Showing papers in "Irish Journal of Medical Science in 1990"
TL;DR: A case of RADS occurring following exposure to chlorine gas and which has persisted at 6 years follow-up is described.
Abstract: Reactive Airways Dysfunction Syndrome (RADS) has been described following exposure to various irritant gases(1). We describe a case of RADS occurring following exposure to chlorine gas and which has persisted at 6 years follow-up.
39 citations
TL;DR: It is concluded that renal biopsy remains the only definitive method of establishing the underlying lesion causing idiopathic nephrotic syndrome.
Abstract: The clinical and histopathologic findings in 225 Irish adults with nephrotic syndrome were reviewed. Membranous nephropathy was the most common lesion found (28%), followed by proliferative glomerulonephritis (17%), and focal sclerosing glomerulonephritis (16%). Minimal change disease was the least frequent cause for idiopathic nephrotic syndrome (12%). The major secondary cause of nephrotic syndrome was amyloidosis (13%). The patients were analysed for the predictive value of the level of renal function, presence or absence of hypertension, and the degree of proteinuria. It was not possible to determine the nature of the underlying lesion giving rise to the nephrotic syndrome using any of these variables. There was also no significant difference between primary and secondary glomerular disease with regard to these factors. It is concluded that renal biopsy remains the only definitive method of establishing the underlying lesion causing idiopathic nephrotic syndrome.
19 citations
TL;DR: It was found that a significant proportion of SCCs and BCCs were not related to chronic sun exposure and it is proposed that other environmental agents and genetic factors may also contribute to the high incidence of skin cancer in Ireland.
Abstract: The significance of chronic sun exposure in the pathogenesis of skin cancers squamous cell carcinoma (SCC). basal cell carcinoma (BCC) and melanoma was morphologically assessed. Histological sections of 223 consecutive skin cancers were reviewed, these were stained with aldehyde fuchsin and the degree of associated solar elastosis estimated. The anatomic distribution of SCC and BCC and the SCC:BCC ratio were significantly different in the Irish population studied when compared to other major series. It was found that a significant proportion of SCCs and BCCs were not related to chronic sun exposure. As expected, only melanomas arising in lentigo maligna were associated with long-term irradiation. It is proposed that other environmental agents and genetic factors may also contribute to the high incidence of skin cancer in Ireland.
15 citations
TL;DR: Sixty-nine opiate addicts on methadone maintenance programmes at the Drug Treatment Centre were interviewed, all meet DSM 3 criteria for opioid dependency; most were young, poorly educated, unemployed and had involvement with both police and prison.
Abstract: This research aimed at investigating the extent of risk of HIV transmission among known HIV-positive drug misusers, and measuring the degree (if any) of positive change in such behaviour following diagnosis. To achieve this end, 69 opiate addicts on methadone maintenance programmes at the National Drug Treatment Centre were interviewed. Most of these were young, with low levels of educational achievement, a history of unemployment and involvement with crime. They had usually started taking drugs at a young age, with heroin the primary drug of misuse, administered by injection. Of the sample, 70% were HIV-positive. These were found, since diagnosis, to have changed their injecting habits and sexual behaviour significantly.
14 citations
TL;DR: Wemicke’s encephalopathy is a serious neurological manifestation of vitamin Bl deficiency and a case occurring secondary to hyperemesis gravidarum is reported.
Abstract: Wernicke's encephalopathy is a serious neurological manifestation of vitamin B1 deficiency We report a case occurring secondary to hyperemesis gravidarum
13 citations
TL;DR: A more thorough examination of the problem regarding the prophylaxis of thrombo-embolic risk in patients affected by chronic atrial fibrillation is suggested.
Abstract: The cerebral CT-scan results of 72 patients with chronic atrial fibrillation (AF) were compared to those of an ageand sex-matched control group, affected by muscle-tensive headache.
13 citations
TL;DR: Brain's laryngeal mask airway (L.M.A.) can play a part in achieving this objective of day case surgery by modifying Anaesthetic methods and techniques.
