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Biomedical subjects

P Kelsey

Publications and source records attributed to P Kelsey.

15 recordsLinked to original sources
PubMed1998

Delayed diagnosis and unnecessary percutaneous biopsies in cases of myeloma presenting as chest wall tumours.

We report on five cases of myeloma presenting at a single institution over an 8-year period between 1988 and 1996. All presented with bony pain and a chest wall mass arising from a rib on chest X-ray. Myeloma was not confirmed until 22, 25 and 50 days after admission in three of the cases who each suffered a potentially hazardous percutaneous chest wall biopsy which was undiagnostic. A fourth case did not suffer diagnostic delay as his biopsy showed sheets of plasma cells although, as in all five cases, evidence of myeloma was clearly present on serum/urine electrophoresis, skeletal survey and marrow aspirate, making chest wall biopsy unnecessary. The only case who suffered no diagnostic delay and no percutaneous chest wall biopsy was the only case to have a comprehensive chest X-ray report listing myeloma as a differential diagnosis and suggesting a haematology referral.

Aged↗
PubMed1998

Alendronate-induced esophagitis: case report of a recently recognized form of severe esophagitis with esophageal stricture--radiographic features.

Alendronate sodium, an aminobiphosphonate used primarily to treat osteoporosis in postmenopausal women, is known to cause esophagitis. A 71-year-old woman experienced severe, acute esophagitis and severe stricture of the esophagus due to oral alendronate therapy. Unlike in previous cases, she had taken alendronate for 10 months before the onset of complications and the stricture proved resistant to dilation.

Administration, Oral↗
PubMed1997

Primary acquired sideroblastic anemia, thrombocytosis, and trisomy 8.

Myelodysplastic syndromes are usually associated with pancytopenia. Disorders involving deletion of the long arm of chromosome 5 (5q-syndrome) and, rarely, patients with karyotypic abnormalities involving chromosome 3 associated with abnormal thrombopoiesis may have a normal or even raised platelet count. Other cytogenetic abnormalities in myelodysplasia are invariably associated with cytopenia in one or all cell lineages. We report a patient who initially presented with slight anemia and a raised platelet count. Further investigations suggested a diagnosis of primary acquired sideroblastic anemia. Cytogenetic examination revealed a clone with trisomy 8. We believe this is the first reported case of trisomy 8 with trilineage myelodysplasia and thrombocytosis with primary acquired sideroblastic anemia.

Aged↗
PubMed1996

The Perth endoluminal bifurcated graft system--development and early experience.

The study aim was to develop a reliable endoluminal graft system that would enable the deployment of a bifurcated graft for infrarenal abdominal aortic aneurysms. A life-size plastic model was made of an abdominal aorta and iliac arteries, with a 50-mm infrarenal abdominal aortic aneurysm. This model was used to develop and test self-expanding graft systems, based on a barbed Gianturco stent and series of stainless-steel 'Z' stents within a woven Dacron graft. The bifurcated system developed involves a trouser graft with one long leg and one short. This graft-system is delivered through one femoral artery with deployment of the proximal aortic end infrarenally and the longer trouser leg within the ipsilateral common iliac artery. The short trouser leg is left hanging free within the distal end of the aneurysm cavity, just above the bifurcation. It is held open by a self-expanding stent and is cannulated from the contralateral femoral artery with a guide wire. A simple straight self-expanding stented graft is then deployed to extend this short trouser leg down into the common iliac artery, effectively creating an extension to the short leg. The graft system has been deployed in 21 patients with satisfactory exclusion of the aneurysm in 17 (81%). There has been one mortality and no conversion to open repair. All 17 aneurysms remain excluded at median follow-up of 30 (range 4-60) weeks. None of the four graft stents that leaked (two proximal and two distal) sealed spontaneously. Deployment of the uncovered Gianturco stent across the renal artery origins in 18 cases (85%) has not been associated with renal artery occlusion or deterioration in renal function at a median follow-up of 30 (range 4-60) weeks. The ability to deploy a bifurcated system increases the potential for endoluminal treatment of abdominal aortic aneurysm.

Aged↗
PubMed1992

Treatment of bile duct stones by laser lithotripsy: results in 12 patients.

