• Vaginal haemangioendothelioma: an unusual tumour.

      Mohan, H; Shireen, R; Hayes, B; Canney, A; Mooney, E E; Murphy, J; Department of Gynaecology, St Vincent's University Hospital, Elm Park, Dublin 4, , Ireland. eibhlinmohan@hotmail.com (2012-02-01)
      Vaginal tumours are uncommon and this is a particularly rare case of a vaginal haemangioendothelioma in a 38-year-old woman. Initial presentation consisted of symptoms similar to uterovaginal prolapse with "something coming down". Examination under anaesthesia demonstrated a necrotic anterior vaginal wall tumour. Histology of the lesion revealed a haemangioendothelioma which had some features of haemangiopericytoma. While the natural history of vaginal haemangioendothelioma is uncertain, as a group, they have a propensity for local recurrence. To our knowledge this is the third reported case of a vaginal haemangioendothelioma. Management of this tumour is challenging given the paucity of literature on this tumour. There is a need to add rare tumours to our "knowledge bank" to guide management of these unusual tumours.
    • The value of appropriate assessment prior to specialist referral in men with prostatic symptoms.

      Quinlan, M R; O'Daly, B J; O'Brien, M F; Gardner, S; Lennon, G; Mulvin, D W; Quinlan, D M; Department of Urology, St Vincent's University Hospital, Dublin 4, Republic of, Ireland. lynagh@hotmail.com (2012-02-01)
      BACKGROUND: Referrals to Urology OPD of men with a likely diagnosis of BPH are common. AIMS: To review referrals to OPD of men with lower urinary tract symptoms (LUTS) to establish how many could have been managed without specialist assessment. METHODS: We reviewed records of 200 male patients referred to OPD with LUTS. We assessed whether the referral source had performed digital rectal examination (DRE), International Prostate Symptom Score (IPSS), Bother Score or PSA level. RESULTS: 74% of patients were referred by GPs. In 31.5% of cases DRE was performed prior to referral. One GP had completed an IPSS, none a Bother Score. 96% had a PSA checked before OPD. Ultimately, 88.5% of our patients were diagnosed with BPH. CONCLUSIONS: With better pre-assessment in the form of DRE, IPSS and Bother Score, allied to a PSA check, many patients with LUTS could be managed in a primary care setting.
    • The value of level III clearance in patients with axillary and sentinel node positive breast cancer.

      Dillon, Mary F; Advani, Vriti; Masterson, Catherine; O'Loughlin, Christina; Quinn, Cecily M; O'Higgins, Niall; Evoy, Denis; McDermott, Enda W; Department of Surgery, St Vincent's University Hospital, Elm Park, Dublin,, Ireland. maryfdillon@hotmail.com (2012-02-01)
      BACKGROUND: The value of level III axillary clearance is contentious, with great variance worldwide in the extent and levels of clearance performed. OBJECTIVE: To determine rates of level III positivity in patients undergoing level I-III axillary clearance, and identify which patients are at highest risk of involved level III nodes. METHODS: From a database of 2850 patients derived from symptomatic and population-based screening service, 1179 patients who underwent level I-III clearance between the years 1999-2007 were identified. The pathology, surgical details, and prior sentinel nodes biopsies of patients were recorded. RESULTS: Eleven hundred seventy nine patients had level I-III axillary clearance. Of the patients, 63% (n = 747) were node positive. Of patients with node positive disease, 23% (n = 168) were level II positive and 19% (n = 141) were level III positive. Two hundred fifty patients had positive sentinel node biopsies prior to axillary clearance. Of these, 12% (n = 30) and 9% (n = 22) were level II and level III positive, respectively. On multivariate analysis, factors predictive of level III involvement in patients with node positive disease were tumor size (P < 0.001, OR = 1.36; 95% CI: 1.2-1.5), invasive lobular disease (P < 0.001, OR = 3.6; 95% CI: 1.9-6.95), extranodal extension (P < 0.001, OR = 0.27; 95% CI: 0.18-0.4), and lymphovascular invasion (P = 0.04, OR = 0.58; 95% CI: 0.35-1). Lobular invasive disease (P = 0.049, OR = 4.1; 95% CI: 1-16.8), extranodal spread (P = 0.003, OR = 0.18; 95% CI: 0.06-0.57), and having more than one positive sentinel node (P = 0.009, OR = 4.9; 95% CI: 1.5-16.1) were predictive of level III involvement in patients with sentinel node positive disease. CONCLUSION: Level III clearance has a selective but definite role to play in patients who have node positive breast carcinoma. Pathological characteristics of the primary tumor are of particular use in identifying those who are at various risk of level III nodal involvement.
    • Varicella-zoster virus immunity in dermatological patients on systemic immunosuppressant treatment.

