• Acute simultaneous bilateral avulsion fractures of the tibial tubercles in a 15-year-old male hurler: case report and literature review.

      Hanley, C; Roche, S J; Chhabra, J; Department of Trauma and Orthopaedics, Waterford Regional Hospital, Waterford,, Ireland. (2012-02-01)
      BACKGROUND: Avulsion fractures of the tibial tubercle are an unusual injury pattern generally occurring in the adolescent male during sporting activities. Bilateral simultaneous fractures are extremely rare. They are often associated with other underlying orthopaedic pathology. AIMS: We present a case of bilateral tibial tubercle avulsions occurring in a 15 year-old male hurler. We describe the management and necessary investigations required for this type of trauma and present a literature review on this rarely encountered injury. CONCLUSION: Although this type of atypical fracture pattern is associated with high energy trauma and other underlying pathology, we have shown that once treated, the patient can expect to make a prompt return to sporting activities with no significant long-term functional deficit.
    • Acute sixth nerve palsy in a young man, beware of the 'red herring'.

      O'Neill, E C; Connell, P P; Kadare, S; Tormey, P T; Ophthalmology Department, Waterford Regional Hospital, Waterford, Ireland., evelynoneill@yahoo.com (2012-02-01)
      BACKGROUND: Cranial nerve palsies has several etiologies including vascular insufficiency, neoplasm, trauma and inflammation. Isolated sixth nerve palsy is an extremely rare presenting feature of leukemia. AIM: We describe an unusual ocular presentation of a bilateral progressive sixth nerve palsy in a young male with a preceding head injury. CONCLUSION: Acquired sixth nerve palsies in young adults may be due to trauma but in the absence of a definitive history other systemic processes must be outruled. We describe a case of bilateral sixth nerve palsy in a patient with ALL with no obvious CNS involvement. Potential etiological mechanisms are discussed.
    • Acutrak versus Herbert screw fixation for scaphoid non-union and delayed union.

      Oduwole, Kayode O; Cichy, Benedikt; Dillon, John P; Wilson, Joan; O'Beirne, John; Departments of Orthopaedic Surgery, Waterford Regional Hospital, Waterford, Ireland. odukayolajide@yahoo.com (2012-04)
      To compare the treatment outcome of Acutrak versus Herbert screw fixation for scaphoid non-union and delayed union.
    • Arts and health-an intercultural marriage

      Grehan, Mary (Helsinki Metropolia University of Applied Sciences, 2012-10-22)
    • Atypical femoral neck stress fracture in a marathon runner: a case report and literature review.

      Department of Trauma and Orthopaedics, Waterford Regional Hospital, Co Waterford,, Ireland. (2012-02-01)
      BACKGROUND: Femoral neck stress fractures are relatively rare and may present as sports-related injuries. The presentation is variable, and prompt diagnosis facilitates the earliest return to pre-morbid functional activity levels. Delayed detection may precipitate femoral non-union or avascular necrosis, resulting in long-term functional deficit. AIMS: We present the case of a basicervical femoral neck stress fracture occurring in a 23-year-old marathon runner. The pathophysiology and practical management issues related to this unusual injury pattern are discussed. CONCLUSION: The growing interest in amateur athletic activities should raise the index of suspicion for stress fractures of the femoral neck in healthy adults with atypical hip pain. Increased levels of patient education and physician awareness can reduce the incidence of long-term morbidity in cases of this unusual sports-related injury.
    • An audit of current practice and management of metastatic spinal cord compression at a regional cancer centre.

