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Article ; Online: Re-amputation and survival following toe amputation: outcome data from a tertiary referral centre.

Collins, Patrick M / Joyce, Doireann P / O'Beirn, Ellen S / Elkady, Ramy / Boyle, Emily / Egan, Bridget / Tierney, Sean

2021 Volume 191, Issue 3, Page(s) 1193–1199

Abstract: Purpose: Toe amputation is a commonly performed procedure for irreversible foot sepsis. However, outcome and predictors of outcome are poorly understood. Our aim was to determine survival and rate of progression to further amputation following index toe ...

Abstract	Purpose: Toe amputation is a commonly performed procedure for irreversible foot sepsis. However, outcome and predictors of outcome are poorly understood. Our aim was to determine survival and rate of progression to further amputation following index toe amputation. Methods: Consecutive patients between 2010 and 2015 were included. Progression to further minor amputation, major amputation or death was recorded. Multivariable Cox regression analyses were undertaken to determine independent predictors of outcome and survival. Results: One hundred forty-six patients were included, with mean age of 65 years. Fifty-five (37.7%) patients underwent hallux amputation, while 91 (62.3%) underwent amputation of non-hallux digit(s). Following index toe amputation, 63 (43.2%) patients progressed to further minor or major ipsilateral amputation, median time to which was 36 months. Twenty-one patients (14.4%) progressed to major ipsilateral amputation. Patients undergoing index non-hallux amputation were significantly more likely to require further minor amputation (P = 0.050); however, the rate of major amputation between hallux (14.5%) and non-hallux (14.3%) groups was similar. Overall, 5-year ipsilateral amputation-free (iAFS) was 39.6 ± 4.1%, ipsilateral major amputation-free (iMAFS) was 55.9 ± 4.1% and overall survival (OS) was 64.3 ± 4.0% and did not differ between index amputation sites. Conclusion: Almost half of patients undergoing toe amputation required further digital amputation. However, limb preservation rates are high, and a majority of patients are alive at 5-year follow-up. There was no significant difference in outcome between patients undergoing hallux and non-hallux primary procedures. Overall, increasing age remains the only independent predictor of iMAFS and OS.
MeSH term(s)	Aged ; Amputation/methods ; Diabetic Foot ; Humans ; Retrospective Studies ; Risk Factors ; Tertiary Care Centers ; Toes/surgery ; Treatment Outcome
Language	English
Publishing date	2021-06-22
Publishing country	Ireland
Document type	Journal Article
ZDB-ID	390895-1
ISSN	1863-4362 ; 0021-1265
ISSN (online)	1863-4362
ISSN	0021-1265
DOI	10.1007/s11845-021-02682-4
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Article ; Online: A systematic review and meta-analysis of comparative studies comparing nonthermal versus thermal endovenous ablation in superficial venous incompetence.

Hassanin, Ahmed / Aherne, Thomas M / Greene, Garrett / Boyle, Emily / Egan, Bridget / Tierney, Sean / Walsh, Stewart R / McHugh, Seamus / Aly, Sayed

Journal of vascular surgery. Venous and lymphatic disorders

2019 Volume 7, Issue 6, Page(s) 902–913.e3

Abstract: Objective: Endovenous thermal ablation (TA) offers an effective initial treatment option for superficial venous incompetence of the lower limb. These techniques offer lower complication rates with similar efficacy to traditional open surgery. In recent ... ...

