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Biomedical subjects

K M Kelly

Publications and source records attributed to K M Kelly.

At least 19 recordsLinked to original sources
PubMed1992

Long-term efficacy of triple-vessel angioplasty in patients with severe three-vessel coronary artery disease.

Between May 1982 and December 1988, a total of 103 patients underwent angioplasty of all three major coronary arteries at a single institution. Angiographic success was achieved in 334 of 352 vessels (95%) and in 441 of 460 lesions (96%). No patients required urgent bypass surgery, and none died during the procedure; six had non-Q wave infarctions. The mean length of follow-up time was 49 +/- 15 months (range 28 to 107 months). There have been 11 deaths, and one patient has undergone cardiac transplantation. Thirty-six patients had a clinical recurrence; 30 had repeat angioplasty and five had bypass surgery. Another nine patients eventually had bypass surgery after the clinical recurrence. At 48 months actuarial event-free rates are myocardial infarction, 98%; bypass surgery, 88%; and death, 89%. Of 86 current survivors, 58 are in functional class O to I, 21 are in class II, and seven are in class III.

Adult↗
PubMed1992

Demineralized perforated bone implants in craniofacial surgery.

Between July 1990 and September 1991, demineralized perforated allogeneic bone implants (Pacific Coast Tissue Bank, Los Angeles, CA) were placed in 72 patients. Because many patients received more than one implant, a total of 248 implants were used in 80 procedures. The technology of processing demineralized bone implants is described in detail. All patients were operated on by one surgeon (K.E.S.) at the Humana Craniofacial Institute in Dallas, Texas. Forty-one patients had craniofacial deformities, 16 had secondary deformities following cleft lip and palate repair, 8 had bony defects following removal of tumors, and 10 had various skeletal deformities following trauma. Of the 72 patients, 6 had two surgical procedures during which additional implants were inserted. Implants placed in the cranial vault and the maxillary complex, including alveolar grafts, were inlay grafts, whereas implants placed in the orbital, nasal, paranasal, temporal, and malar areas were onlay grafts used for contouring, augmentation, or both. Complications were limited to delayed wound healing in 6 patients. According to our observations, demineralized perforated bone implants represent an encouraging alternative to autogenous bone grafting. Further clinical and experimental studies are necessary to obtain more information about this material.

Adolescent↗
PubMed1992

Results of multidisciplinary management of bilateral cleft lip and palate at the Iowa Cleft Palate Center.

Bilateral cleft of the lip and palate is by many standards the most complex and severe form of the defect. The complexity and severity of the defect require an unusual degree of cooperation among all specialists and especially between the surgeon and the orthodontist. There are no published findings that we know about in which comprehensive data from a number of disciplines are reported for the same group of bilateral cleft patients. Fifty randomly selected patients with bilateral complete clefts were examined by the Iowa team and two orthodontists from other institutions. The evaluations revealed that a large number of patients over the age of 10 have multiple residual problems requiring further treatment. Only 23 percent of the older patients studied were judged to have had treatment completed by the surgeon, speech pathologist, and orthodontist. It is very difficult to state whether the results obtained by our team can be considered satisfactory because there are no comparable studies that have attempted to evaluate the same parameters in multidisciplinary management.

Adolescent↗
PubMed1991

Tetrahydroaminoacridine (THA) reduces voltage-dependent calcium currents in rat sensory neurons.

Tetrahydroaminoacridine (THA) is a centrally active anticholinesterase that also interacts with neuronal K+ and Na+ channels and cardiac Ca2+ channels. The effects of THA on neuronal voltage-dependent Ca2+ channels are not known. We tested the effects of THA (25 nM-250 microM) on the Ca2+ current components of acutely dissociated rat nodose ganglion and dorsal root ganglion (DRG) neurons using the whole cell patch clamp recording technique. THA reduced the low-threshold (T) and high-threshold (N/L) Ca2+ current components in a concentration-dependent manner (IC50 approximately equal to 125 microM for T; approximately equal to 80 microM for N/L). Minimal current reduction was seen below approximately 10 microM. Our results show that THA reduces voltage-dependent Ca2+ currents in rodent sensory neurons suggesting another means by which THA may affect Ca(2+)-dependent physiologic processes.

Animals↗
PubMed1991

Blood flow in expanded tissue treated with an anticontractile agent.

