Biomedical subjects

J M Ryan

Publications and source records attributed to J M Ryan.

At least 91 records · Page 5Linked to original sources

PubMed1990

Assessing injury severity during general war. Will the Military Triage system meet future needs?

The injuries likely to occur during a future general war will differ in severity and number from those experienced during recent short campaigns, terrorist incidents and natural disasters. If general war should break out in Europe, casualty numbers will lean towards the First World War rather than the Second in scale. Medical assets can expect, at least temporarily, to be overwhelmed with casualties. To deal with this problem, casualty management will be staged through five echelons or lines of medical support. The principal problem that will face medical attendants at the forward lines will be the sorting of casualties by priority so that those unable to tolerate delay in treatment will be evacuated rapidly before the less severely injured. Sorting will be achieved by the application of a crude scoring system known as Military Triage. We examine this concept and discuss its likely effectiveness in a scenario characterised by limited medical resources and a high flow of casualties. With the widespread introduction of modern and complex injury severity scoring systems into civilian trauma practice it is timely to examine their potential role in augmenting or replacing the current Military Triage system.

Disaster Planning↗

PubMed1990

The Hungerford disaster. A late perspective of the military experience.

Two years have passed since the worst firearms incident in recent British civil history. Most of the casualties were managed at a local district general hospital; this experience was reported soon afterwards. Two casualties were managed at Princess Alexandra's Hospital, RAF Wroughton; both are still under review. This paper describes their injuries, investigations and treatment. Current thoughts on optimal management are discussed; areas of particular controversy are highlighted.

Adult↗

PubMed1989

T lymphocytes in infectious mononucleosis; effect of IL-2 on the outgrowth of Epstein-Barr virus-infected cells.

The addition of interleukin-2 (IL-2) to lymphocyte cultures from acute infectious mononucleosis (IM) donors dramatically increased the incidence of regression in such cultures and resulted in the emergence of an IL-2 dependent, CD3 Epstein-Barr virus nuclear antigen (EBNA)-negative cell population. Corresponding cultures seeded in the absence of IL-2 rarely regressed and were quickly dominated by IL-2 independent, CD3-negative, EBNA-positive cells. Lymphocyte cultures from Epstein-Barr virus (EBV) seropositive donors showed enhanced regression in the presence of IL-2 but failed to regress after the removal of the E-rosetting population. Cultures from EBV-seronegative donors showed no evidence of regression in the presence or absence of IL-2. E-rosetting cells isolated from cultures from acute IM donors that had been cultured in the presence of IL-2 lysed autologous and allogeneic lymphoblastoid cell lines.

Antibodies, Viral↗

PubMed1989

Construction and characterization of a herpes simplex virus type 1 mutant unable to transinduce immediate-early gene expression.

A herpes simplex virus mutant, in1814, possessing a 12-base-pair insertion in the gene encoding the transinducing factor Vmw65 has been constructed. The insertion abolished the ability of Vmw65 to transinduce immediate-early (IE) gene expression and to form a protein-DNA complex with cell proteins and the IE-specific regulatory element TAATGAGAT. Accumulation of IE RNA 1 and 2 was reduced four- to fivefold in in1814-infected cells, but the level of IE RNA 4 was reduced only by twofold, and IE RNA 3 was unaffected. Mutant in1814 had a high particle/PFU ratio, but many of the particles, although unable to form plaques, were capable of normal participation in the early stages of infection at high multiplicity of infection. The defect of in1814 was overcome partially by transfection of a plasmid encoding the IE protein Vmw110 into cells prior to titration and by prior infection with ultraviolet light-inactivated herpes simplex virus. Mutant in1814 was essentially avirulent when injected into mice. The results demonstrate that transinduction of IE transcription by Vmw65 is important at low multiplicity of infection and in vivo but that at high multiplicity of infection the function is redundant.

Animals↗

PubMed1989

British Military Hospital Dharan: the range, mode of presentation and management of malignancies presenting to the department of surgery during 1985-86.

