Showing papers in "Irish Journal of Medical Science in 1987"
65 citations
TL;DR: The study has confirmed that goniotomy is the operation of first choice in patients presenting at age three to six months, however, at all ages where Goniotomy fails, trabeculectomy is a very effective secondary procedure.
Abstract: A RETROSPECTIVE study of primary congenital glaucoma, over a 20 year period, is reported. There were 22 cases in 20 years, giving an incidence in Northern Ireland of 1: 22,000 live births. The male to female ratio was approximately 2 : 1 and 27% of cases were familial.
23 citations
TL;DR: Three patients with coeliac disease (CD) and ulcerative colitis (UC) are described, from a population of 438 CD patients, with a rare association requiring clinical awareness.
Abstract: THREE patients with coeliac disease (CD) and ulcerative colitis (UC), from a population of 438 CD patients, are described. This is a rare association requiring clinical awareness. Patients not responding to appropriate treatment, should have the second diagnosis outruled.
16 citations
TL;DR: The immunohistochemical findings in this study suggest that LGC contain precursors of the IgA producing plasma cells which ultimately populate the lamina propria of the intestinal mucosa.
Abstract: LYMPHOGLANDULAR complexes (LGC) of the normal human colon have not been studied in detail hitherto and little is known of their structure, distribution or function This study was undertaken to document synthetic properties of the epithelium of the LGC, the site and subset composition of their lymphocyte population and regional variations in these parameters that might exist within the normal large bowel In the twenty-seven, macroscopically and microscopically normal colons examined, LGC epithelium produced the same types of mucin as colonic epithelium away from the lymphoid aggregates although the amounts of all mucin classes were considerably reduced Secretory component production was the same in LGC epithelium as elsewhere LGC in the ascending colon were larger and contained more lymphocytes (255±44 cells per high power field) than those in other anatomic regions (142±13; p<0001) There was a greater ratio of B to T lymphocytes in LGC of the rectum (193±048) than in LGC of other regions (103±005; p<0005) Rectal LGC also contained proportionately more T-suppressor cells than LGC elsewhere, the helper to suppressor ratio in these structures in the rectum being 225±031 against a mean ratio of 40±10 (p<00001) in LGC of other areas The immunohistochemical findings in this study suggest that LGC contain precursors of the IgA producing plasma cells which ultimately populate the lamina propria of the intestinal mucosa More lymphocytes were found in the lamina propria overlying the lymphoid aggregate of the LGC (38±5 cells per high power field) than in the lamina propria of the intervening mucosa (18±4; p<00001) although the subset ratios in both these areas was the same In general, lymphocytes were no more frequent within the epithelium of the LGC (4±3 per 40 epithelial cells) than in other colonic epithelium, with the exception of certain rectal LGC, the epithelium of which contained raised numbers of lymphocytes (6±3; p<005)
16 citations
TL;DR: Between 1970 and 1984, 17 children (10 girls and 7 boys, ages 4 weeks to 5 years) were treated at The authors' Lady’s Hospital for Sick Children, Crumlin, Dublin, with three types of vascular rings encountered.
Abstract: BETWEEN 1970 and 1984, 17 children (10 girls and 7 boys, ages 4 weeks to 5 years) were treated at Our Lady’s Hospital for Sick Children, Crumlin, Dublin. Three types of vascular rings were encountered.
The principle presenting feature was stridor. Barium swallow was found to be the most reliable single investigation at arriving at a diagnosis. Surgical repair was performed always through the left chest. All patients were asymptomatic at the time of follow-up. There were no deaths in this series.
15 citations
TL;DR: The greater the grade and number of ribs fractured, the more likely the occurrence of haemothorax, and these two variables can be used to predict which rib fracture victims are most likely to develop this complication.
Abstract: TWO hundred and twenty cases of fractured ribs were retrospectively reviewed. Haemothorax developed in 30 cases (13.6%), its occurrence being delayed in 53% of cases. The age of the patient, mode of injury and the highest rib fractured had no bearing on which patients developed a haemothorax, but it occurred less frequently with anterior rib fractures. The greater the grade and number of ribs fractured, the more likely the occurrence of haemothorax, and these two variables can be used to predict which rib fracture victims are most likely to develop this complication.
