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Biomedical subjects

J J Murray

Publications and source records attributed to J J Murray.

At least 145 records · Page 8Linked to original sources
PubMed1991

Intraoperative colonic lavage and primary anastomosis in nonelective colon resection.

In selected individuals requiring emergency colon resection, intraoperative colonic lavage with primary anastomosis represents a safe alternative to staged reconstruction. This procedure achieves excellent mechanical preparation of the colon, facilitates safe anastomosis, and avoids the disadvantages associated with multistaged operations. At our institution, 25 patients requiring urgent segmental resection of the left colon have undergone intraoperative colonic lavage. Primary anastomosis without fecal diversion has been performed in 21 of these patients. Obstruction of the large intestine was the indication for operation in 56 percent of the patients in this series. Ten patients (40 percent) required laparotomy for an acute intra-abdominal inflammatory process. No post-operative deaths have occurred in our series, and no patient has sustained clinically evident anastomotic leakage. A pelvic abscess developed in one patient after sigmoid colectomy for diverticulitis. Three patients required treatment for wound infection. Based on our results, we recommend resection with intraoperative colonic lavage and primary anastomosis as the preferred treatment for the majority of patients requiring nonelective segmental left colon resection.

Adult↗
PubMed1991

Anorectal physiology testing. A survey of availability and use.

Survey forms were sent to all members of the Coloproctology Section of the Royal Society of Medicine and the American Society of Colon and Rectal Surgeons to obtain their opinions of the availability, actual use, and perceived helpfulness of different methods for the evaluation of the physiology of the colon and rectum. Responses revealed a similarity in age and practice patterns in both groups. Of the 19 methods surveyed, greater than 90 percent of respondents in both groups rely on three traditional methods of patient evaluation: patient history, digital examination, and sigmoidoscopy. Four other methods have gained acceptance by the majority of respondents in both groups: colon transit studies, defecography, perfused-catheter manometry, and rectal compliance. The three methods ranked lowest in availability, actual use, and helpfulness by both groups were single-fiber electromyography, use of a perineometer, and evoked potential studies. Our study provides a baseline for future surveys on the investigative efforts of physicians studying the physiology of the colon, rectum, and anus.

Anal Canal↗
PubMed1991

Pouchitis--is it a wastebasket diagnosis?

Pouchitis is a poorly defined syndrome that is unique to patients with an ileal reservoir. During a prospective follow-up review of 215 patients who underwent ileal pouch-anal anastomosis, pouchitis was diagnosed in 30 patients (14 percent). Based on the clinical course, two distinct patterns of pouchitis were recognized: patients who experienced two or fewer episodes (Group 1-18 patients) and patients who experienced at least three episodes (Group 2-12 patients). Histopathologic review of resected colons revealed a preponderance of indeterminate colitis in patients in Group 2 (58.3 percent) compared with patients in Group 1 (0 percent). In Group 1; 88.9 percent of patients responded to therapy with metronidazole. Only 25 percent of patients in Group 2 responded to metronidazole alone. Most patients in Group 2 required sulfasalazine, topical steroids, or both. Of the 30 patients with pouchitis, four (13.3 percent) had a distinct endoscopic pattern of distal inflammation. This subset of patients with short strip pouchitis was successfully treated with topical steroid preparations. The clinical differences suggest different causes of pouchitis in these two groups.

Adenomatous Polyposis Coli↗
PubMed1991

Carcinoma and the ileal pouch-anal anastomosis.

Of 362 patients undergoing ileal pouch-anal anastomosis, 12 (five with chronic ulcerative colitis and seven with familial adenomatous polyposis) had 16 associated carcinomas. Incidental carcinoma was found in four patients who had undergone ileal pouch-anal anastomosis, six patients had known carcinoma, and carcinoma was suspected in two patients with high-grade dysplasia. No tumor was Stage C or D. After a median observation period of 24 months, no evidence of recurrence was documented. Data suggest that patients with carcinoma complicating chronic ulcerative colitis and familial adenomatous polyposis can safely undergo ileal pouch-anal anastomosis; however, it may be prudent to perform resection and later ileal pouch-anal anastomosis after a period of observation and appropriate adjuvant therapy because of the difficulty in intraoperative staging.

