• Salvage of critical limb ischemia with the "trellis reserve'' of subintimal superficial femoral-popliteal artery occlusion: a new modality in managing critical limb ischemia--a case report.

      Sultan, Sherif; Heskin, Leonie; Hynes, Niamh; Akhtar, Yousaf; Cough, Val; Manning, Brian; Aremu, M; Courtney, D; Western Vascular Institute, Department of Vascular and Endovascular Surgery, University College Hospital Galway, Ireland. sherifsultan@esatclear.ie (Vascular and endovascular surgery, 2005)
      Subintimal angioplasty is a safe, effective, but nondurable procedure in treating long superficial femoral artery occlusions in patients with severe lower limb ischemia. The authors report a case of acute thrombosis that presented 16 weeks after subintimal angioplasty. The ;;Trellis'' percutaneous thrombolytic infusion system permitted a controlled site-specific infusion of recombinant tissue-type plasminogen activator (rtPA). The unique design of the ;;Trellis'' allowed complete aspiration of thrombus and avoiding regional and systemic thrombolytic side effects. The ;;Trellis'' system is effective in percutaneous management of thrombotic lesions; however, intimal dissection may need to be addressed.
    • Satisfaction rates with the current Special Type Consultation (STC) reimbursement scheme among General Practitioners – A Mixed Methods Study.

      Kiely, A; O’Meara, S; Fitzgerald, N; Regan, AM; Durcan, P; McGuire, G; Kelly, ME (Irish Medical Journal, 2017-03)
      The Special Type Consultation (STC) scheme is a fee-for-service reimbursement scheme for General Practitioners (GPs) in Ireland. Introduced in 1989, the scheme includes specified patient services involving the application of a learned skill, e.g. suturing. This study aims to establish the extent to which GPs believe this scheme is appropriate for current General Practice. This is an embedded mixed-methods study combining quantitative data on GPs working experience of and qualitative data on GPs attitudes towards the scheme. Data were collected by means of an anonymous postal questionnaire. The response rate was 60.4% (n=159.) Twenty-nine percent (n=46) disagreed and 65% (n=104) strongly disagreed that the current list of special items is satisfactory. Two overriding themes were identified: economics and advancement of the STC process. This study demonstrates an overwhelming consensus among GPs that the current STC scheme is outdated and in urgent need of revision to reflect modern General Practice.
    • Scaffold with a natural mesh-like architecture: isolation, structural, and in vitro characterization.

      Burugapalli, Krishna; Thapasimuttu, Anilkumar; Chan, Jeffrey C Y; Yao, Li; Brody, Sarah; Kelly, Jack L; Pandit, Abhay; Department of Mechanical and Biomedical Engineering, National University of Ireland, Galway, Republic of Ireland. (2007-03)
      An intact extracellular matrix (ECM) with a mesh-like architecture has been identified in the peri-muscular sub-serosal connective tissue (PSCT) of cholecyst (gallbladder). The PSCT layer of cholecyst wall is isolated by mechanical delamination of other layers and decellularized with a treatment with peracetic acid and ethanol solution (PES) in water to obtain the final matrix, which is referred to as cholecyst-derived ECM (CEM). CEM is cross-linked with different concentrations of glutaraldehyde (GA) to demonstrate that the susceptibility of CEM to degradation can be controlled. Quantitative and qualitative macromolecular composition assessments revealed that collagen is the primary structural component of CEM. Elastin is also present. In addition, the ultra-structural studies on CEM reveal the presence of a three-dimensional fibrous mesh-like network structure with similar nanoscale architecture on both mucosal and serosal surfaces. In vitro cell culture studies show that CEM provides a supporting structure for the attachment and proliferation of murine fibroblasts (3T3) and human umbilical vein endothelial cells (HUVEC). CEM is also shown to support the attachment and differentiation of rat adrenal pheochromocytoma cells (PC12).
    • Screening complications and treatment of Gestational Diabetes

      Dennedy, C; O'Sullivan, E; Dunne, F (Diabetes and Primary Care, 2010)
    • Screening complications and treatment of gestational diabetes.

