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Biomedical subjects

J Murphy

Publications and source records attributed to J Murphy.

At least 433 records · Page 24Linked to original sources
PubMedDate not supplied

Endometrial pipelle biopsy compared to conventional dilatation and curettage.

Dilatation and curettage (D + C) is the most common operation performed in Britain. The liberal use of D + C has been criticised. The objective of this study was to evaluate the use of outpatient endometrial pipelle biopsy and determine its safety in terms of detecting abnormalities. Complications and financial costs were also evaluated. Data were reviewed from an active gynaecological unit from February 1993 to January 1995. A total of 303 D + Cs and 104 endometrial pipelle biopsies were performed in this period. Nine malignancies were detected by D + C and 1 by pipelle biopsy. A total of 24 and 3 benign abnormalities were detected by each method respectively. There was a higher complication rate in the D + C group but the failure rate was higher in the endometrial pipelle biopsy group. The monetary savings over this period is estimated at 20,307 pounds. There were no missed malignancies to our knowledge over the 8 yr period since endometrial pipelle biopsy was introduced to the hospital.

Adult↗
PubMedDate not supplied

Transabdominal ultrasound and its correlation with clinical findings in gynaecology.

Details of 86 patients with a pelvic mass who underwent a laparotomy under the gynaecological service in St. Vincent's Hospital were reviewed. Findings at laparotomy were correlated with ultrasound findings. Overall, ultrasound appears to be more sensitive and specific in the determination of the origins of a pelvic mass compared to clinical examination. The sensitivity and specificity of ultrasound in detecting a uterine mass is 94 per cent and 99 per cent respectively. This contrasts sharply with clinical examination (sensitivity = 74 per cent; specificity = 94 per cent). The sensitivity and specificity of ultrasound in detecting an ovarian mass is 92 per cent and 71 per cent. Ultrasound is capable of predicting benign disease with reasonable confidence but the prediction of malignancy is less reliable.

False Positive Reactions↗
PubMedDate not supplied

Selenium status of Irish adults: evidence of insufficiency.

BACKGROUND: Sub-optimal selenium status may have a role in the aetiology of various pathologies. Selenium status depends on adequate selenium in the diet. A relatively high proportion of Irish adults (17% men; 46% women) have an inadequate dietary intake. AIM: A study was designed to examine the selenium status of healthy Irish adults. METHODS: Ninety-one healthy Irish adults, aged 18-67 years, were recruited from the Cork City area. A fasting blood sample was collected from each subject and each was assayed for serum selenium an index of serum selenium. RESULTS: Mean (+/- SD) serum selenium concentration in healthy Irish adults was 76 (+/- 21)microg/l. There was no significant difference in values between males and females or between postmenopausal and premenopausal women or between the three main age categories. CONCLUSION: Current serum selenium values of Irish adults would not appear to be sufficient to achieve optimal activity of glutathione peroxidase, which occurs at serum selenium concentration around 95microg/l. Sub-optimal selenium status may increase susceptibility to various chronic disorders.

Adolescent↗
PubMedDate not supplied

Lung perfusion patterns after bidirectional cavopulmonary anastomosis (Hemi-Fontan procedure).

Perfusion lung scans were performed immediately prior to Fontan procedure in 45 patients with a functional single ventricle who underwent the hemi-Fontan procedure as an intermediate stage between the initial palliative shunt procedure and the final complete Fontan anastomosis. Symmetric pulmonary blood flow (PBF) distribution was found in 27% of patients, whereas moderately to severely abnormal PBF distribution was found in 35% of patients. The achieved systemic aortic saturation following the hemi-Fontan procedure was not affected by these abnormalities.

Anastomosis, Surgical↗
PubMedDate not supplied

Serotonergic neurons in the alcohol preferring rats.

