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Biomedical subjects

R H Morgan

Publications and source records attributed to R H Morgan.

At least 19 recordsLinked to original sources
PubMed1992

Postural changes in femoral artery blood flow in normal subjects, patients with peripheral vascular occlusive disease and patients undergoing lumbar sympathectomy, measured by duplex ultrasound flowmetry.

Regulatory peripheral vasoconstriction occurs in response to lower limb dependency. In mildly ischaemic limbs these responses are retained but are lost in patients with rest pain. Previously used methods have inherent difficulties when applied during postural change. We studied orthostatic responses in 12 normal subjects (aged 22-74 years, median 52 years) and 16 patients (aged 21-83 years, median 48 years) with mild and severe peripheral vascular disease using a duplex ultrasound flowmeter. In the normal subjects the 60-s mean common femoral artery volume flow values (ml min-1 +/- S.D.) were 77 +/- 83; -78 +/- 116; -190 +/- 136 for elevation, dependency and standing respectively. For claudicants (n = 7) the values were 18 +/- 37; -112 +/- 123; -216 +/- 103, respectively. In rest pain patients (n = 9) the responses were reversed, being -252 +/- 124; 131 +/- 89 and 184 +/- 85. Significant differences were apparent between elevation, dependency and standing flows, in each of the three groups (all p less than 0.0001). The rest pain group displayed characteristically different responses compared with both normal subjects and claudicants, for each postural change (p less than 0.0001 in all cases). Investigation of the dependency response was undertaken in eight further patients with rest pain before and after lumbar chemical sympathectomy and a characteristic pre-sympathectomy response predicted the clinical outcome.

Aged↗
PubMed1991

Effect of postural change on common femoral artery volume flow, measured by duplex ultrasound, in normal subjects and patients with peripheral vascular disease.

Regulatory peripheral vasoconstriction occurs in response to adoption of the erect posture. Mildly ischaemic limbs are thought to exhibit near normal responses, but patients with rest pain show increases in blood flow on limb dependency. Previous methods of limb blood flow quantification (xenon clearance and venous occlusion plethysmography) have inherent difficulties when applied in these situations. We studied orthostatic responses in 12 normal subjects (aged 22-74 years (median 52) and 16 patients (aged 21-83 (median 48) with mild and severe peripheral vascular disease, using a duplex flowmeter system. In the normal subjects changes in the 60s mean, common femoral artery volume flow values were as follows (ml min-1 (1 SD]: 77 (83), -78 (116) and -190 (136), for elevation, dependency, and standing respectively. For claudicants (n = 7) the values were 18 (37), -112 (123) and -216 (103) respectively. In rest pain patients (n = 9) the responses were reversed, being -252 (124), 131 (89) and 184 (85) respectively. Significant differences were apparent between elevation, dependency and standing flows in each of the three groups (P less than 0.0001). Normal subject and claudicant responses on elevation and dependency differed significantly (P less than 0.0001 and 0.03 respectively). On standing, the responses were similarly significantly different. The rest pain group displayed characteristically different responses compared with both normal subjects and claudicants for each postural change (P less than 0.0001 in all cases). Duplex ultrasound volume flowmetry is non-invasive and offers an excellent method of quantifying physiological changes.

Adult↗
PubMed1991

Day case laparoscopy: a survey of postoperative pain and an assessment of the value of diclofenac.

A randomised, controlled study was undertaken to assess the postoperative pain and side effects experienced by patients undergoing day case diagnostic laparoscopy and laparoscopic sterilisation, and to evaluate the effectiveness in these patients of peroperative diclofenac. Patients undergoing laparoscopic sterilisation had significantly higher pain scores at one hour postoperatively, and at discharge, than patients undergoing diagnostic laparoscopy (p less than 0.01) but there were no significant differences in pain scores 24 hours after discharge. The incidence of postoperative side effects following discharge from hospital was high, but there were no significant differences between the groups. Diclofenac had no significant effect in either group on the severity of postoperative pain, or the incidence of postoperative side effects.

Acetaminophen↗
PubMed1990

Common femoral artery volume flow in peripheral vascular disease.

Common femoral artery volume flow was measured at rest and during postocclusive reactive hyperaemia in 80 normal subjects and 67 patients with radiological evidence of occlusive peripheral vascular disease. At rest, means(s.d.) common femoral artery volume flow in normal subjects (344(135) ml/min) and all patients with peripheral vascular disease (401(168) ml/min) was not significantly different. During postocclusive reactive hyperaemia, mean(s.d.) peak flow was significantly higher in normal subjects (1951(438) ml/min) than in patients with peripheral vascular disease (996(457) ml/min) (P less than 0.01). Common femoral artery volume flow in patients with critical ischaemia and intermittent claudication did not differ at rest but mean(s.d.) peak flow in patients with critical ischaemia (697(276) ml/min) was significantly lower than in claudicants (1131(447) ml/min) (P less than 0.01). Mean(s.d.) resting common femoral artery volume flow in limbs with femoropopliteal disease (457(185) ml/min) was significantly greater than that in limbs with occlusion of the aortoiliac segment (308(130) ml/min) (P less than 0.01). However, this difference did not persist during postocclusive reactive hyperaemia. A hyperaemic index, calculated from the hyperaemic responses to below knee and whole limb ischaemia, was used to quantify segmental perfusion during postocclusive reactive hyperaemia. The mean(s.d.) value in normal subjects, 46(9) per cent, and in those with aortoiliac disease, 52(12) per cent, indicated approximately equal perfusion of the above and below knee limb segments. In those with femoropopliteal disease the mean(s.d.) hyperaemic index was 17(13) per cent, revealing relative hypoperfusion of the below knee segment.

