Search PubMed⌕ Search

Biomedical subjects

R Kay

Publications and source records attributed to R Kay.

At least 73 records · Page 4Linked to original sources
PubMed1998

The absence of crossing vessels in association with ureteropelvic junction obstruction detected by prenatal ultrasonography.

PURPOSE: The widespread use of prenatal ultrasonography has led to a marked increase in the incidence of ureteropelvic junction obstruction presenting in infancy. Which of these prenatally detected lesions requires repair has yet to be fully determined. Attempts to characterize prenatally detected ureteropelvic junction obstruction in regard to symptomatic obstruction detected later in life may provide useful insights into the management of these incidentally discovered lesions. We evaluated the presence of crossing vessels in ureteropelvic junction obstruction identified by prenatal ultrasonography. MATERIALS AND METHODS: We reviewed the records of patients who underwent dismembered pyeloplasty for primary ureteropelvic junction obstruction with specific attention to the mode of presentation and presence of crossing vessels associated with obstruction. RESULTS: In 30 patients with a mean age of 6 months ureteropelvic junction obstruction detected prenatally was not associated with a crossing vessel. Ureteropelvic junction obstruction was identified postnatally in 125 patients who underwent open pyeloplasty. It was detected incidentally in 8, of whom crossing vessels were present in 1 (12%). There were signs or symptoms related to ureteropelvic junction obstruction in 117 patients. In contrast to the group with prenatally detected ureteropelvic junction obstruction in which crossing vessels were never noted, crossing vessels were associated with 36 (30%) of the 120 kidneys operated on in this postnatally discovered group. CONCLUSIONS: No crossing vessels were present in patients with prenatally detected ureteropelvic junction obstruction compared with 30% in symptomatic patients. This finding may reflect the natural history of the disorder, or it may suggest that prenatally identified ureteropelvic junction obstruction is an entity largely different from obstruction presenting later in life.

Adolescent↗
PubMed1998

Disproportionate fetal growth and fingerprint patterns.

Fingerprint whorl patterns are formed during fetal life. In a group of 180 term infants, those with more fingerprint whorls tended to have a small abdominal circumference (P = 0.09) and high ratio of head to abdominal circumference (P = 0.008). These associations were independent of the relation between the whorl counts of the mothers and their infants. We also found an independent correlation between the babies' whorl count and the combination of increasing subscapular (P = 0.03) and decreasing triceps (P = 0.02) skinfold thicknesses of the mothers. Whorl patterns are associated with adult hypertension; maternal nutritional status may influence their common origin during fetal development.

Adult↗
PubMed1998

Genetic and environmental risk factors for Parkinson's disease in a Chinese population.

An epidemiological study of the environmental and genetic factors as well as the possible interplay between them was conducted among 215 patients with Parkinson's disease and 313 controls in a Chinese population in Hong Kong. In univariate analysis, a regular tea drinking habit was found to be a protective factor, which had not been reported before. Smoking (a protective factor), family history, duration of pesticide exposure (in years) in farming and pesticide exposure during farming in women (both risk factors) have been reported previously. In multivariate analysis, current smoking reached borderline significance at the 5% level and the variables, years exposed to pesticides and family history were significant at the 10% level. By contrast with the common occurrence of polymorphism of the CYP2D6 gene (a gene involved with xenobiotic metabolism) in white people, it is very rare in China and is not thought to be a significant factor contributing to Parkinson's disease in Chinese people.

Aged↗
PubMed1998

Is in-hospital stroke mortality an accurate measure of quality of care?

We examined the validity of using in-hospital stroke mortality as predicted by the Cleveland Hospital Outcomes Indicators of Care Evaluations (CHOICE) model as a measure of quality of care. A total of 223 patients admitted to the hospital for stroke were evaluated by the CHOICE model, which predicted that 19 stroke deaths would occur. We reviewed the 19 patients with the highest predicted mortality, according to CHOICE, and three additional patients who died following stroke. We found that The CHOICE model accurately predicts in-hospital stroke mortality for large populations but not for individual patients. CHOICE and other stroke outcome models rely heavily on early Do Not Resuscitate orders and coma but exclude important variables found in the literature on stroke. No correlation between in-hospital stroke mortality and quality of care was demonstrated. Mortality prediction models used to guide consumers on where to receive stroke care are potentially misleading, as they do not assess functional neurologic recovery or the process of care that are essential elements of quality.

Cerebrovascular Disorders↗
PubMed1998

Intracranial stenosis in Chinese patients with acute stroke.

We studied 100 consecutive acute stroke patients in a Chinese population with transcranial Doppler and CT. Twenty patients had intracerebral hemorrhage and 14 patients did not have adequate temporal windows for transcranial Doppler examination. Among the remaining 66 patients, 22 patients (33%) had intracranial occlusive diseases and 3 (6%) had extracranial carotid stenosis. Our data showed that intracranial occlusive disease is the most commonly found vascular lesion in our acute stroke patients.

Adult↗
PubMed1998

Primary lymphedema of the genitalia in children and adolescents.

