Sylvester O'Halloran Surgical Scientific Meeting - IJMS | Irish Journal ...

VOLUME 174 NUMBER 1 JANUARY, FEBRUARY, MARCH 2005 

SUPPLEMENT 1 

Sylvester O’Halloran 

Surgical Scientific Meeting 

Jean Monnet Theatre DG016 

Main Building, University of Limerick 

4th and 5th March 2005

SYLVESTER O’HALLORAN SURGICAL SCIENTIFIC MEETING • 4 - 5 MARCH 2005 • JEAN MONNET THEATRE, UNIVERSITY OF LIMERICK 

EDITORIAL BOARD 

Editor 

Assistant Editor 

Editorial Assistant 

Editorial Consultant 

Statistical Consultant 

Editorial Advisers 

EXECUTIVE OF THE ACADEMY 

President 

General Secretary 

Immediate Past President 

Members 

David Bouchier-Hayes 

Arnold DK Hill 

Helen Moore 

John Daly 

Alan Kelly 

E Quigley 

S Tierney 

H O’Connor 

G O’Sullivan 

J Lucey 

A Clarke 

L Viani 

M O’Doherty 

J Fenton 

P Murray 

D Bouchier-Hayes 

ADK Hill 

BL Sheppard 

D Bouchier-Hayes 

A Keenan 

F O’Kelly 

JD Gaffney 

FE Murray 

F Howell 

This journal is indexed by Current Contents, 

Embase and is included in the abstracting 

and indexing of the Bio Sciences Information 

Service of Biological Abstacts. It is available in 

microfilm from University Microfils Ltd. 

All communications to the Editor 

should be addressed to: 

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Published by 

The Royal Academy of Medicine in Ireland 

ISSN 0021-1265 

Designed by 

Austin Butler 

IRISH JOURNAL OF MEDICAL SCIENCE • VOLUME 174 • NUMBER 1 • SUPPLEMENT 1

SPONSORS 

1 



SESSION PROGRAMME ONE 

The Royal Academy of Medicine in Ireland would like to thank the 

following companies and institutes for sponsoring this event: 

Friday 4th March 2005 - Session 1 Scientific (2.00pm) 

Jean Monnet Theatre DG016, Main Building University of Limerick 

LEO Pharma 

(Sponsors of the O’Halloran Prize for the best Oral Paper) 

Time Allowed 

7 minutes Speaking; 3 minutes Discussion 

Chairpersons 

Mr Gerry Byrnes and Mr. Arnold Hill 

AstraZeneca Pharmaceuticals 

(Sponsors of Prize for the best Poster) 

Aventis 

Ipsen Pharmaceuticals 

Johnson & Johnson 

Med Surgical 

Mid-Western Regional Hospital, Limerick 

Tyco Healthcare 

Wyeth Laboratories 

Session 1: 14.00 – 15.50 

14.00–14.10 1. The effect of obstetric trauma on the pudendal nerve – early 

report on the development of an acute animal model to stimulate 

the anatomical distortions associated with childbirth 

C. F. Healy, C. O’Brien, C. O’Herlihy, P. R. O’Connell 

Dept. of Colorectal Surgery, Mater Misericordiae University 

Hospital, Dublin, Dept. of Obstetrics and Gynaecology University 

College Dublin, The Conway Institute of Biomolecular & 

Biomedical Research, UCD 

14.10-14.20 2. Reduced expression of IRAK-1 and IkB-a is responsible for BLP 

tolerance and its cross-tolerance to LPS 

C Hui Li, J.H. Wang, S Ding Li, H.P. Redmond 

Dept. of Academic Surgery, University College Cork 

14.20-14.30 3. High motility group box protein 1 (HMGB1) mediates the local and 

systemic effects of acute pancreatitis 

A. O’Callaghan, J.H. Wang, H.P. Redmond 

Dept. of Surgery, Cork University Hospital, Cork 

14.30-14.40 4. Superior statin survival statistics: mediated by more than 

cholesterol reduction in the transplant population 

D. Hennessey, D.G. Healy, R.W.G. Watson, J.M. Fitzpatrick, A.E. Wood, 

E. O’Malley 

National Centre for Cardiothoracic Surgery, Mater Misericordiae 

University Hospital, Dublin, The Conway Institute of Biomolecular 

& Biomedical Research, UCD 

14.40-14.50 5. Accelerated perioperative tumour growth increases 

vasculogenesis but may occur independent of vascular endothelial 

growth factor (VEGF) 

B.D. Barry*, M.J. Smith, J.H. Wang, H.P. Redmond 

Dept. of Academic Surgery, Cork University Hospital, Cork 

IRISH JOURNAL OF MEDICAL SCIENCE • VOLUME 174 • NUMBER 1 • SUPPLEMENT 1 


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14.50-15.00 6. Evaluating COX 2 and apoptosis levels in pre-treatment biopsies 

as response predictors for rectal cancer undergoing neoadjuvant 

radiochemotherapy 

F.M. Smith 1 , E. Kay 2 , P. Crotty 2 , E. F. Gaffney 2 , R.B. Stephens 1 , 

M.J. Kennedy 1 , J.V. Reynolds 1 

University Depts. of Surgery and the Academic Unit of Clinical 

and Molecular Oncology, St. James’s Hospital & Trinity College 

Dublin 1 , Depts. of Histopathology, St. James’s, Beaumont & Tallaght 

Hospitals 2 , Dublin 

15.00-15.10 7. HER 2 transcriptional regulation – a positive role for ETS-2 and SRC-1 

D. Alazawi, E. Myers, E. W. McDermott, N. J. O’Higgins, A. D. K. Hill, 

L. S. Young 

Dept. of Surgery, St. Vincent’s University Hospital, Dublin and 

Conway Institute of Biomolecular & Biomedical Research, UCD 

15.10-15.20 8. BRCA1 regulation of the mitotic checkpoint proteins underlying 

Taxol-resistance in human breast cancer 

W. Y. Chung 1 , A. McGoldrick 1 , E. Gallagher 1 , B. Flynn 1 , M. J. Kerin 2 , 

P. A. Davern 1,3 , A. McCann 1 

The Conway Institute of Biomolecular & Biomedical Research, 

UCD 1 , Dept. of Surgery, Mater Misericordiae University Hospital, 

Dublin 2 , Dept. of Pathology, Mater Misericordiae University 

Hospital, Dublin 3 

15.20-15.30 9. Modulation of coregulatory protein expression in 

human breast cancer 

D. O. Kavanagh 2 , A. D. K. Hill 1 , E.W.M. McDermott 1 , N. J. O’Higgins 1 , 

L.S. Young 2 

Dept. of Surgery, St. Vincent’s University Hospital, Dublin 1 , The 

Conway Institute of Biomolecular & Biomedical Research, UCD 2 

15.30-15.40 10. Electrochemotherapy – preclinical development and clinical utility 

J. Larkin, C. Collins, D. Soden, M. Tangney, O. Breathnach, S. O’Reilly, S. 

Aarons, G.C. O’Sullivan 

Cork Cancer Research Centre, Mercy University Hospital, Cork 

15.40-15.50 11. Inhibition of COX-2 and oxidative pathways as a means to 

decrease oesophageal injury in a surgical reflux model 

O. Murphy 1 , N. Ravi 1 , G.S.A. McDonald 2 , J.V. Reynolds 1 

Depts. of Surgery 1 and Histopathology 2 , St. James’s Hospital, Dublin 

and Trinity College, Dublin 

15.50-16.10 Coffee Visit Posters & Trade Exhibition 

Friday 4th March 2005 - Session 2 (Prize Session) (4.10pm) 

Sponsored by Leo Pharma 

Jean Monnet Theatre DG016, Main Building, University of Limerick 

Time Allowed 


Chairpersons 

Mr Eamon Kavanagh and Prof. David Bouchier-Hayes 

Session 2: 16.10 – 18.00 

16.10-16.20 12. Growth factor activation of the mitogen-activated protein (MAP) 

kinase pathway increases breast coactivator protein expression 

and stimulates breast tumourigenesis 

R.S. Prichard, A.D.K. Hill, E.W. McDermott, N. J. O’Higgins, L.S. Young 

Dept. of Surgery, St. Vincent’s University Hospital, Dublin 

16.20-16.30 13. Non-invasive monitoring and response prediction for rectal cancer 

undergoing neoadjuvant radiochemotherapy (RCT) 

F. M. Smith 1 , R. B. Stephens 1 , E. F. Gaffney 1 , P. Crotty, E.F. Petricoin 3rd 2 , 

L. Liotta 2 , J.V. Reynolds 2 , M.J. Kennedy 1 

Dept. of Surgery & the Academic Unit of Clinical and Molecular 

Oncology, St. James’s University Hospital & Trinity College, Dublin 1 , 

FDA-NCI Clinical Proteomics Program, Laboratory of Pathology, 

Centre for Cancer Research, National Cancer Institute, Bethesda, MD 2 

16.30-16.40 14. Immunogenetherapy of solid tumours using electroporation to 

deliver GMCSF/B7-1 combination plasmid 

C.G. Collins, M. Tangney, J. Larkin, D. Soden, S. Aarons, G.C. O’Sullivan 

Cork Cancer Research Centre, Mercy University Hospital, Cork 

16.40-16.50 15. Association of TNF alpha gene -308 GG genotype with postoperative 

infections in oesophageal cancer patients 

K. Azim, D. Kelleher, R. McManus, J. V. Reynolds 

Dept. of Clinic Surgery, Dept. of Clinical Medicine and Dublin 

Molecular Medicine Centre, Trinity College, Dublin, St. James’s 

University Dublin 

16.50-17.00 16. Abnormal type I and type III collagen production is responsible for 

abnormalities of wound healing in DEB patients 

S. Ding Li, J.H. Wang, C Hui Li, H.P. Redmond 

Dept. of Academic Surgery, University College Cork 



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17.00-17.10 17. Hypoxia protects human renal proximal tubular epithelial cells from 

cyctotoxic immunosuppressant medications and reperfusion injury 

in a model of kidney preservation 

P Daly, DA Healy, RE Power, NG Docherty, JM Fitzpatrick, RWG Watson 

Dept. of Surgery, The Conway Institute of Biomolecular & Biomedical 

Research, UCD, Mater Misericordiae University Hospital, Dublin 

17.10-17.20 18. Epigenetic silencing of the intergrin a4 gene by hypermethylation in 

pancreatic ductal adenocarcinoma 

S.T. Martin, S.R. Hustinx, C.J. Yeo, R.H. Hruban, M. Goggins 

Pancreatic Cancer Early Detection Laboratory, Depts. of GI Pathology 

and Surgery, The Johns Hopkins Medical Institutions, Baltimore, 

Maryland, USA 

17.20-17.30 19. Escape of prolonged selective COX-2 inhibition of tumour 

M. Barry, J. Harmey, A. Treumann*, G. Roche-Nagle, D.J. Bouchier-Hayes 

Dept. of Surgery, Education and Research Centre, Beaumont Hospital, 

Dublin, Dept. of Clinical Pharmacology, Royal College of Surgeons in 

Ireland, Dublin* 

17.30-17.40 20. Screen detected breast cancer: a different disease 

J. P. Burke*, M. R. Kell, F. Flanagan, M. J. Kerin 

National Breast Cancer Screening Prog., Mater Misericordiae 

University Hospital, Dublin 

17.40-17.50 21. Correlation between micrometastatic burden and prognosis in 

patients with breast cancer 

E. Faul, M. A. Kelly, N. J. Aherne, N. Relihan, J. H. Wang, J. Kelly, 

D. Richardson, D. O’Hanlon, H.P. Redmond 

Dept. of Surgery, Cork University Hospital 

17.50-18.00 22. An alternative to EMG sensors in the detection of calf muscle 

pump activity 

K. J. O’Donovan 1 , D. T. O’Keeffe 1 , P.A. Grace 2 , G.M. Lyons 1 

Biomedical Electronics, Laboratory, Dept. of Electronic & Computer 

Engineering, University of Limerick 1 , Vascular Imaging Laboratory, 

Dept. of Vascular Surgery, Mid-Western Regional Hospital, Limerick 2 

18.00-18.20 Visit Posters & Trade Exhibition 

18.20-19.10 13th Sylvester O’Halloran Lecture 

IMPROVING OUTCOMES IN BREAST CANCER 

Presented by Prof. David George, Prof. of Surgery, University of Glasgow 

20.30 Reception (Dunraven Arms Hotel, Co. Limerick) 

21.00 Dinner (Dress Informal) 

Saturday 5th March 2005 - Session 3 Clinical (9.00am) 


Time Allowed 


Chairpersons 

Mr David Waldron and Mr. Ian Wilson 

Session 3: 09.00 – 10.50 

09.00-09.10 23. Is there an optimal route for injecting radioisotope for sentinel 

lymph node biopsy injection in patients with breast cancer 

D. Kavangh 1 , A. D. K. Hill 1 , R. Kennelly 1 , T. B. Crotty 2 , C. Quinn 2 , 

A. O’Doherty 3 , C. D. Collins 3 , E. W. McDermott 1 , N. J. O’Higgins 1 

Depts. of Surgery 1 , Pathology 2 and Radiology 3 , St. Vincent’s University 

Hospital, Dublin, The Conway Institute of Biomolecular & Biomedical 

Research, UCD 

09.10-09.20 24. The efficacy of ultrasound, stereotactic and clinical core biopsies in 

the diagnosis of breast cancer, with an analysis of false negative cases 

M. F. Dillon 1 , A. D. K. Hill 1,4 , C. M. Quinn 2 , A. O’Doherty 3 , 

E. W. McDermott 1,4 N. J. O’Higgins 1,4 Dept. of Surgery 1 

Dept. of Pathology 2 , Dept. of Radiology 3 , St. Vincent’s University 

Hospital, Dublin, The Conway Institute of Biomolecular & Biomedical 

Research 4 , UCD 

09.20-09.30 25. ‘Location, location, location’ – the importance of location in the 

assessment of mastalgia in the general female population 

A. O’Connor, J. C. Coffey, A. Hanley, P. O’Connor, R. G. K. Watson 

Dept. of General Surgery, Waterford Regional Hospital 

09.30-09.40 26. A prospective observational study of carotid artery stenting (CAST) 

under neuro-protection and carotid endarterectomy (CEA) in high 

risk patients. Technical and clinical outcome 

N. Hynes, B. Mahendran, J. Asad, E. Andrews, S. Tawfik, A. Ishtiaq, 

G. O’Sullivan, S. Sultan 

Western Vascular Institute, University College Hospital Galway 

09.40-09.50 27. Natural history and clinical outcome of patients with documented 

carotid artery occlusion 

S. Cheema, M. C. Moloney, P. Burke, P. A. Grace* Dept. of Vascular 

Surgery, Mid-Western Regional Hospital, Limerick and The National 

Institute of Health Sciences, University of Limerick* 



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09.50-10.00 28. Hand held continuous wave Doppler versus colour duplex for preoperative 

identification for a saphenopopliteal junction 

M. A. Aremu, N. Haider, S. Nicholls, M. P. Colgan, P. Madhavan, 

D.J. Moore, G. Shanik 

St. James’s Vascular Institute, St. James’s University Hospital, Dublin 

10.00-10.10 29. Prospective trial comparing contrast swallow, CT scanning and 

endoscopy in the diagnosis of anastomotic leak following upper 

digestive tract surgery 

D. Broe, B.A. Hogan, D.C. Winter, C.G. Murphy, M.J. Lee, P.J. Broe 

Depts. of Surgery and Radiology, Beaumont Hospital, Dublin 

10.10-10.20 30. Long term follow-up of patients undergoing anti-reflux surgery 

P. A. Sloane, J. Dowdall, S. Roche, M. F. Khan, O. J. McAnena 

Dept. of General Surgery, University College Galway 

10.20-10.30 31. Boerhaave’s syndrome: fourteen cases of spontaneous 

oesophageal rupture with varying management strategies in a 

single centre 

R. S. Prichard, J. Butt, N. Al-Sarraf, S. Frolich, B. Manning, N. Ravi, 

J .V. Reynolds 

Upper Gastrointestinal Surgical Professorial Unit, St. James’s 


10.30-10.40 32. Pulmonary emboli in the surgical community 

R. FitzGerald, S. Rajendran, C. Canning, Z. Martin, D. Beddy, 

J. B. O’Mahony, K. Mealy, D. Evoy 

Dept. of Surgery, Wexford General Hospital 

10.40-10.50 33. Prediction of Abdominal Aortic Aneurysm (AAA) rupture using 

numerical and experimental techniques 

A. Callanan, L. Morris, T. McGloughlin 

Biomedical Electronics Laboratory, Dept. of Electronic and 

Computer Engineering, University of Limerick 

10.50 – 11.20 Coffee Visit Posters, Trade Exhibition & Poster Adjudication 

Saturday 5 th March 2005 - Session 4 Surgical Practice (11.10am) 

Jean Monnet Theatre DG016, Main Building University of Limerick 

Time Allowed 


Chairpersons 

Mr Ralph Keane and Mr. Peter Gillen 

Session 4: 11.10 – 13.00 

11.10-11.20 34. Assessment of the value of pelvic ultrasonography (PU) in premenopausal 

women with right iliac fossa pain 

H. Stunell, D. Collins, M. Aremu, M. Doyle, K.C. Conlon 

Professional Surgical Unit, The Adelaide and Meath Hospital 

incorporating the National Children’s Hospital, Trinity College, Dublin 

11.20-11.30 35. Laparoscopic appendicectomy benefits patients and practitioners 

equally in non-specialist centres 

M. Jafri, T. Khani, J. Butt, F. Lennon 

Dept. of Surgery, Our Lady of Lourdes Hospital, Drogheda 

11.30-11.40 36. The European Working Time Directive – an NCHD perspective 

Z. Martin, C. Canning, D. Beddy, D. Evoy, J.B. O’Mahony, K. Mealy 


11.40-11.50 37. Assessing the impact of patients taking discharge against medical 

advice in a regional hospital 

H. Askar, J. B. Conneely, P. Gillen 

Dept. of Surgery, Louth/Meath Surgical Group, Our Lady of Lourdes 

Hospital, Drogheda 

11.50-12.00 38. Bullying of junior doctors: a bitter reality 

S. Cheema, K. Ahmad, S. K. Giri, V. K. Kaliaperumal, S. A. Naqvi 

Dept. of Surgery, Mid-Western Regional Hospital, Limerick 

12.00-12.10 39. How valid is the ‘eyeball test’ in evaluating patients for 

vascular surgery 

N. Collins, E. G. Kavanagh, M.P. Colgan, P. Madhavan, D.J. Moore, 

G.D. Shanik 




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12.10-12.20 40. Changes in management of infrainguinal limb ischemia coinciding 

with the introduction of a dedicated endovascular theatre 

L. Cunningham, E.G. Kavanagh, M.V. Forlee, M.P. Colgan, 

P. Madhaven, D.J. Moore, G.D. Shanik 


12.20-12.30 41. The use of computer interface in the rapid diagnostic Breast Clinic 

