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Biomedical subjects

M J Kelly

Publications and source records attributed to M J Kelly.

At least 19 recordsLinked to original sources
PubMed2007

Results of a survey of the role of multidisciplinary team coordinators for colorectal cancer in England and Wales.

OBJECTIVE: Over the last 6 years, multidisciplinary teams (MDTs) have been established and play a key role in organizing the delivery of cancer care in the UK. There are no published data on the roles of their co-coordinators. To seek the views of colorectal multidisciplinary team co-ordinators (MDTCs) on what they do and how they do it. METHOD: Questionnaires were sent to the colorectal MDTC, or equivalent, in all 180 NHS hospital trusts in England and Wales where colorectal cancer surgery is performed. RESULTS: There was a 70% response rate. Seventy-one per cent of trusts now have a dedicated MDTC, whereas in 2002, only 40% had one. MDTCs generally keep their information on databases, but these differ, and are not coordinated with data entry into the national colorectal cancer database of the Association of Coloproctology of Great Britain and Ireland. In only 26 trusts does the MDTC communicate decisions to primary care, and the patients seem almost completely excluded from this process. CONCLUSION: The recently formed national MDTC Forum should grasp the opportunity of coordinating all of this well-intentioned but pluralistic activity to the benefit of patients, primary care and hospital teams. An effective MDTC with a robust database will be the key in achieving cancer waiting time targets with useful audit, thereby improving patient care.

Chi-Square Distribution↗
PubMed2006

Women presenting with lower abdominal pain: a missed opportunity for chlamydia screening?

INTRODUCTION: Many young women presenting with lower abdominal pain are referred to general surgeons with possible appendicitis. For some of these patients there will be a gynaecological cause for their pain. There has been a steady increase in the incidence of Chlamydia infections and pelvic inflammatory disease (PID) among the general population. Therefore, are general surgeons considering this as a diagnosis for lower abdominal pain in women? METHODS: One hundred and ninety three women who had been admitted with lower abdominal pain to a single hospital between 1999 and 2001 were identified using computerised records and the notes were examined. One hundred and eighty six women were included in the audit. Investigations and treatments instigated for these patients were then carefully recorded. RESULTS: Seventy-four patients underwent appendicectomy, of which 59 were histologically confirmed. Eighty-nine patients (47.8%) of admissions had no final diagnosis and were not screened for Chlamydia trachomatis. Sexual history was recorded in only 51% of admissions. Vaginal swabs were sent in only 7.3% of admissions. CONCLUSION: Current guidelines for Chlamydia trachomatis screening produced by the Chief Medical Officer (CMO) include screening in women presenting with lower abdominal pain as well as those with post-coital or intermenstrual bleeding. Most women who present with classical symptoms of PID will present to gynaecological specialities for further management. However, a significant number of women presenting atypically will be referred to surgeons to exclude gastrointestinal causes for their lower abdominal pain. These women could and probably should be screened for Chlamydia trachomatis.

Abdominal Pain↗
PubMed2006

Straight to test: introduction of a city-wide protocol driven investigation of suspected colorectal cancer.

OBJECTIVE: To decrease waiting times for colorectal cancer diagnosis. METHODS: Following extensive negotiations on three sites, we replaced the standard referral route of GP to outpatient clinic with city-wide implementation of a protocol driven sequence based on the patient's declared symptoms, the initial consultation being replaced by the first test taking place within 31 days. No choice in test allocation was granted; difficult cases were adjudicated by named consultants. We used a 'dry run' to make sure that our planned changes would not overload our local capacity, leading to a pilot run involving 1/3 clinicians, followed by a full cross-city implementation over two months. RESULTS: In 2001, before the pilot only 116/188 (62%) of our colorectal cancers who were referred either under the 2-week-wait arrangements or on a 'soon' basis were diagnosed within 31 days of referral. Our 'dry run' established that we did have the capacity to service our planned sequence of tests. In the pilot, all colorectal cancers were diagnosed within 31 days of referral, and 95% of all diagnoses (no abnormality or benign disease) were reached within 31 days of referral. After full implementation 19/19 (100%) of our cancers coming through our protocol system were diagnosed within 31 days and 95% of patients with benign disease. CONCLUSION: Follow-up audit of our system one and two years later shows that we now diagnose approximately 80% of our colorectal cancers who are referred under the 2 week wait or as 'soon' referrals within 31 days. We have successfully redesigned our service, at minimal expense, in a way, which should enable us to meet the government targets in the National Cancer Plan.

