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Beecher SM, Wilkinson JE, Cuggy C, O'Shaughnessy M. Patient's perspective of treatment in Dupuytren's Disease: collagenase versus limited fasciectomy. J Hand Surg Eur Vol 2022; 47:1172-1174. [PMID: 35469501 DOI: 10.1177/17531934221095681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Suzanne M Beecher
- Department of Plastic & Reconstructive Surgery, Cork University Hospital, Cork, Ireland
| | - Jordan E Wilkinson
- Department of Plastic & Reconstructive Surgery, Cork University Hospital, Cork, Ireland
| | - Conor Cuggy
- Department of Plastic & Reconstructive Surgery, Cork University Hospital, Cork, Ireland
| | - Michael O'Shaughnessy
- Department of Plastic & Reconstructive Surgery, Cork University Hospital, Cork, Ireland
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2
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Al Khalaf SY, Bodunde E, Maher G, O'Reilly ÉJ, McCarthy FP, O'Shaughnessy M, O’Neill SM, Khashan AS. Chronic Kidney Disease and Adverse Pregnancy Outcomes: A Systematic Review and Meta-analysis. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objective
Chronic kidney disease (CKD) has been linked with adverse pregnancy outcomes, but few studies have examined the influence of cause and severity. The aim of this meta-analysis was to synthesize the evidence on CKD and adverse pregnancy outcome, by cause and severity of CKD where reported.
Data sources
We searched PubMed, Embase, and Web of Science from inception to May 2021. Study selection and Data Extraction: Studies reporting associations between CKD and adverse pregnancy outcomes were included according to pre-defined eligibility criteria (PROSPERO protocol registration: CRD42020211925). Two reviewers independently screened titles, abstracts, and full-text articles and performed data extraction. The certainty of the evidence was assessed using the GRADE approach.
Main Outcomes and Measures: We used random-effects meta-analyses to calculate pooled estimates. Primary outcomes included pre-eclampsia, Caesarean section (CS), preterm birth (PTB <37 wk.) and small for gestational age (SGA).
Results
In total, 31 studies were included. The certainty of the evidence was deemed to be ‘very low' for all outcomes using the GRADE approach as expected given the observational study design. Pre-pregnancy CKD was associated with pre-eclampsia [pooled adjusted odds ratio (aOR)=2.58 (1.33-5.01)], CS [aOR=1.65 (1.21-2.25)], PTB [aOR=1.73 (1.31-2.27)] and SGA [aOR= 1.93 (1.06-3.52)]. Subgroup analyses suggested that different causes of CKD had differing risks for adverse pregnancy outcomes, and later stages of CKD, compared to earlier stages, were associated with higher odds of pre-eclampsia [crude OR = 2.77 (1.73-4.44)], PTB [4.21 (2.99-5.92)], and SGA [2.43 (1.33-4.46)].
Conclusions
CKD was associated with a higher risk of adverse pregnancy outcomes, and the degree of risk varied by cause and severity. These findings highlight the need for further studies of a more robust quality evaluating the effects of cause and severity of kidney disease on adverse pregnancy outcomes.
Key messages
Pre-pregnancy CKD was associated with higher risk of adverse pregnancy outcomes. The risk of adverse pregnancy outcomes varied by CKD cause and severity.
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Affiliation(s)
- SY Al Khalaf
- School of Public Health, University College Cork, Cork, Ireland
- INFANT Research Centre, University College Cork, Cork, Ireland
| | - E Bodunde
- School of Public Health, University College Cork, Cork, Ireland
| | - G Maher
- School of Public Health, University College Cork, Cork, Ireland
- INFANT Research Centre, University College Cork, Cork, Ireland
| | - ÉJ O'Reilly
- School of Public Health, University College Cork, Cork, Ireland
- Department of Nutrition, Harvard T.H., Chan School of Public Health, Boston, MA, USA
| | - FP McCarthy
- INFANT Research Centre, University College Cork, Cork, Ireland
- Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, Cork, Ireland
| | - M O'Shaughnessy
- Department of Renal Medicine, Cork University Hospital, Cork, Ireland
| | - SM O’Neill
- School of Public Health Alumna, University College Cork, Cork, Ireland
| | - AS Khashan
- School of Public Health, University College Cork, Cork, Ireland
- INFANT Research Centre, University College Cork, Cork, Ireland
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3
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Beecher SM, Lennon P, O'Shaughnessy M, Barry CP. Recurrent Ameloblastoma Involving Fibula Neo-mandible: Management with Digital Planning and Reconstruction Using a Contralateral Free Fibula Flap. Cureus 2020; 12:e7880. [PMID: 32489734 PMCID: PMC7255542 DOI: 10.7759/cureus.7880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Ameloblastoma is a locally aggressive tumor that most commonly arises in the mandible. It has a high rate of recurrence if inadequately excised. We report a case of a patient who developed recurrence of his ameloblastoma in his fibula flap mandibular reconstruction despite clear resection margins 23 years after resection. This is the first reported case of recurrent ameloblastoma in a neo-mandible reconstruction in the setting of negative margins. We discuss its surgical management using digital planning and reconstruction using a contralateral free fibula flap. Ameloblastoma is a locally aggressive entity that requires complete excision. Recurrence can even occur in the reconstruction, which can present a challenge to manage. Consideration should be given to repeat excision and second osseous flap reconstruction.
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Affiliation(s)
- Suzanne M Beecher
- Plastic & Reconstructive Surgery, Cork University Hospital, Cork, IRL
| | - Paul Lennon
- Ear, Nose & Throat Surgery, St. James's Hospital, Dublin, IRL
| | | | - Conor P Barry
- Maxillofacial Surgery, St. James's Hospital, Dublin, IRL
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4
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Sugrue R, Efstathiades A, O'Shaughnessy M. Trifurcation of the recurrent motor branch discovered during carpal tunnel release. BMJ Case Rep 2020; 13:13/3/e230155. [PMID: 32169974 DOI: 10.1136/bcr-2019-230155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Ryan Sugrue
- Plastic Surgery Department, Cork University Hospital Group, Cork, Ireland
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5
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Abstract
Synovial cysts very rarely affect the temporomandibular joint (TMJ). On review of the literature, there are 29 reported cases of unilateral synovial cysts of the TMJ. We present a case of bilateral synovial cysts occurring at the TMJs.
