Showing papers in "Irish Journal of Medical Science in 2007"
TL;DR: The presence of irritant, carcinogenic and neurotoxic compounds in electrosurgical smoke is demonstrated, which may have considerable implications for the health and safety of all involved in surgical practice, as exposure to these compounds pose potential risks to health.
Abstract: Exposure to surgical smoke during electrosurgery may be harmful to theatre personnel. This study quantified toxic compounds present and we were particularly interested in isolating toluene, ethylbenzene and xylene due to their putative carcinogenic effects. A variety of surgical procedures were studied. Smoke samples emitted during electrosurgery were collected in charcoal tubes and analysed by gas chromatography coupled with mass spectrometry. Surgery involving mainly thermal decomposition of adipose tissue produced greater quantities of aldehydes and lower concentrations of toluene. In contrast, smoke generated during epidermal tissue ablation produced higher levels of toluene, ethyl benzene and xylene. This study demonstrated the presence of irritant, carcinogenic and neurotoxic compounds in electrosurgical smoke. This may have considerable implications for the health and safety of all involved in surgical practice, as exposure to these compounds pose potential risks to health.
93 citations
TL;DR: A significant increase in the incidence of papillary carcinoma was demonstrated in an Irish hospital over the past 30 years, which may be related to increasing dietary iodine intake and may be significant as papilla carcinoma is associated with a more favourable prognosis.
Abstract: To assess changing trends in histological types of thyroid cancer in an Irish hospital over the past 30 years. Biographical data, tumour characteristics, treatment and outcome from 190 patients with thyroid carcinoma from 1970 to 2000 were reviewed retrospectively. Detailed records of 190 patients with thyroid cancer were identified with a mean age at presentation of 50 years. From 1970 to 1979 the distribution of histological types was: papillary carcinoma; 9 patients (4.7%), follicular; 17 patients (8.9%), anaplastic; 9 patients (4.7%), medullary; 1 patient (0.5%) and lymphoma; 1 patient (0.5%). From 1980 to 1989 papillary carcinoma accounted for 32 patients (16.8%), follicular; 14 patients (7.3%), anaplastic; 13 patients (6.8%), medullary; 7 patients (3.7%) and lymphoma; 5 patients (2.6%). From 1990 to 1999 papillary cancer accounted for 48 patients (25.2%), follicular; 14 patients (7.3%), anaplastic; 8 patients (4.2%), medullary; 7 patients (3.7%) and lymphoma; 5 patients (2.6%). Survival rates were significantly better for those aged less than 45 years (P < 0.0001), female sex (P < 0.01) and those with papillary carcinoma (P < 0.01). This study demonstrated a significant increase in the incidence of papillary carcinoma. This may be related to increasing dietary iodine intake and may be significant as papillary carcinoma is associated with a more favourable prognosis.
58 citations
TL;DR: The potential of TLR2 as a drug target in autoimmune and inflammatory disease is discussed, which is implicated in several auto-immune and inflammatory conditions and its role in disease pathogenesis has been supported by numerous reports ofTLR2 polymorphisms in humans linked to disease.
Abstract: The last decade has revealed interesting insights into the initiation and pathophysiology of the innate immune system. Toll-like receptors are of key importance for this process and they are a family of receptors expressed mainly on leukocytes that recognize a variety of microbial products derived from bacteria, viruses, protozoa and fungi. As key players of innate immunity, TLRs and downstream signalling components are important target candidates for drug development. In this review, we focus on TLR2, which recognizes bacterial lipopeptide. TLR2 forms dimers with TLR1 or TLR6. The TLR2/TLR1 dimer recognizes triacylated lipopeptides, whilst the TLR2/TLR6 dimer recognizes diacylated lipopeptides. TLR2 has been implicated in several auto-immune and inflammatory conditions, and its role in disease pathogenesis has been supported by numerous reports of TLR2 polymorphisms in humans linked to disease. Here we discuss the potential of TLR2 as a drug target in autoimmune and inflammatory disease.
47 citations
TL;DR: A phone survey of urology out-patient non-attenders over 1-month was performed to determine reasons forNon-attendance, to identify patients who could be discharged, and the manner in which patients want reminders.
