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Biomedical subjects

M Connolly

Publications and source records attributed to M Connolly.

At least 91 records · Page 5Linked to original sources
PubMed1989

Etiologic factors in renovascular fibromuscular dysplasia. A case-control study.

The role of several factors that have been suggested as being of etiologic importance in renovascular fibromuscular dysplasia was examined in a case-control study of 33 patients with angiographically demonstrated fibromuscular dysplasia and 61 renal transplant donor control subjects with normal renal arteries. The factors studied included use of oral contraceptive agents or markers of sex hormone dysfunction, mechanical stress to the renal artery wall, human lymphocytic antigen (HLA) type, cigarette smoking, history of hypertension for more than 5 years, and family history of cardiovascular disease. The risk of fibromuscular dysplasia was significantly (p = 0.003) increased (odds ratio = 4.1, 95% confidence interval = 1.5-10.9) among cigarette smokers. A significant (p less than 0.001) dose-response relation was noted between cigarette use and the risk of fibromuscular dysplasia developing (odds ratio = 8.6 for those who had smoked more than 10 pack-years). Personal history of hypertension more than 5 years was also associated (odds ratio = 5.0, 95% confidence interval = 1.1-22.8) with a significantly (p = 0.036) increased risk for the development of fibromuscular dysplasia. HLA-DRw6 antigen was more common in the 33 fibromuscular dysplasia patients than in the 61 renal transplant donor control subjects (odds ratio = 3.00, p = 0.067) or a second group of 934 ambulatory control subjects (odds ratio = 2.51, p = 0.031). Adjustment for cigarette smoking increased the odds ratio to 5.0 (95% confidence interval = 1.3-19.6). There was a positive though not statistically significant (odds ratio = 1.7, p = 0.175) association noted between family history of cardiovascular disease and fibromuscular dysplasia.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Chemotherapy, radiation therapy, and resection for carcinoma of the esophagus. Long-term results.

From May 1980 to May 1984, preoperative chemotherapy (mitomycin C and 5-fluorouracil) was added to radiation therapy in patients with potentially operable squamous cell carcinoma of the esophagus. Of 129 patients observed, 122 were followed up until death or to the present. Only 33 were able to complete preoperative chemotherapy and radiation and undergo resection. There were 28 men and five women, their ages ranging from 42 to 81 years (average 60 years). There were 22 black and 11 white patients. The location of the tumor was in the middle third in 70% of the patients. Among the 33 patients, the clinical TNM classification was as follows: T1 N0 M0, three patients; T2 N0 M0, 27 patients; T2 N1 M0, two patients; and T3 N0 M0, one patient. The length of the lesions when measurable in the absence of complete obstruction varied from 3 to 17 cm (average 7 cm). The operative mortality rate in this group was 12% (4/33). There was no viable residual tumor in the surgical specimen of the esophagus in 33% (11/33) of those patients completing triple therapy. However, in two of the 11 patients, left gastric nodes contained tumor and in one there was a minute esophageal perforation. The 2-year survival rate was 33% (11/33), and the 5-year survival rate was 15.4% (5/33). Among the 11 patients having 2-year survival, the surgical specimen was normal in six and abnormal in five. Of the five patients having 5-year survival, the surgical specimen was normal in three and abnormal in two. The absence of tumor in the surgical specimen did not appear to confer any better chance for long-term survival. Data were compared to our 1967-1975 series of 75 patients receiving only preoperative radiation and resection. There was no significant difference in survival rates at 2 years (20% [1975] versus 33% [1984], p = 0.2118) or at 5 years (10% [1975] versus 15.4% [1984], p = 0.5796). The addition of preoperative chemotherapy as an adjunct did not result in a statistically significant increase in 2-year or 5-year survival rates.

Adenocarcinoma↗
PubMed1989

Cost of neonatal intensive and special care.

A detailed costing of neonatal intensive and special care was made for the year 1986 at the Rotunda Hospital. Cost was expressed at 1986 prices in punts. There was 1,364 admissions including external transfers giving a total of 10,086 bed days, divided into 1,044 intensive care and 9,042 special care bed days. The total cost of intensive and special care was 1,342,500 pounds. Costs per inpatient day were 288 pounds for intensive and 115 pounds for special care. Sixty percent of the intensive care bed days were used by infants weighting less than 1,500 g birth weight and 93% by infants less than 2,500 g birth weight; this emphasizes the effect of population mix on resource use. The average cost of intensive care survivors by birth weight were: less than 1,000 g - 16,226 pounds (8,052 pounds-23,535 pounds); 1,000 g-1,499 g - 13,412 pounds (1,898 pounds-22,456 pounds); 1,500 g-2,499 g - 8,864 pounds (633 pounds-17,666 pounds); 2,500 g + - 5,123 pounds (384 pounds-12,636 pounds). The average cost of all admissions to special or intensive care was 984.24 pounds. Using this figure (984.24 pounds) and assuming that 13% of all births in 1986 required special or intensive care the total health care expenditure on neonatal special or intensive care in 1986 amounts to 8.03 million pounds of a total Department of Health budget of 1,269 million pounds. By allocating infants to the currently used neonatal diagnostic related groupings (DRGs) and assigning costs at 1987 US reimbursement levels, the total cost to the Rotunda would be 1,878,750 pounds punts. The current level of DRGs derived from the reimbursement rates in the United States which is insufficient to meet the actual cost incurred there, is 40% greater than current total funding of neonatal intensive and special care in the Rotunda. Current funding levels in the United Kingdom are 13% to 80% greater than in the Rotunda.

