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Biomedical subjects

M C Barry

Publications and source records attributed to M C Barry.

35 records · Page 2Linked to original sources
PubMed1996

Glyceryl trinitrate prevents neutrophil activation but not thromboxane release following ischaemia-reperfusion injury.

The aim of this study was to determine whether glyceryl trinitrate (GTN) has a protective effect on neutrophil-mediated lung injury in a model of aortic occlusion (30 min) and reperfusion (120 min). Sprague-Dawley rats were randomized into control (n = 11), ischaemia-reperfusion (IR) (n = 12), and IR treated with GTN (2 micrograms kg-1 min-1) during reperfusion (n = 10). Myeloperoxidase (MPO) activity measured pulmonary neutrophil influx. Pulmonary endothelial permeability was measured by wet:dry weight ratio, bronchoalveolar lavage (BAL) protein and neutrophil counts. Neutrophil superoxide release was measured by flow cytometry in a further IR versus GTN experiment (n = 6 in each group). The significant increase in MPO activity produced by IR to a level of 7.99 units g-1 was prevented by GTN which reduced the level to 4.73 units g-1. The increase in pulmonary microvascular leakage after reperfusion was also prevented by GTN: BAL protein without GTN was 992 micrograms ml-1 and with GTN 579 micrograms ml-1; BAL neutrophil count without GTN was 3219 cells mm-3 and with GTN 820 cells mm-3; the wet:dry lung weight ratio without GTN was 3.8 and with GTN 3.3. Neutrophil superoxide release increased significantly after 40 min of reperfusion in the untreated IR group (P < 0.05). This increase was prevented in the GTN-treated group. GTN administration had no effect on plasma thromboxane production during revascularization. These data suggest that GTN administration during the reperfusion phase has the potential to decrease pulmonary microvascular injury.

Animals↗
PubMed1996

Prediction of ruminal volatile fatty acids and pH within the net carbohydrate and protein system.

A steady-state model of the production, absorption, passage, and concentration of ruminal VFA and pH is developed from published literature data and is structured to use the feed descriptions and inputs from the net carbohydrate and protein system. Included are the effects of pH on growth rate and yield of structural and non-structural carbohydrate-fermenting bacteria; production of acetate, propionate, butyrate, lactate, and methane; conversion of lactate to VFA; ruminal absorption of acids; and prediction of ruminal pH from dietary measures and from ruminal buffering and acidity. The root mean square error of predicted total VFA concentration was 12 mM. Individual VFA fractions were inadequately predicted. In a review of literature data, effective NDF (eNDF) provided a better correlation with ruminal pH than forage or NDF. Digestion rate of NDF remained at normal levels above pH 6.2, which corresponds to a minimum eNDF of 20% of dietary DM. Further research is needed to determine the individual VFA produced from carbohydrate fractions at various pH, the appropriateness of partitioning the starch and pectin carbohydrate pool into slowly and rapidly degraded fractions, and the effect on microbial yield, total tract digestibility, and predicted energy values of feeds.

Acetates↗
PubMed1995

Application of the Cornell Net Carbohydrate and Protein model for cattle consuming forages.

Accurate prediction of forage biological values and performance with animals fed forages requires accurately accounting for factors that influence animal requirements and feedstuff utilization. The Cornell Net Carbohydrate and Protein System (CNCPS) is an application model that uses a combination of mechanistic and empirical approaches to account for the effects of variation in animal factors and feed carbohydrate and protein fractions on animal performance. Thus, accurate animal and environmental descriptions, DMI, feed carbohydrate, and protein fractions and their digestion rates are required inputs. In 25 growth periods with calves fed high-forage diets, the CNCPS accounted for 74, 81, and 83%, respectively, of the variation in ADG predicted to be supported by the ME, metabolizable protein, and essential amino acid intake, the first-limiting of all three accounting for 81% of the variation with a -1% bias. Thus, the CNCPS can be used to accurately describe forage quality and the effects of changes in forage composition on animal performance. The model was sensitive to variations in NDF, CP, protein solubility, NDF and starch digestion rates, feed and microbial amino acid composition, maintenance protein requirement, body protein amino acid content, and the coefficient of efficiency of use of absorbed protein. Analysis of several trials indicates an improved efficiency of ME use with improved amino acid balances. Uses of the CNCPS discussed include interpreting, planning and applying research, teaching, developing tables of requirements and biological values for feeds, complex nutritional accounting, and predicting performance and profits.

