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Biomedical subjects

D Morris

Publications and source records attributed to D Morris.

At least 181 records · Page 10Linked to original sources
PubMed1985

A randomized trial of photocoagulation or injection sclerotherapy for the treatment of first- and second-degree hemorrhoids.

One hundred thirty-five patients with a diagnosis of hemorrhoids were randomized to receive either photocoagulation (P) (N = 73) or injection sclerotherapy with phenol (I) (N = 62). Each patient was assessed at one, four, and 12-month intervals after treatment. At one, four, and 12 months, there was no clinical difference between the groups; at 12 months, however, the proportion of patients who were symptomatically improved or asymptomatic was 59 percent after photocoagulation compared with 50 percent of those treated by injection (P = 73 percent; I = 50 percent). Seven patients treated by photocoagulation required repeated therapy compared with only one after injection (P less than 0.02). Additional therapy was used in eight patients after photocoagulation, as compared with three after injection. The operation rate for each group, however, was similar. There were no complications of therapy. Photocoagulation is an easy, non-invasive, safe method of treatment, giving results that are comparable to treatment by injection sclerotherapy.

Adult↗
PubMed1985

A format for integrating the interpretation of exercise ejection fraction and wall motion and its application in identifying equivocal responses.

The conventional interpretation of ejection fraction change with exercise may be limited because it does not consider the rest value, define equivocal responses or integrate wall motion data reproducibly. Thus, a format was developed for combined interpretation of rest and exercise radionuclide ejection fraction and wall motion by reviewing the reported data for the exercise responses of patients without prior myocardial infarction. The ejection fraction data of 202 normal patients and of 259 patients with coronary artery disease were first fitted to beta distributions. The true positive and false positive rates for coronary disease for each combination of rest and exercise ejection fraction were then determined directly from these distributions. A given rest/exercise ejection fraction combination was "normal" if the false positive rate was greater than the true positive rate, or "abnormal" if the true positive rate was greater than the false positive rate, and "equivocal" when the rates were similar (within a 50% confidence interval). This analytic format, which predicted an inverse relation between rest ejection fraction and the change required with exercise, was then validated prospectively in 854 patients without myocardial infarction (557 with and 297 without angiographic coronary artery disease). Using the conventional criterion of an abnormal test result (less than 0.05 absolute rise in ejection fraction with exercise or a wall motion abnormality), sensitivity was 85 +/- 2% and specificity only 42 +/- 3%. The statistical format had a sensitivity of 70 +/- 2% and specificity of 70 +/- 3%, resulting in a twofold increase in information content. This format has at least two advantages over conventional interpretation: 1) it provides an explicit definition of equivocal responses; and 2) it reproducibly integrates discordant ejection fraction and wall motion responses and allows for the combined analysis of other nonscintigraphic observations, such as age and sex.

Adult↗
PubMed1985

A longitudinal study of bronchodilator responsiveness in cystic fibrosis.

The prevalence of bronchodilator responsiveness was evaluated in 20 outpatients with cystic fibrosis (CF) every 1 to 3 months for a 1-yr period and in 20 patients with CF during a hospital admission. All but 1 subject (95%) showed a significant bronchodilator response at least once on an outpatient basis; nonhospitalized subjects were responsive 49% of the time. Bronchodilator responsiveness was unrelated to long-term pulmonary severity or indexes of atopy but it was significantly influenced by season of the year; 70% of the population was responsive in winter compared with 25% in summer. Bronchodilator responsiveness increased during hospital admission together with improvement in baseline values; 23% of the population was responsive during the first 3 days compared with 80% by the end of the second week of admission. After discharge, a reverse pattern occurred, with decrease in bronchodilator responsiveness and a fall in baseline values. However, in some patients, bronchodilator responsiveness was lost when baseline values were still at their best. Bronchodilator responsiveness in CF tends to undulate with pulmonary exacerbations of the disease.

Adolescent↗
PubMed1984

Intragastric N-nitrosation is unlikely to be responsible for gastric carcinoma developing after operations for duodenal ulcer.

Three groups of patients studied after operations which had cured their duodenal ulcer were compared with a control group (no operation, n = 8). The surgical procedures included: proximal gastric vagotomy (n = 7), truncal vagotomy and pyloroplasty (n = 7), truncal vagotomy and antrectomy (n = 8). Samples of gastric juice were aspirated half hourly or hourly over 24 hours for measurement of pH, counts of all identified bacteria, nitrite and total N-nitrosocompounds. Although the pH over 24 hours was significantly higher after proximal gastric vagotomy (p less than 0.05) and truncal vagotomy and antrectomy (p less than 0.001) than controls, there was no difference between truncal vagotomy and pyloroplasty and controls. Counts of nitrate reducing bacteria over 24 hours were also significantly higher after truncal vagotomy and antrectomy than controls (p less than 0.1) but no differences were observed between the other groups. Only after truncal vagotomy and antrectomy was nitrite over 24 hours significantly increased compared with controls (p less than 0.01). Despite these higher values after truncal vagotomy and antrectomy, there was no significant difference in total N-nitrosocompounds between any of the four groups. Whereas bacterial counts and nitrite increased with pH, no correlation was found between total N-nitrosocompounds and pH. These results provide no evidence that exposure to total N-nitrosocompounds is increased after operations for duodenal ulcer.