      Dennedy, C; O Sullivan, E; Dunne, F (Diabetes and Primary Care, 2010)
    • The Selfie Wrist – Selfie induced trauma

      Lyons, RF; Kelly, JC; Murphy, CG (Irish Medical Journal, 2017-06)
      The selfie phenomenon has exploded worldwide over the past two years. Selfies have been linked to a large number of mortalities and significant morbidity worldwide. However, trauma associated with selfies including fractures, is rarely publicised. Here we present a case series of upper extremity trauma secondary to selfies across all age groups during the summer period. Four cases of distal radius and ulna trauma in all age groups were reported. This case series highlights the dangers associated with taking selfies and the trauma that can result.
    • Sequential compression biomechanical device in patients with critical limb ischemia and nonreconstructible peripheral vascular disease.

      Sultan, Sherif; Hamada, Nader; Soylu, Esraa; Fahy, Anne; Hynes, Niamh; Tawfick, Wael; Department of Vascular and Endovascular Surgery, Western Vascular Institute, University College Hospital, Galway, Ireland. sherif.sultan@hse.ie (Journal of vascular surgery, 2011-08)
      Critical limb ischemia (CLI) patients who are unsuitable for intervention face the dire prospect of primary amputation. Sequential compression biomechanical device (SCBD) therapy provides a limb salvage option for these patients. This study assessed the outcome of SCBD in severe CLI patients who otherwise would face an amputation. Primary end points were limb salvage and 30-day mortality. Secondary end points were hemodynamic outcomes (increase in popliteal artery flow and toe pressure), ulcer healing, quality-adjusted time without symptoms of disease or toxicity of treatment (Q-TwiST), and cost-effectiveness.
    • Sequential compression biomechanical device versus primary amputation in patients with critical limb ischemia.

      Tawfick, Wael A; Hamada, Nader; Soylu, Esraa; Fahy, Anne; Hynes, Niamh; Sultan, Sherif; 1Department of Vascular and Endovascular Surgery, Western Vascular Institute, University College Hospital, Galway (UCHG), Galway, Ireland. (Vascular and endovascular surgery, 2013-10)
      Introduction: Patients with critical limb ischemia (CLI), who are unsuitable for intervention, face the consequence of primary amputation. Sequential compression biomechanical device (SCBD) therapy provides a limb salvage option for these patients. Objectives: To assess the outcome of SCBD in patients with severe CLI who are unsuitable for revascularization. Primary end points were limb salvage and 30-day mortality. Methods: From 2005 to 2012, 189 patients with severe CLI were not suitable for revascularization. In all, 171 joined the SCBD program. We match controlled 75 primary amputations. Results: All patients were Rutherford category 4 or higher. Sustained clinical improvement was 68% at 1 year. Mean toe pressure increased from 19.9 to 35.42 mm Hg, P < .0001. Mean popliteal flow increased from 35.44 to 55.91 cm/sec, P < .0001. The 30-day mortality was 0.6%. Limb salvage was 94% at 5 years. Freedom from major adverse clinical events was 62.5%. All-cause survival was 69%. Median cost of managing a primary amputation patient is €29 815 compared to €3985 for SCBD. We treated 171 patients with artassist at a cost of €681 965. However, primary amputation for 75 patients cost €2 236 125. Conclusion: The SCBD therapy is a cost-effective and clinically effective solution in patients with CLI having no option of revascularization. It provides adequate limb salvage while providing relief of rest pain without any intervention.
    • A series of oral lesions presenting to an otolaryngology Department

      Khan, SU; O Connor, TE; Keogh, IJ (Irish Medical Journal, 2015-06)
      This study was performed to assess the incidence and intraoral distribution of different mucosal lesions in a representative population. Retrospective review of clinical notes and assessment of histology reports of patients were performed, who presented with different oral lesions to University Hospital Galway, between January 2007 and December 2008.Of the 106 histology reports evaluated, 94 were identified as benign lesions while 12 were malignant lesions. 96 of these patients were referred from G.P services, 6 patients were referred from other departments while 4 patients came through emergency department by self referral. The numbers and incidence of the commonest lesions in order of frequency were chronic inflammation 20 (18.8%), papilloma 19 (17.1%), fibroma 09 (8.4%), mucocele 09 (8.4%) and leukoplakia 08 (7.5%).We concluded that majority of the presented oral lesions are benign (88.7%). Chronic inflammation (18.8%) is the commonest benign oral lesion and all white lesions which represents 34% of oral lesions are not true leukoplakia.
    • Services for Children With Central Auditory Processing Disorder in the Republic of Ireland: Current and Future Service Provision

