• Alcohol misuse in the general hospital: some hard facts.

      Bradshaw, P; Denny, M; Cassidy, E M; South Lee Mental Health Service, GF Unit, Cork University Hospital, Wilton, Cork,, Ireland. (2012-02-03)
      AIMS: To examine (1) the prevalence of alcohol use disorders in adult general hospital inpatients; (2) the accuracy of documentation in relation to alcohol use. METHODS: A total of 210 random patients were interviewed out of 1,448 consecutive new admissions to CUH over 7 days. Case notes were reviewed for 206 (98%). Alcohol consumption was assessed using the Fast Alcohol Screening Test (FAST) and weekly drinking diary. FAST-positive (and a random sample of FAST-negative) patients then had a standardized interview. RESULTS: A total of 82% admitted for drinking alcohol. Among them 22% were drinking in excess of guidelines, 9% had DSM-IV Alcohol Abuse and 7% dependence. The sensitivity and specificity of the FAST for detecting those drinking above guidelines were 89 and 94% and for detecting a DSM-IV diagnosis was 100 and 73%. The majority of case notes contained inadequate information about alcohol intake. CONCLUSION: Alcohol use disorders are common and often undetected in the general hospital setting.
    • Alemtuzumab in the treatment of IVIG-dependent chronic inflammatory demyelinating polyneuropathy.

      Marsh, E A; Hirst, C L; Llewelyn, J G; Cossburn, M D; Reilly, M M; Krishnan, A; Doran, M; Ryan, A M; Coles, A J; Jones, J L; et al. (2010-06)
      Chronic inflammatory demyelinating polyneuropathy (CIDP) is an idiopathic immune mediated neuropathy causing demyelination and conduction block thought to occur as the result of an aberrant autoimmune response resulting in peripheral nerve inflammation mediated by T cells and humoral factors. Diagnosis commonly prompts initial treatment with steroids or intravenous immunoglobulin (IVIG) on which 5-35% subsequently become dependent to maintain function. Despite a number of small scale trials, the role for alternative long-term immunosuppression remains unclear. Alemtuzumab is a humanised monoclonal antibody targeting the CD52 antigen present on the surface of lymphocytes and monocytes. A single intravenous infusion results in rapid and profound lymphopoenia lasting >12 months. We report its use and clinical outcome in a small series of patients with severe IVIG-dependent CIDP. Seven patients (4 Males; 3 Females) who had failed to respond to conventional immunosuppression were treated in 5 centres receiving 9 courses of alemtuzumab (dose range 60-150 mg). Following treatment, mean monthly IVIG use fell 26% from 202 to 149 g and IVIG administration frequency from 22 to 136 days. Two patients had prolonged remission, two patients had a partial response and no clear benefit was observed in the remaining three patients (2 Males, 1 Females). Responding patients had a younger age at onset (19.5 years) and shorter disease duration than non-responders. Three patients developed autoimmune disease following treatment. Alemtuzumab may offer an alternative treatment for a subset of early onset IVIG dependent CIDP patients failing conventional immunosuppressive agents, but concerns about toxicity may limit its use.
    • Analysis of phenotype, genotype and serotype distribution in erythromycin-resistant group B streptococci isolated from vaginal flora in Southern Ireland.

      Kiely, R A; Lucey, B; Cotter, L; Department of Medical Microbiology, Cork University Hospital, Cork, Ireland. (2010-02)
      The screening of 2000 women of childbearing age in Cork between 2004 and 2006 produced 37 erythromycin-resistant group B streptococcus (GBS) isolates. PCR analysis was performed to determine the basis for erythromycin resistance. The ermTR gene was most frequently expressed (n = 19), followed by the ermB gene (n = 8). Four isolates harboured the mefA gene. Six isolates yielded no PCR products. Some phenotype-genotype correlation was observed. All isolates expressing the mefA gene displayed the M phenotype whilst all those expressing ermB displayed the constitutive macrolide resistance (cMLS(B)) phenotype. Of 19 isolates that expressed the ermTR gene, 16 displayed the inducible macrolide resistance (iMLS(B)) phenotype. Serotype analysis revealed that serotypes III and V predominated in these isolates. The identification of two erythromycin-resistant serotype VIII isolates among this collection represents the first reported finding of erythromycin resistance in this serotype. A single isolate was non-typable using two latex agglutination serotyping kits.
    • An assessment of the feasibility and effectiveness of an e-learning module in delivering a curriculum in radiation protection to undergraduate medical students.

