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Search Results: 1 - 10 of 387723 matches for " Owen J. O’Connor "
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Interventional Radiology and the Care of the Oncology Patient
Siobhan B. O'Neill,Owen J. O'Connor,Max F. Ryan,Michael M. Maher
Radiology Research and Practice , 2011, DOI: 10.1155/2011/160867
Abstract: Interventional Radiology (IR) is occupying an increasingly prominent role in the care of patients with cancer, with involvement from initial diagnosis, right through to minimally invasive treatment of the malignancy and its complications. Adequate diagnostic samples can be obtained under image guidance by percutaneous biopsy and needle aspiration in an accurate and minimally invasive manner. IR techniques may be used to place central venous access devices with well-established safety and efficacy. Therapeutic applications of IR in the oncology patient include local tumour treatments such as transarterial chemo-embolisation and radiofrequency ablation, as well as management of complications of malignancy such as pain, organ obstruction, and venous thrombosis. 1. Introduction Management of malignancy is now in the domain of the multi-disciplinary team and Interventional Radiology (IR) is occupying a prominent role in this environment [1, 2]. IR input begins with establishing the initial diagnosis of cancer, and involvement now extends to minimally invasive treatment of malignancy, often in combination with other modalities. IR has also assumed an important place in the management of the complications of malignancy, which may result from malignancy itself or secondary to treatment. This paper provides an updated overview of the role of IR in the management of the oncology patient. 2. Interventional Radiology in the Diagnosis of Cancer Appropriate treatment of malignancy is dependent on a timely definitive diagnosis and on accurate staging of disease. While non-invasive imaging techniques have improved assessment and staging for cancer, histologic confirmation remains the gold standard for definitive diagnosis of many tumours. Biopsies to establish histological diagnosis are increasingly performed using minimally invasive techniques by interventional radiologists [3]. The direct visualisation enabled by image guidance during biopsy permits safe passage of a needle into an organ or mass, improving efficacy and minimising trauma to surrounding structures (Figure 1). These minimally invasive techniques are applicable to a wide range of biopsy sites and, in most organ systems, have been demonstrated to be highly accurate with a low complication rate [3]. In biopsy planning, modern cross-sectional imaging techniques help define lesion location, accessibility, and suitability for biopsy and aid in ensuring the correct lesion is sampled in the context of multiple lesions. In selected cases where lesions are present in more than one organ, percutaneous biopsy may
Esophageal intramural pseudodiverticulosis characterized by barium esophagography: a case report
Owen J O'Connor, Adrian Brady, Fergus Shanahan, Eamonn Quigley, Michael O'Riordain, Michael M Maher
Journal of Medical Case Reports , 2010, DOI: 10.1186/1752-1947-4-145
Abstract: We present a case of esophageal intramural pseudodiverticulosis in a 72-year-old Caucasian man who presented with dysphagia and with a background history of alcohol abuse. An upper gastrointestinal endoscopy of our patient showed an esophageal stricture with abnormal mucosal appearances, but no malignant cells were seen at biopsy. Appearances on a barium esophagram were pathognomonic for esophageal intramural pseudodiverticulosis.We demonstrate the enduring usefulness of barium esophagography in the characterization of abnormal mucosal appearances at endoscopy.Esophageal intramural pseudodiverticulosis is a rare condition characterized by the dilatation of submucosal glands. Based on approximately 250 cases reported to date, this condition is slightly more common in men than in women [1,2]. Intramural pseudodiverticulosis is most commonly associated with gastrooesophageal reflux and esophagitis and less commonly with alcoholism, diabetes mellitus, Crohn's disease, tuberculosis, Mallory-Weiss syndrome and achalasia [3,4]. The average age at presentation is 54 years and patients typically present with dysphagia, which is frequently associated with stricture formation, as in case we describe here [3,4]. Symptoms usually respond well to anti-inflammatory medication and balloon