S Sheehan

Publications (29)54.37 Total impact

• Article: Evolution of mycotic aortic aneurysm treatment by endovascular repair

  L. Nqwena, M. A. Moloney, D. H. O’Donnell, S. Sheehan, D. P. Brophy, H. Prins
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  ABSTRACT: IntroductionEndovascular intervention for mycotic aortic aneurysms is now an alternative treatment option. Case reportAn 83-year-old male presented with confusion and pyrexia of unknown origin. Acute deterioration and subsequent computed tomography scan of the abdomen revealed a contained rupture of a mycotic aortic aneurysm for which the patient had a successful endovascular repair. Conclusion Endovascular management of aortic mycotic aneurysms provides an alternate and potentially safer method of intervention, particularly in patients deemed unsuitable for open repair. KeywordsPyrexia of unknown origin-Sepsis-Computed tomography-Aorta-Mycotic aneurysm-Endovascular repair
  Irish Journal of Medical Science 04/2012; · 0.58 Impact Factor
• Article: Evaluation of thrombolysis and surgery in the emergency management of the acutely ischaemic limb

  C. Behan, P. Neary, C. Hurson, S. Richards, T. Powell, A. Owens, D. McErlaine, S. Sheehan, D. Mehigan, V. Keaveny
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  ABSTRACT: Acute limb ischaemia has a significant morbidity and mortality. In selected cases, the use of catheter directed tPA thrombolysis offers the surgeon an alternative to emergency surgery. This approach does not demonstrate any increase in the rate of limb loss.
  Irish Journal of Medical Science 04/2012; 171:24-25. · 0.58 Impact Factor
• Article: Iodine intake in pregnancy in Ireland — A cause for concern?

  Z. Nawoor, R. Burns, D. F. Smith, S. Sheehan, C. O’Herlihy, P. P. A. Smyth
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  ABSTRACT: BackgroundAdequate dietary iodine intake is necessary to maintain maternal thyroid function at a level permitting normal neuropsychological development of the foetus. Aims and MethodsTo determine dietary iodine status by measuring urinary iodine excretion (UIE), proportional to dietary intake, in Irish mothers during the first trimester of pregnancy. ResultsMedian UIE showed seasonal variations, being lower in summer than in winter. The median values in pregnant women were, summer 45μg/l, winter 68μg/l. Equivalent values for controls were 43 and 91μg/l respectively UIE required to achieve WHO recommended daily iodine intakes would be 120–180μg/l. In the Irish subjects UIE values suggestive of iodine deficiency (<50μg/l) were observed in 55% of pregnant women tested in summer and 23% in winter. Dairy milk iodine, a major dietary iodine source, showed similar variation. ConclusionsWhile there is as yet no available evidence of widespread thyroid hypofunction in the Irish obstetric population, the findings are a cause of concern, which if confirmed by a more comprehensive investigation, may indicate the need for iodine prophylaxis.
  Irish Journal of Medical Science 04/2012; 175(2):21-24. · 0.58 Impact Factor
• Article: Evolution of mycotic aortic aneurysm treatment by endovascular repair.

  L Nqwena, M A Moloney, D H O'Donnell, S Sheehan, D P Brophy, H Prins
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  ABSTRACT: Endovascular intervention for mycotic aortic aneurysms is now an alternative treatment option. An 83-year-old male presented with confusion and pyrexia of unknown origin. Acute deterioration and subsequent computed tomography scan of the abdomen revealed a contained rupture of a mycotic aortic aneurysm for which the patient had a successful endovascular repair. Endovascular management of aortic mycotic aneurysms provides an alternate and potentially safer method of intervention, particularly in patients deemed unsuitable for open repair.
  Irish Journal of Medical Science 08/2010; 181(3):401-4. · 0.58 Impact Factor
• Article: Secondary aortoenteric fistula presenting with small bowel obstruction.

  R P Killeen, M A Moloney, D H O'Donnell, S Sheehan, D P Brophy
  Emergency Medicine Journal 10/2009; 26(9):640. · 1.44 Impact Factor
• Article: Surgical audit using the POSSUM scoring tool in vascular surgery patients.

