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Biomedical subjects

M C Kelly

Publications and source records attributed to M C Kelly.

At least 19 recordsLinked to original sources
PubMed2006

The gastrin gene promoter is regulated by p73 isoforms in tumor cells.

p73, a new p53 family member, is a transcription factor that is increasingly recognized in cancer research as an important player in tumorigenesis as well as in chemotherapeutic drug sensitivity. Despite the substantial structural and functional similarities to p53, accumulating evidence suggests that p53 and p73 may differently regulate their transcriptional targets. In this study, we have investigated the role of p73 in regulation of the gastrin gene promoter. Gastrin is a peptide hormone and an important factor in determining the progression of a number of human malignancies. Our results show that p73 can bind to the gastrin promoter. This leads to transcriptional upregulation of gastrin mRNA. We also found that the levels of gastrin and p73 transcripts correlate in primary gastric tumors. Taken together, our results demonstrate a novel mechanism for regulation of gastrin gene transcription and support a concept that p53 and p73 may have different biological roles in tumors.

Animals↗
PubMed1998

Intrathecal diamorphine for analgesia after caesarean section. A dose finding study and assessment of side-effects.

Eighty women undergoing elective Caesarean section under spinal anaesthesia using hyperbaric bupivacaine 0.5% were randomly allocated to receive, in addition, intrathecal diamorphine 0.125, 0.25 or 0.375 mg or saline. Postoperative morphine requirements, measured using a patient-controlled analgesia system, were reduced in a dose-dependent manner by diamorphine. Pain scores were significantly lower at 2 and 6 h following the two larger doses of diamorphine. Less supplemental analgesia was required intra-operatively if intrathecal diamorphine had been given. The incidences of vomiting and pruritus were also dose-related. No respiratory rates of less than 14 breath.min-1 were recorded and the incidence of oxygen saturation readings less than 95% and 90% did not differ between groups. There were no adverse neonatal effects. Intrathecal diamorphine in the present study was found to be safe in doses of up to 0.375 mg following Caesarean section. However, minor side-effects were frequently observed.

Adult↗
PubMed1997

Low dose epidural bupivacaine/fentanyl infusion does not mask uterine rupture.

A patient is described in whom the symptoms and signs of uterine rupture were not masked by combined spinal epidural analgesia with an epidural infusion of 0.1% bupivacaine and 1.5 microg ml(-l) fentanyl. Early recognition of the dehiscence of a previous caesarean section scar resulted in an excellent neonatal and maternal outcome.

Journal Article↗
PubMed1997

A comparison of the effect of intrathecal and extradural fentanyl on gastric emptying in laboring women.

UNLABELLED: We studied gastric emptying, using acetaminophen absorption, in 105 women in labor divided into three equal groups of 35 each, after intrathecal (i.t.) (25 micrograms, Group S) or extradural (50 micrograms, Group E) fentanyl in combination with bupivacaine and compared with a control group (Group C) receiving extradural bupivacaine only. The time to maximal acetaminophen concentration (tCamax), maximal acetaminophen concentration (Camax), and areas under the acetaminophen concentration-time curve at 90 and 120 min (AUC90 and AUC120, respectively) were determined. Median (range) tCamax values were 120 (15-180), 82.5 (15-180), and 90 (15-180) min in Groups S, E, and C, respectively (P < 0.05). Mean +/- SD Camax was 13.4 +/- 8.82, 17.9 +/- 8.06, and 15.0 +/- 6.22 micrograms/mL in Groups S, E, and C, respectively (P < 0.05). Mean +/- SD AUC90 and AUC120 were also significantly smaller in Group S than in the other two groups (430 +/- 616, 736 +/- 504, and 672 +/- 453; and 649 +/- 592, 1063 +/- 627, and 1053 +/- 616 micrograms.mL-1.min-1 in Groups S, E, and C, respectively). We conclude that the administration of fentanyl 25 micrograms i.t. delays gastric emptying in labor compared with both extradural fentanyl 50 micrograms with bupivacaine and extradural bupivacaine alone. IMPLICATIONS: We examined emptying of the stomach in women in labor after administration of analgesics by the spinal or the epidural route. We observed that the analgesic, fentanyl, administered by the spinal route, although relieving pain rapidly, may delay emptying of the stomach. In theory, delayed gastric emptying may increase the chance of vomiting and aspiration of gastric contents.

