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Hirsch AG, Stewart WF, Sundaresan AS, Young AJ, Kennedy TL, Scott Greene J, Feng W, Tan BK, Schleimer RP, Kern RC, Lidder A, Schwartz BS. Nasal and sinus symptoms and chronic rhinosinusitis in a population-based sample. Allergy 2017; 72:274-281. [PMID: 27590749 DOI: 10.1111/all.13042] [Citation(s) in RCA: 140] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND The objective of this study was to describe the first US-based study to use the European Position Paper on Rhinosinusitis (EPOS) criteria to study the prevalence of chronic rhinosinusitis (CRS) in a general-population sample. METHODS A CRS symptom questionnaire was mailed to 23 700 primary care patients from Geisinger Clinic, a health system serving 45 counties in Pennsylvania. CRS cases were categorized into four unique subgroups based on EPOS symptoms: obstruction and discharge with no smell loss or pain/pressure; smell loss without pain/pressure; facial pain and/or pressure without smell loss; and both smell loss and pain/pressure. All cases were required to have nasal obstruction or discharge. Logistic regression was used to evaluate potential factors associated with CRS subgroups. RESULTS We found that 11.9% of patients met criteria for CRS. Prevalence peaked at 15.9% between ages 50 and 59 years and then dropped to 6.8% after age 69. The odds of CRS was higher among patients who were white, younger, smokers, had a history of Medical Assistance, and had other diseases. When CRS subgroups were modeled separately, these associations were no longer significant for some CRS subgroups. Comorbid diseases were most strongly associated with CRS cases who reported smell loss and facial pain and/or pressure and had the weakest associations with CRS cases who did not report these symptoms. CONCLUSIONS CRS is a highly prevalent and heterogeneous condition. Differences in risk factors and health outcomes across symptom subgroups may be indicative of differences in etiology that have implications for disease management.
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Affiliation(s)
- A. G. Hirsch
- Department of Epidemiology and Health Services Research; Geisinger Health System; Danville PA USA
| | - W. F. Stewart
- Research Development and Dissemination; Sutter Health; San Francisco CA USA
| | - A. S. Sundaresan
- Department of Epidemiology and Health Services Research; Geisinger Health System; Danville PA USA
| | - A. J. Young
- Department of Biomedical and Translational Informatics; Geisinger Health System; Danville PA USA
| | - T. L. Kennedy
- Department of Otolaryngology/Head and Neck/Facial Plastic Surgery; Geisinger Health System; Danville PA USA
| | - J. Scott Greene
- Department of Otolaryngology/Head and Neck/Facial Plastic Surgery; Geisinger Health System; Danville PA USA
| | - W. Feng
- Department of Biomedical and Translational Informatics; Geisinger Health System; Danville PA USA
| | - B. K. Tan
- Department of Otolaryngology Head and Neck Surgery Department of Medicine; Northwestern University Feinberg School of Medicine; Chicago IL USA
- Division of Allergy and Immunology; Department of Medicine; Northwestern University Feinberg School of Medicine; Chicago IL USA
| | - R. P. Schleimer
- Department of Otolaryngology Head and Neck Surgery Department of Medicine; Northwestern University Feinberg School of Medicine; Chicago IL USA
- Division of Allergy and Immunology; Department of Medicine; Northwestern University Feinberg School of Medicine; Chicago IL USA
| | - R. C. Kern
- Department of Otolaryngology Head and Neck Surgery Department of Medicine; Northwestern University Feinberg School of Medicine; Chicago IL USA
- Division of Allergy and Immunology; Department of Medicine; Northwestern University Feinberg School of Medicine; Chicago IL USA
| | - A. Lidder
- University of Rochester School of Medicine and Dentistry; University of Rochester Medical Center; Rochester NY USA
| | - B. S. Schwartz
- Department of Epidemiology and Health Services Research; Geisinger Health System; Danville PA USA
- Department of Environmental Health Sciences; Johns Hopkins University Bloomberg School of Public Health; Baltimore MA USA
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Hirsch AG, Yan XS, Sundaresan AS, Tan BK, Schleimer RP, Kern RC, Kennedy TL, Greene JS, Schwartz BS. Five-year risk of incident disease following a diagnosis of chronic rhinosinusitis. Allergy 2015; 70:1613-21. [PMID: 26332371 DOI: 10.1111/all.12759] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) has a broad range of comorbidities. Due to a lack of longitudinal studies, it is not known whether these comorbidities cause CRS, are promoted by CRS, or share a systemic disease process with CRS. OBJECTIVE The objective of this study was to determine the risk of incident disease within 5 years after a new diagnosis of CRS with nasal polyps (CRSwNP) and without nasal polyps (CRSsNP). METHODS We conducted a case-control study nested within the longitudinal cohort of primary care patients in the Geisinger Clinic using electronic health record data. We evaluated incident disease over 5 years in newly diagnosed CRSwNP and CRSsNP cases compared to controls using multivariable Cox regression models. RESULTS CRSsNP (n = 3612) cases were at greater risk (HR, 95% confidence interval) than controls for incidence of: upper airway diseases, including adenotonsillitis (3.29, 2.41-4.50); lower aerodigestive tract diseases, including asthma (2.69, 2.14-3.38); epithelial conditions, including atopic dermatitis (2.75, 1.23-6.16); and hypertension (1.38, 1.19-1.61). CRSwNP (n = 241) cases were at greater risk for obesity than controls (1.74, 1.08-2.80), but CRSwNP was not associated with other diseases. CONCLUSION The risk of other diseases associated with CRS adds to the burden of an already highly burdensome condition, and suggests either that CRS promotes onset of other diseases or is an indicator of systemic disease processes. Different patterns of association with diseases by CRS phenotype may be due to CRSwNP sample size limitations or reflect a different pattern of disease onset by phenotype. These findings have implications for screening guidelines and care of CRS patients.
