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Biomedical subjects

M Barry

Publications and source records attributed to M Barry.

At least 199 records · Page 11Linked to original sources
PubMed1984

Managing thyroid abnormalities in adults exposed to upper body irradiation in childhood: a decision analysis. Should patients without palpable nodules be scanned and those with scan defects be subjected to subtotal thyroidectomy?

This decision analysis compares two currently recommended management strategies for adults at increased risk for thyroid carcinoma due to childhood upper body irradiation who present without palpable thyroid nodularity: 1) scan-surgery: initially thyroid scan every patient, then perform subtotal thyroidectomy for each patient with single or multiple scan defects; and 2) no scan reexamine: do not scan initially, but reexamine at least every 2 yr, reserving surgery for those in whom palpable nodularity later develops. When surgical morbidity and mortality are taken into account, the expected utility of the no scan reexamine strategy slightly outweighs that of scan-surgery; this preference is maintained in several sensitivity analyses, unless more than 80% of occult cancers progress to palpable size. Moreover, the financial costs of universal scanning coupled with surgery are considerably greater. The no scan-reexamine approach, therefore, deserves serious consideration as the preferred strategy. Since the expected utilities of the two strategies are nearly equal, however, patient attitudes toward risk should be given particular weight in choosing management.

Adult↗
PubMed1984

Microsurgical anatomy of the region of the tentorial incisura.

The microsurgical anatomy of the tentorial incisura was evaluated in 25 adult cadavers using X 3 to X 40 magnification. The area surrounding the incisura is divided into the anterior, middle, and posterior incisural spaces. The anterior incisural space is located anterior to the brain stem and extends upward around the optic chiasm to the subcallosal area; the middle incisural space is located lateral to the brain stem and is intimately related to the hippocampal formation in the medial part of the temporal lobe; and the posterior incisural space is located posterior to the midbrain and corresponds to the region of the pineal gland and vein of Galen. The neural, cisternal, ventricular, and vascular relationships of each space were examined. The arterial relationships in the anterior incisural space and the venous relationships in the posterior incisural space are extremely complex, since the anterior incisural space contains all the components of the circle of Willis and the bifurcation of the internal carotid and basilar arteries, and the posterior incisural space contains the convergence of the internal cerebral and basal veins and many of their tributaries on the vein of Galen. The discussion reviews tentorial herniation and operative approaches to the incisura.

Brain↗
PubMed1984

Microsurgical anatomy of the anterior perforating arteries.

The anterior perforating arteries, the group of arteries that enter the brain through the anterior perforated substance (APS), were examined using X 3 to X 40 magnification in 50 cerebral hemispheres obtained from 25 adult cadavers. These arteries arose from the internal carotid, middle and anterior cerebral, and the anterior choroidal arteries. The carotid branches to the APS arose distal to the origin of the anterior choroidal artery. The anterior choroidal artery branches arose from the main or superior branch of the artery. The middle cerebral artery branches to the APS (the lenticulostriate arteries) arose from the M1 and M2 segments and were divided into medial, intermediate, and lateral groups, each of which had a characteristic configuration. The anterior cerebral artery branches arose from the A1 segment and from the recurrent artery. The internal carotid and anterior choroidal artery branches entered the posterior half of the central portion of the APS. The lenticulostriate branches entered the middle and posterior portions of the lateral half of the APS. The A1 segment gave rise to branches which entered the medial half of the APS above the optic nerve and chiasm. The recurrent artery sent branches into the anterior two-thirds of the full mediolateral extent of the APS. The relationship of these branches to the cerebral structures above the APS and to the common aneurysm sites is reviewed.

Carotid Arteries↗
PubMed1983

Clinical findings in Southeast Asian refugees.

Since 1979, we have provided comprehensive medical care to a group of 142 Southeast Asian refugees who relocated in Connecticut. In this group, we identified clinically important issues in child development. As plotted on standard growth curves, 47% of refugee children were below the fifth percentile in height for age and 22% were below the fifth percentile in weight for height. Although these children are potentially at increased risk for nutrition-related health problems, our clinical assessment did not confirm malnutrition. We also confirm a high prevalence of intestinal parasitism (59%), positive tuberculin test results (40%), and hepatitis B antigenemia (16%), as observed previously by health authorities. We conclude that anthropometry should not replace a clinical nutritional assessment of refugee children.

Adolescent↗
PubMed1983

Hematologic abnormalities in Southeast Asian refugees.

