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Biomedical subjects

M Morrisey

Publications and source records attributed to M Morrisey.

9 recordsLinked to original sources
PubMed2001

A cost-effectiveness analysis of biliary anastomosis with or without T-tube after orthotopic liver transplantation.

Biliary reconstruction continues to be a major source of morbidity following orthotopic liver transplantation. We wished to determine if choledochocholedochostomy without a T-tube was associated with fewer biliary complications and was less costly than choledochocholedochostomy with a T-tube. A retrospective cohort study of patients who underwent liver transplantation was performed. Patients were stratified into two groups: group I had bile duct reconstruction with T-tube and group II did not have a T-tube. The results were interpreted on an intention-to-treat analysis. We identified 147 adult patients who underwent initial liver transplantation. There were 76 patients in group I and 71 patients in group II. There were no statistical differences between the two groups regarding underlying cause of liver disease, patient age, gender or United Network for Organ Sharing status. As the decision to use a T-tube was made at the time of surgery, the two groups may not be strictly comparable. The mean hospital stay was longer in group I (31.1 +/- 27.9d) than in group II (18.8 +/- 15.5d) (p = 0.001). Biliary complications were statistically more frequent in patients from group I patients (25/76, 32.9%) than in patients from group II (11/71, 15.5%) (p = 0.01). There was a trend for the costs associated with diagnostic and therapeutic procedures for the management of biliary complications to be greater for group I than for group II, although this was not statistically significant (p = 0.235). Our study suggests choledochocholedochostomy without T-tube reconstruction is the preferred strategy for biliary reconstruction in orthotopic liver transplantation. It is not only associated with fewer biliary complications, but also less costly than using choledochocholedochostomy over a T-tube. Randomized prospective studies are needed to confirm our results.

Anastomosis, Surgical↗
PubMed1999

A simple model to estimate survival after retransplantation of the liver.

To formulate a model predicting survival after liver retransplantation, we analyzed in detail the last 150 cases of hepatic retransplantation at UCLA. Cox proportional hazards regression analysis identified five variables that demonstrated independent simultaneous prognostic value in estimating patient survival after retransplantation: (1) age group (pediatric or adult), (2) recipient requiring preoperative mechanical ventilation, (3) donor organ cold ischemia > or =12 hr, (4) preoperative serum creatinine, and (5) preoperative serum total bilirubin. The Cox regression equation that predicts survival based on these covariates was simplified by assigning individual patients a risk classification based on a 5-point scoring system. We demonstrate that this system can be employed to identify a subgroup of patients in which the expected outcome is too poor to justify retransplantation. These findings may assist in the rational selection of patients suitable for retransplantation.

Adult↗
PubMed1999

A phase II study of 5-fluorouracil, leucovorin, and interferon-alpha in the treatment of patients with metastatic or recurrent gastric carcinoma: an Eastern Cooperative Oncology Group study (E5292).

BACKGROUND: Chemotherapy has a limited impact on adenocarcinoma of the stomach. Although biochemical modulation of 5-fluorouracil (5-FU) by leucovorin (LV) and interferon-alpha (IFN-alpha) has improved the outcomes of patients with metastatic colorectal carcinoma compared with 5-FU alone, this approach has not been extensively evaluated in the treatment of advanced gastric carcinoma. METHODS: Twenty-seven patients with bidimensionally measurable, metastatic gastric carcinoma and an Eastern Cooperative Oncology Group performance status of 0 or 1 received the combination of IFN-alpha (5 million U/m2 administered subcutaneously daily on Days 1-7), LV (500 mg/m2 administered intravenously over 30 minutes immediately after IFN-alpha on Days 2-6), and 5-FU (370 mg/m2 given as an intravenous bolus 60 minutes after LV on Days 2-6), with treatment repeated every 4 weeks. Oral cryotherapy was administered routinely before each dose of 5-FU to reduce the incidence of severe stomatitis. RESULTS: The median age of the patients was 58 years (range, 20-76), and 22 patients had residual, unresectable primary lesions. The median number of cycles received was 3 (range, 1-11). Of 24 patients who received at least 2 cycles of treatment, 15 (62.5%) did not require dose reduction for toxicity during the initial 2 cycles. The predominant toxicities were gastrointestinal: diarrhea and stomatitis of Grade 3-4 occurred in 28.6% and 35.7% of patients, respectively. Other severe (Grade 3-4) toxicities were granulocytopenia (which occurred in 21.4% of patients) and fatigue (in 10.7%). Fever and flu-like symptoms were common but usually mild. Of 24 patients who were evaluable for response, 3 had partial responses (PR) of 16, 23, and 33 weeks' duration, respectively, for a response rate of 12.5% (95% confidence interval = 2.7-32.4%). Two additional patients had reductions in tumor size sufficient for PR, but scans to document the minimum required response duration of 4 weeks were not obtained before progressive disease occurred. The median progression-free and overall survivals were 2.5 and 7.8 months, respectively. CONCLUSIONS: Although this regimen can be administered safely with appropriate supportive care to patients with good performance status, it has limited therapeutic activity in patients with advanced gastric carcinoma.

Adult↗
PubMed1998

The effect of a teledermatology program on rural referral patterns to dermatologists and the management of skin disease.

