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O'Leary C, Greally M, McCaffrey J, Hughes P, Lawler LLP, O'Connell M, Geoghegan T, Farrelly C. Single-institution experience with selective internal radiation therapy (SIRT) for the treatment of unresectable colorectal liver metastases. Ir J Med Sci 2018; 188:43-53. [PMID: 29511912 DOI: 10.1007/s11845-018-1773-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 02/23/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Liver metastases are the commonest cause of death for patients with colorectal cancer. Growing evidence supports the use of selective internal radiation therapy (SIRT) in combination with conventional chemotherapy regimens for liver-only or liver-dominant unresectable metastatic colorectal cancer. AIMS To measure and evaluate outcomes of the first 20 consecutive patients with unresectable colorectal liver metastasis selected for SIRT in addition to their chemotherapy at a single Irish institution. METHODS Retrospective case series was performed. Patient charts and medical records were reviewed. RESULTS All 20 patients (100%) selected for angiographic workup were subsequently successfully treated with radioembolization. All patients were discharged 1 day post-SIRT. At initial imaging evaluation, 12 (60%) had a partial response in their liver, 2 (10%) had stable disease, and 6 (30%) had liver-specific progressive disease. Median follow up was 10 months (range 6-26). At last follow up, 14 (70%) patients were alive and 6 (30%) deceased. Most recent imaging demonstrated 2 (10%) with a complete response, 7 (35%) had a partial response, 2 (10%) had stable disease, and 9 (45%) had progressive disease within their liver. One patient was downstaged to hepatic resection, and one with a complete hepatic response had his primary sigmoid tumor resected 11 months post-SIRT. CONCLUSIONS SIRT is a safe and effective therapy for certain patients with unresectable colorectal liver metastases. This case series supports our opinion that selected patients should be offered SIRT in concert with their medical oncologist, concomitant with their chemotherapy. Larger multi-center studies are required to more clearly define the patient groups that will derive most benefit from SIRT.
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McCarthy S, Paul L, O'Connell M. Skin Cancer Awareness Amongst Irish Golfers. IRISH MEDICAL JOURNAL 2017; 110:620. [PMID: 29169002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Aim The aim of this study was to assess skin cancer awareness and identify the UV protective measures used by golfers within the Munster region of Ireland. Methods Subjects were recruited from throughout the Munster region at a regional competition, and at three other local golf clubs and "pro" shops. Participants filled out a short anonymous validated questionnaire when collecting their score cards7. Results One hundred and sixty-three golfers completed the questionnaire with a mean age of 65.6 years. 137 (84%) were male and 26 (16%) were female. We noted a high incidence of both non-melanoma and melanoma skin cancer in our subjects. Sixteen (9.8%) had a previous history of skin cancer, with 8 melanomas and 8 non-melanoma skin cancers. A high percentage, 85%, of the golfers surveyed were compliant with SPF use. However many were using too low a SPF, 63 (44%) were using a SPF less than 30. Knowledge of risk of skin cancer is better amongst the golfers surveyed when compared to the general population. Most respondents (N = 96 (59%)) were aware that melanoma can lead to death if left untreated and 114 (70%) recognized that melanoma can be cured if treated early. Conclusion Golfers may benefit from targeted education emphasizing the importance of higher SPF use. Other interventions that may benefit this population would include availability of sunscreens and educational literature in 'pro' shops at golf courses.
