Showing papers in "Irish Journal of Medical Science in 1988"
TL;DR: The extent of heroin use in the area was greatest in the 1979–1981 period and during this time it was concentrated in the under 25 year age groups, particularly males 15–19 years old.
Abstract: A STUDY on the extent of heroin use in a Dublin South Inner City Electoral Ward during the period 1979–1985 was conducted between May and September. A total of 82 questionnaires were completed. Each respondent had a settled address in the Ward during 1979–1985. All gave a history of heroin use. The authenticity of heroin use was validated for all respondents through medical records. The extent of heroin use in the area was greatest in the 1979–1981 period and during this time it was concentrated in the under 25 year age groups, particularly males 15–19 years old. Since 1981 there has been a marked decline in heroin use within the Ward. The profile of the heroin user is similar to that described in previous Medico-Social Research Board studies.
35 citations
TL;DR: Only mithramycin held promise for the effective treatment of fibrous dysplasia in this patient, but its potential toxicity and the need for intravenous administration limit its applicability.
Abstract: TREATMENT of a patient with symptomatic progressive fibrous dysplasia offered an opportunity to examine the effectiveness of agents known to influence bone turnover, in modifying the activity of the disorder. In response to calcitonin markedly elevated urinary hydroxyproline excretion was unaltered although serum alkaline phosphatase tended to fall. However, the urinary calcium excretion more than doubled. In contrast, the introduction of intravenous mithramycin, brought about a reduction in serum alkaline phosphatase, urinary hydroxyproline excretion and urinary calcium. However, nausea, abnormal liver function and poor patient compliance resulted in abandoning mithramycin. The diphosphonate etidronate did not make any definite impact. Only mithramycin held promise for the effective treatment of fibrous dysplasia in this patient, but its potential toxicity and the need for intravenous administration limit its applicability. Calcitonin-resistant osteocolast activity is possibly involved in the aetiology of fibrous dysplasia.
19 citations
TL;DR: A RETROSPECTIVE study confirmed the incidence of Edward’s Syndrome to be 1 in 3349-considerably higher than reported in most comparable studies, and the role that prenatal foetal assessment might play in identifying such affected foetuses and determining their method of delivery is discussed.
Abstract: A RETROSPECTIVE study confirmed the incidence of Edward’s Syndrome to be 1 in 3349-considerably higher than reported in most comparable studies. Median survival of the liveborn infants was four days, with a mean of 17 days, and a range of one hour to ten weeks. Fifty per cent of all liveborn babies with this potentially lethal genetic condition were delivered by caesarean section. The role that prenatal foetal assessment, including foetal karyotyping, might play in identifying such affected foetuses and determining their method of delivery is discussed. This is particularly important in view of the fact that a considerable proportion of the mothers of offspring with this condition are of advanced maternal age and high parity.
16 citations
TL;DR: This paper reviews the characteristics and treatment progress of 45 opiate addicts who were referred to the Clinic over a two year period and the emergence of maternal addiction as a serious problem in Ireland.
Abstract: The increase in the number of patients presenting to the National Drug Advisory and Treatment Centre addicted to opiates has been accompanied by an increase in the number of pregnant opiate addicts attending for treatment. Studies published in January 1982 referred to the emergence of maternal addiction as a serious problem in Ireland. Since then the escalation of this specific problem has continued and a programme designed to meet the needs of the pregnant addict was initiated at the clinic. This paper reviews the characteristics and treatment progress of 45 opiate addicts who were referred to the clinic over a two year period.
15 citations
TL;DR: The data from each conference have been combined to provide a comprehensive audit of general surgery at a busy teaching hospital.
Abstract: A Regular morbidity and mortality conference has been conducted over a period of 18 months The conference has been a useful forum for postgraduate surgical education and continuous assessment of surgical trainees The data from each conference have been combined to provide a comprehensive audit of general surgery at a busy teaching hospital
13 citations
TL;DR: Regression analysis indicated that a one percent increase in body fat content would be expected to result in decreases in performance on these tests as follows: 12 minute run-walk, 45.76 yds, chins, sit ups, standing long jump, shuttle run.
