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Biomedical subjects

M C Murphy

Publications and source records attributed to M C Murphy.

At least 55 records · Page 3Linked to original sources
PubMed1991

Risk factors for cardiac operations in adult Jehovah's Witnesses.

During a 27-year-period, 663 adults of the Jehovah's Witness faith underwent open heart procedures at the Texas Heart Institute. To determine the effect of recent changes in operative techniques and in the patient population itself on early mortality, we reevaluated the surgical outcome in this special group of patients. We reviewed the charts of 88 consecutive Jehovah's Witness patients who had an open heart operation between January 1986 and March 1989 and compared demographic variables in this group with those of 575 patients who underwent operation between May 1963 and January 1986. In our recent series, patients were older (mean age, 61 years versus 54 years), and 16% were seen for repeat procedures. Early mortality (less than or equal to 30 days postoperatively) was lower in the recent series than in the earlier series (7.0% versus 10.7%), but the difference between the groups was not statistically significant. We identified several important factors associated with an increased risk of early death in the recent group of patients. These factors included repeat cardiac operations (p less than 0.01), especially for valvar dysfunction, severe left ventricular dysfunction (defined as an ejection fraction less than 0.35) (p less than 0.01), and a hemoglobin level lower than 80 g/L (8 g/dL) (p less than 0.01) on postoperative day 1. Although blood loss remains the leading cause of death in these patients, cardiac operations can be performed with an acceptable mortality.

Aged↗
PubMed1990

Surgical treatment of cardiac tumors: a 25-year experience.

From 1964 to 1989, we performed operations on 133 patients with cardiac tumors. There were 58 male and 75 female patients ranging in age from three days to 81 years; 101 were adults, and 32 were children (less than 12 years of age). Primary tumors (102 benign and 12 malignant) were found in 114 patients and metastatic tumors in 19. Symptoms included congestive heart failure, arrhythmias, emboli, and chest pain. Diagnosis was accomplished through angiography, echocardiography, computed tomography, and magnetic resonance imaging. Operative treatment encompassed techniques ranging from biopsy to complete excision (including hypothermic circulatory arrest and cardiac autotransplantation) depending on the site of disease and the extent of involvement. Overall operative survival was 91%. Twelve patients died early (within 30 days of operation), and follow-up was obtained for 110 (90.9%) of the remaining 121 survivors (total patient-years of follow-up, 572.8; mean follow-up, 5.2 years). Of the 20 patients who died late, 15 had malignant disease. Operative survival for patients with primary cardiac malignancies and for those with metastatic disease was 83% and 68.4%, respectively, with 3 and 5 patients, respectively, still living. We advocate an aggressive surgical approach, especially in patients with benign tumors, who can expect an excellent outcome. For patients with malignant or metastatic disease, palliation and cure are also possible if aggressive surgical actions are taken.

Adenocarcinoma↗
PubMed1990

Management of chylopericardium.

Chylopericardium is a rare entity that may be congenital in origin or secondary to surgical trauma, mediastinal lymphangiomas-hygromas, or radiation. Current treatment progresses from dietary medium-chain triglycerides and pericardiocentesis, to pericardial drainage, to thoracotomy with pericardiectomy and thoracic duct ligation. Between January 1986 and January 1989, we treated four children with chylopericardium: three secondary to mediastinal lymphangioma-hygroma, and one following cardiac surgery. The patients ranged in age from newborn to 16 years. All had signs of cardiac tamponade and three underwent initial pericardiocentesis or tube drainage. One 6-week-old infant with a mediastinal cystic hygroma developed chylopericardium following resection of the hygroma and responded to 9 days of tube drainage. The remaining children did not respond to repeated pericardiocenteses or prolonged drainage and underwent pericardial-peritoneal shunting with Denver shunts. The shunt was removed in 14 days in one patient. One patient had the shunt exteriorized for 8 weeks and one patient continues to use the shunt after 3 years. The chylopericardium resolved in each case without recurrence. Pericardial-peritoneal shunting provides a simple and effective alternative to prolonged pericardial drainage or thoracotomy in patients with chylopericardium of various etiologies.

