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Biomedical subjects

M J Kelly

Publications and source records attributed to M J Kelly.

At least 163 records · Page 9Linked to original sources
PubMed1985

Studies on the mechanism of action of dioctyl sodium sulphosuccinate in the human jejunum.

An intestinal perfusion technique has been used to investigate the mechanism of action of the laxative, dioctyl sodium sulphosuccinate, in the human jejunum. Dioctyl sodium sulphosuccinate stimulated net secretion of water, sodium, chloride and potassium and inhibited net absorption of glucose and bicarbonate. These changes in water and solute transport were partially reversed by administration of indomethacin (4 mg/kg/day orally for three days), which suggests that they are mediated in part by endogenous prostaglandins.

Alkaline Phosphatase↗
PubMed1985

Relative nutritional value of whole protein, hydrolysed protein and free amino acids in man.

To compare their effects on nitrogen balance, diets containing either lactalbumin whole protein, its peptide-rich enzymic hydrolysate or an equivalent mixture of free amino acids as the sole source of dietary nitrogen were fed to two healthy subjects, each studied for 38 days on two separate occasions. The nitrogen intake (47 mg/kg body wt/day) induced a state of negative nitrogen balance, stimulating nitrogen conservation. Net daily nitrogen balance (mean +/- SD) in subject 1 was -0.23 +/- 0.72 g (amino acids) vs + 0.05 +/- 0.52 g (protein) and -0.21 +/- 0.58 g (amino acids) vs -0.05 +/- 0.57 g (hydrolysate), and in subject 2, -0.19 +/- 0.60 g (amino acids) vs -0.16 +/- 0.51 g (protein) and -0.42 +/- 0.35 g (amino acids) vs -0.62 +/- 0.34 g (hydrolysate). Analysis of these results by the cumulative sum technique showed no significant differences in the effect of the three nitrogen sources on nitrogen balance. This study indicates that there is no nutritional evidence to support the current practice of prescribing expensive enteral diets containing peptides or amino acids rather than the much cheaper whole protein to patients with normal gastrointestinal function.

Amino Acids↗
PubMed1985

Prognostic significance of left ventricular ejection fraction after acute myocardial infarction. A bedside radionuclide study.

The prognostic significance of left ventricular ejection fraction measurements obtained at the bedside was assessed in 171 patients as soon as possible after acute myocardial infarction. Ejection fraction was measured with a radionuclide first pass portable probe method within a mean of 24 hours of the onset of major symptoms. The results were related prospectively to the subsequent incidence of ventricular fibrillation in hospital, and to hospital and postdischarge deaths in a mean follow up period of 15 (range 9-21) months. All eight episodes of primary ventricular fibrillation, all 12 deaths due to pump failure in hospital, and also 12 out of 13 postdischarge deaths occurred in that minority of 81 patients whose initial postinfarction left ventricular ejection fraction was less than 0.35. Multivariate correlation with clinical, enzymatic, and electrocardiographic indicators of myocardial infarction showed that the prognostic significance of these indicators could largely be explained by their association with low left ventricular ejection fractions. Left ventricular ejection fraction measured within the initial 24 hours after acute myocardial infarction predicts prognosis throughout the subsequent year.

Adult↗
PubMed1985

Non-invasive assessment of pulmonary blood supply after staged repair of pulmonary atresia.

Radionuclide studies were performed to determine pulmonary blood flow in six children who had undergone surgery for pulmonary atresia, ventricular septal defect, and hypoplastic pulmonary arteries with or without major aortopulmonary collateral arteries. Lung blood flow was assessed from both particle perfusion lung scans and the pulmonary and systemic phase of a radionuclide dynamic flow study. Five patients had perfusion defects identified on the particle perfusion lung scan. In three of these, abnormal areas were perfused only during the systemic phase of the flow study, a combination of findings that indicate the presence of perfusion by collateral arteries. In one patient no systemic perfusion was noted and in one an initial particle perfusion study indicated the presence of a lung segment perfused by a collateral artery. In this last patient the particle perfusion scan after total correction showed a reduction in the size of the lung perfusion defect and no evidence of lung perfusion during the systemic phase of the flow study. The particle perfusion lung scan in the sixth patient showed pronounced asymmetry in blood flow to the lungs with no segmental perfusion defect on the particle perfusion scan and no abnormalities on the systemic flow study. It is concluded that radionuclide lung perfusion and flow studies provide useful information on lung perfusion and merit further evaluation to define their role in the management of these patients.