Adult↗
PubMed1996

Use of a modified non-rebreathing mask during upper intestinal endoscopy.

BACKGROUND AND STUDY AIMS: Recently, attention has been drawn to the significant occurrence of respiratory and other complications during upper intestinal endoscopy. This prospective study was designed to compare the incidence and severity of oxygen desaturation when two different methods of oxygen delivery were used during elective oesophagogastroduodenoscopy. PATIENTS AND METHODS: After local medical ethics committee approval and written informed consent, one hundred patients undergoing elective oesophagogastroduodenoscopy were randomly allocated to receive supplemental oxygen at either four litres per minute via nasal specular or ten litres per minute through a specially modified non-rebreathing mask. Oxygen saturations during endoscopy facilitated by midazolam sedation were recorded, and non-parametric tests were used to compare the oxygen saturations in the two groups. RESULTS: The mean oxygen saturations were significantly better during the procedure for American Society of Anesthesiology (ASA) grade 2 and 3 patients who received oxygen with the modified mask than for those who received oxygen via nasal specular (98.6% vs. 97.0%, P = 0.004 for ASA grade 2 and 98.4% vs. 95.5, P = 0.006 for ASA grade 3). CONCLUSIONS: For ASA grade 2 and 3 patients, the modified non-rebreathing mask significantly improves oxygen saturations during upper intestinal endoscopy. This technique should be more widely used for patients at moderate and high risk.

Adult↗
PubMed1996

Respiratory effects of spinal anaesthesia for caesarean section.

We report the changes observed in a number of pulmonary function tests performed on 36 patients undergoing Caesarean section under spinal anaesthesia. The tests comprised peak expiratory flow, forced expiratory volume in one second, forced vital capacity, forced expiratory volume in one second to forced vital capacity ratio and the maximal mid-expiratory flow. Significant changes occurred that are consistent with a restrictive ventilatory defect. These changes persisted for four hours after the induction of spinal anaesthesia. Administration of 35% oxygen by facemask failed to change significantly fetal umbilical vein pH or partial pressure of oxygen.

Adult↗
PubMed1995

Effect of nebulized lignocaine on airway irritation and haemodynamic changes during induction of anaesthesia with desflurane.

This study was designed to assess the effect of nebulized lignocaine or saline given before induction on the quality of induction of anaesthesia with desflurane in unpremedicated, young, adult males. Of the first six patients, five developed laryngospasm, breath-holding, coughing and increased secretions. In four patients oxygen saturation decreased to 92% or less. Significant tachycardia and hypertension occurred in four patients, and bradyarrhythmia after induction occurred in three patients. Hiccups and bronchospasm occurred in one patient. Because of the unacceptably high incidence of complications, the study was discontinued. The incidence and severity of complications were not decreased by administration of nebulized lignocaine and were higher than those reported by other workers. We conclude that in unpremedicated, young, adult males, induction of anaesthesia with desflurane and nitrous oxide in oxygen was associated with a high incidence of respiratory irritant effects, tachycardia, hypertension and post-induction bradyarrhythmia. We also found that lignocaine, as used in this study, did not appear to obtund the cardiovascular and respiratory complications during inhalation induction using desflurane.

Adult↗
PubMed1995

Relief of tension subcutaneous emphysema using a large bore subcutaneous drain.

We report a case of subcutaneous emphysema following multiple attempts to cannulate both subclavian veins for pacemaker insertion. Initial bilateral pneumothoraces were complicated by subcutaneous emphysema which became so severe that respiration and cardiac output became seriously impaired. The insertion of a single large bore subcutaneous drain produced a dramatic improvement. The aetiology, complications and management of tension subcutaneous emphysema are discussed.

Aged↗
PubMed1994

Investigation of an outbreak of Clostridium difficile infection in a general hospital by numerical analysis of protein patterns by sodium dodecyl sulfate-polyacrylamide gel electrophoresis.

One hundred forty-five cultures of Clostridium difficile, including strains from an apparent nosocomial outbreak of infection, were characterized by one-dimensional sodium dodecyl sulfate-polyacrylamide gel electrophoresis of whole-cell proteins. Each protein pattern was characterized by the presence of one to three dense bands which were highly reproducible. The first 100 strains (in chronological order) were used as the basis for a numerical analysis which divided the strains into 17 phenons (EP types 1 to 17). The protein patterns of the remaining 45 strains were identified to type by comparing their individual patterns against a data base made up of the protein patterns of the first 100 strains. EP type 1 was the most common, with 70 of 139 (50%) patient isolates having this pattern type, and it accounted for 26 of 35 strains (74%) from patients in a medical teaching ward from which the outbreak was believed to have originated. This type was also found as a high proportion of isolations in a number of other medical and oncology wards, but the majority of these isolates occurred subsequent to the isolations on the initial outbreak ward. This technique can therefore provide a method for tracing the possible spread of epidemic strains in hospitals and other institutions and may contribute to a better understanding of the epidemiology of C. difficile.

