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Murphy SJX, Lim ST, Kinsella JA, Tierney S, Egan B, Feeley TM, Murphy SM, Walsh RA, Collins DR, Coughlan T, O'Neill D, Harbison JA, Madhavan P, O'Neill SM, Colgan MP, Cox D, Moran N, Hamilton G, Meaney JF, McCabe DJH. Relationship between 'on-treatment platelet reactivity', shear stress, and micro-embolic signals in asymptomatic and symptomatic carotid stenosis. J Neurol 2019; 267:168-184. [PMID: 31606758 DOI: 10.1007/s00415-019-09550-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 09/17/2019] [Accepted: 09/19/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Assessment of 'high on-treatment platelet reactivity (HTPR)' could enhance understanding of the pathophysiology of first or recurrent vascular events in carotid stenosis patients on antiplatelet therapy. METHODS This prospective, multi-centre study assessed antiplatelet-HTPR status and its relationship with micro-emboli signals (MES) in asymptomatic vs. symptomatic ≥ 50-99% carotid stenosis. Platelet function/reactivity was assessed under 'moderately high shear stress' with the PFA-100® and 'low shear stress' with VerifyNow® and Multiplate® analysers. Bilateral 1-h transcranial Doppler ultrasound of the middle cerebral arteries classified patients as MES + ve or MES - ve. RESULTS Data from 34 asymptomatic patients were compared with 43 symptomatic patients in the 'early phase' (≤ 4 weeks) and 37 patients in the 'late phase' (≥ 3 months) after TIA/ischaemic stroke. Median daily aspirin doses were higher in early symptomatic (225 mg; P < 0.001), but not late symptomatic (75 mg; P = 0.62) vs. asymptomatic patients (75 mg). There was a lower prevalence of aspirin-HTPR in early (28.6%; P = 0.028), but not late symptomatic (38.9%; P = 0.22) compared with asymptomatic patients (56.7%) on the PFA-100®, but not on the VerifyNow® or Multiplate® (P ≤ 0.53). Early symptomatic patients had a higher prevalence of aspirin-HTPR on the PFA-100® (28.6%) vs. VerifyNow® (9.5%; P = 0.049), but not Multiplate® assays (11.9%, P = 0.10). There was no difference in aspirin-HTPR prevalence between any symptomatic vs. asymptomatic MES + ve or MES - ve subgroup. DISCUSSION Recently symptomatic moderate-severe carotid stenosis patients had a lower prevalence of aspirin-HTPR than their asymptomatic counterparts on the PFA-100®, likely related to higher aspirin doses. The prevalence of antiplatelet-HTPR was positively influenced by higher shear stress levels, but not MES status.
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Affiliation(s)
- S J X Murphy
- Department of Neurology, AMNCH/Tallaght University Hospital, Dublin, Ireland.,Stroke Service, AMNCH/Tallaght University Hospital, Dublin, Ireland
| | - S T Lim
- Department of Neurology, AMNCH/Tallaght University Hospital, Dublin, Ireland.,Stroke Service, AMNCH/Tallaght University Hospital, Dublin, Ireland
| | - J A Kinsella
- Department of Neurology, St Vincent's University Hospital, University College Dublin, Dublin, Ireland
| | - S Tierney
- Department of Vascular Surgery, AMNCH/Tallaght University Hospital, Dublin, Ireland
| | - B Egan
- Department of Vascular Surgery, AMNCH/Tallaght University Hospital, Dublin, Ireland
| | - T M Feeley
- Department of Vascular Surgery, AMNCH/Tallaght University Hospital, Dublin, Ireland.,Dublin Midlands Hospital Group, Dublin, Ireland
| | - S M Murphy
- Department of Neurology, AMNCH/Tallaght University Hospital, Dublin, Ireland.,Stroke Service, AMNCH/Tallaght University Hospital, Dublin, Ireland.,Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - R A Walsh
- Department of Neurology, AMNCH/Tallaght University Hospital, Dublin, Ireland.,Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - D R Collins
- Age-Related Health Care Department, AMNCH/Tallaght University Hospital, Dublin, Ireland.,Stroke Service, AMNCH/Tallaght University Hospital, Dublin, Ireland
| | - T Coughlan
- Age-Related Health Care Department, AMNCH/Tallaght University Hospital, Dublin, Ireland.,Stroke Service, AMNCH/Tallaght University Hospital, Dublin, Ireland
| | - D O'Neill
- Age-Related Health Care Department, AMNCH/Tallaght University Hospital, Dublin, Ireland.,Stroke Service, AMNCH/Tallaght University Hospital, Dublin, Ireland
| | - J A Harbison
- Department of Medicine for the Elderly/Stroke Service, St. James's Hospital/Trinity College Dublin, Dublin, Ireland
| | - P Madhavan
- Department of Vascular Surgery, St. James's Hospital/Trinity College Dublin, Dublin, Ireland
| | - S M O'Neill
- Department of Vascular Surgery, St. James's Hospital/Trinity College Dublin, Dublin, Ireland
| | - M P Colgan
- Department of Vascular Surgery, St. James's Hospital/Trinity College Dublin, Dublin, Ireland
| | - D Cox
- Department of Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland.,Irish Centre for Vascular Biology, Dublin, Ireland
| | - N Moran
- Department of Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland.,Irish Centre for Vascular Biology, Dublin, Ireland
| | - G Hamilton
- Department of Vascular Surgery, University Department of Surgery, Royal Free Hampstead NHS Trust, London, UK
| | - J F Meaney
- Department of Radiology, Centre for Advanced Medical Imaging, St. James's Hospital/Trinity College Dublin, Dublin, Ireland
| | - D J H McCabe
- Vascular Neurology Research Foundation, C/O Department of Neurology, The Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital (AMNCH)/Tallaght University Hospital, Tallaght, Dublin 24, Ireland. .,Department of Neurology, AMNCH/Tallaght University Hospital, Dublin, Ireland. .,Stroke Service, AMNCH/Tallaght University Hospital, Dublin, Ireland. .,Department of Clinical Neurosciences, Royal Free Campus, UCL Queen Square Institute of Neurology, London, UK. .,Irish Centre for Vascular Biology, Dublin, Ireland. .,Stroke Clinical Trials Network Ireland, Dublin, Ireland. .,Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Dublin, Ireland.
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Murphy SJX, Lim ST, Kinsella JA, Tierney S, Egan B, Feeley TM, Murphy SM, Walsh RA, Collins DR, Coughlan T, O'Neill D, Harbison JA, Madhavan P, O'Neill SM, Colgan MP, Cox D, Moran N, Hamilton G, McCabe DJH. Increased Leucocyte-Platelet Complex Formation in Recently Symptomatic versus Asymptomatic Carotid Stenosis Patients and in Micro-emboli Negative Subgroups. Thromb Haemost 2019; 119:821-833. [PMID: 30769362 DOI: 10.1055/s-0039-1678666] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Cerebral micro-embolic signals (MES) predict risk of stroke in carotid stenosis patients. However, MES-negative 'recently symptomatic patients' also have a higher stroke risk than 'asymptomatic patients'. Differences in platelet activation status may contribute to this disparity in risk. METHODS This prospective, observational study assessed platelet biomarkers and their relationship with MES in asymptomatic versus symptomatic moderate (≥50-69%) or severe (≥70-99%) carotid stenosis patients. Full blood count parameters were measured and whole-blood flow cytometry was used to quantify platelet surface CD62P and CD63 expression and leucocyte-platelet complex formation. Bilateral simultaneous transcranial Doppler ultrasound of the middle cerebral arteries classified patients as 'MES positive' or 'MES negative'. RESULTS Data from 34 asymptomatic patients were compared with those from 43 symptomatic patients in the 'early phase' (≤ 4 weeks) and 37 of these symptomatic patients in the 'late phase' (≥ 3 months) after transient ischaemic attack/ischaemic stroke. There were no differences in %CD62P or %CD63 expression between early or late symptomatic and asymptomatic patients overall (p > 0.05). The percentage of lymphocyte-platelet complexes was higher in early symptomatic than in asymptomatic patients (2.8 vs. 2.16%; p < 0.001). MES were more commonly observed in early symptomatic (31.4%; p = 0.027) but not in late symptomatic (6.7%; p = 0.996) versus asymptomatic patients (7.1%). The percentage of lymphocyte-platelet complexes was higher in early symptomatic than in asymptomatic MES-negative patients (2.7 vs. 2.17%; p = 0.02). CONCLUSION These data add to the evidence that leucocyte-platelet complex formation/platelet activation is increased in recently symptomatic versus asymptomatic patients, and may contribute to the pathogenesis of first and subsequent strokes in carotid stenosis patients, including those who are MES negative.
