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Biomedical subjects

M Farrell

Publications and source records attributed to M Farrell.

At least 91 records · Page 5Linked to original sources
PubMed1996

Alternative techniques of feeding gastrostomy in children: a critical analysis.

BACKGROUND: In the era of managed care, the operative procedure applied to solve a given problem should vary with the status of the patient, the training and experience of the specialist, an analysis of morbidity and mortality rates, and a cost analysis of therapeutic alternatives. The purpose of this study was to critically analyze three different techniques for gastric feeding access in children. STUDY DESIGN: A retrospective analysis of patients who underwent primary feeding gastrostomy was performed at our institution. Patients who underwent gastrostomy placement concurrently with another major procedure were excluded. RESULTS: Over a 36-month period, 98 children underwent placement of a feeding gastrostomy by one of three alternative techniques: an open Stamm gastrostomy (Stamm, n=47), a pull-out percutaneous endoscopic gastrostomy (PEG, n=32), or an antegrade percutaneous fluoroscopically guided gastrostomy (PFGG, n=19). An open gastrostomy was performed more frequently in younger patients (average age, 49.7+/-11.9 months for PFGG). The sex distribution and indication for tube placement were similar in all groups (altered mental status: Stamm 43 percent, PEG 19 percent, and PFGG 38 percent; mechanical feeding difficulty: Stamm 66 percent, PEG 13 percent, and PFGG 21 percent; or failure to thrive Stamm 58 percent, PEG 17 percent, and PFGG 25 percent). Complications were most common in this high-risk patient population with PEG (19 percent), when compared with PFGG (16 percent) and Stamm (11 percent), although these were not statistically significant. Whereas reflux was frequent (Stamm 6 percent, PEG 9 percent, and PFGG 21 percent), only three patients in the entire series required a subsequent antireflux operation during the observation period. The three procedures were similar on hospital charge analysis (Stamm $1,316,29+/-63.33. PEG $1,130.04+/-94.88, and PFGG $1,079.83+/-109.12). When professional fees were included, the PFGG may be more economical than both the PEG and Stamm gastrostomy (Stamm $3,101.29+/-73/33. PEG $3,314.04+/-94.88, and PFGG $1,485.77+/-74.41, p<0.05). However, this may be misleading because the radiologist's fee was absorbed into the hospital charge is some cases, and therefore could not be fully accounted for in the total professional fee. CONCLUSIONS: The data from our institution demonstrate that there is no significant difference in these three feeding-access techniques when comparing procedural cost-effectiveness, indications for tube placement, or morbidity rates. The choice of procedure should be individualized giving consideration to the overall health of the child, the comfort of the specialist peforming the given procedure, and the institutional experience.

Anesthesia, General↗
PubMed1996

Multidisciplinary pain clinics for older people. Do they have a role?

Chronic pain occurs frequently in older people but is rarely considered a problem which warrants specialized attention by physicians or specialists in pain management. However a small proportion of older people with significant psychologic and physical disability from pain fail to respond to conservative management strategies. In this article, the authors describe the operations of a successful multidisciplinary pain management center for older people and briefly outline outcomes according to measures of pain, mood, and activity. Other factors that are specific and important to the management of chronic pain in older patients are discussed also. Despite some disadvantages, it is concluded that there is a place for multidisciplinary pain clinics for older people.

Aged↗
PubMed1995

Does prenatal exposure to influenza in mice induce pyramidal cell disarray in the dorsal hippocampus?

Epidemiological studies point to an association between prenatal exposure to influenza and later schizophrenia. Such studies are consistent with neuropathologic reports demonstrating cytoarchitectural abnormalities in the hippocampus and parahippocampal gyrus suggestive of second trimester developmental anomalies. The hypothesis that prenatal exposure to influenza in the second trimester may induce hippocampal pyramidal cell disarray in mice was investigated. Between days 9-16 of pregnancy, 35 Balb/c mice were intranasally inoculated with either a mouse-adapted or non mouse-adapted pool of Influenza A/Singapore/1/57 (H2N2), and 10 controls were inoculated with normal saline. Offspring were sacrificed on day 21 postpartum. Microscopic examination of the CA1-CA2 junctional areas in the offspring of mice exposed to influenza failed to demonstrate excess pyramidal cell disarray when compared with influenza-free, age matched controls. There was evidence that disarray was greater among those exposed on day 13 of pregnancy. Analyses of the data by sex and severity of maternal infection failed to reveal any significant effects.

