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Biomedical subjects

J A Ryan

Publications and source records attributed to J A Ryan.

At least 109 records · Page 6Linked to original sources
PubMed1983

Immunogenic and protective properties of meningococcal serotype 2a protein in the hen-embryo model.

The ability of serotype 2 outer membrane protein (SP-2) of Neisseria meningitidis strain M986 serogroup B, serotype 2a (B, 2a) to stimulate antibody formation in hens and to confer protection against meningococcal challenge to embryos from immunised hens was investigated. Hens, housed with roosters, were immunised with 100 micrograms of SP-2 once a week for 5 weeks to maintain consistent levels of serum antibody during the study. Antibodies in sera of hens, yolks and plasma of 13-day-old embryos reacted in enzyme-linked immunosorbent assays and immunodiffusion with outer membrane vesicles (OMV) from serotypes 2a, 2b and 2c and most of the other prototype group B strains of N. meningitidis. Cross-reactivity of hen sera with most OMV appeared after only one injection of SP-2. Embryos from immunised hens were protected against challenge with up to 10,000 LD50 doses of either the homologous strain M986 (B, 2a) or strain M1011 (B, 2a). Protection was also evident against strains 614 (W135, 2a), S5896 (Y, 2c) and 2241 (C, 2a), but not against strain 78704 (C, 2a) despite strong cross-reactivity of antibody with OMV of this strain. Embryos were only partially protected against strain 78069 (B, 2b) and were fully susceptible to strain 2996 (B, 2b). Some protection was also obtained against meningococcal strains M1080 (B, 1), M982 (B,9), S3032 (B, 12), 79001 (B, 12), 79694 (B, 15-related) but not strain 77252 (B, nontypable). These results suggest that proteins extracted from both serotype 2a and 2b meningococci would provide the broadest protection against infection with group B, serotype 2 meningococci and that antibody, presumably directed against common peptides in the major outer membrane proteins, can prevent infection by some other disease-associated serotypes of N. meningitidis.

Animals↗
PubMed1983

Serotypes of Neisseria meningitidis associated with an increased incidence of meningitis cases in the Hamilton area, Ontario, during 1978 and 1979.

The distribution of serotypes among strains of Neisseria meningitidis responsible for a marked increase of meningitis cases in the Hamilton area, Ontario, in 1978 and 1979 was determined. Twenty-six serogroup B and two serogroup W135 strains isolated from cerebrospinal fluid, blood, and skin of 28 patients were serotyped by agar gel double diffusion. Twenty-one (81%) of the group B strains were serotype 2b as judged by the formation of characteristic serotype precipitin bands with the specific anti-2996 (type 2b) serum. Fourteen of the serotype 2b strains also reacted with anti-77252 serum, which suggested that one strain or several closely related strains were mainly responsible for the increase in meningitis during the 2-year period. Examination of the outer membrane complexes (OMC) of the strains by polyacrylamide gel electrophoresis in the presence of sodium dodecyl sulfate (SDS-PAGE) revealed that all 21 of the serotype 2b strains contained the class 2 protein (molecular weight 41500) which is known to be the site of the serotype 2b determinant. Further characterization of the serotype 2b, 77252 strains by enzyme-linked immunosorbent assays (ELISA) and SDS-PAGE suggested that the 77252 determinant was present in the class 1 proteins of these strains. The serotype 2b containing strains were isolated from 77.7 and 70% of males and females, respectively, from 81.8% of children less than 5 years of age, and from 75.0% of patients of all age groups. The study indicates the important role of serotype 2b meningococci in causing the increased incidence of meningitis and further substantiates the important association of the serotype 2b determinant with group B serotype 2 meningococcal disease in Canada.

Bacterial Outer Membrane Proteins↗
PubMed1983

Cholecystitis in teenage girls.

Cholecystectomy was carried out in 17 teenage girls for cholecystitis at Virginia Mason Hospital, Seattle, between 1971 and 1980. The incidence increased with increasing age. Gallbladder disease was associated with recent pregnancy or birth control pill use (71%), obesity (65%) and family history of gallbladder disease (47%). All but one patient had at least one of these risk factors. No patient had congenital anomalies, blood dyscrasias or other underlying illness. Patients most commonly had recurrent attacks of abdominal pain; seven had symptoms for more than six months. Although the clinical presentations were often mild, six patients had jaundice, three had chemical pancreatitis, one had hemorrhagic pancreatitis, one had pancreatic pseudocyst and abscess and one had a common duct stone. One patient had cholesterosis and 16 had cholelithiasis. All patients were cured by operation. During the same time period, only two boys, both aged 14 years, nonobese and with no family history of gallbladder disease, underwent cholecystectomy, both for acaculous cholecystitis.

