PubMed Health⌕ Search

Biomedical subjects

D Mulvihill

Publications and source records attributed to D Mulvihill.

14 recordsLinked to original sources
PubMed1995

Sonographic investigation of female infants with inguinal masses.

We present three cases of indirect inguinal hernias occurring in female infants aged between six weeks and two months. In each case ovarian tissue was identified sonographically within the herniated tissues. All cases presented with tender masses within the labia majora. This relatively common clinical condition should be high on the list of differential diagnoses of inguinal masses in female infants. Early recognition of an ovary decreases the risk of infarction plus the sonographic detection of ovarian tissue is diagnostic in gender differentiation of infants with ambiguous genitalia.

Choristoma↗
PubMed1990

True incidence of pacemaker syndrome.

Although the purported incidence of pacemaker syndrome according to the literature is only 5%-15%, this is based on a series of patients with VVI pacing. Increasing numbers of studies are being reported in which patients prefer the dual chamber mode despite little benefit being demonstrated on objective testing, suggesting that pacemaker syndrome may be more common than is generally reported. This study was designed to evaluate the reported symptoms in a series of patients programmed to both the VVI and one or more dual chamber modes. Forty unselected patients with dual chamber pacemakers were entered into a blind, randomized trial comparing the symptoms associated with VVI pacing to those associated with dual chamber pacing. Patients were randomized to either VVI or dual chamber pacing. At the end of 1 week, questionnaires rating 16 different symptoms were completed. Blood pressure, LV function, presence of ventriculoatrial conduction, and ability to override the pacemaker were evaluated. The pacemaker was then programmed to the other mode. Overall, 12 of 16 symptoms were significantly worse in the VVI as compared to dual chamber mode. The most highly significant (P less than 0.005) were shortness of breath, dizziness, fatigue, pulsations in the neck or abdomen, cough, and apprehension. Pacemaker syndrome was clinically recognized in 83% of patients paced in the VVI mode with 65% of patients experiencing moderate to severe symptoms. There were no readily identified clinical, hemodynamic, or electrophysiological parameters that predicted which patients would develop pacemaker syndrome. Thus, when patients have an opportunity to experience both pacing modes in close proximity to one another, there is a high incidence of pacemaker syndrome in the VVI mode.

Aged↗
PubMed1989

Exercise-induced ST segment depression in the diagnosis of multivessel coronary disease: a meta analysis.

To evaluate the variability in the reported accuracy of the exercise electrocardiogram (ECG) for predicting severe coronary disease, meta analysis was applied to 60 consecutively published reports comparing exercise-induced ST depression with coronary angiographic findings. The 60 reports included 62 distinct study groups comprising 12,030 patients who underwent both tests. Both technical and methodologic factors were analyzed. Wide variability in sensitivity and specificity was found (mean sensitivity 81% [range 40% to 100%, SD 12%]; mean specificity 66% [range 17% to 100%, SD 16%]). All three variables found to be significantly and independently related to sensitivity were methodologic (the exclusion of patients with right bundle branch block, the comparison with another exercise test thought to be superior in accuracy and the exclusion of patients taking digitalis). Exclusion of patients with right bundle branch block and comparison with a "better" exercise test were both significantly associated with sensitivity for the prediction of triple vessel or left main coronary artery disease. Adjustment of exercise-induced ECG changes for changes in heart rate was strongly associated with the specificity for critical disease (partial R2 = 0.436, p = 0.0001).

Coronary Angiography↗
PubMed1989

Intrarenal abscess caused by Klebsiella pneumoniae in a neonate: modern management and diagnosis.

We recently cared for a 12-day-old infant who was hospitalized for renal abscess caused by Klebsiella pneumoniae, an organism not identified as etiologic in the three newborns described to date with this disorder. The advent of cross-sectional diagnostic imaging techniques, specifically ultrasonography and computed tomography (CT), has changed the management of renal abscess in children and neonates. Ultrasonography is the diagnostic procedure of choice, but CT is another reliable imaging modality, particularly if there is spread of the abscess outside the kidney. Whether surgery is necessary for a resolution of renal abscess remains controversial. However, percutaneous aspiration under diet ultrasonographic or CT guidance has replaced routine exploration and deroofing of the abscess and therefore made the management of renal abscess achievable by simpler, less invasive techniques.

Abscess↗
PubMed1989

Exercise-induced ST depression in the diagnosis of coronary artery disease. A meta-analysis.

To evaluate the variability in the reported diagnostic accuracy of the exercise electrocardiogram, we applied meta-analysis to 147 consecutively published reports comparing exercise-induced ST depression with coronary angiography. These reports involved 24,074 patients who underwent both tests. Population characteristics and technical and methodologic factors, including publication year, number of electrocardiographic leads, exercise protocol, use of hyperventilation, definition of an abnormal ST response, exclusion of certain subgroups, and blinding of test interpretation were analyzed. Wide variability in sensitivity and specificity was found (mean sensitivity, 68%; range, 23-100%; SD, 16%; and mean specificity, 77%; range, 17-100%; SD, 17%). The four study characteristics found to be significantly and independently related to sensitivity were the treatment of equivocal test results, comparison with a "better" test such as thallium scintigraphy, exclusion of patients on digitalis, and publication year. The four variables found to be significantly and independently related to specificity were the treatment of upsloping ST depressions, the exclusion of subjects with prior infarction or left bundle branch block, and the use of preexercise hyperventilation. Stepwise linear regression explained less than 35% of the variance in sensitivities and specificities reported in the 147 publications. There is wide variability in the reported accuracy of the exercise electrocardiogram. This variability is not explained by information reported in the medical literature.