Abnormalities, Multiple↗
PubMed1984

Enalapril for severe congestive heart failure. A double-blind study.

The effects of the new, orally administered converting-enzyme inhibitor, enalapril (MK-421), were studied in 12 ambulatory patients with severe cardiac failure who were also receiving digoxin and diuretic agents. The study was double-blind, parallel, placebo-controlled and randomized. The clinical characteristics and pretreatment exercise performance were similar in the two groups of patients. All vasodilator drugs had been withdrawn two weeks before the start of the trial. At 12 weeks, the patients receiving enalapril showed a significant improvement in the functional class of the disease, exercise time (P less than 0.01), and maximum workload achieved, and experienced relief of symptoms. Blood pressure fell in patients receiving active treatment suggesting a reduction of afterload. Left ventricular ejection fraction was unchanged in enalapril-treated patients, but fell in patients on placebo (P less than 0.001). Enalapril was well tolerated without apparent adverse effects. It was effective when used with digoxin and diuretic agents in the treatment of severe cardiac failure, and its efficacy was maintained throughout 12 weeks of therapy.

Administration, Oral↗
PubMed1984

Scintigraphic localization of a recurrent phaeochromocytoma by means of iodine-131 metaiodobenzylguanidine.

A new adrenomedullary scintigraphic imaging agent, iodine-131-labelled metaiodobenzylguanidine (MIBG), was used to localize a recurrent phaeochromocytoma in a 27-year-old man in whom the site of tumour could not be determined by any other means. MIBG scintigraphy is easy to perform and is highly specific for functioning aberrant adrenomedullary tissue. It complements other methods for localization of phaeochromocytoma and, under some circumstances, it may become the initial imaging procedure of choice in the screening of patients in whom the biochemical or clinical evidence suggests the presence of such tumours.

3-Iodobenzylguanidine↗
PubMed1984

Distribution of immunoreactive substance P neurons in the hypothalamus and pituitary of the rhesus monkey.

The distribution of immunoreactive substance P (IR-SP) neurons was examined in the hypothalamus and pituitary gland of the rhesus monkey by using the peroxidase-antiperoxidase immunocytochemical technique. Immunoreactive SP cell bodies were observed in the arcuate nucleus, in the region lateral to the arcuate nucleus, and in the median eminence (ME). Immunoreactive SP cells were also seen in the periventricular area of the dorsal tuberal region. A rich network of SP fibers was concentrated in the arcuate region, and the fiber stain was particularly dense in the external zone of the median eminence and in the external layer of the infundibular stalk. Also, substance P fibers were seen in the internal layer of the pituitary stalk and in the neural lobe of the pituitary gland. Outside the hypothalamus a dense network of IR-SP fibers was observed in the globus pallidus.

Animals↗
PubMed1984

Identification of estrogen-responsive LHRH neurons in the guinea pig hypothalamus.

Intracellular recordings, dye-labeling and immunocytochemistry were performed in arcuate and cell-poor zone (ARC-CPZ) neurons in hypothalamic slices obtained from cycling, female guinea pigs. The hypothalamic slices were perfused with artificial medium for 9-10 hours during which time intracellular recordings were made through procion yellow electrodes and KC1/KCitrate-filled electrodes. 17 beta-Estradiol (E2) in concentrations of 10(-9) to 10(-8) M hyperpolarized and/or inhibited the spontaneous activity of 42 out of 102 ARC-CPZ neurons. Following the electrophysiological recording, procion yellow was injected in most of the recorded cells and all of the hypothalamic slices were processed immunocytochemically for LHRH. Densely stained LHRH cell bodies and fibers were widely distributed in the mediobasal hypothalamic region. Of the 42 E2-responsive neurons recorded, four contained immunoreactive luteinizing hormone-releasing hormone. These studies show that the hypothalamic slice preparation can be utilized to study the electrophysiology of ARC-CPZ neurons. Moreover, ARC-CPZ neurons and in particular, ARC-CPZ LHRH neurons in the female guinea pig are a site of rapid membrane effects of estrogen, which may be related to the negative feedback actions of estrogen on gonadotropin secretion.

Animals↗
PubMed1984

Oral beta-adrenergic blockade with metoprolol in chronic severe dilated cardiomyopathy.

