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Biomedical subjects

R W Morris

Publications and source records attributed to R W Morris.

At least 109 records · Page 6Linked to original sources
PubMed1991

Comparison of the real-time use of glycosylated haemoglobin and plasma fructosamine in the diabetic clinic.

The within-clinic use of glycosylated haemoglobin (HbA1) and plasma fructosamine results in assessing blood glucose control and clinical management was compared in 1030 diabetic patients. The physician initially reviewed the patient with one randomly allocated measure (HbA1 or fructosamine) and completed a questionnaire concerning perception of blood glucose control, alteration to diet, alteration to medication, referral for diabetes education, and follow-up interval. The patient was then re-assessed using the second measure and the questionnaire repeated. Discordance rates for the study end-points, judged as binary outcomes, were: blood glucose control 15%; alteration to diet 7%; alteration to medication 9%; referral for education 3%; follow-up interval 4%. A significantly greater number of patients were rated as poorly controlled with HbA1 than with fructosamine (p less than 0.001) and were, in consequence, more frequently recommended alteration to diet and medication, referral for education and shorter follow-up interval; the rate of discordance for at least one of the management decisions was 16%. Multifactorial analysis showed that discordant management was dependent on the reviewing physician (p less than 0.001) and a history of cardiovascular disease (p less than 0.01); but neither type of diabetes, nor presence of nephropathy or variant haemoglobins, nor plasma glucose concentration, significantly influenced the likelihood of a discordance. Replacing HbA1 with fructosamine in the diabetic clinic may result in significant differences in the physician's perception of blood glucose control and in the management of patients.

Adult↗
PubMed1991

Audit from preschool developmental surveillance of vision, hearing, and language referrals.

Referrals from preschool medical examinations were followed up for two years to assess attendance rate, waiting time for appointment, appropriateness of the referral, the diagnosis and management of the condition. Altogether 184 children were referrals for ophthalmology, 285 for audiology, and 195 for speech therapy. The median waiting time for an appointment was 46 days in ophthalmology, 175 days in audiology, and 83 days in speech therapy. The poorest attendance rate was identified in speech therapy (75%). Approximately 60% of examined children had a justified referral to ophthalmology and 20% had a clear defect. Over half the children in audiology (55%) had an altered impedance or hearing impairment. Of those with a hearing problem kept under review only half improved spontaneously. In speech therapy 80% of those assessed had a language problem. Many health problems were detected for which parents were unaware or did not use the service. Parental awareness alone will not uncover the sizable level of lingual and sensorial problems in inner city areas. This audit identified specific deficiencies in the provision of services and a number of organisational changes are suggested to improve their effectiveness.

Age Factors↗
PubMed1991

A graded combination regimen for maintenance of gastric pH above 3.5 in critically ill patients.

Prophylaxis of acute upper gastrointestinal bleeding by control of gastric pH has been widely advocated for intensive care patients. H2-blockers and antacids have been used and demonstrated to be incompletely effective at maintaining gastric pH above 4. A study of 100 patients measured the efficacy of two-hourly gastric pH measurement and titrated therapy consisting of five levels: 1. no therapy 2. ranitidine 50 mg 8 hourly intravenously 3. ranitidine plus Mylanta 30 ml 2 hourly by nasogastric tube 4. ranitidine plus Mylanta 60 ml 2 hourly and 5. ranitidine 100 mg 8 hourly intravenously plus Mylanta II 60 ml 2 hourly. The level of treatment required by proportions of the total study group were (1) 15%, (2) 71%, (3) 96%, (4) 100%. Head-injured and intubated patients generally fell in the more resistant group while patients having had major elective surgery required lower levels of therapy. If control of gastric pH is to be uniformly achieved, a technique of titrated therapy based on gastric pH measurements is supported as cheaper and more effective than other standardised treatment regimens.

Adult↗
PubMed1991

Coronal alignment after total knee replacement.

