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Biomedical subjects

G C O'Toole

Publications and source records attributed to G C O'Toole.

7 recordsLinked to original sources
PubMed2005

Traumatic lower limb fractures following complete spinal cord injury.

Patients with complete spinal cord injury experience a rapid bone mineral density loss that places them at an increased risk of lower limb fracture following trivial injury. We aimed to establish if spinal cord injured patients treated at our unit have an increased incidence of lower limb fracture, and if so to identify a cohort of patients who may benefit from prophylactic treatment to preserve bone mineral density. We reviewed 158 patients treated between January 1994 and July 2002. There was a significantly increased incidence of lower limb fracture in patients with complete spinal cord injury (5 fractures in 4 patients), when compared to the cohort of patients with spinal injury who subsequently attained mobility (no fractures). Prophylactic bisphosphonates reduce disuse osteopenia and warrant prospective assessment in patients with complete spinal cord injury in whom they may confer a protective effect against lower limb fracture.

Adult↗
PubMed2003

The effect of leg length discrepancy on foot loading patterns and contact times.

The effect of a simulated leg length discrepancy on foot loading patterns and gait cycle times in normal individuals was investigated. Thirty feet of 15 normal volunteers were evaluated. Leg length discrepancy was simulated using flexible polyurethane soles. As leg length discrepancy increased, the total loading increased from 35.31 to 37.99 kg/cm2/sec, forefoot loading increased from 15.58 to 19 kg/cm2/sec, hindfoot loading remained the same. All subjects, except females with middle loading patterns, demonstrated increased hallux loading. The contact phase of gait decreased from 22% to 13%, the midstance phase remained the same, the propulsion phase increased from 44% to 50%. All findings were statistically significant. Leg length discrepancy has significant effects on the foot. Different adaptive loading patterns amongst subsets of individuals are seen.

Adaptation, Physiological↗
PubMed2002

Elective total hip arthroplasty in patients aged 85 years and older.

Previous reports indicate that elderly patients suffer more complications than younger patients undergoing total hip arthroplasty (THR). We reviewed 60 consecutive elderly patients undergoing THR. Statistical comparisons were made with a control group of patients. The average age was 86.6 (range 85-92) years. Pre-operative D'Aubigne-Postel Score averaged 8.4 (range 1-14) points, post-operative D'Aubigne-Postel Score averaged 13.1 (range 9-18) points. Compared to the control group, elderly patients had an increased intra-operative blood loss, increased blood transfusion rates, (p=0.0005) and a longer hospital stay (p = 0.0002). Comparing D'Aubigne-Postel scores, there was no significant difference between the two groups (p<0.001). We conclude that THR in elderly patients is a safe procedure and leads to functional improvements similar to those seen in younger counterparts.

Aged↗
PubMed2001

A critical appraisal of the out-patient fracture clinic: is communication really the key?

The most common factor in an adversarial doctor-patient relationship is failed communication. We audited our communication skills, patient satisfaction and assessed patients' capacity for retaining information. 120 consecutive first time patients with one of 5 fracture types were assessed. Patients scored (a) the doctor's communication skills and (b) their overall fracture clinic experience. Patient satisfaction was high, mean 8.2 (range 2-10, SD 1.76) points. There was a statistically significant difference in a patient's knowledge pre and post consultation. Forty-three patients (36%) could recall a specific consequence of the fracture (p<0.005). Forty (31%) and twenty six (22%) patients could recall the name of the Registrar and Consultant respectively. Doctors scored 9.2 (range 7-10, SD 1.23) points for communication skills. Patients are concerned with a fracture's impact on daily activities, often failing to register who treats them and any serious consequences. With doctors being scored so highly, the dilemma remains of how better to deliver the message.

Ambulatory Care↗
PubMed1999

Defunctioning loop ileostomy: a prospective audit.

BACKGROUND: Defunctioning loop ileostomies are uncommonly used forms of fecal diversion. The aim of this study was to determine the morbidity associated with both construction and reversal of loop ileostomies. STUDY DESIGN: An analysis was performed of all patients who underwent loop ileostomy construction or reversal between 1990 and 1997, with data being collected prospectively. RESULTS: One-hundred-two patients, (43 male, 59 female) with a mean age of 38 years (range 13 to 81 years) had loop ileostomies constructed. Indications for ileostomy construction included inflammatory bowel disease (76 patients), ultralow anterior resection for carcinoma (16 patients), or miscellaneous reasons (10 patients). Nine patients (9%) had complications arising from ileostomy construction including 4 parastomal infections, 3 high output ileostomies, 1 small-bowel obstruction, and 1 ileostomy stenosis in the early postoperative period. Only the stricture required surgical intervention. All other complications improved with conservative management. Mean time to ileostomy reversal was 120 days. Three patients (4%) had complications associated with reversal. All of these complications required surgical intervention, 2 for small bowel obstruction, and 1 for small bowel perforation. Currently 84 patients have had their ileostomy reversed, and 12 patients have had their loop ileostomy converted to a permanent stoma for reasons not related to the loop ileostomy itself. CONCLUSIONS: Defunctioning loop ileostomy is associated with low morbidity. We recommend a defunctioning ileostomy as the procedure of choice for temporary fecal diversion.

Adolescent↗
PubMedDate not supplied

The management of ureteric calculi without extracorporeal shock-wave lithotripsy.

BACKGROUND: Extracorporeal shock-wave lithotripsy (ESWL) is a relatively new technological adjunct in the treatment of renal calculi, but availability is limited. AIM: The aim of this study was to assess the outcome of ureteroscopic procedures in a unit without on-site ESWL facility. METHODS: A retrospective study of all cases of ureteric calculi presenting to this hospital during the period 1991 to 1997 was performed. RESULTS: One hundred and thirty five patients with a mean age of 46.8 years were evaluated. Ninety-four (69.5%) had their stone successfully manipulated and/or extracted at ureteroscopy. Using strict criteria, 41 patients (30.5%) had failed ureteroscopies. Fourteen (10.4%) suffered complications related to their ureteroscopy, thirteen had their complications treated conservatively and three (2.3%) needed open procedures. CONCLUSION: Ureteroscopy has a high success rate and low morbidity. We continue to advocate ureteroscopy in the initial management of ureteric calculi.

Humans↗