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Biomedical subjects

P H Kay

Publications and source records attributed to P H Kay.

At least 109 records · Page 6Linked to original sources
PubMed1983

Disease associations with complotypes, supratypes and haplotypes.

We have used the term supratype to describe combinations of alleles and have examined associations with disease. In RA and insulin-dependent diabetes one or more supratypes appear to be important but their functional significance remains obscure. In MG and SLE the HLA supratype may contain loci involved in immunoregulation, complement synthesis and hormone metabolism. MG induced by D-Pen is associated with Bw35/DR1 rather than A1, B8, DR3. In contrast there is no evidence of a supratype in AS. We have proposed a model for the pathogenesis of sacroiliitis and AS and have postulated two non-linked genes which act stepwise upon HLA-B27. There are cogent reasons for examining the functional effects of known loci within the MHC and particularly those involved in the expression of complement components.

Alleles↗
PubMed1983

Experience with the modified Blalock-Taussig operation using polytetrafluoroethylene (Impra) grafts.

Between June 1978 and January 1982, 115 patients underwent 122 subclavian artery-pulmonary artery shunts using polytetrafluoroethylene (PTFE Impra) grafts. Forty-six of the patients had a ductus dependent pulmonary circulation, the patency of which was maintained by an infusion of prostaglandin E2 in 29 cases. There were nine hospital deaths, four of which were related to shunt failure. Five patients underwent a second shunt procedure within one week of the first. There were two cases of late graft occlusion. Twelve shunts were considered to have failed. The actuarial estimate of shunt patency was 90% (+/- 3%) at two years for all patients and 74% (+/- 10%) for neonates. There was no statistically significant difference in two year shunt patency between 4 mm grafts (88 +/- 5%) and 6 mm grafts (96 +/- 3%). The modified Blalock shunt using a PTFE graft is an effective pulmonary-systemic shunt with a good short term patency.

Adolescent↗
PubMed1983

Open mitral valvotomy: fourteen years' experience.

During the period 1968 to 1980, 222 patients with mitral valve disease in which stenosis was the dominant lesion were admitted under the care of the senior author. All patients presented with severe dyspnoea (NYHA grades 3 or 4). One hundred and fifty seven (71%) patients were treated by open mitral valvotomy. One patient died within 30 days of operation (0.6% hospital mortality) and one suffered a transient cerebrovascular accident. One hundred and twenty four (70%) patients were followed up for one to 14 years (mean 7.5 years). There were seven late deaths. Actuarial curves predict the 90.2% 10 year survival after open mitral valvotomy. Eight patients required mitral valve replacement for restenosis corresponding to 16% at 10 years. The remaining patients are in NYHA grades 1 and 2.

Adolescent↗
PubMed1983

Chordal rupture. I: aetiology and natural history.

Between 1970 and 1981, 12% of patients undergoing mitral valve surgery were found to have chordal rupture. Spontaneous or primary rupture accounted for 74.6% of patients (primary group); in the remainder (secondary group) chordal rupture complicated chronic rheumatic valvular disease (8.9%), bacterial endocarditis on both normal (8.5%) and rheumatic valves (4.7%), ischaemic heart disease (2.3%), acute rheumatic fever (0.5%), and osteogenesis imperfecta (0.5%). Isolated posterior rupture was seen most frequently (54%), with anterior rupture in 36% and rupture of both mitral cusps in 10% of patients. A short symptomatic history of acute mitral regurgitation was rare, occurring in only 4% of patients in either the primary or secondary groups, suggesting that mitral regurgitation due to ruptured chordae is a progressive disease. In contrast to previous reports the clinical presentation did not help to differentiate the aetiology of the chordal rupture.

Adolescent↗
PubMed1983

Chordal rupture. II: comparison between repair and replacement.

