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Biomedical subjects

M E Moran

Publications and source records attributed to M E Moran.

At least 37 records · Page 2Linked to original sources
PubMed1996

Interpersonal improvement in chronically depressed patients treated with desipramine.

OBJECTIVE: Interpersonal difficulties of dysthymic patients are little studied. We used the Inventory of Interpersonal Problems (IIP) to assess baseline status and medication response in chronic depression. METHOD: 39 chronically depressed subjects answered the IIP at entry and after 10 weeks of desipramine (DMI). Seventeen DMI responders completed IIPs after a 16-week continuation phase. RESULTS: Mean scores improved on all six IIP subscales during acute treatment. Continuation phase IIP improved non-significantly, approaching normative scores. Baseline IIP score correlated inversely with treatment outcome. CONCLUSIONS: Findings replicate in greater interpersonal detail research demonstrating rapid social amelioration in chronically depressed responders to antidepressant medication. The IIP may be useful as a predictive and interpersonal sensitivity measure in treatment studies of chronic depression.

Adult↗
PubMed1996

Superior gluteal artery injury secondary to posterior iliac crest bone graft harvesting. A surgical technique to control hemorrhage.

STUDY DESIGN: This case series and cadaveric dissection illustrates a method of obtaining hemostasis of iatrogenic superior gluteal vessel injury sustained during posterior iliac crest bone graft harvesting. OBJECTIVES: To show a simple and effective method of obtaining hemostasis of the iatrogenic superior gluteal vessel injury associated with posterior iliac crest bone graft harvesting. SUMMARY OF BACKGROUND DATA: Management of superior gluteal vessel injury has included direct pressure, enlargement of the sciatic notch to allow for exposure of bleeding vessels, retroperitoneal or transperitoneal approaches, and angiographic embolization to obtain hemostasis. The authors present several cases and a cadaveric study to show a simple and effective technique used to control hemorrhage secondary to iatrogenic superior gluteal vessel injury sustained at the time of posterior iliac crest bone graft harvesting. METHODS: The management of iatrogenic superior gluteal vessel injury secondary to posterior iliac crest bone graft harvesting involved the extension of the surgical incision, detachment of the origin of the gluteus maximus, lateral retraction of the gluteus maximus along with the tethered superior gluteal vessels, and visualization and ligation of the injured vessels. RESULTS: Hemostasis was achieved quickly with minimal loss of blood. Additional surgery or angiographic embolization was not required. CONCLUSIONS: In the cases presented, extension of the posterior iliac bone graft incision, detachment of the origin, and reflection of the gluteus maximus provided excellent exposure and hemostasis of the iatrogenic laceration of the superior gluteal artery. This technique is simple and effective and may prevent the need for transperitoneal and retroperitoneal approaches or angiographic embolization.

Adolescent↗
PubMed1995

Upper urinary tract videourodynamics: a more complete Whitaker test.

A modification of the Whitaker test is described using only a single nephrostomy tube for both inflow and pressure measurement. The technique also includes ureteral transit time and fluoroscopic imaging. This technique has been used in ten patients, all of whom had symptoms and/or imaging suggesting obstruction. Five patients had no obstruction on testing with true renal pelvic pressures </= 10 cm of H20 at all times. Five patients were obstructed (four distally and one proximally) with true renal pelvic pressure >20cm. This technique requires only one access port into the renal pelvis. The addition of fluoroscopy and ureteral transit time considerably aided our interpretation of the test. These modifications have made the Whitaker test more complete.

Journal Article↗
PubMed1993

Laparoscopic use of the ureteral illuminator.

Laparoscopic identification of the ureters is complicated by decreased tactile sensation and magnified video imaging. We report our experience in placing a ureteral illuminator to aid in ureteral identification prior to six laparoscopic urologic procedures. The ureteral illuminator facilitated laparoscopic ureteral identification during five nephoureterectomies and one ureterolithotomy. Illuminator placement required a minimum of anesthetic time and resulted in no complications. Preoperative placement of a ureteral illuminator aids laparoscopic ureteral identification and may reduce the incidence of inadvertent ureteral injury.

Equipment Design↗
PubMed1993

Obturator neuropathy after laparoscopic pelvic lymphadenectomy.

A case of obturator nerve injury with delayed manifestation following laparoscopic pelvic lymphadenectomy is presented. While the incidence of obturator nerve injury does not appear to differ between open surgical and laparoscopic approaches, the laparoscopic approach demands unequivocal visualization of the nerve when utilizing electrocautery because of the risk of nerve injury from thermal conduction through apposed tissues.

Humans↗
PubMed1993

Ureteroscopic cytologic diagnosis of upper tract lesions.

