Research by staff affiliated to University Hospital Waterford

Recent Submissions

  • Axillary artery and brachial plexus injury secondary to blunt trauma.

    Foley, James; Elamien, Ahmed; McCann, Brendan (2021-03-13)
    Rupture of the axillary artery in the absence of a fracture of dislocation is a rare traumatic event. An associated injury to the brachial plexus may accompany an axillary artery injury but has rarely been reported in the literature. We present the case of an elderly female, who fell onto an outstretched arm and sustained an axillary artery rupture, combined with a brachial plexus injury. The patient in this case did well post-operatively. The challenge in these cases is early recognition and diagnosis of a vascular injury. A significant mechanism of injury needs to alert the clinician to the possibility of such injuries and if suspected, early investigation and surgical exploration should be initiated to prevent limb ischemia. Subsequently, if the neurological symptoms do not improve, consideration must be given to the possibility of a nerve injury and early recognition and management to prevent long-term functional deficits.
  • Long-Term Surveillance and Laparoscopic Management of Zinner Syndrome.

    Kelly, Niall P; Fuentes-Bonachera, Adrian; Shields, William P; Cullen, Ivor M; Daly, Padraig J (2021-03-09)
    Zinner syndrome was first described in 1914 and represents the triad of unilateral renal agenesis and ipsilateral seminal vesicle cyst and ipsilateral ejaculatory duct obstruction. Seminal vesicle cysts are often asymptomatic but can also present with pain, haematospermia, or other lower urinary tract symptoms. Treatment strategies include observation and surgical excision. We present the laparoscopic management of an enlarged seminal vesicle cyst, consistent with Zinner syndrome, 14 years after the initial diagnosis. A 58-year-old male patient was diagnosed with a left-sided seminal vesicle cyst while undergoing assessment for renal transplant due to progressively worsening renal function in his solitary right kidney. The otherwise asymptomatic cyst enlarged from the time of initial diagnosis in 2004 (11.3 cm × 9.7 cm × 13.1 cm) to nearly double the size in 2018 (12.8 cm × 11.9 cm × 14.2 cm). This cyst size ultimately precluded renal transplant, and the patient was referred for excision. Laparoscopic excision of the cyst was performed, histopathology confirmed seminal vesicle cyst tissue, and there has been no recurrence of the cyst to date. The patient remains active on the renal transplant waitlist. Zinner syndrome is a rare syndrome, with the seminal vesicle cysts being managed by observation or surgical excision. We report the longest documented observation of a seminal vesicle cyst, culminating in a safe and successful laparoscopic excision.
  • The environmental impact of personal protective equipment in a pre and post COVID era in the ENT clinic.

    Farrell, Eric; Smyth, David (2021-05-27)
    Purpose: The use of single use plastic items and plastic wrapping has increased over the last number of decades. Outside of the medical field there has been a conscious drive to reduce single use plastic and reuse items to reduce the amount of waste we produce. We undertook this investigation to quantify our plastic waste production and generate ideas to reduce this volume. Methodology: Data was collected from a University Hospital ENT outpatient department via real-time recording methods using standard data collection forms. We measured plastic unit usage pre and post COVID restrictions and compared this to our number of patient encounters. Projections of plastic usage were determined via a hypothetical resumption of patient services model. Results: In total there were 440 patients included. In period one the mean units of plastic used per day was 65.1 (median 67; range 27-84). In the second period, the mean number of plastic units was 23.4 (median 22; range 1-7). Blue nitrile gloves and masks were the most commonly used single use items. The hypothetical projection model predicted a 147.6% increase in single use items following the introduction of COVID precautions. Conclusion: We have a duty of care not only to our patients but future generations of patients and the environment which we share. Single use items and excessive plastic wrapping have benefits in terms of convenience and sterility, but these conveniences can be easily extended to reusable types to limit our volume of waste, reduce our waste management costs and protect our environment.
  • Is postoperative non-weight-bearing necessary? INWN Study protocol for a pragmatic randomised multicentre trial of operatively treated ankle fracture.

