• Who benefits from supported employment: a meta-analytic study.

      Campbell, Kikuko; Bond, Gary R; Drake, Robert E; Department of Psychiatry, Royal College of Surgeons in Ireland, Beaumont, Hospital, Dublin, Ireland. kiyamamo@iupui.edu (2012-02-01)
      AIMS: This meta-analysis sought to identify which subgroups of clients with severe mental illness (SMI) benefited from evidence-based supported employment. METHODS: We used meta-analysis to pool the samples from 4 randomized controlled trials comparing the Individual Placement and Support (IPS) model of supported employment to well-regarded vocational approaches using stepwise models and brokered services. Meta-analysis was used to determine the magnitude of effects for IPS/control group differences within specific client subgroups (defined by 2 work history, 7 sociodemographic, and 8 clinical variables) on 3 competitive employment outcomes (obtaining a job, total weeks worked, and job tenure). RESULTS: The findings strongly favored IPS, with large effect sizes across all outcomes: 0.96 for job acquisition, 0.79 for total weeks worked, and 0.74 for job tenure. Overall, 90 (77%) of the 117 effect sizes calculated for the 39 subgroups exceeded 0.70, and all 117 favored IPS. CONCLUSIONS: IPS produces better competitive employment outcomes for persons with SMI than alternative vocational programs regardless of background demographic, clinical, and employment characteristics.
    • Whole body imaging in the abdominal cancer patient: pitfalls of PET-CT.

      McDermott, Shaunagh; Skehan, Stephen J; Department of Radiology, St. Vincent's University Hospital, Elm Park, Dublin, 4, , Ireland. mcdermottshaunagh@gmail.com (2012-02-01)
      Proper interpretation of PET-CT images requires knowledge of the normal physiological distribution of the tracer, frequently encountered physiological variants, and benign pathological causes of FDG uptake that can be confused with a malignant neoplasm. In addition, not all malignant processes are associated with avid tracer uptake. A basic knowledge of the technique of image acquisition is also required to avoid pitfalls such as misregistration of anatomical and scintigraphic data. This article reviews these potential pitfalls as they apply to the abdomen and pelvis of patients with cancer.
    • Whole body MRI in the diagnosis of chronic recurrent multifocal osteomyelitis.

      Kennedy, M T; Murphy, T; Murphy, M; Laffan, E; Connolly, P; Department of Orthopaedic Surgery, Children's University Hospital, Temple Street, Dublin 1, Ireland. muiris_kennedy@yahoo.ie (2012-06)
      Chronic recurrent multifocal osteomyelitis (CRMO) is a diagnosis of exclusion primarily in children and adolescents. As part of the essential criteria for the diagnosis of CRMO, multifocal lesions must be identified. We present the case of an 11-year-old boy with CRMO, whose diagnosis was facilitated by the use of whole body magnetic resonance imaging (WBMR), but not isotope bone scanning.
    • Whole-Body MRI versus PET in assessment of multiple myeloma disease activity.

      Shortt, Conor P; Gleeson, Tadhg G; Breen, Karen A; McHugh, John; O'Connell, Martin J; O'Gorman, Peter J; Eustace, Stephen J; Department of Radiology and Diagnostic Imaging, Mater Misericordiae University Hospital, Dublin, Ireland. (AJR. American journal of roentgenology, 2009-04)
      The purpose of this study was to compare FDG PET; whole-body MRI; and the reference standard, bone marrow aspiration and biopsy, to determine the best imaging technique for assessment of disease activity in multiple myeloma.
    • Why does it take so long? ‘Lean processing’ in the aseptic compounding unit at the Midland Regional Hospital Tullamore

      Greene, C; Crimmins, É; Garvey, E; Midland Regional Hospital Tullamore (2011-06)
      Increasing numbers of oncology/haematology patients attending Midland Regional Hospital Tullamore (MRHT) has increased the workload of the Regional Oncology Haematology Pharmacy (ROHP) compounding unit. Staff restrictions require optimisation of current workflow practices. This audit (November 2010 and June 2011) focused on workflow in the aseptic compounding unit. In MRHT, ‘go-aheads’ are given by nurses and doctors. Drugs are compounded on an individual patient basis, except for batch production of bevacizumab and cetuximab. Focusing on the workflow process and comparing individual versus batch production in this audit may identify trends to improve efficiency.
    • Widespread cortical morphologic changes in juvenile myoclonic epilepsy: evidence from structural MRI.