Teledermatology can be defined as the use of imaging and telecommunications technologies to provide skin care services at a distance. The potential value of teledermatology is especially great in rural and medically underserved areas that do not have, or cannot support, providers specializing in the diagnosis and management of skin diseases. Rural patients and primary care providers should be able to use teledermatology as a greatly simplified and potentially less expensive means of referral to an urban dermatologist. In an effort to gauge the impact of a simple teledermatology system on referral patterns and the management of rural patients with skin disorders, we studied baseline rates of referral to dermatologists from five primary care clinics in rural Oregon. Economical, easy-to-use teledermatology systems were subsequently installed, and the effects on patient referral and management were recorded over time. The interim results suggest that primary care providers (PCPs) are reluctant to refer patients with skin conditions, even when the primary care providers confidence in the correct diagnosis and treatment plan for that condition are relatively low. The installation of a teledermatology system increases the number of patients referred for specialist evaluation dramatically, even while the number of in-person visits to specialists fell. Although diagnostic agreement between dermatologists and primary care providers was mixed, a marked difference was found in their recommended treatment plans. A number of cases were found in which use of the telemedicine technology system resulted in reversing conditions that had been poorly controlled for a number of years prior to teleconsultation. This work is important as an indicator that referral rates to dermatologists may be inappropriately low in rural areas of the U.S., and that use of teledermatology may improve this trend.

Dermatology↗
PubMed1997

Long-term survival after retransplantation of the liver.

OBJECTIVE: The authors determined the long-term outcome of patients undergoing hepatic retransplantation at their institution. Donor, operative, and recipient factors impacting on outcome as well as parameters of patient resource utilization were examined. SUMMARY BACKGROUND DATA: Hepatic retransplantation provides the only available option for liver transplant recipients in whom an existing graft has failed. However, such patients are known to exhibit patient and graft survival after retransplantation that is inferior to that expected using the same organs in naiive recipients. The critical shortage of donor organs and resultant prolonged patient waiting periods before transplantation prompted the authors to evaluate the results of a liberal policy of retransplantation and to examine the factors contributing to the inferior outcome observed in retransplanted patients. METHODS: A total of 2053 liver transplants were performed at the UCLA Medical Center during a 13-year period from February 1, 1984, to October 1, 1996. A total of 356 retransplants were performed in 299 patients (retransplant rate = 17%). Multivariate regression analysis was performed to identify variables associated with survival. Additionally, a case-control comparison was performed between the last 150 retransplanted patients and 150 primarily transplanted patients who were matched for age and United Network of Organ Sharing (UNOS) status. Differences between these groups in donor, operative, and recipient variables were studied for their correlation with patient survival. Days of hospital and intensive care unit stay, and hospital charges incurred during the transplant admissions were compared for retransplanted patients and control patients. RESULTS: Survival of retransplanted patients at 1, 5, and 10 years was 62%, 47%, and 45%, respectively. This survival is significantly less than that seen in patients undergoing primary hepatic transplantation at the authors' center during the same period (83%, 74%, and 68%). A number of variables proved to have a significant impact on outcome including recipient age group, interval to retransplantation, total number of grafts, and recipient UNOS status. Recipient primary diagnosis, cause for retransplantation, and whether the patient was retransplanted before or after June 1, 1992, did not reach statistical significance as factors influencing survival. In the case-control comparison, the authors found that of the more than 25 variables studied, only preoperative ventilator status showed both a significant difference between control patients and retransplanted patients and also was a factor predictive of survival in retransplanted patients. Retransplant patients had significantly longer hospital and intensive care unit stays and accumulated total hospitalization charges more than 170% of those by control patients. CONCLUSIONS: Hepatic retransplantation, although life-saving in almost 50% of patients with a failing liver allograft, is costly and uses scarce donor organs inefficiently. The data presented define patient characteristics and preoperative variables that impact patient outcome and should assist in the rational application of retransplantation.

Adolescent↗
PubMed1997

Small group insurance reform: how are state programs measuring up?

In the past decade, states have responded to the health insurance needs of small businesses by launching a number of reforms. According to authors Michael Morrisey and Gail Jensen, more than 30 states have implemented "bare-bones" policies that seek to make minimum-benefit, affordable coverage available to small employers. Almost all states have enacted legislation modifying the underwriting practices that insurers may use with respect to such things as pre-existing conditions and occupational exclusions. Other states have provided tax or employer subsidies. But despite the efforts of the states, the authors found the state policies have had little success. Drawing from a survey found that the few employers who were aware of the programs found them to be unappealing. In discovering what doesn't work, the authors are able to suggest remedies for the states' small group insurance ills, such as offering long-term instead of short-term subsidies.

Eligibility Determination↗
PubMed1995

Case study: obsessive-compulsive disorder after severe traumatic brain injury in an adolescent.

The neurological underpinnings of obsessive-compulsive disorder (OCD) are still largely undetermined. We report a prospective case study of a young subject who developed OCD and impulsive aggression after traumatic brain injury. The implications are that frontal and temporal lobe lesions may be sufficient to precipitate OCD in the absence of clear striatal injury and that compulsivity and impulsivity may represent different psychophysiological states.

Brain↗
PubMed1991

Chemical, microbiological and sensory evaluation of a dried salted product produced from sardines (Sardinops caerula) and cereals.

The chemical, microbiological and sensory stability of a dried salted product prepared from sardines and cereals was evaluated during a 12-week storage period. The product is named NUTRIPEZ and was produced in 20 kg/lots, both with and without smoke treatment. The product was stored under both tropical and room conditions in Mexico City, and packaged in two types of flexible packaging. Rancidity analyses were done by the peroxide value, TBA test and sensory evaluation. The results demonstrated that both the smoking of the product and the cellopolyal packaging, offered the best protection against oxidation.

Analysis of Variance↗