Search PubMed⌕ Search

Biomedical subjects

R Ryan

Publications and source records attributed to R Ryan.

At least 37 records · Page 2Linked to original sources
PubMed2000

A new presentation of angiopathy in neurofibromatosis type 1.

Neurofibromatosis is a genetic condition characterized by localized over-growth of mesodermal and ectodermal tissues. Neurofibromatosis type 1 is characterized by cutaneous and skeletal abnormalities. Angiopathy is rare. We describe a new presentation of angiopathy in neurofibromatosis type 1. The patient presented with extensive bruising of the right side of her neck together with intra-oral and pharyngeal submucosal haemorrhage. Radiological investigation confirmed that an aneurysm of the right ascending pharyngeal artery had ruptured. This was successfully embolized without complication.

Aneurysm, Ruptured↗
PubMed2000

Is paediatric day case tonsillectomy desirable? The parents' perspective.

Tonsillectomy is the most commonly performed otolaryngological procedure in most units. There is considerable financial pressure to perform paediatric tonsillectomy as a day case. Responding to concern that day case tonsillectomy might not be welcomed by parents or felt to be in the best interests of the patients, we carried out an audit of paediatric tonsillectomy, by means of a questionnaire for parents and nursing staff to complete while 32 consecutive patients underwent tonsillectomy as inpatients. Although eight parents (25%) felt that day surgery should be an option, none of those surveyed felt that on this occasion their child was well enough to be discharged home six hours postoperatively. Furthermore, no child in the audit fulfilled all the essential discharge criteria at six hours. In this area, at least, it appears parents do not uniformly welcome paediatric day case tonsillectomy.

Ambulatory Surgical Procedures↗
PubMed1999

Evaluation of two-test serodiagnostic method for early Lyme disease in clinical practice.

The Centers for Disease Control and Prevention (CDC) recommend a two-test approach for the serodiagnosis of Lyme disease (LD), with EIA testing followed by Western immunoblotting (WB) of EIA-equivocal and -positive specimens. This approach was compared with a simplified two-test approach (WB of EIA equivocals only) and WB alone for early LD. Case-patients with erythema migrans (EM) rash >/=5 cm were recruited from three primary-care practices in LD-endemic areas to provide acute- (S1) and convalescent-phase serum specimens (S2). The simplified approach had the highest sensitivity when either S1 or S2 samples were tested, nearly doubling when S2 were tested, while decreasing slightly for the other two approaches. Accordingly, the simplified approach had the lowest negative likelihood ratio for either S1 or S2. For early LD with EM, the simplified approach performed well and was less costly than the other testing approaches since less WB is required.

Adolescent↗
PubMed1999

A three-dimensional gadolinium-enhanced MR venography technique for imaging central veins.

OBJECTIVE: We evaluated the use of a three-dimensional gadolinium-enhanced MR venography technique in selected patients with suspected central venous abnormalities. SUBJECTS AND METHODS: Thirty-seven patients with suspected thrombosis, stenosis, occlusion, or compression of the axillary vein, subclavian vein, brachiocephalic vein, or superior or inferior vena cava or with suspected malfunction of central venous catheters were imaged. For all patients, we obtained a three-dimensional dynamic gadolinium-enhanced (bolus injection, 30 40 ml) breath-hold spoiled gradient-recalled acquisition in the steady state as well as conventional venous images from either Doppler sonography, CT, or digital subtraction venography. Breathhold fast multiplanar spoiled gradient-recalled acquisitions in the steady state were obtained using the following parameters: TR/TE, 10.3/1.9; flip angle, 45 degrees; matrix size, 256 x 128; number of excitations, one; field of view, 36-48 cm; number of partitions, 28; and slice thickness, 2.54 mm. MR venograms and conventional images were interpreted by two observers in consensus who were unaware of clinical information and the diagnosis. RESULTS: MR venograms were of diagnostic quality for all 37 patients. Thirteen patients had normal venous systems seen on both conventional and MR images. MR venography showed all nine venous stenoses, the one pericatheter fibrin sheath, and the one jugular vein thrombosis. Axillary or subclavian vein thrombosis was correctly diagnosed with MR venography in all four patients with this condition. Mediastinal venous compression was accurately depicted by MR venography in the five patients who had such compression. Finally, MR venography revealed the correct diagnosis in the three patients with inferior vena cava thrombus and tumor and the one patient with inferior vena cava compression. Thus, MR venography was 100% sensitive, specific, and accurate in the diagnosis of abnormalities affecting large central veins. CONCLUSION: Compared with conventional imaging, gadolinium-enhanced breathhold MR venography is easy to perform, well tolerated, and highly accurate in depicting central venous abnormalities.

Adult↗
PubMed1998

Persistent parasitemia after acute babesiosis.

