Showing papers in "Irish Journal of Medical Science in 1984"

Excessive cold pressor responses in the irritable bowel syndrome.

Abstract: Irritable bowel syndrome patients have significantly greater rises in systolic and diastolic blood pressure following immersion of the hand in iced water at 0°C compared with the controls. This study does not allow one to conclude if widespread dysautonomia is part of or secondary to the irritable bowel syndrome. Detailed study of the autonomic nervous system in irritable bowel syndrome might help to elucidate the pathogenesis of at least some of the pathophysiology of irritable bowel syndrome and should suggest therapeutic agents likely to benefit patients.

Late referral of patients with rheumatoid arthritis to rheumatologists.

Abstract: One possible reason for advanced disability occurring in patients with rheumatoid arthritis (RA) is late referral to specialist rheumatology departments. To determine the extent of late referral in RA, associated clinical features, and reasons for its occurrence, 50 successive patients newly referred to two rheumatology departments in Dublin and London were studied and compared.Clinical features of disease activity and severity were similar in both groups.Thirteen patients, 12 female, were identified who had developed RA more than 10 years before their first specialist referral. In seeking to explain this phenomenon, geographic, social and clinical factors were examined. Late referral was not associated with distance from specialist centres, older age at onset, or milder disease forms. Eleven of the 13 patients lived within 10 miles of the relevant rheumatology department. Considerable joint destruction and disability was present, but only 4 had previously received specific disease remittive agents. In conclusion, late specialist referral of patients with RA occurred with equal frequency in both centres. This phenomenon is probably more widespread and contributes to unnecessary disability in RA.

Diabetes in pregnancy--Matthews Duncan revisited.

Abstract: Master, Colleagues, Ladies and Gentlemen, I am grateful for the honour you have done me in inviting me to give the Ninian Falkiner Memorial Lecture for 1982.

Crohn's disease in London in the latter half of the nineteenth century.

Abstract: Between at least 31 and 56 patients with Crohn’s disease were seen in the London teaching hospitals in the latter half of the last century. The disease is not, as has been suggested, a ‘new’ disease of this century.

Upper lobe bronchiectasis in the yellow nail syndrome : Report of a case

Abstract: A patient is described with an unusual distribution of bronchiectasis in association with the yellow nail syndrome. Bronchoalveolar lavage demonstrated increased neutrophils but no increase in lymphocytes in the lavage fluid.

Fibreoptic bronchoscopy in the intensive care unit.

Abstract: Fibreoptic bronchoscopy has largely replaced rigid bronchoscopy in the intensive therapy unit. Retained bronchial secretions may be removed and difficult intubations performed with the flexible fibreoptic bronchoscope. In addition, it may provide uncontaminated lower airway samples for microbiological studies that can aid in the choice of antibiotic therapy. In our series of fibre-optic bronchoscopies performed on critically ill patients the procedure was effective in improving atelectasis in all cases in which retained bronchial secretions were found. In most patients the degree of bronchial occlusion by mucous plugs was far greater than expected on the basis of chest radiography. Fibreoptic bronchoscopy was also successful in diagnosing bronchogenic carcinoma, gastric content aspiration, bronchial avulsion and laryngeal oedema. We conclude that fibreoptic bronchoscopy is a safe and valuable procedure in the intensive care unit.

The normal personality profile of irritable bowel syndrome patients.

Abstract: IRRITABLE bowel syndrome sufferers have a normal premorbid personality profile. Site or sites of major symptomatology is independent of premorbid personality and such personality does not influence short term prognosis. Previous studies showing increased anxiety levels in irritable bowel syndrome patients were based on post morbid personality assessments.

A comparison of plasma and saliva levels of carbamazepine and phenytoin as monotherapy

Abstract: CORRELATIONS of plasma and saliva levels of the anticonvulsants carbamazepine and phenytoin are presented in two series of patients on monotherapy, along with the relationship of dose (mg/ kg body weight) with these levels.

Failure of cord serum cholesterol and betalipoprotein as screening tests for familial hyperlipoproteinaemia.

