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Biomedical subjects

R J Coughlan

Publications and source records attributed to R J Coughlan.

18 recordsLinked to original sources
PubMed1992

Avascular necrosis of the femoral head post heart-transplantation and steroid dosage.

Avascular necrosis (avn) post heart-transplantation has been considered to be due to the high doses of steroids used to immunosuppress these patients in attempting to prevent transplant rejection. This study shows that avascular necrosis occurs even when low dose steroids regimes are used and demonstrates no significant correlation between steroid dosage and the development of avn. Patients with symptomatic avn benefit from early diagnosis and management of their condition in that the need for total joint arthroplasty can be prevented in many cases.

Adult↗
PubMed1992

Low energy high frequency pulsed electromagnetic therapy for acute whiplash injuries. A double blind randomized controlled study.

The standard treatment of acute whiplash injuries (soft collar and analgesia) is frequently unsuccessful. Pulsed electromagnetic therapy PEMT (as pulsed 27 MHz) has been shown to have pro-healing and anti-inflammatory effects. This study examines the effect of PEMT on the acute whiplash syndrome. One half of the 40 patients entering the study received active PEMT collars: the other half facsimile (placebo). All patients were given instructions to wear the collar for eight hours a day at home and advised to mobilise their necks. At 2 and 4 weeks the actively treated group had significantly improved (p less than 0.05) in terms of pain (visual analogue scale). By chance movement scores for the PEMT group were significantly worse at entry to the study than the control group (p less than 0.05). At 12 weeks they had become significantly better (p less than 0.05). PEMT as described is safe for domiciliary use and this study suggests that PEMT has a beneficial effect in the management of the acute whiplash injury.

Accidents, Traffic↗
PubMed1991

Magnetic resonance imaging in the assessment of rheumatoid arthritis--a comparison with plain film radiographs.

Conventional radiography lacks sensitivity in early rheumatoid disease. MRI with its advantages of soft tissue discrimination and multiplanar imaging facility might detect earlier disease. This study compares the MR images and conventional radiographs of 11 rheumatoid patients' wrists and carpi. In all cases, erosions were more extensive and numerous on the MR images compared to plain radiographs. MR is useful in detecting early aggressive disease and in monitoring the response to treatments.

Adult↗
PubMed1991

Skeletal tuberculosis.

Skeletal tuberculosis is an uncommon form of tuberculosis. During the period 1977-87, the number of cases diagnosed in two Dublin hospitals has remained at a constant level. The present study reports on 36 adults with skeletal tuberculosis and shows more frequent extraspinal involvement than other studies. The long duration of symptoms prior to diagnosis of 10.79 (+/- 8.8) months suggests that tuberculosis is not being considered early in the course of unexplained inflammatory arthritides especially in the elderly patient. The under utilisation of the Mantoux test in diagnosis is also a matter of concern.

Adolescent↗
PubMed1990

Pulsed high frequency (27MHz) electromagnetic therapy for persistent neck pain. A double blind, placebo-controlled study of 20 patients.

In the majority of patients with neck pain, symptoms will resolve spontaneously or quite quickly in response to therapy. However, some patients' symptoms persist for a long period, irrespective of therapy. In this study, 20 patients with persistent (greater than 8 weeks) neck pain were enrolled in a double blind, placebo-controlled trial of low energy, pulsed electromagnetic therapy (PEMT)--a treatment previously shown to be effective in soft tissue injuries. For the first 3-week period, group A (10 patients) received active PEMT units while group B (10 patients) received facsimile placebo units. After 3 weeks, both pain (visual analogue scale (P less than .023) and range of movement (P less than .002) had improved in the group on active treatment compared to the controls. After the second 3 weeks, during which both groups used active units, there were significant improvements in observed scores for pain and range of movement in both groups. PEMT, in the form described, can be used at home easily in the treatment of patients with neck pain. It is frequently successful and without side effects.

Adult↗
PubMed1989

Synovial fluids from infected joints contain active metalloproteinases and no inhibitory activity.

