Search PubMed⌕ Search

Biomedical subjects

R Ryan

Publications and source records attributed to R Ryan.

103 records · Page 6Linked to original sources
PubMedDate not supplied

Multiple-attack efficacy and tolerability of sumatriptan nasal spray in the treatment of migraine.

OBJECTIVE: Sumatriptan hemisulfate nasal spray may provide a useful therapeutic option for patients with migraine who find injectable medications inconvenient or uncomfortable and for patients whose migraine-associated nausea and vomiting preclude the use of oral medication. This study was the first US trial to evaluate the effects of sumatriptan nasal spray administered for multiple migraine attacks. DESIGN/INTERVENTIONS: Sumatriptan nasal spray (5, 10, or 20 mg) was administered via a 1-shot nasal applicator into either nostril for up to 3 migraine attacks occurring over 6 months in a randomized, double-blind, parallel-group, placebo-controlled study. SETTING: Fifty-six outpatient clinical centers in the United States. PATIENTS: A total of 1086 men and women diagnosed with migraine with or without aura per International Headache Society criteria. MAIN OUTCOME MEASURES: Percentage of patients with headache relief (moderate or severe predose pain reduced to mild or none); percentage of patients with no or mild (vs moderate or severe) clinical disability; percentage of patients with nausea, vomiting, photophobia, or phonophobia; adverse events; clinical laboratory test results. RESULTS: Across attacks, headache relief in the 20-, 10-, and 5-mg drug and placebo groups was experienced 120 minutes postdose by 60%, 54%, 44%, and 32% of patients, respectively (P<.05 for each sumatriptan nasal spray group vs placebo, for the 10-mg vs 5-mg drug group, and for the 20-mg vs 5-mg drug group). Two thirds of the 20-mg patients treating 3 attacks experienced relief at 2 hours postdose for at least 2 of 3 attacks. Clinical disability scores at 120 minutes in the 20-, 10-, and 5-mg drug and placebo groups reflected no or mild impairment in 70%, 67%, 57%, and 50% of patients, respectively (P<.05 for the 10- or 20-mg drug group vs placebo group, and for the 20-mg vs 5- mg drug group). Similar efficacy rates were observed for nausea, photophobia, and phonophobia. For all parameters, individual-attack efficacy rates did not differ from across-attack rates. The incidence of adverse events was not dose related. The most frequently reported adverse event in the active treatment groups was taste disturbance (bad, bitter, or unpleasant). CONCLUSIONS: Sumatriptan hemisulfate nasal spray (5, 10, or 20 mg) is effective and well tolerated in the treatment of multiple migraine attacks. The 20-mg dose was associated with the highest efficacy rates across the greatest number of parameters.

Administration, Intranasal↗
PubMedDate not supplied

Crossover comparison of rizatriptan 5 mg and 10 mg versus sumatriptan 25 mg and 50 mg in migraine. Rizatriptan Protocol 046 Study Group.

Rizatriptan is a selective 5-HT1B/1D receptor agonist with rapid oral absorption and early onset of action in the acute treatment of migraine. This double-blind, placebo-controlled, crossover study compared rizatriptan 5 mg versus sumatriptan 25 mg, and rizatriptan 10 mg versus sumatriptan 50 mg. A total of 1329 patients were allocated to one of five groups for treatment of two attacks: rizatriptan 5 mg/sumatriptan 25 mg; sumatriptan 25 mg/rizatriptan 5 mg; rizatriptan 10 mg/sumatriptan 50 mg; sumatriptan 50 mg/rizatriptan 10 mg; placebo/placebo. For each attack, patients rated headache severity, presence of associated symptoms, and functional disability prior to dosing and at intervals through 4 hours thereafter. Patients also rated their satisfaction with medication. Rizatriptan 5 mg and 10 mg provided faster relief of headache pain and greater relief of migraine symptoms than the 25-mg and 50-mg doses of sumatriptan, respectively. The response to rizatriptan was better than sumatriptan on additional measures including functional disability and satisfaction with medication. All active treatments were highly effective compared to placebo and acted as early as 30 minutes after dosing. All active treatments were well-tolerated and showed comparable safety profiles.

Adult↗
PubMedDate not supplied

Pulmonary artery stenosis resulting in ventilation-perfusion mismatch in a young female.

Pulmonary embolism is a disorder associated with significant morbidity and mortality in which early, accurate diagnosis is imperative. Controversy exists as to whether this disorder is being overdiagnosed or underdiagnosed. Processes other than pulmonary embolism may produce scintigraphic ventilation-perfusion mismatch and alter the diagnostic specificity of this technique in a small but significant subset of patients. We report a case in which pulmonary ventilation-perfusion mismatch was produced by pulmonary vessel stenosis without evidence of embolic disease. Paradoxically, although the specificity in diagnosing pulmonary embolism with scintigraphic techniques has increased markedly, still greater caution must be exercised in order to preserve this specificity.

Adult↗
PubMedDate not supplied

Structured exercise circuit program for burn patients.

