Biomedical subjects
Publications and source records attributed to J F Kelly.
The synchronous performance of aortic and gastrointestinal surgery may hold an increased risk of aortic graft infection. The experience of one surgeon who performed 32 such synchronous operations over a period of 11 years is reviewed. No graft infection occurred and it is concluded that such combined operations may be safer to perform than staged surgery in elderly patients.
Of the 622 patients admitted to a geriatric medical unit during the period November 1985 to October 1986, 211 (33.9%) had been discharged from hospital within the previous year. Of these, 117 (55.5%) had previously been admitted to the geriatric medical unit (18.8% of all admissions). The reasons for readmission were deterioration of existing disease (47.4%), new medical events (33.2%), poor management of previous discharge (9.5%), and social problems (5.7%). Age was not a significant factor influencing readmission. Readmission was judged preventable by better management of the previous admission and discharge in only 33 cases (15.6% of readmissions). A prospective study of the patients discharged in the same year revealed that 19.3% were readmitted in the following year, and of these readmissions 2.3% were considered to be preventable. There was no difference in medical causes for readmission in the two years. A significant number of the patients readmitted in both years studied was categorized as "high dependency". The figures suggest that although unplanned readmission is common, it is generally not preventable by better management of the previous admission, and often reflects a highly dependent and medically frail group of patients, in whom early intervention with readmission is appropriate.
In December 1990, a survey was sent to 1,296 randomly selected members of the American Association of Oral and Maxillofacial Surgeons (AAOMS) to determine their previous experience with standards and criteria of care, their type of practice, the educational methods that influence their professional decisions, and their attitudes about the development and use of parameters of care. A 55.7% response was obtained. This article reports the results of this survey. The average age of responding surgeons was 45 years and they had been in practice an average of 15 years. The majority were in private practice, had hospital staff privileges, worked between 31 and 55 hours per week, spent 90% of their working week in direct patient care, and devoted an average of 9.16 hours per month to professional affairs outside of their practice. Forty-two percent (42%) of the practitioners were in solo practice, whereas 50% practiced in groups. Surgeons concentrated 65% of their patient care time on dentoalveolar surgery and a significant number planned increases in practice activity in implant, orthognathic, and temporomandibular joint surgery. They learned new clinical skills in various ways, there being a difference between the most convenient and effective methods of learning. A majority of surgeons had been involved with quality assurance activities in the past 5 years. They were predominantly favorable to parameters now and when they first learned about them, but few thought they had a clear understanding about how parameters of care would be used.(ABSTRACT TRUNCATED AT 250 WORDS)
For several years the National Technical Institute for the Deaf (NTID) at the Rochester Institute of Technology has offered a course that focuses on preparing video resumes. Professionals from the Instructional Television Department and the National Center of Employment for the Deaf have collaborated with communication instructors to develop this option for NTID students. This paper describes the instruction and evaluation process from the perspective of NTID instructors, students, and other technical professionals. Employers who have hired NTID students and those who have no familiarity with deaf employees also participated in the evaluation. Their comments give valuable insights into the often different perspectives of deafness between those who have worked with deaf employees and those who lack such experience. Video resumes were found to be a viable tool in the job search, and the process of preparing the video was found to be a stimulating and rewarding experience for the participating students.
Laparoscopic cholecystectomy is a safe and effective procedure in specialist centres, but its wider application will depend on the ability of general surgeons to become skilled in this technique. 180 patients underwent elective laparoscopic cholecystectomy during a nine-month period at a single district general hospital. All patients who would have been eligible for elective open cholecystectomy were offered the laparoscopic alternative. Laparoscopic cholecystectomy was abandoned in favour of an open procedure in 10 (6%) patients. Median operating time was 55 min. 2 patients had serious morbidity (right hepatic duct injury and a duodenal fistula) and there were no deaths. 3 patients required subsequent treatment for retained common duct stones. 90% of patients were discharged within 48 h of the operation and the median time to resume full activity after discharge was 12 days. Laparoscopic cholecystectomy is a safe and cost-effective technique in a district general hospital.
This investigation compared the spoken and written English errors of 20 hearing-impaired postsecondary students with intelligible speech and poor English language. Error categories used to assess the language samples were function, content, and structure. Spoken and written performances were distinguished only by a greater number of function word errors in writing samples. A trend toward greater complexity in writing was also found. Implications for instruction are discussed.
This case report records the rare presentation of accelerated hypertension secondary to long-standing renal tuberculosis and the subsequent beneficial response to surgery predicted by lateralisation of renin levels within the renal veins. The patient's hypertension proved difficult to control medically and he was therefore assessed for possible surgical management. Renin sampling revealed clear lateralisation within the renal veins indicating possible benefits from surgery. Nephro-ureterectomy was performed and, post-operatively, the patient's hypertension, while not completely resolved, was easily controlled with monotherapy. Patients with unilateral renal tuberculosis and hypertension which prove difficult to control should have measurement bilaterally of renal venous renin which may indicate potential benefits from surgery.
