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Biomedical subjects

J Murphy

Publications and source records attributed to J Murphy.

At least 253 records · Page 14Linked to original sources
PubMed1990

DNA analysis using polymerase chain reactions in the families of children with cystic fibrosis.

The results of our experience in DNA analysis in cystic fibrosis families using polymerase chain reaction (PCR) is reported. Of the first 10 families studied, seven were fully informative using the probe KM19 and PCR. In the remaining three families, Southern blotting analysis and the probe pXV2c were required before full information was obtained in two and partial information in the other family. The methods used, the current place of PCR and the clinical relevance of DNA analysis are discussed.

Blotting, Southern↗
PubMed1990

Balloon angioplasty--branch pulmonary artery stenosis: results from the Valvuloplasty and Angioplasty of Congenital Anomalies Registry.

Balloon angioplasty for branch pulmonary artery stenosis was reported from 27 institutions to the Valvuloplasty and Angioplasty of Congenital Anomalies Registry. One hundred eighty-two procedures were performed in 156 patients ranging in age from 0.2 to 46.2 years (mean 7.7). Short-term angiographic appearance, hemodynamic results and immediate complications were recorded. Vessel dimension at the site of stenosis increased from 4.5 +/- 2.0 (mean +/- standard deviation) to 6.8 +/- 3.0 mm (p less than 0.001) with greater increases in vessel dimension at the site of stenosis if the balloon diameter was greater than 3 X the original dimension of the stenosis. There was no significant benefit related to age or prior surgical intervention. The mean peak systolic pressure gradient was reduced from 49 +/- 25 to 37 +/- 26 mm Hg (p less than 0.001) and pressure proximal to the stenosis decreased from 69 +/- 25 to 63 +/- 24 mm Hg (p less than 0.001). Complications occurred in 21 patients and included vessel rupture and death in 2 patients, vessel perforation or rupture with survival in 3, cardiac arrest and death in 1, paradoxical embolism and death in 1 and low output and death in 1. Balloon angioplasty for branch pulmonary artery stenosis increases vessel dimension at the site of stenosis, reduces systolic pressure gradient and to a minor degree, reduces proximal pressure. Long-term outcome and potential complications are as yet uncertain.

Catheterization↗
PubMed1990

A small animal model of human Helicobacter pylori active chronic gastritis.

Isolation of a spiral-shaped bacterium closely related to Helicobacter pylori from the cat stomach made it possible to investigate new small animal models of gastric infection. Pure cultures of this bacterium, provisionally named "Helicobacter felis," were fed to germ-free mice. The organism colonized the stomach in large numbers in mucus and deep in the gastric pits and showed the same gastric trophism found with H. pylori. Significant histopathology was seen in all H. felis-infected mice. At 2 weeks postinfection, an acute inflammatory response was seen composed primarily of eosinophils and neutrophils. At 3 weeks, the polymorphonuclear response was more pronounced with large numbers of neutrophils in some areas forming small microabscesses. Lymphocytes also increased in number. By 8 weeks, several relatively large lymphoid nodules were present in the submucosa. Multiple small microabscesses were still present in the pyloric mucosa. This is the first animal model of bacterial gastritis to be described that shows progression from acute inflammation to persistent acute on chronic inflammation (active chronic) as is seen in human infection with H. pylori.

Acute Disease↗
PubMed1990

The value and significance of routine urine cultures in patients referred for radiation therapy of prostatic malignancy.

Radiation therapy of the prostate requires a simulator visit when a urinary catheter and rectal balloon are used for field determination. Radiation changes combined with the previous instrumentation, surgery and therapy makes diagnosing urinary tract infection (UTI) difficult. For this study a UTI was defined as the isolation of the same organism(s) at any concentration in two of three sequential urine samples. Urine cultures were obtained prior to radiation therapy (during and after the simulator visit) and while receiving radiation treatments. The study of 291 patients revealed a UTI in 20 (6.9%) prior to undergoing simulator evaluation and in an additional 13 patients at the first visit after to give an incidence of 11.34% prior to receiving radiation. The bacterial isolates in the 13 patients were more suggestive of reactivated chronic infection than catheter associated UTI. During radiation therapy approximately 1%-2% of patients developed a UTI per week. This study justified the use of routine urine cultures in these patients and suggests that further investigations should be done to reduce the incidence of infections occurring both prior to and during radiation therapy.