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Affiliation(s)
- A. G. Hirsch
- Center for Health Research; Geisinger Health System; Danville PA USA
| | - X. S. Yan
- Center for Health Research; Geisinger Health System; Danville PA USA
- Research Development and Dissemination; Sutter Health; San Franciso
| | - A. S. Sundaresan
- Center for Health Research; Geisinger Health System; Danville PA USA
| | - B. K. Tan
- Department of Otolaryngology Head and Neck Surgery and the Division of Allergy and Immunology; Department of Medicine; Northwestern University Feinberg School of Medicine; Chicago IL USA
| | - R. P. Schleimer
- Department of Otolaryngology Head and Neck Surgery and the Division of Allergy and Immunology; Department of Medicine; Northwestern University Feinberg School of Medicine; Chicago IL USA
| | - R. C. Kern
- Department of Otolaryngology Head and Neck Surgery and the Division of Allergy and Immunology; Department of Medicine; Northwestern University Feinberg School of Medicine; Chicago IL USA
| | - T. L. Kennedy
- Department of Otolaryngology/Head and Neck/Facial Plastic Surgery; Geisinger Health System; Danville PA USA
| | - J. S. Greene
- Department of Otolaryngology/Head and Neck/Facial Plastic Surgery; Geisinger Health System; Danville PA USA
| | - B. S. Schwartz
- Center for Health Research; Geisinger Health System; Danville PA USA
- Department of Environmental Health Sciences; Johns Hopkins University Bloomberg School of Public Health; Baltimore MD USA
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Kennedy TL. Clinical surgery international. Vol. 7. Peptic ulcer. D. C. Carter. 240 × 160 mm. Pp. 219. Illustrated. 1983. Edinburgh: Churchill Livingstone. £19·00. Br J Surg 2005. [DOI: 10.1002/bjs.1800710643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Kennedy TL. Pye's surgical handicraft. 21st edition J. Kyle. 230 × 150 mm. Pp. 754 + xi. Illustrated. 1984. Bristol: Wright PSG. £14.95. Br J Surg 2005. [DOI: 10.1002/bjs.1800711029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Kennedy TL. Surgical disorders of adrenal gland: Physiologic background and treatment. Timothy S. Harrison, Donald S. Gann, Anthony John Edis and Richard H. Egdahl. 230 × 155 mm. Pp. 150 + x. Illustrated. 1975. New York: Grune & Stratton. $14.50. Br J Surg 2005. [DOI: 10.1002/bjs.1800630727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
OBJECTIVE To outline a rational approach to the management of cystic hygroma based on the authors' experience, the natural history of the disease, and the results of surgical treatment. STUDY DESIGN AND METHODS A retrospective review of all patients with the diagnosis of lymphangioma or cystic hygroma from 1958 to 2000 was performed. RESULTS Seventy-four patients were identified with 46 cases confined to the cervicofacial region. Surgical excision was performed on 60 of the 74 cases involving all regions of the body and 34 of the 46 patients with head and neck lesions. The location of the malformation is the most important determinate for surgical success. While surgical excision was the main treatment modality, 11 of 12 untreated patients were noted to improve, with 8 patients showing complete resolution. CONCLUSIONS In the treatment of lymphangiomas, the physician should be experienced in the management of such lesions, be aware of spontaneous resolution, and recognize the limitations and potential harm of surgery in certain instances.
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Affiliation(s)
- T L Kennedy
- Department of Otolaryngology-Head and Neck Surgery, Geisinger Medical Center, Danville, Pennsylvania 17822-1333, USA
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Branstetter BF, Weissman JL, Kennedy TL, Whitaker M. The CT appearance of thyroglossal duct carcinoma. AJNR Am J Neuroradiol 2000; 21:1547-50. [PMID: 11003294 PMCID: PMC7974032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/1999] [Accepted: 03/10/2000] [Indexed: 02/17/2023]
Abstract
BACKGROUND AND PURPOSE Thyroid carcinoma arising in a thyroglossal duct cyst may be clinically indistinguishable from a benign thyroglossal duct cyst. The preoperative diagnosis of carcinoma, however, can have important implications for surgical planning and postoperative treatment. Our purpose was to describe the CT appearance of thyroglossal duct carcinoma and identify the features that distinguish thyroglossal duct carcinoma from benign thyroglossal duct cysts. METHODS Retrospective review of the medical records from the University of Pittsburgh Medical Center and Geisinger Medical Center (Danville, Pennsylvania) identified six patients with papillary thyroid carcinoma within the thyroglossal duct who had undergone preoperative CT examinations of the neck. There were two women and four men. Their ages ranged from 14 to 59 years. Three patients underwent contrast-enhanced CT of the neck, and three underwent unenhanced CT. All CT examinations consisted of 3- to 5-mm-thick contiguous axial sections. RESULTS Each patient had an anterior neck mass with a cystic component. Two of the masses had dense or enhancing mural nodules, two had irregular calcification throughout the mass, and two had dense or enhancing mural nodules with additional foci of calcification. One patient had cervical lymphadenopathy. CONCLUSION Carcinoma should be considered in thyroglossal duct cysts that have a mural nodule or calcification or both.
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Affiliation(s)
- B F Branstetter
- Department of Radiology, University of Pittsburgh Medical Center, PA 15213, USA
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Abstract
OBJECTIVE To demonstrate the role of two-dimensional reconstruction images on computed tomography (CT) in the treatment planning for laryngeal amyloidosis. To discuss the treatment for isolated laryngeal amyloidosis and compare the role of endoscopic versus an open surgical approach to management. STUDY DESIGN Retrospective review. METHODS The medical records from 1984 to the present with the diagnosis of localized respiratory tract amyloidosis at Geisinger Medical Center were reviewed. RESULTS Five previously unpublished cases of localized laryngeal amyloidosis were identified with the supraglottic region the major site of involvement. Hoarseness and airway compromise were the presenting symptoms. CT two-dimensional reconstruction imaging was used to evaluate two cases with extensive laryngeal involvement that required an external surgical approach to relieve symptoms. CONCLUSIONS Localized laryngeal amyloidosis is a rare disease that requires surgical management when symptomatic. CT two-dimensional reconstruction can be helpful in detailing the extent of disease and planning surgery. A lateral external supraglottic approach has been found to be successful in treating patients with large supraglottic masses.
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Affiliation(s)
- T L Kennedy
- Department of Otolaryngology--Head and Neck Surgery, Geisinger Medical Center, Danville, Pennsylvania 17822-1333, USA
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Abstract
OBJECTIVE To discuss the authors' experience with thyroglossal duct carcinoma and present a rational approach to the management of this entity. STUDY DESIGN AND METHODS A retrospective review of the cytopathology and pathology records of all patients with the diagnosis of a thyroglossal duct remnant from 1965 to 1997 was performed. RESULTS Three cases of papillary thyroglossal duct carcinoma were identified, with one suspected squamous cell carcinoma by needle aspiration. The papillary carcinomas are discussed in detail to illustrate the difficulty encountered in managing the thyroid gland in the setting of a thyroglossal duct carcinoma. Fine-needle aspiration proved effective in making the diagnosis preoperatively. CONCLUSIONS The authors recommend that a thyroglossal duct cyst with a microscopic focus of papillary carcinoma, without cyst wall invasion, be managed with a Sistrunk procedure. Treatment of all other thyroglossal duct papillary carcinomas should include removal of all thyroid tissue followed by radioactive iodine treatment.
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Affiliation(s)
- T L Kennedy
- Department of Otolaryngology and Head and Neck Surgery, Geisinger Medical Center, Danville, Pennsylvania 17822-1333, USA
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Abstract
Planar imaging has made significant contributions to the evaluation of patients with non-nodal neck masses. The clinical history, physical examination, and imaging characteristics of these lesions are often complimentary. Yet, planar imaging much more accurately defines the size, location, and extent of these lesions than is revealed on physical examination. The CT and MR characteristics are often sufficiently specific to arrive at the correct preoperative diagnosis in these patients. We present the classical radiographic and clinical features of several non-nodal neck masses.