Two cases of narcolepsy presenting in elderly patients are reported. Delay in diagnosis prior to presentation resulted in considerable psychosocial problems for both patients. Satisfactory responses to therapy were achieved with patients regaining independence. Difficulties associated with this diagnosis in the elderly are discussed.
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This rapid, sensitive, simple radioreceptor assay (RRA) for l-propranolol and its active metabolites in unextracted samples requires 5 microL of sample, a beta-adrenergic antagonist, 125-l-labeled (-)cyanopindolol (125ICYP), and turkey erythrocyte membrane receptors (Kd = 40 pmol/L). Equal volumes (100 microL) of diluted sample and 125ICYP are incubated with 500 microL of erythrocyte membranes for 30 min. Cold isotonic saline (2.5 mL) is added, and the mixture is centrifuged. The concentration of drug that inhibited receptor binding by 50% (IC50) was l-propranolol, 1.5 micrograms/L; d-propranolol, 243 micrograms/L; and 4-hydroxypropranolol, 8.8 micrograms/L. Analytical recovery of propranolol added to serum was 93 to 120%; results for 138 clinical samples tested by this method and by liquid chromatography correlated well (r = 0.96). Results correlated strongly (r = 0.98) for 23 clinical samples tested by RRA and analyzed for both propranolol and 4-hydroxypropranolol by liquid chromatography. The sensitivity of this RRA was 0.3 micrograms/L, and both intra- and interassay CVs were less than 12%. Modifications of this method could permit testing of other nonselective beta-blockers.
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The relative sensitivity and usefulness of FEV1 and SGaw measurements in determining airway responsiveness to stimuli causing changes in bronchomotor tone depend to a great extent on the population studied. Though neither test provides a great deal of information regarding the site of airway obstruction, when used together they provide a reliable and sensitive indicator of airway responsiveness.
Polymerized ragweed antigens of different molecular weight ranges were studied to determine if the degree of allergenicity was dependent on molecular size of the polymers. In this study, allergenicity is defined as the ability to elict IgE-mediated skin reactivity. Ragweed antigen treated with glutaraldehyde was fractionated into one preparation with a molecular weight range of 200,000 to 20,000,000 and another with molecular weights less than 200,000. Except for the difference in molecular sizes of the two molecular sizes of the two preparations, all ragweed polymers had been treated in an identical fashion. The low molecular weight fraction had cutaneous endpoint reactivity greater than 10(5) to 10(8) times that of the high molecular weight materials. In these and other studies, immunogenicity defined as the ability to induce an IgG antibody response was retained by the high molecular weight material. The results are consitent with the hypothesis that allergenicity decreases as the molecular weight of the polymerized allergen increases.
Bronchial sensitivity to grass and ragweed extracts was determined in four adult asthmatic subjects at the beginning and end of the grass and ragweed pollen seasons. 4 subjects with ragweed sensitivity had increased bronchial sensitivity to ragweed antigen at the end of the ragweed season. 2 of 3 grass sensitive subjects demonstrated increased bronchial sensitivity to grass antigen after the grass pollen season. This study suggests that natural environmetnal exposure to pollen antigens may induce priming in the lung.
Clinical assessment of bone-graft healing in the maxillofacial region is generally limited to clinical evaluation, radiographs, and biopsy. A noninvasive quantitative radionuclide method has been developed in an animal model, and it seems to allow earlier prediction of graft failure or success than conventional methods. Using a localization technique to identify preselected regions of interest reproducibly in the graft and adjacent host bone, an activity ration was developed between the graft region and a contralateral control. Two mandibular grafting systems were evaluated with this technique. When the activity ratio for the graft region over the period of study approached, or was greater than, the activity ratio for the host bone, the graft subsequently proved successful by clinical observation and gross dissection. When the activity ratio for the host bone remained greater than that of the graft, healing did not occur and the grafts were unsuccessful. This method allowed prediction of graft fate by 6 wk after grafting, and preceded radiographic confirmation of repair or failure by 2-3 wk.
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In 5 patients with respiratory symptoms consistent with humidifier or air conditioner disease, a hypersensitivity pneumonitis, no identifiable organism was cultured from the humidifier water (HW). The water source to the humidifier or air conditioner was investigated for possible antigens which might explain the occurrence of the disease. Three subjects who lived in the same city supplied by Lake Michigan had increased IgG antibody activity against the city water supply when compared with another patient from a different city and a control subject. Both of the latter lived in cities with water supplied from Lake Michigan. Two of the 5 patients showed definite inhibition by concentrated tap water (TW) of IgG antibody against HW. The source of antigens in water was not determined but must be considered in cases of this type of hypersensitivity pneumonitis. A sixth case consistent with humidifier disease had Cephalosporium cultured from her HW. On gel diffusion there was a band of identity with her serum against Cephalosporium extract and her own HW, and by radioimmunoassay (RIA) there was over 50% inhibition of her IgG antibody activity against HW by Cephalosporium. No antibody against her city TW was demonstrated.