N. Birido, M. Atkinson, J. Rothwell, J. Geraghty 

The Tallaght Breast Unit, The Adelaide and Meath Hospital 

incorporating the National Children’s Hospital, Dublin 

12.30-12.40 42. Development of a wireless network programme 

D. Toomey, M. Aremu, M. Doyle, K. Ryder, K.C. Conlon 

Professorial Surgical Unit, The Adelaide and Meath Hospital 


12.40-12.50 43. Determining validity and knowledge transfer efficiency for a novel 

entirely web based lecture series 

A. Sheikh, P. F. Ridgway, K. J. Sweeney, U. Shan, E. McDermott, 

N. J. O’Higgins, P. Felle*, A.D.K. Hill Dept. of Surgery, 

St. Vincent’s University Hospital, Dublin, The Conway Institute 

of Biomolecular & Biomedical Science and Dept. of Healthcare 

Informatics*, University College, Dublin 

12.50-13.00 44. Validation of a novel hybrid surgical simulator 

D. Broe, P.F. Ridgway, S. Johnson, S. Tierney, K.C. Conlon 

Professorial Surgical Unit, The Adelaide and Meath Hospital 


12.40 Panel Adjudication for Sylvester O’Halloran Prize 

13.00-13.45 Sir Thomas Myles Lecture 

THE IRISH HEALTH SYSTEM: THE GOOD, THE BAD AND THE UGLY 

Presented by Prof. Miriam Wiley, Health Economist, Economic & 

Social Research Institute Dublin 

Followed by Presentations of 

• O’Halloran Prize (Sponsored by Leo Pharma) 

• Poster Prize (Sponsored by AstraZeneca Pharmaceuticals) 

Saturday 5th March 2005 Session 5 Orthopaedic Session (11.10am) 


Time Allowed 


Chairpersons 

Prof. Eric Masterson and Mr. Dermott O’Farrell 

Session 5: 11.10 – 13.00 

11.10-11.20 45. Change in intermetatarsal angle of hallux valgus following first 

metatarsophalangeal arthrodesis 

J. Cronin, S. Kutty, J. Limbers, M.M. Stephens 

Cappagh National Orthopaedic Hospital, Dublin 

11.20-11.30 46. Use of a cementless modular implant for arthroplasty in 

developmental dysplasia of the hip: Early results 

A. Glynn, P. Connolly, D. McCormack, J. O’Byrne 

Cappagh National Orthopaedic Hospital, Dublin 

11.30-11.40 47. Plavix – panacea or poison 

P. McKenna, P.C. Looi, J.A. Harty, D. O’Farrell, F. Condon 

Dept. of Orthopaedic Surgery, Mid-Western Regional Hospital, 

Limerick 

11.40-11.50 48. Blackthorn injuries to the hand 

J. B. Lynch, G. Sim, J. L. Kelly, P. J. Regan, J. McCann 

University College Hospital, Galway 

11.50-12.00 49. Ring-fencing – bed protection for the patient 

N. T. O’Malley, J. A. Sproule, P. Nicholson, J. J. Rice, J. P McElwain 

Dept. of Trauma & Orthopaedic Surgery, The Adelaide and Meath 

Hospital incorporating the National Children’s Hospital, Dublin 

12.00-12.10 50. Penalty Points: are they working 

J. S. Butler, J. P. Burke, D. G. Healy, M. M. Stephens, F. McManus, 

D. McCormack, J. M. O’Byrne, A. R. Poynton 

The National Spinal Injuries Unit, Dept. of Orthopaedic Surgery, 

Mater Misericordiae University, Hospital, Dublin 

10 IRISH JOURNAL OF MEDICAL SCIENCE • VOLUME 174 • NUMBER 1 • SUPPLEMENT 1 

IRISH JOURNAL OF MEDICAL SCIENCE • VOLUME 174 • NUMBER 1 • SUPPLEMENT 1 11

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12.10-12.20 51. A demographic analysis of traumatic spinal injury in the west of 

Ireland from August 1996 to October 2000 

P.A. Sloane, J.P. McCabe 

Dept. of Orthopaedic and Trauma Surgery, Merlin Park Regional 

Hospital, Galway 

12.20-12.30 52. A review of the presentation and management of pyogenic 

spinal infection 

J. S. Butler, M.J. Shelly, M. Timan, W.G. Powderly, J. M. O’Byrne 

The National Spinal Injuries Unit, Dept. of Orthopaedic Surgery, 

Mater Misericordiae University, Hospital, Dublin 




Presented by Prof. Miriam Wiley, Health Economist, Economic & 

Social Research Institute Dublin 




Saturday 5th March 2005 Session 6 Head & Neck Session (11.10am) 


Time Allowed 


Chairpersons 

Prof. John Fenton and Mr. Tadhg O’Dwyer 

Session 6: 11.10 – 13.00 

11.10-11.20 53. Vibration assessment of cartilage grafts using bi-axial 

mechanical testing 

R. Gallagher 1 , D. Apatsidis 2 , A. Pandit 2 , N. Considine 1 , N. Patil 1 

1 

Dept. of Otolaryngology, Sligo General Hospital and 2 Dept. of 

Biomedical Engineering, National University of Ireland, Galway 

11.20-11.30 54. Minimal incision for thyroid surgery 

I. Miller J. Hughes, M. Rafferty, C. Tynan 

Dept. of Otolaryngology, St. James’s University Hospital, Dublin 

11.30-11.40 55. The facial nerve: one editorial, two authors, top-cited 

R. N. Wormald, I. Ahmed, J. E. Fenton 

Dept. of ENT Surgery, Mid-Western Regional Hospital, Limerick 

11.40-11.50 56. A role for pneumolysin, a pneumococcal protein, in cochlear 

damage associated with meningitis 

L. J. Skinner, M. Beurg, J. M. Aran, D. Dulon 

Laboratoire de l’Audition, Hôpital Pellegrin, Bordeaux, France 

11.50-12.00 57. ‘A man’s best friend’ A seven-year retrospective analysis of facial 

lacerations as a result of dog bites in the MWHB region 

N. Boyle, M. Murphy, F. Mulcahy, G. Kearns 

Dept. of Oral and Maxillofacial Surgery, Mid-Western Regional 

Hospital, Limerick 

12.00-12.10 58. A role for the MAPK activated transcription factor PEA3 in HER2 

regulation in human thyroid cancer 

D. O. Kavanagh, E. Myers, C. O’Riain, T. B. Crotty, E. W. McDermott, 

N. J. O’Higgins, A. D. K. Hill, L. S. Young 

Depts. of Surgery and Pathology, St. Vincent’s University Hospital, 

Dublin and The Conway Institute of Biomolecular & Biomedical 

Research, UCD 

12.10-12.20 59. Adenoid cystic carcinoma of the head and neck: a review of cases 

F. Glynn, M. Harney, T. P. O’Dwyer (Dept of Otolaryngology, Head & 

Neck Surgery, Mater Misericordiae University Hospital, Dublin) 

12.20-12.30 60. Returning to contact sports following infectious mononucleosis 

T. O’Connor, L. Skinner, J.E. Fenton 

Dept. of Otolaryngology, Head and Neck Surgery, Mid-Western 

Regional Hospital, Limerick 

12.30-12.40 61. Nitinol accuflex stents and KTP laser – are they compatible 

O. Young, F. Kirrane, J. Hughes, J.E. Fenton 

Dept. of ENT Surgery, Mid-Western Regional Hospital, Limerick 

12.40-12.50 62. Parapharyngeal space tumours: is a midline approach necessary 

G. K. C. Sim, T. P. O’Dwyer 

Dept. of Otolaryngology, Head and Neck Surgery, Mater 

Misericordiae University Hospital, Dublin 



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12.50-13.00 63. Radioablation therpy is an essential adjunct to ensure total 

thyroidectomy for carcinoma 

N. Keenan, K.J. Sweeney, F. Barker 1 , P.F. Ridgway, S. Skehan 2 , M. Moriarty 3 , 

ADK Hill, E. McDermott, N.J. O’Higgins 

Dept. of Surgery, St. Vincent’s University Hospital, Dublin and 

Depts. of Nuclear Medicine 1 , Radiology 2 & Radiotherpay 3 , 

St. Luke’s Hospital, Dublin 




Presented by Prof. Miriam Wiley, Health Economist, 

Economic & Social Research Institute Dublin 


Poster Session – Sponsored by 

Poster 1. 

Poster 2. 

Poster 3. 

Poster 4. 



Preventing adverse medical events – identifying prescription errors on a 

general surgical ward 

K. Bates, D. Beddy, Z. Martin, C. Whiriskey, M. Murphy, D. Evoy, K. Mealy, J.B. O’Mahony 


Prospective implementation of a risk adjusted audit in a vascular unit: 

a model for quality assurance 

J.S. Byrne, E. Condon, M. Ahmed, D. Mehigan, S. Sheehan, M. Barry 

Dept. of Vascular Surgery, St. Vincent’s University Hospital, Dublin 

HMGB1-Induced proinflammatory cytokine release is unaltered by tolerisation 

with bacterial lipoprotein 

J.C. Coffey, J.H. Wang, H.P. Redmond 

Dept of Surgery, Cork University Hospital 

The sequential combination of electrosensitisation and low-intensity ultrasound 

therapy produces a synergistic antitumour effect 

J. Larkin 1,2 , D. Soden 1 , C. Collins 1,2 , M. Tangney 1 , J. Preston 3 , L. Russell 3 , G.C. O’Sullivan 1,2 

Cork Cancer Research Centre, Mercy University Hosptial 1 , Cork, Dept. of Surgery, 

Mercy University Hospital 2 , Cork, University of Ulster 3 , Co. Derry 

Poster 5. 

Poster 6. 

Poster 7. 

Poster 8. 

Poster 9. 

Poster 10. 

Poster 11. 

Poster 12. 

Poster 13. 

Achalasia: 11-year retrospective review comparing symptomatic outcome and 

quality of life following Heller’s myotomy versus pneumatic dilatation of 

the oesophagus 

M. C. Whelan, M. McCafferty, P. J. Byrne, J. V. Reynolds 

University Dept. of Surgery, Trinity Centre for Health Sciences, St. James’s 

Hospital, Dublin 

The Univeristy of Limerick Prolong TM Vascular Graft 

M. Walsh, T. McGloughlin 

Centre for Applied Biomedical Engineering Research, Dept. of Mechanical and 

Aeronautical Engineering, University of Limerick 

The solution to a big hole: dermal collagen graft 

K. Ahmad, D. J. Waldron, P. A. Grace 

Dept. of Surgery, Mid-Western Regional Hospital and University of Limerick 

Initial short term experience in non-operative management of critical limb 

ischaemia (CLI) using a biomedical device 

S. Tawfik, A. Fahy, N. Hynes, B. Mahendran, A. Lowery, J. Asad, E. Andrews, 

A. Ishtiaq, S. Sultan 

Western Vascular Institute, Dept. of Vascular and Endovascular Surgery, 

University College Hospital Galway 

Wedge resection with segmental phenolization in the treatment of 

ingrowing toenails. A better outcome 

F. M. Shaikh, M. Jafri, R. Keane 

Dept. of Surgery, St. John’s Hospital, Limerick 

The role of gamma probe activity counts and intra-operative PTH assay in 

predicting a parathyroid adenoma in minimally invasive parathyroidectomy 

G. Murphy, E. Myers, M. O’Donovan, H.P. Redmond 

Dept. of Surgery, Cork University Hospital 

Implementation of the continuous auto-transfusion system (CATS) in open 

AAA repair: a seven-year experience 

W. Tawfick, S.E. Tawfik, N. Hynes, B. Mahendran, A. Jawad, A. Ishtiaq, E. Andrews, 

D. Courtney, S. Sultan 

Western Vascular Institute, Dept. of Vascular and Endovascular Surgery, 


Prospective study of self administered enema for left colonoscopy. 

I. Z. Khan, S. A. Khan, A. H. M. Medani, O. Elzamzami, D. Buckley Dept. of 

Surgery, Midlands Regional Hospital, Mullingar, Co. Westmeath 

Liver resection for non-colorectal metastases 

M. Ahmed, M. B. Zaman, D. Maguire, J. Geoghegan, O. Traynor 

The Liver Unit, St. Vincent’s University Hospital, Dublin 



1 

PROGRAMME 

SESSION ONE 



1 

SESSION ONE 

Poster 14. 

Poster 15. 

Poster 16. 

Poster 17. 

Poster 18. 

Acute cholecystitis – is interval cholecystectomy justifiable 

A. Hafeez, W. Y. Kwong, F . O. Cunningham, J. P. McGrath 

Dept. of Gastrointestinal Surgery, Our Lady’s Hospital, Navan, Meath 

The role of hand held Doppler in acute scrotal pain 

K. Ahmad, P. Hickey, S. C. Ng, S.T. Cheema, J. Drumm, S. A. Naqvi 

Dept. of Surgery, Mid-western Regional Hospital, Limerick 

Equestrian related injuries – not just an Olympic problem! 

G. McHugh, Z. Martin, K. Mealy, J. B. O’Mahony, D. Evoy 

Dept. of Surgery, Wexford General Hospital, Wexford 

Atypical Myobacterial Tenosynovitis of the hand. The management role of 

preoperative Magnetic Resonant Imaging (MRI) 

T. Ismael 


Two rare causes of carpal tunnel syndrome 

W. H. C. Tiong, T. Ismael, P. J. Regan 

Dept. of Plastic, Reconstructive and Hand Surgery, 


1 

The 

effect of obstetric trauma on the pudendal nerve - 

early report on the development of an acute animal model 

to simulate the anatomical distortions associated 

with childbirth 

Childbirth is the most common 

cause of faecal incontinence. 

Damage to the pudendal nerve is 

a major component of childbirth 

injury. The site and the mechanism 

of injury is unknown. 

Aim 

To develop an acute animal model that 

simulates the anatomical distortions caused 

by childbirth on the pelvic floor and anal 

sphincter complex. 

slowly inflated (1.5 mls) to mimic a singleton 

pregnancy. 

Results 

The pudendal nerve was electrically 

stimulated at its spinal origin. Inflation of two 

balloons within the pelvis caused a reduction 

in contraction of the anal sphincter. Evoked 

concentric needle EMG signal was reduced 

during inflation and recovered after deflation. 

The electrical threshold to evoke a visible 

contraction increased following five minutes 

of balloon inflation. 

CF Healy, C O’Brien, 

C O’Herlihy, PR O’Connell 

Dept. of Colorectal 

Surgery, Mater 

Misericordiae Hospital, 

Dept. of Obstetrics and 

Gynaecology, University 

College Dublin, Conway 

Institute of Biomolecular 

and Biomedical Sciences 

Poster 19. 

Poster 20. 

Poster 21. 

Poster 22. 

Poster 23. 

Dupuytren’s contracture in a child – a case report and review of literature 

W. Lee, J.B. Lynch, J.L. Kelly 

Dept. of Plastic, Reconstruction and Hand Surgery, 


Release of anterior neck burn contracture using artificial dermis and vacuum 

assisted closure – a case report 

J. B. Lynch, T. Ismael, A. Saad, J. L. Kelly Dept. of Plastic Surgery, 


A review of ENT consultant postal questionnaires 

N. Ramphul, J. Saunders*, I. Ahmed, J.E. Fenton 

Dept. of ENT, Head and Neck Surgery, Mid-Western Regional Hospital, Limerick 

and Statistical Consulting Unit*, Dept. of Mathematics and Statistics, 

University of Limerick 

Seven-year retrospective review of facial lacerations treated under general 

anaesthesia by the Oral and Maxillofacial Surgery Dept. of the Mid-Western 

Regional Hospital 

N. Boyle, M. Murphy, F. Mulcahy, G. Kearns 

Dept. of Oral and Maxillofacial Surgery, Mid-Western Regional Hospital, Limerick 

Isolated mandibular angle fractures (MAF): a seven-year retrospective study 

C. P. Barry, G. Kearns 

Dept. of Oral and Maxillofacial Surgery, Mid-Western Regional Hospital, Limerick 

2 

Reduced 

Methods 

Twelve female virgin wistar rats (weight 200- 

250g) underwent mini-laparotomy under 

urethane anaesthesia. To mimic parturition, a 

paediatric catheter (6 Fr Folysil) was sutured 

securely into the retro-uterine space and 

Conclusions 

An acute animal model has been developed 

that disturbs the pudendal nerve supply to 

the anal sphincter complex. This may allow 

study of the long-term effects of nerve 

damage following simulated birth trauma. 

expression of IRAK-1 and IkB-a is responsible for 

BLP tolerance and its cross-tolerance to LPS 

Tolerance to bacterial cell wall 

components may represent an 

essential regulatory mechanism 

during bacterial infection. 

We have previously demonstrated that 

bacterial lipoprotein (BLP) can induce 

tolerance to itself and cross-tolerance to LPS, 

and we found BLP tolerance inhibited NF-kB 

activation. In this study the regulation of 

TLR2-mediated upstream signal transduction 

of the NF-kB pathway in BLP-tolerant human 

THP-1 monocytic cells was investigated. 

Methods 

Control THP-1 cells (C) were pre-treated 

with culture medium for 24 hours, and then 

stimulated with 1 mg/ml BLP. BLP tolerance 

was induced by pre-treating THP-1 cells with 

0.1 mg/ml BLP for 24 hours, and then restimulating 

with 1 mg/ml BLP (T) and 1 mg/ml 

LPS (CT) respectively. Cytometric bead array, 

Western blot and real time PCR were used to 

determine TNF-a release, protein and mRNA 

expression. 

