PubMed Health⌕ Search

Biomedical subjects

P Fitzpatrick

Publications and source records attributed to P Fitzpatrick.

At least 19 recordsLinked to original sources
PubMed2007

Free fetal DNA is not increased before 20 weeks in intrauterine growth restriction or pre-eclampsia.

BACKGROUND: The aim of this study was to quantify maternal plasma fetal DNA and total DNA in early pregnancy in intrauterine growth restriction (IUGR) or pre-eclampsia (PET). METHODS: A nested case control study was carried out in a University Teaching Hospital. Plasma samples were obtained from 1993 women before 20 weeks of gestation. Pregnancies complicated by IUGR or PET were identified and compared to controls. DNA was extracted and real-time quantitative PCR applied for the SRY and beta-actin genes. IUGR or PET groups were compared to controls using the chi(2) and Wilcoxon rank sum tests. RESULTS: SRY was detected in 86% of IUGR (31/36), 94% of PET (15/16) and 78% of controls (56/72). The median SRY was similar in women with IUGR (28 GE/mL) or PET (30.5 GE/mL) and controls (27.5 GE/mL). beta-actin was increased in the IUGR group (3975 GE/mL) compared to controls (1835 GE/mL) (p = 0.045). Cigarette consumption was greater in the IUGR group compared to controls (p = 0.004). CONCLUSIONS: Fetal DNA quantitation in maternal plasma before 20 weeks is not a useful predictor of IUGR or PET. beta-actin levels were elevated before 20 weeks in women with IUGR and may be a marker of maternal susceptibility to this condition.

Actins↗
PubMed2006

Trends in medical student use of tobacco, alcohol and drugs in an Irish university, 1973-2002.

Questionnaire surveys of medical students in an Irish university were carried out in 1973 (n=765), 1990 (n=522) and 2002 (n=537), with differentiation of western students (e.g., from the Republic of Ireland, the UK, or Australia) and non-western students (e.g., Malaysia). We report on changes in tobacco smoking, drinking and drug-taking over three decades, and we note that, among western students, estimated prevalence of being a current smoker has declined overall from 28.8% in 1973 to 15.3% in 1990 to 9.2% in 2002 (p<0.001), falling in both males (p<0.001) and females (p<0.01). Ex-smokers rose from 5.9% to 15.1% between 1990 and 2002, corresponding with the decline in current smokers. The prevalence of current drinkers has risen over the period, to 82.5% among western students in 2002 (p<0.05); female drinking has increased steadily since 1973 (p<0.001), and the overall proportion of CAGE-positive drinkers has risen since 1990 (p<0.001). The mean weekly alcohol consumption has risen in both sexes since 1990 (males 14.3 units to 19.4, p<0.01; females 6.0 to 9.5, p<0.001). There was an increase in the proportion of students ever offered drugs between 1973 and 2002 (p<0.001). Although smoking rates have fallen, our findings show a marked increase in alcohol and drug consumption between 1973 and 2002. Personal misuse of addictive substances by doctors may mean that doctors will fail to take misuse by patients seriously. A need for preventative and ameliorative action during the medical school years is clear.

Adolescent↗
PubMed2006

Diagnosis of pulmonary emboli and image quality at CT pulmonary angiography: influence of imaging direction with multidetector CT.

AIM: To determine whether there was a significant difference in the prevalence of emboli detected when patients underwent computed tomography pulmonary angiography (CTPA) in a craniocaudal direction versus a caudocranial direction. MATERIALS AND METHODS: This was a prospective study of 203 consecutive patients attending for CTPA for suspected pulmonary embolus. Imaging was performed on a multisection Siemens Volume Zoom CT machine, with bolus tracking centred on the main pulmonary artery after intravenous administration of contrast at 3 ml/s. Patients were examined in a single breath-hold, from the top of the aortic arch to the highest point of the diaphragm, in a randomly assigned cranio-caudal (group A), or caudo-cranial (group B) direction. Images were reviewed on a workstation in a cranio-caudal direction jointly by two radiologists unaware of the original imaging direction. The presence, number and position of arterial emboli were noted, and a subjective assessment of overall image quality and opacification of upper and lower lobe vessels (grade 1, 2, 3, or 4) was made. RESULTS: Emboli were detected in 46 patients. There was no significant difference in the prevalence of emboli detected in the two groups [group A craniocaudal direction n=22, group B caudocranial direction n=24 (p=0.76)]. Imaging direction did not significantly influence overall image quality (p=0.07), however, there was a significantly greater proportion of patients in group A with grade 1 opacification of the upper lobe arteries (p=0.02). CONCLUSION: Imaging direction does not significantly influence the diagnosis of pulmonary emboli but it does significantly improve the upper lobe pulmonary arterial enhancement with fewer non-diagnostic images, and on that basis we recommend that craniocaudal direction be used for CTPA studies.