Abstract	Objective: Endovenous thermal ablation (TA) offers an effective initial treatment option for superficial venous incompetence of the lower limb. These techniques offer lower complication rates with similar efficacy to traditional open surgery. In recent years, nonthermal ablation (NTA) in the form of mechanochemical ablation and cyanoacrylate vein ablation has been suggested to further reduce perioperative morbidity. This study aimed to compare the use of both thermal and nonthermal endovenous ablative techniques in the management of superficial venous incompetence. Methods: A search of online databases including MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, and Cochrane database was last performed in January 2019. Comparative studies comparing NTA with TA were included. The primary outcome was technical success. Secondary outcomes included operative pain, complications, modification of disease severity, and quality of life. Results: Six studies describing the outcomes of 1236 participants and 1256 truncal ablations were included for analysis. Follow-up ranged from 6 weeks to 36 months. With regard to overall technical success, 458 of 483 (94.8%) receiving NTA and 521 of 553 (94.2%) undergoing TA had successful truncal ablation on follow-up ultrasound imaging at the study end point (pooled risk ratio, 1.01; 95% confidence interval [CI], 0.99-1.04). Subgroup analysis identified no difference in success between groups during immediate, 6-month, 12-month, or >12-month follow-up periods. Postprocedural pain was generally lower in those undergoing NTA with a mean difference of -18.11 (95% CI, -36.7 to 0.48). Techniques experienced significatly lower rates of ecchymosis (risk ratio, 0.43; 95% CI, 0.23-0.78), with no difference identified with regard to rates of paresthesia, phlebitis, and skin pigmentation. Further assessment of quality of life (mean difference, -0.27; 95% CI, -0.57 to 0.04) and Venous Clinical Severity Score (-0.52; 95% CI, -1.05 to 0.01) revealed no difference between groups. Included data were deemed of moderate methodologic quality. Conclusions: Nonthermal techniques are as effective as standard TA in the first year and, in some studies, may be associated with less procedural pain. These data suggest that NTA offers an alternative and safe means to treat superficial venous disease. There is, however, a need for further powered trials with larger numbers of patients and longer follow-up to definitively examine this hypothesis.
MeSH term(s)	Ablation Techniques/adverse effects ; Embolization, Therapeutic/adverse effects ; Endovascular Procedures/adverse effects ; Humans ; Postoperative Complications/etiology ; Risk Factors ; Treatment Outcome ; Varicose Veins/diagnostic imaging ; Varicose Veins/physiopathology ; Varicose Veins/surgery ; Venous Insufficiency/diagnostic imaging ; Venous Insufficiency/physiopathology ; Venous Insufficiency/surgery
Language	English
Publishing date	2019-10-15
Publishing country	United States
Document type	Journal Article ; Meta-Analysis ; Systematic Review
ISSN	2213-3348
ISSN (online)	2213-3348
DOI	10.1016/j.jvsv.2019.06.009
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Book: History in the making

Egan, Bridget / Winstanley, Margaret

the first 10 years of the Make Smoking History campaign

2010

Title variant	Make Smoking History campaign
Institution	Cancer Council Western Australia. / Tobacco Programs Division
Author's details	[written by Bridget Egan and Margaret Winstanley]
MeSH term(s)	Smoking Cessation/history ; Government Programs/history ; Smoking/adverse effects ; Health Promotion/history ; Mass Media/history ; History, 21st Century
Keywords	Western Australia
Language	English
Size	24 p. :, ill., ports.
Publisher	Tobacco Programs Division, Cancer Council Western Australia
Publishing place	Shenton Park, WA
Document type	Book
Note	Cover title.
ISBN	9781876628147 ; 1876628146 ; 1876628141
Database	Catalogue of the US National Library of Medicine (NLM)

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Article ; Online: Mortality rates of patients undergoing emergency laparotomy in an Irish university teaching hospital.

Kiernan, Aoife C / Waters, Peadar S / Tierney, Sean / Neary, Paul / Donnelly, Maria / Kavanagh, Dara O / Egan, Bridget

Irish journal of medical science

2018 Volume 187, Issue 4, Page(s) 1039–1044

Abstract: Introduction: Emergency laparotomy (EL) is a commonly performed operation with increased morbidity and mortality. Currently, there is a lack of published outcomes following emergency laparotomy within an Irish population. The aim of this study was to ... ...

