• Early aggressive intra-venous pulse cyclophosphamide therapy for interstitial lung disease in a patient with systemic sclerosis. A case report.

      Peshin, R; O'Neill, L; Browne, P; O'Connell, P; Kearns, G; Department of Rheumatology, Beaumont Hospital, Dublin, Republic of Ireland. rohit_peshin@yahoo.com (2009-06)
      Interstitial lung disease is an important cause of mortality and morbidity in patients with systemic sclerosis (SSc). There are currently no recommended guidelines for management of these patients. This is probably due to the rarity of this condition, as well as clinical trials with only a small number of cases. There are published case report and case series along with the two main trials, viz. Scleroderma Lung Study and the Fibrosing Alveolitis Study, but again, there is no consensus on treatment protocols. In this report, we present a case of aggressive interstitial lung disease in a patient with SSc, which improved dramatically on treatment with intra-venous cyclophosphamide and high dose prednisolone therapy.
    • Early experience of a fall and fracture prevention clinic at Mayo General Hospital.

      Hanley, A; Ali, M T; Murphy, J; Beaumont Hospital, Beaumont, Dublin 9, Ireland. alanhanley@gmail.com (2010-06)
      Falls in the elderly are a significant public health problem. Previous studies have shown that most falls are multifactorial and an efficacious way of reducing the risk of falling is provided by a falls clinic.
    • EBV-positive B cell cerebral lymphoma 12 years after sex-mismatched kidney transplantation: post-transplant lymphoproliferative disorder or donor-derived lymphoma?

      Phelan, Paul J; Murphy, Rory K J; Farrell, Michael; O'Toole, Orna; Heffernan, Josie; O'Brien, Donncha; Breathnach, Oscar; Conlon, Peter J; Department of Nephrology, Beaumont Hospital, Dublin, Ireland. paulphel@gmail.com (2010-06)
      We present a follow-up case report of possible transmission of lymphoma 12 years after deceased-donor renal transplantation from a male donor who was found at autopsy to have had an occult lymphoma. The female recipient underwent prompt transplant nephrectomy. However, 12 years later, she presented with cerebral B cell lymphoma. A donor origin for the cerebral lymphoma was supported by in situ hybridization demonstration of a Y chromosome in the lymphoma. There was a dramatic resolution of the cerebral lesions with tapering of immunosuppression and introduction of rituximab treatment. The finding of a Y chromosome in the cerebral lymphoma does not exclude a host contribution to lymphoma development.
    • Economic analysis of combined endoscopic and endobronchial ultrasound in the evaluation of patients with suspected non-small cell lung cancer.

      Harewood, Gavin C; Pascual, Jorge; Raimondo, Massimo; Woodward, Timothy; Johnson, Margaret; McComb, Barbara; Odell, John; Jamil, Laith H; Gill, Kanwar Rupinder S; Wallace, Michael B; et al. (2010-03)
      Lung cancer remains the most common cause of cancer-related death in the United States. This study evaluated the costs of alternative diagnostic evaluations for patients with suspected non-small cell lung cancer (NSCLC). Researchers used a cost-minimization model to compare various diagnostic approaches in the evaluation of patients with NSCLC. It was less expensive to use an initial endoscopic ultrasound (EUS) with fine needle aspiration (FNA) to detect a mediastinal lymph node metastasis ($18,603 per patient), compared with combined EUS FNA and endobronchial ultrasound (EBUS) with FNA ($18,753). The results were sensitive to the prevalence of malignant mediastinal lymph nodes; EUS FNA remained least costly, if the probability of nodal metastases was <32.9%, as would occur in a patient without abnormal lymph nodes on computed tomography (CT). While EUS FNA combined with EBUS FNA was the most economical approach, if the rate of nodal metastases was higher, as would be the case in patients with abnormal lymph nodes on CT. Both of these strategies were less costly than bronchoscopy or mediastinoscopy. The pre-test probability of nodal metastases can determine the most cost-effective testing strategy for evaluation of a patient with NSCLC. Pre-procedure CT may be helpful in assessing probability of mediastinal nodal metastases.
    • Effect of 1,24R-dihydroxyvitamin D3 on the growth of human keratinocytes.