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Affiliation(s)
- Christina Buckley
- Department of Plastic and Reconstructive Surgery, Cork University Hospital Group, Cork, Ireland
| | - Suzanne Beecher
- Department of Plastic and Reconstructive Surgery, Cork University Hospital Group, Cork, Ireland
| | - Duncan Sleeman
- Oral and Maxillofacial Surgery Department, Cork University Hospital Group, Cork, Ireland
| | - Michael O'Shaughnessy
- Department of Plastic and Reconstructive Surgery, Cork University Hospital Group, Cork, Ireland
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6
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Fahimuddin FZ, Murphy R, O'Shaughnessy M. Surgical management of an incarcerated uterus in a gynecological patient: A case report. Case Rep Womens Health 2019; 23:e00123. [PMID: 31193867 PMCID: PMC6543195 DOI: 10.1016/j.crwh.2019.e00123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 05/08/2019] [Accepted: 05/13/2019] [Indexed: 11/26/2022] Open
Abstract
Uterine incarceration is most often described as occurring in pregnancies. Presenting with severe pelvic pain, urinary retention, and in some cases spontaneous abortion, this complication often arises at 12–15 weeks of gestational age. Although usually considered an obstetrical complication, uterine incarceration can occur in nongravid females. This case report presents a gynecological patient with acute urinary retention secondary to uterine incarceration. The patient chose surgical management, and surgery provided immediate symptomatic relief. Our case highlights an uncommon etiology of acute urinary retention and demonstrates the importance of considering the diagnosis of uterine incarceration in nongravid as well as gravid females. Uterine incarceration occurs in first or second trimester and can result in miscarriage; In nongravid patients, it presents with pain and urinary retention; Interventions are more aggressive in nongravid patients
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Affiliation(s)
- Fatimah Z Fahimuddin
- Department of Obstetrics and Gynecology, University of California, San Francisco - Fresno Medical Education Program, 155 N. Fresno St, Fresno, CA 93701, USA
| | - Rebecca Murphy
- Family Health Care Network, 401 E School Ave, Visalia, CA 93291, USA
| | - Michael O'Shaughnessy
- Department of Obstetrics and Gynecology, University of California, San Francisco - Fresno Medical Education Program, 155 N. Fresno St, Fresno, CA 93701, USA
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7
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O'Shaughnessy M, Allen N, O'Regan J, Payne-Danson E, Mentre L, Davin D, Lavin P, Grimes T. Agreement between renal prescribing references and determination of prescribing appropriateness in hospitalized patients with chronic kidney disease. QJM 2017; 110:623-628. [PMID: 28431157 PMCID: PMC6256938 DOI: 10.1093/qjmed/hcx086] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is a risk factor for adverse drug events. The clinical significance of discordance between renal prescribing references is unknown. AIM We determined the prevalence of potentially inappropriate prescribing (PIP) in CKD, measured agreement between two prescribing references, and assessed potential for harm consequent to PIP. DESIGN Single-centre observational study. METHODS A random sample of hospitalized patients with CKD were grouped according to baseline CKD stage (3, 4, or 5). Prescriptions requiring caution in CKD were referenced against the Renal Drug Handbook (RDH) and British National Formulary (BNF) to identify PIP (non-compliance with recommendations). Inter-reference agreement was measured using percentage agreement and Kappa coefficient. Potential for harm consequent to PIP was assessed by physicians and pharmacists using a validated scale. One-year mortality was compared between patients with or without PIP during admission. RESULTS Among 119 patients (median age 73 years, 50% male), 136 cases of PIP were identified in 78 (65.5%) patients. PIP prevalence, per patient, was 64.7% using the BNF and 28.6% using the RDH (fair agreement, Kappa 0.33, P < 0.001). The majority (63.2%) of PIP cases detected exclusively by the BNF carried minimal or no potential for harm. PIP was not significantly associated with one-year mortality (34.7% vs. 21.1%, P = 0.14). CONCLUSIONS PIP was common in hospitalized patients with CKD. Substantial discordance between renal prescribing references was apparent. The development of universally-adopted, evidence-based, prescribing guidelines for CKD might optimize medications safety in this vulnerable group.
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Affiliation(s)
- M O'Shaughnessy
- Department of Pharmacy, Adelaide and Meath Hospital, Trinity Health Kidney Centre, Tallaght, Dublin D24 NROA, Ireland
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - N Allen
- Department of Pharmacy, Adelaide and Meath Hospital, Trinity Health Kidney Centre, Tallaght, Dublin D24 NROA, Ireland
| | - J O'Regan
- Department of Pharmacy, Adelaide and Meath Hospital, Trinity Health Kidney Centre, Tallaght, Dublin D24 NROA, Ireland
| | - E Payne-Danson
- Department of Pharmacy, Adelaide and Meath Hospital, Trinity Health Kidney Centre, Tallaght, Dublin D24 NROA, Ireland
- School of Pharmacy and Pharmaceutical Sciences, University of Dublin Trinity College, Dublin D02 W272, Ireland
| | - L Mentre
- Department of Pharmacy, Adelaide and Meath Hospital, Trinity Health Kidney Centre, Tallaght, Dublin D24 NROA, Ireland
- School of Pharmacy and Pharmaceutical Sciences, University of Dublin Trinity College, Dublin D02 W272, Ireland
| | - D Davin
- Department of Pharmacy, Adelaide and Meath Hospital, Trinity Health Kidney Centre, Tallaght, Dublin D24 NROA, Ireland
| | - P Lavin
- Department of Pharmacy, Adelaide and Meath Hospital, Trinity Health Kidney Centre, Tallaght, Dublin D24 NROA, Ireland
| | - T Grimes
- Department of Pharmacy, Adelaide and Meath Hospital, Trinity Health Kidney Centre, Tallaght, Dublin D24 NROA, Ireland
- School of Pharmacy and Pharmaceutical Sciences, University of Dublin Trinity College, Dublin D02 W272, Ireland
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8
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Kearney L, Dolan RT, Clover AJ, Kelly EJ, O'Broin E, O'Shaughnessy M, O'Sullivan ST. Does Demand for Breast Augmentation Reflect National Financial Trends? Aesthetic Plast Surg 2017; 41:293-297. [PMID: 28062963 DOI: 10.1007/s00266-016-0773-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Accepted: 12/13/2016] [Indexed: 11/25/2022]
Abstract
Aesthetic plastic surgery is a consumer-driven industry, subject to influence by financial forces. A changing economic environment may thus impact on the demand for surgery. The aim of this study was to explore trends in demand for bilateral breast augmentation (BBA) in consecutively presenting patients over an 11-year period and to examine if a correlation exists between these trends and changes in Gross Domestic Product (GDP), a key economic indicator. This study revealed a correlation between annual number of breast augmentation procedures performed and GDP values (r 2 = 0.34, p value = 0.059). Additionally, predicted number of BBA procedures, based on predicted GDP growth in Ireland, strongly correlated with actual number of BBA performed (r 2 = 0.93, p value = 0.000001). Predicted GDP growth can potentially forecast future demand for BBA in our cohort allowing plastic surgeons to modify their practice accordingly. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- L Kearney
- Department of Plastic and Reconstructive Surgery, Cork University Hospital and South Infirmary and Victoria University Hospital, Cork, Ireland.
| | - R T Dolan
- Department of Plastic and Reconstructive Surgery, Cork University Hospital and South Infirmary and Victoria University Hospital, Cork, Ireland
| | - A J Clover
- Department of Plastic and Reconstructive Surgery, Cork University Hospital and South Infirmary and Victoria University Hospital, Cork, Ireland
| | - E J Kelly
- Department of Plastic and Reconstructive Surgery, Cork University Hospital and South Infirmary and Victoria University Hospital, Cork, Ireland
| | - E O'Broin
- Department of Plastic and Reconstructive Surgery, Cork University Hospital and South Infirmary and Victoria University Hospital, Cork, Ireland
| | - M O'Shaughnessy
- Department of Plastic and Reconstructive Surgery, Cork University Hospital and South Infirmary and Victoria University Hospital, Cork, Ireland
| | - S T O'Sullivan
- Department of Plastic and Reconstructive Surgery, Cork University Hospital and South Infirmary and Victoria University Hospital, Cork, Ireland
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9
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Buckley CE, Tong E, Spence LD, O'Shaughnessy M. Intraneural ganglion cyst involving the tibial nerve-a case report. BJR Case Rep 2017; 3:20160116. [PMID: 30363240 PMCID: PMC6159266 DOI: 10.1259/bjrcr.20160116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 10/25/2016] [Accepted: 11/23/2016] [Indexed: 11/05/2022] Open
Abstract
Intraneural ganglia are rare non-neoplastic cysts that are caused by an accumulation of thick mucinous fluid. This occurs within the epineurium of peripheral nerves, which is encased in a dense fibrous capsule. The most common presentation of this tumour is local and/or radiating pain. Involvement of the tibial nerve is extremely uncommon, with less than 18 reported cases in the literature. We present a case of an intraneural tibial nerve ganglion cyst in a young male. We also discuss the current literature and proposed pathogenesis and treatment of this rare entity.
