• Natural history of Crohn’s disease: is the tide beginning to turn?

      Ó Maoláin, M; Egan, LJ (Irish Medical Journal, 2011-03)
    • Natural history of fetal trisomy 18 after prenatal diagnosis.

      Burke, Annette L; Field, Katie; Morrison, John J; Galway University Hospital, National University of Ireland Galway, Newcastle Road, Galway, Ireland. (2013-03)
      To evaluate the natural fetal and neonatal outcome for pregnancies with an established prenatal diagnosis of fetal trisomy 18, and a parental decision for continuation of the pregnancy.
    • Non-motor complications associated with restless legs syndrome

      Lucey, Rebbeca; Browne, Patrick; Counihan, Timothy (Nursing in General Practice, 2015-01)
      Restless legs syndrome (RLS), or Willis-Ekbom Disorder, is a common neurological disorder involving an irresistible need to move the limbs, usually associated with abnormal burning or itching sensations in the extremities.1 These abnormal sensations are provoked by rest or inactivity and, at least, temporarily relieved by movement.2 While the legs are the most commonly affected limbs, it often spreads to other parts of the body, particularly the arms.3 Phantom limbs can also be affected.4 It affects between 7.2% and 11% of the population in Europe and North America5 and is twice as common in females as males.6
    • Nonoperative active management of critical limb ischemia: initial experience using a sequential compression biomechanical device for limb salvage.

      Sultan, Sherif; Esan, Olubunmi; Fahy, Anne; Department of Vascular and Endovascular Surgery, Western Vascular Institute, University College Hospital Galway, Galway, Ireland. sherifsultan@esatclear.ie (Vascular, 2008)
      Critical limb ischemia (CLI) patients are at high risk of primary amputation. Using a sequential compression biomechanical device (SCBD) represents a nonoperative option in threatened limbs. We aimed to determine the outcome of using SCBD in amputation-bound nonreconstructable CLI patients regarding limb salvage and 90-day mortality. Thirty-five patients with 39 critically ischemic limbs (rest pain = 12, tissue loss = 27) presented over 24 months. Thirty patients had nonreconstructable arterial outflow vessels, and five were inoperable owing to severe comorbidity scores. All were Rutherford classification 4 or 5 with multilevel disease. All underwent a 12-week treatment protocol and received the best medical treatment. The mean follow-up was 10 months (SD +/- 6 months). There were four amputations, with an 18-month cumulative limb salvage rate of 88% (standard error [SE] +/- 7.62%). Ninety-day mortality was zero. Mean toe pressures increased from 38.2 to 67 mm Hg (SD +/- 33.7, 95% confidence interval [CI] 55-79). Popliteal artery flow velocity increased from 45 to 47.9 cm/s (95% CI 35.9-59.7). Cumulative survival at 12 months was 81.2% (SE +/- 11.1) for SCBD, compared with 69.2% in the control group (SE +/- 12.8%) (p = .4, hazards ratio = 0.58, 95% CI 0.15-2.32). The mean total cost of primary amputation per patient is euro29,815 ($44,000) in comparison with euro13,900 ($20,515) for SCBD patients. SCBD enhances limb salvage and reduces length of hospital stay, nonoperatively, in patients with nonreconstructable vessels.
    • Novel use of hand fracture fixation plates in the surgical stabilisation of flail chest.

      Dunlop, Rebecca L E; Tiong, William; Veerasingam, Devendran; Kelly, John L; Department of Plastic and Reconstructive Surgery, University College Hospital, Galway, Ireland. rebeccapollard@doctors.org.uk (Elsevier Ltd., 2010-01)
      Plastic surgeons specialize in working closely with other surgical colleagues to help solve clinical problems. In this case, we performed surgical stabilisation of a large flail chest fragment in conjunction with the cardiothoracic surgical team, using the mini-plating set more commonly used for hand fracture fixation. The use of this fixation system for flail chest has not previously been described, but offers advantages over other reported methods, primarily by dispensing with the need for an extensive thoracotomy incision and by providing robust stabilisation without the presence of prominent hardware.
    • An online management information system for objective structured clinical examinations

      Kropmans,Thomas JB; O’Donovan, Barry GG; Cunningham, David; Murphy, Andrew W; Flaherty, Gerard; Nestel, Debra; Dunne, Fidelma P; Galway University Hospital (Canadian Center of Science and Education, 2012-01-01)
      Objective Structured Clinical Examinations (OSCE) are adopted for high stakes assessment in medical education. Students pass through a series of timed stations demonstrating specific skills. Examiners observe and rate students using predetermined criteria. In most OSCEs low level technology is used to capture, analyse and produce results. We describe an OSCE Management Information System (OMIS) to streamline the OSCE process and improve quality assurance. OMIS captured OSCE data in real time using a Web 2.0 platform. We compared the traditional paper trail outcome with detailed real time analyses of separate stations. Using a paper trail version only one student failed the OSCE. However, OMIS identified nineteen possibly ‘incompetent’ students. Although there are limitations to the design of the study, the results are promising and likely to lead to defendable judgements on student performance.
    • Optimal patient positioning for ligamentotaxis during balloon kyphoplasty of the thoracolumbar and lumbar spine.

