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Biomedical subjects

N Ryan

Publications and source records attributed to N Ryan.

At least 37 records · Page 2Linked to original sources
PubMed1994

Fluoxetine for childhood anxiety disorders.

OBJECTIVE: The objective of this open study was to determine the efficacy and safety of fluoxetine for the treatment of children and adolescents with anxiety disorders. METHOD: Twenty-one patients with overanxious disorders, social phobia, or separation anxiety disorder, who were unresponsive to previous psychopharmacological and psychotherapeutic interventions, were treated openly with fluoxetine for up to 10 months. Patients with lifetime histories of obsessive-compulsive disorder (OCD) or panic disorder, or with current major depression, were excluded. Beneficial and adverse effects of fluoxetine were ascertained using the improvement and severity subscales of the Clinical Global Impression Scale (CGIS) in two ways: (1) independent chart reviews by two child psychiatrists and (2) prospective assessments by the treating nurses and the patients' mothers. RESULTS: Eighty-one percent (n = 17) of patients showed moderate to marked improvement in anxiety symptoms. The severity of anxiety as measured by the CGIS was also significantly reduced from marked to mild (effect size: 2.3). There were no significant side effects. CONCLUSIONS: These results suggest that fluoxetine may be an effective and safe treatment for nondepressed children and adolescents with anxiety disorders other than OCD and panic disorder. Future investigations using double-blind, placebo-controlled methodologies are warranted.

Adolescent↗
PubMed1993

Another sudden death in a child treated with desipramine.

The sudden death of three children receiving the tricyclic antidepressant medication desipramine for behavioral disorders was reported in 1990. We now provide new information about these children and describe a fourth case. Because desipramine is a useful medication for many children, these deaths pose clinical dilemmas for physicians and families. The cardiac long QT syndrome has been proposed as a mechanism for these sudden deaths. Considerable uncertainty remains about the basis of the apparent association between the use of desipramine and the sudden deaths.

Attention Deficit Disorder with Hyperactivity↗
PubMed1992

Assessing Alzheimer severity with a global clinical scale.

Diagnosis of dementia needs to be complemented by precise determination of disease severity across the broad spectrum of disease progression. The Mini-Mental State Exam (MMS), the Activities-of-Daily-Living assessment (ADL) and the Clinical Dementia Rating scale (CDR) were modified for direct comparability and administered to 112 outpatients and 45 nursing home residents with a range of dementia severity from mild to profound. The scales showed the highest correlations for the probable Alzheimer's disease patient group (62) (Global Assessment of Dementia; GAD vs. ADL: r = 0.91; Extended Mini-Mental Assessment; EMA vs. GAD: r = 0.91; ADL vs. EMA: r = 0.86). For these patients, scores on the individual scales tended to be similar. Disparity among the three scores for individual cases was associated with the presence of comorbidities. The high correlations and correspondence among these scales demonstrate their reliability, validity, and utility in the assessment of dementia severity. The use of an average of these measures, with their increased precision, may give a more accurate indication of dementia severity over a broader range of impairment.

Activities of Daily Living↗
PubMed1992

Pathogenesis of Providencia alcalifaciens-induced diarrhea.

Providencia alcalifaciens is a member of the family Enterobacteriaceae. There are reports that P. alcalifaciens can cause diarrhea, but the mechanism(s) by which it causes diarrhea is known. We studied P. alcalifaciens isolated from a child and two adults with diarrhea for enteropathogenicity. The three isolates did not exhibit any characteristic adherence to cultured HEp-2 cell monolayers, and they did not produce enterotoxins, cytotoxins, or keratoconjunctivitis in the Sereny test. Two isolates invaded cultured HEp-2 cell monolayers, producing localized bacterial clusters and actin condensation. The pattern of actin condensation was different from that produced by enteropathogenic Escherichia coli but similar to that produced by Shigella flexneri. Invasion and actin condensation were poor for the third isolate. Histology of adult rabbit small intestinal loops inoculated with all three isolates revealed bacterial attachment to, penetration of, and microulcer formation on the surface epithelium and hyperemia, edema, and polymorphonuclear cell infiltration of lamina propria. All the isolates produced diarrhea in rabbits with removable intestinal ties, and some of these rabbits developed hindlimb paralysis. Intestinal histology of the rabbits with removable intestinal ties which developed diarrhea showed changes similar to that in adult rabbits on which ileal loop assays had been performed. Transmission electron microscopy of intestinal tissues also confirmed tissue penetration by the isolates. Nerve tissue histology of two rabbits that developed hindlimb paralysis showed focal mononuclear cell infiltration around peripheral nerve sheaths. It is concluded that some strains of P. alcalifaciens are enteropathogenic and that they cause diarrhea by invading the intestinal mucosal epithelium. However, the relevance to human disease of the hindlimb paralysis observed in this animal model is not clear.

