Showing papers in "Irish Journal of Medical Science in 2001"

The effect of the anaesthetic agent isoflurane on the rate of neutrophil apoptosis in vitro.

Abstract: Volatile anaesthetic agents influence neutrophil function, and potentially, the inflammatory response to surgery The objective of this study was to determine the effect of isoflurane (1–4%) on human polymorphonuclear neutrophil apoptosisin vitro Venous blood from 12 healthy volunteers was exposed to 0, 1, and 4% isoflurane delivered via a 14G Wallace flexihub internal jugular cannula, at a fresh gas flow of 051/min for 5 minutes Isolated neutrophils were assessed for apoptosis at 1, 12, and 24 hours in culture using dual staining with annexin V-FITC and propidium iodide (Annexin-V FITC assay) Data were analysed using paired, one-tailed Student’s t-tests p 1% > 0% Human neutrophil apoptosis is inhibited in a concentration-dependent mannerin vitro by isoflurane in clinical concentrations

Predictors of first hip fracture and mortality post fracture in older women

Abstract: Hip fracture causes significant morbidity and mortality in older women. To document factors contributing to the risk of hip fracture in older women and to assess the effect of hip fracture on subsequent mortality. Case-control study of 89 women with hip fracture and 89 controls, with two-year follow-up. Singh index and bone mineral density were calculated. Osteoporotic indices did not differ significantly between cases and controls. Significant predictors of risk were sleeping tablets, perception of health as fair/poor and a lower mental status score. Patients were 3.57 times more likely to die in the first year after fracture, with no difference between the groups in year two. After adjustment, hip fracture did not remain significantly associated with mortality. Inability to walk 100 yards alone prior to fracture and lower social class were significantly associated with mortality at 12 months. Age alone was significantly associated at 12–24 months. Factors related to falls and fracture may be more discriminatory predictors of hip fracture risk than osteoporosis in older females. Medications for sleep should be prescribed with caution. Hip fracture may have an independent effect on one year mortality, this effect is not seen in the second year.

Clinical outcome after acquisition of Burkholderia cepacia in patients with cystic fibrosis.

Abstract: Respiratory disease is the major cause of morbidity and mortality in cystic fibrosis (CF). The significance ofBurkholderia cepacia (B. cepacia) in the pathogenesis of lung disease in CF is debated, but its exact role remains unclear. To assess the impact of respiratory tract colonisation withB. cepacia in patients with CF by measuring changes in pulmonary function and body mass index (BMI). Three groups of patients were defined based on sputum culture isolates: Group 1 wereB. cepacia andPseudomonas aeruginosa (P. aeruginosa) positive patients; Group 2 wereP. aeruginosa positive; and Group 3 were colonised with neither organism. Forced expiratory volume (FEV1) and BMI were measured annually from 1987 to 1995 and the year of acquisition ofP. aeruginosa orB. cepacia was recorded. The mean annual decrease in FEV1 was significantly different in all three groups: Group 1, −5.4 (5.1)%; Group 2, −3.9 (6.5)%; and Group 3, −1.6 (1.0)%, (p<0.05). The mean percentage decrease in FEV1 of a sub-group of Group 1 patients where theB. cepacia acquisition date was known was 6.1% per year versus 1.55% in Group 2 patients (p<0.05). Acquisition ofB. cepacia may be a cause of, rather than a marker for, a decrease in pulmonary function.

Where do patients with cancer die in Belfast

Abstract: Background Most patients with cancer prefer to die at home but the majority die in institutions.

Exploration of the acute scrotum: a retrospective analysis of 100 consecutive cases

Abstract: Background Acute scrotal pain is a common urological emergency. Urgent exploration is the standard means of management, as no investigation can confidently exclude torsion of testis from the differential diagnoses. In our department, all patients up to the age of 40 years, presenting with acute scrotal pain undergo emergency scrotal exploration.

