PubMed Health⌕ Search

Biomedical subjects

Mary Barry

Publications and source records attributed to Mary Barry.

6 recordsLinked to original sources
PubMed2006

Aortoenteric fistula: a diagnostic dilemma.

OBJECTIVE: To assess the sensitivity and specificity of computed tomography (CT) in the diagnosis of aortoenteric fistula (AEF) and to determine the most accurate CT signs of the disease. METHODS: Hospital records were reviewed over a 20-year period. Twenty-three patients in whom a final diagnosis of AEF was made at laparotomy or autopsy were identified. Ten of these had CT performed. Twelve control cases were also collected. The 22 cases, (10 cases of AEF and 12 controls), were reviewed retrospectively by two independent readers, who were blinded to the clinical features and outcome. Each case was examined for six specific radiological findings. The outcome of other adopted investigative modalities was also examined. RESULTS: The presence of peri-aortic ectopic gas (>2 weeks following surgery) in the context of gastrointestinal (GI) blood loss was 100% specific for AEF. If AEF was considered to be present where signs of peri-aortic infection were present in a patient with GI bleeding, CT had an overall specificity of 100% (95% confidence interval = 1.0-1.0) and sensitivity of 50%. CONCLUSION: CT can rule in the diagnosis of AEF but cannot rule it out. CT is recommended as the first-line investigation in a stable patient with suspected AEF.

Aged↗
PubMed2006

Case report: evidence for transplacental transfer of maternally administered infliximab to the newborn.

BACKGROUND & AIMS: Control of Crohn's disease (CD) is important for conception and sustaining a pregnancy to term. Small series of infliximab use during pregnancy have reported favorable fetal and maternal outcomes. As a result of heightened maternal concern triggered by recent labeling changes, infliximab levels were measured in the newborn of a mother treated with infliximab. METHODS: Serum and breast milk infliximab levels were measured by enzyme-linked immunosorbent assay. RESULTS: A 32-year-old woman with treatment-refractory CD continued infliximab therapy throughout pregnancy. Five infusions of infliximab, 10 mg/kg, the last one 2 weeks before delivery, successfully controlled her symptoms. Six weeks after delivery, the breast-fed infant's serum infliximab level was 39.5 microg/mL. Infliximab was not detected in the breast milk. Serial measurements revealed a continued slow decline of the infant's infliximab levels during the following 6 months, despite resumption of breast-feeding and subsequent retreatments of the mother with infliximab. CONCLUSIONS: Clinically significant infliximab levels were detected in the offspring. High infliximab levels in the serum of this infant are likely due to placental transfer, not breast-feeding. Similar to other maternally acquired antibodies, the half-life of infliximab appears prolonged in newborns. The true short-term and long-term implications of exposure to infliximab during the newborn period are unknown. Patients and physicians must be informed about in utero exposure to infliximab and potentially other therapeutic antibodies. The timing of infusions to minimize antibody transfer to the fetus might be an important strategic consideration when therapeutic antibodies are used in pregnancy.

Adult↗
PubMed2005

Liquid chromatography-tandem mass spectrometry analysis of erythrocyte thiopurine nucleotides and effect of thiopurine methyltransferase gene variants on these metabolites in patients receiving azathioprine/6-mercaptopurine therapy.