A double-blind crossover trial was performed to assess the effect of metoprolol in 10 patients (mean age 55 years) with severe dilated cardiomyopathy. All patients clinically had idiopathic dilated cardiomyopathy; however, at coronary angiography, four had occult coronary disease. All were in New York Heart Association functional class III with a left ventricular ejection fraction less than 35% as assessed by rest radionuclide ventriculography. Studies were performed before treatment, after 4 weeks of metoprolol therapy and after 4 weeks of placebo administration. Erect bicycle sprint exercise was used to determine maximal work load. Hemodynamic variables and radionuclide left ventricular ejection fraction were recorded at rest and during graded supine bicycle exercise. Cardiac medications were unchanged throughout the trial. The mean (+/- standard error of the mean) dose of metoprolol was 130 +/- 13 mg/day. Metoprolol did not change symptoms, chest X-ray findings or exercise tolerance (baseline 700 +/- 73, placebo 690 +/- 85, metoprolol 710 +/- 81 kilopond-meters [kpm]/min). Metoprolol produced a significant decrease in heart rate at rest and during exercise (p less than 0.001). Mean blood pressure and left ventricular filling pressure did not differ significantly in the baseline, placebo and metoprolol studies. There was a slight, but significant (p less than 0.05) decrease in cardiac index with metoprolol compared with placebo and baseline studies. The small, but significant increase in left ventricular ejection fraction from baseline to the metoprolol and placebo studies (p less than 0.001) was considered a result of spontaneous improvement rather than of therapy. No significant differences were found between the patients with and without coronary disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗
PubMed1984

Distribution of substance P neurons in the epithalamus of the rat: an immunohistochemical investigation.

Substance P (SP) immunoreactivity was studied in the epithalamus of intact and superior cervical ganglionectomized female rats by using the peroxidase-antiperoxidase immunocytochemical technique. Cells containing immunoreactive SP were located in the medial habenula, and SP fibers were observed in the lateral habenula, habenular commissure, pineal stalk, and the pineal organ. Bilateral removal of the superior cervical ganglia did not affect the immunocytochemical staining of SP-containing cells and fibers 15-30 days later. It is suggested that habenular neurons containing SP send projections into the pineal organ of the rat.

Animals↗
PubMed1984

Right and left ventricular function at rest and with exercise after the Mustard operation for transposition of the great arteries.

Right and left ventricular function was assessed in 25 children (mean age at study 12.2 years and at operation 2.6 years) after a Mustard repair for transposition of the great arteries. Gated first pass and gated equilibrium radionuclide ventriculography was performed on all patients at rest and during supine bicycle exercise. The mean right ventricular ejection fraction did not increase with exercise by either technique. Individual results for right ventricular ejection fraction showed that with the gated equilibrium technique 71% had an abnormal exercise response (normal response being an increase in ejection fraction greater than 5%) and with the gated first pass technique 61% had abnormal results. Although the mean left ventricular ejection fraction increased significantly with exercise, 35% of patients had an abnormal exercise response with the equilibrium technique and 41% with the first pass technique. There was no evidence of a predictive relation between ventricular function and any clinical or haemodynamic variable examined. Covert right and left ventricular dysfunction can frequently be detected by exercise radionuclide ventriculography in long term survivors of repair for transposition of the great arteries. The prognostic consequences of these findings are unclear at present.

Adolescent↗
PubMed1984

Acute intravenous and sustained oral treatment with the beta1 agonist prenalterol in patients with chronic severe cardiac failure.

Prenalterol, a beta1 agonist, was given in a single blind acute intravenous study to seven patients with cardiac failure (New York Heart Association class II and III). It was then given in a double blind crossover study of sustained oral prenalterol to six of them. As a result of dose titration studies the oral dose of prenalterol given was 100 mg twice a day in all patients. Erect bicycle sprint tests were performed to exercise tolerance before and after treatment had been started. Cardiac function was assessed at rest and during graded supine bicycle exercise by determining haemodynamic indices using a Swan-Ganz catheter and radionuclide left ventricular ejection fractions. In the intravenous study cardiac function was assessed at rest and during exercise after a control infusion of dextrose and after an infusion of 5 mg prenalterol. In the oral crossover study a placebo or prenalterol were given for two periods of two weeks; at the end of each period exercise tolerance was measured and cardiac function assessed at rest and during exercise. Throughout the study period there was no change in symptoms, medication, or exercise tolerance. Intravenous prenalterol significantly improved cardiac function; left ventricular ejection fraction and cardiac index increased and left ventricular filling pressure fell both at rest and during exercise. Sustained oral treatment with prenalterol, however, did not improve resting left ventricular filling pressure or left ventricular ejection fraction at rest or during exercise but did increase heart rate at rest, and mean blood pressure and peripheral vascular resistance at rest and during exercise; in fact, during exercise left ventricular filling pressure was significantly increased while cardiac index and stroke volume index were decreased by prenalterol. Sustained oral treatment with prenalterol did not have the beneficial effects on cardiac function produced by intravenous treatment and in fact had deleterious effect on the measured indices of cardiac function during exercise.

