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Biomedical subjects

M E Murray

Publications and source records attributed to M E Murray.

At least 19 recordsLinked to original sources
PubMed1997

The clinical importance of axillary lymphadenopathy detected on screening mammography.

The aim of this study was to determine the incidence and cause of axillary lymphadenopathy detected by screening mammography and to devise a management protocol for this pathology. In a retrospective study of 95,806 consecutive screening mammograms, 37 cases of 'pathological' axillary nodes were identified using two or more of the following criteria: size > 2 cm, replacement of fatty hilum, rounded shape and generalized increased density. In 16 cases with an additional mammographic abnormality, 12 had a mass (10 malignant and two benign) and four had suspicious calcification (all malignant). In 12 of these cases, the lymph nodes showed malignancy (75%). In 21 patients with lymphadenopathy alone on screening, six patients had a known underlying diagnosis and were not recalled from screening. The remaining 15 patients were recalled for further assessment including fine needle aspiration cytology (FNAC). The ultimate diagnosis was benign in 10 cases (48%)--six reactive changes, one healed granulomatous disease, one rheumatoid arthritis, one amyloid and one acute infection--and malignant in 11 cases (52%)--six non-Hodgkin's lymphoma, four metastatic carcinoma and one leukaemia. In conclusion, there is a high incidence of malignant nodal involvement in cases of screen detected lymphadenopathy (62% of cases in our series). We would advise that patients with lymphadenopathy as the sole finding on screening mammography and in whom there is no known underlying cause should undergo FNAC followed by excision biopsy. Fifty per cent of such patients in this study had underlying malignancy.

Aged↗
PubMed1996

Comparisons of outcomes of maternity care by obstetricians and certified nurse-midwives.

OBJECTIVE: To determine whether pregnancy outcomes differ by provider group when alternative explanations are taken into account. METHODS: Pregnancy outcomes were compared for 710 women cared for by private obstetricians and 471 cared for by certified nurse-midwives. At intake, all women qualified for nurse-midwifery care. They were retained in their original group for analysis, even if they were later referred to physicians. Infant and maternal mortality, 30 clinical indicators, satisfaction with care, and monetary charges were studied. The study site's history and philosophy of honoring consumer choice of provider precluded random assignment, but multivariate analyses minimized the effects of multiple confounding factors. The statistical power was adequate for the study design. RESULTS: Significant differences (P < .05) between the obstetrician and nurse-midwife groups were found for seven clinically important outcomes: infant abrasions (7 versus 4%), infant remaining with mother for the entire hospital stay (15 versus 27%), third- or fourth-degree perineal laceration (23 versus 7%), number of complications (0.7 versus 0.4), satisfaction with care, average hospital charges ($5427 versus $4296), and average professional fee charges ($3425 versus $3237). When maternal risk, selection bias, and the medical intensiveness of care were controlled, the provider group did not continue to have an independent effect on infant abrasions, hemorrhage, and professional fee charges; when women's preferences were added, the difference in hospital charges disappeared. However, the provider group continued to have significant independent effects on the other four outcomes. Interaction effects were not significant. CONCLUSION: Although most outcomes were equally good, important differences between obstetrician and nurse-midwife care remained after multivariate analysis.

Adolescent↗
PubMed1996

The role of ultrasound in screening patients referred for sialography: a possible protocol.

In a prospective study, ultrasound examination of the salivary glands was performed in 31 consecutive patients referred for sialography. Good correlation between ultrasound and digital sialography was observed in 26 patients with only one false negative ultrasound in a patient with significant sialectasis. We recommend initial ultrasound examination in patients with symptoms suggesting an inflammatory lesion in the salivary glands. If this is normal or reveals a solid mass, sialography is not indicated. If ultrasound examination demonstrates the presence of calculi, duct dilatation, cystic elements or an enlarged gland, digital sialography should be performed to identify lesions in the main duct such as strictures or obstructing calculi.

Adolescent↗
PubMed1994

Osteomyelitis of the skull base: the role of high resolution CT in diagnosis.