    Khojaly, Ramy; Mac Niocaill, Ruairí; Shahab, Muhammad; Nagle, Matthew; Taylor, Colm; Rowan, Fiachra E; Cleary, May (2021-05-27)
    Background: Postoperative management regimes vary following open reduction and internal fixation (ORIF) of unstable ankle fractures. There is an evolving understanding that extended periods of immobilisation and weight-bearing limitation may lead to poorer clinical outcomes. Traditional non-weight-bearing cast immobilisation may prevent loss of fixation, and this practice continues in many centres. The purpose of this trial is to investigate the safety and efficacy of immediate weight-bearing (IWB) and range of motion (ROM) exercise regimes following ORIF of unstable ankle fractures with a particular focus on functional outcomes and complication rates. Methods: A pragmatic randomised controlled multicentre trial, comparing IWB in a walking boot and ROM within 24 h versus non-weight-bearing (NWB) and immobilisation in a cast for 6 weeks, following ORIF of all types of unstable adult ankle fractures (lateral malleolar, bimalleolar, trimalleolar with or without syndesmotic injury) is proposed. All patients presenting to three trauma units will be included. The exclusion criteria will be skeletal immaturity and tibial plafond fractures. The three institutional review boards have granted ethical approval. The primary outcome measure will be the functional Olerud-Molander Ankle Score (OMAS). Secondary outcomes include wound infection (deep and superficial), displacement of osteosynthesis, the full arc of ankle motion (plantar flexion and dorsal flection), RAND-36 Item Short Form Survey (SF-36) scoring, time to return to work and postoperative hospital length of stay. The trial will be reported in accordance with the CONSORT statement for reporting a pragmatic trial, and this protocol will follow the SPIRIT guidance. Discussion: Traditional management of operatively treated ankle fractures includes an extended period of non-weight-bearing. There is emerging evidence that earlier weight-bearing may have equivocal outcomes and favourable patient satisfaction but higher wound-related complications. These studies often preclude more complicated fracture patterns or patient-related factors. To our knowledge, immediate weight-bearing (IWB) following ORIF of all types of unstable ankle fractures has not been investigated in a controlled prospective manner in recent decades. This pragmatic randomised-controlled multicentre trial will investigate immediate weight-bearing following ORIF of all ankle fracture patterns in the usual care condition. It is hoped that these results will contribute to the modern management of ankle fractures.
  • Correction to: Is postoperative non-weight-bearing necessary? INWN Study protocol for a pragmatic randomised multicentre trial of operatively treated ankle fracture.

    Khojaly, Ramy; Niocaill, Ruairí Mac; Shahab, Muhammad; Nagle, Matthew; Taylor, Colm; Rowan, Fiachra E; Cleary, May (2021-06-21)
  • Evaluation of Microdissection Testicular Sperm Extraction (mTESE), Outcomes and Predictive Factors in Ireland: The Gold Standard for Men with Non-Obstructive Azoospermia.

    Rohan, Pat; Daly, Niamh; O'Kelly, Aoife; O'Leary, Martin; Dineen, Tim; Shah, Nigam; Daly, Padraig; Waterstone, John; Cullen, Ivor (2021-04)
    In this study, sperm retrieval rate (SRR) was 47.06%. (16/34). The mean age in those who had retrieved sperm at mTESE was 37.9±2.6 years. Johnson Score (JS) and FSH were statistically different between successful and unsuccessful mTESE groups (p=0.017*10-5 and p=0.004, respectively). Optimal cutoff values for FSH, T and JS were 15 IU/L, 13 nmol/L and 5, respectively. The pregnancy rate was 63.64% (7/11) among men who went on to use mTESE sperm in an ICSI cycle.
  • Colonic Metastasis of Primary Lung Cancer.

