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Tralhao J.G.,University of Sfax | Tralhao J.G.,Biophysics Biomathematics Institute | Hoti E.,Saint Vincents University Hospital | Oliveiros B.,Biophysics Biomathematics Institute | And 2 more authors.
Hepato-Gastroenterology | Year: 2012

Background/Aims: To investigate the impact of liver resection on the perioperative hepatic function by evaluation of ICG-clearance. Methodology: Twenty-five patients underwent major hepatic resection (Group A) and 36 underwent minor hepatic resection (Group B). Thirteen patients who received no liver surgery, acted as control group (Group C). ICG-clearance measured by a non-invasive technique was expressed in terms of plasma disappearance rate (PDR-ICG-%/min) and retention rate of ICG 15 min (ICG-R15-%) after administration ICG (0.5mg/kg) before anesthesia induction (T0), immediately after the surgery (T1) and 24h after (T2). Results: There was statistically significant differences between the three groups: ICG-PDR (p<0.004) ICG-R15 (p<0.040). These differences were observed between groups A and C at T1, between A and B, and C, at T2 for ICG-PDR and between groups A and T2 for ICG-R15. There were no differences between groups for hemoglobin, platelets, PT, creatinine, albumin total protein, bilirubin and ALP. Conclusions: ICG clearance is a safe non-invasive dynamic tool to quantify the liver function in patients following hepatic surgery. It also can be used to evaluate the liver surgery impact on hepatic function which can help to diagnose early hepatic dysfunction and guide the therapeutic decision making process. © H.G.E. Update Medical Publishing S.A.


Hoti E.,Center Hepato Biliaire | Hoti E.,Saint Vincents University Hospital | Salloum C.,Center Hepato Biliaire | Azoulay D.,Center Hepato Biliaire | And 2 more authors.
Digestive Surgery | Year: 2011

Through the years, liver resection and bleeding control techniques have progressively evolved. However, for liver tumors located unfavorably, the standard techniques are not suitable due to either failure to control the bleeding or to liver ischemia induced by prolonged interruption of perfusion. In this regard, total vascular exclusion (TVE) with in situ hypothermic perfusion is advantageous as it protects the parenchyma, achieves better vascular control and enables difficult vascular reconstructions or reimplantations. The advantages of this procedure described as early as 1960s by Fortner were also confirmed by our team in a subsequent report. We showed that TVE with in situ hypothermic perfusion is superior to TVE alone if used for more than 60 min in complex resections with or without vascular reconstruction. Other techniques (ex situ liver resection developed by Pichlmayr and ante situm liver resection by Hannoun) have been described; however, they have not been widely accepted due to a high rate of complications. In this article, we report our operative technique as well as discuss some important operative points. Copyright © 2011 S. Karger AG.


Lavelle A.,University College Dublin | Lavelle A.,Saint Vincents University Hospital | Lennon G.,University College Dublin | Lennon G.,Saint Vincents University Hospital | And 19 more authors.
Gut | Year: 2015

Objectives The relevance of spatial composition in the microbial changes associated with UC is unclear. We coupled luminal brush samples, mucosal biopsies and laser capture microdissection with deep sequencing of the gut microbiota to develop an integrated spatial assessment of the microbial community in controls and UC. Design A total of 98 samples were sequenced to a mean depth of 31 642 reads from nine individuals, four control volunteers undergoing routine colonoscopy and five patients undergoing surgical colectomy for medically-refractory UC. Samples were retrieved at four colorectal locations, incorporating the luminal microbiota, mucus gel layer and whole mucosal biopsies. Results Interpersonal variability accounted for approximately half of the total variance. Surprisingly, within individuals, asymmetric Eigenvector map analysis demonstrated differentiation between the luminal and mucus gel microbiota, in both controls and UC, with no differentiation between colorectal regions. At a taxonomic level, differentiation was evident between both cohorts, as well as between the luminal and mucosal compartments, with a small group of taxa uniquely discriminating the luminal and mucosal microbiota in colitis. There was no correlation between regional inflammation and a breakdown in this spatial differentiation or bacterial diversity. Conclusions Our study demonstrates a conserved spatial structure to the colonic microbiota, differentiating the luminal and mucosal communities, within the context of marked interpersonal variability. While elements of this structure overlap between UC and control volunteers, there are differences between the two groups, both in terms of the overall taxonomic composition and how spatial structure is ascribable to distinct taxa. © 2015 BMJ Publishing Group Ltd & British Society of Gastroenterology.


