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Biomedical subjects

M Kelly

Publications and source records attributed to M Kelly.

At least 127 records · Page 7Linked to original sources
PubMed1997

Randomised trial comparing a policy of early with selective amniotomy in uncomplicated labour at term.

OBJECTIVE: To compare two management policies: rupture of the fetal membranes when women are in normal labour or leave them intact as long as feasible. SETTING: The labour ward of a city university hospital. DESIGN: Automated randomised clinical trial. PARTICIPANTS: 1540 women in uncomplicated term labour. Data on labour duration, blood loss, oxytocin use and fetal condition were collected from 1132 women. Some data from nulliparous women has been presented earlier by the UK Amniotomy Group. MAIN OUTCOME MEASURES: Duration of labour, Apgar score, fetal morbidity and maternal morbidity including perineal injury, mode of delivery, epidural rates and the total number of vaginal examinations in the first stage of labour after amniotomy. INTERVENTIONS: Amniotomy at the next vaginal examination or amniotomy only if indicated. The median cervical dilatation at membrane rupture was 2 cm greater in the first group. RESULTS: A policy of routine amniotomy in labour had no measurable advantage over selective amniotomy for parous women (difference = 4 min) but shortened labour in nulliparous women by 1 h (Mann-Whitney U test: P < 0.05). There was a suggestion of a higher caesarean section rate (OR 1.9; 95% CI 0.9-3.5), and there were more vaginal examinations after membrane rupture in the group allocated routine amniotomy. There were no measurable differences in oxytocin use, fetal condition at birth, retained placenta rates, blood loss, pain or analgesia requirements. CONCLUSION: Routine amniotomy may shorten the first labour but not subsequent ones. There is a suggestion that routine surgical interference may be harmful by increasing the risk of caesarean section, and this agrees with data from other trials (common odds ratio 1.2; 95% CI 0.92-1.6).

Adult↗
PubMed1997

The case for stopping cervical screening at age 50.

OBJECTIVE: To determine the pattern of abnormal cervical cytology in women aged 50 to 60 years and to determine whether the development of cervical neoplasia in this age group is confined to women who have been inadequately screened. DESIGN: Retrospective case analysis study. POPULATION: An 11-year birth cohort of women in Grampian Region born between 2/10/33 and 1/10/44, and those who had significant cytological abnormalities in the 5 year period 1/10/89 to 30/9/94. MAIN OUTCOME MEASURES: Cytological and histological outcome for women with significant cytological abnormalities between 50 to 60 years of age and the interval between three consecutive smears taken up to 50 years of age for those women. RESULTS: Of 23,440 women aged 50 to 60 years ever screened in Grampian Region, 229 (1%) had significant cytological abnormalities. Seventy had CIN 3 and 15 had invasive disease of the cervix. Among approximately 9000 women with adequate smear histories prior to age 50, one case of CIN 3 and one case of invasion were detected. The prevalence of invasive disease in the whole cohort during this five year period was 59/100,000. Among the previously well screened women the prevalence was 11/100,000. CONCLUSION: The incidence of preinvasive disease of the cervix is low over the age of 50 and is seen almost exclusively in inadequately screened women. There would appear to be little benefit in continuing cervical screening over the age of 50 in women who have had regular negative smears. The release of this low risk group from the cervical screening programme could alleviate anxiety and could enable reallocation of resources to target better high risk women who default from regular screening and to reduce screening intervals where necessary to three years.

Age Factors↗
PubMed1997

Physical localisation of the breakpoints of a constitutional translocation t(5;6)(q21;q21) in a child with bilateral Wilms' tumour.

A 6 month old boy presented with bilateral Wilms' tumour. Cytogenetic analysis of the lymphocytes from the patient showed a de novo balanced translocation t(5;6)(q21;q21), which was also present in the tumour material as the sole cytogenetic abnormality. To facilitate the identification of the translocation breakpoints, we have established a lymphoblastoid cell line (MA214L) from the patient which maintains the translocation in culture. We have used Genethon microsatellite markers as sequence tagged sites (STSs) to isolate yeast artificial chromosome (YAC) clones to 5q and 6q from human genomic libraries. Using fluorescence in situ hybridisation (FISH) on metaphase preparations of MA214L, we have physically defined the translocation breakpoints between YAC clones on each chromosome arm. The genetic distance separating the flanking YACs on 6q21 is 3 cM, while that on 5q21 is 4 cM. To date this is the first report of these chromosomal regions being implicated in Wilms' tumourigenesis.

Chromosome Fragility↗
PubMed1997

A comparison of hospice and hospital care for people who die: views of the surviving spouse.