      Leong, Sum; Mc Laughlin, Patrick; O'Connor, Owen J; O'Flynn, Siun; Maher, Michael M; Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland. leong81@gmail.com (2012-03)
      Integrating radiation protection (RP) education in the undergraduate medical curriculum is gaining importance and is mandatory in certain jurisdictions. An e-learning module for RP was developed at the authors' medical school and was integrated into year 4 of the 5-year undergraduate medical program. The aim of this study was to investigate its impact on RP knowledge, student preferences for various teaching methods, self-assessment of RP knowledge, and perceptions of career prospects in radiology. Likert-type 5-point scale evaluations and general comments about the RP module and various methods of teaching were also obtained.
    • Association between preoperative magnetic resonance imaging, pain intensity and quantitative sensory testing in patients awaiting lumbar diskectomy.

      Hegarty, Dominic; O'Connor, Owen J; Moore, Micheal; O'Regan, Kevin N; Shorten, George; Maher, Michael M; Department of Anaesthetics Radiology, Cork University Hospital, Cork, Ireland. (2011-02)
      Magnetic resonance imaging (MRI) offers important information regarding the morphology, location and size of a herniated disc, which influences the decision to offer lumbar diskectomy (LD). This study aims to examine the association between clinical neurophysiologic indices including pain intensity and quantitative sensory testing (QST), and the degree of lumbar nerve root compromise depicted on magnetic resonance (MR) in patients awaiting LD.
    • An atypical case of successful resuscitation of an accidental profound hypothermia patient, occurring in a temperate climate.

      Coleman, E; Doddakula, K; Meeke, R; Marshall, C; Jahangir, S; Hinchion, J; Cardiothoracic Surgery, Cork University Hospital, Cork, Ireland. coleman@shb.ie (2010-03)
      Cases of accidental profound hypothermia occur most frequently in cold, northern climates. We describe an atypical case, occurring in a temperate climate, where a hypothermic cardiac-arrested patient was successfully resuscitated using extracorporeal circulation (ECC).
    • An audit of traumatic nerve injury.

      O'Connor, G; McNamara, B (2009-07)
      The impact of trauma in the Irish healthcare setting is considerable. We present the results of a retrospective assessment of referrals to a Neurophysiology department for suspected traumatic nerve injury. A broad range of traumatic neuropathies was demonstrated on testing, from numerous causes. We demonstrate an increased liklihood of traumatic nerve injury after fracture / dislocation (p = 0.007). Our series demonstrates the need for clinicians to be aware of the possibility of nerve injury post trauma, especially after bony injury.
    • Brief reports: a clinical evaluation of block characteristics using one milliliter 2% lidocaine in ultrasound-guided axillary brachial plexus block.

      O'Donnell, Brian; Riordan, John; Ahmad, Ishtiaq; Iohom, Gabriella; Department of Anaesthesia, Cork University Hospital, Wilton Rd., Cork, Ireland. briodnl@gmail.co (2010-09)
      We report onset and duration of ultrasound-guided axillary brachial plexus block using 1 mL of 2% lidocaine with 1:200,000 epinephrine per nerve (total local anesthetic volume 4 mL). Block performance time, block onset time, duration of surgery, and block duration were measured. Seventeen consecutive patients were recruited. The mean (SD) block performance and onset times were 271 (67.9) seconds and 9.7 (3.7) minutes, respectively. Block duration was 160.8 (30.7) minutes. All operations were performed using regional anesthesia alone. The duration of anesthesia obtained is sufficient for most ambulatory hand surgery.
    • Can state or response entropy be used as a measure of sleep depth?

