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Biomedical subjects

D Kay

Publications and source records attributed to D Kay.

At least 37 records · Page 2Linked to original sources
PubMed1997

Analysis of the treatment of spontaneous sustained stable ventricular tachycardia.

OBJECTIVES: To determine the termination rate of spontaneous sustained stable ventricular tachycardia (SSSVT) as a function of the first and second therapeutic interventions used, and to determine factors associated with successful termination. METHODS: A multihospital, retrospective analysis of the treatment of patients with SSSVT was performed. The setting included 2 urban county hospitals, 2 urban private hospitals, and a Veterans Affairs hospital. Cases were identified by discharge diagnosis and ECG characteristics, and confirmed by electrophysiology study or ECG criteria. RESULTS: There were 40 cases of SSSVT identified. Excluding adenosine, 35 patients were treated with lidocaine as a first intervention. The rate of termination with lidocaine bolus was 17% (6 of 35) (95% CI 7-34%). Regarding the 35 patients initially treated with lidocaine, the odds of termination of SSSVT were 11 times greater in those without a history of previous myocardial infarction (MI) than in those with a history of MI (95% CI 0.96-551). Of the 29 patients who failed initial lidocaine treatment, 23 were treated with a second lidocaine bolus, with a termination rate of 18% (4 of 22) (95% CI 5-40%). Only 2 patients with sustained ventricular tachycardia had a concurrent MI, and the tachycardia was unresponsive to initial lidocaine bolus in both cases. Fifteen patients received adenosine with no tachycardia terminations and no significant adverse effects. CONCLUSIONS: The rate of SSSVT termination with lidocaine was low, particularly in patients with a history of Mi.

Anti-Arrhythmia Agents↗
PubMed1996

Intracellular accumulation of unconjugated bilirubin inhibits phytohemagglutin-induced proliferation and interleukin-2 production of human lymphocytes.

Decreased immune responses have been documented in hyperbilirubinemic patients. This study investigates the effects of intracellular bilirubin accumulation on lymphoproliferative response to phytohemagglutin A (PHA). Human peripheral blood mononuclear cells (PBMNC) were preincubated with unconjugated bilirubin dissolved in bovine albumin solution at pathological levels seen in clinical hyperbilirubinemia (0-12 mg/dl), washed, and further cultured with PHA. DNA synthesis was measured by [3H]thymidine uptake. Interleukin-2 (IL-2) activity was determined by the CTLL proliferation assay. The amount of intracellular bilirubin and expression of cell surface antigens were analyzed by flow cytometry. In vitro exposure of normal PBMNC to bilirubin resulted in the accumulation of intracellular bilirubin and a decrease in DNA synthesis after PHA stimulation in a time- and dose-dependent manner. Addition of autologous untreated monocytes could not correct the decreased DNA synthesis of bilirubin-treated lymphocytes. IL-2 production by bilirubin-treated PBMNC after PHA stimulation was significantly decreased compared to bilirubin-untreated PBMNC. However, addition of exogenous IL-2 to pretreated PBMNC could not correct the decreased DNA synthesis. Expression of Tac antigen and transferrin receptor on bilirubin-treated lymphocytes after PHA stimulation was not significantly different from bilirubin-untreated cells. These results suggest that decreased PHA-induced T-lymphocyte proliferation following bilirubin-pretreatment may result from impairment of proliferation at a step beyond transferrin receptor expression. These observations may help explain the increased susceptibility to infection often observed in hyperbilirubinemic patients.

Antigens, CD↗
PubMed1996

Copper in drinking water--an investigation into possible health effects.

A study was carried out to examine the possible relationship between levels of copper in drinking water and the incidence of specified childhood liver complaints presenting at a major UK paediatric liver unit. Public drinking water supplies were generally found to have levels of copper which were well below the EC standard of 3,000 micrograms/l. In private supplies, a slightly greater number of samples were found to exceed the prescribed concentration; in one instance a value of 26,000 micrograms/l was recorded. Data describing infant patients reporting to Kings College Hospital, London with specified liver complaints were examined. Where the address of patients could be determined (220 out of 240 cases), all patients were found to live in areas served by public drinking water supplies and were, thus, unlikely to have experienced elevated drinking water copper concentrations.

Child↗
PubMed1996

Marine waters contaminated with domestic sewage: nonenteric illnesses associated with bather exposure in the United Kingdom.

OBJECTIVES: This study identified possible dose-response relationships among bathers exposed to marine waters contaminated with domestic sewage and subsequent risk of nonenteric illness. METHODS: Four intervention follow-up studies were conducted within the United Kingdom. Healthy volunteers (n = 1273) were randomized into bather and nonbather groups. Intensive water-quality monitoring was used to assign five bacteriological indices of water quality to individual bathers. Illnesses studied were acute febrile respiratory illness, and eye, ear, and skin ailments. RESULTS: Fecal streptococci exposure was predictive of acute febrile respiratory illness, while fecal coliform exposure was predictive of ear ailments. Estimated thresholds of effect occurred at bather exposures above 60 fecal streptococci and 100 fecal coliform per 100 ml of water, respectively. Although no relationship was found between eye ailments and indicator organism exposure, compared with nonbathers, bathers were at higher risk for eye ailments. CONCLUSIONS: Nonenteric illness can be transmitted via recreational contact with marine waters contaminated with sewage. These results argue against the use of a single indicator to establish water quality standards.