dilatation of strictures.A 72-year-old Caucasian man (height: 170 cm, weight: 85 kg) presented with a 4-year history of mild dysphagia for solid foods. His medical history was notable for alcohol abuse and associated alcoholic hepatitis. An upper gastrointestinal endoscopy was initially performed on our patient. At endoscopy, a stricture of the mid-esophagus with numerous tiny erythematous macules on the mucosal surface was seen (Figure 1). There was clinical uncertainty about the cause of the stricture and the mucosal appearances. A barium esophagogram was performed (Figures 2A and 2B). Barium esophagogram demonstrated a smooth stricture of the mid-esophagus with numerous small (2 mm to 4 mm), fl
Minimization of Radiation Exposure due to Computed Tomography in Inflammatory Bowel Disease
Patrick D. Mc Laughlin,Owen J. OConnor,Siobhán B. O’Neill,Fergus Shanahan
ISRN Gastroenterology , 2012, DOI: 10.5402/2012/790279
Abstract:
The Use of PET-CT in the Assessment of Patients with Colorectal Carcinoma
Owen J. O'Connor,Shanaugh McDermott,James Slattery,Dushyant Sahani,Michael A. Blake
International Journal of Surgical Oncology , 2011, DOI: 10.1155/2011/846512
Abstract: Colorectal cancer is the third most commonly diagnosed cancer, accounting for 53,219 deaths in 2007 and an estimated 146,970 new cases in the USA during 2009. The combination of FDG PET and CT has proven to be of great benefit for the assessment of colorectal cancer. This is most evident in the detection of occult metastases, particularly intra- or extrahepatic sites of disease, that would preclude a curative procedure or in the detection of local recurrence. FDG PET is generally not used for the diagnosis of colorectal cancer although there are circumstances where PET-CT may make the initial diagnosis, particularly with its more widespread use. In addition, precancerous adenomatous polyps can also be detected incidentally on whole-body images performed for other indications; sensitivity increases with increasing polyp size. False-negative FDG PET findings have been reported with mucinous adenocarcinoma, and false-positive findings have been reported due to inflammatory conditions such as diverticulitis, colitis, and postoperative scarring. Therefore, detailed evaluation of the CT component of a PET/CT exam, including assessment of the entire colon, is essential. 1. Manuscript Colorectal cancer (CRC) is a major cause of cancer-related mortality in Western countries. It is the third most commonly diagnosed cancer, with an estimated 146, 970 new cases diagnosed in the USA during 2009 [1]. In 2007, the annual mortality rate from colorectal cancer was 20.0 and 14.1 per 100,000 in men and women, respectively, accounting for 53,219 deaths [2]. Approximately 80% of patients present with locoregional disease and 20% with metastatic disease [3]. Positron emission tomography-computed tomography (PET-CT) is of considerable assistance to clinicians in the management of patients with CRC. 2. PET-CT for the Initial Diagnosis of CRC In practice, FDG PET is rarely used for the primary diagnosis of CRC although there are circumstances where PET-CT makes the initial diagnosis (Figure 1). Figure 1: Rectal carcinoma depicted on PET-CT. (a) There is circumferential rectal thickening (arrow) on contrast-enhanced CT. (b) There is avid FDG radiotracer uptake (arrow) on axial FDG-PET. (c) Increased FDG uptake on FDG-PET correlates with thickening (arrow) due to rectal carcinoma seen on CT. Precancerous adenomatous polyps can also be detected incidentally on whole-body images performed for other indications. The sensitivity of PET-CT in this setting improves with increasing polyp size [4, 5]. CT can help distinguish benign from malignant causes of abnormal FDG uptake, and
Minimization of Radiation Exposure due to Computed Tomography in Inflammatory Bowel Disease
Patrick D. Mc Laughlin,Owen J. OConnor,Siobhán B. O’Neill,Fergus Shanahan,Michael M. Maher
ISRN Gastroenterology , 2012, DOI: 10.5402/2012/790279
