| Beddy, P., Ridgway, P., Beddy, D., Clarke, E., Traynor, O. & Tierney, S. (2008), "Defining useful surrogates for user participation in online medical learning.". Adv Health Sci Educ Theory Pract . |
| Abstract: "School for Surgeons" is a web-based distance learning program which provides online clinical-based tutorials to surgical trainees. Our aim was to determine surrogates of active participation and to assess the efficacy of methods to improve usage. Server logs of the 82 participants in the "School for Surgeons" were assessed for the two terms of the first year of the program. Data collected included total time online, mean session time, page requests, numbers of sessions online and the total number of assignments. An intervention regarding comparative peer usage patterns was delivered to the cohort between terms one and two. Of the 82 trainees enrolled, 83% (85% second term) logged into the program. Of all participants 88% (97% second term) submitted at least one assignment. Median submissions were four (eight second term) per trainee. Assignment submission closely correlated with number of sessions, total time online, downloads and page requests. Peer-based comparative feedback resulted in a significant increase in the number of assignments submitted (p < 0.01). Despite its recent introduction, "School for Surgeons" has a good participation rate. Assignment submission is a valid surrogate for usage. Students can be encouraged to move from passive observation to active participation in a virtual learning environment by providing structured comparative feedback ranking their performance. |
BibTeX:
@article{Beddy2008,
author = {Peter Beddy and Paul Ridgway and David Beddy and Eric Clarke and Oscar Traynor and Sean Tierney},
title = {Defining useful surrogates for user participation in online medical learning.},
journal = {Adv Health Sci Educ Theory Pract},
year = {2008},
url = {http://dx.doi.org/10.1007/s10459-008-9141-3},
doi = {http://dx.doi.org/10.1007/s10459-008-9141-3}
}
|
| Broe, D., Ridgway, P.F., Johnson, S., Tierney, S. & Conlon, K.C. (2006), "Construct validation of a novel hybrid surgical simulator.". Surg Endosc . Volume 20(6), pp. 900-904. |
| Abstract: BACKGROUND: Simulated minimal access surgery has improved recently as both a learning and assessment tool. The construct validation of a novel simulator, ProMis, is described for use by residents in training. METHODS: ProMis is a surgical simulator that can design tasks in both virtual and actual reality. A pilot group of surgical residents ranging from novice to expert completed three standardized tasks: orientation, dissection, and basic suturing. The tasks were tested for construct validity. Two experienced surgeons examined the recorded tasks in a blinded fashion using an objective structured assessment of technical skills format (OSATS: task-specific checklist and global rating score) as well as metrics delivered by the simulator. RESULTS: The findings showed excellent interrater reliability (Cronbach's alpha of 0.88 for the checklist and 0.93 for the global rating). The median scores in the experience groups were statistically different in both the global rating and the task-specific checklists (p < 0.05). The scores for the orientation task alone did not reach significance (p = 0.1), suggesting that modification is required before ProMis could be used in isolation as an assessment tool. CONCLUSIONS: The three simulated tasks in combination are construct valid for differentiating experience levels among surgeons in training. This hybrid simulator has potential added benefits of marrying the virtual with actual, and of combining simple box traits and advanced virtual reality simulation. |
BibTeX:
@article{Broe2006,
author = {D. Broe and P. F. Ridgway and S. Johnson and S. Tierney and K. C. Conlon},
title = {Construct validation of a novel hybrid surgical simulator.},
journal = {Surg Endosc},
year = {2006},
volume = {20},
number = {6},
pages = {900--904},
url = {http://dx.doi.org/10.1007/s00464-005-0530-x},
doi = {http://dx.doi.org/10.1007/s00464-005-0530-x}
}
|
| Cox, M., Madhavan, P. & Feeley, T.M. (1998), "Primary repair of ruptured aortitis.". Eur J Vasc Endovasc Surg . Volume 15(5), pp. 454-455. |
BibTeX:
@article{Cox1998,
author = {M. Cox and P. Madhavan and T. M. Feeley},
title = {Primary repair of ruptured aortitis.},
journal = {Eur J Vasc Endovasc Surg},
year = {1998},
volume = {15},
number = {5},
pages = {454--455}
}
|
| Crerand, S., Feeley, T.M., Waldron, R.P., Corrigan, T., Hederman, W., O'Connell, F.X. & Heffernan, S.J. (1991), "Colorectal carcinoma over 30 years at one hospital: no evidence for a shift to the right.". Int J Colorectal Dis . Volume 6(4), pp. 184-187. |
| Abstract: Many recent reports in the North American literature have documented an increase in the ratio of proximal to distal colorectal cancers with an increase in right-sided lesions. In order to assess trends in the distribution of large bowel carcinoma at our hospital we reviewed the files of 1553 patients who presented with primary colorectal carcinoma over a 30-year period. Thirty-nine percent of patients were over 70 years old and 51% were in the 50-69 year age group. Seventy five percent of the carcinomas were left-sided, 22% right-sided and caecal carcinomas accounted for 18 This distribution varied only slightly over the study period. Left-sided lesions were more common in males (55 p less than 0.005), and right-sided lesions were more common in females (57 p less than 0.005). Caecal carcinoma was more common in patients over 69 years old than in younger patients (p less than 0.001). In elderly females (greater than 69 years) 30% of colorectal carcinomas occurred in the caecum. These findings may have important implications for the investigation of patients with suspected colorectal disease or for screening programmes. |
BibTeX:
@article{Crerand1991,
author = {S. Crerand and T. M. Feeley and R. P. Waldron and T. Corrigan and W. Hederman and F. X. O'Connell and S. J. Heffernan},
title = {Colorectal carcinoma over 30 years at one hospital: no evidence for a shift to the right.},
journal = {Int J Colorectal Dis},
year = {1991},
volume = {6},
number = {4},
pages = {184--187}
}
|
| Davies, M.G., Feeley, T.M., Moore, D.J. & Shanik, G.D. (1990), "Home parenteral nutrition using a totally implanted subcutaneous venous access device.". Br J Clin Pract . Volume 44(12), pp. 750. |
| Abstract: Despite advances in the design and care of in-dwelling catheters, sepsis remains a significant problem in patients on long-term parenteral nutrition. In recent years there have been a number of reports concerning the successful use of totally implanted subcutaneous venous access devices in the management of patients requiring long-term intermittent intravenous administration of cytotoxic therapy and frequent blood sampling. The use of such a system for the administration of supplementary home parenteral nutrition in a patient with short-bowel syndrome is reported. |
BibTeX:
@article{Davies1990,
author = {M. G. Davies and T. M. Feeley and D. J. Moore and G. D. Shanik},
title = {Home parenteral nutrition using a totally implanted subcutaneous venous access device.},
journal = {Br J Clin Pract},
year = {1990},
volume = {44},
number = {12},
pages = {750}
}
|
| Davies, M.G., Feeley, T.M., O'Malley, M.K., Colgan, M.P., Moore, D.J. & Shanik, G.D. (1991), "Infrainguinal polytetrafluoroethylene grafts: saved limbs or wasted effort? A report on ten years' experience.". Ann Vasc Surg . Volume 5(6), pp. 519-524. |
| Abstract: Two-hundred and twenty-four infrainguinal polytetrafluoroethylene reconstructions were performed for critical ischemia over a 10 year period: 48 to the above-knee popliteal artery, 113 to the below-knee popliteal artery, and 63 to the tibial vessels. The cumulative patency rates were 84 +/- 6% and 63 +/- 9% for above-knee popliteal, 53 +/- 5% and 35 +/- 7% for below-knee popliteal, 45 +/- 6% and 30 +/- 9% for tibial vessels at one and five years respectively. Limb salvage rates were 81 +/- 6% and 73 +/- 9% (above-knee popliteal), 69 +/- 5% and 57 +/- 9% (below-knee popliteal), 64 +/- 7% and 32 +/- 10% (tibial vessels) at one and five years respectively. Graft occlusion did not result in limb loss in 32 cases. Preoperatively, 54% of the patients had limited mobility while 43% were regarded as severely restricted. At follow-up, 57% of the patients were considered to be independent, 26% had limited mobility, and 17% were still severely restricted. Polytetrafluoroethylene provides good short-term limb salvage and improved mobility in patients with critical ischemia and poor life expectancy. Its use is well worth the effort. |
BibTeX:
@article{Davies1991,
author = {M. G. Davies and T. M. Feeley and M. K. O'Malley and M. P. Colgan and D. J. Moore and G. D. Shanik},
title = {Infrainguinal polytetrafluoroethylene grafts: saved limbs or wasted effort? A report on ten years' experience.},
journal = {Ann Vasc Surg},
year = {1991},
volume = {5},
number = {6},
pages = {519--524}
}
|
| Dillon, M.F., Carr, C.J., Feeley, T.M.F. & Tierney, S. (2005), "Impact of the informed consent process on patients' understanding of varicose veins and their treatment.". Ir J Med Sci . Volume 174(3), pp. 23-27. |
| Abstract: AIM: It is particularly important that patients have reasonable understanding of the risks, benefits and nature of elective surgery. This study sought to analyse this level of understanding in patients undergoing varicose vein surgery METHODS: Eighty two patients completed a questionnaire in the vascular outpatient clinic and were asked to complete a telephone questionnaire following the clinic. RESULTS: Pain (n = 46) was the primary reason patients considered varicose vein surgery followed by appearance (n = 32). Most patients felt that varicose veins placed them at high risk of leg ulcers (n = 46) and DVT (n = 41). A high level of expectation that surgery would significantly affect pain and flares was recorded. While the outpatient visit did not materially change these misconceptions, an educational leaflet significantly enhanced the recall of complications (p = 0.028) in patients who remembered receiving a leaflet. CONCLUSION: Patients attending varicose vein clinics have an unrealistic expectation of the benefits of surgery and fail to understand the benign nature of their condition. The outpatient process has little effect on patient-held beliefs. |
BibTeX:
@article{Dillon2005,
author = {M. F. Dillon and C. J. Carr and T. M F Feeley and S. Tierney},
title = {Impact of the informed consent process on patients' understanding of varicose veins and their treatment.},
journal = {Ir J Med Sci},
year = {2005},
volume = {174},
number = {3},
pages = {23--27}
}
|
| Donnelly, M., Tierney, S. & Feeley, T.M. (2005), "Anatomical variation at the saphenofemoral junction.". Br J Surg . Volume 92(3), pp. 322-325. |
| Abstract: BACKGROUND: This study was designed to document the surgical anatomy of the saphenofemoral junction (SFJ). METHODS: The anatomy of the SFJ was recorded diagrammatically in 2089 consecutive groin dissections performed to treat primary varicose veins. The number of primary tributaries, bifid systems, junctional tributaries and the relationship of the external pudendal artery (EPA) to the long saphenous vein (LSV) were recorded. RESULTS: The LSV was bifid in 18.1 per cent of legs. The number of tributaries at the SFJ varied from one to ten. In 33.4 per cent one or more (junctional) tributaries joined the LSV or common femoral vein deep to the deep fascia. The EPA crossed anterior to 16.8 per cent of LSVs. In 4.6 per cent it passed posterior to one large tributary or trunk of a bifid LSV and anterior to the second trunk, making identification of the second trunk particularly difficult. CONCLUSION: A thorough understanding of the anatomical variations of the SFJ is important in ensuring that the junction is managed safely and adequately in patients with varicose veins. Failure to appreciate these variations may account for a significant proportion of inadequate primary varicose vein surgery. |
BibTeX:
@article{Donnelly2005,
author = {M. Donnelly and S. Tierney and T. M. Feeley},
