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Biomedical subjects

James Kelly

Publications and source records attributed to James Kelly.

33 records · Page 2Linked to original sources
PubMed2003

Ear, nose and throat disorders in children with Down syndrome.

OBJECTIVE: To document the reasons for which children with Down syndrome were referred to a pediatric otolaryngology practice, the underlying causes for these referrals, and the complications of routine surgical therapy. STUDY DESIGN: The study is a retrospective review of children referred to the Pediatric Otolaryngology Clinic at the University of New Mexico Health Sciences Center (Albuquerque, NM) during a period of 2.5 years. METHODS: Data were collected on 55 parameters related to ethnicity, demographics, diagnosis, surgical therapy, complications, and systemic comorbid conditions. RESULTS: The ethnicity of the study population was predominantly Hispanic or Latino (62%). The majority of children (76%) were referred for upper airway obstruction. Obstructive sleep apnea and laryngomalacia were the most common disorders in these children. An otological disorder was diagnosed in 70% of the children. Complications occurred after 27% of procedures for insertion of pressure equalization (PE) tubes to treat recurrent otitis media. Systemic comorbid conditions were present in 93% of the children, and the most common was gastroesophageal reflux disease. CONCLUSIONS: Obstructive sleep apnea and laryngomalacia were the most common reasons for referral of children with Down syndrome. Routine surgical procedures that required general anesthesia caused complications that are not common in other children. Treatment for systemic comorbid conditions should be considered as a component of therapy for otolaryngological disorders in children with Down syndrome.

Child↗
PubMed2003

Dog bites of the scalp, face, and neck in children.

OBJECTIVE: To update the surgical management of injuries from dog bites of the scalp, face, and neck in children. STUDY DESIGN: Retrospective case review. METHODS: A retrospective review of 44 children with dog bites of the scalp, face, and neck was carried out at the University of New Mexico Health Sciences Center (Albuquerque, NM) between January 1, 1995, and December 31, 2000. Data on demographics, hospitalization, surgery, and outcome were collected and entered into an Access 2000 database. RESULTS: The children ranged in age from 1.0 to 12.1 years. The mean age of the study population was 5.2 years (+/-2.9 y standard deviation). Sixteen severely injured children (36%) were hospitalized to repair damage to the airway and blood vessels of the neck or to treat hemodynamic compromise. The length of stay in hospital ranged from 1 to 16 days. The most common injury in these children was a scalp laceration (57%). Twenty-six less severely injured children (64%) were not hospitalized. The most common surgery in these children (88%) was repair of multiple facial lacerations. Attention deficit hyperactivity disorder was noted in the medical records of 12 children (29%). Complications occurred in five children (31%) who were hospitalized and nine children (35%) who were not hospitalized. CONCLUSIONS: The injured child is typically a 5-year-old boy attacked by a familiar dog at home or in the local neighborhood. Children with the diagnosis of attention deficit hyperactivity disorder appear to be at a higher risk of dog bite injuries and should be monitored during interactions with dogs. The goal of surgical management for severely injured children is to avoid immediate mortality and to establish a schedule of multiple-staged procedures for revision surgeries. An optimal cosmetic result is the principal goal for less severely injured children.

Animals↗
PubMed2003

Magnetic resonance direct thrombus imaging: a novel technique for imaging venous thromboemboli.

Invasive testing is now seldom required in patients with suspected venous thromboembolism (VTE). However, a corollary of noninvasive imaging is increased complexity as results are often yielded as probabilities rather than definitive answers and additional testing is frequently required following initial imaging. This creates a milieu in which misunderstandings and protocol violations are common, potentially leading to diagnostic errors. A highly accurate noninvasive imaging technique which allows immediate treatment decisions to be made is needed. Magnetic resonance direct thrombus imaging (MRDTI) is a novel technique which detects methaemoglobin in clot, allowing visualisation of thrombus without using intravenous contrast. It has two major advantages over conventional modalities which identify it as having the potential to fill this role. Firstly, direct visualisation of thrombus overcomes many of the pitfalls of conventional techniques, which have either identified thrombus as a filling defect or in terms of surrogates. Secondly, simultaneous imaging of the legs and chest allows a comprehensive assessment of thrombus load, minimising the importance of overlooked subsegmental pulmonary embolism (PE) and potentially facilitating more titrated treatment. Early data suggest MRDTI is highly accurate for the detection of both deep vein thrombosis (DVT) and PE, and ongoing out-come studies are evaluating the safety of withholding treatment in suspected DVT and PE on the basis of negative MRDTI alone. If favorable, a multi-centre outcome study evaluating cost-effectiveness as well as safety would be justified. Subject to further evaluation, this technique has the potential greatly to simplify and standardise the investigation of suspected VTE.

Algorithms↗
PubMed2002

Plasma D-dimers in the diagnosis of venous thromboembolism.

