• Cross-sectional Analysis of the Standards of Consent Applied to Anaesthesia in Ireland: Are Anaesthetists Aware of their Legal and Ethical Obligations?

      Cafferkey A; Lyons, B (Irish Medical Journal, 2018-01)
      Consent to a medical intervention has legally and ethically evolved to a process prioritising autonomy and patient-led decision-making. This cross-sectional analysis investigated Irish anaesthetists’ practices of taking consent. Following ethical approval, trainees and fellows of the College of Anaesthetists of Ireland were invited to participate in a 33 question online survey. One hundred and sixty responses (11.8%) were received, an equal number coming from consultants and trainees. The majority (93.7%) worked in a teaching hospital. Fifteen percent said their department had guidelines on obtaining consent for anaesthesia, but only 4.5% said their department used a separate consent form. Most (63.8%) do not usually document consent. A significant number rarely (21.8%) or never (27.8%) explained risks to patients. Lack of time was identified as the most frequent barrier (77.6%), with just under half first meeting the patient in the theatre holding-bay or the anaesthetic room. Forty-one percent felt the ultimate decision regarding which anaesthetic technique is employed should usually lie with the anaesthetist alone. These results suggest a wide variation in the practice of obtaining consent for anaesthesia. Less than half deemed their practice to be adequate in this regard, while 50% were concerned about litigation stemming from inadequate consent.
    • A novel homozygous truncating GNAT1 mutation implicated in retinal degeneration.

      Carrigan, Matthew; Duignan, Emma; Humphries, Pete; Palfi, Arpad; Kenna, Paul F; Farrar, G Jane (2016-04)
      The GNAT1 gene encodes the α subunit of the rod transducin protein, a key element in the rod phototransduction cascade. Variants in GNAT1 have been implicated in stationary night-blindness in the past, but unlike other proteins in the same pathway, it has not previously been implicated in retinitis pigmentosa.
    • Ophthalmic manifestations of vitamin A and D deficiency in two autistic teenagers: case reports and a review of the literature.

      Duignan, Emma; Kenna, Paul; Watson, Rosemarie; Fitzsimon, Susan; Brosnahan, Donal (Karger Publishing, 2015-01)
      We describe the cases of 2 autistic children with ophthalmic and systemic manifestations of vitamin A deficiency due to food faddism. Although vitamin A deficiency is common in the developing world, reports in developed societies are rare. Our patients presented over a 1-year period. The patients were 14 and 13 years old at the time of presentation and were both found to have marked features of vitamin A deficiency related to unusual dietary habits. Anterior segment signs of xerophthalmia were present in both patients. In addition, patient 1 showed evidence of a rod-predominant retinopathy, which resolved with vitamin A supplementation. Due to its rare occurrence, hypovitaminosis A must be highlighted and anticipated in this cohort.
    • Lemierres syndrome: the forgotten disease

      Morariu, I; Curran, A; Killeen, RP (Irish Medical Journal, 2014-09)
      Lemierres syndrome is a rare and potentially fatal entity affecting otherwise healthy and young adults. The infection originates in the throat and spreads via a septic trombophlebitis of the internal jugular vein, with development of distant septic emboli. This clinical picture is characteristic but many clinicians are unaware of the condition and diagnosis is often delayed with potentially fatal consequences.
    • Systematic review and meta-analysis of wound drains after thyroid surgery.

      Woods, R S R; Woods, J F C; Duignan, E S; Timon, C; Department of Otolaryngology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland. (2014-04)
      Drainage after routine thyroid and parathyroid surgery remains controversial. However, there is increasing evidence from a number of randomized clinical trials (RCTs) suggesting no benefit from the use of drains.
    • Adoption of intracameral antibiotic prophylaxis of endophthalmitis following cataract surgery: update on the ESCRS Endophthalmitis Study.

      Barry, Peter; Royal Victoria Eye and Ear Hospital and St Vincent's University Hospital, Dublin, Ireland. (2014-01)
      To determine the use of intracameral cefuroxime at the end of cataract surgery since the beneficial results were first reported by the European Society of Cataract and Refractive Surgeons Endophthalmitis Study Group in 2006, 250 ophthalmic surgeons affiliated with both public and private hospitals and clinics across Europe were surveyed. The questions regarded their awareness of the results of the ESCRS endophthalmitis study and their current use or non-use of intracameral antibiotics in their cataract procedures. Seventy-four percent of respondents said they always or usually use intracameral antibiotics in their cataract surgery procedures. The most frequently cited reasons for not using cefuroxime or other intracameral antibiotics was the lack of an approved commercial preparation and related anxieties regarding the risk of dilution errors and contamination. More than 90% of respondents said they would use cefuroxime if an approved single-unit dose product were commercially available.
    • Proteomics in uveal melanoma.