      Sui, J; Fleming, J S; Kehoe, M; Waterford Regional Hospital, Dunmore Road, Waterford. slsui@yahoo.com (2012-02-01)
      Metastatic spinal cord compression (MSCC) is an oncological emergency requiring prompt recognition and management to preserve neurological function and mobility. We performed an audit to assess current practice of MSCC against current best practice as outlined by NICE. Our retrospective audit identified 10 patients from January to December 2009 with confirmed MSCC. The most common primary tumours were prostate 3 (30%), breast 3 (30%) and lung 2 (20%). Pain was the main presenting symptom 9 (90%), followed by weakness 7 (70%) and sensory changes 1 (10%). 5 (50%) had MRI within 24 hours and only 6 (60%) underwent full MRI scan. 8 (80%) had corticosteroids before MRI scan. 6 (60%) received radiotherapy within 24 hours. Only 4 (40%) were referred to orthopaedics and none of these patients had been recommended surgery. Up 14 days following radiological confirmation of MSCC, the number of patients who were unable to walk increased by 20%. Only 5 (50%) were discharged during this period of study. Our audit reported a number of variances in management compared to NICE guideline. These can be improved by following a'fast track' referral pathway and regular education for junior doctors and primary care doctors.
    • "Between the jigs and the reels": bilateral metatarsal phalangeal stress fractures in a young Irish dancer.

      O'Halloran, Emily; Vioreanu, Mihai; Padinjarathala, Benny; Department of Trauma & Orthopaedic Surgery, Waterford Regional Hospital,, Waterford, Republic of Ireland. ohalloranemily@gmail.com (2012-02-01)
    • 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. chugez031070@yahoo.co.uk (2012-05)
    • Changes in intraocular pressure and anterior segment morphometry after uneventful phacoemulsification cataract surgery.

      Dooley, I; Charalampidou, S; Malik, A; Loughman, J; Molloy, L; Beatty, S; Department of Ophthalmology, Waterford Regional Hospital, Waterford, Ireland., iandooley@eustace.net (2012-02-01)
      PURPOSE: To study changes in anterior segment morphometry after uneventful phacoemulsification cataract surgery, and to investigate whether there is a relationship between any observed changes and intraocular pressure (IOP) reduction after the procedure. METHODS: The anterior chamber depth (ACD), anterior chamber volume (ACV), anterior chamber angle (ACA), central corneal thickness (CCT), and IOP were measured in 101 non-glaucomatous eyes before and after uneventful phacoemulsification cataract surgery. RESULTS: After cataract surgery, the mean ACD, ACV, and ACA values increased by 1.08 mm, 54.4 mm(3), and 13.1 degrees , respectively, and the mean IOP (corrected for CCT) decreased by 3.2 mm Hg. The predictive value of a previously described index (preoperative ACD/preoperative IOP (corrected for CCT) or CPD ratio) for IOP (corrected for CCT) reduction after cataract surgery was confirmed, reflected in an r(2) value of 23.3% between these two parameters (P<0.001). Other indices predictive of IOP reduction after cataract surgery were also identified, including preoperative IOP/preoperative ACV and preoperative IOP/preoperative ACA, reflected in r(2) values of 13.7 and 13.7%, respectively (P<0.001 and P<0.001, respectively). CONCLUSIONS: Our study confirms the predictive value of the CPD ratio for IOP reduction after cataract surgery, and may contribute to the decision-making process in patients with glaucoma or ocular hypertension. Furthermore, two novel indices of preoperative parameters that are predictive for IOP reduction after cataract surgery were identified, and enhance our understanding of the mechanisms underlying IOP changes after this procedure.
    • A comparative study of renal dysfunction in patients with inflammatory arthropathies: strong association with cardiovascular diseases and not with anti-rheumatic therapies, inflammatory markers or duration of arthritis.