Abstract	Introduction: Emergency laparotomy (EL) is a commonly performed operation with increased morbidity and mortality. Currently, there is a lack of published outcomes following emergency laparotomy within an Irish population. The aim of this study was to assess our outcomes and compare these to predefined outcomes from NELA. Methods: A review of a prospectively maintained database of all patients who underwent an emergency laparotomy between January 1st 2015 and October 31st 2016 was performed. Patient demographics, operative indication and procedures, preoperative lactate, time of surgery, admission to high dependency unit (HDU) and mortality (30- and 90-day mortality) were included. Statistical analysis was performed using Minitab V18 with p < 0.05 considered significant. Results: One hundred twenty-four emergency operations were performed on 120 patients. The median age was 60 years. Indications for surgery included the following (%): peritonitis (32.45%), obstruction (22.5%), complicated hernia (19.1%), mesenteric ischaemia (15%), trauma (4.1%), and acute haemorrhage (3.3%). A consultant surgeon and consultant anaesthetist were present at 79 and 78% of EL carried out, respectively. Reported 30- and 90-day mortality were 6.66 and 11.6%, respectively. Thirty-day mortality was 20% in octogenarians. Index lactate did not correlate with mortality (p = 0.43). A significant proportion of mortalities had procedures carried out between 6 pm and midnight with the highest mortality rate in patients with mesenteric ischaemia (p < 0.05). Conclusion: EL is associated with high mortality rates. Our mortality figures compare favourably with the NELA data. We support the development of a national database to facilitate improvements in the quality of care delivered to this high-risk cohort.
MeSH term(s)	Adolescent ; Adult ; Aged ; Aged, 80 and over ; Female ; Hospitals, Teaching ; Humans ; Laparotomy/methods ; Laparotomy/mortality ; Male ; Middle Aged ; Mortality ; Prospective Studies ; Retrospective Studies ; Universities ; Young Adult
Language	English
Publishing date	2018-02-15
Publishing country	Ireland
Document type	Journal Article
ZDB-ID	390895-1
ISSN	1863-4362 ; 0021-1265
ISSN (online)	1863-4362
ISSN	0021-1265
DOI	10.1007/s11845-018-1759-4
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Article ; Online: Frequency of inter-specialty consensus decisions and adherence to advice following discussion at a weekly neurovascular multidisciplinary meeting.

Irish journal of medical science

2023 Volume 192, Issue 6, Page(s) 3051–3062

Abstract: Background/aims: Data are limited on the frequency of 'consensus decisions' between sub-specialists attending a neurovascular multidisciplinary meeting (MDM) regarding management of patients with extracranial carotid/vertebral stenoses and post-MDM ' ... ...

Abstract	Background/aims: Data are limited on the frequency of 'consensus decisions' between sub-specialists attending a neurovascular multidisciplinary meeting (MDM) regarding management of patients with extracranial carotid/vertebral stenoses and post-MDM 'adherence' to such advice. Methods: This prospective audit/quality improvement project collated prospectively-recorded data from a weekly Neurovascular/Stroke Centre MDM documenting the proportion of extracranial carotid/vertebral stenosis patients in whom 'consensus management decisions' were reached by neurologists, vascular surgeons, stroke physicians-geriatricians and neuroradiologists. Adherence to MDM advice was analysed in asymptomatic carotid stenosis (ACS), symptomatic carotid stenosis (SCS), 'indeterminate symptomatic status stenosis' (ISS) and vertebral artery stenosis (VAS) patients, including intervals between index event to MDM + / - intervention. Results: One hundred fifteen patients were discussed: 108 with carotid stenosis and 7 with VAS. Consensus regarding management was noted in 96.5% (111/115): 100% with ACS and VAS, 96.2% with SCS and 92.9% with ISS. Adherence to MDM management advice was 96.4% (107/111): 100% in ACS, ISS and VAS patients; 92% (46/50) in SCS patients. The median interval from index symptoms to revascularisation in 50-99% SCS patients was 12.5 days (IQR: 9-18.3 days; N = 26), with a median interval from MDM to revascularisation of 5.5 days (IQR: 1-7 days). Thirty patients underwent revascularisation. Two out of twenty-nine patients (6.9%) with either SCS or ISS had a peri-procedural ipsilateral ischaemic stroke, with no further strokes/deaths during 3-months follow-up. Conclusions: The high frequency of inter-specialty consensus regarding management and adherence to proposed treatment supports a collaborative/multidisciplinary model of care in patients with extracranial arterial stenoses. Service development should aim to shorten times between MDM discussion-intervention and optimise prevention of stroke/death.
MeSH term(s)	Humans ; Carotid Stenosis/surgery ; Stroke/prevention & control ; Endarterectomy, Carotid ; Constriction, Pathologic/etiology ; Consensus ; Brain Ischemia ; Treatment Outcome ; Risk Factors
Language	English
Publishing date	2023-04-21
Publishing country	Ireland
Document type	Journal Article
ZDB-ID	390895-1
ISSN	1863-4362 ; 0021-1265
ISSN (online)	1863-4362
ISSN	0021-1265
DOI	10.1007/s11845-023-03319-4
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Article ; Online: Correction to: Frequency of inter‑specialty consensus decisions and adherence to advice following discussion at a weekly neurovascular multidisciplinary meeting.

