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Biomedical subjects

J F Murray

Publications and source records attributed to J F Murray.

At least 19 recordsLinked to original sources
PubMed1992

Pulmonary edema associated with salt water near-drowning: new insights.

In this case report we describe the clinical and laboratory findings of a man who nearly drowned after aspirating a large quantity of seawater. The aspiration of salt water, which is strongly hypertonic with respect to plasma, resulted in severe pulmonary edema, both from the quantity of aspirated seawater and the osmotically driven ultrafiltrate of plasma that accumulated in the air spaces. The initial concentration of protein in the edema fluid sample was very low, 0.7 g/dl, consistent with only a minimal increase in epithelial permeability. Approximately 4 h later, there was a marked increase in the concentration of protein in the residual alveolar fluid associated with improvement in several clinical indices, indicating that the excess alveolar fluid was reabsorbed very rapidly. In addition, the magnesium concentration was markedly elevated because of the aspiration of magnesium-containing seawater, which may have diagnostic importance for near-drowning in salt water. The data from this case provide evidence for well-preserved alveolar epithelial barrier function after aspiration of large quantities of hypertonic salt water.

Animals↗
PubMed1992

Toward a synthetic approach to the Rorschach: the case of a psychotic child.

Much Rorschach research on case material focuses on the utility of a single scoring system, set of variables, or scale in isolation from other systems, scales, or perspectives. This approach fails to acknowledge the complexity of the Rorschach and to reflect the manner in which sophisticated clinicians select and synthesize various perspectives during the clinical inference and decision-making process. A case of a psychotic child is presented to illustrate the utility of a synthetic approach to the Rorschach. The strengths and weaknesses of various Rorschach perspectives in addressing specific diagnostic issues is explored through the case material.

Aggression↗
PubMed1992

Can NBME scores distinguish students who choose a practice-based clerkship?

The National Board of Medical Examiners (NBME) examination Part II scores of students taking a two- to three-month community practice-based third-year family practice clerkship were compared with the scores of comparison students who had been matched on the basis of NBME Part I results. No significant differences between groups were seen for the total score or the scores in medicine or surgery. Significantly higher scores were seen for the clerkship students in the public health section. Significantly lower scores were obtained by this group on the psychiatry section, probably since many of the clerkship students did not take the regular psychiatry clerkship prior to taking the NBME Part II examination. No significant changes were seen in the scores for medicine or surgery. The results for ob/gyn and pediatrics were inconsistent. Taking this community practice-based clerkship appears to provide an equivalent amount of cognitive information.

Clinical Clerkship↗
PubMed1991

Internal neurolysis fails to improve the results of primary carpal tunnel decompression.

This prospective, randomized study compares two treatment methods in patients with primary carpal tunnel syndrome. Decompression of the transverse carpal ligament was done in thirty-two hands (thirty patients) and decompression of the transverse carpal ligament with the addition of an internal neurolysis of the median nerve was done in thirty-one hands (twenty-nine patients). Relief of symptoms was described in eighty-eight percent of the patients with carpal ligament release and eighty-one percent of patients with carpal ligament release plus internal neurolysis. Improvement in hand sensibility testing, in thenar muscle strength, and atrophy was noted in both treatment groups with no statistical difference between groups. The addition of an internal neurolysis to division of the transverse carpal ligament does not add significant improvement in the sensory or motor outcome of patients with primary carpal tunnel syndrome.

Carpal Tunnel Syndrome↗
PubMed1991

An emerging global programme against tuberculosis: agenda for research, including the impact of HIV infection.

During the last 5 years, a worldwide resurgence of tuberculosis has been convincingly documented. Increased numbers of cases have been reported from several industrialized countries and there has been a veritable explosion of tuberculosis in the developing countries of sub-Saharan Africa. The fact that most of this increase is attributable to coexisting infection with the human immunodeficiency virus (HIV) should come as no surprise, because of the role played by cell-mediated immunity in protecting against tuberculosis and the depletion of this immunity by HIV infection. The World Health Organization estimates that there are more than 3 million persons in the world dually infected with HIV and tubercle bacilli. To combat this problem, there needs to be an expansion of programmes designed to identify and treat all patients with tuberculosis, whether HIV infected or not. In addition, the prospects for further advances in basic research, clinical research, epidemiological research and operations research, which have broad application to clinical medicine, are great, and these results will help combat the dual scourges of HIV infection and tuberculosis.

Global Health↗
PubMed1991

Tuberculosis and human immunodeficiency virus infection during the 1990's.

Among the many infectious complications of infection with human immunodeficiency virus (HIV), tuberculosis is now recognized as one of the most important. Coexisting HIV infection is believed responsible for the soaring incidence of tuberculosis in Africa, and for the increase in the number of reported cases in the United States. As HIV-induced immunosuppression worsens, tuberculosis may supervene by reactivation of remotely acquired infection or failure to defend against newly acquired Mycobacterium tuberculosis. Both mechanisms undoubtedly occur in Africa where the rate of exposure is high; the former prevails in the United States. The risk of tuberculous infection progressing to tuberculous disease is about six times higher in HIV seropositive than seronegative persons. Although not incontrovertibly established, tuberculosis probably also has a deleterious effect on coexisting HIV infection, either by accelerating the rate of destruction of CD4+ lymphocytes and/or promoting the release of new virions from HIV-infected macrophages. Tuberculosis, whether HIV-linked or not, can be controlled by the traditional means of case-finding and treatment, vaccination with BCG, and chemoprophylaxis. HIV infection can be controlled by eliminating high-risk behavior, and using uncontaminated blood and other medical supplies. An extensive campaign is needed to prevent further spread of these dual scourges that are overwhelming already meager health resources in many parts of the world.

