Irish medical journal最新文献

Peripheral Intravenous (IV) cannulation is a common clinical procedure conducted in most stroke patients during their hospital admission. IV access is crucial in the hyperacute and re-habilitation phases of stroke care for administering lifesaving treatments, conducting investi-gations, managing secondary risk factors and treating stroke related complications. Despite its importance, peripheral IV cannulation can cause several complications including infection, thrombosis, and pain. In stroke patients with motor and sensory impairments, cannulation poses unique challenges and can potentially hinder rehabilitation interventions and increase risks of injury and post stroke spasticity. This paper explores the lack of specific guidelines for IV cannulation in the stroke affected upper limb and emphasizes the necessity of careful con-sideration and alternative strategies to mitigate risks.

Introduction: Hip hemiarthroplasty is a common procedure for femoral neck fractures in the geriatric population. Immediate implant-related complications such as dislocation, periprosthetic fracture, and leg length discrepancy are uncommon, but should be ruled out with the use of post-operative X-rays. There is some debate as to the timing of the post-operative X-rays. Some orthopaedic units prefer immediate postoperative in theatre X-rays, while other units opt for departmental X-ray the following day. The aim of this study was to compare in theatre postoperative X-rays versus departmental next day X-rays, to see if there was any significant difference in diagnosing immediate implant related complications.

Methods: This is a single centre retrospective observational study including radiologic review of AP Pelvis X-rays for patients who had a cemented or uncemented bipolar hemiarthroplasty for neck of femur fracture from May 2018 until January 2023. Two independent orthopaedic surgeons reviewed the X-rays, to exclude any periprosthetic fractures, dislocations or other immediate implant related complications. A total of 1115 patients who underwent uncemented or cemented bipolar hemiarthroplasty data was collected from 2018 to 2023.Patients were operated using Anterolateral or Posterior approach as per preference of the operating consultant.

Results: Minimal or no complications were observed in 1,095 (98.2%) patients, both immediately after hip hemiarthroplasty and 24 hours postoperatively. At the same time, 20 (1.8 %) patients had complications, which were picked up on the x-rays two weeks or later after the procedure. It explains that postoperative in-theatre X-rays have negligible clinical influence. It emphasises the lack of early postoperative problems detected by intraoperative theatre x-rays after hip hemiarthroplasty. This gives an indication that such early postoperative imaging might not be critical in recognising early complications.

Discussion: Day one post operative, inter departmental, post mobilization hip x-rays are reliable, cost effective, less time consuming, require less manual handling, better quality and are sufficient enough to out rule implant related complications, in patients post Bipolar Hip Hemiarthroplasty.

Presentation: A 75-year-old man presented to the emergency department with a 5-week history of confusion, daytime somnolence, and fatigue. His physical examination was unremarkable.

Diagnosis: Investigations initially showed deranged Liver function tests. Extensive investigations were done following that including CT brain, MRI brain, septic screen, Arterial blood gas, and Lumbar puncture, which were all inconclusive. An Electroencephalogram was suggestive of Encephalopathy. His Ammonia level was high (123). Triphasic CT liver, revealed Intrahepatic portosystemic venous shunt and was diagnosed with hyperammonaemic hepatic encephalopathy due to Intrahepatic portosystemic venous shunt.

Treatment: Management included the commencement of Lactulose, Rifaximin, and L-ornithine L-aspartate (LOLA). An IR-guided embolisation of the porto-venous shunt was performed. At two-month review, the patient reported no further episodes of confusion.

Discussion: Intrahepatic portosystemic venous shunts should be considered in the differential diagnosis of patients presenting with confusion or other unexplained neurological symptoms, especially in the presence of liver dysfunction. Early diagnosis and appropriate management are crucial for favourable outcomes.

Aim: To evaluate the role of paediatric ocular imaging in paediatric ophthalmology through a case series, defining the retinal features observed in various paediatric pathological and trauma-related (abusive or non-abusive) conditions in patients aged four weeks to 16 years in a tertiary paediatric hospital in Dublin, Ireland.

Methods: A retrospective record-based study was conducted at Children's Health Ireland (CHI) at Temple Street, analysing ocular images of patients aged four weeks to 16 years, spanning five years, from 2018 to 2022. Following pupillary dilation, retinal examinations were performed using the 'RetCam 3', a handheld device for supine examinations in younger children, or the 'Topcon KR 800' for older patients. Images were reviewed with haemorrhages categorised by number, size, and location. Demographic and clinical details were tabulated, with counts and percentages calculated for categorical variables. Odds ratios and 95% confidence intervals (CI) were derived using the Mantel-Haenszel method, with statistical significance set at p-value <0.05.

Results: Of the 25 cases that met the age category of four weeks to 16 years, RHs were most common in infants (16 cases). Retinopathy of prematurity (ROP) was identified in nine cases (age range: 2 mo - 19 mo, mean age 7 mo), presumed trauma in five cases (age range: 2 mo - 10 mo, mean age 6 mo), metabolic/genetic conditions in four cases (age range: 8 mo - 8 years), infections in two cases, tumours in two cases, and three cases with no confirmed diagnosis. Most RHs were few, intraretinal, located in the posterior pole and periphery of the eye. RH incidence was significantly higher in ROP and trauma cases (p = 0.027), with an odds ratio of 1.4 (95% CI: 0.08 - 25.14). ROP cases showed small, localised haemorrhages, while cases of presumed trauma had multilayer and large (> 5 disc diameter (DD)) haemorrhages (p = 0.058) that extend to the ora serrata (p = 0.018).

Discussion: The study highlights paediatric ocular imaging's role in documenting RH patterns, aiding differential diagnosis across paediatric conditions. Paediatric ocular imaging's detailed capabilities provide clinical insights, reducing the need for multiple exams while promoting standardised documentation. Integrating ocular imaging technology supports establishing national guidelines and training programs that improve accessibility across diverse healthcare settings. Future research should validate these findings through multi-modal approaches and standardised practices, exploring paediatric ocular imaging utility in routine paediatric care. Additionally, advancements in artificial intelligence (AI) can further improve retinal examination efficiency, ultimately enhancing paediatric ophthalmology and child welfare in Ireland.