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Biomedical subjects

D G Kelly

Publications and source records attributed to D G Kelly.

At least 37 records · Page 2Linked to original sources
PubMed1994

Effect of stimulus force on perioral direction discrimination: clinical implications.

Clinicians have used the same instrument (viz, Semmes-Weinstein pressure aesthesiometers [Research Design, Inc, Houston, TX] or "von Frey hairs") for tests of both contact detection and direction discrimination. However, patients' ability to discriminate direction may be underestimated by barely detectable moving stimuli. To determine whether the aesthesiometers underestimate direction discrimination, we evaluated the capacity of 13 normal subjects to distinguish opposing directions provided by 10 different hairs. The hairs were selected to deliver forces below and above the contact-detection threshold. Each was stroked over 1.0 cm of perioral skin at the velocity at which the subject was predicted to best discriminate direction of motion. It was found that valid estimates of perioral direction discrimination can be obtained with appropriately selected aesthesiometers. Specifically, the least stiff hair whose handle displays a manufacturer's marking two units greater than that of the contact-detection "threshold hair" should be used to deliver the moving stimuli. The resultant force applied by this hair will exceed 10 times the subject's contact-detection threshold force. If a less-stiff hair is used, the capacity to distinguish direction may be underestimated.

Adolescent↗
PubMed1992

Improvement in attitudes toward the elderly following traditional and geriatric mock clinics for physical therapy students.

The purpose of this study was to determine whether the attitudes of students in a physical therapy education program toward the elderly could be influenced positively by (1) having classroom discussion led by an individual with expertise in geriatrics and (2) having only individuals aged 65 years or older participate in a specially designed geriatric mock clinic (GMC). Subjects were 47 first-year students divided into a control group (n = 24) and an experimental group (n = 23). Students in the control group participated in two 4-week clinical rotations. Students in the experimental group participated in one 5-week clinical rotation and in one 3-week GMC. Students in both groups were given a pretest and a posttest administration of the Kogan Old People Scale to assess their attitudes toward the elderly. No significant difference was found between the two groups' overall attitude scores on the pretest or the posttest results. Overall, positive attitude scores increased significantly for both groups, although the increase was greater for the experimental group than for the control group. Negative attitude scores decreased significantly for the experimental group, but did not change for the control group. We concluded that both traditional clinical rotations and a specially designed GMC influenced the students positively. Suggestions have been made for the Clinical Instructor who wishes to influence physical therapy students' attitudes to meet the increasing needs of the elderly patient population.

Adult↗
PubMed1992

Prognostic value of renal venous involvement in renal carcinoma.

A series of 108 renal tumour nephrectomies carried out between 1975 and 1984 was studied to determine the prognostic statistical significance of the relationship between venous involvement and various pathological features. Tumour size, spread, histological grade and lymph node involvement were compared between V0 tumours (58%), V1 (32%) and V2 tumours (10%). Actuarial 5-year survival rates revealed a poor prognosis with venous involvement (V0 66%, V1 27%, V2 33%). Tumours larger than 10 cm with perirenal spread and of higher histological grade were significantly related to venous involvement. Survival between renal vein involvement and inferior vena caval extension was statistically similar, but it was influenced by tumour size and higher grade. Perirenal spread and nodal involvement were poor indicators.

Adult↗
PubMed1991

How to protect human pancreatic enzyme activities in frozen duodenal juice.

We determined whether activity of pancreatic enzymes could be maintained in frozen duodenal juice by diluting the specimens or by adding nutrients or a chymotrypsin inhibitor. Human duodenal juice was obtained during cholecystokinin octapeptide IV administration. Trypsin, chymotrypsin, lipolytic, lipase, and colipase activities were measured in fresh undiluted or diluted (1:4 and 1:16 with saline and T-tube bile) duodenal juice as well as after adding CaCl2, casein, triolein, or a chymotrypsin inhibitor. Subsequently, the samples were frozen at -20 degrees C, and enzyme activities were measured at 1, 2, 3, 7, 14, 28, and 56 days. Activities of chymotrypsin and colipase did not change during freezer storage. Trypsin survival was variable in juice from different subjects. By contrast, in duodenal juice to which no nutrient or only CaCl2 had been added, 90%, 65%, and 40% (P = 0.05 vs. undiluted) of lipolytic activity was lost by 56 days in undiluted and 1:4 or 1:16 diluted duodenal juice samples, respectively. The loss of lipolytic activity was prevented (P less than 0.05) by adding casein or casein and triolein to undiluted and 1:4 diluted samples and turkey egg white to undiluted samples. The loss of lipolytic activity was strongly associated with loss of lipase activity (r = 0.97) but only weakly associated with loss of colipase activity (r = 0.49). In summary, chymotrypsin and colipase are well preserved in frozen duodenal juice and can be used to accurately assess concentrations of pancreatic enzymes after thawing frozen duodenal samples. If it is necessary to measure lipolytic activity after freezing samples, lipase can be maintained by adding casein or a chymotrypsin inhibitor to juice before freezing.

