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Biomedical subjects

B M Morgan

Publications and source records attributed to B M Morgan.

At least 37 records · Page 2Linked to original sources
PubMed1988

A single dose epidural technique for caesarean section. A comparison between 0.5% bupivacaine plain and 0.5% bupivacaine with adrenaline.

An epidural technique based on a fractionated injection through a Tuohy needle of 20 ml over 10 minutes, was investigated in 40 mothers who underwent elective caesarean section. Mothers were randomized to receive either 0.5% bupivacaine plain or 0.5% bupivacaine with adrenaline 1:200,000. After a 2-ml test dose, the remaining 18 ml was injected over 5 minutes. The use of adrenaline did not significantly alter the onset or duration, but improved the efficacy of the epidural block. Mean time to onset of adequate surgical anaesthesia was 20 minutes. Only 10 patients required more than the initial 100 mg of bupivacaine. Epidural anaesthesia was supplemented in eight patients with nitrous oxide and/or intravenous opioids.

Adult↗
PubMed1985

Increased severity and morbidity of acute hepatitis in drug abusers with simultaneously acquired hepatitis B and hepatitis D virus infections.

Hepatitis D virus (delta agent) markers were present in 111 (36%) of 308 intravenous drug abusers who were positive for hepatitis B surface antigen (HBsAg), 52 of these having hepatitis D virus antigenaemia. IgM antibody to hepatitis B core antigen (anti-HBc IgM) was present in 92 out of 95 subjects tested, indicating that hepatitis D virus and hepatitis B virus infections had been acquired simultaneously. Hepatitis D virus markers were present in three out of four patients with fulminant hepatitis, and in 80 of 223 (36%) with mild or moderate hepatitis compared with four of 29 (14%) of those who were asymptomatic. These proportional differences were significant (p less than 0.001). Hepatitis D virus markers were present in twice as many patients positive for anti-HBc IgM requiring admission to hospital with acute hepatitis compared with outpatients attending a drug treatment centre. Tests on one patient showed complete disappearance of HBsAg, but hepatitis D antigen (HDAg or delta antigen) and hepatitis B e antigen (HBeAg) were still present in serum samples. All five patients with chronic active hepatitis had hepatitis D antibody (anti-HD) compared with seven of 24 (29%) with chronic persistent hepatitis (p = 0.008). Blocking anti-HD persisted for long periods after simultaneous infections with hepatitis B virus and hepatitis D virus but at lower titres than in patients with chronic liver disease.

Acute Disease↗
PubMed1984

Anaesthetic morbidity following caesarean section under epidural or general anaesthesia.

To find out whether morbidity in the first postoperative week is affected by type of anaesthetic technique, healthy patients who had caesarean sections under epidural anaesthesia were compared with those who were given a general anaesthetic. Epidural anaesthesia was associated with less pain (p less than 0.00001) and discomfort in the immediate postoperative period. By the second day fewer epidural patients had gastrointestinal stasis, pyrexia (p less than 0.05), and coughing (p less than 0.00001). Breastfeeding and mobilisation started earlier. Fewer mothers were coughing (p less than 0.005), had fever (p less than 0.01), or felt tired and depressed (p less than 0.005) by the sixth postoperative day after epidural caesarean section. The epidemiology of anaesthetic morbidity needs to be assessed in other surgical patients.

Anesthesia, Epidural↗
PubMed1984

Sensitive enzyme immunoassay for the detection of delta antigen and anti-delta, using serum as the delta antigen source.

A sensitive enzyme-linked immunosorbent assay (ELISA, EIA) was developed for the detection of delta antigen in serum treated with Tween 20. The serum delta antigen so derived was used in an ELISA for anti-delta. Both tests were specific and more sensitive than radioimmunoassay (RIA) when applied to testing parenteral drug abusers. It is concluded that the different sources of delta-antigen used may account for the different sensitivities noted, and that delta antigenaemia in acute infection may be more frequently detectable than was first thought, amounting to 71% of those with delta infection in this study and that these sera are a convenient alternative source of antigen.

