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Biomedical subjects

M Harrison

Publications and source records attributed to M Harrison.

At least 37 records · Page 2Linked to original sources
PubMed1991

Variation in management based on type of choledochal cyst.

The management of 23 patients treated for choledochal cysts at the Oregon Health Sciences University between 1969 and 1990 is reviewed. The median age was 27 years, with a range from 1 month to 90 years. Seventy-eight percent of patients presented with abdominal pain, and 35% were jaundiced. Three patients presented with cholangitis, two with cyst rupture, and one with recurrent pancreatitis. Nine patients had had previous biliary surgery. The diagnosis was made in all patients with ultrasound and/or cholangiography. Fifteen patients (65%) had type I cysts, 2 had a type II cyst, 5 (22%) had type III cysts, and 1 had a type IV cyst. Stones were present in four (17%) cysts, and all excised cysts were benign. Seventeen patients with type I and II choledochal cysts had complete cyst excision and choledochoenterostomy. Four of five patients with type III cysts had endoscopic cyst incision and drainage, while the fifth patient had transduodenal cyst excision and sphincteroplasty. The patient with a type IV cyst had extrahepatic cyst excision and choledochojejunostomy. There were no operative deaths. Two postoperative complications occurred: cholangitis and a prolonged ileus. All patients had resolution of their pain and jaundice. Two patients had late cholangitis. Cyst excision and choledochojejunostomy are the treatment of choice for types I and II choledochal cysts. Extrahepatic cyst excision and choledochojejunostomy may be adequate treatment for type IV cysts. Endoscopic incision and drainage is appropriate for selected patients with type III cysts.

Adolescent↗
PubMed1991

Drug addiction in pregnancy: the interface of science, emotion, and social policy.

The problem of drug addiction in pregnancy has been posed as a conflict between the rights of women and those of their fetuses. This paper presents a framework that incorporates emotion, identification, scientific research, and ethical issues as components to be used in establishing policy with respect to drug addicted pregnant women. Three approaches--voluntary treatment, involuntary treatment or incarceration, and maintaining of the status quo--are discussed with attention to class and economic aspects of women's lives and society's concern for fetal well-being. A model is proposed that addresses the needs of pregnant drug-addicted women and their fetuses, and that serves as an alternative to forced treatment or criminal prosecution.

Attitude↗
PubMed1991

EEG suppression and anoxic depolarization: influences on cerebral oxygenation during ischemia.

Cerebral ischemia provokes sequential changes that include EEG suppression, anoxic depolarization (AD) with maximal increases in extracellular potassium ion activity (K+o), and anoxia with maximal decreases in tissue oxygen tension (tPO2) and increases in the reduction/oxidation (redox) ratios of the mitochondrial electron transport carriers. Studies were directed toward relationships among these events during cerebral ischemia ("four-vessel occlusion model") in pentobarbital anesthetized rats. Results demonstrate that EEG suppression and anoxic depolarization do not occur as a simple function of progressive oxygen decline during cerebral ischemia. Rates of K+ elevation, tPO2 decline, and cytochrome a,a3 reduction were decreased in the immediate period following EEG suppression. Latency to EEG suppression was inversely correlated with latency to maximal cytochrome reduction. In contrast, AD was associated with increased rates of tPO2 decline and cytochrome a,a3 reduction. Latency to AD was related to latency of subsequent maximal cytochrome a,a3 reduction. These data suggest that EEG suppression spares oxygen while AD accelerates the progression to energy failure by accelerating the decline in oxygen stores in brain following global ischemia.

Animals↗
PubMed1991

Family-centered early intervention. The perceptions of professionals.

This paper, based on a nationwide survey, examines the attitudes and opinions of professionals regarding parent-professional involvement in the planning and implementation of goals and services for hearing-impaired infants and toddlers and their families. The implications of the findings are discussed as they pertain to PL 99-457, the new federal mandate for services to young children with special needs and their families.

Age Factors↗
PubMed1991

Cyclophotocoagulation with the transscleral contact neodymium: YAG laser versus cyclocryotherapy in rabbits.

