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M Cahill

Publications and source records attributed to M Cahill.

At least 19 recordsLinked to original sources
PubMed2006

Medium- and long-term outcome of laparoscopic redo fundoplication.

BACKGROUND: For a small subset of patients, laparoscopic fundoplication fails, typically resulting in recurrent reflux or severe dysphagia. Although redo fundoplications can be performed laparoscopically, few studies have examined their long-term efficacy. METHODS: Using a prospectively maintained database, the authors identified and contacted 41 patients who had undergone redo laparoscopic fundoplications at the University of Washington between 1996 and 2001. The median follow-up period was 50 months (range, 20-95 months). Current symptoms were compared with those acquired and entered into the authors' database preoperatively. Patients also were asked to return for esophageal manometry and pH testing. RESULTS: All redo fundoplications were performed laparoscopically. There were no conversions. The most common indication for redo fundoplication was recurrent reflux. The most common anatomic abnormality was a herniated wrap. Heartburn improved in 61%, regurgitation in 69%, and dysphagia in 74% of the patients. Complete resolution of these symptoms was achieved, respectively, in 45%, 41% and 38% of these same patients. Overall, 68% of the patients rated the success of the procedure as either "excellent" or "good," and 78% said they were happy they chose to have it. For those who underwent reoperation for gastroesophageal reflux disease, distal esophageal acid exposure according to 24-h pH monitoring decreased after redo fundoplication from 15.7% +/- 18.1% to 3.4% +/- 3.6% (p = 0.041). CONCLUSION: Although not as successful as primary fundoplication, a majority of patients can expect durable improvement in their symptoms with a laparoscopic redo fundoplication.

Adult↗
PubMed2006

Long-term outcomes of laparoscopic antireflux surgery for gastroesophageal reflux disease (GERD)-related airway disorder.

UNLABELLED: A strong link exists between gastroesophageal reflux disease (GERD) and airway diseases. Surgical therapy has been recommended as it is more effective than medical therapy in the short-term, but there is little data on the effectiveness of surgery long-term. We analyzed the long-term response of GERD-related airway disease after laparoscopic anti-reflux surgery (LARS). METHODS: In 2004, we contacted 128 patients with airway symptoms and GERD who underwent laparoscopic antireflux surgery (LARS) between 12/1993 and 12/ 2002. At median follow-up of 53 months (19-110 mo) we studied the effects on symptoms, esophageal acid exposure, and medication use and we analyzed the data to determine predictors of successful resolution of airway symptoms. RESULTS: Cough, hoarseness, wheezing, sore throat, and dyspnea improved in 65-75% of patients. Heartburn improved in 91% (105/116) of patients and regurgitation in 92% (90/98). The response rate for airway symptoms was the same in patients with and without heartburn. Almost every patient took proton pump inhibitors (PPIs) preoperatively (99%, 127/128) and 61% (n = 78) were taking double or triple dose. Postoperatively, 33% (n = 45) of patients were using daily antiacid therapy but no one was on double dose. The only factor that predicted a successful surgical outcome was the presence of abnormal reflux in the pharynx as determined by 24-hour pharyngeal pH monitoring. One hundred eleven (87%) patients rated their results as excellent (n = 78, 57%) or good (n = 33, 24%). CONCLUSION: LARS provides an effective and durable barrier to reflux, and in so doing improves GERD-related airway symptoms in approximately 70% of patients and improves typical GERD symptoms in approximately 90% of patients. Pharyngeal pH monitoring identifies those patients more likely to benefit from LARS, but better diagnostic tools are needed to improve the response of airway symptoms to that of typical esophageal symptoms.

Adolescent↗
PubMed2005

Writing to patients: 'putting the patient in the picture'.

We have explored consultant, general practitioner and patient attitudes toward the proposal that following an outpatient consultation, consultants should consider communicating directly with patients in the form of a summary letter, with a copy to the referring general practitioner or other professionals as appropriate. We conducted in-depth interviews with a purposive sample of 20 consultants, 16 patients and 12 general practitioners. The consultants and general practitioners were both involved in the care of participating patients. Patients highlighted the likely value of summary letters including, increased knowledge, improvement recall of the clinical encounter, and reassurance. Clinicians were concerned that patients would not understand letters from consultants. Additional concerns included the impact of letter on consultant-general practitioner relationship and medico-legal issues. These findings reflect fundamental differences in expectations about the nature and quality of communications between doctors and their patients.