14 citations
TL;DR: Percutaneous radial artery cannulation was studied prospectively in 200 patients undergoing elective cardiac surgery and factors associated with an increased incidence of an impalpable pulse were female sex and prolonged cannulation.
Abstract: Percutaneous radial artery cannulation was studied prospectively in 200 patients undergoing elective cardiac surgery. There was no case of infected cannulation site. The frequency of absent radial pulsation was 30% twenty four hours after decannulation, decreasing to 15% four days after decannulation. Factors associated with an increased incidence of an impalpable pulse were female sex (p< 0.001) and prolonged cannulation (p< 0.05).
12 citations
TL;DR: A 26 year old patient with Behcet’s Disease presented with severe gastrointestinal bleeding and upper gastrointestinal endoscopy and radiology revealed oesophageal ulceration.
Abstract: A 26 year old patient with Behcet’s Disease presented with severe gastrointestinal bleeding. Upper gastrointestinal endoscopy and radiology revealed oesophageal ulceration. The patient responded well to cimetidine therapy. Haemorrhage as a result of oesophageal involvement in Behcet’s disease has not previously been described.
10 citations
TL;DR: A patient with cardiac ascites without liver cirrhosis who developed fatal spontaneous bacterial peritonitis is described, which is the second reported case of this complication developing in cardiac ascite.
Abstract: A patient is described with cardiac ascites without liver cirrhosis who developed fatal spontaneous bacterial peritonitis. To our knowledge this is the second reported case of this complication developing in cardiac ascites. Spontaneous bacterial peritonitis should be considered in septic patients with cardiac ascites even in the absence of liver cirrhosis.
9 citations
9 citations
TL;DR: A very highly significant difference was found between the urban and rural children in the Rutter B2 (teachers) questionnaire.
Abstract: Seven — eleven year old children in urban and rural schools were studied using the Rutter B2 (teachers) questionnaire. A very highly significant difference was found between the urban and rural children.
TL;DR: A retrospective study of 134 patients presenting at an Accident and Emergency department with ureteric colic to determine if the presence of dipstick haematuria could be used as a screening test for the existence of a calculus found it to have a low specificity.
Abstract: We performed a retrospective study of 134 patients presenting at an Accident and Emergency department with ureteric colic, to determine if the presence of dipstick haematuria could be used as a screening test for the presence of a calculus.
TL;DR: Pneumomediastinum occurs in many situations which involve forced expiration against a closed glottis (Valsalva manoeuvre), and is benign with spontaneous resolution, but observation for possible complications is recommended.
Abstract: Pneumomediastinum occurs in many situations which involve forced expiration against a closed glottis (Valsalva manoeuvre). Although this predisposing event occurs frequently in athletic exertion, pneumomediastinum rarely results. Two new cases are described. The course is benign with spontaneous resolution, but observation for possible complications is recommended.
TL;DR: A patient presenting with a cystic mass in his liver due to a metastasis from a carcinoid tumour is described, which should be considered when a patient is found to have a cysts mass in the liver.
Abstract: Although hepatic metastases from gastrointestinal carcinoid tumours are common, cyst formation in these secondaries is only rarely reported. The present report describes a patient presenting with a cystic mass in his liver due to a metastasis from a carcinoid tumour. As prolonged survival is possible in patient with a carcinoid tumour, even in the presence of liver metastases, cyst formation in a carcinoid secondary should be considered when a patient is found to have a cystic mass in the liver.
TL;DR: Patients in Northern Ireland with nasopharyngeal carcinoma were investigated for evidence of Epstein-Barr virus infection and the most useful marker of infection was anti-VCA IgM which was present in all cases and was absent in all other groups apart from one NPC patient.
Abstract: Patients in Northern Ireland with nasopharyngeal carcinoma (NPC) were investigated for evidence of Epstein-Barr virus infection. Eight out of 9 patients with NPC, plus one additional patient with a hypopharyngeal carcinoma, demonstrated serological evidence of EBV infection.