The present study investigates blood flow at several stages of expansion with and without enhancement by anticontractile agents (papaverine). Twelve 1-kg guinea pigs were divided into two groups. In group 1 were six animals undergoing tissue expansion without anticontractile agents, and in group 2 were six animals treated with a saturated solution of papaverine prior to expansion. Laser-Doppler velocimetry was used to monitor the changes in blood perfusion that occurred with each expansion. Animals pretreated with papaverine (group 2) maintained higher blood flow following inflation of the expander than untreated animals (group 1). This study provides physiologic evidence of the benefits of pharmacologic enhancement of the expansion process. Agents of this type may have a future role in the prevention of ischemic complications.

Animals↗
PubMed1991

Cricoid quartersection vs. anterior-posterior cricoid split: effect on subglottic growth in rabbits.

Five-week-old New Zealand white rabbits were divided into three groups: control, anterior-posterior cricoid split with stent, and cricoid quartersection (anterior-posterior-lateral cricoid split) with stent. The stents were removed 2 weeks after placement. The rabbits were allowed to grow for six months, at which time they were killed and the larynges were studied. Average, minimal, and maximal subglottal cross-sectional areas were calculated for each animal and adjusted for weight. The cricoid quartersection group had significantly greater average, minimal, and maximal subglottal cross-sectional areas compared to controls and significantly greater minimal and maximal cross-sectional areas compared to the anterior-posterior cricoid split group. The anterior-posterior cricoid split group and the control group did not significantly differ with respect to any of the three parameters. The results indicate that anterior-posterior cricoid split and cricoid quartersection do not adversely affect subglottic growth. Cricoid quartersectioning was superior to the anterior-posterior cricoid split in its ability to expand subglottic airway dimension.

Animals↗
PubMed1991

Reflections on research.

The authors present their reflections on several of the major topics related to research. The subjects discussed include the quantity and quality of research; the motivation for research; the research process; research paradigm; restraints of research; and freedom to research. They point out that the haste to achieve success and to publish in most cases has precluded the learning process about the substance and methodology of research. An attempt is made to relate general problems of research and its methodology to research in the area of congenital facial deformities.

Cleft Lip↗
PubMed1990

Valproic acid selectively reduces the low-threshold (T) calcium current in rat nodose neurons.

Valproic acid (VPA) is an antiepileptic drug used in the treatment of a wide variety of human seizures including generalized absence (GA) (petit mal) seizures. The mechanism of action of VPA in controlling GA seizures is not known. We tested the effects of VPA on the Ca2+ current components of acutely dissociated rat nodose ganglion neurons. VPA reduced the low-threshold (T) Ca2+ current at clinically relevant concentrations but had no effect on the high-threshold (N and L) current components. The effect on T current was concentration-dependent and most apparent at peak current. There was little effect seen on late current. VPA did not affect the rate or voltage-dependency of T current activation. The selective reduction of T current may be a means by which VPA is effective in controlling GA seizures.

Animals↗
PubMed1990

Electrophysiology and anatomy of medulla interneurons in the optic lobe of the cockroach, Periplaneta americana.

1. Medulla interneurons of the optic lobe of P. americana were studied to determine their spectral properties. These neurons exhibited tonic firing which changed with monochromatic broadfield illumination of the ipsilateral eye. The response patterns of these neurons were analyzed by inferring their relation to the ultraviolet (UV) and green (G) photoreceptor groups of the eye. Their anatomy was described after injection of Lucifer yellow. 2. Broadband neurons received either excitatory or inhibitory input from both UV and G receptors. These neurons were not strictly sensitive to luminosity levels and had large cell bodies in the central rind of the medulla and wide dendritic arbors in the medulla neuropil. 3. Narrow band neurons received input from predominantly one receptor type. Their spectral sensitivity curves were more finely tuned than those of the primary receptors presumably due to neural interactions within the optic lobe. 4. Color opponent neurons were inhibited by UV and excited by G inputs in their sustained response. Under certain conditions, some of these neurons also showed G inhibition. These neurons suggested the presence of a subsystem involved in color vision. 5. Broadband, narrow band and color opponent properties were seen in some single neurons when tested over a 5-6 log unit range of intensity. The responses of some of these neurons changed when stimulus duration was increased. These findings indicated that functional classification for these neurons was dependent on stimulus intensity and duration. 6. Polarizational sensitivity was tested in preliminary experiments. Two neurons responded to the movement and direction of polarized light.

