Identifying CHD risk factors in children: intrafamilial lipoprotein correlations.
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Adolescent↗
Biomedical subjects
K A Kelly
Publications and source records attributed to K A Kelly.
Surgical management of inflammatory bowel disease.
Indications for operation in patients with inflammatory bowel disease are now standardized as a result of the vast surgicaL experience that has been accumulated during the past 40 years. The surgical indications in Crohn's disease and chronic ulcerative colitis vary minimally with the anatomic distribution of either disease, and can be recognized easily in a particular patient. Consequently, decision or judgment regarding the need for operation is rarely difficult. Delaying operation on the basis of fear of recurrence of Crohn's disease is unrealistic because (1) indications for operation are complications of the disease that have not responded or cannot be expected to respond to medical treatment, (2) conservative resection primarily removes diseased bowel that will never return to normal, (3) many patients, perhaps 50%, will never have recurrence of disease, and (4) those who have recurrence will have experienced varying periods when they were free of disease and relieved of the serious complications for which their operations were performed. The value of surgery in the treatment of patients with chronic ulcerative colitis can be stated even more positively, because recurrence of disease is never a concern after proctocolectomy.
Adult↗
Clinical chemistry determinations for a biracial cohort of 1,605 normal and hyperlipidemic schoolchildren aged 6 to 17.
Distributions of nine clinical chemistry determinations (serum bilirubin, globulin, creatinine, thyroxine, alkaline phosphatase, hematocrit, aspartate aminotransferase, uric acid, and plasma glucose) were assessed for 1,605 schoolchildren aged 6 to 17 years, in the Cincinati Lipid Research Clinic's Princeton School District study. Nine hundred and sixteen children were randomly recalled, and 689 were recalled by virtue of elevated (top decile) plasma cholesterol or triglyceride or both. For each clinical chemistry measurement, the following factors were considered: random and hyperlipidemic recall groups, age, sex, and race. The data were arrayed to provide the fifth percentile, the median, and the ninety-fifth percentile levels, as well as the 90% confidence interval of about the fifth and ninety-fifth percentile estimates. These data allow black-white age and sex, and normal-hyperlipidemic comparisons of commonly measured clinical chemistry determinations among a large population of children. This study also provides, for the methods used, accurate estimations of age-, sex-, race-, and recall group-specific percentile distributions for selected clinical chemistry determinations for children.
Adolescent↗
Improved results with continent ileostomy.
The objective of this study was to determine if recent technical modifications have improved our results with continent ileostomy (Kock pouch). The modifications were that the valve of the pouch was made at least 5 cm in length and was anchored with specially placed, nonabsorbable sutures or staples. The pouch was drained continuously for the first four postoperative weeks, after which it was only gradually allowed to expand. Results from our first 149 patients were compared to those from our last 150 patients, in whom the modified approach was used. The age, sex, indications for operation and types of operation were similar in the early and late groups. No postoperative deaths occurred, and the incidence of continence at dismissal from hospital was near 100% in both groups. However, 15 pouches were excised in the early group as opposed to only five in the late group (p < 0.01). Moreover, the need for revision of the valve by one year was 43% in the early group but only 22% in the late group (p < 0.001). Long-term follow-up showed that complete continence was present in 60% of patients in the early group and 75% of patients in the later group (p < 0.05), although only about 5% of patients in either group wore an ileostomy bag. We concluded that recent technical changes have improved the results after continent ileostomy.
Adult↗
Diarrhoea after continent ileostomy.
To determine the nature and frequency of malabsorption in patients with continent ileostomies, faeces and urine from 42 patients with ileal pouches and from 19 patients with conventional ileostomies were analysed and compared. The patients with conventional ileostomy were matched with patients with ileal pouches. Thirteen of the patients with pouches were found to have excessive faecal volumes which were accompanied by increased faecal losses of electrolytes, nitrogen, and fat, and by decreased vitamin B12 uptake. The remaining patients with continent ileostomies had faecal and urinary outputs which were similar to those of patients with conventional ileostomies. Thus, evidence of malabsorption was found in approximately 30% of this group of patients with continent ileostomies.