Abstract: An increase in day case surgery has followed a reduction in the number of hospital beds available. Anaesthetic methods and techniques must be modified so that patients can be safely discharged as soon as possible following surgery. The use of Brain's laryngeal mask airway (L.M.A.) can play a part in achieving this objective.
13 citations
TL;DR: A 36 year old woman admitted long-standing drug abuse, including intravenous injection of crushed methadone tablets which contain talc filler, when confronted with evidence of intravenous talcosis.
Abstract: We report a case of intravenous talcosis in a 36 year old woman. Although she initially denied drug abuse clinical suspicion was aroused by the finding of obliterated peripheral veins, a pleural rub and a peripheral nodular lesion on chest x-ray. Diagnosis of intravenous talcosis was confirmed by finding birefringent particles on transbronchial biopsy. Confronted with this evidence the patient admitted long-standing drug abuse, including intravenous injection of crushed methadone tablets which contain talc filler.
12 citations
TL;DR: An unusual case of a well-documented granulomatous hepatitis in secondary syphilis in a 47-year-old male is presented and a review of the literature concerning syphilitic granulOMatous liver disease is presented.
Abstract: An unusual case of a well-documented granulomatous hepatitis in secondary syphilis in a 47-year-old male is presented. This hepatic pathology in secondary syphilis is summarised, and a review of the literatureregarding syphilitic granulomatous hepatitis presented.
11 citations
TL;DR: It is concluded that secretor status is unlikely to play a major role in susceptibility to pseudomonas aeruginosa infection in patients with cystic fibrosis.
Abstract: In cystic fibrosis, a majority of patients develop persistent lifelong respiratory tract colonisation with pseudomonas aeruginosa while a minority do not appear to become colonised. There is some evidence that nonsecretion of ABO Blood Group antigens into body secretions is a marker for susceptibility to certain gram negative infections.
9 citations
TL;DR: It is concluded that N-myc activation by amplification confers aggressive properties on a variety of embryonal tumours, rather than being restricted to initiation of neoplasia in tumours of neuroectodermal origin.
Abstract: DNA, extracted from tumours arising in 29 paediatric patients [14 neuroblastoma, 9 Wilms tumour (nephroblastoma), 6 miscellaneous] was investigated for evidence of N-myc amplification, using pNb-l,a recombinant plasmid containing a 1.0 Kb fragment homologous to the 5′ end of the human N-myc gene. Within the neuroblastoma group, 4 patients had 15 or more copies of N-myc which correlated with advanced disease stage, and 3 other patients showed low grade amplification (2–5 copies). Low grade amplification was also observed in one patient with stage III unfavourable histology Wilms tumour, resistant to treatment. N-myc was present at single copy level in all other tumours studied. It is concluded that N-myc activation by amplification confers aggressive properties on a variety of embryonal tumours, rather than being restricted to initiation of neoplasia in tumours of neuroectodermal origin. A greater understanding of the complex interaction of a number of oncogenes involved in neuroblastoma may enable more effective therapeutic strategies to be devised.
TL;DR: Direct Antibiotic Sensitivity Testing is a rapid means of diagnosing urinary tract infection (UTI) and obtaining antibiotic sensitivity patterns of the infecting organisms and should be considered by general practitioners as an alternative to the problems and delays involved in sending urine samples to the laboratory and in awaiting the results.
Abstract: Direct Antibiotic Sensitivity Testing (DST) is a rapid means of diagnosing urinary tract infection (UTI) and obtaining antibiotic sensitivity patterns of the infecting organisms. In this study 227 urine samples from general practice were analysed using this technique with those obtained using the standard laboratory method. DST was shown to be 94.6% sensitive, and 80.7% specific. Escherichia coli was the commonest infecting organism. Augmentin was the most effective antibiotic tested, all organisms tested in vitro, being susceptible. Direct Sensitivity Testing is rapid, inexpensive, easy to perform, highly sensitive and specific. It should be considered by general practitioners as an alternative to the problems and delays involved in sending urine samples to the laboratory and in awaiting the results.