Animals↗
PubMed1991

Depression in children and adolescents: new data on 'undertreatment' and a literature review on the efficacy of available treatments.

This article reports on the treatment received by 38 adolescents during an episode of major depression which had a median duration of 4 months. The one subject who received any pharmacologic treatment was prescribed an antianxiety agent. Sixteen percent received psychotherapy. These results are consistent with evidence from studies of adults indicating that depression is underrecognized and undertreated. An important caveat is that the small sample size limits the generalizability of these findings. Moreover, which medication should be prescribed when a diagnosis of depression is made is not yet known with certainty, as literature reviews indicate that more controlled trials of psychotherapeutic and psychopharmacologic treatments for adolescents with depression are needed to better understand the efficacy of treating depressed adolescents.

Adolescent↗
PubMed1991

Racing performance of Thoroughbred horses after arthroscopic surgery of the carpus.

The case record, and subsequent racing performance, of 110 horses that had undergone arthroscopic surgery of the carpus, were reviewed. Of these, 87% resumed racing, with 43% able to win at least one race, after surgery. Horses with chip fractures from the distal radius had the best prognosis, while horses with sagittal fractures of the third carpal bone had the poorest. The performance of horses with bilateral lesions was similar to those with unilateral lesions. It was concluded that arthroscopic surgery was a suitable technique for the diagnosis and treatment of carpal lesions in the horse.

Animals↗
PubMed1990

Online access to MEDLINE in clinical settings. A study of use and usefulness.

STUDY OBJECTIVE: We introduced self-service access to the medical literature database, MEDLINE, into clinical settings to assess the frequency, patterns, purposes, and success of use. DESIGN: Longitudinal descriptive study. SETTING: Inpatient and outpatient services of a university medical center. PARTICIPANTS: All trainees and attending staff working at the service sites were invited to participate; 158 (84%) did so. INTERVENTIONS: Free online access was provided to MEDLINE through GRATEFUL MED software. Participants were offered a 2-hour introduction to online searching and 2 hours of free search time. MEASUREMENTS AND MAIN RESULTS: For each search, a computer program requested identification of the user and the question to be addressed. Search transactions were recorded automatically. Interviews were conducted after a random sample of searches, and search questions were given to more expert searchers to run for comparison with the original. Eighty-one percent of participants did searches on study computers, at a mean rate of 2.7 searches per month. On comparison searches, participants retrieved 55% of the number of relevant articles retrieved by reference librarians (P = 0.024) and 50% more irrelevant articles (P less than 0.001). Forty-seven percent of searches on patient problems affected clinical decisions, but often on scanty information. CONCLUSIONS: MEDLINE searching from clinical settings is feasible with brief training and affects clinical decisions. However, inexperienced searchers miss many relevant citations and search inefficiently. Further studies are needed to assess the impact of searching on physician performance and patient care.

Academic Medical Centers↗
PubMed1990

The pituitary gland in pregnancy: a clinicopathologic and immunohistochemical study of 69 cases.

A histologic and immunocytochemical study of 69 autopsy-obtained pituitaries from women who died during pregnancy, after abortion, or in the postpartum period revealed an accumulation of large chromophobic to slightly acidophilic and periodic acid-Schiff-negative pregnancy cells that were immunoreactive for prolactin but not for other pituitary hormones. This increase in the number of prolactin cells was confirmed by cell counts. Thus, pregnancy cells are capable of prolactin production. The finding of mitotic figures in such cells supports the view that they arise by multiplication from preexisting prolactin cells. With use of "mirror section" techniques, no mammosomatotrophs (cells immunoreactive for growth hormone and prolactin) were identified. Hyperplasia of prolactin cells was evident at 1 month of pregnancy and gradually disappeared within several months after delivery or abortion; the process of involution seemed to be retarded in the one lactating patient investigated. In some pituitaries, the accumulation of prolactin cells was so extensive that the hyperplastic foci resembled microadenomas. Another striking change in the pituitaries of pregnant women was appreciable reduction of immunostaining of gonadotropic cells, a process that was reversible as soon as 1 month after delivery. Among the 69 pituitaries studied, 8 noninvasive microadenomas (12%) were encountered (7 contained prolactin only and 1 was plurihormonal). Prolactin-producing adenomas were no more numerous or larger than were similar tumors encountered in nonpregnant women or normal men; thus, pregnancy neither initiates formation of pituitary adenomas nor accelerates their growth. In the pituitaries that harbored prolactin-producing adenomas, massive pregnancy cell hyperplasia was evident outside the tumor; thus, prolactin production by adenoma cells did not seem to suppress the proliferation of prolactin-containing pregnancy cells.

