James's Hospital Research Articles

Phenytoin and Ranitidine Interaction

Letters15 May 1994Phenytoin and Ranitidine InteractionC. S. Ted Tse, PharmD and Peter Iagmin, MDC. S. Ted Tse, PharmDSt. James Hospital and Health Centers; Chicago Heights, IL 60411Search for more papers by this author and Peter Iagmin, MDSt. James Hospital and Health Centers; Chicago Heights, IL 60411Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-120-10-199405150-00018 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:We report a rare case of elevated phenytoin plasma concentration associated with the concurrent use of ranitidine that persisted for several days after therapy with phenytoin was discontinued but that declined rapidly after ranitidine was withdrawn.A 77-year-old African-American man with a 1-year history of severe stroke and residual right hemiparesis had entered our hospice for a new-onset seizure 4 weeks before this hospitalization. He was treated with phenytoin, 100 mg orally three times daily, and was discharged 1 week later with oral phenytoin suspension, 300 mg three times daily. Ranitidine, 150 mg orally twice daily, was ...

The natural history of HIV infection in women attending a sexually transmitted disease clinic in Dublin.

To determine the progression rates to AIDS in women in Dublin. 109 HIV-1 seropositive women who presented to the Department of Genitourinary Medicine, St. James's Hospital, Dublin, were included in a retrospective analysis. Of these 101 (93%) were intravenous drug users (IVDUs), 7 were heterosexual partners of IVDUs and one had a hetero-sexual partner of no known risk group. Forty-four women (40%) had had 57 children since the time of their first known HIV seropositive test. Progression rates from CDC Stage 11/111 to AIDS are computed. Progression curves are generated according to the Kaplan-Meier method using the Statistical Analysis Software (SAS). The estimated cumulative progression rate at 5 years was 24% (SE 6.6%). 17 out of 109 (15.6%) developed AIDS. The mean follow up time was 2.8 years (SE 0.2). The prevalence of oesophageal candidiasis taking development of AIDS as the point in time was 9 out of 17 (53%), of Mycobacterium hominis infection (TB) 5 (29%) and of Pneumocystis carcinii pneumonia (PCP) 2 (12%). There was no statistical difference in progression rates to AIDS between those women who had children after becoming infected versus those who had none. Progression rates to AIDS in Irish women is higher than reported in other studies of homosexual/bisexual men, but is similar to rates estimated for both male and female IVDUs. Oesophageal candidiasis is the commonest presenting AIDS diagnosis followed by TB, while PCP is rare, contrary to the findings of similar studies in the USA.

Platelet activation in normotensive and hypertensive pregnancies complicated by intrauterine growth retardation.

To study platelet function in normotensive and hypertensive intrauterine growth retardation (IUGR). ADP and collagen induced whole blood platelet aggregation, beta-thromboglobulin release and platelet count were measured in the IUGR groups at a mean gestational age of 36 weeks (28-40), and at 1, 24, 48 h and six weeks post delivery. The normal pregnancy group were studied serially at 12, 20, 28, 32 and 36 weeks of gestation and at 1, 24, 48 h and six weeks post delivery. Trinity College Medical School, St. James's Hospital, Dublin. Twenty-nine women with a fetus with diagnosed IUGR were recruited for the study. Of these, 15 were normotensive throughout their pregnancy and the remaining 14 pregnancies were complicated by both hypertension and proteinuria. Twenty healthy primigravida acted as controls. In the hypertensive IUGR group, levels of collagen and ADP induced aggregation were almost 50% lower before delivery than in normal pregnancy. Platelet count in the hypertensive group was decreased by 30% compared with normal pregnancy. Levels of beta-thromboglobulin were 40 to 50% higher in both the normotensive and hypertensive IUGR groups compared with normal pregnancy. Unlike the hypertensive IUGR group, the normotensive IUGR group showed similar levels of platelet count and ADP and collagen induced aggregation to those found at 36 weeks of normal pregnancy. In the early puerperium of hypertensive pregnancies, the platelet parameters measured returned gradually to normal. The normotensive IUGR group had increased levels of ADP induced aggregation in the first 24 to 48 h post delivery. The platelet count in the normotensive but not the hypertensive group correlated with birthweight. Normotensive and hypertensive IUGR are accompanied by platelet activation. In normotensive IUGR, this activation appears to be confined to the uteroplacental circulation. In hypertensive IUGR, the results suggest that platelet activation also extends into the peripheral circulation resulting in a reduced platelet responsiveness and a lower platelet count. Release of vasoactive amines from activated platelets in the peripheral circulation may be responsible for the clinical syndrome of hypertension and proteinuria present in pregnancies complicated by pre-eclampsia and IUGR but absent in normotensive IUGR.

