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Triviño A, Davidson C, Clements DN, Ryan JM. Objective comparison of a sit to stand test to the walk test for the identification of unilateral lameness caused by cranial cruciate ligament disease in dogs. J Small Anim Pract 2024; 65:24-29. [PMID: 37876317 DOI: 10.1111/jsap.13679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 08/11/2023] [Accepted: 10/01/2023] [Indexed: 10/26/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate a sit to stand test with the walk test for the identification of unilateral cranial cruciate ligament rupture in dogs. MATERIALS AND METHODS Peak vertical force and vertical impulse were measured on a pressure-sensitive walkway, during a sit to stand test and walk test, and in 10 dogs with unilateral cranial cruciate ligament rupture and 18 non-lame dogs. Data collected were used to calculate symmetry indices (SI) of ipsilateral and contralateral hindlimbs (HL), diagonal limb pairs (DLP) and ipsilateral limb pairs (ILP). RESULTS The symmetry indices of peak vertical force of HL during the walk test and sit to stand test were 100% and 90% sensitive for discriminating lame and non-lame dogs respectively. The symmetry indices of vertical impulse of HLs during the walk test and sit to stand test were 100% and 50% sensitive for discriminating lame and non-lame dogs respectively. Analysis of ipsilateral and diagonal limb pairs did not improve the discrimination in either test. The time taken to collect data from the sit to stand test data was shorter than for the walk test. CLINICAL SIGNIFICANCE Whilst the sit to stand test required a shorter time for collection of data than the walk test, it did not accurately identify all dogs with lameness associated with CCLR, and thus has relatively limited clinical utility in its tested form.
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Affiliation(s)
- A Triviño
- Lamond Veterinary Clinic, Bankton Square, Murieston, Livingston, EH54 9EY, Scotland
| | - C Davidson
- The Royal (Dick) School of Veterinary Studies, Hospital for Small Animals, The University of Edinburgh, Edinburgh, UK
| | - D N Clements
- The Royal (Dick) School of Veterinary Studies, Hospital for Small Animals, The University of Edinburgh, Edinburgh, UK
| | - J M Ryan
- The Royal (Dick) School of Veterinary Studies, Hospital for Small Animals, The University of Edinburgh, Edinburgh, UK
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Nordt SP, Ryan JM, Kelly D, Kutubi A, Saleh R, Quinn C, Al Kharusi T, Tiernan EJ. Palliative care patient emergency department visits at tertiary university-based emergency department in Ireland. Am J Emerg Med 2023; 66:76-80. [PMID: 36736062 DOI: 10.1016/j.ajem.2023.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/15/2023] [Accepted: 01/18/2023] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Palliative care patients often present to the emergency department (ED) for various reasons e.g., acute illness, pain, altered mental status, and complications of therapy. Many visits involve less severe etiologies e.g., dyspnea, constipation, fear as patients approach the end of life, which may be more effectively and efficiently managed outside of the ED. The objective of this study is to identify and assess the frequency of presenting complaints, primary diagnosis, triage acuity, need for admission, in an Irish setting. METHODS A single-center retrospective, observational study of palliative care patients presenting to a tertiary-care university hospital emergency department in Dublin, Ireland. Study subjects were identified using the palliative care database and cross-referencing with the ED electronic patient record system database. The primary objective to identify potential areas to minimize ED visits and improve patient care and quality of life by elucidating reasons for visits. Outcome measures include presenting complaint, primary diagnosis, triage severity score, admission, discharge, death in hospital. Statistical analysis presented as descriptive statistics. RESULTS Four-hundred-ninety-nine ED visits, 245 (49%) were male, and 254 (51%) were female with a mean age of 69.3 years-of-age. Most patients, 285 (57.1%) self-referred to the emergency department, with general practitioners and skilled nursing facility referrals 72 (14.4%) and 39 (7.8%), respectively. Primary diagnoses were various cancers, chronic obstructive pulmonary disease, congestive heart failure, and dementia. Major reasons for visits were dyspnea, pain, falls, trauma, fever, and altered mental status. Two-hundred-eighty-nine patients (58%) had an emergency severity index (ESI) score of 1 or 2 demonstrating a higher level of acuity. Three-hundred-fifty-eight (71.7%) were admitted, 141 (28.3%) discharged to home, 64 (12.8%) admitted patients died during their hospital admission. CONCLUSIONS Palliative care patients utilize ED services not uncommonly. Though many of these patients presented with higher acuity triage scores, 42% had lower ESI scores and may be effectively managed outside of the ED. These data suggest developing mechanisms for these patients to be urgently evaluated in their homes or facilities obviating the need for an ED evaluation.
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Affiliation(s)
- Sean Patrick Nordt
- Department of Emergency Medicine, Loma Linda University, School of Medicine, Loma Linda, CA, United States of America.
| | - John M Ryan
- Department of Emergency Medicine, St. Vincent's University Hospital, Dublin, Ireland
| | | | | | | | | | | | - Eoin J Tiernan
- Department of Palliative Medicine, St. Vincent's University Hospital, Dublin, Ireland
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Acton H, Motyer R, O'Mahony J, Brennan I, Ryan JM. Transurethral ureteric embolization for locally advanced cervical cancer with uretero-vaginal fistula - A case report. Int J Surg Case Rep 2023; 104:107944. [PMID: 36822028 PMCID: PMC9978460 DOI: 10.1016/j.ijscr.2023.107944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 02/17/2023] [Indexed: 02/22/2023] Open
Abstract
INTRODUCTION Targeted radiotherapy, surgery, and localised disease progression can all result in fistulous tract formation in patients with a pelvic malignancy, in particular cervical or endometrial cancer. This report discusses a novel technique for palliative management of ureterovaginal fistulas in end-stage disease. PRESENTATION OF CASE REPORT We report the case of a 37 year old female with metastatic cervical squamous cell carcinoma previously treated with chemoradiation who presented with progressive disease and secondary development of a symptomatic ureterovaginal fistula. DISCUSSION This case report discusses the causes and sequalae of uretero-vaginal fistula formation, the role of the interventional radiology with regards to palliative intervention, and potential patient factors that can affect performance of such procedures. CONCLUSION Interventional radiology plays an important role in palliative and symptomatic management of end stage malignant disease. Ureteric embolisation via a retrograde transurethral approach by way of an existing stent is a novel approach to access making the procedure easier for both the patient and radiologist.
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Affiliation(s)
- H Acton
- Department of Interventional Radiology, St. James's Hospital, Dublin, Ireland.