Adenocarcinoma↗
PubMed1991

Nonelective colon resection. Alternatives to multistage resections.

Compared with the prolonged cumulative hospitalization and morbidity that accompany staged resection for the treatment of obstructing or inflammatory disorders of the left colon, our results confirm that resection with intraoperative lavage and primary anastomosis is a safe alternative. In the absence of intraoperative lavage, all patients in our series would have required a multistage procedure. Intraoperative lavage with primary anastomosis does not challenge the accepted criteria for safe bowel anastomosis. Rather, it offers another means for meeting those criteria. This alternative should be considered in the management of any patient whose primary indication for colostomy is the lack of adequate mechanical preparation of the colon. Although our experience indicates that intraoperative lavage and primary anastomosis can be employed safely in the treatment of inflammatory disorders of the colon, it is not recommended in the presence of fecal peritonitis, a large contiguous pelvic abscess, or systemic sepsis. In these individuals, the additional operating time required for intraoperative lavage and the potential consequences of anastomotic dehiscence pose too great a risk.

Colectomy↗
PubMed1991

Drug-mineral interactions: a new responsibility for the hospital dietitian.

Recent hospital accreditation guidelines encourage hospital dietitians to monitor patient drug therapy and provide education regarding drug-food interactions. However, information concerning these interactions is lacking, even though they can occur frequently. Minerals in foods can complex with drugs and/or alter the gastrointestinal environment to affect the normal absorption processes of drugs and minerals. There are three types of drug-mineral interactions: (a) malabsorption of the mineral and/or drug; (b) mineral depletion and retention; and (c) drug-mineral interactions induced by simultaneous antacid ingestion. It is recommended that oral drugs be administered on an empty stomach 1 hour before or 2 hours after a meal and at least 2 hours before or after antacid use. A small snack of refined carbohydrates with low nutrient density can be consumed with drugs that cause gastric upset when given on an empty stomach.

Antacids↗
PubMed1990

Isolation and enzymic assay of choline and phosphocholine present in cell extracts with picomole sensitivity.

Increasing interest in receptor-regulated phospholipase C and phospholipase D hydrolysis of cellular phosphatidylcholine motivates the development of a sensitive and simple assay for the water-soluble hydrolytic products of these reactions, phosphocholine and choline respectively. Choline was partially purified from the methanol/water upper phase of a Bligh & Dyer extract by ion-pair extraction using sodium tetraphenylboron, and the mass of choline was determined by a radioenzymic assay using choline kinase and [32P]ATP. After removal of choline from the upper phase, the mass of residual phosphocholine was determined by converting it into choline by using alkaline phosphatase, followed by radioactive phosphorylation. In addition to excellent sensitivity (5 pmol for choline and 10 pmol for phosphocholine), these assays demonstrated little mutual interference (phosphocholine----choline = 0%; choline----phosphocholine = 5%), were extremely reproducible (average S.E.M. of 3.5% for choline and 2.9% for phosphocholine), and were simple to perform with instrumentation typically available in most laboratories. In addition, the ability to apply the extraction technique to the upper phase of Bligh & Dyer extracts permitted simple analysis not only of choline and phosphocholine, but also of phosphatidylcholine and lipid products of phospholipase C and phospholipase D activity (1,2-diacylglycerol and phosphatidic acid respectively) from the same cell or tissue sample.

Animals↗
PubMed1990

Strictureplasty of the small bowel in patients with Crohn's disease. An effective surgical option.