      Ronan, Lisa; Alhusaini, Saud; Scanlon, Cathy; Doherty, Colin P; Delanty, Norman; Fitzsimons, Mary; Brain Morphometry Laboratory, Neurophysics Department, Beaumont Hospital, Dublin, Ireland. (2012-04)
      Atypical morphology of the surface of the cerebral cortex may be related to abnormal cortical folding (gyrification) and therefore may indicate underlying malformations of cortical development (MCDs). Using magnetic resonance imaging (MRI)-based analysis, we examined cortical morphology in patients with juvenile myoclonic epilepsy (JME).
    • Will crystal parkin help in understanding the future of Parkinson's disease?

      Olszewska, Diana Angelika; Lynch, Tim (2015-02-24)
      A commentary on Structure and function of Parkin E3 ubiquitin ligase reveals aspects of RING and HECT ligases by Riley BE, Lougheed JC, Callaway K, Velasquez M, Brecht E, Nguyen L, et al. Nat Commun (2013) 4:1982. doi:10.1038/ncomms2982
    • Wilms tumor arising in extracoelomic paravertebral soft tissues.

      Mulligan, Linda; Nosherwan, Asma; Hayes, Roisin; Pears, Jane; McDermott, Michael; O'Sullivan, Maureen; Department of Pathology, Our Lady's Children's Hospital, Crumlin, Dublin 12,, Ireland. (2012-02-01)
      Extrarenal Wilms tumor (ERWT) is a well-established entity which most commonly arises within the genitourinary tract, including intracoelomic paranephric soft tissue. Rarely, ERWT arises within teratoma, and it tends to occur predominantly in distinct settings, such as females with spinal defects and males with testicular teratomas. We report a unique ERWT arising within an extracoelomic teratoma of the paraspinal musculature, thereby expanding the range of reported locations for this unusual tumor.
    • Withdrawal of corticosteroids in inflammatory bowel disease patients after dependency periods ranging from 2 to 45 years: a proposed method.

      Murphy, S J; Wang, L; Anderson, L A; Steinlauf, A; Present, D H; Mechanick, J I; Centre for Colorectal disease, St. Vincent's University Hospital, Dublin,, Ireland. s.murphy@qub.ac.uk (2012-02-01)
      BACKGROUND: Even in the biologic era, corticosteroid dependency in IBD patients is common and causes a lot of morbidity, but methods of withdrawal are not well described. AIM: To assess the effectiveness of a corticosteroid withdrawal method. METHODS: Twelve patients (10 men, 2 women; 6 ulcerative colitis, 6 Crohn's disease), median age 53.5 years (range 29-75) were included. IBD patients with quiescent disease refractory to conventional weaning were transitioned to oral dexamethasone, educated about symptoms of the corticosteroid withdrawal syndrome (CWS) and weaned under the supervision of an endocrinologist. When patients failed to wean despite a slow weaning pace and their IBD remaining quiescent, low dose synthetic ACTH stimulation testing was performed to assess for adrenal insufficiency. Multivariate analysis was performed to assess predictors of a slow wean. RESULTS: Median durations for disease and corticosteroid dependency were 21 (range 3-45) and 14 (range 2-45) years respectively. Ten patients (83%) were successfully weaned after a median follow-up from final wean of 38 months (range 5-73). Disease flares occurred in two patients, CWS in five and ACTH testing was performed in 10. Multivariate analysis showed that longer duration of corticosteroid use appeared to be associated with a slower wean (P = 0.056). CONCLUSIONS: Corticosteroid withdrawal using this protocol had a high success rate and durable effect and was effective in patients with long-standing (up to 45 years) dependency. As symptoms of CWS mimic symptoms of IBD disease flares, gastroenterologists may have difficulty distinguishing them, which may be a contributory factor to the frequency of corticosteroid dependency in IBD patients.
    • WITHDRAWN: Active versus expectant management in the third stage of labour.

