fungoides (MF) is a recently recognized clinical variant of MF, which appears as dry scaling patches and plaques, or as a generalized eruption. Acquired ichthyosis is well recognized as a paraneoplastic cutaneous presentation of malignancy, especially in lymphoproliferative disorders. In contrast, the ichthyosiform eruption in ichthyotic MF is attributable to infiltration of the skin by tumour cells. We report the case of a 15-year-old boy who presented with a 5-year history of enlarging pruritic plaques on the forehead and back, patchy alopecia and generalized ichthyosis. Histology of the forehead and back showed a dense, lymphocytic, folliculocentric and perivascular infiltrate of predominantly CD4-positive T cells consistent with folliculotropic MF. Histological examination of biopsies from ichthyotic skin found similar features. Our patient had a histological diagnosis at the age of 15 years, making him the youngest reported patient with either folliculotropic MF or ichthyotic MF.
    • Kicking society's tobacco habit: does the butt stop here?

      Winter, Desmond C; Institute for Clinical Outcomes Research and Education, St Vincent's University Hospital, Elm Park, Dublin 00004, Ireland. des.winter@gmail.com (2012-04)
    • Kinetics of host immune responses and cytomegalovirus resistance in a liver transplant patient.

      Schaffer, Kirsten; Moran, Julie; Duffy, Margaret; McCormick, Aiden P; Hall, William W; Hassan, Jaythoon; Department of Microbiology, St. Vincent's University Hospital, Elm Park, Dublin, , Ireland. kirsten.e.schaffer@ucd.ie (2012-02-01)
      Among solid organ transplant (SOT) recipients, donor-seropositive/recipient-seronegative (D+/R-) cytomegalovirus (CMV) status is associated with the highest risk of ganciclovir-resistant CMV disease, which has been reported for patients receiving oral ganciclovir but not valganciclovir prophylaxis. We report a case of CMV breakthrough infection in a D+/R- liver transplant patient while he was receiving oral valganciclovir. Forty samples collected over 6 months were analyzed for the CMV viral load, lymphocyte counts, cytokine levels, and lymphocyte differentiation status. Genotypic resistance testing of the viral UL97 gene was performed when the patient failed to respond. CMV viremia occurred on day 50 post-transplant, and 5 samples taken between days 50 and 85 showed the wild-type UL97 genotype. The appearance of deletion 594-595 was observed from day 114 post-transplant. Viral loads declined when foscarnet was commenced and remained below 10,000 copies/mL when the lymphocyte count was greater than 1000/microL (P = 0.02). T cell responses revealed significant expansion of CD8+ terminal effector memory cells. CD4+ cells were largely populations of naive and central memory cells. Circulating interleukin 10 (IL-10) levels correlated with the viral load (P < 0.0001). Seroconversion occurred on day 230. The CMV viral load in combination with lymphocyte counts and IL-10 may be a predictive marker for the risk of development of resistant CMV disease in D+/R- SOT patients.
    • Knowledge, attitudes and practices in the provision of nutritional care.

      Fletcher, Antoinette; Carey, Eileen; St Vincent's University Hospital Dublin. (2012-02-01)
      The nutritional care of patients is one of the primary responsibilities of all registered nurses (Persenius et al, 2008). A poor nutritional status can lead to malnutrition, which can have serious consequences for an individual's quality of life (Field and Smith, 2008). This paper commences with an introduction to the concept of nutrition, provides an overview of nutritional guidelines and nutritional screening tools which identify those at risk of malnutrition. It reviews the literature on nurses' knowledge, attitudes and practices in the provision of nutritional care and debates challenges and opportunities encountered to help nurses ensure adequate patient nutrition.
    • Laparoscopic lavage for perforated diverticulitis: a population analysis.

      Rogers, Ailín C; Collins, Danielle; O'Sullivan, Gerald C; Winter, Desmond C; Institute for Clinical Outcomes Research & Education and Centre for Colorectal Disease, St Vincent's University Hospital, Elm Park, Dublin, Ireland. (2012-09)
      Laparoscopic lavage has shown promising results in nonfeculent perforated diverticulitis. It is an appealing strategy; it avoids the complications associated with resection. However, there has been some reluctance to widespread uptake because of the scarcity of large-scale studies.
    • Late onset tuberculosis infection in patients receiving anti-TNFα therapy.

      Mongey, A-B; Doran, J P; Kleinerova, J; Fitzgerald, O; McDonnell, T J; Department of Rheumatology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland. anne.b.mongey@ucd.ie. (2014-01)
    • Late-onset CMV disease following CMV prophylaxis.