Adolescent↗
PubMed2006

Drinking, drugs and driving in Ireland: more evidence for action.

OBJECTIVE: To examine the prevalence of drug positivity among drivers suspected of driving under the influence of an intoxicant, and consequently apprehended by the police in Ireland. DESIGN: 2000 specimens were selected for drug analysis, 1000 with results under the limit for alcohol and 1000 over the limit. The limit for alcohol is 80 mg/100 ml in blood and 107 mg/100 ml in urine. Seven drugs/drug classes were examined; amphetamines, methamphetamines, benzodiazapines, cannabinoids, cocaine, opiates and methadone. RESULTS: 331 (33.1%) of the drivers under the legal limit for alcohol tested positive for one or more of the relevant drugs, and the corresponding figures of drivers over the limit was 142 (14.2%; p<0.001). Using weighted analysis, this corresponds to 15.7% (95% confidence interval (CI) 13.5% to 18.1%) of all tested drivers (15.8% in men and 14.5% in women). Among drivers who had minimal blood alcohol levels, 67.9% (95% CI 61.2% to 74.1%) were taking at least one type of drug. The prevalence of taking drugs reduced steadily as alcohol concentrations increased, but still remained as high as 11.1% (95% CI 8.3% to 14.6%) for drivers with blood alcohol concentrations >200 mg/100 ml. Being under the limit for alcohol, stopped in a city area, stopped between 6 am and 4 pm, or 4 pm and 9 pm, and being of a younger age were each independently associated with drug positivity. CONCLUSIONS: There are immediate implications for the evidential breath alcohol program and for checkpoints; in the event of a nil or low alcohol reading being obtained, a separate blood or urine specimen should be sought for analysis, which is currently non-routine.

Adult↗
PubMed2006

Comparison of early postoperative rehabilitation outcome following total knee arthroplasty using different surgical approaches and instrumentation.

PURPOSE: To assess early postoperative rehabilitation outcome following computer-assisted total knee arthroplasty (TKA) or standard instrumentation TKA using a medial parapatellar or subvastus approach. METHODS: A prospective controlled trial of 70 consecutive patients undergoing TKA with a low contact stress rotating platform prosthesis was conducted. Patients were randomised to receive surgery with either computer navigation or standard instrumentation. A medial parapatellar or subvastus approach was used according to the surgeons' preference. Outcome measures included preoperative knee function, intra-operative factors, and postoperative rehabilitation. RESULTS: Duration of surgery was significantly longer when using computer navigation; however, operating time decreased with greater experience. A higher incidence and duration of early postoperative quadriceps dysfunction was associated with computer-assisted TKA through the medial parapatellar approach than through the subvastus approach or TKA performed with standard instrumentation. No patient who received surgery through the subvastus approach had a lag of more than 20 degrees, at 48 hours postoperatively, regardless of the instrumentation used. CONCLUSION: Computer-assisted TKA through a medial parapatellar approach was associated with delayed recovery of the quadriceps during early postoperative rehabilitation. This was due to the additional quadriceps dissection required to place the femoral tracking array. The subvastus approach is therefore recommended for computer-assisted TKA.

Aged↗
PubMed2005

The influence of pharmacological mydriasis on biomicroscopic evaluation of the glaucomatous optic nerve head.