Antibodies, Viral↗
PubMed1984

The consumers' attitude to obstetric care.

Questionnaires were sent to 1000 mothers, 1 year after childbirth, to elicit opinions about various aspects of obstetric care in labour and effects on child bonding. Questionnaires were returned by 632 women. Some attitudes were in broad agreement with the views of natural childbirth groups but more were in agreement with the established medical view. The majority of women did not consider that medical care was excessive and 63% found fetal monitoring reassuring. Questions on mother and child bonding showed that only few mothers (19%) though that this was influenced by events during labour and delivery. Having pain in labour was seen as an essential part of the emotional experience of childbirth by 45% of the respondents. This attitude and others were correlated with certain psychological traits, marital status and race. Before changes are made in obstetric practices in response to 'consumer' pressure, the opinions of recently delivered mothers ought to be taken into account.

Attitude to Health↗
PubMed1983

Mechanisms of airway narrowing in acute pulmonary oedema in dogs: influence of the vagus and lung volume.

In spontaneously breathing dogs (n = 8), maintained in the upright position, bronchial luminal diameter was measured from tantalum bronchograms. Changes in total intrathoracic lung volume were measured from radiographs taken at functional residual capacity (FRCR). With cooling of the cervical vagi to 0-4 degrees C mean bronchial diameter increased to 117 +/- 15 (SD)% of baseline diameter and FRCR increased to 113 +/- 16 of baseline volumes respectively. There was a significant correlation between changes in FRCR and bronchial diameter. After the vagi were rewarmed, pulmonary oedema was induced by rapid intravenous infusion of Hartmann's solution. Bronchi narrowed to a mean of 86 +/- 9% of baseline calibre and FRCR decreased (mean = 95 +/- 15%). With vagotomy bronchial diameter increased (mean = 102 +/- 12% of baseline diameter) but FRCR did not change significantly. Excluding one dog with gross oedema, changes in bronchial diameter due to oedema correlated positively with changes in FRCR; after vagotomy the relationship between diameter and FRCR was similar to that seen after vagal cooling in the baseline state, though individual values were lower. The shift in the diameter-FRCR relationship with vagotomy demonstrates that the direct bronchoconstrictor effect of the vagus is approximately doubled in the presence of pulmonary oedema. Bronchial and peribronchial oedema does not appear to directly narrow the bronchial lumen.

Animals↗
PubMed1983

Anaesthesia for caesarean section. A medical audit of junior anaesthetic staff practice.

This survey compared the safety of 261 healthy mothers of whom 170 received extradural and 91 general anaesthesia for Caesarean section. Anaesthetics were conducted in routine hospital practice by six anaesthetic registrars. Failed intubation occurred in one patient, awareness was reported by 12 patients following general anaesthesia and two patients had abnormal reactions to drugs. In contrast, the numerous complications that arose with extradural anaesthesia were less serious and easier to manage. Hypotension occurred in 11 patients, inadequacy of analgesia in 25 patients and a period of unawareness in 16 patients following sedation after delivery. Extradural block for Caesarean section is thus seen as safer than general anaesthesia when performed by the same group of anaesthetic trainees on healthy mothers.

Adult↗
PubMed1982

Analgesia and satisfaction in childbirth (the Queen Charlotte's 1000 Mother Survey).

Maternal satisfaction with the experience of childbirth was investigated in 1000 women having a vaginal delivery of a live child. Effective pain relief did not ensure a satisfactory birth experience. Epidural block produced the most effective analgesia but there were more dissatisfied women among the epidural patients than among those who did not receive this analgesia (p less than 0.05). Bad experience scores were evaluated one year later and were clearly related to a forceps delivery and long labour, both of which were more common in the epidural group. The desirability of an "epidural on demand" service should be tested against an "epidural when necessary" service.

Analgesia↗
PubMed1982

Pulmonary interstitial compliance: a function of the osmotic constituents of the interstitium.

