Search PubMed⌕ Search

Biomedical subjects

M O'Sullivan

Publications and source records attributed to M O'Sullivan.

At least 55 records · Page 3Linked to original sources
PubMed2001

Trauma-induced coagulopathy and treatment in Kosovo.

The 67th Combat Support Hospital at Camp Bondsteel, Kosovo, treated victims of trauma on an almost daily basis at the beginning of U.S. peacekeeping efforts in the region. Military health care personnel must respond quickly and efficiently when confronted with patient wounds resulting in massive blood losses. The limited medical resources of a field hospital often complicate efforts to treat the most severe injuries. One such case involved a young farmer riddled with gunshot wounds. Early volume/blood resuscitation before, during, and after surgery led to a massive blood coagulopathy. This case study describes the actions the physicians and nurses initiated to save this victim of violence. The subsequent discussion delineates methods to reduce intraoperative blood losses, blood transfusion alternatives, and technological advances in trauma resuscitation.

Adult↗
PubMed2000

Displaced supracondylar fractures of the humerus in children.

We performed an outcome study of completely displaced supracondylar fractures in children in order to assess the outcome of primary open reduction and internal fixation for these injuries. A total of 16 patients (mean age of 5.9 years) were included in the study. The mean follow-up was 2.6 years and patients were assessed after fracture healing using the criteria of Flynn et al. and Mark et al. Thirteen patients had an excellent result, two had good results with less than 10 degrees loss of carrying angle and one had a fair result based on degree of loss of elbow flexion. Open reduction and internal fixation of these fractures is an effective and safe method of primary treatment and is associated with good outcomes. We recommend a low threshold of proceeding to open treatment in these serious injuries.

Child↗
PubMed2000

Multidisciplinary case-based learning for undergraduate students.

This report describes the introduction of case-based learning into the final-year dental programme at the Dublin Dental School. Students attended a series of one-hour sessions in groups of 8. Each group appointed a chairman for each session and a tutor facilitated the discussion. Case details were provided during the session with relevant diagnostic records. At weekly discussion sessions, the group findings and treatment options were considered. The diagnosis and treatment plans were then discussed by clinicians involved in the treatment of the case. Following the last session, the case-based learning programme was evaluated by means of a questionnaire distributed to both tutors and students. Both students and tutors rated the sessions positively. Case-based learning was found to be a worthwhile progression from problem-based learning.

Case Management↗
PubMed2000

Students' perceptions of the relative advantages and disadvantages of community-based and hospital-based teaching: a qualitative study.

AIMS: To obtain the perceptions of first-year clinical medical students of the relative advantages and disadvantages of community-based and hospital-based clinical teaching. METHODS: A qualitative study. A purposive sample of first-year clinical medical students who had experienced both community-based and hospital-based teaching was invited to participate in individual semistructured interviews or focus groups. Interviews and focus groups were audiotaped and transcribed to facilitate content analysis of the data. A total of 24 students participated in individual interviews and a further 18 took part in focus groups. RESULTS: Respondents identified advantages and disadvantages specific to teaching in each setting. Chief advantages of hospital-based learning were perceived to include learning about specialties and the management of acute conditions, and gaining experience of procedures and investigations. Community-based learning was perceived as particularly appropriate for learning about psychosocial issues in medicine, for increasing students' awareness of patient autonomy and for improving communication skills. In addition, aspects of organization and of teaching methods employed by community tutors, although not site-specific, were viewed as conducive to a positive educational experience. Students perceived some areas, such as clinical skills acquisition, to be equally well learned in either setting. DISCUSSION: As community-based teaching forms a greater proportion of the undergraduate medical experience, medical educators must find ways of determining the specific advantages that community and hospital settings can contribute to undergraduate learning and of using these resources effectively to develop comprehensive and integrated curricula. Innovations in teaching methods may also be necessary to provide an effective educational experience and promote active learning.

Adult↗
PubMed2000

Increased mast cells in the irritable bowel syndrome.

