Showing papers in "Irish Journal of Medical Science in 1989"
TL;DR: Abnormal presentation of the fetus, displacement of the cervix and anaemia were the most common clinical features and partial removal of the placenta is the most hazardous procedure and should not be undertaken.
Abstract: Twenty-three cases of advanced abdominal pregnancy were managed at Harare Hospital, Zimbabwe, over a 10 year period. The incidence was 1 in 9500 total deliveries and 1 in 60 ectopic pregnancies. There were no maternal deaths but perinatal mortality was 83%. Of the 5 liveborn infants, 4 had pressure deformities and 3 were small for gestational age. There was one neonatal death due to pulmonary hypoplasia. Diagnosis is difficult and is often first suggested by failed induction of labour in a case of presumed intrauterine death. Abnormal presentation of the fetus, displacement of the cervix and anaemia were the most common clinical features. At operation, haemorrhagic shock occurred more frequently when attempts were made to remove the placenta. However, the average post-operative stay of patients who had placental tissue left was 22.4 days compared with 8.3 days for those who had the placenta removed. It is recommended that the placenta be removed only if its entire blood supply can be ligated. Partial removal of the placenta is the most hazardous procedure and should not be undertaken.
41 citations
TL;DR: This study shows that overexpression of the c-erb B-2 oncoprotein is easily identifiable and can be detected on paraffin embedded sections using an immunohistochemical technique.
Abstract: Using a specific polyclonal antibody (21N) to the c-erbB-2 oncoprotein, a total of 200 primary breast carcinomas of various histological types and 46 benign breast lesions, were immunohistochemically stained, to identify those tissues over-expressing this putative transmembrane receptor. Positivity for this oncoprotein was evident as an intense brown granular staining predominantly located at the cell membrane and was present in 17% (n = 34) of the primary breast carcinomas investigated. With the exception of one case of apocrine metaplasia, none of the remaining benign breast samples (n = 45) were positive for this oncoprotein. This study shows that overexpression of the c-erb B-2 oncoprotein is easily identifiable and can be detected on paraffin embedded sections using an immunohistochemical technique. The results obtained correlate well with other c-erbB2 detection systems and in addition, positivity for this oncoprotein is mostly confined to the malignant phenotype.
19 citations
TL;DR: Of the 53 patients who had less than perfect technique 37 showed an initial improvement with training and this Author suggests that all patients should be fully evaluated before starting on inhalers and the most appropriate delivery system selected for them.
Abstract: 71 Patients who were using inhalers in an inner city Dublin teaching practice were assessed by the author over a four month period to see if they were using their inhalers properly. 18 (25%) had perfect technique, 26 (37%) had adequate technique and 27 (38%) had poor technique. The patients most likely to have poor technique were those using a Metered Dose Inhaler (M.D.I.), patients using inhalers for less than one year and patients with a diagnosis of C.O.A.D. as opposed to Asthma. Of the 53 patients who had less than perfect technique 37 showed an initial improvement with training. This Author suggests that all patients should be fully evaluated before starting on inhalers and the most appropriate delivery system selected for them. They should be carefully instructed on its correct use and arrangements made for regular follow up to ensure good inhaler technique. This should lead to a greater clinical response and improved patient compliance.
18 citations
TL;DR: An association with auto-immune thyroiditis is described for the first time and the importance of extensive examination of the coronary arteries at autopsy is emphasised as the lesion was confined to a small focus near the apex of the heart.
Abstract: A 41 year old woman died suddenly and unexpectedly as a result of a spontaneous primary dissection of acoronary artery. This rare condition occurs typically in pre-menopausal women often in the peripartum period and hormonal changes have been among several suggested aetiological factors. In this case an association with auto-immune thyroiditis is described for the first time and the importance of extensive examination of the coronary arteries at autopsy is emphasised as the lesion was confined to a small focus near the apex of the heart
18 citations
TL;DR: The diagnostic value of conventional chest percussion compared with ausculatory percussion was defined using the chest x-ray as a gold standard using the prevalence of disease in 100 lung fields and the majority of lesions were not detected, resulting in very low sensitivities.
