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Biomedical subjects

J P Kelleher

Publications and source records attributed to J P Kelleher.

At least 19 recordsLinked to original sources
PubMed1999

Treatment of nonpsychotic relatives of patients with schizophrenia: four case studies.

BACKGROUND: Substantial evidence now shows that the genetic vulnerability to schizophrenia can be manifested clinically in first-degree relatives of people with schizophrenia, even without the full manifestations of the disorder. One pattern of problems observed involves the combination of negative symptoms and neuropsychological deficits. We have investigated whether a low dose of a novel antipsychotic medication, risperidone, could attenuate these clinical problems in non-psychotic, first-degree relatives, and report here findings from our first 4 cases. METHODS: Twelve adults who were first-degree relatives of patients with schizophrenia were evaluated for the presence of negative symptoms and neuropsychological deficits (in attention and working memory, long-term verbal memory and executive functions). Four subjects who met our predetermined criteria, and who did not demonstrate medical contraindications, were enrolled in a 6-week trial of risperidone. Clinical and medical measures were assessed before, during and after treatment. Doses of risperidone started at 0.25 mg and were increased to 1.0-2.0 mg/day. RESULTS: These subjects showed substantial reductions in negative symptoms, and one subject showed modest reductions. All four subjects showed substantial improvements on some tests of attention and working memory. Side effects of risperidone were temporary and mainly mild. CONCLUSIONS: These initial findings support two conclusions. First, clinical deficits in non-psychotic first-degree relatives of people with schizophrenia are identifiable, and to a significant extent, reversible. Second, risperidone may eventually serve as an effective treatment for people whose lives are impaired by similar or related problems.

Adult↗
PubMed1995

Cough induced by angiotensin-converting-enzyme inhibitors: Airway responses to inhalation of methacholine in patients who have essential hypertension.

We investigated whether patients with cough due to angiotensin-converting-enzyme inhibitors have a common pattern of airway responses to methacholine inhalation. Studies assessing only presence or absence of hyperresponsiveness to this agent have produced conflicting results. Spirometric testing before and after methacholine was performed in 14 hypertensive patients at least two weeks after discontinuation of these inhibitors, when cough had abated or disappeared. Subjects were predominantly female (86%) nonsmokers (93%), with high prevalence of respiratory atopic illnesses (57%) probably due to ethnic background (72% Hispanic). Premethacholine spirometric values were normal. Postmethacholine bronchoconstriction of varying degrees was observed in seven patients, but reached the level of hyperresponsiveness in only one patient with asthma. The other seven subjects exhibited no bronchoconstriction. The two groups did not differ in age, concomitant illnesses (e.g., atopy) and medications, or blood pressure reduction. We conclude that airway responses to cholinergic stimulation do not exhibit a common pattern and are randomly distributed in hypertensive patients who develop cough induced by angiotensin-converting-enzyme inhibitors.

Aged↗
PubMed1993

Transurethral microwave treatment for benign prostatic hypertrophy: a randomised controlled clinical trial.

OBJECTIVES: To determine whether transurethral microwave treatment for patients with benign prostatic hypertrophy provides significant symptomatic relief, a reduction in residual urine volumes, and improvements in flow rates compared with sham treatment. DESIGN: Prospective double blind randomised study with follow up at three months. SETTING: Department of Urology in a London teaching hospital. PATIENTS: 40 men completed the study: 22 received microwave treatment and 18 received sham treatment. Entry criteria were symptoms of prostatism of at least six months' duration, a total symptom score > 14, and a peak urine flow rate < 15 ml/s or a residual urine volume > 50 ml. Exclusion criteria were prostatic cancer, a residual urine volume > 200 ml, a very large prostate, an obstructing middle lobe, acute urinary retention, impaired renal function, coexisting urinary tract disease, and previous prostatic surgery. INTERVENTIONS: A single 90 minute transurethral microwave treatment or sham treatment. OUTCOME MEASURES: Patients' symptoms (including daytime frequency and nocturia) recorded in a self assessment symptom score questionnaire, peak urinary flow rates, and residual urine volumes. RESULTS: The mean total symptom scores of the patients who received microwave treatment fell from 30 to 11 compared with a fall from 31 to 26 for patients who received sham treatment (p < 0.001). Among patients who received microwave treatment daytime frequency fell from 9.4 to 5.5 voids a day and night time frequency from 3.5 to 1.6 voids a night; residual urine volumes fell from 104 ml to 52 ml; and peak urine flow rates increased by 2.3 ml/s. In the control group there was no improvement in any of these features. Treatment preserved sexual function and antegrade ejaculation. CONCLUSIONS: For selected patients with prostatism microwave treatment is effective and has few side effects.

