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Biomedical subjects

E A Murphy

Publications and source records attributed to E A Murphy.

At least 37 records · Page 2Linked to original sources

Inhibition by protease inhibitors of chemotaxis induced by elastin-derived peptides.

We studied the effect of two inhibitors of human neutrophil proteases on neutrophil chemotaxis induced by the hexapeptide Val-Gly-Val-Ala-Pro-Gly (VGVAPG), a recurring sequence in the elastin molecule. The inhibitors were tosyl-Phe chloromethyl ketone (TFCK) and N-methoxysuccinyl-Ala-Ala-Pro-Val chloromethyl ketone (MAAPVCK). We assayed chemotactic activity by the double-membrane technique in a modified Boyden chamber, after incubating the cells for 1 hr with varying concentrations of inhibitor. We observed a concentration-dependent inhibitory effect. We also measured the potency of the two chloromethyl ketones as protease inhibitors. The more potent protease inhibitor, MAAPVCK, was also the more effective in inhibiting VGVAPG-induced chemotaxis; its inhibitor dissociation constant was KI = 28 nM with elastase and KI = 33 nM with cathepsin G. For TFCK the corresponding KI values were 37 microM and 200 microM. The incubating concentration required to lower chemotaxis by half its uninhibited value was C0.5 = 0.64 microM for MAAPVCK, compared to C0.5 = 3.4 microM for TFCK. A third peptide, triglycinate (gly3), which did not inhibit the proteolytic activity of either elastase or cathepsin G, did not inhibit chemotaxis. Chemotaxis induced by formyl Met-Leu-Phe (fMLP) was weakly inhibited by both chloromethyl ketones with TFCK being somewhat more effective than MAAPVCK. We concluded that inhibition of VGVAPG-induced chemotaxis is in part specific, receptor mediated. We suggest that proteolytic inhibitors protect the extracellular matrix from degradation by inhibiting chemotaxis. Comparing the inhibitor concentrations required to half proteolytic activity with the concentration required to half chemotactic activity, we further suggest that the two functions may be of comparable significance.

Amino Acid Sequence↗

Laparoscopically assisted abdominal aortic aneurysm repair. A report of 10 cases.

BACKGROUND: Laparoscopic surgery decreases postoperative pain and length of hospital stay. Whether laparoscopically assisted abdominal aortic aneurysm (AAA) repair can be safely and reliably performed is unknown. This prospective study was designed to establish the feasibility of laparoscopically assisted AAA repair and its effects on intraoperative and postoperative variables. METHODS: With IRB approval, 10 patients with infrarenal AAA requiring a tube graft underwent laparoscopically assisted AAA repair. The procedure consisted of laparoscopic dissection of the aneurysm neck and iliac vessels. Then, through an 8-11-cm minilaparotomy, a standard endoaneurysmorrhaphy was performed. Data included laparoscopic and total operative times, blood loss, fluid requirements, duration of nasogastric suction (NGT), and lengths of intensive care unit (ICU) and postoperative hospital stays. RESULTS: Laparoscopically assisted AAA was completed in nine of 10 patients. The first patient was converted to a standard incision because the aneurysm neck could not be adequately dissected. Laparoscopic and total operative times were 1.8 +/- 0.4 and 4.5 +/- 0.7 h, respectively. Mean blood loss was 1 +/- 0.6 l. Intraoperative fluid requirement was 6.6 +/- 1.3 l. The duration of NGT suction was 1.8 +/- 1.0 days. The ICU stay was 2.1 +/- 0.8 days and hospital stay was 6.7 +/- 2.5 days. There were two minor complications and no deaths. CONCLUSIONS: Laparoscopically assisted AAA repair is technically feasible with acceptable blood loss, operative time, morbidity, and mortality. Potential advantages may be early removal of the NGT and shorter ICU and hospital stays. Prospective randomized trials are needed to determine if laparoscopically assisted AAA repair is advantageous.

Aged↗

Low dose desensitisation does not reduce the toxicity of sulphasalazine in rheumatoid arthritis.

OBJECTIVE: To examine the proposal that pretreatment low dose desensitisation may reduce the incidence of toxicity of sulphasalazine in the treatment of rheumatoid arthritis (RA). METHODS: A double blind, placebo controlled trial was performed with 422 patients satisfying the American College of Rheumatology criteria for RA who required sulphasalazine treatment because of increased disease activity. Patients received either sulphasalazine desensitisation, or placebo, for three weeks before commencement of sulphasalazine treatment. The frequency and nature of adverse effects and changes in clinical and laboratory parameters of disease activity were measured after three and six months. RESULTS: Improvement in the efficacy of sulphalasazine (measured by clinical and laboratory parameters) was significant and similar in magnitude in both groups. There was no significant difference between actively and placebo desensitised patients as regards the incidence or profile of adverse effects (toxicity). CONCLUSION: Pretreatment low dose desensitisation is unhelpful in reducing the toxicity associated with sulphasalazine treatment of RA.