Adolescent↗
PubMed1990

Bidirectional crossover and late outcome after coronary angioplasty and bypass surgery: 8 to 11 year follow-up.

Between March 1978 and July 1981, 217 symptomatic patients underwent coronary angioplasty as an alternative to coronary bypass surgery. Angioplasty was successful in 143 patients (66%), unsuccessful but uncomplicated in 65 (30%) and complicated in 9 (4%) by one or more of the following criteria: Q wave myocardial infarction (2%), emergency surgery (4%) or death (0.5%). Late follow-up evaluation was obtained in 213 patients at a mean of 9 +/- 1 years. Of patients in whom angioplasty was successful, 59 (42%) of 140 required another revascularization procedure (repeat angioplasty in 26% and bypass surgery in 16%). The actuarial survival rate at 5, 9 and 10 years after successful angioplasty was 98%, 93% and 92%, respectively. Of the 65 patients with unsuccessful and uncomplicated angioplasty (usually as a result of technical factors), 58 underwent elective bypass surgery within 2 months and 56 survived. These 56 surgical patients were compared with the 140 patients with successful angioplasty. Univariate analysis of prognostic factors did not reveal significant differences between these two groups. At late follow-up study, the successful angioplasty and the successful surgical groups had similar rates of survival (93% versus 95%, p = NS) and of death or infarction, or both (11% versus 12.5%, p = NS). Repeat revascularization was required more frequently after successful angioplasty than after surgery (42% versus 18%, p less than 0.001). Crossover from angioplasty to surgery occurred slightly more often than from surgery to angioplasty (16% versus 12.5%, p = NS). The time to crossover from angioplasty to surgery occurred earlier than from surgery to angioplasty (mean 21 versus 76 months, p less than 0.001).

Angioplasty, Balloon, Coronary↗
PubMed1990

Coronary angioplasty after coronary bypass surgery: initial results and late outcome in 422 patients.

From 1978 to 1988, coronary angioplasty was performed in 422 patients with prior coronary artery bypass surgery (264 patients with native coronary artery angioplasty and 158 patients with graft angioplasty). Angioplasty was successful in 84%, unsuccessful but uncomplicated in 11% and complicated by one or more major cardiac events in 5% (myocardial infarction 5%, emergency bypass surgery 2% and death 0.2%). Follow-up data were obtained in 99% of 356 patients with successful angioplasty. At a mean of 33 +/- 26 months, 92% were alive, 73% had improvement in angina and 61% were free of angina. One or more of the following late events occurred in 67 patients (19%): myocardial infarction (6%), elective reoperation (13%) and cardiac death (6%). Repeat angioplasty was performed in 27%, with a success rate of 89% and no deaths. Initial success rates were equal in native vessel versus graft angioplasty, but late outcome was less favorable with the latter because of a higher rate of infarction (11% versus 4%, p less than 0.05) and need for reoperation (19% versus 10%, p less than 0.05). The initial success rate was higher in vein grafts less than 1 year old compared with grafts 1 to 4 years or greater than 4 years after operation (92% versus 85% versus 83%, respectively) and adverse late events were less frequent after angioplasty in recent vein grafts (less than 1 year 13%, 1 to 4 years 35%, greater than 4 years 29%; less than 1 versus greater than 1 year, p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Angina Pectoris↗
PubMed1990

Cor triatriatum and anomalous pulmonary venous return: an unusual case.

In December 1954, a 29-year-old man with cor triatriatum underwent partial surgical repair consisting of left atrial implantation of a single anomalous pulmonary vein that had been draining into the innominate vein. In April 1989, at age 64, he returned for definitive cardiac repair. The contrast between these 2 procedures illustrates the tremendous progress that has been made in cardiac diagnosis and surgery during the past 35 years.

Journal Article↗
PubMed1989

Pleuroperitoneal shunts in the management of persistent chylothorax.

