Drunken injured drivers: are they "getting away with murder"?
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Accidents, Traffic↗
Biomedical subjects
J J Kelly
Publications and source records attributed to J J Kelly.
The electrodiagnostic findings in peripheral neuropathy associated with monoclonal gammopathy.
The electrodiagnostic findings in 51 patients with monoclonal serum proteins of different etiologies and peripheral neuropathies are analyzed and the findings in an additional 10 patients with multiple myeloma are discussed. The nine patients with monoclonal gammopathy of undetermined significance had electrodiagnostic patterns consistent with either predominant axonal degeneration or demyelination. Almost all 15 patients with osteosclerotic myeloma had evidence of a demyelinating neuropathy. The 27 patients with primary systemic amyloidosis almost always displayed evidence of an axonal neuropathy with superimposed carpal tunnel syndrome in some cases. The 10 patients with multiple myeloma had heterogeneous findings. Electrodiagnostic studies can aid in classifying these patients and suggest the likelihood of a specific etiology.
Amyloidosis↗
Osteosclerotic myeloma and peripheral neuropathy.
Sixteen cases of osteosclerotic myeloma and peripheral neuropathy (SM-PN) were reviewed. The neuropathy resembled chronic inflammatory-demyelinating polyneuropathy with predominantly motor disability, high CSF protein levels, and low motor nerve conduction velocities. Twelve of the 16 patients had detectable levels of monoclonal serum proteins, all with lambda light chains, but results of other laboratory studies were usually normal. Most of the patients also had organomegaly, endocrine abnormalities, or both. Treatment of solitary lesions with tumoricidal irradiation usually improved the neuropathy and reversed the nonneurologic abnormalities; chemotherapy for multiple osteosclerotic lesions was less helpful.
Adult↗
Prophylactic carotid endarterectomy for asymptomatic bruit. A look at cardiac risk.
We assessed the influence of preoperative cardiac risk factors in 57 patients undergoing 70 prophylactic carotid endarterectomies (PCE) and found that: (1) 47 (83%) had at least one cardiac risk factor and (2) nine of 15 deaths occurring in the late follow-up period (40 to 120 months) were due to cardiac causes. Perioperatively, one patient sustained a mild stroke. Although the cumulative stroke-free occurrence rate was kept to less than 6% over the five-year period, cardiac morbidity and mortality greatly influenced the quality of life after PCE. Therefore, PCE is suggested only for patients who have minimal preoperative cardiac risk factors or for those patients whose cardiac risk factors can be improved by medical therapy.
Aged↗
The laboratory diagnosis of mild myasthenia gravis.
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Adult↗
Endoneurial effects of sera from patients with acute inflammatory polyradiculoneuropathy: electrophysiologic studies on normal and demyelinated rat nerves.
Serum from 10 patients with acute inflammatory demyelinative polyradiculoneuropathy (AIDP) and 10 age-matched controls was injected into rat sciatic nerve. No statistically significant changes in any electrophysiologic parameters were found at 1 week. In nerves studied with serial recordings over 60 minutes, a small but significantly greater reduction in compound muscle action potential (CMAP) was observed at 60 minutes with AIDP serum injected into normal or focally demyelinated nerves. The small reduction in CMAP amplitude in the first hour is of uncertain clinical significance.
Action Potentials↗
Possible approaches to improving the international comparability of immigration and emigration statistics: an illustration of the Canadian situation
"This article seeks to highlight the extent of the lack of standardization which exists in the field of international migration statistics and, using statistics for Canada as an example, to illustrate how significant progress towards resolving this problem could be made if sufficient numbers of countries made their immigration and emigration statistics gradually comply more fully with the United Nations recommendations."
Americas↗
Electrophysiological studies of Guillain-Barré syndrome with different susceptibilities to develop EAN serum on 2 strains of rats.