  J S Byrne, E T Condon, M Ahmed, R Conroy, D Mehigan, S J Sheehan, M C Barry
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  ABSTRACT: Currently, crude morbidity and mortality rates are used to assess vascular surgical outcome. However, as a high-risk specialty, this may not be representative of quality of care. We evaluated the POSSUM score as a measure of performance in our vascular unit, and also its usefulness on an individual patient basis for predicting outcome. A total of 106 patients were prospectively scored using the vascular-POSSUM score, and mean predicted and observed morbidity and mortality were compared with one-sample t tests. Receiver operator characteristic curves were used to determine if POSSUM scores were associated with the end-points of morbidity and mortality. Predicted and observed morbidity (41 and 35.8%, respectively) were not significantly different (P = 0.066). POSSUM did, however, over-predict mortality at 9.7% compared to the observed mortality of 5.7% (P = 0.021). While the discrimination for predicting morbidity was poor, POSSUM scores were significantly associated with mortality endpoints (area under ROC curve = 0.97250). POSSUM morbidity scores closely correlate with observed outcomes. Although POSSUM did over-predict mortality, high mortality scores may be useful for identifying patients at particularly high risk post-operatively. The POSSUM score is a useful adjunct to interpretation of morbidity and mortality statistics, and we would recommend its wider implementation for surgical audit.
  Irish Journal of Medical Science 03/2009; 178(4):453-6. · 0.58 Impact Factor
• Article: Endoscopic thoracic sympathectomy for long QT syndrome.

  I Murphy, D Moneley, D Kelly, B Foley, S Sheehan
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  ABSTRACT: A 54-year-old woman was referred to our service with intractable ventricular arrhythmias secondary to a familial long-QT syndrome. Her first presentation was 4 years previously, when she suffered a cardiac arrest, at this time an (Automatic Implantable Cardioverter Defibrillator) AICD device was inserted and she was commenced on sympathetic blockers. She remained symptomatic with ongoing tachyarrhythmias and the subsequent automatic cardioversion or defibrillation was causing significant amount of distress. She underwent a left transthoracic endoscopic cardiac sympathectomy and made a good postoperative recovery. She remains asymptomatic at four months. Though open sympathectomy is an established treatment, there are only isolated reports of thoracoscopic sympathetic cardiac denervation in the literature.
  Irish Journal of Medical Science 07/2008; 177(2):167-9. · 0.58 Impact Factor
• Source

  Available from: Peter P A Smyth

  Article: Short-term changes in maternal and neonatal urinary iodine excretion.

  P P A Smyth, D F Smith, S Sheehan, M Higgins, R Burns, C O'Herlihy
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  ABSTRACT: Investigation of maternal urinary iodine (UI) excretion in the immediate antenatal and early postpartum periods showed a precipitous fall in median values from 93 microg/L antenatally to 36 microg/L at delivery subsequently rising to 49 microg/L and 63 microg/L at days 3 and 10 postpartum respectively. The fate of ingested iodine not appearing in the maternal urine is unknown but measurement of UI in babies born to nursing mothers suggested transfer from the mother with median neonatal values of 117 and 159 microg/L being recorded at days 3 and 10. While maternal UI seemed to relatively unaffected by breast feeding, median UI from breast feeding babies (148 microg/L) was significantly greater than in those bottle feeding (50 microg/L). This was also reflected by the finding that no breast feeding baby had a UI values < 50 microg/L in comparison to 50% of bottle feeders. The depressed values in mothers and relatively high values in their infants could present a false picture and suggest the need to defer any investigations of iodine status at this time. The findings do however suggest a need for further investigations aimed at determining the fate of iodine ingested perinatally and its possible physiological significance in maintaining thyroid status in the mother and neonate.
  Thyroid 04/2007; 17(3):219-22. · 4.79 Impact Factor
• Article: Abdominal aortic aneurysm repair and colonic infarction: a risk factor appraisal.

