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Biomedical subjects

J Kelly

Publications and source records attributed to J Kelly.

At least 271 records · Page 15Linked to original sources
PubMed1995

Ethiopia: an epidemiological study of vesico-vaginal fistula in Addis Ababa.

A 10% sample was drawn from 3000 records on vesicovaginal fistulae operations performed at the Addis Ababa Fistula Hospital for Poor Women with Childbirth Injuries and their content were analyzed. In 88% of the cases under review the operation was classified as successful. The results of this study underline the tremendous maternal health gains which can be achieved by appropriate obstetric care in case of obstructed labour. It also reinforced the need for early detection and referral of high risk births among the very young mothers who are likely to experience an obstructed labour, the loss of the child, vesico-vaginal fistulae and possibly a ruptured uterus. In the absence of likely increases in the availability of transport, the building of waiting homes at maternal clinics is encouraged so that women can await delivery in the vicinity of a referral centre. There is a need for increased attendance of delivery by trained personnel as well as for continuing education for both staff and traditional birth attendants. It is further recommended to train former patients as helpers for the dedicated care which needs to be extended to the unfortunate, and often stigmatized victims.

Adolescent↗
PubMed1995

Medroxyprogesterone treatment for paraphiliacs.

This study addresses the following questions: (1) what are the essential components of a medroxyprogesterone acetate (MPA) pretreatment evaluation?; (2) do paraphilic men treated with MPA (Depo-Provera) report a lowering of both deviant and nondeviant sexual drive and activities?; (3) is behavioral improvement associated with testosterone level reductions?; and (4) what significant side effects are associated with MPA treatment? A total of 29 paraphilic men who underwent a comprehensive psychiatric, medical, and legal evaluation and were eligible for treatment with MPA were followed naturalistically while receiving concurrent MPA and group therapy. The principal outcome measures were data obtained from a weekly self-reported psychosexual inventory that quantified five dimensions of deviant and nondeviant sexual activities and testosterone levels that were drawn pretreatment and after three and six months of MPA. Self-reported data were analyzed by nonparametric methods. Because MPA's effectiveness is evident early in treatment, we report on data from the first six months. Subjects reported a differential rate of suppression of sexual activities, a median of up to two weeks for deviant and 2 to 10 weeks for nondeviant behaviors (p < or = .01 for each of the five dimensions). Testosterone levels suppressed to less than 0.5 ng per milliliter for all but two subjects at three months and for all at six months. Recidivism was reported for one subject. Except for one subject who developed pulmonary emboli, no major medical problems were encountered. MPA safely and effectively reduced sex drive, controlled deviant sexual impulses and behavior, and lowered the testosterone levels of these paraphilic men during the first six months of treatment. However, the relative rapidity and completeness of the response raises questions regarding possible distortions in self-reported sexual activities. This should alert the practicing clinician to consider the use of collateral sources of information in interpreting treatment outcome for patients with paraphilic behaviors. Also, longer follow-up periods are required for monitoring treatment efficacy.

Adolescent↗
PubMed1995

Irradiated polyglactin 910: a new synthetic absorbable suture.

Two hundred and thirty-six patients had a variety of skin and mucosal wounds sutured with a new rapidly absorbed suture material (irradiated polyglactin 910). No wound complications could be attributed to the material. These included 62 patients with scalp wounds, taking part in a comparative trial with traditional interrupted, monofilament, non-absorbable suturing. No difference in the cosmetic result could be detected three months later. The irradiated polyglactin disappeared from the wound surface spontaneously and suture removal was not normally required. Irradiated polyglactin 910 is suitable for closure of wounds where rapid suture absorption is desirable, particularly for wounds in the scalp, scrotum, and perineum and is an ideal material for mucocutaneous anastomosis at stoma surgery. Loss of suture strength is so rapid that suture removal is unnecessary, eliminating the need for further medical or paramedical care. As absorption is by hydrolysis rather than enzymatic digestion, stitch abscesses are not seen.

Humans↗
PubMed1995

Pharmacodynamics and drug therapy.

Medical pharmacology is the study of chemicals or drugs that interact with the human body. Knowledge of the molecular biology of drug action can enhance nursing practice and the provision of holistic patient care.

Drug Therapy↗
PubMed1995

The Scenario-Based Engineering Process (SEP): a user-centered approach for the development of health care systems.

The Scenario-based Engineering Process (SEP) is a user-focused methodology for large and complex system design. This process supports new application development from requirements analysis with domain models to component selection, design and modification, implementation, integration, and archival placement. It is built upon object-oriented methodologies, domain modeling strategies, and scenario-based techniques to provide an analysis process for mapping application requirements to available components. We are using SEP in the health care applications that we are developing. The process has already achieved success in the manufacturing and military domains and is being adopted by many organizations. SEP should prove viable in any domain containing scenarios that can be decomposed into tasks.

Artificial Intelligence↗
PubMed1995

Lethal violence and psychosis: a clinical profile.