PURPOSE: Congenital lymphedema is a rare disorder that may result in disfiguring edema of the male genitalia. We reviewed our experience with 5 cases to advance our understanding of this challenging problem. MATERIALS AND METHODS: Four boys with significant lymphedema underwent excision of the involved subcutaneous genital tissue and coverage with local skin flaps. Two boys in whom this approach failed later underwent complete excision of the involved subcutaneous tissue and skin, and coverage with split thickness skin grafts. The boy with minimal edema was observed. RESULTS: Two of the 4 boys who underwent subcutaneous genital tissue resection and coverage with local skin flaps are markedly improved, although 1 requires further revision. In the other 2 boys treatment failed, necessitating repeat genital tissue excision and grafting. While there have been no recurrences in the grafted areas, each patient has required additional operations to manage recurrent edema in adjacent tissues of the perineum and inguinal region, and in 1 significant contraction of the grafted skin developed. Mild genital lymphedema in the remaining patient has remained stable during 10 years of followup. CONCLUSIONS: Congenital lymphedema of the genitalia is a challenging problem. Recurrences requiring multiple operations are common. We recommend expectant management of mild cases. In more severe cases excision without grafting should be attempted. While skin grafting may be the most definitive solution, it does not prevent recurrence in adjacent regions, and it carries the risk of skin contraction. Skin grafts should only be used when other techniques have failed.

Adolescent↗
PubMed1998

Tumors of the adrenogenital syndrome: an aggressive conservative approach.

PURPOSE: Testicular masses in male individuals with the adrenogenital syndrome are a clinical and pathological diagnostic dilemma. The major differential diagnosis of gonadal nodules in this setting includes interstitial Leydig cell tumors and secondary benign tumors of possible adrenal rest origin. Management of these 2 entities obviously differs. We report clinical, biochemical and pathological features in 3 children with rare bilateral testicular masses and the adrenogenital syndrome in an attempt to define better the natural history of these entities and formulate recommendations for management. MATERIALS AND METHODS: All 3 patients had a history of precocious puberty. Two boys were diagnosed with the adrenogenital syndrome at birth, and presented with bilateral testicular masses at ages 5 and 17 years, respectively. The remaining patient was diagnosed at age 15 years after testicular and adrenal masses developed. All 3 cases were classified as 21-hydroxylase deficiency with markedly elevated levels of 17-hydroxyprogesterone, dehydroepiandrosterone, adrenocorticotropic hormone and androstenedione. Testosterone levels were mildly elevated above normal age matched values. Testicular biopsies were done in each case. RESULTS: Two cases were initially interpreted as bilateral Leydig cell tumors but they were histologically reclassified as tumors of the adrenogenital syndrome. The other case was diagnosed as interstitial cell hyperplasia. Although corticosteroid therapy corrected each steroid abnormality, in no case did tumors resolve, but there was gradual regression in 1. Each patient has been followed conservatively for 4 years. There has been no increase in tumor size or evidence of metastatic disease. CONCLUSIONS: Bilateral testicular masses in children with the adrenogenital syndrome may mimic Leydig cell tumors, which also commonly cause precocious puberty. Orchiectomy for Leydig cell tumors in boys with precocious puberty is contraindicated without a complete endocrinological profile. When congenital adrenal hyperplasia is diagnosed, these tumors appear to be derived from cells of possible adrenal origin stimulated by adrenocorticotropic hormone and they may be followed conservatively.

Adolescent↗
PubMed1997

Management of bilateral Wilms' tumors in the daughter of Jehovah's Witnesses.

Surgical treatment of the children of Jehovah's Witnesses is a challenging problem both ethically and technically. The authors recently operated on such a child who had bilateral Wilms' tumors. Techniques used to minimize blood loss included erythropoietin, hemodilution, and the argon beam coagulator. A full understanding of the religious, legal, and ethical issues is essential when treating the children of Jehovah's Witnesses.

Child, Preschool↗
PubMed1997

Use of a de-epithelialized local skin flap in hypospadias repairs accomplished by tubularization of the incised urethral plate.

OBJECTIVES: Snodgrass recently described a form of urethral tubularization with longitudinal incision of the urethral plate to create an elliptical meatus. To prevent fistulae, a transverse island of dorsal subcutaneous tissue was used to cover the repair. The generation of this flap may compromise blood supply to the skin that is used in the skin closure, and predispose to penile torsion. We have modified the technique to address these concerns, while accomplishing the major goal of functional success-particularly minimizing or eliminating fistulae. METHODS: Eighteen boys, aged 6 months to 6 years, with distal or midshaft hypospadias, underwent a one-stage repair using a modification of Snodgrass' technique. Rather than a transverse island flap of subcutaneous tissue, a local de-epithelialized skin flap was used to cover the urethroplasty. RESULTS: Sixteen patients have returned for follow-up, and all patients have an excellent cosmetic and functional result with an elliptical glanular meatus. There have been no cases of fistula or meatal stenosis. CONCLUSIONS: Distal hypospadias repair utilizing a de-epithelialized local skin flap to cover a tubularized incised urethral plate gives an excellent cosmetic and functional result. Optimal blood supply to the ultimate skin coverage is preserved, and penile torsion is avoided.

