Biomedical subjects
Publications and source records attributed to D A Murphy.
Sarcoidosis of the bones in the hands and feet is not uncommon. However, sarcoidosis involving the axial skeleton is unusual. The authors present the case of a 37-year-old man with sarcoidosis who developed low-back pain. Radionuclide bone scan demonstrated abnormalities in the pelvis, spine, and scapulae. A bone scan directed open biopsy of an abnormality in diagnostic tissue from the ilium.
The capacity of intrinsic cardiac efferent parasympathetic and sympathetic neurons to modify the heart was investigated in nine anesthetized open-chest dogs with adrenal glands removed from the circulation. The effects elicited by intravenously administered isoproterenol, tyramine, and nicotine on cardiac variables were examined before and after acute decentralization of the heart. Major vessels, as well as other tissues at the base of the heart, were denuded by means of an ultrasonic aspirator that removed neural elements without damaging muscles or blood vessels. The efficacy of the acute decentralization was assured by testing cardiac responses elicited by right and left stellate ganglia and cervical vagosympathetic complex stimulations after surgery. Heart rate, atrial force, and both right and left ventricular intramyocardial systolic pressures were augmented similarly by isoproterenol and tyramine before and after acute decentralization, indicating that the surgery necessary to decentralize the heart did not obtund cardiac myocyte function. Power spectral analysis of heart rate and left ventricular chamber pressure rate of change indicated an almost complete lack of variability of these indexes after, but not before, acute decentralization. Despite these changes, similar cardiac augmentation was elicited by nicotine before and after acute decentralization. Cardiac augmentation was elicited by nicotine in acutely decentralized preparations after atropine administration but not after beta-adrenergic blockade. These data indicate that the canine intrinsic cardiac nervous system contains a significant population of nicotine-sensitive adrenergic neurons that modulate the heart. Furthermore, the intrinsic cardiac nervous system does not appear to be primarily responsible for the heart rate and ventricular pressure variability found in intact hearts.
OBJECTIVE: This study reports the results of a behavior change intervention offered to women at high risk for human immunodeficiency virus (HIV) infection seen in an urban primary health care clinic. METHODS: Participants were 197 women randomly assigned to either an HIV/acquired immunodeficiency syndrome (AIDS) risk reduction group or a comparison group. Women in the HIV/AIDS intervention group attended five group sessions focusing on risk education; skills training in condom use, sexual assertiveness, problem solving, and risk trigger self-management; and peer support for change efforts. Women in the comparison group attended sessions on health topics unrelated to AIDS. RESULTS: At the 3-month follow-up, women in the HIV/AIDS intervention group had increased in sexual communication and negotiation skills. Unprotected sexual intercourse had declined significantly and condom use had increased from 26% to 56% of all intercourse occasions. Women in the comparison group showed no change. CONCLUSIONS: Socially disadvantaged women can be assisted in reducing their risk of contracting HIV infection. Risk reduction behavior change interventions should be offered routinely in primary health care clinics serving low-income and high-risk patients.
Behavior change remains the only means for primary prevention of HIV disease. Psychology should take a leading role in efforts to curtail the epidemic, but has not contributed to HIV prevention at a level proportionate to the urgency of the crisis. The authors propose an updated agenda for behavioral research on AIDS-HIV prevention implementing accelerated community trials of promising behavior change models, conducting trials of community-level interventions on a large scale and focused on populations most vulnerable to HIV infections, establishing partnerships between HIV research and community service organizations, integrating efforts from across psychology disciplines to advance and refine HIV prevention interventions, and mobilizing interdisciplinary HIV prevention resources and communication mechanisms to rapidly translate research findings to community and public policy arenas.
African-American women recruited from low-income housing projects in Chicago (N = 106) were randomly assigned to view 1 of 3 20-min videotapes: a standard public health service tape on prevention of acquired immunodeficiency syndrome (AIDS), the same public health service tape but matching presenter and participant ethnicity and sex, or a tape that included the same content but was framed in a context specifically intended to increase cultural relevance. Participants who viewed the tapes presented by African-American women were significantly more sensitized to AIDS and were more likely to have discussed AIDS with friends, to be tested for human immunodeficiency virus (HIV) antibodies during the follow-up interval, and to request condoms at follow-up. These results support the use of culturally sensitive AIDS prevention messages targeted to specific populations, particularly to promote HIV-antibody testing.