title = {Anatomical variation at the saphenofemoral junction.},
journal = {Br J Surg},
year = {2005},
volume = {92},
number = {3},
pages = {322--325},
url = {http://dx.doi.org/10.1002/bjs.4822},
doi = {http://dx.doi.org/10.1002/bjs.4822}
}
|
| Egan, B., Donnelly, M., Bresnihan, M., Tierney, S. & Feeley, M. (2006), "Neovascularization: an "innocent bystander" in recurrent varicose veins.". J Vasc Surg . Volume 44(6), pp. 1279-84; discussion 1284. |
| Abstract: OBJECTIVE: Varicose vein recurrence after surgery occurs in up to 60% of patients. A variety of technical factors have been implicated, but biological factors such as neovascularization have more recently been proposed. The objective of this study was to characterize the relative contribution of technical and biological factors to recurrence in a large prospective series of recurrent varicose veins. METHODS: Duplex and operative findings were recorded prospectively in a consecutive series of 500 limbs undergoing surgery for recurrent varicose veins between 1995 and 2005 in a university teaching hospital. Only limbs with previous saphenofemoral junction surgery were included. All limbs had preoperative duplex mapping by an accredited vascular technician who assessed the status of the great saphenous vein (GSV) in the thigh and groin, sought sonographic evidence of neovascularization, and reported on the presence of reflux in the short saphenous vein and perforator sites (typical and atypical). All operations were performed with an attending vascular surgeon as the lead operator. RESULTS: Primary GSV surgery was incomplete in 83.2% of limbs. A completely intact GSV system was present in 17.4% of limbs. An incompetent thigh saphenous vein was present in 44.2% of limbs, 37.6% had GSV stump incompetence with one or more intact tributaries, and 16% had both a residual thigh GSV and an incompetent stump with intact tributaries. Non-GSV sites of reflux were identified in 25% of limbs. Neovascularization was identified on duplex scanning in 41 (8.2 limbs. However, in 27 of these, surgical exploration revealed a residual GSV stump with 1 or more significant tributaries. Each of the remaining 14 (2.8 limbs had a residual incompetent thigh GSV. CONCLUSIONS: Despite reports to the contrary, neovascularization occurs in a relatively small proportion of patients with recurrent varicose veins. All recurrent varicose veins associated with duplex-diagnosed neovascularization are also associated with persistent reflux in the GSV stump tributaries, thigh GSV, or both. Recurrence after primary varicose vein surgery is associated with inadequate primary surgery or progression of disease, and neovascularization alone is not a cause of recurrent varicose veins. |
BibTeX:
@article{Egan2006,
author = {Bridget Egan and Michael Donnelly and Mary Bresnihan and Sean Tierney and Martin Feeley},
title = {Neovascularization: an "innocent bystander" in recurrent varicose veins.},
journal = {J Vasc Surg},
year = {2006},
volume = {44},
number = {6},
pages = {1279--84; discussion 1284},
url = {http://dx.doi.org/10.1016/j.jvs.2006.08.017},
doi = {http://dx.doi.org/10.1016/j.jvs.2006.08.017}
}
|
| Egan, B., O'Byrne, J.M., O'Farrell, D., O'Donnell, A., Wood, A.E., Neligan, M.C. & O'Brien, T.M. (1996), "Orthopaedic complications following cardiac transplantation.". Ir Med J . Volume 89(1), pp. 26-27. |
| Abstract: Cardiac transplantation has become the treatment of choice for end stage heart disease. In 1990 2,000 transplants were performed worldwide. Orthopaedic Surgeons will be asked with increasing frequency to evaluate and treat bone and soft tissue problems with these patients. Orthopaedic service at the Mater Hospital has been involved in the follow-up treatment of orthopaedic complications in 46 transplant patients over a six year period. Thirty eight were male and eight were female. The ages were between 12 years and 65 years (mean 44.3). Nine (20 of these patients developed thirteen orthopaedic complications: A vascular Necrosis of the hip (AVN) (4), Soft tissue infections (3), Osteoporosis (2), Stress Fractures (2), Osteomyelitis (1) and Ostomalacia (1). The mode of presentation, investigation and management of orthopaedic problems particular to these patients is described. Most patients who develop bony complications have had increased doses of steroids for episodes of rejection. This study highlights the special features of this patient population that require modification of the treatment approach such as the need to avoid the drug Erythromycin and the increased risk of AVN of the hip in patients who require high dose steroids. |
BibTeX:
@article{Egan1996a,
author = {B. Egan and J. M. O'Byrne and D. O'Farrell and A. O'Donnell and A. E. Wood and M. C. Neligan and T. M. O'Brien},
title = {Orthopaedic complications following cardiac transplantation.},
journal = {Ir Med J},
year = {1996},
volume = {89},
number = {1},
pages = {26--27}
}
|
| Egan, B.M., Abdih, H., Kelly, C.J., Condron, C. & Bouchier-Hayes, D.J. (2001), "Effect of intravenous taurine on endotoxin-induced acute lung injury in sheep.". Eur J Surg . Volume 167(8), pp. 575-580. |
| Abstract: OBJECTIVE: To find out if pretreatment with taurine would reduce the severity of endotoxin-induced acute lung injury in a large animal model. DESIGN: Randomised controlled study under licence from the Department of Health. SETTING: Department of Surgical Research, Ireland. ANIMALS: 15 male Suffolk sheep. INTERVENTIONS: Vascular catheters were placed in the femoral artery and vein and a Swan-Ganz catheter in the external jugular vein under general anaesthetic. Animals were randomized into three groups: control with measurements taken at baseline and half hourly up to 90 minutes; endotoxin, given Escherichia coli endotoxin intravenously after baseline measurements and taurine given 300 mg/kg 1 hour before endotoxin was given. MAIN OUTCOME MEASURES: Mean systemic arterial pressure, mean pulmonary arterial pressure, arterial oxygen tension (PO2), pulmonary myeloperoxidase activity, and neutrophil respiratory burst activity. RESULTS: Endotoxin induced a severe lung injury characterised by a decrease in mean systemic blood pressure and an increase in pulmonary artery pressure, hypoxia, and an increase in pulmonary myeloperoxidase activity. Pretreatment with intravenous taurine significantly reduced these haemodynamic changes. It reduced pulmonary myeloperoxidase activity and peripheral neutropenia and increased neutrophil respiratory burst activity. CONCLUSIONS: This data suggest that taurine may have a therapeutic role in preventing the lung injury seen in endotoxaemia. |
BibTeX:
@article{Egan2001,
author = {B. M. Egan and H. Abdih and C. J. Kelly and C. Condron and D. J. Bouchier-Hayes},
title = {Effect of intravenous taurine on endotoxin-induced acute lung injury in sheep.},
journal = {Eur J Surg},
year = {2001},
volume = {167},
number = {8},
pages = {575--580},
url = {http://dx.doi.org/10.1080/110241501753171164},
doi = {http://dx.doi.org/10.1080/110241501753171164}
}
|
| Egan, B.M., Bouchier-Hayes, D.J., Condron, C., Kelly, C.J. & Abdih, H. (2002), "Taurolidine attenuates the hemodynamic and respiratory changes associated with endotoxemia.". Shock . Volume 17(4), pp. 308-311. |
| Abstract: The purpose of this study was to determine if prereatment with taurolidine, a known anti-endotoxin agent, would attenuate the hemodynamic and respiratory responses associated with endotoxin induced lung injury in a large animal model in a randomized controlled study under license from the Department of Health. All animals underwent a general anesthetic. Vascular catheters were placed in the femoral artery and in the femoral vein. A Swan-Ganz Catheter was inserted for measurement of pulmonary artery pressure. Animals were randomized into three groups: Control, with measurements taken at baseline and half hourly up to 90 min; Endotoxin, receiving 5microg/Kg E. coli endotoxin intravenously after baseline measurements; and Endotoxin + Taurolidine, receiving 5g of taurolidine via intraperitoneal infusion 1 h before endotoxin administration. Main outcome measures were mean systemic arterial pressure (MAP), mean pulmonary arterial pressure (MPAP), arterial oxygen tension (pO2), serum endotoxin concentration, and pulmonary myeloperoxidase. Endotoxin induced a significant lung injury characterized by an increase in pulmonary artery pressure, hypoxia, and systemic hypotension. Pretreatment with intraperitoneal taurolidine significantly attenuated these hemodynamic and respiratory changes. Serum endotoxin concentration was also significantly reduced as was lung myeloperoxidase. The data suggest that taurolidine may have a therapeutic role in preventing the lung injury seen in endotoxemia. |
BibTeX:
@article{Egan2002b,
author = {Bridget M Egan and David J Bouchier-Hayes and Claire Condron and Cathal J Kelly and Hazem Abdih},
title = {Taurolidine attenuates the hemodynamic and respiratory changes associated with endotoxemia.},
journal = {Shock},
year = {2002},
volume = {17},
number = {4},
pages = {308--311}
}
|
| Egan, B.M., Chen, G., Kelly, C.J. & Bouchier-Hayes, D.J. (2001), "Taurine attenuates LPS-induced rolling and adhesion in rat microcirculation.". J Surg Res . Volume 95(2), pp. 85-91. |
| Abstract: BACKGROUND: Adhesion of polymorphonuclear leukocytes (PMN) to endothelial cells and subsequent transendothelial migration are an early key events in the inflammatory response and play an important part in the pathogenesis of septic shock, contributing to vascular and tissue injury. Taurine (2-aminoethanesulfonic acid) is a sulphur-containing beta amino acid. It is a known antioxidant, possesses antimicrobial properties, and has previously been shown to be protective to the endothelium both in vivo and in vitro. The aim of this study was to determine if pretreatment with taurinewould attenuate the lipopolysaccharide (LPS)-induced increase in leukocyte-endothelial interactions and microvascular permeability during endotoxemia. MATERIALS AND METHODS: Male Sprague-Dawley rats (300-350 g) were randomized into three groups: (1) Control, (2) LPS, and (3) LPS + Taurine groups. Taurine was administered orally as a 4% solution. Endotoxemia was induced using Escherichia Coli endotoxin (Serotype 0.55 B5)-15 mg/kg via a slow intravenous infusion. Using mesenteric postcapillary venules (28-32-microm diameter) the number of adherent and migrated leukocytes and their rolling velocity were measured by intravital microscopy at baseline and subsequently at 10, 30, 60, and 90 min post administration of LPS. RESULTS: Following administration of LPS there was a reduction in leukocyte rolling velocity at 30, 60 and 90 min. This was accompanied by a significant increase in the number of adherent leukocytes at 10, 30, 60 and 90 min. Transendothelial migration was significantly increased at 90 min. Taurine significantly attenuated the LPS-induced reduction in leukocyte rolling velocity at 10 and 30 min and the number of adherent leukocytes at all time points. Taurine also attenuated the LPS-induced increase in transendothelial migration at 90 min. CONCLUSIONS: These results demonstrate that taurine ameliorates endotoxin-induced leukocyte-endothelial cell interactions associated with sepsis, thereby suggesting that taurine may have a therapeutic role in the preventionof endothelial damage in sepsis. |
BibTeX:
@article{Egan2001d,
author = {B. M. Egan and G. Chen and C. J. Kelly and D. J. Bouchier-Hayes},
title = {Taurine attenuates LPS-induced rolling and adhesion in rat microcirculation.},
journal = {J Surg Res},
year = {2001},
volume = {95},
number = {2},
pages = {85--91},
url = {http://dx.doi.org/10.1006/jsre.2000.6005},
doi = {http://dx.doi.org/10.1006/jsre.2000.6005}
}
|
| Eguare, E., Tierney, S., Barry, M.C. & Grace, P.A. (2000), "Management of head injury in a regional hospital.". Ir J Med Sci . Volume 169(2), pp. 103-106. |