      Cawley, D T; Sexton, P; Murphy, T; McCabe, J P; Department of Orthopaedic and Trauma Surgery, Merlin Park Hospital, Galway University Hospitals, Galway, Ireland. derekcawley@hotmail.com (2011-06)
      Percutaneous balloon kyphoplasty aims to restore vertebral height, correct angular deformity and stabilize the spine in the setting of vertebral compression fractures. The patient is positioned prone with supports under the iliac crests and upper thorax to allow gravity to extend the spine. In the treatment of lumbar fractures, we evaluated patient positioning with the contribution of hip extension to increase anterior ligamentotaxis, thus facilitating restoration of vertebral height. Our positioning technique created a mean anterior height increase from 72% to 78% of the average height of the cranial and caudal vertebrae (p=0.037). Balloon inflation did not significantly further increase anterior or posterior vertebral height, or Cobb angle.
    • Orientation to time as a guide to the presence and severity of cognitive impairment in older hospital patients.

      O'Keeffe, Emma; Mukhtar, Osman; O'Keeffe, Shaun T; Department of Geriatric Medicine, Unit 4, Merlin Park University Hospital, Galway, Ireland. sokanc@iolfree.ie (2011-05)
      Testing of orientation to time is an important part of mental status examination. The validity of errors in different aspects of temporal orientation was examined in older hospital patients as a guide to the presence of dementia or delirium and as a measure of the severity of dementia, as defined by the Global Deterioration Scale.
    • Ottawa Knee Rule: Investigating Use and Application in a Tertiary Teaching Hospital.

      Mohamed, Abubakr; Babikir, Elkhidir; Mustafa, Mohamed Kamal Elbashir (2020-06-24)
      Background Knee injuries are encountered commonly in the emergency departments (EDs) in Ireland. Validated clinical decision rules such as Ottawa knee rule (OKR) can be used in acute knee injury settings to reduce the number of unnecessary radiography. Clinical judgment can be used to distinguish between suspected fractures and non-fractures in many cases; however, radiography is still routinely requested. Objectives We evaluated the OKRs in a high-volume tertiary teaching hospital in Ireland to determine whether the rule could be safely used to decide whether patients with acute blunt knee trauma should undergo radiography. Methods This was an observational study conducted in the ED over a three-month period in a tertiary referral hospital. A total of 110 patients with acute knee injuries were examined using OKR. Inclusion criteria included patients with acute knee injuries due to blunt trauma or twisting injury and patients with lacerations or contusions. Open fractures and fractures due to penetrating injury were excluded from the study. Results Fractures were seen in 12 (13.2%) of the 110 patents who met the inclusion criteria. The OKR predicted all 12 fractures. Sensitivity was 100%, and specificity was 39%. Conclusions The OKR is highly sensitive for fracture in this setting and can be safely used to decide whether patients with acute blunt knee trauma should undergo radiography.
    • Paediatric sutureless circumcision-an alternative to the standard technique.

      Department of Urology, Galway University Hospital, Galway, Ireland,, drbriankelly@hotmail.com. (2012-01-31)
      INTRODUCTION: Circumcision is one of the most commonly performed surgical procedures in male children. A range of surgical techniques exist for this commonly performed procedure. The aim of this study is to assess the safety, functional outcome and cosmetic appearance of a sutureless circumcision technique. METHODS: Over a 9-year period, 502 consecutive primary sutureless circumcisions were performed by a single surgeon. All 502 cases were entered prospectively into a database including all relevant clinical details and a review was performed. The technique used to perform the sutureless circumcision is a modification of the standard sleeve technique with the use of a bipolar diathermy and the application of 2-octyl cyanoacrylate (2-OCA) to approximate the tissue edges. RESULTS: All boys in this study were pre-pubescent and the ages ranged from 6 months to 12 years (mean age 3.5 years). All patients had this procedure performed as a day case and under general anaesthetic. Complications included: haemorrhage (2.2%), haematoma (1.4%), wound infection (4%), allergic reaction (0.2%) and wound dehiscence (0.8%). Only 9 (1.8%) parents or patients were dissatisfied with the cosmetic appearance. CONCLUSION: The use of 2-OCA as a tissue adhesive for sutureless circumcisions is an alternative to the standard suture technique. The use of this tissue adhesive, 2-OCA, results in comparable complication rates to the standard circumcision technique and results in excellent post-operative cosmetic satisfaction.
    • A Pain in the Neck - A review of Deep Space Neck Infections in theEmergency Department

