Paediatric trauma associated with all-terrain vehicles.

All-terrain vehicles (ATVs) are used extensively in the agricultural and forestry industries where they are marketed as an inexpensive alternative to tractors. Recent years have seen an increase in recreational use of ATVs, particularly quad bikes. More worrying is the increased use of privately owned ATVs among the paediatric population.

Does size matter? The impact of calf muscle volume on venous return in patients with venous leg ulcers.

Objectives: The calf muscle pump is recognized as an integral component of effective venous return from the lower limbs. The aim of this study was to determine if there is a correlation between calf muscle volume and venous blood flow among patients with venous leg ulcers.

Methods: Nine patients with venous leg ulceration were recruited for this study.

Current trends in the management of acute appendicitis.

Background: While laparoscopic appendectomy (LA) has become established in the diagnosis and treatment of acute appendicitis, its utilisation compared to open appendectomy (OA) is variable.

Aim: To compare the utilisation and outcome of laparoscopic (LA) versus OA in an Irish regional hospital setting.

Method: Retrospective review of OA and LA performed from 2003 to 2005.

Purulent pericarditis.

Background: Bacterial pericarditis has become a clinical rarity since the onset of antimicrobial therapy, yet remains fatal in a large majority of cases.

Aim: We present the case of a 57-year-old male, admitted with a short history of pleuritic chest pain and dyspnoea. Investigations led to diagnosis of pyopericardium, most likely secondary to fistulating thoracic malignancy.

Stroke unit care: recurrence, mortality and institutionalisation rates-a four year follow-up study.

Background: he benefits of stroke unit care in terms of reducing mortality, morbidity and the need for institutional care in the short term are clear. Less evidence exists of its longer term benefits.

Aim: The aim of this study was to measure the rates of mortality, institutionalisation and stroke recurrence over a4-year period following stroke unit care.

KTP laser and nitinol alloy stents: are they compatible?

Background/objective: Nitinol alloy stents are in frequent use in recanalizing malignant airway stenoses. Potassium titanyl phosphate (KTP) is one of the lasers of choice in removal of obstructing airway lesions. There is a paucity of research regarding the safety of these advances working together.

Ultrasound-guided suprascapular nerve block technique.

Background: In this article, we describe a case report of using real-time, high-resolution ultrasound guidance to facilitate blockade of the suprascapular nerve. We describe a case report and technique for using a portable ultrasound scanner (38 mm broadband (13-6 MHz) linear array transducer (SonoSite Micromaxx SonoSite, Inc. 21919 30th Drive SE Bothwell W.

Natural history and clinical outcome of patients with documented carotid artery occlusion.

Background: An occluded internal carotid artery (ICA) is considered a "safe artery" as it causes few symptoms. However, it has recently been suggested that spontaneous recanalisation of ICA occlusions may occur.

Aim: To determine the incidence of ICA recanalisation among patients with a previously documented occluded ICA.

Doppler-guided haemorrhoidal arteries ligation: preliminary clinical experience.

In 1995, Morinaga reported on a new technique in the treatment of haemorrhoids. It relies on the reduction of haemorrhoidal vascular flow by suturing haemorrhoidal arteries. The artery is located by Doppler ultrasound transducer, haemorrhoidal artery ligation (HAL).

Near death and neurocardiogenic syncope.

We report the case of an 18-year-old female who presented as an out-of-hospital ventricular fibrillation cardiac arrest. She required ICD insertion and recovered without deficit. Following recurrent syncopal episodes we diagnosed the co-existence of Neurocardiogenic syncope.

Experience with porcine acellular dermal collagen implant in one-stage tension-free reconstruction of acute and chronic abdominal wall defects.

Background: Elective or emergency reconstruction of abdominal wall defects (AWD) is often difficult. Various techniques have been proposed for reconstructing AWD, including the use of synthetic implants. Porcine acellular dermal collagen (Permacol(TM)) is a biologic implant (PADCI) derived from porcine dermis.

Superior border plating technique in the management of isolated mandibular angle fractures: a retrospective study of 50 consecutive patients.

Purpose: To determine the complication rate for patients presenting with isolated mandibular angle fractures treated by open reduction and internal fixation using a single superior border miniplate technique.

Patients And Methods: This is a retrospective study of consecutive patients with isolated mandibular angle fractures treated using a specific protocol at a Regional Oral and Maxillofacial Department between January 1998 and December 2004. Patient demographics, fracture etiology, length of hospital stay, removal of third molar, and postoperative complications were recorded.