Mast cells (MC) release potent mediators which alter enteric nerve and smooth muscle function and may play a role in the pathogenesis of the irritable bowel syndrome (IBS). The aim of this study was to determine if MC were increased in the colon of IBS patients compared to controls. Biopsy specimens were obtained from the caecum, ascending colon, descending colon and rectum of 28 patients: 14 IBS (Rome criteria); seven normal; and seven inflammatory controls. Tissue was stained immunohistochemically using a monoclonal mouse antibody for human mast cell tryptase (AA1). Tissue area occupied by tryptase-positive MC (volume density of mast cells) was quantified by image analysis. The number of plasma cells, lymphocytes, eosinophils, neutrophils and macrophages were each graded semiquantitatively (0-4) in haematoxylin and eosin stained sections. Mast cell volume density was significantly (P < 0.05) higher in IBS (0.91 +/- 0.18; CI 0.79; 1.0) than normal controls (0.55 +/- 0.14; CI 0.40; 0.69) in the caecum but not at other sites. Apart from MC, there was no evidence of increased cellular infiltrate in the IBS group. MC were significantly increased in the caecum of IBS patients compared to controls. The multiple effects of the intestinal mast cell alone, or as a participant of a persistent inflammatory response, may be fundamental to the pathogenesis of IBS.

Adult↗
PubMed2000

A blinded, randomized comparison of a novel, low-dose, triple regimen with fleet phospho-soda: a study of colon cleanliness, speed and success of colonoscopy.

BACKGROUND AND STUDY AIMS: A clean colon is essential for an efficient examination. The aim of this study was to compare a novel low-dose, low volume triple regimen with Fleet Phospho-soda. METHODS: A blinded, experienced colonoscopist examined 132 consecutive patients randomly allocated to receive either a triple regimen consisting of senna syrup (sennoside B), Picolax (sodium picosulphate), and Klean Prep (polyethylene glycol 3350), or Fleet Phospho-soda (sodium dihydrogen phosphate and disodium phosphate dodecahydrate). The colonoscopist recorded cleanliness according to a scoring system (1-very clean to 4-solid stools), and time taken to reach the caecum. RESULTS: In the triple regimen group (n = 81), 73% scored 1 or 2 compared with 57% in the Fleet Phospho-soda group (n = 51, p = 0.037 Mann-Whitney U-test). Examination to caecum was achieved in 95% of the triple regimen group and 89% of the Fleet Phospho-soda group. Among those examined as far as the caecum, the time to reach the caecum was 11 minutes (range 5-50) in the triple regimen group compared with 16 minutes (range 5-65) in the Fleet Phospho-soda group (p = 0.08, Mann-Whitney U-test). Patient tolerability was not assessed in this study. CONCLUSIONS: This novel triple regimen produces a cleaner colon than Fleet Phospho-soda, is associated with a trend towards a quicker and more efficient colonic examination, and is also 30% cheaper per patient.

Adolescent↗
PubMed2000

Intravenous pamidronate treatment of polyostotic fibrous dysplasia associated with the McCune Albright syndrome.

OBJECTIVES: An open trial of pamidronate treatment was undertaken in 5 children and 4 young adults with polyostotic fibrous dysplasia associated with McCune Albright syndrome to assess clinical response, bone turnover, and cardiovascular status over a 2-year period. STUDY DESIGN: Pamidronate was administered by intravenous infusion 1 mg/kg/d for 3 days every 6 months for 2 years. Bone turnover was measured at 0, 6, 12, 18, and 24 months with bone mineral density, and cardiac output was assessed by echocardiography at 0, 12, and 24 months. RESULTS: All subjects reported marked reduction in bone pain and sustained increased mobility. The fracture rate decreased in most. Orthopedic insertion of intramedullary rods was successful with maintenance of rod position. Mean osteocalcin levels fell from 35.5 +/- 5.6 microg/L to 28.4 +/- 4.1 microg/L (P <.03). Other bone turnover marker changes were not significant. The mean bone mineral density at lumbar spine increased from 0.5 +/- 0.08 to 0.67 +/- 0.03 g/cm(2) (P <.002) in children and 1.16 +/- 0.6 to 1.33 +/- 0.08 g/cm(2) in adults (P <.005). Other changes in bone mineral density were not significant. Cardiac output did not change significantly. CONCLUSIONS: Pamidronate treatment is an effective therapeutic modality for children with polyostotic fibrous dysplasia, with a good short-term safety profile. Failure to demonstrate major biochemical or bone densitometry improvements is due to the nature of the fibrous dysplasia and intercurrent microfracture.