Since 1979, we have provided comprehensive medical care to a group of 142 Southeast Asian refugees who relocated in Connecticut. In this group, we identified many hematologic abnormalities in both adults and children (18% anemias, 35% microcytosis). The majority of anemias were microcytic, secondary to iron deficiency and inherited disorders of hemoglobin synthesis. The latter were present in at least 7.5% of our population and accounted for the majority of patients with microcytosis. We conclude that hemoglobin electrophoresis and serological tests for iron stores can detect the cause of anemia found in most Southeast Asian refugees.

Adolescent↗
PubMed1983

Allergic reaction to protamine: a late complication of elective vasectomy?

Nucleoprotamines are a normal component of human sperm cells. Antibodies against these protamines develop in 22 to 33 per cent of patients undergoing elective vasectomy. These antibodies, in turn, have been shown to cross-react with medicinal protamines, which are extracted commercially from the testes of salmon and certain other fish. This cross-reactivity against protamines raises the possibility that patients who have undergone elective vasectomy may be at increased risk of an allergic reaction developing if they are later exposed to protamine as a medication. Since medicinal protamines currently enjoy widespread clinical use, this information should be borne in mind by those clinician using protamine and by urologists when counselling patients concerning elective vasectomy for sterilization.

Adult↗
PubMed1982

Relapse of Paragonimus westermani lung infection after bithionol therapy.

Clinical trials of bithionol in treating Paragonimus westermani lung infection have been conducted in areas of endemic infection. Bithionol has been reported to cure over 90% of infected patients. We report a case of a 32-year-old Laotian man residing in Connecticut who relapsed with P. westermani pneumonitis 4 months after apparent eradication of infection with bithionol (40 mg/kg by mouth every other day for 10 doses). He was successfully treated with a second course of bithionol (40 mg/kg by mouth every other day for 15 doses). The mechanism of relapse of P. westermani infection following bithionol therapy should be evaluated.

Adult↗
PubMed1982

A tube for enteral nutrition of patients with aphagopraxia and patients with ventilator assistance.

A new feeding tube was designed for use in patients who cannot swallow. A comparison of our ability to pass a commercially available, mercury weighted, small feeding tube or the new, nonweighted feeding tube was made. Forty-one consecutive patients who had endotracheal intubation and who had mechanical ventilation assistance or who had suffered injuries to the central nervous system, producing aphagopraxia were compared. In the 22 patients in whom the guided tube system was first tried, enteric support was possible in 20. Gastric placement was possible in only 12 of 19 patients in whom the mercury weighted tubes were first tried and in only one of these patients did the tube pass into the small intestine beyond the ligament of Treitz. Seventeen of 20 nonweighted tubes passed into the small intestine. The newly designed small feeding tube system should be used as the initial means of gaining access to the intestine for enteric nutritional support of patients in intensive care units and after strokes or neurologic injuries when the patient cannot swallow.

Deglutition Disorders↗
PubMed1981

Testicular cyclic nucleotide phosphodiesterase in the rat. Kinetic properties and changes with age.

The assay for cyclic nucleotide phosphodiesterase has been applied, with certain modifications, to the measurement of the soluble forms of these enzymes in the rat testis. The homogenization and incubation conditions were adjusted to achieve linear product formation as a function of time and protein concentrations and the resulting products were isolated by ion exchange chromatography using 5 mM HCl as the eluting agent. Phosphodiesterase activities were present in the testicular cytosol (105,000 g supernatant) of adult rats which were capable of hydrolyzing cAMP with a high (Km2 microM) and low Km20 microM) affinity and GMP with a relatively high affinity (Km3 microM). The low affinity cAMP enzyme activity could be stimulated with divalent ions such as calcium, magnesium, and manganese. At 18 days of age, all three enzyme activities were present in the testis, although both the high and low affinity cAMP phosphodiesterase displayed maximal rates (Vmax) that were only one third of the adult testis (when expressed per mg protein).

3',5'-Cyclic-AMP Phosphodiesterases↗
PubMed1980

Formerly-addicted-now-controlled opiate users.

Preliminary data are reported on 10 former heroin addicts who have maintained long-term occasional patterns of heroin use. Emphasis is placed on the degree of their past addiction and present control. The implication of the existence of such users for etiological theories, treatment, and further research are discussed.

Adult↗
PubMed1980

New catheter-pump system for diastolic synchronized coronary sinus retroperfusion.