Abstract: Out-patient non-attendance leads to inefficiency and patient morbidity. A phone survey of urology out-patient non-attenders over 1-month was performed to determine reasons for non-attendance, to identify patients who could be discharged, and the manner in which patients want reminders. Seventy-six non-attenders were contacted. Fourteen were GP referred new patients. The reason for non-attendance (n = 10) was due to patient issues. Of the patients due for review (n = 62), it was a first non-attendance in 56. Only 41 (66%) claimed to have received notification or appointment cards. Eight patients said they were written to and 13 (21%) denied either receiving a written notification or an appointment card. Only eight patients rang to confirm/change their appointment. Ninety-nine percent said that they would like a further appointment by text message (34%), phone (37%), letter (36%) or email (6%). We now hope to implement a number of methods to further reduce non-attendance rates based on the findings in this study.
36 citations
TL;DR: There was a significant change in diagnosis in 55%, and in management in nearly 70% patients, and early referral may lead to early discharge for 65% patients.
Abstract: Background
To determine the impact of neurological consultations on the care of hospital in-patients and to ascertain patients’ perceptions, referrals were prospectively recorded over a 6-month period. The neurology team’s view and changes suggested to management were documented. All referred patients’ notes were reviewed at 6 months and the impact of a neurology referral was determined.
25 citations
TL;DR: A 69-year-old man who developed urticaria, hypotension and loss of consciousness within minutes of receiving intravenous gentamicin was successfully resuscitated and made a full recovery.
Abstract: Background
Gentamicin is a common cause of allergic contact dermatitis but immediate (type 1) hypersensitivity is unusual.
21 citations
TL;DR: Ultrasound guidance for ilioinguinal and iliohypogastric nerve block in the inguinal region is both feasible and a promising technique.
Abstract: Ilioinguinal/iliohypogastric nerve block combined with general anaesthesia facilitates inguinal herniorrhaphy in an ambulatory setting by improving analgesia and reducing opioid requirements. Case reports in children indicate the possibility of colonic puncture and associated morbidity with blind ilioinguinal and iliohypogastric blockade. To investigate the feasibility of ultrasound guided ilioinguinal/iliohypogastric nerve block. Pilot study of four patients where ultrasound imaging was used to identify the ASIS, anterior abdominal muscle layers, the peritoneum and to guide local anaesthetic infiltration in patients undergoing inguinal hernia surgery and appendicectomy. All patients had successful blocks, without complications. Mean visual analogue scores were 2/10 in the post anaesthesia care unit. Mean opioid consumption was 10 mg of intramuscular morphine in the first 24 h. Ultrasound guidance for ilioinguinal and iliohypogastric nerve block in the inguinal region is both feasible and a promising technique.
18 citations
TL;DR: GISTs are rare and surgical resection, increasingly with minimally invasive approaches, is associated with high cure rates, particularly in gastric tumours.
Abstract: Gastrointestinal stromal tumours (GISTs), although rare, are increasingly recognized, characterized immuno-phenotypically in most cases by a mutation in C-Kit. The advent of imatinib, a tyrosine kinase inhibitor, has presented a novel and effective therapy in advanced disease. The aim of this study was to present the experience and outcomes of a single centre. Review of prospective GIST database at St James Hospital from 1997 to 2005. Survival data were analysed using Kaplan–Meier methods. A total of 32 patients (19 males/13 females) with a median age of 61 years (10–84) were treated. The stomach (n = 20) was the dominant site. Surgery was the first line of treatment for all these tumours, and in seven cases this was performed laparoscopically. C-Kit was positive in 81% of cases. The median survival was 78 months with a 5-year survival of 71%. GISTs are rare and surgical resection, increasingly with minimally invasive approaches, is associated with high cure rates, particularly in gastric tumours.
17 citations
TL;DR: The results in this audit suggest that the system of ureteric stent follow-up is not effective and a new system is introduced that is a safer and a satisfactory alternative to the stent logbooks.
Abstract: Background
Temporary ureteric stent insertion is an integral part of modern endo-urological practice. Delayed stent removal or forgotten stents are associated with increased patient morbidity and complications which are often difficult to manage.
16 citations
TL;DR: A case of PCP secondary to immune-suppression in a 41-year-old man with psoriatic arthritis being treated with the immune-modulatory agent etanercept is reported, highlighting a recognised but previously unreported complication of etanenercept.
Abstract: Pneumocystis carinii pneumonia (PCP) is a rare form of pneumonia associated with immune-suppression. It is common in patients with AIDS and with a CD4 count of less than 200 cells/mm3. We report a case of PCP secondary to immune-suppression in a 41-year-old man with psoriatic arthritis being treated with the immune-modulatory agent etanercept. Diagnosis of PCP was made histologically using tissue obtained via transbronchial biopsy. There was a good response to standard treatment with high-dose co-trimoxazole. This report highlights a recognised but previously unreported complication of etanercept.
