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Biomedical subjects

J Keating

Publications and source records attributed to J Keating.

At least 55 records · Page 3Linked to original sources
PubMed1991

Dissolution of cholesterol gall stones using methyltertbutyl ether: a safe effective treatment.

Methyltertbutyl ether (MTBE) administered by percutaneous transhepatic catheter rapidly dissolves radiolucent cholesterol gall bladder stones. However, complete dissolution and clearance of non-cholesterol debris is essential to prevent recurrence. In this study we analysed 25 consecutive patients with reference to efficacy and recurrence based on the presence or absence of non-cholesterol stone fragments after dissolution. Placement of the catheter was successful in 24 patients, one patient requiring cholecystectomy for bile peritonitis. MTBE was infused and aspirated continuously, four to six cycles per minute, resulting in rapid stone dissolution (median six hours; range 4-23 hours for solitary stones and median seven hours, range 4-30 hours for multiple stones). In 18 patients who had complete dissolution, four (22%) had recurrent stones within six to 18 months. Five patients had residual debris which failed to clear completely despite bile acid treatment. One patient with an incomplete rim of calcium in a large stone did not respond to MTBE treatment. A further patient required cholecystectomy for symptomatic recurrence. There were no serious side effects observed. MTBE treatment is a rapid, safe, and effective treatment for patients who refuse surgery or who for medical reasons cannot undergo cholecystectomy. The results of this study confirm that complete dissolution of all fragments is essential and may prevent recurrence.

Adult↗
PubMed1991

Surgery offers the best palliation for carcinoma of the pancreas.

This debate discusses the palliative management of pancreatic cancer. The arguments in favour of surgical palliation are that this approach allows all symptoms to be treated or prevented, the diagnosis can be confirmed histologically and a final assessment of resectability can be made. The arguments against the use of surgery are that survival is short and that effective alternative therapies are available: endoscopic intubation, percutaneous coeliac plexus block and pancreatic enzyme supplements. The most appropriate policy, however, is to tailor the management plan to suit the individual patient.

Aged↗
PubMed1990

Sexual fantasies of heterosexual and homosexual men.

Heterosexual men and homosexual men rated how arousing different sexual fantasies were and how often they had used these fantasies over the previous year. Within each group, sensual and genital same-orientation fantasies were more arousing than either public-sex or dominance-submissive fantasies, which in turn were more arousing than aggressive-sex fantasies. For both heterosexual and homosexual men the extent to which a fantasy was arousing correlated with the person's experience of the activity depicted in the fantasy. The frequency of use of a fantasy correlated positively with its arousal level but not always substantially so. The results are discussed in the context of the mediating role of fantasy in human sexual arousal.

Adult↗
PubMed1990

The effects of swabbing the skin on apparent blood ethanol concentration.

The swabbing of the arm with ethanol before venepuncture significantly raised the apparent blood ethanol concentration, when compared to the unswabbed arm. In contrast, when isopropanol was substituted for ethanol in these studies, no change in the blood ethanol concentration was determined.

1-Propanol↗
PubMed1988

Glutathione S-transferase levels in autoimmune chronic active hepatitis: a more sensitive index of hepatocellular damage than aspartate transaminase.

Glutathione S-transferase (GST; EC 2.5.1.18), a sensitive marker of hepatocellular damage, was measured in patients on therapy for histologically proven, autoimmune chronic active hepatitis at various stages of the disease. GST levels were elevated in 65% of serum samples despite immuno-suppressive treatment compared with aspartate transaminase (AST) which was increased in only 23% of samples. In 55% of samples with normal AST concentrations, GST was elevated. No samples demonstrated abnormal transaminase with normal GST levels. It is concluded that continuing hepatocellular damage occurs in patients with autoimmune chronic active hepatitis on immuno-suppressive treatment.

Adolescent↗
PubMed1988

Kidney pathology in liver allograft recipients after long-term treatment with cyclosporin A.