BACKGROUND: Polymorphic thiopurine S-methyltransferase (TPMT) is a major determinant of thiopurine toxicity. METHODS: We extracted 6-thioguanine nucleotides (6-TGNs) and 6-methylmercaptopurine nucleotides (6-MMPNs) from erythrocytes with perchloric acid and converted them to 6-thioguanine (6-TG) and a 6-methylmercaptopurine (6-MMP) derivative during a 60-min acid hydrolysis step. The liquid chromatography system consisted of a C(18) column with an ammonium acetate-formic acid-acetonitrile buffer. 8-Bromoadenine was the internal standard. Analytes were measured with positive ionization and multiple reaction monitoring mode. With PCR-restriction fragment length polymorphism analysis and TaqMan allelic discrimination, common TPMT alleles (*1, *2, *3A, *3B, *3C) were determined in 31 792 individuals. We used perchloric acid extraction, acid hydrolysis, and HPLC with ultraviolet detection to measure erythrocyte 6-TG and 6-MMP nucleotide concentrations in 6189 patients with inflammatory bowel disease receiving azathioprine/6-mercaptopurine therapy. RESULTS: Intra- and interday imprecision were <10% at low and high analyte concentrations. The conversion of 6-TG and 6-MMP nucleoside mono-, di-, and triphosphates was complete after hydrolysis. Allelic frequency for TPMT variant alleles ranged from 0.0063% (*3B) to 3.61% (*3A). Compared with wild types, TPMT heterozygotes had an 8.3-fold higher risk for 6-TGNs >450 pmol/8 x 10(8) erythrocytes (concentration associated with increased risk for leukopenia), but an 8.2-fold lower risk for 6-MMPNs >5700 pmol/8 x 10(8) erythrocytes (concentration associated with increased risk for hepatotoxicity). CONCLUSIONS: The liquid chromatography-tandem mass spectrometry method can be applied to the routine monitoring of thiopurine therapy. The association between TPMT genotype and metabolite concentrations illustrates the utility of pharmacogenetics in the management of patients undergoing treatment with thiopurines.

Adult↗
PubMed2005

A Colorado statewide survey of walking and its relation to excessive weight.

INTRODUCTION: There is an urgent need to increase the physical activity in the population. Small-scale success has been achieved in programs like Colorado on the Move (COM), an obesity prevention program using electronic pedometers. METHODS: To provide baseline information for COM, this first-ever statewide survey of walking was conducted with 1098 individuals. The weighted mean BMI was 25.3 +/- 0.18 kg x m(-2), and mean age was 44 +/- 0.42 yr of age. Subjects participated in a short telephone interview and then were sent a pedometer to wear for four consecutive days. A total of 742 of the 1098 subjects completed the pedometer phase. RESULTS: The average adult in Colorado reported taking 6804 steps per day. About 33% reported taking fewer than 5000 steps per day, and only 16% reported taking 10,000 or more steps per day. Steps per day increased with other self-reported measures of physical activity (P = 0.0001) and decreased with self-reported inactivity (P = 0.0001). Significant determinants of steps per day included increasing age (negative, P = 0.001), marital status (positive for single status, P = 0.05), income (positive for incomes of dollar 25,000 to dollar 99,000, P = 0.003), and increasing BMI (negative for BMI > or = 30 kg x m(-2), P = 0.000). Obese individuals (BMI > or = 30 kg x m(-2)) walked about 2000 fewer steps per day than normal-weight individuals. These results provide the first population data on current walking levels, on how this relates to self-reported physical activity, and on determinants of walking. Results also provide a baseline level of walking for future evaluation of COM. CONCLUSION: Increasing steps per day appears to be a good target to use in interventions to increase physical activity. Even in Colorado, one of the leanest states, very low levels of physical activity are seen in much of the population.

Adolescent↗
PubMed2003

Advances in clinical laboratory tests for inflammatory bowel disease.

Inflammatory bowel disease (IBD) is a generic term that refers to Crohn's disease and chronic ulcerative colitis (UC). The CD and UC are considered to be distinct forms of IBD; but there is a subgroup of CD with a UC-like presentation. The genetic factors play a significant role in IBD. IBD is associated with a strong familial pattern. Recent studies support the hypothesis that IBD patients have a dysregulated immune response to endogenous bacteria in the gastrointestinal tract. The serologic responses seen in Crohn's disease include antibodies to Saccharomyces cerevisiae, mycobacteria, bacteroides and E. coli. The pANCA antibody seen in UC and CD has been demonstrated to react with epitopes of H1 histone, Bacteroides caccae (Ton-B linked outer membrane protein), Pseudomonas fluorescens-associated bacterial protein I-2, mycobacterial histone 1 homologue called Hup B. In recent years, several serologic markers have been found to be useful for the diagnosis and differentiation of CD and UC. These markers include the following antibodies: (a) pANCA, (b) ASCA, (c) anti-pancreatic antibody, (d) OmpC antibody and (e) I-2 antibody and antibodies to anaerobic coccoid rods. The application of a panel of markers with the use of an algorithm (i.e. IBD First Step) can identify specific subtypes of IBD that have different clinical courses and progression of the diseases. The serologic markers are useful for the diagnosis and management of CD and UC patients.

Antibodies↗