Serial samples of synovial fluid aspirated from two patients with septic arthritis were assayed for proteinases and proteinase inhibitors. Active metalloproteinases but no proteinase inhibitors were present in all samples taken prior to treatment. The levels of active metalloproteinases fell with time although proenzyme forms were still present in the fluids. Both alpha 2-macroglobulin and the tissue inhibitor of metalloproteinases were found in the septic synovial fluids after treatment commenced. It is proposed that the lack of inhibitors and the presence of active proteinases capable of digesting collagen, gelatin and proteoglycan accounts for the rapid loss of cartilage found in septic arthritis.

Aged↗
PubMed1989

Beneficial effect of monoclonal antibody to interleukin 2 receptor on activated T cells in rheumatoid arthritis.

Campath 6, a rat IgG2b monoclonal antibody to the interleukin 2 receptor on activated T cells, was used to treat three patients with active rheumatoid arthritis unresponsive to conventional treatment. Two patients had an excellent response for about three months. There were no significant side effects. The results suggest that activated T cells are of importance in the pathogenesis of rheumatoid arthritis. Although infusions of rat monoclonal antibodies could not be repeated because of the risk of sensitisation, the development of humanised monoclonal antibodies targeted against specific T cell sets would allow repeated courses of treatment to be given.

Adult↗
PubMed1987

7S IgM in the sera of patients with arthritis.

Using radial immunodiffusion in 7% agarose, 7S IgM was quantified in the sera of 45 normal individuals, 37 patients with rheumatoid arthritis (RA), 18 patients with psoriatic arthritis and 11 patients with ankylosing spondylitis. 7S IgM was only found in the sera of patients with RA, 43% of whom had detectable levels of 7S IgM (median 47.5 micrograms/ml). The patients with 7S IgM had significantly higher IgM rheumatoid factor (IgM RF) and C-reactive protein levels in their sera (p less than 0.005). There was a strong correlation between 7S IgM and IgM RF levels in the sera of these patients. These data demonstrate that patients with more active and severe disease have 7S IgM present in their sera but the absence of 7S IgM from the sera of some patients with high levels of IgM RF and CRP suggest that additional factors may influence the synthesis and secretion of 7S IgM by B cells in RA.

Arthritis↗
PubMed1987

Algodystrophy: a common unrecognized cause of chronic knee pain.

Thirty-three patients with undiagnosed chronic knee pain had features of autonomic disturbance. Thermography is a useful imaging technique for demonstrating this abnormality. The patients lacked the thermographic symmetry observed in 16 normal controls but this returned with resolution of the pain. Recognized radiological and scintigraphic features of algodystrophy were found. The long duration of symptoms, high proportion of young females and the severity of the associated disability were notable. It is suggested that algodystrophy is a more frequent cause of chronic knee pain than previously recognized. Autonomic abnormalities may be less intense in disease at this site, particularly in young females and may be overlooked. This characteristic of algodystrophy of the knee may contribute to chronicity and subsequent disability.

Adolescent↗
PubMed1985

Is there more than one signal for an acute phase response?

Prealbumin was shown to be a sensitive indicator of disease activity in a prospective study of 21 patients with active ankylosing spondylitis (AS) who were treated with 3 intravenous pulses of methylprednisolone and its concentration was found to change at a different rate to C-reactive protein (CRP). In those diseases in which CRP concentration rises with active disease, i.e., rheumatoid arthritis, AS and Crohn's disease, prealbumin fell, but in those diseases in which CRP rises only slightly, i.e., systemic lupus erythematosus, progressive systemic sclerosis and ulcerative colitis, there was nevertheless a fall in serum prealbumin, indicating that there was an acute phase response occurring. Fever, arthritis and infection were the only disease manifestations that were associated with an elevated CRP in both groups of diseases. There is therefore more than one signal for an acute phase response depending on the nature of the disease pathology.

Acute-Phase Proteins↗