• Acute subarachnoid haemorrhage following liquid sclerotherapy

      Danapal, M.; Garvin, J.; O'Brien, D.; Leahy, A. (2012-03)
    • Acute surgical management in idiopathic intracranial hypertension.

      Zakaria, Zaitun; Fenton, Eoin; Sattar, Muhammad Taufiq; Department of Neurosurgery, Beaumont Hospital, Dublin, Ireland. zakariaz@tcd.ie (2012)
      Idiopathic intracranial hypertension is a headache syndrome with progressive symptoms of raised intracranial pressure. Most commonly, it is a slow process where surveillance and medical management are the main treatment modalities. We describe herein an acute presentation with bilateral sixth nerve palsies, papilloedema and visual deterioration, where acute surgical intervention was a vision-saving operation.
    • Acute upper arm ischaemia: a rare presentation of non-Hodgkin's lymphoma.

      Daruwalla, Z J; Razak, A R A; Duke, D; Grogan, L; Department of Orthopaedic Surgery, Beaumont Hospital, Beaumont Road, Dublin 9, Republic of Ireland. zubinjimmydaruwalla@rcsi.ie (2010-12)
      Digital ischaemia has been sparsely reported in current literature. Its association with lymphomatous conditions has been described in even more exceptional occurrences. We present the first case of upper arm ischaemia associated with non-Hodgkin's lymphoma. A brief literature review of this rare phenomenon is also accompanied with it.
    • Adenocarcinoma arising in a retrorectal teratoma: Case report and review of the literature.

      McCawley, N; Hanly, A; Solon, G; Shilling, C; Deasy, J; Kay, E W; McNamara, D A;  Department of Colorectal Surgery, Beaumont Hospital, Dublin 9, Ireland.  Department of Pathology, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin 9, Ireland. (2010-10-19)
    • Adenocarcinoma arising in a retrorectal teratoma: case report and review of the literature.

      McCawley, N; Hanly, A; Solon, G; Shilling, C; Deasy, J; Kay, E W; McNamara, D A; Department of Colorectal Surgery, Beaumont Hospital, Dublin, Ireland. (2012-02-01)
    • Adjunctive levetiracetam in children, adolescents, and adults with primary generalized seizures: Open-label, noncomparative, multicenter, long-term follow-up study.

      Delanty, Norman; Jones, John; Tonner, Francoise; Division of Neurology, Beaumont Hospital, Dublin, Ireland UCB Pharma, Raleigh,, North Carolina, U.S.A.1 UCB Pharma, Brussels, Belgium1. (2012-02-01)
      Purpose: To evaluate the long-term efficacy and tolerability of adjunctive levetiracetam (LEV) in patients with uncontrolled idiopathic generalized epilepsy (IGE). Methods: This phase III, open-label, long-term, follow-up study (N167; NCT00150748) enrolled patients (4 to <65 years) with primary generalized seizures (tonic-clonic, myoclonic, absence). Patients received adjunctive LEV at individualized doses (1,000-4,000 mg/day; 20-80 mg/kg/day for children/adolescents weighing <50 kg). Efficacy results are reported for all seizure types [intention-to-treat (ITT) population, N = 217] and subpopulations with tonic-clonic (n = 152), myoclonic (n = 121), and/or absence (n = 70) seizures at baseline. Key Findings: One hundred twenty-five (57.6%) of 217 patients were still receiving treatment at the end of the study. Mean (standard deviation, SD) LEV dose was 2,917.5 (562.9) mg/day. Median (Q1-Q3) exposure to LEV was 2.1 (1.5-2.8) years, and the maximum duration was 4.6 years. Most patients were taking one (124/217, 57.1%) or >/=2 (92/217, 42.4%) concomitant antiepileptic drugs (AEDs). Seizure freedom of >/=6 months (all seizure types; primary efficacy end point) was achieved by 122 (56.2%) of 217 patients, and 49 (22.6%) of 217 patients had complete seizure freedom. Seizure freedom of >/=6 months from tonic-clonic, myoclonic, and absence seizures was achieved by 95 (62.5%) of 152, 75 (62.0%) of 121, and 44 (62.9%) of 70 patients, respectively. Mean (SD) maximum seizure freedom duration was 371.7 (352.4) days. At least one treatment-emergent adverse event (TEAE) was reported by 165 (76%) of 217 patients; most TEAEs were mild/moderate in severity, with no indication of an increased incidence over time. Seventeen (7.8%) of 217 patients discontinued medication because of TEAEs. The most common psychiatric TEAEs were depression (16/217, 7.4%), insomnia (9/217, 4.1%), nervousness (8/217, 3.7%), and anxiety (7/217, 3.2%). Significance: Adjunctive LEV (range 1,000-4,000 mg/day) demonstrated efficacy as a long-term treatment for primary generalized seizures in children, adolescents, and adults with IGE, and was well tolerated.
    • Adjuvant chemotherapy for colorectal cancer in the over 75 age group: A 10-year experience

      Bambury, R M; Coleman, N H; Tharmabala, M M; Gough, D; Grogan, W; Breathnach, O S; Beaumont Hospital, Beaumont Road, Dublin 9, Ireland. (2010-05)
    • Adult outpatient diabetes care in the Republic of Ireland: A survey of public hospitals

      O'Donnell, M; De Suin, A; O'Mullane, M; Dinneen, S; Smith, D; Bradley, C (2009-02-08)
    • Adult-onset nemaline myopathy presenting as respiratory failure.