Africa↗
PubMed1991

[A cursed duo: HIV infection and tuberculosis].

Tuberculosis remains a health problem of extraordinary magnitude, especially in developing countries. Unfortunately, many of the same countries have the additional burden of a remarkably high prevalence of HIV infection. Because of the inherent capacity of tubercle bacilli to take advantage of deficiencies in cell-mediated immunity, tuberculosis has become an extremely important infectious complication of HIV disease in those developing countries in which the two infections coexist; the same is true, although to a lesser extent, in developed countries among those groups of patients with HIV infection, in which there is also a high prevalence of remotely acquired tuberculosis.

Africa↗
PubMed1990

Cursed duet: HIV infection and tuberculosis.

Tuberculosis remains a health problem of extraordinary magnitude, especially in developing countries. Unfortunately, many of the same countries have the additional burden of a remarkably high prevalence of HIV infection. Because of the inherent capacity of tubercle bacilli to take advantage of deficiencies in cell-mediated immunity, tuberculosis has become an extremely important infectious complication of HIV disease in those developing countries in which the two infections coexist; the same is true, although to a lesser extent, in developed countries among those groups of patients with HIV infection in which there is also a high prevalence of remotely acquired tuberculosis. Prof. Chrétien helped call attention to the link between tuberculosis and HIV infection in France. Now, it is obvious that his cogent observations extend to much of the rest of the world.

HIV Infections↗
PubMed1990

Plasma tumor necrosis factor in patients with septic shock. Mortality rate, incidence of adult respiratory distress syndrome, and effects of methylprednisolone administration.

We assayed serial plasma samples from 86 patients, who were enrolled in a prospective randomized trial of the effects of methylprednisolone (MPSS) in septic shock, for the presence of cytokine tumor necrosis factor (TNF) using an enzyme-linked immunosorbent assay. TNF was present in the plasma of 27 of the 74 patients with septic shock, but in only 1 of the 12 patients with shock due to other causes. TNF was detected with equal frequency in patients with shock from gram-negative or from gram-positive bacillary sepsis. TNF levels were highest on the initial sample and decreased significantly over the subsequent 24 h in both the patients treated with MPSS and in those given placebo. Patients with detectable TNF had a higher incidence and severity of the adult respiratory distress syndrome and a higher mortality rate than did patients without detectable TNF.

Humans↗
PubMed1990

Effects of aerosolized artificial surfactant on repeated oleic acid injury in sheep.

We studied the effects of an artificial surfactant, Exosurf, administered as an aerosol on respiratory system compliance (Crs), total respiratory resistance (RT), and gas exchange (PO2) in anesthetized, paralyzed sheep with oleic acid (OA)-induced lung injury. Paired experiments with OA were performed in 10 sheep, 5 of which received Exosurf in the first experiment and aerosolized 0.9% NaCl in the second; in the other 5 sheep the order of Exosurf and NaCl was reversed. Paired experiments without OA were performed in 6 additional sheep that served as controls. In the first set of experiments, OA caused significant abnormalities, compared to control and baseline values (p less than 0.02), in Crs, RT, and PO2; there was no difference between animals that received Exosurf and those that received NaCl. Baseline values for PO2 and Crs during the second set of experiments with OA were lower than controls (p less than 0.002), indicating that the animals had not fully recovered from their initial injury. After OA, the animals that received NaCl (i.e., the ones that received Exosurf the first time) had higher PO2 and Crs values (p less than 0.01) than those that received NaCl first and Exosurf second. There was no difference in postmortem lung water content between the animals that received Exosurf or NaCl first, both of which were higher than control (p less than 0.01). Studies in 3 additional sheep showed peripheral deposition of aerosol. Thus, we failed to show an acutely beneficial effect of aerosolized Exosurf in OA-induced lung injury; Exosurf did, however, appear to provide protection against some of the consequences of repeated lung injury.

Aerosols↗
PubMed1990

Elevated von Willebrand factor antigen is an early plasma predictor of acute lung injury in nonpulmonary sepsis syndrome.

In this prospective study of 45 patients, we tested the hypothesis that markedly elevated levels of plasma von Willebrand antigen (vWf-Ag) a marker of endothelial cell injury, might predict the development of acute lung injury in patients with nonpulmonary sepsis syndrome. Acute lung injury was quantified on a four-point scoring system. At the time of entry into the study, none of the 45 patients had evidence of lung injury. Subsequently, 15 patients developed lung injury and 30 patients did not develop lung injury. The mean plasma vWf-Ag level was markedly elevated in the 15 patients who developed lung injury compared with the 30 patients who did not develop lung injury (588 +/- 204 vs. 338 +/- 196, percentage of control, P less than 0.01). Furthermore, a plasma vWf-Ag level greater than or equal to 450 was 87% sensitive and 77% specific for predicting the development of acute lung injury in the setting of nonpulmonary sepsis. In addition, the combination of a plasma vWf-Ag greater than 450 and nonpulmonary organ failure at the time of entry into the study had a positive predictive value of 80% for acute lung injury. Also, a plasma vWf-Ag level greater than 450 had a positive predictive value of 80% for identifying nonsurvivors. Thus, in patients with nonpulmonary sepsis, an elevated level of plasma vWf-Ag is a useful, early biochemical marker of endothelial injury and it has both predictive and prognostic value.

Acute Disease↗