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Biomedical subjects

J J Murray

Publications and source records attributed to J J Murray.

At least 109 records · Page 6Linked to original sources
PubMed1994

Biofeedback training is useful in fecal incontinence but disappointing in constipation.

BACKGROUND: Successful biofeedback therapy has been reported in the treatment of fecal incontinence and constipation. It is uncertain which groups of incontinent patients benefit from biofeedback, and our impression has been that biofeedback is more successful for incontinence than for constipation. PURPOSE: This study was designed to review the results of biofeedback therapy at the Lahey Clinic. METHODS: Biofeedback was performed using an eight-channel, water-perfused manometry system. Patients saw anal canal pressures as a color bar graph on a computer screen. Assessment after biofeedback was by manometry and by telephone interview with an independent researcher. RESULTS: Fifteen patients (13 women and 2 men) with incontinence underwent a mean of three (range, 1-7) biofeedback sessions. The cause was obstetric (four patients), postsurgical (five patients), and idiopathic (six patients). Complete resolution of symptoms was reported in four patients, considerable improvement in four patients, and some improvement in three patients. Manometry showed a mean increase of 15.3 (range, -3-30) mmHg in resting pressure and 35.7 (range, 13-57) mmHg in squeezing pressure after biofeedback. A successful outcome could not be predicted on the basis of cause, severity of incontinence, or initial manometry. Twelve patients (10 women and 2 men) with constipation underwent a mean of three (range, 1-14) biofeedback sessions. Each had manometric evidence of paradoxic nonrelaxing external sphincter or puborectalis muscle confirmed by defography or electromyography. All patients could be taught to relax their sphincter in response to bearing down. Despite this, only one patient reported resolution of symptoms, three patients had reduced straining, and three patients had some gain in insight. CONCLUSIONS: Biofeedback helped 73 percent of patients with fecal incontinence, and its use should be considered regardless of the cause or severity of incontinence or of results on initial manometry. In contrast, biofeedback directed at correcting paradoxic external sphincter contraction has been disappointing.

Adolescent↗
PubMed1994

Reperfusion enhances the local release of endothelin after regional myocardial ischemia.

The role of endothelin, a potent long-acting vasoconstrictor peptide, in the pathogenesis of the "no-reflow" phenomenon was investigated in nine closed-chest mongrel dogs undergoing 90 minutes of proximal left anterior descending artery occlusion and 3.5 hours of reperfusion. Endothelin levels were measured serially from the coronary sinus (CS) and aorta (Ao) by radioimmunoassay and correlated with regional myocardial blood perfusion. Prolonged anesthesia, surgery, and vascular instrumentation did not change endothelin levels in four sham animals. A progressive and parallel increase in CS and Ao endothelin levels occurred during coronary occlusion. A further increase in CS levels was observed during the reperfusion period, resulting in significantly higher values of the peptide at 30 and 60 minutes (30 minutes: CS 22.1 +/- 3.5 vs Ao 15.1 +/- 5.1 pg/ml; 60 minutes: CS 21.1 +/- 4.5 vs Ao 15.0 +/- 3.6 pg/ml; p < 0.05 by analysis of variance). Microvascular perfusion determined semiquantitatively with fluorescent beads was significantly reduced in the central ischemic zone (CIZ) compared with that in the nonischemic zone (NIZ) (CIZ endocardium 1.14 +/- 0.4 beads/m2, CIZ midmyocardium 1.19 +/- 0.3 beads/m2, NIZ 3.8 +/- 0.6 beads/m2; p < 0.05). A significant correlation was noted between mean reperfusion levels of endothelin in the CS and endocardial flow in the CIZ (r = -0.88; p = 0.009). This study demonstrates that reperfusion per se enhanced the spillover of endothelin from the cardiac interstitium. Local release of endothelin may contribute to the progressive decrease in microvascular flow in the reperfused bed.

Animals↗
PubMed1994

Factors that influence the setting characteristics of encapsulated glass ionomer cements.