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Affiliation(s)
- Stephen J X Murphy
- Department of Neurology, Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH)/Tallaght University Hospital, Dublin, Ireland.,Stroke Service, Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH)/Tallaght University Hospital, Dublin, Ireland
| | - Soon Tjin Lim
- Department of Neurology, Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH)/Tallaght University Hospital, Dublin, Ireland.,Stroke Service, Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH)/Tallaght University Hospital, Dublin, Ireland
| | - Justin A Kinsella
- Department of Neurology, St Vincent's University Hospital, University College Dublin, Dublin, Ireland
| | - Sean Tierney
- Department of Vascular Surgery, Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH)/Tallaght University Hospital, Dublin, Ireland
| | - Bridget Egan
- Department of Vascular Surgery, Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH)/Tallaght University Hospital, Dublin, Ireland
| | - T M Feeley
- Department of Vascular Surgery, Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH)/Tallaght University Hospital, Dublin, Ireland.,Dublin Midlands Hospital Group, Ireland
| | - Sinead M Murphy
- Department of Neurology, Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH)/Tallaght University Hospital, Dublin, Ireland.,Age-Related Health Care Department, Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH)/Tallaght University Hospital, Dublin, Ireland.,Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Ireland
| | - Richard A Walsh
- Department of Neurology, Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH)/Tallaght University Hospital, Dublin, Ireland.,Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Ireland
| | - D R Collins
- Stroke Service, Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH)/Tallaght University Hospital, Dublin, Ireland.,Age-Related Health Care Department, Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH)/Tallaght University Hospital, Dublin, Ireland
| | - Tara Coughlan
- Stroke Service, Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH)/Tallaght University Hospital, Dublin, Ireland.,Age-Related Health Care Department, Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH)/Tallaght University Hospital, Dublin, Ireland
| | - Desmond O'Neill
- Stroke Service, Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH)/Tallaght University Hospital, Dublin, Ireland.,Age-Related Health Care Department, Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH)/Tallaght University Hospital, Dublin, Ireland
| | - Joseph A Harbison
- Department of Medicine for the Elderly/Stroke Service, St James Hospital/Trinity College Dublin, Ireland
| | - Prakash Madhavan
- Department of Vascular Surgery, St James Hospital/Trinity College Dublin, Dublin, Ireland
| | - Sean M O'Neill
- Department of Vascular Surgery, St James Hospital/Trinity College Dublin, Dublin, Ireland
| | - Mary P Colgan
- Department of Vascular Surgery, St James Hospital/Trinity College Dublin, Dublin, Ireland
| | - Dermot Cox
- Department of Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Niamh Moran
- Department of Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - George Hamilton
- Department of Vascular Surgery, University Department of Surgery, Royal Free Hampstead NHS Trust, London, United Kingdom
| | - Dominick J H McCabe
- Department of Neurology, Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH)/Tallaght University Hospital, Dublin, Ireland.,Stroke Service, Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH)/Tallaght University Hospital, Dublin, Ireland.,Age-Related Health Care Department, Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH)/Tallaght University Hospital, Dublin, Ireland.,Vascular Neurology Research Foundation, c/o Department of Neurology, Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH)/Tallaght University Hospital, Dublin, Ireland.,Department of Clinical Neurosciences, Royal Free Campus, UCL Institute of Neurology, London, United Kingdom.,Irish Centre for Vascular Biology, Dublin, Ireland
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Tobin WO, Kinsella JA, Kavanagh GF, O'Donnell JS, McGrath RT, Tierney S, Egan B, Feeley TM, Coughlan T, Collins DR, O'Neill D, Murphy S, Lim SJ, Murphy RP, McCabe D. Profile of von Willebrand factor antigen and von Willebrand factor propeptide in an overall TIA and ischaemic stroke population and amongst subtypes. J Neurol Sci 2017; 375:404-410. [PMID: 28320178 DOI: 10.1016/j.jns.2017.02.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 02/20/2017] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Von Willebrand factor propeptide (VWF:Ag II) is proposed to be a more sensitive marker of acute endothelial activation than von Willebrand factor antigen (VWF:Ag). Simultaneous data on VWF:Ag and VWF:Ag II profiles are very limited following TIA and ischaemic stroke. METHODS In this prospective, observational, case-control study, plasma VWF:Ag and VWF:Ag II levels were quantified in 164 patients≤4weeks of TIA or ischaemic stroke (baseline), and then ≥14days (14d) and ≥90days (90d) later, and compared with those from 27 healthy controls. TIA and stroke subtyping was performed according to the TOAST classification. The relationship between VWF:Ag and VWF:Ag II levels and platelet activation status was assessed. RESULTS 'Unadjusted' VWF:Ag and VWF:Ag II levels were higher in patients at baseline, 14d and 90d than in controls (p≤0.03). VWF:Ag levels remained higher in patients than controls at baseline (p≤0.03), but not at 14d or 90d after controlling for differences in age or hypertension, and were higher in patients at baseline and 90d after controlling for smoking status (p≤0.04). 'Adjusted' VWF:Ag II levels were not higher in patients than controls after controlling for age, hypertension or smoking (p≥0.1). Patients with symptomatic carotid stenosis (N=46) had higher VWF:Ag and VWF:Ag II levels than controls at all time-points (p≤0.002). There was no significant correlation between platelet activation status and VWF:Ag or VWF:Ag II levels. CONCLUSIONS VWF:Ag and VWF:Ag II levels are increased in an overall TIA and ischaemic stroke population, especially in patients with recently symptomatic carotid stenosis. VWF:Ag II was not superior to VWF:Ag at detecting acute endothelial activation in this cohort and might reflect timing of blood sampling in our study.
