Sean Loughran - Academia.edu (original) (raw)

Papers by Sean Loughran

Annals of The Royal College of Surgeons of England, Sep 1, 2016

Spongostan ® (Ethicon) to form a cement restrictor that can accommodate large canal diameters and... more Spongostan ® (Ethicon) to form a cement restrictor that can accommodate large canal diameters and provide excellent pressurisation. TECHNIQUE The technique involves the application of Spongostan ® foam on to a Surgicel ® mesh, which is rolled on to the Spongostan ® foam, forming a uniform cylindrical structure. The diameter of the restrictor is adjusted to the desired femoral canal diameter by increasing the thickness of the Spongostan ® foam. The restrictor is inserted into the medullary canal and guided to the appropriate position using a standard cement restrictor inserter, where it expands uniformly, creating an effective restrictor. Bone cement is applied and pressurisation commenced prior to implant insertion. The bespoke restrictor glides with minimal resistance and maintains its form during insertion. DISCUSSION Numerous plug designs and materials are available, ranging from nonresorbable to resorbable. All restrictors should avoid intramedullary cement leakage and plug migration during cement and stem insertion to ensure adequate intramedullary pressures. The use of the Surgicel ®-Spongostan ® haemostatic restrictor overcomes some of the limitations of standard cement restrictors. These include the ability to bypass a narrow femoral isthmus, accommodate large femoral canals (particularly in revision procedures), and the flexibility of adjusting the restrictor to the desired diameter of the medullary canal, providing a bespoke cement restrictor.

Otolaryngology-Head and Neck Surgery, Nov 1, 2006

OBJECTIVESTo investigate the etiology of nasal polyps and its relationship to allergy. The preval... more OBJECTIVESTo investigate the etiology of nasal polyps and its relationship to allergy. The prevalence of positive food and inhalant skin tests in patients with nasal polyps and nonatopic controls was compared.STUDY DESIGN AND SETTINGProspective controlled study in tertiary referral rhinology clinic.RESULTSSeventy percent (70%) of the patients with nasal polyps had positive skin tests to an average of four foodstuffs, compared to 34 percent of controls (P = 0.006). Only 35 percent of the nasal polyp patients also had positive inhalant skin tests. Overall, the prevalence of positive inhalant skin tests was similar in the nasal polyp patients and controls.CONCLUSIONSThese findings suggest that the positive skin tests to foods are not merely a reflection of the general atopic status of patients with nasal polyps. It may be that non‐IgE‐mediated hypersensitivities, such as to ingested foods, play a role on the basis of a significant number of patients with positive intradermal skin tests to foods.SIGNIFICANCEEvaluation of the allergic status of patients with polyposis is important. Dietary manipulation may be indicated, though its role needs further investigation.

Clinical Otolaryngology, Nov 18, 2005

Endoscopic ligation of the sphenopalatine artery (ESPAL) has recently become the treatment of cho... more Endoscopic ligation of the sphenopalatine artery (ESPAL) has recently become the treatment of choice for refractory epistaxis. This paper reviews the background, indications and potential complications of ESPAL. • The main focus of this article is an online video tutorial on the anatomy and surgical technique of ESPAL. Web links lead to video clips of operative steps and therefore this paper should be read in front of a computer with access to the internet. • To study the techniques the links detailed below should be followed. (For computers running realplayer software the .wmv extension in each of these links should be replaced with the .rm extension.

Journal of Head Neck & Spine Surgery, 2018

Introduction: Thyroid "incidentalomas" are increasing in frequency, thought mainly to be a result... more Introduction: Thyroid "incidentalomas" are increasing in frequency, thought mainly to be a result of the enhanced sensitivity of ultrasonography and the increasing use of this imaging technique. We present two cases of thyroid nodules in paediatric patients which were found to be intrathyroidal thymic tissue. Case report: The first case displayed ultrasonographic features that were highly suspicious for papillary thyroid cancer with microcalcification, however following diagnostic hemithyroidectomy the lesion was diagnosed as intra-thyroidal ectopic thymic tissue. Histologically, calcified Hassall's corpuscles would account for the calcified appearance of the nodule on ultrasound scan. We describe a further case of intra-thyroidal ectopic thymic tissue in another paediatric patient who presented with a thyroid mass. Discussion: It is important to consider thymic remnant tissue as a differential diagnosis for incidental thyroid nodules.