Adolescent↗
PubMed1982

Use of a split-sheath vein introducer for subclavian venipuncture in the placement of silicone catheters for chronic venous access.

The technique of venous cutdown for placement of silicone catheters can be difficult, uncomfortable for the patient, and very time-consuming. Adapting a technique used for the placement of permanent transvenous pacemaker leads, subclavian venotomy and a split-sheath dilator can be used for direct placement of large-bore catheters into the superior vena cava. This approach decreases patient discomfort and the likelihood of infectious or hemorrhagic complications of silicone catheter placement, and has greatly simplified and shortened this procedure.

Catheterization↗
PubMed1982

Acute respiratory distress syndrome after peritoneovenous shunt.

A case is presented in which a fatal acute respiratory distress syndrome, associated with disseminated intravascular coagulation, developed immediately after the insertion of a peritoneovenous shunt for management of refractory ascites. The absence of left-sided heart failure or fluid overload was established by (a) lack of diuresis from intravenous furosemide; (b) repeatedly normal pulmonary wedge pressures; and (c) autopsy findings. The nature of the toxic effect of this patient's ascites upon the alveolar membrane remains obscure.

Acute Disease↗
PubMed1981

Early postoperative jejunal feeding of elemental diet in gastrointestinal surgery.

Gastric and colonic ileus after major abdominal operation precludes normal oral nutrition in the immediate postoperative period. Since small bowel motility and absorptive capacity are present immediately after operation, the small bowel may be used for feeding. We prospectively evaluated the efficacy of early postoperative jejunal feeding of elemental diet in three groups of patients. Fourteen adults undergoing elective partial colectomy were randomized to receive jejunal feeding of elemental diet (ED) or isotonic intravenous infusions of dextrose (IV). Considering all avenues of nutrition for the first ten postoperative days, seven ED patients received a mean daily input of 2283 calories and 14.1 grams of nitrogen compared to 800 calories and 3.4 grams of nitrogen for the seven IV controls (P less than 0.005). The ED patients lost 2.4 per cent of their body weight during the first postoperative month compared to a 6.1 per cent weight loss for the IV controls (P less than 0.005). The ED group required an intravenous catheter for 1.8 days, compared to 6.6 days for the IV group (P less than 0.005). Twenty consecutive patients subjected to major upper gastrointestinal operations received a daily mean of 1468 calories and 9.7 grams of nitrogen jejunally during the first ten postoperative days. Mean weight loss at two and four weeks postoperatively was 2.8 per cent and 3.5 per cent of preoperative weight. Ten patients received jejunal elemental diet for longer than one month because of postoperative complications or adjunctive therapy for cancer. Mean weight loss was 2.8 per cent. Early postoperative jejunal feeding of elemental diet supplies more nutrients and results in less weight loss than does intravenous therapy with isotonic dextrose. Early postoperative feeding is of value in patients undergoing major operations on the upper gastrointestinal tract.

Adult↗
PubMed1980

Nutritional benefits of immediate postoperative jejunal feeding of an elemental diet.

Positive nitrogen balance and preservation of body weight and total proteins were demonstrated in 26 patients undergoing extensive upper gastrointestinal operations who were randomized to receive elemental diet by a needle catheter jejunostomy. Infusions were started immediately after operation and continued for 10 days. In 26 patients receiving enteral feedings and 22 intravenous control patients, mean cumulative 10 day nitrogen balance was +11.7 +/- 5.4 and -44.7 +/- 6.5 g, respectively (p = 0.0001). Enterally fed patients lost only 0.02 +/- 0.5 kg of weight compared with 3.8 +/- 0.3 kg in control patients. The only complications were diarrhea in 34 percent of the study patients and one broken catheter. It is probable that the nitrogen and body weight preservation provided by enteral hyperalimentation equals or exceeds that demonstrated for total parenteral nutrition in postoperative patients.

Adult↗
PubMed1980

Intraoperative localization of small bowel bleeding sites with combined use of angiographic methods and methylene blue injection.

Superselective catheter placement with angiographic techniques and methylene blue injection at laparotomy through a prepositioned angiographic catheter have helped to localize small bowel bleeding lesions. The technique has been applied successfully in two patients with arteriovenous malformations and one patient with bleeding mucosal ulcerations of the small bowel.

Adult↗
PubMed1979

Separation and spectral properties of diisopropylphosphate, the major decomposition product of isoflurophate.

The reaction of water with isoflurophate to form diisopropylphosphate was examined and confirmed. Isolation of this decomposition product from an antiglaucoma drug formulation is described. A known reference compound was isolated from a commercial mixture also containing the monoisopropyl ester. The isolation, purification, and molecular spectroscopic and elemental confirmation of structure are described. IR, NMR, and mass spectra are included. Additionally, a GLC procedure and parameters used to identify diisopropylphosphate in a degraded peanut oil formulation of isofluorphate are reported. Reaction mixtures of this drug with water and sodium hydroxide were analyzed by GLC with the expected results.