Results 

BLP tolerant THP-1 cells had a significant 

C Hui Li, J Huai Wang, 

S Ding Li, HP Redmond 

Dept. of Academic Surgery, 

University College Cork, 

Wilton, Cork 



1 

SESSION ONE 



1 

SESSION ONE 

3 

High 

4 

Superior 

reduction in TNF-a production in response 

to high doses of BLP (8612 vs 6042245 ng/ml, 

p

1 

SESSION ONE 



1 

SESSION ONE 

6 

Evaluating COX 2 and apoptosis levels in pre-treatment 

biopsies as response predictors for rectal cancer 

undergoing neoadjuvant radiochemotherapy 

7 

HER2 

Rectal cancer is increasingly 

treated by neoadjuvant 

radiochemotherapy (RCT) followed 

by surgery. 

A molecular understanding of mediators 

of response or resistance to this therapy is 

important. We aimed to determine whether 

COX-2 expression or apoptosis levels in pretreatment 

biopsies (PTB) could be used to 

predict response. Archival, paraffin embedded 

PTB from 49 patients who underwent RCT 

were studied by immunohistochemistry 

for COX 2 and TUNEL staining for apoptosis. 

These were assessed in a blinded fashion. 

COX 2 staining was scored based on the 

intensity and percentage of cells staining. 

Apoptosis was scored as the percentage of 

apoptosomes per 1000 tumour cells. 

Pathological response was determined by 

tumour regression grade (TRG) based on the 

percentage of tumour to radiation-induced 

fibrosis. Complete pathological response 

occurred in 6 (12%) patients. Of the remaining 

43 patients, 15(30%) were TRG 2, 11 (22%) were 

TRG 3 and 17(34%) were TRG 4. Patients with 

strong COX 2 expression in PTB were more 

likely to demonstrate poor response (TRG 

4) to treatment than those with light or 

moderate expression (p=0.027 Chi square). 

Similarly poor response was more likely 

if patients had low levels of spontaneous 

apoptosis in PTBs (p=0.028 Chi square). Both 

strong COX 2 expression and high apoptotic 

counts in PTB predict good response to RCT. 

As COX 2 inhibitors are widely available, their 

administration to patients overexpressing 

COX 2 either before or during treatment may 

improve overall response to RCT. 

transcriptional regulation - a positive role for ETS-2 

and SRC-1 

Overexpression of the human 

epidermal growth factor receptor, 

HER2, is associated with a poor 

prognosis in human breast cancer. 

Ets transcription factors are known 

to regulate the transcription of HER2. 

Interactions between p160 co-activator 

proteins and Ets transcription factors 

have been described. We investigated the 

interaction between the MAPK activated 

transcription factor, Ets-2, and the co-activator 

SRC-1 in breast cancer patients of known 

HER2 status. 

Expression and co-expression of Ets- 

2 and the SRC-1 was investigated 

using immunohistochemistry and 

immunofluorescence in a cohort of breast 

tumour patients (n=134). Protein expression, 

protein-DNA interactions and proteinprotein 

interactions were assessed using 

western blot, electromobility shift, and coimmunoprecipitation 

analysis, respectively. 

HER2 status was evaluated using the Hercep 

Tesp immunocytochemical assay and 

subsequently confirmed by fluorescent in situ 

hybridisation. 

Ets-2 associated with reduced disease-free 

survival (p

1 

SESSION ONE 



1 

SESSION ONE 

9 

Modulation of coregulatory protein expression in human 

breast cancer 

10 

The oestrogen receptor is 

influenced by the presence of 

ligand and specific co-regulatory 

proteins including the coactivators 

SRC-1 and AIB-1 and the 

corepressors NCoR and SMRT. 

These are present at rate limiting levels 

acting as molecular switches modulating 

transcription of genes relevant to tumour 

progression (e.g. cyclin D1). 

Hypothesis 

Endocrine-resistant breast cancers may 

result from a shift in equilibrium between 

coactivator and corepressor expression. 

Methods 

The ability of 17-ß-oestradiol, tamoxifen and 

faslodex to modulate coregulatory protein 

and cyclin D1 expression was assessed in 

MCF-7 (tamoxifen/faslodex sensitive) and 

LY2 (tamoxifen/faslodex resistant) cells and 

primary cultures using western blotting. 

This was repeated following pre-incubation 

with cycloheximide. Phosphorylation was 

examined using immunoprecipitation and 

Cyclin D1 protein expression & 

Proliferation Index 

Electrochemotherapy - preclinical development and 

clinical utility 

Electrochemotherapy is the 

application of electric pulses 

to tumour tissue to render the 

cell membranes permeable to 

western blotting. Messenger RNA was 

assessed using northern blotting. 

Results 

In MCF-7 cells and primary cultures 17-ßoestradiol 

upregulated SRC-1 and AIB-1 

protein, mRNA and phosphorylation. SMRT 

protein, mRNA and phosphorylation was 

reduced. Tamoxifen downregulated SRC-1 

protein, mRNA but induced increased 

phosphorylation, AIB-1 and SMRT protein and 

mRNA was increased but phosphorylation 

unchanged. Faslodex increased SRC-1 protein 

and mRNA but decreased phosphorylation. 

NCoR was unchanged. All alterations 

in protein expression were abrogated 

with cycloheximide. Altered coregulatory 

expression in response to ER modulators was 

absent using LY2 cells. 

Conclusion 

Differential expression of coregulatory proteins 

in response to oestrogen receptor modulators 

may determine the direction of transcription 

of genes relevant to tumour progression. This 

shift in equilibrium in the ratio of coactivator 

to corepressor protein may in part explain 

resistance to endocrine therapies. 

17-ß-oestradiol 4-OH-tamoxifen Faslodex 

MCF-7 \ [ [ 

LY-2 \ \ \ 

impermeant or poorly permeant 

anticancer drugs; thereby 

facilitating a potent cytotoxic effect. 

DO Kavanagh 2 , ADK Hill 1,2 , 

EWM McDermott 1 , 

NJ O’Higgins 1 , LS Young 2 

1 

Dept. of Surgery, St 

Vincent’s University 

Hospital; 2 The Conway 

Institute of Biomedical and 

Biomolecular Research, 

Belfield, University College 

Dublin 

11 

The aims of this study were to develop 

an optimised, reproducible system of 

electrochemotherapy, and to investigate its 

clinical utility in patients with cutaneous/ 

subcutaneous tumours refractory to 

conventional anticancer treatments. 

We used six histologically distinct cell-lines 

to optimise voltage, pulse length and drug 

concentration in vitro. Tumours derived 

from these cell-lines were used in mice to 

assess the efficacy of the optimised system. 

Patients (n=9) with cutaneous/subcutaneous 

metastases (n=75) from a variety of cancers, 

unresponsive to chemoradiotherapy, were 

treated with electrochemotherapy to the 

metastatic nodules. 

Optimum voltage in vitro was between 1000- 

1400V; optimum pulse length 100µsec and 

optimum bleomycin concentration 10µg/ 

ml. At completion of in vivo experiments, 

Inhibition of COX-2 and oxidative pathways as a means 

to decrease oesophageal injury in a surgical reflux model 

Inflammation and oxidative stress 

from chronic reflux of acid and 

bile may result in progressive 

oesophageal injury with changes 

from oesophagitis through 

metaplasia to adenocarcinoma. 

Anti-inflammatories and antioxidants have 

rationale in this disease model, and this 

study investigated the effects of vitamin 

C, a powerful antioxidant, and Rofecoxib, a 

selective COX-2 inhibitor, on oesophageal 

injury in a rodent model. 

Six weeks after oesophagojejunostomy, 

130 surviving female wistar rats were 

randomised to four groups. Groups 1-3 

received Rofecoxib 1mg/day, vitamin C 10mg/ 

day or vitamin C 35mg/day. Group 4 received 

no treatment. Animals were killed 16 weeks 

electrochemotherapy treated tumours in 

mice (n=36) using these parameters were 

significantly smaller than the corresponding 

control tumours in volume (p

21 

1 

SESSION TWO ONE 



2 

SESSION 


12 

Growth factor activation of the mitogen-activated 

protien (MAP) kinase pathway increases breast 

coactivator protein expression and stimulates breast 

tumourigenesis 

In breast cancer, overexpression 

of the epidermal growth factor 

receptor Her2 is associated 

with poor overall survival rates. 

Overexpression leads to an 

increase in steroid co-activator 

protein expression. This occurs 

though the MAP-kinase pathway 

and may serve, not only to drive 

breast tumourigenesis, but also 

to alter endocrine therapies from 

antagonist to agonist profiles. 

Aims 

To characterize the regulation of oestrogen 

receptor coactivator proteins and associated 

mRNA following stimulation of epidermal 

growth factor receptors. 

Methods 

Western blotting in SK-Br-3, MCF-7 breast 

carcinoma cell lines and primary breast 

cultures assessed the protein expression 

of the coactivator proteins, SRC1 and AIB1. 

Associated co-activator mRNA was assessed 

by northern blotting. Activation of the MAPK 

pathway was assessed by utilization a MEK 

inhibitor, PD 98059. Human breast carcinoma 

tissue, of known Her2Neu status, was stained 

using immunohistochemical techniques for 

activated MAPK. 

Results 

Up-regulation of the level of expression of 

the coactivator proteins (AIB1 and SRC1) was 

demonstrated following stimulation with 

epidermal growth factor, basic fibroblastic 

growth factor and Heregulin. Downregulation 

of coactivator protein expression 

was shown following incubation with 

Herceptin. These results signalled through the 

mitogen activated protein kinase pathway, 

demonstrated using the MEK inhibitor 

PD 9805. 

Conclusions 

These results implicate a growth factor 

pathway, acting through a MAPK signalling 

pathway, in the regulation of the coactivator 

proteins. Alterations in the level of expression 

or activation of the coactivator proteins alters 

the delicate balance at the oestrogen receptor 

and may drive not only tumorigenesis but 

also the development of endocrine resistance. 

RS Prichard, ADK Hill, 

EW McDermott, 

NJ O’Higgins, L Young 

Dept. of Surgery, 

St Vincents University 

Hospital, Elm Park, Dublin 

13 

14 

Non-invasive monitoring and response prediction 

for rectal cancer undergoing neoadjuvant 

radiochemotherapy (RCT) 

We sought to discover whether 

the low molecular weight region 

of the serum proteome contained 

information that could be used 

to predict and monitor response 

to RCT for patients with locally 

advanced rectal cancer. 

After obtaining ethical approval and informed 

consent, serum samples from 15 patients 

undergoing RCT were prospectively collected. 

Each patient had serum drawn pre-treatment 

then at 24hrs, 48hrs, 1 week, 3 weeks and 

5 weeks into RCT. Response to treatment 

was measured by Tumour Regression Grade 

(TRG). All serum samples, run in duplicate, 

were analysed by surface-enhanced laser 

desorption / ionisation (SELDI) mass 

spectrometry. This generated protein mass 

profiles, which were analysed using Biomarker 

PatternsTM software (Ciphergen). In total, six 

patients demonstrated good response (TRG 

1+2), four moderate response (TRG 3) and five 

poor response (TRG 4). Time-course analysis 

revealed incremental changes in peak height, 

which could be directly related to treatment 

and resolved with the completion of therapy. 

Furthermore, in pre-treatment blood samples, 

one particular peak at mass / charge (M/Z) 

ratio of 25640 could be used to differentiate 

good responders from poor responders with 

a high degree of precision (p=0.002 t-test). 

This is the first report that serum proteomics 

may be used to predict and monitor response 

to RCT. We have shown that treatmentrelated 

changes are identifiable in blood over 

time. More importantly, responders could 

be prospectively differentiated from nonresponders 

on the basis of pre-treatment 

serum sample analysis. This technique may 

offer a non-invasive method of predicting 

response before or early into RCT. 

References 

1. Liotta LA, Ferrari M, Petricoin E. Clinical 

proteomics: written in blood. Nature. 2003 

Oct 30; 425(6961):905 

2. Petricoin EF, Ardekani AM, Hitt BA et al. 

Use of proteomic patterns in serum to 

identify ovarian cancer. Lancet. 2002 Feb 16; 

359(9306):572-7. 

Immunogenetherapy of solid tumours using 

electroporation to deliver GMCSF/B7-1 

combination plasmid 

FM Smith 1 , RB Stephens 1 , 

EF Gaffney 1 , P Crotty, EF 

Petricoin. 3rd 2 , L Liotta 2 , JV 

Reynolds 1 , MJ Kennedy 1 

Dept. of Surgery and the 

Academic Unit of Clinical 

and Molecular Oncology 1 , 

St James’s Hospital and 

Trinity College Dublin. 

FDA-NCI Clinical 

Proteomics Program, 

Laboratory of Pathology 2 , 

Center for Cancer 

Research, National Cancer 

Institute, Bethesda, MD. 

Effective anti-tumour 

immunotherapy requires: 

a) immune targeting of tumour 

associated antigens on cancer 

cell membranes, b) strategic 

abrogation of certain tolerances 

acquired during ontogeny or 

tumour growth, c) surmounting 

immune escape mechanisms at 

tumour cell level. 

Gene therapy induced expression of 

immunostimulatory molecules at tumour 

cell level might induce antitumour immune 

mechanisms by recruitment of and 

enhancing viability of antigen processing cells 

and specific tumoricidal lymphocytes. 

CG Collins, M Tangney, 

J Larkin, D Soden, S Aarons, 

GC O’Sullivan 

Cork Cancer Research 

Centre, Mercy University 

Hospital, Cork. 



21 

1 




2 

SESSION 


15 

Aim 

To investigate the anti-tumour efficacy 

of immunogenetherapy using a plasmid 

coding for GMCSF and the B7-1 costimulatory 

immune molecule, delivered into growing 

solid tumours by electroporation. 

Methods 

Murine fibrosarcomas (JBS) growing in BALBC 

mice, (≤100mm3) were administered either 

GMCSF/B7-1 expressing or gene-free plasmids. 

Control groups consisted of no treatment, 

electroporation alone, or intratumoral 

plasmid injection without electroporation. 

Tumour growth curves were generated and 

responding mice were rechallenged with 

either similar or different tumour cell types to 

determine tumour response specificity. 

Results 

Anti-tumour responses were found only in 

those treated by GMCSF/B7-1 electroporation; 

complete tumour regression in 63% 

(p

21 

1 




2 

SESSION 


Experimental Design 

Human renal proximal tubular epithelial (HK- 

2) cells were incubated either under normoxic 

(21% O2) or hypoxic (1% O2) conditions for 

varying periods (6, 12 and 24 hours). The cells 

were removed from the hypoxic conditions to 

mimic reperfusion injury and cultured for a 

further 24 hours with varying concentrations 

of Cyclosporine A (CSA). Cell viability and 

apoptosis were measured by flow cytometry. 

Results 

Hypoxia alone for 6,12 and 24 hours produced 

no change in cell non-viability as compared 

to cells cultured in normal conditions 

Table 1 

18 

(5.991.3% vs 5.80.9%). When the cells were 

removed from hypoxic conditions after six 

hours and returned to normoxic conditions 

in the presence 80 µM of CSA, the CSA 

was shown to induce apoptosis which was 

blocked following different times in a hypoxic 

environment, with the most significant 

protection with 24 hours of hypoxia. 

Conclusions 

Exposure of HK-2 cells to reperfusion may 

predispose them to further injury and death 

by immunosuppressants. This implies that 

pre-conditioning at the time of retrieval may 

prevent subsequent injury and thus DGF. 

0 µM CSA 80µM CSA 

0 hours 9.5 ± 3.3* 13.8 ± 3.0 *** 

6 hours 8.3 ± 2.8 11.8 ± 1.6 

12 hours 5.7 ± 0.6 11.4 ± 2.2 

24hours 6.5 ± 1.5 7.13 ± 3.3** 

* p

21 

1 




2 

SESSION 


21 

2.2%, SDBC vs. SBC, actuarial risk of cancer 

at 5 years). However SDBC patients had 

significantly lower grade tumours (1.95 

vs. 2.44, SDBC vs. SBC, P

31 

1 

SESSION THREE ONE 



3 

SESSION 


23 

24 

Is there an optimal route for injecting radioisotope for 

sentinel lymph node biopsy injection in patients with 

breast cancer 

Sentinel lymph node (SLN) biopsy 

has evolved in recent times as 

a means of staging the axilla in 

patients with T1 and T2 breast 

cancers. It remains unclear as 

to which is the optimum route 

of injection. The purpose of this 

study was to determine if the 

intradermal (ID) route, is superior 

to the intraparenchymal (IP) route. 

Methods 

SLN biopsy was performed in 321 patients 

with T1 and T2 breast cancer and clinically 

negative nodes using IP or ID injection 

of radiocolloid isotope. Preoperative 

lymphoscintigraphy was used to identify the 

node prior to surgery. The sentinel node was 

subsequently identified at operation using 

a combination of isosulfan blue dye and 

a hand held γ probe. The initial 80 patients 

underwent IP injection of radioisotope into 

four peritumoral sites. The remaining 241 

patients had ID injection over the tumour. 

Both patient groups were similar in terms of 

age and clinicopathological parameters. 

Results 

Preoperative lymphoscintigraphy identified 

the SLN more frequently following 

intradermal injection (230/241;9%) compared 

to the intraparenchymal route (60/80; 75%). 

(P < 0.0001: chi-squared). A combination 

of blue dye and isotope administration 

accurately located the SLN in 76 (96%) of the 

IP group compared to 241 (100%) in the ID 

group (P < 0.004). 

Conclusion 

ID injection of radioisotope was associated 

with a 95% rate of identification of the SLN on 

lymphoscintigraphy and a 100% identification 

rate at surgery. We recommend the 

intradermal route for injecting radioisotope 

for sentinel lymph node biopsy. 

The efficacy of ultrasound, stereotactic and clinical 

core biopsies in the diagnosis of breast cancer, with an 

analysis of false negative cases 

Preoperative core biopsy in breast 

cancer is becoming the standard 

of care. The aim of this study was 

to analyse the various methods 

of core biopsy with respect 

to diagnostic accuracy and to 

examine the management and 

outcome of those patients with 

false-negative biopsies. 

