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THERE is a correlation between the maximum blood glucose rise following the oral investion of lactose and jejunal lactase activity. Many patients with a low maximum blood glucose rise have normal lactase activity and so the test may only be employed as a screening test. Following the ingestion of 50 G lactose a maximum blood glucose rise of at least 1.5 mmol/l is required before one may assume normal lactase activity. A normal maximum blood glucose rise in the presence of low lactase activity is rare and is not associated with lactose intolerance.

Impacted ureteric stones can pose a treatment challenge due to the high level of failure of ESWL and endourological approaches. Laparoscopic ureterolithotomy can provide a safe and successful alternative to these and open, invasive procedures. Interval laparoscopic ureterolithtomy was carried out following placement of a percutaneous nephrostomy. This was performed through an trans-peritoneal approach with the ureterotomy closed by intracorporeal suturing and placement of a JJ stent without the need for an abdominal wound drain. Laparoscopic ureterolithotomy is a safe, minimally invasive method of managing large, impacted ureteric stones with minimal associated patient morbidity.

The natural history of metastatic melanoma involving lymph nodes, in the absence of a known primary site (cutaneous, ocular or mucosal) has, to date, been poorly defined; and the optimal management of this rare subtype of disease is therefore unclear. Melanomas of unknown primary site (MUP) are estimated to comprise between 3.7 and 6% of all melanomas (Anbari et al. in Cancer 79:1861–1821, 1997). Between 2002 and 2007, 478 patients were treated for melanoma in our department in Cork University Hospital, five of whom presented with MUP. We discuss their cases herein. We should continue to treat this cohort of patients with an aggressive surgical approach and consider them for adjuvant therapies currently used to treat stage III disease.

A positive learning environment in which postgraduate doctors are supported, supervised and nurtured, is likely to lead to enhanced professional satisfaction and improved patient care. The aims of the current study were to use the PHEEM inventory to determine the aspects of their current learning environment which junior doctors rate most and least positively. The PHEEM questionnaire was administered to all junior doctors working in medical subspecialties at Galway University Hospitals in Ireland. A response rate of 60 % (n = 61) was obtained. The mean total PHEEM score was 82.88 ± 18.99, corresponding to an educational environment with more positive than negative aspects but with room for improvement. The mean total PHEEM score (±standard deviation) of registrars (89.65 ± 20.92) exceeded that of Interns (84.00 ± 15.26) and SHOs (75.12 ± 18.09). Over half (55 %) of the individual items were rated by the junior doctors as more positive than negative. Nineteen items (48 %) pointed to areas in need of enhancement, whilst 3 items were rated as satisfactory or better. Analysis of qualitative data confirmed that deficiencies exist in various aspects of the educational climate, including protected educational time, access to suitable learning opportunities, the nature of tasks performed by junior doctors, the hospital bleep protocol, implementation of the European Working Time Directive, feedback and career guidance. Recommendations stemming from this study should lead to improvements in the quality of the educational environment of junior doctors and may stimulate similar evaluations in other teaching hospitals.

Despite the important role of some haematological parameters in tendency to thrombosis is known, their relationship with long-term stent thrombosis (ST) remains unclear. This study aimed to investigate the association between the mean platelet volume (MPV) to platelet count (PC) ratio and long-term ST and mortality in patients with ST-segment–elevation myocardial infarction (STEMI) treated successfully by primary percutaneous coronary intervention (pPCI). In a retrospective cohort study, according to their baseline MPV/PC ratios, 3667 consecutive STEMI patients undergoing pPCI were divided into three groups: tertile 1 (T1) (n = 1222, 0.357 ≥ MPV/PC ≥ 0.043), tertile 2 (T2) (n = 1222, 0.033 < MPV/PC < 0.043) and tertile 3 (T3) (n = 1223, 0.009 ≤ MPV/PC ≤ 0.032). Patients were followed up with for 5 years, focusing on ST and all-cause mortality outcomes. Patients with T1 displayed a greater 5-year ST rate, including a 2.76-fold greater (95% confidence interval 1.68–10.33) rate than that of patients with T3, who had the lowest rates and were used as the reference group. Meanwhile, the 5-year mortality rate was similarly higher among patients with T1 by 1.72 times (95% confidence interval 1.33–2.22) relative to that among patients with T3. These significant relationships persisted even after adjustment for all confounders. We found that higher MPV/PC ratios were associated with long-term ST and mortality. The MPV/PC ratio may constitute both a rapid and an easily obtainable parameter for identifying reliably high-risk patients who have undergone pPCI.