Administration, Oral↗
PubMed1984

A stewardship challenge: reconciling faith and finances.

As financial constraints have tightened in recent years, Catholic health care facilities have undergone the double pressure of having to safeguard the integrity of their Christian mission while maintaining economic viability. The conflict between faith and finances, however, represents a tension that has been felt since Biblical times. The dichotomy between ministry and money can be traced from Scripture's admonition that money is the root of all evil, through the Manichean heresy of the early Church, right up to the conflict that today's sponsoring congregations experience in seeking to reconcile multimillion-dollar budgets with their efforts to maintain a simple life-style and raise the existence level of the poor. Mission integrity and fiscal viability are not irreconcilable, however. Effective management can advance, not impede, the mission's cause. Sound business decisions need not exclude social or mission values. Indeed, ministry and management are united in the Gospel message of stewardship. The Gospel itself abounds in management lessons, perhaps the clearest of which is the parable of the talents, in which we are told to manage our gifts wisely so that they are actually increased and not just maintained. Numerous contemporary Church documents also suggest that the multimillion-dollar services that we have inherited and developed must continue to be managed well so that their yield, ministerial and financial, is increased. To resolve much of the misunderstanding within sponsorship groups and health care facilities, an action agenda is needed: The nature of work must be given prayerful reflection, so that it can be understood as a sharing in the creative act of God and as a part of each person's spirituality. Moreover, an institution should be viewed and managed as a positive power base and educational center for developing and advancing positions consistent with the Gospel. Institutional policies and procedures, of course, should be made to reflect this new understanding of the management-ministry relationship. Considerations of ministry, economy, and quality should be included in mission statements and philosophies, and financial officers and mission personnel should be challenged to integrate fiscal viability with mission integrity. Finally, a model for ethical decision making should be developed and adopted so that both orientations--ministry and management--are harmoniously balanced in the institution's decisions.

Catholicism↗
PubMed1984

Hepatobiliary scintigraphy.

The recently acquired ability to tag 99mTc to a number of chemicals which are excreted avidly by the liver and concentrated in the gallbladder has enabled improved diagnosis of acute cholecystitis. This article gives a brief overview of the imaging technique.

Acute Disease↗
PubMed1983

Comparison of supine and erect bicycle exercise electrocardiography in coronary heart disease: accentuation of exercise-induced ischemic ST depression by supine posture.

Exercise-induced electrocardiographic ST depression was compared during supine and erect graded bicycle exercise in 43 patients with chest pain but no prior myocardial infarct; all had greater than or equal to 1 mm of ST depression during either erect or supine exercise; 16 had multivessel, 24 had 1-vessel and 3 had no coronary artery disease. Supine exercise used 4 minutes/stage and erect exercise used either 4 minutes or 3 minutes/stage with identical graded work loads for both postures. Chest pain occurred in 31 patients during erect and in 29 during supine exercise. ST depression was greater than or equal to 1 mm in 28 patients during erect exercise and in all 43 during supine exercise (p less than 0.001); mean maximal ST depression was 1.3 +/- 0.2 mm during erect and 2.6 +/- 0.2 mm during supine exercise (p less than 0.001). Maximal work load was higher during erect than supine exercise (745 +/- 32 versus 678 +/- 32 kpm/min; p less than 0.001). The accentuation of ST depression by supine posture was not attributable to the changes in heart rate, rate-pressure product or mean blood pressure during supine versus erect exercise. In the 10 patients who had 2 erect bicycle tests using work load durations of 3 and 4 minutes, the maximal ST depression was not significantly different (erect 3 minutes 1.3 +/- 0.5 mm and erect 4 minutes 1.4 +/- 0.4 mm).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