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Biomedical subjects

T R Kelly

Publications and source records attributed to T R Kelly.

At least 19 recordsLinked to original sources
PubMed1992

Female sex steroid induced epithelial changes in the gallbladder of the ovariectomized Syrian hamster.

Ovariectomized Syrian hamsters treated by female sex steroids during a 1-month period show gallbladder surface epithelial changes in the fundic area consistent with apical bulging and decapitations of the epithelial cells. These events were detected in the infundibulum and the fundic or body regions of estrogen- and estrogen+progesterone-treated hamsters. In control hamsters, these events were restricted to the region in the vicinity of the bile duct. Following steroid treatment, intraluminal deposits detected resembled Ca-bilirubinate deposits described in previous studies while decapitations are similar to endometrial epithelium changes associated with hormonal physiological changes or treatments. Moreover some small electron-dense deposits are comparable to those found in human cholesterol gallstones. This report indicates that, besides an alteration in bile composition, cell fragments originating from the surface epithelium of the bile duct and/or of the gallbladder mucosal epithelium could participate in gallstone nucleation.

Animals↗
PubMed1991

Primary hyperparathyroidism during pregnancy.

Historically, primary hyperparathyroidism during pregnancy was associated with significant risk of maternal morbidity and fetal death. Maternal hypercalcemia results in fetal hypercalcemia, leading to suppression of fetal parathyroid gland function. Neonatal hypocalcemia with tetany is a common occurrence after birth when maternal calcium flow is interrupted. From 1930 to 1990, 109 cases of women with primary hyperparathyroidism associated with pregnancy have been reported, 39 of whom were treated surgically before delivery. Although fetal mortality rates for medically treated women have improved, fetal morbidity continues to remain higher than in women who undergo surgical treatment of parathyroid disease during pregnancy. Of 850 patients treated surgically for primary hyperparathyroidism since 1960, 12 were pregnant. Four of the patients were treated medically during pregnancy and underwent surgery after delivery; all four infants had neonatal hypocalcemia and tetany. The remaining eight patients were treated surgically during pregnancy: six in the second trimester and two (one with associated pancreatitis and one with hypercalcemic crisis) during the first trimester. There was no fetal or maternal morbidity or death in the surgical group. Parathyroid adenomas were present in 10 of the patients, hyperplasia in one, and parathyroid carcinoma in one. The management of maternal primary hyperparathyroidism diagnosed during pregnancy should be based on the patient's symptoms and severity of disease. Hyperparathyroidism characterized by progressive symptoms should be treated surgically, preferably during the second trimester. Symptom-free patients and those with mild hypercalcemia diagnosed in the third trimester may be managed medically, postponing operation until after delivery.

Female↗
PubMed1990

Osteitis fibrosa cystica (brown tumor) of the spine with cord compression: report of a case with needle aspiration biopsy findings.

A case of osteitis fibrosa cystica or brown tumor of bone in a patient presenting with acute spinal cord compression that was suggested initially by needle aspiration biopsy of the spine is described. Following the aspiration biopsy, excision of vertebral lesions, cord decompression, and spinal fusion were successfully performed. A parathyroid adenoma was subsequently identified and also resected. Along with the diagnosis of malignancy, the presence of hyperparathyroidism with osteitis fibrosa cystica should be considered in a patient presenting with lytic lesions in bone, especially if they are associated with hypercalcemia. Serum parathormone level determination is usually diagnostic of hyperparathyroidism, but this test has a 7-10-day turnaround time. Preoperative needle aspiration biopsy is a safe and rapid method of diagnosing osteitis fibrosa cystica and may be of critical importance in a patient with acute and progressive symptoms such as cord compression.

Adenoma↗
PubMed1989

Human gallbladder mucosa ultrastructure: evidence of intraepithelial nerve structures.

