Research by staff affiliated to the Beacon Hospital

Recent Submissions

  • The impact of surgery for vulval cancer upon health-related quality of life and pelvic floor outcomes during the first year of treatment: a longitudinal, mixed methods study.

    Jones, Georgina L; Jacques, Richard M; Thompson, Joanne; Wood, Hilary J; Hughes, Jane; Ledger, William; Alazzam, Mo'iad; Radley, Stephen C; Tidy, John A (John Wiley & Sons, 2016-06)
    To measure the long-term impact of surgical treatment for vulval cancer upon health-related quality of life and pelvic floor outcomes during the first year of therapy.
  • A nutraceutical approach (Armolipid Plus) to reduce total and LDL cholesterol in individuals with mild to moderate dyslipidemia: Review of the clinical evidence.

    Barrios, Vivencio; Escobar, Carlos; Cicero, Arrigo Francesco Giuseppe; Burke, David; Fasching, Peter; Banach, Maciej; Bruckert, Eric; Beacon Hospital (Elsevier, 2017-02)
    Compelling evidence supports the effectiveness of the reduction of total and LDL cholesterol (TC and LDL-C) in primarily preventing cardiovascular events, within the framework of life-long prevention programs mainly consisting in lifestyle changes. Pharmacological treatment should be introduced when lifestyle changes, including use of nutraceuticals, have failed. ESC/EAS guidelines list a number of nutraceutical compounds and functional foods which have been individually studied in randomized, controlled clinical trials (RCTs). To date only a proprietary formulation of three naturally occurring substances with putative complementary lipid-lowering properties - red yeast rice, policosanol and berberine - combined with folic acid, astaxanthin, and coenzyme Q10 (Armolipid Plus(®)) has been extensively investigated in several RCTs, 7 of which were placebo-controlled, 2 were ezetimibe comparators and 4 were "real life" studies comparing diet and Armolipid Plus to diet alone. The trials included mostly patients with mild to moderate dyslipidemia, treated for 6-48 weeks. The trials also included special populations and patients in whom statins were contraindicated or who could not tolerate them. Armolipid Plus has proved to be able to achieve significant reductions in TC (11-21%) and in LDL-C (15-31%) levels, which is equivalent to expectations from low dose statins. In patients intolerant to statins, who do not achieve their therapeutic target with ezetimibe, Armolipid Plus can achieve a further 10% improvement in TC and LDL-C. The safety and tolerability of Armolipid Plus were excellent, thought likely due to the intentional combination of low doses of its active ingredients: low enough not to be associated with untoward effects, but high enough to exert therapeutic effects in combination with other complementary substances. Consequently, in the event of intolerance to statins, Armolipid Plus offers an effective alternative, which is devoid of the safety risks associated with synthetic pharmacological therapy. In conclusion Armolipid Plus, in addition to dietary measures, could be a rational choice for individuals with mild to moderate hyperlipidemia and for all dyslipidemic patients in whom statins are not indicated or who cannot tolerate them.
  • Cervical Cancer Prevention: New Frontiers of Diagnostic Strategies.

    Origoni, Massimo; Prendiville, Walter; Paraskevaidis, Evangelos (Hindawi Publishing Corporation, 2015-05)
  • The future role for colposcopy in Europe.

