• 2016 WSES guidelines on acute calculous cholecystitis.

      Ansaloni, L; Pisano, M; Coccolini, F; Peitzmann, A B; Fingerhut, A; Catena, F; Agresta, F; Allegri, A; Bailey, I; Balogh, Z J; et al. (World journal of emergency surgery : WJES, 2016)
      Acute calculus cholecystitis is a very common disease with several area of uncertainty. The World Society of Emergency Surgery developed extensive guidelines in order to cover grey areas. The diagnostic criteria, the antimicrobial therapy, the evaluation of associated common bile duct stones, the identification of "high risk" patients, the surgical timing, the type of surgery, and the alternatives to surgery are discussed. Moreover the algorithm is proposed: as soon as diagnosis is made and after the evaluation of choledocholitiasis risk, laparoscopic cholecystectomy should be offered to all patients exception of those with high risk of morbidity or mortality. These Guidelines must be considered as an adjunctive tool for decision but they are not substitute of the clinical judgement for the individual patient.
    • 2017 update of the WSES guidelines for emergency repair of complicated abdominal wall hernias.

      Birindelli, Arianna; Sartelli, Massimo; Di Saverio, Salomone; Coccolini, Federico; Ansaloni, Luca; van Ramshorst, Gabrielle H; Campanelli, Giampiero; Khokha, Vladimir; Moore, Ernest E; Peitzman, Andrew; et al. (BioMed Central, 2017)
      Emergency repair of complicated abdominal wall hernias may be associated with worsen outcome and a significant rate of postoperative complications. There is no consensus on management of complicated abdominal hernias. The main matter of debate is about the use of mesh in case of intestinal resection and the type of mesh to be used. Wound infection is the most common complication encountered and represents an immense burden especially in the presence of a mesh. The recurrence rate is an important topic that influences the final outcome. A World Society of Emergency Surgery (WSES) Consensus Conference was held in Bergamo in July 2013 with the aim to define recommendations for emergency repair of abdominal wall hernias in adults. This document represents the executive summary of the consensus conference approved by a WSES expert panel. In 2016, the guidelines have been revised and updated according to the most recent available literature.
    • Adult ileocolic intussusception secondary to ileocaecal valve polyp.

      Chugthai, Saqib Zeeshan; Atif, Abdul Hakeem; Chughtai, Jehan Zeb; Miptah, Najaa Hayatul; Couse, Neville; Letterkenny General Hospital, Surgery, 135 Foxhills, Letterkenny, County Donegal,, Ireland. (2012-01-31)
      Intussusception is relatively common in children, but it is a rare cause of abdominal pain and intestinal obstruction in adults. The aetiology, clinical presentation and management of this condition differs in adults and children. Preoperative clinical diagnosis is usually difficult due to the non-specific and intermittent nature of the symptoms. Ultrasound and computed tomography can be helpful in establishing the diagnosis. We present a case of adult ileocolic intussusception with classical radiological signs and operative findings. In adults the diagnosis of intussusception should be considered in a case of intermittent abdominal pain, especially with clinical signs of intermittent bowel obstruction.
    • Angioembolization for pelvic fractures.

      Letterkenny General Hospital, Letterkenny, Ireland. (2012-01-31)
    • Avascular necrosis of femoral heads post-adrenal surgery for Cushing's syndrome: a rare presentation.

      Letterkenny General Hospital, Letterkenny, Co. Donegal, Ireland,, modelian@gmail.com. (2012-01-31)
      Avascular necrosis (AVN) is a well-recognized complication of patients on high-dose steroids for a long time. Exogenous hypercortisolism is a well known cause of AVN and a number of cases have been reported. Cushing's syndrome describes hypercortisolism of any cause endogenous or exogenous. A variety of traumatic and non-traumatic factors contribute to the aetiology of AVN although exogenous glucocorticoids administration and alcoholism are among the most common non-traumatic causes. AVN secondary to endogenous hypercortisolism is rare and very few case reports are available describing this complication. No literature is available on AVN presenting post-adrenal surgery. Here we present a young woman who presented with avascular necrosis of both hips 1 year after adrenalectomy for Cushing's syndrome.
    • Breast cancer risk assessment and screening - Is it a persistent problem in a rural population?

