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Biomedical subjects

M J Murray

Publications and source records attributed to M J Murray.

At least 109 records · Page 6Linked to original sources
PubMed1993

Effects of cerebrospinal fluid drainage in patients undergoing thoracic and thoracoabdominal aortic surgery.

Cerebrospinal fluid (CSF) drainage has been reported to protect the spinal cord during surgical procedures requiring thoracic aortic cross-clamping. In 1986, CSF pressure monitoring and drainage was begun in an attempt to reduce the incidence of paraplegia associated with surgical repair of descending thoracic and thoracoabdominal aortic aneurysms (TAAA). These Group II patients (n = 50) were retrospectively compared to Group I patients (n = 49) who had undergone similar surgical procedures in the previous 3 years before CSF monitoring was introduced into this practice. Group II patients had intrathecal catheters placed for monitoring of CSF pressure and drainage of CSF to maintain the pressure < or = 15 mmHg. Seven patients (four in Group I, three in Group II) died before recovering from the anesthetic. Of the 47 patients in Group II who survived, none had clinically apparent complications such as an epidural hematoma or meningitis from the intrathecal catheter. The mean aortic cross-clamp time was 58.6 +/- 30.5 minutes (mean +/- SD) in Group I versus 65 +/- 42.6 minutes in Group II. Twenty-three patients in Group I and 16 patients in Group II had a shunt to the distal aorta. To maintain a CSF pressure of < or = 15 mmHg in Group II, an average of 46.9 +/- 6.9 mL of CSF was withdrawn. Of the 45 survivors in Group I, 4 developed a spinal cord deficit; the number of patients with spinal cord deficit in Group II was 4 out of the 47 who survived.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1993

Intraoperative measurement of activated partial thromboplastin time and prothrombin time by a portable laser photometer in patients following cardiopulmonary bypass.

Intraoperative capabilities to rapidly assess coagulation status following cardiopulmonary bypass (CPB) may be of benefit in providing optimal hemostasis and transfusion management, because CPB causes abnormalities in coagulation that may increase morbidity and mortality. The Ciba Corning 512 coagulation monitor (Ciba Corning, Medfield, MA) is a compact and portable device that rapidly determines the prothrombin time (PT) and activated partial thromboplastin time (APTT) in whole blood samples. One hundred patients requiring CPB had APTT and PT determined in whole blood specimens by the 512 coagulation monitor and in plasma specimens by the hospital laboratory from the same arterial blood sample obtained after protamine administration. Correlation coefficients of 0.95 and 0.77 were obtained for the paired APTT and PT tests, respectively (P < 0.01). A bias of 12.6 seconds and 0.77 seconds was determined for the APTT and PT, respectively. The 95% confidence intervals of the bias of the APTT and PT were 9.7 seconds to 15.5 seconds and 0.3 seconds to 1.16 seconds, respectively. The 512 coagulation monitor provided APTT and PT results in less than 3 minutes compared to approximately 45 minutes for the hospital laboratory. A reduction in accuracy was associated with the 512 coagulation monitor PT and APTT when different sampling sites were used. The 512 coagulation monitor accuracy was not affected by a variation of hemoglobin concentration or platelet count between 6 and 12 gm/dL and 15 to 300 x 10(9)/L, respectively. In conclusion, the 512 coagulation monitor provided a rapid APTT and PT result, but the APTT was less accurate. Speeding access to hospital laboratory results would be even more efficacious and accurate.

Adult↗
PubMed1993

Nutritional support of critically ill patients.

Severe depletion of body protein stores can result from prolonged starvation or from hormonal and cytokine-mediated effects during critical illness. Recent advances in the understanding of cytokine actions have substantially refined the interpretation of the nutritional assessment of critically ill patients. In addition, the design of nutritional programs for hospitalized patients has changed considerably during the past decade. Although nutritional support of critically ill patients will not lead to positive nitrogen balance, nutrition can increase protein synthesis, enhance immune function, and beneficially modify the body's response to an illness.

Critical Illness↗
PubMed1993

Depression and category learning.

This article explores the relationship between depression and category learning. We predicted that depression would impair categorization performance on criteria-attribute tasks, which require systematic hypothesis testing, but not on family-resemblance tasks, which allow processing strategies that are likely preserved in depression. These predictions were confirmed in 2 experiments using different stimuli, tasks, and S populations. We discuss some implications of the empirical connections among depression, the use of less sophisticated cognitive strategies, and category learning.

Adult↗
PubMed1993

Postoperative pain. Analgesics make a difference in many ways.

Because pain has so many potent physiologic and psychological effects, successful management of postoperative pain can significantly influence the speed and degree of recovery. Drug therapy combined with nonpharmacologic pain-relief methods and an understanding of each patient's needs are required. Drs Ziser and Murray discuss the types of post-surgical pain experienced by patients and the pharmacologic treatment of this pain.

