Mid Western Regional Hospital

Dooradoyle, Ireland

Mid Western Regional Hospital

Dooradoyle, Ireland
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Smith F.M.,Mid Western Regional Hospital | Waldron D.,Mid Western Regional Hospital | Winter D.C.,Park University
British Journal of Surgery | Year: 2010

Background: A complete pathological response occurs in 10-30 per cent of patients with locally advanced rectal cancer undergoing neoadjuvant chemoradiotherapy (CRT). The standard of care has been radical surgery with high morbidity risks and the challenges of stomata despite the favourable prognosis. This review assessed minimalist approaches (transanal excision or observation alone) to tumours with a response to CRT. Methods: A systematic review was performed using PubMed and Embase databases. Keywords included: 'rectal', 'cancer', 'transanal', 'conservative', 'complete pathological response', 'radiotherapy' and 'neoadjuvant'. Original articles from all relevant listings were sourced. These were hand searched for further articles of relevance. Main outcome measures assessed were rates of local recurrence and overall survival, and equivalence to radical surgery. Results: Purely conservative 'watch and wait' strategies after CRT are still controversial. Originally used for elderly patients or those who refused surgery, the data support transanal excision of rectal tumours showing a good response to CRT. A complete pathological response in the T stage (ypT0) indicates < 5 per cent risk of nodal metastases. Conclusion: Rectal tumours showing an excellent response to CRT may be suitable for local excision, with equivalent outcomes to radical surgery. This approach should be the subject of prospective clinical trials in specialist centres. Copyright © 2010 British Journal of Surgery Society Ltd.

Frohlich S.,National University of Ireland | Lambe E.,Mercy University Hospital | O'Dea J.,Mid Western Regional Hospital
Irish Journal of Medical Science | Year: 2011

The recreational use of the so-called "legalhighs" has been in both the medical and political arena over the last year as a result of the appearance of "head shops" in many towns in Ireland. These shops specialized in selling new psychotropic compounds that circumvented established drug legislation. Little is known about the potentially harmful effects of these substances but case reports suggest a plethora of harmful psychological and physical effects. Our case describes for the first time acute liver failure associated with the ingestion of two of these amphetamine type compounds. © Royal Academy of Medicine in Ireland 2010.

Molony D.S.,University of Limerick | Kavanagh E.G.,Mid Western Regional Hospital | Madhavan P.,St James Hospital | Walsh M.T.,University of Limerick | McGloughlin T.M.,University of Limerick
European Journal of Vascular and Endovascular Surgery | Year: 2010

Objectives: Endovascular aneurysm repair for abdominal aortic aneurysm (AAA) is now a widely adopted treatment. Several complications remain to be fully resolved and perhaps the most significant of these is graft migration. Haemodynamic drag forces are believed to be partly responsible for migration of the device. The objective of this work was to investigate the drag forces in patient-specific AAA stent-grafts. Methods: CT scan data was obtained from 10 post-operative AAA patients treated with stentgrafts. 3D models of the aneurysm, intraluminal thrombus and stent-graft were created. The drag forces were determined by fluid-structure interaction simulations. A worst case scenario was investigated by altering the aortic waveforms. Results: The median resultant drag force was 5.46 N (range: 2.53e10.84). An increase in proximal neck angulation resulted in an increase in the resultant drag force (p = 0.009). The primary force vector was found to act in an anterior caudal direction for most patients. The worst case scenario simulation resulted in a greatest drag force of 16 N. Conclusions: Numerical methods can be used to determine patient-specific drag forces which may help determine the likelihood of stent-graft migration. Anterioreposterior neck angulation appears to be the greatest determinant of drag force magnitude. Graft dislodgement may occur anteriorally as well as caudally. © 2010 European Society for Vascular Surgery.

Davis N.F.,Mid Western Regional Hospital | McGuire B.B.,Mid Western Regional Hospital | Callanan A.,University of Limerick | Flood H.D.,Mid Western Regional Hospital | McGloughlin T.M.,University of Limerick
Journal of Urology | Year: 2010