Adult↗
PubMed2003

Cerebral venous sinus thrombosis precipitated by Graves' disease and Factor V Leiden mutation.

We report a case of simultaneous presentation of cerebral venous sinus thrombosis and thyrotoxicosis in a 28 year-old female subsequently found to have the Factor V Leiden mutation. She made an excellent neurological recovery with anticoagulation. The mode of presentation of the case was surprising, as she had no thrombotic episodes in two previous pregnancies. This suggests that thyrotoxicosis may give rise to a hypercoagulable state.

Adult↗
PubMed2002

Pseudoexfoliation and sensorineural hearing loss.

AIMS: There is increasing evidence that pseudoexfoliation (PXF) not only affects ocular anterior segment structures, but may also be a systemic disease. This study was undertaken to assess the relationship between PXF and sensorineural hearing loss. METHODS: Patients with PXF were identified from hospital records and underwent complete ocular examination. The sum of pure-tone hearing thresholds measured at 1, 2 and 3 kHz (HTL1,2,3) in each ear was compared with the ISO 7029 standard sex-matched, median age-associated hearing loss summed over the same frequencies (AAHL1,2,3). The proportion of ears with thresholds higher than the ISO 7029 median AAHL1,2,3 on the same side as eyes without PXF was compared with the proportion of ears ipsilateral to eyes with PXF but without glaucoma and similarly the proportion of ears on the same side as eyes with PXF and glaucoma. RESULTS: In total, 69 patients were studied, of whom 39 were male (56.5%). The mean age of the male patients was 75.8 years, while that of the female group was 75.1 years. All patients had PXF affecting at least one eye. Overall 101 ears (73.7%) had a higher HTL1,2,3 than the ISO 7029 median AAHL1,2,3 which included 56 ears of 78 in the male group (71.8%) and 45 ears of 59 in the female group (76.3%). There was no significant difference between the proportion of ears with HTL1,2,3 higher than the ISO 7029 median AAHL1,2,3 on the same side as eyes without PXF, with PXF but not glaucoma and with PXF and glaucoma, in either the male or female groups. CONCLUSIONS: A large proportion of patients with PXF have sensorineural hearing loss in comparison to age-matched controls, regardless of whether or not there is associated glaucoma. This finding supports the theory that PXF may be a systemic condition.

Aged↗
PubMed2001

Autosomal dominant peripheral cystic retinal patches and non-cystic retinal tufts associated with peripapillary crescents, retinal breaks and uveitis.

PURPOSE: To characterise an Irish kindred with apparent autosomal dominant peripheral retinal lesions and peripapillary crescents associated with retinal breaks and uveitis and assess whether these findings were associated with altered homocysteine metabolism. METHODS: Family members were followed prospectively and regularly examined. Molecular genetic analysis was performed on family members to detect cystathionine beta-synthase (CBS) 307G-S and 5,10-methylenetetrahydrofolate (MTHFR) 677C-T mutations. RESULTS: Over 11 years, 25 family members in four generations were examined, none of whom had significant refractive errors. Fifteen affected individuals had peripheral cystic retinal patches and in some cases non-cystic retinal tufts, associated with peripapillary pigmentation. Mean age at first examination of affected and non-affected individuals was the same. During follow-up the fundal findings remained unchanged in the affected group and no clinical characteristics developed in the unaffected individuals. Two affected siblings had associated uveitis and rhegmatogenous retinal detachment, which were successfully treated, while a third affected individual had a pigmented retinal break not requiring treatment. Heterozygosity for the CBS 307G-S mutation did not segregate with affected individuals while the MTHFR 677C-T mutation was not detected. CONCLUSIONS: This family has previously undescribed fundal findings inherited in an apparent autosomal dominant pattern associated with retinal breaks and uveitis. There is no associated inherited alteration of homocysteine metabolism.

Adolescent↗
PubMed2001

Classification of the spectrum of Coats' disease as subtypes of idiopathic retinal telangiectasis with exudation.