We used a pulsed tunable dye laser (operating at 60 mJ per pulse, 504-nm wavelength) to fragment large (0.8-4.5 cm) stones retained in the hepatic ducts or common bile duct in 12 patients after cholecystectomy. Attempts to extract stones via a T-tube or endoscope had been unsuccessful in all patients. In nine of 12 patients, all stone fragments were successfully eliminated during the initial treatment. In one patient, fragmentation occurred but debris remained, requiring endoscopic stenting. Pseudomonas sepsis developed in this patient 30 days after the procedure and was treated by extraction of the stone fragments. Fragments remaining after lithotripsy were cleared at the same sitting by using saline flushing or endoscopic or percutaneous basket extraction. In two of 12 patients, the treatment was unsuccessful because of laser malfunction. The treatment was performed without complications, except for clinically insignificant hyperamylasemia, which occurred in two patients. Our experience suggests that laser lithotripsy offers a safe alternative for nonsurgical treatment of large retained biliary stones for patients in whom traditional treatments have failed.

Aged↗
PubMed1990

CT demonstration of traumatic ventral hernia and diaphragmatic rupture. A case report.

Traumatic ventral hernias occur rarely. A case is presented where bowel has herniated through a traumatic defect of the anterior abdominal musculature, demonstrated by CT. This has not been previously reported in the literature. These loops of bowel showed mural thickening and high density indicating severe injury and were found at laparotomy to be ischaemic. The patient simultaneously suffered rupture of the right hemidiaphragm, also demonstrated by CT and also an uncommon injury.

Aged↗
PubMed1988

Simple microbiologic detection of Campylobacter pylori.

A study of 84 gastric biopsies taken from 42 adult patients revealed simple techniques for Gram stain and culture for Campylobacter pylori. In an initial study of 18 biopsies, Gram stains prepared from ground, diluted tissue were all negative for curved, gram-negative rods, whereas 13 of these specimens were positive for C. pylori by culture. The Gram stains for the remaining 66 biopsies were prepared by a rinse-imprint technique. In this group, there were 30 Gram stains positive for organisms resembling C. pylori and 32 positive cultures. By Gram-staining two sites, fundus and antrum, the sensitivity of the Gram stain for identifying a positive specimen increased from 91 to 100%. Gram stain may be the preferred technique for rapid diagnosis. When cultured, C. pylori was recovered most often on modified Thayer-Martin medium incubated microaerophilically at 35 degrees C. The presence of antibiotics in modified Thayer-Martin medium limited upper respiratory flora overgrowth, which was often present on nonselective media.

Biopsy↗
PubMed1984

Cytomegalovirus- and Cryptosporidium-associated acalculous gangrenous cholecystitis.

A well-documented case of cytomegalovirus- and Cryptosporidium-associated cholecystitis is described in a 19-year-old heterosexual Haitian man who had the acquired immune deficiency syndrome and acute acalculous gangrenous cholecystitis associated with these pathogens. This case adds to the spectrum of the manifestations of the profoundly immunocompromised state.

Acquired Immunodeficiency Syndrome↗
PubMed1983

Quantitative cytochemistry of blood neutrophils in myelodysplastic syndromes and chronic granulocytic leukaemia.

Quantitative cytochemistry of components of blood neutrophil azurophilic granules (myeloperoxidase, chloroacetate esterase, beta-glucuronidase, and acid phosphatase) and specific granules (lactoferrin) has been performed by scanning and integrating microdensitometry in 13 patients with a myelodysplastic syndrome and 11 patients with chronic granulocytic leukaemia. Both patient groups showed a reduction of enzyme activity in azurophilic granules, and also of lactoferrin, consistent with abnormal development of neutrophil granules. These cytochemical changes in blood neutrophils are similar to those found in acute myeloid leukaemia, are consistent with a leukaemic maturation defect, and may be of diagnostic value.

Acid Phosphatase↗
PubMed1982

Cytomegalovirus retinitis in a young homosexual male with acquired immunodeficiency.

A case is reported of histopathologically documented CMV retinitis. It is part of a recently appreciated syndrome in young homosexual men, in which cellular immune deficiency has been documented and in which CMV infection may play a role. This case demonstrates that CMV retinitis is not excluded by negative CMV serology or cultures.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Adventitial cystic disease of the popliteal artery: early recurrence after CT guided percutaneous aspiration.

Adventitial cystic disease of the popliteal artery is a rare condition of debated aetiology. The recommended treatment has been cyst removal with or without replacement of the artery. Recently percutaneous aspiration has been suggested as another method of treatment for this condition. In this case, percutaneous aspiration was performed twice. Surgical intervention was eventually performed because of early cyst recurrence. Our experience suggests that aspiration is a treatment option but, if used, close long-term follow-up is necessary to detect recurrence.

Arterial Occlusive Diseases↗