Search PubMed⌕ Search

Biomedical subjects

W Morrison

Publications and source records attributed to W Morrison.

At least 19 recordsLinked to original sources
PubMed2006

Resurfacing the nasomaxillary cavity for management of epistaxis in Osler-Rendu-Weber disease.

Recurrent massive epistaxes due to heriditary haemorrhagic telangectasia were managed in two patients by ablation of the mucosa of the nasal and maxillary cavities and resurfacing with radial forearm fasciocutaneous free flaps. Both patients had undergone multiple procedures attempting to control the epistaxes prior to the definitive procedures described. Both patients remained epistaxis free postoperatively and retained their nasal airways. Olfactory function was preserved in the second patient due to preservation of the superior turbinate and cribriform olfactory mucosa.

Aged↗
PubMed2005

Speech and swallowing following radial forearm flap reconstruction of major soft palate defects.

Velopharyngeal function is often compromised by the resection and reconstruction of oropharyngeal and palatal tumours. While free tissue transfer has improved the outcomes of head and neck reconstruction. In general, palatal reconstruction remains a challenge. Velopharyngeal function was analysed in eight patients following microsurgical reconstruction of defects of between 50 and 100% of the soft palate. The radial forearm fasciocutaneous free flap was used in all cases. The outcome of reconstruction was analysed by patient questionnaire and with standardised tests of speech and swallowing function. Velopharyngeal function post-operatively ranged from poor to near normal. Poor function appeared due to the loss of active elevation and contracture of the reconstructed palate producing failure of velopharyngeal closure during swallowing and speech. The results emphasise the limitations of reconstruction of a dynamic structure such as the soft palate with the static fold of skin and soft tissue produced by a fasciocutaneous flap. The relatively poor results obtained suggest that an anatomical approach to soft palate reconstruction is inadequate and reduction of the calibre of the velopharyngeal aperture is required to compensate for the lack of mobility in the reconstructed palate.

Carcinoma, Squamous Cell↗
PubMed2002

Free flaps in the treatment of locally advanced malignancy of the scalp and forehead.

Locally advanced cutaneous malignancy of the scalp and forehead is a disease that requires an aggressive approach to resection and reconstruction. Free flap reconstruction in these sites has been advocated because of the advantages of importing large amounts of well-vascularized tissue into a recipient site, which has often been compromised by previous surgery or radiotherapy. A consecutive series of 32 free flap reconstructions in 29 patients with cutaneous malignancy of the scalp and forehead was reviewed. The flap failure rate was 6% (two flaps) and the major complication rate was 10%. Of the surviving flaps, 97% (N = 29) were successful in reconstructing a challenging group of defects. Three patients developed local recurrence of the primary malignancy (mean follow-up, 21 months). The use of a broad repertoire of free tissue transfers in reconstruction of the scalp and forehead defects has allowed effective treatment of locally advanced malignancy of this region. Critical analysis of the results, however, indicates that microsurgical reconstruction is not without morbidity and that there are refinements in the diagnostic and operative steps of management that can maximize the functional and aesthetic results.

Adult↗
PubMed2002

Hypothermia in elderly patients presenting to accident & emergency during the onset of winter.

It is well established that the elderly population is vulnerable to hypothermia, leading to increased morbidity. A prospective observational study took place between 1 October 1999 and 31 December 1999 in a large teaching hospital Accident and Emergency department. Core temperature was assessed at presentation using a tympanic probe on patients over 65 years of age. A total of 1543 eligible patients attended during the study period. Complete data was available on 958 patients. Forty-eight patients (5%) were found to be hypothermic (core temperature < 35 degrees Celcius). There were two peaks in hypothermic presentations; these corresponded to periods of cold weather. The incidence of hypothermia was higher in non-ambulant patients and those with co-morbidity; the majority of patients lived in relatively deprived areas by a postcode derived deprivation index. Mortality was 34% in patients hypothermic at presentation. Hypothermia contributes to mortality and morbidity in elderly patients; its incidence may be higher than previously reported.

Aged↗
PubMed2002

Emergency ambulance dispatch: is there a case for triage?

