• T251 The impact of radiofrequency lesioning on patients with trigeminal neuralgia: A ten-year audit

      Rahman, N.; Fullen, B.M.; Canavan, D.; Keaveny, J.; Stassen, L. (2011-09)
    • Takayasu's arteritis: a challenging diagnosis.

      Fanning, D M; Hickey, D P; Department of Urology and Transplantation, Beaumont Hospital, Dublin 9, Ireland. fanningdee@yahoo.co.uk (2009-03)
      The practices of medicine and surgery are inherently and irrevocably entwined. This case report highlights the need for an integrated, multi-disciplinary approach to care of the modern patient. Our patient fulfils the traditional Ishikawa's criteria and the modified Ishikawa's criteria for the clinical diagnosis of Takayasu's disease. Her case underpins the need for co-ordinated care and careful periodic review of the symptomatology and signs of the multiple clinic attendees.
    • Taurine attenuates radiation-induced lung fibrosis in C57/Bl6 fibrosis prone mice.

      Robb, W B; Condron, C; Moriarty, M; Walsh, T N; Bouchier-Hayes, D J; Department of Surgery, Beaumont Hospital, The Royal College of Surgeons in Ireland, Dublin, Ireland. wrobb@rcsi.ie (2010-03)
      The amino acid taurine has an established role in attenuating lung fibrosis secondary to bleomycin-induced injury. This study evaluates taurine's effect on TGF-beta1 expression and the development of lung fibrosis after single-dose thoracic radiotherapy.
    • Taurine modulates neutrophil function but potentiates uropathogenic E. coli infection in the murine bladder.

      Condron, Claire; Casey, Rowan G; Kehoe, Siobhan; Toomey, Deirdre; Creagh, Tom; Bouchier-Hayes, David J; Department of Surgery, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland. (2010-08)
      Eradication of a urinary tract infection (UTI) appears to be related to a number of innate host defence mechanisms and their interactions with invading bacteria. Recurrent UTIs (rUTIs) pose a difficult problem in that these bacteria use both host and bacterial factors to evade elimination. Neutrophil bactericidal function is depressed, both systemically and in urine, in patients with a history of recurrent UTI. Taurine is a semi-essential amino acid and is successful in preserving neutrophil bactericidal function in urine. Taurine may preserve neutrophil function at the urothelium and thus aid UTI resolution. Adult female (6 weeks old) C57Bl/6 mice were randomised into three groups: a saline gavage only control group, a saline gavage + E. coli group, and a taurine gavage + E. coli group [21 g/70 kg taurine in 0.9% normal saline (N/S) for 5 days]. Whilst taurine gavage pre-treatment resulted in increased serum neutrophils respiratory burst activity, at the urothelial-endothelial interface it caused higher colony forming units in the urine and a higher incidence of E. coli invasion in the bladder wall with no evidence of increased bladder wall neutrophils infiltration on MPO assay of histological assessment. Histologically there was also evidence of reduced bladder inflammation and urothelial cell apoptosis. In conclusion, taurine effectively increases neutrophils activity but given its anti-inflammatory properties, at the expense of decreased urothelial-endothelial activation thus preventing clearance of active E. coli infection in the bladder. Despite the negative results, this study demonstrates the importance of modulating interactions at the urothelial interface.
    • TB or not TB?: a case of isolated testicular TB with scrotal involvement.

      Bhargava, A; Davenport, C; Gibbons, N; McConkey, S; Department of Infectious Diseases, Beaumont Hospital, Dublin 9, Ireland. abhargava99@yahoo.com (2009-06)
      Despite the genitourinary tract being the most common site affected by extrapulmonary TB, isolated testicular TB remains a rare clinical entity. In patients with co-morbidities such as hepatic impairment, treatment proves a challenge, as first-line hepatotoxic pharmaceuticals are contraindicated. Here, we report a case of isolated testicular TB with scrotal involvement, on a background of hepatic dysfunction.
    • A Technical Assessment of the Utility of Reverse Phase Protein Arrays for the Study of the Functional Proteome in Non-microdissected Human Breast Cancers.