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Lonergan PE, Nic An Riogh A, O'Kelly F, Lundon DJ, O'Sullivan D, O'Connell M, Hegarty PK. Dynamic sentinel node biopsy for penile cancer: an initial experience in an Irish Hospital. Ir J Med Sci 2017; 186:841-845. [PMID: 28102480 DOI: 10.1007/s11845-017-1558-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 01/11/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND The presence of nodal metastases is the single most important prognostic factor in penile cancer. However, reliable assessment of nodal status in clinically node-negative (cN0) patients poses a challenge. Approximately 20% of these patients harbour occult nodal metastases. Currently available non-invasive radiological investigations are unreliable in excluding micrometastatic disease. AIM Dynamic sentinel node biopsy (DSNB) is a minimally invasive procedure for assessing lymph node involvement. We report our initial experience with DSNB in assessing the status of regional lymph nodes in cN0 penile cancer patients. METHODS DSNB was performed in penile cancer patients with at least one cN0 groin. All patients undergoing DSNB at our institution were included. Lymphoscintigraphic images were obtained from all patients, after intradermal, peritumoral injection of a Technetium-99m nanocolloid. The sentinel nodes were defined as the nodes identified on lymphoscintigraphy, which were also radioactive intraoperatively using a gamma probe. RESULTS In total, 18 groins from 11 patients underwent DSNB. Of these, 11 patients underwent bilateral DSNB and 4 had unilateral DSNB. The mean (range) age of patients at the time of presentation of their primary tumour was 63 (39-78) years. A mean of 1.2 nodes per groin was retrieved. One lymph node was positive in one patient, who subsequently underwent a bilateral inguinal lymph node dissection. Overall, the median (range) follow-up was 12.8 (2.7-31.3) months with no local or regional recurrences. CONCLUSION Further cases and longer follow-up will define the accuracy of this technique in the Irish population.
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Dupan S, O'Connell M, Kenny RA, Finucane C. 41BAROREFLEX SENSITIVITY AND ARTERIAL STIFFNESS INFLUENCE ORTHOSTATIC BLOOD PRESSURE RESPONSES IN OLDER ADULTS: INSIGHTS FROM THE IRISH LONGITUDINAL STUDY ON AGEING. Age Ageing 2016. [DOI: 10.1093/ageing/afw026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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McCarthy A, Lonergan R, Olszewska DA, O'Dowd S, Cummins G, Magennis B, Fallon EM, Pender N, Huey ED, Cosentino S, O'Rourke K, Kelly BD, O'Connell M, Delon I, Farrell M, Spillantini MG, Rowland LP, Fahn S, Craig P, Hutton M, Lynch T. Closing the tau loop: the missing tau mutation. Brain 2015; 138:3100-9. [PMID: 26297556 DOI: 10.1093/brain/awv234] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 06/27/2015] [Indexed: 12/30/2022] Open
Abstract
Frontotemporal lobar degeneration comprises a group of disorders characterized by behavioural, executive, language impairment and sometimes features of parkinsonism and motor neuron disease. In 1994 we described an Irish-American family with frontotemporal dementia linked to chromosome 17 associated with extensive tau pathology. We named this disinhibition-dementia-parkinsonism-amyotrophy complex. We subsequently identified mutations in the MAPT gene. Eleven MAPT gene splice site stem loop mutations were identified over time except for 5' splice site of exon 10. We recently identified another Irish family with autosomal dominant early amnesia and behavioural change or parkinsonism associated with the 'missing' +15 mutation at the intronic boundary of exon 10. We performed a clinical, neuropsychological and neuroimaging study on the proband and four siblings, including two affected siblings. We sequenced MAPT and performed segregation analysis. We looked for a biological effect of the tau variant by performing real-time polymerase chain reaction analysis of RNA extracted from human embryonic kidney cells transfected with exon trapping constructs. We found a c.915+15A>C exon 10/intron 10 stem loop mutation in all affected subjects but not in the unaffected. The c.915+15A>C variant caused a shift in tau splicing pattern to a predominantly exon 10+ pattern presumably resulting in predominant 4 repeat tau and little 3 repeat tau. This strongly suggests that the c.915+15A>C variant is a mutation and that it causes frontotemporal dementia linked to chromosome 17 in this pedigree by shifting tau transcription and translation to +4 repeat tau. Tau (MAPT) screening should be considered in families where amnesia or atypical parkinsonism coexists with behavioural disturbance early in the disease process. We describe the final missing stem loop tau mutation predicted 15 years ago. Mutations have now been identified at all predicted sites within the 'stem' when the stem-loop model was first proposed and no mutations have been found within the 'loop' region as expected. Therefore we 'close the tau loop' having 'opened the loop' 21 years ago.
