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Biomedical subjects

M Morgan

Publications and source records attributed to M Morgan.

At least 145 records · Page 8Linked to original sources
PubMed1996

Angioscopically-assisted in situ saphenous vein bypass for infrainguinal revascularisation.

OBJECTIVES AND STUDY DESIGN: The diagnostic capability of angioscopy for endoluminal evaluation is established and its superiority over arteriography for completion studies has been confirmed. The therapeutic use of angioscopy in vein graft preparation is more controversial. The aim of this prospective study was to establish whether angioscopic vein preparation confers real benefits over existing techniques. METHODS: Forty-seven patients were randomised to either full angioscopic (ANG) vein preparation (23 patients) or conventional (CON) in situ grafting (19 patients). All patients underwent completion studies with arteriography and angioscopy and postoperatively, entered a Duplex graft surveillance programme. RESULTS: There was a significant difference in the incidence of wound morbidity: 26% in the ANG group as against 63% in the CON group (Fisher's exact test: p = 0.043), but no significant differences with respect to duration of operation, duration of vein graft preparation, length of hospital stay and both 30 day and 12 month secondary cumulative patencies (log rank test: p > 0.5). Completion angioscopy detected eight persistent valve cusps in six patients, all missed at arteriography, but failed to detect arteriovenous fistulae. CONCLUSIONS: Angioscopic preparation reduces wound morbidity and complements arteriography for detecting intraoperative defects. A large, prospective, randomised trial is now warranted to fully evaluate the potential therapeutic role of angioscopy with respect to current vascular practice.

Aged↗
PubMed1996

Angioscopy for quality control of saphenous vein during bypass grafting.

OBJECTIVES: Although autogenous vein is the conduit of choice for infrainguinal bypass grafting, some 20-30% of vein grafts fail during the first year postoperatively. Many of these failed veins are now known to have pre-existing pathological changes. Angioscopy enables intraoperative endoluminal visualisation of veins and can reveal anomalies, some previously unsuspected, despite preoperative Duplex ultrasound mapping and normal external appearances. The aim of this study was to compare angioscopic findings with contemporary histological appearances and with subsequent graft outcome and ultimately, to identify those endoluminal features which might be predictive for failure. METHODS: Angioscopic vein inspection was carried out using Olympus 1.4 and 2.2mm angioscopes in patients undergoing femoropopliteal/distal bypass. Severe disease in the veins of five patients led to preferential use of polytetrafluoroethylene (PTFE) for above-knee bypasses. The remaining 38 videotaped sequences were reviewed by two surgeons and scored using a scale of 0 to 3, based on frequency and distribution of angioscopically detected lesions. These included haemorrhagic mural plaques, flimsy intraluminal strands, webs/bands and mobile/adherent thrombus. Vein harvested at operation was assessed by a pathologist according to the level of pre-existing abnormality. RESULTS: There were significant associations between angioscopy/histology scores and graft survival (chi 2 = 22.00; df:3; p < 0.001; chi 2 = 22.43; df:3; p < 0.001 respectively). There was a significant correlation between angioscopy and histology scores (R8 = 0.725; p < 0.001). CONCLUSIONS: Angioscopy allows immediate identification of the at risk, poor quality vein graft at the time of surgery, without the delays inherent with histological preparation and assessment. Recognition of abnormalities at angioscopy may ultimately improve graft outcome by prospectively eliminating use of poor vein.

Adult↗
PubMed1996

Postpartum psychiatric disorder: who should be admitted and to which hospital?

OBJECTIVE: To review the question of whether an infant should be admitted to psychiatric services when a severe psychiatric disorder necessitates admission of the mother. METHOD: All available literature on mother-infant joint admission was reviewed and arguments for and against are summarised. RESULTS: Early reports favoured joint admission, then opinions changed, possibly for economic reasons. Recent thinking encompasses research data on (i) longer-term adverse effects of postnatal depression on the children, and (ii) the finding of psychological and psychiatric morbidity in many of the fathers. Joint admission to designated special units is valuable, but such facilities are only cost-efficient and effective if established as part of an appropriate broader plan for managing postpartum, psychiatric disorder. CONCLUSIONS: (1) Further research is needed to answer this question definitively. (2) Services at primary and secondary level require expansion. (3) All services should target the whole family.

Ambulatory Care↗
PubMed1995

Is Bell's palsy a reactivation of varicella zoster virus?

Despite various pointers to an infectious aetiology, the cause of Bell's palsy remains obscure. We examined paired sera from 62 patients with facial palsy and 50 age and sex matched contemporaneous controls. Significantly more patients than controls had IgM antibodies by ELISA to varicella zoster virus (56.5% vs. 20%, P = 0.0001) and herpes simplex virus (41.9% vs. 18%, P = 0.006). Additionally, significantly more patients than controls were positive for CF antibody to varicella zoster virus (14.5% vs. 0%, P = 0.004) but not to herpes simplex or cytomegalovirus. Significantly more controls than patients (54% vs. 25.8%, P = 0.002) had no evidence of antigenic stimulation by any of the herpesvirus group. No significant difference between patients and controls in seropositivity by IgM ELISA to cytomegalovirus. Epstein-Barr virus and IFA for human herpes virus 6 was found. Furthermore, there was no significant difference between the two groups as to evidence of recent infection by the following agents: rubella virus and Borrelia burgdorferi by IgM ELISA, influenza A. influenza B, adenovirus, respiratory syncytial virus, mumps and measles. Mycoplasma pneumoniae, Coxiella burnetii and chlamydia spp. by complement fixation test. The first reported case of clinically and serologically proven Mycoplasma pneumoniae pneumonia associated with Bell's palsy is described. The rate of complete recovery at 6-8 weeks after onset was not significantly different in patients who were given steroids compared to those who were not. Ear related symptoms were the most common, occurring in 12 of 65 cases, but only three (4.6%) had clinical shingles (vesicles in ear).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

The value of pre-discharge Duplex scanning in infrainguinal graft surveillance.