The slow rate of the setting reaction of glass ionomer cements (GICs) is one of the problems associated with their clinical use. The manufacturers of these materials suggest that increasing the mixing time will increase the rate of reaction and it was the purpose of this study to investigate the limits of this relationship. The method used to monitor the setting reaction with Differential Thermal Analysis (DTA). The results obtained using DTA were compared with those obtained using the ISO penetrometer method as defined in the ISO standard for water-based cements, ISO 9917:1991E. It was shown that increasing the mixing time of cements did not significantly reduce the setting time (P > 0.05). Under the conditions of the study it was only possible to measure a working time for the Chemfil II (and then only if it was mixed for less than 12 s). Storing the capsules at 4 degrees C did enable a working time to be measured using the DTA for all the materials, however these storage conditions also produced a significant increase in the setting time which would be undesirable to the clinician. The penetrometer method underestimated the duration of the setting reaction by up to 32% compared with the DTA method. However it was a quick and reproducible method of measuring setting time and as such may still be an appropriate method for use in the ISO standards.

Cermet Cements↗
PubMed1994

The effect of children's dental anxiety on the behaviour of a dentist.

Two groups of children were given the Child Manifest Anxiety Scale to measure their general anxiety and the Venham Picture Scale to assess their dental anxiety. The experimental group consisted of children who had been referred with a specific problem of anxiety. The control group had been referred for dental problems other than anxiety. The two groups of children did not differ with respect to general anxiety but the experimental group showed significantly higher scores on the scale of dental anxiety, indicating that dentally anxious children are not always anxious in other situations. The children were treated by one dentist and, during treatment, the behaviour of the dentist was observed and measured using the Weinstein Dentist Behaviour Scale. It was found that the dentist changed his behaviour when dealing with anxious children and adopted some, but not all, of the anxiety management techniques that have been found in previous studies to reduce stress of dentally anxious children.

Adolescent↗
PubMed1994

Strategic planning in non-profits: profit from it.

Non-profit human service organizations, both public and private, face unique challenges and opportunities in the climate of the 1990s as human needs are increasing, funding is decreasing, and threats to organizational well-being are encountered. The purpose of this paper is to describe, advocate for, and illustrate a strategic planning model which facilitates a proactive, energizing, futuristic vision as services are being planned and delivered. Three case examples are used: a large state-run county social services department; a small, private, sectarian agency that provides group home services for the developmentally disabled; and a medium sized federal public health hospital.

Group Homes↗
PubMed1994

Leukotrienes as mediators of nasal inflammation.

The three sets of studies that we have described support the notion that leukotrienes play a role in the nasal inflammatory response to allergen challenge. Strong inhibition of both leukotrienes and symptoms by A-64077, a trend toward inhibition of both leukotrienes and symptoms by SC-45662, and a lack of effect on either leukotrienes or symptoms by dietary eicosapentaenoic acid provide a consistent association between alterations of leukotrienes and nasal symptoms. A great deal of evidence has now accumulated that leukotrienes are important mediators of inflammation in vivo, but we also know that the chronic stimulus of hay fever produces a much more complex picture than seen in an acute challenge model and that many other mediators such as kinins, other peptides, histamine, and eicosanoids produced outside the 5-lipoxygenase pathway are involved (34,35). Further clinical research will be needed to develop optimal dosing regimens and delivery systems to achieve high concentrations of potent and safe 5-lipoxygenase inhibitors at sites that are critical for producing clinically useful results by modulation of the 5-lipoxygenase pathway.

Arachidonate 5-Lipoxygenase↗
PubMed1994

Positive modulation of intracellular Ca2+ levels by adenosine A2b receptors, prostacyclin, and prostaglandin E1 via a cholera toxin-sensitive mechanism in human erythroleukemia cells.

Human erythroleukemia (HEL) cells express megakaryocyte/platelet membrane markers and thus have been used as a model for studying platelet membrane receptors and their coupling to cell signaling pathways. Our previous studies, however, indicated that platelets and HEL cells possess different subtypes of adenosine A2 receptors. Furthermore, we now report that, whereas adenosine inhibits intracellular Ca2+ increases in platelets, it potentiates the rise in intracellular Ca2+ produced by thrombin, prostaglandin E1, thapsigargin, and the calcium ionophore A23187 in HEL cells. Stable adenosine analogs potentiated intracellular Ca2+ increases with a rank order of potencies of 5'-N-ethylcarboxamidoadenosine (NECA) > (R)-(-)-N6-(2-phenylisopropyl)adenosine (R-PIA) >> CGS 21680, suggesting that this effect is mediated by A2b receptors. EC50 values for NECA and R-PIA were 0.8 and 42 microM, respectively. NECA (100 microM) potentiated by 2-3-fold the increase in intracellular Ca2+ produced by 0.3 unit/ml thrombin. This effect was mimicked by cholera toxin and was shared by other Gs-coupled receptors, such as those activated by the prostacyclin analog iloprost and prostaglandin E1, indicating the involvement of Gs proteins. Adenosine analogs also increased intracellular cAMP with the same rank order of potencies. The membrane-permeable analog 8-bromo-cAMP, however, had no effect on intracellular Ca2+ levels, indicating that the potentiation of intracellular Ca2+ increases and the activation of adenylate cyclase are parallel but independent events. The increase in intracellular Ca2+ produced by adenosine is due not to an increase in phosphoinositide hydrolysis but, rather, to an increase in calcium influx, and it is lost if cells are studied in the absence of extracellular Ca2+. We conclude, therefore, that adenosine A2b receptors in HEL cells are coupled to Gs proteins and their activation leads to stimulation of adenylate cyclase and, independently, to potentiation of the rise in intracellular Ca2+. We speculate that A2b receptors in HEL cells activate a calcium channel through a cholera toxin-sensitive mechanism that requires an initial increase in intracellular Ca2+.