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Wiborg O, O'Connell M, Thiele R, Wichert M, Kolb G. Automated and Continuous Production of Microstructured Metallic Plates via Cold Embossing. Chem Eng Technol 2015. [DOI: 10.1002/ceat.201400708] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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O'Connell M, Wonodi C. Routine immunization consultants (RICON) review in Nigeria: A country
driven management approach for health systems strengthening in routine
immunization. Ann Glob Health 2015. [DOI: 10.1016/j.aogh.2015.02.920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Anglim B, Maher N, Cunningham O, Mulcahy D, Harbison J, O'Connell M. A rare case of cryptogenic stroke with an incidental finding of patent foramen ovale. IRISH MEDICAL JOURNAL 2015; 108:92. [PMID: 25876305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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McKinley J, O'Connell M, Farrell M, Lynch T. Normal dopamine transporter imaging does not exclude multiple system atrophy. Parkinsonism Relat Disord 2014; 20:933-4. [PMID: 24861660 DOI: 10.1016/j.parkreldis.2014.04.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 04/14/2014] [Accepted: 04/15/2014] [Indexed: 11/16/2022]
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Chróinín DN, Marnane M, Akijian L, Merwick A, Fallon E, Horgan G, Dolan E, Murphy S, O'Rourke K, O'Malley K, O'Donohoe M, McDonnell C, Noone I, Barry M, Crowe M, Kavanagh E, O'Connell M, Kelly PJ. Serum lipids associated with inflammation-related PET-FDG uptake in symptomatic carotid plaque. Neurology 2014; 82:1693-9. [PMID: 24727313 DOI: 10.1212/wnl.0000000000000408] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We hypothesized that serum lipids, which experimental data suggest may be key initiators of carotid plaque inflammation, would be associated with plaque inflammation on (18)fluorodeoxyglucose (FDG)-PET in patients with acutely symptomatic carotid stenosis. METHODS In this cohort study, consecutive patients with acute symptomatic internal carotid artery (ICA) stenosis (≥50%) underwent carotid PET-CT. We quantified plaque FDG uptake as follows: (1) average maximum standardized uptake values (SUVmax) across 10 regions of interest (ROI); (2) highest single ROI SUV measure (SUVROImax); (3) averaged mean SUV across 10 ROIs (SUVmean). RESULTS Sixty-one patients were included. Plaque inflammatory FDG SUVmax was associated with increasing tertiles of low-density lipoprotein (LDL) (trend p = 0.004), total cholesterol (p = 0.009), and triglycerides (p = 0.01), and with lower high-density lipoprotein (HDL) (p = 0.005). When analyzed as a continuous variable, LDL was associated with symptomatic ICA SUVmean (Spearman rho 0.44, p = 0.009), SUVROImax (rho 0.33, p = 0.01), and SUVmax (rho 0.35, p = 0.06). Total cholesterol was associated with SUVmean (rho 0.33, p = 0.009), with trends for SUVmax (rho 0.24, p = 0.059) and SUVROImax (rho 0.23, p = 0.08). Triglycerides were associated with SUVmax (rho 0.32, p = 0.01) and SUVROImax (rho 0.35, p = 0.005). HDL was associated with lower SUVmax (rho -0.37, p = 0.004) and SUVROImax (rho -0.44, p = 0.0004). On multivariable linear regression analysis adjusting for age, sex, degree of carotid stenosis, statins, and smoking, LDL (p = 0.008) and total cholesterol (p = 0.04) were independently associated with SUVmax. CONCLUSION Serum LDL and total cholesterol were associated with acutely symptomatic carotid plaque FDG uptake, supporting experimental data suggesting lipids may promote plaque inflammation, mediating rupture and clinical events.