Adult↗
PubMed1995

Indicator organism sources and coastal water quality: a catchment study on the island of Jersey.

Compliance monitoring of bathing waters at La Grève de Lecq on the North coast of Jersey revealed a significant deterioration in water quality between 1992 and 1993, as indexed by presumptive coliform, presumptive Escherichia coli and streptococci concentrations. During the 1993 bathing season the beach failed to attain the compliance with the EC Guideline criteria for presumptive E. coli and streptococci. A bacteriological survey of the stream catchment draining to the beach revealed that: (i) concentrations of faecal indicator organisms were enhanced at high discharge after rainfall; and (ii) a captive water fowl population, which expanded between 1990 and 1993, was a potential source of faecal pollution. Strategies for catchment management are discussed.

Analysis of Variance↗
PubMed1994

Predicting likelihood of gastroenteritis from sea bathing: results from randomised exposure.

The health effects of bathing in coastal waters is an area of scientific controversy. We conducted the first ever randomised "trial" of an environmental exposure to measure the health effects of this activity. The trial was spread over four summers in four UK resorts and 1216 adults took part. Detailed interviews were used to collect data on potential confounding factors and intensive water quality monitoring was used to provide more precise indices of exposure. 548 people were randomised to bathing, and the exposure included total immersion of the head. Crude rates of gastroenteritis were significantly higher in the exposed group (14.8 per 100) than the unexposed group (9.7 per 100; p = 0.01). Linear trend and multiple logistic regression techniques were used to establish relations between gastroenteritis and microbiological water quality. Of a range of microbiological indicators assayed only faecal streptococci concentration, measured at chest depth, showed a significant dose-response relation with gastroenteritis. Adverse health effects were identified when faecal streptococci concentrations exceeded 32 per 100 mL. This relation was independent of non-water-related predictors of gastroenteritis. We do not suggest that faecal streptococci caused the excess of gastrointestinal symptoms in sea bathers but these microorganisms do seem to be a better indicator of water quality than the traditional coliform counts. Bathing water standards should be revised with these findings in mind.

Adult↗
PubMed1994

HEC consortium survey: current perspectives of physicians and nurses.

At the request of the Midwest Bioethics Center (MBC), we surveyed nurses' and physicians' attitudes and needs regarding Hospital Ethics Committees (HECs). The primary objective of this research project was to inform the practices and policies of the Ethics Committee Consortium of the Bioethics Center. Four thousand eight hundred and twenty-nine surveys were distributed to the medical and nursing staff of eight Kansas City metropolitan area hospitals. One thousand and fifty-five surveys were returned, representing a response rate of 21%. This survey examined five areas believed to be related to nurse and physician use of and participation on HECs: [1] Training in Biomedical Ethics; [2] Nature and Purpose of HECs; [3] HEC Functions-Case Consultation; [4] Ethical Decision-Making and Patient Care; and [5] Continuing Education. Important findings include lack of knowledge regarding whether case review is required or optional, and whether recommendations are binding or advisory; a perception that training in medical ethics was inadequate; and a strong indication that HECs should be accessible. These findings are consistent with and extend the findings of prior descriptive research in this area.

Adult↗
PubMed1993

Water and non-water-related risk factors for gastroenteritis among bathers exposed to sewage-contaminated marine waters.

All previously published epidemiological studies of the health effects of bathing in marine waters contaminated with domestic sewage contain three major methodological weaknesses in study design: (1) failure to control for the substantial amount of temporal and spatial variation in indicator organism densities shown to occur within just a few hours at marine water bathing locations; (2) failure to relate indicator organism density directly to the individual bather; and (3) failure to rigorously control for non-water-related risk factors on previously reported associations between bathing in marine waters and illness among such bathers. We report the results of two intervention follow-up studies specifically designed to address these methodological weaknesses. We restricted study outcome to bathing-associated gastroenteritis since this is the illness most consistently reported to be associated with bathing in marine waters, and upon which both current US Marine Water Quality Criteria and other standards used worldwide are based. Our results show that faecal streptococci was the only indicator organism to predict the occurrence of gastroenteritis among bathers, and this occurred at only one of the three water quality sampling depths used in our study. The consumption of three different foods known or suspected to act as vectors in the transmission of gastroenteritis, as well as one non-food, non-water-related risk factor for gastroenteritis were found to significantly increase the risk of gastroenteritis among bathers. Multiple logistic regression modelling showed that these non-water-related risk factors confounded the relationship between exposure to marine waters of varying faecal streptococci densities and the occurrence of gastroenteritis among bathers to a moderate degree. Moreover, these analyses showed that the risk of gastroenteritis to the individual bather caused by these non-water-related risk factors, approximated the risk of gastroenteritis among bathers exposed to waters containing relatively high faecal streptococci densities. The implications of these findings with regard to the validity of present marine water quality criteria and on the need for, and design of, future epidemiological studies of bathing water associated illness are discussed.