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Affiliation(s)
- W O Tobin
- Vascular Neurology Research Foundation, The Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital, Trinity College Dublin, Ireland; Department of Neurology, College of Medicine, Mayo Clinic, Rochester, MN, United States
| | - J A Kinsella
- Vascular Neurology Research Foundation, The Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital, Trinity College Dublin, Ireland; Department of Neurology, St. Vincent's University Hospital, University College Dublin, Elm Park, Dublin 4, Ireland
| | - G F Kavanagh
- Vascular Neurology Research Foundation, The Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital, Trinity College Dublin, Ireland
| | - J S O'Donnell
- Irish Centre for Vascular Biology, Royal College of Surgeons of Ireland, Ireland
| | - R T McGrath
- Irish Centre for Vascular Biology, Royal College of Surgeons of Ireland, Ireland
| | - S Tierney
- Department of Neurology, The Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital, Trinity College Dublin, Ireland; Department of Vascular Surgery, The Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital, Trinity College Dublin, Ireland
| | - B Egan
- Department of Neurology, The Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital, Trinity College Dublin, Ireland; Department of Vascular Surgery, The Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital, Trinity College Dublin, Ireland
| | - T M Feeley
- Department of Neurology, The Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital, Trinity College Dublin, Ireland; Department of Vascular Surgery, The Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital, Trinity College Dublin, Ireland
| | - T Coughlan
- Department of Age-Related Health Care, The Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital, Trinity College Dublin, Ireland; Stroke Service, The Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital, Trinity College Dublin, Ireland
| | - D R Collins
- Department of Age-Related Health Care, The Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital, Trinity College Dublin, Ireland; Stroke Service, The Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital, Trinity College Dublin, Ireland
| | - D O'Neill
- Department of Age-Related Health Care, The Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital, Trinity College Dublin, Ireland; Stroke Service, The Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital, Trinity College Dublin, Ireland
| | - Sjx Murphy
- Vascular Neurology Research Foundation, The Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital, Trinity College Dublin, Ireland; Stroke Service, The Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital, Trinity College Dublin, Ireland
| | - S J Lim
- Vascular Neurology Research Foundation, The Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital, Trinity College Dublin, Ireland; Stroke Service, The Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital, Trinity College Dublin, Ireland
| | - R P Murphy
- Vascular Neurology Research Foundation, The Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital, Trinity College Dublin, Ireland; Stroke Service, The Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital, Trinity College Dublin, Ireland
| | - Djh McCabe
- Vascular Neurology Research Foundation, The Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital, Trinity College Dublin, Ireland; Stroke Service, The Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital, Trinity College Dublin, Ireland; Department of Clinical Neurosciences, Royal Free Campus, UCL Institute of Neurology, London, UK; Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Ireland.
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4
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Kinsella JA, Tobin WO, Kavanagh GF, O'Donnell JS, McGrath RT, Tierney S, Feeley TM, Egan B, O'Neill D, Collins DR, Coughlan T, Harbison JA, Doherty CP, Madhavan P, Moore DJ, O'Neill SM, Colgan MP, Saqqur M, Murphy RP, Moran N, Hamilton G, McCabe DJH. Increased thrombin generation potential in symptomatic versus asymptomatic moderate or severe carotid stenosis and relationship with cerebral microemboli. J Neurol Neurosurg Psychiatry 2015; 86:460-7. [PMID: 25033981 DOI: 10.1136/jnnp-2013-307556] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The importance of thrombin generation in the pathogenesis of TIA or stroke and its relationship with cerebral microembolic signals (MES) in asymptomatic and symptomatic carotid stenosis has not been comprehensively assessed. METHODS Plasma thrombin generation parameters from patients with moderate or severe (≥ 50%) asymptomatic carotid stenosis were compared with those from patients with symptomatic carotid stenosis in the early (≤ 4 weeks) and late phases (≥ 3 months) after TIA or stroke in this prospective, pilot observational study. Thrombin generation profile was longitudinally assessed in symptomatic patients with data at each time point. Bilateral transcranial Doppler ultrasound monitoring of the middle cerebral arteries was performed whenever possible to classify patients as MES-positive or MES-negative. RESULTS Data from 31 asymptomatic, 46 'early symptomatic' and 35 'late symptomatic' patients were analysed. Peak thrombin (344.2 nM vs 305.3 nM; p = 0.01) and endogenous thrombin potential (1772.4 vs 1589.7; p = 0.047) were higher in early symptomatic than asymptomatic patients. Peak thrombin production decreased in symptomatic patients followed up from the early to late phase after TIA or stroke (339.7 nM vs 308.6 nM; p = 0.02). Transcranial Doppler ultrasound data were available in 25 asymptomatic, 31 early symptomatic and 27 late symptomatic patients. Early symptomatic MES-positive patients had a shorter 'time-to-peak thrombin' than asymptomatic MES-positive patients (p=0.04), suggesting a more procoagulant state in this early symptomatic subgroup. DISCUSSION Thrombin generation potential is greater in patients with recently symptomatic than asymptomatic carotid stenosis, and decreases over time following TIA or stroke associated with carotid stenosis. These data improve our understanding of the haemostatic/thrombotic biomarker profile in moderate-severe carotid stenosis.
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Affiliation(s)
- J A Kinsella
- Department of Neurology, The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital, Trinity College Dublin, Dublin, Ireland
| | - W O Tobin
- Department of Neurology, The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital, Trinity College Dublin, Dublin, Ireland
| | - G F Kavanagh
- Department of Neurology, The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital, Trinity College Dublin, Dublin, Ireland
| | - J S O'Donnell
- Haemostasis Research Group, St James Hospital, Trinity College Dublin, Dublin, Ireland
| | - R T McGrath
- Haemostasis Research Group, St James Hospital, Trinity College Dublin, Dublin, Ireland
| | - S Tierney
- Department of Vascular Surgery, The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital, Trinity College Dublin, Dublin, Ireland
| | - T M Feeley
- Department of Vascular Surgery, The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital, Trinity College Dublin, Dublin, Ireland
| | - B Egan
- Department of Vascular Surgery, The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital, Trinity College Dublin, Dublin, Ireland
| | - D O'Neill
- Age-Related Health Care, The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital, Trinity College Dublin, Dublin, Ireland Stroke Service, The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital, Trinity College Dublin, Dublin, Ireland
| | - D R Collins
- Age-Related Health Care, The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital, Trinity College Dublin, Dublin, Ireland Stroke Service, The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital, Trinity College Dublin, Dublin, Ireland
| | - T Coughlan
- Age-Related Health Care, The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital, Trinity College Dublin, Dublin, Ireland Stroke Service, The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital, Trinity College Dublin, Dublin, Ireland
| | - J A Harbison
- Departments of Medicine for the Elderly/Stroke Service, St James Hospital, Trinity College Dublin, Dublin, Ireland
| | - C P Doherty
- Department of Neurology, St James Hospital, Trinity College Dublin, Dublin, Ireland
| | - P Madhavan
- Department of Vascular Surgery, St James Hospital, Trinity College Dublin, Dublin, Ireland
| | - D J Moore
- Department of Vascular Surgery, St James Hospital, Trinity College Dublin, Dublin, Ireland
| | - S M O'Neill
- Department of Vascular Surgery, St James Hospital, Trinity College Dublin, Dublin, Ireland
| | - M P Colgan
- Department of Vascular Surgery, St James Hospital, Trinity College Dublin, Dublin, Ireland
| | - M Saqqur
- Department of Medicine (Neurology), University of Calgary, Alberta, Canada
| | - R P Murphy
- Department of Neurology, The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital, Trinity College Dublin, Dublin, Ireland Stroke Service, The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital, Trinity College Dublin, Dublin, Ireland
| | - N Moran
- Department of Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - G Hamilton
- University Department of Surgery, Royal Free Hampstead NHS Trust, London, UK
| | - D J H McCabe
- Department of Neurology, The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital, Trinity College Dublin, Dublin, Ireland Stroke Service, The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital, Trinity College Dublin, Dublin, Ireland Department of Clinical Neurosciences, Royal Free Campus, UCL Institute of Neurology, London, UK
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Tobin WO, Kinsella JA, Kavanagh GF, O'Donnell JS, McGrath RT, Coughlan T, Collins DR, O'Neill D, Egan B, Tierney S, Feeley TM, Murphy RP, McCabe DJH. Longitudinal assessment of von Willebrand factor antigen and von Willebrand factor propeptide in response to alteration of antiplatelet therapy after TIA or ischaemic stroke. J Neurol 2014; 261:1405-12. [PMID: 24781842 DOI: 10.1007/s00415-014-7362-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Revised: 04/18/2014] [Accepted: 04/18/2014] [Indexed: 10/25/2022]
Abstract
The impact of commencing or changing antiplatelet therapy on von Willebrand factor antigen (VWF:Ag) and von Willebrand factor propeptide (VWF:Ag II) levels has not been comprehensively assessed following TIA or ischaemic stroke. In this pilot, longitudinal, observational analytical study, VWF:Ag and VWF:Ag II levels were simultaneously quantified in platelet poor plasma by ELISA in patients within 4 weeks of TIA or ischaemic stroke (baseline), and then 14 days (14d) and >90 days (90d) after altering antiplatelet therapy. Ninety-one patients were recruited. Eighteen were initially assessed on no antiplatelet therapy, and then after 14d (N = 17) and 90d (N = 8) on aspirin monotherapy; 21 patients were assessed on aspirin and after 14d and 90d on clopidogrel; 52 were assessed on aspirin monotherapy, and after 14d and 90d on aspirin and dipyridamole combination therapy. VWF:Ag, VWF:Ag II levels and VWF:Ag/VWF:Ag II ratio were unchanged at 14d and 90d in the overall study population (p ≥ 0.1). VWF:Ag and VWF:Ag II levels remained stable at 14d and 90d after commencing aspirin (p ≥ 0.054), and after changing from aspirin to clopidogrel (p ≥ 0.2). Following the addition of dipyridamole MR to aspirin, there was a significant reduction in VWF:Ag levels at 14d (p = 0.03) and 90d (p = 0.005), but not in VWF:Ag II levels (p ≥ 0.3). The addition of dipyridamole to aspirin led to a persistent reduction in VWF:Ag but not in VWF:Ag II levels, suggesting that dipyridamole may inhibit release of platelet-derived VWF:Ag following TIA or ischaemic stroke.