TL;DR: The result may assist attempts to map the genetic data on MS, opens the way for a reassessment of the attempts to identify the environmental factors, and it makes possible the completion of nonempirical risk tables for various countries.
Abstract: The object of this study was to determine, if possible, the mode of inheritance of the susceptibility to multiple sclerosis (MS).
TL;DR: A 63 year old man with pulmonary tuberculosis developed nephrotic syndrome secondary to immune complex nephritis and renal lesion that resolved with standard chemotherapy.
Abstract: A 63 year old man with pulmonary tuberculosis developed nephrotic syndrome secondary to immune complex nephritis. The nephrotic syndrome and renal lesion resolved with standard chemotherapy.
TL;DR: It is found that CyA can be an effective therapy for otherwise refractory nephrotic syndrome, although relapse on withdrawal of CyA may well be a significant clinical problem.
Abstract: Nine adult patients with resistant nephrotic syndrome were treated with cyclosporin A (CyA). All had failed to respond to high dose corticosteroids with or without cyclophosphamide. Three patients had minimal change disease, 3 had focal sclerosing glomerulosclerosis (FSGS), 2 had mesangio-capillary GN, and one had membranous nephropathy. The mean age of the patients was 26.4 years (range 16 to 39 years). CyA was given orally twice daily at a mean dose of 6.7 mg/kg/24 hours (range 6–10 mg/kg/24 hours). Four patients achieved full remission, two patients went into partial remission, and three failed to respond. Two patients developed clinical nephrotoxicity, which reversed on dose reduction or cessation of CyA. All 3 patients with minimal change disease who responded subsequently relapsed after stopping CyA, but remitted rapidly on reintroduction of the drug. We suggest that the mode of action of CyA in nephrotic syndrome may be related to intra-renal vasoconstriction in addition to its direct immunosuppressive effect. In this limited series, we found that CyA can be an effective therapy for otherwise refractory nephrotic syndrome, although relapse on withdrawal of CyA may well be a significant clinical problem.
TL;DR: The patient who presented with small bowel perforation died in the immediate post-operative period, while the patient whoPresented withSmall bowel obstruction is alive and well six months later.
Abstract: A case of small bowel perforation and a case of small bowel obstruction as a result of metastatic lung carcinoma are presented. The surgical management of each is discussed. The patient who presented with small bowel perforation died in the immediate post-operative period, while the patient who presented with small bowel obstruction is alive and well six months later. Patients with primary lung carcinoma who present with an acute abdomen should be treated by standard surgical principles irrespective of their primary pathology
TL;DR: It is concluded that the aetiology of ALO in this group involves the absorption of toxic home water aluminium in the presence of an elevated PTH level and a GFR <50 mls/min/1.73m.
Abstract: The incidence of aluminium osteomalacia (ALO) in patients with chronic renal failure neither on dialysis nor taking aluminium-containing phosphate binders (ACPB) is not well documented. Biochemical and histological bone investigations were performed in 35 patients fulfilling the above conditions, among whom we found an incidence of ALO of 17%. In the ALO group, salient findings were PTH level (mean ± s.d.) of 3.1±1.4 ng/ml (normal <0.5 ng/ml); elevated home tap-water aluminium levels of 6.5±1.2 umol/1 (normal <2 umol/1); and a GFR of 20.5 mls/min/ 1.73m, (range 2–50 mls/min/1.73m).
TL;DR: Patients undergoing cholecystectomy were studied and allocated at random to a control group and a treated group to whom physiotherapy instruction was given, with no statistical difference in values pre-operatively and on the 2nd and 5th post-operative days.
Abstract: Sixty patients undergoing cholecystectomy were studied and allocated at random to a control group and a treated group to whom physiotherapy instruction was given. Respiratory function tests were recorded pre-operatively and on the 2nd and 5th post-operative days. These showed no statistical difference in values pre-operatively, a statistically significant difference in value in both groups for all tests on the 2nd postoperative day, with maintenance of such reduced value for forced vital capacity (F.V.C) and peak flow (P.F.) in the control group on the 5th post-operative day.
