1
|
Shriver S, Knierim KE, O'Shea JP, Glover GH, Golby AJ. Pneumatically driven finger movement: a novel passive functional MR imaging technique for presurgical motor and sensory mapping. AJNR Am J Neuroradiol 2013; 34:E5-7. [PMID: 21778242 DOI: 10.3174/ajnr.a2626] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Two of the most common reasons for failure to obtain adequate preoperative functional data are inadequate task performance and excessive head motion. With an MR imaging-compatible pneumatically driven manipulandum, passive motor tasks elicited reproducible contralateral activation in the M1 and S1 in 10 healthy controls and 6 patients. The SMA was localized in all healthy controls and in 5 of 6 patients. Head motion was reduced in passive tasks compared with active tasks.
Collapse
Affiliation(s)
- S Shriver
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
| | | | | | | | | |
Collapse
|
2
|
Blyth CC, Darragh H, Whelan A, O'Shea JP, Beaman MH, McCarthy JS. Evaluation of clinical guidelines for the management of Staphylococcus aureus bacteraemia. Intern Med J 2002; 32:224-32. [PMID: 12036220 DOI: 10.1046/j.1445-5994.2001.00205.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND While treatment guidelines have been developed to guide the management of Staphylococcus aureus bacteraemia, there is a need to validate these guidelines in different clinical settings and to relate the effect of compliance to clinical outcome. AIMS To assess the impact of adherence to treatment guidelines on clinical outcome and to explore the role of transoesophageal echocardiography (TOE) in risk stratification. METHODS We undertook a 2-year mixed retrospective and prospective study of all cases of S. aureus bacteraemia at Fremantle Hospital, documenting the clinical and microbiological features of each case, the results of echocardiography, adherence with published clinical guidelines and clinical outcome. RESULTS Failure to comply with guidelines was observed in 41% (38 of 93) of cases, the majority receiving abbreviated treatment. An increased rate of relapse was observed among patients who received inadequate therapy (5/38 vs 1/55; P= 0.04). Ten of 28 eligible patients underwent TOE and the test led to significant changes in management in two of those cases. CONCLUSIONS While non-adherence with clinical guidelines was associated with an increased risk of relapse, the role of TOE in risk stratification was limited by factors including cost, limited acceptance of the test and the need for prolonged therapy for other indications.
Collapse
Affiliation(s)
- C C Blyth
- Department of Medicine, University of Western Australia, Fremantle, Australia
| | | | | | | | | | | |
Collapse
|
3
|
O'Shea JP, Sarwat MA, Sutcliffe CJ. Asleep-Awake-Asleep general anesthesia for open cervical rhizotomy: case report and description of the technique. J Neurosurg Anesthesiol 2000; 12:356-8. [PMID: 11147384 DOI: 10.1097/00008506-200010000-00008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The authors describe the technique of Asleep-Awake-Asleep anesthesia for open dorsal rhizotomy in a 78-year-old female patient, admitted to the hospital with intractable pain in the distribution of C2 dermatome following a road traffic accident. The patient was anesthetised and the rhizotomy performed using the intradural approach. Anesthesia was conducted by Total Intravenous Anesthesia using a Target Controlled Infusion system. The patient was awakened twice intraoperatively to verify success of the rhizotomy. Complete pain relief was obtained and maintained at 1 year follow-up.
