PRESENTATION: A 62-year-old female, diagnosed with intermediate IMDC risk metastatic clear cell renal cell cancer, with multifocal metastases to left pleural membrane and primary renal mass in-situ, received combination...PRESENTATION: A 62-year-old female, diagnosed with intermediate IMDC risk metastatic clear cell renal cell cancer, with multifocal metastases to left pleural membrane and primary renal mass in-situ, received combination of 1st line Nivolumab/Ipilimumab therapy. She was admitted to hospital within 2 weeks of administration of 1st cycle of immunotherapy with severe abdominal pain, vomiting, and nausea. On examination, she was noted to have severe abdominal tenderness with positive guarding. Her blood levels showed increased white cell count, C-reactive protein, and high lactate levels. DIAGNOSIS: A CT Abdomen and Pelvis and CT Mesenteric Angiogram was performed which showed evidence of mechanical small bowel obstruction. Secondary mesenteric oedema was also noted, and early ischemic changes of bowel were evident. TREATMENT: Emergency laparotomy was performed. Omental banding of the small bowel loop was noted. This omental banding had resulted in bowel obstruction and ischemia. She underwent surgical resection of 15cm of gangrenous small bowel with an ileostomy formation. Histological examination revealed inflammatory cells and exudate present in small bowel biopsy sample. DISCUSSION: Small bowel obstruction because of an omental band is an extremely rare occurrence. It is thus postulated that the patients omental band developed as a consequence of immune mediated enteritis secondary to immunotherapy. Although small bowel obstruction secondary to immunotherapy is rare, with under five cases in the literature, it is a potentially life-threatening complication that treating physicians need to be aware of.
PRESENTATION: The patient presented with acute urinary retention, fever (39°C), and rapidly progressive bilateral lower limb weakness progressing to flaccid paraplegia (0/5 MRC) with a T6 sensory level. DIAGNOSIS: MRI sp...PRESENTATION: The patient presented with acute urinary retention, fever (39°C), and rapidly progressive bilateral lower limb weakness progressing to flaccid paraplegia (0/5 MRC) with a T6 sensory level. DIAGNOSIS: MRI spine demonstrated longitudinally extensive T2-hyperintense intramedullary lesions from T6 to the conus. CSF analysis showed lymphocytic pleocytosis and elevated protein; autoimmune serology confirmed active systemic lupus erythematosus (SLE). SLE-associated longitudinally extensive transverse myelitis (LETM) was diagnosed following exclusion of other differential diagnoses. TREATMENT: High-dose intravenous methylprednisolone, intravenous immunoglobulin (IVIg), and rituximab were administered. Corticosteroids precipitated psychosis, managed with antipsychotics. Maintenance therapy with mycophenolate mofetil and hydroxychloroquine was continued. Despite aggressive immunotherapy, there was no neurological recovery, and the patient remained paraplegic with neurogenic bowel and bladder dysfunction. DISCUSSION: This case underscores LETM as a rare, aggressive manifestation of SLE that can occur even in patients of European ancestry. Despite prompt multimodal immunotherapy, neurological recovery was absent, reflecting the poor prognosis of extensive cord involvement. Early recognition, exclusion of mimics, and coordinated multidisciplinary care are vital to optimise outcomes and quality of life.
PRESENTATION: A female adolescent presented with a generalised tonic-clonic seizure preceded by hands stiffness. She presented with a sudden history of being unresponsive with head deviation to right side, followed by up...PRESENTATION: A female adolescent presented with a generalised tonic-clonic seizure preceded by hands stiffness. She presented with a sudden history of being unresponsive with head deviation to right side, followed by up-rolling of eyes, and whole body shaking which self-terminated after five minutes. On examination, she was in postictal state, with inward clenching of both hands and fingers. The rest of her systemic examination was normal. DIAGNOSIS: Laboratory results showed severe hypocalcaemia, hypomagnesaemia, hyperphosphatemia, elevated parathyroid hormone (PTH), and critically low vitamin D. ECG showed a prolonged QTc interval. Biochemical profile was consistent with secondary hyperparathyroidism. Severe vitamin D deficiency was the cause of her hypocalcaemia. TREATMENT: The patient was managed acutely with intravenous calcium gluconate and magnesium, followed by oral calcium and vitamin D supplementation. DISCUSSION: This case highlights hypocalcaemia-induced seizures due to vitamin D deficiency in an adolescent, emphasising the importance of early recognition, biochemical assessment, and supplementation in at-risk populations.
