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Biomedical subjects

J B Murphy

Publications and source records attributed to J B Murphy.

At least 37 records · Page 2Linked to original sources
PubMed1991

Liver transplantation in the United States: 1988 to 1990.

Between 1988 and 1990, the frequency of liver transplantation in the United States increased by 57%. During this same period, the number of transplant centers performing this procedure increased from 58 to 80. Despite this increase, only 15 centers reported a total of at least 100 procedures during these 3 years, compared to 25 centers that performed 12 or less liver transplantations. Recipient characteristics have been changing over time: a larger proportion of recipients were males in 1990 than in 1988 or 1989. The distribution of recipients changed dramatically; the median age increased by 4 years, due to an increased proportion of transplantations among those age 40 and older and a decrease in children younger then age 10. Another major change was in functional status; in 1988 and 1989, over half of the recipients were hospitalized while awaiting transplantation, but this was reversed in 1990, when the majority of patients was at home awaiting transplantation. Furthermore, the proportion of patients in the highest functional class more than tripled. Alcoholic liver disease, which in 1989 became the most common primary liver disease of patients undergoing liver transplantation, continues to be the indication for an increasing number of recipients. The proportion of recipients with biliary atresia and primary biliary cirrhosis, the most common diagnoses in 1988, continues to decrease. Most of the mortality was noted in the first 6 months, when overall cumulative patient mortality was about 20%, half of which occurred in the first 4 weeks after OLTX. The cumulative 3-year posttransplant survival rate was 67%. Similarly, cumulative retransplant-free survival rates were 84% at 1 month and 58% at 3 years. As previously described (1), recipient factors associated with survival included age, UNOS description, diagnosis, and ABO matching. Older recipients, those with poorer functional status at time of transplantation, recipients with either fulminant liver failure or malignancies, and those who received a graft from an ABO-compatible or -incompatible donor, had the worst survival rates. Furthermore, in the current analysis we found that the outcome of recipients was affected adversely by grafts from female donors. Racial differences were noted, but the large quantity of missing data precluded definitive statements regarding any association with survival. Both recipient and donor ages were significant prognostic factors. For adults in the multivariate model, increasing recipient age was associated with higher mortality. Among children, however, younger donor age seemed to have an adverse effect on recipient survival. Donor characteristics also changed during this period.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1991

The post-operative care of the older patient: the geriatric and rehabilitation perspective.

As the population of our nation and our state grows older operative procedures will be performed at increasing rates on older patients. Unique aspects of older persons and the conditions with which they are afflicted place them at high risk for loss of function, medical complications, and surgical complications in the perioperative period. Only by conducting comprehensive preoperative assessments, establishing appropriate goals, maintaining meticulous perioperative care and beginning rehabilitation early will it be possible to reduce these risks and maximize the functional outcome for the older surgical patient.

Activities of Daily Living↗
PubMed1991

Older Rhode Islanders: demography, health status and the implications for the practice of medicine.

There is a large and growing elderly population in Rhode Island and that population is getting older. Rhode Island's elders are maldistributed geographically and represent a larger proportion of the population than nationally. Most have significant chronic conditions and many have major limitations in functional abilities. Relatively few reside in long-term care facilities and generally, the community-dwelling population rates their health favorably. The elderly in Rhode Island make more physician visits than any other segment of the population and account for a disproportionate number of hospital and nursing home days. The number of primary care physicians practicing adult medicine in Rhode Island has diminished and if the trends of graduating medical students continue, further decreases are to be expected. The costs of health care for the elderly in Rhode Island have skyrocketed over the last 20 years, and are projected to continue to increase dramatically over the next 40-50 years in part as a result in the growth of the state's elderly population. These cost increases will be magnified if health care costs in general continue to outpace other segments of our economy. If Rhode Island is to adequately meet the health care needs of older Rhode Islanders over the next 40-50 years, major changes must occur. Initiatives to prevent or forestall the onset of chronic illnesses and resultant functional limitations are likely to improve the quality of life of older Rhode Islanders as well as positively influence the costs of health care for this segment of our state's population.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1990

Liver transplantation in the United States: 1988 to 1989.