Adolescent↗
PubMed2000

Outcome after musculoskeletal trauma treated in a regional hospital.

BACKGROUND: Trauma remains the leading cause of death and morbidity in the under-35-year-old population. The majority of reports assessing outcome after trauma emanate from North American Level I trauma centers. We sought to examine outcome after trauma treated in an Irish regional unit. METHODS: All patients admitted over a 1-year period with an Injury Severity Score > or =9 were evaluated and 61 patients recruited to the study. Demographic data, medical history, and details of the mechanism and pattern of injury and treatment were collected. Patients' functional outcome was assessed using the Sickness Impact Profile (SIP), duration of hospital stay, and return to work. RESULTS: Significant residual disability was noted (mean SIP 13.63+/-14.60). Thirty-seven percent of patients had not returned to work despite a mean follow-up of 18.36 months. Factors associated with a poor outcome include increasing age, a blue-collar occupation, lower limb fractures, comorbid conditions, and the presence of complications. CONCLUSION: Optimizing primary care of the trauma victim may help to minimize consequent morbidity. A small group of patients suffer permanent disability, and vocational retraining opportunities should be made available to them.

Accidental Falls↗
PubMed2000

Reduced cerebral blood flow in white matter in ischaemic leukoaraiosis demonstrated using quantitative exogenous contrast based perfusion MRI.

OBJECTIVE: White matter hypoperfusion may play a part in the pathogenesis of ischaemic leukoaraiosis, but demonstration of this requires a high resolution quantitative method of cerebral blood flow (CBF) measurement. Initial exogenous contrast based MRI methods only allowed measurement of relative cerebral blood volume (CBV) values, but more recently a mathematical approach has been developed which enables absolute regional CBF and CBV to be determined. This technique was applied to patients with ischaemic leukoaraiosis to determine whether reduced white matter CBF in this patient group could be demonstrated. METHODS: Eight patients with ischaemic leukoaraiosis (radiological leukoaraiosis and clinical lacunar stroke), and nine age matched controls were studied. A spin echo echoplanar image sequence was used on a 1.5 Tesla MR system. An arterial input function was obtained from voxels placed over the middle cerebral arteries. Cerebral blood flow, CBV, and mean transit (MTT) maps were derived. Regions of interest were placed at standard positions in the white and grey matter and mean values of CBF, CBV, and MTT were compared between the two groups. RESULTS: Mean (SD) white matter CBF was significantly reduced in patients by 38% (13.40 (4.87) v 21.74 (3.53) ml/min/ 100 g, p=0.002). Significant reductions in CBF were seen in all white matter regions. By contrast there was no reduction in CBF in any grey matter region. There was no significant difference in white matter CBV between cases and controls; mean values were lower in all white matter regions for patients but this did not reach significance for any region. By contrast mean grey matter CBV was significantly higher in patients than in controls. Mean MTT values were higher in all regions of grey and white matter in the patient group, but this only achieved significance for the superior white matter. CONCLUSION: A quantitative MR perfusion method showed reduced white matter CBF in patients with ischaemic leukoaraiosis, but normal grey matter CBF. This is consistent with hypoperfusion playing a part in the pathogenesis of ischaemic leukoaraiosis. The absolute values of white matter and grey matter CBF obtained in the patient groups were very similar to those in previous PET studies, providing further evidence for the validity of the regional CBF measurements obtained using this quantitative MR perfusion technique. The high spatial resolution and lack of radioactive administration makes such techniques ideal for longitudinal studies in this condition.

Aged↗
PubMed2000

Quality of life of asymptomatic men with nonmetastatic prostate cancer on androgen deprivation therapy.

PURPOSE: We evaluate the quality of life of asymptomatic men with nonmetastatic prostate cancer who receive androgen deprivation therapy. MATERIALS AND METHODS: Quality of life was longitudinally evaluated in a cohort of 144 men with locally advanced prostate cancer or prostate specific antigen relapse after local therapy who chose to receive (79 patients) or not to receive (65 patients) androgen deprivation therapy. Androgen deprivation therapy consisted of orchiectomy, leuprolide alone or leuprolide plus flutamide. Multivariate analysis of variance was used to test the effect of different treatment regimens on patient quality of life. RESULTS: Men who received androgen suppression had more fatigue, loss of energy, emotional distress and a lower overall quality of life than men who deferred hormone therapy. Combined androgen blockade had a greater adverse effect on quality of life than monotherapy. CONCLUSIONS: Androgen deprivation therapy may significantly impair the physical and emotional health of asymptomatic patients with nonmetastatic prostate cancer.

