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Biomedical subjects

A M Kelly

Publications and source records attributed to A M Kelly.

At least 73 records · Page 4Linked to original sources
PubMed1997

Intravenous chlorpromazine versus intramuscular sumatriptan for acute migraine.

OBJECTIVE: To establish whether there is any difference in the efficacy of a chlorpromazine regimen and a sumatriptan regimen for the management of the pain of acute severe migraine. SETTING: Two urban teaching hospital emergency departments. METHODS: Prospective, randomised, unblinded, crossover trial. All patients received intravenous metoclopramide 10 mg and 1000 ml of normal saline over 1 h; 20 were then randomised to receive intramuscular sumatriptan 6 mg and 23 to receive intravenous chlorpromazine, 12.5 mg increments to a maximum of 37.5 mg. Response to treatment was measured using visual analogue pain scales. RESULTS: No difference in efficacy between the sumatriptan regimen and the chlorpromazine regimen was found. Adverse effects were mild and equally distributed between the groups. CONCLUSIONS: The chlorpromazine and sumatriptan regimens studied are both very effective for the relief of the headache of severe migraine.

Adolescent↗
PubMed1997

The European Register for Clinical Chemists. (European Communities Confederation of Clinical Chemistry, Working Group on Registration).

To ensure freedom of movement in the European Union, a limited number of professions is regulated by a so-called Sectorial Directive; all other disciplines, including clinical chemistry, fall under a General Directive. However, clinical chemists in the EU wish their specialty to be more specifically regulated; this means that common standards of education, training, experience and compliance with continuing professional developments must be guaranteed. Therefore, the European Communities Confederation of Clinical Chemistry (EC4) is about to implement the European Register for clinical chemists, and has composed a guide to this Register. The document describes the conditions for entry to specialty training, the minimum standards for registration (university education and postgraduate vocational training with a minimum total of eight years), the competencies of those qualifying for registration, and the operation of the register. Registration guarantees professional and managerial competencies; the title conferred is "European Clinical Chemist". EC4 recognises the existing national registers as far as they are based on the minimal requirements as indicated. An EC4 Register Commission (EC4RC) will maintain and control the European Register, supported by National Clinical Chemistry Registration Committees (NCCRC). An NCCRC controls the quality of the education in each country and assesses candidates. An individual (EU citizen or non-EU citizen trained in an EU country) applies privately for the European Register to EC4RC and, where applicable, the application is accompanied by a document from the NCCRC of the country of registration, stating that the applicant has the necessary qualifications. For EU citizens trained outside the EU the final decision is with EC4RC; non-EU citizens not trained in an EU country are not eligible for registration. Registration is renewed once every five years.

Chemistry, Clinical↗
PubMed1996

Teaching resuscitation skills using the newly deceased.

In many hospital emergency departments doctors learn life-saving technical skills on patients who have recently died. This longstanding practice is justified as providing training that cannot be offered in any other way. But can it continue without the informed consent of relatives and the general approval of the public?

Australia↗
PubMed1996

Selective expression of a ski transgene affects IIb fast muscles and skeletal structure.

The expression of a ski transgene in the bind leg muscles of mice follows a spatial and temporal pattern reminiscent of the pattern of myogenic development. Anterior muscles, which are formed earliest during development, are also the first muscles to express ski mRNA. Muscles derived from the posterior muscle group, formed later during development, exhibit delayed expression of ski mRNA. In addition, there is regional variation in ski mRNA levels within a particular muscle. Superficial regions of fast muscles, which contain a large percentage of type IIb fibers and have a high ATPase activity, express a higher level of ski mRNA than the deep portions of the same muscles. The deep regions contain a lower percentage of type IIb fibers and lower ATPase activity. The soleus, a slow muscle composed predominantly of type I fibers, expresses low ATPase activity and contains much lower levels of ski mRNA. mRNA from the ski transgene is also expressed at high levels in the osteocytes of the leg bones of 15-day and older transgenic mice. High levels of Ski protein is present in the osteocytes of the leg bones. ski expression appears to cause remodeling of the tibia and fibula. The cross-sectional area of the tibia and fibula of ski transgenic mice is significantly decreased compared to controls. X-rays of the skeletons of ski transgenic mice suggest that the bones of the entire skeleton are thinner than the bones in normal mice. Pathological stress fractures were found in several bones in the ski transgenic mice.

Animals↗
PubMed1996

Plaster checks by nurses: safe and efficient?