To compare the quality of inpatient care for dying people in St Christopher's Hospice, London and nearby hospitals in 1994 and make comparisons with earlier studies of the same setting, interviews were undertaken with spouses of people who had died from cancer in these settings, matched by age and sex. The subjects comprised 66 people who had died in 1994, 33 of whom had died in the hospice, 33 in local hospitals. The mean age was 70.2, 61% were male. The hospice group were more likely to know that they were dying and less likely to be admitted as emergencies. Treatment for pain, breathlessness and nausea from both sources provided relief in almost all cases. Most information about the illness was given by hospital doctors before hospice care occurred. Where it occurred, communication by hospice staff was judged better than that by hospital doctors. Staff in hospitals were more likely to be judged 'very busy'. Hospice respondents were less likely to want improvements, and more likely to judge the institution as being 'like a family'. Earlier studies had shown a trend for symptom control to have improved in hospitals but for difference in the psychosocial climate to favour the hospice, By 1994, this latter difference was still obtained. We stress the role of hospital staff and general practitioners in helping patients accept a terminal prognosis, so that better-planned care can proceed. The busy public atmosphere of some hospital wards may not be conducive to the good care of dying people.

Aged↗
PubMed1997

A comparison of hospice and hospital care for the spouses of people who die.

To compare the quality of care for spouses of dying people in St Christopher's Hospice, London and nearby hospitals in 1994 and to make comparisons with earlier studies of the same setting, interviews were undertaken with spouses of people who had died from cancer in these settings, matched by the deceased's age and sex. The subjects comprised 66 people whose spouses had died in 1994, 33 of whom had died in the hospice, 33 in local hospitals. The mean age was 69.3; 61% were female. No significant differences between groups were found on the outcome measures (adjustment to bereavement, anxiety and psychosomatic symptoms at the time of the final admission), largely replicating earlier studies in the same setting. In various respects hospitals have moved closer to hospice practice: in contrast to earlier studies, there were no differences in visiting patterns or in spouses helping with inpatient care. Bereavement follow-up is now initiated in some cases by hospitals. Liberal visiting hours could be stressful, however, and spouses sometimes helped with care to remedy staff shortcomings. Regret at not being present at the death was more common in the hospital group. Bereavement interventions may have more effect on subsequent adjustment if targeted on high-risk individuals. Other benefits than adjustment, however, may be achievable. Steps to create a calm atmosphere on hospital wards where people can be with their relatives near the time of death are desirable.

Aged↗
PubMed1997

Oral morphine as symptomatic treatment of dyspnoea in patients with advanced cancer.

We report an open, uncontrolled study to evaluate the effectiveness of regular oral morphine as symptomatic treatment of dyspnoea in patients with advanced cancer receiving standard clinical care. Fifteen patients were assessed initially, and then 48 h and 7-10 days after starting treatment with oral morphine or having their dose increased. Dyspnoea, measured on a visual analogue scale (0-100), fell by a median of 14 (95% confidence interval -1.5, 25.5; Wilcoxon statistic 32.0; P = 0.06) in the nine who completed all three assessments. The three patients who died during the study did not show symptomatic benefit and, like the three who withdrew, experienced increased sedation and/or dizziness. Sedation was significantly increased at 48 h; median rise 10.5 (95% confidence interval 7, 25; Wilcoxon statistic 74; P = 0.007). Baseline respiratory function (FEV1, FVC, peak flow) was poor and the patients' respiratory rate was unaffected. Regular, titrated oral morphine may improve dyspnoea in some patients with advanced cancer but can cause significant short-term adverse effects. Oral morphine should be given to these patients as a therapeutic trial. Patients should be advised about side-effects and carefully monitored. Larger studies are needed to establish which patients are most likely to benefit and optimal dosage regimens.

Administration, Oral↗
PubMed1997

Clustering of childhood IDDM. Links with age and place of residence.

OBJECTIVE: To improve understanding of the etiology of IDDM by analyzing spatial and space-time distribution of the incidence in children. RESEARCH DESIGN AND METHODS: Statistical tests to detect clustering were applied to a population-based register of 1,490 children (aged 0-16 years) with IDDM in Yorkshire, northern England. The Knox test analyzed clustering in space and time, and the Potthoff-Whittinghill test quantified spatial differences in incidence between small-area census units (electoral wards). The Potthoff-Whittinghill test was conditioned for childhood population density and deprivation (Townsend index). RESULTS: Both tests demonstrated clustering of IDDM in Yorkshire children. Space-time and spatial clustering is strongest in the younger children (0-4 and 5-9 years of age), even after conditioning for known associations. Clustering was more common in the county of Humberside during the years 1982-1985 and in wards of low population density (< 0.26 0- to 16 year-old subjects per hectare). CONCLUSIONS: The study revealed a nonrandom space-time distribution of IDDM in children not accounted for by known covarying demographic factors. The Potthoff-Whittinghill test has not previously been applied to childhood IDDM. The new finding of strong clustering in young children is consistent with early exposure, possibly in utero, to infectious agents or localized environmental sources.

