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Biomedical subjects

R M Morse

Publications and source records attributed to R M Morse.

At least 19 recordsLinked to original sources
PubMed1992

The definition of alcoholism. The Joint Committee of the National Council on Alcoholism and Drug Dependence and the American Society of Addiction Medicine to Study the Definition and Criteria for the Diagnosis of Alcoholism.

To establish a more precise use of the term alcoholism, a 23-member multidisciplinary committee of the National Council on Alcoholism and Drug Dependence and the American Society of Addiction Medicine conducted a 2-year study of the definition of alcoholism in the light of current concepts. The goals of the committee were to create by consensus a revised definition that is (1) scientifically valid, (2) clinically useful, and (3) understandable by the general public. Therefore, the committee agreed to define alcoholism as a primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterized by impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking, most notably denial. Each of these symptoms may be continuous or periodic.

Alcoholism↗
PubMed1992

Disulfiram treatment of patients with both alcohol dependence and other psychiatric disorders: a review.

In treatment of alcohol dependence, disulfiram is most useful in conjunction with a structured, supervised, aftercare program. However, it has been reported to cause psychiatric side effects and to interact with various psychiatric medications. Many patients with alcohol dependence suffer from other psychiatric disorders and are treated with such psychiatric medications. This paper reviews the pertinent clinical pharmacology of disulfiram and the literature on potential psychiatric complications and drug interactions of disulfiram. At the usual dosage, about 250 mg/day, disulfiram does not appear to increase significantly the risk of psychiatric complications or of psychiatric drug interactions. Therefore, it can be considered a treatment option for patients with alcohol dependence and other psychiatric disorders.

Alcoholism↗
PubMed1992

Substance use disorder diagnostic schedule (SUDDS): the equivalence and validity of a computer-administered and an interviewer-administered format.

In order to evaluate the equivalence of interviewer-administered and computer-administered forms of the substance use disorder diagnostic schedule (SUDDS), both forms were presented to 100 substance-dependent inpatients. An additional 101 psychiatric outpatients were administered one form or the other. For patients who received both forms of the SUDDS, the percentage agreement ranged from 96% for the classification of a lifetime diagnosis of alcohol abuse/dependence to 88% for the classification of current diagnosis of alcohol abuse/dependence (kappa coefficients ranged from 0.709 to 0.865). Overall agreement with a clinician diagnosis (validity) and the two forms of administration varied from 100% for computer-generated diagnosis of current alcohol abuse/dependence to 71% for computer-generated lifetime diagnosis of drug abuse/dependence, when stratified by number of symptoms reported. No consistent differences were found in the performances of the two forms of the SUDDS, and we conclude that they may be used interchangeably.

Adult↗
PubMed1991

The CAL: an MMPI alcoholism scale for general medical patients.

We developed a MMPI alcoholism scale based on adult medical patient samples. Our criterion group consisted of 736 inpatients (525 males; 211 females) diagnosed as having alcoholism according to DSM-III criteria. Three contrast samples that totaled 13,120 individuals were used for control purposes. MMPI items were chosen by means of logistic regression. The 33 items yielded by this procedure formed a provisional scale (CAL, for common alcoholism logistic) that worked equally well for males and females. With new cross-validation samples, with sensitivity (proportion of alcoholics correctly identified) set at 90%, the specificity (proportion of nonalcoholics correctly identified) ranged from 90% to 96% for selected contrast samples. We conclude that this scale shows promise as a screening device in similar populations.

Adult↗
PubMed1991

Ureteral calculi: natural history and treatment in an era of advanced technology.

Patients with ureteral stones may be managed expectantly, or treated with a variety of invasive and noninvasive techniques depending on stone composition, size and location, expectations of the patient and experience of the surgeon. Of 378 patients with documented ureteral calculi 60% passed the stones spontaneously. Passage rates from the proximal, middle and distal ureter were 22, 46 and 71%, respectively. Basketing under fluoroscopic control of distal stones was successful in 79% of the attempts and for those in whom this approach failed ureteroscopy was performed, with a success rate of 90%. When ureteroscopy was used as the initial treatment of distal stones removal was achieved in 81% of the patients. These statistics serve as a reminder that traditional therapy of ureteral stones has not lost its role in contemporary practice.

Endoscopy↗
PubMed1991

Self-Administered Alcoholism Screening Test: a comparison of conventional versus computer-administered formats.