| Abstract: BACKGROUND: Concern about delay in the treatment of serious head injury may result in unnecessary transfer to neurosurgical units for scanning and neurosurgical assessment. AIMS: This study assessed the management of head injuries in a regional hospital with computed tomographic (CT) and 'image-link' facilities allowing instantaneous transmission of CT scans to the regional neurosurgical unit for specialist assessment. METHODS: A retrospective study was carried out of all head injuries presenting to Limerick Regional General Hospital in a single year. Data gathered included mechanism of injury, mode of transfer, requirement for admission and length of stay. Neurological status was assessed using the Glasgow Coma Scale (GCS) and functional status using the Glasgow Outcome Scale. RESULTS: Between January and December 1995, 1,564 patients presented with head injuries to the accident and emergency (A/E) department of Limerick Regional General Hospital. Twenty (1 were dead on arrival, 12% required hospital admission and the remainder were discharged after assessment. Seventy-six per cent were males and 74% under 40 years of age. Among the 194 patients requiring hospital admission, 14% had a skull fracture and 22 had a severe head injury. CT brain scans were performed in 43 patients and were abnormal in 42 On the basis of CT and clinical findings, six patients were transferred immediately for a neurosurgical procedure and one was transferred later following clinical deterioration. CONCLUSIONS: A CT scan and image-link facility permitting remote neurosurgical advice allows the majority of patients with head injury to be safely managed in well-equipped regional units without onsite neurosurgical expertise. |
BibTeX:
@article{Eguare2000,
author = {E. Eguare and S. Tierney and M. C. Barry and P. A. Grace},
title = {Management of head injury in a regional hospital.},
journal = {Ir J Med Sci},
year = {2000},
volume = {169},
number = {2},
pages = {103--106}
}
|
| Eguare, E., Tierney, S., Maher, R., Creamer, M., Grace, P., Cronin, C.J. & Burke, P. (2006), "Demands for vascular access in a renal dialysis unit: implications for a regional vascular unit.". Ir J Med Sci . Volume 175(1), pp. 24-28. |
| Abstract: BACKGROUND: The development of regional dialysis units and the expanding indications for dialysis has led to increased demand for vascular access surgery. Consequently, the provision and maintenance of access, and the management of related complications has created a considerable burden on vascular surgical units in hospitals providing renal replacement therapy (RRT). AIMS: The objectives of our study were to review our experience with a variety of vascular access modalities for haemodialysis and to quantify the associated surgical workload. METHODS: We reviewed our experience in a consecutive group of dialysis patients who had access surgery for RRT in a regional hospital setting. RESULTS: Between January 1995 and January 2000, 69 patients entered the long-term dialysis programme in the Mid-Western region (population = 320,000). Of the 158 procedures performed, 138 (87 were for access creation, and 20 (13 related to access revision procedures. Twenty patients (29 developed a total of 30 access related complications. Vascular access procedures accounted for 10% of the vascular surgical workload (1598 procedures) in the five-year period. CONCLUSION: Vascular access is an important part of the haemodialysis services and surgical expertise should be available at local level to cope with likely demand. |
BibTeX:
@article{Eguare2006,
author = {E. Eguare and S. Tierney and R. Maher and M. Creamer and P. Grace and C. J. Cronin and P. Burke},
title = {Demands for vascular access in a renal dialysis unit: implications for a regional vascular unit.},
journal = {Ir J Med Sci},
year = {2006},
volume = {175},
number = {1},
pages = {24--28}
}
|
| Feeley, T.M., Clanachan, A.S. & Scott, G.W. (1987), "Contractility of human gallbladder muscle in vitro.". Aliment Pharmacol Ther . Volume 1(6), pp. 607-616. |
| Abstract: This study examined the effects of transmural nerve stimulation, acetylcholine, adrenoceptor agonists and several peptides on the contractility of strips of human gallbladder in vitro. Acetylcholine caused concentration-related contractions of the tissues and the sensitivity to acetylcholine was similar in gallbladders with mild and severe chronic cholecystitis. Noradrenaline and adrenaline relaxed gallbladder strips, probably via beta 2-adrenoceptor stimulation. Transmural nerve stimulation always caused contractions, but in the presence of atropine inhibitory responses were demonstrable and these were antagonized by propranolol. There was no evidence of non-adrenergic inhibitory neural responses. Of the peptides tested, only cholecystokinin octapeptide (CCK-OP), gastrin, pentagastrin, substance P and caerulein caused contractions. Responses to CCK-OP, gastrin and pentagastrin were antagonized by dibutyryl cyclic GMP. Hormones which had no effect upon human gallbladder strips included motilin, secretin, bombesin, neurotensin, glucagon, vasopressin, VIP and somatostatin. Considerable differences therefore exist between human tissues and those from experimental animals with respect to the direct actions of neural and hormonal stimuli on gallbladder contractility. |
BibTeX:
@article{Feeley1987,
author = {T. M. Feeley and A. S. Clanachan and G. W. Scott},
title = {Contractility of human gallbladder muscle in vitro.},
journal = {Aliment Pharmacol Ther},
year = {1987},
volume = {1},
number = {6},
pages = {607--616}
}
|
| Feeley, T.M., Clanachan, A.S. & Scott, G.W. (1984), "The effects of vasoactive intestinal polypeptide on the motility of human and guinea pig gallbladder.". Can J Physiol Pharmacol . Volume 62(4), pp. 356-359. |
| Abstract: The effects of several preparations of vasoactive intestinal polypeptide (VIP) on the motility of strips of human and guinea pig gallbladder were investigated in vitro. VIP (10(-12) to 10(-6) M) had no measurable effects on the spontaneous activity, resting tone or cholecystokinin-octapeptide induced tone of human gallbladder strips. However, VIP (10(-12) to 10(-6) M) caused biphasic effects on the tone of guinea pig gallbladder strips. At low concentrations (10(-12) to 10(-10) M) contractions were observed that became smaller at higher concentrations (10(-9) to 10(-8) M). At still higher concentrations (10(-7) to 10(-6) M) relaxations were elicited. It appears that VIP is not as potent a relaxant of gallbladder muscle as first described. Human gallbladder tissue was totally unresponsive to the VIP preparations tested. |
BibTeX:
@article{Feeley1984a,
author = {T. M. Feeley and A. S. Clanachan and G. W. Scott},
title = {The effects of vasoactive intestinal polypeptide on the motility of human and guinea pig gallbladder.},
journal = {Can J Physiol Pharmacol},
year = {1984},
volume = {62},
number = {4},
pages = {356--359}
}
|
| Feeley, T.M., Leen, E.J., Colgan, M.P., Moore, D.J., Hourihane, D.O. & Shanik, G.D. (1991), "Histologic characteristics of carotid artery plaque.". J Vasc Surg . Volume 13(5), pp. 719-724. |
| Abstract: Carotid plaque characteristics associated with the production of symptoms were identified with quantification of carotid plaque constituents in high-grade stenotic asymptomatic (n = 8) and symptomatic (n = 44) plaques. Asymptomatic plaques contained significantly more fibrous/collagen material (88 than symptomatic plaques (66 (p less than 0.05). Hemorrhage constituted 2% and 1% of asymptomatic and symptomatic plaques, respectively. The predominant nonfibrous material was a pink amorphous material mixed with cholesterol, which composed 7% of asymptomatic and 27% of symptomatic plaques (p less than 0.05). No relationship was found between plaque composition and the number of ipsilateral ischemic neurologic events, nor was there evidence of a healing process. B-mode ultrasound scanning had a sensitivity of 94% in identifying plaque with greater than 80% fibrous content. We believe that plaque composition may be a useful discriminating factor in selecting asymptomatic patients for carotid endarterectomy. |
BibTeX:
@article{Feeley1991,
author = {T. M. Feeley and E. J. Leen and M. P. Colgan and D. J. Moore and D. O. Hourihane and G. D. Shanik},
title = {Histologic characteristics of carotid artery plaque.},
journal = {J Vasc Surg},
year = {1991},
volume = {13},
number = {5},
pages = {719--724}
}
|
| Feeley, T.M., Longe, L.G. & Ellis, W. (1984), "Results of surgery for prolapsed intervertebral disc.". Ir Med J . Volume 77(3), pp. 72-74. |
BibTeX:
@article{Feeley1984b,
author = {T. M. Feeley and L. G. Longe and W. Ellis},
title = {Results of surgery for prolapsed intervertebral disc.},
journal = {Ir Med J},
year = {1984},
volume = {77},
number = {3},
pages = {72--74}
}
|
| Feeley, T.M., McFarlane, D.E. & Devlin, H.B. (1982), "Acute appendicitis: are any investigations cost effective?". Ir Med J . Volume 75(12), pp. 475-476. |
BibTeX:
@article{Feeley1982,
author = {T. M. Feeley and D. E. McFarlane and H. B. Devlin},
title = {Acute appendicitis: are any investigations cost effective?},
journal = {Ir Med J},
year = {1982},
volume = {75},
number = {12},
pages = {475--476}
}
|
| Feeley, T.M. & O'Higgins, N. (1983), "An atypical case of abdominal actinomycosis.". Ir Med J . Volume 76(9), pp. 387. |
BibTeX:
@article{Feeley1983,
author = {T. M. Feeley and N. O'Higgins},
title = {An atypical case of abdominal actinomycosis.},
journal = {Ir Med J},
year = {1983},
volume = {76},
number = {9},
pages = {387}
}
|
| Feeley, T.M., Peel, A.L. & Devlin, H.B. (1982), "Mastectomy and its consequences.". Br Med J (Clin Res Ed) . Volume 284(6324), pp. 1246. |
BibTeX:
@article{Feeley1982a,
author = {T. M. Feeley and A. L. Peel and H. B. Devlin},
title = {Mastectomy and its consequences.},
journal = {Br Med J (Clin Res Ed)},
year = {1982},
volume = {284},
number = {6324},
pages = {1246}
}
|
| Feeley, T.M. & Rosenberg, I.L. (1984), "Malignant change in fistula-in-ano.". Ir Med J . Volume 77(10), pp. 326. |
BibTeX:
@article{Feeley1984,
author = {T. M. Feeley and I. L. Rosenberg},
title = {Malignant change in fistula-in-ano.},
journal = {Ir Med J},
year = {1984},
volume = {77},
number = {10},
pages = {326}
}
|
| Fenlon, H.M., Phelan, N., Tierney, S., Gorey, T. & Ennis, J.T. (1998), "Tc-99m tetrofosmin scintigraphy as an adjunct to plain-film mammography in palpable breast lesions.". Clin Radiol . Volume 53(1), pp. 17-24. |
| Abstract: AIM: To investigate the use of Tc-99m tetrofosmin as a breast imaging agent and to compare results of Tc-99m tetrofosmin scintimammography with plain-film mammography and pathological outcome. PATIENTS and METHODS: Forty-four patients (mean age, 51 years; range 26-79 years) with a palpable breast mass requiring fine needle aspiration biopsy (FNAB) were prospectively studied. All patients had Tc-99m tetrofosmin scintimammography. Patients over 35 years of age had two view mammography performed on the same day. FNAB was performed within 2 weeks of imaging, and patients referred for surgery as appropriate. Results of scintigraphy and plain-film mammography were correlated with pathological outcome. RESULTS: Of the 44 patients, 21 had biopsy proven malignancy while 23 had benign lesions. Of the 21 patients with carcinoma, 20 (95.2 had positive Tc-99m tetrofosmin scintimammography while 21 (91.3 of the 23 patients with benign histology had negative scintigraphy. The sensitivity of scintimammography was 95.24 the specificity was 91.3 with a positive predictive value of 90.9% and a negative predictive value of 95.45 Thirty-eight patients had two view mammography performed (six patients were <35 years of age). Of these 38 patients, 21 had biopsy proven malignancy while 17 had benign histology (all patients <35 years of age had benign histology). Of the 21 patients with malignancy, plain-film mammography was suspicious for malignancy in 17 (81 while four were reported as benign. Of the 17 with benign disease, 14 patients (82.4 had benign appearances on plain-film mammography while three (18 had one or more findings suspicious for malignancy. The sensitivity of plain-film mammography in our group was 81 with a specificity of 82.4 a positive predictive value of 85% and a negative predictive value of 77.8 Tc-99m tetrofosmin scintimammography correctly characterized all seven lesions where mammographic evaluation was limited because of dense breast parenchyma or previous surgery and/or radiotherapy. CONCLUSION: Tc-99m tetrofosmin scintimammography is an accurate, well tolerated and non-invasive method of differentiating benign from malignant palpable breast lesions. Negative Tc-99m tetrofosmin scintimammography excludes malignancy with a high degree of confidence while false-positive scintigraphy can occur in cases of proliferative dysplasia and hypercellular fibroadenoma. Tc-99m tetrofosmin scintimammography is particularly useful when plain-film mammography is indeterminate or limited in patients with dense breasts or a history of previous surgery and/or radiotherapy. |
