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Evans CM. Three hundred sixty-five days post-HMO. COLLEGE REVIEW (DENVER, COLO.) 1991; 7:12-5. [PMID: 10104342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Carolina Medical Care was conceived as a physician-owned HMO. Two-and-a-half years later, it was declared insolvent and shut down. As a founding member of the HMO, a third of its 15,000 patients were capitated to the Mecklenburg Medical Group. This case study examines the efforts to keep those patients following dissolution of the HMO.
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Reid D, Glass CA, Evans CM, Turner S. Screening impotence by home nocturnal tumescence self-monitoring. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 1990; 29:439-41. [PMID: 2289082 DOI: 10.1111/j.2044-8260.1990.tb00910.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Twenty subjects complaining of impotence were assessed using nocturnal penile tumescence (NPT), neurological, vascular and hormonal analysis. Subjects undertook NPT in both home and hospital environments: 10 hospital first and 10 home first. There were high levels of agreement between diagnosis using NPT in the two conditions and diagnosis from the physiological tests. There was a high correlation of frequency of erections between the home and hospital conditions, together with a high consecutive night reliability when using the monitor in the home condition (r = .94, p = .001).
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Davies G, Evans CM, Shand WS, Walker-Smith JA. Surgery for Crohn's disease in childhood: influence of site of disease and operative procedure on outcome. Br J Surg 1990; 77:891-4. [PMID: 2393812 DOI: 10.1002/bjs.1800770816] [Citation(s) in RCA: 55] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Factors influencing outcome after surgery have been studied in 67 children requiring bowel resection or diversion of the faecal stream for Crohn's disease. Patients were divided into four groups on the basis of disease location at time of surgery, and mean follow-up was 4.5 years. All three children with panenteric disease (group 1) have relapsed. Best results were observed in cases with disease confined to the small bowel (group 2) and ileocaecal region (group 3), in whom surgery was followed by sustained remission in six out of seven and 24 out of 30 patients respectively. In the 27 children with colitis (group 4), results were mixed. Six of the seven patients who had staged colonic resections with a primary anastomosis relapsed, as did three out of four patients given a loop ileostomy to divert the faecal flow; in contrast, 15 out of 16 children who had a subtotal colectomy with ileostomy as the primary procedure have remained well, with only minor problems involving the rectal stump. An acceleration in growth velocity was observed during the first year after operation in 89 per cent of 40 children studied. Outcome after surgery for Crohn's disease in childhood depends mainly on disease location, but is influenced by the type of primary operation performed. In addition to symptomatic relief the principal early benefit of surgery is improved growth.
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Evans CM. Disability insurance: merging group and individual policies. COLLEGE REVIEW (DENVER, COLO.) 1990; 7:16-9. [PMID: 10120650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
This case study explains how the Mecklenburg Medical group, after discovering a gap in the disability insurance for its physicians, followed through by negotiating a new plan which also covered non-physician employees.
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Evans CM, Murphy JF, Gray OP, Rosen M. Epidural versus general anaesthesia for elective caesarean section. Effect on Apgar score and acid-base status of the newborn. Anaesthesia 1989; 44:778-82. [PMID: 2802131 DOI: 10.1111/j.1365-2044.1989.tb09271.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Elective Caesarean section deliveries over a 5-year period were studied to compare the effect of epidural block with general anaesthesia on the condition of the infant at birth. The Apgar score and umbilical arterial acid-base status were used as determinants of the latter. Epidural block was used in 139 (22.8%) mothers while 471 (77.2%) were performed under general anaesthesia. No babies in the epidural group were severely depressed (Apgar less than 4), compared with 6.2% in the general anaesthesia group. Only 4.3% of the epidural sections were moderately depressed (Apgar 4-6), compared with 15.4% of the others. These differences remained highly significant when infants of less than 2500 g were excluded, and when matched groups were compared. Mean umbilical arterial pH was similar within the two groups (pH 7.28), and was not consistent with asphyxia in almost 90% of the depressed infants. The findings suggest that general anaesthesia, rather than asphyxia or aortocaval compression, is responsible for most of the depressed infants born by elective Caesarean section. This may involve over 20% of babies delivered in this manner, so greater use of epidural block for elective Caesarean section is recommended. Further investigations are required to improve results with general anaesthesia.