Bacteria↗
PubMed1990

Preventive treatment of asymptomatic left ventricular dysfunction following myocardial infarction.

Progressive asymptomatic ventricular dilatation can occur following myocardial infarction and severe ventricular dysfunction is often present by the time clinical congestive heart failure occurs. In a randomized, double-blind trial, the effects of captopril 25 mg tid, frusemide 40 mg daily and placebo were studied in 90 patients with asymptomatic left ventricular dysfunction (ejection fraction less than 45%) 1 week following Q wave myocardial infarction. Left ventricular volumes and function were assessed at intervals during the subsequent year using two-dimensional echocardiography. The frusemide and placebo groups showed significant increases in ventricular volumes with stroke volume index unchanged and ejection fraction slightly reduced, whereas the captopril group showed a significant reduction in left ventricular end-systolic volume index with stroke volume index and ejection fraction increased. At 12 months the difference in the change in ejection fraction from baseline between the captopril and frusemide groups was 10.5% and captopril and placebo groups 9.6% (both P less than 0.0001). There was a significant difference in occurrence of clinical heart failure in the placebo group compared with the other groups (P less than 0.05). Blood pressure increased significantly within the normal range in the placebo and frusemide groups whereas there was essentially no change from baseline in the captopril group. There was no significant correlation between baseline left ventricular volumes and function and subsequent change, and anterior and inferior infarct subgroups showed similar responses within the treatment groups. In conclusion, captopril improves asymptomatic ventricular dysfunction and prevents clinical heart failure during the year following myocardial infarction. Frusemide may also prevent clinical heart failure but not progressive ventricular dilatation.

Adult↗
PubMed1990

Excessive faecal losses of vitamin A (retinol) in cystic fibrosis.

Vitamin A (retinol) deficiency is a recognised complication of cystic fibrosis and is presumed to be a consequence of an impairment in the digestion and absorption of dietary fats. The dietary intake of fat and retinol was assessed from a seven day weighed food intake in 11 subjects with cystic fibrosis and 12 matched controls. Faecal excretion of retinol and fat were measured from three day stool collections. There was little difference between the two groups in the intake of fat or retinol equivalents. When studied the subjects with cystic fibrosis were clinically stable and the apparent absorption of fat was not significantly different to that in the controls. There was a significant increase in the faecal losses of retinol in cystic fibrosis, which was unrelated to the degree of fat in the stool. In cystic fibrosis the median retinol recovered in the stool was 40% of the intake, compared with 1.8% in the controls. It is concluded that there is a specific defect in the handling of retinol by the gastrointestinal tract in cystic fibrosis, which may be unrelated to the digestion and absorption of dietary fat.

Adolescent↗
PubMed1990

Acute hospital medical care for the elderly: is there a valid performance indicator?

Many clinicians have doubts about the validity of using activity data to measure the efficiency of health services, since they take no account of outcome. In elderly patients presenting with acute illness, minimising the time spent in hospital or institutional care is a justifiable aim in itself. If allowance is made for deaths and readmissions, valid performance indicators might be derived from the distribution of the resulting 'Adjusted Length of Stay'. By surveying all medical patients aged 65 and over, admitted as emergencies to the hospitals of one large health district, this study investigated whether such an index (the Adjusted length of Stay) could be of practical value. The influence of the following characteristics on the patient's length of stay were assessed; age, social circumstances, premorbid disability and the nature of the presenting complaint. Patients admitted to general medical and health care of the elderly wards were compared and investigated, to determine whether their outcome was similar after adjusting for differences in these characteristics. Although there was some overlap, marked differences emerged in age distribution, nature of the presenting illness and prevalence of previous disability. These factors were all found to have a substantial effect on the time spent in hospital. The Adjusted Length of Stay Index could be calculated with little change to existing methods of data collection. It provides a fairer basis for overall evaluation of acute medical services for the elderly than current performance indicators.

