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Biomedical subjects

A G Morgan

Publications and source records attributed to A G Morgan.

At least 91 records · Page 5Linked to original sources
PubMed1986

Prognostic factors in upper G.I. bleeding.

This presentation draws upon the experience of the O.M.G.E. Multi-national Upper G.I. Bleeding Survey, using data collected during 1980-1982 by 185 clinicians from 44 centres in 21 countries to discuss two questions. First, can prognostic factors be identified in patients presenting to hospital with upper G.I. bleeding, and if so what are they? Second, is it possible - by combining the two technologies of endoscopy and computers - to provide an individual patient with a short-term prognostic prediction sufficiently accurate to affect patient management. Amongst 4,010 patients, a number of clinical factors were found to affect short-term prognosis. These included patient age, previous history of heart or liver disease, confusion and dehydration on admission, jaundice, and ascites. Identification of the bleeding source via endoscopy was shown to aid short-term prognosis - especially in the period of the 2nd to 10th days post-admission. Use of computer analysis enabled "high risk" patients to be defined (of whom 63.8% suffered further bleeding and 30.0% died), and also a comparable "low risk" group (of whom only 4% suffered further bleeding and none died). Finally, "time-dependence" studies have been used to identify a group of patients who (by the 2nd day post-admission) have a residual risk of further bleeding sufficiently low (well under 1%) to suggest that considerable resources can be saved by the judicious use of endoscopy and computer science.

Age Factors↗
PubMed1985

Can preliminary screening of dyspeptic patients allow more effective use of investigational techniques?

A total of 1041 patients with undiagnosed dyspepsia were interviewed to determine whether they required investigation for organic disease. The interviewer, a research assistant without medical qualifications, used a standard data sheet. The information obtained was analysed by computer, and, according to the results, patients were predicted to be at high, medium, or low risk. They were then followed up and the final diagnosis was compared with the risk predicted by computer. Patients predicted to be at low risk had a 10% chance of having ulcer disease and a 0.3% chance of having cancer, whereas patients predicted to be at high risk had a 20% chance of having ulcer disease and a 10% chance of having cancer. Appropriate preliminary screening of patients with acute dyspepsia can separate a group at low risk who will require investigation only if their symptoms do not resolve and a group at high risk requiring urgent outpatient consultation.

Duodenal Ulcer↗
PubMed1985

Comparison between ranitidine and ranitidine plus Caved-S in the treatment of gastric ulceration.

In a double blind endoscopically controlled study, 100 patients with gastric ulcers were treated with either ranitidine or ranitidine plus Caved-S. On single therapy, 58% of ulcers were healed at four weeks, 92% at eight weeks and 96% at 12 weeks. Combination therapy did not alter the healing rate, nor improve on the control of dyspeptic symptoms. No difference in healing rate was found between good and poor drug compliance patients. This suggests that ranitidine may be equally effective at lower dosages. Thirty seven patients had developed their ulcer while taking non-steroidal anti-inflammatory drugs. These patients were mainly elderly women who had a higher risk of bleeding (p = 0.006) from a large ulcer (p = 0.009).

Aged↗
PubMed1985

Maintenance therapy: a two year comparison between Caved-S and cimetidine treatment in the prevention of symptomatic gastric ulcer recurrence.

Eighty two patients with an endoscopically healed gastric ulcer, were treated for two years with either Caved-S tablets, two twice daily or cimetidine 400 mg at night. During the first year, 12% (four out of 34) of the Caved-S group and 10% (four out of 41) of the cimetidine group had an ulcer recurrence. By the end of the second year, the recurrence rate was 29% (nine out of 31) in the Caved-S group, and 25% (eight out of 32) for the cimetidine group. Ulcer relapse occurred frequently in patients with either a dyspeptic history of over six months (p less than 0.05), or a past history of a gastric ulcer (p less than 0.001). Ulcers recurred rapidly after maintenance therapy; Caved-S two out of 22; cimetidine seven out of 23, within four months (NS). This study shows that long term maintenance therapy is safe and reasonably effective. The high recurrence rate after stopping treatment suggests that therapy in high risk or elderly patients should be for life.

Adult↗
PubMed1985

Membranous glomerulonephropathy with crescents in systemic lupus erythematosus.

