Abstracts of the 22nd Sylvester O’Halloran Meeting, 27 February – 1 March 2014, Co. Limerick, Ireland.

ROYAL ACADEMY OF MEDICINE IN IRELAND IRISH JOURNAL OF MEDICAL SCIENCE

22nd Sylvester O’Halloran Meeting Thursday 27th February–Saturday 1st March 2014 The Graduate Entry Medical School, Faculty of Education & Health Sciences, University of Limerick, Co. Limerick, Ireland

Irish Journal of Medical Science Volume 183 Supplement 1 DOI 10.1007/s11845-013-1062-3

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Ir J Med Sci (2014) 183 (Suppl 1):S1–S69

Disclosure Statement The operational costs of the Sylvester O’Halloran Meeting 2014 are funded with the support of a number of commercial bodies through educational grants. These are listed overleaf.

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22nd Sylvester O’Halloran Meeting 2014

Endoscopy Workshop sponsored by Pentax & Sword Medical Barringtons Hospital Sponsors of Catering at the SOH Meeting

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22nd Sylvester O’Halloran Meeting 2014 General Surgery Overview Draft Programme

Thursday 27th February 2014

IRISH ASSOCIATION OF VASCULAR SURGEONS VENOUS DISEASE MASTERCLASS 2014 FACULTY Mr E Kavanagh, University Hospital Limerick Mr P Burke, University Hospital Limerick Prof. S Walsh, University Hospital Limerick Others TBC

COURSE PROGRAMME Registration & Lunch

12.15–12.45

Mr Eamon Kavanagh Welcome

12.45–13.00

Venous Pathology and Management

13.00–15.00

Venous Anatomy and Pathophysiology

13.00–13.20

Management of Venous Ulcers

13.20–13.40

Deep Vein Thrombosis – the Haematologist’s Perspective

13.40–14.00

Interventional Management of Deep Vein Thrombosis – Thrombolysis and Filters

14.00–14.20

Imaging of Venous Problems

14.20–14.40

Varicose Veins Interventions

14.40–15.00

Coffee Break

15.00–15.20

18.00–18.45 19.00

Refreshments The Inaugural Hedderman Lecture Prof. Ronan O’Connell, Professor and Consultant Surgeon, UCD ‘‘The Ileal Pouch – Then and Now’’ Venue: GEMS0-016, Graduate Entry Medical School

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Meetings Daily Schedule Surgical

Friday 28th February to Saturday 1st March

ENT/Head & Neck Session

Friday 28th February

16.20–17.40

Orthopaedics

Saturday 1st March

09.00–12.40

Anaesthesia

Saturday 1st March

09.00–10.30

Friday 28th February 09.00–11.30

Endoscopy Workshop Sponsored by Pentax & Sword Medical Venue: HS-1006, Centre for Health Sciences

11.30–12.00

Coffee

12.00–13.00

Irish Higher Surgical Training Group Debate on Training Motion: The Traditional Apprenticeship Model of Surgical Training is Dead and should be Buried Prof. Oscar Traynor/Prof. Michael Kerin Chair: Ms Patricia Cronin, IHSTG

13.00–13.30

Lunch

13.30–15.00

Clinical Session I/Poster Adjudication

15.10–15.40

ASGBI Paper Prize

15.40–17.30

Plenary Session

17.30–18.30

Prof. Eilis McGovern (National Programme Director for Medical Training in the Health Service Executive) ‘‘Spotlight on Irish Surgical Training and Workforce Planning’’

20.30

Reception in The Dunraven Arms Hotel, Adare, Co Limerick

Saturday 1st March 09.10–10.30

Clinical Session II

10.30–10.50

Coffee

10.50–12.10

Surgical Practice Session

12.15–12.50

Sir Thomas Myles Lecture ‘‘Bringing Research from the Bench to the Bedside’’ — A Case Study The Application of Biomedical Electronics in the Management of Venous Leg Ulcers Prof. Gearoid O’Laighin Professor of Electronic Engineering, School of Engineering & Informatics, NUI Galway & Principal Investigator, National Centre for Biomedical Engineering Science, NUI Galway

12.50–13.00

Prize Winner Announcements

13.00

Meeting Ends/Lunch

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Friday 28/02/2014 Clinical Session 1 Time Allowed: 7 min Speaking 3 min Discussion Chairpersons: Ms Elizabeth Connelly/Mr Tariq Abdelhafiz Room:

GEMS0-016

Session I

13.30–15.00

13.30–13.40

1. Surgical management of great saphenous varicosities: a meta-analysis N.P. Lynch 1, M Clarke2, G Fulton1 Department of Surgery, Cork University Hospital, Wilton Cork, Ireland1, Postgraduate Research Faculty, Royal College Of Surgeons Ireland, Dublin, Ireland2

13.40–13.50

2. Breast cancer diagnosis: a retrospective cohort study to derive a clinical prediction rule for breast cancer and prospective validation of this rule in an Irish cohort D.P. Joyce, R. Galvin, E. Downey, A.D.K. Hill Department of breast surgery, Beaumont Hospital, Dublin 9, Ireland

13.50–14.00

3. Investigating the importance of variants at 12p11, 12q24 and 21q21 in breast cancer in the west of Ireland T.P. McVeigh, U.M. McVeigh, N. Miller, K.J. Sweeney, M.J. Kerin Discipline of Surgery, National University of Ireland, Galway, Ireland

14.00–14.10

4. Activated systemic inflammatory response at diagnosis reduces lymph node count in colonic carcinoma Brenda Murphy, Rory Kennelly, Hamad Yousef, Brian Mehigan, Paul McCormick Department of Colorectal Surgery, St James Hospital, Dublin 8, Ireland

14.10–14.20

5. Early post-operative removal of urethral catheter in patients undergoing colorectal surgery with epidural analgesia—a single-centre prospective randomised controlled clinical trial D. Coyle, K. Joyce, J.T. Garvin, M. Regan, O.J. McAnena, P. Neary, M.R. Joyce Department of Surgery, University College Hospital, Galway, Ireland

14.20–14.30

6. Endovascular versus open repair of ruptured abdominal aortic aneurysm: report from an Irish vascular centre T. Aherne1, S. McHugh1,2, J. Byrne1, T. Goetz2, E.M. Boyle1,2, M. Allen1, A. Leahy1, D. Moneley1, P. Naughton1 Department of Vascular Surgery, Beaumont Hospital, Dublin 9, Ireland1, Royal College of Surgeons in Ireland, 123 St. Stephens Green, Dublin 2, Ireland2

14.30–14.40

7. Frequency of pathogenic variants in known susceptibility genes in the Irish familial breast cancer population F. Aloraifi1,2,3, J. McGreevy1,2,3, T. McDevitt1,2,3, A. Green1,2,3, A. Bracken1,2,3, J. Geraghty1,2,3 Department of Smurfit Institute of Genetics, Trinity College Dublin, Dublin, Ireland1, Department of National Centre for Medical Genetics, Our Lady’s Children’s Hospital, Crumlin, Dublin, Ireland2, Department of Surgery, St Vincent’s University Hospital, University College Hospital, Dublin, Ireland3

14.40–14.50

8. 1000 Laparoscopic bowel resections: standardised techniques yield standard outcomes M. O’Sullivan, M. Whelan, N. Fearon, D. Collins, D. Buckley, P. Neary Department of Colorectal Surgery, Tallaght Hospital, Dublin 24, Ireland

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15.10–15.40

ASGBI Paper Prize

Friday 28/02/2014

Plenary Session

Time Allowed:

7 min Speaking 3 min Discussion

Chairpersons:

Prof. Arnold Hill & Prof. Stewart Walsh

Room:

GEMS0-016

Session 2

15.40–17.30

15.40–15.50

9. HOXC11 impacts steroidal adaptability in aromatase inhibitor resistance by upregulating the androgen receptor A. Ali1,3, F. Bane1, Y. Hao2, D. McCartan1, P. O’Gaora2, A.D.K. Hill1,3, L.S. Young1, M. McIlroy1 Endocrine Oncology Research Group, Royal College of Dublin, Dublin 2, Ireland1, School of Medicine and Medical Sciences, University College Dublin, Dublin 4, Ireland2, Department of Surgery, Beaumont Hospital, Dublin, Ireland3

15.50–16.00

10. Stimuli responsive release of small molecule drugs from thermosensitive liposomes within a hydrogel depot: a novel drug delivery system for multiple pro-angiogenic agents C.C. Herron1, H. O’Neill1, A. Lo´pez-Noriega1, C.L. Hastings1, C.O. McDonnell2, G.P. Duffy1 Tissue Engineering Research Group, Department of Anatomy, Royal College of Surgeons in Ireland, Dublin 2, Ireland1, Department of Vascular Surgery, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland2

16.00–16.10

11. Fractal analysis of the chick extra-embryonic angiogenesis following cadmium exposure A. Kaskova-Gheorghescu1, N.V. Buchete2, J. Thompson1 School of Medicine and Medical Science, University College Dublin, Belfield, Dublin 4, Ireland1, School of Physics and Complex and Adaptive Systems Laboratory, University College Dublin, Belfield, Dublin 4, Ireland2

16.10–16.20

12. Secretion of exosome-encapsulated oncomirs by colorectal cancer cells in vitro C. Clancy, M.R. Joyce, M.J. Kerin, R.M. Dwyer Discipline of surgery, School of medicine, National University of Ireland, Galway Dept of Colorectal Surgery, University College Hospital Galway, Galway, Ireland

16.20–16.30

13. Quantifying migration of a commercially available endovascular stent graft in an environment that is representative of the physiological state B. Lynch1, J. Nelson2, T.M. McGloughlin1 Centre for Applied Biomedical Engineering Research (CABER), Dept of Mechanical, Aeronautical and Biomedical Engineering and The Material and Surface Science Institute (MSSI), University of Limerick, Co. Limerick, Ireland1, Dept Electronic and Computer Engineering, University of Limerick, Co. Limerick, Ireland2

16.30–16.40

14. M1 polarised macrophages develop a endotoxin tolerance-like phenomenon in response to bacterial stimulation N.M. Foley, J.H. Wang, H.P. Redmond Department of Academic Surgery, Cork University Hospital, Co. Corcaigh, Ireland

16.40–16.50

15. Targeting of TSG101 may provide a putative pathway to prevent exosomal communication in triple negative breast cancer tumours Shiva Sharma1,2, Luke Gubbins1,2, Christian Cawley1,2, Jeremy Simpson3, Malcolm Kell4, Amanda McCann1,2 UCD School of Medicine and Medical Science, Dublin, Ireland1, UCD Conway Institute for Biomolecular and Biomedical Research, Dublin, Ireland2, UCD School Of Biology & Environment Science, Dublin, Ireland3, Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland4

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16.50–17.00

16. The mesenteric organ—a novel source of fibroblasts in benign and malignant colorectal disease S.M. Sahebally1,2, M.G. Kiernan1, C. Dunne1, P.A. Kiely3, J.C. Coffey1,2 4i Centre for Interventions in Inflammation, Infection and Immunity, Graduate Entry Medical School, University of Limerick, Co. Limerick, Ireland1, Department of Surgery, University Hospital Limerick, Co. Limerick, Ireland2, Department of Life Sciences, Materials and Surface Science Institute and Stokes Institute, University of Limerick, Co. Limerick, Ireland3

17.00–17.10

17. Vitamin K derivatives inhibit the growth and proliferation of triple negative breast cancer cells *M. Kiely1,2, *S.J. Hodgins3, S. Tormey3, P.A. Kiely1,2, E.M. O’Connor1 Department of Life Science, University of Limerick, Limerick, Ireland1, Materials and Surface Science Institute and Stokes Institute, University of Limerick, Limerick, Ireland2, Department of Medicine, Mid-Western Regional Hospital, Limerick and Graduate Entry Medical School, University of Limerick, Limerick, Ireland3

17.10–17.20

18. Applying novel cell monitoring platforms to study the behaviour of triple negative breast cancer cells in 2-dimensional and 3-dimensional culture Adebola Ogunsakin1, Maeve Kiely1, Shona Tormey2, Patrick A. Kiely1, 3 Department of Life Sciences and Materials and Surface Science Institute, University of Limerick, Limerick, Ireland1, Department of Medicine, Mid-Western Regional Hospital, Limerick, Ireland2, Stokes Institute, University of Limerick, Limerick, Ireland3

17.20–17.30

19. Adipophilin (ADFP) is a novel and independent prognostic biomarker in colorectal cancer J. Hogan 1,2, L. O’Byrne 2, M. O’Callaghan 2, Catriona Dowling3, Patrick Kiely3, M. Kalady4,5, J.C. Coffey 1,2,6 UL Hospitals, University Hospital Limerick, Co. Limerick, Ireland1, Graduate entry Medical School, University of Limerick, Co. Limerick, Ireland2, Department of Life Sciences, University of Limerick, Co. Limerick, Ireland3, Department of Colorectal Surgery, Digestive Diseases Institute, Cleveland Clinic, Cleveland, OH, USA4, Cancer Biology Department, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA5, Center for Interventions in Infection, Inflammation and Immunity (4i), Graduate Entry Medical School, University of Limerick, Co. Limerick, Ireland6

17.30

Prof. Eilis McGovern (National Programme Director for Medical Training in the Health Service Executive) ‘‘Spotlight on Irish Surgical Training & Workforce Planning’’

Friday 28/02/2014

Head & Neck Session

Time Allowed:


Chairpersons:

Prof. John Fenton & Mr David Smyth

Room:

GEMS0-028

Session 3

16.20–18.10

16.20–16.30

20. Indications and outcomes of adenoidectomy in children under 12 months of age: a 10 year review T.S. Ahmed, P. Doody, H. Daya Department of ENT Surgery, St. George’s Hospital, London, UK

16.30–16.40

21. The association between intractable middle ear effusion, nasal polyps and Churg–Strauss syndrome W. Hasan, D. Smyth, E. Lang, L. Skinner, M. Donnelly, J.E. Fenton Department of Otolaryngology/Head and Neck Surgery, Waterford Regional Hospital & Limerick University Hospital, Co. Limerick, Ireland

16.40–16.50

22. Failure to report on research ethics committee approval and informed consent in otolaryngology journals S.P. Murphy, C. O’Rourke, J.E. Fenton Department of Otolaryngology/Head and Neck Surgery, Limerick University Hospital, Co. Limerick, Ireland

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16.50–17.00

23. Outcomes and prognostic indicators for intra-operative extended incisions in thyroidectomy Colin O’Rourke, Prof. C Timon 1 Royal Victoria Eye and Ear Hospital, Dublin, Ireland, 2St. James Hospital, Dublin, Ireland

17.00–17.10

24. Tracheostomy—a topic forgotten? knowledge of tracheostomy amongst junior doctors and medical students C.W.R. Fitzgerald, C. Oosthuizen, C. Wijaya, D.S. Leonard, J.B. Kinsella Department of Otolaryngology, Head and Neck Surgery, St James’s Hospital, Dublin 8, Ireland

17.10–17.20

25. Clinical need V’s financial penalty K. Davies, F. O Duffy, O. Young University College Hospital Galway, Newcastle, Co Galway, Ireland

17.20–17.30

26. Are symptoms of post-traumatic stress in patients experiencing nasal fractures reduced following surgery? a pilot study S. Gallagher1, C. O’Rourke2, J. C. Oosthuizen2, C. Wijaya2, O.T. Muldoon1, J. E. Fenton2 Department of Psychology, University of Limerick, Limerick, Ireland1, Department of ENT and Head and Neck Surgery, University Hospital Limerick, Limerick, Ireland2

17.30–17.40

27. The productive operating theatre in ENT ´ . Cathaín, A. Smyth, M. Bresnihan E´. O Department of ENT, Sligo Regional Hospital, The Mall, Sligo, Ireland

17.40–17.50

28. Letter to the editor—a publication loophole? E. Tierney, C. O’Rourke, J.E. Fenton Department of Otolaryngology/Head and Neck Surgery, University Hospital Limerick, Co. Limerick, Ireland

17.50–18.00

29. Ergonomics in ENT surgery C. O’Rourke, J.E. Fenton Department of Otolaryngology/Head and Neck Surgery, Limerick University Hospital, Co. Limerick, Ireland

18.00–18.10

30. Globus pharyngeus: just a variation of normal? C. Gullane, J. Doody, C. O’Rourke, J.E. Fenton Department of Otolaryngology/Head and Neck Surgery, Limerick University Hospital, Co. Limerick, Ireland

Saturday 01/03/2014

Clinical Session II

Time Allowed:


Chairpersons:

Mr Paul Burke/Mr Martin O’Sullivan

Room:

GEMS0-016

Session 4

09.10–10.30

09.10–09.20

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31. Loose seton management of anal fistula: a multi-centre study of 200 patients ME. Kelly, H. Heneghan, S. Martin, DC. Winter Dept of Surgery, St Vincent’s University Hospital, Dublin, Ireland


S11

09.20–09.30

32. The role of laparoscopic sleeve gastrectomy in the treatment of morbid obesity; review of outcomes in a consecutive series with a minimum follow-up of 1 year Moloney, B1, Ahern S1, Finucane, F1, McAnena E2, Lowe, D1,2, McAnena, O.1,2 Department of Surgery, Galway Roscommon University Hospitals Group, Department of Medicine, Galway Roscommon University Hospitals Group, Department of Anaesthesia, Galway Roscommon University Hospitals Group, Galway, Ireland1, Galway Clinic, Galway, Ireland2

09.30–09.40

33. High resolution manometry and oesophageal pressure topography: filling the gaps of conventional oesophageal manometry K.C. Ng, P.A. Carroll, L. Barry, T. Murphy Department of Surgery, Mercy University Hospital, Cork, Ireland

09.40–09.50

34. Technical deficiencies resulting in recurrent inguinal hernias in the era of Lichtenstein tension-free mesh repairs J. F. C. Woods, P. A. Cronin, G. McEntee Department of General Surgery, Mater Misericordiae University Hospital, Dublin 7, Ireland

09.50–10.00

35. Varicose veins: the ultrasound pattern of recurrence L. Fitzgerald, M.C. Grouden, D.J. Moore, Z. Martin, P. Madhavan, S.M. O’Neill, M.P. Colgan St James’s Vascular Institute, St James’s Hospital, Dublin 8, Ireland

10.00–10.10

36. Factors affecting hormonal therapy adherence in breast cancer patients E.M. Quinn, M.J. O’Sullivan Dept of Breast Surgery, Cork University Hospital, Wilton, Cork, Ireland

10.10–10.20

37. Comparing supervised exercise and endovascular revascularization in the management of peripheral arterial disease: a review T. Aherne, S. McHugh, A. Leahy, D. Moneley, P. Naughton Department of Vascular Surgery, Beaumont Hospital, Dublin 9, Ireland

10.20–10.30

38. An immunohistochemical and stereological appraisal of mesocolic lymphangiology—implications for surgical technique in resectional colorectal surgery K. Culligan1, R. Sehgal1, D. Mulligan1, C. Dunne1, S. Walsh1, F. Quondamatteo2, P. Dockery2, JC. Coffey1 Department of Surgery, Centre for Interventions in Infection, Inflammation and Immunity (4i), Graduate Entry Medical School, University Hospitals Group Limerick, Limerick, Ireland1, Anatomy Unit, School of Medicine, NUI Galway, University Rd, Galway, Ireland2

Saturday 01/03/2014

Surgical Practice Session

Time Allowed:


Chairpersons:

Ms Deborah McNamara & Ms Anne Merrigan

Room:

GEMS0-016

Session 5

10.50–12.10

10.50–11.00

39. National Clinical Programmes, bed cohorting and inpatient length of stay; an analysis of variation over time and between specialities M.P. Murphy1, S.M. Bollard1, P. Hurney2, M.J. Kerin1, K.J. Sweeney3 Discipline of Surgery, School of Medicine, NUI Galway, Galway, Ireland1, Information Services Department, Galway University Hospitals, Galway, Ireland2, Surgical Directorate, Galway Roscommon University Hospitals Group, Galway, Ireland3

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11.00–11.10

40. Improving surgical site infection prevention practices through a multifaceted educational intervention P. W. Owens1, S. M. McHugh2, M. Clarke-Moloney2, D. Healy2, F. Fitzpatrick3, P. McCormick4, E. Kavanagh2, S. R. Walsh2 Post-graduate School of Medicine, University of Limerick, Limerick, Ireland1, Department of Surgery, University Hospital Limerick, Dooradoyle, Co. Limerick, Ireland2, Health Protection Surveillance Centre, Dublin 1, Ireland3, Department of Surgery, Adelaide & Meath National Children’s Hospital, Tallaght, Dublin 24, Ireland4

11.10–11.20

41. ‘‘WhatsAppTM’’ Doc? An analysis of cross-platform smartphone messaging technology in the provision of surgical patient care R. Murphy, E. Ni Mhuricheartaigh, L. Townsend, B. O’Kelly, W. White, E. O’Neill, S. McHugh, E. Boyle, P. Naughton, D. Moneley, A. Leahy, A. Hill Department of Surgery, Beaumont Hospital, Dublin 9, Ireland

11.20–11.30

42. Economic impact of emergency theatre delays and poor prioritisation compliance S. Beecher, D.P. O’Leary, R. McLaughlin Department of Surgery, University College Hospital Galway, Galway, Ireland

11.30–11.40

43. ‘‘Is General Surgery still relevant to the sub specialised trainee?’’ A 10 year comparison of general vs. specialty surgical practice C. Fleming1,2, E.A. Andrews2, M.A. Corrigan1,2 Breast Research Centre, Cork University Hospital, Cork, Ireland Department of Surgery, Cork University Hospital, Cork, Ireland

11.40–11.50

44. Health technology implementation: the need for generic template model generation in the surgical context S.P. Murphy, Z. Coyne, S. O’Regan, J. Kelly, J.C. Coffey Department of Surgery, Mid-Western Regional Hospital, Limerick, Ireland

11.50–12.00.

45. PATI: patient accessed tailored information N.M. Foley1, G. Connolly3, S. Tabirca3, B. Maher2, T. Cil4, E.A. Lehane5, C. O’Riordan6, I. Bailey6, M.A. Corrigan1 Breast Research Centre, Cork University Hospital, Wilton, Cork, Ireland1, School of Medicine, University College Cork, Cork, Ireland2, School of Computer Science and Information Technology, University College Cork, Cork, Ireland3, Division of General Surgery, University of Toronto, Toronto, ON, Canada4, Catherine McAuley School of Nursing & Midwifery, University College Cork, Cork, Ireland5, The National Adult Literacy Agency, Dublin, Ireland6

12.00–12.10

46. Laparoscopic cholecystectomy in Ireland: who operates where? I. Reynolds1, J.C. Bolger1,2, Z. Al-Hilli1, A.D.K. Hill1,2. Dept of Surgery, Beaumont Hospital, Dublin 9, Ireland1, Dept of Surgery, Royal College of Surgeons in Ireland, Dublin 2, Ireland2

12.10–12.50

Sir Thomas Myles Lecture ‘‘Bringing Research from the Bench to the Bedside’’ — A Case Study The Application of Biomedical Electronics in the Management of Venous Leg Ulcers

12.50–13.00

Prize Winner Announcements

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Ir J Med Sci (2014) 183 (Suppl 1):S1–S69 Saturday 01/03/2014

Orthopaedic Session I

Time Allowed:


Chairpersons:

Mr. Dermot O’Farrell & Mr. Lester D’Souza

Room:

GEMS0-029

Session 6

09.00–11.00

S13

09.00–09.07

47. A retrospective review of calcaneus fractures managed in tertiary referral centre R. Lyons, C. Kiernan, S. Kearns Department of Orthopaedic and Trauma Surgery, Galway University Hospital Group, Galway, Ireland

09.07–09.14

48. Functional outcomes from total wrist arthrodesis—patient perceptions of activity level after surgery M. Hennessy1,2, C. Quinlan2, P. Fleming2 School of Medicine, University College Cork, Co Cork, Ireland1, Department of Orthopaedics, Cork University Hospital/South Infirmary Victoria Hospital, Co Cork, Ireland2

09.14–09.21

49. Review of corrective radial osteotomys in post traumatic distal radius fracture wrists Ms. C.Kiernan, A.Kelly, Mr. M O Sullivan UCHG Galway, Bons Secours Galway, Galway, Ireland

09.21–09.28

50. Anatomical analysis of distal phalanx and FDP footprint C. Kiernan1, P Tierney2, M O’Sullivan1 UCHG, Galway, Ireland1, Trinity College, Dublin, Ireland2

09.28–09.35

51. A novel tissue engineering scaffold for the regeneration and repair of knee joint osteochondral defects A.C. Ramesh1,2,3, T.J. Levingstone1,2,3, R.T. Brady1,2,3, J. Gleeson1,2,3,4, F.O’Brien1,2,3 Tissue Engineering Research Group, Department of Anatomy, Royal College of Surgeons in Ireland, Dublin, Ireland1, Trinity Centre for Bioengineering, Trinity College Dublin, Dublin, Ireland2, Advanced Materials and Bioengineering Research (AMBER) Centre, RCSI & TCD, Dublin, Ireland3, SurgaColl Technologies Ltd., Rubicon Centre, Rossa Avenue, Cork, Ireland4

09.35–09.42

52. Assessing the ability of tissue-engineered cartilage to promote bone regeneration in weight-bearing and nonweightbearing sites: an in vivo study E.M. Thompson1,2,3, A. Matsiko1,2,3, J.P. Gleeson1,2,3, D.J. Kelly1,2,3, F.J. O’brien1,2,3 Tissue Engineering Research Group, Department of Anatomy, RCSI, Dublin 2, Ireland1, Trinity Centre for Bioengineering, TCD, Dublin 2, Ireland2, Advanced Materials and Bioengineering Research (AMBER) Centre, RCSI & TCD, Dublin 2, Ireland3

09.42–09.49

53. Measurement of normal fibular growth in paediatric leg length discrepancy using Computed Tomography Scanogram N.P. McGoldrick, K. Olajide, J. Noel, P. Kiely, D. Moore, P. Kelly The Children’s Medical and Research Foundation, Department of Paediatric Orthopaedic Surgery, Our Lady’s Children’s Hospital, Crumlin, Dublin 12, Ireland

09.49–09.56

54. Increased BMI as a risk factor for upper extremity fractures in children and adolescents A.R Moriarity, A Abdulkarim, M Mullins, D Niall, E Sheehan Department of Orthopaedics, Midland Regional Hospital, Tullamore, Ireland

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09.56–10.03

55. Levels of evidence in the treatment of slipped capital femoral epiphysis research: a systematic review A.R. Moriarity, J Kennedy, J.F. Baker, P.J. Kiely Department of Orthopaedic Surgery, Our Lady’s Children’s Hospital, Crumlin, Dublin, Ireland

10.03–10.10

56. Leucocyte esterase in the rapid diagnosis of paediatric septic arthritis E.G. Kelly, J.P. Cashman Childrens University Hospital, Temple St. Dublin, Ireland

10.10–10.17

57. Characterization of patellar tendon reflex in cerebral palsy children using motion analysis Y. Elhassan 1, R. O’Sullivan 1, D. Kiernan 1, M. Walsh 1, T. O’Brien 1, 1 The Gait laboratory, Central Remedial Clinic, Clontarf, Dublin, Ireland1

10.17–10.24

58. Outcome of first metatarsophalangeal joint fusion using a precontoured plate M.M. Hennessy1, B.R. O’Connor1, R. Gul1 Department of Orthopaedic Surgery, Cork University Hospital, Wilton, Cork, Ireland

10.24–10.31

59. Management of 14,903 ankle fractures requiring operative fixation in the Republic of Ireland: an epidemiological study from 2002–09 O. Carmody1, M. Kennedy1, S. Morris1 1 Trauma and Orthopaedic Surgery, National Orthopaedic Surgery, Cappagh, Dublin, Ireland

10.31–10.38

60. Postero-lateral antiglide plating of Danis-Weber Blower end of fibula fractures without the use of an interfragmentary compression and distal screw fixation C.T.Cronin1, M. M. Zafar1, R.M. Merchant1, E. Kelly 1, B. Anto1 1 Department of Orthopaedic Surgery, Waterford Regional Hospital, Dunmore Road, Ireland

10.38–10.45

61. A prospective study of intraoperative accuracy of ankle joint injection A.C.Ramesh1,2, F. Maleki1–3, J.N. Mckenna1–3 1 Santry Sports clinic, Dublin, Ireland, 2St. James Hospital, Dublin, Ireland, 3Adelaide And Meath Hospital, Dublin, Ireland

10.45–10.52

62. A comparison study of four different techniques for arthrodesis of 1st MTPJ A.C.Ramesh1,2, F. Maleki1-5, C.Fox3, M. Nissar3, J.N. Mckenna1,2,3, P.Kelly3, M.M.Stephens4,5 Santry Sports clinic, Dublin, Ireland1, St. James Hospital, Dublin, Ireland2, Adelaide And Meath Hospital, Dublin, Ireland3, Cappagh national Orthopaedic Hospital, Dublin, Ireland4, Bons Secours Hospital, Dublin Ireland5

11.00–11.20

Coffee

Saturday 01/03/2014

Orthopaedic Session II

Time Allowed:


Chairpersons:

Mr Dermot O’Farrell, Mr Finbarr Condon & Mr Brian Lenehan

Room:

GEMS0-029

Session 7

11.20–13.15

11.20–11.27

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63. An Analysis of outcome of whiplash injury in an Irish setting E. McCabe, M. Jadaan, D. Abdallah, J.P. McCabe Department of Trauma and Orthopaedic Surgery, Galway University Hospitals, Galway, Ireland


S15

11.27–11.34

64. Systematic review and meta-analysis of closed suction drainage versus non-drainage in primary hip arthroplasty E.G. Kelly, J.P. Cashman, R. Conroy, J. O’Byrne Cappagh National Orthopaedic Hospital, Finglas, Dublin, Ireland

11.34–11.41

65. Short term outcome of uncemented total hip arthroplasty in patients with bleeding disorders K.M. Ryan, G. Colgan, J. Dowling, T. McCarthy Trauma and Orthopaedic Department, St. James’s Hospital, Dublin, Ireland

11.41–11.48

66. A prospective study of local vancomycin powder application to spinal fusion wounds. Is this practice clinically and biochemically safe in preventing wound infection? E. Murphy, A. Shafqat, G. Thong, R. Piggott, E. Rahall Department of Orthopaedics and Trauma, Galway University Hospitals, Galway, Ireland

11.48–11.54

67. Total hip arthroplasty in the very young patient under 30 years: a single surgeon series with a mean 10 year follow up P.W. Owens1,2, D.F. Lui2, S. O’Dwyer2, E. Masterson1,2 Graduate Entry Medical School, University of Limerick, Castletroy, Co. Limerick, Ireland1, Department of Trauma and Orthopaedics, University Hospital Limerick, Dooradoyle, Co. Limerick, Ireland2

11.54–12.01

68. Tip-cortical distance: assessing IM nail position in the distal femoral canal and its relation to periprosthetic fracture L.R. Carroll, A. Shafqat, J.A. Harty Department of Orthopaedics, Cork University Hospital, Cork, Ireland

12.01–12.08

69. Analysis of outcomes of kyphoplasty as a treatment for vertebral compression fractures. Review of a consecutive series with a minimum follow up of one year B. Moloney, S. Ahern, M. Jadaan, JP. McCab Spine Service, Department of Trauma and Orthopaedic Surgery, Galway and Roscommon University Hospitals Group, Galway, Ireland

12.08–12.15

70. Analysis of the recalled depuy ASR hip system M. Curtin, M. Jadaan, W. Curtin Department of Trauma and Orthopaedic Surgery, Galway University Hospitals, Galway, Ireland

12.15–12.22

71. Relationship between BMI and depth of lumbar surgical field A. Shafqat, M. Jadaan, J.P. McCabe Department of Trauma & Orthopaedics, Galway University Hospitals, Galway, Ireland

12.22–12.29

72. In-vivo measurement of spinal flexibility in idiopathic adolescent scoliosis C. Nı´ Fhoghlu´, S.A. Brennan, D. Brabazon, P. Kiely Dublin City University, Dublin 9, Ireland

12.29–12.36

73. A six year follow up of the Birmingham hip resurfacing arthroplasty B. Moloney, M. Quinn, G. Solayar, K. Kaar, W. Curtin Department of Trauma and Orthopaedic Surgery, Galway and Roscommon University Hospitals Group, Galway, Ireland

12.36–12.43

74. A ‘Hip’ Approach to revision hip surgery—3D printing in complex acetabular reconstruction A. Hughes1 P. Soden1 B. O’Donnchadha2 A. Tansey2, A. Abdulkarim3 C. McMahon4, C. Hurson1,3 Department of Orthopaedic Surgery, St. Vincent’s University Hospital, Dublin, Ireland1, Department of Mechanical Engineering, Tallaght Institute of Technology, Dublin, Ireland2, Department of Orthopaedic Surgery, Cappagh National Orthopaedic Hospital, Dublin, Ireland3, Department of Radiology, St. Vincent’s University Hospital, Dublin, Ireland4

12.43–12.50

75. The role of serial post-revision ion levels and return to normal in metal on metal hip arthroplasty R. Merchant, G.McHugh, K. Bergin, G. Mc Coy, A. Wozniak, J. Quinlan Waterford Regional Hospital and Lourdes Orthopedic Hospital, Kilcreene, Ireland

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12.50–12.57

76. A 10-year review of postoperative complications following femoral fracture fixation with the intramedullary hip screw L.R. Carroll, A. Shafqat, J.A. Harty Department of Orthopaedics, Cork University Hospital, Cork, Ireland

12.57–13.04

77. A case series of multi-drug resistant infected total hip replacements: a novel customised temporary antibiotic eluting hip spacer used in University Hospital Limerick C.M. Bowe, C. O’Connor, N.H. O’Connell, L. Power, S. Lynch, J. Queally, E. Masterson, F. Condon Department of Orthopaedic Surgery, University Hospital Limerick, Limerick

13.04–13.11

78. Radiographic assessment of anterior femoral curvature to determine its relation to age and bone health L.R. Carroll, K. Deasy, E. O’Malley, M. O’Keeffe, J.A. Harty Department of Orthopaedics, Cork University Hospital, Cork, Ireland

Saturday 01/03/2014

Anaesthesia Session

Session 8

09.00–15.10

Room:

GEMS0-028

09.00–10.40

Critical Care Vignettes Non-Invasive Ventilation for Acute respiratory Failure: B Plant Renal Replacement Therapy and SLED in ICU: L Plant Cardiovascular support in Sepsis: R Plant Antibiotics and Antifungals: D O’Brien Practical guide to Nutrition in ICU: S O’Riain Neurocritical care in a non-Specialist Setting: B O’Sullivan Paediatric resuscitation prior to transfer: C McMahon The Critically ill parturient: N Hayes

11.00–13.30

Munster Critical Care Audit Data: J Cahill and presenters from each ICU in Munster

14.00–17.00

Presentations for the O’Shaughnessy Anaesthesia Research Medal UL GEMS Anaesthesia Section Essay Prize None of the presentations / lectures involves direct trade promotional activity

Time Allowed:


Chairpersons:

Dominic Harmon

14.00–14.10

79. The ‘‘Great Ormond Street Hospital Aide Memoire Surgical Checklist,’’ — An audit of the adaption of the WHO Surgical Checklist, launched by the Safe Surgery Saves Lives campaign in 2007 F. Roberts1, A. Hughes1, I. Walker2 School of Medicine,University College Dublin, Dublin, Ireland1, Department of Anaesthesia, Great Ormond Street Hospital, London, UK2

14.10–14.20

80. An audit on vascular inpatient referrals to the pain service during a one year period in University Hospital Limerick C. McCarthy, D. Harmon Department of Anaesthesia and Pain Medicine, Limerick University Hospital, Dooradoyle, Limerick, Ireland

14.20–14.30

81. Opening statements of patients attending pain clinic consultations A. Imran, D. Harmon Department of Anaesthesia and Pain Medicine, Limerick University Hospital, Dooradoyle, Limerick, Ireland

14.30–14.40

82. Anaesthesia Websites: What patients really want? F. Kavanagh, V. Malone, O. Murphy, G.J. Fitzpatrick Department of Anaesthesia, Critical Care and Pain Medicine, AMNCH, Tallaght, Dublin 24, Ireland

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14.40–14.50

83. Selection of optimum Baska mask size in male patients, an initial study V. Alexiev1, A. Ochana2, A. Quinn3, T. Foto3, J.G. McDonnell4, J.G. Laffey5 Clinical Tutor and Clinical Lecturer1, Specialist Registrar2, Registrar3, Consultant and Senior Clinical Lecturer4, Department of Anaesthesia, Galway University Hospitals and, National University of Ireland, Galway, Ireland; and Professor, Department of Anaesthesia, St Michael’s Hospital, Toronto, and University of Toronto, Canada5

14.50–15.00

84. Severe cerebral malaria in ICU in a Dublin hospital R. Chaudhri, K. Hurley, C. Fagan Department of Anaesthesia and Intensive Care, St James’s Hospital, Dublin, Ireland

15.00–15.10

85. Outcome of Patients admitted to Intensive Care with Liver disease Dr. T. McDonnell, Dr. K. Clarkson University College Hospital Galway, Galway, Ireland

General Poster Session Friday 28th February 2014 1.

Follow up arrangements for breast cancer patients; is it appropriate to transfer surveillance to general practice? D. Kerrigan1, M. Ryan1, P.S. Waters1, J. Hanaghan2, M.Irfan1,3, W. Khan1 Department of Surgery, Mayo General Hospital, Mayo, Ireland1, Department of Radiology, Mayo General Hospital and Galway University Hospital, Mayo, Ireland2, Discipline of Surgery, Galway University Hospital, Galway, Ireland3

2.

Management of paediatric acute appendicitis in the general hospital setting — a national survey of preferred surgical technique I. Robertson, M. Costello, N. Shea, I. Khan, R. Waldron, W. Khan, K. Barry Department of Surgery, Mayo General Hospital, Castlebar, Co Mayo, Ireland

3.

The use of smartphone applications by urology trainees G.J. Nason, M. Burke, M. Akram, S. Giri, H.D. Flood Department of Urology, University Hospital Limerick, Limerick, Ireland

4.

Investigating changing patterns in chemotherapy prescribing since the introduction of oncotypedx L. Hughes, T.P. McVeigh, P.S. Waters, M. Keane, K.J. Sweeney, M.J. Kerin Discipline of Surgery, National University of Ireland, Galway, Ireland

5.

Nasogastric nutrition in severe acute pancreatitis: a systematic review and meta-analysis D. Nally, E. Kelly, M. Byrne, P.F. Ridgway Department of Surgery, Limerick University Hospital, Limerick, Ireland

6.

Endovascular management of distal renal artery aneurysms. Preservation of branches using multilayer stent R. Flaherty, M. Alawy, S. Sultan Western Vascular Institute, Department of Vascular and Endovascular Surgery, Galway University Hospital, Newcastle Road, Galway, Ireland

7.

Not so clear cut: how well does 1.5T MRI staging of prostate cancer correlate with histological staging? a single centre study P. Staunton, P. Lonergan, M. Morrin, F.Keeling, G. Smyth, R. Power Departments of Urology and Radiology, Beaumont Hospital, Dublin 9, Ireland

8.

Risk factors associated with the diagnosis of abdominal aortic aneurysm in an Irish screened population W. White1, S.M. McHugh1, P. O’Halloran1, B. Murphy2, E. Boyle1, M. Allen1,2, P. Naughton1, D. Moneley1, A. Leahy1 Department of Vascular Surgery, Beaumont Hospital, Dublin 91, Department of Surgery, Connolly Memorial Hospital, Blanchardstown, Dublin 152

9.

Treatment of abdominal aortic aneurysms in patients with total iliac occlusion M. ElKassaby, M. Alawy, M. Zaki, W. Tawfick, N. Hynes, S. Sultan Western Vascular Institute (WVI), Department of Vascular & Endovascular Surgery, College Hospital, Galway (UCHG), Newcastle Road, Galway, Ireland

10.

