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Biomedical subjects

J J Ryan

Publications and source records attributed to J J Ryan.

At least 145 records · Page 8Linked to original sources
PubMed1990

Long-term indwelling silastic central venous catheters: clinical audit leading to improved surgical technique.

A retrospective audit of the surgical insertion and clinical outcome of silastic venous catheters on our Haematology Unit was performed for the period 1985 to 1988. Twenty-three (58%) of the 40 lines had complications, and analysis showed that many were due to problems related to the surgical technique used. This altered our clinical practice, and over a 12 month period (January 1989 to January 1990) 26 central venous catheters have been placed in 24 patients by a dedicated surgical team using a standardized, altered technique. This has been to place all catheters via the right internal jugular vein and to confirm line position by on-table radiographic screening. A significant improvement in results is presented.

Adolescent↗
PubMed1990

Factor analysis of the mainland Chinese version of the Wechsler Adult Intelligence Scale (WAIS-RC) in a brain-damaged sample.

We factor analyzed the Chinese revision of the Wechsler Adult Intelligence Scale (WAIS-RC) in a sample of 59 individuals with medically diagnosed brain damage. The Chinese subjects consisted of 42 males and 17 females with means for Verbal. Performance, and Full Scale IQ of 83.88 (SD = 22.11), 75.49 (SD = 20.63), and 78.42 (SD = 21.97), respectively. Clear support was found for a general intelligence factor (g) and the Full Scale IQ. Similarly, the two-factor solution provided support for Wechsler's (1981) Verbal and Performance IQ designations. The three-factor solution revealed the familiar Verbal-Comprehension and Perceptual-Organization factors. However, the Freedom From Distractibility factor was less clearly defined. Comparisons of Chinese and American factor structures for neurologically impaired persons demonstrated high coefficients of congruence, ranging from .93 to .98. Overall, the findings demonstrated substantial congruence cross culturally for Chinese and American brain-damaged samples and suggest that the WAIS-RC measures essentially the same constructs as the WAIS-R.

Adolescent↗
PubMed1990

Credentials and clinical activities of internship supervisors in neuropsychology: a comparison of VA and non-VA training sites.

Surveyed 69 VA and 101 non-VA internships to (a) delineate the credentials and activities of supervisors in clinical neuropsychology, and (b) compare the credentials and activities of the two groups. Questionnaires were returned by 83% of VA and 62% of non-VA internships. A majority of each group was trained in clinical psychology. The proportions of supervisors with board certification and relevant coursework and/or training experiences (e.g., postdoctoral fellowship) were the same for both groups. Similarities were noted in time devoted to research and training, number of interns supervised, preferred assessment tools, and favored approach to clinical evaluation. Conversely, VA instructors devoted more time to clinical practice, while non-VA personnel claimed more publications. The majority of VA supervisors were trained in VA settings, while most non-VA respondents interned at university medical centers or state hospitals. The training and credentials of both groups evidenced wide ranging competencies. The need for improved training and credentialing of practitioners and supervisors was discussed.

Journal Article↗
PubMed1990

Prognostic significance of nondiploid DNA determined by flow cytometry in sporadic and familial medullary thyroid carcinoma.

To clarify the role of DNA measurements in predicting outcome after surgical treatment of medullary thyroid carcinoma (MTC), we performed flow cytometric analysis in nuclear suspensions of 119 MTC tumors. Of the 119 patients, 63 (53%) patients had sporadic tumors and 56 (47%) patients had familial tumors; survivors were followed for a mean of 13 years. DNA content was normal in 92 (77%) patients and abnormal (nondiploid) in 27 (23%) patients. Ten-year cause-specific mortality rates were 12%, 42%, and 49% with diploid, tetraploid/polyploid, or aneuploid tumors (p = 0.0009) and were greater with nondiploid tumors both in the sporadic (p = 0.012) and multiple endocrine neoplasia (familial) cases (p = 0.114). None of 27 patients with TNM stage I disease died of MTC. In patients with TNM stages II, III, and IV disease, DNA nondiploid tumors were associated with increased deaths from MTC. In a Cox proportional hazards model involving all 119 patients and adjusted for disease stage and inheritance pattern, nondiploid DNA was independently associated with increased deaths from MTC (p = 0.008). In an identical Cox model restricted to the 92 DNA diploid tumors, an S-phase fraction of 15.0% or more remained a significant variable (p = 0.034) after adjustment for stage and inheritance pattern. We therefore conclude that DNA measurements do have a role to play in predicting outcome after surgical treatment of MTC.

Adolescent↗
PubMed1989

The increasing importance of chronic rejection as a cause of renal allograft failure.