Purpose The field of tissue engineering focuses on developing strategies for reconstructing injured, diseased, and congenitally absent tissues and organs. During the last decade urologists have benefited from remodeling and regenerative properties of bioscaffolds derived from xenogenic extracellular matrices. We comprehensively reviewed the current literature on structural and functional characteristics of xenogenic extracellular matrix grafting since it was first described in urological surgery. We also reviewed the clinical limitations, and assessed the potential for safe and effective urological application of extracellular matrix grafting in place of autogenous tissue. Materials and Methods We performed literature searches for English language publications using the PubMed® and MEDLINE® databases. Keywords included "xenogenic," "extracellular matrix" and "genitourinary tract applications." A total of 112 articles were scrutinized, of which 50 were suitable for review based on clinical relevance and importance of content. Results Since the mid 1990s xenogenic extracellular matrices have been used to successfully treat a number of pathological conditions that affect the upper and lower genitourinary tract. They are typically prepared from porcine organs such as small intestine and bladder. These organs are harvested and subjected to decellularization and sterilization techniques before surgical implantation. Bioinductive growth factors that are retained during the preparation process induce constructive tissue remodeling as the extracellular matrix is simultaneously degraded and excreted. However, recent documented concerns over durability, decreased mechanical strength and residual porcine DNA after preparation techniques have temporarily hampered the potential of extracellular matrices as a reliable replacement for genitourinary tract structures. Conclusions Extracellular matrices are a useful alternative for successfully treating a number of urological conditions that affect the genitourinary tract. However, clinical concerns regarding mechanical limitations and biosafety need to be addressed before their long-term role in reconstructive urological surgery can be clearly established. © 2010 American Urological Association Education and Research, Inc.

Chiavaroli S.,University of Limerick | Newport D.,University of Limerick | Woulfe B.,Mid Western Regional Hospital
Biomicrofluidics | Year: 2010

A barrier in scaling laboratory processes into automated microfluidic devices has been the transfer of laboratory based assays: Where engineering meets biological protocol. One basic requirement is to reliably and accurately know the distribution and number of biological cells being dispensed. In this study, a novel optical counting technique to efficiently quantify the number of cells flowing into a microtube is presented. REH, B-lymphoid precursor leukemia, are stained with a fluorescent dye and frames of moving cells are recorded using a charge coupled device (CCD) camera. The basic principle is to calculate the total fluorescence intensity of the image and to divide it by the average intensity of a single cell. This method allows counting the number of cells with an uncertainty ±5%, which compares favorably to the standard biological methodology, based on the manual Trypan Blue assay, which is destructive to the cells and presents an uncertainty in the order of 20%. The use of a microdevice for vertical hydrodynamic focusing, which can reduce the background noise of out of focus cells by concentrating the cells in a thin layer, has further improved the technique. Computational fluid dynamics (CFD) simulation and confocal laser scanning microscopy images have shown an 82% reduction in the vertical displacement of the cells. For the flow rates imposed during this study, a throughput of 100-200 cells/s is achieved. © 2010 American Institute of Physics.

Tierney M.,University of Limerick | Fraser A.,Mid Western Regional Hospital | Kennedy N.,University of Limerick
Journal of Physical Activity and Health | Year: 2012

Background: Physical activity is associated with improved health outcomes in many populations. It is assumed that physical activity levels in the rheumatoid arthritis (RA) population may be reduced as a result of symptoms of the disease. The objective of this review is to establish the current evidence base for levels of physical activity in the RA population. Methods: A systematic review was performed of 7 databases (Ema-base, MEDLINE, AMED, Biomedical Reference Collection Expanded, CINAHL, Nursing and Allied Health Collection, and SportsDiscus) up to February 2011 to examine the evidence in the area. Results: One hundred and thirty-six studies were identified through electronic searching. One hundred and six were excluded based on title and/or abstract analysis and a further 14 were excluded based on full text analysis. Sixteen studies meeting the criteria were deemed suitable for inclusion. The results of the included studies indicate that the level of physical activity may be lower among individuals with RA when compared with healthy controls or normative data. Conclusions: There are a number of methodological considerations at play within the studies reviewed which prohibits definitive conclusion on the physical activity levels of this population group. Given the known health benefits of physical activity, further research in this area appears indicated. © 2012 Human Kinetics, Inc.

Tierney M.,University of Limerick | Fraser A.,Mid Western Regional Hospital | Purtill H.,University of Limerick | Kennedy N.,University of Limerick
Arthritis Care and Research | Year: 2013

Objective: Measuring physical activity in people with rheumatoid arthritis (RA) is of great importance in light of the increased mortality in this population due to cardiovascular disease. Validation of activity monitors in specific populations is recommended to ensure the accuracy of physical activity measurement. Thus, the purpose of this study was to determine the validity of the SenseWear Pro3 Armband (SWA) as a measure of physical activity during activities of daily living (ADL) in people with RA. Methods: Fourteen subjects (8 men and 6 women) with a diagnosis of RA were recruited from rheumatology clinics at the Mid-Western Regional Hospitals, Limerick, Ireland. Participants undertook a series of ADL of varying intensities. The SWA was compared to the criterion measures of the Oxycon Mobile indirect calorimetry system (energy expenditure in kJ) and of manual video observation (step count). Bland and Altman, intraclass correlation coefficient (ICC), and correlation analyses were done using SPSS, version 19.0. Results: The SWA showed substantial agreement (ICC 0.717, P < 0.001) and a strong relationship (Pearson's correlation coefficient = 0.852) compared with the criterion measure when estimating energy expenditure during ADL. However, it was found that the SWA overestimated energy expenditure, particularly at higher intensity levels. The ability of the SWA to estimate step counts during ADL was poor (ICC 0.304, P = 0.038). Conclusion: The SWA can be considered a valid tool to estimate energy expenditure during ADL in the RA population; however, attention should be paid to its tendency to overestimate energy expenditure. Copyright © 2013 by the American College of Rheumatology.