Clinical suspicion for venous thromboembolism (VTE) mandates objective testing to confirm or exclude the diagnosis. However, current imaging modalities are imperfect because of a small but important risk of complications with invasive techniques or limited sensitivity with noninvasive ones. A diagnostic tool for VTE is needed that is noninvasive and highly accurate, allowing immediate treatment decisions to be made in most cases. Plasma D-dimers (D-ds), specific cross-linked fibrin derivatives, partially fulfill these criteria in that they are sensitive markers for thrombosis but lack specificity. They therefore cannot be used to make a positive diagnosis of VTE; however, they generally have high negative predictive value and are useful as an exclusionary test, a potentially important role given that VTE is eventually ruled out in most patients investigated. Clinical management studies are clarifying the role of D-ds in the diagnostic paradigm of VTE: negative ultrasound and D-d findings obviate the need for serial imaging in suspected deep vein thrombosis, and anticoagulant therapy can be safely withheld in patients with non-high clinical suspicion for pulmonary embolism and non-high probability ventilation perfusion scan if D-d test results are negative. More recently, the combination of a negative SimpliRED (AGEN Biomedical Ltd, Brisbane, Australia) D-d result and low clinical suspicion derived using a formal scoring system has been shown to exclude deep vein thrombosis and pulmonary embolism and to obviate the need for imaging. Several different D-d assays are now available, and clinicians should be aware of the performance characteristics of the test used before incorporation into diagnostic algorithms as these will differ between assays, and the results of clinical management studies cannot necessarily be safely extrapolated to assays other than those specifically evaluated. If alternative assays are to be substituted, these should consistently have been shown to possess equivalent or greater sensitivity.

Biomarkers↗
PubMed2002

Bilateral orbital complications of pediatric rhinosinusitis.

Orbital complications of pediatric rhinosinusitis are usually unilateral at presentation. We describe 3 children with bilateral orbital cellulitis that occurred as a complication of rhinosinusitis. The children ranged in age from 11 to 14 years, had prolonged hospital stays that ranged from 10 to 19 days, and underwent multiple surgical procedures to drain subperiosteal and intraorbital abscesses. They appeared to have direct spread of disease from the ethmoid sinuses to both orbits, without intracranial spread of infection. Therefore, the presence of bilateral orbital complications of rhinosinusitis does not necessarily imply spread of disease to the cavernous sinus. Children who present with bilateral orbital complications of rhinosinusitis should be treated aggressively from the outset, since they suffer from a more widespread form of the disease.

Adolescent↗
PubMed2002

Initial experience with stapled anoplasty in the operative management of prolapsing hemorrhoids and mucosal rectal prolapse.

BACKGROUND: Excisional hemorrhoidectomy has remained the standard procedure in the operative management of hemorrhoids. Innovations in surgical technique have recently been introduced to try to decrease the pain associated with it. Stapled anoplasty has had promising early results in this regard. The aim of this study was to determine the ease or difficulty in introducing this new procedure, its efficacy, safety, and pain profile. DATA SOURCES: Nineteen patients underwent stapled anoplasty and were followed up from 8 weeks to 6 months postoperatively. Data were accrued through clinical evaluation and patient questionnaires. CONCLUSIONS: Seventy-two percent of patients had good to excellent results. There were no significant complications. Eighteen patients underwent surgery in an ambulatory setting and were discharged from hospital in a mean of 189 minutes. The procedure is safe and easily mastered. The staple line should be placed precisely at 3.5 to 4 cm from the dentate line to ensure greater efficacy.

Adult↗
PubMed2002

Delayed-onset multifocal polymicrobial keratitis after laser in situ keratomileusis.

We report a case of mixed Aspergillus fumigatus and coagulase-negative Staphylococcus stromal keratitis in a 43-year-old man who developed discomfort and swelling in his right eye 20 days after uneventful bilateral laser in situ keratomileusis (LASIK). Clinical examination revealed 2 distinct corneal infiltrates beneath the LASIK flap. Corneal scrapings were taken for microscopic examination and culture. Both infiltrates initially improved on topical antibiotic therapy, but over the next 18 days, 1 infiltrate worsened and repeat cultures were performed, which demonstrated A fumigatus. Natamycin 5% and amphotericin 0.1% were started and continued for 8 weeks with resolution of the infiltrate and return of the best corrected visual acuity. Delayed-onset multifocal keratitis is a rare complication of LASIK. Fungal entities should be considered in the differential diagnosis.

Adult↗
PubMed2002

Pulmonary embolism and pneumonia may be confounded after acute stroke and may co-exist.

Pulmonary embolism and pneumonia are prevalent complications after acute stroke that overlap significantly in their timing, risk factors and clinical features. Consequently, confounding and co-existence of these diagnoses can occur and is probably commoner than is generally appreciated. Correct identification of pulmonary embolism in these patients is important as the mortality of this condition following stroke is higher than in unselected patients. Clinicians should have a low threshold for suspicion of, and objective testing for, pulmonary embolism in stroke patients with acute cardiorespiratory symptoms, even if an alternative diagnosis is evident.

Humans↗