Kenny F, Christodoulou N, AdeConde A
… +3 more, Sidhu A, Brillantes J, O'Byrne J
Ir Med J
· 2026 Mar · PMID 41869980
AIMS: Hip inflammatory conditions such as trochanteric bursitis and osteoarthritis significantly impact functional ability. While hip arthroplasty is common, hip injections are a less invasive pain management option for...AIMS: Hip inflammatory conditions such as trochanteric bursitis and osteoarthritis significantly impact functional ability. While hip arthroplasty is common, hip injections are a less invasive pain management option for these conditions. Concerns about driving safety post-injection have led to guidelines advising against driving for 12-24 hours. This study assesses brake response time (BRT) before and after hip injections to determine driving fitness. METHODS: In this prospective study, 55 patients scheduled for steroid and local anaesthetic hip injections at a National Orthopaedic Hospital were recruited. BRT was measured using a brake response machine both before and 30 minutes after the injection. Pain levels were assessed using the Visual Analog Scale (VAS). Paired t-tests compared pre- and post-injection BRT and VAS scores. RESULTS: This study included 64 hips in patients with a mean age of 61.6 years. There was no significant difference in mean BRT pre- and post-injection (0.83 vs 0.84 seconds, p = 0.856). VAS scores significantly decreased post-injection (4.94 vs 3.52, p = 0.0243). DISCUSSION: BRT was unaffected post-hip injection, suggesting patients can safely drive after receiving one. This result can impact patient experience of attending for an injection. Larger future studies assessing other driving factors are recommended.
Fricke LT, Bartels HC, Corbett G
… +2 more, Lüthe L, Corcoran S
Ir Med J
· 2026 Mar · PMID 41869971
AIMS: Preterm birth is the leading cause for potentially lifelong morbidity and neonatal death. This study explores pregnancy outcomes for women with a surgically short cervix and no history of preterm birth. METHODS: Th...AIMS: Preterm birth is the leading cause for potentially lifelong morbidity and neonatal death. This study explores pregnancy outcomes for women with a surgically short cervix and no history of preterm birth. METHODS: This was a single-centre prospective cohort study including 144 patients who attended a specialist preterm birth clinic in a tertiary referral maternity hospital between 2019 and 2023. Inclusion criteria were significant cervical surgical history and no history of preterm birth. RESULTS: Among women with prior significant cervical surgical, those with a short cervical length (n=8/40, 20%) had a higher rate of preterm birth than women with a normal cervical length (n=7/104, 7%). Women with a short cervical length who had received a transabdominal cerclage were less likely to experience preterm birth (n=0/18, 0%) than if they did not have a transabdominal cerclage (n=5/22, 23%). Women with a normal cervical length could safely be managed conservatively. CONCLUSION: Women with a short cervical length and no history of preterm birth may benefit from transabdominal cerclage. Where there is a history of significant cervical surgery but the cervical length remains normal, there is a high chance of a term birth. This study provides reassuring data to help counsel patients effectively.
AIMS: The aim of this study was to describe a snapshot experience of firework-related injuries during a single Halloween at the national paediatric burns unit. METHODS: This was a retrospective review of paediatric patie...AIMS: The aim of this study was to describe a snapshot experience of firework-related injuries during a single Halloween at the national paediatric burns unit. METHODS: This was a retrospective review of paediatric patients referred to the plastic surgery service in the week of Halloween 2024. Baseline characteristics in addition to date of injury, mechanism of injury, intervention, and patient outcomes were collected. Data was collected using theatre logbooks, hospital in-patient enquiry, and plastic surgery dressing clinic logbooks. RESULTS: In total, 10 referrals were made to the service for management of firework-related injuries over the 7-day period. All patients referred were male, with an average age of 12.1 years. Three patients required admission; two were taken to theatre for management of hand fractures under general anaesthetic, with one patient also sustaining an injury to his eye, resulting in permanent loss of vision. One patient underwent exploration of his hand under a local anaesthetic. Average length of stay for the 3 patients who required admission was 2.6 days. DISCUSSION: In addition to being prepared to manage a surge in these injuries at Halloween, healthcare professionals have a role in raising public awareness in an effort to mitigate these potentially devastating injuries.