BACKGROUND: Babesiosis, a zoonosis caused by the protozoan Babesia microti, is usually not treated when the symptoms are mild, because the parasitemia appears to be transient. However, the microscopical methods used to diagnose this infection are insensitive, and few infected people have been followed longitudinally. We compared the duration of parasitemia in people who had received specific antibabesial therapy with that in silently infected people who had not been treated. METHODS: Forty-six babesia-infected subjects were identified from 1991 through 1996 in a prospective, community-based study designed to detect episodes of illness and of seroconversion among the residents of southeastern Connecticut and Block Island, Rhode Island. Subjects with acute babesial illness were monitored every 3 months for up to 27 months by means of thin blood smears, Bab. microti polymerase-chain-reaction assays, serologic tests, and questionnaires. RESULTS: Babesial DNA persisted in the blood for a mean of 82 days in 24 infected subjects without specific symptoms who received no specific therapy. Babesial DNA persisted for 16 days in 22 acutely ill subjects who received clindamycin and quinine therapy (P=0.03), of whom 9 had side effects from the treatment. Among the subjects who did not receive specific therapy, symptoms of babesiosis persisted for a mean of 114 days in five subjects with babesial DNA present for 3 or more months and for only 15 days in seven others in whom the DNA was detectable for less than 3 months (P<0.05); one subject had recrudescent disease after two years. CONCLUSIONS: When left untreated, silent babesial infection may persist for months or even years. Although treatment with clindamycin and quinine reduces the duration of parasitemia, infection may still persist and recrudesce and side effects are common. Improved treatments are needed.

Animals↗
PubMed1998

Sumatriptan injection reduces productivity loss during a migraine attack: results of a double-blind, placebo-controlled trial.

OBJECTIVE: To evaluate the impact of sumatriptan succinate injection compared with placebo on productivity loss during a migraine attack in the workplace. DESIGN: Randomized, double-blind, placebo-controlled, parallel-group clinical trial. SETTING: Fifteen clinical centers in the United States. PATIENTS: One hundred thirty-five patients 18 years and older diagnosed as having migraine according to International Headache Society criteria. INTERVENTIONS: Patients self-administered sumatriptan injection (6 mg) or matching placebo to treat a moderate or severe migraine occurring within the first 4 hours of a minimum 8-hour work shift. MAIN OUTCOME MEASURES: Mean productivity loss 2 hours after dosing and across the work shift; percentages of patients returning to normal work performance within 2 hours after dosing and across the work shift; percentages of patients experiencing headache relief (reduction of moderate or severe predose pain to mild or no pain) 1 and 2 hours after dosing. RESULTS: Mean productivity loss was significantly (P< or =.002) lower in the sumatriptan group compared with the placebo group both during the 2-hour postdose period (sumatriptan, 39 minutes; placebo, 54 minutes) and across the work shift (sumatriptan, 86 minutes; placebo, 168 minutes). Significantly (P<.001) greater percentages of patients in the sumatriptan group compared with the placebo group returned to normal work performance by 2 hours after dosing (sumatriptan, 52%; placebo, 9%) and across the work shift (sumatriptan, 66%; placebo, 18%). Significantly (P< or =.001) greater percentages of patients in the sumatriptan group compared with the placebo group experienced headache relief 1 hour after dosing (sumatriptan, 69%; placebo, 18%) and 2 hours after dosing (sumatriptan, 79%; placebo, 32%). CONCLUSION: Sumatriptan reduced migraine-associated productivity loss during a minimum 8-hour work shift by approximately 50% compared with placebo and alleviated headache in more than three fourths of patients.

Adult↗
PubMed1998

Endovascular treatment of renal artery thrombosis caused by umbilical artery catheterization.

Renal arterial thrombosis, usually in association with aortic thrombosis, has been reported as a result of prolonged neonatal umbilical artery catheterization. A case of renal artery thrombosis attributable to umbilical artery catheterization, resulting in malignant renovascular hypertension, in a 15-day-old neonate, treated by catheter-directed thrombolysis through the involuting umbilical artery, was studied. Resolution of systemic hypertension and partial return of right renal function followed rapid thrombus dissolution.

Catheterization↗
PubMed1998

ENT day surgery in England and Wales--an audit by the Royal College of Surgeons (Eng.) Comparative Audit Service.

An audit of day surgery was carried out by the Royal College of Surgeons (Eng.) Comparative Audit service. Data from 121 respondents on over 3,962 day cases were analysed from both retrospective information and from prospective individual patient proformas. The day surgery rate is 31 per cent. The variability of facilities for day-surgery, the timing of lists, type of anaesthetic used and case-mix are discussed. Outcome and the reasons for admission to an overnight bed are analysed. The overall admission rate was found to be 2.8 per cent (range 0.6-19.5 per cent between consultants). Seventy per cent of ENT day-surgery was performed on morning lists which have a lower admission rate than afternoon lists. The main reasons for admission are vomiting 30 per cent, haemorrhage 20 per cent and inadequate recovery from anaesthetic 22 per cent. A more detailed analysis of reasons for admission were given for tonsillectomy, adenoidectomy, FESS, and grommets. Recommendations are given which might increase the scope of safe day-surgery and reduce admission rate.