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Affiliation(s)
| | - Emma Tong
- Plastic Surgery Unit, Cork University Hospital, Cork, Ireland
| | - Liam D Spence
- Department of Radiology, Cork University Hospital, Cork, Ireland
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10
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Gupta R, Dyer A, O'Keefe A, Belette A, Somani S, O'Shaughnessy M, Yarbrough M. P279 Leaving the nest: improving food allergy management on college campuses. Ann Allergy Asthma Immunol 2016. [DOI: 10.1016/j.anai.2016.09.292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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11
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Joyce CW, Woods JFC, Murphy S, Bollard S, Kelly JL, Carroll SM, O'Shaughnessy M. A Five-Year Review of Tag Rugby Hand Injuries. Injury 2016; 47:2266-2268. [PMID: 27553391 DOI: 10.1016/j.injury.2016.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 08/03/2016] [Accepted: 08/05/2016] [Indexed: 02/02/2023]
Abstract
Tag rugby is one of the fastest growing sports in Ireland. It is a soft-contact team game that is loosely based on the rugby league format except players try to remove Velcro tags from their opponents' shorts rather than engage in a typical rugby tackle. The purpose of this study was to examine all tag rugby associated hand injuries over a five-year period in three large tertiary referral hospitals in Ireland. Using the patient corresponding system, 228 patients with hand injury related tag rugby injuries were observed from 2010 to 2015. There were 138 males and 90 females in the study and over 40% of patients required surgery. Most of the patients were young professionals with an average age of 30. Twenty-five patients worked in the financial services whilst there were 23 teachers. Fractures accounted for 124 of the 228 injuries and mallet injuries accounted for 53. Eighty percent of all injuries occurred during the tackle. The mean number of days missed from work was 9.1±13.8 days. These injuries resulted in an average of seven hospital appointments per patient. Considering it is a soft-contact sport, it is surprising the number of hand injuries that we have observed. Although safety measures have been introduced to decrease the number of hand injuries in recent years, there is a need for further improvements. Better player education about seeking prompt medical attention once an injury occurs, coupled with longer shorts worn by players may improve measures for the sport.
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Affiliation(s)
- C W Joyce
- Department of Plastic Surgery and Hand Surgery, Cork University Hospital, Cork, Ireland.
| | - J F C Woods
- Department of Plastic Surgery and Hand Surgery, University Hospital Galway, Ireland
| | - S Murphy
- Department of Plastic Surgery and Hand Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - S Bollard
- Department of Plastic Surgery and Hand Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - J L Kelly
- Department of Plastic Surgery and Hand Surgery, University Hospital Galway, Ireland
| | - S M Carroll
- Department of Plastic Surgery and Hand Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - M O'Shaughnessy
- Department of Plastic Surgery and Hand Surgery, Cork University Hospital, Cork, Ireland
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12
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Cahill KC, Theopold C, O'Shaughnessy M. Experiences with pins and rubber band traction in the treatment of proximal interphalangeal joint contracture. Plast Surg (Oakv) 2016; 24:20-2. [PMID: 27054133 DOI: 10.4172/plastic-surgery.1000948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Proximal interphalangeal joint (PIPJ) contracture is a difficult problem to treat regardless of etiology. Although numerous interventions have been recommended, published results are mediocre at best. OBJECTIVE The authors describe their experience and results of using a modification of pins and rubber band traction (PRBT) - applying a dynamic extension apparatus to a contracted PIPJ using the constant traction force in a stretched rubber (elastic) band. METHOD A retrospective review of patients treated with this method was performed, and the results are presented. The technique itself is described, and clinical photographs illustrate the method. RESULTS Mean PIPJ flexion contracture before PRBT was 82° (range 60° to 110°). The full correction of eight contracted PIPJs in seven patients was achieved, in a mean of 17.8 days (range 14 to 31 days). At one month postremoval of PRBT, the mean PIPJ flexion contracture was 22.8° (range 0° to 46°). DISCUSSION The method is compared with previously described methods of PIPJ contracture correction, whether surgical or splinting; the latter may be static, dynamic or a combination of the two. The results of previously published studies are discussed and compared with the method described. CONCLUSION The present method is a powerful and effective simplification of a previously described method of correcting PIPJ contractures. This technique is simple, 'low-tech' and can be applied under local anesthetic; the authors believe it offers a useful adjunct to surgical release.
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Affiliation(s)
- Kevin C Cahill
- Department of Plastic, Reconstructive & Hand Surgery, Cork University Hospital, Wilton, Cork, Ireland
| | - Christoph Theopold
- Department of Plastic, Reconstructive & Hand Surgery, Cork University Hospital, Wilton, Cork, Ireland
| | - Michael O'Shaughnessy
- Department of Plastic, Reconstructive & Hand Surgery, Cork University Hospital, Wilton, Cork, Ireland
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13
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McInerney NM, O'Shaughnessy M, Clover J. A hand flexion contracture with progression. BMJ 2014; 349:g6137. [PMID: 25358591 DOI: 10.1136/bmj.g6137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Niall M McInerney
- Department of Plastic and Reconstructive Surgery, Cork University Hospital, Cork, Republic of Ireland
| | - Michael O'Shaughnessy
- Department of Plastic and Reconstructive Surgery, Cork University Hospital, Cork, Republic of Ireland
| | - James Clover
- Department of Plastic and Reconstructive Surgery, Cork University Hospital, Cork, Republic of Ireland
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14
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Mahon N, Chan JCY, Nizar B, Feeley L, O'Shaughnessy M. SEA URCHIN SPINE ARTHRITIS OF THE PROXIMAL INTERPHALANGEAL JOINT OF THE HAND: RADIOLOGICAL, INTRAOPERATIVE AND HISTOPATHOLOGICAL FINDINGS. ACTA ACUST UNITED AC 2014; 19:261-4. [DOI: 10.1142/s021881041472023x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Penetrating sea urchin spine injuries, can lead to devastating, irreversible consequences. Persistent inflammation, cutaneous granuloma, neuroma, tenosynovitis, arthritis and destructive arthritis, leading to permanent loss of function and digit amputation, can occur. We present a case of a patient who developed sea urchin spine arthritis of the proximal interphalangeal joint. Only 17 cases of sea urchin spine arthritis of the hand have been documented in the medical literature. However, in this case, the article also includes sequential radiographs, histopathological slides, and intra-operative photographs.