| | - R Motyer
- Department of Interventional Radiology, St. James's Hospital, Dublin, Ireland
| | - J O'Mahony
- Department of Interventional Radiology, St. James's Hospital, Dublin, Ireland
| | - I Brennan
- Department of Interventional Radiology, St. James's Hospital, Dublin, Ireland
| | - J M Ryan
- Department of Interventional Radiology, St. James's Hospital, Dublin, Ireland
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Munsch MA, Via GG, Roebke AJ, Everhart JS, Ryan JM, Vasileff WK. Patient-specific factors, but neither regional anesthesia nor hip-specific cryotherapy, predict postoperative opioid requirements after hip arthroscopy for femoroacetabular impingement (FAI) syndrome. J Clin Orthop Trauma 2022; 28:101848. [PMID: 35378774 PMCID: PMC8976140 DOI: 10.1016/j.jcot.2022.101848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 01/10/2022] [Accepted: 03/23/2022] [Indexed: 10/18/2022] Open
Abstract
Background We sought to determine whether regional nerve block, cryotherapy variant, or patient-specific factors predict postoperative opioid requirements and pain control following hip arthroscopy. Methods 104 patients underwent hip arthroscopy with (n = 31) or without (n = 73) regional block and received cryotherapy with a universal pad [joint non-specific; no compression (n = 60)] or circumferential hip/groin wrap with intermittent compression (n = 44). Outcomes included total opioid prescription amounts, requests for refills, and unplanned clinical encounters for postoperative pain within 45 days of surgery. Multivariate modeling was used to determine the effect of perioperative regional nerve block and type of cryotherapy device on outcomes after adjusting for patient demographics, previous opioid use, mental health disorder history, and surgery length. Results The average amount of 5 mg oxycodone pill equivalents prescribed within 45 days of surgery was 40.5 (SD 14.8); 36% requested refills, 20% presented to another physician, and 21% called the surgeon's office due to pain. Neither the hip-specific cryotherapy pad nor regional block was predictive of opioid amounts prescribed, refill requests, or unplanned clinical encounters due to pain. Refill requests within 45 days were more common with baseline opioid use (p < 0.001), increased age (p = 0.007), and mental health disorder history (p = 0.008). Total opioid amounts prescribed within 45 days were higher with workers compensation (p = 0.03), a larger initial opioid prescription (p < 0.001), baseline opioid use (p < 0.001), history of mental health disorder (p = 0.02), and increased age (p = 0.02). Together, these variables explained 61% of the variance in opioid amounts prescribed. Conclusion Patient factors are strong predictors of postoperative opioid requirements after hip arthroscopy. Postoperative opioid prescription amounts, opioid refill requests, and pain-related calls or office visits were not affected by use of a perioperative regional nerve block or type of cryotherapy delivery system. Level of evidence III, retrospective cohort study.
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Affiliation(s)
- Maria A. Munsch
- Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Garrhett G. Via
- Department of Orthopaedic Surgery, Wright State University, Dayton, OH, USA
| | - Austin J. Roebke
- Department of Orthopedics, The Ohio State Wexner Medical Center, Columbus, OH, USA
| | | | - John M. Ryan
- Department of Orthopedics, The Ohio State Wexner Medical Center, Columbus, OH, USA
| | - W. Kelton Vasileff
- Department of Orthopedics, The Ohio State Wexner Medical Center, Columbus, OH, USA
- Corresponding author. Department of Orthopaedics, The Ohio State University Jameson Crane Sports Medicine Institute, 2835 Fred Taylor Drive, Columbus, OH, 43202, USA.
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Madden ME, Sivolapenko D, Johnson A, Lodzinska J, Ryan JM, Suñol A. What Is Your Neurologic Diagnosis? J Am Vet Med Assoc 2021; 259:845-848. [PMID: 34609189 DOI: 10.2460/javma.259.8.845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Rhind SM, MacKay J, Brown AJ, Mosley CJ, Ryan JM, Hughes KJ, Boyd S. Developing Miller's Pyramid to Support Students' Assessment Literacy. J Vet Med Educ 2021; 48:158-162. [PMID: 32149588 DOI: 10.3138/jvme.2019-0058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Assessment literacy is increasingly recognized as an important concept to consider when developing assessment strategies for courses and programs. Assessment literacy approaches support students in their understanding of assessment expectations and help them both understand and optimize their performance in assessment. In this teaching tip, a model for assessment literacy that builds on the well-known Miller's Pyramid model for assessment in clinical disciplines is proposed and contextualized. The model progresses thinking from assessment methods themselves to consideration of the activities that need to be built into curricula to ensure that assessment literacy is addressed at each level of the pyramid. The teaching tip provides specific examples at each of the levels. Finally, the relevance of this work to overall curriculum design is emphasized.
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Clements DN, Ryan JM, Handel IG, Gow AG, Campbell S, Hurst E, Mellanby RJ. Relationship between vitamin D status and clinical outcomes in dogs with a cranial cruciate ligament rupture. Res Vet Sci 2021; 136:385-389. [PMID: 33799168 DOI: 10.1016/j.rvsc.2021.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/07/2020] [Accepted: 03/23/2021] [Indexed: 11/16/2022]
Abstract
Cranial cruciate ligament rupture (CCLR) is one of the most common orthopaedic disorders diagnosed in dogs yet the factors which influence postoperative clinical outcomes are poorly understood. Low vitamin D status has been linked to poorer clinical outcomes in human patients undergoing elective orthopaedic surgery. The aim of this study was to examine the relationship between pre-operative vitamin D status, as defined by serum 25 hydroxyvitamin D (25(OH)D) concentrations, and initial disease severity and clinical outcomes in dogs undergoing surgical treatment for a CCLR. Serum 25(OH)D concentrations were measured in 44 dogs with a CCLR on the day before surgery. C-reactive protein concentrations were measured at a median time of 1 day post-surgery and the patient's clinical and radiographic response to CCLR surgical treatment was assessed at a median timepoint of 60 days post-surgery. Serum 25(OH)D concentrations in dogs with a CCLR was not significantly different to a population of healthy dogs (median 74.1 nmol/L and 88.40 nmol/L, respectively). There was no significant correlation between pre-operative serum 25(OH)D concentrations and length of pre-diagnosis clinical signs, pre-operative lameness scores or day 1 post-operative CRP concentrations. Thirty nine of the 44 dogs were re-examined at a median 60 days post-surgery. There was no relationship between the day 60 lameness scores and pre-operative serum 25(OH)D concentrations. In summary, we discovered that the vitamin D status of dogs with a CCLR was not significantly lower than healthy dogs and pre-operative serum 25(OH)D concentrations were not correlated to either pre-surgical disease severity or post-operative clinical outcomes.
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Affiliation(s)
- Dylan N Clements
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, The University of Edinburgh, Hospital for Small Animals, Easter Bush Veterinary Centre, Roslin, Midlothian EH25 9RG, United Kingdom
| | - John M Ryan
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, The University of Edinburgh, Hospital for Small Animals, Easter Bush Veterinary Centre, Roslin, Midlothian EH25 9RG, United Kingdom
| | - Ian G Handel
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, The University of Edinburgh, Hospital for Small Animals, Easter Bush Veterinary Centre, Roslin, Midlothian EH25 9RG, United Kingdom
| | - Adam G Gow
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, The University of Edinburgh, Hospital for Small Animals, Easter Bush Veterinary Centre, Roslin, Midlothian EH25 9RG, United Kingdom
| | - Susan Campbell
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, The University of Edinburgh, Hospital for Small Animals, Easter Bush Veterinary Centre, Roslin, Midlothian EH25 9RG, United Kingdom
| | - Emma Hurst
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, The University of Edinburgh, Hospital for Small Animals, Easter Bush Veterinary Centre, Roslin, Midlothian EH25 9RG, United Kingdom; Mass Spectrometry Core, Edinburgh Clinical Research Facility, Queen's Medical Research Institute, The University of Edinburgh, Little France Crescent, Edinburgh EH16 4TJ, Scotland, United Kingdom
| | - Richard J Mellanby
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, The University of Edinburgh, Hospital for Small Animals, Easter Bush Veterinary Centre, Roslin, Midlothian EH25 9RG, United Kingdom.