      Hennessy, Bryan T; Lu, Yiling; Gonzalez-Angulo, Ana Maria; Carey, Mark S; Myhre, Simen; Ju, Zhenlin; Davies, Michael A; Liu, Wenbin; Coombes, Kevin; Meric-Bernstam, Funda; et al. (2010-12)
      INTRODUCTION: The lack of large panels of validated antibodies, tissue handling variability, and intratumoral heterogeneity potentially hamper comprehensive study of the functional proteome in non-microdissected solid tumors. The purpose of this study was to address these concerns and to demonstrate clinical utility for the functional analysis of proteins in non-microdissected breast tumors using reverse phase protein arrays (RPPA). METHODS: Herein, 82 antibodies that recognize kinase and steroid signaling proteins and effectors were validated for RPPA. Intraslide and interslide coefficients of variability were <15%. Multiple sites in non-microdissected breast tumors were analyzed using RPPA after intervals of up to 24 h on the benchtop at room temperature following surgical resection. RESULTS: Twenty-one of 82 total and phosphoproteins demonstrated time-dependent instability at room temperature with most variability occurring at later time points between 6 and 24 h. However, the 82-protein functional proteomic "fingerprint" was robust in most tumors even when maintained at room temperature for 24 h before freezing. In repeat samples from each tumor, intratumoral protein levels were markedly less variable than intertumoral levels. Indeed, an independent analysis of prognostic biomarkers in tissue from multiple tumor sites accurately and reproducibly predicted patient outcomes. Significant correlations were observed between RPPA and immunohistochemistry. However, RPPA demonstrated a superior dynamic range. Classification of 128 breast cancers using RPPA identified six subgroups with markedly different patient outcomes that demonstrated a significant correlation with breast cancer subtypes identified by transcriptional profiling. CONCLUSION: Thus, the robustness of RPPA and stability of the functional proteomic "fingerprint" facilitate the study of the functional proteome in non-microdissected breast tumors.
    • Temporal fossa intra-extracranial dumbbell schwannoma.

      Wong, Limy; Abubaker, Khalid; Cryan, Jane; Brett, Francesca M; Caird, John; Department of Neurosurgery, Beaumont Hospital, Dublin 9, Ireland. limywong@gmail.com (2011-02)
      Intra-extracranial schwannomas arising unrelated to major cranial nerves are exceedingly rare neoplasms. We report the case of a 23-year-old male who presented with a 9 month history of progressive temporal swelling which was excised and found histologically to be a schwannoma. A succinct review of the relevant literature is presented.
    • Temporal fossa intra-extracranial dumbbell schwannoma.

      Wong, Limy; Abubaker, Khalid; Cryan, Jane; Brett, Francesca M; Caird, John; Department of Neurosurgery, Beaumont Hospital, Dublin 9, Ireland., limywong@gmail.com (2012-02-01)
      Intra-extracranial schwannomas arising unrelated to major cranial nerves are exceedingly rare neoplasms. We report the case of a 23-year-old male who presented with a 9 month history of progressive temporal swelling which was excised and found histologically to be a schwannoma. A succinct review of the relevant literature is presented.
    • Therapeutic modulation of miRNA for the treatment of proinflammatory lung diseases.

      Hassan, Tidi; McKiernan, Paul J; McElvaney, Noel G; Cryan, Sally Ann; Greene, Catherine M; Respiratory Research Division, Department of Medicine, Royal College of Surgeons in Ireland, Education and Research Centre, Beaumont Hospital, Dublin 9, Ireland. (2012-03)
      miRNAs are short, nonprotein coding RNAs that regulate target gene expression principally by causing translational repression and/or mRNA degradation. miRNAs are involved in most mammalian biological processes and have pivotal roles in controlling the expression of factors involved in basal and stimulus-induced signaling pathways. Considering their central role in the regulation of gene expression, miRNAs represent therapeutic drug targets. Here we describe how miRNAs are involved in the regulation of aspects of innate immunity and inflammation, what happens when this goes awry, such as in the chronic inflammatory lung diseases cystic fibrosis and asthma, and discuss the current state-of-the-art miRNA-targeted therapeutics.
    • Therapy with omalizumab for patients with severe allergic asthma improves asthma control and reduces overall healthcare costs.