Orthotopic liver transplantation was performed more often in 1989 than in 1988. This procedure was performed at 57 institutions in 1988 and at 64 in 1989. Among the 53 institutions in which OLTX was performed in both years, the tendency was to increase volume. Volume in 1988 was not an indicator for volume increase or decrease in the next year. For example, about 60% of the centers which performed 5-9 OLTXs in 1988 had a greater volume in 1989. This was similar to the percentage among centers which performed 30-49 OLTXs in 1988. Only centers which performed at least 100 OLTXs in 1988 increased in volume uniformly (3 centers). There was about a 25% increase in the number of OLTX recipients, and the characteristics of the recipient population changed. In 1989, as compared to 1988, there was a larger proportion of recipients over age 40 with a concomitant proportionate decrease in pediatric recipients. Indications for OLTX were also different. In 1988, biliary atresia and primary biliary cirrhosis were the major diagnoses for which OLTX was performed. In 1989, however, alcoholic cirrhosis was the most prevalent diagnosis among OLTX recipients, accounting for more than 1 of every 7 procedures. We also found that the distribution of UNOS description changed. Significantly more recipients were classified in the best functional group, and significantly more recipients were on life support in 1989 compared to 1988. Whether this reflects a change in the actual functional status of recipients, or change in the management of these patients, is a topic for further research.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Aspiration associated with long-term gastric versus jejunal feeding: a critical analysis of the literature.

Neurogenic oropharyngeal dysphagia (NOD), common among rehabilitation populations, is a risk factor for aspiration. A history of recurrent aspiration is an indication for gastric feedings according to some physicians, although according to others it is a contraindication to gastric feedings and an indication for jejunal feedings. In light of these divergent opinions, the literature from 1978 to 1989 on aspiration in patients with severe NOD was examined to determine whether empiric evidence supports the preferential use of a gastric or a jejunal feeding site. The data reviewed did not support the preferential use of either feeding site. Forty-five studies met inclusion criteria. Two studies compared aspiration rates in patients receiving gastric feedings to those receiving jejunal feedings. Another study reported complications with gastric and jejunal feedings but did not compare the two feeding groups. Forty-two studies evaluated either gastric (36) or jejunal (6) feedings. The relative risks of aspiration associated with gastric and jejunal feedings could not be determined reliably because of heterogenous and inadequately described patient populations, poorly described data collection methods, nonoperational definitions of aspiration, small sample sizes, and unspecified time frames, feeding protocols, and care settings. Few data about long-term jejunal feeding, extremely variable data on the risk of aspiration during long-term gastric feeding, and much variation in clinical practice support a need for further research designed to determine the proper role for gastric and jejunal feeding. Recommendations for research and the role of the rehabilitation team in determining the best enterostomy site are suggested.

Deglutition Disorders↗
PubMed1989

The use of stabilization plates in the immediate repair of defects following mandibular resection.

The results of immediate stabilization for surgical defects of the mandible in 18 patients are presented. Fourteen patients with malignant lesions underwent immediate stabilization without bone grafting, but with associated myocutaneous flap soft tissue reconstruction. Four patients with benign lesions were treated with immediate stabilization and bone graft reconstruction, but without myocutaneous flap soft tissue reconstruction. Results at from 4 to 34 months reveal two bone plates lost to massive intraoral exposure. The remaining plates remain in place with excellent functional and cosmetic results.

Bone Plates↗
PubMed1989

Salvage of jeopardized total-knee prosthesis: the role of the gastrocnemius muscle flap.

