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Biomedical subjects

M C Morrison

Publications and source records attributed to M C Morrison.

16 recordsLinked to original sources
PubMed1992

Sclerotherapy of malignant pleural effusion through sonographically placed small-bore catheters.

Pleural sclerosis after drainage with a small-bore catheter was performed in 21 patients with malignant pleural effusions. Intrapleural catheters 7- to 24-French in size were placed by using sonographic guidance. Tetracycline (18 patients) and bleomycin (four patients) were used as sclerosing agents (one patient had both). Clinical and radiologic follow-up was available on all patients until they died (range, 2 weeks to 25 months; mean, 3.6 months). Pleural sclerosis was successful in 15 (71%) of 21 patients. Two patients in whom pleurodesis failed had pleural sclerosis repeated, with one success and one failure. All of the failures were in patients in whom the amount of chest-tube drainage was more than 100 ml/day. Pleurodesis with tetracycline was painful in six patients; no pain was associated with use of bleomycin. Small pneumothoraces developed in four patients at the time of chest-tube placement, without consequence. A superimposed infection that developed in a patient having continuous drainage of pleural fluid was successfully treated with antibiotics. Pleural sclerotherapy can be performed through sonographically placed small-bore catheters with results comparable to those seen with large-bore, surgically placed catheters.

Adult↗
PubMed1992

Surgical training.

Explore the source record for details and available documents.

General Surgery↗
PubMed1991

Malignant small bowel obstruction and ascites: not a contraindication to percutaneous gastrostomy.

Percutaneous gastrostomy (PG) with gastropexy was performed for relief of malignant small bowel obstruction in 12 patients with extensive ascites. Abdominal paracentesis was performed before PG in nine patients and after PG in one patient. Gastrostomy catheters were inserted without complication in all patients. Clinical follow up revealed that pericatheter leakage of ascitic fluid and skin excoriation occurred only in the three patients who did not have paracentesis performed before PG. No dislodgement of gastrostomy catheters occurred but mild peritonitis was noted in one patient. Our experience suggests that although in the past extensive ascites was a relative contraindication for PG, these patients can now be successfully treated with a combination of ultrasound-guided paracentesis to reduce pericatheter leakage of ascitic fluid, and gastropexy to prevent catheter dislodgement.

Abdomen↗
PubMed1991

Percutaneous contact dissolution of gallstones: complexity of radiologic care.

The clinical and technical considerations for successful gallstone dissolution with methyl tert-butyl ether (MTBE) are often underestimated. Patients are selected for MTBE therapy on the basis of a functioning gallbladder without evidence of acute inflammation or calcified stones at plain radiography. A transhepatic route is favored for percutaneous insertion of the cholecystostomy catheter because of the theoretic reduced frequency of bile leakage. MTBE is delivered manually through the catheter in a closed system, with dissolution times of 4-16 hours. After MTBE dissolution, residual debris in the gallbladder is present at follow-up sonography in up to 75% of patients. The high frequency of residual debris, the potential for stone recurrence, and the labor-intensive nature of MTBE therapy make its future uncertain, especially with the advent of laparoscopic cholecystectomy.

Cholelithiasis↗
PubMed1991

Treatment of critically ill patients with sepsis of unknown cause: value of percutaneous cholecystostomy.

Because of the difficulty in diagnosing acute cholecystitis in critically ill patients with severe intercurrent illness by clinical and imaging methods or percutaneous aspiration of the gallbladder, a trial of percutaneous cholecystostomy was performed in 24 patients in the intensive-care unit with persistent, unexplained sepsis after a complete clinical, laboratory, and radiologic search showed no alternative source of infection. Persistent high fevers, despite antibiotic therapy, were present in all patients, with elevated WBC count in 18 patients, vague abdominal tenderness in 11, and septic shock requiring vasopressors in 15. Sonographically, all patients had distended, spherical gallbladders, six had gallstones, eight had wall thickening, three had pericholecystic fluid, and four had Murphy's sign. All patients were seen by a senior abdominal surgeon, who agreed to a trial of percutaneous cholecystostomy. Fourteen patients (58%) responded to percutaneous cholecystostomy, as evidenced by a decrease in WBC count, defervescence, and the ability to be weaned off vasopressors. Bile cultures were positive in four patients. Ten patients (42%) did not respond to percutaneous cholecystostomy; five eventually died of unrelated causes. A respiratory source of infection was eventually found in three of these 10 patients, with no proved source of infection in the remainder. No complications related to catheter insertion occurred in this group of patients. Bile leaks occurred in two patients when the percutaneous cholecystostomy catheter was removed, but without serious consequence. Our experience suggests that a lower threshold for performing percutaneous cholecystostomy in this difficult clinical subset of patients is worthwhile.