16 citations
TL;DR: The findings of this work suggest that dietary cholesterol and sodium intake may be linked to cognitive impairment.
Abstract: There is evidence of a link between nutrient intake and cognitive impairment and decline in old age. There has been no study of nutrient intake in Irish subjects at risk of dementia. To investigate the possible link between nutrient intake and cognitive performance in a group of Irish adults at risk of dementia, and to compare the nutrient intake in these adults stratified by the absence or presence of the apolipoprotein E (APOE) e4 allele. Forty-four subjects, who were first-degree blood relatives of people with Alzheimer’s disease, were recruited. Cognitive performance and nutritional intake were assessed and apolipoprotein E (APOE) genotype determined. The intakes of cholesterol (P < 0.037) and Na (P < 0.037) were significantly higher in subjects with altered cognitive performance. There was no significant difference in nutrient intakes between APOE e-4 allele positive and APOE e-4 allele negative subjects. The findings of this work suggest that dietary cholesterol and sodium intake may be linked to cognitive impairment.
TL;DR: Pneumobilia following blunt abdominal trauma is not an absolute indication for laparotomy, but it is an important diagnostic sign in spontaneous biliary enteric fistulae.
Abstract: Background
Pneumobilia is the presence of gas within the biliary tree. It is an important diagnostic sign in spontaneous biliary enteric fistulae, classically in gallstone ileus. There are a number of other causes including surgically created biliary enteric fistula, instrumentation of the bile duct at endoscopic retrograde cholangiopancreatography, emphysematous cholecystitis and pyogenic cholangitis. Pneumobilia has also been reported following blunt abdominal trauma. The significance of isolated pneumobilia following abdominal trauma has not been conclusively established.
TL;DR: ANP increases UAER in normoalbuminuric type-2 diabetic subjects and the natriuretic response to ANP was similar to diabetic subjects, and hyperglycaemic did not enhance the album inuric response to AnP.
Abstract: Background
Atrial natriuretic peptide (ANP) is elevated in patients with type-2 diabetes and microalbuminuria. The purpose of this study is to evaluate if ANP increases Urinary Albumin Eaxcretion Rate (UAER) in type-2 diabetes.
TL;DR: Younger patients had lower platelet counts, larger spleens and a higher incidence of hypersplenism suggesting that hypers plenism is significantly related to the age of onset of chronic liver disease.
Abstract: The aim of this study was to investigate whether hypersplenism is related to the age of onset of liver disease. Hypersplenism was assessed in 84 consecutive cirrhotic patients attending a university hospital liver clinic. Hypersplenism was present in 78% of patients and severe in 39%. Severe hypersplenism was more common in patients with cystic fibrosis liver disease (88%, P < 0.0001) and autoimmune hepatitis (60%, P = 0.0006) compared to alcoholic cirrhosis (12%). There was a significant correlation between patient age and platelet count r = 0.525, P < 0.0001 in the group as a whole and for the sub-group of patients with autoimmune hepatitis r = 0.54, P = 0.047. There was a negative correlation between age and spleen size r = −0.611, P < 0.0001. Younger patients had lower platelet counts, larger spleens and a higher incidence of hypersplenism suggesting that hypersplenism is significantly related to the age of onset of chronic liver disease.
TL;DR: There were strong links between social circumstances and infanticide in nineteenth-century Ireland, compounded by myriad diagnostic and therapeutic challenges associated with forensic psychiatric committal and lengthy detention in poorly-therapeutic facilities.
Abstract: Infanticide has been described in almost every human society. To present a case of infanticide from nineteenth-century Ireland and explore related diagnostic, therapeutic and judicial issues. This paper uses original archival material from the Central Mental Hospital, Dublin to present a case of infanticide and inform an exploration of related issues. In 1892, ‘Dora’, a thirty-four year old servant from Dublin, was found guilty of the murder of her eight-month old child and sentenced to indefinite detention at the Central Mental Hospital, Ireland’s only inpatient forensic psychiatry facility. The subsequent experiences of Dora (“a case of melancholia”) illustrate many of the diagnostic, therapeutic and judicial issues surrounding infanticide in nineteenth-century Ireland. There were strong links between social circumstances and infanticide in nineteenth-century Ireland, compounded by myriad diagnostic and therapeutic challenges associated with forensic psychiatric committal and lengthy detention in poorly-therapeutic facilities
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TL;DR: The new interferon gamma release assays (IGRA) may be a viable alternative screening method to the tuberculin skin test (TST) and such an infection should always be considered as the donor pool becomes increasingly more travelled particularly to endemic areas.