Maquet's line passes from the centre of the femoral head to the centre of the body of the talus. The distance of this line from the centre of the knee on a long-leg radiograph provides the most accurate measure of coronal alignment. Malalignment causes abnormal forces which may lead to loosening after knee replacement. We report a series of 115 Denham knee replacements performed between 1976 and 1981 using the earliest design of components, inserted with intramedullary guide rods. Patients were assessed clinically and long-leg standing radiographs were taken before operation, soon after surgery and up to 12 years later. In two-thirds of the knees (68%) Maquet's line passed through the middle third of the prosthesis on postoperative films and the incidence of subsequent loosening was 3%. When Maquet's line was medial or lateral to this, an error of approximately +/- 3 degrees, the incidence of loosening at a median period of eight years was 24%. This difference is highly significant (p = 0.001). Accurate coronal alignment appears to be an important factor in prevention of loosening. Means of improving the accuracy of alignment and of measuring it on long-leg radiographs are discussed.

Adult↗
PubMed1991

Survivorship analysis and confidence intervals. An assessment with reference to the Stanmore total knee replacement.

Survivorship analysis is a useful way of expressing the long-term results of joint replacement: it provides a means of comparing the life span of one type of prosthesis with another. However, such studies should include a full life-table and the confidence intervals for the survival rates at given times. At least 40 surviving prostheses are required to provide reliable results.

Confidence Intervals↗
PubMed1990

The effects of improved blood glucose on growth hormone and cortisol secretion in insulin-dependent diabetes mellitus.

Growth hormone and cortisol secretion were studied in 25 patients with insulin-dependent diabetes before (Study 1) and 2 weeks after improved glucoregulation (Study 2). Blood samples for serum growth hormone (GH) and blood glucose determination were collected at hourly intervals whilst blood samples for cortisol and C-peptide were collected every 6 h during the 24-h period in Study 1 and Study 2. Glycaemic control was significantly improved in Study 2 compared to that in Study 1 (8.5 vs 13.3 mmol/l; P less than 0.001). With improved control, growth hormone levels rose by 21% (5.7 vs 4.7 mU/l; P less than 0.05). Throughout both study periods growth hormone levels were higher in patients with no residual C-peptide secretion (10 CpN patients) compared with patients with residual beta-cell function (15 CpP patients) (7.1 vs 3.2 mU/l in Study 1; 8.9 vs 4.2 mU/l in Study 2; P less than 0.001). Characteristic shapes of the 24-h blood glucose profile curves during both study periods were significantly different between the CpN and CpP group. Plasma cortisol decreased in both groups with improved metabolic control (P less than 0.001) but the observed different diurnal pattern did not change. These results demonstrate the importance of residual endogenous insulin secretion in determining growth hormone secretion in insulin-dependent diabetes and have important implications for glycaemic control and risk of microvascular complications.

Adult↗
PubMed1990

Effects of improved blood glucose on insulin-induced hypoglycaemia, TRH, GnRH and exercise tests in insulin-dependent diabetes.

In order to evaluate effects of metabolic control on pituitary function in insulin-dependent diabetes exercise, hypoglycaemia (insulin tolerance test), thyrotrophin releasing hormone and gonadotrophin releasing hormone, tests were performed on 25 patients before (Study 1) and after 2 weeks of improved metabolic control (Study 2). Patients were sub-divided into C-peptide negative (CpN, 10 patients with no residual C-peptide secretion) and C-peptide positive (CpP, 15 patients with residual beta-cell function) groups for analysis of results. Exercise induced higher growth hormone responses in CpN patients independent of metabolic control (P less than 0.001). Thyrotrophin releasing hormone induced higher growth hormone responses in CpN patients; this response was threefold greater after improved control (P less than 0.005). Growth hormone and cortisol response to hypoglycaemia and thyroid stimulating hormone and prolactin secretion in response to thyrotrophin releasing hormone were unaffected by residual beta-cell function or metabolic control. Luteinizing hormone response to gonadotrophin releasing hormone in CpN patients was impaired and lower after improved control (P less than 0.002). The results indicate an association between residual pancreatic insulin secretory and hypothalamic/pituitary function, possibly reflecting central neurosecretion of insulin.

Blood Glucose↗
PubMed1990

Effects of mononuclear cell leukemia on altered hepatocellular foci in Fischer 344 rats.

