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Biomedical subjects

L Kelly

Publications and source records attributed to L Kelly.

At least 109 records · Page 6Linked to original sources
PubMed1994

Reinnervated lateral antebrachial cutaneous neurosome flaps in oral reconstruction: are we making sense?

Eight patients who underwent a partial glossectomy and associated floor of the mouth resection for squamous cell carcinoma were reconstructed with a sensate radial forearm flap in which the lateral antebrachial cutaneous nerve was anastomosed to the (divided) lingual nerve. The patients were compared prospectively with matched controls who received noninnervated forearm flaps for the same defect. A "blinded" therapist performed detailed sensory testing at least 6 months following surgery. In all modalities examined, the sensate proved superior to the nonsensate flap and not statistically different from the opposite side of the tongue. Two-point discrimination and pressure sensitivity were much greater in the innervated forearm flaps than in the forearms from which they came. The results are discussed with reference to the density of sensory receptors, the degree of cortical representation, and the subcortical anatomy of the neurosensory tracts. It appears that the density of sensory receptors is not directly related to the sensory potential in a given tissue transfer and that this potential is more related to the cortical fidelity of the recipient nerve. A historical matched cohort of 10 patients receiving pectoralis flaps for similar defects also was examined. Although the follow-up was longer, reinnervation was of a very low order--even worse than with noninnervated forearm flaps. This work supports the concept that sensory reinnervation should be attempted whenever possible following ablative oral surgery. This would include suture or grafting of major sensory nerves as well as the reinnervation of flaps.

Aged↗
PubMed1994

Alloimmunisation via previous transfusion places female Kpb-negative recipients at risk for having children with clinically significant hemolytic disease of the newborn.

We report a case of clinically significant hemolytic disease of the newborn due to Kpb alloimmunisation requiring obstetric intervention. This case and a review of the literature are in contrast to reviews of hemolytic disease of the newborn that either ascribe no significance to the Kpb antigen or suggest that it causes only rare or mild disease. Analysis of our Kpb-negative donor pool suggests that prior transfusion greatly increases the chance of alloimmunisation. The role of frozen rare donor registry cells as a public resource is emphasised.

Adult↗
PubMed1994

The treatment of severe behavior problems in school settings using a technical assistance model.

We evaluated the feasibility of local school personnel conducting functional analysis and reinforcement-based treatment procedures within actual classroom settings. Following an initial in-service workshop on functional assessment and differential reinforcement procedures, on-site technical assistance was provided two to four times per month to local school personnel working in transdisciplinary teams. Overall results suggest that local school personnel were able to implement all procedures adequately with periodic technical assistance. In addition, functional analysis was effective in identifying individual maintaining contingencies, the derived treatments were effective, and the results were maintained throughout the approximate 18 months of this investigation.

Aggression↗
PubMed1994

Rapid assay of lactoferrin in keratoconjunctivitis sicca.

We compared measurement of lactoferrin concentration by the LactoCard solid phase ELISA assay with the LactoPlate radial immunodiffusion assay in tears of normal patients and those with keratoconjunctivitis sicca. The LactoCard, a new lactoferrin assay, allows rapid determination of tear lactoferrin concentration in 10-15 min, a notable improvement over the 3 days required of the LactoPlate. There was no statistically significant difference between the accuracy of the two assays in normal patients nor in those patients with a diagnosis of keratoconjunctivitis sicca. Both assays showed a significant decrease in tear lactoferrin concentration in patients with severe keratoconjunctivitis sicca when compared to normal patients. The LactoCard is a rapid and reliable means of measuring tear lactoferrin concentration in a clinical setting.

Adult↗
PubMed1993

Correlation of two-point discrimination and hand function following median nerve injury.

Two-point discrimination (2pd) (moving and static) and object identification were assessed in 43 patients after median nerve repair and graft in the middistal forearm. The mean age was 37 years (range, 16-78 yr). Twenty-six patients underwent primary median nerve repair and 17 had secondary median nerve grafts. The minimum follow-up time was 2 years. The values of moving 2pd and static 2pd ranged from 2 to > 16 mm. Both moving 2pd and static 2pd had strong correlational relationships with hand function as measured by object identification. Correlation coefficients for the relationship between 2pd (moving and static) and total objects identified ranged from 0.66 to 0.74.

Adolescent↗
PubMed1993

Development of a new measure of fine sensory function.