Emergency telephone calls for an ambulance (999 calls) are usually dealt with first-come first-served. We have devised and assessed criteria that ambulance dispatch might use to prioritize responses. Data were collected retrospectively on consecutive patients presenting to an accident and emergency (A&E) department after a 999 call. An unblinded researcher abstracted data including age, date, time, caller, location, reason for call and A&E diagnosis and each case was examined for ten predetermined criteria necessitating an immediate ambulance response--namely, cardiac arrest; chest pain; shortness of breath; altered mental status/seizure; abdominal/loin pain >65 years old; fresh haematemesis; fall >2m; stabbing; major burns. 471 patients were recruited, 55% male, median age 50 years. 406 calls came from bystanders or the patients themselves, 36 from general practitioners, 8 from other hospitals and 21 from the police. 52% of patients were admitted. 44% met at least one of the above criteria. Most patients did not meet the criteria for an immediate ambulance response but might nonetheless be suitable for an urgent response. The criteria used in this study have the advantage of being based on the history provided by the caller. The introduction of a priority-based dispatch system could reduce response times to those who are seriously ill, and also improve road safety.

Ambulances↗
PubMed2001

Combined interferon-alfa, 13-cis-retinoic acid, and alpha-tocopherol in locally advanced head and neck squamous cell carcinoma: novel bioadjuvant phase II trial.

PURPOSE: Retinoids and interferons (IFNs) have single-agent and synergistic combined effects in modulating cell proliferation, differentiation, and apoptosis in vitro and clinical activity in vivo in the head and neck and other sites. Alpha-tocopherol has chemopreventive activity in the head and neck and may decrease 13-cis-retinoic acid (13-cRA) toxicity. We designed the present phase II adjuvant trial to prevent recurrence or second primary tumors (SPTs) using 13-cRA, IFN-alpha, and alpha-tocopherol in locally advanced-stage head and neck cancer. PATIENTS AND METHODS: After definitive local treatment with surgery, radiotherapy, or both, patients with locally advanced SCCHN were treated with 13-cRA (50 mg/m(2)/d, orally, daily), IFN-alpha (3 x 10(6) IU/m(2), subcutaneous injection, three times a week), and alpha-tocopherol (1,200 IU/d, orally, daily) for 12 months, with a dose modification. Screening for recurrence or SPTs was performed every 3 months. RESULTS: Tumors of 11 (24%) of the 45 treated patients were stage III, and 34 (76%) were stage IV. Thirty-eight (86%) of 44 patients completed the full 12-month treatment (doses modified as needed). Toxicity generally was consistent with previous IFN and 13-cRA reports and included mild to moderate mucocutaneous and flu-like symptoms; occasional significant fatigue (grade 3 in 7% of patients), mild to moderate hypertriglyceridemia in 30% of patients who continued treatment along with antilipid therapy, and mild hematologic side effects. Six patients did not complete the planned treatment because of intolerable toxicity or social problems. At a median 24-months of follow-up, our clinical end point rates were 9% for local/regional recurrence (four patients), 5% for local/regional recurrence and distant metastases (two patients), and 2% for SPT (one patient), which was acute promyelocytic leukemia (ie, not of the upper aerodigestive tract). Median 1- and 2-year rates of overall survival were 98% and 91%, respectively, and of disease-free survival were 91% and 84%, respectively. CONCLUSION: The novel biologic agent combination of IFN-alpha, 13-cRA, and alpha-tocopherol was generally well tolerated and promising as adjuvant therapy for locally advanced squamous cell carcinoma of the head and neck. We are currently conducting a phase III randomized study of this combination (v no treatment) to confirm these phase II study results.

Adult↗
PubMed2001

The role of neck dissection after chemoradiotherapy for oropharyngeal cancer with advanced nodal disease.

OBJECTIVE: To analyze and compare the effectiveness of sequential platinum-based chemotherapy and radiotherapy with and without selective neck dissection in patients with N2a and greater stage node-positive squamous cell carcinoma of the oropharynx. DESIGN: Nonrandomized controlled trial. SETTING: Tertiary referral center. PATIENTS: Sixty-six patients with squamous cell carcinoma of the oropharynx staged N2a or greater. INTERVENTIONS: Platinum-based induction chemotherapy followed by definitive radiation therapy; and selective neck dissections 6 to 10 weeks following the completion of radiation therapy in patients with radiographic evidence suggesting residual neck disease. MAIN OUTCOME MEASURES: Locoregional recurrence and disease-free survival. RESULTS: Of 66 patients, 24 (36%) had complete responses in the primary local tumor (oropharynx) and regional disease (neck nodes), as assessed clinically and radiographically. These patients had lower rates of locoregional recurrence than did patients showing no or partial responses, but the differences were not significant (P>.05). Of 18 patients undergoing neck dissection, 10 (56%) had pathological evidence of residual tumor. Patients showing a complete response of regional and neck disease had significantly improved disease-specific and overall survival (P = .01 for both) compared with patients showing no or partial responses of their neck disease. Patients with no or partial responses who underwent neck dissections had significantly improved overall survival compared with similar patients who did not undergo neck dissections (P = .002). CONCLUSIONS: Even in patients with bulky nodal disease, a complete response in the neck to sequential chemotherapy and radiotherapy may indicate that neck surgery is not necessary for good locoregional control and improved disease-free survival. Neck dissection is recommended for patients with no or partial radiographic responses.