Organ transplant recipients given immunosuppressive treatment with cyclosporin A are at risk of injury due to nephrotoxicity. Eight liver allografted patients whose renal function became impaired during therapy with cyclosporin A for up to 4.5 years were investigated by renal biopsy. Ischemic changes in glomeruli were found to be greater than in controls, and there was focal tubular atrophy, but an excess of lesions in small arteries could not be demonstrated. In one patient there were glomerular changes suggestive of thrombotic microangiopathy. Interstitial fibrosis and cellular infiltration were slight. The pathogenesis of the ischemia remains to be elucidated, but reasons are advanced for favoring the view that the mechanism of cyclosporin A nephrotoxicity is primarily vasomotor, causing a reduction of renal blood flow and glomerular filtration rate without permanent organic arterial narrowing; nephrons become damaged irreversibly nevertheless.

Adult↗
PubMed1987

Margin of safety in positioning modern double-lumen endotracheal tubes.

The authors have defined the margin of safety in positioning a double-lumen tube as the length of tracheobronchial tree over which it may be moved or positioned without obstructing a conducting airway. The purpose of this study was to measure the margin of safety in positioning three modern double-lumen tubes (Mallinkrodt [Broncho-Cath], Rusch [Endobronchial tubes], and Sheridan [Broncho-Trach]). The margin of safety in positioning a: 1) left-sided double-lumen tube (all manufacturers) is the length of the left mainstem bronchus minus the length from the proximal margin of the left cuff to left lumen tip; 2) Mallinkrodt right-sided double-lumen tube is the length of the right mainstem bronchus minus the length of the right cuff; and 3) Rusch right-sided double-lumen tube is the length of the right upper lobe ventilation slot minus the diameter of the right upper lobe. The length of the right and left mainstem bronchi were measured by in vivo fiberoptic bronchoscopy (n = 69), in fresh cadavers (n = 42), and in lung casts (n = 55), and the diameter of the right upper lobe bronchus was measured in lung casts (n = 55). The average +/- SD male left and right mainstem bronchial lengths were 49 +/- 8 and 19 +/- 6 mm, respectively, the average +/- SD female left and right mainstem bronchial lengths were 44 +/- 7 and 15 +/- 5 mm, respectively, the average right upper lobe bronchial diameter was 11 mm, the proximal left cuff to left lumen tip distance was 30 mm, the length of the Mallinkrodt right cuff was 10 mm, and the length of the Rusch right upper lobe ventilation slot was 15 mm. The average margin of safety in positioning left-sided double-lumen tubes ranged 16-19 mm for the different manufacturers. The average margin of safety in positioning Mallinkrodt right-sided double-lumen tubes was 8 mm, and the margin of safety in positioning Rusch right-sided double-lumen tubes ranged 1-4 mm, depending on French size. The authors concluded that left-sided double-lumen tubes are much preferable to right-sided double-lumen tubes because they have a much greater positioning margin of safety, and that proper confirmation of proper position of either a left- or right-sided double-lumen tube should be aided by fiberoptic bronchoscopy, because the absolute distances that constitute the margin of safety are extremely small.

Bronchi↗
PubMed1985

An improvement in cognitive function following polypharmacy reduction in a group of epileptic patients.

18 epileptic patients on polypharmacy were assessed, using a battery of psychometric tests including the Wechsler Adult Intelligence Scale, Benton Visual Retention Test and Alertness and Concentration tests. The same patients were reassessed one year later following a trial to reduce their polypharmacy. The results for 12 patients whose treatment was reduced to monotherapy were statistically analysed, using the Wilcoxon Matched Pairs Test. Significant changes were found on a number of test scores which included Full Scale WAIS I.Q., W.A.I.S. Performance I.Q., Digit Symbol, Block Design and Object Assembly, Benton Visual Retention Test Error Score and Concentration Test Score. The other tests showed no improvement over baseline. The results point to the improvement in some areas of cognitive function which follows a reduction in polypharmacy to monotherapy.

