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J O'Hara

Publications and source records attributed to J O'Hara.

At least 19 recordsLinked to original sources
PubMed2006

The significance of MRI findings for non-rhinological disease.

OBJECTIVES: Mucosal changes in the paranasal sinuses are detected in 30-50% of scans for non-rhinological disease. This study assesses the relationship between symptoms of rhinosinusitis and radiological evidence of sinus pathology in patients undergoing magnetic resonance imaging (MRI) scans for unrelated pathology. DESIGN: Prospective observational study, evaluating symptoms of rhinosinusitis in patients undergoing MRI scanning of the internal acoustic meati. A visual analogue scale (VAS) of rhinological symptoms was completed immediately before scanning, specifying symptoms present at the time of completing the questionnaire. Symptom scores were recorded by one of the investigators, blinded to the MRI images. Two investigators independently rated sinus mucosal thickening for each scan, both of whom were blinded to the symptom scores. Lund and Mackay scoring systems were used for both symptom and radiological scores, which were then compared. SETTING: Otolaryngology and Radiology Departments in a large teaching hospital. PARTICIPANTS: Fifty consecutive patients were recruited over a 2-month period. MAIN OUTCOME MEASURES: Visual analogue scale symptom scores were compared with radiological scores for sinus mucosal thickening. RESULTS: No statistically significant relationship was demonstrated between rhinological symptoms and radiological features suggestive of rhinosinusitis in patients undergoing MRI scanning for non-rhinological disease. CONCLUSIONS: The relationship between rhinological symptoms and MRI findings of sinus pathology is not straightforward. Management decisions should be made on the basis of nasal history and endoscopy, rather than radiological findings. This is the first study assessing this relationship by documenting symptoms on the day of scanning, using a validated scoring system.

Adult↗
PubMed2006

"Post-nasal drip syndrome": most patients with purulent nasal secretions do not complain of chronic cough.

INTRODUCTION: Post-nasal drip syndrome (PNDS) is quoted as a common cause of chronic cough. However, there is little evidence to explain the mechanism by which PNDS may stimulate the cough reflex. This cohort study looks at patients with purulent nasal secretions, who may best represent any potential candidate for PNDS, and observes the frequency of symptomatic coughing. METHODS: One-hundred and eight consecutive patients referred to a rhinology clinic with symptoms of chronic infective rhinosinusitis, all with purulent nasal secretions identified on nasendoscopy, were observed through investigation and treatment. Patients were initially treated with broad-spectrum antibiotics and nasal douching. The frequency of coughing was recorded pre- and post- treatment. RESULTS: Eighty-nine percent of patients complained of post-nasal secretions. Twenty-three (21%) patients complained of cough. Eight had co-existing asthma, 3 had bronchiectasis, 1 had sarcoid and 2 had had a recent respiratory tract infection. Therefore 9 patients (8%) had purulent nasal secretions and a cough with no other discernable pathology. Cough improved in 8 of the 9 patients following treatment. Cough improved in 9 of the 14 patients with other possible co-existing causes for cough. CONCLUSIONS: Only a small proportion of patients with purulent rhinosinusitis without coexisting chest disease complain of cough. Although nasal disease may be a genuine cause for chronic cough it is unlikely to be as common a cause as has been reported. Postnasal secretions do not appear to be an adequate cause for cough and the term 'PNDS' should be replaced by rhinosinusitis when nasal disease is the cause of chronic cough.

Adolescent↗
PubMed2005

The aetiology of chronic cough: a review of current theories for the otorhinolaryngologist.

Most studies agree that post-nasal drip syndrome (PNDS), asthma, gastroesophageal reflux disease (GORD), and laryngopharyngeal reflux (LPR) are the commonest causes of chronic cough in the immunocompetent, non-smoking patient who is not taking an angiotensin-converting enzyme inhibitor. No diagnostic test has been found to define those who are said to have PNDS other than a response to a first-generation antihistamine. Examining the available evidence suggests that mechanical stimulation of the pharynx by mucus is not an adequate theory for the production of cough. Inflammatory mediators in the lower airways are raised in PNDS, cough variant asthma and GORD, and the theory that an inflammatory process is affecting 'one airway' is a plausible one. Nasal disease is more likely to result in cough from the co-existing involvement of the lower airways through an as yet undefined pathway, and eosinophil and mast cell mediation appear a likely mechanism.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed2002

Prevalence of hearing impairment in siblings of deaf children.