Quantitative stereologic analyses were conducted on hematoxylin and eosin-stained liver sections to investigate the potential effects of the presence of mononuclear cell leukemia in Fischer 344 rats on the occurrence of altered hepatocellular foci (AHF). The study consisted of 132 male and 144 female rats taken from control groups at the termination of seven, 2-year National Toxicology Program (NTP) carcinogenicity studies. A minimum of 10 male and 10 female rats were killed at 6, 9, 12, 15, and 18 months into the seven NTP studies to assess progressive development of AHF. At the end of the studies, 43 males and 35 females had histologic evidence of mononuclear cell leukemia in the liver. There were no differences in the morphologic features of AHF between leukemic and non-leukemic rats; however, there was a decreased incidence of clear AHF in both sexes and in basophilic, vacuolated, and mixed-cell AHF in males. Stereologic analysis revealed that there was also a 40 to 73% reduction in the density of basophilic, clear, vacuolated, and mixed-cell AHF in male rats with leukemia and a 31 and 70% reduction in basophilic and clear AHF, respectively, in females with leukemia. The number of eosinophilic AHF was statistically unchanged in both sexes. The eosinophilic AHF, however, were 2.3 times larger and occupied a 4.3-fold greater volume fraction of the liver in leukemic male rats. Changes in the incidence and density of AHF were directly associated with the severity of the leukemia.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1990

Does the radial arterial line degrade the performance of a pulse oximeter?

The presence of radial arterial lines may diminish distal digital perfusion. Using a pair of pulse oximeters on the index fingers of cannulated and noncannulated arms the saturation and oximeter pulse strength were assessed. Three hundred paired measurements in fifty consecutive Intensive Care patients were undertaken more than two hours after cannula insertion. The pulse strength was 19.7 (SD 6.1) and 19.7 (SD 5.7) on the cannulated and noncannulated sides while the saturation was 97.3 (SD 2.3) and 97.1 (SD 2.4) respectively. These differences are not clinically important and the study demonstrates that reliable pulse oximetry measurements may be made distal to a radial artery cannula. It is recommended that in each individual the placement of the sensor be such as to ensure the best signal and the most stable saturation readings.

Catheterization, Peripheral↗
PubMed1990

The effects of time of trauma patient presentation on emergency department utilization.

All three posed temporal questions have now been answered as being positive factors in ED utilization: 1) Major and minor trauma patients should be expected to present at ED in largest numbers around 17.67 hr each day and especially during the month of August. Some types of major trauma (i.e., medical, surgical, psychiatric patients) require longer periods for stabilization in the ED before being discharged to the appropriate care unit. Such patients also tend to arrive later at the ED than do patients destined for MICU, SICU, or CCU. 2) Changing the trauma ordinance did not affect the temporal effects noted above but did produce a strikingly large influx of minor trauma presents relative to major trauma presents during the post-ordinance period. 3) The nature and number of the ED staffing should be reviewed and probably changed in order to reflect the large influx of trauma presents during the 1600 to 2400 hr shift. The third question has the most impact on ED utilization during the "Golden Hour of Trauma". Individual emergency departments must cope with the fact that the maximum demand on facilities and professional health expertise will normally occur during the hours from 1600 to 2400 each day. Some EDs have recognized this increased demand and have responded by maximizing the quantity and quality of their staff on the 1600 to 2400 hr shift. These data indicate that more EDs should follow suit as soon as possible.

Chicago↗
PubMed1990

Endocytosis of cationized horseradish peroxidase by glomerular epithelial cells is reduced in puromycin glomerulopathy.

Rats were treated with a single intravenous injection of aminonucleoside of puromycin and were sacrificed between 1 and 21 days after injection. The conjugate of horseradish peroxidase with a poly-L-lysine (HRP.PL) was used to reveal endocytotic activity in glomerular epithelial cells (GEC). This conjugate was injected intravenously 2 h before each sacrifice. Renal tissue was taken and treated cytochemically with a conventional DAB technique and observed by light and electron microscopy. The assessment of endocytosis by glomerular epithelial cells was performed on 1-micron sections by counting HRP.PL grains in the GEC and expressing this in terms of the area of glomerulus examined. The results were compared to those found in normal rats. Our results show that GEC endocytotic function was reduced during the whole period of the experiment. It fell quickly from 1 day after puromycin injection and reached the most marked reduction on the 4th day, preceding the peak of proteinuria which was between 7 and 12 days. From the 5th day onward the endocytotic function gradually recovered, but was still abnormal at the end of the experiment.