BibTeX:
@article{Fenlon1998,
author = {H. M. Fenlon and N. Phelan and S. Tierney and T. Gorey and J. T. Ennis},
title = {Tc-99m tetrofosmin scintigraphy as an adjunct to plain-film mammography in palpable breast lesions.},
journal = {Clin Radiol},
year = {1998},
volume = {53},
number = {1},
pages = {17--24}
}
|
| Fenlon, H.M., Phelan, N.C., O'Sullivan, P., Tierney, S., Gorey, T. & Ennis, J.T. (1997), "Benign versus malignant breast disease: comparison of contrast-enhanced MR imaging and Tc-99m tetrofosmin scintimammography.". Radiology . Volume 205(1), pp. 214-220. |
| Abstract: PURPOSE: To compare technetium-99m tetrofosmin scintimammography with contrast material-enhanced magnetic resonance (MR) imaging in the characterization of palpable breast masses. MATERIALS AND METHODS: Forty-seven patients (mean age, 51 years) with a palpable breast mass were prospectively examined with scintimammography, MR imaging, and conventional mammography 2 weeks before fine-needle aspiration biopsy. RESULTS: In three patients, MR imaging was aborted. Of the remaining 44 patients, 21 had biopsy-proved cancer and 23 had benign disease. The sensitivity of mammography was 81 specificity, 82 positive predictive value (PPV), 85 and negative predictive value (NPV), 78 The sensitivity of scintimammography was 95 specificity, 91 PPV, 91 and NPV, 95 The sensitivity of MR imaging was 90 specificity, 91 PPV, 90 and NPV, 91 In 11 patients with previous breast cancer, scintimammographic findings were positive in all four with tumor recurrence and negative in all seven with benign disease. Masses were correctly characterized with MR imaging in eight of these 11 patients. CONCLUSION: Although both techniques accurately differentiate benign from malignant palpable breast masses, scintimammography is more accurate in the posttreatment breast. Because of lower cost, wider availability, and high patient acceptance, scintimammography may provide a valuable alternative to MR imaging for noninvasive characterization of palpable breast disease. |
BibTeX:
@article{Fenlon1997,
author = {H. M. Fenlon and N. C. Phelan and P. O'Sullivan and S. Tierney and T. Gorey and J. T. Ennis},
title = {Benign versus malignant breast disease: comparison of contrast-enhanced MR imaging and Tc-99m tetrofosmin scintimammography.},
journal = {Radiology},
year = {1997},
volume = {205},
number = {1},
pages = {214--220}
}
|
| Fitzgerald, E., Feeley, T.M. & Tierney, S. (2004), "Current treatments for axillary hyperhidrosis.". Surgeon . Volume 2(6), pp. 311-4, 360. |
| Abstract: Primary hyperhidrosis affects up to 1% of the population and has a significant negative impact on quality of life. It affects the axillae in approximately 80% of cases. Hyperhidrosis results from excessive sympathetic stimulation of the eccrine sweat glands: the various treatment modalities available target points along the pathway between the central nervous system and the peripheral gland. The first line of treatment is topical aluminium chloride, which is effective in the majority of cases. Alternative treatments such as systemic anti-cholinergics and iontophoresis have significant disadvantages, while surgical sympathectomy has been regarded as the gold-standard in treatment of this condition. Recently, attention has focused on the use of intradermal botulinum toxin for the treatment of axillary hyperhidrosis. This is a highly effective, minimally-invasive treatment with few side effects, and is now recommended as the treatment of choice in isolated axillary hyperhidrosis |
BibTeX:
@article{Fitzgerald2004,
author = {E. Fitzgerald and T. M. Feeley and S. Tierney},
title = {Current treatments for axillary hyperhidrosis.},
journal = {Surgeon},
year = {2004},
volume = {2},
number = {6},
pages = {311--4, 360}
}
|
| Flynn, R., Geraghty, J.G., Keogh, B. & Feeley, T.M. (1991), "Rare presentation of gastric leiomyosarcoma.". Postgrad Med J . Volume 67(788), pp. 589-590. |
BibTeX:
@article{Flynn1991,
author = {R. Flynn and J. G. Geraghty and B. Keogh and T. M. Feeley},
title = {Rare presentation of gastric leiomyosarcoma.},
journal = {Postgrad Med J},
year = {1991},
volume = {67},
number = {788},
pages = {589--590}
}
|
| Geoghegan, T., Persaud, T., O'Grady, H., Tierney, S. & Torreggiani, W.C. (2005), "Aorto-caval fistula.". Hosp Med . Volume 66(7), pp. 425. |
BibTeX:
@article{Geoghegan2005,
author = {Tony Geoghegan and Thara Persaud and Helen O'Grady and Sean Tierney and William C Torreggiani},
title = {Aorto-caval fistula.},
journal = {Hosp Med},
year = {2005},
volume = {66},
number = {7},
pages = {425}
}
|
| Gill, K.P., Feeley, T.M. & Keane, F.B. (1989), "Toxic megacolon and perforation caused by Salmonella.". Br J Surg . Volume 76(8), pp. 796. |
BibTeX:
@article{Gill1989,
author = {K. P. Gill and T. M. Feeley and F. B. Keane},
title = {Toxic megacolon and perforation caused by Salmonella.},
journal = {Br J Surg},
year = {1989},
volume = {76},
number = {8},
pages = {796}
}
|
| Gorey, T.F., O'riordain, M.G., Tierney, S., Buckley, D. & Fitzpatrick, J.M. (1996), "Laparoscopic-assisted rectopexy using a novel hand-access port.". J Laparoendosc Surg . Volume 6(5), pp. 325-328. |
| Abstract: Many surgeons who were ready converts to laparoscopic cholecystectomy did not translate the technique to more advanced procedures. There are several reasons: increased operating times, a steeper learning curve, concern for oncological efficacy, and the loss of manual tactile ability. As shown with this report on laparoscopic assisted rectopexy, many of these difficulties can be overcome using the IntromitTM while still maintaining the benefits of minimally invasive surgery. |
BibTeX:
@article{Gorey1996a,
author = {T. F. Gorey and M. G. O'riordain and S. Tierney and D. Buckley and J. M. Fitzpatrick},
title = {Laparoscopic-assisted rectopexy using a novel hand-access port.},
journal = {J Laparoendosc Surg},
year = {1996},
volume = {6},
number = {5},
pages = {325--328}
}
|
| Gorey, T.F., Tierney, S., O'Riordain, M., Buckley, D., Gibbons, N. & Fitzpatrick, J.M. (1996), "Case report: combined hand access with laparoscopic pneumoperitoneum in intraperitoneal adhesiolysis.". Ir J Med Sci . Volume 165(4), pp. 297-298. |
| Abstract: Previous abdominal surgery is one of the relative contraindications to safe induction of pneumoperitoneum with a Veress needle. Similarly visual inspection with a telescope may be limited and instrumental manipulation difficult. The manual ability to distract bowel loops and finger dissect greatly facilitates adhesiolysis and this is lost with conventional laparoscopy. A novel hand-access port is described which combines manual tactile ability with minimally invasive laparoscopic adhesiolysis. |
BibTeX:
@article{Gorey1996,
author = {T. F. Gorey and S. Tierney and M. O'Riordain and D. Buckley and N. Gibbons and J. M. Fitzpatrick},
title = {Case report: combined hand access with laparoscopic pneumoperitoneum in intraperitoneal adhesiolysis.},
journal = {Ir J Med Sci},
year = {1996},
volume = {165},
number = {4},
pages = {297--298}
}
|
| Havránek, E.G., Tierney, S., Man, W.K., Scott-Coombes, D.M. & Thompson, J.N. (1999), "The role of fibrinolytic system proteins in cholesterol gallstone formation.". Scand J Gastroenterol . Volume 34(5), pp. 516-519. |
| Abstract: BACKGROUND: Accelerated nucleation, supersaturation of bile, and biliary stasis are known to be key factors in cholesterol gallstone formation. The mechanisms through which these factors interact to form stones are still incompletely understood. Among the proteins now known to be present in bile are several components of the fibrinolytic system: tissue plasminogen activator, urokinase-like plasminogen activator, and plasminogen activator inhibitors 1 and 2. The concentrations of plasminogen activator inhibitors 1 and 2 in gallbladder bile are increased in patients with gallstones. The aim of this study was to determine whether these fibrinolytic system proteins act as pro-nucleating agents for cholesterol gallstone formation. METHODS: Nucleation assays were done on gallbladder bile from eight cholesterol stone patients and eight control patients. The effects of tissue plasminogen activator, urokinase-like plasminogen activator, and plasminogen activator inhibitors I and 2 on cholesterol crystal appearance time (CCAT) were tested, by direct observation using polarizing microscopy, after measurement of biliary lipids and calculation of cholesterol saturation indices. RESULTS: There was no significant difference in cholesterol saturation indices between bile that nucleated and bile that did not (mean, 2.0 +/- 1.5 versus 1.8 +/- 0.5). When all samples in which nucleation occurred were compared, tissue plasminogen activator significantly shortened CCAT median from 4.75 days (range, 2-21) to 3.5 days (2.5-18) (P < 0.05). This was similar to the effect of fibronectin (3.75 days; range, 2-20), a known pro-nucleator used as a nucleation accelerating control (P < 0.05). None of the other fibrinolytic system proteins significantly accelerated CCAT. CONCLUSIONS: The results of this study suggest that tissue plasminogen activator may act as a pro-nucleating agent for cholesterol gallstone formation in gallbladder bile. |
BibTeX:
@article{Havranek1999,
author = {E. G. Havránek and S. Tierney and W. K. Man and D. M. Scott-Coombes and J. N. Thompson},
title = {The role of fibrinolytic system proteins in cholesterol gallstone formation.},
journal = {Scand J Gastroenterol},
year = {1999},
volume = {34},
number = {5},
pages = {516--519}
}
|
| Healy, C.F., Doyle, M., Egan, B., Hendrick, B., O'Malley, M.K. & O'Donohoe, M.K. (2007), "Transfusion requirements and outcomes in patients undergoing abdominal aortic surgery using intra-operative cell salvage.". Ir J Med Sci . Volume 176(1), pp. 33-36. |
| Abstract: BACKGROUND: Intraoperative cell salvage (ICS) is the recovery, anticoagulation, filtration and reinfusion of blood lost during surgery. The aim of this study is to determine the safety and efficacy of ICS in emergency and elective abdominal aortic surgery. METHODS: This study reviews volumes of blood loss, blood salvaged with ICS, allogenic blood requirements, and clinical outcomes in patients undergoing abdominal aortic surgery using ICS. RESULTS: Seventy-nine patients undergoing abdominal aortic surgery are included. Supplemental allogenic blood was not required in 45/79 (57 of all patients. Transfusion with allogenic blood was not necessary in 41/63 (66 of elective abdominal aortic aneurysm repairs. ICS was associated with no major complications. CONCLUSION: ICS is a safe procedure and substantially reduces the need for blood transfusion in patients undergoing abdominal aortic surgery. It may substantially alleviate shortages of allogenic blood and should be part of the armamentarium of vascular units. |
BibTeX:
@article{Healy2007,
author = {C. F. Healy and M. Doyle and B. Egan and B. Hendrick and M. K. O'Malley and M. K. O'Donohoe},
title = {Transfusion requirements and outcomes in patients undergoing abdominal aortic surgery using intra-operative cell salvage.},
journal = {Ir J Med Sci},
year = {2007},
volume = {176},
number = {1},
pages = {33--36}
}
|
| Issa, M.M., Feeley, T.M., Beesley, W.H., Daly, P.A. & Cullinane, C.J. (1987), "Haemangiosarcoma of the breast.". Ir J Med Sci . Volume 156(2), pp. 65. |
BibTeX:
@article{Issa1987,
author = {M. M. Issa and T. M. Feeley and W. H. Beesley and P. A. Daly and C. J. Cullinane},
title = {Haemangiosarcoma of the breast.},
journal = {Ir J Med Sci},
year = {1987},
volume = {156},
number = {2},
pages = {65}
}
|
| Kalbassi, M.R., Tierney, S., Grace, P.A. & Burke, P.E. (2000), "Regional vascular surgical units: a practical means of providing specialist services.". Ir J Med Sci . Volume 169(2), pp. 107-109. |