      Matsumoto, K; Hashimoto, K; Kiyoki, M; Yamamoto, M; Yoshikawa, K; Department of Dermatology, Osaka University School of Medicine, Japan. (1990-02)
      The effect of 1,24R-dihydroxyvitamin D3 (1,24R(OH)2D3), a synthetic analogue of a biologically active form of vitamin D3 (1,25-dihydroxyvitamin D3, 1,25(OH)2D3), on the growth of human keratinocytes cultured in serum-free medium was investigated. The growth of cultured normal human keratinocytes was inhibited by 65% by 10(-8)M 1,24R(OH)2D3 and by 90% by 10(-7)M 1,24(OH)2D3. It inhibited cell growth almost completely at 10(-6)M. The DNA synthesis of keratinocytes was also inhibited with 1,24R(OH)2D3 by 27% at 10(-8)M, 59% at 10(-7)M, and 92% at 10(-6)M. The inhibition of cell growth and DNA synthesis were more remarkable by 1,24R(OH)2D3 than by 1,25(OH)2D3. 1,24R(OH)2D3 also inhibited the growth of keratinocytes derived from patients with psoriasis vulgaris; the growth inhibitory effect was again more remarkable with 1,24R(OH)2D3 than with 1,25(OH)2D3. The viability and protein synthesis of keratinocytes were not affected by 1,24R(OH)2D3, suggesting that the growth inhibitory effect is due to its biological activity, not to cytotoxicity. The binding of [3H]-labeled 1,25(OH)2D3 to its receptor in the cytosolic fraction of cultured keratinocytes was competitively substituted by unlabeled 1,24R(OH)2D3 as well as 1,25(OH)2D3, suggesting that 1,24R(OH)2D3 binds to the 1,25(OH)2D3 receptor. It was found that the affinity of 1,24R(OH)2D3 for the receptor was slightly higher than that of 1,25(OH)2D3. These results demonstrate that 1,24R(OH)2D3 functions as a potent growth inhibitor in vitro in human keratinocytes from both normal and psoriatic epidermis, and it possesses a higher affinity for the 1,25(OH)2D3 receptor in cultured human keratinocytes. The difference in affinity of 1,24R(OH)2D3 for the 1,25(OH)2D3 receptor correlates with its greater inhibition of keratinocyte growth than 1,25(OH)2D3. 1,24R(OH)2D3 may be useful in the treatment of psoriasis.
    • Effect of a novel air disinfection system on airborne micro-organisms in a hospital outpatient clinic.

      O'Brien, D; Stevens, N; Fitzgerald-Hughes, D; Humphreys, H; Departments of Microbiology, The Royal College of Surgeons in Ireland and, Beaumont Hospital, RCSI Education and Research Centre, Beaumont Hospital, Dublin,, Ireland. (2012-02-01)
    • The effect of liposome encapsulation on the pharmacokinetics of recombinant secretory leukocyte protease inhibitor (rSLPI) therapy after local delivery to a guinea pig asthma model.

      Gibbons, Aileen; Padilla-Carlin, Danielle; Kelly, Ciara; Hickey, Anthony J; Taggart, Clifford; McElvaney, Noel G; Cryan, Sally-Ann; School of Pharmacy, Royal College of Surgeons in Ireland, Dublin, Ireland. (2011-09)
      Inhaled recombinant Secretory Leukocyte Protease Inhibitor (rSLPI) has shown potential for treatment of inflammatory lung conditions. Rapid inactivation of rSLPI by cathepsin L (Cat L) and rapid clearance from the lungs have limited clinical efficacy. Encapsulation of rSLPI within 1,2-Dioleoyl-sn-Glycero-3-[Phospho-L-Serine]:Cholesterol liposomes (DOPS-rSLPI) protects rSLPI against Cat L inactivation in vitro. We aimed to determine the effect of liposomes on rSLPI pharmacokinetics and activity in vitro and after local delivery to the airways in vivo.
    • Effect of patient coping preferences on quality of life following renal transplantation.

      White, Ciara; Gallagher, Pamela; Beaumont Hospital, Dublin, Ireland. ciarawhite@beaumont.ie (2010-11)
      This paper is a report of a study investigating the relationships between quality of life, patient coping preferences, and desire to be actively involved in care following renal transplantation.
    • Effect of perioperative blood transfusions on long term graft outcomes in renal transplant patients.

      O'Brien, Frank J; Lineen, James; Kennedy, Claire M; Phelan, Paul J; Kelly, Patrick O; Denton, Mark D; Magee, Colm; Conlon, Peter J; Department of Nephrology, Beaumont Hospital, Dublin, Ireland. frankjobrien84@gmail.com (2012-06)
      It is established that blood transfusions will promote sensitization to human leucocyte antigen (HLA) antigens, increase time spent waiting for transplantation and may lead to higher rates of rejection. Less is known about how perioperative blood transfusion influence patient and graft outcome. This study aims to establish if there is an association between perioperative blood transfusion and graft or patient survival.
    • The effectiveness of exercise therapy with and without manual therapy for hip osteoarthritis: A multicentre randomised controlled trial

      French, H; Cusack, T; Brennan, A; Fitzpatrick, M; Caffrey, A; Gilsenan, C; Cuddy, V; White, B; Kane, D; O'Connell, P; et al. (2011-04)
    • The effects of usual footwear on balance amongst elderly women attending a day hospital.

