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Biomedical subjects

P A O'Connor

Publications and source records attributed to P A O'Connor.

At least 19 recordsLinked to original sources
PubMed2004

Staphylococcal diaphyseal subacute osteomyelitis of the ulna in a child: an unusual cause of post-traumatic forearm swelling.

Paediatric subacute osteomyelitis (SAO) presents a diagnostic and therapeutic challenge to clinicians. Typically located in the metaphysis of long bones, diaphyseal SAO of the upper limb is rare. We present the case of a three-year-old girl referred to our fracture clinic as an occult fracture following trauma to her forearm with normal initial radiographs. Follow-up radiographs one week later showed cortical erosion of the distal ulna, while a subsequent MRI scan showed soft tissue swelling with an area of high signal in the distal ulna. A limited biopsy diagnosed staphylococcal subacute osteomyelitis of the ulna. The patient responded to high dose antibiotic therapy and made a full recovery. We present this case to highlight the high index of suspicion required to diagnose and appropriately manage this insidious condition, which may easily be confused with any number of benign and malignant bony lesions and provide a review of the relevant literature.

Anti-Bacterial Agents↗
PubMed2003

Anterior displacement correlates with neurological impairment in cervical facet dislocations.

We studied all patients with either unifacetal or bifacetal dislocations treated in our National Spinal Injuries Unit between January 1996 and December 2000. There were 25 cases, of which 13 were unifacetal and 12 bifacetal. Craniocervical traction was employed in 21 cases and closed reduction achieved in 11. Eighteen patients underwent surgical stabilisation. Traction weights of up to 36 kg were employed, but there was no relationship found between the level of dislocation and traction weight. Anterior translation was measured by a newly described method, and we found a statistically significant correlation between the neurological score on admission and the degree of anterior translation.

Adolescent↗
PubMed2003

Lower limb dysesthesia--an ominous sign in lumbar fractures.

Attempts at diagnosing dural lacerations secondary to fractures of the lumbar vertebrae on plain radiographs has varied considerably. If undiagnosed these injuries can cause serious complications. We present a clinical sign not previously documented to our knowledge. Plain radiographs in this case failed to show significant canal compromise but excessive hip pain, with the limb held in a characteristic posture, heralded cauda equina injury in a burst lumbar fracture. The limb was held in hip and knee flexion, with resistance to passive extension due to lower limb dysesthesia. This sign helped in determining the investigation and treatment of our patient.

Adult↗
PubMed2002

Lisfranc injuries: patient- and physician-based functional outcomes.

The purpose of this study was to assess functional outcome of patients with a Lisfranc fracture dislocation of the foot by applying validated patient- and physician-based scoring systems and to compare these outcome tools. Of 25 injuries sustained by 24 patients treated in our institution between January 1995 and June 2001, 16 were available for review with a mean follow-up period of 36 (10-74) months. Injuries were classified according to Myerson. Outcome instruments used were: (a) Medical Outcomes Study 36-Item Short Form Health Survey (SF-36), (b) Baltimore Painful Foot score (PFS) and (c) American Orthopedic Foot and Ankle Society (AOFAS) mid-foot scoring scale. Four patients had an excellent outcome on the PFS scale, seven were classified as good, three fair and two poor. There was a statistically significant correlation between the PFS and Role Physical (RP) element of the SF-36.

Adolescent↗
PubMed1992

Comparison of neuroendocrine and behavioral effects of ipsapirone, a 5-HT1A agonist, in three stress paradigms: immobilization, forced swim and conditioned fear.

Ipsapirone is an anxiolytic drug and a serotonin1A (5-HT1A) agonist. The aim of the present study was to investigate the effects of low doses of ipsapirone on the hormonal and behavioral response to three stress procedures: immobilization, forced swim and conditioned emotional response (CER). We examined the effect of ipsapirone (0.1, 0.5 or 1.0 mg/kg) on plasma renin concentration (PRC), adrenal corticotropic hormone (ACTH), corticosterone, prolactin and defecation in rats exposed to immobilization, forced swim or CER stress. All three stressors significantly elevated all the hormone levels (P less than 0.01). Immobilization-induced elevations of PRC, and corticosterone were inhibited by the highest doses of ipsapirone (0.5 and 1 mg/kg, i.p.). However, ipsapirone did not modify the immobilization-induced elevations of plasma ACTH, prolactin or defecation. Ipsapirone was relatively ineffective at reducing the endocrine responses to forced swim. Ipsapirone reduced some, but not all of the hormonal responses to CER stress. CER-induced elevations of corticosterone and prolactin were not inhibited by ipsapirone. However, the ACTH response to CER was significantly (P less than 0.01) inhibited by all doses of ipsapirone and the highest dose of ipsapirone attenuated the renin response. In contrast with the hormonal responses, ipsapirone inhibited all of the behavioral responses to CER stress. Ipsapirone inhibited CER-induced freezing behavior and defecation, while dose-dependently reversing the suppressive effect of CER on exploring, grooming and rearing behaviors. In conclusion, there is a dissociation between the influence of ipsapirone on the endocrine and behavioral responses to CER stress. Ipsapirone also has differential effects on the neuroendocrine response to the three stressors studied. Ipsapirone was most effective in attenuating the hormonal responses to CER, followed by immobilization and swim stress. Of the hormones studied, the stimulation of renin secretion after exposure to the three stressors was most sensitive to ipsapirone, while corticosterone and prolactin were the least sensitive to ipsapirone.

Animals↗
PubMed1991

Caterpillar-induced keratitis.