  P Neary, C Hurson, D O Briain, A Brabazon, D Mehigan, T V Keaveny, S Sheehan
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  ABSTRACT: Colonic infarction is a recognized complication of abdominal aortic aneurysm (AAA) surgery. The clinical difficulty in establishing the diagnosis combined with the patient's poor physiological status is usually associated with a fatal outcome. We assessed our experience with this problem to identify a possible risk factor profile for these patients. Patients records were identified from the operative logs, intensive care unit, Hospital Inpatient Enquiry system and vascular unit databases over a 6-year period. A total of 405 patients underwent AAA repair during this period; 140 as emergency ruptures. Nine patients were identified from the databases with known colonic infarction (2.2%). One was a woman. The mean age was 70 years. Seven patients had emergency ruptures (5%). Twenty independent risk factors were analysed using univariate and multivariate logistic regression models. Significant risk factors identified by using a multivariate analysis included the nature of the presenting patient, preoperative hypotension, prolonged cross-clamp time, intra-operative ischaemia and postoperative acidosis. Confirmatory diagnosis was made by colonoscopy in eight patients. One patient survived following the salvage surgery. The mean duration of survival was 10.5 days. The overall mortality was 89% of patients. In our unit infrarenal AAA repair has a 2.2% rate of colonic infarction. A definitive diagnosis is best made by colonoscopy. A risk factor profile for the development of colonic infarction may be constructed on the basis of specific clinical parameters. Earlier intervention on the basis of this profile may ultimately reduce the current excessive mortality.
  Colorectal Disease 03/2007; 9(2):166-72. · 2.93 Impact Factor
• Article: Radiation-induced femoral arteritis.

  S M Kieran, R A Cahill, S Sheehan, M C Barry
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  ABSTRACT: Radiation arteritis is currently an uncommon sequalae of external beam radiation, however because of the increasing use of radiotherapy in the management of neoplastic conditions its recognition is increasingly important. We present two cases of debilitating femoral occlusive disease, secondary to radiation exposure, at a long period post irradiation and review the pathophysiolgy and management options for this condition.
  Irish medical journal 07/2004; 97(6):179-80.
• Article: Aortic saddle embolus causing paraplegia.

  D O Kavanagh, S Richards, M C Barry, S Sheehan
  Irish medical journal 05/2004; 97(4):117.
• Article: Early Outcomes Following Alternative Treatment Strategies in the Management of the Acutely Ischemic Limb

  P. Neary, C. Behan, T. Powell, T. Owens, D. MacErlaine, D. Mehigan, S. Sheehan, T.V. Keaveny
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  ABSTRACT: The modem emergency management of the acutely ischemic limb has evolved considerably with the introduction of catheter-directed thrombolysis. Following preservation of life, the next goal of intervention in these emergency cases, whether with surgery or thrombolysis, is limb salvage. We report our own experience with both approaches in the early outcome of the emergency management of the acutely ischemic limb. This is a retrospective review of a tertiary-level vascular units experience. The inclusion criteria consisted of acute limb ischemia as defined by the guidelines of the Vascular Surgical Society of Great Britain and Ireland. Data acquisition used the hospitals inpatient enquiry system, and its operative and radiology databases. Analysis used the 2 test and the Yates correction factor (p < 0.05). Patients: N=84. Events: 103. Median age: females, 82 yrs; males, 71 yrs. 17–91 yrs. Females vs. males > 70years: 2=5.4, d.f.=1, 0.01 < p, 0.02) (2: p= 0.05). Seventy-one patients underwent preoperative angiography. Successful limb salvage was achieved in 75% of cases. Overall, the amputation and mortality rates were 16.5% and 13.1%, respectively. We initially treated 62% of events with surgery and 38% with thrombolysis. In those patients who underwent thrombolysis there, 31% went on to have reconstructive surgery. Thrombolytic treatment resulted in a limb salvage rate of 69%. Thrombolysis was discontinued in six cases due to complications. Significant differences in outcome were not demonstrable between the two treatment groups (2=1.1, d.f.=1, 0.5 < p < 0.1). Acute limb ischemia has significant morbidity and mortality rates. The use of catheter-directed thrombolysis offers the surgeon an alternative to emergency surgery. This approach does not demonstrate any increase in the rate of limb loss.
  International Journal of Angiology 04/2004; 13(2):75-80.
• Article: Evaluation of the impact of transthoracic endoscopic sympathectomy on patients with palmar hyperhydrosis.