Costs and Cost Analysis↗
PubMed1988

Reversal of histamine-induced bronchoconstriction by the H1-receptor antagonist levocabastine: a potential model for efficacy in anaphylaxis.

1. The rate of onset and magnitude of the effect of levocabastine, a potent H1-receptor antagonist, in reversing histamine-induced bronchoconstriction were determined in a double-blind cross-over trial against saline placebo. Histamine was administered by nebuliser so that forced expiratory volume in 1 second (FEV1) was reduced to 80-75% of baseline FEV1 in 10 men with mildly or moderately responsive airways and the effects of intravenous injection of saline or saline + 200 micrograms levocabastine were studied. 2. The maximum rate of recovery of FEV1 was 7[2-10]% min-1 (median [range]) in the first 5 min after levocabastine injection, but only 4[1-7]% min-1 after saline alone (P less than 0.05). 3. The median area under the recovery curve of FEV1 from 0 to 30 min after injection was 405 [228-498]% basal FEV1 X min after levocabastine and 301[98-502]% basal FEV1 X min after saline alone (P less than 0.002). 4. FEV1 returned to 90% of baseline within 30 min in all subjects after levocabastine, but not after saline alone (P less than 0.002). 5. Histamine-induced bronchoconstriction was relieved more quickly by levocabastine than saline alone. This model may have application to the study of drugs used in the treatment of anaphylaxis.

Adult↗
PubMed1987

Educational program on evaluation of alleged sexual abuse victims.

Increased awareness of the problem of child sexual abuse has resulted in increasing numbers of children presenting to professionals for the evaluation of possible sexual victimization. A multidisciplinary project to develop professionals' knowledge and skills in the identification and evaluation of possible victims is described. The program focused on the child as a victim and emphasized developmental perspectives with regard to identification, interviewing children, the medical examination, and children in the legal system. Fifty-one medical and social work professionals from ten Indiana counties attended the program and responded to questionnaires about their experience and knowledge. Of 40 (78%) respondents, 63% had had no previous training in the medical evaluation for child sexual abuse. Child protective workers referred alleged victims primarily to the child's regular physician (37%) or emergency room (31%) for medical examination. Knowledge about child sexual abuse improved significantly at two weeks postsymposium (p = .001) and remained improved at six months postsymposium (p less than .02). These original participants have subsequently organized similar multidisciplinary programs in their local communities for medical, social, law enforcement, and legal professionals; thus, they have been "seeds" for further educational and cooperative efforts throughout the state.

Adult↗
PubMed1986

An outbreak of tuberculosis in a children's hospital.

A 3-year-old girl was admitted to a children's hospital; subsequently her mother was found to have pulmonary tuberculosis with smear-positive sputum. Of over 400 patients, their families and staff at risk in the hospital, 30 inpatients, three outpatients, two sibling visitors and one staff member became infected. A retrospective cohort study of exposed inpatients identified exposure duration, exposure proximity and primary diagnosis as independent predictors of infection risk. Children with neoplastic disease who were being treated with cytotoxic and immunosuppressive therapy with clotting factors were at a greater risk of developing clinical disease including disseminated infection. Altogether three generations of infected children and adults were diagnosed amongst community and hospital contacts in this extended outbreak. These findings support current recommendations for the follow-up of highly susceptible casual contacts of cases of pulmonary tuberculosis with smear-positive sputa.

Adult↗
PubMed1986

Prevention of reperfusion injury of the ischemic spinal cord: use of recombinant superoxide dismutase.