      Costello, R W; Long, D A; Gaine, S; Mc Donnell, T; Gilmartin, J J; Lane, S J; Departments of Respiratory, Medicine Beaumont Hospital, Dublin 9, Ireland., rcostello@rcsi.ie (2012-02-01)
      BACKGROUND: Patients with asthma who have persistent symptoms despite treatment with inhaled steroids and long-acting beta agonists are considered to have severe asthma. Omalizumab is a monoclonal antibody directed against IgE, which is used as an add-on treatment for patients who have severe persistent allergic asthma. AIMS: The aim of this study was to assess the clinical benefit and healthcare utilisation of patients who responded to omalizumab therapy and to establish an overall cost implication. METHODS: This was an observational retrospective cohort study designed to investigate the effect of omalizumab on exacerbations of asthma before and after 6 months of treatment in Irish patients. RESULTS: Centres who had treated patients with severe allergic asthma for the 6 months prior and post omalizumab treatment were audited with a standardised assessment tool. Sixty-three (32 male) patients were studied. In the 6 months prior to omalizumab 41 of 63 (66%) had been hospitalised, and this fell to 15 of 63 (24%), p < 0.0001 in the 6 months after treatment was started. Hospital admissions reduced from 2.4 +/- 0.41 to 0.8 +/- 0.37 and the mean number of bed days occupied was reduced from 16.6 +/- 2.94 to 5.3 +/- 2.57 days, p < 0.001. The number of oral corticosteroid doses used fell from 3.1 +/- 0.27 to 1.2 +/- 0.17, p < 0.001. The overall cost saving per omalizumab responder patients for 6 months was 834. CONCLUSIONS: Six months therapy with omalizumab reduced the number of bed days, the number of hospitalisations and the use of oral corticosteroids compared to the 6 months prior to commencement. Despite the cost of the additional therapy there were overall savings in health costs.
    • Therapy with omalizumab for patients with severe allergic asthma improves asthma control and reduces overall healthcare costs.

      Costello, R W; Long, D A; Gaine, S; Mc Donnell, T; Gilmartin, J J; Lane, S J; Departments of Respiratory, Medicine Beaumont Hospital, Dublin, 9, Ireland, rcostello@rcsi.ie. (2011-05-11)
      BACKGROUND: Patients with asthma who have persistent symptoms despite treatment with inhaled steroids and long-acting beta agonists are considered to have severe asthma. Omalizumab is a monoclonal antibody directed against IgE, which is used as an add-on treatment for patients who have severe persistent allergic asthma. AIMS: The aim of this study was to assess the clinical benefit and healthcare utilisation of patients who responded to omalizumab therapy and to establish an overall cost implication. METHODS: This was an observational retrospective cohort study designed to investigate the effect of omalizumab on exacerbations of asthma before and after 6 months of treatment in Irish patients. RESULTS: Centres who had treated patients with severe allergic asthma for the 6 months prior and post omalizumab treatment were audited with a standardised assessment tool. Sixty-three (32 male) patients were studied. In the 6 months prior to omalizumab 41 of 63 (66%) had been hospitalised, and this fell to 15 of 63 (24%), p < 0.0001 in the 6 months after treatment was started. Hospital admissions reduced from 2.4 ± 0.41 to 0.8 ± 0.37 and the mean number of bed days occupied was reduced from 16.6 ± 2.94 to 5.3 ± 2.57 days, p < 0.001. The number of oral corticosteroid doses used fell from 3.1 ± 0.27 to 1.2 ± 0.17, p < 0.001. The overall cost saving per omalizumab responder patients for 6 months was 834. CONCLUSIONS: Six months therapy with omalizumab reduced the number of bed days, the number of hospitalisations and the use of oral corticosteroids compared to the 6 months prior to commencement. Despite the cost of the additional therapy there were overall savings in health costs.
    • Thermotolerance-induced goblet cell activity confers protection in post-operative gut barrier dysfunction.