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Affiliation(s)
- Nicola Mahon
- Department of Plastics, Hand and Reconstructive Surgery, Cork University Hospital, Ireland
| | - Jeffrey C. Y. Chan
- Department of Plastics, Hand and Reconstructive Surgery, Cork University Hospital, Ireland
| | - Bafiq Nizar
- Department of Plastics, Hand and Reconstructive Surgery, Cork University Hospital, Ireland
| | - Linda Feeley
- Department of Histopathology, Cork University Hospital, Ireland
| | - Michael O'Shaughnessy
- Department of Plastics, Hand and Reconstructive Surgery, Cork University Hospital, Ireland
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15
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Potter SM, O'Shaughnessy M. Hereditary neuropathy with liability to pressure palsy: global neuropathy after tourniquet use. J Hand Surg Eur Vol 2014; 39:212-3. [PMID: 24080438 DOI: 10.1177/1753193413507173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- S M Potter
- Department of Plastic and Reconstructive Surgery, Cork University Hospital, Saint Mary's Orthopaedic Hospital, Cork, Ireland
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16
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Murphy SM, Browne K, Tuite DJ, O'Shaughnessy M. Dual pathology proximal median nerve compression of the forearm. J Plast Reconstr Aesthet Surg 2013; 66:1792-4. [DOI: 10.1016/j.bjps.2013.04.054] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 04/06/2013] [Accepted: 04/23/2013] [Indexed: 11/16/2022]
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17
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Salwa SP, Bourke MG, Forde PF, O'Shaughnessy M, O'Sullivan ST, Kelly EJ, Soden DM, Clover AJP. Electrochemotherapy for the treatment of ocular basal cell carcinoma; a novel adjunct in the disease management. J Plast Reconstr Aesthet Surg 2013; 67:403-6. [PMID: 23916385 DOI: 10.1016/j.bjps.2013.07.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 07/09/2013] [Indexed: 11/28/2022]
Abstract
Basal Cell Carcinoma (BCC) affecting the ocular region is potentially problematic due to its ability to infiltrate aesthetic and functional structures. Due to the paucity of local tissue, resection frequently requires reconstruction with skin grafts or local flaps. Surgical treatment may not be suitable for patients with multiple co-morbidities. Electrochemotherapy (ECT) is a technique where cells are temporarily permeabilized after exposure to a brief electrical field and when combined with normally impermeant chemotherapy drugs can resolve cutaneous cancers - even those previously recalcitrant to chemotherapy or radiotherapy. Its particular advantage is its speed of application and the minimal damage to the surrounding healthy tissue structures. We present a series of 3 patients with BCCs in the peri-ocular region and significant co-morbidities deemed unsuitable for surgical resection, who underwent ECT. The lesions were all primary BCC ranging in size from 0.5 cm(2) to 1 cm(2). Two lesions were on the upper eyelid and one on the lower eyelid. ECT was performed using an 8-needle electrode and a CE approved electroporation generator with intra-lesional Bleomycin. All lesions responded to treatment. All BCC's completely resolved, with acceptable scarring. No side effects were reported from the Bleomycin or the electric pulses. ECT for peri-ocular BCC is an adjunct to surgical excision in the management of surgically problematic lesions. This technique could provide a useful initial treatment option for patients who are medically unfit or where resection and would be associated with significant morbidity.
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Affiliation(s)
- S P Salwa
- Cork Cancer Research Centre, Mercy University Hospital and Leslie C. Quick Jnr. Laboratory, University College Cork, Cork, Ireland
| | - M G Bourke
- Cork Cancer Research Centre, Mercy University Hospital and Leslie C. Quick Jnr. Laboratory, University College Cork, Cork, Ireland
| | - P F Forde
- Cork Cancer Research Centre, Mercy University Hospital and Leslie C. Quick Jnr. Laboratory, University College Cork, Cork, Ireland
| | - M O'Shaughnessy
- Department of Plastic and Reconstructive Surgery, Cork University Hospital, Cork, Ireland
| | - S T O'Sullivan
- Department of Plastic and Reconstructive Surgery, Cork University Hospital, Cork, Ireland
| | - E J Kelly
- Department of Plastic and Reconstructive Surgery, Cork University Hospital, Cork, Ireland
| | - D M Soden
- Cork Cancer Research Centre, Mercy University Hospital and Leslie C. Quick Jnr. Laboratory, University College Cork, Cork, Ireland
| | - A J P Clover
- Cork Cancer Research Centre, Mercy University Hospital and Leslie C. Quick Jnr. Laboratory, University College Cork, Cork, Ireland; Department of Plastic and Reconstructive Surgery, Cork University Hospital, Cork, Ireland.
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Kieran I, Fitzgerald E, Murphy S, O'Shaughnessy M. Changes in the workload composition in a plastic surgery unit over a 12 year period. Ir J Med Sci 2013; 182:657-62. [PMID: 23575627 DOI: 10.1007/s11845-013-0948-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Accepted: 04/01/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND Guidelines issued by the British Association of Plastic Reconstructive and Aesthetic Surgeons suggest that the ratio of elective to emergency cases in plastic surgery units should be 2:1. AIM To investigate how the workload composition of a regional plastic surgery unit compared with these guidelines. METHODS The changes in the workload composition of a regional plastic surgery unit were examined by retrospectively analysing all plastic and reconstructive surgery cases performed over 12 years (1998-2009). RESULTS This time period saw a change from a 1:2 ratio of elective to trauma procedures, to the recommended ratio, at a time when the overall caseload increased by almost 40 % (3,281 procedures in 1998 to 4,529 procedures in 2009). CONCLUSION Expansion of staff numbers at consultant and non-consultant grades, and increased resources (allocated theatre sessions and outpatient clinics) were pivotal to this change.
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Affiliation(s)
- I Kieran
- Plastic and Reconstructive Surgery Department, Cork University Hospital, Wilton, Cork, Ireland,
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Hannon E, O'Shaughnessy M, Clover AJP. Does upgraded histological grade account for increase in recurrence rates? RE: Re-excision of incompletely excised cutaneous squamous cell carcinoma: histological findings influence prognosis. J Plast Reconstr Aesthet Surg 2013; 66:874-5. [PMID: 23419682 DOI: 10.1016/j.bjps.2013.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 01/22/2013] [Indexed: 10/27/2022]
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20
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Wett B, Omari A, Podmirseg SM, Han M, Akintayo O, Gómez Brandón M, Murthy S, Bott C, Hell M, Takács I, Nyhuis G, O'Shaughnessy M. Going for mainstream deammonification from bench to full scale for maximized resource efficiency. Water Sci Technol 2013; 68:283-9. [PMID: 23863418 DOI: 10.2166/wst.2013.150] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
A three-pronged coordinated research effort was undertaken by cooperating utilities at three different experimental scales investigating bioaugmentation, enrichment and performance of anammox organisms in mainstream treatment. Two major technological components were applied: density-based sludge wasting by a selective cyclone to retain anammox granules and intermittent aeration to repress nitrite oxidizers. This paper evaluates process conditions and operation modes to direct more nitrogen to the resource-saving metabolic route of deammonification.
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Affiliation(s)
- B Wett
- ARAconsult, Unterbergerstr.1, A-6020 Innsbruck, Austria.
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Henry FP, Farkhad RI, Butt FS, O'Shaughnessy M, O'Sullivan ST. A comparison between complete immobilisation and protected active mobilisation in sensory nerve recovery following isolated digital nerve injury. J Hand Surg Eur Vol 2012; 37:422-6. [PMID: 22147643 DOI: 10.1177/1753193411431208] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Post-operative immobilisation following isolated digital nerve repair remains a controversial issue amongst the microsurgical community. Protocols differ from unit to unit and even, as evidenced in our unit, may differ from consultant to consultant. We undertook a retrospective review of 46 patients who underwent isolated digital nerve repair over a 6-month period. Follow-up ranged from 6 to 18 months. Twenty-four were managed with protected active mobilisation over a 4-week period while 22 were immobilised over the same period. Outcomes such as return to work, cold intolerance, two-point discrimination and temperature differentiation were used as indicators of clinical recovery. Our results showed that there was no significant difference noted in either clinical assessment of recovery or return to work following either post-operative protocol, suggesting that either regime may be adopted, tailored to the patient's needs and resources of the unit.
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Affiliation(s)
- F P Henry
- Department of Plastic, Reconstructive and Hand Surgery, Cork University Hospital, Wilton, Cork, Ireland.
