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Biomedical subjects

T R Kelly

Publications and source records attributed to T R Kelly.

At least 55 records · Page 3Linked to original sources
PubMed1982

Gallstone pancreatitis: the second time around.

Over a 16-year period from 1965 to 1981, 35 patients who had undergone previous operation for gallstone pancreatitis were treated by us because of retained or recurrent common bile duct stones. The recurrence rate of gallstone pancreatitis in this study, after "the first time around," was 92%. The interval between the initial operation and the recurrent attack of gallstone pancreatitis ranged from 1 month to 30 years. The mean interval was 2 years for patients with retained stones and 12 years for patients with recurrent stones. There were stones present in 83% of the common bile ducts, 23% of which were impacted at the ampulla of Vater. Thirty-seven percent of the patients passed stones in the stool measuring up to 8 mm in size. Of the patients who had early operation, 66% had impacted ampullary stones, but only 18% of patients who underwent delayed surgery had such stones. The recurrence of gallstone pancreatitis, "the second time around," was only 2%. The data attest to the facts that (1) the natural history of a retained or recurrent common bile duct stone in a patient previously operated on for gallstone pancreatitis is recurrence of the disease, and (2) absolute stone clearance of the common bile duct the first time around will cure virtually all the patients. Further support for the "migratory theory" of gallstone pancreatitis is substantiated by this study.

Adult↗
PubMed1982

Adrenal adenoma. Isolated testosterone secretion.

A rare case of an adrenal adenoma that produced virilization by an isolated secretion of testosterone without a concomitant increase in 17-ketosteroids is reported. It was erroneously concluded that the patient's hypertestosteronemia was due to an ovarian disorder because the urinary 17-ketosteroids were normal. It then was speculated that the adenoma's enzyme system was so efficient it was capable of converting the more prevalent androstenedione directly to testosterone without metabolizing it to 17-ketosteroids. Removal of the adrenal adenoma completely cured the patient's hirsutism.

17-Ketosteroids↗
PubMed1981

Primary hyperparathyroidism: hyperparathyroid crisis.

Hyperparathyroid crisis is a rare disease but should be suspected in acutely ill patients complaining of weakness, lethargy, nausea, vomiting, confusion and abdominal pain. Despite the variety of clinical manifestations, the syndrome forms a distinctive pattern which, in the presence of a serum calcium level greater than 16 mg/100 ml, should be recognized. The most difficult problem in diagnosis is the differentiation of hyperparathyroid crisis from ectopic parathyroid hormone-producing tumors. The disease is an endocrine emergency which requires prompt surgery after rapid correction of dehydration and hypercalcemia. The best results are achieved by removing offending parathyroid tissue within 72 hours after the onset of symptoms.

Adenoma↗
PubMed1980

Primary hyperparathyroidism. A personal experience with 242 cases.

Two hundred forty-two patients with primary hyperparathyroidism operated on at Akron City Hospital are reviewed. The importance of the association of peptic ulcer and pancreatitis with primary hyperparathyroidism is stressed. Nineteen percent of the patients had associated peptic ulcer or pancreatitis. The mechanisms involved in the production of these diseases in patients with primary hyperparathyroidism are emphasized. The two deaths occurred in the small but challenging group of patients with acute parathyroid crisis and carcinoma. The decision concerning the extent of parathyroidectomy should be made by the surgeon for each patient, based on the number, location and gross appearance of the identified glands. Removal of a single enlarged gland, if the other three glands are normal, is all that needs to be done in most cases. A recurrence rate of 1 percent and an appreciable decrease in postoperative tetany support this conservative approach. Subtotal parathyroidectomy should be reserved for patients with diffuse hyperplasia.

Adenoma↗
PubMed1980

Primary hyperparathyroidism: the case for conservative surgery.

Analysis of a series of 205 surgically treated cases of primary hyperparathyroidism was carried out to assess the long-term results of the conservative approach of selectively removing the adenoma only. If primary hyperparathyroidism is due to multiple gland involvement in one-third to one-half of patients, an appreciable number of patients with recurrent disease should have been encountered during this study of the results of conservative no instances of permanent tetany, supports the conservative approach to the treatment when only a single enlarged gland is encountered. Subtotal parathyroidectomy should be reserved for those few cases in which multiple enlarged glands are found, especially in association with multiple endocrine neoplasm, familial hyperparathyroidism, and secondary hyperparathyroidism.

Adenoma↗
PubMed1980

Benign liver tumors: presenting profiles and treatment.

The presenting profiles of three cases of benign hepatic cell tumors associated with ingestion of oral contraceptives assisted in the diagnosis and treatment of these interesting tumors. One patient had evidence of bleeding at the time of presentation that required emergency anatomic right lobe resection. Another had symptoms of acute cholecystitis and a mass that at surgical operation was found to be nonresectable. The tumor involuted after discontinuation of oral contraceptives. A final patient with a freely movable asymptomatic mass had a pedunculated liver tumor that was easily resected. Options in treatment of these benign liver tumors must be kept in mind. As the natural history of these lesions evolves, other modes of treatment less formidable than resection, such as discontinuation of oral contraceptives and occlusion of the hepatic artery circulation, may be effectively employed.

Adenoma↗
PubMed1979

Thoracic outlet syndrome: current concepts of treatment.

This current concept of treatment of the Thoracic Outlet Syndrome based on a personal experience with 304 patients, resulted in complete (85%) or partial (7%) relief of symptoms in 92% of operated patients. The diagnosis centers upon 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 are only 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.

Female↗
PubMed1976

Gallstone pancreatitis: pathophysiology.

The stools of 45 patients with proven gallstones pancreatitis were screened for gallstones. An equal number of peripheral with gallstones but without pancreatitis served as the control group. Gallstones were found in the stools of 38 of the 45 patients (84 percent) with gallstone pancreatitis and in only five (11 percent) patients of the control group. The patients with gallstone pancreatitis experienced a relief of symptoms and a decrease in the levels of serum amylase and bilirubin prior to rectal passage of the stones. Operative cholangiography revealed reflux of contrast material into the pancreatic duct of 67 percent of the patients with gallstone pancreatitis and in only 18 percent of the controls. Of the 38 patients that passed stones, 30 cholangiograms (79 percent) demonstrated a functioning common channel. it would appear that a functioning common channel is necessary for reflux and in addition favors stone passage. This study suggests that the pathophysiology of gallstone pancreatitis relates to the temporary impaction of migrating stones at the ampulla of Vater.

Acute Disease↗