      Johnston, Alison; Neary, Shane; Sugrue, Michael; Department of Breast Surgery, Breast Centre North West, Letterkenny University Hospital, Donegal Clinical Research Academy, Ireland (Remedy Publications LLC, 2017-08-09)
      Trend analysis of breast screening uptake in those meeting screening criteria that were newly diagnosed with breast cancer. Retrospective review of all breast cancer patients diagnosed between 2010 and 2014. Patients’ demographics, screening, risk assessment, pathological stages and surgical treatment utilization were recorded. 150 patients, mean ages 55.4 ± 10.2 years (range 29–90), were studied. Overall 65/150 (43.3%) had optimal screening pre cancer diagnosis and 85/150 (56.7%) suboptimal. The trend in optimal screening improved from 30% to 60% over the study period. The mean overall tumour size (excluding DCIS patients) in 131 patients was 32.8 mm; 26.9 mm in optimally and 38.5 mm in the suboptimally screened groups (p = 0.06 x2 df8). 113/150 (75.3%) diagnosed with early stage breast cancer and 37/150 (24.7%) late stage. Principally late stage at diagnosis was within the group with suboptimal screening; 100%, 100%, 63.6%, 75% and 60% respectively for years 2010–2014. This study identified improving trends in compliance with international screening and risk assessment guidelines. Failure to screen results in more advanced disease; further public health measures to engage appropriate screening may improve stage at presentation and breast cancer outcomes.
    • The Centricity Score: A Novel Measurement to Aid in Conservative Breast Cancer Surgery

      Sugrue, Ryan; McGowan, Katherine; McNamara, Cillian; Sugrue, Michael (Advances in Breast Cancer Research, 2014-10)
      Introduction: This study describes an intra-operative scoring system to advise the surgeon of the centricity of the tumour in the excised specimen. Methods: Spatial estimations were prospectively made in 10 consecutive patients undergoing wide local excision (WLE) using Bioptics intra-operative digital specimen imaging. The centricity score was defined as 100 – (ICD/SD × 100), where ICD is the inter-centre distance between the specimen’s centre and the tumour’s centre. Results: 10 patients with invasive breast cancer (T1b to T4a), mean age 56 years (range 44 - 71) were studied. The mean tumour and specimen diameter was 24 mm ± 10 (range 12 - 48) and 101 mm ± 22 (range 64 - 140). The mean centricity score was 86 ± 9 (range 65 - 95). Conclusion: This study successfully describes an intraoperative radiological spatial scoring system for patients undergoing WLE. Tumours were well centered in specimens with an overall score of 86/100. The centricity score could be used to guide excision and potentially set benchmarks for conservative breast surgery.
    • Cigarette use and cardiovascular risk in chronic kidney disease: an unappreciated modifiable lifestyle risk factor.

      Stack, Austin G; Murthy, Bhamidipati V R; Regional Kidney Centre, Department of Medicine, Letterkenny General Hospital,, Health Services Executive, County Donegal, Ireland. austin.stack@hse.ie (2012-01-31)
      Tobacco use is a major modifiable cardiovascular risk factor in the general population and contributes to excess cardiovascular risk. Emerging evidence from large-scale observational studies suggests that continued tobacco use is also an independent cardiovascular risk factor among patients with chronic kidney disease (CKD). The benefits of smoking cessation programs on improving the heath status of patients and reducing mortality are unequivocal in the general population. Despite this, there has been little effort in pursuing tobacco cessation programs in dialysis cohorts or those with lesser degrees of kidney impairment. Most of our attention to date has focused on the development of "kidney-specific" interventions that reduce rates of renal disease progression and improve dialysis outcomes. The purpose of this current review is to describe the epidemiology of tobacco use among patients with CKD, draw attention to its negative impact on cardiovascular morbidity and mortality, and finally highlight potential strategies for successful intervention. We hope that this study heightens the importance of tobacco use in CKD, stimulates renewed interest in the barriers and challenges that exist in achieving smoking cessation, and endorses the efficacy of intervention strategies and the immeasurable benefits of quitting on cardiovascular and noncardiovascular outcomes.
    • Combined Patients and Medical Related Cosmetic Breast Cancer Outcomes—A Preferred Approach to Outcomes Assessment