Abstract: Patient awareness and concern regarding the potential health risks from ionizing radiation have peaked recently (Coakley et al., 2011) following widespread press and media coverage of the projected cancer risks from the increasing use of computed tomography (CT) (Berrington et al., 2007). The typical young and educated patient with inflammatory bowel disease (IBD) may in particular be conscious of his/her exposure to ionising radiation as a result of diagnostic imaging. Cumulative effective doses (CEDs) in patients with IBD have been reported as being high and are rising, primarily due to the more widespread and repeated use of CT (Desmond et al., 2008). Radiologists, technologists, and referring physicians have a responsibility to firstly counsel their patients accurately regarding the actual risks of ionizing radiation exposure; secondly to limit the use of those imaging modalities which involve ionising radiation to clinical situations where they are likely to change management; thirdly to ensure that a diagnostic quality imaging examination is acquired with lowest possible radiation exposure. In this paper, we synopsize available evidence related to radiation exposure and risk and we report advances in low-dose CT technology and examine the role for alternative imaging modalities such as ultrasonography or magnetic resonance imaging which avoid radiation exposure. 1. Introduction Increased exposure to ionising radiation in patients with Crohn’s disease has been documented in recent publications and is a significant cause for concern [1, 2]. Improvements in CT hardware and software have greatly expanded its role in the diagnosis and characterisation of IBD, the detection of complications, and the assessment of response to treatment [2]. These advances have been hugely beneficial to the management of many patients, but CT may on occasion become a victim of its own success when IBD patients may undergo CT examination for a less than robust indication and the radiologist’s report may not have any impact upon patient management. In these cases, the potential for carcinogenesis as a result of radiation exposure is difficult to justify. 2. Ionizing Radiation: Potential Hazards in IBD Patient Cancer induction is the primary concern for IBD patients who are routinely exposed to ionizing radiation. IBD patients can be subjected to serial imaging studies over prolonged periods of followup due to early age of presentation and, sometimes, decades of active disease [2]. In addition, IBD patients are already at increased risk of certain malignancies such as
An assessment of medical students’ awareness of radiation exposures associated with diagnostic imaging investigations
Jennifer O’Sullivan,Owen J. OConnor,Kevin O’Regan,Bronagh Clarke,Louise N. Burgoyne,Max F. Ryan,Michael M. Maher
Insights into Imaging , 2010, DOI: 10.1007/s13244-010-0009-8
Abstract: Assessment of students’ awareness of radiation exposures in diagnostic imaging demonstrates improved performance with increasing years in medical school and/or increasing exposure to CICR. Findings support the Euroatom 97 directive position, advocating implementation of radiation protection instruction into the undergraduate medical curriculum.
The impact of routine open nonsuction drainage on fluid accumulation after thyroid surgery: a prospective randomised clinical trial
Peter M Neary, Owen J O'Connor, Azher Shafiq, Edel M Quinn, Justin J Kelly, Buckley Juliette, Ronan A Cahill, Josephine Barry, Henry P Redmond
World Journal of Surgical Oncology , 2012, DOI: 10.1186/1477-7819-10-72
Abstract: We conducted a prospective randomised clinical trial on patients undergoing thyroid surgery. Patients were randomly assigned to a drain group (n?=?49) or a no-drain group (n?=?44) immediately prior to wound closure. Patients underwent a neck ultrasound on day 1 and day 2 postoperatively. After surgery, we evaluated visual analogue scale pain scores, postoperative analgesic requirements, self-reported scar satisfaction at 6 weeks and complications.There was significantly less mean fluid accumulated in the drain group on both day 1, 16.4 versus 25.1 ml (P-value?=?0.005), and day 2, 18.4 versus 25.7 ml (P-value?=?0.026), following surgery. We found no significant differences between the groups with regard to length of stay, scar satisfaction, visual analogue scale pain score and analgesic requirements. There were four versus one wound infections in the drain versus no-drain groups. This finding was not statistically significant (P?=?0.154). No life-threatening bleeds occurred in either group.Fluid accumulation after thyroid surgery was significantly lessened by drainage. However, this study did not show any clinical benefit associated with this finding in the nonemergent setting. Drains themselves showed a trend indicating that they may augment infection rates. The results of this study suggest that the frequency of acute life-threatening bleeds remains extremely low following abandoning drains. We advocate abandoning routine use of thyroid drains.ISRCTN94715414