Animal Feed↗
PubMed1993

Predicting amino acid adequacy of diets fed to Holstein steers.

The Cornell Net Carbohydrate and Protein System (CNCPS) and NRC (1985) models were evaluated for accuracy in predicting metabolizable protein (MP) and essential amino acid (EAA) allowable ADG, using chemical body and feed composition data from feeding trials with Holstein steers. Nine Holstein steers (113 to 200 kg) were slaughtered and determined to have the following whole-body essential amino acid composition of (grams/100 grams of protein): arginine, 5.94; histidine, 2.07; isoleucine, 2.28; leucine, 5.72; lysine, 5.81; methionine, 1.99; phenylalanine, 3.04; threonine, 3.52; tryptophan, .57; and valine, 3.32. The NRC and CNCPS were then tested against data from 25 feeding periods, each representing the 56-d growth of 10 Holstein steers (mean BW of 162 kg), to determine their ability to predict the gain allowed by the supply of MP and the first-limiting EAA. The NRC (1985) system accounted for 46% of the variation in MP allowable gain, with an average bias of -30%. The CNCPS accounted for 87 and 73% of the variation in MP and EAA allowable gain, with a bias of 8 and 5%, respectively. The bias was reduced to 3% (R2 of .82) when ADG was predicted by the factor (ME, MP, or EAA) first-limiting ADG.

Amino Acids, Essential↗
PubMedDate not supplied

Changing trends in acute peptic ulcer surgery in a district surgical unit.

Despite changes in management and the advances in therapeutics, surgeons are still required to treat the complications of peptic ulceration. A retrospective review of all open surgical interventions for complications of peptic ulcer disease between January 1983 and December 1993 was carried out. There were no exclusion criteria. Open gastric surgery accounted for 3% of all inpatient surgical procedures and 13% of all the major operations. There were 341 adult and 132 paediatric procedures performed in the 11 year period. Acute gastric procedures accounted for 34% of major gastric surgery in this district unit. 76 perforated ulcers and 39 bleeding ulcers required surgery. 38% of the patients were over 70 years. The perioperative mortality was 13.9% (4% for those under 70 years). The overall morbidity rate was 71% and procedure-related morbidity rate was 17%. Acute gastric surgery has a very high inpatient morbidity and is associated with a significant mortality particularly in elderly patients.

Acute Disease↗
PubMedDate not supplied

The value of metastatic screening in early primary breast cancer.

Up to 25 per cent of patients presenting with "early" breast cancer subsequently develop distant metastases indicating that this group must have occult disseminated disease when initially evaluated. Routine pre-operative haematological and radiological investigation is recommended in order to identify these patients and alter their management accordingly. The aim of this study was to examine the outcome of a pre-operative metastatic screening programme in patients presenting with early breast cancer. Eighty-two patients underwent surgery for stage I-II breast cancer over a 5 yr period from 1990-1995. Before surgery all patients underwent screening tests for metastatic disease. These included a full blood count, liver function tests, chest x-ray, skeletal survey and abdominal ultrasound. Of the 82 patients, metastatic screening significantly altered management in only 1 patient who was found to have asymptomatic lymphangitis carcinomatosa on chest x-ray. The results of this study suggest that the number of patients restaged by screening for metastatic breast cancer may be small and questions the necessity for its routine use in the management of early primary breast cancer.

Adult↗
PubMedDate not supplied

Management of head injury in a regional hospital.

BACKGROUND: Concern about delay in the treatment of serious head injury may result in unnecessary transfer to neurosurgical units for scanning and neurosurgical assessment. AIMS: This study assessed the management of head injuries in a regional hospital with computed tomographic (CT) and 'image-link' facilities allowing instantaneous transmission of CT scans to the regional neurosurgical unit for specialist assessment. METHODS: A retrospective study was carried out of all head injuries presenting to Limerick Regional General Hospital in a single year. Data gathered included mechanism of injury, mode of transfer, requirement for admission and length of stay. Neurological status was assessed using the Glasgow Coma Scale (GCS) and functional status using the Glasgow Outcome Scale. RESULTS: Between January and December 1995, 1,564 patients presented with head injuries to the accident and emergency (A/E) department of Limerick Regional General Hospital. Twenty (1%) were dead on arrival, 12% required hospital admission and the remainder were discharged after assessment. Seventy-six per cent were males and 74% under 40 years of age. Among the 194 patients requiring hospital admission, 14% had a skull fracture and 22 had a severe head injury. CT brain scans were performed in 43 patients and were abnormal in 42%. On the basis of CT and clinical findings, six patients were transferred immediately for a neurosurgical procedure and one was transferred later following clinical deterioration. CONCLUSIONS: A CT scan and image-link facility permitting remote neurosurgical advice allows the majority of patients with head injury to be safely managed in well-equipped regional units without onsite neurosurgical expertise.

