Altnagelvin Area Hospital

Derry, United Kingdom

Altnagelvin Area Hospital

Derry, United Kingdom
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van der Hoeven E.J.R.J.,St Antonius Hospital | McVerry F.,Altnagelvin Area Hospital | Vos J.A.,St Antonius Hospital | Algra A.,University Utrecht | And 3 more authors.
International Journal of Stroke | Year: 2016

Background and Aim: Our aim was to assess the prognostic value of a semiquantitative computed tomography angiography-based grading system, for the prediction of outcome in patients with acute basilar artery occlusion, based on the presence of potential collateral pathways on computed tomography angiography: the posterior circulation collateral score (PC-CS). Methods: One hundred forty-nine patients with acute basilar artery occlusion from the Basilar Artery International Cooperation Study were included. We related poor outcome at one month, defined as a modified Rankin scale score of 4 or 5, or death to collateral flow with Poisson regression. We used a 10 points grading system to quantify the potential for collateral flow in the posterior communicating arteries and the cerebellar arteries. Additionally, the relation between the presence and size of posterior communicating arteries and outcome was analyzed. Results: Thirty-six patients had poor (PC-CS: 0–3), 59 patients intermediate (PC-CS: 4–5), and 54 patients good (PC-CS: 6–10) collaterals. Multivariable analyses showed a statistically significant lower risk of poor outcome in patients with a good PC-CS than in patients with a poor PC-CS (risk ratio (RR): 0.74, 95% confidence interval (CI): 0.58–0.96), but not for patients with an intermediate PC-CS compared with patients with a poor PC-CS (RR: 0.95, 95% CI: 0.78–1.15). Multivariable analyses showed a statistically significant lower risk of poor outcome for the presence of at least one posterior communicating artery and for larger caliber of posterior communicating arteries (RR: 0.79, 95% CI: 0.66–0.95 and 0.76, 95% CI: 0.61–0.96, respectively). Conclusions: The PC-CS predicted poor outcome at one month. In a separate analysis, both the absence and smaller caliber of posterior communicating arteries predicted poor outcome. © 2016, © 2016 World Stroke Organization.


Wilson C.P.,University of Ulster | Ward M.,University of Ulster | McNulty H.,University of Ulster | Strain J.J.,University of Ulster | And 4 more authors.
American Journal of Clinical Nutrition | Year: 2012

Background: We recently reported that the elevated blood pressure (BP) observed in patients with cardiovascular disease who are homozygous for the 677C→T polymorphism (TT genotype) in the gene encoding methylenetetrahydrofolate reductase (MTHFR) was responsive to supplementation with riboflavin - the cofactor for MTHFR. Objective: The objective was to investigate the effect of riboflavin on BP targeted at patients with the TT genotype 4 y after initial investigation, during which time major changes in the clinical guidelines for antihypertensive therapy were introduced. Design: A total of 83 patients (representing all 3 genotypes) who participated in a placebo-controlled riboflavin intervention for 16 wk in 2004 agreed to take part. Nested within this follow-up, those with the TT genotype (n = 31) proceeded to intervention with riboflavin (1.6 mg/d for 16 wk) or placebo, conducted in a crossover style whereby the 2004 treatment groups were reversed. Results: At follow-up in 2008, as in 2004, patients with the TT genotype had higher systolic BP (P < 0.01), with a nonsignificant trend noted for higher diastolic BP (P = 0.051). Despite the marked changes in antihypertensive therapy that had occurred, BP remained unchanged in patients with the TT genotype at the time of followup. Riboflavin supplementation (administered in 2004 and 2008) produced an overall decrease in systolic (-9.2 ± 12.8 mm Hg; P = 0.001) and diastolic (-6.0 ± 9.9 mm Hg; P = 0.003) BP. Conclusions: Optimizing riboflavin status offers a low-cost targeted strategy for managing elevated BP in this genetically at-risk group. These findings, if confirmed in the general population, could have important implications for the prevention of hypertension. © 2012 American Society for Nutrition.


Ball E.M.A.,Musgrave Park Hospital | McKeeman H.M.A.,Belfast City Hospital | Patterson C.,Queen's University of Belfast | Burns J.,Musgrave Park Hospital | And 6 more authors.
Annals of the Rheumatic Diseases | Year: 2013