Adenoma↗
PubMed1989

Cortisol secretion in prepubertal children with major depressive disorder. Episode and recovery.

Plasma cortisol concentrations were measured every 20 minutes for 24 hours in a group of 45 rigorously assessed, drug-free, prepubertal children who met the unmodified Research Diagnostic Criteria for major depressive disorder (MDD), 20 children with nonaffective psychiatric disorders, and eight normal controls. All children were studied in a low-stress environment. There were no significant differences in plasma cortisol concentration among the three groups as measured by 24-hour mean, peak, nocturnal rise, or nadir values. Division of the MDD group into subgroups based on endogenicity, psychotic symptoms, and suicidality also failed to reveal significant differences for cortisol secretion. Hypersecretion of cortisol (defined as 2 SDs above the grand mean) was identified in only four children with depressive illness and one normal control. Following clinical recovery, 24 depressed children were restudied in a drug-free state and compared with themselves during the episode of illness and with both groups of controls. No significant differences in plasma cortisol concentrations were found. All four depressed hypersecretors were restudied after clinical recovery, and one showed persistence of hypersecretion. These results suggest that abnormalities of cortisol secretion occur infrequently in prepubertal children with major depression when they are studied in a nonstressful environment.

Age Factors↗
PubMed1989

Effects of estrogen on the human pituitary: a clinicopathologic study.

Pituitary glands obtained at autopsy of 67 men treated with diethylstilbestrol were examined for diffuse and nodular lactotrophic hyperplasia as well as prolactin cell tumorlets or adenomas. A control group consisted of 42 untreated patients with prostatic carcinoma and 209 other elderly men. Diffuse and nodular lactotrophic hyperplasia and the percentage of prolactin cells were greater in treated patients, but these differences were not statistically significant. The higher frequency of prolactin cell adenomas among treated patients (19%) than among control subjects (11%) also lacked statistical significance. An apparent low frequency of occurrence of adenoma in control patients with prostatic carcinoma remains unexplained. No correlation was noted between tumor number, size, morphologic features, or immunoreactivity and such factors as dose of estrogen therapy, associated diseases, ultimate cause of death, or patient age. A correlation was noted, however, between duration of estrogen therapy and the total number of pituitary adenomas, including those composed of prolactin cells. Relative proportions of other types of adenoma were similar within the study and control groups. We conclude that estrogen medication cannot be considered a major risk factor in the cause of prolactin-producing adenomas in older men.

Adenoma↗
PubMed1989

Cortisol secretion in adolescents with major depressive disorder.

Plasma cortisol concentrations were determined every 20 min for 24 h, in a nonstressful environment, among 48 rigorously assessed, mostly outpatient, drug-free adolescent subjects during an episode of major depression (MDD) and among 40 normal adolescent subjects. There were no significant differences in the 24-h mean, peak, or nadir, or the time of the nocturnal rise, in plasma cortisol in the 2 groups. Analyses of different subgroups of MDD adolescents according to suicidality, severity of depression, separation anxiety, psychotic subtype, endogenicity, duration of episode, and sex also revealed no significant group differences. Only one adolescent (with MDD) was identified clearly as a hypersecretor of cortisol. These results indicate that abnormalities of spontaneous cortisol secretion are an unusual finding among adolescents with major depression when studied in a nonstressful environment.

Adolescent↗
PubMed1989

Adenohypophysial changes in conventional, germ free and food-restricted aging Lobund-Wistar rats. A histologic, immunocytochemical and electron microscopic study.

The pituitaries of aging male Lobund-Wistar rats were investigated by histology, immunocytochemistry and electron microscopy. In contrast to previous studies undertaken on aging rats of various strains, no lactotroph hyperplasia was found in the adenohypophysis of the present study. Lactotroph adenomas producing PRL were infrequent, whereas gonadotroph adenomas containing FSH and LH were common. The frequency of gonadotroph adenomas was decreased in germ free as well as food-restricted rats and in those in which the germ free state was associated with reduced food intake.

Adenoma↗
PubMed1988

Parasitic infections of refugees.

The Victorian refugee screening programme, in contrast to similar programmes elsewhere in Australia, includes an examination for faecal parasites. The results of such screening at Fairfield Infectious Diseases Hospital for the 16-month period December 1, 1984-March 31, 1986 are presented. For most of the population groups that were studied, there was a high prevalence of intestinal parasites, which often warranted treatment. Additionally, marked differences were noted among the nationalities in the range of parasites that was detected. This information is of particular importance for those who are delivering health services to members of these different ethnic communities, especially in other states where screening is less comprehensive.