Animals↗
PubMed1990

Multivessel coronary angioplasty early after acute myocardial infarction.

Coronary angioplasty has been applied in patients with recent myocardial infarction, but results of angioplasty of multiple vessels early after myocardial infarction in patients with severe multivessel disease have not been reported. Coronary angioplasty of multiple vessels was performed in 105 patients 0 to 15 days (mean 5 +/- 4) after recent myocardial infarction. There were 77 men (73%) and 28 women (27%), with a mean age of 57 years. All patients had severe multivessel disease, 68% with two vessel and 32% with three vessel disease. Twenty-eight patients (27%) had successful thrombolysis before angioplasty and 70 (67%) had postinfarction angina. Mean left ventricular ejection fraction was 58 +/- 10% and was less than 45% in 13 patients (12%). Angioplasty was attempted in 319 lesions (mean 3 lesions per patient, range 2 to 9) and 252 vessels (mean 2.4 vessels per patient, range 2 to 4), with success in 302 lesions (95%) and 237 vessels (94%); angioplasty was done in two stages in 59 patients (56%). Clinical success was achieved in 102 patients (97%). Complications included myocardial infarction in six patients (5.7%) (one Q wave, five non-Q wave), urgent bypass surgery in two (1.9%) and death in one (0.9%); overall, seven patients (7%) had a major complication. All patients had a follow-up duration greater than 1 year (mean 31 months, range 12 to 73). Clinical recurrence developed in 24 patients (23%), of whom 21 had repeat angioplasty, 1 had bypass surgery and 2 were managed medically. Ten patients (9.8%) had a late infarction and 5 (4.9%) died of cardiac death during the follow-up period.(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Balloon, Coronary↗
PubMed1990

Fostering self-help on an inpatient unit.

A self-help movement for people with chronic mental illness is growing but is not as advanced as the system of self-help for the chemically dependent. Barriers to organized self-help among those with chronic mental illness include stigma, denial, and the debilitating effects of the illnesses themselves. The authors developed a coping group on a 12-bed psychiatric unit to address these problems. The group was designed to strengthen ties with a local self-help club and to foster the idea that people with chronic mental illness can have a positive impact on the course of their illness. Mental health consumers who were successfully coping with their illnesses were guest speakers and role models for group members. The coping group, which was well received by participants, stimulated research questions and suggested potential modifications of clinical practice. In recent years, a mental health consumer movement has gathered momentum. Individuals who have been receiving psychiatric services are now clamoring for a more active role. There are currently several national consumer organizations that are growing in power and visibility. Some self-help groups, like Recovery Inc., are primarily therapy groups concerned with personal growth. Others, like the National Mental Health Consumers Association, are involved in supporting research and empowerment through political action as well as focusing on mutual-aid groups.

Adaptation, Psychological↗
PubMed1990

Enhancement of expansion of guinea pig skin by local delivery of an anticontractile agent using a new bilumen expander.

We have shown previously that anticontractile agents used with tissue expanders provide significantly more rapid expansion in an animal model than in controls without these agents. We describe an improved method of delivery involving a perforated concentric envelope enclosing a tissue expander (type 2) in place of the single circumferential perforated catheter (type 1) used previously by us. Eleven guinea pigs received a type 1 expander and ten received a type 2 expander. The anticontractile agent theophylline was delivered in saline around each expander, and all the expanders from both groups were inflated to a similar pressure every three days for twelve days. Significantly greater expansion, in terms of total volume delivered to the expander, was noted using the type 2 expander. We conclude that the concentric device offers further improvement, probably as a result of more uniform distribution of the agent in the tissue around the expander.

Animals↗
PubMed1990

Multiple intracerebral hemorrhages after smoking "crack" cocaine.

After smoking "crack" cocaine and consuming large quantities of ethanol, a 36-year-old man developed multiple, bilateral, deep, and superficial cerebral hematomas. He was hypertensive for several days, but angiography revealed no evidence of vascular malformation or vasculitis. The multifocality of the hematomas and lack of underlying disease suggest that the hemorrhages resulted from cocaine-induced acute hypertension or arterial spasm, possibly potentiated by heavy ethanol consumption.