With the loss of sight, the blind individual must rely on tactile senses for function, and yet assessment of hand sensibility is not routinely integrated into evaluations of the blind. The available sensory measures lack the sensitivity to differentiate higher levels of hand sensibility, and therefore, a new more sensitive measure of fine sensory function was developed. A 3 x 3 braille dot cell was developed, and pattern variation was utilized to assess higher discriminatory abilities. Thirty blind and sighted subjects were evaluated, and intertester reliability of fine sensory function (braille pattern identification) was established (r = 0.95). Comparison between braille identification and measures of threshold and innervation density revealed the strongest correlational relationship with two-point discrimination. This study supports the assessment of fine sensory function with braille pattern identification.

Activities of Daily Living↗
PubMed1993

Establishment of reliability in the evaluation of hand sensibility.

Evaluation of hand sensibility using measures of threshold and tactile discrimination are standard assessment methods following nerve injury. Many of the available sensory measures for the quantification of hand sensibility lack verification of intertester reliability. Intertester reliability of vibration threshold, cutaneous pressure threshold, two-point discrimination, object identification, and texture identification was established. The intraclass correlation coefficient ranged from 0.96 to 0.99 for all variables except texture identification (r = 0.77). Comparisons were made between the sensory measures and each functional measure. The strongest correlational relationship was between two-point identification and object identification. Based on the results of this study, evaluation of hand sensibility may be attained with measurement of vibration and cutaneous pressure threshold, two-point discrimination, and object identification.

Adult↗
PubMed1992

Provocative sensory testing in carpal tunnel syndrome.

This study reports the relationship between three clinical tests in the diagnosis of carpal tunnel syndrome and the stages of nerve compression. Assessments of 158 patients with carpal tunnel syndrome were reviewed retrospectively. 77% of patients had at least one of the clinical signs present. The incidence of positive pressure-provocative and Phalen's tests were similar and more likely to occur in combination than separately. Tinel's sign was more likely to be positive in the later stages of nerve compression. Our results suggest that the presence or absence of a provocative test is dependent upon the severity of the nerve compression.

Adult↗
PubMed1992

Sensory recovery after median nerve grafting.

Fourteen patients were evaluated prospectively after median nerve grafts. Twelve male and two female patients with a mean age of 41 years were included. Mean time since surgery was 4 years. Detailed sensory evaluations were completed. Statistical evaluation analyzed relationships between object identification, sensory tests, and graft length. According to the S-0 to S-4 grading system, 11 patients were considered to be S-3+ or greater. Recovery of moving two-point discrimination of 2 to 3 mm. was achieved by 50% of the patients. Strong correlations were found between object identification and static two-point discrimination, moving two-point discrimination, and graft length. Cutaneous pressure threshold and vibration threshold correlated weakly with object identification.

Adult↗
PubMed1992

Ocular manifestations of Noonan syndrome.

Noonan syndrome is a genetic condition inherited in an autosomally dominant manner, characterised by congenital heart disease, short stature, abnormal facies and the somatic features of Turner's syndrome, but a normal Karyotype. The ophthalmological and orthoptic findings on 58 patients with Noonan syndrome are reported. External features were hypertelorism (74%), downward sloping palpebral apertures (38%), epicanthic folds (39%) and ptosis (48%). The orthoptic examination revealed strabismus in 48%, refractive errors in 61%, amblyopia in 33%, and nystagmus in 9% of cases. Sixty-three per cent of cases had anterior segment changes consisting of: Prominent corneal nerves (46%), anterior stromal dystrophy (4%), cataracts (8%) and panuveitis (2%). Fundal changes occurred in 20% of the study group, including optic nerve head drusen, optic disc hypoplasia, colobomas and myelinated nerves. Forty-seven per cent required non surgical treatment and a further 16% had undergone surgery for strabismus or ptosis. Only three patients had no visual defects. With such a high incidence of ophthalmic abnormalities it is clearly important that children with Noonan syndrome are screened by an ophthalmologist at an early age.

Adolescent↗
PubMed1992

Verification of the pressure provocative test in carpal tunnel syndrome.

Three provocative tests (pressure, Phalen's test, and Tinel's sign) were studied in 30 patients with carpal tunnel syndrome and 30 control subjects. The pressure provocative test had a sensitivity of 100%. In contrast, Phalen's test was 88% sensitive and Tinel's sign only 67% sensitive. The pressure provocative test is a sensitive indicator of median nerve compression at the wrist with a faster reaction time than Phalen's test (mean time of 9 seconds vs 30 seconds). It is an appropriate provocative test in patients with stiff or painful wrists when wrist flexion is restricted.

Adult↗
PubMed1992

Use of descriptive and experimental analyses to identify the functional properties of aberrant behavior in school settings.