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Affiliation(s)
- W W Woodruff
- Wilson Memorial Regional Medical Center, Park Avenue Associates in Radiology, Johnson City, NY 13790, USA
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Beatty OL, Russell CF, Kennedy L, Hadden DR, Kennedy TL, Atkinson AB. Phaeochromocytoma in Northern Ireland: a 21 year review. Eur J Surg 1996; 162:695-702. [PMID: 8908450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
OBJECTIVE To report our experience of 41 patients with phaeochromocytoma. DESIGN Retrospective study. SETTING Teaching hospital, United Kingdom. SUBJECTS Forty-one patients who presented with phaeochromocytoma 1970-1991. INTERVENTIONS Removal of tumour (n = 38). MAIN OUTCOME MEASURES Mortality, morbidity, and recurrence. RESULTS Thirty-four patients had sporadic tumours, five had the multiple endocrine neoplasia (MEN) type 2 syndrome, and two had non-MEN familial phaeochromocytoma. Thirty-six patients (88%) presented with symptoms of catecholamine excess, and 37 (90%) were hypertensive. The diagnosis was confirmed biochemically in 37. Tumours were located using computed tomography (n = 26), vascular studies (n = 11), and ultrasonography (n = 3). Thirty-eight patients had their tumours resected, of whom 10 (27%) developed complications. There were no postoperative deaths. Two patients were managed conservatively, and one died before diagnosis. Six patients developed recurrent tumours a mean of five years after the initial operation, and another patient had an inoperable tumour at initial diagnosis; four of these seven died from metastatic disease. Metaiodobenzylguanidine (MIBG) scans were positive in three of the patients who developed recurrences. CONCLUSIONS Patients with phaeochromocytoma can now be operated on safely but prolonged follow-up is essential.
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Affiliation(s)
- O L Beatty
- Sir George E. Clark Metabolic Unit, Royal Victoria Hospital, Belfast, Northern Ireland
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Dimitriadis E, Owens D, Collins P, Johnson A, Tomkin G, Cronin CC, Barry D, Crowley B, Ferriss JB, Hetherton AM, Smith DF, O’Herlihy C, Smyth PPA, Fiad TM, Culliton M, Dunbar J, Cunningham SK, McKenna TJ, Heaney AP, Loughrey GL, McCance DR, Mcllrath E, Hadden DR, Kennedy L, Sheridan B, Ferris JB, Whyte A, Cleary PE, McAuley DJ, Mathew B, Bailey IC, Curtin A, Lenehan K, Deegan P, Henry M, Stapleton M, Baker H, Duggan PF, Mitchell TH, O’Hare JA, Geoghegan M, Abuaisha F, Fearon U, Clarke D, Roberts RN, Traub AI, Thompson W, Whitehead H, Holmes J, Roberts R, Al-Mandhari NA, Greer A, Carson D, Traub T, Hadden D, Heaney AP, Ferguson T, Atkinson AB, O’Keeffe S, Devlin JG, Donnellan C, Russell CR, Kennedy TL, Kennedy AL, Atkinson AB, Long HA, Conway DJ, Mercer PM, Murphy D, Stokes M, Sheahan K, O’Higgins NJ, Dunne FP, Ratcliffe WA, Mansour P, Heath DA, O’Meara NM, Sturis J, Herold KC, Polonsky KS, Beatty OL, Ritchie CM, Bell PM, Kennedy AL, Clarke D, Fearon U, Levy JC, Turkington E, Hadden DW, Harper R, Ennis CN, Johnston GD, Scanlan P, Foley M, Stronge J, Firth R, Hanson RL, Jacobsson LTH, Bennett PH, Bishop DT, Knowler WC. Irish endocrine society. Ir J Med Sci 1994. [DOI: 10.1007/bf02943261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
OBJECTIVES In 1991, all active board-certified pediatric cardiologists were polled by questionnaire to examine the relation of subspecialty training and motivational and satisfaction issues to practice characteristics. BACKGROUND Previous questionnaires with regard to manpower status and practice characteristics were published in 1967 and 1980. These indicated a field predominantly centered in academic medicine with growth in manpower close to predicted need. METHODS The questionnaire was mailed to 844 of 884 active board-certified pediatric cardiologists and was returned anonymously by 570, a 68% response rate. RESULTS Among respondents, the mean year in which fellowship training was completed was 1974. The average length of subspecialty training was 31 months for all respondents and 34 months among those completing training since 1981. Seventy-seven percent of subspecialty training centered on clinical training. Although there has been a slight increase in research training in recent years, only 18 respondents completed > or = 22 months of research training. Respondents devote a mean of 89% of professional hours to subspecialty activities and spend 63% of total hours in clinical care. Total hours, income and procedures were related to site of professional activity. Professional satisfaction was high in the factors considered more important: professional challenge and interaction, clinical resources, career security and clinical autonomy. CONCLUSIONS The field of pediatric cardiology is a subspecialty centered on patient care and performance of diagnostic and interventional techniques. Professional activities varied according to practice site. Pediatric cardiologists with basic research training and professional activity remain a minority. Satisfaction is high, with greatest satisfaction in professional interactions and least satisfaction with income and free time.
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Affiliation(s)
- R G Williams
- Department of Pediatrics, University of California, Los Angeles Medical Center 90024-1743
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O'Brien JA, Van Why SK, Keller MS, Gaudio KM, Kennedy TL, Siegel NJ. Altered renovascular resistance after spontaneous recovery from hemolytic uremic syndrome. Yale J Biol Med 1994; 67:1-14. [PMID: 7645308 PMCID: PMC2590798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Twenty-three patients were evaluated from 1-15 (mean 6) years after recovering from an episode of diarrhea-associated associated childhood hemolytic uremic syndrome (DA-HUS). All patients had received only conservative treatment; none had been given experimental, anti-coagulant, or immunological therapies. Follow-up studies included morphologic and duplex Doppler sonograms. Doppler sonography was used to determine the resistive index, a measure of renovascular resistance. Histories and physical examinations revealed no abnormalities. Results of laboratory studies, which included calculated glomerular filtration rates, were all within normal limits, except for one patient with minor urinary abnormalities. Renal sonograms showed no significant abnormalities of kidney length or parenchymal appearance. However, Doppler sonographic examinations revealed that the DA-HUS patients demonstrated less of a decrease in renovascular resistance with age than did the control group (p < 0.0002). After recovery, patients treated exclusively with conservative management during an acute episode of DA-HUS appeared to have an excellent long-term prognosis. Comparison of our results with those from other studies in which investigational therapies have been used during the acute phase of DA-HUS suggests that latent toxicities which cause long term sequelae may not have been appreciated previously. The clinical significance of the altered renal vascular resistance remains to be delineated.