    Leeson, Simon C; Alibegashvili, Tamar; Arbyn, Marc; Bergeron, Christine; Carriero, Carmine; Mergui, Jean-Luc; Nieminen, Pekka; Prendiville, Walter; Redman, Charles W E; Rieck, Gudrun C; Quaas, Jens; Petry, K Ulrich; 1Department of Obstetrics and Gynaecology, Betsi Cadwaladr University Health Board, Bangor, Gwynedd, UK; 2Department of Gynecology, National Screening Center, Tbilisi, Georgia; 3Unit of Cancer Epidemiology, Scientific Institute of Public Health, Brussels, Belgium; 4Laboratoire Cerba, Paris, France; 5Department of Gynecology and Obstetrics, University of Bari, Bari, Italy; 6Hôpital Tenon, Service de Gynécologie Obstétrique et Médecine de la Reproduction, Paris, France; 7Department of Obstetrics and Gynecology, Helsinki University Hospital, Finland; 8The Beacon Hospital, Sandyford, Dublin, Ireland; 9Department of Obstetrics and Gynaecology, University Hospital of North Staffordshire, Stoke-on-Trent, UK; 10D-18437 Stralsund, Grünthal, Germany; and 11Department of Obstetrics and Gynaecology, Klinikum Wolfsburg, Wolfsburg, Germany. (2014-01)
    Improvements in the performance of cervical screening may be limited by the diagnostic performance of colposcopy. Nonetheless, colposcopy remains the best available tool to assess women considered at high risk for having or developing cervical cancer. The provision and role of colposcopy across Europe is variable. Introduction of vaccination against human papillomavirus (HPV) types 16 and 18 as well as the possible switch to HPV-based screening is likely to change the profiles of women presenting to colposcopy services and provide management difficulties for the colposcopist.The standard of colposcopy in Europe can be maintained or improved despite a variable availability of screening. The prevalence of cervical intraepithelial neoplasia grade 3 may decrease for women having had HPV vaccination. The incidence of cervical intraepithelial neoplasia grade 3 and cervical cancer in second and subsequent rounds of HPV-based screening are likely to decrease compared to cytology-based screening. In HPV-based screening, the numbers of women with no detectable or minor abnormalities at colposcopy and with screen-detected glandular disease are likely to increase. We have considered how these issues will affect states that have varying implementation of organized cervical screening programs and varying degrees of implementation of HPV testing or vaccination.The development of quality assurance across Europe accompanying these program changes is discussed.
  • HPV testing and vaccination in Europe.

    Leeson, Simon C; Alibegashvili, Tamar; Arbyn, Marc; Bergeron, Christine; Carriero, Carmine; Mergui, Jean-Luc; Nieminen, Pekka; Prendiville, Walter; Redman, Charles W E; Rieck, Gudrun C; Quaas, Jens; Petry, K Ulrich; 1Department of Obstetrics and Gynaecology, Betsi Cadwaladr University Health Board, Bangor, Gwynedd, UK; 2Department of Gynecology, National Screening Center, Tbilisi, Georgia; 3Unit of Cancer Epidemiology, Scientific Institute of Public Health, Brussels, Belgium; 4Laboratoire Cerba, Paris, France; 5Department of Gynecology and Obstetrics, University of Bari, Bari, Italy; 6Hôpital Tenon, Service de Gynécologie Obstétrique et Médecine de la Reproduction, Paris, France; 7Department of Obstetrics and Gynecology, Helsinki University Hospital, Finland; 8The Beacon Hospital, Sandyford, Dublin, Ireland; 9Department of Obstetrics and Gynaecology, University Hospital of North Staffordshire, Stoke-on-Trent, UK; 10D-18437 Stralsund, Grünthal, Germany; and 11Department of Obstetrics and Gynaecology, Klinikum Wolfsburg, Wolfsburg, Germany. (2014-01)
    Current cytology-based screening has a moderate sensitivity to detect cervical intraepithelial neoplasia grade 3 (CIN 3) and cervical cancer even in those states providing rigorous quality control of their cervical screening programs. The impact of vaccination against human papillomavirus (HPV) types 16 and 18 as well as the incorporation of HPV testing on the detection of CIN 3 and cancer is discussed. HPV testing used as a triage for atypical squamous cells of undetermined significance (ASCUS) and low-grade squamous intraepithelial lesions, test of cure after treatment, and HPV-based primary screening may improve current cervical screening programs.HPV testing as a triage test for ASCUS seems to offer an improved sensitivity, with a similar specificity as compared to repeat cytology for diagnosing high-grade CIN and has been recommended throughout most EU states. HPV testing as a triage test for low-grade squamous intraepithelial lesions has a low specificity and is not recommended in most member states. HPV test of cure offers an improved sensitivity compared to cytology for women with persistent cervical precancer after treatment. HPV-based cervical cancer screening is more effective than screening with cytology. The effects of HPV-based screening depend on the organization of the program and on adherence to algorithms for screening triage. Otherwise, it is likely that HPV-based screening will increase the referral rate to colposcopy including more women with no detectable cervical lesion. HPV vaccination will require many years to evaluate any beneficial effects on cervical cancer incidence and mortality.
  • Stereotactic radiosurgery for the treatment of brain metastases; results from a single institution experience.