Clinical value of antenatal fetal pulse oximetry

The aim of this prospective observational study was to see if high quality fetal pulse oximetry signals can be obtained from the fetus before labour. It was carried out in Labour Ward, Clarendon Wing, Leeds General Infirmary and St. James Hospital, Leeds. We studied Caucasian term fetuses antenatally and 20 fetuses during labour. Antenatal fetal oxygen saturation was measured using a sensor passed through the cervix onto the membranes covering the fetus before the onset of labour. The quality of these signals was compared to data obtained from 20 fetuses monitored during active labour after amniotomy. High quality pulse oximetry signals were obtained for less than 1% of the monitoring time before the onset of labour (95% CI 0-2.5%). High quality data was seen 38.6% of the time once the membranes were ruptured and the head descendend into the pelvis. With present technology fetal pulse oximetry will not contribute to antenatal fetal assessment.

COPD and hospice: Collaboration or conflict?

This article describes the struggle between the philosophies of Hospice and Respiratory Care at Saint James Hospital in Pontiac, Illinois. It presents a case study about an end-stage Chronic Obstructive Pulmonary Disease(COPD)patient in the hospice program that catalyzed change. The article shows resolution of the struggles, draws conclusions from the process, and illuminates pertinent issues.

Fatal trauma: A five year review in a Dublin hospital

The autopsy reports and clinical data of 96 patients presenting to St. James's Hospital with trauma of fatal outcome, between January 1, 1986 and December 31, 1990, were analysed. Eighty-one (84%) deaths were due to road traffic accidents and all were the result of blunt trauma. Ninety-five (99%) had an Abbreviated Injury Scale (AIS) score > or = 3 in at least one anatomical category. Cerebral trauma (41%) and shock and haemorrhage secondary to multiple injuries (40%) were the commonest causes of death. Sixty-eight (71%) patients were dead on arrival at the hospital. Of the twenty-eight deaths occurring after admission to hospital nine (32%) were potentially preventable. The mean (sem) Injury Severity Score (ISS) for those with preventable deaths was 24.1 (3.8). These data have implications for the development of trauma care facilities in Ireland.

The spectrum of psoriasis in an Irish HIV population

AbstractObject Report of the pattern of psoriasis and response to therapy in psoriatic patients infected with HIV‐1.Setting Department of Dermatology, St. James's Hospital, DublinSubjects Seven HIV‐positive patients with psoriasis: six seen as part of a prospective dermatological assessment of all HIV‐positive patients; one separately referredObservations Three patients had psoriasis vulgaris which was limited and responsive to conventional therapy; one also had flexural psoriasis which proved difficult to control.Four patients had features of keratodermia blennorrhagicum; their skin disease was severe and warranted systemic treatment in three cases, without adverse affects. However, only one patient fulfilled the complete criteria for Reiter's syndrome.As six of the seven cases occurred in a prospective age‐ and sex‐matched controlled study of skin disease in 92 HIV‐1‐infected patients in which only two controls had psoriasis, it would suggest that there may be an increased prevalence of psoriasis in the HIV‐1 population.

Authors' reply

BJOG: An International Journal of Obstetrics & GynaecologyVolume 100, Issue 8 p. 796-796 Authors' reply J. L. Onwude, J. L. Onwude Department of Obstetrics and Gynaecology St James Hospital LeedsSearch for more papers by this authorJ. G. Thornton, J. G. Thornton Department of Obstetrics and Gynaecology St James Hospital LeedsSearch for more papers by this author J. L. Onwude, J. L. Onwude Department of Obstetrics and Gynaecology St James Hospital LeedsSearch for more papers by this authorJ. G. Thornton, J. G. Thornton Department of Obstetrics and Gynaecology St James Hospital LeedsSearch for more papers by this author First published: August 1993 https://doi.org/10.1111/j.1471-0528.1993.tb14297.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume100, Issue8August 1993Pages 796-796 RelatedInformation

