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Biomedical subjects

J H Sullivan

Publications and source records attributed to J H Sullivan.

At least 19 recordsLinked to original sources
PubMed2000

Effect of antiretroviral therapy on the incidence of bacterial pneumonia in patients with advanced HIV infection.

To determine the relationship of combination antiretroviral therapy and bacterial pneumonia, we assessed incidence of and risk factors for bacterial pneumonia in 1,898 human immunodeficiency virus (HIV)-infected patients with CD4 cell counts < 200/mm(3) followed in the Johns Hopkins HIV clinic between 1993 and 1998. A total of 352 episodes of bacterial pneumonia occurred during 2,310 patient-years of follow-up. Incidence of bacterial pneumonia decreased from 22.7 episodes/100 person-years (py) in the first half of 1993 to 12.3 episodes/100 py in the first half of 1996, reaching a nadir of 9.1 episodes/100 py in the second half of 1997 (p < 0.05). The use of protease inhibitor-containing regimens was associated with a decreased risk of bacterial pneumonia (risk ratio [RR] 0.55, 95% CI 0.31 to 0.94). Lower CD4 cell counts (RR 2.22, 95% CI 1.54 to 3.18), injection drug use as HIV transmission category (RR2.0, 95% CI 1.43 to 2.76), and prior Pneumocystis carinii pneumonia (RR 3.88, 95% CI 1.65 to 9.16) were also significantly associated with bacterial pneumonia. Trimethoprim-sulfamethoxazole and macrolide use were not significantly associated with risk of bacterial pneumonia. There has been a dramatic decline in the incidence of bacterial pneumonia resulting from the use of combination antiretroviral therapy containing protease inhibitors.

Adolescent↗
PubMed1992

Contrast enema diagnosis of necrotizing enterocolitis.

Contrast enema was performed in a select group of 126 neonates with ambiguous diagnosis of necrotizing enterocolitis (NEC). Enema findings were compared with that on plain abdominal radiographs (AXR) and the clinical outcome. Thirty-one of the 34 patients with a discharge diagnosis of NEC were interpreted to have a positive contrast enema, and 91 of the 92 patients without a discharge diagnosis of NEC were interpreted to have a negative contrast enema. The AXR was interpreted as positive in 57 patients and as negative or indeterminate in 69. Not a single case of perforation was produced. Judicious use of contrast enema can improve specificity of diagnosis in cases with discordant clinical and plain radiographic findings.

Barium Sulfate↗
PubMed1991

Self-compression plates for orbital rim fractures.

The development and principles of self-compression plating, as well as a series of patients treated with this technique, are described. The use of such plates has specific advantages over other techniques for disorders encountered by the oculoplastic surgeon. The indications for plating were displaced trimalar fracture, displaced trimalar fracture with orbital rim fragment, and comminuted orbital rim fracture. Results were good; no complications have been observed to date. Comparison of compression plating to other methods for repair of orbital fractures is made. Self-compression plating with Vitallium plates is an effective modality for the treatment of a broad spectrum of patients with orbital rim fractures.

Adolescent↗
PubMed1989

Pretarsal fixation of gold weights in facial nerve palsy.

Implantation of a gold weight in the pretarsal space was performed on 17 patients with poor eyelid closure secondary to facial nerve weakness. Successful results were obtained in 14 (82%) of 17 patients. Postmortem histopathology of such a case demonstrated firm fibrous encapsulation of the weight. Although some authors advocate fixation of lid weights to the orbital septum, fixation in the pretarsal space is preferred for the following reasons: (a) "cheesewiring" is less likely to occur, (b) a limited levator recession may be more easily performed, (c) greater mechanical benefits are obtained, and (d) the potential for inferior migration is less.

Adult↗
PubMed1986

Eyelid anaphylactic reaction to atracurium with general anesthesia.

Atracurium is a relatively new neuromuscular blocking anesthetic with known histamine release effects which has become popular in ophthalmic anesthesia. This report describes the IV use of Atracurium causing an anaphylactic reaction manifested by localized edema of all four eyelids, conjunctival chemosis and mild laryngeal edema requiring scheduled ptosis and strabismus surgery to be cancelled.

Anaphylaxis↗
PubMed1979

Cryosurgery in ophthalmic practice.

Cutaneous cryosurgery is useful in an ophthalmic practice in the treatment of basal cell carcinoma, trichiasis, and other benign cutaneous disorders. Indications and techniques for using liquid nitrogen and nitrous oxide instruments are discussed.

Body Temperature Regulation↗
PubMed1978

Cryosurgery for trichiasis.

A series of 41 cases of trichiasis was treated with cryosurgery using a standard retinal cryoprobe. The failure rate was approximately 50 per cent. The results should be improved by using properly designed equipment capable of cooling the lash follicles to -20 degrees C, and ensuring that this temperature is achieved by using a tissue thermocouple. A double freeze-thaw cycle should be used and a long-acting local anaesthetic containing adrenaline. The main complication is depigmentation which is a problem only with heavily pigmented patients. Cryosurgery does have potential for the treatment of trichiasis.

Adolescent↗
PubMed1976

Cryotherapy of basal cell carcinoma in oculoplastic surgery.

Cryotherapy was an effective modality in the treatment of basal cell carcinoma in the eyelid and periorbital area and cured 93% of the 29 lesions in 25 patients. This method was especially advantageous in patients with blood clotting disorders; those with medical contraindications to, or who refused, classical surgery; patients who had prior radiation or surgery; patients with the basal cell nevus syndrome or xeroderma pigmentosa; and in patients with medial canthal tumors. Experimental cryotherapy in the albino rabbit showed their lacrimal system is not adversely affected by freezing in the temperature range required for tumor death.

Animals↗
PubMed1976

Lower eyelid reconstruction by tarsal transposition.

We reconstructed the lower eyelids of 13 patients using a tarsoconjunctival flap from the upper eyelid. The laterally based pedicle flap permitted a one-stage repair without prolonged occlusion of the eye. The technique was best suited to lesions involving the lateral aspect of the lower eyelid, but can be applied to lesions of the central and medial eyelid. The functional and cosmetic results were equal or superior to tarsoconjunctival advancement flaps.

Adult↗
PubMed1976

Cryosurgery for treatment of trichiasis.

We cryosurgically destroyed eyelashes in rabbits and applied the technique to treat 23 selected patients with trichiasis. Liquid nitrogen was sprayed on the eyelid margin by using a double, rapid-freeze, slow-thaw cycle monitored by a subcutaneous thermocouple to -30 degrees C. It was an improvement on electrolysis and a simple alternative to surgery.

Animals↗