We investigated the effect of recombinant superoxide dismutase, an oxygen free radical scavenger, on the prevention of reperfusion injury of the ischemic spinal cord. Somatosensory evoked potentials (SEPs) were obtained in 23 dogs. Spinal cord ischemia was produced by cross-clamping the descending thoracic aorta just distal to the origin of the left subclavian artery through a left thoracotomy. Mean proximal aortic blood pressure was maintained between 90 and 100 mm Hg by partial exsanguination. Serial SEPs were obtained at 60-second intervals until the SEP disappeared. Aortic cross-clamping was continued for 10 additional minutes after the disappearance of the SEP. In Group 1 (N = 8), no medication was given when the aortic cross-clamp was removed. In Group 2 (N = 8), a bolus of 25,000 units of superoxide dismutase was injected into the proximal aorta prior to removal of the aortic cross-clamp, and was followed by 5,000 units per minute for 10 minutes after release of the cross-clamp. In Group 3 (N = 7), 50,000 units of superoxide dismutase was administered as a bolus prior to removal of the aortic cross-clamp, followed by an additional 10,000 units per minute for 10 minutes as in Group 2. The postoperative neurological status was assessed by Tarlov's criteria. There was no significant difference in aortic cross-clamp time among the three groups. Paraplegia developed in 4 animals in Group 1; the remaining 4 dogs had paraparesis. In Group 2, paraparesis developed in 2 of 8 dogs; the other 6 had no neurological injury. All the animals in Group 3 had complete recovery.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1986

Strategy for treatment of acute evolving myocardial infarction with pulsatile left heart assist device. Can this modality increase survival and enhance myocardial salvage?

This article describes the technique of left heart bypass in the treatment of both experimental and clinical acute myocardial infarction. A new technique of closed-chest percutaneous left heart bypass that can be used in patients with acute evolving myocardial infarction and cardiogenic shock is also described.

Acute Disease↗
PubMed1985

Prediction of recurrence in incompletely excised basal cell carcinoma.

This 5-year prospective study evaluated histologic criteria as predictors of tumor recurrence for the individual with a "positive-margin" basal cell carcinoma. The results demonstrated that 93 percent of patients with greater than 75 percent of their tumor cords containing irregularities in in the peripheral palisade had tumor recurrence, while no patient with less than 25 percent of their tumor cords containing irregularities in the peripheral palisade developed a recurrence in 5 years of follow-up. After statistical analysis for the other histologic variables, the presence of greater than 75 percent irregularities in the peripheral palisade conferred a 39-fold increased risk of tumor recurrence, significant at the p much less than 0.001 level. For the patient in the intermediate group (25 to 75 percent irregularities in the peripheral palisade), the presence of a weak host response (absent to minimal infiltration of small lymphocytes) increased the risk of tumor recurrence fourfold, with this effect being significant at the p less than 0.05 level. The presence of tumor ulceration conferred a 2.8-fold increased risk for tumor recurrence, significant at the p less than 0.01 level, while the presence of squamous differentiation conferred no increased risk. This study may provide a valid basis for predicting tumor recurrence in the individual with a positive-margin basal cell carcinoma.

Adult↗
PubMed1985

The complete pattern of ocular dominance stripes in the striate cortex and visual field of the macaque monkey.

Ocular dominance stripes in the striate cortex of a macaque monkey were labeled by autoradiography after injection of [3H]proline into one eye. The stripes were reconstructed on a representation of the flattened cortical surface by two independent techniques: one used computer graphics, and the other was the manual unfolding procedure of Van Essen and Maunsell (VanEssen, D. C., and J. H. R. Maunsell (1980) J. Comp. Neurol. 191: 255-281). The two reconstructions differed in many details of the pattern but were in agreement on its general features. As described in earlier studies, the stripes formed a system of parallel bands, with numerous branches and islands. They were roughly orthogonal to the V1/V2 border throughout the binocular segment of the cortex. In the lateral part of the operculum, where the fovea is represented, the stripes were less orderly than elsewhere. In the calcarine fissure the stripes ran directly across the striate cortex from its dorsal to its ventral margin. In the far periphery the stripes for the ipsilateral eye became progressively narrower, eventually fragmenting into small islands at the edge of the monocular segment. The overall periodicity (width of a left- plus right-eye pair of stripes) averaged 0.88 mm but decreased by a factor of about 2 from center to periphery. This decrease was not accounted for solely by shrinkage of the ipsilateral eye stripes. The flattened cortical reconstruction was transformed back into visual field coordinates, using information about visual field topography obtained from the detailed mapping study of Van Essen et al. (Van Essen, D.C., W.T. Newsome, and J.H.R. Maunsell (1984) Vision Res. 24: 429-448), as well as from more limited mapping done in the same monkey that was used for the reconstruction. In the transformed map, the stripes increased in width about 40-fold from the fovea to the far periphery. As deduced previously (LeVay, S., D. H. Hubel, and T. N. Wiesel (1975) J. Comp. Neurol. 159: 559-576; Hubel, D. H., and D. C., Freeman (1977) Brain Res. 122: 336-343), there were portions of the map in which the stripes followed curves approximating isoeccentricity lines, but this relationship was not very exact or consistent. The pattern of stripes appears to be more meaningfully related to the geometry of the cortical surface. This has significant implications for understanding the developmental mechanisms involved in stripe formation.