Aged↗
PubMed1997

Medical evaluation of persons with mental retardation referred for psychiatric assessment.

Many people with developmental disabilities and "challenging behaviors" present to primary care physicians, internists, or general psychiatrists for assessment and treatment. These clinicians seek to provide the comprehensive biopsychosocial assessment necessary for successful treatment, but may encounter interference from funding agencies. Epidemiologic data on medical comorbidity in persons with developmental disabilities with a primarily "behavioral" presentation may assist in facilitating these assessments. A total of 1135 people with mental retardation referred for mental health assessment were medically evaluated according to a two-step protocol which included a screening evaluation of all persons and expanded testing, depending on clinical status. The workup was considered complete when the person with either improving clinically or had a specific terminal diagnosis and was as comfortable as possible. Medical comorbidity was about double that of people referred for mental health assessment who do not have mental retardation. Common conditions presented in unusual ways, and less frequent conditions presented more often. The cost of the medical assessments was promptly recovered in a variety of savings to systems. Comprehensive medical assessment discloses increased medical comorbidity in persons with mental retardation referred for psychiatric evaluation. Comprehensive treatment based on the assessment findings appears to be associated with better clinical outcomes and cost savings to systems.

Adult↗
PubMed1997

The effects of ion implantation on rate of tooth movement: an in vitro model.

Recently, the ion-implantation process has been applied to orthodontic wires. By altering the surface composition of a wire, the ion-implantation process supposedly decreases the frictional forces produced during tooth movement. The purpose of this study was to compare the amount of tooth movement produced by different orthodontic wire compositions, under identical conditions, by using an in vitro model. The wires tested were stainless steel, nickel-titanium (control and ion implanted), and beta-titanium (control and ion implanted). The amount of tooth movement was measured and compared. Results demonstrate that, stainless steel produced the least frictional force during in vitro tooth movement, followed by ion-implanted nickel-titanium, ion-implanted beta-titanium, untreated nickel-titanium, and finally, untreated beta-titanium. A Wilcoxon rank sum test showed statistically significant differences in the amount of movement seen with the ion-implanted wires when compared with their untreated counterparts.

Analysis of Variance↗
PubMed1997

A state-university collaboration to serve persons with developmental disabilities and mental health needs.

Persons with developmental disabilities and mental health needs present a complex and potentially rewarding challenge to workers in both developmental disabilities (DD) and mental health (MH) fields. These individuals may be shuttled between (DD) and (MH) systems. Effective care requires the person obtain services from both systems. This paper describes one possible mechanism of service delivery for persons with developmental disabilities and mental health needs.

Colorado↗
PubMed1997

Immediate and short-term effects of benzalkonium chloride on the human nasal mucosa in vivo.

The in vivo effects of benzalkonium chloride, which is a preservative in most nasal sprays and drops, have been investigated in normal human volunteers. Saccharin clearance time was slightly prolonged 10 min after 0.02% benzalkonium chloride was applied, compared to that following 0.9% saline (n = 27, P = 0.04, Wilcoxon test). Sixty-five normal volunteers were randomly assigned to receive saline, fluticasone propionate aqueous nasal spray or placebo (which contained all the ingredients of fluticasone aqueous spray incl. 0.02% benzalkonium chloride, minus the fluticasone propionate) for 2 weeks, two puffs twice a day on a double-blind basis. Symptom scores, acoustic rhinometry, saccharin clearance time and ciliary beat frequency were measured immediately prior to this study and again at 2 weeks. Fifty-eight individuals completed the study with > 80% compliance. There was no significant difference between the three groups in any of the variables tested. Benzalkonium chloride causes slight prolongation of mucociliary clearance shortly after application but has no detectable effect on nasal mucosal function after 2 weeks regular use.

Adult↗
PubMed1997

Sumatriptan nasal spray for the acute treatment of migraine. Results of two clinical studies.