Adolescent↗
PubMedDate not supplied

Management of patients undergoing splenectomy in an Irish teaching hospital: impact of guidelines.

INTRODUCTION: Overwhelming post-splenectomy infection (OPSI) has a 50-70% mortality rate and carries a lifetime risk for the asplenic patient. Specific British guidelines have been developed to reduce its incidence. AIMS: To determine whether British guidelines were being followed in our own institution and what impact they had on overwhelming post-splenectomy infection. METHODS: Retrospective chart review of 100 splenectomies performed by Department of Surgery, Beaumont Hospital from January 1990 to January 2000. RESULTS: Twenty per cent of patients were discharged without any recommended vaccinations. Prophylactic antibiotics were not prescribed in 53% of patients. Just 12% of charts document a verbal explanation of the complications and management of asplenia to the patient. Overall septic mortality was 12%, of whom 8% died in hospital and 4% after discharge. CONCLUSION: Management of the asplenic patient has improved but is far from complete. A central register of asplenic patients and national asplenic guidelines should be established in Ireland to ensure optimum patient care.

Adolescent↗
PubMedDate not supplied

Traumatic pseudoaneurysm of the internal carotid artery presenting with oculosympathetic palsy.

BACKGROUND: Blunt internal carotid artery (ICA) injury is rare but undiagnosed can have disastrous clinical consequences. AIM: To report a late presentation of blunt ICA injury in a young male following a road traffic accident. RESULT: A 16-year-old male presented 11 days following a head injury with a unilateral Horner's syndrome. Imaging confirmed a pseudoaneurysm of the ICA. The patient was treated with anticoagulant therapy. CONCLUSION: Diagnosis of ICA injury requires a high index of suspicion and presentation with unusual neurological signs following blunt trauma to the head and neck requires prompt investigation.

Accidents, Traffic↗
PubMedDate not supplied

Bilateral subclavian steal syndrome.

BACKGROUND: Bilateral atherosclerotic subclavian artery occlusion is rare. AIM: To describe the surgical treatment of a patient with symptomatic bilateral subclavian artery occlusion. METHODS: A midline sternotomy and bilateral aorto-subclavian bypass was performed in a male with upper limb, exercise-induced vertigo. RESULTS: Postoperatively symptomatic improvement paralleled an increase in brachial systolic arterial blood pressure readings. CONCLUSION: Bypass grafting is the more durable option for subclavian artery occlusion, as angioplasty with or without stenting is associated with a higher rate of late stenosis.

Aortography↗
PubMedDate not supplied

Aorto-enteric fistula: changing management strategies.

BACKGROUND: Traditionally treatment of aorto-enteric fistulae involved placement of an extra-anatomic bypass and graft excision. This is associated with limb loss (10-40%) and high mortality (10-70%). More recently in situ revascularisation has been advocated. AIMS: To examine our experience with the changing management of aorto-enteric fistulae over a 22-year period. METHODS: Demographic, clinical, operative and pathological data were recorded retrospectively. RESULTS: Twenty-one patients were included. Seven had primary fistulae. Six died prior to intervention. Five had an extra-anatomical bypass (60% mortality, 40% limb loss), four had in-situ revascularisation (25% mortality), four had a primary repair (25% mortality) and two had insertion of a tube graft (primary fistulae). The overall survival rate was 38%. The postoperative survival rate was 6o%. CONCLUSION: Techniques for operative management continue to evolve. The current trend is towards a local surgical approach with prolonged and intensive postoperative antimicrobial therapy. In our experience this approach has yielded acceptable outcomes.

Aged↗
PubMedDate not supplied

Prospective evaluation of the efficacy of dermal botulinium toxin for primary axillary hyperhidrosis.

