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Biomedical subjects

P Kenny

Publications and source records attributed to P Kenny.

At least 19 recordsLinked to original sources
PubMed2002

Outcomes following quadriceps tendon ruptures.

Complete rupture of the quadriceps femoris tendon is a well-described injury. There is a scarcity of literature relating to the outcome of patients with this injury after surgery. We undertook a retrospective analysis of patients who had surgical repair of their ruptured quadriceps tendon at our institution over a seven year period-totalling 27 patients. Males were more commonly affected with a M:F ratio of 8:1. The peak incidence was in the sixth decade of life. The non-dominant limb was twice as likely to be affected. Assessment consisted of completion of a functional knee questionnaire, clinical examination and isokinetic testing on a Biodex dynanometer. Symptomatic outcome following surgical repair was excellent with a mean symptom score generated of 22.7 out of a maximum of 25. 18/19 patients returned to their premorbid level of activity on average 18.1 weeks following injury. There was no difference in quadriceps girth comparing affected and unaffected limbs. Less than 5 degrees deficit in range of motion existed between affected and unaffected limbs. Approximately two-thirds of patients were the same or better when comparing peak torque/body weight, average power, maximum average peak torque and total work/body weight in affected and unaffected limbs.

Adult↗
PubMed2001

Genetic hemochromatosis, a Celtic disease: is it now time for population screening?

In populations of northern European ancestry, hereditary hemochromatosis (HH) is tightly linked to mutations within the hemochromatosis gene (HFE gene). Over 93% of Irish HH patients are homozygous for the HFE gene C282Y mutation, providing a reliable diagnostic marker of the disease in this population. However, the prevalence of the C282Y mutation and that of the second HFE gene mutation, H63D, have yet to be determined within the Irish population. The objective of this study was to identify the true prevalence of the genetic form of HH in the Irish population. DNA was extracted from 1002 randomly selected newborn screening cards and analyzed for the C282Y and H63D mutations within the HFE gene. Complete results were obtained from 800 cards. Mutations were identified in 364 (46%) neonates. Eight (1%) neonates were homozygous for C282Y and 8 (1%) were homozygous for H63D. One hundred and fifty-five (19%) neonates were C282Y heterozygous and 226 (28%) were H63D heterozygous. Of these, 33 (4%) carried one copy of both C282Y and H63D mutations, i.e., compound heterozygous. Allele frequencies for C282Y and H63D were 11% and 15%, respectively. The high C282Y allele frequency in the Irish population together with its close linkage to HH indicate that C282Y genotyping is the preferred screening strategy for this disease in Ireland.

Ethnicity↗
PubMed2001

The urinary excretion of gamma-hydroxybutyric acid in man.

gamma-Hydroxybutyric acid (GHB) has been widely associated with drug-facilitated sexual assault (DFSA). However, its excretion profile in man has not been well characterized. To assess the detectability of GHB for forensic cases and to correlate urinary levels with dose, we have examined the excretion profiles of 1- and 2-g doses of GHB (sodium salt) in a healthy male volunteer. The urinary levels were measured by a novel, simple and highly reproducible method. The drug was found to be excreted in small amounts in the free form (0.86 and 1.16% for 1- and 2-g doses, respectively) rapidly in urine (< or = 10 h). The urinary levels were found to be in the low mg L(-1) range (up to 29.1 mg L(-1)). The work presented demonstrates that it is of the utmost importance to collect the samples as soon as possible following the alleged assault.

Adult↗
PubMed2000

Quality of life three months and one year after first treatment for early stage breast cancer: influence of treatment and patient characteristics.

This paper reports the quality of life (QoL) of a large cohort of Australian women three and twelve months after surgery for early stage breast cancer (ESBC), and shows that the impact of disease and treatment on QoL differed by age, education and marital status. Eighty-three percent of eligible patients were recruited; 86% had breast conserving surgery and 14% mastectomy. Response rates were 93% (n = 305) at three months and 88% (n = 291) at one year. Quality of life was measured with the EORTC core questionnaire (QLQ-C30) and an ESBC-specific questionnaire. Multilevel analysis was used to estimate the effects and interactions of time, treatment and patient characteristics. Most symptoms declined between three months and one year, but arm and menopausal symptoms persisted. Emotional, social and role functioning improved over time, and fear of disease recurrence diminished. Younger women faired worse than older women on a broad range of QoL dimensions. Single women and those with less education faired worse on a number of dimensions. The negative impact of mastectomy on body image was greatest among married women, particularly young married women. These sociodemographic distinctions are relevant when discussing treatment options with women facing a diagnosis of ESBC.

