• A 76 year old female diagnosed with cystic fibrosis

      O’Brien, ME; Murphy, DM; Plant, BJ (Irish Medical Journal, 2014-09)
      The diagnosis of Cystic Fibrosis (CF) requires a high clinical suspicion in patients presenting at all ages. Early recognition permits referral to a specialist centre and may reduce the morbidity and mortality associated with CF. We report the case of the oldest patient in Ireland diagnosed with CF at 76 years of age and highlight the clinical features of her presentation.
    • Abnormalities of contrast sensitivity and electroretinogram following sevoflurane anaesthesia.

      Iohom, G; Gardiner, C; Whyte, A; O'Connor, G; Shorten, G; Cork University Hospital and University College Cork, Department of Anaesthesia, and Intensive Care Medicine, Cork, Ireland. (2012-02-03)
      BACKGROUND AND OBJECTIVE: We tested the hypothesis that disturbances of the visual pathway following sevoflurane general anaesthesia (a) exist and persist even after clinical discharge criteria have been met and (b) are associated with decreased contrast sensitivity. METHODS: We performed pattern and full-field flash electroretinograms (ERG) in 10 unpremedicated ASA I patients who underwent nitrous oxide/sevoflurane anaesthesia. ERG and contrast sensitivity were recorded preoperatively, immediately after discharge from the recovery room and 2 h after discontinuation of sevoflurane. The time at which the Post Anaesthesia Discharge Score first exceeded 9 was also noted. Data were analysed using paired, one-tailed t-tests and Pearson's correlation coefficient. RESULTS: On the full-field photopic ERG, b-wave latency was greater at each postoperative time point (31.6+/-1.1 and 30.8+/-1.1 ms) compared to preoperatively (30.1+/-1.1 ms, P < 0.001 and P = 0.03, respectively). Oscillatory potential latencies were greater on discharge from the recovery room compared with preanaesthetic values (23.1+/-3.1 vs. 22.4+/-3.3 ms, P = 0.01) and returned to baseline by 2 h after emergence from anaesthesia. Also at 2 h after emergence from anaesthesia: (a) P50 latency on the pattern ERG was greater than at baseline (81.5+/-17.9 vs. 51.15+/-22.6ms, P = 0.004); (b) N95 amplitude was less compared to preanaesthetic values (2.6+/-0.5 vs. 3.3+/-0.4 microV, P = 0.003) and (c) contrast sensitivity was less compared to baseline values (349+/-153 vs. 404+/-140, P = 0.048). A positive correlation was demonstrated between contrast sensitivity and both N95 amplitude and b-wave latency (r = 0.99 and r = -0.55 at significance levels of P < 0.005 and P < 0.05, respectively). CONCLUSIONS: Postoperative ERG abnormalities and associated decreases in contrast sensitivity are consistently present in patients who have undergone nitrous oxide/sevoflurane anaesthesia. These abnormalities persist beyond the time at which standard clinical discharge criteria have been met.
    • Absorbable Polydioxanone (PDS) suture provides fewer wound complications than polyester (ethibond) suture in acute Tendo-Achilles rupture repair

      Baig, M N; J G Galbraith, J G; Yousaf, I; Din, Robert (Irish Medical Journal, 2017-05)
      We prospectively studied acute Achilles tendon rupture in patients over a two 2-year period and reviewed the causes, outcome and complications. There were 53 patients included with acute Achilles rupture with minimum follow up period of 6 months. We compared the outcomes including infection rate and Boyden score between the two groups repaired by Polydioxanone and Polyester respectively. All infected cases had a suture repair using the polyester suture. The difference in the infection rate was highly significant between the 2 groups (p=0.001). All 34 patients (100%) in the PDS group had good / excellent results based on the Boyden clinical assessment. Conversely, only 16 patients 9(68.4%) had good or excellent results IN Polyester repair group. Patients treated with a non- absorbable suture (ethibond) material for repair had a higher incidence infection and worse Boyden scores than the absorbable PDS group.
    • Accidental human poisoning with a veterinary tranquilliser.

      Cummins, F H; Cork University Hospital, Cork, Ireland. cumminsfergal@hotmail.com (2012-02-03)
    • Accidental shotgun injuries sustained in game-shooting.