The equivalence of paper-and-pencil-administered and computer-administered versions of the Self-Administered Alcoholism Screening Test (SAAST) was investigated with alcoholic inpatients and nonalcoholic psychiatric outpatients. When the two formats were administered in counterbalanced order, total score mean differences were nonsignificant. In addition, mean differences on a short-form version were also nonsignificant. Equivalence was also determined by comparing the two formats in terms of classification agreement (i.e., classification of subjects into alcoholic and nonalcoholic categories). Agreement between the two formats was 95% in both the total score and short-form versions. Implications of these results as well as the advantages and disadvantages of using computer-administered alcoholism screening tests are discussed.

Adult↗
PubMed1990

Detection of clinically occult prostate cancer.

A large number of cases of prostatic carcinoma are discovered unexpectedly by simple prostatectomy performed for presumed benign disease. The ability to discover these cancers preoperatively is an appealing concept, in other words, to screen: the use of a test to detect a disease in an asymptomatic individual. The ideal screening test would be noninvasive, inexpensive, reliable, and reproducible. It would also have a high sensitivity and specificity, neither allowing a disease process to be missed by a falsely negative result nor leading to unnecessary and more invasive studies by a falsely positive one. It has been suggested that an acceptable screening test have a sensitivity of at least 95 per cent and a specificity of 100 per cent. An equally important criterion for a successful screening program for cancer has to do with the biologic potential of the discovered malignancy. The adage is that more men die with prostate cancer than of prostate cancer. However, the biologic potential of prostate cancer has not been fully elucidated, and it is not entirely clear who will benefit from treatment and who should be left alone. At the present time, noninvasive imaging modalities and biochemical markers are not clinically useful in detecting occult prostatic carcinoma. Furthermore, no study has proved that routine screening reduces the mortality rate from prostate cancer. Many authors believe that screening men for prostate cancer should be regarded as investigational and that currently, only screening programs for breast and cervical cancer have been fully demonstrated to be effective. New studies are needed that include control groups who are not subjected to the early diagnostic modality, assessing both the disadvantages of the screening program and the potential benefits.

Acid Phosphatase↗
PubMed1989

A study of the incorporation of urinary macromolecules onto crystals of different mineral compositions.

A new method used to study the binding of proteins onto calcium oxalate crystals demonstrated this interaction to be a selective process regarding the types of adsorbed proteins. To determine whether the incorporation of urinary macromolecules onto crystals formed in urine in vitro is dependent on the specific crystalline composition, this technique was applied to both uric acid and calcium oxalate crystals. Powdered uric acid was dissolved in urine and the pH lowered to 5.5. The resulting uric acid crystals were centrifuged and the pellet dialyzed against water at pH 8.0. Calcium oxalate crystals produced by the addition of 0.1 M calcium chloride and 0.1 M sodium oxalate to an aliquot of the same urine sample were demineralized with 5% EDTA. Gel filtration chromatography was used to isolate the protein fraction of an aliquot of the urine samples before and after crystallization of uric acid and calcium oxalate. The proteins recovered from the crystals and urine samples were separated by two-dimensional polyacrylamide gel electrophoresis. Analysis of the gels confirmed that the binding of urinary proteins onto crystals is a selective process and indicate that this interaction is dependent on the specific inorganic composition of the crystals.

Adult↗
PubMed1989

A controlled study of lithium carbonate in the treatment of alcoholism.

A prospective double-blind placebo-controlled trial conducted during a 6-month period showed that lithium carbonate was no better than placebo in producing total abstinence in patients with alcoholism, regardless of whether they were depressed. A high dropout rate, the effect of compliance, and difficulties in measuring improvement in these patients impose some limitations in interpreting the results of this study.

Adult↗
PubMed1989

Self-administered alcoholism screening test (SAAST): comparison of classificatory accuracy in two cultures.

Results of stepwise discriminant analyses of the Self-Administered Alcoholism Screening Test (SAAST) administered to 181 alcoholics and 123 nonalcoholics in Mexico City were compared with results of a similar analysis of a sample in the United States (Rochester, MN). With sensitivities of 90% and 95%, specificities were 91.1% to 99.2% in the Mexican sample for total score and a nine-item version derived from the Mexican sample gave specificities between 95.1% and 99.2% at 90% and 95% sensitivities, as with the Rochester sample. The two items with greatest predictive power were the same in both cultures.