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Pahwa R, Lyons KE, Hauser RA, Fahn S, Jankovic J, Pourcher E, Hsu A, O'Connell M, Kell S, Gupta S. Randomized trial of IPX066, carbidopa/levodopa extended release, in early Parkinson's disease. Parkinsonism Relat Disord 2014; 20:142-8. [DOI: 10.1016/j.parkreldis.2013.08.017] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Revised: 08/15/2013] [Accepted: 08/27/2013] [Indexed: 10/26/2022]
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Essex MN, O'Connell M, Bhadra Brown P. Response to nonsteroidal anti-inflammatory drugs in African Americans with osteoarthritis of the knee. J Int Med Res 2013; 40:2251-66. [PMID: 23321182 DOI: 10.1177/030006051204000623] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE This 6-week, randomized, double-blind, parallel-group study compared the analgesic efficacy, tolerability and safety of celecoxib, naproxen and placebo in African Americans with osteoarthritis (OA) of the knee. METHODS A total of 322 patients aged ≥ 45 years with OA of the knee in a flare state received 200 mg celecoxib orally once daily, 500 mg naproxen orally twice daily or placebo for 6 weeks. The primary endpoint was change from baseline in the Patient's Assessment of Arthritis Pain. RESULTS Celecoxib was as effective as naproxen in reducing OA pain. Similar efficacy was observed in many of the secondary outcome measures. Celecoxib was well tolerated and demonstrated favorable upper gastro-intestinal tolerability. Improvements in outcome measures were numerically greater in the active treatment groups compared with the placebo group, but did not reach statistical significance. CONCLUSIONS Celecoxib was as effective as naproxen in relieving OA pain in African Americans and was well tolerated. Few significant differences were observed between active treatments and placebo, possibly because of a strong placebo effect.
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Greiner H, Schaller-Ammann R, Huber A, O'Connell M, Krejci J, Porro G, Korsatko S, Gurban J, Deller S, Brunner M, Berghofer A, Priedl J, Zijlstra E, Heise T, Pieber TR, Schaupp L. Continuous Blood Glucose Monitoring (Cgm) System Based on Intravenous Microdialysis and Glucose Sensing. BIOMED ENG-BIOMED TE 2013; 58 Suppl 1:/j/bmte.2013.58.issue-s1-I/bmt-2013-4224/bmt-2013-4224.xml. [PMID: 24042873 DOI: 10.1515/bmt-2013-4224] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Pazderska A, O'Connell M, Pender N, Gavin C, Murray B, O'Dowd S. Insights into thermoregulation: A clinico-radiological description of Shapiro syndrome. J Neurol Sci 2013; 329:66-8. [DOI: 10.1016/j.jns.2013.03.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 03/13/2013] [Accepted: 03/14/2013] [Indexed: 11/30/2022]
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Hauser RA, Hsu A, Kell S, Espay AJ, Sethi K, Stacy M, Ondo W, O'Connell M, Gupta S. Extended-release carbidopa-levodopa (IPX066) compared with immediate-release carbidopa-levodopa in patients with Parkinson's disease and motor fluctuations: a phase 3 randomised, double-blind trial. Lancet Neurol 2013; 12:346-56. [DOI: 10.1016/s1474-4422(13)70025-5] [Citation(s) in RCA: 103] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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O'Dowd S, Curtin D, Waite AJ, Roberts K, Pender N, Reid V, O'Connell M, Williams NM, Morris HR, Traynor BJ, Lynch T. C9ORF72 expansion in amyotrophic lateral sclerosis/frontotemporal dementia also causes parkinsonism. Mov Disord 2012; 27:1072-4. [PMID: 22807188 DOI: 10.1002/mds.25022] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Eastin T, O'Connell M, Gorgas D, Schwaab J. 33 A Novel Approach to the Asynchronous Learning Curriculum. Ann Emerg Med 2012. [DOI: 10.1016/j.annemergmed.2012.07.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Marnane M, Merwick A, Sheehan OC, Hannon N, Foran P, Grant T, Dolan E, Moroney J, Murphy S, O'Rourke K, O'Malley K, O'Donohoe M, McDonnell C, Noone I, Barry M, Crowe M, Kavanagh E, O'Connell M, Kelly PJ. Carotid plaque inflammation on 18F-fluorodeoxyglucose positron emission tomography predicts early stroke recurrence. Ann Neurol 2012; 71:709-18. [DOI: 10.1002/ana.23553] [Citation(s) in RCA: 182] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Revised: 11/04/2011] [Accepted: 12/14/2011] [Indexed: 11/06/2022]