Adolescent↗
PubMed1997

The effects of chronic cocaine self-administration on the menstrual cycle in rhesus monkeys.

Clinical studies suggest that cocaine disrupts reproductive function, but because cocaine abusers often abuse opiates and alcohol, it has been difficult to determine the contribution of cocaine alone. The effects of chronic cocaine self-administration on menstrual cycle duration and basal levels of progesterone were examined in eight female rhesus monkeys and compared with the effects of occasional administration of single cocaine doses (0.4 or 0.8 mg/kg) in six otherwise drug-free controls. All monkeys had normal ovulatory menstrual cycles before cocaine exposure. Monkeys self-administered cocaine (0.10 mg/kg/injection) and food (1 gm banana pellets) in 4 daily sessions on a second-order schedule (fixed ratio 2 [variable ratio 16:S]). Cocaine intake was limited to 8 mg/kg/day. During the first cocaine exposure (256-776 days), monkeys self-administered 3.51 (+/- 0.77) to 7.41 (+/- 0.27) mg/kg/day. During the second cocaine exposure (103-623 days), monkeys self-administered 6.18 (+/- 0.77) to 7.41 (+/- 0.27) mg/kg/day. In these prospective longitudinal studies, 48% of the menstrual cycles were of abnormal duration in the cocaine self-administration group, whereas only 6% of the menstrual cycles were abnormal in the control group. There were 19 episodes of amenorrhea (61-190 days of no menses). During cocaine self-administration, approximately one-third of the menstrual cycles were anovulatory with low mid-luteal progesterone levels of 2.04 (+/- 0.6) to 4.13 (+/- 0.5) ng/ml. Over 25% of menstrual cycles were anovulatory during cocaine withdrawal with mid-luteal progesterone levels below 5 ng/ml. These data indicate that chronic cocaine exposure can disrupt the menstrual cycle in rhesus monkeys and that menstrual cycle abnormalities often persist during cocaine withdrawal. These data are consistent with clinical studies and reports of cocaine-induced disruption of the estrous cycle in rodents.

Adrenocorticotropic Hormone↗
PubMed1997

Late effects of early surgery on lipoma and lipomeningocele in children less than 1 year old.

PURPOSE: We attempted to assess the usefulness of urodynamic testing for diagnosing lipoma and lipomeningocele, and the late effects of early neurosurgical intervention in children less than 1 year old. MATERIALS AND METHODS: A total of 28 patients in whom spinal surgery was performed before age 1 year for correcting lipoma and lipomeningocele underwent neurological and urodynamic evaluation preoperatively, and within 3 months and up to 14.5 years postoperatively. RESULTS: Preoperatively 15 patients (54%) had an abnormal neurological examination and 7 had an abnormal urodynamic study. Of the 13 patients with a normal neurological examination 3 had an abnormal urodynamic study. Overall 10 patients (37%) had an abnormal urodynamic examination preoperatively. Immediately after surgery 8 patients (29%) had improvement (2 of 15 with an abnormal neurological examination and 6 of 10 with an abnormal urodynamic study), whereas the condition of 9 (32%) worsened, including 4 of the 13 who were neurologically and 6 of the 18 who were urodynamically normal (1 in both categories). With time an additional 7 patients (25%) had progressive deterioration, including 6 urodynamically and 5 neurologically (4 in both categories), 2 (7%) had improvement (1 each urodynamically and neurologically) and the condition of 19 (68%) remained stable. Six patients (21%) underwent secondary spinal surgery for recurrent tethering. CONCLUSIONS: Early surgical repair seems to provide a degree of protection against later spinal cord tethering, and subsequent neurological and/or urodynamic deterioration (25% of our patients versus a reported 80% of those followed expectantly).

Female↗
PubMed1997

Trauma to the neck and larynx.

Trauma is the leading cause of death for persons from 8 months to 44 years of age. The precise incidence of neck trauma is unknown. Autopsy studies have shown that the majority of the individuals with a major airway injury die at the scene of the accident, as a result of asphyxia caused by interruption or obstruction of the airway, compounded by aspiration of blood and intrapulmonary hemorrhage. A neck traumatized patient thoroughly challenges the practitioner's ability to coordinate, diagnose, and rapidly formulate a proper method of treatment.

Adolescent↗
PubMed1997

Pressure at residual volume: a useful adjunct to standard fill cystometry.