Collapse
Affiliation(s)
- J P O'Shea
- Royal London Hospital, Whitechapel, United Kingdom
| | | | | |
Collapse
|
4
|
Swift PC, Turner JH, Oxer HF, O'Shea JP, Lane GK, Woollard KV. Myocardial hibernation identified by hyperbaric oxygen treatment and echocardiography in postinfarction patients: comparison with exercise thallium scintigraphy. Am Heart J 1992; 124:1151-8. [PMID: 1442480 DOI: 10.1016/0002-8703(92)90394-b] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
To evaluate the potential for hyperbaric oxygen (HBO) to produce transient improvement in function in areas of myocardium ischemic at rest (hibernating myocardium), 24 patients were studied within 1 week of acute myocardial infarction. Results were compared with single-photon emission computed tomography (SPECT) thallium-201 exercise scintigraphy. Echocardiography demonstrated improved contraction following HBO in 20 of 62 damaged left ventricular segments in 12 of 24 patients. Thirteen of the 28 segments and 9 of the 14 patients showing reversible ischemia on SPECT imaging showed improvement with HBO. There were eight segments with apparently normal resting contraction that showed a reversible thallium defect. Of 42 segments with fixed contraction abnormalities following HBO, eight had reversible thallium defects, four had normal thallium kinetics, and 30 had fixed thallium defects. Thus hyperbaric oxygen can demonstrate improvement in function in some segments of left ventricle after infarction. There is some overlap with viability as determined by thallium studies, but the two techniques may be complementary in describing myocardial ischemia.
Collapse
Affiliation(s)
- P C Swift
- Department of Cardiovascular Medicine, Fremantle Hospital, Australia
| | | | | | | | | | | |
Collapse
|
5
|
Rodriguez L, Monterroso VH, Abascal VM, King ME, O'Shea JP, Palacios IF, Weyman AE. Does asymmetric mitral valve disease predict an adverse outcome after percutaneous balloon mitral valvotomy? An echocardiographic study. Am Heart J 1992; 123:1678-82. [PMID: 1595546 DOI: 10.1016/0002-8703(92)90821-c] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- L Rodriguez
- Department of Medicine, Massachusetts General Hospital, Boston 02114
| | | | | | | | | | | | | |
Collapse
|
6
|
Risk SC, D'Ambra MN, Griffin B, Fine R, O'Shea JP. Left atrial V waves following mitral valve replacement are not specific for significant mitral regurgitation. J Cardiothorac Vasc Anesth 1992; 6:3-7. [PMID: 1543850 DOI: 10.1016/1053-0770(91)90035-r] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Left atrial or pulmonary capillary wedge pressure V waves are used immediately after mitral valve replacement to evaluate valve competence. However, their correlation with hemodynamically significant regurgitation has not been established. Transesophageal echocardiography (TEE) was used to prospectively examine whether left atrial V waves represented significant mitral regurgitation in 11 patients undergoing mitral valve replacement. Left atrial pressure V waves were measured in the immediate postcardiopulmonary bypass period by direct cannulation of the right superior pulmonary vein and recorded on a paper chart recorder. In each patient, three evaluations of mitral regurgitation by Doppler TEE were made at 15-minute intervals. In 22 of 33 evaluations, left atrial V waves with peak V wave height more than 5 mm Hg above the mean left atrial pressure were present. However, only in 3 of these periods did transesophageal echocardiography show evidence of more than trace mitral regurgitation by pulsed Doppler and color flow mapping. As indicators of mild-to-severe mitral regurgitation diagnosed by TEE, left atrial V waves had a specificity for the three evaluation periods of 40%, 30%, and 40%. Left atrial V waves with peak height greater than 5 mm Hg above mean left atrial pressure frequently appear following mitral valve replacement, but these V waves are nonspecific signs of mitral regurgitation.