      Hackett, C B; Wall, D; Fitzgerald, S F; Rogers, S; Kirby, B; Department of Dermatology, St Vincent's University Hospital, Elm Park, Dublin 4, , Ireland. c.hackett@svuh.ie (2012-02-01)
      BACKGROUND: Primary varicella infection is caused by varicella-zoster virus (VZV). It is a common childhood infection, which is usually benign but can occasionally cause morbidity and mortality. In immunosuppressed adults, atypical presentation and disseminated disease can occur with significant morbidity and mortality. A VZV vaccine is available. OBJECTIVES: This study was designed to measure the prevalence of immunity to VZV and to determine the predictive value of a self-reported history of varicella infection in a population of dermatological patients receiving systemic immunosuppressant therapy. We sought to assess the need for routine serological testing for varicella-zoster immunity in this cohort. METHODS: Serological testing for VZV immunity was done on 228 patients receiving systemic immunosuppressive treatment for a dermatological condition. Information regarding a history of previous primary VZV infection was obtained from each patient. RESULTS: Two hundred and twenty-eight patients had VZV serology performed. The mean age of the patients was 49.6 years. The prevalence of VZV seropositivity in this cohort was 98.7%. One hundred and two patients (44.7%) reported having a definite history of primary VZV. The sensitivity of a self-reported history of VZV infection was 45.3% with a specificity of 100%. The positive and negative predictive values of a self-reported history of VZV for serologically confirmed immunity were 100% and 2.3%, respectively. CONCLUSIONS: The prevalence of VZV IgG antibodies in our cohort of Irish dermatology patients receiving immunosuppressive therapy is 98.7%. A recalled history of varicella infection is a good predictor of serological immunity. This study has shown that there are VZV-susceptible individuals within our cohort. These patients did not have a clear history of previous infection. We recommend serological testing of patients without a clear history of infection prior to the commencement of immunosuppressive therapy and vaccination of patients with negative serology.
    • Vertroplasty for spinal fracture.

      O'Sullivan, M; Ryan, J (2011-05)
    • Very late bare-metal stent thrombosis, rare but stormy!

      Ali, Mohammed; McDonald, Ken; Department of Cardiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland. mtali100@gmail.com (2011-08)
      Recurrent in-stent thrombosis is rarely reported, with catastrophic clinical consequences of either acute coronary syndrome or death. We present a case of recurrent in-stent thrombosis with its outcome and a concise literature review.
    • Video-assisted lobectomy for endobronchial leiomyoma.

      Bartosik, Waldemar; Crowther, Stephen; Narski, Maciej; Fabre, Aurélie; Department of Thoracic Surgery, Saint Vincent's University Hospital, Elm Park, Dublin 4, Ireland. w_bartosik@o2.pl (2011-02)
      Endobronchial leiomyomas are rare tumours arising from the smooth muscle on the bronchial tree. We describe a patient with a six-month history of chest infections, who was treated surgically with a video-assisted thoracic surgery (VATS) lobectomy. The pathology revealed an endobronchial leiomyoma that coexisted with postobstructive pulmonary non-necrotising granulomas.
    • Vitamin D nutrient intake for all life stages

      McKenna, M; McCarthy, R; Kilbane, M (Irish Medical Journal, 2011-05-25)
    • A Web-Based Electronic Neurology Referral System: A Solution for anOverburdened Healthcare System

      Williams, L; O’Riordan, S; McGuigan, C; Hutchinson, M; Tubridy, N (Irish Medical Journal (IMJ), 2012-10)
    • What are the spondyloarthropathies?