Electronic communication & eHealth solutions in the vascular surgery clinic J.H. Belchos1,3, M. Wheatcroft1, S. Bandali2, N. Archer2, A. McKibbon2 and M.A. Moloney1,2 Department of Vascular Surgery, St. Michael’s Hospital, Toronto, Canada1, eHealth, McMaster University, Hamilton, Ontario, Canada2, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland3

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11.

Predicting risk in breast cancer: an assessment of screening tools A. Al-Tuama1, J.C. Bolger2, T. Roche2, A.D.K. Hill2 School of Medicine, Royal College of Surgeons in Ireland, Dublin 21, Dept of Surgery, Beaumont Hospital, Dublin 92

12.

Contrast enhanced digital mammography — a useful adjuvant to digital mammography? A. McGuire, N. Relihan, D.P. O’Leary, M. Ryan, H.P. Redmond Department of Surgery, Cork University Hospital, Corcaigh, Ireland

13.

Axillary burden is higher for node-positive breast cancer patients detected by fine-needle aspiration cytology when compared with those detected by a sentinel lymph node biopsy M.R. Boland1, I. Daskalova1, Z. Al Hilli1, D. Evoy1, J. Geraghty1, J. Rothwell1, A. O’Doherty2, C. Quinn3, R.S. Prichard1, E.W. McDermott1 The Departments of Breast Surgery1, Radiology2 and Pathology3, St.Vincent’s University Hospital, Dublin 4

14.

Factors affecting time-to-theatre in 1000 cases of suspected appendicitis S. Beecher, D.P. O’Leary, R. McLaughlin Department of Surgery, University College Hospital Galway, Galway, Ireland

15.

Pre-operative levels of interleukin-6 (IL-6) and vascular endothelial growth factor (VEGF) predict higher post-operative tumour stage in colon cancer patients N.M. Foley, D. Hechtl, P. O’Leary, J.H. Wang, R.W. Pfirrman, H.P. Redmond Department of Academic Surgery, Cork University Hospital and University College Cork, Co. Cork, Ireland

16.

An international multi-centre review of the malignancy rate of excised papillomatous breast lesions N.M. Foley1, J. Racz2, T. Cil2, C. Holloway2, L. Romics3, Z. Matral4, B. Bennett1, S. Nofech-Moses5, E. Slodkowska5, L. Mallon3, M.A. Corrigan1 Breast Research Centre, Cork University Hospital, Cork, Ireland1, Department of Surgical Oncology, University of Toronto, Ontario, Canada2, Department of Breast Surgery & Pathology, Victoria Infirmary, Glasgow, Scotland3, Department of Breast and Sarcoma Surgery, National Institute of Oncology, Budapest, Hungary4, Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada5

17.

What is the role of sentinel lymph node biopsy in triple negative breast cancer Patients? A. Butt, S. O’Reilly, J. Gilmore, L. Kelly, M.A. Corrigan Breast Research Unit, Cork University Hospital, Cork, Ireland

18.

Clinician-led telephone clinic — the way forward A. Galbraith, D. Collins, B. McGovern, M.C. Whelan, C.M. Shabaz, PC. Neary, DO.Kavanagh Department of Surgery, Tallaght Hospital, Dublin, Dublin 24

19.

Pancreaticogastrostomy versus pancreaticojejunostomy post-Whipples — an audit to compare patient complication and outcome A. Hughes1, N. Linnane1, O.M Griffin2, D. Maguire1, E. Hoti1 Department of Surgery, St. Vincent’s University Hospital, Dublin1, Department of Nutrition and Dietetics, St Vincent’s University Hospital, Dublin2

20.

Ureteroscopy in a paediatric population: is it a useful tool? R. Headon, S. O’Regan, G.J. Nason, M. Burke, H.D. Flood Department of Urology, University Hospital Limerick. Medical Student, Graduate Entry Medical School, UL

21.

Percutaneous cholecystostomy — indications and outcomes in an Irish population C.W. Fitzgerald, M.K. O’Reilly, T. Geoghegan, G.P. McEntee Department of Surgery, Mater Misericordiae University Hospital, Dublin 7, Ireland

22.

Outcome of deceased donor renal transplantation in patients with an ileal conduit L.C. McLoughlin, N.F. Davis, C.M. Dowling, R.E. Power, P. Mohan, D.P. Hickey, G.P. Smyth, M.M.P. Eng, D.M. Little Department of Urology and Transplantation, Beaumont Hospital, Dublin

23.

Ex vivo reconstruction of the donor renal artery in renal transplantation: a case control study L.C. McLoughlin, N.F. Davis, C.M. Dowling, R.E. Power, P. Mohan, D.P. Hickey, G.P. Smyth, M.M.P. Eng, D.M. Little Department of Urology and Transplantation, Beaumont Hospital, Dublin

24.

An evaluation of the correlation between primary tumour and lymph node response following neoadjuvant therapy in breast cancer C. Fleming, K. McCarthy, M.J. O’Sullivan, H.P. Redmond, M.A. Corrigan Breast Research Centre, Cork University Hospital, Cork, Ireland, University College Cork, College Road, Cork, Ireland

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25.

The role of Nissen’s fundoplication in the management of GERD in patients with cystic fibrosis B Fiore1, H. Henegan1, E.F. McKone2, C.J. Gallagher2, J. Geoghegan1 Department of Hepatobiliary Pancreatic Surgery1, Department of Respiratory Medicine, St. Vincent’s University Hospital, Dublin, Ireland2

26.

Assessing the quality of online information for patients with carotid disease — an observational Study C.J. Keogh1, S.M. McHugh2, A. Hannigan1, D. Healy2, M. Clarke Moloney2, P.E. Burke2, E.G. Kavanagh2, P.A. Grace1,2, S.R. Walsh1,2 Graduate Entry Medical School (GEMS), University of Limerick, Co. Limerick, Ireland1, Department of Vascular Surgery, University Hospital Limerick, Co. Limerick, Ireland2

27.

Hematologic indices predict oncologic outcomes in colon cancer J. Hogan1, J. East2, G. Samaha2, M. Medani1, W. MacKerricher2, S. Polinkevych2, S.R. Walsh1,2, J. Calvin Coffey1,2,3 Department of surgery, University Hospital Limerick, Co. Limerick, Ireland1, Graduate Entry Medical School, University of Limerick, Co. Limerick, Ireland2, Center for Interventions in Infection, Inflammation and Immunity (4i), Graduate Entry Medical School, University of Limerick, Ireland3

28.

Case series of patients with diabetic foot ulceration in Galway University Hospitals R. Mannion1, E. Young2, D. Gallagher3, D. Walsh4, S.F. Dinneen1,5 School of Medicine, National University of Ireland Galway (NUIG), Galway, Ireland1, Merlin Park Podiatry Clinic, Galway, Ireland2, Medical Assessment Unit, Galway University Hospitals, Galway, Ireland3, Midwestern Regional Hospital, Limerick, Limerick, Ireland4, Dept. of Diabetes and Endocrinology, Galway University Hospitals, Galway, Ireland5

29.

Evolution in management of the axilla in node positive breast cancer A. Nic an Rıógh, M. McAllister, E.M. Quinn, K.J. Sweeney Department of Breast Surgery, University Hospital Galway, Galway, Ireland

30.

Predicting acute appendicitis? a prospective comparison of the alvarado score, the appendicitis inflammatory response score and clinical assessment D. Kolla´r, D.P. McCartan, M. Bourke, K.S.C. Cross, J. Dowdall Department of Surgery, Waterford Regional Hospital, Republic of Ireland

31.

White-cell-count lymphocyte ratio (WLR) is highly accurate in predicting complicated diverticulitis N.G. Wan Lin1, Hwa Jong Song1, Rishabh Sehgal1, Peter O. Leary1, John Hogan1, J.C. Coffey1,2 University Hospital Limerick, Limerick, Ireland1, 4i center for intervention in infection, inflammation and immunity, University Hospital Limerick, Limerick, Ireland

32.

Stop The Clot! an analysis of venous thromboembolism prophylaxis in general surgical patients in sligo regional Hospital R. Connolly, C. Connolly, Z. Khan Department of Surgery, Sligo Regional Hospital and School of Medicine, National University of Ireland, Galway

33.

New emergency abdominal surgery course – an exciting development M. Sugrue, P. Regan, N. Couse Clinical Research Academy, General Surgery, Letterkenny Hospital, Donegal, Ireland

34.

Inguinal hernia repair in the elderly: patient selection is key V. Chia 1, D. Hehir 2, M.J. Kerin1 Department of Surgery, University Hospital, Galway1, Department of Surgery, Midland Regional Hospital, Tullamore, Ireland2

35.

Polyp and adenoma detection rates in the proximal and distal colon. Is overall polyp detection an accurate measure of quality? C.O. ‘Toole’’, T. Coughlan’’, P. O’Byrne1 Barringtons Hospital Limerick, Graduate entry medical school University of Limerick1

Orthopaedic Poster Session Saturday 1st March 2014 1.

Metastatic transitional cell carcinoma of the tibia radiologically mimicking osteosarcoma L.P. Cunningham, B.J. O’Neill, J.F. Quinlan Orthopaedics Department, Tallaght Hospital, Dublin 24

2.

Health Technology Implementation: the need for generic template model generation in the surgical context S.P. Murphy, Z. Coyne, S. O’Regan, J. Kelly, J.C. Coffey Department of Surgery, Mid-Western Regional Hospital, Limerick, Ireland

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3.

Total Hip Replacement in patients with Haemophilia — risk of bleeding and haematoma formation K. Ryan, G. Colgan, J. Baker, T McCarthy, N Hogan Department of Orthopaedics, St James Hospital, Dublin 8

4.

A qualitative content analysis of scoliosis narratives hosted through social media websites K.M. Ryan, A. McGrath Cappagh National Orthopaedic Hospital, Finglas, Dublin 11

5.

Familial Predisposition for injury to the Anterior Cruciate Ligament Stephen Brennan1, Mr. Dermot O’Farrell MCh, FRCS (ortho)2 RCSI 4th Year Medical Student, Knockdrinna, Stoneyford, Co. Kilkenny, Ireland1, The Regional Orthopaedic Hospital, Croom, Co. Limerick, Kilkenny, Ireland2

6.

The impact of an educational intervention on the generic prescribing rate in an orthopaedic department F. Roche, S. Carolan, L.P. Cunningham, B. Suleiman Institute of Leadership, RCSI, Reservoir House, Ballymoss Road, Sandyford, Dublin 18. Trauma and Orthopaedics Department, Tallaght Hospital, Dublin 24

7.

Lag Screw Cut Out: Assessing Tip-Apex Distance and A Calcar-Referenced Tip-Apex Distance L.R. Carroll, M. Athar, A. Shafqat, J.A. Harty Department of Orthopaedics, Cork University Hospital, Cork, Ireland

8.

Systematic review of complications in spinal surgery: a comparison of retrospective and prospective study design C.L. Power1, S. Henari1,2, J. Street3, B. Lenehan1,2 University of Limerick Graduate Entry Medical School, Co. Limerick, Ireland1, Department of Surgery, University Hospital Limerick, Co. Limerick, Ireland2, Department of Surgery, CNOSP Vancouver General Hospital, University of British Columbia, Vancouver, Canada3

9.

The effect of cement, bone and blood on surgical gloves A.R Moriarity, A Abdulkarim, E Sheehan Department of Orthopaedics, Midland Regional Hospital, Tullamore, Ireland

10.

Limb-sparing surgery using ringed polytetrafluoroethylene (PTFE) grafts for vascular reconstruction following excision of soft tissue sarcoma in the lower extremity A.Cullen1, S.Sheehan2, S.Dudeney1 Department of Trauma and Orthopaedic Surgery1, Department of Vascular Surgery, St Vincent’s University Hospital, Elm Park, Dublin 42

11.

Radiation safety knowledge and practices among orthopaedic trainees M. Nugent, O. Carmody, S. Dudeney Cappagh National Orthopaedic Hospital, Finglas, Dublin 11

12.

The use of diathermy in orthopaedic surgery: How safe is the tip? A.R. Moriarity, P. Coffey, A. Abdulkarim, E Sheehan Department of Orthopaedic Surgery, Midland Regional Hospital, Tullamore, Ireland

13.

Multiple trauma case requiring multiple surgical disciplines — an example of successful management S. Casey1, A. McKenna1, O. Shelley1, B. Mehigan2, T. McCarthy3 Dept. of Plastic Surgery, St James’s Hospital, St James’s Street Dublin 81, Dept. of Colorectal Surgery GEMS Directorate, St James’s Hospital, St James’s Street Dublin 82, Dept. of Orthopaedic and Trauma Surgery OMEGA Directorate, St James’s Hospital, St James’s Street Dublin 83

14.

Resection and Reconstruction of Soft Tissue Sarcomas with Major Vascular Involvement N.P. McGoldrick1, J.S. Butler1, S. Sheehan2, S. Dudeney1, G.C. O’Toole1 National Sarcoma Service, Department of Trauma & Orthopedic Surgery, St Vincent’s University Hospital, Elm Park, Dublin 41, Department of Vascular Surgery, St Vincent’s University Hospital, Elm Park, Dublin 42

15.

Facebook as a source of information on common orthopaedic procedures - a quality analysis N.P. McGoldrick, J.F. Baker, D.P. Byrne, T. McCarthy Department of Orthopaedics & Trauma Surgery, St James Hospital, Dublin 8, Ireland

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Anaesthesia Poster Session Saturday 1st March 2014 16.

Post thoracotomy pain originating from costo-transverse joints; diagnosis and treatment C. McCarthy, D. Harmon Department of Anaesthesia and Pain Medicine, Limerick University Hospital, Dooradoyle, Limerick, Ireland

17.

Herpes infection over intrathecal pump reservoir-case report Dr. J. Riordan, Dr. J. Stow, Dr. S. Subani, Dr. P. Murphy, Dr. D. O’Keeffe Department of Anaesthesia & Pain Medicine, St Vincent’s University Hospital, Elm Park, Dublin 4, Ireland

18.

Ischaemic hand pain increased during haemodialysis: management by median nerve catheter J.M. Vinagre, C.J. Skerritt, D.C. Harmon Department of Anaesthesia and Pain Medicine, University Hospital Limerick, Dooradoyle, Limerick, Ireland

19.

A Survey of Chronic Pain Patients’ Experiences in the Emergency Department G. Fitzpatrick, S.O. Chonaile, D. Harmon Department of Anaesthesia and Pain Medicine, Limerick University Hospital, Dooradoyle, Limerick, Ireland

20.

The use of local anaesthetic infusion techniques in a university teaching hospital A.M. Kiernan, K. Doody, A. Burgess, M. Merrick, D. Harmon Department of Pain Medicine, University Hospital Limerick, Dooradoyle, Limerick, Ireland

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Ir J Med Sci (2014) 183 (Suppl 1):S1–S69 DOI 10.1007/s11845-013-1062-3 Ó Royal Academy of Medicine in Ireland 2014

1. Surgical management of great saphenous varicosities: a meta-analysis N.P. Lynch 1, M Clarke2, G Fulton1 Department of Surgery, Cork University Hospital, Wilton Cork, Ireland1, Postgraduate Research Faculty, Royal College Of Surgeons Ireland, Dublin, Ireland2 The purpose of this systematic review and meta-analysis is to synthesize the available evidence of randomized controlled trials comparing endovenous laser therapy (EVLT) to traditional open surgery for the treatment of great saphenous vein (GSV) varicose veins in terms of clinical effectiveness, patient satisfaction and complications. Online databases MEDLINE, CINAHL, EMBASE and the Cochrane library were searched to identify eligible studies. All randomized controlled trials comparing EVLT to HLS that used ultrasound examination as an outcome measure and had follow up of one year or more were included. Pooled risk ratios with 95 % confidence intervals were used as the measure of effect for each dichotomous outcome. Eight eligible publications relating to six randomized controlled trials were identified. The clinical efficacy of EVLT is comparable to that of surgery in the relatively short follow up period described in the studies. Meta-analysis of the data concerning post operative assessment by color duplex ultrasonography shows a trend towards higher risk of ultrasound recurrence after EVLT at 12 months (RR, 2.38; 95 % CI, 0.68-8.3; I2 = 56.6 %). Quality of life questionnaires reveal similar outcomes for EVLT and surgery. There is low quality evidence to suggest surgery is associated with more pain, sensory complications and infection. There is some weak evidence to suggest that EVLT has a higher risk of ultrasound detected recurrence at 12 months following treatment compared to open surgery. However it may be associated with less sensory complications, pigmentation and infection. There is significant heterogeneity in the studies which precluded meta-analysis in some cases. Conflicts of interest: None Disclosures: None

2. Breast cancer diagnosis: a retrospective cohort study to derive a clinical prediction rule for breast cancer and prospective validation of this rule in an Irish cohort D.P. Joyce, R. Galvin, E. Downey, A.D.K. Hill Department of breast surgery, Beaumont Hospital, Dublin 9, Ireland Introduction: The number of referrals to symptomatic breast units (SBU) in Ireland has increased substantially in recent years. However this exponential increase in referrals has not translated to a corresponding increase in diagnoses, which have remained stable. Clinical prediction rules (CPR) are tools that quantify the contribution of the history, physical examination and diagnostic tests in the diagnosis of medical conditions. They allow clinicians to stratify patients according to the probability of having a target disorder.

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Aims and objectives: The aim of this study is to derive and validate a new breast cancer CPR in an Irish population. We will attempt to identify a threshold score for urgent referral to the SBU. In addition we aim to identify a group of patients who may avoid referral. Methods: We carried out a retrospective cohort study using routinely collected data from the Beaumont Hospital SBU database over a two year period. Patients were divided into a derivation cohort and a validation cohort. A CPR for breast cancer was calculated using univariate and multivariate analyses. Logistic regression and receiver operation characteristics curves were used for discrimination analysis. Results: We identified age greater than 60 years, presence of a breast lump, nipple changes and nipple discharge as being independently associated with increased odds of having breast cancer. We derived a CPR based on these variables. The maximum attainable score was 12. A threshold score of 5 for discrimination between high and low risk patients was chosen based on the significant increase in odds ratio for this score. The overall discriminative performance of the rule was confirmed using ROC curve analysis which indicated 76 % overall accuracy. ConclusionThe CPR that we have derived and validated has a high level of predictive accuracy and may therefore be a valuable clinical tool for application in a general practice setting. Conflicts of interest: None Disclosures: None

3. Investigating the importance of variants at 12p11, 12q24 and 21q21 in breast cancer in the west of Ireland T.P. McVeigh, U.M. McVeigh, N. Miller, K.J. Sweeney, M.J. Kerin Discipline of Surgery, National University of Ireland, Galway, Ireland Introduction: A large genome-wide association study found that novel breast cancer susceptibility loci at 12q24 (rs1292011); 12p11 (rs10771399) and 21q21 (rs2823093) were associated with breast cancer in women of European ancestry. The aim of our study was to investigate the prevalence of variants at these three loci in a specific Irish subpopulation, and to examine the association between these variants and breast cancer in this cohort. Methods: Blood samples were collected from patients from the West of Ireland with breast cancer (cases), as well as from healthy female controls. DNA was extracted from these samples using a salting out method. Genotyping was then performed using a custom Taqman assay, and the process repeated for each target. The Hardy–Weinberg test of equilibrium was performed for each target. Results: A total of 1639 samples were genotyped, including 1191 cases and 448 controls. The variant at 21q21 was found to be out of H–W equilibrium (X2 = 6.01), and the variant at 12p11 borderline (X2 = 3.53). Sixty-nine per cent of breast cancer cases demonstrated at least one copy of the variant at 12q24 compared to 72 % controls (p = 0.426, X2). There was no difference in the prevalence of the variant across molecular subtype, grade or stage. Conclusion: All three genetic variants were detected in the population in the west of Ireland. However, the observed frequency of two of the variants was far below that expected. This finding reflects genetic heterogeneity even within continents, and highlights the need for population-specific investigation for potential disease-causing variants. Conflict of Interest: Nil Disclosures: Nil


4. Activated systemic inflammatory response at diagnosis reduces lymph node count in colonic carcinoma Brenda Murphy, Rory Kennelly, Hamad Yousef, Brian Mehigan, Paul McCormick Department of Colorectal Surgery, St James Hospital, Dublin 8, Ireland Prognosis following colon cancer surgery improves with higher lymph node yields. This has been attributed to superior surgical technique and excellence in pathology. However, in an era of subspecialty training, the variance in lymph node yields cannot be fully explained thus. Pre-operative elevated markers of systemic inflammation also affect prognosis, probably explained by an immunogenic response to cancer. We hypothesise that lymph node counts, lymph node metastasis and systemic inflammatory response (SIR) are linked. A prospectively maintained database was interrogated. All patients undergoing curative colonic resection over a five year period were included. Neutrophil lymphocyte ratio (NLR) and albumin were used as markers of SIR. NLR C 4, Albumin \ 35 was used as cut off points for SIR. 316 patients underwent surgery. 14 were excluded due to incomplete data. 195 patients had NLR \ 4 and 107 had NLR C 4. There was no difference in age, sex or disease stage between groups. Patients with NLR of C 4 had lower mean lymph node yields (17.6 ± 7.1 vs. 19.2 ± 7.9 (P = 0.036)). A significant correlation was found between NLR and numbers of positive nodes (R2 = 0.15 P = 0.011) and lymph node ratio (R2 = 0.15 P = 0.01). There was no correlation between albumin and lymph node count, lymph node ratio or lymph node metastasis. Prognosis in colon cancer is linked to the patient’s immune response. Lymph node count is reduced when SIR is activated. Lymph node metastases and higher lymph node ratios are more likely in patients with elevated NLR. Conflict of Interest: The authors state no conflict of interest. Disclosures: The authors have no disclosures to make.

5. Early post-operative removal of urethral catheter in patients undergoing colorectal surgery with epidural analgesia—a single-centre prospective randomised controlled clinical trial D. Coyle, K. Joyce, J.T. Garvin, M. Regan, O.J. McAnena, P. Neary, M.R. Joyce Department of Surgery, University College Hospital, Galway, Ireland Post-operative epidural analgesia (POEA) is associated with faster return to bowel function and better pain scores than parenteral opiates after colorectal surgery, but may be associated with higher risk of post-operative urinary retention (POUR). Delayed removal of urethral catheter (UC) in patients receiving POEA following colorectal surgery is, however, associated with an increased risk of UTI and impairs mobility. We aimed to determine if early postoperative removal of UC in patients undergoing colorectal surgery with POEA was associated with a higher incidence of POUR. A

S23 prospective randomized controlled clinical trial was undertaken. Eligible patients were assigned to either an experimental study arm, SG1 (UC removed 48 h post-operatively), or to a control arm, SG2 (UC removed following cessation of POEA). Rates of POUR, urinary tract infection (UTI), pulmonary complications and surgical site infection (SSI) were recorded. Forty-one patients were recruited (SG1: n = 17; SG2: n = 24). POUR developed in 3 males (23 %) in SG1 and 2 males (22.2 %) in SG2. No females were affected by POUR. Males in SG1 were not at significantly increased risk of POUR compared to those in SG2 (R.R 1.05, p = 1). No patient developed UTI post-operatively. SG1 and SG2 had similar rates of pulmonary complication (SG1: n = 2; SG2: = n = 3, p = 0.233) and SSI (SG1: n = 5; SG2: n = 3, p = 0.105). Removal of UC at 48 h post-operatively in selected patients receiving POEA following colorectal resection was not associated with increased risk of POUR compared to conventional practice and thus may further facilitate enhanced recovery following colorectal surgery. Registration Number: NCT01508767 (http://www.clinicaltrials.gov) Conflict of interest: None declared Disclosures: None declared

6. Endovascular versus open repair of ruptured abdominal aortic aneurysm: report from an Irish vascular centre T. Aherne1, S. McHugh1,2, J. Byrne1, T. Goetz2, E.M. Boyle1,2, M. Allen1, A. Leahy1, D. Moneley1, P. Naughton1 Department of Vascular Surgery, Beaumont Hospital, Dublin 9, Ireland1, Royal College of Surgeons in Ireland, 123 St. Stephens Green, Dublin 2, Ireland2 Introduction: Endovascular aneurysm repair (EVAR) is a comparatively less invasive technique than open repair (OR). Debate remains with regard to the benefit of EVAR for patients with ruptured abdominal aortic aneurysm (RAAA). We sought to evaluate and report outcomes of EVAR for RAAA in an Irish tertiary vascular referral centre. Methods: Patients undergoing emergency surgery for ruptured or symptomatic AAA were identified from theatre logbooks and HIPE database. Retrospective chart review was undertaken. Data were exported to SPSS version 20 for statistical analysis with p \ 0.05 considered significant. Results: A total of 54 patients underwent emergency AAA surgery during the time period. Of these 36 (66.7 %) underwent EVAR with the remaining 18 (33.3 %) repaired open. Overall mortality rate in those undergoing EVAR was 25 % (n = 9/36), compared with 38.9 % (n = 7/18) in those undergoing open surgery. In those undergoing EVAR, 44.4 % required ICU stay compared with 72 % of those undergoing OR. With regard to prognostic indicators of patient outcome, increasing patient age was noted to be significantly associated with increased mortality (p = 0.021), as was increased ASA score at time of surgery (p = 0.008). Conclusions: Endovascular aneurysm repair is an acceptable approach in patients presenting with RAAA. Increasing age and ASA score are significant predictors of mortality in patients with RAAA undergoing intervention. Conflict of interest: None Disclosures: None

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7. Frequency of pathogenic variants in known susceptibility genes in the Irish familial breast cancer population

Conflicts of interest: None Disclosures: None

F. Aloraifi1,2,3, J. McGreevy1,2,3, T. McDevitt1,2,3, A. Green1,2,3, A. Bracken1,2,3, J. Geraghty1,2,3

8. 1000 Laparoscopic bowel resections: standardised techniques yield standard outcomes

Department of Smurfit Institute of Genetics, Trinity College Dublin, Dublin, Ireland1, Department of National Centre for Medical Genetics, Our Lady’s Children’s Hospital, Crumlin, Dublin, Ireland2, Department of Surgery, St Vincent’s University Hospital, University College Hospital, Dublin, Ireland3

M. O’Sullivan, M. Whelan, N. Fearon, D. Collins, D. Buckley, P. Neary

Breast cancer is the leading cause of cancer deaths in females worldwide occurring in both hereditary and sporadic forms. Women with inherited pathogenic mutations in the BRCA1 or BRCA2 genes have up to an 85 % risk of developing breast cancer in their lifetimes. These patients are candidates for risk reduction measures such as intensive radiological screening, prophylactic surgery or chemoprevention. However, only about 20 % of familial breast cancer cases are attributed to mutations in BRCA1 and BRCA2, while a further 5-10 % is attributed to mutations in other rare susceptibility genes such as TP53, ATM and CHEK2 1. Despite extensive efforts to explain the missing heritability of this disease, the majority of familial clustering in breast cancer remains largely unexplained. Importantly, mutations in rare susceptibility genes have shown significant population variability. In this present study, we applied high-throughput sequencing of known breast cancer susceptibility genes to screen a cohort of 104 high-risk, non-BRCA1/BRCA2 (BRCAx) Irish hereditary breast cancer cases and 101 geographically matched controls. We identified germline heterozygous pathogenic mutations in several known susceptibility genes, such as ATM (* 5 %), RAD50 (* 3 %), CHEK2 (* 2 %), PALB2 (* 1 %), and TP53 (* 1 %); accounting for 12 % of the Irish BRCAx cohort. To the best of our knowledge, this is the first time full sequencing of the above genes has been tested the familial breast cancer Irish population. Taken together, this study provides proof of principle to implement sequencing of selected gene panels for hereditary breast cancer testing in clinical practice.

A number of case series and prospective randomised trials have documented the safety and efficacy of laparoscopic colectomy for a variety of colorectal pathology, including cancer. The use of a standardised approach allows for comparisons across institutions and is replicable in other centres. A retrospective analysis was performed on a consecutive series of laparoscopic resections performed in Tallaght Hospital using a standardised laparoscopic technique and enhanced recovery pathway. Patients were assessed for operation type, indication for surgery, rate of conversion to open, complications, duration of stay and readmission within 30 days. Over 1000 (n = 1003) consecutive colorectal resections were identified between March 2005 and March 2013. The age range of the patients was 16-89 years. Resections comprised of anterior resections 43 % (n = 435), right hemicolectomy 17 % (n = 170), left hemicolectomy 10 % (n = 103), sub-total colectomy 5 % (n = 49), abdomino-perineal resection 2 % (n = 19), J pouch 2 % (n = 19) and others including ileocecectomy, jejunal resection and proctectomy. The indications for surgery were colorectal neoplasia, diverticular disease; inflammatory bowel disease. The rate of conversion to open was: 12.66 % Length of stay and complication rates were comparable to international standards. This study validates previously published data with regards to standardised approach to laparoscopy within an enhanced recovery programme. Conflict of Interest: None

Department of Colorectal Surgery, Tallaght Hospital, Dublin 24, Ireland

1,2

Irish Figures

International Figures

Gene Name

BRCAx Healthy Relative risk Cases Controls (RR) (95 % (n = 104) (n = 101) confidence intervals)

Frequency of familial breast cancer (%)

Lifetime risk of developing breast cancer in women, % (RR)

9. HOXC11 impacts steroidal adaptability in aromatase inhibitor resistance by upregulating the androgen receptor

ATM

5

0

2.02 (1.76 – 2.32)

2

20 (2.3)

RAD50

3

0

2.00 (1.74 – 2.96)

0.5

(4)

A. Ali1,3, F. Bane1, Y. Hao2, D. McCartan1, P. O’Gaora2, A.D.K. Hill1,3, L.S. Young1, M. McIlroy1

CHEK2 2

0

1.99 (1.73 – 2.28)

2

20 (2.0)

TP53

1

0

1.98 (1.72 – 2.27)

0.1

80-90 (10-20)

PALB2

1

0

1.98 (1.72 – 2.27)

0.4

20 (2.0)

Table 1. Pathogenic variants detected in Irish BRCAx cases and controls. Fisher’s Exact test was used to calculate relative risk. References: 1. Lalloo, F. & Evans, D. G. Familial breast cancer. Clin. Genet. 2012; 82:105–14. 2. Tommiska, J. et al. Evaluation of RAD50 in familial breast cancer predisposition. Int. J. Cancer. 2006, 118: 2911–6.

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Endocrine Oncology Research Group, Royal College of Dublin, Dublin 2, Ireland1, School of Medicine and Medical Sciences, University College Dublin, Dublin 4, Ireland2, Department of Surgery, Beaumont Hospital, Dublin, Ireland3 Aromatase Inhibitors (AI) are the gold-standard treatment of postmenopausal breast cancer. They inhibit the conversion of androgens to estrone by cyp 19 thereby blocking ligand-dependent activation of the estrogen receptor. Research from our lab has identified the homeobox protein, HOXC11, as an indicator of poor response to endocrine therapy and metastases development (1). We aim to investigate role of the HOXC11 target gene prosaposin (PSAP) in aromatase inhibitor resistance and assess the impact of PSAP and Androgen Receptor (AR) on clinical outcome. RNA-sequencing was performed to identify HOXC11 target genes in endocrineresistant breast cancer. Molecular biology techniques were used to


S25

validate these findings. Statistical analysis (STATA10) was used to ascertain the impact of these genes on survival rates in a cohort of breast cancer patients (n = 488). Results show that PSAP is the most significant target gene regulated by HOXC11. PSAP upregulates AR (mRNA and protein level). Treatment with anti-androgen reduced cell proliferation and motility in AI resistant cells. Survival analysis of breast cancer patients (n = 488) indicates that protective influence of AR is lost in AI treated patients. In conclusion, HOXC11 upregulates PSAP which promotes AR expression in AI resistance. This elucidates a novel mechanism enabling tumour utilization of androgens for cell proliferation. AR normally has a protective effect on breast cancer, however, in the AI treated population this is lost. Thus androgen antagonists (Bicalutamide) could have efficacy in treating refractory disease either alone or in combination with PI3K inhibitors/GPR37 blockers. Serum secreted PSAP as potential companion diagnostic. References:

Using DFO as a model drug we have shown the ability to bring about a stimuli-responsive release of an efficacious pro-angiogenic agent, which we propose as an adjunct in the treatment of CLI. Conflict of interest: None

1. McIlroy M, McCartan D, Early S, O’Gaora P, Pennington S, Hill A, Young L. Cancer Res.2010; 70(4);1585-94

Vascular endothelium is an important target of cadmium (Cd) toxicity. It was noticed that exposure to Cd can alter the expression of VE-cadherin and VEGF, molecules essential for angiogenesis. In this study, we examine vascular development, following Cd treatment, in the chick extra-embryonic membrane using methods based on fractal analysis of vascular patterns measured from digitally acquired images. Embryos incubated for 60 h to stage 16-17 were explanted according to Dugan’s method and treated with 50lL of 50 lmol CdAc vs. Na Ac. Images of the embryos were subsequently captured at 4, 8, 24 and 48 h after treatment, processed (i.e., converted into 8 bit format, binarized and skeletonized) and analyzed quantitatively by calculating the fractal dimensions corresponding to various vascular patterns. Additionally, the corresponding vascular density was measured using a method based on counting intersections between vascular network image and a square grid overlay. The fractal dimension in the Cd treated group was reduced consistently when compared with the control group. Vascular density was also decreased at all time-points in the Cd-treated group when compared with controls. Our results demonstrate that Cd exposure clearly impairs vascular development by reducing both the vascular branching pattern (as reflected by the corresponding fractal dimension) and the vascular density, accordingly. This study demonstrates the feasibility of using fractal-based analysis methods to quantify the extent of impairment of vascular development following exposure to toxic agents, such as Cd, in a time-dependent manner. Conflict of interest: none Disclosure: none

Conflicts of interest: None Disclosures: None

10. Stimuli responsive release of small molecule drugs from thermosensitive liposomes within a hydrogel depot: a novel drug delivery system for multiple pro-angiogenic agents. C.C. Herron1, H. O’Neill1, A. Lo´pez-Noriega1, C.L. Hastings1, C.O. McDonnell2, G.P. Duffy1 Tissue Engineering Research Group, Department of Anatomy, Royal College of Surgeons in Ireland, Dublin 2, Ireland1, Department of Vascular Surgery, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland2 Chronic, critical limb ischaemia (CLI) represents a severe manifestation of peripheral arterial disease. Revascularisation procedures are invasive and carry significant risk of morbidity. Therapeutic angiogenesis involving the use of drugs, stem cells and growth factors may be a potential alternative. In order to mimic the complexity of the angiogenic process, treatments must be given in a manner that allows for spatio-temporal and controllable release. Liposomes are artificially-prepared vesicles with lipid bilayers which can be used as a vehicle for drug delivery. Thermosensitive liposomes were encapsulated with 100 lM of desferrioxamine (DFO), a pro-angiogenic agent. The liposome/DFO complexes were loaded into a chitosan/b-glycerophosphate gel, which acts as a biological depot.The same concentration of free DFO was free-loaded into the gel. Dual release of DFO was possible via the diffusion of the free loaded drug through the hydrogel and secondly via the application of a hyperthermic pulse to disrupt the liposomes and release encapsulated DFO. 90 % of the free loaded DFO was released from the gel over the first 4 days. Following a heat pulse to 42 °C at day 6 a second peak of drug release was possible via disruption of the liposomes and release of their DFO. This corresponds to a 2-fold increase in drug release compared to control. In gels containing liposomal DFO alone we illustrated an ability to control and bring about a 15 % increase in drug release as late as day 12.