      Harney, T; Mullarkey, C; O’Donnell, J (Irish Medical Journal, 2012-12)
    • Panton-Valentine Leukocidin-Producing Staphylococcal aureus: Report of Four Siblings.

      Department of Dermatology, Galway University Hospital, Galway, Ireland. (2012-01-31)
      Panton-Valentine leukocidin (PVL)-producing Staphylococcus aureus results in leukocyte destruction and tissue necrosis (Pediatric Dermatology 2007;24:401). It can be associated with a spectrum of clinical manifestations that range from localized staphylococcal skin infections to sometimes severe necrotizing pneumonia (Clin Infect Dis 1999;29:1128). We report a case of four siblings, three brothers whose atopic dermatitis was complicated by cutaneous lesions and furunculosis, while their 21-month-old sister had a fatal PVL positive staphylococcal pneumonia.
    • Parkinson’s disease – a brief practical approach

      Browne, Patrick; Daly, Lorna; Counihan, Timothy (Nursing in General Practice, 2014-09)
      arkinson’s disease (PD) is the second most common neurodegenerative disease after Alzheimer’s disease, and affects about 1% of the population over 65 year of age. Although the incidence of PD rises with advancing age, juvenile onset PD (onset under 40 years of age) is well recognised and is associated with identifiable genetic mutations in a significant proportion of cases. The cause of PD remains unknown. One possibility is that affected individuals may have inherited a predisposition to developing PD and that some environmental exposure may trigger the start of neuronal degeneration. The recent identification of a number of genetic mutations in families with several affected members, has enhanced our understanding of the pathogenesis of neuronal degeneration in PD. These gene mutations result in a number of possible abnormalities including abnormal protein folding/aggregation, defective protein clearance, defective cell resistance to oxidative stress, mitochondrial dysfunction – such abnormalities may contribute to pathogenesis.
    • Patients accessing ambulatory care for HIV-infection: epidemiology and prevalence assessment

      Tuite, H; Horgan, M; Mallon, PWG; McConkey, SJ; Mooka, B; Mulcahy, F; Walsh, C; O’Hora, A; O’Flanagan, D; Bergin, C; et al. (Irish Medical Journal, 2015-07)
      This study describes the demographics and treatment status of HIV-infected adults accessing ambulatory care in the Republic of Ireland and estimates diagnosed HIV prevalence rates. 3254 HIV-infected adults attended 1 of the 6 specialist HIV centres in the 12-month period 1 st July 2009 to 30 th June 2010. 2023/3254 (62%) were male, 1761/3133 (56%) Irish and 1048/3133 (34%) African. 1924/3098 (62%) resided in the Dublin area. The mean age was 39.8 years (SD 9.3); probable route of acquisition was available for 2898/3254 (89%); heterosexual acquisition accounted for 1442 (50%), MSM 777 (27%) and IDU 598 (21%). 2574/3202 (80%) were on highly active antiretroviral therapy (HAART).Of these 87% had HIV-RNA levels < 50cpm and 94% < 500cpm. The HIV diagnosed prevalence rate is estimated at 1.09/1000 nationally and at 2.25/1000 in the Dublin area for 15-59 year olds
    • Patients on hemodialysis are better served by a proximal arteriovenous fistula for long-term venous access.

      Sultan, Sherif; Hynes, Niamh; Hamada, Nader; Tawfick, Wael; Department of Vascular and Endovascular Surgery, Western Vascular Institute, Galway University Hospital, Galway, Ireland. sherif.sultan@hse.ie (2012-11)
      Patients with end-stage renal disease should have arteriovenous fistula (AVF) formation 3 to 6 months prior to commencing hemodialysis (HD). However, this is not always possible with strained health care resources. We aim to compare autologous proximal AVF (PAVF) with distal AVF (DAVF) in patients already on HD. Primary end point is 4-year functional primary. Secondary end point is freedom from major adverse clinical events (MACEs). From January 2003 to June 2009, out of 495 AVF formations, 179 (36%) patients were already on HD. These patients had 200 AVF formations (49 DAVF vs 151 PAVF) in arms in which no previous fistula had been formed. No synthetic graft was used. Four-year primary functional patency significantly improved with PAVF (68.9% ± SD 8.8%) compared to DAVF (7.3% ± SD 4.9%; P < .0001). Five-year freedom from MACE was 85% with PAVF compared to 40% with DAVF (P < .005). Proximal AVF bestows long-term functional access with fewer complications compared to DAVF for patients already on HD.
    • Patients’ Attitude towards Travelling For Breast Services versus Waiting Longer For Local Services