Irish journal of medical science

2023 Volume 193, Issue 1, Page(s) 541

Language	English
Publishing date	2023-05-18
Publishing country	Ireland
Document type	Published Erratum
ZDB-ID	390895-1
ISSN	1863-4362 ; 0021-1265
ISSN (online)	1863-4362
ISSN	0021-1265
DOI	10.1007/s11845-023-03396-5
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Article: Experience with botulinum toxin therapy for axillary hyperhidrosis and comparison to modelled data for endoscopic thoracic sympathectomy - A quality of life and cost effectiveness analysis.

Gibbons, John P / Nugent, Emmeline / O'Donohoe, Nollaig / Maher, Barry / Egan, Bridget / Feeley, Martin / Tierney, Sean

The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland

2016 Volume 14, Issue 5, Page(s) 260–264

Abstract: Aim: To estimate cost-effectiveness of botulinum toxin therapy for axillary hyperhidrosis compared to the standard surgical intervention of endoscopic thoracic sympathectomy (ETS).: Methods: The validated dermatology life quality index questionnaire ... ...

Abstract	Aim: To estimate cost-effectiveness of botulinum toxin therapy for axillary hyperhidrosis compared to the standard surgical intervention of endoscopic thoracic sympathectomy (ETS). Methods: The validated dermatology life quality index questionnaire was given to patients attending for treatment over a 4 month period, to assess their quality of life (QoL) over the preceding week (n = 44). Follow-up was performed 4-6 weeks later by telephone using the same questionnaire to validate the effectiveness of the treatment. The duration of effect of the botulinum toxin treatment was also recorded and this data was used as the basis for cost effectiveness analysis. Using HIPE data, the baseline cost for single intervention using botulinum toxin and ETS was retrieved. Using figures provided by HIPE and expert opinion of the costs of complications, a stochastic model for 10,000 patients was used to evaluate the total costs for ETS including the complications. Results: The results from the QoL analysis show that botulinum toxin therapy is a successful therapy for improvement of symptoms. It was revealed that the mean interval before recurrence of original symptoms after botulinum toxin therapy was 5.6 months. The baseline cost for both treatments are €389 for botulinum toxin and €9389 for uncomplicated ETS. The stochastic model yields a mean cost of €11,390 for ETS including complications. Conclusions: Treatments reached cost equivalence after 13.3 years. However, given the efficacy of the botulinum toxin therapy and the low risk we propose that botulinum toxin therapy for hyperhidrosis should be considered the gold standard.
MeSH term(s)	Adult ; Axilla ; Botulinum Toxins/administration & dosage ; Botulinum Toxins/economics ; Dermatologic Agents/administration & dosage ; Dermatologic Agents/economics ; Female ; Follow-Up Studies ; Humans ; Hyperhidrosis/diagnosis ; Hyperhidrosis/drug therapy ; Hyperhidrosis/economics ; Hyperhidrosis/surgery ; Male ; Patient Satisfaction ; Pilot Projects ; Quality of Life ; Retrospective Studies ; Scotland ; Surveys and Questionnaires ; Sympathectomy/economics ; Thoracoscopy/economics ; Thoracoscopy/methods ; Treatment Outcome
Chemical Substances	Dermatologic Agents ; Botulinum Toxins (EC 3.4.24.69)
Language	English
Publishing date	2016-10
Publishing country	Scotland
Document type	Comparative Study ; Journal Article
ZDB-ID	2102927-1
ISSN	1479-666X
ISSN	1479-666X
DOI	10.1016/j.surge.2015.05.002
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Article ; Online: Lower limb impalement injury with reinforced steel cables.

