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Biomedical subjects

D H Keeling

Publications and source records attributed to D H Keeling.

At least 19 recordsLinked to original sources
PubMed1992

Myocardial dysfunction in ankylosing spondylitis.

Echocardiographic evidence has suggested abnormalities of the myocardial function in patients with ankylosing spondylitis. In this work the cardiac function in patients with ankylosing spondylitis and in normal volunteers was evaluated. Twenty four normal volunteers and 21 patients with ankylosing spondylitis aged 18-45 were studied. None had overt cardiac disease. Cardiac function was assessed at rest with echocardiography, at rest and during supine bicycle exercise using radionuclide angiography in the left anterior oblique position following equilibration with 740 MBq of technetium-99. The subjects undertook supine bicycle exercise with 30 W increments every three minutes to the point of fatigue. Comparison of data from normal volunteers and patients with ankylosing spondylitis were made using Student's t test for independent samples or the Mann-Whitney non-parametric technique, as appropriate. Subjects were matched for age, sex, height, and weight. There were no echocardiographic differences; however, global nuclide left ventricular function showed several differences between normal volunteers and patients with ankylosing spondylitis. The peak filling rate during exercise was significantly lower in patients with ankylosing spondylitis: normal volunteers 6.5 (SD 1.2); patients with ankylosing spondylitis 5.7 (1.2). The time to reach peak filling during exercise was significantly lower in patients with ankylosing spondylitis: normal volunteers 102 (22); patients with ankylosing spondylitis 120 (23). Regional analysis also showed differences between patients with ankylosing spondylitis and normal volunteers both at rest and during exercise. In the anteroseptal region the filling fraction and peak filling rate were significantly lower in patients with ankylosing spondylitis. Most of the differences (although not all) were in the variables of diastolic function. This study shows that there are subtle abnormalities in cardiac function in patients with ankylosing spondylitis. The major abnormalities are in the diastolic function, suggesting a decrease in left ventricular compliance.

Adult↗
PubMed1991

A prospective, randomised double-blind crossover study to examine the efficacy of strontium-89 in pain palliation in patients with advanced prostate cancer metastatic to bone.

The palliative efficacy of strontium-89 chloride has been evaluated in a prospective double-blind crossover study comparing it with stable strontium as placebo in 32 patients with prostate cancer metastatic to bone. Response was assessed 5 weeks after each treatment. 26 patients were evaluable. Complete pain relief was only reported following strontium-89 injection. Statistical comparison between placebo and strontium-89 showed clear evidence of a therapeutic response to strontium-89 compared with only a limited placebo effect (P less than 0.01).

Aged↗
PubMed1988

The effect of cisplatin on renal function in patients with testicular tumours.

A retrospective study was carried out on the immediate and delayed effects of cisplatin on renal function. 51Cr EDTA clearance was serially measured in 22 patients with testicular tumours treated with cisplatin based chemotherapy to a cumulative dose of 180 to 900 mg. The immediate effect of one to five courses of cisplatin was a 23% reduction in glomerular filtration rate (GFR) from a mean of 137 +/- 29.5 ml/min to 106 +/- 33 ml/min (P less than 0.01). Of 17 patients who were followed up from 6 to 60 months, five showed some recovery of function. Two of these five had complete recovery and three improved from a mean of 63% of initial clearance to 76% after 18 to 48 months. Seven patients showed no further change in function, the clearance remaining at a mean of 105 ml/min after 6 to 55 months and five demonstrated a further decrease in glomerular filtration rate, by a mean of 24 ml/min, after 6 to 60 months. We have concluded that there is an inevitable reduction in glomerular filtration rate with cisplatin chemotherapy. Full recovery of function is unusual and in some cases there is further deterioration without exposure to additional nephrotoxic agents.

Adolescent↗
PubMed1988

Bedside nuclear probe for detection and quantification of left to right intracardiac shunts.