Abstract: Percussion of the chest is thought to be insensitive in detecting small or deeply situated chest lesions. A newer technique, ausculatory percussion, has been reported as having a far higher sensitivity. In a controlled blind study the diagnostic value of conventional chest percussion compared with ausculatory percussion was defined using the chest x-ray as a gold standard. The prevalence of disease in 100 lung fields was 26%. The majority of lesions were not detected by either technique resulting in very low sensitivities of 15.4% for conventional percussion and 19.2% for ausculatory percussion. A positive result with ausculatory percussion was twice as likely to be false as true (positive predictive value 31.2%). The technique did not add to the diagnostic value of conventional percussion. Both techniques have major limitations. Patients with suspected lung disease still require chest x-ray examination if percussion is normal.
17 citations
TL;DR: No subjective or objective evidence of beneficial effect was observed from the use of Pirenzipine in irritable bowel syndrome patients who had not responded to a high fibre diet.
Abstract: No subjective or objective evidence of beneficial effect was observed from the use of Pirenzipine in irritable bowel syndrome (TBS) patients who had not responded to a high fibre diet.
15 citations
12 citations
TL;DR: The shortage of Nursing Home and long-term care facilities resulted in prolonged hospital stay for many patients and the major factors which determined mortality and morbidity were the age of the patient, male sex, and the degree of social dependence of the patients both before and after the fracture.
Abstract: In this study 147 patients with hip fractures were reviewed and reassessed to establish their mortality and morbidity. The early mortality was 10.8% and this rose to 27% at three months. The major factors which determined mortality and morbidity were the age of the patient, male sex, and the degree of social dependence of the patient both before and after the fracture. The site of the fracture or the type of anaesthetic used did not significantly affect the outcome. The shortage of Nursing Home and long-term care facilities resulted in prolonged hospital stay for many patients.
12 citations
TL;DR: This one year survey suggests that neither vaginal or abdominal hysterectomy causes significant ongoing disruption of lower urinary tract function.
Abstract: Twenty-five patients who had a simple hysterectomy procedure underwent urodynamic assessment to assess the effect of surgery on lower urinary tract function. This one year survey suggests that neither vaginal or abdominal hysterectomy causes significant ongoing disruption of such function.
11 citations
TL;DR: It is suggested that the use of a formalised mental state examination such as the Mini Mental State, in addition to the usual clinical assessment of mental state, may improve the accuracy of prediction of abnormality on CT scan.
Abstract: From 6,300 psychiatric admissions over a 37 month period, all 54 patient referrals for CT were identified and their charts reviewed. CT influenced diagnosis, management or prognosis in 11.7 percent of patients scanned. There was poor correlation between organicity on CT scan and findings on physical examination, laboratory testing, EEG and psychological testing. The mental state examination was the single significant correlate of CT abnormality. We suggest that the use of a formalised mental state examination such as the Mini Mental State, in addition to the usual clinical assessment of mental state, may improve the accuracy of prediction of abnormality on CT scan. The introduction of X-ray computed tomography (CT) is recognised to be one of the most important innovations in the recent history of clinical medicine. In neurology the value of a non-invasive technique for examining the intracranial contents was quickly realised in the areas of diagnosis, particularly in the detection of vascular accidents and tumours. CT has also attained a significant place in psychiatry. In research studies, it has provided important information on schizophrenia, alcoholism and chronic organic reactions. The place of CT in clinical psychiatry is less clear. As its availability has increased, such scans are being requested with increasing frequency in psychiatric patients. Cranial CT is a highly sensitive diagnostic procedure which, when used unselectively, may result in the discovery of incidental findings. Until recently, a function of the psychiatrist in relation to diagnosis was to first seek to distinguish symptoms produced by organic pathology from those produced by functional illness.(ABSTRACT TRUNCATED AT 250 WORDS)
10 citations
TL;DR: The results suggest that an immunoregulatory defect may exist in some patients with RA which allows for enhanced expression of EBV.
Abstract: Serum antibodies to Epstein-Barr virus (EBV) were measured in members of twenty-nine families in which two or more first degree relatives had rheumatoid arthritis (RA). These patients were assessed clinically for activity of disease and their treatment recorded. A higher proportion of seropositive individuals was found among patients and affected kindred than among the non-affected groups. Antibody titres to Viral Capsid Antigen (VCA) tended to be higher in patients and affected kindred. In those individuals in whom antibody to Early Antigen (EA) was present there was a lower titre of antibody to Epstein-Barr Nuclear Antigen, (ENBA). The results suggest that an immunoregulatory defect may exist in some patients with RA which allows for enhanced expression of EBV.
TL;DR: Caroli’s disease in a 36year old Irish woman who has extensive bilobar involvement without congenital hepatic fibrosis or portal hypertension is described.