Coronary Disease↗
PubMed1987

Risk of developing complete heart block during bedside pulmonary artery catheterization in patients with left bundle-branch block.

We examined the incidence of complete heart block (CHB) as a complication of pulmonary artery catheterization with balloon-tipped, flow-directed catheters in patients with left bundle-branch block (LBBB). The study group included 47 consecutive critically ill patients with LBBB in the medical intensive care and coronary care units, who underwent a total of 82 pulmonary artery catheterizations. Twenty-six patients had an acute myocardial infarction, 34 patients had severe congestive heart failure (Killip class III or class IV), and 15 patients died during their hospitalization. Thirty patients had an old LBBB (more than one month in age), nine patients had a new LBBB, and the age of the LBBB was indeterminate in eight patients. There were five episodes of CHB in the group of patients with old LBBB. However, none of these episodes were related to the pulmonary artery catheterization, since CHB occurred either prior to catheterization (one case) or from one to 16 days after the pulmonary artery catheter had been removed (four cases). There were no episodes of CHB related to the pulmonary artery catheterization procedure in the patients with either old LBBB or indeterminate-aged LBBB. There were two episodes of CHB in patients with new LBBB. In both patients, the CHB occurred one day after the pulmonary artery catheter had been inserted. In both patients, CHB developed after episodes of ventricular tachycardia that eventually resulted in their deaths. Although it is unlikely, we could not rule out the possibility that the CHB was related to the presence of the pulmonary artery catheter. We conclude that the incidence of CHB complicating pulmonary artery catheterization with balloon-tipped, flow-directed catheters in critically ill patients with old or indeterminate-aged LBBB is extremely low. Therefore, we do not recommend the routine placement of a temporary transvenous pacemaker in all patients with LBBB prior to pulmonary artery catheterization.

Aged↗
PubMed1984

The effectiveness of child psychiatric inpatient care.

After 900 admissions there is evidence that the programme for the inpatient hospitalization of psychiatrically ill children for a pre-determined period, can provide effective treatment. The time limited aspect appears to maximize the utilization of staff and family time. Parents' reports, rating scale information and assessments of outcome seem to agree that most children benefit. While hospitalizing the most difficult cases, the 29 day stay, 2% referral rate to foster homes and 7% re-admission rate of this unit, compares favourably with other child psychiatric units.

Adolescent↗
PubMed1979

Chronic and occult stool retention: a clinical tool for its evaluation in school-aged children.

A scoring method was developed to assess severity of stool retention using plain abdominal radiographs. To determine whether the technique was clinically valid in identifying chronic stool retention, the method was used to evaluate films taken of children with known stool retention before and after therapy. The method showed significant statistical differences between symptomatic pre-therapy films and controls and between pre- and post-therapy films of treatment "successes." No significant differences were found between pre- and post-therapy "failures." Use of radiographs is not a substitute for careful history taking and examination, but this scoring method for evaluating stool retention can be recommended prior to more extensive, invasive investigations in children presenting with functional abdominal complaints.

Abdomen↗
PubMed1979

Radiographic evaluation of the spine after surgical correction of scoliosis.

Scoliosis is frequently a progressive deformity despite the best efforts at external bracing and various exercises. In childhood, scoliosis is usually insidious and is rarely symptomatic. In later years, however, scoliosis leads to cardiopulmonary compromise, neurologic dysfunction, degenerative joint disease, and cosmetic deformities. Therefore, surgical correction is indicated in selected patients. Internal fixation with spinal fusion is more effective than fusion alone. Postoperative radiographs must be examined closely for general as well as orthopedic complications. Loss of correction and failure of hardware are signs of pseudarthrosis. Radiographic follow-up evaluation should include two views whenever possible.

Bone Nails↗
PubMedDate not supplied

Coexisting endogenous lipoid pneumonia, cholesterol granulomas, and pulmonary alveolar proteinosis in a pediatric population: a clinical, radiographic, and pathologic correlation.

Benign pulmonary diseases that have been associated with the accumulation of endogenous lipids within the alveoli, bronchioles, and interstitial tissues include endogenous lipoid pneumonia (ELP), pulmonary alveolar proteinosis (PAP), pulmonary interstitial and intra-alveolar cholesterol granulomas (PICG), various xanthomatous lesions, and malakoplakia. In ELP, fat-filled finely vacuolated macrophages fill the alveoli. In PAP, the aveoli become filled with cholesterol and periodic acid-Schiff (PAS)-positive acellular debris. In PICG, cholesterol esters are released from degenerating macrophages and, as organization occurs, the cholesterol is deposited in the form of acicular clefts within the interstitium. These morphologically distinct presentations of endogenous lipid deposition within the lung have long been thought to represent unique disease processes but several authors now postulate a possible relationship between these entities. We report here on the clinical, radiographic, and morphologic findings in eight pediatric patients with diverse primary disease processes who were subsequently found to have varying and often coexisting degrees of ELP, PAP, and PICG.

Adolescent↗