BACKGROUND: Primary axillary hyperhidrosis (PAH) is an embarassing, socially disabling condition, most commonly seen in young people. Previous treatments for this condition have included sympathectomy or axillary skin excision. Recently botulinum toxin has been used to provide effective, non-invasive treatment for this condition. AIMS: To investigate the effect of botulinum toxin injection in patients with PAH on sweat production and psychological wellbeing. METHODS: Ten patients were assessed before treatment with botulinum toxin injection using gravimetric analysis and a psychometric questionnaire. Patients were reassessed at intervals of one, four and twelve weeks following treatment. RESULTS: Injection with botulinum toxin resulted in significant improvement in patients physical symptoms and psychological wellbeing. However, improvement was short-lived with recurrence of symptoms at three months. CONCLUSION: Botulinum toxin injection provides very effective short-term relief of PAH. While its limitations should be recognised and explained when consenting patients for treatment, this does not necessarily diminish its value in the treatment of PAH.

Axilla↗
PubMedDate not supplied

The impact of the establishment of a surgical high dependency unit on management of abdominal aortic aneurysm.

BACKGROUND: Our ability to maintain satisfactory levels of outcome after elective abdominal aortic aneurysm (AAA) surgery is increasingly strained by rising levels of co-morbidity in the presenting population. In this study we present a comparative outcome analysis of patients undergoing elective AAA surgery 18 months before and after the establishment of a surgical high dependency unit (HDU). METHODS: The preoperative status (ASA and POSSUM scores), operative factors and postoperative outcomes as well as duration of stay were calculated for 104 patients undergoing elective AAA repair (57 prior to the HDU opening and 47 patients afterwards). RESULTS: Patients undergoing surgery in the latter period had significantly higher ASA (2.5 +/- 0.06 versus 2.7 +/- 0.7; p = 0.007), overall POSSUM (33.2 +/- 0.5 versus 35.5 +/- 0.8; p = 0.02) and physiological POSSUM (16.3 +/- 0.3 versus 15.5 +/- 0.2; p = 0.048) scores than those operated on prior to establishment of the HDU (data are mean +/- SEM; 2-tailed p-score). The two groups had similar total lengths of hospital stay (518 versus 534 days). However, following establishment of the HDU patients occupied fewer ICU bed days (110 versus 181). This resulted in a saving of Euro 50,750. CONCLUSION: The efficiency and quality of care following elective AAA surgery can be improved by provision of HDU step-down facilities without significantly increased expenditure.

Aged↗
PubMedDate not supplied

Nutritional, respiratory, and psychological effects of recombinant human growth hormone in patients undergoing abdominal aortic aneurysm repair.

BACKGROUND: Recombinant human growth hormone (rhGH) has been shown to have powerful anabolic effects and to reduce or even prevent nitrogen catabolism in stressed patients. The effects of rhGH on functional parameters are less clearly defined. The aim of this study was to assess the effects of perioperative rhGH on nutritional markers, skeletal muscle function, and psychological well-being in patients undergoing infrarenal, abdominal aortic aneurysm repair. METHODS: Thirty-three patients undergoing elective infrarenal abdominal aortic aneurysm repair were randomized to one of three groups: (1) control (n = 12): placebo for 6 days before and after surgery; (2) preop + postop (n = 10): rhGH (Genotropin; Pharmacia Ltd, Uppsala, Sweden) 0.3 IU/kg/d for 6 days before and after surgery; and (3) postop (n = 11): placebo for 6 days before and rhGH 0.3 IU/kg/d for 6 days after surgery. Patients were assessed on days -7 and -1 before surgery and days 7, 14, and 60 after surgery. RESULTS: Administration of rhGH resulted in increased insulin-like growth factor 1 levels, the increase being significantly more marked in the group given rhGH preoperatively. Preoperative and postoperative rhGH reduced the postoperative decrease in both serum transferrin and grip strength at day 7 by 30% and 70%, respectively. Postoperative respiratory function and arterial oxygenation also were improved, with significant differences in arterial oxygenation between rhGH-treated and untreated groups. No difference in mood was seen between groups after surgery, nor was there any difference between subjective assessment of fatigue scores between groups. CONCLUSIONS: This pilot study indicates that rhGH administered preoperatively has beneficial effects on skeletal muscle and respiratory function and may be more useful than postoperative rhGH administration alone.

Aged↗
PubMedDate not supplied

149 consecutive thyroid operations--indications, technique and outcome.

One hundred and forty nine patients underwent thyroid and parathyroid surgery over a nine year period. The most common indications for surgery were the presence of a solitary thyroid nodule (56%) or the onset of pressure symptoms (30%). Carcinoma was found in 7.4% of cases. Wound complications occurred in 5%. The permanent nerve injury rate was 0.67%. The incidence of permanent hypothyroidism after surgery was 4%. No patients developed permanent hypoparathyroidism.

Adolescent↗