      Haroon, Muhammad; Adeeb, Fahd; Devlin, Joe; O Gradaigh, Donncha; Walker, Frank; Department of Rheumatology, Waterford Regional Hospital, Waterford, Ireland., mharoon301@hotmail.com (2012-02-01)
      AIMS: The aim of this study was to investigate the prevalence of chronic kidney disease (CKD) among comparable patients with rheumatoid arthritis (RA) and seronegative inflammatory arthritis, and to explore any predictive factors for renal impairment. METHODS: Consecutive patients with peripheral joint disease (oligo and polyarthritis) were recruited from our inflammatory arthritis clinics. We divided patients in two groups: RA group and seronegative inflammatory arthritis group. The cohort consisted of 183 patients (RA = 107, seronegative arthritis = 76 [psoriatic arthritis = 69, undifferentiated oligoarthritis = 7]). Estimated glomerular filtration rate (eGFR) was calculated using the established Modification of Diet in Renal Disease equation. Demographic details, disease-specific characteristics, anti-rheumatic drugs and the presence of cardiovascular diseases were recorded. RESULTS: In total, 17.48% (n = 32) of the cohort had CKD. There was no statistically significant variation between the two groups as regards baseline demographics, disease characteristics, use of anti-rheumatic drugs and the presence of individual cardiovascular diseases. We found that eGFR and the presence of CKD were similar among these groups. Among patients with CKD, 72% had undiagnosed CKD. No association of statistical significance was noted between CKD and the use of corticosteroids, disease-modifying antirheumatic drugs and anti-tumor necrosis factor agents. The association of cardiovascular diseases with CKD remained significant after adjusting for confounders (age, gender, duration of arthritis, high C-reactive protein, use of anti-rheumatic drugs). CONCLUSIONS: Patients with inflammatory arthritis are more prone to have CKD. This could have serious implications, as the majority of rheumatology patients use non-steroidal anti-inflammatory drugs and different immunosuppressives, such as methotrexate. No association of kidney dysfunction was noted with inflammatory disease-specific characteristics; rather it appears to have a positive independent association with cardiovascular diseases.
    • Coping with uncertainty: T1a,bN0M0 HER2-positive breast cancer, do we have a treatment threshold?

      Kelly, C M; Pritchard, K I; Trudeau, M; Andreopoulou, E; Hess, K; Pusztai, L; Department of Medical Oncology, Waterford Regional Hospital, Dunmore Road,, Waterford, Ireland. catherine.kelly@ucd.ie (2012-02-01)
      BACKGROUND: Recent retrospective studies have suggested that patients with T1a,bN0M0 human epidermal growth factor receptor 2 (HER2)-positive breast cancer are at a higher risk for recurrence and might benefit from adjuvant trastuzumab. The absolute benefits associated with treating this subgroup are uncertain. Design: We reviewed recent studies examining the prognostic value of HER2 in patients with node-negative T1a,b HER2-positive breast cancer. We calculated the number needed to treat (NNT) using baseline risk estimates for untreated T1a,bN0M0 breast cancer and the number needed to harm (NNH) using the incidence of cardiac events in each of the adjuvant trastuzumab clinical trials. RESULTS: Several studies were identified, each with limitations inherent to retrospective database analyses: small cohort sizes, lack of systematic HER2 testing in older specimens, variations in the use of adjuvant therapy and definitions of study end points, and lack of information relating to comorbidities. The 5-year disease-free survival in the pre-trastuzumab era ranged from 77% to 95%. Comparisons between small HER2 -positive and small HER2 -negative cancers showed numerically worse outcome for the HER2-positive cohort in some but not all studies. In many instances, the NNH was larger (26-250) than the NNT (13-35); however, in a subset of patients, the NNH was lower (6) than the NNT (13-35). CONCLUSIONS: Better prediction tools to estimate more precisely the risk for death due to comorbid illness versus breast cancer are needed. In some patients, the risks of therapy could outweigh the benefits. Treatment selection for T1a,bN0 HER2-positive cancers remains in the transition area between evidence- and subjective judgment-based medicine.
    • 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. johngroarke1@eircom.net (2013-03)
      Non-cardiac aetiologies are common among patients presenting with chest pain.
    • A critical evaluation of Web sites offering patient information on tinnitus.