The definitive diagnosis of upper urinary tract lesions often relies on providing adequate tissue samples for cytopathologic review. Uretreopyeloscopy allows direct examination of these lesions and enables tissue sampling under visual control. A retrospective analysis of 11 patients with 13 abnormal upper tracts was performed, comparing sampling techniques performed under endoscopic vision (brush biopsy, fine-needle aspiration [FNA], and forceps biopsy) with standard retrograde catheter lavage. Forceps biopsy was the most accurate of the direct vision sampling methods (100%), although it provided adequate tissue only 56% of the time. Direct vision brush biopsy and FNA were better than forceps biopsy at providing adequate tissue but were less accurate, at 83% and 89%, respectively. Surprisingly, retrograde catheter lavage was superior to direct vision sampling methods. These results may be attributable to patient selection bias in that five of seven upper tracts found to have malignancy had multifocal disease. One patient developed a distal ureteral stricture from instrumentation that was managed successfully with an endoureterotomy.

Adult↗
PubMed1993

Effects of high-energy shock waves on rapidly proliferating cells: African clawed toad (Xenopus laevis) zygote model.

To date few studies have described the effects of high-energy shock waves (HESW) on benign, rapidly proliferating cells. In the African clawed toad (Xenopus laevis) model, previously described in vitro fertilization methods were used to study the effects of HESW on zygote cleavage and blastocytosis. Groups of 50 freshly fertilized ova were placed at the bottom of clear ultracentrifuge tubes filled with 5% DeBoers solution, positioned at the f2 focus utilizing the biprismatically split halogen red laser of a Dornier XL-1 experimental lithotripter, and treated using an 80-nF capacitor at various kilovoltages and shock wave (SW) numbers. Controls were treated in an identical fashion but kept outside the f2 focus. Cell lysis was the most notable finding at power settings in the standard treatment range (12 kV or greater). Increasing kilovoltage at a constant SW number (100) correlated linearly with the number of zygotes lysed in each group. There was an apparent logarithmic decrease in progression to cleavage and early development with increasing kilovoltage. At 10 kV, no effect on development was observed. Increasing SW numbers at a constant 19 kV correlated linearly with an increase in the number of lysed zygotes in each group. Increasing the SW number at constant kilovoltage correlated with an apparent logarithmic decrease in progression to cleavage and early development. This effect was observed with as few as 10 SW. These experiments have demonstrated a correlation between viability and lysis of zygotes with increasing treatment energies. The data suggest a threshold setting that minimally affects cellular activity (10 kV).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1993

Endourologist at work: laparoscopic placement of drains after nephrectomy.

The exact indications and ideal candidates for laparoscopic nephrectomy are yet to be identified. Occasionally, urologists might drain the renal fossa, depending on the pathogenesis of the renal disease prompting the nephrectomy, as with chronic infection. The authors describe a technique of placing a closed drainage system under full view with insufflation after laparoscopic nephrectomy. No additional stab wounds are necessary.

Drainage↗
PubMed1993

Stationary and automated laparoscopically assisted technologies.

The extent that laparoscopy may impact upon the practice of surgery remains to be clarified. One problem with these techniques is the maintenance of an adequate, stationary visual field in morphometrically different abdomens. This requires the attentive, trained, and skillful utilization of someone or something to operate the camera portal. Herein reported are the theory, advantages, disadvantages, and clinical utilization of mechanical and robotic arm systems to replace this second assistant during laparoscopic surgery.

Humans↗
PubMed1993

Microfibrillar collagen hemostat during laparoscopically directed liver biopsy.

Meticulous hemostasis is a necessity during laparoscopic procedures in maintaining a clear visual field and avoiding the need for an extended laparotomy to secure hemostasis. Methods of hemostasis available to laparoscopic surgeons include direct pressure, suture/clip ligation, conventional monopolar or argon-enhanced coagulation, and application of topical hemostatic agents. The effectiveness of topical hemostatic agents for open surgical procedures has been demonstrated; however, to date, laparoscopic utilization of topical hemostatic agents has been hampered by lack of compatible forms for laparoscopic instillation. Endo-Avitene is a 15 x 50 mm rolled sheet of microfibrillar collagen hemostat, available in an applicator capable of placement through standard laparoscopic trocar. The use of Endo-Avitene during laparoscopically-directed liver biopsies in a porcine model is reported. The effective hemostatic properties of microfibrillar collagen hemostat were reaffirmed and the clinical utility of Endo-Avitene for laparoscopic use is demonstrated.

Animals↗
PubMed1992

Prevalence and comorbidity of dysthymic disorder among psychiatric outpatients.