      O'Sullivan, S T; O'Shaughnessy, M; O'Connor, T P; Department of Plastic & Reconstructive Surgery, Cork University Hospital,, Ireland. (2012-02-03)
    • ACE up the sleeve - are vascular patients medically optimized?

      Coveney, A P; O'Brien, G C; Fulton, G J; Department of Vascular Surgery, Cork University Hospital, National University of Ireland, Cork, Ireland. acoveney@gmail.com (2011-03)
      To examine the current medical management of arteriopathic patients attending a vascular surgical service at a university teaching hospital over a 6-month period. The prescribing of antiplatelets, statins, angiotensin-converting enzyme (ACE) inhibitors, or angiotensin receptor blockers and beta-blockers was specifically examined. Vascular patients are often under the care of multiple specialties, and therefore the influence of different medical specialties on the patients' medical management was also examined.
    • Acquired generalised neuromyotonia, cutaneous lupus erythematosus and alopecia areata in a patient with myasthenia gravis.

      O'Sullivan, S S; Mullins, Gerard M; Neligan, Aidan; McNamara, Brian; Galvin, Roderick J; Department of Neurology and Neurophysiology, Cork University Hospital, Wilton,, Cork, Ireland. sosulliv@ion.ucl.ac.uk (2012-02-03)
      We describe a patient with the diagnoses of acquired neuromyotonia, cutaneous lupus erythematosus and alopecia areata, occurring many years after a thymectomy for myasthenia gravis associated with a thymoma. We review the current literature on autoimmune conditions associated with myasthenia gravis and thymectomy. To our knowledge, this combination of multiple autoimmune conditions has not been reported previously.
    • Actinomyces pyogenes septic arthritis in a diabetic farmer.

      Lynch, M; O'Leary, J; Murnaghan, D; Cryan, B; Department of Medical Microbiology, Cork University Hospital, Wilton, Ireland. (2012-02-03)
      We report a case of septic arthritis and osteomyelitis of the left ankle due to Actinomyces pyogenes in a diabetic farmer. Few confirmed human cases of A. pyogenes infection have been reported, partly because of inadequate identification of this bacterium. Bacteriological characteristics of the organism, which resembles Arcanobacterium haemolyticum, are described with a review of previous case reports.
    • Activated endothelial interleukin-1beta, -6, and -8 concentrations and intercellular adhesion molecule-1 expression are attenuated by lidocaine.

      Lan, Wei; Harmon, Dominic C; Wang, Jiang H; Shorten, George D; Redmond, Paul H; Academic Department of Surgery, Cork University Hospital, University College,, Cork, Ireland. dweilan@hotmail.com (2012-02-03)
      Endothelial cells play a key role in ischemia reperfusion injury. We investigated the effects of lidocaine on activated human umbilical vein endothelial cell (HUVEC) interleukin (IL)-1beta, IL-6, and IL-8 concentrations and intercellular adhesion molecule-1 (ICAM-1) expression. HUVECs were pretreated with different concentrations of lidocaine (0 to 0.5 mg/mL) for 60 min, thereafter tumor necrosis factor-alpha was added at a concentration of 2.5 ng/mL and the cells incubated for 4 h. Supernatants were harvested, and cytokine concentrations were analyzed by enzyme-linked immunosorbent assay. Endothelial ICAM-1 expression was analyzed by using flow cytometry. Differences were assessed using analysis of variance and post hoc unpaired Student's t-test where appropriate. Lidocaine (0.5 mg/mL) decreased IL-1beta (1.89 +/- 0.11 versus 4.16 +/- 1.27 pg/mL; P = 0.009), IL-6 (65.5 +/- 5.14 versus 162 +/- 11.5 pg/mL; P < 0.001), and IL-8 (3869 +/- 785 versus 14,961 +/- 406 pg/mL; P < 0.001) concentrations compared with the control. IL-1beta, IL-6, and IL-8 concentrations in HUVECs treated with clinically relevant plasma concentrations of lidocaine (0.005 mg/mL) were similar to control. ICAM-1 expression on lidocaine-treated (0.05 mg/mL) HUVECs was less than on controls (198 +/- 52.7 versus 298 +/- 50.3; Mean Channel Fluorescence; P < 0.001). Activated endothelial IL-1beta, IL-6, and IL-8 concentrations and ICAM-1 expression are attenuated only by lidocaine at concentrations larger than clinically relevant concentrations.
    • Activated human neutrophils release hepatocyte growth factor/scatter factor.