Clinical Protocols↗
PubMed2006

Focal MIBI uptake is a better indicator of active myeloma than diffuse uptake.

PURPOSE: Technetium-99m 2-methoxyisobutylisonitrile (MIBI) imaging has been proposed as a front-line investigation to detect bone disease both before and after the treatment of myeloma. In this study, we have compared the pattern of MIBI uptake (focal and diffuse) between patients with proven myeloma and a cohort of patients without myeloma, in order to identify the uptake pattern that best correlates with disease activity. METHODS: Nineteen scans were taken in 16 consecutive patients (nine males and seven females: aged 39-71 yr) with active myeloma. A further 20 scans (10 subjects having MIBI myocardial perfusion scintigraphy and 10 subjects having MIBI parathyroid adenoma localisation studies), comprised the control (non-myeloma) cohort. Scans were evaluated in a double-blinded fashion by two observers for any diffuse skeletal MIBI uptake (homogeneous uptake in spine, sternum and/or long bones), and/or abnormal focal uptake (patchy, focal or tubular uptake in the skeleton or soft tissues). RESULTS: The pattern of MIBI uptake was significantly different in the myeloma-positive subjects and the control cohort. Focal uptake was highly discriminatory, being seen in 15 of 19 (79%) scans of the myeloma-positive group as opposed to one of 20 (5%) scans of the control group (P < 0.0001). In contrast, diffuse uptake was seen in 17 of 19 (89%) scans in patients with myeloma, and in 11 of 20 (55%) of the control cohort (P = 0.02). Using multiple logistic regression analysis, any focal uptake was significantly predictive for active myeloma (P = 0.0007) but diffuse uptake was not (P = 0.15). Diffuse uptake alone, without focal uptake, was found in four of 19 scans with myeloma and in 10 of 20 without active myeloma, but was not significantly associated with absence of active myeloma (P = 0.06). Using the criteria of Pace et al. for positivity (diffuse activity >50% myocardial activity), we demonstrated improved specificity from 45% to 100%, but significantly impaired sensitivity for presence of myeloma (79% vs. 37%, P = 0.02). CONCLUSION: Our study thus illustrates that the presence of any focal uptake of MIBI is useful in indicating active myeloma whereas diffuse uptake is not.

Adolescent↗
PubMed2006

A pharmacological action of vitamin E unrelated to its antioxidant capacity.

The pharmacological action of vitamin E on the mechanical activity of isolated guinea pig colonic smooth muscle was examined in normoxic and hypoxic conditions. In hypoxia, but not normoxia, alpha-tocopherol (1-160 microM) evoked rapid concentration-dependent contractions from the colon. This was also seen with other members of the vitamin E family, and potency measurements gave EC(50) values (microM) of 10.6 +/- 0.9 for D-alpha-tocopherol, 6.0 +/- 1.2 for D-beta-tocopherol, 7.5 +/- 0.7 for D-gamma-tocopherol, and 6.1 +/- 1.5 for D-delta-tocopherol. This order of potency for the components of the vitamin differs from previously studied bioassay systems and from their antioxidant activity. A range of potent natural and synthetic antioxidants was not active in this system. Compounds with structural similarities to the side chain of vitamin E produced similar stimulatory responses and some, like phytol, were more potent than the vitamin (EC(50): 1.0 +/- 0.2 microM), whereas ring structures related to the vitamin, like Trolox C, antagonized the stimulant responses in a concentration-dependent manner. Therefore, this model system measures, directly, vitamin E-induced responses through a mechanism that does not appear to be related to the known antioxidant capacity of these agents.