Collapse
Affiliation(s)
- S C Risk
- Department of Anesthesia, Massachusetts General Hospital, Boston 02114
| | | | | | | | | |
Collapse
|
7
|
O'Shea JP, Abascal VM, Wilkins GT, Marshall JE, Brandi S, Acquatella H, Block PC, Palacios IF, Weyman AE. Unusual sequelae after percutaneous mitral valvuloplasty: a Doppler echocardiographic study. J Am Coll Cardiol 1992; 19:186-91. [PMID: 1729331 DOI: 10.1016/0735-1097(92)90071-t] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Percutaneous mitral valvuloplasty is a promising new technique for the treatment of mitral stenosis, with a relatively low complication rate reported to date. To assess the sequelae of this procedure, Doppler echocardiographic studies were prospectively performed before and after percutaneous mitral valvuloplasty in a series of 172 patients (mean age 53 +/- 17 years). After balloon dilation, mitral valve area increased from 0.9 +/- 0.3 to 2 +/- 0.8 cm2 (p less than 0.0001), mean gradient decreased from 16 +/- 6 to 6 +/- 3 mm Hg (p less than 0.0001) and mean left atrial pressure decreased from 24 +/- 7 to 14 +/- 6 mm Hg (p less than 0.0001). Although most patients were symptomatically improved, six (4%) were identified who had unusual sequelae evident on Doppler echocardiographic examination immediately after percutaneous mitral valvuloplasty. These included rupture of a posterior mitral valve leaflet, producing a flail distal leaflet portion with severe mitral regurgitation detected on Doppler color flow mapping (n = 1); asymptomatic rupture of the chordae tendineae attached to the anterior mitral valve leaflet with systolic anterior motion of the ruptured chordae into the left ventricular outflow tract (n = 1); a double-orifice mitral valve (n = 1); and evidence of a tear in the anterior mitral valve leaflet (n = 3), producing on both pulsed Doppler ultrasound and color flow mapping a second discrete jet of mitral regurgitation in addition to regurgitation through the main mitral valve orifice. All six patients made a satisfactory recovery and none has required mitral valve replacement.(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
Affiliation(s)
- J P O'Shea
- Department of Medicine, Massachusetts General Hospital, Boston 02114
| | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Abstract
The magnitude and spatial distribution of normal leakage through mechanical prosthetic valves were studied in an in vitro model of mitral regurgitation. The effective regurgitant orifice was calculated from regurgitant rate at different transvalvular pressure differences and flow velocities. This effective orifice area was 0.6 to 2 mm2 for three tilting disc prostheses (Medtronic-Hall sizes 21, 25 and 29) and 0.2 to 1.1 mm2 for three bileaflet valves (St. Jude Medical sizes 21, 25 and 33). In the single disc valves, Doppler color flow examination disclosed a prominent central regurgitant jet around the central hole for the strut, accompanied by minor leakage along the rim of the disc (central to peripheral jet area ratio 3.3 +/- 1.2). The bileaflet prostheses showed a peculiar complex pattern: in planes parallel to the two disc axes, convergent peripherally arising jets were visualized, whereas in orthogonal planes several diverging jets were seen. Mounting the disc and bileaflet valves on a water-filled tube allowed reproduction and interpretation of this pattern: for the bileaflet valve, the jets originated predominantly from valve ring protrusions that contained the axis hinge points and created a converging V pattern in planes parallel to the leaflets and a diverging V pattern in orthogonal planes. Similar patterns were observed during transesophageal echocardiography in 20 patients with a normally functioning St. Jude prosthesis. In 10 patients with a Medtronic-Hall valve, a dominant central jet was observed with one or more smaller peripheral jets. The median central to peripheral jet area ratio was 5 to 1.(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
Affiliation(s)
- F A Flachskampf
- Noninvasive Cardiac Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston
| | | | | | | | | | | |
Collapse
|
9
|
O'Shea JP, Southern JF, D'Ambra MN, Magro C, Guerrero JL, Marshall JE, Vlahakes GV, Levine RA, Weyman AE. Effects of prolonged transesophageal echocardiographic imaging and probe manipulation on the esophagus--an echocardiographic-pathologic study. J Am Coll Cardiol 1991; 17:1426-9. [PMID: 2016462 DOI: 10.1016/s0735-1097(10)80158-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Transesophageal echocardiography is being increasingly utilized in the operating room and intensive care and ambulatory settings. However, to date no data are available concerning possible trauma of the transesophageal echocardiographic technique to the esophagus due to probe insertion, manipulation or direct ultrasound energy transmission. To test the hypothesis that transesophageal manipulations caused no traumatic or thermal injury to the esophageal mucosa, 12 animals were studied with continuous transesophageal echocardiography for a period of variable duration (mean 4.6 h +/- 51 min). The study group consisted of four monkeys (mean weight 5.7 +/- 0.6 kg and eight mongrel dogs (mean weight 29.8 +/- 1.4 kg). The eight dogs were studied during right heart bypass with full heparinization for 6.6 +/- 0.2 h, whereas the four monkeys were studied for 60 to 90 min in the absence of cardiopulmonary bypass and anticoagulation. Immediately after completion of transesophageal echocardiography in each case, the esophagus was entirely excised. Detailed macroscopic and microscopic examination of the esophagus revealed no significant mucosal or thermal injury. This preliminary animal study suggests that transesophageal echocardiography is safe for the esophageal mucosa in animals as small as 5 kg in weight, despite prolonged use and in the presence of systemic anticoagulation.