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Ryan JM, Toomey DP. Emergent repair of a fourth-degree perineal tear - a video vignette. Colorectal Dis 2020; 22:1767. [PMID: 32441470 DOI: 10.1111/codi.15154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 04/30/2020] [Indexed: 02/08/2023]
Affiliation(s)
- J M Ryan
- Department of General Surgery, Midland Regional Hospital, Mullingar, Co. Westmeath, Ireland
| | - D P Toomey
- Department of General Surgery, Midland Regional Hospital, Mullingar, Co. Westmeath, Ireland.,Department of Colorectal Surgery, Mater Misericordiae University Hospital, Dublin 7, Ireland
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Clements DN, Bruce G, Ryan JM, Handel IG, Oikonomidis IL, Gow AG, Evans H, Campbell S, Hurst E, Mellanby RJ. Effects of surgery on free and total 25 hydroxyvitamin D concentrations in dogs. J Vet Intern Med 2020; 34:2617-2621. [PMID: 33179819 PMCID: PMC7694799 DOI: 10.1111/jvim.15933] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 09/25/2020] [Accepted: 09/25/2020] [Indexed: 12/11/2022] Open
Abstract
Background It is unclear whether a low total 25(OH)D concentration is a cause or consequence of illnesses. To address this knowledge gap, studies measuring free and total 25(OH)D during the evolution and resolution of an inflammatory process are required. Objectives Serum total and free 25(OH)D concentrations would transiently decline after cruciate surgery in dogs. Animals Seventeen client‐owned dogs with a spontaneous cranial cruciate ligament rupture (CCLR). Methods A longitudinal cohort study involving the measurement of serum concentrations of total and free 25(OH)D, total calcium, creatinine, albumin, phosphate, C‐reactive protein and plasma ionized calcium, at 1 day before and a median time of 1 and 60 days after surgical treatment of CCLR. Results Median serum concentrations of total 25(OH)D before surgery (80.3 nmoL/L [range, 43.5‐137.3]) significantly declined immediately after surgery; (64.8 nmoL/L [range, 36.3‐116.5] 1 day after surgery, P < .005) before increasing to become nonsignificantly different from concentrations before surgery at day 60 after surgery (median 78.0 nmoL/L [range, 24.2‐115.8], P = .14). In contrast, median free 25(OH)D concentrations before surgery (7.6 pg/mL [range, 3.8‐12.2]) significantly increased immediately after surgery (9.2 pg/mL [range, 5.2‐15.7], P < .05) before declining to become nonsignificantly different from before surgery concentrations at day 60 after surgery (median 6.2 pg/mL [range, 4.0‐15.8], P = .37). Conclusion and Clinical Importance This study reveals the difficulties of assessing vitamin D status in dogs following elective surgery.
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Affiliation(s)
- Dylan N Clements
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, The University of Edinburgh, Hospital for Small Animals, Roslin, Midlothian, UK
| | - Gemma Bruce
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, The University of Edinburgh, Hospital for Small Animals, Roslin, Midlothian, UK
| | - John M Ryan
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, The University of Edinburgh, Hospital for Small Animals, Roslin, Midlothian, UK
| | - Ian G Handel
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, The University of Edinburgh, Hospital for Small Animals, Roslin, Midlothian, UK
| | - Ioannis L Oikonomidis
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, The University of Edinburgh, Hospital for Small Animals, Roslin, Midlothian, UK
| | - Adam G Gow
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, The University of Edinburgh, Hospital for Small Animals, Roslin, Midlothian, UK
| | - Helen Evans
- Nationwide Specialist Laboratories, Unit 2 Sawston Park, Cambridge, Cambridgeshire, UK
| | - Susan Campbell
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, The University of Edinburgh, Hospital for Small Animals, Roslin, Midlothian, UK
| | - Emma Hurst
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, The University of Edinburgh, Hospital for Small Animals, Roslin, Midlothian, UK
| | - Richard J Mellanby
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, The University of Edinburgh, Hospital for Small Animals, Roslin, Midlothian, UK
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Mahoney P, Clasper J, Ryan JM. Obituary: Dr Leslie David Payne. J ROY ARMY MED CORPS 2018. [DOI: 10.1136/jramc-2018-001039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ryan JM, Rogers AC, Arumugasamy M. Reply to comment to: 'Technical description of laparoscopic Morgagni hernia repair with primary closure and onlay composite mesh placement.'. Hernia 2018; 22:709-710. [PMID: 29754256 DOI: 10.1007/s10029-018-1781-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 05/05/2018] [Indexed: 11/29/2022]
Affiliation(s)
- J M Ryan
- Department of Upper Gastrointestinal Surgery, Beaumont Hospital, Beaumont Road, Beaumont, Co. Dublin, Dublin 9, Ireland.
| | - A C Rogers
- Department of Upper Gastrointestinal Surgery, Beaumont Hospital, Beaumont Road, Beaumont, Co. Dublin, Dublin 9, Ireland
| | - M Arumugasamy
- Department of Upper Gastrointestinal Surgery, Beaumont Hospital, Beaumont Road, Beaumont, Co. Dublin, Dublin 9, Ireland
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Brackett MG, Ryan JM, Haddock FJ, Romero MF, Brackett WW. Use of a Modified Matrix Band Technique to Restore Subgingival Root Caries. Oper Dent 2018; 43:467-471. [PMID: 29570028 DOI: 10.2341/17-142-t] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Given the increasing incidence of root caries in the elderly population, clinicians frequently must isolate and restore subgingival preparations. This article demonstrates a technique utilizing a modified Tofflemire matrix band that creates a preparation free of crevicular fluid and blood for restoration with resin-modified glass ionomer cement.
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Ryan JM, Rogers AC, Hannan EJ, Mastrosimone A, Arumugasamy M. Technical description of laparoscopic Morgagni hernia repair with primary closure and onlay composite mesh placement. Hernia 2018; 22:697-705. [PMID: 29556855 DOI: 10.1007/s10029-018-1760-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Accepted: 03/10/2018] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Morgagni hernias rarely present in adult life and, thus, little data exist on the optimal method of surgical repair. The laparoscopic approach has grown in popularity since the first reported case in 1992. This article showcases a method for laparoscopic repair of Morgagni hernias using both primary closure and mesh reinforcement. OPERATIVE APPROACH There were three obese women who presented in adulthood with cardiopulmonary symptoms; in all cases, the symptoms were attributable to local compressive effects of large Morgagni hernias. All three hernias were repaired laparoscopically, first by approximating the diaphragm to the fascia of the anterior abdominal wall, followed by insertion of a composite mesh, tacked to the diaphragm, to buttress the closure. All patients had excellent outcomes with symptom resolution. DISCUSSION This case series describes a method of laparoscopic Morgagni hernia repair using primary closure reinforced with a mesh, with excellent postoperative outcomes. Others have described thoracic or open approaches. The authors feel that the method described herein is likely to reduce recurrence in a patient population who are often overweight or obese and, thus, have a high risk of this complication. Furthermore, we discuss all reported laparoscopic repair cases in the literature and highlight the paucity of evidence on the optimal approach.
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Affiliation(s)
- J M Ryan
- Department of Upper Gastrointestinal Surgery, Beaumont Hospital, Beaumont Road, Beaumont, Co. Dublin, Ireland.