Adolescent↗
PubMed1988

Anorexia nervosa: an immunohistochemical study of the pituitary gland.

The morphologic features of the anterior pituitary gland were studied by immunohistologic methods in 12 patients who had died of complications of anorexia nervosa, 4 patients who had died while on a "crash diet", 13 patients who had died of organic disease associated with inanition, and 5 age- and sex-matched control subjects who had been involved in sudden fatal accidents. All known pituitary hormones were found to be present. Abnormalities noted in both the patients with anorexia and those with organic inanition included relative hypogranulation of adrenocorticotropic and, to a lesser extent, growth hormone cells. These changes are of unknown importance but are likely the result of starvation in that they were not observed in patients on a "crash diet" or in control patients. We conclude that no specific or etiologic abnormalities are present in the pituitary glands of subjects with anorexia nervosa and that the altered secretion of adenohypophyseal hormones often noted in patients with this disorder cannot be attributed to a primary pituitary disorder.

Adolescent↗
PubMed1988

Immunocytochemical localization of synaptophysin in human hypophyses and pituitary adenomas.

Synaptophysin (SYP) was demonstrated in the cytoplasm of somatotrophs, lactotrophs, thyrotrophs, and gonadotrophs by the avidin-biotin-peroxidase complex method using a monoclonal antibody (SY38). Some adenohypophysial corticotrophs, most corticotrophs spreading to the posterior lobe, and Crooke's hyaline material did not immunoreact with anti-SYP. In the neurohypophysis, nerve fibers and pituicytes were immunopositive. Most pituitary adenomas, including null cell adenomas, immunostained with SYP. The presence of SYP could not be correlated with hormone content, cytoplasmic granularity, and clinical symptoms. Neuron-specific enolase was expressed with SYP in most adenomas, whereas chromogranin was present only in a few tumors. Although SYP cannot be used as a general marker to identify specifically pituitary cells or adenomas, its demonstration may be helpful in immunocytochemical characterization of some null cell adenomas.

Adenoma↗
PubMed1987

Electroencephalographic sleep of adolescents with major depression and normal controls.

Forty-nine, mostly outpatient (86%), nonbipolar adolescents, aged Tanner stage III to 18 years, with a current diagnosis of major depressive disorder and 40 adolescents without current presence or history of psychiatric disorder were studied polysomnographically for three consecutive nights. Sleep latency was significantly longer in the depressive groups. The nonendogenous depressive patients exhibited significantly more awake time and lower sleep efficiency during the sleep period. No significant group differences were found for first rapid eye movement (REM) period latency, REM density, or any other REM sleep measures. Age correlated significantly with REM latency and delta sleep time, especially among depressive patients. No significant correlations between sleep measures and severity of illness were found. It appears that the classic REM sleep findings associated with the adult depressive syndrome are not present among depressive adolescents, indicating a later ontogeny for these abnormalities.

Adolescent↗
PubMed1987

Identification of corticotrophs in the human pituitary with mAB lu-5, a novel immunocytochemical marker.

The presence of mAB lu-5, a panepithelial, monoclonal antibody was studied in human adenohypophyses and pituitary adenomas by immunohistochemistry using the avidinbiotin-peroxidase complex technique. In nontumorous adenohypophyses, only corticotrophs showed strong immunoreactivity, whereas other adenohypophysial cell types exhibited little or no staining. Positive immunostaining was observed in corticotrophs spreading to the posterior lobe, in cells of squamous nests located in the pars tuberalis and several cells lining pars intermedia cavities. The Crooke's hyaline material in the cytoplasm of corticotrophs was immunopositive. In adenomatous corticotrophs and cytoplasmic fibrous bodies of sparsely granulated adenomatous somatotrophs, distinct mAB lu-5 immunoreactivity was evident. GH-, PRL-, TSH-, FSH-, LH-, alpha-subunit-producing adenomas, null cell adenomas and oncocytomas showed no convincing staining. Immunopositivity in corticotroph adenomas was diffusely distributed in the cytoplasm and was not located in secretory granules, indicating that mAB lu-5 did not stain ACTH. Immunoreactivity with mAB lu-5 was not specific for pituitary corticotrophs, since the antibody stained nontumorous epithelial cells and epithelial tumor cells in other organs as well. It can be concluded that mAB lu-5 is a valuable immunocytochemical marker in pituitary related studies, especially in those pituitary adenomas in which immunostaining for ACTH is weak or equivocal; in these cases, it can confirm the diagnosis of corticotroph adenoma. The antibody yields similar results as keratin antisera. In our experience, however, it gives a stronger, more distinct immunopositivity with less nonspecific background staining.

Adenoma↗