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Biomedical subjects

D L Morris

Publications and source records attributed to D L Morris.

At least 325 records · Page 18Linked to original sources
PubMed1987

Accuracy of identification of early gastric cancer.

Two hundred and nineteen patients underwent gastrectomy for cancer in Nottingham University Hospital between January 1978 and December 1985. Twenty of these patients had early gastric cancer (EGC). Barium meal was performed in 15 patients and upper gastrointestinal endoscopy in 15. In all cases, barium meal failed to define the early nature of this disease. Only two lesions were thought to be EGC endoscopically and at laparotomy three were considered to be EGC. As neither radiologist, endoscopist nor surgeon can reliably identify EGC, all patients with gastric cancer in the absence of proven metastases should undergo gastrectomy.

Adenocarcinoma↗
PubMed1987

Pre-operative albendazole therapy for hydatid cyst.

Surgical management of hydatid cyst is associated with recurrence in 10 per cent of patients. The role of perioperative chemotherapy in prevention of recurrence has not been extensively explored. Sixteen patients with Echinoccus granulosus were treated with albendazole 10 mg kg-1 before operation; of fourteen patients who received albendazole for 1 month or more before operation only one (with doubtful therapeutic compliance) had viable protoscoleces, in contrast both of the two remaining patients who received only 1 and 3 weeks therapy had live disease at the time of operation. A 1 month pre-operative course of albendazole kills most if not all protoscoleces within hydatid cysts in man. This may allow pre-operative 'sterilization' of cysts and a reduction in the risk of recurrence.

Albendazole↗
PubMed1987

Selection of patients for surgery following peptic ulcer haemorrhage.

Surgery remains the only widely available and well-proven means of stopping haemorrhage from peptic ulcers and preventing its recurrence but carries an unavoidable morbidity. If surgery is to be used to maximum effect with minimum morbidity, an accurate means of predicting which patients will suffer further haemorrhage is needed. Although over 80 per cent of patients who rebleed have the endoscopic stigmata of haemorrhage, a policy of operation in all patients with stigmata would lead to a very high operation rate and a high proportion of unnecessary operations, as one-half of the patients with stigmata do not rebleed. Clinical data were collected prospectively from 278 cases of peptic ulcer haemorrhage. The data from a randomly selected 75 per cent of the cases were analysed by stepwise logistical regression. Patients who had the endoscopic stigmata of haemorrhage and who had a probability of further haemorrhage, calculated from the regression equation, of more than 0.2 were identified as a high risk group. This definition was validated using the 25 per cent of cases not used in the initial analysis. Eighty-four per cent of patients in the high risk group suffered further haemorrhage and all such patients therefore require early surgery: such a policy would have resulted in an operation rate of 28 per cent. Thirty per cent of the patients who had further haemorrhage were not identified as being at high risk but none of them had a severe rebleed. The regression equation greatly enhanced the value of stigmata in guiding surgical decision making and merits further evaluation.

Aged↗
PubMed1987

A comparison of the effects of albendazole, its sulphone metabolite, and mebendazole on the viability of protoscoleces of Echinococcus granulosus in an in vitro culture system.

The effects of albendazole, its sulphone metabolite and mebendazole on the viability of Echinococcus granulosus protoscoleces in vitro were investigated. Significant reductions in viability occurred in cultures treated with albendazole parent compound at 100 micrograms/litre, but lower concentrations were ineffective. The sulphone metabolite of albendazole had no significant effect at concentrations of 50 and 100 micrograms/litre over periods of up to 71 days. Mebendazole induced significant reductions in viability at 100 micrograms/litre.

Albendazole↗
PubMed1987

Determination of minimum effective concentration of praziquantel in in vitro cultures of protoscoleces of Echinococcus granulosus.

The minimum effective concentration of praziquantel against protoscoleces of Echinococcus granulosus (ovine strain) was determined in vitro; 20 micrograms/litre gave statistically significant results. No difference was seen between the sensitivity of ovine and equine protoscoleces at 50 micrograms/litre. Morphological observations on treated protocsoleces and passage into gerbils both suggested that the eosin-exclusion technique overestimates viability. Electron microscopy of treated protoscoleces showed severe, disruptive tegumentary damage. Praziquantel is thus an extremely active protoscolicidal agent that may have an important peri-operative role in preventing recurrence.

Animals↗
PubMed1987

Magnetic resonance imaging in hydatid disease.