Over a 2-year period percutaneous renal biopsies were carried out on 23 patients with systemic lupus nephritis. When classified by immunofluorescence, and light and electron microscopy, 4 patients had mesangial disease, 1 had focal and segmental proliferation, 5 had diffuse proliferation and 5 had membranous changes. 3 biopsies were unclassifiable with end-stage changes and 5 showed an unusual combination of pure membranous changes in association with significant crescent formation. The outcome of the latter group of patients was uniformly poor. We think that this group represents a distinct histological entity with a poor prognosis.

Adolescent↗
PubMed1985

Widespread crystallisation of paraprotein in myelomatosis.

Two patients with myelomatosis leading to acute renal failure were found at autopsy to have extensive crystalline deposits of paraprotein within the capsular space of the glomeruli, renal tubules and renal blood vessels. In one case, crystalline deposits in the renal arteries had caused infarction of both kidneys. Both patients had extensive paraprotein deposits in the heart and in other tissues, leading to myocardial infarction in one case. This patient also had extensive pulmonary deposits of paraprotein without a local plasma cell infiltrate, an appearance which has not been described before. Crystalline deposition does not appear to be specifically associated with a single class of paraprotein. This type of disease, affecting many organs, may be more common than has generally been appreciated and should be considered as a cause of otherwise unexplained organ failure in patients with myelomatosis.

Acute Kidney Injury↗
PubMed1984

Glomerular function and hyperuricaemia in sickle cell disease.

Renal insufficiency is common in adults with homozygous sickle cell disease, and the contribution of glomerular failure to the hyperuricaemia which is often a feature of the disease has therefore been investigated. In a study of 64 patients between the ages of 15 and 66, serum urate concentration was dependent on renal urate clearance and also on creatinine clearance. The relation between serum urate and creatinine clearance was abnormal in patients with sickle cell disease and it is suggested that this might be caused by high single nephron glomerular filtration rates. Both the amount of urate excreted per millilitre of glomerular filtrate and the fractional excretion of urate increased with falling creatinine clearance, suggesting that the ability to increase tubular urate secretion was preserved. Patients with extensive tubular disease as shown by tubular proteinuria had serum urate concentrations which were not significantly different from those of age and sex matched non-proteinuric patients. Evidence that renal tubular disease interferes with urate secretion and causes hyperuricaemia in patients with sickle cell disease needs to be reinterpreted in the light of these findings.

Adolescent↗
PubMed1984

O.M.G.E. International Upper Gastro-intestinal Bleeding Survey 1978-1982.

This presentation describes a further survey conducted under the auspices of the O.M.G.E. Research Committee; an international survey of over 4000 patients presenting to 185 clinicians in 44 centres in 21 countries. This multinational survey has been the first in this area of medicine to use specifically designed proformata and pre-agreed definitions of terminology, alongside automated data analysis. A total of 4073 patients' data were forwarded from the 44 centres, the vast majority (4010, 98.5%) containing acceptable data from subsequent analysis. As regards diagnosis, 36% of patients had peptic ulceration, 13% had varices and 6% gastric erosions as sole cause of their bleeding: 22% had multiple pathology (the most common combination being hiatus hernia and peptic ulceration). The diagnostic breakdown varied however from centre to centre. Detailed computer-aided studies show it is currently impossible to determine the source of bleeding without recourse to high technology such as radiological or endoscopic intervention. If identification of the source of the bleeding is desirable clinically, then these high technology investigations must be employed. As regards prognosis, a computer program has enabled categorisation of patients into risk categories as regards further or continued bleeding or death. This program has been tested on 2623 patients with considerable accuracy. In the computer's 'high risk' category, 60% of patients re-bled and 32% died. Conversely in the 'very low' risk category, only 4% re-bled and no patient died. These findings have enabled the construction of a simple prognostic system for use in remote areas, Initial testing (in Sikkim) indicates such a system may be of real value. Finally, immediate treatment and outcome were studied in 4010 patients. As regards management, roughly four fifths (82.7%) were transfused, 85% came to endoscopy (65.3% coming to endoscopy within 36 h of their admission to hospital) and 8.5% came to surgery. The overall death rate was low (8.3%) but amongst patients who bled further, the mortality was 30.7%--these factors being influenced by diagnosis rather than centre. The high mortality rate on conservative treatment and relatively low post-operative mortality, perhaps argue a case for more aggressive investigation and treatment.