Blood-borne infections in Dublin’s opiate users

Abstract: Injecting drug users are at high risk of acquiring blood-borne infections. Ireland has had a harm reduction policy of methadone maintenance and needle exchange since 1992. The aim of this paper is to estimate prevalence of hepatitis B, hepatitis C and HIV infection and appropriate uptake of hepatitis B vaccine in methadone attendees and to make recommendations for a simple record-based surveillance system. The study involves a retrospective study of 138 client records for evidence of laboratory tests or test results for blood-borne viruses and appropriate immunisation against hepatitis B. A total of 60% of clients had evidence of one or more laboratory tests in their notes. Of those tested for individual viruses, 5.1% were positive for hepatitis B surface antigen, 78.8% had antibodies to hepatitis C and 16.7% were HIV positive. Nearly two-thirds of clients had no evidence of vaccination or information on prior immunity in their records. The authors concluded that a standardised written protocol for screening for blood-borne viruses and for immunisation against hepatitis B in methadone service attendees was clearly needed, and was subsequently introduced by the Eastern Region Health Authority.

Molecular genotyping of human cryptosporidiosis in Northern Ireland: epidemiological aspects and review.

Abstract: Background Cryptosporidium parvum is the most common of the protozoal pathogens associated with gastrointestinal disease in Northern Ireland Genotyping techniques are valuable in helping to elucidate sources and modes of transmission of this parasite There have been no reports on the prevalence of genotypes in Northern Ireland, mainly due to a lack of discriminatory genotyping techniques, which recently have become available

Diagnostic and therapeutic ERCP: a large single centre's experience.

Abstract: Most large published series on endoscopic retrograde cholangiopancreatography (ERCP) are multicentrebased and consequently reflect varying experience. To assess morbidity and mortality rates of ERCP in a single tertiary referral centre. A series of 1,758 consecutive ERCPs performed in 1,148 patients between 1991 and 1994 were reviewed to evaluate indications, findings, procedures, success, complication and mortality rates. There were 1,108 (63%) successful initial ERCPs, 11% failed cannulation attempts and 26% follow-up ERCPs. The desired duct was successfully cannulated in 96.5% of cases. Initial cannulation failure rate was 8.8%. Twenty-seven per cent had normal ERCPs, 30% had choledocholithiasis and 22% had strictures. Fifty-five per cent had therapeutic ERCPs. Major complications occurred in 3.5% with four ERCP-related deaths (0.35%). Therapeutic ERCP had a higher incidence of major complications compared to diagnostic ERCP: 4.6% vs 2.1%, (p=0.02); and mortality rate was 0.5% vs 0.2%, (p=0.4). Significant haemorrhage secondary to biliary sphincterotomy, pre-cut papillotomy and snare papillectomy accounted for most of the difference (1.6%). The majority of ERCPs were performed in elderly patients, over half of whom required therapeutic ERCP. Therapeutic ERCP carried significantly higher complication rate compared with diagnostic ERCP. Unsuccessful cannulation and follow-up ERCP accounted for 11% and 26% of ERCP workload, respectively.

Exercise and osteoporosis

Abstract: Osteoporosis is a systemic skeletal disease characterised by low bone density and micro architectural deterioration of bone tissue with a consequent increase in bone fragility and susceptibility to fracture. It is a silent disease. It is the result of the negative balance between bone formation and bone resorption, i.e. more bone is lost than is formed. It is the most common bone disease worldwide and is now a major health problem. Bones require a normal level of systemic hormones, adequate caloric intake, particularly protein, calcium and vitamin D and regular weight-bearing exercise throughout life. A large bone mass early in life protects against osteoporosis. Peak bone mass is determined by sex, heredity family history, race, diet and exercise. Sixty per cent of bone growth occurs during adolescence. Moderate exercise protects against osteoporosis, but too little or excessive exercise may cause osteoporosis.

Hepatic abscesses in elderly patients mimicking metastatic disease.

Abstract: Background There is considerable overlap between the clinical presentation and radiological appearances of hepatic abscesses and hepatic metastases. The distinction is important given the treatable nature of hepatic abscesses compared with most forms of metastatic disease and the very high morbidity and mortality associated with untreated or missed pyogenic abscesses.

Cardiac rehabilitation service provision in Ireland: the Irish Association of Cardiac Rehabilitation survey.