Total-knee arthroplasty has provided many patients with excellent long-term functional results. However, exposure of a total-knee replacement usually eventuates in failure. The relatively superficial location of the prosthesis, the need for early active motion, previous surgical incisions, and a variety of systemic factors may militate against early wound healing. Restoration of well-vascularized soft-tissue cover can salvage an otherwise disastrous situation. The authors recommend early operative intervention upon observation of wound breakdown, devitalized skin edges, or significant subcutaneous infection leading to necrotic overlying skin. The operative procedure found to salvage the majority of prostheses consists of adequate debridement, antibiotic irrigation (of the joint, if exposed), and coverage with a well-vascularized muscle flap, preferably the medial gastrocnemius muscle. The operative technique and ultimate long-term outcome are reviewed based on experience with 10 consecutive patients presenting with a jeopardized knee prosthesis. Follow-up ranged from 1 to 6 years. Representative case histories are presented.

Adult↗
PubMed1989

Pitt-UNOS Liver Transplant Registry.

The Pitt-UNOS Liver Transplant Registry maintains a computerized database of all orthotopic liver transplantations (OLTX) performed in the United States since October 1, 1987. Recipient data, which are collected at the time of transplantation and at specified follow-up time periods, are reported to the Registry directly, while donor data are transmitted through UNOS Central. During the first year of registration (October 1, 1987 through September 30, 1988), 1,561 liver transplantations were performed on 1,377 patients; 146 patients received 2 livers and another 19 patients received 3 livers. There were 29 multiorgan transplants, including 18 liver/kidney, 7 liver/pancreas, 1 liver/small bowel, 2 liver/kidney/heart, and 1 liver/kidney/pancreas. Among the 52 centers reporting at least 1 liver transplant during this time period, 34 (65%) performed less than 20 procedures and only 7 (13%) performed at least 50 transplantations. Sixty-three percent of the donors were male; 63% were less than 25 years of age and in 72% the cause of death was motor vehicle accidents, gunshot wounds, or cerebrovascular accidents. Recipients were older than donors, 37% above age 45. About 25% of the recipients required intensive care or life support. The majority suffered from cirrhosis of cholestatic, autoimmune, viral, alcoholic, or unspecified etiology. The 6-month cumulative survival following OLTX was 76%, and the 6-month retransplant-free survival rate was 69%. Survival rates at 1 year were 72% and 64%, respectively. Factors associated with patient survival were diagnosis of liver disease and work (UNOS) status. Patients with fulminant liver failure or malignancies had the poorest survival, and patients with cholestatic cirrhosis or other cirrhosis had the best.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Geriatric psychiatry manpower--seven services in Scotland.

The method of calculating district psychiatric manpower described by Watson was applied to seven geriatric psychiatry services in Scotland serving a population of 1,445,000 including 209,600 individuals over the age of 65 years of age. The overall medical staffing of these services was only 63.6% of the estimated requirement and when individual consultants were considered only 62% of the necessary time was available. If it is assumed that half of the extra medical time should be provided by consultants, then 3.2 consultant WTEs will be needed for geriatric psychiatry for a population of 200,000 with 30,000 elderly people. If there was no change in the proportion of medical work provided by consultants, the figure would be 2.9 consultant WTEs per 30,000 population aged over 65 years. Extra supporting staff are also required to meet the requirements of the Watson formula.

Aged↗
PubMed1988

Arteriovenous malformation of the maxillary sinus: an unusual clinical presentation.

Arteriovenous (AV) malformation is a rare vascular lesion of the jaws with a benign clinical presentation. As a result, AV malformation may be excluded from a presurgical differential diagnosis, with catastrophic results. Review of the pertinent literature showed no documentation of AV malformation in the maxillary sinus, and therefore we present the case of a 43-year-old white man with a history of blunt trauma to the paranasal region, whose differential diagnosis included a vascular lesion.

Adult↗
PubMed1987

Investigation of the role of individual tryptophan residues in the binding of Escherichia coli single-stranded DNA binding protein to single-stranded polynucleotides. A study by optical detection of magnetic resonance and site-selected mutagenesis.

