• Identification and Characterization of Prodromal Risk Syndromes in Young Adolescents in the Community: A Population-Based Clinical Interview Study.

      1Department of Psychiatry, Royal College of Surgeons in Ireland, Education and, Research Centre, Beaumont Hospital, Dublin 9, Ireland. (2012-02-01)
      While a great deal of research has been conducted on prodromal risk syndromes in relation to help-seeking individuals who present to the clinic, there is a lack of research on prodromal risk syndromes in the general population. The current study aimed first to establish whether prodromal risk syndromes could be detected in non-help-seeking community-based adolescents and secondly to characterize this group in terms of Axis-1 psychopathology and general functioning. We conducted in-depth clinical interviews with a population sample of 212 school-going adolescents in order to assess for prodromal risk syndromes, Axis-1 psychopathology, and global (social/occupational) functioning. Between 0.9% and 8% of the community sample met criteria for a risk syndrome, depending on varying disability criteria. The risk syndrome group had a higher prevalence of co-occurring nonpsychotic Axis-1 psychiatric disorders (OR = 4.77, 95% CI = 1.81-12.52; P < .01) and poorer global functioning (F = 24.5, df = 1, P < .0001) compared with controls. Individuals in the community who fulfill criteria for prodromal risk syndromes demonstrate strong similarities with clinically presenting risk syndrome patients not just in terms of psychotic symptom criteria but also in terms of co-occurring psychopathology and global functioning.
    • Identification of β2-microglobulin as a urinary biomarker for chronic allograft nephropathy using proteomic methods.

      Johnston, Olwyn; Cassidy, Hilary; O'Connell, Séin; O'Riordan, Aisling; Gallagher, William; Maguire, Patricia B; Wynne, Kieran; Cagney, Gerard; Ryan, Michael P; Conlon, Peter J; et al. (2011-08)
      Chronic allograft nephropathy (CAN) remains the leading cause of renal graft loss after the first year following renal transplantation. This study aimed to identify novel urinary proteomic profiles, which could distinguish and predict CAN in susceptible individuals.
    • Identifying coronary artery disease in men with type 2 diabetes: osteoprotegerin, pulse wave velocity, and other biomarkers of cardiovascular risk.

      Davenport, Colin; Ashley, David T; O'Sullivan, Eoin P; Corley, Brian T; Fitzgerald, Patricia; Agha, Amar; Thompson, Christopher J; O'Gorman, Donal J; Smith, Diarmuid; Department of Diabetes and Endocrinology, Royal College of Surgeons in Ireland, Medical School, Beaumont Hospital, Dublin, Ireland. drcdavenport@gmail.com (2012-02-01)
      OBJECTIVES: In patients with type 2 diabetes, high serum levels of osteoprotegerin (OPG) have been associated with a greater risk of cardiovascular events. However, it remains unclear how well OPG performs when compared with traditional biomarkers of cardiovascular risk such as high-sensitivity C-reactive protein (hsCRP). Furthermore, OPG levels are also high in the presence of diabetes-related microvascular disease, and it is unclear whether OPG can distinguish microvascular disease from large-vessel atherosclerosis. The first aim of this study was to compare OPG levels against other biomarkers of cardiovascular risk in the identification of patients with documented multivessel coronary artery disease (CAD). The second aim was to compare OPG levels in patients with microvascular complications (microalbuminuria) against those with established CAD. METHODS: Three groups of male patients with type 2 diabetes were recruited: patients without microvascular complications or large-vessel atherosclerosis (n = 24), patients with microalbuminuria only (n = 23), and patients with microalbuminuria and documented multivessel CAD (n = 25). OPG, hsCRP, interleukin 6, urate, and pulse wave velocity were measured. RESULTS: Serum OPG levels were significantly higher in patients with a combination of microalbuminuria and CAD than in those with microalbuminuria alone. There were no significant differences in any of the other biomarkers between the groups. CONCLUSION: OPG was found to be superior to the other biomarkers studied in identifying patients with documented CAD. The presence of CAD was a greater determinant of serum OPG levels than microalbuminuria in our population. These findings support the use of OPG as a biomarker of cardiovascular risk.
    • Idiopathic intracranial hypertension: lumboperitoneal shunts versus ventriculoperitoneal shunts--case series and literature review.