      Logue-Kennedy, M.; Lyons, R.; Carroll, C.; Byrne, M.; Dignan, E.; O'Hagan, L. (2012-04-30)
    • Sevoflurane and the Feto-Placental Vasculature: The Role of Nitric Oxide and Vasoactive Eicosanoids

      Farragher, R; Maharaj, C; Higgins, B (Anesthesia and Analgesia, 2008)
    • Shiitake Flagellate Dermatitis: the First Case Reported in Ireland

      Byrne, N; Foley, C; Cotter, M; O’Gorman, S; Storan, Eoin R; Marren, P (Irish Medical Journal, 2017-01)
      Shiitake (Lentinula edodes) is the second most commonly consumed mushroom worldwide1. It is used in Asian medicine for its anticarcinogenic, antihypertensive and lipid lowering properties2. Furthermore, extracts of these mushrooms are used in over-the-counter dietary supplements designed to improve the immune system1. The first case of shiitake mushroom induced flagellate dermatitis was described in Japan in 1977 and it is now being reported in the western world3. After literary review and consultation with the Irish National Poisons Information Centre, we believe this is the first reported case of shiitake flagellate dermatitis in Ireland
    • Six years' experience with prostaglandin I2 infusion in elective open repair of abdominal aortic aneurysm: a parallel group observational study in a tertiary referral vascular center.

      Beirne, Chris; Hynes, Niamh; Sultan, Sherif; Department of Vascular and Endovascular Surgery, Western Vascular Institute, Galway University Hospitals, Galway, Ireland. (Annals of vascular surgery, 2008-11)
      The prostaglandin I(2) (PGI(2)) analogue iloprost, a potent vasodilator and inhibitor of platelet activation, has traditionally been utilized in pulmonary hypertension and off-label use for revascularization of chronic critical lower limb ischemia. This study was designed to assess the effect of 72 hr iloprost infusion on systemic ischemia post-open elective abdominal aortic aneurysm (EAAA) surgery. Between January 2000 and 2007, 104 patients undergoing open EAAA were identified: 36 had juxtarenal, 15 had suprarenal, and 53 had infrarenal aneurysms, with a mean maximal diameter of 6.9 cm. The male-to-female ratio was 2.5:1, with a mean age of 71.9 years. No statistically significant difference was seen between the study groups with regard to age, sex, risk factors, American Society of Anesthesiologists (ASA) grade, or diameter of aneurysm repaired. All emergency, urgent, and endovascular procedures for aneurysms were excluded. Fifty-seven patients received iloprost infusion for 72 hr in the immediate postoperative period compared with 47 patients who did not. Patients were monitored for signs of pulmonary, renal, cardiac, systemic ischemia, and postoperative intensive care unit (ICU) morbidity. Statistically significantly increased ventilation rates (p=0.0048), pulmonary complication rates (p=0.0019), and myocardial ischemia (p=0.0446) were noted in those patients not receiving iloprost. These patients also had significantly higher renal indices including estimate glomerular filtration rate changes (p=0.041) and postoperative urea level rises (p=0.0286). Peripheral limb trashing was noted in five patients (11.6%) in the non-iloprost group compared with no patients who received iloprost. Increased rates of transfusion requirements and bowel complications were noted in those who did not receive iloprost, with their ICU stay greater than twice that of iloprost patients. All-cause morbidity affected 67% of patients not receiving iloprost compared to 40% who did. Survival rates were significantly better with iloprost than without in both 30-day (p=0.009) and 5-year cumulative (p=0.0187) survival. Iloprost infusion for 72 hr after open AAA repair was associated with improved systemic perfusion and decreased systemic ischemia. Patients had a significant survival benefit at 30 days and 5 years and significantly improved renal, cardiac, and respiratory function.
    • The sodium iodide symporter (NIS) and potential regulators in normal, benign and malignant human breast tissue.