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Affiliation(s)
- W O Tobin
- Department of Neurology, The Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital, Trinity College Dublin, Dublin, Ireland
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Kinsella JA, Tobin WO, Kavanagh GF, O'Donnell JS, McGrath RT, Tierney S, Feeley TM, Egan B, O'Neill D, Collins RD, Coughlan T, Harbison JA, Doherty CP, Madhavan P, Moore DJ, O'Neill SM, Colgan MP, Saqqur M, Murphy RP, Moran N, Hamilton G, McCabe DJH. Increased endothelial activation in recently symptomatic versus asymptomatic carotid artery stenosis and in cerebral microembolic-signal-negative patient subgroups. Eur J Neurol 2014; 21:969-e55. [PMID: 24712648 DOI: 10.1111/ene.12403] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 02/07/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE von Willebrand factor propeptide (VWF:Ag II) is potentially a more sensitive marker of acute endothelial activation than von Willebrand factor antigen (VWF:Ag). These biomarkers have not been simultaneously assessed in asymptomatic versus symptomatic carotid stenosis patients. The relationship between endothelial activation and cerebral microembolic signals (MESs) detected on transcranial Doppler ultrasound is unknown. METHODS In this multicentre observational analytical study, plasma VWF:Ag and VWF:Ag II levels in patients with ≥50% asymptomatic carotid stenosis were compared with those from patients with ≥50% symptomatic carotid stenosis in the 'early' (≤4 weeks) and 'late' (≥3 months) phases after transient ischaemic attack or ischaemic stroke. Endothelial activation was also longitudinally assessed in symptomatic patients during follow-up. Transcranial Doppler ultrasound monitoring classified patients as MES-positive or MES-negative. RESULTS Data from 31 asymptomatic patients were compared with those from 46 early symptomatic and 35 late phase symptomatic carotid stenosis patients, 23 of whom had undergone carotid intervention. VWF:Ag II levels were higher in early (12.8 μg/ml; P < 0.001), late (10.6 μg/ml; P = 0.01) and late post-intervention (10.6 μg/ml; P = 0.038) symptomatic patients than asymptomatic patients (8.9 μg/ml). VWF:Ag levels decreased in symptomatic patients followed up from the early to late phase after symptom onset (P = 0.048). Early symptomatic MES-negative patients had higher VWF: Ag II levels (13.3 vs. 9.0 μg/ml; P < 0.001) than asymptomatic MES-negative patients. CONCLUSIONS Endothelial activation is enhanced in symptomatic versus asymptomatic carotid stenosis patients, in early symptomatic versus asymptomatic MES-negative patients, and decreases over time in symptomatic patients. VWF:Ag II levels are a more sensitive marker of endothelial activation than VWF:Ag levels in carotid stenosis. The potential value of endothelial biomarkers and concurrent cerebral MES detection at predicting stroke risk in carotid stenosis warrants further study.
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Affiliation(s)
- J A Kinsella
- Department of Neurology, Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital, Trinity College Dublin, Dublin, Ireland
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Kinsella JA, Tobin WO, Tierney S, Feeley TM, Egan B, Collins DR, Coughlan T, O'Neill D, Harbison J, Madhavan P, Moore DJ, O'Neill SM, Colgan MP, Doherty CP, Murphy RP, Saqqur M, Moran N, Hamilton G, McCabe DJH. Increased platelet activation in early symptomatic vs. asymptomatic carotid stenosis and relationship with microembolic status: results from the Platelets and Carotid Stenosis Study. J Thromb Haemost 2013; 11:1407-16. [PMID: 23621656 DOI: 10.1111/jth.12277] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 03/31/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cerebral microembolic signals (MES) may predict increased stroke risk in carotid stenosis. However, the relationship between platelet counts or platelet activation status and MES in symptomatic vs. asymptomatic carotid stenosis has not been comprehensively assessed. SETTING University teaching hospitals. METHODS This prospective, pilot observational study assessed platelet counts and platelet activation status, and the relationship between platelet activation and MES in asymptomatic vs. early (≤ 4 weeks after TIA/stroke) and late phase (≥ 3 months) symptomatic moderate or severe (≥ 50%) carotid stenosis patients. Full blood count measurements were performed, and whole blood flow cytometry was used to quantify platelet surface activation marker expression (CD62P and CD63) and circulating leucocyte-platelet complexes. Bilateral simultaneous transcranial Doppler ultrasound monitoring of the middle cerebral arteries was performed for 1 h to classify patients as MES positive or MES negative. RESULTS Data from 31 asymptomatic patients were compared with 46 symptomatic patients in the early phase, and 35 of these patients were followed up to the late phase after symptom onset. The median platelet count (211 vs. 200 × 10(9) L(-1) ; P = 0.03) and the median percentage of lymphocyte-platelet complexes was higher in early symptomatic than asymptomatic patients (2.8 vs. 2.4%; P = 0.001). The percentage of lymphocyte-platelet complexes was higher in early symptomatic than in asymptomatic patients with ≥ 70% carotid stenosis (P = 0.0005) and symptomatic patients recruited within 7 days of symptom onset (P = 0.028). Complete TCD data were available in 25 asymptomatic, 31 early phase symptomatic and 27 late phase symptomatic patients. Twelve per cent of asymptomatic vs. 32% of early phase symptomatic (P = 0.02) and 19% of late phase symptomatic patients (P = 0.2) were MES positive. Early symptomatic MES-negative patients had a higher percentage of lymphocyte-platelet complexes than asymptomatic MES-negative patients (2.8 vs. 2.3%; P = 0.0085). DISCUSSION Recently, symptomatic carotid stenosis patients have had higher platelet counts (potentially reflecting increased platelet production, mobilization or reduced clearance) and platelet activation status than asymptomatic patients. MES were more frequently detected in early symptomatic than asymptomatic patients, but the differences between late symptomatic and asymptomatic groups were not significant. Increased lymphocyte-platelet complex formation in recently symptomatic vs. asymptomatic MES-negative patients indicates enhanced platelet activation in this early symptomatic subgroup. Platelet biomarkers, in combination with TCD, have the potential to aid risk-stratification in asymptomatic and symptomatic carotid stenosis patients.
