Search PubMed⌕ Search

Biomedical subjects

J A Ryan

Publications and source records attributed to J A Ryan.

At least 73 records · Page 4Linked to original sources
PubMed1989

Liver resection without blood transfusion.

A personal series of 58 liver resections was reviewed to identify technical factors minimizing blood transfusions. We identified a concept of vascular isolation prior to parenchymal division (VIP) which used singularly or in combination the following methods of vascular control: parenchymal compression, Pringle maneuver, hepatic venous tourniquet, hilar division, hepatic vein division, and Heaney maneuver. VIP significantly decreased the need for transfusion; of 34 patients with VIP only 2 (6 percent) required transfusion, whereas of 24 patients without VIP, 18 (75 percent) required transfusion (p less than 0.001).

Adult↗
PubMed1989

Effect of iron on the guaiac reaction.

Most studies show that oral ingestion of iron does not cause a positive stool guaiac reaction. However, all in vitro studies show that iron does cause a positive guaiac reaction and some in vivo studies have shown a positive stool guaiac reaction in response to oral iron. This study examines this unresolved question. Twenty-five normal volunteers were given 900 mg of ferrous sulfate a day. Two Hemoccult II and two HemoQuant tests were obtained before and during iron therapy. All Hemoccult II tests were negative before and after oral iron. Four HemoQuant tests were slightly elevated before oral iron and one was slightly elevated after oral iron. Ferrous sulfate, 300 mg, was dissolved in 1 L of water. The solution was acidic (pH = 3.9) and produced a positive Hemoccult II test. When the solution was titrated with sodium hydroxide to a pH of greater than or equal to 6.0, iron precipitated out and the mixture no longer produced a positive Hemoccult II reaction. Our data show that ferric iron (Fe3+) in solution will give a positive guaiac reaction directly and ferrous iron (Fe2+) will give a positive guaiac reaction after hydrogen peroxide is added because it oxidizes Fe2+ to Fe3+. Iron solutions are acidic and when titrated toward a neutral pH, the iron is precipitated out and the solution is then guaiac-negative. Thus, our in vivo data confirm most previous in vivo studies; furthermore, the discrepancy between in vivo and in vitro studies can be explained as a pH-dependent phenomenon of in vitro iron solutions. Oral iron should not cause a positive guaiac reaction, and the HemoQuant results show no increase in occult blood loss in subjects on oral iron therapy.

Administration, Oral↗
PubMed1989

Protective efficacy of mouse serum to the N-propionyl derivative of meningococcal group B polysaccharide.

The protective properties of antibodies induced by immunization of mice with a conjugate of tetanus toxoid and the N-propionyl derivative of group B meningococcal polysaccharide (N-Pr-GBMP-TT) have been investigated. Mice immunized with the conjugate produced antibodies which were bactericidal for Neisseria meningitidis strains B:2b:P1.Ham and B:15:P1.16. Passive protection studies indicated that the conjugate serum completely eliminated or reduced considerably levels of bacteremia by the same strains in mice. There was no bactericidal activity or passive protection against a strain of N. meningitidis C:2b:P1.2. Following absorption of the conjugate serum with GBMP the non-absorbed antibody, directed to N-Pr-GBMP, was bactericidal and protected mice against bacteremia with group B meningococci. Thus N-Pr-GBMP antibodies which do not bind to the GBMP are protective in vitro and in vivo.

Animals↗
PubMed1989

Nurses' attitudes toward physical assaults by patients.

This article reports the survey findings of 184 psychiatric nurses' attitudes toward patient physical assault. Attitudes related to staff competence and performance, legal aspects, patient responsibility and safety were measured on a self-report questionnaire. Data were interpreted based on the scant literature related to patient assaults. Findings indicated that attitudes related to legal aspects of patient assault varied considerably among nursing staff. Discussion highlighted the influence of attitudes on both assaulted staff as well as the victim's colleagues.

Attitude of Health Personnel↗
PubMed1989

The assaulted nurse: short-term and long-term responses.