      Mahon, P; Greene, B R; Lynch, E M; McNamara, B; Shorten, G D; Department of Anaesthesia and Intensive Care Medicine, Cork University Hospital, and University College Cork, Cork, Ireland. rsimahon@hotmail.com (2012-02-03)
      SUMMARY: In this prospective observational study we examined the potential of the spectral entropy measures 'state' and 'response' entropy (Entropy monitor), as measures of sleep depth in 12 healthy adult subjects. Both median state and response entropy values varied significantly with sleep stage (p = 0.017 and p = 0.014 respectively; ANOVA). Median state or response entropy did not decrease significantly during the transition from awake to stage I sleep (p > 0.017). State entropy values decreased significantly between sleep stages I and II (p < 0.001). Both state and response entropy values were significantly less (40 and 45 arbitrary units respectively) in stage III (slow wave sleep) vs stage II sleep (p = 0.008). We conclude that state and response entropy values, when expressed as a function of time, may be a useful means of quantifying aspects of sleep.
    • Clinical trial: the efficacy, impact on quality of life, and safety and tolerability of prucalopride in severe chronic constipation--a 12-week, randomized, double-blind, placebo-controlled study.

      Quigley, E M M; Vandeplassche, L; Kerstens, R; Ausma, J; Alimentary Pharmabiotic Centre, University College Cork, Cork, Ireland. e.quigley@ucc.ie (2009-02-01)
      Chronic constipation may result in disabling symptoms, is often unsatisfactorily treated by laxatives and negatively impacts quality of life (QoL).
    • Demonstration of the course of the posterior intercostal artery on CT angiography: relevance to interventional radiology procedures in the chest.

      Dewhurst, Catherine; O'Neill, Siobhan; O'Regan, Kevin; Maher, Michael; Department of Radiology, Cork University Hospital, Cork, Ireland. cathydewhurst@gmail.com (2012-07-13)
      To document the course of the posterior intercostal artery (PIA) within the intercostal space (IS) in vivo using computed tomography angiography (CTA).
    • Determinants of outcome for patients undergoing lumbar discectomy: a pilot study.

      Hickey, Oonagh T; Burke, Siun M; Hafeez, Parvais; Mudrakouski, Alexander L; Hayes, Ivan D; Keohane, Catherine; Butler, Mark A; Shorten, George D; Department of Anaesthesia, Cork University Hospital, Cork City, Ireland. oonaghhickey@yahoo.co.uk (2010-08)
      One-third of patients who undergo lumbar discectomy continue to suffer from persistent pain postoperatively. Greater preoperative warmth thresholds and greater preoperative cerebrospinal fluid concentrations of stable serum nitric oxide metabolites are associated with a worse outcome. The principal objective of this study was to examine the relationship between patient outcome (defined using the Modified Stauffer-Coventry evaluating criteria) and preoperative pain perception threshold to an electrical stimulus.
    • Determinants of outcome for patients undergoing lumbar discectomy: a pilot study.