TL;DR: It is concluded that two litre dialysate causes significant reduction of TLC, VC and FRC, and a reduction in Pa02 and A-a02 but has no effect on airways resistance.
Abstract: There have been many reports showing diminished vital capacity (VC), total lung capacity (TLC), and functional residual capacity (FRC), after the infusion of peritoneal dialysate in patients on continuous ambulatory peritoneal dialysis (C.A.P.D.) for chronic renal failure. We also examined the effects of the infusion of two litres of dialysate on airways resistance (Raw) using total body plethysmography and on arterial blood gasses.
TL;DR: This study identified that subset of patients which might have benefitted from more intensive treatment and analysed their overall survival from diagnosis to assess the prognostic significance of clinical and laboratory features present at diagnosis.
Abstract: 58 patients under the age of 14 years with acute lymphoblastic leukaemia were managed from 1971 to 1985. We analysed their overall survival from diagnosis to assess the prognostic significance of clinical and laboratory features presentatdiagnosis. Factors which were statistically significant included white blood count, platelet count, palpable lymph node enlargement, mediastinal widening on chest x-ray and palpable splenic enlargement The purpose of this study was to identify that subset of patients which might have benefitted from more intensive treatment.
TL;DR: The results of this experimental study suggest that the local toxicity of I.P. chemotherapy may be reduced by the inclusion of a vinca alkaloid group of chemotherapeutic agents, such as cisplatin and bleomycin.
Abstract: Intraperitoneal (I.P.) administration of chemotherapeutic agents, in particular, cisplatin and bleomycin is successfully used in the treatment of ovarian and gastrointestinal malignancies. Their use however, is limited by the rapid development of adhesions. The vinca alkaloid group of chemotherapeutic agents has been shown to impair the acute inflammatory reaction, which plays an important role in adhesion formation, thereby providing the rationale for addition of vindesine to an I.P. regimen containing cisplatin and bleomycin. A rat model was used to study the effects of various I.P. chemotherapeutic regimens on adhesion formation. Four groups were studied (30 rats/Group). Regimens used included Group A (Saline), Group B (Vindesine 0.1 mg/kg), Group C (Cisplatin 5 mg/kg and Bleomycin 0.2 mg/kg), and Group D (Cisplatin 5 mg/kg, Bleomycin 0.2 mg/kg and Vindesine 0.1 mg/kg). In order to grade adhesion formation, animals were sacrificed on days 2, 14 and 28, with the severity of adhesions graded on a scale of I-IV in order of increasing severity. Adhesion formation in Group A (Saline) and Group B (Vindesine) was similar. The addition of Vindesine to Group C (Cisplatin and Bleomycin) resulted in a significant reduction in adhesion formation (p less than 0.01). The results of this experimental study suggest that the local toxicity of I.P. chemotherapy may be reduced by the inclusion of a vinca alkaloid.
TL;DR: The results show that the oral retinoid isotretinoin (13-cis-retinoic acid; Roacentane) is highly effective in clearing acne.
Abstract: The results of treatment of cystic and antibiotic-resistant acne vulgaris in 96 consecutive patients with the oral retinoid isotretinoin (13-cis-retinoic acid; Roacentane) are reported retrospectively. The results show that the drug, while toxic in the short term, is highly effective in clearing acne.
TL;DR: A case of localised Wegener’s granulomatosis presenting with central nervous system symptoms and signs and the diagnosic criteria of the disease are discussed.
Abstract: A case of localised Wegener’s granulomatosis presenting with central nervous system symptoms and signs is described. The difficulties of early diagnosis are highlighted and the diagnosic criteria of the disease are discussed.
TL;DR: One hundred and seventy-two consecutive cases of acute myocardial infarction admitted to a coronary care unit were studied with regard to ventricular arrhythmias - pre-mature ventricular contractions (PVC), ventricular tachycardia (VT) and ventricular fibrillation (VF).