Abstract: The first national survey of cardiac rehabilitation services was conducted. To establish levels of service provision, service formats, and geographic distribution of cardiac rehabilitation services in 1998. Public hospitals in the Republic (n=41) and Northern Ireland (n=12) which provide services to cardiac patients were surveyed. Response rate was 81%. Twelve centres (29%) in the Republic and nine (75%) in Northern Ireland provided cardiac rehabilitation. There was wide geographic variability in service provision. Most centres were unable to identify-the proportion of eligible patient participation. Most programmes were established for less than five years. All programmes had multidisciplinary teams, multicomponent courses and co-ordihators. Additionally, 44% of hospitats without programmes had plans regarding programme establishment. The findings highlight the underdeveloped but rapidly expanding nature of cardiac rehabilitation services in Ireland. They provide a baseline from which to address rehabilitation needs and to judge the success of the National Cardiovascular Health Strategy in addressing these needs.

Safety guidelines for radiolocalised sentinel node resection.

Abstract: Sentinel node radiolocalisation procedures are associated with low levels of radiation exposure. Radioactive material is present in the operating theatre and pathology laboratory. In most hospitals there are no official regulations in place for sentinel node radiation exposure. To establish guidelines on the safety of sentinel node mapping with emphasis on the management of radioisotopes. The current literature regarding sentinel node procedures and radiation safety was reviewed. EU and US radiation safety regulations were scrutinised. Personnel involved in sentinel node procedures are exposed to low levels of radiation. These levels are not high enough to require designated radiation workers in the theatre and pathology laboratory. Awareness of radiation safety and certain precautions during the procedure and processing of the specimen can further reduce levels of exposure. Although low levels of radiation exposure are associated with sentinel node procedures, awareness of radiation safety and adherence to regulations, along with close interdepartmental co-operation, are recommended for further reduction in radiation exposure and safe application of this technique.

Outcome of infants born to hepatitis C infected women

Abstract: Hepatitis C virus (HCV) can be transmitted vertically from mother to infant, either late in pregnancy or at delivery. To determine the outcome of infants bom to HCV infected women, to characterise epidemiology and to design an appropriate infant monitoring schedule. Three hundred and fourteen infants, born to 296 HCV positive women between 1994 and 1999 were monitored for a median of 18 months (range 1–52). Forty per cent of infants were small for age and 46% had neonatal abstinence syndrome (NAS). Of 173 infants of delned status, 11 were infected (vertical transmission rate [VTR] 6.4%, 95% CI 2.8–10). Infected infants were diagnosed at a median of three months (range 0.5–10). Liver transaminases elevation was documented in 8% of uninfected infants. A negative HCV PCR test before one month of age did not exclude infection but all infected patients had detectable HCV RNA when next tested (range 2–10 months). 94% of infants bom to HCV antibody positive women are not HIV infected. Liver transaminase elevation in exposed infants is not always indicative of infection. A minimum monitoring schedule of testing (PCR and antibody) at six to eight weeks, six and 18 months allows early diagnosis while detecting late seroconversions.

Opiate-related deaths in Dublin.

Abstract: In Ireland Intravenous drug misuse, principally heroin, occurs primarily in the Greater Dublin area. Methadone maintenance treatment has been an important part of the response to opiate misuse in Dublin since 1992. The aims of this study were to determine the number of opiate-related deaths in Dublin city and county during 1999, to establish the number of methadone-related deaths and to determine the proportion of these deaths associated with methadone prescribed according to guidelines. A retrospective review of all coroners' inquest files in Dublin city and county during 1999 was undertaken. A total of 84 opioid-related deaths were recorded. Seventy eight ( 92.9%) of opioid related deaths were male. Seventy three (86.9%) had two or more drugs identified toxicologically. There were 45 methadone related deaths, of which 15 (33.3%) were receiving methadone prescribed according to guidelines. It is concluded that opiate-related deaths occur primarily in males in the 25-34 year age group and are associated with a high level of polydrug use. Diverted methadone accounted for the majority of deaths involving methadone.

The role of apoptotic cell death in cardiovascular disease.