| Abstract: BACKGROUND: A comprehensive regional emergency and elective vascular surgical service was established in Limerick Regional General Hospital between 1994 and 1996 following the appointment of three surgeons with vascular training. AIM: To compare vascular surgical activity before and after the establishment of a regional vascular service. METHODS: This study used local and national computerised databases, clinic letters, theatre registers and radiology records to compare vascular surgical activity before (1992) and after (1997) this service was established. RESULTS: Total outpatient activity increased almost six-fold and total number of inpatient vascular procedures (including radiological) increased from 146 to 432, but the venous proportion declined from 70% to 36 The number of major arterial procedures increased from 37 to 165 in 1997 including 10 carotid endarterectomies, 24 aortic reconstructions and 54 lower limb reconstructions representing rates of 3/100,000, 8/100,000 and 17/100,000 population respectively. CONCLUSION: As substantial changes in disease patterns are unlikely, these data indicate that patients previously diverted elsewhere for therapy are now cared for within the health board region and that further increases in workload may be expected. We suggest that these data mandate the reallocation of resources to fund appropriately staffed and audited regional vascular units. |
BibTeX:
@article{Kalbassi2000,
author = {M. R. Kalbassi and S. Tierney and P. A. Grace and P. E. Burke},
title = {Regional vascular surgical units: a practical means of providing specialist services.},
journal = {Ir J Med Sci},
year = {2000},
volume = {169},
number = {2},
pages = {107--109}
}
|
| Kiely, P.D., Tierney, S., Barry, M., Delaney, P.V., Drumm, J. & Grace, P.A. (2000), "Infantile hypertrophic pyloric stenosis in a regional centre.". Ir J Med Sci . Volume 169(2), pp. 100-102. |
| Abstract: BACKGROUND: It has been suggested that only specialist paediatric surgeons should manage infantile hypertrophic pyloric stenosis (IHPS). AIM: The aim of this retrospective study was to ascertain whether the majority of these infants might be managed in a well-equipped regional centre. METHODS: Using the Hospital Inpatient Enquiry database, all cases of IHPS within a single administrative health region were identified over a six-year period. A chart review was performed to obtain demographic and clinical information for each patient. Reports from the Central Statistics Office were used to obtain data on population and live births for the region. RESULTS: Seventy patients with IHPS were identified from this region from 1991 to 1996, 63 (90 of which were treated in the region. Of the remaining seven, four were referred directly to specialised paediatric surgical hospitals because of prematurity (n = 1), low birth weight (n = 1), capillary haemangioma (n = 1) and severe metabolic derangement (n = 1) while three were assessed and treated in general hospitals outside the region. Of the 63 infants undergoing pyloromyotomy in this region, the duodenal mucosa was breached in four (6; there were wound complications in three (5; and one required a re-pyloromyotomy. The mean postoperative stay was eight days (range 2-42 days). CONCLUSION: The majority of infants with IHPS may be safely managed in regional centres with transfer to specialist paediatric centres reserved for 'high risk' cases. The management of IHPS at a regional level has important implications and presents opportunities for surgical training. |
BibTeX:
@article{Kiely2000,
author = {P. D. Kiely and S. Tierney and M. Barry and P. V. Delaney and J. Drumm and P. A. Grace},
title = {Infantile hypertrophic pyloric stenosis in a regional centre.},
journal = {Ir J Med Sci},
year = {2000},
volume = {169},
number = {2},
pages = {100--102}
}
|
| Kingston, R., Barry, M., Tierney, S., Drumm, J. & Grace, P. (2001), "Treatment of surgical patients is evidence-based.". Eur J Surg . Volume 167(5), pp. 324-330. |
| Abstract: OBJECTIVES: To assess the type of evidence that supported our management of surgical patients. DESIGN: Retrospective audit. SETTING: Teaching hospital, Republic of Ireland. PATIENTS: All 222 patients admitted by two surgical teams during one month. Patients admitted for diagnostic procedures were included if they were treated as a result. MAIN OUTCOME MEASURES: Diagnosis and treatment were established from the notes. Evidence for each intervention was then sought in MEDLINE 1986-1999, Best Evidence 1991-1999, and the Cochrane Database of Systematic Reviews Issue 3, 1999, and graded into one of five categories: systematic review, meta-analysis, randomised controlled trial, prospective study, or retrospective study. RESULTS: Treatment was supported by systematic review in 14, by meta-analysis in 12, by randomised controlled trial in 75, by prospective studies in 55, by retrospective studies in 58, and by no evidence in 8. CONCLUSIONS: Everyday surgical practice in our unit is supported by good quality evidence from recent publications. |
BibTeX:
@article{Kingston2001,
author = {R. Kingston and M. Barry and S. Tierney and J. Drumm and P. Grace},
title = {Treatment of surgical patients is evidence-based.},
journal = {Eur J Surg},
year = {2001},
volume = {167},
number = {5},
pages = {324--330},
url = {http://dx.doi.org/10.1080/110241501750215168},
doi = {http://dx.doi.org/10.1080/110241501750215168}
}
|
| Leahy, A.L., McCollum, P.T., Feeley, T.M., Sugrue, M., Grouden, M.C., O'Connell, D.J., Moore, D.J. & Shanik, G.D. (1988), "Duplex ultrasonography and selection of patients for carotid endarterectomy: plaque morphology or luminal narrowing?". J Vasc Surg . Volume 8(5), pp. 558-562. |
| Abstract: Percentage of carotid stenosis and plaque morphology as determined by duplex scanning were correlated with symptoms and CT evidence of infarction in 108 patients. Severity of carotid stenosis less than 49% or greater than 50% narrowing was not associated with an increased risk of ipsilateral symptoms or CT infarction. However, a heterogeneous plaque appearance, suggesting intraplaque hemorrhage, did correlate with ipsilateral cerebral symptoms. Heterogeneous plaque appearance may be a more reliable indication for carotid endarterectomy than a hemodynamically significant stenosis. |
BibTeX:
@article{Leahy1988,
author = {A. L. Leahy and P. T. McCollum and T. M. Feeley and M. Sugrue and M. C. Grouden and D. J. O'Connell and D. J. Moore and G. D. Shanik},
title = {Duplex ultrasonography and selection of patients for carotid endarterectomy: plaque morphology or luminal narrowing?},
journal = {J Vasc Surg},
year = {1988},
volume = {8},
number = {5},
pages = {558--562}
}
|
| Leen, E.J., Feeley, T.M., Colgan, M.P., O'Malley, M.K., Moore, D.J., Hourihane, D.O. & Shanik, G.D. (1990), ""Haemorrhagic" carotid plaque does not contain haemorrhage.". Eur J Vasc Surg . Volume 4(2), pp. 123-128. |
| Abstract: The presence of haemorrhage in carotid bifurcation atheromatous plaques is widely believed to be associated with the production of ischaemic neurological events. This study set out to characterise plaque composition in symptomatic (SYM) and asymptomatic (ASYM) patients and to identify, if possible, the origin of intra-plaque haemorrhage. Fifty-nine plaques (50 SYM and 9 ASYM) were serially sectioned and examined for haemorrhage, haemosiderin, fibrin, cholesterol and collagen. Immunoperoxidase and electron microscopy studies were carried out on sections from five plaques in order to identify blood breakdown products. Intra-plaque haemorrhage was identified in 40 (68 plaques and was similar in SYM and ASYM plaques. In only one did it constitute more than 15% of plaque content, and in the remainder it consisted of small collections of erythrocytes constituting greater than 1% of plaque content in only 21 (35 plaques. The predominant non-fibrous component was a pink amorphous material mixed with cholesterol. Apart from traces of platelet breakdown products there was no evidence of haemorrhage in this pink material. Plaque roof rupture or ulceration was seen in 39 (66 and in almost all cases overlay the amorphous/cholesterol material. Blood vessels were identified in 51 87 plaques but were in close proximity to haemorrhage in only nine (15. |
BibTeX:
@article{Leen1990,
author = {E. J. Leen and T. M. Feeley and M. P. Colgan and M. K. O'Malley and D. J. Moore and D. O. Hourihane and G. D. Shanik},
title = {"Haemorrhagic" carotid plaque does not contain haemorrhage.},
journal = {Eur J Vasc Surg},
year = {1990},
volume = {4},
number = {2},
pages = {123--128}
}
|
| Lennon, F., Feeley, T.M., Clanachan, A.S. & Scott, G.W. (1984), "Effects of histamine receptor stimulation on diseased gallbladder and cystic duct.". Gastroenterology . Volume 87(2), pp. 257-262. |
| Abstract: The effects of histamine receptor stimulation on the motility of diseased human gallbladder and cystic duct were studied on tissue strips in vitro. Histamine produced concentration-dependent contractions in normal tissues and in tissues from each disease group, but the sensitivity of the strips to histamine as measured by the median effective dose was dependent upon the grade of disease: normal, 90.0 microM; mild chronic cholecystitis, 32.4 microM; advanced chronic cholecystitis, 12.5 microM; and acute cholecystitis, 3.0 microM. There were no differences in histamine sensitivity among different regions (body, neck, and cystic duct) of the biliary system. Studies with receptor-selective agonists and antagonists indicated that the contractile effects were mediated via histamine H1 receptors. Histamine H2 receptor agonists caused only small relaxant responses in about 30% of strips from gallbladder body, but were without effect in gallbladder neck and cystic duct. We conclude that the effects of histamine on the motility of diseased human gallbladder may depend upon the severity of the cholecystitis. |
BibTeX:
@article{Lennon1984,
author = {F. Lennon and T. M. Feeley and A. S. Clanachan and G. W. Scott},
title = {Effects of histamine receptor stimulation on diseased gallbladder and cystic duct.},
journal = {Gastroenterology},
year = {1984},
volume = {87},
number = {2},
pages = {257--262}
}
|
| Lipsett, P.A., Tierney, S., Gordon, T.A. & Perler, B.A. (1994), "Carotid endarterectomy--is intensive care unit care necessary?". J Vasc Surg . Volume 20(3), pp. 403-9; discussion 409-10. |
| Abstract: PURPOSE: The purpose of this study was to determine whether postoperative intensive care unit care is necessary for all patients undergoing carotid endarterectomy and whether a subgroup of patients at low-risk not requiring treatment in the intensive care unit could be identified. METHODS: Case control analysis of random numbers sample over the last decade of 50% of patients undergoing isolated carotid endarterectomy at a tertiary care hospital. One hundred twenty-nine patients undergoing carotid endarterectomy were identified. Preoperative risk factors, intraoperative course, intensive case unit interventions including vasoactive agents, myocardial ischemia/infarction, arrhythmias, bronchospasm, reintubation, neurologic events, and need for reoperation, were recorded. Timing of interventions, length of stay in intensive care unit, and postoperative course were all recorded. Financial impact was assessed. RESULTS: Among 129 patients only 31 patients did not require intensive care unit interventions. A multivariate linear regression analysis demonstrated a model in which a preoperative history of hypertension, myocardial infarction, arrhythmia, and chronic renal failure were 83% predictive of the need for an intensive care unit bed. Specifically, patients could be stratified into a low-risk group before the operation by less than four risk factors. Additionally, all patients requiring interventions or with adverse outcomes were identified by the eight postoperative hour. CONCLUSIONS: In preoperative scheduling of intensive care unit beds, patients with less than four risk factors can be stratified to monitoring beds and those with greater than or equal to four can be stratified to intervention beds. After 8 hours, if no interventions are necessary or adverse outcomes occur, then floor recovery is safe. Patients who satisfy this algorithm would save 50% of current intensive care unit charges. |
