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Biomedical subjects

J K Kelly

Publications and source records attributed to J K Kelly.

At least 55 records · Page 3Linked to original sources
PubMed1988

Pilot study of cyclosporin A in patients with symptomatic primary biliary cirrhosis.

The purpose of this pilot study was to determine whether daily administration of cyclosporin A to symptomatic patients with primary biliary cirrhosis for 1 yr would lead to a significant and sustained improvement in liver enzyme abnormalities. Twelve adult patients (11 female, 1 male; aged 52.6 +/- 8.9 yr, mean +/- SD) with serologic and histologically defined primary biliary cirrhosis were randomized to receive either oral cyclosporin A or vehicle placebo. Cyclosporin A was administered at sufficient dosages to maintain serum radioimmunoassay trough levels between 100 and 200 ng/ml (starting dosage, 2.5 mg/kg.day). After 1 yr of therapy, significant changes from pretreatment values were seen only in recipients of cyclosporin A. These included a 37% decrease in mean serum alkaline phosphatase and a 43% decrease in gamma-glutamyltransferase (controls +3% and -14%, respectively). Mean serum bilirubin and albumin levels and prothrombin times remained unaltered in the two groups, as did the extent of inflammation and fibrosis and the histologic staging of liver biopsy specimens. Although mean serum creatinine levels increased by 51% in recipients of cyclosporin A (+2% in controls), there were no associated changes in diastolic blood pressure or creatinine clearance values. Other side effects including thrombocytopenia, hirsutism, headaches, tremor, and parasthesiae were common in the treated group but not of sufficient severity to warrant adjustment in the dosage or discontinuation of therapy. The observed changes in hepatic, renal, and hematologic tests tended to return to baseline after discontinuation of therapy. Two patients, both placebo recipients, died of liver failure during the study period. The results of this study indicate that in symptomatic primary biliary cirrhosis, cyclosporin A administration is associated with a significant improvement in cholestatic liver enzyme abnormalities that persists for the duration of therapy. A progressive rise in serum creatinine levels and a high incidence of side effects raise concerns regarding the long-term safety of this agent in primary biliary cirrhosis.

Adult↗
PubMed1988

Intestinal metaplasia and dysplasia of prostatic urethra secondary to stricture.

We report a case of intestinal metaplasia and dysplasia (villous adenoma) of the prostatic urethra secondary to stricture of the prostatic portion of the urethra and chronic inflammation. This sequence of events has previously been recognized in the urothelium of the bladder as a precursor of adenocarcinoma of intestinal type. Premalignant dysplasia of glandular type is rare in the urethra, as is adenocarcinoma, and this case suggests that the pathway to some adenocarcinomas of the urethra may be through intestinal metaplasia and dysplasia similar to the process recognized in the stomach, nose, and urinary bladder.

Adenoma↗
PubMed1988

The chronological sequence in the pathology of Crohn's disease.

Sixty-three consecutive reexcisions of bowel for recurrent Crohn's disease where the former excision had removed all apparent disease were studied. Nine pathologic parameters (small ulcers, granulomas, regeneration, metaplasia, submucosal lymphoid follicles, transmural inflammation, large ulcers, sinuses, and strictures) were correlated to the interval of time since the former excision to document the disease progression. By regression analysis, only the presence of strictures or large ulcers correlated with time. First quartile times suggest that small ulcers and granulomas were the earliest lesions of those studied. Regeneration, metaplasia, submucosal lymphoid follicles, and transmural inflammation appear to be sequelae of ulceration. Sinuses and strictures are late complications of ulceration. The results confirm clinical, radiological, and subjective pathological impressions of the progress of the disease and suggest a central role for ulceration in this disease.

Crohn Disease↗
PubMed1988

Recognizing tympanostomy tubes on temporal bone CT: typical and atypical appearances.