TL;DR: Fifty mothers who suffered a threatened abortion whose pregnancy continued at least till 28 weeks gestation were compared to the next matched delivered mother (control group), at risk of perinatal death from abruptio placentae, post-partum haemorrhage, retained placentas and a small baby.
Abstract: Fifty mothers (study group) who suffered a threatened abortion whose pregnancy continued at least till 28 weeks gestation were compared to the next matched delivered mother (control group). Study mothers were at risk of perinatal death from abruptio placentae, post-partum haemorrhage, retained placentas and a small baby. Those study mothers with severe symptoms delivered earlier. Abortion is the commonest cause of pregnancy failure. Statistics from our hospital (for the last decade) reveal that 11% of pregnant women seen aborted. The real incidence of abortion we now know is even higher as beta-chorionic gonadotrophin assay reveals that abortion commonly occurs before a missed period1, and also patients with complete abortions may not be referred to hospital. Threatened abortion occurs in 16% of pregnancies2. Hospital based studies indicate that half these pregnancies will continue though numbers will be influenced by individual admission policy. The earlier the bleeding the greater the risk of loss3, but this is only 9.3% if the fetal heart can be shown on ultrasonography4. Comparative studies show that should pregnancy continue to viability there is a higher incidence of pre-term births, small for gestation age babies, retained placentas5 and perinatal deaths6. Many such studies exclude mothers whose bleeding did not require hospital admission and patients were not always matched with controls. We thought it opportune to compare patients seen in our hospital who had experienced a threatened abortion whose pregnancies continued with matched controls.
TL;DR: Overall satisfaction with hospital care was high but where possible most patients preferred to be nursed at home and relatives were willing to provide care for them and an association between the presence of physical and psychological symptoms points to the need for a multidisciplinary approach to symptom control.
Abstract: A Study of the views of a representative sample of 200 cancer patients attending two Dublin hospitals on the care received by them during their illness was undertaken. Information on communication, physical and psychological symptoms and care in hospital and in the community was obtained.
TL;DR: 3 staples, flour/bread, milk and potatoes account for more than 40% of dietary energy, protein, fibre, K, Ca, Mg, P, Fe, vitamins B6 and C, thiamin, riboflavin, folate, pantothenic acid and biotin.
Abstract: DATA on expenditure on 125 food items in the Household Budget Survey 1980 was used to estimate nutrient consumption. Daily per capita intakes of energy, protein, fat, carbohydrates, fibre, starch and sugars were respectively 12.0MJ, 90.4g, 114.8g, 390.5g, 23.3g, 224.4g and 158.1g. Average daily consumption of vitamins were: retinol, 1069ug; carotene, 2442ug; vitamin D, 1.87ug; thiamin, 1.85 mg; riboflavin, 2.05mg; nicotinic acid, 19.0mg; vitamin C, 75.9mg; vitamin E, 4.76ug; vitamin B6, 1.9ug; vitamin B12, 7.59ug; free folate, 121ug; total folate, 220ug; pantothenic acid, 5.9ug; biotin, 26.3ug. Mineral consumption per person per day (in mg) were: Na, 4984; K, 4132; Ca, 1133; Mg, 340; P, 1513; Fe, 14; Cu, 2; Zn, 14; S, 751; Cl, 7826. Average daily intakes of the major fatty acids were: C12:0, 2.5g; C14:0, 6.9g; C16:0, 25.8g; C18:0, 12.3g; C16:1, 3.1g; C18:1, 33.0g; C18:2, 6.5g; C18:3, 1.3g. The P/S ratio was 0.16. Intakes of 18 amino acids varied between 1.2–20.2g/capita/d. The intakes of each essential amino acid was more than twice the recommended amounts. 3 staples, flour/bread, milk and potatoes account for more than 40% of dietary energy, protein, fibre, K, Ca, Mg, P, Fe, vitamins B6 and C, thiamin, riboflavin, folate, pantothenic acid and biotin.
TL;DR: A retrospective analysis of the indications for, and the management of, both penetrating and lamellar keratoplasty was carried out, and significant changes, in both indications and management were noted.