Abstract: Cord serum lipids including immunoreactive beta lipoprotein were measured in a group of 2044 neonates. Infants with values over the 95th percentile were followed up over a 3 year period to evaluate the usefulness of cord blood testing as a screen for subsequent hyperlipidaemia. Eight children were identified as persistently hyperlipidaemic; a further 96 infants proved to be “false-positives”. The two groups could not be distinguished by retrospective examination of the cord figures. This study confirms that cord serum total cholesterol is not of value as a population screening test and indicates that immunochemically measured beta-lipoprotein is no better.

Chronic active hepatitis in intravenous drug abusers may be delta agent infection associated.

Abstract: Twenty-seven parenteral drug users had serum tested for delta aintigen and antidelta antibody and had liver biopsies performed. All patients has been referred from the Drug Advisory and Treatment Centre by its Medical Director. Of the thirteen delta positive patients four had chronic active hepatitis. All four patients with chronic active hepatitis were delta positive. This study suggests that delta agent infection increases the risk of progression of intravenous drug abuse associated liver disease to chronic active hepatitis.

Complications of maternal spina bifida

Abstract: A case of repaired lumbar meningomyelocele with urinary diversion complicating pregnancy is reported. The complications anticipated and those that arose are discussed and the genetic aspect alluded to.

Different dietary fibre formulations and the irritable bowel syndrome.

Abstract: A DIET composed predominantly of fruit and vegetable fibre is equally beneficial to irritable bowel syndrome patients during short term follow up as an isogram diet composed predominantly of cereal fibre. Whilst the mode(s) of effect of either diet is (are) unknown, a placebo effect alone is an unlikely explanation.

The effects of cardiopulmonary bypass on immune mechanisms of man.

Abstract: Immunological functions were evaluated in a group of six male patients undergoing elective cardiopulmonary bypass.

Acute lymphocytic leukaemia presenting as spontaneous splenic rupture.

Abstract: A case of spontaneous rupture of the spleen as a primary manifestation of acute lymphocytic leukaemia is presented. Pathological findings suggest that the splenic rupture in this case was due to infiltration and destruction of the trabecular arteries by leukaemic cells. Splenectomy was carried out successfully and remission subsequently obtained with chemotherapy.

Phaeochromocytoma presenting in pregnancy.

Abstract: TWO cases of phaeochromocytoma presenting as hypertension in pregnancy are described. The importance of considering all differential diagnoses especially when hypertension presents early in pregnancy is stressed.

Enzyme immunoassay of progesterone in saliva.

Abstract: A very sensitive enzyme immunoassay for direct measurement of progesterone has been developed. It is a solid phase assay on microtitre plates and there are no extraction, separation or centrifugation steps. The assay is suitable for frequent monitoring of progesterone levels in saliva during the menstrual cycle. Expensive equipment or special facilities are not required. The assay is very suitable for hospital laboratories that currently lack facilities for measuring progesterone by radioimmunoassay.

Metabolic abnormalities associated with tobramycin therapy

Abstract: Five patients who developed hypomagnesaemia, hypokalaemia, and hypocalcaemia in association with Tobramycin therapy are described. In all cases the proximate lesion of the disorder appeared to be a defect of magnesium conversion by the distal nephron. Onset of tetany led to detection of the syndrome in three patients (two of whom also had ventricular arrhythmias), but two were asymptomatic and detected only by biochemical screening. Spontaneous resolution occurred in all cases within four to twenty-one days (mean ten days) during which time intensive biochemical monitoring and support were required to prevent recurrence.

Familial temporal arteritis.

Abstract: A brother and sister with temporal arteritis are reported. It is the first brother-sister sibship with temporal arteritis recorded in this country and only the third in the literature.

Rapid jejunal biopsy without radiological screening

Abstract: Thirty patients had jejunal biopsy performed by Crosby Capsule in conjunction with a fibre-optic endoscope. Ten patients were radiologically screened initially to check that the capsule had attained a jejunal position using a standardised method and 20 patients had biopsy performed subsequently without screening. Jejunal biopsies were obtained in 19 patients in the unscreened group. Premature capsule firing in stomach resulted in one failure. It is concluded that this technique permits rapid, reliable jejunal biopsy. Patients requiring this investigation can be included on routine endoscopy lists.