A consequence of reducing early graft failure due to acute rejection has been that more patients are at risk of chronic rejection, something which has become an increasingly important cause of graft loss. We examine the graft survival rates and reasons for failure in our unit from 1981 to 1986. Patients were divided into two series according to treatment of acute rejection episodes. From 1983 onwards, by treating acute vascular (poor prognosis) episodes with antilymphocyte globulin (ALG), we have significantly improved the 6-month actuarial graft survival rate. However, the percentage of total graft failure due to chronic rejection in this second series has significantly increased. The need for greater understanding of the aetiology of chronic rejection, together with its present unsatisfactory treatment, is discussed.

Adult↗
PubMed1989

Order of item difficulty on picture arrangement: data from a normal elderly sample.

In a sample of 226 normal elderly persons the order of item difficulty for the WAIS-R Picture Arrangement subtest was examined. Means for age and education were 80.8 yr. (SD = 5.2) and 10.9 yr. (SD = 2.9), respectively. The current order of items does not conform to the expectation of increasing difficulty. When testing elderly persons, intrasubtest scatter on Picture Arrangement should not be used to infer pathology.

Aged↗
PubMed1988

Mortality from papillary thyroid carcinoma. A case-control study of 56 lethal cases.

To document the presentation, findings, therapy, and postoperative course of lethal papillary thyroid carcinoma (PTC), 56 fatal cases were studied in a retrospective case-matched control fashion. These patients and their controls were taken from a larger series receiving their primary treatment at one institution (Mayo Clinic; 1946-1970). Mean follow-up for the lethal cohort was 8.5 years and 16.6 years for controls. Age, sex, tumor size, histologic grade, extent of disease at presentation, European Organization for Research on Treatment of Cancer (EORTC) and AGES scores (patient's age, tumor grade, tumor extent, and tumor size), and DNA ploidy pattern were found to be significant prognostic factors. The immediate causes of death were most frequently either local airway obstruction or respiratory insufficiency from pulmonary metastases. The results suggest that it is possible, at the time of initial treatment, to assess an individual patient's risk of dying from PTC. Aggressive postoperative adjunctive therapy should be restricted to that minority of patients who are at highest risk of death from PTC.

Adolescent↗
PubMed1988

Genetic analysis of the presentation of minor lymphocyte stimulating determinants. I. Combined importance of MHC and non-MHC influences.

In the course of studying the MHC restriction of minor lymphocyte stimulating (Mls) determinants, we observed that variation in the ability to present Mlsc determinants occurred with stimulator cells from different mouse strains that express the same class II MHC restricting elements; for example, one Iad-bearing strain, C3H.HTG, presented this non-MHC moiety, whereas another, C3H.OH, could not. As another example, the prototype Mlsb nonstimulatory H-2d stimulator cell, BALB/c, was shown to encode Mlsc even though it failed to trigger proliferation across this non-MHC barrier. In contrast, H-2d-compatible DBA/2 stimulator cells were capable of eliciting detectable levels of unprimed responder T cell proliferation across an Mlsc difference. Even when the BALB/c H-2d haplotype was replaced with the fully permissive H-2K halplotype, these BALB.K stimulator cells presented Mlsc (but not MHC) less effectively than H-2K-compatible C3H/HeJ stimulator cells. Analysis of the Mlsc-presenting capacity of stimulator cells obtained from (BALB.K x C3H) F1 x BALB.K first backcross and (BALB.K x C3H)F2 animals indicated that non-MHC-control influencing stimulatory ability of this non-H-2 Ag was multigenic. In addition, the capacity of DBA/2 to present Mlsa determinants more effectively than MHC-identical LT/ChReSv stimulator cells may indicate that the presentation of this Mls specificity is also influenced by non-MHC Ir genes. Thus the Mls phenotype of an animal should be considered the combined result of an Mls structural gene, the MHC haplotype, and multiple non-H-2 regulatory influences.

Animals↗
PubMed1988

Comparison of two IQ conversion tables for the Vocabulary-Block Design short form.

This study compared Brooker and Cyr (1986) and Silverstein (1982) WAIS-R IQ conversion tables for the Vocabulary-Block Design combination. Subjects were 150 veterans unselected with respect to diagnosis. Means for Full Scale IQ, Brooker and Cyr IQ, and Silverstein IQ were 94.17 (SD = 15.05), 96.68 (SD = 15.35), and 96.87 (SD = 15.30), respectively. Correlations between Full Scale IQ and both IQ estimates were highly significant: Brooker and Cyr r(148) = .91, p less than .001; Silverstein r(148) = .92, p less than .001. Both short-form IQs overestimated Full Scale IQ; average difference of 1.51 points for Brooker and Cyr and 1.67 for Silverstein were found. Agreement between both short form IQ estimates and Full Scale in terms of Wechsler's seven category intelligence classification was 62%. Both conversion tables yield comparable Full Scale IQ estimates.