      Kieran, Stephen M; Skinner, Liam J; Donnelly, Martin; Smyth, David A; Department of Otolaryngology, Head and Neck Surgery, Waterford Regional Hospital,, Co. Waterford, Ireland. skieran@rcsi.ie (2012-02-01)
      The Internet is a vast information resource for both patients and healthcare professionals. However, the quality and content often lack formal scrutiny, so we examined the quality of patient information regarding tinnitus on the Internet. Using the three most popular search engines (google.com, yahoo.com, and msn.com), we found pertinent Web sites using the search term tinnitus. Web sites' accountability and authorship were evaluated using previously published criteria. The quality of patient information about tinnitus was assessed using a new 10-point scale, the Tinnitus Information Value (TIV). Statistical analysis was performed using the independent sample t-test (p
    • Cystic fibrosis transmembrane conductance regulator intracellular processing, trafficking, and opportunities for mutation-specific treatment.

      Rogan, Mark P; Stoltz, David A; Hornick, Douglas B; Department of Respiratory Medicine, Waterford Regional Hospital, Waterford,, Ireland. (2012-02-01)
      Recent advances in basic science have greatly expanded our understanding of the cystic fibrosis (CF) transmembrane conductance regulator (CFTR), the chloride and bicarbonate channel that is encoded by the gene, which is mutated in patients with CF. We review the structure, function, biosynthetic processing, and intracellular trafficking of CFTR and discuss the five classes of mutations and their impact on the CF phenotype. The therapeutic discussion is focused on the significant progress toward CFTR mutation-specific therapies. We review the results of encouraging clinical trials examining orally administered therapeutics, including agents that promote read-through of class I mutations (premature termination codons); correctors, which overcome the CFTR misfolding that characterizes the common class II mutation F508del; and potentiators, which enhance the function of class III or IV mutated CFTR at the plasma membrane. Long-term outcomes from successful mutation-specific treatments could finally answer the question that has been lingering since and even before the CFTR gene discovery: Will therapies that specifically restore CFTR-mediated chloride secretion slow or arrest the deleterious cascade of events leading to chronic infection, bronchiectasis, and end-stage lung disease?
    • Ectopic pituitary adenoma presenting as midline nasopharyngeal mass.

      Ali, R; Noma, U; Jansen, M; Smyth, D; Department of Otolaryngology, Waterford Regional Hospital, Dunmore Road,, Waterford, Ireland. rohana.oconnell@gmail.com (2012-02-01)
      INTRODUCTION: Ectopic pituitary adenomas are extremely rare. We report a case of ectopic pituitary adenoma in the midline of the nasopharynx. This adenoma probably arose from the pharyngeal remnant of Rathke's pouch. METHODS: We discuss a case of a lady who presented to our unit with 2 months history of dryness and sensation of lump in her throat and a long standing history of hypothyroidism. Examination of nasopharynx revealed a smooth and fluctuant midline mass. CT scan of nose and paranasal sinuses confirmed the midline mass with small defect communicating with the sphenoid sinus. An initial diagnosis of Thornwaldt's cyst was made and she underwent upper aerodigestive tract endoscopy and marsupialization of the mass. Histopathological examination revealed ectopic pituitary adenoma. CONCLUSION: Ectopic pituitary adenoma is an important differential diagnosis for a midline nasopharyngeal mass. It is recommended that prior to surgical resection of midline nasopharyngeal mass biopsy is taken and MRI is performed.
    • Efficacy and safety of combining intra-articular methylprednisolone and anti-TNF agent to achieve prolonged remission in patients with recurrent inflammatory monoarthritis.