AIMS: To investigate whether pharmacological mydriasis influences interobserver agreement or within-observer agreement (comparing estimates made before and after dilation) in the evaluation of the optic nerve head (ONH) of the glaucoma suspect or patient. METHODS: Monoscopic disc photographs of the ONH were assessed by each observer on two separate occasions in order to establish baseline intra- and inter-observer agreement. Then the ONH of 53 eyes of 53 patients was examined by each observer on two separate occasions, the pupil being pharmacologically dilated on only one of these visits. Each observer commented on the vertical and horizontal cup-to-disc (C/D) ratio, and the presence of the following ONH parameters: laminar dots; disc haemorrhage; disc saucering; disc notching, and peripapillary atrophy (PPA). RESULTS: Intersessional variability of C/D ratio estimates, based on photographs of the ONH, was similar for the two observers. The mean (+/-standard deviation) age of the 53 patients was 70 (+/-15) years, and the male : female ratio was 28 : 25. Intraobserver agreement of C/D ratio estimation performed through a dilated pupil on one occasion and an undilated pupil on the other occasion was not statistically different between observers. Interobserver agreement of C/D ratio estimates were not adversely affected in a statistically meaningful way if ONH evaluation was performed by each observer under conditions of nonmydriasis or by each observer under conditions of pharmacological mydriasis. Within-observer (before and after dilation) and interobserver agreement with respect to the presence of laminar dots (kappa=0.41-0.69), PPA (kappa=0.36-0.54), and pathological cupping (kappa=0.46-0.68) was typically moderate to good across the two visits where the pupil was dilated on one occasion only, but less reliable for saucering, disc notching and disc margin haemorrhage. CONCLUSION: Routine pharmacological mydriasis is not essential for reproducible evaluation of the ONH for patients in whom a satisfactory view of the optic disc can be achieved through the undilated pupil.

Adult↗
PubMed2005

Urban-rural variation in mortality and hospital admission rates for unintentional injury in Ireland.

OBJECTIVE: To explore urban-rural differences in the mortality and hospital admission rates for unintentional injuries in the Republic of Ireland. DESIGN: Standardised mortality ratios (SMRs) in residents of urban and non-city areas (called rural areas) from all causes of unintentional injury were calculated using Central Statistics Office mortality data from 1980-2000. Hospital admission data (Hospital In-Patient Enquiry) from 1993-2000 were used to calculate standardised hospital admission ratios (SARs) in urban and rural residents. Population data were obtained from the 1981, 1986, 1991, and 1996 censuses. RESULTS: The rate of unintentional injury mortality was significantly higher in rural residents for all-cause unintentional injury mortality (SMR 103.0, 95% confidence interval 101 to 105), and specifically for deaths related to motor vehicle trauma (MVT), drowning, machinery, and firearms. There were significantly higher SMRs in urban residents for falls and poisoning. The rate of unintentional injury hospital admission was significantly higher in rural residents for all-cause unintentional injury (SAR 104.6, 95% confidence interval 104 to 105) and specifically for injuries from falls, MVT, being struck by or against an object, injuries in pedal cyclists, fire/burn injuries, and machinery injuries. SARs were significantly higher in residents of urban areas for poisoning and injuries in pedestrians. CONCLUSIONS: There are urban-rural differences in mortality and admissions for injuries in Ireland. Possible reasons for the higher rural mortality rates are higher case fatality in MVT and rural exposure to hazardous farm machinery, firearms, and open areas of water. This information could assist in targeting prevention programmes under the proposed National Injury Prevention Strategy.

Accidental Falls↗
PubMed2001

Short-term benefit of arthroscopic washout in degenerative arthritis of the knee.

Over a 4-year period, 55 consecutive knee arthroscopies were performed on 54 patients with symptomatic mild to moderate osteoarthritis. There were 30 female patients and the average patient age was 60.9 years. The average follow-up period was 29.6 months. All patients underwent diagnostic arthroscopy and washout. Further procedures including removal of loose bodies and partial meniscal resection were necessary in 19 patients. There were no significant postoperative complications. Thirty-seven patients had subjective improvement in symptoms. The average duration of benefit was 25.5 months. Arthroscopy and appropriate debridement of the degenerative knee results in significant subjective improvement. This relatively minor procedure can delay or indeed obviate the need for reconstructive surgery.

Aged↗
PubMed2001

Urgent coronary bypass surgery for failed percutaneous coronary intervention in the stent era: Is backup still necessary?

BACKGROUND: Current practice guidelines for performance of percutaneous coronary intervention (PCI) in the United States mandate availability of on-site surgical backup. With the decreasing frequency of urgent coronary bypass surgery (UCABG) with newer technologies, it is unclear whether such backup continues to be necessary. METHODS: A database of 5655 consecutive patients undergoing PCI at a single center between August 1, 1992, and December 31, 1997, was analyzed. Outcomes were determined as well as clinical, lesion, and procedural characteristics of patients during 4 time periods preceding and during use of coronary stenting. RESULTS: Frequency of UCABG for failed PCI decreased from 2.2% to 0.6% in the most recent time period (P <.01) with no change in incidence of in-hospital death or myocardial infarction. Incidence of stenting progressively increased to 72% in the latest period. Patients requiring UCABG had a higher prevalence of acute coronary syndromes (95%) and type B lesions (79%), but these characteristics were also common in patients who did not undergo UCABG. Although coronary stents were available during the last 3 periods studied, only 30% of UCABG patients had lesions or complications amenable to stenting, and stenting attempts in these patients were all unsuccessful. Despite stenting and use of perfusion balloons and intra-aortic balloon pumps, only 40% of patients having UCABG were stable and pain free on transfer to the operating room. CONCLUSIONS: Although use of UCABG for a failed PCI is currently very low, there are no satisfactory predictors, patients requiring UCABG are frequently clinically unstable, and availability of stenting does not reliably eliminate the need for UCABG or result in a decrease in mortality. This small group of patients continues to require readily available surgical standby.