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22
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Theopold C, Potter S, Dempsey M, O'Shaughnessy M. A randomised controlled trial of absorbable versus non-absorbable sutures for skin closure after open carpal tunnel release. J Hand Surg Eur Vol 2012; 37:350-3. [PMID: 21987279 DOI: 10.1177/1753193411422334] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We compared the aesthetic outcome of scars after closure of open carpal tunnel incisions with either absorbable 4-0 Vicryl Rapide or non-absorbable 4-0 Novafil. Patients were recruited in a randomized controlled trial and scars were scored at 6 weeks using a modified Patient and Observer Scar Assessment Scale. Scores demonstrated differences only for pain, vascularity and cross-hatching between both groups, though none of these were statistically significant. The dissolving and falling out of Vicryl Rapide was significantly more comfortable than removal of 4-0 Novafil sutures, assessed on a numerical analogue scale. There was no difference in infection rate between both study groups, supporting overall the use of Vicryl Rapide for the closure of palmar hand incisions, in light of the convenience and cost savings associated with absorbable sutures.
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Affiliation(s)
- C Theopold
- Department of Plastic and Reconstructive Surgery, Cork University Hospital, Wilton, Cork, Republic of Ireland.
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23
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Salwa S, Bourke M, O'Shaughnessy M, O'Sullivan S, Kelly J, O'Sullivan G. Electrochemotherapy - a novel effective approach to naso-ocular basal cell carcinoma treatment. Eur J Surg Oncol 2011. [DOI: 10.1016/j.ejso.2011.08.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Tiong WHC, O'Shaughnessy M, O'Sullivan ST. Cost awareness among doctors in an Irish university-affiliated teaching hospital. Clin Pract 2011; 1:e91. [PMID: 24765391 PMCID: PMC3981395 DOI: 10.4081/cp.2011.e91] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Accepted: 10/12/2011] [Indexed: 11/23/2022] Open
Abstract
Previous studies in USA and Canada have found that physicians and physicians in training have a limited understanding of medical care costs. In this study, we set out to survey all grades of doctors in the surgical department, emergency department, and anaesthetic department in a university-affiliated, Irish teaching hospital. Open-ended questionnaires on cost of 25 routinely used items in the hospital were sent to each department. The aims of the study were to assess the present knowledge of cost among the various grades of doctors, and to evaluate the level of professional experience on cost awareness and their confidence in their estimates. We had an overall response rate of 56.8% with 68.5% of doctors admitted to have estimated more than 90% of their responses. Ninety three percent of doctors have no confidence in their estimates on cost of listed items. We found that the lack of cost awareness was universal among doctors of all grades (P = 0.236). The doctors in our study population showed a high level of inaccuracy on their estimates of cost of routinely used items with 84% of the items overestimated. Our results were discouraging and demonstrated that considerable educational activity will be necessary if doctors are to be more cost effective in meeting the national health care budget.
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Affiliation(s)
- William H C Tiong
- Department of Plastic and Reconstructive Surgery, Cork University Hospital, Cork, Ireland
| | - Michael O'Shaughnessy
- Department of Plastic and Reconstructive Surgery, Cork University Hospital, Cork, Ireland
| | - Sean T O'Sullivan
- Department of Plastic and Reconstructive Surgery, Cork University Hospital, Cork, Ireland
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Nugent N, O'Shaughnessy M. Closed central slip injuries--a missed diagnosis? Ir Med J 2011; 104:248-250. [PMID: 22125881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The extensor apparatus of the finger is a complex structure and injury can lead to significant digital dysfunction. Closed central slip injuries may be missed or diagnosis delayed because of lack of an open wound and often no radiographic abnormality, and can result in boutonniere deformities if untreated. This study aimed to quantify the number of patients attending with closed central slip injuries and to ascertain if the initial diagnosis was correct. The number of patients presenting to us over a 6 month period was recorded. The original diagnosis, time to diagnosis of central slip injury and the presence/absence of a boutonniere deformity were recorded. Ten patients were included in the study. Seven (70%) injuries were due to sport. Eight (80%) had a delayed diagnosis of central slip injury. Six (60%) had previously presented to general practitioners or emergency departments. Seven (70%) had boutonniere deformities. Closed central slip injuries can be missed. Simple clinical tests can diagnose central slip disruption.
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Affiliation(s)
- N Nugent
- Department of Plastic Surgery, Cork University Hospital, Wilton, Cork.
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Abstract
The present study reports on a new, rapidly growing patient subpopulation presenting with hand injuries to the Department of Plastic Surgery in Cork University Hospital (Ireland). The impact of the 10 new European Union accession states on the trauma workload is examined. The associated growth in expenditure on interpreter services is also examined. Potential risk factors in the foreign workers' new working environment is explored.
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Affiliation(s)
- Thorsten Sattler
- Department of Plastic and Hand Surgery, University Medical Centre, Freiburg, Germany
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27
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Nugent N, Henry F, O'Shaughnessy M. An unusual presentation of a glomus tumour. Ir Med J 2011; 104:51-52. [PMID: 21465877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Glomus tumours are benign, soft tissue tumours, usually of fingertips. Classically they present with severe pain, temperature sensitivity and localised tenderness. The diagnosis is often delayed due to sometimes non-specific symptoms and rarity of the disorder. While usually a clinical diagnosis, imaging may be necessary for diagnosis and localisation. We present a case of glomus tumour of the fingertip with an unusual history.
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Affiliation(s)
- N Nugent
- Department of Plastic Surgery, Cork University Hospital, Wilton, Cork.
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28
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Wett B, Murthy S, Takács I, Hell M, Bowden G, Deur A, O'Shaughnessy M. Key Parameters for Control of DEMON Deammonification Process. ACTA ACUST UNITED AC 2007. [DOI: 10.2175/193317707x257017] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Oittinen HAL, O'Shaughnessy M, Cullinane AB, Keohane C. Malignant melanoma of the ciliary body presenting as extraocular metastasis in the temporalis muscle. J Clin Pathol 2007; 60:834-5. [PMID: 17545559 PMCID: PMC1995796 DOI: 10.1136/jcp.2005.033613] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
OBJECTIVE Power lawnmowers can pose significant danger of injury to both the operator and the bystander, from direct contact with the rotary blades or missile injury. Our objective was to review our experience with paediatric lawnmower-associated trauma, and the safety recommendations available to operators of power lawnmowers. METHODS The patient cohort comprised paediatric (<16 years of age) patients treated for lawnmower-associated trauma, by the plastic surgery service, between 1996 and 2003. These patients were identified retrospectively. Age at the time of injury, location and extent of bony and soft tissue injuries sustained, treatment instituted and clinical outcome were recorded. Brochures and instruction manuals of six lawnmower manufacturers were reviewed, and safety recommendations noted. RESULTS Fifteen patients were identified. The majority of injuries occurred from direct contact with the rotary blades (93%); the remaining child sustained a burn injury. Fourteen children (93%) required operative intervention. Seven patients (46%) sustained injuries resulting in amputation, two of whom had major limb amputations. All children, except the burns patient, underwent wound debridement and received antibiotic therapy. Reconstructive methods ranged from primary closure to free tissue transfer. Many patients required multiple procedures. In all instruction manuals, instructions to keep children and pets indoors or out of the yard when mowing were found. CONCLUSIONS Lawnmower injuries can be devastating, particularly in children. Many victims have lasting deformities as a result of their injuries. Awareness of and stringent adherence to safety precautions during use of power lawnmowers can prevent many of these accidents.
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Affiliation(s)
- Nora Nugent
- Department of Plastic Surgery, Cork University Hospital, Wilton, Cork, Ireland.
