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Biomedical subjects

D M Morris

Publications and source records attributed to D M Morris.

At least 55 records · Page 3Linked to original sources
PubMed1991

Unresectable pancreatic cancer: what is the optimal procedure?

We retrospectively reviewed cases of pancreatic cancer to determine the benefit of various methods of biliary decompression and the role of prophylactic gastroenterostomy (GE) in management. Twenty-seven patients had only biliary bypass, and 26 had biliary bypass and GE. Operative mortality was similar for both groups (22% and 19%, respectively). The complication rates were almost identical (37% and 35%). Differences in operative mortality, incidence of cholangitis, and recurrence of jaundice were not statistically significant between patients having biliary decompression via the common bile duct or the gallbladder. Operative mortality associated with choledochoenterostomy was 33% versus 17% for cholecystoenterostomy. Gastric outlet obstruction developed in 5% of patients who did not have GE. We conclude that cholecystojejunostomy is an effective method of biliary bypass. Because its addition did not seem to increase operative morbidity or mortality, we advocate GE at the initial exploration to prevent gastric outlet obstruction.

Aged↗
PubMed1990

Use of carbon fibers for repair of abdominal-wall defects in rats.

Carbon in the form of 8-micron fibers induces growth of connective tissue. The purpose of this study was to measure and histologically characterize tissue ingrowth occurring in carbon fibers implanted for up to 12 months in abdominal-wall defects in rats, compared with polypropylene mesh. Carbon fibers induced significantly more tissue ingrowth than polypropylene mesh at 6 to 12 months postoperatively. The predominant tissues associated with carbon fibers and polypropylene mesh were dense connective tissue and fat, respectively. Fragmentation of the implants did not occur, and implant debris was not found in the regional lymph nodes. Carbon fibers are potentially useful for reinforcing abdominal-wall defects.

Abdominal Muscles↗
PubMed1990

Preoperative chemotherapy is beneficial for geriatric patients with locally advanced and metastatic breast cancer.

The relationship between aging and drug toxicity has been documented. We reviewed patients with Stage IIIB and Stage IV breast cancer with the primary tumor intact at presentation to compare the toxicity secondary to chemotherapy, the disease-free survival, and the survival in both young and elderly women. Fifty-three patients were studied. All received preoperative chemotherapy and mastectomy as part of treatment for breast cancer. Sixty years was used arbitrarily to divide the patients into two groups. Data were analyzed by unpaired T-test. Hematologic, nutritional, infectious, and cardiac toxicities were noted and compared between groups. Disease-free survival was studied in patients with Stage IIIB disease. Survival was examined in patients with Stage IIIB and Stage IV disease. We could not detect any statistically significant differences between young and elderly patients in any of these groups. The elderly patients in this study seemed to derive as much benefit from chemotherapy as did younger patients.

Adenocarcinoma↗
PubMed1989

Cardiac complications of aneurysm repair.

To assess the early morbidity and mortality from coronary artery disease (CAD), we reviewed the charts of 49 patients who had elective resection of infrarenal abdominal aortic aneurysms between September 1978 and February 1986 at the VA and LSU medical centers in Shreveport. On the basis of history, physical examination, and resting electrocardiogram, patients were divided into two groups--those with clinical evidence of coronary artery disease (group 1, n = 21) and those without clinical evidence of coronary artery disease (group 2, n = 28). End points measured were perioperative (30-day) myocardial infarction (MI) rate and death. A definite MI was diagnosed when an abnormally elevated CPK-MB was accompanied by a new electrocardiographic abnormality or a reversal of the normal LDH isoenzyme pattern. A possible MI was diagnosed when an elevated CPK-MB was the only abnormality. In group 1, one definite (4.5%) and two possible (9.5%) MIs occurred. In group 2, there were no definite or possible MIs. All cardiac events were discovered by measurements of cardiac enzymes, since none of the patients had cardiac symptoms. This retrospective study reveals a low incidence of clinically significant cardiac events after resection of abdominal aortic aneurysms, even in patients with clinical evidence of coronary artery disease. Prophylactic coronary artery bypass surgery does not appear to be necessary for most patients needing repair of an abdominal aortic aneurysm.

Aged↗
PubMed1988

Nerve sheath tumors of the sciatic nerve and sacral plexus.

Eight patients with sciatic nerve and sacral plexus nerve sheath tumors, seen at Louisiana State University Medical Center in Shreveport, are presented. These cases illustrate the broad spectrum of pathology and modes of presentation of patients with nerve sheath tumors in this region. Patients can be divided into 4 groups. Group I includes subgluteal and/or thigh lesions with a well-defined mass on CT. Group II patients have neuroforaminal enlargement (defined by CT) and usually have radicular leg pain. Patients in group III have intrapelvic tumors with extension into the thigh. They usually have a poorly defined mass on CT. Group IV includes patients that have an intrapelvic mass (usually well defined) with radicular leg pain and/or mass effect. CT scanning proved to be the diagnostic procedure of choice. It delineated the location and extent of the tumor and thus was important in determining resectability. The variable course of these tumors is emphasized. A conservative nonoperative approach should be considered in asymptomatic and/or neurologically stable patients.

Adult↗
PubMed1988

Concomitant abdominal aortic aneurysm and malignant disease: a difficult management problem.