Whereas some people appear to cope after learning that they have human immunodeficiency virus (HIV) infection, others experience depression and suicidal ideation. In this study, 142 persons with HIV infection were administered the Center for Epidemiological Studies Depression Scale (CES-D). High levels of depression were predicted by lower perceived social support, attributions that health was influenced more by chance, high-risk sexual behavior practices, and greater number of HIV illness symptoms and greater duration of time knowing of one's own positive serostatus. Ongoing high-risk sexual behavior practices were predicted by higher levels of recreational drug use and of depression. These findings highlight the need for improved mental health services for persons with HIV conditions.
OBJECTIVE: Although many studies have documented patterns of emotional distress in persons with HIV disease, there have been few controlled evaluations of therapy outcomes with these individuals. This research evaluated the effects of brief cognitive-behavioral or social support group therapy with this population. METHOD: Sixty-eight depressed men with HIV infection were randomly assigned to one of three conditions: eight-session cognitive-behavioral groups, eight-session social support groups, or a comparison condition. Before and after intervention and at 3-month follow-up, all participants were individually assessed by using measures of symptoms of distress as well as substance use and sexual practices. RESULTS: Relative to the comparison group, both the cognitive-behavioral and social support group therapies produced reductions in depression, hostility, and somatization. The social support intervention also produced reductions in overall psychiatric symptoms and tended to reduce maladaptive interpersonal sensitivity, anxiety, and frequency of unprotected receptive anal intercourse, while the cognitive-behavioral intervention resulted in less frequent illicit drug use during the follow-up period. Tests for clinical significance of change particularly underscored benefits of the social support group intervention both at postintervention and at long-term follow-up. CONCLUSIONS: Brief group therapy for depressed persons with HIV infection produced reductions in symptoms of distress. The two forms of therapy resulted in shared and unique improvements in functioning, although social support groups focused on emotional coping presented greater evidence of clinically significant change. As more persons contract HIV infection and live longer with HIV disease, further research is needed to evaluate outcomes of mental health services with these individuals.
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A 25-year-old woman with acute knee pain and a lytic area in the proximal femur was diagnosed as having multiple myeloma (MM). This case is one of only eight in patients younger than aged 30 years to meet modern diagnostic criteria for MM. Failure to consider MM in young individuals precludes early diagnosis and valuable time for treatment.
High and low-aggressive boys with attention deficit-hyperactivity disorder (ADHD) were compared and the effects of methylphenidate were examined on measures from three domains of aggression: (1) directly observed verbal and nonverbal aggressive behaviors exhibited in the context of a day treatment program, (2) aggressive responding when provoked during a laboratory task, and (3) social information processing patterns exhibited on tasks designed to tap the putative cognitive components of aggression. The high-aggressive (HA) and low-aggressive (LA) subgroups differed significantly on observational measures of aggression and on the laboratory provocation task, but the HA group showed more deviant cognitions on only one of the numerous measures of social information processing. Regarding medication effects on the direct observation measures, methylphenidate decreased aggression for both subgroups. On the laboratory provocation task, methylphenidate had only minimal effects. Significant drug effects were obtained on only two recall social information processing measures.
Cardiovascular responses were elicited in 12 patients undergoing cardiac operations when cardiopulmonary neural elements between the aortic root and pulmonary artery or in the right atrial ganglionated plexus were stimulated. Heart rate and left ventricular intramyocardial systolic pressure were augmented when cardiopulmonary nerves between the aorta and pulmonary artery were stimulated in 11 of the 12 patients. Right ventricular intramyocardial systolic pressure was augmented in 7 of these 11 patients. Cardiodepressor responses were elicited when the right atrial ganglionated plexus (9 patients) or a cardiopulmonary nerve (2 patients) was stimulated. These results demonstrate that electrical stimulation of the human extrinsic and intrinsic cardiac nervous systems can alter cardiodynamics, different responses being elicited when different neural structures are stimulated. These data are in accord with those obtained from canine experiments and suggest that the human extrinsic and intrinsic cardiac nervous system contains functionally similar neural elements to those found in other mammals.
Two patients are described with antidromic reentry tachycardia successfully treated by interruption of an anterior septal accessory atrioventricular node and bundle. This anomalous connection resembles an atrioventricular conduction sling seen in complex congenital heart malformations. It has atrioventricular node-like properties, is located in the anterior septal area, will only conduct antegrade, and has an insulated connection to the right bundle branch. Rather than nodoventricular, nodofascicular, atriofascicular, or Mahaim, a more appropriate label for the connection is accessory atrioventricular node and bundle.