    Bhutta, Salman Idrees; Ahmed, Yasar; Zahid, Talal; Rehman, Habib Ur; Nur, Mutaz M; Mahmood, Tariq; Calvert, Paula (2021-06-17)
    The colon is an uncommon secondary site for metastasis of lung adenocarcinoma. Distinguishing primary colonic carcinoma from metastatic spread of lung carcinoma can be difficult. We present a case of a patient with lung adenocarcinoma who, on abdominal computed tomography scan examination, was found to have a sigmoid tumor that was thought to represent a synchronous primary colorectal adenocarcinoma. Histological examination of endoscopic sigmoid tumor biopsies confirmed this to be metastasis from the lung adenocarcinoma. The patient subsequently developed major rectal bleeding and deteriorated significantly. This case also illustrates the poor prognosis association with colorectal metastasis of lung cancer.
  • Challenges of Cancer Screening

    Kelly, D; OConnor, M (Irish Medical Journal, 2019-06)
    The goal of cancer screening is to detect presymptomatic disease and commence treatment sooner, thereby reducing the incidence of advanced disease and the associated morbidity and mortality1. Challenges exist around designing, managing and evaluating national screening strategies. Programs require clear governance, reporting structures, accountability and regular appraisal of staff. The Scally report highlighted the vital role Public health expertise should play in delivering and integrating these services along with managing the flow of patient information between the National Cancer Control Programme and the National Cancer Registry2. All screening programmes must have a robust Quality Assurance (QA) process and be able to conduct audit effectively1.
  • Surgical Parathyroidectomy Services

    Burke, E; Waris, A; O’Donoghue, G (Irish Medical Journal, 2019-04)
    Retrospectively audit our experience with surgical parathyroidectomy over a 5 year period from the beginning of 2013 to June 2018.
  • Use of “Months of the Year Backwards” (MOTYB) as a Screening Tool for Delirium in Palliative Care Patients in the Acute Hospital Setting

    Ryan, S; Hayes, D; Creedon, B; University Hospital Waterford (Irish Medical Journal, 2018-09)
    Delirium is common in palliative care. It effects up to 88% of patients with advanced cancer at end of life and has a point prevalence of 20% in the acute hospital setting across all diagnoses. It is under diagnosed and not optimally treated. “Months of the Year Backwards” (MOTYB) is an ideal screening tool for delirium with a sensitivity of 83.8%. It is brief to perform and carries low burden for patients. The aim of this study is to investigate the use of MOTYB as a screening tool for delirium in palliative care patients in the acute hospital setting.
  • Safety Incident Management Team Report for NIMLT Case 50796

    Health Service Executive (Health Service Executive (HSE), 2017-01-17)
    This is a report on the management of a patient safety incident involving BowelScreen and symptomatic colonoscopy services at Wexford General Hospital (WGH). The patient safety incident relates to the work of a Consultant Endoscopist (referred to as Clinician Y) employed by WGH who undertook screening colonoscopies on behalf of the BowelScreen Programme since the commencement of the screening programme in WGH in March 2013. Clinician Y also performed non-screening colonoscopies for the diagnosis of symptomatic patients as part of routine surgical service provision at WGH. The management of the patient safety incident was in accordance with the HSE Safety Incident Management Policy with particular reference to the HSE Guidelines for the Implementation a Look-back Review Process in the HSE (1-3).
  • Rapid identification and antimicrobial susceptibility testing of positive blood cultures using MALDI-TOF MS and a modification of the standardised disc diffusion test: a pilot study.

    Fitzgerald, C; Stapleton, P; Phelan, E; Mulhare, P; Carey, B; Hickey, M; Lynch, B; Doyle, M; Microbiology Laboratory, University Hospital Waterford, Waterford, Ireland. (BMJ, 2016-04-27)
    In an era when clinical microbiology laboratories are under increasing financial pressure, there is a need for inexpensive, yet effective, rapid microbiology tests. The aim of this study was to evaluate a novel modification of standard methodology for the identification and antimicrobial susceptibility testing (AST) of pathogens in positive blood cultures, reducing the turnaround time of laboratory results by 24 h.
  • Managing pain in the older person in the community