      Abubaker, Khalid; Ali, Zulfiqar; Raza, Kazim; Bolger, Ciaran; Rawluk, Daniel; O'Brien, Donncha; Department of Neurosurgery, Beaumont Hospital, Beaumont, Dublin, Ireland. Khalidnm500@hotmail.com (2011-02)
      Idiopathic intracranial hypertension (IIH) is an uncommon but important cause of headache that can lead to visual loss. This study was undertaken to review our experience in the treatment of IIH by neuronavigation-assisted ventriculoperitoneal (VP) shunts with programmable valves as compared to lumboperitoneal (LP) shunts.
    • Idiopathic intracranial hypertension: lumboperitoneal shunts versus ventriculoperitoneal shunts--case series and literature review.

      Abubaker, Khalid; Ali, Zulfiqar; Raza, Kazim; Bolger, Ciaran; Rawluk, Daniel; O'Brien, Donncha; Department of Neurosurgery, Beaumont Hospital, Beaumont, Dublin, Ireland., Khalidnm500@hotmail.com (2012-02-01)
      OBJECTIVES: Idiopathic intracranial hypertension (IIH) is an uncommon but important cause of headache that can lead to visual loss. This study was undertaken to review our experience in the treatment of IIH by neuronavigation-assisted ventriculoperitoneal (VP) shunts with programmable valves as compared to lumboperitoneal (LP) shunts. METHODS: A retrospective chart review was conducted on 25 patients treated for IIH between 2001 and 2009. Age, sex, clinical presentation, methods of treatment and failure rates were recorded. RESULTS: Seventy-two per cent were treated initially with LP shunts. Failure rate was 11% in this group. Neuronavigation-assisted VP shunts were used to treat 28%. In this group, the failure rate was 14%. CONCLUSION: Our experience indicates that both LP shunts and VP shuts are effective in controlling all the clinical manifestations of IIH in the immediate postoperative period. Failure rates are slightly higher for VP shunts (14%) than LP shunts (11%). However, revision rates are higher with LP shunts (60%) than with VP shunts (30%).
    • IL-8 dictates glycosaminoglycan binding and stability of IL-18 in cystic fibrosis.

      Reeves, Emer P; Williamson, Michael; Byrne, Barry; Bergin, David A; Smith, Stephen G J; Greally, Peter; O'Kennedy, Richard; O'Neill, Shane J; McElvaney, Noel G; Respiratory Research Division, Department of Medicine, Royal College of Surgeons in Ireland, Education and Research Centre, Beaumont Hospital, Dublin, Ireland. emerreeves@rcsi.ie (2010-02-01)
      Dysregulation of airway inflammation contributes to lung disease in cystic fibrosis (CF). Inflammation is mediated by inflammatory cytokines, including IL-8, which illustrates an increase in biological half-life and proinflammatory activity when bound to glycosaminoglycans (GAGs). The aim of this project was to compare IL-8 and IL-18 for their relative stability, activity, and interaction with GAGs, including chondroitin sulfate, hyaluronic acid, and heparan sulfate, present in high quantities in the lungs of patients with CF. Bronchoalveolar lavage fluid was collected from patients with CF (n = 28), non-CF controls (n = 14), and patients with chronic obstructive pulmonary disease (n = 12). Increased levels of IL-8 and reduced concentrations of IL-18 were detected in bronchial samples obtained from CF individuals. The low level of IL-18 was not a defect in IL-18 production, as the pro- and mature forms of the molecule were expressed and produced by CF epithelial cells and monocytes. There was, however, a marked competition between IL-8 and IL-18 for binding to GAGs. A pronounced loss of IL-18 binding capacity occurred in the presence of IL-8, which displaced IL-18 from these anionic-matrices, rendering the cytokine susceptible to proteolytic degradation by neutrophil elastase. As a biological consequence of IL-18 degradation, reduced levels of IL-2 were secreted by Jurkat T lymphocytes. In conclusion, a novel mechanism has been identified highlighting the potential of IL-8 to determine the fate of other inflammatory molecules, such as IL-18, within the inflammatory milieu of the CF lung.
    • Ileostomy obstruction in the third trimester of pregnancy.

      Spring, A; Lee, M; Patchett, S; Deasy, J; Wilson, I; Cahill, R A; Department of Colorectal Surgery, Beaumont Hospital, Dublin 9, Ireland. (2012-09)
    • Iliopsoas abscess: a re-emerging clinical entity not to be forgotten.