Abstract: Programmed cell death, or apoptesis, is a distinct, managed form of cell death. It is fundamentally different from necrosis. It is a genetically controlled, energy-dependent method of cellular deletion without inflammation. In the cardiovascular system, apoptosis occurs as a primary and secondary event in disease pathogenesis. This review addresses our current understanding of the initiation, propagation and significance of apoptosis in the cardiovascular system, as well as assessing therapeutic potentials arising therefrom. A Medline search was performed and relevant publications reviewed. Further articles were obtained from the references of these publications. Apoptotic cell death is a key element in the pathogenesis and progression of ischaemia-reperfusion (IR) injury, cardiac failure, myocardial infarction, atherosclerosis, endothelial dysfunction and the clinical syndromes which these situations produce. Our increased understanding of the role of apoptosis in the pathogenesis of cardiovascular disease offers potential to develop new therapeutic strategies.

Day case laparoscopic cholecystectomy is feasible.

Abstract: Laparoscopic cholecystectomy is the operation of choice for cholelithiasis. The aims of our study were to assess the feasibility of day case laparoscopic cholecystectomy (DCLC) in selected patients. DCLC was introduced in this unit in July 1999, The first 50 patients were prospectively evaluated up to February 2001. All patients were under 55 years of age with an ASA grade of I (n=48) or II (n=2). The mean age was 41.1 years (range 20–55 years) and the male:female ratio was 1:6. All patients had a standard anaesthetic protocol. Patients were discharged 10 to 12 hours postoperatively with a pro forma, which was reviewed at one week in the clinic, The conversion rate was 2%. Three required overnight admission due to excessive nausea, hypertension and for an unforeseen psychosocial problem. Ninety per cent of patients were suitable for same day discharge. No patient required subsequent readmission. DCLC is feasible and safe in carefully selected patients and has the advantages of convenience and cost-effectiveness.

Soluble adhesion molecules in inflammatory bowel disease.

Abstract: Soluble adhesion molecules are elevated in a number of inflammatory conditions. To investigate the correlation of soluble intercellular adhesion molecule-1 (sICAM-1) and sE-selectin with the activity of inflammatory bowel disease (IBD). sICAM-1 and sE-selectin were measured by an enzyme-linked immunosorbent assay (ELISA) in 53 patients with ulcerative colitis (UC) and 38 patients with Crohn’s disease (CD). Patients with active UC and CD had significantly higher sICAM-1 than patients with inactive disease and controls. Paients with pancolitis had significantly higher levels than patients with distal colitis. There was a significant difference in sE-selectin levels between paients with acive CD and control sICAM-1. sE-seiectin did not correlate with the Harvey Bradshaw index (HBI). C-reactive protein (CRP) and microalbuminuria were better markers than sICAM-1 or sE-selectin which correlated with serum tumour necrosis factor (TNF)-α. sICAM-1 and sE-selecin are elevated in the serum of paients with IBD but CRP and microalbuminuria reflect clinical disease activity more accurately. This study does not support the routine use of soluble adhesion molecules as disease activity markers in IBD.

Prognostic implications of p53 and bcl-2 expression in 108 women with stage two breast cancer.

Abstract: Background The mortality and morbidity of patients with breast cancer can vary even between individuals with similar histological stage at diagnosis. Identification of those individuals with prognostically poorer tumours is an essential prerequisite in planning adjuvant therapies. Some prognostic indices of tumour size, grade, oestrogen receptor status and nodal status are well established.

Deliberate self-poisoning in an Irish county hospital.

Abstract: Background In 1997, 433 people committed suicide in Ireland, one-quarter of whom were less than 24 years of age,

The increasing prevalence of childhood sickle-cell disease in Ireland

Abstract: Ireland has been relatively free of sickle-cell disease (SCD) and a care policy for the disease has not been established. To determine the prevalence of childhood SCD in Ireland and to predict requirements for a comprehensive care and assessment programme. We retrospectively analysed the data of children with SCD presenting with sickle-cell crisis to one institution from January 1999 to April 2001. We also determined the nature and severity of the presenting haemoglobinopathy phenotype. Ninety-two patients with haemoglobinopathy have been registered with the Paediatric Haematology Service. The majority are from Nigeria with a smaller number from Angola and the Congo. Sixty have sickle-cell trait, 23 SCD, four haemoglobin SC disease and two haemoglobin E (HbE). There have been 32 sickle-cell crises. The majority were haemolytic or splenic sequestration events with a smaller number of aplastic and vaso-occlusive events and one osteomyelitis. The increasing number of children presenting with SCD as a result of the increasing refugee numbers requires a comprehensive care approach similar to that required for paediatric haemophilia to ensure optimum care.