      McCourt, M; Wang, J H; Sookhai, S; Redmond, H P; Department of Surgery, Professorial Unit, Cork University Hospital, Cork,, Ireland. (2012-02-03)
      BACKGROUND: Hepatocyte growth factor or scatter factor (HGF/SF) is a pleiotropic cytokine that has potent angiogenic properties. We have previously demonstrated that neutrophils (PMN) are directly angiogenic by releasing vascular endothelial growth factor (VEGF). We hypothesized that the acute inflammatory response can stimulate PMN to release HGF. AIMS: To examine the effects of inflammatory mediators on PMN HGF release and the effect of recombinant human HGF (rhHGF) on PMN adhesion receptor expression and PMN VEGF release. METHODS: In the first experiment, PMN were isolated from healthy volunteers and stimulated with tumour necrosis factor-alpha (TNF-alpha), lipopolysaccharide (LPS), interleukin-8 (IL-8), and formyl methionyl-leucyl-phenylalanine (fMLP). Culture supernatants were assayed for HGF using ELISA. In the second experiment, PMN were lysed to measure total HGF release and HGF expression in the PMN was detected by Western immunoblotting. Finally, PMN were stimulated with rhHGF. PMN CD 11a, CD 11b, and CD 18 receptor expression and VEGF release was measured using flow cytometry and ELISA respectively. RESULTS: TNF-alpha, LPS and fMLP stimulation resulted in significantly increased release of PMN HGF (755+/-216, 484+/-221 and 565+/-278 pg/ml, respectively) compared to controls (118+/-42 pg/ml). IL-8 had no effect. Total HGF release following cell lysis and Western blot suggests that HGF is released from intracellular stores. Recombinant human HGF did not alter PMN adhesion receptor expression and had no effect on PMN VEGF release. CONCLUSIONS: This study demonstrates that pro-inflammatory mediators can stimulate HGF release from a PMN intracellular store and that activated PMN in addition to secreting VEGF have further angiogenic potential by releasing HGF.
    • Activated protein C attenuates acute ischaemia reperfusion injury in skeletal muscle.

      Dillon, J P; Laing, A J; Cahill, R A; O'Brien, G C; Street, J T; Wang, J H; Mc Guinness, A; Redmond, H P; Department of Academic Surgery and Orthopaedics, Cork University Hospital and, National University of Ireland, Cork, Ireland. dillionjp@o2.ie (2012-02-03)
      Activated protein C (APC) is an endogenous anti-coagulant with anti-inflammatory properties. The purpose of the present study was to evaluate the effects of activated protein C in the setting of skeletal muscle ischaemia reperfusion injury (IRI). IRI was induced in rats by applying rubber bands above the levels of the greater trochanters bilaterally for a period of 2h followed by 12h reperfusion. Treatment groups received either equal volumes of normal saline or activated protein C prior to tourniquet release. Following 12h reperfusion, muscle function was assessed electrophysiologically by electrical field stimulation. The animals were then sacrificed and skeletal muscle harvested for evaluation. Activated protein C significantly attenuated skeletal muscle reperfusion injury as shown by reduced myeloperoxidase content, wet to dry ratio and electrical properties of skeletal muscle. Further in vitro work was carried out on neutrophils isolated from healthy volunteers to determine the direct effect of APC on neutrophil function. The effects of APC on TNF-alpha stimulated neutrophils were examined by measuring CD18 expression as well as reactive oxygen species generation. The in vitro work demonstrated a reduction in CD18 expression and reactive oxygen species generation. We conclude that activated protein C may have a protective role in the setting of skeletal muscle ischaemia reperfusion injury and that this is in part mediated by a direct inhibitory effect on neutrophil activation.
    • Activation of a TLR9 mediated innate immune response in preeclampsia.