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Affiliation(s)
- J A O'Brien
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT 06520, USA
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Abstract
OBJECTIVE We assessed the current role of bilateral adrenalectomy in the overall management strategy of hypercortisolism. DESIGN Retrospective review of case notes. PATIENTS Twenty-six patients (20F/6M); mean age 46 years (range 15-70 years), median duration of follow-up 5.25 years (0.6-19.1 years) who had undergone bilateral adrenalectomy at the Royal Victoria Hospital since 1972. Eighteen had had prior transsphenoidal surgery which did not control the hypercortisolism. MEASUREMENTS Morbidity, mortality, incidence of Nelson's syndrome. RESULTS Surgery was performed through bilateral postero-lateral incisions (20 patients) or a long epigastric incision (six patients). The mean combined weight of the adrenals at surgery was 11.2 g. Twenty patients received subcutaneous heparin and 18 antibiotic prophylaxis peri and post-operatively. There was no operative mortality. Minor complications included one post-operative wound infection and a small pneumothorax requiring drainage. Major complications occurred in two other patients, both with pre-existing invasive pituitary tumours and considered at high risk because of age and general debility. One patient had a massive pulmonary embolus and the other a subphrenic abscess post-operatively. This latter patient, the only mortality, died from an unrelated cause three years post-operatively. Six patients have subsequently undergone pituitary surgery and three have received external pituitary irradiation therapy for expanding tumours. CONCLUSIONS Bilateral adrenalectomy, in experienced hands, is a relatively safe and useful management option in patients with hypercortisolism. Growth of a pituitary adenoma post-operatively is now the most worrying complication.
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Affiliation(s)
- D R McCance
- Sir George E. Clark Metabolic Unit, Royal Victoria Hospital, Belfast, N. Ireland
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Affiliation(s)
- T L Kennedy
- Department of Otolaryngology, Head and Neck Surgery, Geisinger Medical Center, Danville, Pa. 17822
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Pellitteri PK, Kennedy TL, Youn BA. The influence of intensive hyperbaric oxygen therapy on skin flap survival in a swine model. Arch Otolaryngol Head Neck Surg 1992; 118:1050-4. [PMID: 1389055 DOI: 10.1001/archotol.1992.01880100040011] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Conflicting reports exist regarding the influence of hyperbaric oxygen therapy on random skin flap survival. The present investigation sought to demonstrate enhanced survival of experimental random skin flaps in swine using an intensive and tapering hyperbaric oxygen therapy regimen that would have direct application in human clinical trials. Random cutaneous flaps were surgically constructed on 12 domestic pigs. Flaps were designed to obtain a predictable length of necrosis. Six pigs did not undergo hyperbaric oxygen therapy and served as surgical controls. Six pigs were subjected to an intensive tapering hyperbaric regimen within 1.5 hours of completing the surgical procedure. Treatments were administered in a research hyperbaric vessel at a depth of 2.0 atm absolute (10 m of seawater) for 90 minutes of oxygen treatment in a tapering schedule over 6 days. This was structured to provide intensive therapy initially during the period of maximum tissue trauma and ischemia. Extent of flap necrosis was assessed by tracing clear plastic templates at necropsy, then converting to square centimeters using a computer digitizer tablet. The difference in flap necrosis between groups was significant, with random flaps subjected to hyperbaric oxygen therapy demonstrating a mean 35% less necrosis than surgical controls. Skin flaps treated with hyperbaric oxygen therapy demonstrated a mean survival of 77%, with a range of 56% to 100%. This reflected a 12% improvement in mean surviving area for hyperbaric oxygen therapy flaps over untreated surgical controls. We are unaware of similar studies reporting a comparable degree of enhancement in random skin flap survival using hyperbaric oxygen therapy alone. Adjunctive hyperbaric oxygen therapy in an intensive tapering schedule significantly improved flap survival in this model. Further investigations need to determine the optimum frequency of treatments and depth necessary to attain maximum tissue viability.
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Affiliation(s)
- P K Pellitteri
- Department of Otolaryngology and Head and Neck Surgery, Geisinger Medical Center, Danville, Pa 17822-1333
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Abstract
Cervicofacial nontuberculous mycobacterial infections of the head and neck are difficult to treat surgically because of their common location near the branches of the facial nerve. Curettage of these lesions through a small skin incision makes treatment simple without injury to the facial nerve fibers and leaves the patient with an excellent cosmetic result. Most discussions on the topic, however, favor complete surgical excision even though curettage has been reported as a safe and excellent means of treatment. For the past 2 years, the department of otolaryngology-head and neck surgery at the Geisinger Medical Center, Danville, Pa, has used curettage in seven patients as the primary treatment modality for these facial and cervical infections. A review of these cases is presented.
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Affiliation(s)
- T L Kennedy
- Department of Otolaryngology-Head and Neck Surgery, Geisinger Medical Center, Danville, Pa. 17822
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Smyth PPA, Lazarus JH, Parkes AB, Hetherton AM, Ndiaye M, Devlin JG, Brosnan E, Lee P, Paton C, Burke C, Jenkins AJ, Steele JS, Janus ED, Santamaria JD, Best JD, Beatty OL, Atkinson AB, Browne J, Clarke K, Sheridan B, Bell PM, McCance DR, Russell CFJ, Kennedy TL, Hadden DR, Kennedy L, Young IS, Torney JJ, Trimble ER, Qiu HX, Zhang SH, Johnston CF, Buchanan KD, Cunningham SK, MKenna TJ, Rooney DP, Neely RDG, Cullen C, Ennis CN, Trimble ER, McAteer DS, Mulholland G, Ekeke N, Fillmore D, Ardill JES, Thompson W, Cuny WJ, Shaw C, Harper MA, Murnaghan GA, Kennedy L, O’Hare J, Geoghegan M, O’Herlihy C, Ryan R, Smyth PPA, Dineen SF, Silverberg JD, Batts KP, Ballard DJ, Rizza RA, Brennan GM, McVeigh GE, Johnston GD, McDermott BJ, Hayes JR, Montwill J, Fiad TM, Culliton M. Irish endocrine society. Ir J Med Sci 1992. [DOI: 10.1007/bf02996209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Collins JS, Buchanan KD, Kennedy TL, Johnston CF, Ardill JE, Sloan JM, McIlrath EM, Russell C. Changing patterns in presentation and management of the Zollinger-Ellison syndrome in Northern Ireland, 1970-1988. Q J Med 1991; 78:215-25. [PMID: 1675471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The clinical features, diagnostic methods, management and survival in 16 cases of Zollinger-Ellison syndrome encountered in Northern Ireland between the years 1970 and 1988 are described. While the majority of patients in the first decade of the study period had surgical treatment, those presenting in the latter period have been managed with medical therapy in the form of H2-receptor antagonists or omeprazole. The increasing use of these agents seems to be altering the severe clinical features of this condition, reducing the indications for surgery and maintaining patients, with or without evidence of metastatic disease, in clinical remission.