Colipases↗
PubMed1991

Influence of prior orchiopexy on stage and prognosis of testicular cancer.

Thirty-four cryptorchid testis cancer cases were studied, of whom 9 patients had prior orchiopexy at the time of cancer diagnosis. Disease stage in this group was: stage I = 4, stage II = 1 and stages III and IV = 4 cases. Seventy-eight percent of these cases (n = 7) had non-seminomas; 4 of these patients died. In the uncorrected cryptorchidism group (n = 25), disease stage was: stage I = 12, stage II = 9 and stages III and IV = 4 cases. Of these cases, 64% (n = 16) had seminomas and 6 patients died. Orchiopexy marginally reduced the symptomatic interval for subsequent cancer and probably decreased the risk of seminoma development. Orchiopexy did not lead to a more favourable disease presentation or prognosis because of the adverse bias of advanced-stage non-seminomas in this group.

Adult↗
PubMed1990

Effects of trauma to the mandibular nerve on human perioral directional sensitivity.

The capacity of 4 patients who had previously experienced trauma to their mandibular nerves to distinguish opposing directions of tactile motion over the distribution of the mental nerve was compared to that of 8 neurologically normal adults. Brushing stimuli were delivered to the perioral region and were precisely controlled for their velocity, the length of skin traversed, the width of skin contacted, and the orientation and direction of motion. A temporal, 2-alternative, forced choice method was used to obtain estimates of directional sensitivity, d'. It was discovered that impairment in cutaneous directional sensitivity could be readily detected within areas of hypaesthesia. Although directional sensitivity was found to increase linearly with the length of skin traversed for both the patients and the neurologically normal adults, the slope and the x-intercept of the linear relationship differed between the two groups. The difference in the slope suggests that direction discrimination within the hypaesthetic areas is relatively insensitive to changes in the length of skin traversed. The difference in the x-intercept suggests that a greater length of skin must be traversed before any information about direction is made available at the hypaesthetic sites. The dependency of the capacity of neurologically normal and impaired individuals to process information about direction of tactile motion on the length of skin traversed and the velocity of stimulation suggests that a high degree of stimulus control is required for the detection and quantification of subtle neurosensory deficits.

Adolescent↗
PubMed1990

Diuretics after transurethral prostatectomy: a double-blind controlled trial comparing frusemide and mannitol.

Mannitol and frusemide were compared in a randomized, controlled, double-blind trial for their effects in promoting diuresis after prostatectomy and on indices of water intoxication. The drugs had comparable diuretic effects. Sodium loss was greater with frusemide, contributing to sodium depletion after operation. Administration of frusemide was associated with more frequent need for i.v. volume expansion after operation. Plasma osmolality was greater with mannitol (289 (SD 4.2 mosmol kg-1 at 1 h after operation and 285 (5.3) mosmol kg-1 at 4 h after operation) than with frusemide (282 (7.1) mosmol kg-1 and 279 (6.7) mosmol kg-1, respectively) (P less than 0.05). Plasma concentration of sodium was significantly greater with mannitol (136.9 (3.1) mmol litre-1) than with frusemide (134.4 (2.8) mmol litre-1) only on the morning after surgery (P less than 0.05). Mannitol is an effective alternative to frusemide in inducing diuresis after prostatectomy, and may protect against water intoxication.

Diuresis↗
PubMed1990

Stability in contractive nonlinear neural networks.

We consider models of the form mu chi = -x + p + WF(x) where x = x(t) is a vector whose entries represent the electrical activities in the units of a neural network. W is a matrix of synaptic weights, F is a nonlinear function, and p is a vector (constant or slowly varying over time) of inputs to the units. If the map WF(x) is a contraction, then the system has a unique equilibrium which is globally asymptotically stable; consequently the network acts as a stable encoder in that its steady-state response to an input is independent of the initial state of the network. We consider some relatively mild restrictions on W and F(x), involving the eigenvalues of W and the derivative of F, that are sufficient to ensure that WF(x) is a contraction. We show that in the linear case with spatially-homogeneous synaptic weight, the eigenvalues of W are simply related to the Fourier transform of the connection pattern. This relation makes it possible, given cortical activity patterns as measured by autoradiographic labeling, to construct a pattern of synaptic weights which produces steady state patterns showing similar frequency characteristics. Finally, we consider the relationships, in the spatial and frequency domains, between the equilibrium of the model and that of the linear approximation mu chi = -x + p + Wx; this latter equilibrium can be computed easily from p in the homogeneous case using discrete Fourier transforms.

Artificial Intelligence↗
PubMed1989

Effects of traverse length on human perioral directional sensitivity.