Whole blood platelet aggregation in moderate and severe pre‐eclampsia

To compare whole blood platelet aggregation in moderate and severe pre-eclampsia with normal pregnancy. Whole blood platelet aggregation in response to collagen, ADP, PAF, adrenalin and arachidonic acid was measured in the pre-eclampsia group at 36 weeks gestation and at 1, 24 and 48 h and at five days and six weeks post delivery. The normal pregnancy group were studied serially at 12, 20, 28, 32, and 36 weeks gestation and at 1, 24, 48 h and six weeks post delivery. Trinity College Medical School, St James's Hospital, Dublin. Thirty women with diagnosed pre-eclampsia were recruited for the study. Fifteen of these women had severe pre-eclampsia and the remaining 15 had moderate disease. The pre-eclampsia group were compared with 20 healthy primigravid women with uncomplicated pregnancies and deliveries. In women with severe pre-eclampsia, platelet aggregation in response to collagen, ADP, adrenalin and arachidonic acid was significantly lower at 36 weeks gestation compared with normal pregnancy. Lower levels of collagen induced aggregation were also found at 1 h post delivery when compared with normal pregnancy. Women with moderate pre-eclampsia showed a decreased response to aggregating agents at 36 weeks gestation but this was not significant. ADP, collagen and PAF induced aggregation was higher in women with moderate pre-eclampsia at 36 weeks gestation and during the early puerperium compared with severe pre-eclampsia. The clinical signs of pre-eclampsia are accompanied by a reduction in platelet responsiveness, the extent of which is related to the severity of the disease. This suggests that an abnormal platelet activation occurs early in pregnancies destined to be complicated by pre-eclampsia. This activation may be involved in the pathogenesis of pre-eclampsia since its inhibition using low dose aspirin has been shown to modify the disease in high risk pregnancies.

Use of a Dublin inner city A & E department by patients with known HIV-1 infection.

During the period January 1990 to January 1992 260 patients known to be infected with human immunodeficiency virus type 1 (HIV-1) attended the Accident & Emergency (A & E) Department of St James's Hospital, Dublin. There was a total of 709 visits with a mean annual attendance rate of 2.7, twice that for the general A & E population. Eighty-nine per cent of patients were intravenous drug users (IVDUs), 9% homosexual/bisexual and 2% heterosexual. Known HIV-1 seropositive patients accounted for 0.7% and 0.8% of the total number of patients who attended A & E in 1990 and 1991 respectively. The majority of patients disclosed their HIV status. Bacterial respiratory tract infection was the single most common reason for attending A & E and for admission to hospital. Seventy-two per cent of IVDUs fulfilled Centers of Disease Control (CDC) criteria for stage II and III disease; the majority of these used A & E for primary medical care, although listed with a general practitioner (GP) and attending during the daytime. Sixty-eight per cent of homosexuals/bisexuals were CDC stage IV with AIDS defining illnesses accounting for 52.6% of clinical presentations. Of this risk category, 79% required medical admission. Homosexuals/bisexuals represent more advanced disease, thus the full impact of HIV-1 infection in IVDUs in this A & E setting has yet to be realized.

Audit of psychiatric emergencies in the A & E department of an urban general hospital

AbstractObjectives: To ascertain the frequency and nature of emergencies referred to psychiatrists at the A & E Department of an urban teaching general hospital. Deliberate self-harm and other forms of violence were to be special foci of the study, as was substance abuse, particularly alcohol abuse. Clinical management strategies used by psychiatric emergency staff were also to be assessed. Method: A retrospective audit was made of all of the reports of emergencies written by psychiatric trainees (who were first on call to the A & E) during a six-month period (January-June, 1991). The reports were analysed according to demographic characteristics, main clinical problem, presence or absence of each special focus problem, and also clinical management strategies. Main outcome measures were recorded as percentages of relevant groupings. Mean and median ages were reported as indicated. Results: The 550 emergency psychiatric reports represented 2.2% of A & E attendances. Fifty-two percent were male and 70% were between 15 and 44 years of age. Forty-eight percent resided outside the psychiatric catchment area of St. James's Hospital. Forty-six percent of all psychiatric emergencies required careful assessment of suicidal potential; twenty percent were admitted to inpatient care, 53% were referred to out-patient or day-patient care, 7% to their general practitioner and just 3% to social services. Conclusions: 1. Emergency assessment at the A & E provides a considerable workload for the psychiatric service of an urban general hospital. 2. Careful assessment of suicidal potential still represents an important part of this emergency work. 3. Only 1 in 5 patients were referred on to in-patient care. Undue pressure should not be placed on psychiatric trainees to manage potentially suicidal patients outside hospital. 4. Few referrals were made by psychiatric trainees to general practitioners or to the social services, suggesting that more formal consultant supervision of trainees in this emergency work is warranted.