Adult↗
PubMed1993

Hepatic tumors: role of computed tomographic arterial portography in surgical planning.

Various imaging modalities currently used to evaluate liver tumors include magnetic resonance imaging, ultrasonography, contrast-enhanced computed tomography, and computed tomographic arterial portography. In our review of 28 cases, we found CT arterial portography to be very sensitive, and in 5 of these 28 cases CT arterial portography was a key factor in altering the course of therapy.

Adult↗
PubMed1992

Health effects of white-water canoeing.

There is little quantitative information on the relation between water quality and disease attack rates after recreational activities in fresh water. We conducted a prospective cohort study to measure the health effects of white-water and slalom canoeing in two channels with different degrees of microbial contamination. Site A, fed by a lowland river, showed high enterovirus concentrations (arithmetic mean 198 pfu per 10 litre and moderate faecal coliform concentrations (geometric mean 285/dl); at site B, from an upland impoundment, all samples were free of enteroviruses and the geometric mean faecal coliform concentration was 22/dl. Between 5 and 7 days after exposure canoeists using site A had significantly higher incidences of gastrointestinal and upper respiratory symptoms than canoeists using site B or non-exposed controls (spectators). Like seawater bathers, fresh-water canoeists can be made ill by sewage contamination. The hazard of fresh water may be best measured by counting of viruses rather than bacteria.

Adult↗
PubMed1991

Development of intrapancreatic transplantable model of pancreatic duct adenocarcinoma in Syrian golden hamsters.

Intrapancreatic and subcutaneous (SC) inoculation of cultured pancreatic cancer cells, derived from an induced primary pancreatic cancer in a Syrian hamster, resulted in tumor take in all recipient hamsters. The intrapancreatic allografts grew rapidly, were invasive, and metastasized into the lymph nodes and liver in 2 of 9 cases. In comparison, SC tumors grew relatively slower and formed a large encapsulated mass without invasion and metastases. Histologically, tumors of both sites showed fairly well-differentiated adenocarcinomas of ductal/ductular type resembling the induced primary cancer. Similar to the primary induced pancreatic cancers, tumor cells of both allografts expressed blood-group-related antigens, including A, B, H, Le(b), Le(y), Le(x), and tumor-associated antigen TAG-72. The tumor cells did not express Le(a), CA 19-9, 17-1A, or DU-PAN-2. The expression of these antigens was retained in the metastases and presented the same patterns of reactivity as the allografts. Thus intrapancreatic transplantation provides a rapid model for production of pancreatic cancer with morphologic similarities to human pancreatic cancer.

Adenocarcinoma↗
PubMed1989

Idiotypic cascades in cancer patients treated with monoclonal antibody CO17-1A.

We have previously shown that gastrointestinal cancer patients treated with monoclonal antibody CO17-1A (Ab1) developed anti-idiotypic antibodies (Ab2) to the Ab1. We now demonstrate that patients produce anti-anti-idiotypic antibodies (Ab3) to their autologous Ab2. Ab3 were demonstrated in culture supernatants of peripheral blood mononuclear cells from five Ab1-treated patients after stimulation of the cells with heterologous Ab2 that functionally mimicked the tumor antigen (Ag) defined by Ab1 and immunologically cross reacted with the patients' Ab2. Ab3 shared idiotopes with Ab1 and were Ab1-like in their binding specificities to tumor cells, Ag, and Ab2. Such antibodies were also elicited by stimulating cells with Ag. However, they were not produced by stimulating posttreatment mononuclear cells with control proteins or by stimulating pretreatment cells with either Ag or Ab2. Our results demonstrate idiotypic cascades in cancer patients treated with monoclonal antibody. Ag-specific Ab3 responses may underlie delayed clinical responses often observed in cancer patients treated with monoclonal antibodies of various specificities.

Adenocarcinoma↗
PubMed1989

Bronchopulmonary sequestration.

Bronchopulmonary sequestration is a rare lesion making up less than 10% of all congenital pulmonary malformations. The two classic types, extralobar and intralobar, can be distinguished by whether or not the sequestered pulmonary tissue is enclosed by a separate visceral pleural lining. A case of intralobar bronchopulmonary sequestration is presented. At present, aortography is necessary to establish the diagnosis, but other imaging modalities including computed tomography, ultrasound, and magnetic resonance imaging offer the potential for additional useful information.

Adult↗