Abstract: Caroli’s disease in a 36year old Irish woman who has extensive bilobar involvement without congenital hepatic fibrosis or portal hypertension. The difficulty of diagnosis and the intractable nature of the disease are emphasised and recent improvements in diagnosis and management are discussed.
TL;DR: In this article, 104 patients suffering from neurotic or reactive depressioDDn were treated with either alprazolam or amitriptyline in randomised, double-blind fashion.
Abstract: 104 patients suffering from neurotic or reactive depressioDDn were treated with either alprazolam or amitriptyline in randomised, double-blind fashion.
TL;DR: A case of fatal aplastic anaemia following prolonged administration of diclofenac in a 77 year old lady with rheumatoid arthritis is reported.
Abstract: Aplastic anaemia is recognised to occur following the use of some non-steroidal anti-inflammatory drugs. We report a case of fatal aplastic anaemia following prolonged administration of diclofenac in a 77 year old lady with rheumatoid arthritis. To our knowledge this is the first report of fatal aplastic anaemia associated with diclofenac use in an elderly patient.
TL;DR: The importance of clinical awareness and detailed evaluation and follow up of the cardiovascular system in Kawasaki disease is emphasised and there is also a need, however, to exclude other diagnoses which may have a similar clinical presentation.
Abstract: Thirteen patients with Kawasaki disease were reviewed. The average age at presentation was 31 months (range: 6 weeks to 8 years). Mean follow up was 36 months, with a range of 5 to 53 months. Cardiovascular manifestations were present in 9 patients. These comprised pericarditis with myocarditis (2), pericardial effusion (4), coronary artery ectasia (3), coronary artery aneurysms (3), peripheral artery aneurysm (1) and peripheral vasculitis (1). Treatment consisted of aspirin alone in 11 and gammaglobulin with aspirin in 2 patients. One patient with coronary artery involvement died following a myocardial infarction. A large coronary artery aneurysm persists, 31 months after initial detection in another patient. Spontaneous resolution of the cardiovascular complications occurred in the remaining seven patients. The importance of clinical awareness and detailed evaluation and follow up of the cardiovascular system in Kawasaki disease is emphasised. There is also a need, however, to exclude other diagnoses which may have a similar clinical presentation.
TL;DR: The most common diagnosis necessitating a hospital visit was a suspected foreign body in the upper aerodigestive tract, followed by epistaxis and some form of ear sepsis, and there was a noticeable lack of primary involvement in such areas as facial and neck trauma.
Abstract: The night-time and weekend otolaryngology service provided to an urban population slightly in excess of half a million people is analysed over a six month period. During this time, 147 calls were received, of which 116(79%) required a hospital visit by the Registrar-on-call. Children accounted for 39% of patients seen and adults 61%.
TL;DR: There was no rebound insomnia when temazepam was withdrawn either abruptly or gradually in long- term hospitalised elderly patients and may not be effective as a long-term hypnotic.
Abstract: 31 of 36 elderly mainly confused hospitalized patients (69-98 years) taking temazepam 10 mgs nocte for more than one month completed a double blind randomised placebo controlled trial comparing abrupt versus gradual withdrawal of temazepam. Hours of sleep were recorded for all patients during a 7 day baseline period while taking temazepam 10 mg nocte. Then the abrupt withdrawal (AW) group (n = 15) received placebo for 10 nights and the gradual withdrawal (GW) group (n = 16) received temazepam 5 mg for the first 4 nights, 2 mg for the next 4 nights and placebo for the last 2 nights. There was no significant difference in mean hours of nightly sleep during the baseline period between the AW group (5.9 +/- 1.1 SD) and GW group (5.8 +/- 1.1 SD) and between the baseline and withdrawal periods in each group (withdrawal periods, AW 5.6 +/- 1.2, GW 5.6 +/- 1.0). There was no rebound insomnia when temazepam was withdrawn either abruptly or gradually in long-term hospitalised elderly patients and may not be effective as a long-term hypnotic.
TL;DR: Patients presenting for routine and emergency anaesthesia and those suffering from trauma should have a preoperative chest X-ray, according to American Society of Anaesthesiologists grades III, IV and V.
Abstract: 687 patients presenting for routine and emergency anaesthesia were studied. 297 were found to have a chest X-ray. Abnormalities on chest X-ray were scattered amongst most age groups. Patients in American Society of Anaesthesiologists grade I were found to have abnormalities in only 4% of cases, and the abnormalities were of no anaesthetic significance. The incidence of abnormalities increased to 25% in grade II, 52% in grade III and 81% in grades IV and V. Patients in American Society of Anaesthesiologists grades III, IV and V, and those suffering from trauma should have a preoperative chest X-ray.