Sera from 10 patients with AIDP and 10 age-matched controls were microinjected into the tibial division of rat sciatic nerve using improved microinjection techniques and coded sera. No statistically significant changes in conduction velocity or amplitude of the compound muscle action potential (CMAP) or in the monophasic compound action potential (CAP) parameters was found at 1 week. In nerves studied with serial recording over 1 h a small but significantly greater reduction in CMAP amplitude was observed at 60 min in the AIDP group and at both 30 and 60 min when only sera from very severely affected (bed-ridden) patients were considered. A similar reduction was found following microinjection into focally demyelinated nerves. The finding of a small reduction in CMAP amplitude in the first hour suggests the presence in some AIDP patients of serum blocking or demyelinating factors but the clinical significance of this small reduction is uncertain.
Action Potentials↗
Intraoperative prereconstruction arteriography.
Intraoperative arteriography was performed in 57 patients undergoing arterial reconstructive surgery of the lower extremity prior to selection of the site for the distal anastomosis. In 42 patients (74%), this procedure proved to be of significant benefit. Prereconstructive intraoperative arteriography influenced surgery for seven patients in the following ways: (1) two patients had visualization of vessels not demonstrated on the preoperative arteriogram; and (2) five patients had demonstration of occlusive disease that favored selection of a more distal site of anastomosis. In the remaining 35 patients, the tibial vessels and arch were visualized more clearly, so that the degree and extent of disease were better appreciated. This may have important prognostic significance. On postreconstructive arteriography, an additional five patients were shown to have an anastomotic defect that was corrected in the operating room. Intraoperative arteriography is a rapid, safe, and simple procedure that should be considered as an adjunct in reconstructive surgery of the lower extremity.
Angiography↗
The spectrum of peripheral neuropathy in myeloma.
The records of 20 patients with typical or sclerotic (sclerotic or mixed sclerotic and lytic) multiple myeloma and peripheral neuropathy who were seen during a 13-year period were analyzed to determine the natural history of the neuropathy. In the 10 patients with typical multiple myeloma, the clinical pattern was heterogeneous. Chemotherapy for multiple myeloma did not affect the neuropathy. The 10 patients who had sclerotic myeloma presented in a relatively homogeneous manner, with a predominantly motor neuropathy. Tumoricidal radiation therapy to localized plasmacytomas resulted in pronounced improvement in the neuropathy of two patients, mild improvement in three, and mild improvement in the endocrine abnormalities of one patient.
Amyloidosis↗
Prevalence of monoclonal protein in peripheral neuropathy.
We attempted to survey with serum protein electrophoresis all patients with peripheral neuropathy of unknown cause presenting at our institution within 1 year to determine the prevalence of monoclonal serum proteins in this group. Eighty-four percent of these patients were evaluated, and 10% of these had a monoclonal serum protein. This figure was statistically different from that obtained in two community studies in the literature. Because these patients often present difficult diagnostic problems, serum protein electrophoresis is necessary in the evaluation of cryptogenic neuropathies.
Aged↗
A clinical and electrophysiological evaluation of myoclonus.
The records of 23 consecutive patients with myoclonus who were seen during a 16-month period were analyzed prospectively. The patients were divided into two groups: epileptic and nonepileptic. The epileptic patients had focal and stimulus-elicitable myoclonus with enlarged somatosensory evoked potentials and enhanced long-loop reflexes, and they responded well to anticonvulsants, especially clonazepam and valproic acid. The nonepileptic group had massive and spontaneous jerks with normal-sized somatosensory evoked potentials and long-loop reflexes, and they responded poorly to anticonvulsants. Evaluation of these clinical and electrophysiologic characteristics can help in the classification of obscure movement disorders and in predicting responses to therapy.
Adolescent↗
Neurologic aspects of thyroid dysfunction.