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Affiliation(s)
- J A Kinsella
- Department of Neurology, The Adelaide and Meath Hospital Dublin/National Children's Hospital, Trinity College Dublin, Ireland
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Tobin WO, Kinsella JA, Kavanagh GF, O'Donnell JS, McGrath RA, Collins DR, Coughlan T, O'Neill D, Egan B, Tierney S, Feeley TM, Murphy RP, McCabe DJH. Longitudinal assessment of thrombin generation potential in response to alteration of antiplatelet therapy after TIA or ischaemic stroke. J Neurol 2012; 260:590-6. [PMID: 23064666 DOI: 10.1007/s00415-012-6684-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2012] [Revised: 09/03/2012] [Accepted: 09/19/2012] [Indexed: 10/27/2022]
Abstract
The impact of changing antiplatelet therapy on thrombin generation potential in patients with ischaemic cerebrovascular disease (CVD) is unclear. We assessed patients within 4 weeks of TIA or ischaemic stroke (baseline), and then 14 days (14d) and >90 days (90d) after altering antiplatelet therapy. Thrombin generation was assessed in platelet poor plasma. Ninety-one patients were recruited. Twenty-four were initially assessed on no antiplatelet therapy, and then after 14d (N = 23) and 90d (N = 8) on aspirin monotherapy; 52 were assessed on aspirin monotherapy, and after 14 and 90 days on aspirin and dipyridamole combination therapy; 21 patients were assessed on aspirin and after 14 days (N = 21) and 90 days (N = 19) on clopidogrel. Peak thrombin generation and endogenous thrombin potential were reduced at 14 and 90 days (p ≤ 0.04) in the overall cohort. We assessed the impact of individual antiplatelet regimens on thrombin generation parameters to investigate the cause of this effect. Lag time and time-to-peak thrombin generation were unchanged at 14 days, but reduced 90 days after commencing aspirin (p ≤ 0.009). Lag time, peak thrombin generation and endogenous thrombin potential were reduced at both 14 and 90 days after adding dipyridamole to aspirin (p ≤ 0.01). Lag time was reduced 14 days after changing from aspirin to clopidogrel (p = 0.045), but this effect was not maintained at 90 days (p = 0.2). This pilot study did not show any consistent effects of commencing aspirin, or of changing from aspirin to clopidogrel on thrombin generation potential during follow-up. The addition of dipyridamole to aspirin led to a persistent reduction in peak and total thrombin generation ex vivo, and illustrates the diverse, potentially beneficial, newly recognised 'anti-coagulant' effects of dipyridamole in ischaemic CVD.
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Affiliation(s)
- W O Tobin
- Department of Neurology, The Adelaide and Meath Hospital, incorporating the National Children's Hospital (AMNCH), Trinity College Dublin, Tallaght, Dublin, 24, Ireland
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Tobin WO, Kinsella JA, Coughlan T, Collins DR, O'Neill D, Murphy RP, Egan B, Tierney S, Feeley TM, McCabe DJH. High on-treatment platelet reactivity on commonly prescribed antiplatelet agents following transient ischaemic attack or ischaemic stroke: results from the Trinity Antiplatelet Responsiveness (TRAP) study. Eur J Neurol 2012; 20:344-52. [DOI: 10.1111/j.1468-1331.2012.03861.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2012] [Accepted: 07/25/2012] [Indexed: 11/26/2022]
Affiliation(s)
- W. O. Tobin
- Department of Neurology; Adelaide and Meath Hospital; Dublin, incorporating the National Children's Hospital; Trinity College Dublin; Dublin; Ireland
| | - J. A. Kinsella
- Department of Neurology; Adelaide and Meath Hospital; Dublin, incorporating the National Children's Hospital; Trinity College Dublin; Dublin; Ireland
| | | | | | | | | | - B. Egan
- Department of Vascular Surgery; Adelaide and Meath Hospital; Dublin, incorporating the National Children's Hospital; Trinity College Dublin; Dublin; Ireland
| | - S. Tierney
- Department of Vascular Surgery; Adelaide and Meath Hospital; Dublin, incorporating the National Children's Hospital; Trinity College Dublin; Dublin; Ireland
| | - T. M. Feeley
- Department of Vascular Surgery; Adelaide and Meath Hospital; Dublin, incorporating the National Children's Hospital; Trinity College Dublin; Dublin; Ireland
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Kinsella J, Tobin O, Tierney S, Feeley TM, Egan B, Collins DR, Coughlan T, O'Neill D, Harbison J, Doherty C, Madhavan P, Moore D, O'Neill S, Murphy R, Saqqur M, Hamilton G, Mccabe D. Increased Lymphocyte-Platelet Complex Formation as a Measure of Enhanced Platelet Activation in Recently Symptomatic Versus Asymptomatic 'Microembolic Signal Negative' Carotid Stenosis Patients - Results from the Platelets and Carotid Stenosis (PACS) Study (S33.004). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s33.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Kinsella J, Tobin O, Tierney S, Feeley TM, Egan B, Collins DR, Coughlan T, O'Neill D, Harbison J, Doherty C, Madhavan P, Moore D, O'Neill S, Murphy R, Hamilton G, Mccabe D. Increased Platelet Count and Lymphocyte-Platelet Complex Formation in Patients with Recently Symptomatic Versus Asymptomatic Carotid Stenosis: Results from the Platelets and Carotid Stenosis (PACS) Study (P01.026). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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12
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Kinsella J, Tobin O, Tierney S, Feeley TM, Egan B, Collins DR, Coughlan T, O'Neill D, Harbison J, Doherty C, Madhavan P, Moore D, O'Neill S, Murphy R, Saqqur M, Hamilton G, Mccabe D. Increased Lymphocyte-Platelet Complex Formation as a Measure of Enhanced Platelet Activation in Recently Symptomatic Versus Asymptomatic 'Microembolic Signal Negative' Carotid Stenosis Patients - Results from the Platelets and Carotid Stenosis (PACS) Study (IN3-2.004). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.in3-2.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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13
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Nason GJ, Strapp H, Kiernan C, Moore K, Gibney J, Feeley TM, Egan B, Tierney S. The cost utility of a multi-disciplinary foot protection clinic (MDFPC) in an Irish hospital setting. Ir J Med Sci 2012; 182:41-5. [PMID: 22528251 DOI: 10.1007/s11845-012-0823-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2011] [Accepted: 03/31/2012] [Indexed: 01/22/2023]
Abstract
BACKGROUND Foot ulceration which may result in lower limb amputation is one of the most feared complications among patients with diabetes and the prevention of both ulceration and amputation is a major challenge facing the health service. Many studies have proposed dedicated diabetic foot teams as the future of diabetic foot care. AIMS We aimed to quantify the cost benefit and sustainability of a multi-disciplinary foot protection clinic (MDFPC) in an Irish university hospital setting. METHODS A dedicated bi-weekly consultant-led MDFPC including Vascular Surgery, Endocrinology, Orthopaedic Surgery, Podiatry, Orthotics and Tissue Viability was established in June 2008. RESULTS Between 2006 and 2010, a total of 221 lower limb procedures (major/minor amputations and debridement) were performed. The number of major amputations decreased from 12 during the control period (2 years before the clinic) to 7 in the study period (2 years after the clinic). After costing all activity associated with the clinic, there was an overall saving of €114,063 per year associated with the introduction of the MDFPC. CONCLUSION This is the first study in an Irish context, and one of few international studies, to demonstrate that an aggressive-coordinated approach to diabetic foot care is both cost effective and clinically efficient in reducing the burden of foot-related complications in a diabetic population.
