Irish journal of medical science
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Review Case Reports
Use your head: overcoming epicardial complications during a single-catheter chronic total occlusion-a case-based review.
The success of attempts at opening chronic total occlusions (CTO) has dramatically increased in recent times due to the development of new techniques such as the use of the retrograde approach through epicardial collaterals. However, this approach admittedly brings with it an increased risk, and this must be balanced against the potential benefits. We present the case of a 61-year-old gentleman with Canadian Cardiovascular Society (CCS) Class III angina with a background history of hypertension and dyslipidaemia, who was an ex-smoker, and whose diagnostic coronary angiogram revealed CTOs of both the right and left circumflex coronary arteries. ⋯ Unfortunately, upon removal of the Corsair, a rupture of the epicardial collateral was noted with profuse bleeding into the pericardial space. This was treated successfully with a BeGraft-covered stent to obtain proximal control, and a Cooke Tornado neuro-interventional coil to obtain distal control, delivered antegrade through the now recanalized RCA. This case-based review then highlights several unique learning points, in particular to understand, in general terms, the approach to CTO; to understand the potential complications associated with a retrograde epicardial collateral approach; to understand the stepwise approach to dealing with perforation; and, finally, to understand how an occlusion coil works.
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Activity-based funding (ABF) is a reimbursement model for public hospitals in Ireland. Little data exist regarding cost estimates for acute surgical admissions in Ireland. This study presents a novel method of direct cost estimation for testicular torsion (TT) care in Ireland. ⋯ Just over two-thirds of cases (70%, n = 1230) were reimbursed with public funding. This novel cost estimation model may serve as a template for future direct cost estimates for surgical interventions in Ireland. This will improve the accuracy of future economic evaluation for healthcare interventions in Ireland.
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Medullary thyroid cancer (MTC) accounts for only 4% of thyroid carcinomas but 15% of thyroid cancer deaths. MTC is a tumour of the calcitonin secreting parafollicular C cells in the thyroid which can occur sporadically or be hereditary in multiple endocrine neoplasias type 2 syndromes due to germline RET mutations. Sporadic forms of MTC can also be caused by mutations in the RET protooncogene. ⋯ Recently, researchers have been exploring non-surgical options including external beam radiotherapy and multikinase inhibitors such as vandetanib and cabozantinib for the treatment of MTC. Surgical management of MTC remains controversial and varies significantly dependent on the extent of disease. Chemotherapeutic options have undetermined effects on survival to date.
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Ureteric stents play an essential role in urology. However, patients can suffer a range of stent-related symptoms with stent in situ and during removal. Conventional ureteric stents are removed using a flexible cystoscopy, whereas magnetic stents may be rapidly removed with a smaller catheter-like retrieval device. ⋯ Furthermore, majority of the studies reported a reduction in the cost associated with magnetic ureteric stents. There is no significant difference in pain from indwelling ureteric stents. There is a reduction in pain with the removal of magnetic ureteric stents compared to conventional removal via cystoscopy and an associated reduction in cost.
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Diabetes mellitus (DM) is a global public health issue. Type 1 diabetes (T1D) is the predominant diabetes type in children and always requires insulin therapy. The incidence rate of newly diagnosed T1D in children continues to increase in Ireland Roche et al. (Eur J Pediatr 175(12):1913-1919, 2016) and worldwide Patterson et al. (Diabetologia 62(3):408-417, 2019). ⋯ A literature review was performed using PubMed, Medline, Embase and Cochrane library to evaluate play, art, music and exercise therapy in the treatment of DM using the keywords: "paediatric", "diabetes", "play therapy", "art therapy", "music therapy" and "exercise therapy". These search terms initially returned 270 cases, which resulted in a total of 11 papers being reviewed after eliminating duplicate or irrelevant papers. Literature review showed that all therapies have a positive impact on the child, but there is limited research looking at the impact of therapy on quantitative measures such as HbA1c or 'time in range'.