Animals↗
PubMed2004

Patient information following emergency laparoscopy for right iliac fossa pain.

Laparoscopy is increasingly used as a diagnostic and therapeutic tool in the management of emergency surgical admissions. Laparoscopic scars give little clue to the operation performed. Hence, the future assessment of patients re-admitted with abdominal pain, often needs to rely on the patient's own account of the operation performed. This study attempted to evaluate the quality of communication between surgeons and patients regarding the results of their laparoscopy and how much information was retained by the patients on discharge. Seventy-seven patients were identified from computerised medical records. A detailed case note review was undertaken looking at operative findings, procedure performed, and documentation of surgeon-to-patient communication. A questionnaire was posted to patients asking their opinion regarding the quality of communication from surgeons. The questionnaire asked specific questions regarding the patient's understanding of the operation performed and its findings. Overall communication between surgeons and patients was good. However, a small proportion of patients were unsure of their diagnosis and what therapeutic procedure had been performed following laparoscopy. This included one patient (out of 28 who had undergone laparoscopic appendectomy) who was unsure if their appendix had been removed. Two from 12 patients diagnosed with pelvic pathology at laparoscopy who were unclear of their diagnosis and two patients with histologically normal appendices who thought their appendices had been inflamed at removal. Greater effort must be made to inform patients of their laparoscopic findings and any therapeutic procedure performed. We recommend the use of written information leaflets to be sent to the patient's home address to ensure that all patients are fully aware of their laparoscopic findings. For any future emergency admission, the patient's knowledge of any previous surgery and whether their appendix is in situ is of considerable diagnostic value to the assessing clinician. More effort must be made to enable patients to retain such necessary information.

Abdominal Pain↗
PubMed2004

Colo-rectal anastomotic leakage often masquerades as a cardiac complication.

OBJECTIVE: The aim of this study was to identify the mode of presentation of patients with clinical anastomotic leaks following restorative colorectal resection for carcinoma. PATIENTS AND METHODS: Prospective information was collected on all patients having restorative resection of colorectal cancer. These data were reviewed for a five-year period (1994-1998) to identify all patients who had suffered a clinical anastomotic leak and their notes were retrieved and reviewed. RESULTS: Three hundred and seventy-nine patients underwent restorative resection for colorectal cancer during the study period (178 female, 201 male), mean age 70 years (range 36-94). There were 22 (6%) clinical anastomotic leaks. Seven (32%) patients presented with obvious abdominal peritonitis. The remaining 15 (68%) were initially misdiagnosed. Thirteen (59%) patients were treated for cardiac symptoms, 1 (5%) patient for obstruction and 1 (5%) for ascites. The delay in diagnosis ranged from 0 to 11 days (mean 4 days). For the whole series of 379 there were 30 patients who suffered cardiac symptoms (8%) 13(43%) of whom had an anastomotic leak. CONCLUSION: Patients who develop cardiac symptoms following restorative colorectal resection for carcinoma should have a water soluble enema as there is a 40% chance that they will have an anastomotic leak.

Adult↗
PubMed2003

Corrosion behavior of nitinol wires in body fluid environments.

In this study, breakdown potentials were measured for unpolished and mechanically polished nitinol wires in simulated body fluids. These wires are similar to those used in the manufacture of stents. Considerable scatter was observed in the results indicating a variable surface state. After appropriate heat treatments, the measured breakdown values were lower but more reproducible for the mechanically polished samples. Significantly higher breakdown potentials were observed for cross-section wire samples. Some wires were tested in human blood and the breakdown values were higher than in Ringer and 0.9% NaCl solutions. Energy dispersive X-ray analysis of the surface layers indicated that oxide thickening occurred after heat treatments. Dynamic secondary ion mass spectroscopy also revealed thickened surface oxides on the wires. The oxide was predominantly made up of TiO(2) with a very thin layer of NiO at the outer surface. Galvanic corrosion tests were performed on nitinol wires coupled with gold, elgiloy/phynox, and stainless steel. Nitinol was found to be anodic in all cases yet the currents measured were small. In tests in which nitinol-gold couples were immersed in 0.9% NaCl for periods up to 12 months, only very small amounts of nickel (in the part per billion range) were released into solution and scanning electron microscopy examination revealed no corrosion.