Adult↗
PubMed1984

Unnecessary polypharmacy in patients with frequent seizures.

35 patients with a mean seizure frequency of 15 attacks per months were studied. 19 were taking a 2-drug combination, 13 a 3-drug combination and 3 patients a 4-drug combination. Treatment was reduced to monotherapy in 21 patients and to a 2-drug combination in 8 patients. There was an increase in seizure frequency in 6 patients taking a 2-drug combination when an attempt was made to reduce the treatment to monotherapy. Reduction in polypharmacy resulted in an improvement in seizure control in 54% of patients. Carbamazepine replaced polypharmacy as monotherapy in 19 patients and phenytoin and sodium valproate in 2 other patients. Improvement in seizure control was associated with optimal blood levels in 17 patients taking carbamazepine and in the 2 patients taking sodium valproate and phenytoin. Serum levels in all patients taking 2-drug combination were within the optimal range.

Adolescent↗
PubMed1982

Management of the primary dentition in vitamin D-resistant rickets.

Vitamin D-resistant rickets (familial hypophosphatemia) is a systemic disease secondary to defective renal-tubular reabsorption of phosphate. The major oral manifestations are spontaneous abscesses in a caries-free dentition. Pulpotomies or extractions were frequently described in the dental literature as the therapies of choice. This article presents a new prophylactic approach utilizing zinc oxide--eugenol pulpectomies and full crown coverage in an attempt to retain the primary dentition and prevent abscess formation.

Abscess↗
PubMed1980

Lateral medullary syndrome after neck injury.

Several reported cases of brainstem stroke followed neck manipulation or trauma. We describe a 28-year-old man who had a lateral medullary syndrome after cervical hyperextension in an automobile accident. Angiography revealed complete occlusion of the left vertebral artery.

Adult↗
PubMed1979

Availability of adipose tissue tocopherol in the guinea pig.

Young guinea pigs were fed a purified diet containing vitamin E for 3 weeks and then fed the diet without vitamin E for 8 weeks. Levels of vitamin E in plasma and liver decreased to low values within a week. Depletion rates for heart and muscle were much slower, whereas the rate of loss from fat was negligible. In experiments with more mature guinea pigs and a depletion period of 4 months, the depletion rate of tocopherol from fat was also barely detectable. Both yound and mature guinea pigs developed myopathy after 8 weeks of depletion. Apparently, tocopherol in adipose tissue is not sufficiently available to maintain plasma tocopherol levels or to prevent signs of vitamin E deficiency. Even during fasting, adipose tissue tocopherol was not mobilized readily. During a 4 day fast, adipose tissue mass diminished considerably, but there was no appreciable loss of tocopherol.

Adipose Tissue↗
PubMed1977

Randomized sequential hormonal therapy vs adrenalectomy for metastatic breast carcinoma.

One hundred sixty-one postmenopausal and 65 premenopausal women, a total of 226 patients with metastatic breast carcinoma, were included in this randomized study to evaluate the merits of adrenalectomy as the primary mode of therapy as compared to the customary sequential hormonal manipulation. The 145 evaluable postmenopausal patients were randomized as follows: (1) primary additive hormone therapy first followed by adrenalectomy and (2) primary adrenalectomy followed by chemotherapy and/or additive hormone therapy. When 76 patients in group 1 were compared with 70 patients in group 2 regarding their survival time, there was no essential difference, but the response rate was 20% vs 38.6%, a significant difference. The 55 evaluable premenopausal women were randomized into two groups: (1) oophorectomy followed by adrenalectomy; (2) adrenalectomy-oophorectomy as primary mode of therapy. The response rate in group 1 was 17.4% as compared with 41.9% in group 2, but again there was no difference in the survival time among these two groups. When sequential hormonal manipulation was utilized, only one-third of these patients were subjected to adrenalectomy because of their rapidly deteriorating condition. Adrenalectomy performed as a secondary procedure showed a lower response rate but the total survival time was comparable with primary adrenalectomy patients.

Adrenalectomy↗