| | - A C Rogers
- Department of Upper Gastrointestinal Surgery, Beaumont Hospital, Beaumont Road, Beaumont, Co. Dublin, Ireland
| | - E J Hannan
- Department of Upper Gastrointestinal Surgery, Beaumont Hospital, Beaumont Road, Beaumont, Co. Dublin, Ireland
| | - A Mastrosimone
- Department of Upper Gastrointestinal Surgery, Beaumont Hospital, Beaumont Road, Beaumont, Co. Dublin, Ireland
| | - M Arumugasamy
- Department of Upper Gastrointestinal Surgery, Beaumont Hospital, Beaumont Road, Beaumont, Co. Dublin, Ireland
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Bove AM, Clohisy J, DeWitt J, Di Stasi S, Enseki K, Harris-Hayes M, Lewis CL, Reiman MP, Ryan JM. Cost-effectiveness Analysis of Hip Arthroscopic Surgery and Structured Rehabilitation Alone in Individuals With Hip Labral Tears: Letter to the Editor. Am J Sports Med 2017; 45:NP1-NP2. [PMID: 28272934 DOI: 10.1177/0363546517691278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Ryan JM, Roberts P. Definitive surgical trauma skills: a new skills course for specialist registrars and consultants in general surgery in the United Kingdom. Trauma 2016. [DOI: 10.1191/1460408602ta240oa] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In an era of increasing subspecialization within UK surgical practice, few senior trainees and a diminishing number of consultants feel competent operating outside their chosen specialist eld. General surgery and orthopaedic trainees, however, remain in the front line of trauma management. Subspecialization is, to some degree, affecting training of orthopaedic surgeons; there are some that do not deal with trauma. However, it is in the so-called field of general surgery that subspecialization has had the greatest impact. Many trainees are now more familiar with endoscopic techniques than open laparotomy and, even within the open abdomen, few wish to explore organ systems or regions outside their `zone of comfort’. Trauma, especially that inflicted by rearms, does not respect anatomical or speciality boundaries. This raises the question of how best to train surgeons in the future to manage severe multisystem injury. To manage trauma competently there is a need to master operative skills that cover the whole of the abdominal cavity, including the pelvis and the retroperitoneum. General surgeons should be competent and confident to carry out trauma thoracotomies and able to cope with central and peripheral vascular trauma. Further skills and knowledge are also required: these encompass trauma epidemiology, critical decision making and, not least, a detailed knowledge of surgical anatomy. Knowledge can be most severely tested when dealing with multi-system trauma! There is also a particular need to give military surgeons the competencies required to deal with battlefield trauma, 90% of which is caused by penetrating injury. Military surgeons, by definition, still need to be `generalists’. The Raven department of education at the Royal College of Surgeons of England, the Royal Defence Medical College (now the Royal Centre for Defence Medicine, Birmingham), and the Uniformed Services University of the Health Sciences, Washington, have developed a Definitive Surgical Trauma Skills (DSTS) course to meet this specific training need. This tripartite venture was developed in association with the Societe International de Chirugie (SIC) and the International Association for the Surgery of Trauma and Surgical Intensive Care (IATSIC).
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Affiliation(s)
- JM Ryan
- Raven Department of Education, Royal College of Surgeons of England, London, UK,
| | - P Roberts
- Raven Department of Education, Royal College of Surgeons of England, London, UK
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Affiliation(s)
- J M Ryan
- The Leonard Centre of Conflict Recovery, Academic Division of Surgical Specialties, Royal Free and University College Medical School, London, UK.
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O'Connor U, Walsh C, Gallagher A, Dowling A, Guiney M, Ryan JM, McEniff N, O'Reilly G. Occupational radiation dose to eyes from interventional radiology procedures in light of the new eye lens dose limit from the International Commission on Radiological Protection. Br J Radiol 2015; 88:20140627. [PMID: 25761211 PMCID: PMC4628470 DOI: 10.1259/bjr.20140627] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 02/27/2015] [Accepted: 03/10/2015] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE In 2011, the International Commission on Radiological Protection (ICRP) recommended a substantial reduction in the equivalent dose limit for the lens of the eye, in line with a reduced threshold of absorbed dose for radiation-induced cataracts. This is of particular relevance in interventional radiology (IR) where it is well established that staff doses can be significant, however, there is a lack of data on IR eye doses in terms of Hp(3). Hp(3) is the personal dose equivalent at a depth of 3 mm in soft tissue and is used for measuring lens dose. We aimed to obtain a reliable estimate of eye dose to IR operators. METHODS Lens doses were measured for four interventional radiologists over a 3-month period using dosemeters specifically designed to measure Hp(3). RESULTS Based on their typical workloads, two of the four interventional radiologists would exceed the new ICRP dose limit with annual estimated doses of 31 and 45 mSv to their left eye. These results are for an "unprotected" eye, and for IR staff who routinely wear lead glasses, the dose beneath the glasses is likely to be significantly lower. Staff eye dose normalized to patient kerma-area product and eye dose per procedure have been included in the analysis. CONCLUSION Eye doses to IR operators have been established using a dedicated Hp(3) dosemeter. Estimated annual doses have the potential to exceed the new ICRP limit. ADVANCES IN KNOWLEDGE We have estimated lens dose to interventional radiologists in terms of Hp(3) for the first time in an Irish hospital setting.
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Affiliation(s)
- U O'Connor
- Department of Medical Physics and Bioengineering, St James's Hospital, Dublin, Ireland
| | - C Walsh
- Department of Medical Physics and Bioengineering, St James's Hospital, Dublin, Ireland
| | - A Gallagher
- Department of Medical Physics and Bioengineering, St James's Hospital, Dublin, Ireland
| | - A Dowling
- Department of Medical Physics and Bioengineering, St James's Hospital, Dublin, Ireland
| | - M Guiney
- Department of Radiology, St James's Hospital, Dublin, Ireland
| | - J M Ryan
- Department of Radiology, St James's Hospital, Dublin, Ireland
| | - N McEniff
- Department of Radiology, St James's Hospital, Dublin, Ireland
| | - G O'Reilly
- Department of Medical Physics and Bioengineering, St James's Hospital, Dublin, Ireland
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Ryan JM, Harris JD, Graham WC, Virk SS, Ellis TJ. Origin of the direct and reflected head of the rectus femoris: an anatomic study. Arthroscopy 2014; 30:796-802. [PMID: 24793210 DOI: 10.1016/j.arthro.2014.03.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 02/28/2014] [Accepted: 03/06/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE This study aimed to define the footprint of the direct and reflected heads of the rectus femoris and the relation of the anterior inferior iliac spine (AIIS) to adjacent neurovascular (lateral circumflex femoral artery and femoral nerve), bony (anterior superior iliac spine [ASIS]), and tendinous structures (iliopsoas). METHODS Twelve fresh-frozen cadaveric hip joints from 6 cadavers, average age of 44.5 (±9.9) years, were carefully dissected of skin and fascia to expose the muscular, capsular, and bony structures of the anterior hip and pelvis. Using digital calipers, measurements were taken of the footprint of the rectus femoris on the AIIS, superior-lateral acetabulum and hip capsule, and adjacent anatomic structures. RESULTS The average dimensions of the footprint of the direct head of the rectus femoris were 13.4 mm (±1.7) × 26.0 mm (±4.1), whereas the dimensions of the reflected head footprint were 47.7 mm (±4.4) × 16.8 mm (±2.2). Important anatomic structures, including the femoral nerve, psoas tendon, and lateral circumflex femoral artery, were noted in proximity to the AIIS. The neurovascular structure closest to the AIIS was the femoral nerve (20.8 ± 3.4 mm). CONCLUSIONS The rectus femoris direct and reflected heads originate over a broad area of the anterolateral pelvis and are in close proximity to critical neurovascular structures, and care must be taken to avoid them during hip arthroscopy. CLINICAL RELEVANCE A thorough knowledge of the anatomy of the proximal rectus femoris is valuable for any surgical exposure of the anterior hip joint, particularly arthroscopic subspine decompression and open femoroacetabular impingement (FAI) surgery.
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Affiliation(s)
- John M Ryan
- Department of Orthopaedics, Ohio State University, Columbus, Ohio, U.S.A
| | - Joshua D Harris
- Houston Methodist Hospital, Center for Orthopaedics and Sports Medicine, Houston, Texas, U.S.A
| | - William C Graham
- Department of Orthopaedics, Ohio State University, Columbus, Ohio, U.S.A
| | - Sohrab S Virk
- Department of Orthopaedics, Ohio State University, Columbus, Ohio, U.S.A
| | - Thomas J Ellis
- Department of Orthopaedics, Ohio State University, Columbus, Ohio, U.S.A..