Medical records of 158 patients with abdominal aortic aneurysms seen between 1972 and 1984 were reviewed. Twenty patients, or 12.6%, had a histologically proven malignant neoplasm in addition to their aneurysm. The mean age of patients with cancer was 69 yr and for those without cancer, 68 yr. The most common cancers in this study were prostate, colorectal, and lung. Patients were placed in five categories according to the chronological presentation of the malignancy in relation to the aneurysm. Our study indicated that the incidence of malignant disease associated with abdominal aortic aneurysms is increasing. Absolute indications for operation initially on the aneurysm are the presence of symptoms or rupture. Absolute indications for operation initially on the malignancy are complications from the presence of the tumor such as hemorrhage, perforation, or obstruction. The type and stage of the cancer are major factors in determining operative treatment and priorities.

Aged↗
PubMed1988

Shotgun wounds involving the head and neck.

Since limited information is available on the management and spectrum of injuries sustained by patients with shotgun wounds to the head and neck, we reviewed the records of 26 patients with shotgun wounds involving the head and neck region. Fifty-four percent of these patients had associated injuries involving the trunk or extremities, and 43 percent of these patients required repair of these associated injuries. Overall, 23 percent of patients with shotgun wounds of the head and neck region had injuries of other anatomic areas that required operative treatment. In these patients, the major life-threatening injuries were not related to the head and neck region but were related to injuries of other anatomic areas. By stratifying the patients according to the anatomic pattern of injury (point blank, close range, or long range) and their hemodynamic status on presentation to the emergency room, it was possible to predict the need for surgery as well as the risk of death.

Adolescent↗
PubMed1988

Effect of respiratory cycle on measurements of cardiac output by thermodilution.

Current recommendations for obtaining reproducible measurements of cardiac output by thermodilution are contradictory. Several investigators have shown that reproducibility of measurements can be improved by initiating injections at specific moments in the respiratory cycle. We prospectively studied 31 patients, comparing three thermodilution measurements of cardiac output at peak-inspiration, end-exhalation and random in mechanically ventilated patients. Patients were separated into two groups: group 1 was composed of intubated patients on intermittent mandatory ventilation (IMV) without spontaneous overbreathing, and group 2 included patients on IMV with spontaneous overbreathing. The results from this study demonstrated no statistical difference in the ranges or standard deviations of the measurements of cardiac output among injections initiated at random, peak-inspiration or end-exhalation in either group. We conclude that the reproducibility of measurements cannot be enhanced by initiating injections at specific moments in the respiratory cycle.

Analysis of Variance↗
PubMed1987

Release of corrosion products by F-75 cobalt base alloy in the rat. III: Effects of a carbon surface coating.

A pyrolytic carbon coating was applied to F-75 chromium-cobalt-molybdenum alloy in an effort to reduce the release of corrosion products in vivo. After intramuscular implantation in the rat, a complex pattern of serum and urine concentration elevations of chromium, cobalt, and nickel was seen. The carbon-coated implants released more chromium and cobalt than uncoated controls, as seen by significantly elevated metal concentrations in serum and urine. Animals receiving carbon-coated implants showed a high rate of recurrent implant site inflammation. Neoplastic infiltration of 24 animals with coated implants, but not in any of the 16 animals which received either uncoated F-75 microsphere or poly(ethylene) particulate implants.

Alloys↗
PubMed1987

Cranial nerve injuries during carotid endarterectomy.

Our experience with patients undergoing carotid endarterectomy over a 10 year period has been retrospectively reviewed. Nerve injuries were detected by reviewing postoperative progress and clinic notes. One hundred twenty-nine procedures were performed on 112 patients, 12 of whom (9.3 percent) sustained major nerve injuries. These included five vagal nerve injuries causing ipsilateral vocal cord paralysis and hoarseness, four injuries of the marginal mandibular nerve, and three injuries of the hypoglossal nerve. Evidence of nerve dysfunction was not present preoperatively. None of the patients with nerve injury sustained a stroke as a result of carotid operation. Vocal cord paralysis was documented by indirect laryngoscopy. The incidence of cranial nerve injury during carotid endarterectomy appears to be higher than expected, particularly if asymptomatic patients are investigated; however, most injuries are transient and result not from transection but from trauma during dissection, retraction, and clamping of the vessels. The pertinent anatomy and techniques for preventing these injuries have been reviewed.

Carotid Artery Diseases↗
PubMed1987

Effect of incidental appendectomy on the development of wound infection in patients undergoing staging laparotomy for Hodgkin's disease.

Two hundred ten patients were retrospectively studied to evaluate the risk of appendectomy performed during laparotomy for staging of Hodgkin's disease. Seventy-nine patients did not have their appendix removed, and a wound infection developed in 1. One hundred thirty-one patients had an appendectomy, and 7 wound infections occurred in this group. This difference was not statistically significant. No patient died as a consequence of their wound infection, and no intraabdominal infections occurred. Our data suggest that the risk for development of a wound infection after a staging laparotomy for Hodgkin's disease is increased by performing an incidental appendectomy as part of the procedure. Although the differences noted were not statistically significant, this was probably due to the sample size. Based on our data, we do not routinely remove the appendix at the time of staging laparotomy.

Adolescent↗
PubMed1987

Bleeding duodenal ulcer after gastric bypass procedure for obesity.

A patient without previous history of peptic ulcer disease had gastrointestinal bleeding from a duodenal ulcer four years after having a gastric bypass procedure for obesity. The use of the technetium-labeled red blood cell scan helped localize the source of bleeding in this patient after routine endoscopy and barium studies failed to show any abnormality of the upper and lower gastrointestinal tracts. The patient has done well after subtotal gastrectomy for treatment of this disorder.

Duodenal Ulcer↗