Collapse
Affiliation(s)
- J P O'Shea
- Department of Pathology, Massachusetts General Hospital, Boston 02114
| | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Thomas JD, O'Shea JP, Rodriguez L, Popovic AD, Svizerro T, Weyman AE. Impact of orifice geometry on the shape of jets: an in vitro Doppler color flow study. J Am Coll Cardiol 1991; 17:901-8. [PMID: 1999627 DOI: 10.1016/0735-1097(91)90872-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
To investigate the influence of orifice geometry on the three-dimensional shape of jets, an in vitro Doppler color flow study was performed. Jets were formed by discharging blood through round orifices and through orifices with major/minor axis ratios of 2:1, 3:1 and 5:1. These were repeated with orifice areas of 0.1, 0.3 and 0.5 cm2. For turbulent and laminar jets formed by these orifices, Doppler color flow images were obtained from two orthogonal scanning planes aligned with the major and minor orifice axes. Jet width was measured at 1 cm intervals from 0 to 5 cm from the orifice and used to calculate jet eccentricity (ratio of major to minor axis widths) and the rate of divergence of the jet walls. Jets were observed to diverge more rapidly along walls aligned with the orifice minor axis rather than along the major axis. This differential spreading led to the development of circular symmetry at a short distance from the orifice. Jet divergence (theta) occurred more rapidly for turbulent jets and for jets formed by larger orifices: theta (zero) = 0.80 + 6.3.A + 7.0.T + 0.47.E-OR (r = 95, p less than 0.0001, n = 48), where A is orifice area (cm2); T is 0 for laminar jets, 1 for turbulent jets and E-OR combines orifice eccentricity and scanning orientation, ranging from -5 for 5:1 orifices imaged along the major axis, 0 for circular orifices to 5 for 5:1 orifices imaged along the minor axis. Within the jet, eccentricity decayed approximately exponentially with distance from the orifice, more rapidly for turbulent jets, more slowly for the larger and more eccentric orifices.(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
Affiliation(s)
- J D Thomas
- Noninvasive Cardiac Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston 02114
| | | | | | | | | | | |
Collapse
|
11
|
Abascal VM, Wilkins GT, O'Shea JP, Choong CY, Palacios IF, Thomas JD, Rosas E, Newell JB, Block PC, Weyman AE. Prediction of successful outcome in 130 patients undergoing percutaneous balloon mitral valvotomy. Circulation 1990; 82:448-56. [PMID: 2372892 DOI: 10.1161/01.cir.82.2.448] [Citation(s) in RCA: 177] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
We studied 130 patients undergoing percutaneous balloon mitral valvotomy. The relation between valvular morphology according to a previously described echocardiographic scoring system and hemodynamic outcome expressed as qualitative ("good" and suboptimal) and as absolute change in valve area was analyzed. The relative importance of the individual components of this echocardiographic score (valvular thickening, mobility, calcification, and subvalvular disease) to the change in valve area after valvotomy was also examined. Mean transmitral pressure gradient decreased from 16 +/- 6 to 6 +/- 3 mm Hg (p less than 0.0001), and mitral valve area increased from 0.9 +/- 0.3 to 1.8 +/- 0.7 cm2 (p less than 0.0001). Results in individual patients were variable. Eighty-four percent (61 of 73) of patients with an echocardiographic score of 8 or less had a "good" outcome (final valve area greater than or equal to 1.5 cm2 and an increase in valve area of greater than or equal to 25%), whereas 58% (33 of 57) of patients with an echocardiographic score of 8 or more had a suboptimal result (p less than 0.001). The sensitivity of an echocardiographic score of 8 or less for predicting a "good" outcome was 72%, and the specificity was 73%. The echocardiographic score correlated negatively (r = -0.40, p less than 0.0001) with the absolute increase in mitral valve area after valvotomy, but there was substantial scatter in the data. Of the four components of the total echocardiographic score, valvular thickening correlated best with the absolute change in value area (r = -0.47, p less than 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
Affiliation(s)
- V M Abascal
