Artificial stupidity.
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Attitude of Health Personnel↗
Biomedical subjects
R Morris
Publications and source records attributed to R Morris.
Ideal pain relief following laparoscopic cholecystectomy.
In a previous report the effectiveness of intraperitoneal bupivacaine in reducing pain following laparoscopic cholecystectomy was demonstrated. Other methods of pain relief are commonly used but none has been compared following laparoscopic cholecystectomy. In two further studies we have compared the analgesic effect of intraperitoneal bupivacaine against wound infiltration with bupivacaine, and against intraperitoneal bupivacaine with the addition of a non-steroidal anti-inflammatory drug (NSAID) in patients undergoing laparoscopic cholecystectomy. Two consecutive studies were performed. In the first, patients in group 1 were given 20 ml of 0.25% bupivacaine into the peritoneal cavity; patients in group 2 were given 20 ml of 0.25% bupivacaine injected into the trocar wounds. In the second study, patients in group 1 were given 20 ml of 0.25% bupivacaine into the peritoneal cavity; patients in group 2 were given 20 ml of 0.25% bupivacaine into the peritoneal cavity and a diclofenac suppository (100 mg) one hour before surgery. Postoperative pain was assessed with a visual analogue pain scale. There was no difference in pain scores in the two groups in either study. Intraperitoneal bupivacaine is as effective as wound infiltration. The addition of an NSAID makes no difference in the reduction of postoperative pain following laparoscopic cholecystectomy.
Adult↗
The national sentinel audit for stroke: a tool for raising standards of care.
STUDY OBJECTIVE: To assess the quality of inpatient care and follow-up for stroke in England, Wales and Northern Ireland. DESIGN: Retrospective audit of case notes and service organisation. SETTING: 197 trust (80% of eligible trusts in England, Wales and Northern Ireland). PATIENTS: 6,894 consecutive stroke patients admitted between 1 January 1998 and 31 March 1998 (up to 40 per trust). AUDIT TOOL: The Intercollegiate Stroke Audit. RESULTS: Most patients were admitted to acute hospitals with access to the appropriate acute investigations and treatments. Only 64% of trusts had a physician with responsibility for stroke and only 50% had a stroke team. Involvement of different members of the multidisciplinary team within appropriate time-frames varied from 37% to 61%. Assessment of impairments specific to stroke was inadequate (screening for swallowing disorders in only 55%, cognitive function tests in 23% and visual field examination in 44%). Rehabilitation goals were agreed by the multidisciplinary team in only 55% of eligible cases. 41% of patients were contacted by their GP within 3 days of discharge. The best compliance with standards was achieved for the 18% of patients who spent at least 50% of their time in a stroke unit. CONCLUSIONS: This national audit demonstrates that care is suboptimal in many areas, and that there is wide variation in standards for the management of stroke across the country. This may have implications for clinical governance.
Aftercare↗
Internal limiting membrane removal for traumatic macular holes.
OBJECTIVE: To evaluate a new surgical technique for traumatic macular holes and to provide epidemiological information for such holes. MATERIALS AND METHODS: Vitrectomy with internal limiting membrane (ILM) removal but without adjuvant use on 17 consecutive eyes. RESULTS: The hole closed in 100% of eyes. Vision improved > or = 2 Snellen lines in 16 eyes (94%). The macula showed additional trauma-related damage in 10 eyes (59%). No permanent complication related to ILM removal was seen. Among 4440 eyes with contusion trauma in the United States Eye Injury Registry, the risk of macular hole formation is 9 times higher in eyes closed than with open globe injury (1.4% versus 0.15%). CONCLUSIONS: Without introducing special risks, removal of the macular ILM appears to be a highly successful surgical option in improving vision in eyes with traumatic macular holes. The majority of eyes benefit from ILM removal, even when additional traumatic macular pathology is present.
Adolescent↗
Neuroprosthesis consumers' forum: consumer priorities for research directions.
The purpose of this forum was to discuss with consumers having spinal cord injury what their research priorities would be for the field of functional electrical stimulation (FES) and to explore the impact of technology in the lives of people with disabilities. Both FES users and nonusers were included on the panel. The format for the discussion was primarily question and answer, with each participant giving his or her personal response to the moderator's question. Consumer research priorities depended on the individual and his or her personal priorities, preferences, background, history, and level of injury. Common themes that emerged were independence, ease of movement, ease of control, and spontaneity. From the consumers' perspective, the focus of research to restore function ought to be based on the needs and desires of the consumer, not just on the scientifically intriguing aspects of a particular technology.
Electric Stimulation Therapy↗
Effects of prostaglandin E(2) on proliferation and apoptosis of epithelial ovarian cancer cells.
OBJECTIVE: There is strong evidence indicating that prostaglandins (PG) and their synthesizing enzyme cyclooxygenase-2 (COX-2) play an important role in tumorigenesis. The purposes of the present study were to determine the pattern of expression of COX-2 and the effect of PG treatment on proliferation and apoptosis in epithelial ovarian cancer cells. METHODS: Two epithelial ovarian cancer cell lines, MDAH-2774 and SKOV3, were grown in flasks to confluence. Cells were then treated with exogenous dimethyl prostaglandin E(2) (dmPGE(2)) at increasing concentrations of 0-10 microg/mL. Total RNA was extracted from cells at different treatment doses and subjected to reverse transcriptase-polymerase chain reaction for the semiquantitative analysis of COX-2, Bcl-2, and bax expression. Flow cytometry was performed to assess effect of treatment on the cell cycle. The TUNEL assay was used to assess apoptosis. RESULTS: We found that COX-2 was constitutively expressed in the MDAH-2774 and SKOV3 epithelial ovarian cancer cells as determined by detection of a 304-bp amplified fragment using specific primers for the COX-2 gene. Treatment of both cell lines with dmPGE(2) resulted in dose-dependently higher expression of COX-2, Bcl-2, and bax mRNA compared with untreated cells. These changes were associated with an increase in the proliferative fraction and with a simultaneous reduction in apoptosis. CONCLUSIONS: Prostaglandin E(2) stimulated proliferation and reduced apoptosis in epithelial ovarian cancer cells. These effects were associated with overexpression of COX-2 and an increase in the ratio of Bcl-2:bax mRNA.
Apoptosis↗
White sponge nevus. Diagnosis by light microscopic and ultrastructural cytology.
The lesions of white sponge nevus, an autosomal dominant abnormality of squamous epithelial differentiation that primarily affects the oral cavity, may be grossly similar to those of other hereditary mucosal syndromes, infections or preneoplastic/neoplastic processes. This differential diagnosis is best resolved in many cases by exfoliative cytology, interpreted in the context of clinical history and physical findings. The following report describes a case of white sponge nevus with typical clinical and cytologic findings, in which the diagnosis was confirmed by ultrastructural cytology. Light microscopic cytology revealed parakeratotic cells and many cells containing dense eosinophilic intracytoplasmic inclusions. Electron micrographs of exfoliated cells demonstrated that these inclusions are composed of disordered aggregates of tonofilaments.
Child↗
Monday to Wednesday tiredness and thirst.
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3,4-Methylenedioxyamphetamine↗