Anorexia↗

Laparoscopic aortic replacement in the porcine model: a feasibility study in preparation for laparoscopically assisted abdominal aortic aneurysm repair in humans.

BACKGROUND: Current laparoscopic vascular techniques have centered around aortofemoral bypass for the treatment of patients with aortic occlusive disease. However, the majority of aortic surgeries are performed for the treatment of aortic aneurysmal disease. With this mind, we undertook this study to assess the feasibility of laparoscopic aortic replacement in the porcine model in preparation for laparoscopically assisted abdominal aortic aneurysm (AAA) repair in humans. STUDY DESIGN: Twenty-three female pigs weighing between 35 and 40 kg underwent laparoscopic aortic dissection by either a transabdominal or retroperitoneal approach. The infrarenal aorta was laparoscopically dissected, isolated, and cross clamped. Then a custom designed cuffed polytetrafluoroethylene graft was inserted. After reestablishing and confirming distal flow, the animals were sacrificed. RESULTS: Fifteen functioning aortic grafts were placed in 21 animals who had the transabdominal approach. One functioning graft was placed in the retroperitoneal group. Complications included bladder, ureteral, inferior vena cava, renal vein, and aortic injuries. By the end of the study, the operative time was reduced from six to less than two hours; blood loss was reduced from 1,000 to 150 mL; and cross-clamping time was reduced from 60 to 15 minutes. CONCLUSIONS: In the porcine model, laparoscopic abdominal aortic replacement is associated with a significant learning curve. However, this method of repair is technically feasible and warrants further investigation in the treatment of AAA in humans.

Animals↗

Patients' views of low back pain and its management in general practice.

BACKGROUND: Low back pain is a common and persistent problem. Research studies seeking to improve the quality of management of this condition have tended to ignore the opinions of patients. There is a growing acceptance of the importance of taking patients' views into account in developing management and educational programmes for a variety of conditions. AIM: This study set out to elicit the views of patients concerning low back pain and its management in general practice. METHOD: Fifty-two in-depth interviews were conducted with patients selected from a broad range of 12 general practices. RESULTS: Analysis of the interviews identified seven themes relating to: quality of life, prognosis, secondary prevention, help-seeking behaviour, explanation of underlying pathology, satisfaction with general practitioner management, and complementary therapy. Different patient viewpoints or perspectives were expressed within each of these themes. Patients adapted to the progress of their low back pain and were not seeking a 'magical cure' from either conventional or complementary therapies. CONCLUSION: Patients' views on low back pain are heterogeneous. The dissatisfaction expressed with medical explanations for the pain may be related to superficial clinical management and the constraints of general practice. Good management of low back pain needs to take patients' complex views of the condition into account.

Adolescent↗

Laparoscopic-assisted abdominal aortic aneurysm repair.

Since the advent of laparoscopy, the sweeping changes seen in general surgery have not been paralleled in vascular surgery. There have been case reports of laparoscopic-assisted aortobifemoral bypass for occlusive disease. Because aneurysmal disease comprises the majority of aortic surgery, we pursued animal and cadaveric feasibility studies for laparoscopic-assisted abdominal aortic aneurysm (AAA) repair. We present a case report of the first clinical case performed under Institutional Review Board protocol using this technique. The patient was a 62-year-old male with a 6-cm infrarenal AAA. After obtaining a pneumoperitoneum, a modified fish retractor was used to exclude the bowel. Ten 11-mm ports provided access to laparoscopically dissect the neck of the aneurysm and the iliac vessels. Then, a 10-cm minilaparotomy was performed and standard vascular clamps were inserted via the port incisions. Standard aneurysmorraphy was performed with a polytetrafluoroethylene (PTFE) tube graft. Laparoscopy conferred three major benefits: better visualization of the aneurysm neck, less bowel manipulation, and avoidance of hypothermia. This case report illustrates the feasibility of laparoscopic-assisted aneurysm repair. Controlled human studies will define the role of laparoscopy in AAA surgery.

Aortic Aneurysm, Abdominal↗

A prospective longitudinal evaluation of pregnancy in the Marfan syndrome.

