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Biomedical subjects

J M Ryan

Publications and source records attributed to J M Ryan.

At least 55 records · Page 3Linked to original sources
PubMed1998

A & E nursing and the Internet.

The Internet is a relatively new addition to the world of information technology which can be incorporated for use in Accident & Emergency (A & E) nursing, It can provide an information resource and a communications tool for helping A & E nurses in their work. This paper explains the Internet for novices. It discusses the requirements for accessing it and how it can be used by A & E nurses. The aim of the paper is to inform, stimulate and encourage A & E nurses who know little about the Internet to adopt it into their nursing practice.

Computer Communication Networks↗
PubMed1998

Alendronate-induced esophagitis: case report of a recently recognized form of severe esophagitis with esophageal stricture--radiographic features.

Alendronate sodium, an aminobiphosphonate used primarily to treat osteoporosis in postmenopausal women, is known to cause esophagitis. A 71-year-old woman experienced severe, acute esophagitis and severe stricture of the esophagus due to oral alendronate therapy. Unlike in previous cases, she had taken alendronate for 10 months before the onset of complications and the stricture proved resistant to dilation.

Administration, Oral↗
PubMed1998

Topographic position of forelimb motoneuron pools is conserved in vertebrate evolution.

The neuromotor conservatism hypothesis predicts that neuromotor patterns in homologous tetrapod muscles are conserved evolutionarily despite the musculoskeletal modifications of vertebrate limbs. A complete description of the anatomical organization of the neurons innervating homologous limb muscles is a prerequisite to any test of the neuromotor conservatism hypothesis. This study uses the retrograde neuronal tracer WGA-HRP to selectively label the motor neuron pools of seven homologous forelimb muscles in mice (Mus musculus) and iguanas (Iguana iguana): Mm. pectoralis, spinodeltoideus, biceps brachii, lateral and long heads of triceps brachii, and the supraspinatus and infraspinatus (in mice) or their reptilian homolog, the supracoracoideus (in iguanas). In vertebrates, motoneurons are arranged in longitudinal columns of cells in the ventral horn of the spinal cord. Mouse motor pools average 1,952 microns in length, except the pectoralis pool which averaged 2,949 microns in length. Iguana pools average 3,196 microns in length. The number of neurons per pool ranged from 70-199 in mice and from 58-114 neurons in iguanas. In both iguanas and mice the motor pools for the spinodeltoids, biceps, and the supracoracoideus (or its mammalian homologs) lie anterior to the pectoralis and triceps motor pools. In the transverse plane, the pectoralis pool lies medial to those of the triceps. The pools of the biceps and spinodeltoids are located dorsal and lateral to those of the pectoralis and supracoracoideus (or its homologs in mammals). The resulting motor pool maps support the hypothesis that the anatomical organization of motoneurons in ancestral reptiles has been retained in these two tetrapod descendents.

Animals↗
PubMed1998

Performing radiologic gastrostomy or gastrojejunostomy in patients with malignant ascites.

OBJECTIVE: We describe our protocol for performing decompression radiologic gastrostomy and gastrojejunostomy in patients with ascites and small-bowel obstruction. We also assess the technical success rate, the complications, and the morbidity and mortality in 45 patients who underwent radiologic gastrostomy. MATERIALS AND METHODS: Forty-five consecutive patients with ascites associated with metastatic ovarian cancer underwent a radiologic gastrostomy or gastrojejunostomy with gastropexy. Six patients underwent gastrostomy, and 39 patients underwent gastrojejunostomy. Locking catheters were placed using the Seldinger technique after gastropexy in all patients. Paracentesis was performed before gastrostomy or gastrojejunostomy. Additional serial paracenteses were performed after the procedure when reaccumulation of ascites close to the site of gastropexy was detected on follow-up sonography. RESULTS: Forty-five procedures were attempted. The technical success rate was 97.8%. The complication rate was 15.6%. Three major complications (6.7%) and four minor complications (8.9%) occurred. One procedure-related death (2.2%) occurred 16 days after gastrojejunostomy. CONCLUSION: Radiologic gastrostomy and gastrojejunostomy can be performed safely in patients with ascites if the patients undergo paracentesis first and if the reaccumulation of ascites is prevented after tube placement. In patients with ascites, gastropexy plays an important role in preventing pericatheter leakage. Ascites and peritoneal carcinomatosis should not be considered contraindications for radiologic gastrostomy or gastrojejunostomy.