Aged↗
PubMed2000

Communication between dentists and laboratory technicians.

A questionnaire was sent to 29 laboratory technicians regarding prescription writing by dentists for single anterior maxillary unit metal ceramic prostheses. Sixty nine per cent of the technicians responded and of these 40 per cent included copies of the typical prescriptions they receive. The results clearly showed that the standard of communication between dentist and laboratory technician is inadequate, although it has improved over recent years. The effectiveness of the Medical Devices Directive legislation was considered by reviewing the prescription sheets. It was concluded that many technicians still rely on contacting the prescribing dentist by telephone to clarify instructions and are often forced to make decisions without the necessary information. The finer details of prosthesis construction were found to be the weakest area of prescription writing. Time pressure was deemed the single greatest impediment to a harmonious working relationship. The recommendations of this paper are based on improving the levels of communication between these two members of the dental team. It is proposed that dentists should increase their awareness of the laboratory environment by maintaining closer links with their technicians. This would not only expand their understanding and appreciation of the laboratory environment, but also give the opportunity for discussing new developments in dental technology. Further undergraduate training in the area of laboratory prescription writing is also recommended.

Communication↗
PubMed1999

Influence of smoking status on the disease-related outcomes of patients with tobacco-associated superficial transitional cell carcinoma of the bladder.

BACKGROUND: The aim of this study was to assess the influence of tobacco exposure, at the time of diagnosis, on the disease-related outcomes of patients with tobacco-associated superficial transitional cell carcinoma (TCC) of the bladder. METHODS: A retrospective cohort study was performed using the MSKCC Registry to identify all institutional cases of "noninvasive" TCC (n = 1632) between 1985 and 1995. After employing exclusion criteria, 286 cases of incident tobacco-associated superficial TCC were divided into 3 strata of tobacco exposure (127 ex-smokers, 51 quitters, and 108 continued smokers) by chart review and post hoc questionnaires (n = 82). Measured outcomes included recurrence free survival and survival free of adverse events (defined a priori as disease progression or other urinary tract TCC). RESULTS: There were no significant differences among ex-smokers, quitters, and continued smokers in terms of stage, grade, tumor size, multifocality, up-front bacillus Calmette-Guérin therapy, or median follow-up. Ex-smokers presented at a later age than individuals who continued to smoke. Post hoc questionnaires and chart reviews were compared in terms of smoking status at time of diagnosis, and reliability was excellent (kappa = 0.89). Multivariate analyses revealed diminished recurrence free survival among continued smokers versus quitters or ex-smokers. Univariate analyses revealed diminished adverse event free survival among continued smokers versus quitters or ex-smokers. Multivariate models assessing adverse event free survival revealed a similar trend (P = 0.06). CONCLUSIONS: Continued smokers experience worse disease-associated outcomes than patients who quit smoking. Smoking cessation should thus be employed as a tertiary prevention strategy for patients with superficial TCC.

Adult↗
PubMed1999

Resistance to Fas-mediated T cell apoptosis in asthma.

Over activation of CD4+ T cells in the peripheral blood and airway tissues is characteristic of asthma; therefore, we investigated whether activated T cells from asthmatic subjects have altered apoptotic potential through the Fas death receptor. We found that mitogen-stimulated peripheral blood T cells of asthmatic subjects expressed cell surface Fas, but failed to undergo the normal degree of apoptosis after Fas receptor ligation. T cells from asthmatics exhibited normal apoptotic responses to gamma-irradiation (dependent on IL-1 converting enzyme family proteases), ceramide, and mitogen challenge, suggesting functional integrity of the apoptotic pathway. Furthermore, the defect in Fas-dependent apoptosis was overcome by prestimulation with allogeneic accessory cells instead of mitogen. Taken together, the findings suggest that selective resistance to Fas-dependent apoptosis reflects altered Ag-driven, accessory cell-dependent signaling and that ineffective activation of Fas signal transduction may contribute to T cell-dependent immunoinflammation in asthma.