Abstract: Disease caused by Mycobacterium tuberculosis (MTB) is a well-recognised complication of renal transplantation worldwide due to immunosuppression. It is more common in developing countries. Infection isolated to a renal allograft is rare and infection transmitted by the allograft is also very rare. To describe the first reported case of MTB in a renal transplant transmitted from the donor in Ireland and review the literature. A 53-year-old male 29 months after allogenic renal transplant for adult polycystic kidney disease with no other risk factors for MTB presented with deteriorating renal function. Pathological examination of a renal biopsy specimen showed caseating granulomata. MTB was confirmed by culture of early morning urine. MTB isolated to a renal transplant is rare in the developed world. Such an infection should always be considered as our donor pool becomes increasingly more travelled particularly to endemic areas. The new interferon gamma release assays (IGRA) may be a viable alternative screening method to the tuberculin skin test (TST).
TL;DR: A national debate on screening for fetal abnormality is required urgently and recommendations are made to improve the service through the use of a standard protocol to examine fetal structures.
Abstract: Background
Since 1997, the RCOG have recommended that ultrasound screening for fetal abnormality in pregnancy should be offered to all women.
TL;DR: A higher frequency of euthyroidism occurs in patients with TNG than with Graves’ disease following RAI, particularly when suppressed TSH levels were suppressed at time of RAI-treatment.
Abstract: Strategies to increase frequency of euthyroidism following radioactive (RAI) treatment of hyperthyroidism are required. To examine the role of TSH in development of hypothyroidism post RAI treatment in patients with Graves’ disease (N = 98) or toxic nodular goiter, TNG (N = 88). This retrospective study examined thyroid status over a mean of 3.7 years post-RAI. Although RAI dose was significantly higher in TNG group, hypothyroidism occurred more frequently in Graves’ disease (71.4 and 22.7%) P < 0.001. The TSH levels at the time of RAI treatment were lower in TNG patients who remained euthyroid, (0.4±0.1 vs. 1.2±0.5 mU/l, P < 0.0022). A higher frequency of euthyroidism occurs in patients with TNG than with Graves’ disease following RAI, particularly when suppressed TSH levels were suppressed at time of RAI-treatment.
TL;DR: This multivariate model enables the exclusion of ‘musculoskeletal sepsis’ as a differential diagnosis in limping children with none of these three presenting variables with 99% certainty.
Abstract: The acutely limping child presents a significant diagnostic challenge. The purpose of this study was to create a clinically useful algorithm to allow exclusion of ‘musculoskeletal sepsis’ as a differential diagnosis in the child presenting with limp. Data were collected on all 286 limping children admitted to our centre over a 3-year-period. Using logistic regression analysis, the predictive model was constructed, to exclude infection. Duration of symptoms, constitutional symptoms, temperature, white cell count and ESR were significantly different in children with musculoskeletal infection (P 1, 37.0°C; and ESR >35 mm/h were present, the predicted probability of infection was 0.66, falling to 0.01 when none were present. This multivariate model enables us to rule out musculoskeletal infection with 99% certainty in limping children with none of these three presenting variables.
TL;DR: Three case reports of patients with long chain fatty acid oxidation defects who have shown significant benefits from treatment are reported and illustrate the clinical heterogeneity of longChain fatty acids oxidation defects and opportunities for effective management if correctly diagnosed.
Abstract: Background
Mitochondrial β oxidation plays a major role in energy production. Long chain fatty acid oxidation defects include deficiency of the trifunctional protein (rare) or more commonly defects of the long chain 3-hydroxy acyl-CoA dehydrogenase enzyme (LCHAD). These long chain defects have variable presentations, they may present in the neonate or infant with sudden death, hepatopathy (Reyes disease), hypoketotic hypoglycaemia, rhabdomyolysis, myopathy, cardiomyopathy and with late complications such as peripheral neuropathy, pigmentary retinopathy, retinal degeneration and progressive visual loss. The correct diagnosis at presentation is not only life saving but also allows for the appropriate dietary and other intervention, which may have major effects on outcome.
TL;DR: Investigation of the nature of construction related ocular injury in non-nationals found hammering, grinding, drilling and splash injury was common, with attendance at safety courses highest in Irish nationals.
