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Biomedical subjects

D G Kelly

Publications and source records attributed to D G Kelly.

At least 19 recordsLinked to original sources
PubMed2001

An open trial of octreotide long-acting release in the management of short bowel syndrome.

OBJECTIVES: The aim of this study was to assess the effects of the long-acting release (LAR) depot octreotide preparation Sandostatin LAR Depot on stool water and electrolyte losses, fecal fat excretion, and GI transit in patients with short bowel syndrome. METHODS: We performed a 15-wk, prospective, open-label study of intramuscular (i.m.) Sandostatin LAR Depot, 20 mg, at 0, 3, 7, and 11 wk. Balance studies were performed before and at the end of the 15-wk study. Baseline and posttreatment measurements of body weight, stool fat, sodium and potassium, and gastric and small bowel transit of a radiolabeled egg meal were compared by paired analysis. RESULTS: We studied eight patients with short bowel syndrome (five women and three men; mean age 52 yr, range 37-72 yr) who had been TPN dependent for a mean of 11.8 yr (range 1.5-22 yr). The underlying diagnoses were Crohn's disease (n = 6), intestinal ischemia (n = 1), and resection for carcinoid tumor (n = 1). Treatment with Sandostatin LAR Depot significantly increased small bowel transit time (p = 0.03). Changes in body weight, urine volume, stool weight, fecal fat excretion, stool sodium and potassium excretion, or gastric emptying rate were highly variable, and no overall significance was observed. CONCLUSIONS: Sandostatin LAR Depot for 15 wk significantly prolonged small bowel transit time. Body weight and stool parameters in response to Sandostatin LAR Depot treatment needs to be assessed further in multicenter studies assessing dose, frequency of administration, and a larger sample size.

Adult↗
PubMed2000

Frequency and site-dependent variations in vibration detection thresholds on the face.

An adaptive psychophysical procedure was used to estimate the vibration detection threshold at seven spatially matched sites on the two sides of the face and at one scalp site. Repeated measurements over six testing sessions were made for stimuli vibrating at 1, 10 and 100 Hz for each of 21 neurologically healthy, young adult females. Approximately 14 stimulus trials were required to obtain each estimate of the threshold amplitude. Thresholds varied as a function of frequency (p < 0.0001), side (p < 0.001) and site (p < 0.0001). Compared to stimulation at 100 Hz at which the estimates were lowest, thresholds were 3.1 times greater at 10 Hz and 5.4 times greater at 1 Hz. Thresholds were lowest on the vermilion and highest on the cheek and chin. The preauricular skin and scalp exhibited an intermediate level of sensitivity. Whereas thresholds were comparable on the two sides of the face for stimulation at 1 Hz, they averaged 1.33 times greater on the right side for stimulation at 10 and 100Hz. Moreover, thresholds obtained during the last two sessions were 16% higher than those obtained during the first two sessions (p < 0.02), suggesting that subjects on average became more conservative in reporting the presence of the stimulus. The sensitivity in discriminating differences in tactile function favors use of the rapidly administered testing procedure in a clinical setting.

Adolescent↗
PubMed1999

Nutrition in inflammatory bowel disease.

The nutritional impact of inflammatory bowel disease is notable, both in Crohn's disease and ulcerative colitis. The causes of malnutrition include decreased intake, maldigestion, malabsorption, accelerated nutrient losses, increased requirements, and drug-nutrient interactions. Inflammatory bowel disease causes alterations in body composition and, because of these changes, affects energy expenditure. Various approaches have been most effective in correcting malnutrition, supporting growth, and managing short-bowel syndrome, but the success of primary therapy has been limited.

Diet↗
PubMed1999

A letter-recognition task to assess lingual tactile acuity.