  O Young, P Neary, T V Keaveny, D Mehigan, S Sheehan
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  ABSTRACT: We assessed the impact of transthoracic endoscopic sympathectomy (TES) on the quality of life of patients with palmar hyperhydrosis. A retrospective questionnaire based study. Patients undergoing TES at our institution between 1997 and 2002 received a SF-36 quality of life postal questionnaire. The pre- and post-operative symptoms were assessed. Statistical analysis was by means of the Student's t test. Ninety-four TES were carried out in 62 patients. Forty-one cases were female. The age range was 17-64 years. The mean follow-up period was 38.46 months. Mean hospital stay was 3 days. Compensatory hyperhydrosis was reported in 29 cases and only considered severe in four cases (9.7%). Forty-one patients replied to the questionnaire (66%). The overall quality of life (as assessed by the SF-36 form) was unanimously improved (p<0.0009) and demonstrated significant improvements in social functioning (p<0.0002), physical role limitations (p<0.0007), emotional well-being (p<0.0007) and overall energy levels (p<0.05). TES resulted in significant improvements inpatient's overall quality of life, social and emotional functioning. The procedure is associated with minimal morbidity and only a short inpatient stay is required. Patients should be cautioned on the possibility of compensatory hyperhydrosis which may occur in a small number of cases.
  European Journal of Vascular and Endovascular Surgery 12/2003; 26(6):673-6. · 2.99 Impact Factor
• Article: Assessment of degree of internal carotid artery stenosis based on duplex velocity measurements using an artificial neural network

  R. Mofidi, A. Brabazon, T. Powell, C. Hurson, S. Sheehan, D. Mehigan, D. MacErlaine, T. V. Keaveny
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  ABSTRACT: Background:Duplex imaging is increasingly used as a stand-alone investigation before carotid endarterectomy. There is concern regarding the wide variation in diagnostic methods of grading internal carotid artery (ICA) stenosis using duplex velocity criteria. The aim of the study was to design an artificial neural network (ANN) that is able to provide a measure of the degree of ICA stenosis based on the four most commonly used duplex velocity profiles.Methods:One hundred and four consecutive patients who were admitted for assessment of carotid occlusive disease were included. All patients underwent arch injection digital subtraction angiography and carotid duplex ultrasonography. Peak systolic velocity (PSV) and end-diastolic velocity (EDV) in the ICA and common carotid artery (CCA) were measured. The degree of angiographic stenosis was measured by two blinded investigators. A three-layered perceptron ANN was constructed using the NeuroSolutionsTM version 1 software program (NeuroDimension, Gainesville, FL, USA). The accuracy of the model in predicting the degree of ICA stenosis was expressed as the mean squared error (MSE) of the actual degree of angiographic stenosis. The performance of the neural network model was compared with that of the linear regression model at predicting the degree of ICA stenosis and classifying a degree of ICA stenosis greater than 50 per cent.Results:One hundred and sixty-eight carotid bifurcations were available for analysis. The MSE of the ANN at predicting the degree of ICA stenosis was 0·096 (overall accuracy of 84 per cent), which was superior to a linear regression model (MSE 0·132; overall accuracy 73 per cent) (P < 0·001). Both models were equally accurate at identifying a degree of ICA stenosis greater than 50 per cent (ANN accuracy 0·91 versus regression model accuracy 0·89; P = 0·09).Conclusion:Neural network algorithms are able to predict the degree of ICA stenosis with reasonable accuracy and outperform linear regression analysis on the basis of a limited set of duplex velocity measurements. With further refinement, ANN models could replace duplex criteria in assessment of the degree of ICA stenosis. © 2001 British Journal of Surgery Society Ltd
  British Journal of Surgery 12/2002; 88(4):600 - 600. · 4.61 Impact Factor
• Article: Effects of human recombinant growth hormone (rhGH) on inflammatory responses in patients undergoing abdominal aortic aneurysm repair