      Prendiville, Walter J P; Elbourne, Diana; McDonald, Susan J; Department of Obstetrics and Gynaecology, Coombe Lying-In Hospital, Dolphin's, Barn, Dublin 8, Ireland. (2012-02-01)
      BACKGROUND: Expectant management of the third stage of labour involves allowing the placenta to deliver spontaneously or aiding by gravity or nipple stimulation. Active management involves administration of a prophylactic oxytocic before delivery of the placenta, and usually early cord clamping and cutting, and controlled cord traction of the umbilical cord. OBJECTIVES: The objective of this review was to assess the effects of active versus expectant management on blood loss, post partum haemorrhage and other maternal and perinatal complications of the third stage of labour. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register. SELECTION CRITERIA: Randomised trials comparing active and expectant management of the third stage of labour in women who were expecting a vaginal delivery. DATA COLLECTION AND ANALYSIS: Trial quality was assessed and data were extracted independently by the reviewers. MAIN RESULTS: Five studies were included. Four of the trials were of good quality. Compared to expectant management, active management (in the setting of a maternity hospital) was associated with the following reduced risks: maternal blood loss (weighted mean difference -79.33 millilitres, 95% confidence interval -94.29 to -64.37); post partum haemorrhage of more than 500 millilitres (relative risk 0.38, 95% confidence interval 0.32 to 0.46); prolonged third stage of labour (weighted mean difference -9.77 minutes, 95% confidence interval -10.00 to -9.53). Active management was associated with an increased risk of maternal nausea (relative risk 1.83, 95% confidence interval 1.51 to 2.23), vomiting and raised blood pressure (probably due to the use of ergometrine). No advantages or disadvantages were apparent for the baby. AUTHORS' CONCLUSIONS: Routine 'active management' is superior to 'expectant management' in terms of blood loss, post partum haemorrhage and other serious complications of the third stage of labour. Active management is, however, associated with an increased risk of unpleasant side effects (eg nausea and vomiting), and hypertension, where ergometrine is used. Active management should be the routine management of choice for women expecting to deliver a baby by vaginal delivery in a maternity hospital. The implications are less clear for other settings including domiciliary practice (in developing and industrialised countries).
    • Women in hospital medicine: Facts, figures and personal experiences

      Meghen, K; Sweeney, C; Linehan, C; O‘Flynn, S; Boylan, G (Irish Medical Journal, 2013-02)
    • Working Backs Project--implementing low back pain guidelines

      Cunningham, C. G.; Flynn, T. A.; Toole, C. M.; Ryan, R. G.; Gueret, P. W. J.; Bulfin, S.; Seale, O.; Blake, C. (2012-04-30)
    • The worrying modern scenario of benign pathology after nephrectomy for presumed renal cancer

      Inder, SM; Smyth, L; Davis, NF; Thornhill, J (Irish Medical Journal, 2016-01)
      The detection of incidental renal tumours has dramatically increased over the last twenty years as a result of widespread ultrasound and CT scanning for various other conditions. Renal cancer is now an incidental diagnosis in over 50% of cases 1 . Survival rates have dramatically improved as a result of early surgical intervention (radical or partial nephrectomy) 2 . However, despite advances in radiology, benign renal lesions may be indeterminate from renal cancer. We report our incidence of patients undergoing nephrectomy for clinically diagnosed renal cancer but with subsequent benign pathology.
    • Wound dressings-an overview

      Moore, Z; O'Brien, J J (2011-10)
    • Wunderlich syndrome as the first manifestation of renal cell carcinoma.