Abstract: A retrospective analysis of the indications for, and the management of, both penetrating and lamellar keratoplasty was carried out. The two groups chosen were the 49 keratoplasties performed during the period from January 1975 to June 1977 and the 84 keratoplasties performed between January 1985 and September 1986. Significant changes, in both indications and management, were noted.
TL;DR: A retrospective study of hospital records looking for clinical and bacteriological findings which helped lead to an early diagnosis of tuberculosis seen in The Children’s Hospital, Temple Street over the past 10 years found no mortality, but long-term sequelae occurred in 5 of the 7 cases of tuberculous meningitis.
Abstract: We reviewed 26 cases of tuberculosis seen in The Children’s Hospital, Temple Street over the past 10 years by means of a retrospective study of hospital records. In all cases we specifically looked for clinical and bacteriological findings which helped lead to an early diagnosis. There were 15 cases of pulmonary tuberculosis and 11 cases of extrapulmonary disease including 7 cases of tuberculous meningitis. 36% had received BCG vaccination. 16% had positive cultures of mycobacterium tuberculosis. 86% had a positive tuberculin reaction and 73% had definite contact with open tuberculosis. 84% of patients with contacts had a positive tuberculin reaction. There was no mortality, but long-term sequelae occurred in 5 of the 7 cases of tuberculous meningitis.
TL;DR: In this and other studies, PSA is superior to conventional serum markers in sensitivity, prediction of CaP stage and in longitudinal monitoring of disease.
Abstract: A NEW immunoradiometric assay based on a dual monoclonal antibody reaction system (Hybritech-TANDEMR) was used to measure serum levels of prostate-specific antigen (PSA) and prostatic acid phosphatase (PAP) in 39 patients with prostatic carcinoma (CaP), in 57 with benign prostatic hyperplasia (BPH) and in 14 without prostatic disease. Serum PSA was elevated in 82% of patients with CaP while PAP was elevated in only 54%. In this and other studies, PSA is superior to conventional serum markers in sensitivity, prediction of CaP stage and in longitudinal monitoring of disease. A 16% false positive rate precludes PSA as a screening test. The assay used was found to be simple and reliable.
TL;DR: Intrathecal morphine provides effective analgesia in labour and further carefully designed studies are warranted.
Abstract: The use of intrathecal opiates to provide pain relief in labour has yet to be fully assessed. In a pilot study of 24 healthy patients, we report on the analgesia achieved by intrathecal injection of morphine. We also report on its effect on the progress of labour, the neonatal outcome, and the incidence of maternal side effects. There was a marked reduction in the pain score recorded by both primiparous and multiparous patients. The mean interval from injection to delivery was 3.5 hours. 71% of our patients complained of side effects, however 84% of these side effects occurred after delivery. In all but two cases, side effects were regarded as mild and not distressing to the patient. Ten patients in this study received naloxone after delivery and in these patients minor side effects occurred less frequently. Intrathecal morphine provides effective analgesia in labour and further carefully designed studies are warranted.
TL;DR: This study provides, for the first time, an estimate of the prevalence of Toxocara infection in Irish children aged two to five years attending a Dublin paediatric hospital in 1983.
Abstract: THIS study provides, for the first time, an estimate of the prevalence of Toxocara infection in Irish children. Sera from 302 children aged two to five years attending a Dublin paediatric hospital in 1983 were examined for toxocaral antibodies. Fifty-seven (19%) of the children had significantly elevated specific antibody levels in the diagnostic range suggestive of current or past infection.
TL;DR: It is concluded that the work is worthwhile from an educational, scientific and health care point of view but the problem of rarer diseases makes extension to a national or international population necessary.