11. Fractal analysis of the chick extra-embryonic angiogenesis following cadmium exposure A. Kaskova-Gheorghescu1, N.V. Buchete2, J. Thompson1 School of Medicine and Medical Science, University College Dublin, Belfield, Dublin 4, Ireland1, School of Physics and Complex and Adaptive Systems Laboratory, University College Dublin, Belfield, Dublin 4, Ireland2

12. Secretion of exosome-encapsulated oncomiRs by colorectal cancer cells in vitro C. Clancy, M.R. Joyce, M.J. Kerin, R.M. Dwyer Discipline of surgery, School of medicine, National University of Ireland, Galway Dept of Colorectal Surgery, University College Hospital Galway, Galway, Ireland Introduction: Colorectal cancer is the 4th most common cause of cancer related mortality worldwide and the processes leading to tumour growth and metastasis are poorly understood. Lipid vesicles

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S26 known as exosomes which contain microRNA are secreted by cancer cells. Exosomes play a role in intercellular communication and are known to exert tumorigenic effects but the mechanism remains unclear. The aim of this study is to identify exosome-encapsulated microRNAs secreted by colorectal cancer cells in vitro. Methods: Two colorectal cancer cell (CCC) lines were cultured in exosome free media. Conditioned media containing all secreted factors was harvested at 48 h. Exosomes were isolated by differential centrifugation, microfiltration and ultracentrifugation. Transmission electron microscopy (TEM) was used to visualise exosomes. Protein extraction and western blot targeting exosome associated proteins was performed. MicroRNA was extracted using the mirVanaTM kit. MicroRNA array analysis was performed following verification of the quality of RNA using an Agilent Bioanalyzer. Results: Exosomes secreted by CCCs were successfully isolated. TEM confirmed the presence of lipid vesicles 40-100 nm in diameter. The presence of exosome associated marker CD63 was confirmed by western blot. Exosome extracts were confirmed to contain microRNAs. Array analysis revealed 401 microRNAs identified in HCT116 secreted exosomes and 416 in HT29 secreted exosomes. 345 microRNAs were common to exosomes from both cell lines. A subset of exosome-encapsulated miRNAs identified have an established role in colorectal cancer (miR-200c, miR-155, miR-135) Conclusions: CCCs actively secrete exosome-encapsulated miRNAs. These miRNAs may play an important role in colorectal cancer initiation, progression and metastasis. The authors have no disclosures or conflicts of interest to declare

Ir J Med Sci (2014) 183 (Suppl 1):S1–S69 silicone as a test material and thus validate their use in future testing. Additional testing will be carried out using other commercially available stent grafts in the idealised AAA models. Subsequently, the study will be repeated using patient specific silicone models. This study highlights the need for safe, reliable non-invasive monitoring in order to significantly reduce re-intervention rates. References: 1. Schwarze ML, Shen Y, Hemmerich J, Dale W. Age-related trends in utilization and outcome of open and endovascular repair for abdominal aortic aneurysm in the United States, 2001-2006. J Vasc Surg. 2009; 50(4):722-9. e2. 2. Corbett T, Molony D, Kavanagh E, Grace P, Walsh M, McGloughlin T. Experimental Analysis of Endovascular Treatment of AAA and Predictors of Long Term Outcomes Conflict of interest: None Disclosures: None

14. M1 polarised macrophages develop a endotoxin tolerance-like phenomenon in response to bacterial stimulation N.M. Foley, J.H. Wang, H.P. Redmond Department of Academic Surgery, Cork University Hospital, Co. Corcaigh, Ireland

13. Quantifying migration of a commercially available endovascular stent graft in an environment that is representative of the physiological state B. Lynch1, J. Nelson2, T.M. McGloughlin1 Centre for Applied Biomedical Engineering Research (CABER), Dept of Mechanical, Aeronautical and Biomedical Engineering and The Material and Surface Science Institute (MSSI), University of Limerick, Co. Limerick, Ireland1, Dept Electronic and Computer Engineering, University of Limerick, Co. Limerick, Ireland2 More than 50 % of all abdominal aortic aneurysms (AAA’s) are now treated by Endovascular Aneurysm Repair (EVAR) in the United States. Migration is an issue for all types of endografts and its prevalence has a significant range in literature. Studies have reported an increase after 24 months in the occurrence of device migration and this remains one of the greatest clinical challenges for long term EVAR performance A test rig has been constructed that produces a physiological aortic flow loop which allows the recreation of any aortic waveform with realistic flow and pressure conditions. The AAA model dimensions were taken from the EUROSTAR database. A Medtronic AneuRx stentgraft was employed and the key measurement of migration was defined as 5 mm of distal movement. The force required to cause the stent graft to distally displace [ 5 mm is measured by a motorised force gauge. The force required to displace the Medtronic AneuRx stent graft was 8.05-11.01 N which are comparable to those found in the literature (8.03-9.38 N) These comparable results endorse the functionality of the test rig construction in examining migration forces and support the use of

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Introduction: Macrophages, an important component of immunity, are divided into subpopulations based on their functional phenotypes. M1 and M2 macrophages have different inflammatory mediators and phagocytic profiles. Aims 1. To establish a predominant M1and M2 polarisation pattern in vitro. 2. To examine the inflammatory cytokine response to bacterial stimulation in polarised cells. 3. To determine the phagocytic activity in polarised cells after stimulation with bacteria. Methods: Peritoneal and bone marrow derived macrophages were harvested from C57BL/6 mice. The cells were exposed to polarising stimuli for 18-24 h. LPS and IFN-c were used to induce M1 and IL-4 was used to induce M2. ELISA was performed on the supernatant to confirm the M1 and M2 phenotypes. Polarised cells were further stimulated with heat-killed S. aureus or FITC-labeled E coli. Inflammatory cytokine production and phagocytosis were assessed by ELISA and FACScan analysis. Results: M1 macrophages were characterised by high levels of TNFalpha and IL-12p70. M2 macrophages were characterised by high levels of TGF-beta and low levels of IL12p70. The M1 polarized marophages, when exposed to gram-positive bacteria, had lower levels of TNF-alpha than the M2 macrophages. Phagocytosis assays revealed similar results for both M1 and M2 macrophages. Conclusion: M1 macrophages are expected to produce higher levels of TNF-alpha, however we found that M1 macrophages exposed to bacterial stimulation had lower levels of TNF-alpha compared with their M2 counterparts. This unexpected result indicates a tolerisation effect developed during the M1 polarisation, and further work is required to clarify the underlying mechanism(s). There is no disclosure and no conflict of interest to declare


15. Targeting of TSG101 may provide a putative pathway to prevent exosomal communication in Triple negative breast cancer tumours Shiva Sharma1,2, Luke Gubbins1,2, Christian Cawley1,2, Jeremy Simpson3, Malcolm Kell4, Amanda McCann1,2 UCD School of Medicine and Medical Science, Dublin, Ireland1, UCD Conway Institute for Biomolecular and Biomedical Research, Dublin, Ireland2, UCD School Of Biology & Environment Science, Dublin, Ireland3, Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland4 Introduction: TSG101 is an essential protein and constituent of cellular function as it is involved in the sorting and trafficking of cell components destined for release by cells. TSG101 has also been identified as a fundamental protein in the relatively novel field of exosomes, which are small nano-vesicles released by all cells but has garnered much interest in the field of cancer biology. Much interest in exosomes has been in its ability to carry information to the surrounding tumour microenvironment and to distant sites. Limited information is known about TSG101 and exosomes in the field of breast cancer and even less in the field of the difficult to treat subset of Triple Negative Breast Cancer (TNBC). We propose that TNBC tumours demonstrating high levels of TSG101 are more likely to recur locally and at distant sites due to enhanced exosome mediated communication in the tumour microenvironment. Materials and methods: We set out to elucidate if TSG101 levels are differentially expressed in the TNBC cell lines MDA-MB-231 and BT-549 through Western Blot analysis in response to cellular stresses in the form of hypoxia and Paclitaxel treatment. Tumour-derived exosomes (TEx) were harvested from cell culture and analysed using Nanosight technology to characterise the size and number of exosomes produced from cell lines. Results: When the TNBC cell lines BT-549 and MDA-MB-231 are treated with the common chemotherapeutic agent Paclitaxel (TaxolÓ) we observe that cell viability deceases in the BT-549 while the MDAMB-231 line shows less sensitivity. When treated Taxol TSG101 levels steadily decrease in the BT-549, while in the MDA-MB-231 line levels remain stably expressed. The autophagic protein LC3II showed no change in the BT-549 line after Taxol treatment while in MDA-MD-231 LC3II levels were decreased corresponding to less autophagic cell death. When we performed an siRNA knockdown of TSG101 we noted that less exosomes were released compared to the scramble control group on Nanosight profiling. Conclusion: We conclude that TSG101 is differentially expressed in the TNBC in vitro and that expression levels are influenced by Taxol treatment. We also conclude that siRNA knockdown of TSG101 impedes the release of exosomes. We suggest that TNBC tumours that clinically express high levels of TSG101 may potentially provide a mechanism for the dissemination of malignant phenotypes.

16. The mesenteric organ—a novel source of fibroblasts in benign and malignant colorectal disease

S27 Materials and Surface Science Institute and Stokes Institute, University of Limerick, Co. Limerick, Ireland3 Purpose: Although fibroblasts (FBs) are key cellular mediators of gastrointestinal fibrosis their origin remains unknown. Our recent work identified FBs in a connective tissue lattice within the mesenteric organ (MO). The aims of this study were to 1) harvest, and 2) characterize them. Methods: A novel technique was developed based on the harvest of MO mesothelium in both benign and malignant colorectal resections. From these, a single mesothelial cell suspension was prepared and cultured ex vivo. FBs emerged early in culture and were identified using IF and confocal microscopy. Adhesive and proliferative cellular characteristics were established using a Real Time Cell Analyzer (RTCA, xCELLigence) machine. FBs were also transfected with a plasmid encoding the SV40 T antigen in order to immortalize cells and the above experiments repeated. Results: A summary of the study cohort is provided in Table 1. There was no difference in adhesion rates between FBs from benign (i.e. Crohn’s disease) and malignant conditions. Mesenteric FBs derived from younger patients (\ 50 years) proliferated faster than those from older patients ([ 50 years) in both benign and malignant settings (P \ 0.0001). FBs from younger patients with malignant conditions proliferated faster and reached confluency quicker (P \ 0.0001) than FBs from similar age patients with benign disease. Of note the proliferation rates of malignant FBs closely resembled that of transfected FBs. Transfected FBs both adhered and proliferated quicker than nontransformed FBs from the same patients (P \ 0.0001). Conclusions: The MO is a novel source of FBs that can be expanded ex vivo, immortalized and characterized. Mesenteric FBs from younger patients adhered and proliferated quicker than those from older patients, irrespective of the original pathology. Mesenteric FBs from malignant settings differed significantly in properties compared with those from benign conditions. Table 1. Study Cohort and Demographics Patient & study Characteristics Number of patients, n

20

Male/Female (%)

13 (65)/7 (35)

Median age (IQR), years

65 (53-76)

Operations, n - Benign

6 (Crohn’s disease x4, diverticular x1, appendicular mass x1) 14

- Malignant Site where mesentery harvested, n (%) - TI

4 (20)

- Ascending colon

5 (25)

- Sigmoid colon

11 (55)

17. Vitamin K derivatives inhibit the growth and proliferation of triple negative breast cancer cells

S.M. Sahebally1,2, M.G. Kiernan1, C. Dunne1, P.A. Kiely3, J.C. Coffey1,2 4i Centre Graduate Limerick, Limerick,

for Interventions in Inflammation, Infection and Immunity, Entry Medical School, University of Limerick, Co. Ireland1, Department of Surgery, University Hospital Co. Limerick, Ireland2, Department of Life Sciences,

*M. Kiely1,2, *S.J. Hodgins3, S. Tormey3, P.A. Kiely1,2, E.M. O’Connor1 Department of Life Science, University of Limerick, Limerick, Ireland1, Materials and Surface Science Institute and Stokes Institute,

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S28 University of Limerick, Limerick, Ireland2, Department of Medicine, Mid-Western Regional Hospital, Limerick and Graduate Entry Medical School, University of Limerick, Limerick, Ireland3 *equal contribution from both Triple negative breast cancer (TNBC) is a breast cancer subtype accounting for approximately 15 % of diagnosed cases. TNBC has a younger patient profile and is associated with a more aggressive phenotype. Currently there is no targeted treatment available for TNBC. Vitamin K (VK), is well known for the essential role it plays in the clotting cascade. Obtained in the diet and from bacteria in the gut, the anti-tumour properties of VK derivatives have been reported in both hepatocellular carcinoma1 and glioblastoma2. In this study we used a novel impedance-based live cell monitoring platform (xCELLigenceTM) to determine the effects that VK derivatives have on the TNBC cell line, MDA-MB231. Using two VK compounds, menaquinone (VK2) and menadione (VK3), the cells were treated with concentrations previously reported in the literature to have an anticancer effect on human glioblastoma cells. After initial testing, these concentrations were adjusted to 100 lM, 125 lM and 150 lM (menaquinone) and 1 lM, 5 lM and 7 lM (menadione). Here, we report a significant growth inhibitory effect which is dose dependant when cells are treated with either compound at these concentrations. This effect was seen in adhesion and proliferation with both compounds dramatically slowing down growth of the breast cancer cells. Additional analysis of cells treated with menaquinone (100 lM) in combination with a low glucose nutrient media showed a further significant decrease in adhesion and proliferation. This is the first study of its kind showing the real-time effects of VK derivatives on TNBC and suggests that dietary factors may be important considerations for patients. References: 1. Hitomi, Misuzu, et al. ‘‘Antitumor effects of vitamins K1, K2 and K3 on hepatocellular carcinoma in vitro and in vivo.’’ International journal of oncology. 2005, 26.3:713. 2. Oztopcu, Pinar, et al. ‘‘Comparison of vitamins K * 1, K * 2 and K * 3 effects on growth of rat glioma and human glioblastoma multiforme cells in vitro.’’ Acta neurologica belgica. 2004, 104:106-110. Conflicts of Interest: none Disclosures: none

18. Applying novel cell monitoring platforms to study the behaviour of triple negative breast cancer cells in 2-Dimensional and 3-Dimensional culture Adebola Ogunsakin1, Maeve Kiely1, Shona Tormey2, Patrick A. Kiely1, 3 Department of Life Sciences and Materials and Surface Science Institute, University of Limerick, Limerick, Ireland1, Department of Medicine, Mid-Western Regional Hospital, Limerick, Ireland2, Stokes Institute, University of Limerick, Limerick, Ireland3 Triple negative breast cancers (TNBCs) are immunohistologically characterized as estrogen receptor, progesterone receptor and Her2/ neu negative, making them resistant to present chemotherapeutic targets and associated with bad prognosis1. Increased expression of IGF-1R and circulation of IGF-1 have been implicated in increased risk for breast cancer and increased cellular proliferation in TNBC cells1, 3. To monitor cell morphology and behavior, 3D cell cultures have been found to more closely imitate the in vivo environment and produce gene expression profiles that are more closely related to

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Ir J Med Sci (2014) 183 (Suppl 1):S1–S69 physiological quantities when compared to 2D cell cultures2. To culture cells in 3D we use Matrigel which mimics the extracellular matrix in vivo. We used malignant breast cancer cell line, MDA MB 231 and plated them in varying concentrations of IGF-1 and control 10 % FBS. Cellular adhesion and proliferation were then monitored and measured using the xCELLigence System. We also compared the gene expression profile for TNBC cells cultured in 2D and 3D using real time qPCR. In particular we focused on expression of the scaffolding protein RACK1 which is known to be involved in cellular processes such as adhesion, proliferation and migration. References: 1. Davison, Z. et al. 2011. Insulin-like Growth Factor– Dependent Proliferation and Survival of Triple-Negative Breast Cancer Cells: Implications for Therapy. Neoplasia, 13(6), pp. 504-515 2. Kenny, P., et al. 2007. The morphologies of breast cancer cell lines in three-dimensional assays correlate with their profiles of gene expression. Molecular Oncology, 1 (1), pp. 84-96. 3. Pollak MN, et al. 2008. Insulin-like growth factors and neoplasia. Nat Rev Cancer 8 (12), pp. 915-28. Conflict of Interest: None. Disclosures: None.

19. Adipophilin (ADFP) is a novel and independent prognostic biomarker in colorectal cancer. J. Hogan 1,2, L. O’Byrne 2, M. O’Callaghan 2, Catriona Dowling3, Patrick Kiely3, M. Kalady4,5, J.C. Coffey 1,2,6 UL Hospitals, University Hospital Limerick, Co. Limerick, Ireland1, Graduate entry Medical School, University of Limerick, Co. Limerick, Ireland2, Department of Life Sciences, University of Limerick, Co. Limerick, Ireland3, Department of Colorectal Surgery, Digestive Diseases Institute, Cleveland Clinic, Cleveland, OH, USA4, Cancer Biology Department, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA5, Center for Interventions in Infection, Inflammation and Immunity (4i), Graduate Entry Medical School, University of Limerick, Co. Limerick, Ireland6 Background: We recently exploited expression data available in NIH sponsored Gene Expression Omnibus (GEO), to develop a novel means of determining nodal status in colorectal cancer (CRC)1. The methodology identified a number of novel and established genes in the colorectal cancer metastatic process, which were further evaluated in the current study. Methodology: A UL Colorectal Cancer Archive was established based on data derived from the Gene Expression Omnibus. Utilizing this library, genes frequently dysregulated (ADFP) between early and late stage CRC were identified1. The association between ADFP and outcome was assessed using a regression-tree analysis (CRT), Kaplan–Meier estimates and log rank analysis. A validation process comprising RT-PCR derived gene expression of ADFP was utilized to compare ADFP expression between normal and malignant CRC tissue. Results: CRT identified the optimal ADFP expression value cut-off point. In node negative disease (stages I and II combined) (p = 0.05) and a stage II specific analysis (p \ 0.001), increased ADFP expression was associated with adverse DFS (Kaplan–Meier estimate/ log rank analysis). Similarly, in node positive disease (stages III and IV) (p \ 0.001) and a stage III specific analysis (p = 0.009) increased ADFP was associated with adverse DFS. A comparison of

Ir J Med Sci (2014) 183 (Suppl 1):S1–S69 RT-PCR derived expression values (n = 20) between normal and malignant tissue revealed a difference in mean expression values (p = 0.01). Conclusions: ADFP is a novel and independent prognostic biomarker in CRC. ADFP may be used as an adjunct to TNM staging in determining suitability for chemotherapy in stage II CRC. Reference: 1. Hogan J, Judge C, O’Callaghan M et al. A novel and robut method for determining lymph node status in colorectal cancer. 2013. Oct 28th. EPUB ahead of print.

20. Indications and outcomes of adenoidectomy in children under 12 months of age: a 10 year review T.S. Ahmed, P. Doody, H. Daya

S29 Introduction: Churg–Strauss syndrome is an autoimmune medium and small vessel disease associated with airway allergic hypersensitivity and oesinophilia. It usually manifests in three stages; allergic phase, oesinophillic phase and vasculitic phase. Eosinophilic otitis media is a newly recognised intractable middle ear disease, characterised by the accumulation of eosinophils in middle ear effusion and middle ear mucosa. In our study we explore the link between patients with intractable middle ear effusion, nasal polyps and Churg–Strass syndrome. Methods: Ten years retrospective review of all patients who underwent nasal polypectomies and Grommet insertions. Results: 16 patients were identified. The median age at first procedure was 45 years. 75 % of patients had at least 4 positive diagnostic criteria. Eosinophilia and asthma were present in 68.75 % and 87.5 % of patients respectively. Conclusion: A diagnosis of Churg–Strauss should be considered in all patients with chronic rhinosinusitis with nasal polyps and persistent OME.

Department of ENT Surgery, St. George’s Hospital, London, UK Adenoidal hypertrophy can cause problems including obstructive sleep apnoea (OSA). The most effective treatment is adenoidectomy but is seldom performed below age 1. This study aims to define characteristics of infants under12 months undergoing adenoidectomy and evaluate its safety and efficacy. All children under 12 months undergoing adenoidectomy at our hospital between 2002 and 2012 were identified. A retrospective chart review was performed and data including patient demographics, investigations, perioperative hospitalisation details and clinical outcomes were extracted. 9 children in this cohort underwent adenoidectomy (mean age 8.8 months, range 4-11 months). The mean weight was 8.5 kg (SD 2.3). All patients were male and the majority (89 %) were of Black Caribbean or Asian origin. One child had Down syndrome. Three children had underlying OSA. Over half had failure to thrive and reflux symptoms. Adenoidal hypertrophy was confirmed preoperatively by nasendoscopy in 7 cases (78 %). Surgery was performed using suction diathermy. Post-operatively an exceptional case was discharged on the same day whilst the remainder were observed overnight in hospital, one child having a planned paediatric intensive care unit admission. No post-operative complications were recorded. Nasal breathing improved in all cases although two children (22 %) subsequently underwent tonsillectomy, one of these also requiring revision adenoidectomy. Adenoidectomy is an effective treatment in children aged below 12 months. Our results suggest that in appropriately selected individuals there is no significantly increased risk of perioperative morbidity or complications. Parents need to be counselled about potentials for adenoid regrowth and a possible future need for tonsillectomy. Conflict of interest: None Disclosures: None

22. Failure to report on research ethics committee approval and informed consent in otolaryngology journals

21. The association between intractable middle ear effusion, nasal polyps and Churg–Strauss syndrome

23. Outcomes and prognostic indicators for intra-operative extended incisions in thyroidectomy

S.P. Murphy, C. O’Rourke, J.E. Fenton Department of Otolaryngology/Head and Neck Surgery, Limerick University Hospital, Co. Limerick, Ireland Objective: Medical research involving human subjects must follow ethical standards as outlined in the Declaration of Helsinki of the World Medical Association. The aim of this study was to assess the frequency of reporting of informed consent and regional ethical committee (REC) approval in all reports of trials published in the major European Otolaryngolgy journals. Methods: All clinical research articles published online in the calendar year 2012 in Clinical Otolaryngology, The Journal of Laryngology and Otology and The European Achieves of Oto-RhinoLaryngology were analysed. Publications were categorised into prospective studies, retrospective studies, description of new methods and case reports. Results: Of the 250 articles reviewed, 148 (59.2 %) met the inclusion criteria (manuscripts reporting human subjects, human tissue or identifiable personal data research). 6 (4 %) lacked a statement of REC approval, 13 (8.7 %) lacked disclosure of informed consent and 3 (2 %) lacked both. Articles that did not state REC approval were associated with not stating informed consent (p \ 0.05). Conclusion: Articles that lack explicit statements of REC approval and informed consent are infrequent but continue to be published in major otolaryngology journals. Conflicts of interest: None Disclosures: None

W. Hasan, D. Smyth, E. Lang, L. Skinner, M. Donnelly, J.E. Fenton Colin O’Rourke, Prof. C Timon Department of Otolaryngology/Head and Neck Surgery, Waterford Regional Hospital & Limerick University Hospital, Co. Limerick, Ireland

Royal Victoria Eye and Ear Hospital, Dublin, Ireland,1 St. James Hospital, Dublin, Ireland2

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S30 Aims: The recent surge of interest in developing minimally invasive techniques in thyroid surgery has led to shorter incisions. However, these advancements are associated with a steep learning curve and in many cases require the surgeon to extend the original incision intraoperatively. The aim of our study is to examine the incidence, outcomes and prognostic indicators of patients who underwent intraoperative extended incisions during a thyroidectomy. Methods: The study design is a retrospective cohort study. All thyroidectomy operations carried out by a single surgeon in two tertiary referral centers from 2007 – 2012 were analysed. The intervention group includes any patient undergoing a thyroidectomy, who had the original surgical incision extended intra-operatively. The comparison group is the remainder of the source population. Results: 73 patients (17 %) who had an extended incision (intervention group) and 368 (83 %) who had no extended incision (comparison group) were included in the study. There was no significant difference in sex (p = 0.55), age (p = 0.52) or patient weight (p = 0.52) between the two groups. There was a significant relationship between indication for operation and having an extended incision (p = 0.002). There was a significant difference in the size of the incision between the two groups. The intervention group had shorter incisions made originally (39.6 vs. 45.8 mm, p = 0.004). Substernal extension of the thyroid pre-operatively and evidence of a deviated trachea intra-operatively were positive predictors of having an extended incision (p = 0.03 & p = 0.01). There was no associated morbidity with having an extended incision. Conclusions: This study confirms the previously unreported high incidence of extended incisions for thyroidectomy, along with important predictors of incision size. Larger studies are required to confirm there is no increase in morbidity associated with extended incisions. Conflict of interest: None Disclosures: None

24. Tracheostomy—a topic forgotten? Knowledge of tracheostomy amongst junior doctors and medical students C.W.R. Fitzgerald, C. Oosthuizen, C. Wijaya, D.S. Leonard, J.B. Kinsella Department of Otolaryngology, Head and Neck Surgery, St James’s Hospital, Dublin 8, Ireland Introduction: Knowledge of tracheostomy management is an essential skill for doctors working in the hospital setting. Any emergent cases arising require prompt action from the attending medical officer on duty, while awaiting the arrival of specialist personnel. We surveyed knowledge of general and emergency tracheostomy management among intern-grade junior doctors and medical students in order to compare knowledge levels in these groups and assess the impact of a structured tracheostomy-teaching programme on knowledge. Methods: A questionnaire consisting of multiple choice questions and short clinical scenarios was administered to 81 medical students and junior doctors at a university teaching hospital. 27 fourth-year medical students at the beginning of a two-week otolaryngology placement, 28 fourth-year medical students at the end of a two-week otolaryngology placement and 26 intern-grade hospital doctors were surveyed. Results: The mean score of correct answers amongst intern-grade hospital doctors was 50.77 %; students at the beginning of placement 39.26 %; and students at the end of placement 62.86 %. Medical

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Ir J Med Sci (2014) 183 (Suppl 1):S1–S69 students had a statistically significant improvement in their scores following an education programme (p = \0.001). Conclusion: Knowledge of general and emergency management of tracheostomised patients is poor among both medical students and intern-grade trainee doctors. As junior house officers may be responsible for the initial management of tracheostomy-related emergencies, competence in this area is essential. Our results demonstrate that while a structured undergraduate training programme has a significant, positive impact on the understanding of tracheostomies amongst medical students, continued medical education in relation to tracheostomy management is needed to maintain these skills. Conflicts of Interest: The authors declare no conflicts of interest Disclosures: No disclosures

25. Clinical need vs financial penalty K. Davies, F. O Duffy, O. Young University College Hospital Galway, Newcastle, Co Galway, Ireland Aim: In the current special delivery unit climate1, where hospitals are potentially financially penalized for long waiting times, we are currently assessing the impact of long outpatient waiting times on our unit. Methods: An initiative clinic was set up at our institution specifically for long waiters. We surveyed the patients prior to consultation with a five point questionnaire. Patient responses were then correlated with clinical findings, investigations and management outcomes. Results: This study is currently ongoing. To date we have 41 patient responses. Mean wait time for clinic appointments was 63.5 months. Age range was from 5 – 86 years with a mean age of 43. To date, six patients have been listed for surgery, seven prescribed medical management, four referred for hearing aids, two sent for radiological investigation and two provided with a review appointment. Only eight patients had no further treatment following consultation. Of note, a number of patients used this appointment to attend for a problem unrelated to their original referral. Conclusion: Current outpatient waiting times for otolaryngology clinics are excessive and unacceptable. Our study highlights however that clinical need still has to be the primary determinant of appointment allocation rather than the threat of financial penalty. References: 1. Plunkett O, O’Shaughnessy C, Nugent C, Protocol for the management of outpatient services, Special Delivery Unit, December 2012 Conflict of interest: None Disclosures: None

26. Are symptoms of post-traumatic stress in patients experiencing nasal fractures reduced following surgery? A pilot study S. Gallagher1, C. O’Rourke2, J. C. Oosthuizen2, C. Wijaya2, O.T. Muldoon1, J. E. Fenton2 Department of Psychology, University of Limerick, Limerick, Ireland1, Department of ENT and Head and Neck Surgery, University Hospital Limerick, Limerick, Ireland2 Recently researchers have paid increasing attention to psychological adjustment associated with abnormalities of appearance with

Ir J Med Sci (2014) 183 (Suppl 1):S1–S69 discrimination, social isolation and elevated levels of stress being reported. 1,2 In cases of facial trauma, nasal fractures account for approximately 40 % of bone injuries. However, little attention has been paid to the psychological consequences of patients experiencing nasal fractures or how surgical manipulation may affect these experiences. Seventeen patients (1 female), attending the ear nose and throat clinic at University Hospital Limerick participated in a pilot study that examined the psychological correlates of nasal fracture pre and post-surgery. Injuries were primarily sports-related (76 %) and measures of post-traumatic stress symptoms, coping, and body image concerns were completed at both time-points. Based on clinical of [ 25 on the post-traumatic stress scale, 35 % of patients needed psychological support before surgery and 29 % afterwards; this percentage decrease was not significant, v2 (1) = 1.89, p = 0.28. A significant positive correlation between body image concerns and post-traumatic stress symptoms after surgery, r = 0.65, n = 17, p = 0.005 was also found; patients more concerned about their body image reported higher stress symptomology. Moreover, patients whose fractures were not attributed to sport had higher rates of post-traumatic stress before surgery, t (1,16) = 2.47, p = 0.03; this pattern was not evident after surgery implying that surgical manipulation is a stress reducing agent. Thus, nasal fractures are associated with high rates of stress symptomology and there appears to be differences in stress symptomology depending on source of injury. References: 1. Moss T., Carr T. Understanding adjustment to disfigurement: the role of self-concept. Psychol Health. 2004, 19:737-748 2. Thompson A., Kent, G. Adjusting to disfigurement: Processes involved in dealing with being visibly different. Clinic Psychol Rev. 2001, 21: 663–682 Conflict of interest: None Disclosures: None

27. The productive operating theatre in ENT ´ . Cathaín, A. Smyth, M. Bresnihan E´. O Department of ENT, Sligo Regional Hospital, The Mall, Sligo, Ireland In November 2011, Sligo Regional Hospital was approached by RCSI to pilot the TPOT programme. TPOT (The Productive Operating Theatre) is an NHS initiative aimed at improving the overall efficiency of theatre. Data obtained from April 2011 showed that 394 min were wasted on start times of ENT lists at the cost of €20.83 per minute of theatre time, with an overall loss of €8,207 on delayed start times alone in that month. In January 2012 a TPOT programme leader was appointed. 8 patients due for theatre the same day were followed by the TPOT programme leader from arrival at the main entrance of the hospital to arrival in theatre. Reasons for delay were identified at this stage. Patient and staff satisfaction questionnaires were performed after the implementation of a new patient pathway system whereby the first patient on the list arrives in the theatre recovery area at 07:00 on the morning of their operation, pre-assessed with an ASA of 1. By implementing this new system, theatre start times have improved from 26 % of on-time starts in April 2012 to 73 % on-time starts in June 2013. This has resulted in significant savings and also an increase in patient and staff satisfaction. TPOT has been successfully implemented in ENT in Sligo Regional Hospital. The aim is to roll-out the initiative to other specialties. We are working towards creating a designated area for

S31 admission of the first patient on each of our lists and improving efficiency in theatre. Conflict of interest: None Disclosures: None

28. Letter to the editor—a publication loophole? E. Tierney, C. O’Rourke, J.E. Fenton Department of Otolaryngology/Head and Neck Surgery, University Hospital Limerick, Co. Limerick, Ireland Introduction: The letter to the editor represents a potential loophole within which publications can be made without having to satisfy the stringent requirements scientific manuscripts are usually subject to prior to publication. Therefore the aim of our study was to illicit the true role of the letter to the editor, and whether individual journal guidelines and criteria for composing letters to the editor are specified and adhered to. Method: All published letters in four leading otorhinolaryngology journals from January -December 2012 were analysed. Data recorded included; letter theme and length, number of authors and citations, department and country of origin and inclusion of images/tables/ figures. Results: 17 different countries yielded a total of 90 letters; (Clinical Otolaryngology; n = 53 (58 %), The Journal of Laryngology and Otology; n = 4 (4.4 %), The Laryngoscope; n = 18 (20 %), and the European Archives of Oto-Rhino-Laryngology; n = 15 (16.7 %). 33.3 % were responses to original articles, 21 % were authors’ replies, 11 % described technical innovations unrelated to original journal material, 6.7 % were responding to other letters and another 6.7 % were pilot studies. Case reports, audits and literature reviews each represented 5.5 % of the letters and 4.4 % were unclassifiable. Author numbers ranged from 1-9 (mean 3.76), average letter length was 1 page and citation numbers ranged from 1-14 (mean 3.48). Conclusion: While there were significant discrepancies between journals, the letter to the editor may be acting as a platform to share otorhinolaryngology innovations. However, as a result original publications may be subject to less scrutiny and peer review thus nullifying their magnitude of effect. Conflict of interest: none Disclosures: none

29. Ergonomics in ENT surgery C. O’Rourke, J.E. Fenton Department of Otolaryngology/Head and Neck Surgery, Limerick University Hospital, Co. Limerick, Ireland Introduction: Ear, Nose and Throat (ENT) Surgery presents unique ergonomic challenges to surgeons due to the diverse positioning required in a typical operating list. Various surgical procedures impose different physical demands on surgeons and high prevalence rates of neck, back and shoulder pains have been reported among ENT Surgeons. However, there are relatively few studies about ergonomics in otolaryngology. This is a review of the current literature published on the subject of ergonomics in ENT surgery. Methods: Literature review. Results: Overall, 6 studies were identified. The methods used for evaluation were; 4 studies used surgeon questionnaires, 1 used a screening survey tool, 1 used a novel objective measure of posture.

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S32 Musculoskeletal symptoms were present in greater than 75 % of surgeons in all studies, the majority of which were attributed to surgical practice. Only a minority of surgeons who responded to questionnaires were aware of ergonomic principles Conclusion: These findings may confirm that most surgeons believe that an operative environment affects their physical health. Increased knowledge of surgical ergonomics may lead to strategies that improve workplace health and safety. Studies combining surgeon questionnaires with approved objective measures of posture are required to evaluate the importance of ergonomics in ENT Surgery.

30. Globus pharyngeus; just a variation of normal? C. Gullane, J. Doody, C. O’Rourke, J.E. Fenton Department of Otolaryngology/Head and Neck Surgery, Limerick University Hospital, Co. Limerick, Ireland To determine whether or not globus pharyngeus is a pathological condition or just a variation of normal. Background: Globus pharyngeus is a well-known but poorly understood phenomenon that otorhinolarynglogists see on a daily basis in clinics [1] with approximately 4 % of new ENT referrals comprised of globus patients [2]. Many studies have tried to quantify or characterise this ‘‘condition’’ but there appears to be little or no agreement in the literature on the diagnosis or pathogenesis of globus. Methods: Using a comprehensive chart review, we retrospectively examined the caseload of a single surgeon spanning the last 5 years. Our study looked specifically at the nasopharyngoscopic findings in these patients as well as any subsequent investigations performed. Exclusion criteria included patients who smoked and those with a known history of laryngopharyngeal reflux or gastro-oesophageal reflux. Results: There were no differences in the endoscopic findings in patients with globus pharyngeus and those who do not have the condition. Conclusions: Globus pharyngeus is a subjective condition that has never been shown to have any consistent physical findings. There is no consensus on its diagnosis and no strong link has ever been made between globus and disease. It is our argument that globus pharyngeus is entirely subjective and is simply a variation of a normal, universal sensation. Reference: 1. Belafsky, P.C., Editorial comment. Current Opinion in Otolaryngology & Head and Neck Surgery, 2008. 16(6): p. 497 10.1097/MOO.0b013e328317797e. 2. Moloy PJ, Charter R. The globus symptom. Incidence, therapeutic response, and age and sex relationships. Arch Otolaryngol.1982;108: 740–744. Conflict of interest: None Disclosures: None

31. Loose Seton Management of Anal Fistula: a MultiCentre Study of 200 Patients M.E. Kelly, H. Heneghan, S. Martin, D.C. Winter Dept of Surgery, St Vincent’s University Hospital, Dublin, Ireland Background/Aim: Peri-anal abscesses and fistulae-in-ano are common anorectal complaint causing significant distress to patients, and present

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Ir J Med Sci (2014) 183 (Suppl 1):S1–S69 considerable challenge to the treating surgeon. Core management principal is achieving closure of the fistula while maintaining continence. There are numerous treatment approaches with large debate about which method is ‘‘ideal’’. Our aim was to assess the tolerance and efficacy of loose seton placement in the treatment of fistula-in-ano. Methods: A retrospective multi-centre review of the management of anal fistulae with loose seton placement over a three-year period was performed. All patients underwent a standardized procedure, and were rescheduled for an elective change of seton until fistula resolution. Patients’ demographics, medical history, co-morbidities, overall number and time interval between seton placements, tolerance and morbidity of the procedure were recorded. Results: 200 consecutive patients had loose seton placement. 69.5 % (n = 139) were male, mean age was 42.6 years. The median number of setons required for each patient was 3(Range 1-8, Mean 2.84). The mean interval between changes was 3.08 months (range 2-4 months). All patients had successful clearance of fistula. The procedure was well-tolerated in 96 % of patients (n = 187). Only 1 % (n = 2) could not tolerate the presence of seton due to significant discomfort. Fistula recurrence rate was 6 % (n = 12). Conclusions: Recently, newer treatment modalities have been reported with enthusiasm. However, there remains a lack of strong statistical evidence of efficacy to support their use. Overall, seton placement remains a key, well tolerated, pragmatic low-cost solution to this common and difficult condition as evident by our study. Conflict of interest: All authors declare no conflict of interest

32. The role of laparoscopic sleeve gastrectomy in the treatment of morbid obesity; review of outcomes in a consecutive series with a minimum follow-up of 1 year B. Moloney1, S. Ahern1, F. Finucane1, E. McAnena2, D. Lowe1,2, O. McAnena1,2 Department of Surgery, Galway Roscommon University Hospitals Group, Department of Medicine, Galway Roscommon University Hospitals Group, Department of Anaesthesia, Galway Roscommon University Hospitals Group, Galway, Ireland1, Galway Clinic, Galway, Ireland2 Introduction: Global prevalence of obesity has soared alarmingly in recent years, coined by the WHO as a global epidemic. In cases of failed lifestyle and medical treatments, laparoscopic sleeve gastrectomy (LSG) is increasingly being considered as a primary surgical procedure for extreme morbid obesity. Aims/Background: Following the introduction of LSG to institution since 2009, we examine a retrospective cohort to assess objective outcomes of this surgery with an average follow up time in excess of 2.5 years. Method: In this cohort of patients who underwent LSG, we analysed the percent of excess weight loss (%EWL) and the effect on Body Mass Index (BMI), Hypertension and Diabetes. Intra-operative and post-operative complications were also reviewed. Results: 150 LSG’s have been performed. 108 patients were included in this study. The average age was 44. Of these, 71.3 % were female and 28.7 % male. After two years, Average percentage of Excess Weight Loss (%EWL) was 54.2 % due to an average decrease in weight by 44 kg. BMI was shown to be reduced by 15 kg/m2. 43.3 % of patients who had pre-existing Hypertension, after two years, 83.2 % of patients had these medications reduced, while 32.1 % had their antihypertensive medications discontinued. Pre-existing diabetes was

Ir J Med Sci (2014) 183 (Suppl 1):S1–S69 identified in 32.2 % of patients. Post-operatively, 96.2 % of these patients had their medications reduced, while 70.6 % of the patients had their medications discontinued. There was no mortality. Significant post-operative complications were identified in 7 % of patients of which 4 required prolonged and/or repeat admissions as a consequence. Conclusions: LSG is a proven alternative management for morbid obesity and associated co-morbidities. Our results are comparable to international standards. Resorting to surgery for morbid obesity requires careful preparation, both medically and psychologically to ensure optimal outcome in suitable candidates. Although post-operative complications can be considerable, it appears as though the benefits of LSG in the long term outweigh these risks.

33. High resolution manometry and oesophageal pressure topography: filling the gaps of conventional oesophageal manometry K.C. Ng, P.A. Carroll, L. Barry, T. Murphy Department of Surgery, Mercy University Hospital, Cork, Ireland Background: High resolution manometry (HRM) and oesophageal pressure topography (EPT) is a novel technology that allows an objective assessment of oesophageal motility and sphincter function and has been integrated into a new classification scheme for oesophageal motility disorders, referred to as the Chicago classification scheme. This scheme has evolved to allow characterization of clinically relevant oesophageal phenotypes. We describe our initial experience with HRM and EPT. Method: A retrospective review of consecutive HRM procedures performed between January and September 2013 was performed. The indications and results from HRM and EPT interpreted according to the Chicago classification (1) were recorded. Results: 74 patients were referred for HRM. The most common indication for HRM was non-obstructive dysphagia, accounting for 68 % of the cases. Other indications included uncontrolled regurgitation (31 %), heartburn (23 %) and chest pain (19 %). 7 patients (9 %) did not tolerate the procedure. 19 (26 %) patients were diagnosed with achalasia and these patients were differentiated into three distinct subtypes: Type II achalasia was the most common sub-type (21 %). 12 patients (16 %) had evidence of a functional oesophagogastric outlet obstruction. Jackhammer oesophagus was diagnosed in 6 patients (8 %). Weak peristalsis with large and small peristalistic breaks on EPT were identified in 16 patients (21 %). 7 patients had normal oesophageal motility. Conclusions: To our knowledge, this is the first report of HRM and EPT in an Irish healthcare setting. HRM allows for the enhanced assessment of oesophageal motility and sphincter function compared to conventional manometry and the description of distinct clinically relevant phenotypes. References: 1. Bredenoord A.J., Fox M., Kahrilas P.J., Pandolfino J.E., Schwizer W., Smout A.J.P.M. Chicago classification criteria of esophageal motility disorders defined in high resolution esophageal pressure topography. Neurogastroenterol Motil. 2012 March; 24(Suppl 1): 57–65. Conflict of interest: None Disclosures: None

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34. Technical deficiencies resulting in recurrent inguinal hernias in the era of Lichtenstein tension-free mesh repairs J. F. C. Woods, P. A. Cronin, G. McEntee Department of General Surgery, Mater Misericordiae University Hospital, Dublin 7, Ireland Introduction: Inguinal hernia recurrence has greatly reduced since the adoption of the Lichtenstein tension-free mesh repair became widely practiced in the 1990s. However, a recurrence rate of 3-4 % is still a significant cause for patient morbidity and surgeon distress. Aim: To evaluate the morphology of recurrences in light of the original surgery findings Materials and Methods Recurrent hernias following Lichtenstein tension-free repair over a 10 year period were included. Operative findings from the primary and recurrent repair were recorded. Results: 1,233 inguinal hernia repairs were performed from 2002-2013. Of 39 repairs for recurrence, 17 were originally repaired using the Lichtenstein method. The majority of recurrences (n = 13, 76.5 %) were originally direct hernias and 4 (23.5 %) were indirect. Direct hernias recurred in two fashions, with a defect medial to the mesh (n = 8) or with an indirect sac (n = 3). 1 direct hernia recurred through a large hole in the mesh and 1 where the mesh had lifted off entirely. For the originally indirect hernias that had recurred there were 2 indirect sacs, 1 medial recurrence and 1 where the mesh lifted off. Recurrence was independent of the grade of operating surgeon at primary repair. Discussion: Most recurrences were following direct inguinal hernia repair. The majority were at the medial margin and a smaller proportion were indirect recurrences. The authors recommend placement of extra medial sutures and some overlap of the mesh medially, in addition to proper exploration of the cord for an indirect sac to decrease the rate of recurrence in the future. Conflict of interest: Nil Disclosures: Nil

35. Varicose veins: the ultrasound pattern of recurrence L. Fitzgerald, M.C. Grouden, D.J. Moore, Z. Martin, P. Madhavan, S.M. O’Neill, M.P. Colgan St James’s Vascular Institute, St James’s Hospital, Dublin 8, Ireland Varicose vein recurrence rates of 20-70 % at 10 years post surgery are reported. Up to 25 % of procedures for varicose veins are performed for recurrent disease. The object of this study was to define the anatomical pattern of recurrent varicose veins and determine where possible the completeness of previous surgery. All consecutive patients presenting with recurrent varicose veins were enrolled in the study. Patients were questioned on previous surgery and a complete ultrasound venous evaluation performed. 127 patients with recurrent varicose veins in 169 limbs were enrolled. There were 34 males and 93 females with a mean age of 55 years.

