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Biomedical subjects

J J Kelly

Publications and source records attributed to J J Kelly.

At least 163 records · Page 9Linked to original sources
PubMed1980

The economic impact of acute variceal bleeding: cost-effectiveness implications for medical and surgical therapy.

The hospital costs and its respective components for 32 patients with acute variceal bleeding were determined. The average total cost for treating the 32 patients was $35,000. The cost for those patients who underwent elective surgery ($53,000) was approximately twofold that of the elective medical group. Nutritional and metabolic rehabilitation that prolonged hospitalization, reutilization of the intensive care unit, and perioperative blood requirements were the significant factors that increased the cost of treating the surgically treated patients. Derivation of the cost/benefit ratio, however, showed that the decreased rehospitalization rate of the surgically treated group and the apparent better "quality of life" almost offset the increased initial hospital costs for this group.

Adult↗
PubMed1980

The relative value of carotid noninvasive testing as determined by receiver operator characteristic curves.

To determine the relative value of carotid phonoangiography (CPA), oculoplethysmography-Kartchner (OPG-K), and Doppler ultrasonic arteriography (UA), 90 vessels undergoing carotid endarterectomy were prospectively examined. By analyzing the data on receiver operator characteristic curves, the dynamic relationship between sensitivity and specificity for each of the three noninvasive tests was assessed. Disease was defined by either the percentage of angiographic stenosis or the mean pressure gradient across the carotid (deltaP). All three tests were shown to be relatively insensitive, but quite specific, if disease was defined by 50% and 60% angiographic stenosis or deltaP of greater than 10 and 20 mm Hg. By employing a more rigid definition of disease, 70% stenosis or deltaP of greater than 30 mm Hg, sensitivity was increased for all examinations and was highest in OPG-K and UA for a given specificity. The sensitivity for UA was enhanced to 80% with a comparable specificity, if those 23 UA exams with plaque were treated as positive studies. The combination of CPA, OPG-K, and UA was superior to any one of these tests alone, but the best value balancing maximum sensitivity and specificity still was associated with a 23% false negative rate. This study would suggest that these three tests should be limited to screening patients at risk for carotid stenosis and not for symptomatic patients. To achieve the best balance between sensitivity and specificity, lax threshold criteria for calling the test positive should be employed, and the tests should be used in combination.

Angiography↗
PubMed1980

A comparison of the early noninvasive hemodynamic results after aortofemoral or axillofemoral bypass graft.

Aortofemoral (AF) and axillofemoral bypass grafts (AXFG) are alleged to have similar patency rates, but little is known of their comparative functional results. In 91 limbs clinically selected for AXFG or AF, pulse volume recording amplitude (PVR) and Dopper systolic ankle/brachial artery pressure ratio (DSP A/B) were measured before and 6 months after surgery. Preoperatively, the limbs were classified by angiography into aortoiliac disease alone (AI) or AI and femoropopliteal disease (AIFP), and were further classified by PVR and DSP A/B into claudication and limb salvage groups. Six months after surgery, the degree of hemodynamic improvement was comparable for AF and AXFG for limbs with AI. After AXFG in AIFP, however, the claudication group showed less of an improvement in DSP A/B ratio and PVR than with AF. There was no functional improvement after AXFG in the limb salvage group. AF appears to be associated with better functional results than AXFG in AIFP.

Arterial Occlusive Diseases↗
PubMed1979

Failure of carotid stump pressures. Its incidence as a predictor for a temporary shunt during carotid endarterectomy.

A total of 289 carotid endarterectomies were performed in 204 patients. A decision to place a temporary shunt during carotid endarterectomy in this series was made entirely on the basis of intraoperative EEG monitoring. Retrospectively, the correlation between stump pressures and the results of intraoperative EEG monitoring in each case was determined. Evidence of ischemia developed in 6% of the total series on intraoperative EEG monitoring despite a stump pressure of greater than 50 mm Hg. The degree of disagreement between stump pressure and EEG varied according to clinical category in this series. In those endarterectomies performed for completed stroke, all cases requiring shunting had stump pressures less than 50 mm Hg. In those cases performed for symptoms of vertebral basilar insufficiency, however, 77% of the cases requiring an intraoperative shunt had stump pressures greater than 50 mm Hg. A review of the complication rate in the various study groups indicates that the use of intraoperative EEG is a safe indicator of cerebral ischemia during carotid endarterectomy regardless of stump pressure.

Blood Pressure↗
PubMed1979

The natural history of peripheral neuropathy in primary systemic amyloidosis.

The records of 31 patients with primary systemic amyloidosis and peripheral neuropathy seen during a 17-year period were analyzed to define the natural history of the neuropathy. Patients tended to be older men with a painful, distal, symmetrical sensorimotor neuropathy and prominent autonomic features. Loss of pain and temperature sensation was frequently more striking than loss of mechanoreception. Renal, cardiac, hematological, and gastrointestinal dysfunction often overshadowed the neuropathy. Clinical, neurophysiological, and histopathological studies pointed to axonal degeneration with predominant but not exclusive involvement of small myelinated and unmyelinated fibers. The neuropathy was progressive in all patients with or without treatment, but death was typically due to supervening medical complications.