PURPOSE: An increasing variety of eponymous terms have been used to describe atypical cases of Coats' disease. A group of typical cases of Coats' disease and other cases of differing severity were classified as one of four subtypes of idiopathic retinal telangiectasis with exudation and compared with regard to clinical outcome. METHODS: In a retrospective clinical review patients with typical and atypical Coats' disease were classified as severe, focal, juxtafoveal or associated (with another disease) forms of idiopathic retinal telangiectasis with exudation. RESULTS: 53 eyes in 50 patients were examined of which 62% (n=31) were male. 12 eyes were classified as severe (group 1), 22 focal (group 2), 12 juxtafoveal (group 3) and 7 associated (group 4). The mean age at diagnosis was lowest in group 1 eyes (6.8 years). The best visual acuity at presentation was 6/60 in group 1 whereas high proportions of eyes in the other groups had initial visual acuities of 6/24 or better. In group 1 only one eye was treated, the majority of eyes were blind or had been enucleated whereas 34 (79%) of eyes in the other groups were suitable for treatment and 29 eyes (67%) retained pre-treatment visual acuity or better at last follow-up. CONCLUSIONS: Idiopathic retinal telangiectasis with exudation is a spectrum of disease, which is synonymous with Coats' disease. In this retrospective study eyes with severe idiopathic retinal telangiectasis with exudation corresponding to typical Coats' disease, have poorer vision at presentation, are less suitable for treatment and have worse outcomes than eyes with other subtypes. The spectrum of disease severity seen in idiopathic retinal telangiectasis with exudation may be due to second somatic mutations in genes with an existing germline mutation (the two hit theory) and a mosaic phenotype.

Adolescent↗
PubMed2001

The effects of ropivacaine hydrochloride on platelet function: an assessment using the platelet function analyser (PFA-100).

Amide local anaesthetics impair blood clotting in a concentration-dependent manner by inhibition of platelet function and enhanced fibrinolysis. We hypothesised that the presence of ropivacaine in the epidural space could decrease the efficacy of an epidural blood patch, as this technique requires that the injected blood can clot in order to be effective. Ropivacaine is an aminoamide local anaesthetic used increasingly for epidural analgesia during labour. The concentration of local anaesthetic in blood achieved in the epidural space during the performance of an epidural blood patch is likely to be the greatest which occurs (intentionally) in any clinical setting. This study was undertaken to investigate whether concentrations of ropivacaine in blood, which could occur: (i) clinically in the epidural space and (ii) in plasma during an epidural infusion of ropivacaine, alter platelet function. A platelet function analyser (Dade PFA-100, Miami) was employed to assess the effects of ropivacaine-treated blood on platelet function. The greater concentrations of ropivacaine studied (3.75 and 1.88 mg x ml(-1)), which correspond to those which could occur in the epidural space, produced significant inhibition of platelet aggregation. We conclude that the presence of ropivacaine in the epidural space may decrease the efficacy of an early or prophylactic epidural blood patch.

Adult↗
PubMed2001

Thermolabile MTHFR genotype and retinal vascular occlusive disease.

BACKGROUND: Raised levels of total plasma homocysteine (tHcy) are associated with an increased risk of retinal vascular occlusive disease. A thermolabile form of a pivotal enzyme in homocysteine metabolism, methylenetetrahydrofolate reductase (MTHFR), has been associated with vascular occlusive disease and raised tHcy levels. The relation between thermolabile MTHFR genotype, tHcy, and retinal vascular occlusive disease has not been determined. METHODS: A retrospective case-control study involving hospital based controls and cases with retinal vascular occlusions in whom tHcy levels had been determined was undertaken. Genotyping for the MTHFR 677 C-T mutation that specifies the thermolabile form of the enzyme was performed by established methods in all subjects. The relation between homozygosity for thermolabile MTHFR genotype (TT), raised tHcy levels, and risk of retinal vascular occlusive disease was examined. RESULTS: 87 cases of retinal vascular occlusive disease (mean age 68.7 years) comprising 26 cases of retinal artery occlusion and 61 of retinal vein occlusion were compared with 87 controls (mean age 70.2 years). The TT genotype did not confer a significantly increased risk of retinal vascular occlusive disease. The mean tHcy level was significantly higher in the cases than in the controls (p<0.0001). Overall, and in both the cases and controls, the frequency of the TT genotype was higher in those with normal tHcy levels than in those with increased levels of tHcy. However, the TT genotype did not significantly alter the risk of increased tHcy levels in these patients. CONCLUSIONS: The TT genotype is not associated with an increased risk of retinal vascular occlusive disease or increased tHcy levels in this group of elderly patients. In older patients, nutritional rather than genetic factors may be more important in increasing tHcy levels, a known risk factor for retinal vascular occlusive disease.

