44th Sir Peter Freyer Memorial Lecture & Surgical Symposium 2019

Dorsal root ganglion pulsed radiofrequency treatment for chronic cervical radicular pain: a retrospective review of outcomes in fifty-nine cases Abstract Pulsed radiofrequency treatment adjacent to the cervical dorsal root ganglion is used to treat persistent cervical radicular pain that has not responded to conservative therapies. This technique has gained popularity in years for both cervical and lumbosacral radicular pain. The evidence to support its use is still evolving. Methods We performed a retrospective review of outcomes in 59 patients who underwent this therapy over a 3-year period in our institution. We evaluated a reduction in pain, duration of pain relief, reduction in use of analgesics and progression to surgery. Results Our results demonstrated 49 patients experienced some relief. Forty patients of the 59 experienced an improvement in pain of 50% or more. The mean duration of relief in this group was 37 weeks. Seven patients experienced complete resolution of their pain. In this group, the mean duration of relief was 39 weeks. Regarding the 53 patients who were taking medication for pain prior to the procedure, 37 patients reduced or discontinued their usage after the procedure. Conclusion Despite the limitations of a retrospective study, we feel our study adds to the growing evidence base that pulsed radiofrequency treatment adjacent to the cervical dorsal root ganglion has a role in the treatment of chronic cervical radicular pain.

The prevalence and incidence of thyroid dysfunction in patients with diabetes - a longitudinal follow-up study Abstract Background Thyroid dysfunction (TD) occurs in 13.4% of diabetic patients, which has prompted recommendations for annual thyroid screening in patients with diabetes. However, recommendations for annual screening should be based on disease incidence rather than prevalence. Methods In 1997–1998, seven hundred and thirty patients (618 type 2 diabetes, 55% male; 112 type 1 diabetes, 47% male) were sequentially screened for TD. The 639 patients with normal thyroid function were followed from 1999 to 2006, with annual thyroid function tests. Results A total of 21/112 (19%) with type 1 diabetes (T1DM) and 70/618 (11%) with type 2 diabetes (T2DM) had TD. TD was more frequent in females (p < 0.05) and T1DM (p = 0.04). The mean annual rate of conversion to abnormal tests was 2.1%. At 8 years, there were 100 new cases of TD representing 15.6% of the cohort (17 T1DM and 83 T2DM). TD was more frequent in females (p < 0.05), but there was no difference in the incidence of new TD between T1DM and T2DM (p = 0.39). Conclusions Our data confirms the high prevalence of TD in diabetic patients, in concordance with the results from other series. We found only 25 treatable cases of new thyroid disease from 639 patients in the 8-year follow-up, less than 0.5% per year. The low incidence of treatable thyroid disease challenges the need for annual screening for thyroid abnormalities in patients with type 2 diabetes.

May zoledronic acid have negative effects on cognition and muscle performance? Abstract Background We aimed to investigate the effects of zoledronic acid treatment on daily living activities, cognitive functions, depression, muscle strength, and performance. Methods The study was conducted retrospectively. Bone mineral densitometry (BMD) values, Katz activities of daily living (ADL), Lawton-Brody instrumental activities of daily living (IADL), mini mental state examination (MMSE), geriatric depression scale (GDS), mini nutritional assessment (MNA), grip strength, and gait speed scores before and 6 months after zoledronic acid administration were compared. Results A total of 115 patients were included in the study. There was a significant increase in lumbar total (p < .001), femoral neck (p = .002), and femur total (p = .001) BMD values after zoledronic acid treatment. Significant decrease was found in MMSE (p = .016) and gait speed scores (p = .008) after zoledronic acid treatment, but no significant difference was found in terms of Katz ADL, Lawton-Brody IADL, MNA, GDS, and grip strength (p > .05). Conclusion Our study indicated that zoledronic acid did not affect daily living activities, depression, and muscle strength. Although we have concluded that cognitive and muscle performance may be adversely affected by zoledronic acid treatment.