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Marnane M, Merwick A, Sheehan OC, Hannon N, Foran P, Grant T, Dolan E, Moroney J, Murphy S, O'Rourke K, O'Malley K, O'Donohoe M, McDonnell C, Noone I, Barry M, Crowe M, Kavanagh E, O'Connell M, Kelly PJ. Abstract 2756: Carotid Plaque Inflammation On
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F-Fluorodeoxyglucose Positron Emission Tomography Predicts Early Stroke Recurrence- The Dublin Carotid Atherosclerosis Stroke Study. Stroke 2012. [DOI: 10.1161/str.43.suppl_1.a2756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background
Symptomatic carotid stenosis is associated with a 3-fold risk of early stroke recurrence compared to other stroke subtypes. Current carotid imaging techniques rely on estimating plaque-related lumen narrowing but do not evaluate intra-plaque inflammation, a key mediator of plaque rupture and thromboembolism. Using combined
18
F-fluorodeoxyglucose positron emission tomography/CT (FDG-PET/CT) we investigated the relationship between inflammation-related FDG uptake and stroke recurrence.
Methods
Consecutive patients with a recent (median 6.5 days [IQR 4-8]) stroke, TIA, or retinal embolism and ipsilateral carotid stenosis ( ≥50%) were included. FDG uptake was quantified as mean standardised uptake values (SUV, g/ml). Patients were followed prospectively for stroke recurrence.
Results
60 patients were included (25 stroke, 29 TIA, 6 retinal embolism). 22% (13/60) had stroke recurrence within 90 days. FDG uptake in ipsilateral carotid plaque was greater in patients with early recurrent stroke (mean SUV 1.85 [SD 0.44] vs. 1.58 [SD 0.32] g/ml, p=0.02). On life-table analysis, 90-day recurrence rates with mean SUV greater than a 2.14g/ml threshold were 80% (CI 41.8-99.2%) versus 22.9% (CI 12.3-40.3%) with SUV ≤2.14g/ml (log-rank p<0.0001). In a Cox regression model including age and degree of stenosis (50-69% or ≥70%), mean plaque FDG uptake was the only independent predictor of stroke recurrence (adjusted hazard ratio 6.1, CI 1.3-28.8, p=0.02).
Conclusion
In recently-symptomatic carotid stenosis, inflammation-related FDG uptake was associated with early stroke recurrence, independent of the degree of stenosis. Plaque FDG-PET may identify patients at highest risk for stroke recurrence, who may be selected for immediate revascularisation or intensive medical treatment.
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Cheung WY, Shi Q, O'Connell M, Cassidy J, Blanke CD, Kerr DJ, Van Cutsem E, Alberts SR, Yothers GA, Sargent DJ. Predictive and prognostic value of gender in early-stage colon cancer: A pooled analysis of 33,345 patients from the ACCENT database. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.3619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Martyn F, Phelan O, O'Connell M. Hepatitis C: is there a case for universal screening in pregnancy? IRISH MEDICAL JOURNAL 2011; 104:144-146. [PMID: 21736090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Hepatitis C (HCV) is not routinely screened for antenatally in all maternity hospitals. Most hospitals adopt a policy of targeted screening. The policy in the Coombe Women and Infants University Hospital in Dublin changed from targeted screening in 2006 to universal screening in 2007. We audited the two consecutive years. The prevalence of HCV in our antenatal population was 1.4% for 2006 (67/4666) when targeted screening applied and in 2007--0.71% (66/9222) when universal screening came into affect. One woman in 2007 would not have been detected by targeted screening--1.49% (1/67). Fifty five percent (37/67) of women were HCV-RNA positive in 2006 and 57.5% (38/66) were positive in 2007. We conclude that there were similar detection rates for HCV in 2006 and 2007 and that universal screening is not required if inclusive criteria for selective screening are employed but is of use in research context.