Analgesia, Patient-Controlled↗
PubMed1993

Improved survival with neoadjuvant therapy and resection for adenocarcinoma of the esophagus.

OBJECTIVE: This study sought to determine the impact of preoperative chemotherapy and radiation therapy (neoadjuvant therapy) followed by resection in patients with adenocarcinoma of the esophagus. SUMMARY BACKGROUND DATA: Long-term survival in patients with carcinoma of the esophagus has been poor. An increase in the incidence of adenocarcinoma of the esophagus has been reported recently. METHODS: Fifty-eight patients with biopsy-proven adenocarcinoma of the esophagus treated at this institution from January 1951 through February 1993 were studied. Since 1989, 24 patients were entered prospectively into a multimodality treatment protocol consisting of preoperative cisplatin, 5-fluorouracil (5-FU), and leucovorin with or without etoposide, and concomitant mediastinal radiation (30 Gy). Patients were re-evaluated and offered resection. RESULTS: There were no deaths related to neoadjuvant therapy and toxicity was minimal. Before multimodality therapy was used, the operative mortality rate was 19% (3 of 16 patients). With multimodality therapy, there have been no operative deaths (0 of 23 patients). The median survival time in patients treated before multimodality therapy was 8 months and has yet to be reached for those treated with the neoadjuvant regimen (> 26 months, p < 0.0001). The actuarial survival rate at 24 months was 15% before multimodality therapy and 76% with multimodality therapy. No difference in survival was noted in neoadjuvant protocols with or without etoposide (p = 0.827). CONCLUSIONS: Multimodality therapy with preoperative chemotherapy and radiation therapy followed by resection appears to offer a survival advantage to patients with adenocarcinoma of the esophagus.

Actuarial Analysis↗
PubMed1993

Measurement of 24-h gastric pH using an indwelling pH electrode in horses unfed, fed and treated with ranitidine.

A glass combined pH-reference electrode was placed in the stomachs of 5 adult horses and pH was recorded every 6 mins for 24 h while (1) feed and all bedding materials were withheld for 24 h (unfed), (2) horses had free access to Timothy grass hay for 24 h (fed), and (3) horses had free access to Timothy grass hay and were treated with ranitidine, 6.6 mg/kg body weight, orally, every 8 h for 48 h (fed + ranitidine). There was a significant (P = 0.007) difference in median 24-h gastric pH amongst the 3 protocols, the value being 3.1 in fed horses and 1.55 in unfed horses (P = 0.05) and 4.6 in fed + ranitidine horses (P = 0.05 compared with fed horses). The percentage of pH readings < 2.0 was significantly greater (P = 0.05) in unfed (76%) than in fed (30%) horses, and in fed horses than in fed + ranitidine (9%) horses. The percentage of readings > 2.0, 3.0, 4.0, 5.0 and 6.0 were each significantly (P = 0.05) greater in fed + ranitidine horses than in fed horses, and in fed than in unfed horses. There was no difference (P = 0.13) between median gastric pH values from different times of day in unfed horses (00:00 to 06:00 h, 1.5; 06:00 to 12:00 h, 1.6; 12:00 to 18:00 h, 1.7; and 18:00 to 24:00 h, 1.5). We conclude that gastric acidity is greatest when horses do not have access to feed material and that ranitidine effectively suppresses gastric acidity in horses under conditions of free access to hay.

Animals↗
PubMed1993

Age-related characteristics of gastric squamous epithelial mucosa in foals.

Specimens of grossly normal gastric stratified squamous epithelial mucosa adjacent to the margo plicatus on the right side and along the greater curvature were obtained from 7 foetuses, 10 term foals and 12 foals 2-35 days old. Gastric squamous epithelium from the foetuses changed markedly during gestation. At 150-270 days, the epithelium was 8-10 cells thick, with a single layer of basal cells. Epithelial cells were polyhedral and had abundant clear or slightly stained cytoplasm. In the 300-day foetus the basal layer was thicker, epithelial cells were polyhedral, and there was a flattened 1 cell-thick layer superficially. In the 335-day foetus, the epithelial cells were flat and there was a superficial layer of keratinised cells, 1-2 cells thick. In term foals, the gastric epithelium consisted of 10-12 cell layers, with 4-5 thin layers of surface keratin. Epithelial projections (papillae) were either absent or not pronounced. The gastric epithelium became thicker with increasing age, including increased epithelial cell layers, thickening of the keratinised layers, and more pronounced papillae. Desquamation was observed in the keratinised layers of gastric squamous epithelium from foals > or = 2 days of age.