      Sugrue, Michael; Johnston, Alison; Degnim, Amy; Rubio, Isabel T.; Van den Tol, M. Petrouska; Djohan, Risal; Valentine, Mark; Mac Gregor, Geraldine; 1. Breast Centre North West, Letterkenny University Hospital, Donegal, Ireland 2. Donegal Clinical Research Academy, Donegal, Ireland. 3. Mayo Clinic, Rochester, NY, USA. 4. Vall d’Hebron Hospital Universitario, Barcelona, Spain. 5&6 University Medical Centre, Amsterdam, Netherlands (Advances in Breast Cancer Research, 2018-12)
      Introduction: Reducing positive margins and need for re-excision yet maintaining cosmesis is key in breast cancer surgery. This study describes the evaluation of early outcomes of a combined cosmetic assessment programme following breast conservation surgery (BCS). Methods: An ethically approved prospective study was conducted at Letterkenny University Hospital and a 15-month timeframe was chosen. All consecutive patients undergoing conservative breast surgery with complete local excision, from July 2015 to October 2016, were entered into the study. Patients undergoing mastectomy and reconstruction with either implant or autologous tissue were not included. 41 patients undergoing BCS were analysed. Objective and subjective cosmetic evaluations were carried out. Assessments used were the Breast Cancer Conservative Treatment—cosmetic results [BCCT.core 2.0] Software, a panel of 4 experts in breast surgery and the Breast Cancer Treatment Outcome Scale (BCTOS). Demographic and pathological data, breast excision weight, % breast volume excised (BVE), margin positivity, complications and re-excision were documented. Data was expressed as mean and standard deviation for normally distributed data and medians and inter quartile range for non-normal data. Scores were also dichotomised to excellent/good and fair/poor and results were analysed. Results: 41 patients’ mean age is 55 ± 13 years. Mean breast volume was 768.3 cm3 ± 440; BVE weighed 78.6g ± 42.6 (18.9 - 214.4) and %BVE 11.3% ± 5.2% (5.1 - 23.3). Re-excision rate was 2/41 (4.9%) all for positive margins. 0/41 infections or haematomas occurred.
    • Community-based health efforts for the prevention of falls in the elderly.

      Hanley, Alan; Silke, Carmel; Murphy, John; Department of Medicine, Letterkenny General Hospital, Letterkenny, Co Donegal,, Ireland. alan.hanley@gmail.com (2012-01-31)
      Falls are a major public health problem in the elderly population. The associated health care cost is great. It has therefore become an important public health matter to evaluate those interventions that might be effective in reducing the risk of falls. Risk factors that predict an increased risk of falling are described. We discuss interventions that can be employed in the community to reduce the risk of falls and associated injuries by discipline, including physiotherapy, occupational therapy, and physician-led interventions. We also discuss the cost-effectiveness of such interventions.
    • Compression fractures of the vertebrae during a "bumpy" boat ride.

      Chukwunyerenwa, C K; O'Rourke, P; Orthopaedic Unit, Letterkenny General Hospital, Letterkenny, Co. Donegal,, Republic of Ireland. Chukwunyerenwa@yahoo.com (2012-01-31)
      INTRODUCTION: Compression fracture of the vertebrae is common, often the result of falls from height and motor vehicle accidents in the younger age groups. It can occur following minor trauma in the elderly and in those with osteoporosis. MATERIALS AND METHODS: We present an interesting case of compression fracture of the vertebral bodies occurring simultaneously in a couple during a boat ride while on holiday. One individual had fracture of the T8, while the other fractured the L1 vertebrae. Both injuries were treated conservatively with Taylor braces. CONCLUSION: We highlight one of the potential hazards of this recreational activity, and the almost identical fracture pattern in this couple.
    • European undergraduate curriculum in geriatric medicine developed using an international modified Delphi technique.

      Masud, Tahir; Blundell, Adrian; Gordon, Adam Lee; Mulpeter, Ken; Roller, Regina; Singler, Katrin; Goeldlin, Adrian; Stuck, Andreas (Oxford University Press, 2014-09)
      the rise in the number of older, frail adults necessitates that future doctors are adequately trained in the skills of geriatric medicine. Few countries have dedicated curricula in geriatric medicine at the undergraduate level. The aim of this project was to develop a consensus among geriatricians on a curriculum with the minimal requirements that a medical student should achieve by the end of medical school.
    • Evaluation of the patient generated index as a measure of quality-of-life in people with severe traumatic brain injury.