Adult↗
Gastric emptying of liquids and solids: roles of proximal and distal stomach.
The objective was to explore the hypothesis that the proximal stomach has a major role in gastric emptying of liquids and the distal stomach a major role in gastric emptying of solids. The results of experiments on the intact stomach and on the stomach after selective resections, denervations, and during hormonal infusions are, in general, consistent with the hypothesis.
Animals↗
Canine jejunal absorption and transit during interdigestive and digestive motor states.
To determine whether absorption varies during interdigestive and digestive motor states, an isolated, 75-cm segment of jejunum was perfused in each of five dogs with an isosmolar solution of 130 mM glucose, 80 mM NaCl, and [3H]polyethylene glycol (PEG). Effluent was collected from the distal stoma during 10-min intervals. Electrical activity of the segment was recorded concurrently. Transit times were assessed with boluses of [14C]-PEG. The dogs were studied during phase I, phase II, and phase III of the interdigestive myoelectric complex and also after a 200-g meal of liver. Absorption during fasting was greatest during phase I and least during phase III of the interdigestive myoelectric complex; feeding enhanced absorption over that seen during any phase of fasting. Transit was slowest in phase I of fasting and most rapid during phase III; transits during phase II of fasting and after feeding were roughly equal. Using indicator-dilution calculations, static volumes were greatest and mean flows slowest during phase I. Thus, jejunal absorption during fasting decreased as transit increased sequentially with the interdigestive myoelectric phases. However, after feeding, although transit time was similar to phase II, absorption was greater.
Action Potentials↗
Patterns of movement of liquids and solids through canine jejunum.
Our aim was to determine whether interdigestive and digestive motor patterns influence the transit of liquids and solids through the jejunum. In six dogs, a 75-cm segment of jejunum was isolated from the intestinal stream, but myoneural continuity between the segment and the proximal bowel was maintained via a bridge of tunica muscularis. Recording electrodes were implanted on the segment. After recovery, the transit of liquids alone, solids alone, and liquids and solids given together were measured during phases I, II, and III of the interdigestive myoelectric complex and also 30 and 120 min after feeding. During fasting, transit of liquids was most rapid during phase III, slowest in phase I, and intermediate during phase II. After feeding, transit resembled that of phase II of fasting. Transit of spheres was slower, although the patterns of transit resembled those of liquids during fasting and after feeding. Transit of liquids was unaffected by spheres, but transit of spheres was speeded by liquids. We concluded that changes in interdigestive and digestive motor patterns exerted a marked effect on the pattern of transit of both liquids and solids through the jejunal segment.
Animals↗
Proximal gastric vagotomy. Initial experience.
Proximal gastric vagotomy was performed in 223 patients with chronic duodenal ulceration between 1973 and 1977. The follow-up ranged from 6 to 78 months with a mean of 39 months. There was no operative mortality. Adverse postoperative sequelae, including delayed gastric emptying, dumping, diarrhea, and reflux gastritis, were seen in less than 3% of patients. Ulcers recurred in 11 patients (4.9%). We conclude that proximal gastric vagotomy is an effective, safe, and satisfactory operation for chronic duodenal ulcer over the short term.
Chronic Disease↗
Which operation for duodenal ulcer?
Proximal gastric vagotomy is favored by many Mayo Clinic surgeons when operating electively for chronic duodenal ulcer. The operation is safe, has fewer side effects than subtotal gastrectomy, truncal vagotomy and drainage, or truncal vagotomy and antrectomy, and provides satisfactory anti-ulcer protection.
Drainage↗
Can endogenous gastrin inhibit canine interdigestive gastric motility?
