This Month’s IMJ

January 2018 Vol 111 Number 1

IMJ Commentary

 Negligence Claims Costs are Rising Rapidly in the UK

JFA Murphy


Lithium Use in Pregnancy

Doyle S 1, Green AJ1,2

Original Papers

Oral Cancer Awareness of Non-Consultant Hospital Doctors in Irish Hospitals

D Shanahan1 CM Healy2

Shanahan and Healy address the issue of oral cancer awareness.  They surveyed 221 NCHDs.  60% were uncertain, and 21% very unsure of oral cancer diagnosis. 80% do not routinely examine the oral mucosa.  More education is required at both undergraduate and postgraduate levels.

Cross-sectional Analysis of the Standards of Consent Applied to Anaesthesia in Ireland: Are Anaesthetists Aware of their Legal and Ethical Obligations?

Cafferkey A, Lyons B

Cafferkey and Lyons report on the responses of 160 anaesthetists. 63.8% do not usually document consent.  21.8% rarely and 27.8% never explain the risks to patients.  The findings suggest wide variation in the practice of obtaining consent for anaesthesia.

Overnight emergency CT imaging: a 10-year experience at an Irish tertiary referral hospital.

Hynes J1, Redmond CE1, Healy GM1, Cronin, J2, Heffernan, EJ1.

Hynes et al report that over a 10-year period, overnight CT scan imaging increased.  The increase was from 0.4 to 1.2 studies per night.  64% of the scans were normal.

Peripherally Inserted Central Catheters (PICCs) and Potential Cost Savings and Shortened Bed Stays In an Acute Hospital Setting.

 C O’Brien, J Mc Marrow, E O’Dwyer, P Govender, WC Torreggiani

O’Brien et al describe 2404 referrals for PICC line insertion 2009-15.  During the study period the annual number of PICC insertions increased from 255 to 508 annually.

A Review Of Referral Patterns For Sagittal Synostosis In Ireland: 2008-2013

M J Berney, A McGillivary, J Caird, D J Murray

Berney et al describe 81 children with sagittal synostosis.  74% were referred before 6 months, and 26% were late referrals.  Late referral led to a more complex referral pathway.

Is Increasing Life Expectancy Leading To More Complexity?

H Johnson, A O’Farrell, D McKeow, G Sayers, C Hayes, D Beaton

Johnson et al examined the relationship between age over 65 years and indicators of clinical complexity in acute hospitals.  Over the period 2005-2014 the number and rate of hospital admissions increased especially for those over 85 years.

A Descriptive Study Of The Burden Of Animal-Related Trauma At Cork University Hospital.

M Sheehan, C Deasy

Sheehan and Deasy report that 54 patients were admitted to CUH with major farm animal related trauma over a 5 year period.  Most were orthopaedic injuries, fractures of the tibia and fibula being the commonest.  59% of cases required surgery, and 16.7% were admitted to the intensive care unit.

Management of Bone Fragility in Primary Care in Ireland

R O’Connor, A O’Regan , J O ‘Doherty

O’Connor et al studied 243 patients at risk of bone fragility.  Using DEXA scan examinations, 17% had osteoporosis, 11 had osteopaenia.  63% were currently being prescribed bisphosphonates. 21% did not have a baseline scan before commencing bisphosphonate therapy.

Case Reports

A Unique Case of Concurrent Long Bone Osteomyelitis and Empyema Caused by Fusobacterium nucleatum.

S Waqas, C Bannan, A Fe Talento, D Byrne, S O’Connell, S Clarke, C Merry

Waqas et al describe a 51 year old man who presented with right thigh swelling, left sided empyema, and poor dentition.  Following investigations the unifying diagnosis was dental disease complicated by Fusobacterium Nucleatum.  The patient made a complete recovery following an 8- week course of antibiotics.

Laryngeal Chondrosarcoma: A rare cause of critical upper airway obstruction.

K Tuite, J.C Oosthuizen, T Subramaniam, J.B Kinsella

Tuite et al describe the case of an 82 year old male with dyspnea and dysphonia.  Endoscopy revealed a large submucosal mass at the laryngeal inlet.  A subsequent CT scan and histology confirmed a chondrosarcoma.  A total laryngectomy was performed.

Primary Renal Carcinoid – A Case Report

M O’Sullivan, ML Gargan, R Flynn, SCrowther, WTorreggiani

O’Sullivan et al describe a 37 year old female with gastrointestinal symptoms.  Abdominal CT scan showed a lesion in the lower pole of the left kidney.  The biopsy confirmed a well differentiated neuroendocrine tumour.  A nephrectomy was performed.

Iron Refractory Iron Deficiency Anaemia: A Rare Cause of Iron Deficiency Anaemia

T McGrath, M Cotter

McGrath and Cotter describe a 17 months old boy with a hypochromic, microcytic anaemia which was refractory to iron therapy.  The cause was 2 mutations in the TMPRSS6 gene.  He was successfully treated with intravenous iron sucrose 200mgs

Short Reports

Paediatric Type 2 Diabetes Still Rare in an Irish Tertiary Referral Unit

R Kernan, A Carroll, N Mc Grath, CM Mc Donnell, NP Murphy

Kernan et al report that in their patient cohort of 320 children with diabetes only 2% (7/320) had type 2 diabetes.  The 7 children with type 2 diabetes were overweight, hypertensive, and mainly non-caucasian.  The affected children required insulin therapy.

Research Correspondence

Menafrivac, Its Success Against Group A Meningococcus In Sub-Saharan Africa And The Challenges Which Lie Ahead.

L FW Leader

Alternative Piece


C Fitzpatrick, R M Berlin

Letters to the Editor

True Resistance to Local Anaesthetics: An Unusual Cause of Failure

A Sleiwah, M McBride, S Dustagheer.

Uterine Sacculation in Pregnancy

Langhe, W. M. Blake, M. Gannon