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Biomedical subjects

R Kay

Publications and source records attributed to R Kay.

At least 163 records · Page 9Linked to original sources
PubMed1990

The placebo response of subfertile couples to attending a tertiary referral centre.

The objective of this study was to determine whether there was a placebo response to clinic attendance in couples with prolonged (greater than 4 years) subfertility. From 4 to 18 years of subfertility we observed a treatment independent cumulative conception rate of 22%, which was independent of the length of subfertility. Twenty-seven women conceived after 1 to 4 years' subfertility, and 30 conceived after greater than 4 years' subfertility. The fecundity of the latter group was significantly greater than that of women with 1 to 4 years' subfertility, being similar to "normal" subjects who had stopped contraception. This study demonstrates that a subgroup of apparently normal women with greater than 4 years' subfertility responded positively to clinic attendance independent of any investigation(s) or therapy.

Adult↗
PubMed1990

Influence of nephrectomy on the growth of a murine Wilms tumor: a study using parabiotic rats.

It has been reported that unilateral nephrectomy causes acceleration of the growth of a Wistar/Furth rat Wilms tumor. We studied this phenomenon in parabiotic rats by measuring tumor growth after either sham nephrectomy, or excision of 1, 2 or 3 kidneys. We observed no stimulation of tumor growth in the experimental groups. Renal function was significantly decreased after removal of 2 or 3 kidneys. Serum creatinine levels were significantly different between right and left members of parabiotic pairs in these 2 groups. The effect of unilateral and bilateral nephrectomy on tumor growth in single rats also was examined. In these rats progressive increases in tumor growth were observed after unilateral and bilateral nephrectomy. Our inability to demonstrate a tumor-stimulating factor in the parabiotic model may be due partly to incomplete sharing of humoral factors between parabionts. Serum transfer studies in vitro may prove more fruitful in demonstrating such a factor.

Animals↗
PubMed1990

Clindamycin/primaquine therapy and secondary prophylaxis against Pneumocystis carinii pneumonia in patients with AIDS.

We found a program of intravenous and subsequent oral clindamycin, combined with oral primaquine, to be effective for Pneumocystis carinii pneumonia in nine patients with AIDS. The pneumonias were either primary or recurrent and sometimes severe, with cavity formation and/or pneumothorax. Maintenance therapy at lowered dose by mouth was effective in preventing recurrence in seven patients. One patient died of other opportunistic infections on day 24, and therapy was discontinued in another on day 11 because of skin rash. We conclude that clindamycin/primaquine is effective for therapy of P carinii pneumonia in patients with AIDS, as well as for long-term secondary prophylaxis at lowered dosage.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Ureterocalicostomy for reconstruction of complicated pelviureteric junction obstruction.

Seven patients with complicated pelviureteric junction (PUJ) obstruction underwent reconstruction by means of ureterocalicostomy; 5 had undergone previous surgery and 2 had primary obstruction. Radiographic studies showed resolution or improvement of the obstruction in 5 patients, who remain asymptomatic 15 to 47 months (mean 30) post-operatively. Obstruction persists in 1 patient and the other developed renal artery thrombosis with subsequent loss of the kidney. It was concluded that ureterocalicostomy can provide long-term, successful reconstruction of a complicated PUJ obstruction, but significant complications may be associated with the procedure.

Adult↗
PubMed1990

A case control study of some hematological and biochemical variables in acute stroke and their prognostic value.

Hematocrit, total white cell and platelet counts, plasma urea and creatinine concentrations were estimated in 291 patients (mean age 70 +/- 12 years) admitted consecutively over a 6-month period to a district general hospital with acute stroke. Urinary albumin/creatinine ratio was also determined in a subgroup of patients during a follow-up visit 3 months after ictus. Results were compared with those from age- and sex-matched community controls. Total white cell count was elevated in all types of stroke compared with values from control subjects. Platelet count, plasma urea and creatinine concentrations were higher and the plasma albumin/globulin ratio was lower among patients with ischemic stroke. Elevated total white cell count, urea and creatinine, which were of prognostic significance, were found to be associated with the severity of stroke as indicated by the Glasgow coma score, and did not have any independent prognostic value. Elevated hematocrit was not shown to be a risk factor and did not have any prognostic significance. A low plasma albumin/globulin ratio, an index of plasma viscosity, was a possible risk factor for ischemic strokes. Urinary albumin/creatinine ratios in the highest quintile increased the risk of stroke 13-fold.