All patients undergoing core biopsy for breast 

abnormalities over a five-year period (1999- 

2003) were reviewed. The accuracy rates 

for each method of core, the histological 

agreement between the core pathology 

and subsequent excision pathology, and 

the length of follow-up for cases of benign 

disease were studied. Patients whose biopsies 

were benign but who were subsequently 

diagnosed with cancer underwent detailed 

review. There were 2,427 core biopsies 

D Kavanagh 1 , ADK Hill 1 , 

R Kennelly 1 , TB Crotty 2 , 

C Quinn 2 , A O’Doherty 3 , 

CD Collins 3 , 

EW McDermott 1 , 

NJ O’ Higgins 1 

Depts. of Surgery 1 , 

Pathology 2 and Radiology 3 , 

St Vincent’s University 

Hospital and Conway 

Institute of Biomolecular 

& Biomedical Research, 

University College Dublin, 

Dublin 

MF Dillon 1 , ADK Hill 1,4 , 

CM Quinn 2 , A O’Doherty 3 , 

EW McDermott 1,4 , 

NJ O’Higgins 1,4 

Dept. of Surgery 1 , Dept. 

of Pathology 2 , Dept. of 

Radiology 3 , St Vincent’s 

University Hospital, 

Dublin; Conway Institute 

of Biomolecular & 

Biomedical Research 4 , 

University College Dublin 

25 

performed over the five-year period, 

resulting in a final diagnosis of cancer in 

1384 patients, benign disease in 954 patients, 

and atypical disease in 89 patients. Biopsy 

method consisted of 1,279 ultrasound-guided 

cores, 739 clinically-guided cores and 409 

stereotactic-guided cores. The overall falsenegative 

rate was 6.1%, with specific rates for 

ultrasound-; clinical-; and stereotactic-guided 

cores of 1.7%, 13% and 8.9%, respectively. Falsenegative 

biopsies occurred in 85 patients, and 

in eight of these patients the diagnosis was 

delayed by greater than two months. In all 

other false-negative cases, ‘triple assessment’ 

review allowed prompt recognition of 

discordant biopsy results and further 

evaluation. Ultrasound guidance should be 

used to perform core biopsies in evaluating 

all breast abnormalities visible on ultrasound. 

Adherence to principles of triple assessment 

following biopsy allows for early recognition 

of the majority of false-negative cases. 

‘Location, location, location’ – the importance of 

location in the assessment of mastalgia in the general 

female population 

Mastalgia is the most common 

symptom affecting women who 

attend breast care services amounting 

to over 70% of new referrals. 

The ability to screen this cohort for high 

risk patients would greatly facilitate their 

management. The aim of this study was to 

determine whether it was clinically possible 

to screen these patients, based on the pattern 

of mastalgia, with a view to identifying those 

at increased risk of a significant underlying 

pathological process. 

Methods 

A prospective cohort based analysis was 

performed on all females referred for 

evaluation of mastalgia to a regional 

symptomatic breast care unit from July to 

December 2004 inclusive. The 90 patients 

identified in the study were categorised 

according to age, character and distribution 

of pain, as well as the use of exogenous 

hormonal preparations, such as HRT or OCP. 

The distribution of mastalgia as well as its 

correlation with an underlying abnormality 

was determined (using either mammography 

or ultrasound). 

Results 

New-onset cyclical pain occurred in two 

groups primarily, 20-30 years (n=4) and 40- 

50 years (n=14). Cyclical upper outer quadrant 

pain in the 20-30 year (n=3) age group 

was benign. Pain following an alternative 

distribution or temporal pattern, in this 

age group, was always associated with an 

a significant lesion. A similar profile was 

observed for patients in the 40 - 50 age group. 

Non-cyclical mastalgia in the 60 - 70-year-old 

population (n=8) was mostly associated with 

neoplasia (n=7). 

Conclusions 

Mastalgia accounts for a large proportion of 

referrals to symptomatic breast clinics on a 

daily basis, despite this, few data exist on the 

topographical distribution of mastalgia and 

its correlation with an underlying disease 

process. In this study, cyclical pain located in 

the upper outer quadrant was always benign. 

Pain following an alternative distribution, or 

temporal pattern, should therefore alert the 

physician to the presence of an underlying 

pathology. Given the prevalence of mastalgia 

in general, these findings should aid in the 

screening for patients at increased risk of 

harboring a significant abnormality. 

A O’Connor, JC Coffey, 

A Hanley, P O’Connor, 

RGK Watson 

Dept. of General Surgery, 

Waterford Regional 

Hospital 



31 

1 




3 

SESSION 


26 

27 

A prospective observational study of carotid artery 

stenting (CAST) under neuro-protection and carotid 

endarterectomy (CEA) in high-risk patients. Technical 

and clinical outcome 

Aim of our study is to compare CEA 

with CAST in high-risk patients 

regarding technical and clinical 

success and efficacy in reducing 

morbidity and mortality. 

From August 2003-2004, 640 patients were 

treated for carotid artery disease; 74 had a 

carotid intervention. 40 patients were ASA III or 

higher and were assigned to CEA or CAST. The 

groups were matched demographically. Duplex 

was sole imaging modality for quantifying the 

type of plaque and degree of stenosis. Patients 

with echolucent plaques were offered CEA. 

CAST were performed under local anaesthesia 

with primary stenting using Angioguard® 

filter wire, Xact® tapered stent, post stenting 

dilatation and Perclose® automatic suture 

system. All CEA were done under general 

anaesthetic with routine shunting, tacking and 

ultrathin HemaCarotid patch. 

Both groups had a mean age of 71, male to 

female ratio of 13:7, and symptomatic to 

asymptomatic ratio of 16:4. All asymptomatic 

patients had contralateral occlusions. There 

were significantly more patients with higher 

risk factors in the CAST group (p

31 

1 




3 

SESSION 


29 

Prospective trial comparing contrast swallow, CT 

scanning and endoscopy in the diagnosis of anastomotic 

leak following upper digestive tract surgery 

30 

Anastomotic leaks following 

gastro-oesophageal surgery are 

not uncommon. The identification 

and assessment of severity can be 

challenging with contrast swallow 

radiology. 

Routine studies fail to identify clinically 

significant anastomotic leaks as well as 

demonstrating non-significant leaks in 

asymptomatic patients. We conducted a 

prospective trial comparing contrast swallow 

radiography, contrast enhanced computed 

tomography (CT) scanning and endoscopy 

in patients undergoing gastro-oesophageal 

resection to determine the optimal method 

of investigating anastomotic leak in the postoperative 

period. Thirty-two patients were 

studied following oesophagectomy (n=24) 

and gastrectomy (N=8) in a prospective, 

non-randomised trial. All patients underwent 

contrast swallow and CT scanning on day 

seven post-operatively followed by endoscopy 

on day eight. The radiologist and endoscopist 

were blinded to their respective findings 

which were recorded independently on 

the database. Thirty patients underwent 

all three studies. Four anastomotic leaks 

were identified. Both symptomatic leaks 

were identified on endoscopy. Only one of 

these was noted on Day Seven radiology. 

Two asymptomatic anastomotic defects 

were identified on endoscopy alone. These 

patients recovered fully with conservative 

therapy. Two patients were deemed too 

unfit to undergo endoscopy given their 

poor performance status. Contrast swallow 

demonstrated one false (pseudo) leak which 

was outruled definitively by CT scanning and 

endoscopy. Results suggest that endoscopy 

is the preferred method of assessment of 

anastomotic integrity in patients undergoing 

oesophagogastric resection. Contrast swallow 

and CT scanning are less accurate. We would 

advocate the use of selective endoscopy in 

those with clinical suspicion of leak. 

Long term follow-up of patients undergoing 

anti-reflux surgery 

Many studies show excellent 

short to medium term results 

following Laparoscopic Nissen 

fundoplication. Few consider 

outcome more than five years 

post-operatively. 

The aim was to evaluate long-term patient 

satisfaction and durability of Laparoscopic 

Nissen fundoplication. All patients 

who underwent Laparoscopic Nissen 

fundoplication from September 1993 to 

December 1998 were included. An outcome 

questionnaire was constructed based on 

previously validated questionnaires. Patients 

were telephoned between February and 

May 2004. During the study period 133 

patients underwent Laparoscopic Nissen 

fundoplication. Male to female ratio was 1.4:1, 

mean age 42.3 years (range 12 - 77 years), and 

mean follow-up 94 months (range 62 - 128 

months). One hundred and eight patients 

(81.2%) responded to the questionnaire. 

Eight patients had recurrence of symptoms 

at a mean of 42 months post fundoplication 

(range 2 to 72 months). Seventy-five percent 

of recurrences offered more than three 

years post fundoplication. In three of the 

eight patients (37.5%) recurrence was more 

than five years post fundoplication. Four 

D Broe, BA Hogan, 

DC Winter, CG Murphy, 

MJ Lee, PJ Broe 

Depts. of Surgery and 

Radiology, Beaumont 

Hospital, Beaumont, 

Dublin 

PA Sloane, J Dowdall, 

S Roche, MF Khan, 

OJ McAnena 

Dept. of General Surgery, 

University College 


Current Address of First 

Author: Regenerative 

Medicine Institute, NCBES, 

National University of 

Ireland, Galway 

31 

underwent refundoplication at a mean of 

54.25 months after original surgery (range 12 

to 86 months). Outcome was rated as cure 

or excellent by 101 patients (93.5%), including 

all four patients who had refundoplication. 

Seven patients (6.5%) rated outcome as 

failure, four because of symptom recurrence 

and three because of wrap take down. 

Laparoscopic Nissen fundoplication results 

in a high degree of patient satisfaction. 

A significant proportion of symptom 

recurrences occur late. Short to medium 

term follow-up studies do not identify these 

patients. This needs to be considered when 

evaluating their outcome. 

Boerhaave’s syndrome: fourteen cases of spontaneous 

oesophageal rupture with varying management 

strategies in a single centre 

Spontaneous oesophageal rupture, 

also known as Boerhaave’s 

syndrome, is rare and carries a high 

associated morbidity and mortality. 

Individual surgical experience 

with this condition remains low 

and therefore the management of 

Boerhaave’s remains controversial. 

Methods 

A retrospective review of cases presenting 

to St. James’s hospital, as a tertiary referral 

centre, over a period of eight years was 

reviewed. Perforations were excluded if 

iatrogenic or secondary to underlying 

oesophageal disease. 

Results 

A total of fourteen patients were identified. 

There were eleven men and three women, 

whose ages ranged from 39 to 75 years. 

Eight patients were managed operatively 

while six were managed conservatively. 

Diagnosis was based on clinical history 

and examination, oesophageal contrast 

swallow and CT scanning. Seven patients 

underwent thoracotomy with primary closure 

of the oesophageal perforation and tissue 

reinforcement. One patient underwent 

oesophagogastrectomy. Mean post-operative 

stay was 39 days with a mean ICU stay of 7.5 

days. A covered stent was placed at OGD in 

two patients who were treated conservatively. 

Mean in-patient stay for those managed nonoperatively 

was 61 days with 18.2 days in ICU. 

Mortality was identical in both groups (n=1). 

Morbidity was slightly higher in the group 

treated conservatively (n=4/6) compared to 

surgical intervention (n=5/8) 

Conclusions 

Surgical intervention remains the gold 

standard for cases which are diagnosed 

promptly. Where the diagnosis is delayed 

utilization of covered oesophageal stents 

is a viable option. In single institutions, 

management strategies can be customised, 

thus reducing overall mortality. 

RS Prichard, J Butt, 

N Al-Sarraf, S Frolich, 

B Manning, N Ravi, 

JV Reynolds 

Upper Gastrointestinal 

Surgical Professorial 

Unit, St. James’s Hospital, 

James’s Street, Dublin 

32 Pulmonary emboli in the surgical community R FitzGerald, S Rajendran, 

Despite significant advances in the 

prevention and treatment of venous 

thromboembolism, pulmonary embolism 

remains the most common 

preventable cause of hospital death. 

It is imperative, thus, to identify at risk-patient 

groups who would benefit from higher dose 

thromboprophylaxis in an attempt to decrease 

morbidity and mortality from this condition. 

We performed a retrospective study of 

all patients admitted to Wexford General 

C Canning, Z Martin, 

D Beddy, JB O’Mahony, 

K Mealy, D Evoy 

Dept. of Surgery, Wexford 

General Hospital, Wexford 



31 

1 




SESSION 

4SESSION FOUR ONE 

Hospital between 1999 and 2004 (48,036 

patients – 40% surgical and 60% medical). 

220 patients were found to have PE’s 

complicating their hospital stay. A thorough 

chart review was performed of the 31 surgical 

patients in this group in an attempt to 

highlight patient populations at high risk. 

Patient characteristics were as follows; 

10(32.2%) were male and 21(67.8%) were 

female. All except two were on standard 

anti-thromboembolic prophylaxis. 

The outstanding two patients had a 

contraindication to prophylactic treatment 

(unstable GI bleeding) and were given TEDS 

on admission. Of the 31 surgical patients 

15 had operative intervention during their 

admission. Nine of these were elective 

procedures and six were emergency. Fourteen 

patients underwent major operations, 10 

of which were for malignant disease. Three 

patients had a history of a thromboembolic 

event in the past. Eighty percent of patients 

were over the age of 65. All six deaths 

occurred in patients over the age of 65. 

Thromboembolic events, despite the use of 

appropriate prophylactic measures, continue 

to cause significant morbidity and mortality. 

They occur more frequently in non-surgical 

patients than in surgical patients. Our study 

highlights the burden of thromboembolic 

disease in the elderly. 

avoid unnecessary surgery for suspected 

appendicitis in women less than 50 years 

with right iliac fossa pain. Retrospectively, 

adult females

41 

1 

SESSION FOUR ONE 



SESSION 


36 

The European Working Time Directive – 

an NCHD perspective 

The implementation of the 

European Working Time Directive 

for NCHDs remains a challenge in 

Ireland. 

The aim of this study was to evaluate the 

time spent in different areas of activity for 

NCHDs of different grades. We performed a 

prospective study of the working hours of all 

the NCHDs in the Dept. of Surgery in Wexford 

General Hospital. Time spent was divided 

into (i) education and training (consultant 

present), (ii) general medical, (iii) paramedical 

and (iv) clerical. This audit was performed 

over a one-week period and included both the 

regular working day and on-call hours. The 

NCHD Grade 

Education & 

Training 

(% in hours) 

percentage time spent by each NCHD grade 

performing different tasks is demonstrated in 

the table below. 

This study illustrates the excessive amount 

(>50%) of time spent by interns performing 

non-medical duties. Paramedical and clerical 

staff deployment could satisfactorily decrease 

NCHD working hours in line with the EWTD 

and thus allow more time for education and 

training. In addition if NCHD shift work is 

implemented to satisfy the EWTD, without 

a change in current consultant practice, 

this will have a major negative impact on 

education and training opportunities (> 75% 

reduction), particularly for the registrar and 

SHO grades. 

General 

Medical 

(% in hours) 

Paramedical 

(% in hours) 

Clerical 

(% in hours) 

Registrar Regular day 48 48 4 

‘Out of hours’ 16 84 

SHO Regular day 52 31.5 8 8.5 

‘Out of hours’ 5 72 8 15 

Intern Regular day 8.8 34 21 36.2 

‘Out of hours’ 9 8 30 53 

Z Martin, C Canning, 

D Beddy, D Evoy, 

JB O’Mahony, K Mealy 



Materials & Methods 

Retrospective chart review of all patients 

recorded as having taken discharge against 

medical advice during the twelve-month 

period from 01/06/2003 to 31/05/2004. 

Results 

Two hundred and twelve patients took their 

own discharge against medical advice, six of 

whom presented on more than one occasion. 

63.8% were males. Ninety-two percent were 

self-referrals. In 70% of all cases either alcohol 

or recreational drugs had been consumed. In 

32% of cases, threatening or violent behaviour 

was documented. Median length of stay 

38 Bullying of junior doctors: a bitter reality S Cheema, K Ahmad, 

Workplace bullying in health systems 

is a well known fact. 1 It leads to 

breakdown in teamwork and has a 

significant effect on the individual’s 

personal life. True prevalence of 

bullying in junior doctors working in 

Ireland is unknown. The aim of study 

was to determine the prevalence of 

bullying and its effects on junior 

hospital doctors. 

was less than one day at an average cost of 

u666/patient, not including weighting for 

staff salaries. Ninety-one percent signed 

themselves out of hospital while nine percent 

discharged themselves but refused to sign 

any documents. 

Discussion 

Treating non-compliant patients imposes 

a significant burden on medical staff and a 

major financial burden on an institution. The 

absence of clear guidelines in this context 

hinders the efficient management of 

such patients. 

completed responses were returned. Our 

sample is approximately 15% of the total 

target population. There were 344 (71%) 

male and 139 (29%) female responders. 

Two hundred and ninety-two (60%) were 

European nationals (EU) and 191(40%) non- 

EU nationals. Thirty percent of junior doctors 

claimed to be bullied. Seniors colleagues and 

nurses were identified as the commonest 

bullies. Fifty percent felt bullying affected 

their performance and productivity at work. 

Table 1 (overleaf) summarizes the responses 

to the questionnaire. 

SK Giri, VK Kaliaperumal, 

SA Naqvi 

Dept. of Surgery, Mid- 

Western Regional Hospital, 

Dooradoyle, Limerick 

37 

Assessing the impact of patients taking discharge 

against medical advice in a regional hospital 

Medical practice is predicated upon 

offering treatment to patients who 

by implication reserve the right to 

refuse treatment and discharge 

themselves against medical advice. 

It is the responsibility of the clinician to 

fully inform such patients of the risks 

and implications of their condition and 

potential sequelae of lack of treatment. 

Notwithstanding a clinician’s medicolegal 

responsibilities while a patient is under his/ 

her care, there are less clear-cut implications 

in the context of a self-discharging patient. 

The situation is often complicated where 

alcohol and controlled substances are 

aetiological factors. We examined the burden 

imposed on services in our institution by 

patients who refused treatment. 

