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Biomedical subjects

J Morris

Publications and source records attributed to J Morris.

At least 181 records · Page 10Linked to original sources
PubMed1998

Breast cyst simulating metastases on iodine-131 imaging in thyroid carcinoma.

False-positive radioiodine uptake has been reported in many organ systems. We describe a female patient who had mixed papillary and follicular thyroid carcinoma, and on radioiodine total-body imaging demonstrated focal, lower-right chest uptake. Special prone imaging with the right breast dependent proved that the uptake was inside the right breast. Review of a recent breast ultrasound and mammograms showed this uptake to correspond to a large breast cyst. It is known that 131I breast uptake may be functional within the mammary gland. In this patient, it was due to retention within the cyst after the background activity decreased. Knowledge of this phenomenon may improve the interpretation of total-body 131INa studies.

Breast Neoplasms↗
PubMed1997

Fluidization characteristics of and protein adsorption on fluoride-modified porous zirconium oxide particles.

Porous zirconia particles of specific gravity approximately 3.2 g/ml, mean particle sizes of approximately 50 microns, and terminal settling velocity of approximately 2.8 mm/s in water, were synthesized using an oil emulsion method from 1000 A colloids and were evaluated for their potential use in expanded bed protein adsorption. Expanded beds of particles were stable even for small volume, shallow beds (settled bed: 10 ml, height to diameter ratio < 1.0) and even for fluidization velocities common to much larger particles (210 cm/h for a three-fold bed expansion). When the surface of these particles was modified by fluoride adsorption, the total bed capacity for bovine serum albumin (BSA) adsorption was 42 +/- 2 mg BSA/ml of settled bed volume at linear velocities of 109-210 cm/h. Residence time distribution studies of several solutes under non-binding conditions were performed to assess the degree of liquid mixing and channeling in the expanded bed as a function of fluidization velocity. Liquid mixing and channeling were also studied as a function of distributor design. With these very dense particles, the degree of channeling and mixing did not worsen with the degree of expansion. Elution of adsorbed BSA while the bed was expanded (by a step increase in ionic strength) was rapid resulting in a narrow peak at high fluidization velocities without resorting to settling of the bed. The dynamic binding capacity of BSA at 5% breakthrough (protein effluent concentration equal to 5% of the inlet concentration) was the same for a two-fold expanded bed as for a settled bed (22 +/- 2 mg BSA/ml of settled bed volume), though it decreased for higher bed expansions. BSA binding was reproducible following repeated cleaning of the adsorbent with 0.25 M sodium hydroxide.

Adsorption↗
PubMed1997

Incidence of HIV and HTLV-1 infection among sexually transmitted disease clinic attenders in Jamaica.

Of 970 sexually transmitted disease (STD) patients enrolled at the Comprehensive Health Centre, Kingston, Jamaica, between November 1990 and January 1991, 710 (73%, 333 men and 377 women) were reexamined between January 1992 and July 1993 to estimate the incidence of HIV and HTLV-I infection and to identify risk factors for infection. Of those reexamined, 20% were recruited passively when they returned to the clinic of their own accord, and 80% were recruited actively through field visits to their homes. Passively recruited persons were significantly more likely than active recruits to have had a sexually transmitted disease since enrollment or at their follow-up visit. Seven men and one woman became HIV positive during the period of follow-up. The overall HIV incidence rate was 0.7 per 100 person years (95% confidence interval [CI] = 0.3 to 1.4), 1.4 (CI = 0.6 to 2.8) for men and 0.2 (CI = 0.004 to 0.9) for women. Four of 270 men and 4 of 318 women were HTLV-I positive, an overall incidence of 0.9 per 100 person years (CI = 0.4 to 1.7), 1.0 for men and 0.8 for women. HTLV-I infection was associated with an age of 30 years or older (p < 0.01). The presumed lower transmission probability for HTLV-I may combine with a higher prevalence of HTLV-I in sexual partners to produce similar overall incidence rates for the two infections. The HIV and HTLV-I incidence rates may have been underestimated, because the study subjects who did not return to the clinic may have had a somewhat higher risk. On univariate analysis, there were significant associations between HIV infection in men and drinking alcohol before sex, cocaine use, total number of sex partners, sex with a prostitute since enrollment, ever accepting money for sex, the average number of sex partners per month, bruising during sex, and genital ulcers found on follow-up examination. This analysis needs to be interpreted with caution in view of the small number of seroconverters, which did not allow testing for independent effects in a logistic regression model.

