Assessing the clinical utility of pre-operative neutrophil-lymphocyte ratio as a predictor of clinicopathological parameters in patients being treated for primary breast cancer.

Background: There is a paucity of data supporting the role of neutrophil-lymphocyte ratios (NLR) to determine clinicopathological parameters in patients being treated for primary breast cancer.

Aims: To evaluate the association between pre-operative NLR and clinicopathological parameters in patients diagnosed with breast cancer.

Methods: A retrospective cohort study was performed.

Implications of Highly Penetrant Genetic Variants on Breast Surgery.

It seems the most probable beneficiaries from the molecular era are those harboring hereditary genetic variants, which are responsible for 5% to 10% of all breast cancer diagnoses. There are several key implications of such variants on clinical practice, from expedited anticipation of primary cancer diagnoses, which can have their risk mitigated by risk reduction surgery, to pragmatism surrounding the management of male breast cancer patients. This communication discusses the implications of highly penetrant (or pathogenic) hereditary variants in contemporary breast surgery practice.

Opioid prescribing after breast surgery: A systematic review of guidelines.

Background: Despite advances in opioid-sparing analgesia, opioid prescribing in breast surgery remains suboptimal. Besides delayed rehabilitation, excess post-operative opioids may contribute significantly to opioid dependence. This systematic review of guidelines evaluates current opioid-prescribing recommendations after breast surgery to identify trends in prescribing.

Impact of Acute Surgical Assessment Unit Dedicated Ultrasound Access at a Tertiary Care Hospital.

Background Delayed diagnosis, unnecessary hospital admissions and extended length of stay are the problems associated with inappropriate access to radiological investigations. The acute surgical assessment unit (ASAU) in Limerick has two dedicated ultrasound scan (USS) slots daily to overcome this problem. The aim of the current study was to investigate the clinical impact on patient care and the cost-effectiveness of such an ASAU USS access.

Delayed gastropleural fistula: a rare cause of a persistent pleural effusion after blunt force trauma.

A gastropleural fistula (GPF) is a rare pathological connection between the stomach and pleural cavity. Diagnosis and treatment are frequently delayed due to the lack of specific clinical, laboratory and radiological findings. We describe a case of a 53-year-old gentleman who presented to our institution with respiratory sepsis and a massive haemopneumothorax on imaging.

Expression of Annexin A2 Promotes Cancer Progression in Estrogen Receptor Negative Breast Cancers.

When breast cancer progresses to a metastatic stage, survival rates decline rapidly and it is considered incurable. Thus, deciphering the critical mechanisms of metastasis is of vital importance to develop new treatment options. We hypothesize that studying the proteins that are newly synthesized during the metastatic processes of migration and invasion will greatly enhance our understanding of breast cancer progression.

Timing of Low Molecular Weight Heparin Administration in Breast Surgery and Post-Operative Haematoma Formation.

Aims The aims of this study were to: identify current practice regarding low molecular weight heparin (LMWH) prophylaxis in elective breast surgery, to determine if timing of administration of LMWH prophylaxis or specific patient demographic factors impacts the rate of post-operative haematoma formation. Methods Retrospective cohort study involving 100 patients who underwent elective breast surgery in a tertiary centre in Ireland in 2017. Medical charts were reviewed to collect data on; timing of LMWH administration, incidence of post-operative haematoma and patient's age, BMI, smoking status and anti-coagulant use.

Patient experience in a surgical assessment unit following a closed-loop audit using a Kaizen Lean system.

Background: The Acute Surgical Assessment Unit (ASAU) in University Hospital Limerick (UHL) has provided a solution to overcrowding and long waiting times since centralization of emergency services to UHL. Recognising the importance of its evolving role, the ASAU in UHL has recently undergone a major revamp to ease the pressure in the overcrowded emergency department (ED). This included a new purpose state-of-the-art-built unit and equipment, improved staffing levels and use of a Kaizen Lean system to identify key area of delays and inefficiency with subsequent implementation of suggestions derived after Kaizen Lean.

Breast infections - Microbiology and treatment in an era of antibiotic resistance.

Introduction: Primary breast abscesses occur in <1% of non-lactating women, rising to 11% in women with lactational mastitis. In patients undergoing breast cancer surgery, the inflammatory response to post-operative surgical site infection (SSI) has been implicated in recurrence. Anti-microbial resistance increasingly hampers treatment in each group.

Axillary ultrasound-guided core biopsy in breast cancer: identifying higher nodal burden and more aggressive clinicopathological characteristics.

Background: Patients with sentinel lymph node (SLN) metastases may not require axillary lymph node dissection (ALND) but it remains unclear if patients with a positive ultrasound-guided axillary core biopsy (ACB) would satisfy such criteria.

Aims: The aim of this study was to assess if breast cancer patients with a positive pre-operative ACB have more aggressive tumour characteristics/higher axillary nodal burden compared to those with a positive SLN.

Methods: Data was extracted from a prospectively maintained breast cancer database between 2012 and 2015.

Breast cancer and chronic pain: a mixed methods review.

Background: More patients are surviving breast cancer; however, many complain of persistent pain, which significantly impacts on their lives. Studies have predominantly examined risk factors alone. This mixed methods study will systematically compare prospective and retrospective studies of chronic pain following breast cancer treatment.