H Askar, JB Conneely, 

P Gillen 

Dept. of Surgery, Louth/ 

Meath Surgical Group, Our 

Lady of Lourdes Hospital, 

Drogheda, Co. Louth 

Methods 

An anonymous questionnaire survey was 

conducted. The data including age, gender, 

job grade and ethnic origin in addition to 10 

specific questions, validated before, regarding 

the bullying, its source, frequency, its effects 

on home life and productivity of work and 

the different types of bullying behaviors were 

collected. Statistical analyses were done as 

appropriate. 

Results 

Nine-hundred and fifty questionnaires 

were posted to junior hospital doctors 

working in south and western regions of 

Ireland. Four hundred and eighty-three (51%) 

Discussion 

Accusation of bullying has become much 

more common in medicine. This may 

represent increased awareness. Bullying is 

based on the perception of victim and not 

the intention of person accused. In most 

institutions policies are already in place to 

deal with bullying behaviour. We conclude 

bullying of junior doctors in Irish Health 

system is common. Increased awareness and 

reporting is the first step in controlling 

the problem. 

References 

1. Quine L. Workplace bullying in junior doctors: 

questionnaire survey. BMJ 2002; 324: 878-879 



41 

1 




SESSION 


Table 1 - Response to questions 

39 

How valid is the ‘eyeball test’ in evaluating patients 

for vascular surgery 

Prevalence studies have 

shown that patient history, 

clinical examination, and 

electrocardiography will indicate 

the presence of coronary artery 

disease in up to 40% to 60% of 

vascular surgical patients. 

Objectives & Methods 

We reviewed a database of elective vascular 

surgical operations to assess the adequacy 

of preoperative cardiac assessment at our 

institution where a policy of reserving 

stress testing and angiography solely for 

symptomatic patients exists. All other 

patients have an electrocardiogram and a 

transthoracic echocardiogram; fitness for 

surgery is left to the discretion of the surgeon 

QUESTIONS NO YES 

Persistent unjustified criticism 270(56%) 223(44%) 

Attempt to humiliate 353(73%) 130(27%) 

Inappropriate Jokes 382(79%) 101(21%) 

Undue pressure to produce work 164(34%) 319(66%) 

Attempt to demoralize 352(73%) 131(27%) 

Discrimination on race & gender 331(69%) 152(31%) 

Bullying affect home life 304(63%) 179(37%) 

How often been bullied 161(33%) 322(67%) 

Affect productivity at work 243(50%) 240(50%) 

and anaesthetist. Causes of morbidity and 

mortality were noted from data on 734 

patients collected prospectively between 

1998 and 2004. 

Results 

As shown in the table below, cardiac causes 

accounted for 44% of all 30-day perioperative 

deaths and significant cardiac events 

occurred in 8.5%, 5.3% and 2.1% and 4.1% 

of aorto-iliac bypasses, abdominal aortic 

aneurysm repairs, carotid endarterectomies 

and fem-distal bypasses respectively. 

Conclusion 

Although a policy of minimal preoperative 

cardiac work-up exists at our institution, 

our results indicate an acceptable level of 

cardiac morbidity and mortality for patients 

undergoing elective vascular surgery. 

N Collins, EG Kavanagh, 

MP Colgan, P Madhavan, 

DJ Moore, GD Shanik 

St. James’s Vascular 

Institute, Dublin 

Perioperative 

Deaths 

AORTOILIAC 

BYPASS (N=94) 

AORTIC 

ANEURYSM 

REPAIR (N=94) 

CAROTID 

ENDARTERECT- 

OMY (N=340) 

FEM-DISTAL 

BYPASS (N=172) 

8 (8.5%) 5 (5.3%) 7 (2.1%) 7 (4.1%) 

Cardiac Death 4 (4.3%) 3 (3.2%) 2 (0.6%) 3 (1.7%) 

MI/cardiac arrest 4 (4.3%) 3 (3.2%) 2 (0.6%) 1 (0.6%) 

Cardiac Failure 1 (1.1%) 0 1 (0.3%) 2 (1.2%) 

Arrhythmia 1 (1.1%) 0 8 (2.3%) 1 (0.6%) 

40 

Changes in management of infrainguinal limb 

ischaemia coinciding with the introduction of a 

dedicated endovascular theatre 

Angioplasty is becoming increasingly 

popular as first line therapy for 

infrainguinal limb ischaemia, however 

it is not yet proven to reduce the 

number of surgical bypass procedures 

or amputation rate. 

Objectives & Methods 

We reviewed the number of procedures 

performed for peripheral vascular disease 

to assess changes in practice since the 

introduction of a fixed imaging endovascular 

theatre (EVT) in October 2002. The number of 

angioplasty, bypass and amputation procedures 

were noted from the vascular database for 

a two-year period prior to and following the 

opening of the endovascular theatre. 

PRE EVT 

Results 

As shown in the table, there was a 

significant increase in endovascular 

procedures for peripheral vascular disease 

and a corresponding reduction in bypass 

operations (p

41 

1 




SESSION 


41 

The use of computer interface in the rapid diagnostic 

breast clinic 

Evaluation of performance by 

regular audit should be an integral 

part of any unit. This however 

requires additional commitment 

from medical and clerical staff in 

addition to the assistance of a data 

manager. 

The Tallaght Breast Unit in collaboration 

with the Information Technology (IT) Dept. 

has designed a software program for use at 

its one stop Rapid Diagnostic Clinic to help 

address and facilitate the audit process. 

We hypothesise that the introduction of a 

computer based clinical consultation will 

facilitate auditing of the clinic’s performance. 

The database was developed using Key Extra. 

This development tool is a module of Order 

Communications. The system is interfaced 

to PIMS (Patient Information Management 

System) which automatically captures patient 

demographics. The consultation is paperless 

and data input is mainly by drop down lists. 

Mandatory fields ensure maximum data 

capture as well as standardised consultation. 

Automated data were retrieved for audit 

purposes and research. Information 

regarding the number of patients seen, 

interval between referral and clinical review, 

number of cancers diagnosed, discharge rate 

and triple assessment results was readily 

available. Using Business Objects, standard 

templates for a range of reports resulted in 

a reduction of time spent processing them. 

These reports could then be regenerated for 

any required date range. 

The implementation of this program has 

proven to be an invaluable audit tool. It 

has enabled the regular evaluation of the 

Rapid Diagnostic Clinic and helped identify 

shortcomings. 

N Birido, M Atkinson, 

J Rothwell, J Geraghty 

The Tallaght Breast Unit, 

The Adelaide and Meath 

Hospital Incorporating 

the National Children’s 


42 Development of a wireless network programme D Toomey, M Aremu, 

Changes in the healthcare 

environment coupled with the 

rapidly expanding knowledge base, 

curricular reforms and increases in 

medical students class size have 

made it impossible to continue 

clinical teaching in the 

traditional mode. 

In addition, the delivery of clinical care within 

our hospital services is also about to undergo 

significant change. Implementation of the 

European Union Working Time directive 

will have a significant impact on hospital 

functionality. Emerging data show that the 

use of handheld devices can not only be 

useful from the educational standpoint but 

connected to the central hospital information 

systems can facilitate practice management, 

improve quality of care, and results in overall 

cost reductions. The aim of this pilot project 

was to introduce wireless hand-held PC 

system which in real time allows access of 

patient data from a central computer system, 

M Doyle, K Ryder, 

KC Conlon 

Professorial Surgical Unit, 

The Adelaide and Meath 

Hospital incorporating 

the National Children’s 

Hospital, Trinity College 

Dublin, Tallaght, D24 

generate an accurate audit database, order 

investigations and access results at the 

bedside and develop electronic teaching 

modules for the non-consultant hospital 

doctors and medical students. Thin client 

servers were introduced on two surgical 

wards. A middleware programme was written 

to allow integration of the system to the 

existing hospital information technologies. 

Data acquisition, order entry actions and 

43 

Determining validity and knowledge transfer efficiency 

for a novel entirely web based lecture series 

Web based learning has been 

increasingly advocated as a 

modern efficient method of 

teaching surgery. Efficiency of 

knowledge transfer and validity 

to date has not been subjected to 

rigorous study. 

An entirely web based five-week lecture 

course was specifically designed where 

50% had additional voice over files. The 

lecture series were specifically balanced 

to contain paired topics where the preexistent 

knowledge base would be similar 

in both groups. A bespoke multiple choice 

examination was structured so that only 

written material presented was examined. 

Pearson correlations were conducted 

elucidating the relationship between 

the usage, both lecture groups and MCQ 

marks. Web usage was estimated utilising 

surrogates including number of hits as well 

as logon timing. Face validity was assessed by 

standardised questionnaire. 

discharge summaries were created using 

the system. Multiple disease management 

protocols were created and accessed by 

housestaff and students. This system has 

facilitated efficient management and audit of 

surgical patients at our institution. We believe 

that further development of this system will 

improve efficiencies, add to the educational 

experience and also advance the care of 

our patients. 

Eighty-eight students took part in the 

lecture series and subsequent exam and 

questionnaire. Usage rates were significantly 

augmented in the fifth week when compared 

to the previous four weeks (mean total hits 

weeks 1-4 (SEM): 100.9 (9.7) and mean total 

hits week 5: 152.1 (13.1); p

41 

1 




5 

SESSION 

SESSION FIVE ONE 

44 Validation of a novel hybrid surgical simulator D Broe, PF Ridgway, 

Simulated minimal access surgery 

has improved both as a learning and 

assessment tool in recent times. 

We describe the validation of a novel 

simulator for use of assessment of residents 

in training. We used a hybrid simulator with 

both virtual and actual tasks. A group of 

surgical residents ranging from novice to 

expert completed three standardised tasks 

(orientation, dissection and basic suturing). 

There was no antecedent training on the 

model. Tasks were tested for construct validity 

(ability of the test to predict experience level). 

Two experienced surgeons examined the 

recorded tasks in a blinded fashion using 

OSATS (objective structured assessment of 

surgical skills) format. OSATS combined a 

task specific checklist and global rating score. 

Results demonstrated good inter-examiner 

reliability (Cronbach’alpha: 0.88 checklist and 

0.93 global rating). The median scores in the 

experience groups were statistically different 

in both global rating and task specific 

checklists (p

51 

1 




5 

SESSION 


47 Plavix - panacea or poison P McKenna, PC Looi, 

PLAVIX (clopidogrel bisulfate) is an 

inhibitor of platelet aggregation 

acting by direct inhibition of 

adenosine diphosphate. 

Its role in patients with hip fractures has to 

date not been assessed. We retrospectively 

reviewed all hip fracture patients admitted 

to our unit over a two-year period, all of 

whom were on Plavix, on admission. A control 

group of patients who also had hip fractures, 

but who were not on Plavix was analysed. 

We compared pre-op ASA scores, Age, Time 

to surgery, Haemoglobin, Pre- and post-op 

mobility status, complication rates, Mortality 

rates. We analysed 20 patients in the Plavix 

group, and compared them with an age, 

sex and ASA score matched group with hip 

fractures. The mean age in the Plavix group 

was 82.2 years (range 72-92), control group 

81yrs (range 73-90). The Mean pre-op ASA 

score, Plavix group 3.55 (range 2-5), control 

group 2.9 (range 2-5). Time to surgery was 7.2 

days in the Plavix group, there were two preop 

mortalities in this group. Time to surgery 

in the control group was 2.5 days, with no 

pre-op mortality. There were three in-patient 

post-op mortalities in the Plavix group, with 

none in the control group. Post-operative 

Mobility at six weeks and three months 

showed no significant difference between 

the two groups. This study demonstrates the 

increased risk associated with hip fracture in 

patients on Plavix. The difference between 

the groups may be explained by a slightly 

worse pre-op ASA score in the Plavix group, 

however the prolonged time to surgery may 

significantly worsen the prognosis for 

this group. 

JA Harty, D O`Farrell, 

F Condon 

Dept of Orthopaedic 

Surgery, Mid-Western 

Regional Hospital, Limerick 

49 Ring-fencing - bed protection for the patient NT O’Malley, JA Sproule, 

Given the high and fluctuating 

admission figures in Trauma 

Orthopaedics, with priority appropriately 

being given to the primary 

trauma patient, difficulty arise in 

admitting patients for secondary 

procedures due to bed shortages. 

A ring-fencing policy was initiated whereby 

only trauma patients could be admitted to the 

ward in an effort to overcome the previously 

high cancellation figures (155 in a 12-month 

period), and also to maximise efficiency in 

accepting referrals from other centres. 

Figures were retrospectively accumulated 

from admission office files where it was 

noted if the patients (a) cancelled themselves, 

or (b) were cancelled through lack of beds. 

The latter figures were correlated with 

prospective data collected on the ward when 

infringements of the “ring-fence” policy 

occurred, such as when a non-trauma patient 

was admitted to the ward. 

Overall, there was a 20% decrease in 

cancelled secondary trauma admissions 

to the ward once the ring-fencing policy 

was implemented, in direct comparison 

to the previous 12-month period. Of note 

the number of “breaks” in the ring-fence 

accounted for 30% of cancelled admissions. 

In summary, by implementing a bedprotection 

policy our unit has decreased 

the secondary trauma waiting list by 40%. 

This measure, in conjunction with a planned 

discharge policy and maximum utilisation of 

the day ward will help optimise the Trauma 

unit efficiency and throughout. 

P Nicholson, JJ Rice, 

JP McElwain 

Dept of Trauma & 

Orthopaedics AMNCH 

Tallaght Dublin 

48 Blackthorn injuries to the hand JB Lynch, G Sim, JL Kelly, 

The blackthorn is one of the 

commonest European shrubs. It is 

traditionally known as the witches 

tree associated with decay, death 

and black magic and is frequently 

encountered in rural communities 

where the toxic extracts may result 

in severe hand injuries. 

Aim 

The aim of this study is to establish the 

pattern of blackthorn injuries and to highlight 

their severity. 

Methods 

Fifteen patients were identified over a fiveyear 

period. Eleven of these were male. 

Penetrating thorn injuries were noted in the 

digits in eight cases, palm or dorsum of hand 

in six cases and the wrist in one case. 

Results 

Presentation was delayed from weeks to 

months with symptoms progressing slowly, 

ranging from pain and swelling to acute 

cellulitis and abscess formation. Fourteen 

patients underwent wound exploration under 

anaesthesia to remove the thorn remnant. 

At follow-up residual symptoms such as 

persistent joint pain and swelling were 

associated with stiffness and reduced range 

of movement. 

Conclusion 

A seemingly innocuous penetrating injury 

from the blackthorn may result in longterm 

continued disability. Early presentation for 

treatment is recommended. 

PJ Regan, J McCann 




50 Penalty points: are they working JS Butler, JP Burke, 

We conducted a retrospective 

study of all acute admissions to the 

National Spinal Injuries Centre (NSIC) 

over a six-year period (November 1st 

1998 to October 31st 2004, n=966) 

to analyse the trends in Road Traffic 

Accident (RTA) related spinal injuries 

following the introduction of a post 

penalty points system. 

RTA-related spinal injuries accounted for 

39.3% of cases admitted to the NSIC over 

these six years. 35.2 % of these had some 

degree of neurological injury. RTA-related 

spinal injuries are significantly more common 

in males, with males between the ages of 16 

and 24 accounting for 31% of all RTA-related 

spinal injury admissions compared with 

females of the same age group accounting 

for 9.7%. There was an initial reduction of 

48.4% in RTA associated NSIC admissions 

following the introduction of Penalty Points, 

this has not been sustained. The number of 

road deaths has decreased since 1997 from 

472 to 376 in 2002 however the number of 

deaths/1000 collisions has increased over this 

period, from 34.74/1000 collisions in 1997 to 

39.24/1000 in 2002. The majority of patients 

who sustained a spinal injury were drivers, 

on a routine journey and on a rural road. The 

highest proportion of accidents resulting 

in spinal injury occurred during weekends 

(64.3% from Fri-Sun) and from midnight to 

6am (29.3%). 

We conclude the initial reduction in RTArelated 

NSIC admissions has not been 

sustained and the number of deaths per 

thousand collisions continues to rise. Young 

male drivers are currently the greatest 

at-risk group. 

DG Healy, MM Stephens, 

F McManus, D McCormack, 

JM O’Byrne, AR Poynton 

The National Spinal 

Injuries Unit, Dept of 

Orthopaedic Surgery, 

Mater Misericordiae 



51 

1 




6SESSION SESSION ONE SIX 

51 

A demographic analysis of traumatic spinal injury in 

the west of Ireland from August 1996 to October 2000 

53 

Vibration assessment of cartilage grafts using bi-axial 

mechanical testing 

52 

Spinal trauma demographics are 

poorly documented. Presently no 

such published data exist in Ireland. 

The aim was to retrospectively assess spinal 

trauma demographics of patients admitted 

to the Dept. of Orthopaedics and Trauma, 

Merlin Park Regional Hospital. HIPE records 

were searched for the period August 1996 to 

September 2000. Analysis of the data from 

charts and radiographs was performed. Of 

285 admissions, 175 were male (61.4%) and 

110 female (38.6%); (male:female 1.59:1.00). 

The range was 11-92 years (both sexes). Peak 

incidence was from 20-24 years, with 33 

admissions (11.6%). 49.1% of injuries were 

lumbar, 17.5% cervical, 23.9% thoracic, and 1.8% 

sacral. 7.7% were multi-regional. 217 injuries 

were to a solitary vertebra (76.1%), with 68 to 

multiple vertebrae (23.9%). 60% of injuries were 

due to falls, 35% to motor vehicle accidents 

(MVAs), and 5% to other mechanisms. Of 14 

cases with neurological abnormalities (4.9%), 

11 were male and three female. Six had upper 

limb findings, four lower limb findings, with 

four cases of quadriplegia. Fifty-six patients had 

additional injuries (19.6%); (39 male, 17 female). 

Seventy-eight patients had CT scans (27.4%), 

and 15 had MRIs (5.3%); five had both (1.8%). 265 

patients were treated conservatively (93.0%), 12 

were transferred (4.2%) and eight had surgery 

(2.8%). Falls cause most spinal trauma, but in 

the c-spine, MVAs are the primary cause. Fifty 

percent of injuries are lumbar. Twenty-five 

percent of injuries affect multiple vertebrae. 