Adult↗
PubMed1997

Screening for prostate cancer: what do general practitioners think?

AIM: To determine how general practitioners in New Zealand view screening for prostate cancer and the extent to which this is undertaken in general practice. METHOD: A questionnaire survey of a random sample of 500 general practitioners. RESULTS: Completed questionnaires were received from 317 of an eligible sample of 462. Approximately 50% believed digital rectal examination (DRE) and prostate specific antigen (PSA) were effective screening tests for prostate cancer and that asymptomatic men should be screened; 40% believed all men aged 50 years or more should be screened using either DRE or PSA. The majority of the general practitioners currently screen at least some of the men aged 50 years or more on their lists using DRE or PSA regardless of beliefs about the efficacy of the tests. The results also indicated that significantly more general practitioners in the age groups 50-59 years and 60 years and over believed asymptomatic patients should be screened with DRE or PSA. CONCLUSION: Despite the absence of evidence to support screening for prostate cancer using DRE or PSA and the increasing number of professional organisations releasing guidelines and statements to that effect, the majority of the general practitioners who participated in this survey are screening some of their patients aged 50 years or more using DRE and/or PSA.

Adult↗
PubMed1997

Breast cancer surgery in New Zealand: consensus or variation?

AIMS: To explore how patients with early breast cancer are managed surgically in New Zealand. METHODS: A questionnaire was mailed to 195 surgeons registered as general surgeons. RESULTS: Replies were received from 112 of the 186 currently working surgeons (60%), of whom 76 indicated that they treated patients with breast disease. Six per cent indicated that they treated > 50 newly diagnosed breast cancer patients in 1994. A minority, 29%, had formal protocols documented for the surgical management of breast cancer patients in their unit. One-third would make the decision about treatment themselves, two-thirds would involve other specialties. Almost all would offer the patient a choice of treatment when this was appropriate. Only 9% would recommend mastectomy for a T1/2NO tumour located in the upper outer breast quadrant. There were no significant differences between surgeons when divided by regional health authority, type of hospital and numbers of patients treated annually. CONCLUSIONS: There appears to be agreement amongst surgeons regarding the preferred form of surgical treatment of patients with stage I or II disease. The results indicate that the surgical treatment of early stage disease is consistent with published guidelines.

Adult↗
PubMed1997

Psychophysiological and modulatory interactions in neuroimaging.

In this paper we introduce the idea of explaining responses, in one cortical area, in terms of an interaction between the influence of another area and some experimental (sensory or task-related) parameter. We refer to these effects as psychophysiological interactions and relate them to interactions based solely on experimental factors (i.e., psychological interactions), in factorial designs, and interactions among neurophysiological measurements (i.e., physiological interactions). We have framed psychophysiological interactions in terms of functional integration by noting that the degree to which the activity in one area can be predicted, on the basis of activity in another, corresponds to the contribution of the second to the first, where this contribution can be related to effective connectivity. A psychophysiological interaction means that the contribution of one area to another changes significantly with the experimental or psychological context. Alternatively these interactions can be thought of as a contribution-dependent change in regional responses to an experimental or psychological factor. In other words the contribution can be thought of as modulating the responses elicited by a particular stimulus or psychological process. The potential importance of this approach lies in (i) conferring a degree of functional specificity on this aspect of effective connectivity and (ii) providing a model of modulation, where the contribution from a distal area can be considered to modulate responses to the psychological or stimulus-specific factor defining the interaction. Although distinct in neurobiological terms, these are equivalent perspectives on the same underlying interaction. We illustrate these points using a functional magnetic resonance imaging study of attention to visual motion and a position emission tomography study of visual priming. We focus on interactions among extrastriate, inferotemporal, and posterior parietal regions during visual processing, under different attentional and perceptual conditions.

Attention↗
PubMed1997

Gamma delta T-cells in human cutaneous immunology.

Gamma delta T-Cells represent a minor subpopulation of T-lymphocytes in man and their role in normal and diseased human skin is unknown. This article is a comprehensive review of T-lymphocytes bearing the gamma delta T-cell receptor in normal and pathological human skin. Firstly, we have documented the occurrence of gamma delta T-cells in normal skin and in a range of reactive and malignant skin conditions. We have then discussed the experimental findings regarding the repertoire used by gamma delta T-cells in normal human skin and in cutaneous disorders with an increased percentage of gamma delta T-cells.