TL;DR: A case of cervical pregnancy resulting in intra abdominal rupture in the first trimester is reported, and pathological examination of the uterus showed placenta percreta.
Abstract: A case of cervical pregnancy resulting in intra abdominal rupture in the first trimester is reported The clinical features of this rare cause of uterine rupture are outlined Pathological examination of the uterus showed placenta percreta
TL;DR: A 14 year old boy presented with recurrent attacks of macroscopic haematuria proceeded by tonsillitis, which revealed generalised vitiligo and biochemical investigations revealed primary hypothyroidism and primary adrenocortical insufficiency with negative organ specific autoimmune screen.
Abstract: A 14 year old boy presented with recurrent attacks of macroscopic haematuria proceeded by tonsillitis. Clinical examination revealed generalised vitiligo. Renal function was normal with microscopic haematuria. Percutaneous renal biopsy showed mesangial proliferation on light microscopy with deposition of IgA and IgM in a granular pattern in the mesangium and glomerular basement membrane compatible with a diagnosis of IgA nephropathy. Biochemical investigations revealed primary hypothyroidism and primary adrenocortical insufficiency with negative organ specific autoimmune screen. Renal function has not deteriorated after three years follow-up. This particular association has not been previously described to our knowledge.
TL;DR: Autoimmune haematological abnormalities should be excluded in patients with Graves’ disease and thyroid function and thyroid antibody status should be evaluated in Patients with autoimmune haemolytic anaemia.
Abstract: This report describes simultaneous autoimmune thyrotoxicosis and autoimmune haemolytic anaemia. Autoimmune haematological abnormalities should be excluded in patients with Graves' disease and thyroid function and thyroid antibody status should be evaluated in patients with autoimmune haemolytic anaemia.
TL;DR: It is recommended that when “idiopathic” hypothalamic failure is diagnosed, imaging procedures, including CT or nuclear magnetic resonance examinations, should be repeated on at least one occasion, after an interval of approximately 6 months.
Abstract: Hormonal evidence of widespread hypothalamic failure, including diabetes insipidus, hyper-prolactinaemia, growth failure, hypothyroidism, and adrenal failure, was present in a boy of 14 years. Investigation with computerised axial tomography (CT) and metrizamide encephalography failed to identify any anatomical abnormality at the time of presentation. However, 18 months later papilloedema was noted at which time a suprasellar mass and gross dilatation of the ventricular system were readily identified using CT and a germinoma was subsequently diagnosed and treated. In the light of this experience we recommend that when “idiopathic” hypothalamic failure is diagnosed, imaging procedures, including CT or nuclear magnetic resonance examinations, should be repeated on at least one occasion, after an interval of approximately 6 months.
TL;DR: Gut infections with Salmonella enteritidis are becoming increasingly common in this community and throughout the Western world and over the past two years, in this area, there has been an almost thirty-fold increase in the number of recorded cases of infections due to this organism.
Abstract: During a five month period in the summer of 1987, seven cases of reactive arthritis were seen at Musgrave Park Hospital, Belfast. Of the seven patients, five were male and two female. Their ages ranged from 13 to 44 (mean: 26±4) years. Five patients gave a preceding short history of diarrhoea which was usually mild. All patients presented with acute inflammatory oligoarthritis which predominantly affected the lower limbs. The knees were involved in 100%, the ankles in 70% with enthesopathy in 30% of cases. The diagnosis was confirmed in all cases by positive serology for Salmonella enteritidis. In three patients, stool cultures grew a particular strain of Salmonella enteritidis (phage type 4). Six patients were HLA-B27 positive. It is not possible to estimate the prevalence of reactive arthritis in this outbreak because there were different sources of infection and the total number of gastroenteritis cases was unknown. However, gut infections with Salmonella enteritidis are becoming increasingly common in this community and throughout the Western world. Over the past two years, in our area, there has been an almost thirty-fold increase in the number of recorded cases of infections due to this organism. By far the commonest source of infection appears to be poultry and egg products.
TL;DR: Since 1986 in vitro fertilisation and allied techniques have formed a part of the fertility service at St James’s Hospital and by June 1988 using routine methodology, IVF or GIFT has been attempted at least once in 94 women with a further 17 having one repeat procedure and 4 two repeat procedures performed.