Abstract: Construction-related ocular injuries are an important cause of vision loss but few studies on the incidence, epidemiology and nature of these injuries exist. Due to the perceived increase in occupation-related eye injuries in non-nationals we aimed to investigate the nature of such injuries presenting to a single eye unit over a two-month period. One hundred and fifty-five patients presenting to the accident and emergency department with construction related ocular injury were examined. Of 155 patients, 80 were Irish and 75 non-national, of whom 60, 21.3 and 6.7% were Polish, Lithuanian and Romanian, respectively. Common causative factors included hammering, grinding, drilling and splash injury. Average rate of eyewear protection usage was 35%, with attendance at safety courses highest in Irish nationals. A penetrating eye injury rate of 4.9% overall was observed, all in non-nationals. Construction related ocular injury is a serious cause of visual loss in non-nationals. Greater adherence to safety regulations and training is required.
TL;DR: A high index of clinical suspicion is needed to diagnose and successfully manage leg bone pain syndrome in a patient with ulcerative colitis receiving cyclosporin.
Abstract: Background
Leg bone pain syndrome is an unusual condition associated with the use of calcineurin antagonists, initially described in patients receiving allograft transplantation.
TL;DR: The purpose of this review is to examine critically the information that can be derived from the technique and to highlight the application of this evidence in clinical practice.
Abstract: Ambulatory blood pressure measurement has been in use in clinical practice for nearly half a century. However, despite the benefits the technique brings to managing patients with hypertension it is much under-used in practice. The purpose of this review is to examine critically the information that can be derived from the technique and to highlight the application of this evidence in clinical practice.
TL;DR: Access to existing services must be increased, and significant resources must be put into the development of dedicated primary care services.
Abstract: The Structure of Irish General Practice over 23 years was the third in a series of national studies that examined the development of general practice in 1982, 1992, and 2005. This study analysed specific data from the 2005 survey to determine the types of services offered by GPs, and to examine the changes in access to diagnostic/treatment services from 1982 to 2005. A questionnaire was sent to a stratified random sample of Irish GPs seeking information on their practice. 476 (87%) valid questionnaires were returned. The range of services offered by GPs had increased. Access to diagnostic/treatment services was limited, and varied considerably depending on the type of practice. Access to chest X-rays and skeletal X-rays had decreased. Access to existing services must be increased, and significant resources must be put into the development of dedicated primary care services.
TL;DR: Despite a growing trend in pain management and publication of guidelines, only 71% of teaching hospitals in the Republic of Ireland have acute pain services, and further resources are needed to address this deficiency.
Abstract: Background
Acute Pain Services (APS) evolved in response to the desire for improved management of postoperative pain.
TL;DR: Physicians initiating long-term disulfiram therapy should be aware of these adverse effects and recommend annual ophthalmic reviews with visual field testing, and patients should be reassured with respect to the reversibility of these effects.
Abstract: Aim
To report a case of optic and peripheral neuropathy after chronic use of disulfiram for alcohol dependence management.
TL;DR: The early pregnancy assessment unit (EPAU) is a dedicated service that provides quick and easy accessibility to diagnosis, treatment and support service as discussed by the authors, however, it is not suitable for women experiencing bleeding in early pregnancy.
Abstract: Women experiencing bleeding in early pregnancy suffer considerable anxiety. Waiting for a considerable time for a diagnosis adds to their grievance. Early Pregnancy Assessment Unit (EPAU) is a dedicated service that provides quick and easy accessibility to diagnosis, treatment and support service. To monitor the first 6 months of the EPAU service in the Rotunda Hospital, to identify its shortcomings, so that we can ensure effective EPAU care in future. A retrospective audit between July and December 2002 was performed. A majority of patients (83.4%) were self-referrals. All patients were seen between 1 and 3 h. In the miscarriage group, 218/278 (78.4%) was managed surgically by evacuation and a further 60/278 (21.6%) received conservative or medical treatment. Among 13 ectopic pregnancies, 5/13 (39%) had laparoscopic management. This clinic has enabled us to manage early pregnancy bleeding in an effective manner within a satisfactory time period. The high surgical intervention rate for miscarriages is highlighted to support the need for greater emphasis on medical and expectant management.
TL;DR: The prevalence of the FVL mutation in Irish patients undergoing total hip replacement was 2% but was not a risk factor for acute symptomatic DVT/PE.
Abstract: Background
The Factor V Leiden (FVL) mutation is the commonest genetic abnormality associated with venous thromboembolism.
TL;DR: Pneumomediastinum is an uncommon entity that presents with relatively non-specific symptoms and signs and will require radiological investigations to clarify the diagnosis, which will require close observation for the development of complications and occult visceral perforation.
Abstract: Background
We present two cases of pneumomediastinum in patients who presented to the accident and emergency department of a large teaching hospital. One case had a history of inhalational drug abuse, which may have contributed to the event, while the other had no obvious precipitating factors.