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C Mulholland

Publications and source records attributed to C Mulholland.

17 recordsLinked to original sources
PubMed2006

Determinants of neuropsychological and behavioural outcomes in early childhood survivors of congenital heart disease.

AIMS: To evaluate the relative effect of cyanosis, surgical interventions and family processes on neuropsychological and behavioural outcomes in 4-year-old survivors of serious congenital heart disease (CHD). METHODS: 90 children with a range of cyanotic and acyanotic conditions, who underwent either corrective or palliative surgery, completed a neuropsychological and behavioural evaluation. Families of participants were also profiled by evaluation of maternal mental health, worry, social support, parenting style and family functioning. RESULTS: Compromised neuropsychological outcomes were associated with a combination of cyanotic conditions and open-heart surgery, but this was not exacerbated by having a complex, palliative, status. Both cyanotic and acyanotic conditions were associated with specific sensorimotor delays, regardless of method of the correction. Only children with complex conditions and palliative interventions seemed at risk of poor behavioural outcomes; indeed, children with cyanosis with complete repair showed favourable behavioural outcomes compared with controls. Multivariate analyses highlighted the sometimes greater relevance of family processes (eg parenting style, maternal mental health and worry), rather than disease or surgical factors, in predicting especially behavioural outcomes. CONCLUSIONS: The findings (1) suggest a more complex relationship between cyanosis, surgical methods of correction, neuropsychological and behavioural outcomes than previously charted, (2) highlight that family processes may be aetiologically more important than disease and surgical factors, and (3) indicate specific targets for secondary prevention programmes for this at-risk population.

Anxiety↗
PubMed2004

Pilonidal sinus of the penis.

A pilonidal sinus is a subcutaneous sinus containing hair. It is most commonly found in the natal cleft of hirsute men. Here we describe the unusual finding of a pilonidal sinus arising on the male foreskin.

Humans↗
PubMed2000

Depressive symptoms in stable chronic schizophrenia: prevalence and relationship to psychopathology and treatment.

The prevalence and correlates of the depressive syndrome were explored in a population of 120 patients with stable, chronic schizophrenia living in the community. The presence of clinically significant depressive symptoms was defined by a score of 17 or greater on the Beck Depression Inventory. Patients were examined to assess severity of schizophrenic symptoms and medication side-effects. Sixteen of the 120 patients (13.3%) had significant depressive symptoms. Depressive symptoms were significantly correlated with the hostility/suspiciousness (P<0.0001), the positive symptom (P=0.0009) factor of the BPRS and with scores on the Significant Others Scale, a measure of patients' perceived lack of social support (P=0.0004). The association between depression and akathisia approached significance (P=0.007). There was no correlation with demographic variables, alcohol intake, antipsychotic dosage or anticholinergic dosage. Using a scale that rates the subjective aspects of the depressive syndrome, we found no evidence of a relationship between depression and negative symptoms in this population. These results indicate that persistent depressive symptoms in stable patients in the community are related to the degree of persistent positive psychotic symptoms, patient perceptions of social support and, weakly, to the degree of akathisia but not other aspects of antipsychotic treatment.

Adolescent↗
PubMed1998

Gastro-intestinal complications following neonatal cardiac catheterisation.

BACKGROUND: Infants with congenital cyanotic heart disease are at increased risk of developing necrotising enterocolitis (NEC). We examined a cohort of infants with congenital cyanotic heart disease in order to assess the role of cardiac catheterisation in the pathogenesis of NEC. METHODS: Sixty-five infants with congenital cyanotic heart disease were assessed in a retrospective study. The incidence of gastrointestinal complications was compared between infants who required cardiac catheterisation and those who did not. RESULTS: There were 38 infants who required cardiac catheterisation and 27 who did not. Both groups were similar for known risk factors for NEC. Eleven of the catheterised infants developed bloody stools versus 4 of the non-catheterised infants (OR 2.34; 95% CI 0.65-8.36). Five of the catheterised infants developed classical NEC versus none of the non-catheterised infants (OR 4.24; 95% CI 0.47-38.5). Four of the five infants who developed NEC did so during re-introduction of feeds following cardiac catheterisation. CONCLUSION: Infants with congenital cyanotic heart disease appear to be at a greater risk of gastrointestinal complications including necrotising enterocolitis in the days following cardiac catheterisation. We suggest a more cautious approach to feeding is required during this period.