The purpose of this prospective study was to identify attitudinal changes and to describe the emotional, cognitive, social, and biophysiological short- and long-term reactions of nursing staff being physically assaulted by a patient. Sixty-one assaulted nursing staff at the University of California Los Angeles Neuropsychiatric Institute comprised the sample. Responses to the assault were elicited through weekly self-report questionnaires and interviews at week 1 and week 6. Follow-up questionnaires were completed at 6 months to 1 year following the assault. Sixty-seven percent (41/61) of the staff met the "responder" criteria during week 1. Eighteen percent (11/61) of the assaulted staff continued to experience moderate to severe responses 6 weeks following the assault. Long-term follow-up showed that 21% (8/39) of the staff were responders at 6 months, and 16% (4/25) were responders at 1 year. Two overall trends were evident: an overall decrease in the frequency of moderate to severe responses in each of the four categories from weeks 1 to 6, with increases during weeks 3 and 4, and a higher frequency of moderate, rather than intense and severe, responses throughout the 6 week period. No significant changes in attitudes were found. The data support the need for formalized clinical, educational, and administrative programs to assist staff in coping with this stressful work experience.

Attitude of Health Personnel↗
PubMed1988

Surgical versus endoscopic management of common bile duct stones.

The charts of all patients with common bile duct (CBD) stones admitted to Virginia Mason Medical Center between January 1, 1981 and July 31, 1986 were reviewed to define current methods of management and results of operative versus endoscopic therapy. Two hundred thirty-seven patients with CBD stones were treated. One hundred thirty patients had intact gallbladders. Of these patients, 76 (59%) underwent cholecystectomy and common bile duct exploration (CBDE) while 54 (41%) underwent endoscopic papillotomy (EP) only. Of the 107 patients admitted with recurrent stones after cholecystectomy, all but five were treated with EP. The overall mortality rate was 3.0%. Complications, success, and death rates were all similar for CBDE and EP, but the complications of EP were often serious and directly related to the procedure (GI hemorrhage, 6; duodenal perforation, 5; biliary sepsis, 4; pancreatitis, 1). Patients undergoing EP required significantly shorter hospitalization than those undergoing CBDE. Multivariate analysis showed that age greater than 70 years, technical failure, and complications increased the risk of death, regardless of procedure performed. Twenty-one per cent of those undergoing EP with gallbladders intact eventually required cholecystectomy. The conclusion is that the results of EP and CBDE are similar, and the use of EP has not reduced the mortality rates of this disease.

Adult↗
PubMed1988

Nd-YAG laser photoablation of sessile villous and tubular adenomas of the colorectum.

Neodymium (Nd)-YAG laser photoablation treatment was used to treat 46 patients with broad-based villous and tubular adenomas of the colon or rectum. These adenomas were distributed throughout the large bowel, with the majority (72%) located above the peritoneal reflection. Patients received an average of 2.1 treatments per adenoma, with 22 patients (48%) requiring only one treatment. Overall treatment success was achieved in 89% of cases (mean follow-up of 12 months), with four patients undergoing continued therapy. Of the patients who received a full course of treatment, only two (4%) were not taken to complete photoablation. Complications were minimal, and 92% of all laser treatments were done on an outpatient basis. Four patients had documented polyp recurrence that was controlled with additional laser treatment. Two patients with malignant polyps who were not surgical candidates were also treated with the laser, with no tumor recurrence seen at 11 and 14 months. Nd-YAG laser photoablation of large colonic polyps offers a safe, efficient, and cost-effective alternative to standard surgical resection.

Adenoma↗
PubMed1988

Pancreatic ductal adenocarcinoma: diagnosis and staging with dynamic CT.

