PubMed Health⌕ Search

Biomedical subjects

R J Morris

Publications and source records attributed to R J Morris.

240 records · Page 14Linked to original sources
PubMedDate not supplied

Coronary artery bypass grafting in patients with chronic renal failure: A reappraisal.

BACKGROUND AND AIMS: Chronic renal failure (CRF) is known to increase the morbidity and mortality in patients undergoing cardiac operations. Successful outcome of coronary artery bypass grafting (CABG) in some patients with CRF has been reported, but remains controversial. METHODS: Forty-four patients with CRF who underwent CABG were examined. Two groups were analyzed. Group I consisted of 13 patients with end-stage renal disease on hemodialysis. Group II consisted of 31 patients with a creatinine > or = 1.6 gm/dL for a minimum of 6 months, but were not on dialysis. There were 36 male and 8 female patients, with a mean age of 71 years. RESULTS: The hospital mortality was 10 patients (23%) with 4 (31%) hospital deaths in Group I, and 6 (19%) in Group II. There was major morbidity in 35 (80%) patients. In Group II there were 8 (26%) patients who required permanent postoperative dialysis. A control group of 547 patients 70 years of age who underwent CABG had 30 hospital mortalities (5%) and 75 morbidities (13%). The average length of stay was 27 days. Fifteen patients died at a mean of 34 months after being discharged from the hospital. Nineteen of the original 44 patients remain alive at a mean of 32 months. The total mortality at 6 years and 4 months was 57%. CONCLUSIONS: Older and sicker patients with CRF who undergo CABG are at an exceptionally high risk for mortality and morbidity. For CRF patients not on dialysis with a creatinine 2.5 gm/dL, there is a strong likelihood of permanent postoperative dialysis. Long-term follow-up shows survival to be well below their non-CRF counterparts.

Age Factors↗
PubMedDate not supplied

Coronary artery bypass grafting in patients in their third decade of life.

BACKGROUND AND AIM: Coronary artery disease (CAD) and coronary artery bypass grafting (CABG) in young patients are different than their older counterparts. The purpose of this study is to more fully define the issues of CABG in patients in their third decade of life. METHODS: The medical records from all patients under forty years of age undergoing CABG at Allegheny University Hospital, Hahnemann Division, Philadelphia, PA from July 1990 to June 1995 were examined. Surgical outcome, psychosocial, and sexual issues were examined. Lipid analyses were compared perioperatively. RESULTS: There were 43 male and 9 female patients. The mean age was 35 years (23 to 39 years). Risk factors included 43 (83%) patients with a history of smoking, 34 (65%) with familial hypercholesterolemia, 25 (48%) with a family history of CAD, 23 (44%) with hypertension, and 11 (21%) with diabetes. The mean preoperative serum cholesterol was 241 mg/dL. There were no hospital mortalities. Morbidities were found in 18 (35%) patients, including 9 (17%) cardiac, 5 (10%) pulmonary, 3 (6%) infectious, and 1 (2%) renal. In follow-up, three cardiac-related mortalities occurred within five years of surgery. Sixteen patients were readmitted to a hospital for cardiac related causes. Thirty-two (62%) patients failed to return to work, twenty-five (48%) failed to engage in regular exercise, and twenty-four resumed smoking. Psychosocial changes were found postoperatively in thirty (58%) patients. Eight (15%) patients admitted to sexual changes following surgery. Postoperative lipid profiles were minimally altered from preoperative values. CONCLUSIONS: Surgical revascularization is successful in alleviating symptoms with minimal risk. Postoperatively, a number of cardiac related events occurred. A significant number of patients resume smoking, fail to engage in regular exercise, fail to resume work, and fail to take prescribed lipid-lowering agents. Psychosocial and sexual dysfunctions are prominent.

Adult↗
PubMedDate not supplied

Superior oblique tuck surgery in the management of superior oblique palsies.

Three hundred and twenty-four patients with superior oblique muscle palsies required surgery over a 15-year period. Forty-four patients underwent superior oblique tuck surgery. Fifteen patients had unilateral and six bilateral tucks alone. Seventeen had unilateral tucks and three bilateral tucks in conjunction with other extraocular muscle surgery. Three had unilateral tucks with a contralateral Harada-Ito procedure. The best results were obtained with isolated superior oblique tucks and tucks in conjunction with a contralateral inferior rectus muscle recession or an ipsilateral inferior oblique muscle weakening procedure. The mean vertical correction following isolated, unilateral surgery was 3.6 prism diopters (range, 0 to 11 delta) in primary gaze and 15.3 delta (range, 0 to 40 delta) in the field of maximum deviation. The mean eso correction in downgaze with bilateral superior oblique tucks was 15.2 delta (range, 10 to 21 delta). There was no statistically significant correlation between the size of the tuck and the amount of deviation corrected. Some degree of postoperative Brown syndrome was seen in all patients, but became less marked with time and in no patient was it severe enough to require reversal of the tuck. In only four patients was there a significant lessening of the effect of the procedure with time. The results show that the superior oblique tuck procedure is an effective operation. In patients with unilateral muscle palsies, 64.3% with an abnormal head posture, 37.5% with diplopia, and 100% with both an abnormal head posture and diplopia achieved an excellent result. In patients with bilateral muscle palsies, 50% with an abnormal head posture and 66% with both an abnormal head posture and diplopia achieved an excellent result.

Adolescent↗
PubMedDate not supplied

Documenting pediatric lens problems with the MTI polaroid photoscreener.

PURPOSE: To evaluate the use of the MTI photoscreener (Medical Technology Inc, Iowa City, Iowa) in assessing and documenting lens abnormalities in the pediatric ophthalmology clinic. METHODS: MTI photoscreener photographs of pediatric patients with lens abnormalities were taken to assess and document lens opacities and subluxation, to assist with explanations to parents, and to monitor progression of abnormalities. Postoperative photographs were taken to assess opacification of the posterior capsule and contact lens fit. RESULTS: Nineteen children with lens abnormalities were examined. Twelve patients underwent surgery and 9 patients had postoperative photoscreener pictures. Illustrative cases are reported. CONCLUSION: The MTI photoscreener is a useful adjunct to clinical examination in the assessment and documentation of pediatric lens abnormalities.

Aphakia, Postcataract↗
PubMedDate not supplied

Immunologic and functional features of the leukemic cell of hairy cell leukemia: evidence for a Null hypothesis.

We report results of the immunologic evaluation of three unusual patients with hairy cell leukemia (HCL) whose HC were surface immunoglobulin (slg) negative. Mononuclear cell preparations containing 82%, 51%, and 42% hairy cells (HC), respectively, were obtained from three males with the typical syndrome and characteristic tartrate-resistant acid phosphatase-staining HC. Monocyte features were lacking in that HC did not stain for alpha-napthylacetate esterase, lacked receptors for C3, failed to produce chemiluminescence, and produced decreased 51Cr release in antibody-dependent cellular cytotoxicity against human red cell targets. Receptors for sheep erythrocytes, a T-cell marker, were decreased. Evidence against a B-cell origin of HC was provided by low numbers of slg staining and C3 receptor-bearing cells. Our results favor the hypothesis that HC in these three patients represent neoplastic proliferation of Null lymphocytes. Such an origin may explain the heterogeneity of markers previously described on HC of patients with HCL.

Antibody-Dependent Cell Cytotoxicity↗