International Journal of Head and Neck Surgery, 2018

Laryngeal cancer remains one of the most common airway cancers. Although the incidence has genera... more Laryngeal cancer remains one of the most common airway cancers. Although the incidence has generally declined, the overall survival has actually decreased over the last 40 years despite advancements in its treatment. Treating a malignancy in this region is challenging, and management involves a balance between primary oncological control, organ and functional preservation, and minimizing treatment morbidity. Patients with laryngeal cancer require a truly multidisciplinary team approach. Surgery remains an integral part of management, with several viable organ preservation-based surgical approaches evolving over recent years. There have also been significant advancements in other nonsurgical laryngeal preservation treatment modalities, such as radiation and chemotherapy. However, there still remains a need for further research in understanding the disease, and more innovation in its treatment. Future research in the treatment of laryngeal cancer should be focused on strategies to improve locoregional control and overall survival, while reducing patient morbidity and the impact on quality of life.

Clinical Otolaryngology, 2019

The demand for inpatient beds continues to increase nationally. Subsequently, there is an increas... more The demand for inpatient beds continues to increase nationally. Subsequently, there is an increasing drive towards elective surgeries being performed as day case procedures. Overall, there has been an improvement in day case procedure rates in ENT (ears, nose and throat) with 50.9% of ENT cases performed as day case procedures according to statistics obtained from NHS Digital for 2015/16 1 and 2016/17. 2 This is an improvement of 0.2% from the figures of 2015/16 to 2016/17. However, certain procedures such as parotidectomies are still largely performed as inpatient procedures due to the placement of drains postoperatively to prevent haematoma formation with 3.5% of cases performed as day case in 2016/17. In this article, we describe the potential use of ARTISS™ for controlling postoperative haemostasis in patients undergoing parotid surgery allowing them to be discharged on the day of surgery. 2 | ME THODS 2.1 | Ethical considerations Data were collected using electronic patient notes following Salford Royal NHS Foundation Trust audit guidelines. Ethical approval was not required for this study. Patient consent was obtained prior to the use of ARTISS™. 2.2 | ARTISS™ ARTISS™ is a fibrin sealant produced by the American company, Baxter Corp. It is a liquid fibrin sealant comprising of two components. The first component is a sealer protein solution containing human fibrinogen and aprotinin. This solution prevents the premature breakdown of the clot at the site of application. 3 The second component is a thrombin solution containing human thrombin and calcium chloride. ARTISS™ is one of the four sprayable fibrin sealants licensed for use in the UK. ARTISS™ is used to control bleeding in surgery due to its haemostatic and adhesive abilities. ARTISS™ works by converting fibrinogen into insoluble fibrin with the use of thrombin and small amounts of calcium chloride. The process mimics the last part of the coagulation cascade and is independent of the patient's coagulation status. 3

International Journal of Pediatric Otorhinolaryngology, 2003

In February 2001 the United Kingdom Department of Health in conjunction with the British Associat... more In February 2001 the United Kingdom Department of Health in conjunction with the British Association of Otolaryngology, Head and Neck Surgeons decreed that all non-emergency tonsillectomies should be performed using disposable instruments because of the theoretical risk of transmission of variant Creutzfeld-Jakob disease (vCJD). There was an understandable delay in the provision of these instruments by the various manufacturers, leading to an increase in waiting time for surgery. It was decided to assess parental attitudes to the risk of vCJD, and assess the effect the additional delay had on their child. A questionnaire was sent to the parents of all 249 children on the waiting list for tonsillectomy. Seventy percent replied, and of these, 37% felt there was a risk of reusing instruments, only 10% felt there was no risk, and the remaining 53% did not know if there was any risk. Nevertheless 41% of parents would have gone ahead using old instruments if allowed. All parents of the 73 children waiting greater than 6 months were questioned on the effect of the additional delay. Only 7% reported improvement in symptoms, and 68% felt the additional delay had badly affected their child&amp;amp;amp;#39;s health and wellbeing. Ninety percent of parents felt their child&amp;amp;amp;#39;s symptoms still warranted tonsillectomy. There is an awareness of risk of vCJD among parents whose children await tonsillectomy, although understandably the level of risk they feel is hard to quantify. The rate of symptom resolution whilst on the waiting list was very low.