Myringotomy with placement of a tympanostomy tube is a common surgical procedure. Although CT is not performed to evaluate these tubes, recognizing and accurately reporting their presence are important for a number of reasons. These include misidentification of the tube as a foreign body or a dislocated ossicle, misidentification of debris or normal ossicles as a tympanostomy tube, confirmation of the presence of a tube not seen on otoscopic evaluation, stimulation of careful search for cholesteatoma, and documentation of intervention. The purpose of this study is to show the CT appearance of tympanostomy tubes and to determine factors that make their identification on CT difficult. We reviewed all CT studies of the temporal bone performed over a 1-year period to determine the presence and appearance of tympanostomy tubes. Of the 118 CT scans evaluated, 19 patients (16%) had 34 tympanostomy tubes; of these 34 tubes, 13 (38%) had CT features that hindered identification of the tubes. Factors that resulted in obscured tubes, in order of frequency, included surrounding fluid, technical problems such as motion and artifacts, and atypical location. By knowing the appropriate location and CT appearance of tympanostomy tubes, misidentification of the tubes can be avoided.

Adolescent↗
PubMed1988

Mesenteric venous thrombosis due to antithrombin III deficiency.

A 19-year-old woman developed gradually worsening abdominal pain, signs of peritonitis, and hematemesis. Laparotomy revealed peritonitis due to segmental small-bowel infarction, and the underlying pathologic condition was mesenteric vein thrombosis. A primary thrombotic disorder was suggested and antithrombin III deficiency was found. Before anticoagulant therapy could be initiated, she developed hemorrhagic cerebral infarction and died. Her history included three episodes of deep vein thrombosis while taking oral contraceptives. Her father died of spontaneous mesenteric and portal vein thrombosis at age 29 years. This report underlines the importance of careful interpretation of the vascular pathology in cases of intestinal ischemia.

Adult↗
PubMed1987

The pathogenesis of inflammatory polyps.

Eighty-six consecutive colonic resection specimens for inflammatory bowel disease were studied to determine the modes of inflammatory polyp formation. The two major groups of inflammatory polyps were polypoid mucosal tags due to undermining ulceration and mature inflammatory polyps composed of mucosa, muscularis mucosae, and a submucosal core. Mature inflammatory polyps were derived from polypoid mucosal tags after regeneration and the adjacent mucosa showed regenerative changes and submucosal scarring. The study confirms that ulceration which undermines the muscularis mucosae is the major precursor of inflammatory polyps.

Colitis, Ulcerative↗
PubMed1987

Reovirus type 3 infection in patients with primary biliary cirrhosis and primary sclerosing cholangitis.

Reovirus type 3 (Reo-3) infection has recently been implicated in the pathogenesis of certain idiopathic, cholestatic liver diseases of newborns. In the present study, antibody titres to Reo-3 virus (anti-Reo-3) were determined in sera from 43 adults with idiopathic cholestatic liver disease, including 34 patients with primary biliary cirrhosis (PBC) and 9 patients with primary sclerosing cholangitis (PSC). Seventy-four adults with various other causes of chronic liver disease and 16 healthy volunteers served as controls. Geometric mean titres of anti-Reo-3 were significantly higher in PBC and PSC sera than chronic liver disease and healthy controls (P less than 0.005). Mean antibody titres for all patient groups, however, were within the 95% confidence limits for normals. Seven of 34 (21%) PBC patients and 3/9 (33%) PSC patients had elevated titres of anti-Reo-3, as compared to only 4/74 (5%) chronic liver disease (P less than 0.05) and 0/16 (0%) healthy control subjects (P less than 0.05) (Fisher's Exact Test). Antibody titres to five other common viruses were normal in patients with high anti-Reo-3 titres when compared to age- and sex-matched controls with liver disease. Immunoperoxidase staining for Reo-3 viral markers and cultures of liver biopsy material for Reo-3 virus were negative in both patients and controls. The results of this study indicate that, although patients with PBC and PSC have higher anti-Reo-3 antibody titres than patients with other forms of chronic liver disease or healthy volunteers, only a minority of these patients have titres that exceed the 95% confidence limits for normals.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

The histopathology of rectosigmoid biopsies from adults with bloody diarrhea due to verotoxin-producing Escherichia coli.

