Adelaide and Meath Incorporating National Childrens Hospital

Tallaght, Ireland

Adelaide and Meath Incorporating National Childrens Hospital

Tallaght, Ireland

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Daly C.A.,Royal Brompton Hospital | Clemens F.,London School of Hygiene and Tropical Medicine | Lopez Sendon J.L.,Hospital Universitario Gregorio Maranon | Tavazzi L.,Policlinico S. Matteo | And 10 more authors.
Postgraduate Medical Journal | Year: 2010

Aims: To examine resting heart rate (HR) in a population presenting with stable angina in relation to prior and subsequent pharmacological treatment, comorbid conditions and clinical outcome. Methods and results: The European Heart Survey was a prospective, observational, cohort study of 3779 patients with stable angina newly presenting to cardiology services. Mean baseline resting HR was 73 beats/min (bpm) and 52.3% of patients had a baseline HR > 70 bpm. Over half of patients were on no chronotropic medication at baseline. Patients with chronic respiratory disease or diabetes had higher resting HRs (75-76 bpm), and were more likely to have been receiving calcium channel blockers at baseline assessment. Overall, b-blockers were the most common treatment administered following cardiologist assessment, but were used less frequently in patients with chronic respiratory disease and diabetes, and the dosages used were less than that found to be effective in clinical trials. Mean daily doses of metoprolol, bisoprolol, carvedilol, and atenolol were 75 mg, 6 mg, 19 mg and 55 mg, respectively. Higher HR at baseline was associated with higher rates of cardiovascular mortality and hospitalisation for heart failure. Conclusion: Control of ischaemic symptoms through heart rate modification in patients with angina is currently inadequate, both by primary referring physicians and cardiologists. Given the adverse outcome associated with higher resting heart rates in this as in other studies, and the availability of specific HR reducing strategies, attention should be given to achieving optimal HR control.


Dobson L.,Royal College of Surgeons in Ireland | Conway C.,Royal College of Surgeons in Ireland | Hanley A.,Royal College of Surgeons in Ireland | Johnson A.,Royal College of Surgeons in Ireland | And 7 more authors.
Histopathology | Year: 2010

Aims: Accurate determination of HER-2 status is critical to identify patients for whom trastuzumab treatment will be of benefit. Although the recommended primary method of evaluation is immunohistochemistry, numerous reports of variability in interpretation have raised uncertainty about the reliability of results. Recent guidelines have suggested that image analysis could be an effective tool for achieving consistent interpretation, and this study aimed to assess whether this technology has potential as a diagnostic support tool. Methods and results: Across a cohort of 275 cases, image analysis could accurately classify HER-2 status, with 91% agreement between computer-aided classification and the pathology review. Assessment of the continuity of membranous immunoreactivity in addition to intensity of reactivity was critical to distinguish between negative and equivocal cases and enabled image analysis to report a lower referral rate of cases for confirmatory fluorescence in situ hybridization (FISH) testing. An excellent concordance rate of 95% was observed between FISH and the automated review across 136 informative cases. Conclusions: This study has validated that image analysis can robustly and accurately evaluate HER-2 status in immunohistochemically stained tissue. Based on these findings, image analysis has great potential as a diagnostic support tool for pathologists and biomedical scientists, and may significantly improve the standardization of HER-2 testing by providing a quantitative reference method for interpretation. © 2010 Blackwell Publishing Limited.


Ellanti P.,Adelaide and Meath Incorporating National Childrens Hospital | Connolly S.S.,Adelaide and Meath Incorporating National Childrens Hospital | McDermott R.,Adelaide and Meath Incorporating National Childrens Hospital | Crotty P.L.,Adelaide and Meath Incorporating National Childrens Hospital | Grainger R.,Adelaide and Meath Incorporating National Childrens Hospital
Irish Journal of Medical Science | Year: 2011

Background: Metastatic involvement of the penis is most commonly from a primary malignant genitourinary tumour. It is a rare phenomenon usually reflecting disseminated malignancy associated with a poor prognosis. Metastasis to the penis mimicking priapism is extremely rare, particularly in the absence of disseminated disease. Materials and methods: We describe a case of painful priapism caused by a high-grade urothelial malignancy without disseminated disease. Conclusion: Life expectancy is estimated at less than 1 year in these patients. Our patient remains in clinical and radiologic remission over 36 months from his original radical surgery. © 2010 Royal Academy of Medicine in Ireland.