Alprostadil↗
PubMed1994

The shortened dental arch: supplementary analyses from the 1988 adult dental health survey.

Information on 2297 dentate adults, aged 15-75+ years, who participated in the 1988 national survey of adult dental health in the United Kingdom, was reviewed in order to determine what proportion in each age group fulfilled the criteria for a 'shortened dental arch'. The proportion of people with four good quadrants was 90 per cent at 16-24 years falling to 2 per cent at 65-74 years. Overall, 54 per cent of the sample had four good quadrants. This is a more stringent measure of dental health than the proportion with 21 or more standing teeth, where the corresponding values were 100 per cent, 24 per cent and 80 per cent.

Adolescent↗
PubMed1993

The effect of inhibition of 5-lipoxygenase by zileuton in mild-to-moderate asthma.

OBJECTIVE: To evaluate the effectiveness of inhibiting the formation of the 5-lipoxygenase products of arachidonic acid by the 5-lipoxygenase inhibitor zileuton in the treatment of mild-to-moderate asthma. DESIGN: Randomized, double-blind, placebo-controlled study. SETTING: University hospitals and private allergy and pulmonary practices. PATIENTS: A total of 139 persons with asthma who had a forced expiratory volume in 1 second (FEV1) of 40% to 75% of the predicted value and who were not being treated with inhaled or oral steroids. INTERVENTION: Zileuton, 2.4 g/d or 1.6 g/d, or placebo for 4 weeks. MEASUREMENTS: Airway function, beta-agonist use, and symptoms; inhibition of 5-lipoxygenase assessed by measurement of urinary leukotriene E4 (LTE4). RESULTS: Zileuton produced a 0.35-L (95% CI, 0.25 to 0.45 L) increase in the FEV1 within 1 hour of administration (P < 0.001 compared with placebo), equivalent to a 14.6% increase from baseline. After 4 weeks of zileuton therapy, airway function and symptoms improved, with the greatest improvements occurring in the 2.4 g/d group: This group's FEV1 increased by 0.32 L (CI, 0.16 to 0.48 L), a 13.4% increase, compared with a 0.05-L (CI, -0.10 to 0.20 L) increase in patients taking placebo (P = 0.02). Symptoms and frequency of beta-agonist use also decreased with zileuton, 2.4 g/d. The mean urinary LTE4 level decreased by 39.2 pg/mg creatinine (CI, 18.1 to 60.4 pg/mg creatinine) and 26.5 pg/mg creatinine (CI, 6.6 to 46.5 pg/mg creatinine) in the 2.4 g/d and 1.6 g/d groups, respectively, compared with a slight increase in the placebo group (P = 0.007 and P = 0.05). No difference was noted in the number of adverse events among treatment groups. CONCLUSIONS: Inhibition of 5-lipoxygenase can improve airway function and decrease symptoms and medication use in patients with asthma, suggesting that this inhibition can be useful therapy for asthma. Also, 5-lipoxygenase products may mediate part of the baseline airway obstruction in patients with mild-to-moderate asthma.

Adult↗
PubMed1993

Long-term results of the ileoanal pouch procedure.