Adult↗
PubMed1988

Cognitive sequelae of tardive dyskinesia.

Severity and location of tardive dyskinesia (TD) symptoms and diagnosis were related to neurocognitive dysfunction as measured by the Wechsler Adult Intelligence Scale (WAIS) and the Wechsler Memory Scale using schizophrenic and affective patients. Diagnosis, severity, and location of TD symptoms were related to cognitive dysfunction. Total symptom severity correlated significantly negatively with 10 of 14 WAIS scores and with four of seven Wechsler Memory scores in the total group with combined schizophrenic and affective patients. The magnitude of the relationships between TD symptom severity and cognitive deficit was strongly affected by the location of the symptoms and the diagnosis of the patient. In the total group, severity of facial TD symptoms correlated significantly negatively with 11 of 14 WAIS scores and with all eight memory scores. TD symptoms in the extremities correlated significantly negatively with only two WAIS and two memory scores, whereas truncal TD symptoms did not correlate significantly negatively with any WAIS or memory scores. Patients diagnosed as schizophrenic showed significant negative correlations of total TD symptom severity with 12 of 14 WAIS scores and with seven of eight Wechsler Memory Scale scores. Patients diagnosed as having affective disorder showed only one significant correlation between total TD symptom severity and WAIS or memory scores. Length of institutionalization has been found to be related to TD symptoms in schizophrenic but not affective patients. In the present study, institutionalization was negatively correlated with severity of facial TD symptoms but not with severity of TD symptoms of the trunk or extremities.(ABSTRACT TRUNCATED AT 250 WORDS)

Antipsychotic Agents↗
PubMed1988

Distant metastases in differentiated thyroid carcinoma: a multivariate analysis of prognostic variables.

From a cohort of 988 patients with differentiated thyroid carcinoma receiving primary surgical treatment between 1946 and 1970, we studied the 85 (9%) patients who had distant metastases diagnosed during life. Clinically detected metastases were found in 7% of the 859 patients with papillary cancers, 19% of the 100 patients with follicular cancers, and 34% of the 29 patients with Hürthle cell cancers. The total experience amounted to 607 patient-years of observation after the diagnosis of metastases, with a median follow-up in the 12 survivors of 23 yr (range, 13-32 yr). At the time of first diagnosis of metastases, the lungs only were involved in 53%, and bones only in 20%; 16% had multiple organ involvement. The overall mortality rates 5 and 10 yr after the diagnosis of metastases were 65% and 75%, respectively. Seventy-eight percent of all deaths were directly attributable to thyroid cancer; 82% of cancer deaths occurred within 5 yr. By univariate analysis, patient age, tumor extent, pattern of lung involvement, radioiodine uptake of the metastases, and radioiodine treatment were significant prognostic factors. By multivariate analysis, only age (as a continuous variable) at the time of first diagnosis of distant metastases (P less than 0.0001) and involvement of multiple organ sites (P = 0.0003) were independently associated with cancer mortality. The survival at 5 yr in 12 patients aged less than 40 yr with only a single organ involved was 92%. Older patients (aged greater than or equal to 40 yr) with a single metastasis (n = 59) had a lower survival (38% at 5 yr). The highest risk of cancer death (92% at 5 yr) was found in the 14 patients (any age) who at the time of first diagnosis of metastases had multiple organ involvement. The Cox regression model suggested that radioiodine therapy did not have a significant influence on survival, after adjusting for age and extent of metastatic involvement.

Adolescent↗
PubMed1988

Validity of the Luria-Nebraska language scales in aphasia.

The language scales of the Luria-Nebraska Neuropsychological Battery (LNNB) were administered to patients classified as either Broca's (n = 7) or Wernicke's (n = 7) aphasics. Group comparisons were made on the standard scales (e.g., Receptive Speech, Expressive Speech, Reading & Writing) and on 13 factor-analytically derived subscales (McKay & Golden, 1981). Results indicated that the standard T-score profile failed to discriminate the distinctively different language syndromes. Only two of the 13 factor scales differentiated the groups. Although Wernicke's patients were more impaired than Broca's patients on factor-analytically derived measures of basic language comprehension, it was concluded that the subscales added little to the standard profile in terms of aphasia syndrome identification. Distinctively different profiles of impaired and retained language abilities did not emerge on the LNNB factor scales. The battery cannot be recommended for use with aphasic patients.

Aged↗
PubMed1988

Construct validity of the Denman Memory for Human Faces test.