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Affiliation(s)
- J S Collins
- Department of Medicine, Queen's University of Belfast, Northern Ireland
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Pellitteri PK, Kennedy TL, Vrabec DP, Beiler D, Hellstrom M. Radiotherapy. The mainstay in the treatment of early glottic carcinoma. Arch Otolaryngol Head Neck Surg 1991; 117:297-301. [PMID: 1998569 DOI: 10.1001/archotol.1991.01870150065008] [Citation(s) in RCA: 63] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Early squamous cell carcinoma of the glottis may be effectively treated with surgery or radiation therapy. Controversy exists as to whether radiation therapy effects survival at the expense of vocal function by ultimately requiring more total laryngectomies for salvage of local tumor recurrence. This study reviewed the medical records of 185 patients with T1 or T2, NO invasive squamous cell carcinoma of the glottis treated with primary radiation therapy between 1969 and 1984. All patients were followed up for a minimum of 5 years after completion of therapy. One hundred sixty-one patients met the criteria for local control analysis. Radiation therapy controlled disease in 93% (105 of 113) of patients with T1 lesions and 73% (38 of 48) of those with T2 tumors. Ultimate control of disease for T1 and T2 lesions, including surgical salvage, was 111 (98%) of 113 and 44 (92%) of 48 patients, respectively. The rate of successful surgical salvage was 75% (T1) and 70% (T2). The T2 lesions with impaired vocal cord mobility or anterior commissure disease were identified as being at increased risk for recurrence after primary radiation therapy. Overall voice preservation was 90%. Our data demonstrate that radiation therapy effects disease-free survival rates that are comparable to those produced by surgery, without sacrificing voice. Although a small percentage of patients with selected early glottic lesions may be more effectively treated with primary conservation surgery, these data do not support a change in philosophy concerning primary treatment of early glottic cancer with radiation therapy.
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Affiliation(s)
- P K Pellitteri
- Department of Otolaryngology, Head and Neck Surgery, Geisinger Medical Center, Danville, Pa. 17822
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22
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Abstract
From August 1969 to December 1989, 600 patients had elective proximal gastric vagotomy for duodenal ulceration with an operative mortality of 0.2 per cent. Of these, 372 patients had surgery over 10 years ago. Three hundred and forty-two patients survived for more than 10 years and, in a prospective study, 305 were reviewed, forming the basis of this 10-20-year follow-up report. Forty-six (15 per cent) have had recurrent ulceration; 80 per cent of these developed symptoms within 5 years and no patient has had recurrence after 13 years. Although 29 patients required reoperation for recurrent ulceration, the current patient satisfaction rate for Visick grades I and II is 92 per cent. Only two patients required reoperation because of gastric stasis. It is concluded that proximal gastric vagotomy is a safe and satisfactory first choice operation for duodenal ulceration.
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Abstract
Hygroma cysticum coli or cystic hygroma remains a complex entity in terms of its development and management. Most recently, cystic hygroma has been categorized as part of a larger spectrum that includes lymphangiomas. The majority of lymphangiomas occur in the head and neck as cystic hygromas with the posterior cervical region as the most common site. Since its original description, there have been many attempts at treatment modalities: surgical excision remains the treatment of choice. The literature is reviewed and 40 cases from the author's institution are presented. The purposes of this review are, first, to bring some order to the theories and development of this lesion and its various pathological presentations. Second, to approach the treatment of these difficult lesions in an objective manner and to set up guidelines for management.
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Affiliation(s)
- T L Kennedy
- Department of Otolaryngology and Head and Neck Surgery, Geisinger Medical Center, Danville, PA 17822
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Abstract
Aneurysmal bone cyst is an uncommon benign lesion that rarely presents in the craniofacial region. No prior reports of this entity involving the mandible could be found in the otolaryngologic literature, and it has been reported only infrequently in the maxilla. Two previously unreported cases originating in the mandible are presented with a review of the literature, pathology, and diagnosis of this lesion. Treatment of this lesion consists of complete surgical removal and immediate bone grafting for reconstruction.
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Affiliation(s)
- N A Giddings
- Department of Otolaryngology, Geisinger Medical Center, Danville, PA 17822
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25
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Abstract
Perichondritis of the pinna is a serious late infection of burns involving the ear. The avascular nature of this injury renders systemic antibiotic therapy ineffective in delivering adequate levels of drug to the area to provide antimicrobial activity. Treatment has traditionally been surgery in some form, resulting in further disfigurement of the damaged cartilagenous framework. Iontophoresis, a method of dispersing charged particles through a relatively impermeable membrane by a light electrical field, appears to be a feasible method of antibiotic delivery. This initial pilot study investigated the development of perichondritic-like burns in ten rabbit ears, and techniques for gentamicin iontophoresis and assay in devitalized cartilage. Five rabbits, with ear burns simulating perichondritis, were treated with gentamicin iontophoresis on one ear and gentamicin-soaked gauze on the other. Resulting assays of the ear cartilages, after four treatments over a 2-day period, demonstrated a nearly twenty-fold increase in gentamicin levels in the iontophoresis-treated ears, compared to low levels in the soaked ears. Systemic absorption was negligible in all rabbits.
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Affiliation(s)
- R A Macaluso
- Department of Otolaryngology, Geisinger Medical Center, Danville, PA 17822
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Kaplan AA, Toueg S, Kennedy TL. Complement kinetics during continuous arteriovenous hemofiltration: studies with a new polysulfone hemofilter. Blood Purif 1988; 6:27-36. [PMID: 3257877 DOI: 10.1159/000169481] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Biocompatibility of the Renaflo polysulfone hemofilter was assessed during treatments with continuous arteriovenous hemofiltration. Pre- versus postfilter levels of C3a, C4a, C5a and leukocyte counts were measured prior to and 15, 60 and 90 min after placement of the Renaflo. Results revealed a small, and previously unrecognized, increase in postfilter C3a (1,224 +/- 56 vs. 1,535 +/- 150 ng/ml, mean +/- SEM, n = 15; p less than 0.01). A comparable increase was also found during treatment with an Amicon polysulfone filter. There were no other significant changes in any parameter studied and no patient exhibited symptoms related to complement activation. We conclude that the Renaflo filter is safe for use during continuous arteriovenous hemofiltration. Although clinically insignificant, there is a detectable activation of C3 by polysulfone membranes.
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Affiliation(s)
- A A Kaplan
- Department of Pediatrics, University of Connecticut Health Center, Farmington
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28
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Giddings NA, Kennedy TL, Vrabec DP. Primary small cell carcinoma of the larynx: analysis of treatment. J Otolaryngol 1987; 16:157-66. [PMID: 3599170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Primary small cell carcinoma of the larynx continues to pose problems in its treatment. Four patients with this neoplasm were seen in a seven-year period at our institution and 49 patients were reviewed from the world literature. The only variables which significantly affected survival were the presence of metastases at initial examination and treatment modality. Those patients treated with chemotherapy and radiation therapy had an increased length of survival and increased chance of survival as compared to patients subjected to other treatment modalities. Because of the small number of patients reported in the world literature and lack of controlled studies, the treatment of small cell carcinoma of the larynx remains controversial; this retrospective analysis suggests that combination chemotherapy plus radiation offers the best chance for cure.