HLA-DR antigens and insulin dependent diabetes mellitus in the west of Ireland.

Abstract: AN increase in four HLA antigens was found in a group of 49 unrelated insulin dependent diabetes mellitus (IDDM) patients from the West of Ireland. There was an increase in HLA-B8 and HLA B15 but these were secondary to the increases in HLA-DR3 and DR4. DR4 was significantly associated with IDDM and had a higher relative risk for the disease than did DR3. A selective decrease in B12 in male patients and an association between DR4 and younger age at onset of disease was noticed.

Haemoglobin solution as an oxygen-carrying resuscitation fluid in haemorrhagic shock.

Abstract: A SOLUTION of pyridoxalated haemoglobin has been prepared and tested in an animal shock model by comparing its efficiency in resuscitating an animal from hypovolaemic shock with dextran. It is as efficient as dextran in restoring blood pressure, and makes more oxygen available to the tissues. Great care must be exercised in the preparation of the haemoglobin solution.

Cystic adventitial disease of the popliteal artery

Abstract: Four cases of cystic degeneration of the popliteal artery are presented together with a review of the literature. Cyst evacuation is supported as the recommended treatment.

Henry Maunsell (1806–1879): An early community physician

Abstract: The story of the ancestry of academic community medicine has been confounded by the persistent interchange of titles of the specialty which over the years has included, hygiene, state medicine, sanitary science, public health, and social and preventive medicine. Nevertheless the subject can be identified by its aims (the promotion of the health of the general public) and its methods (community diagnosis and intervention among total populations). These criteria support the claim for Henry Maunsell as the first professor of the subject in these islands.

The locus of control: it's significance in the irritable bowel syndrome.

Abstract: PSYCHOLOGICAL factors have a role in Irritable Bowel Syndrome symptomatology. The locus of control test determines an individual’s degree of internality or externality. The degree of internality or externality does not influence the site of major Irritable Bowel Syndrome symptomatology. Externalizers have a worse prognosis than internalizers. This effect on prognosis should be borne in mind when testing for diet and or drug efficacy.

Hyperamylasaemia following extracorporeal perfusion.

Abstract: The serum level of total, pancreatic and salivary amylase, together with the amylase / creatinine clearance ratios, were measured in a prospective study of 22 patients subjected to continuous extracorporeal perfusion. None of the patients had a raised serum pancreatic amylase while 6 patients (27%) had a raised salivary amylase. The group with raised serum amylase and the group with normal serum amylase levels had significantly raised clearance values for total, pancreatic and salivary amylase, with no evidence of clinical pancreatitis.

Metabolic changes in small bowel ischaemia.

Abstract: REVERSIBLE small bowel ischaemia was produced in 24 rats by applying a microvascular clip to the superior mesenteric artery. A constant length of intestine was devascularised as outlined by dye injection. Forty-three serial blood samples were taken for acid-base and electrolyte analysis from the onset of vascular occlusion at 10 minute intervals until five minutes following revascularisation.

Some aspects of the molecular pathology of thrombosis and haemorrhage.

Abstract: SINCE the institution of these annual lectures to the. memory of Professor E. J. Conway, FRS, some individual lecturers so honoured have had the privilege of working in Ireland at a time when the late E. J. Conway influenced greatly the scientific scene in Ireland. I recall my attendance at a meeting of the Academy where Professor Conway made a brief appearance shortly before his death. The respect and admiration for the man amongst those present was immense and was merely a reflection of what Professor Conway meant to Irish science and medicine. For myself, I have worked abroad (mostly in the U.K.) for most of my scientific career during a time period and in a subject which did not overlap with that of Professor Conway. Despite this fact, the times are numerous when colleagues have asked "did you study under Professor Conway ? this question has been asked in various parts of Europe, the U.S. and Australia. His fame reached out to all the world through his work on transport in the kidney (Conway et al, 1937; Conway et al, 1946) and the development of immunodiffusion techniques (Conway, 1957). The true scientific philosopher was expressed in his paper which deals with oceanic evolutionary notions (Conway, 1943). He lacked narrow and exclusive thinking (which thinking, unfortunately, can bedevil even the most distinguished intellects) in that his studies of the physical aspects of biology did not exclude the