Irish Medical Journal

Online ISSN: 0332-3102
Publications
Article
The adoption of a physically active lifestyle is widely believed to be a component of preventive medicine best initiated in childhood. Information on the factors that influence activity behaviour is prerequisite to effective health promotion. Data were collected from a cohort of preadolescent children in 5th and 6th classes of 62 Irish national primary school. 1,602 children were interviewed, 810 girls and 792 boys. Gender differences in recreational activity were significant (p <.0001), and a significant decline was observed in girls' activity from 5th to 6th class (p<.0001). Evidence of social class effect on behaviour was not convincing. In regression analysis, primary PE (B,0.016, 95% CI 0.012 to 0.021, p <.0001). gender (B, -.209, 95% CI -.277 to -.141, p < .0001), sports club membership (B,.201, 95% CI .131 to .272, p < .0001), and social integration status (B, .039, 95% CI .024 to .055, p < .0001) were identified as significant independent predictors of recreational activity. Parental support and physical self-perception were weak predictors. Findings suggest that the primary school plays an important role in the socialisation of children into active lifestyles.
 
Article
Eleven cases of phyllodes tumour were managed at a single institute over 12 years period. All patients were females, the mean age was 48 years, painless breast lump was the commonest presentation, the left breast was affected in (55%), the upper outer quadrant was the most commonly involved site (60%). Four cases were malignant and the remaining 7 were benign. The diagnostic accuracy rate of fine needle aspiration cytology and intraoperative frozen section was 17% and 37.5% respectively. Adequate treatment was wide local excision in benign cases and simple mastectomy in malignant tumour. At a mean follow-up of 37 months the local recurrence and distant metastasis rate was 27% and 9% respectively.
 
Article
A chart review of 112 patients who underwent cold knife conisation was performed. Records showed that 73.5% of the patients smoked cigarettes and 26.5% were using oral contraception. In 85.7% of cases pre-operative cytology/colposcopy findings were within one grade of the cone histology. The majority of lesions were CIN III (59.9%). Only 4.5% were normal. Human papilloma virus infection was detected histologically in 26.8% of patients. Pre-operative punch biopsy was undertaken in only five cases. Post-operative haemorrhage (9.0%) and genito-urinary infection (9.0%) were the main complications seen. The incidence of residual disease and post-cone hysterectomy was significantly higher if the margins of resection of the cone were unclear. Large-loop excision of the transformation zone (LLETZ) has now replaced cold knife conisation in both study centres due to its lower morbidity and reduced demand on hospital resources.
 
Article
Laparoscopic nephrectomy for both benign and malignant diseases of kidney is increasingly being performed. We report our experience with the first 120 consecutive laparoscopic nephrectomy performed in our hospital. It is the retrospective analysis of a prospectively maintained database of 4 years period. The parameters examined included age, gender, indications, operative time, blood loss, intraoperative and post operative complications. Mean age of surgery was 59 years (rang 19-84years). The indications for surgery included solid renal masses (71 patients), non-functioning kidneys (43), and collecting system tumours (6). The mean operating time was 132 minutes (range 75-270), average blood loss was 209 ml (range 0-1090) and average hospital stay was 4.7days (range 2-20). Bleeding, bowel injury and poor progression of laparoscopic procedure were the reasons in 7 (5.8%) cases converted to open surgery. There was 1 (0.8%) perioperative mortality. Eight (6.6%) patients developed post operative complications. Laparoscopic nephrectomy has inherent benefits and may be considered an alternate therapeutic option for kidney diseases with acceptable morbidity
 