Abstract: CLINICAL data were gathered prospectively by proforma, usually within 7 days of admission, on 405 cases of jaundice presenting in a general hospital over 8 years. Ten percent of cases were recorded by 2 or more doctors. The recording doctor entered his diagnosis, his confidence in it and the three items of evidence he considered most diagnostically significant. The cases were also presented for diagnosis to the surgical team individually and as a group at weekly postgraduate conferences. Final diagnosis was obtained by operation, imaging, body chemistry, autopsy or clinical course. Gallstones and infectious hepatitis were most common, followed by obstructive carcinoma and metastatic tumour, and by chronic hepatitis and cirrhosis. Sixteen other diseases with less than 10 cases each accounted for 57 cases, while 27 others lacked firm diagnosis. Ninety-nine doctors contributed from one to 16 cases each. Those examining ten cases or more improved their diagnostic accuracy. Inter-observer disagreement was 20% and clinicians’ diagnostic accuragy was 76%. Although 246 data were sought on each case, only 92 appeared in ten or more cases. Use of these gave an overall computed diagnostic accuracy of 80% which was little affected by further reduction of the indicants to the 27 most significant.
TL;DR: It is clear that colons affected by diverticulosis or carcinoma cannot be used as ‘normal’ control material for study of the colonic lymphoid tissue in inflammatory bowel disease.
Abstract: THE lymphoglandular complexes (LGC) of 41 colons resected for a variety of diseases, were studied by routine light microscopy and immuno-histochemistry. Mucin production in the epithelium and cell numbers and subsets within the lymphoid aggregates were assessed and the results compared with data derived from 27 normal colons. Neither the volume nor type of mucin elaborated by LCG epithelium in diseased colons differed from normal. In LGC of colons resected for carcinoma suppressor T-lymphocytes (Leu 2a+) were increased whereas in diverticular disease both B-lymphocytes (B1+) and T-helper lymphocytes (Leu 3a+) were elevated with a reduction in T-suppressor numbers. All these deviations from normal were statistcally significant (p<0.0001). In colons resected for ulcerative colitis B-lymphocyte numbers were reduced and T-suppressor numbers were increased in LGC of all regions, irrespective of their proximity to areas of inflammation. In Crohn’s colitis B-lymphocyte numbers were increased in to be elucidated. It is clear, however, that colons affected by diverticulosis or carcinoma cannot be used as ‘normal’ control material for study of the colonic lymphoid tissue in inflammatory bowel disease.
TL;DR: The findings supported the feasability of a comprehensive national registry for testicular tumours but preliminary improvements in health care recording would be necessary.
Abstract: A NATIONAL cancer registry for testicular tumours was established. Based on the initial six months, its construction, operations and capability were evaluated. The concept was widely accepted, the resultant data base was reliable by established international criteria but inadequate coding of patient record systems reduced efficiency. The findings supported the feasability of a comprehensive national registry but preliminary improvements in health care recording would be necessary.
TL;DR: Spontaneous reversion to sinus rhythm from long-standing atrial fibrillation is described in 4 patients, who had undergone Starr-Edwards mitral valve replacements some years previously, and did not appear to benefit the patients clinically or be accompanied by echocardiographic evidence of left atrial contraction.
Abstract: Spontaneous reversion to sinus rhythm from long-standing atrial fibrillation is described in 4 patients, who had undergone Starr-Edwards mitral valve replacements some years previously. The reversion to sinus rhythm was spontaneous and did not follow electrical conversion or change in drug therapy. The change to sinus rhythm did not appear to benefit the patients clinically and was not accompanied by echocardiographic evidence of left atrial contraction.
TL;DR: Survival in this group was better than those who did not respond or who relapsed, but even these patients had a better survival than thoseWho did not receive X-ray treatment, which was unhelpful in patients with pT4 tumours.
Abstract: Between January 1965 and December 1984, 156 patients of 80 years or more with bladder carcinoma were seen. Associated medical conditions were present in 64%. All patients had transurethral resection of their tumour as a primary procedure, and 4 (2.6%) died in the first month afterwards. Recurrences developed in 22 patients (43%) with pTa histology and 11 patients (61%) with pT1; the recurrence patterns were similar in both groups, but the patients with tpT1 had more multiple or large tumours at diagnosis and had a higher incidence of increase in T stage. Patients with pT3 histology were managed by deep X-ray treatment and this was associated with a 39% complete response rate. Survival in this group was better than those who did not respond or who relapsed, but even these patients had a better survival than those who did not receive X-ray treatment. No patient had radical cystectomy and diversion. Palliative deep X-ray treatment was unhelpful in patients with pT4 tumours.