PubMed Health⌕ Search

Biomedical subjects

J P Kelly

Publications and source records attributed to J P Kelly.

At least 19 recordsLinked to original sources
PubMed1992

High prevalence of cobalamin deficiency in elderly outpatients.

OBJECTIVE: To measure the prevalence of cobalamin (vitamin B12) deficiency in geriatric outpatients as documented by both low serum cobalamin levels and elevations of serum methylmalonic acid and homocysteine and to determine the response to cobalamin treatment. DESIGN: Prospective study screening elderly subjects for cobalamin deficiency using radiodilution cobalamin assays as well as stable isotope dilution gas chromatography-mass spectrometry methylmalonic acid and homocysteine assays. In patients with serum cobalamin levels < or = 300 pg/mL, the response to cobalamin treatment in the group with levels of methylmalonic acid and/or homocysteine > 3 standard deviations (SD) above the mean for normals was compared with that of those without such elevations. SETTING: Outpatient geriatric clinics at the VA Medical Center and University Health Sciences Center, Denver, CO. PATIENTS: One-hundred and fifty-two consecutive outpatients, ages 65 to 99, were screened. Twenty-nine subjects with serum cobalamin levels < or = 300 pg/mL were prospectively evaluated and treated with cobalamin. MAIN OUTCOME MEASURES: Cobalamin, methylmalonic acid, homocysteine, complete blood counts, neurologic examination, and neuropsychological testing. RESULTS: The prevalence of cobalamin deficiency as defined by a serum cobalamin level < or = 300 pg/mL and levels of serum methylmalonic acid and/or homocysteine elevated to > 3 SD was 14.5% of the screened outpatients. A similar proportion of patients with low normal serum cobalamin levels (between 201 and 300 pg/mL) demonstrated elevated metabolites > 3 SD (56%) compared with patients with low serum cobalamin levels (< or = 200 pg/mL) (62%). Cobalamin therapy caused a marked fall or complete correction of the elevated methylmalonic acid and homocysteine levels in each patient who was treated prospectively. Results for complete blood count, lactate dehydrogenase, bilirubin, baseline neurologic score, and baseline neuropsychologic scores did not differ in the group of patients with elevated metabolites compared with those with normal metabolites. The mean red cell volume fell significantly in the patients with elevated metabolites after 6 months of cobalamin treatment. One patient with elevated metabolites had marked improvement in his neurologic abnormalities after 6 months of cobalamin treatment. CONCLUSION: There was a high (14.5%) prevalence of cobalamin deficiency as demonstrated by elevations in serum methylmalonic acid and homocysteine in addition to low or low normal serum cobalamin levels in elderly outpatients. The serum cobalamin level was insensitive for screening since similar numbers of patients with low normal serum cobalamin levels of 201-300 pg/mL compared with patients with low cobalamin levels (< or = 200 pg/mL) had markedly elevated metabolites which fell with cobalamin treatment. Additional studies will be required to define the full clinical benefit from treatment with Cbl in elderly subjects.

Aged↗
PubMed1991

Concussion in sports. Guidelines for the prevention of catastrophic outcome.

Concussion (defined as a traumatically induced alteration in mental status, not necessarily with loss of consciousness) is a common form of sports-related injury too often dismissed as trivial by physicians, athletic trainers, coaches, sports reporters, and athletes themselves. While head injuries can occur in virtually any form of athletic activity, they occur most frequently in contact sports, such as football, boxing, and martial arts competition, or from high-velocity collisions or falls in basketball, soccer, and ice hockey. The pathophysiology of concussion is less well understood than that of severe head injury, and it has received less attention as a result. We describe a high school football player who died of diffuse brain swelling after repeated concussions without loss of consciousness. Guidelines have been developed to reduce the risk of such serious catastrophic outcomes after concussion in sports.

Adolescent↗
PubMed1991

Topography and mechanics of the cupula in the fish lateral line. I. Variation of cupular structure and composition in three dimensions.

The cupula of the supraorbital neuromast in the lateral line canal of the clown knifefish contains vertical columns. In the central region of the cupula overlying the macula, these columns are densely packed, are relatively constant in size, and run from the base of the cupula to the surface of the cupula which is exposed to canal fluid. There are two types of columns, dark and light, which form elliptical compartments in planes of section that cut across the columns; the cupula therefore has the appearance of mosaic tile in such sections. The dark compartments contain tubules that extend from the base of the cupula at the junction with the macula to the top of the cupula. Each tubule is associated with the kinocilium of a single hair cell. The lateral parts of the cupula, not overlying the macula, also contain compartments, but these compartments differ in size and structure from those in the central region. In addition to the compartments, the central region of the cupula also contains spherical aggregates of droplets. These small aggregates, termed mora, are found principally in a layer within the central region of the cupula, but are also found outside this layer. Because of their light-reflecting properties, the mora can be used for noninvasive optical measurements in vivo of the motion of the cupula.