      Ramasamy, Pathma; Murphy, Conor C; Clynes, Martin; Horgan, Noel; Moriarty, Paul; Tiernan, Damien; Beatty, Stephen; Kennedy, Susan; Meleady, Paula; Royal College of Surgeons Ireland, Stephen's Green, Dublin 2, Ireland; National Institute for Cellular Biotechnology, Dublin City University, Collins Avenue, Glasnevin, Dublin 9, Ireland. Electronic address: Pathma.Ramasamy@dcu.ie. (2014-01)
      Uveal melanoma is the most common primary intraocular malignancy in adults, with an incidence of 5-7 per million per year. It is associated with the development of metastasis in about 50% of cases, and 40% of patients with uveal melanoma die of metastatic disease despite successful treatment of the primary tumour. The survival rates at 5, 10 and 15 years are 65%, 50% and 45% respectively. Unlike progress made in many other areas of cancer, uveal melanoma is still poorly understood and survival rates have remained similar over the past 25 years. Recently, advances made in molecular genetics have improved our understanding of this disease and stratification of patients into low risk and high risk for developing metastasis. However, only a limited number of studies have been performed using proteomic methods. This review will give an overview of various proteomic technologies currently employed in life sciences research, and discuss proteomic studies of uveal melanoma.
    • "Tarantula keratitis": a case report.

      McAnena, L; Murphy, C; O'Connor, J; Royal Victoria Eye and Ear Hospital (RVEEH), Adelaide Road, Dublin 2, Ireland. lmcanena@yahoo.co.uk (2013-09)
      A case of an 11-year-old boy presenting with a two-week history of a red, irritated right eye after handling a Chilean Rose Tarantula at an exotic pet exhibition. Examination revealed innumerable microscopic hairs embedded at all levels of the cornea. He was commenced on steroid drops with subjective and objective improvement at follow up.
    • A method for the prescription of inexpensive spectacles by non-specialist healthcare workers: S-Glasses.

      Treacy, M P; Treacy, M G; Dimitrov, B D; Seager, F E; Stamp, M A; Murphy, C C; Department of Ophthalmology, Royal College of Surgeons in Ireland, Royal Victoria Eye and Ear Hospital, Dublin 2, Republic of Ireland. Max@Treacy.ie (2013-04)
      Globally, 153 million people are visually impaired from uncorrected refractive error. The aim of this research was to verify a method whereby autorefractors could be used by non-specialist health-workers to prescribe spectacles, which used a small stock of preformed lenses that fit frames with standardised apertures. These spectacles were named S-Glasses (Smart Glasses).
    • Glomangiopericytoma (sinonasal-type haemangiopericytoma).

      Oosthuizen, J C; Kennedy, S; Timon, C; Department of Otorhinolaryngology, Head and Neck Surgery, The Royal Victoria Eye and Ear Hospital, Dublin, Republic of Ireland. C.Oosth@gmail.com (2012-10)
      Glomangiopericytoma is a rare sinonasal tumour of perivascular myoid phenotype, which accounts for less than 1 per cent of all sinonasal tumours.
    • The case for intraocular delivery of PPAR agonists in the treatment of diabetic retinopathy.

      Treacy, Maxwell P; Hurst, Tara P; Royal Victoria Eye and Ear Hospital, Adelaide Road, Dublin 2, Dublin, Ireland. max@treacy.ie (2012-09)
      Systemic therapeutics targeting the peroxisome proliferator-activated receptors have been found to be beneficial in the treatment of diabetic retinopathy. In this paper, we provide a rationale for the use of these therapeutics as intraocular agents. In addition, we introduce the peroxisome proliferator-activated receptors and describe their functions in response to the drugs.
    • Orbital exenteration in periorbital malignancies.

      Roche, Phoebe; Timon, Conrad; Department of Otolaryngology, Royal Victoria Eye and Ear Hospital, Adelaide Road, Dublin 2, Ireland. phoebe.roche@yahoo.co.uk (2012-08)
      Orbital exenteration is a disfiguring procedure most commonly performed for locally advanced or recurrent periorbital malignancies.
    • Changing trends in Thyroidectomy

      Chukudebelu, Obinna; Dias, Andrew; Timon, Conrad (Irish Medical Journal, 2012-06)
    • The changing face of informed surgical consent.