Ascites↗
PubMed1997

Role of a psychiatric liaison nurse in an A & E department.

Attendances at Accident & Emergency (A & E) departments by patients with mental health problems are on the increase. An emphasis on care in the community for patients with psychiatric disorders, and a society which is placing increased demands on the vulnerable, has meant that A & E departments are increasingly having to manage patients who have self-harmed and patients with acute mental health problems. Arguably, it is no longer acceptable or necessary for all patients presenting with self-harm to be admitted to hospital or to have a full evaluation by a psychiatrist. Other options exist whereby such patients can be managed in an efficient and appropriate way. One such option is the introduction of a psychiatric liaison nurse to the A & E department, who can liaise with A & E staff and with all available psychiatric services to offer optimal treatment for a patient. Such a service can obviate the need for involving psychiatric services directly on the day a patient presents. This paper describes the role of a psychiatric liaison nurse in an A & E department. It illustrates how effective the role can be by describing two case histories and outlining the psychiatric liaison nurse's work practice in the A & E department.

Adult↗
PubMed1997

Evaluation of a protocol for selective empiric treatment of fever without localising signs.

A protocol for management of young febrile children at risk for bacteraemia has been used at Westmead Hospital, a university based hospital in the western Sydney region, since early 1994. Implementation of the protocol was retrospectively evaluated for the 12 month period 1 June 1994 to 31 May 1995, using the emergency department log book as the primary data source. Altogether 498 children, aged from 3 months to 3 years, with a fever > or = 39.5 degrees C were identified over this period, of whom 291 were admitted to hospital because of evidence of sepsis or identified focal infection and 207 children without focal infection were observed in the short stay annexe of the emergency department. Fifty children, considered at high risk of bacteraemia because of a total white cell count > or = 20 x 10(9)/1 received empiric antibiotic treatment with ceftriaxone, of whom 19 subsequently had proved bacteraemia and another 10 had focal infection identified during observation in the short stay annexe. Bacteraemia was due to Streptococcus pneumoniae in 16 cases and Haemophilus influenzae type b in three. No adverse events occurred at follow up. Use of a management protocol and selection on higher white cell count criterion than previously recommended by US centres resulted in restriction of empiric antibiotic treatment to a small proportion of young febrile children presenting to a busy emergency department of whom 38% were bacteraemic.

Bacteremia↗
PubMed1997

Opportunities for emergency medicine training in Australia.

Opportunities exist for graduates from the United Kingdom to undertake some of their emergency medicine training in Australia. Guidelines for graduates are presented on when to travel, how to find a position, what information one should obtain about a position, and how to acquire the necessary visa and medical registration. A successful visit takes some time to plan and requires cooperation between the negotiating parties. The graduate who undertakes training abroad can expect to benefit professionally and personally. The development of an international exchange network for trainees would streamline the process and broaden the appeal to graduates of completing some of their emergency medicine training in another country.

Australia↗
PubMed1997

Gamma hydroxybutyrate--a coma inducing recreational drug.

The effects of gamma hydroxybutyrate, a coma inducing recreational drug, are described and illustrated by case reports of five patients presenting to accident and emergency (A&E). All had depressed levels of consciousness. There was strong circumstantial evidence of gamma hydroxybutyrate ingestion in all cases, and laboratory evidence in two. All recovered and supportive treatment. gamma Hydroxybutyrate has become a fashionable recreational drug. The majority of people who have ingested it will recover spontaneously without long term sequelae but its toxic effects may be dramatic while they last, particularly when it is taken with other drugs or alcohol.

Adult↗
PubMed1997

Accident and emergency medicine--making waves on the Internet.