Acoustic Maculae↗
PubMed1991

Psychophysical measurement of spectral sensitivity and color vision in red-light-reared tree shrews (Tupaia belangeri).

The role of the spectral lighting environment on the post-natal development of spectral sensitivity and color vision was studied in tree shrews (Tupaia belangeri) that were born and reared to adulthood in cyclic red light. Normal tree shrews are dichromats, possessing short-wavelength-sensitive (SWS) and long-wavelength-sensitive (LWS) cone receptors and a small population of rods. Red-light-rearing (RLR) produced differential stimulation of the cone types by effectively eliminating photic stimulation of the SWS cones, without depriving the LWS cones. Spectral sensitivity and color vision were measured behaviorally for RLR shrews and normal shrews under different ambient light levels. Spectral sensitivity functions were deutan-like, exhibiting maxima at ca 450 and 550 nm and a minimum at 510 nm. No significant differences in spectral sensitivity were observed between RLR and control animals. Furthermore, all animals demonstrated deutan-type dichromatic color vision evidenced by their ability to discriminate monochromatic lights from equally-bright achromatic lights except for a "neutral point" near 505 nm. These results demonstrate that a population of functional SWS cones survived the lack of post-natal photic stimulation. However, RLR shrews differed from controls in that they were poorer at making chromatic/achromatic discriminations. While no severe disorganization of color vision was evident, the poorer discrimination displayed by the RLR animals is likely the result of changes in post-receptoral visual mechanisms.

Animals↗
PubMed1991

Risks of agranulocytosis and aplastic anemia in relation to the use of cardiovascular drugs: The International Agranulocytosis and Aplastic Anemia Study.

The risks of agranulocytosis and aplastic anemia in relation to the use of cardiovascular drugs were estimated in a population-based case-control study conducted in Israel and Europe (total population, 23 million). Cardiovascular drug use in the week before onset of illness was compared between 270 patients hospitalized with agranulocytosis and 1870 hospitalized control subjects. Propranolol (relative risk, 2.5), dipyridamole (3.8), digoxin (2.5), and acetyldigoxin (9.9) were significantly associated with agranulocytosis. The excess risks attributable to these drugs ranged from one to three cases per 10 million persons exposed for up to 1 week. Increased risks were also observed for cinepazide (used by six cases and no control subjects), procainamide (7, 1), and aprindine (5, 1); based on crude relative risk estimates, the excess risks for the latter two drugs were approximately three per million persons exposed for up to 1 week. The use of cardiovascular drugs in a 5-month period ending 1 month before hospital admission was compared between 152 patients with aplastic anemia and 2180 control subjects. Furosemide was the only significantly associated drug (relative risk, 3.1); the excess risk attributable to any exposure in a 5-month interval was 1.7 per million.

Adrenergic beta-Antagonists↗
PubMed1990

Reliability of personal interview data in a hospital-based case-control study.

Responses to interview questions were compared for concordance among 492 individuals interviewed more than once in a hospital-based case-control surveillance system in the United States, Canada, and Israel between 1976 and 1982. Reliability of the data was determined using the Kappa statistic and the intraclass correlation coefficient. Reliability was good to excellent for demographic factors, such as birthplace, and for medical conditions/procedures that require hospitalization or continuing medical care, such as hysterectomy. Reliability was fair to good for less serious or less well-defined medical conditions/procedures, such as cystic breast disease, and for current habits, such as daily coffee consumption. Regarding medication use, reliability was poor to fair for drugs taken intermittently, such as aspirin and penicillin, and good to excellent for drugs taken on a regular basis, such as oral contraceptives. As expected, medications were reported more consistently when duration of use was prolonged. The data were also analyzed according to two intervals between interviews (less than 1 year and greater than or equal to 1 year). For most factors, reliability was not materially affected by interval. Where differences were observed, reliability tended to be better when the second interview followed the first by less than 1 year. These results suggest that structured interviews administered to hospital patients by trained personnel can elicit reliable data on demographic and medical history factors.

Adult↗
PubMed1989

Hydralazine use in relation to cancers of the lung, colon, and rectum.