Cardiac Catheterization↗
PubMed1996

Regional variations in the utilization rate of vaginal and abdominal hysterectomies in the United Kingdom.

BACKGROUND: Large geographic variations in hysterectomy rates are well known; however, very little is known about geographic variations in the route of the procedure, i.e. whether it is performed abdominally or vaginally. We compared utilization rates for abdominal and vaginal hysterectomies for the 14 Regional Health Authorities of England, and Northern Ireland over a three-year period. METHODS: Data were collected in the form of hospital episode statistics and small area analysis techniques were used to document regional variations. RESULTS: Large regional differences in the utilization of vaginal hysterectomies were recorded. Three areas in particular (Northern Ireland, Yorkshire and NW Thames) displayed high vaginal to abdominal ratios. Northern Ireland recorded the highest ratio (0.366), Mersey Regional Health Authority the lowest (0.139). The use of the vaginal route was found to increase with age, and was the most common route for the > 65 years age group. CONCLUSION: Despite an increasing volume of evidence advocating the use of the vaginal route, there appears to be a resistance to its use, except in older women. The role of physician practice style, and in particular group clinical judgement, is highlighted as being significantly involved in explaining the observed geographic variations.

Adult↗
PubMed1996

Total radical trapping antioxidant potential (TRAP) and exercise.

The relationship between physical activity, physical fitness and total radical trapping antioxidant potential (TRAP) was examined in the Northern Ireland Health and Activity Survey. This was a cross-sectional population study (n = 1600) using a two-stage probability sample of the population. TRAP was calculated using the sum of the individual serum antioxidant concentrations (urate, protein thiols, ascorbate, alpha tocopherol and bilirubin) multiplied by their respective stoichiometric values. Physical fitness was determined by estimation of VO2max by extrapolation from submaximal oxygen uptake, and physical activity was recorded by computer-assisted interview. Mean serum TRAP concentrations were significantly higher in males (653 +/- 8.2 mumol/l, mean +/- SEM) compared to females (564 +/- 8.0 mumol/l) (p < 0.0001). Both male and female smokers had significantly lower TRAP values than non-smokers (males p < 0.0001, females p = 0.02). In females, there was a positive relationship of TRAP with age (p < 0.001) and body mass index (p < 0.001) but a negative relationship with physical fitness (p < 0.05). The known beneficial effects of exercise and activity do not appear to be directly mediated through increased antioxidant status.

Adolescent↗
PubMed1994

Ascorbate and malondialdehyde in stroke patients.

It is believed that free radical formation and subsequent oxidative damage in the form of lipid peroxidation may be a factor in the cerebral damage secondary to the ischaemia of a cerebrovascular accident (CVA). Total serum ascorbate and malondialdehyde (MDA) were measured in 45 patients with CVA on the day of admission to hospital (Time 0) and 48 hours later (Time 48 hours) and also in 45 age and sex matched controls. There was no statistical difference in total serum ascorbate between the control group (34.2 mumol/l +/- 3.1, mean +/- SEM) and the CVA patients at Time 0 (37.3 +/- 2.9) but there was a statistically significant decrease at Time 48 hours (22.7 +/- 2.0) (p < 0.001) in the CVA patients. With MDA there was no statistical difference between the patients at Time 0 (0.79 mumol/l +/- 0.06) and the control group (0.83 +/- 0.06) but there was a significant increase at Time 48 hours (1.65 +/- 0.08) (p < 0.001). These findings are in keeping with possible evidence of free radical damage in CVA.

Aged↗
PubMed1994

Ascorbate and exercise in the Northern Ireland population.

The relationship between physical activity, physical fitness and serum ascorbate was examined in the Northern Ireland Health and Activity Survey. This was a cross sectional population study (n = 1600), using a two stage probability sample, of the population of N. Ireland. Physical activity profile was recorded by computer assisted interview and physical fitness was determined by estimation of VO2 max by extrapolation from submaximal oxygen uptake. Serum ascorbate was measured using a colorimetric reaction of 2,4 dinitrophenylhydrazine with dehydroascorbate. Mean serum ascorbate was greater in females than males (p < 0.001), and was lower in smokers than non-smokers in both males (p = 0.01) and females (p < 0.001). There was no statistically significant relationship between serum ascorbate and age, social class, body mass index, physical activity or physical fitness in males but there was a relationship with age (p < 0.01) and physical fitness (p < 0.05) in females.