O'Connor G.,Mid Western Regional Hospital
European journal of emergency medicine : official journal of the European Society for Emergency Medicine | Year: 2010

The management of wounds in children is stressful, not only for the child, but also for parents and staff. In our Emergency Department (ED), we currently do not have a paediatric sedation policy, and thus children requiring suturing, not amenable to distraction and infiltrative anaesthesia, are referred to specialty teams for general anaesthesia. We proposed that the introduction of a topical anaesthetic gel (lidocaine, adrenaline, tetracaine - LAT) might help to reduce the number of referrals, by allowing the ED staff to perform the procedures, in combination with nonpharmacological approaches. We carried out a retrospective review of ED records of all children aged 14 years or less attending with wounds, over an 8-month period, from 01 May 2007 to 31 January 2008. Two hundred and one (50.6%) patients presented before the introduction of LAT gel, whereas 196 (49.3%) patients presented afterwards. A total of 39 (19.4%) patients were referred for specialty review pre-LAT, whereas only 19 (9.7%) patients were referred in the LAT group. Of these, 31 (15.4%) pre-LAT and 15 (7.7%) LAT group required general anaesthesia. There is a significant difference between these two groups, using Fischer's exact test, P=0.018. We have found that the introduction of topical anaesthetic gel in ED has significantly reduced the number of children with wounds referred to specialty teams for general anaesthesia. This has important implications for patient safety and hospital resources.

Harmon D.,Mid Western Regional Hospital | Alexiev V.,Mid Western Regional Hospital
Pain Physician | Year: 2011

Background: The iliolumbar ligament plays an important biomechanic role in anchoringthe spine to the pelvic ring and stabilizing the sacroiliac joint. Iliolumbar syndrome is aback pain condition caused by pathology of the iliolumbar ligament. History and physicalexamination are important in the assessment of back pain, but they lack sufficientspecificity. Injection of small volumes of local anesthetic into the structure consideredto be the source of the pain (i.e. the iliolumbar ligament) increases the specificity of thediagnostic workup.Objective: To describe an ultrasound - guided technique for injecting the iliolumbarligament.Study design: Case report based on knowledge of topographic anatomy andsonoanatomy.Setting: Outpatient clinic.Methods: A patient with a clinical picture suggestive of iliolumbar syndrome wasselected. An ultrasound-guided injection of the iliolumbar ligament with local anestheticwas performed. We recorded the patient's subjective assessment of pain and the changein range of movement and pain scores during provocative tests.Results: Following the injection, the patient's pain score decreased, provocation testsbecame negative, and the range of movement increased.Limitations: Case report. Target specificity and dispersion of local anesthetic spread notconfirmed with an independent technique (i.e. magnetic resonance imaging).Conclusions: Ultrasound guidance allows the selective deposition of small volumes oflocal anesthetic into structures believed to cause soft tissue back pain and thus to confirmor exclude the working diagnosis. Further studies are needed to confirm our conclusionsand to prove the clinical feasibility of this technique.

Davis N.F.,Mid Western Regional Hospital | Smyth L.G.,Mid Western Regional Hospital | Flood H.D.,Mid Western Regional Hospital
BJU International | Year: 2012

OBJECTIVES • To assess Internet search trends for erectile dysfunction (ED) subsequent to public awareness campaigns being launched within the Republic of Ireland • To assess whether the advent of such campaigns correlates with increased Internet search activity for ED. MATERIALS AND METHODS • Google insights for search was utilized to examine Internet search trends for the term ' erectile dysfunction'across all categories between January 2005 and December 2011. • Search activity was limited to users from the Republic of Ireland within this timeframe. • Additionally, the number of Irish Internet media campaigns and Irish web pages providing information on ED was assessed between January 2005 and December 2011. • Statistical analysis of the data was performed using analysis of variance and Student's t-tests for pairwise comparisons. RESULTS • There has been a significant increase in mean search activity for ED on an annual basis since 2007 ( P < 0.001). • The number of Irish web pages associated with information on ED has also increased significantly on an annual basis since 2007 ( P < 0.001). • There have been seven different Irish Internet media campaigns on ED since 2007 compared to two from 2005 to 2007 ( P < 0.001). • There was no significant change in mean search activity for ED from 2005 to 2007 CONCLUSIONS • The advent of recent Internet media campaigns and increasing number of Irish web pages is associated with a significant increase in online activity for ED in the Republic of Ireland. • Novel online technologies appear to provide a useful tool for educating the general public on the symptoms and treatment options available for ED. © 2012 THE AUTHORS.

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