Between June 1981 and June 1988, we placed pleuroperitoneal shunts in 16 patients for the management of refractory chylothorax on the Pediatric Surgical Service, University of Virginia. The cause of the chylothorax was caval thrombosis from central venous catheters in 5 patients, idiopathic in 3, and mediastinal lymphangioma in 2, and in 6, it developed after a cardiac procedure. Chylothorax in each patient was unresponsive to thoracentesis, tube thoracostomy, and dietary manipulations. A Denver double-valved shunt system is currently employed and is implanted using general anesthesia. Manual pumping is required postoperatively for several months. Twelve (75%) of the 16 patients had excellent results with complete elimination of the chylothorax and resolution of symptoms. In 10 of these 12, the shunt has been removed. Four had an unsatisfactory result: 3 had inferior vena cava hypertension, and 3 were low-birth-weight premature infants. Four patients seen early in this series required revision of the position of the pleural catheter, with successful drainage in each instance. Pleuroperitoneal shunting is a safe, simple, and effective treatment of chylothorax in infants and children. In view of our success in treating chylothorax with these shunts, we recommend early shunting before the development of nutritional or immunological depletion.

Adolescent↗
PubMed1989

Optical verification of a technique for in situ ultrasonic measurement of articular cartilage thickness.

Several investigators have used pulse-echo ultrasonics to measure the thickness of articular cartilage in situ. The underlying assumption in all measurements was that the second reflection used in thickness calculations was from the calcified-cartilage/cartilage boundary (tidemark). To investigate this assumption, the thickness of 24 cartilage plugs excised from a human femoral head was measured both ultrasonically and optically. Measurements established that the second reflection was from the tidemark and validated the ultrasonic technique as a method of mapping the thickness distribution of articular cartilage in synovial joints in situ.

Acetabulum↗
PubMed1989

DNA-DNA homology among lactose- and sucrose-fermenting transconjugants from Lactococcus lactis strains exhibiting reduced bacteriophage sensitivity.

DNA-DNA homology between a reduced bacteriophage sensitivity (Rbs+) probe and DNA from both Rbs+ and Rbs- Lactococcus lactis strains was examined. Homology was detected between the probe and five plasmids (pCI750, pCC34, pEB56, pNP2, and pJS88) isolated from lactose-positive Rbs+ transconjugants and between the probe and genomic DNA of a sucrose-positive Rbs+ transconjugant. Additionally, hybridizations conducted between the probe and plasmids reported to encode abortive bacteriophage infection indicated homology with pTR2030 but not with pBF61 and pGBK17. The results suggest that a common genetic determinant(s) may be present in a variety of lactococcal plasmids coding for Rbs+.

Bacteriophages↗
PubMed1989

Choice of a childbirth method after cesarean.

Concern about the rising cesarean-section rate and the high percentage of elective repeat cesareans led to an exploratory, retrospective examination of women's decision-making about a childbirth method after cesarean. Fifty women who had delivered by a repeat cesarean (RC) or vaginal birth after cesarean (VBAC) participated in a telephone interview. Three questions were addressed: (1) who made the decision for a birth method; (2) what factors were associated with the choice of method; and (3) was the choice of method associated with the actual method of delivery? The majority of women (90%) perceived that they were the primary decision-maker for a birth method, and choice of birth method was positively associated with actual method of delivery. The major reason for VBAC choice was to experience a vaginal birth, whereas the primary reason for RC choice was to avoid an unsuccessful labor. Other factors associated with choice of a birth method were: sources of information and support, beliefs, previous cesarean experience and locus of control. These findings have important implications for enhancing women's health-care decision-making, as well as for reducing the rate of repeat-cesarean deliveries.

Adult↗
PubMed1989

Education of patients undergoing coronary angioplasty: factors affecting learning during a structured educational program.