      Donnelly, C; Kennedy, F; Keane, C; Schaffer, K; McCormick, P A; Pharmacy Department, St Vincent's University Hospital, Elm Park, Dublin 4,, Ireland. c.donnelly@st-vincents.ie (2012-02-01)
      BACKGROUND: Cytomegalovirus (CMV) is the most common opportunistic infection after solid-organ transplantation, increasing morbidity and mortality. Three months of oral valganciclovir have been shown to provide effective prophylaxis. Late-onset CMV disease, occurring after the discontinuation of prophylaxis, is now increasingly recognised. AIMS: To investigate the incidence and the time of detection of CMV infections in liver transplant recipients who received CMV prophylaxis. METHODS: Retrospective review of 64 high- and moderate-risk patients with 1 year of follow-up. RESULTS: The incidence of CMV infection was 12.5%, with 4.7% disease. All cases of symptomatic CMV disease were of late-onset. CONCLUSIONS: The incidence of CMV infections in this study was low compared with literature reports; however, the late-onset disease is an emerging problem. Detection of late-onset disease may be delayed because of less frequent clinic follow-up visits. Increased regular laboratory monitoring may allow earlier detection at the asymptomatic infection stage.
    • Late-onset progressive visual loss in a man with unusual MRI findings: MS, Harding's, Leber's or Leber's Plus?

      Cawley, N; Molloy, A; Cassidy, L; Tubridy, N; Department of Neurology, St. Vincent's University Hospital, Elm Park, Dublin 4,, Ireland. (2012-02-01)
      Leber's hereditary optic neuropathy (LHON) is a maternally inherited disorder, typically presenting in the second and third decade. We report the case of an elderly gentleman with significant vascular risk factors, presenting with slowly progressive, bilateral, visual loss with high signal lesions in the pericallosal and periventricular deep white matter on MRI brain studies. Possible diagnoses included late-onset MS, ischaemic optic neuropathies, a mitochondrial disorder or an overlap syndrome such as Harding's disease.
    • Lemierre's syndrome.

      O'Dwyer, D N; Ryan, S; O'Keefe, T; Lyons, J; Lavelle, L; McKone, E; St Vincent's University Hospital, Elm Park, Dublin 4, Ireland., daviodwyer@gmail.com (2012-02-01)
      Lemierre's syndrome is a rare disease that results in an oropharyngeal infection, which precipitates an internal jugular vein thrombosis and metastatic infection. Fusobacterium necrophorum is an anaerobic Gram-negative bacillus and has been identified as the causative agent. We describe the case of a young girl whose presentation and diagnosis were confounded by a history of valvular heart disease. Infection of heart valves can produce many of the signs and symptoms associated with Lemierre's syndrome. We describe the diagnosis, investigation and optimal management of this rare disorder.
    • Letter: single liver stiffness measurement predicts liver-related mortality in chronic hepatitis C.

      McCormick, P A; Elrayah, E; Hughes, B; Schmidt, D; Moloney, J (Alimentary pharmacology & therapeutics, 2014-06)
    • Levels of oxidative damage and lipid peroxidation in thyroid neoplasia.

      Young, Orla; Crotty, Tom; O'Connell, Rohana; O'Sullivan, Jacintha; Curran, Aongus J; Department of Otolaryngology, Head & Neck Surgery, UCD School of Medicine &, Medical Science, St Vincent's University Hospital, Elm Park, Dublin. (2012-02-01)
      BACKGROUND: This study assessed the presence of oxidative damage and lipid peroxidation in thyroid neoplasia. METHODS: Using tissue microarrays and immunohistochemistry, we assessed levels of DNA damage (8-oxo-dG) and lipid peroxidation (4-HNE) in 71 follicular thyroid adenoma (FTA), 45 papillary thyroid carcinoma (PTC), and 17 follicular thyroid carcinoma (FTC) and matched normal thyroid tissue. RESULTS: Cytoplasmic 8-oxo-dG and 4-HNE expression was significantly higher in FTA, FTC, and PTC tissue compared to matched normal tissue (all p values < .001). Similarly, elevated nuclear levels of 8-oxo-dG were seen in all in FTA, FTC, and PTC tissue compared to matched normal (p values < .07, < .001, < .001, respectively). In contrast, a higher level of 4-HNE expression was detected in normal thyroid tissue compared with matched tumor tissue (p < .001 for all groups). Comparing all 3 groups, 4-HNE levels were higher than 8-oxo-dG levels (p < .001 for all groups) except that cytoplasmic levels of 8-oxo-dG were higher than 4-HNE in all (p < .001). These results were independent of proliferation status. CONCLUSION: High levels of DNA damage and lipid peroxidation in benign and malignant thyroid neoplasia indicates this damage is an early event that may influence disease progression.
    • A Life-Saving Palsy: Hereditary Neuropathy with Liability to Pressure Palsies (HNPP) Presenting As Hand Weakness during Cardiopulmonary Resuscitation (CPR) Training

      Hughes, H; Tubridy, N; Connolly, S; St. Vincent’s University Hospital, Dublin (Irish Medical Journal, 2018-09)
      Hereditary neuropathy with liability to pressure palsies (HNPP), is an uncommon condition characterised by recurrent episodes of painless, focal motor and sensory peripheral neuropathies, often preceded by nerve compression 1, 2. Despite the rarity of the condition, HNPP should form part of the differential diagnosis in patients presenting with this picture.
    • Localization of nuclear cathepsin L and its association with disease progression and poor outcome in colorectal cancer.