BACKGROUND: Sumatriptan nasal spray may be particularly useful for patients whose nausea and vomiting preclude them from using oral migraine medication or for patients who prefer not to use an injectable migraine medication. The objective of this study was to evaluate in two clinical studies the efficacy and tolerability of the intranasal form of sumatriptan in the acute treatment of a single migraine attack. International Headache Society-diagnosed adult migraineurs in two randomized, double-blind, parallel-group, multicenter studies (n = 409 and 436) used sumatriptan nasal spray 20 mg, 10 mg, or placebo (2:1:1) for the acute treatment of a single migraine attack at home. Predose and at predetermined postdose intervals, patients recorded headache severity (none, mild, moderate, severe); time to meaningful relief; clinical disability (none, mildly impaired, severely impaired, bed rest required); presence/absence of nausea, photophobia, and phonophobia; and the occurrence of adverse events. Two hours postdose in the two studies, moderate or severe baseline pain was reduced to mild or none in 62 to 63% of patients treated with sumatriptan 20 mg, 43 to 54% of patients treated with sumatriptan 10 mg, and 29 to 35% of placebo-treated patients (p < 0.05 20 mg versus placebo for both studies and 10 mg versus placebo for study 1). Onset of relief relative to placebo began as early as 15 minutes postdose (sumatriptan 20 mg, study 2). Clinical disability at 2 hours postdose was reported as mildly impaired or normal in 72 to 74% of patients treated with sumatriptan 20 mg, 56 to 68% of patients treated with sumatriptan 10 mg, and 47 to 58% of placebo-treated patients (p < 0.05 20 mg versus placebo for both studies). Similar efficacy rates were observed for nausea, photophobia, and phonophobia. The most common adverse event in the active treatment groups was disturbance of taste (bad, bitter, or unpleasant taste). Aside from this event, the pattern and incidence of adverse events did not differ among treatment groups. From these results we determined that sumatriptan nasal spray is a rapidly effective, well-tolerated migraine treatment. The 20-mg dose was effective in treating the entire migraine symptom complex, and the 10-mg dose was less consistently effective.

Acute Disease↗
PubMed1996

Concurrent Lyme disease and babesiosis. Evidence for increased severity and duration of illness.

OBJECTIVE: To determine whether patients coinfected with Lyme disease and babesiosis in sites where both diseases are zoonotic experience a greater number of symptoms for a longer period of time than those with either infection alone. DESIGN: Community-based, yearly serosurvey and clinic-based cohort study. SETTING: Island community in Rhode Island and 2 Connecticut medical clinics from 1990 to 1994. STUDY PARTICIPANTS: Long-term residents of the island community and patients seeking treatment at the clinics. MAIN OUTCOME MEASURES: Seroreactivity to the agents of Lyme disease and babesiosis and number and duration of symptoms. RESULTS: Of 1156 serosurvey subjects, 97 (8.4%) were seroreactive against Lyme disease spirochete antigen, of whom 14 (14%) also were seroreactive against babesial antigen. Of 240 patients diagnosed with Lyme disease, 26 (11%) were coinfected with babesiosis. Coinfected patients experienced fatigue (P = .002), headache (P < .001), sweats (P < .001), chills (P = .03), anorexia (P = .04), emotional lability (P = .02), nausea (P = .004), conjunctivitis (P = .04), and splenomegaly (P = .01) more frequently than those with Lyme disease alone. Thirteen (50%) of 26 coinfected patients were symptomatic for 3 months or longer compared with 7 (4%) of the 184 patients with Lyme disease alone from whom follow-up data were available (P < .001). Patients coinfected with Lyme disease experienced more symptoms and a more persistent episode of illness than did those (n = 10) experiencing babesial infection alone. Circulating spirochetal DNA was detected more than 3 times as often in coinfected patients as in those with Lyme disease alone (P = .06). CONCLUSIONS: Approximately 10% of patients with Lyme disease in southern New England are coinfected with babesiosis in sites where both diseases are zoonotic. The number of symptoms and duration of illness in patients with concurrent Lyme disease and babesiosis are greater than in patients with either infection alone. In areas where both Lyme disease and babesiosis have been reported, the possibility of concomitant babesial infection should be considered when moderate to severe Lyme disease has been diagnosed.

Adolescent↗
PubMed1996

Comparison of PCR with blood smear and inoculation of small animals for diagnosis of Babesia microti parasitemia.

The specific diagnosis of babesiosis, which is caused by the piroplasm Babesia microti, is made by microscopic identification of the organism in Giemsa-stained thin blood smears, detection of babesial antibody in acute-and convalescent-phase sera, or identification of the organism following the injection of patient blood into laboratory animals. Although rapid diagnosis can be made with thin blood smears, parasites are often not visualized early in the course of infection. PCR is a new, rapid diagnostic technique for the detection of Babesia spp. that has not yet been systematically evaluated. We conducted a blinded study of the sensitivity, specificity, and reproducibility of the PCR-based test with patients with babesiosis and a group of asymptomatic subjects residing in a region in southern New England where babesiosis is enzootic. Among 19 patients with recent babesial illness, we found that PCR was as sensitive and specific as the use of Giemsa-stained blood smears and inoculation of hamsters. Among asymptomatic subjects, the PCR result was positive for 3 persons with recent babesial infection and was negative for 41 persons without previous babesial infection. We conclude that the B. microti PCR procedure is sufficiently sensitive, specific, and reproducible for use in the diagnosis of acute babesiosis.

Animals↗