      Al-Hilli, Z; Prichard, R S; Roche-Nagle, G; Deasy, J; McNamara, D A (2009-02)
      Iliopsoas abscesses are relatively rare clinical entities. They present with subtle and non-specific symptoms and as a result the diagnosis is often delayed, leading to significant morbidity and mortality. With an increasing number of immunocompromised patients in the population the prevalence of this condition is set to rise. Therefore, early diagnosis and appropriate management remain a challenge for clinicians. We present three patients with iliopsoas abscesses, two of which were primary and one of which was secondary to Crohn's disease. The average age of patients was 59 years and both patients with primary psoas abscesses were male. All presented with non-specific symptoms. Psoas sign was present in only one patient. CT confirmed the diagnosis in all cases. Treatment consisted of appropriate antibiotic cover and associated percutaneous drainage. The psoas abscess that was secondary to underlying Crohn's disease was subsequently treated with surgical excision of the affected segment of bowel and lavage of the abscess cavity. A high index of suspicion is required to ensure the accurate and early diagnosis of this rare clinical entity. Abdominal CT scanning remains the gold standard for diagnosis. Management is with appropriate antibiotics and adequate drainage. This can be achieved by either percutaneous or surgical drainage. Such treatment can reduce the overall morbidity and mortality of this condition.
    • Images in cardiovascular medicine. Use of embolic protection to prevent stroke during catheter ablation of atrial fibrillation.

      Munir, Ahmad; Safian, Robert D; Haines, David E; Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI, 48073, USA. (2012-02-01)
    • Images in clinical medicine. Bilateral hilar and mediastinal lymphadenopathy.

      Kavanagh, Richard; Smith, Diarmuid; Beaumont Hospital, Dublin, Ireland. (2011-06-16)
    • Images in clinical medicine. Bilateral hilar and mediastinal lymphadenopathy.

      Kavanagh, Richard; Smith, Diarmuid; Beaumont Hospital, Dublin, Ireland. (2012-02-01)
    • Imaging features of encapsulating peritoneal sclerosis in continuous ambulatory peritoneal dialysis patients.

      Ti, Joanna P; Al-Aradi, Ali; Conlon, Peter J; Lee, Michael J; Morrin, Martina M; Department of Radiology, Beaumont Hospital, Dublin, Ireland. joanna_ti@eircom.net <joanna_ti@eircom.net> (2010-07)
      OBJECTIVE: The purpose of this article is to present the spectrum of radiologic findings of encapsulating peritoneal sclerosis in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). CONCLUSION: Although a rare diagnosis, encapsulating peritoneal sclerosis in patients undergoing CAPD has a high morbidity and mortality. Diagnosis is often delayed because clinical features are insidious and nonspecific. Radiologic imaging may be helpful in the early diagnosis of encapsulating peritoneal sclerosis and in facilitating timely intervention for CAPD patients with encapsulating peritoneal sclerosis.
    • Imaging patients with renal colic: a comparative analysis of the impact of non-contrast helical computed tomography versus intravenous pyelography on the speed of patient processing in the Emergency Department.

      Quirke, M; Divilly, F; O'Kelly, P; Winder, S; Gilligan, P; c/o Dr P Gilligan, Consultant in Emergency Medicine, Beaumont Hospital, Beaumont Road, PO BOX 1297, Dublin 9, Ireland; mmmquirke@hotmail.com. (2011-03)
      Introduction Non-contrast helical CT (NHCT) became the procedure of choice for investigating Emergency Department (ED) patients presenting with suspected renal colic at Beaumont Hospital, Dublin, in 2008. The impact of NHCT on waiting times and patient management was compared with intravenous pyelography (IVP). Methods A retrospective, comparative cohort analysis of 95 patients who had IVP and 109 patients who had NHCT was performed. Length of ED stay from time of scan ordering to referral or discharge was analysed relative to time of day and scan result. Results Patients having NHCT who attended between 00:00-08:00 h, had a twofold longer length of stay than those who had IVP between the same hours (median 7.07 h vs 3.03 h, p=0.0294). The length of ED stay for patients attending between 08:00 and 24:00 h was similar in both groups. The presence of urolithiasis did not impact on length of stay. A significant alternate/incidental diagnosis was reported in 28 patients having NHCT, of which 12 were cancerous growths. Conclusion NHCT allows for the detection of incidental/alternate diagnoses that may not be otherwise detected in patients with renal colic. Compared to IVP, NHCT has not impacted positively on the speed of patient processing in the ED under study. For patients presenting after midnight, it is associated with over a twofold longer length of stay from the time of scan ordering to referral or discharge. This leads to prolonged patient stays in the ED, and as such contributes to overcrowding.
    • Imaging patients with renal colic: a comparative analysis of the impact of non-contrast helical computed tomography versus intravenous pyelography on the speed of patient processing in the Emergency Department.