Article
The majority of patients with tuberculosis in Ireland are now diagnosed and initially treated in general hospitals. This study, based on 121 consecutive patients with bacteriologically proven tuberculosis in St. Vincent's Hospital, Dublin, 1974-1979, emphasises that the modern profile of tuberculosis may significantly differ from traditional descriptions. Predominant pulmonary disease occurred in 66.1% of cases, while extrapulmonary leisons accounted for the remaining 33.9%. Disease active in more than one organ-site was detected in 11.6% of cases. During the period of this study, the number of smear-negative cases rose progressively from 15.8% to 51.2%. Patients with pulmonary tuberculosis had few classic symptoms (haemoptysis, weight-loss, night-sweats), frequently had complaints of very short duration, and rarely demonstrated physical signs or laboratory investigations classically associated with active disease. Elderly patients contributed disproportionately to the figures - 32.5% of pulmonary patients were over the age of 65. Lower socioeconomic status was associated with a higher prevalence of smear-positive disease and, consequently, with advanced lesions. Other prominent risk-factors included a high prevalence of a family history of tuberculosis (20.9%), immuno-suppressive therapy (9.2%), previous gastrectomy (7.6%) and diabetes mellitus (4.3%). Radiological features were variable, but smear-positive pulmonary disease was associated with more advanced roentgenographic changes such as cavitation or bilateral infiltrates. Tuberculin testing was carried out infrequently and, even when performed, the results were often not recorded. Although the vast majority of smear-positive pulmonary cases were diagnosed quickly, 10% of patients were still undiagnosed after 2 weeks. Scrutiny of initial treatment regimes showed satisfactory orthodox chemotherapy in 84.0%, effective, but 'old-fashioned' regimes in 10.1% and inappropriate therapy in 5.9% of cases. Only a minority of cases (43.4%) required transfer to a sanatorium, and these largely comprised smear-positive pulmonary disease, referred solely because of lack of simple isolation facilities in the general hospital. Of the 7 patients who died, all had pulmonary lesions, and the majority were elderly with smear-negative disease. Only 4 of the 7 fatal cases died directly as a result of their tuberculosis. In only two instances was the diagnosis of tuberculosis confirmed and treatment instituted a significant period before death. Follow-up of patients and contact tracing was performed in many diverse ways and locations, and was fragmented between hospital physicians, general practitioners and public health and community care doctors.
 
Article
This study was undertaken in 1972 to evaluate ICRF 159 adjunctive to cyclical use of four drugs, namely mustine, vibblastine or vincristine (oncovin), procarbazine and prednisone (MVPP or MOPP) in the treatment of the generalised lymphomata and 3 consecutive cases of malignant lymphoma were included. Eleven patients (85%) responded, eight completely and three partially. The period of survival from onset of treatment ranged from three months to 42 montss with a median survival of 36 months. The response related to histology showed that patients with Hodgkin's disease fared best of all.
 
Article
We report the following cases of Duplication (12p) Syndrome. This is a rare entity which may present with developmental delay, dysmorphic features and malformations.
 
Article
Abstract Prevalence of childhood overweight and obesity remains high in Ireland. In this study an intervention conducted within primary care was evaluated. This involved a structured discussion with parents at the 13 month immunisations with their general practitioner (GP), including measuring weight of the toddler and parental education regarding healthy nutrition and physical activity for their toddler. There was a telephone follow-up interview with parents three months later assessing change in toddler diet/lifestyle. Endpoints assessed included parents' reports of specific lifestyle parameters with regard to the toddler and parental assessment of the usefulness of the intervention. 39 toddlers were studied. Most lifestyle parameters had improved at follow up. Reported fruit and vegetable intake of more than 4 portions per day increased from 20.5% of toddlers at baseline 28.6% at follow up. The number of toddlers abstaining from unhealthy snacks increased from 15.4% to 21.4%. Television watching of more than 2 hours daily decreased from 12.8% to 0%. Supervised exercise of more than thirty minutes per day increased from 69.2% to 89.3%. The majority of parents reported at follow up that they found the intervention acceptable (100%, n = 28) and useful (79%, n = 22).
 
Article
We report ten uterine and four extrauterine sarcomas encountered in a twelve month period (1989-90). The seven new cases of uterine sarcomas represent an estimated one third of all cases of malignancy of the corpus uteri, which were diagnosed at the gynaecology departments of St James's and Adelaide hospitals in one year. Overall, the prognosis was poor in the uterine sarcoma group-only one patient in clinically tumour free and five have succumbed to their disease. Delay in diagnosis especially in younger women with fibroid uterus contributed to this outcome.
 
Article
One hundred and forty nine patients underwent thyroid and parathyroid surgery over a nine year period. The most common indications for surgery were the presence of a solitary thyroid nodule (56%) or the onset of pressure symptoms (30%). Carcinoma was found in 7.4% of cases. Wound complications occurred in 5%. The permanent nerve injury rate was 0.67%. The incidence of permanent hypothyroidism after surgery was 4%. No patients developed permanent hypoparathyroidism.
 