During the period 1970-81, 183 patients underwent mitral valve surgery for chordal rupture. Of these, 82 (45%) patients were treated by mitral valve repair and 101 (55%) by mitral valve replacement. Mean age at surgery was 57 years. The early mortality was nine of 183 (4.9%) patients, of whom five had undergone replacement and four repair. During the follow up period (mean 3.6 years, range 0.8-12.2 years) a further 27 patients died; 23 of these had undergone mitral valve replacement and four mitral valve repair. Cerebrovascular events accounted for 35% of the deaths after mitral valve replacement and none of those after mitral valve repair. In 11 patients repair was technically unsatisfactory, and mitral valve replacement was undertaken at the same operation; a further five patients required late replacement (mean 1.4 years) for pronounced mitral regurgitation. Actuarial curves predict a six year survival of 68 +/- 5.7% (mean +/- SD) for all patients after mitral valve replacement compared with 88 +/- 6.9% (mean +/- SD) after repair (p less than 0.01). Actuarial survival curves favour mitral valve repair as the procedure choice for chordal rupture, and in isolated posterior cusp repair breakdown of the repair is a rare occurrence.

Adolescent↗
PubMed1983

Pulmonary aspergilloma: analysis of prognosis in relation to haemoptysis and survey of treatment.

From 1956 to 1980 85 patients were admitted to the Brompton Hospital, London, with pulmonary aspergilloma. The mean follow-up period was 8.7 years and 85% of patients were followed for five years or until death if this was earlier. There were 41 deaths, 27 from respiratory causes: 11 from pneumonia, six from chronic respiratory failure, seven after surgery for aspergilloma, and three from haemoptysis. Medical treatment alone was given to 36 patients, of whom three died of haemoptysis. Systemic antifungal treatment was given to 18 patients without benefit. Intracavitary antifungals were helpful in three out of 10 patients. Surgical resection was performed in 41 patients, of whom three (7%) died after operation and a further six (15%) developed major complications. Cavernostomy was performed in nine patients considered unfit for resection; four died after operation. Haemoptysis was absent or minor in 40 patients, of whom 19 were treated medically and 18 by resection, with similar five-year survival rates of 65% and 75%. Frank or major haemoptysis occurred in 45 patients, of whom 17 were treated medically and 23 by resection, with five-year survivals of 41% and 84% (p less than 0.02). The better survival of the surgical group in this retrospective survey may have been due to the selection of patients with better lung function and more localised pulmonary disease. Our observations suggest that surgical resection for aspergilloma should be restricted to patients with severe haemoptysis and adequate pulmonary function. In patients unfit for resection cavernostomy is hazardous.

Adolescent↗
PubMed1983

Immunogenetics of rheumatoid arthritis.

There is overwhelming evidence that Rheumatoid Arthritis (RA) is under genetic influence, but the mechanisms are unclear. Many studies have implicated HLA-DRA as an important marker for disease susceptibility, though this is not the case in all racial groups. Analysis of familial RA has shown a marked restriction in allelic combinations or supratypes. Mapping of the MHC by complement allotyping has further emphasised the relatively limited number of supratypes associated with RA. Disease associated supratypes may also serve as markers for complications induced by drugs such as D-penicillamine, and be shared by other diseases such as Type I Diabetes. That supratypes may have important biological functions is drawn from studies in complement C2 deficiency and 21-hydroxylase deficiency. Examination of supratypes should allow a more direct approach in understanding the pathogenetic mechanisms in RA, and the role of other markers outside the MHC.

Adult↗
PubMed1983

Treatment of thyroid carcinoma in 107 cases.

One hundred and seven patients with thyroid carcinoma were treated. Thirty-one per cent of the tumours were papillary, 27% were follicular, 28% anaplastic, 4% medullary, and 10% were lymphomas. In the differentiated group of tumours, lobectomy followed by suppressive doses of thyroxine was the commonest surgical treatment. This series confirms that in the absence of extrathyroid dissemination, lobectomy is a safe and effective treatment.

Adenocarcinoma↗
PubMed1982

The diagnostic significance of autoantibodies to the acetylcholine receptor.

The predictive value of the assay for antibodies to the acetylcholine receptor (anti-AChR) is dependent upon the reference range used and the question being asked by the clinician. A reference range has been established after assaying sera from 200 healthy individuals, 314 patients with diseases often considered in the differential diagnosis of myasthenia gravis (MG) or found in association with MG, and 72 patients with active adult onset MG. If the assay is to be used to screen an unselected population for MG a conservative cut off point (2 units) should be used. After establishment of a differential diagnosis more significant may be attributed to a lower result (1 unit or greater). A negative result does not exclude MG. In patients with Systemic Lupus Erythematosus. Graves' disease or thymoma anti-AChR has been demonstrated in the absence of signs of MG. Such patients may have latent or subclinical MG. Two such patients subsequently developed clinically evident MG concomitant with a rise in anti AChR titre above their particular 'biological threshold'.

