Biomedical subjects
Publications and source records attributed to J F Kelly.
The relative sensitivity and usefulness of FEV1 and SGaw measurements in determining airway responsiveness to stimuli causing changes in bronchomotor tone depend to a great extent on the population studied. Though neither test provides a great deal of information regarding the site of airway obstruction, when used together they provide a reliable and sensitive indicator of airway responsiveness.
Polymerized ragweed antigens of different molecular weight ranges were studied to determine if the degree of allergenicity was dependent on molecular size of the polymers. In this study, allergenicity is defined as the ability to elict IgE-mediated skin reactivity. Ragweed antigen treated with glutaraldehyde was fractionated into one preparation with a molecular weight range of 200,000 to 20,000,000 and another with molecular weights less than 200,000. Except for the difference in molecular sizes of the two molecular sizes of the two preparations, all ragweed polymers had been treated in an identical fashion. The low molecular weight fraction had cutaneous endpoint reactivity greater than 10(5) to 10(8) times that of the high molecular weight materials. In these and other studies, immunogenicity defined as the ability to induce an IgG antibody response was retained by the high molecular weight material. The results are consitent with the hypothesis that allergenicity decreases as the molecular weight of the polymerized allergen increases.
Bronchial sensitivity to grass and ragweed extracts was determined in four adult asthmatic subjects at the beginning and end of the grass and ragweed pollen seasons. 4 subjects with ragweed sensitivity had increased bronchial sensitivity to ragweed antigen at the end of the ragweed season. 2 of 3 grass sensitive subjects demonstrated increased bronchial sensitivity to grass antigen after the grass pollen season. This study suggests that natural environmetnal exposure to pollen antigens may induce priming in the lung.
Clinical assessment of bone-graft healing in the maxillofacial region is generally limited to clinical evaluation, radiographs, and biopsy. A noninvasive quantitative radionuclide method has been developed in an animal model, and it seems to allow earlier prediction of graft failure or success than conventional methods. Using a localization technique to identify preselected regions of interest reproducibly in the graft and adjacent host bone, an activity ration was developed between the graft region and a contralateral control. Two mandibular grafting systems were evaluated with this technique. When the activity ratio for the graft region over the period of study approached, or was greater than, the activity ratio for the host bone, the graft subsequently proved successful by clinical observation and gross dissection. When the activity ratio for the host bone remained greater than that of the graft, healing did not occur and the grafts were unsuccessful. This method allowed prediction of graft fate by 6 wk after grafting, and preceded radiographic confirmation of repair or failure by 2-3 wk.
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In 5 patients with respiratory symptoms consistent with humidifier or air conditioner disease, a hypersensitivity pneumonitis, no identifiable organism was cultured from the humidifier water (HW). The water source to the humidifier or air conditioner was investigated for possible antigens which might explain the occurrence of the disease. Three subjects who lived in the same city supplied by Lake Michigan had increased IgG antibody activity against the city water supply when compared with another patient from a different city and a control subject. Both of the latter lived in cities with water supplied from Lake Michigan. Two of the 5 patients showed definite inhibition by concentrated tap water (TW) of IgG antibody against HW. The source of antigens in water was not determined but must be considered in cases of this type of hypersensitivity pneumonitis. A sixth case consistent with humidifier disease had Cephalosporium cultured from her HW. On gel diffusion there was a band of identity with her serum against Cephalosporium extract and her own HW, and by radioimmunoassay (RIA) there was over 50% inhibition of her IgG antibody activity against HW by Cephalosporium. No antibody against her city TW was demonstrated.
Patients with prior anaphylactoid reactions (AR) to radiographic contrast media (RCM) are at increased risk for another reaction upon repeat exposure to RCM. One hundred one patients, who had prior AR to RCM, who gave informed consent, and who had an essential need for a repeat RCM study, were pretreated with prednisone, 50 mg orally every 6 hours for 3 doses ending one hour prior to RCM study, and diphenhydramine, 50 mg intramuscularly, one hour prior to RCM study. The repeat RCM study was then carried out using standard procedures with resuscitation equipment readily available. Ninety-six patients had no reaction. Five of the 101 (4.95%) developed AR. These AR consisted only of mild urticaria or pruritus. No significant or life-threatening reactions occurred. Pretreatment decreases the risk in this population of patients and is recommended as standard prophylaxis for patients requiring RCM who have had a previous AR.