Abstract: Since 1986 in vitro fertilisation and allied techniques have formed a part of the fertility service at St. James’s Hospital. By June 1988 using routine methodology, IVF or GIFT has been attempted at least once in 94 women with a further 17 having one repeat procedure and 4 two repeat procedures performed. Although embryos were cultured from 54% of oocytes in which fertilisation was attempted, no pregnancies were achieved during that period with IVF. Ten pregnancies had occurred during a GIFT cycle (9 at first attempt, 16%) 60% of these are on-going. Also continuing were pregnancies where ovulation induction was abandoned on day 8(1) and where conception occurred spontaneously whilst on the waiting list for the procedure (8) and in untreated cycles following the procedure (4) (16%). Seventy percent of patients who failed the first time expressed a wish to try again.
TL;DR: It is concluded that initial antibiotic therapy for patients with CAP need not routinely include cover for Legionella, and a serological screen of blood bank donors and renal transplant recipients failed to detect antibody to Legionella pneumophila supporting the clinical findings of a low prevalence of infection.
Abstract: The commonest infectious agents identified in community acquired pneumonia (CAP) amongst 50 patients admitted to a Dublin hospital were Streptococcus pneumoniae and Haemophilis influenzae. Legionella pneumophila pneumonia occurred in only one patient who acquired infection abroad. A serological screen of blood bank donors and renal transplant recipients failed to detect antibody to Legionella pneumophila supporting the clinical findings of a low prevalence of infection in this community. It is concluded that initial antibiotic therapy for patients with CAP need not routinely include cover for Legionella.
TL;DR: Anxiety, depression, self-esteem, behavioural deviance and prosocial behaviour were studied in children attending a normal school in a disadvantaged urban area, using self-rated and teacher-rated questionnaire.
Abstract: Anxiety, depression, self-esteem, behavioural deviance and prosocial behaviour were studied in children attending a normal school in a disadvantaged urban area, using self-rated and teacher-ratedquestionnaires. Theprevalence of depression was rated as 5%. 15% described frequent suicidal thoughts. 40% scored as behaviourally deviant. Significant correlations were found between the variables studied. The rates of depression and behavioural deviance were higher than in comparable British populations.
TL;DR: The greatest improvement in functional class was noted in those patients who underwent joint replacement who presented with severe disability to a rheumatology unit following comprehensive rehabilition.
Abstract: 26 patients with rheumatoid arthritis (RA) who presented with severe disability to a rheumatology unit were reviewed following comprehensive rehabilition. This comprised in-patient evaluation, alteration in drug therapy, physical and occupational therapy and in many cases, orthopaedic surgery. Sustained benefit is observed 4–6 years later in terms of disease activity and functional class. The greatest improvement in functional class was noted in those patients who underwent joint replacement.
TL;DR: Serum CA 125 levels are more sensitive than clinical or radiological assessment in monitoring response/relapse in ovarian cancer and the CA 125 level after 3 cycles of chemotherapy is of major prognostic value in predicting survival.
Abstract: In a study of 33 newly diagnosed patients with ovarian cancer, we have correlated serum levels of the tumour marker CA 125 with disease stage, response to cytotoxic therapy and survival. Elevated levels were found in 22/ 28 patients (79%) with Stage III/IV disease, compared with 0/5 patients with Stage I disease and 7/38 patients (19%) with non-ovarian malignancies. Of 15 patients with measurable disease, serum CA 125 levels correlated with clinical response to treatment in 11; the remaining 4 patients had persistently elevated CA 125 levels in spite of clinical response and subsequently developed early relapse. Among the 13 patients with no measurable disease, 11 remained in clinical and radiological remission with treatment, with a fall to normal CA 125 levels; 2 patients who had persistently elevated CA 125 levels developed disease recurrence after completion of chemotherapy. Sequential measurements of CA 125 for up to 2 years in 8 patients showed that risingCA 125 levels preceded clinical relapse by a median of 3 months. The most important prognostic value of CA 125 was the level following 3 cycles of chemotherapy, independent of clinical status - median survival for 15 patients with normal CA 125 at 3 months was 15+ months compared with a median survival of 6 months in 13 patients who had elevated CA 125 at 3 months. These data confirm that 1) serum CA 125 levels are more sensitive than clinical or radiological assessment in monitoring response/relapse in ovarian cancer and 2) the CA 125 level after 3 cycles of chemotherapy is of major prognostic value in predicting survival.