Aging↗
PubMed1993

Effects of endotoxin on pigs prefed omega-3 vs. omega-6 fatty acid-enriched diets.

We investigated in a porcine model whether omega-3 fatty acids modify the physiological response to sepsis. For 8 days, 16 male pigs were fed a diet containing 18% fat by weight enriched with either omega-3 or omega-6 fatty acids (FA). A group of six pigs receiving their regular diet served as controls. The omega-3 FA-supplemented pigs had elevated levels of omega-3 FA in their serum-free FA, serum phospholipid (PL), and platelet PL levels compared with either of the other groups. On the ninth day, the unanesthetized pigs were injected with 0.3 mg/kg of endotoxin (Escherichia coli) intravenously. The animals had a significant decrease in their arterial O2 pressure (PaO2) [from 84.4 +/- 6.8 (SD) to 64 +/- 9.4, and from 83.1 +/- 7.2 to 55.9 +/- 6.3 mmHg in the omega-6 FA and regular diet groups, respectively]. The PaO2 did not decrease in the omega-3 FA pigs. The omega-3 FA group had significantly lower pulmonary vascular resistance (541 +/- 205 dyn.s.cm-5) 20 min after endotoxin compared with either the omega-6 FA or regular diet groups (797 +/- 233 and 1,102 +/- 552 dyn.s.cm-5, respectively) and more normal blood pressure compared with the other two groups. Plasma thromboxane (Tx) B2 and 6-ketoprostaglandin F1 alpha (6-keto-PGF1 alpha) levels were lowest in the omega-3 FA diet group and highest in the regular diet group.(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of Variance↗
PubMed1992

Gastric ulceration in horses: 91 cases (1987-1990).

Gastroendoscopy was performed on 111 horses (1 to 22 years old) that had signs of abdominal discomfort of variable duration and severity. At least 1 episode of colic had been observed within 48 hours of examination in 31 horses. Recurrent episodes of colic were observed in 28 horses within 2 to 10 days of examination, 31 horses within 11 to 30 days, 12 horses within 31 to 60 days, and in 9 horses at more than 60 days after the initial examination. Gastric ulceration was found in 91 of 111 horses examined. Other abnormalities involving the gastrointestinal tract or other abdominal viscera were not found on examination in 57 of 91 horses with gastric ulcers. The most frequent concurrent abnormalities found in the remaining 34 horses with gastric ulcers were impaction of the large colon (n = 6), colonic tympany (n = 6), peritonitis (n = 6), gastric impaction (n = 4), ileocecal intussusception (n = 3), small-colon impaction (n = 4), and proximal enteritis (n = 2). Thirteen horses with gastric ulceration underwent abdominal surgery, and in 5 horses, lesions were not found at surgery. Gastric ulceration was determined to be the primary cause of colic in 31 horses on the basis of the lack of other abnormalities, clinical response to treatment with histamine type-2 receptor (H2) antagonists, and confirmation of improvement or resolution of gastric ulceration via endoscopy. Gastric ulceration was the suspected cause of colic in 26 other horses on the basis of the lack of other abnormalities, severity of lesions, and clinical response to treatment with H2 antagonists.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1992

A national survey on the practice patterns of anesthesiologist intensivists in the use of muscle relaxants.

OBJECTIVE: To determine the practice patterns of anesthesiologist intensivists (with the special certificate of competence in critical care medicine from the American Board of Anesthesiology) in the use of neuromuscular blocking drugs, in the ICU setting. DESIGN: A survey. PARTICIPANTS: All anesthesiologists with the special certificate of competence in critical care (n = 374) were selected for this study. Of the 339 who could be contacted and who were still actively practicing, 185 (55%) completed the survey. RESULTS: In the ICU setting, anesthesiologist intensivists most commonly used vecuronium (52%) administered by bolus injection, bolus injection followed by infusion, or by continuous infusion. The most frequent indication for muscle relaxation was facilitation of mechanical ventilation (89%). Neuromuscular blockade was most commonly monitored clinically (55%), with only 34% of respondents using a peripheral nerve stimulator. All respondents indicated the concomitant use of sedatives or narcotics with muscle relaxants. CONCLUSIONS: This study was created to address the dearth of information regarding actual usage of muscle relaxants in the ICU setting. The survey population was chosen as one with great familiarity in the use of muscle relaxants. The 55% response rate was significantly greater than the expected response rate for a single mailing survey. In the ICU setting, neuromuscular blocking drugs are most frequently used to facilitate mechanical ventilation. The prevalence of vecuronium use is of interest in light of recent case reports of prolonged neuromuscular blockade after long-term vecuronium administration. The low frequency of peripheral nerve stimulator monitoring during muscle relaxation may contribute, in part, to the problem of prolonged blockade after drug withdrawal. Muscle relaxants are not used in the absence of sedation and/or analgesia by this practitioner population.