Background: Plantar fasciitis is a common cause of heel pain. The aim of this study was twofold: to compare steroid injection with placebo injection and to compare ultrasound guided with unguided steroid injection in the management of this condition. Methods: 65 patients with inferior heel pain were recruited between November 2008 and June 2011. Heel pain was measured using a visual analogue scale (VAS) at baseline and follow-up 6 and 12 weeks after injection. Results: 22 patients were randomised to ultrasound guided steroid injection, 21 patients to palpation guided steroid injection and 22 to ultrasound guided placebo injection. There was a significant difference in VAS scores between the groups at 6 and 12 weeks (p=0.018 and p=0.004, respectively). There was a 19.7 (95% CI 2.5 to 37.0) difference in mean VAS scores at 6 weeks between the ultrasound guided steroid group and the placebo group and a 24.0 (95% CI 6.6 to 41.3) difference between the unguided steroid group and the placebo group at 6 weeks. At 12 weeks, the mean difference was 25.1 (95% CI 6.5 to 43.6) and 28.4 (95% CI 11.1 to 45.7) respectively between both steroid injection groups and the placebo group. There was no difference in VAS scores following steroid injection between the ultrasound guided and the unguided groups at either time point. Plantar fascia thickness was significantly reduced after injection in both active treatment groups ( p=0.00). Conclusions: In this study, steroid injection showed a clear benefit over placebo at 6 weeks and this difference was maintained at 12 weeks. Trial Registration No ISRCTN79628180 (www.controlled-trials.com).


Rao M.M.,John Goligher Colorectal Unit | Zawislak W.,Altnagelvin Area Hospital | Kennedy R.,Altnagelvin Area Hospital | Gilliland R.,Ulster Hospital
International Journal of Colorectal Disease | Year: 2010

Background: The optimal treatment of chronic pilonidal sinus is a matter of debate. Although excision and suture offers faster healing, it is associated with an increased incidence of wound infection. This study compared excision and primary closure of pilonidal sinus using incorporated gentamicin impregnated collagen with conventional laying open. Methods: Consecutive patients with pilonidal sinus were randomly assigned to one of two treatment groups: (1) open method-wound left open post-excision and (2) closed method-wound closed in two layers over gentamicin impregnated collagen. The main outcome measures were operating time, hospital stay, linear analogue pain scores (days 1, 2, 4, 7 and 14), healing rates, analgesic use and cost. Rate of recurrence at 5 years was further assessed by means of a telephone survey. Results: Sixty patients were recruited from June 1999 to December 2000. Operating time was significantly longer in the closed method. Pain scores were significantly lower for the closed group. A significantly higher proportion of closed wounds healed at 4 weeks. The overall cost per patient was significantly lower for the closed group. Recurrence rate was similar at 5 years. Conclusion: Excision and primary closure over a gentamicin impregnated collagen is a cost-effective method of treating pilonidal sinuses, as it ensures faster healing, causes less pain and its long-term recurrence rates are similar to other techniques. © 2009 Springer-Verlag.


Lindsay J.R.,Altnagelvin Area Hospital | Oldfield E.H.,U.S. National Institutes of Health | Stratakis C.A.,U.S. National Institutes of Health | Nieman L.K.,U.S. National Institutes of Health
Journal of Clinical Endocrinology and Metabolism | Year: 2011

Context: Selective adenomectomy via transsphenoidal surgery induces remission of Cushing's disease (CD) in most patients. Although an undetectable postoperative serum cortisol (<2 μg/dl) has been advocated as an index of remission, there is no consensus on predictors of recurrence. Objective: We hypothesized that patients with subnormal cortisol (2- 4.9 μg/dl) might achieve long-term remission and that postoperative responses to CRH might predict recurrence. Design, Setting, and Participants: We prospectively studied CD patients with initial remission after adenomectomy or hemihypophysectomy (n = 14). Long-term recurrence (n = 39) or remission (n = 293) was assigned by laboratory results, glucocorticoid dependence, or patient survey at a mean of 10.6 yr after surgery. Intervention and Main Outcome Measures: Postoperatively, morning cortisol was measured on d 3-5, and cortisol and ACTH responses to ovine CRH were assessed around d 10. Results: Follow-up duration was median 11 yr (range 1-22.8 yr). Fewer patients achieved a cortisol nadir below 2 μg/dl (87%) than below 5 μg/dl (98%), yet recurrence rates were similar (<2 μg/dl, 9.5%; <5 μg/dl, 10.4%; 2-4.9 μg/dl, 20%; not significant). CRH-stimulated cortisol (P < 0.002) and ACTH(P = 0.04) values were higher for the recurrence than the remission group. However, no basal or stimulated ACTH or serum or urine cortisol cutoff value predicted all who later recurred. Conclusions: A postoperative cortisol below 2 μg/dl predicts long-term remission after transsphenoidal surgery in CD. Remission in those with intermediate d 3-5 postoperative cortisol values (2- 4.9 μg/dl) suggests that these patients do not require immediate reoperation. However, because no single cortisol cutoff value excludes all patients with recurrence, all require long-term clinical follow-up. Copyright © 2011 by The Endocrine Society.