Double-Blind Method↗
PubMed1993

Can renal blood flow, glomerular filtration rate or 99mTc-DMSA uptake predict outcome in experimental unilateral renal obstruction?

Single kidney glomerular filtration rate (SK GFR), single kidney blood flow (SK BF) and differential renal function (DRF), using both technetium labelled diethylene-pentaacetic acid (99mTc-DTPA) and dimercaptosuccinic acid (99mTc-DMSA), were examined as predictors of outcome in a pig model of complete unilateral ureteric obstruction. SK GFR and SK BF were unable to predict outcome following relief of obstruction but there was a high curvilinear correlation between DRF assessed at the end of defined periods of obstruction and after relief of obstruction using 99mTc-DMSA. Functional recovery was near complete using DMSA when the loss in DRF did not exceed 30%, after which there was an exponential decline in expected recovery. There was no difference between DRF using 99mTc-DTPA or 99mTc-DMSA in controls or before or after obstruction but significant differences between assessment by these radionuclides existed in the obstructed kidney at 24 h, 5 days, 10 days and 20 days. 99mTc-DMSA is a sensitive agent in the prediction of outcome following acute complete obstruction in the pig but its assessment of DRF in the obstructed kidney differs markedly from that of 99mTc-DTPA.

Animals↗
PubMed1992

Urinary endothelin (ET1) in complete ureteric obstruction in the miniature pig.

Segmental renal scarring occurs in experimental obstructive uropathy in the multipapillary porcine kidney, and segmental abnormalities in renal perfusion are likely to be responsible. This preliminary study examines the urinary excretion of the potent locally active vasoconstrictor endothelin 1 (ET 1) in a pig model of renal obstruction and subsequent relief. Significant urinary excretion of ET 1 from the postobstructive kidney was found to occur after longstanding obstruction. Preglomerular arteriolar stenosis may be the cause of the renal ischaemia in obstruction that is at first reversible but later becomes irreversible if the stimulus persists. ET 1 may be implicated in the pathogenesis of this injury.

Animals↗
PubMed1992

Endoscopic placement of CAPD catheters: a review of one hundred procedures.

One hundred consecutive endoscopically placed peritoneal dialysis catheters inserted in 95 patients over an 18-month period have been reviewed. All catheters were placed for chronic dialysis (CAPD). Following insertion there were five early catheter failures (4 failed to drain, 1 perforated viscus) and 13 early complications (7 leaks, 3 tunnel bleeds, 2 scrotal oedema, 1 wound infection). In the long term six patients required transfer to haemodialysis (2 recurrent peritonitis, 2 pain on outflow, 1 unable to cope, 1 persistent vomiting). Overall probability of catheter survival as predicted by Kaplan-Meier analysis was 0.85 at 18 months. These results confirm that endoscopic placement of CAPD catheters is safe and reliable. In addition there is a low early failure rate and the long-term catheter survival figure is comparable with the best series reported. This procedure allows direct visualization of the peritoneal cavity, thus minimizing the risk of visceral damage. Furthermore, the procedure is well tolerated under local anaesthesia and allows early institution of dialysis because of the extremely low leakage rate (11%). Endoscopic placement of CAPD catheters is now the procedure of choice in our centre. General anaesthetic and mini-laparotomy are thus avoided in most of this high-risk group.

Adolescent↗
PubMed1991

Renal injury in complete ureteric obstruction. A functional and morphological study.

This preliminary study examined reno-vascular injury sustained by the multipapillary porcine kidney in acute and chronic complete ureteric obstruction. In combination with measurement of upper tract pressure, regional function was assessed by [99mTc]-dimercaptosuccinic acid (DMSA) uptake and qualitative renal perfusion, by resin casting of the arterial tree prior to scanning electron microscopy (SEM). In acute obstruction, segmental defects were noted in the renal poles on both [99mTc]-DMSA scanning and casting. On SEM there was a polar afferent arteriolar vasodilatation after 30 min of obstruction and, subsequently, a segmental reduction in cortical perfusion. In kidneys that had been obstructed for 20 days, we observed a marked reduction in outer cortical perfusion coincident with afferent arteriolar vasoconstriction. The pathogenesis and significance of segmental injury to the multipapillary kidney in obstructive uropathy is discussed.