The Journal of Laryngology & Otology, 2016

This is the official guideline endorsed by the specialty associations involved in the care of hea... more This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. With an age standardised incidence rate of 0.63 per 100 000 population, hypopharynx cancers account for a small proportion of the head and neck cancer workload in the UK, and thus suffer from the lack of high level evidence. This paper discusses the evidence base pertaining to the management of hypopharyngeal cancer and provides recommendations on management for this group of patients receiving cancer care.Recommendations• Cross-sectional imaging with computed tomography of the head, neck and chest is necessary for all patients; magnetic resonance imaging of the primary site is useful particularly in advanced disease; and computed tomography and positron emission tomography to look for distant disease. (R)• Careful evaluation of the upper and lower extents of the disease is necessary, which may require contrast swallow or computed tomography and posi...

I certify that this dissertation which I now submit for examination for the award of MSc in Compu... more I certify that this dissertation which I now submit for examination for the award of MSc in Computing (Assistive Technology), is entirely my own work and has not been taken from the work of others save and to the extent that such work has been cited and acknowledged within the test of my work. This dissertation was prepared according to the regulations for postgraduate study of the Dublin Institute of Technology and has not been submitted in whole or part for an award in any other Institute or University. The work reported on in this dissertation conforms to the principles and requirements of the Institute s guidelines for ethics in research.

British Journal of Hospital Medicine, 2011

The Scientific World Journal, 2014

Introduction. Anaplastic thyroid carcinoma (ATC) is rare yet accounts for up to 50% of all thyroi... more Introduction. Anaplastic thyroid carcinoma (ATC) is rare yet accounts for up to 50% of all thyroid cancer deaths. This study reviews outcomes of patients with confirmed ATC referred to a tertiary oncology centre plus reviews the literature to explore how poor outcomes may be improved.Materials and Methods. The management and outcomes of 20 patients with ATC were reviewed.Results. Median age at diagnosis was 69.5 years. 19 patients died due to ATC, 40% of whom died from asphyxiation. Median survival for all cases was 59 days. Patients who had previous surgery prior to other treatment modalities had a longer median survival overall compared to those who had not had previous surgery (142 days compared to 59 days) and produced the one long-term survivor. Chemotherapy followed by radiotherapy (without previous surgery) was associated with longer median survival (220 days). Palliative radiotherapy alone did not decrease the rate of death by asphyxiation when compared to other single modal...

Head & Neck, 2015

ABSTRACTBackgroundAnaplastic thyroid carcinoma (ATC) is an uncommon thyroid malignancy with a poo... more ABSTRACTBackgroundAnaplastic thyroid carcinoma (ATC) is an uncommon thyroid malignancy with a poor prognosis. American Thyroid Association (ATA) guidelines acknowledge the complexity of airway management in these patients. We studied our local experience with the aim of providing guidance in airway management in ATC.MethodsPatients with histologically confirmed ATC from January 2004 to December 2011 were identified from our institutional database. The data were retrospectively analyzed using hospital case notes.ResultsTwenty‐six patients were identified with ATC, 25 of who died from the disease. Five of 26 patients (19%) had stridor at presentation. A further 6 of 26 patients (23%) developed stridor during or soon after radiotherapy. Nine patients (36%) died of airway obstruction.ConclusionTracheotomy can facilitate completion of palliative treatment in those patients with ATC and stridor. Given the short life expectancy of these patients, a balanced decision must be made regarding ...