      Oosthuizen, J C; Burns, P; Timon, C; Department of Otorhinolaryngology, Head and Neck Surgery, The Royal Victoria Eye and Ear Hospital, Dublin, Ireland. C.Oosth@gmail.com (2012-03)
      To determine whether procedure-specific brochures improve patients' pre-operative knowledge, to determine the amount of information expected by patients during the consenting process, and to determine whether the recently proposed 'Request for Treatment' consenting process is viable on a large scale.
    • Clinical image: keratitis in reactive arthritis.

      Collins, Niamh E; Fitzgerald, Oliver; Murphy, Conor C; Royal Victoria Eye and Ear Hospital, Royal College of Surgeons Ireland, Dublin,, Ireland. (2012-02-01)
    • The effect of gastric decompression on postoperative nausea and emesis in pediatric, tonsillectomy patients.

      Chukudebelu, O; Leonard, D S; Healy, A; McCoy, D; Charles, D; Hone, S; Rafferty, M; Department of Otolaryngology, Royal Victoria Eye and Ear Hospital, Adelaide Road,, Dublin 2, Ireland. BBChukud@yahoo.com (2012-02-01)
    • Temporomandibular joint osteochondromatosis: an unusual cause of preauricular swelling.

      Phelan, Eimear; Griffin, John; Timon, Conn; Department of Otolaryngology, Royal Victoria Eye and Ear Hospital, Dublin,, Ireland. (2012-02-01)
      We report an unusual and rare cause of preauricular swelling and review the most recent literature concerning synovial osteochondromatosis of the temporomandibular joint. We report the clinical and radiologic findings of a case of synovial osteochondromatosis of the temporomandibular joint that presented as preauricular swelling in a female patient. This disease typically affects large joints; fewer than 100 cases reported in the literature affect the temporomandibular joint. This case illustrates that disorders of the temporomandibular joint should also be included in the differential diagnosis of patients who present with a preauricular mass.
    • Meta-analysis of timolol on diurnal and nighttime intraocular pressure and blood pressure.

      Lee, Princeton Wen-Yuan; Doyle, Aoife; Stewart, Jeanette A; Kristoffersen, Caroline J; Stewart, William C; Royal Victoria Eye and Ear Hospital, Dublin, Ireland. (2012-02-01)
      PURPOSE: To evaluate the nighttime intraocular pressure (IOP) and blood pressure (BP) response to timolol treatment in patients with ocular hypertension or primary open-angle glaucoma. METHODS: This was a meta-analysis of previously published studies that must have been randomized, prospective, crossover or parallel, single or double-masked trials. The treatment period must have been >/=2 weeks with >/=19 patients per treatment arm for a crossover, and >/=50 patients for a parallel designed trial. Studies must have included both baseline and treated 24-hour curves. RESULTS: For the IOP analysis, we included 8 articles with 340 patients. A reduction from baseline was observed for timolol at each time point and for the 24-hour curve (p0.05). CONCLUSIONS: This meta-analysis suggests that topical timolol therapy provides an ocular hypotensive effect over the 24-hour curve, including the nighttime hours, and while small reductions in the systolic and diastolic pressures occur, the ocular perfusion pressure is not altered over 24 hours.
    • Nd:YAG laser hyaloidotomy for valsalva pre-macular haemorrhage.

      Kirwan, R P; Cahill, M T; Department of Ophthalmic Surgery, The Royal Victoria Eye and Ear Hospital,, Adelaide Road, Dublin 2, Ireland. ruaidhri.kirwan@ucd.ie (2012-02-01)
      AIM: To report a case of successful drainage of a large pre-macular haemorrhage using laser photo-disruption of the posterior hyaloid membrane. MATERIALS AND METHODS: A case report. RESULTS: A 47-year-old man presented acutely to our emergency department complaining of a 24-h history of sudden onset, painless and persistent loss of vision in his left eye. Immediately before noticing this loss of vision, he had been vomiting violently from excessive alcohol intake. The left visual acuity was counting fingers. Dilated fundoscopy of the left eye revealed a large pre-macular haemorrhage which was 14 disc diametres in size. Clotting investigations were normal. A diagnosis of valsalva retinopathy was made and the patient elected to receive a prompt neodymium-doped yttrium aluminium garnet (Nd:YAG) laser posterior hyaloidotomy as an outpatient. At 1 week follow-up, the haemorrhage had drained completely into the vitreous space revealing a healthy macula and the visual acuity had improved to 6/12 unaided. At 6-month follow-up the left visual acuity stabilised at 6/9 unaided. CONCLUSION: Nd:YAG laser posterior hyaloidotomy is a useful outpatient procedure for successful clearance of large pre-macular haemorrhages that offers patients rapid recovery of visual acuity and the avoidance of more invasive intraocular surgery.