Our aim was to determine whether endogenously released gastrin inhibits cyclic interdigestive motility in the proximal stomach. In 4 dogs with chronic duodenal electrodes and isolated innervated antral pouches, we constructed proximal gastric pouches, the external neural connections of which were completely severed by autotransplanting the pouches to the left pelvis. After recovery, the antral pouch was irrigated with 0.2% acetylcholine for 3.7 hr at 90 ml/hr, while intraluminal pressure was monitored in the proximal gastric pouch and myoelectric activity was recorded from the duodenum. Blood was collected concurrently for radioimmunoassay of gastrin. The antral irrigations increased serum gastrin from a mean +/- SEM of 85 +/- 14 pg/ml before irrigation to a mean +/- SEM of 350 +/- 54 pg/ml after 30 min of irrigation (P less than 0.001), and the increased levels continued throughout the remaining 3.2 hr of irrigation. The irrigations also suppressed the cycles of interdigestive motor activity in the proximal gastric pouch and the cycles of interdigestive myoelectric activity in the duodenum. The cycles had a mean duration +/- SEM of 105 +/- 5 min before irrigation in both the proximal gastric pouch and duodenum, but were abolished in every test during irrigation. Irrigation inhibited the cycles even when cimetidine was given intravenously at 200 mg/hr to block gastrin-stimulated secretion of HCl, duodenal acidification, and subsequent release of duodenal hormones. However, cimetidine alone had no effect on the interdigestive cycles. We concluded that antral irrigation with acetylcholine inhibited interdigestive cyclic motility in the proximal stomach via a hormonal mechanism and that gastrin was likely the hormone involved.
Acetylcholine↗
Myoelectric and motor patterns of continent pouch and conventional ileostomy.
Our aim was to compare the myoelectrical and motor properties of the continent ileal pouch of 19 patients with those of the terminal ileum of six patients with Brooke ileostomy. The undistended ileum in both types of ileostomy exhibited pacesetter potentials at a mean frequency of 9.1 cycles per minute during fasting upon which were superimposed the cyclic bursts of action potentials and attendant contractions characteristic of the interdigestive state. Both types of ileostomy also accommodated to distention, with intraluminal pressure being kept low as the ileum filled. However, the amplitudes of the changes in intraluminal pressure present in the pouch were less than those present in the Brooke ileum both before and during distention, and the volumes to which the ileum could be distended were far greater in the patients with ileal pouches than in those with the Brooke ileostomy. Feeding did not alter the responses to distention of either type of ileostomy. We conclude that the electrical and motor patterns of the undistended ileum are similar in both types of ileostomy, but that the anatomic and motor properties of the pouch allow it to accept far larger intraluminal volumes both during fasting and after feeding.
Action Potentials↗
Enhancing absorption in the canine short bowel syndrome by intesitnal pacing.
Our goal was to determine whether intestinal absorption could be enhanced by pacing the small bowel backward in dogs with the short bowel syndrome. In five dogs the aborad one third of the small bowel and the entire colon were removed, and an ileorectostomy was established. The small bowel and the entire colon were removed, and an ileorectostomy was established. The duodenum was transected and reanastomosed 10 cm from the pylorus to facilitate pacing, and cannulas were inserted in the intestine at 15, 110, and 115 cm for perfusion, sample collection, and balloon occlusion, respectively. Recording and stimulating electrodes were affixed to the bowel between perfusion and collection cannulas. In four or more trials in each dog, an isotonic perfusate of glucose (138 mM), NaCl (76 mM), and 3H-polyethylene glycol was introduced via the proximal cannula at 2.9 ml/min and effluent collected from the distal cannula for 3 hours. During hour 2, electrical stimuli were applied to the distal end of the perfused segment to drive the pacesetter potentials, hence contractions, of the perfused segment backward. Pacing decreased markedly the output of water, glucose, sodium, and potassium and increased the concentration of polyethylene glycol in the effluent. We concluded that retrograde electrical pacing increased small intestinal absorption of water, glucose, and sodium and decreased output of potassium in dogs with short bowel syndrome.