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Clifford A, O'Connell M, Gabriel S, Miller LE, Block JE. The KineSpring load absorber implant: rationale, design and biomechanical characterization. J Med Eng Technol 2011; 35:65-71. [PMID: 21142591 DOI: 10.3109/03091902.2010.535592] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Osteoarthritis (OA) of the knee is the leading cause of disability in the adult population. Although a number of treatments for knee OA are available, none effectively prevent OA progression. Currently, a wide therapeutic gap exists for patients who have unsuccessfully exhausted conservative OA treatments but who are hesitant or ineligible to undergo invasive surgery. The KineSpring device is a novel, joint preserving, minimally invasive implant that reduces medial compartment loading without significantly impacting the loading of the lateral compartment. This article describes the rationale for and the design of the KineSpring device and summarizes results of initial biomechanical testing in an OA cadaver model.
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Burton F, Alkaade S, Collins D, Muddana V, Slivka A, Brand RE, Gelrud A, Banks PA, Sherman S, Anderson MA, Romagnuolo J, Lawrence C, Baillie J, Gardner TB, Lewis MD, Amann ST, Lieb JG, O'Connell M, Kennard ED, Yadav D, Whitcomb DC, Forsmark CE. Use and perceived effectiveness of non-analgesic medical therapies for chronic pancreatitis in the United States. Aliment Pharmacol Ther 2011; 33:149-59. [PMID: 21083584 PMCID: PMC3142582 DOI: 10.1111/j.1365-2036.2010.04491.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Effectiveness of medical therapies in chronic pancreatitis has been described in small studies of selected patients. AIM To describe frequency and perceived effectiveness of non-analgesic medical therapies in chronic pancreatitis patients evaluated at US referral centres. METHODS Using data on 516 chronic pancreatitis patients enrolled prospectively in the NAPS2 Study, we evaluated how often medical therapies [pancreatic enzyme replacement therapy (PERT), vitamins/antioxidants (AO), octreotide, coeliac plexus block (CPB)] were utilized and considered useful by physicians. RESULTS Oral PERT was commonly used (70%), more frequently in the presence of exocrine insufficiency (EI) (88% vs. 61%, P < 0.001) and pain (74% vs. 59%, P < 0.002). On multivariable analyses, predictors of PERT usage were EI (OR 5.14, 95% CI 2.87-9.18), constant (OR 3.42, 95% CI 1.93-6.04) or intermittent pain (OR 1.98, 95% CI 1.14-3.45). Efficacy of PERT was predicted only by EI (OR 2.16, 95% CI 1.36-3.42). AO were tried less often (14%) and were more effective in idiopathic and obstructive vs. alcoholic chronic pancreatitis (25% vs. 4%, P = 0.03). Other therapies were infrequently used (CPB - 5%, octreotide - 7%) with efficacy generally <50%. CONCLUSIONS Pancreatic enzyme replacement therapy is commonly utilized, but is considered useful in only subsets of chronic pancreatitis patients. Other medical therapies are used infrequently and have limited efficacy.
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Khan R, Burgoyne L, O'Connell M, Dempsey EM. Antenatal management of the expectant mother and extreme preterm infant at the limits of viability. IRISH MEDICAL JOURNAL 2010; 103:266-269. [PMID: 21186749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
We explored the opinions of healthcare providers on the antenatal management and outcome of preterm delivery at less than 28 weeks gestation. An anonymous postal questionnaire was sent to health care providers. The response rate was 55% (74% Obstetrician, 70% neonatologist). Twenty four weeks is the limit at which most would advocate intervention. At 23 weeks 67% of neonatologists advocate antenatal steroids. 50% of all health care providers advocate cardiotocographic monitoring at 24 weeks gestation. Written information on survival and long-term outcome is provided by 8% of the respondents. Neonatologists (50%) were more likely than obstetrician (40%) to advocate caesarean section at 25 weeks. We conclude that 24 weeks is the limit at which most would advocate intervention. Significant variation exists both between and within each health care group at less than 25 weeks. Establishment and provision of national outcome data may aid decision making at the limits of viability.
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