Animals↗
PubMed1997

The natural history of dysphagia following a stroke.

To assess the frequency and natural history of swallowing problems following an acute stroke, 121 consecutive patients admitted within 24 hours of the onset of their stroke were studied prospectively. The ability to swallow was assessed repeatedly by a physician, a speech and language therapist, and by videofluoroscopy. Clinically 51% (61/121) of patients were assessed as being at risk of aspiration on admission. Many swallowing problems resolved over the first 7 days, through 28/110 (27%) were still considered at risk by the physician. Over a 6-month period, most problems had resolved, but some patients had persistent difficulties (6, 8%), and a few (2, 3% at 6 months) had developed swallowing problems. Ninety-five patients underwent videofluoroscopic examination within a median time of 2 days; 21 (22%) were aspirating. At 1 month a repeat examination showed that 12 (15%) were aspirating. Only 4 of these were persistent; the remaining 8 had not been previously identified. This study has confirmed that swallowing problems following acute stroke are common, and it has been documented that the dysphagia may persist, recur in some patients, or develop in others later in the history of their stroke.

Aged↗
PubMed1997

High prevalence of irritable bowel syndrome in patients attending urological outpatient departments.

Irritable bowel syndrome patients often complain of urinary symptoms such as frequency, urgency, and dysuria, raising the possibility of inappropriate referral to the urologist. To resolve this issue, the prevalence of irritable bowel syndrome was compared in patients attending urological and control clinics (dermatology and ENT). The overall prevalence of irritable bowel syndrome was 31.2% in the urological clinic compared with 21.2% in the controls (P < 0.001), but striking, differences emerged, depending on presenting complaint. Irritable bowel symptoms were particularly common in patients presenting with loin pain (male: 40.9%, P = 0.004; female: 50%, P = 0.03), dysuria (male: 43.8%, P = 0.007; female: 46.2%, P = 0.01) and frequency/urgency (male: 31.7%, P = 0.002; female: 42.4%, P = 0.006), and the male/female prevalence was 24% and 44%. These results suggest that in irritable bowel syndrome, urinary symptoms including loin pain can present diagnostic dilemmas in both the gastroenterological and urological setting, underlining the importance of specialists in these fields working together in order to define better ways of managing such patients.

Adolescent↗
PubMed1997

The irritable bowel severity scoring system: a simple method of monitoring irritable bowel syndrome and its progress.

BACKGROUND: The clinical assessment and investigation of irritable bowel syndrome would be greatly facilitated by the introduction of a simple, easy to use severity scoring system. Such a system, developed in our department over a number of years, has been submitted to validation in a total of 141 patients and 40 healthy controls. METHODS: The system, incorporating pain, distension, bowel dysfunction and quality of life/global well-being, was assessed for its ability to reliably score patients previously classified as mild, moderate or severe. The reproducibility and sensitivity to change of the system was also assessed. RESULTS: The maximum achievable score was 500. Mild, moderate and severe cases were indicated by scores of 75 to 175, 175 to 300 and > 300 respectively. Controls scored below 75 and patients scoring in this range can be considered to be in remission. There was a highly significant difference between controls and patients as a whole (P = 0.0001) as well as significant differences (P < 0.01) between all severity categories. Scores repeated within 24 h were very reproducible and sensitivity to change was also extremely good (P < 0.001) with a change of 50 reliably indicating improvement. CONCLUSION: These results suggest that this scoring system should prove to be a valuable instrument in helping to meet the many challenges offered by irritable bowel syndrome.

Adult↗
PubMed1997

Management of idiopathic carpal tunnel syndrome (ICTS): a survey of rheumatologists' practice and proposed guidelines.

This questionnaire survey was undertaken to study the approaches to diagnosis and management of idiopathic carpal tunnel syndrome by rheumatologists. Analysis of the completed questionnaires (81% response) showed variations in availability and referral for electrophysiological tests (EMG), initial choice of treatment (depending on patient's age and occupation, duration of symptoms, severity of clinical and EMG findings) and decompression surgery. This led the authors to propose guidelines in the management of this common condition.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1997

Anopheles gambiae gonotrophic cycle duration, biting and exiting behaviour unaffected by permethrin-impregnated bednets in The Gambia.