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Ryan JM, Lascelles BDX, Benito J, Hash J, Smith SH, Bennett D, Argyle DJ, Clements DN. Histological and molecular characterisation of feline humeral condylar osteoarthritis. BMC Vet Res 2013; 9:110. [PMID: 23731511 PMCID: PMC3681712 DOI: 10.1186/1746-6148-9-110] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 05/14/2013] [Indexed: 11/10/2022] Open
Abstract
Background Osteoarthritis (OA) is a clinically important and common disease of older cats. The pathological changes and molecular mechanisms which underpin the disease have yet to be described. In this study we evaluated selected histological and transcriptomic measures in the articular cartilage and subchondral bone (SCB) of the humeral condyle of cats with or without OA. Results The histomorphometric changes in humeral condyle were concentrated in the medial aspect of the condyle. Cats with OA had a reduction in articular chondrocyte density, an increase in the histopathological score of the articular cartilage and a decrease in the SCB porosity of the medial part of the humeral condyle. An increase in LUM gene expression was observed in OA cartilage from the medial part of the humeral condyle. Conclusions Histopathological changes identified in OA of the feline humeral condyle appear to primarily affect the medial aspect of the joint. Histological changes suggest that SCB is involved in the OA process in cats. Differentiating which changes represent OA rather than the aging process, or the effects of obesity and or bodyweight requires further investigation.
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Affiliation(s)
- John M Ryan
- Royal (Dick) School of Veterinary Studies and Roslin Institute, Division of Veterinary Clinical Sciences, Hospital for Small Animals, Easter Bush Veterinary Centre, The University of Edinburgh, Roslin, Midlothian EH25 9RG, Scotland
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Crehan F, O'Shea D, Ryan JM, Horgan F. A profile of elderly fallers referred for physiotherapy in the emergency department of a Dublin teaching hospital. Ir Med J 2013; 106:173-176. [PMID: 23909153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Ireland has an ageing population and the elderly are over-represented in Emergency Departments (ED)--a quarter of these presentations resulting from falls. A prospective study design was employed using a convenience sample to profile elderly fallers referred for physiotherapy in ED. Forty-subjects were assessed over 14 weeks. Mean age was 84.88 years (s.d. 7.3) and 31 (77.5%) were female. All demonstrated slow walking speed and 26 (65%) demonstrated poor grip strength. A quarter of subjects reported fear of falling and 30 (75%) were classified as frail. Elderly fallers in ED are a frail group of socially vulnerable patients who demonstrate a risk of further falls. Osteoporosis had been diagnosed in 9 (22.5%) subjects--a low prevalence compared with international research, but 25 (62.5%) subjects had never had a DEXA scan. The prevalence of frailty in the sample of elderly fallers in this study was very high (75%).
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Affiliation(s)
- F Crehan
- St Vincent's University Hospital, Elm Park, Dublin 4.
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Vijay GKM, Abeles RD, Ramage S, Riva A, Ryan JM, Taylor NJ, Wendon JA, Chokshi S, Ma Y, Shawcross DL. PMO-125 Neutrophil intracellular toll-like receptor (TLR) 9 expression serves as a biomarker that determines presence and severity of encephalopathy in acute liver failure and cirrhosis. Gut 2012. [DOI: 10.1136/gutjnl-2012-302514b.125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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McCarthy E, Mahony NO, Guiney M, Ryan JM. Successful catheter directed thrombolysis of IVC and renal vein occlusive thrombus. Ir Med J 2011; 104:311-312. [PMID: 22256445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Thrombus formation is a recognised complication of IVC filter placement, however IVC and bilateral renal vein occlusion secondary to thrombus is much less common. We present a case of infrahepatic caval and bilateral renal vein occlusion secondary to thrombosis of a suprarenal IVC filter. With progressive clinical deterioration and failure of conservative medical management the patient underwent successful mechanical disruption and catheter directed thrombolysis.
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Affiliation(s)
- E McCarthy
- Department of Radiology, St James's Hospital, Dublin 8.
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Demaria M, Stanley BJ, Hauptman JG, Steficek BA, Fritz MC, Ryan JM, Lam NA, Moore TW, Hadley HS. Effects of Negative Pressure Wound Therapy on Healing of Open Wounds in Dogs. Vet Surg 2011; 40:658-69. [DOI: 10.1111/j.1532-950x.2011.00849.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Abstract
This paper describes a previously unreported complication of chest tube thoracostomy: scalpel blade dislodgement within the pleural space. Techniques and complications of chest tube thoracostomy are then discussed.
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Affiliation(s)
- H Poncia
- Royal Sussex County Hospital, Brighton, United Kingdom
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25
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Feller KD, Lagerholm S, Clubwala R, Silver MT, Haughey D, Ryan JM, Loew ER, Deutschlander ME, Kenyon KL. Characterization of photoreceptor cell types in the little brown bat Myotis lucifugus (Vespertilionidae). Comp Biochem Physiol B Biochem Mol Biol 2009; 154:412-8. [PMID: 19720154 DOI: 10.1016/j.cbpb.2009.08.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2009] [Revised: 08/21/2009] [Accepted: 08/21/2009] [Indexed: 11/26/2022]
Abstract
We report the expression of three visual opsins in the retina of the little brown bat (Myotis lucifugus, Vespertilionidae). Gene sequences for a rod-specific opsin and two cone-specific opsins were cloned from cDNA derived from bat eyes. Comparative sequence analyses indicate that the two cone opsins correspond to an ultraviolet short-wavelength opsin (SWS1) and a long-wavelength opsin (LWS). Immunocytochemistry using antisera to visual opsins revealed that the little brown bat retina contains two types of cone photoreceptors within a rod-dominated background. However, unlike other mammalian photoreceptors, M. lucifugus cones and rods are morphologically indistinguishable by light microscopy. Both photoreceptor types have a thin, elongated outer segment. Using microspectrophotometry we classified the absorption spectrum for the ubiquitous rods. Similar to other mammals, bat rhodopsin has an absorption peak near 500 nm. Although we were unable to confirm a spectral range, cellular and molecular analyses indicate that M. lucifugus expresses two types of cone visual pigments located within the photoreceptor layer. This study provides important insights into the visual capacity of a nocturnal microchiropteran species.
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Affiliation(s)
- K D Feller
- Department of Biology, Hobart and William Smith Colleges, Geneva, New York, 14456, USA
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Ryan JM. "Not Cas, not A&E but Emergency Medicine". Arch Emerg Med 2009. [DOI: 10.1136/emj.2008.069955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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English K, Ryan JM, Tobin L, Murphy MJ, Barry FP, Mahon BP. Cell contact, prostaglandin E(2) and transforming growth factor beta 1 play non-redundant roles in human mesenchymal stem cell induction of CD4+CD25(High) forkhead box P3+ regulatory T cells. Clin Exp Immunol 2009; 156:149-60. [PMID: 19210524 DOI: 10.1111/j.1365-2249.2009.03874.x] [Citation(s) in RCA: 505] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Adult human mesenchymal stromal or stem cells (MSC) can differentiate into a variety of cell types and are candidate cellular therapeutics in regenerative medicine. Surprisingly, these cells also display multiple potent immunomodulatory capabilities, including allosuppression, making allogeneic cell therapy a possibility. The exact mechanisms involved in regulatory T cell induction by allogeneic human MSC was examined, using purified CD4+ populations and well-characterized bone marrow-derived adult human MSC. Allogeneic MSC were shown to induce forkhead box P3 (FoxP3)+ and CD25+ mRNA and protein expression in CD4+ T cells. This phenomenon required direct contact between MSC and purified T cells, although cell contact was not required for MSC induction of FoxP3 expression in an unseparated mononuclear cell population. In addition, through use of antagonists and neutralizing antibodies, MSC-derived prostaglandins and transforming growth factor (TGF)-beta1 were shown to have a non-redundant role in the induction of CD4+CD25+FoxP3+ T cells. Purified CD4+CD25+ T cells induced by MSC co-culture expressed TGF-beta1 and were able to suppress alloantigen-driven proliferative responses in mixed lymphocyte reaction. These data clarify the mechanisms of human MSC-mediated allosuppression, supporting a sequential process of regulatory T cell induction involving direct MSC contact with CD4+ cells followed by both prostaglandin E(2) and TGF-beta1 expression. Overall, this study provides a rational basis for ongoing clinical studies involving allogeneic MSC.
