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Biomedical subjects

C Brophy

Publications and source records attributed to C Brophy.

At least 37 records · Page 2Linked to original sources
PubMed1989

Reversible respiratory muscle weakness in hyperthyroidism.

Breathlessness is a common complaint in patients with hyperthyroidism, and respiratory failure requiring artificial ventilation, although rare, can occur. While a proximal myopathy is frequently recognized, diaphragm muscle function has not hitherto been studied in detail in thyrotoxicosis. The strength of the quadriceps femoris and respiratory muscles was therefore assessed in seven consecutive thyrotoxic patients, on presentation and during medical treatment, when euthyroid. Prior to therapy, reduced quadriceps muscle strength, vital capacity, and global expiratory and inspiratory muscle strength were found. Diaphragmatic weakness was present in one of four patients studied by measuring transdiaphragmatic pressures during maximal sniffs and during bilateral phrenic nerve stimulation at 1 Hz (twitch). After treatment, significant improvement occurred in quadriceps muscle strength, vital capacity, and global respiratory muscle strength. Sniff and twitch transdiaphragmatic pressures also increased significantly. These results indicate that respiratory muscle weakness occurs in hyperthyroidism and that such weakness is reversible with medical treatment. It is important to realize that respiratory muscles may be directly affected when assessing thyrotoxic patients with breathlessness, as severe involvement of the respiratory muscles may cause respiratory failure.

Chronic Disease↗
PubMed1989

Meckel's diverticulum in the pediatric surgical population.

Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract. We reviewed our experience with 31 cases of Meckel's diverticulum in children from 1966 to 1987. Twenty-four patients presented with clinical manifestations: ten from bleeding, ten from obstruction, and four from diverticulitis. Seven Meckel's were incidental findings at laparotomy. Fifty percent of the patients with bleeding had abdominal pain and 100% had ectopic gastric mucosa in the Meckel's. In six cases the technetium scan identified the Meckel's; there was one false negative scan. Obstruction secondary to a Meckel's diverticulum was due to an internal hernia in five and to intussusception in five. Three patients with intussusception had concomitant bleeding. Diverticulitis was clinically similar to appendicitis. There were no complications and no deaths following surgical resection of Meckel's diverticulum.

Child↗
PubMed1989

The effect of aminophylline on respiratory and limb muscle contractility in man.

The effect of oral aminophylline on respiratory muscle and quadriceps femoris strength was compared with placebo in five normal subjects. A double-blind randomized cross-over protocol, spanning 2-3 wks, was followed. Aminophylline was taken before both placebo and active drug periods to establish correct dosage, to allow tolerance to side-effects to develop, and to keep the two limbs of the study identical and double-blind. Maximal static inspiratory and expiratory mouth pressures at residual volume and total lung capacity, respectively, maximal sniff transdiaphragmatic pressure, maximal voluntary quadriceps femoris contraction force and theophylline levels were measured during placebo and active drug periods. For the group, there were no significant differences between respiratory or quadriceps muscle strength on aminophylline and on placebo although there was a tendency for greater values on aminophylline. Mean theophylline level was 14.6 mg.l-1 (range 8.4-25.0 mg.l-1). We conclude that aminophylline produces no enhancement of skeletal muscle strength, at therapeutic dosage in normal subjects.

Adult↗
PubMed1989

Primary small bowel malignant tumors. Unrecognized until emergent laparotomy.

Forty-five consecutive cases of primary small bowel malignant tumors treated at our institution from 1969-1983 were reviewed. Sixty-four per cent of the patients had surgical emergencies. Fourteen patients had intestinal obstruction, 11 had gastrointestinal (GI) hemorrhage, and 4 had perforation of the small bowel. The remaining 16 patients were explored for persistent symptoms, an abnormality on GI series, or a mass lesion on CT scan. Thirty-eight patients underwent resection of the tumor and seven had palliative bypass procedures. This study suggests that a high index of suspicion and early diagnostic evaluation including a small bowel series is necessary to prevent the large number of small bowel tumors presenting as surgical emergencies. In particular, small bowel tumors should be suspected in patients with abdominal pain of unknown etiology, unexplained weight loss, or occult GI bleeding.

Adenocarcinoma↗
PubMed1988

Propranolol delays the formation of aneurysms in the male blotchy mouse.