      Abd Elwahab, S; McGough, P; Cooley, G; McLaughlin, R (Irish Medical Journal, 2018-05)
      Geographical access is a cornerstone of health care provision. However, prolonged waiting for breast clinic appointments in local services results in delayed diagnosis and excessive anxiety for patients. In this study, we present a patient satisfaction survey results of an initiative to offer out-patient clinic appointments for non-urgent patients referred to the breast unit in Letterkenny General Hospital (LGH), Ireland, and exceeded the recommended waiting period of 12 weeks. These patients were offered appointment in University Hospital Galway (UCHG), which is an average travel time of about 3.5-4.5 hours away from LGH. 163 patients out of 336 (48.5%) patients actively waiting more than 12 weeks for appointments in LGH accepted alternative appointments in UCHG. Despite the long travel distance for these patients, 100% of them reported high satisfaction and 97.3% said they would accept further UCHG appointments if a similar situation of prolonged waiting in LGH arises. None of these patients were diagnosed with cancer, and only one had a benign lumpectomy. This study showed that if offered alternative appointments, just under half of the patients would accept. The initiative provides a feasible solution for long waiters, and the survey shows that patients’ satisfaction remains high despite long travel.
    • Pattern of change in renal function following radical nephrectomy for renal cell carcinoma

      Coyle, D; Quinlan, MR; D’Arcy, FT; Kelly, BD; Corcoran, O; Durkan, GC; Jaffry, S; Walsh, K; Rogers, E (2015-09)
      Radical nephrectomy (RN) is an independent risk factor for the development of chronic kidney disease (CKD) in those with renal cell carcinoma (RCC). We aimed to examine the pattern of change in post-operative renal function in patients who underwent RN for RCC over a 3 year period at our institution. We performed a retrospective review of histological and biochemical findings in patients undergoing RN for RCC over a 38 month period. Estimated glomerular filtration rate (eGFR) was recorded pre- and post-operatively and at follow-up. We analysed data on 131 patients (median follow-up 24 months). The proportion of patients with advanced CKD increased significantly at follow-up with 48 (85.7%) patients, classified as having stage 2 CKD pre-operatively, being re-classified as stage 3-5. Mean eGFR was significantly lower pre-operatively (76.6 mL/min/1.73 m2) compared to hospital discharge (61 mL/ min/1.73 m2, p<0.001) and follow-up (55.5 mL/min/1.73 m2, p<0.001). Those with pT1 tumours sustained a significantly greater decline in eGFR compared to other stages. In conclusion, patients with pT1a and pT1b tumours sustain a disproportionate decline in renal function and may benefit the most from NSS.
    • Perampanel: An audit of clinical experience using the epilepsy electronic patient record.

      Ryan, E; Colleran, N; Cullinane, P; Fitzsimons, M; Flynn, C; Delanty, N; Hennessy, M (Irish Medical Journal, 2016-07)
      Perampanel is a non-competitive antagonist of AMPA glutamate receptors on post synaptic neurons. The aim of this study was to conduct an audit of the experience of perampanel treatment in Ireland based on the interrogation of the national epilepsy electronic patient record (EPR). A retrospective audit was compiled which reviewed the progress of patients who had been treated across two regional epilepsy centres. The EPR was used to identify patients and collect information relevant to their perampanel therapy. Collected data was entered into a statistical package for social sciences for analysis using descriptive statistics. 70 patients were identified for inclusion in this audit. Partial onset epilepsy was the predominant epilepsy syndrome treated with perampanel. Eight milligrams daily was the maximum dose achieved in 31.45% (n=22). Complex partial seizures demonstrated the best seizure response to perampanel, which was optimal at doses of 4mgs to 8mgs once daily. Treatment was discontinued primarily due to side effect profile (28.5%; n=20). The common side effects reported were behavioural alteration, sedation and dizziness. Abnormal thoughts were identified in 4.2% (n=3). Overall perampanel has been shown to be an effective adjunct. The EPR was demonstrated as an effective tool for audit and research.