The histopathology of rectosigmoid biopsies from 20 patients with bloody diarrhea resulting from verotoxin-producing Escherichia coli infection is reported. The biopsies displayed a range of appearances, from normal to mild, nonspecific inflammation to acute infectious-type colitis. Surface-adherent or invasive bacteria were not identified. The morphologic features of infectious colitis and the absence of bacteria suggest that verotoxin may be responsible for the pathologic changes.

Bacterial Toxins↗
PubMed1987

Residual stalks of pedunculated adenomas. An underrecognized type of colonic polyp.

Variable lengths of stalk of colonic pedunculated adenomas may be left behind at polypectomy. At follow-up endoscopy, a residual stalk is a smooth-surfaced, sessile polyp, without a distinct head, and may be difficult to remove. It may be mistaken endoscopically for either a recurrent adenoma or a polyp missed at the original procedure. Histologically, it has a coat of normal mucosa and a core of submucosa in which recanalized blood vessels, scarring, and hemosiderin deposition (consequences of thermocautery) may be seen. We present four cases illustrating the clinicopathologic problem and the pathologic appearances. One caused clinical concern because of its size and location at the site of former polypectomy. One was histologically confusing and raised the question of a vascular malformation. The third, seen at segmental colectomy after endosocopic biopsy of an adenoma, illustrates the gross appearances. The fourth contained regenerative mucosa and recanalized submucosal blood vessels.

Colonic Polyps↗
PubMed1987

The pathology of Q fever hepatitis. A case diagnosed by liver biopsy.

A 52-year-old woman with fever and low grade hepatitis had Q fever, a diagnosis made by the characteristic granulomas, containing fibrin and vacuoles, on liver biopsy and confirmed by serology. Fibrin was demonstrated in the granulomas but Coxiella burnetii antigens were not. The literature on the histopathology of the liver in both acute Q fever and Q fever endocarditis shows that none of the 220 cases of Q fever endocarditis, with one possible exception, had the characteristic granulomas of acute Q fever. Rather they displayed a range from normality through nonspecific reactive hepatitis to occasional nonspecific granulomas. Thus, the characteristic granulomas of acute Q fever appear to be transient even if active infection persists. The definition of chronic Q fever should have a temporal characteristic rather than a serologic one.

Female↗
PubMed1987

Invasiveness of Yersinia enterocolitica lacking the virulence plasmid: an in-vivo study.

Rabbits were given, by the intra-gastric route, two isogenic strains of Yersinia enterocolitica that differed only in the presence or absence of the virulence plasmid. Clinical illness and characteristic morphological lesions of Y. enterocolitica infection were seen only in rabbits infected with the plasmid-bearing strain (MCH700S). Although rabbits infected with a strain lacking the plasmid (MCH700L) remained healthy, mild histological changes in the small intestine, consisting of epithelial-cell damage, dilatation of lymphatics and a slight increase in neutrophil polymorphonuclear leukocytes in lamina propria, were seen in the first 12 h after inoculation. Bacteria, which were identified as Y. enterocolitica by indirect fluorescent antibody staining, were seen in dilated lymphatics. These early lesions tended to abate quickly and were no longer detectable at 24 h. Strain MCH700L was recovered from the mesenteric lymph nodes in increasing numbers until 24 h after inoculation; the number then began to decrease rapidly. In contrast, the early lesions in rabbits given strain MCH700S progressed to micro-abscesses, focal destruction of villi, and ulcerations beginning 24 h after inoculation; the number of bacteria recovered from the lymph nodes continued to increase beyond 24 h after inoculation. Bacteria were also recovered from the liver and spleen. These results suggest that both plasmid-bearing and non-bearing strains of Y. enterocolitica are capable of penetrating the intestinal mucosa. However, the virulence plasmid is required for invading bacteria to proliferate in the host tissue and to establish infection.