      Hogan, Mark; Nangle, Niamh; Morrison, Todd G; McGuire, Brian E; School of Psychology, National University of Ireland, Galway, Ireland. markf.hogan@hse.ie (2013)
      Quality-of-life (QoL) measures may be useful in quantifying the personal impact of an acquired brain injury and as an indicator of the effectiveness of service provision. This study investigated the validity of the patient generated index (PGI) as a measure of QoL with a sample of adults who had sustained a severe traumatic brain injury.
    • Exercise and limitations in physical activity levels among new dialysis patients in the United States: an epidemiologic study.

      Stack, Austin G; Murthy, Bhamidipati; Regional Kidney Center, Department of Medicine, Letterkenny General Hospital, Health Services Executive (HSE) West, Letterkenny, County Donegal, Ireland. Austin.Stack@hse.ie (Annals of epidemiology, 2008-12)
      Epidemiologic studies of physical activity among patients with end-stage renal disease (ESRD) are lacking. The aim of this study was to describe the patterns of physical activity among new dialysis patients in the United States.
    • Failure to engage in breast screening and risk assessment results in more advanced stage at diagnosis

      Johnston, Alison; Curran, Sharon; Sugrue, Michael (Scientific Research Publishing, 2015-04-09)
      Abstract Background: Although well established, population based screening and family risk assessment for breast cancer have come under increasing scrutiny. The concept of over diagnosis is increasingly cited in cancer publications. This study assessed the impact of failure to screen or risk assess patients attending with a new diagnosis of breast cancer. Methods: A retrospective review was undertaken of 200 consecutive patients diagnosed with breast cancer between January 2010 and September 2012 at Letterkenny Hospital. Appropriate screening was defined as biennial in those aged 50 - 66 and in those 40 - 49 with moderate/high family history risk (NICE criteria or IBIS criteria). Patient demographics, screening history, diagnosis date and stage (TNM) were documented. Patients with previous breast cancer were not included (n = 17). Results: 200 consecutive patients, whose mean age was 61 (range 28 - 99), were studied. 112/200 (56%) met no criteria for screening or family history assessment, and 88/200 (44%) met criteria for either screening (in 56) or family history assessment (in 32). 61/88 (69.3%) meeting criteria did not have a mammogram or risk assessment. The stage of breast cancer was significantly earlier in those screened appropriately, with early stage cancer in n = 111/139 (79.9 %) and late in n = 28/139 (20.1%), compared with 38/61 (62.3%) and 23/61 (37.7%) in those failing to be screened appropriately (p = 0.01 χ2 df1). Conclusion: Failure to engage in breast screening and risk assessment resulted in more advanced stage at diagnosis.
    • How to deal with an open abdomen?

      De Waele, Jan J; Kaplan, Mark; Sugrue, Michael; Sibaja, Pablo; Björck, Martin (Anaesthesiology intensive therapy, 2015)
      Appropriate open abdomen treatment is one of the key elements in the management of patients who require decompressive laparotomy or in whom the abdomen is left open prophylactically. Apart from fluid control and protection from external injury, fluid evacuation and facilitation of early closure are now the goals of open abdomen treatment. Abdominal negative pressure therapy has emerged as the most appropriate method to reach these goals. Especially when combined with strategies that allow progressive approximation of the fascial edges, high closure rates can be obtained. Intra-abdominal pressure measurement can be used to guide the surgical strategy and continued attention to intra-abdominal hypertension is necessary. This paper reviews recent advances as well as identifying the remaining challenges in patients requiring open abdomen treatment. The new classification system of the open abdomen is an important tool to use when comparing the efficacy of different strategies, as well as different systems of temporary abdominal closure.
    • The Impact of Chronic Obstructive Pulmonary Disease and Smoking on Mortality and Kidney Transplantation in End-Stage Kidney Disease.