Coronary retroperfusion with the object of delivering oxygenated blood to the ischemic myocardium might be defined as the process of withdrawing blood from a systemic artery and reinjecting it into the coronary sinus. A diastolic synchronized retroperfusion catheter-pump system is presented and feasibility of achieving retrograde infusion of arterial blood was tested. An autoinflatable bladder catheter was specially designed to compartmentalize the coronary sinus at onset of diastole and insure unidirectional retrograde infusion of arterial blood. Bladder deflation at onset of systole allowed coronary venous drainage. Actuation of the retroperfusion bladder catheter was obtained from an electropneumatic console triggered by the electrocardiogram. In vitro and animal studies indicate that this system converted the natural (steady) arteriovenous shunt flow into an artificially pulsed shunt flow, with maximal positive flow in diastole and trivial negative flow in systole but did not alter absolute magnitude of shunt flow. Thus, diastolic synchronized retroperfusion of arterial blood through the coronary sinus may provide temporary protection from acute myocardial ischemia.

Animals↗
PubMed1979

Biomechanics of the patellofemoral joint.

The patellofemoral joint contains 2 complex mechanisms for ameliorating forces transmitted across it, namely increasing extensor lever arm-r in the important range of flexion 30 degrees-70 degrees and increasing contact area with increasing flexion. In this range the patella bears sole responsibility for transmitting resultant flexion of quadriceps force to the femur. Here lies the thickest cartilage in the body and perhaps not surprisingly, the most frequent site of cartilage degeneration. The Q-angle and valgus vector explain the predominance of the pathologic lesions on the lateral side of the joint as well as the associated dislocations, subluxations, lateral pressure syndromes, and patellofemoral arthrosis. Extension exercises against resistance produce non-physiologic loading of patellar articular cartilage. Even relatively small loads which are commonly used in physical therapy departments produce pressures far in excess of normal activities, such as stair climbing or squatting. Patients who are placed on such exercise programs are often made worse and develop symptoms which they did not have before. Straight leg raising with weights, on the other hand, maximally stresses the quadriceps muscle without any patellofemoral compression since the patella is out of contact, proximal to the trochlea.

Adolescent↗
PubMed1975

Transfusional iron overload: the relationship between tissue iron concentration and hepatic fibrosis in thalassaemia.

The interrelationships between liver iron concentration, the duration of iron-loading, and hepatic fibrosis, assessed morphometrically, have been studied in 32 specimens of liver obtained from 19 heavily transfused patients with thalassaemia major whose age ranged from 4 to 19 yr. Similar observations were made in a matched group of thalassaemic patients treated with long-term chelation therapy. The degree of liver damage ranged from very slight increase in fibrous tissue to severe fibrosis and cirrhosis. The severity of the fibrosis was closely correlated both with liver iron concentration and with age. While the relationship between fibrosis and age was linear, both the severity and the rate of fibrosis were exponentially related to liver iron concentration, damage accelerating as liver iron concentration exceeded 3 per cent, dry weight. By producing a modest but significant reduction in liver iron concentration chelation therapy resulted in a disproportionate but predictable retardation in the progression of the fibrosis. The factors affecting the distribution of iron between parenchymal and reticuloendothelial cells were also examined. In general stainable iron was uniformly distributed between parenchymal and reticuloendothelial cells from the early stages of iron-loading. Parenchymal siderosis was relatively heavier in splenectomised patients and in patients with liver iron concentrations above 3 per cent, dry weight than in non-splenectomised patients or patients with liver iron levels of less than 3 per cent, dry weight, but this did not affect the severity of the fibrosis. The relevance of these findings to the traditional concepts of the pathology of transfusional siderosis is discussed.

Adolescent↗
PubMed1975

Serum ferritin in patients with iron overload and with acute and chronic liver diseases.

An immunoradiometric assay was used to determine serum ferritin in patients with iron overload disorders and in patients with liver disease. In patients with iron overload, serum ferritin was closely correlated in an exponential manner with quantitative measurements of storage iron; however, a different relationship applied when storage iron levels were within normal range, suggesting that circulating ferritin is in equilibrium with two functionally distinct tissue ferritin pools. High ferritin levels were common in patients both with acute and chronic liver disease, normal values being virtually confined to women and to subjects with a history of recent hemorrhage. In liver disease generally, serum ferritin varied both with the serum transaminase level and with liver iron concentration, but correlated well with neither factor separately. There was no correlation with the serum iron or total iron-binding capacity. An extremely close correlation was found between serum ferritin and an empirical index derived from the product of the serum transaminase times liver iron concentration, implying that the circulating level depended on both the degree of hepatocellular injury and liver iron store. There was a close linear correlation between the serum ferritin-transaminase ratio and liver iron concentration in all disorders studied, and this index may prove to be the most useful value for diagnostic purposes.

Acetaminophen↗