Angioplasty, Balloon, Coronary↗
PubMed2001

Factors associated with postoperative infection.

OBJECTIVE: We have developed and analyzed a large surgical prophylaxis database and now report the factors significantly associated with early infection, readmission due to infection, and death within 28 days of surgery. This study is intended to be a stepping-stone for further studies using our clinical database. DESIGN AND SETTING: A computerized database of 9,016 surgical patients from a 400-bed community hospital was examined. Multivariate logistic regression and tree-based modeling were used to identify factors associated with the outcomes. Factors considered included surgical procedure, prophylactic antibiotic, age, gender, serum creatinine, and albumin. RESULTS: 12.6% had an early infection, 2.5% were readmitted due to infection, and 2.5% died within 28 days. Most combination prophylactic antibiotics were associated with an increased probability of an early infection. Decreased albumin and increased age were associated with an increased probability of an early infection. Tracheostomy and amputations were associated with an increased probability of an early infection, whereas gallbladder and orthopedic procedures involving the arm were associated with a decreased probability. Factors associated with readmission due to infection included dialysis shunt, vascular repair, and an early infection. Factors associated with increased probability of death within 28 days included age, albumin, serum creatinine, and an early infection. Gallbladder procedures and obstetric-gynecologic procedures were associated with a decreased probability of death within 28 days. DISCUSSION: Older patients and those with a decreased albumin were most likely to have an early infection. To the extent that an early infection was a significant risk factor for readmission due to infection, the impact of age and albumin on the probability of readmission due to infection is demonstrated by their effects on early infections. Interestingly, albumin and age were significantly associated with death within 28 days, in addition to early infection, showing the predictive association between these factors and early death.

Anti-Bacterial Agents↗
PubMed2001

Juvenile nasopharyngeal angiofibroma.

Juvenile nasopharyngeal angiofibroma is a rare yet potentially destructive vascular tumor that typically affects adolescent males. While the etiology of these tumors remains unknown, great advances have been made in their diagnosis and treatment. When juvenile nasopharyngeal angiofibroma is diagnosed at an early stage, the prognosis is generally very good, as patients can be treated with a combination of pre-operative embolization and surgical resection. Advanced juvenile nasopharyngeal angiofibroma is much more difficult to treat, since orbital and intracranial involvement are common in the natural progression of the disease. However, due to the rather innocuous presenting symptoms (commonly, nasal obstruction and epistaxis), diagnosis most often occurs in the later stages of the disease. For this reason, it is important for all physicians to have a high degree of suspicion for juvenile nasopharyngeal angiofibroma when evaluating a male adolescent with these symptoms.

Adolescent↗
PubMed2000

Inertia tensor and weight-percept models of length perception by static holding.

S. J. Lederman, S. R. Ganeshan, and R. E. Ellis (1996) reported an experiment demonstrating that for occluded rods of equal mass and length but different diameters length perception by static holding was larger for rods of smaller diameter. They concluded that participants inferred length from illusory weight percepts. However, rods of equal mass and length that differ in diameter also differ in the eigenvalues of their respective inertia tensors. In the present experiments, the authors manipulated the diameters (Experiment 1) and the inertial eigenvalues (Experiments 4 and 5) of statically held objects. As has been shown with wielded objects, perceived length was a function of the eigenvalues. Additional experiments failed to confirm the expectation from the weight-percept model that perceived length maps to the estimated weight (Experiments 2 and 3). Physical quantities, not psychological quantities, seem to explain length perception by static holding.

Adult↗
PubMed2000

Community Mothers Programme--seven year follow-up of a randomized controlled trial of non-professional intervention in parenting.