    Molloy, Niamh (Nursing in General Practice, 2015-03)
    Eff ective pain management remains a challenge in modern day clinical practice. Managing persistent pain in the older adult encounters many challenges and the management of chronic pain in the community demands a comprehensive understanding of the physiology of pain and pain processing as well as an understanding of the various assessment tools available and methods to manage pain. it is essential before treating pain that it is assessed using a recognised pain assessment tool that is valid, reliable and comprehensive. in essence, a holistic approach is required with all aspects of the biopsychosocial model considered.
  • The effectiveness of a stratified group intervention using the STarTBack screening tool in patients with LBP - a non randomised controlled trial

    Murphy, Susan E; Blake, Catherine; Power, Camillus K; Fullen, Brona M (BMC Musculoskeletal Disorders, 2013)
  • An Irish breast cancer survivorship study: are we meeting our patients' needs?

    Naidoo, J; Hayes, E; Teo, MY; Horgan, A; Calvert, P; O’Connor, M (Irish Medical Journal (IMJ), 2013-10)
    Irish breast cancer survivors' needs have not been studied. Physical, psychological, social and spiritual concerns were investigated. Patient satisfaction with hospital discharge, GP follow-up, and the benefit of a discharge pack was investigated. A cohort of patients from the South East Cancer Centre was identified. Inclusion criteria: localized breast cancer, completion of adjuvant therapy, GP-led follow-up in the last 5 years. An anonymous questionnaire was developed, and ethical approval obtained. Subgroup analyses for age and time since diagnosis and discharge were completed. 80 patients were identified. 44 patients (55%) completed the questionnaire, 5 (6%) were excluded. Commonest concerns included: fatigue (51%), fear of recurrence (69%) and second cancers concerns (69%.) 23 (59%) and 25 patients (64%) were satisfied with discharge and GP follow-up respectively. 27 patients (67%) reported benefit from a discharge pack. Irish breast cancer survivors had concerns, and were satisfied with GP follow-up.
  • Should patients with extrapulmonary small-cell carcinoma receive prophylactic cranial irradiation?

    Naidoo, Jarushka; Teo, Min Yuen; Deady, Sandra; Comber, Harry; Calvert, Paula; * Department of Medical Oncology, Waterford Regional Hospital, Waterford, Ireland; †Department of Medical Oncology, The Adelaide and Meath Hospital Tallaght, Dublin, Ireland; and ‡Department of Research and Data Analysis, National Cancer Registry of Ireland, Cork, Ireland. (2013-09)
    Extrapulmonary small-cell carcinoma (EPSCC) is a rare disease. Management is based on small-cell lung carcinoma. Prophylactic cranial irradiation (PCI) is not routinely administered in EPSCC. This study investigates the role of PCI in EPSCC, by analyzing the incidence, treatment, and survival of patients with brain metastases in a national cohort. Disease biology and epidemiology are also investigated.
  • Cost burden of non-specific chest pain admissions.

    Groarke, J; O'Brien, J; Go, G; Susanto, M; Owens, P; Maree, A O; Department of Cardiology, Waterford Regional Hospital, Waterford, Ireland. (2013-03)
    Non-cardiac aetiologies are common among patients presenting with chest pain.
  • Identification of patients with low-risk pulmonary embolism suitable for outpatient treatment using the pulmonary embolism severity index (PESI).

    McCabe, A; Hassan, T; Doyle, M; McCann, B; Emergency Department, Waterford Regional Hospital, Dunmore East Road, Waterford, Ireland. (2013-06)
    There is increasing evidence that outpatient treatment of patients with low-risk stable pulmonary embolism (PE) is safe, effective and potentially reduces costs. It is not clear how many patients presenting to an Irish Emergency Department (ED) are potentially suitable for outpatient management.
  • A case of pelvic actinomycosis with bilateral hydronephrosis and renal failure associated with prolonged intrauterine contraceptive systems use.

    Ugezu, C H; Kelly, I; Walker, F; Stratton, J F; Department of Obstetrics and Gynaecology, Waterford Regional Hospital, Ireland. (2012-05)

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