PURPOSE: Determining the role of the bladder in incontinence and/or upper urinary tract deterioration involves the cystometrographic evaluation of detrusor compliance. Management decisions based on information provided by standard fill water cystometry assume that data reflect the physiological state of the patient but this is not always true. We report the use of pressure at residual volume as a physiological measurement to aid in the interpretation of data obtained during standard fill urodynamics. MATERIALS AND METHODS: All patients presenting to our urodynamic suite for standard cystometry between June 1994 and December 1995 underwent measurement of bladder pressure at insertion of the urodynamic catheter. Residual volume and pressure measured before draining this urine, that is pressure at residual volume, were recorded. The bladder was then filled at a rate equal to or less than 10% per minute of known or predicted capacity. When a volume equal to the residual volume had been instilled, filling pressure was recorded and the remainder of the standard urodynamic evaluation was completed. Uncooperative patients as well as those with an active infection or residual volume less than 10 ml. were excluded from further analysis. RESULTS: In 152 children pressure at residual volume was compared to filling pressure and the difference was analyzed. Filling pressure was higher than pressure at residual volume in the majority of cases. In 59 children there was a positive change (filling pressure greater than pressure at residual volume) of 5 cm. water or greater and in 13 there was a negative change (pressure at residual volume greater than filling pressure) of 5 cm. water or less. When only cases in which pressure at residual volume was greater than 5 cm. water were analyzed, 46 and 33% had a difference between filling pressure and pressure at residual volume of 5 cm. water or greater and 10 cm. water or greater, respectively. CONCLUSIONS: Pressure at residual volume is physiological, simple to determine and may provide additional information regarding storage characteristics of the bladder. In the context of the clinical history differences between pressure at residual volume and filling pressure may help to interpret standard fill cystometry data.

Adolescent↗
PubMed1997

A method of drop administration.

Self-administering drops can be a daunting task for many patients. The authors describe a method of drop administration that allows a patient to accurately place drops without the need for special devices or touching the eye. With the bottle of drops held upside down, the back of the thumb is rested on the forehead to stabilize the bottle. The bottle tip can be seen over the eye. The other hand retracts the inferior lid to catch the drop. Poor compliance is common and is often caused by difficulties with drop administration. This simple technique may improve compliance.

Humans↗
PubMed1996

Linkage analyses of schizophrenia to chromosome 6p24-p22: an attempt to replicate.

The present study evaluates evidence for linkage of schizophrenia to chromosome 6p24-p22. An independent sample of 211 families ascertained on the basis of having an affected sib-pair diagnosed with schizophrenia or schizoaffective disorder was assessed with seventeen polymorphic markers spanning a 37cM region. Linkage analysis was performed with parametric and non-parametric methods to test for cosegregation using 4 models of inheritance. Neither two-point nor multipoint non-parametric analyses reached significance at a level less than 0.01 for any markers examined in the region and lod score analyses were not suggestive of linkage. Based on initial findings in the present data set and recently published linkage results, two specific areas were densely covered with markers and tested for linkage disequilibrium. After correcting for multiple comparisons within each locus, no significant deviation from expected allele transmission ratios was observed. The present findings together with the published literature fail to find consistent evidence of a linkage for schizophrenia to a single locus on chromosome 6.

Adult↗
PubMed1996

Levels of PCDDs, PCDFs and non-ortho PCBs in dietary supplement fish oil obtained in Spain.

Levels of PCDDs, PCDFs and non-ortho PCBs are reported for fish oils available in Spain which are consumed by the population as a dietary supplement. Trace enrichment methodology based on the use of modified silica and activated carbon chromatography was combined with on-column extraction (FMS 100) to separate PCDDs, PCDFs and PCBs from lipid material. The extracts were further cleaned up on disposable Florisil columns and analysed by HRGC/HRMS (PCDD/F and non-ortho PCB fractions). Mean levels found in the samples were 10.50 ppt for total PCDDs and 9.95 ppt for total PCDFs. Calculated PCDD/F I-TEQ values were found to be 2.11 ppt on a lipid weight basis. Total mean levels found for co-planar PCBs (#77, 126 and 169) were 18.26 ppt and the calculated I-TEQ value was 0.31 ppt on a lipid weight basis.

Benzofurans↗
PubMed1996

PCDDS and PCDFS in milk from farms in Derbyshire, U.K.

As part of a programme to establish the background levels of PCDD/Fs in milk in the U.K., samples of cows' milk were collected from farms in Derbyshire in 1990 and 1991. The concentrations of PCDD/Fs in the samples from two farms in the Bolsover area of Derbyshire were found to be significantly elevated compared with the normal range for PCDD/Fs in milk in the U.K. Details of the findings and the actions taken as a result are given. The concentrations of PCDD/Fs in milk from those farms previously supplying milk for human consumption are now below the Maximum Tolerable Concentration of 17.5 ng TEQ/kg fat.

Animals↗