      Hickey, Oonagh T; Burke, Siun M; Hafeez, Parvais; Mudrakouski, Alexander L; Hayes, Ivan D; Keohane, Catherine; Butler, Mark A; Shorten, George D; Department of Anaesthesia, Cork University Hospital, Cork City, Ireland., oonaghhickey@yahoo.co.uk (2012-02-03)
      BACKGROUND AND OBJECTIVE: One-third of patients who undergo lumbar discectomy continue to suffer from persistent pain postoperatively. Greater preoperative warmth thresholds and greater preoperative cerebrospinal fluid concentrations of stable serum nitric oxide metabolites are associated with a worse outcome. The principal objective of this study was to examine the relationship between patient outcome (defined using the Modified Stauffer-Coventry evaluating criteria) and preoperative pain perception threshold to an electrical stimulus. METHODS: A prospective observational pilot study of patients (n = 39) was performed. Quantitative sensory testing, visual analogue scales for anxiety and pain, the Hospital Anxiety and Depression (HADS) Scale and the McGill Pain Questionnaire were completed, and serum nitric oxide metabolites were measured perioperatively. Excised disc tissue was examined histologically, and immunohistochemistry for phospholipase A2 was performed. RESULTS: Ten patients (26%) had an unsatisfactory outcome. Those with a satisfactory outcome had greater preoperative pain perception thresholds over the affected dermatome, which decreased by 2 months postoperatively. These patients also demonstrated a decrease in nitric oxide metabolites from preoperatively to 18 h postoperatively. Greater preoperative HADS scores, and greater pain intensity 4 h and 24 h postoperatively were associated with an unsatisfactory outcome. CONCLUSION: Patients with a satisfactory outcome demonstrate a decrease in pain perception thresholds and plasma concentration of stable nitric oxide metabolites during the perioperative period. Patients with an unsatisfactory outcome following lumbar discectomy experience greater preoperative anxiety and greater pain during the early postoperative period. These findings justify a larger prospective observational study.
    • Development of low-dose protocols for thin-section CT assessment of cystic fibrosis in pediatric patients.

      O'Connor, Owen J; Vandeleur, Moya; McGarrigle, Anne Marie; Moore, Niamh; McWilliams, Sebastian R; McSweeney, Sean E; O'Neill, Michael; Ni Chroinin, Muireann; Maher, Michael M; Department of Radiology, University College Cork and Cork University Hospital, Wilton, Cork 1111, Ireland. (2010-12)
      To develop low-dose thin-section computed tomographic (CT) protocols for assessment of cystic fibrosis (CF) in pediatric patients and determine the clinical usefulness thereof compared with chest radiography.
    • Do helmets worn for hurling fail to protect the ear? Identification of an emerging injury pattern.

      Martin-Smith, James D; Chan, Jeffery C Y; Power, Kieran T; Crowley, Paddy J; Clover, Anthony James P; Department of Plastic and Reconstructive Surgery, Cork University Hospital, Cork, Ireland. jmartins@tcd.ie (2012-12)
      Hurling is an Irish national game of stick and ball known for its ferocity, played by 190 000 players. Facial injuries were common but have been significantly reduced by legislation enforcing compulsory helmet wearing. Current standard helmets worn by hurlers do not offer protection to the external ear. Here we describe an emerging pattern of ear injuries and demonstrate the risk of external ear injuries in hurlers complying with current helmet safety standards. A 6-month retrospective analysis was carried out of patients attending Cork University Hospital (CUH) with ear lacerations sustained while hurling. Patient notes were reviewed and helmet manufacturers were interviewed. Seven patients were identified, all of whom sustained complex through ear lacerations while wearing helmets complying with current safety standards. Current helmet design fails to protect the external ear placing it at an increased risk of injury, a potential solution is to include ear protection in the helmet design.
    • Does Courvoisier's sign stand the test of time?

      Murphy, K; McLaughlin, P; O'Connor, B R; Breen, M; O'Súilleabháin, C; Maceneaney, P; Maher, M M; Department of Radiology, Cork University Hospital and University College, Cork, Ireland. kevin.murphy4@hse.ie (2012-11)
      To investigate the validity of Courvoisier's sign, in the age of cross-sectional imaging and image analysis software by objectively measuring gallbladder volumes at magnetic resonance cholangiopancreatography (MRCP) in patients with and without biliary obstruction and to assess whether gallbladder volume is more significantly increased in patients with gallstone-related rather than non-gallstone-related biliary obstruction.
    • Dyskalaemia following diffuse axonal injury: case report and review of the literature.