Deadly combination: and colorectal malignancy.

Gas gangrene is a life-threatening, necrotising soft tissue infection. Colorectal malignancy-associated is a rare cause of gas gangrene. This case outlines an initial presentation of colonic malignancy as gas gangrene from infection.

Upper limb lymphedema in breast cancer patients in the era of Z0011, sentinel lymph node biopsy and breast conservation.

Introduction: Surgical techniques in breast cancer (BCa) have seen a dramatic change recently with breast-conserving surgery (BCS) and sentinel lymph node biopsy (SLNB). The ACOSOG-Z0011 trial reported equivalence in outcomes for certain patients with SLN metastases treated with axillary lymph node dissection (ALND) or SLNB alone. Our aim was to investigate changes in lymphedema referral patterns in BCa patients over the last 3 years in a specialist unit and to elucidate effects of SLNB, BCS, and Z0011 trial publication on such patterns.

Extracellular matrix gene expression profiling using microfluidics for colorectal carcinoma stratification.

In cancer, biomarkers have many potential applications including generation of a differential diagnosis, prediction of response to treatment, and monitoring disease progression. Many molecular biomarkers have been put forward for different diseases but most of them do not possess the required specificity and sensitivity. A biomarker with a high sensitivity has a low specificity and vice versa.

A colonic duplication cyst causing bowel ischaemia in a 74-year-old lady.

Colonic duplication cysts are rare congenital malformations that predominantly present before the age of 2 years. We report the case of a 74-year-old lady who presented with sudden onset abdominal pain. A computed tomography scan noted a calcified structure adjacent to abnormal loops of bowel.

Real-time cell analysis of the inhibitory effect of vitamin K2 on adhesion and proliferation of breast cancer cells.

Breast cancer is the most prevalent cancer type worldwide. Continued efforts to improve treatment strategies for patients with breast cancer will be instrumental in reducing the death rates associated with this disease. In particular, the triple-negative breast cancer subtype of breast cancer has no targeted therapy available so it is essential to continue to work on any potential therapies.

Primary cilia-mediated mechanotransduction in human mesenchymal stem cells.

Physical loading is a potent stimulus required to maintain bone homeostasis, partly through the renewal and osteogenic differentiation of mesenchymal stem cells (MSCs). However, the mechanism by which MSCs sense a biophysical force and translate that into a biochemical bone forming response (mechanotransduction) remains poorly understood. The primary cilium is a single sensory cellular extension, which has recently been shown to demonstrate a role in cellular mechanotransduction and MSC lineage commitment.

Early weight gain as a predictor of substantial weight gain with olanzapine/fluoxetine combination: an analysis of 2 adult studies in treatment-resistant depression.

Weight gain during olanzapine/fluoxetine combination (OFC) therapy is very common. We examined early (at 2 weeks) weight gain as a predictor of later (at 26 weeks) substantial weight gain in patients with treatment-resistant depression during OFC pharmacotherapy. Data were analyzed from 2 studies (Study 1 and Study 2)-each with an acute, double-blind phase and an open-label phase-in patients who completed 26 weeks of open-label treatment (N = 306).

Colonic perforation in Behcet's syndrome.

A 17-year-old gentleman was admitted to our hospital for headache, the differential diagnosis of which included Behcet's syndrome (BS). He developed an acute abdomen and was found to have air under the diaphragm on erect chest X-ray. Subsequent laparotomy revealed multiple perforations throughout the colon.

Current status of combined hormone replacement therapy in clinical practice.

Approximately 20 million women worldwide use hormone replacement therapy (HRT). Formerly, it was thought to confer beneficial cardiac protection and reduce osteoporosis in addition to relieving the symptoms of menopause. However, many recent trials have contradicted these beliefs.

Vaginal herniation: case report and review of the literature.

Objective: The purpose of this study was to discuss the treatment of a case of spontaneous intestinal herniation per vagina in a patient who had undergone previous transabdominal hysterectomy and to review the related literature.

Study Design: A computer-based search of the English literature from January 1900 to October 2004 with the use of the terms vaginal herniation, vaginal evisceration, and vaginal trauma/injury was performed. Causes, presentation, and treatment were discussed and compared with a recent case that was treated locally in our hospital.

Lipoma of the cord and round ligament: an overlooked diagnosis?

Lipoma of the cord, once considered rare and insignificant, has been cast in a new light by laparoscopic pre-peritoneal surgery, with diagnostic and therapeutic implications. This study aimed to determine the incidence, significance and association of spermatic cord lipomas to inguinal hernias. A retrospective review was performed for all hernia operations carried out between January 1999 and November 2002.

Effect of tumour and chemoradiotherapy on oesophageal motility.

Background: The contribution of dysmotility to dysphagia in oesophageal cancer is unclear.

Aim: To examine oesophageal motility in patients with oesophageal carcinoma and to assess the effect of chemoradiotherapy on motility.

Methods: Stationary manometry and 24-hour pH-metry were performed in 12 patients with oesophageal carcinoma and one week following completion of chemoradiotherapy using 5-fluorouracil (5-FU), cisplatin and 40Gy radiotherapy.