Caterpillar hairs are responsible for a well-described though infrequent form of ocular trauma and disease sometimes referred to under the term ophthalmia nodosa. Four patients with this condition are presented with a review of the pathology and treatment guidelines.

Adolescent↗
PubMed1988

Prediction of intellectual deficits in children with acute lymphoblastic leukemia.

Possible predictors of reported lower cognitive functioning in irradiated children with acute lymphoblastic leukemia (ALL) were investigated. Thirty-four subjects, 5-14 years old, with ALL in continuous complete remission and without evidence of current or past central nervous system disease, were examined 9-110 months after diagnosis, using standard measures of intelligence and academic achievement. Subjects with a history of post-irradiation somnolence syndrome were significantly older at diagnosis than nonsomnolent subjects. Intelligence (IQ) was found to be unrelated to history of somnolence syndrome. IQ and achievement were unrelated to age at irradiation, irradiation-examination interval, and radiation dosages. The strongest predictor of IQ by far is parental social class. The importance of controlling for social class differences when searching for treatment effects on IQ and achievement is stressed.

Achievement↗
PubMed1988

Preschool behavior problems and subsequent risk of injury.

The hospital records of 951 children from a previously established birth cohort for which behavioral and extensive background information was available were checked for 3 years following the fifth birthday of the youngest child. The aim was to determine whether children with certain specific behavior disorders had a higher rate of injury than those without. Although the predicted relationships between overactive behavior, decreased concentration, and injury rate were not found, the hypothesis of an increased risk of injury for boys and for children with discipline problems was confirmed. Also, the association between male sex and injury remained after controlling for the behavior variables related to injury. In general, some support was found for the suggestion of increased risk of injury among children who have specific behavior problems, although, contrary to widespread belief, this relationship accounts for only a small percentage of the injuries found in the cohort. Moreover, the relationship is modified by maternal characteristics and by the sex of the child. Unexpectedly, encopresis and marked fears were found to be risk factors for injury, although these effects were relatively small.

Attention Deficit Disorder with Hyperactivity↗
PubMed1986

Ten-year consistency in neurological test performance of children without focal neurological deficit.

To assess 'soft-sign' persistence and its correlates outside a referred sample, 159 members of a local birth cohort of the United National Collaborative Perinatal Project were traced and their performance on six neurological test scales was measured at age 17 by examiners blind to their status at age seven. A comparison group was also formed, who had been 'sign-free' at age seven. On four of the six tests (dysdiadochokinesis, mirror movements, dysgraphesthesia and motor slowness) index boys did significantly worse than the comparison boys; by contrast, index girls scored significantly worse than comparisons only on motor slowness.

Adolescent↗
PubMed1986

Assessment of neurological 'soft signs' in adolescents: reliability studies.

The validity and reliability of a scoring system for 'neurological soft signs' in teenagers was assessed. Six scales were adapted and fitted into the framework of a conventional neurological examination. The following emerged: each of the three multi-item scales had high internal consistency; inter-rater agreement on mirror movements of 'live' subjects was satisfactory; ratings of videotapes agreed among examiners for mirror movements and dysdiadochokinesis but not for choreiform movements; data-based cut-off scores defining present vs. absent were congruent with the ratings of outside neurologists; and each examiner was consistent in rating mirror movements and rapid alternating movements from videotapes over several months.

Adolescent↗
PubMed1985

Neurological soft signs. Their relationship to psychiatric disorder and intelligence in childhood and adolescence.

Sixty-three male and 27 female adolescents known to have had neurological soft signs at the age of 7 years were compared with controls with no soft signs at age 7. Adolescents with early soft signs had significantly lower IQs and were more likely to have a psychiatric disorder characterized by anxiety, withdrawal, and depression. All the girls and 80% (12/15) of the boys with an anxiety-withdrawal diagnosis showed early soft signs. There was no relationship between early soft signs and attention deficit or conduct disorders. Examination of the relative contributions of anxiety at age 7, IQ, and social and family disadvantage to later diagnosis showed that most of the variance was accounted for by soft signs independently of IQ. Soft signs and anxious dependent behavior at age 7 were strongly predictive of persistent psychiatric disorder characterized by anxiety and withdrawal.

Adolescent↗
PubMed1985

Group A beta-hemolytic streptococcal vulvovaginitis: a recurring problem.

Differential diagnosis of purulent vulvovaginitis in prepubertal girls should include infection caused by group A beta-hemolytic streptococci. Cultures should be obtained not only for N. gonorrhoeae but also for respiratory and skin pathogens such as streptococci. While a specific diagnosis of group A streptococcal vulvovaginitis does not exclude child abuse or a vaginal foreign body, the child's symptoms and parental anxiety and concern can usually be rapidly alleviated with oral antibiotics effective against streptococci. Further investigation beyond culturing and treatment with antibiotics can be reserved for cases where history, physical findings, and response to therapy indicate such a need.

Child↗
PubMed1982

Return to the family and its consequence for rehospitalization among recently discharged mental patients.

This study examined the contribution that living arrangements made to the rehospitalization rates of mental patients discharged to the community during the first 7 months they spent there. Over 20,000 mental patients discharged from psychiatric facilities in the state of New York were categorized on the basis of the living arrangements to which they were discharged. These included living alone, parental, marital, other relatives or friends, and domiciliary settings. The sample was divided in half and results of the analysis of the first sample were replicated on the second sample. Analysis of covariance and multiple regression techniques revealed that patients discharged to marital settings were rehospitalized less than those discharged to other settings, and that there were no differences in the return rates among the remaining settings. The major predictor of rehospitalization was the number of previous hospitalizations. The implications of these findings for further research on supportive as well as stressful parameters of community and family settings are discussed.

Adolescent↗