The zinc iodide-osmium tetroxide (ZIO) fixative-staining method was used along with topographical ultrastructure to investigate cholecystectomized human gallbladders under light and electron microscopic techniques. This method delineated neuronal structures which may be involved in controlling the functions of the gallbladder epithelium. Three epithelial cell types were described in the surface epithelium: 1) Columnar clear cells; 2) dark, tuft osmiophilic cells; and 3) basal clear cells with electron-dense granules and showing intense ZIOphilic staining properties. While mucous granules were delineated in the first two cell types, the columnar epithelial clear cells are of uncertain function(s) and content but are probably absorptive cells. The small basal clear cells displaying intense ZIOphilia are associated with intraepithelial nerve endings. These nerve structures may have a sensory and/or motor function(s); they were detected throughout the gallbladder epithelial lining and mucosa.

Epithelial Cells↗
PubMed1989

Intercalating agents with covalent bond forming capability. A novel type of potential anticancer agents. 2. Derivatives of chrysophanol and emodin.

Fifty-one new C-methyl-modified derivatives of the anthraquinones chrysophanol and emodin or their various methyl ethers were prepared for structure-activity relationship studies of anticancer activity against mouse leukemia L1210 and human leukemia HL-60 cells. Representative compounds were spectrophotometrically studied for their capacity to interact with natural and denatured DNA. In general, those anthraquinones bearing an amino function interact with DNA. 1,8-Dimethoxyanthraquinones are incapable of intercalating into DNA. 1- or 8-Monohydroxymono-methoxyanthraquinones, however, interact with DNA to some extent. No straightforward correlation is apparent between the DNA-affinity data of the compounds studied spectrophotometrically and their cytotoxic effects. Cytotoxic potencies of these compounds on cell growth inhibition during a 72-h period are inversely correlated to their potencies when inhibiting [3H]TdR incorporation into DNA during the initial 30 min of exposure. Surprisingly, some compounds that showed more cytotoxicity did not inhibit initial TdR incorporation (0-30 min), while some others that strongly inhibited TdR incorporation initially did not exhibit cytotoxicity in 72 h. The results suggest that the cytotoxicity produced by these compounds is time dependent and is not a direct result of initial inhibition of DNA replication.

Animals↗
PubMed1989

Pseudogout as a clue and complication in primary hyperparathyroidism.

The pseudogout syndrome has been suggested to be a diagnostic clue of hyperparathyroidism or a complication after parathyroidectomy that abruptly relieves hypercalcemia. In this report of 20 patients who had pseudogout, eight had intermittent attacks of arthritis associated with chondrocalcinosis that led through the pseudogout syndrome to a confirmed diagnosis of primary hyperparathyroidism. In an additional 12 patients, the diagnosis of pseudogout was made in patients who suffered from acute arthritis after parathyroidectomy that relieved the primary hyperparathyroidism. The postoperative attacks were seen most commonly on or after the second day after surgery and were associated with the lowest point in serum calcium levels. Pseudogout occurred in one or more joints, often involving the knee. The diagnosis was proved by aspiration of joint synovial fluid in many of the patients and identification of calcium pyrophosphate dihydrate crystals. To estimate the incidence of pseudogout in the population of patients with primary hyperparathyroidism, these 20 patients were distinguished in 531 patients undergoing parathyroidectomy, for a 3.8% incidence of the pseudogout feature. No other markers of higher risk for this complication were apparent, including age, sex, biochemistry, or prior history. This collected experience suggests that (1) pseudogout is a biochemical entity associated with primary hyperparathyroidism and may offer a useful clue to the recognition of the disease in screening; (2) acute arthritis after parathyroidectomy is most likely pseudogout, and this complication occurs more frequently than has been recognized previously; (3) patients with hypercalcemia have a high incidence of calcium pyrophosphate dihydrate crystal deposition in articular cartilage (chondrocalcinosis); and (4) relative hypocalcemia after parathyroidectomy is a stimulus for crystal shedding into synovial fluid, which may precipitate acute attacks of pseudogout.

Adult↗
PubMed1989

Management of gallstone pancreatitis during pregnancy and the postpartum period.