      Quirke, M; Divilly, F; O'Kelly, P; Winder, S; Gilligan, P; Emergency Department, Beaumont Hospital, Beaumont Road, PO BOX 1297, Dublin 9,, Ireland. mmmquirke@hotmail.com (2012-02-01)
      INTRODUCTION: Non-contrast helical CT (NHCT) became the procedure of choice for investigating Emergency Department (ED) patients presenting with suspected renal colic at Beaumont Hospital, Dublin, in 2008. The impact of NHCT on waiting times and patient management was compared with intravenous pyelography (IVP). METHODS: A retrospective, comparative cohort analysis of 95 patients who had IVP and 109 patients who had NHCT was performed. Length of ED stay from time of scan ordering to referral or discharge was analysed relative to time of day and scan result. RESULTS: Patients having NHCT who attended between 00:00-08:00 h, had a twofold longer length of stay than those who had IVP between the same hours (median 7.07 h vs 3.03 h, p=0.0294). The length of ED stay for patients attending between 08:00 and 24:00 h was similar in both groups. The presence of urolithiasis did not impact on length of stay. A significant alternate/incidental diagnosis was reported in 28 patients having NHCT, of which 12 were cancerous growths. CONCLUSION: NHCT allows for the detection of incidental/alternate diagnoses that may not be otherwise detected in patients with renal colic. Compared to IVP, NHCT has not impacted positively on the speed of patient processing in the ED under study. For patients presenting after midnight, it is associated with over a twofold longer length of stay from the time of scan ordering to referral or discharge. This leads to prolonged patient stays in the ED, and as such contributes to overcrowding.
    • Immediate re-transplantation following early kidney transplant thrombosis.

      Phelan, Paul J; Magee, Colm; O'Kelly, Patrick; J O'Brien, Frank; Little, Dilly; Conlon, Peter J; Departments of Nephrology Transplantation, Beaumont Hospital, Dublin, Ireland. (2011-08)
      Allograft thrombosis is a devastating early complication of renal transplantation that ultimately leads to allograft loss. We report here on our experience of nine cases of immediate re-transplantation following early kidney transplant thrombosis at a single centre between January 1990 and June 2009. The mean age was 42.9 years at time of transplant. For seven patients, the allograft thrombosis was their first kidney transplant and seven of the nine cases had a deceased donor transplant. The initial transplants functioned for a mean of 1.67 days and the patients received a second allograft at a mean of 3.1 days after graft failure. All of the re-transplants worked immediately. Four allografts failed after a mean of 52.5 months (2-155 months). Two of these died with a functioning allograft, one failed owing to chronic allograft nephropathy and one owing to persistent acute cellular rejection. The remaining five patients still have a functioning allograft after a mean of 101.8 months (7-187 months). One year allograft and patient survival after re-transplantation were 87.5% and 100% respectively (after 5 years, both were 57%). Immediate re-transplantation following early kidney transplant thrombosis can be a success. It may be considered in selected cases after allograft thrombosis.
    • Immediate re-transplantation following early kidney transplant thrombosis.

      Phelan, Paul J; Magee, Colm; O'Kelly, Patrick; J O'Brien, Frank; Little, Dilly; Conlon, Peter J; Department of Nephrology, Beaumont Hospital, Dublin, Ireland. paulphel@gmail.com (2012-02-01)
      Allograft thrombosis is a devastating early complication of renal transplantation that ultimately leads to allograft loss. We report here on our experience of nine cases of immediate re-transplantation following early kidney transplant thrombosis at a single centre between January 1990 and June 2009. The mean age was 42.9 years at time of transplant. For seven patients, the allograft thrombosis was their first kidney transplant and seven of the nine cases had a deceased donor transplant. The initial transplants functioned for a mean of 1.67 days and the patients received a second allograft at a mean of 3.1 days after graft failure. All of the re-transplants worked immediately. Four allografts failed after a mean of 52.5 months (2-155 months). Two of these died with a functioning allograft, one failed owing to chronic allograft nephropathy and one owing to persistent acute cellular rejection. The remaining five patients still have a functioning allograft after a mean of 101.8 months (7-187 months). One year allograft and patient survival after re-transplantation were 87.5% and 100% respectively (after 5 years, both were 57%). Immediate re-transplantation following early kidney transplant thrombosis can be a success. It may be considered in selected cases after allograft thrombosis.
    • Immunohistochemical (INC) profile to distinguish urothelial from squamous differentiation in carcinomas of urothelial tract

      Gulmann, C; Paner, G P; Parakh, R S; Hansel, D E; Shen, S S; Ro, J Y; Annaiah, C; Lopez-Beltran, A; Rao, P; Arora, K; et al. (2011-02)
    • An immunohistochemical and fluorescence in situ hybridization-based comparison between the Oracle HER2 Bond Immunohistochemical System, Dako HercepTest, and Vysis PathVysion HER2 FISH using both commercially validated and modified ASCO/CAP and United Kingdom HER2 IHC scoring guidelines.