Assessed the validity of the Denman Memory for Human Faces (MHF) subtest employing a clinical sample. Factor analysis with marker variables was employed to establish the nature of the extracted factors. The MHF subtest, WAIS-R Verbal (i.e., Information, Vocabulary, and Digit Span) and Performance (i.e., Block Design and Object Assembly) subtests, the Wechsler Memory Scale Mental Control, Paired Associate Learning, 30-min Logical Memory, and 30-min Visual Reproduction, and Benton's Facial Recognition Test were subjected to a maximum likelihood factoring procedure with Varimax rotation. Four factors were extracted which accounted for 72.7% of the variance. Factor I was perceptual-organization, Factor II was verbal comprehension, Factor III was general memory, and Factor IV was attention-concentration. The MHF subtest achieved a substantial loading (i.e., 0.56) on the general memory factor along with Logical Memory (0.54), Visual Reproduction (0.51), and Paired Associate Learning (0.71). Clinical applications of the MHF were discussed.

Adult↗
PubMed1988

Effect of disc moistening method on Bacillus stearothermophilus disc assay zone diameters.

Effect of disc moistening method on the Bacillus stearothermophilus disc assay zone size was studied. Pasteurized homogenized milk was subdivided and three levels of US Pharmacopeial reference standard penicillin G were added. Disc assay filter paper discs were moistened using the standard capillary action procedure and a method incorporating the use of a 90-microliters micropipetter. Amount of milk sample absorbed by discs prepared by the capillary action method was correlated with disc mass. Variation in amount of milk absorbed by discs was significantly greater when discs were prepared by capillary action. Zone diameter means and standard errors across all penicillin G concentrations tested were not significantly different for the two methods. The 90-microliters micropipetter method is recommended as an alternative to the capillary action method.

Animals↗
PubMed1988

Papillary thyroid carcinoma in children and adults: long-term follow-up of 1039 patients conservatively treated at one institution during three decades.

Fifty-eight children (18 boys, 40 girls) less than 17 years of age, undergoing initial surgery because of papillary thyroid carcinoma (PTC) at Mayo Clinic from 1946 through 1975 and followed up for a median time of 27.6 years were compared with 981 adults (323 men, 658 women) treated during the same period and followed up for a median period of 19.5 years. At initial evaluation, mean tumor size (+/- SD) was greater in children (3.1 +/- 1.7 cm) than in adults (2.1 +/- 1.7 cm) (p less than 0.001); tumor DNA content was nondiploid in 10% of 39 children and in 25% of 110 adults (p = 0.047). Neck node metastases at diagnosis were detected in more children (89.7%) than adults (34.7%) (p less than 0.0001), but extrathyroidal invasion was not significantly more frequent in children (24.1%) than adults (15.8%) (p = 0.095). Distant metastases at diagnosis were detected in more children (6.9%) than adults (2.1%) (p = 0.022). Postoperatively, neck node metastases recurred more frequently in children (30%) than in adults (7%) (p less than 0.001), but local neck recurrences were not significantly more frequent in children (12%) than in adults (5%) (p = 0.083). Postoperative distant metastases occurred with similar frequency in children (6%) and adults (5%) (p = 0.98). Survival (all causes of death) for both adults and children up to 30 years after the initial surgery was no different from expected survival rates. Only adults aged more than 40 years had a significantly higher mortality from PTC than did children (p less than 0.0001). Fourteen percent of children had died of PTC by 15 years after diagnosis of distant metastases, whereas 68% of similarly affected adults were dead at 15 years (p = 0.014). PTC was more often metastatic to neck nodes and lungs before initial surgery and more often recurrent in neck lymph nodes postoperatively. However, PTC tended to be less fatal in children, and this may be related to the infrequency of nondiploid DNA content in the childhood PTC tumors.

Adolescent↗
PubMed1987

Mls is not a single gene, allelic system. Different stimulatory Mls determinants are the products of at least two nonallelic, unlinked genes.

Mls determinants share with MHC products the unique property of stimulating T cells at extraordinarily high precursor frequencies. The Mls system was originally described as a single locus on chromosome 1, with four alleles, Mlsa, Mlsb, Mlsc, and Mlsd, that encode polymorphic cell surface structures. However, the fundamental issues of polymorphism and allelism in the Mls system remain controversial. To clarify these questions, a formal segregation analysis of the genes encoding Mlsa and Mlsc determinants was carried out by testing the capacity of spleen cells from progeny of (Mlsa X Mlsc)F1 X Mlsb breedings to stimulate responses by unprimed T cells and by Mlsa- and Mlsc-specific cloned T cells. The results of this analysis indicated that the gene encoding Mlsa determinants is neither allelic to nor linked to the gene encoding Mlsc determinants. Together with previous findings, these results also suggest that another strongly stimulatory type, Mlsd, in fact results from the independent expression of unlinked Mlsa and Mlsc gene products. Based on these observations, it is concluded that, contrary to conventional concepts, the stimulatory phenotypes designated as Mlsa, Mlsc, and Mlsd can be accounted for by the independent expression of the products of at least two unlinked gene loci.

Alleles↗