One must always consider the possibility of a 

second spinal injury. There is poor access to out 

of hours radiological imaging. 

PA Sloane, JP McCabe 

Dept. of Orthopaedic and 

Trauma Surgery, Merlin 

Park Regional Hospital, 

Galway 

Over the last several decades, a 

number of graft materials have 

been used to replace and/or 

reinforce the tympanic membrane 

and scutum in otology. 

These include cartilage, which is readily 

available from the operation site, is pliable, 

and allows for good functional results. The 

objective of this research was to conduct 

preliminary investigations in characterising 

the vibration properties of cartilage using 

bi-axial mechanical techniques, and to 

determine the effect of graft thickness 

on the resulting vibrational properties. 

Cartilage removed during septoplasties/ 

septorhinoplasties and excess tragal cartilage 

from tympanoplasties/mastoidectomies was 

obtained. Informed consent was taken from 

the patients before the tissue was procured. 

A biaxial test fixture allowed the cartilage 

to be stressed along two axes. The fixture 

was attached to the base and crosshead of a 

tensile test machine. Force was transmitted 

through four stainless steel cables. Each cable 

was attached at one end to a load cell (10N) 

and at the other to the cartilage sample via a 

small clip. The mechanical properties of the 

cartilage were elucidated and data examined 

to assess difference in stiffness with varying 

thickness of the graft. Similar studies have 

been conducted on heart valves, skin and 

large intestine towards the design of medical 

devices by the NUIG research group. 

R Gallagher 1 , D Apatsidis 2 , 

A Pandit 2 , N Considine 1 , 

N Patil 1 

Dept. of Otolaryngology, 

Sligo General Hospital, 

Sligo 1 ; Dept. of Biomedical 

Engineering, National 

University of Ireland, 

Galway 2 

A review of the presentation and management of 

pyogenic spinal infection 

Haematogenous pyogenic spinal 

infection encompasses spondylodiskitis, 

septic discitis, vertebral 

osteomyelitis and epidural abscess. 

Management of pyogenic spinal infection can 

involve conservative methods and surgical 

intervention. We carried out a retrospective 

review of 48 cases of pyogenic vertebral 

osteomyelitis presenting over a twelve-year 

period to the National Spinal Injuries Unit of the 

Republic of Ireland. Our objective was to analyse 

the presentation, aetiology, management 

and outcome of 48 cases of non-tuberculous 

pyogenic spinal infection. 

Methods 

Both the Hospital Inpatient Enquiry (HIPE) 

System and the National Spinal Injuries Unit 

Database were used to identify our study 

cohort. The medical records, blood results, 

radiologic imaging and bacteriology results of 

all patients identified were reviewed. 

Results 

The average age of presentation was 59 years 

with an almost even distribution between 

males and females. Most patients took between 

three and six weeks to present to hospital. 

Diagnosis was confirmed by serological testing 

of inflammatory markers and radiological 

imaging. The most frequently isolated pathogen 

was Staph. aureus (75% of cases). Ninety-four 

percent of cases were managed by conservative 

measures alone, including antibiotic therapy 

and spinal bracing. However, in 6% of cases 

surgical intervention was required due to 

neurological compromise or mechanical 

instability. 

Conclusions 

With this large cohort of non-tuberculous, 

pyogenic spinal infections from the NSIU, we 

conclude that Staph. aureus is the predominant 

pathogen. In the vast majority, conservative 

management with antibiotic therapy and spinal 

bracing is very successful. However in 6% of 

cases surgical intervention is warranted and 

referral to a specialist centre is appropriate. 

JS Butler, MJ Shelly, 

M Timan, WG Powderly, 

JM O’Byrne 

National Spinal Injuries 

Unit, Dept of Orthopaedic 

Surgery, Mater 

Misericordiae University 

Hospital, Eccles St, Dublin 

54 Minimal incision for thyroid surgery I Miller, J Hughes, 

There is controversy over the 

optimal position and minimal 

length of the thyroidectomy 

incision. A large proportion of 

thyroid pathology is for benign 

pathology in women. There would 

be great advantage in an incision 

that offers adequate access and 

pleasing cosmetic scar. 

Study Design - Prospective. 

Methods 

From January 2003 to June 2004 the senior 

author (CT) performed 126 consecutive 

thyroidectomies. All patients except, those 

requiring neck dissection, had endoscopic 

assisted thyroidectomy performed or with 

previous thyroid surgery were included, 

leaving 80 patients for analysis. The first 40 

cases were attempted through a 5cm incision 

and the second 40 through a 4cm incision. 

The initial incision was extended as required. 

The weight and the jistology of the gland 

were recorded. 

Results 

Fifty-six hemi-thyroidectomies, two subtotal 

and 22 total thyroidectomies were 

performed. In the first group the median 

gland weight was 39.5grms and 62% of these 

were removed through a 5cm incision. In the 

second group the median gland weight was 

34grms and 75% were removed through a 

4cm incision. 

Conclusion 

The minimal incision provides excellent 

cosmesis for the majority of patients and is 

a useful addition to the thyroid surgeon’s 

armamentarium. 

M Rafferty, C Tynan 

Dept. of Otolaryngology, 

St. James’s Hospital, 

James’s Street, Dublin 



61 

1 

SESSION ONE SIX 




55 The facial nerve: one editorial, two authors, top-cited RN Wormald, I Ahmed, 

56 

The Science Citation Index (SCI) 

was introduced as a method of 

information retrieval such that a 

researcher can discover if a paper 

has been included as a reference in 

other publications. 

Citation analysis has been used as an 

objective measure of the quality of an article; 

the number of times that it has been cited 

or the citation score suggests a notable 

impact on the relevant scientific community. 

Citation analysis allows an author to assess 

supportive or argumentative discussion 

on a relevant topic and to produce a more 

accurate and impartial literature review. The 

aim of this study was to identify the mostcited 

article in otolaryngology/head and neck 

surgery journals and to provide a snapshot 

of the papers that cited it. Using a database 

provided by the Institute of Scientific 

Information (Philadelphia, PA) the most cited 

article in 28 clinical otolaryngology-head and 

neck journals and the papers that referenced 

it were identified. This was an editorial 

published in Otolaryngology Head Neck 

Surgery in 1985 by House and Brackmann on 

a grading system for the categorization of 

facial nerve function. The article received 615 

citations from a broad spectrum of specialties 

involved in the management of the facial 

nerve. The majority of citations were by 

articles published in otolaryngology/head 

and neck surgery or neurosurgery journals 

and were supportive of the system. However, 

the high citation rate is also due to the 

perceived shortcomings and lack of universal 

acceptance of the classification. 

A role for pneumolysin, a pneumococcal protein, in 

cochlear damage associated with meningitis 

Bacterial meningitis and chronic 

suppurative otitis media caused 

by Streptococcus pneumonia 

are associated with considerable 

otological morbidity. 

Pneumolysin, a pneumococcal protein, 

has been implicated as one of the main 

virulence/cytotoxic factors. Its pathogenicity 

is intimately dependent on an ability to 

form transmembrane pores on binding with 

cholesterol in target tissues. In the current 

study, wild type pneumolysin was perfused, 

at a number of different concentrations, 

into the guinea pig cochlea. The effects of 

this cytolytic exotoxin on the organ of Corti 

were characterised by electrocochleography. 

Intracochlear perfusion of pneumolysin 

(10µg/50µl) reduced the compound action 

potential of the auditory nerve within seconds. 

The cochlear microphonics (CM : F1=8kHz, 

F2=9.68kHz) and their distortion product 

(DPCM=2F1-F2) were also reduced, albeit 

in a slightly less dramatic fashion. At lower 

concentrations (1µg/50µl), a selective and earlier 

effect on inner hair cells was observed. These 

results clearly show that when sensory cells of 

the organ of Corti are exposed to pneumolysin 

a significant ototoxicity ensues (complete 

cochlear death when the concentration is 

high enough). Toxicity is dose-dependent and 

appears to be site-specific. Additional in-vitro 

work (organotypic culture, spectrofluorimetry 

and immunohistochemistry) is also presented 

that confirms the above in-vivo findings 

and explores possible underlying apoptotic 

mechanisms. 

JE Fenton 

Dept.of ENT Limerick 

Regional Hospital 

LJ Skinner, M Beurg, 

JM Aran, D Dulon 

Laboratoire de l’Audition, 

Hôpital Pellegrin, 

Bordeaux, France 

57 

58 

‘A man’s best friend’ A seven-year retrospective 

analysis of facial lacerations as a result of dog bites in 

the MWHB region 

Dog attacks involving children are 

common. 1 This is a retrospective 

study of facial lacerations involving 

dogs treated in the Mid-Western 

Regional Hospital. 

All patients were admitted on the Oral 

and Maxillofacial Surgery service. The data 

recorded: age, gender, location of lacerations, 

location of attack, time between presentation 

and admission and between admission 

and treatment, treatment on emergency 

or routine lists, hospital stay and patients 

requiring general anaesthesia for suture 

removal. 

The population was 14 (male four (29%), 

female 10 (71%). Mean age 4 (2-9) years. Four 

(29%) required booster tetanus toxoid. Eight 

(57%) had multiple lacerations. The following 

sites were involved: lips 9 (65%), eyebrows 

4 (28%) and cheek, chin and eyelids. Ten 

(71%) of attacks were domestic (7 family, 3 

grandparent), three (21%) on the street, one 

(7%) babysitters. Time between presentation 

and admission was two hours (range 1-4 

hours). Mean time between admission and 

treatment was five hours (range 1.5 - 13 hours). 

Eleven (79%) of patients were treated out 

of hours and three (21%) on routine lists. All 

patients received intravenous antibiotics 

in hospital followed by oral antibiotics on 

discharge. Mean hospital stay was 2 (1 - 5) 

days. Suture removal was performed 5days 

postoperatively. Eight (57%) patients required 

general anaesthetic. No patients required scar 

revision. 

This study confirms that the majority of 

dog bite injuries occur to young children in 

a domestic environment. Early admission, 

treatment with intravenous antibiotics 

and debridement and suturing of these 

lacerations leads to a satisfactory outcome in 

this small series. 

References 

I. Hallock GG. Dog Bites of the face with 

tissue loss J. Craniomaxillofacial Trauma 

1996; 2.(3): 49 55 

A role for the MAPK activated transcription factor 

PEA3 in HER2 regulation in human thyroid cancer 

While surgical resection remains 

the cornerstone of primary 

treatment in thyroid cancer it is 

often of limited benefit in the 

setting of poorly differentiated 

neoplasms. 

HER2, a human epidermal growth factor 

receptor, is recognised as a poor prognostic 

indicator in many cancers. PEA3 is a target 

of the mitogen activated protein kinase 

pathway (MAPK) and has been implicated in 

the transcriptional regulation of HER2. Our 

aim was to investigate the role of HER2 and 

PEA3 in human thyroid cancer. 

N Boyle, M Murphy, 

F Mulcahy, G Kearns 

Dept. of Oral and 

Maxillofacial, Mid- 


Dooradoyle, Limerick 

DO Kavanagh, E Myers, 

C O’Riain, TB Crotty, 

EW McDermott, 

NJ O’Higgins, ADK Hill, 

LS Young 

Depts. of Surgery and 

Pathology, St. Vincent’s 

University Hospital and 

the Conway Institute, 

University College Dublin 



61 

1 





59 

We localised the protein expression of PEA3 

and HER2 in a cohort of 108 thyroid cancer 

patients using immunohistochemistry. 

The influence of an activated MAPK on 

PEA3 protein expression and protein-DNA 

interaction within the HER2 promoter was 

assessed using western blotting and shift 

analysis respectively. PEA3 or HER2 protein 

expression was not detected in normal or 

adenomatous thyroid tissue. HER2 and PEA3 

expression associated with lymphovascular 

invasion (p=0.044, p=0.038 respectively), 

Adenoid cystic carcinoma of the head and neck: a 

review of cases 

Adenoid cystic carcinoma (ACC) 

is a slowly growing but highly 

malignant tumour of salivary 

gland origin that accounts for 10%- 

15% of salivary gland neoplasms 

and 1%-2% of all head and neck 

malignancies. 

It can arise within the major and minor 

salivary glands or mucous glands of the oral 

cavity and upper respiratory system. The most 

common site of occurrence is the palate, 

followed by the minor salivary glands and 

the paranasal sinuses. ACC is characterised 

by extensive local tissue infiltration and 

perineural spread, which result in a high rate 

of local recurrence despite aggressive surgical 

resection. Vascular invasion and a propensity 

for delayed metastases to distant sites also 

contribute to poor longterm prognosis. 

Objective 

To review all cases of ACC with respect to 

tumour site, T-stage, histological pattern and 

grade and surgical margins, in an effort to 

anaplastic tumours (p

61 

1 





62 

observed via an operating microscope and 

classified as 0 - no damage, 1 - stent charred 

but intact, 2 - stent destruction. The effects 

of the above were initially observed in air, 

followed by 75% oxygen and 25% nitrous 

oxide, 90% oxygen and 10% nitrous oxide 

mixtures and finally in 100% oxygen. 

We observed that once the KTP laser power 

setting was greater than 1.0 watts, all 

Parapharyngeal space tumours: is a midline approach 

necessary 

The parapharyngeal space (PPS) 

lies lateral to the upper pharynx. 

It is a potential space shaped like 

an inverted pyramid from the skull 

base to the hyoid bone. The PPS 

is important in the diagnosis of 

head and neck tumours due to its 

central location. 

PPS tumours comprise 0.5% of all head and 

neck neoplasms. 70-80% are benign and 20- 

30% malignant. Salivary gland, neurogenic 

and metastatic tumours are most common. 

Diagnosing and treating these tumours 

require surgical excision. The size, location, 

relationship to surrounding structures and 

suspicions of malignancy determine the type 

of surgical approach. 

Deep lobe of parotid and neurogenic tumours 

require a lateral approach (transparotid or 

transcervical). Midline approach (transoral or 

transmandibular) is used for minor salivary 

gland tumours situated in medial and 

upper PPS. 

We aim to outline the indications for the 

transmandibular technique. 

stents were damaged by laser irradiation 

independent of time or varied gaseous 

environments. 

Given the low power levels at which damage 

occurs, we suggest that KTP laser is unsafe to 

use in the presence of a Nitinol Accuflex stent. 

Results 

All patients with PPS tumours presenting 

to our Dept. at the Mater Hospital between 

1990 and 2004 were studied. Twenty-seven 

patients were treated. Eighteen patients 

(66.7%) had pleomorphic adenoma, two 

(7.4%) had malignant change in pleomorphic 

adenoma, two (7.4%) had Schwannoma, one 

(3.7%) each of sarcoma, lymphoma, polycystic 

sialadenitis, acinic cell carcinoma and 

Castleman’s Disease. 

Eighteen patients were treated with 

the transparotid approach, four by 

transmandibular, two by transoral, one 

by transcervical and one by combined 

transparotid and transmandibular approach. 

Conclusion 

Tumours more than 7cm in size and situated 

high up medially in the PPS were accessed via 

the transmandibular technique. Advantages 

and disadvantages will be outlined in this 

paper as will the complications. 

References 

Olsen KD. Tumours and surgery of the 

parapharyngeal space. Laryngoscope 

1994,104(suppl 63):1-28. 

GKC Sim, TP O’Dwyer 

Dept. of Otolaryngology/ 

Head & Neck Surgery, 

Mater Misericordiae 

Hospital 

63 

Radioablation therapy is an essential adjunct to 

ensure total thyroidectomy for carcinoma 

Adequate oncologic procedure for 

thyroid cancer mandates complete 

ablation of all functional thyroid 

tissue. Residual thyroid tissue 

following total thyroidectomy may 

be ablated using radioactive iodine 

ablation (RT). 

The aim of this study was to examine 

the effectiveness of RT following total 

thyroidectomy for cancer. 

A retrospective review was conducted of all 

patients undergoing RT, between January 

2003 and December 2004, for thyroid cancer 

following total thyroidectomy. All patients 

underwent a postoperative I131 (70 MBq) 

thyroid bed uptake scan. Radioablation was 

carried out by a single oral dose of I131 titrated 

to body surface area. Patients underwent 

follow-up thyroid bed uptake scans six 

months following RT. Whole body uptake 

scans pre and post treatment were also 

carried out in all patients. 

Forty-five patients (12 male, 32 female) with 

a median age (interquartile range; IQR) 41 

years (31-57) were included in the study. Thirty 

patients (67%) had papillary carcinoma, the 

remaining cancers were follicular (n=9), 

anaplastic (n=2) and Hurthle cell (n=4). The 

median (IQR) uptake of I131 following total 

thyroidectomy was 2.4% (0.7% – 7.1%). All 

patients received a median (IQR) dose of I131 

of 3635 MBq (2905 – 3819). Following RT the 

median (IQR) uptake 0.045% (0.02% – 0.073%) 

(p=0.0002 vs. postoperative; Wilcoxon signed 

rank test). Four patients had evidence of 

metastatic thyroid tissue outside the neck 

postoperatively. Three of these patients had 

complete resolution of metastases following 

treatment. 

Surgery alone is inadequate to achieve total 

thyroid ablation. Radioablation significantly 

reduces the volume of residual thyroid tissue 

and should be considered as a standard 

adjunct to surgery. 

N Keenan, KJ Sweeney, 

F Barker 1 , PF Ridgway, 

S Skehan 2 , M Moriarty 3 , 

ADK Hill, E McDermott, 

NJ O’Higgins 


St Vincent’s University 

Hospital and Depts. 

of Nuclear Medicine 1 , 

Radiology 2 and 

Radiotherapy 3 , St Luke’s 




1 

POSTER SESSION SESSION ONE 



1 


1 

Preventing 

2 

Prospective 

adverse medical events - identifying 

prescription errors on a general surgical ward 

One in ten patients suffer an 

unintended injury attributable to 

medical management that results 

in death, life-threatening illness, 

prolongation of hospital stay, or 

disability at time of discharge. 

Mistakes in prescribing medications are 

frequently identified as causes of adverse 

events. The aim of this study was to assess 

prescribing errors on a general surgical ward. 