Abstract: The relationship between body fat content and nine measures of physical performance were investigated in a group of 70 adolescent males of mean age 15.48 years. Five of these measures of physical performance were found to be significantly related to body fat content 12 minute run-walk test, chins, sit ups, standing long jump, shuttle run. Regression analysis indicated that a one percent increase in body fat content would be expected to result in decreases in performance on these tests as follows: 12 minute run-walk, 45.76 yds. (or 1.57% of the mean score for the group); chins, 0.32 (5.06% of mean score); sit ups, 0.496 (1.27% Of mean score); standing long jump, 5.08 cm (2.62% of mean score); shuttle run, 0.151 secs. (0.77% of mean score). The implications of these results are discussed.
12 citations
TL;DR: It is suggested that clinical and subclinical abnormalities of pancreatic function are not uncommon in patients with sarcoidosis and acute pancreatitis.
Abstract: PANCREATIC disease is rarely reported in sarcoidosis. We describe 3 patients with sarcoidosis and acute pancreatitis. In a prospective study 15/92 patients with sarcoidosis had an abnormal level of serum pancreatic amylase and 6/39 had an elevated serum immunorective trypsin. These findings suggest that clinical and subclinical abnormalities of pancreatic function are not uncommon in patients with sarcoidosis.
12 citations
TL;DR: The results provide sufficient evidence of sporadic iodine deficiency to justify a more widespread study of the iodine status of the Irish population with a view to making recommendations on the possible need for iodine prophylaxis.
Abstract: A study of urinary iodine excretion and thyroid gland uptake of radioactive iodine131 I was undertaken in the Dublin area with a view to providing data on the current iodine status in Ireland. A mean urinary iodine excretion of 118±82 ug/ gram creatinine (Median 96) obtained from 821 subjects attending general hospital outpatient clinics in the Dublin area in 1987, while excluding severe iodine deficiency in this particular cohort, obscured the fact that 250 (30%) had iodine excretion values<-70 ug/g creatinine, a value approximating to the minimum daily iodine requirement.
11 citations
TL;DR: It is argued that atrophic processes of ‘normal’ ageing, which are subject to large individual differences, may interact importantly with the consequences of neurodevelopmental abnormality in schizophrenia to determine both clinical state and the sequelae of its treatment.
Abstract: Alterations in neurotransmitter receptors, neuroleptic drug action and cerebral structure with ageing, and their functional correlates, are reviewed as they relate to current hypotheses on the pathophysiology of schizophrenia and its longitudinal course. Some of the changes in course of illness and in response to neuroleptic treatment that can occur in schizophrenia may involve such age-dependent effects. It is argued that atrophic processes of ‘normal’ ageing, which are subject to large individual differences, may interact importantly with the consequences of neurodevelopmental abnormality in schizophrenia to determine both clinical state and the sequelae of its treatment.
11 citations
TL;DR: It is concluded that meningococcal infection remains common in north Dublin and that the national meningitis and septicaemia mortality to young children should be a cause for concern.
Abstract: TWO hundred and seventy five cases of meningococcal meningitis and/or septicaemia treated at the Children’s Hospital Temple Street, Dublin between January 1970 and December 1986 were retrospectively reviewed. Peak incidence was in 1981 (50 cases) and these cases were reviewed in greater detail. The mortality declined from 20 per cent for the 5 year period from 1972–1976 to 2.2 per cent from 1982–1986. The overall mortality 1970–1986 was 7.3 per cent. Over 90 per cent of meningococcal infections were caused by Group B neisseria meningitidis. The disease was seen most frequently during the winter months.
9 citations
TL;DR: Patients with ulcerative colitis and patients with Crohn’s disease had pitted erythrocyte counts above the level found in normosplenic individuals, which tends to be higher in patients with more extensive and more active disease.
Abstract: SPLENIC function was assessed by counting the percentage of pitted erythrocytes in twenty patients with ulcerative colitis and eighteen patients with Crohn’s disease.
TL;DR: The survey points to a relatively low level of transmission of tuberculosis infection among primary school children and suggests the need to review BCG vaccination policy.
Abstract: THE objective of the study was to determine the natural tuberculin conversion rate in primary school children. Seventy-six percent of senior infants and 83 % of sixth class children enrolled in national schools in the academic year 1984/85 were included in the survey. Approximately two-thirds of both groups showed a BCG vaccination scar. Thirty-eight percent of scar present infants and 42% of scar present 6th class children were tuberculin positive Heaf grade 1 or greater. Among scar absent children 3.4% of the infants and 7% of the 6th class were tuberculin positive Heaf grade 1 or greater. For reasons detailed in the text, there are grounds for suspecting that the latter results are artificially inflated. The true figures for the natural conversion rate in unvaccinated children are likely to be of the order of 1.4% of infants and 4.7% of 6th class. However interpreted, the survey points to a relatively low level of transmission of tuberculosis infection among primary school children and suggests the need to review BCG vaccination policy.