British Military Hospital Dharan provides the surgeon with an opportunity, unparalleled anywhere in the United Kingdom to observe and manage a range of malignancies. The historical and contemporary reasons for this are outlined. The paper illustrates the military hospital experience and mode of presentation of a wide range of malignant conditions treated during the tour. Differences from United Kingdom practice are noted and where known, the reasons for this are discussed. Problems in diagnosis, treatment and continuing care, unique to a practice of this kind, are highlighted. The training potential of a hospital of this nature for future military surgeons is discussed.

Female↗

PubMed1989

Augmentation of diastolic function with phosphodiesterase inhibition in congestive heart failure.

Phosphodiesterase inhibition promotes both cellular uptake and release of calcium, which should thus facilitate both myocardial relaxation and myocardial contraction. To test the hypothesis that phosphodiesterase inhibition augments both diastolic and systolic ventricular function, parameters of left ventricular ejection and filling were measured in patients with dilated cardiomyopathy before and after therapy with the phosphodiesterase inhibitor enoximone. Baseline radionuclide ventriculography was performed in all subjects with derivation of left ventricular ejection fraction and peak diastolic filling rate. These parameters were again assessed after 3 months of therapy with either placebo (six patients) or enoximone (seven patients). Ejection fraction increased significantly (p less than 0.05) in the enoximone group (change from baseline = 11 +/- 14 ejection fraction units) but did not change in the placebo group (0.2 +/- 5 ejection fraction units). Enoximone administration was associated with a significant (p less than 0.05) increase in peak filling rate, from 0.9 +/- 0.5 to 1.4 +/- 0.5 end-diastolic volumes per second, which was noted in the placebo group (1.2 +/- 0.6 to 1.4 +/- 0.9 end-diastolic volumes per second; p = not significant). Thus, in comparison with placebo, exoximone augmented both diastolic and systolic function in dilated cardiomyopathy. This identifies an additional influence of this class of inotropic agent on the function of the intact ventricle that is consistent with previously described cellular mechanisms and that may significantly contribute to a restoration of normal hemodynamic status in dilated cardiomyopathy.

Blood Pressure↗

PubMed1989

Prevalence of mitral valve prolapse in primary fibromyalgia: a pilot investigation.

Fifty patients with primary fibromyalgia and a negative cardiovascular symptom history underwent echocardiography to determine the prevalence of mitral valve prolapse (MVP). The mean age of the population was 40 +/- 13 years (14 men, 36 women). Mitral valve prolapse was detected in 75%; 33% with myxomatous mitral valve leaflets. The prevalence of MVP in this population is significantly higher (p less than 0.0001) than in the general population. Primary fibromyalgia and MVP may be part of a more generalized connective tissue abnormality characterized by distinct genetically determined variants.

Adult↗

PubMed1988

British Military Hospital Dharan: surgical experience 1985-86.

The clinical experience of an army surgeon in a military hospital in East Nepal is discussed. The truly general nature of the work load is highlighted and the need for a broad based general training in surgery for such a task is well illustrated. A high degree of interdisciplinary cooperation was experienced and was indeed essential for good clinical practice. The health problems of a developing country are glimpsed. The severe limitations imposed on clinical practice as a consequence of limited facilities are particularly noteworthy.

Delivery of Health Care↗

PubMed1988

Wound ballistics: contemporary and future research.

Wound ballistics research has contributed much to the understanding of the pathophysiology of missile injury that now exists. From this store of knowledge treatment regimes have evolved which have greatly improved the lot of the soldier wounded in war. However, research must keep pace with changes that are taking place in weapons research and development so that the particular needs of the Army Medical Services on a future battlefield can be met. The differing needs of civilian and military medical services are highlighted. The marked differences that exist between the missile wound seen and treated in a late twentieth century hospital and the wounds likely to be encountered on the modern battlefield are enumerated and discussed.

Humans↗

PubMed1988

Prognostic utility of the exercise thallium-201 test in ambulatory patients with chest pain: comparison with cardiac catheterization.