Hypothyroidism and hyperthyroidism are common medical disorders that are often accompanied by diverse types of neurologic and neuromuscular dysfunction. Although some of these associated disorders are well known to physicians, others are not. All of these neurologic manifestations are important because they can severe as important clues to the diagnosis of a thyroid disorder. Furthermore, they are often related to the patients' presenting complaints. In addition, much like other manifestations of thyroid dysfunction, they are often reversible with return of the patient to the euthyroid state.
Eye Manifestations↗
Brachial plexus neuropathy. An electrophysiologic evaluation.
Electromyographic data were analyzed in a retrospective study of 16 patients with idiopathic brachial plexus neuropathy (BPN) and 15 patients with secondary BPN. In both groups, abnormalities on sensory and musculocutaneous motor conduction studies and lack of paraspinal fibrillation potentials on needle examination seemed most helpful in localizing a lesion to the brachial plexus. Routine motor conduction studies (distal and proximal ulnar and median) and F-wave latencies were less helpful.
Adolescent↗
Management of variceal hemorrhage: results of a standardized protocol using vasopressin and transhepatic embolization.
We reviewed the courses of 40 patients with variceal bleeding treated with a standardized protocol, including intravenous (IV) vasopressin (Pitressin) and transhepatic embolization. Twelve of the 32 patients with acute episodes of massive variceal bleeding responded to the administration of IV vasopressin alone. Of the 20 patients who did not respond to vasopressin therapy, emergency transhepatic portography with embolization produced cessation of bleeding in ten (50%). The remaining ten patients who failed to respond to either IV vasopressin therapy or transhepatic embolization died, regardless of whether they were treated with aggressive medical therapy or emergency portosystemic shunt. Transhepatic embolization in both the emergent and elective situation demonstrated a thrombotic complication rate of 20%, which limited or precluded eventual therapy with elective portosystemic shunt. Because of this relatively high incidence of occult portal thromboses after transhepatic embolization, transhepatic portography should be obtained routinely prior to elective portosystemic shunts in those patients who have a history of transhepatic embolization.
Adult↗
Carotene in bovine milk fat globules: observations on origin and high content in tissue mitochondria.
The location and origin of carotenoids in bovine milk fat globules was investigated using spectral absorption of lipid solutions at 461 nm to quantitate carotene. Release of membrane from globules as a result of churning to butter or by freezing and thawing of the globules yielded membrane preparations which were devoid of carotene. Globule cores from these procedures exhibited carotene concentrations comparable to those in total milk lipids. Fractionation of lactating bovine tissue and analysis of lipid extracts revealed that the intracellular fat droplets have carotene concentrations approximating those of secreted globules. However, intracellular membranes of the tissue, particularly the mitochondria, are much richer in carotenoids than formative or secreted fat globules. The evidence indicates that bovine milk fat globules acquire carotene during their formation in the cell, but that some minor fraction of the total carotene may be extracted from the enveloping secretory membrane. Mean carotene values (microgram/g of lipid) for fractions from three samples of lactating tissue were: whole tissue 47, mitochondria 461, microsomes 69, cytosol 67, fat droplets 8, milk 9. One tissue analysis indicated that Golgi membranes contain somewhat more carotene than do microsomes.
Animals↗
A primate model for the study of the interaction of 111In-labeled baboon platelets with Dacron arterial prostheses.
This paper presents early experience with a primate model for the noninvasive study of the interaction of circulating platelets with healing arterial prostheses. These experiments demonstrate that baboon platelets can be isolated and labeled with 111Indium with high efficiency using a sterile technique. Platelets subjected to this process have a linear life span similar to that of 51Chromium-labeled baboon platelets. The high energy gamma emission of 111Indium oxine allows for external scanning using a standard gamma camera. The small quantity of 111Indium-labeled platelets in the region of the graft can be discriminated from the surrounding blood vessel and quantitated by gamma camera imaging and computer analysis. There was a significant increase in the platelet deposition on prosthetic surfaces observed 5--48 hours after graft implantation and injection of 111Indium-labeled autologous platelets.
Animals↗