• Is simple nephrectomy truly simple? Comparison with the radical alternative.

      Connolly, S S; O'Brien, M Frank; Kunni, I M; Phelan, E; Conroy, R; Thornhill, J A; Grainger, R; Department of Urology, Trinity College Dublin, Adelaide and Meath incorporating National Children's Hospital, Tallaght, Dublin 24, Ireland. steconnolly@rcsi.ie (2011-03)
      The Oxford English dictionary defines the term "simple" as "easily done" and "uncomplicated". We tested the validity of this terminology in relation to open nephrectomy surgery.
    • Is subclinical hypothyroidism associated with impaired uteroplacental bloodflow?

      Breathnach, FM; Cooley, SM; Donnelly, J; Geary, M; Malone, FD; Rotunda Hospital (2009-01)
    • Is The Consent Process Appropriate - The Interns’ Perspective?

      Rohan, P; Keane, K; Nason, GJ; Caulfield, RH (Irish Medical Journal (IMJ), 2018-04)
      Consent is an integral component to any medical procedure involving a competent patient, a communicating doctor, and transfer of information about the procedure. The aim of this study was to assess interns’ experience of the consent process.
    • Is the contribution of alcohol to fatal traumatic brain injuries being underestimated in the acute hospital setting?

      O'Toole, O; Mahon, C; Lynch, K; Brett, F M; Department of Neuropathology, Beaumont Hospital, Beaumont, Dublin. (2011-04-05)
      Alcohol consumption in Ireland has nearly doubled during the period 1989-2001. To evaluate the relationship of alcohol to fatal head injuries in the acute hospital setting we created a data base of all fatal traumatic brain injuries in the Department of Neuropathology at Beaumont Hospital over a ten year period (1997-2006 inclusive). 498 cases were identified (351 males: 147 females). Fatalities were highest in males aged 19-25 years (N=101) and 51-70 years (N=109). Falls (N=210) and road traffic accidents (N=183) were the commonest modes of presentation. 36/210 (17%) falls had positive blood alcohol testing, 9/210 (4.3%) had documentation of alcohol in notes but no testing, 35/210 (16.7%) tested negative for alcohol and 130/210 (61.9%) were not tested. The RTA group (N=183) comprised drivers (n=79), passengers (n=47) and pedestrians (n=57). 65/79 (82.2%) of drivers were males aged 19-25 years. Blood alcohol was only available in 27/79 (34.1%) drivers and was positive in 13/27 (48.1%). 14/75 (18.7%) pedestrians were tested for alcohol, 4/14 (28.6%) were positive. Overall 142/183 (77.6%) of the RTA group were not tested. The contribution of alcohol to fatal traumatic brain injuries is probably being underestimated due to omission of blood alcohol concentration testing on admission to hospital. Absence of national guidelines on blood alcohol testing in the emergency department compounds the problem.
    • Is the current BST ePortfolio fulfilling its role in the training of clinical medicine SHOs?

      Grennan, S; Crowley, S; Quidwai, S; Barrett, O; Kooblall, M (Irish Medical Journal, 2016-01)
      While the objective recording of clinical competencies in an electronic portfolio (ePortfolio) has become a key aspect of basic specialist training (BST), it continues to divide opinion. We surveyed medical trainees and their supervisors in the Dublin region examining their views of the ePortfolio and workplace-based assessments (WPBAs). Responses were received from 27 of 149 (18.1%) SHOs and 24 of 307 (7.9%) consultants. Our results highlight significant dissatisfaction amongst trainees with 20 (74.1%) stating that the ePortfolio is not an effective educational tool. Consultants had more mixed views. While 16 (66.7%) reported that feedback sessions were useful for trainee development, only 4 (16.7%) found the ePortfolio to be useful in highlighting trainees’ strengths and weaknesses. Although other studies have emphasised its educational potential, our results suggest that practical barriers, such as time constraints and a lack of training, lead to poor engagement and a negative view of the ePortfolio.
    • Is the NHS best practice tariff for Type 1 diabetes applicable in the Irish context?

      O’ Brien, N; McGlacken-Byrne, SM; Hawkes, CP; Murphy, N (Irish Medical Journal, 2014-07)
      The National Health Service in the UK has identified thirteen key standards of paediatric diabetes care. Funding depends on services meeting these standards. The aim of this study was to determine if these standards are applicable in an Irish setting. All patients attending the diabetes service during 2012 were included. Patient charts, electronic appointments, nursing notes and computerised results were used to ascertain relevant information for comparison with the NHS standards. Patients attended a mean 2.97 (SD 0.7) medical and 2.2 (SD 2.9) nursing appointments per year, with a median additional contacts of 8 nurse phone calls (range 0 â 125). Most standards were met by this service. In comparing our service to the NHS standard, we have identified a number of areas for improving our service provision. Limited resources and staff shortages make a number of these standards unachievable, namely annual dietetic review and three monthly outpatient appointments.
    • Is the quality of endoscopic research improving? A 20-year review.