European Thyroid Journal, 2013

values of 1.0, 1.8 and 2.9%, respectively (p = 0.0031). There was a statistically significant rel... more values of 1.0, 1.8 and 2.9%, respectively (p = 0.0031). There was a statistically significant relationship between number of thyroidectomies performed and median pre-ablation 131 I TBU values up to the optimal number of 11 operations beyond which there was no further significant difference between surgeons. There were differences in remnant size between endocrine and general surgeons (p = 0.001), otolaryngology and general surgeons (p = 0.023) but not between endocrine and otolaryngology surgeons (p = 0.167). Conclusion: Using the pre-ablation 131 I uptake scan as a surrogate for thyroid remnant quantification following thyroidectomy demonstrates the relationship between the surgical volume and size of thyroid remnant. The study also demonstrated beneficial effects of specialisation with specialist surgeons achieving the smallest thyroid remnant.

Cochrane Database of Systematic Reviews, 2002

Radiotherapy versus open surgery versus endolaryngeal surgery (with or without laser) for early l... more Radiotherapy versus open surgery versus endolaryngeal surgery (with or without laser) for early laryngeal squamous cell cancer.

The Journal of Laryngology & Otology, 2011

Objective:To compare the key functional results (regarding swallowing and voice rehabilitation) i... more Objective:To compare the key functional results (regarding swallowing and voice rehabilitation) in patients treated by pharyngo-laryngectomy with flap reconstruction, versus standard, wide-field, total laryngectomy.Method:We studied 97 patients who had undergone total laryngectomy and pharyngo-laryngectomy with flap reconstruction. The main outcome measures were swallowing (i.e. solid food, soft diet, fluid or enteral feeding) and fluent voice development.Results:There were 79 men and 18 women, with follow up of one to 19 years. Voice (p = 0.037) and swallowing (p = 0.041) results were significantly worse after circumferential pharyngo-laryngectomy than after non-circumferential pharyngo-laryngectomy. There was no significant difference in voice (p = 0.23) or swallowing (p = 0.655) results, comparing total laryngectomy and non-circumferential pharyngo-laryngectomy. The presence of a post-operative fistula significantly influenced voice (p = 0.001) and swallowing (p = 0.009) outcomes...

The Journal of Laryngology & Otology, 2010

Objective:We report a case of anterior spinal artery syndrome, an extremely rare complication, fo... more Objective:We report a case of anterior spinal artery syndrome, an extremely rare complication, following head and neck surgery.Method:A case report and literature review concerning anterior spinal artery syndrome is presented.Results:A 64-year-old man developed an anterior spinal artery infarction following total laryngectomy and bilateral neck dissections for post-radiotherapy glottic carcinoma. Anterior spinal artery infarction is a rare syndrome. It typically presents with weakness, loss of pain and temperature sensation below the level of the injury, with relative sparing of position and vibratory sensation. Recovery is variable.Conclusion:To the best of our knowledge, this is the first case report in the English language literature of anterior spinal artery syndrome following a head and neck procedure. This case report highlights a rare complication, and also the susceptibility of head and neck surgery patients to different complications. In head and neck cancer patients suffer...

The Journal of Laryngology & Otology, 2000

A questionnaire was sent to 100 consultant otolaryngologists from three selected health regions i... more A questionnaire was sent to 100 consultant otolaryngologists from three selected health regions in the United Kingdom enquiring about their assessment and management of a patient presenting with sudden-onset sensorineural hearing loss. Seventy – six replied, of whom 42 stated a sub – specialist interest in otology. Seventy – eight percent of respondents would order routine blood tests including the erythrocyte sedimentation rate (ESR) and syphilis serology; in addition 38 per cent would order a magnetic resonance image (MRI) scan at the first presentation. The vast majority would treat such a patient (89 per cent), although the method and combination varied widely. A review of the literature confirmed that the level of evidence for treating this condition is limited and therefore the wide disparity in consultants’ practice is not surprising.

The Journal of Laryngology & Otology, 1999

Secondary tracheo-oesophageal puncture is frequently used for voice restoration after laryngectom... more Secondary tracheo-oesophageal puncture is frequently used for voice restoration after laryngectomy. A method utilizing a flexible gastroscope passed via a mini-laparotomy and gastrotomy in a retrograde manner is described in a patient where extensive pharyngeal resection made it impossible to cannulate the upper aerodigestive tract. The patient suffered minimal morbidity and produced reasonable speech.