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S34 Primary operative procedures had been performed a median of 15 years previously (range 1-30 years). The majority (75 %) gave a history of previous high tie and strip while only 10 limbs (5 %) had undergone EVLT. Nine limbs (5 %) had previous SPJ ligation and eight limbs (5 %) had both ligated. Eight limbs (5 %) had simple avulsions and the remaining 5 patients were unsure of their previous surgery. Of the 129 limbs with reported previous stripping of the GSV, the GSV was present and incompetent in 61cases (47 %). The SSV was patent and incompetent in six of the nine (66 %) previous SPJ ligation. Truncal incompetence was found in five cases (50 %) where the patient had previous avulsions only. There was incomplete ablation in four (40 %) treated by laser. These results suggest that incomplete surgery remains a major cause of recurrence. Treatment of varicose veins should be carefully planned based on ultrasound findings. Conflict of interest: None Disclosures: None

36. Factors affecting hormonal therapy adherence in breast cancer patients E.M. Quinn, M.J. O’Sullivan Dept of Breast Surgery, Cork University Hospital, Wilton, Cork, Ireland Anti-oestrogen therapies, namely tamoxifen and aromatase inhibitors (AIs), are important adjuvant therapies for oestrogen-receptor (ER)/progesterone-receptor (PR) positive breast cancer. Nonadherence can be associated with increased risk of disease recurrence.1 The aim of this study was to assess adherence rates and factors affecting adherence to anti-oestrogen therapy in an Irish population. We performed a questionnaire based cohort study of 223 patients with ER/PR positive breast cancer, currently prescribed anti-oestrogen therapy. Anonymous questionnaires, including a validated medication adherence score (MAS), were completed by consecutive patients attending breast/oncology clinical follow-up between May and August 2013. Data was collected regarding therapy type, MAS, discontinuation of therapy, switching of therapy, side effects and demographics. Of 223 patients, 66 % reported complete adherence on the MAS. Factors associated with reduced MAS scores were younger age (p = 0.006), side effects experienced (p = 0.016), lack of emotional support (p = 0.003) and internet usage (p = 0.003). 12 % of patients reported stopping their initial hormonal therapy permanently; of these 39 % did so due to side effects experienced. A further 8 % reported temporarily stopping their hormonal therapy; again 39 % did so due to unbearable side effects. Overall 73 % of patients reported side effects from their hormonal therapy, most commonly sweats/flushes (48 % of tamoxifen users) and joint pain (13.9 % of AI users). Only 68.5 % of patients understand why they are prescribed this medication. Our results demonstrate incomplete adherence to prescribed hormonal therapy in this population. Increased attention to managing side effects of hormonal therapies may increase adherence rates, thus having a potential positive impact on patient outcomes. References: 1. Barron et al., Br J Cancer, 2013, 109: 1513

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Ir J Med Sci (2014) 183 (Suppl 1):S1–S69 Conflict of interest: None Disclosures: None

37. Comparing supervised exercise and endovascular revascularization in the management of peripheral arterial disease: a review T. Aherne, S. McHugh, A. Leahy, D. Moneley, P. Naughton Department of Vascular Surgery, Beaumont Hospital, Dublin 9, Ireland Introduction: Peripheral arterial disease (PAD) is a common condition and it is associated with considerable morbidity and mortality. At present, conflicting views exist as to the optimal non-surgical management of PAD. While studies to date are supportive of supervised exercise training (SET) the incorporation of SET into PAD treatment protocols is varied. We aim to compare the merits of endovascular revascularization (EVR) and SET in the management of PAD. Methods: A systematic literature search was performed using the PubMed database. Randomized studies directly comparing exercise with invasive procedures were included. Intermittent claudication distance (ICD), maximum walk distance (MWD) and ankle-brachial pressure index (ABPI) were the primary markers of walking performance. Results: Fifteen trials including 1,374 patients were identified. When compared, SET offered superior walking outcomes at 6 and 12 months. Conversely, EVR resulted in higher ABPI measurements. Significantly, combination of both offers superior walk performance and quality of life with an associated reduction in re-intervention rates. Exercise compliance across all studies was 80 % with no reported morbidities. Procedural morbidity following EVR varied widely with reported rates of complications and failure up to 15.8 % and 20.6 % respectively. A mean of 12.4 % of those randomized to SET alone required crossover to a more invasive management option. Conclusion: Exercise is effective and safe. SET should be advocated as the gold-standard of care in PAD. In those failing conservative management a combination of both SET and EVR appears to offer superior outcomes to monotherapy. Unfortunately, to date SET programs remain inaccessible to many surgeons. Conflict of interest: None Disclosures: None

38. An immunohistochemical and stereological appraisal of mesocolic lymphangiology—implications for surgical technique in resectional colorectal surgery K. Culligan1, R. Sehgal1, D. Mulligan1, C. Dunne1, S. Walsh1, F. Quondamatteo2, P. Dockery2, J.C. Coffey1 Department of Surgery, Centre for Interventions in Infection, Inflammation and Immunity (4i), Graduate Entry Medical School, University Hospitals Group Limerick, Limerick, Ireland1, Anatomy Unit, School of Medicine, NUI Galway, University Rd, Galway, Ireland2 Background: Inadequate mesenteric resection is associated with adverse oncologic outcome in colon cancer, disruption of the mesenteric lymphatic package has been implicated.. Recent studies have determined mesenteric anatomy and histology and now provide an opportunity to accurately determine the distribution of lymphatic vessels


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(LV). The aim of this study was to characterise the distribution of the LV within the small intestinal and colonic mesentery, and in Toldt‘s fascia. Methods: Mesenteric samples were harvested from 12 human cadavers. Samples were taken from the small bowel mesentery, ascending, transverse, descending mesocolon and from both apposed and non-apposed mesosigmoid. Serial sections were stained immunohistochemically with monoclonal antibody D2-40 (podoplanin), and Masson‘s Trichrome. Lymphatic vessel (LV) density and radius of diffusion were determined using a stereological approach. Results: LV were embedded within the mesenteric connective tissue lattice throughout each region. LV were identifiable within the submesothelial connective tissue. Along the upper submesothelial layer they measured 10.2 ± 4.1 lm in diameter, and had an average radius of diffusion of 174.72 ± 97.68 lm. Unexpectedly, LV were identified in Toldt‘s fascia where they measured 4.3 ± 3.1 lm in diameter, and had a radius of diffusion of 165.12 ± 66.26 lm. Conclusions: This is the first study to systematically determine and quantify the distribution of lymphatic vessels within the mesenteric organ and underlying Toldt‘s fascia. A rich lymphatic network occupies all levels of the mesenteric connective tissue lattice. Within the latter, they are found within 0.1 mm of peritonealised mesenteric surfaces and are separated by an average distance of 0.17 mm. Conflict of Interest: None declared.

39. National clinical programmes, bed cohorting and inpatient length of stay; an analysis of variation over time and between specialities M.P. Murphy1, S.M. Bollard1, P. Hurney2, M.J. Kerin1, K.J. Sweeney3 Discipline of Surgery, School of Medicine, NUI Galway, Galway, Ireland1, Information Services Department, Galway University Hospitals, Galway, Ireland2, Surgical Directorate, Galway Roscommon University Hospitals Group, Galway, Ireland3 Introduction: The average length of inpatient stay in hospital (AvLOS) is frequently used as a marker of efficiency. Reducing the AvLOS reduces the cost per patient and enables a greater numbers of patients to be treated over a given time period. Aim: To identify trends in the variation of AvLOS in our institution over time and between specialities. Method: A dataset was obtained from the information services department detailing every hospital admission for the three year period from July 2010 to June 2013. Data was analysed using Microsoft ExcelÒ and MinitabÒ. Results: There was an overall increase in AvLOS across the 2011/2012 time period. On further examination, this can be attributed to the implementation of the acute medicine programme (AMP) and the transfer of some services from Merlin Park University Hospital on January 1st 2012 which resulted in a substantial increase in total admissions to our institution. 2010/2011

2011/2012

2012/2013

Medicine Total

6.95

7.44

6.4

Medicine emergency admissions

7.14

8.22

7.71

Medicine elective admissions

6.76

6.67

5.1

Surgery Total

5.43

5.52

4.79

Surgery emergency admissions

4.81

5.53

4.71

Surgery elective admissions

6.06

5.52

4.86

The AvLOS was higher for medicine than surgery across the board. There is a noticeable difference between medical emergency and

elective admissions (emergency admissions with a longer AvLOS) but this is not borne out in surgery. Conclusion: AvLOS in our institution shows significant variation over time and across specialities. Some of the variation can be explained but there are clear patterns that warrant further investigation. Conflict of Interest: None. Disclosures: None.

40. Improving surgical site infection prevention practices through a multifaceted educational intervention P. W. Owens1, S. M. McHugh2, M. Clarke-Moloney2, D. Healy2, F. Fitzpatrick3, P. McCormick4, E. Kavanagh2, S. R. Walsh2 Post-graduate School of Medicine, University of Limerick, Limerick, Ireland1, Department of Surgery, University Hospital Limerick, Dooradoyle, Co. Limerick, Ireland2, Health Protection Surveillance Centre, Dublin 1, Ireland3, Department of Surgery, Adelaide & Meath National Children’s Hospital, Tallaght, Dublin 24, Ireland4 As part of the national clinical programme on healthcare-associated infection prevention, the Royal College of Surgeons in Ireland (RCSI) and Royal College of Physicians of Ireland (RCPI) working group developed a quality improvement tool for prevention of surgical site infection (SSI). We aimed to validate the effectiveness of an educational campaign, which utilises this novel quality improvement tool, in improving SSI prevention processes in a tertiary hospital. Prior to the SSI prevention educational campaign, a consecutively selected cohort of 50 surgical patients were prospectively audited and details of antibiotic administration recorded. Recommendations from the quality improvement tool on prophylactic antibiotic administration and optimal surgical site infection practices were delivered via poster campaign, educational presentations and feedback of audit data. Post-intervention, the audit was repeated with a group of 45 patients. Our results demonstrate a post intervention improvement in administration of prophylaxis within the recommended 60 min prior to incision from 54 % to 68 %. Furthermore, there was an improvement from 71 % to 92 % in prescribing antibiotics for the appropriate post-operative duration. We conclude that a multifaceted educational program, conveying recommendations from the RCSI/RCPI quality improvement tool, may be effective in changing SSI prevention practices. Conflict of Interest: None. Disclosures: None.

41. ‘‘WhatsAppTM’’ Doc? An analysis of cross-platform smartphone messaging technology in the provision of surgical patient care R. Murphy, E. Ni Mhuricheartaigh, L. Townsend, B. O’Kelly, W. White, E. O’Neill, S. McHugh, E. Boyle, P. Naughton, D. Moneley, A. Leahy, A. Hill. Department of Surgery, Beaumont Hospital, Dublin 9, Ireland Introduction: Mobile technology available through smartphone usage continues to expand. There is potential for incorporating both

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S36 social media and app technology into daily practice. We describe the usage of a commonly utilised social group messaging application ‘‘WhatsApp MessengerTM’’ in the daily care of acute surgical inpatients in a tertiary centre. Methods: WhatsApp Messenger TM is a cross-platform mobile messaging app which allows users to exchange group messages without SMS. As a pilot study surgical interns in a tertiary vascular unit downloaded WhatsApp Messenger TM and utilised it over a three month period. In addition a focus group of interns across three hospitals were surveyed with regard to smartphone and social media usage in the everyday delivery of inpatient care. Results: With regard to usage, a total of 1,504 WhatsApp messages were sent over the time period. These related to the delegation of ward duties with the remainder relating to the scheduling of ward rounds and communication of clinical questions. In the focus group of 57 interns, 93 % of junior doctors owned a smartphone with the ability to use Whatsapp. Overall 46 (81 %) believed cross-platform mobile messaging applications could improve communication in a hospital setting,. Furthermore 45 (79 %) used their phones more frequently than the hospital pager system to contact other health professionals. Conclusions: WhatsApp Messenger TM and other smartphone communication applications can facilitate communication in a hospital setting, with the potential to improve quality of patient care. Conflict of Interest: There are no conflicts of interest in this research Disclosures: N/A

42. Economic impact of emergency theatre delays and poor prioritisation compliance Beecher S, O’Leary DP, McLaughlin R, Department of Surgery, University College Hospital Galway, Galway, Ireland A key principle of acute surgical service provision is establishment of an emergency theatre. Efficient running of an emergency theatre is dependent upon assessment and prioritisation of acutely ill surgical patients. Time-to-theatre (TTT) is a key performance indicator of theatre efficiency. We examined our institution’s experience with running a designated emergency theatre for acute surgical patients. A retrospective review of an electronic prospectively maintained database was performed between 1/2/12 and 31/1/13. Cases were prospectively divided into high (TTT within 30 min), medium (TTT within 6 h) and low priority (TTT within 24 h). A cost analysis was conducted to assess the economic impact of delayed TTT, with every 24 h delay incurring the cost of an additional overnight bed. In total, 3,646 procedures were performed. Median age was 44 years. Male to female ratio was 1.46:1. Overall mean TTT was 1614 min. Age \ 16 year had a lower mean TTT at 621 min (p = 0.001). The [ 65 year age group had a significantly longer mean TTT of 2332 min (p \ 0.001). There was an unequal distribution of cases between priority categories, with 96 % of cases prioritised as high. Appendicectomy was the most common general surgical procedure. Mean TTT for appendicectomy was 60.8 % higher than the recommended (p \ 0.001). The economic impact of delayed TTT was calculated, generating a figure of €3,839,766.06 of additional costs, amounting to €10,519.91/day. In conclusion, delayed TTT and poor prioritisation strategy compliance incurs significant costs. New strategies must be devised to ensure efficient running of the emergency theatre. Conflict of interest: None Disclosure: None

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43. ‘‘Is general surgery still relevant to the sub specialised trainee?’’ A 10 year comparison of general vs. specialty surgical practice C. Fleming1,2, E.A. Andrews2, M.A. Corrigan1,2 Breast Research Centre, Cork University Hospital, Cork, Ireland1, Department of Surgery, Cork University Hospital, Cork, Ireland2 Background: The splintering of general surgery (GS) into subspecialties in the past decade has brought into question the relevance of a continued emphases on traditional general surgical training. With the majority of higher surgical trainees now expressing a clear preference to sub specialise, this study sought to determine the changes in general surgical practice in a specialist centre over the past decade. Methods: A retrospective review of surgical admissions at Cork University Hospital was performed at three individual time points during the evolution of centralisation: 2002, 2007 & 2012. Basic demographic details of both elective & emergency admissions were tabulated & analysed. Results: 11,288 surgical admissions were recorded (2002:2773, 2007:3498 & 2012:5017), showing an increase of 81 % over the total ten year period. Average length of stay reduced significantly in both elective (3.62 to 2.58 bed days) & emergency admissions (7.36 to 5.65, p = 0.013). While growth in overall service provision was seen, the practice of general emergency surgery versus specialty relevant emergency surgery showed no statistically significant change in practice from 2002-2012 (p = 0.87). While emergency surgery steadily increased, elective general surgery dropped from 27 % to 18 % of elective workload during study duration. Appendicectomy & OGD were the most common procedures performed in all 3 comparative years. Conclusion: General surgical emergency work continues to constitute a major part of the specialists practice. The results emphasise the importance of general surgical training even for those trainees committed to sub specialisation. Conflict of Interest: NIL Disclosure: NIL

44. Health technology implementation: the need for generic template model generation in the surgical context S.P. Murphy, Z. Coyne, S. O’Regan, J. Kelly, J.C. Coffey Department of Surgery, Mid-Western Regional Hospital, Limerick, Ireland Often the driver behind the proposal of new surgical technologies to management, the surgeon requires expert knowledge of entrepreneurship, accounting and finance for large-scale multi-million euro proposals. This study investigated the requirement for a generic template model to aid this process through an examination of the surgeon’s level of self-confidence in these areas and to ascertain the aspects of health technology implementation that surgeons find most difficult. A survey of 200 consultant surgeons in the Republic of Ireland utilised Likert and rating scales to assess self-confidence and potentially important components of a generic template. Almost all of the surgeons (96 %) who participated had no formal training in entrepreneurship, business management or finance. Few had gained experience in these fields throughout their careers with 83.3 % having never written a business plan and only 8.6 % who

Ir J Med Sci (2014) 183 (Suppl 1):S1–S69 previously negotiated service contracts with suppliers. Consequently, the majority of surgeons (66 %) had little confidence in their ability to propose a new technology to their hospital management. The components of the generic template most valued by surgeons were associated with aiding in the complex process of cost analysis and identification of value in the surgical system. The study has identified the need for generic business model generation for new technology purchases in the surgical context with a focus on identifying value in the surgical process and providing a framework for cost analysis. References: 1. Healy D.A., Murphy S.P., Burke J.P., Coffey J.C. Artificial interfaces (‘‘AI’’) in surgery: Historic development, current status and program implementation in the public health sector. Surg.Onc. 2013 22(2):77-85 2. Kaplan R.S., Porter M.E., How to solve the cost crisis in health care. Harv.Bus.Rev. 2009 89(9) 46-52 Conflict of Interest: none Disclosures: none

45. PATI: patient accessed tailored information N.M. Foley1, G. Connolly3, S. Tabirca3, B. Maher2, T. Cil4, E.A. Lehane5, C. O’Riordan6, I. Bailey6, M.A. Corrigan1 Breast Research Centre, Cork University Hospital, Wilton, Cork, Ireland1, School of Medicine, University College Cork, Cork, Ireland2, School of Computer Science and Information Technology, University College Cork, Cork, Ireland3, Division of General Surgery, University of Toronto, Toronto, ON, Canada4, Catherine McAuley School of Nursing & Midwifery, University College Cork, Cork, Ireland5, The National Adult Literacy Agency, Dublin, Ireland6 Background: Gaining empowerment through knowledge is a common theme among breast cancer patients. Information gathering can reduce feelings of uncertainty & produce feelings of hope & control. However 25 % of adults have only basic literacy skills. We have developed a mobile application that is educational at all literacy levels as well as supporting early discharge & remote monitoring of post operative patients, independent of geographical location. Materials: Developed over 6 months, the app contains patient tailored content, including information on patient specific surgery as well as general breast cancer related information. Patients update drain output & pain scores daily; information which is directly relayed to the phone of the relevant breast care nurse & surgeon. Additionally patients can communicate anonymously with other study participants through a moderated ‘whiteboard’. Direct patient video/audio education is delivered on drain & wound care, along with physiotherapy & previous patients delivering frequently asked questions. Results: Adhering to eMedical developmental protocols & in partnership with NALA (national adult literacy agency) the application is now available on iPads used by participating breast cancer patients. Data is collected on knowledge acquisition, anxiety & technology familiarity. In tandem qualitative & quantitative assessment of use of the app is also collected. Conclusions: This project reflects the initial stages in the development of online patient pathways for breast cancer care. PATI will empower patients & primary care, shifting the care paradigm away from tertiary centres & towards the community. Conflict of interest – Disclaimer: This project was supported by a financial grant provided from the TRAP (Translational Research Access Programme) Medical School Research Committee, University College Cork.

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46. Laparoscopic cholecystectomy in Ireland: who operates where? I. Reynolds1, J.C. Bolger1,2, Z. Al-Hilli1, A.D.K. Hill1,2 Dept of Surgery, Beaumont Hospital, Dublin 9, Ireland1, Dept of Surgery, Royal College of Surgeons in Ireland, Dublin 2, Ireland2 Introduction: Laparoscopic cholecystectomy is one of the commonest surgical procedures performed in both the acute and the elective setting. It is an ideal training operation, comprising a number of stages suitable for developing laparoscopic skills of both junior and senior surgical trainees. As such, trainees should be exposed to large volumes of laparoscopic cholecystectomies during their training. Patients operated on in the private sector are excluded from the potential training pool. Aims: i) to compare operating patterns in the public and private sectors. ii) to compare outcome data between public and private sectors. Methods: National HIPE data encompassing the calendar years 2010-2012 was interrogated. Similar datasets were obtained from private health insurers VHI, AVIVA and Laya. Volumes of operations performed and length of stay data were compared. Results: 22,807 cholecystectomies were performed in the years studied. Of these, 9,662 were public patients. There was a 12 % increase procedures performed on public patients over the study period. 13, 145 procedures were performed in the private sector. Of these, 4,063 were private patients in public hospitals. Average length of stay (ALOS) was significantly longer in the public system as compared with the private sector (3.6 days vs 2.7 days, p = 0.01). 11 % of laparoscopic cholecystectomies were day cases in the private sector. Conclusions: A significant proportion of laparoscopic cholecystectomies are done privately, potentially representing a large volume of missed training opportunities. ALOS is significantly greater in the public sector. This may represent greater

47. A retrospective review of calcaneus fractures managed in tertiary referral centre R. Lyons, C. Kiernan, S. Kearns Department of Orthopaedic and Trauma Surgery, Galway University Hospital Group, Galway, Ireland Fractures of the calcaneus are the most common tarsal bone injury presenting to the orthopaedic services. A large proportion of these result in complex injuries in younger patients with significant longterm morbidity. Treatment is regularly referred to tertiary hospitals for sub specialist surgical care. A retrospective analysis was preformed of all surgically treated calcaneal fractures in a university teaching hospital over three years. Chart review and radiological analysis were conducted to obtain referral patterns, patient demographics, operative procedures, radiological classification including postoperative bohler angles and outcome scores. We found a total of 22 fractures that were included in the study. The majority of fractures were unilateral (81 %). 18 % suffering bilateral fractures. The majority of those affected were males (81 %). The age range was 20-63 years, with a mean of 44 years. Pre operative CT scanning was preformed on all patients, and fractures were classified using Sanders criteria. Open reduction internal fixation was

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S38 the perferred method of intervention, though percutaneous fixation was performed when approprate. The average length of hosptial stay was 4 days. The majority had a combination of general aneasthesia and regional block which aided adequate pain control. Clinical outcomes were reviewed at follow up including pain scores and functional status. In conclusion our results demonstrate the benefits of treatment by a dedicated foot and ankle surgeon in a specialist unit. CT scanning aids classification of the fractures and is essential for operative planning. Correct patient selection for operative intervention is necessasy for good clinical outcomes and good functional status. Conflicts of interest: None. Disclosures: None.

48. Functional outcomes from total wrist arthrodesis— patient perceptions of activity level after surgery M. Hennessy1,2, C. Quinlan2, P. Fleming2 School of Medicine, University College Cork, Co Cork, Ireland1, Department of Orthopaedics, Cork University Hospital/South Infirmary Victoria Hospital, Co Cork, Ireland2 Total wrist arthodesis is performed for the management of pain arising from a variety of conditions, commonly rheumatoid, posttraumatic and osteoarthritis. While its advantages are well described, minimal data regarding subjective functional outcomes in patients undergoing this procedure exist in the literature. The aim of this study was to assess post-operative function and patient satisfaction following unilateral total wrist arthrodesis. This was a cross-sectional study. All patients undergoing total wrist arthrodesis at our institution over a seven-year period were identified. The Disability of Arm, Shoulder and Hand (DASH) questionnaire [1] was distributed, to all patients with additional questions regarding ability to complete everyday activities. Statistical analysis was performed using SPSS. Fourteen of the 17 patients who underwent the procedure responded at a mean of 35.7 months post-surgery. The majority of patients were male. The mean age of all participants was 50.5 (range 20-75 years). The median DASH score was 64.37 (interquartile range 39.44 - 86.87). 58 % of respondents indicated they had mild to no difficulty with activities of daily living since surgery. 78 % of patients stated they were satisfied with the level of pain they now experience while 41 % had no residual pain. There was no significant correlation between disability level and the age at which patients underwent the procedure. Despite a DASH score indicative of substantial disability following total wrist arthrodesis, our study showed that the majority of patients treated at our institution, experienced an improvement in symptoms post operatively and were satisfied with the outcome of their surgery. References: 1. Gummesson, C., I. Atroshi, and C. Ekdahl, The disabilities of the arm, shoulder and hand (DASH) outcome questionnaire: longitudinal construct validity and measuring self-rated health change after surgery. BMC Musculoskelet Disord, 2003. 4: p. 11. Conflicts of interest: None. Disclosures: None.

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49. Review of corrective radial osteotomys in post traumatic distal radius fracture wrists Ms. C.Kiernan, A.Kelly, Mr. M O Sullivan UCHG Galway, Bons Secours Galway, Galway, Ireland Introduction: The painful wrist following a distal radius fracture is a challenging case for the Orthopaedic surgeon. There are many procedures and therapies used to treat these patients based on the underlying pathology. A distal radius osteotomy is used to correct the alignment of the radius with a view to improving range of motion and pain at the wrist. We undertook a retrospective review of patients at our institution undergoing corrective distal radial osteotomy following traumatic distal radius fracture. Methods: A clinical review of all patients undergoing distal radial osteotomy following a traumatic distal radius fracture was preformed. 11 patients were identified from theatre logbooks. Patients were called for a clinical review, (6 attended) during which a clinical exam with bilateral measurements of wrist flexion, extension, supination, pronation, ulnar deviation, radial deviation, grip strength, lateral pinch and tripod pinch was measured. Patients also completed a DASH and PRWE questionnaire. Results: Injured hand n=6

Uninjured hand n=6

Wrist Extension

43.1 (20-65)

56.6 (48-80)

Wrist Flexion

51.1 (40-70)

70.4 (50-80)

Supination

82.5 (70 – 110)

86 (75-120)

Pronation Ulnar Deviation

75 (60-90) 27.6 (25-32)

89 (80-95) 36.2 (30-45)

Radial Deviation

14.8 (8-21)

21.4 (18-25)

Grip Strength

20.3 (12-32)

31.2 (18-46)

Lateral Pinch

4.4 (0.5- 8)

6.5 (5-8)

Tripod Pinch

4.1 (1.5-7)

6 (4-8.5)

Functional Scores

N=6

DASH

37.5 (0-67.5)

PRWE

45.2 (0 – 79.5)

Better range of movement postoperatively?

100 % yes

Would you have the same procedure again?

100 % yes

Conclusion and discussion: Patients preformed worse in all aspects of wrist movement following a radial osteotomy after a distal radius fracture however all patients were happy that they had undergone the procedure and would have the same procedure again. They all reported better range of motion postoperatively. We do not have preoperative wrist movement analysis or functional outcome scores on this cohort and we propose to carry out a prospective study to include theses measurements to quantify the reported benefit that this procedure offers to patients Conflicts of interest: None. Disclosures: None.


50. Anatomical analysis of distal phalanx and FDP footprint C. Kiernan1, P Tierney2, M O’Sullivan1 UCHG, Galway, Ireland1, Trinity College, Dublin, Ireland2 Introduction: The development of Tag Rugby as a sport has resulted in an increased incidence of FDP avulsion injuries which are nortiorisly difficult to treat. The button repair is plagued by nail deformities and the anchor repair has seen an increased number of aseptic loosening which has resulted in patients requiring further surgeries and resultant deformed nails. One must wonder where the fault lies with the current anchors. One hypothesis is that the distal phalanx is too small to allow the anchor to fit. Aim: The aim of this study was to measure the dimensions of distal phalanxes and compare the dimensions to commonly used anchors. Methods: 12 fresh frozen hands were dissected and the dimensions of the 4 fingers were measured with a vernier calipers (0.01 mm accuracy) Results: —Index: Width: 7.36, 6.31, 10.69 mm. AP: 3.52, 4.4, 6.75 mm. Length: 17.98 mm —Middle: Width: 7.39, 6.67, 11.29 mm. AP: 3.98, 4.47, 6.97 mm Length: 19.48 mm —Ring: Width: 7.07, 6.96, 11.11 mm AP: 3.98, 4.27, 6.95 mm. Length: 19.29 mm —Little: Width: 5.80, 5.53, 9.76 mm AP: 3.61, 3.73, 5.99 mm. Length: 17.59 mm Conclusion: The mitek micro anchor is 1.3 mm x 3.7 mm. The manufacturer recommends drill bits of 1.3 mm x 5 mm in length for insertion thus the drill may penetrate the far cortex resulting in failure. No conflict of interest or disclosures

51. A novel tissue engineering scaffold for the regeneration and repair of knee joint osteochondral defects A.C. Ramesh1,2,3, T.J. Levingstone1,2,3, R.T. Brady1,2,3, J. Gleeson1,2,3,4, F.O’Brien1,2,3 Tissue Engineering Research Group, Department of Anatomy, Royal College of Surgeons in Ireland, Dublin, Ireland1, Trinity Centre for Bioengineering, Trinity College Dublin, Dublin, Ireland2, Advanced Materials and Bioengineering Research (AMBER) Centre, RCSI & TCD, Dublin, Ireland3, SurgaColl Technologies Ltd., Rubicon Centre, Rossa Avenue, Cork, Ireland4 Articular cartilage has poor repair properties. Damage as a result of disease or injury frequently leads to formation of an osteochondral defect. Conventional repair methods, including allograft, autograft and microfracture, have a number of disadvantages in terms of cost, they require multiple operations and there is a risk of infection.[1, 2] A novel multilayered scaffold developed in our lab, addresses this issue. It consists of three seamlessly intergraded, highly porous layers that allow cells to migrate and proliferate without any interference. Each layer is custom built to encourage the formation of distinct tissue that mimic the composition and structure of the native tissues. In vivo assessment was carried out bilaterally in a caprine model. Defects in one joint were implanted with the multilayered scaffold, the opposite limb of the same animal were left empty. This was followed by assessments at 3 months, 6 months and 1 year intervals. The quality of the repair at the various time points was graded

S39 macroscopically using the ICRS (International Cartilage Repair Society) score and assessed using micro-CT (computed tomography) analysis and histological staining of the samples. As early as 3 months greater levels of bone formation in the multilayered scaffold group were evident through micro-CT. The results were similar at 6 months. Finally, at 1 year the controls showed some degradation of the cartilaginous layer, whereas the multilayered scaffold group showed formation of hyaline-like cartilage over the defect and regeneration of the subchondral bone. References: 1. Smith, G.D., G. Knutsen, and J.B. Richardson, A clinical review of cartilage repair techniques. J Bone Joint Surg Br, 2005. 87(4): p. 445-9. 2.Steadman, J.R., W.G. Rodkey, and K.K. Briggs, Microfracture: Its History and Experience of the Developing Surgeon. Cartilage, 2010. 1(2): p. 78-86. Author Disclosure Information: A.C. Ramesh: None. T. Levingstone: None. R. Brady: None. J. Gleeson: Paid consultant biomaterial cornpany. F. O’Brien: None.

52. Assessing the ability of tissue-engineered cartilage to promote bone regeneration in weight-bearing and nonweight-bearing sites: an in vivo study E.M. Thompson1,2,3, A. Matsiko1,2,3, J.P. Gleeson1,2,3, D.J. Kelly1,2,3, F.J. O’brien1,2,3 Tissue Engineering Research Group, Department of Anatomy, RCSI, Dublin 2, Ireland1, Trinity Centre for Bioengineering, TCD, Dublin 2, Ireland2, Advanced Materials and Bioengineering Research (AMBER) Centre, RCSI & TCD, Dublin 2, Ireland3 Despite being the second most transplanted human tissue, autogenous bone grafting has inherent limitations. Tissue engineered scaffolds offer a viable alternative as bone void fillers. To overcome the risk of avascular necrosis and failure following implantation of such constructs (1) we have developed tissue engineered scaffolds that mimic the cartilaginous template of developmental bone formation via endochondral ossification, promoting chondrocyte hypertrophy and the release of angiogenic factors such as vascular endothelial growth factor. The aim of this study was to assess the in vivo functionality and potential of these tissue engineered cartilage constructs to enhance healing and promote bone formation in clinically relevant critical-sized bone defects. Collagen-glycosaminoglycan and collagen-hydroxyapatite scaffolds were fabricated (2), seeded with mesenchymal stem cells and cultured in the presence of chondrogenic and hypertrophic factors prior to implantation in weight-bearing femoral and nonweightbearing calvarial Fischer rat bone defects. Quantitative analysis was performed with micro CT, histomorphometry and immunohistochemistry. Statistical analysis: two-way ANOVA with Tukey’s post hoc analysis with n = 4/group. Previous in vitro results confirmed the ability of these scaffolds to support hypertrophic cartilage formation. Analysis of in vivo bone formation is currently ongoing, however initial results suggest that collagen-glycosaminoglycan and collagen-hydroxyapatite scaffolds produce greater levels of neotissue formation and are more likely to bridge defect gaps with functional tissue in comparison to empty controls. Furthermore, greatest levels of bone formation were observed in the collagen-glycosaminoglycan group, previously optimised for cartilage production. This study demonstrates the potential of such angiogenic factorreleasing biomimetic systems to enhance healing in bone repair applications.

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S40 ACKNOWLEDGEMENTS Funding provided by Health Research Board (HRA_POR/2011/27) and the European Research Council (ERC grant agreement no. 239685). References: 1. Lyons FG, Al-Munajjed AA, Kieran SM, Toner ME, Murphy CM, Duffy GP, et al. The healing of bony defects by cell-free collagen-based scaffolds compared to stem cell-seeded tissue engineered constructs. Biomaterials. 2010;31(35):9232-43. 2. Matsiko A, Levingstone TJ, O’Brien FJ, Gleeson JP. Addition of hyaluronic acid improves cellular infiltration and promotes early-stage chondrogenesis in a collagen-based scaffold for cartilage tissue engineering. Journal of the mechanical behavior of biomedical materials. 2012;11:41-52. Conflict of interest: FJOB is a shareholder and paid consultant with SurgaColl Technologies who have licensed the collagen-hydroxyapatite scaffolds described herein. Disclosures:

53. Measurement of normal fibular growth in paediatric leg length discrepancy using computed tomography scanogram N.P. McGoldrick, K. Olajide, J. Noel, P. Kiely, D. Moore, P. Kelly The Children’s Medical and Research Foundation, Department of Paediatric Orthopaedic Surgery, Our Lady’s Children’s Hospital, Crumlin, Dublin 12, Ireland Current understanding of normal lower limb growth and growth prediction has its origins in the work of Anderson et al. published in the early 1960s. There are now a multitude of clinical and mathematical methods to guide treatment, including the timing of epiphysiodesis. Early research in the area did not provide any information on the growth of the fibula. It is now well recognized that abnormal growth of paired long bones is capable of evolving into deformity of clinical significance. Abnormal growth of the fibula in relation to the tibia may produce deformity at both the knee and ankle. Existing work examining fibular growth used plain film radiography only. Computed Tomography (CT) scanogram is now the preferred method for evaluating leg length discrepancy in the paediatric population. Fibular growth was evaluated for 28 children (n = 28, 16 girls and 12 boys) presenting with leg length discrepancy. Mean age at presentation was 111.1 months (range 33 – 155 months). For inclusion, each child had to have at least five CT scanograms performed, at six monthly intervals. Fibular length was calculated digitally as the distance from the proximal edge of the proximal epiphysis to the most distal edge of the distal epiphysis. Two measurements of the fibula were recorded and the mean determined for the purpose of calculation. A graph for annual fibular growth was then plotted using this information, and fibular growth velocity calculated. CT Scanograms may be used to calculate normal fibular growth in children presenting with leg length discrepancy. Conflict of Interests: None

54. Increased BMI as a risk factor for upper extremity fractures in children and adolescents A.R Moriarity, A Abdulkarim, M Mullins, D Niall, E Sheehan Department of Orthopaedics, Midland Regional Hospital, Tullamore, Ireland

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Ir J Med Sci (2014) 183 (Suppl 1):S1–S69 Introduction: The childhood obesity epidemic has brought us new trends in musculoskeletal pathology. There are few studies assessing the relationship between obesity and upper extremity trauma with relation to the severity, location or pattern. The aim of our study was to investigate the relationship between BMI and upper extremity fractures in children and adolescents of different ages and genders in the Midlands of Ireland. Methods: Data was collected prospectively on 280 children and adolescents between 2 to 17 years of age who presented to hospital with upper extremity trauma. We determined BMI and BMI-for-age percentiles for each patient. Fracture types were classified and the management recorded. The associations among the BMI class and specific upper extremity fractures were estimated using multiple logistic regression models and expressed with odds ratios (ORs) and 95 % confidence intervals (CIs) using multivariate analysis. Results: Children of both genders with a BMI above the 85th percentile for their age group had an increased OR of an upper extremity fractures (OR, 1.84, with 95 % CI, 1.21-1.34) compared to children of the same age below the 85th percentile. Children with a raised BMI were more likely to require operative management and their treatment duration was longer than their normal weight peers (P \ 0.05). Conclusion: Our study found that children with a BMI above the 85th percentile for their age were at increased risk of a more severe upper extremity fracture compared to children with a lower BMI. Conflict of interest: none Disclosures: none

55. Levels of evidence in the treatment of slipped capital femoral epiphysis research: a systematic review A.R. Moriarity, J Kennedy, J.F. Baker, P.J. Kiely Department of Orthopaedic Surgery, Our Lady’s Children’s Hospital, Crumlin, Dublin, Ireland Background: There is an increasing demand for evidence-based research to guide the management of patients. The primary aim of this study was to review the available studies on surgical management of SCFE and to categorize them by study type and level of evidence as proposed by the Oxford Centre for Evidence-Based Medicine. Secondary aims were to correlate the level of evidence with the impact factor of the journal; to evaluate the level of evidence over time, and; to evaluate the geographic distribution of the included studies. Methods: Therapeutic studies published between 1991 and 2013 that reported on SCFE were identified using the databases PubMed, EMBASE, and the Cochrane Library. Search terms included: ‘‘SCFE AND Management OR Treatment’’. Categorization and correlation between the level of evidence and the impact factor of the journal was analyzed together with linear regression models to reveal any significant trends over time. Results: A total of 1516 studies were found, of which 326 were included in the final analysis. The most frequent study type was the case series (50.1 %) followed by case reports (23.9 %) and expert opinion (13.8 %). RCTs accounted for only 0.6 %. JPO had the most studies (22.6 %) and the highest number of level 2 (n = 1) and level 3 (n = 15) type evidence. There was no progression of level of evidence over time. There was no correlation between level of evidence and impact factor of journal. Conclusion: The majority of therapeutic studies on SCFE are of low level of evidence. High level RCTs are difficult to perform in pediatric surgery, however the management of SCFE would benefit from well-designed, clinical RCTs to advance evidence-based practice. Conflict of interest: none Disclosures: none


56. Leucocyte esterase in the rapid diagnosis of paediatric septic arthritis E.G. Kelly, J.P. Cashman Childrens University Hospital, Temple St. Dublin, Ireland Introduction: Septic arthritis is the infection of any joint with the most common aetiological factor being bacterial. Septic arthritis can occur in any age group, however, the majority of cases will occur in the age group less than twenty years. Currently a synovial fluid analysis is required for diagnosis. A Gram stain takes approximately 40 min to complete costs approximately €2.42. The patient remains under anaesthesia while waiting for the result of these diagnostic tests to be performed which increases the anaesthesia time and operational costs. Methods: A multi site prospective trial with full ethics committee approval took place at 4 sites between July 2012 and July 2013. This covers the major National paediatric centres and their referral networks. 13 patients were successfully enrolled. Hip and knee presentations accounted for 84.6 %. 9/13 presented with Kocher 3 or 4. The mean presenting white cell count was 12 with the mean CRP being 92. Four patients had a positive blood culture on admission- all group B streptococcus meningitis. 9 patients with joint aspirate gram stain positive were leucocyte positive. 3 patients who were gram stain negative were LE negative. There were no false positives and one false negative. Sensitivity of this bedside test is 90 % with a specificity of 100 %. Conclusion: The use of joint aspirate for gram stain and culture is costly in time and resources. The clinical implications of a reliably sensitive and specific rapid point of care diagnostic tool in septic arthritis may lead to rapid treatment, decrease theatre time and improve outcome in patients. Despite the high specificity and sensitivity is an indication as to the usefulness of this test but is more likely a reflection of low study numbers to-date. Conflicts of interest: None. Disclosures: None.