We have attempted to dehydrate the lung interstitium to determine the nature of forces holding water in that compartment. We administered furosemide with and without bovine albumin intravenously to rabbits (n = 21) 18-24 h before they were anesthetized with pentobarbital sodium. Renal pedicels were ligated and 51Cr-labeled EDTA was injected to estimate lung interstitial water volume. After a period of equilibration the thorax was rapidly opened, and left atrial pressure was measured by direct puncture. 125I-labeled albumin was injected to label the lung vascular volume, and the rabbits were killed 3 min later. Lungs were removed and drained of blood, and extravascular water volume, interstitial volume, and dry weight were determined. Results from these rabbits were compared with a group of normal (n = 4) and overhydrated (n = 6) rabbits. We have found that lung interstitial water is removed in proportion to the change in intravascular forces. We estimate interstitial compliance to be 1.76% cmH2O-1. Our results are compatible with the hypothesis that removal of water is opposed by an increase in interstitial colloid osmotic pressure and not by a fall of hydrostatic pressure. This implies that in the normally hydrated state interstitial hydrostatic pressure is ambient.

Animals↗
PubMed1981

The radiographic detection of acute pulmonary oedema. A comparison of radiographic appearances, densitometry and lung water in dogs.

We have induced acute pulmonary oedema in upright anaesthetized dogs by increasing pulmonary microvascular permeability or by extracellular fluid volume overload in order to determine the sensitivity and specificity of the radiograph to the presence of abnormal lung water. Radiographs were taken before and after development of oedema. At the end of the experiment we removed the inflated lungs and froze them in liquid nitrogen and subsequently examined them macroscopically in the frozen state. The extravascular water/dry lung weight ratio was measured gravimetrically on seven portions of each lung. Finally without the base-line films for comparison. We directly measured the change in opacity of the films with a radiographic densitometer. When a dog's mean extravascular water/g dry lung was increased by more than 35% it was invariably recognized, in one or more zones, as definite oedema. Control dogs were reliably recognized as normal when base-line films were used but the distinction between normal and minor degrees of oedema could not be made without the base-line films. There was a positive correlation between radiological grade and lung water, but a great deal of overlap between grades. Densitometry was not a sensitive or reliable method for diagnosing or quantifying oedema. Oedema was usually associated with a decrease in volume of the lower lung zones.

Absorptiometry, Photon↗
PubMed1980

Epidural analgesia for uneventful labour.

The effectiveness of epidural analgesia for uneventful labour was assessed in 200 patients who had received epidural blocks performed by trainee anaesthetists and whose subsequent management was supervised by trainee midwives. Although 88% of mothers were satisfied with the pain relief, only 46% had a completely painless labour after insertion of the epidural block. The major cause of pain was due to delay by attendant midwives in repeating the dose of local anaesthetic. Epidural analgesia is potentially highly effective, but in practice this seems to be related to the expertise of the anaesthetists and the midwives. Almost half the deliveries were instrumental, the proportion being greater for primipara, and this was presumably related to the epidural analgesia.

Anesthesia, Epidural↗
PubMed1980

Maternal death. A review of maternal deaths at one hospital from 1958 to 1978.

A retrospective examination of all maternal deaths at Queen Charlotte's Hospital in the last 20 years shows that general anaesthesia is the greatest single cause of maternal death. This highlights the need for considerable reduction in the inherently dangerous technique of general anaesthesia to patients in labour and, where possible, its replacement by extradural and spinal blocks.

Adult↗
PubMed1980

The relationship between elevated blood pressure and obesity in Black children.

Blood pressures, heights and weights were measured in 1,692 elementary school black children. Elevated blood pressure (EBP) was defined as a systolic or diastolic reading above the 90th percentile for age, and weights were categorized into five classes based on weight for height norms. Systolic EBP children, whether boys or girls, were three times as likely to be obese as black children in the total population, and a similar relationship held for diastolic EBP children.

Black or African American↗