AIMS: Herbal, vitamin, and mineral supplement use is common among cancer survivors, but little is known about patterns among men with prostate cancer (PCa) in Ireland. This study aimed to examine prevalence, symptom burd...AIMS: Herbal, vitamin, and mineral supplement use is common among cancer survivors, but little is known about patterns among men with prostate cancer (PCa) in Ireland. This study aimed to examine prevalence, symptom burden, and associations between supplement use and PCa-related symptoms. METHODS: Between May and June 2025, a national cross-sectional online survey was conducted among men with a PCa diagnosis. Information collected included demographics, clinical history, symptoms, supplement use, reasons for use, sources of information, and whether use was discussed with healthcare providers. RESULTS: Of 74 responses, 46% (n=34) were eligible. Among these, 62% (n=21) were over 60 years and 94% (n=32) were overweight or obese; 47% (n=16) were 3-5 years post-diagnosis. Erectile dysfunction and reduced libido were the most common symptoms 85% (n=29). Supplement use was reported by 85% (n=29): 82% (n=28) used vitamins/minerals and 32% (n=11) used herbal products. Vitamin D was the most frequent vitamin 50% (n=17) and turmeric the leading herbal 18% (n=6). Over half 53% (n=18) had not discussed supplement use with healthcare providers. CONCLUSION: Herbal and vitamin and mineral supplement is highly prevalent among Irish men with prostate cancer, particularly vitamin and mineral products, with vitamin D most common. Improved communication and clinical guidance are needed in survivorship care.
AIMS: To identify in-hospital, 30-day, and one-year mortality rates in patients aged 90 and above who underwent hip fracture surgery at an Irish tertiary referral hospital. METHODS: The authors retrospectively examined t...AIMS: To identify in-hospital, 30-day, and one-year mortality rates in patients aged 90 and above who underwent hip fracture surgery at an Irish tertiary referral hospital. METHODS: The authors retrospectively examined two years of theatre lists from 2021 to 2023. Inclusion criteria were an age of 90 and above at the time of fracture and surgical treatment of a proximal femur fracture. Exclusion criteria were periprosthetic fractures and patients who had conservative management. Mortality rates were extracted from hospital records and a national online death notices website. RESULTS: We identified 69 patients aged greater than 90 years old who received surgical management of a hip fracture between November 2021 and November 2023. Among these 69 patients, in-hospital mortality was 6 (8.7%), 30-day mortality was also 6 (8.7%), and one-year mortality was 23 (33%). CONCLUSION: The one-year mortality rate among a sample of nonagenarians managed surgically for hip fracture at a single Irish hospital is higher than the estimated all-age one-year mortality rate, demonstrating significant long-term mortality in the eldest patients. No "90 paradox" was observed in mortality rates.
O'Mahony CJ, Low E, Lynch OE
… +3 more, Daly K, D'Arcy F, Dowling C
Ir Med J
· 2026 Mar · PMID 41869919
AIM: Non-visible haematuria (NVH) is a common reason for referral to urology services1. There is contrasting guidelines internationally regarding its investigation1,2. The aim of this study is to investigate the rate of...AIM: Non-visible haematuria (NVH) is a common reason for referral to urology services1. There is contrasting guidelines internationally regarding its investigation1,2. The aim of this study is to investigate the rate of detection and resource burden of NVH on a tertiary urology service. METHODS: A retrospective chart review was performed which identified patients who were investigated for NVH from July 2023 to July 2024. Data was collected on patient demographics, indication, findings, and radiological imaging. Information regarding cost of investigations were also obtained. RESULTS: A total of 1,868 flexible cystoscopies were reviewed, with 175 (9.4%) indicated for NVH. One clinical diagnosis of bladder tumour was identified, and two cystoscopies identified an erythematous area warranting biopsy, both of which were benign. Imaging identified three patients with findings requiring follow-up imaging. Cost of flexible cystoscopy is estimated at €609, ultrasound imaging €102, CT imaging €170, and outpatient clinic appointment €150. This equates to minimum cost of €861 for investigation of NVH. DISCUSSION: Non-visible haematuria has a detection rate of 6% for urological malignancy in recent large volume studies2,3. Investigation contributes to a significant resource burden. Additionally, the risk to patients of these investigations must be considered. We welcome universal terminology and guidelines to be established.