PURPOSE: This study evaluated a novel neurosensory test based on letter recognition developed for the assessment of spatial acuity of the tongue. PATIENTS AND METHODS: An up-down tracking procedure was used to estimate the threshold height for the recognition of embossed letters of the alphabet examined by the tongue tip. The 48 stimuli consisted of acrylic strips, one side of which bore a letter (A, I, J, L, O, T, U, or W) of 3, 4, 5, 6, 7, or 8 mm in height. Twenty neurologically normal young adults were tested. RESULTS: Stable estimates of the threshold height were obtained after delivery of only 15 trials. Threshold height averaged 5.1 mm (range, 3.7 to 6.6 mm) and was unaffected by gender (P>.88). Although the letters were identified correctly 54% of the time, on average, the tangibility of individual letters varied from 5% correct (for W) to 82% correct (for T). The letter W was never identified by 16 of 20 subjects; T, O, and U were identified by all subjects. Analysis of errors confirmed that subjects relied on spatial cues to make the discriminations; 58% of the incorrect responses were made to 1 or 2 letters with spatial features similar to those of the stimulus letter. CONCLUSIONS: The threshold height for letter recognition can be obtained easily and rapidly, exhibits low among-subject variability, and reflects the capacity to extract and process spatial information. Letters of similar legibility on the tongue should be used to minimize underestimation of subjects' true acuities.

Adolescent↗
PubMed1999

Survival of home parenteral nutrition-treated patients: 20 years of experience at the Mayo Clinic.

OBJECTIVE: To present the largest single institutional review of demographics, associated primary diseases, and survival of patients receiving home parenteral nutrition (HPN). MATERIAL AND METHODS: We conducted a retrospective review of medical records of all Mayo Clinic patients treated with HPN between 1975 and 1995. The probability of survival was calculated by using Kaplan-Meier analysis. RESULTS: In the 225 study patients requiring HPN (median age, 51 years), the main underlying primary diseases were as follows: inflammatory bowel disease (IBD) (N = 50), nonterminal active cancer (N = 39), ischemic bowel (N = 35), radiation enteritis (N = 32), motility disorder (chronic pseudo-obstruction) (N = 26), and adhesive intestinal obstruction (N = 18). Other conditions included intestinal and pancreatic fistula, refractory sprue, dumping syndrome, and protein-losing enteropathy. The overall probability of 5-year survival during HPN was 60%. The probability of survival at 5 years based on the primary disease was 92% for IBD, 60% for ischemic bowel, 54% for radiation enteritis, 48% for motility disorder, and 38% for cancer. The probability of 5-year survival stratified by age at initiation of HPN was as follows: younger than 40 years, 80%; 40 through 60 years, 62%; and older than 60 years, 30%. Most deaths during therapy with HPN were attributable to the primary disease. Among the 20 patients who died of an HPN-related cause, 11 deaths were from catheter sepsis, 4 from liver failure, 2 from venous thrombosis, and 2 from metabolic abnormalities. CONCLUSION: Survival of HPN-treated patients is best predicted on the basis of the primary disease and the age at initiation of HPN. Patients with IBD and age younger than 40 years have a better 5-year survival in comparison with other groups. Most deaths during treatment with HPN are a result of the primary disease; HPN-related deaths are uncommon.

Adult↗
PubMed1998

Urinary tract fistulas following gynaecological surgery.

Urinary tract fistulas are a relatively uncommon but important complication of gynaecological surgery. Between 1980 and 1995 we identified 17 patients who developed a urinary tract fistula after gynaecological surgery. Seven of the patients had surgery performed for neoplastic disease but none of these patients received adjuvant radiotherapy before the formation of the fistula. There were 12 vesicovaginal fistulas and five ureteric fistulas. Four of the vesicovaginal fistulas were repaired by the vaginal approach and five vesicovaginal fistulas were repaired by the abdominal route. Three vesicovaginal fistulas were treated by catheterisation alone. Two of the 17 patients took medicolegal action. Early recognition and repair of urinary tract fistulas is recommended. Repair of vesicovaginal fistulas by the vaginal approach is advised. The litigious nature of this distressing condition is lessened when early primary closure is successful.

Journal Article↗
PubMed1998

Evocation and characterization of percepts of apparent motion on the face.