Fibrotic strictures of the small bowel are known to cause chronic bowel obstruction in patients with Crohn's disease. Strictureplasty without resection permits relief of bowel obstruction and preservation of bowel length. The records of 13 patients who underwent 52 strictureplasties for Crohn's disease at the Lahey Clinic Medical Center, Burlington, Mass, from 1982 through 1989 were reviewed to determine the results of this surgical intervention. Nine patients were treated with strictureplasty only, while the remaining 4 patients underwent concomitant small-bowel resection for stenosed areas not amendable to strictureplasty. One early complication occurred in a patient in whom a pelvic abscess developed. In a median follow-up period of 2 years (range, 0.5 to 7 years), 9 patients were rehospitalized because of obstruction from Crohn's enteritis. Four patients required further surgery, 3 patients underwent strictureplasty at a newly stenosed area of small bowel, and 1 patient required resection of the initial strictureplasty. Strictureplasty is an effective surgical option for patients with Crohn's disease who have symptomatic small-bowel strictures.

Adult↗
PubMed1990

Platelet-vessel wall interactions in individuals who smoke cigarettes.

Our studies have shown that there an increased excretion of urinary metabolites of thromboxane A2 in healthy, young male chronic smokers. This arachidonic acid metabolite from platelets reflects evidence of increased activation in vivo. These data contrast with the ex vivo study of platelets in chronic smokers and point out the fact that selection of cells for ex vivo study may not appropriately reflect the in vivo pathophysiologic situation. The platelet activation related to chronic smoking appears to result from both a direct, non-sympathoadrenally mediated activation which is rapidly inducible and reversible as well as a more persistent activation which long outlasts the smoke exposure. This latter mechanism appears to result from persistent vascular damage as reflected by the enhanced prostacyclin metabolite excretion. The acute, direct effect of smoking on the platelet appears to be a minor component of the altered platelet function. This latter inference may account for the inability in some studies to observe a small incremental, acute change superimposed on the persistently increased platelet reactivity secondary to the enhanced interactions with a damaged vasculature.

Blood Platelets↗
PubMed1990

Bleeding stomal varices. The role of local treatment.

The authors reviewed their experience with 12 patients (median age, 38 years; range, 24 to 66 years) who had bleeding stomal varices. Stomal variceal bleeding occurred between 1 and 11 years (median, 5.5 years) after creation of the stoma. Control of bleeding initially consisted of direct pressure; recurrent bleeding occurred in one patient who died before definitive therapy could be performed. The remaining 11 patients underwent a total of 18 additional procedures for control of bleeding stomal varices, including 9 local procedures, 8 portosystemic shunts, and 1 liver transplantation. Seven patients were dead of hepatic failure a median of 4 years (range, 1 to 9 years) after treatment. Recurrent bleeding occurred in three patients after local treatment and in one patient after a portosystemic shunt. Bleeding stomal varices are a manifestation of severe liver disease and portal hypertension. Although local procedures may be effective for initial control of bleeding, recurrent bleeding often occurs. Mortality is high because of the severity of the underlying liver disease.

Adult↗
PubMed1990

Perianal hidradenitis suppurativa. The Lahey Clinic experience.

Perianal hidradenitis suppurativa, a chronic recurrent inflammatory disease of apocrine glands, adjacent anal canal skin, and soft tissues, is characteristically ignored and misdiagnosed. A retrospective analysis of 43 patients with perianal hidradenitis suppurativa was performed; 40 patients (93 percent) were male and 3 (7 percent) were female, with a median age at presentation of 29 years. Symptoms, including pain, swelling, purulent discharge, and pruritus, had been present for a median of six years. Diagnoses at the time of presentation included pilonidal disease (28 percent), anal fistula (37 percent), and perirectal abscess (16 percent). Associated medical conditions included diabetes (12 percent) and obesity (12 percent), and 70 percent of the patients were smokers. Once the correct diagnosis was established, 72 percent of patients had wide local excision with healing by secondary intention, and 28 percent of patients had incision and drainage or limited local excision. Although 67 percent of the patients had recurrence of disease after initial treatment, wide excision was more successful in preventing recurrence. Skin grafting failed uniformly, and colostomy was rarely necessary. Despite its relatively common occurrence, perianal hidradenitis suppurativa is infrequently diagnosed correctly and recurs in many patients despite appropriate surgical treatment, making the disease a source of frustration for surgeon and patient alike.