Aged↗
PubMed1990

Acute and long-term changes in serum lipids after acute stroke.

We studied serum lipid profiles in 171 patients less than or equal to 48 hours after the onset of acute stroke and 3 months later. The 83 patients suffering cerebral infarction had significantly higher serum concentrations of total cholesterol, low density lipoprotein-cholesterol, and apolipoprotein B and significantly lower serum concentrations of triglycerides and lipoprotein (a) less than or equal to 48 hours after ictus than 3 months later. The lipid profiles of the 53 patients suffering lacunar infarction were similar on both occasions, the only significant differences being higher total cholesterol and low density lipoprotein-cholesterol concentrations less than or equal to 48 hours after ictus. No significant changes were observed among the 35 patients suffering cerebral hemorrhage apart from a significantly higher concentration of high density lipoprotein3-cholesterol less than or equal to 48 hours after ictus. Our study, with many patients classified according to stroke subtype, gives results different from those of previous studies with much fewer patients. We conclude that in studies of serum lipid and lipoprotein concentrations as risk factors for cerebral infarction, comparing values obtained less than or equal to 48 hours after admission with control values may incorrectly identify certain lipid fractions as risk factors.

Aged↗
PubMed1990

Response to control of hyperthyroidism in patients with myasthenia gravis and thyrotoxicosis.

Three patients presenting with both myasthenia gravis and thyrotoxicosis were treated initially with pyridostigmine and carbimazole respectively. Control of the hyperthyroidism was achieved in all cases but was accompanied by deterioration of the myasthenic symptoms in two and persistence in one. Thymectomy was performed with subsequent improvement in all three patients. Histology showed thymic hyperplasia in each case. The relationship of myasthenia gravis, thyrotoxicosis and the thymus is discussed.

Adult↗
PubMed1989

Sympathetic nervous system during converting enzyme inhibition.

Angiotensin II can stimulate the sympathetic system and inhibit vagal (parasympathetic) outflow under experimental circumstances in animals. Blockade of angiotensin II formation by angiotensin-converting enzyme (ACE) inhibitors might therefore be expected to result in a reduction of sympathetic activity and enhanced parasympathetic activity. Whether this is so in normotensive or hypertensive humans and in human cardiac failure is unclear, since available techniques for recording activity of the sympathetic and parasympathetic systems are imperfect. Nevertheless, most evidence that comes from measurements of venous norepinephrine suggests that the ACE inhibitors have little or no effect on sympathetic activity in normotension and hypertension, although the activated sympathetic system in severe cardiac failure is probably suppressed. It appears that the ACE inhibitors have a parasympathomimetic action that may contribute to the hemodynamic effects of these drugs. Additional information using direct recordings of sympathetic traffic or measurements of norepinephrine "spillover" is needed to clarify the effects of ACE inhibitors on the sympathetic system.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1989

Electrocardiographic pseudo-myocardial infarct pattern in malignant cardiac disease.

A patient with disseminated diffuse histiocytic lymphoma had persistent electrocardiographic (ECG) signs of acute myocardial infarction without clinical, enzymatic, or hemodynamic evidence of myocardial necrosis. The ECG findings were felt to be secondary to myocardial tumor invasion by antemortem noninvasive testing. This was confirmed by postmortem examination. Based on this report and a literature review, the particular ECG findings noted (lateral leads) are felt to be highly predictive of direct tumor invasion in this setting.

Adult↗
PubMed1989

The polymorphonuclear leucocyte count in childhood haemolytic uraemic syndrome.