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Affiliation(s)
- K English
- Institute of Immunology, National University of Ireland Maynooth, Maynooth, Co. Kildare, Ireland
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Sevigny JJ, Ryan JM, van Dyck CH, Peng Y, Lines CR, Nessly ML. Growth hormone secretagogue MK-677: no clinical effect on AD progression in a randomized trial. Neurology 2008; 71:1702-8. [PMID: 19015485 DOI: 10.1212/01.wnl.0000335163.88054.e7] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND In animals, insulin-like growth factor-1 (IGF-1) increases clearance of beta-amyloid, a pathologic hallmark of Alzheimer disease (AD), from the CNS. Serum IGF-1 level decreases with age, and shows a further decrease in AD. We examined whether the growth hormone secretagogue MK-677 (ibutamoren mesylate), a potent inducer of IGF-1 secretion, slows the rate of progression of symptoms in patients with AD. METHODS A double-blind, multicenter study was conducted in which 563 patients with mild to moderate AD were randomized to receive MK-677 25 mg or placebo daily for 12 months. Efficacy measures were mean change from baseline at month 12 on the Clinician's Interview Based Impression of Change with caregiver input (CIBIC-plus), the cognitive subscale of the Alzheimer's Disease Assessment Scale (ADAS-Cog), Alzheimer's Disease Cooperative Study-Activities of Daily Living (ADCS-ADL), and the Clinical Dementia Rating-sum of boxes (CDR-sob). RESULTS A total of 416 patients completed treatment and assessments at 12 months. Administration of MK-677 25 mg resulted in a 60.1% increase in serum IGF-1 levels at 6 weeks and a 72.9% increase at 12 months. In mixed-effects models that included treatment, time (month), randomization strata (baseline MMSE score < or =20 vs >20), and interaction of treatment-by-time, there were no significant differences between the treatment groups on the CIBIC-plus or the mean change from baseline scores on the ADAS-Cog, ADCS-ADL, or CDR-sob scores over 12 months. CONCLUSION Despite evidence of target engagement as indicated by an increase in serum insulin-like growth factor-1, the human growth hormone secretagogue MK-677 25 mg was ineffective at slowing the rate of progression of Alzheimer disease.
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Affiliation(s)
- J J Sevigny
- Merck Research Laboratories, North Wales, PA 19454, USA.
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31
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Abdo AA, Allen B, Aune T, Berley D, Blaufuss E, Casanova S, Chen C, Dingus BL, Ellsworth RW, Fleysher L, Fleysher R, Gonzalez MM, Goodman JA, Hoffman CM, Hüntemeyer PH, Kolterman BE, Lansdell CP, Linnemann JT, McEnery JE, Mincer AI, Nemethy P, Noyes D, Pretz J, Ryan JM, Parkinson PMS, Shoup A, Sinnis G, Smith AJ, Sullivan GW, Vasileiou V, Walker GP, Williams DA, Yodh GB. Discovery of localized regions of excess 10-TeV cosmic rays. Phys Rev Lett 2008; 101:221101. [PMID: 19113471 DOI: 10.1103/physrevlett.101.221101] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2008] [Revised: 09/29/2008] [Indexed: 05/27/2023]
Abstract
The 7 year data set of the Milagro TeV observatory contains 2.2 x 10(11) events of which most are due to hadronic cosmic rays. These data are searched for evidence of intermediate scale structure. Excess emission on angular scales of approximately 10 degrees has been found in two localized regions of unknown origin with greater than 12sigma significance. Both regions are inconsistent with pure gamma-ray emission with high confidence. One of the regions has a different energy spectrum than the isotropic cosmic-ray flux at a level of 4.6sigma, and it is consistent with hard spectrum protons with an exponential cutoff, with the most significant excess at approximately 10 TeV. Potential causes of these excesses are explored, but no compelling explanations are found.
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Affiliation(s)
- A A Abdo
- Naval Research Laboratory, Washington, DC, USA
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Abstract
In the recent Falklands campaign four Army Field Surgical Teams were deployed in the two phases of the war. They functioned as Advanced Surgical Centres and operated on 233 casualties. There were 3 deaths. The patterns of wounding and the methods of casualty management are discussed and compared with other recent campaigns.
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Affiliation(s)
- J M Ryan
- Department of Accident & Emergency Medicine, The Royal Sussex County Hospital, Brighton, BN2 5BE, UK.
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Ryan JM, Barry F, Murphy JM, Mahon BP. Interferon-gamma does not break, but promotes the immunosuppressive capacity of adult human mesenchymal stem cells. Clin Exp Immunol 2007; 149:353-63. [PMID: 17521318 PMCID: PMC1941956 DOI: 10.1111/j.1365-2249.2007.03422.x] [Citation(s) in RCA: 466] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The ability of mesenchymal stem cells (MSC) to suppress alloresponsiveness is poorly understood. Herein, an allogeneic mixed lymphocyte response was used as a model to investigate the mechanisms of MSC-mediated immunomodulation. Human MSC are demonstrated to express the immunosuppressive cytokines hepatocyte growth factor (HGF), interleukin (IL)-10 and transforming growth factor (TGF)-beta1 at concentrations that suppress alloresponses in vitro. MSC also express cyclooxygenase 1 and 2 and produce prostaglandin E2 constitutively. Blocking studies with indomethacin confirmed that prostaglandins contribute to MSC-mediated allosuppression. The proinflammatory cytokine interferon (IFN)-gamma did not ablate MSC inhibition of alloantigen-driven proliferation but up-regulated HGF and TGF-beta1. IFN-gamma also induced expression of indoleamine 2,3, dioxygenase (IDO), involved in tryptophan catabolism. Use of an antagonist, 1-methyl-L-tryptophan, restored alloresponsiveness and confirmed an IDO contribution to IFN-gamma-induced immunomodulation by MSC. Addition of the tryptophan catabolite kynurenine to mixed lymphocyte reactions (MLR), blocked alloproliferation. These findings support a model where IDO exerts its effect through the local accumulation of tryptophan metabolites rather than through tryptophan depletion. Taken together, these data demonstrate that soluble factors, or products derived from MSC, modulate immune responses and suggest that MSC create an immunosuppressive microenvironment capable of modulating alloresponsiveness even in the presence of IFN-gamma.
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Affiliation(s)
- J M Ryan
- Institute of Immunology, National University of Ireland Maynooth, Maynooth, Co. Kildare, Ireland
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Maddock RJ, Buonocore MH, Lavoie SP, Copeland LE, Kile SJ, Richards AL, Ryan JM. Brain lactate responses during visual stimulation in fasting and hyperglycemic subjects: a proton magnetic resonance spectroscopy study at 1.5 Tesla. Psychiatry Res 2006; 148:47-54. [PMID: 17020804 PMCID: PMC1851693 DOI: 10.1016/j.pscychresns.2006.02.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2005] [Revised: 01/24/2006] [Accepted: 02/20/2006] [Indexed: 11/18/2022]
Abstract
Proton magnetic resonance spectroscopy ((1)H-MRS) studies showing increased lactate during neural activation support a broader role for lactate in brain energy metabolism than was traditionally recognized. Proton MRS measures of brain lactate responses have been used to study regional brain metabolism in clinical populations. This study examined whether variations in blood glucose influence the lactate response to visual stimulation in the visual cortex. Six subjects were scanned twice, receiving either saline or 21% glucose intravenously. Using (1)H-MRS at 1.5 Tesla with a long echo time (TE=288 ms), the lactate doublet was visible at 1.32 ppm in the visual cortex of all subjects. Lactate increased significantly from resting to visual stimulation. Hyperglycemia had no effect on this increase. The order of the slice-selective gradients for defining the spectroscopy voxel had a pronounced effect on the extent of contamination by signal originating outside the voxel. The results of this preliminary study demonstrate a method for observing a consistent activity-stimulated increase in brain lactate at 1.5 T and show that variations in blood glucose across the normal range have little effect on this response.