Murphy, Colin G / Butler, Joseph S / Green, Connor / Egan, Bridget M / Sparkes, Joseph

The American surgeon

2013 Volume 79, Issue 2, Page(s) E63–4

MeSH term(s)	Accidents, Occupational ; Adult ; Construction Industry ; Foreign Bodies/etiology ; Foreign Bodies/therapy ; Humans ; Leg Injuries/diagnosis ; Leg Injuries/etiology ; Leg Injuries/therapy ; Male ; Occupational Injuries/diagnosis ; Occupational Injuries/etiology ; Occupational Injuries/therapy ; Steel ; Wounds, Penetrating/diagnosis ; Wounds, Penetrating/etiology ; Wounds, Penetrating/therapy
Chemical Substances	Steel (12597-69-2)
Language	English
Publishing date	2013-02
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	202465-2
ISSN	1555-9823 ; 0003-1348
ISSN (online)	1555-9823
ISSN	0003-1348
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Article ; Online: von Willebrand Factor Antigen, von Willebrand Factor Propeptide, and ADAMTS13 in Carotid Stenosis and Their Relationship with Cerebral Microemboli.

Thrombosis and haemostasis

2020 Volume 121, Issue 1, Page(s) 86–97

Abstract: Background: The relationship between von Willebrand factor antigen (VWF:Ag), VWF propeptide (VWFpp), VWFpp/VWF:Ag ratio, ADAMTS13 activity, and microembolic signal (MES) status in carotid stenosis is unknown.: Methods: This prospective, multicenter ...

Abstract	Background: The relationship between von Willebrand factor antigen (VWF:Ag), VWF propeptide (VWFpp), VWFpp/VWF:Ag ratio, ADAMTS13 activity, and microembolic signal (MES) status in carotid stenosis is unknown. Methods: This prospective, multicenter study simultaneously assessed plasma VWF:Ag levels, VWFpp levels and ADAMTS13 activity, and their relationship with MES in asymptomatic versus symptomatic moderate-to-severe (≥50-99%) carotid stenosis patients. One-hour transcranial Doppler ultrasound of the middle cerebral arteries classified patients as MES+ve or MES-ve. Results: Data from 34 asymptomatic patients were compared with 43 symptomatic patients in the "early phase" (≤4 weeks) and 37 patients in the "late phase" (≥3 months) after transient ischemic attack (TIA)/ischemic stroke. VWF:Ag levels were higher ( Discussion: VWF:Ag expression, a marker of endothelial ± platelet activation, is enhanced in recently symptomatic versus asymptomatic carotid stenosis patients, including in MES-ve patients, and decreases with ADAMTS13 activity over time following atherosclerotic TIA/ischemic stroke.
MeSH term(s)	ADAMTS13 Protein/blood ; ADAMTS13 Protein/metabolism ; Aged ; Carotid Stenosis/blood ; Carotid Stenosis/complications ; Carotid Stenosis/metabolism ; Female ; Humans ; Intracranial Embolism/blood ; Intracranial Embolism/etiology ; Intracranial Embolism/metabolism ; Male ; Middle Aged ; Prospective Studies ; von Willebrand Factor/analysis ; von Willebrand Factor/metabolism
Chemical Substances	Von Willebrand antigen ; von Willebrand Factor ; ADAMTS13 Protein (EC 3.4.24.87) ; ADAMTS13 protein, human (EC 3.4.24.87)
Language	English
Publishing date	2020-09-15
Publishing country	Germany
Document type	Journal Article ; Multicenter Study
ZDB-ID	518294-3
ISSN	2567-689X ; 0340-6245
ISSN (online)	2567-689X
ISSN	0340-6245
DOI	10.1055/s-0040-1715440
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Article: Neovascularization: an "innocent bystander" in recurrent varicose veins.

