Tony Geoghegan

Young injectors: a comparative analysis of risk behaviour.

This study compares the injecting and sexual risk-behaviour of young injectors, with injectors over the age of 25. All respondents presented for the first time at the Merchants’ Quay Health Promotion Unit between May 1st 1997 and February 28th 1998. Analysis revealed that the young injectors were significantly more likely to report recently borrowing and lending used injecting equipment, and injecting paraphernalia. Regarding sexual risk behaviour, younger respondents were proportionately more likely to report being sexually active, having multiple sexual partners, and having a regular partner who is an injecting drug user. However, they were significantly more likely than older clients to report condom use. The suggestion is that the harm minimisation message, which reached its zenith in the early 1990s, has now been somewhat de-emphasised in both policy and practice. Consequently, it is not reaching the young injectors who have recently initiated intravenous drug use. Additional strategies are needed to target this group of drug users, in order to promote positive behaviour changes.

Fabrication and Assessment of 3D Printed Anatomical Models of the Lower Limb for Anatomical Teaching and Femoral Vessel Access Training in Medicine.

For centuries, cadaveric dissection has been the touchstone of anatomy education. It offers a medical student intimate access to his or her first patient. In contrast to idealized artisan anatomical models, it presents the natural variation of anatomy in fine detail. However, a new teaching construct has appeared recently in which artificial cadavers are manufactured through three‐dimensional (3D) printing of patient specific radiological data sets. In this article, a simple powder based printer is made more versatile to manufacture hard bones, silicone muscles and perfusable blood vessels. The approach involves blending modern approaches (3D printing) with more ancient ones (casting and lost‐wax techniques). These anatomically accurate models can augment the approach to anatomy teaching from dissection to synthesis of 3D‐printed parts held together with embedded rare earth magnets. Vascular simulation is possible through application of pumps and artificial blood. The resulting arteries and veins can be cannulated and imaged with Doppler ultrasound. In some respects, 3D‐printed anatomy is superior to older teaching methods because the parts are cheap, scalable, they can cover the entire age span, they can be both dissected and reassembled and the data files can be printed anywhere in the world and mass produced. Anatomical diversity can be collated as a digital repository and reprinted rather than waiting for the rare variant to appear in the dissection room. It is predicted that 3D printing will revolutionize anatomy when poly‐material printing is perfected in the early 21st century. Anat Sci Educ.

Gender differences in characteristics of drug users presenting to a Dublin syringe exchange

A significant minority of the new clients presenting to the Merchants Quay health promotion unit are female, and there are notable gender differences in drug use patterns among new attendees. To date there has been no research into gender difference and drug use in Ireland with the exception of areas of study concerned with maternal opiate use. This study explores the gender difference in patterns of drug use, risk behaviour, health and well being among new 934 attendees to a Dublin syringe exchange. From May 1997 to April 1998 data was collected by means of structured interviews with all first time clients who presented at the Merchants Quay Health Promotion Unit. All Information collected was based on clients self-reported behaviour. Of the new clients, 24.3% were female and 75.7% were male. n nThe female clients were significantly younger than their male counterparts, more likely to report having a sexual partner who was an injecting drug user and to be living with an injecting drug user. They were also more likely to report recently sharing injecting paraphernalia. The interval between initiating intravenous drug use and first presenting at the Merchants Quay health promotion unit was significantly shorter for female clients. One of the most important concerns with regard to illicit intravenous drug use is that of needle sharing and its associated risks (HIV and hepatitis.) This study highlights the greater personal involvement of women with other drug users, and its consequences in terms of health-related problems and risk behaviour. It is possible to take advantage of the fact that young women present for treatment at a younger age than their male counterparts, and at a much earlier stage in their injecting careers.

de Garengeot hernia with a mucinous neoplasm of the appendix, two clinical rarities combine to yield a first for the literature

A woman in her 70s presented for a scheduled CT scan for workup of an adnexal lesion. The adnexa were within normal limits; however, a blind-ending tubular structure was noted in the right femoral canal (figures 1 and 2). The diagnosis of a de Garengeot hernia was made. This is a rare type of hernia that occurs when the appendix descends to lie in the femoral canal. Femoral hernias comprise roughly 3% of all abdominal wall hernias, andxa0de Garengeot hernias comprises 0.8%–1% of all femoral hernias.1nnnnFigure 1 nCT scan axial images. Green arrows: dilated appendix in …

Novel Use of a Pneumatic Compression Device for Haemostasis of Haemodialysis Fistula Access Catheterisation Sites

PurposeTransradial pneumatic compression devices can be used to achieve haemostasis following radial artery puncture. This article describes a novel technique for acquiring haemostasis of arterio-venous haemodialysis fistula access sites without the need for suture placement using one such compression device.Materials and MethodsA retrospective review of fistulograms with or without angioplasty/thrombectomy in a single institution was performed. 20 procedures performed on 12 patients who underwent percutaneous intervention of failing or thrombosed arterio-venous fistulas (AVF) had 27 puncture sites. Haemostasis was achieved using a pneumatic compression device at all access sites. Procedure details including size of access sheath, heparin administration and complications were recorded.ResultsTwo diagnostic fistulograms, 14 fistulograms and angioplasties and four thrombectomies were performed via access sheaths with an average size (±SD) of 6 Fr (±1.12). IV unfractionated heparin was administered in 11 of 20 procedures. Haemostasis was achieved in 26 of 27 access sites following 15–20xa0min of compression using the pneumatic compression device. One case experienced limited bleeding from an inflow access site that was successfully treated with reinflation of the device for a further 5xa0min. No other complication was recorded.ConclusionsHaemostasis of arterio-venous haemodialysis fistula access sites can be safely and effectively achieved using a pneumatic compression device. This is a technically simple, safe and sutureless technique for acquiring haemostasis after AVF intervention.