Autoantibodies↗
PubMed1981

The exclusion pyloroplasty.

A modification of the standard Heinecke-Mickulicz pyloroplasty is described. This is particularly useful in the treatment of large posterosuperior duodenal ulcers with haemorrhage (and perforation) and excludes the ulcer crater from the new gastroduodenal channel.

Duodenal Ulcer↗
PubMed1978

Acute abdominal complications of systemic lupus erythematosus.

Four patients with acute abdominal complications of systemic lupus erythematosus requiring laparotomy are presented. The complications consisted of intestinal ischaemia, without perforation, in 3 patients and omental infarction in the fourth. In 2 patients the abdominal emergency was the first manifestation of the collagen disease. Tissue removed from 3 patients showed a marked vasculitis on histological examination. The pathogenesis and management of acute abdominal complications of systemic lupus erythematosus are discussed and the literature reviewed.

Abdomen, Acute↗
PubMed1978

The treatment of perforated duodenal ulcer.

The prognosis of 189 patients with a perforated duodenal ulcer was analysed. There were three treatment groups, non-operative, simple closure and definitive ulcer surgery. The prognosis of the patients was analysed in terms of the chronicity of the ulcer. Perforations occurring in acute duodenal ulcers have an excellent prognosis, with similar results in each group in this series. All perforations of chronic duodenal ulcers should be treated by emergency surgery.

Acute Disease↗
PubMedDate not supplied

Cross-reactivity of anti-acetylcholine receptor autoantibodies.

The heterogeneity of the specificities of anti-acetylcholine receptor (anti-AChR) antibodies of myasthenia gravis (MG) patients has been demonstrated by comparing reactions against a panel of xenogeneic AChR. For each patient there was a more or less unique cross-reactivity profile. Such heterogeneity emphasizes the need to use human AChR for the routine detection of anti-AChR. In vitro cross-reactivity was important in predicting the effect of anti-AChR after passive transfer to rats. Specificity may influence the outcome in human neonates receiving maternal anti-AChR via the placenta. In contrast to the extreme heterogeneity seen in spontaneous MG, the antibodies associated with D-penicillamine-induced MG were more homogeneous.

Animals↗
PubMedDate not supplied

Heterogeneity of steroid 21-hydroxylase genes in classical congenital adrenal hyperplasia.

Careful genotyping of three families, each having a member with classical salt-losing steroid 21-hydroxylase deficiency, has allowed identification of carrier haplotypes. Digestion with TaqI or EcoRI and probing with a cDNA probe for the 21-hydroxylase genes (pC21/3c) revealed that all six affected haplotypes are abnormal with at least EcoRI. The data suggest that there is extreme polymorphism of the 21-hydroxylase genes and that dysfunction may result from several different abnormalities.

Adrenal Hyperplasia, Congenital↗
PubMedDate not supplied

Heterogeneity and linkage of equine C4 and steroid 21-hydroxylase genes.

The fourth component of complement (C4) is polymorphic in most species studied, and is encoded by a gene or genes within the MHC. In man and mouse there are two closely linked C4 and steroid 21-hydroxylase (21-OH) genes. Therefore we have used Southern blotting to determine whether equine C4 and 21-OH genes are linked. C4 restriction fragment length polymorphism (RFLP) was found with the enzymes EcoRI and BamHI. Comparison of the sizes of EcoRI-digested fragments of genomic DNA hybridizing with C4 and 21-OH probes revealed that equine C4 and 21-OH genes are separated by no more than 13 kb. Further, there is no evidence of C4 and 21-OH gene duplication in the horse. Segregation of ELA and different polymorphic forms of equine C4 suggest that C4 and 21-OH genes are within the MHC. It is likely that equine MHC supratypes will provide improved markers of disease susceptibility.

Animals↗