      Anwar, Malik M; Harewood, Gavin C; Zeb, Faisal; Slattery, Eoin; Hamed, Mohamed A (2011-06)
    • Is there a requirement for axillary lymph node dissection following identification of micro-metastasis or isolated tumour cells at sentinel node biopsy for breast cancer?

      Joyce, D P; Solon, J G; Prichard, R S; Power, C; Hill, A D K; Department of Surgery, Royal College of Surgeons in Ireland and Beaumont Hospital, Beaumont Road, Dublin 9, Ireland. (2012-02-29)
      INTRODUCTION: Recent decades have seen a significant shift towards conservative management of the axilla. Increasingly, immunohistochemical analysis of sentinel nodes leads to the detection of small tumour deposits, the significance of which remains uncertain. The aims of this study are to examine patients whose sentinel lymph nodes are positive for macro-metastasis, micro-metastasis or isolated tumour cells (ITCs) and to determine the rate of further nodal disease after axillary lymph node dissection (ALND). METHODS: A retrospective analysis of all patients undergoing a sentinel lymph node biopsy (SLNB) between January 2007 and December 2010 in a tertiary referral breast unit was performed. Patients who underwent an axillary lymph node dissection for macro-metastasis, micro-metastasis or ITCs were identified. Demographics, histological data and the rate of further axillary disease were examined. RESULTS: In total, 664 breast cancer patients attended the symptomatic breast unit during the study period, 360 of whom underwent a SLNB. Seventy patients had a SLNB positive for macro-metastasis. All of these patients underwent ALND. A positive SLNB with either micro-metastasis or ITCs was identified in 58 patients. Only 41 of the 58 patients went on to have an ALND, due primarily to variations in surgeons' preferences. Nineteen patients with micro-metastasis underwent an ALND. Four patients had further axillary disease (21%). Twenty-two patients had ITCs identified, of whom only one had further disease (4.5%). No statistically significant difference was found between the two groups in terms of tumour size, grade, lymphovascular invasion or oestrogen receptor status. CONCLUSION: ALND should be considered in patients with micro-metastasis at SLNB. It should rarely be employed in the setting of SLNB positive for ITCs.
    • Is there an Association between Peripheral Immune Markers and Structural/Functional Neuroimaging Findings?

      Frodl, Thomas; Amico, Francesco; Department of Psychiatry, Trinity College Institute of Neuroscience, Trinity College Dublin; Adelaide and Meath incorporating the National's Children Hospital Dublin; St. James's Hospital Dublin. Electronic address: frodlt@tcd.ie. (2013-01-10)
      OBJECTIVES: There is mounting evidence that inflammatory processes play a key role in emotional as well as cognitive dysfunctions. In this context, research employing magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MR spectroscopy) suggests a possible link between structural/functional anomalies in the brain and an increase of circulating inflammation markers. The present paper reviews this research, with particular focus on major depressive disorder (MDD), cognitive impairment in older adults, Alzheimer's disease (AD) and schizophrenia. RESULTS: In MDD, cognitive impairment and AD, inflammatory processes have been found to be associated with both structural and functional anomalies, perhaps under the influence of environmental stress. Not enough research can suggest similar considerations in schizophrenia, although studies in mice and non-human primates support the belief that inflammatory responses generated during pregnancy can affect brain development and contribute to the etiology of schizophrenia. CONCLUSIONS: The present review suggests a link between inflammatory processes and MRI detected anomalies in the brain of individuals with MDD, older adults with cognitive impairment as well as of individuals with AD and schizophrenia.
    • Is universal screening for hepatitis C infection prior to commencing antitumour necrosis factor-α therapy necessary?

      Reid, C T; De Gascun, C; Hall, W; Collins, P; Lally, A; Kirby, B; Department of Dermatology, Saint Vincent's University Hospital, Elm Park, Dublin 4, Ireland. (2013-12)
      Screening for hepatitis C virus (HCV) prior to the commencement of antitumour necrosis factor (anti-TNF)-α therapies for dermatological disease is recommended for all patients.
    • Is valve choice a significant determinant of paravalular leak post-transcatheter aortic valve implantation? A systematic review and meta-analysis.

      O'Sullivan, Katie E; Gough, Aideen; Segurado, Ricardo; Barry, Mitchel; Sugrue, Declan; Hurley, John; Mater University Hospital and Mater Private Hospital, Dublin, Ireland. (2013-11-01)
      Paravalvular regurgitation (PVR) following transcatheter aortic valve implantation (TAVI) is associated with poor survival. The two main valve delivery systems used to date differ significantly in both structure and deployment technique. The primary objective of this study was to perform a systematic review and meta-analysis of studies identifying PVR in patients post-TAVI using Medtronic CoreValve (MCV) and Edward Sapien (ES) valves in order to identify whether a significant difference exists between valve types. The secondary objective was to identify additional factors predisposing to PVR to provide an overview of the other associated considerations.
    • Ischaemic stroke in children secondary to post varicella angiopathy.