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Affiliation(s)
- G J Nason
- Department of Vascular Surgery, Adelaide and Meath (incorporating the National Children's) Hospital, Tallaght, Dublin 24, Ireland.
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14
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Good DW, Al Chalabi H, Hameed F, Egan B, Tierney S, Feeley TM. Erratum to: Popliteo–pedal bypass surgery for critical limb ischemia. Ir J Med Sci 2012. [DOI: 10.1007/s11845-011-0754-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Quinlan MR, Egan B, Feeley TM, Tierney S. Changing trends in surgical treatment of carotid disease in Ireland (1996-2003). Ir J Med Sci 2008; 177:193-6. [PMID: 18587539 DOI: 10.1007/s11845-008-0178-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2007] [Accepted: 06/11/2008] [Indexed: 11/28/2022]
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.
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Affiliation(s)
- M R Quinlan
- Department of Vascular Surgery, The Adelaide and Meath Hospital incorporating the National Children's Hospital, Tallaght, Dublin 24, Republic of Ireland.
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O'Riordan JM, Fitzgerald E, Gowing C, O'Grady H, Feeley TM, Tierney S. Topical local anaesthetic (tetracaine) reduces pain from botulinum toxin injections for axillary hyperhidrosis. Br J Surg 2006; 93:713-4. [PMID: 16671065 DOI: 10.1002/bjs.5347] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A helpful tip
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Affiliation(s)
- J M O'Riordan
- Department of General and Vascular Surgery, The Adelaide and Meath Hospitals incorporating, The National Children's Hospital, Tallaght, Dublin 24, Ireland
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Abstract
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.
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Affiliation(s)
- M Donnelly
- Department of Vascular Surgery, The Adelaide and Meath Hospital/National Children's Hospital, Tallaght, Dublin 24, Ireland
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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
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Affiliation(s)
- E Fitzgerald
- Department of Surgery, Adelaide and Meath Hospital, Tallaght, Dublin 24
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Donnelly M, Tierney S, Feeley TM. Anatomical variation of the saphenofemoral junction may contribute to recurrent varicose veins. Ir J Med Sci 2002. [DOI: 10.1007/bf03170036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Cox M, Madhavan P, Feeley TM. Primary repair of ruptured aortitis. Eur J Vasc Endovasc Surg 1998; 15:454-5. [PMID: 9633504 DOI: 10.1016/s1078-5884(98)80210-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- M Cox
- Department of Surgery, Meath/Adelaide Hospitals, Dublin, Ireland
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Affiliation(s)
- P Madhavan
- Department of Surgery, Meath/Adelaide Hospitals, Dublin, Ireland
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Relihan N, McGreal G, Murray M, McDermott EW, O’Higgins NJ, Duffy MJ, McNamara DA, Harmey J, Wang JH, Donovan D, Walsh TN, Bouchier-Hayes DJ, Kay E, Kelly JD, Weir HP, Keane PF, Johnston SR, Williamson KE, Hamilton PW, McManus D, Morrin M, Delaney PV, Winter DC, Harvey BJ, Geibel JP, O’Sullivan GC, Delaney CP, Coffey R, Gorey TF, Fitzpatrick JM, Fanning NF, Kirwan W, Cotter T, Bouchier-Hayes D, Redmond HP, McNamara DA, Pidgeon G, Harmey J, Walsh TN, Bouchier-Hayes DJ, Redmond HP, Fennessy F, Wang JH, Kelly C, Bouchier-Hayes D, Delaney CP, Flavin R, Coffey R, Gorey TF, Fitzpatrick JM, Rasheed AM, Wang JH, Kelly C, Bouchier-Hayes DJ, Leahy A, Lang EE, Caldwell MTP, Tanner WA, Kiely PD, O’Reilly M, Tierney S, Barry M, Delaney PV, Drumm J, Grace PA, Gallagher CM, Grant DC, Connell P, Barry MK, Traynor O, Hyland JMP, O’Sullivan MJ, Evoy D, Redmond HP, Kirwan WO, Cannon B, Kenny-Walshe L, Whelton MJ, O’Grady H, O’Neill S, Grant DC, Barry MK, Traynor O, Hyland JM, Teh SH, O’Ceallaigh S, O’Donohoe MK, Tanner WA, Keane FB, O’Toole GC, Grant DC, Barry MK, Hyland JMP, Calleary J, Basso L, Amjad SB, Khan Z, McMullin L, Joyce WP, Balfe PJ, Caldwell MT, Keane FB, Tanner WA, Teahan S, Al-Brekeit K, Tierney S, Rasheed A, Bouchier-Hayes D, Leahy A, O’Neill S, Delaney CP, Gorey TF, Fitzpatrick JM, Cullen A, O’Keane C, Fennessy F, Kelly C, Bouchier-Hayes D, Fennessy F, Wang JH, Kelly C, Bouchier-Hayes DJ, Winter DC, MacFarlane J, Harvey BJ, O’Sullivan GC, Walsh M, McGloughlin T, Grace P, Colgan D, Madhavan P, Sultan S, Colgan MP, Moore D, Shanik G, McEniff N, Molloy M, Eguare E, Fiuza C, Grace P, Burke P, Maher R, Creamer M, Cronin CJ, Sigurdsso HH, Kim W, Linklater G, Cross KS, Simpson WG, Shaw JAM, Pearson DWM, Fitzgerald P, Quinn P, Tierney S, Bouchier-Hayes D, Brady CM, Shah SMA, Ehtisham M, Khan MS, Flood HD, Loubani M, Sweeney K, Lenehan B, Lynch V, Joy A, McGreal G, Reidy D, Mahalingam K, Cashman W, Mulligan ED, Purcell T, Dunne B, Griffin M, Noonan N, Hollywood D, Keeling N, Reynolds JV, Hennessy TPJ, O’Halloran D, McGreal G, McDermott EW, O’Higgins NJ, Neary P, Hamilton D, Haider N, Aherne N, Watson RGK, Walsh D, Murphy M, Joyce M, Johnston S, Clinton O, Given HF, Brannigan A, O’Donohoe M, Donohoe J, Corrigan T, Bresnihan M, O’Donohoe MK, Feeley TM, Sultan S, Madhavan P, Colgan MP, Moore D, Shanik G, McMonagle MP, Quinlan D, Kelly D, Hegarty PK, Tan B, Cronin C, Brady MP, Zeeshan M, McAvinchey DJ, Aherne N, Mooney C, Coyle D, Haider N, Hamilton D, Neary P, Watson RGK, Khayyat G, Masterson E, Thambi-Pillai T, Farah K, Delaney CP, Codd MB, Fitzpatrick JM, Gorey TF, Barry MK, Tsiotos GG, Johnson CD, Sarr MG, Kell MR, Lynch M, Ryan D, O’Donovan A, Winter DC, Redmond HP, Delaney CP, Cassidy M, Doyle M, Fulton G, O’Connell PR, Kingston R, Dillon M, Barry M, Tierney S, Grace PA, McGreal G, Lenehan B, Murray M, McDermott E, O’Higgins N, Kell MR, O’Sullivan RG, Tan B, O’Donnell JA. Sylvester o’halloran surgical scientific meeting. Ir J Med Sci 1998. [DOI: 10.1007/bf02937403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Maher M, Caldwell MP, Waldron R, Murchan P, Beesley W, Feeley TM, Tanner WA, Keane FB. Staged resection or primary anastomosis for obstructing lesions to the left colon. Ir Med J 1996; 89:138-139. [PMID: 8824036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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.