OBJECTIVE: To assess the prevalence of hearing impairment in siblings of children with profound to total hearing impairment. METHOD: Two hundred and twenty siblings of children at a deaf school in Karachi completed the screening program. This consisted of a questionnaire and pure tone audiometry. RESULTS: One out of three (73 siblings) had a threshold of 25 dB or greater in their better ear. In a population, already aware of hearing loss, we note that only fifteen siblings had a previous audiogram. Although a positive family history is associated with hearing impairment in the siblings, no increase due to consanguineous marriages was noted. CONCLUSION: This assessment has underlined the need to increase public awareness of hearing impairment. It has also exposed the lack of it in families exposed to the condition.

Adolescent↗
PubMed1998

Power spectral heart rate analysis demonstrates decreased activity of the sympathetic nervous system during low bupivacaine spinal anesthesia.

STUDY OBJECTIVE: To evaluate the onset of spinal anesthesia with power spectral heart rate analysis to determine the influence of the block on the autonomic nervous system. DESIGN: Prospective, clinical evaluation. SETTING: Tertiary-care teaching hospital. PATIENTS: 27 ASA physical status I and II patients scheduled for lower extremity orthopedic surgery and free of major cardiac disease or cardiac drugs with direct influence of heart rate (HR) or blood pressure (BP). INTERVENTIONS: Prior to anesthesia, a baseline power spectral heart rate reading was taken in the supine position. Spinal anesthesia was established in the sitting position with 15 mg of bupivacaine and 0.2 mg epinephrine introduced at the L3-L4 interspace with a 22-gauge Quincke needle. The patient was returned supine, and power spectral heart rate data were again collected at 5-minute intervals throughout the procedure. Level of the spinal block was checked at 5-minute intervals until 30 minutes and considered complete when two consecutive readings were unchanged. MEASUREMENTS AND MAIN RESULTS: Heart rate and BP were recorded at baseline and at five-minute intervals after injection. Power spectral heart rate data included low-frequency activity (LFa), high-frequency activity (HFa), and the ratio (LFa/HFa). Spinal level achieved was recorded by thoracic dermatome at complete onset. Heart rate and BP remained within 20% of control in all cases. Complete onset of the spinal block was present by 30 minutes in all cases. The average level of spinal anesthesia was T8. Compared with baseline, LFa activity decreased, HFa activity remained unchanged, and the ratio was decreased. During endoprosthesis insertion, 9 of 14 total hip patients had a transient ten-fold increase in LFa activity, without HFa change, and a corresponding increase in the ratio. CONCLUSIONS: Power spectral heart rate analysis during low thoracic bupivacaine spinal anesthesia is compatible with decreased sympathetic activity during stable hemodynamic intervals. Insertion of hip endoprosthesis resulted in a dramatic, transient increase in sympathetic activity, indicating that sympathetic activation was still possible despite the presence of surgical anesthesia from the subarachnoid block.

Anesthesia, Spinal↗
PubMed1997

Effectiveness of bupivacaine administered via femoral nerve catheter for pain control after anterior cruciate ligament repair.

STUDY OBJECTIVE: To evaluate the quality of pain control achieved with continuous local anesthetic infusion via a femoral nerve catheter, and to determine the optimum concentration of bupivacaine necessary to maintain pain control after full surgical anesthesia is established with 0.5% bupivacaine. DESIGN: Randomized, prospective study. SETTING: Tertiary care teaching center. PATIENTS: 25 ASA physical status I and II patients scheduled to undergo arthroscopically-aided anterior cruciate ligament (ACL) reconstruction by one surgeon, and who were willing to accept a femoral nerve catheter for postoperative pain control. INTERVENTIONS: All patients received general anesthesia with propofol/alfentanil (10 ml/1 ml) mixture and nitrous oxide/oxygen (60%/40%) mixture via endotracheal tube. After induction of general anesthesia, a femoral nerve catheter was inserted with the aid of a nerve stimulator, and 20 ml of 0.5% bupivacaine was administered. The surgery was completed in a standard manner and the patients were randomized into three groups for the concentration of local anesthetic to continue the pain relief into the recovery phase. On awakening, all patients were determined to have a functioning femoral nerve catheter. Group 1 received 0.0625% (n = 8) bupivacaine, Group 2 0.125% (n = 9) bupivacaine, and Group 3 0.25% (n = 8) bupivacaine; all doses were initiated in a blinded manner at 0.12 ml/kg/hr. Patients also received intravenous patient-controlled analgesia with morphine via demand mode only, with a 1.0 mg dose and a 6 minute lock-out interval. MEASUREMENTS AND MAIN RESULTS: Pain was determined at defined intervals by visual analog scale (VAS). Data collected included demographics, VAS scores, and total morphine administered. All patients were pain-free on emergence from general anesthesia. No patient required parenteral opioid for pain control while in the postanesthesia care unit. There were no significant differences in pain scores among groups, and average pain scores (2.5 to 4.0) indicate good pain control throughout the entire hospitalization. There were no complications. CONCLUSIONS: Low concentrations of bupivacaine delivered via femoral nerve catheter after an established femoral nerve block can provide excellent postoperative pain control after ACL reconstruction.