A 10-station structured exercise circuit was developed for burn patients. This conditioning program was designed to accelerate overall functional mobility. The effectiveness of this structured exercise program (SEP) was examined with respect to length of hospitalization, number of outpatient occupational/physical therapy visits required over a three-month period following discharge, and number of days required to return to work post-discharge. Results showed no change in hospitalization. There was, however, a significant decrease in the number of outpatient therapy visits required post-discharge and an earlier return to work date for those patients enrolled in the SEP.

Adult↗
PubMedDate not supplied

Metacarpal fractures in the athlete.

Fifty-six fractures of the metacarpal occurring in 53 athletes were studied from September 1985 to December 1986, regarding mechanism of injury, type of fracture, type of treatment, and time lost from sport. Age range of the patients was 8 to 28 years with greater than 77% being in the 14 to 18 year age range, the high school athlete. Twenty-nine of the fractures occurred in football, 14 in basketball, and the remainder were divided between various other sports. The most common mechanism of injury involved falls or hitting an object such as a helmet or another player. Fractures were evenly divided regarding which digit was involved in football, whereas most basketball injuries occurred in the fourth and fifth metacarpal. Fractures were analyzed as to type of radiographic appearance and this was correlated with time lost from competition or participation. No significant difference among fracture type regarding time lost was noted. Forty-six of the fractures (82%) were minimally displaced or undisplaced and were treated by means of simple casting and/or splinting whereas 10 were displaced. Two of the 10 underwent closed reduction and casting; 3 underwent closed reduction and percutaneous pin fixation; and 5 (9%) underwent open reduction internal fixation using AO type plates and screws. All fractures healed primarily clinically and radiographically. The average time lost from practice or competition in this group overall was 13.7 days, (range, 0 to 56 days). Average time lost from basketball was 19.8 days and from football 10.63 days overall. Average time lost from sport in stable fractures treated with casting or splinting was 12.3 days.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

Clinical effect of blowing nitrogen gas across the cornea during photorefractive keratectomy.

OBJECTIVE: We evaluated the clinical effects of blowing nitrogen gas over the cornea during photorefractive keratectomy. METHODS: We retrospectively compared clinical outcomes of 32 patients (37 eyes), divided into two groups who had photorefractive keratectomy with nitrogen gas blowing across the cornea (n = 19) and without nitrogen gas (n = 18). All photorefractive keratectomies were performed between April 1991 and August 1992. Ablation zone diameters were 5.0 or 5.5 mm. The average attempted correction was -3.47 +/- 1.76 diopters (D) in the nitrogen gas group, and -3.48 +/- 1.25 D in the non-nitrogen gas group. RESULTS: The nitrogen gas group achieved more accurate corrections than the non-nitrogen gas group, but had a significantly greater amount of corneal haze at all postoperative examinations. Corneal haze was most evident at 1 month and gradually diminished therafter in both groups. At 6 months, videokeratography revealed a central island in 2 eyes (11.1%) of the non-nitrogen gas group. Because of undercorrection (2 eyes) or central island (1 eye), 3 out of 18 eyes in the non-nitrogen gas group were reablated 6 months later. CONCLUSIONS: The non-nitrogen gas group had more undercorrections and a higher frequency rate of central steep islands, but nitrogen gas blowing caused a greater amount of corneal haze.

Administration, Topical↗
PubMedDate not supplied

Comparison of rapid methods of antimicrobial susceptibility in Haemophilus influenzae.

A method is described for the rapid, simultaneous determination of the MIC's of chloramphenicol and ampicillin to Haemophilus influenzae. Excellent agreement was observed between the Autobac method and the agar dilution method for antimicrobial susceptibility. All ampicillin resistant Haemophilus isolates produced beta lactamase and none of the suceptible strains produced this enzyme.

Ampicillin↗
PubMedDate not supplied

Urinary tract symptoms: microbiologic evaluation in rural family practice.

In order to define the etiology of urinary symptoms in rural family practice, this study examines 106 patients (88 women, 18 men) who went to their family physicians in private practice or a resident-faculty practice with genitourinary symptoms. Evaluation of each patient included history, physical examination, urinalysis, and urine or cervical cultures for bacteria, Mycoplasma, and Chlamydia. Using agar plate culturing techniques, 37 patients (35 percent) were identified as having significant urine bacteria. Chlamydia was rarely associated with urinary tract symptoms. Mycoplasma hominis, however, was isolated and felt to be etiologic in 19 (22 percent) of the 88 symptomatic women (P = 0.0026). Older women (mean age 42 years, P less than 0.001) with greater than 5 white blood cells per high-power field (WBC/hpf) on microscopic urinalysis (P less than 0.001) were likely to have cystitis and significant bacteria on urine culture. Younger women (mean age 31 years, P less than 0.001) with less than 5 WBC/hpf (P less than 0.001) had negative urine cultures and were likely to have M. hominis as a pathogen. These results demonstrate that the etiology of genitourinary symptoms seen in rural family practice may vary substantially from those seen in other patient care settings.

Adult↗