    Burke, D; Mascott, C; Rock, L; Callinan, S; Mihai, A; Thirion, P; Armstrong, J G; UPMC Beacon Cancer Centre, UPMC Beacon Hospital, Sandyford, Dublin, 18, Ireland. burkedfb@gmail.com (2013-09)
    Stereotactic radiosurgery is frequently used for the treatment of brain metastases. This study provides a retrospective evaluation of patients with secondary lesions of the brain treated with stereotactic radiosurgery (SRS) at our institution.
  • Remembering the importance of preventing blood-borne infections in the critical care setting.

    Leonard, Lenora; Timmins, Fiona; Infection Prevention & Control Nurse Specialist, UPMC Beacon Hospital Dublin, Dublin, Ireland. (2013)
  • Coupling failure between stem and femoral component in a constrained revision total knee arthroplasty.

    Butt, Ahsan Javed; Shaikh, Aamir Hassan; Cameron, Hugh U; Department of Trauma and Orthopaedic Surgery, UPMC, Beacon Hospital Dublin, Ireland. (2013-02)
    Knee revision using constrained implants is associated with greater stresses on the implant and interface surfaces. The present report describes a case of failure of the screw coupling between the stem and the femoral component. The cause of the failure is surmised with outline of the treatment in this case with extensive femoral bone loss. Revision implant stability was augmented with the use of a cemented femoral stem, screw fixation and the metaphyseal sleeve of an S-ROM modular hip system (DePuy international Ltd).
  • Predictability of corneal flap thickness in laser in situ keratomileusis using a 200 kHz femtosecond laser.

    Cummings, Arthur B; Cummings, Brendan K; Kelly, Gabrielle E; Wellington Eye Clinic and UPMC Beacon Hospital, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland. abc@wellingtoneyeclinic.com (2013-03)
    To compare the intended versus the resultant thickness of laser in situ keratomileusis (LASIK) flaps created with a new femtosecond laser and to report the 3-month postoperative refractive outcomes.
  • External cardiac compression may be harmful in some scenarios of pulseless electrical activity.

    Hogan, T S; Department of Anaesthesia, UPMC Beacon Hospital, Sandyford, Dublin 18, Ireland. dr.tshogan@eircom.net (2012-10)
    Pulseless electrical activity occurs when organised or semi-organised electrical activity of the heart persists but the product of systemic vascular resistance and the increase in systemic arterial flow generated by the ejection of the left venticular stroke volume is not sufficient to produce a clinically detectable pulse. Pulseless electrical activity encompasses a very heterogeneous variety of severe circulatory shock states ranging in severity from pseudo-cardiac arrest to effective cardiac arrest. Outcomes of cardiopulmonary resuscitation for pulseless electrical activity are generally poor. Impairment of cardiac filling is the limiting factor to cardiac output in many scenarios of pulseless electrical activity, including extreme vasodilatory shock states. There is no evidence that external cardiac compression can increase cardiac output when impaired cardiac filling is the limiting factor to cardiac output. If impaired cardiac filling is the limiting factor to cardiac output and the heart is effectively ejecting all the blood returning to it, then external cardiac compression can only increase cardiac output if it increases venous return and cardiac filling. Repeated cardiac compression asynchronous with the patient's cardiac cycle and raised mean intrathoracic pressure due to chest compression can be expected to reduce rather than to increase cardiac filling and therefore to reduce rather than to increase cardiac output in such circumstances. The hypothesis is proposed that the performance of external cardiac compression will have zero or negative effect on cardiac output in pulseless electrical activity when impaired cardiac filling is the limiting factor to cardiac output. External cardiac compression may be both directly and indirectly harmful to significant sub-groups of patients with pulseless electrical activity. We have neither evidence nor theory to provide comfort that external cardiac compression is not harmful in many scenarios of pulseless electrical activity. Investigation using a variety of animal models of pulseless electrical activity produced by different shock-inducing mechanisms is required to provide an evidence base for resuscitation guidelines.
  • Patient knowledge of risk factors 18 months after a nurse-led vascular intervention