PubMed | Saint Vincents University Hospital and Charles University
Type: Journal Article | Journal: JAMA dermatology | Year: 2016

Daylight photodynamic therapy using topical methyl 5-aminolevulinic acid (MAL) for actinic keratoses (AKs) is as effective as conventional photodynamic therapy but has the advantage of being almost pain free. Daylight photodynamic therapy, however, requires dry and warm weather conditions.To establish if topical MAL photodynamic therapy using a white light light-emitting diode (LED) lamp is as effective and well-tolerated as daylight photodynamic therapy for the treatment of AKs.Overall, 22 men with significant photodamage and a high number of AKs were enrolled in this prospective, randomized, single-blind study, employing a split-scalp design, comparing the effectiveness and adverse effects of daylight photodynamic therapy and artificial white light (AWL) LED photodynamic therapy for the treatment of AKs on the forehead and scalp. Organ transplant recipients were excluded. Patients were treated and evaluated at an academic tertiary referral dermatology center. Treatment lasted from April 2014 to July 2014 and follow-up visits occurred for 9 months posttreatment.Two symmetrical treatment fields were defined and AKs counted, mapped, and photographed at baseline, 1, 3, 6, and 9 months. Patients had half of their scalp treated with daylight photodynamic therapy and the other half treated with AWL photodynamic therapy 1 week apart and randomly allocated. MAL was applied, and treatment commenced 30 minutes later and lasted 2 hours. Irradiance, illuminance, and light spectra measurements were performed. The integrated dose in J/cm2 was measured. The effective light dose, weighted to the absorption spectrum for protoporphyrin IX, was calculated.The primary end point was the reduction in total AK count per treatment field. Secondary end points included adverse effects and patient satisfaction.We enrolled 22 men with a median age of 72 years (range, 47-85 years) at baseline, the total (median of AKs per field) were 469 (20.5) for the DPDT group and 496 (20.5) for the AWLPDT group (P=.34). The median number and percentage of reduction in AKs per field were 12 and 62.3% for DPDT and 14 and 67.7% for AWLPDT at 1 month (P=.21 and P=.13, respectively). There was no significant difference in the reduction percentage of AKs for either treatment at 1, 3, and 6 months. At 9 months, the median number and percentage of reduction in AKs per field was 9.0 and 48.4% for DPDT and 12.0 and 64.4% for AWLPDT (P=.13 and P=.05, respectively). Pain was reported by 14 patients with DPDT and 16 patients with AWLPDT (median maximum score [out of 100], 4 vs 6; P=.51). Moderate erythema was reported by 9 patients after DPDT and 14 patients after AWLPDT. On a scale of 0 (intolerable) to 10 (very tolerable) patients rated DPDT as 9.5 and AWLPDT as 9 (P=.37).Photodynamic therapy using an AWL source was as effective and well-tolerated as daylight photodynamic therapy.clinicaltrials.gov Identifier: NCT02520700.


Caiazza F.,Saint Vincents University Hospital | Caiazza F.,University College Dublin | Ryan E.J.,Saint Vincents University Hospital | Ryan E.J.,University College Dublin | And 6 more authors.
Frontiers in Oncology | Year: 2015

Upon binding their cognate receptors, ERα (ESR1) and ERβ (ESR2), estrogens activate intracellular signaling cascades that have important consequences for cellular behavior. Historically linked to carcinogenesis in reproductive organs, estrogens have also been implicated in the pathogenesis of different cancer types of non-reproductive tissues including the colon. ERβ is the predominant estrogen receptor expressed in both normal and malignant colonic epithelium. However, during colon cancer progression, ERβ expression is lost, suggesting that estrogen signaling may play a role in disease progression. Estrogens may in fact exert an anti-tumor effect through selective activation of pro-apoptotic signaling mediated by ERß, inhibition of inflammatory signals and modulation of the tumor microenvironment. In this review, we analyze the estrogen pathway as a possible therapeutic avenue in colorectal cancer, we report the most recent experimental evidence to explain the cellular and molecular mechanisms of estrogen-mediated protection against colorectal tumorigenesis, and we discuss future challenges and potential avenues for targeted therapy. © 2015 Caiazza, Ryan, Doherty, Winter and Sheahan.


