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Biomedical subjects

K A Kelly

Publications and source records attributed to K A Kelly.

At least 181 records · Page 10Linked to original sources
PubMed1986

Vertical gastroplasty for morbid obesity: clinical experience.

Our objective was to develop an operation for morbid obesity that would be simple, safe, and effective and yet have few long-term adverse physiologic effects. Vertical gastroplasty was chosen. A small proximal gastric pouch was fashioned by stapling vertically beginning 5 cm distal to the cardia along the lesser curvature of the stomach and ending just lateral to the esophagogastric junction along the greater curvature. A 1.1-cm channel through the staple line was left near the lesser curvature of the stomach. No gastric incisions, enterostomies, or anastomoses were necessary. Among 57 patients (with a mean +/- SEM preoperative weight of 136 +/- 4.5 kg) operated on since January 1981, no deaths occurred and no gastric reoperations were done. The hospital stay was short (mean, 9 days). In 32 patients who were followed up for 1 year or longer, the mean percentage of excess weight lost was 39% at 6 months, 43% at 12 months, and 34% at 24 months. Two patients had disruption of the staple line and regained weight by 24 months postoperatively. Channel stenosis occurred within 6 months after operation in seven patients, all of whom were managed successfully with endoscopic dilation. We conclude that vertical gastroplasty is a simple, safe operation for morbid obesity with few adverse sequelae, but the percentage of excess weight lost during a 1- to 4-year follow-up exceeded 50% in only 31% of our patients.

Adolescent↗
PubMed1986

Achieving enteric continence: principles and applications.

Continence may be defined broadly as the ability to defer the passage of enteric content voluntarily to a socially acceptable time and place. In health, continence is provided by the anorectum; several factors interplay to achieve control. When the colon and rectum are removed because of intractable inflammatory bowel disease, a Brooke ileostomy that is incontinent of stool and gas is traditionally constructed, and control of the stoma is provided by an external appliance. Although the functional results after a Brooke ileostomy are good, we believe that restoration of continence would enhance the quality of life. The methods by which continence is restored surgically have undergone evolutionary changes based on an expanding knowledge of the principles of continence gained in the laboratory. In this report, we detail the current status of our understanding of anorectal continence mechanisms and of the principles of ileal continence, in order to examine how "ileo-anal" continence has been achieved in patients who require proctocolectomy.

Adult↗
PubMed1986

Familial and individual influences on blood pressure.

Although familial aggregation of blood pressure is well documented, few studies have considered the changing contribution of genetic and environmental influences during adulthood. Applying maximum likelihood model fitting to blood pressure covariation in balanced pedigrees including both parents and their young adult twin offsprings (25 MZ, 32 DZ, aged between 16 and 24 years), it is shown that the increased variation in parents is explained by such developmental changes. For DBP, an apparent reduction in heritability from 68% to 38% from young adulthood to middle age results from the increasing impact of individual environmental experience (E1), with little or no influence from shared family environmental (E2). For SBP, shared environmental effects may play a part. Given the relatively small size of the present sample, the conclusions are to be seen as tentative. An augmented family study, incorporating middle aged twins and their young adult offspring, will clarify the causation of these developmental changes.

Adolescent↗
PubMed1986

Anal and neorectal function after ileal pouch-anal anastomosis.

Bowel function varies markedly among patients with colectomy and ileal pouch-anal anastomosis. Little is known of the mechanisms controlling fecal continence and frequency of defecation after operation. The aim of this study was to determine which features of the anal sphincter and neorectum accounted for the variation in clinical outcome. Twenty patients were studied 4 to 35 months after operation and compared to 12 healthy volunteers. Despite several patients exhibiting impaired fecal continence, anal sphincteric length and pressures and ileal pouch capacity and distensibility were similar in patients and controls. Patients with poor results, however, had rapid filling of their ileal pouch, which resulted in early onset of high amplitude propulsive pressure waves in the pouch. As these waves became more frequent, defecation resulted. Patients with poor results also were not able to empty adequately their pouch. The poorer the completeness of evacuation, the more frequent the defecation (r = 0.62, p less than 0.01). The authors conclude that rapid pouch filling and impaired pouch evacuation can lead to increased stool frequency in patients after ileal pouch-anal anastomosis.

Adult↗
PubMed1986

Sexual function in women after proctocolectomy.