Alloys↗
PubMed2003

The engineering of quantum-dot devices.

Insofar as quantum-dot structures represent the extrapolation of today's microstructures used for electronic and optoelectronic device applications, their low-cost manufacture presents many challenges which will take some time to overcome if tunnel and quantum-well devices are any guide.

Journal Article↗
PubMed2003

Management of benign rectal strictures: a review of present therapeutic procedures.

PURPOSE: A significant benign stricture of the rectum is uncommon but can be a recalcitrant condition to treat. Case reports detailing a particular treatment option abound in the surgical literature. An overall précis of the different techniques available is presented, with a comparison of their relative strengths and weaknesses. METHODS: A literature search was undertaken from 1963 to the present day, using MEDLINE. Keywords were benign, strictures, and rectum. RESULTS: Balloon dilation is the most frequent intervention described in the literature. Repeated dilation with time often is required to achieve normal bowel function. Electrocautery resection or incision combined with dilation increases the success rate without increasing the complication rate. Transanal strictureplasty with mechanical staplers is reported as achieving the best success with the smallest complication rate; however, only a minority of strictures are suitable to be managed in this way, and therefore, the numbers treated are small. CONCLUSIONS: All of the techniques reviewed compared favorably with formal stricture resection in terms of success rate and complications.

Anastomosis, Surgical↗
PubMed2003

A snapshot of MDT working and patient mapping in the UK colorectal cancer centres in 2002.

OBJECTIVES: To ascertain the position nationally of Colorectal Multi-Disciplinary Team (MDT) implementation as part of the NHS cancer plan. Also to define nationally patterns of 'bottlenecks' in the patient journey from referral to treatment. METHODS: A simple questionnaire was sent to the lead clinician at all 183 cancer networks asking about their current MDT organization, and whether they had undertaken a mapping exercise of the patient journey. RESULTS: Ninety-one percent (n = 166) of the questionnaires were returned, and of these 90% (n = 150) stated that their MDT meeting was up and running. Sixty-two percent (n = 102) stated they were having problems running their MDT meeting and of these 32% (n = 33) did not have a dedicated MDT clerk. Several of the Calman-Hine identified 'core personnel' are attending infrequently. Sixty-four percent (n = 107) of respondents have carried out a patient mapping process with 65% (n = 70) claiming it was a success, leaving 27% (n = 32) with no immediate plans to undertake the process. CONCLUSIONS: Although MDT activity is near-universal, the survey has highlighted a wide variation in MDT meeting implementation across England, with the same problems being experienced by most centres. Organizational problems are common, and we feel that a dedicated MDT clerk is essential for smooth running. Further areas that require development have been identified by most respondents as radiological, oncological and endoscopic services. It is anticipated that true collaboration nationally will develop, and contact with the nine pilot sites is encouraged to explore solutions to difficulties.

Cancer Care Facilities↗
PubMed2002

Passivation of nitinol wire for vascular implants--a demonstration of the benefits.

This study investigated a passivation process for polished nitinol wires and vascular stent components, after being given a typical shape setting heat treatment. Heat treated samples were passivated in a nitric acid solution and a series of corrosion tests, surface analysis and chemical analysis was performed. Potentiodynamic polarization tests demonstrated a significant increase in breakdown potential for passivated samples, compared to heat treated surfaces. Surface analysis indicated that the passivation reduces Ni and NiO content in the oxide and increases TiO2 content. Chemical analysis of passivation solutions suggests that the improvement in corrosion resistance is proportional to the quantity of nickel removed. Long term immersion tests demonstrate that nickel release from the surface of the material decreases with time and the quantity of nickel released is lower for passivated samples. The improved corrosion resistance is maintained after extended periods of immersion in saline solution.