      Oon, Sheng F; Murphy, Michael; Connolly, Stephen S; Department of Urology, St. Vincent'sUniversity Hospital, Elm Park, Dublin, Ireland. shengfeioon@rcsi.ie (2010)
    • X inactivation in females with X-linked Charcot-Marie-Tooth disease.

      Murphy, Sinéad M; Ovens, Richard; Polke, James; Siskind, Carly E; Laurà, Matilde; Bull, Karen; Ramdharry, Gita; Houlden, Henry; Murphy, Raymond P J; Shy, Michael E; et al. (Neuromuscular disorders : NMD, 2012-07)
      X-linked Charcot-Marie-Tooth disease (CMT1X) is the second most common inherited neuropathy, caused by mutations in gap junction beta-1 (GJB1). Males have a uniformly moderately severe phenotype while females have a variable phenotype, suggested to be due to X inactivation. We aimed to assess X inactivation pattern in females with CMT1X and correlate this with phenotype using the CMT examination score to determine whether the X inactivation pattern accounted for the variable phenotype in females with CMT1X. We determined X inactivation pattern in 67 females with CMT1X and 24 controls using the androgen receptor assay. We were able to determine which X chromosome carried the GJB1 mutation in 30 females. There was no difference in X inactivation pattern between patients and controls. In addition, there was no correlation between X inactivation pattern in blood and phenotype. A possible explanation for these findings is that the X inactivation pattern in Schwann cells rather than in blood may explain the variable phenotype in females with CMT1X.
    • An X11alpha/FSBP complex represses transcription of the GSK3beta gene promoter.

      Lau, Kwok-Fai; Perkinton, Michael S; Rodriguez, Lilia; McLoughlin, Declan M; Miller, Christopher C J; Department of Biochemistry Science, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR. kflau@cuhk.edu.hk (2010-08-04)
      X11alpha is a neuronal adaptor protein that interacts with the amyloid precursor protein (APP) through a centrally located phosphotyrosine binding domain to inhibit the production of Abeta peptide that is deposited in Alzheimer's disease brains. X11alpha also contains two C-terminal postsynaptic density-95, large discs, zona occludens 1 (PDZ) domains, and we show here that through its PDZ domains, X11alpha interacts with a novel transcription factor, fibrinogen silencer binding protein. Moreover, we show that an X11alpha/fibrinogen silencer binding protein complex signals to the nucleus to repress glycogen synthase kinase-3beta promoter activity. Glycogen synthase kinase-3beta is a favoured candidate kinase for phosphorylating tau in Alzheimer's disease. Our findings show a new function for X11alpha that may impact on Alzheimer's disease pathogenesis.
    • X11beta rescues memory and long-term potentiation deficits in Alzheimer's disease APPswe Tg2576 mice.

      Mitchell, Jacqueline C; Ariff, Belall B; Yates, Darran M; Lau, Kwok-Fai; Perkinton, Michael S; Rogelj, Boris; Stephenson, John D; Miller, Christopher C J; McLoughlin, Declan M; MRC Centre for Neurodegeneration Research, King's College London, Institute of Psychiatry, London SE5 8AF, UK. (2009-12-01)
      Increased production and deposition of amyloid beta-protein (Abeta) are believed to be key pathogenic events in Alzheimer's disease. As such, routes for lowering cerebral Abeta levels represent potential therapeutic targets for Alzheimer's disease. X11beta is a neuronal adaptor protein that binds to the intracellular domain of the amyloid precursor protein (APP). Overexpression of X11beta inhibits Abeta production in a number of experimental systems. However, whether these changes to APP processing and Abeta production induced by X11beta overexpression also induce beneficial effects to memory and synaptic plasticity are not known. We report here that X11beta-mediated reduction in cerebral Abeta is associated with normalization of both cognition and in vivo long-term potentiation in aged APPswe Tg2576 transgenic mice that model the amyloid pathology of Alzheimer's disease. Overexpression of X11beta itself has no detectable adverse effects upon mouse behaviour. These findings support the notion that modulation of X11beta function represents a therapeutic target for Abeta-mediated neuronal dysfunction in Alzheimer's disease.