- Department of Medicine, Massachusetts General Hospital, Boston 02114
| | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Abstract
Percutaneous mitral balloon valvuloplasty was performed in 150 patients. There were 124 women and 26 men (mean age 53 +/- 1 years). A left to right shunt through the created atrial communication was present in 28 patients (19%) after valvuloplasty. The pulmonary to systemic flow ratio was greater than or equal to 2:1 in 4 patients and less than 2:1 in 24. Univariate predictors of left to right shunting after valvuloplasty included older age (p less than 0.01), lower cardiac output before mitral valvuloplasty (p less than 0.01), higher New York Heart Association functional class before valvuloplasty (p less than 0.05), presence of mitral valve calcification under fluoroscopy (p less than 0.01) and higher echocardiographic score (p less than 0.05). Multiple stepwise logistic regression analysis identified the presence of mitral valve calcification (p less than 0.02) and lower cardiac output (p less than 0.02) as the independent predictors of a left to right shunt through the atrial communication after balloon valvuloplasty. Follow-up (10 +/- 1 months) of patients with an atrial septal defect after valvuloplasty showed that 1) 6 patients died (3 in the hospital and 3 at 2, 16 and 18 months, respectively, after valvuloplasty); 2) an atrial septal defect was demonstrated in 3 of 6 patients who underwent mitral valve replacement (6 +/- 0.8 months after valvuloplasty); and 3) 13 patients were in functional class I, 2 patients were in class II and 1 patient was in class III at 13 +/- 1 months after valvuloplasty.(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
Affiliation(s)
- P Casale
- Department of Medicine (Cardiac Unit), Massachusetts General Hospital, Harvard Medical School, Boston 02114
| | | | | | | |
Collapse
|
13
|
Affiliation(s)
- C Risk
- Department of Anesthesia, Massachusetts General Hospital, Boston
| | | | | | | |
Collapse
|
14
|
Thomas JD, Liu CM, Flachskampf FA, O'Shea JP, Davidoff R, Weyman AE. Quantification of jet flow by momentum analysis. An in vitro color Doppler flow study. Circulation 1990; 81:247-59. [PMID: 2404625 DOI: 10.1161/01.cir.81.1.247] [Citation(s) in RCA: 126] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Previous investigations have shown that the size of a regurgitant jet as assessed by color Doppler flow mapping is independently affected by the flow rate and velocity (or driving pressure) of the jet. Fluid dynamics theory predicts that jet momentum (given by the orifice flow rate multiplied by velocity) should best predict the appearance of the jet in the receiving chamber and also that this momentum should remain constant throughout the jet. To test this hypothesis, we measured jet area versus driving pressure, flow rate, velocity, orifice area, and momentum and showed that momentum is the optimal jet parameter: jet area = 1.25 (momentum).28, r = 0.989, p less than 0.0001. However, the very curvilinear nature of this function indicated that chamber constraint strongly affected jet area, which limited the ability to predict jet momentum from observed jet area. To circumvent this limitation, we analyzed the velocities per se within the Doppler flow map. For jets formed by 1-81-mm Hg driving pressure through 0.005-0.5-cm2 orifices, the velocity distribution confirmed the fluid dynamic prediction: Gaussian (bell-shaped) profiles across the jet at each level with the centerline velocity decaying inversely with distance from the orifice. Furthermore, momentum was calculated directly from the flow maps, which was relatively constant within the jet and in good agreement with the known jet momentum at the orifice (r = 0.99). Finally, the measured momentum was divided by orifice velocity to yield an accurate estimate of the orifice flow rate (r = 0.99). Momentum was also divided by the square of velocity to yield effective orifice area (r = 0.84). We conclude that momentum is the single jet parameter that best predicts the color area displayed by Doppler flow mapping. Momentum can be measured directly from the velocities within the flow map, and when combined with orifice velocity, momentum provides an accurate estimate of flow rate and orifice area.