BibTeX:
@article{Lipsett1994,
author = {P. A. Lipsett and S. Tierney and T. A. Gordon and B. A. Perler},
title = {Carotid endarterectomy--is intensive care unit care necessary?},
journal = {J Vasc Surg},
year = {1994},
volume = {20},
number = {3},
pages = {403--9; discussion 409-10}
}
|
| Madhavan, P., Boyle, T., Coyle, J., Cox, M., McEniff, N., Molloy, M. & Feeley, T.M. (1998), "Cystic adventitial disease.". Eur J Vasc Endovasc Surg . Volume 15(5), pp. 456-458. |
BibTeX:
@article{Madhavan1998,
author = {P. Madhavan and T. Boyle and J. Coyle and M. Cox and N. McEniff and M. Molloy and T. M. Feeley},
title = {Cystic adventitial disease.},
journal = {Eur J Vasc Endovasc Surg},
year = {1998},
volume = {15},
number = {5},
pages = {456--458}
}
|
| Maher, M., Caldwell, M.P., Waldron, R., Murchan, P., Beesley, W., Feeley, T.M., Tanner, W.A. & Keane, F.B. (1996), "Staged resection or primary anastomosis for obstructing lesions to the left colon.". Ir Med J . Volume 89(4), pp. 138-139. |
| Abstract: The management of obstructing left-sided colonic and rectal lesions has traditionally been by a staged procedure. The introduction of 'on-table lavage', has made primary resection and anastomosis of the large bowel feasible for patients presenting as emergencies. We have studied the perioperative course of 28 patients who presented with left colonic obstruction to determine whether primary anastomosis conferred additional morbidity. The patients ranged in age from 29 to 89 years (mean 66 years) at presentation. The ASA status of patients was comparable in both groups (Table 1). Fourteen patients underwent resection, on-table lavage, and primary anastomosis (PA) and 14 a Hartmann's procedure (HP). The mean operative time for the PA procedure was 200 minutes compared to 110 minutes for the HP group. There was no significant difference in the postoperative complication rate nor mean hospital stay rate for the primary procedures between the two groups. There was no clinical anastomotic leak in patients undergoing primary anastomosis. However secondary surgery for patients undergoing colorectal reconnection conferred added morbidity for patients who had a HP. We conclude that resection, on-table lavage, and primary anastomosis is safe in the management of left-sided colonic obstruction and in most cases is the treatment of choice. |
BibTeX:
@article{Maher1996,
author = {M. Maher and M. P. Caldwell and R. Waldron and P. Murchan and W. Beesley and T. M. Feeley and W. A. Tanner and F. B. Keane},
title = {Staged resection or primary anastomosis for obstructing lesions to the left colon.},
journal = {Ir Med J},
year = {1996},
volume = {89},
number = {4},
pages = {138--139}
}
|
| McCormick, P.H., Chen, G., Tierney, S., Kelly, C.J. & Bouchier-Hayes, D.J. (2003), "Clinically applicable thermal preconditioning attenuates leukocyte-endothelial interactions.". J Am Coll Surg . Volume 197(1), pp. 71-78. |
| Abstract: BACKGROUND: We have previously demonstrated that clinically applicable thermal preconditioning induces heat shock protein 72 (HSP72) and protects against a subsequent ischemia-reperfusion (I/R) injury in an animal model. A core component of I/R injuries is the interaction between activated leukocytes and endothelial cells. We hypothesized that the effects of clinically applicable thermal preconditioning are mediated through attenuation of this leukocyte-endothelial (L-E) interaction. STUDY DESIGN: Twenty-one male Sprague Dawley rats were divided into control, I/R, and preconditioning plus I/R groups. Preconditioning was done under general anesthesia and the animals' temperature raised by 1 degrees C for 15 minutes in a water bath. This was repeated once a day for 5 successive days. I/R injury was caused by occlusion of the superior mesenteric artery for 10 minutes followed by 1 hour of reperfusion. L-E interactions were analyzed using intravital microscopy of a mesenteric vessel in vivo. L-E interactions were determined using leukocyte velocity (which decreases as cells interact), and number of adherent and migrated leukocytes. HSP72 was assessed by Western blot. RESULTS: Ischemia-reperfusion caused a decrease in leukocyte rolling velocity at all timepoints (p < 0.05 versus controls). Preconditioning attenuated the effects of I/R, and leukocyte rolling velocity was significantly improved versus I/R (p < 0.05) to levels similar to those in controls. Similarly, the number of adherent and migrating leukocytes increased significantly (p < 0.05) after I/R versus control at all time points, and preconditioning attenuated these to control levels, (p < 0.05 versus I/R) at both the 30- and 60-minute postischemia time points. Upregulation of HSP72 was demonstrated on Western blot. CONCLUSIONS: These results demonstrate that the benefit of clinically applicable thermal preconditioning is at least partially because of an immunomodulatory role in attenuating leukocyte-endothelial interactions associated with an increased expression of HSP 72. |
BibTeX:
@article{McCormick2003,
author = {Paul H McCormick and Gang Chen and Sean Tierney and Cathal J Kelly and David J Bouchier-Hayes},
title = {Clinically applicable thermal preconditioning attenuates leukocyte-endothelial interactions.},
journal = {J Am Coll Surg},
year = {2003},
volume = {197},
number = {1},
pages = {71--78},
url = {http://dx.doi.org/10.1016/S1072-7515(03)00392-2},
doi = {http://dx.doi.org/10.1016/S1072-7515(03)00392-2}
}
|
| McCormick, P.H., Tanner, W.A., Keane, F.B.V. & Tierney, S. (2003), "Minimally invasive techniques in common surgical procedures: implications for training.". Ir J Med Sci . Volume 172(1), pp. 27-29. |
| Abstract: BACKGROUND: Laparoscopic techniques are increasingly used in common surgical procedures. Many of these procedures are used to teach basic surgical trainees (BST) and therefore introduction of these techniques may have implications for training. AIMS: To establish whether the introduction of laparoscopic techniques reduced the opportunity of BSTs to perform surgical procedures. METHODS: Patients undergoing hernia repair or appendicectomy in 1991 (when laparoscopy was first introduced) and 1997 (when laparoscopy was readily available) were identified using the Hospital In-Patient Enquiry (HIPE) database. The principal operator and whether the procedure was open or laparoscopic were identified by chart review. RESULTS: The data showed a 50% reduction in the number of appendicectomies performed by BSTs following the introduction of laparoscopic techniques. The number of hernia repairs performed by BSTs has been preserved but the proportion by BSTs fell from 10 to 6 The proportion of BST-performed procedures carried out laparoscopically has been reduced compared with the registrar-performed group. CONCLUSIONS: The use of minimally invasive techniques has had a negative effect on surgical training. Appropriate measures must be taken to minimise this and such measures should include a structured approach to laparoscopic training and greater access to laparoscopic training facilities. |
BibTeX:
@article{McCormick2003a,
author = {P. H. McCormick and W. A. Tanner and F. B V Keane and S. Tierney},
title = {Minimally invasive techniques in common surgical procedures: implications for training.},
journal = {Ir J Med Sci},
year = {2003},
volume = {172},
number = {1},
pages = {27--29}
}
|
| Murchan, P., Sugrue, M.E., O'Malley, M.K., Feeley, T.M., Shanik, D.G. & Moore, D.J. (1990), "A new technique for bilateral iliac vein and inferior vena cava reconstruction using reinforced polytetrafluoroethylene.". Ann Vasc Surg . Volume 4(3), pp. 302-304. |
| Abstract: We report on the management of a patient with intractable venous claudication and ulceration due to bilateral iliac vein and inferior vena cava occlusion. An inverted V graft was constructed from two 8 mm diameter reinforced PTFE grafts. The upper end was anastomosed to the inferior infrarenal vena cava and the lower ends anastomosed to the common femoral veins. Bilateral arteriovenous fistulas were fashioned. Nine months later the graft is patent and the patient's only symptom is mild ankle edema. The theoretical advantage of this type of graft is that occlusion of one limb will not compromise the other, thus leaving a number of secondary options open if this should happen. |
BibTeX:
@article{Murchan1990,
author = {P. Murchan and M. E. Sugrue and M. K. O'Malley and T. M. Feeley and D. G. Shanik and D. J. Moore},
title = {A new technique for bilateral iliac vein and inferior vena cava reconstruction using reinforced polytetrafluoroethylene.},
journal = {Ann Vasc Surg},
year = {1990},
volume = {4},
number = {3},
pages = {302--304}
}
|
| Murphy, J.O., Sweeney, K.J., O'Mahony, J.C., Johnston, S.M., Conlon, K., Keane, F.B.V. & Tierney, S. (2003), "Surgical informatics on the Internet: any improvement?". Surgeon . Volume 1(3), pp. 177-179. |
| Abstract: PURPOSE: The Internet is a popular, but ungoverned, source of medical information. This study tracked the change in performance of commonly available search engines and the quality of medical data therein over a four-year period. METHODS: We compared the accuracy of information on a commonly performed surgical procedure (vasectomy) using six standard search engines in a four-year period and with two recently developed search engines. The top 25 ranked sites cited by each search engine were scored for description of the procedure, post-operative instructions, complications and unproven associations. RESULTS: There was no improvement in quality of individual sites over the study period. Additionally, the hit rate of search engines remained poor with 27 sites cited (40 in 2002 either irrelevant or unavailable. DISCUSSION: Few useful sites with accurate information on surgical procedures are available on the Internet and simple search strategies fail to identify site quality or relevancy. CONCLUSION: At present, the Internet cannot be recommended as a reliable resource for many aspects of health information for patients. The onus is on health-care providers to provide high quality sites and direct patients to these sources of reliable information |
BibTeX:
@article{Murphy2003,
author = {J. O. Murphy and K. J. Sweeney and J. C. O'Mahony and S. M. Johnston and K. Conlon and F. B V Keane and S. Tierney},
title = {Surgical informatics on the Internet: any improvement?},
journal = {Surgeon},
year = {2003},
volume = {1},
number = {3},
pages = {177--179}
}
|
| Murphy, S.M., Donnelly, M., Fitzgerald, T., Tanner, W.A., Keane, F.B.V. & Tierney, S. (2004), "Patients' recall of clinical information following laparoscopy for acute abdominal pain.". Br J Surg . Volume 91(4), pp. 485-488. |
| Abstract: BACKGROUND: Failures in doctor-patient communication and patients' understanding continue to confound improvements in the delivery of quality healthcare. In the context of acute abdominal pain managed by means of laparoscopy, it was hypothesized that patients are either not adequately informed, or do not reliably retain simple relevant information transmitted at the time of the procedure. This study was designed to evaluate the reliability of information transfer between doctor and patient in this setting, including the diagnosis and whether or not the appendix was removed. METHODS: A retrospective study of 350 consecutive patients who had undergone laparoscopy for acute abdominal pain over 3.5 years was designed. Each patient completed a telephone questionnaire that was used to evaluate the accuracy of patients' information. RESULTS: In total, 26.9 per cent of patients did not know or were incorrect regarding the surgical procedure performed. Similarly, 20.0 per cent of all patients did not know or were incorrect regarding the status of their appendix after surgery and 30.0 per cent of patients were incorrect regarding the diagnosis. Despite all of these statistics, 91.4 per cent of patients were happy with the information they had received regarding the procedure. CONCLUSION: Some 26.9 per cent of patients who underwent laparoscopy for acute abdominal pain were incorrect or did not know about the procedure that had been performed. This could lead to a further unnecessary operation should they re-present with similar symptoms. |