Thrombolytic therapy in acute myocardial infarction

Members J. H. Horgan (Chairman) Beaumont Hospital. Dr. Peter Crean St. James Hospital, Dublin. Dr. Kieran Daly University College Hospital, Galway. Dr. Will Fannell Regional Hospital, Cork. Dr. Gary Fitzgerald Ardkeen Hospital, Watefford. Dr. Paddy McKieman Wexford County Hospital. Dr. James Mahon St. Lakes Hospital, Kilkenny. Dr. Donal Murray Sligo General Hospital. Dr. Peter Quigley St. Vincent's Hospital, Dublin Conlributor: Dr. R.M. CaliffDuke University Medical Center, Durham, N.C.

News

Nurses from Dublin's St James Hospital at the funeral of Valerie Place, the Irish nurse murdered in Somalia last month. Ms Place was working for the humanitarian organisation Concern.

Irish nurse killed in Somalia.

The murder of Irish nurse Valerie Place, pictured in Baidoa just two hours before she was shot by Somalian gunmen last week, has forced aid workers to take steps to protect themselves in the war- tom East African republic. Valerie, who had been in Somalia since finishing her nurse training at St James Hospital in Dublin last September, worked for the Irish humanitarian organisation Concern, which has 22 other nurses working in the country. Ms Place died when her car came under attack on the road outside Mogadishu. Jack Finucane, Head of Concern's Africa Division, said volunteers would no longer travel by road in Somalia. Nula Corcoran, Principal Tutor at St James Hospital in Dublin, said Valerie was a 'lovely person, with excellent potential'.

Contraceptive practices in HIV seropositive females in Ireland.

A questionnaire was administered to a cohort of 130 HIV seropositive women attending the Department of Genitourinary Medicine, St James's Hospital, Dublin, in order to establish their current contraceptive practices. Forty (42%) of the sexually active women did not use reliable contraception; 55 (57%) used a method reliable in fertility control only, and 21 (22%) used a method reliable in terms of both partner and congenital transmission. The intravenous drug users were less likely to use reliable contraception, 9 (39%), in comparison to the heterosexual group 14 (70%), P < 0.05. The heterosexual group were more likely to use condoms consistently, 7 (35%) in comparison to one (4%) of intravenous drug users, P < 0.02. Nineteen children, 3 borne to heterosexual mothers and 16 borne to intravenous drug-using mothers were HIV seropositive after 18 months.

Increased whole blood platelet aggregation in normal pregnancy can be prevented in vitro by aspirin and dazmegrel (UK38485)

Objective To determine the effect of normal pregnancy and the early puerperium on whole blood platelet aggregation and to assess the role of thromboxane A2 (TXA2) in platelet aggregation in pregnancy. Design A prospective descriptive study. Setting TCD Medical School, St James's Hospital, Dublin. Subjects Twenty healthy primigravidae who remained normotensive during pregnancy and the puerperium. Interventions 20 ml blood samples were obtained serially at 12, 20, 28, 32 and 36 weeks gestation, during established labour and at 1 h, 24 h, 48 h and 6 weeks after delivery. Main outcome measures Whole blood platelet aggregation in response to aggregating agents ADP, PAF (platelet aggregating factor) collagen, adrenaline and arachidonic acid (AA) at each stage of pregnancy and peuerperium was measured using a particle counting technique. The in vitro effect of aspirin and dazmegrel (thromboxane synthetase inhibitor UK38485) on platelet aggregation in pregnancy was also investigated. Results Platelet aggregation in response to collagen, adrenaline, ADP and AA were increased in the last trimester, during labour and at 1 h after delivery but decreased 24–48 h after delivery. Platelet aggregation in response to AA, collagen and adrenalin was reduced by both aspirin and dazmegrel. Conclusions The earliest and most marked increases in platelet aggregation during normal pregnancy were found in response to AA and collagen. These platelet changes were prevented when whole blood was pre-incubated with either aspirin or dazmegrel. This suggests that enhanced production of TXA2 is reponsible for increased platelet reactivity in normal pregnancy.

The impact of HIV disease on an Irish prison population.