Permethrin-impregnated bednets protect children against malaria in The Gambia, where Anopheles gambiae complex mosquitoes are the main vectors of malaria. However, no effect has been found on mosquito density, parous rates or sporozoite rates in An.gambiae sensu lato populations; only a reduction in the numbers of mosquitoes resting indoors in rooms with treated bednets. A possible explanation for this paradox is that exposure to treated bednets leads to changed vector behaviour such as a shift in biting time, a diversion to biting outdoors instead of indoors, to biting animals instead of humans, or to increased duration of the gonotrophic cycle. To investigate these possibilities, we observed the biting and existing behaviour of An.gambiae in ten pairs of villages, in half of which the residents used permethrin-treated bednets. The possible influence of treated bednets on the gonotrophic cycle length was evaluated by mark-release-recapture experiment. No significant difference was found between villages with treated and untreated bednets in the indoor/outdoor ratio of human biting, in mean biting times or in human blood indices of An.gambiae females found resting indoors in the mornings. The proportions of unfed, fed or gravid An.gambiae females collected in exit traps, and the number of females exiting showed no significant differences between rooms with treated and untreated bednets. Indications for a gonotrophic cycle length of 2 days were found. No evidence for any change in duration of the gonotrophic cycle in relation to exposure to treated bednets was found, although the number of recaptures was low in the villages with treated bednets. Since equal numbers of infective An.gambiae were found in villages with treated or untreated bednets, and no changes in mosquito behaviour were detected, we cannot account for how children are protected against malaria by treated bednets. One possibility is that mosquitoes divert to bite other hosts, including adults.

Animals↗
PubMed1997

Changes in advance care planning in nursing homes before and after the patient Self-Determination Act: report of a 10-state survey.

OBJECTIVE: The Patient Self-Determination Act (PSDA) implemented in 1991 has focused national attention on the right of patients to be involved in decision-making and on the use of written advance directives. We report changes in advance care planning with the PSDA and other historical events in nursing homes in 10 states. DESIGN: Pre- and Post-observational cohort study. PATIENTS: Nursing home residents, residing in 270 long-term care facilities in 10 states, stratified to ensure representation of urban and rural facilities in each state. In 1990, 2175 patients were sampled, and 2088 different patients from the same facilities were sampled in 1993. Six-month follow-up was obtained at both time periods. MAIN OUTCOME MEASURES: Advance care planning was defined as the documentation in the medical record of a living will, a durable power of attorney, a "Do Not Resuscitate" (DNR) order, a "Do Not Hospitalize" (DNH) order, or an order to forgo artificial nutrition or hospitalization. RESULTS: The rate of chart documentation of living wills increased from 4.2% in 1990 to 13.3% in 1993, and DNR orders increased dramatically from 31.1% to 51.5%. The rates of DNH and orders to forgo artificial hydration and nutrition remained less than 8% in both years. We found striking variations in advance care planing among the 10 states. In 1990, having a DNR order varied from 10.1% to 69.2% across the 10 states. With the exception of Oregon, where 69.2% of patients already had a DNR order, the states saw a 1.5 to 3.1 times increase in the rate of DNR orders in 1993 compared with 1990. CONCLUSION: With the implementation of the PSDA, there was modest increase in documentation of living wills, but DNH and orders to forgo artificial hydration and nutrition remained the same. There was a substantial increase in DNR orders that began before the PSDA implementation. This increase was associated both with the implementation of the PSDA and the increased debate about the appropriateness of CPR for nursing home residents. This increase varied considerably among geographic areas from the 10 states. Future research is needed to understand this geographic variation.

Advance Care Planning↗
PubMed1997

Changes in hospitalization associated with introducing the Resident Assessment Instrument.