Aged↗
PubMed1979

Facial myokymia with polyradiculoneuropathy.

Two patients had bilateral facial myokymia in association with polyradiculoneuropathy. Characteristic electromyographic findings allow polyradiculoneuropathy to be differentiated from other causes of facial movements, and support the possibility that extraaxial facial nerve involvement is another cause of facial myokymia.

Adult↗
PubMed1979

A prospective study of Doppler pressures and segmental plethysmography before and following aortofemoral bypass. Implications for predicting success and for adopting a uniform method of classifying arterial disease.

To determine the clinical and hemodynamic changes associated with aortofemoral bypass, 44 limbs of 31 patients underwent segmental plethysmography (PVR) and Doppler pressures (DSP) before operation, immediately after operation, and again at 6 months. Prior to operation patients were separated by angiographic criteria into two groups: aortoiliac segment disease alone (AI) (n = 22), and aortoiliac and femoropopliteal segment disease (AIFP) (n = 22). At 6 months the two groups were subdivided into four groups based on relief (oSx) or lack of relief (+Sx) of symptoms. Before operation the only significant difference between the four groups was a higher thigh PVR and calf DSP in the AI + Sx group. Six month PVR values in AIoSx were improved nearly twofold over preoperative measurements at the thigh and calf, but at the thigh level only for AIFPxSx. DSP was increased at all three levels in both AI and AIFPoSx groups. No hemodynamic improvement occurred in either the AI or the AIFP + Sx groups. A derivative index of PVR (thigh-ankle/15 mm) or the FPomega was significantly lower in AIFOsSx before operation. There was a significant disparity between classification by hemodynamics and by symptoms prior to operation which lessened somewhat after operation. These studies suggest that success or failure can be predicted before operation in AIFP by FPomega, and arterial disease should be classified by a combination of symptoms, angiography, and hemodynamics.

Angiography↗
PubMed1978

Intracranial arteriovenous malformations in childhood.

During the 13-year period 1964 through 1976, 37 patients less than 20 years with an intracranial, parenchymal arteriovenous fistula were seen at the Mayo Clinic. The most frequent mode of presentation was hemorrhage or seizure. Other than angiography, computed tomography with contrast enhancement was the most helpful diagnostic test. Surgery was restricted to patients with intraparenchymal hematomas, intractable seizures, or subarachnoid hemorrhage with accessible lesions and to 1 infant with a massive, sumptomatic malformation. Surgery generally was tolerated well, with reversal of most acute focal neurological deficits related to hematomas. In the nonsurgical group, follow-up revealed a fairly stable neurological status during the period of the study.

Adolescent↗
PubMed1978

Acetylcholine release in diaphragm of rats with chronic experimental autoimmune myasthenia gravis.

Recent evidence indicates that in chronic experimental autoimmune myasthenia gravis (EAMG) and in human myasthenia gravis, the defect of neuromuscular transmission results from immune-mediated destruction of post-synaptic membrane at the neuromuscular junction, with a reduction in the density of acetylcholine (ACh) receptors and decreased sensitivity to ACh released by nerve impulses. In the present study, the amount of ACh released by nerve impulse in rats with chronic EAMG and control rats of the same age, weight, and sex was compared. Phrenic nerve-hemidiaphragm preparations were stimulated in vitro, and the amount of ACh released was measured by bioassay. Despite a marked reduction in the amplitude of miniature end-plate potentials in chronic EAMG, ACh output at rest and during stimulation was not different from that of control rats. These data support the concept that the defect of neuromuscular transmission is due to a reduction of postsynaptic sensitivity to ACh.

Acetylcholine↗
PubMed1978

Movement-activated central fast rhythms: an EEG finding in action myoclonus.

Five patients with relatively mild but disabling action myoclonus displayed a subtle and heretofore unemphasized electroencephalographic manifestation of action myoclonus consisting of low-voltage, central fast activity somatotopically related to the extremity being used. The importance of recognizing this rhythm lies in its association with milder forms of action myoclonus which resemble other types of movement disorders, the difficulty in recognizing this rhythm unless special tests are carried out, and the beneficial response of anticonvulsant therapy if the nature of the movement is realized.

Adolescent↗
PubMed1976

Remission and recovery from chronic, established, complete heart block.

The return of A-V conduction is described in a patient after two decades of high-grade or complete congenital heart block. Similar cases have been reported by others, with remission or even recovery commencing up to the fourth decade or later. A similar phenomenon is also described in four patients with acquired heart block of four to ten years' duration; in them, remission was usuallly brief but persisted for seven years in one patient. No full report of this seems to have been published previously. Possible explanations are discussed, but no conclusion is reached. Apart from its interest, the phenomenon is of importance with respect to the selection of demand-type electronic pacemakers in the management of patients with heart block.

Aged↗