The authors assessed the accuracy of dynamic computed tomography (CT) in diagnosis and staging of ductal adenocarcinoma of the pancreas and analyzed the survival rates of patients with resectable and unresectable tumors. A correct diagnosis based on CT findings was made in 159 of 174 patients (91%) with 13 false-positive (8%) and two false-negative diagnoses (1%). The 13 false-positive diagnoses highlight the need for confirmation of diagnosis with biopsy. The accuracy of staging with CT was compared with that of angiography (42 patients) and surgery (51 patients). CT was more accurate than angiography in demonstrating tumor involvement of major peripancreatic vessels. Staging criteria were reliable: No unresectable tumors based on CT findings were found to be resectable during surgery (42 patients), while only three of nine resectable tumors based on CT findings were found to be unresectable. Thus, no tumors were incorrectly staged, which would potentially deny surgery for a patient. The average survival rate after resection was 14 months, while the survival rates after palliative (biliary or gastrointestinal bypass) or no treatment were 8 months and 5 months, respectively.

Angiography↗
PubMed1988

Infected pancreatic fluid collections: percutaneous catheter drainage.

Thirty-eight infected pancreatic fluid collections in 23 patients with acute or chronic pancreatitis were drained percutaneously following initial diagnosis with computed tomography and fine-needle aspiration. Fifteen (65.2%) patients were cured completely without surgery. Eight (34.8%) patients required some type of surgery despite successful treatment of the fluid collection, and in two (6.5%) the collection recurred after catheter removal. Complications occurred in three (13%) patients, but only one complication (4%), empyema, was a direct result of catheter drainage. Catheter drainage time averaged 29 days for 16 patients with isolated collections and 96 days and 104 days for patients with collections with pancreatic duct fistulas (nine patients) or gastrointestinal fistulas (14 patients), respectively. This study confirms that infected pancreatic fluid collections can be safely and effectively treated with percutaneous catheter techniques in most patients.

Abscess↗
PubMed1988

Nonoperative versus operative treatment of obstructive jaundice in pancreatic cancer: cost and survival analysis.

Pancreatic carcinoma is complicated by malignant obstructive jaundice in 40-70% of cases. Patients frequently are old, debilitated, unresectable, and faced with a dismal prognosis. Invasive endoscopic and radiologic procedures in the inoperable patient can provide palliation without the need for surgery, in most cases. Few studies have compared nonoperative palliation with conventional surgical biliary enteric bypass procedures. In a retrospective study of patients with pancreatic carcinoma, we found no difference between operative and nonoperative treatment in survival, total hospitalization, or morbidity and mortality. Cost analysis revealed significant savings with nonoperative treatment.

Aged↗
PubMed1987

Sexual practices, sexually transmitted diseases, and the incidence of anal cancer.

To elucidate the risk factors for anal cancer, we interviewed and obtained blood specimens from 148 persons with anal cancer and from 166 controls with colon cancer in whom these diseases were diagnosed during 1978-1985. We found that in men, a history of receptive anal intercourse (related to homosexual behavior) was strongly associated with the occurrence of anal cancer (relative risk, 33.1; 95 percent confidence interval, 4.0 to 272.1). Anal intercourse was only weakly associated with the risk of anal cancer in women (relative risk, 1.8; 95 percent confidence interval, 0.7 to 4.2). Among the subjects with squamous-cell anal cancer, 47.1 percent of homosexual men, 28.6 percent of heterosexual men, and 28.3 percent of women gave a history of genital warts, as compared with only 1 to 2 percent of controls and no patients with transitional-cell anal cancer. In patients without a history of warts, anal cancer was associated with a history of gonorrhea in heterosexual men (relative risk, 17.2; 95 percent confidence interval, 2.0 to 149.4) and with seropositivity for herpes simplex type 2 (relative risk, 4.1; 95 percent confidence interval, 1.9 to 8.8) and Chlamydia trachomatis (relative risk, 2.3; 95 percent confidence interval, 1.1 to 4.8) in women. Current cigarette smoking was a substantial risk factor in both women (relative risk, 7.7; 95 percent confidence interval, 3.5 to 17.2) and men (relative risk, 9.4; 95 percent confidence interval, 2.3 to 38.5). We conclude that homosexual behavior in men is a risk factor for anal cancer, and that squamous-cell anal cancer is also associated with a history of genital warts, an association suggesting that papillomavirus infection is a cause of anal cancer. Certain other genital infections and cigarette smoking are also associated with anal cancer.