57. Characterization of patellar tendon reflex in cerebral palsy children using motion analysis Y. Elhassan 1, R. O’Sullivan 1, D. Kiernan 1, M. Walsh 1, T. O’Brien 1, 1 The Gait laboratory, Central Remedial Clinic, Clontarf, Dublin, Ireland1 INTRODUCTION and AIM Spasticity in Cerebral Palsy (CP) is a major cause of extensive function impairment and major disability, and quadriceps muscle is important for functional activities. The aim of this study was to use motion analysis (CODA mpx 30 system) as a tool to objectively characterize the Patellar Tendon Reflex (PTR) in CP compared to healthy controls. Patients/materials and methods: This was a case control study comparing the PTR in 15 CP subjects (6 diplegic, 2 quadriplegic, 7 hemiplegic; GMFCS 1-3) and 15 healthy controls. The groups were matched for gender, age, height and weight. Three markers were attached to each limb (greater trochanter, the lateral knee joint line and lateral malleolus). Surface EMG was used to measure rectus femoris muscle activity. All PTRs were elicited by same investigator using a hand held clinical patellar hammer with a marker attached to measure hammer acceleration. Kinematics were recorded using the CODA mpx 30 system. Six reflexes were elicited from each limb

S41 - three while the subject relaxed and three while performing the Jendrassik manoeuvre. Reflex response measurements were compared including (1) Reflex response latency (EMG) (2) Movement latency (3) Knee angular displacement (4) Knee angular velocity. Stata IC/ 12.1 was used for data analysis. Data were found to be normally distributed using the Kolmogorov–Smirnov Test. Groups were compared using unpaired student t test and linear regression. RESULTS Knee angular displacement and EMG reflex latency were found to be significantly different between the two groups for relaxed PTR (p-value 0.004 and 0.00 respectively). The EMG reflex latency did not differ between the groups when performing the Jendrassik manoeuvre 1. This was because performing the Jandrassick shortened the EMG reflex latency in healthy controls 2. Knee angular velocity, although found not to be statistically different, was still larger in cerebral palsy subjects (normal = 2.08 ± 0.66 rad/s and CP = 2.16 ± 0.13 rad/s), and found to be directly correlated to the angular displacement. We developed a formula from the angular displacement diagrams which allows us to distinguish normal from spastic PTRs Table shows the Mean + Standard deviation of the Patellar Tendon Reflex measurement and the relevant P value comparing normal legs to spastic legs in cerebral palsy children. Angular displacement and reflex latency significantly differ. Measured Variable

Normal lower limb Mean ± SD

CP Affected lower limb Mean ± SD (P value)

relaxed

Jendrassik

relaxed

Hammer acceleration mm/s2

41.73 ± 5.44

45.145 ± 5.26 39.53 ± 5.34

Angular displacement degree

20.05 ± 5.47

Angular velocity rad/s

2.08 ± 0.66

Movement latency ms

43.95 ± 14.06 43.25 ± 14.10 41.67 ± 22.23 42.29 ± 16.59

Reflex latency ms

18.11 ± 5.44

19.52 ± 6.13

2.05 ± 0.89

16.58 ± 6.67

Jendrassik 41.70 ± 6.63

(0.14)

(0.04)

12.81 ± 7.30

12.45 ± 5.11

(0.004)

(0.00)

2.16 ± 0 .13

1.941 ± 0.10

(0.71)

(0.62)

(0.58)

(0.77)

13.11 ± 3.23

15.68 ± 6.55

(0.00)

(0.60)

DISCUSSION and CONCLUSIONS In this study we found that motion analysis was a feasible and quick method to measure the PTR and can differentiate between CP and control subjects. We found that while both EMG response latency and knee angular displacement differed between the groups neither movement latency or knee angular velocity were statistically different in CP. We found that EMG response latency was shorter in normal controls when performing the Jendrassik manoeuvre and they performed similarly to CP subjects. However, again this was only significant on EMG analysis. This highlights the potential pitfalls of using the clinical PTR in isolation and clinical movement analysis should also be used where available. References: 1. Voerman GE, Gregoric M, Hermens HJ. Neurophysiological methods for the assessment of spasticity: the Hoffmann reflex, the tendon reflex, and the stretch reflex. Disability and rehabilitation. 2005;27(1-2):33-68. 2. Burridge JH, Wood DE, Hermens HJ, Voerman GE, Johnson GR, van Wijck F, et al. Theoretical and methodological considerations in the measurement of spasticity. Disability and rehabilitation. 2005;27(1-2):69-80

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58. Outcome of first metatarsophalangeal joint fusion using a precontoured plate M.M. Hennessy1, B.R. O’Connor1, R. Gul1 Department of Orthopaedic Surgery, Cork University Hospital, Wilton, Cork, Ireland Successful arthrodesis of the first metatarsophalangeal joint (MTPJ) for hallux valgus requires bone union and adequate realignment to refunction the first ray. Individuals with severe hallux valgus often experience significant pain and functional limitation. The purpose of this study was to determine the results of arthrodesis of the first MTPJ using a pre-contoured dorsal plate for internal fixation for the correction of the hallux valgus deformity. We retrospectively assessed outcomes of first MTPJ fusions, performed in 2 teaching hospitals over a 2 year period, using a precontoured dorsal plate (1) by objective radiological alignment and subjective symptomology. Thirty Three patients underwent 37 first MTPJ arthrodeses. The mean reduction of the inter-metatarsal angle was 5.67 degrees (p \ 0.05) and hallux valgus angle was 33 degrees (p \ 0.05). The short-form 12 (2) assessment of global health demonstrated a significant improvement in both physical and mental health composite scores of 16.4 & 10.4 (p \ 0.05) points respectively. The foot and ankle outcome score (2) demonstrated a cumulative decrease of 35 % (59.28) (p \ 0.05) in all domains. Thirty-seven (37 in 33 patients) joints were successfully arthrodesed, with radiological union in 95 % of patients. 4 patients required re-intervention; one patient developed deep infection requiring removal of plate, two patients developed non-union and one patient required removal of plates from both great toes because of irritation from the plate. Both objective and subjective parameters demonstrated significant improvements using this method of fixation, where we achieved a high fusion rate with a low (11 %) incidence of complications. References:

Ir J Med Sci (2014) 183 (Suppl 1):S1–S69 fixation. 1 82 % of all operative ankle procedures in Ireland are carried out on patients between 18-65 years old. Aims & Methods:We felt it was imperative to study the incidence within various age groups, the associated length of hospital stay and to offer suggestions of reducing this length-of-stay. The National Hospital Inpatient Enquiry system (data collection accuracy 95.9 %-98.2 %), ICD-coding and data from the Central Statistics Office were analysed. 2 Results: 14,903 ankle fractures underwent ORIF between 2002-09 (average 1,928/year). While there was a statistical increase in ORIF’s in the over 65 group, there was no overall increase in the incidence of surgical procedures. The average length-of-stay in 2002 was 4.8 days, but had significantly dropped to 4.0 days by 2009. This was most marked in the over 65’s where it decreased from 10.5 to 7.7 days. The annual incidence of ankle fractures requiring operative intervention in Ireland was 44.43 per 100,000 persons. Conclusion: This study highlights many issues, namely: a) While there is a significant decrease in length-of-stay to 4 days, we feel this figure could be significantly reduced further..b) While the incidence of ankle fractures in the over 65 group remained stable, surprisingly there was a statistically significant increase in the number of operative procedures within this age group. References: 1. Jensen SL, Andresen BK, Mencke S, Nielsen PT. Epidemiology of ankle fractures. A prospective population-based study of 212 cases in Aalborg, Denmark. Orthop Scand;69(1)48-50, Economic and Social Research Institute. Activity in Acute Public Hospitals in Ireland. Section 1;6, Table 1.2. Conflict of Interest Statement: In respect of the paper titled; ‘‘Management of Ankle Fractures Requiring Operative Fixation in the Republic of Ireland: An Epidemiological Study from 2002-09’’ the following statements are true: No author named on this paper has any conflict of interest to declare. No external funding was sought or received to produce this paper.

1. Salis-Sogilo, G., Thomas, W. Arthrodesis of the metatarsophalangeal Joint of the Great Toe. Arch Orthopedic Trauma Surgery. 1979: 85:7-12 2. Dawson, J., Doll, H., Coffey, J., et. al. Responsiveness and Minimally Important Change for the Manchester-Oxford Foot Questionnaire (MOXFQ) Compared with AOFAS and SF-36 Assessments Following Surgery for Hallux Valgus. Osteoarthritis Research Society International. 2007: 15; 918-931

60. Postero-lateral antiglide plating of Danis-Weber B lower end of fibula fractures without the use of an interfragmentary compression and distal screw fixation

Conflicts of interest: None. Disclosures: None.

1

59. Management of 14,903 ankle fractures requiring operative fixation in the Republic of Ireland: an epidemiological study from 2002-09 O. Carmody1, M. Kennedy1, S. Morris1 1

Trauma and Orthopaedic Surgery, National Orthopaedic Surgery, Cappagh, Dublin, Ireland Introduction: Note: No previous similar study to this has been carried out in the Republic of Ireland, to our knowledge.Ankle fractures are the most common lower limb fracture in all age groups in Ireland. Approximately 43 % of all ankle fractures will require operative

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C.T.Cronin1, M. M. Zafar1, R.M. Merchant1, E. Kelly 1, B. Anto1 Department of Orthopaedic Surgery, Waterford Regional Hospital, Dunmore Road, Ireland Dorsal antiglide plating is is a biomechanically sound technique for the treatment of Danis-Weber B type fractures of the distal fibula. A posterolateral approach can be employed and the system can be used without the use of a distal screw. It confers better stabilization than a lateral locking plate, and is advantageous by its absence of intraarticular or palpable screw. This study examined the clinical outcomes of posterior antiglide plate osteosynthesis using minimally invasive approach at our centre, without the interfragmentary compression and distal fragment screws. Primary outcomes included symptomatic hardware and re-operation rates. Secondary outcomes included infection, Foot and Ankle Scores and range of motion. This was a retrospective cohort study of 58 patients treated using this approach using data from chart review and imaging. Evaluation of complications, mobility, and patient satisfaction was gathered

Ir J Med Sci (2014) 183 (Suppl 1):S1–S69 prospectively using the validated and standardised questionnaire based on AOFOS Foot and Ankle Scores by telephone interview. 28 (49.1 %) of patients were male. There were no post-operative infections, loss of reduction, non-union or requirement for reoperation. Weber functional assessment reported 9 (15.7 %) excellent results, 47 (82.5 %) and 1 (1.7 %) showed poor results. 2 (3.44 %) complained of symptoms consistent with peroneal tendonitis at 3 months. There were no complaints of metalwork prominence and no requirement for hardware removal in this cohort during this period. Dorsal antiglide plating without the use of a distal screw is safe and effective and has minimal complications, confers good functional outcome, with a reduced requirement for secondary surgical removal of hardware. Conflict of interest: none Disclosures: none required

61. A prospective study of intraoperative accuracy of ankle joint injection A.C.Ramesh1,2, F. Maleki1–3, J.N. Mckenna1–3 1

Santry Sports clinic, Dublin, Ireland, 2St. James Hospital, Dublin, Ireland, 3Adelaide And Meath Hospital, Dublin, Ireland Blind intra-articular injections (IAI) of various joints have been carried out for diagnosis and treatments of different pathologies in sport medicine, rheumatology, general practice and orthopaedics. Injections are carried out by palpation, the accuracy of which is determined by patient improvement in clinical outcome. The gold standard for any joint injection is image guidance. Previous studies have shown higher accuracy for blind IAI (1,2). The objective of this study was to evaluate the intraoperative accuracy of ankle IAI. There were a total of 100 patients over a seven month period. There were 78 male and 22 female patients. The mean age was 33.8 years. All ankle joint insufflation was carried out by the principal surgeon (JM) with 10 ml of physiological saline. A small incision was made over the injection site and access to the joint achieved by a haemostat. A positive result was documented by a back flow of saline when the joint capsule was breached. ANOVA and Fishers’ exact test were carried out evaluate and significance between groups using SPSS statistical package. Overall 63 % of ankle joint injections were intra-articular. There was no statistical difference between male and female injection rates. There was statistical difference between right and left ankles. There was a statistically higher failure rate in early degenerative versus scopes for ligamentous or chondral injuries. The failure rate in degenerative ankles is 63 % compared to an overall failure rate of 37 %. This paper clearly shows that blind ankle IAI is not accurate as only 2/3 of injections were intra-articular. We therefore, suggest that perhaps almost all ankle injection whether being diagnostic or therapeutic should be done under some form of image guidance. Reference: 1. Cunnington J, Marshall N, Hide G, Bracewell C, Isaac J, Platt P, Kane D,. A randomized, Double blind, Controlled Study of Ultrasound-Guide Corticosteroid Injection Into the Joints of Patients With Inflammatory Arthritis. Arthritis & Rheumatism Vol. 6\2, No 7, July 2010 2. Lopes R.V, Futado R.N.V, Parmigiani L, Rosenfeld A, Fernandes A.R.C, and Natour J,. Accuracy of Intra-articular injection in peripheral joints performed blindly in patients with rheumatoid arthritis. Rheumatology 2008; 47 : 1792-1794

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62. A comparison study of four different techniques for arthrodesis of 1st MTPJ A.C.Ramesh1,2, F. Maleki1-5, C.Fox3, M. Nissar3, J.N. Mckenna1,2,3, P.Kelly3, M.M.Stephens4,5 Santry Sports clinic, Dublin, Ireland1, St. James Hospital, Dublin, Ireland2, Adelaide And Meath Hospital, Dublin, Ireland3, Cappagh national Orthopaedic Hospital, Dublin, Ireland4, Bons Secours Hospital, Dublin Ireland5 First metatarsophalangeal arthrodesis often performed for several arthropathy entities such as end stage Hallux valgus, Hallux rigidus and Rheumatoid arthritis (1,2).We performed a retrospective review of first MTPJ fusion using Bold and Acutrack compression screws, universal 1/3 tubular plate and Hallu-S non locking plate. Main objectives were to compare their fusion rates and evaluate functional outcomes. Operations carried out between September 2008 and December 2012. Total of 297 patients (348 feet) included in the study. Mean age was 62.4 years. There were 259 female and 38 male. 101 had fusion of first MTPJ using two Acutrack screws and 89 with 2 bold screws. 65 fused with Hallu-S plate, and 42 used universal 1/3 tubular plate. Patients evaluated clinically and by X-rays at 6 weeks and 3 month. Functional outcome scores performed using Manchester-Oxford Foot Questionnaire (MOFQ). Failure rate of first MTPJ fusion by Acutrack screw was 2.4 %, Bold screws 9.6 % and Universal 1/3 tubular plate 12.5 %. However, Hallu-S plate had no failure. All treatment groups also showed very low MOFQ scores. We conclude that ideal procedure for 1stscrew followed by 2 Acutrack compression screws. MTPJ fusion is a low profile, precontoured plate with lag. Reference: 1. Gimple K, Anspacher JC, Kopta JA. Metatarsophalangeal joint fusion of the great toe. Orthopaedics 1978;11:462-7 2. Turan I, Lingren U. Compression-screw arthrodesis of first metatarsophalangeal joint of the foot. Clin Orthop Relate res 1987;221(August):292-5

63. An analysis of outcome of whiplash injury in an Irish setting E. McCabe, M. Jadaan, D. Abdallah, J.P. McCabe Department of Trauma and Orthopaedic Surgery, Galway University Hospitals, Galway, Ireland Introduction: Soft tissue injury to the cervical spine or whiplash following road traffic accidents is a common presentation to medical practitioners and results from an acceleration-deceleration injury of the cervical spine. The associated symptoms are largely subjective and include neck pain/stiffness; cervicogenic headaches; interscapular pain; upper limb pain, paraesthesia and weakness. Current treatment protocols involve patient education and conservative care including physiotherapy. Aims: We aimed to determine the current practices in the delivery of care and the impact of associated litigation on whiplash injury patients. Methods and Results: The records of a specialist spine surgeon over a fifteen year period from 1996 to 2011 were reviewed. A total of 303 patients (169 female [56.1 %] and 132 [43.9 %] male [43.29 %])

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S44 presented on referral from their GP with soft tissue injury of the cervical spine following a motor vehicle collision. All were ultimately involved in litigation with a third party. All patients were investigated with plain film x-ray and MRI and in selected cases, CT (trimodal imaging). The documented patients were followed for two years postaccident. A conservative approach was initially used in all cases with a small number proceeding to surgery. Conclusion: It should be assumed that all patients complaining of neck pain following a road accident have a potentially unstable injury even if presenting beyond the day of injury. Multimodal imaging should be followed in all cases. Pure whiplash is a diagnosis of exclusion. Neck pain which persists for three months after the accident may require on-going supportive measures. Radicular symptoms without mechanical nerve root compression are common. There is nothing to disclose and no conflict of interests.

64. Systematic review and meta-analysis of closed suction drainage versus non-drainage in primary hip arthroplasty E.G. Kelly, J.P. Cashman, R. Conroy, J. O’Byrne Cappagh National Orthopaedic Hospital, Finglas, Dublin, Ireland Introduction: The use of drains in surgery has been dogmatically instituted in some disciplines. Total hip arthroplasty is classically associated with the use of drains for a 24-hour period post operatively. The use of closed suction drains in THA has become increasingly controversial with multiple randomised control trials performed to assess the benefit to outcome in THA. The aim of this systematic review is to demonstrate that closed suction drainage does not infer a benefit in primary total hip arthroplasty patients. Methods: A systematic review and meta-analysis was conducted adhering to the PRISMA guidelines. A search of the available literature was performed on PubMed, Cochrane Central Registry of Controlled Trials, MEDLINE (OVID) and EMBASE were searched using a combination of MeSH terms and Boolean operators. All data analysis was performed using the Cochrane Collaboration’s Review Manager 5.1 Results: 16 studies (n = 2705) were included in the analysis. Postoperative closed suction drainage was found to increase total blood loss, the blood transfusion requirement and length of sty in the hospital (p \ 0.05). The non-drain use group demonstrated a greater post-operative thigh circumference (p \ 0.05) but an equivocal pain score (p = 0.16). Heterogeneity was observed between studies; therefore, results must be interpreted with caution. Conclusion: The routine use of closed suction drainage systems post primary hip arthroplasty is not supported by this meta-analysis. However, the heterogeneity between studies does limit the accuracy of the meta-analysis.

65. Short term outcome of uncemented total hip arthroplasty in patients with bleeding disorders K.M. Ryan, G. Colgan, J. Dowling, T. McCarthy Trauma and Orthopaedic Department, St. James’s Hospital, Dublin, Ireland Patients with bleeding disorders, in particular haemophilia, are reported to have inferior outcomes with regards to Total Hip Arthroplasty (THA).

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Ir J Med Sci (2014) 183 (Suppl 1):S1–S69 Post-operative early loosening of components are of particular concern, with high revision rates reported in cemented THA. The aim of this study was to analyse short-term results of uncemented total hip arthroplasty in patients with known bleeding disorders. A retrospective review was performed on all patients with known bleeding disorders who underwent uncemented THA in a tertiary referral centre. Primary outcome was the presence of component loosening on radiological follow-up. All radiographs were analysed by two blinded independent consultant arthroplasty surgeons, and assessed for loosening, osteolysis and integration. Secondary outcomes such as age, gender, revision surgeries, length of follow-up, specific factor deficiency and post-operative wound complications were also recorded. Six patients (4 male, 2 female) with bleeding disorders underwent uncemented THA, from April 2010 to June 2013. One patient underwent a hybrid THA. 4 had Haemophilia, 3 had alternative bleeding disorders. Average age was 59.5 years; (range 28-74). There were no revision surgeries or post-operative wound complications. Patients were all satisfied with functional outcomes on follow-up. Average clinical and radiological follow-up was 21 months; (range 6-42 months).All components were well fixed at the time of latest radiological follow-up. In conclusion, the present study shows that early functional and radiological results of uncemented Total Hip Arthroplasty are favourable. Conflicts of interest: none Disclosures: nil

66. A prospective study of local vancomycin powder application to spinal fusion wounds. Is this practice clinically and biochemically safe in preventing wound infection? E. Murphy, A. Shafqat, G. Thong, R. Piggott, E. Rahall Department of Orthopaedics and Trauma, Galway University Hospitals, Galway, Ireland Introduction: Deep wound infection after spinal surgery is a potentially devastating complication and is associated with higher morbidity, mortality and health care costs. Different measures including intraoperative application of vancomycin powder to wounds has been employed previously to decrease the infection rate. Objectives: The primary objective of this ongoing clinical study is to evaluate the systemic uptake of prophylactically applied vancomycin in instrumented spinal fusion surgery to determine biochemical efficacy of vancomycin in reducing infection rate. Secondary outcomes are to show any side effects including nephrotoxicity related to its local application and record superficial and deep wound infections. Methods: A prospective study has been designed to recruit consecutive patients, between September 2013 and September 2014, operated by a single surgeon. All patients undergoing instrumented spinal fusion surgery (elective & trauma), in a single institution, have been included. 1 g vancomycin is being applied to the subfascial layer and serum levels are measured 12 h post administration. All patients routinely have renal functions checked post operatively to evaluate nephrotoxic effects. Results: To date 20 patients, 10 trauma and 10 elective, have been evaluated. The mean age of our population is 51.6 with 13 males and7 females. 2 patients have shown systemic uptake (vancomycin level: [ 3.3 mg/L) with 18 having negligible systemic levels

Ir J Med Sci (2014) 183 (Suppl 1):S1–S69 (vancomycin level: \ 3.3 mg/L). There have been no superficial or deep wound infections so far and no clinical nephrotoxic or systemic side effects identified. Conclusion: This ongoing trial demonstrates that systemic uptake of vancomycin after local application to the wound is negligible for the vast majority of patients. However it has shown clinical and biochemical safety for its use and remains a cost effective and low risk strategy to combat surgical site and deep wound infections. Data collection is proceeding.

67. Total Hip Arthroplasty in the Very Young Patient Under 30 Years: A Single Surgeon Series with a Mean 10 Year Follow Up P.W. Owens1,2, D.F. Lui2, S. O’Dwyer2, E. Masterson1,2 Graduate Entry Medical School, University of Limerick, Castletroy, Co. Limerick, Ireland1, Department of Trauma and Orthopaedics, University Hospital Limerick, Dooradoyle, Co. Limerick, Ireland2 End-stage hip disease in young patients poses a challenge for orthopaedic surgeons. These patients will have a higher level of demand. Implant design and technique are of importance as revision total hip arthroplasty (THA) will be an important factor to consider for this population. This is a prospective cohort study of a single surgeon series of 26 THA’s in 23 patients, younger than 30 years and undergoing surgery between 2000 and 2008. We analysed pre and post operative Harris Hip Scores (HHS), with a mean follow up of 10 years (Range 4 – 13 years). We assessed indications, implantation technique, revision aetiology and morbidity. Our results show a follow up of over 90 %. Mean age was 24 (range 16-30). 69 % were female. Mean HHS ranged pre-operatively from 54 (95 % CI: 49.4 – 58.6) to 94 post operatively (95 % CI: 86.7 – 101.3) at 10 years. Paired T Test of mean values showed significant improvement (P \ 0.05). All components were uncemented. 73 % were metal-on-metal, 12 % ceramic-on-metal and 15 % metal-onpoly bearings. 2 patients had revisions, one for dislocation and one for acetabular loosening. 3 patients had bilateral THA’s. Recent roentograms show 0 % aseptic loosening. We conclude excellent outcomes following total hip replacement in the very young patient. Uncemented femoral stems and acetabular components with metal on metal bearings have proven to be a good combination. There is statistical improvement in their HHS’s, reflective of excellent function and minimal pain. Our figures show 92 % success rate at a mean of 10 years. Conflict of Interest: None. Disclosures: None.

S45 fracture has not been reported. The aim of this study is to determine intramedullary nail position in the distal femoral canal, and to determine its relation to periprosthetic fracture. A single-centre, retrospective review identified cephalomedullary nail cases. Tip-Cortical Distance (TCD) was measured for all available patients. TCD is described as the distance from the distal intramedullary nail tip to the femoral cortex. TCD was measured anteriorly and posteriorly to devise the Anterior-Posterior (AP) Ratio, which describes nail position within the femoral canal. One hundred twenty-five long intramedullary nail cases were reviewed. Eight patients (M = 80.9yrs, SD = 12.0) with periprosthetic fractures distal to intramedullary nail were compared to 117 controls (M = 73.6yrs, SD = 16.4). Anterior TCD for periprosthetic fractures (M = 2.85 mm, SD = 2.8) was significantly different (p = 0.001) compared to controls (M = 6.71 mm, SD = 3.1). Posterior TCD for periprosthetic fractures (M = 19.5 mm, SD = 5.7) was not significantly different (p = 0.907) compared to controls (M = 19.7 mm, SD = 4.4). AP Ratio for periprosthetic fracture cases (M = 0.157) was significantly different (p = 0.009) compared to controls (M = 0.365). This is the first study evaluating TCD in periprosthetic fracture. Our findings indicate that intramedullary nails with 2.0 m radius of curvature consistently lie anterior in the distal femoral canal, and this anterior position is significantly associated with postoperative periprosthetic fracture. This strengthens the need to reevaluate intramedullary nails with the goal of reducing complications and improving patient outcomes. References: 1. Collinge CA, Beltran CM. Does Modern Nail Geometry Affect Positioning in the Distal Femur of Elderly Patients with Hip Fractures? A Comparison of Otherwise Identical Intramedullary Nails with a 200 cm versus 150 cm Radius of Curvature. J Orthop Trauma. 2013 Jan 2. 2. Bazylewicz DB, Egol KA, Koval KJ. Cortical Encroachment Following Cephalomedullary Nailing of the Proximal Femur: evaluation of a more anatomic radius of curvature. J Orthop Trauma. 2013 Jan 2. Conflict of Interest: The above named authors have no conflicts of interest related to this project. Disclosures: The above named authors have no relevant disclosures related to this project.

69. Analysis of outcomes of kyphoplasty as a treatment for vertebral compression fractures. Review of a consecutive series with a minimum follow up of one year B. Moloney, S. Ahern, M. Jadaan, JP. McCab

68. Tip-cortical distance: assessing IM nail position in the distal femoral canal and its relation to periprosthetic fracture L.R. Carroll, A. Shafqat, J.A. Harty Department of Orthopaedics, Cork University Hospital, Cork, Ireland Mismatch between intramedullary nails for femoral fracture fixation and femoral curvature has been documented. Measuring the intramedullary nail position in the distal femoral canal has been described.1, 2 The association between this distance and periprosthetic

Spine Service, Department of Trauma and Orthopaedic Surgery, Galway and Roscommon University Hospitals Group, Galway, Ireland Introduction: Kyphoplasty is a minimally invasive vertebral augmentation procedure in which percutaneous injection of filler into a vertebral body assists in the treatment of vertebral fractures. Its low complication rate has established it as a primary treatment for vertebral compression fractures (VCF). Aim: Following introduction of kyphoplasty to Ireland by the senior author in 2006, the study assesses objective and structural outcomes in a consecutive series of patients with a minimum follow up of 1 year.

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S46 Method: A retrospective analysis of patients who suffered painful VCF was performed. Requisite for surgery was determined. Clinical outcomes, such as pain relief and quality of life, were assessed using the Visual Analogue Score (VAS) and the Short Form (36) Health Survey (SF36). Correction of compression and kyphosis was determined by measuring the vertebral height and endplate angles to assess restoration of the sagittal alignment. Results: 84 Kyphoplasties were performed on 71 patients with an average age of 55.4. While 70.4 % were female, 29.6 % were male. VCF was found to be due to trauma (34.6 %), cancer (23 %), and insufficiency (42.3 %). Radiological comparison revealed convincing kyposis reduction and vertebral height restoration in patients who underwent the procedure. Complications occurred in 0 patients. A subgroup of 56 (78.8 %) of patients were available for pain relief and quality of life analysis. Both the SF36 and the VAS decreased significantly (p \ 0.05) with the trauma subgroup describing best outcomes. Conclusion: Our findings, which correlate with international comparison, display that kyphoplasty is an effective procedure for the stabilisation of vertebral compression fractures.

70. Analysis of the recalled depuy ASR hip system M. Curtin, M. Jadaan, W. Curtin Department of Trauma and Orthopaedic Surgery, Galway University Hospitals, Galway, Ireland Introduction: The ASR hip system was voluntarily recalled in 2010 as it was associated with a 5 year revision rate of 13 %. Several authors have reported revision rates of up to 48.8 % for these implants. Aims: The aims of this study were to analyse a single surgeon experience with the ASR devices between 2004 and 2013 Methods: Patient data was obtained from a database used to monitor patients progress from the time of the recall. All charts were retrospectively analysed, WOMAC scores, X-rays, serum ion levels and biochemical parameters are presented. Results: 249 cases were identified in 235 patients - 111 stemmed MoM implants and 138 resurfacing procedures. 81 % of patients were male, 19 % were female. The average age was 54 years. 21 cases (10.2 %) were revised - 11 female, 10 male. 10 stemmed MoM prostheses, and 11 resurfacing were revised. All revisions were performed following the public recall. The mean time to revision was 4.77 years. The mean WOMAC score of the entire cohort was 85 while that of the revised cases was 58.47. 17 revisions were attributed to patient discomfort, 2 to periprosthetic fracture, and 2 to component loosening. Conclusion: In this highly observed cohort the ASR revision rate is higher than what would be acceptable in modern arthroplasty practise. It is however quite low in comparison to other published series. We discuss possible reasons to explain the observed differences.

Ir J Med Sci (2014) 183 (Suppl 1):S1–S69 Aim: To establish the association between Body Mass Index (BMI) and the depth of subcutaneous fat in the lumbar region as well as the depth of the surgical field in lumbar spinal surgery. Methods: A single center, single surgeon, retrospective database review was conducted of all the patients who underwent elective lumbar spinal surgery between 2009 and 2013. All patients had MRI s available to assess the distance between skin and posterior tip of the spinous process of L5 (S–S) in the mid-sagittal section and between the skin and posterior surface of the lamina of L5 (S-L). Age, gender, body weight, height and all cases of infections were recorded. Statistical analysis was performed to establish the relationship between S–S and S-L distances and the BMI, age and gender of patients. Results: We found 79 patients that fitted our criteria, 35 females and 44 males. The mean age was 52.7 yr (20-86), mean weight 80.48 kg (47.0-117), mean height 171 cm (150-210), mean BMI 27.57 (18.439.5), mean BMI for males 28.17 and mean BMI for females 26.82. The thickness of subcutaneous fat (S–S distance) ranged from 9.6 mm to 98.0 mm with a mean of 39.495 (34.55 for males and 45.71 for females), and the depth of the surgical field (S-L distance) ranged from 34.3 mm to 125 mm with a mean of 68.41(72.68 for males and 65.02 for females). There was a positive correlation between BMI and S–S in females (r = 0.56, p \ 0.01) and in males (r = 0.47, p \ 0.01), as well as a positive, though weaker, correlation between BMI and S-L in females (r = 0.40, p \ 0.01) and males (r = 0.42, p \ 0.01). Age and height did not correlate significantly with either S–S or S-L. Weight significantly correlated with S-L in males (r = 0.54, p \ 0.001) but not in females (r = 0.32, p [ 0.05), and the correlation between S–S and weight was significantly positive in both males (r = 0.48, p \ 0.01) and females (r = 0.45, p \ 0.01). There was a significant difference in the means of both S–S and S-L measurements between obese (BMI C 30) and non-obese (BMI \ 30) patients. The difference in mean S–S between these two groups was equal to 13.17 mm (t = 3.497, p \ 0.01), and the difference in mean S-L between the two groups was equal to 10.53 mm (t = 2.543, p \ 0.05). In fitting linear regression models for S–S and S-L as dependent variables, BMI and gender were found to be significant independent predictors of both measures. Conclusion: Our results suggest that BMI is positively correlated with the thickness of subcutaneous fat in the lumbar region (S–S) and with the depth of the surgical field in that region. Gender and weight, but not age and height, were also found to correlate with both measures. Conflict of Interest: None. Disclosures: None.

72. In-vivo measurement of spinal flexibility in idiopathic adolescent scoliosis C. Nı´ Fhoghlu´, S.A. Brennan, D. Brabazon, P. Kiely Dublin City University, Dublin 9, Ireland

71. Relationship between BMI and depth of lumbar surgical field A. Shafqat, M. Jadaan, J.P. McCabe Department of Trauma & Orthopaedics, Galway University Hospitals, Galway, Ireland

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The aim of this study was to develop a new type of pre-operative flexibility test for adolescent idiopathic scoliosis. The objective was to develop a test that was standardized and would allow for measurement of in vivo forces required for curve correction. It was undertaken to compare the results of this new test with the current gold standard of side bending radiographs. An axial traction force of 1.5 times body weight was applied through the spine of patients using a traction jig. Postero-anterior, side-bending and traction radiographs were taken. Cobb angle and apical vertebra axial rotation measurements were obtained. Flexibility indices in the

Ir J Med Sci (2014) 183 (Suppl 1):S1–S69 coronal and axial planes were calculated. Cobb angle reduction and axial derotation were compared between the two methods. Fifteen patients with a mean age of 15.1 years were assessed. The mean traction force imparted was 800 Newton’s. The mean Cobb angle measurement was 60.4˚ on postero-anterior radiograph, 52.7˚ on side bend film and 44.5˚ on traction at 1.5 body weight. The mean corresponding apical vertebrae axial rotations were 23.9˚, 22.2˚ and 16.5˚. The mean Cobb angle reduction was 15.9 for traction and 7.7 for side bend radiographs (p \ 0.0001). The mean apical vertebra derotation was 7.4 for traction and 1.7 degrees for side bend radiographs (p = 0.0083). The mean flexibility index in the coronal plane was 0.479. The mean flexibility index in the axial plane was 0.240. Our novel method of traction radiographs at 1.5 times body weight is a safe and reproducible method of assessing curve flexibility in patients with scoliosis. This method achieves a larger Cobb angle and axial derotation when compared to side-bending radiographs. Conflict of interest: The authors declare that they have no conflict of interest.

73. A six year follow up of the Birmingham hip resurfacing arthroplasty B. Moloney, M. Quinn, G. Solayar, K. Kaar, W. Curtin Department of Trauma and Orthopaedic Surgery, Galway and Roscommon University Hospitals Group, Galway, Ireland Introduction: Recent events have highlighted the importance of implant design for survival and wear-related complications following metal-on-metal hip resurfacing arthroplasty. Methods: We examine a retrospective cohort to assess mid-term survival of the most widely used implant, the Birmingham Hip Resurfacing (BHR). The aim of this study was to report the predicted ten year survival and patient-reported functional outcome of the BHR from an independent centre. In this cohort of 320 patients (355 BHRs) with a mean age of 58.1 years, followed for a mean of 8.98 years, the survival and patient-reported functional outcome were identified. Results: The nine-year survival rate for all hips was 96.4 % (95 % confidence interval (CI) 94.3 to 98.5). Rate of revision was 3.1 % (8 revisions) with infection (1.2 %), Aseptic loosening (1.2 %) and impingement (0.8 %) identified as offenders. The mean WOMAC was 94.86 for resurfacings, and 94.23 for stemmed implants. (p 0.419) The mean VAS score was 0.46 for resurfacing and 0.66 for stemmed implants (p 0.173). Of note, all revisions occurred in female patients who underwent resurfacing alone. Discussion: This study displays excellent mid-term results with the Birmingham hip arthroplasty, particularly in the stemmed implants. Our findings were comparable, to ten year outcomes in the literature of designer centres.

74. A ‘Hip’ approach to revision hip surgery—3D printing in complex acetabular reconstruction A. Hughes1 P. Soden1 B. O’Donnchadha2 A. Tansey2, A. Abdulkarim3 C. McMahon4, C. Hurson1,3 Department of Orthopaedic Surgery, St. Vincent’s University Hospital, Dublin, Ireland1, Department of Mechanical Engineering, Tallaght Institute of Technology, Dublin, Ireland2, Department of Orthopaedic Surgery, Cappagh National Orthopaedic Hospital, Dublin, Ireland3, Department of Radiology, St. Vincent’s University Hospital, Dublin, Ireland4

S47 Revision hip arthroplasty requires a comprehensive appreciation of abnormal bony anatomy. Advances in radiology and manufacturing technology have made three-dimensional representation of actual osseous anatomy obtainable. These models provide a visual and tactile reproduction of the bony abnormality in question. Life size three dimensional models were manufactured from CT scans of two patients. The first had multiple previous hip arthroplasties and bilateral hip infections. There was a pelvic discontinuity on the right and a severe postero-superior deficiency on the left. The second patient had a first stage revision for infection and recurrent dislocations. Specific metal reduction protocols were used to reduce artefact. The dicom images were imported into Mimics, medical imaging processing software. The models were manufactured using the rapid prototyping process, Selective Laser Sintering (SLS). The models allowed accurate templating using the actual prosthesis templates prior to surgery. Acetabular cup size, augment and buttress sizes, as well as cage dimensions were selected, adjusted and re-sterilised in advance. This reduced operative time, blood loss and improved surgical decision making. Screw trajectory simulation was also carried out on the models, thus reducing the chance of neurovascular injury. With 3D printing technology, complex pelvic deformities can be better evaluated and can be treated with improved precision. The life size models allow accurate surgical simulation, thus improving anatomical appreciation and pre-operative planning. The accuracy and cost-effectiveness of the technique were impressive and its use should prove invaluable as a tool to aid clinical practice. Conflict of interest: None. Disclosures: None.

75. The role of serial post-revision ion levels and return to normal in metal on metal hip arthroplasty R. Merchant, G. McHugh, K. Bergin, G. Mc Coy, A. Wozniak, J. Quinlan, Waterford Regional Hospital and Lourdes Orthopedic Hospital, Kilcreene, Ireland Introduction: Ion levels post revision of metal on metal hip arthroplasty tend to show a steady decline. The trend generally follows a rapid decline in the first two weeks lasting for about two months. This is then followed by a gradual reduction over two years. We aimed to identify factors which affected the time to normalization of metal ions post revision. Methodology: Prospectively collected patient data based on DePuy’s ASR recall in 2010 was analyzed of procedures carried out in a single regional centre. Patient demographics (sex, age, height, weight and BMI) along with head size, surgical approach and whether stemmed or resurfaced femoral components were used. All patients had at least 2 blood samples taken 1 year apart. Data was analyzed using SPSS v 20. Mixed model linear regression was used to analyze repeated ion measures Results: 103 had revision surgery. 49 patients had bloods returned to normal subsequent to revision and 23 patients had normalized blood ion levels prior to revision surgery. Mean time to normalization was 30 months. There was no statistical significant difference in time to normalization between stemmed vs resurfaced implants (p = 0.220 for cobalt and p = 0.055 for chromium), Acetabular inclination (high or low) (p = 0.38 for cobalt, p = 044 for chromium), BMI (high and low) (p = 0.51 for cobalt and p = 0.23 for chromium) or surgical approach (anterolateral/posterior) (p = 0.11). Conclusion: Normalization of ion levels is not affected by surgical approach, BMI, Acetabular inclination, or stemmed vs resurfaced implants. It can take [ 2 years for ion levels to normalize Authors declare no conflict of interest.