Article
The use of 14C-urea breath testing for diagnosis of Helicobacter pylori infection in gastric mucosa has gained widespread acceptance and utilisation. We evaluated a 14C urea breath test (UBT) in 116 patients undergoing endoscopy. Seventy four patients were administered 185 kBq (5 mCi-conventional dose), and 42 patients reduced dose (92.5 IBq, 2.5 mCi) of 14C-urea. All were tested for H. pylori using culture, direct microscopy of gastric biopsies and histological evaluation of paraffin stained sections. Using the mean + three standard deviations as the cut-off value, a sensitivity of 96% and specificity of 100% was found for the conventional dose test. At reduced dose, sensitivity was 100% and specificity 96%. Positive and negative predictive values were 100% and 93% for the conventional dose test, and 96% and 100% for testing at reduced dose. We conclude that the UBT is a simple, non-invasive and useful diagnostic alternative for detection of H. pylori in infected patients. We advocate its use in patients less than 45 years of age without alarm symptoms, and also in cases where the need for endoscopic evaluation is not vital, such as after eradication therapy.
 
Article
A series of 166 groin hernias, repaired over a period of two years, is followed up for five years. The overall incidence of recurrence is 4.3% and 3.3% recurrence for adult first time inguinal hernia and 8% recurrence for adult inguinal hernia which has previously been repaired. There was no recurrence in paediatric inguinal hernia or femoral hernia. There was no peri-operative mortality. Recurrence can be minimised only by the utmost attention to detail and by close supervision of trainee personnel.
 
Article
This study deals with the dietary intakes of a representative sample of Cork city area, school-going children, aged 15-17 years (n=125). Dietary intake was assessed by diet history with published food portion sizes to estimate size. Background data and information on lifestyle were collected by means of a questionnaire. Results indicate that, in general, the study group was reasonably well nourished. However, fat consumption (40%) was higher than the target of <35% for energy intake, for both males and females, and saturated fat intake (15%) was also above the 10% of energy guideline. The percentage of energy derived from carbohydrate (45%) was below the guideline value of 50% for energy intake for males and females. Relatively low iron, calcium and folate intakes were found for females. Smoking was more prevalent among females than males. Alcohol consumption among females was higher than among males. Even though all students participated in some physical activity, less females participated in high activity sport. Based on these results, some concern about the dietary habits and the related health consequences in Cork adolescents appears justified.
 
Article
In the past 17 years neonatal mortality survey has provided important data on the trends in deaths of all live born infants born in Southern Ireland who are greater than 500 g birth weight and who die within the first 28 days of life. The aims of this study were to report neonatal mortality data for Southern Ireland for 2004, to examine trends in neonatal mortality over the past 17 years and compare Irish Neonatal Mortality rates to other countries around the world. The neonatal mortality rate for 2004 was 2.9/1000 with a corrected NMR of 1.9/1000. The response rate to the survey was 100%. Prematurity is now the leading cause of neonatal mortality representing a change from previous years. Deaths related to asphyxia have remained largely unchanged. When compared to international figures Ireland compares favourably to other countries around the world.
 
Article
The number of refugees in Western Europe has risen dramatically. Such an increase poses unique challenges for all health personnel. This paper describes how the Republic of Ireland, a country with little experience of refugees, initially coped with 178 Bosnian refugees. An open-access general practitioner service was combined with a general screening protocol. Patients with significant problems tended to visit GP's, for appropriate treatment, soon after arrival. Of a total of 92 problems diagnosed at screening, general medical (14%), psychiatric (14%) and gynaecological (11%) were the most frequently encountered. Of the 30 problems referred, 80% were referred by a GP. Deficiencies in immunisation and drug history are highlighted. We make recommendations to improve the quality of future initial refugee assessment procedures.
 
Article
We describe the case of an 18 year old lady who presented with chest pain, breathlessness and hypertension. The initial diagnosis of renal artery stenosis, while correct, was incomplete. The finding of a reduced right radial pulse suggested the possibility of a large vessel vasculitis. She was also found to have critical coronary artery disease that required stenting and aortic incompetence. Renal artery stenting was also performed. Additional investigations confirmed Takayasu's arteritis. With immunosuppressive therapy and stenting she is now well and normotensive but may require aortic valve replacement in the future.
 
Article
We report on an 18 month girl who presented having ingested and aspirated a mouthful of Isoparaffin stored in a bottle of mineral water served to her unwittingly by her grandmother. The patient subsequently developed respiratory distress and multiple bilateral lung abscesses.
 
Top-cited authors
Cecily C Kelleher
  • University College Dublin
Gloria Avalos
  • National University of Ireland, Galway
Desmond O'Neill
  • Trinity College Dublin
Fenton Howell
  • Department of Health, Ireland
Michael J Turner
  • University College Dublin