      Horgan, N Frances; Crehan, Fiona; Bartlett, Emma; Keogan, Fiona; O'Grady, Anne Marie; Moore, Allan R; Donegan, Ciaran F; Curran, Martina; School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin 2, Ireland. fhorgan@rcsi.ie (2009-01)
      to examine the effects of footwear on balance in a sample of older women attending a day hospital.
    • Efficacy and safety of colonic stenting for malignant disease in the elderly.

      Donnellan, Fergal; Cullen, Garret; Cagney, Daniel; O'Halloran, Phil; Harewood, Gavin C; Murray, Frank E; Patchett, Stephen E; Department of Gastroenterology, Beaumont Hospital, Dublin, Ireland. fdonnellan77@hotmail.com (2010-06)
      Self-expandable metal stents (SEMS) are an accepted palliation for malignant colorectal obstruction. Outcomes of stent insertion solely in older patients are unknown.
    • EFNS guidelines for the molecular diagnosis of neurogenetic disorders: motoneuron, peripheral nerve and muscle disorders.

      Burgunder, J-M; Schöls, L; Baets, J; Andersen, P; Gasser, T; Szolnoki, Z; Fontaine, B; Van Broeckhoven, C; Di Donato, S; De Jonghe, P; et al. (2011-02)
      These EFNS guidelines on the molecular diagnosis of motoneuron disorders, neuropathies and myopathies are designed to summarize the possibilities and limitations of molecular genetic techniques and to provide diagnostic criteria for deciding when a molecular diagnostic work-up is indicated.
    • EFNS guidelines on the Clinical Management of Amyotrophic Lateral Sclerosis (MALS) - revised report of an EFNS task force.

      Umea University, Umea, Sweden University of Edinburgh, Edinburgh, UK Centre, Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland , Hospital de Santa Maria, Lisbon, Portugal University of Turin and San Giovanni, Hospital, Turin, Italy University of Leuven and VIB, Leuven, Belgium Trinity, College and Beaumont Hospital, Dublin, Ireland Medizinische Hochschule Hannover, , Germany School of Clinical and Experimental Medicine, University of Birmingham, and Queen Elizabeth Hospital, Birmingham, UK Hopital de la Salpetriere, Paris,, France University of Milan Medical School, Milan, Italy Jagiellonian University, Medical College, Krakow, Poland Munich University Hospital, Munich, Germany, Kantonsspital St Gallen and University Hospital Basel, Basel, Switzerland. (2012-02-01)
      Background: The evidence base for the diagnosis and management of amyotrophic lateral sclerosis (ALS) is weak. Objectives: To provide evidence-based or expert recommendations for the diagnosis and management of ALS based on a literature search and the consensus of an expert panel. Methods: All available medical reference systems were searched, and original papers, meta-analyses, review papers, book chapters and guidelines recommendations were reviewed. The final literature search was performed in February 2011. Recommendations were reached by consensus. Recommendations: Patients with symptoms suggestive of ALS should be assessed as soon as possible by an experienced neurologist. Early diagnosis should be pursued, and investigations, including neurophysiology, performed with a high priority. The patient should be informed of the diagnosis by a consultant with a good knowledge of the patient and the disease. Following diagnosis, the patient and relatives/carers should receive regular support from a multidisciplinary care team. Medication with riluzole should be initiated as early as possible. Control of symptoms such as sialorrhoea, thick mucus, emotional lability, cramps, spasticity and pain should be attempted. Percutaneous endoscopic gastrostomy feeding improves nutrition and quality of life, and gastrostomy tubes should be placed before respiratory insufficiency develops. Non-invasive positive-pressure ventilation also improves survival and quality of life. Maintaining the patient's ability to communicate is essential. During the entire course of the disease, every effort should be made to maintain patient autonomy. Advance directives for palliative end-of-life care should be discussed early with the patient and carers, respecting the patient's social and cultural background.
    • Elafin, an elastase-specific inhibitor, is cleaved by its cognate enzyme neutrophil elastase in sputum from individuals with cystic fibrosis.