This prospective, blinded comparison study compared plaster checks performed by nurses with those performed by doctors. Nurses performed this task well. Allowing plaster checks to be performed by nurses, with referral to a doctor if they are concerned, would have reduced the number of plaster checks performed by doctors by two-thirds. Institution of this process could result in reductions in waiting time for patients presenting for plaster checks and in improved efficiency in the Emergency department.

Casts, Surgical↗
PubMed1996

Administration of rectal indomethacin does not reduce the requirement for intravenous narcotic analgesia in acute renal colic.

The aim of this study was to compare the total dose of intravenous pethidine required to give satisfactory analgesia to patients with acute renal colic between two groups, one of which was also administered rectal indomethacin on presentation and one which was not. This was a prospective, randomized, unblinded comparison study. Each group contained 39 patients. Group 1 received rectal indomethacin 100 mg and intravenous pethidine in 25 mg increments until pain was satisfactorily relieved. Group 2 received increments of intravenous pethidine alone. The primary endpoint was total pethidine dose required to achieve analgesia to the patient's satisfaction. No significant difference in total pethidine dose between the groups was found. It was concluded that administration of rectal indomethacin does not reduce the total dose of intravenous pethidine required to relieve the pain of acute renal colic.

Acute Disease↗
PubMed1996

Height and surfacing as risk factors for injury in falls from playground equipment: a case-control study.

OBJECTIVES: Despite the widespread promotion of safety standards no epidemiological studies have adequately evaluated their effectiveness in preventing injury in falls from playground equipment. This study evaluated the effectiveness of the height and surfacing requirements of the New Zealand standard for playgrounds and playground equipment. SETTING: Early childhood education centres and schools in two major cities in the South Island of New Zealand. METHODS: Data were collected on 300 children aged 14 years or less who had fallen from playground equipment. Of these, 110 (cases) had sustained injury and received medical attention, while 190 (controls) had not sustained injury requiring medical attention. RESULTS: Logistic regression models fitted to the data indicated that the risk of injury being sustained in a fall was increased if the equipment failed to comply with the maximum fall height (odds ratio (OR) = 3.0; 95% confidence interval (CI) 0.7 to 13.1), surfacing (OR = 2.3; 95% CI 1.0 to 5.0), or safe fall height (OR = 2.1; 95% CI 1.1 to 4.0) requirements. Falls from heights in excess of 1.5 metres increased the risk of injury 4.1 times that of falls from 1.5 metres or less and it was estimated that a 45% reduction in children attending emergency departments could be achieved if the maximum fall height was lowered to 1.5 metres. CONCLUSIONS: Although the height and surfacing requirements of the New Zealand standard are effective in preventing injury in falls from playground equipment, consideration should be given to lowering the maximum permissible fall height to 1.5 metres.

Accidental Falls↗
PubMed1995

Characterization of a human perinatal myosin heavy-chain transcript.

Using a monoclonal antibody specific to the neonatal myosin heavy chain, we have cloned the full-length heavy chain cDNA from an 18-week human fetal cDNA library. Ribonuclease protection assays were used to survey a human muscle collection ranging from 11 weeks gestation to 16 years. Expression of the RNA encoded by this cDNA was observed at 20 and 21 weeks gestation and at 2 days after birth. No expression was observed at 13.5 weeks, before 2 years, at 2 years, or after 2 years gestation. Due to the timing of its expression, this cDNA appears to represent of the human fetal myosin heavy chain. Sequencing of the entire 6010 bases showed high similarity to the rat perinatal myosin heavy chain [Periasamy, M., Wieczorek, D. F. & Nadal-Ginard, B. (1984) J. Biol. Chem. 21, 13,573-13,578]. However, moderate divergence was observed when compared to a previously described human perinatal myosin heavy chain [Karsch-Mizrachi, I., Feghali, R., Shows, T. B. & Leinwand, L. A. (1990) Gene 89, 289-294; Feghali, R. & Leinwand, L. A. (1989) J. Cell Biol. 108, 1791-1797]. Restriction fragment-length polymorphism analyses of sites in both the S1 and rod domains showed the presence of this fetal myosin heavy chain sequence in all 27 genomic samples examined. Restriction fragment-length polymorphism analysis failed to find the previously described perinatal isoform in any sample.

Amino Acid Sequence↗
PubMed1995

Cancer and congenital abnormalities in Asian children: a population-based study from the West Midlands.