Alloys↗
PubMed2001

The NMR structure of the 47-kDa dimeric enzyme 3,4-dihydroxy-2-butanone-4-phosphate synthase and ligand binding studies reveal the location of the active site.

Recent developments in NMR have extended the size range of proteins amenable to structural and functional characterization to include many larger proteins involved in important cellular processes. By applying a combination of residue-specific isotope labeling and protein deuteration strategies tailored to yield specific information, we were able to determine the solution structure and study structure-activity relationships of 3,4-dihydroxy-2-butanone-4-phosphate synthase, a 47-kDa enzyme from the Escherichia coli riboflavin biosynthesis pathway and an attractive target for novel antibiotics. Our investigations of the enzyme's ligand binding by NMR and site-directed mutagenesis yields a conclusive picture of the location and identity of residues directly involved in substrate binding and catalysis. Our studies illustrate the power of state-of-the-art NMR techniques for the structural characterization and investigation of ligand binding in protein complexes approaching the 50-kDa range in solution.

Amino Acid Sequence↗
PubMed2001

Estrogen biphasically modifies hypothalamic GABAergic function concomitantly with negative and positive control of luteinizing hormone release.

The principal role of estrogen is its control of the female ovulatory cycle via negative and positive feedback on gonadotropin secretion. However, a detailed, cohesive picture of how the steroid specifically regulates the excitability of hypothalamic neurons involved in the central control of gonadotropin secretion is still emerging. Here, we used an ovariectomized female guinea pig model to test the hypothesis that estrogen acts on GABAergic neurons in the preoptic area (POA) to elicit a biphasic profile of luteinizing hormone (LH) secretion. Intracellular electrophysiological recordings revealed that estradiol benzoate (EB; 25 microgram, s.c.) decreased the hyperpolarizing response of GABAergic neurons to the GABA(B) receptor agonist baclofen 24 hr after treatment. This effect of GABA(B) receptor stimulation in unidentified POA neurons was still depressed 42 hr after EB administration. By the use of a ribonuclease protection assay, however, EB reduced glutamic acid decarboxylase mRNA expression 42 hr but not 24 hr after its administration. Thus, estrogen attenuated the autoinhibition of GABAergic POA neurons during the initial LH suppressive (i.e., negative feedback) phase and subsequently reduced GABAergic function during the LH surge (i.e., positive feedback). These studies demonstrate that the effects of estrogen on hypothalamic GABAergic neurons coincide with the inhibitory and stimulatory actions, respectively, of the steroid on LH secretion. Furthermore, the data provide novel insights into the mechanism by which estrogen regulates hypothalamic GABAergic neurons, which are critical for the biphasic modulation of LH release observed over the course of the female ovulatory cycle.

Action Potentials↗
PubMed2001

A prospective blinded evaluation of exercise thallium-201 SPET in patients with suspected chronic exertional compartment syndrome of the leg.

This study compared the quantitative and qualitative results of leg thallium-201 single-photon emission tomography (SPET) imaging in patients with and without raised intracompartmental pressure associated with exercise-related leg pain. The purpose of this study was to clarify the aetiology of chronic exertional compartment syndrome (CECS), and to investigate the diagnostic applications of 201Tl SPET in CECS. Thirty-four study participants underwent compartment pressure testing (CPT) between March and August 2000. There were 25 positive CPT results (patient group), and nine negative CPT results (control group). All 34 participants underwent scintigraphy. Quantitative and qualitative assessments were performed for the anterolateral and deep posterior compartments of the lower leg. There was no significant difference in either quantitative or qualitative assessments of perfusion between those compartments with and those without CECS. In contrast, a marked effect of exercise type upon compartment perfusion pattern was noted. Results of this study indicate that there is no compartment perfusion deficit in those patients with raised intracompartmental pressure associated with CECS, and suggest a non-ischaemic basis for the pain associated with CECS. They also suggest no role for exercise perfusion scintigraphy in the diagnosis of this syndrome.

Adult↗