      Haroon, Muhammad; O'Gradaigh, Donncha; Department of Rheumatology, Waterford Regional Hospital, Waterford, Ireland., mharoon301@hotmail.com (2012-02-01)
      OBJECTIVE: To control local inflammation, the role of intra-articular corticosteroid is well established; similarly, with time there are more reports on the experience of intra-articular anti-TNF agent for localized joint inflammation. The aim of this study was to assess the safety, local tolerability and clinical response after combining intra-articular administration of corticosteroids and anti-TNF agents for recurrent inflammatory monoarthritis. METHODS: Patients with recurrent monoarthritis of the knee were recruited from our inflammatory arthritis clinics. These patients required intra-articular corticosteroids every 8-12 weeks, with good short-term results. Five such consecutive patients were invited to partake in this study. Patients were maintained on their baseline immunosuppressive therapy. After aspiration of knee joint, the involved joint was injected with 80mg of methylprednisolone mixed with 5ml of lignocaine 1%; this was followed by the injection of an anti-TNF agent. RESULTS: In majority of our patients (three out of five), combining anti-TNF agent and methylprednisolone led to prolonged anti-inflammatory response, and these patients remain in remission to date (mean follow-up of 12 months). These responders were noted to be naive to anti-TNF therapy. Conversely, the remaining two patients were found to be on baseline systemic anti-TNF therapy, and both of them failed to respond either partly or completely. CONCLUSION: Combining intra-articular corticosteroid and anti-TNF agent has proved to be safe in our cohort of patients. We conclude that in particular subset of patients who suffer from recurrent inflammatory monoarthritis or oligoarthritis, combination therapy of intra-articular corticosteroids and anti-TNF agents appears attractive and promising.
    • Estimation of effective lens position using a method independent of preoperative keratometry readings.

      Dooley, Ian; Charalampidou, Sofia; Nolan, John; Loughman, James; Molloy, Laura; Beatty, Stephen; Department of Ophthalmology, Waterford Regional Hospital, Institute of Eye, Surgery, Dublin, Ireland. iandooley@eustace.net (2012-02-01)
      PURPOSE: To evaluate the validity of a keratometry (K)-independent method of estimating effective lens position (ELP) before phacoemulsification cataract surgery. SETTING: Institute of Eye Surgery, Whitfield Clinic, Waterford, Ireland. DESIGN: Evaluation of diagnostic test or technology. METHODS: The anterior chamber diameter and corneal height in eyes scheduled for cataract surgery were measured with a rotating Scheimpflug camera. Corneal height and anterior chamber diameter were used to estimate the ELP in a K-independent method (using the SRK/T [ELP(rs)] and Holladay 1 [ELP(rh)] formulas). RESULTS: The mean ELP was calculated using the traditional (mean ELP(s) 5.59 mm +/- 0.52 mm [SD]; mean ELP(h) 5.63 +/- 0.42 mm) and K-independent (mean ELP(rs) 5.55 +/- 0.42 mm; mean ELP(rh) +/- SD 5.60 +/- 0.36 mm) methods. Agreement between ELP(s) and ELP(rs) and between ELP(h) and ELP(rh) were represented by Bland-Altman plots, with mean differences (+/- 1.96 SD) of 0.06 +/- 0.65 mm (range -0.59 to +0.71 mm; P=.08) in association with ELP(rs) and -0.04 +/- 0.39 mm (range -0.43 to +0.35 mm; P=.08) in association with ELP(rh). The mean absolute error for ELP(s) versus ELP(rs) estimation and for ELP(h) versus ELP(rh) estimation was 0.242 +/- 0.222 mm (range 0.001 to 1.272 mm) and 0.152 +/- 0.137 mm (range 0.001 to 0.814 mm), respectively. CONCLUSION: This study confirms that the K-independent ELP estimation method is comparable to traditional K-dependent methods and may be useful in post-refractive surgery patients.
    • Estimation of effective lens position using a method independent of preoperative keratometry readings.

      Dooley, Ian; Charalampidou, Sofia; Nolan, John; Loughman, James; Molloy, Laura; Beatty, Stephen; Department of Ophthalmology, Waterford Regional Hospital, Institute of Eye Surgery, Dublin, Ireland. iandooley@eustace.net (2011-03)
      This study confirms that the K-independent ELP estimation method is comparable to traditional K-dependent methods and may be useful in post-refractive surgery patients.