Previously, we have shown that the serotonin (5-HT) content and fiber density in a number of terminal brain regions have been found to be decreased in the selectively bred, alcohol preferring (P) rats than in the alcohol nonpreferring (NP) rats. In this study, we further report that, compared with NP rats, there were fewer 5-HT-immunostained (5-HT-IM) neurons in the major ascending raphe nuclei of the P rats. Among the three major groups of 5-HT neurons responsible for the majority of ascending projections to forebrain, dorsal raphe (B7), median raphe (B8), and B9, there were fewer 5-HT-IM neurons in the median and dorsal raphe (not including nucleus oralis) of P rats, compared with NP rats (unpaired Student's test). No difference was observed in the B9 group. When the animals were treated with pargyline and L-tryptophan to enhance the 5-HT in the neurons, the number of 5-HT-IM neurons increased in both lines of rats. However, the difference in the number of 5-HT neurons between the rat lines remained. The intensity of 5-HT-IM was also found to be lower in the dorsal raphe neurons of the untreated P than in the untreated NP rats. The decreased 5-HT-IM was supported by high performance liquid chromatography measurement of 5-HT content, which also indicated that 5-HT content of the dorsal raphe was lower in the P than in the NP rats.(ABSTRACT TRUNCATED AT 250 WORDS)

Alcohol Drinking↗
PubMedDate not supplied

A non-invasive method for measuring cardiac output: the effect of Christmas lunch.

Cardiac output was measured in ten patients at routine cardiac catheterisation and three patients with severe heart failure by means of a carbon dioxide rebreathing technique with a computer-assisted mass spectrometer and compared with cardiac output measured by thermodilution. There was a close correlation (r = 0.96, p less than 0.01) between the two methods. Cardiac output measured by the carbon dioxide rebreathing technique increased after a typical Christmas lunch by a mean of 1.6 1/min in a group of healthy volunteers.

Carbon Dioxide↗
PubMedDate not supplied

Evaluation and analysis of patient outcomes with an intrasegmental fixation system in lumbar spinal fusion.

BACKGROUND CONTEXT: A new spinal fixation system with polydirectional screws and modular links with interconnecting radial serrations has been developed. The system allows the linking of multiple points of fixation, two points at a time (intrasegmental fixation), thus eliminating the need for intraoperative contouring of rods or plates. PURPOSE: Evaluation of this new type of spine system was done through biomechanical studies, analysis of lumbar lordosis preservation postoperatively, and multicenter review of patient outcomes with a minimum of 1 year follow-up. STUDY DESIGN/SETTING: Biomechanical studies of the spine system were performed according to American Society for Testing and Materials (ASTM) standards. To evaluate the maintenance of lordosis, radiographs from the first 119 patients were reviewed by the authors. Analysis of patient outcomes consisted of a review of the first 259 patients who underwent spinal fusion surgery with the new spine system. PATIENT SAMPLE: Evaluation of patient outcomes consisted of 122 men and 137 women with an average age of 50+/-13 years (range, 22-96 years) and a mean follow-up of 20+/-6 months (range, 12-54 months). The patient population was at high risk for fusion failure, with 127 smokers (49%), 141 who had previous spine surgery (54%), 22 with osteoporosis (8%), 63 were obese (24%), and 32 with diabetes (12%). One hundred two patients (39%) had a one-level fusion, 105 patients (41%) had two levels fused, and 52 patients (20%) had three or more levels fused. The majority of patients (66%) were covered under workers' compensation. OUTCOME MEASURES/METHODS: Radiographic fusion was deemed successful when the presence of trabecular bridging bone from transverse process to transverse process was observed, as well as no fixation failure nor radiographic evidence of screw loosening. Clinical success was rated excellent, good, fair, or poor depending on the patients pain level, function, and pain medication intake. RESULTS: Biomechanical studies of this intrasegmental fixation system have shown it to be strong under both static and fatigue testing, with exceptional strength in compression bending. In evaluating preservation of lumbar lordosis, no statistically significant loss of lordosis was observed. Overall, radiographic fusion was noted in 229 of 259 patients (88%) and did not differ significantly (p>.10) by the number of levels fused. Clinically, 69 patients (27%) had an excellent result, 111 patients (43%) had a good result, 50 patients (19%) had a fair result, and 29 patients (11%) had a poor result. The high rate of successful patient outcomes did not differ significantly (p>.10) by the number of levels fused, or other patient or surgical variables, except for the satisfaction level of workers' compensation versus nonworkers' compensation. One hundred of 118 patients (85%) who were working before surgery returned to work at an average 9+/-4 months postoperatively (range, 2-20 months). The use of direct current (DC) stimulation in this population was reserved for patients with one or more risk factors for fusion failure and was noted to be of benefit. There were no recorded intraoperative complications, but postoperatively 5 device and 19 non-device-related complications (9%) were noted, which is comparable to other lumbar fusion series. CONCLUSIONS: The results of these analyses show consistent patient outcomes regardless of the number of levels fused with an intrasegmental system. This may be attributable to the increased biomechanical strength of the system at each segment, coupled with the ability of intrasegmental fixation to maintain sagittal plane balance through preservation of the patient's lordotic curve.