OBJECTIVE: To compare the rates of hospitalization among cohorts of nursing home residents assembled before and after the implementation of the federally mandated Resident Assessment Instrument (RAI). SAMPLE: Subjects were nursing home residents chosen from 268 facilities in major Metropolitan Statistics Areas in 10 states and representing more than 1500 facilities and 60,000 residents. Two resident cohorts (1990 and 1993) were sampled (8 to 16 residents per facility, depending upon facility size) as part of an evaluation of the impact of implementing the RAI. METHODS: Research nurses reviewed records, interviewed staff, observed patients, and completed an RAI at baseline and 6 months later. All transitions during this interval (hospital admissions, nursing home transfers, returns home, death, etc.) were tracked. Using polytomous logistic regression, we tested the effect of cohort on the probability of being hospitalized in light of the competing risks of dying or remaining in the home, controlling for demographic and casemix variables, and having a DNR order in the chart. RESULTS: A total of 4196 residents were studied, 2118 in 1990 (age 81.3, female 77.7%, LOS 6+ months 49.8%) and 2078 in 1993 (age 81.7, females 75.5%, LOS 6+ months 50.2%). The unadjusted probability of hospitalization dropped from .205 to .151. Multivariate analyses revealed a significant adjusted odds of hospitalization of .74 (95% CI .60-.91) and no cohort effect on home discharge or death. Among severely cognitively impaired residents, the adjusted odds of hospitalization in 1993 compared with the 1990 cohort was 0.74 (.53-1.03). Finally, among survivors in both cohorts who had a follow-up MDS performed, and whose ADL remained stable, 15.9% were hospitalized in 1990, whereas only 10.9% were hospitalized in 1993. On the other hand, ADL decliners were more likely to have been hospitalized in 1993 than in 1990 (40.6% vs 25.2%). CONCLUSIONS: Although other changes in the industry, clinical practice, and health care policy may have influenced hospitalization of nursing home residents, the substantial reductions observed among the cognitively impaired and those with stable ADL suggest superior and uniform assessment information in the form of the RAI contributed significantly to this decline.

Activities of Daily Living↗
PubMed1997

Relation of serum cytokine concentrations to cardiovascular risk factors and coronary heart disease.

OBJECTIVE: To determine whether serum concentrations of the cytokines tumour necrosis factor alpha (TNF alpha) and interleukin 6 (IL-6), which regulate C reactive protein, are associated with cardiovascular risk factors and prevalent coronary heart disease. DESIGN: A population based cross sectional study. SUBJECTS AND METHODS: 198 men aged 50 to 69 years were part of a random population sample drawn from south London. Serum cytokine and C reactive protein concentrations were determined by enzyme linked immunosorbent assay. The presence of coronary heart disease was determined by Rose angina questionnaire and Minnesota coded electrocardiogram. RESULTS: Serum TNF alpha concentrations were positively related to body mass index and Helicobacter pylori infection, but inversely related to alcohol consumption. IL-6 concentrations were positively associated with smoking, symptoms of chronic bronchitis, age, and father having a manual occupation. TNF alpha was associated with increased IL-6 and triglycerides, and reduced high density lipoprotein cholesterol. IL-6 was associated with raised fibrinogen, sialic acid, and triglycerides. ECG abnormalities were independently associated with increases in IL-6 and TNF alpha, each by approximately 50% (P < 0.05 for TNF alpha, P < 0.1 for IL-6). The corresponding increases in men with an abnormal ECG or symptomatic coronary heart disease were 28% for TNF alpha and 36% for IL-6 (P = 0.14 for TNF alpha and P < 0.05 for IL-6). CONCLUSIONS: This study confirms that many of the phenomena with which C reactive protein is associated, are also associated with serum levels of cytokine, which may be the mechanism.

Aged↗
PubMed1997

Sickle erythrocytes induce prostacyclin and thromboxane synthesis by isolated perfused rat lungs.

The role of eicosanoids in the pathogenesis of acute or chronic lung syndrome in sickle cell disease is unknown. We investigated the synthesis of prostacyclin (PGI2), thromboxane (Tx) A2, and prostaglandin (PG) E2 by three groups of isolated rat lungs perfused with buffer (GPBS), normal (HbAA), and sickle (HbSS) erythrocyte suspensions. Isolated lungs were perfused at a constant pressure and flow rate (Q) of 40 ml x kg(-1) x min(-1) with GPBS or 7% erythrocyte suspensions for 15 min. Autologous platelet-rich plasma (PRP) was added, and perfusion was continued for 15 min and then at two times Q for another 15 min. Perfusate samples were assayed for the specific eicosanoids. Perfusate level of PGI2 in GPBS lungs was the least among the three groups. However, the PGI2 level in HbSS lungs was 90% higher than from HbAA lungs after 15 min of perfusion and was 180% higher on perfusion with PRP. Additionally, coperfusion of erythrocytes and PRP augmented perfusate levels of TxA2 and PGE2 over 1,000% more in HbSS than HbAAlungs. These data show that HbSS erythrocytes increased perfusate levels of the eicosanoids, suggesting increased synthesis, perhaps due to aberrant erythrocyte-endothelium interactions.

Acid-Base Equilibrium↗