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Biomedical subjects

M E Ryan

Publications and source records attributed to M E Ryan.

At least 73 records · Page 4Linked to original sources
PubMed1988

Parvovirus infections. From benign to life-threatening.

Erythema infectiosum, aplastic crisis, intrauterine fetal demise, and an acute polyarthralgia syndrome can all be caused by human parvovirus B19. The major pathophysiologic effect of infection seems to be cessation of erythropoiesis as a result of cytolytic infection of red cell precursors. Erythema infectiosum is a benign disease that usually occurs in childhood. The acute polyarthralgia syndrome is likewise benign, and patients in whom parvovirus infection has been confirmed by serologic testing can be reassured that their joint symptoms are likely to be self-limited. Parvovirus-induced aplastic crisis in a patient with chronic hemolytic anemia is life-threatening but can be reversed with blood transfusions if recognized promptly. Parvovirus infection during pregnancy clearly increases the risk of fetal demise, and parental anxiety is understandably high. An organized approach using a combination of tests to monitor mother and fetus can provide optimal care in these cases.

Adolescent↗
PubMed1988

Adenomatous and hyperplastic polyps cannot be reliably distinguished by their appearance through the fiberoptic sigmoidoscope.

This prospective study is designed to determine if experienced sigmoidoscopists can, from gross appearance, differentiate adenomas and hyperplastic polyps. Six hundred eleven polyps discovered at fiberoptic sigmoidoscopy were removed completely or biopsied for histologic examination. The polyp's size, distance from the anal verge, color, and the endoscopist's diagnosis were analyzed. Hyperplastic polyps were significantly smaller, of lighter color, and located closer to the anus than adenomas. The sensitivity of the endoscopic diagnosis for adenomas is 0.80 and the specificity 0.71. We conclude the endoscopic diagnosis of polyps 1.0 cm and smaller is not accurate enough for decision making, and these should be biopsied to guide management. Since 97% of polyps larger than 1.0 cm are adenomas, their removal can be advised without biopsy.

Adenoma↗
PubMed1987

Cephalosporin therapy for childhood meningitis.

Ampicillin and chloramphenicol have been used for initial empiric therapy of childhood meningitis since the mid-1970s. Problems associated with these drugs include the possibility of chloramphenicol-associated aplastic anemia and the existence of Hemophilus influenzae type b resistance to both ampicillin and chloramphenicol. Several second- and third-generation cephalosporins have been shown to be as effective as ampicillin and chloramphenicol in the treatment of childhood meningitis.

Adolescent↗
PubMed1987

Diffuse vascular ectasia of the gastric antrum.

Diffuse vascular ectasia of the gastric antrum may present as occult gastrointestinal blood loss and iron-deficiency anemia. Four patients are described with iron-deficiency anemia in whom characteristic lesions were found at endoscopy. As in previous reports, lesions are either angioid linear streaking of the antrum with convergence at the pylorus ("watermelon stomach") or diffuse, well-demarcated erythematous areas. Biopsy with the electrocautery forceps may show dilated ectatic mucosal vessels often containing fibrin thrombi which will establish a diagnosis. Standard biopsy techniques failed to make a diagnosis in two of the three patients in which it was attempted. Medical therapy consisted of iron replacement and transfusion as needed. In three of the four cases, symptomatic anemia recurred and required antrectomy for management of the anemia. The antrectomy specimens revealed ectatic mucosal and submucosal vessels with a fibrotic pattern involving the lamina propria. This pattern has been previously reported. One patient was treated with corticosteroids transiently with resolution of her anemia. The endoscopic appearance of this entity may mimic antral gastritis and needs to be considered in the differential diagnosis of iron-deficiency anemia from chronic gastrointestinal blood loss.

Aged↗
PubMed1986

Common bacterial pneumonitis in infants. Determining the etiology and tailoring the treatment.

In infantile pneumonia, we recommend close attention to the history and physical examination. Baseline studies, including CBC, ESR, blood cultures, and chest film, should be performed at onset and repeated as warranted. Nasopharyngeal secretions or washings should be drawn by means of gentle suction and specimens sent for Gram stain, fluorescent antibody stain for respiratory syncytial virus, and culture for bacteria and for viruses if possible. Acute and convalescent serum specimens should be obtained in serious cases to search for antibodies to RSV, adenovirus, influenza, parainfluenza, cytomegalovirus, and Chlamydia. Serum and urine specimens may be collected for countercurrent immunoelectrophoresis and latex agglutination testing for Hemophilus influenzae type B, Streptococcus pneumoniae, and if indicated, group B streptococcus. If deterioration continues and all tests are negative, the clinician should consider a more invasive procedure such as flexible fiberoptic bronchoscopy, needle aspiration, or open lung biopsy. While awaiting identification of the pathogen, the physician should institute empiric therapy with optimum doses of antimicrobials and monitoring of serum levels of drug. Often the clinician is faced with deterioration and a negative workup. In this situation, other agents may be added, such as antifungal, antiviral, antiprotozoan, and antituberculous agents, as well as various antibiotics, to cover rare and unusual pathogens. Further consultation, even by phone, may at this point provide some insight into an otherwise confusing case.

Bacterial Infections↗
PubMed1986

Diagnosis of rheumatic fever. A guide to the criteria and manifestations.

Serious errors may arise from misinterpretation of the Jones criteria for rheumatic fever. Many patients "fulfill" the criteria and yet have another disease. The danger in such cases is that the actual illness is not diagnosed and the patient is not treated for it. If salicylates or steroids are administered prematurely, ie, before the signs and symptoms of rheumatic fever are fully recognizable, a vague syndrome may develop and elicit an uncertain diagnosis and improper treatment.

Antistreptolysin↗
PubMed1983

Acute necrotizing ulcerative gingivitis in children with cancer.

We reviewed the findings for 15 immunosuppressed children with cancer who had 18 episodes of acute necrotizing ulcerative gingivitis. Predisposing factors were then assessed for their influence on the course of infection. The nutritional status and oral hygiene of most patients were poor. Eleven of the 18 episodes involved the spontaneous exfoliation of primary or permanent teeth, and 16 of the 18 episodes were complicated by other infections. The infection completely cleared in only two of ten patients who were not in remission and persisted for more than 15 weeks or until death in all of the remaining patients with active disease. By contrast, all six episodes of infection during remission cleared within an average of 4 1/2 weeks. Among the many contributing factors, decreased host resistance, relapse, and neutropenia seemed to have the most negative influence on recovery from this severe form of gingivitis.

Adolescent↗
PubMed1982

Sulconazole nitrate 1.0 percent cream: a comparison with miconazole in the treatment of tinea pedis and tinea cruris/corporis.

Sulconazole nitrate 1.0 percent cream was compared to miconazole nitrate 2.0 percent cream in a double-blind, parallel study involving ninety-six patients with cutaneous dermatophytosis. Both agents were highly effective, with no statistically significant differences in the parameters studied. Among tinea pedis patients, all of seven treated with sulconazole and six of nine treated with miconazole were mycologically cured (negative culture and potassium hydroxide test) at the end of four weeks of twice a day treatment, and there were no relapses by week 9. Among tinea cruris/corporis patients, the rates of mycological cure after three weeks of twice a day treatment with sulconazole or miconazole were, respectively, twenty-nine of thirty-two (91 percent) and 100 percent of thirty one (accompanied in all cases by complete or significant clearing of signs and symptoms); the respective relapse rates were four of twenty-five (16 percent) and eight of twenty-three (35 percent). Miconazole resulted in two cases of severe irritant dermatitis requiring discontinuation of treatment, whereas sulconazole produced no severe irritant reactions.

Adolescent↗