The goal of this study was to determine the prognostic utility of the exercise thallium-201 stress test in ambulatory patients with chest pain who were also referred for cardiac catheterization. Accordingly, 4 to 8 year (mean +/- 1SD, 4.6 +/- 2.6 years) follow-up data were obtained for all but one of 383 patients who underwent both exercise thallium-201 stress testing and cardiac catheterization from 1978 to 1981. Eighty-three patients had a revascularization procedure performed within 3 months of testing and were excluded from analysis. Of the remaining 299 patients, 210 had no events and 89 had events (41 deaths, nine nonfatal myocardial infarctions, and 39 revascularization procedures greater than or equal to 3 months after testing). When all clinical, exercise, thallium-201, and catheterization variables were analyzed by Cox regression analysis, the number of diseased vessels (when defined as greater than or equal to 50% luminal diameter narrowing) was the single most important predictor of future cardiac events (chi 2 = 38.1) followed by the number of segments demonstrating redistribution on delayed thallium-201 images (chi 2 = 16.3), except in the case of nonfatal myocardial infarction, for which redistribution was the most important predictor of future events. When coronary artery disease was defined as 70% or greater luminal diameter narrowing, the number of diseased vessels significantly (p less than .01) lost its power to predict events (chi 2 = 14.5). Other variables found to independently predict future events included change in heart rate from rest to exercise (chi 2 = 13.0), ST segment depression on exercise (chi 2 = 13.0), occurrence of ventricular arrhythmias on exercise (chi 2 = 5.9), and beta-blocker therapy (chi 2 = 4.3). The exclusion of myocardial revascularization procedures as an event did not change the results significantly. Although the number of diseased vessels was the single most important determinant of future events, the exercise thallium-201 stress test when considered as a whole (which included the number of segments demonstrating redistribution on delayed thallium-201 images, change in heart rate from rest to exercise, ST segment depression on the electrocardiogram, and ventricular premature beats on exercise) was equally powerful (chi 2 = 41.6). Combination of both catheterization and exercise thallium-201 data was superior to either alone (chi 2 = 57.5) for determining future events. Exercise stress test alone (without thallium-201 data) was inferior to the exercise thallium-201 stress test or cardiac catheterization for predicting future events (chi 2 = 30.6).(ABSTRACT TRUNCATED AT 400 WORDS)

Cardiac Catheterization↗

PubMed1987

Inappropriate traditional treatment resulting in limb amputation.

Four cases are described where inappropriate treatment by the traditional Nepali spiritualist healer or jhankri resulted in amputation of a previously healthy limb. Such treatments may involve the use of tourniquets, burning, scarification and herbal remedies.

Adolescent↗

PubMed1986

Evidence for progression from mild to severe mitral regurgitation in mitral valve prolapse.

Little information is available concerning the progression of mild to severe mitral regurgitation (MR) in patients with mitral valve prolapse (MVP). This study reports 86 patients, average age 60 years, who presented with cardiac symptoms, precordial systolic murmur, severe MR and a high incidence of MVP on echocardiography (57 of 75 [75%] ) and left ventriculography (61 of 84 [73%] ). Seventy-five surgically excised mitral valves appeared grossly enlarged and floppy. Histologic studies showed extensive myxomatous changes throughout the leaflets and chordae. Eighty patients had had precordial murmurs first described at average age 34 years, but the average age at which symptoms of cardiac dysfunction appeared was 59. However, once symptoms developed, mitral valve surgery was required within 1 year in 67 of 76 patients who had undergone surgery. Atrial fibrillation, present in 48 of 86 patients (56%), or ruptured chordae tendineae, present in 39 of 76 patients (51%), may have contributed to this rapid progression and deterioration. Additionally, 13 patients had a remote history of documented infective endocarditis. Twenty-eight patients had at least 1 type of serial clinical evaluation that indicated progressive MR in all 28 patients on the basis of changing auscultatory findings (24 of 26), progressive radiographic cardiomegaly (24 of 25), echocardiographic left atrial enlargement (4.3 to 5 cm in 11 patients) and angiographically worsening MR (14 of 15). Twenty-four of these patients had evidence of MVP on at least 1 of their initial studies. Thus, mild MR due to MVP and myxomatous mitral valves is a progressive disease in some patients with MVP.