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Evans CM, Purohit S, Colbert JW, Lear PA, Makin T, Scobie DJ, Williamson EP, Sells RA. Amoxycillin-clavulanic acid (Augmentin) antibiotic prophylaxis against wound infections in renal failure patients. J Antimicrob Chemother 1988; 22:363-9. [PMID: 3053562 DOI: 10.1093/jac/22.3.363] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
A randomized, controlled trial of the use of amoxycillin with clavulanic acid (Augmentin) for prophylaxis against wound infections following major surgery, including transplantation, in patients with chronic renal failure, was undertaken. Six of 22 control patients developed wound infections (27%) whereas no patient in the treatment group (24) developed a wound infection (P less than 0.05). After the termination of this trial, the next 35 consecutive patients received prophylactic amoxycillin/clavulanate; of these only two developed wound infections associated with leakage from their pancreatic anastomoses. All the wound infections were shown to be caused by bacteria sensitive to amoxycillin/clavulanate. Pharmacokinetic studies in patients have shown that a bactericidal concentration of the drugs was present for up to 20 h post-operatively in patients on dialysis, and in recipients of non-functioning renal transplants. In patients with normal renal transplant function excretion of the drug within 12 h was observed.
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Sells RA, Hillis A, Bone MJ, Evans P, Evans CM, Scott MM. Donor-specific transfusion with and without cyclosporine A--a controlled clinical trial. Transplant Proc 1988; 20:270-3. [PMID: 3291255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Parys BT, Evans CM, Parsons KF. Bulbocavernosus reflex latency in the investigation of diabetic impotence. BRITISH JOURNAL OF UROLOGY 1988; 61:59-62. [PMID: 3342302 DOI: 10.1111/j.1464-410x.1988.tb09163.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Impotence in males is a well recognised complication of diabetes mellitus, commonly held to be due to an autonomic neuropathy. The aim of this study was to determine the incidence of periphero-conus neuropathy in diabetic impotence. Nineteen diabetic males seeking treatment for loss of potency had bulbocavernosus reflex latency (BCRL) and sacral reflex latencies (SRLs) performed. The conduction studies indicated that impotence in these cases was associated with peripheral neuropathy in 21% of patients and that BCRL and SRLs are sensitive and useful diagnostic tests.
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Hillis AN, Duguid J, Evans CM, Bone JM, Sells RA. Three year experience of donor specific transfusion and concomitant cyclosporine A. Transplant Proc 1987; 19:2248-9. [PMID: 2978890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Williamson EP, Evans CM, Machin DG, Woolfenden KA, de Bolla AR, Parsons KF. Urinary frequency and urgency. BMJ 1987; 294:308-9. [PMID: 3101855 PMCID: PMC1245314 DOI: 10.1136/bmj.294.6567.308-d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Sinclair GR, Evans CM, Kench P. Vascular lesion of the verumontanum. BRITISH JOURNAL OF UROLOGY 1985; 57:111-2. [PMID: 3971097 DOI: 10.1111/j.1464-410x.1985.tb09001.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Evans CM. Vantage points. Orthopedics 1984; 7:226-9. [PMID: 24822669 DOI: 10.3928/0147-7447-19840201-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Evans CM, Fellows SJ, Rack PM, Ross HF, Walters DK. Response of the normal human ankle joint to imposed sinusoidal movements. J Physiol 1983; 344:483-502. [PMID: 6655591 PMCID: PMC1193854 DOI: 10.1113/jphysiol.1983.sp014953] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Ankle joints were subjected to sinusoidal movements at a range of amplitudes and frequencies. Records were made of electromyograms (e.m.g.s) in calf muscles, and of the forces at the joints. When the leg is relaxed, the ankle joint resists an imposed sinusoidal movement with a small approximately sinusoidal force. It is stiffer in its resistance to small movements than to large ones, and this resistance is greater when the joint is dorsiflexed than when it is plantarflexed. If the subject exerts a steady mean flexing force, the imposed sinusoidal movement generates reflex activity which may be recorded as a modulation of the gastrocnemius and soleus e.m.g.s. The e.m.g. response to the sinusoidal movement occurs later in cycles of movement at high than at low frequencies, as one could expect of a reflex pathway that involves a delay. The results suggest that this delay is between 50 and 60 ms, and we conclude that under these circumstances spinal stretch reflexes are playing the important part. The relation of the resisting force to the movement has been displayed as a vector. As the frequency changes, this vector describes the circular path that is characteristic of a system which includes delays or lags; this path enables one to draw conclusions about the amplitude and timing of the reflex resistance to the movement. When a subject exerts a moderate flexing force against the sinusoidal movement for some minutes, the reflex response becomes progressively potentiated. A subject whose reflex responses are normally slight may then exhibit a vigorous reflex response to the movement of that ankle. This enhancement of spinal reflex activity was accompanied by an increase in the myotatic reflex response at the ankle. Reflex responses to sinusoidal movement were most clearly seen when the subject exerted a mean flexing force that amounted to about one-fifth of his maximum. Very small movements (+/- 0.5 degrees) generated little or no reflex response. With large amplitudes of movement there was more reflex activity, but at some amplitude (which varied from subject to subject and from time to time) the reflex mechanism appeared to 'saturate', and further increases in amplitude were not accompanied by comparable increases in the reflex response. With movements at 10-15 Hz the e.m.g. response often became large in alternate cycles, with less activity in the intervening cycles.(ABSTRACT TRUNCATED AT 400 WORDS)
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Desmond AD, Woolfenden KA, Evans CM. The importance of urodynamic investigation following spontaneous rupture of the bladder. J Urol 1983; 129:140-2. [PMID: 6827669 DOI: 10.1016/s0022-5347(17)51962-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
We report a case of spontaneous intraperitoneal rupture of the bladder. Followup urodynamic studies revealed unsuspected detrusor bladder neck dyssynergia that was treated by unilateral endoscopic bladder neck incision. The pathogenesis of spontaneous bladder rupture is discussed and we recommend urodynamic evaluation in all cases of spontaneous rupture.