We investigated prevalence and comorbidity of DSM-III dysthymic disorder in a psychiatric outpatient clinic. Seventy-five consecutive outpatients received structured interviews. Prevalence of dysthymic disorder was 36% in the consecutive sample. Thirty-four dysthymic and 56 non-dysthymic patients were compared for comorbidity. Dysthymic subjects were more likely to meet criteria for major depression, social phobia, and avoidant, self-defeating, dependent, and borderline personality disorders. Dysthymic disorder was usually of early onset, predating comorbid disorders, and had often not received adequate antidepressant treatment. These results help define dysthymic disorder as prevalent, usually predating axis I comorbidity, and associated with particular axis II diagnoses.

Adult↗
PubMed1992

Injury of rat renal vessels following extracorporeal shock wave treatment.

The locations of extracorporeal shock wave treatment induced renal vascular injury and the sources of significant renal hemorrhage were determined in a rat model by means of two different vascular casting procedures. Silicone-rubber injected vascular preparations for light microscopy or corrosion casts for scanning electron microscopy were made following gross examination of the treated organs and their contralateral controls. After 1000 shock waves at 18 kV, five out of 20 treated kidneys appeared to be normal or minimally affected, while 15 showed gross evidence of marked vascular injury. Gross interstitial hemorrhage (15/20), subcapsular hematomas (7/20), and hemorrhages into the renal pelvis (5/20) were confirmed by extravasations of casting materials. These could be traced back to their vascular sources in several instances. Disruptions of interlobar and arcuate veins gave rise to most significant interstitial, subcapsular, and renal pelvic extravasations. On a microscopic scale cortical venules were among the most frequently injured vessels. The arterial vasculature was not spared. Arterial injury ranged from complete arcuate occlusion to small afferent arteriolar and glomerular capillary extravasations. The significance of shock wave induced vascular injury is discussed with respect to potential clinical side effects of ESWL.

Animals↗
PubMed1992

Venomous bites to the external genitalia: an unusual cause of acute scrotum.

The acute scrotum generates a long list of differential diagnoses. An unusual etiology includes insect envenomation, which typically is an acute process with rapid onset of symptomatologies. Two patients with genital envenomation are reported. We review the reported cases at our institution with all types of bites and stings. Symptoms of pain and pruritus, and signs of ecchymosis and edema preceding exfoliating dermatitis were evident in both cases. Mild analgesics and antihistamines promoted resolution in each instance.

Acute Disease↗
PubMed1992

Biological resurfacing of full-thickness defects in patellar articular cartilage of the rabbit. Investigation of autogenous periosteal grafts subjected to continuous passive motion.

We compared the effects of continuous passive motion with those of intermittent active motion on the results of the resurfacing with autogenous periosteal grafts of full-thickness defects on the articular surface of rabbit patellae. Of 45 rabbits with defects, 30 received grafts. Fifteen of these had continuous passive motion for two weeks and intermittent active motion for four weeks; the other 15 had intermittent active motion for six weeks. In 15 the defects were not grafted (control group) and they had intermittent active motion for six weeks. Ten more rabbits had a sham operation. Six weeks after surgery, the results were assessed by the gross appearance, histology, histochemistry, immunohistochemistry and electron microscopy. By all assessments the quality of neochondrogenesis produced by periosteal grafts was superior to that in ungrafted defects (p less than 0.05) and the results in continuous passive motion treated animals were superior to those in intermittent active motion treated animals (p less than 0.05). The periosteal grafts produced hyaline cartilage containing type II collagen but the organisation of its fibres was irregular.

Animals↗
PubMed1991

The potential for regeneration of articular cartilage in defects created by chondral shaving and subchondral abrasion. An experimental investigation in rabbits.

Animal models for chondral shaving and subchondral abrasion were created to resolve the controversy about the nature of the repair tissue after these procedures and to determine the effect of continuous passive motion on the quality of the repair tissue. Chondral shaving was performed on the patella in forty adolescent rabbits, and subchondral abrasion was performed on the patella in another forty rabbits. In both procedures, a three-millimeter-diameter defect was created. After the operation, twenty animals from each group were allowed intermittent active motion; the remainder were treated by continuous passive motion for two weeks, followed by intermittent active motion. Half of the animals from each group were killed at four weeks and the other half, at twelve weeks. There was no evidence of repair tissue in the defects at either four or twelve weeks after chondral shaving, regardless of the postoperative treatment. The remaining underlying cartilage, however, had degenerated. After abrasion of subchondral bone, the defects in animals that were treated with only intermittent active motion healed at twelve weeks, although the quality of the repair tissue varied. All ten of the animals that were treated with continuous passive motion, however, had mature, hyaline-like cartilage as the predominant repair tissue at twelve weeks, compared with six of the ten animals that were treated with intermittent active motion (p less than 0.05). We concluded that, in this model, partial-thickness defects created by chondral shaving do not heal; rather, the remaining underlying cartilage degenerates. Full-thickness defects created by subchondral abrasion can heal by regeneration of hyaline-like cartilage. Such healing is enhanced by continuous passive motion for two weeks postoperatively.

Animals↗