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31
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Phillips P, Bonner S, Gataric N, Bai T, Wilcox P, Hogg R, O'Shaughnessy M, Montaner J. Nontuberculous mycobacterial immune reconstitution syndrome in HIV-infected patients: spectrum of disease and long-term follow-up. Clin Infect Dis 2005; 41:1483-97. [PMID: 16231262 DOI: 10.1086/497269] [Citation(s) in RCA: 174] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2005] [Accepted: 07/06/2005] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The long-term outcome and spectrum of disease of nontuberculous mycobacterial immune reconstitution syndrome have not been described. METHODS We report the findings of an observational study. RESULTS Among 51 patients (43 with Mycobacterium avium complex [MAC] infection, 2 with Mycobacterium genavense infection, and 6 whose samples were smear positive but culture negative) from 1993-2004, the median follow-up period was 29 months. The incidence of nontuberculous mycobacterial immune reconstitution syndrome was 3.5% among patients initiating highly active antiretroviral therapy (HAART) with a baseline CD4+ cell count of <100 cells/microL. Three main clinical presentations were peripheral lymphadenitis (in 17 patients), pulmonary-thoracic disease (in 15 patients), and intra-abdominal disease (in 13 patients). Six other patients had cases that involved joint, spine, prostate, skin, soft tissue, and spontaneously resolving MAC bacteremia. Disease was usually localized. Median CD4+ cell counts before initiation of HAART and at diagnosis were 20 and 120 cells/microL, respectively, and the median reduction in human immunodeficiency virus (HIV) RNA load was 2.5 log10 copies/mL. Intra-abdominal disease was frequently preceded by disseminated MAC infection (in 62% of cases, compared with 6%-33% of cases for other groups; P=.003) and accounted for 16 (43%) of 36 hospitalizations (compared with 5%-35% for other groups; P=.008). The relapse rate was not higher among 10 patients who received no MAC therapy or received MAC therapy for < or =2 weeks. Prednisone was associated with clinical responses in 8 (89%) of 9 patients with evaluable cases. In total, 7 patients (14%) had 13 subsequent culture-positive MAC events (6 of which were cases of immune reconstitution syndrome, and 7 of which were cases of disseminated MAC infection). Ten patients (20%) died (2 of disseminated MAC infection, 5 of other opportunistic infections, and 3 of HIV-unrelated causes). CONCLUSIONS Nontuberculous mycobacterial immune reconstitution syndrome has a wide range of clinical presentations and severity. The long-term prognosis is favorable for HAART-adherent patients. Intra-abdominal disease is associated with greater morbidity than is peripheral lymphadenitis. The role of antimycobacterial therapy is uncertain, given the self-limited course of most nonabdominal cases.
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Affiliation(s)
- Peter Phillips
- Division of Infectious Diseases, St. Paul's Hospital, Vancouver, British Columbia, Canada.
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Renwick AG, Thompson JP, O'Shaughnessy M, Walter EJ. The metabolism of cyclamate to cyclohexylamine in humans during long-term administration. Toxicol Appl Pharmacol 2004; 196:367-80. [PMID: 15094307 DOI: 10.1016/j.taap.2004.01.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2003] [Accepted: 01/21/2004] [Indexed: 11/28/2022]
Abstract
A group of 14 subjects, who had been identified from 261 volunteers in a 1-week screen as being able to metabolize the sweetener cyclamate to cyclohexylamine (>0.2% of a daily dose), and 31 nonconverters (<0.2% metabolism) were given calcium cyclamate tablets (equivalent to 250 mg cyclamic acid, 3 times daily) for a period of 13 weeks. The metabolism of cyclamate to cyclohexylamine was determined using twice-weekly timed (3 h) urine collections during week 1-3 and 7-13. Urine specimens were collected on all other study days to investigate day-to-day fluctuations in cyclohexylamine excretion. Analyses of the twice weekly timed urine collections showed that subjects recruited as nonconverters essentially remained nonconverters. Of the converters, three showed consistently low metabolism, five showed erratic metabolism, five showed low metabolism initially, which increased during the latter part of the study, and one subject showed consistently high metabolism throughout the study. Analysis of the day-to-day urine specimens showed marked intrasubject variability. The plasma concentrations of cyclohexylamine measured on weeks 1-3 and 7-13 reflected the urine profiles. The highest individual long-term average steady-state excretion values based on the 3-h urine collections and daily samples were 21%, 23%, 25%, 29%, 34%, and 38%. The maximum % metabolism detected in the high converters occasionally reached the value of 60% reported in previous short-term studies, but this high activity was not maintained, and was followed by periods of lower metabolism. The results of this metabolism study support an acceptable daily intake (ADI) of 0-11 mg/kg body weight per day.
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Affiliation(s)
- A G Renwick
- Clinical Pharmacology Group, Allergy and Inflammation Research Division, School of Medicine, University of Southampton, Bassett Crescent East, Southampton SO16 7PX, UK.
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Abstract
Sarcoidosis of the phalanx is rare and is usually associated with severe systemic disease. We present a patient with recurrent phalangeal sarcoidosis and new evidence of a changing radiological pattern. The clinical presentation and outcome is discussed. High dose steroid treatment and careful long-term follow-up is recommended.
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Affiliation(s)
- John L Kelly
- The Department of Plastic Surgery, St. Vincent's Hospital, Melbourne, Victoria, Australia 3065 Australia.
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Hogg R, Cahn P, Katabira ET, Lange J, Samuel NM, O'Shaughnessy M, Vella S, Wainberg MA, Montaner J. Time to act: global apathy towards HIV/AIDS is a crime against humanity. Lancet 2002; 360:1710-1. [PMID: 12480418 DOI: 10.1016/s0140-6736(02)11722-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Robert Hogg
- Department of Health Care and Epidemiology and BC Center for Excellence in HIV/AIDS, University of British Columbia
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Phillips P, Chan K, Hogg R, Bessuille E, Black W, Talbot J, O'Shaughnessy M, Montaner J. Azithromycin prophylaxis for Mycobacterium avium complex during the era of highly active antiretroviral therapy: evaluation of a provincial program. Clin Infect Dis 2002; 34:371-8. [PMID: 11774085 DOI: 10.1086/324743] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2001] [Revised: 07/25/2001] [Indexed: 11/03/2022] Open
Abstract
Mycobacterium avium complex (MAC) disease was evaluated in a provincial program of azithromycin prophylaxis. Highly active antiretroviral therapy (HAART) was prescribed to 383 (65%) of 587 patients eligible for MAC prophylaxis (CD4 <75 cells/mm3). By use of an intent-to-treat analysis, MAC disease was observed in 21 of 271 patients who did not receive prophylaxis (incidence rate, 8 events per 100 person-years). MAC events occurred in 10 of 316 patients who received azithromycin (2.37 events per 100 person-years). Localized lymphadenitis compatible with immune reconstitution disease accounted for 23% of all MAC events, in contrast to studies in the pre-HAART era, where almost all cases were disseminated. None of the MAC isolates from the 10 prophylaxis failures were resistant to azithromycin. Azithromycin appeared to be protective against disseminated MAC in patients who were either unresponsive or nonadherent to HAART, but it did not prevent the development of immune reconstitution disease due to MAC.
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Affiliation(s)
- Peter Phillips
- AIDS Program and Division of Infectious Diseases, St. Paul's Hospital, Vancouver, BC V6Z 1Y6, Canada.