In a 22 year study, 21 women had acute pancreatitis develop during pregnancy (11 women) or within six weeks post partum (ten women). Gallstones were the cause of the pancreatitis in all. Operation during the acute attack of pancreatitis was required in only two. Acute pancreatitis subsided in the remaining 19 patients; they were operated upon during the second trimester or the early postpartum period. During pregnancy, surgical treatment for gallstone pancreatitis should consist of cholecystectomy and exploration of the common bile duct without operative cholangiography. During the postpartum period, operative cholangiography is used to determine whether or not exploration of the common bile duct is necessary. Acute pancreatitis associated with pregnancy is "gallstone" pancreatitis; there is no evidence that pregnancy is a specific etiologic factor in pancreatitis. As opposed to nonoperative treatment of symptomatic gallstone pancreatitis in pregnancy, which is accompanied by maternal morbidity or fetal mortality, surgical treatment during the optimal time of the second trimester or early postpartum period was associated with no maternal morbidity or fetal mortality and no recurrent pancreatitis.

Acute Disease↗
PubMed1988

Thoracic outlet syndrome.

The diagnosis and treatment of thoracic outlet syndrome based on a personal experience with 473 patients resulted in relief of symptoms in over 90 percent of patients treated operatively. The diagnosis centers on a thorough history and the exclusion of other causes of arm and shoulder pain, utilizing a strict flow pattern of differential diagnosis. Angiography and electromyography are of limited value and should only be performed in selected cases. Operation should be reserved for the thoroughly evaluated patient who continues to have pain despite adequate conservative therapy. Transaxillary removal of the first rib, fibromuscular bands, and cervical rib, when present, is the operation of choice.

Adult↗
PubMed1988

Gallstone pancreatitis: a prospective randomized trial of the timing of surgery.

The correct timing of surgery in cases of gallstone pancreatitis is debatable. To delineate more clearly the influence of the timing of surgery in the treatment of the disease, a prospective randomized clinical study of early surgery (less than 48 hours after admission) and delayed surgery (more than 48 hours after admission) was conducted in 165 patients. Ranson's prognostic signs of severity of disease were used to classify the patients into two risk groups: mild pancreatitis (three or fewer positive signs) and severe pancreatitis (more than three positive signs). In patients with three or fewer positive Ranson's signs, the time of surgery appeared to have little effect on the outcome, whereas in patients with more than three positive signs, early surgery resulted in a significant increase in rates of morbidity and mortality. Controlled randomization showed that in patients with gallstone pancreatitis, edematous or hemorrhagic necrotizing pancreatitis can develop, with or without impacted stones, early or late in the progression of the disease, during early or delayed surgery. These findings suggest that (1) although a gallstone initiates a bout of pancreatitis, it does not cause the progression of the disease; (2) the fate of the progression of pancreatitis is decided early by the amount of digestive enzymes being activated; (3) early removal of an impacted stone does not ameliorate the progression of pancreatitis; and (4) surgery should be performed during the initial hospital admission after the pancreatitis has subsided.

Adult↗
PubMed1988

Primary hyperparathyroidism.

An experience with 316 patients operated upon with a presumptive diagnosis of primary hyperparathyroidism is presented. Of the 316 patients, 291 (92.1 per cent) were cured after the initial cervical exploration without using any technique for preoperative localization of parathyroid tissue. Persistent and recurrent hyperparathyroidism occurred in 4.0 and 3.7 per cent, respectively. The success rate for secondary operations (cervical and mediastinal) was 82 per cent. Permanent unilateral vocal cord paralysis occurred in three patients and persistent symptomatic hypercalcemia occurred in another two. Twelve (4 per cent) of the patients had hyperparathyroid crisis and five (1.8 per cent) had carcinoma of the parathyroid gland. The mean follow-up time was six years. Removal of a single macroscopically enlarged gland, if the other glands are normal, is all that needs to be done in most instances. Subtotal parathyroidectomy should be preserved for those patients who have diffuse glandular hyperplasia.

Adult↗
PubMed1985

Synthesis and dopamine autoreceptor activity of a 5-(methylmercapto)methyl-substituted derivative of (+/-)-3-PPP (3-(3-hydroxyphenyl)-1-n-propylpiperidine).