The percepts evoked by sequential stimulation of sites in close spatial proximity (< or = 2.5 cm) on the face were studied. Both method-of-limits and magnitude-estimation procedures were used to identify and characterize alterations in the percepts produced by systematic changes in the temporal and spatial parameters of the sequence. Each site was stimulated by a vertically oriented row of miniature vibrating probes. Apparent motion was consistently perceived when the delay between the onsets of sequentially activated rows (interstimulus onset interval, or ISOI) fell within a relatively narrow range of values, the lower limit of which approximated 5 msec. Both the upper limit and the perceived smoothness and continuity of the motion percepts (goodness of motion) increased with the duration for which each row stimulated the skin over the range evaluated, 15-185 msec. For the successive activation of only two rows, goodness of motion was not influenced by changes in their separation from 0.4 to 2.5 cm. The ISOI values at which magnitude estimates of goodness of motion were highest increased with the duration for which each row stimulated the skin. As such, maximum goodness of motion decreased with increases in the apparent velocity of motion. When the number of sequentially activated rows was increased from two to four or more, the quality of the motion percepts improved. For the successive activation of multiple closely spaced rows, values of ISOI at which numerical estimates of goodness of motion were highest approximated integral fractions of the duration for which each row stimulated the skin. In this situation, the probes rose and fell in a regular, step-locked rhythm to simulate an edge-like or rectangular object moving across the skin. The goodness of motion so attained was relatively independent of the apparent velocity of motion.

Adult↗
PubMed1997

Utility of square-wave gratings to assess perioral spatial acuity.

PURPOSE: The usefulness of square-wave gratings to assess perioral spatial resolution acuity was evaluated. MATERIALS AND METHODS: A psychophysical tracking procedure was used to estimate the threshold groove width for discriminating orientation (horizontal or vertical) of square-wave gratings pressed into the skin. Ten positionally matched sites on the two sides of the face of 36 right-handed, healthy young adults were studied. Commercially available gratings provided alternating ridge- and-groove stimuli with element widths from 0.35 to 3.0 mm. RESULTS: Thirty-three of the 36 subjects could discriminate orientation at all six sites on the vermilion (threshold width averaged 1.06 mm for grooves and for ridges). Thresholds were lower on the mid-portion of the lower vermilion than on the mid-portion of the upper vermilion (P < .05). Moreover, thresholds were lower on the right side of the vermilion than on the left side (P < .02). In contrast to the vermilion, only 25 and 30 subjects could discriminate orientation on the left and right hairy upper lip, respectively; and two or fewer subjects, at each of 12 sites on the chin and cheeks. CONCLUSIONS: Clinical use of small square-wave gratings with ridge and groove widths of 3 mm or smaller is limited to the vermilion. Moreover, baseline values are needed for individual patients to minimize false-positive diagnoses of sensory impairment. The size required of coarser gratings to test other perioral sites may preclude their use for evaluation of discrete, suspect skin areas.

Adolescent↗
PubMed1997

Effect of growth hormone, glutamine, and diet on adaptation in short-bowel syndrome: a randomized, controlled study.

BACKGROUND & AIMS: The effects of parenteral growth hormone, glutamine supplementation, and a high carbohydrate-low fat (HCLF) diet on gut adaptation in short-bowel syndrome are unclear. The aim of this study was to compare effects of this treatment regimen and placebo in patients with short-bowel syndrome. METHODS: A randomized, 6-week, double-blind, placebo-controlled, crossover study in 8 patients with short-bowel syndrome (average small bowel length, 71 cm; mean duration, 12.9 years) was performed. Active treatment was growth hormone (0.14 mg.kg-1.day-1), oral glutamine (0.63 g.kg-1.day-1), and the HCLF diet for 21 days. The weight, basal metabolic rate, nutrient and electrolyte balance, serum insulin-like growth factor I levels, D-xylose absorption, morphology and DNA proliferation of small intestinal mucosa, and gastrointestinal transit were evaluated. Treatments were compared by paired t test. RESULTS: Active treatment transiently increased body weight, significantly but modestly increased the absorption of sodium and potassium, and decreased gastric emptying. The assimilation of macronutrients, stool volumes, and morphometry of small bowel mucosa were not statistically different in the two treatment arms. CONCLUSIONS: Although treatment with growth hormone, glutamine, and HCLF diet for 3 weeks resulted in modest improvements in electrolyte absorption and delayed gastric emptying, there were no improvements in small bowel morphology, stool losses, or macronutrient absorption.

