Myles Joyce

Publications (6)11.6 Total impact

• Article: Ureteric obstruction in familial adenomatous polyposis-associated desmoid disease.

  Myles Joyce, Emilio Mignanelli, James Church
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  ABSTRACT: Intra-abdominal desmoid disease is the second leading cause of death in familial adenomatous polyposis patients. The aim of this study was to identify the incidence, management, and outcomes for familial adenomatous polyposis associated intra-abdominal desmoids causing ureteric obstruction. Clinical data were abstracted from an institutional review board-approved, prospectively maintained familial polyposis registry. Of 107 patients identified with familial adenomatous polyposis related desmoid disease, 30 (28%) had documented CT scan evidence of ureteric obstruction. There was a 1:2.3 female predominance. Preceding surgery was the most prominent risk factor for development of desmoid disease (28 of 30 patients); 2 patients were diagnosed with desmoids before abdominal surgery. Overall, 11 patients had ureteric obstruction at the time of diagnosis. In the other 19 patients, median time from desmoid diagnosis to ureteric obstruction was 2 years. Pharmacologic management alone was effective in 8 patients. Eighteen patients (60%) underwent retrograde ureteric stent insertion. Five patients (17%) required percutaneous nephrostomy tubes. Three patients (10%) underwent autotransplant of 4 kidneys, and 4 patients (13%) required nephrectomy. One patient underwent ureterolysis, and another underwent ureteric resection with reimplantation. One-third of patients required more than one urologic procedure, and 63% had extensive small-bowel involvement with desmoid. The majority of patients with familial adenomatous polyposis associated desmoid disease who develop hydronephrosis require stenting. Complete obstruction may necessitate a nephrostomy. Renal autotransplant is an option for persistent symptomatic obstruction. Physicians treating patients with familial adenomatous polyposis and desmoid disease must be aware of the potential for development of ureteric obstruction and available treatment options.
  Diseases of the Colon & Rectum 03/2010; 53(3):327-32. · 3.13 Impact Factor
• Article: Magnetic resonance imaging in the management of anal fistula and anorectal sepsis.

  Myles Joyce, Joseph C Veniero, Ravi Pokala Kiran
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  ABSTRACT: Complex perianal disease may be extremely debilitating for the patient with significant impingement on quality of life. The accurate identification of anatomical areas of involvement and subsequent appropriate management is crucial to achieving a successful outcome when treating anorectal sepsis and anal fistulae. Magnetic resonance imaging (MRI) has become a powerful tool in the evaluation of anal anatomy. In patients with complex disease MRI is an important adjunct in delineating disease location and extent, its relationship to sphincter muscles, and in planning management. MRI also plays an important role in evaluating the response to medical and surgical therapies.
  Clinics in colon and rectal surgery. 08/2008; 21(3):213-9.
• Article: Surgical management of Ehlers-Danlos syndrome type IV following abdominal trauma.

  Joseph T Garvin, Myles Joyce, Mairead Redahan, Aonghus O'Loughlin, Ronan Waldron
  The Journal of trauma 06/2008; 64(5):1376-9. · 2.48 Impact Factor
• Source

  Available from: Rowan G Casey

  Article: Two-week treatment with pravastatin improves ventriculo-vascular haemodynamic interactions in young men with type 1 diabetes.

  Rowan G Casey, Myles Joyce, Kevin Moore, Chris Thompson, Patricia Fitzgerald, David J Bouchier-Hayes
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  ABSTRACT: Young patients with diabetes but without established vascular disease have altered conduit and resistance artery reactivity. Early endothelial dysfunction is an initial step in atherogenesis: reductions in nitric oxide (NO) production in these vascular beds are implicated. The study aim was two-fold: first, to detect baseline abnormalities in cardiac function, conduit vessels and the microcirculation using applanation tonometry, brachial artery ultrasound and laser Doppler fluximetry, respectively; and second, to investigate any modification in these parameters with the use of pravastatin. Nine young men with diabetes and normoalbuminuria were randomised in a double-blind cross-over fashion to placebo or pravastatin (40 mg) treatment for two weeks. They underwent scans on three separate occasions. Control patients (n=12) underwent a baseline scan but were not given any drug treatment. It was found that patients with diabetes had significantly higher systolic and diastolic blood pressures, heart rate and Buckberg index (propensity to myocardial ischaemia). Brachial artery reactivity and microcirculatory dilation were both reduced. Levels of von Willebrand Factor, a marker of endothelial damage, were also elevated. Pravastatin treatment restored these sub-clinical abnormalities towards normal levels. In conclusion, pravastatin improves vascular abnormalities in young male patients with diabetes through alterations in microcirculation and conduit vessel function, with secondary myocardial effects. This may be of benefit in preventing end-organ injury.
  Diabetes & Vascular Disease Research 04/2007; 4(1):53-61. · 2.12 Impact Factor
• Article: Taurine attenuates acute hyperglycaemia-induced endothelial cell apoptosis, leucocyte-endothelial cell interactions and cardiac dysfunction.

  Rowan G Casey, Chen Gang, Myles Joyce, David J Bouchier-Hayes
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  ABSTRACT: Hyperglycaemia is implicated in microvascular inflammatory injury and subsequent cardiac injury/dysfunction. Leucocyte adhesion to the endothelium, migration into tissue and toxic metabolite release are early critical steps. Taurine is a semi-essential amino acid that is endothelial protective and restrains excess leucocyte activity by the formation of less toxic inflammatory mediators. The aim was to establish if taurine reduces acute hyperglycaemia-induced endothelial cell apoptosis and leucocyte interactions and associated cardiac abnormalities. Male Sprague-Dawley rats (190-250 g) were randomised to control, hyperglycaemia, and hyperglycaemia plus taurine pre-treated groups. Taurine was gavaged (200 mg/kg body weight) for 5 days. Intravenous hyperglycaemia was established which was 4 times that of baseline for the 3-hour experiment. Using intravital microscopy, mesenteric post-capillary venules were examined for leucocyte rolling, adhesion and migration every 30 min from baseline. Endothelial cell apoptosis and intracellular adhesion molecule (ICAM-1) expression were assessed. In a separate experiment, blood pressure, pulse rate, cardiac injury marker (troponin T), cardiac tissue injury and oedema were also assessed. Hyperglycaemia significantly increased leucocyte adhesion and migration. Blood pressure and troponin T were also elevated significantly. Taurine prevented these cardiac changes, endothelial cell apoptosis and ICAM-1 expression. Taurine may have a therapeutic role in reducing diabetic microvascular inflammatory injury and concomitant cardiac dysfunction.
  Journal of Vascular Research 02/2007; 44(1):31-9. · 2.65 Impact Factor
• Article: Laparoscopic mesh repair of a diaphragmatic hernia of Bochdalek.

  Myles Joyce, Cathal Moran, Mohammed Khan, Dermot Lowe, Oliver McAnena
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  ABSTRACT: The advent of minimally invasive surgery has facilitated the laparoscopic repair of diaphragmatic hernias. One of the difficulties associated with long-standing Bochdalek or Morgagni hernias is that the herniated contents are often quite adherent to the diaphragmatic defect and require considerable dissection before the reduction of herniated organs. Ultrasonic dissection using a harmonic coagulation shears allowed safe, bloodless division of the long-standing adhesions, which is essential for atraumatic reduction of herniated thoracic contents. We herein report the successful laparoscopic mesh repair of a Bochdalek hernia in a 67-year-old man.
  Surgical laparoscopy, endoscopy & percutaneous techniques 09/2006; 16(4):267-9. · 1.23 Impact Factor