The early diagnosis of hypersensitivity lung disease (HLD) is important because of its progressive morbidity. It is often difficult to establish the diagnosis in the early stages because of the absence of defined symptoms. Case histories of 2 patients with pigeon breeder's HLD are reported. Both patients presented with unusual manifestations of the disease: one patient was asymptomatic but had an abnormal chest radiograph; the other patient had a normal chest radiograph but experienced occasional symptoms of exertional dyspnea. Both patients had abnormal pulmonary function and precipitin bands against pigeon serum. Following inhalation challenge with pigeon serum both patients developed fever and leukocytosis, but no significant pulmonary function response was observed. In both patients pulmonary function tests returned to near normal levels after corticosteroid therapy. Early detection of HLD may prevent progressive irreversible pulmonary damage. This requires a high index of clinical suspicion and appropriate screening tests. Inhalation challenge procedures are useful in establishing the diagnosis.
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An immediate-type systemic reaction in a dog following intravenous radiographic contrast media (RCM) manifested by urticaria and wheezing on one occasion and urticaria alone on another occasion is described. This reactivity disappeared spontaneously and plans to study the mechanisms of such a reaction were not possible. If such reactivity is more persistent in certain other dogs, a model for study of immediate type reactivity to RCM would be available.
Allogeneic bone biologically interacts with host tissues at a graft site. Addition of autogenous cancellous bone and marrow to allogeneic bone enhances the osteogenic activity of the graft. These observations have been confirmed by noninvasive, quantitative radionuclide methods. The process of freeze-drying greatly reduces and, from the standpoint of clinical significance, essentially eliminates the antigenicity of allogeneic bone. Judged by the results of 14 cases that are under continuous follow-up, allogeneic bone graft augmentation of the denture-bearing area is a possible alternative to autogenous grafting. The process of obtaining and preparing the blanked bone for surgery is reasonable although some questions remain, such as the desirable length of time for tissue reconstitution and the need for culturing or adding antibiotics to the reconstitution solution, or both. It appears that the addition of autogenous cancellous bone and marrow is desirable in most instances unless the dimension of the area to be augmented is quite small or an iliac osteotomy is precluded for medical reasons. The occurrence of complications such as infection and dehiscence during the postoperative course is similar to that in patients with autogenous grafts. Dehiscence can be expected although it appears that if the graft has been supplemented with autogenous cancellous marrow the incidence and extent are dminished. It should be emphasized that dehiscence does not signify failure of the graft-allogeneic bone is not sloughed in toto after being exposed to the oral cavity. Secondary soft tissue procedures can be used in patients with allogeneic grafts; additional cases with long-term follow-up are still needed to establish this method.
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The distribution of hematoporphyrin derivative has been studied in patients undergoing transurethral resections and total cystectomy for carcinoma of the bladder. Although hematoporphyrin derivative fluorescence was not confined to malignant tissues with the dose used there was preferential localization in malignant and pre-malignant epithelium. Also high intensity illumination of an area of hematoporphyrin derivative sensitized carcinoma caused tumor destruction. Therefore, it is suggested that hematoporphyrin derivative could be used as an aid to the diagnosis and treatment of carcinoma of the bladder.
To evaluate accurately changes in blood volume during oral-facial corrective surgery, double-tagged radioisotope blood volume studies were performed preoperatively and postoperatively. Unexpectedly large RCV deficits that were not consistent with EBL were observed in studies conducted at two separate facilities. Hypotensive general anesthesia was used for the intended purpose of reducing blood loss in oral-facial corrective surgery. Various physiological parameters were measured preoperatively, intraoperatively, and postoperatively to evaluate patient response to this anesthetic method. The MAP was reduced from 89.94 +/- 2.13 to 72.79 +/- 1.63 mm Hg under the influence of NaN infusion supplemented with halothane. No dose-response relationship existed between NaN and the intraoperative MAP. A 44% reduction in the measured red cell volume was observed in comparison to a previously studied group of patients who underwent similar surgical procedures under normotensive anesthesia. It is concluded from an extensive review of the literature that the most vulnerable period for serious complications is in the immediate postoperative period. No significant complications or adverse effects were observed in this study. It cannot be emphasized too strongly that the safety of this hypotensive technique lies in constant and careful monitoring of the patient and meticulous attention to all details of anesthetic management.
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Eleven human bladder carcinomata of different degrees of differentiation were implanted in mice immunosuppressed by thymectomy, anti-thymocyte serum and x-rays. Seven carcinomata grew well and one poorly and 3 produced mainly fibrous nodules in the mice. Normal human bladder tissues were grown from 4 other patients. The administration of a haematoporphyrin derivative (HpD), followed 24 h later by exposure to white light, caused marked destruction of tumours but little or none of normal bladder tissues. HpD or light alone caused no damage to tumours or normal tissues. It is suggested that photodynamic therapy may be applicable in the treatment of superficial transitional cell carcinoma of the bladder.
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Sequential interpretation of osseous repair, more sensitive than with conventional radiography, is possible with a noninvasive, nondestructive radio-nuclide method. The method was used in the evaluation of the progress of osteogenic activity in mandibular bone grafts in 24 beagle dogs.