In an attempt to enhance the potency of the dopamine autoreceptor agonist 3-PPP, racemic cis-3-(3-hydroxyphenyl)-5-[(methylmercapto)methyl]-N-n-propylpiperidine has been prepared in a stereoselective synthesis. NMR studies of 3 show a diequatorial conformation for the 3- and 5-substituents, which gives compound 3 an intriguing overlap with the ergoline derivative pergolide. Pharmacological testing revealed that 3, which is a 5-(methylmercapto)methyl derivative of racemic 3-PPP does not show the anticipated potency increase as a dopamine autoreceptor agonist. In vitro (inhibition of tyrosine hydroxylation) 3 and 1 have similar potency, and the in vivo potency (inhibition of GBL accelerated dopamine synthesis) of 3 is inferior to that of 1.

4-Butyrolactone↗
PubMed1984

Gallstone pancreatitis. Local predisposing factors.

Local predisposing anatomic and stone factors were studied in 150 patients with gallstones in order to analyze why some patients with cholelithiasis acquire gallstone pancreatitis and others do not. Number and size of gallstones in the gallbladder and common bile duct, presence of pancreatic duct reflux, diameter of the cystic duct, and size of the duodenal orifice and ampulla of Vater were all studied in 75 patients with gallstone pancreatitis (Group I), 75 patients with cholelithiasis (Group II), and by dissections in 50 autopsy specimens. Stones 5 mm or less in diameter were present in 51 (70%) of Group I gallbladders as compared to 30 (41%) of Group II patients (p less than 0.001). Impacted common bile duct stones were found in 21 (29%) of the Group I patients and only four (5%) of the patients in Group II (p less than 0.001). The mean size of the stones that impacted at the ampulla of Vater in the Group I patients were 3.10 mm, whereas in the Group II patients the mean size of the stones was 7.50 mm (p less than 0.001). The Group I cystic ducts were larger (3.80 mm) than the ducts in the Group II patients (2.36 mm) (p less than 0.001). On operative cholangiography, 50 (67%) showed reflux of contrast material into the pancreatic duct compared to only 14 (18%) in the control Group II (p less than 0.001). These data indicate that small gallbladder stones, enlarged cystic ducts, properly sized impacted stones, and a functioning common channel are predisposing local etiologic factors in the development of gallstone pancreatitis.

Adult↗
PubMed1983

Pancreatic somatostatinoma.

The presence of cholelithiasis, steatorrhea, diabetes mellitus, and a pancreatic tumor initiated a diagnostic workup for somatostatinoma in a 43 year old black woman. The hypothesis of somatostatinoma was supported by a high level of plasma-like immunoreactivity and secretory granules resembling D-cell granules by electron microscopy. The patient has been euglycemic and well since complete resection of the tumor. This is the seventh reported case of somatostatinoma and the second to be benign.

Adenoma, Islet Cell↗
PubMed1983

A new inflatable T tube for completion cholangiography.

A new inflatable T tube has been designed and used in the performance of completion cholangiography following exploration of the common bile duct. The T tube has proved to be useful in avoiding the time delays and frustrations associated with suturing, removal and resuturing of T tubes during identification and removal of common bile duct stones. Furthermore, after clearance of the common bile duct of stones, the inflatable T tube may be left in the common bile duct for the purpose of drainage and postoperative cholangiograms. Finally, the T tube is of sufficient size (14F) to allow any possible postoperative roentgenographic extraction procedures to be done.

Cholangiography↗
PubMed1982

Carcinoma of the gallbladder.

One hundred ten cases of primary carcinoma of the gallbladder occurring over a 25 year period were reviewed. Except for anemia and weight loss, the signs, symptoms, laboratory, and roentgenographic studies were of little value in the preoperative diagnosis of the disease. Most patients presented with advanced disease with extension to the liver and metastases to the common bile duct nodes. In nine patients the tumor was not clinically apparent at the time of cholecystectomy, the diagnosis being made postoperatively by the pathologist. By the end of the first postoperative year, 85 percent of the patients had died. Only two patients survived more than 5 years, for an overall 5 year survival rate of 2 percent. Usually the only survivors are patients with lesions resected early that were not apparent to the operating surgeon and without deep invasion of the gallbladder wall. The best hope for reducing the mortality from this disease lies in earlier cholecystectomy in patients with benign gallbladder disease and in extending the limits of resection when small, and presumably early, lesions are encountered.

Aged↗