      Cronin, David; Kaliaperumal, Chandrasekaran; Kumar, Ramanathan; Kaar, George; Department of Neurosurgery, Cork University Hospital, Cork, Ireland. (2012)
      Traumatic brain injury, and its management, commonly causes derangements in potassium balance. There are a number of recognised causative factors including head trauma, hypothermia and iatrogenic factors such as pharmacological agents and permissive cooling. We describe a case of a 19-year-old man with a severe traumatic brain injury. In a 36-h period, his intracranial pressure increased despite maximal medical therapy and he developed refractory hypokalaemia. Immediately following a decompressive craniectomy, the patient was noted to be profoundly hyperkalaemic; this led to the development of ventricular tachycardia and cardiac arrest, from which the patient did not recover. The effects of brain injury on potassium balance are not well appreciated; the effect of decompressive craniectomy on potassium (K(+)) balance has not been described previously. We would like to emphasise the potential effect of diffuse axonal injury, a severe form of brain injury and decompressive craniectomy on potassium balance.
    • Effects of abdominal fat distribution parameters on severity of acute pancreatitis.

      O'Leary, D P; O'Neill, D; McLaughlin, P; O'Neill, S; Myers, E; Maher, M M; Redmond, H P; Department of Academic Surgery, Cork University Hospital, Wilton, Cork, Ireland. olearypeter83@hotmail.com (2012-07)
      Obesity is a well-established risk factor for acute pancreatitis. Increased visceral fat has been shown to exacerbate the pro-inflammatory milieu experienced by patients. This study aimed to investigate the relationship between the severity of acute pancreatitis and abdominal fat distribution parameters measured on computed tomography (CT) scan.
    • Emergence of MRSA clone ST22 in healthy young adults in the community in the absence of risk factors.

      Mollaghan, A M; Lucey, B; Coffey, A; Cotter, L; Department of Biological Sciences, Cork Institute of Technology, Bishopstown, Cork, Ireland. (2010-05)
      One thousand adults aged between 18 and 35 years were investigated for nasal colonization with community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA). Each volunteer completed a questionnaire to assess the presence or absence of risk factors for hospital-acquired MRSA (HA-MRSA) carriage. All MRSA isolated were characterized by microbiological and molecular methods. A S. aureus carriage rate of 22% and a MRSA carriage rate of 0.7% were observed. Analysis of the questionnaires revealed 121 individuals with HA-MRSA risk factors. Subsequently two MRSA infections with associated risk factors were excluded from calculation of the true carriage rate and an adjusted rate of 0.57% (5/879) was established. All seven MRSA isolates expressed the genotypic profile ST22-MRSA-IV, were PVL negative, agr type 1, and differed only by their antimicrobial susceptibility patterns. ST22-MRSA-IV (EMRSA-15) has shown worldwide spread in the hospital setting but has not been previously documented in isolation in the community.
    • Epiphyseal maturity indicators at the knee and their relationship to chronological age: results of an Irish population study.

      O'Connor, Jean E; Coyle, Joseph; Spence, Liam D; Last, Jason; UCD School of Medicine and Medical Science, Dublin, Ireland. jean.oconnor@ucd.ie (Wiley, 2013-09)
      Skeletal maturation is divisible to three main components; the time of appearance of an ossification center, its change in morphology and time of fusion to a primary ossification center. With regard to the knee, the intermediate period between appearance and fusion of the ossification centers extends over a period of greater than 10 years. This study aims to investigate radiographically the age at which morphological changes of the epiphyses at the knee occur in a modern Irish population. Radiographs of 221 subjects (137 males; 84 females) aged 9-19 years were examined. Seven nonmetric indicators of maturity were assessed using criteria modified from the Roche, Wainer, and Thissen method and Pyle and Hoerr's atlas of the knee. Reference charts are presented which display the timeline for each of the grades of development of the seven indicators. Mean age was found to increase significantly with successive grades of development of each of the seven indicators. A significant difference was noted between males and females at the same grade of development for six of the seven indicators. The narrowest age range reported for a single grade of development was 2.2 years for Grade 2 of development of the tibial tuberosity for males. The information on changing morphology of the epiphyses at the knee in the present study may provide an adjunct to methods used for evaluation of skeletal maturity before surgery for orthopedic disorders or to evaluate skeletal age in clinical scenarios where either delayed or precocious skeletal maturation is suspected.