Between January 1987 and January 1991, 168 known HIV-infected prisoners have been incarcerated in Dublin's Mountjoy prison. This figure constitutes 16.6% of the total HIV-infected population in the Republic of Ireland over the same period. One hundred and forty-one (84%) of these prisoners have attended the Department of Genitourinary Medicine, St James's Hospital, Dublin. This group displayed considerable morbidity from HIV-related disease. Respiratory tract infection was the most frequent complication seen. Much additional morbidity was directly attributable to intravenous drug use. A survey of a representative group of inmates revealed that 64.7% were diagnosed HIV-positive in prison. The mean length of time spent incarcerated since the diagnosis of HIV infection was 38.9 months. Twenty-nine of 34 individuals who answered a questionnaire were imprisoned for drug-related crimes and 32 of 34 prisoners admitted to parenteral drug use within the prison. As the HIV epidemic unfolds in Dublin, increasing numbers of prisoners with symptomatic HIV disease will spend time incarcerated in Mountjoy prison. This will pose a considerable burden on prison and hospital medical services alike.

Possible upregulation of hypothalamic 5-hydroxytryptamine receptors in patients with postviral fatigue syndrome.

To study the dynamic function of hypothalamic 5-hydroxytryptamine receptors in patients with postviral fatigue syndrome. Prospective comparison of patients with postviral fatigue syndrome with two control groups. Department of neurology, University of Glasgow, Southern General Hospital; department of psychiatry, St James's Hospital, Dublin. 15 patients with postviral fatigue syndrome, 13 age and sex matched healthy subjects, and 13 patients with primary depression. Serum prolactin concentrations before and one, two, and three hours after administration of buspirone. Because of the effects of sex hormones on prolactin secretion data for men and women were analysed separately. There was no significant difference in baseline prolactin concentrations between patients with postviral fatigue syndrome and healthy subjects or those with primary depression. However, the percentage difference between peak and baseline values was significantly higher in patients with postviral fatigue syndrome than the control groups (one way analysis of variance: women, p = 0.003; men, p = 0.004). The results suggest upregulation of hypothalamic 5-hydroxytryptamine receptors in patients with postviral fatigue syndrome but not in those with primary depression. The buspirone challenge test may therefore be useful in distinguishing these two conditions. Larger studies are required to explore the potential value of drugs acting on central 5-hydroxytryptamine receptors in the treatment of patients with the postviral fatigue syndrome.

Increased whole blood platelet aggregation in normal pregnancy can be prevented in vitro by aspirin and dazmegrel (UK38485).

To determine the effect of normal pregnancy and the early puerperium on whole blood platelet aggregation and to assess the role of thromboxane A2 (TXA2) in platelet aggregation in pregnancy. A prospective descriptive study. TCD Medical School, St James's Hospital, Dublin. Twenty healthy primigravidae who remained normotensive during pregnancy and the puerperium. 20 ml blood samples were obtained serially at 12, 20, 28, 32 and 36 weeks gestation, during established labour and at 1 h, 24 h, 48 h and 6 weeks after delivery. Whole blood platelet aggregation in response to aggregating agents ADP, PAF (platelet aggregating factor) collagen, adrenaline and arachidonic acid (AA) at each stage of pregnancy and peuerperium was measured using a particle counting technique. The in vitro effect of aspirin and dazmegrel (thromboxane synthetase inhibitor UK38485) on platelet aggregation in pregnancy was also investigated. Platelet aggregation in response to collagen, adrenaline, ADP and AA were increased in the last trimester, during labour and at 1 h after delivery but decreased 24-48 h after delivery. Platelet aggregation in response to AA, collagen and adrenalin was reduced by both aspirin and dazmegrel. The earliest and most marked increases in platelet aggregation during normal pregnancy were found in response to AA and collagen. These platelet changes were prevented when whole blood was pre-incubated with either aspirin or dazmegrel. This suggests that enhanced production of TXA2 is responsible for increased platelet reactivity in normal pregnancy.

Admissions for HIV-1 Related Disease in a Dublin Hospital 1987–1990

Between January 1987 and December 1990, 179 patients (131 men, 48 women) infected with human immunodeficiency virus type 1 (HIV-1) were admitted 408 times to St James's Hospital, Dublin. One hundred and thirty-two (73.7%) patients were intravenous drug users. The commonest cause of admission was bacterial lower respiratory tract infection (84 patients, 21%). At the time of study 95 (53%) patients fulfilled Centers for Disease Control (CDC) criteria for stage IV disease. HIV antibody status in 26 of these patients with stage IV disease was unknown prior to their admission to hospital with symptomatic disease. Pneumocystis carinii pneumonia was the most frequent stage IV defining diagnosis. The mean length of hospital stay for patients with CDC stage II/III and stage IV disease was 8.5 (median 7) and 13.5 (median 8) days respectively.