O'Fearraigh P.,Altnagelvin Area Hospital
Journal of the Irish Dental Association | Year: 2010

Maxillofacial and dental defects often have detrimental effects on patient health and appearance. A holistic approach of restoring lost dentition along with bone and soft tissue is now the standard treatment of these defects. Recent improvements in reconstructive techniques, especially osseointegration, microvascular free tissue transfer, and improvements in bone engineering, have yielded excellent functional and aesthetic outcomes. This article reviews the literature on these modern reconstructive and rehabilitation techniques.


McKay M.,Altnagelvin Area Hospital
Nursing children and young people | Year: 2012

This article aims to identify and critically review three pain assessment tools that have been recommended for use by the Royal College of Nursing (2009) in clinical practice for the child with severe learning disabilities. The tools are assessed and their application specifically to orthopaedic practice is discussed with a view to providing adequate pain relief for this group of children.


Dargan D.,Altnagelvin Area Hospital | Jenkinson M.J.,Altnagelvin Area Hospital | Acton J.D.,Altnagelvin Area Hospital
Injury | Year: 2014

A retrospective review of the use of the Dall-Miles plate for periprothetic femoral fractures was performed at our institution. Twenty-seven fractures around a hip replacement were fixed using a Dall- Miles plate within 34 months. The mean age at operation was 74 (33-90) years. Twenty fractures were Vancouver B1, two B2, and five type C. Mean follow-up was 11 (2-41) months. Two fractured plates required revision and two fixations loosened, developing varus malunion. One malunion was related to deep infection. All four events occurred within six months of fixation. Two individuals were deceased within 3 months of surgery. Similar complications were evident in nine series published between 1990 and 2012. Increased incidence of periprosthetic femoral fractures is anticipated in a population with significant co-morbidities. Cortical strut allograft, iliac autograft and orthobiological supplementation remain options where non-union is anticipated. © 2014 Elsevier Ltd. All rights reserved.


Adams M.,Altnagelvin Area Hospital | Caffrey R.,Altnagelvin Area Hospital
Journal of Laryngology and Otology | Year: 2014

Background: Coincident thyroid and head and neck squamous cell carcinomas are rare. This paper presents a case of synchronous laryngeal squamous cell carcinoma, follicular thyroid carcinoma and micropapillary thyroid carcinoma. Methods: A PubMed search was performed for articles describing synchronous thyroid and head and neck squamous cell carcinomas, using the search terms 'thyroid cancer', 'cancer of the head and neck', 'synchronous' and 'synchronous neoplasm'. Results: The literature suggests that the head and neck squamous cell carcinoma stage is a better predictor of outcome than the extent of surgical treatment of the thyroid gland in synchronous malignancies. Conclusion: The decision regarding surgical treatment of the thyroid in synchronous thyroid and head and neck squamous cell carcinomas should take several factors into account. The head and neck squamous cell carcinoma stage is the strongest predictor of outcome, although patient-related factors and the location of malignant thyroid tissue may also affect management. © 2014 JLO (1984) Limited.


McKenna M.,Altnagelvin Area Hospital | McMenamin M.M.,Altnagelvin Area Hospital
Cancer Cytopathology | Year: 2014

BACKGROUND In the United Kingdom, human papillomavirus (HPV) testing is used to triage women with borderline cytology or mild dyskaryosis; however, in young women, the value of triage is limited by the high HPV prevalence rate. The current study examined the impact of HPV triage on colposcopy referral, colposcopy procedures, and patient outcome in a cervical screening population that included women aged < 25 years. METHODS Women aged 18 to 65 years attending for cervical screening in Northern Ireland were tested for HPV if their cytology result demonstrated borderline cytology or mild dyskaryosis. Of the 866 women eligible for HPV triage, those who tested negative for HPV were returned to routine screening and women who tested positive were referred to colposcopy. RESULTS HPV prevalence was 82.07% in women aged < 25 years and 54.69% in women aged ≥ 25 years. Colposcopy referrals increased by 42.67%. The odds of undergoing a large loop excision of the transformation zone (LLETZ) compared with punch biopsy increased by 0.056 per year above the age of 31 years. LLETZ performed in women aged ≥ 25 years and those aged < 25 years yielded rates of cervical intraepithelial neoplasia of type 2 or higher (≥ CIN2) of 57.04% and 80.00%, respectively. The positive predictive value of HPV triage for detecting ≥ CIN2 was 29.92% in women aged < 25 years and 27.51% in the older age group. CONCLUSIONS HPV triage substantially increased colposcopy referrals. The positive predictive value of a positive HPV test to detect ≥ CIN2 was not affected by age. LLETZ performed in women aged < 25 years yielded higher rates of ≥ CIN2 compared with the older age group. Cancer (Cancer Cytopathol) 2014;122:702-710. © 2014 American Cancer Society.

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