OBJECTIVE: We undertook a prospective evaluation of the outcomes of pregnancy, both maternal and fetal, and the long-term impact of pregnancy on Marfan syndrome in a series of consecutive, unselected patients. STUDY DESIGN: Forty-five pregnancies in 21 Marfan syndrome patients were prospectively observed in one institution between 1983 and 1992. During pregnancy, patients were monitored with serial echocardiograms and close attention to symptoms. Maternal and fetal outcomes were monitored with serial echocardiographic data were analyzed by least-squares regression. Eighteen of the patients were followed up for 15 months to 13 years after the completion of their last pregnancy for investigation of the long-term impact of pregnancy on the cardiovascular manifestations of Marfan syndrome. RESULTS: Aortic dissection occurred in two patients, both with increased risk for dissection established before pregnancy. The incidence of obstetric complications otherwise did not exceed that in the general population. Echocardiographic data demonstrated little to no change in aortic root diameter throughout pregnancy in most patients. Long-term follow-up showed no apparent worsening of cardiovascular status attributable to pregnancy in comparison with a group of 18 women with Marfan syndrome who were of similar age, had a similar degree of disease severity, and underwent no pregnancies. CONCLUSIONS: Patients with Marfan syndrome in whom cardiovascular involvement is minor and aortic root diameter is < 40 mm usually tolerate pregnancy well, with favorable maternal and fetal outcomes, and without subsequent evidence of aggravated aortic root dilatation over time.

Abortion, Spontaneous↗

Patient education for low back pain in general practice.

This comparative study of patient and general practitioner perceptions of patient education for low back pain (LBP) revealed significant differences in perspective. It suggests that although some general practitioners recognise the importance of patient education, they blame patients for its assumed failure as a management strategy. The patients in this study identified a range of reasons which explain their difficulties in following prevention advice which relate to not only limitations in themselves, but also to broader contextual factors over which they have little control. It is argued that both the inadequacy of current professional assumptions and the contextual factors that influence patients' prevention behaviours need to be acknowledged as a first step towards improving patient education for LBP in general practice.

Adult↗

General practitioner perceptions of low back pain patients.

General practitioners' perceptions of low back pain (LBP) patients were investigated through a series of in-depth semi-structured interviews, as part of a wider study which also investigated patient perceptions. An exhaustive analysis of the interview transcripts revealed six principal ways in which GPs distinguished between different patients as a means of deciding how to treat them. This differentiation, on the basis of patient characteristics, is the major focus for the resulting discussion and conclusions, and is used as a way of exploring more effective strategies for the future.

Attitude of Health Personnel↗

T-cell clonality in synovial fluid from rheumatoid joints before and after culture in interleukin-2.

T-cell receptor (TCR) gamma gene rearrangements which have been amplified in polymerase chain reactions (PCRs) and analysed by high resolution polyacrylamide gel electrophoresis have been used to investigate the clonal diversity of T-cells in joint effusions from 16 patients with rheumatoid arthritis, one with systemic lupus erythematosus and one with psoriatic arthropathy. Polyclonality was found in every case but an oligoclonal subset of dominant rearrangements was also demonstrated in all but the patient with psoriasis. Marked changes in the relative preponderance of the various clonotypes were observed in 29 of 48 paired tests from 12 cases before and after culture in media containing interleukin-2 (IL-2) showing that SF mononuclear cells cultured in vitro with IL-2 are not representative of those present in vivo.

Adult↗

Progression of aortic dilatation and the benefit of long-term beta-adrenergic blockade in Marfan's syndrome.

BACKGROUND: The aortic root enlarges progressively in Marfan's syndrome, and this enlargement is associated with aortic regurgitation and dissection. Long-term treatment with beta-adrenergic blockade, by reducing the impulse (i.e., the rate of pressure change in the aortic root) of left ventricular ejection and the heart rate, may protect the aortic root. METHODS: We conducted an open-label, randomized trial of propranolol in adolescent and adult patients with classic Marfan's syndrome (32 treated and 38 untreated [control] patients). Aortic-root dimensions and clinical end points (aortic regurgitation, aortic dissection, cardiovascular surgery, congestive heart failure, and death) were monitored for an average of 9.3 years in the control group and 10.7 years in the treatment group. All 70 patients were included in the analysis according to the intention-to-treat principle. RESULTS: The dose of propranolol was individualized; the mean (+/- SE) dose was 212 +/- 68 mg per day. The mean slope of the regression line for the aortic-root dimensions, which reflect the rate of dilatation, was significantly lower in the treatment group than in the control group (0.023 vs. 0.084 per year, P < 0.001). Clinical end points were reached in five patients in the treatment group and nine in the control group. The Kaplan-Meier survival curve for the treatment group differed significantly from that for the control group during the middle years of the trial and remained better for the treatment group throughout the study. CONCLUSIONS: Prophylactic beta-adrenergic blockade is effective in slowing the rate of aortic dilatation and reducing the development of aortic complications in some patients with Marfan's syndrome.

Adolescent↗

Molecular cloning of the human mucosal lymphocyte integrin alpha E subunit. Unusual structure and restricted RNA distribution.