      Williamson, Rachel D; McCarthy, Fergus P; Kenny, Louise C; McCarthy, Cathal M (Scientific Reports, 2019-04-11)
      Preeclampsia is a multisystemic disorder leading to the development of a placental ischemic microenvironment with a resultant increase in oxidative stress. There is evidence that mitochondrial dysfunction and the innate immune system both play a role in the pathophysiology of this disease. Mitochondrial DAMPs such as mtDNA bind specifc pattern recognition receptors such as Toll-like receptor 9 (TLR9) on the endosomal surface of immune cells, in particular neutrophils, subsequently activating them and triggering an innate response. We hypothesised that the exaggerated innate immune response seen in preeclampsia is provoked by dysfunctional mitochondria. Here we provide evidence that TLR9 activity is signifcantly increased at time of disease in women with preeclampsia. Furthermore, we show activation of neutrophil markers, Calprotectin, Myeloperoxidase (MPO), and IL-8 are signifcantly increased at time of disease compared to uncomplicated pregnancies. This research supports a potential role of TLR9 activation of an innate immune response evident in preeclampsia which may possibly be initially triggered by dysfunctional mitochondria.
    • Activation of hemostasis and decline in cognitive function in older people.

      Stott, David J; Robertson, Michele; Rumley, Ann; Welsh, Paul; Sattar, Naveed; Packard, Christopher J; Shepherd, James; Trompet, Stella; Westendorp, Rudi G J; de Craen, Anton J M; et al. (2010-03)
      To determine whether activation of hemostatic function (thrombosis and fibrinolysis) is associated with cognitive decline in older people.
    • Acute cardiac failure in neuroleptic malignant syndrome.

      Sparrow, Patrick; Murnaghan, Dermot; Kearney, Peter; Hogan, John; Sheppard, Mary N; Department of Cardiology, Cork University Hospital, Cork, Ireland., patsparrow@doctors.net.uk (2012-02-03)
      We present a case of rapid onset acute cardiac failure developing as part of neuroleptic malignant syndrome in a 35-year-old woman following treatment with thioridazine and lithium. Post mortem histology of cardiac and skeletal muscle showed similar changes of focal cellular necrosis and vacuolation suggesting a common disease process.
    • Acute compartment syndrome and the role of regional anesthesia.

      Mannion, Stephen; Capdevila, Xavier; Department of Anaesthesiology, South Infirmary-Victoria University Hospital,, Cork, Ireland. Mannionstephen@gmail.com (2012-02-01)
    • Acute exertional peroneal compartmental syndrome following prolonged horse riding.

      Nicholson, P; Devitt, A; Stevens, M; Mahalingum, K; Department of Orthopaedic Surgery, Cork University Hospital, Ireland. (2012-02-03)
    • Acute hospital medicine--a new sub-speciality or internal medicine re-born?

      Kellett, John; Nenagh Hospital, Department of Medicine, Nenagh, Co. Tipperary, Ireland. jgkellett@eircom.net (2011-08)
    • Acute medical assessment units: an efficient alternative to in-hospital acute medical care.

      Watts, M; Powys, L; Hora, C O; Kinsella, S; Saunders, J; Reid, L; Finucane, P; Department of Medicine, Mid-Western Regional Hospital, Dooradoyle, Limerick. michael.watts@hse.ie (Irish Medical Journal, 2011-02)
      Acute Medical Assessment Units (AMAUs) are being proposed as an alternative to congested Emergency Departments (EDs for the assessment of patients with a range of acute medical problems. We retrospectively reviewed the discharge destination of patients referred to a newly established AMAU during a six-month period. During the same period we contrasted activity in the ED for a similar group of patients. 1,562 patients were assessed in the AMAU. 196 (12.5%) were admitted to an in-patient bed and 1,148 (73.5%) were entered into specific diagnosis-driven out-patient pathways. 1,465 patients attended the ED and 635 (43.3%) were admitted. Out-patient alternatives to expensive in-patient care need to be provided at the 'coal face" of acute referral. The AMAU provides this, and as a consequence admission rates are relatively low. This is achieved by directly communicating with GPs, accessing senior clinical decision makers, and providing immediate access to diagnostically driven outpatient pathways.