Review of data from 79 children with the haemolytic uraemic syndrome (HUS) showed that the polymorphonuclear leucocyte (PMN) count at presentation in childhood HUS predicts outcome. Logistic regression analysis of several features at presentation identified only the PMN count and the presence of a diarrhoeal prodrome as having a significant effect on the outcome (P less than 0.01 and P less than 0.001 respectively). The geometric mean PMN count was significantly raised in 70 children who had typical HUS following a diarrhoeal prodrome (D+ cases) compared with that of 9 children who had atypical disease without diarrhoea (D- cases) (t-test on log-transformed data, P less than 0.005). Fifty-seven children with D+ HUS who recovered completely had a significantly lower geometric mean PMN count than D+ cases with a bad outcome (P less than 0.001). Four of these patients, who died in the acute stage of the disease, had a significantly higher mean count than the rest of the D+ patients (P less than 0.001). Multiple regression analysis demonstrated that the PMN count in D+ cases was not significantly influenced by haemoglobin concentration, platelet count, length of the prodrome, or the administration of antibiotics in the prodromal period. A high PMN count at presentation in D+ HUS indicates a poor prognosis. The data emphasise the heterogeneity of HUS and suggest that PMN participate in the pathogenesis of the disorder in typical D+ cases but not in atypical D- cases.

Child↗
PubMed1989

Is routine examination of the male partner of any prognostic value in the routine assessment of couples who complain of involuntary infertility?

The purpose of this study was to determine whether routine examination of the male partner is of value in assessing couples complaining of involuntary infertility. The relationship between male age, a previous paternity, male physical characteristics, and fertility outcome was examined. Life table analysis was performed after accounting for known female factors. Five hundred forty-four couples were recruited to the study. All conceptions were independent of treatment to either partner in which the female partner was found to be "normal" on investigation. Although male age and several physical characteristics were related to fertility outcome when all couples were examined, this was, by virtue of these variables, being related to female age and the length of involuntary infertility before investigation. When only those couples were examined in which the female partner was normal on investigation (n = 250), past paternity (x1(2) = 4.21, P = 0.040, RR = 1.81) was the only variable that retained a significant relationship to fertility outcome. It was concluded that routine examination of the male partner is of no prognostic value for couples complaining of involuntary infertility.

Adult↗
PubMed1989

Endoscopic correction of vesicoureteral reflux in the renal transplant candidate.

High grade vesicoureteral reflux is a well recognized risk factor for post-transplant infection that has been managed commonly with native nephrectomy. Recent reports have described the successful correction of vesicoureteral reflux by the subtrigonal injection of polytetrafluoroethylene (Teflon) paste. We treated 5 transplant candidates with vesicoureteral reflux with this technique. Ureteral reflux was corrected in 80 per cent of the treated ureters with 6 months of followup. Of the patients 3 have undergone successful renal transplantation without complication. This procedure is well suited to the end stage renal disease patient preparing for renal transplantation, since it avoids an open operation on the pre-transplant bladder and preserves the native kidney, thus, facilitating pretransplant dialysis.

Endoscopy↗
PubMed1989

Experience with extra-adrenal pheochromocytoma.

From 1955 to 1985, 20 patients presented with a total of 22 extra-adrenal pheochromocytomas (2 had multiple tumors and 2 had a malignant extra-adrenal pheochromocytoma). There were 13 male and 7 female patients, and the highest incidence was in the second decade. Although most patients presented with symptoms typical of pheochromocytoma, several presented with unusual features related to the anatomical location, such as mediastinal mass (chest tumor), upper airway obstruction (neck tumor) or gross hematuria (bladder tumor). In 5 of 6 patients in whom plasma catecholamine levels were fractionated epinephrine levels were elevated. The most common tumor location was the superior para-aortic region (13 patients). In 16 patients the location of tumors was established before treatment. Computerized tomography (9 patients) was the most accurate imaging study for tumor localization. A total of 19 patients underwent complete excision of all pheochromocytomas. Postoperative followup information (median interval 120 months) was available for 15 of these patients. Three patients had recurrent pheochromocytoma that was treated successfully. One patient had essential hypertension. No patient had metastatic disease. The low incidence of malignancy suggests a benign course for extra-adrenal pheochromocytoma and represents a departure from the previously reported higher incidence of malignancy with extra-adrenal pheochromocytoma.