Cancer and associated congenital abnormalities were investigated in Muslim and non-Muslim Asian children from the West Midlands. Cancer incidence rates were calculated for Indian (non-Muslim), Pakistani/Bangladeshi (Muslim) and white children diagnosed from 1978 to 1992. Incidence was significantly higher in the Pakistanis, with an age-standardised rate (ASR) of 163 cases per million per year, compared with 115 for Indian and 125 for white children. Among Asian cancer patients, congenital malformations were significantly more common in Muslim (21%) compared with non-Muslim (7%). In Muslims the malformation excess was caused by autosomal recessive and dominant disorders (in 8% and 5% of cases respectively). Cancer malformation/predisposition syndromes were found in 10% of Muslims, compared with 2% of non-Muslims. In 33% of the Muslims with malformations, childhood cancer and a malformation were also present in a close relative. None of the non-Muslims with malformations had a relative with childhood cancer. The cancer excess in Muslims may be partly related to inherited genes causing both malformations and cancer. The prevalence of autosomal recessive disorders may be related to consanguinity, which is common in the Pakistani Muslim population. The high incidence of autosomal dominant disorders may be related to older paternal age at conception, giving rise to spontaneous mutations.

Adolescent↗
PubMed1995

Regulation of c-ski transgene expression in developing and mature mice.

The control of c-ski transgene expression and muscle hypertrophy have been investigated in transgenic mice. In adult animals, the level of transgene expression is linked to the specialized phenotype of individual muscles, high levels occur in fast muscles and significantly lower levels in muscles with high metabolic activity (diaphragm, soleus). These findings have led us to propose that a threshold must be passed before ski-induced growth can occur. We now show that within fast muscles, induced hypertrophy uniquely involves IIb fibers. This pattern of expression is under development control; levels of c-ski mRNA are low in all muscles at birth. In the diaphragm, there is a sevenfold increase in c-ski message levels between 5 d and maturity. By contrast, in fast extensor digitorum longus and anterior tibial muscles, there is a 24-fold increase in levels between 5 and 12 d postpartum. Muscle hypertrophy and antibody staining for c-ski protein in myofiber nuclei emerge concurrently. This pattern of c-ski expression parallels the appearance of IIb myosin heavy chain transcripts (Wydert et al., 1987) and differentiation of IIb fibers, suggesting that amplification of c-ski mRNA levels is linked to the development of IIb fiber specialization. Manipulations that are known to perturb IIb fiber development, neonatal denervation, and neonatally induced hypothyroidism inhibit high levels of c-ski expression and hypertrophy. In the adult fast EDL, denervation leads to rapid atrophy of IIb fibers and a significant decline in levels of c-ski mRNA. The results suggest that the environment of differentiated IIb fibers permits the expression of high levels of c-ski mRNA and this, in turn, induces hypertrophy.

Aging↗
PubMed1994

Failed validation of a clinical decision rule for the use of radiography in acute ankle injury.

AIM: To validate the Ottawa clinical decision rule for the use of radiography in acute ankle injuries. METHOD: A prospective, multicentre trial of 350 adult patients presenting with acute ankle injuries consisting of correlation of the features of the Ottawa clinical decision rule with the results of x-rays. RESULTS: There were 75 fractures in 350 patients, five of which would have been missed by the clinical decision rule. The sensitivity of the rule was 93% with a specificity of 11%. The positive predictive value was 22%, the false negative rate 14%. Fractures that would have been missed by the clinical decision rule included one unstable fracture of the ankle, one fracture of the talus, one calcaneal fracture and one fracture each of the cuboid and navicular. CONCLUSION: The Ottawa clinical decision rule for the use of radiography in acute ankle injuries is unacceptable for application in emergency departments in New Zealand due to a high false negative rate.

Acute Disease↗
PubMed1994

Radioimmunotherapy of metastatic colorectal tumours with iodine-131-labelled antibody to carcinoembryonic antigen: phase I/II study with comparative biodistribution of intact and F(ab')2 antibodies.