      Kent, Brian D; Eltayeb, Elhadi E; Woodman, Alastair; Mutwali, Arif; Nguyen, Hoang T; Stack, Austin G; Regional Kidney Centre, Letterkenny General Hospital, Health Services Executive-West, Donegal, Ireland. (2012-09-07)
      Background: Chronic obstructive pulmonary disease (COPD) and tobacco use are leading causes of morbidity and mortality. The prevalence and clinical impact of COPD on mortality and kidney transplantation among patients who begin dialysis therapy is unclear. Methods: We explored the clinical impact of COPD and continued tobacco use on overall mortality and kidney transplantation in a national cohort study of US dialysis patients. National data on all dialysis patients (n = 769,984), incident between May 1995 and December 2004 and followed until October 31, 2006, were analyzed from the United States Renal Data System. Prevalence and period trends were determined while multivariable Cox regression evaluated relative hazard ratios (RR) for death and kidney transplantation. Results: The prevalence of COPD was 7.5% overall and increased from 6.7 to 8.1% from 1995-2004. COPD correlated significantly with older age, cardiovascular conditions, cancer, malnutrition, poor functional status, and tobacco use. Adjusted mortality risks were significantly higher for patients with COPD (RR = 1.20, 95% CI 1.18-1.21), especially among current smokers (RR = 1.28, 95% CI 1.25-1.32), and varied inversely with advancing age. In contrast, the adjusted risks of kidney transplantation were significantly lower for patients with COPD (RR = 0.47, 95% CI 0.41-0.54, for smokers and RR = 0.54, 95% CI 0.50-0.58, for non-smokers) than without COPD [RR = 0.72, 95% CI 0.70-0.75, for smokers and RR = 1.00 for non-smokers (referent category)]. Conclusions: Patients with COPD who begin dialysis therapy in the US experience higher mortality and lower rates of kidney transplantation, outcomes that are far worse among current smokers.
    • Intra-abdominal pressure and abdominal compartment syndrome in acute general surgery.

      Sugrue, Michael; Buhkari, Yasir; Department of Surgery, Letterkenny General Hospital and Galway University, Hospitals, Letterkenny, Donegal, Ireland. acstrauma@hotmail.com (2012-01-31)
      BACKGROUND: Intra-abdominal pressure (IAP) is a harbinger of intra-abdominal mischief, and its measurement is cheap, simple to perform, and reproducible. Intra-abdominal hypertension (IAH), especially grades 3 and 4 (IAP > 18 mmHg), occurs in over a third of patients and is associated with an increase in intra-abdominal sepsis, bleeding, renal failure, and death. PATIENTS AND METHODS: Increased IAP reading may provide an objective bedside stimulus for surgeons to expedite diagnostic and therapeutic work-up of critically ill patients. One of the greatest challenges surgeons and intensivists face worldwide is lack of recognition of the known association between IAH, ACS, and intra-abdominal sepsis. This lack of awareness of IAH and its progression to ACS may delay timely intervention and contribute to excessive patient resuscitation. CONCLUSIONS: All patients entering the intensive care unit (ICU) after emergency general surgery or massive fluid resuscitation should have an IAP measurement performed every 6 h. Each ICU should have guidelines relating to techniques of IAP measurement and an algorithm for management of IAH.
    • Management of chemotherapy-induced nausea and vomiting.

      Zubairi, Ishtiaq H; Letterkenny General Hospital, Letterkenny, Co Donegal, Republic of Ireland. (2006-08)
      Chemotherapy-induced nausea and vomiting are symptoms that cause major concern to oncology patients. This article explores the types of nausea and vomiting in the context of chemotherapy, and discusses their pathogenesis and management.
    • Proceedings of resources for optimal care of acute care and emergency surgery consensus summit Donegal Ireland.

      Sugrue, M; Maier, R; Moore, E E; Boermeester, M; Catena, F; Coccolini, F; Leppaniemi, A; Peitzman, A; Velmahos, G; Ansaloni, L; et al. (World Journal of Emergency Surgery, 2017-01-01)
      Opportunities to improve emergency surgery outcomes exist through guided better practice and reduced variability. Few attempts have been made to define optimal care in emergency surgery, and few clinically derived key performance indicators (KPIs) have been published. A summit was therefore convened to look at resources for optimal care of emergency surgery. The aim of the Donegal Summit was to set a platform in place to develop guidelines and KPIs in emergency surgery. The project had multidisciplinary global involvement in producing consensus statements regarding emergency surgery care in key areas, and to assess feasibility of producing KPIs that could be used to monitor process and outcome of care in the future. Forty-four key opinion leaders in emergency surgery, across 7 disciplines from 17 countries, composed evidence-based position papers on 14 key areas of emergency surgery and 112 KPIs in 20 acute conditions or emergency systems. The summit was successful in achieving position papers and KPIs in emergency surgery. While position papers were limited by non-graded evidence and non-validated KPIs, the process set a foundation for the future advancement of emergency surgery.