In the decade since acquired immune deficiency syndrome (AIDS) was first diagnosed, behavioral research has focused intensively on risk reduction change processes and, to a lesser extent, on mental health needs of persons with human immunodeficiency virus (HIV) conditions. Although research to date has yielded important findings for primary prevention efforts and has identified some psychological dimensions relevant to mental health interventions, there is a pressing need for much more systematic intervention outcome research in both the prevention/behavior change and emotional coping areas. Progress in these areas will be facilitated by better linkage of intervention approaches to behavioral theory; identification of intervention elements that produce HIV risk behavior change; evaluated field-testing of promising intervention models; continued focus on populations that remain at risk (such as gay men and injection drug users); and expansion of prevention efforts to urban, poor, and minority populations increasingly threatened as AIDS/HIV enters a "second wave." Although AIDS is still a relatively new problem, existing behavioral medicine conceptual models and intervention strategies can be adapted to meet the enormous challenges created by AIDS and HIV infection.
The anxiolytic-like potential of anpirtoline was assessed in a mouse light/dark aversion test. Anpirtoline (1.0 ng kg(-1)-1.0 micrograms kg-1 i.p.) reduced the aversive responding of mice. This was detected as an increase in the latency to locate the non-aversive compartment and by decreases in the percentage of the time spent in the dark compartment, and the numbers of rears and line crossings in the dark compartment. In radioligand binding studies anpirtoline displayed submicromolar affinity for 5-HT1A, 5-HT1B and 5-HT3 receptor recognition sites (Ki = 151, 28 and 30 nM, respectively) and more modest affinity for 5-HT2 receptor recognition sites (Ki = 1.48 microM). It is concluded that anpirtoline has a unique spectrum of affinity for 5-HT receptor subtypes, its interaction with which may account for its anxiolytic-like activity.
OBJECTIVE: There is growing concern that chronic mentally ill adults living in the community have a high risk for HIV infection. The purpose of this study was to identify risk knowledge, high-risk behaviors, and risk-related encounters of chronic psychiatric outpatients. METHOD: Detailed information on high-risk behaviors and risk-related situations during the past 12 months was collected from 60 outpatients appearing for regular visits at inner-city community mental health clinics. RESULTS: Of the 60 outpatients, 37 (62%) had been sexually active during the past year, and 42% of the men and 19% of the women reported multiple sexual contacts and infrequent use of condoms during intercourse. Assessments of the patients' knowledge of AIDS risks revealed substantial deficits in their practical understanding of AIDS and risk reduction measures. Although use of intravenous drugs was uncommon in this group, many subjects reported histories of 1) trading sex for money, drugs, or a place to stay, 2) coercion to engage in unwanted sex, 3) causal sexual encounters, and 4) sexual activity after use of drugs or intoxicants. Twenty percent of the subjects had met their sexual partners on the streets, in parks, or in other public places. One-third had been treated for sexually transmitted diseases other than AIDS. CONCLUSIONS: These findings underscore the need for AIDS risk assessment, counseling, and prevention programs for the chronic mentally ill.
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Aortic valve endocarditis with extension to the tricuspid annulus and ventricular septum in an intravenous drug abuser - with Mycobacterium avium-intracellulare identified as the offending organism - forms the basis of this report. The aortic root and ventricular septal defect were successfully repaired using an aortic cryopreserved homograft. This case is of particular interest because M avium-intracellulare has not been recognized as a cause of endocarditis. The incidence of atypical organisms as a cause of endocarditis may increase in the future because of the rise of drug abuse and the acquired immune deficiency syndrome in North America.
We studied in anesthetized dogs, the effects of cardiopulmonary bypass with normothermic whole blood, crossclamping of the aortic root, and continuous warm blood cardioplegia on the ability of the efferent sympathetic nervous system to augment the heart and that of the efferent parasympathetic nervous system to depress the heart. In control states, heart rate, atrial force of contraction, and right and left ventricular wall systolic pressures were augmented by stimulation of the intrathoracic efferent sympathetic nervous system and by administration of isoproterenol into the systemic circulation. After 1 hour of normothermic cardiopulmonary bypass that utilized aortic crossclamping and continuous perfusion of the coronary arteries with normothermic blood (20 mEq/L potassium), cardiac-augmenting effects induced by the efferent sympathetic nervous system and by isoproterenol were similar. Depressive responses elicited by the efferent parasympathetic nervous system were also unaffected by these procedures. Continuous warm blood cardioplegia does not result in impairment of the efferent sympathetic nervous system regulating the heart.