A cadmium telluride nuclear probe with an Elscint gamma camera was used to detect and measure left to right intracardiac shunts at the bedside in 34 patients. Fifteen also had right heart catheterisation and oximetric measurement of the shunt. For the nuclear technique 740 MBq (20 mCi) of technetium-99m pertechnetate was injected into the right antecubital vein and the pulmonary to systemic flow ratio (QP:QS) was measured by the gamma variate technique. Data were not obtained in four patients because the nuclear probe failed in three patients and one storage disc was corrupted. Data from the gamma camera were lost in another patient. When the size of the shunt measured by the nuclear probe was compared with that measured by the oximetric technique the mean difference (SD of mean difference) was 0.36 (SD 0.78) and when it was compared with the gamma camera it was 0.08 (SD 0.67). Analysis of scatter plots showed that the larger the shunt, the larger the discrepancy. Twenty four of 29 data sets showed complete agreement between the nuclear probe and gamma camera on the size of the shunt. Any differences were small. These data indicate that left to right intracardiac shunts may be measured accurately by a nuclear probe at the bedside in either the coronary care unit or outpatient department.

Adolescent↗
PubMed1987

Restoration of active haemopoiesis in a patient with myelofibrosis and subsequent termination in acute myeloblastic leukaemia: case report and review of the literature.

A patient with polycythaemia vera developed typical myelofibrosis after 15 yr. After a further 8 months, during which time she was pancytopenic and transfusion-dependent, a slow spontaneous recovery in haemopoiesis occurred and the full blood count became normal. 6 months later pancytopenia recurred and soon afterwards the patient developed acute myeloblastic leukaemia from which she died. The evolution of bone marrow morphology and isotopic studies. Only 2 previous reports of this kind of transformation exist in the literature, although restoration of normal or polycythaemic haemopoiesis has been reported in 8 patients with myelofibrosis. It is likely that these transformations occur because of alterations in stem cell behaviour rather than as a result of therapy.

Acute Disease↗
PubMed1984

Adverse reactions to radiopharmaceuticals. United Kingdom 1977-1983.

Details of reports to the UK Adverse Reaction Reporting Scheme for the years 1977-1983 are given. These show a changing pattern since earlier reports, in part due to the discontinuance of older radiopharmaceuticals and changes in quality control measures, but also to the introduction of methylene diphosphonate for bone imaging which has accounted for nearly half of our more recent reports. Colloids for reticulo-endothelial (liver) scans account for about one third of this series. The great majority of reactions are of an idiosyncratic hypersensitive nature and none due to sterility problems or pyrogens. Accurate incidence figures are difficult to obtain but including even the trivial forms of reaction, we estimate a reaction rate of between 1:1000 and 1:10,000 in vivo nuclear medicine procedures, a figure considerably higher than most previous surveys have suggested.

Albumins↗
PubMed1975

An assessment of the value of spleen scanning in the staging of Hodgkin's disease.

The value of non-invasive spleen scanning with 51Cr-chromate heat damaged red cells has been assessed in 68 patients with histologically proved Hodgkin's disease in whom pre-treatment laparotomy with splenectomy was performed. The scans were reported independently by two observers. Following this, the uptake pattern of the radioactive tracer and size of organ on the scan were compared with the post-operative weight and pathology of the spleen. From these results it is concluded that this method of spleen scanning is an unreliable technique in staging Hodgkin's disease.

Hodgkin Disease↗
PubMed1972

Changes in the normal range of thyroidal radioiodine uptake.

Three series of patients shown to be euthyroid but originally referred for thyroid uptake tests in vivo have been compared. In 1958-59, the ;normal' mean thyroid uptake was 23.5% and 38.2% respectively at four and 24 hours. By 1967, the mean uptakes had dropped to 20.4% and 31.6%-a significant change at both times. By 1972 there was, however, no sign of a further reduction of the mean normal values for thyroid uptake. These results are compared with changes observed in other series in the USA and elsewhere.

Bread↗