Many surgeons consider the ileoanal pouch procedure to be the procedure of choice for patients who require surgery for ulcerative colitis and familial adenomatous polyposis. To determine long-term results, 460 patients (mean +/- SD age, 31 +/- 9 years) who underwent the ileoanal pouch procedure from 1980 through 1991 were prospectively observed by computerized registry. The leading indication for operation was ulcerative colitis (n = 382; 83%). A J-shaped reservoir was created in 434 patients (94%). More than 5 years after ileostomy closure, the mean number of bowel movements was 5.8 +/- 2.2, and 13% of patients had leakage. Most patients (94%) were satisfied with their results. Sixteen patients (3.5%) required recreation of a permanent stoma for pouch failure. Complications (major and minor) occurred in 266 patients (58%) and included obstruction (n = 94; 20%), pouch fistula (n = 26; 6%), anastomotic stricture (n = 40; 9%), anastomosis separation (n = 14; 3%), and pouchitis (n = 83; 18%). Modifications in technique and increased operative experience have significantly decreased the incidence of obstruction (P = .05) and pouch-related complications (P = .004). Despite complications, long-term results are acceptable, and patient satisfaction remains high.

Adult↗
PubMed1993

Sphincter-saving alternatives in the management of adenocarcinoma involving the distal rectum. 5-year follow-up results in 40 patients.

We reviewed the treatment outcome in 40 patients undergoing full-thickness local excision (seven patients) or electrocoagulation (33 patients) for adenocarcinoma of the rectum. Patients were followed up for a minimum of 5 years or until death (mean follow-up, 7.6 years). Twenty-two patients (55%) survived 5 years free of disease or were free of disease at the time of death due to other causes following local treatment. Eight (62%) of 13 patients with persistent or locally recurrent disease were successfully treated with additional local therapy, rectal resection, or combined radiation therapy and chemotherapy. Overall, 30 (75%) of 40 patients embarking on a program of local treatment for carcinoma of the rectum survived 5 years free of disease or were free of disease at the time of death due to other causes.

Adenocarcinoma↗
PubMed1993

Alteration in intestinal permeability after ileal pouch-anal anastomosis.

PURPOSE: The physiologic changes that occur when the small bowel is used as a reservoir, as in the ileal pouch-anal anastomosis, are poorly understood. Alterations in bowel permeability, which may lead to bacterial translocation that could result in illness or dysfunction of the pouch, may be one such consequence of the pouch procedure. METHODS: Whole-bowel permeability was evaluated in patients with and without the pouch through the use of an orally consumed nonmetabolizable sugar clearance technique. Patients in whom the ileal pouch-anal anastomosis was performed for ulcerative colitis (17 patients) and patients with familial polyposis (7 patients) were compared with normal healthy volunteers (10 patients) and patients with ulcerative colitis with and without curative colectomy and ileostomy (6 and 5 patients, respectively). RESULTS: Measured by this technique, no differences were noted in bowel permeability between the volunteers and patients with ulcerative colitis, even after colectomy and ileostomy (1.7 +/- 0.4 in normal healthy volunteers, 1.8 +/- 0.5 in patients with ulcerative colitis without stoma, and 1.4 +/- 0.2 in patients with ulcerative colitis with ileostomy). The group of patients with an ileal reservoir, however, had a significantly increased index of measured bowel permeability (3.5 +/- 0.5 in patients with ulcerative colitis and 5.1 +/- 0.7 in patients with familial polyposis; P < 0.05 by analysis of variance compared with normal healthy volunteers and patients with ulcerative colitis with or without ileostomy). CONCLUSION: The exact site, cause, and consequence of this possible alteration of bowel permeability are unclear but appear to be related to the presence of the pouch and are not caused by the underlying pathologic diagnosis.

Adenomatous Polyposis Coli↗
PubMed1993

Obstruction after ileal pouch-anal anastomosis: a preventable complication?

Small bowel obstruction is a common complication after ileal pouch-anal anastomosis. This review of 460 patients examines the frequency of small bowel obstruction and determines potential risk factors. The leading indication for ileal pouch-anal anastomosis was ulcerative colitis (83 percent). In 142 patients (31 percent), loop ileostomy was rotated 180 degrees to facilitate emptying of the ileostomy. Ninety-four patients (20 percent) had 109 episodes of obstruction. Obstruction occurred after creation of the pouch (40 episodes), closure of the ileostomy (29 episodes), or developed during the subsequent follow-up period (40 episodes). Operative intervention was required in 39 percent of the episodes (7 percent of all patients). At operation, the most common point of obstruction was at closure of the ileostomy (n = 22/42, 52 percent). In 16 of these patients, the ileostomy had been rotated. Multiple risk factors, including age, sex, primary diagnosis, surgeon incidence, pouch type, prior colectomy, steroid usage, stomal rotation, technique of closure of the ileostomy, and prior obstruction, were examined by univariate and multivariate analysis. Of all factors, only stomal rotation was statistically significant (P = 0.0005, chi-squared analysis). Rotation of the loop ileostomy during ileal pouch-anal anastomosis, although an apparent technical refinement, is unnecessary and predisposes to obstruction.