Adult↗
PubMed2001

Replantation.

Explore the source record for details and available documents.

Animals↗
PubMed2001

A survey of the perceived quality of patient handover by ambulance staff in the resuscitation room.

OBJECTIVES: The aim of this study was to examine the quality of handover of patients in the resuscitation room by describing the current perceptions of medical and ambulance staff. METHODS: This was a descriptive survey using two anonymous questionnaires to gauge current opinion, one designed for medical staff and the other for ambulance staff. Questionnaires were distributed to medical staff in two teaching hospital accident and emergency (A&E) departments and ambulance personnel in the Tayside region of Scotland. RESULTS: 30 medical and 67 ambulance staff completed questionnaires. Some 19.4% of ambulance staff received formal training in giving a handover, 83% of the remaining felt there was a need for training. Medical staff conveyed their belief that handovers were very variable between crews and that they did not feel radio reports were well structured. Ambulance crews felt that medical staff did not pay attention to their handovers. Ambulance staff seemed satisfied with the quality of their handovers, although medical staff were less positive particularly in the context of self poisoning and chest pain. Both seem to be least confident with regards to the handover of paediatric emergencies. Medical staff were generally less satisfied with the reporting of vital signs than the history provided. CONCLUSIONS: Despite a generally positive perception of handovers there may be some room for improvement, in particular in the area of medical emergencies. Ambulance staff training should produce a structure for the handover that is recognisable to medical staff. The aim being a smooth and efficient transfer from prehospital agencies to A&E staff.

Ambulances↗
PubMed2000

Primary care or A&E? A study of patients redirected from an accident & emergency department.

A departmental policy was introduced whereby patients with a complaint of over three days duration are assessed at triage by senior doctors as to whether they should be seen in A&E or redirected to primary care. This pilot study aimed to establish numbers, demographics, reasons for attending and outcome. A total of 179 patients were studied. Most were young men attending during working hours on week days. Most had symptoms for more than one week and had not seen their GP. Of 137 patients advised to see their GP--67 did so. No adverse outcomes were reported. Twenty-three patients were seen in A&E: six had fractures, one required admission. Limited resources and increasing demands means that A&E must define its service. This system selects out those patients with prolonged symptoms who are likely to be able to be managed in the primary care setting.

Adolescent↗
PubMed1999

Muscle protection following motor nerve repair in combination with leukemia inhibitory factor.

Leukemia inhibitory factor (LIF) has been shown to stimulate growth of muscle and nerve cells. In this rat study, in which the nerve to the medial head of the gastrocnemius was divided and repaired and slow-release LIF was administered at the repair site, we evaluated recovery by measuring the force of muscle contraction and of muscle bulk. Thirty-five male Sprague-Dawley rats (325-375 g) were randomly divided into 5 different groups according to type of treatment: denervated, end-to-end nerve repair, end-to-end nerve repair with LIF, neurotization, and neurotization with LIF. The contralateral side served as a nonoperated control group. Leukemia inhibitory factor was administered for 28 days to the site of the nerve repair via an implanted osmotic infusion pump. Muscle mass and muscular function were evaluated at 6 weeks using electrophysiologic techniques. The medial gastrocnemius muscle mass of the repair + LIF group was greater than the repair-alone group. The peak twitch, relative twitch, relative tetanic, and tetanic forces generated from the repair + LIF group were also significantly higher than those in the repair-alone group. Although neurotization was almost as effective as end-to-end nerve repair for reinnervating muscle, LIF had no increased effect on neurotization. These data suggest that LIF protects muscular function and reduces denervation atrophy following end-to-end nerve repair.

Animals↗
PubMed1999

Will I make it through this choppy water? A psychological characteristic as a predeterminant factor to coping with multiple sclerosis.