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Affiliation(s)
- Richard J Maddock
- Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento, CA 95817, USA.
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Tuite DJ, Ryan JM, Johnston C, Brophy DP, McEniff N. Ureteroiliac fistula: a late sequela of radiotherapy and long-term ureteric stent placement. Clin Radiol 2006; 61:531-4. [PMID: 16713425 DOI: 10.1016/j.crad.2006.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2005] [Revised: 01/23/2006] [Accepted: 02/03/2006] [Indexed: 11/21/2022]
Affiliation(s)
- D J Tuite
- Department of Interventional Radiology, St James's Hospital, Dublin, Ireland.
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Abstract
Every interventional procedure can result in infective complications. Generally the incidence is low; however, with newer and more aggressive techniques the infection risk is more prevalent and can result in serious adverse outcomes to our patients. Antibiotic prophylaxis has become commonplace; however, there is little controlled data to underpin our regimens and most choices are based on surgical practice and anecdotal evidence. The rise of antibiotic resistance and treatment of many immunocompromised patients further compounds the difficulties faced. The purpose of this article was to examine the evidence that is presented regarding antibiotic prophylaxis in interventional radiology and highlight how we integrate this into our daily practice. In particular we will focus on evolving procedures and techniques that are associated with a high incidence of infection.
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Affiliation(s)
- P Beddy
- Department of Interventional Radiology, St. James Hospital, Dublin, Ireland
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Atkins R, Benbow W, Berley D, Blaufuss E, Coyne DG, DeYoung T, Dingus BL, Dorfan DE, Ellsworth RW, Fleysher L, Fleysher R, Gisler G, Gonzalez MM, Goodman JA, Haines TJ, Hays E, Hoffman CM, Kelley LA, Lansdell CP, Linnemann JT, McEnery JE, Miller RS, Mincer AI, Morales MF, Nemethy P, Noyes D, Ryan JM, Samuelson FW, Parkinson PMS, Shoup A, Sinnis G, Smith AJ, Sullivan GW, Williams DA, Wilson ME, Xu XW, Yodh GB. Evidence for TeV gamma-ray emission from a region of the galactic plane. Phys Rev Lett 2005; 95:251103. [PMID: 16384445 DOI: 10.1103/physrevlett.95.251103] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2005] [Revised: 10/05/2005] [Indexed: 05/05/2023]
Abstract
Gamma-ray emission from a narrow band at the galactic equator has previously been detected up to 30 GeV. We report evidence for a TeV gamma-ray signal from a region of the galactic plane by Milagro, a large-field-of-view water Cherenkov detector for extensive air showers. An excess with a significance of 4.5 standard deviations has been observed from the region of galactic longitude l E (40 degrees, 100 degrees) and latitude /b/ < 5 degrees. Under the assumption of a simple power law spectrum, with no cutoff in the EGRET-Milagro energy range, the measured integral flux is phi gamma(>3.5 TeV) = (6.4 +/- 1.4 +/- 2.1) x 10(-11) cm(-2) s(-1) sr(-1). This flux is consistent with an extrapolation of the EGRET spectrum between 1 and 30 GeV in this galactic region.
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Affiliation(s)
- R Atkins
- Department of Physics, University of Wisconsin, 1150 University Avenue, Madison, Wisconsin 53706, USA
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Abstract
Brighton and Hove has one of the highest rates of drug-related deaths in the UK. The deceased commonly have had contact with a number of organizations isolated from each other. The aim of this study was to explore aspects of drug addiction in Brighton as the first stage in the creation of a local Drug addiction Intervention Network (DIN) and to make recommendations about improving the effectiveness of medical contacts so that modifiable risk factors could be addressed appropriately and consistently. The coroner's records of the drug-related deaths in 1998 for Brighton and Hove were cross-referenced with computerized records of the Accident & Emergency department of the local hospital and the police station. Of the 36 drug misusers who died during the year, most were male, mean age 34 years. Alcohol was a common comorbid finding. Seventy-eight per cent were known to the A&E department and 62% had been arrested locally during 1997 or 1998. Such retrospective data can only give limited information. We, therefore, performed a prospective survey. It was carried out by the forensic medical examiner (FME) in 1997-1998, interviewing 41 arrestees to give a profile of the criminally involved drug misusers. With the information obtained, the A&E doctors and FMEs were able to review the medical advice given and establish a protocol for the transfer of severely intoxicated arrestees.
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Affiliation(s)
- D G Burris
- Department of Surgery, USUHS, 4301 Jones Bridge Road, Bethesda, MD 20814-4799, USA
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Abstract
RATIONALE AND OBJECTIVES This study was conducted to define and characterize magnetic resonance (MR) contrast medium enhancement of the renal cortex, medulla, and pelvocaliceal system in normal and hydronephrotic kidneys with and without furosemide administration. MATERIALS AND METHODS In 30 subjects known or suspected to have unilateral hydronephrosis and normal serum creatinine levels, multiple timed sets of coronal fast spoiled gradient-echo images were acquired before and after contrast medium administration. MR renograms were derived from changes in the signal intensity (SI) of the cortex, medulla, and pelvocaliceal system. Ten subjects received 40 mg of intravenous furosemide approximately 10 minutes before contrast medium administration. RESULTS The following values were significantly different between subjects who were given furosemide and those who were not: the peak cortical, medullary, and pelvocaliceal system SIs measured in the normal kidneys during the 4 1/2 minutes following contrast medium administration (163.2 +/- 17.7 [mean arbitrary units plus or minus standard error] vs 120.5 +/- 10.2 [P = .033], 155.5 +/- 18.8 vs 111.5 +/- 9.4 [P = .025], and 332.5 +/- 27.2 vs 229.3 +/- 31.9 [P = .026], respectively); the crossover time between the SI curves of the pelvocaliceal system and the medulla in the normal kidney (2.45 minutes +/- 0.2 vs 3.27 minutes +/- 0.25 [P = .02]); and the peak SIs of the cortex, medulla, and pelvocaliceal system in the unilateral obstructive hydronephrotic kidneys throughout the first 4 1/2 minutes after contrast medium administration (174.6 +/- 16.4 vs 90.6 +/- 13.7 [P = .003], 117.6 +/- 14.1 vs 86.7 +/- 11.8 [P = .015], and 337.2 +/- 41.4 vs 143.1 +/- 74.4 [P = .034], respectively). CONCLUSION MR renography can be used to depict three separate components of renal enhancement: cortical, medullary, and pelvocaliceal. Furosemide-induced diuresis increases renal parenchymal and pelvocaliceal SI and urinary flow rates.
