• Catheter-related infection in Irish intensive care units diagnosed with HELICS criteria: a multi-centre surveillance study.

      Conrick-Martin, I; Foley, M; Roche, F M; Fraher, M H; Burns, K M; Morrison, P; Healy, M; Power, M W; Fitzpatrick, F; Phelan, D; et al. (2013-03)
      Catheter-related infection (CRI) surveillance is advocated as a healthcare quality indicator. However, there is no national CRI surveillance programme or standardized CRI definitions in Irish intensive care units (ICUs).
    • Clinical, immunological and treatment-related factors associated with normalised CD4+/CD8+ T-cell ratio: effect of naïve and memory T-cell subsets.

      Tinago, Willard; Coghlan, Elizabeth; Macken, Alan; McAndrews, Julie; Doak, Brenda; Prior-Fuller, Charlotte; Lambert, John S; Sheehan, Gerard J; Mallon, Patrick W G (2014)
      Although effective antiretroviral therapy(ART) increases CD4+ T-cell count, responses to ART vary considerably and only a minority of patients normalise their CD4+/CD8+ ratio. Although retention of naïve CD4+ T-cells is thought to predict better immune responses, relationships between CD4+ and CD8+ T-cell subsets and CD4+/CD8+ ratio have not been well described.
    • Complexities of revision mastoid surgery in a migratory population cohort.

      Lennon, P; Khoo, S G; Colreavy, M; Department of Otolaryngology, Head and Neck Surgery, Mater Misericordiae University Hospital, Eccles St., Dublin 7. paullennon81@gmail.com (Irish Medical Journal (IMJ), 2012-03)
      We present a review of patients from Eastern Europe who have recently immigrated to Ireland with complicated otological disease. We carried out a retrospective chart review of these patients. These are a complicated cohort of 7 patients, 5 (71.4%) of whom had previous ear surgery, none had old notes and there was often a need for interpreters (3 or 42.8%) and challenging surgery. Follow up was also problematic with many of the patients. In summary this is a case series to highlight a relatively new group of patients to emphasize the need for pre-operative CT scans, facial nerve monitoring and the difficult nature of revision surgery with no old notes.
    • Delayed diagnosis of novel H1N1 influenza pneumonitis in a vaccinated heart transplant recipient.

      Judge, Eoin P; Hannan, Margaret M; McCarthy, James F; Egan, Jim J; Irish National Heart & Lung Transplant Program, Mater Misericordiae University Hospital, Dublin, Ireland. (2011-03)
    • IgG N-glycans as potential biomarkers for determining galactose tolerance in Classical Galactosaemia.

      Coss, K P; Byrne, J C; Coman, D J; Adamczyk, B; Abrahams, J L; Saldova, R; Brown, A Y; Walsh, O; Hendroff, U; Carolan, C; et al. (2012-02)
      N-glycan processing and assembly defects have been demonstrated in untreated and partially treated patients with Classical Galactosaemia. These defects may contribute to the ongoing pathophysiology of this disease. The aim of this study was to develop an informative method of studying differential galactose tolerance levels and diet control in individuals with Galactosaemia, compared to the standard biochemical markers. Ten Galactosaemia adults with normal intellectual outcomes were analyzed in the study. Five subjects followed galactose liberalization, increments of 300 mg to 4000 mg/day over 16 weeks, and were compared to five adult Galactosaemia controls on a galactose restricted diet. All study subjects underwent clinical and biochemical monitoring of red blood cell galactose-1-phosphate (RBC Gal-1-P) and urinary galactitol levels. Serum N-glycans were isolated and analyzed by normal phase high-performance liquid chromatography (NP-HPLC) with galactosylation of IgG used as a specific biomarker of galactose tolerance. IgG N-glycan profiles showed consistent individual alterations in response to diet liberalization. The individual profiles were improved for all, but one study subject, at a galactose intake of 1000 mg/day, with decreases in agalactosylated (G0) and increases in digalactosylated (G2) N-glycans. We conclude that IgG N-glycan profiling is an improved method of monitoring variable galactosylation and determining individual galactose tolerance in Galactosaemia compared to the standard methods.
    • The long-term functional outcome of type II odontoid fractures managed non-operatively.