Adult↗

PubMed1986

Comparative morphology and evolution of cheek pouches in rodents.

There are two types of cheek pouches in extant rodents. Internal cheek pouches are evaginations of the oral cavity deep to M. platysma and M. sphincter colli profundus, and have evolved independently in some species of the superfamilies Sciuroidea and Muroidea. External, furlined cheek pouches open lateral to and separate from the oral cavity, (also deep to M. platysma and M. sphincter colli profundus), and occur in all species of the families Geomyidae and Heteromyidae. The presence of external, furlined cheek pouches is a synapomorphy for the superfamily Geomyoidea. The posterior retractor muscle of the pouch is derived from facial musculature in sciurids, from trapezius musculature in cricetids, and from both facial and trapezius muscle groups in the Geomyoidea. Differences also exist in the musculature associated with the pouch opening. In the Sciuridae and Cricetidae, the M. buccinatorius muscle group acts as a sphincter to control the size of the pouch opening. In the Geomyoidea, the size of the opening is controlled by the M. orbicularis sacculi in concert with a slip of the M. platysma myoides. Thin sections and scanning electron micrographs of the pouch tissue reveal the presence of dermal papillae in Phodopus sungorus but not in a close relative, Mesocricetus auratus. All members of the subfamily Cricetinae have a peninsula of highly folded tissue projecting anteriorly from the posteromedial pouch wall. This folding allows for expansion of the pouch walls when food is stored in the pouch.

Animals↗

PubMed1986

T lymphocyte lines from arthritic synovial fluid: establishment and function.

T lymphocyte lines have been established, with the addition of interleukin-2 (IL-2), from the synovial fluid (SF) of patients with arthritis. Characterisation of seven of these SF-derived T cell lines showed them to be T3+, T11+, and to contain a significant proportion of T8+ cells (mean 41%). The proportion of T4+ cells varied among the lines, with a mean T4+/T8+ ratio of 0.6. A significant autologous mixed lymphocyte reaction (AMLR) was observed only in one of four T cell lines assayed. Two of four lines assayed showed natural killer (NK) cell-like activity, while one line displayed a significant suppressor activity, suggesting that the T cell population in SF contained NK-like cells or suppressor cells, or both, either of which may be selected in the establishment of SF-derived T cell lines.

Arthritis↗

PubMed1986

Evolution of a hereditary cardiac conduction and muscle disorder: a study involving a family with six generations affected.

This study describes six generations of a family with autosomal dominant cardiac conduction system and myocardial disease with recognizable clinical stages. A 20 year follow-up of nine family members, a medical questionnaire of 196, electrocardiographic screening of 91, noninvasive testing of 20, and catheterization with endomyocardial biopsy of six are the basis of this report. The clinical stages are as follows: Stage I occurs in the second and third decades of life and is characterized by an absence of symptoms, normal heart size, sinus bradycardia, and premature atrial contractions. Stage II is marked by first-degree atrioventricular block in the third and fourth decades. Stage III occurs in the fourth and fifth decades and is accompanied by chest pain, fatigue, lightheadedness, and advanced atrioventricular block followed by the development of atrial fibrillation or flutter. Stage IV, in the fifth and sixth decades of life, is characterized by congestive heart failure and recurrent ventricular arrhythmias. Light microscopy of right ventricular endomyocardial biopsy specimens from patients in stage II revealed very mild fibrosis; electron microscopy of the specimens demonstrated mild dilatation of tubules, mitochondrial swelling, and minimal myofibrillar loss. Biopsy specimens from patients with stage III disease were similar to those from patients with stage II disease except for an increase of myofibrillar loss. The stage IV specimens had diffuse fibrosis and more severe tubular dilatation, mitochondrial cristolysis, and myofibrillar loss. At autopsy in the proband, the atrial changes were more severe than the ventricular and were especially marked in the sinoatrial and atrial myocardium. Early recognition of the disease and use of pacemakers and antiarrhythmic agents have proved beneficial for affected family members. Thorough family studies of patients with conduction system disease and/or dilated cardiomyopathy are necessary to better understand the hereditary basis and natural course of this category of disease.