      Ryan, James; Curran, Catherine E; Hennessy, Emer; Newell, John; Morris, John C; Kerin, Michael J; Dwyer, Roisin M; Division of Surgery, School of Medicine, National University of Ireland Galway, Galway, Ireland. (2011-01)
      The presence, relevance and regulation of the Sodium Iodide Symporter (NIS) in human mammary tissue remains poorly understood. This study aimed to quantify relative expression of NIS and putative regulators in human breast tissue, with relationships observed further investigated in vitro.
    • Spontaneous aortic rupture due to human immunodeficiency virus-associated vasculitis: A lesson learnt.

      Waters, Peadar S; Dover, Mary; Tawfick, Wael; Hynes, Niamh; Sultan, Sherif; Department of Vascular and Endovascular Surgery, Western Vascular Institute, Galway University Hospital, Galway, Ireland. (Vascular, 2013-09-02)
    • Standards in operation notes is it time to re-emphasise their importance?

      Cahill, KC (Irish Medical Journal, 2016-01)
      Guidelines exist for operation notes from the Royal College of Surgeons of England but compliance has been shown to be variable. The authors performed a closed loop audit of compliance with RCS standards in an Irish Plastic Surgery department. Thirty random operation notes were selected from a conserved pool of authors - before and after an educational intervention to increase awareness of the RCS guidelines. Following education, improvements were noted but also deteriorations â time increased from 12 (40%) to 16 (53%), emergency/elective status from none (0%) to 11 (36%), and operative diagnosis from seven (23%) to 21 (70%). However notably among the findings, surgeonâ s name decreased from 30 (100%) to 26 (86%), findings from 27 (90%) to 21 (53%) and tissue altered from 27 (90%) to 20 (66%). As some specialities are developing operation note standards specific to individual procedures, the findings are compared with previous similar published work.
    • Stellate ganglion blockade for analgesia following upper limb surgery.

      McDonnell, J G; Finnerty, O; Laffey, J G; Department of Anaesthesia and Intensive Care Medicine, Galway University, Hospital, Galway, Ireland. (2012-01-31)
      We report the successful use of a stellate ganglion block as part of a multi-modal postoperative analgesic regimen. Four patients scheduled for orthopaedic surgery following upper limb trauma underwent blockade of the stellate ganglion pre-operatively under ultrasound guidance. Patients reported excellent postoperative analgesia, with postoperative VAS pain scores between 0 and 2, and consumption of morphine in the first 24 h ranging from 0 to 14 mg. While these are preliminary findings, and must be confirmed in a clinical trial, they highlight the potential for stellate ganglion blockade to provide analgesia following major upper limb surgery.
    • Stenting for infantile adult aortic coarctation with successful conception of zygomatic twins at 4 years' post-intervention.

      Waters, Peadar S; Mitchell, David P; Tawfick, Wael; Hynes, Niamh; Sultan, Sherif; Western Vascular Institute, University College Hospital, Galway, Ireland. Electronic address: peadarwaters@hotmail.com. (International journal of surgery case reports, 2013)
      Aortic coarctation is a congenital defect which rarely presents in adulthood but results in significant morbidity and mortality. Endovascular techniques present novel therapeutic options for managing this anomaly with comparable results to traditional open surgical repair.
    • Stereology of human myometrium in pregnancy: influence of maternal body mass index and age.

      Sweeney, Eva M; Crankshaw, Denis J; O'Brien, Yvonne; Dockery, Peter; Morrison, John J; Department of Obstetrics and Gynecology, National University of Ireland Galway, Galway University Hospital, Galway, Ireland. (2013-04)
      Knowledge of the stereology of human myometrium in pregnancy is limited. Uterine contractile performance may be altered in association with maternal obesity and advanced maternal age. The aim of this study was to investigate the stereology of human myometrium in pregnancy, and to evaluate a potential influence of maternal body mass index (BMI) and age.