  K. Mealy, M. Barry, L. O’Mahony, S. Sheehan, P. Burke, C. McCormack, A. S. Whitehead, D. Bouchier-Hayes
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  ABSTRACT: Background: Human recombinant growth hormone (rhGH) has been shown to increase skeletal muscle protein synthesis and improve nitrogen balance in critically ill patients and those undergoing surgery. rhGH effects on hepatic protein turnover in critically ill patients are less clearly understood. Objective: To examine rhGH effects on hepatic acute phase protein responses and inflammatory cytokine release in patients undergoing major surgery. Design: Prospective double blind randomised trial. Setting: Tertiary referral university teaching hospital. Patients: Patients undergoing elective abdominal aortic aneurysm repair. Intervention: Patients received rhGH (Genotropin, 0.3 IU/kg per day, n=8) or placebo (n=10) for 6 days prior to surgery. Results: Blood levels of growth hormone (GH) and insulin-like growth factor (IGF-1) were measured following rhGH treatment and C-reactive protein (CRP), serum amyloid A (SAA) and the cytokines interleukin-6 (IL-6) and the IL-1 receptor antagonist (IL-1ra) were measured for up to 24 h following surgery. Significant increases in plasma rhGH (0.84 ± 0.3, mean (sem) versus 52 ± 20 mU/1, p<0.0008) and IGF-1 levels (119 ± 13 versus 644 ± 110 ng/ml, p<0.0001) were seen prior to surgery following rhGH administration. No differences in acute phase protein or cytokine levels were seen following surgery in patients receiving rhGH. Conclusions: These results indicate that pre-operative administration of rhGH does not alter acute phase protein or inflammatory cytokine release in response to major surgery.
  Intensive Care Medicine 04/1998; 24(2):128-131. · 5.40 Impact Factor
• Article: An "all comers" policy for ruptured abdominal aortic aneurysms: how can results be improved?

  M C Barry, P E Burke, S Sheehan, A Leahy, P J Broe, D J Bouchier-Hayes
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  ABSTRACT: To review our experience of a non-selective policy for the treatment of ruptured abdominal aortic aneurysm to see if the policy was justified, and to identify any preoperative risk factors that adversely influenced outcome. Retrospective study. Teaching hospital, Republic of Ireland. 258 patients admitted with abdominal aortic aneurysms between January 1982 and December 1993. Definitive surgical treatment. Morbidity, mortality, and risk factors. In-hospital mortality for all patients was 43% (110/258). Overall, women did worse than men (28/44, 64%, died, compared with 96/214, 45%, p=0.03). The mortality among patients over the age of 80 (23/45, 51%) was not significantly different from that among younger patients (97/202, 48%). Blood pressure, platelet count, and haemoglobin concentration were all significantly lower preoperatively among those who died (p < 0.05). Age alone cannot be used to justify witholding definitive surgical treatment. Treatment should be aimed towards reversing haematological and haemodynamic abnormalities preoperatively to try to improve outcome.
  The European Journal of Surgery 04/1998; 164(4):263-70.
• Article: Effects of human recombinant growth hormone (rhGH) on inflammatory responses in patients undergoing abdominal aortic aneurysm repair.

  K Mealy, M Barry, L O'Mahony, S Sheehan, P Burke, C McCormack, A S Whitehead, D Bouchier-Hayes
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  ABSTRACT: Human recombinant growth hormone (rhGH) has been shown to increase skeletal muscle protein synthesis and improve nitrogen balance in critically ill patients and those undergoing surgery. rhGH effects on hepatic protein turnover in critically ill patients are less clearly understood. To examine rhGH effects on hepatic acute phase protein responses and inflammatory cytokine release in patients undergoing major surgery. Prospective double blind randomised trial. Tertiary referral university teaching hospital. Patients undergoing elective abdominal aortic aneurysm repair. Patients received rhGH (Genotropin, 0.3 IU/kg per day, n = 8) or placebo (n = 10) for 6 days prior to surgery. Blood levels of growth hormone (GH) and insulin-like growth factor (IGF-1) were measured following rhGH treatment and C-reactive protein (CRP), serum amyloid A (SAA) and the cytokines interleukin-6 (IL-6) and the IL-1 receptor antagonist (IL-1ra) were measured for up to 24 h following surgery. Significant increases in plasma rhGH (0.84 +/- 0.3, mean (sem) versus 52 +/- 20 mU/l, p < 0.0008) and IGF-1 levels (119 +/- 13 versus 644 +/- 110 ng/ml, p < 0.0001) were seen prior to surgery following rhGH administration. No differences in acute phase protein or cytokine levels were seen following surgery in patients receiving rhGH. These results indicate that pre-operative administration of rhGH does not alter acute phase protein or inflammatory cytokine release in response to major surgery.
  Intensive Care Medicine 02/1998; 24(2):128-31. · 5.40 Impact Factor
• Article: Immunological and physiological responses to aortic surgery: effect of reperfusion on neutrophil and monocyte activation and pulmonary function.