Propranolol has been reported to prevent aortic aneurysms in the beta-aminoproprionitrile-fed broad-breasted white turkey model. The purpose of this investigation was to determine the effect of propranolol in another animal model of aortic aneurysms, the spontaneously aneurysm-prone Blotchy (BLO) mouse. One hundred fourteen male BLO mice were fed control chow or a diet supplemented with 0.10% (w/w) propranolol. Groups were sacrificed at monthly intervals and the presence of aneurysms was determined after latex injection into the left ventricle. Aortic diameter was also measured at the widest point in a subset of mice from each group sacrificed at 4-5 months of age. At 4 months 86% of control and 32% of propranolol-fed animals had aneurysms (P less than 0.001). The difference in mean aortic diameter was also decreased by 33% in the propranolol-fed group (P less than 0.01). This study suggests that propranolol delays the formation of aneurysms in this spontaneous, genetically determined animal model.

Animals↗
PubMed1988

Assessment of diaphragm weakness.

Thirty patients with breathlessness and diaphragm weakness were studied by measuring transdiaphragmatic pressures during maximal inspirations to total lung capacity, maximal static inspiratory efforts from residual volume, and maximal sniffs from functional residual capacity. Maximal static respiratory mouth pressures were also recorded, and rib cage and abdominal movements were monitored with pairs of magnetometers. Sniff transdiaphragmatic pressure was abnormally low in all patients and was correlated with transdiaphragmatic pressure during other maneuvers, and with maximal static inspiratory mouth pressures. There was no relationship between the severity of dyspnea and transdiaphragmatic pressure in the group as a whole. The weakest patients had orthopnea and paradoxical inward inspiratory motion of the anterior abdominal wall; measurements suggested that at least 30 cm H2O transdiaphragmatic pressure was required to overcome the hydrostatic pressure of the abdominal contents. By contrast, patients with mild diaphragm weakness had neither orthopnea nor abdominal paradox. Thus, patients with breathlessness and diaphragm dysfunction may have varying degrees of diaphragm weakness that may be difficult to detect clinically; the diagnosis and quantification of diaphragm weakness requires the measurement of transdiaphragmatic pressure.

Adolescent↗
PubMed1988

Respiratory muscle weakness during upper respiratory tract infections.

Global respiratory muscle strength was studied in 22 normal healthy volunteers during a 4-month winter period. Twelve subjects developed naturally acquired upper respiratory tract infections. Maximal static expiratory and inspiratory mouth pressures fell significantly during these infections. The greatest falls were documented between the third and seventh days of clinical illness. Full recovery occurred by the fourteenth day. We conclude that significant abnormalities of respiratory muscle function can occur during upper respiratory tract infections in otherwise healthy young adults.

Adult↗
PubMed1988

Respiratory muscle function in myasthenia gravis.

Global respiratory muscle function and diaphragmatic strength were assessed and compared with quadriceps femoris muscle strength in 17 patients with generalized mild-to-moderate myasthenia gravis and breathlessness. Initial measurements, made 10 h after the last dose of oral anticholinesterase therapy, demonstrated reduced maximal static expiratory (52.4 +/- 26.8% predicted) and inspiratory (54.0 +/- 23.5% predicted) mouth pressures in 16 patients, and reduced quadriceps femoris muscle strength in all cases. Vital capacity (VC) (70.9 +/- 19.0% predicted) was abnormal in 12 patients. Transdiaphragmatic pressure recorded during maximal sniffs (sniff Pdl) was reduced in eight patients, whereas pressure recorded during bilateral phrenic nerve stimulation at 1 Hz (twitch Pdi) was reduced in only three. There was no relationship between the grade of myasthenia or the severity of dyspnea and any of the measurements of respiratory muscle strength. After the administration of edrophonium hydrochloride (Tensilon), there was a significant increase in maximal static expiratory and inspiratory mouth pressures in quadriceps muscle strength and in sniff Pdi. The small increase in VC was not significant, and twitch Pdi increased in only one patient. Phrenic nerve conduction time was normal before and after Tensilon. Two patients with severe long-standing myasthenia showed no improvement in any measurement after Tensilon. We conclude that expiratory and inspiratory muscle weakness was not uncommon in patients with myasthenia gravis. Respiratory muscle strength improved after Tensilon. Vital capacity was a less sensitive measure of respiratory muscle strength than were respiratory mouth pressures and sniff Pdi. Diaphragmatic involvement was not detected by twitch Pdi unless the weakness was severe.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Phrenic nerve stimulation in normal subjects and in patients with diaphragmatic weakness.