BibTeX:
@article{Murphy2004,
author = {S. M. Murphy and M. Donnelly and T. Fitzgerald and W. A. Tanner and F. B V Keane and S. Tierney},
title = {Patients' recall of clinical information following laparoscopy for acute abdominal pain.},
journal = {Br J Surg},
year = {2004},
volume = {91},
number = {4},
pages = {485--488},
url = {http://dx.doi.org/10.1002/bjs.4460},
doi = {http://dx.doi.org/10.1002/bjs.4460}
}
|
| Murphy, S.M. & Tierney, S. (2002), "A normal appendix found during diagnostic laparoscopy should not be removed (Br J Surg 2001;88:251-4).". Br J Surg . Volume 89(5), pp. 624; author reply 625. |
BibTeX:
@article{Murphy2002,
author = {S. M. Murphy and S. Tierney},
title = {A normal appendix found during diagnostic laparoscopy should not be removed (Br J Surg 2001;88:251-4).},
journal = {Br J Surg},
year = {2002},
volume = {89},
number = {5},
pages = {624; author reply 625}
}
|
| O'Donohoe, M.K., Murchan, P.M., Marks, P., Feely, J. & Feeley, T.M. (1993), "Endothelium derived relaxing factor is absent in experimental in situ vein grafts.". Eur J Vasc Surg . Volume 7(2), pp. 144-150. |
| Abstract: Endothelium derived relaxing factor (EDRF) is a local modulator of vasomotor tone in most blood vessels. Reversed vein grafts in several animal models do not produce EDRF when stimulated, and have been shown to have altered responses to several vasoconstrictors. The preservation of EDRF production and vasomotor function in in situ vein grafts was examined in this study. In situ vein grafts of the right carotid artery were performed in five mongrel dogs using external jugular vein. The contralateral jugular vein was used as a control. The vessels were harvested after 6 weeks and rings from the central portion of each vessel studied in vitro in an organ bath. Following cumulative dose response curves to noradrenaline, the rings were precontracted with the estimated ED50 (50% effective dose) dose of noradrenaline, and cumulative doses of acetylcholine added to induce EDRF release. The vein grafts were hypersensitive to noradrenaline, the ED50 being reduced from 8.7 +/- 2.7 x 10(-7) M in the jugular veins to 1.7 +/- 0.7 x 10(-7) M in the vein grafts (p < 0.05). All of the jugular vein segments relaxed in response to acetylcholine with a mean maximal relaxation of 42 +/- 6% of precontraction. None of the vein graft segments relaxed in response to acetylcholine despite the presence of an intact endothelium on scanning electron microscopy, but did relax in response to calcium ionophore. The results indicate that in situ vein grafts, like reversed grafts, fail to produce EDRF in response to acetylcholine. The grafts are also hypersensitive to noradrenaline.(ABSTRACT TRUNCATED AT 250 WORDS) |
BibTeX:
@article{O'Donohoe1993,
author = {M. K. O'Donohoe and P. M. Murchan and P. Marks and J. Feely and T. M. Feeley},
title = {Endothelium derived relaxing factor is absent in experimental in situ vein grafts.},
journal = {Eur J Vasc Surg},
year = {1993},
volume = {7},
number = {2},
pages = {144--150}
}
|
| O'Riordan, J.M., Fitzgerald, E., Gowing, C., O'Grady, H., Feeley, T.M. & Tierney, S. (2006), "Topical local anaesthetic (tetracaine) reduces pain from botulinum toxin injections for axillary hyperhidrosis.". Br J Surg . Volume 93(6), pp. 713-714. |
BibTeX:
@article{O'Riordan2006,
author = {J. M. O'Riordan and E. Fitzgerald and C. Gowing and H. O'Grady and T. M. Feeley and S. Tierney},
title = {Topical local anaesthetic (tetracaine) reduces pain from botulinum toxin injections for axillary hyperhidrosis.},
journal = {Br J Surg},
year = {2006},
volume = {93},
number = {6},
pages = {713--714},
url = {http://dx.doi.org/10.1002/bjs.5347},
doi = {http://dx.doi.org/10.1002/bjs.5347}
}
|
| Quinlan, M.R., Egan, B., Feeley, T.M. & Tierney, S. (2008), "Changing trends in surgical treatment of carotid disease in Ireland (1996-2003).". Ir J Med Sci . Volume 177(3), pp. 193-196. |
| Abstract: BACKGROUND: Carotid endarterectomy (CEA) is a well-established method of stroke prevention in patients with symptomatic, high-grade internal carotid artery stenosis. AIMS: To assess the change in carotid surgery practice in health board regions in Ireland over two different time periods in the past 11 years (1996-1998/2001-2003). METHODS: Numbers of discharges of patients with a procedure code CEA (38.12) between 1996-1998 and 2001-2003 were obtained from the Hospital In-Patient Enquiry (HIPE) database maintained by the Economic and Social Research Institute (ESRI). Population data was obtained from national censuses. RESULTS: There has been considerable change in the level of carotid surgery activity in specific health board regions between the two periods. CONCLUSIONS: Still no region comes close to achieving levels of CEA recommended by population studies. This is important in the context of the MRC asymptomatic carotid surgery trial (ACST), as the numbers suitable for CEA will probably increase further in the future. |
BibTeX:
@article{Quinlan2008,
author = {M. R. Quinlan and B. Egan and T. M. Feeley and S. Tierney},
title = {Changing trends in surgical treatment of carotid disease in Ireland (1996-2003).},
journal = {Ir J Med Sci},
year = {2008},
volume = {177},
number = {3},
pages = {193--196},
url = {http://dx.doi.org/10.1007/s11845-008-0178-3},
doi = {http://dx.doi.org/10.1007/s11845-008-0178-3}
}
|
| Roche-Nagle, G., Curran, J., Bouchier-Hayes, D.J. & Tierney, S. (2007), "Risk-based evaluation of thromboprophylaxis among surgical inpatients: are low risk patients treated unnecessarily?". Ir J Med Sci . Volume 176(3), pp. 169-173. |
| Abstract: BACKGROUND: Venous thromboembolism is a common source of morbidity and mortality but a variety of preventative measures are available. AIMS: To audit the current practice of thromboprophylaxis and compare against published protocols. METHODS: Three-hundred and seventy-six (376) surgical patients were surveyed prospectively. A Performa was completed recording the presence of up to 11 risk factors. A risk score was calculated and the use of specific thromboprophylatic measures identified. RESULTS: Heparin thromboprophylaxis was widely used, eight patients (who were on aspirin therapy) failed to receive any prophylaxis (risk factors 4-6). In addition there were 60 patients at low risk (risk score <2) received LMWH from which they were unlikely to benefit. CONCLUSIONS: Thromboembolic prophylaxis is widely but unselectively applied. Adoption of a risk: benefit ratio approach should ensure those who would benefit from thromboprophylaxis are adequately treated while those in whom thromboprophylaxis is not indicated are spared unnecessary therapy. |
BibTeX:
@article{Roche-Nagle2007,
author = {G. Roche-Nagle and J. Curran and D. J. Bouchier-Hayes and S. Tierney},
title = {Risk-based evaluation of thromboprophylaxis among surgical inpatients: are low risk patients treated unnecessarily?},
journal = {Ir J Med Sci},
year = {2007},
volume = {176},
number = {3},
pages = {169--173},
url = {http://dx.doi.org/10.1007/s11845-007-0049-3},
doi = {http://dx.doi.org/10.1007/s11845-007-0049-3}
}
|
| Sugrue, M.E., Carolan, J., Leen, E.J., Feeley, T.M., Moore, D.J. & Shanik, G.D. (1990), "The use of infrared laser therapy in the treatment of venous ulceration.". Ann Vasc Surg . Volume 4(2), pp. 179-181. |
| Abstract: Management of intractable venous ulceration remains an unrewarding task which is increasingly delegated to the realm of the vascular surgeon. The purpose of this pilot study was to assess the ulcer-healing effects of the newest form of biostimulation--the low power laser. Twelve patients with chronic venous ulcers unresponsive to conservative measures were treated with infrared laser irradiation for twelve weeks. Two ulcers healed completely and there was a 27% (p less than 0.01) reduction in size of the remaining ulcers. Treatment resulted in a 44% (p less than 0.01) increase in ulcer floor area occupied by healthy granulation tissue. The most dramatic effect of laser treatment was the reduction in ulcer pain, from 7.5 to 3.5 (linear analogue scale) (p less than 0.001). Laser irradiation had no effect on TcPO2, number of skin capillaries or pericapillary fibrin deposition in the lipodermatosclerotic area around the ulcer. The results of this pilot study are encouraging and a carefully controlled randomized study is indicated to compare low power laser irradiation to conventional treatment in the management of venous ulcers. |
BibTeX:
@article{Sugrue1990,
author = {M. E. Sugrue and J. Carolan and E. J. Leen and T. M. Feeley and D. J. Moore and G. D. Shanik},
title = {The use of infrared laser therapy in the treatment of venous ulceration.},
journal = {Ann Vasc Surg},
year = {1990},
volume = {4},
number = {2},
pages = {179--181}
}
|
| Tierney, S., Aslam, M., Rennie, K. & Grace, P. (1996), "Infrared optoelectronic volumetry, the ideal way to measure limb volume.". Eur J Vasc Endovasc Surg . Volume 12(4), pp. 412-417. |
| Abstract: OBJECTIVES: The aim of the study was to compare a novel infrared optoelectronic system (Perometer) of limb volume measurement with water displacement and two indirect measurement techniques. DESIGN: A prospective experimental study. METHODS: In 10 healthy male volunteers (20 limbs) we compared limb volume measurements obtained by water displacement, infrared perometry, the disc model method and the frustrum method. In a further 17 patients with swollen limbs due to lymphatic (9 limbs) or venous (11 limbs) disease, perometry was compared to the disc model method and the frustrum method only. RESULTS: In normal limbs, mean +/- S.D. limb volume using water displacement was 1802 +/- 268 ml. Perometer values agreed almost exactly (1809 +/- 262 ml, r = 0.97, variation +/- 7% by limits of agreement) but both the disc (1923 +/- 306 ml, r = 0.90, variation +/- 14 and frustrum (1905 +/- 372 ml, r = 0.72, variation +/- 28 methods significantly overestimated limb volumes (p < 0.05 (ANOVA, Fisher's Least Significant Difference)). In diseased limbs perometer, disc method and frustrum method results were 2415 +/- 995 ml, 2494 +/- 969 ml, and 2413 +/- 870 ml representing variation of +/- 17% and +/- 23% for disc method and frustrum method respectively compared to perometry. CONCLUSIONS: Perometry is a novel, extremely accurate and easy method for assessing limb volume. It provides more accurate results than traditional indirect measurement of limb volume and potentially is a very useful clinical and research tool. |
BibTeX:
@article{Tierney1996,
author = {S. Tierney and M. Aslam and K. Rennie and P. Grace},
title = {Infrared optoelectronic volumetry, the ideal way to measure limb volume.},
journal = {Eur J Vasc Endovasc Surg},
year = {1996},
volume = {12},
number = {4},
pages = {412--417}
}
|
| Tierney, S., Burke, P., Fitzgerald, P., O'Sullivan, T., Grace, P. & Bouchier-Hayes, D. (1993), "Ankle fracture is associated with prolonged venous dysfunction.". Br J Surg . Volume 80(1), pp. 36-38. |
| Abstract: Leg swelling is a significant problem following ankle fracture. Venous pump function and femoral and popliteal venous patency were assessed prospectively in 26 patients with ankle fractures requiring open reduction, internal fixation and immobilization in plaster. Functional venous volume, venous filling index (VFI), ejection volume fraction (EVF) and residual volume fraction (RVF) were measured using air plethysmography at 5 days and at 6, 12 and 18 weeks after fracture. The uninjured leg was used as a control. Popliteal and femoral venous patency was determined using duplex ultrasonography. No patient developed deep vein thrombosis during the study. At 5 days after fracture there was a significant reduction in mean(s.d.) EVF, 18.2(12.1) versus 55.9(19.5) per cent, and increase in RVF, 87.0(14.3) versus 42.5(22.2) per cent (both P < 0.001). Analogous values were similar at 6 weeks, EVF 28.5(21.2) versus 55.6(21.9) per cent, RVF 82.2(16.8) versus 48.5(23.8) per cent (both P < 0.001), and at 12 weeks, EVF 39.1(16.0) versus 60.3(14.9) per cent, RVF 64.7(18.8) versus 38.8(13.2) per cent (both P < 0.001). However, by 18 weeks there was no significant difference in venous function between fractured and control limbs. It is concluded that there is a significant and prolonged impairment in venous pump function following ankle fracture. |