A cross-sectional observational study 

examined prescribing records of 100 surgical 

inpatients randomly selected. A committee 

consisting of a doctor, pharmacist and nurse 

assessed legibility and prescribing error on 

drug cardexes. 

From 100 drug cardexes 946 individual 

prescriptions were examined. The patient’s 

name and hospital record number were 

omitted in 7% and 8% respectively of the 

100 charts audited. One in four prescriptions 

were deemed illegible. Dosage frequency 

and strength was omitted in 11% and 

8% of prescriptions respectively. Route 

of administration was omitted in 3% of 

prescriptions while the prescriber’s signature 

was not present in 2%. 

Other studies have demonstrated half of 

adverse patient events are preventable. In 

this study a significant number of simple 

prescribing errors were identified that could 

contribute to medical error. The findings 

suggest that an education programme 

emphasising these simple errors could 

improve patient safety. 

implementation of a risk adjusted audit in a 

Vascular Unit: a model for quality assurance 

Currently, crude morbidity and 

mortality rates are used to assess 

vascular surgical outcome and 

may not be representative of 

quality of care. This study aims to 

demonstrate the advantages of 

comparative vascular surgical audit 

with a risk-adjusted scoring system 

to monitor quality of care. 

Methods 

A validated vascular risk adjusted scoring 

system, V-POSSUM ( Vascular-Physiological 

and Operative Severity Score for the 

enUmeration of Morbidity and Mortality), 

was applied to a prospective series of 56 

vascular procedures over a two-month 

period. 30-day in-hospital morbidity and 

mortality were recorded. The patients 

were stratified into three groups based on 

expected morbidity as calculated with the V- 

POSSUM formula, group one 0-10% expected 

morbidity, group two 11-50% and group 

three 51-100%. Mean expected (V-POSSUM) 

and observed morbidity and mortality were 

calculated for each group. 

Results 

The mean expected morbidities for groups 

one, two and three were 7.3+/-0.9%, 23.9+/- 

6.1%, and 86.6+/-8.2% respectively. Observed 

K Bates, D Beddy, Z Martin, 

C Whiriskey, M Murphy, 

D Evoy, K Mealy, 

JB O’Mahony 



JS Byrne, E Condon, 

M Ahmed, D Mehigan, 

S Sheehan, M Barry 

Dept. of Vascular Surgery, 

St. Vincent’s University 

Hospital, Elm Park, Dublin 

3 

HMGB1-induced 

morbidities were 8.3%, 13%, and 60% for 

the same groups respectively. The expected 

mortalities for groups one, two and three 

were 0.5%, 1.9% and 30.13+/-9.1% respectively. 

Observed mortality was 0%, 0% and 30% 

for the three groups respectively. Observed 

morbidity and mortality in all three groups 

was similar or better than expected. 

Conclusions 

Comparative vascular surgical audit offers a 

validated simple method of assessing surgical 

performance and quality of care. 

proinflammatory cytokine release is 

unaltered by tolerisation with bacterial lipoprotein 

High mobility group box protein 

1 (HMGB1) is a proinflammtory 

cytokine that leads to lethality in 

sepsis. Tolerisation with bacterial 

lipoprotein (BLP) protects against 

lethality in sepsis in part by reducing 

HMGB1 gene transcription. Herein 

we characterised the effects of BLP 

tolerisation on HMGB1-induced 

cytokine secretion. 

Methods 

Human peripheral monocytes were harvested 

from healthy volunteers (n=10). Spontaneous 

as well as BLP (1000 ng/ml), LPS (1000 ng/ml) 

and rhHMGB1 (1000 ng/ml)-induced cytokine 

release were assessed following monocyte 

incubation with each, for 12 hours. A panel 

of cytokines (proinflammatory: TNF-a, IL- 

1ß, IL-6, IL-12p70) (anti-inflammatory: IL-10) 

were assessed flow cytometrically using a 

cytometric bead array (CBA). Next, moncytes 

were tolerised by coincubating with BLP 

(10 ng/ml) for 24 hours, after which the 

stimulatory effects of the above agents were 

again assessed as described. *P

1 




1 


4 

The 

sequential combination of electrosensitisation and 

low-intensity ultrasound therapy produces a synergistic 

antitumour effect 

5 

Achalasia: 

11-year retrospective review comparing 

symptomatic outcome and quality of life following Heller’s 

myotomy versus pneumatic dilatation of the oesophagus 

Use of electric-fields and 

ultrasound have both been shown 

to facilitate drug and gene delivery 

into tumours and tissues. In recent 

work, electrochemotherapy with 

bleomycin or, high-intensity focused 

ultrasound have shown promise 

for treatment of solid tumours 

with local control of cancers 

resistant to other therapies. 

Low-intensity ultrasound does not cause 

thermal ablation. This study demonstrates 

synergistic antitumour effects of local 

application of low-intensity ultrasound to 

tumours following exposure to an electricfield, 

and initial development of an optimised, 

reproducible system for achieving this effect. 

Tumours of the human oesophageal cellline 

OE19 were established in athymic nude 

mice and tumours of the murine colon 

adenocarcinoma cell-line C26 were established 

in immunocompetent Balb-C mice. Groups 

were constructed to compare effects on 

tumour growth of ultrasound alone, electric 

field alone, and combination of both against 

untreated controls. Tumours were measured 

on alternate days post-treatment, tumour 

volume calculated, and tumour growth 

curves constructed for all groups. 

Combined treatment caused OE19 regression 

in 66.6% of mice with two complete 

regressions lasting thirty days. No regressions 

occurred in the other groups (p

1 




1 


7 

The 

Intimal hyperplasia is known to be more 

evident with prosthetic grafts where it is 

concentrated at areas of flow disturbance 

around the distal anastomosis. Several factors 

have been implicated in the development 

of intimal hyperplasia including differences 

in the mechanical properties between 

prosthetic graft and native vessel and low 

flow states due to poor run-off. It is known 

that flow patterns created by end-to-side 

distal anastomoses exert abnormal wall 

shear stress distributions on the endothelial 

cells on the bed of the junction. The role of 

wall shear stress (WSS) in intimal thickening 

has been the subject of much debate. Several 

vascular surgeons have achieved improved 

patency rates for polytetrafluoroethylene 

(PTFE) bypasses by using an interposition vein 

cuff or patch. One theory of how vein cuffs or 

patches may improve anastomotic junctional 

hemodynamics is by decelerating the flow, 

thereby reducing peak WSS and relaxing WSS 

gradients. As a result it is commonly perceived 

that an optimum graft/artery junction 

geometry may exist. However, the patency 

solution to a big hole: dermal collagen graft 

K Ahmad; DJ Waldron; 

Large incisional hernias are 

a common complication of 

abdominal surgery and can be very 

difficult to manage. Porcine dermal 

collagen graft (Permacol) is a 

sterile, moist, tough but flexible 

sheet, which contains acellular, 

cross-linked porcine dermal 

collagen and elastin fibres. 

It is non-allergenic and non-toxic. Porcine 

dermal collagen grafts have recently become 

available for incisional hernia repair and we 

report our early experience with this material. 

rates associated with these procedures are 

moderate. Each technique is said to have an 

added advantage over conventional bypass 

grafting with synthetic grafts in that the use 

of autologous vein helps buffer compliance 

mismatch between the elastic host artery 

and the rigid graft when synthetic grafts 

are used. Each technique is also thought to 

improve the flow patterns in the junction 

area, and thus improve the patency rates of 

the bypass procedure. It is believed that an 

optimum graft/artery junction geometry 

to significantly improve peripheral bypass 

patency rates may not exist. 1 

A novel device the Prolong Graft is 

presented as one of the few methods of 

producing significantly improved paterncy 

rates for this procedure. 

References 

1. Walsh M, McGloughlin T. Flow patterns in a 

novel end-to-side bypass graft Biomedical 

Engineering Society Annual Meeting 

Philadelphia USA Oct 13th -16th 2004 

Methodology 

Thirteen successive patients undergone 

incisional hernia repair with porcine dermal 

collagen graft between August 2002 and 

October 2004 were included. 

The patients ages ranged from 42 to 82 

years and 54% were female. Three patients 

had an emergency repair for obstructed 

incisional hernia while 10 patients had an 

elective procedure. Five patients had previous 

attempts to repair their hernias; one had 

three repairs, one had two repairs and three 

had one attempt at repair. Ten patients had 

a single graft (10x15-cm) repair, two had two 

grafts and one patient had seven grafts to 

repair a giant incisional hernia. Postoperative 

hospital stay ranged from 8 days to 36-days. 

PA Grace 


Mid-Western Regional 

Hospital & University of 

Limerick 

The follow-up ranged from 3 to 18 months with 

no recurrence. One patient had a localised 

wound infection that settled with oral 

antibiotics. Two patients had wound breakdown 

with necrosis of skin flaps, one with active 

Crohn’s disease and on steroids and the 

second with an iliac artery aneurysm repair. 

Conclusion 

Porcine dermal collagen graft is a 

safe biological material that is readily 

incorporated into the host tissue resulting 

in a permanent repair. It is especially useful 

in hostile wounds. The advantages of this 

graft emphasise the potential use of this 

biomaterial in a wider range of surgical 

applications. The disadvantages of this 

material are that it is only available in a single 

size of 10 x 15 cm and is very expensive at 

E2,073.83 per sheet. 

8 

Initial short term experience in non-operative 

management of critical limb ischaemia (CLI) using a 

biomechanical device 

Revascularisation is not always 

feasible in a significant proportion 

of patients with CLI due to 

anatomical or co-morbid factors. 

Our aim is to report our initial experience 

with ArtAssist® device in patients with CLI. 

Our primary endpoints were limb salvage and 

symptomatic patency. Secondary end points 

were changes in ABPI and toe pressures. 

From August to November 2004, 34 patients 

presented with CLI. Of these, 10 (12 limbs) 

were not suitable for revascularisation and 

were treated with ArtAssist® for 12 weeks. 

Exclusion criteria were severe infection, DVT 

and inability to tolerate compression. All 

patients were given best medical treatment 

and had a duplex scan and ABPI, initially and 

at four weeks intervals thereafter. MRA was 

done in those anatomically unsuitable for 

reconstruction. 

Male: female was 7:3. Mean age was 77.5 

years (range 58-89 years). Six patients were 

included due to anatomical factors and four 

due to co-morbidities. All patients were at 

least Rutherford classification IV and ASA 

III. Six patients were diabetic, and two were 

immobile. The paired-student’s t test was 

used and ABPI increase of 0.05 in this short 

period was taken to be clinically significant. 

Limb salvage was 100%. There was 

a significant decrease in analgesia 

requirements from week 1 onwards. Gangrene 

remained dry and non-progressive with 

no need for antibiotics. ABPI increased 

significantly (t = 1.911, df=11, p

1 




1 


9 

Wedge resection with segmental phenolization in the 

treatment of ingrowing toenails. A better outcome 

In growing toe nails cause a great 

deal of discomfort and may result 

in missed time from school, work 

and sports. Different treatments 

methods with different outcomes 

have been described in the 

literature ranging from simple 

conservative measures e.g. silver 

nitrate cautery to more radical 

surgical procedures like partial 

matrix excision with or without 

segmental phenolization 1,2 but the 

standard approach is still the topic 

of debate. 

A retrospective analysis was undertaken 

on 100 consecutive patients (55 males and 

45 females) who had ingrowing toe nail 

surgery of the hallux between January 2000 

to June 2004. In all 168 procedures were 

performed on medial and/or lateral margins 

of one or both halluces. All procedures were 

performed by same surgeon in the day ward. 

A telephonic questionnaire was used to 

evaluate the postoperative 

morbidity, complications recurrence, patient’s 

satisfaction for scar and overall satisfaction. 

The overall response rate was 60%. 

Recurrence rate requiring further surgery was 

less than 1% (1 in 105 procedures studied). 

Postoperative infection rate was 2.4%. 

Patients’ scar satisfaction was 98% and 

overall patients’ satisfaction rate 99%. The 

mean time to return to work and normal 

activates was 2.1 weeks. 

Compared to the international standards 

our results show that this technique is safe, 

quick less painful and easy with minimal 

complications, better cosmetic results and 

the recurrence rate is less than 1%. 

References 

1. Gerritsma-Bleeker CL, Klaase JM, Geelkerken 

RH, Hermans J, van Det RJ. Partial matrix 

excision or segmental phenolization for 

ingrowing toenails. Arch Surg. 2002 Mar; 

137(3):320-5. 

2. Fulton GJ, O’Donohoe MK, Reynolds JV, 

Keane FB, Tanner WA. Wedge resection alone 

or combined with segmental phenolization 

for the treatment of ingrowing toenail. 

Br J Surg. 1994 Jul; 81(7):1074-5. 

FM Shaikh, M Jafri, R Keane 

Dept. of Surgery, St. John’s 


11 

Methods 

Fifty-one patients undergoing surgery for 

a suspected parathyroid adenoma were 

prospectively analysed. All patients had 

a sestamibi scan performed three hours 

pre-operatively. PTH levels were recorded 

pre-operatively and five minutes after 

excision of a suspected adenoma. We used 

the combination of histological diagnosis 

and normalization of post-operative serum 

calcium levels to define successful resection 

of a parathyroid adenoma. Statistical analysis 

was performed using the Wilcoxan Rank test. 

Results 

In-vivo counts over the adenoma and 

background were compared with ex-vivo counts 

over the resected specimen. The decrease in 

PTH five minutes post excision was recorded. 

An ex-vivo count of 40 % over the resected 

specimen combined with a 45% decrease 

in PTH levels were significantly associated 

with a histologically confirmed parathyroid 

adenoma (p=0.018 and p=0.021 respectively). 

Conclusion 

A combination of ex-vivo gamma probe activity 

counts and intra-operative PTH assay accurately 

predicts resection of a parathyroid adenoma. 

Implementation of the continuous auto-transfusion 

system (CATS) in open AAA repair: a seven-year experience 

CATS is aimed at conserving the 

use of allogenic blood. However it 

often does not prevent the need 

for transfusion. 

The aim of our study is to assess the 

benefit of CATS in reducing allogenic blood 

transfusion intraoperatively and within the 

first 24 hours. Primary endpoint is number 

of packed RBCs transfused, complications of 

massive transfusion, mortality and secondary 

endpoint is length of hospital stay. 

CATS patients were re-infused an average of 

596ml (161-2600ml) of packed RBC’s. Eight 

patients (16%) did not require any further 

allogenic transfusion, while eighteen patients 

(36%) required only 2 units or less allogenic 

transfusion within the first 24 hours. All 

patients in the control group required 3 

or more units of allogenic packed RBC’s 

within the first 24 postoperative hours. The 

difference in mortality rates between the 

groups, 10% in the CATS group compared to 

14% in the Control group, was not statistically 

significant. 

W Tawfick, SE Tawfik, 

N Hynes, B Mahendran, 

A Jawad, A Ishtiaq, 

E Andrews, D Courtney, 

S Sultan 

Western Vascular Institute, 

Dept. of Vascular and 

Endovascular Surgery, 

University College Hospital 

Galway, Galway 

10 

The role of gamma probe activity counts and intraoperative 

PTH assay in predicting a parathyroid 

adenoma in minimally invasive parathyroidectomy 

The role of gamma probe activity 

and intra-operative parathyroid 

hormone (PTH) assay is well 

established in the surgery of 

primary hyperparathyroidism. 

The aim of this study was to 

assess the accuracy of using 

these techniques combined, as 

predictors of successful resection 

of a parathyroid adenoma. 

G Murphy, E Myers, 

M O’Donovan, 

HP Redmond 

Dept. of Surgery, Cork 

University Hospital 

Between August 1997 to August 2004, 85 

patients underwent open AAA repair. Fifty 

of which were done using the “CATS”. Fiftyseven 

percent of the patients were male with 

a mean age of 70 years in the CATS group 

and 65 years in the control group. Thirty-five 

patients in the CATS group and 23 in the 

control group were elective. 

CATS has markedly reduced the amount 

of blood transfused & subsequently the 

complications associated with allogenic 

blood transfusion in AAA surgery. Although 

expensive to setup initially, it has proven to be 

more cost-effective using it on a continuous 

basis for over two years. 



1 




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12 

Prospective study of self administered enema for 

left colonoscopy 

The aim of this study was to 

compare home administered 

enema with hospital administered 

enema, to evaluate its acceptance 

comparing instructions on 

telephone with personal 

instructions. Sixty-three day cases 

patients were prospectively studied. 

Group 1 patients were given written and 

verbal instructions at outpatient visit. Group 

2 patients were contacted by telephone, 

phosphate enema was posted to them with 

written instructions. All patients were given a 

questionnaire on their satisfaction. Adequacy 

of preparation was graded by the endoscopist, 

blinded to the preparation method,on a scale 

of 0-10. 

Group 1 (20 patients). 14 (70%) agreed. Six 

(30%) refused and another two (10%) were 

unable to self administer. 

Group 2 (22 patients). Nine (41%) agreed, three 

(13.6%) were excluded due to inability and ten 

(45.45%) were reluctant. 

Group 3 (21 patients) reluctant or unable to 

administer home preparation were given the 

enema by the nursing staff. 

Bowel preparation was better in Group 1 & 2. 

There was higher acceptance rate when 

the procedure was explained in person. 

Satisfaction in both groups was similar. 

Home administration had a high degree 

of patient satisfaction. Majority of patient 

administered the enema satisfactorily, with 

good results. There was a reduced nursing 

workload, with a improved throughput in 

the endoscopy suite. We now routinely offer 

this preparation at the time of outpatient 

consultation in our unit. 

References 

Lund J.N., Buckley D, Bennett D, Maxwell- 

Armstrong C, Smith A, Tierney G, Scholefield 

J A randomised trial of hospital versus 

home administered enemas for flexible 

sigmoidoscopy. BMJ. 1998 Oct 31;317(7167):1201. 

Drew P.J., Hughes M, Hodson R, Farouk R, Lee 

P.W., Wedgwood K.R., Monson J.R., Duthie 

G.S. The optimum bowel preparation for 

flexible sigmoidoscopy. Eur J Surg Oncol. 1997 

Aug;23(4):315-6. 