To investigate the relationship between lethal violence and psychosis, the authors examined symptomatology, neuropsychological functioning, and the nature of perpetrator-victim relationships of patients with psychotic disorders who were committed to a forensic psychiatric hospital following violent, primarily criminal behavior. A severely violent group, composed primarily of psychotic patients charged with murder, was compared with a less severely violent group that was composed primarily of psychotic patients involved with property crimes. As compared with the less violent group, the severely violent group was more likely to have delusional beliefs about specific personal targets and to have delusions about significant others being replaced by impostors. These beliefs were accompanied by higher scores on neuropsychological tests of intellectual and academic abilities. A high number of their blood relatives were victims of psychotic murder. These results indicated that a higher incidence of lethal or near lethal acts of violence may characterize intellectually intact but psychotic individuals with organize delusions involving personal, accessible targets.

Adult↗
PubMed1994

Understanding transdermal medication.

1. The use of the skin as a route of drug delivery is becoming increasingly popular. 2. Transdermal medication combines the relative ease of oral medication with many of the advantages of IV administration. 3. Nurses must understand transdermal medication in order to help and advise their clients about this form of treatment.

Administration, Cutaneous↗
PubMed1994

Cutaneous cryptococcosis with molluscum contagiosum coinfection in a patient with acquired immunodeficiency syndrome.

We report the first patient with acquired immunodeficiency syndrome in whom molluscum contagiosum and Cryptococcus neoformans were documented in the same cutaneous lesion. While cases of the co-occurrence of two pathologic entities in patients with acquired immunodeficiency syndrome have been reported, namely cytomegalovirus with herpes simplex virus and Kaposi's sarcoma with Histoplasma capsulatum, the findings in this patient are unique. The clinical presentation of cutaneous lesions caused by molluscum contagiosum and by Cryptococcus neoformans is reviewed. The findings in this case are more remarkable still given the often-noted tendency of cutaneous cryptococcosis to masquerade as molluscum contagiosum. It may be that the lesions of molluscum contagiosum create a favorable environment for cryptococcal dissemination. Examination of a biopsy specimen is crucial to the diagnosis of skin lesions, often atypical or deceptive, in immunosuppressed patients.

AIDS-Related Opportunistic Infections↗
PubMed1994

Study of pharmacokinetics and pharmacodynamics of two preparations of metoclopramide.

A pharmacokinetic-pharmacodynamic cross-over study in a group of volunteers (8 male, 4 female) was performed to evaluate the activity and plasma levels of a new sustained-release metoclopramide (CAS 364-62-5) formulation (Cronoprimperan) in comparison to a standard formulation (Primperan). During the course of this trial volunteers on both medications complained of mild to moderate adverse effects as headaches and drowsiness. Elevated monocyte counts were seen in all volunteers at the end of the study without determinable relationship to the medications. No relevant differences were observed between the two preparations in the standard motor and coordination tests. The new sustained-release metoclopramide formulation showed 12-h coverage with a plateau shaped form for achieving constant blood levels throughout the day without reaching blood concentrations above clinically tolerable limits.

Adolescent↗
PubMed1993

Is salivary flow related to personality?

Studies conducted in the 1960s proposed that stimulated salivary flow was negatively correlated with the personality trait of introversion-extraversion such that introverted individuals were supposed to salivate more strongly to lemon-juice stimulation than were extraverts. The relationship was re-examined in the present study in light of more recent but inconsistent findings. A sample of 36 male and female volunteers showed no significant relationship between stimulated salivary flow and extraversion. Nor was flow related to State or Trait anxiety according to Spielberger's anxiety inventory, or to CNS activation as assessed by an objective electronic test. It was concluded that there was no evidence to relate stimulated salivary flow rates to personality in volunteers selected from a non-psychiatric population.

Adult↗
PubMed1993

Circulating intercellular adhesion molecule-1 in amniotic fluid, maternal serum alpha-fetoprotein levels, and intrauterine growth retardation.