Adult↗
PubMed1990

Serial measurement of blood flow in expanded tissue by laser Doppler velocimetry.

This study provides additional information about changes in blood flow in expanded tissue as measured by laser Doppler. Five one-kilogram albino Hartley guinea pigs were implanted with commercially available hemispheric expanders. The expanders were inflated every 3 days on four successive occasions. Blood flow measurements were taken on each animal just before each inflation, immediately after inflation, and then at 1, 2, 3, 4, and 24 hours after expansion. Measurement of flow changes immediately after each inflation of the expander showed that, initially, blood flow in the tissue overlying the expander recovered quickly, but as the expansion process was continued, the flow did not return to baseline values so rapidly. This might be an indication that tissue expansion in patients could be carried out more rapidly during the initial inflations, with increasing recovery periods between inflations as the expansion process continued.

Animals↗
PubMed1990

Does interference with mucoperiosteum and palatal bone affect craniofacial growth? An experimental study in beagles.

This study was designed to assess the effects of raising mucoperiosteal flaps and exposing palatal bone at the time of palatoplasty. Using 62 beagle puppies as subjects, we tested the hypothesis that raising mucoperiosteal flaps does not interfere with craniofacial growth. We further hypothesized that the size of the area of bone exposed following palatoplasty does affect subsequent craniofacial growth. The animals were divided into four groups: two control groups (unoperated and unrepaired) and two experimental groups. In the first experimental group, two-flap palatoplasty was used to close the surgically induced palatal defect, leaving narrow strips (0 to 2.5 mm) of bone exposed lateral to the flaps. In the second group, one flap was raised to close the defect, leaving a wide area (5 to 6 mm) of palatal bone exposed on one side. Thirty-four direct craniometric measurements were analyzed. Animals that had elevation of both mucoperiosteal flaps with narrow strips of denuded bone on both sides had less severe craniofacial growth aberrations than those in which the defect was left unrepaired or was repaired with one mucoperiosteal flap leaving a wider area of bare bone exposed. These findings suggest that raising mucoperiosteal flaps is less detrimental to craniofacial growth than leaving large areas of exposed palatal bone.

Analysis of Variance↗
PubMed1988

The hemodynamic effects of intravenous ranitidine in intensive care unit patients: a double-blind prospective study.

The hemodynamic effects of intravenous ranitidine were studied in a prospective double-blind fashion in postoperative intensive care unit patients to determine if this H2 blocker produced the same transient fall in mean arterial pressure and systemic vascular resistance known to occur with cimetidine infusion. We found no statistically significant hemodynamic changes from baseline associated with infusion of 50 mg ranitidine over a 5-minute period. The different chemical ring structure of ranitidine and its effect on H2 vascular and cardiac receptors may account for these observations.

Adult↗
PubMed1988

Triple vessel coronary angioplasty: acute outcome and long-term results.

Triple vessel coronary angioplasty, defined as angioplasty of one or more lesions in each of the three major coronary arteries (left anterior descending, left circumflex, right coronary artery) was performed in 50 (11%) of 469 patients who had angioplasty of multiple vessels. There were 32 men and 18 women with a mean age of 56 years. All 50 patients had severe three vessel coronary disease and represent approximately 5% of patients with three vessel disease who had revascularization in this institution; 8 (16%) had previous coronary bypass surgery, and 23 (46%) had previous myocardial infarction. Unstable angina was present in 33 patients (66%) and 96% had Canadian Heart Association class III or IV angina; mean left ventricular ejection fraction was 57 +/- 11%. Angioplasty was performed in 176 vessels (3.5 vessels per patient, range 3 to 6) and in 250 lesions (5 lesions per patient, range 3 to 9); angiographic success was achieved in 240 lesions (96%) and 166 vessels (94%). Success in all vessels attempted was achieved in 40 (80%) of the 50 patients. Clinical success (angiographic success associated with clinical improvement) was obtained in all 50 patients in whom triple vessel angioplasty was performed; none of them required urgent bypass surgery and 5 patients (10%) had a non-Q wave myocardial infarction. In four other patients triple vessel angioplasty was planned but not performed because of failure to dilate the primary vessel; urgent bypass surgery was required in one of these, who developed a Q wave infarction. Thus, overall clinical success in 54 patients was 93%; the incidence rate of myocardial infarction was 11%, and that of urgent surgery 1.8%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