      O'Grady, Anthony; Allen, David; Happerfield, Lisa; Johnson, Nicola; Provenzano, Elena; Pinder, Sarah E; Tee, Lilian; Gu, Mai; Kay, Elaine W; Department of Pathology, R.C.S.I. Education & Research Centre, Beaumont Hospital, Dublin 9, Ireland. togrady@rcsi.ie (2010-12)
      Immunohistochemistry (IHC) is used as the frontline assay to determine HER2 status in invasive breast cancer patients. The aim of the study was to compare the performance of the Leica Oracle HER2 Bond IHC System (Oracle) with the current most readily accepted Dako HercepTest (HercepTest), using both commercially validated and modified ASCO/CAP and UK HER2 IHC scoring guidelines. A total of 445 breast cancer samples from 3 international clinical HER2 referral centers were stained with the 2 test systems and scored in a blinded fashion by experienced pathologists. The overall agreement between the 2 tests in a 3×3 (negative, equivocal and positive) analysis shows a concordance of 86.7% and 86.3%, respectively when analyzed using commercially validated and modified ASCO/CAP and UK HER2 IHC scoring guidelines. There is a good concordance between the Oracle and the HercepTest. The advantages of a complete fully automated test such as the Oracle include standardization of key analytical factors and improved turn around time. The implementation of the modified ASCO/CAP and UK HER2 IHC scoring guidelines has minimal effect on either assay interpretation, showing that Oracle can be used as a methodology for accurately determining HER2 IHC status in formalin fixed, paraffin-embedded breast cancer tissue.
    • Impact of admission screening for methicillin-resistant Staphylococcus aureus on the length of stay in an emergency department.

      Gilligan, P; Quirke, M; Winder, S; Humphreys, H; Emergency Department, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland. hegartydeirdre@ireland.com (2010-06)
      Preventing and controlling methicillin-resistant Staphylococcus aureus (MRSA) includes early detection and isolation. In the emergency department (ED), such measures have to be balanced with the requirement to treat patients urgently and transfer quickly to an acute hospital bed. We assessed, in a busy and overcrowded ED, the contribution made to a patient's stay by previous MRSA risk group identification and by selective rescreening of those patients who were previously documented in the research hospital as being MRSA positive. Patients with a previous diagnosis of MRSA colonisation were flagged automatically as 'risk group' (RG) on their arrival in the ED and were compared with 'non-risk group' (NRG), i.e. not previously demonstrated in the research hospital to be infected or colonised with MRSA. Over an 18 month period, there were 16 456 admissions via the ED, of which 985 (6%) were RG patients. The expected median times to be admitted following a request for a ward bed for NRG and RG patients were 10.4 and 12.9h, respectively. Female sex, age >65 years, and RG status all independently predicted a statistically significantly longer stay in the ED following a request for a hospital bed. We consider that national and local policies for MRSA need to balance the welfare of patients in the ED with the need to comply with best practice, when there are inadequate ED and inpatient isolation facilities. Patients with MRSA requiring emergency admission must have a bed available for them.
    • Impact of obesity on cardiovascular disease.

      Zalesin, Kerstyn C; Franklin, Barry A; Miller, Wendy M; Peterson, Eric D; McCullough, Peter A; Division of Nutrition and Preventative Medicine, Department of Medicine, William , Beaumont Hospital, 4949 Coolidge Highway, Royal Oak, MI 48073, USA., kzalesin@beaumont.edu (2012-02-01)
      Obesity promotes a cascade of secondary pathologies including diabetes, insulin resistance, dyslipidemia, inflammation, thrombosis, hypertension, the metabolic syndrome, and OSA, which collectively heighten the risk for cardiovascular disease. Obesity may also be an independent moderator of cardiac risk apart from these comorbid conditions. Rates of obesity and cardiac disease continue to rise in a parallel and exponential manner. Because obesity is potentially one of the most modifiable mediators of cardiovascular morbidity and mortality, effective treatment and prevention interventions should have a profound and favorable impact on public health.