Bartosik W.,Park University | Raza A.,Park University | Kalimuthu S.,Saint Vincents University Hospital | Fabre A.,Saint Vincents University Hospital
Interactive Cardiovascular and Thoracic Surgery | Year: 2012

Lymphomatoid granulomatosis (LYG) of the lung is an extremely rare, Epstain-Barr virus-related lymphoproliferative disease. We report a case of pulmonary LYG that presented as a large necrotic mass. © The Author 2012. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.


Myers E.,Saint Vincents University Hospital | Kavanagh D.O.,Saint Vincents University Hospital | Ghous H.,Saint Vincents University Hospital | Evoy D.,Saint Vincents University Hospital | McDermott E.W.,Saint Vincents University Hospital
Colorectal Disease | Year: 2010

Aim: The management of appendicitis has evolved from the era of open surgery with a negative appendicectomy rate ranging from 20 to 30%. Diagnostic adjuncts such as computed tomography (CT), ultrasound (US) and diagnostic laparoscopy (DL) facilitate refinement of the clinical impression in equivocal cases. The aim of this study was to determine the impact of the increased availability and selective utilization of diagnostic adjuncts on the negative appendicectomy rate. Method: This was a retrospective study of all emergency appendicectomy procedures performed over two 12-month periods encompassing 1996 and 2006. Clinical, radiological, operative and pathological data were analysed. Diagnostic adjuncts were only employed in equivocal cases. Statistical analysis was performed using the chi-squared test. Results: A total of 218 and 171 patients underwent an appendicectomy in 2006 and 1996 respectively. There were 103 men in 1996 and 128 in 2006. There was a significant increase in laparoscopic appendicectomy [131(60%) vs 31 (18%), P > 0.001]. In addition, there was a significant increase in the use of CT (38 vs 1, P < 0.001) and US (39 vs 4, P < 0.001).There was also a significant difference in the use of DL without appendicectomy (39 vs 8, P < 0.001). The negative appendicectomy rate was lower in 2006 (15%. vs 22%, P = 0.13).The perforation rates in both study periods were similar (10%. vs 8%). Conclusion: A policy of selective usage of diagnostic adjuncts only in equivocal cases of appendicitis does not significantly reduce the negative appendicectomy rate. © 2010 The Authors. Journal Compilation © 2010 The Association of Coloproctology of Great Britain and Ireland.


O'Gorman S.M.,Saint Vincents University Hospital | Britton D.,Saint Vincents University Hospital | Collins P.,Saint Vincents University Hospital
Clinical and Experimental Dermatology | Year: 2015

Zoophilic dermatophytes can cause highly inflammatory cutaneous infections. Cattle represent the largest reservoir for the zoophilic dermatophyte Trichophyton verrucosum. Effective vaccination programmes have contributed to a low rate of livestock infection in central and northern Europe, and T. verrucosum infection is relatively more common in southern Europe and in Arabic countries. Transmission to humans typically results from direct contact with infected livestock. It may also be transmitted from person to person. We report two cases of T. verrucosum skin infections in Irish farmers. In both cases, effective treatment was delayed due to misdiagnosis of the condition as a bacterial infection in the primary care setting. Both cases responded rapidly to treatment with oral terbinafine. Culture of T. verrucosum can take 3 weeks or longer to grow, therefore a high index of clinical suspicion is necessary, and skin scrapings for potassium hydroxide microscopy and culture are essential for accurate diagnosis. © 2014 British Association of Dermatologists.