      FitzGerald, Oliver; Maksymowych, Walter P; Dept of Rheumatology, St. Vincents University Hospital, Elm Park, Dublin, 4, Ireland. oliver.fitzgerald@ucd.ie (2010-10)
    • Whipple's procedure for an oligometastasis to the pancreas from a leiomyosarcoma of the thigh.

      Burke, J P; Maguire, D; Dillon, J; Moriarty, M; O'Toole, G C; Department of Orthopaedic Surgery, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland. john.burke@ucd.ie (2012-09)
      Pancreatic tumours are most frequently primary, with lesions secondary to metastasis uncommon.
    • Whole body imaging in the abdominal cancer patient: pitfalls of PET-CT.

      McDermott, Shaunagh; Skehan, Stephen J; Department of Radiology, St. Vincent's University Hospital, Elm Park, Dublin, 4, , Ireland. mcdermottshaunagh@gmail.com (2012-02-01)
      Proper interpretation of PET-CT images requires knowledge of the normal physiological distribution of the tracer, frequently encountered physiological variants, and benign pathological causes of FDG uptake that can be confused with a malignant neoplasm. In addition, not all malignant processes are associated with avid tracer uptake. A basic knowledge of the technique of image acquisition is also required to avoid pitfalls such as misregistration of anatomical and scintigraphic data. This article reviews these potential pitfalls as they apply to the abdomen and pelvis of patients with cancer.
    • Withdrawal of corticosteroids in inflammatory bowel disease patients after dependency periods ranging from 2 to 45 years: a proposed method.

      Murphy, S J; Wang, L; Anderson, L A; Steinlauf, A; Present, D H; Mechanick, J I; Centre for Colorectal disease, St. Vincent's University Hospital, Dublin,, Ireland. s.murphy@qub.ac.uk (2012-02-01)
      BACKGROUND: Even in the biologic era, corticosteroid dependency in IBD patients is common and causes a lot of morbidity, but methods of withdrawal are not well described. AIM: To assess the effectiveness of a corticosteroid withdrawal method. METHODS: Twelve patients (10 men, 2 women; 6 ulcerative colitis, 6 Crohn's disease), median age 53.5 years (range 29-75) were included. IBD patients with quiescent disease refractory to conventional weaning were transitioned to oral dexamethasone, educated about symptoms of the corticosteroid withdrawal syndrome (CWS) and weaned under the supervision of an endocrinologist. When patients failed to wean despite a slow weaning pace and their IBD remaining quiescent, low dose synthetic ACTH stimulation testing was performed to assess for adrenal insufficiency. Multivariate analysis was performed to assess predictors of a slow wean. RESULTS: Median durations for disease and corticosteroid dependency were 21 (range 3-45) and 14 (range 2-45) years respectively. Ten patients (83%) were successfully weaned after a median follow-up from final wean of 38 months (range 5-73). Disease flares occurred in two patients, CWS in five and ACTH testing was performed in 10. Multivariate analysis showed that longer duration of corticosteroid use appeared to be associated with a slower wean (P = 0.056). CONCLUSIONS: Corticosteroid withdrawal using this protocol had a high success rate and durable effect and was effective in patients with long-standing (up to 45 years) dependency. As symptoms of CWS mimic symptoms of IBD disease flares, gastroenterologists may have difficulty distinguishing them, which may be a contributory factor to the frequency of corticosteroid dependency in IBD patients.
    • Working Backs Project--implementing low back pain guidelines

      Cunningham, C. G.; Flynn, T. A.; Toole, C. M.; Ryan, R. G.; Gueret, P. W. J.; Bulfin, S.; Seale, O.; Blake, C. (2012-04-30)
    • Wunderlich syndrome as the first manifestation of renal cell carcinoma.

      Oon, Sheng F; Murphy, Michael; Connolly, Stephen S; Department of Urology, St. Vincent'sUniversity Hospital, Elm Park, Dublin, Ireland. shengfeioon@rcsi.ie (2010)