Animals↗
PubMed1995

Elevated levels of lipoprotein (a) in association with cerebrovascular saccular aneurysmal disease.

The relationship between cerebrovascular aneurysmal disease and atherosclerosis remains unclear. Elevated serum levels of lipoprotein (a) (Lp[a]), are an independent risk factor for atherosclerosis. We measured serum Lp(a) levels in 50 patients who had angiographically proven saccular aneurysmal disease and who were free of clinically significant atheromatous disease (as judged by their medical histories and the results of physical examination, electrocardiography, and carotid angiography). The Lp(a) serum levels in these patients were compared with the Lp(a) serum levels in a group of 42 normal healthy controls. Serum Lp(a) levels in the patients was 20.1 +/- 0.42 mg/dl (median +/- standard error); however, median serum Lp(a) in the control subjects was 10.8 +/- 0.47 mg/dl (P < 0.01). Among females, the difference in serum Lp(a) levels was significant; the levels were 22.2 +/- 0.6 for female patients (n = 29) and 9.5 +/- 0.53 in female control subjects (n = 26) (P < 0.005). The most significant difference (P < 0.002) was seen in females < 50 years old (14 patients, 10 control subjects). No significant differences were seen in the Lp(a) serum levels between 21 male patients and 16 male control subjects. Lp(a) levels above the threshold level (30 mg/dl) were found in 20 patients and 7 control subjects (chi 2 = 5.99, P < 0.02); 12 female patients and 3 female control subjects (chi 2 = 6.16, P < 0.02; 8 male patients and 4 male control subjects (this difference was not significant). These results indicate either that cerebrovascular aneurysmal disease and subclinical atherosclerosis are related or that Lp(a) is a risk factor for vasculopathies other than atheroma.

Adult↗
PubMed1995

The effect of a child's hospitalisation on the parental role.

Hospitalisation of a child is likely to lead to emotional, social and environmental disturbance for the family and will affect the parental role. A number of factors may influence parental adaptation to the situation. It is essential that health-care staff build caring relationships with the sick child's parents.

Adult↗
PubMed1995

Prehospital actions by health-care providers and physicians.

Extensive worldwide experience and literature exist on the benefits of early intervention in patients with an acute myocardial infarction. To make these benefits available to as much of the population as possible a number of goals have to be accomplished. Patients and bystanders must be taught to recognize the significance of symptoms and call immediately for assistance. Local emergency medical service has to dispatch appropriate personnel and equipment to the scene expeditiously. Transport without unacceptable delays must occur to appropriate facilities along with rapid initiation of treatment. A program to achieve these goals would be expected to substantially reduce morbidity and mortality. Attention is directed to prehospital actions by health-care providers including dispatch of personnel and equipment to the scene, stabilization and treatment in the field, and triage and transport of the patient to the most appropriate medical facility.

Emergency Medical Services↗
PubMed1995

The aesthetic nose: do we agree?

The surgeon and patient use the preoperative consultations to develop an agreement regarding the aesthetic goals of a rhinoplasty. This study was designed to evaluate whether people do agree on what makes a nose attractive. Computerized video-imaging technology was used to create nine case studies. The graphics software permitted precise modification to either tip projection, tip rotation, or size of the dorsal hump. Only one parameter was altered in each case. Two hundred fifty judges were asked to identify the most attractive image in each case study. Significant trends were observed in each case, but every image received the preference of some judges. Most judges preferred midrange values in eight of nine cases, but overrotation of the tip was preferred to tip droop, overremoval of the dorsal hump was preferred to underremoval, and overprojection of the tip was preferred to underprojection. The discrepancy in what constitutes an aesthetic nose reinforces the need for the surgeon to clearly understand the patient's specific requests rather than to aim to produce a "standard nose.".

Humans↗