Adolescent↗
PubMed1993

Sphincter-saving alternatives for treatment of adenocarcinoma involving distal rectum.

In reviewing the results achieved with local treatment of carcinoma of the rectum, it becomes apparent that no single approach to the treatment of carcinoma of the rectum is optimal for all patients. As is true in patients with carcinoma of the breast and other malignant lesions, selection of the appropriate treatment alternatives for a patient with carcinoma confined to the distal rectum requires accurate preoperative staging of the disease. Physicians interested in treating patients with carcinoma of the rectum should have the full spectrum of treatment alternatives available.

Adenocarcinoma↗
PubMed1993

Activation of complement by Fluosol attributable to the pluronic detergent micelle structure.

Fluosol, a complex mixture of perfluorocarbons with a high oxygen-carrying capacity emulsified with the detergent pluronic F-68 and various lipids, recently was approved for adjuvant therapy to reduce myocardial ischemia during coronary angioplasty. Anaphylactoid reactions after Fluosol infusion through activation of the complement pathway have been reported in some patients. We examined the mechanism of complement activation by Fluosol. In vitro, incubation of both dog and human plasma with Fluosol for 1 h caused a significant reduction in total hemolytic complement levels (CH50). None of the individual components of Fluosol tested activated complement. A reduction in CH50 levels similar to that observed with Fluosol was obtained after incubation of dog or human plasma with the detergent pluronic F-68 in combination with either perfluorocarbon. In vivo, a bolus injection of the detergent and perfluorocarbon fully mimicked the anaphylactoid reaction of Fluosol previously observed in dogs, with transient profound hypotension, tachycardia, and reduction in CH50 levels occurring < or = 5 min. To investigate further the mechanism by which the pluronic/perfluorocarbon combination activates complement, an inert dense liquid (mineral oil or silicon oil) substituted for the perfluorocarbons produced comparable complement activation both in vitro and in vivo. These observations suggest that creation of a larger pluronic micelle around a core of perfluorocarbons or any inert dense substance, causes formation of a specific surface configuration, resulting in activation of the complement cascade.

Animals↗
PubMed1993

Efficacy of preventive agents for dental caries. Systemic fluorides: water fluoridation.

The effectiveness of fluoridation has been documented by observational and interventional studies for over 50 years. Data are available from 113 studies in 23 countries. The modal reduction in DMFT values for primary teeth was 40-49% and 50-59% for permanent teeth. The pattern of caries now occurring in fluoride and low-fluoride areas in 15- to 16-year-old children illustrates the impact of water fluoridation on first and second molars. The secular changes in caries in Hartlepool, a natural fluoride area in the North East of England, shows only a modest change between 1949 and 1989. Information on the pre-eruptive effects of water fluoridation has been reviewed, suggesting that fluoridation should start at birth to provide optimal protection to primary teeth. At 15 years of age, the maximum DMFS reduction in a fluoridated area was due about half to the pre-eruptive and about half to the post-eruptive effect of fluoride.

Adolescent↗
PubMed1993

Trends in the community dental service 1980-1990.

The recent past has seen many changes that have had an impact on the dental care of children: for example, demographic changes, changes in the prevalence of dental caries, changes in manpower and changes in the organisation of dental services. The community dental service (CDS) in particular has had a major role to play in the provision of care to many children in this country. An analysis of the statistical returns to the Department of Health for the community dental services in England and Wales for the years 1985-1990 shows that staffing in the CDS has declined from 1,544 (Whole Time Equivalents--WTE) to 1,309 (WTE) in 5 years. The total clinical hours worked has also reduced from 2.02 million to 1.59 million in ten years. Hours spent on administration have increased from 53,490 to 87,091 in the same period. Clinical time spent on treating handicapped adults has increased almost ten fold from 14,644 hours in 1980 to 122,463 hours in 1990. Time devoted to mother and child (pre-school) services in about the same as in 1985. Hours spent on school services have reduced from a peak of almost 2 million in 1985 to 1.38 million in 1989-90. Trends in eight aspects of dental treatment are presented.

Administrative Personnel↗