The sinister significance of dysphagia.

Abstract: There is evident need of an oesophageal cancer awareness programme if prognosis is to be improved.

The future of paediatric surgery outside specialist paediatric hospitals.

Abstract: In Ireland, general surgeons provide paediatric surgical services to patients remote from specialist paediatric units. To review general paediatric surgical services in the Mid-Western Health Board (MWHB) region with a view to informing future policy decisions in Ireland. From 1995 to 2000, the paediatric surgical workload at the Mid-Western Regional Hospital was reviewed. Operations performed, level of operating surgeon, morbidity and mortality were recorded. There were 3,166 general paediatric surgical patients cared for by three general surgeons and one urologist, all with paediatric surgical training. There was an increase in day cases (55% to 70%) and operations at which the consultant was the main operator (40% to 67%). There was no mortality and the morbidity rate was less than 1%. General paediatric surgery and urology is well provided for in the MWHB by appropriately trained surgeons. Lack of opportunity for surgeons in training to obtain general paediatric surgical experience will put this service at risk as the current cohort of surgeons retire. Expansion in specialist paediatric surgical services, changes in general surgical training to include general paediatric surgery or proleptic appointments may be required.

Ingested foreign bodies in the paediatric patient.

Abstract: Background Paediatric foreign body (FB) ingestion is a common problem and while most can be managed conservatively, a sub-population require intervention.

Electrogastrography: a non-invasive measurement of gastric function.

Abstract: Electrogastrography (EGG) is the non-invasive measurement of gastric electrical activity. With the development of modern technology, improved recording and automated analysis, it is a reliable and accurate technique for the measurement of gastric myoelectrical activity providing information about the frequency and regularity of the gastric slow wave. The aim of this report is to evaluate its role in clinical practice. The literature is reviewed and its role investigated. EGG has been successfully used in the investigation of gastroparesis, non-ulcer dyspepsia (NUD), gastric emptying (GE) disorders and diabetes mellitus (DM). EGG also provides an insight into the effect of medications on gastric function, e.g. edrophonium, cisapride, erythromycin and proton-pump inhibitors (PPI). EGG has a developing role in the assessment of gastric dysfunction and on the effect of medical treatment. The effect of surgery and anaesthesia on gastric myoelectric activity is less clear.

The research abstract: worth getting it right

Abstract: Scientific merit and clarity are critical in evaluation of quality in research. We hypothesised that avoidable errors of presentation adversely impact on abstract selection for scientific meetings. To prospectively evaluate compliance with abstract guidelines among abstracts submitted to a national surgical scientific meeting. Compliance of all submitted abstracts with 13 instructions to authors was compared using ANOVA and Chi-squared tests. Results are expressed as mean (standard deviation, range). Of 45 abstracts submitted, only 8 (17%) complied with all guidelines. Rejected abstracts were less concise than accepted abstracts (280.5 ± 73.8 words vs. 244.2 ± 42.5; p=0.006) and were more likely to be rejected (χ2 = 8.67, 1 df, p<0.05). There was no significant difference between the number of errors in accepted (1.6 [1.43, 0–4]) versus rejected (2.4 [1.87, 0–7], ANOVA; p=0.217) abstracts. All late submissions (30%) were rejected. Nine abstracts (20%) contained statistical errors or omissions. Succinct presentation may reflect clarity of focus or increased writing experience. Reviewers favour concise abstracts. Concise presentation and timely submission are easily achieved and increase the likelihood of research acceptance for scientific meetings.

Views of Irish general practitioners on screening for cervical cancer.

Abstract: Background A national cervical screening programme is being established in Ireland and there is little information on the level of resources required.