Animals↗
PubMed1989

Measurement of S-phase fractions in lymphoid tissue comparing fresh versus paraffin-embedded tissue and 4',6'-diamidino-2 phenylindole dihydrochloride versus propidium iodide staining.

S-phase fractions for 62 lymphoid biopsies were calculated, by means of flow cytometry, from both fresh and paraffin-embedded tissue. The purposes of this study were to determine whether significant differences were seen between S-phase estimates obtained from fresh and fixed tissue and to compare results obtained with two DNA dyes, namely 4'-6'-diamidino-2 phenylindole dihydrochloride (DAPI) and propidium iodide (PI). The 62 cases consisted of 38 cases of non-Hodgkin's lymphoma (NHL), 19 reactive samples, and 5 cases of Hodgkin's disease. Fifty-four of the samples showed DNA diploid profiles. A good agreement between S-phase results from fresh and fixed tissue was seen, with technical factors accounting for around 20% of the total variance. Using a paired t test, no significant difference was seen between fresh and fixed tissue for diploid cases, but there was a trend for S-phase estimates from fixed tissue to be higher. If all cases (including the eight DNA aneuploid samples) were included in the analysis this difference just reached statistical significance (P less than .05). In a subgroup of 19 of the cases, a comparison was performed on both fresh and fixed tissue of staining with DAPI and PI. A good agreement between results with both DNA stains was found on fresh and fixed tissue, with no significant differences being apparent, and stain-related factors accounted for only 10% of the total variance.

Cell Cycle↗
PubMed1989

Results and evaluations of 48 continuous breeding reproduction studies conducted in mice.

Results of 48 continuous breeding reproduction (RACB) studies are summarized and control data from these studies are used to determine the statistical sensitivity of each endpoint from different parts of these studies. Results of testing individual chemicals compared well with results of multigeneration studies reported in the literature. Continuous breeding studies were able to discriminate reproductive toxicants from nontoxicants, and provided valuable structure-activity information. When mice in continuous cohabitation produce multiple litters, the statistical sensitivity of fertility endpoints is quite high and is comparable to that associated with other sensitive indicators of reproductive function, such as testis weight and sperm parameter measures. The principal advantages of the RACB protocol in comparison to multigeneration studies are: (1) the increased sensitivity and statistical power, (2) the ability to monitor progression of toxicity and to detect subfertility, (3) use of a battery of endpoints including sperm measures, (4) the ability to determine the affected sex(es), and (5) slightly reduced testing time.

Animals↗
PubMed1989

UVA sunbeds: tanning, photoprotection, acute adverse effects and immunological changes.

The effects on 31 normal subjects following exposure to sunbeds containing UVA lamps with minimal UVB emission have been compared in a double-blind study with the effects on nine control subjects of a similar exposure course three times weekly for 4 weeks to sunbeds emitting visible light. On previously untanned areas, all those subjects on active treatment developed a mild tan; in tanned areas they all developed a moderate tan, while all control subjects developed a minimal to mild tan. The mean protection factor against later UVB-induced erythema was 3.2 +/- 0.3 after the active course and 1.6 +/- 0.2 among the controls. Significantly more frequent adverse cutaneous effects for active subjects were pruritus, erythema, freckling, burning sensation, dryness and polymorphic light eruption. Cutaneous Langerhans cell numbers, and blood CD3+ (pan T-cell) and CD4+ (helper T-cell) lymphocyte subsets were reduced in both active and control groups. CD8+ (cytotoxic/suppressor T-cell) counts were similarly but not significantly reduced in both groups. Pityrosporum yeast counts were significantly reduced in both groups. The changes found in both groups seem attributable to small amounts of UVB emission from both active and control lamps.

Adolescent↗