Assessment of healthcare professionals' knowledge of managing emergency complications in patients with a tracheostomy.

Background: Ear, nose, and throat (ENT) surgeons perform the majority of surgical tracheostomies. Intensive care anaesthetists are increasingly performing bedside percutaneous tracheostomy. The objectives of this study were to characterize emergency complications of tracheostomy and to ascertain healthcare professionals' knowledge of life-saving strategies for the patient with a tracheostomy.

Spontaneous splenic rupture in infectious mononucleosis.

Abdominal complaints in patients with infectious mononucleosis should alert the surgeon to the potential, and possibly fatal, risk of splenic rupture. Radiologic evaluation by ultrasonography and computed tomography is indicated for appropriate management. We describe a case in which a diagnosis of splenic rupture occurring spontaneously on a background of infectious mononucleosis was made as a result of a high index of suspicion.

Warfarin prevalence, indications for use and haemorrhagic events.

Warfarin, the standard oral anticoagulant drug used in Ireland, is a widely prescribed medication, particularly in the elderly. A HSE Mid-Western Area wide audit was undertaken over a 12-month period to examine the prevalence and indications for warfarin use and haemorrhagic complications associated with the drug. Every patient receiving warfarin therapy over a 13-week period was included (2564).

The Alvarado score as a tool for diagnosis of acute appendicitis.

In diagnosing appendicitis, clinicians balance the risk of misdiagnosis-removing a normal appendix in patients whose signs and symptoms may not be typical- against the risk of perforation of the appendix that might occur while waiting to see if typical findings emerge. Despite the growing availability of advanced diagnostic testing (U.S/C.

Encrusted cystitis--an unusual cause of recurrent frank haematuria.

Background: Encrusted cystitis associated with malakoplakia is described in the literature as a rare condition characterized by the formation of calcified plaques adherent to or embedded in the bladder mucosa.

Aims: We present the case of a 51-year-old male, presenting with recurrent haematuria associated with minimal exercise. Despite normal ultrasound, IVP, two calcified lesions on his bladder were found on cystoscopy.

Isolated hypoglossal nerve palsy: a harbinger of malignancy.

The hypoglossal nerve is an underrated nerve usually consigned to a few words in anatomical text books, under the last four cranial nerves. However, paralysis of this nerve may be the first indication of a serious underlying disorder. Excluding previous surgery, radiotherapy and trauma, 50 per cent of cases of isolated hypoglossal nerve palsy are idiopathic.

Early onset of colonic adenocarcinoma associated with cystic fibrosis--a case report.

We report the case of the onset of colorectal adenocarcinoma occurring in an 18 year-old patient, suffering from Cystic Fibrosis. This represents a presentation of colon cancer at an earlier stage than previously reported. Despite this, there is an established link between the two diseases although the pathogenesis is, as yet, unknown.

Stroke unit care is superior to general rehabilitation unit care.

Robust evidence exists for the efficacy of stroke units in improving stroke outcome. To date no Irish and little international data exist comparing stroke unit and general rehabilitation unit care. 207 patients admitted to a stroke unit (136--65.

Osteochondral fractures in the knee treated with butyl-2-cyanoacrylate glue. A case report.

We report a new method of fixation of osteochondral fractures using tissue adhesive butyl-2-cyanoacrylate. A traumatic osteochondral fracture of the patella and the medial femoral condyle in a 29-year-old male was fixed with butyl-2-cyanoacrylate tissue adhesive. At 6 month follow-up the fractures showed complete healing, the postoperative knee score was 84 and the functional knee score 90 (Knee Society Clinical Rating System).

An exploration of current leg ulcer management practices in an Irish community setting.

Objective: To establish the prevalence of leg ulceration in the Irish Health Service Executive (HSE) mid-western region and to determine the level of assessment and treatment patients have been receiving in the local community.

Method: Before the introduction of a Doppler training programme, all public health and community health nurses working in the Irish HSE mid-western area were requested to complete an audit form on each patient being treated for leg ulceration during a predefined one-week period. This form recorded details on patient demographics, ulcer aetiology, assessment and treatment.

The Snodgrass repair: is stenting always necessary?

To evaluate the need for stenting in Snodgrass hypospadias repairs. Sixty-five boys underwent hypospadias repairs between April 1996 and July 2001. A variety of techniques were employed.