BibTeX:
@article{Tierney1993b,
author = {S. Tierney and P. Burke and P. Fitzgerald and T. O'Sullivan and P. Grace and D. Bouchier-Hayes},
title = {Ankle fracture is associated with prolonged venous dysfunction.},
journal = {Br J Surg},
year = {1993},
volume = {80},
number = {1},
pages = {36--38}
}
|
| Tierney, S., Fennessy, F. & Hayes, D.B. (2000), "ABC of arterial and vascular disease. Secondary prevention of peripheral vascular disease.". BMJ . Volume 320(7244), pp. 1262-1265. |
BibTeX:
@article{Tierney2000a,
author = {S. Tierney and F. Fennessy and D. B. Hayes},
title = {ABC of arterial and vascular disease. Secondary prevention of peripheral vascular disease.},
journal = {BMJ},
year = {2000},
volume = {320},
number = {7244},
pages = {1262--1265}
}
|
| Tierney, S., Lillemoe, K.D. & Pitt, H.A. (1995), "The current management of common duct stones.". Adv Surg . Volume 28, pp. 271-299. |
BibTeX:
@article{Tierney1995a,
author = {S. Tierney and K. D. Lillemoe and H. A. Pitt},
title = {The current management of common duct stones.},
journal = {Adv Surg},
year = {1995},
volume = {28},
pages = {271--299}
}
|
| Tierney, S., Nakeeb, A., Wong, O., Lipsett, P.A., Sostre, S., Pitt, H.A. & Lillemoe, K.D. (1999), "Progesterone alters biliary flow dynamics.". Ann Surg . Volume 229(2), pp. 205-209. |
| Abstract: OBJECTIVE: To test the hypothesis that progesterone alters sphincter of Oddi and gallbladder function and, therefore, bile flow dynamics. SUMMARY BACKGROUND DATA: Although the effects of progesterone on the biliary tract have been implicated in the increased incidence of gallstones among women, the specific effects of prolonged elevation of progesterone levels, such as occurs with contraceptive progesterone implants and during pregnancy, on the sphincter of Oddi and biliary flow dynamics are still incompletely understood. METHODS: Adult female prairie dogs were randomly assigned to receive subcutaneous implants containing either progesterone or inactive pellet matrix only. Hepatic bile partitioning and gallbladder emptying were determined 14 days later using 99mTc-Mebrofenin cholescintigraphy. RESULTS: Significantly less hepatic bile partitioned into the gallbladder in progesterone-treated than in control animals. The gallbladder ejection fraction was significantly reduced from 73+/-6% in controls to 59+/-3% in the progesterone-treated animals. The rate of gallbladder emptying was significantly reduced from 3.6+/-0.3minute to 2.9+/-0.1minute. CONCLUSIONS: Progesterone administered as subcutaneous implants alters partitioning of hepatic bile between gallbladder and small intestine and, therefore, gallbladder filling. Progesterone also significantly impairs gallbladder emptying in response to cholecystokinin. The effects of progesterone on the sphincter of Oddi and the gallbladder may contribute to the greater prevalence of gallstones and biliary motility disorders among women. |
BibTeX:
@article{Tierney1999,
author = {S. Tierney and A. Nakeeb and O. Wong and P. A. Lipsett and S. Sostre and H. A. Pitt and K. D. Lillemoe},
title = {Progesterone alters biliary flow dynamics.},
journal = {Ann Surg},
year = {1999},
volume = {229},
number = {2},
pages = {205--209}
}
|
| Tierney, S., Pitt, H.A. & Lillemoe, K.D. (1993), "Physiology and pathophysiology of gallbladder motility.". Surg Clin North Am . Volume 73(6), pp. 1267-1290. |
| Abstract: Most significant gallbladder disease is associated with gallbladder stasis. Gallbladder motility is controlled by a complex interplay of hormonal and neural factors. Experimental and clinical studies have demonstrated impaired motility in gallstone disease, and experimental evidence indicates that motility disturbances precede gallstone formation. The ability to measure gallbladder motility clinically has also resulted in better diagnosis and treatment for patients with chronic acalculous cholecystitis. |
BibTeX:
@article{Tierney1993,
author = {S. Tierney and H. A. Pitt and K. D. Lillemoe},
title = {Physiology and pathophysiology of gallbladder motility.},
journal = {Surg Clin North Am},
year = {1993},
volume = {73},
number = {6},
pages = {1267--1290}
}
|
| Tierney, S., Qian, Z., Burrow, C., Lipsett, P.A., Pitt, H.A. & Lillemoe, K.D. (1994), "Estrogen inhibits sphincter of Oddi motility.". J Surg Res . Volume 57(1), pp. 69-73. |
| Abstract: Gallstones and sphincter of Oddi dysfunction are both more common in women than men, suggesting that endogenous hormones may play an important role in these conditions. Female sex hormones are known to affect cholesterol metabolism and gallbladder motility. However, the effect of these hormones on the sphincter of Oddi has not previously been studied. We therefore tested the hypothesis that exogenous estrogen administration would inhibit sphincter of Oddi motility. Twenty-three male prairie dogs fed a nonlithogenic diet were studied. Under alpha-chloralose anesthesia, a side hole pressure-monitored perfusion catheter was positioned in the sphincter of Oddi and perfused with degassed water at 0.15 ml/min. Femoral arterial and venous catheters were placed. Sphincter of Oddi phasic wave frequency (F), amplitude (A), and motility index (MI = F x A), as well as arterial blood pressure (BP), were monitored for 10-min intervals before (control), during 20-min intravenous infusions of 0.1, 1, or 10 micrograms/kg beta-estradiol, and for 20 min after estradiol infusion. No response was observed at the 0.1- or 1-micrograms doses. Sphincter of Oddi motility was significantly (P < 0.05) reduced during estrogen infusion at the higher dose of 10 micrograms, primarily due to decreased phasic wave frequency. Sphincter motility remained depressed for at least 20 min following estrogen infusion. We conclude that estrogen effects on the sphincter of Oddi may contribute to the higher incidence of gallstones and sphincter dysfunction seen in premenopausal women. |
BibTeX:
@article{Tierney1994,
author = {S. Tierney and Z. Qian and C. Burrow and P. A. Lipsett and H. A. Pitt and K. D. Lillemoe},
title = {Estrogen inhibits sphincter of Oddi motility.},
journal = {J Surg Res},
year = {1994},
volume = {57},
number = {1},
pages = {69--73},
url = {http://dx.doi.org/10.1006/jsre.1994.1112},
doi = {http://dx.doi.org/10.1006/jsre.1994.1112}
}
|
| Tierney, S., Qian, Z., Lipsett, P.A., Pitt, H.A. & Lillemoe, K.D. (1998), "Ethanol inhibits sphincter of Oddi motility.". J Gastrointest Surg . Volume 2(4), pp. 356-362. |
| Abstract: Patients with alcohol-induced liver disease are at increased risk for pigment gallstones, which are known to be particularly associated with biliary stasis. Although the effects of ethanol on the sphincter of Oddi are thought to contribute to alcoholic pancreatitis, the precise effects of ethanol on the biliary component of the sphincter of Oddi are unclear. In the prairie dog the common bile and pancreatic ducts enter the duodenum separately, facilitating pressure measurement in the sphincter choledochus in isolation. We therefore used this model to test the hypothesis that ethanol administration alters sphincter of Oddi motility. Twenty-six male prairie dogs fed a nonlithogenic diet were studied. With the animals under alpha-chloralose anesthesia, a side-hole pressure-monitored perfusion catheter was positioned in the sphincter of Oddi and femoral arterial and venous catheters were placed. Sphincter of Oddi phasic wave frequency (F), amplitude (A), and motility index (MI = F x A) and arterial blood pressure were monitored at 10-minute intervals before (baseline), during 20-minute intravenous infusions of 15 mg/kg (n = 9), 150 mg/kg (n = 10), and 1.5 g/kg (n = 7) ethanol and for 20 minutes after ethanol infusion. The 15 mg/kg dose of ethanol had no effect, the 150 mg/kg dose tended to reduce sphincter of Oddi motility, and significant reductions in sphincter of Oddi amplitude and motility index were seen at the 1.5 g/kg dose. These data demonstrate that ethanol infusion inhibits both sphincter of Oddi amplitude and motility index and that this effect persists for at least 20 minutes following ethanol infusion. Ethanol may contribute to gallstone formation by altering biliary sphincter motility. |
BibTeX:
@article{Tierney1998a,
author = {S. Tierney and Z. Qian and P. A. Lipsett and H. A. Pitt and K. D. Lillemoe},
title = {Ethanol inhibits sphincter of Oddi motility.},
journal = {J Gastrointest Surg},
year = {1998},
volume = {2},
number = {4},
pages = {356--362}
}
|
| Tierney, S., Qian, Z., Yung, B., Lipsett, P.A., Pitt, H.A., Sostre, S. & Lillemoe, K.D. (1995), "Gender influences sphincter of Oddi response to cholecystokinin in the prairie dog.". Am J Physiol . Volume 269(4 Pt 1), pp. G476-G480. |
| Abstract: Although gallstones and disorders of biliary tract motility are both more common in women than men, sphincter of Oddi motility has not previously been compared between the sexes. In this study, cholescintigraphy (under ketamine and diazepam anesthesia) was used to determine gallbladder emptying rate and ejection fraction in response to cholecystokinin (CCK) in eight male and six female prairie dogs fed a nonlithogenic diet. Ten days later, under alpha-chloralose anesthesia, sphincter of Oddi phasic wave activity was monitored for 10-min intervals before (control), during 20 min of CCK infusion, and for 20 min after infusion. Gallbladder emptying rate and ejection fraction and baseline sphincter of Oddi frequency, amplitude, and motility index (= frequency x amplitude) did not differ significantly between the sexes. Sphincter of Oddi phasic wave frequency was increased during CCK infusion in both males and females, but the change in amplitude was significantly greater in females, than males. We conclude that the increased incidence of biliary tract disease in women may be due to altered sphincter of Oddi hormonal response. |
BibTeX:
@article{Tierney1995,
author = {S. Tierney and Z. Qian and B. Yung and P. A. Lipsett and H. A. Pitt and S. Sostre and K. D. Lillemoe},
title = {Gender influences sphincter of Oddi response to cholecystokinin in the prairie dog.},
journal = {Am J Physiol},
year = {1995},
volume = {269},
number = {4 Pt 1},
pages = {G476--G480}
}
|
| Tierney, S., Russell, J.D., Walsh, M. & Folan-Curran, J. (1993), "Innervation of the rat tympanic membrane from the superior cervical and glossopharyngeal ganglia.". J Anat . Volume 182 ( Pt 3), pp. 355-360. |
| Abstract: True Blue and Fluorogold were applied to the external surface of the tympanic membrane and middle ear mucosa of Sprague-Dawley rats and neurons in the superior cervical and glossopharyngeal ganglia were labelled with these retrograde tracer dyes. Dye absorption was poor from the tympanic membrane unless the keratinized layer was damaged with crystalline silver nitrate prior to dye application. Stained neurons were scattered throughout the superior cervical ganglion with no evidence of somatotopy. Several neurons in the glossopharyngeal ganglion stained with both dyes when these had been simultaneously applied to both sites in single animals. There was no evidence of dual staining of neurons in the superior cervical ganglion. |
BibTeX:
@article{Tierney1993a,
author = {S. Tierney and J. D. Russell and M. Walsh and J. Folan-Curran},
title = {Innervation of the rat tympanic membrane from the superior cervical and glossopharyngeal ganglia.},
journal = {J Anat},
year = {1993},
volume = {182 ( Pt 3)},
pages = {355--360}
}
|
| Watson, D.P., Murphy, P.D., Feeley, T.M. & Given, F. (1986), "Adenocarcinoma of the duodenum and iron deficiency anaemia.". Ir Med J . Volume 79(5), pp. 134. |
BibTeX:
@article{Watson1986,
author = {D. P. Watson and P. D. Murphy and T. M. Feeley and F. Given},
title = {Adenocarcinoma of the duodenum and iron deficiency anaemia.},
journal = {Ir Med J},
year = {1986},
volume = {79},
number = {5},
pages = {134}
}
|
| (), "". . |
BibTeX:
@article{,
}
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