OBJECTIVE: Our purpose was to determine if circulating intercellular adhesion molecule-1, a marker of chronic inflammation, is present in amniotic fluid in midtrimester, is increased in patients with elevated maternal serum alpha-fetoprotein level, and is associated with intrauterine growth retardation. STUDY DESIGN: Amniotic fluid circulating intercellular adhesion molecule-1 levels were assayed by enzyme-linked immunoassay in 273 samples obtained by midtrimester amniocentesis in gestations involving a single, structurally normal fetus. The control group consisted of 108 patients with normal maternal serum alpha-fetoprotein levels and 165 patients with elevated levels. Intrauterine growth retardation was diagnosed if birth weight was < 10th percentile for the clinically estimated gestational age. RESULTS: Circulating intercellular adhesion molecule-1 was detectable in amniotic fluid in 105 of 273 samples (38%). In the control group it was detectable in amniotic fluid in seven of 108 (6%). In patients with elevated maternal serum alpha-fetoprotein 97 of 164 (59%) had detectable levels (p < 0.001). Of the 273 cases 38 (14%) had intrauterine growth retardation. Of these 23 (59%) had detectable circulating intercellular adhesion molecule-1 levels (p < 0.001). Of the seven cases of intrauterine growth retardation with normal maternal serum alpha-fetoprotein levels, one (14%) had detectable circulating intercellular adhesion molecule-1. Of the 31 cases of intrauterine growth retardation with elevated maternal serum alpha-fetoprotein 22 (71%) had detectable circulating intercellular adhesion molecule-1. When circulating intercellular adhesion molecule-1 was detectable in amniotic fluid, increasing levels was significantly related to decreasing gestational age at delivery (p < 0.005). CONCLUSIONS: Midtrimester amniotic fluid from normal pregnancies does not generally contain detectable circulating intercellular adhesion molecule-1. Detectable amniotic fluid levels are significantly related to a birth weight < 10th percentile at delivery and to elevated midtrimester maternal serum alpha-fetoprotein levels. Increasing circulating intercellular adhesion molecule-1 levels are related to shortened length of gestation. This test may contribute to risk assessment for intrauterine growth retardation and prematurity. Circulating intercellular adhesion molecule-1 is a known marker of inflammatory processes; its further study may also improve understanding of the pathophysiologic mechanisms of certain cases of intrauterine growth retardation and prematurity.

Amniotic Fluid↗
PubMed1993

Modification of cardiac Na+ channels by batrachotoxin: effects on gating, kinetics, and local anesthetic binding.

The purpose of the present study was to examine the characteristics of Na+ channel modification by batrachotoxin (BTX) in cardiac cells, including changes in channel gating and kinetics as well as susceptibility to block by local anesthetic agents. We used the whole cell configuration of the patch clamp technique to measure Na+ current in guinea pig myocytes. Extracellular Na+ concentration and temperature were lowered (5-10 mM, 17 degrees C) in order to maintain good voltage control. Our results demonstrated that 1) BTX modifies cardiac INa, causing a substantial steady-state (noninactivating) component of INa, 2) modification of cardiac Na+ channels by BTX shifts activation to more negative potentials and reduces both maximal gNa and selectivity for Na+; 3) binding of BTX to its receptor in the cardiac Na+ channel reduces the affinity of local anesthetics for their binding site; and 4) BTX-modified channels show use-dependent block by local anesthetics. The reduced blocking potency of local anesthetics for BTX-modified Na+ channels probably results from an allosteric interaction between BTX and local anesthetics for their respective binding sites in the Na+ channel. Our observations that use-dependent block by local anesthetics persists in BTX-modified Na+ channels suggest that this form of extra block can occur in the virtual absence of the inactivated state. Thus, the development of use-dependent block appears to rely primarily on local anesthetic binding to activated Na+ channels under these conditions.

Animals↗
PubMed1993

Mitoxantrone for malignant pleural effusion due to metastatic sarcoma.

Malignant pleural effusion due to metastatic sarcoma is a difficult problem to treat. Mitoxantrone hydrochloride is an anthracenodione that has been reported to be useful when used intracavitary for malignant effusion due to gynaecological malignancies. We reviewed 15 cases of malignant pleural effusion due to pleural involvement by metastatic sarcoma that were treated with intrapleural mitoxantrone. None of the patients had previous pleurodesis. A standard dose of 20 mg per square metre in 50 cc of saline solution was instilled by chest tube after drainage of the effusion. All patients were initially evaluated by chest CAT scans and chest films, control films were done immediately and 6 weeks after treatment. Thirteen cases were evaluated. Three patients presented with fever, two patients had local pain and one patient developed neutropenia. Three patients did not respond to the treatment. Complete resolution of the effusion was achieved in 76% of the patients: such an effect could be due to the local antineoplastic activity of the drug. We believe that mitoxantrone is effective in the treatment of malignant pleural effusion due to pleural involvement with sarcoma without causing significant local or systemic toxicity.

Adolescent↗
PubMed1993

Specific binding sites in the alcR and alcA promoters of the ethanol regulon for the CREA repressor mediating carbon catabolite repression in Aspergillus nidulans.

The CREA repressor responsible for carbon catabolite repression in Aspergillus nidulans represses the transcription of the ethanol regulon. The N-terminal part of the CREA protein encompassing the two zinc fingers (C2H2 class family) and an alanine-rich region was expressed in Escherichia coli as a fusion protein with glutathione-S-transferase. Our results show that CREA is a DNA-binding protein able to bind to the promoters of both the specific trans-acting gene, alcR, and of the structural gene, alcA, encoding the alcohol dehydrogenase I. DNase I protection footprinting experiments revealed several specific binding sites in the alcR and in the alcA promoters having the consensus sequence 5'-G/CPyGGGG-3'. The disruption of one of these CREA-binding sites in the alcR promoter overlapping the induction target for the trans-activator ALCR results in a partially derepressed alc phenotype and derepressed alcR transcription, showing that this binding site is functional in vivo. Our data suggest that CREA represses the ethanol regulon by a double lock mechanism repressing both the trans-acting gene, alcR, and the structural gene, alcA.

Alcohol Dehydrogenase↗