Biomedical subjects

T A Kelly

Publications and source records attributed to T A Kelly.

34 records · Page 2Linked to original sources

PubMed1992

Patient and therapist values in psychotherapy: perceived changes, assimilation, similarity, and outcome.

This study investigated (a) the nature and extent of perceived changes in patients' values (reported retrospectively), (b) the relationship between patients' assimilation of their therapists' values and outcome, and (c) the relationship between the similarity of patient-therapist values (posttherapy) and outcome. A great deal of perceived values change was reported by the patients, but (contrary to expectations) not primarily in values concerning interpersonal morality. Values assimilation demonstrated a fairly substantial positive correlation with therapist's outcome assessment, but not with other measures of outcome, suggesting that the phenomenon may be related more to the therapist's rating bias than to genuine improvement. Patient-therapist dyads whose values were moderately similar showed the most improvement, indicating that an intermediate range of values similarity may function as a predictor of positive outcome. Secondary findings (including the seemingly unique role of religious values) and suggestions for future research directions are discussed.

Adult↗

PubMed1991

Outcomes of direct coronary angioplasty for acute myocardial infarction in candidates and non-candidates for thrombolytic therapy.

Coronary angioplasty without prior thrombolytic therapy was performed in 383 patients with acute myocardial infarction (AMI). Patients were divided into 2 groups depending on whether they were candidates or non-candidates for thrombolytic therapy. Patients were not considered thrombolytic candidates if they: (1) presented in cardiogenic shock, (2) were greater than or equal to 75 years of age, (3) had had coronary artery bypass surgery or, (4) had a reperfusion time of greater than 6 hours. Thrombolytic and nonthrombolytic candidates had similar rates of reperfusion (92 vs 88%), nonfatal reinfarction (6.0 vs 5.9%) and recurrent myocardial ischemia (1.8 vs 0%). Thrombolytic candidates had a lower mortality rate (3.9 vs 24%, p less than 0.0001) and a lower incidence of bleeding (4.6 vs 10.9%, p less than 0.05). Improvement in left ventricular ejection fraction at follow-up angiography was 4.4% in thrombolytic and 10.5% in nonthrombolytic candidates (p less than 0.002). Ejection fraction improved most in patients with anterior wall AMI (7.7% in thrombolytic candidates, 15.1% in nonthrombolytic candidates) and in patients with reperfusion times greater than 6 hours (14.2%). These outcomes suggest that direct coronary angioplasty is a viable alternative method of reperfusion in patients with AMI who are candidates for thrombolytic therapy. Nonthrombolytic candidates are a high-risk group of patients. Direct coronary angioplasty may be beneficial in certain subgroups, especially for patients in cardiogenic shock and for patients presenting greater than 6 hours after the onset of chest pain with evidence of ongoing ischemia.

Aged↗

PubMed1991

Aluminum phthalocyanine-streptavidin: new, sensitive fluorescent tracer for immunoassay.

A new fluorescent reagent based on aluminum phthalocyanine has been developed for general application to immunoassay. This highly sensitive fluorophore, Ultralite 680, may be covalently attached to a variety of biological entities for use as a tracer. We report the use of an Ultralite 680-streptavidin-digoxin conjugate as a tracer in a direct, competitive, heterogeneous, fluorescent immunoassay of digoxin. The assay is performed manually with 50 microL of serum and no sample pre-treatment. Primary anti-digoxin antibody is incubated with a serum sample containing digoxin and Ultralite 680-streptavidin-digoxin. Bound and free tracer are separated, and the bound fluorescence is released and quantified with a commercially available spectrofluorometer. Assay precision was good (CV = 7.05% at a digoxin concentration of 2.00 micrograms/L) and results by our method correlated well with those by a conventional RIA (r = 0.9650, n = 24).

Aluminum↗

PubMed1988

Comparison of outcome of asymptomatic to symptomatic patients older than 20 years of age with valvular aortic stenosis.

A 2-part prospective study was performed to evaluate the clinical outcome of patients with hemodynamically confirmed asymptomatic valvular aortic stenosis (AS). During phase 1, linear regression analysis showed continuous wave Doppler to be highly accurate in predicting catheterization measured peak systolic aortic valve pressure gradients in 101 consecutive patients aged 36 to 83 years (mean 65 +/- 8) with symptomatic AS. During phase 2, 90 additional patients (51 asymptomatic and 39 symptomatic) with Doppler-derived peak systolic aortic valve gradients greater than or equal to 50 mm Hg (range 50 to 132 [mean 68 +/- 19]) were followed for 1 to 45 months. Both groups of patients in phase 2 had similar Doppler gradients and clinical and auscultatory evidence of moderate to severe AS at baseline. Asymptomatic patients were younger (p = 0.01), had higher ejection fractions (p = 0.001) and were less likely to have an electrocardiographic strain pattern (p = 0.01) and left atrial enlargement (p = 0.02). End-diastolic wall thickness, left ventricular cross-sectional myocardial area and estimated left ventricular mass were 18% (p = 0.0001), 20% (p = 0.0008), and 29% (p = 0.002) greater in symptomatic patients. During 17 +/- 9 months of follow-up, 21 asymptomatic patients (41%) became symptomatic. Dyspnea was the most common initial complaint, occurring 2.5 and 4.8 times more often than angina and syncope, respectively. Compared with the 39 symptomatic patients, the 51 asymptomatic patients had a lower cumulative life table incidence of death from any cause (p = 0.002), and from cardiac causes (p = 0.0001) including sudden death (p = 0.013).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1988

Second infections in AIDS. A new facet to the immune mechanism.

