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Biomedical subjects

J Morrison

Publications and source records attributed to J Morrison.

At least 163 records · Page 9Linked to original sources

Nifedipine and conventional therapy for unstable angina pectoris: a randomized, double-blind comparison.

To characterize the potential of nifedipine in the therapy of unstable angina pectoris we implemented a blinded, randomly assigned, titrated schedule of conventional therapy (propranolol, if not contraindicated, and isosorbide dinitrate) or nifedipine for 14 days in 126 patients hospitalized in a coronary care unit for ischemic chest pain of less than 45 min duration. There were no significant differences between conventionally and nifedipine-treated patients with regard to (1) the time to relief of pain as judged by life table analysis, (2) the decrease in anginal attacks per 24 hr from day 0 to day 2 (-2.5 +/- 0.4 for conventional therapy vs; -2.8 +/- 0.3 for nifedipine), (3) the decrease in the number of nitroglycerin tablets consumed per 24 hr (-2.0 +/- 0.5 for conventional vs -2.1 +/- 0.4 for nifedipine therapy), (4) the percentage of patients requiring morphine on day 1 (13% for conventional vs 21% for nifedipine therapy), or (5) the percentage of patients who developed infarction (14% in both groups). Among the 27 patients who did not respond to initial conventional (n = 13) or nifedipine therapy (n = 14), five in each group became pain free when the opposite therapy (either nifedipine or conventional therapy) was added. In the subgroup of 67 patients who were receiving propranolol before randomization, addition of nifedipine was more effective in controlling pain than was an increase in conventional therapy (p = .026). In the subgroup of 59 patients not receiving prior propranolol, initiation of conventional therapy produced more rapid pain relief than initiation of nifedipine therapy alone (p less than .001), which tended to increase heart rate. Thus, for the study population as a whole therapy with nifedipine alone was equivalent to conventional therapy for unstable angina, although this overall equivalence may result from a combination of superiority of nifedipine therapy in patients previously receiving beta-blocker therapy and superiority of beta-blocker therapy in patients not previously receiving beta-blockers.

Angina Pectoris↗

Nifedipine therapy for patients with threatened and acute myocardial infarction: a randomized, double-blind, placebo-controlled comparison.

Preliminary clinical and laboratory observations suggest that nifedipine might prevent progression of threatened myocardial infarction by reversing coronary spasm or might limit necrosis during the course of acute myocardial infarction. We screened 3143 patients with ischemic pain of greater than 45 min duration and randomly assigned 105 eligible patients with threatened myocardial infarction and 66 with acute myocardial infarction to receive nifedipine (20 mg orally every 4 hr for 14 days) or placebo plus standard care. Treatment was started 4.6 +/- 0.1 hr after the onset of pain. Infarct size index was calculated by the MB-creatine kinase (CK) method and expressed as CK-geq/m2 +/- SE. The incidence of progression to infarction among patients with threatened myocardial infarction was not significantly altered by nifedipine (36 of 48 [75%] for placebo-treated and 43 of 57 [75%] for nifedipine-treated patients). Furthermore, infarct size index was similar among placebo- and nifedipine-treated patients (16.9 +/- 1.5 MB-CK-geq/m2, n = 65, and 17.0 +/- 1.5 MB-CK-geq/m2, n = 68, respectively) with threatened myocardial infarction who exhibited infarction and for those with acute myocardial infarction. Among the 171 eligible patients randomly assigned to drug or placebo, 6 month mortality did not differ significantly (8.5% for placebo vs 10.1% for nifedipine, NS), but mortality in the 2 weeks after randomization was significantly higher for nifedipine-treated patients (0% for placebo compared with 7.9% for nifedipine, p = .018).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Maternal smoking and respiratory distress syndrome.

Infants of 603 patients on whom information about smoking habits during pregnancy was available were studied for incidence respiratory distress syndrome. Among the 360 patients who did not smoke, the incidence of respiratory distress syndrome in the neonate was 15.1%, whereas among patients who smoked, the incidence was 9.1%. We speculate that smoking produces a condition of chronic stress in the fetus which brings about an acceleration of fetal pulmonary maturation.

Amniocentesis↗

Left ventricular function and rapid release of creatine kinase MB in acute myocardial infarction. Evidence for spontaneous reperfusion.

Intracoronary thrombolysis during acute myocardial infarction in human beings is associated with rapid release of creatine kinase and improvement of the cardiac ejection fraction. To examine the phenomenon of spontaneous coronary-artery recanalization, we studied the release of creatine kinase MB and sequential radionuclide ventriculograms in 52 patients with transmural myocardial infarction. Patients were divided into two groups according to whether the release of creatine kinase MB (time from base-line to peak serum level) was rapid (n = 24) or slow (n = 28). Patients with slow release had no significant change in global or regional ejection fraction from the time of admission to discharge. However, global ejection fraction in patients with rapid release improved from 0.38 +/- 0.09 (mean +/- S.D.) to 0.48 +/- 0.08 (P less than 0.001). The regional ejection fraction of Q-wave regions also improved, from 0.33 +/- 0.11 to 0.43 +/- 0.13 (P less than 0.001). A negative correlation (r = -0.52, P less than 0.001) existed between time to peak enzyme level and degree of improvement in ejection fraction. With increasing left ventricular damage, patients with rapid release had greater increments in creatine kinase MB than comparable patients with slow release (P = 0.03), suggesting enzyme washout. These data are consistent with the idea that spontaneous reperfusion, leading to altered enzyme release and improvement in ventricular function, is not uncommon after acute myocardial infarction.