Animals↗
PubMed1987

Phlegmonous duodenitis complicating multiple myeloma: a successfully treated case.

A patient receiving chemotherapy for multiple myeloma suddenly developed an acute abdomen, fever, and neutrophil leukocytosis. At laparotomy, the distal two-thirds of the duodenum was swollen and hemorrhagic and was surgically excised. The specimen displayed an acute phlegmonous (suppurative) duodenitis with submucosal and transmural acute inflammation and edema despite an intact mucosa. Blood cultures grew Group B, beta-hemolytic streptococci and gram-positive cocci were present histologically. The patient recovered uneventfully following the surgery and a course of broad spectrum antibiotic therapy. This case illustrates that localized suppurative intestinal infection should be considered when immunosuppressed patients present with an acute abdomen, and that aggressive surgical and antibiotic therapy is warranted.

Cellulitis↗
PubMed1986

The histogenesis of adenocarcinoma of the gallbladder.

A prospective study of 277 cholecystectomy specimens for evidence of isolated epithelial dysplasia of gallbladder mucosa is presented. In addition, 15 cases of primary adenocarcinoma of the gallbladder are retrospectively reviewed with particular reference to the presence of metaplasia and dysplasia adjacent to the infiltrating tumor, in order to establish the relationship between metaplasia, isolated epithelial dysplasia, and adenocarcinoma of the gallbladder. Only one case of isolated epithelial dysplasia was found in the 277 cholecystectomy specimens, and this arose within focal incomplete intestinal metaplasia. In the 15 cases of adenocarcinoma of the gallbladder, benign antral and/or incomplete intestinal metaplasia was found adjacent to the tumor in 11 cases. In 10 cases, dysplasia of this metaplastic epithelium was found in continuity with the tumor. The authors conclude that the most common pathway to adenocarcinoma is via dysplasia of metaplastic gallbladder epithelium.

Adenocarcinoma↗
PubMed1986

Collagenous colitis: a disease of pericryptal fibroblast sheath?

Mucosal biopsies from four women with collagenous colitis and ten controls were studied. By light microscopy the cells of the pericryptal fibroblast sheath appeared diminished in number but increased in size in collagenous colitis. Electron optically in the controls the pericryptal fibroblasts were in intimate contact with the epithelial basal lamina in the crypts. On the free surface the fibroblasts maintained contact with the epithelial cells by attenuated cell processes. In collagenous colitis, in the middle and upper thirds of the crypts the fibroblasts sheath was separated from the epithelium and the fibroblasts assumed the characteristics of myofibroblasts. The separation was accentuated towards the mouths of the crypts. Beneath the surface epithelium the attenuated fibroblast cell processes seen in normal colon were grossly deficient. The basal lamina was also deficient focally and the surface epithelial cells were resting directly on a thickened collagen table. In collagenous colitis the excess collagen appeared to be secreted by the activated myofibroblasts of the pericryptal sheath.

Adult↗
PubMed1986

Fatal myxedema pericarditis in a Christian Scientist.

A case of fatal cardiac tamponade due to myxedema pericarditis is reported. The woman, a 54-year-old Christian Scientist, had never sought medical care and died at home. The pericardial sac occupied most of the thorax and contained 2,270 mL of fluid. A thick, shaggy, fibrinous exudate on the pericardium contained abundant cholesterol clefts typical of chronic effusion and myxedema. Thyroid function tests on postmortem blood revealed profound hypothyroidism, and the thyroid was atrophied, with the histologic appearance of primary atrophic thyroiditis. Pericardial effusion is common in myxedema, but cardiac tamponade is rare, only 13 cases being previously reported, none of which was fatal.

Cardiac Tamponade↗