      Hayes, B; Baker, L; Alhajeri, A; Ryan, S; Lynch, B; The Childrens University Hospital, Temple Street, Dublin. (2007-01)
      Varicella in childhood is a self-limiting disease, which usually follows a benign course. However, complications, although rare, may have serious consequences. Ischaemic stroke secondary to post varicella angiopathy is a well-described complication and is estimated to account for up to a third of all strokes in infants. We present three previously healthy children who presented to our centre with ischaemic cerebrovascular infarction due to varicella angiopathy. All three children first presented within six weeks after onset of varicella infection and had MRI changes characteristic of ischaemic stroke secondary to post varicella angiopathy. While one child made an excellent recovery being left with only a minor deficit, the remaining two children were left with considerable morbidity severely affecting quality of life. The varicella vaccine has been proven to be well tolerated, safe and effective. We conclude that varicella vaccination should be considered for inclusion in the vaccination schedule to prevent serious complications which while rare may have devastating consequences.
    • Isoimmune haemolytic disease: Effect of immunoglobulin on haematological parameters and safety profile

      Freyne, B; O'Hare, F; Molloy, E (Pediatric Research, 2011-11)
      52nd Annual Meeting of the European Socirty for Paediatric Research Newcastle UK October 2011
    • Isolated acute non-cystic white matter injury in term infants presenting with neonatal encephalopathy.

      Barrett, Michael Joseph; Donoghue, Veronica; Mooney, Eoghan E; Slevin, Marie; Persaud, Thara; Twomey, Eilish; Ryan, Stephanie; Laffan, Eoghan; Twomey, Anne; Department of Neonatology, National Maternity Hospital, Holles Street, Dublin 2, Ireland. mjjbarrett@hotmail.com (2013-03)
      We discuss possible aetiological factors, MRI evolution of injury and neuro-developmental outcomes of neonatal encephalopathy (NE). Thirty-six consecutive infants diagnosed with NE were included. In this cohort, four infants (11%) were identified with injury predominantly in the deep white matter on MRI who were significantly of younger gestation, lower birthweight with higher Apgars at one and five minutes compared to controls. Placental high grade villitis of unknown aetiology (VUA) was identified in all four of these infants. Our hypothesis states VUA may induce white matter injury by causing a local inflammatory response and/or oxidative stress during the perinatal period. We underline the importance of continued close and systematic evaluation of all cases of NE, including examination of the placenta, in order to come to a better understanding of the clinical presentation, the patterns of brain injury and the underlying pathophysiological processes.
    • Isolated dislocation of pisiform in an 11-year-old, following a horse bite: a rare injury

      Raval, Pradyumna; Saeed, Nauman; Narayan Mahapatra, Anant; Our Lady of Lourdes Hospital (Springer, 2013-01)
    • Isolated first rib fracture with minimal trauma.

      Breen, K J; Conneely, J B; Winter, D C; Department of Surgery, iCORE, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland. (2011-12)
      The traditional teaching states that upper rib fractures are associated with severe trauma and a high risk of neurovascular insult.
    • Isolated hypoganglionosis: systematic review of a rare intestinal innervation defect.

      Dingemann, Jens; Puri, Prem; National Children's Research Centre, Our Lady's Children's Hospital, Crumlin,, Dublin-12, Ireland. (2012-02-01)
      PURPOSE: Isolated hypoganglionosis (IH) is rare and resembles Hirschsprung's disease. The diagnosis by suction biopsy is difficult. A full-thickness biopsy is essential. Histological features of IH include sparse, small myenteric ganglia, low acetylcholinesterase activity in the lamina propria, and hypertrophy of muscularis mucosae and circular muscle. This review investigates the epidemiology, symptoms, diagnosis, and outcome of patients with IH. METHODS: A systematic review, using the keywords "isolated hypoganglionosis" and "intestinal hypoganglionosis" was performed. Publications were reviewed for epidemiology, histological methods, operative procedures, follow-up, and patient's outcome. RESULTS: Eleven publications from 1978 to 2009 reported 92 patients with IH (69 males and 23 females, age 4.85 years), presenting with constipation or enterocolitis. Diagnosis of IH was made by full-thickness biopsy and AChE staining in 91% of patients with additional staining in 82%; 54 patients had bowel resection and pull-through procedures; 11 patients had ileostomy or colostomy, and 2 had sphincter myectomy. Complications reported were enterocolitis, constipation, and residual disease. Seven patients (8%) died due to enterocolitis or short-bowel complications. CONCLUSION: This review confirms that diagnosis of IH is only possible by histochemical examination of a full-thickness biopsy. Despite advanced age at diagnosis of IH, epidemiological and clinical data are similar to aganglionosis.
    • Isolated hypothyroxinemia in early gestation reflects low toal thyroxine levels, while isolated high thyroid stimulating hormone does not.

      Breathnach, FM; Truemann, A; Rooney, S; Cooley, SM; Donnelly, J; Geary, M; Malone, FD; Rotunda Hospital (2009-01)
    • Isolated trochlear infarction: an uncommon cause of acquired diplopia.

      Walsh, Richard A; Murphy, Raymond P; Moore, David P; McCabe, Dominick J H; Department of Neurology, The Adelaide and Meath Hospital, Dublin, Ireland. (2012-02-01)