V. Donohue's research while affiliated with National Maternity Hospital and other places

We report a case where an antenatal scan showed a cerebral vessel dilatation consistent with a vein of Galen malformation (VGAM). After delivery the diagnosis was confirmed on MRI scan. The infant's condition was stable in relation to the two important clinical indicators, mainly not in congestive cardiac failure and no hydrocephalus. The vein of Galen assessment score as used in Hopital Bicetre was 20/21. The scoring system is based on a multiorgan assessment including the five parameters cardiac, cerebral, respiratory, hepatic and renal (Table 1). A score of < 8 indicates no treatment, 8-12 means immediate intervention while a score > 12 delays intervention to circa six months of age. At four months the head circumference accelerated with hydroceaphalus on scans and the infant became clinically symptomatic. Urgent embolisation was performed. The procedure uses N-butylcyanoacrylate (NBCA) glue as the embolisation agent, which in this case was inserted through the left posteriomedial choroidal artery. Complete obliteration was achieved. The infant subsequently required insertion of a ventriculoperitoneal shunt for the hydrocephalus component. The infant has had no recurrence. He remains well on objective examination he has mild developmental delay. In summary this case highlights the value of antenatal diagnosis,the VGAM assessment score to determine the optimal time of intervention and the effectiveness of embolisation.

Contemporary Irish data on the prevalence of major coronary heart disease (CHD) risk factors are sparse. There is confusion regarding the targeting of interventions such as statin therapy for primary prevention Clinicians are faced with a plethora of risk scoring systems. The Sheffield Risk Table is widely used in the UK: (i) To estimate the prevalence of diabetes and CHD risk factors in the general population of men and women between the ages of 50 to 69 years. (ii) To estimate the proportion of subjects with an absolute risk of a CHD event ≥ 3% per annum, using composite risk scores. (iii) To assess the performance of the Sheffield Risk Table against the original Framingham risk equation in this population.