Either transscleral cyclophotocoagulation with the contact neodymium:YAG (Nd:YAG) laser or cyclocryotherapy (CCT) was performed in rabbits to compare the efficacy of these procedures in reducing intraocular pressure (IOP) as well as the histologic changes they induced. The difference in mean maximum reduction of IOP in the two groups was statistically insignificant, but the Nd:YAG laser irradiation, using 2.5 J, destroyed less tissue than the CCT.

Animals↗
PubMed1990

Recurrent disseminated intravascular coagulation and fulminant intra hepatic thrombosis in a patient with the anti-phospholipid syndrome.

We describe a patient with the lupus anti-coagulant who had recurrent episodes, over a 2 year period, of a severe and disseminated intravascular coagulopathy. This patient also had positive serological assays for syphilis and anti-cardiolipin antibodies. Associated with the coagulopathy were co-expressed episodes of liver disease, ultimately terminating in fulminant liver failure. At autopsy the features were characteristic of the Budd-Chiari syndrome. This is the first report to document how consumptive coagulopathy may present as a dominant feature of the anti-phospholipid syndrome. It also clearly describes an immune mediated thrombotic mechanism as a cause of hepatic veno-occlusive disorders. Furthermore, this case highlights the varied clinical spectrum of the anti-phospholipid syndrome and suggests that a high index of suspicion is required to ensure its diagnosis.

Adult↗
PubMed1990

Sites of sensitivity control within a long-wavelength cone pathway.

A flashed-field increment threshold paradigm was used to examine sites of sensitivity control within a long-wavelength cone pathway. The data were fit with a model containing two static nonlinearities, one at the receptors and the second at a red/green opponent stage. The nonlinearities are modified by multiplicative and subtractive processes of adaptation. Comparisons of the model's parameters with physiological measures of the long-wavelength cones suggest that, in the dark, sensitivity is controlled by the opponent site. At high adapting intensities, receptor nonlinearities may limit sensitivity under some conditions. The data also suggest that the spectral tuning of the opponent site varies with adapting intensity.

Color Perception↗
PubMed1990

A study of selected death certificates from three Dublin teaching hospitals.

One hundred death certificates were compared over two time periods with the corresponding autopsy reports on the cases to ascertain if the causes of death from the two sources were similar. There was poor concordance between the two and it seems likely that reasons for requesting an autopsy did not extend to using the information to complete the death certificates. There were 55 errors on 45 certificates, and 19 certificates were so inaccurate as to warrant a change in the underlying cause of death. In only 10 cases was the certificate signed before the autopsy report was available; however, should clinicians have wished to add autopsy findings to the certificate later, there is no facility on the Irish death certificate to do so. A revision of the format of the certificate is recommended. An examination of death certificates from varied medical sources would be welcome to see if the serious errors identified in this study are more widespread.

Autopsy↗
PubMed1989

Failure to predict intraoperative myocardial ischaemia in patients with coronary artery disease.

Patients with severe coronary artery disease were studied to determine if the preoperative assessment or intraoperative haemodynamic monitoring could predict the occurrence of myocardial ischaemia. Thirty-eight patients undergoing coronary artery surgery who had normal electrocardiograms before induction of anaesthesia were included. Leads II and CS5 were recorded on a Holter monitor and radial arterial and pulmonary artery catheters were used to measure haemodynamic variables. Eight patients developed ST-segment changes greater than or equal to 0.1 mV before sternotomy. Preoperative factors could not be used to predict which patients would develop ST-segment changes. In all 38 patients haemodynamic determinants of myocardial oxygen supply and demand remained within an optimal range despite evidence of ischaemia in eight. This syndrome of ECG changes in the absence of tachycardia and hypertension resembles the syndrome of silent ischaemia documented in awake patients. Our findings suggest that myocardial ischaemia may be caused by decreases in coronary blood flow not associated with changes in haemodynamic variables.

Adult↗
PubMed1989

Gastrointestinal duplications causing relapsing pancreatitis in children.

Two cases of children with relapsing pancreatitis due to intramural gastrointestinal duplications with ductal communication to the pancreas are reported. A gastric duplication with ectopic pancreatic tissue was detected by endoscopic cholangiopancreatography in the gastric antrum of a 6-yr-old girl. A periampullary duodenal duplication was visualized preoperatively by duodenoscopy and computed tomography in a 10-yr-old boy. Resection of the duplication was curative in each case.