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29
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Kennedy TL. Duodenal ulcer, hyperacidity and J C Adams. Ulster Med J 1987; 56:77-8. [PMID: 3296382 PMCID: PMC2448173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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30
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Abstract
A center in Belfast, Northern Ireland, has established a register for tumors of the gastroenteropancreatic endocrine system. Carcinoid tumors occur most frequently. Of the non-carcinoid tumors, insulinomas, gastrinomas, and unknown types have the highest incidence, with other types being extremely rare. The potentially remediable nature of the tumors is stressed, and frequently a good quality of life can be experienced even in the presence of metastatic disease. The syndromes are probably underdiagnosed as they present with clinical features for which there are more common explanations, and appropriate diagnostic methods are therefore not used. The management of the syndromes is reviewed with particular emphasis on the treatment of patients with inoperable disease. Histamine (H2)-receptor antagonist therapy has made an impact in Zollinger-Ellison syndrome, and streptozotocin and somatostatin analogues can control tumor growth and endocrine syndromes, respectively.
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Garstin WI, Johnston GW, Kennedy TL, Spencer EF. Nissen fundoplication: the unhappy 15%. J R Coll Surg Edinb 1986; 31:207-9. [PMID: 3783506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Whelton MJ, Fitzgerald P, Ritchie E, Jenkins D, Leahy AL, Nee JM, Wait RB, Pollock TW, Collins BJ, Elliott H, Sloan JM, McFarland RJ, Love AHG, Mac Mathúna P, O’Reilly T, Kelleher D, Keeling PWN, Feely J, West B, Byrne P, Sheahan G, Stephens R, Hennessy T, Doyle CT, Bloomfield FJ, Maxwell WJ, Hogan FP, Walsh JP, Duffy MJ, O’Sullivan F, O’Donoghue D, Afdhal N, Collins JSA, Kennedy TL, Buchanan KD, Johnston CF, O’Hare MMT, Walsh TN, Alderson D, Tate P, Lavells MI, Ryan P, Lennon G, Walsh D, Hegarty JH, Keane FBV, Tanner WA, Afdhal NH, Long AA, Tobbia I, Tobin B, O’Rafferty R, O’Donoghue DP, Deasy J, Clinton O, Burke G, Delaney P, O’Mahony C, O’Farrelly C, Weir DG, Finch T, Feighery CF, Traynor OJ, Byrne PJ, Hennessy TPJ, Lombard M, Murray FE, Connolly G, Lennon J, Crowe J, McCann A, Seymour C, Broe PJ, Bouchier-Hayes DJ, Bloomfield FF, O’Farrelly C, Stevens F, McCarthy C, Feighery C, McKee CM, McMillan SA, Dawson AT, O’Toole J, Haire M, Callender ME, Fulton TT, McEntee GP, Duignan JP, O’Malley E, Graeme-Cook F, O’Farrelly G, O’B Hourihane D, Fitzgerald R, Dervan P, Lennon JR, Moran B, Delaney PV, Kelly J, O’Shea B, O’Dorioghue DP, Keeling P, Stuart R, Stewart RJ, Parks TG, Devery R, Tomkin GH, McKay PA, O’Connor M, Miller S, McDonald G, Fryene PJ, Martin L, Ryan F, Collum C, Lavelle J, Ennis J, Doyle JS, O’Connor HJ, Schorah CJ, Axon ATR, Riley SE, Garner RC, Burke O, Long JP, Lennon F. Irish Society of Gastroenterology. Ir J Med Sci 1986. [DOI: 10.1007/bf02940056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Anderson JR, Spence RA, Laird JD, Ferguson WR, Kennedy TL. Indium-111 autologous leukocyte imaging in pancreatitis. J Nucl Med 1986; 27:345-52. [PMID: 3712051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Thirty-nine patients with acute pancreatitis have been assessed using a prognostic factor grading system, abdominal ultrasound, and autologous leukocyte imaging. Both prognostic factor grading and leukocyte imaging can accurately assess the severity of the disease early in its course. All patients with a negative indium-labeled leukocyte image recovered without sequelae, whereas five of the 12 patients with a positive image developed complications, including two deaths. Abdominal ultrasound is of no value in assessing severity, but is a useful method of detecting those patients with gallstone-associated disease. In patients with suspected abscess formation following acute pancreatitis, indium leukocyte imaging does not differentiate between fat necrosis and abscess formation. In this situation, computerized tomography should be carried out before laparotomy is undertaken.
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Kennedy TL, Merrow M, Phillips SM, Norman M, Neilson EG. Macrophage chemotaxis in anti-tubular basement membrane-induced interstitial nephritis in guinea pigs. Clin Immunol Immunopathol 1985; 36:243-8. [PMID: 3874035 DOI: 10.1016/0090-1229(85)90126-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Interstitial renal lesions containing T cells and macrophages develop after 14 days in guinea pigs immunized to produce anti-tubular basement membrane-induced interstitial nephritis. We serially examined the renal venous and systemic arterial sera from such animals to determine if chemotactic factors were released across their kidneys. Our findings demonstrated the presence of a macrophage-specific renal chemoattractant with peak detectability on Days 10-14, just subsequent to the deposition of alpha TBM-Ab, but prior to the development of significant renal injury. We propose that such factors may provide important communication signals in the immunopathogenesis of this form of interstitial injury.
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McEntee GP, Ruddy R, Heffernan SJ, Kirwan WO, Doyle CT, Stevens FM, O’Riordan M, Collins JSA, Porter KG, Kelleher D, Cryan E, Flanagan M, Weir DG, Kelly J, O’Farrelly C, O’Mahony C, Thompson A, Rees JP, Feighery C, McKeever U, Lawlor E, Brian West A, Sheahan DG, Maguire C, Tighe B, O’Higgins NJ, Harvey CF, Hood JM, Anderson JR, Wilson BG, Parks TG, Lyons T, Brougham R, West B, O’Briain DS, Falkiner F, Keeling PWN, Keane C, Fitzgerald P, Moss N, Whelton MJ, Unit GI, Watt PCH, Patterson CC, Kennedy TL, Anderson MC, Delaney PV, Gilmartin D, Rhatigan M, Duggan J, Osborne DH, Walsh TN, Alderson D, Farndon JR, Johnston IDA, Given F, Flanagan PV, O’Higgins N, McGeeney KF, Naughton PM, Duignan JP, Morrissey B, O’Malley E, Collins BJ, McFarland RJ, Sloan J, Love AHG, Spense RAJ, Johnston GW, Odling-Smee GW, Walters JW, McCarthy CF. Irish Society Of Gastroenterology 21st Anniversary Year Meeting, November 1983. Ir J Med Sci 1985. [DOI: 10.1007/bf02937364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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O'Hare MM, Huda I, Sloan JM, Kennedy TL, Buchanan KD. Characterization of immunoreactive forms of pancreatic polypeptide in islet cell tumors using antisera with different regional specificities. Cancer 1985; 55:1895-8. [PMID: 2983868 DOI: 10.1002/1097-0142(19850501)55:9<1895::aid-cncr2820550910>3.0.co;2-s] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Tumor tissue from a heterogeneous group of patients with clinically and histologically diagnosed islet cell tumors has been assessed for pancreatic polypeptide (PP) content using radioimmunoassay. Immunoreactive forms of PP, obtained by gel filtration of tissue extracts, were detected using antisera with different regional specificities. Normal pancreatic tissue contained one form of PP coeluting with human PP whereas, tumor tissue from patients with insulinoma, Zollinger-Ellison, and WDHA (watery diarrhea hypokalemic achlorhydric) syndromes contained, in addition, higher molecular weight forms of immunoreactive PP. Furthermore, a lower molecular weight form was detected in tumor tissue from a Zollinger-Ellison syndrome patient. The high molecular weight forms of immunoreactive PP were not recognized using a C-terminal-specific antiserum, whereas the smaller form was only detected using this antiserum. The variation in cross-reactivity observed with two antisera in this study emphasizes the limitations of using a single antiserum to detect molecular forms of peptide hormones, particularly those in islet cell tumors.