Osteomyelitis of the skull base (involving the temporal, occipital or sphenoid bones) is an uncommon condition occurring in elderly diabetic patients which was almost always fatal in the pre-antibiotic era. Despite the advent of effective antibiotics against the usual causative organism, Pseudomonas aeruginosa, the mortality remains high and is related to delay in diagnosis and inappropriate treatment. We report three cases of osteomyelitis of the skull base, in order to illustrate the difficulties encountered in diagnosis and management. The CT scan appearances, which would appear to be typical for the disease, are described and the pathogenesis of skull base osteomyelitis is discussed.

Aged↗
PubMed1993

Diarrhea associated with Aeromonas species in children in day care centers.

Outbreaks of diarrhea caused by enteropathogens have been reported in day care centers (DCC), but Aeromonas species have not been implicated. This study evaluated 381 children involved in 51 outbreaks in four DCC to determine the association of Aeromonas species with diarrhea and to characterize the isolates. The organism was identified in two outbreaks of diarrhea. In one, Aeromonas species were isolated from 6 (24%) of 25 children and in the other from 5 (21%) of 24 children. Seven other Aeromonas strains from children in DCC were studied. Fourteen (78%) of 18 were Aeromonas caviae and 15 were from children with diarrhea. Of the isolates, 75% did not have plasmids detected; all others had unique plasmid patterns. All strains had different DNA content. Twenty-two control isolates of Aeromonas from children with diarrhea in Mexico and Dallas had different chromosomal DNA patterns. Most Aeromonas infections were associated with symptoms. Chromosomal DNA patterns differentiated Aeromonas strains better than did plasmid DNA patterns. The outbreaks of diarrhea were unusual in that several different Aeromonas genospecies were involved in each outbreak.

Aeromonas↗
PubMed1992

Acute renal failure in bone marrow transplantation.

Acute renal failure (ARF) is a serious complication in clients who have undergone bone marrow transplantation (BMT). The majority of cases develop as a result of intrarenal damage. Renal ischemia or nephrotoxic drugs, free hemoglobin, and free myoglobin contribute to acute tubular necrosis (ATN), which is the most likely cause of ARF in BMT clients. Nursing care of hospitalized BMT clients is directed toward the prevention of ARF by identifying clients who are at risk, the early diagnosis of renal impairment, and the administration of comprehensive treatment. Nurses play a vital role in the early diagnosis of renal impairment by assessing the client's fluid status, serum and urine electrolyte levels, and daily weights. The nursing role in managing clients with ARF includes preventing drug nephrotoxicity, maintaining fluid and electrolyte balance, preventing infection, and providing emotional support.

Acute Kidney Injury↗
PubMed1983

Information processed from brief visual displays by learning-disabled boys.

The spans of apprehension of learning-disabled and normal boys were compared by means of a forced-choice letter-recognition task involving tachistoscopic exposures of letter displays. This task provides an estimate of the span that is relatively insensitive to memory or motivational influences. In Experiment 1, the spans of learning-disabled and normal boys were compared under 4 information conditions: with no noise letters present or with 2, 4, or 8 noise letters present. Experiments 2-4 examined 3 possible interpretations of the deficit in the span of apprehension observed for learning-disabled boys in Experiment 1. In Experiment 2, the possibility that the noise letters were more distracting for learning-disabled boys was examined by varying the amount of physical similarity and redundancy between the signal and noise letters. In Experiment 3, the possibility that the visual afterimage of the letter displays faded more rapidly for the learning-disabled boys was examined. In Experiment 4, the possibility that the learning-disabled boys were slower to pick up information from the decaying afterimages was examined. The results of these three experiments indicated that the decreased spans of apprehension observed for the learning-disabled boys in Experiment 1 resulted either from greater distractiveness or from the slower pickup of information, or both. The implications for visual training are discussed.

Attention↗
PubMed1983

Locus of control and achievement motivation in dyslexic children.

Sixty-five dyslexic children and 38 normal children were assessed on internal versus external locus of control and on achievement motivation as measured by formal questionnaires and by teacher ratings. Results indicate less internal locus of control for academic success and general life situations in dyslexic children. A significant relationship between internal locus of control and achievement motivation was found in dyslexic children. Results are discussed with reference to feelings of learned helplessness and depression in learning-disabled children, and to the importance of psychological management of the dyslexic child.

Achievement↗
PubMed1981

Palliative care.

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Aged↗