Studies in animal tumour models of colorectal cancer suggest that F(ab')2 antibody fragments to carcinoembryonic antigen (CEA) labelled with iodine-131 give superior therapy compared with intact anti-CEA antibody. The purpose of this study was to investigate this hypothesis in patients. Ten patients received intact A5B7 IgG1 mouse monoclonal antibody (MAb) to CEA and nine patients received the F(ab')2 fragment of the same antibody. The biodistribution for each molecule was compared using quantitative single-photon emission computerised tomographic (SPECT) gamma-camera imaging. Tumour responses were seen in both groups and myelosuppression was the limiting toxicity. F(ab')2 localised more rapidly than intact antibody in tumour, giving a mean percentage injected activity per kg at 4.25 h after injection of 8.2% for F(ab')2 compared with 4.4% for intact antibody (P < 0.05). No significant difference in antibody clearance from, or cumulative dose per unit administered activity (cGy MBq-1) to, tumour was seen. Distribution in blood was similar for both the intact and fragment antibody. These findings are consistent with more rapid penetration of the smaller F(ab')2 into tumour masses. More efficient early uptake will give higher maximum dose rates to the tumour which is valuable for radioimmunotherapy (RIT) when low dose rates may limit effectiveness of treatment. F(ab')2 fragments may provide a substantially enhanced method of delivering RIT.

Adult↗
PubMed1994

The Ilizarov method for complex fracture nonunions.

INTRODUCTION: Nonunion of complex fractures continues to challenge orthopedic trauma surgeons. Although traditional management results in a successful outcome in 50% to 80% of cases, the Ilizarov method has been reported to be more effective. We evaluated the efficacy of the Ilizarov method for treatment of nonunions. METHODS: Patients were selected based on the presence of nonunion associated with osteomyelitis, treatment failure, or extensive segmental bone loss. Treatment principles include surgical debridement, stabilization, and bone regeneration for correction of defects. Patients were given maximum mobility and were required to function as normally as possible during the course of treatment. RESULTS: Seventeen patients were treated for complex nonunions with the Ilizarov method during a 33-month period. Seven patients were facing the alternative of amputation. Causes of nonunion were osteomyelitis (65%), failure of conventional treatment (23%), and segmental bone loss (12%). Fractures involved the lower (82%) and upper (18%) extremities. Using the Ilizarov method, union was achieved in 94% (16 of 17) of patients over an average time of 6 months. CONCLUSION: Our results indicate that the Ilizarov method is superior to traditional techniques of managing complex nonunions.

Adult↗
PubMed1994

Does learning emergency medicine equip medical students for ward emergencies?

The aim of this study was to assess the competence of senior medical students in recognizing and managing life-threatening ward emergencies and to compare the competence of a group that had received emergency medicine teaching with one that had not. This was achieved by asking 60 final year medical students to complete a structured written clinical examination designed to test these skills. Comparisons were made between the group that had received emergency medicine teaching (the 'taught' group) and that which had not (the 'untaught' group) with respect to numerical scores on the examination and the number of fatal management errors committed. The 'taught' group had an average total score of 285/400 compared with an average score of 223/400 for the 'untaught' group (P < 0.001). The 'untaught' group committed 0.25 fatal errors per student per case compared with the 'taught' group that committed 0.06 fatal errors per student per case (P < 0.001). There is considerable scope to improve the competence of senior medical students for dealing with life-threatening ward emergencies. Students who had received emergency medicine teaching scored significantly better than those who had not suggesting that emergency medicine teaching is a suitable tool to help equip medical students to deal with life threatening ward emergencies.

Clinical Competence↗
PubMed1994

Pharyngeal myopathy of loaded upper airway in dogs with sleep apnea.

Recent work indicates that upper airway dilator muscles of individuals with obstructive sleep apnea syndrome (OSAS) demonstrate an increased level of activity during wakefulness compared with normal subjects. In addition, massive bursts of pharyngeal dilator activity are associated with the termination of upper airway occlusive events during sleep. This complex pattern of altered pharyngeal dilator activation is also observed in the English bulldog, an animal model of OSAS. In the present study, it was hypothesized that such alterations in activity level might lead to changes in the structure of pharyngeal muscles in the bulldog. Full-thickness biopsies were obtained from two pharyngeal dilator muscles, the sternohyoid (SH) and geniohyoid, as well as a limb muscle, the anterior tibialis, in bulldogs (n = 5) and control dogs (n = 7). Immunohistochemical analysis of myosin heavy chain expression revealed an increased contribution of fast type II myosin heavy-chain fibers to SH in bulldogs. The bulldog SH also demonstrated increased connective tissue content compared with control dogs, consistent with the presence of fibrosis. Both pharyngeal dilators in the bulldog exhibited an elevated proportion of morphologically abnormal fibers indicative of ongoing or prior injury. No differences in any of the above parameters were seen between bulldogs and control dogs in the anterior tibialis limb muscle. We conclude that the chronic load and altered pattern of usage imposed on the upper airway dilators in OSAS lead to myopathic changes that may ultimately impair the ability of these muscles to maintain pharyngeal patency.

Airway Obstruction↗