Computed Tomography Colonography Technique: The Role of Intracolonic Gas Volume
Patrick D. McLaughlin,Kevin P. Murphy,Lee Crush,Owen J. O'Connor,Joseph P. Coyle,Cressida R. Brennan,Attiya Suhail,Denis Kelly,Michael M. Maher
Radiology Research and Practice , 2013, DOI: 10.1155/2013/517246
Abstract: Introduction. Poor distention decreases the sensitivity and specificity of CTC. The total volume of gas administered will vary according to many factors. We aim to determine the relationship between the volume of retained gas at the time of image acquisition and colonic distention and specifically the presence of collapsed bowel segments at CTC. Materials and Methods. All patients who underwent CTC over a 12-month period at a single institution were included in the study. Colonic luminal distention was objectively scored by 2 radiologists using an established 4-point scale. Quantitative analysis of the volume of retained gas at the time of image acquisition was conducted using the threshold 3D region growing function of OsiriX. Results. 108 patients were included for volumetric analysis. Mean retained gas volume was 3.3?L. 35% (38/108) of patients had at least one collapsed colonic segment. Significantly lower gas volumes were observed in the patients with collapsed colonic segments when compared with those with fully distended colons 2.6?L versus 3.5?L ( ). Retained volumes were significantly higher for the 78% of patients with ileocecal reflux at 3.4?L versus 2.6?L without ileocecal reflux ( ). Conclusion. Estimation of intraluminal gas volume at CTC is feasible using image segmentation and thresholding tools. An average of 3.5?L of retained gas was found in diagnostically adequate CTC studies with significantly lower mean gas volume observed in patients with collapsed colonic segments. 1. Introduction There are a number of fundamental prerequisites for the successful practice of computed tomographic colonography (CTC), namely, satisfactory bowel preparation, faecal and/or fluid tagging, and good luminal distention, as well as thorough interpretation by an experienced radiologist, trained in CT colonography and aided by a modality workstation with specific software packages for CT colonography [1–3]. Inadequate colonic distention, particularly when mucosal surfaces are collapsed and in apposition, may both obscure true mucosal lesions and create false positive pseudolesions thereby decreasing the sensitivity and specificity of CTC [4]. The presence of collapsed segments also contributes to the frequency of repeat CTC examinations and requirement for subsequent optical endoscopic correlation [5]. Methods of insufflation include manual distention with room air [6], manual distention with CO2 [5], or a combination of both. Most authors now advocate automated insufflation with CO2 [5]. The PROTOCO2L device (EZ EM, NY, USA) automatically delivers CO2 per
Novel therapeutic agents for cutaneous T-Cell lymphoma
Salvia Jain, Jasmine Zain, Owen O'Connor
Journal of Hematology & Oncology , 2012, DOI: 10.1186/1756-8722-5-24
Abstract:
A longitudinal study of quality of life among people living with a progressive neurological illness  [PDF]
Marita P. McCabe, Elodie J. OConnor
Health (Health) , 2013, DOI: 10.4236/health.2013.56A2004
Abstract:

This study investigated predictors of quality of life (QOL) of people with progressive neurological illnesses. Participants were 257 people with motor neurone disease (MND), Huntington’s disease (HD), multiple sclerosis (MS), or Parkinson’s. Participants completed questionnaires on two occasions, 12 months apart. There was an increase in severity of symptoms for people withMND, negative mood for people with HD and Parkinson’s, and social support satisfaction for people with MS. Regression analyses were conducted to determine predictors of QOL for each group. Predictor variables were length of illness, symptoms (physical symptoms, control over body, cognitive symptoms and psychological symptoms), mood, relationship satisfaction and social support. Predictors of QOL were severity of symptoms for people withMND, HD and MS; negative mood for people withMNDand Parkinson’s; and social support satisfaction for people with MS. These results demonstrate the importance of illness severity and mood in predicting QOL, but also indicate differences between illness groups. The limited role played by social support and relationship is a surprising finding from the current study.

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