It has been suggested, based on animal experiments and limited human data, that the anti-hypertensive drug hydralazine might be carcinogenic, and among the sites of concern are the lung and colon. To assess the possible relationship between the use of hydralazine and lung and colorectal cancers in humans, we compared 1006 cases of lung cancer with 3531 hospital control subjects, and 972 cases of colorectal cancer with 3276 controls. Data were collected by interview in hospitals in the United States and Canada. Overall, 1.1% of the lung cancer cases, 1.6% of the colorectal cancer cases, and 1.5% of the controls had used hydralazine. Compared with those who had never used hydralazine, the relative risk estimate of lung cancer for those who first took the drug at least 18 months before hospital admission was 1.1 (95% confidence interval 0.4-2.9). The estimate for use for at least 1 year was 1.4 (0.5-3.8) and for use for at least 5 years the estimate was 0.9 (0.2-4.3). The corresponding relative risk estimates for colorectal cancer were 1.2 (0.5-2.5) for any use, 1.7 (0.8-3.7) for use for at least one year, and 2.4 (0.8-6.9) for five or more years of use. Other antihypertensive treatments and risk factors, including cigarette smoking in the analysis of lung cancer, were taken into account in these estimates. Although the effect of use after long latent intervals could not be evaluated, the results provide no support for the hypothesis that hydralazine use increases the risk of lung cancer.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Noncontraceptive estrogen use and epithelial ovarian cancer.

The relation of noncontraceptive estrogen use to epithelial ovarian cancer was evaluated in a case-control study conducted in hospitals mainly in the northeastern United States. There were 377 cases diagnosed within the year before hospital admission and 2,030 hospital controls; data were collected by interview in the hospital. Compared with women who never took noncontraceptive estrogens, the overall relative risk estimate for women whose estrogen use lasted at least one year and was not combined with progestogens or testosterone was 1.2 (95% confidence interval (CI) 0.8-1.9), after taking into account risk factors for ovarian cancer. There were 55 cases of the endometrioid, clear cell, or malignant mixed mesodermal cell type; the corresponding relative risk estimate was 0.9 (95% CI 0.3-3.0). There were 26 cases of undifferentiated cell type, with a relative risk estimate of 3.6 (95% CI 1.2-11). Relative risk estimates were similar in a subset of the cases (57%) for which pathology slides were reviewed. For estrogen use of long duration, use of high-dose preparations, or use in the distant past, the relative risk estimates were not significantly different from 1.0. The estimates were elevated for some categories of use, but not consistently--for example, for an interval of 5-9 years since estrogen use began (relative risk (RR) = 2.7), but not after shorter or longer intervals, and for use of conjugated estrogens with a dose of 0.3 mg (RR = 3.2) or 1.25 mg (RR = 2.4), but not for doses of 0.625 mg or 2.5 mg. The relative risk estimate was also elevated for use by nulliparous women (RR = 2.4). The results suggest that, overall, noncontraceptive estrogen use is not associated with the risk of epithelial ovarian cancer. Furthermore, our data do not support the hypothesis that estrogens increase the risk of endometrioid ovarian cancer. The elevated estimates could be due to multiple stratification of the data, but they should be explored in further studies, given the lethality of ovarian cancer and the common use of estrogens by postmenopausal women.

Adult↗
PubMed1989

Clinical results with a percutaneous bone-anchored hearing aid.

During a 2-year period ending in July 1987, nine patients were implanted with a percutaneous bone-anchored hearing aid developed at the University of Gothenburg and Chalmers University of Technology, Sweden. Patients selection was based on the presence of conductive or mixed hearing loss in patients who are unable to wear a conventional hearing aid because of infection or ear canal problems. Patients had speech discrimination scores of at least 60% for phonetically balanced monosyllables (CID lists) at 40 dB above threshold, and a pure tone bone conduction average of 45 dB hearing loss or better. Patients were evaluated in sound field, preoperatively and postoperatively using warble tones, speech reception threshold, speech discrimination, and synthetic speech identification. The patient's unaided hearing and hearing with a bone-anchored hearing aid were compared with the patient's hearing with a standard bone conduction hearing aid. Signal to noise ratio testing with the synthetic speech identification test demonstrated that the bone-anchored hearing aid was comparable to a standard bone conduction aid. There were no complications in our series. Five patients who reported otorrhea with conventional hearing aids experienced no otorrhea after implantation. Patient satisfaction, as assessed by questionnaire, revealed that all patients preferred the bone-anchored hearing aid to previously worn hearing aids.