We conducted descriptive and experimental analyses of aberrant behavior in school settings with 2 children with autism, using teachers as assessors. Experimental functional analyses carried out by the investigators were followed by training teachers to conduct a descriptive analysis and a classroom experimental analysis. A comparison of the assessment procedures showed that each procedure identified negative reinforcement as a maintaining variable for aberrant behavior. The teacher implemented an intervention based on the assessment with mixed results. We then replicated the initial results by having the first teacher train a second teacher to carry out the two assessment procedures. The results of these analyses were also in agreement, again identifying negative reinforcement as a variable maintaining aberrant behavior. An intervention based on negative reinforcement was then successfully implemented. These results suggest the applicability and utility of functional analyses carried out in school settings.

Adolescent↗
PubMed1992

Managing resources in the operating department.

A number of articles on the problems of resource management have been published in these pages over the past few years. Although these articles highlighted some of the difficulties and problems faced by theatre nurses, none actually gave a means of resolving them.

Cost-Benefit Analysis↗
PubMed1991

Infectious in vitro transcripts from a cloned cDNA of barley yellow dwarf virus.

A full-length cDNA clone of barley yellow dwarf virus (BYDV-PAV serotype) has been constructed and fused to the bacteriophage T7 RNA polymerase promoter. RNA transcripts produced in vitro, either capped or uncapped, were infectious in Triticum monococcum protoplasts. Protoplasts inoculated with in vitro-transcribed BYDV RNA accumulated coat protein, synthesized new viral RNAs, and produced virus particles. Aphid feeding on extracts from protoplasts inoculated with in vitro RNA transcripts can be used to transfer the virus progeny to whole plants. Introduction of mutations which interrupt specific BYDV-PAV open reading frames (ORFs) V and VI eliminated infectivity while an ORF I-mutant remained infectious. Infectious RNA transcripts derived from BYDV cDNA clones will facilitate analysis of the molecular aspects of BYDV infection and further enhance our understanding of this economically important virus.

Animals↗
PubMed1991

Internal neurolysis fails to improve the results of primary carpal tunnel decompression.

This prospective, randomized study compares two treatment methods in patients with primary carpal tunnel syndrome. Decompression of the transverse carpal ligament was done in thirty-two hands (thirty patients) and decompression of the transverse carpal ligament with the addition of an internal neurolysis of the median nerve was done in thirty-one hands (twenty-nine patients). Relief of symptoms was described in eighty-eight percent of the patients with carpal ligament release and eighty-one percent of patients with carpal ligament release plus internal neurolysis. Improvement in hand sensibility testing, in thenar muscle strength, and atrophy was noted in both treatment groups with no statistical difference between groups. The addition of an internal neurolysis to division of the transverse carpal ligament does not add significant improvement in the sensory or motor outcome of patients with primary carpal tunnel syndrome.

Carpal Tunnel Syndrome↗
PubMed1991

Ventromedial hypothalamic regulation of brown adipose tissue.

The central control of brown fat thermogenesis was evaluated in seventeen rats with moveable electrodes implanted in the ventromedial hypothalamus (VMH) and adjacent structures. Brown adipose tissue and core body temperatures were monitored in response to VMH stimulation; sites which elicited a rise in brown fat temperature were observed in the dorsomedial and anterior ventromedial hypothalamus, with BAT temperature profiles varying widely in duration and peak values. Given the complexity of BAT responses to endogenous VMH signals, these varied profiles may be mediated by dissimilar VMH signals, which remain to be characterized.

Adipose Tissue, Brown↗
PubMed1990

A comparative study of the unfolding thermodynamics of vertebrate metmyoglobins.

Differential scanning microcalorimetry (DSC) of horse, rat, opossum, raccoon, carp, and armadillo metmyoglobins at alkaline pH gave data that fit the two-state unfolding model well. Monte Carlo studies were used to assess the impact of truncating DSC scans on the reliability of the calculated results when aggregation exotherms overlapped the unfolding endotherm at the high-temperature end of the scan. The DSC estimates for the conformational free energy at pH 8 and 298 K are compared to earlier results from isothermal acid and guanidinium chloride unfolding. Stability estimates at pH 8 for these six metmyoglobins obtained by DSC experiments do not agree with free energy estimates at pH 8 from guanidinium chloride unfolding. This is true for all three models used to extrapolate the free energy change to 0 M guanidinium chloride. Among these six myoglobins, significant variation appears in the temperature at which the myoglobin is half-unfolded, in the change in heat capacity upon unfolding, and in the change in enthalpy at 310 K. Calculations made with the hydrophobic model for protein folding [Baldwin, R.L. (1986) Proc. Natl. Acad. Sci. U.S.A. 83, 8069] suggest that a sizable variation exists for that portion of the unfolding enthalpy change assigned to forces other than the hydrophobic effect.

Animals↗