    Tone, J M; Gallagher, P; Agha, A; Thompson, C J (2011)
    Background and aims: Eighteen months after the completion of a vascular risk intervention study, the authors aimed to ascertain whether participants who attended the intensive, nurse-led group had better retention of knowledge of diabetes and heart disease compared with those who had undergone standard diabetes care. Method: A knowledge-based questionnaire was sent to participants who completed the vascular risk intervention study, 94 from the intensive, nurse-led group and 94 from the standard care group. Results: A response rate of 75% was achieved. Although more participants in the intensive group achieved recommended vascular risk targets, there was no increase in retained knowledge of vascular risks. A high proportion of the total cohort could not quantify targets for blood pressure (67.2%), cholesterol (65.1%) or HbA1c (68.1%). Conclusion: In this cohort of people with type 2 diabetes, knowledge retention regarding treatment targets was poor. Education programmes should stress awareness of vascular risk factors and diabetes.
  • Dyslipidaemia--hepatic and intestinal cross-talk.

    Tomkin, Gerald H; Trinity College Dublin and Diabetes Institute of Ireland, Beacon Hospital, Sandyford, Clontra, Quinns Road, Shankill Co, Dublin, Ireland. gerald.tomkin@tcd.ie, tomking@tcd.ie (2010-06)
    Cholesterol metabolism is tightly regulated with the majority of de novo cholesterol synthesis occurring in the liver and intestine. 3 Hydroxy-3-methylglutaryl coenzyme A reductase, a major enzyme involved in cholesterol synthesis, is raised in both liver and intestine in diabetic animals. Niemann PickC1-like1 protein regulates cholesterol absorption in the intestine and facilitates cholesterol transport through the liver. There is evidence to suggest that the effect of inhibition of Niemann PickC1-like1 lowers cholesterol through its effect not only in the intestine but also in the liver. ATP binding cassette proteins G5/G8 regulate cholesterol re-excretion in the intestine and in the liver, cholesterol excretion into the bile. Diabetes is associated with reduced ATP binding cassette protein G5/G8 expression in both the liver and intestine in animal models. Microsomal triglyceride transfer protein is central to the formation of the chylomicron in the intestine and VLDL in the liver. Microsomal triglyceride transfer protein mRNA is increased in diabetes in both the intestine and liver. Cross-talk between the intestine and liver is poorly documented in humans due to the difficulty in obtaining liver biopsies but animal studies are fairly consistent in showing relationships that explain in part mechanisms involved in cholesterol homeostasis.
  • Desmoplastic malignant melanoma presenting as large lung mass.

    Al-Alao, Bassel Suffian; Shuhaibar, Maher Nicolas; Department of Cardiothoracic Surgery, Beacon Hospital, Sandyford, Dublin, 18 Ireland. bassel.al-alao@beaconhospital.ie (2010-08)
    We describe a case of successful minimally invasive thoracoscopic surgical resection of metastatic desmoplastic malignant melanoma replacing the entire right lower lobe of the lung, presenting 4 years after the initial complete resection of the primary scalp lesion. An 89-year-old man presented with a 6-month history of right-sided chest pain. A computed tomographic scan showed a large paravertebral mass with possibility of chest wall invasion. Core biopsy initially raised the suspicion of a schwannoma. We also discussed the atypical delayed presentation and misleading radiologic and histologic findings.
  • Non-small-cell lung cancer: unusual presentation in the gluteal muscle.

    Al-Alao, Bassel Suffian; Westrup, Jennifer; Shuhaibar, Maher Nicolas; Department of Cardiothoracic Surgery, UPMC Beacon Hospital, Sandyford, Dublin 18, Ireland. Bassel.Al-Alao@BeaconHospital.ie (2011-05)
    Lung cancer is one of the most commonly diagnosed cancers in both men and women worldwide. It is also one of the most common forms of cancer in Ireland, accounting for about 20% of all deaths from cancer each year. Early detection of lung cancer is infrequent, and most cases are not diagnosed and treated until they are at an advanced stage. Distant metastases in lung cancer commonly involve the adrenal glands, liver, bones, and central nervous system; they are only rarely seen in the skeletal system. We report a rare case of metastasis to the gluteal muscle as the initial presentation of lung cancer.