Adult↗
PubMed2000

Early stage breast cancer: costs and quality of life one year after treatment by mastectomy or conservative surgery and radiation therapy.

This paper reports a descriptive study of the costs and quality of life (QoL) outcome of treatments for early stage breast cancer in a cohort of Australian women, one year after initial surgical treatment. Mastectomy without breast reconstruction is compared to breast conserving surgery and radiotherapy (breast conservation). Of the 397 women eligible for the study, costing data were collected for 81% and quality of life data for 73%. The cost differences between treatment groups were mainly accounted for by adjuvant therapies, the more expensive being radiotherapy. When compared to women treated by mastectomy, those treated by breast conservation reported better body image but worse physical function. The negative impact of breast cancer and its treatment was greater for younger women, across a number of dimensions of quality of life (regardless of treatment type). While this study shows that breast conservation is more expensive than mastectomy, the QoL results reinforce the importance of patient participation in treatment decisions.

Journal Article↗
PubMed1999

Symptoms 2 weeks, 3 months and 12 months after treatment of early breast cancer: the patients' perspectives.

The physical symptoms and side-effects reported by patients treated for early breast cancer with surgery (S), (breast conservation or mastectomy), radiotherapy (R) and chemotherapy (C) are reported. As part of a large quality-of-life study, eligible patients were invited to complete a questionnaire at three and 12 months after treatment for early breast cancer. Symptoms 2 weeks after surgery were retrospectively collected at the 3-month questionnaire. Comparing the commonly used different therapy combinations (S, S+R, S+C and S+R+C) we found the only loco-regional symptom to show a significant difference between these groups was chest tightness (P<0.001). Both anxiety about attending for and discomfort during C were significantly higher than during R (P<0.00005 and 0.00001 respectively). We found that the addition of R and, or, C to S resulted in surprisingly little variation in physical side-effects.

Journal Article↗
PubMed1999

Damage to the superior gluteal nerve after two different approaches to the hip.

We have carried out a blind, prospective study of 50 consecutive patients undergoing replacement arthroplasty of the hip using two different approaches. Clinical assessment, including the Harris hip score and a modified Trendelenberg test, and electrophysiological examination of the abductor muscles of the hip were undertaken before and three months after surgery. We found that 48% of patients had preoperative evidence of chronic injury to the superior gluteal nerve. Perioperative injury to the nerve occurred commonly with both approaches to the hip. We did not find a significant correlation between injury to the superior gluteal nerve and clinical problems.

Aged↗
PubMed1998

Effects of acute intravenous cocaine on cardiovascular function, human learning, and performance in cocaine addicts.

Continuous non-invasive cardiovascular monitoring in eight healthy cocaine addicts receiving intravenous cocaine (0.325 mg/kg or 0.650 mg/kg) or placebo in double-blind, randomized, cross-over fashion demonstrated significant dose-dependent increases in pulse and mean arterial pressure following cocaine. Pulse and mean arterial pressure peaked 5 min post-cocaine injection and maximal response was sustained for a further 15 min and 35 min afterwards, respectively. Cocaine administration had no significant effect on peripheral oxygen saturation, and no clinically significant abnormalities of rhythm or conduction were seen on the electrocardiogram. These doses and method of single-dose intravenous cocaine administration, and our procedures for cardiovascular monitoring, appear relatively safe for laboratory studies of healthy cocaine addicts with no pre-existing cardiovascular disease. In addition, cocaine-taking (0.325 mg/kg i.v. and 0.650 mg/kg i.v.) was associated with enhanced attention (i.e. increased numbers of correct responses on the Rapid Visual Information Processing Task), but the trend towards reduced reaction time did not achieve statistical significance. Cocaine-taking resulted in a small but statistically insignificant improvement in learning on the Digit Symbol Substitution Task. These results suggest that cocaine-taking in rested subjects is associated with some cognitive enhancement.

Adult↗
PubMed1998

Isradipine prevents global and regional cocaine-induced changes in brain blood flow: a preliminary study.

