Biomedical subjects

G Coughlan

Publications and source records attributed to G Coughlan.

3 recordsLinked to original sources

PubMed1992

Congenital diaphragmatic hernia in the newborn. Outcome in 59 consecutive cases over a ten year period (1980-1989).

A ten year review (1980-1989) of 59 neonates presenting with congenital diaphragmatic hernia (CDH) to Our Lady's Hospital for Sick Children, the main referral centre for neonatal surgery in Ireland, is presented to determine the outcome and make suggestions for improvements. CDH was more common in males (34M, 25F). The hernia was present on the left side in 47 cases and 11 cases were right sided. Overall mortality was 35.6%, with increased mortality for right-sided hernia (54.5%). Mean gestation period for survivors was 39 weeks and for non-survivors was 36 weeks. Fifty-two (88.1%) patients presented with symptoms within first six hours after birth. Nineteen of 59 patients (32%) did not have their airways secured with an endotracheal tube at the time of arrival in the hospital. Recurrent chest infections and gastro-oesophageal reflux were the most common long term complications. The prognosis was better for late presenters. A period of prolonged ventilatory stabilisation with appropriate inotropic support to help correct acidosis before surgery improved results. Surgery should be postponed until ventilatory stabilisation is established. A protocol for safe transport of patients to the referral centre is recommended. It is advisable that all patients with congenital diaphragmatic hernia be intubated as soon as the diagnosis is made and that a doctor accustomed to airway management accompanies the patient to the neonatal surgical centre.

Birth Weight↗

PubMed1989

Ketosis, a complication of theophylline toxicity.

A case of prolonged theophylline toxicity in a young non-diabetic female is reported. Blood gas analysis revealed a mixed respiratory alkalosis and metabolic acidosis. The metabolic acidosis was due to ketoacids, which were detected in the patient's breath and urine. The ketones cleared rapidly when theophylline elimination was increased with activated charcoal, i.v. metoprolol reduced excessive b-adrenergic stimulation and a 10% dextrose infusion repleted hepatic glycogen. Theophylline is known to increase free fatty acid levels. It is postulated that prolonged fasting led to depletion of hepatic glycogen and that ketones were generated by metabolism of elevated serum fatty acids. In previous reviews of the metabolic abnormalities associated with theophylline toxicity ketosis has not been described.

Acidosis↗

PubMed1987

Coeliac proctitis.

An increased association of ulcerative colitis and coeliac disease has been reported, as have the results of several small-bowel biopsy studies in ulcerative colitis. Forty-two patients from a population of 438 patients with coeliac disease had rectal biopsies. Fourteen of these showed inflammation of various degrees of severity, including three compatible with a diagnosis of ulcerative colitis. The presenting complaint in 34 of these patients was diarrhoea or steatorrhoea. Twenty-seven patients had coeliac disease diagnosed at the same time or after their rectal biopsy. The other 15 were previously diagnosed coeliacs. Twelve of the 14 patients with abnormal rectal biopsy specimens were known to have subtotal/total villous atrophy at the time of rectal biopsy. Proctitis as seen in these coeliac patients had no unique features to differentiate it from proctitis caused by other disorders. The diarrhoea/steatorrhoea stopped in all patients on commencement of a gluten-free diet, except in those with ulcerative colitis. Proctitis is common in patients with coeliac disease presenting with diarrhoea/steatorrhoea. This study supports the finding of an increased association of coeliac disease and ulcerative colitis and is, to our knowledge, the first rectal biopsy study of a coeliac population.

Adult↗