Fluorescence and optical detection of triplet state magnetic resonance (ODMR) spectroscopy have been employed to study the complexes formed between single-stranded polynucleotides and Escherichia coli ssb gene products (SSB) in which tryptophans 40, 54, and 88 are selectively, one residue at a time, replaced by phenylalanine using site-specific oligonucleotide mutagenesis. Fluorescence titrations and ODMR results indicate that tryptophans 40 and 54 are the only tryptophan residues in E. coli single-stranded DNA binding protein that are involved in stabilizing the protein-nucleic acid complexes via stacking interactions. Wavelength-selected ODMR measurements on E. coli SSB reveal the presence of two spectrally distinct tryptophan sites (Khamis, M. I., Casas-Finet, J. R., and Maki, A. H. (1987) J. Biol. Chem. 262, 1725-1733). Our present results indicate that tryptophan 54 belongs to the blue-shifted site, while tryptophan 40 belongs to the red-shifted site of the protein.

Amino Acid Sequence↗
PubMed1987

Role of tryptophan 54 in the binding of E. coli single-stranded DNA-binding protein to single-stranded polynucleotides.

Fluorescence and optical detection of triplet state magnetic resonance spectroscopy have been employed to study the complexes formed by single-stranded polynucleotides with both E. coli single-stranded DNA-binding protein and an E. coli ssb gene product in which Trp-54 is replaced by phenylalanine using site specific oligonucleotide mutagenesis. Our results strongly suggest the involvement of Trp-54 in stabilizing the protein-nucleic acid complexes via stacking interactions of the aromatic residue with the nucleotide bases.

DNA-Binding Proteins↗
PubMed1987

The hierarchical relationship between activities of daily living and instrumental activities of daily living.

A three-level hierarchical scale including IADL (shopping and transportation) and ADL (bathing, dressing, transferring, and feeding) was tested and validated based on secondary analysis of three studies of elders in the community: a population-based sample, the Cleveland-GAO, and two service-based samples, the Alternative Health Services Project, a study of Medicaid-eligible elders in Georgia, and the Section 222 Homemaker-Day Care study, a sample of Medicare-eligible elders. Scalability analysis included evaluation of Kronbach's alpha, Guttman analysis, and analysis of the pairwise association of individual items using phi/phi max. Validation included discriminant validity and predictive validity. With respect to discriminant validity, the negative association between functional ability (as measured by the scale) and age was observed. With respect to predictive validity, the negative relationship between functional ability (as measured by the scale) and risk of decline to ADL, death, and hospitalization in a year was observed. A six-level scale similar in structure and detail to the Katz Index of ADL was examined with the three studies. This scale can be used to described a broader range of needs of elders in the community and will be particularly useful to health services planners, practitioners, and researchers.

Activities of Daily Living↗
PubMed1987

Triplet state sublevel kinetics of tryptophan 54 in the complex of Escherichia coli single-stranded DNA binding protein with single-stranded poly(deoxythymidylic) acid.

The individual sublevel kinetics of the lowest triplet state of tryptophan 54 (Trp 54) which is highly perturbed in the complex of Escherichia coli single-stranded DNA binding protein (Eco SSB) with poly(deoxythymidylic) acid (poly[dT]) have been studied by optically detected magnetic resonance (ODMR) spectroscopy. The triplet sublevel decay constants of Trp 54, kx, ky, kz, are 0.99, 0.072, and 0.045 s-1, respectively, in the poly(dT) complex of a point-mutated Eco SSB in which Trp 88 is substituted by phenylalanine. Tx is the only radiative triplet sublevel. Negative polarity of the Tx----Tz and Tx----Ty phosphorescence-detected ODMR signals results from the steady state population pattern, nx greater than ny, nz, and implies that the relations, px greater than or equal to 14py, and px greater than or equal to 22pz exist for the relative populating rates. Spin-orbit coupling between radiative singlet states and the Tx sublevel of the lowest triplet state of Trp 54 is enhanced selectively upon complexing of Eco SSB with poly(dT).

DNA-Binding Proteins↗