Aged↗
PubMed2001

Pupillary autonomic denervation with increasing duration of diabetes mellitus.

BACKGROUND/AIMS: The autonomic pupillary changes in type I and II diabetic patients without clinical evidence of diabetic autonomic neuropathy (DAN) were compared with age matched controls. The relation between pupillary and cardiovascular autonomic function was assessed in the diabetic patients. METHODS: A case-control study was performed with diabetics grouped according to type and duration of diabetes. Static infrared pupillography was used to compare mean dark adapted pupil size and mean percentage changes in pupil size with pilocarpine 0.1% and cocaine 4% in the diabetic and control groups. All diabetic patients underwent cardiovascular autonomic function assessment using the Valsalva ratio, the 30:15 ratio, and testing for orthostatic hypotension. RESULTS: In total, 72 type I and 69 type II diabetic patients were compared with 120 controls. Mean dark adapted pupil size was significantly smaller in diabetic groups than controls. Except for type I diabetics with disease for less than 5 years, all patient groups had significantly greater mean percentage constriction in pupil size in response to dilute pilocarpine than controls. There was no significant difference between the mean percentage dilatation in response to cocaine 4% in diabetics and controls. A high proportion of patients had normal cardiovascular autonomic function particularly when this was assessed with the Valsalva ratio. CONCLUSIONS: Denervation hypersensitivity to dilute pilocarpine is a result of damage to the pupillary parasympathetic supply of diabetic patients. This occurs before the pupillary sympathetic pathway is affected, it can be detected early in the disease, and it may be a possible explanation for the small pupil size seen in diabetic patients. Pupillary autonomic dysfunction occurs before cardiovascular autonomic changes and detection of pupil denervation hypersensitivity to dilute pilocarpine is an inexpensive way to detect early DAN.

Adolescent↗
PubMed2000

Aortoduodenal fistula after endovascular stent-graft of an abdominal aortic aneurysm.

Despite satisfying short- and middle-term effectiveness and feasibility, endovascular stent-grafting for abdominal aortic aneurysm is still under evaluation. We report a case of an aortoduodenal fistula after the use of this technique. Enlargement of the upper aneurysmal neck was followed by caudal migration of the major portion of the stent-graft, which resulted in kinking of the device in the aneurysmal sac. Ulcerations were found on adjacent portions of both the aneurysmal sac and the adjacent duodenum. Only the textile portion of the prosthetic contralateral limb separated the aortic lumen from the corresponding duodenal lumen. Early detection of complications after stent-grafting is essential to allow successful treatment, either surgical or endoluminal.

Angioplasty↗
PubMed2000

Detection and prevalence of early diabetic retinopathy in juvenile diabetics with diabetes for 10 years or more.

PURPOSE: To compare clinical examination using green light with clinical examination using white light in detecting early diabetic retinopathy (DR) in juvenile diabetic patients with disease for 10 or more years. METHODS: All patients were examined clinically using both green light and white light to determine the presence of DR. Each patient underwent seven-field fundus photography, which was used as the defined standard against which the clinical examinations were compared and also to determine the prevalence of DR. Data on age at diagnosis, duration of diabetes mellitus, recent HbA1c levels, treatment for systemic hypertension and microalbuminuria were obtained from medical records. RESULTS: When compared with the defined standard, fundal examination with green light was more sensitive, more specific and had higher predictive values than examination with white light in the detection of early DR. The overall prevalence of DR was 44%, which in all cases was classified as minimal to mild background DR. Patients with DR had significantly higher mean HbA1c levels than those without (p = 0.016). There was no significant association between the prevalence of DR and age at time of examination or diagnosis, duration of diabetes, patient gender, microalbuminuria levels or treatment for systemic hypertension. CONCLUSION: Fundal examination with green light is better than white light in detecting early DR in juvenile diabetics with duration of disease of 10 years or more. Furthermore the presence of DR is associated with poorer diabetic control. Due to coincident lifestyle changes and the probability of long duration of disease, accurate detection of early DR in juvenile diabetics with diabetes for over 10 years is important.