The evolution of celiac disease publications: a holistic approach with bibliometric analysis Abstract Background Despite the increasing number of publications on celiac disease, there is a lack of studies that made a holistic bibliometric evaluation of the studies on this topic. Aims The purpose of this study is to analyze the publications about celiac disease by using bibliometric methods and this way to demonstrate the celiac disease–related trends, top effective articles, journals, and international collaborations between the countries and institutions. Methods All articles published between 1980 and 2018 on celiac disease were downloaded from Web of Science and analyzed with bibliometric methods. The correlations between economic development and publication productivity of the countries were investigated with Spearman’s rank correlation coefficient. Linear regression analysis was used to estimate the number of publications and citations. Results The literature review showed that there were 6545 articles about celiac disease published between the years 1980 and 2018. The top productive country that produced most publications about celiac disease was the Italy. The most prolific journals were the Journal of Pediatric Gastroenterology and Nutrition and Scandinavian Journal of Gastroenterology. There was a moderate positive significant correlation between the number of publications and gross domestic product (r = 0.639, p < 0.001). Conclusions Despite the advanced research on the diagnosis, pathophysiology, and treatment of celiac disease, the global research level about the disease is low. Therefore, the international collaboration about the disease should not remain at only regional contexts; the exchange of knowledge and common studies especially in developing or underdeveloped countries should be supported in terms of prevalence and clinic studies.

AdCom study—adolescent communication group therapy for externalising disorders Abstract Background Communication difficulties are associated with oppositional symptoms in young people. We hypothesise that a communication group intervention will reduce oppositional symptoms in young people. Previous research on communication and social skills training in young people with externalising disorders is limited. Aims We aimed to (1) develop and describe a group communication intervention to promote social competence in adolescents with behaviour difficulties, for use in CAMHS with those with attention-deficit/hyperactivity disorder (ADHD)/externalising disorders, and (2) collect pilot data on the effectiveness of this intervention. Methods We developed and delivered a programme of eight sessions to eight adolescents aged 12 to 13 years. We describe the intervention and challenges running the programme. We present pilot study data on pre- and post-oppositional symptoms. Results Our programme was relatively well attended; pilot data indicated a small reduction in oppositional symptoms in all participants. Challenges in running the group were noted. Conclusions Our pilot study data suggest that further research is needed to study the effects of a communication group intervention on oppositional symptoms in a larger number of adolescents.

The 100 most cited papers about pediatric traumatic brain injury: a bibliometric analysis Abstract Background The high incidence of traumatic brain injury (TBI) in children, combined with the challenges in diagnosis and treatment options, the difficulty of predicting the outcome of each case, and also the wide variety of possibly lifelong complications, has led to an extraordinary number of published papers regarding this topic. This bibliometric analysis is aimed at identifying and reviewing the 100 most cited papers in the most challenging and trending aspects of pediatric traumatic brain injury. Methods A search was performed using the Web of Science database in October 2018. Results were organized by citation number, and the 100 most cited papers were further reviewed and analyzed. Results Our search resulted in 2754 published papers from 1975 until October 2018, of which 1783 (64.74%) had been published in the last decade (2010–2018). The 100 most cited papers about traumatic brain injury in children have an average citation of 140.59 and have been published in 44 different journals. Four hundred thirty-five authors have contributed to these prominent articles, most of them from the USA. Conclusions By reviewing those highly cited papers, we sought to offer significant help not only for studying this challenging field but also for designing new studies.

Upregulated tumor sirtuin 2 expression correlates with reduced TNM stage and better overall survival in surgical breast cancer patients Abstract Background This study is aimed at exploring the correlation of sirtuin 2 (SIRT2) with clinical characteristics as well as overall survival (OS) in breast cancer patients. Methods Totally, 296 primary breast cancer patients who underwent surgical resection were retrospectively reviewed in this study, and SIRT2 expression in tumor and adjacent tissues was determined by immunohistochemistry (IHC) and scored by semiquantitative scoring (0–12). Clinicopathological features were retrieved, and OS was calculated. Results Both SIRT2 IHC semiquantitative score and percentage of SIRT2 high expression by IHC score > 3 were lower in tumor tissues compared with adjacent tissues. Additionally, tumor SIRT2 high expression was associated with lower T stage, decreased N stage, and reduced TNM stage. Kaplan-Meier curves displayed that tumor SIRT2 high expression predicted longer OS. Univariate Cox’s regression analysis showed that tumor SIRT2 high expression was associated with prolonged OS, while multivariate Cox’s regression analysis displayed that tumor SIRT2 high expression was not an independent predictive factor for OS, which implied that tumor SIRT2 might predict OS indirectly through the interaction of tumor features (such as TNM stage) in breast cancer patients. Conclusion SIRT2 expression is lower in tumor tissues compared with adjacent tissues, and tumor SIRT2 high expression correlates with lower T stage, decreased N stage, reduced TNM stage, and longer OS in breast cancer patients.