Collapse
Affiliation(s)
- J D Thomas
- Noninvasive Cardiac Laboratory, Massachusetts General Hospital, Boston 02114
| | | | | | | | | | | |
Collapse
|
15
|
Affiliation(s)
- J P O'Shea
- Department of Cardiac Ultrasound, Massachusetts General Hospital, Boston
| | | |
Collapse
|
16
|
Abstract
The cardiovascular autonomic function of 13 boys with Duchenne muscular dystrophy was examined in order to test the hypothesis that the labile sinus tachycardia of that disorder is due to autonomic dysfunction. Five non-invasive procedures evaluated the responses of heart rate and blood pressure to postural change, the Valsalva maneuver, sustained hand grip and deep breathing. No individual had sufficient evidence of autonomic dysfunction. Most tests were normal (76%), 16% were borderline, and 8% were abnormal. None had more than one abnormal test. Although most had some difficulty with the Valsalva maneuver, the study demonstrated that simple clinical non-invasive testing of autonomic function can be carried out on a young severely handicapped population.
Collapse
Affiliation(s)
- G Miller
- Division of Pediatric Neurology, Milton S. Hershey Medical Center, Hershey, PA 17033
| | | | | |
Collapse
|
17
|
Abstract
A total of 18 male patients with Duchenne muscular dystrophy (DMD), aged 8-29 years (mean, 15.7 years), were prospectively studied to assess the cardiomyopathy associated with DMD, using clinical parameters and noninvasive cardiovascular investigations: electrocardiogram (ECG), Holter monitoring, and echocardiography. In addition, five clinical tests of cardiovascular autonomic function were used to assess the role of the autonomic nervous system in the pathogenesis of dysrhythmias. The majority of subjects were asymptomatic, but four had abnormal physical findings. All had abnormal ECG, the commonest abnormality (in 16) being tall R waves or increased R/S ratios in the right precordial leads; 14 had abnormal findings on echocardiography, including three with poor left ventricular function and five with mitral valve prolapse (MVP). Labile abrupt sinus tachycardia was present in 11, and four had high-grade ventricular ectopy. None had definite clinical evidence of autonomic dysfunction. The cardiomyopathy of DMD appears to be unrelated to disease severity. However, abnormal Q waves or Q/R ratios in ECG leads I, aVL9 and V5-V6 are significantly related to young age (p less than 0.05), and high-grade ventricular ectopy occurred significantly more frequently (p less than 0.05) in older subjects (greater than 15 years). Dysrhythmias were not related to the presence of MVP, poor left ventricular function, or autonomic dysfunction.
Collapse
Affiliation(s)
- L D'Orsogna
- Princess Margaret Hospital for Children, Queen Elizabeth II Medical Centre, Perth, Western Australia
| | | | | |
Collapse
|
18
|
Allen JM, Williams G, O'Shea JP, Smith C, Yeo T, Kerle D, Bloom SR. The effect of previous endocrine therapy on responses to a single dose of an LHRH analogue. Urol Res 1984; 12:249-51. [PMID: 6240150 DOI: 10.1007/bf00256149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Serum concentrations of gonadotropins, testosterone and dehydrotestosterone were determined in patients receiving conventional endocrine therapy for advanced metastatic adenocarcinoma of prostate. The effect over 4 h of a single dose of a long acting analogue of LHRH was determined in these patients and compared to the response in patients receiving the analogues as first choice of treatment. Oestrogen therapy was found to suppress basal and stimulated gonadotropins and testicular androgens. Cyproterone therapy only partially reduced basal hormone concentrations and the response to the LHRH analogue was delayed. Orchidectomy resulted in elevated gonadotropins and an exaggerated response to the analogue. As patients who relapse while failing conventional therapy, may subsequently be treated by further endocrine manipulation, precise determination of their endocrine status should predict any expected benefit. Patients previously treated with stilboestrol are unlikely to respond to orchidectomy or LHRH analogue.