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Badawy AA, Evans CM, Evans M. Production of tolerance and physical dependence in the rat by simple administration of morphine in drinking water. Br J Pharmacol 1982; 75:485-91. [PMID: 7199959 PMCID: PMC2071578 DOI: 10.1111/j.1476-5381.1982.tb09165.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
1 Rats are capable of consuming solutions of morphine sulphate in drinking water ad libitum in the absence of taste-masking chemicals and without the need for scheduled provision or prior parenteral administration of the drug. 2 The success of this method depends on the initial provision of a 0.1 mg/ml solution of morphine sulphate. 3 When the drug concentration is increased to 0.4 mg/ml, the rats achieve an average daily intake of 50 mg/kg body wt. each. 4 Daily intake of morphine may be increased by at least about three fold by increasing the drug concentration to 1.2 mg/ml. 5 Oral morphine administration causes only a moderate loss in body weight. 6 Rats whose daily intake of the drug is 50 mg/kg exhibit tolerance to the analgesic action of morphine and show a drastic loss in body weight at 24 h after withdrawal and most of the behavioural symptoms of the naloxone-precipitated withdrawal syndrome. 7 It is suggested that this simple method of morphine administration is suitable for further biochemical and behavioural studies of the actions of the drug.
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Desmond AD, Evans CM, Jameson RM, Woolfenden KA, Gibbon NO. Critical evaluation of direct vision urethrotomy by urine flow measurement. BRITISH JOURNAL OF UROLOGY 1981; 53:630-3. [PMID: 7317754 DOI: 10.1111/j.1464-410x.1981.tb03278.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Fifty-two male patients were studied prospectively to assess the results of direct vision urethrotomy in the treatment of urethral strictures. The prognosis was found to be significantly worse in those patients who had received extensive previous treatment. A catheter is recommended for at least 3 days and for 4 weeks in patients who have had minimal previous treatment or who have impaired detrusor function. The use of a urine flowmeter is essential for determining the success of treatment and stricture recurrence. Measurement of the recurrence-free period is important for assessing progressive improvement following repeat urethrotomy and for determining which patients cannot be cured by direct vision urethrotomy.
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Herman BM, Box MA, Reagan JA, Evans CM. Alternate approach to the analysis of solar photometer data. APPLIED OPTICS 1981; 20:2925-2928. [PMID: 20333075 DOI: 10.1364/ao.20.002925] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The standard technique of analyzing solar photometer data to determine atmospheric optical depth and the spectral solar constant is shown to inadvertently weight the data unequally. A new approach is proposed which equally weights all the data. Assuming that the deviations of the data points result from real random variations of optical depth during the period of the measurements, this latter approach is shown to yield more reliable results.
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Abstract
A bimodal birth distribution and seasonal trend has been previously reported in cystic fibrosis. The present study of 412 cases in Manchester and Bristol does not confirm the presence of a seasonal trend or any cyclic variation, and in general the trends in the present study are the reverse of those in the previous reports.