TL;DR: It appears that medroxyprogesterone may be of value in pulmonary tuberous sclerosis, an entity that has hitherto been resistant to treatment.
Abstract: A 35 year old woman, known to have tuberous sclerosis, presented with shortness of breath. She was found to have pulmonary infiltration on her chest X-ray, due to tuberous sclerosis and a massive chylous pleural effusion. Despite repeated drainage the effusion continued to reaccumulate. In view of the encouraging response reported in patients with pulmonary lymphangioleimyomatosis we treated our patient with medroxyprogesterone acetate. This led to a resolution of the effusion. She has remained on monthly injections of medroxyprogesterone and remained free of symptoms and pleural effusions over the following twelve months. Thus, it appears that medroxyprogesterone may be of value in pulmonary tuberous sclerosis, an entity that has hitherto been resistant to treatment.
TL;DR: There was no difference between the two agents in their effect on the Bishop score, and fewer patients in the Lamicel group progressed into labour.
Abstract: Forty-two primigravid patients with unfavourable cervices at term were entered into the study. On a random basis, they received either an intravaginal tablet of prostaglandin E2 or Lamicel. Assessment of the effectiveness of the methods was made using a number of factors, including the degree of change in the cervical (Bishop) score. There was no difference between the two agents in their effect on the Bishop score. Fewer patients in the Lamicel group progressed into labour.
TL;DR: An infant delivered at 37 weeks gestation to a woman who received amiodarone in the last trimester of pregnancy showed biochemical evidence of hyperthyroxinaemia, and the drug should be used only with caution during pregancy.
Abstract: An infant delivered at 37 weeks gestation to a woman who received amiodarone in the last trimester of pregnancy showed biochemical evidence of hyperthyroxinaemia. Free Thyroxine levels remained elevated at day 8 but had fallen to within normal limits by one month of age. We suggest amiodarone be used only with caution during pregancy.
TL;DR: Analysis of the management of subsequent labour in 160 patients who as primigravidae, were delivered by caesarean section finds cephalopelvic disproportion was not a contra indication to trial of labour in a subsequent pregnancy.
Abstract: THIS paper analyses the management of subsequent labour in 160 patients who as primigravidae, were delivered by caesarean section.
TL;DR: This retrospective study is additional epidemiological evidence that Crohn’s disease was present but unrecognised prior to this century and not as has been suggested a ‘new’ disease of this century.
Abstract: AT least 29 patients with Crohn’s disease were seen in hospitals in Dublin in the latter half of the last century. This retrospective study is additional epidemiological evidence that Crohn’s disease was present but unrecognised prior to this century and not as has been suggested a ‘new’ disease of this century.
TL;DR: This study examined T lymphocyte ratios in the peripheral blood of 16 patients with CIN and found that similar but more profound lymphocyte abnormalities occur in the acquired immunodeficiency syndrome (AIDS).
Abstract: AN abnormal T4 : T8 lymphocyte ratio has recently been reported in the cervical epithelium of patients with cervical intraepithelial neoplasia (CIN). This study examined T lymphocyte ratios in the peripheral blood of 16 patients with CIN. Nine of the 16 patients had less than 40% T4 lymphocytes and the T4 : T8 ratio was inverted in 7 (44%). Similar but more profound lymphocyte abnormalities occur in the acquired immunodeficiency syndrome (AIDS). This is of interest because both CIN and AIDS are associated with viral infections, sexual intercourse and immunosuppression.
TL;DR: IntestINAL permeability to 51 Cr EDTA was measured in 35 patients with bowel disease and in 19 healthy control subjects drawn from an Irish population, confirming the findings of 2 previous studies.
Abstract: INTESTINAL permeability to 51 Cr EDTA was measured in 35 patients with bowel disease and in 19 healthy control subjects drawn from an Irish population. The percentage urinary excretion of the orally administered dose was highest for patients with Crohn’s disease involving the small bowel (mean 5.89%) and for patients with coeliac disease (4.41%) with the lowest values in the the control subjects (2.93%). However 42% of the controls excreted more than 2.5% of the dose indicating a significant prevalence of abnormal intestinal permeability to Cr EDTA in healthy Irish subjects. This confirms the findings of 2 previous studies and is of particular interest because of the high incidence of coeliac disease in Ireland.