Adolescent↗
PubMed1990

Perirectal abscess in Crohn's disease. Drainage and outcome.

The role of surgical intervention in the treatment of patients with anorectal Crohn's disease is controversial. To clarify the success of aggressive drainage and the subsequent clinical course of patients with Crohn's disease and perirectal abscesses, the authors reviewed the records of 38 patients who presented with this condition during an eight-year period. Twenty-two male and 16 female patients (median age, 32 years; range, 17 to 61 years) with clinically or pathologically confirmed Crohn's disease of the bowel underwent operation for perirectal abscesses. Thirty-two percent of patients had no previous history of anorectal Crohn's disease. Thirty simple abscesses and 8 complex horseshoe abscesses were treated. At operation, 53 percent of patients underwent incision and drainage whereas 26 percent received loop indwelling drains and 21 percent had mushroom catheters placed. After resolution of the index abscess, recurrent abscesses occurred in 45 percent of the patients who underwent catheter drainage and 56 percent of the patients who underwent incision and drainage. More importantly, 44 percent of the incision and drainage group and only 31 percent of the catheter drainage group required subsequent proctectomy to control perineal sepsis. The healing time of the perineal wound was longer than six months in 83 percent of patients requiring rectal excision. We concluded that long-term catheter drainage may offer substantial benefit in the overall outcome of the treatment of patients with Crohn's disease and perirectal abscess.

Abscess↗
PubMed1990

Reduction of intimal hyperplasia and enhanced reactivity of experimental vein bypass grafts with verapamil treatment.

Recent studies have shown that calcium antagonists exert an antiatherogenic effect in animals fed cholesterol. Vein graft intimal hyperplasia is believed to be an early event in atherosclerotic lesion formation, which is a significant cause of graft failure. Altered vasoreactivity has also been postulated in the etiology of vein graft failure. Therefore this study examined the effect of verapamil treatment on the development of intimal hyperplasia and the vasoreactivity of experimental vein bypass grafts. The right external jugular vein was grafted into the right carotid artery of 30 male New Zealand white rabbits fed normal rabbit chow. The left external jugular vein was used as the control vein. Fifteen animals received verapamil (1.25 mg/day for 28 days) via the femoral vein by means of an osmotic pump. In 15 control animals the pump contained saline. Plasma verapamil concentration was 50.9 +/- 13.2 ng/mL (x +/- SEM), a dose that showed no effect on either blood pressure, total serum cholesterol, or in vitro platelet aggregation to ADP. Fourteen of fifteen grafts were patent in each group, for a patency rate of 93%. Histologic examination using computer morphometry showed significant reduction of intimal hyperplasia at the proximal, middle, and distal graft segments (p less than 0.05). In addition in vitro isometric tension studies of the vein grafts and control veins showed that verapamil causes enhanced reactivity of both vein grafts and control veins in response to norepinephrine and histamine (p less than 0.05). Reactivity of vein grafts to serotonin was unaltered. While none of the normal veins in the control group responded to serotonin, normal veins treated with verapamil contracted readily in response to serotonin. Endothelial-dependent relaxation to acetylcholine was absent in both control and verapamil-treated vein grafts, while normal veins from both groups responded to the same extent to acetylcholine. Because we could not demonstrate any difference in platelet or endothelium function between untreated and verapamil-treated animals, we examined the direct effect of verapamil on smooth muscle. Verapamil significantly inhibited [3H]-thymidine incorporation into DNA in vascular smooth muscle cells in culture in a dose-dependent manner. Verapamil treatment significantly reduces intimal hyperplasia in experimental vein grafts and inhibits smooth muscle cell proliferation in culture. Furthermore the enhanced reactivity to norepinephrine and histamine in the verapamil-treated vessels has no detrimental effect on the patency rate at 4 weeks. Thus by inhibiting intimal hyperplasia, calcium antagonists may improve the long-term patency of vein bypass grafts.

Animals↗
PubMed1990

Addition of parenteral cefoxitin to regimen of oral antibiotics for elective colorectal operations. A randomized prospective study.