Animals↗
PubMed1989

Subjective reports of cognition in relation to assessed cognitive performance following coronary artery bypass surgery.

Evidence has accumulated to indicate that a proportion of patients who undergo coronary artery bypass surgery (CABS) do develop significant cognitive deficits. This study examines whether those patients who report cognitive deterioration after CABS do show cognitive changes as assessed by neuropsychological testing. The patients who considered that aspects of their cognitive function had deteriorated, were not found to have reduced functions as assessed on appropriate neuropsychological tests. When mood state was examined, it was found that those who report a deterioration in a particular cognitive function, tended to have significantly higher levels of depression as assessed by the Beck Depression Inventory and, to a lesser extent, have higher levels of state anxiety. These findings emphasise that subjective reports of cognitive function following CABS do not reflect actual changes in cognition but rather appear to be sensitive to mood state.

Adult↗
PubMed1989

Neuropsychological consequences of circulatory arrest with hypothermia--a case report.

This case study reports on the neuropsychological consequences of prolonged circulatory arrest with hypothermia and barbiturate "protection". Measurements performed during surgery showed a prolonged absence of EEG. The neuropsychological assessment revealed a remarkable preservation of function, with the exception of delayed verbal memory and performance on the Trial Making Test. The findings are discussed in relation to the safe duration of circulatory arrest and the protection afforded the brain by hypothermia and barbiturate.

Aged↗
PubMed1989

Quality assurance programme for necropsies.

One hundred and eight consecutive necropsies were entered into a quality assessment of the necropsy service in this hospital using a previously published American protocol. Our results were similar to those of the American series, with confirmation of the major clinical diagnosis in 75%, but a higher rate of unsuspected diagnosis (44%). Necropsy was helpful in 58% of cases. The presentation of selected cases at a monthly conference on causes of death was valuable in correlating clinical and pathological findings, and in helping integrate both services.

Aged↗
PubMed1989

Observations on Sudanese camel nasal myiasis caused by the larvae of Cephalopina titillator.

Forty-four camels slaughtered at Nyala abattoir, western Sudan, were examined for infection with the larvae of Cephalopina titillator. The infection rate was found to be 100 p. 100. The parasitic burden ranged between 8-243 per animal. They were recovered throughout the year. The first stage larvae were noticed from December to May, indicating the breeding season of the fly. The larvae were found to cause visible pathological lesions on the nasopharynx. These were also demonstrated histopathologically. Bacteriological examinations revealed the presence of Pasteurella haemolytica and Klebsiella ozaenae as possible causes of pneumonia, and Corynebacterium species which could possibly cause pyogenic infections locally. Organisms from the camel environment like Bacillus and Proteus species were also isolated.

Animals↗
PubMed1988

Cerebral blood flow during cardiopulmonary bypass.

In a study of the cerebral consequences of cardiopulmonary bypass (CPB), we have assessed cerebral blood flow (CBF) by intra-arterial Xenon 133 clearance, utilising a Novocerebrograph 10a, before, during and immediately following CPB. All patients (n = 51), under the care of a single surgical team underwent elective coronary revascularisation using a standardised anaesthetic and surgical protocol. CBF, measured as the initial slope index (ISI), fell significantly from before (median 22.5) to on bypass (median 20) (Wilcoxon P less than 0.005) and was significantly increased in the immediate post-bypass period (median 28) compared with pre-bypass (Wilcoxon P less than 0.001). Scattergrams reveal CBF to be independent of arterial pressure (BP) but show an important relationship between arterial PaCO2 and CBF. The correlations between PaCO2 and CBF prior to bypass (r = 0.46 P less than 0.005) and post-bypass (r = 0.46 P less than 0.001) are very similar, whilst on bypass, the correlation, although remaining significant, is reduced (r = 0.31 P less than 0.02). The median values for arterial PaCO2 are low throughout the study (pre-bypass median 33 mmHg, on bypass median 28 mm Hg and post-bypass median 36 mm Hg). The maintenance of PaCO2 within the normal range of 35-45 mm Hg may minimise the risk of low CBF due to hypocarbia which could theoretically be harmful in patients known to be at risk of both short term and long term cerebral dysfunction.

Carbon Dioxide↗