Anus Neoplasms↗
PubMed1987

Prevention of wound infection after elective colorectal resection.

Various operative wound handling techniques have been proposed to prevent wound infections after elective colorectal resection, including pelvic drains, wound wicks, topical antibiotics, and subcutaneous drains. Review of 243 consecutive elective colorectal resections performed between 1977 and 1983, in which 64 percent of the patients had significant underlying medical problems, 27 percent were over age 70, and 45 percent had concomitant abdominal procedures, revealed that consistent application of a uniform perioperative protocol emphasizing aseptic and antiseptic techniques minimizes wound and anastomotic infectious complications. Simple wound closure in this setting is sufficient to prevent incisional wound infections.

Anti-Bacterial Agents↗
PubMed1987

En bloc resection of colon cancer adherent to other organs.

This study was undertaken to determine the optimal surgical treatment of colorectal cancers with adherence to adjacent organs in the absence of distant metastases. A retrospective review of colorectal cancer at Virginia Mason Hospital from 1975 to 1979 divided patients with Dukes' stage B2 and C2 colorectal cancers into three treatment groups: standard colectomy, en bloc resection, and colectomy with separation of adherent organs, with 5 year survival rates of 55 percent, 61 percent, and 23 percent, respectively. No operative mortality occurred with en bloc resection. Survival after en bloc resection was influenced by Dukes' stage and the histologic documentation of cancer within the adherent organ. Unacceptably high local recurrence rates and poor 5 year survival rates were observed in cases where adherent organs were separated from the colorectal cancer. We conclude that colorectal cancer adherent to other organs should be treated by en bloc resection. The survival rate after en bloc resection will be comparable to the rate after standard colectomy for nonadherent colorectal cancers.

Adult↗
PubMed1987

Surgical significance of vascular changes in chronic pancreatitis.

To establish a rational approach to the diagnosis and management of pancreatitis complicated by vascular abnormalities, the records of 50 patients who underwent angiography because of pancreatitis were reviewed. The findings included splenic vein thrombosis in 11 patients, splanchnic arterial anomaly or occlusion in ten patients and arterial pseudoaneurysm in six patients. Disease duration and presence of associated splenic vein thrombosis were the only two significant predictors of pseudoaneurysm. The presence of a pseudocyst was not predictive. Gastroesophageal varices, splenomegaly, associated arterial pseudoaneurysm and chronic pancreatic disease were significant predictors of splenic vein thrombosis. Dynamic bolus computed tomography was 100 per cent sensitive in detecting arterial pseudoaneurysm and 71 per cent in detecting splenic vein thrombosis. Eight patients with splenic vein thrombosis underwent splenectomy and the remaining three patients have been observed without splenectomy. Variceal bleeding has not occurred in either group. Five of the six patients with arterial pseudoaneurysm underwent aneurysmectomy without operative mortality. We conclude that arterial and venous complications of pancreatitis are associated with long duration of disease, gastrointestinal tract bleeding, varices and splenomegaly. Dynamic bolus computed tomography will detect vascular complications in these high risk patients. In patients with chronic pancreatitis in whom an operation is indicated, preoperative knowledge of vascular abnormalities may change the planned operative approach.

Adult↗
PubMed1986

Compressed pellet X-ray diffraction monitoring for optimization of crystallinity in lyophilized solids: imipenem: cilastatin sodium case.

A rapid, quantitative X-ray diffraction method to monitor the relative degree of crystallinity of lyophilized materials is described. The method was applied to determine the degree of crystallinity of imipenem [(5 R, 6 S)-3-[[2(formimidoylamino)ethyl]thio]-6-[(R)-1- hydroxyethyl]-7-oxo-1-azabicyclo[3.2.0]hept-2-ene-2-carboxylic acid] in 60 process related samples of the combination product of imipenem and amorphous cilastatin sodium (sodium (Z)-7-[[(R)-2-amino-2-carboxyethyl]thio]-2-[(S)-2,2- dimethylcyclopropanecarboxamido]-2-heptenoate). This assured optimizing process conditions which affect the improvement of crystallinity.

Cilastatin↗