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37
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Irwin ST, McIlrath EM, Kennedy TL. Burhenne technique for extraction of retained biliary calculi. J R Coll Surg Edinb 1985; 30:39-42. [PMID: 3989760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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McGonagle M, Kennedy TL. Laryngospasm induced pulmonary edema. Laryngoscope 1984; 94:1583-5. [PMID: 6503578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Two case reports of laryngospasm-induced pulmonary edema following general anesthesia are presented. Therapy consisted of immediate reintubation, application of positive pressure ventilation, and diuresis. This phenomenon should be recognized rapidly with appropriate therapy instituted immediately to avoid other complications. Preventive measures are discussed and a modified protocol of the management is outlined.
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Abstract
A case of metastatic phaeochromocytoma is presented. Meta-iodobenzylguanidine was used to locate the tumour but failed to show two functioning abdominal metastatic deposits. Although meta-iodobenzylguanidine appears to be highly specific for phaeochromocytoma, a negative scan does not exclude a functioning tumour with confidence.
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Kernohan RM, Anderson JR, McKelvey ST, Kennedy TL. A controlled trial of bipolar electrocoagulation in patients with upper gastrointestinal bleeding. Br J Surg 1984; 71:889-91. [PMID: 6388722 DOI: 10.1002/bjs.1800711128] [Citation(s) in RCA: 53] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
We have assessed the value of the BICAP electrocoagulation probe in reducing the incidence of further bleeding in patients with upper gastrointestinal haemorrhage. One hundred and twenty-nine patients were studied in a prospective randomized controlled trial. There were 85 male and 44 female patients, age range 16-92 years. Forty-five patients had stigmata of recent haemorrhage (visible vessel or spot) and were randomized during endoscopy to 24 control and 21 treatment patients. Seven control patients rebled compared with nine treated patients (Fisher's exact probability test P = 0.44). The transfusion requirements of control patients (3.9 +/- 3.2 units) was not different from that of treated patients (5.7 +/- 3.7 units): Mann Whitney U test, P = 0.06. In the treatment group there was no difference in the operation rate. Also, the number of probe applications between patients with further bleeding and those with no further bleeding was similar (11.6 +/- 5.5 and 11.0 +/- 5.75 respectively). Access with the probe was considered inadequate in 50 per cent of lesions, but this did not correlate with the incidence of rebleeding. Stigmata of recent haemorrhage were significant in predicting rebleeding (P = 0.0019 Fisher's exact probability test). Overall mortality rate of 3.2 per cent was low and was not influenced by electrocoagulation or presence of stigmata of recent haemorrhage. We have not shown that BICAP bipolar electrocoagulation reduces the incidence of rebleeding in upper gastrointestinal haemorrhage.
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41
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Neilan GE, Kennedy TL. Simplified method of preparing lactate-free peritoneal-dialysis solution. Am J Hosp Pharm 1984; 41:1994, 1996. [PMID: 6496483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Manolas KJ, Farmer HM, Wilson HK, Kennedy AL, Joplin GF, Montgomery DA, Kennedy TL, Welbourn RB. The pituitary before and after adrenalectomy for Cushing's syndrome. World J Surg 1984; 8:374-87. [PMID: 6087575 DOI: 10.1007/bf01655082] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Abstract
Seven hundred and thirty five patients who underwent elective vagotomy and drainage procedures in one hospital during 1957-67 were followed up until 1 September 1982. At this time 281 were dead compared with an expected 184. This gives a ratio of observed to expected deaths of 1.53 (p less than 0.0001). The most important cause of increased mortality was lung cancer, which accounted for 33 of the excess deaths (observed to expected ratio 3.53). Gastric cancer yielded an observed to expected ratio of 3.3. Other causes of death that were significantly more common than expected were cerebrovascular accident, bronchopneumonia, and colorectal cancer. It is concluded that although gastric cancer occurs more commonly after vagotomy and drainage than in the general population, it is not as important a cause of death as diseases related to smoking.
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Watt PC, Sloan JM, Donaldson J, Campbell G, Kennedy TL. Relation between gastric histology and gastric juice pH and nitrite and N-nitroso compound concentrations in the stomach after surgery for duodenal ulcer. J Clin Pathol 1984; 37:511-5. [PMID: 6725597 PMCID: PMC498771 DOI: 10.1136/jcp.37.5.511] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Formation of N-nitroso compounds in gastric juice has been implicated in the pathogenesis of cancer in the stomach after operation. Gastric juice was aspirated from 85 subjects: 23 were controls, 51 had previously undergone vagotomy and gastrojejunostomy, and 11 had previously undergone vagotomy and pyloroplasty. The gastric juice samples were analysed for pH, nitrite, and total N-nitroso compounds. A significant correlation was found between pH and nitrite concentration (p less than 0.01). No significant correlation was found between pH and total N-nitroso compound concentration or between nitrite and N-nitroso compound concentration. The vagotomy and gastrojejunostomy patients had higher pH values and higher concentrations of nitrites and N-nitroso compounds than controls (p = 0.01 in all cases). The 51 vagotomy and gastrojejunostomy patients also underwent endoscopy and biopsy. They were divided into three groups: group 1 (21 patients) had no intestinal metaplasia and no more than mild dysplasia; group 2 (20 patients) had intestinal metaplasia; and group 3 (10 patients) had moderate or severe dysplasia. Groups 2 and 3 both had higher pH values and higher nitrite concentrations than group 1 (p = 0.01 in all cases). There was no significant difference, however, between either group 2 or 3 and group 1 for total N-nitroso compound concentration. Since there was no simple linear relation between pH and N-nitroso compound concentration, it was concluded that formation of N-nitroso compounds at high pH was unlikely to be involved in the pathogenesis of gastric cancer in the hypochlorhydric stomach after operation. The relation between nitrite and histological abnormality was not associated with a similar relation between N-nitroso compounds and histological abnormality. It therefore appears that there is no simple relation between N-nitroso compounds and the pathogenesis of premalignant gastric mucosal changes.