  M C Barry, C Kelly, P Burke, S Sheehan, H P Redmond, D Bouchier-Hayes
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  ABSTRACT: The aims of this study were to evaluate the effects of aortic clamping and unclamping on neutrophil and monocyte activation and release of plasma mediators in 20 patients undergoing elective aortic aneurysm surgery, and to correlate these findings with pulmonary haemodynamics and gas exchange. Simultaneous arterial and mixed venous samples were obtained during and after aortic clamping and unclamping. Neutrophil respiratory burst activity in mixed venous samples increased significantly during the period of aortic clamping. An initial increase in neutrophil CD11b expression in venous blood 5 min after clamp removal was followed by a significant decrease in level of expression. Plasma tumour necrosis factor levels increased at the end of the cross-clamp period and reached a maximum 60 min following reperfusion. There was a significant and sustained rise in plasma thromboxane B2 levels following clamp removal. This increase correlated with the development of increased pulmonary vascular resistance. This study confirms the central role played by activated neutrophils in the early stages of reperfusion injury and also suggests a role for plasma mediators in mediating cardiopulmonary dysfunction during major vascular surgery.
  British Journal of Surgery 05/1997; 84(4):513-9. · 4.61 Impact Factor
• Article: Glyceryl trinitrate prevents neutrophil activation but not thromboxane release following ischaemia-reperfusion injury.

  M C Barry, C J Kelly, K Stokes, H Abdih, S Sheehan, P Burke, D Bouchier Hayes
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  ABSTRACT: The aim of this study was to determine whether glyceryl trinitrate (GTN) has a protective effect on neutrophil-mediated lung injury in a model of aortic occlusion (30 min) and reperfusion (120 min). Sprague-Dawley rats were randomized into control (n = 11), ischaemia-reperfusion (IR) (n = 12), and IR treated with GTN (2 micrograms kg-1 min-1) during reperfusion (n = 10). Myeloperoxidase (MPO) activity measured pulmonary neutrophil influx. Pulmonary endothelial permeability was measured by wet:dry weight ratio, bronchoalveolar lavage (BAL) protein and neutrophil counts. Neutrophil superoxide release was measured by flow cytometry in a further IR versus GTN experiment (n = 6 in each group). The significant increase in MPO activity produced by IR to a level of 7.99 units g-1 was prevented by GTN which reduced the level to 4.73 units g-1. The increase in pulmonary microvascular leakage after reperfusion was also prevented by GTN: BAL protein without GTN was 992 micrograms ml-1 and with GTN 579 micrograms ml-1; BAL neutrophil count without GTN was 3219 cells mm-3 and with GTN 820 cells mm-3; the wet:dry lung weight ratio without GTN was 3.8 and with GTN 3.3. Neutrophil superoxide release increased significantly after 40 min of reperfusion in the untreated IR group (P < 0.05). This increase was prevented in the GTN-treated group. GTN administration had no effect on plasma thromboxane production during revascularization. These data suggest that GTN administration during the reperfusion phase has the potential to decrease pulmonary microvascular injury.
  British Journal of Surgery 09/1996; 83(8):1095-1100. · 4.61 Impact Factor
• Article: An aggressive approach to acute superior mesenteric arterial ischemia.

  P A Grace, M Da Costa, A Qureshi, S Sheehan, P Burke, D Bouchier-Hayes
  European Journal of Vascular Surgery 12/1993; 7(6):731-2.