Acclimatization↗
PubMed1997

Survival of human pancreatic enzymes during small bowel transit: effect of nutrients, bile acids, and enzymes.

The activity of pancreatic enzymes declines during aboral intestinal transit. We tested the hypothesis that survival of pancreatic enzyme activities during intestinal transit is affected by amounts or concentrations of calories, nutrients, bile acids, or pancreatic enzymes entering the segments of the small intestine. An oroileal tube was placed in 26 healthy humans. The tube had duodenal, jejunal, and ileal infusion ports for nonabsorbable markers and aspiration ports in the distal duodenum, distal jejunum, and distal ileum. Four infusates of different proportions of protein, fat, and carbohydrate were infused continuously into the duodenum at 40, 90, and 160 kcal/h. Of the nutrients infused into the proximal duodenum, 21 +/- 3, 51 +/- 7, and 39 +/- 5% of fat, protein, and carbohydrate, respectively, were delivered to the distal duodenum. During duodenoileal transit, lipase, chymotrypsin, amylase, and trypsin lost 71 +/- 5, 63 +/- 5, 43 +/- 7, and 38 +/- 9% of activity, respectively (P < 0.01 vs. distal duodenum). During duodenojejunal transit, the activity of each enzyme decreased more than 35% (P < 0.01 vs. distal duodenum), and infusion of more calories into the duodenum improved survival of all enzymes except trypsin (P < 0.05). During jejunoileal transit, greater amounts and concentrations of calories and carbohydrate improved survival of only lipolytic activity (P < 0.01, P < 0.05, respectively), and loss of lipolytic activity correlated directly with delivery of bile acids (r = 0.56, P = 0.05) and chymotrypsin (r = 0.80, P = 0.001) to the distal jejunum. We conclude that intraluminal nutrients increase survival of enzyme activities in the proximal intestine. After absorption of nutrients, the action of chymotrypsin and bile acids decrease lipolytic activity more than activity of other enzymes.

Adolescent↗
PubMed1996

Stimulus-response diversity in local neuronal populations of the cerebral cortex.

In cortex, neighboring 0.05 mm minicolumns have distinctly different receptive fields (RFs). Within minicolumns, neighboring cells have very similar RFs, but differ prominently in their stimulus-evoked temporal behaviors. This is reproduced in a cortical model that has strong inhibition and semi-random lateral connections among cells with similar RFs. Within modeled minicolumns, non-linear dynamics amplify small differences in cells' lateral inputs into large differences in temporal behaviors. Cells' stimulus-evoked behaviors, though complex, are surprisingly orderly, in that (1) time courses of cells' responses are very stimulus-specific and (2) in the presence of a stimulus, activities of some cells fluctuate coherently, and the patterns of coherence are also stimulus-specific. Thus the model, like real cortex, represents stimulus information in the overall strengths and temporal patterns of cells' responses and in patterns of temporal coherence among cells.

Cerebral Cortex↗
PubMed1996

Career satisfaction of physical therapy faculty during their pretenure years.

BACKGROUND AND PURPOSE: The purpose of this study was to compile information about and define variables that are influential in the career satisfaction of tenure-track, full-time, physical therapy faculty who have been employed in academia for 5 years or less but who do not yet have tenure. SUBJECTS AND METHODS: An investigator-developed instrument was used to collect the data. The self-report instrument contained 80 items in four categories: demographics, social supports, teaching, and scholarly activity. Questionnaires were sent to junior physical therapy faculty at the 127 physical therapist schools in the United States and Puerto Rico listed by the American Physical Therapy Association in 1993. There were 163 responses to the survey, representing an estimated 85% of the population of junior faculty as defined by this survey. RESULTS: Eighty-three percent of junior faculty surveyed were satisfied with having taken an academic position, despite feelings of loneliness, tenure anxiety, heavy work loads, and the desire for more guidance from colleagues. CONCLUSION AND DISCUSSION: Social and collegial supports such as relationship with senior faculty and experienced colleagues are key elements influencing faculty satisfaction. Information is given that could be utilized by directors and faculty who are planning to guide the professional development of new faculty.

Adult↗
PubMed1996

Nutrients and cyclical interdigestive pancreatic enzyme secretion in humans.