Fernandes A.I.,University of Coimbra | Tralhao J.G.,University of Coimbra | Abrantes A.,University of Coimbra | Hoti E.,Saint Vincents University Hospital | And 5 more authors.
Liver International | Year: 2015

More than 50% of liver tumours occur in patients aged 65 years or more. Assessment of functional liver regeneration capacity is crucial to minimize postoperative liver failure. We aimed to study functional hepatocellular regeneration, through scintigraphic quantification of Mebrofenin hepatic extraction fraction (HEF), after partial hepatectomy, comparing elderly patients with younger ones. Methods: One hundred and two patients undergoing partial hepatectomy for primary or secondary hepatic lesions were prospectively included and divided in two groups: Group A - 58 patients aged <65 years (33 men, 53.9 ± 8.7 years), Group B - 44 patients aged ≥65 years (32 men, 71 ± 5 years). Groups were comparable in several aspects except for the presence of cirrhosis (more common in Group B, all patients Child-Pugh score A) and the initial diagnosis (Group B - primary lesions, Group A - metastases). The scintigraphic evaluation of Mebrofenin-HEF was performed before surgery, on the 5th and 30th day post-hepatectomy. Results: Mortality and morbidity were 3.4 and 12.1%, respectively, in Group A and 2.3 and 11.4% in Group B (n.s.). HEF values (%), T1/2 (min) and Tmax (min) showed no significant differences between the two groups: Group A (preoperative: HEF = 99.2 ± 1.5%, T1/2 = 36.7 ± 21.3, Tmax = 15 ± 6. Day 5: HEF = 96.3 ± 10.8%, T1/2 = 76.4 ± 75.9; Tmax = 13.3 ± 4.9. Day 30: HEF = 98.4 ± 5.5%, T1/2 = 38.6 ± 7.7, Tmax = 12.8 ± 3.6) and Group B (preoperative: HEF = 95.3 ± 13%, T1/2 = 38.1 ± 24.1; Tmax = 15.9 ± 9.4. Day 5: HEF = 98.4 ± 2.6%, T1/2 = 106.6 ± 131.7; Tmax = 15.1 ± 6.2. Day 30: HEF = 99 ± 2.1%, T1/2 = 40.5 ± 27; Tmax = 15.5 ± 6.7). Conclusion: Our results suggest that functional hepatocellular regeneration is early, fast and similar between elderly and younger patients. Thus, age alone, does not appear to represent an absolute contraindication to hepatectomy. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.


Al Sahaf O.,Cork University Hospital | Myers E.,Cork University Hospital | Jawad M.,Cork University Hospital | Browne T.J.,Cork University Hospital | And 2 more authors.
Diseases of the Colon and Rectum | Year: 2011

BACKGROUND: The status of resected lymph nodes in colon cancer determines prognosis and further treatment. The American Joint Committee on Cancer staging system has designated extramural nodules as nonnodal disease and classified them as extensions of the T category in the sixth edition and as site-specific tumor deposits in the seventh edition. Extracapsular lymph node extension is an established poor prognostic indicator in many cancers. Its significance in colon cancer has not been extensively investigated. OBJECTIVE: This study aimed to determine the prognostic significance of extramural nodules and extracapsular lymph node extension in colon cancer. DESIGN: A pathological review of 114 stage III and 80 stage II colon cancers was undertaken to analyze for p-T stage, p-N stage (using the fifth, sixth, and seventh editions), and the size and contour of nodal and extramural deposits. Multivariate Cox regression models were used to determine the prognostic significance of clinicopathological parameters on survival estimates. RESULTS: According to the sixth and seventh editions of the guidelines, extramural deposits were present in 29% and 31% of patients with stage III colon cancer and in 5% of patients with stage II colon cancer. Extracapsular lymph node invasion was present in 68% of cases. Multivariate analysis demonstrated that lymph node ratio, extracapsular lymph node extension, and adjuvant chemotherapy were independent prognostic factors affecting 5-year disease-free survival. The same 3 variables, in addition to extramural deposits, were independent prognostic factors affecting overall survival. The presence of extramural deposits was associated with an 11% 5-year survival, and extracapsular lymph node invasion was associated with a 33% 5-year survival. CONCLUSIONS: Instead of extramural nodules being included as part of the T category or as site-specific tumor deposits, they should perhaps be classified in the metastasis category. This has major prognostic implications and may broaden the application of a number of adjuvant agents. © The ASCRS 2011.

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