The L-type calcium channel antagonist, isradipine, reduces brain ischemia in animal models of ischemic stroke. These effects of isradipine appear more pronounced in dopamine (DA) rich brain regions. These same DA-rich brain regions have also been shown to be the areas most affected by cocaine-induced ischemic changes. Using a novel quantified approach to single photon emission computerized tomography, we demonstrated that isradipine pre-treatment prevented cocaine-induced ischemic changes, especially in these DA-rich brain regions. This is the first demonstration that any medication, including isradipine, can prevent the ischemic effects of cocaine on brain blood flow. Isradipine may, therefore, be a useful therapeutic agent for the prevention of brain ischemia in cocaine addicts.

Adult↗
PubMed1998

Interprosthetic fracture of the femoral shaft.

Experience in the management of a complication of ipsilateral hip and knee arthroplasty is described. The cases of four female patients who sustained a femoral shaft fracture after ipsilateral hip and knee arthroplasty are reported. All fractures were treated operatively, and in all cases internal fixation devices failed. This complication of multiple joint arthroplasty presents a difficult management problem. Rigid fixation has a high failure rate for this type of fracture. Surface knee arthroplasty provides a better opportunity for internal fixation than a knee arthroplasty with a stemmed femoral component.

Aged↗
PubMed1998

Demonstration of dose-dependent global and regional cocaine-induced reductions in brain blood flow using a novel approach to quantitative single photon emission computerized tomography.

Ischemic stroke is a common cause of morbidity and mortality in cocaine addicts. Because the previous semiquantitative single photon emission computerized tomography (SPECT) method for measuring brain blood flow does not quantify blood flow, the magnitude and specificity of cocaine's effects during drug taking has not been well established. Here, using a novel quantitative approach to SPECT, we established that intravenous cocaine administration to nine recently abstinent cocaine-dependent subjects was associated with significant decreases in global and regional brain blood flow to dopamine-rich areas such as the prefrontal, frontal temporal, and subcortical gray matter. Establishing the utility of this relatively new quantitative SPECT technique provides an important tool for the management of vascular disorders of the brain. Additionally, identifying the site-specific effects of cocaine provides targets for the development of putative therapeutic medications to attenuate or minimize ischemic stroke in cocaine addicts.

Adolescent↗
PubMed1996

Argon-enhanced cutting and coagulation confers advantages over conventional electrocautery for mastectomy.

In this prospective randomized study we have compared argon-enhanced electrosurgery with conventional diathermy in a consecutive series of 50 patients undergoing mastectomy. The groups were comparable in age, menopausal status, tumour size, stage and specimen size. Patients undergoing mastectomy using argon diathermy had significantly less blood loss intraoperatively (521 (67)ml vs 824 (59)ml; P<0.001) and a significantly lower transfusion requirement post-operatively. There were no significant differences in post-operative drainage (1350 (160) ml vs 1527 (169) ml; P=NS), length of hospital stay, incidence of seromas or other complications. Argon diathermy significantly reduces intraoperative blood loss and should be considered as the method of choice in patients undergoing mastectomy.

Argon↗
PubMed1995

Detection of p53 mutations in benign and dysplastic nevi.

We have examined melanocytic cells derived directly from fresh biopsy tissue for the presence of p53 mutations. Using selective media that permits growth of melanocytes and inhibits growth of fibroblasts and keratinocytes, we established short-term, primary cultures of melanocytes from skin biopsies of common acquired nevi, dysplastic nevi, and from metastatic melanoma. Using PCR-single-stranded conformational polymorphism analysis, we have detected p53 mutations in 2 of 11 benign compound nevi and 2 of 5 dysplastic nevi. All nevi positive for p53 mutations were derived from patients who previously had cutaneous moles and three of the four had a family and/or personal history of melanoma.

Base Sequence↗
PubMed1994

The costs and effects of early discharge in the management of fractured hip.

The cost-effectiveness of a Fractured Hip Management Programme (FHMP) was evaluated by considering available measures of patient outcome and comparing the cost of the programme with the value of resources freed by reductions in length of hospital stay. The FHMP adopted a multidisciplinary team approach to care for elderly patients with hip fracture. The aims of the programme were to reduce delays before surgery; provide specialist geriatric medical supervision; improve early post-operative mobility; plan for hospital discharge with rehabilitation in the patient's normal environment; and provide continuity of care by a small number of staff. The cost of managing patients with fractured hip averaged $Aus11,060 per patient before the programme was introduced and $Aus9280 per patient after the FHMP was in place. This reduction in cost was achieved without impairing health outcomes. Patients treated by the programme were no worse off compared with those treated conventionally. In conclusion, the FHMP provided a cost-effective alternative in the management of fractured hip in elderly people.

Aged↗