TL;DR: The overall rate of bacteriological proof of tuberculosis in the Republic of Ireland is disturbingly lower than in Northern Ireland or England and Wales, and raises questions concerning true TB incidence and prevalence in theRepublic of Ireland.
Abstract: THE annual notification rates for Tuberculosis (TB) in the Republic of Ireland is much higher than the rates from three notification areas of the United Kingdom (Northern Ireland, England and Wales, Scotland) and also higher than in most other states of the European Community. Accordingly to ascertain the criteria used in the Republic for notification of TB cases, with special reference to their bacteriological status (presence on absence of Mycobacterium Tuberculosis), a questionnaire was sent to the Directors of the 35 Community care areas in the country, to identify the notification criteria used in the years 1982–85 inclusive. A 94% response was obtained. Replies showed that the total cases notified gradually declined from 1982 (982 cases) to 1985 (732 cases). However the percentage of bacteriologically proven cases (of those whose bacteriological status was known) remained low and essentially unchanged from 1982 (44.7%) to 1985 (45.5%). This percentage varied widely between Health Board Areas (HBAs), for example in 1985 it was 25% in the mid-Western HBA and 77% in the adjacent Midland HBA. The overall rate of bacteriological proof of tuberculosis in the Republic of Ireland is disturbingly lower than in Northern Ireland or England and Wales, and raises questions concerning true TB incidence and prevalence in the Republic. Policy on TB notification in the Republic is in urgent need of revision and standardisation.
TL;DR: Colorectal biopsy specimens and appendices from fourteen patients showing intestinal spirochaetosis were evaluated for the presence of inflammatory cells, mast cells and IgE-containing cells and there was no difference between these and normal controls.
Abstract: Colorectal biopsy specimens and appendices from fourteen patients showing intestinal spirochaetosis were evaluated for the presence of inflammatory cells, mast cells and IgE-containing cells. There was no difference between these and normal controls. Review of clinical features showed no consistent symptoms. Irritable bowel syndrome and pseudoappendicitis were common. Our study provides no evidence to incriminate intestinal spirochaetes as pathogenic organisms.
TL;DR: The data indicate that an excellent correlation exists between the standard biochemical DCC ER assay and the immunhistochemical ER assay ERCA, and that the use of monclonal antibodies to evaluate ER status should overcome most of the problems associated with dextran-coated charcoal assay.
Abstract: WE have compared oestrogen receptor (ER) expression using an immunohistochemical assay with the standard biochemical dextran-coated charcoal assay (DCC) in patients with primary breast carcinoma. Of 35 specimens positive for ER using the biochemical assay, 30 specimens (87%) stained strongly positive using the monoclonal antibody (ERICA). Discordant expression of ER by both techniques was noted in only 7 of 56 specimens (12.5%). As expected ER positivity using both techniques was more frequent in elderly post menopausal women, 21 of 30 (67%). These data indicate that an excellent correlation exists between the standard biochemical DCC ER assay and the immunhistochemical ER assay ERCA. Immunohisto chemical analysis of ER status will be of major importance in characterizing hormonal status of breast tumours in particular where only small biopsies are available for analysis.
TL;DR: Penicillamine is a useful medication prescribed particularly in selected patients with Rheumatoid Arthritis and Primary Biliary Cirrhosis and it may induce the rare immunological disorder Pemphigus in 1 % of patients treated.
Abstract: Penicillamine is a useful medication prescribed particularly in selected patients with Rheumatoid Arthritis and Primary Biliary Cirrhosis. It may induce the rare immunological disorder Pemphigus in 1 % of patients treated. We describe two such cases and briefly review the literature.
TL;DR: Although arthroscopic meniscectomy can be technically demanding its results are clearly superior to those achieved by open menisCEctomy.
Abstract: THIS study was undertaken to assess the outcome of arthroscopic compared with open meniscectomy. Two groups of thirty patients matched for age, sex, site and type of meniscal lesion were included. Economic, socio-economic subjective and objective results were recorded at follow up. Duration of hospital stay and post operative absence from work and sport were significantly shorter than those treated arthroscopically. Symptomatically, the arthroscopic group reported better results. Clinical examination carried out at the time of recall revealed less muscle wasting and greater range of movement in the arthroscopic group. We feel that although arthroscopic meniscectomy can be technically demanding its results are clearly superior to those achieved by open meniscectomy.