Adolescent↗

PubMed1985

Tricuspid stenosis. Atrial systolic murmur, tricuspid opening snap, and right atrial pressure pulse.

Observations on the atrial systolic murmur, the tricuspid opening snap, and the right atrial pressure pulse of tricuspid stenosis are presented, based on catheter manometer intracardiac sound and pressure recordings in five patients with hemodynamically significant tricuspid stenosis. The manometer-recorded right atrial pressure pulse of tricuspid stenosis differed from the normal, with (1) elevation of right atrial pressure, (2) different morphologic features (tall, spiky A wave complete before C; small V wave with an interruption, the tricuspid opening snap notch at termination of the gradual Y descent; a diastolic plateau, the relatively flat diastolic segment of the right atrial pressure pulse following the tricuspid opening snap notch prior to the next A wave), and (3) the relative lack of right atrial pressure and right atrial pressure pulse response with normal respiration. The atrial systolic murmur, recorded in the right ventricular inflow tract, was complete by S1; the crescendo-decrescendo atrial systolic murmur configuration paralleled the right ventricular-right atrial diastolic pressure gradient at the time of the atrial A wave. The right atrial contraction-relaxation process, as reflected by the right atrial A wave ascent and descent, was complete at the onset of ventricular systole with P-R intervals of 170 to 200 msec. Thus, the timing and configuration of the atrial systolic murmur reflected the timing and completion of the right atrial contraction-relaxation process prior to the onset of right ventricular systole and the configuration of the tricuspid diastolic pressure gradient. The tricuspid opening snap was recorded in the right ventricular inflow tract and occurred at the time of a notch at the termination of the Y descent of the right atrial pressure pulse V wave, while right atrial pressure exceeded right ventricular pressure. The sound-pressure events were consistent with angiographic and echocardiographic studies, which showed doming or ballooning of the mobile, fused, stenotic tricuspid valve into the right ventricle during the Y descent of the right atrial pressure pulse. The tricuspid opening snap occurred at the time of the termination of the diastolic movement of the fused tricuspid unit into the right ventricle. These observations are presented within the framework of previous studies in order to trace the development of medical ideas about the pathophysiologic basis for the sound and pressure events of tricuspid stenosis.

Adolescent↗

PubMed1985

T lymphocytes in infectious mononucleosis. I. T cell death in vitro.

A large proportion of T lymphocytes isolated from the peripheral blood of acute infectious mononucleosis (IM) patients rapidly die when cultured in vitro, with greater than 50% dying within 12-15 h of seeding and up to 80% dying within 24 h. The cells die by apoptosis, a morphologically distinct mode of cell death that occurs in circumstances where death is a regulated event such as in embryonic development and hormone-dependent atrophy. In contrast, the level of cell death remained low in cultures of lymphocytes from controls and in the T cell depleted subpopulation from acute IM patients, with less than 2% and 10% of the lymphocytes dying by apoptosis after 36 h in culture, respectively. The rapid death of acute IM T cells in vitro does not involve soluble factors (including the serum fraction) or T cell to T cell contact. It is suggested that this observation may necessitate a re-evaluation of IM T cell function in vitro.

Cell Communication↗

PubMed1985

T lymphocytes in infectious mononucleosis. II. Response in vitro to interleukin-2 and establishment of T cell lines.

The addition of 20% interleukin-2 (IL-2) significantly reduced the percentage of T lymphocytes dying in vitro after being isolated from the peripheral blood of acute infectious mononucleosis (IM) patients. Moreover, the immediate addition of 20% IL-2 to freshly isolated blood allowed IM T cell lines to be readily established from the peripheral blood of acute IM patients. Characterization of seven of these IM T cell lines showed them to be T3+, T11+, T4-, T9- and generally T10-. Over half of the lines characterized were T8+. It will now be possible to re-evaluate IM T cell effector functions as previous assays of IM T cell functions may have been influenced by the presence of rapid and extensive T cell death in vitro.

Cell Line↗