Child↗
PubMed1997

Prepubertal varicoceles.

OBJECTIVES: Varicoceles are rarely detected in prepubertal boys. In an effort to further determine the natural history of prepubertal varicoceles, we have reviewed our experience with prepubertal boys who had varicoceles. METHODS: Eleven patients with prepubertal varicoceles were seen. The majority of patients (9 of 11) were asymptomatic. The mean age was 10.8 years (range 6 to 12). Ten of 11 patients had left-sided varicoceles. All varicoceles were grade III except for one that was grade II. Four patients underwent varicocele ligation, 3 via the Ivanessevich approach and 1 via the Palomo approach. RESULTS: The 4 patients who underwent varicocele ligation (operative group) had a follow-up that ranged from 6 to 72 months (mean 27.2) and the 7 patients who were observed (nonoperative group) had follow-up that ranged from 17 to 84 months (mean 40.8). All patients in the operative group exhibited "catch-up" growth of the affected testicle (mean relative testicular size 47% to 84% at follow-up). The relative left testicular size in the nonoperative group had decreased by a mean of 16.8% from the time of presentation (100% to 83.2% on follow-up). CONCLUSIONS: We conclude that prepubertal boys should be screened in the standing position for the presence of varicoceles. Secondary causes should be excluded. Patients may ultimately require intervention as our initial experience suggests improved testicular growth with early surgical repair.

Age Factors↗
PubMed1997

Auditory brainstem responses after radiotherapy for nasopharyngeal carcinoma.

The effect of irradiation for nasopharyngeal carcinoma on auditory brainstem responses and hearing was investigated in 19 otologically normal patients undergoing standard fractionated megavoltage radiotherapy. Auditory brainstem responses and pure tone audiometry were performed before radiotherapy, and at 3 and 12 months after completion of radiotherapy. There were no significant changes in the wave I-III and III-V interpeak intervals, or in sensorineural hearing thresholds (bone conduction at 4 kHz and average of bone conduction at 0.5, 1, 2 and 4 kHz), after radiotherapy. In contrast to previous studies, we found no evoked potential evidence of subclinical brainstem damage arising from irradiation for nasopharyngeal carcinoma.

Adult↗
PubMed1997

Epidemiological features of testicular teratoma in a prepubertal population.

PURPOSE: Prepubertal teratomas of the testis are rare benign tumors. Knowledge of the epidemiology of testicular teratomas and associated alpha-fetoprotein (AFP) levels could assist in planning treatment for prepubertal patients suspected of having teratoma of the testis. MATERIALS AND METHODS: We evaluated data on testicular teratoma from the Prepubertal Testis Tumor Registry of the Section on Urology of the American Academy of Pediatrics. RESULTS: Median patient age at presentation was 13 months. Teratomas occurred equally in the right and left testes. Most patients presented with a scrotal mass. Preoperative AFP levels were elevated in 20 of the 34 patients and postoperative levels were elevated in 9 of 10. Most patients were treated with radical orchiectomy and no metastatic disease was reported. CONCLUSIONS: Data in the registry confirm the benign nature of this tumor. Normal AFP levels should not be expected in infants with teratoma.

Child↗
PubMed1997

Vascular lesions in Chinese patients with transient ischemic attacks.

We studied 96 Chinese patients with TIAs using transcranial Doppler and duplex ultrasonography. We found intracranial stenosis or occlusion in 51% of cases and extracranial disease in 19% of cases. The most common intracranial lesion was stenosis of the terminal internal carotid artery or proximal middle cerebral artery, whereas the most common extracranial lesion was stenosis of the carotid bifurcation.

Adolescent↗
PubMed1997

The dopamine transporter gene and Parkinson's disease in a Chinese population.

We studied a variable number tandem repeat polymorphism within the dopamine transporter gene (DAT) for an association with Parkinson's disease in a Chinese population. Five alleles were detected, consisting of 6, 8, 9, 10, and 11 copies of the 40 base pair repeat sequence. The 10-copy allele was most common, accounting for 90% of alleles. There were no significant differences between the patients and the control subjects in the distribution frequencies of the alleles or genotypes. Therefore, this polymorphism is not associated with Parkinson's disease in Chinese populations.

Aged↗
PubMed1997

Dichotomizing stroke outcomes based on self-reported dependency.

Patients participating in a clinical trial of stroke therapy were assessed 3 months after randomization using the Barthel Index, the Modified Rankin Scale, questions on activities of daily living, and extent of recovery. Those who needed help in performing the activities of daily living and had not recovered completely were classified as dependent. Self-reported dependency had a sensitivity of 94% and specificity of 80% against the Barthel Index dichotomized at 16 or below, or a sensitivity of 85% and specificity of 87% against the Modified Rankin Scale dichotomized at 2 or above.

Activities of Daily Living↗