TL;DR: The study looked at the diagnostic ability and therapeutic implications of blood cultures, which revealed six patients had alterations in their management based solely on the results of their blood cultures.
Abstract: A five month prospective study of all blood cultures performed on patients over twelve years of age was undertaken at the Regional Hospital, Galway. The study looked at the diagnostic ability and therapeutic implications of blood cultures. In total 324 blood cultures were performed on 270 patients. There were 29 significant isolates grown from blood cultures (8.9%). The specificity of blood cultures, based on combined clinical and laboratory criteria, was 84% and the sensitivity was 31.7%, giving an overall accuracy of 68.2%. Six of the 270 patients had alterations in their management based solely on the results of their blood cultures.
TL;DR: The next few years may see the development of a pharmacological approach to at least attenuate the sequelae of the treatment modalities for vascular disease.
Abstract: It is accepted that vascular smooth muscle cell proliferation is the central event in occlusive vascular disease. Why this occurs in the lesion of atherosclerosis is not yet known for certain but it is probably related in some way to chronic minor endothelial trauma. Intimai hyperplasia, on the other hand, is related to mechanical trauma of the endothelium.
TL;DR: The clinical course of 18 patients from whom mycobacterium tuberculosis (M.tub.) was cultured implicate the tubercle bacillus in either a primary etiological or secondary complicating role in at least some cases of sarcoidosis.
Abstract: HAVING reviewed the records of 208 consecutive cases of sarcoidosis diagnosed in one hospital over a period of 20 years we describe the clinical course of 18 patients (9%) from whom mycobacterium tuberculosis (M.tub.) was cultured. These figures implicate the tubercle bacillus in either a primary etiological or secondary complicating role in at least some cases of sarcoidosis. We favor the former hypothesis and outline a possible mechanism involving interaction between the humoral and cellular immune systems to explain the coexistence of the two diseases, i.e., a changing reaction to an antigen common to both: the tubercle bacillus.
TL;DR: There were twenty-eight urological complications in the series of renal transplants performed at this institution, which represents an overall incidence of 6.2%.
Abstract: FROM January 1st 1975 to December 31st, 1984, 466 renal transplants were performed at our institution. There were 454 case records available for study. There were twenty-eight urological complications in the series. This represents an overall incidence of 6.2%. Eighteen of these complications were ureteral fistulae and ten were ureteral obstructions. Surgical correction was successful in 85% of these patients.
TL;DR: There is a need for heightened awareness of the importance of as pergillus fumigatus as a complication of fibrotic lung disease, of ABPA in asthma and of invasive aspergillosis in neoplasm and disease associated with immunosuppression.
Abstract: THIS paper is a retrospective study of thirty-nine patients with lung disease, caused by aspergillus fumigatus, seen in two large general hospitals over a ten year period. The study was undertaken to establish the pattern and distribution of pulmonary aspergillosis in this group with particular emphasis on the nature of the underlying disorder, management and outcome. The patients fell into three well-defined categories: 1. Localized aspergilloma (fungus ball, mycetoma)-20 patients. 2. Allergic bronchopulmonary aspergillosis (ABPA)-12 patients. 3. Invasive aspergillosis — 7 patients. The aspergilloma group was characterized by severe, preexisting lung disease, poor pulmonary function and, in 50% of cases, life-threatening heamoptysis. This complication was treated surgically (5 cases), by embolisation of the bronchial artery (3 cases) or conservatively (2 cases) depending on clinical and physiologic status. In the ABPA group, all patients had asthma. Seven patients (58%) had bronchographically proven bronchiectasis at the time of diagnosis of ABPA and all but one required long-term oral steroid therapy. The 7 cases of invasive aspergillosis comprised 5 patients with underlying neoplasm, one with myelofibrosis and one with systemic lupus erythematosis most of whom were on some form of immunosuppressive therapy. Surprisingly, clinical and radiologic findings were subtle. In 4 of these 7 cases (57%), aspergillosis precipitated the terminal event and in five of these cases (71%), the diagnosis was not made until post-mortem examination. These data emphasise the diverse mechanisms by which aspergillus fumigatus can cause serious pulmonary pathology. Despite the wide differences in etiopathogenic mechanisms of the three groups, a striking common denominator in this group was the advanced stage of the disease at the time of diagnosis. There is a need for heightened awareness of the importance of aspergillus fumigatus as a complication of fibrotic lung disease, of ABPA in asthma and of invasive aspergillosis in neoplasm and disease associated with immunosuppression.