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Biomedical subjects

P C Kelly

Publications and source records attributed to P C Kelly.

At least 19 recordsLinked to original sources
PubMed1994

Progression of tympanometry and acoustic reflectometry. Findings in children with acute otitis media.

The presence of middle ear effusion (MEE) following acute otitis media (AOM) has been assessed by impedance tympanometry and acoustic reflectometry but has not been assessed serially from the time of presentation for AOM in the same group of patients. This descriptive study examined serial measurements by tympanometry and reflectometry in children with clinical AOM at the time of diagnosis, 3 to 5 days later, and at final follow-up 12 to 15 days after diagnosis. The study entry criteria were conservative in order to represent obvious cases of AOM and included 90 patients representing 107 ears. The objective was to describe the evolution of instrumental findings and to attempt to identify unique patient subpopulations with differing prognoses. We found that combined use of initial tympanometry and reflectometry, while yielding intriguing results, does not allow for identification of subpopulations with good or poor progression for MEE clearance at 2-week follow-up. It is our conclusion that initial tympanometry and reflectometry add to the cost of AOM diagnosis without clear benefit for the individual patient.

Acoustic Impedance Tests↗
PubMed1991

Impedance tympanometry and acoustic reflectometry at myringotomy.

A total of 220 ears undergoing myringotomy and pressure-equalizing tube placement were studied with impedance tympanometry and acoustic reflectometry in a direct comparison for detection of middle-ear effusion. Impedance tympanometry and acoustic reflectometry were equally accurate, detecting the presence or absence of middle-ear effusion in 73% and 72% of ears, respectively. The presence of effusion in ears with tympanographic patterns other than type A and type B was not consistently and reliably predicted. The higher sensitivity of impedance tympanometry (90%) compared with that for acoustic reflectometry (58%) contrasted with the opposite findings for specificities (54% vs 88%). It is concluded that impedance tympanometry and acoustic reflectometry measure different events at the tympanic membrane and their utility lies in the fact that they complement each other. These instruments can aid the experienced otoscopist in confirming a clinical impression and assist the less experienced clinician in validating or improving otoscopic skills.

Acoustic Impedance Tests↗
PubMed1990

Coccidioidomycosis during human immunodeficiency virus infection. A review of 77 patients.

Through a retrospective review, we identified 77 previously unreported cases of coccidioidomycosis during HIV infection. Patients were classified into 1 of 6 categories based on their primary clinical presentation: 20 had focal pulmonary disease (Group 1), 31 had diffuse pulmonary disease (Group 2), 4 had cutaneous coccidioidomycosis (Group 3), 9 had meningitis (Group 4), 7 had extrathoracic lymph node or liver involvement (Group 5), and 6 has positive coccidioidal serology without a clinical focus of infection (Group 6). Coccidioidal serologies were positive on initial testing in 83% of the patients in whom such serologic testing was performed. Sera from 39% of patients were positive for TP antibodies while 74% had CF antibodies. Eleven of 12 seronegative patients had pulmonary disease (Group 1 or 2). Serologic results of other patients sent to a single reference laboratory were similar, with 26% positive for immunodiffusion TP antibodies and 79% positive for immunodiffusion CF antibodies. For the 77 patients in this study, the CD4-lymphocyte count was below 0.250 X 10(9) cells/L in 46 of the 55 patients who had this test performed, and a low CD4 count was significantly associated with mortality (p less than 0.01). At the time of follow-up, 32 of the 77 patients (42%) had died. There were significantly more deaths in those with diffuse pulmonary disease (Group 2) than in other groups (p less than 0.001). Amphotericin B, ketoconazole, fluconazole, and itraconazole were all used as antifungal therapies. Outcome could not be related to the therapy used. Of note, 3 patients developed coccidioidomycosis while receiving ketoconazole for other conditions.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Tandem Y/6 translocation with partial deletion 6 (p23----pter).

An infant with multiple malformations had a de novo tandem translocation of the Y chromosome to chromosome 6. The karyotype 45,X,tan(Y;6) (q12;p23) resulted in a partial monosomy of 6p23----pter. Many of the effects of ring chromosome 6 are present in this case.

