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Biomedical subjects

K Moran

Publications and source records attributed to K Moran.

30 records · Page 2Linked to original sources
PubMed1995

Inter-rater reliability in the medical diagnosis of child sexual abuse.

OBJECTIVE: To examine inter- and intra-rater reliability in the assessment of genital findings in cases of suspected child sexual abuse. METHODOLOGY: Colposcopic photographs of the external genitalia of 70 female children were independently assessed by child sexual abuse teams in Auckland and Sydney. For the Auckland centre, intra-rater reliability was assessed by making a second independent assessment 6 months following the first. Reliability was quantified using per cent of agreement and Cohen's Kappa statistic. RESULTS: There were high levels of inter- and intra-rater agreement. When photographs were classified as normal/non specific or strongly indicative of child sexual abuse, there was 93% agreement between the Auckland and Sydney teams with a kappa score of 0.70. For the two separate ratings made by the Auckland team there was 94% agreement with a kappa score of 0.75. CONCLUSIONS: The high levels of inter- and intra-rater agreement obtained in this study were reassuring. The results obtained compare favourably with the results of reliability studies in other areas of medical practice.

Child↗
PubMed1994

Non-accidental head injury in children.

AIMS: To analyse the clinical features, social circumstances, investigations and outcome of 49 children with significant non-accidental head injury admitted to The Prince of Wales Children's Hospital between 1979 and 1993. CLINICAL FEATURES: Age ranged from one month to eight years, with 30 children less than one year old. There were 28 boys and 21 girls. Thirty-three were in the care of a parent. Eleven of these were known to the Department of Community Services and 22 were from families with stressed socioeconomic circumstances characterised by deprivation. In 44 cases the history was incompatible with the clinical findings. On admission, 21 had marked depression of awareness, with a Glasgow Coma Scale score (GCS) of 9 or less. Eleven of this group were fitting. Seizures were present in a further 13 children who were semi-purposeful (GCS > 9). Twenty-eight had retinal haemorrhages and 35 had soft tissue scalp contusions, 23 in association with skull fracture. Twenty-six had associated injuries. Seven children died. Of the 42 survivors at the time of discharge, 19 had severe motor disability associated with other deficits. Twenty-four were returned to the care of their families. CONCLUSIONS: Retinal haemorrhage and unconsciousness on admission (GCS < or = 9) were positively associated with a poor outcome (P < 0.001 and 0.002, respectively). Cerebral oedema found on computerised tomography was positively associated with severe motor disability on discharge (P < 0.001). Lowest socioeconomic circumstances appeared to be a risk factor for occurrence of injury: 22 of 49 children came from circumstances of deprivation.

Australia↗
PubMed1992

Morphological changes and alterations in regional intrarenal blood flow induced by graded renal ischemia.

A model of renal ischemia was used to study morphological changes and alterations in intrarenal blood flow. Renal artery blood flow was reduced from 120 to 20 ml./minute (normal 172 +/- 14) for 3 weeks. Morphological changes were assessed histologically, and by electronmicroscopy. Intrarenal blood flow was determined using microspheres. Flow rates less than 80 ml./minute resulted in a progressive loss of renal volume with arterial thrombosis and renal infarction at 20 ml./minute. Histological changes included loss of glomerular volume, tubular dilatation (60 ml./minute), tubular cast formation (50 ml./minute) tubular atrophy, interstitial fibrosis, arteriolar thickening (40 ml./minute) and glomerular hyalinization (30 ml./minute). Electronmicroscopy changes at 60 ml./minute (loss of glomerular microvasculature, unfolding of glomerular vascular tuft, appearance of blind ending vessels) progressed to disruption of glomerular architecture noted at 30 ml./minute. Narrowing of medullary blood vessels (60 ml./minute) and neovascularisation (40 ml./minute) was observed. Progressive ischemia decreased medullary, inner cortical and outer cortical blood flow (5.9 to 2.1 ml./minute/gm.) p less than 0.01, with a compensatory increase to the opposite kidney.

Animals↗
PubMed1990

Extracorporeal shockwave lithotripsy monotherapy for paediatric urinary tract calculi.

The role of extracorporeal shockwave lithotripsy (ESWL) in the management of paediatric urinary tract calculi was evaluated. The study group included 22 children (13 male, 9 female) with an age range of 2 to 13 years. The renal calculi, including staghorn and ureteric calculi, varied in size from 0.3 to 5 cm. Overall stone clearance at 3 months was 79% with a low incidence of complications (2 children required nephrostomy drainage for sepsis). ESWL is a non-invasive method of managing even complex stones in children of all ages, irrespective of size or position.

Adolescent↗
PubMed1989

Prognostic value of nucleolar organizer regions and ploidy values in advanced colorectal cancer.

The prognostic value of nucleolar organizer regions and ploidy status in patients with Dukes' C colorectal cancer was determined. In addition, nucleolar organizer regions and ploidy status were compared with the established prognostic indices age, sex, tumour location and degree of histological differentiation. Fifty-one patients (27 men, 24 women) aged 35-81 years (median 64.8 years) were studied. Five years after presentation, 16 patients were alive and well. Survivors had significantly lower nucleolar organizer region counts (median value and range) in primary tumours 12 (8-15) and lymph node metastases 11 (8-15) than non-survivors 17 (14-25) and 18 (13-25) respectively (P less than 0.05). Fewer survivors had aneuploid tumours than non-survivors: four survivors compared with 17 non-survivors. In a regression analysis model, nucleolar organizer regions were the most important individual variable for predicting survival (chi2 = 15, P less than 0.01) while ploidy values (chi2 = 6, P less than 0.2) were equivalent to histological differentiation.

Adult↗
PubMed1987

Alterations of the host defense mechanism in burned patients.

The host defense mechanism against microbial infection is seriously suppressed following a major thermal injury. In this article the specific and nonspecific systems are dissected, demonstrating known sites of alteration, and laying out a rational groundwork for future intervention.

Burns↗