Animals↗
PubMed1991

Reproducibility of renal blood flow estimation in the miniature pig using 99Tcm-DTPA: introducing semiautomatic processing.

This study examines the reproducibility of renal blood flow measurement (RBF) in nine miniature pigs using 99Tcm-DTPA renography, and introduces a new algorithm useful in data processing. Renal blood flow can be estimated using three arterial regions of interest (ROI), the left ventricle (LV), the right lung (RL) and the aorta. Using the LV ROI, left kidney RBF was 9.08 (S.D. 1.69) and right RBF was 10.87 (S.D. 2.26). Reproducibility was assessed by performing renograms on successive days in nine pigs and was found to be best for LV [S.D. of change 0.32 for the left kidney (LK) and 0.74 for the right kidney (RK)] followed by RL (0.77 for LK and 0.75 for RK) and worst for aorta (1.47 for LK and 1.78 for RK).

Algorithms↗
PubMed1991

Estimation of glomerular filtration rate in the miniature pig by kidney uptake on the gamma camera.

Measurement of glomerular filtration rate (GFR) by the renal uptake of 99Tcm-diethylene triamine penta-acetic acid (99Tcm-DTPA) in the miniature pig was compared to that by plasma disappearance of 99Tcm-DTPA using multiple blood samples. Nineteen animals were examined under identical conditions. There was a highly significant relationship between the two tests, r = 0.88, P less than 0.001, although the uptake method gave consistently higher results than those obtained from plasma disappearance. Reproducibility of the uptake method was also assessed in this group of animals by performing two consecutive renograms. Confidence limits of 95% were +/- 7.5% or 0.7 ml min-1 kg-1. The test is useful for the serial examination of single kidney GFR on follow-up renography but is unlikely to replace disappearance techniques as a more accurate means of GFR estimation.

Animals↗
PubMed1991

Sequential renography in acute urinary tract obstruction due to stone disease.

A group of 76 patients with urographically proven acute calculus obstruction was studied prospectively using 99mTc-DTPA renography to see if kidneys at risk of irreversible renal damage could be identified. There was a statistically significant relationship between the presence of obstruction on renography and the subsequent requirement for intervention, but not with the degree of obstruction (partial or severe). Stones over 5 mm in size are highly likely to cause obstruction, a drop in relative renal function and require intervention. In all, 14 patients sustained a drop in relative renal function of greater than 7% on renography and 12 of these returned to normal limits when their calculi had been passed or removed. The 2 kidneys whose function remained impaired had fallen below 25% of overall renal function and both patients had received prior treatment for their calculi. No patient who presented de novo suffered any permanent loss of ipsilateral renal function. The results confirm that the criteria for intervention were well founded and emphasise the importance of achieving a stone-free state after primary treatment. Renography is recommended for stones over 5 mm in size, those in the middle and upper ureter and for those patients discharged with a stone in situ.

Adult↗
PubMed1988

Oxybutynin: is it safe?

Oxybutynin has been widely prescribed in the United Kingdom for more than 5 years on a named patient basis. Complete knowledge of its side effects is therefore particularly important. The literature contains remarkably little data on this topic. We therefore reviewed 192 consecutive patients for whom the drug had been prescribed in a district general hospital; 57% derived benefit while 76% noted side effects, none of which was dangerous or irreversible. Oxybutynin obtained from the two principal suppliers did not appear to differ either in efficacy or side effects. We discuss the uncertain medicolegal implications of named patient prescriptions.

Adolescent↗
PubMed1987

Single dose mezlocillin versus three dose cefuroxime plus metronidazole for the prophylaxis of wound infection after large bowel surgery.

A prospective, randomized, controlled trial was conducted in 116 consecutive patients undergoing colorectal surgery to compare single dose prophylaxis with mezlocillin to cefuroxime plus metronidazole in three doses. Patients were randomized to receive either a single dose of iv mezlocillin (5.0 g) or three doses of iv cefuroxime plus metronidazole at 8-hourly intervals. The first dose was given on the operating table. The overall wound infection rate in the mezlocillin treated patients (n = 54) was 30% and in the patients treated with cefuroxime plus metronidazole (n = 56) 25%. This difference is not statistically significant. When trivial wound infections were disregarded the wound infection rates were 11% and 16% respectively, which again was not statistically significant.

Adult↗