Diagnosis, Computer-Assisted↗
PubMed1984

Proteinuria and glomerular disease in Jamaica.

Clinical, laboratory and renal biopsy data on 50 adult patients investigated in Jamaica because of proteinuria of more than 1 g/day were reviewed. Primary glomerular disease was present in 23 cases and the most common histological pattern was mesangial proliferation. Proteinuria was part of a systemic disease in 27 patients of whom 19 had systemic lupus erythematosus (SLE). Urinary protein excretion was less in patients with systemic diseases than in those with primary glomerulonephritis, but hypoalbuminemia, renal function and presence of edema were not helpful in distinguishing types and causes of renal disease. By comparison with other countries SLE and mesangial proliferative glomerulonephritis are common causes of proteinuria and nephrotic syndrome in Jamaica whereas idiopathic membranous glomerulonephropathy appears to be rare.

Adolescent↗
PubMed1983

Controlled trial of calcitriol in the prevention of bone disease in haemodialysed patients.

Seventy-six patients receiving regular haemodialysis, without biochemical or radiological evidence of renal osteodystrophy, entered a five-year double-blind placebo-controlled trial of calcitriol (1,25-dihydroxycholecalciferol) in the prevention of bone disease. Significantly more patients on placebo developed bone disease as judged by a sustained elevation of plasma alkaline phosphatase or the development of sub-periosteal erosions on hand radiographs. Serum parathyroid hormone fell significantly in the patients receiving calcitriol and was significantly lower than in patients receiving placebo. It is concluded that calcitriol delays and may prevent the development of metabolic bone disease in patients receiving regular haemodialysis therapy.

Adolescent↗
PubMed1982

Erythropoietin and renal function in sickle-cell disease.

The relation between haemoglobin concentration, creatinine clearance, and the serum concentration of erythropoiesis-stimulating factor were assessed in 31 patients with homozygous sickle-cell disease. Haemoglobin concentrations fell significantly with decreasing creatinine clearance (r = 0.58, p less than 0.001) and were positively correlated with the concentration of erythropoiesis-stimulating factor (r = 0.65, p less than 0.001). These observations suggest that erythropoietin concentration is the factor limiting production of red cells in sickle-cell disease with renal insufficiency and have implications for treatment.

Adolescent↗
PubMed1982

Hemodynamic improvement after peritoneovenous shunting in nephrogenic ascites.

A patient being treated by regular hemodialysis for end-stage renal failure had nephrogenic ascites. Despite attempts at fluid removal by ultrafiltration, progressive hypotension and low cardiac output eventually reduced fistula flow so much that hemodialysis became almost impossible. The insertion of a peritoneovenous shunt resulted in reduction of ascites and 78% increase in cardiac output, with consequent correction of hypotension and improvement of fistula flow. Peritoneovenous shunting is a simple and beneficial form of treatment for nephrogenic ascites that does not respond to fluid removal by dialysis.

Ascites↗
PubMed1982

Comparison between cimetidine and Caved-S in the treatment of gastric ulceration, and subsequent maintenance therapy.

One hundred patients with benign gastric ulceration were treated in a single-blind, endoscopically controlled trial to assess the relative efficacy of cimetidine (1 g daily) and Caved-S (six tablets daily). Ulcer healing was assessed after six weeks' treatment, and, if incomplete, after a further six weeks. There was no significant difference between the two drug regimens (approximately 63% at six weeks and 91% at 12 weeks). If an ulcer remains unhealed after 10 weeks' treatment the patient should undergo surgery. There was no difference in the relief of day pain between the two drug regimens but cimetidine was more effective over the first two weeks of treatment relieving night pain, than was Caved-S (p less than 0 . 02). After ulcer healing, drug dosage was reduced (cimetidine to 400 mg at night and Caved-S to two tablets twice daily). So far, 56 patients, 28 in each group, have completed the first year's maintenance treatment, and there have been four ulcer recurrences in each group (14%).

Aged↗