Adult↗
PubMed1988

Coffee drinking and nonfatal myocardial infarction in men under 55 years of age.

The relation of coffee consumption to the risk of nonfatal first myocardial infarction in men under 55 years of age was assessed in a hospital-based case-control study conducted from 1980 to 1983 in hospitals in Massachusetts, Rhode Island, Connecticut, and New York: 1,873 men with first nonfatal myocardial infarctions were compared with 1,161 controls admitted for conditions unrelated to coffee ingestion. After allowance for major risk factors for myocardial infarction, the relative risk estimate for recent consumption of caffeine-containing coffee increased with increasing level of daily intake, from 1.4 for one to two cups per day to 1.6 for three to four cups, 1.8 for five to nine cups, and 2.9 for greater than or equal to 10 cups, relative to consumption of no coffee (p less than 0.001 for trend). The association was apparent in each age group and in both smokers and nonsmokers. For those who drank decaffeinated coffee only, on the basis of small numbers, there was a suggestion of an increased risk among men who had consumed at least five cups daily for less than five years but not among those who had drunk this amount for at least five years; whether the apparent association among the shorter-term drinkers was due to previous consumption of caffeine-containing coffee could not be determined. The findings suggest that caffeine-containing coffee increases the risk of myocardial infarction and that men who drink at least five cups daily may increase their risk by about twofold or more.

Adult↗
PubMed1987

The acoustical characteristics of the normal and abnormal temporomandibular joint.

This paper describes the results of a clinical study that recorded and analyzed sounds emitted from the temporomandibular joint (TMJ) during simple function as a means for differentially diagnosing disorders of the joint. The technique is based on the principle that each different disorder of the TMJ produces a different effect on the mechanical relationship between the articulating surfaces of the joint, and that these mechanical effects can be determined by analyzing joint sounds in relation to joint movement. A total of 79 patients (101 joints) were studied; 32 (46 joints) were diagnosed as having extracapsular disorders, (primarily MPD), 27 (32 joints) were diagnosed as having a displaced disc with reduction, nine (10 joints) were diagnosed as having a displaced disc without reduction, and 11 (13 joints) were diagnosed as degenerative disease (osteoarthritis/arthrosis). In addition, 25 adults (50 joints) with normal TMJs were included as controls. The results of this study demonstrated that each specific disease of the TMJ is characterized by a unique relationship between the sounds propagated by the joint and the movement of the joint. Essentially, an extracapsular disease was characterized by acoustic quiescence during natural (as opposed to maximal) jaw movement, an internal derangement by a usually symmetrical short duration click/reciprocal click, or random click complex, depending on the subcategory of the disorder, and a degenerative disease by a long duration noise during either or both jaw opening and closing. The data further suggest that the technique serves to reflect the mechanical events (and abnormalities) that are involved in function of the diseased joint and has potential for use as a clinical diagnostic tool.

Acoustics↗
PubMed1987

Management of airway trauma. II: Combined injuries of the trachea and esophagus.

Twenty-four consecutive patients with combined injuries of the trachea and esophagus were operated on at the Tulane University Hospital and the Charity Hospital of New Orleans between 1967 and 1983. Only 3 of the injuries resulted from blunt trauma, and 1 of these patients had a total transection of both the trachea and esophagus; the remaining injuries were due to penetrating trauma (20 gunshot wounds; 1 stab wound). The combined lesions involved the cervical region in 20 patients and the thoracic esophagus and trachea or bronchus in 4. All patients underwent bronchoscopy; in recent years all have had esophagoscopy, because our experience indicates that esophagrams, which patients also underwent, have a high rate (12.5%) of false negative results. Operative techniques included a two-layer closure of all esophageal injuries, closure of the trachea with non-absorbable monofilament suture, and transthoracic or cervical drainage. Muscle flaps were used for suture line reinforcement. Associated operative procedures included tracheostomy (5), laparotomy (4), vascular procedures (5), neurologic procedures (2), and closed-tube thoracostomy (6). Five patients (21%) died in the perioperative period, 4 of 20 with combined cervical injuries, and 1 of the 4 with combined thoracic injuries. Deaths resulted from missed injuries to the esophagus (2 patients), a missed tracheal injury (1), associated vascular injury (1), and associated thoracoabdominal injury (1). Two patients experienced cervical esophageal suture line leaks, both of which sealed with conservative therapy. Clinical follow-up showed good results in 90% of the patients who survived.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