One hundred women who had undergone proctocolectomy with a continence-preserving procedure (50 Kock pouches, 50 ileoanal anastomoses) for ulcerative colitis or polyposis coli were interviewed regarding their preoperative and postoperative sexual function. Frequency of intercourse increased and the incidence of dyspareunia decreased after operation in both groups. Patients who had a Kock pouch had a greater incidence of persistent postoperative dyspareunia than patients who underwent an ileoanal procedure (38% vs. 18%, p less than 0.02). Only one patient in each group reported a postoperative disturbance in ability to achieve orgasm. Most women reported no change in their menstrual cycle, but patients with a Kock pouch had more episodic vaginal discharge than patients with an ileoanal anastomosis (18% vs. 0%, p less than 0.001). Postoperative fertility was minimally impaired. Overall, the majority of women in this study who underwent proctocolectomy for benign diseases experienced enhanced sexual function after operation, which they attributed mainly to improved health.

Adenomatous Polyposis Coli↗
PubMed1986

Scintigraphic assessment of neorectal motor function.

Colectomy, mucosal rectectomy, and ileal pouch-anal anastomosis have become alternatives to proctocolectomy and ileostomy for patients with ulcerative colitis or polyposis coli. The aim of this study was to develop a scintigraphic technique for assessment of the "neorectal" motor function of such patients. An artificial stool, consisting of a 7.5% dispersion of aluminum magnesium silicate in water, was labeled with 1 mCi [99mTc]sulfur colloid and instilled into the neorectum. Static pre- and postevacuation scans and dynamic acquisition scans during evacuation were taken with the patient seated on a commode. The imaging provided good anatomic definition of the pouch and quantitated the usual rate and percentage of neorectal evacuation at about 10 ml stool/sec and 60% of instilled stool, respectively. This technique appeared to be a safe, simple, useful tool for assessing the neorectal motor function of patients with ileal pouch-anal anastomosis.

Adult↗
PubMed1985

Anal sphincter electromyography after colectomy, mucosal rectectomy, and ileoanal anastomosis.

Electromyography (EMG) was used to evaluate the external anal sphincter in 27 patients following colectomy, distal mucosal rectectomy, and ileoanal anastomosis. The studies were conducted four months to 58 months (mean, 20 months) following the restoration of intestinal continuity. Nine patients underwent endoanal rectal mucosal stripping, while in 18 patients the rectum was everted to facilitate the stripping. Postoperative continence varied widely, from perfect to frequent and severe mucous of fecal leak. Abnormal motor-unit potentials were identified by EMG in nine patients and this finding was usually associated with poor continence. The sex of the patient, technique of mucosal stripping, and type of anastomosis did not influence the EMG result, but patients at least 40 years old all had abnormal EMGs. We conclude that poor continence after ileoanal anastomosis correlates with an abnormal EMG of the external anal sphincter. The cause of the EMG abnormality is unclear.

Adolescent↗
PubMed1985

Urinary pseudouridine excretion in myelomatosis.

Urinary psi excretion is independent of the main indices of tumour activity in myelomatosis (serum paraprotein, serum beta 2-microglobulin, serum creatinine and urinary light chain production). The mean (+/- s.d.) psi at presentation was 40.7 +/- 22.6 nmol. mumol ucr-1, compared to 25.4 +/- 4.8 nmol. mumol ucr-1 in controls. Urinary psi levels at presentation are significantly related to prognosis, the higher the level the poorer the prognosis. However, when these levels have been stratified according to the corresponding level of serum beta 2m, the level adds little as a prognostic factor.

Adult↗
PubMed1985

Motility of the small intestine after proctocolectomy and ileal pouch-anal anastomosis.

Though the mechanisms of continence after proctocolectomy and ileal pouch-anal anastomosis have been studied, functions of the small intestine have received little attention. However, frequent stools and urgency plague some patients who are otherwise quite continent. Motility of the jejunum and ileum was assessed in eight patients with ulcerative colitis who were studied 4 to 24 months after proctocolectomy and ileal pouch-anal anastomosis; these findings were compared to those in six healthy volunteers. Continuous manometric recordings from the small bowel were obtained in both groups for 16 to 23 hours of fasting; postprandial recordings were made for 6 hours following a mixed meal (800 kcal, 20% protein, 40% fat, 40% carbohydrate) in the ileoanal patients. The duration, velocity of propagation, and periodicity of the migrating motor complex did not differ between the groups (P greater than 0.05). Discrete bursts of clustered contractions were recorded from all of the controls and in five of eight patients. Likewise, we recorded from all controls and five of eight patients large amplitude, prolonged waves of pressure which propagated distally. However, in controls these large amplitude waves were confined to the terminal ileum, but in patients these were detected in the jejunoileum, up to 125 cm proximal to the ileal pouch. We conclude that jejunoileal motility is not greatly altered by proctocolectomy with ileal pouch-anal anastomosis. However, the appearance of the large amplitude, rapidly propagating waves in the proximal jejunoileum after operation may be a response to increased storage within and distention of the distal bowel.

Adult↗
PubMed1985

Ileal "J" pouch-anal anastomosis. Clinical outcome.