Chromatography, Gas↗
PubMed1979

Gracilis muscle flap for closure of rectourethral fistula.

A gracilis muscle flap can be used to close a rectourethral fistula caused by operative trauma and radiation. The flap is rotated easily into the perineum, brings vascularized muscle to irradiated and/or traumatized tissue and is a mechanical barrier between the urethra and the rectum.

Humans↗
PubMed1979

Intraoperative management of renal cell carcinoma with supradiaphragmatic caval extension.

A new technique for inferior vena caval tumor thrombectomy is described. Vascular isolation of the cava from the right atrium to the pelvis is achieved by temporary circulatory arrest of the lower torso. Removal of the neoplastic thrombus under direct vision with minimal blood loss was accomplished in a patient with renal carcinoma, whose tumor extended into the intrapericardial vena cava.

Adenocarcinoma↗
PubMed1979

Gracilis muscle flap for closure of the persistent perineal sinus.

A persistent perineal sinus may develop in those patients undergoing proctocolectomy for inflammatory intestinal disease. Healing often resists the traditional methods of wound management. Wide excision, transposition of the vascularized gracilis muscle flap into the rigid cavity and closure have all allowed rapid primary healing to occur and the return of these patients to full function.

Coccyx↗
PubMed1978

Amino acid derangements in patients with sepsis: treatment with branched chain amino acid rich infusions.

Sepsis is a major catabolic insult resulting in modifications in carbohydrate and fat energy metabolism, and leading to increased muscle breakdown and nitrogen loss. Insulin resistance, which develops in sepsis, decreases glucose utilization, but plasma insulin levels are sufficiently elevated to prevent lipolysis, resulting in a further energy deficit. The availability of fuels in sepsis is therefore limited, and the body resorts to muscle breakdown, gluconeogenesis, and amino acid oxidation for energy supply. Previous work has not defined, however, the exact alterations in amino acid metabolism. Therefore, the following studies were undertaken. Blood samples were drawn from fifteen patients in whom the diagnosis of sepsis was clinically established; the samples were analyzed for amino acid, beta-hydroxyphenylethanolamines, glucose, insulin and glucagon concentrations. The plasma amino acid pattern observed was characterized by an increase in total amino acid content, due mainly to high levels of the aromatic amino acids (phenylalanine and tyrosine) and the sulfur-containing amino acids (taurine, cystine and methionine). Alanine, aspartic acid, glutamic acid and proline were also elevated, but to a lesser degree. The branched chain amino acids (valine, leucine and isoleucine) were within normal limits, as were glycine, serine, threonine, lysine, histidine and tryptophan. Those patients who did not survive sepsis had higher levels of aromatic and sulfur-containing amino acids as compared to those patients surviving sepsis. On the other hand, those patients surviving sepsis had higher levels of alanine and the branched chain amino acids. In a second group of five patients with overwhelming sepsis accompanied by a state of metabolic encephalopathy, a parenteral nutrition solution consisting of 23% dextrose, and an amino acid formulation enriched with branched chain amino acids was administered. In these five patients, normalization of the plasma amino acid pattern and reversal of encephalopathy was observed. The following sequence of events may be postulated: The septic patient develops insulin resistance in the peripheral tissues, primarily muscle, while the adipose tissue is much less affected. The insulin resistance and the inability to utilize fat leads to increased muscle proteolysis. Muscle breakdown results in release into the blood of enormous amounts of various amino acids; the muscle itself is able to oxidize the branched chain amino acids, supplying the muscles' own energy requirements and alanine for gluconeogenesis. The extensive muscle proteolysis coupled with relative hepatic insufficiency occurring early in sepsis results in the appearance in the plasma of high levels of most of the amino acids present in muscle, particularly the aromatic and the sulfur-containing amino acids. The outcome of patients with sepsis might be positively affected by combined therapy with glucose, insulin and branched chain amino acids.

Amino Acids↗
PubMed1977

Continual catheter administration of an elemental diet in infants and children.

Elemental diet offers a safe, simple, widely applicable technique for providing nutritional support in infants and children, thus protecting them against the hazards of malnutrition. Continual catheter administration of elemental diet provides an avenue of nutritional support free of many of the complications associated with total parenteral nutrition. Although mechanical and metabolic complications were avoided by rigid protocol compliance in our group of over 150 patients, further metabolic studies may suggest minor compositional changes providing a more optimal diet for premature and newborn infants.

Abnormalities, Multiple↗