Activities of Daily Living↗
PubMed1990

Cellular and humoral immune responses to a recombinant P. falciparum CS protein in sporozoite-immunized rodents and human volunteers.

The immune responses of sporozoite-immunized rodents and of human volunteers exposed to multiple bites of irradiated Plasmodium falciparum infected mosquitos have been investigated using a yeast-derived recombinant P. falciparum circumsporozoite (rPfCS) protein. The murine immune response to immunization with rPfCS was not genetically restricted. Nine different murine haplotypes, when immunized with rPfCS, developed high levels of antisporozoite antibodies detectable by IFA and RIA. In addition, injection of rPfCS induced a secondary antibody response in P. falciparum sporozoite-primed mice. Murine T-cell epitopes were mapped in the C terminus of the rPfCS protein using overlapping synthetic peptides. The human T-cell response was investigated using T-cell clones derived from peripheral blood lymphocytes (PBL) of a P. falciparum sporozoite-immunized volunteer. A total of 40 CD4+ T-cell clones were obtained. Stimulation indices ranged from 2.5 to 103.4 following challenge with rPfCS in the presence, but not in the absence, of antigen-presenting cells. The clones were specific for rPfCs and did not proliferate or secrete lymphokines when challenged with yeast-derived recombinant P. vivax or P. berghei CS protein or with a yeast-extract control. The clones also recognized the native CS protein in extracts of P. falciparum, but not P. berghei or P. cynomolgi, sporozoites.

Animals↗
PubMed1989

Effect of reducing atrial pressure on atrial natriuretic factor and vasoactive hormones in congestive heart failure secondary to ischemic and nonischemic dilated cardiomyopathy.

The effect of an acute and sustained reduction in atrial pressure on atrial natriuretic factor (ANF) and vasoactive hormone secretion was studied in 9 patients with congestive heart failure (CHF). Intravenous nitroglycerin was titrated to reduce the pulmonary artery wedge pressure by 30 to 50% and maintain this reduction for 4 hours. After 60 minutes of nitroglycerin administration, the mean decrement in wedge pressure was 10.0 +/- 1.7 (standard error) mm Hg (35%) and plasma ANF was 65.3 +/- 13.9 pmol/liter (35%). The initial decrease, sustained reduction and later increase in plasma ANF levels closely paralleled the changes in pulmonary arterial wedge (r = 0.94, p less than 0.0001) and right atrial pressures (r = 0.91, p less than 0.0001) during and immediately after the nitroglycerin infusion. Plasma aldosterone and cortisol levels increased during the first 2 hours of the nitroglycerin infusion, but there was little change in plasma norepinephrine or plasma renin activity. Although levels were elevated in CHF, plasma ANF still responded rapidly to changes in atrial pressure. A sustained reduction in pressure produced a sustained reduction in ANF levels. These findings provide further support for a regulatory role of ANF, even in chronic CHF.

Aged↗
PubMed1989

Increased platelet intracellular calcium concentration in patients with bipolar affective disorders.

Using the fluorescent indicator Fura 2, we measured the free intracellular calcium ion concentration in blood platelets of patients with untreated mania, bipolar depression, and unipolar depression; patients who had recovered from bipolar depression or mania; and age- and sex-matched controls. The baseline intracellular calcium ion concentration was significantly increased in platelets from patients with mania compared with controls. The free intracellular calcium ion concentration after stimulation with platelet-activating factor and thrombin was significantly higher in platelets of manic and bipolar depressed patients than in all other groups. The degree to which intracellular calcium ion concentration increased over baseline after stimulation was significantly lower in unipolar than in bipolar patients. These findings suggest that platelets of manic and depressed bipolar patients have a similar enhancement of intracellular calcium ion activity that is distinctly different from the decreased ability of platelets of unipolar patients to mobilize intracellular calcium in response to stimulation.

Adult↗
PubMed1989

Risk of functional decline among well elders.