Acute Disease↗
PubMed1990

Occlusion of biliary endoprostheses: presentation and management.

A retrospective review of 20 cases of endoprosthesis occlusion in 17 patients was performed. The average length of stent patency before occlusion was 3.7 months. Clinical manifestations included one or a combination of the following: cholangitis (n = 17), jaundice (n = 9), and leakage of bile or purulent material from the percutaneous insertion site (n = 6). Eighteen of 20 episodes of endoprosthesis occlusion were successfully managed with normalization of biochemical parameters and alleviation of clinical manifestations. No therapy was attempted in two episodes of stent occlusion due to widespread metastatic disease. All 17 patients received intravenous fluid replacement and broad-spectrum antibiotic therapy. This was sufficient therapy to relieve symptoms in two cases of occlusion. Occluded stents were removed in the other 16 patients by means of radiologic (n = 10) or endoscopic (n = 6) methods. After the acute septic episode had subsided (2-5 days; mean, 3 days), new endoprostheses were percutaneously inserted in 10 cases of occlusion, long-term internal-external catheters were placed in five, and surgical bypass was performed in one. The authors conclude that endoprosthesis occlusion should not be considered a terminal event in patients with malignant biliary disease.

Aged↗
PubMed1990

Percutaneous cecostomy: controlled transperitoneal approach.

The authors present two cases of percutaneous cecostomy performed with a modified approach previously described for percutaneous gastrostomy and cholecystostomy. T-fastener devices were used to affix the cecum to the anterior abdominal wall; thus, the potential problem of fecal spillage was prevented. In both cases, adequate fecal drainage was provided without complication.

Aged↗
PubMed1990

Percutaneous gastrostomy with gastropexy: experience in 125 patients.

We report our experience with radiologically guided percutaneous tube gastrostomy in 125 patients by using a gastropexy technique in which the anterior gastric wall is nonsurgically sutured to the anterior abdominal wall with percutaneously placed T-fasteners before catheter insertion. Short-term follow-up of up to 2 weeks was available in all patients. In 63 patients, long-term follow-up (greater than 4 weeks; average, 3.5 months; maximum, 1 year) was available. Catheter placement was successful in 124 (99%) of 125 patients, including three patients with anatomic changes after Bilroth II hemigastrectomy and two patients with failed endoscopic attempts. There were no deaths related to the procedure, and no patients required surgical intervention for complications attributable to the gastrostomy procedure. The 30-day mortality rate was 11% (n = 7). These deaths were due to cardiorespiratory arrest and were not attributable to the gastrostomy procedure. Major complications occurred in 1.6% (n = 1) and minor complications in 9.5% (n = 6). These results indicate that percutaneous gastrostomy with gastropexy is a safe and effective technique for placement of catheters in the stomach.

Adult↗
PubMed1990

Percutaneous balloon dilatation of benign biliary strictures.

Percutaneous biliary dilatation is an effective alternative to surgical management of benign biliary strictures that has low morbidity and no reported mortality. Reported success rates for this procedure range from 40% to 90% depending on the size of the series, the type of patient being treated, and the length of follow-up period. The procedure is done in the fluoroscopy suite with an angioplasty balloon catheter. Transhepatic access is most common, but the procedure may be done via existing T-tube tracts or specially created jejunal loops. As the frequency of radical liver surgery such as liver transplant and radical trisegmentectomy rises, so too, the rate of biliary stricture is likely to rise, making percutaneous balloon dilatation an increasingly important tool in the interventional radiologist's armamentarium.

Catheterization↗
PubMed1989

Familial aggregation of multiple myeloma and central nervous system diseases.