Animals↗
PubMed1984

The representation of the visual field in parvicellular and magnocellular layers of the lateral geniculate nucleus in the macaque monkey.

Two-dimensional maps of individual layers of the dorsal lateral geniculate nucleus (LGN) in the macaque monkey were constructed and used as a basis for comparing laminar size, shape, and topographic organization. Topographical data from the electrophysiological investigation of the LGN by Malpeli and Baker ('75) were displayed on maps of all six layers. As known from previous studies, there is a significant over-representation of central vision in the LGN. Unexpectedly, though, the visual representation is anisotropic over portions of most LGN layers. That is, the linear magnification factor (millimeters along the laminar surface per degree of visual field) is not equal for all directions from a given point in the visual field. Moreover, the visual representations in the parvicellular and magnocellular divisions of the LGN differ both in their emphasis on central vision and in their anisotropies. To determine the degree of individual variability, laminar maps were prepared from the LGN of seven other hemispheres. The shapes of laminar maps varied considerably between LGNs, from nearly circular to highly elliptical, but the surface area was relatively constant for each layer. Topographical organization, determined by mapping the optic disc representation on the LGN laminae and by labeling from anterograde and retrograde tracer injections in striate cortex, showed significant individual variability. Interestingly, the visual representations in the LGN and striate cortex are topologically inverted with respect to one another. This indicates that the establishment of geniculocortical connections involves a systematic crossing-over of fibers. Information on cell densities and magnification factors in striate cortex obtained from other studies was compared to the results of the present study in order to estimate ratios of cortical neurons to LGN neurons at different eccentricities. The total number of cortical neurons per LGN neuron is about 130 on average, but it extends over approximately a tenfold range, from less than 100 in the far periphery to nearly 1,000 in the fovea. The estimated number of cells in layers 4A and 4C beta per parvicellular layer neuron is smaller and extends over a slightly narrower range, from 30 to 240, whereas the number of layer 4C alpha neurons per magnocellular neuron varies more widely, from about 45 to 7,000.

Animals↗
PubMedDate not supplied

Pasteurella haemolytica serotypes isolated in Northern Ireland during 1989-1991.

Pasteurella haemolytica isolates from clinical veterinary samples were serotyped over a three year period to determine the distribution of strains in Northern Ireland, to compare the results with the recorded distribution in the remainder of Great Britain and to extend information on the geographical prevalence of the serotypes. Four hundred and nine typable and 91 untypable strains were isolated from 490 animal cases. From 127 typable cattle isolates, the commonest serotype was A1, most frequently associated with calf pneumonia. Serotypes A2, T4, T10 and T15 were the commonest sheep isolates, A2 being most frequently associated with lamb pneumonia and the T-biovars more prevalent in adult pneumonia and lamb septicaemia. The isolates from approximately half the cases were evaluated in terms of the results obtained from gross and histopathological post mortem examination. Approximately two-thirds of these isolates were associated with significant pathology, including a small number of serotypes which are not included in the sheep vaccines currently used in Great Britain.

Animals↗
PubMedDate not supplied

Spinal cord injury without radiographic abnormality (SCIWORA).

Spinal cord injury without radiographic abnormality (SCIWORA) is associated with self-reducing transient subluxation or distraction of the juvenile spine. It accounts for about 40% of spinal injuries in children under sixteen. Children's anatomical features increase their susceptibility to hyperflexion, hyperextension and distraction mechanisms. Nursing management includes an awareness of two of its greatest dangers: a delay in onset of symptoms and a possible recurrence. If these dangers are identified early, the child's potential for recovery is maximized.

Humans↗
PubMedDate not supplied

Community leg ulcer clinics: cost-effectiveness.

This study investigates the cost-effectiveness and efficacy of a new service provided by community leg ulcer clinics, and compares it with treatment in existing hospital-based venous ulcer care clinics. Data were provided prospectively from district nurses and retrospectively from patients. Success in treatment was assessed as a percentage of ulcers completely healed after 12 weeks of treatment, analysed by the up-table method. Treatment success of 22% at 12 weeks using existing methods compared with 80% in community clinics. Costs were estimated to be 433,600 pounds and 169,000 pounds respectively. These findings indicate that community leg ulcer clinics were more effective and less expensive than the previous system of care.

Aged↗
PubMedDate not supplied

Assessment and management of the child with asthma.

The physical challenges of asthma present problems for children and their parents. Nurses can minimize the physical difficulties experienced by asthmatic children and enhance their emotional growth and self confidence by teaching and support.

Asthma↗