Abnormalities, Multiple↗
PubMed1989

Parent, teacher, child. A trilateral approach to attention deficit disorder.

We compared the effectiveness of three instruments in initially diagnosing and monitoring children with attention-deficit disorder with and without hyperactivity (ADD/H). Twenty-one children clinically assessed as having ADD/H and meeting criteria of the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, were examined initially and after treatment with methylphenidate hydrochloride and placebo. The following instruments were used: the ADD-H Comprehensive Teacher Rating Scale, the Connors' Parent Rating Scale-Revised, and the Gordon Diagnostic System. The ADD-H Comprehensive Teacher Rating Scale initially classified 67% of the children as having ADD/H and 14% as borderline. The Connors' Parent Rating Scale-Revised identified 71% as having ADD/H, while the Gordon Diagnostic System assessed 52% as having ADD/H and 29% as borderline. With methylphenidate treatment, the mean scores on the ADD-H Comprehensive Teacher Rating Scale displayed an increase in attention span and a decrease in hyperactivity, the Connors' Parent Rating Scale-Revised showed a significant decrease in ADD/H behavior, and the Gordon Diagnostic System mean scores indicated no significant change.

Attention Deficit Disorder with Hyperactivity↗
PubMed1989

Self-esteem in children medically managed for attention deficit disorder.

Self-esteem was measured initially in a group of 21 eight- to 12-year-old children with newly diagnosed attention deficit disorder/hyperactivity and remeasured after 1-month courses of treatment with methylphenidate and placebo given in double-blind crossover fashion. Multimodal management of all patients included diagnosis, demystification, medication, close follow-up with supportive counseling, and referral as indicated for psychosocial and educational assistance. Long-term follow-up of 12 children who continued to receive methylphenidate was done for an average of 16 months. Initial total self-esteem was low in 30% of all subjects, intermediate in 55%, and high in 15%. No statistically significant changes occurred in self-esteem during the short-term phase of the study despite clinically significant behavioral responses to medication as assessed by serial questionnaires. At long-term follow-up, total, general, and academic self-esteem scores were improved significantly, however. These findings indicate that many preadolescents with attention deficit disorder/hyperactivity exhibit low self-esteem. Despite clinical response to medication, short-term improvement in self-esteem may not occur; however, long-term, multimodal management that includes medication does appear to improve self-esteem.

Attention Deficit Disorder with Hyperactivity↗
PubMed1987

Infantile polyarteritis nodosa with mucocutaneous lymph node syndrome treated with long-term corticosteroids.

Clinical and pathologic similarities between infantile polyarteritis nodosa (IPN) and mucocutaneous lymph node syndrome (MLNS, or Kawasaki disease) have suggested that these entities may be different manifestations of the same basic disease process. We have described a boy with IPN/MLNS treated with long-term corticosteroids for more than eight years after the appearance of multiple aneurysms at 11 months of age. Corticosteroid therapy may be appropriate in the treatment of selected patients with IPN/MLNS if based on age and the presence of aneurysms.

Aneurysm↗
PubMed1986

"Latchkey". Three voices with one message.

Two to five million children, 6 through 13 years old, are unsupervised at home after school. This practice, called "latchkey," involves issues of children without adult supervision for periods of time and questions of safety and social isolation. There are no published age guidelines for "latchkey" or data on actual practice. To investigate age guideline opinions and the factors that influence them, a survey of pediatricians (the professional voice), military police (the legal voice), and parents (the popular voice) was undertaken. Solicited opinions concerned ages at which children can be left alone for brief or extended periods and can be allowed to babysit younger children. The three "voices" expressed similar mean ages and distributions for each of the "latchkey" questions. For less than 15 minutes without supervision, the means approximated 9 years; for periods of 1 hour or longer, 12 years; and for babysitting, 14 years. The data presented do not address actual or appropriate practice, but instead provide a basis to begin investigation.