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S48


76. A 10-year review of postoperative complications following femoral fracture fixation with the intramedullary hip screw

77. A case series of multi-drug resistant infected total hip replacements: a novel customised temporary antibiotic eluting hip spacer used in University Hospital Limerick

L.R. Carroll, A. Shafqat, J.A. Harty Department of Orthopaedics, Cork University Hospital, Cork, Ireland The intramedullary hip screw (IMHS) is commonly used for fixation of unstable peritrochanteric hip fractures. IMHS has been shown to yield superior results to other cephalomedullary nails by allowing early recovery due to solid fixation. However, we have observed an increased rate of revision surgery post-IMHS in our centre leading us to evaluate its effectiveness. A single-centre, retrospective database review was conducted between 2003 and 2012. Clinical and radiographic outcomes were evaluated for all postoperative complications. Preoperative fracture classification and postoperative complications were recorded, with a follow-up duration of six months to three years. We identified a total of 413 IMHS cases: 219 short (M = 78.5yrs) and 194 long (M = 72.1yrs). A total of 192 subtrochanteric and 221 intertrochanteric fractures required surgical intervention. A total of 94 (22.76 %) complications were identified, including periprosthetic fracture, IMHS failure, nonunion, broken distal screws, lag screw cutout, and infection. Most notably, there were 19 periprosthetic fractures, 13 (5.94 %) for short and six (3.09 %) for long IMHS. Periprosthetic fractures (M = 78.2yrs) occurred in patients having eight subtrochanteric (M = 79.5yrs) and 11 intertrochanteric (M = 77.3yrs) fractures at the time of the primary operation. All periprosthetic fractures occurred distal to the tip of the intramedullary nail and required reoperation. While the IMHS has proven useful in fixation of unstable proximal femoral fractures, our findings indicate that they result in high complication rates. This rate of periprosthetic fractures has not been reported previously in the literature. All periprosthetic fractures occurred distal to the intramedullary nail, raising concerns regarding implant design. Table 1: Intramedullary Hip Screw Complications.

Complication

Total

Short IMHS Long IMHS

Periprosthetic Fracture

19

13 (5.94 %)

6 (3.09 %)

IMHS Failure

11

4 (1.83 %)

7 (3.61 %)

Nonunion Fracture

9

3 (1.37 %)

6 (3.09 %)

Broken Distal Screw

22

2 (0.91 %)

20 (10.31 %)

Lag Screw Cut Out

13

8 (3.65 %)

5 (2.58 %)

Lag Screw Changed

2

2 (0.91 %)

–

Lag Screw Removal Lag Screw Back Out

2 6

2 (0.91 %) 4 (1.83 %)

– 2 (1.03 %)

Infection

2

1 (0.46 %)

1 (0.52 %)

Other

8

6 (2.74 %)

2 (1.03 %)

Total Complications

94

45 (20.55 %) 49 (25.26 %)

Total Cases

413

219

194

Conflict of Interest: The above named authors have no conflicts of interest related to this project. Disclosures: The above named authors have no relevant disclosures related to this project.

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C.M. Bowe, C. O’Connor, N.H. O’Connell, L. Power, S. Lynch, J. Queally, E. Masterson, F. Condon Department of Orthopaedic Surgery, University Hospital Limerick, Limerick, Contact author: Joe Queally, [email protected], 086 8091450 The gold standard of treatment for periprosthetic infection post total hip arthroplasty remains a 2 stage revision. The first stage involves placement of a temporary antibiotic eluting cement spacer that maintains soft tension and elutes antibiotics into the periprosthetic space. Complex infection involving proximal femoral bone loss complicates this procedure due to a lack of bone required to anchor a traditional spacer in position. In this study, three cases from University Hospital Limerick involving the use of custom-made antibiotic-loaded proximal femoral replacement hip spacers are presented. These spacers (Tecres, Italy) were custom manufactured based on preoperative radiographic templating. The relevant antibiotic(s) (based on preoperative aspiration sensitivities) were incorporated into the cement. Rapid dissolving antibiotics beads were also placed in the periprosthetic tissues to deliver a high concentration of antibiotics in the initial postoperative period. Case 1 involved a vancomycin and gentamicin eluting spacer in a 69 year old female with MRSA infection), case 2 involved a meropenem spacer in a 74 year old female with ESBL infection and case 3 involved a vancomycin spacer in a 63 year old female. At mean latest follow-up of 6 months, all three cases demonstrated healed wounds, normalised inflammatory markers and maintained partial weight bearing mobility. No spacer specific complications (e.g. dislocation, spaced fracture or antibiotic toxicity) occurred. This case series demonstrates the novel use of a prefabricated spacer in complex periprosthetic infection involving proximal femoral bone loss. The spacers were demonstrated to be efficacious, safe and facilitated patient mobility. Conflict of interest: None of the authors or the institution are in receipt of any funding (loyalties or other payments) in a commercial company related directly or indirectly to the subject of this study.

78. Radiographic assessment of anterior femoral curvature to determine its relation to age and bone health L.R. Carroll, K. Deasy, E. O’Malley, M. O’Keeffe, J.A. Harty Department of Orthopaedics, Cork University Hospital, Cork, Ireland Few radiographic analyses of femoral radius of curvature (ROC) exist, and its relation to bone mineral density (BMD) and cortical thickness has not been investigated.1, 2 This study aims to measure the femoral ROC proximally, distally, and of the entire shaft, and to determine its relation to age, BMD, and cortical thickness. A novel method of measuring femoral curvature is described. Standardized 2D sagittal femoral images were generated from CTPAs (Fig. 1A,B,C). Curvature was measured using a custom designed program (Fig. 1D,E). Patients were cross-referenced with available DXA scans to determine BMD. Cortical thickness was measured 10 cm distal to lesser trochanter (Fig. 1F).

Ir J Med Sci (2014) 183 (Suppl 1):S1–S69 Analysis of 626 femurs (313 patients; M = 68.4yrs, SD = 10.3) included 85 females (M = 70.6yrs, SD = 10.8) and 228 males (M = 67.6yrs, SD = 10.1). Mean entire shaft curvature (ROCEC) was 109.5 cm (SD = 31.6). ROCEC for females (M = 103.5 cm, SD = 24.1) was significantly different (p = 0.004) than males (M = 111.8 cm, SD = 33.7). Femurs were significantly more curved (p \ 0.001) proximally (M = 98.2 cm) than distally (M = 245.3 cm). Female femurs were significantly more curved (p \ 0.001) proximally (M = 107.6 cm) than distally (M = 227.1 cm). Male femurs were significantly more curved (p \ 0.001) proximally (M = 94.6 cm) than distally (M = 262.1 cm). Age was not significantly correlated with femoral ROC (r = 0.089). Sagittal (r = 0.100, p = 0.008) and coronal (r = 0.034, p = 0.208) cortical thickness were not correlated with curvature. DXA scans were available for 32 patients, and BMD was not significantly correlated with ROC (r = 0.194, p = 0.068). Our findings indicate femoral curvature is not correlated with age or indicators of bone health. The ROC reported strengthens the evidence describing a mismatch between femur curvature and intramedullary devices furthering the need to reevaluate device design. References: 1. Egol KA, Chang EY, Cvitkovic J, Kummer FJ, Koval KJ. Mismatch of current intramedullary nails with the anterior bow of the femur. J Orthop Trauma. 2004 Aug;18(7):410-5. 2. Lu ZH, Yu JK, Chen LX, Gong X, Wang YJ, Leung KK. Computed tomographic measurement of gender differences in bowing of the sagittal femoral shaft in persons older than 50 years. J Arthroplasty. 2012 Jun;27(6):1216-20. Conflict of Interest: The above named authors have no conflicts of interest related to this project. Disclosures: The above named authors have no relevant disclosures related to this project.

79. The ‘‘Great Ormond Street Hospital Aide Memoire Surgical Checklist,’’—An audit of the adaption of the WHO Surgical Checklist, launched by the Safe Surgery Saves Lives campaign in 2007 F. Roberts1, A. Hughes1, I. Walker2 School of Medicine, University College Dublin, Dublin, Ireland1, Department of Anaesthesia, Great Ormond Street Hospital, London, UK2 The WHO Safe Surgery Saves Lives campaign, launched in 2007, developed the Surgical Checklist to improve global perioperative safety. Great Ormond Street Hospital developed an adapted version of this checklist to suit their specific requirements. We conducted this audit to quantify how thoroughly and appropriately this checklist was being applied. We created a checklist that encompassed each of the tasks to be performed as listed on the GOSH Aide Memoire, and whether the timing of each step was appropriate. We assessed if the checklist sheet was actually picked up and/or looked at. We observed 21 surgical cases in theatre over a two week period. Not one team completed an entire checklist. The Aide Memoire was picked up and/or looked at on 8 occasions out of a possible 63. Across the board, there was a discrepancy between particular tasks that were nearly always performed, such as consent, surgical site and drug allergies, and those that were rarely done so, such as the review of imaging and confirming warming measures. Time Out was not

S49 carried out on one occasion. A swab/instrument count was performed during all 15 Sign Outs. Across the board there were certain tasks there were nearly always performed as opposed to those that were regularly over-looked. We believe that this could be improved if team members picked up/ looked at the Aide Memoire at each relevant stage. It is clear that the shortcomings highlighted should be addressed/corrected before being re-audited at a later date. Conflicts of interest: None. Disclosures: None.

80. An audit on vascular inpatient referrals to the pain service during a one year period in University Hospital Limerick C. McCarthy, D. Harmon Department of Anaesthesia and Pain Medicine, Limerick University Hospital, Dooradoyle, Limerick, Ireland Vascular surgical patients have significant pain issues. These can increase patient morbidity and mortality (1,2). This is a retrospective audit set out to analyze inpatient pain service referral patterns in vascular patients in University Hospital Limerick. Patients were identified using our inpatient pain service referral forms, these were assessed to ensure they met our inclusion criteria of suffering from a vascular disease process and had an inpatient pain referral. We analysed the demographics, modes of presentation, background risk factors, previous relevant surgeries and analgesic management. The majority of patients were male (58 %) with 42 % female patients. The most common reason for referral was pain due to acute on chronic limb ischemia (42 %), post (vascular)operative pain (26 %), chronic limb ischemia (26 %), requirement for analgesia during vascular dressing change (13 %), Other (\ 1 %). 90 % patients consulted had oral analgesia prescribed, 23 % had oral analgesia and opioid patches, 26 % oral analgesia and second intervention including epidurals/sympathetic blocks. Overall, patients being referred to the pain service most commonly had been previously prescribed Step1/2 of the WHO pain ladder (63 %) with little adjuvants being used. We propose the continuing education of our fellow doctors on effective multimodal pain management and a multidisciplinary approach to pain management to optimize outcomes for our patients. Conflict of interest: none Disclosures: none

81. Opening statements of patients attending pain clinic consultations A. Imran, D. Harmon Department of Anaesthesia and Pain Medicine, Limerick University Hospital, Dooradoyle, Limerick, Ireland Consultation is the bedrock of medical practice. Medical interview is divided into phases for the purpose of study and teaching. The patient’s opening statement is an important part of medical

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S50 interviewing. From the opening statement, the physician obtains information about the patient’s concerns and agenda. Previous studies have found that 75 % of the patients complete their opening statement in less two two minutes. Importantly 77 % of patients are interrupted before the completion of their opening statement. Interruptions result in loss of information and decreased patient satisfaction. Several doctors will have seen chronic pain patients, prior to their pain clinic visit. They will have experienced interruptions in their opening statements regularly. It is the perception that these patients need to be directed to get valuable information with economical use of time. The opening statement of pain patients has not been studied previously. We designed a prospective observational study to assess the length of time of the opening statements in these patients. Ethics committee approval and informed consent was obtained. A standardized open-ended question was used by the pain physician. The opening statement was recorded by an investigator. Factors that may influence length of opening statement were also recorded. Conflict of interest: none Disclosures: none

82. Anaesthesia websites: what patients really want? F. Kavanagh, V. Malone, O. Murphy, G.J. Fitzpatrick Department of Anaesthesia, Critical Care and Pain Medicine, AMNCH, Tallaght, Dublin 24, Ireland Online information gathering by patients regarding their health is common, fostering collaborative physician patient relationships and greater engagement with medical services [i]. However it has been suggested that the medical profession has not made best use of this resource [ii]. The fact that only 25 % of Departments of Anaesthesia in Ireland having dedicated websites or webpages would support this suggestion. The aim of this study was to examine the attitudes of patients in the Republic of Ireland towards the provision of online information about anaesthesia and hospital Departments of Anaesthesia. Patients presenting to the pre assessment clinic of AMNCH were randomly selected and answered an anonymous 19 section survey on their attitudes on the role of a dedicated website for Departments of Anaesthesia and the content they feel would be most appropriate for such a website. 52 patients responded to the survey. Results included: 40.3 % of patients (n = 21) reported they would be either very likely or likely to visit a dedicated website, 66 % (n = 33) would like to see information included on the qualifications of medical staff working in the department, 97.6 % (n = 48) of patients felt information on pre-operative preparation was important, 76 % (n = 35) felt the inclusion of downloadable patient information leaflets on a website would be valuable. The results demonstrate significant patient demand for online information from individual Departments of Anaesthesia. Clearly more work in this area is required to bridge this gap and ensure that our patient’s needs are met. References: I.

Iverson SA, Howard KB, Penney BK. Impact of internet use on health-related behaviors and the patient-physician relationship J Am Osteopath Assoc. 2008 Dec;108(12):699-711. II. Sechrest RC. The internet and the physician-patient relationship. Clin Orthop Relat Res. 2010 Oct;468(10):2566-71 Conflict of interest: Nil Disclosures: Nil

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83. Selection of optimum Baska mask size in male patients, an initial study V. Alexiev1, A. Ochana2, A. Quinn3, T. Foto3, J.G. McDonnell4, J.G. Laffey5 Clinical Tutor and Clinical Lecturer1, Specialist Registrar2, Registrar3, Consultant and Senior Clinical Lecturer4, Department of Anaesthesia, Galway University Hospitals and, National University of Ireland, Galway, Ireland; and Professor, Department of Anaesthesia, St Michael’s Hospital, Toronto, and University of Toronto, Canada5 Introduction: The Baska mask is a novel supraglottic airway device, with postulated attractive features including superior airway seal, non-inflatable cuff potentially reducing the risk of oropharyngeal tissue damage and gastric reflux protection. Recommendations were provided by the manufacturer to guide size selection. However there is no published clinical data to support size choice in male patients. We sought to determine if criteria could be established to define appropriate size of device, to assess ease of use, and to record any immediate or short term complications associated with device use. Methods: Following approval from Galway University Hospital Ethics Committee and informed consent 28 patients were recruited. A stopping rule was used to end recruitment. A standardised intravenous induction was provided. Size of mask used initially was determined by manufacturer guidelines. Masks were placed by one of two operators, each with over 30 prior Baska mask insertions in female patients.Criteria for Successful placement were predefined. Successful mask size, number of attempts, duration to placement and a user rated device difficulty score was recorded, and a leak test performed. Complications (desaturation, lip or teeth damage, blood staining on mask removal, laryngospasm) were recorded. Throat pain, dysphonia and dysphagia were recorded using a 10 – point verbal rating score (VRS) in recovery and on the 1st and 3rd postoperative day. Results: The overall insertion success rate was 93 % and the first attempt success rate was 71 %. The mean airway leak pressure was 32.8 cm H2O. While audible leak was present immediately after successful placement in 54 % of patients, after 5 min only in 4 patients (15 %) suggesting that the cuff seal improved over time. Size 5 Baska mask was used successfully in 53.6 %, size 6 in 35.7 % and size 4 in 3.6 %. There is an argument to use a size 5 mask initially except in taller males where a size 6 mask may be the first choice. Intraoperatively we had to adjust the mask position in 2 patients and use alternative airway device 1 patient. No laryngospasm occurred on emergence. There was blood staining on mask removal in 8 patients, but the incidence of throat pain, dysphonia and dysphagia up to 3 days postoperatively was low. Conclusion: The Baska mask demonstrated high airway leak pressures. The first placement attempt success rate was low. Our data demonstrate a trend towards larger size mask in patients with higher weight or height but unambiguous guidance could not be derived.

84. Severe cerebral malaria in ICU in a Dublin Hospital R. Chaudhri, K. Hurley, C. Fagan Department of Anaesthesia and Intensive Care, St James’s Hospital, Dublin, Ireland Introduction: Malaria is caused by the transmission of Plasmodium (P) species, P. falciparum leading to the most severe form with


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increased mortality. In 2010, 6,244 cases of malaria were imported to Europe (1) with 82 cases in Ireland. Two deaths due to malaria have been reported in Ireland between 2005 to 2009 (2). Case: We report a 53-year old female who presented to their primary hospital with a 3-day history of fever, rigors and night sweats after recently returning from Africa where she visited regularly. She had not taken malaria prophylaxis prior to travel on this occasion. At presentation due to a reduced level of consciousness (GCS 7) she needed to be placed on a life support machine and was transferred to our ICU for tertiary care. A blood smear showed parasitemia of 28 % (P. falciparum) confirming malaria. Intravenous artesunate was commenced and supportive care in ICU continued. An MRI brain confirmed cerebral malaria showing extensive signal abnormality involving the meninges, corticospinal tracts, thalami, pons and upper medulla. Clinically she had significant rigidity of both her arms and legs consistent with extensive upper motor pathology. Given the MRI findings it was initially felt her condition was unlikely to improve. However subsequent MRI scans showed an improvement after 2-weeks of supportive treatment and this was accompanied by clinical improvement. She was discharged from hospital 3-months later having recovered well. Conclusion: This case highlights the occurrence of severe malaria in Dublin and the importance of chemoprophylaxis for prevention of malaria and that it also emphasizes that radiological imaging while supportive of the diagnosis is not specific to prognosticate on individual cases. References:

Conclusion: Patients with liver disease requiring intensive care admission have significantly high in-hospital mortality, particularly when renal replacement therapy is required. In the face of dramatic increase in the number of cases of liver disease and alcoholic liver disease, it is imperative that an individualized approach is taken with close consultation between intensive care physician, hepatologist, the patient and family regarding severity, prognosis and escalation of care. References:

1. World Health Organization Regional Office for Europe: Centralized information system for infectious diseases (CISID). 2012. 2. Burden of imported malaria in Ireland: recommendations for surveillance and prevention September, 2010

1. Follow up arrangements for breast cancer patients; is it appropriate to transfer surveillance to general practice?

Conflict of interest: none

D. Kerrigan1, M. Ryan1, P.S. Waters 1, J. Hanaghan2, M.Irfan1,3, W. Khan1

85. Outcome of patients admitted to intensive care with liver disease

Department of Surgery, Mayo General Hospital, Mayo, Ireland1, Department of Radiology, Mayo General Hospital and Galway University Hospital, Mayo, Ireland2, Discipline of Surgery, Galway University Hospital, Galway, Ireland3

Dr. T. McDonnell, Dr. K. Clarkson University College Hospital Galway, Galway, Ireland Background: Critical care admissions due to liver disease and particularly alcoholic liver disease have increased drastically in the past 25 years according to figures from the UK. (1) Patients with cirrhosis and chronic liver disease are amongst the most physiologically challenged of in-patients and have long been recognized as a cohort of patients with significant mortality. (2) The aim of our study was to identify admissions to the intensive care unit with liver disease, the burden of alcoholic liver disease amongst these patients, the degree of organ support required and overall mortality in this particular cohort of patients. Methods: A retrospective study was performed using our clinical patient management system: Clinical Information Systems (CIS). We used this system to identify and collect data about patients with liver disease admitted between 1st January 2010 and September 30th 2013 excluding liver trauma and liver metastases. Results: 28 patients were identified. Median age for the identified cohort of patients was 57 (37 to 83), 64 % male and 36 % female. The aetiology was alcoholic liver disease in 86 % of those admitted to the intensive care. The average ICU admission was 7.36 days (1-75) and the average total hospital admission was 22.08 days (1-107). Mortality in ICU was 33 % and in-hospital mortality during admission amounted to 50 %. 54 % of patients were intubated, 61 % of patients admitted required vasopressor therapy, 32 % required renal replacement therapy. In those requiring renal replacement therapy there was an 89 % mortality rate with one patient surviving to discharge.

1. Foreman MG, Mannino DM, Moss M. Cirrhosis as a risk factor for sepsis and death: analysis of the National Hospital Discharge Survey. Chest 2003; 124: 1016–20. 2. Shellman RG, Fulkerson WJ, DeLong E, Piantadosi CA. Prognosis of patients with cirrhosis and chronic liver disease admitted to the medical intensive care unit. Crit Care Med 1988;16:671-8 3. Rossaint R; Bouillon B; Cerny V et al. Management of Bleeding Following Major Trauma: An Updated European Guideline. Crit Care. 2010;14(2):R52 Conflict of interst- Nil Disclosures-Nil

General Poster Session

The National Cancer Registry Ireland predicts a 53 % increase in breast cancer incidence by 2030 which will place an increased demand on already stretched hospital resources. The aim of this study was to examine the evidence base for hospital follow up of breast cancer survivors and to identify patient preferences for hospital or community follow up. We surveyed General Practitioner attitudes towards community follow up and quantified the incidence of new or recurrent cancers within a patient cohort to identify their primary symptoms and thus cancer detection in the community. A 22 item questionnaire was distributed to 101 breast cancer survivors randomly chosen from a cohort of 921 patients. A 9 item questionnaire was distributed to 81 General Practitioners. A review of pathology, radiology and clinical records from a single surgeon was performed to identify new diagnoses. Minitab v.18 was used for statistical analysis and p \ 0.05 was considered significant. There is no evidence base to support hospital follow up after primary treatments are completed. Patients are reassured by hospital outpatient appointments (74 %) but have high levels of confidence in General Practitioner follow up (67 %). General Practitioners are equally divided regarding their support for the transfer of oncologic follow up to primary care(51 % v 49 %). Ten of the 14 new cancer episodes identified during a six year surveillance period were associated with obvious clinical signs (p \ 0.05). In conclusion this study suggests that the proposed transfer of follow up for breast cancer patients to general practice by the national cancer control programme is appropriate. Conflict of interest: None Disclosures: None

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2. Management of paediatric acute appendicitis in the general hospital setting — a national survey of preferred surgical technique I. Robertson, M. Costello, N. Shea, I. Khan, R. Waldron, W. Khan, K. Barry Department of Surgery, Mayo General Hospital, Castlebar, Co Mayo, Ireland The advent of laparoscopic surgery has facilitated the management of acute appendicitis in the adult population. In the paediatric population (\12 years), management varies according to institution and/or consultant expertise. The aim of this study was to analyse consultant preference for laparoscopic versus open appendicectomy in the management of acute appendicitis in children under twelve years presenting to general hospitals. A fourteen-point questionnaire was distributed to 81 consultant surgeons identified from the specialist register of the Irish Medical Council and practicing as general surgeons outside of specialist paediatric centres. A response rate of 83 % (67/81) was obtained. Of the 67 surgeons surveyed, eleven (16 %) had formal paediatric training. Sixty percent (40/67) of surgeons expressed a preference for the open technique. The median frequency of on-call rota was [1 in 5 (32/67) and only 3 % (2/67) claimed that the on-call commitment influenced decisionmaking regarding surgical approach. The average minimum age (9.3 years, range 1–14) and average minimum weight (25 kg, range 12–70) at which the operating surgeon would perform a laparoscopic appendicectomy was also recorded. Thirty percent (20/67) of consultant general surgeons had immediate access to specialist paediatric laparoscopic equipment. This study has shown wide variability amongst consultant general surgeons when considering open versus laparoscopic appendicectomy in children under twelve years. Restricted access to specialist paediatric laparoscopic equipment, combined with declining exposure to paediatric surgical training, may continue to limit the numbers of paediatric laparoscopic appendicectomies performed in the general setting. Conflict of interest: None Disclosures: None

3. The use of smartphone applications by urology trainees G.J. Nason, M. Burke, M. Akram, S. Giri, H.D. Flood Department of Urology, University Hospital Limerick, Limerick, Ireland Objective: Smartphones are becoming an indispensible adjunct to their professional lives for time management and lifelong learning to ultimately provide better patient care. Applications are downloadable software with specific roles. The aim of this study was to assess the use of smartphone applications among urology trainees in Ireland. Methods: An anonymous electronic survey was distributed via Survey Monkey Ò to all urology trainees in Ireland assessing their ownership and use of smartphones and downloadable applications. A search of urology applications was performed using the Apple App Store and the Android Market. Results: 36 (81.8 %) of trainees responded with 100 % ownership of smartphones. 28 (77 %) report downloading applications with 11 (30.6 %) reporting paying for them. The mean number of applications downloaded was 4 (Range 1–12). 16 (44.4 %) trainees think

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Ir J Med Sci (2014) 183 (Suppl 1):S1–S69 applications for smartphones are very useful in clinical practice, 14 (42.4 %) think they are useful. A total of 126 urology applications were available. 76 (60.3 %) were designed for physicians, 46 (36.5 %) for patients, 2 (1.6 %) for students and 2 (1.6 %) for urological nurses. Conclusion: There are an ever increasing number of urology applications available. Urology trainees are using smartphones as an educational and reference tool and find them a useful adjunct in clinical practice. No conflicts of interest. No disclosures.

4. Investigating changing patterns in chemotherapy prescribing since the introduction of oncotypedx L. Hughes, T.P. McVeigh, P.S. Waters, M. Keane, K.J. Sweeney, M.J. Kerin Discipline of Surgery, National University of Ireland, Galway, Ireland Introduction: The use of chemotherapy in node-negative, ER-positive breast cancer has changed dramatically since the introduction of OncotypeDX to determine systemic recurrence risk based on tumour genomic signature. Aims: This study aims to 1. Document longitudinal changes in chemotherapy use 2. Assess the impact of new evidence on local protocol Methods: A cohort study was undertaken, including consecutive patients with early node-negative, ER-positive breast cancer diagnosed between 2006 and May 2013, including a period of prospective clinical trial (TAILORx) recruitment. Data was collected regarding patient demographics, tumour clinico-pathological features, OncotypeDX use and recurrence score, and chemotherapy use. All therapeutic decisions were made following multidisciplinary discussion, with adherence to guidelines and consideration of trial protocol and OncotypeDX recurrence scores. Results: 513 consecutive patients were included in the study, of whom 243(46 %) underwent OncotypeDX testing, 97(19 %) as part of the TAILORx clinical trial. OncotypeDX and chemotherapy use are outlined below:

Time Period

20062008

September October 20102011-May October 2013 2011 Not As part of Not Approved available TAILORx routinely for use in Ireland trial available 65 216 75 157

OncotypeDX test availability Number of patients treated OncotypeDX 0 use (n(%)) Chemotherapy 37(57) Use (n(%))

2008August 2010

97(45)

19(26)

127(81)

108(50)

34(46)

51(32)

A total of 230(45 %) patients received chemotherapy. The use of chemotherapy changed in inverse proportion to the availability of the genomic assay. Of those patients in whom OncotypeDX was utilised, 139(57 %) were spared chemotherapy.

Ir J Med Sci (2014) 183 (Suppl 1):S1–S69 Conclusion: This study validates the use of molecular testing in the rationalisation of systemic therapy. Conflict of Interest: Nil Disclosures: Nil

5. Nasogastric nutrition in severe acute pancreatitis: a systematic review and meta-analysis D. Nally, E. Kelly, M. Byrne, P.F. Ridgway Department of Surgery, Limerick University Hospital, Limerick, Ireland Background: In severe acute pancreatitis, enteral nutrition is conventionally administered via naso-jejunal (NJ) tubes to minimise pancreatic stimulation. Nasogastric (NG) delivery may present an alternative route. Objectives: The primary objective was to evaluate feasibility and efficacy of nasogastric feeding. Secondary objectives were to compare nasogastric and naso-jejunal routes and assess the side effects of the NG route. Methods: A systematic review and meta-analysis was performed. Clinical trials were identified via electronic databases. Study selection and data extraction was performed by two reviewers independently. An approved tool was applied to assess the quality of included studies. Results: 450 records were screened. Six and four studies were included for qualitative review and meta-analysis respectively. 147 patients received NG nutrition; exclusive NG feeding was achieved in 90%(133/147). 87%(129/147) received 75% of target calories. In studies where all subjects achieved exclusive NG feeding, 82%(74/90) exceeded 75 % of intended kilocalories. Compared to NJ nutrition, there was no significant difference in delivery of 75 % of nutritional goals, (Pooled Risk Ratio (RR)1.02; 95 % confidence interval (CI) 0.75–1.38.) nor increased risk of change to TPN (pooled RR1.05; 95 % CI 0.45–2.48;) diarrhoea, (pooled RR1.28; 95 % CI 0.62–2.66;) exacerbation of pain, (pooled RR1.10; 95 % CI 0.47–2.61;) or tube displacement (pooled RR0.44, 95 % CI 0.11–1.73). Vomiting and diarrhoea were the most common NG side effects (13.3 % and 12.9 % respectively.) 11.2 % required rate reduction; 3.4 % dislodged the tube. Other side effects included elevated aspirates (9.1 %); abdominal distension (1.5 %); pain exacerbation (7.5 %) and increased disease severity (1.6 %). Conclusion: Nasogastric feeding is feasible and efficacious in 90 % of patients. Further research comparing NG and NJ nutrition is required. Conflict of Interest: None

6. Endovascular management of distal renal artery aneurysms. preservation of branches using multilayer stent R. Flaherty, M. Alawy, S. Sultan Western Vascular Institute, Department of Vascular and Endovascular Surgery, Galway University Hospital, Newcastle Road, Galway, Ireland Objective: We describe our experience in multilayer stenting of distal renal artery aneurysms with relation to patency of side branches, aneurysm shrinkage and renal function.

S53 Report: Between 2009 and 2011 three patients underwent multilayer stenting of distal renal artery aneurysms. The first was referred by a urologist complaining of abdominal pain and had a 25 mm juxta-renal aneurysm at the bifurcation of the upper and lower pole vessels with 4 side branches. The second had an incidental finding of a 2.5 cm aneurysm at the origin of the artery supplying the upper pole in the hilum. The third presented with loin pain and was found to have a 4.4 cm saccular aneurysm at the renal hilum. All three patients were treated with FluidSmart 3D Cardiatis multilayer stents. Results: Patients had a mean follow up of 30 months. They were assessed by repeat CT scan post-operatively and renal function tests. There were no immediate post-operative complications or mortality. None of the aneurysms increased in size during the follow-up period. One patient’s aneurysm shrank by 10mm, from 25 to 15 mm over 19 months. The largest aneurysm at 4.4 cm thrombosed while the stent remained patent to the kidney. This patient was subsequently referred to a nephrologist for management of his cortical/cystic kidney disease. Conclusion: Multilayer stenting can be used to treat branched or distal renal artery aneurysms with exclusion of the aneurysm from the circulation while successfully preserving the flow to the side branches and kidney. Conflict of Interest: There is no financial arrangement or other relationship that could be construed as a conflict of interest. Disclosures: I affirm that all data in the above abstract to be true and supported by proper documentation.

7. Not so clear cut: how well does 1.5T MRI staging of prostate cancer correlate with histological staging? a single centre study P. Staunton, P. Lonergan, M. Morrin, F.Keeling, G. Smyth, R. Power Departments of Urology and Radiology, Beaumont Hospital, Dublin 9, Ireland This study looked at the frequency of the use of 1.5T MRI staging of prostate cancer prior to prostatectomy under two teams at Beaumont Hospital and how well, when undertaken, this staging correlated with histological stage post prostatectomy. Data was collected retrospectively on all prostatectomies completed during the period of July 2011 to July 2013. The individual case data was collected via the department’s prostate cancer database. The presence of an associated staging MRI was established via online radiology records while histology results were obtained from the Beaumont Histology Results Office. In all there were 136 prostatectomies performed of which twenty seven (19.9 %) were performed following MRI staging scan. Of the 27 staging MRIs performed, there were 17 cancers staged at T2, 9 cancers staged at T3 and 1 at T4. For T2 staged cancers, only 8 (47 %) appeared to be correctly staged when compared to the corresponding histological stage reflecting 53 % of cases being upstaged to stage T3. Of the nine T3 staged cancers, none were upstaged to T4 but 7 (78 %) were down staged to T2. This included four T3a and three T3b cancers. The data collected highlights the relatively modest use of MRI staging of prostate cancers in our centre. In our limited series, MRI staging was not consistent for T2 or T3 disease. A further study with a larger sample size in addition to the use of multi-parametric MRI is needed to accurately assess the role of MR in pre-operative staging in our institution. Conflict of interests: None Disclosure: N/A

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8. Risk factors associated with the diagnosis of abdominal aortic aneurysm in an Irish screened population W. White1, S.M. McHugh1, P. O’Halloran1, B. Murphy2, E. Boyle1, M. Allen1,2, P. Naughton1, D. Moneley1, A. Leahy1 Department of Vascular Surgery, Beaumont Hospital, Dublin 91, Department of Surgery, Connolly Memorial Hospital, Blanchardstown, Dublin 152 Introduction: The question as to whether screening for abdominal aortic aneurysm (AAA) should be introduced and who should be screened is an ongoing source of debate. Some authors have recommended screening of high risk groups. Previous studies have attempted to identify what risk factors could be used to identify those in whom screening might be cost-effective. Methods: A pilot AAA screening programme was commenced and carried out over a four year period. Male patients over 60 years were contacted and invited to attend for duplex aortic ultrasound. Clinically significant AAA were referred from the screening programme to vascular surgery. Data collated was exported to SPSS version 20 for statistical analysis with p \ 0.05 considered significant. Results: Overall 1304 males underwent AAA screening. The mean age was 63.8 years. The majority (n = 1275, 97.8 %) did not have a clinically significant aneurysm (\3 cm). Of the remainder, 20 (1.5 %) had an AAA \4 cm, with 6 (0.5 %) AAAs 4–5.5 cm discovered. In total 3 (0.2 %) AAAs of size greater than 5.5 cm were noted. With regard to risk factors, previous histories of ischaemic heart disease (IHD) or cerebrovascular event (CVA) were significant predictors of having an AAA (p = 0.013, p = 0.011). Prior history of hypertension, hypercholesterolaemia, smoking or diabetes was not noted to have a statistically significant association. Conclusion: The efficacy of screening men aged 60 years or older and have a history of IHD or CVA should be evaluated in randomised controlled trials.

9. Treatment of abdominal aortic aneurysms in patients with total iliac occlusion M. ElKassaby, M. Alawy, M. Zaki, W. Tawfick, N. Hynes, S. Sultan Western Vascular Institute (WVI), Department of Vascular & Endovascular Surgery, College Hospital, Galway (UCHG), Newcastle Road, Galway, Ireland Objectives: Aorto-Uni-Iliac (AUI) stent grafts are still a viable option for treatment of abdominal aortic aneurysms (AAA), especially in ruptures (rAAA) or associated severe comorbidities. Severe occlusive arterial disease is a common radiological finding in AAA patients although they may not always manifest clinically to the same degree. Deploying an AUI graft with a femoro-femoral crossover bypass is a solution to this situation, albeit by adding precious time performing the bypass. We present our experience with AAA, with associated total occlusion of one iliac axis and high comorbidities, successfully treated with AUI stenting, without crossover bypass. Results: From 2002 to 2013 a total of 537 EVARs were performed in our tertiary referral centre. 481 were elective and 56 emergency rAAAs. 494 cases received Aorto-Bi-Iliac grafts. 43 had AUI grafts. 37 AUI procedures were performed with femoro-femoral crossover. Six where done without a crossover. In those 6 patients, primary technical success was 85 % (n = 5), and assisted primary technical success was

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Ir J Med Sci (2014) 183 (Suppl 1):S1–S69 15 % (n = 1). None were converted to open repair, or ruptured during follow-up. Primary clinical success at 24months was 85 % (n = 5) and assisted primary clinical success was 15 % (n = 1). No incidence of post-operative critical lower limb ischemia. 2 patients experienced mild chronic ischemic symptoms in the contralateral limb, relieved with conservative medical treatment. Conclusion: The femoro-femoral crossover routinely performed with AUI configuration can be omitted in asymptomatic or mildly symptomatic, iliac artery occlusion. This saves precious operative and anesthetic time in high risk patients, without compromising the vascularity of the limb. Conflict of Interest: There is no financial arrangement or other relationship that could be construed as a conflict of interest. Disclosures: None of the authors have anything to disclose.

10. Electronic communication & eHealth solutions in the vascular surgery clinic J.H. Belchos1,3, M. Wheatcroft1, S. Bandali2, N. Archer2, A. McKibbon2 and M.A. Moloney1,2 Department of Vascular Surgery, St. Michael’s Hospital, Toronto, Canada1, eHealth, McMaster University, Hamilton, Ontario, Canada2, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland3 The patient-physician interaction remains the pivotal event in the treatment algorithm of any disease process. A paradigm shift in information communication technologies (ICT) has provided each party with multiple informative and interactive communication options. ICT is revolutionizing healthcare delivery, understanding that certain subgroups of patients warrant careful identification and education. The goal of this study was to analyze current trends of ICTs in a vascular surgery clinic and to assess their applicability in elderly patients. A patient satisfaction and usability survey was distributed to 278 patients in the clinic, which assessed patient accessibility and willingness to use ICTs to communicate with the clinic and proficiency with self-service technologies. The response rate of the survey was 94 %. 73 % of responders were over 60 years old; with the majority (76 %) preferring home phone for communication. 68 % of patients had cell phones, however only 25 % use text messaging, and would communicate with the clinic via text message. 62 % of patients use email, and half would welcome clinic email communication. When assessing patient technological expertise, nearly 75 % of patients have never used most self-service methods. Within our patient population computer use, Internet access and cell phone use are well below the Canadian average of 78-83 %. Even with advances in ICTs, the majority of vascular surgery patients would not benefit from implementing these relatively new technologies. Nonetheless, change within healthcare ICT is occurring and vulnerable patients need to be educated and informed so they can continue to derive maximum benefit from the healthcare system. Conflict of Interest: There are no conflicts of interest present with any of the authors. Disclosures: None of the parties have any disclosures.

11. Predicting risk in breast cancer: an assessment of screening tools A. Al-Tuama1, J.C. Bolger2, T. Roche2, A.D.K. Hill2 School of Medicine, Royal College of Surgeons in Ireland, Dublin 21, Dept of Surgery, Beaumont Hospital, Dublin 92

Ir J Med Sci (2014) 183 (Suppl 1):S1–S69 Introduction: Breast cancer diagnoses have remained static in Ireland over the last decade, with approximately 2,400 new cases of breast cancer diagnosed annually. Referrals to symptomatic breast services continue to increase. Many of these referrals are for risk assessment of patients with a family history of breast cancer. There are no standardised guidelines used for assessing risk based on family history. Aims: to assess the utility of three different scoring systems for determining family history risk in breast cancer. Methods: 104 consecutive asymptomatic family history referrals were assessed using the NICE criteria, the IBIS scoring system and the Manchester score. Risk estimations were compared across each group to determine variability among risk assessment techniques. Results: There were significant discrepancies in estimating risk assessment using the NICE criteria and the IBIS system. The NICE criteria placed 68 % of patients at medium or high risk as compared with 84 % using IBIS (p = 0.01). Although the NICE criteria recommend consideration for genetic testing in those considered high risk (n = 43), only 9 patients were considered high risk from a BRCA mutation using the Manchester score. Discrepancies in scoring were detected in 46 % of patients. Conclusions: There are significant discrepancies between scoring systems for assessing family history in breast cancer. The NICE criteria are quick and cost effective and should be considered for use in primary care. Due to the IBIS scoring system’s amalgamation of multiple factors it may be useful for dedicated family history clinics. Other scoring systems should be used as adjuncts where appropriate.

