Tracheal stenosis as a complication of tracheostomy.
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Adolescent↗
Biomedical subjects
D A Murphy
Publications and source records attributed to D A Murphy.
Cognitive enhancing actions of DuP 753 detected in a mouse habituation paradigm.
The potential of DuP 753, an angiotensin II receptor antagonist, to improve cognitive performance was assessed in a mouse habituation paradigm. On repeated daily testing DuP 753 (10.0 ng kg-1 p.o.) enhanced the basal cognitive performance of mice (decrease in latency to move from the light to the dark compartment and increases in the rears, line crossings and percentage of time spent in the dark compartment) and overcame the cognitive impairment induced by the administration of scopolamine (0.25 mg kg-1 i.p.). These findings further implicate the modulation of mental function by angiotensin II.
Angiotensin II↗
Global pricing for cardiac care: hard lessons for physicians and hospitals.
The challenges associated with global contracting are becoming apparent as more experience is gained. Contracts held by an open medical staff hospital provide an ever-changing equation. High-cost physicians can join the staff and alter the cost and quality outcomes that the hospital and physicians may anticipate. Also, physicians want to have assurances on how fee distribution is determined. For these reasons, some physicians are developing private contracting vehicles that assure their future. Managed competition is encouraging these creative models to respond to the market demands of payers; in some markets, these vehicles are creating the demand. It is important for both physicians and hospitals to be open to new creative models. Hospitals that insist on controlling the situation decrease its potential success. Flexibility ensures the ability of both entities to respond to new market demands. From the payer perspective, global contracting represents predictability of price and dependability of service. It encourages an economic relationship of dependence between a hospital and its physicians. Utilization of service is no longer the payers' problem; instead, the provider is asking the questions and managing the situation to assure that both quality and economic efficiency outcomes are achieved.
Cardiology Service, Hospital↗
The algebra of healthcare reform: hospital-physician economic alignment.
In summary the tertiary care programs in this nation are trapped in a difficult dilemma. On one side is the ongoing reduction in provider revenue driven by real and powerful market forces. On the other side is a traditional payment system governed by necessary laws that inhibit meaningful re-engineering of tertiary care delivery. If a remedy to this situation cannot be created then it is very likely that all aspects of quality as defined earlier will suffer. It is our hope that by very careful construction of a relationship, with attention to applicable statutes and careful measurement of utilization and quality, a limited business alignment of a hospital and a group of tertiary physicians can be approved in the care of Medicare, Medicaid and all federally funded patients.
Cardiology Service, Hospital↗
Studies of major histocompatibility complex class I/II expression on sequential human heart biopsy specimens after transplantation.
Our previous data indicate that normal human cardiac myocytes do not express detectable levels of major histocompatibility complex (MHC) class II gene products and express only low levels of MHC class I gene products. Examination of heart biopsy samples after transplantation with immunoperoxidase techniques revealed that such myocytes are induced to express high levels of MHC class I/II gene products and that the expression of these gene products appeared to precede histologic evidence of rejection. In efforts to objectively quantitate the level of MHC antigen expression on sequential heart biopsy samples, a radioimmunoassay was set up. Monoclonal antisera was used against human monomorphic MHC class I and II determinants. In addition, to control for the variability in the quantity of biopsy sample, use was made of a monoclonal antisera against human cardiac myosin. A series of three to four sections (4 micron each) of the heart biopsy specimen was treated with each antisera, followed by affinity purified and absorbed iodine 125-labeled goat antimouse immunoglobulin. The mean counts per minute of MHC class I and II was divided by the mean counts per minute obtained with anti-myosin and an index of MHC class I/II derived. Data using such a radioimmunoassay indicate that MHC antigen expression on the heart biopsy specimens does not strictly correlate with histologic rejection grade scores, levels of leukocyte infiltrate, or the immunophenotype of the infiltrating mononuclear cells. Of interest was the finding that an increase in the level of MHC antigen expression occurred before histologic evidence of rejection grades of 3 or greater. In addition, MHC class I antigen expression appeared to increase in heart biopsy samples early during the post-transplant period, followed sequentially by an increase in the level of MHC class II antigen expression. Rejection episodes later during the posttransplant period, however, were accompanied by increased levels of MHC class II antigens. A kinetic analysis of the increase in the levels of MHC class I and II antigens on heart biopsy samples may not only provide a refinement of the histologic scoring of heart biopsy samples for rejection but may also suggest the use of different chemotherapeutic immunosuppressive drug regimens for the treatment of MHC class I as compared with MHC class II dependent rejection episodes.
Antibodies, Monoclonal↗
Does pulsatile flow improve glucose tolerance during extracorporeal circulation.
The present study was designed to determine the effect of pulsatile glow on glucose tolerance during cardiac surgery. Twenty patients were divided into two equal groups; ten patients receiving non-pulsatile bypass and the remaining patients receiving pulsatile flow. Patients receiving pulsatile flow had significantly lower systemic resistance in the intensive care unit. Glucose tolerance, however, was similar in both patient groups. Insulin secretion was impaired and serum glucose remained elevated throughout the period of extracorporeal circulation. We conclude from this study that glucose tolerance is unaffected by pulsatile flow.
Blood Glucose↗
Capacity of intrinsic cardiac neurons to modify the acutely autotransplanted mammalian heart.
The capacity of the intrinsic cardiac nervous system to modify the acutely autotransplanted heart was investigated in eight anesthetized open-chest canine preparations in which the adrenal glands had been removed from the circulation. Cardiac effects elicited by isoproterenol and nicotine were also examined before and after heart-lung transplantation. Cardiac augmentation induced by isoproterenol was similar before and immediately after cardiopulmonary transplantation, indicating that the surgery did not obtund cardiac myocyte function significantly. The initial bradycardia induced by nicotine was greater before transplantation. The subsequent augmentation in left atrial systolic pressure, as well as right and left ventricular intramyocardial systolic pressures, induced by nicotine were similar before and after transplantation. When nicotine was administered to transplanted preparations after atropine administration, cardiac augmentation was induced. Cardiac augmentation was not induced by nicotine after subsequent beta-adrenergic blockade. These data indicate that nicotine-sensitive adrenergic neurons which accompany the transplanted heart are capable of inducing considerable cardiac augmentation. Power spectral analysis of heart rate and left ventricular chamber rate of pressure rise variability indicated an almost complete lack of power in these indexes after, as opposed to before, transplantation. Together with intrinsic cardiac cholinergic neurons, intrinsic cardiac adrenergic neurons may be responsible for physiologically and pharmacologically induced alterations in cardiac variables that occur in acutely transplanted hearts.
Adrenal Glands↗