Adolescent↗
PubMed2000

Raised plasma homocysteine as a risk factor for retinal vascular occlusive disease.

BACKGROUND/AIMS: A moderately elevated plasma concentration of the sulphur amino acid homocysteine is an independent risk factor for atherosclerotic vascular disease. Many of the risk factors associated with coronary, cerebral, and peripheral atherosclerotic vascular disease are common to retinal vascular occlusive disease but it is unclear whether elevated plasma concentrations of homocysteine are also associated with such disease. This study assessed the relation between retinal vascular occlusive disease and elevated levels of plasma total homocysteine (tHcy). METHODS: A retrospective case-control study involving hospital based controls and cases with retinal artery, central retinal vein (including hemiretinal vein), and branch retinal vein occlusions was performed. The relation between elevated tHcy, defined as a level greater than or equal to 12 micromol/l and risk of retinal vascular occlusive disease was examined. RESULTS: 87 cases of retinal vascular occlusive disease including 26 cases of retinal artery occlusion, 40 cases with central retinal vein occlusion, and 21 cases of branch retinal vein occlusion were compared with 87 age matched controls. Mean tHcy levels were higher in all disease groups and this difference was significant in patients with retinal artery occlusions (p= 0.032) and patients with central retinal vein occlusion (p=0.0001). When adjusted for known cardiovascular risk factors, tHcy was an independent risk factor for retinal vascular occlusive disease (OR 2.85 (95% CI 1.43-5.68)). CONCLUSIONS: Elevated tHcy is an independent risk factor for retinal vascular occlusive disease. Assessment of tHcy may be important in the investigation and management of patients with retinal vascular occlusive disease.

Aged↗
PubMed1999

Long-term outcome of epikeratophakia.

PURPOSE: To assess the long-term outcome of epikeratophakia. SETTING: National center for pediatric ophthalmology (The Children's Hospital) and ophthalmology department in a regional general hospital (Waterford Regional Hospital), Republic of Ireland. METHODS: A retrospective clinical review was carried out of 25 eyes (20 patients) with epikeratophakia performed over 10 years. Eyes were assigned to a children's group (Group 1) or an adult group (Group 2), depending on patient age at the time of surgery, and assessed with respect to indication for surgery, visual acuity, condition of the implanted lenticule, complications, refraction, and corneal topography. Histological analysis was performed on 1 removed lenticule. RESULTS: Mean follow-up of all patients was 7.3 years (median 6.8 years; range 4.0 to 10.0 years). Most eyes (n = 18) were contact lens intolerant. Freeze-dried lenticules were implanted in all cases, and all but 1 had stable visual acuity from the early postoperative period to last follow-up. In Group 1 (n = 10), most eyes had a visual acuity of 6/36 or worse preoperatively with an improvement of 1 or more lines in 4 eyes. In Group 2 (n = 14), at last follow-up most eyes retained good or improved visual acuity by 1 or more lines. Most grafts were clear or had insignificant opacities outside the visual axis. The overall complication rate was 12%, with the most serious complication being significant induced astigmatism requiring removal of 1 epigraft. Mean induced astigmatism was 2.50 diopters (D) (median 2.00 D; range 1.00 to 6.00 D), which was accurately predicted within +/- 1.00 D by corneal topography in 14 of 19 eyes. Histology demonstrated infiltration of the implanted lenticule by host keratocytes. CONCLUSION: Epikeratophakia, a reversible procedure with a low complication rate, resulted in stable visual acuity with good lenticule condition and minimal induced regular astigmatism after long-term follow-up.

Adolescent↗
PubMed1999

Recurrence of cyclic esotropia after surgical correction.

Cyclic esotropia is a rare form of strabismus in which a convergent squint appears and disappears typically, but not always, in a regular 48-hour cycle. Characteristically, the convergent squint, when present, has a large angle with associated suppression and no binocular function. On normal or "nonsquinting" days, no manifest deviation is detectable (although in some cases there may be an esophoria). Physiologic diplopia is appreciated, whereas fusion and stereopsis are all normal. Amblyopia may occur in up to 20% of cases.

Child, Preschool↗