Active lifestyles may delay the onset of the functional consequences of chronic disease, potentially increasing active life expectancy. We analyzed the Longitudinal Study of Aging (LSOA) to test the hypothesis that elders participation in an active lifestyle prevents loss of function. Focusing on the cohort aged 70-74 who reported being able to carry 25 lb, walk 1/4 mile, climb 10 steps and do heavy housework without help and without difficulty at baseline, decline was defined as no longer being able to perform these tasks independently and without difficulty 2 years later. Using multivariate logistic regression, results reveal that those who did not report regularly exercising or walking a mile were 1.5 times more likely to decline than those who did, controlling for reported medical conditions and demographic factors. Similar findings (with different models) were observed for both men and women. Findings suggest the potential value of programs oriented toward the primary prevention of functional decline.

Aged↗
PubMed1989

Testicular ischemia and infarction following herniorrhaphy or varicocelectomy: evaluation by radionuclide imaging.

The postoperative use of testicular imaging to evaluate the preservation of testicular circulation has been reported after orchiopexy, excision of a hematocele, and repair of a traumatized tunica albuginea. The authors discuss the previously unreported use of testicular imaging in patients who have undergone recent herniorrhaphy or varicocelectomy. The scan of a patient with intact testicular perfusion following herniorrhaphy is compared to the scans of two patients with absence of perfusion of a testicle five to seven days following respective herniorrhaphy and varicocelectomy surgeries.

Adult↗
PubMed1989

Establishing an enteral product formulary.

An ever-increasing number of enteral nutrition products is being marketed to hospitals for use with nutritionally compromised patients. At the Clinical Center, National Institutes of Health, Bethesda, MD, the nutrition department created a formulary management committee, which developed a system that aligned formulary product selection with the enteral needs of the patients, provided an ongoing system of formulary management, and provided extensive education to dietitians on product formulation. The formulary system involved a stepwise process: determination of categories of products to be considered and criteria for product selection, identification of enteral needs of patients at nutritional risk within the institution, review of current literature on formulation of all major enteral products, and taste evaluation of products to be used orally. Composition of the formulary was then determined, and interdepartmental efforts for implementation were coordinated. The overall department impact included a 37% reduction in variety of products stocked, the creation of an annual update system, and extensive dietitian education on product formulation and usage. The direct impact on patient care was the provision of a formulary specifically targeted to meet the enteral needs of those patients at nutritional risk within the institution.

Enteral Nutrition↗
PubMed1989

Severe pulmonary hemorrhage and systemic vasculitis in association with circulating anti-neutrophil cytoplasm antibodies of IgM class only.

We report an association of severe pulmonary hemorrhage with circulating autoantibodies to neutrophil cytoplasmic antigens (ANCA) restricted to IgM class in three patients with systemic vasculitis. ANCA were detected by indirect immunofluorescence and isotype specific solid phase radioimmunoassay (SPRIA). Institution of immunosuppressive therapy was accompanied by an isotype switch to IgG ANCA and recovery in all three patients. In an associated study, ANCA activity was found in eluates from the washed glomeruli of two postmortem cases, with the same isotype distribution as was present in the sera.

Adolescent↗
PubMed1988

Treatment of patients with symptomless left ventricular dysfunction after myocardial infarction.

In a randomised, double-blind trial 60 patients with left ventricular dysfunction (ejection fraction less than 45%) but without clinical evidence of heart failure 1 week after Q wave myocardial infarction were given captopril 25 mg thrice a day, frusemide 40 mg daily, or placebo. Left ventricular volumes were measured at baseline and at 1, 3, 6, 9, and 12 months with cross-sectional echocardiography and Simpson's rule analysis of standardised apical views. The captopril group showed no significant change in left ventricular end-diastolic volume index but left ventricular end-systolic volume index was significantly reduced and stroke volume index and ejection fraction were significantly increased from 1 month on. In contrast, the frusemide and placebo groups showed significant increases in ventricular volumes, with stroke volume index unchanged and ejection fraction slightly reduced. The changes in the captopril group were significantly different from those in the other groups.

Adult↗