Adult↗
PubMed1997

Tourniquet-induced hypertension correlates with autonomic nervous system changes detected by power spectral heart rate analysis.

STUDY OBJECTIVE: To determine the autonomic changes associated with pneumatic tourniquet-induced hypertension as measured by power spectral heart rate analysis (PSHR). DESIGN: Prospective study. SETTING: Tertiary teaching hospital. PATIENTS: 21 healthy-patients scheduled for lower extremity surgery, during which pneumatic tourniquet inflation was expected to exceed 90 minutes. INTERVENTIONS: Hemodynamic and PSHR data collected at 5 minute intervals during inflation of the pneumatic tourniquet. Tourniquet-induced hypertension (T-HTN) defined at 30% increase above baseline. MEASUREMENTS AND MAIN RESULTS: Blood pressure, heart rate, maximum changes in low frequency variability (LFa), high frequency variability (HFa), and their ratio (LFa/HFa) were measured. Of the 21 patients, 11 had T-HTN. A significantly greater increase in LFa and LFa/HFa ratio was seen in the T-HTN group, where patients were greater in age. LFa, HFa, and ratio were not significantly different with T-HTN until 60 minutes or greater. Best correlation with T-HTN occurred with maximum increase in LFa/HFa ratio compared with increase in LFa or decrease in HFa. CONCLUSION: Tourniquet hypertension correlated with activation of the sympathetic nervous systems, as measured by PSHR variables.

Adult↗
PubMed1996

Arthroscopic shaving of a hematoma after total knee arthroplasty.

A large hematoma in the immediate postoperative period after total knee arthroplasty may result in wound breakdown and skin necrosis, leading to a delay in recovery or prosthetic infection and failure. Needle aspiration is ineffective because of the viscous nature of the hematoma. This is the first report of the use of an arthroscopic shaver to evacuate such a hematoma in an 81-year-old woman 6 days after a primary total knee arthroplasty. This allowed for immediate pain relief, early mobilization, and primary wound healing.

Aged↗
PubMed1995

A rapid test for endotoxin in whole blood.

A rapid whole blood agglutination test has been developed for the detection of endotoxin. The test reagent consists of polymyxin B (PmB) conjugated to the Fab fragment of the anti-glycophorin antibody 1C3/86. After addition of reagent to whole blood, red cell agglutination occurs within two minutes in samples from endotoxaemic patients or with the addition of either whole Gram negative bacteria, supernatants from Gram negative bacterial cultures or purified endotoxin. In clinical samples there was a strong correlation (r = 0.83) between the strength of agglutination and the level of endotoxin measured by the Limulus amaebolysate test (LAL). The prospect of a rapid and accurate test for endotoxin may enable better clinical management of Gram negative sepsis.

Adult↗
PubMed1995

The Bass technique: Charles Cassidy Bass' legacy.

Charles Cassidy Bass a native Mississippian introduced his method of toothbrushing and flossing to the dental community four decades ago. He chastised the academic, public health and military dentists for their lack of knowledge in area of preventive dentistry. Dr. Bass felt that his "Right Kind" method of oral hygiene was not well received by the dental profession. A questionnaire was sent to every United States dental school to determine what effects his teachings had on dental education. The study revealed that C. C. Bass' teachings were indeed accepted by the dental profession and are still in effect today.

Dental Devices, Home Care↗
PubMed1993

The music therapy of an anorectic mentally handicapped adult.

Where words fail, music may be a medium through which to explore one's inner world and experiences. Psychodynamic approaches have helped us to understand what it means to be handicapped (e.g. Sinason, 1992). The subtleties of diagnosing anorexia nervosa have recently been recognized in this group (e.g. Cottrell & Crisp, 1984). Music therapy has been used with clients of normal intelligence who have eating disorders (Nolan, 1989; Sloboda, 1993; Smeijsters & van den Hurk 1993). This article illustrates the music therapy of a woman with Down's syndrome (IQ = 50) and anorexia nervosa. It describes her management and progress in music therapy in relation to her external world and anorectic behaviours.

Adult↗