Action Potentials↗
Hormonal control of gastrointestinal motility.
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Cholecystokinin↗
Surgical treatment of adenocarcinoma. Location: junction of the right, left, and common hepatic biliary ducts.
Thirty-eight patients with primary adenocarcinoma arising at the junction of the right, left, and common hepatic biliary ducts were seen at the Mayo Clinic, Rochester, Minn, between 1950 and 1976. Prompt and lasting relief of jaundice and cholangitis occurred in four patients undergoing resection of the tumor combined with left hepatic lobectomy, and their mean survival was 33 months. Relief of symptoms was only temporary in 26 patients treated with drainage of the biliary tree, and their mean survival was only ten months. Eight patients undergoing exploration only had no relief of symptoms, and none survived beyond four months. We conclude that resection of these tumors in selected patients gives good palliation and offers the chance of long-term cure. If resection is not possible, biliary decompression results in satisfactory palliation, whereas exploration only does not.
Adenocarcinoma↗
Proximal gastric vagotomy and suprapyloric antrectomy. Experimental evaluation in dogs.
In five dogs with Heidenhain pouches, proximal gastric vagotomy and suprapyloric antrectomy did not alter the rate of gastric emptying of 300 mL of 1% dextrose or of 40 plastic spheres, or disrupt the barricade preventing duodenogastric reflux. However, the operation did slow gastric emptying of 50 g of cubed liver and increase the postprandial secretion of hydrochloric acid from the pouch. We concluded that suprapyloric antrectomy can be combined with proximal gastric vagotomy without disturbing the gastric emptying of liquids and indigestible solids or resulting in increased duodenogastric reflux. However, the operation does slow gastric emptying of digestible solids.
Animals↗
Absorption from the jejunum is increased by forward and backward pacing.
In 4 dogs a 75-cm segment of jejunum was isolated from the intestinal stream. Stimulating electrodes were implanted at each end of the segment and recording electrodes at intervals between. The two ends of the segment were fashioned as stomas on the anterior abdominal wall. After recovery, the electrical activity of the segment was continuously recorded, whilst a solution of 100 mmol/l glucose and 90 mmol/l NaCl was infused into the proximal stoma at 2.9 ml/min. Effluent from the distal stoma was collected in 5-min aliquots for three consecutive 30-min periods. In the second period electrical stimuli were given via either the proximal or the distal bipolar electrodes to entrain pacesetter potentials. Both forward and backward electrical pacing decreased the output of water, glucose and sodium from the jejunal segment, but the decrease was significantly greater with backward pacing. We conclude that pacing a segment of jejunum backwards with electrical stimuli produces a greater increase in absorption from the segment than pacing it forwards, a finding which has therapeutic implications in patients with the short bowel syndrome.
Animals↗
The enumeration of rat IgE-secreting cells using a reverse plaque-forming cell assay.
A reverse hemolytic plaque assay utilizing protein A-coated sheep red cells and a specific rabbit anti-rat IgE preparation has been adapted for the enumeration of rat IgE-secreting cells derived from the IR-162 rat plasmacytoma and from rats infected with Nippostrongylus brasiliensis. Under optimal conditions, approximately 10-15% of the viable plasmacytoma cells were scored as plaque-forming cells. In rats infected with 5000 Nippostrongylus brasiliensis larvae, a maximum of 2 x 10(6) IgE-secreting cells were found in the mesenteric lymph nodes, and no IgE plaque-forming cells in their spleens. The kinetics of the mesenteric lymph node plaque-forming cell responses closely coincided with total serum IgE levels, with maximum responses occurring 15-16 days after infection. There was a high degree of correlation between the mesenteric lymph node IgE plaque-forming cell responses and total serum IgE levels of individuals rats. It was concluded that the IgE-secreting cells in the mesenteric lymph nodes contributed, in a large way, to the elevated levels of IgE found in the circulation of these rats.
Animals↗