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Biomedical subjects

R J Coughlan

Publications and source records attributed to R J Coughlan.

At least 19 recordsLinked to original sources
PubMed1995

Symptomatic enlarged iliopsoas bursae in the presence of a normal plain hip radiograph.

The clinical and radiological features of seven cases of enlarged iliopsoas bursae are presented, all of which had normal plain hip radiographs. Two cases had rheumatoid arthritis, one had septic arthritis diagnosed by synovial biopsy and the remaining four cases occurred as isolated findings, in the absence of any recognized hip pathology. A communication with the hip joint was demonstrated in one case associated with septic arthritis. All patients presented with symptoms of hip pain and limitation of movement. Two patients had a groin mass, one of which produced localized pressure symptoms and retroperitoneal extension. All patients had an arthrogram or bursogram performed. In the two cases where a mass was palpable, ultrasound and computed tomography were performed. We conclude that, in the presence of persistent hip pain or reduced range of movement, an enlarged iliopsoas bursa should be considered as a potential diagnosis, even in cases where the plain hip radiograph is normal.

Adult↗
PubMed1993

Treatment of rheumatoid hand synovitis with a regional block technique.

This study reports a novel technique for treating painful rheumatoid hand synovitis using a regional block technique. Nine patients with symptomatic rheumatoid hand synovitis were treated. Assessments of symptoms, grip strength and synovial swelling were made in each hand before the injection, and at 1 and 4 weeks after the procedure. A sphygmomanometer cuff was inflated, on the side of the patients most symptomatic hand, to 220mmHg and a solution of hydrocortisone sodium succinate 50mgs and lignocaine 10mls 0.5% was injected intravenously. The cuff was deflated slowly after 20 minutes. The injected hand improved symptomatically in 7 patients at 1 week, and further improvement was reported in 6 of these 7 at 1 month. Mean grip strength increased significantly in the injected hand both at 1 week (p = 0.01) and 1 month (p = 0.018). There was no change in the other hand. This technique is safe, reduced hand pain and improved grip strength in these patients with rheumatoid hand synovitis.

Arthritis, Rheumatoid↗
PubMed1992

Avascular necrosis of the femoral head post heart-transplantation and steroid dosage.

Avascular necrosis (avn) post heart-transplantation has been considered to be due to the high doses of steroids used to immunosuppress these patients in attempting to prevent transplant rejection. This study shows that avascular necrosis occurs even when low dose steroids regimes are used and demonstrates no significant correlation between steroid dosage and the development of avn. Patients with symptomatic avn benefit from early diagnosis and management of their condition in that the need for total joint arthroplasty can be prevented in many cases.

Adult↗
PubMed1992

Low energy high frequency pulsed electromagnetic therapy for acute whiplash injuries. A double blind randomized controlled study.

The standard treatment of acute whiplash injuries (soft collar and analgesia) is frequently unsuccessful. Pulsed electromagnetic therapy PEMT (as pulsed 27 MHz) has been shown to have pro-healing and anti-inflammatory effects. This study examines the effect of PEMT on the acute whiplash syndrome. One half of the 40 patients entering the study received active PEMT collars: the other half facsimile (placebo). All patients were given instructions to wear the collar for eight hours a day at home and advised to mobilise their necks. At 2 and 4 weeks the actively treated group had significantly improved (p less than 0.05) in terms of pain (visual analogue scale). By chance movement scores for the PEMT group were significantly worse at entry to the study than the control group (p less than 0.05). At 12 weeks they had become significantly better (p less than 0.05). PEMT as described is safe for domiciliary use and this study suggests that PEMT has a beneficial effect in the management of the acute whiplash injury.

Accidents, Traffic↗
PubMed1991

Magnetic resonance imaging in the assessment of rheumatoid arthritis--a comparison with plain film radiographs.

Conventional radiography lacks sensitivity in early rheumatoid disease. MRI with its advantages of soft tissue discrimination and multiplanar imaging facility might detect earlier disease. This study compares the MR images and conventional radiographs of 11 rheumatoid patients' wrists and carpi. In all cases, erosions were more extensive and numerous on the MR images compared to plain radiographs. MR is useful in detecting early aggressive disease and in monitoring the response to treatments.

Adult↗
PubMed1991

Skeletal tuberculosis.

Skeletal tuberculosis is an uncommon form of tuberculosis. During the period 1977-87, the number of cases diagnosed in two Dublin hospitals has remained at a constant level. The present study reports on 36 adults with skeletal tuberculosis and shows more frequent extraspinal involvement than other studies. The long duration of symptoms prior to diagnosis of 10.79 (+/- 8.8) months suggests that tuberculosis is not being considered early in the course of unexplained inflammatory arthritides especially in the elderly patient. The under utilisation of the Mantoux test in diagnosis is also a matter of concern.

Adolescent↗
PubMed1990

Pulsed high frequency (27MHz) electromagnetic therapy for persistent neck pain. A double blind, placebo-controlled study of 20 patients.

In the majority of patients with neck pain, symptoms will resolve spontaneously or quite quickly in response to therapy. However, some patients' symptoms persist for a long period, irrespective of therapy. In this study, 20 patients with persistent (greater than 8 weeks) neck pain were enrolled in a double blind, placebo-controlled trial of low energy, pulsed electromagnetic therapy (PEMT)--a treatment previously shown to be effective in soft tissue injuries. For the first 3-week period, group A (10 patients) received active PEMT units while group B (10 patients) received facsimile placebo units. After 3 weeks, both pain (visual analogue scale (P less than .023) and range of movement (P less than .002) had improved in the group on active treatment compared to the controls. After the second 3 weeks, during which both groups used active units, there were significant improvements in observed scores for pain and range of movement in both groups. PEMT, in the form described, can be used at home easily in the treatment of patients with neck pain. It is frequently successful and without side effects.

Adult↗
PubMed1989

Synovial fluids from infected joints contain active metalloproteinases and no inhibitory activity.

Serial samples of synovial fluid aspirated from two patients with septic arthritis were assayed for proteinases and proteinase inhibitors. Active metalloproteinases but no proteinase inhibitors were present in all samples taken prior to treatment. The levels of active metalloproteinases fell with time although proenzyme forms were still present in the fluids. Both alpha 2-macroglobulin and the tissue inhibitor of metalloproteinases were found in the septic synovial fluids after treatment commenced. It is proposed that the lack of inhibitors and the presence of active proteinases capable of digesting collagen, gelatin and proteoglycan accounts for the rapid loss of cartilage found in septic arthritis.

Aged↗
PubMed1989

Beneficial effect of monoclonal antibody to interleukin 2 receptor on activated T cells in rheumatoid arthritis.

Campath 6, a rat IgG2b monoclonal antibody to the interleukin 2 receptor on activated T cells, was used to treat three patients with active rheumatoid arthritis unresponsive to conventional treatment. Two patients had an excellent response for about three months. There were no significant side effects. The results suggest that activated T cells are of importance in the pathogenesis of rheumatoid arthritis. Although infusions of rat monoclonal antibodies could not be repeated because of the risk of sensitisation, the development of humanised monoclonal antibodies targeted against specific T cell sets would allow repeated courses of treatment to be given.

Adult↗