BACKGROUND: The Community Mothers Programme aims at using experienced volunteer mothers in disadvantaged areas to give support to first-time parents in rearing their children up to 1 year of age. The programme was evaluated by randomized controlled trial in 1990. METHODS: Seven years later, trial participants were interviewed about child health, nutrition, cognitive stimulation, parenting skills, and maternal self-esteem. The aim of this study was to see whether the demonstrated benefits at 1 year of age of this programme could be sustained at age 8. RESULTS: One-third of the original group (38 intervention, 38 control), were contacted and interviewed. The risk for having an accident requiring a hospital visit was lower in the intervention group: relative risk (RR) 0.59, 95 per cent confidence interval (CI) 0.31-1.11. Intervention children were more likely to visit the library weekly: RR 1.58, 95 per cent CI 1.10-2.26. Intervention mothers were more likely to check homework every night: RR 1.23, 95 per cent CI 1.05-1.43 (p=0.006); and to disagree with the statement 'children should be smacked for persistently bad behaviour': RR 2.11, 95 per cent CI 1.10-4.06. They were more likely to disagree with the statement 'I do not have much to be proud of': RR 1.24, 95 per cent CI 1.04-1.40; and to make a positive statement about motherhood than controls: RR 1.53, 95 per cent CI 1.06-2.20. Subsequent children of intervention mothers were more likely to have completed Haemophilus influenzae b: RR 1.26, 95 per cent CI 1.06-1.51; and polio immunization: RR 1.19, 95 per cent CI 1.02-1.40. CONCLUSIONS: The Community Mothers programme had sustained beneficial effects on parenting skills and maternal self-esteem 7 years later with benefit extending to subsequent children.

Child↗
PubMed2000

Total serum cholesterol in relation to psychological correlates in parasuicide.

BACKGROUND: Low cholesterol may act as a peripheral marker for parasuicide. AIMS: To examine the relationship between total serum cholesterol and psychological parameters in parasuicide. METHOD: Total serum cholesterol and self-rated scores for impulsivity, depression and suicidal intent were measured in 100 consecutive patients following parasuicide, pair-matched with normal and psychiatric control groups. RESULTS: Backward, stepwise multiple regression analysis revealed a significantly lower mean cholesterol in the parasuicide population (P < 0.01). Across all groups there was an independent significant (P < 0.01) negative correlation between cholesterol and self-reported scores of impulsivity. No correlation existed between cholesterol and scores for depression or suicidal intent. CONCLUSIONS: The data confirm previous reports of low cholesterol in parasuicide. This is the first reported investigation of the construct of impulsivity in relation to cholesterol. We hypothesise that the reported increased mortality in populations with low cholesterol may derive from increased suicide and accident rates consequent on increased tendencies to impulsivity in these populations.

Adolescent↗
PubMed2000

Reproducible echocardiography in juvenile sheep and its application in the evaluation of a pulmonary valve homograft implant.

Increased use of the ovine animal model in cardiovascular surgical research has created a salient need for standardized echocardiography techniques. To demonstrate a reproducible image in this species and confirm the validity of echocardiography as a diagnostic tool, we implanted 10 sheep with a pulmonary valve homograft and monitored them through weekly echocardiographic examinations until 20 weeks after implantation. We obtained good images from the left cranial and the left caudal transducer windows without needing to sedate the animals. Sedated sheep yielded adequate views from the right apical window. Echocardiographic data on the implanted homografts (including functional capacity, presence of calcification, and hemodynamic information and measurements), completely agreed with the results of the post-explantation examinations.

Animals↗
PubMed1999

Stenting for in-stent restenosis: A long-term clinical follow-up.

We studied the feasibility, safety, and short- and long-term outcomes of treating coronary in-stent restenosis with primary restenting. Thirty-one patients (32 lesions) were treated. Eleven patients had adjunctive rotational atherectomy. Clinical follow-up was obtained in all 31 patients at a mean of 9.1 +/- 5.5 months by direct phone contact with the patients, medical records, and subsequent hospitalization for recurrent symptoms and/or revascularization. There were no cardiac deaths or myocardial infarctions. In native vessels (26 patients), repeat target lesion revascularization was required in eight patients (31%); two other patients (7.7%) had angina and were treated medically. All vein graft lesions had recurrent restenosis. Significant predictors of recurrent clinical events were lesions in vein grafts, multivessel disease, and use of higher poststent deployment inflation pressures. Primary restenting for in-stent restenosis in native vessels is a safe approach with good short-term outcome. Recurrent restenosis remains a problem, as it does with other devices, particularly in vein graft lesions and in patients with multivessel disease. Restenting for in-stent restenosis should probably be used selectively. Cathet. Cardiovasc. Intervent. 48:143-148, 1999.

Aged↗