Magnetic resonance imaging was evaluated in 12 patients with hydatid disease (Echinococcus granulosus). Patients also underwent real time ultrasound and computed tomography imaging. Clear images of hepatic hydatid cysts were produced by magnetic resonance imaging, and intracyst structures were demonstrated. Changes in the appearance of cysts were seen following chemotherapy. Whilst not cost effective at present, if further improvements allow differentiation of simple (epithelial) and hydatid cysts or viable and dead hydatid cysts this technique could be of clinical value.

Echinococcosis↗
PubMed1987

Perioperative prophylaxis with sulbactam and ampicillin compared with metronidazole and cefotaxime in the prevention of wound infection in children undergoing appendectomy.

Sulbactam is a beta-lactamase inhibitor, which when administered with ampicillin, increases the latter agents antibacterial activity against beta-lactamase producing organisms. One hundred children between the ages of 5 and 14 undergoing emergency appendectomy were entered into a prospective randomized trial comparing sulbactam and ampicillin (SA) with metronidazole and cefotaxime (MC) as prophylaxis against postoperative wound infection. Patients in whom the appendix was perforated or gangrenous received a 72-hour course of antibiotics, others received a single dose only. The overall wound infection rate was 8% (14% in patients with perforation or gangrene and 4% in those without). There was no difference in infection rate between the two antibiotic groups; there were three wound infections and one subphrenic abscess in patients receiving SA and four wound infections in patients receiving MC. SA, therefore, appears to be a suitable antibiotic combination for use as prophylaxis in appendicitis in children.

Adolescent↗
PubMed1987

Increased cerebrospinal fluid beta-endorphin immunoreactivity in infants with apnea and in siblings of victims of sudden infant death syndrome.

To gain further insight into the possible role of endogenous opioid peptides in the respiratory difficulties associated with the apnea of infancy and other disorders possibly related to apnea, the levels of beta-endorphin immunoreactivity were measured in the cerebrospinal fluid (CSF) of five groups of infants: (1) infants with proved apnea, (2) infants with histories of an apparent life-threatening event (ALTE), (3) siblings of victims of the sudden infant death syndrome (SIDS), (4) infants with suspected but unproved apnea, and (5) infants undergoing investigation for other acute illnesses. Twenty-two infants considered at risk for an ALTE (groups 1 to 3) had significantly higher CSF beta-endorphin equivalents (88 +/- 7 pg/mL) than did the 22 control patients in groups 4 and 5 (31 +/- 3 pg/mL). Plasma beta-endorphin immunoreactivity, which was also measured in some of the infants, did not correlate with levels in CSF and, in fact, was significantly lower in the groups at risk for an ALTE (50 +/- 9 pg/mL; n = 14) than in the control subjects (80 +/- 6 pg/mL; n = 11). These studies indicate that elevated beta-endorphin immunoreactivity in CSF may be a marker in infants who have apnea and who may be considered at risk for an ALTE.

Adult↗
PubMed1987

Penetration of albendazole sulphoxide into hydatid cysts.

The penetration of albendazole sulphoxide, the principal metabolite of albendazole into hydatid cysts (E granulosus) was measured by means of in vitro animal and clinical studies. The drug freely diffuses across the parasitic membranes. Cyst/serum concentrations of 22% were achieved in patients, longer pre-operative therapy produced higher concentrations.

Albendazole↗
PubMed1987

Electrohydraulic lithotripsy of gall stones--in vitro and animal studies.

Electrohydraulic lithotripsy of human gall stones was investigated in vitro in a bath of saline and in a saline perfused bile duct. The technique was effective--only two stones could not be shattered. Electrohydraulic lithotripsy power requirement correlated with mechanical strength of stones, but not with biochemical composition. A trend toward higher power requirement was recorded with larger stones and stones over 2 cm in diameter could not be fragmented. Safety studies indicated that electrohydraulic lithotripsy was safe, provided the probe tip was not in contact with the bile duct wall. In vivo studies did not show any late effects after 10 days. Electrohydraulic lithotripsy is likely to be useful in the management of biliary calculi.

Animals↗
PubMed1987

Combined chemotherapy and surgery for hydatid bone disease.

Surgical treatment of hydatid bone disease is rarely completely successful because radical excision is only possible at certain sites and secondary infection frequently occurs. Antihelmintic drugs have in the past been only palliative due to poor absorption and consequent low concentration in serum or cysts. We report five patients with Echinococcus granulosus infestation treated with a new chemotherapeutic agent albendazole; in two it was given postoperatively, in two pre-operatively and one child is being followed expectantly. We believe that a combination of chemotherapy and surgery may be efficacious in the treatment of hydatid bone disease.

Adolescent↗