      Kelly, Emer; Farrell, Michael A; McElvaney, Noel G; Department of Respiratory Research, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland. emerkelly@rcsi.ie (2008-11)
      Nemaline myopathy is a rare congenital myopathy that generally presents in childhood. We report a case of a 44-year-old man who presented with severe hypoxic hypercapnic respiratory failure as the initial manifestation of nemaline myopathy. After starting noninvasive ventilation, his pulmonary function test results improved substantially, and over the 4 years since diagnosis his respiratory function remained stable. There are few reported cases of respiratory failure in patients with adult-onset nemaline myopathy, and the insidious onset in this case is even more unusual. This case highlights the varied presenting features of adult-onset nemaline myopathy and that noninvasive ventilation improves respiratory function.
    • Affects of dysphagia and gastrostomy feeding on quality of life for people with motor neurone disease [poster]

      Doyle, L; McElligott, K; aDepartment of Speech & Language Therapy, bDepartment of Nutrition & Dietetics, Beaumont Hospital, Dublin, Ireland (Health Service Executive (HSE), 2014-02-28)
    • Age related outcome in acute subdural haematoma following traumatic head injury.

      Hanif, S; Abodunde, O; Ali, Z; Pidgeon, C; Department of Neurosurgery, Beaumont Hospital, Beaumont, Dublin 9. shahidhanif786@hotmail.com (2009-09)
      Acute subdural haematoma (ASDH) is one of the conditions most strongly associated with severe brain injury. Reports prior to 1980 describe overall mortality rates for acute subdural haematomas (SDH's) ranging from 40% to 90% with poor outcomes observed in all age groups. Recently, improved results have been reported with rapid diagnosis and surgical treatment. The elderly are predisposed to bleeding due to normal cerebral atrophy related to aging, stretching the bridging veins from the dura. Prognosis in ASDH is associated with age, time from injury to treatment, presence of pupillary abnormalities, Glasgow Coma Score (GCS) or motor score on admission, immediate coma or lucid interval, computerized tomography findings (haematoma volume, degree of midline shift, associated intradural lesion, compression of basal cisterns), post-operative intracranial pressure and type of surgery. Advancing age is known to be a determinant of outcome in head injury. We present the results of a retrospective study carried out in Beaumont Hospital, Dublin, Ireland's national neurosurgical centre. The aim of our study was to examine the impact of age on outcome in patients with ASDH following severe head injury. Only cases with acute subdural haematoma requiring surgical evacuation were recruited. Mortality was significantly higher in older patients (50% above 70 years, 25.6% between 40 and 70 years and 26% below 40 years). Overall poor outcome (defined as Glasgow outcome scores 3-5) was also higher in older patients; 74.1% above 70 years, 48% between 40 and 70 years and 30% below 40 years. Poor outcome in traumatic acute subdural haematoma is higher in elderly patients even after surgical intervention.
    • The ageing of HIV: implications for geriatric medicine.

      Kearney, Fiona; Moore, Allan R; Donegan, Ciaran F; Lambert, John; Department of Geriatric Medicine, Beaumont Hospital, Dublin, Ireland. jlambert@mater.ie (2010-09)
      The prevalence of human immunodeficiency virus (HIV) in the over 50 age group is increasing as a consequence of younger adults ageing with HIV, in addition to new diagnoses in later life. We conducted searches in MEDLINE for English language studies published between January 1984 and January 2010 using search terms 'HIV', 'AIDS', 'HIV testing' and 'HIV complications' and selected articles relevant to adults aged 50 years and over. The prevalence, natural history and complications of HIV infection and treatment in older adults are reviewed. In 2007 the Centers for Disease Control and Prevention in the United States reported that 16.8% of new diagnoses of HIV that year were in individuals aged over 50 years. Older adults are vulnerable to late or missed diagnosis, and poorer treatment outcomes, due to the misconception that they are not at risk. A heightened awareness of HIV as a possible diagnosis in older adults is becoming increasingly important. As the HIV population ages, the emergence of disease and treatment complications such as cardiovascular disease, osteoporosis and dementia are evident. Management of older adults with HIV and multiple co-morbidities presents challenges to infectious diseases physicians and geriatricians alike. Inclusion of older adults in future HIV clinical trials will help design healthcare models to provide for this growing population.
    • Albumin as a marker of nutrition: a common pitfall.

      Slattery, Eoin; Patchett, Stephen (2011-10)
    • The alcohol withdrawal syndrome.