12. Contrast enhanced digital mammography — a useful adjuvant to digital mammography? McGuire A, Relihan N, O’Leary DP, Ryan M, Redmond HP Department of Surgery, Cork University Hospital, Corcaigh, Ireland Introduction: Digital mammography has been shown to increase accuracy in detecting breast cancers. Contrast agents have been used in both CT and MRI to explore angiogenesis in breast cancer. Contrast enhanced digital mammography (CEDM) represents a novel technique combining traditional digital mammography (DM) with intravenous administration of contrast medium. Aim: To compare performance of CEDM to DM in both detection and accuracy in predicting tumour size in breast cancer patients. Methods: A retrospective review of our initial experience with CEDM was conducted. Newly diagnosed breast cancer patients between June 2011 and March 2013 were included in the analysis. Detection rates were directly compared. Predicted tumour size in each modality was compared to actual pathology size and was considered concordant if imaging size was within +/- 1cm of pathology size. Results: 87 patients in total had CEDM performed. The median age was 50 years (37–73). 45/87 patients were subsequently diagnosed with breast cancer on core biopsy, median tumour size 25 mm(1–110). Of the 45 cancers, the digital mammogram alone revealed 40 (88.88 %) cases, which were suspicious for malignancy. In comparison, using CEDM, 42(93.33 %) of the cases had suspicious enhancement. CEDM was concordant in 47.05 % of cases, while DM was only concordant in 35.29 %. Conclusion: The results of this study show that CEDM is a useful adjuvant to standard DM in detecting breast cancer. It was also a more accurate predictor of tumour size and could improve the amount of clear margins in breast conserving surgery.

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13. Axillary burden is higher for node-positive breast cancer patients detected by fine-needle aspiration cytology when compared with those detected by a sentinel lymph node biopsy M.M.R. Boland1, I. Daskalova1, Z. Al Hilli1, D. Evoy1, J. Geraghty1, J. Rothwell1, A. O’Doherty2, C. Quinn3, R.S. Prichard1, E.W. McDermott1 The Departments of Breast Surgery1, Radiology2 and Pathology3, St.Vincent’s University Hospital, Dublin 4 Emerging evidence indicates that node-positive breast cancer (BC) patients with a low axillary burden may not benefit from axillary clearance (AC). The aim of this study was to determine axillary nodal burden in patients with positive axillary ultrasound-guided fine needle aspiration cytology (FNAC) compared with those who had negative FNAC followed by a positive sentinel lymph node biopsy (SLNB). A retrospective study was performed involving all patients with BC between 2010 and 2012 who had pre-operative ultrasound guided FNAC. Nodal burden was examined in all patients who proceeded to axillary clearance. Patients who had pre-invasive/recurrent disease, neoadjuvant chemotherapy or who did not undergo axillary surgery were excluded. 407 patients were eligible for analysis. 141 (35 %) had positive FNAC and 266 (65 %) had negative FNAC. Of the 266 FNAC-negative patients, 84 had positive SLNB (Micro-Metastasis, n = 13). The mean total number of lymph nodes (LNs) excised during AC in FNAC-positive patients was 26 vs. 23 in SLN-positive patients (Unpaired t-test; p \ 0.05). The mean number of involved LNs was 7.9 (range 0–47) in FNAC-positive patients vs. 2.8 (range 1–25) in SLN-positive patients (Chi Square test; p \ 0.0001). 49 % of SLNpositive patients had only 1 involved LN, 23 % had 2, and 28 % had C3. 13 % of FNAC-positive patients had 1 involved LN, 12 % had 2, and 74 % had C3. FNAC positive patients have a higher axillary burden than FNAC negative patients with a subsequent positive SLNB. Over 70 % of the SLN positive patients may fulfill the Z0011 trial criteria and may not require further surgery. Conflict of Interest: There are no conflicts of interest Disclosures: There are no disclosures

14. Factors affecting time-to-theatre in 1000 cases of suspected appendicitis S. Beecher, D.P. O’Leary, R. McLaughlin Department of Surgery, University College Hospital Galway, Galway, Ireland Acute appendicitis is increasingly being managed in the setting of a dedicated emergency theatre in keeping with recently published acute surgery guidelines. Despite this however, delays are still encountered between the time of diagnosis and going to theatre. Thus, the aim of this study is to identify factors that influence time-to-theatre (TTT) and to observe the effect of prolonged TTT on patient outcome. A retrospective review of an electronic prospectively maintained database was performed between 31/12/11 and 19/10/13. Factors thought to influence TTT were highlighted. A delay was defined as TTT [8 hours as per acute surgery guidelines. Data analysis was performed using SPSS 20. A total of 1,000 cases of suspected acute appendicitis were identified. Median age was 19 years. Appendicectomy was performed in 90.7 %. 68.1 % underwent laparoscopic appendicectomy. 66.5 % had

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S56 histological appendicitis. Overall mean TTT was 12 hours, 27 minutes. There was a significant association between TTT \8 hours and male gender (p = 0.024), younger age (p = 0.001), no pre-operative radiology (\0.001), elevated WCC (p = 0.007), elevated neutrophils (p = 0.01) and histological confirmation of a perforation (p \ 0.001). Pre-operative radiology was obtained in 26.2 % and increased TTT by 52 % (p \ 0.001). However delayed TTT did not affect outcome variables including post-operative collection (3.59 % v 4.38 %, p = 0.528), readmission rate (6.54 % v 5.72 %) and length of stay (3.1 days v 3.34 days, p = 0.823). In conclusion, this study highlights key factors that influence TTT for a patient with suspected appendicitis. Delays in TTT are not associated with worse patient outcomes; however identification of these influential factors will contribute to emergency theatre efficiency.

15. Pre-operative levels of interleukin-6 (IL-6) and vascular endothelial growth factor (VEGF) predict higher post-operative tumour stage in colon cancer patients N.M. Foley, D. Hechtl, P. O’Leary, J.H. Wang, R.W. Pfirrman, H.P. Redmond Department of Academic Surgery, Cork University Hospital and University College Cork, Co. Cork, Ireland Introduction: Evidence suggests a role for pro-inflammatory cytokines during tumour development. Increased expression of IL-6 has been associated with an unfavourable prognosis in sporadic and colitis associated colorectal cancer.1 High serum VEGF levels pre-operatively has also been associated with reduced survival in colorectal cancer patients.2 Aim: To correlate pre-operative levels of pro-inflammatory cytokines with tumour size, TNM stage, outcome and to establish if there was any association between tumour characteristics and patient outcome. Methods: A prospective database was maintained. Data collected included patient demographics, tumour characteristics and postoperative follow-up. Data was tabulated and statistical analysis was performed using SPSS software (version 20). Results: 25 patients were included for analysis. There was a statistically significant difference in pre-operative IL-6 levels between T4 (n = 10) and T1-3 (n = 15) tumours (p = 0.034). The same held true for VEGF levels (p = 0.026). Difference in mean IL-6 and VEGF levels was not significantly associated with tumour size (p = 0.66, p = 0.757 respectively). High pre-operative levels of IL-6 and VEGF had no effect on disease free or overall survival. IL-6 and VEGF levels were significantly higher in right-sided tumours compared for left-sided tumours (p = 0.03, p = 0.012 respectively). Conclusion: IL-6 and VEGF levels were significantly higher in colorectal cancer patients with more advanced tumours. IL-6 and VEGF had no effect on tumour size, disease free and overall survival. Interestingly, right-sided tumours were associated with higher levels of these pro-inflammatory cytokines. This is a novel finding with potential for further research in this field. References 1. Waldner MJ, Foersch S, Neurath MF, Interleukin-6 – A Key Regulator of Colorectal Cancer Development. IJBS 2012; 8(9):1248–1253 2. Werther K, Christensen IJ, Nielsen HJ et al, Prognostic impact of matched preoperative plasma and serum VEGF in patients with primary colorectal carcinoma. J Cancer 2002, 417–423 Conflict of interest/disclaimer – This study has been kindly sponsored by Geistlich Pharma AG

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16. An international multi-centre review of the malignancy rate of excised papillomatous breast lesions N.M. Foley1, J. Racz2, T. Cil2, C. Holloway2, L. Romics3, Z. Matral4, B. Bennett1, S. Nofech-Moses5, E. Slodkowska5, L. Mallon3, M.A. Corrigan1 Breast Research Centre, Cork University Hospital, Cork, Ireland1, Department of Surgical Oncology, University of Toronto, Ontario, Canada2, Department of Breast Surgery & Pathology, Victoria Infirmary, Glasgow, Scotland3, Department of Breast and Sarcoma Surgery, National Institute of Oncology, Budapest, Hungary4, Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada5 Background: lesions of the breast are a relatively rare, but heterogeneous group ranging from benign to atypical and malignant lesions. There is ongoing debate regarding their management. This study sought to determine the rate of malignancy in excised breast papillomas and to elucidate whether a population of patients exists, in which surgical excision may be unnecessary. Methods: multicentre international retrospective review of core biopsy diagnosed breast papillomas and papillary lesions from 2009 to 2013 was performed. Patient demographics, histopathological and radiological findings were recorded. All data were tabulated and statistical analysis was performed using SPSS (V20). Results: total, 213 core biopsy proven papillomas were included. In this sample, 15 (7 %) invasive carcinomas of the breast were identified. At core biopsy, 23 % of papillomas demonstrated atypia; of these 38.7 % were found, at surgical excision, to be either carcinoma in situ or invasive cancer. In contrast, only 17.7 % of specimens with no atypia at core biopsy were upgraded to in situ or invasive disease. Conclusion: international dataset is one of the largest in the published literature relating to breast papillomas. The overall risk of malignancy for those aged\50 was found to be 13 %. For those aged[50 the risk increased to 32 %. Atypical papillomas and those in patients aged[50 should be excised, however the risk of malignancy among women aged \35 years with no atypia is minimal. This may present an opportunity to study the natural history of these lesions in young asymptomatic women. Conflict of interest/disclaimer - None

17. What is the role of sentinel lymph node biopsy in triple negative breast cancer patients? A. Butt, S. O’Reilly, J. Gilmore, L. Kelly, M.A. Corrigan Breast Research Unit, Cork University Hospital, Cork, Ireland Background: Traditionally the role of sentinel lymph node biopsy (SLNB) was in determining the surgical management of the axilla. However, several recent studies including ACOSOG Z11 & MA-20 have challenged the traditional management paradigm of breast cancer. Additionally, an improved understanding of the biomolecular basis of breast cancer has identified that subgroup of triple negative tumours as behaving more aggressively than other subtypes. This study sought to determine the clinical role of SLNB in triple negative breast cancer in 2013. Methods: All triple negative breast cancers at Cork University Hospital between 2009–2013 were identified using a prospectively collected database. A mock multidisciplinary team was established to review each case. Members were presented with separate records containing (A) all axillary information (B) Just a sentinel node result and (C) No axillary information, and asked to recommend treatment

Ir J Med Sci (2014) 183 (Suppl 1):S1–S69 for each based on the information available. Recommendations were recorded, tabulated and compared. Results: A total of 74 patients were identified in the study period. Twenty-two patients underwent mastectomy while 52 were managed with breast conserving strategies. The medical oncology recommendation was not influenced in any case by the SLNB result, while it altered the surgical management of 17 patients (23 %). A total of 67 patients (91 %) had their radiotherapy recommendation changed as a result of the presence or absence of a SLNB result. Conclusion: Although originally a tool for determining the surgical management of the axilla, SLNB in triple negative breast cancer does not alter the surgical or medical management of the majority of patients. However the data provided by SLNB does play a role in directing the radiotherapy regimen recommended. Conflict of interest: None. Disclosures: None.

S57 Reconstruction following pancreaticoduodenectiomy using a pancreaticogastrostomy (PG) has remerged as a potential safe and beneficial alternative to the traditional pancreaticojejunostomy (PJ)1 specifically by reducing incidence of post-operative pancreatic fistula (POPF). This retrospective audit compared complications, weight change, length of stay and use of pancreatic enzyme replacement therapy (PERT) in patients who underwent a pancreaticoduodenectomy carried out by two surgeons at this centre who recently introduced this approach. The last 20 patients referred to the pancreatic dietitian were reviewed, and data collected regarding baseline nutritional status, preoperative symptoms, procedure type, post operative complications and weight change. SPSS version 19 was used for statistical comparison and analysis. Patient Characteristics (n = 20, 9 PG and 11PJ)

Mean (SD)

18. Clinician-led telephone clinic — the way forward A. Galbraith, D. Collins, B. McGovern, M.C. Whelan, C.M. Shabaz, P.C. Neary, D.O. Kavanagh

Age (years)

63.8 (10.6)

BMI (kg/m2)

24.5 (4.3)

Pre op weight loss (%)

2.57 % (4.2)

POD light diet attempted

3.5 (0.761)

Department of Surgery, Tallaght Hospital, Dublin, Dublin 24

Post op LOS (day)

23.15 (20)

Recently there has been increased demand for outpatient specialist assessment. Unfortunately this has become increasingly challenging for both the patient and primary physician to access. In our department we have recognised the need for change and identified a subset of patients suitable for telephone follow-up, therefore relieving the pressure upon the out-patient department. Our aim was to audit the role of a clinician-led telephone clinic in reducing waiting times. Low risk patients who underwent key procedures including appendicectomy, cholecystectomy and hernia repair; devoid of significant postoperative morbidity were selected. Clinician-led clinics were successfully piloted over a five month period. Subsequently we extended the population to include follow-up of endoscopic, anorectal and daycare procedures. A clinician-led telephone clinic was held at 6 weekly intervals, allowing the assessment of up to 60 patients. A retrospective analysis of patient outcomes was performed. 214 patients have been included. 81 % of patients contacted were discharged back to their general practitioner, with subsequent written notification provided. 4.6 % required a repeat telephone call. 3.2 % were called back to the mainstream clinic appointment. 8.4 % were booked for an additional day case/endoscopy procedure. To conclude telephone clinics provide an opportunity to carefully assess large volume of patients, whilst providing a robust follow-up system of pathology reports which is paramount for patient safety. Furthermore, this strategy has ensured achievement of key performance indicators as defined in the national service plan. Future work is aimed at evaluating patient satisfaction and expanding the patient cohort. Conflict of interest: None of the authors have any conflict of interest Disclosure: Nothing to disclose

Post op weight loss (%)

5.5 % (5.52)

19. Pancreaticogastrostomy versus pancreaticojejunostomy post-whipples — an audit to compare patient complication and outcome A. Hughes1, N. Linnane1, O.M. Griffin2, D. Maguire1, E. Hoti1 Department of Surgery, St. Vincent’s University Hospital, Dublin1, Department of Nutrition and Dietetics, St Vincent’s University Hospital, Dublin2

There were no significant difference in complications, length of stay or weight change according to reconstruction type. 60 % of patients commenced PERT whilst inpatient, however all patients required PERT on OPD attendance. Positive correlation was found between POPF and wound infection (p \ 0.05), and with BMI at surgery and post-operative weight loss (p \ 0.05). These results are limited given the small sample size, but show no difference in patient outcome in terms of reconstruction methods. They do highlight the need for service improvement irrespective of anastamosis type: specifically adopting an ERAS approach to avoid delay in resuming oral intake, and timely initiation of PERT. References: 1. Topal B, Fiews S, Aerts R, Weerts J,Feryn T, Roeyn G, Bertrand C, Hubert C, Janssens M, Closset J. Pancreaticojejunostomy versus pancreaticogastrostomy reconstruction after pancreaticoduodenectomy for pancreatic and periampullary tumours: a multicentre randomised trial. Lancet Oncology 2013, 14:655–662. Conflict of interest: None. Disclosures: None.

20. Ureteroscopy in a paediatric population: is it a useful tool? R. Headon, S. O’Regan, G.J. Nason, M. Burke, H.D. Flood Department of Urology, University Hospital Limerick. Medical Student, Graduate Entry Medical School, UL Introduction: With the development of smaller and smaller ureteroscopes, endoscopic treatment of urolithiasis has become easier and safer. The aim of this study was to assess the use, efficacy and safety of ureteroscopy for urolithiasis in a paediatric population. Methods: A retrospective review was performed of all patients under the age of 16 years who underwent ureteroscopy between 1996 and

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2013. Patient demographics, stone position, stone clearance and subsequent stone formation were recorded. Results: 8 patients underwent 21 ureteroscopic procedures during the study period. The mean age was 6.5 years (range: 8 months–16 years). All patients were male. 5 patients had documented positive urine cultures. 2 patients had an abnormality on biochemical stone profile. An underlying secondary diagnosis or a positive family history of urolithiasis was not observed in any patient. Two had rigid ureteroscopy, 7 had flexible ureterorenoscopy and 1 had a subsequent open procedure. 7.5 or 6 French adult ureteroscopes were used in all patients. No patients required ureteric dilation. JJ-stents were utilised in 7 patients. All patients required further treatment in the form of ESWL. Stone clearance was achieved in 7 patients. However, 3 patients subsequently developed further stones. The mean follow up of 7 discharged patients was 6 years 7 months (range: 4 months–9 years 10 months), 1 patient is still undergoing treatment of ESWL. Conclusion: Ureteroscopy is a rare but useful tool in the treatment of stones in a paediatric population.

underwent PC between 2008 and 2012. Data was collated and analysed using Stata 9.0. Results 37 patients underwent 38 PC’s during the study period, (22 male;15 female). Median age was 72 years (range 30 to 90 years). Median ASA grade was 3 with all patients recording multiple comorbidities (78 % with cardiac history, 35 % with respiratory, 24 % malignancy). Median length of stay was 17 days (range 6–124 days). 44 % required High Dependency or Intensive Care Unit level care. Cholecystostomy remained in situ for a median 10 days (range 1–50). Overall 30-day mortality was 14.3 %. 11 of 35 patients proceeded to have completion cholecystectomy with an open rate of 55 %. Complications were recorded in 3 cases (8 %). Conclusion Percutaneous cholecystostomy is an accepted and safe form of treatment for acute cholecystitis in a select subset of patients with multiple comorbidities. Our outcomes compare with the published literature, however, an overall shorter duration of drainage and younger patient cohort are noted. Conflicts of interest: The authors declare no conflicts of interest Disclosures: No disclosures

Tables

Patient Stone Position

Diagnostic Modality

1

Distal Left Ureteric stone + Bilateral Staghorn calculi

X-Ray KUB

2

Inadequate information

3

Left Staghorn calculus + Distal Left ureteric X-Ray KUB stone

4

Distal Right ureteric calculus

CT KUB

5

Staghorn calculus left kidney

X-Ray KUB

6 7

PUJ obstruction Left renal pelvis + proximal ureter calculi, Right renal pelvis calculus

US KUB X-Ray KUB

8

Lower pole calculus Left kidney

US KUB

Conflict of interest: None Disclosures: None

21. Percutaneous cholecystostomy — indications and outcomes in an Irish population

22. Outcome of deceased donor renal transplantation in patients with an ileal conduit L.C. McLoughlin, N.F. Davis, C.M. Dowling, R.E. Power, P. Mohan, D.P. Hickey, G.P. Smyth, M.M.P. Eng, D.M. Little Department of Urology and Transplantation, Beaumont Hospital, Dublin Renal transplantation in patients with an ileal conduit is uncommon and occasionally controversial as it has been associated with high rated of morbidity and mortality. 17 patients with an ileal conduit received a deceased donor renal transplant at out institution between January 1986 and December 2012. We retrospectively reviewed their allograft and surgical outcome. There were 4 mortalities at 5, 5, 39 and 66 months post transplant. 16 of 17 grafts functioned immediately; 1 patient had primary non function secondary to vascular thrombosis. 13 of 17 (76.5 %) grafts were functioning at a mean follow up period of 105 months. The mean serum creatinine at latest follow up was 111lmol/l (±38.62) 5 patients had 7 episodes of urosepsis requiring hospital admission and 5 patients were treated for renal stone disease post transplant. We conclude that given improvements in immunosuppression, surgical technique, infection treatment and selection criteria, we believe that renal transplantation in the patient with an ileal conduit yields excellent graft survival although there is a high morbidity rate in this cohort of patients in the long term. Conflict of interest: None Disclosure: None

C.W. Fitzgerald, M.K. O’Reilly, T. Geoghegan, G.P. McEntee Department of Surgery, Mater Misericordiae University Hospital, Dublin 7, Ireland Aims Percutaneous cholecystostomy (PC) has gained popularity as a minimally invasive form of treatment for acute cholecystitis, particularly in patients with poor pre-morbid performance status and the critically ill. The aim of this study was to assess the indications and outcomes of patients undergoing PC. Methods A retrospective review of relevant prospectively maintained patient databases (Hospital Inpatient Enquiry system (HIPE), the HSE National Integrated Medical Imaging System (NIMIS) database and local hospital records) was performed to identify patients who

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23. Ex vivo reconstruction of the donor renal artery in renal transplantation: a case control study L.C. McLoughlin, N.F. Davis, C.M. Dowling, R.E. Power, P. Mohan, D.P. Hickey, G.P. Smyth, M.M.P. Eng, D.M. Little Department of Urology and Transplantation, Beaumont Hospital, Dublin Transplantation of renal allografts with anatomic variability or injured vasculature poses a challenge to the transplanting surgeon. These grafts can be salvaged for transplantation with ex vivo bench

Ir J Med Sci (2014) 183 (Suppl 1):S1–S69 reconstruction of the vasculature. We investigated whether renal allograft function is impaired in these reconstructed allografts, compared to the donor-matched, un-reconstructed allograft. Reconstructed allografts were transplanted into 60 recipients at our institution between 1986 and 2012. Data was collected from the operative records of these patients and from the National Renal Transplant Database. A control group was selected from the matched pair of the recipient in deceased donor transplantation. We found no significant difference in the overall graft and patient survival rates (p = 1.0, p = 0.178). Serum creatinine levels were not significantly higher in the study group at 1, 3 and 12 months post operatively (p = 0.08, p = 0.4385, p = 0.6961). There were 2 cases of vascular thrombosis in the study group that were not related to the ex vivo reconstruction. A significantly greater proportion of reconstructed patients were investigated with a Doppler ultrasound post operatively (p = 0.007). Although we have demonstrated a higher index of clinical suspicion of transplant failure in patients with a reconstructed allograft, this practice has proven to be a safe and useful technique with equivocal outcome when compared to normal grafts thus increasing the organ pool available for transplantation. Conflict of interest: None Disclosure: None

24. An evaluation of the correlation between primary tumour and lymph node response following neoadjuvant therapy in breast cancer C. Fleming, K. McCarthy, M.J. O’Sullivan, H.P. Redmond, M.A. Corrigan Breast Research Centre, Cork University Hospital, Cork, Ireland, University College Cork, College Road, Cork, Ireland Background: Neoadjuvant therapy (NAT) offers a unique opportunity to assess tumour response to systemic agents. However a discrepancy may exist between the response of the primary tumour & involved nodes, perhaps reflecting biomolecular differences. This study sought to assess the frequency of discordance in this response post NAT. Methods: All node positive patients receiving NAT at the Southern Breast Cancer Centre at Cork University Hospital from 2009-2012 were identified through a prospectively collected database. Basic demographics, along with radiological & pathological features were tabulated & analysed. Nodal response were estimated from standard pathological response to treatment measurements. Statistical analysis was performed using SPSS (version 21). Results: A total of 66 node positive patients had completed surgery & were eligible for inclusion. Median age was 50 years (range 38–75), all patients underwent axillary clearance and 64 % underwent mastectomy. Statistical significance was seen in improvement of tumour grade following NAT (p \ 0.01) and a 51 % average reduction in tumour size was observed. There was an overall positive correlation between tumour and lymph node (LN) response following NAT (Spearman correlation coefficient 0.541, p \ 0.001). Eleven patients achieved a LN complete pathological response (CPR) with all having a CPR in tumour also. A CPR in the tumour predicted complete nodal response in 73 % of cases. Conclusion: While correlation was seen between tumour and LN response following NAT, 27 % of primary tumours with CPR had persistently positive LN’s. This represents a significant discordance between the primary tumour and the LN and may represent a concern for the potential lack of response of occult systemic metastasis. A biomolecular analysis of these is being determined. Conflict of Interest: NIL

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25. The role of Nissen’s fundoplication in the management of GERD in patients with cystic fibrosis B. Fiore1, H. Henegan1, E.F. McKone2, C.J. Gallagher2, J. Geoghegan1 Department of Hepatobiliary Pancreatic Surgery1, Department of Respiratory Medicine, St. Vincent’s University Hospital, Dublin, Ireland2 Introduction: Gastroesophageal Reflux Disease (GERD) is 7 times more common in Cystic Fibrosis (CF) patients. GERD can affect nutritional status and plays a role in the development of bronchiolitis obliterans syndrome among patients who have undergone lung transplantation. The aim of this study was to assess the effects of antireflux surgery in CF patients Methods: All CF patients who underwent Nissen’s fundoplication in St Vincent’s University Hospital were identified, and their demographic and clinical data reviewed. Primary outcomes were changes in weight and FEV1 from 24 months preoperatively to 24 months postoperatively. Results : Between January 2002-October 2013 11 CF patients (7 female, median age 28 years) underwent laparoscopic Nissen’s fundoplication. Of these, 4 had undergone lung transplantation. Preoperatively, all patients were symptomatic despite medical therapy for GERD and the median DeMeester score was 114. Mortality and morbidity rates were 0 % and 18 % respectively (2 patients experienced mild postoperative dysphagia, which resolved with expectant management). Median postoperative length of stay was 6 days. The median FEV1 24 months prior to fundoplication was 62 %, at the time of the surgery it was 49 %, and 24 months postoperatively it was 56 % (p = ns). There was no significant change in weight or BMI in the postoperative period. At 24 months postoperatively all patients were asymptomatic (45 % had discontinued antireflux therapy). Conclusions: Nissen’s fundoplication is a safe and effective treatment for GERD in CF patients. Further studies are necessary to establish if early surgical treatment of GERD can delay FEV1 deterioration and improve their nutritional status. Conflict of interest: None Disclosures: None

26. Assessing the quality of online information for patients with carotid disease – an observational study C.J. Keogh1, S.M. McHugh2, A. Hannigan1, D. Healy2, M. Clarke Moloney2, P.E. Burke2, E.G. Kavanagh2, P.A. Grace1,2, S.R. Walsh1,2 Graduate Entry Medical School (GEMS), University of Limerick, Co. Limerick, Ireland1, Department of Vascular Surgery, University Hospital Limerick, Co. Limerick, Ireland2 Introduction: Controversy exists relating to carotid endarterectomy (CEA) versus carotid artery stenting (CAS). We aimed to assess the quality of online patient information relating to both. Methods The Google search engine was searched for ‘‘carotid endarterectomy’’ and ‘‘carotid stenting’’. The first 50 webpages returned were assessed. The Gunning Fog Index (GFI) and Flesch Reading Ease Score (FRES) were calculated to assess the readability. The LIDA tool (Minervation Ltd, Oxofrd, U. K.) was used to assess accessibility, usability and reliability. Results : 20 % (n = 10) of the webpages returned for CEAA were from peer reviewed sources with 34 % (n = 17) posted by hospitals

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S60 or health services. Comparatively, for CAS, 40 % (n = 20) were peer reviewed with 16 % (n = 8) posted by hospitals or health services. GFI and FRES scores indicated webpages for both CEA and CAS had poor general readability. Webpages for CEA were easier to read than those for CAS (mean FRES difference of 6.7 (95 % CI 0.51 to 12.93, p = 0.03). Median LIDA scores demonstrated acceptable reliability, accessibility and usability of information for both CEA and CAS webpages. The more readable webpages were not associated with higher LIDA scores for either CEA or CAS webpages. Conclusion Webpages providing information on carotid disease management must be made more readable. Online information currently available to patients regarding CAS is more difficult to read and comprehend than CEA.

27. Hematologic indices predict oncologic outcomes in colon cancer J. Hogan1, J. East2, G. Samaha2, M. Medani1, W. MacKerricher2, S. Polinkevych2, S.R. Walsh1,2, J. Calvin Coffey1,2,3 Department of surgery, University Hospital Limerick, Co. Limerick, Ireland1, Graduate Entry Medical School, University of Limerick, Co. Limerick, Ireland2, Center for Interventions in Infection, Inflammation and Immunity (4i), Graduate Entry Medical School, University of Limerick, Ireland3 Background : Systemic inflammation is associated with adverse oncological outcomes in colorectal cancer (CRC). Therefore markers of systemic inflammation such as the neutrophil/lymphocyte ratio may be associated with long-term oncological outcomes. This study aimed to characterize the relationship between several ratios derived from hematologic indices using a classification and regression tree analysis. Methods : Hematologic white cell ratios were established for all patients undergoing colonic cancer resection (N = 436) with curative intent in a regional cancer center. The optimal ratios associated with overall survival were established in a training set (n = 386) using a classification and regression tree technique (CRT). The association between ratios and overall survival was assessed in a separate test set (n = 50). Within the test set, two groups were generated based on each ratio (above and below the cut-off point identified in the training set). The association between ratios and overall survival was assessed using a stepwise cox proportional hazards regression model. Results : CRT analysis identified the following optimal hematological ratios associated with adverse overall survival (OS): neutrophil/ lymphocyte ratio (NLR) greater than 3.40 and white cell count/lymphocyte ratio (WLR) greater than 5.28. NLR [ 3.40 was an independent predictor of adverse OS on multivariate analysis (HR 3.4, 95 % CI 2.64 – 5.13, p \ 0.001). WLR [ 5.28 (HR 4.10, 95 % CI 3.13 – 7.42, p = 0.03) was also an independent prognostic factor. Conclusions: Multiple ratios derived from standard hematological indices are independent predictors of overall survival.

28. Case series of patients with diabetic foot ulceration in Galway University Hospitals R. Mannion1, E. Young2, D. Gallagher3, D. Walsh4, S.F. Dinneen1,5 School of Medicine, National University of Ireland Galway (NUIG), Galway, Ireland1, Merlin Park Podiatry Clinic, Galway, Ireland2, Medical Assessment Unit, Galway University Hospitals, Galway,

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Ir J Med Sci (2014) 183 (Suppl 1):S1–S69 Ireland3, Midwestern Regional Hospital, Limerick, Limerick, Ireland4, Dept. of Diabetes and Endocrinology, Galway University Hospitals, Galway, Ireland5 Aim: This audit aimed to describe all patients with active diabetic foot ulceration in Galway University Hospitals (GUH) between April 2012 and March 2013. Methods: We undertook a retrospective review of clinical and laboratory records (over the two years prior to ulceration) among patients attending the Diabetes Day Centre (DDC), Merlin Park Podiatry Clinic (MPPC) and hospital inpatients. Information was sourced from the DIAMOND Clinical Information System, the MPPC chart, hospital inpatient enquiry (HIPE) records and electronic-discharge summaries. Results: 129 patients, 16 (12 %) had type 1 diabetes and 113 (88 %) type 2 diabetes. Ulcer type was neuropathic (41 %), neuro-ischaemic (19 %), or ischaemic (16 %). Ulcer documented as healed in 18 %, not healed in 22 %, and not documented in 60 %. Foot deformity and neuropathy was present in 22 % and 59 % respectively. Peripheral vascular disease was documented in 29 %. 12 % were current smokers and 34 % past smokers. 33 % had BMI [30kg/m2. HbA1c was [53mmol/mol in 34 % and not documented in 54 %. 28 % of patients had amputations (this would be 17 % if toe amputations were excluded; a lot of the literature defines it in different ways and usually excludes toes; amputation rates vary between 14-20 % in international studies). Wheelchair use documented in 4 %. 70 % were taking antihypertensive medication. 36 % had retinopathy. Stage 3 or further stages of chronic kidney disease was in 22 %. Microalbuminuria was reported in 16 %. 28 % had ischaemic heart disease and 6 % had cerebrovascular disease. 48 % of patients were taking insulin, 66 % oral hypogylcaemics, 70 % anti-platelet drugs, 8 % warfarin and 73 % statins. Conclusion: This is the first report detailing diabetic foot ulceration in GUH. This data provides a baseline to compare patient outcomes in future years on a local and national level. Conflict of interest: None Disclosures: None

29. Evolution in management of the axilla in node positive breast cancer A. Nic an Rıógh, M. McAllister, E.M. Quinn, K.J. Sweeney Department of Breast Surgery, University Hospital Galway, Galway, Ireland Traditionally breast cancer patients with positive sentinel lymph node biopsies (SLNBs) underwent axillary clearance (AC) followed by adjuvant chemotherapy. We aim to assess the impact of recent changes in management of the axilla1 in node positive breast cancer.We performed a retrospective cohort study of patients with positive SLNBs between January 2011-December 2012 at our institution. Data was collected via hospital discharge records and pathology reports. We specifically looked at dates of initial surgery and completion of all adjuvant therapies, and pathological evidence of chemotherapy response.During the study period, 103 patients had positive SLNBs. 57 patients progressed to AC, of which 22 had chemotherapy prior to completion AC. Nine of these patients had positive nodes at AC, of whom three showed partial/complete chemotherapy response. Our results are summarised below. In conclusion, our study shows evidence of changing management of the axilla in breast cancer. Without impacting on overall time to completion of therapy, chemotherapy prior to completion AC provides prognostic information for SLNB positive patients requiring AC.


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Positive SLNB n 5 103 AC: n 5 57

No AC: n 5 46

3.08

4.32

SLNB Mean nodes B3 nodes positive

51

46

[3 nodes positive

6

0

T1

17

12

T2

29

27

T3

10

5

T4

0

0

Tis

0

Chemotherapy

Pre AC 22

Radiotherapy

Yes No Yes No

Tumour Stage

15

31. White-cell-count lymphocyte ratio (WLR) is highly accurate in predicting complicated diverticulitis

2

7

Post AC None 27 8 17

10

Mean duration of therapy 269 181 255 167 (days)* Patients with Positive Nodes at AC

assigned the highest proportion of patients to the high probability of appendicitis group (45 %, p \ 0.001). A high AIR score was associated with high specificity (97 %) and positive predictive values (88 %) but a specificity (33 %) that was lower than the Alvarado score (80 %) or surgical assessment (63 %). Conclusions: The AIR score is accurate at excluding appendicitis in those deemed low risk and in predicting it in those deemed high risk. Its use as the basis for selective CT imaging in those deemed medium risk should be considered. Conflict of interest: None Disclosures: None

8

1

Nodes with Chemotherapy 2 Effect

1

*Non-significant Reference: 1 Giuliano A.E., Hunk K.K., Ballman K.V. et al. Axillary dissection vs. no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial. JAMA. 2011, 305(6):569–75. Conflict of interest: None declared. Disclosures: None.

30. Predicting acute appendicitis? a prospective comparison of the alvarado score, the appendicitis inflammatory response score and clinical assessment D. Kolla´r, D.P. McCartan, M. Bourke, K.S.C. Cross, J. Dowdall Department of Surgery, Waterford Regional Hospital, Republic of Ireland Background: Patients presenting with suspected appendicitis pose a diagnostic challenge. The Appendicitis Inflammatory Response (AIR) score has out-performed the Alvarado score in two retrospective studies. The aim of this study was to prospectively evaluate the AIR Score and compare its performance in predicting risk of appendicitis to both the Alvarado score and the clinical impression of a senior surgeon. Methods: All parameters included in the AIR and Alvarado scores as well as the initial clinical impression of a senior surgeon were prospectively recorded on patients referred to the surgical on call team with acute right iliac fossa pain over a 6-month period. Predictions were correlated with the final diagnosis of appendicitis. Results: Appendicitis was the final diagnosis in 67 of 182 patients (37 %). The three methods of assessment stratified similar proportions (*40 %) of patients to a low probability of appendicitis (p = 0.233) with a false negative rate of\8 % that did not differ between the AIR score, Alvarado score or clinical assessment. The Alvarado score

N.G. Wan Lin1, Hwa Jong Song1, Rishabh Sehgal1, Peter O Leary1, John Hogan1, J.C. Coffey1,2 University Hospital Limerick, Limerick, Ireland1, 4i center for intervention in infection, inflammation and immunity, University Hospital Limerick, Limerick, Ireland2 Introduction: The lack of a single effective and sensitive test for diverticulitis (DD) posed a great challenge in assessing disease severity. No test accurately distinguishes between complicated and uncomplicated DD. The aim of this study was to determine whether inflammatory markers and hematological ratios could be utilized to predict disease activity in DD. Methods: We conducted a retrospective analysis of DD patients a 5-year period. CT scans were utilized to categorize patients as complicated and uncomplicated DD. Hematological and inflammatory indices were recorded for each admission. White cell count/lymphocyte ratio (WLR), neutrophil/lymphocyte ratio (NLR) and white cell count/neutrophil ratios (WNR) were generated and evaluated with respect to their association with complicated diverticulitis. A summary receiver operating characteristic (sROC) curve was generated with respect to each inflammatory marker and ratio in order to determine parameters that correlated with disease severity. Results: 228 cases of DD were included in the analysis (101 complicated, 127 uncomplicated). Lymphocyte count was the only inflammatory marker not predictive of complicated diverticulitis (AUC 0.47, p = 0.43). WLR (AUC 0.95, p \ 0.001) was highly accurate in distinguishing complicated and uncomplicated disease (sensitivity 85 %, specificity 98 %). Remaining inflammatory markers were moderately predictive of complicated disease: WCC (AUC 0.64, p = 0.001), CRP (AUC 0.63, p 0.02), platelets (AUC 0.60, p 0.02) and neutrophils (AUC 0.62, p = 0.005). Conclusions: The current study demonstrates the limited predictive properties of inflammatory markers in identifying complicated DD. WLR, however, was highly accurate in distinguishing complicated and uncomplicated DD. Conflict of interest: None Disclosures: None

32. Stop The Clot! an analysis of venous thromboembolism prophylaxis in general surgical patients in sligo regional hospital R. Connolly, C. Connolly, Z. Khan Department of Surgery, Sligo Regional Hospital and School of Medicine, National University of Ireland, Galway

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S62 Background: Deep Venous Thrombosis (DVT) and pulmonary embolism (PE) are manifestations of venous thromboembolism (VTE). VTE events are the most common cause of death in the inpatient setting1. It is estimated that the use of low molecular weight and unfractionated heparins in ‘‘at risk’’ patients can reduce symptomatic VTE disease by up to 50 % and fatal PE by 66 % 2. Optimised prophylaxis would result in better patient outcomes, shorter lengths of hospital stay and reduced overall cost 2,3. Objectives: The aim of this study was to determine the portion of surgical patients at risk of VTE in Sligo Regional Hospital and to assess whether these patients were in receipt of appropriate thromboprophylaxis. We aimed to compare current practices employed in this hospital to the recommendations outlined in the latest NICE clinical guidelines. We wish to recommend methods of improving doctor compliance with prescription of prophylactic therapies. Methodology: All general surgical inpatients in Sligo Regional Hospital were assessed on the basis of a hospital chart, drug kardex and clinical review on a single date in November 2013. A pro forma based on NICE Clinical Guidelines 92, ‘‘Venous thromboembolism; reducing the risk’’, Jan 2010, was used as the auditing tool. Risk factors for VTE and bleeding, outlined in Table 1, were included. The date of initiation of pharmacological and/or mechanical treatment was noted as well as the dose of pharmacological VTE prophylaxis. Results: The average age of the 33 patients included in this study was 66 years old; with ages ranging from 35 to 92 years. All patients were assessed for VTE/bleeding risk. 30 % of patients had at least one risk factor for bleeding and 100 % had at least one risk factor for VTE. 38 % of patients were classified as high risk for VTE, with the remainder being of moderate risk. VTE prophylaxis was given appropriately to 72 % of patients. Of the patients provided with appropriate thromboprophylaxis, 38 % had no prophylactic cover for twenty-four hours or more due to delayed prescription. The dosing was not always appropriate. 28 % of patients were in receipt of inappropriate prophylaxis, with almost half of this cohort receiving no prophylactic therapy whatsoever. Conclusion: Despite long-standing recognition of the risk of VTE in surgical patients, venous thromboprophylaxis remains underutilized. Passive dissemination of guidelines alone is unlikely to improve VTE prophylaxis practice. A number of active strategies are required, such as a specialised segment on the drug kardex, clinician education workshops and frequent auditing. We suggest that all drug kardexes remain invalid until a VTE risk assessment has been conducted and appropriate prophylactic cover prescribed by the relevant member of the treating team. These strategies would ensure that at-risk patients receive appropriate care with the added benefits of shorter hospital stays and reduced overall cost to Sligo Regional Hospital4. References: 1. White RH, Zhou H, Romano PS. Incidence of symptomatic venous thromboembolism after different elective or urgent surgical procedures. Thromb Haemost 2003; 90:446. 2. Kent et al. Improving venous thromboembolic disease prophylaxis in medical inpatients; a role for education and audit. Ir J Med Sci, 2011; 180; 163–166.