A structured educational program for patients undergoing coronary angioplasty was designed and administered to 97 patients undergoing their first procedure. Knowledge, coping style, social support, health locus of control, IQ, and demographic and medical factors were assessed before the procedure. Risk factor knowledge, anxiety, and medical status were assessed before discharge, and at 6 months and 2 years after angioplasty. Total knowledge mean score for all patients was higher at discharge (p less than 0.05). There was no significant difference between knowledge scores at baseline and at either 6 months or 2 years. Analyses revealed that patients with a repressive coping style learned less during hospitalization (p less than 0.05). No factors predicted retention of knowledge at 6 months or 2 years. These results indicate that a structured educational approach may have beneficial effects on immediate knowledge gain, although these results are not sustained. Coping assessment may provide information valuable for understanding differences in knowledge retention.

Adult↗
PubMed1989

Cardiac surgical emergencies.

Cardiac surgical emergencies are broken down into three categories: cardiac trauma, aortic dissection, and surgery for acute myocardial infarctions. Emphasis is given to describing the presentation of patients with such problems, and to the salient aspects of the clinical strategies for managing each problem. An important goal of each section is focusing the critical care physician on the early recognition of cardiac surgical emergencies and providing him with some rationale for instituting an expeditious plan of therapy.

Aged↗
PubMed1988

Transluminal coronary angioplasty in the treatment of silent ischemia.

Fifty-four asymptomatic patients with positive thallium exercise tests underwent coronary angiography followed by coronary angioplasty (PTCA), as the primary therapy for silent ischemia. The procedure was technically successful in 89% of these patients. Emergency bypass graft surgery was necessary in 2 (3.6%) and q-wave myocardial infarction occurred in 1 (1.8%) of these. All fifty-four patients have been followed for a mean of 35 months since angioplasty. Of the 48 patients with initially successful PTCA, 12 had either clinical restenosis (9/14 or 19%) or a new lesion (3/48 or 6%) during follow-up, which required a repeat PTCA. At the longest follow-up, 46 (85%) had been successfully treated with on or more PTCA procedures. Two patients (3.6%) had sustained late q-wave myocardial infarction and two additional patients reported angina pectoris. There were no deaths. Angioplasty as a primary therapy for silent ischemia appears efficacious, with success and restenosis rates comparable to those in the symptomatic population. Event-free survival is improved, compared with natural history data for patients with silent ischemia from other studies. Prudent risk/benefit analysis may help to define subgroups most likely to benefit from this intervention.

Adult↗
PubMed1988

Concomitant conjugal transfer of reduced-bacteriophage-sensitivity mechanisms with lactose- and sucrose-fermenting ability in lactic streptococci.

Ten previously reported lactose-positive (Lac) transconjugants from Streptococcus lactis, S. cremoris, and S. lactis subsp. diacetylactis and one sucrose-positive (Suc) transconjugant from S. lactis were examined for their sensitivity to prolate- and small isometric-headed bacteriophages. Four of the Lac transconjugants showed a 10- to 100-fold reduction in the efficiency of plating (EOP) as well as a reduced plaque size for the prolate phage c2 and were insensitive to the small isometric phage 712. A fifth Lac transconjugant demonstrated a similar reduced sensitivity to phage c2; however, this transconjugant was able to plaque phage 712, but with a reduced plaque size and EOP. The other five Lac transconjugants were sensitive to both c2 and 712 phages. The Suc transconjugant plaqued phage 712 with a reduced plaque size and EOP, but no reduction in plaque size or EOP was observed for phage c2. The Lac and reduced bacteriophage sensitivity (Rbs) phenotypes were correlated with specific plasmids in the Lac transconjugants. As four of the Lac transconjugants exhibited a phenotypically indistinguishable Rbs, one (AB001) was selected for further study. The Rbs in AB001 for both small isometric- and prolate-headed phages was not related to adsorption, and the reduced EOP for phage c2 was not related to the presence of a restriction and modification system. The latent period for phage c2 was unchanged, but the burst size was reduced 80%. The presence of the plasmid coding for Rbs retarded the lysis of a mitomycin C-induced prophage-containing strain. The Rbs mechanism appears to be abortive phage infection. This study supports previous observations that Rbs and conjugal transfer ability are physically linked among some group N streptococci. The results presented have implications in the identification of plasmids coding for Rbs and may also aid in explaining the dissemination of Rbs genes among lactic streptococci.

Journal Article↗