The human mucosal lymphocyte-1 (HML-1) antigen is expressed on a subclass of T-lymphocytes known as intra-epithelial lymphocytes which are located between mucosal epithelial cells. The HML-1 complex is known to mediate adhesion of intra-epithelial T-lymphocytes to epithelial cell monolayers in vitro. We and others have shown that the HML-1 antigen is an integrin composed of the beta 7 subunit in association with a novel alpha subunit, alpha E. Here we report the cloning of the alpha E cDNA and its primary amino acid sequence. alpha E contained an inserted or I domain and was more homologous to the other I domain containing integrins than to the cleaved group of integrin alpha subunits. However, alpha E contained a unique extra domain of 55 amino acids located just NH2-terminal to the I domain without counterpart in other integrins. This extra domain contained a stretch of 18 consecutive charged residues and included a proteolytic cleavage site. Thus alpha E is the only I domain containing integrin alpha subunit that is also cleaved, and the cleavage site is distinct from that of members of the cleaved group of integrin alpha subunits. These structural features mark alpha E as an unusual member of the integrin family. High levels of alpha E and beta 7 mRNA were restricted to mucosal lymphocytes supporting the hypothesis that alpha E beta 7 plays a role in the localization or site-specific functions of intra-epithelial T-lymphocytes.

Amino Acid Sequence↗

Effects of hormone replacement therapy in rheumatoid arthritis: a double blind placebo-controlled study.

AIMS: To study the effects of ovarian hormone replacement therapy (HRT) on bone mineral density and disease activity in postmenopausal women with rheumatoid arthritis (RA). METHOD: A placebo controlled double-blind study was carried out on 62 patients with RA, 22 on placebo and 40 on HRT (transdermal oestradiol patches twice weekly for 48 weeks plus norithisterone tablets when clinically indicated). Bone mineral density of spine, hip and wrist was measured at 0 and 48 weeks and clinical and laboratory measures of general well-being and disease activity at 0, 12, 24 and 48 weeks. RESULTS: Thirteen of 22 (59%) of placebo and 31 of 40 (78%) of the HRT group completed 48 weeks in the study. At entry, bone mineral density (BMD) values in the lumbar spine and femoral neck were similar to those in age and sex matched controls in both treatment groups, whereas at the distal radius, BMD was significantly reduced to approximately 50% of control values (both p < 0.001 from controls). In the HRT group, spine BMD increased significantly by a median of +0.94% at 48 weeks (p = 0.024), but did not change significantly in the placebo group. BMD at the femoral neck and distal radius did not change in either group. In the HRT group, there was significant improvement in well being as assessed by the Nottingham Health Care Profile (p < 0.01) and in the articular index (p < 0.05). There were no significant changes in ESR or CRP in either group. CONCLUSION: Transdermal HRT was well tolerated, increased well being, reduced articular index and increased lumbar spine bone density over a one year period in postmenopausal women with RA. Although no laboratory evidence was found of a disease modifying effect, the symptomatic benefits and improvements in bone density indicate that HRT may be a valuable adjunct to conventional antirheumatic therapy in RA.

Activities of Daily Living↗

Angular homeostasis. IX. Polygonal orbits with a moving target: implications for anomalous numbers of digits in congenital heart disease.

This paper explores properties of discrete processes in which a pursuer seeks a target that is moving at constant velocity r that is a fixed proportion of the speed of the pursuer. The pursuer is subjected to proportional angular homeostasis, so chosen that the number of steps per circuit is small. The orbits relative to the target may assume any of four forms: polygons that reverse their sense an infinite number of times; or polygons that after a finite number of reversals ultimately come to have an integer numbers of sides; or have a rational numbers of sides; or have an irrational number of sides that densely fill an annulus. None of the polygons is regular. In the parameter space, the boundary line between the first of these sets and the other three has a somewhat bizarre pattern and may possibly be fractal, but no proof is forthcoming. Unlike the pattern with a stationary target, there may be a set or catchment of diverse values of the speed ratio, r, and the correction coefficient, b that all result in figures of some specified number, n, of sides (although with vertices in differing locations). Catchments have been found for only those polygons that have the winding number of 1. The implications are discussed that this property has for the genetic coding of biological traits that are countable. Some attention is also paid to the relevance of polygons with few sides to ontogenic growth when the correction coefficient is cyclically arc- or time-dependent.

Abnormalities, Multiple↗

The spectrum of disease associated with a positive ANCA.

This is a retrospective analysis of all patients with a raised titre of ANCA in a single centre over a two-year period. Sixty-five patients were identified and clinical data is presented for 58 of these-34 male and 24 female. The median age is 56 years (13-83). Fourteen patients had Wegener's granulomatosis, 14 microscopic polyarteritis nodosa and 30 had other diagnoses. The patients with unexpectedly positive results are discussed in detail. This study confirms the sensitivity of ANCA in Wegener's granulomatosis and microscopic polyarteritis nodosa but suggests that the test is not as specific as initially claimed.

Adult↗