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Ir J Med Sci (2014) 183 (Suppl 1):S1–S69 3. Cohen et al. Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study); a multinational cross-sectional study. The Lancet, 2008 Feb; 371 (2):387–394. 4. Boddi M, Barbani F, Abbate R, et al. Reduction in deep vein thrombosis incidence in intensive care after a clinician education program. J Thromb Haemost 2010; 8:121. Conflict of interest: None Disclosures: None

33. New emergency abdominal surgery course — an exciting development M. Sugrue, P. Regan, N. Couse Clinical Research Academy, General Surgery, Letterkenny Hospital, Donegal, Ireland Emergency Surgery counts for 15 to 25 % of all hospital admissions . Wide variations in delivery of care and outcomes are reported in emergency surgery. Optimising training in key emergency presentations will improve delivery of care. This paper evaluates a new Emergency Surgery Course developed through the Donegal Clinical Research Academy at Letterkenny Hospital. Methods: Common presentations in emergency general surgery were identified and a curriculum including short lectures, recent guidelines and literature review. Each were followed by interactive case discussion including video of presentation, examination imaging and surgery. The course was first run in 2012 and modified in 2103. All 50 participants attending in Dublin in July 2013 were asked to complete an evaluation. International Faculty representing the European Society of Trauma and Emergency Surgery, the American College of Surgeons, MOSES course from Australia and the Association of Surgeons of Great Britain and Ireland. Results 50 participants ranged from basic surgery trainees to consultant surgeons mainly fro Ireland. 39/50 completed evaluation forms. The mean overall ratings of 8.5/10 ± 0.9. Case discussion were rated more highly at 8.7 ± 0.2, compared to talks at 8.3 ± 0.5 37 of the 39 rated the course as ‘better than any they had previously attended’ in their surgical training. Comments were universally favourable. The course has been run in Portugal in November and should go to Spain and South America. Conclusion: The Emergency Surgery Course was an outstanding success setting a potential platform for optimizing the delivery of surgical education and enhancing Emergency Surgery knowledge. Conflict of interest: None Disclosures: None

34. Inguinal hernia repair in the elderly: patient selection is key V. Chia 1, D. Hehir 2, M.J. Kerin1 Department of Surgery, University Hospital, Galway1, Department of Surgery, Midland Regional Hospital, Tullamore, Ireland2 Introduction : Inguinal hernia repair is one of the most common surgical procedure performed. There is good evidence that both laparoscopic and open approaches have comparable results. However, there are limited studies looking at this in the elderly population (patients [70 years old).

Ir J Med Sci (2014) 183 (Suppl 1):S1–S69 Methods : A retrospective study was performed on all inguinal hernia repair performed in elderly patients over a 5 year period between Jan 2008 and Dec 2012.Demographics, patient’s medical conditions, BMI, ASA status, operative details, length of stay and complications were collected and analysed with SPSS (SPSS 17.0 Inc, Chicago, IL). p \ 0.05 was considered statistically significant. Results : There were a total of 151 patients. 61 % of the patients (n = 96) were in the laparoscopic group and 39 % of the patients (n = 55) were in the open group. The mean age was 76.8 (range 70–91) years old. In the laparoscopic group, 21 % of the patients has ASA class III compared to 41 % in the open group. Majority of the patients stayed for 1 day post operatively (66 % in the laparoscopic group, 65 % in the open group). There is no mortality in this series and the conversion rate was 4 % (n = 4). The complication rates were comparable; 33 % in laparoscopic vs 26 % in open. The most common complications in both groups were hematoma followed by urinary retention. Conclusion : Both laparoscopic and open hernia repair in the elderly population yield similar results and have acceptable outcomes. Conflict of interest: None Disclosures: None

35. Polyp and adenoma detection rates in the proximal and distal colon. Is overall polyp detection an accurate measure of quality? C. O‘Toole’’, T. Coughlan’’, P. O’Byrne1 Barringtons Hospital Limerick, Graduate entry medical school University of Limerick1 Objectives: Little is known about the correlation between the polyp detection rate (PDR) and the adenoma detection rate (ADR) in individual colonic segments. We sought to characterise and compare ADR and PDR in each colonic segment, estimate ADR using the conversion factor, APDRQ, and assess the correlation between estimated and actual ADR for each colonic segment. We hypothesised that PDR was not a good surrogate of colonoscopy quality as the ADR/APDRQ rate varied between segments. Methods: As part of a quality improvement program, a retrospective chart review was conducted of all outpatient colonoscopies performed by 8 consultant endoscopists between November 2013 and November 2014 at a single institution. PDR, ADR, and the APDRQ were calculated for each endoscopist, using data from the entire colon and then for each colonic segment separately. Actual ADR was compared with estimated ADR based on the measured APDRQ. Results: During 3051 colonoscopies, 2,285 polyps were removed; (49 %) were adenomas. PDR and ADR correlated well in segments proximal to the splenic flexure, but diverged in distal segments. ADR was significantly higher in the right colon than in the left The correlation between estimated and actual ADR using the APDRQ was significantly higher in the right colon. Conclusions: Although PDR and ADR correlate well in segments proximal to the splenic flexure, they do not correlate well in the left colon. Caution should be exercised when using PDR as a surrogate for ADR and colonoscopy quality if data from the rectum and sigmoid are included.

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Orthopaedic Poster Session 1. Metastatic transitional cell carcinoma of the tibia radiologically mimicking osteosarcoma L.P. Cunningham, B.J. O’Neill, J.F. Quinlan Orthopaedics Department, Tallaght Hospital, Dublin 24 We report a case of a 73-year-old lady with transitional cell carcinoma and no evidence of metastatic disease presenting with gradual weight loss, pretibial swelling and painful weightbearing. Investigations revealed a lesion of the right tibial diaphysis. The radiological and clinical appearance was that of primary osteosarcoma. Biopsy results revealed metastatic transitional cell carcinoma of the tibia. Intramedullary nailing was performed which relieved pain on weightbearing. The patient declined radiotherapy and was started on a palliative care regimen. This case illustrates the importance of histological diagnosis in the treatment of diaphyseal lesions. Conflict of interest: None Disclosures: None

2. Health technology implementation: the need for generic template model generation in the surgical context S.P. Murphy, Z. Coyne, S. O’Regan, J. Kelly, J.C. Coffey Department of Surgery, Mid-Western Regional Hospital, Limerick, Ireland Often the driver behind the proposal of new surgical technologies to management, the surgeon requires expert knowledge of entrepreneurship, accounting and finance for large-scale multi-million euro proposals. This study investigated the requirement for a generic template model to aid this process through an examination of the surgeon’s level of self-confidence in these areas and to ascertain the aspects of health technology implementation that surgeons find most difficult. A survey of 200 consultant surgeons in the Republic of Ireland utilised Likert and rating scales to assess self-confidence and potentially important components of a generic template. Almost all of the surgeons (96 %) who participated had no formal training in entrepreneurship, business management or finance. Few had gained experience in these fields throughout their careers with 83.3 % having never written a business plan and only 8.6 % who previously negotiated service contracts with suppliers. Consequently, the majority of surgeons (66 %) had little confidence in their ability to propose a new technology to their hospital management. The components of the generic template most valued by surgeons were associated with aiding in the complex process of cost analysis and identification of value in the surgical system. The study has identified the need for generic business model generation for new technology purchases in the surgical context with a focus on identifying value in the surgical process and providing a framework for cost analysis.

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S64 References: 1. Healy D.A., Murphy S.P., Burke J.P., Coffey J.C. Artificial interfaces (‘‘AI’’) in surgery: Historic development, current status and program implementation in the public health sector. Surg.Onc. 2013 22(2):77-85 2. Kaplan R.S., Porter M.E., How to solve the cost crisis in health care. Harv.Bus.Rev. 2009 89(9):46–52 Conflict of Interest: None Disclosures: None

3. Total hip replacement in patients with haemophilia — risk of bleeding and haematoma formation K. Ryan, G. Colgan, J. Baker, T. McCarthy, N. Hogan Department of Orthopaedics, St James Hospital, Dublin 8 Undergoing a major surgical intervention such as total hip replacement (THR) with a rare underlying clotting disorder like Haemophilia poses its own unique challenges. Despite the advances in factor replacement and medical management, the potential for excessive and uncontrolled haemorrhage exists. The aim of this study was to quantify blood loss, peri-operative transfusion requirements and risk of haematoma formation in a cohort of patients with haemophilia undergoing THR in the National Centre for Hereditary Coagulation Disorders, compared to normal controls. All patients with Haemophilia Type A+B who had undergone THR in the last 10 years were identified. A comprehensive review of operative records, laboratory parameters and peri-operative haematological management was conducted. Ten male patients (11 THR) were identified. Mean age was 54 yrs (2869yrs). The mean intra-operative blood loss was 570mls (200-1250mls) compared to 440mls (50-670mls) in normal controls, which was significant (p \ 0.05). Mean drop in haemoglobin was 3.4g/dl in 48 hours. Only one patient required a post-operative transfusion of 2 units Red Cell Concentrate. There were no complications of haematoma formation. In conclusion, the results in our Institution compare favourably with the established blood loss in the literature, and by assessment with International Guidelines.1,2Average blood loss in patients with haemophilia was higher than in normal controls, but there were no increased transfusion requirements. Conflict of interest: None Disclosures: nil

4. A qualitative content analysis of scoliosis narratives hosted through social media websites K.M. Ryan, A. McGrath, Cappagh

Ir J Med Sci (2014) 183 (Suppl 1):S1–S69 of hits. All clips were fully transcribed. Data was analysed using qualitative content analysis. The number of hits ranged from 522,573 to 2,431. Duration ranged from 12.52 to 1.39 minutes. Patient’s consistently reported a very positive experience. Five categories, namely (1) Pain (2) Experience with bracing (3) Experience of surgery (4) Expressing gratitude: namely to family, friends and the surgeon involved and (5) Wanting to a˜ reach out and give back’ to others with scoliosis, were key issues. In conclusion, participating in blogs has been shown to generate important peer and social support for adolescents with scoliosis. Identifying patterns of use in social media allows us to construct new paradigms of communication for the next generation of scoliosis patients. Conflict of interest: None Disclosures: nil

5. Familial predisposition for injury to the anterior cruciate ligament Stephen Brennan1, Mr. Dermot O’Farrell MCh, FRCS (ortho)2 RCSI 4th Year Medical Student, Knockdrinna, Stoneyford, Co. Kilkenny, Ireland1, The Regional Orthopaedic Hospital, Croom, Co. Limerick, Kilkenny, Ireland2 Introduction : Anterior Cruciate Ligament (ACL) injuries are common and are almost exclusively linked to sport. This study set out to determine if there is a familial predisposition for the injury. Method : A study cohort was contacted by SMS and by a follow up telephone questionnaire. Results : 308 patients were contacted during the study, with 148 (48 %) responding. 21 (14.8 %) of those who responded were found to have a first degree relative with the same injury. When all the relatives were taken into account, a total of 54 ACL injuries were accounted for across 46 patients. The average age of ACL injury was 21 years old, with 63 % of the injuries occuring before the age of 25. 96 % of the injuries were sports related, although there was no diiference in the incident of the injury across the four major sports of Rugby, Hurling, Soccer and Gaelic Football. Discussion and Conclusion : While the injury is commonly thought to be associated with contact during sports, this study has also shown that the majority of the injuries (65 %) suffered by those with a family history of the injury occurred outside the contact zone. The study also suggests that there may be a role for assessment of at risk individuals and preventive exercise programmes, such as plyometrics and dynamic balance. In conclusion a familial predisposition was shown, with more injuries occurring in non contact situations.

6. The impact of an educational intervention on the generic prescribing rate in an orthopaedic department

Cappagh National Orthopaedic Hospital, Finglas, Dublin 11 The internet has become a major source of health-related information for patients. Social media and networking host a significant amount of scoliosis related information. Previous papers looked at the prevalence of internet use among parents attending a pediatric scoliosis clinic. However, there is no published literature looking specifically at internet usage of the children themselves. This study’s objective was to apply qualitative content analysis to the most highly rated patient scoliosis narratives hosted on YouTube, thereby gaining a deeper understanding of the most critical factors from the patient’s own perspective. Data for analysis was extracted from YouTube, using the search terms ‘‘scoliosis stories’’ and ‘‘scoliosis’’. Data recorded from the top 30 rated videos included video title, author, URL, length and number

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F. Roche, S. Carolan, L.P. Cunningham, B. Suleiman Institute of Leadership, RCSI, Reservoir House, Ballymoss Road, Sandyford, Dublin 18. Trauma and Orthopaedics Department, Tallaght Hospital, Dublin 24 The aim of this observational study was to describe the impact of a non-consultant hospital doctor (NCHD) educational intervention on the generic prescribing rate in an orthopaedic department using audit and cost-analysis. Ten departmental NCHDs participated in the study. The discharge generic prescribing rate increased from a baseline period (1-31 January, 2013) rate of 38 % to a post-intervention period (1-31 March, 2013) rate of 65 %, corresponding to a net monthly financial benefit of Eur364. NCHD educational

Ir J Med Sci (2014) 183 (Suppl 1):S1–S69 intervention is successful in improving the generic prescribing rate and has a positive cost-benefit. Conflict of interest: None Disclosures: None

7. Lag screw cut out: assessing tip-apex distance and a calcar-referenced tip-apex distance L.R. Carroll, M. Athar, A. Shafqat, J.A. Harty Department of Orthopaedics, Cork University Hospital, Cork, Ireland Cephalomedullary nailing of femoral fractures employs statically locked lag screw fixation. Tip-Apex Distance (TAD) strives for centre-centre lag screw placement to reduce complications of cutout.1Recent biomechanical studies have shown calcar-referenced TAD (CalTAD), with inferior lag screw position, offers superior axial and torsional stiffness.2The aim of this study is to evaluate TAD and CalTAD in cases of lag screw cutout, and to compare them to matched controls. A single-centre, retrospective review identified cephalomedullary nail cases for proximal femoral fractures. Fifteen cutout cases were identified and 45 uncomplicated controls were matched for age, gender, and fracture pattern. TAD and CalTAD were measured. Sixty patients were reviewed, including 15 cutout cases (M=79.9yrs, SD=11.1) and 45 matched controls (M=79.5yrs, SD=10.4). Forty-four females (11 cases, 33 controls) and 16 males (4 cases, 12 controls) were evaluated. TAD for cutouts (M=22.1mm, SD=6.1, Range=14.1-37.0) was not significantly different (p=.288) compared to controls (M=20.0mm, SD=6.6, Range=9.1-38.8). Cutout occurred in 10 patients with TAD less than 25.0mm. CalTAD for cutouts (M=26.1mm, SD=8.1, Range=12.4-42.5) was not significantly different (p=.069) compared to controls (M=22.8mm, SD=5.2, Range=13.3-36.2). This is the first clinical comparison of TAD and CalTAD in lag screw cutout and matched controls. Our findings did not reach significance, however, they serve as a starting point in clinical evaluation of CalTAD. Previous studies suggest a TAD less than 25.0mm sufficiently minimizes cutout risk in dynamic lag screws. Our findings suggest that a 25.0mm ceiling may not be adequate in reducing cutout risk in devices utilizing statically locked lag screws. References: 1. Baumgaertner MR, Curtin SL, Lindskog DM, Keggi JM. The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip. J Bone Joint Surg Am. 1995 Jul;77(7):1058–64. 2. Kuzyk PR, Zdero R, Shah S, Olsen M, Waddell JP, Schemitsch EH. Femoral head lag screw position for cephalomedullary nails: a biomechanical analysis. J Orthop Trauma. 2012 Jul;26(7):414-21. Conflict of Interest: The above named authors have no conflicts of interest related to this project. Disclosures: The above named authors have no relevant disclosures related to this project.

8. Systematic review of complications in spinal surgery: a comparison of retrospective and prospective study design C.L. Power1, S. Henari1,2, J. Street3, B. Lenehan1,2 University of Limerick Graduate Entry Medical School, Co. Limerick, Ireland1, Department of Surgery, University Hospital Limerick, Co.

S65 Limerick, Ireland2, Department of Surgery, CNOSP Vancouver General Hospital, University of British Columbia, Vancouver, Canada3 This paper aims to systematically review the existing literature relating to complications of spinal surgery, in order to examine for a consensus of complications across papers and to evaluate the merits of prospective versus retrospective study design. The key words ‘‘spine surgery’’ and ‘‘complications’’ were chosen, and a MEDLINE search was performed for the years 1992-2010. We restricted our review by using only English language publications from core spine journals, focusing on adult, non oncology patients. All abstracts were reviewed by two authors (SH and BL), with consensus reached for inclusion. In each publication we noted the site of surgery, study design, year of publication, duration of follow-up, complication type, procedure level and method of complication collection. All data was inputted on an Excel database. Our search revealed 832 papers, of which 177 met our inclusion criteria. Prospectively collected studies had a higher overall reported complication rate than retrospective studies. Seventeen of 120 retrospective studies reported no complications or failed to mention them, while 6 of 57 prospective studies reported no complications or failed to mention them. Across articles there was no consensus of complications, and methodology often failed to establish a reporting system. This study identified a significant rate of complications relating to spinal surgery. We identified that prospective study design is more effective when accounting for these complications, representing a significant issue that is best studied prospectively with adherence to strict study controls. Conflict of interest: None Disclosures: None

9. The effect of cement, bone and blood on surgical gloves A.R Moriarity, A Abdulkarim, E Sheehan Department of Orthopaedics, Midland Regional Hospital, Tullamore, Ireland Introduction: Surgical gloves function as a mechanical barrier that reduces transmission of body fluids and pathogens from hospital personnel to patients and vice versa. The effectiveness of this barrier is dependent upon the integrity of the glove. Infectious agents have been shown to pass through unnoticed glove microperforations. There are no known EBM recommendations in orthopaedics as to when gloves should be changed. The aim of our study was to determine whether the intrinsic properties of sterile surgical gloves can be compromised when exposed to common orthopaedic materials in the operating theatre. Methods: Latex and neoprene surgical gloves were exposed to cement, bone shavings and blood over increasing time increments. Following each time point, the palmar surface and finger tips of the gloves were analyzed under the scanning electron microscope (SEM), and were tested for changes in contact angle and tensile properties. Results: Exposure to cement caused a significant increase in both the neoprene and latex glove porosity diameter and dispersion distance (p \ 0.05). Cement exposure also decreased the tensile properties of the gloves and increased the contact angle. Exposure to bone shavings and blood did not significantly alter either of the glove’s properties tested. Discussion: This study provides evidence that exposure to cement, a common orthopaedic material, can disrupt the intrinsic properties of the gloves worn in the operating theatre. This can lead to micro or

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S66 macro perforations putting both the patient and operating room personnel at risk of contamination. Conflict of interest: None Disclosures: None

10. Limb-sparing surgery using ringed polytetrafluoroethylene (PTFE) grafts for vascular reconstruction following excision of soft tissue sarcoma in the lower extremity A.Cullen1, S.Sheehan2, S.Dudeney1 Department of Trauma and Orthopaedic Surgery1, Department of Vascular Surgery, St Vincent’s University Hospital, Elm Park, Dublin 42 Historically, limb amputation has been the primary treatment for patients with bone or soft-tissue sarcomas involving major blood vessels of the extremities. More recently it has been shown that vascular reconstruction enables limb salvage to be achieved in patients with lower extremity sarcomas, where en-bloc removal requires resection of the major vessels.[1] Autologous venous graft for vascular reconstruction is usually the treatment of choice, with saphenous vein being the preferred conduit when it is of adequate calibre.[2]We present the case of a 30 year old male who presented with a large, high grade synovial cell sarcoma in his left thigh, which featured encasement of the distal superficial femoral and proximal popliteal vessels. The contra lateral saphenous vein was found to be of insufficient diameter for vascular reconstruction. We demonstrate the use of ringed polytetrafluoroethylene (PTFE) grafts to reconstruct the major vessels and enable limb sparing surgery. References: [1] Umezawa H, Sakuraba M, Miyamoto S, et al, Analysis of immediate vascular reconstruction for lower-limb salvage in patients with lower-limb bone and soft-tissue sarcoma. J Plast Reconstr Aesthet Surg. 2013 May;66(5):608–16. [2] Baxter BT, Mahoney C, Johnson PJ, et al, Concomitant arterial and venous reconstruction with resection of lower extremity sarcomas. Ann Vasc Surg. 2007 May; 21(3):272–9. Conflict of interest: None Disclosures: None

11. Radiation safety knowledge and practices among orthopaedic trainees M. Nugent, O. Carmody, S. Dudeney Cappagh National Orthopaedic Hospital, Finglas, Dublin 11 Fluoroscopy is frequently used in orthopaedic surgery, particularly in a trauma setting. Exposure of patients and staff to ionising radiation has been studied extensively, however little work has been done to evaluate current knowledge and practices among orthopaedic trainees. This study aimed to investigate the knowledge and practices of Irish orthopaedic trainees regarding use of ionising radiation. A confidential internet-based survey on workplace radiation safety practices was distributed via email to 40 higher specialist trainees. Questions included related to radiation safety training and regular work practices. A total of 26 trainees completed the questionnaire (65 % response rate). All reported regular exposure to ionising radiation. Compliance

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Ir J Med Sci (2014) 183 (Suppl 1):S1–S69 with body shields was high (25, 96 %), however other protective measures such as thyroid shields were less frequently employed. The ALARA (as low as reasonably achievable) principle was practised regularly by 14 (54 %). Radiation safety training was variable — while just over half (14) respondents felt adequately trained in radiation safety, 17 (65 %) had attended a radiation protection course. Use of dosimeters was particularly poor, with only 4 (15 %) using them regularly and most citing lack of availability as the main barrier. Although most Irish orthopaedic trainees have some knowledge regarding radiation safety, many do not regularly use all available measures to reduce exposure to ionising radiation. Barriers to use of protective mechanisms include lack of availability and perceived impracticality. Conflict of interest: None Disclosures: None

12. The use of diathermy in orthopaedic surgery: How safe is the tip? A.R. Moriarity, P. Coffey, A. Abdulkarim, E Sheehan Department of Orthopaedic Surgery, Midland Regional Hospital, Tullamore, Ireland Introduction: The role of diathermy in orthopaedic surgery has increased dramatically since its introduction. There are well documented hazards associated with diathermy use however no single study to date has focused on the potential for diathermy tips to cause wound contamination and infection. Our primary objective was to determine the prevalence of bacterial contamination of diathermy tips during orthopaedic surgery and to assess any correlation with surgical site infections. Methods: Diathermy tips from 86 consecutive orthopaedic procedures were cultured using direct and enriched media. None of the diathermy tips were used for the skin incision. All patients underwent an orthopaedic procedure for a non-infected condition. For each procedure an unused control diathermy tip was placed on the instrument table at the beginning of the procedure and processed similarly. All patients were followed for any postoperative complications. Results: 108 diathermy tips from 86 orthopaedic procedures were cultured. None of the tips cultured directly on blood agar demonstrated bacterial growth. Following enrichment culture, 6 (5.6 %) of the procedure diathermy tips and 1 (0.92 %) of the control tips demonstrated bacterial growth. Coagulase-negative staphylococci (83.3 %) and proprionibacterium (16.7 %) were cultured from the tips. 1 of the patients who had bacterial growth from the diathermy tip developed a superficial surgical site infection. Conclusions: Our study suggests that diathermy tips and the tissue it coagulates may not be as sterile as previously thought. There may be benefit in changing the diathermy tips during orthopaedic procedures as they may represent a possible source of bacterial contamination.

13. Multiple trauma case requiring multiple surgical disciplines- an example of successful management S. Casey1, A. McKenna1, O. Shelley1, B. Mehigan2, T. McCarthy3 Dept. of Plastic Surgery, St James’s Hospital, St James’s Street Dublin 81, Dept. of Colorectal Surgery GEMS Directorate, St James’s

Ir J Med Sci (2014) 183 (Suppl 1):S1–S69 Hospital, St James’s Street Dublin 82, Dept. of Orthopaedic and Trauma Surgery OMEGA Directorate, St James’s Hospital, St James’s Street Dublin 83 Case: 28 year old male pedestrian brought to the emergency department after collision with a truck sustaining a crush injury to his right leg and groin. He was managed following ATLS protocol. Significant blood loss necessitated numerous transfusions; his condition remained critical. Examination and imaging demonstrated multiple fractures in the right superior and inferior rami, coccyx and an open contaminated comminuted fracture of the right femur. There was degloving of his right thigh and buttock, and anal sphincter disruption. He was taken emergently to theatre for right femoral vein repair and laparosocopic defunctioning colostomy by the Colorectal team. A right retrograde femoral nail was inserted by the Orthopaedic team. Multiple wound debridements of his right thigh and buttock were necessary with VAC dressings post-operatively. A split thickness graft was placed after several weeks along with longterm prophylactic antimicrobials. His condition gradually improved. Repeat Xrays confirmed good callus formation and progressive weight bearing was recommended. Intense MDT input facilitated home discharge 3 months later. Uncomplicated femoral intramedullary nail removal took place one year later. Attempted debridement and grafting of a presacral non-healing ulcer failed to take. However with conservative management the wound healed slowly. Complete mobilization and stoma reversal are the next steps in recovery. A multidisciplinary approach to the trauma patient remains the cornerstone of optimal care. A damage control approach to surgical procedures should guide management, including closure and stabilisation of pelvic ring disruptions, packing, embolisation and local haemostatic measures.1 Conflict of interst- Nil Disclosures-Nil

14. Resection and reconstruction of soft tissue sarcomas with major vascular involvement. N.P. McGoldrick1, J.S. Butler1, S. Sheehan2, S. Dudeney1, G.C. O’Toole1 NNational Sarcoma Service, Department of Trauma & Orthopedic Surgery, St Vincent’s University Hospital, Elm Park, Dublin 41, Department of Vascular Surgery, St Vincent’s University Hospital, Elm Park, Dublin 42 Soft tissue sarcomas are rare malignant mesodermal tumors accounting for approximately 1 % of all cancers diagnosed annually. Sarcomas involving the structures in the pelvis and extremities are of particular interest to the orthopedic surgeon. Tumors that encase and invade large calibre vascular structures represent a major surgical challenge in terms of safety of excision with acceptability of surgical margins. Technical advances in the fields of both orthopedic and vascular surgery have resulted in a trend towards limb salvage with vascular reconstruction in preference to amputation. A variety of reconstructive techniques including both synthetic and autogenous graft reconstruction have made complex limb-salvage surgery feasible. Nevertheless, limb-salvage surgery with concomitant vascular reconstruction is associated with higher rates of post-operative

S67 complications including infection and amputation. We present a case series of soft tissue sarcomas with vascular compromise, which required combined resection and complex vascular reconstruction. We treated four patients (n = 4, three females, and one male) in our Unit with soft tissue masses in the pelvis and extremity, which were found to invade adjacent vascular structures. Histology confirmed both leiomyosarcoma (n = 2) and alveolar soft part sarcoma (n = 2). Both synthetic graft and autogenous graft (long saphenous vein) techniques were utilised. Arterial reconstruction was undertaken in all cases. Venous reconstruction was performed in one case. One patient required graft thrombectomy at one month post-operatively for thrombosis. We present a series of complex tumour cases with concomitant vascular reconstructions drawn from our institution’s experience as a national tertiary referral sarcoma service. Conflict of Interests: None Disclosures: None

15. Facebook as a source of information on common orthopaedic procedures - a quality analysis N.P. McGoldrick, J.F. Baker, D.P. Byrne, T. McCarthy Department of Orthopaedics & Trauma Surgery, St James Hospital, Dublin 8, Ireland There has been an explosion in the popularity of social networking websites allowing rapid dissemination of information. The social networking service Facebook claims over one billion users. The quality and reliability of medical information available within Facebook is unknown. We sought to assess the quality of orthopaedic-specific information focusing on three common orthopaedic procedures. A search was performed to identify all Facebook pages relating to each of three orthopaedic procedures: ‘‘Hip Replacement’’; ‘‘ACL reconstruction’’ and; ‘‘Discectomy’’. The top 20 pages identified for each were categorized based on authorship type. Each page was assessed for information quality using two recognized scoring systems: DISCERN (0–80, higher score better) and Journal of American Medical Association [JAMA] criteria (0–4, higher score better). 66 pages were analysed. Twenty-four pages were deemed not to be relevant to orthopaedics and were excluded from further analysis. 42 pages in total were assessed for quality. The majority of these pages were Commercial (45.2 %). The remainder were Personal (26.2 %), Academic (4.8 %), Physician-provided (2.4 %) or Other (21.4 %). The mean DISCERN score for all pages was 29.88 (±SD 10.34, range 17–62). Eleven pages (26.2 %) scored the lowest possible rating (poor quality, with ‘‘serious or extensive shortcomings’’). The mean JAMA score was 1.33 (±SD 1.05). 2 pages scored maximally. Despite the popularity of Facebook the readily found information on common orthopaedic procedures is poor. Information obtained on social networking sites must be approached with caution and Facebook cannot be considered a reliable source of good quality information. Conflict of Interests: None Disclosures: None

Anaesthesia Poster Session 16. Post thoracotomy pain originating from costotransverse joints; diagnosis and treatment C. McCarthy, D. Harmon

1

Rossaint R; Bouillon B; Cerny V et al Management of Bleeding Following Major Trauma: An Updated European Guideline. Crit Care. 2010;14(2):R52

Department of Anaesthesia and Pain Medicine, Limerick University Hospital, Dooradoyle, Limerick, Ireland

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S68 We describe a case report highlighting post thoracotomy pain originating from costo-transverse joints. A 51 year old woman reported severe posterior chest wall pain on her right side. Her pain was constant but exacerbated by posture, movement and respiration. She was six weeks post thoracotomy for lung carcinoma. She was on regular multimodal analgesia including large doses of strong opioids. These were causing sedation, nausea and constipation. Clinical findings such as reproduction of pain on mobilisation of affected ribs pointed toward a diagnosis of costotransverse joint dysfunction. Reproduction of pain was also possible with pressure of the ultrasound transducer over the right T5 and T6 costotransverse joints above and below her surgical scar. Ultrasound was used to guide injection of the right T5 and T6 costo-transverse joints. Injection led to successful resolution of her pain, and confirmed diagnosis. In this case report we describe post thoracotomy pain originating from costo-transverse joints. Post thoracotomy pain is typically considered to be neuropathic in nature. Costo-transverse joint pain is a poorly recognized source but potentially common cause of pain in this scenario. An ultrasound guided technique offers many advantages. Conflict of interest: None Disclosures: None

17. Herpes infection over intrathecal pump reseviorcase report Dr. J. Riordan, Dr. J Stow, Dr. S. Subani, Dr. P. Murphy, Dr. D. O’Keefe Dept Anaesthesia and Pain Medicine, St. Vincent’s University Hospital, Elm Park,, Dublin 4, Ireland Introduction: Intrathecal pump technology has facilitates continuous central nervous system drug delivery. This allows for symptom relief while minimising the systemic effects of delivering the same drug parentarally. It is not without significant morbidity and mortality and every effort must be made to minimise complications. Background: Mrs. T.C., A 40 year old lady presented to our service for an elective intrathecal pump refill. She had been admitted 2 days prior to this, to her local hospital with diarrhoea, nausea and vomiting and feeling generally unwell. She also complained of a rash on her anterior abdominal wall which had developed that morning. This rash was followed the distribution of the T9 dermatome. The rash was associated with parasthesia suggestive of a herpetic infection. Case: The intrathecal pump was interrogated and at her rate of infusion, allowed for approximately 48 hours further delivery of intrathecal hydromorphone and baclofen prior to the pump becoming empty. After some consideration it was felt that refilling the pump by inserting a needle through the rash could expose her to the potentially devastating intrathecal infection. The patient was also at risk of both opiate and baclofen withdrawal syndromes should drug delivery be halted abruptly, as well as pump dysfunction should the reservoir empty. Management and discussion: The patient was admitted for observation. She was placed on 15 mg Oxycodone bd and Baclofen 30 mg tds orally to provide symptom relief and to offset a potential withdrawal syndrome.Shewas placed on a high dose acyclovir orally. After 48 hours she was discharged but her rash persisted. To facilitate ongoing pump function, the rate of infusion was reduced to 10 % of its baseline rate. Her pump was refilled uneventfully when her infection had resolved two weeks later. Her IT pump continues to function normally and she remains well.

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Ir J Med Sci (2014) 183 (Suppl 1):S1–S69 No conflict of interest/disclosures.

18. Ischaemic hand pain increased during haemodialysis: management by median nerve catheter J.M. Vinagre, C.J. Skerritt, D.C. Harmon Department of Anaesthesia and Pain Medicine, University Hospital Limerick, Dooradoyle, Ireland We describe a case report and ultrasound guided technique of median nerve injection for ischaemic hand pain increased during haemodialysis. A 66-year-old man was admitted with a painful ischaemic 3rd digit of the left hand. Type 1 diabetes mellitus for over 30 years had led to the development of diabetic nephropathy. End-Stage Kidney Disease (EKSD) demanded haemodialysis for the past 3 years. An ulceration of the tip of the left hallux and small non-healing laceration on the distal aspect of the 3rd digit of the left hand were being followed-up by vascular surgery as a possible case of dialysis access-induced steal syndrome. On presentation, oral analgaesia alone did not provide significant pain relief. It was also noted that distal left upper limb pain was increased during haemodialysis. The ultrasound transducer was used to visualize the median nerve on the volar aspect of the left forearm. Realtime imaging was used to direct a 20G cannula into the vicinity of the median nerve. Local anaesthetic was injected under direct vision. The patient’s symptoms improved significantly, particularly during haemodialysis sessions. The vascular team adopted an expectant therapy regarding possible digit amputation. Peripheral nerve injections can be offered in ischaemic pain of the affected limbs, particularly when expectant therapy is adopted regarding tissue viability. Key words: Technique; Ultrasound; Median Nerve; Haemodialysis; Steal Syndrome; AV fistula Conflict of interest: None Disclosures: None

19. A survey of chronic pain patients’ experiences in the emergency department G. Fitzpatrick, S.O. Chonaile, D. Harmon Department of Anaesthesia and Pain Medicine, University Hospital Limerick, Dooradoyle, Ireland Objective: Chronic pain patients represent a unique challenge in the Emergency Department. Our aim was to determine the attitude of this group of patients to the Emergency Department in order to improve and streamline their future visits. Methods: A six-month survey was carried out on Chronic Pain Patients regarding their Emergency Department Attendances. Results: Breakthrough Pain was the main reason for visiting the Emergency Department. Only 55 % were satisfied with the treatment received. Problems indicated included under treatment of pain, long waits, and perceived lack of knowledge of their condition. 90 % were not offered a nerve block. 71 % felt that the creation of personalised Patient Plans would expedite their trip through the Emergency Department. Conclusions: This survey provided many useful insights into Chronic Pain Patients attitude to the Emergency Department. Closer liaison with the Chronic Pain services and the patients themselves may improve the quality of care provided to patients in the future. Conflict of interest: None Disclosures: None


20. The use of local anaesthetic infusion techniques in a university teaching hospital A.M. Kiernan, K. Doody, A. Burgess, M. Merrick, D. Harmon Department of Pain Medicine, University Hospital Limerick, Dooradoyle, Limerick, Ireland Continuous analgesic infusion techniques using local anaesthetic are used as part of a multimodal analgesic approach to postoperative pain management. Local anaesthetic block infusion techniques offer the potential of a decreased requirement for opioids with a low risk of catheter related complications1. This allows for more effective postoperative analgesia with improved recovery and decreased morbidity 2. A prospective audit was performed on data obtained through daily pain assessment by the University Hospital Limerick acute pain service in 2012. Pain scores were measured using a 1–10 numerical rating scale at rest and movement at 24 hour intervals for the first 72

S69 hours of the postoperative period. In addition, morphine consumption for those who utilized patient controlled analgesia was recorded. Statistical analysis was performed. Wound infusion was the most commonly utilized form of local anaesthetic infusion technique with 0.0125 % levobuvicaine the most commonly used local anaesthetic agent. Pain scores were considerably lower at both rest and movement. Morphine consumption varied greatly across surgical categories with the lowest use in breast surgery (71.8 mgs/72 hrs) and highest consumption in gynecological surgery (141.9 mgs/48 hrs). Females (n = 80) had consistently lower pain scores at rest and on movement as well as lower morphine consumption on postoperative days two and three. References: 1. Liu SS, Richman JM, Thirlby RC, Wu CL. Journal of the American College of Surgeons 2006, 203(6):912–932. 2. Kehlet H, Liu SS. Anesthesiology 2007, 107(3): 369–371. Conflict of interest: None Disclosures: None

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Abstracts of the 23rd Sylvester O’Halloran Perioperative Scientific Symposium, March 6-7, 2015, Limerick, Ireland.

Abstracts of the SIR 2014 Annual Scientific Meeting Program Convergence, 22–27 March 2014, San Diego, CA.

Deutsche Physiologische Gesellschaft. Abstracts of the 51. meeting (spring meeting) March 27--30, 1979, Kiel.

Genomic Resources Notes Accepted 1 February 2014 - 31 March 2014.

Abstracts of the British Psychosocial Oncology Society, 2014 Annual Conference, 27 - 28 February 2014, Preston, UK.

Abstracts of the USCAP 103rd Annual Meeting, March 1-7, 2014, San Diego, California.

Abstracts from the USCAP 103rd Annual Meeting, March 1-7, 2014, San Diego, California.

Abstracts of the SIR 2015 Annual Scientific Meeting, February 28-March 5, 2015, Atlanta, GA.

Abstracts of the 2014 SGI 61st Annual Scientific Meeting, March 26-29, 2014, Florence Italy.

Abstracts of the Annual Meeting of the Danish Pathology Society, 13-15 March 2014, Herlev, Denmark.

IRSSD 2014 Meeting Abstracts.

Abstracts of the 4th Annual Meeting, Frontiers in Neurology, November 21, 2014, Dublin, Ireland.

Abstracts of the EAO 23rd Annual Scientific Meeting, September 25-27, 2014, Rome, Italy.

Abstracts of the American Society for Clinical Pharmacology and Therapeutics 2014 Annual Meeting, March 18-22, 2014, Atlanta, Georgia.

Abstract of the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction 2014 Winter Meeting February 25-March 1, 2014, Miami, Florida.

Abstracts of the 48th Annual Scientific Meeting of the Vascular Society of Great Britain and Ireland, 27–29 November 2013.

Abstracts of the 11th World Congress of the International Hepato-Pancreato-Biliary Association, 22-27 March 2014, Seoul, Korea.

Quarterly intrinsic disorder digest (January-February-March, 2014).

Abstracts of the 93rd Annual Meeting of the German Physiological Society, 13-15 March 2014, Mainz, Germany.

Abstracts of the Urological Society of Australia and New Zealand, 67th Annual Scientific Meeting, Brisbane, Australia, 16-19 March 2014.

Abstracts of the 53rd Annual Meeting of the European Society for Paediatric Endocrinology (ESPE), September 18-20, 2014, Dublin, Ireland.

Proceedings of the British Medical Ultrasound Society. 22nd annual meeting. Harrogate, December 4-6, 1990. Abstracts.

Northern Ireland disease surveillance report for January to March 2014.

The College of Podiatry Annual Conference 2014: meeting abstracts.