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Abram WP, Jones F, McGuigan M, Corbally N, Malone JF, Mothersill C, Seymour C, Martin WMC, Mulgrew S, Moriarty M, Bailey D, Duignan JP, Morrissey B, Crowe J, Lennon J, O’Malley E, Atkinson RJ, Lowry WS, O’Loughlin G, Herity N, Blake P, Conroy R, Buchanan KD, O’Hare MMT, Kennedy TL, Hadden DR, Thornes RD, Reynolds M, McCann SR, McCormick D, Clarke R, VandenBerg HW, Murphy RF, McCluskey DR, Russell RJ, Earls BJP, VandenBerg HW, Wilson R, Kennedy DG, O’Hare MMT, Huda I, Gibbons JRP, Kennedy TL, Buchanan KD, Johnston CF, Shaw C, Buchanan KD, Headon BB, Reen DJ, Kennedy DG, VandenBerg HW, Murphy RF, Lowry WS, Rottger J, O’Reilly D, Mullins L, McCarthy M, Collins JK, Seymour CB, Mothersill C, Moriarty M, Malone JF, Conere TJ, El-Badawi MG, Koriech O, Horton PW, Gordon L, Lowry WS, Wallace I, Meldrum RA. Irish association for cancer research. Ir J Med Sci 1984. [DOI: 10.1007/bf02939824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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46
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Watt PC, Sloan JM, Kennedy TL. Relation between intragastric bile acid concentration and mucosal abnormality in the stomach after vagotomy and gastroenterostomy for duodenal ulcer. J Clin Pathol 1984; 37:506-10. [PMID: 6725596 PMCID: PMC498770 DOI: 10.1136/jcp.37.5.506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
A high incidence of possible premalignant conditions of the gastric mucosa has been reported in the postoperative stomach and it has been suggested that bile plays a role in their pathogenesis. Fifty eight patients who had had a vagotomy and gastrojejunostomy between 1957 and 1967 underwent endoscopy and biopsy. Subsequently, samples of fasting and postprandial gastric juice were taken from all patients for analysis of total bile acid. The patients were divided into three histological groups: group 1 (24 patients) had gastritis or mucosal atrophy but no more than mild dysplasia; group 2 (23 patients) had intestinal metaplasia in one or more biopsies; group 3 (11 patients) had moderate or severe dysplasia in one or more biopsies. Group 2 and group 3 patients had higher fasting intragastric bile acid concentrations than group 1 (p less than 0.01 in both cases). There was no difference between fasting bile acid concentrations in groups 2 and 3. In the postprandial phase groups 2 and 3 also had higher peak intragastric concentrations than group 1 (p less than 0.01 in both cases). Again, there was no significant difference between groups 2 and 3. It is concluded that there is a relation between mucosal abnormality in the postoperative stomach and intragastric bile acid concentration. The possible aetiological link between bile acid and these mucosal abnormalities is discussed.
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47
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Watt PCH, Sloan JM, Kennedy TL. When is biopsy of the stomach ethical? West J Med 1984. [DOI: 10.1136/bmj.288.6422.1006-e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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48
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Drury RR, Cregan D, Keenan P, Murphy M, Drury MI, Reeves WG, Kennedy L, Manolas K, Wilson K, Montgomery DAD, Joplin GJ, Kennedy TL, Welbourn RB, Byrne M, Skrabanek P, Tempany E, Powell D, Beacom R, Middleton D, Sawhney B, Noonan N, Tomkin GH, Hutchinson M, Kingston SM, Collins WCJ, Bell PM, Hayes JR, Hadden DR, O’hanrahan TJ, Dervan P, Heffernan SJ, McMullan NM, Smyth PPA, Curtis JA, Baily JD, Bain J, Sequeira S, McKenna TJ, Sullivan PA, DeQuattro V, Foti A, Atkinson AB, Carson DJ, Kennedy H, Woods AL, Sheridan B, O’Hare JA, Ferriss JB, Brady D, Twomey BM, O’Sullivan DJ, Lyons TJ, Postlethwaite W, Svheridan B, Woodhead JS, Sinnamon DG, Traub AI, Thompson W, Neylan D, O’Donovan DK, McMullan N, Blair ALT, Wilson EA, Merrett JD, Weaver JA, Osterberg PH, Magee B, Hadden. Irish endocrine society. Ir J Med Sci 1984. [DOI: 10.1007/bf02942004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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49
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Watt PC, Sloan JM, Donaldson JD, Patterson CC, Kennedy TL. Relationship between histology and gastric juice pH and nitrite in the stomach after operation for duodenal ulcer. Gut 1984; 25:246-52. [PMID: 6698440 PMCID: PMC1432297 DOI: 10.1136/gut.25.3.246] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
One hundred patients who had undergone operation for duodenal ulcer (68 vagotomy and gastroenterostomy; seven vagotomy and pyloroplasty; 22 gastrectomy and three gastroenterostomy) 10 or more years previously each underwent endoscopy. Biopsies were taken and gastric juice aspirated for measurement of pH and nitrite concentration. Patients were divided into five histological grades; chronic superficial gastritis (+/- minimal atrophic gastritis) (35), atrophic gastritis/intestinal metaplasia (30), mild dysplasia (21), moderate/severe dysplasia (13) and carcinoma (one). A wide spectrum of pH values was found with 35 patients having a fasting intragastric pH below 4.0 and 65 above 4.0. A strong relationship was found between histological grade and pH. Patients with chronic superficial gastritis had a fasting intragastric pH below 4.0 more frequently than those with moderate/severe dysplasia (p less than 0.001). Gastric juice nitrite concentrations were higher in the moderate/severe dysplasia group than in the chronic superficial gastritis group (p = 0.02). The strong correlation between pH and nitrite concentration, previously documented, was confirmed. The implications of these findings in the pathogenesis of carcinogenesis in the postoperative stomach are discussed.
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Hirszel P, Yamase HT, Carney WR, Galen MA, Graeber CW, Johnson KJ, Kennedy TL, Lapkin RA, McLean RH, Rosenworcel E. Mesangial proliferative glomerulonephritis with IgM deposits. Clinicopathologic analysis and evidence for morphologic transitions. Nephron Clin Pract 1984; 38:100-8. [PMID: 6382035 DOI: 10.1159/000183289] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
To determine the natural history of mesangial proliferative glomerulonephritis (MesPGN) with IgM deposits and its relationship to minimal change disease (MC) and focal segmental glomerulosclerosis (FGS), we studied the clinical characteristics and outcome in 20 patients with MesPGN, 8 with MC, and 10 with FGS. IgM deposits were present in glomeruli of all MesPGN patients. Progression to FGS was documented in 2 patients with MesPGN, 1 of whom developed renal failure. Transition from MC to MesPGN occurred in 1 patient. 2 MC patients developed FGS, with decline in renal function in 1 of them. These data suggest the possibility of histologic transition from MC to FGS directly or through the stage of MesPGN.
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