Adult↗

An immunological study of infection of hamsters with large and small plaque canine distemper viruses.

The small plaque virus (SPV), derived from the Onderstepoort strain of canine distemper virus (CDV) does not cause a lethal encephalitis in weanling hamsters. When we immunosuppressed hamsters infected with this virus they developed an acute disease, similar to that produced by the large plaque virus (LPV). Passive transfer of maternal antibody from SPV infected mothers to their offspring was effective in preventing acute disease following LPV infection. Co-infection of animals with both LPV and SPV resulted in increased hamster survival, associated with high titres of serum antibody. Similarly, heat inactivated SPV, present during infection with LPV, increased the survival rate. Heat inactivated LPV did not inhibit acute disease, although hamsters had high titres of neutralizing antibody. A small number of animals developed a delayed or recurring paralysis after immunosuppression, exposure to maternal antibody or co-infection. It would appear that the neurovirulence of CDV for hamsters can be modified by altering the levels of circulating antibody early in infection.

Animals↗

Information control and the exercise of power in the obstetrical encounter.

Interactions between doctor and patient involve participants with unequal power and possibly different interests. While a number of studies have focused upon the doctor/patient relationship, few have examined the utility of the concept of power and its capacity to help us understand the outcome of these interactions. The information sought by pregnant women from their obstetricians is used to provide a case study of one conceptualization and test of the utility of the concept of power. Pregnant women and their obstetricians are found to have different perceptions of the information that should be exchanged during their interactions. Women generally fail to obtain the information they want. Lower social class patients desire more and obtain less information than their higher status counterparts.

Australia↗

Understanding preterm labour: the use of Path Analysis.

A retrospective study was performed on 465 spontaneous preterm and 13,949 term births, in order to analyze the sequence of events that culminate in preterm labour. Twenty-one variables were investigated by the mathematical technique of Path Analysis. Nine direct and independent precursors of preterm labour were identified. These were antepartum haemorrhage, poor antenatal attendance, previous delivery of a small baby, multiple pregnancy, proteinuria, grand multiparity, cervical suture, low maternal weight, and a history of bleeding before 20 weeks.

Abortion, Spontaneous↗

Pregnancy after renal transplantation.

The results of a series of 6 pregnancies (including 1 set of twins) in renal transplant patients are presented with a review of the relevant literature. There were no fetal anomalies or deaths, or episodes of renal compromise or graft rejection. The important complications were hypertension (4), prematurity (4) and fetal growth retardation (2).

Adult↗

The use of antenatal tests of fetal welfare.

The value of antenatal tests of fetal welfare is a constant source of controversy and confusion to obstetricians and general practitioners. The proliferation of such tests indicates that none is ideal and all are relatively imprecise.

Estriol↗

Preparation of fingernails for trace element analysis.

There are substantial differences in the reported elemental composition of human nails. Most investigators have used extensive washing procedures to minimize environmental contamination, however, such washing poses the risk of extraction of elements bound to the nail matrix. To determine if a portion of this variability could be accounted for by the "washing solutions" used by different investigators, nails were washed in nine solvents previously used for cleaning nails and their residual elemental composition measured by atomic absorption spectroscopy or energy dispersion analysis. In general, treatment with organic solvents resulted in less elemental loss than did treatment with aqueous detergents, while aqueous acids caused the greatest loss. Organic solvents more readily extracted iron and magnesium than calcium, copper and zinc. Virtually all of the magnesium was extracted by distilled water or aqueous detergents.

Calcium↗

First-aid for snake-bite: efficacy of a constrictive bandage with limb immobilization in the management of human envenomation.

A herpetologist was bitten on the thumb by a common brown snake (Pseudonaja textilis). A constrictive bandage to impede lymphatic and capillary flow was applied, and the upper limb was immobilized. Two hours after the bite, there were no signs of symptoms of envenomation and venom (to a sensitivity of 0.5 ng/mL) was undetectable in serum and urine. Within five minutes of removal of the constrictive bandage, significant signs of envenomation developed, and serum and urine levels of venom rose significantly. The patient received two ampoules of brown-snake antivenom, and had recovered within six hours. No anaphylaxis of other allergic phenomena occurred, despite the fact that three other doses of antivenom had been administered in the preceding 36 months for prior elapid envenomation. By means of an experimental whole-mouse technique, and an enzyme-linked immunospecific assay (ELISA) system, the snake involved was shown to deliver 4.91 mg of venom in an average bite. A constrictive bandage properly applied to impede lymphatic and capillary flow, together with limb immobilization, is effective in the field management of human elapid envenomation.

Animals↗

Rethinking the military family syndrome.

The author presents prospective data on 140 child and adolescent military dependents and 234 nonmilitary subjects to assess the validity of the "military family syndrome." The only significant diagnostic difference was that military dependents had a lesser prevalence of schizophrenia and schizophreniform psychosis; the few environmental differences did not consistently favor either group. The author concludes that if the military family syndrome exists at all, its effects are more subtle and its causes are less obvious than has been previously stated.

Adolescent↗

The effect of differently worded no-smoking signs on smoking behavior.

The effect of positively versus negatively worded no-smoking signs was investigated in an attempt to determine the effectiveness of controlling smoking in a hospital setting. Unobtrusive measurements of smoking behavior were taken in the main lobby before and after the placement of positively and negatively worded no-smoking signs. The results clearly showed that there was less smoking under the experimental sign condition. Positively worded signs appeared to produce better compliance than negatively worded signs.

Behavior↗