OBJECTIVES: Protocols and criteria for Duplex-based graft surveillance programmes (GS) vary widely as to the optimum regimens for maximising detection of "at risk" grafts. Few centres recommend starting GS before discharge. The aim of this study was to audit our experience with respect to early scanning. SETTING: Vascular Studies Unit, Bristol Royal Infirmary. METHOD: The records of 123 patients entering GS from January 1992 were reviewed. Patients were scanned at 1 week, 6 weeks and 3, 6, 9 and 12 months post-bypass. Haemodynamic criteria used were a peak mean velocity (PMV) less than 45 cm/s and a focal velocity disturbance with a V2/V1 ratio of 1.5 or more. RESULTS: Forty-six abnormalities (37% detection rate) were identified on scans within one week. In all cases, on-table completion studies with either arteriography and/or flow measurements had failed to identify the anomalies subsequently detected by Duplex. At 1 week, six grafts had occluded, 27 had a focal PMV increase (mean V2/V1 ratio: 2.6; range 1.5-4.3), four had low flow velocities, four had arteriovenous fistulae, one contained mobile thrombus, two had retained cusps and two had hamstring entrapment. Of 40 patent, but compromised grafts, 18 warranted immediate investigation. Of the 27 patients with velocity disturbances on Duplex, 25 were simply observed but, eight have since required intervention for definitive stenoses at these sites which, in retrospect, were evident within the first postoperative week. CONCLUSIONS: Pre-discharge scanning is a useful modality for detecting technical problems. Intrinsic graft abnormalities, possibly the sites of future definitive stenoses, have been visualised even at 1 week and once identified, can be more closely scrutinised thereafter. Pre-discharge colour Duplex is recommended as standard practice for quality control after infrainguinal bypass.

Arterial Occlusive Diseases↗
PubMed1995

Clonal structure of invasive Streptococcus pyogenes in Northern Scotland.

We have used molecular techniques to characterize 51 group A streptococci from Scotland and 17 'serious disease' isolates from other countries, in order to establish the clonal structure of invasive Streptococcus pyogenes strains circulating between 1986 and 1993. Strains were grouped by restriction endonuclease analysis, pulsed field gel electrophoresis and ribotyping patterns, and were examined for the presence of alleles of the speA gene by polymerase chain reaction and DNA sequence analysis. Serious and fatal infections in Scotland were caused by several clones. One clone (9 of 51 strains) was M type 1 and possessed the speA gene allele 2. This was the clone previously identified as causing severe infection in the USA. Another clone (5 of 51 strains) was M type 3 and had speA gene allele 3. In view of the clear association of more than one clone with severe, invasive and fatal infections, horizontal gene exchange between genotypes merits further investigation.

Base Sequence↗
PubMed1995

The SF-36 health survey questionnaire: is it suitable for use with older adults?

An Anglicized version of the SF-36, a recently developed generic health status measure, was tested among people aged 65 years and over in hospital outpatient and general practice settings as both a self-completed and interview-administered instrument. The SF-36 was quick to complete, with 84% completed in 10 minutes or less (median time 8 minutes), while the distribution of scores provided further evidence of its sensitivity and validity. As an interview-administered instrument the SF-36 was acceptable among all age groups, although 32% of outpatients and 10% of general-practice patients, consisting predominantly of people aged 75 years and over with poor physical or mental health scores, felt unable to self-complete the questionnaire. In addition, 26% of respondents missed out at least one of the 36 statements, with missing items being significantly related to older age and self-completion. Missing responses were mainly concentrated on a small number of questions whose emphasis on work or vigorous activities meant that they were frequently regarded as not applicable by elderly people. Suggested modifications to these questions for elderly respondents are given. With these changes the SF-36 is regarded as suitable for use as a self-completed questionnaire among the younger age group of elderly people, although some assistance may often be required by people aged 75 years and over and especially those with poor physical or mental health.

Activities of Daily Living↗
PubMed1995

The significance of ethnicity for health promotion: patients' use of anti-hypertensive drugs in inner London.

Afro-Caribbeans are the second largest ethnic minority in the UK and are concentrated in some inner London areas where they comprise over 12% of the population. Standardized mortality ratios for stroke are relatively high among the Afro-Caribbeans, for whom the control of high blood pressure is thus of particular significance. Semi-structured interviews were conducted with matched groups of 'white' and Afro-Caribbean hypertensive patients attending 15 general practices in an inner London area to examine their beliefs and practices regarding the prescribed drugs. Adherence was high among 'white' patients, but less than half the Afro-Caribbeans took the drugs regularly as prescribed with many having poorly controlled blood pressures. Non-adherence was influenced by traditional cultural beliefs and practices which often strengthened concerns about the long-term harmful effects of drugs and provided an alternative resource in terms of herbal remedies. There was also evidence of a cultural gulf and lack of communication between Afro-Caribbean patients and their general practitioners, thus reducing the effectiveness of this preventive strategy.

Adult↗