GROUP 1 GROUP 2 GROUP 3 

Mean Score 0-10 9.0 9.2 8.6 

Inadequate preparation < 8 12% 14% 27% 

Patient acceptance 70% 41% NA 

Patient satisfaction 80% 84% NA 

IZ Khan, SA Khan, 

AHM Medani, 

O Elzamzami, D Buckley 

Dept. of Surgery, Midllands 

Regional Hospital, 

Mullingar, Westmeath 

13 Liver resection for non-colorectal metastases M Ahmed, MB Zaman, 

14 

A total of 380 liver resections were 

performed in this unit from 1991 to 

2004, 22 were for non-colorectal 

liver metastases. 

There were 15 women and seven men 

(mean age 53.4 years) Origin included 

carcinoid (4), kidney (4), breast (3), 

sarcoma (5), ovarian (2) Islet cell tumour 

(1), adrenal (1), melanoma (1), and unknown 

primary (1). There were 15 anatomical 

resections (10 bisegmentectomies, five left 

lateral segmentectomies, four extended 

left hepatectomies, one right hepatectomy, 

one extended right hepatectomy, and 

one monosegmentectomy) and six nonanatomical 

resections. 

In-hospital mortality occurred in two patients 

with severe metabolic derangements 

due to Cushing’s syndrome and carcinoid 

respectively. Seven patients died with 

recurrent disease within five years of surgery. 

Three with sarcoma, one with breast, one 

with kidney, one with carcinoid and one with 

unknown primary. Patients with sarcoma 

had worse prognosis as three out of five died 

within three years of surgery from recurrent 

disease. There were ten deaths in total but 

remaining twelve patients were disease free 

with a mean follow-up of 37 months (range 

10-120 months). Longest survival (10 year) was 

observed in patients with carcinoid. 

Liver resection can prolong survival in 

carefully selected patients with noncolorectal 

metastasis in the absence of 

other therapeutic alternatives. Survival 

was significantly better in patient with 

secondaries from neuroendocrine tumours, 

worse for those with sarcomas. 

Acute cholecystitis – is interval cholecystectomy 

justifiable 

The optimal means of managing 

patients presenting with acute 

cholecystitis remains controversial. 

Interval laparoscopic cholecystectomy has 

been an accepted management for 

some time. However, some consider 

that it may be associated with increased 

morbidity. This is a consequence of 

unplanned readmissions due to symptomatic 

cholelithiasis or recurring cholecystitis. 

The aim of our study was to establish 

the morbidity attributable to interval 

laparoscopic cholecystectomy in our practice. 

All patients presenting with acute 

cholecystitis in 2002 and subsequently 

undergoing a laparoscopic cholecystectomy 

were included in our study. 

Of 79 patients admitted with symptomatic 

cholelithiasis, 55 were diagnosed with acute 

cholecystitis. There were 41 female and 14 

male patients. Choledocholithiasis was 

documented in eight patients requiring an 

ERCP. All had an interval cholecystectomy 

planned. Five of the fifty five patients 

represented early with recurrent cholecystitis. 

All underwent cholecystectomy at the time 

of second admission. Interval laparoscopic 

cholecystectomy was successfully completed 

in the remaining 50 patients, one of 

which required conversion to an open 

cholecystectomy. The average length of hospital 

stay was 3.5 days. There were no mortalities. 

Interval laparoscopic cholecystectomy is 

an effective and safe option in treatment 

of acute cholecystitis. Although 9% of our 

patients represented early this was not 

associated with increased morbidity. 

D Maguire, J Geoghegan, 

O Traynor 

The Liver Unit, St. Vincent’s 

University Hospital, 

Elm Park, Dublin 

A Hafeez, WY Kwong, 

FO Cunningham, 

J P McGrath 

Dept. of Gastrointestinal 

Surgery, Our Lady’s 

Hospital, Navan, Meath 



1 




1 


15 The role of hand held Doppler in acute scrotal pain K Ahmad; P Hickey; SC Ng; 

Testicular pain represents a 

troublesome clinical entity whose 

diagnostic evaluation and effective 

treatment is a challenge for the 

surgeon. 

Testicular torsion is a devastating acute 

condition due to strangulation of the arterial 

blood supply to the testis. Ultra-Sonography 

plays an important role in the assessment of 

the patient with acute scrotal pain but may 

delay the diagnosis for some minutes or hours. 

Methodology 

Twenty-two successive patients who 

presented to the A/E Dept. between Oct.2003 

and June 2004, had hand held doppler (HHD) 

examination of their testicular arteries. Data 

collected about the pain, swelling, tenderness, 

HHD, ultrasound studies and exploratory 

findings. 

Results 

All the patients had HHD examination. 

Fifteen patients had positive testicular artery 

signals while seven patients had no signals. 

All seven were explored and confirmed 

the diagnosis of testicular torsion. Of the 

15 cases with positive signals, three were 

explored, as these patients had a very strong 

clinical suspicion of testicular torsion but on 

exploration no torsion was found. The HHD & 

clinical examination was repeated four hourly 

for 12 hours. The remaining 12 cases with 

positive HHD signals had a planned testicular 

ultrasound which confirmed the diagnosis of 

inflammatory disease. All these patients were 

subsequently reviewed by the urologist. 

Conclusion 

Our study reveals that the HHD examination 

is an easy and reliable tool for assessing the 

testicular blood flow in the emergency Dept.. 

Prompt surgical exploration is recommended 

if there is any uncertainty about the 

diagnosis. We recommend a multi-centre 

study should be carried out to establish the 

role of HHD examination in acute scrotal pain. 

ST Cheema; J Drumm; 

SA Naqvi 




16 Equestrian related injuries – not just an Olympic problem! G. McHugh, Z. Martin, 

17 

Equestrian-related injuries are 

known to be very common and are 

a significant cause of morbidity 

and mortality. 

However, whilst numerous articles are 

available in the literature, very little data exist 

at a national level regarding the number of 

patients involved, the injuries sustained or on 

how many could have been prevented. 

We performed a retrospective study over 

a two-year period to quantify equestrian 

related injuries in our catchment area and 

how they might be prevented. 

73 patients required admission following 

equestrian related injury in this time period. 

The age distribution was bi-modal with 

a peak in the teenage years and a second 

smaller peak in the 40 – 50-year-old age 

group. Almost half of the patients were 

injured by a straightforward fall off the 

horse whilst a third were injured by a kick. 

Interestingly the compliance with helmet 

use in those who fell from a horse was good 

at 91% however the uptake among those 

who were kicked was much lower at 19% 

resulting in a much higher percentage of skull 

fractures. 

Our study supports other studies showing 

the highest incidence of injury in young 

amateur female riders. We propose the need 

for increasing awareness and training in this 

group. Also, protective head gear should be 

made compulsory in those working in an 

equestrian environment in an attempt to 

decrease the morbidity from head injuries. 

Atypical mycobacterial tenosynovitis of the hand. The 

management role of preoperative magnetic resonant 

Imaging (MRI) 

K.Mealy, J.B. O’Mahony, 

D Evoy 



SYMPTOMS, DURATION, DOPPLER, U/S, EXPLORATION NUMBERS % 

Testicular Pain 22 100 

Scrotal Swelling 19 86 

Tenderness 18 81 

Duration < 24hr 17 77 

Hand held doppler done 22 100 

Ultrasound scan done 12 54 

Doppler signal positive on testicular artery 15 68 

No doppler signals on testicular artery with hand held doppler 07 31 

Exploration done 10 45 

Torsion found 07 31 

Tuberculosis of the hand is rare. 

The tendon sheath of the hand 

and wrist is the most commonly 

involved parts. 

The diagnosis of the flexor sheath 

tuberculosis is difficult and it is usually 

made after surgery both pathologically and 

bacteriologically from material obtained at 

operation, over the past four years decayed 

atypical Mycobacterial hand infections are 

reported far more often than those caused 

by Mycobacterium tuberculosis, the use of 

magnetic resonant image (MRI) may give 

preoperative diagnostic aid of the tuberculous 

tenosynovitis and allow evaluations of the 

extent of the disease and justify the use of 

the antituberculous drug in the immediate 

postoperative period when there is delay in 

the definitive histological or bacteriological 

diagnosis. We are presenting a case report of 

an atypical Mycobacterial tenosynovitis of 

the hand with MRI finding and reviewing the 

articles to outline the management of 

these cases. 

T Ismael 





1 




1 


18 Two rare causes of carpal tunnel syndrome WHC Tiong, T Ismael, 

Carpal Tunnel Syndrome (CTS) 

is the most common peripheral 

nerve entrapment. Most carpal 

tunnel syndromes are idiopathic. 

Other causes include intrinsic factors 

(exerting pressure within the tunnel), 

extrinsic factors (exerting pressure from 

outside the tunnel), and overuse/exertional 

factors. The extrinsic factors include 

compression by benign tumours such as 

lipomas, ganglion, and vascular malformation. 

We present benign schwannoma and fibroma 

of tendon sheath (FTS) as two separate rare 

causes of CTS. Both benign schwannoma and 

FTS are very rare causes of CTS with only two 

cases and five cases reported in the literature 

over the last 30 years respectively. 

Peripheral nerve tumours are rare with 

an incidence of 1 per 100000 per annum. 

Primary nerve tumours have been reported 

to account for 1-5% of all hand tumours. 

The most common among them is benign 

schwannoma. FTS is a well-circumscribed, 

often lobulated but non-encapsulated 

tumour attached to tendon or tendon sheath. 

Both tumours tend to cause symptoms 

secondary to compression of adjacent 

structures without actual penetration into 

parental structures. This enables surgical 

enucleation of the tumour and hence, every 

attempt should be made to preserve the 

parental structure involved. Although these 

are benign tumours, inadequate excision of 

these tumour can lead to recurrence. 

The conclusion drawn from both of the 

above cases is the emphasis of complete 

local excision with maximum preservation 

of parental structures for all these benign 

tumours in the hand. 

References 

1. Josty IC, Sykes PJ. An unusual schwannoma 

of the median nerve: effects on the motor 

branch. Br J Plast Surg. 2001 Jan; 54 (1): 71-3 

2. Rosai J. Rosai and Ackerman’s Surgical 

Pathology. 9th ed. Vol 2. 2004 Mosby: 2264-66 

PJ Regan 

Dept. of Plastic, 

Reconstructive and Hand 

Surgery, University College 

Hospital Galway 

20 

Release of anterior neck burn contracture using 

artificial dermis and vacuum assisted closure 

– a case report 

Contractures are commonly 

encountered following burn injury 

and are debilitating in terms of 

function and cosmetic appearance. 

The objective in releasing a contracture of 

the anterior neck is to improve both function 

and appearance, by restoring the anatomic 

profile and contour of the neck. A number 

of methods have been reported in the 

literature for the treatment of anterior neck 

contractures. These include split skin grafts, 

full thickness grafts, local flaps, z-plasties and 

free flaps. Tissue expansion is also an optional 

adjunct to reconstruction. 

Method 

We report a novel method used to release 

an anterior neck contracture in a 14-year-old 

boy using artificial dermis – Integra (Intergra 

Life Sciences, Plainsboro, NJ) and vacuum 

assisted closure (KCI, San Antonio, Texas). 

It is the first of its kind in the literature. A 

bilateral fish mouth incision was used to 

release a severe anterior neck contracture 

in a 14-year-boy. Integra was sutured into 

the 25 x 8 cm defect and held in place by a 

vacuum assisted closure pump at continuous 

pressure of 75 mmHg. Two weeks later, the 

Integra was covered with a split skin graft. A 

post-operative infection necessitated further 

debridement and a second split skin graft, 

which took successfully. There was 95% take 

of skin graft in this case. 

Conclusion 

This abstract highlights a novel method of 

releasing an anterior neck contracture, with 

a high percentage graft take over artificial 

neodermis. 

JB Lynch, T Ismael, A Saad, 

JL Kelly 

Dept. of Plastic Surgery, 



19 

Dupuytren’s contracture in a child – a case report and 

review of literature 

Dupuytren’s disease is a superficial, 

progressive fibromatosis of 

unknown aetiology, resulting in 

palmar nodules and contractures 

of the fingers. 

It is thought to be inherited as an autosomal 

dominant condition with incomplete 

penetrance and generally a disease of 

adults with a peak incidence over 40 years 

of age. Dupuytren’s diathesis as described 

by Hueston is characterised by an early age 

of onset, a strong family history, bilateral 

aggressive disease with rapidly progressing 

contractures which is prone to early 

recurrence and is often associated with 

other fibromatoses such as Lederhosen and 

Peyronie’s disease. Dupuytren’s disease in 

children is exceedingly rare. Only a few cases 

are reported in the literature. We present a 

case of histologically confirmed diagnosis of 

Dupuytren’s disease in a 12-year-old boy who 

presented with a flexion contracture of his 

thumb. Following fasciectomy, he achieved 

good result with full extension of his thumb. 

We aim to highlight this condition as one 

of the differential diagnosis in a child who 

presents with fibrotic bands or nodules in the 

hand and also to review its current literature. 

W Lee, JB Lynch, JL Kelly 

Dept. of Plastic, 

Reconstructive and Hand 

Surgery, University College 


21 A review of ENT consultant postal questionnaires N Ramphul, J Saunders*, 

In recent years, there appears 

to have been an increase in the 

number of postal questionnaires 

being received by ENT consultants. 

Questionnaires with unsound methodology 

waste the time of those who send and 

receive them, as inferences cannot be made 

from their results. In this study, a review was 

performed on a sample of 19 questionnaire 

studies published in two ENT Journals 

between January 1998 and December 2002. 

Each study was given a 30-point score, 

based on the quality of its methodology. The 

average score assigned to each study was 

32%, suggesting that quality of methodology 

was generally poor. These results should serve 

as a warning to those embarking on and 

those interpreting research of this kind. 

I Ahmed, JE Fenton 

Dept. of ENT, Head 

and Neck Surgery, Mid 


Limerick and Statistical 

Consulting Unit*, Dept. 

of Mathematics and 

Statistics, University of 

Limerick 



1 



22 

23 

Seven-year retrospective review of facial lacerations treated 

under general anaesthesia by the Oral and Maxillofacial 

Surgery Deptartment of the Mid-Western Regional Hospital 

Patients with facial lacerations 

commonly present to Accident and 

Emergency Departments. A large 

number particularly children require 

suturing under general anaesthesia. 1 

This is a seven-year (1998 – 2004) retrospective 

study of facial lacerations admitted under the 

Oral and Maxillofacial Surgery Service and 

treated under general anaesthesia at the MWRH, 

Limerick. The data recorded: aetiology, gender, 

age, site location where injury occurred, site of 

facial laceration, associated injuries, admission to 

treatment time, hospital stay, for scar revision. 

The population was 216 [male 138 (64%), female 

78 (36%)]. The mean age was 11 years (13 months 

- 86 years). One hundred and twenty-two (57%) of 

patients were less than 10-years-old. Aetiological 

factors: falls 134 (62%), road traffic accidents 27 

(12.5%), assaults 19 (8.7%), dog bites 14 (6.4%), 

miscellaneous 22 (10%). The following locations 

were recorded: domestic/farm 119 (55%), public 

place 80 (37%), school 12 (5.5%), bar 5 (2%). 

Laceration sites were: lip 36%, forehead 23%, 

cheek 19%, and tongue 12.5%. Other sites included 

the palate, the gingiva, chin and scalp. 43 (20%) 

patients had associated injuries: 20 orthopaedic, 

nine facial fractures, five dental, two skull fractures, 

one globe rupture and five miscellaneous. 

Admission to treatment was 12 hours (range 2 – 48 

hours). One hundred and seventeen (54%) treated 

out of hours, 99 (46%) routine lists. Hospital stay 

was three (range 1 – 18) days. Two patients (0.9%) 

required scar revision. 

Suturing of facial lacerations leads to significant 

out of hours activity (54%), but also disruption of 

routine operating lists (46%). The availability of an 

emergency theatre facility to treat these patients 

would reduce the need to postpone elective surgery. 

References 

1. Zerfowski M, Bremerich A: Clin Oral Investig 

1998; Sep2 (3) 120-4 

Isolated mandibular angle fractures (MAF): a seven-year 

retrospective study 

N Boyle, M Murphy, 

F Mulcahy, G Kearns 


Maxillofacial Surgery, 


Hospital, Dooradoyle, 

Limerick 

The management of MAF is 

traditionally associated with high 

complication rates. 

This is a seven-year retrospective study of 

patients with isolated MAF treated using the 

following protocol: arch bar placement, exposure 

of fracture site, 2.0mm miniplate adapted to the 

superior border, wisdom tooth removal unless 

completely covered by bone, guiding elastics 

used postoperatively, as necessary to achieve an 

ideal occlusion. Patient demographics, fracture 

aetiology, removal of tooth in the fracture line, 

length of hospital stay (LHS), and postoperative 

complications were recorded. Patients with 

concomitant maxillofacial fractures or those 

with MAF treated with closed reduction or open 

reduction via an extraoral approach were excluded. 

Forty-seven subjects (45 male, 2 female) were 

included. The mean age was 24.3 (16- 42) years. 

The mean time to presentation following injury 

was 1.75 (0-16) days. Fracture aetiology was as 

follows: assault 68% (n=32), sport 21% (n=10) falls 

9% (n=4); road traffic accidents 2% (n=1). Alcohol 

intake was reported in 90% (n=29) of the assaults. 

LHS was 5.4 (3-12) days. Pre- and postoperative stay 

1.9 (0-6) and 2.5 (1-5) days respectively. All patients 

underwent successful fracture treatment. 10.5% 

(n=5) of patients experienced minor complications. 

Soft tissue infection occurred in 8.5% (n=4). 

This occurred following fracture healing and 

was treated with oral antibiotics and bone plate 

removal as day case surgery. Fracture of the bone 

plate occurred in one case (2%). No bone related 

infections, malunion, nonunion or malocclusions 

were recorded. The mean follow-up was 26.2 

(3-104) weeks. 

Adherence to a strict protocol in the management 

of isolated MAF results in relatively low 

complication rates. 

CP Barry, GJ Kearns 


Maxillofacial Surgery, 



72 IRISH JOURNAL OF MEDICAL SCIENCE • VOLUME 174 • NUMBER 1 • SUPPLEMENT 1

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