Bacteria↗
PubMed1984

Cyclohexanone extraction: an improvement in the thiobarbituric acid method for the determination of nonenzymatic glycosylation of hair and epidermal keratin.

Colorimetric techniques such as the thiobarbituric acid assay are widely used for the determination of nonenzymatic glycosylation of proteins. One of the major problems associated with this technique is the high nonspecific background absorbance which, due to its variability, results in loss of sensitivity. This report describes a method of removing the nonspecific absorbance by extracting the final chromogen into cyclohexanone. Using this method for the determination of nonenzymatic glycosylation of hair and epidermal keratin, at least 90% of the background absorbance is removed, increasing the sensitivity of the technique. This allows more effective discrimination of the level of glycolsylation of proteins from control and diabetic patients, by reducing the degree of overlap. The requirement for individual borohydride reduced samples is also avoided, thus simplifying the technique. Cyclohexanone extraction provides a simple addition to the standard thiobarbituric acid technique with significant improvement in results.

Aged↗
PubMed1984

Alternative referent standards for cardiac normality. Implications for diagnostic testing.

The radionuclide ventriculographic exercise response was evaluated in three patient populations representing alternative referent standards for cardiac normality: patients with normal coronary arteriograms, healthy volunteers, and uncatheterized patients with a low probability of coronary artery disease. Disease probability was determined by Bayesian analysis of age, sex, symptoms, and the results of cardiac fluoroscopy, exercise electrocardiography, or thallium scintigraphy. A wide range of ventriculographic responses was noted in the 62 catheterized normal patients; 21 (34%) had an abnormal ejection fraction response and 22 (35%) had an abnormal wall motion response. In contrast, the ejection fraction and wall motion responses were normal in the 9 volunteers. In 90 patients (18 catheterized and 72 uncatheterized) who had low disease probability (less than 1%), abnormal responses were rare; the ejection fraction response was abnormal in only 7% and the wall motion response was abnormal in 8%. Thus, these three populations are not equivalent referent standards of normality. Volunteers and patients with low disease probability provide too strict a standard, and their use can overestimate test specificity; catheterized normal patients, on the other hand, provide too lenient a standard, and their use can underestimate test specificity.

Adult↗
PubMed1983

The declining specificity of exercise radionuclide ventriculography.

Although exercise radionuclide ventriculography was initially reported to be a highly specific test for coronary-artery disease, later studies reported a high false-positive rate. To verify this turnabout, we analyzed the responses in 77 angiographically normal patients; 32 were studied from 1978 to 1979 (the early period), and 45 from 1980 to 1982 (the recent period). Most patients studied in the early period had normal responses (94 per cent for ejection fraction and 84 per cent for wall motion). In contrast, normal responses were less frequent in patients studied in the recent period (49 per cent for ejection fraction and 36 per cent for wall motion, P less than 0.001). The probability of coronary disease before testing was higher in these patients (38 vs. 7 per cent, P less than 0.001). More patients studied in the recent period underwent radionuclide ventriculography before angiography (78 vs. 22 per cent, P less than 0.001), and more of these prior studies had abnormal results than those performed after angiography (55 vs. 6 per cent, P less than 0.0001). Thus, two factors are responsible for the temporal decline in specificity: a change in the population being tested (pretest referral bias) and a preferential selection of patients with a positive test response for coronary angiography (post-test referral bias).

Adult↗
PubMed1983

Incidence of the luteinized unruptured follicle phenomenon in cycling women.

A prospective study is presented in order to determine the frequency of the luteinized unruptured follicle (LUF) in a population of 66 regularly cycling women. They were monitored by daily ultrasound for a total of 183 cycles, and the LUF was detected in 9 cycles, giving an incidence of 4.9%. The results of daily changes of luteinizing hormone, estradiol, and progesterone provide support for the thesis that the LUF behaves steroidogenically as a corpus luteum and that the luteal phase duration is normal. Continued monitoring in 35 cycles revealed a recurrence in only one case during a fourth subsequent cycle. Thus, the findings indicate that the LUF is a sporadic and infrequent phenomenon. It is therefore an uncommon cause of infertile cycles in potentially fertile women and represents a biologic variable rather than a syndrome. Based on ultrasonic and endocrine observations, a mechanism is proposed for the resolution of the LUF.

Adult↗
PubMed1983

Surgical operation rates: a twelve year experience in Stockton on Tees.

A review of twelve years surgical practice in a district in the North East of England is presented. During this period 63 562 surgical operations were undertaken. Analyses of these operations show that the amount of elective general surgery undertaken has almost doubled and the rate of emergency general surgery has remained remarkably constant. There has been a significant increase in the number of gallbladder, varicose vein and minor general surgical procedures performed. There has also been a significant increase in urological surgery and in orthopaedic surgery which has doubled over the study period.

Adolescent↗