Egan, Bridget / Donnelly, Michael / Bresnihan, Mary / Tierney, Sean / Feeley, Martin

Journal of vascular surgery

2006 Volume 44, Issue 6, Page(s) 1279–84; discussion 1284

Abstract: Objective: Varicose vein recurrence after surgery occurs in up to 60% of patients. A variety of technical factors have been implicated, but biological factors such as neovascularization have more recently been proposed. The objective of this study was ... ...

Abstract	Objective: Varicose vein recurrence after surgery occurs in up to 60% of patients. A variety of technical factors have been implicated, but biological factors such as neovascularization have more recently been proposed. The objective of this study was to characterize the relative contribution of technical and biological factors to recurrence in a large prospective series of recurrent varicose veins. Methods: Duplex and operative findings were recorded prospectively in a consecutive series of 500 limbs undergoing surgery for recurrent varicose veins between 1995 and 2005 in a university teaching hospital. Only limbs with previous saphenofemoral junction surgery were included. All limbs had preoperative duplex mapping by an accredited vascular technician who assessed the status of the great saphenous vein (GSV) in the thigh and groin, sought sonographic evidence of neovascularization, and reported on the presence of reflux in the short saphenous vein and perforator sites (typical and atypical). All operations were performed with an attending vascular surgeon as the lead operator. Results: Primary GSV surgery was incomplete in 83.2% of limbs. A completely intact GSV system was present in 17.4% of limbs. An incompetent thigh saphenous vein was present in 44.2% of limbs, 37.6% had GSV stump incompetence with one or more intact tributaries, and 16% had both a residual thigh GSV and an incompetent stump with intact tributaries. Non-GSV sites of reflux were identified in 25% of limbs. Neovascularization was identified on duplex scanning in 41 (8.2%) limbs. However, in 27 of these, surgical exploration revealed a residual GSV stump with 1 or more significant tributaries. Each of the remaining 14 (2.8%) limbs had a residual incompetent thigh GSV. Conclusions: Despite reports to the contrary, neovascularization occurs in a relatively small proportion of patients with recurrent varicose veins. All recurrent varicose veins associated with duplex-diagnosed neovascularization are also associated with persistent reflux in the GSV stump tributaries, thigh GSV, or both. Recurrence after primary varicose vein surgery is associated with inadequate primary surgery or progression of disease, and neovascularization alone is not a cause of recurrent varicose veins.
MeSH term(s)	Female ; Humans ; Male ; Middle Aged ; Neovascularization, Pathologic/diagnostic imaging ; Neovascularization, Pathologic/etiology ; Prospective Studies ; Recurrence ; Reoperation ; Saphenous Vein/diagnostic imaging ; Saphenous Vein/surgery ; Treatment Outcome ; Ultrasonography, Doppler, Duplex ; Varicose Veins/complications ; Varicose Veins/diagnostic imaging ; Varicose Veins/prevention & control ; Varicose Veins/surgery ; Vascular Surgical Procedures ; Venous Insufficiency/complications ; Venous Insufficiency/diagnostic imaging ; Venous Insufficiency/prevention & control ; Venous Insufficiency/surgery
Language	English
Publishing date	2006-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	605700-7
ISSN	1097-6809 ; 0741-5214
ISSN (online)	1097-6809
ISSN	0741-5214
DOI	10.1016/j.jvs.2006.08.017
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