Adolescent↗
PubMed1989

Pelvic neuroblastoma.

Neuroblastoma usually presents as an upper abdominal mass arising from the adrenal gland. Recent experience with neuroblastoma of the spermatic cord, bladder and pelvis demonstrates the propensity of this tumor to arise in unusual areas. The need for unusual and unexpected masses in children to be evaluated thoroughly for neuroblastoma and for therapy to be individualized based on histological criteria, patient age and location of the tumor is demonstrated.

Adolescent↗
PubMed1989

Female age, the length of involuntary infertility prior to investigation and fertility outcome.

The objectives of this study were two-fold: firstly to determine whether female age exerts an influence on the fertility outcome of couples attending an infertility clinic, independent of demographic and clinical details; and secondly to examine the relationship between the length of involuntary infertility prior to investigation and the subsequent chance of conception. Seven-hundred-and-thirty-one subjects whose partner did not have azoospermia were recruited to the study. Female age ranged from 20 to 46 (mean = 31.1). The range of involuntary infertility prior to investigation was 12-216 (mean = 62) months. One-hundred-and-twenty-four women conceived. The following variables achieved the 5% level of significance when a stepwise analysis was performed on all cases; the concentration of spermatozoa exhibiting slow or sluggish linear or non-linear motility (chi 2(1) = 17.57, P less than 0.0001, RR = 1.67 per 50 x 10(6)), female age (chi 2(1) = 12.44, P = 0.0004, RR = 0.92 per annum), tubal status (chi 2(1) = 12.22, P = 0.0005, RR = 2.15), length of infertility before investigation (chi 2(1) = 11.22, P = 0.0008, RR = 0.87 per annum) and past paternity (chi 2(1) = 8.43, P = 0.0037, RR = 1.81). Female age was found to be positively correlated with the incidence and severity of ovulatory dysfunction, tubal occlusive disease, pelvic adhesions and endometriosis. Where the female partner was 'normal' on investigation, all conceptions were independent of treatment to either partner.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1989

Hospital readmissions: a re-evaluation of criteria.

A prospective study surveyed patients discharged from the Cardiology, Cardiovascular Surgery, and Gastroenterology services of the Cleveland Clinic Hospital during April and September 1987. The total number of hospital discharges during the study period was 5,349; the study population discharged during this period included 1,640 patients (30.7% of all hospital discharges). In the study population, 149 patients were readmitted (9.1%). The percentage of readmissions was similar for both months and similar to that reported in the literature. However, when readmissions were categorized into four subsets, significant differences were found. The four categories were: 1) complication of a previous admission (16.8% of readmissions), 2) recurrence of the disease process (11.4% of readmissions), 3) planned treatment (53% of readmissions), and 4) unrelated new diagnosis (16.1% of readmissions). The authors conclude that reviewing readmission rates without using these subdivisions can be misleading, and the results are inappropriate for evaluating the quality of medical care given in an acute care hospital. They recommend that these four subdivisions be included in future studies of readmission rates in acute care hospitals.

Delivery of Health Care↗
PubMed1989

Adrenocortical carcinoma in children.

Adrenocortical carcinoma in childhood is a rare, potentially fatal disease. Despite its often-dramatic presentation, there typically has been a distressingly long delay between the onset of symptoms and the time of diagnosis, which undoubtedly has contributed to the poor prognosis in these children by permitting the disease to reach an advanced stage before treatment is started. It is therefore imperative that the physician recognize the endocrine manifestations of these tumors. Although biochemical evaluation is helpful, it often cannot differentiate benign from malignant neoplasms and therefore should not unduly delay intervention. Aggressive surgical resection continues to be the mainstay of treatment as the role of adjuvant therapy continues to evolve. It is hoped that increased familiarity with this unusual tumor will result in earlier detection, prompt intervention, and improved survival for children with adrenocortical carcinoma.

Adrenal Cortex Neoplasms↗