The internet is a communications and information tool which has recently entered the world of accident and emergency (A&E) medicine. It is a worldwide instrument facilitating the dissemination of ideas and clinical information in the specialty. It is being embraced by all disciplines involved in A&E medicine. Part I introduces the internet to those in A&E medicine unfamiliar with this technology. It describes the varied resources of the internet in A&E medicine and speculates on its future role. Part II supplies the reader with the necessary information to get on-line and explains some of the more technical aspects of the internet.

Computer Communication Networks↗
PubMed1997

Fish tank granuloma--a frequently misdiagnosed infection of the upper limb.

Five patients attended the accident and emergency (A&E) department with fish tank granuloma caused by an infection with Mycobacterium marinum. All patients had forearm symptoms which were initially misdiagnosed. They were later recognised by the presence of superficial cutaneous lesions in a sporotrichotic distribution. Definitive diagnosis was confirmed by the histological appearances of a biopsy and or culture of the organism. All patients responded to oral minocycline and had uncomplicated recoveries once the diagnosis was established. A&E doctors need to be aware of the possible diagnosis of fish tank granuloma especially when treating forearm infections which have been resistant to antibiotics.

Adult↗
PubMed1997

Percutaneous gastrostomy with T-fastener gastropexy: results of 316 consecutive procedures.

PURPOSE: To assess the rates of technical success and complications associated with radiologic gastrostomy or gastrojejunostomy performed with T-fastener gastropexy. MATERIALS AND METHODS: In 316 consecutive patients, radiologic gastrostomy or gastrojejunostomy with T-fastener gastropexy was performed over a 10-year period. Results of the procedures were reviewed. Results of follow-up were available for all patients. RESULTS: Of 316 procedures, 314 were successful (technical success rate, 99.4%). Six (1.9%) major complications occurred; 50% occurred in patients with peritoneal involvement from ovarian carcinoma. Ten (3.2%) minor complications occurred. Four minor complications occurred in patients with ovarian cancer and ascites. The 30-day mortality rate was 3.8% (12 patients) with one procedure-related death (0.3%). CONCLUSION: A T-fastener gastropexy may have a protective role in prevention of leakage of gastric contents into the peritoneum in patients with ascites. Ascites need no longer be considered a contraindication for radiologic gastrostomy. A gastropexy enables routine use of larger gastrostomy tubes and ready replacement of a displaced tube even before the development of a mature tract.

Adult↗
PubMed1997

Organization of forelimb motoneuron pools in two bat species (Eptesicus fuscus and Myotis lucifugus).

The present investigation provides further evidence of the conservation of motor nuclei in amniotes. The position of six forelimb and shoulder motor pools were mapped in two species of bat, Eptesicus fuscus and Myotis lucifugus. The intraspinal locations of motor pools were revealed by labeling with the retrograde neuronal tracer WGA-HRP injected into the bellies of six muscles: m. pectoralis, m. spinodeltoideus, mm. triceps brachii (long and lateral heads), m. infraspinatus, m. supraspinatus, and m. biceps brachii. The positions of the labeled motor pools were reconstructed from serial transverse and horizontal sections of the spinal cord. WGA-HRP-labeled cells were located midway between cervical spinal nerves four and five to midway between cervical spinal nerve eight and the first thoracic spinal nerve. Individual motor pools formed fusiform clusters of cells with little intermingling of neurons between adjacent motor pools. The pectoralis motor pool contained significantly more motoneurons than all other motor pools for M. lucifugus. The pectoralis pool in E. fuscus contained more motoneurons than the biceps, supraspinatus, and infraspinatus, but not the spinodeltoid or the triceps brachii. The biceps, spinodeltoid, infraspinatus and supraspinatus pools were located rostrally; the pectoralis and triceps pools caudally. The pectoralis pool was the most medial and the spinodeltoid pool was the most lateral. These data suggest that the locations of shoulder and forelimb motor pools are ontogenetically and phylogenetically conserved across tetrapods and independent of the function of the muscles in adults.

Animals↗