Collapse
|
19
|
Sanburg A, O'Shea JP, Dusci L. Chemical stability of lignocaine and glyceryl trinitrate infusion solutions. Med J Aust 1984; 140:723. [PMID: 6427566 DOI: 10.5694/j.1326-5377.1984.tb108363.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
|
20
|
Abstract
Fifteen patients with advanced carcinoma of the prostate were treated with a luteinising hormone releasing hormone agonist ICI 118 630. Three of 5 patients who had failed conventional hormone therapy have had a marked alleviation of bone pain, though no objective evidence of disease regression. Nine of 10 patients previously untreated have shown objective evidence of disease response. This drug appears to have advantages over conventional hormone therapy.
Collapse
|
21
|
Allen JM, O'Shea JP, Mashiter K, Williams G, Bloom SR. Advanced carcinoma of the prostate: treatment with a gonadotrophin releasing hormone agonist. Br Med J (Clin Res Ed) 1983; 286:1607-9. [PMID: 6221774 PMCID: PMC1547931 DOI: 10.1136/bmj.286.6378.1607] [Citation(s) in RCA: 70] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Ten patients with advanced progressive adenocarcinoma of the prostate were treated with a long acting analogue of gonadotrophin releasing hormone. Eight of these patients responded to treatment in terms of pain relief and clinical regression of tumour. Serum gonadotrophin and testosterone concentrations were significantly suppressed by the end of the second week of treatment, testosterone concentrations being comparable with those achieved by castration. The two patients who failed to respond had both relapsed previously when receiving conventional treatment, and neither showed any endocrine response to the analogue. Superagonists of gonadotrophin releasing hormone may be the treatment of choice in adenocarcinoma of the prostate, but further trials are required to establish long term safety and efficacy.
Collapse
|
22
|
Abstract
At the age of 50 the author, a former competitive weight lifter, undertook a year-long training program to see how much of his former strength could be regained.
Collapse
|
23
|
Abstract
In brief: The development of optimal strength potential in American female athletes has been neglected. This study documents the response of 13 men and 13 women of college age to an intensive power lifting program designed to duplicate a program followed by competitive male lifters. The results identified two significant training concepts: (1) the full squat must be considered the cornerstone exercise, because it quickly stimulates overall strength increases in both men and women, and (2) the women had the same physiological ability as men to tolerate and adapt to the demanding physical stress of power lifting.
Collapse
|
24
|
O'Shea JP, Swift LC. Industrial action in pathology departments. Health Serv Manpow Rev 1980; 6:22-5. [PMID: 10295057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
|
25
|
Abstract
Twelve matched pairs of subjects, fed a high protein diet, were trained with weights for 6 weeks. In the final 3 weeks twelve subjects received 5 milligrams of methandrostenolone (Dianabol) twice daily. Maximum weight lifting, thickness of skin folds, oxygen uptake, blood chemistry profile, and concentration of blood lipids were determined. Also used were cable tensiometry and anthropometric measurements. The strength of treated subjects increased significantly; their mean weight gain was 2.48 kilograms with no significant change in skin fold thickness. Several anthropometric measurements increased significantly, as did oxygen uptake ability and nitrogen retention by the blood.
Collapse
|
26
|
O'Shea JP. National Health Service. West J Med 1948. [DOI: 10.1136/bmj.1.4561.1106-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
27
|
O'Shea JP. National Health Service. West J Med 1948. [DOI: 10.1136/bmj.1.4542.172-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
28
|
|