Abstract: One hundred and seventy-two consecutive cases of acute myocardial infarction (MI) admitted to a coronary care unit were studied with regard to ventricular arrhythmias - pre-mature ventricular contractions (PVC), ventricular tachycardia (VT) and ventricular fibrillation (VF). Sixty-seven (39%) patients had ventricular arrhythmias (PCC-VT-VF), of whom 17 (9.8%) had VT and 11 (6.4%) VF. VT and VF, but not total arrhythmias, were more common in anterior infarctions. Fifty-six out of 67 (83.5%) of these patients arrived at Accident & Emergency (A&E) within the first six hours of onset of chest pain. Ten out of 11 (91 %) patients who had VF did so in the first six hours. PVCs were poor predictors of the occurrence of VF (positive predictive value 5.9%). Forty-three patients (84%) who had PVCs did not develop any further arrhythmias.
TL;DR: B19 parvovirus infection is a principal cause of transient bone marrow suppression in patients with chronic haemolytic anaemias and is described in a family of five individuals with hereditary spherocytosis.
Abstract: B19 parvovirus infection is a principal cause of transient bone marrow suppression in patients with chronic haemolytic anaemias. Acute infection is described in a family of five individuals with hereditary spherocytosis; three of them developed marked hypoplastic anaemia.
TL;DR: Of the 44 patients with positive results, 15 were diagnosed as being homozygous for a specific lysosomal enzyme deficiency, 4 were identified as having multiple enzyme deficiencies (mucolipidosis Type II/I-cell disease) and 25 had heterozygote (carrier) enzyme levels.
Abstract: The inherited lysosomal storage diseases are a distinct group of inborn errors of metabolism characterised by deficiencies in specific lysosomal enzymes. As many as 40 such disorders have now been described in man. We have measured the activities of up to 16 lysosomal acid hydrolases in plasma and/or extracts of leucocytes and cultured skin fibroblasts from 198 patients referred from throughout Ireland. These 16 assays allowed the biochemical diagnosis of 20 lysosomal storage diseases. Activities were compared with reference ranges to determine homozygotes and heterozygotes. Of the 44 patients with positive results, 15 were diagnosed as being homozygous for a specific lysosomal enzyme deficiency, 4 were identified as having multiple enzyme deficiencies (mucolipidosis Type II/I-cell disease) and 25 had heterozygote (carrier) enzyme levels. Of the latter, 24 were either parents (obligate heterozygotes) or siblings of homozygotes and one was a heterozygote for the X-linked recessively inherited Fabry's disease.
TL;DR: It is concluded that biopsy for suspected musculoskeletal tumours should not be delegated to junior residents and should be performed in centres that have experience in the management of such tumours.
Abstract: The problems of biopsy procedures and the effect that these had on subsequent surgery were studied in fifty one consecutive patients with musculoskeletal tumours. Difficulties included inadequate tissue for histology in 4 patients, wound infection in 5, haematoma formation in 2, inappropriate biopsy site in 7 and incorrectplacement of drain exit site in 4.
TL;DR: The association between MS and MCH antigens in Northern Ireland in a group of 104 patients is investigated and there is a particularly strong association betweenMS and HLA-DR2, 65.4% compared with 25.5% in 184 controls.
Abstract: Multiple sclerosis has been, shown to be associated with the presence of certain major histocompatibility (MHC) tissue antigens which are coded on chromosome 6. There are racial differences in the antigens associated with MS. The strength of the associations vary in different communities in Western Europe. We have investigated the association between MS and MCH antigens in Northern Ireland in a group of 104 patients. There is a particularly strong association between MS and HLA-DR2, 65.4% compared with 25.5% in 184 controls. A weaker association has been demonstrated with HLA-A3 (44.2% vs 26.5% in controls). There have been conflicting reports concerning an association of HLA-DW2 and HLA-DR2 with a rapidly progressive form of MS. Our data do not support that hypothesis.