BACKGROUND AND AIMS: It is hypothesised that nutrients increase pancreatic enzyme secretion by converting cyclical interdigestive secretion to a non-cyclical pattern. This study tested the hypotheses that nutrients do not interrupt cycles and determined the relation of nutrients, calories, and osmotic load to the rate of pancreatic secretion. METHODS: Twenty six healthy persons were intubated with oroduodenal and orogastric tubes. Each had one of four different solutions containing 12 to 36% of calories as protein, 24 to 48% as fat, and 40 to 64% as carbohydrate infused into the duodenum at 40, 90, or 160 kcal/h for 300 minutes. Nine g/l sodium chloride (290 mOsm) was added to 16 infusates; osmolality of the other 10 infusates was 24 to 98 mOsm. Pancreatic enzyme outputs were measured every 15 minutes and peaks of enzyme secretion were identified. RESULTS: The number of enzyme peaks was similar for the different infusates and the proportion of nutrients in the infusates did not affect secretion of individual enzymes. The nadir, but not the peak of the cycles of enzyme outputs correlated with increasing the caloric load (r = 0.55, p < 0.003 for nadir:peak ratio). Increasing osmolality did not affect cycling but reduced (p < 0.001) enzyme output. CONCLUSION: Nutrients entering the duodenum do not abolish cycles of enzyme secretion; instead they modulate cycles by increasing the nadir. Forty and 90 kcal infusions submaximally stimulate pancreatic secretion and might be used in patients with pancreatitis without producing pain; adding sodium chloride to solutions should increase this effect.

Amylases↗
PubMed1995

Gender-, side- and site-dependent variations in human perioral spatial resolution.

Twenty-eight right-handed, young adults participated in a sensory testing experiment to evaluate spatial resolution at 10 positionally matched sites on the right- and left-hand sides of the face. An adaptive psychophysical (i.e. tracking) procedure was used to estimate the threshold spatial separation for perceiving two points of contact at each site. Estimates of the threshold at one site on both sides of the face were also obtained with a method-of-limits procedure similar to that employed for clinical evaluation of patients. In addition, each individual was asked to rate (i) his(her) overall facial sensitivity to touch and (ii) the degree to which he(she) could discern subtle changes in lip, cheek and chin position during speech, chewing and facial expression. Analysis of the estimates of the threshold separation obtained with the tracking procedure revealed a significant effect of gender (p < 0.04) and of site (p < 0.001). Females were more spatially sensitive than males: average threshold separations were 1.55 mm less. Most notably, the threshold increased ninefold with distance posterolaterally from the oral opening. The vermilion of the upper lip was the most spatially sensitive site (population geometric mean = 2.4 mm) and the preauricular skin the least spatially sensitive site (20.9 mm). Significant effects of side and of interactions among gender, side and site were not observed. The estimates obtained with the method-of-limits procedure were very similar to those obtained with the tracking procedure: the latter were 0.67 mm less on the average. Individuals' ratings of overall facial sensitivity to touch were similar for males and females (p > 0.70). Females, however, reported greater ability to discern subtle changes in lip, cheek and chin position than males (p < 0.03). The ratings of this sensory function correlated negatively with the estimates of the threshold separation on the vermilion of the upper lip (p < 0.03).

Adaptation, Physiological↗
PubMed1995

Nutritional considerations in inflammatory bowel diseases.

Although many foods have been suggested to play a role in the cause of IBD, there are not yet definitive data to support diet as a cause of either CD or UC. Malnutrition is a common occurrence in IBD, and this must be considered in the treatment of these diseases. Nutritional support in IBD has limited use as primary therapy (Table 2). Even though parenteral and enteral nutrition have been associated with remission, relapse frequently occurs when normal food intake is resumed. Likewise, fistulae may resolve with aggressive, nutritional therapy, but they frequently recur with reinstitution of food. In short bowel syndrome caused by extensive intestinal resection performed in CD, parenteral nutrition provides an important mode of therapy. In addition, perioperative use of nutritional support may decrease the incidence of postoperative complications in patients who are malnourished. Nutritional support in pediatric patients with CD who have growth failure has been effective in stimulating growth.

Child↗