One hundred eighty-eight patients undergoing abdominal colectomy with distal mucosal proctectomy and endorectal ileal pouch-anal anastomosis were reviewed to assess long-term functional results and to identify factors that might influence them. There was no postoperative mortality, but 10 patients (5.3%) required permanent ileostomy because of postoperative complications or the development of unsuspected Crohn's disease. Immediate postoperative complications, including pelvic sepsis, small bowel obstruction requiring surgery, anastomotic stricture, and ileostomy dysfunction, were observed in 11%, 9%, 14% and 9% of patients, respectively. No males were impotent but nine (9%) developed retrograde ejaculation. Pouchitis occurred in 8% of patients. Among 157 patients assessed at least 60 days after ileostomy closure (mean +/- SD, 375 +/- 216 days), all evacuated their neorectum spontaneously, and stool frequency was 6.0 +/- 2.6 daily and 1.2 +/- 1.3 nightly. While continence was generally good, 2.5% of patients during waking hours and 4.5% during sleep had occasional frank soilage. Moreover, seepage was noted in 25 and 47% of patients during daytime and nighttime, respectively. Both stool frequency and degree of continence improved with time. Patients less than 50 years of age and those with polyposis coli had fewer stools and better continence than those older than 50 or those with ulcerative colitis. It is concluded that ileal "J" pouch-anal anastomosis can be performed safely and will provide acceptable anorectal function without late deterioration.

Adolescent↗
PubMed1984

Gastric influences on canine small intestinal myoelectric activity.

The aim was to determine whether the canine stomach modulates interdigestive and digestive small intestinal myoelectric activity. In four conscious dogs with electrodes implanted chronically on the duodenum and jejunum, enteric myoelectric activity was recorded during fasting and after feeding a 200-g liver meal. The dogs then underwent total gastrectomy and esophagoduodenostomy, after which they were restudied. Gastrectomy did not alter the pattern of the enteric interdigestive myoelectric complexes; the occurrence, period, duration of phase III, and consistency of distal propagation of enteric IMCs remained unchanged. Gastrectomy also preserved both the postcibal inhibition of the enteric IMCs and the postcibal induction of the fed myoelectric pattern in the small bowel. However, the onset of the fed pattern occurred more promptly after gastrectomy than before gastrectomy. We concluded that the pattern of canine duodenal and jejunal interdigestive myoelectric activity was largely independent of the stomach. The more rapid onset of the fed pattern with feeding postgastrectomy may relate to more rapid entry of chyme into the small intestine.

Animals↗
PubMed1984

The endorectal ileal pouch-anal anastomosis. Current clinical results.

One hundred thirteen patients with either chronic ulcerative colitis (108 patients) or familial polyposis coli (five patients) received an ileal J pouch-anal anastomosis after sphincter-saving proctocolectomy. There were no postoperative deaths. Leaks (radiologic and/or clinical) from the pouch or ileoanal anastomosis occurred in 14 per cent of patients. Small-bowel obstruction, requiring operative correction, occurred in 7 per cent and 3 per cent, respectively, of patients after either proctocolectomy or closure of the loop ileostomy. All 66 patients whose diverting ileostomy had been closed for at least three months could defecate spontaneously and their mean (+/- SE) stool frequency per 24 hours was 9.0 +/- 1 at one month and 5.9 +/- at 12 months. Major fecal incontinence was observed in 3 per cent of patients, and two patients eventually required a permanent ileostomy. The ileal J pouch-anal anastomosis has become our procedure of choice in selected patients who require proctocolectomy.

Adolescent↗
PubMed1984

An evaluation of high-dose medroxyprogesterone acetate (MPA) therapy in women with advanced breast cancer.

The efficacy of high-dose intramuscular MPA therapy in controlling progressive measurable metastatic breast carcinoma was assessed in 32 women. In addition serial measurements of MPA blood levels were carried out in 20 of the patients and subjective effects of treatment were monitored in detail in 18 of the women. Overall 6 patients (19%) gained an objective response and a further 7 (22%) experienced disease stasis from 4-17 months whilst on treatment. Significant differences in serum MPA levels were seen between responders and non-responders, objective tumour shrinkage only being seen in those patients who rapidly attained, and sustained, blood levels in excess of 100 ng ml-1. Subjective assessment showed no evidence of a euphoriant effect of MPA therapy in the non-responders group.

Adult↗
PubMed1984

Serological differences in Legionella pneumophila infections.

Guinea pigs were infected with two subtypes of Legionella pneumophila serogroup 1 (UH1 and RH1). Seroconversion by indirect fluorescent-antibody assay was demonstrated in 94 to 97% of guinea pigs when the challenge strain was used as the antigen. The standard Philadelphia 1 antigen demonstrated seroconversion in 94% UH1-challenged animals, but in only 66% of RH1-challenged animals.

Animals↗