The capacity of 8 neurologically healthy adults to distinguish direction of motion on the skin overlying the mental foramen was determined. The velocity, orientation, and the length and width of skin traversed by the moving tactile stimuli were precisely controlled. Directional sensitivity, d', was found to depend on both stimulus velocity and the length of skin traversed. Since the relationship between d' and velocity at each traverse length was well described by a generalized gamma function, it was possible to quantitatively characterize the effects of changes in traverse length on the relationship between d' and velocity. Specifically, peak (i.e., maximal) directional sensitivity increased as the length of skin traversed was increased, yet the velocity which resulted in peak directional sensitivity (i.e., the optimal or model velocity) remained invariant over the range of traverse lengths investigated (0.35-1.0 cm). The effect of stimulus velocity on directional sensitivity was least at the longest traverse lengths used. The generalized gamma function model fit the relationship between directional sensitivity and velocity equally well at all traverse lengths studied. The results lead us to anticipate that stimuli of the type used in this study should prove valuable for the detection and quantification of disturbances in orofacial tactile spatiotemporal integration in patients with peripheral nerve injury.

Adolescent↗
PubMed1988

Renal dysplasia--a clinicopathological review.

A review of 15 cases of unilateral renal dysplasia is presented. Seven patients came to medical attention with urinary tract infection. Only 4 presented with an abdominal mass. Eight patients were found to have ipsilateral ureteric anomalies and 4 of these also had contralateral ureteric problems. Five patients had extra-renal anomalies and these included Turner's syndrome, scoliosis and congenital dislocation of the hip. Histological examination, in all cases, revealed the presence of primitive ducts surrounded by concentric layers of cellular mesenchyme. Metaplastic cartilage was noted in only 7 of the 15 cases.

Adolescent↗
PubMed1988

An evaluation of predisposing factors for testis cancer in Ireland.

All testis cancer in Ireland (1980-1985) was analysed (n = 240). Incidence was highest in young adults (5.8/10(5)/year in those aged 25-34 years) with a moderate level in the elderly (1.8/10(5)/year in those over 75 years). Associations elsewhere with maldescent and social class were confirmed but cryptorchidism (12%) was more common than expected. Significant infertility was not identified. Associations with urban domicile (77%, p = 0.001), mental handicap (2.8%, p less than 0.05), recent vasectomy (1.2%, p = 0.009) and certain occupations were observed.

Adult↗
PubMed1988

Physician-dependent prognostic variables in the management of testicular cancer.

A study of 246 cases of germ cell testicular cancer in Ireland between 1980 and 1985 confirmed that the personnel and the manner of management can significantly influence the outcome. Inadequate staging by omitting marker assays or CT scan reduced prognosis. Failure to use standard chemotherapy (PVB, BEP, POMBACE, VAB) or a reduced dosage diminished survival. Regular investigations are necessary during treatment, including marker assays, chest X-ray and CT scan. Frequent monitoring is important in later follow-up. Management by a urologist improved survival, especially if he was involved from the outset. The results also favoured the concept of combined management by a urologist and an oncologist.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1987

Patients' delay in the presentation of testis cancer in Ireland.

A study of 217 cases of testis cancer in Ireland revealed a longer duration of symptoms (median 2.8 months, mean 10 months) than elsewhere: 32% of patients waited at least 6 months before seeking medical advice. Delay was associated with metastases (P = 0.001), diminished prospects of cure (P = 0.001) and increased mortality (P = 0.002) but not with marker status or complexity of treatment required. Eleven per cent did not notice a detectable swelling and 25% waited at least 3 months after such a discovery. These facts and the incidence of maldescent (12%, with more than two-thirds untreated) highlight the need for better health education in this area.

Attitude to Health↗
PubMed1987

Transitional cell carcinoma in patients under forty years of age.

Transitional cell carcinoma of the urinary tract in patients under the age of 40 is often thought to be a milder form than in the older age groups. However, the literature provides little information on this and is contradictory. We report a series which shows that there is a significant recurrence rate, albeit less than in those aged over 40. The tumours were predominantly low grade and low stage and none could be described as aggressive.

Adolescent↗
PubMed1986

Recent trends in mortality due to testicular cancer in Ireland: a comparison with England and Wales.

In the period 1961-84, the number of deaths in Ireland due to the testis cancer rose by 64%. This was due both to significant male population expansion (25.3%) and to an increased mortality rate. In the 25-34 years age group, one of the groups at highest risk, the mortality rate rose by 123%. In contrast, in England and Wales, although the male population has risen by 8.5% since 1961, the number of deaths has decreased by 17%. This is due to falling mortality rates, for example an 18% decrease in those aged 25-34 years. The highest rate of all occurred in those Irish over 75 years old. The changing Irish trends appear to lag behind those in England and Wales by some decades, and this raises important aetiological considerations.

Adolescent↗