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Affiliation(s)
- M Maher
- Department of Surgery, Meath Hospital, Dublin
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Barry MC, Burke P, Joyce WP, Sheehan S, Broe P, Bouchier-Hayes D, Mccollum PT, Holdsworth RI, Stonebridge PA, Belch JJ, O≿suilleabhain C, Waldron D, Hehir D, O≿donnell JA, Brady MP, Kelly J, O≿donnell J, Morasch MD, Couse NF, Colgan MP, Moore DJ, Shanik GD, Russell JD, O≿dwyer TP, Russell J, Walsh M, Lennon GM, Sweeney P, Grainger R, Mcdermott TED, Thornhill JA, Butler MR, Vashisht R, Koppikar M, Rogers HS, Stokes MA, Carroll T, Regan MC, Fitzpatrick JM, Gorey TF, Mccarthy J, Redmond HP, Duggan S, Watson RWG, O≿donnel R, Clements WDB, Mccaigue MD, Halliday IM, Rowlands BJ, O≿hanlon D, Kerin M, Kent P, Grimes H, Maher D, Given HF, Keogh I, Given HF, McAnena O, O≿hanlon DM, Chin D, Mccarthy P, Kennedy S, Dolan J, Mercer P, Mcdermott EW, Duffy MJ, O≿higgins NJ, Delaney CP, Mcgeeney KF, Dolan S, Campbell C, Mccluggage G, Halliday MI, Khan F, Delaney P, Barrett N, Morrin M, Ma QY, Anderson NH, Magee GD, Norwood W, Meagher PJ, Kelly CJ, Deasy JM, Baldota S, Jakoubek F, Mcloughlin H, Eustace PW, Waldron R, Johnston JG, Shuaib I, Strunz B, Hall T, Williams N, Delaney PV, Donnelly VS, O≿herlihy C, O≿connell PR, Walsh M, Attwood SEA, Evoy DA, Boyle B, Brown S, Stephens RB, Gillen P, Attwood S, Tanner WA, Keane FBV, Morris S, Reid S, Neary P, Horgan P, Traynor O, Hyland J, Barrett J, Collins JK, O≿sullivan G, Boyle TJ, Lyerly JK, Gallagher HJ, Naama H, Shou J, Daly JM, Wang JH, Barclay RG, Creagh T, Smalley T, Waters C, Mundy AR, Campbell GR, Stokes K, Kelly C, Abdih H, Bouchier Hayes D, Loughnane F, Ahearne M, Akram M, Drumm J, Collins GN, Mulvin D, Malone F, Kelly D, Delaney C, Mckeever J, Mehigan D, Keaveny TV, Hennessy A, Grace P, Mcgee H, Boyle CAO, Mohan P, Cross KS, Feeley TM, O≿donoghue JM, Al-Ghazal SK, Mccann J, Regan M, Stokes M, Graham F, Young L, Flanagan F, Ennis J, Fitzpatrick J, Gorey T, Walsh S, Callahan J, Macgowan SW, Malone C, Young LS, Wood AE, Madhavan P, O≿sullivan R, Durkan M, Nyhan T, Lynch G, Egan J, Mcavinchey D, Bulle B. Sylvester O’halloran surgical scientific meeting. Ir J Med Sci 1994. [DOI: 10.1007/bf02967098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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O'Donohoe MK, Murchan PM, Marks P, Feely J, Feeley TM. Endothelium derived relaxing factor is absent in experimental in situ vein grafts. Eur J Vasc Surg 1993; 7:144-50. [PMID: 8385030 DOI: 10.1016/s0950-821x(05)80754-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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)
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Affiliation(s)
- M K O'Donohoe
- Department of Surgery, Meath Hospital, Dublin, Ireland
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Coulter J, Molloy RG, Moran KT, Waldron R, Kirwan WO, O’Suilleabhain C, Horgan A, Mealy K, Burke P, Hyland J, Horgan AF, Sheehan M, Browne RM, Austin O, Clery AP, Deasy JM, Sulaiman-Shoaib S, Soeda J, O’Briain DS, Puri P, Coveney EC, McAllister V, McDermott EWM, O’Higgins NJ, Maher M, Caldwell MTP, Murchan P, Beesley W, Feeley TM, Tanner WA, Keane FBV, Abbasakoor F, Attwood SEA, McGrath LP, Stephens RB, O’Broin E, Davies MG, McGinley J, Mannion C, Gupta S, Shine MF, Lennon F, Ninan G, Fitzgerald RJ, Guiney EJ, O’Donnell B, O’Donnell AF, Luke D, Wood AE, Murphy PG, Walsh TN, Hill ADK, Li H, Hennessy TPJ, Noonan N, Breslin B, Keeling PWN, Curran AJ, Gough DB, Davidson IR, Keeling P, O’Leary DP, Smythe A, Bird NC, Johnson AG, Nicholson P, Traynor O, Dawson K, Aitken J, Cooke BA, Parbhoo SP, N.Williams N, Daly JM, Herlyn M, Bouchier-Hayes D, Stuart RC, Allen MJ, Thompson WD, Peel ALG, Hehir DT, Cronin K, McCann A, Dervan PA, Heffernan SJ, Hederman WP, Galea MH, Dilks B, Gilmour A, Ellis LO, Elston CW, Blarney RW, O’Rourke S, Mookens A, Carter R, Parkin D, Couse NF, Delaney CP, Horgan PG, Fitzpatrick JM, Gorey TF, O’Byrne JM, McCabe JP, Stephens M, McManus F, L.Mangan J, Barr DA, Mulvenna GJ, Maginn P, Kernohan WG, Mollan RAB, O’Flanagan SJ, Stack JP, Dervan P, Hurson B, Tierney S, Fitzgerald P, O’Sullivan T, Grace P, Wyatt JP, Evans RJ, Cusack SP, McGowan S, McGovem E, Schwaitzberg SD, Connolly RJ, Sullivan RP, Mortimer G, Geraghty JG, O’Dwyer PJ, McGlone BS, O’Brien DP, Younis HA, Given HF, Phelan C, Byrne J, Barry K, Gough D, Hanrahan L, Given F, Sweeney JP, Korebrits AM, Reynolds JV, Gorey TF, O’Hanlon DM, Stokes MA, Redmond HP, McCarthy J, Daly JM, Losty P, Murphy M, Butler PEM, Grace PG, Novell JR, Hobbs SK, Smith O, Hazlehurst G, Brozovic B, Rolles K, Burroughs A, Mallett S, Mehta A, Buckley D, Waldron D, O’Brien D, Curran C, Given F, Grey L, Leahy A, Darzi A, Leader D, Broe P, Geoghegan JG, Cheng CA, Lawson DC, Pappas TN, O’Sullivan D, Lieber MM, Colby TV, Barrett DM, Rogers E, Greally J, Bredin HC, Corcoran MO, Kenny M, Horgan P, Headon D, Grace A, Grace PA, Bouchier-Hayes D, Cross S, Hehir D, O’Briain S, Hartigan P, Colgan MP, Moore D, Shanik G, Zaidi SZ, Hehir DJ, Cross KS, Colgan MP, Moore DJ, Shanik DG, Lacy P, Cross S, Hehir D, Moore D, Shanik G, Coleman JE, McEnroe CS, Gelfand JA, O’Donnell TF, Callow AD, Buckley DJ, O’Riordain DS, O’Donnell JA, Meagher P, Boos K, Gillen P, Corrigan T, Vashisht R, Sian M, Sharp EJ, O’Malley MK, Kerin MJ, Wilkinson D, Parkin A, Kester RC, Maher MM, Waldron RP, Waldron DJ, Brady MP, Allen M, Lyncy TH, Waymont B, Emtage L, Blackledge GR, Hughes MA, Wallace DMA, O’Sullivan D, Mynderse L, Barrett DM, Rogers E, Grimes H, Chambers F, Lowe D, Bredin HC, Corcoran MO, Waldron DJ, Prasad B, O’Sullivan DC, Gillen MBP, McNicholas M, Traynor O, Bredin H, O’Dowd TH, Corcoran M, O’Donoghue JM, Corcoran M, McGuire M, McNamara A, Creagh T, Grainger R, McDermott TBD, Butler MR, Gleeson M, Creagh T, Grainger R, McDermott TED, Hurley JP, Hone R, Neligan M, Hurley J, White M, McDonagh P, Phelan D, McGovern E, Quinn F, Breatnach F, O’Meara A, McGrath JP, McCann SR, Gaffney EF, Hennessy A, Leader M, Taleb FS, McKiernan MV, Leyden PJ, McCann JJ, Coleman J, Quereshi A, Ajayi N, McEntee G, Osborne H, Bouchier-Hayes DJ, Johnston S, O’Malley K, Smyth E, Bouchier-Hayes DL, Darzi A, Quereshi A, McEntee G, O’Connell PR, Gorey T, McAnena OJ, Reed MW, Duncan JL, Reilly CS, McGibney C, Lawlor P, Lawless B, McGuinness E, Leahy S. Sixteenth sir peter freyer memorial lecture and surgical symposium September 13th & 14th, 1991 Session I. Ir J Med Sci 1992. [DOI: 10.1007/bf02942125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Crerand S, Feeley TM, Waldron RP, Corrigan T, Hederman W, O'Connell FX, Heffernan SJ. Colorectal carcinoma over 30 years at one hospital: no evidence for a shift to the right. Int J Colorectal Dis 1991; 6:184-7. [PMID: 1770282 DOI: 10.1007/bf00341386] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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.