Ellanti P.,Adelaide and Meath Incorporating National Childrens Hospital | Clarke B.,Adelaide and Meath Incorporating National Childrens Hospital | Gray J.,Adelaide and Meath Incorporating National Childrens Hospital
Irish Journal of Medical Science | Year: 2010

Introduction: Osteopoikilosis is a rare and asymptomatic disease of the bone that is often discovered incidentally on radiography. On a plain radiograph it is manifested by multiple, small, circular or oval shaped radio-dense lesions which are diagnostic for this condition and are often mistaken for metastatic disease. Materials and methods: We present the case of a 24-year-old female patient with osteopoikilosis diagnosed incidentally on radiographs. Conclusion: Osteopoikilosis is a benign sclerosing dysplasia of bone of unknown aetiology that requires no specific treatment. © 2010 Royal Academy of Medicine in Ireland.


PubMed | Adelaide and Meath Incorporating National Childrens Hospital
Type: Case Reports | Journal: Irish journal of medical science | Year: 2011

Metastatic involvement of the penis is most commonly from a primary malignant genitourinary tumour. It is a rare phenomenon usually reflecting disseminated malignancy associated with a poor prognosis. Metastasis to the penis mimicking priapism is extremely rare, particularly in the absence of disseminated disease.We describe a case of painful priapism caused by a high-grade urothelial malignancy without disseminated disease.Life expectancy is estimated at less than 1 year in these patients. Our patient remains in clinical and radiologic remission over 36 months from his original radical surgery.


PubMed | Adelaide and Meath incorporating National Childrens Hospital
Type: Case Reports | Journal: Irish journal of medical science | Year: 2010

Osteopoikilosis is a rare and asymptomatic disease of the bone that is often discovered incidentally on radiography. On a plain radiograph it is manifested by multiple, small, circular or oval shaped radio-dense lesions which are diagnostic for this condition and are often mistaken for metastatic disease.We present the case of a 24-year-old female patient with osteopoikilosis diagnosed incidentally on radiographs.Osteopoikilosis is a benign sclerosing dysplasia of bone of unknown aetiology that requires no specific treatment.


PubMed | Adelaide and Meath Incorporating National Childrens Hospital
Type: Journal Article | Journal: European journal of radiology | Year: 2011

The purpose of our study was to describe the magnetic resonance imaging (MRI) features of bipartite patella in asymptomatic patients.The study was prospective in type and performed following institutional ethical committees approval. In total, 25 subjects were recruited into the study and informed consent obtained in each case. The local radiology database was utilised in conjunction with a clinical questionnaire to identify patients who had asymptomatic bipartite patella. Any patient with a history of trauma or symptomatic disease was excluded from the study. MRI imaging was performed in each case on a 1.5 T system using a dedicated knee coil and a standardised knee protocol. The images obtained were then analysed by two musculoskeletal radiologists in consensus.Of the 25 subjects, there were 8 females and 17 males. The mean age was 34.6 years. All but one of the bipartite fragments were located on the superolateral aspect of the patella. In 23 cases, one fragment was identified. The average transverse diameter of the fragment was 12.8 mm. The average distance between the fragment and the adjacent patella in the axial plane was 1.46 mm. In addition, the cartilage overlying the patella and accessory fragment was intact in all cases. The average thickness of the patella cartilage at its border to the fragment was 2.4mm with an average ratio of the cartilage thickness of the fragment as compared with the cartilage thickness of the patella of 0.72. There was no evidence of high signal or bone marrow oedema on fluid sensitive sequences within either the patella or the fragment in any of the patients. Fluid was identified in the cleft between the patella and the fragment in the majority of cases.Asymptomatic bipartite patella is characterised by intact but thinned cartilage along the border between the patella and the fragment, fluid between the cleft and a lack of any bone marrow oedema or high signal within the patella or its fragment.


PubMed | Adelaide And Meath Incorporating National Childrens Hospital
Type: Case Reports | Journal: European radiology | Year: 2011

We describe a case of calvarial tuberculosis with an associated extra-dural collection. This presentation has rarely been reported in the literature and the magnetic resonance imaging features are not well documented.


PubMed | Adelaide and Meath Incorporating National Childrens Hospital
Type: Journal Article | Journal: Irish journal of medical science | Year: 2011

Needlestick injuries (NSI) remain an occupational hazard for doctors. Previous reports suggested that needlestick practice among interns could be improved.We aimed to report the current occupational sharp practice and experience amongst a modern cohort of Irish interns.A self-designed questionnaire was distributed among interns at two Dublin-based teaching hospitals.Thirty-one interns completed a self-designed questionnaire. Notably, only 26% routinely wore gloves when performing phlebotomy like tasks; 35% considered their training adequate; 26% had suffered a NSI within the first 8 months of work--over half occurred between 0000 and 0800 hours. There was a higher rate of reporting NSI than in historical reports.Improvements have been made in occupational health management of NSI. However, practical preparation for internship continues to remain a concern. Efforts are needed to reduce unnecessary risk of suffering a NSI among our junior doctors.

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