The efficacy of cefoxitin, a perioperative parenteral antibiotic, combined with mechanical bowel preparation and oral antibiotics to prevent wound infections and other septic complications in patients undergoing elective colorectal operations, was examined in a prospective randomized study. All 197 patients who completed the study received mechanical bowel preparation and oral neomycin/erythromycin base. In addition a perioperative parenteral antibiotic was given in three divided doses to 101 patients. The other 96 patients received no parenteral antibiotics. The overall incidence of intra-abdominal septic complications was 7.3% (7 of 96) in the control group (no cefoxitin) and 5% (5 of 101) in the treatment group (cefoxitin). This difference was not statistically significant. The incidence of abdominal wound infection was 14.6% in the control group and 5% in the treatment group, a statistically significant difference (p = 0.02). The addition of perioperative parenteral cefoxitin greatly reduced the incidence of wound infections in patients undergoing elective colorectal operations who had been prepared with mechanical bowel cleansing and oral antimicrobial agents.

Abscess↗
PubMed1990

Preferential proximal coronary dilation by activators of guanylate cyclase in awake dogs.

The vasodilation effects of activators of guanylate cyclase, atrial natriuretic peptide (ANP), nitroglycerin (NTG), and acetylcholine (ACh), on the epicardial conductance arteries and the distal resistance coronary vessels were examined in chronically instrumented awake dogs and related serially to plasma guanosine 3',5'-cyclic monophosphate (cGMP) levels. Left atrial bolus injections of ANP (3 micrograms/kg; n = 7), NTG (13 micrograms/kg; n = 7), or ACh (0.13 micrograms/kg; n = 3) induced sustained increases in epicardial coronary dimension (ultrasonic crystals), 3.3, 5.7, and 6.7%, respectively, lasting greater than 40 min for ANP and NTG and greater than 3 min for ACh, and relatively brief increases in blood flow (resistance artery vasomotion) for each agent. Plasma samples withdrawn serially after injections of each agent demonstrated that only ANP increased cGMP level; the time course of ANP-induced epicardial vasodilation followed more closely the increase in cGMP than that of plasma ANP. These data demonstrated that these three activators of guanylate cyclase induced preferential sustained epicardial vasodilation and only brief distal coronary vasodilation with minor or no change in systemic hemodynamics. The prolonged increase in plasma cGMP after ANP injection suggested continuous cGMP production during ANP-induced proximal vasodilation. These data demonstrate a striking heterogeneity of vasomotor responses in the coronary arterial vasculature and suggest that cGMP-mediated vasodilation mechanisms are more predominant in proximal conductance arteries compared with distal resistance vessels.

Acetylcholine↗
PubMed1990

Current issues in the use of fluorides in dentistry.

Britain, along with many other developed countries, has experienced a dramatic decline in prevalence of dental caries. This has been attributed to the widespread use of fluoride toothpastes, which has done much to improve children's dental health. Studies indicate that fluoridation of water supplies would confer an additional benefit to dental public health, while other fluoride vehicles (mouthrinses, topical gels and varnishes, tablets and drops) are valuable in preventing caries in high-risk patients. The authors review the issues involved.

Adolescent↗
PubMed1990

Dental health of handicapped children; results of a questionnaire to parents.

A questionnaire survey of parents of handicapped children, to complement a clinical examination, was carried out in 25 special schools in Newcastle and Northumberland. From the data collected a number of important issues are raised. Some parents have to travel greater distances than are necessary given the availability of dental services locally, either because it is more convenient or because their child requires special care. As a result perhaps the frequency of attendance of children with handicaps is poorer than that of normal children. With exceptions, most children were assessed as being amenable to routine dental care, and over one third of wheelchair bound patients claimed to be regular attenders, yet a smaller minority of handicapped child patients were seen routinely in general dental practice, compared with the usual child population. The need for greater efforts on the part of parents, dentists and other health care providers in improving the dental health of handicapped children is underlined.

Adolescent↗