The ability to cope with major stressors and adversity in our lives is as individual as the human experience. An unpredictable disease such as Multiple Sclerosis (MS) can demand major adjustments to one's lifestyle, employment, and personal relationships. Why is it that some sail smoothly through major upheaval in all of these realms despite the acquisition of significant physical disability while others are immobilized by seemingly trivial disruptions in their routine. How can we, as health professionals, assist those who are coping in a non-adaptive manner, to identify and implement more effective strategies. Does focused counseling early in the disease promote effective coping? Existing literature reviews coping with chronic illness, detailing the tools and strategies which individuals may use to manage stressors. This paper will build on this foundation of knowledge. How well you are determines how well you cope. The emphasis will be on "premorbid" personality traits which may be critical to coping. The author will critically examine the practicality of utilizing existing assessment tools for those at differing stages of MS and offer assessment guidelines for nurses working both with newly diagnosed and well-established disease. Suggestions for counseling techniques which may promote effective coping behaviors will be offered. How an individual copes with a chronic illness such as MS has implications for that person's family, social network and society at large. Those who become overwhelmed by a disease such as MS will stop working earlier, utilize more healthcare resources, and rate themselves as having poor quality of life. Nurses and other health professionals who have regular contact with those with MS may be able to influence this scenario.

Adaptation, Psychological↗
PubMed1998

Helical CT of calcaneal fractures: technique and imaging features.

Since the degree of comminution, fracture alignment, and articular congruity of intra-articular calcaneal fractures are important determinants in surgical treatment and patient prognosis, we review helical computed tomographic (CT) technique and features for detecting and assessing the extent of acute calcaneal fractures. Helical CT can be used to classify these fractures and facilitate the surgeon's understanding of the anatomy and position of the fracture components in all orthogonal planes independently of the patient's condition, foot placement in the CT gantry, or other injuries.

Calcaneus↗
PubMed1996

Depression and multiple sclerosis.

The objective of the present study were (1) to ascertain the lifetime risk of a depression in a representative group of multiple sclerosis (MS) patients, (2) to assess the morbidity risks for depression among first-degree relatives of these MS patients, and (3) to compare these familial risks for first-degree relatives of MS patients with those for first-degree relatives of a primary depression population, i.e., depression but no MS. We psychiatrically evaluated 221 MS patients (index cases) using a structured clinical interview for the DSM-III-R and calculated the rate and lifetime risk of depression for these index cases using the product limit estimate of survival function. We obtained psychiatric histories for all first-degree relatives of index cases, and we calculated morbidity risks for depression for these relatives using the maximum likelihood approach and compared the risks using the likelihood ratio tests. Index cases had a 50.3% lifetime risk of depression. Morbidity risks for depression among first-degree relatives of index cases were decidedly lower when compared with morbidity risks among first-degree relatives of the reference population. Although there appears to be a very high rate of depression among MS patients, the data for their first-degree relatives do not support a clear genetic basis for this depression, or at least the same genetic basis that probably operates within families when depression occurs in the absence of MS.

Adolescent↗
PubMed1996

Betaseron: a breakthrough treatment for multiple sclerosis.

Multiple sclerosis (MS) is the most common cause of disability in young adults; in Canada, it affects 1 in 1,000 people. A chronic and complicated demyelinating autoimmune disorder of the central nervous system, MS has no known cure. Indeed, there has been no effective treatment until recently.

Adjuvants, Immunologic↗
PubMed1995

Urinary myelin basic protein-like material as a correlate of the progression of multiple sclerosis.

In the multicenter, randomized, placebo-controlled trial of alternate-day injections of recombinant interferon beta-1b in relapsing-remitting multiple sclerosis (MS), urine specimens were collected periodically from all patients (n = 64) in two of the clinical test sites over the 2 years of the study. Urine specimens were also collected over two consecutive 24-hour periods from 43 patients from a third center. Urine samples were assayed for their content of myelin basic protein-like material (MBPLM), the level of which was correlated with clinical changes, cranial magnetic resonance imaging results, and the development of progressive disease. Concordant changes in creatinine values affected some of the relationships of MBPLM. The level of urinary MBPLM correlated with a chronic progressive course and with the number of lesions and the total lesion area on cranial magnetic resonance images. A rise in the level of urinary MBPLM appeared to antedate the clinical transition from a relapsing-remitting to a chronic progressive course. By chance, the randomized entry of patients led to significant differences in urinary MBPLM levels among the three treatment groups, thus precluding correlation studies of treatment effects. However, the patient group from which 24-hour specimens were collected showed that the patients with relapsing-remitting MS changing to a chronic progressive course, and more specifically, those patients with chronic progressive MS receiving placebo, had the highest values of urinary MBPLM. These findings indicate that urinary MBPLM may offer an objective test and possibly serve as a surrogate marker for detecting or predicting the failure of remission or the transition to a progressive phase of MS.

Analysis of Variance↗