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Biomedical subjects

C R Morris

Publications and source records attributed to C R Morris.

96 records · Page 6Linked to original sources

Gonococcal arthritis in an era of increasing penicillin resistance. Presentations and outcomes in 41 recent cases (1985-1991).

BACKGROUND: To assess the impact of recent reports of disseminated gonococcal infection caused by penicillin-resistant organisms, we reviewed the presenting features, clinical course, and outcomes of a group of patients with gonococcal arthritis treated in recent years. METHODS: We reviewed the records of all cases of acute arthritis associated with a culture positive for Neisseria gonorrhoeae at our institution from July 1985 through December 1991. RESULTS: Forty-one cases were identified. Patients included 34 women and 38 blacks; the mean age was 22.6 years. Duration of symptoms averaged 4.8 days at presentation. Other features included migratory arthralgias (n = 27), urogenital symptoms or signs (n = 26), fever (n = 21), and skin lesions (n = 16). Comorbid conditions included intravenous drug use (n = 8) and systemic lupus erythematosus (n = 3). The knee was the most commonly affected joint. Positive culture results were obtained from 32 urogenital samples (86%), 14 synovial fluid samples (44%), seven rectal samples (39%), four blood samples (12%), and two throat samples (7%). All synovial fluid samples with positive culture results had white blood cell counts higher than 20.0 x 10(9)/L. Response to therapy with penicillin and/or ceftriaxone was prompt, and mean duration of hospitalization was 5.8 days. Patients who required longer hospitalization had a higher mean erythrocyte sedimentation rate and higher frequencies of positive synovial fluid culture results and comorbid conditions. Penicillin sensitivity could be determined in 30 patients on the basis of clinical response or in vitro testing. Among these patients, two cases of penicillin-resistant organisms were identified, one beta-lactamase positive and one beta-lactamase negative. CONCLUSIONS: The clinical features of patients with gonococcal arthritis have changed very little since the last large reported series over a decade ago. Underlying conditions appear to be more common, but response to antibiotic therapy and eventual outcome remain excellent. The finding of penicillin-resistant organisms in at least 5% of patients reinforces recent recommendations that third-generation cephalosporin agents be used as initial therapy for disseminated gonococcal infections until drug susceptibilities are known.

Adult↗

Two-week (ten-day) inhalation toxicity and two-week recovery study of phenol vapor in the rat.

The toxicity of phenol vapor was evaluated in male and female Fischer 344 rats (20/sex/group) via flow-past nose-only inhalation exposure. The test animals were exposed to target concentrations of 0 (air control), 0.5, 5.0, or 25 parts per million (ppm) of phenol in air for 6 hours/day, 5 days/week, for 2 weeks. High pressure liquid chromatography (HPLC) measurement of phenol test atmospheres determined mean (+/- standard deviation) analytical concentrations of 0.0 +/- 0.0, 0.52 +/- 0.078, 4.9 +/- 0.57, and 25 +/- 2.2 ppm, respectively. After 2 weeks of exposure, 10 test animals/sex/group were sampled for clinical chemistry and hematology parameters, and then sacrificed. Histopathological examination included the nasopharyngeal tissues, larynx, trachea, lungs with mainstem bronchi, kidney, liver, and spleen. The remaining 10 animals/sex/group were retained for a 2-week recovery period. Recovery groups of animals were evaluated as described previously and then sacrificed. No signs of toxicity in clinical observations (including overt neurological signs), body weights, food consumption, clinical pathology, organ weights, macroscopic pathology or microscopic pathology were seen during the exposures or at either sacrifice interval. In conclusion, 2-week inhalation exposures to phenol vapor at concentrations up to and including 25 ppm did not produce any adverse effects.

Administration, Inhalation↗

Patterns of arginine and nitric oxide in patients with sickle cell disease with vaso-occlusive crisis and acute chest syndrome.

PURPOSE: Our objective was to evaluate L-arginine and nitric oxide metabolite (NOx) levels in children with sickle cell disease (SCD) at steady-state and during vaso-occlusive crisis (VOC). Because alterations in nitric oxide production may have an important role in the pathophysiology of SCD, our second aim was to determine if a relationship exists between these levels and vaso-occlusive crisis (VOC). PATIENTS AND METHODS: Plasma L-arginine and serum NOx levels were examined in 36 patients with SCD with 39 episodes of VOC and 10 children with SCD at steady-state. Daily levels were obtained in children requiring hospitalization. RESULTS: Steady-state L-arginine levels were normal in children with SCD. L-arginine levels were low, however, in children with VOC (37.4 +/- 2.7 vs. 53.6 +/- 4.6 micromol/L; P = 0.008) but returned to baseline during hospitalization. In contrast, NOx levels were normal at presentation but decreased during hospitalization for both patients with VOC and patients with acute chest syndrome (ACS) (21.1 +/- 2.0, 17.4 +/- 2.4, and 12.3 +/- 1.6 micromol/L, respectively; P < 0.05). In the patients with VOC who had ACS develop, L-arginine decreased to the lowest levels at the time of the ACS diagnosis, correlating with decreasing NOx levels. CONCLUSION: These data suggest that there may be a relationship between the L-arginine-nitric oxide pathway and vaso-occlusion in SCD. Low arginine levels during VOC could reflect a state of acute substrate depletion that results in a decrease in nitric oxide production.

Acute Disease↗

How architecture wins technology wars.

Signs of revolutionary transformation in the global computer industry are everywhere. A roll call of the major industry players reads like a waiting list in the emergency room. The usual explanations for the industry's turmoil are at best inadequate. Scale, friendly government policies, manufacturing capabilities, a strong position in desktop markets, excellent software, top design skills--none of these is sufficient, either by itself or in combination, to ensure competitive success in information technology. A new paradigm is required to explain patterns of success and failure. Simply stated, success flows to the company that manages to establish proprietary architectural control over a broad, fast-moving, competitive space. Architectural strategies have become crucial to information technology because of the astonishing rate of improvement in microprocessors and other semiconductor components. Since no single vendor can keep pace with the outpouring of cheap, powerful, mass-produced components, customers insist on stitching together their own local systems solutions. Architectures impose order on the system and make the interconnections possible. The architectural controller is the company that controls the standard by which the entire information package is assembled. Microsoft's Windows is an excellent example of this. Because of the popularity of Windows, companies like Lotus must conform their software to its parameters in order to compete for market share. In the 1990s, proprietary architectural control is not only possible but indispensable to competitive success. What's more, it has broader implications for organizational structure: architectural competition is giving rise to a new form of business organization.

Computer Systems↗