      Ali, Rohana; Farrell, Thomas; Beaumont Hospital, Beaumont, Dublin 13, Ireland. rohana.oconnell@gmail.com (2009-06)
      There is evidence that some level of protection against the adverse sequelae of surgery is provided by induction of thermotolerance; this protective effect was explored by study of several indicators of bowel wall damage in animals exposed to surgical insults. It has been argued that the mechanism of the protective effect of thermotolerance involves heat shock proteins (HSPs). We hypothesized that the protective effect of thermotolerance may be due in part to changes in the bowel wall itself, and we investigated this hypothesis in an experimental rat model.
    • Thyrotoxic periodic paralysis due to excessive L-thyroxine replacement in a Caucasian man.

      Hannon, M J; Behan, L A; Agha, A; Academic Department of Endocrinology, Beaumont Hospital/RCSI Medical School, Dublin 9, Ireland. (2009-09)
      Thyrotoxic periodic paralysis is a potentially fatal complication of hyperthyroidism, more common in Asian races, which is defined by a massive intracellular flux of potassium. This leads to profound hypokalaemia and muscle paralysis. Although the paralysis is temporary, it may be lethal if not diagnosed and treated rapidly, as profound hypokalaemia may induce respiratory muscle paralysis or cardiac arrest. The condition is often misdiagnosed in the west due to its comparative rarity in Caucasians; however it is now increasingly described in Caucasians and is also being seen with increasing frequency in western hospitals due to increasing immigration and population mobility. Here we describe the case of a patient with panhypopituitarism due to a craniopharyngioma, who developed thyrotoxic periodic paralysis due to excessive L-thyroxine replacement. This disorder has been described in Asian subjects but, to our knowledge, thyrotoxic periodic paralysis secondary to excessive L-thyroxine replacement has never been described in Caucasians.
    • Tight glycaemic control is a key factor in wound healing enhancement strategies in an experimental diabetes mellitus model.

      O'Sullivan, J B; Hanson, R; Chan, F; Bouchier-Hayes, D J; Department of Surgery, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland. jbarryosullivan@mac.com (2011-03)
      Diabetes mellitus is a leading cause of impaired wound healing. The aim of this study was to establish a glucose-controlled diabetic wound healing model.
    • Tight glycaemic control is a key factor in wound healing enhancement strategies in an experimental diabetes mellitus model.

      O'Sullivan, J B; Hanson, R; Chan, F; Bouchier-Hayes, D J; Department of Surgery, Royal College of Surgeons in Ireland, Beaumont Hospital,, Dublin, Ireland. jbarryosullivan@mac.com (2012-02-01)
      BACKGROUND: Diabetes mellitus is a leading cause of impaired wound healing. The aim of this study was to establish a glucose-controlled diabetic wound healing model. METHOD: Sprague-Dawley rats were divided into three groups: Control group (C), Diabetic Non-glucose Controlled group (DNC) and Diabetic glucose Controlled group (DC). RESULTS: Glucose control was achieved using Insulman Rapid (average daily glucose level <10 mmol/L). 18 Sprague-Dawley rats underwent a dorsal skin wound incision and 10 days later were killed. Fresh and fixed wound tensile strength, hydroxyproline and transforming growth factor beta-1 levels were improved in the DC group when compared to the DNC group. The quantity of fibroblasts present was similar in each group. CONCLUSION: This study demonstrates the impact that diabetes has on acute wound healing and suggests that wound modulating agents must be tested in both the tightly glucose-controlled as well as the poorly glucose-controlled diabetic animal models prior to proceeding with translational clinical studies.
    • Time of day variation in polyp detection rate for colonoscopies performed on a 3-hour shift schedule.

      Munson, Gregory W; Harewood, Gavin C; Francis, Dawn L; Department of Gastroenterology, Mayo Clinic, Rochester, MN 55905, USA. (2011-03)
      Recent research suggests that the colonoscopy polyp detection rate (PDR) varies by time of day, possibly because of endoscopist fatigue. Mayo Clinic Rochester (MCR) schedules colonoscopies on 3-hour shifts, which should minimize fatigue.
    • A "time-and-motion" study of endoscopic practice: strategies to enhance efficiency.

      Harewood, Gavin C; Chrysostomou, Kristia; Himy, Naila; Leong, Wai Ling; Department of Gastroenterology and Hepatology, Beaumont Hospital, Dublin, Ireland. (2008-12)
      With the growing demand on endoscopic resources, achieving optimal efficiency has assumed increasing importance.