Degenerative central nervous system diseases such as Alzheimer's disease and lymphoreticular malignancies such as multiple myeloma occur with increased frequency with advancing age. Relatives of early-onset Alzheimer's disease patients may have an increased risk of lymphoreticular malignancies. This led us to evaluate the family history of central nervous system diseases in a case-control study of multiple myeloma. Thirteen of 439 multiple myeloma cases had one or more first-degree relatives with degenerative or demyelinating central nervous system disease. In comparison, there were nine "positive" family histories in 1,317 matched hospital controls (relative risk = 4.4, 95% confidence interval = 1.9-10.3). Relative risks for the component categories of Parkinson's disease, multiple sclerosis, and miscellaneous degenerative central nervous system diseases were 3.0, 4.0 and 11.9, respectively. Our findings suggest that the degenerative and demyelinating central nervous system diseases and the lymphoreticular malignancies may comprise an etiologically related group of "protean diseases." These diseases may have a shared genetic susceptibility, possibly an immunologic abnormality. The varied disease manifestation in family members suggests a second necessary etiologic step of a variable and possibly environmental nature.

Aged↗
PubMed1987

Evaluation of dipstick urine studies using a scoring system based on test performance characteristics.

A weighted scoring system based on the selection of four measures of the performance characteristics of a laboratory test--sensitivity, specificity, and false positive and false negative rates--was devised to provide a rationale basis for ranking and evaluating dipstick urine screening tests as a criterion for elimination of routine urine microscopic examination. Equal weight was assigned to each performance characteristic, and an arbitrarily chosen scoring scale of 100 was selected for simplicity. When a summation procedure was applied to urine studies available in the medical literature, three categories of author acceptability were found: accept: score greater than 80; conditional accept: score 70-80; reject: score less than 70. Studies incorporating leukocyte esterase (LE) were found to have the highest scores and the highest author acceptability, whereas studies lacking LE had the lowest scores and lowest author acceptability. This easy-to-use, weighted scoring system is proposed as a guide for deciding whether dipstick screening tests are acceptable as a way of eliminating routine microscopic examination.

Carboxylic Ester Hydrolases↗
PubMed1987

Scintigraphic evaluation of brain death: significance of sagittal sinus visualization.

Radiotracer scintigraphy has been commonly used in this country to confirm and document the clinical diagnosis of brain death. Whether the presence of radiotracer activity in the region of sagittal venous sinus (SVS) represents actual blood flow to the brain in the absence of demonstrable cerebral arterial flow remains a controversial issue. Our retrospective study was performed to review the significance of such sagittal tracer activity. Of the 53 patients showing no cerebral arterial flow, 26 showed tracer activity in the region of SVS. The clinical status, EEG findings, and outcome of all 53 patients were the same irrespective of the presence or absence of SVS tracer activity. We conclude that the mere presence of SVS in the absence of demonstrable cerebral arterial flow activity is not clinically significant and does not contradict the diagnosis of brain death.

Brain Death↗
PubMed1986

Dipstick testing of urine--can it replace urine microscopy?

One thousand consecutive urine specimens were studied to assess the sensitivity of a commercially available dipstick (Chemstrip 8, Boehringer Mannheim Corp., Indianapolis, IN) to predict the presence or absence of microscopic abnormalities. The Chemstrip 8 had a sensitivity of 78%, specificity of 54%, and a false negative rate of 38%. An additional 1,000 consecutive urine specimens were then studied using the Chemstrip 9, a reagent dipstick that includes the leukocyte esterase (LE) test. The Chemstrip 9 had a sensitivity of 82%, specificity of 42%, and a false negative rate of 36%. Chi-squared analysis revealed that the two dipsticks were not significantly different (chi 2 = 0.17, P greater than 0.5). Clinical review of patients with false negative results showed that approximately one-third to one-half of these patients had either spinal cord injury or genitourinary problems. Maximal potential savings in workload of approximately 10% were found if microscopic examinations were to be performed only on urine specimens with abnormal dipsticks. Our data suggest that in our patient population, we should not eliminate microscopic urine examination based on abnormal dipstick findings.

Esterases↗