Adolescent↗
PubMed1999

Clinical significance of small (less than 0.2 cm3) hypoechoic lesions in men with normal digital rectal examinations and prostate-specific antigen levels less than 10 ng/mL.

OBJECTIVES: Most men diagnosed with prostate cancer in 1998 presented with a normal digital rectal examination (DRE) and minimal elevations in serum prostate-specific antigen (PSA) (less than 10 ng/mL). Considerable attention is often given toward identifying small hypoechoic (less than 0.2 cm3) lesions at the time of transrectal ultrasound-guided prostate biopsy. We sought to determine the significance of these lesions and whether an additional biopsy of this area is clinically useful. METHODS: A prospective data base containing detailed information on 614 biopsies performed by a single urologist was examined. All patients with a hypoechoic lesion underwent sextant prostate biopsy plus a separately labeled core directed through the hypoechoic area. Eighty-one patients who fit the following criteria were assessed: PSA less than 10 ng/mL, normal DRE, and hypoechoic lesion volume less than 0.2 cm3. RESULTS: The mean age of this group was 63.5 years, and the mean PSA was 7.1 ng/mL. Of the 81 patients with small hypoechoic lesions, 20 (24.7%) were positive for cancer in at least one prostatic core. Of the 81 hypoechoic area biopsies (HABs), 14 (17.3%) were positive for cancer; 1 (1.2%) demonstrated high-grade prostatic intraepithelial neoplasia, and 66 (81 .5%) were negative. In 11 of the patients (78.6%) with positive HABs, at least one additional core was positive for cancer. In 3 of the patients (21.4%) with positive HABs, no additional cores were positive for cancer (P<0.05). CONCLUSIONS: A significant proportion of small hypoechoic lesions in patients with early T1c prostate cancer are positive for malignancy. Although the overall yield of separate hypoechoic area biopsy is low (3.7%), approximately 15% of cancers would be missed if directed HABs were not performed (P<0.05). Identification and biopsy of small hypoechoic lesions are indicated in this group of patients.

Adult↗
PubMed1999

The cost of hospital care in the year before and after parasuicide.

This study, based in Ireland in the Limerick centre of the WHO/EURO Multicentre Study of Parasuicide, tests the hypothesis that the uptake of hospital services increases significantly following an act of parasuicide. To investigate this, the costs of hospital attendance in the year before and in the year after an act of parasuicide are measured and compared. The sample is comprised of the first 100 individuals who attended an acute general hospital following an act of parasuicide after July 1, 1995. Using a computerized patient record system, every hospital attendance is identified, for each individual, in the 12 months before and after the parasuicide act. This includes every visit to the Emergency Room as well as both general and psychiatric inpatient admissions and outpatient attendances. There was a 50% increase in the uptake of hospital services--32% of the sample attended hospital in the year before compared with 48% in the year after. The total yearly costs for the 100 patients almost doubled from IR 53,652 Pounds (Euro 68,138) to IR 104,454 Pounds (Euro 132,657). Generalizing to the 539 individuals who engaged in parasuicide in the Limerick catchment area, total costs increased from IR 289,184 Pounds (Euro 367,264) to IR 563,007 Pounds (Euro 715,019). This study is an initial step toward the more complex task of estimating to what extent the increased uptake of hospital services is due to the consequences of parasuicide and how much is due to other aspects of the patient's health.

Adolescent↗
PubMed1998

Suicidal ideation and acts of self-harm among Dublin school children.

The purpose of this study is to ascertain rates of suicidal ideation and self-harm in a classroom population of 13- and 14-year-old children using a screening questionnaire and to confirm accuracy of these screening results by home interview. There were significant differences between suicidal ideation rates at screening and at home interview (44% vs. 29%) and between self-harm rates (8% vs. 2%). Those with suicidal ideation at home interview believed more in a "right to suicide" and believed suicidal ideation to be more widespread among adolescents. School factors were believed by respondents to be important in the causation of adolescent suicide. Fewer than one-fifth would advise consultation with a psychiatrist to a suicidal friend.

Adolescent↗