Biomedical subjects
R O'Sullivan
Publications and source records attributed to R O'Sullivan.
Attention deficit hyperactivity disorder in childhood among adults with major depression.
The prevalence of attention deficit hyperactivity disorder (ADHD) with childhood onset and its relationship to course and treatment outcome of major depressive disorder (MDD) in adults was studied in 116 patients (ages 18-65) consecutively enrolled for treatment of MDD. Sixteen percent of the patient were found to meet full or subthreshold criteria for the DSM-III-R diagnosis of childhood ADHD. Twelve percent endorsed persistence of ADHD symptoms into adulthood. Depressed adults meeting criteria for childhood ADHD did not differ significantly from other depressed adults on any measures related to the chronicity or severity of the mood disorder, Axis I comorbidity, or response to acute antidepressant treatment. Our results are clinically important as they suggest that clinicians need to be aware of the possibility that a substantial proportion of patients with MDD may suffer from comorbid ADHD and that treatments need to include the targeting of possible residual ADHD symptoms in addition to those of depression.
Fluoxetine treatment of anger attacks: a replication study.
"Anger attacks" are outbursts of anger which are accompanied by intense autonomic arousal and are clearly inappropriate to the situation in which they occur. The Anger Attacks Questionnaire, designed to assess these attacks, was administered to 164 consecutive patients (78 men and 86 women; mean age, 40.5 +/- 11.0 years) diagnosed as having major depression with the Structured Clinical Interview for DSM-III-R. These patients were treated openly with fluoxetine, 20 mg/day for 8 weeks, and the prevalence of anger attacks was assessed before and after treatment. At baseline, 64 (39%) (26 men and 38 women) of these patients reported having anger attacks according to our criteria. Forty-one (64%) of the 64 depressed patients with anger attacks at baseline did not report anger attacks following fluoxetine treatment, while 7 (7%) of the 100 patients who did not have anger attacks at baseline reported these attacks following treatment, with this difference being statistically significant (chi 2 = 22.7, p < .0005).
Assessment of intracochlear ossification by three-dimensional reconstruction of computerized scans.
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Case report: vascular anomaly in Dieulafoy's disease.
We present a case of a vascular anomaly with Dieulafoy's disease in a young man. The diagnosis was made by coeliac and selective left gastric angiography after endoscopy, laparotomy and angiography had failed to detect the lesion. The patient was treated successfully by laparotomy and resection of the bleeding area in the stomach. This is the second report of a vascular anomaly with Dieulafoy's disease.
Orbital lesions with granulomatous inflammation.
Orbital lesions characterized by granulomatous inflammation are a heterogeneous group of diseases of various causes with a common histopathological substrate involving aggregates of epithelioid cells. Forty-one patients (27 females and 14 males) with biopsy-proven granulomatous inflammation were seen at an orbital clinic between 1978 and 1989. The mean age at presentation was 40.2 (extremes 6 and 77) years. Two main clinical presentations were noted: painless, subacute or chronic mass effect, and tender, subacute inflammatory process. Six patients had secondary features that were infiltrative in character. The lesions were primarily located in the anterior superior orbit. In nearly half the patients the granulomatous reaction was confined to the orbit (predominantly ruptured dermoid and localized orbital sarcoid), and the remainder had either regional involvement (Wegener's granulomatosis or fibro-osseous process) or systemic involvement (sarcoidosis).
Leeuwenhoek and the structure of dentine.
This short paper includes extracts from the original translations of Leeuwenhoek's descriptions of the histology of teeth, investigates his findings and demonstrates that in addition to describing dentinal tubules, he may have identified the presence of calcospherites within that tissue.
Value of CT scanning in assessing location and extent of epidural and paraspinal inflammatory conditions.
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A case-control study of the clinical diagnosis and course of Lassa fever.
A prospective case-control study of Lassa fever was established in Sierra Leone to measure the frequency and case-fatality ratio of Lassa fever among febrile hospital admissions and to better delineate the clinical diagnosis and course of this disease. Lassa fever was responsible for 10%-16% of all adult medical admissions and for approximately 30% of adult deaths in the two hospitals studied. The case-fatality ratio for 441 hospitalized patients was 16.5%. We found the best predictor of Lassa fever to be the combination of fever, pharyngitis, retrosternal pain, and proteinuria (predictive value together, .81); of outcome, the best predictor was the combination of fever, sore throat, and vomiting (relative risk of death, 5.5). Complications included mucosal bleeding (17%), bilateral or unilateral eighth-nerve deafness (4%), and pleural (3%) or pericardial (2%) effusion. Lassa fever is endemic in this area and is a more-common cause of hospital admission and death than has previously been described; this disease must be considered when diagnosing febrile illness in West Africa.
Lassa fever in children in Sierra Leone, West Africa.
A systematic study of Lassa fever in febrile children was undertaken over a four-year period, from August 1977 to August 1981, in the Eastern Province of Sierra Leone, West Africa. 479 patients were studied; of these, 245 had adequate specimens to confirm or exclude the laboratory diagnosis of Lassa fever. 51 cases of Lassa fever were identified (21% of patients from whom diagnosis was possible). Virus was isolated from 23 patients. All children had fever; cough and vomiting were present in over 60% of cases studied. The five to nine-year age group had the highest prevalence rate (41% of cases). Seasonal clustering occurred in April, May, and August. A significantly higher proportion of females than males had Lassa fever, a finding which remains to be explained. It is concluded that Lassa fever is a disease of significant concern in the paediatric age group.
Survey of ophthalmic patients in hospital.
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Hostility changes following antidepressant treatment: relationship to stress and negative thinking.
It is unclear whether changes in hostility following treatment are primarily related to improvement in depressive symptoms or are also closely associated with reductions in negative thinking or perceived stress. We evaluated 94 outpatients with major depression before and after eight weeks of fluoxetine treatment by administering the Symptom Questionnaire (SQ) Hostility Scale, the Hamilton Rating Scale for Depression (HAM-D), the Cognitions Questionnaire (CQ) and the Perceived Stress Scale (PSS). We observed significant elevations in scores on these questionnaires in depressed patients as compared to normal controls. Following treatment with fluoxetine, there was a statistically significant reduction in scores on all four questionnaires. We observed that changes in SQ Hostility were significantly positively related to changes in both depression severity and perceived stress, with these relationships remaining significant after adjusting for gender and baseline SQ Hostility. The relationship between SQ Hostility changes and reductions in negative thinking became significant only after adjusting for gender and baseline SQ hostility. Our results suggest that the marked decrease in hostility following antidepressant treatment is related to a reduction in depressive symptoms, stress levels and negative thinking.
Nutritional assessment of continuous ambulatory peritoneal dialysis patients.
This study revealed the following. Malnutrition was frequent (41.6%) in patients on CAPD for less than three months and was present in 18.1% of patients on CAPD for longer than 3 months. Fifty percent of these malnourished patients returned to normal on conventional nutritional management within 2 to 6 months, but 10% remained malnourished throughout the study period. There was increased mortality among malnourished patients, but we were unable to demonstrate that the state of nutrition was an independent risk factor, because of the increased prevalence of other co-morbid risk factors known to influence survival and because of the limitation of a small sample size. The influence, if any, of nutritional state as an independent risk factor on the survival of CAPD patients should be answered, because malnutrition is potentially reversible with aggressive nutritional interventions, such as enteral, parenteral, or intraperitoneal supplementation.