Single-institution experience with selective internal radiation therapy (SIRT) for the treatment of unresectable colorectal liver metastases

BackgroundLiver metastases are the commonest cause of death for patients with colorectal cancer. Growing evidence supports the use of selective internal radiation therapy (SIRT) in combination with conventional chemotherapy regimens for liver-only or liver-dominant unresectable metastatic colorectal cancer.AimsTo measure and evaluate outcomes of the first 20 consecutive patients with unresectable colorectal liver metastasis selected for SIRT in addition to their chemotherapy at a single Irish institution.MethodsRetrospective case series was performed. Patient charts and medical records were reviewed.ResultsAll 20 patients (100%) selected for angiographic workup were subsequently successfully treated with radioembolization. All patients were discharged 1xa0day post-SIRT. At initial imaging evaluation, 12 (60%) had a partial response in their liver, 2 (10%) had stable disease, and 6 (30%) had liver-specific progressive disease. Median follow up was 10xa0months (range 6–26). At last follow up, 14 (70%) patients were alive and 6 (30%) deceased. Most recent imaging demonstrated 2 (10%) with a complete response, 7 (35%) had a partial response, 2 (10%) had stable disease, and 9 (45%) had progressive disease within their liver. One patient was downstaged to hepatic resection, and one with a complete hepatic response had his primary sigmoid tumor resected 11xa0months post-SIRT.ConclusionsSIRT is a safe and effective therapy for certain patients with unresectable colorectal liver metastases. This case series supports our opinion that selected patients should be offered SIRT in concert with their medical oncologist, concomitant with their chemotherapy. Larger multi-center studies are required to more clearly define the patient groups that will derive most benefit from SIRT.

What Are the Indications for Prophylactic Embolization of Renal Angiomyolipomas? A Review of the Current Evidence in the Literature

Renal angiomyolipomas (AMLs) are benign tumours that may occur sporadically in the general population or in patients with tuberous sclerosis complex. The concern with AMLs is that of retroperitoneal hemorrhage, which can be fatal. Classically the trigger for prophylactic intervention was thought to be an AML diameter of ≥4 cm. However, this value is largely based on data from case series and heterogeneous retrospective studies. The PICO (patient, intervention, comparison, outcome) paradigm was used to systematically search the Cochrane database, TRIP database, and PubMed. The quality of evidence in the literature is poor regarding the indications for prophylactic embolization of AMLs (level 4). There are no prospective studies that adequately assess embolization vs other treatment modalities. However, using the available evidence we have produced recommendations for when intervention should be considered. We have also made recommendations regarding the direction of future research.

Asymptomatic Renal Pseudoaneurysm Following Laparoscopic Partial Nephrectomy

A 66-year-old-woman underwent a laparoscopic left partial nephrectomy for a 3u2009cm partially exophytic tumor arising from the posterior interpolar region of the left kidney. Follow-up surveillance computed tomography 6xa0months following the surgery found an incidental 4u2009cm lesion in the left kidney that is avidly enhanced in the arterial phase, consistent with a renal pseudoaneurysm. She was completely asymptomatic. Renal pseudoaneurysm is a rare complication following minimally invasive nephron-sparing surgery and typically presents in the early postoperative period with gross hematuria. However, a large renal pseudoaneurysm may also present as an asymptomatic incidental finding and is amenable to angioembolization.

Loss of renal India ink artifact—a useful radiological sign for obstructive hydronephrosis in pregnancy☆

Magnetic resonance imaging is a useful tool for investigating causes of abdominal pain in pregnancy. Differentiating between physiologic hydronephrosis of pregnancy and pathologic hydronephrosis can be challenging for clinicians and radiologists. This report describes loss of the India ink artifact around the obstructed kidney as a novel and potentially useful radiological sign, which may be of value in the evaluation of abdominal pain and hydronephrosis in pregnancy.

Megaseminal vesicles in adult polycystic kidney disease.

dentally detected on cross-sectional imaging studies; however, if it is not recognized preoperatively in patients undergoing pancreatoduodenectomy it may lead to incomplete resection of the uncinate process with a sinus or fistula emanating from a side branch. Accordingly, it is imperative to carefully assess the relationship of the pancreatic duct relative to the portal vein in all cases of circumportal pancreas. The ductal anatomy can be readily assessed on axial contrast-enhanced CT imaging, fat-suppressed T2-weighted magnetic resonance imaging (MRI) as well as contrastenhanced fat-suppressed T1-weighted MRI.