      McKeon, A; Frye, M A; Delanty, Norman; Department of Neurology and Clinical Neurosciences, Beaumont Hospital, Dublin, and Royal College of Surgeons in Ireland, Dublin, Ireland. mckeon.andrew@mayo.edu (2008-08)
      The alcohol withdrawal syndrome (AWS) is a common management problem in hospital practice for neurologists, psychiatrists and general physicians alike. Although some patients have mild symptoms and may even be managed in the outpatient setting, others have more severe symptoms or a history of adverse outcomes that requires close inpatient supervision and benzodiazepine therapy. Many patients with AWS have multiple management issues (withdrawal symptoms, delirium tremens, the Wernicke-Korsakoff syndrome, seizures, depression, polysubstance abuse, electrolyte disturbances and liver disease), which requires a coordinated, multidisciplinary approach. Although AWS may be complex, careful evaluation and available treatments should ensure safe detoxification for most patients.
    • Aldosterone as a renal growth factor.

      Thomas, Warren; Dooley, Ruth; Harvey, Brian J; Department of Molecular Medicine, Royal College of Surgeons in Ireland, Education and Research Centre, Beaumont Hospital, Dublin 9, Ireland. wthomas@rcsi.ie (2011-04-05)
      Aldosterone regulates blood pressure through its effects on the cardiovascular system and kidney. Aldosterone can also contribute to the development of hypertension that leads to chronic pathologies such as nephropathy and renal fibrosis. Aldosterone directly modulates renal cell proliferation and differentiation as part of normal kidney development. The stimulation of rapidly activated protein kinase cascades is one facet of how aldosterone regulates renal cell growth. These cascades may also contribute to myofibroblastic transformation and cell proliferation observed in pathological conditions of the kidney. Polycystic kidney disease is a genetic disorder that is accelerated by hypertension. EGFR-dependent proliferation of the renal epithelium is a factor in cyst development and trans-activation of EGFR is a key feature in initiating aldosterone-induced signalling cascades. Delineating the components of aldosterone-induced signalling cascades may identify novel therapeutic targets for proliferative diseases of the kidney.
    • Aldosterone-induced signalling and cation transport in the distal nephron.

      Thomas, Warren; McEneaney, Victoria; Harvey, Brian J; Department of Molecular Medicine, Royal College of Surgeons in Ireland Education and Research Centre, Beaumont Hospital, Dublin, Ireland. wthomas@rcsi.ie (2008-10)
      Aldosterone is an important regulator of Na(+) and K(+) transport in the distal nephron modulating the surface expression of transporters through the action of the mineralocorticoid receptor as a ligand-dependent transcription factor. Aldosterone stimulates the rapid activation of protein kinase-based signalling cascades that modulate the genomic effects of the hormone. Evidence is accumulating about the multi-factorial regulation of the epithelial sodium channel (ENaC) by aldosterone. Recent published data suggests that the activation of a novel PKC/PKD signalling pathway through the c-Src-dependent trans-activation of epidermal growth factor receptor contributes to early ENaC trafficking in response to aldosterone.
    • Alpha-1 antitrypsin deficiency.

      Kelly, Emer; Greene, Catherine M; Carroll, Tomas P; McElvaney, Noel G; O'Neill, Shane J; Department of Respiratory Research, Royal College of Surgeons in Ireland, Beaumont Hospital, Education Research Building, Beaumont Road, Dublin, Ireland. emerkelly@rcsi.ie (2010-06)
      To review the topic of alpha-1 antitrypsin (AAT) deficiency.
    • Alpha-1 antitrypsin: a potent anti-inflammatory and potential novel therapeutic agent.

      Bergin, David A; Hurley, Killian; McElvaney, Noel G; Reeves, Emer P; Respiratory Research Division, Department of Medicine, Royal College of Surgeons in Ireland, Education and Research Centre, Beaumont Hospital, Dublin 9, Ireland. (2012-04)
      Alpha-1 antitrypsin (AAT) has long been thought of as an important anti-protease in the lung where it is known to decrease the destructive effects of major proteases such as neutrophil elastase. In recent years, the perception of this protein in this simple one dimensional capacity as an anti-protease has evolved and it is now recognised that AAT has significant anti-inflammatory properties affecting a wide range of inflammatory cells, leading to its potential therapeutic use in a number of important diseases. This present review aims to discuss the described anti-inflammatory actions of AAT in modulating key immune cell functions, delineate known signalling pathways and specifically to identify the models of disease in which AAT has been shown to be effective as a therapy.
    • Alveolar rhabdomyosarcoma originating between the fourth and fifth metatarsal--case report and literature review.

      Bolger, J C; Walsh, J C; Hughes, R E; Eustace, S J; Harrington, P; Department of Surgery, Beaumont University Hospital, Beaumont, Dublin 9, Ireland. jarlathbolger@yahoo.co.uk (2010-09)
      We report a case of alveolar rhabdomyosarcoma arising between the fourth and fifth metatarsal. A 13-year-old boy presented to outpatients with a history of pain and swelling in the lateral aspect of his left forefoot. Plain radiographs and MRI showed a soft tissue mass displacing the fourth metatarsal. Percutaneous biopsy revealed an alveolar rhabdomyosarcoma. Staging scans showed advanced metastatic disease. The patient was treated with chemotherapy. This highly malignant lesion remains challenging to diagnose, and difficult to treat successfully.