      Butler, J S; Dolan, R T; Burbridge, M; Hurson, C J; O'Byrne, J M; McCormack, D; Synnott, K; Poynton, A R; National Spinal Injuries Unit, Department of Trauma and Orthopaedic Surgery, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland. josephsbutler@hotmail.com (2010-10)
      Odontoid fractures currently account for 9-15% of all adult cervical spine fractures, with type II fractures accounting for the majority of these injuries. Despite recent advances in internal fixation techniques, the management of type II fractures still remains controversial with advocates still supporting non-rigid immobilization as the definitive treatment of these injuries. At the NSIU, over an 11-year period between 1 July 1996 and 30 June 2006, 66 patients (n = 66) were treated by external immobilization for type II odontoid fractures. The medical records, radiographs and CT scans of all patients identified were reviewed. Clinical follow-up evaluation was performed using the Cervical Spine Outcomes Questionnaire (CSOQ). The objectives of this study were to evaluate the long-term functional outcome of patients suffering isolated type II odontoid fractures managed non-operatively and to correlate patient age and device type with clinical and functional outcome. Of the 66 patients, there were 42 males and 24 females (M:F = 1.75:1) managed non-operatively for type II odontoid fractures. The mean follow-up time was 66 months. Advancing age was highly correlated with poorer long-term functional outcomes when assessing neck pain (r = 0.19, P = 0.1219), shoulder and arm pain (r = 0.41, P = 0.0007), physical symptoms (r = 0.25, P = 0.472), functional disability (r = 0.24, P = 0.0476) and psychological distress (r = 0.41, P = 0.0007). Patients >65 years displayed a higher rate of pseudoarthrosis (21.43 vs. 1.92%) and established non-union (7.14 vs. 0%) than patients <65 years. The non-operative management of type II odontoid fractures is an effective and satisfactory method of treating type II odontoid fractures, particularly those of a stable nature. However, patients of advancing age have been demonstrated to have significantly poorer functional outcomes in the long term. This may be linked to higher rates of non-union.
    • Multicentric Castleman's disease & HIV infection.

      Cotter, A; Lambert, J; O'Gorman, P; Department Infectious Diseases, Mater Misericordiae University Hospital, Eccles St., Dublin 7 and University College Dublin, School of Medicine & Medical Sciences, Dublin. aoife@aoifecotter.com (2009-10)
      We report the case of a 35 year patient from Nigeria who presented with fever and splenomegaly. The initial diagnosis was Salmonellosis. However, relapsing symptoms lead to a re-evaluation and ultimately a diagnosis of Multicentric Castleman's Disease (MCD). There is no gold standard treatment but our patient responded to Rituximab and Highly active anti-retroviral therapy. MCD is a rare, aggressive disease that should be considered in a HIV positive patient presenting with fever and significant lymphadenopathy.
    • Percutaneous transthoracic computed tomography-guided AICD insertion in a patient with extracardiac Fontan conduit.

      Murphy, Darra T; Moynagh, Michael R; Walsh, Kevin P; Nölke, Lars; Murray, John G; Department of Radiology, Mater Misericordiae University Hospital, Dublin 7, Ireland. darramurphy@me.com (2011-02)
      Percutaneous pulmonary venous atrial puncture was performed under computed tomography guidance to successfully place an automated implantable cardiac defibrillator into a 26-year-old patient with extracardiac Fontan conduit who had presented with two out-of-hospital cardiac arrests. The procedure avoided the need for lead placement at thoracotomy.
    • Prevalence of Internet use amongst an elective spinal surgery outpatient population.

      Baker, Joseph F; Devitt, Brian M; Kiely, Paul D; Green, James; Mulhall, Kevin J; Synnott, Keith A; Poynton, Ashley R; Department of Orthopaedic Surgery, Mater Misericordiae Hospital, Eccles Street, Dublin 7, Ireland. joseph.f.baker@gmail.com (2010-10)
      Nationally 62% of individuals in Ireland have internet access. Previous published work has suggested that internet use is higher among those with low back pain. We aimed to determine the levels of internet access and use amongst an elective spinal outpatient population and determine what characteristics influence these. We distributed a self-designed questionnaire to patients attending elective spinal outpatient clinics. Data including demographics, history of surgery, number of visits, level of satisfaction with previous consultations, access to the internet, possession of health insurance, and details regarding use of the internet to research one's spinal complaint were collected. 213 patients completed the questionnaire. 159 (75%) had access to the internet. Of this group 48 (23%) used the internet to research their spinal condition. Increasing age, higher education level, and possession of health insurance were all significantly associated with access to the internet (p < 0.05). A higher education level predicted greater internet use while possession of insurance weakly predicted non-use (p < 0.05). In our practice, internet access is consistent with national statistics and use is comparable to previous reports. Approximately, one quarter of outpatients will use the internet to research their spinal condition. Should we use this medium to disseminate information we need to be aware some groups may not have access.
    • Prospective, blinded trial of whole-body magnetic resonance imaging versus computed tomography positron emission tomography in staging primary and recurrent cancer of the head and neck.

      O'Neill, J P; Moynagh, M; Kavanagh, E; O'Dwyer, T; Department of Otolaryngology, Head and Neck Surgery, The Mater Hospital, Dublin, , Ireland. joneill@rcsi.ie (2012-02-01)
      OBJECTIVES: To compare the use of computed tomography - positron emission tomography and whole-body magnetic resonance imaging for the staging of head and neck cancer. PATIENTS AND METHODS: From January to July 2009, 15 consecutive head and neck cancer patients (11 men and four women; mean age 59 years; age range 19 to 81 years) underwent computed tomography - positron emission tomography and whole-body magnetic resonance imaging for pre-therapeutic evaluation. All scans were staged, as per the American Joint Committee on Cancer tumour-node-metastasis classification, by two blinded consultant radiologists, in two sittings. Diagnoses were confirmed by histopathological examination of endoscopic biopsies, and in some cases whole surgical specimens. RESULTS: Tumour staging showed a 74 per cent concordance, node staging an 80 per cent concordance and metastasis staging a 100 per cent concordance, comparing the two imaging modalities. CONCLUSION: This study found radiological staging discordance between the two imaging modalities. Whole-body magnetic resonance imaging is an emerging staging modality with superior visualisation of metastatic disease, which does not require exposure to ionising radiation.
    • Pulmonary abnormalities on high-resolution CT demonstrate more rapid decline than FEV1 in adults with cystic fibrosis.

