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Introduction: Renal cell carcinoma (RCC) represents about 3% of adult malignancies in Ireland. Worldwide there is a reported increasing incidence and recent studies report a stage migration towards smaller tumours. We assess the clinico-pathological features and survival of patients with RCC in a surgically treated cohort. Methods: A retrospective analysis of all nephrectomies carried out between 1995 and 2012 was carried out in an Irish tertiary referral university hospital. Data recorded included patient demographics, size of tumour, tumour-node-metastasis (TNM) classification, operative details and final pathology. The data were divided into 3 equal consecutive time periods for comparison purposes: Group 1 (1995)(1996)(1997)(1998)(1999)(2000), Group 2 (2001Group 2 ( -2006 and Group 3 (2007Group 3 ( -2012. Survival data were verified with the National Cancer Registry of Ireland. Results: In total, 507 patients underwent nephrectomies in the study period. The median tumour size was 5.8 cm (range: 1.2-20 cm) and there was no statistical reduction in size observed over time (p = 0.477). A total of 142 (28%) RCCs were classified as pT1a, 111 (21.9%) were pT1b, 67 (13.2%) were pT2, 103 (20.3%) were pT3a, 75 (14.8%) were pT3b and 9 (1.8%) were pT4. There was no statistical T-stage migration observed (p = 0.213). There was a significant grade reduction over time (p = 0.017). There was significant differences noted in overall survival between the T-stages (p < 0.001), nuclear grades (p < 0.001) and histological subtypes (p = 0.022). Conclusion: There was a rising incidence in the number of nephrectomies over the study period. Despite previous reports, a stage migration was not evident; however, a grade reduction was apparent in this Irish surgical series. We can demonstrate that tumour stage, nuclear grade and histological subtype are significant prognosticators of relative survival in RCC.

PurposeMany patients attending their primary care physician with symptoms suggestive of new onset heart failure, have a 12 lead electrocardiogram (ECG) as part of an initial triage work up. However, the role of ECG in predicting heart failure in the community is not yet defined. We thus examined the ability of ECG to predict heart failure in this patient population.MethodAll 733 patients attending the rapid access clinic for possible heart failure in St Vincent’s University Hospital, Dublin, from the period of 2000 till 2012 were included in this study. 12-lead ECG was performed using the Agilent Page Writer 100 ECG machine and interpreted by independent cardiologists. The ECGs were analysed along side the diagnosis of heart failure. ROC curves were performed to assess the robustness of the ECG in predicting heart failure.ResultHeart failure patients had significant prolonged QRS duration, prolonged QT duration, prolonged QTc and more rightward T wave axis compared to the non heart failure group. They also had significant ECG evidence of prior myocardial ischaemia, intraventricular conduction disorder, abnormal axis, ventricular hypertrophy and atrial fibrillation. Using the ECG evidence of myocardial ischaemia, intraventricular conduction disorder, atrioventricular disorder, abnormal axis, atrial enlargement, ventricular hypertrophy, ventricular arrhythmia and atrial fibrillation as a predictive model, the ROC analysis showed that the ECG model is a reasonable test (AUC = 0.81) to help predict heart failure in the community. Adding BNP to the model increased the robustness of the model in predicting heart failure (AUC = 0.88).ConclusionThe utility of the 12-lead ECG in predicting heart failure in the community is under appreciated. This study showed that this simple test is useful and can offer primary care physicians the ability to expedite the diagnosis of heart failure in order to start relevant further investigation and treatment in the community. In conclusion, ECG is a useful test in predicting heart failure in the community, however addition of BNP into the model helped to increase the robustness of the test.

Aims: To determine financial implications of implementing cardiac magnetic resonance imaging (CMR) in the diagnostic pathway of a population with unexplained acute myocardial injury and normal coronary angiography.Methods and Results: We performed a focused cost-benefit analysis using a hypothetical population of 2,000 patients with unexplained acute myocardial injury and normal coronary angiography divided into two groups to receive either standard or CMR guided management over a 10-year period. As healthcare practice and costs considerably vary geographically and over time, an algorithm with 15 key variables was developed to permit user-defined calculations of cost-benefit and other analyses. Using current UK costs, routine use of CMR increases healthcare spending by 14% per patient in the first year. After 7 years, CMR guided practice is cost neutral, reducing cost by 3% per patient 10 years following presentation. In addition, CMR -guided therapy results in 7 fewer myocardial infarctions and 14 fewer major bleeding events per 1,000 patients over a 10-year period. The three most sensitive variables were, in decreasing order, the cost of CMR, the cost of ticagrelor and the percentage of the population with MI requiring DAPT.Conclusion: Routine use of CMR in patients with unexplained acute myocardial injury and normal coronary angiography is associated with cost reductions in the medium to long term. The initial higher cost of CMR is offset over time and delivers a more personalized and higher quality of care.