Harrington C, Quinn G, Meldrum D
… +1 more, Kearney H
Ir Med J
· 2026 Mar · PMID 41869918
AIMS: To determine the prevalence of vestibular symptoms in people with multiple sclerosis (pwMS) and to examine associations with infratentorial MRI abnormalities. METHODS: We conducted a cross-sectional study of pwMS a...AIMS: To determine the prevalence of vestibular symptoms in people with multiple sclerosis (pwMS) and to examine associations with infratentorial MRI abnormalities. METHODS: We conducted a cross-sectional study of pwMS attending a university hospital, using a self-report questionnaire to assess vestibular symptoms. MRI brain scans were analysed for (i) active T2 lesions, (ii) middle cerebellar peduncle (MCP) lesion count, and (iii) total infratento-rial lesion count. Associations with symptoms were tested using Chi-squared analysis. RESULTS: Eighty pwMS participated with a mean age 46.1 ± 13.9 years, 64 female (80%), and 64 (80%) had relapsing remitting MS. Vestibular symptoms were identified in 74 participants (92.5%), including imbalance, vertigo, and dizziness most frequently reported. No associations were observed between symptoms and active lesions or MCP lesion counts. However, infratento-rial lesion burden was significantly associated with head motion intolerance (p = 0.007). CONCLUSION: Vestibular symptoms are common in pwMS yet frequently under-recognised. Our findings highlight the clinical relevance of infratentorial lesion counts, a routinely available MRI metric, in identifying patients at risk of vestibular dysfunction. Early referral to vestibular rehabilitation in patients with high infratentorial lesion burden may help reduce falls and improve quality of life.
AIM: To assess thyroid immune-related adverse events (irAEs) in patients receiving immune checkpoint inhibitors (ICIs) and estimate future endocrine service burden. METHODS: A retrospective audit was conducted of patient...AIM: To assess thyroid immune-related adverse events (irAEs) in patients receiving immune checkpoint inhibitors (ICIs) and estimate future endocrine service burden. METHODS: A retrospective audit was conducted of patients who received ICIs at St James's Hospital from July to December 2022. Data included cancer type, ICI regimen, thyroid function test (TFT) abnormalities, and levothyroxine initiation. Management was evaluated against European Society of Endocrinology (ESE) guidelines. Prescribing data from Q3/4 2024 was used to project future case numbers. RESULTS: Among 96 patients, 10 (10.4%) developed thyroiditis and 9 (9.4%) hypothyroidism without prior thyroiditis. 46 (47.9%) had other TFT abnormalities. 9 of 11 (82%) of those started on levothyroxine were appropriately managed. Recent ICI prescribing showed a 329% increase in use, projecting approximately 280 cases of abnormal TFTs per 6-month period going forward. CONCLUSION: These findings support the need for proactive monitoring, guideline adherence, and strengthened endocrine-oncology collaboration to manage rising clinical demand.
Bourke M, Ramiah V, Byrne C
… +10 more, Mason C, Sands F, Coary R, Riches R, Devlin E, Hawkins C, Hawkins H, Portas K, Lynders M, Breslin D
Ir Med J
· 2026 Mar · PMID 41869898
Major trauma in Ireland now affects older adults more than any other group, with patients aged ≥65 years making up over half of all national cases. Most injuries arise from low-mechanism falls, bringing frailty, multimor...Major trauma in Ireland now affects older adults more than any other group, with patients aged ≥65 years making up over half of all national cases. Most injuries arise from low-mechanism falls, bringing frailty, multimorbidity, and polypharmacy into routine trauma care. Traditional trauma education has not always kept pace with these changes. The UK Heartlands' Elderly Care Trauma & Ongoing Recovery (HECTOR) course was developed specifically to support clinicians managing older trauma patients. This study describes the adaptation of HECTOR to the Irish context and evaluates a pilot delivery of the course. Using Kern's six-step framework, the curriculum was modified to align with Irish guidelines, system structures, and resource availability. A one-day pilot course was delivered to 18 multidisciplinary clinicians during the 2025 Irish Association for Emergency Medicine (IAEM) meeting. Twelve participants completed post-course evaluations. Feedback was overwhelmingly positive, highlighting relevance, practicality, and the value of the interprofessional format. The findings indicate strong feasibility and support further rollout with more rigorous evaluation.