Phrenic nerve stimulation is often considered to be difficult and unreliable. The time taken for the phrenic nerves to be located and adequately stimulated was measured in 110 subjects, aged 21-89 years, 26 of whom had diaphragmatic weakness; and phrenic nerve conduction time was recorded in 76 of these individuals. Each phrenic nerve was stimulated transcutaneously in the neck with square wave impulses 0.1 ms in duration at 1 Hz and 80-160 volts while diaphragmatic muscle action potentials were recorded with surface electrodes. The time taken to locate either phrenic nerve ranged from two seconds to 22 minutes (median 10s). Both nerves were located in 83 of the 84 control subjects (99%) and in 21 of the 26 patients with diaphragmatic weakness (81%). Mean (SD) phrenic nerve conduction time in the control subjects was 6.94 (0.77) ms on the right and 6.61 (0.77) ms on the left. A weak relationship was found between conduction time and the subjects' age and height. Four out of 24 patients with diaphragmatic weakness had a prolonged phrenic nerve conduction time. Transcutaneous stimulation of the phrenic nerves was not a time consuming procedure, and it was well tolerated, reproducible, and successful in 95% of subjects.

Adult↗
PubMed1986

Esophageal rupture after routine Maloney dilatation. A proposed mechanism.

Maloney dilatation of the esophagus is rarely associated with esophageal rupture. An 82-year-old man underwent routine upper endoscopy followed by esophageal dilatation, which was complicated by severe esophageal disruption and mediastinitis. One possible mechanism is gastric dilatation with obturation of the distal esophagus causing excessive pressure at the gastroesophageal (GE) junction. Endoscopy should always be followed by gastric air removal before introducing esophageal dilators.

Aged↗
PubMed1985

Action of abdominal muscles on rib cage in humans.

To assess the actions of the rectus abdominis and external oblique muscles on the rib cage in humans, these two muscles were stimulated with surface electrodes in four normal supine subjects at functional residual capacity. Changes in anteroposterior and transverse rib cage diameters and changes in xiphipubic distance were measured with pairs of magnetometers. Stimulation of rectus abdominis produced a marked decrease in the xiphipubic distance and in the anteroposterior diameter, thus making the rib cage more elliptic. In contrast, stimulation of the external oblique caused a decrease in the transverse diameter, making the rib cage more cylindrical. When both muscles were stimulated simultaneously, the resultant rib cage distortion depended on the relative voltage at which each muscle was stimulated. Electromyogram recordings showed that there was no cross contamination or activity of the diaphragm during the muscle stimulations. Transdiaphragmatic pressure increased with the voltage of stimulation, suggesting passive lengthening of the diaphragm. X-ray studies were performed in two subjects and confirmed the main magnetometer findings. These studies thus confirm that the rib cage in humans is more easily distortable than conventionally thought. The abdominal muscles can distort it in either direction depending on which muscles are contracting.

Abdominal Muscles↗
PubMed1985

The relationship of anxiety to childhood depression.

In order to investigate the relationship between anxiety and depression in emotionally disturbed children, 30 hospitalized inpatient children were individually administered the Children's Depression Inventory (CDI), the Children's Manifest Anxiety Scale-Revised (CMAS-R), and the State-Trait Anxiety Inventory for Children (STAIC). Results indicated a significant relationship between CDI scores, the CMAS-R and its factors, and the STAIC. Correlations between the various factors of anxiety and depression suggest a complex relationship between the two constructs. Stepwise regression analyses indicated further the complexity of this relationship. Results were discussed in terms of the possible differential role which the different anxiety factors play in depression.

Anxiety Disorders↗
PubMed1984

Influence of meal weight and caloric content on gastric emptying of meals in man.

This study was designed to assess the relative influence of meal weight and caloric content on gastric emptying of liquid and solid meals in man. A dual radioisotopic method which permits noninvasive and simultaneous measurement of liquid- and solid-phase emptying by external gamma camera techniques was employed. Nine healthy volunteer subjects ingested 50-, 300-, and 900-g lettuce and water meals adjusted to either 68, 208, or 633 kcal with added salad oil. The following observations were made: (1) absolute emptying rates (grams of solid food emptied from the stomach per minute) increased directly and significantly with meal weight; (2) increasing meal total caloric content significantly slowed solid food gastric emptying but did not overcome the enhancing effect of meal weight; and (3) liquid emptying rates were uninfluenced by meal total kcal amount.

Energy Intake↗
PubMed1984

Psychological factors in adjustment to orthognathic surgery.

The psychological adjustment of 30 orthognathic surgery patients was evaluated before and on three occasions after surgery. Results of preoperative testing showed the group to be well adjusted, and there were no major changes in psychological functioning as a result of surgery. Motivation for surgery included both functional and esthetic goals, and the majority of patients were satisfied with the results of surgery. The patient's perception of the surgeon was significantly related to pre- and postoperative adjustment. Two of the measures used, the Health Opinion Survey and the Impact Message Inventory, have potential as brief early screening devices to identify patients who may experience problems in psychological adjustment to orthognathic surgery.

Adolescent↗