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Aguirre J, Buttery L, O'Shaughnessy M, Afzal F, Fernandez de Marticorena I, Hukkanen M, Huang P, MacIntyre I, Polak J. Endothelial nitric oxide synthase gene-deficient mice demonstrate marked retardation in postnatal bone formation, reduced bone volume, and defects in osteoblast maturation and activity. Am J Pathol 2001; 158:247-57. [PMID: 11141498 PMCID: PMC1850250 DOI: 10.1016/s0002-9440(10)63963-6] [Citation(s) in RCA: 187] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/19/2000] [Indexed: 12/30/2022]
Abstract
Nitric oxide (NO) has been implicated in the local regulation of bone metabolism. However, the contribution made by specific NO synthase (NOS) enzymes is unclear. Here we show that endothelial NOS gene knockout mice (eNOS-/-) have marked abnormalities in bone formation. Histomorphometric analysis of eNOS-/- femurs showed bone volume and bone formation rate was reduced by up to 45% (P: < 0.01) and 52% (P: < 0.01), respectively. These abnormalities were prevalent in young (6 to 9 weeks old) adults but by 12 to 18 weeks bone phenotype was restored toward wild-type. Dual energy X-ray absorptiometry analysis confirmed the age-related bone abnormalities revealing significant reductions in femoral (P: < 0.05) and spinal bone mineral densities (P: < 0.01) at 8 weeks that were normalized at 12 weeks. Reduction in bone formation and volume was not related to increased osteoclast numbers or activity but rather to dysfunctional osteoblasts. Osteoblast numbers and mineralizing activity were reduced in eNOS-/- mice. In vitro, osteoblasts from calvarial explants showed retarded proliferation and differentiation (alkaline phosphatase activity and mineral deposition) that could be restored by exogenous administration of a NO donor. These cells were also unresponsive to 17ss-estradiol and had an attenuated chemotactic response to transforming growth factor-beta. In conclusion, eNOS is involved in the postnatal regulation of bone mass and lack of eNOS gene results in reduced bone formation and volume and this is related to impaired osteoblast function.
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Affiliation(s)
- J Aguirre
- Department of Histochemistry, Imperial College School of Medicine, Hammersmith Campus, London, United Kingdom
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O'Shaughnessy M, Anderson GL, Pierangeli S, Acland RD, Johnson PC, Peter FW, Barker JH. In vitro platelet aggregation studies in microvascular surgery research: a method in the rat model. Microsurgery 2000; 17:238-42. [PMID: 9140958 DOI: 10.1002/(sici)1098-2752(1996)17:4<238::aid-micr12>3.0.co;2-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
There is now a growing awareness of the central role of platelet function in microvascular thrombosis. Platelet aggregation studies remain one of the most useful ways of studying platelet function and response to different stimuli. This brief communication highlights some of the main variables that can affect platelet aggregation in rats and emphasizes the existence of important differences in these variables compared with human platelet aggregation.
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Affiliation(s)
- M O'Shaughnessy
- Division of Plastic and Reconstructive Surgery, Cork University Hospial, Wilton, Ireland
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O'Donoghue JM, O'Sullivan ST, O'Shaughnessy M, O'Connor TP. Effects of a silicone-coated polyamide net dressing and calcium alginate on the healing of split skin graft donor sites: a prospective randomised trial. Acta Chir Plast 2000; 42:3-6. [PMID: 10815307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
An open randomised prospectively controlled trial was performed to assess the healing efficacy, slippage rate and degree of discomfort on removal of calcium alginate and a silicone-coated polyamide net dressing on split skin graft donor sites. Sixteen patients were randomised to the calcium alginate group and 14 to the silicone-coated group. The donor sites were assessed at days 7, 10, 14 and up to day 21. The mean time to healing in the calcium alginate group was 8.75 +/- 0.78 days (range 7 to 14 days) compared to 12 +/- 0.62 days (range 7 to 16 days) for the silicone-coated group (p < 0.01). Although more silicone-coated dressings slipped (5 versus 1), the difference was not statistically significant. Pain during the first dressing change was assessed using a visual analogue pain scale. Although no significant differences were found between the groups, it was necessary to change the dressing protocol in the silicone-coated arm of the trial after entering the first two patients. Overlaid absorbent gauze adhered to the donor site through the fenestrations in the dressing necessitating the placement of paraffin gauze between the experimental dressing and the overlying cotton gauze. There was one infection in the study, occurring in the alginate group. Based on these results we recommend calcium alginate as the dressing of choice for split skin graft donor sites.
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Affiliation(s)
- J M O'Donoghue
- Department of Plastic Surgery, Cork University Hospital, Wilton, Ireland
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O'Sullivan ST, O'Donoghue JM, Hayes D, O'Shaughnessy M. Squamous cell carcinoma of the finger masquerading as an abscess. Case report. Scand J Plast Reconstr Surg Hand Surg 2000; 34:91-2. [PMID: 10756582 DOI: 10.1080/02844310050160231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
A 43-year-old man presented with an abscess on his left ring finger, which recurred despite multiple drainage procedures. Histological examination of the lesion was unhelpful; it was only on histopathological examination of the finger after ray amputation that the diagnosis of cutaneous squamous cell carcinoma was established. This case illustrates the need to consider malignancy when dealing with chronic finger infections.
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Affiliation(s)
- S T O'Sullivan
- Department of Plastic and Hand Surgery, Cork University Hospital, Wilton, Ireland
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DeMatteo D, Major C, Block B, Coates R, Fearon M, Goldberg E, King SM, Millson M, O'Shaughnessy M, Read SE. Toronto street youth and HIV/AIDS: prevalence, demographics, and risks. J Adolesc Health 1999; 25:358-66. [PMID: 10551667 DOI: 10.1016/s1054-139x(99)00059-2] [Citation(s) in RCA: 88] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The purposes of this study were: (a) to identify human immunodeficiency virus (HIV) prevalence in Toronto street youth through paired blood and saliva specimens; (b) to identify the HIV risk and prevention behaviors of street involved youth; and (c) to identify demographic or other factors that may contribute to the risk of street youth becoming infected with HIV/acquired immunodeficiency syndrome (AIDS) in the future. METHODS This was a cross-sectional convenience study of street-involved youth aged 14-25 years. The youth participated in interviews to identify HIV-related knowledge and personal risk and preventive behaviors. Following interviews, they were asked to provide a saliva sample, blood spot, or both. They could refuse one or both samples without jeopardizing their involvement or receiving an honorarium. Two males were the only participants who declined to provide a sample. RESULTS Fifteen of 695 (2.2%) youth tested positive for HIV infection. All were male, ranging in age from 18 to 25 years. Same and opposite sex, intravenous (IV) drug use, prostitution, and incarceration were risk factors associated with positive HIV test results. The rate of HIV infection was seven times greater for the group 20 years of age and older (20-25) compared to the younger group aged 14-9 years. The proportion testing positive for HIV from small cities, towns, and rural communities in Ontario was 40%; yet, they represented 21% of the study population. Most (57%) youth had been on their own for no more than 3 years and had moved frequently. Nearly two thirds (60%) had stayed in hostels or homeless shelters in the previous 6 months. CONCLUSION Street youth in Canada are at high risk of HIV infection with their risk increasing with age. Unprotected (same and opposite) sex, IV drug use, prostitution and incarceration were linked to their HIV infections. The high level of mobility identified by street youth challenges governments, communities, and public health officials to develop appropriate prevention strategies and to carefully monitor the spread of HIV infection in this vulnerable population.
