Biomedical subjects
Publications and source records attributed to G E Murphy.
An iris suture is sometimes indicated for additional fixation of a Shearing posterior chamber lens. This suture may be placed after prolapsing the superior J-loop through the iridectomy and limbal incision, thus allowing direct visualization while working safely away from the posterior capsule. Possible indications and contraindications for this technique are discussed.
There is considerable risk of marked endothelial cell loss associated with insertion of an intraocular implant into an eye which has shown a tendency to anterior chamber collapse or shallowing during manipulation of the cataract section. A technique of bridging the anterior chamber for safe insertion of a J-loop posterior chamber lens is described.
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Sterile corneal ulcerations and perforations associated with Sjögren's syndrome affected 18 eyes in 14 patients. Seven of the 18 eyes were perforated on presentation. Nine of the 18 eyes had received topical steroid treatment prior to referral. Two of the eyes had undergone recent anterior segment surgery and suffered perforated corneas postoperatively while receiving topical steroid treatment. All 14 patients had successful management of their corneal ulceration or management of their corneal ulceration or perforation (reepithelialization of the corneal defect, restoration or maintenance of the anterior chamber, and stromal scarring with visual acuity equal to or better than on presentation). Two of the 18 eyes had sterile infiltrated ulcers. We believe that this type of ulcer responds less predictably to therapy than the noninfiltrated lesions.
Following the demonstration by Solomon and Hellon that in the past 30 years, successive birth cohorts in Alberta, Canada, carry successively higher suicide risks as they age, we examined data by birth cohort in the Vital Statistics of the United States by race and sex over a similar period. We found the same phenomenon, in reduced magnitude, in birth cohorts of much greater size. Not only does each successive birth cohort start with a higher suicide rate, at each successive five-year interval it has a higher rate than the preceding cohort had at that age. The regularity of this phenomenon over the past 25 years in the United States implies continually rising suicide rates in these birth cohorts. It suggests that whatever the cause of this effect, it is early and lasting. Birth cohort analysis appears to offer an important new tool for studying suicide. Its implications have only begun to be examined.
We earlier reported that nearly one third of a consecutive series of 31 alcoholics who committed suicide had experienced loss of a close interpersonal relationship within six weeks or less of their death. In a replication study of 50 additional unselected alcoholic suicides, we found that 26% had experienced such loss within six weeks. As before, the distribution of such events was strikingly and significantly skewed toward the final weeks of the subject's life. This powerful confirmation gives added significance to such loss as a predictor of suicide among alcoholics.
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A series of individuals who committed suicide by overdose of medication was matched for age, sex, and marital status with individuals who committed suicide by other means in the same time period. Somewhat more of those who died by overdose had been under the recent care of a physician (91% versus 71%). Over half of those who died by overdose had received a prescription within a week or less before dying or had an unlimited prescription for a fully lethal amount of the hypnotic substance ingested. Individuals receiving smaller prescriptions (less than a total of 1.5 g secobarbital or the equivalent) either augmented this supply with other medications available or used something else entirely. Thus, in over half the cases, the physician supplied the complete means for suicide in a single prescription. The availability of a recently prescribed lethal amount of medication strikingly distinguished the ingesters from the noningester controls.
Forty-nine out of 60 persons who committed suicide had been under the care of 71 physicians within 6 months or less before committing suicide. Over two thirds of the patients had histories of suicide attempts or threats. These histories were known to only two fifths of the physicians responsible for their care, despite the information being readily available from other sources. There was substantial evidence of depressive illness in three quarters of the patients, yet the diagnosis was rarely made except by psychiatrists, and therefore the depression was rarely treated. Although a few patients had been recognized as representing suicidal risk, the great majority had not. The failure to diagnose and to treat depressive illness and the failure to be informed about the risk factors in these cases represent missed opportunities for preventive intervention.
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Explore the source record for details and available documents.
Rabbits fed a lipid-rich, cholesterol-poor diet and given concomitant injections of foreign protein, over a period as long as 17 months, developed in their coronary arteries both a) proliferative fibromuscular intimal thickening closely resembling the diffuse intimal thickening that commonly occurs in coronary arteries of man, and b) fatty-proliferative fibromuscular intimal thickening that closely resembles coronary atherosclerosis in man. In contrast, rabbits of another group that were concurrently fed the same diet for as long as 22 months without injections of foreign protein developed changes in arteries of their hearts that resemble neither coronary atherosclerosis nor diffuse intimal thickening in man. Fatty-proliferative changes in aortas of the first group of rabbits are strikingly greater and more closely resemble human aortic atherosclerosis than those in the latter group. In the course of the experiments, the average serum cholesterol was not significantly different in the two groups of rabbits. It was approximately 200 to 250 mg%, which is the average serum cholesterol in adult humans in the United States. These experiments support the hypothesis that the synergy of arterial injury, in particular immunologic injury, and a diet rich in lipid can lead to atherosclerosis in man.
Clinicopathologic evidence suggests that diffuse intimal thickening, a type of arteriosclerosis without manifest lipid deposit, may predispose to later developing atherosclerosis in man. This hypothesis was tested in the following experiments. Injury to coronary arteries of rabbits was induced by immunologic means, and arterial lesions were allowed to heal for many weeks. One group of animals was then sacrificed, and in their coronary arteries were found numerous fibromuscular intimal lesions closely resembling diffuse intimal thickening in man. The remaining rabbits were fed a cholesterol-supplemented diet for 80 days and then sacrificed. Fibromuscular intimal lesions of coronary arteries were found in these rabbits also. However, approximately two-thirds of these lesions were found to contain lipid, and many closely resembled coronary atherosclerosis in man. Further analysis of the data indicates that the atherosclerotic lesions in the rabbits evolved from immunologically induced fibromuscular intimal lesions which later and preferentially accumulated lipid in the presence of hypercholesterolemia. Results of these experiments suggest that in man fibromuscular intimal lesions, and in particular diffuse intimal thickening, acquired earlier in life can later accumulate lipid preferentially and thus redispose to atherosclerosis.