Adolescent↗
PubMed1994

Patients' perception of day case surgery.

A postal questionnaire was used to assess patient compliance with instructions, post-operative sequelae and general practitioner workload resulting from the day case unit of Daisy Hill Hospital, Newry. Compliance with instructions was good. There was little post-operative pain but there was a high incidence of other side effects. Few patients needed to see their general practitioner in the week following surgery.

Adult↗
PubMed1989

Age and malignant melanoma: comparison of variables in different age-groups.

Variables were compared in patients with clinical stage I superficial spreading melanoma who had been divided into three age-groups. The study included 736 consecutive patients who were prospectively entered into the data base of the Melanoma Cooperative Group of New York University Medical Center. Compared with the younger patients ( less than 40 years), older patients (greater than or equal to 60 years) had superficial spreading melanomas that were, on average, of greater thickness, level, and diameter. Younger patients were more likely than older patients to show evidence that their melanomas arose from preexisting nevocytic nevi. There was no difference in the 10-year survival between groups when melanomas were matched by thickness. Thus it is as important to perform periodic total cutaneous examinations in the elderly as it is in younger persons, and age alone should not determine management strategies.

Adult↗
PubMed1987

Cerebrospinal fluid immunoglobulins and neuronal antibodies in neuropsychiatric systemic lupus erythematosus and related conditions.

Neuronal antibodies found in the cerebrospinal fluid (CSF) of patients with systemic lupus erythematosus (SLE) may be locally produced, or may enter through a damaged blood-brain barrier. We measured CSF serum/albumin and IgG ratios, oligoclonal banding, and paired CSF/serum neuronal antibody in 36 patients and 98 controls. Only 14% of SLE CSF contained neuronal antibodies; 80% of these had clinically overt neuropsychiatric manifestations. None of 73 patients with noninflammatory central nervous system (CNS) disease had CSF-neuronal antibodies, compared with 8/61 with SLE or related inflammatory CNS disorders (p less than .001). In SLE, CSF neuronal antibodies were accompanied by high titer serum neuronal antibodies (p less than 0.03) or abnormal Q-albumin and occurred only when serum neuronal antibodies were present. CSF-neuronal antibodies appear to be related to immune-inflammatory CNS disease, especially SLE, and may traverse a damaged blood-brain barrier.

Antibodies↗
PubMed1986

Manubriosternal joint dislocation in rheumatoid arthritis: the role of thoracic kyphosis.

A case report of manubriosternal joint (MSJ) dislocation in a rheumatoid patient with thoracic kyphosis is presented together with a review of the relevant literature. Variations in the anatomical nature of the MSJ between normal individuals are described. In 43% of the population its characteristics are noted to be such that it may be involved in rheumatoid arthritis (RA). A joint thus involved can be dislocated by forces generated by longstanding thoracic kyphosis and transmitted to the manubrium via the first rib. Xeroradiographs of the MSJ region in our patient showed dislocation of the joint in the upright position and its subsequent reduction on lying the patient flat. We suggest that this demonstrated reduction is secondary to the lessening of the thoracic kyphosis that occurs in the supine position. It is concluded that in RA MSJ dislocation is a function of thoracic kyphosis.

Arthritis, Rheumatoid↗
PubMed1984

Rapid identification of antibiotic-resistant corynebacteria with the API 20S system.

The API 20S system (Analytab Products, Plainview, N.Y.) was evaluated for the rapid identification of multiply antibiotic-resistant aerobic diphtheroids. Sixty-eight clinical isolates of multiply resistant Centers for Disease Control group JK and group D2 corynebacteria had API 20S profiles which were clearly different from those of a number of strains of other Corynebacterium species which were tested. The API 20S system allowed more rapid identification of antibiotic-resistant diphtheroids than conventional biochemical tests. Its use for corynebacteria other than group JK and group D2 is not recommended at this time.

Anti-Bacterial Agents↗