      Judge, Eoin P; Dodd, Jonathan D; Masterson, James B; Gallagher, Charles G; Department of Respiratory Medicine, St Vincent's University Hospital, Dublin, Ireland. (2006-11)
      FEV1 may remain stable while high-resolution CT (HRCT) appearances deteriorate in children with cystic fibrosis (CF). However, spirometry results commonly decline in older age groups.
    • Segmental fracture of the lumbar spine.

      O'hEireamhoin, Sven; Devitt, Brian; Baker, Joseph; Kiely, Paul; Synnott, Keith; Department of Trauma and Orthopaedics, Mater Misericordiae University Hospital, Dublin, Ireland. svenerwin@hotmail.com (2010-10-01)
      A case report is presented.
    • Sentinel lymph node biopsy in node-negative squamous cell carcinoma of the oral cavity and oropharynx.

      Burns, P; Foster, A; Walshe, P; O'Dwyer, T; Department of Otorhinolaryngology, Mater Hospital, Dublin, Ireland., drfatihtunca@yahoo.com (2012-02-01)
      OBJECTIVES: Considerable controversy exists regarding the merits of elective neck dissection in patients with early stage oral cavity and oropharyngeal squamous cell carcinoma. It is highly desirable to have a method of identifying those patients who would benefit from further treatment of the neck when they are clinically node-negative. The purpose of the present study was to examine the use of sentinel lymph node biopsy in identifying occult neck disease in a cohort of patients with node-negative oral cavity and oropharyngeal squamous cell carcinoma. DESIGN: We evaluated a total of 13 patients with oral cavity and oropharyngeal cancer who were clinically and radiologically node-negative. RESULTS: A sentinel lymph node was found in all 13 patients, revealing metastatic disease in five patients, four of whom had one or more positive sentinel lymph nodes. There was one false negative result, in which the sentinel lymph node was negative for tumour whereas histological examination of the neck dissection specimen showed occult disease. CONCLUSION: In view of these findings, we would recommend the use of sentinel lymph node biopsy in cases of oral cavity and oropharyngeal squamous cell carcinoma, in order to aid the differentiation of those patients whose necks are harbouring occult disease and who require further treatment.
    • Surgical trainees neuropraxia? An unusual case of compression of the lateral cutaneous nerve of the forearm.

      Seoighe, D M; Baker, J F; Mulhall, K J; Department of Plastic and Reconstructive Surgery, Mater Misericordiae Hospital, Eccles Street, Dublin 7, Ireland. deirdre.seoighe@gmail.com (2010-09)
      Compression of the lateral cutaneous nerve of the forearm is an uncommon diagnosis but has been associated with strenuous upper limb activity. We report the unique case of a 32-year-old male orthopaedic trainee who suffered this nerve palsy as a result of prolonged elbow extension and forearm pronation while the single assistant during a hip resurfacing procedure. Conservative measures were sufficient for sensory recovery to be clinically detectable after 12 weeks.
    • Transient isolated lingual nerve neuropraxia associated with general anaesthesia and laryngeal mask use: two case reports and a review of the literature.

      Foley, E; Mc Dermott, T E D; Shanahan, E; Phelan, D; Department of Anaesthesia and Intensive Care, Mater Hospital, Dublin, Ireland., edfoley@eircom.net (2012-02-01)
      BACKGROUND: Transient, isolated lingual nerve neuropraxia is a rare complication following general anaesthesia. Reports implicate airway manipulation and we describe two new cases associated with laryngeal mask airway (LMA) and review the related English language literature. RESULTS: Unilateral numbness and loss of taste on the anterior tongue were the characteristic symptoms. Collation of literature data (median and range) with that from the new cases showed: patient age was 38 (20-61) years and female to male ratio was 1.2:1. Surgery time was 62.5 (20-150) min and symptom duration was 28 (7-120) days. CONCLUSION: Lingual neuropraxias reported have been transient and patients can be advised, despite disturbing symptoms, that recovery is anticipated in about 1 month. Lingual neuropraxia reports are becoming more frequent, perhaps associated with increasing LMA use. Research is recommended as modification to LMA cuff volume, pressure and/or position within the oral cavity might ameliorate the entity.
    • What do you think of us? Evaluating patient knowledge of and satisfaction with a psychiatric outpatient service.

      Jabbar, F; Casey, P; Schelten, S L; Kelly, B D; Department of Adult Psychiatry, Mater Misericordiae University Hospital, University College Dublin, 62/63 Eccles Street, Dublin 7, Ireland. (2011-03)
      This study aimed to measure patient satisfaction with the care they were receiving; examine patients' knowledge of the psychiatric services in general; and identify variables associated with satisfaction.