The lack of secondary infections or the delay in their appearance in immunodeficient individuals (specifically AIDS patients) previously immunized prior to their immune deficit points to an as yet overlooked mechanism in the immune response. It is proposed that on second exposure to the antigen (Ag) there is a unique Ag presentation that alters the Ag in such a way as to induced a state of tolerance.

Acquired Immunodeficiency Syndrome↗

PubMed1988

The role of the immune system in central nervous system regeneration (theoretical considerations).

The nervous and immune systems are shown to be interrelated. Steroids inhibit both regeneration and the immune response. Crushing injuries enhance regeneration. A synthesis of these apparently unrelated phenomena is formulated into an immune hypothesis of regeneration. Steroids, in suppressing the immune response, decrease lymphokine production and the subsequent stimulation of nerve cell regeneration. Crushing injuries to nerve fibers cause nerve protein to become antigenic, thereby eliciting the production of "non-toxic" antibodies, which paradoxically protect the nerve fibers from immune attack and cause an augmented lymphokine production and subsequent nerve cell regeneration.

Antibody Formation↗

PubMed1987

Cardiac tamponade in systemic lupus erythematosus: an unusual initial manifestation.

I have described a patient in whom cardiac tamponade occurred as the initial clinical manifestation of SLE. Although pericarditis is a common clinical entity in SLE, cardiac tamponade with this disease is rare. If suspected, the diagnosis can be made by the proper selection of tests of serum and pericardial fluid, which should include the search for pericardial LE cells. This report emphasizes the importance of screening for connective tissue disease in patients with pericarditis.

Adult↗

PubMed1987

Hypertrophic cardiomyopathy and myocardial ischemia with normal coronary arteries.

The case reported herein illustrates an unusual form of nonobstructive hypertrophic cardiomyopathy which was associated with Wolff-Parkinson-White syndrome, myocardial ischemia and necrosis despite normal coronary arteries. The patient is unique since the hypertrophied myocardial segment was localized exclusively to the posterolateral free wall. Quantitative thallium-201 scintigraphy demonstrated reversible ischemia that corresponded precisely with this region of posterolateral hypertrophy. While the exact mechanism for ischemia in patients with hypertrophic cardiomyopathy and normal coronary arteries remains controversial, a functional rather than anatomic disturbance of blood flow seems likely.

Adolescent↗

PubMed1986

Atrial pacing for conversion of atrial flutter.

Fifty-seven episodes of atrial flutter in 46 consecutive medically treated patients (aged 60 +/- 17 years) were treated by rapid atrial pacing. Thirty-three patients (72%) had structural heart disease. Most pacing trials were conducted in patients receiving digoxin (88%) and antiarrhythmic drugs (77%). In 51 of 57 trials (89%), patients were successfully converted to normal sinus rhythm. Multivariate analysis revealed that patients who had congestive heart failure and who were older were more likely to be refractory to pacing. Left atrial size did not influence outcome. Confirmation of local atrial capture with a bipolar atrial electrogram and use of multiple atrial pacing sites enhanced the success rate. Eight patients (17%) demonstrated sinus node suppression after atrial pacing; sinus node disease was previously unsuspected in 4 of these patients. These bradyarrhythmias were easily managed because a pacing catheter was already in place. The only significant complication was femoral vein thrombosis in 1 patient. It is concluded that atrial pacing is an effective, safe and convenient method for the elective conversion of atrial flutter in the general population of medically treated patients. This technique is an attractive alternative to transthoracic cardioversion, and may be preferable in many patients.

Adult↗

PubMed1984

Acquired immune deficiency syndrome (AIDS). Hypotheses on the etiology.

AIDS could be caused by a mutant hepatitis B virus or even a prion-like agent. Hepatitis B, as a retro-like virus, might induce cancerous cells, which, like other malignant cells, could produce substances that inhibit macrophages and their activation of T-cells. Hepatitis B, by reverse transcription, might become a provirus in or adjacent to the Ir gene of the major histocompatibility locus (MHC) altering the Ia antigen on macrophages and inhibiting the immune response. A prion could by reverse translation produce a similar effect on the Ir gene or by protein----protein replication create new antigenic proteins which could confuse immune signals from the macrophages to T-cells; create enzymes modifying existing antigenic determinants; and create proteins not recognized as "self" that could initiate a frank, but subtle autoimmune phenomenon. Any one, or an interaction of these events, could create a "negative autoimmunity": the immune system would attack itself.

Acquired Immunodeficiency Syndrome↗

PubMed1984