Adolescent↗
PubMed1994

The need for closer control of warfarin therapy.

Warfarin therapy is associated with a variety of haemorrhagic complications. We report a representative series of six cases of warfarin-induced bleeding in non-cerebral sites admitted to one unit. In all of these cases, there was inadequate control of anticoagulation, resulting in major morbidity and one death. In particular, closer attention must be paid to the indications for and duration of warfarin treatment.

Aged↗
PubMed1988

Massive pulmonary embolism; the place for embolectomy.

Untreated massive pulmonary embolism is associated with a high mortality. Pulmonary embolectomy has been largely superceded by thrombolytic therapy, but there are cases in which pulmonary embolectomy remains the treatment of choice. We present three case reports and discuss the merits of the various treatments available for massive pulmonary embolism. The primary treatment of massive pulmonary embolism should be thrombolytic therapy, but for patients who are at risk of haemorrhage following surgery, who are in cardiogenic shock despite medical treatment, or fail to improve following cardiac arrest, then pulmonary embolectomy remains the treatment of choice.

Aged↗
PubMed1983

Human polyomavirus in pregnancy. A model for the study of defence mechanisms to virus reactivation.

We have carried out a longitudinal study of human polyomavirus infection in 71 pregnant women and correlated the virological findings with changes in the defence system in the same patients. As reactivation of human polyomaviruses generally occurred late in the second trimester it was possible to distinguish between the immunological changes which preceded the onset of reactivation and those which were secondary to the infection. Evidence of reactivation was detected in 26 women; all had high or rising antibody titres against BK or JC virus, but only five of these developed viruria. A positive correlation was observed between a high monocyte count in early pregnancy and subsequent virus reactivation. The virus excretors had significantly lower neutrophil counts than the women who had no evidence of virus reactivation. In contrast, women with serological evidence of virus activity but no viruria has significantly higher neutrophil counts than the non-activators. They also had stronger lymphocyte responses to PHA than the virus excretors. Virus activators were found to have a significant lymphopenia in the third trimester compared to the non-activators. High antibody levels did not appear to inhibit virus excretion. These findings suggest that monocytosis may predispose to reactivation of human polyomaviruses in pregnancy. On the other hand, ability to contain the virus once it has been activated, was associated with neutrophilia, and relatively vigorous in vitro reactivity of lymphocytes to PHA. Persistent lymphopenia was probably secondary to virus reactivation. The model on which this study is based could be adapted to investigate the causes of reactivation of other viruses. It may also help to identify risk factors in patients who are particularly susceptible to infection with opportunistic viruses.

Animals↗
PubMed1983

A longitudinal study of leucocyte blood counts and lymphocyte responses in pregnancy: a marked early increase of monocyte-lymphocyte ratio.

Seventy-seven pregnant women were studied repeatedly from the first trimester until 4 weeks after delivery. Neutrophil count was increased but constant in all stages of pregnancy. In contrast, there was a marked increase in monocyte numbers in the first and early second trimester, followed by a gradual decrease towards normal before term. A progressive decrease in total lymphocyte count was observed up to 25-28 weeks, when it increased again, although not reaching the non-pregnant level before term. These fluctuations in monocyte and lymphocyte numbers have not been described before and could explain contradictory findings of previous studies. They may also be important in relation to the mechanisms which prevent rejection of the fetal allograft. Absolute T cell counts were not significantly decreased, but a striking reduction was observed in B cell numbers in early pregnancy. Lymphocyte response to T cell mitogens was decreased throughout pregnancy. It is concluded that immunological studies of pregnancy must take account of the dynamic nature of this condition.

B-Lymphocytes↗
PubMedDate not supplied

An unusual case of delusional misidentification: 'delusional hermaphroditism'.

A 44-year-old man presented with an unusually colourful and complex form of delusional misidentification. He demonstrated Fregoli syndrome, environmental reduplication and the delusional belief that he and a female friend had been incorporated into the same body. This latter phenomenon has not been described before and adds a new dimension to the rich variety of these syndromes. It is suggested that the term 'delusional hermaphroditism' be used to describe this form of delusional misidentification.

Adult↗