Adult↗
PubMedDate not supplied

Use of CA-125 and ultrasound in high-risk women.

Our objective was a retrospective study reporting on ovarian cancer screening in a high-risk female population using both CA-125 and ultrasound over a 7-year period. We used risk estimates of carrying a BRCA mutation that were based on family history. Subjects were screened with CA-125 and ultrasound every 6 months. Each of 311 high-risk subjects had between 1 and 17 screening visits. Overall, 33 of 1209 (2.7%) CA-125 results were abnormal (>35 U/ml); 226 of 1342 (17%) ultrasounds were abnormal, with abnormalities ranging from benign appearing cystic changes to more ominous patterns. Since entry into the program, 29 subjects (9%) have undergone surgery. In 20 of these, the preoperative screening was normal; in six, only the ultrasound was abnormal, and in two, only the CA-125 was abnormal (46-91 U/ml). In only one subject undergoing surgery were both serial CA-125 levels (52-91 U/ml) and ultrasound abnormal. In 7 years of screening, one patient (0.3%) has been diagnosed with ovarian cancer (stage IA, grade 1 endometrioid adenocarcinoma). Overall, 31 (10%) subjects have completed BRCA testing. We conclude that despite screening results comparable to other studies, the detection of only one ovarian cancer over 7 years is lower than expected. Explanations for this observation are discussed. Despite the limitations of CA-125 and ultrasound, we continue to recommend these screening modalities for high-risk women. At the present time, they offer the best opportunity to detect ovarian cancers early. With increasing knowledge of BRCA testing, more women may benefit from this testing in assessing their personal risk.

Adult↗
PubMedDate not supplied

Uterine papillary serous carcinoma: evaluation of multimodality treatment with abdominopelvic radiotherapy and chemotherapy.

The aim of this study was to compare overall survival (OS), progression-free survival (PFS), and relapse patterns between different modalities of treatment for uterine papillary serous carcinoma (UPSC). A retrospective review of 124 patients with pathologically confirmed UPSC was performed, of whom, 97 patients were eligible for study. Postoperative treatment groups included adjuvant radiotherapy consisting of whole abdomen and a pelvic boost (abdominopelvic radiotherapy [APRT]) (55 patients), paclitaxel and carboplatin chemotherapy (CT) for six cycles followed by APRT (18 patients), CT only (5 patients), and 19 patients were observed without postoperative adjuvant therapy. Three-year OS was 81% and 63% for the CT followed by APRT and APRT alone, respectively (P= 0.11). After controlling for stage, the group treated with APRT alone had significantly decreased OS and PFS compared to the CT/APRT group (HR 3.6; 1.3-9.8; P= 0.01) and (HR 2.9; 95% CI 1.1-7.3; P= 0.03), respectively. Within the limitations of a retrospective study, the results of this study indicate that multimodality postoperative treatment with paclitaxel and a platinum-based CT followed by APRT may increase the survival of patients with UPSC. However, further prospective studies using these combined modalities are needed to confirm these findings.