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Affiliation(s)
- Richard W Katzberg
- Department of Radiology, University of California, Davis Medical Center, Research Imaging Center, 4701 X St, Sacramento, CA 95817, USA
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Ryan JM, Fleggson M, Beavis J, Macnab C. Fast-track surgical referral in a population displaced by war and conflict. J R Soc Med 2003. [PMID: 12562973 PMCID: PMC539393 DOI: 10.1258/jrsm.96.2.56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
After the 1988-1994 conflict between Armenia and Azerbaijan, fought over the territory of Nagorno-Karabakh, large numbers of people were resettled in camps in southern Azerbaijan. Healthcare in the camps was generally good but there was no access to hospitals. The Leonard Cheshire Centre of Conflict Recovery (LCC) organized a 'fast-track' system of surgical care in the southern camps by securing the help of still-functioning hospitals in the distant capital, Baku. Regular clinics were held in the camps for visiting specialists; and, by arrangement with the Government of Azerbaijan and various non-governmental organizations, treatment was offered to those who fell within strict selection criteria. After a pilot study yielded clear benefits, the scheme was transferred to a local non-governmental organization, which successfully operated an expanded version. The hidden cost of war often includes the neglect of chronic medical conditions that require secondary and tertiary care. The 'fast-track' system illustrates the potential of existing facilities to meet these needs at modest cost, given sufficient support.
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Affiliation(s)
- J M Ryan
- Leonard Cheshire Centre of Conflict Recovery, Academic Division of Surgical Specialties, Royal Free and University College Medical School, 4 Taviton Street, London WC1H OBT, UK.
| | - Matthew Fleggson
- Leonard Cheshire Centre of Conflict Recovery, Academic Division of
Surgical Specialties, Royal Free and University College Medical School, 4
Taviton Street, London WC1H OBT; and Catastrophes and Conflict Forum, Royal
Society of Medicine, 1 Wimpole Street, London W1G 0AE, UK
| | - John Beavis
- Leonard Cheshire Centre of Conflict Recovery, Academic Division of
Surgical Specialties, Royal Free and University College Medical School, 4
Taviton Street, London WC1H OBT; and Catastrophes and Conflict Forum, Royal
Society of Medicine, 1 Wimpole Street, London W1G 0AE, UK
| | - Cara Macnab
- Leonard Cheshire Centre of Conflict Recovery, Academic Division of
Surgical Specialties, Royal Free and University College Medical School, 4
Taviton Street, London WC1H OBT; and Catastrophes and Conflict Forum, Royal
Society of Medicine, 1 Wimpole Street, London W1G 0AE, UK
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Ryan JM, Fleggson M, Beavis J, Macnab C. Fast-track surgical referral in a population displaced by war and conflict. J R Soc Med 2003; 96:56-9. [PMID: 12562973 PMCID: PMC539393 DOI: 10.1177/014107680309600202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
After the 1988-1994 conflict between Armenia and Azerbaijan, fought over the territory of Nagorno-Karabakh, large numbers of people were resettled in camps in southern Azerbaijan. Healthcare in the camps was generally good but there was no access to hospitals. The Leonard Cheshire Centre of Conflict Recovery (LCC) organized a 'fast-track' system of surgical care in the southern camps by securing the help of still-functioning hospitals in the distant capital, Baku. Regular clinics were held in the camps for visiting specialists; and, by arrangement with the Government of Azerbaijan and various non-governmental organizations, treatment was offered to those who fell within strict selection criteria. After a pilot study yielded clear benefits, the scheme was transferred to a local non-governmental organization, which successfully operated an expanded version. The hidden cost of war often includes the neglect of chronic medical conditions that require secondary and tertiary care. The 'fast-track' system illustrates the potential of existing facilities to meet these needs at modest cost, given sufficient support.
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Affiliation(s)
- J M Ryan
- Leonard Cheshire Centre of Conflict Recovery, Academic Division of Surgical Specialties, Royal Free and University College Medical School, 4 Taviton Street, London WC1H OBT, UK.
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Katzberg RW, Ivanovic M, Buonocore MH, Brock JM, Ryan JM, Whang K. Initial results of the effects of diuresis on gadolinium enhancement in MR imaging of the abdomen. Acad Radiol 2002; 9:886-94. [PMID: 12186436 DOI: 10.1016/s1076-6332(03)80457-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
RATIONALE AND OBJECTIVES The authors performed this study to assess the effects of furosemide-induced diuresis on paramagnetic contrast material enhancement at magnetic resonance (MR) imaging of the kidney, liver, spleen, and psoas muscle. MATERIALS AND METHODS Twenty-five patients (average age, 44.9 years; age range, 23-74 years; 13 men, 12 women) who were suspected of having unilateral renal hydronephrosis received 0.1 mmol/kg contrast material with a standardized injection and imaging protocol to assess organ signal intensity at 0-5 minutes after injection. All patients had a normal serum creatinine level. Imaging was performed with a 1.5-T magnet by using a fat-suppressed fast spoiled gradient-echo pulse sequence and a 70 degrees flip angle. Eight patients received 40 mg of furosemide 10 minutes before contrast material injection. RESULTS The areas of the renal cortical and medullary signal intensity curves minus baseline in the unilateral normal kidneys were significantly greater in the group who received furosemide (P = .026 and P = .037, respectively). The areas of the renal cortical and medullary signal intensity minus baseline in the unilateral hydronephrotic kidneys were also significantly greater in the group that received furosemide (P = .036 and P = .026, respectively). There was a statistically significant increase in splenic enhancement (P = .02) and a tendency for increased liver (P = .09) and psoas muscle (P = .08) enhancement. CONCLUSION Furosemide-induced diuresis appears to potentiate the cortical and medullary MR renogram, as well as the MR splenogram. A rapid shift in water compartmentalization from the intracellular to the extracellular space and increased renal water content with diuresis are possible explanations.
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Affiliation(s)
- Richard W Katzberg
- Department of Radiology, University of California/Davis Medical Center, Research Imaging Center, Sacramento 95817, USA
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Katzberg RW, Ivanovic M, Buonocore MH, Pellot-Barakat C, Brock JM, Ryan JM, Whang K. Gadolinium-enhanced T1-weighted renal and abdominal MR imaging: quantitative discrepancy between clinical and in vitro findings. Acad Radiol 2002; 9:679-87. [PMID: 12061742 DOI: 10.1016/s1076-6332(03)80313-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
RATIONALE AND OBJECTIVES This study was conducted to compare the magnetic resonance (MR) contrast medium enhancement of abdominal organs in vivo with the signal intensity (SI) values of known in vitro gadolinium solutions. MATERIALS AND METHODS A phantom was imaged with the MR contrast medium gadodiamide (Omniscan; Nycomed, Princeton, NJ) of solutions at full-strength (0.5 mmol/mL), one-third, 1/10, and 1/100 concentrations. A fat-suppressed fast spoiled gradient-echo pulse sequence with flip angles ranging from 10 degrees to 170 degrees (at 20 degrees increments) was performed with a 1.5-T magnet. In 12 subjects, the SIs of abdominal organs were determined with identical imaging parameters, before and after administration of gadodiamide injection at 0.1 mmol/kg. RESULTS As anticipated, the plot of SI in relation to gadodiamide concentration is nonlinear, with a decrease in SI due to T2 effects at concentrations above 0.05 mmol/mL. The kidney showed the highest SI after gadodiamide enhancement (125.2 +/- 11.6 [standard error] at 2.5 minutes), followed by the liver (76.5 +/- 11.5 at 1 minute) and spleen (57.26 +/- 9.35 at 30 seconds). The SI of the renal medulla (114.2 +/- 9.8 at 4.5 minutes) was approximately one-third that in phantom observations. CONCLUSION The authors observed a marked discrepancy between empirical contrast medium performance in abdominal organs and SI values for comparable gadodiamide concentrations in vitro. One possible reason is the intracellular compartmentalization of water molecules in vivo. These results suggest a need for a better understanding of MR contrast medium performance in vivo.
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Affiliation(s)
- Richard W Katzberg
- Department of Radiology, University of California/Davis Medical Center, Research Imaging Center, Sacramento, CA 95817, USA
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Ryan JM, Heyworth J. Rapid assessment of chest pain. "Casualty" is outdated term for "emergency medicine". BMJ 2002; 324:422. [PMID: 11850379 PMCID: PMC1122342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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