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Badawy AA, Punjani NF, Evans CM, Evans M. Inhibition of rat brain tryptophan metabolism by ethanol withdrawal and possible involvement of the enhanced liver tryptophan pyrrolase activity. Biochem J 1980; 192:449-55. [PMID: 7195200 PMCID: PMC1162359 DOI: 10.1042/bj1920449] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
1. Chronic ethanol administration to rats was previously shown to enhance brain 5-hydroxytryptamine synthesis by increasing the availability of circulating tryptophan to the brain secondarily to the NAD(P)H-mediated inhibition of liver tryptophan pyrrolase activity. 2. At 24h after ethanol withdrawal, all the above effects were observed because liver [NAD(P)H] was still increased. By contrast, all aspects of liver and brain tryptophan metabolism were normal at 12 days after withdrawal. 3. At 7--9 days after withdrawal, brain 5-hydroxytryptamine synthesis was decreased, as was tryptophan availability to the brain. Liver tryptophan pyrrolase activity at these time-intervals was maximally enhanced. 4. Administration of nicotinamide during the withdrawal phase not only abolished the withdrawal-induced enhancement of tryptophan pyrrolase activity on day 8, but also maintained the inhibition previously caused by ethanol. Under these conditions, the withdrawal-induced decreases in brain 5-hydroxytryptamine synthesis and tryptophan availability to the brain were abolished, and both functions were enhanced. Nicotinamide alone exerted similar effects in control rats. 5. It is suggested that ethanol withdrawal inhibits brain 5-hydroxytryptamine synthesis by decreasing tryptophan availability to the brain secondarily to the enhanced liver tryptophan pyrrolase activity. 6. The results are discussed in relation to the possible involvement of 5-hydroxytryptamine in dependence on ethanol and other drugs.
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Taylor MC, Kulatilake AE, Evans CM. Relief of malignant ascites due to disseminated carcinoma of the kidney, using the LeVeen shunt. BRITISH JOURNAL OF UROLOGY 1980; 52:324. [PMID: 7427000 DOI: 10.1111/j.1464-410x.1980.tb08928.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Evans CM, Clarke TK, Barnouti H, Crosby AC, Holmes S, Kulatilake AE. A controlled trial of different treatment regimens in patients with urinary tract infections after lower urinary tract surgery. Curr Med Res Opin 1980; 6:386-92. [PMID: 6988169 DOI: 10.1185/03007998009109456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
One hundred and four patients who developed urinary tract infections after catheterization for acute retention of urine and surgery of the bladder or urethra were randomly allocated to four treatment groups. Analysis of the results in 65 patients showed that co-trimoxazole and 1 g cephradine administered twice daily for 1 week were successful in eradicating the urinary tract infections in 93% and 88% of the patients, respectively. The same dose of cephradine administered 4-times a day eradicated 64% of the infections. In patients for whom no treatment was given, the original infection did not clear in 65%. Escherichia coli and coagulase-negative staphylococci were the commonest infecting organisms. The in vitro sensitivity testing of antibiotics did not correlate well with the successful eradication of the infecting organism.
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Evans CM, Blamey RW, Elston CW. Traffic of lymphocytes in the thoracic duct and renal lymph after allotransplantation and in immunosuppression. Transplantation 1978; 26:382-7. [PMID: 366821 DOI: 10.1097/00007890-197812000-00003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
A marked rise is seen in the number of white blood cells in the lymph leaving the sheep kidney after allografting; the number of lymphocytes leaving the kidney rising in direct relation to the degree of damage from acute rejection. No such rise is demonstrable in the number of lymphocytes in the thoracic duct lymph of sheep with rejecting kidney allografts. Indeed, there is an apparent decrease in the number of lymphocytes in the thoracic duct lymph of sheep with rejecting kidney allografts. Indeed, there is an apparent decrease in the number of circulating lymphocytes in the body when acute rejection is fully developed. Animals on immunosuppressive regimens show no alteration in the number of lymphocytes collected on thoracic duct cannulation, but immunosuppression appears to reduce the lymphocyte traffic through the kidney.
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Evans CM, Brain PF. Effects of age at castration on testosterone induced aggression-promoting cues in groups of male mice. Physiol Behav 1978; 21:19-23. [PMID: 567815 DOI: 10.1016/0031-9384(78)90270-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Davies P, Woods KA, Evans CM, Gray WM, Kulatilake AE. The value of provocative and acute urography in patients with intermittent loin pain. BRITISH JOURNAL OF UROLOGY 1978; 50:227-32. [PMID: 753466 DOI: 10.1111/j.1464-410x.1978.tb02814.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Twenty-two patients with intermittent loin pain thought to be typical of primary pelvic hydronephrosis but with normal appearances at standard excretion urography were subjected to diuretic urography using Frusemide-induced diuresis. If this was normal, acute urography was performed when the patient had pain. Abnormal appearances were shown in only 15 patients. In 4, only the erect films revealed the hydronephrosis. Dilatation occurred in response to a diuretic load in 9 and the abnormality was shown at the time of an attack of pain in 4. The hydronephrosis was shown only during the attack of pain in 2, a diuretic urogram having been normal. In 2 patients the nephrographic signs of acute obstruction were shown to be due to occlusion of the pelvi-ureteric junction at the time of an attack of pain. The importance of sequential examination, the value of erect films and acute urography are stressed.
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