Rhegmatogenous retinal detachments: primary reattachment rates and visual outcomes over a 4-year period Abstract Background and Aims To describe rhegmatogenous retinal detachment surgery in a Dublin tertiary referral centre over a 4-year period and to examine factors predictive of surgical and anatomical success. Methods A retrospective study was performed by reviewing the surgical log and the charts of patients who underwent a primary retinal detachment repair in a specialist centre over a 4-year period between 2012 and 2015. We excluded exudative and tractional cases. Multiple parameters were recorded including macular status, visual acuity, type of procedure, complications and visual and anatomical outcomes at 6 months post operation. Primary reattachment rate was calculated alongside change in visual acuity. Chi-square testing and analysis of variance were utilized to determine the effect which lens status, macular status, extent of breaks and type of procedure had on outcome and visual success. Results A total of 613 primary rhegmatogenous retinal detachment repairs were performed over the 4-year period. Our primary reattachment rate was calculated to be 88.58% (annual range 85.25–91.30%) with a perioperative complication rate of 2.94%. We noted a statistical significant improvement in VA with a median logMAR VA of 1.0 at presentation to 0.5 at 6 months post procedure. Macular status (chi-square test p = 0.15, X2 = 2.072) and lens status (chi-square test p = 0.2974, X2 = 1.086) had no statistical effect on the final anatomical outcome. However, eyes with giant retinal tears were more likely to redetach than those without (chi-square test p = 0.0069, X2 = 7.3). There was no statistical significant difference in the proportion of eyes achieving visual success by surgery category (one-way ANOVA analysis p = 0.501). Conclusions This is the first study of its kind in Ireland and will help surgeons benchmark their results against international standards in the future. Accurate recording of logMAR acuity and intraoperative complications is imperative to assist with prospective studies.

Ureteric stenting with magnetic retrieval: an alternative to traditional methods Abstract Introduction Ureteric stents are frequently placed following endo-urological procedures. These stents cause significant morbidity for patients. Standard ureteric stents are removed by flexible cystoscopy. This procedure can be unpleasant for patients and requires additional resources. A newly designed magnetic stent allows removal in an outpatient setting. The aim of our study is to compare the magnetic stent and standard ureteric stents with regard to morbidity, pain on stent removal and cost-effectiveness. Methods This study was carried out across two sites between September 2016 and July 2017. In site A, a magnetic stent (Urotech, Black-Star®) is removed by magnetic retrieval device. Fifty consecutive patients completed the validated Ureteric Stent Symptom Questionnaire (USSQ) and visual analogue scale (VAS) at the time of stent removal. On site B, a soft polyurethane stent (Cook Universa) was removed by flexible cystoscopy. Fifty patients were identified retrospectively and completed questionnaires by post. Cost analysis was also performed. Results One hundred questionnaires were included for analysis. No significant difference in stent morbidity as assessed by the USSQ was shown between both groups. Median duration of stenting was significantly shorter in the magnetic stent group (5.5 versus 21.5 days, p < 0.001). Mean pain on stent removal was significantly less with magnetic retrieval (2.9 versus 3.9, p < 0.05). Complication rates were similar in both groups. Cost analysis showed a cost saving of €203 per patient with the magnetic stent group. Conclusion Magnetic stents cause similar morbidity for patients compared with standard stents removed by flexible cystoscopy; they are associated with less pain at removal and are cost saving.