Adult↗
PubMed1989

Nifedipine in patients with peripheral vascular disease.

The calcium antagonist nifedipine has been studied in a group of patients with intermittent claudication. In a long-term double blind, placebo controlled trial in 27 patients there was no effect on exercise tolerance as measured by pedal ergometry and only a limited improvement in symptom score on double dose nifedipine. Common femoral artery volumetric blood flow (measured by duplex ultrasound) was unaffected. The acute effects on blood flow were also studied, with a mean increase of 23% in common femoral artery blood flow 30 min after sublingual nifedipine. The administration of nifedipine to patients with peripheral vascular disease will not adversely affect claudication symptoms, and may result in an acute improvement in lower limb blood flow. Nifedipine is a suitable antihypertensive in patients who suffer from intermittent claudication.

Administration, Sublingual↗
PubMed1988

Use of myocutaneous flaps for primary cover following lymph node dissection for malignant melanoma.

We report seven patients undergoing palliative surgery for advanced malignant melanoma, who required wide excision of skin and underlying tissue in association with lymph node dissection. In each case, primary closure of the wound was facilitated by the use of a myocutaneous flap. Four ilio-inguinal lymph node dissections were closed with rectus abdominis flaps, two cervical dissections were closed with a pectoralis major flap, and a limited latissimus dorsi flap was used for one axillary clearance. Primary healing was achieved in all cases; morbidity was low, with one wound infection and two limited lymphatic collections. All donor sites were closed primarily and healed well. We conclude that in selected patients the use of a myocutaneous flap procedure gives excellent coverage of large defects with low morbidity. In particular, there is rapid convalescence and return of good function after palliative resections, while the wide excision minimizes local recurrence where the tumour is in proximity to overlying skin.

Adult↗
PubMed1987

Digital and radial artery blood flow in patients with Raynaud's phenomenon in response to nifedipine.

The effect of nifedipine on haemodynamic changes in the hand after cooling in 10 patients with Raynaud's phenomenon is assessed. Nifedipine reduced the fall in digit blood flow induced by cooling and limited the increase in pulsatility index (a measure of peripheral resistance). There was good correlation between digital arterial inflow (measured by strain gauge plethysmography) and radial artery pulsatility index (measured by Doppler waveform analysis).

Adult↗
PubMed1987

Nifedipine in patients with Raynaud's syndrome--effects on radial artery blood flow.

The acute effect of nifedipine on hand blood flow of 20 patients with Raynaud's phenomenon, treated in a double-blind, crossover study, is reported. Radial artery blood flow was found to correlate with the reciprocal of the pulsatility index. This simple Doppler technique gave an instantaneous record of the effect of cooling on hand blood flow. In patients with Raynaud's phenomenon, nifedipine prevents the reduction of hand blood flow that is induced by cooling in untreated patients.

Administration, Sublingual↗
PubMed1987

The effects of nifedipine on blood flow in peripheral vascular disease of the lower limbs.

The effects of nifedipine on blood flow to the lower limb have been investigated in 19 patients with calf claudication, and in 8 patients with critical leg ischaemia, using Doppler techniques. In claudicants, common femoral artery blood flow increased by 55% after sublingual nifedipine, despite a fall in systolic blood pressure and no alteration in the ankle/brachial index. In patients with critical ischaemia given intravenous nifedipine, common femoral blood flow increased to reach a peak 90 minutes after the start of the infusion. The femoral artery pulsatility index, derived from the Doppler waveform, is a reliable guide to changes in blood volume flow.

Administration, Sublingual↗
PubMed1979

Proficiency examination of physicians for classifying pneumoconiosis chest films.

An examination has been developed to test the proficiency of physicians classifying chest radiographs with pneumoconiosis in accordance with the classification system promulgated by the International Labor Office in Geneva. The examination, prepared by Johns Hopkins University under contract with the National Institute of Occupational Safety and Health, was commissioned to identify physicians qualified to serve in national pneumoconiosis programs directed both to epidemiological research and to the compensation of coal miners and others who suffer from dust-related illness. The examination, consisting of 125 chest radiographs, includes examples of a broad range of disease extending from normal to far advanced pneumoconiosis. An examinee passes or fails by ability to classify the films, within prescribed limits, in the same manner as an expert panel of radiologists. The examination is open to radiologists, chest physicians, occupational health specialists, and other physicians interested in pneumoconiosis. By the end of 1978, the examination had been given to 202 candidates, including 116 radiologists 30 chest physicians, three candidates certified in preventive medicine, two family practitioners, and 51 others. Of the 202 candidates, 118 (58.4%) passed and 84 (41.6%) failed. Among the candidates taking the examination for the first time, 74 radiologists (63.8%) and 18 chest physicians (60%) received passing grades. Of the remainder, 21 physicians (37.5%) were successful. Early experience indicates the examination is quite successful in meeting its primary objectives, which suggests that this type of examination may be applicable in other situations to separate those who meet certain standards of performance in radiology from those who do not.

Clinical Competence↗