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Affiliation(s)
- S Crerand
- Department of Surgery, Mater Misericordiae Hospital, Dublin, Ireland
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Davies MG, Feeley TM, O'Malley MK, Colgan MP, Moore DJ, Shanik GD. Infrainguinal polytetrafluoroethylene grafts: saved limbs or wasted effort? A report on ten years' experience. Ann Vasc Surg 1991; 5:519-24. [PMID: 1772757 DOI: 10.1007/bf02015275] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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.
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Affiliation(s)
- M G Davies
- Department of Vascular Surgery, St. James' Hospital, Dublin, Ireland
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Flynn R, Geraghty JG, Keogh B, Feeley TM. Rare presentation of gastric leiomyosarcoma. Postgrad Med J 1991; 67:589-90. [PMID: 1924039 PMCID: PMC2398911 DOI: 10.1136/pgmj.67.788.589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Feeley TM, Leen EJ, Colgan MP, Moore DJ, Hourihane DO, Shanik GD. Histologic characteristics of carotid artery plaque. J Vasc Surg 1991; 13:719-24. [PMID: 2027212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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.
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Affiliation(s)
- T M Feeley
- Department of Vascular Surgery, St. James' Hospital, Dublin, Ireland
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31
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Davies MG, Feeley TM, Moore DJ, Shanik GD. Home parenteral nutrition using a totally implanted subcutaneous venous access device. Br J Clin Pract 1990; 44:750. [PMID: 2129327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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.
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Affiliation(s)
- M G Davies
- Department of Vascular Surgery, St James' Hospital, Dublin
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Murchan P, Sugrue ME, O'Malley MK, Feeley TM, Shanik DG, Moore DJ. A new technique for bilateral iliac vein and inferior vena cava reconstruction using reinforced polytetrafluoroethylene. Ann Vasc Surg 1990; 4:302-4. [PMID: 2340252 DOI: 10.1007/bf02009462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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.
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Affiliation(s)
- P Murchan
- Department of Vascular Surgery, St. James' Hospital, Dublin, Ireland
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Leen EJ, Feeley TM, Colgan MP, O'Malley MK, Moore DJ, Hourihane DO, Shanik GD. "Haemorrhagic" carotid plaque does not contain haemorrhage. Eur J Vasc Surg 1990; 4:123-8. [PMID: 2351214 DOI: 10.1016/s0950-821x(05)80425-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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%).
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Affiliation(s)
- E J Leen
- Department of Vascular Surgery, St. James's Hospital, Dublin, Ireland
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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.
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Affiliation(s)
- M E Sugrue
- Department of Vascular Surgery, St. James's Hospital, Dublin, Ireland
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35
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Affiliation(s)
- K P Gill
- Department of Surgery, Adelaide Hospital, Dublin, Ireland
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Leahy AL, McCollum PT, Feeley TM, Sugrue M, Grouden MC, O'Connell DJ, Moore DJ, Shanik GD. Duplex ultrasonography and selection of patients for carotid endarterectomy: plaque morphology or luminal narrowing? J Vasc Surg 1988; 8:558-62. [PMID: 3054171 DOI: 10.1067/mva.1988.avs0080558] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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.
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Affiliation(s)
- A L Leahy
- Department of Vascular Surgery, St. James' Hospital, Dublin, Ireland
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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.
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Affiliation(s)
- T M Feeley
- Department of Pharmacology, University of Alberta, Edmonton, Canada
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Watson DP, Murphy PD, Feeley TM, Given F. Adenocarcinoma of the duodenum and iron deficiency anaemia. Ir Med J 1986; 79:134. [PMID: 3721827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Feeley TM, Rosenberg IL. Malignant change in fistula-in-ano. Ir Med J 1984; 77:326. [PMID: 6094391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Lennon F, Feeley TM, Clanachan AS, Scott GW. Effects of histamine receptor stimulation on diseased gallbladder and cystic duct. Gastroenterology 1984; 87:257-62. [PMID: 6735072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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.
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Feeley TM, Clanachan AS, Scott GW. The effects of vasoactive intestinal polypeptide on the motility of human and guinea pig gallbladder. Can J Physiol Pharmacol 1984; 62:356-9. [PMID: 6329495 DOI: 10.1139/y84-057] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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.
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Feeley TM, Longe LG, Ellis W. Results of surgery for prolapsed intervertebral disc. Ir Med J 1984; 77:72-4. [PMID: 6706530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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44
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Feeley TM, O'Higgins N. An atypical case of abdominal actinomycosis. Ir Med J 1983; 76:387. [PMID: 6662664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Feeley TM, McFarlane DE, Devlin HB. Acute appendicitis: are any investigations cost effective? Ir Med J 1982; 75:475-6. [PMID: 6819248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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46
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47
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