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Biomedical subjects

H Kay

Publications and source records attributed to H Kay.

At least 19 recordsLinked to original sources
PubMed1988

Sonography of the low transverse incision, cesarean section: a prospective study.

Using sonography, the uterine incision site was prospectively studied in 36 asymptomatic patients, two days after cesarean section. The findings were compared with those seen in 21 symptomatic, postcesarean patients. In the asymptomatic patients, the incision site was visualized as an oval symmetric region of distinct echogenicity interposed between the lower uterine segment and the posterior wall of the urinary bladder. In eight of the 36 asymptomatic patients, a small (less than 1.5 cm) round hypoechoic mass was present in or adjacent to the uterine incision and distinct from the normal incision. These probably represented insignificant hematomas. Of the 21 symptomatic patients, 17 had either a subfascial hematoma, a bladder-flap hematoma, or endometritis. Two were sonographically normal, and one showed a hematoma in the paracolic gutter. In the remaining patient, there was a 5-mm asymmetrically placed hypoechoic mass representing an insignificant hematoma. Significant bladder-flap hematomas were characteristically round, greater than 2 cm masses asymmetrically placed in or adjacent to the uterine incision. Using sonography, the normal appearance of the lower uterine incision can be distinguished from significant hematomas.

Abdomen↗
PubMed1985

Ischemia at rest is independent of the extent of ventricular dysfunction and arrhythmias in patients with coronary artery disease.

To assess the relation between myocardial ischemia, ventricular arrhythmias (VA), and left ventricular (LV) dysfunction, we evaluated 74 patients with coronary artery disease (CAD) using radionuclide angiography (to determine the resting ejection fraction [EF]), resting thallium-201 scintigraphy (to ascertain the extent of resting ischemia), and 24-hour Holter monitoring (to assess VA). Thirty patients had resting ischemia, 26 had resting EF less than 30%, and 27 had repetitive VA. Patients with and without ischemia had similar EFs (36 +/- 14 vs 38 +/- 14, p = NS). Further, patients with and without repetitive forms of VA had a similar number of resting ischemic segments (1.1 +/- 1.7 vs 1.1 +/- 2.2, p = NS). Patients with EFs less than 30 had more VA than patients with EFs greater than or equal to 30 (Holter class 4.3 +/- 2.3 vs 3.0 +/- 1.8, p less than 0.01) but a similar extent of ischemia (1.4 +/- 2.2 vs 1.0 +/- 1.7, p = NS). Thus, while patients with lower EFs have more repetitive forms of VA, ischemia at rest is independent of VA and EF. These data suggest that prognostic stratification of patients with CAD for intervention studies should include a separate consideration of ischemia.

Arrhythmias, Cardiac↗
PubMed1984

Determinants of outcome following left ventricular aneurysmectomy.

UNLABELLED: The determinants of outcome after left ventricular aneurysmectomy are not well understood. We analyzed preoperative follow-up information on 38 patients who had undergone left ventricular aneurysmectomy. At a mean follow-up of 39 months (range 6 to 68), 25 patients (66%) improved by at least one functional class (New York Heart Association) (Group I), and 13 patients (Group II) either died (n: 8) or had persistent congestive heart failure (n: 5). Patients in Group I had significantly higher left ventricular ejection fraction before surgery than patients in Group II (38 +/- 12% vs. 29 +/- 14%, P less than 0.04). The volume of the aneurysm at end-diastole was smaller among patients in Group I than Group II (42 +/- 32 ml vs. 73 +/- 47 ml, P less than 0.04). The contractile indices of the nonaneurysm segment, contractile segment ejection fraction, basilar half ejection fraction, and basilar fractional area shortening were not significantly different between the two groups. There was no difference between the two groups in the preoperative left ventricular end-diastolic pressure, cardiac index, pulmonary artery wedge pressure, pulmonary artery pressure, extent of coronary artery disease, number of bypass grafts inserted, or aortic cross-clamp times. CONCLUSION: 1) The ejection fraction and volume of the aneurysm are more important predictors of outcome after left ventricular aneurysmectomy than the contractile indices of the nonaneurysmal left ventricle and 2) symptomatic improvement occurs in 66% of patients after left ventricular aneurysmectomy.

Adult↗
PubMed1984

Prognostic implications of rest and exercise radionuclide ventriculography in patients with suspected or proven coronary heart disease.