Adenocarcinoma, Papillary↗
PubMedDate not supplied

A retrospective analysis of neoadjuvant platinum-based chemotherapy versus up-front surgery in advanced ovarian cancer.

The objective of this study is to compare progression-free survival (PFS) and overall survival (OS) of ovarian cancer patients treated with neoadjuvant chemotherapy and surgery to primary surgery and postoperative chemotherapy. Retrospective analysis from 1998 to 2003 of 116 patients with ovarian cancer was performed. Fifty women diagnosed by positive cytology received three cycles of carboplatin and paclitaxel. Thirty-six patients subsequently underwent cytoreductive surgery and completed three further cycles postoperatively. The OS and PFS were compared in 66 women treated with primary surgery and postoperative chemotherapy. A statistically significant difference was observed for OS (P= 0.03, HR = 1.85, CI = 1.06-3.23) and PFS (P= 0.04, HR = 1.61, CI = 1.03-2.53) favoring the primary surgery group. Due to the small numbers, age, grade, stage, pleural effusions, and histologic cell type were controlled for separately in the bivariate analyses. Controlling for stage made the results weaker. A matched subgroup survival analysis was performed on patients who had surgery following neoadjuvant chemotherapy. After matching for stage and grade and controlling age and pleural effusions (N= 28 matched pairs), there was no statistical difference for OS (P= 0.95, HR = 1.04, CI = 0.33-3.30) or PFS (P= 0.79, HR = 1.11, CI = 0.98-1.04). It is concluded that primary surgery should be considered in all patients. Neoadjuvant chemotherapy may be an alternative in a subset of women with the intent to also perform interval debulking.

Adenocarcinoma↗
PubMedDate not supplied

A regional network review of health care delivery to children and adolescents with end-stage renal disease.

A detailed survey of dialysis facilities in Texas (ESRD Network No. 11) evaluated the health care delivery to all ESRD patients under 21 year of age. 38 units reported data on 115 patients (50 males, 65 females) ranging in age from 7 months to 20 years. Home peritoneal dialysis was used in 20% of the patients with the rest treated by in-center hemodialysis. 50% of the patients were active transplant candidates at the time of survey; of the remaining 58 patients, there were medical reasons for the nontransplant status of 33 but 25 patients elected to stay on dialysis in the absence of medical contraindications to transplant. The units provided excellent support for the psychosocial, educational, nutritional and growth needs of the children and adolescents surveyed.

Adolescent↗
PubMedDate not supplied

No effect of fetal sex on amniotic fluid alpha-fetoprotein.

OBJECTIVE: To evaluate the effect of fetal sex on the concentration of amniotic fluid alpha-fetoprotein (AF-AFP) in singletons and twins. MATERIAL AND METHODS: Amniocentesis was performed for advanced maternal age between 15 and 20 weeks of gestation. Only patients with normal karyotypes, uncomplicated gestations and normal ultrasound examination were included. AFP was measured in amniotic fluid by RIA and results, expressed as multiples of the median (MoM), were grouped according to fetal sex and were compared by t test. RESULTS: A total of 603 singleton pregnancies (294 females and 309 males) and 45 twin pregnancies discordant for sex met the inclusion criteria. The mean AF-AFP in singleton males was 1.06 vs. 1.04 MoM in singleton females. In twins, the mean AF-AFP was, respectively, 1.05 and 1.07 MoM (p > 0.05). CONCLUSION: Gender had no impact on AF-AFP in singleton or twin pregnancies, suggesting that the differential influence of sex hormones on the activity of the AFP gene is negligible.

Adult↗