Adolescent↗
PubMed1985

A survey of parental opinions on corporal punishment in schools.

Forty-three states permit corporal punishment in schools. This practice continues despite the universal opposition of professional organizations, including the American Academy of Pediatrics. This study determines parental attitudes concerning the use of physical punishment in schools. The surveyed sample is drawn from parents of military dependents who brought their children to this clinic for routine physical examinations. One hundred and twenty-nine of 132 questionnaires were returned for a 98% response rate. Fifty-one percent of the parents supported the use of corporal punishment in schools, 37% disagreed (77% of these strongly), 11% had no opinion, and 1% did not respond to the question. Analysis of the responses displayed a relationship between parental attitudes on the use of corporal punishment and opinion of the positive effects of physical punishment on children's behavior (p less than 0.0001). No relationship was found between position on corporal punishment and the respondent (mother, father, or both), the age of parents, the military rank of the sponsor (the individual whose military service makes the child eligible for military medical care, i.e., father, mother, guardian, etc.), the sex of the children, the marital status of the parents, or the schools attended by the children (public or private). Thirty-four percent of parents believed corporal punishment would improve behavior, and 20% of parents felt that physical punishment would improve their child's academic performance.

Achievement↗
PubMed1981

Rapid identification of material colonization with group B streptococci by use of fluorescent antibody.

To identify women colonized with group B streptococci during parturition, we used pooled type-specific fluorescent antibody to examine vaginal swabs enriched by preincubation in selective broth medium. In preliminary experiments, group B streptococcus strain III-Bell was reliably detectable with fluorescent antibody at concentrations of greater than 10(5) colony-forming units per ml, achieved after 6 h of incubation of small inocula (18 to 26 colony-forming units). Of the vaginal swabs from 924 parturient women examined prospectively by both fluorescent antibody and selective bacteriology techniques, group B streptococci were isolated in 154. The sensitivity of the fluorescent antibody technique increased with increasing incubation time and ranged from 49% (3 to 6 h) to 81% (7 to 12 h) to 83% (13 to 18 h) to 93% (greater than 18 h). Colonized mothers identified within 6 h by the fluorescent antibody technique had higher rates of vertical transmission to their newborn infants (61%) than colonized mothers whose fluorescent antibody examinations were negative within this time interval (32%; P = 0.027). However, because of the timing of their admissions, none of the colonized mothers of the four infants who developed early-onset group B streptococcal sepsis were identified with fluorescent antibody until after delivery. Although its sensitivity approaches selective culture methods after 6 h of incubation, fluorescent antibody examination of vaginal swabs does not appear to offer a practical approach to identifying colonized parturient women for intrapartum antibiotic prophylaxis of group B streptococcal infection.

Female↗
PubMed1979

Histoplasmin-CYL, a yeast phase reagent in skin test studies with humans.

A yeast phase histoplasmin, designated CYL, was studied in 156 humans living in areas of the United States endemic for histoplasmosis, coccidioidomycosis, or both fungal entities. Comparisons were made with Food and Drug Administration reference mycelial histoplasmin. Among persons without concurrent spherulin sensitivity, reactor rates and sizes were the same with both reagents. Some persons with spherulin sensitivity reacted only to the mycelial reagent. Histoplasmin-CYL skin tests did not induce significant changes in complement-fixing antibody in histoplasmin-reactive subjects.

Antibodies, Fungal↗
PubMed1978

Liposarcoma of the foot: a case report.

A 56-year-old black, apparently healthy female presented with a rapidly growing mass on the medial aspect of her left hallux. The mass was seen on x-ray examination, and did not appear locally invasive. Excision revealed the mass to be a well differentiated liposarcoma, and after further consultation, the left hallux was amputated. Although the incidence of differentiated liposarcoma in the foot is rare, the preceding case should reiterate to all the need for closer investigation of soft tissue masses which may appear in the foot. Prompt excision of malignant tumors results in a good prognosis for the patients, whereas misdiagnosis based on the apparently benign appearance may lead to unnecessary delay and a less fortuitous prognosis for the patient.

Female↗