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Affiliation(s)
- D DeMatteo
- Department of Pediatrics, The Hospital for Sick Children/University of Toronto, Ontario, Canada
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Jahnke N, Yip B, Hogg RS, O'Shaughnessy M, Montaner JS. Antiviral effect of AZT versus stavudine in combination with lamivudine and indinavir in the context of a populational study. J Acquir Immune Defic Syndr 1999; 21:347-8. [PMID: 10428115 DOI: 10.1097/00126334-199908010-00014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hukkanen MV, Platts LA, Fernandez De Marticorena I, O'Shaughnessy M, MacIntyre I, Polak JM. Developmental regulation of nitric oxide synthase expression in rat skeletal bone. J Bone Miner Res 1999; 14:868-77. [PMID: 10352094 DOI: 10.1359/jbmr.1999.14.6.868] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Nitric oxide (NO) has been implicated in bone growth and remodeling by studies showing that inhibition of NO-synthase (NOS) activity retards normal gain in bone mineral density both during skeletal development and after sexual maturity. In the present study, we aimed to assess the level of expression and cellular localization of the three NOS isoforms during skeletal bone development from neonatal to sexual maturity in female Wistar rats. Reverse transcription polymerase chain reaction (RT-PCR) was used to analyze the presence of NOS1 (neuronal), NOS2 (inducible), and NOS3 (endothelial) transcripts in femoral bone from neonatal, 4-, 8-, and 12-week-old rats. RT-PCR amplified NOS1, NOS2, and NOS3 transcripts of 472-, 807-, and 289-bp, respectively. There were no detectable differences in the levels of NOS1 mRNA between the groups; however, NOS2 mRNA was more abundant in the neonatal group compared with 4-, 8-, and 12-week groups. Expression of NOS1 protein could not be detected in bones by either Western blotting or immunocytochemistry in any of the age groups investigated. Western blots for NOS2 revealed expression in the neonatal group only and it was not detected in any of the older age groups. Immunostaining for NOS2 was also most evident in the neonatal group and was localized specifically to trabecular osteoblasts and osteoclasts. In all age groups studied, NOS3 mRNA and protein were found in bone-resorbing osteoclasts, cuboidal active osteoblasts, and osteocytes. Semiquantitative RT-PCR provided evidence of down-regulation of NOS3 transcripts during the skeletal development. This was confirmed using in situ hybridization, which showed higher expression in neonatal and 4-week groups than in other groups. Western blots and counting the ratio of trabecular osteoblasts that were NOS3 immunoreactive showed parallel down-regulation of NOS3 protein during skeletal development. Taken together, these data show that there is regulation of NOS2 and in particular NOS3 expression during skeletal development and this may be significant to trabecular bone growth and remodeling.
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Affiliation(s)
- M V Hukkanen
- Department of Histochemistry, Imperial College School of Medicine, Hammersmith Campus, London, United Kingdom
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Abstract
The field of antiretroviral therapy is evolving at a very rapid pace. At this time, the initiation and optimization of antiretroviral therapy is based on serial plasma viral load determinations which aim to suppress viral replication to as low as possible for as long as possible, thus preventing disease progression. Currently available antiretrovirals require combination therapy with at least three agents to achieve this goal. Increasing availability of newer and more potent antiretroviral regimens will continue to enhance and simplify the number of therapeutic options available in the not too distant future.
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Affiliation(s)
- J S Montaner
- BC Center for Excellence on HIV/AIDS St Paul's Hospital, University of British Columbia, Vancouver, Canada
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46
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FitzGerald JM, Patrick DM, Strathdee S, Rekart M, Elwood RK, Schecter MT, Montaner J, O'Shaughnessy M. Use of incentives to increase compliance for TB screening in a population of intravenous drug users. Vancouver Injection Drug Use Study Group. Int J Tuberc Lung Dis 1999; 3:153-5. [PMID: 10091882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
SETTING Intravenous drug users (IDUs) represent a high risk group for dual human immunodeficiency virus (HIV) and tuberculosis (TB) infection. Screening with TB skin testing has therefore been suggested in this group. Subjects' compliance for returning to have TB skin test results read is a major problem. In the setting of a needle exchange program we evaluated the role of financial incentives to increase compliance. METHODS We evaluated the role of giving a small financial incentive of Can $5 to subjects if they returned to have their purified protein derivative (PPD) skin test read. IDUs who had previously been skin-tested were compared with IDUs drawn from a similar population who, prospectively, were offered a financial incentive. RESULTS During the initial period 558 subjects were evaluated and no incentive was offered. During the second phase of the study 549 IDUs were assessed but were also offered Can $5 if they returned to have their skin test read. Use of incentives increased compliance from 43% to 78% (P = 0.001). During the same period three active cases of TB were also diagnosed. CONCLUSIONS We suggest that use of financial incentives can increase the return of IDUs to have their skin tests read. Further studies are required to assess the efficacy of follow-up interventions, especially the use of isoniazid chemoprophylaxis.
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Affiliation(s)
- J M FitzGerald
- British Columbia Centre for Disease Control Society, BC Centre for Excellence in HIV/AIDS and the University of British Columbia, Vancouver, Canada.
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Abstract
The light and heavy chain variable regions of three mouse hybridoma cell lines (AG11, AE6 and EH1) that produce monoclonal antibodies against an overlapping epitope at the C-terminus of Nef were cloned. Sequence analysis of the light and heavy chain variable regions indicated that clones AG11 and AE6, but not EH1, were highly related. Single-chain antibodies were constructed from the cDNA clones of AG11 and EH1, and subcloned into an eukaryotic expressing vector with the green fluorescent protein as marker for expression. Such intracellular antibodies may provide a way in which to inhibit the function of Nef during HIV-1 infection of cells.
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MESH Headings
- Amino Acid Sequence
- Animals
- Antibodies, Monoclonal/genetics
- Antibodies, Monoclonal/immunology
- Base Sequence
- Cell Line
- Cloning, Molecular
- DNA, Complementary
- Epitopes, B-Lymphocyte/chemistry
- Epitopes, B-Lymphocyte/immunology
- Gene Products, nef/immunology
- Genes, Reporter
- Green Fluorescent Proteins
- HIV-1/immunology
- Humans
- Hybridomas
- Luminescent Proteins/chemistry
- Mice
- Molecular Sequence Data
- Precipitin Tests
- Recombinant Fusion Proteins/chemistry
- Sequence Homology, Amino Acid
- nef Gene Products, Human Immunodeficiency Virus
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Affiliation(s)
- A H Chang
- B.C. Center for Excellence in HIV/AIDS, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
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Affiliation(s)
- J S Montaner
- BC Centre for Excellence on HIV/AIDS, Canadian HIV Trials Network, St Paul's Hospital, University of British Columbia, Vancouver
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O'Sullivan ST, Panchal J, O'Donoghue JM, Beausang ES, O'Shaughnessy M, O'Connor TP. Is there still a role for traditional methods in the management of fractures of the zygomatic complex? Injury 1998; 29:413-5. [PMID: 9813694 DOI: 10.1016/s0020-1383(98)00063-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
With the introduction of low-profile mini-plating systems, a trend has developed towards open reduction and rigid internal fixation (ORIF) of fractures of the cranio-facial skeleton. The current policy for management of zygomatic fractures in our unit is to attempt primary reduction by traditional methods, and proceed to ORIF in the event of unsatisfactory fracture stability or alignment. Over a one-year period, 109 patients underwent surgical correction of fractures of the zygomatic complex. Standard Gilles' elevation was performed in 71 cases, percutaneous elevation in three cases, and ORIF was performed in 35 cases. Mean follow-up was 190 days. One case of persistent infraorbital step and three cases of residual malar flattening were documented in patients who underwent Gilles or percutaneous elevation. Morbidity associated with ORIF was minimal. We conclude that while ORIF of zygomatic fractures may offer better results than traditional methods in the management of complex fractures, traditional methods still have a role to play in less complex fractures.
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Affiliation(s)
- S T O'Sullivan
- Department of Plastic and Reconstructive Surgery, Cork University Hospital, Ireland
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Abstract
An anomalous muscle crossing the wrist joint is described. The morphology and clinical relevance of this and other unnamed muscles occurring at the wrist are discussed.
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Affiliation(s)
- E J Kelly
- Plastic Surgery Department, Cork University Hospital, Republic of Ireland
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