      Guyot, Nicolas; Butler, Marcus W; McNally, Paul; Weldon, Sinead; Greene, Catherine M; Levine, Rodney L; O'Neill, Shane J; Taggart, Clifford C; McElvaney, Noel G; Pulmonary Research Division, Department of Medicine, The Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin 9, Ireland. (2008-11-21)
      Elafin is a neutrophil serine protease inhibitor expressed in lung and displaying anti-inflammatory and anti-bacterial properties. Previous studies demonstrated that some innate host defense molecules of the cystic fibrosis (CF) and chronic obstructive pulmonary disease airways are impaired due to increased proteolytic degradation observed during lung inflammation. In light of these findings, we thus focused on the status of elafin in CF lung. We showed in the present study that elafin is cleaved in sputum from individuals with CF. Pseudomonas aeruginosa-positive CF sputum, which was found to contain lower elafin levels and higher neutrophil elastase (NE) activity compared with P. aeruginosa-negative samples, was particularly effective in cleaving recombinant elafin. NE plays a pivotal role in the process as only NE inhibitors are able to inhibit elafin degradation. Further in vitro studies demonstrated that incubation of recombinant elafin with excess of NE leads to the rapid cleavage of the inhibitor. Two cleavage sites were identified at the N-terminal extremity of elafin (Val-5-Lys-6 and Val-9-Ser-10). Interestingly, purified fragments of the inhibitor (Lys-6-Gln-57 and Ser-10-Gln-57) were shown to still be active for inhibiting NE. However, NE in excess was shown to strongly diminish the ability of elafin to bind lipopolysaccharide (LPS) and its capacity to be immobilized by transglutamination. In conclusion, this study provides evidence that elafin is cleaved by its cognate enzyme NE present at excessive concentration in CF sputum and that P. aeruginosa infection promotes this effect. Such cleavage may have repercussions on the innate immune function of elafin.
    • Electrical field stimulation promotes anastomotic healing in poorly perfused rat colon.

      Kennelly, Rory; Conneely, John B; Bouchier-Hayes, David J; Winter, Desmond C; Institute for Clinical Outcomes, Research and Education, St Vincent's University Hospital, Dublin 00004, Ireland. kennellyrory@yahoo.ie (2011-03)
      Hypoperfusion of the bowel is a risk factor for anastomotic failure. Electrical field stimulation has been shown to improve repair in ischemic tissue, but its influence in hypoperfused colon has not been investigated. The hypothesis of this experimental animal study was that electrical field stimulation improves anastomotic healing in ischemic bowel.
    • Electronic clinical decision support systems attitudes and barriers to use in the oncology setting.

      Collins, I M; Breathnach, O; Felle, P; Department of Cancer Medicine, Peter MacCallum Cancer Institute, Locked Bag No. 1, A'Beckett St., Melbourne, VIC, 8006, Australia, ian.collins@petermac.org. (2012-03-02)
      BACKGROUND: There is little evidence regarding attitudes to clinical decision support systems (CDSS) in oncology. AIMS: We examined the current usage, awareness, and concerns of Irish medical oncologists and oncology pharmacists in this area. METHODS: A questionnaire was sent to 27 medical oncologists and 34 oncology pharmacists, identified through professional interest groups. Respondents ranked concerns regarding their use of a CDSS on a scale from 1 to 4, with 4 being most important. RESULTS: Overall, 67% (41/61) responded, 48% (13/27) of oncologists and 82% (28/34) of pharmacists surveyed. Concerns included "difficulty defining complex clinical situations with a set of rules" (mean ± SD) (3.2 ± 0.9), "ensuring evidence base is up to date and relevant" (3.2 ± 0.9) and "lack of clinically relevant suggestions" (2.9 ± 0.9). Ninety-three percent reported using a CDSS but 54% were unaware of this. CONCLUSION: While there are benefits to using a CDSS, concerns must be addressed through user education. This may be a starting point for a user-centred design approach to the development of future local systems through a consultative process.
    • Electrophysiological correlates of working memory in children at risk for psychosis and controls

      Rawdon, C; Murphy, J; Blanchard, M M; Kavanagh, F; Kelleher, I; Clarke, M; Roche, R A P; Cannon, M (2011-02)
    • Emergence of MRSA in positive blood cultures from patients with febrile neutropenia--a cause for concern.

      Morris, Patrick G; Hassan, Tidi; McNamara, Mairead; Hassan, Astrid; Wiig, Rebecca; Grogan, Liam; Breathnach, Oscar S; Smyth, Edmond; Humphreys, Hilary; Department of Oncology, Beaumont Hospital, Dublin 9, Dublin, Ireland. (2008-09)
      Febrile neutropenia (FN) causes considerable morbidity in patients on cytotoxic chemotherapy. Recently, there has been a trend towards fewer Gram-negative and more Gram-positive infections with increasing antibiotic resistance. To assess these patterns, data from a supra-regional cancer centre in Ireland were reviewed.