      Sullivan, Shane; Tosetto, Miriam; Kevans, David; Coss, Alan; Wang, Laimun; O'Donoghue, Diarmuid; Hyland, John; Sheahan, Kieran; Mulcahy, Hugh; O'Sullivan, Jacintha; et al. (2012-02-01)
      Previous in vitro studies have identified a nuclear isoform of Cathepsin L. The aim of this study was to examine if nuclear Cathepsin L exists in vivo and examine its association with clinical, pathological and patient outcome data. Cellular localization (nuclear and cytoplasmic) and expression levels v of Cathespin L in 186 colorectal cancer cases using immunohistochemistry. The molecular weight and activity of nuclear and cytoplasmic Cathepsin L in vivo and in vitro were assessed by Western blotting and ELISA, respectively. Epithelial nuclear staining percentage (p = 0.04) and intensity (p = 0.006) increased with advancing tumor stage, whereas stromal cytoplasmic staining decreased (p = 0.02). Using multivariate statistical analysis, survival was inversely associated with staining intensity in the epithelial cytoplasm (p = 0.01) and stromal nuclei (p = 0.007). In different colorectal cell lines and in vivo tumors, pro- and active Cathepsin L isoforms were present in both the cytoplasm and nuclear samples, with pro-Cathepsin L at 50 kDa and active Cathepsin L at 25 kDa. Purified nuclear and cytoplasmic fractions from cell lines and tumors showed active Cathepsin L activity. The identification of nuclear Cathepsin L may play an important prognostic role in colorectal disease progression and patient outcome. Moreover, these findings suggest that altering active nuclear Cathepsin L may significantly influence disease progression.
    • Long-term follow-up of patients with spontaneous clearance of hepatitis C: does viral clearance mean cure?

      Iqbal, M; McCormick, P A; Cannon, M; Murphy, N; Flanagan, P; Hegarty, J E; Thornton, L (Irish Medical Journal, 2017-06)
      Up to 40% of patients with hepatitis C virus (HCV) antibodies are negative for HCV RNA at initial evaluation. If there is a risk of viral re-activation, long term follow-up is required with attendant financial, psychological and medical implications. We investigated the risk of re-activation in the Irish anti-D cohort. Information was obtained from the national hepatitis C database which includes data on patients infected by anti-D immunoglobulin in two large outbreaks, 1977-9 and 1991-94. As part of a screening programme, starting in 1994, 64,907 females exposed to anti-D immunoglobulin were evaluated. Three hundred and forty-seven were found to be antibody positive but HCV RNA negative at initial assessment. 93% had subsequent RNA tests. There was no evidence of HCV recurrence in patients whose infection resolved spontaneously. It appears that two initial sequential negative results for HCV RNA are sufficient to confirm spontaneous viral clearance and probable cure of hepatitis C virus infection.
    • Long-term statin therapy in patients with systolic heart failure and normal cholesterol: effects on elevated serum markers of collagen turnover, inflammation, and B-type natriuretic peptide.

      Abulhul, Esam; McDonald, Kenneth; Martos, Ramon; Phelan, Dermot; Spiers, J Paul; Hennessy, Martina; Baugh, John; Watson, Chris; O'Loughlin, Christina; Ledwidge, Mark; et al. (2012-01)
      The role of statin therapy in heart failure (HF) is unclear. The amino-terminal propeptide of procollagen type III (PIIINP) predicts outcome in HF, and yet there are conflicting reports of statin therapy effects on PIIINP.
    • The major cause of multiple sclerosis is environmental: genetics has a minor role--commentary.

      Hutchinson, Michael; St Vincent's University Hospital. mhutchin@iol.ie (2012-02-01)
    • Management of acute diverticulitis: is less more?

      Hogan, Aisling; Winter, Des; Institute for Clinical Outcomes Research and Education, St. Vincent's University , Hospital, Dublin, Ireland. aislinghogan@yahoo.com (2012-02-01)
    • The Management of Incidental Prostate Cancer Following TURP

      Matanhelia, D.M; Croghan, S.; Nason, G.J; O’Connell, C.; Galvin, D.J.; 1. St Vincent’s University Hospital 2. Mater Misericordiae University Hospital (Irish Medical Journal, 2019-02)
      Prostate cancer (CaP) is the most common non-cutaneous cancer diagnosed in Ireland with a cumulative lifetime risk of 1 in 7 men1. At autopsy, up to 60% of 80 years olds have latent CaP2 while up to 80% have benign prostatic hyperplasia (BPH) 3. The detection of CaP incidentally has fallen in the post prostate specific antigen (PSA) era from ~ 20% to ~5%4. Incidental CaP detected at transurethral resection of prostate (TURP) can be sub-classified into pT1a (<5% of prostate chips) and pT1b (>5% of prostate chips) and the management subsequently stratified.
    • Management of synchronous rectal and prostate cancer.

      Kavanagh, D O; Quinlan, D M; Armstrong, J G; Hyland, J M P; O'Connell, P R; Winter, D C; Center for Colorectal Disease, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland. dara_kav@hotmail.com (2012-11)
      Although well described, there is limited published data related to management on the coexistence of prostate and rectal cancer. The aim of this study was to describe a single institution's experience with this and propose a treatment algorithm based on the best available evidence.