Adult↗
PubMed1988

Resurrecting the ICAS: a competitor for the MAC in screening medical patients for alcoholism?

Although the MacAndrew scale (MAC) is the most widely used of the MMPI alcoholism screening scales, evidence to support its continued use is equivocal, and recent data raise serious questions about its efficacy in the screening of medical patients. In comparison, the Institutionalized Chronic Alcoholic Scale (ICAS), an 8-item scale, has an equivalent correct classification rate among male alcoholics and is significantly better than the MAC scale at identifying female alcoholics. Furthermore, misclassification rates among medical patients and normal persons are substantially lower for the ICAS than for the MAC scale, although the ICAS overidentifies potential alcoholism among normal women and female medical patients. However, reliability coefficients across the criterion and contrast samples are disappointingly low, and the use of the ICAS cannot be defended on that basis.

Adolescent↗
PubMed1988

Screening medical patients for alcoholism with the MMPI: a comparison of seven scales.

Seven alcoholism scales for the MMPI were evaluated for effectiveness in screening medical patients. Sensitivity and specificity were assessed by use of five contrast samples: (1) 736 inpatients from an alcohol and drug dependence unit; (2) 4,923 unselected medical outpatients; (3) 7,044 selected medical outpatients; (4) 214 psychiatric inpatients; and (5) 1,408 contemporary normal persons. None of these scales can be recommended for use in screening medical patients. However, endorsement of MMPI item 215 should lead to further evaluation because classification was more accurate with this single item than with any of the scales evaluated.

Adolescent↗
PubMed1988

Iatrogenic colon and rectal injuries associated with urological intervention: report of 14 patients.

Iatrogenic large bowel injuries are a potential complication of many urological procedures. During the last 6 years we have cared for 14 patients with iatrogenic injuries involving either the colon or rectum. The injuries occurred as a complication of radical prostatectomy, percutaneous stone removal, nephrectomy, urethral catheter placement, percutaneous suprapubic catheter placement and penectomy with associated cystoprostatectomy. One patient died of these complications, while in most instances hospitalization was prolonged and additional operative intervention often was required.

Adult↗
PubMed1988

A new approach to the study of urinary macromolecules as a participant in calcium oxalate crystallization.

Despite intense investigation, the relationship of urinary proteins to urinary stone matrix formation remains poorly understood. In an attempt to gain more information regarding this interaction, the binding of urinary proteins to calcium oxalate crystals formed in urine in vitro was studied. 0.1 M calcium chloride and 0.1 M sodium oxalate were added to an aliquot of urine collected from five non-infected, non-stone forming males. The resulting calcium oxalate crystals were centrifuged and the pellet demineralized with 5% EDTA. Gel filtration chromatography was used to isolate the protein fraction from the urine samples before and after crystallization of calcium oxalate. The proteins recovered from the crystals and urine were separated by two-dimensional polyacrylamide gel electrophoresis. Many, but not all of the urinary proteins were bound by the crystals. Albumin, seen to the most abundant urinary protein, was absent or markedly diminished in all instances, and the second most abundant urinary protein, PC-30, became the predominant protein component of the crystals. An unidentified protein with approximate molecular weight of 22,000 daltons and isoelectric point of 6.4 was highly concentrated by the crystals even when undetected in the urine. The study suggests that the binding of urinary proteins to calcium oxalate crystals formed in urine in vitro is not a random event but rather a selective phenomenon.

Adult↗
PubMed1988

Alcoholism in elderly persons: medical aspects and prognosis of 216 inpatients.

We describe 216 elderly patients (65 years of age or older) who were treated for alcoholism in an inpatient treatment program. Emphasis is placed on the demographics, medical characteristics, results of laboratory tests, outcome of treatment, and various comparisons of early- and late-onset alcoholism. The frequency of serious medical disorders among these patients was higher than would be expected for the overall population of a similar age. Elderly alcoholics have more abnormal results of commonly used laboratory tests than do younger alcoholics. Our data show that the elderly alcoholic can be successfully treated in a medically oriented inpatient treatment program. The concept of less-intensive treatment for the elderly alcoholic is generally not supported. More-intensive treatment may be necessary for some of these patients because of the high frequency of accompanying major medical and psychiatric problems. Early-onset alcoholism predominated, but we found no major differences between the two groups.

Adult↗