Rest and exercise radionuclide ventriculography were assessed for their value in predicting major cardiac events in patients with chest pain. Of 219 patients who were followed for up to 51 months, 42 had major cardiac events: 12 patients (5.5%) died, 5 (2.2%) sustained nonfatal myocardial infarction, and 25 (11.4%) had coronary arterial bypass grafting. Univariate and multivariate survival analysis revealed that exercise left ventricular ejection fraction was the best predictor for total major events and the resting ejection fraction to be the best predictor for death or nonfatal myocardial infarction. These two variables were strong predictors in the entire group of patients and in subgroups: patients with or without Q-wave infarction, patients with high probability of coronary artery disease and those with abnormal resting left ventricular function. Thus, radionuclide angiography provides important prognostic data that permits the physician to categorize patients with chest pain syndromes with respect to subsequent cardiac events. If validated, this model or a modification of it could identify patients at high risk of subsequent major cardiac events who are candidates for intensive follow up and therapy or further invasive evaluation, as well as patients at low risk of subsequent major cardiac events for whom standard follow up would be appropriate.

Angiography↗
PubMed1983

New method of assessing visual acuity with pictures.

It is never easy to assess accurately the vision of an illiterate child. Children under the age of 3 who are unable to understand and co-operate with tests using shapes and a key card present an even greater problem. All available subjective tests for this age group may maintain a small child's interest, but the accuracy of the recorded vision is very much in doubt. The new test described below is designed for 2-3-year old children. It combines the well recognised advantages of using pictures to gain the child's attention with the accuracy of a graded test based on Snellen's chart sizing. It is therefore both a practical and more accurate alternative test for this age group.

Child, Preschool↗
PubMed1983

Computed tomography of the normal sternum.

The normal CT anatomy of the sternum was studied in 35 patients. In addition to the normal appearance of the sternum, normal variants that may mimic disease were often noted. In the manubrium, part of the posterior cortical margin was unsharp and irregular in 34 of 35 patients. Part of the anterior cortical margin was indistinct in 20 of the 35 patients. Angulation of the CT gantry to a position more nearly perpendicular to the manubrium improved the definition of the cortical margins. The body of the sternum was ovoid to rectangular and usually had sharp cortical margins. Sections through the manubriosternal joint and xyphoid often demonstrated irregular mottled calcifications and indistinct margins again simulating bony lesions. The rib insertions, sternal clavicular joints, and adjacent soft-tissue appearance also were evaluated.

Adolescent↗
PubMed1977

Methotrexate-induced malabsorption in children with acute lymphoblastic leukaemia.

A one-hour D-xylose absorption test was performed on 18 children with acute lymphoblastic leukaemia. Xylose absorption was normal in children who had not received methotrexate, but there was a significant degree of malabsorption in those who had taken methotrexate within the previous seven days. There was a progressive and significant increase in malabsorption related to the cumulative dose of methotrexate. These findings provide further evidence that regular methotrexate treatment every seven days is more toxic than if it is more widely spaced. The spacing of treatment is currently under investigation.

Child↗
PubMed1976

The control of postoperative wound pain with the use of bupivacaine injections.

In a study of 50 operative cases 0.5% bupivacaine hydrochloride solution was injected in the area of the subcostal nerves at the time of closure of the wound except in 2 with previously noted infection. In the latter 2 cases the solution was injected when the wound was opened. No untoward results were noted from these injections and a definite decrease in the use of analgesics was required. In addition, there is preliminary evidence that peristalsis and flatus occur much earlier in cases in which the solution was used compared to a control group. Respiration was enhanced, earlier patient mobility was noted and the general depression from injectable analgesics was avoided.

Bupivacaine↗
PubMed1976

Surgery for congenital heart disease in the adult.

A total of 205 adults with a variety of congenital heart lesions underwent operation for total correction of their defects. Operative and long-term mortality were 3 and 4 percent, respectively. There has been only one operative death in the past five years (85 patients). While most defects were repaired with good hemodynamic and symptomatic improvement, the three lesions associated with the worst results were cyanotic tetralogy of Fallot, severe pulmonic stenosis complicated by atrial septal defect, and ostium primum atrial septal defect. Myocardial failure due to end-stage myocardial fibrosis was the major cause of operative mortality. Myocardial fibrosis and irreversible pulmonary changes seemed to be the two factors limiting operative correctio

Adolescent↗
PubMed1975

Iliac artery aneurysm: a common cause of ureteral obstruction.

Iliac artery aneurysms may cause ureteral obstruction. Six cases are reported. The major symptom is renal colic but a palpable aneurysm and a bruit may be found preoperatively and urinalysis may reveal microhematuria. On x-ray the ureter may be deviated medially, anteriorly or laterally. The ureter is bound down in a dense, desmoplastic reaction. All of our patients were treated by ureterolysis, with resection and grafting of the aneurysm in 4 of the 6.

Aged↗