Anesthesiology↗
PubMed1992

The effects of stress on gastric ulceration, T3, T4, reverse T3 and cortisol in neonatal foals.

Sixteen neonatal foals stressed by disease underwent endoscopic examination of their stomachs and blood was assayed for triiodothyronine (T3), reverse T3 (rT3), thyroxine (T4) and cortisol, to determine the effects of severe physiological stress and the occurrence of gastric ulcers. compared with eight age-matched controls, six foals had abnormal cortisol, seven had abnormal T3 and 12 had abnormal T4. Eleven of 13 foals had rT3 outside the 95 per cent confidence interval for clinically normal foals of comparable ages. Gastric lesions were seen more frequently in stressed foals, and gastric glandular mucosal lesions were noted in 40 per cent of the stressed foals. Previous studies report low (3 per cent) occurrence of gastric mucosal lesions. The frequency of squamous mucosal lesions was not different from that reported previously, indicating that stress has little effect on the development of lesions at this site.

Animals↗
PubMed1992

The effects of famotidine, ranitidine and magnesium hydroxide/aluminium hydroxide on gastric fluid pH in adult horses.

Gastric fluid pH was measured in five adult horses following nasogastric administration of famotidine, 0.5, 1.0, and 2.0 mg/kg bodyweight (bwt); ranitidine, 4.4 and 6.6 mg/kg bwt and an antacid containing magnesium hydroxide (40 mg/ml) and aluminium hydroxide (45 mg/ml), 120 and 180 ml. Fluid was aspirated through a 16 French nasogastric feeding tube at 15 min intervals, and pH was measured using a pH meter. Basal gastric fluid pH was measured at 20 min intervals for 6 h in each horse and, with the exception of two measurements of 4.66 and 4.17, ranged from 1.42 to 2.41, with a mean pH of 1.88 +/- 0.18. The response to both ranitidine and famotidine was variable between horses and between dosages. The mean gastric fluid pH values following administration of a single dose of famotidine or ranitidine were famotidine, 0.5 mg/kg bwt, 3.63 +/- 1.72; famotidine, 1.0 mg/kg bwt, 3.41 +/- 1.40; famotidine, 2.0 mg/kg bwt, 4.18 +/- 2.06; ranitidine, 4.4 mg/kg bwt, 4.07 +/- 1.25; ranitidine 6.6 mg/kg bwt, 5.34 +/- 1.12. Differences in mean gastric fluid pH between famotidine dose levels and between ranitidine dose levels were not significant (P > 0.10). Gastric fluid pH increased to greater than 6 in three horses receiving 0.5 mg/kg bwt, five horses receiving 1.0 mg/kg bwt and three horses receiving 2.0 mg/kg bwt famotidine. Gastric fluid pH increased to greater than 6 in each of the five horses receiving 6.6 mg/kg bwt ranitidine and in four of five horses receiving 4.4 mg/kg bwt ranitidine. During the 6 h post administration, ranitidine tended to increase gastric fluid pH greater than 6 longer (166 +/- 106 mins) than famotidine (98 +/- 110 mins) and this difference was nearly significant (P = 0.054). The response to antacid was variable and consistently short-lived. The mean gastric fluid pH values for 6 h after administration of 120 ml or 180 ml were 2.42 +/- 0.71 and 2.44 +/- 0.47, respectively. Gastric fluid pH increased to greater than 6 in only two horses, for 15 and 30 mins, respectively. The increase in gastric fluid pH was significantly greater for ranitidine (P < 0.001) and famotidine (P < 0.02) than for antacid. The duration of the effect was significantly longer for ranitidine doses (P < 0.001) and nearly so for famotidine doses (P < 0.055) than for antacid.

Aluminum Hydroxide↗
PubMed1992

Epidermal growth factor-like activity in mares' milk.

Epidermal growth factor (EGF)-like activity was measured in mares' colostrum and milk by radioreceptor assay. Milk samples were collected from 22 mares 1 or more times during early lactation. Samples of colostrum were taken after parturition and before the foal first suckled (presuckle), within 6 hours after the foal first suckled (postsuckle), and on days 1, 2, 4, and 8 of lactation. In the 5 mares from which milk samples were obtained at each sampling time, presuckle colostral mean EGF-like activity (17.8 ng/ml) was greatest (P less than 0.05). The mean values for EGF-like activity at all other sampling times were not significantly different from each other (postsuckle colostrum, 9.7 ng/ml; day 1, 9.6 ng/ml; day 2, 8.5 ng/ml; day 4, 8.0 ng/ml; day 8, 7.8 ng/ml).

Animals↗
PubMed1992

Spinal cord injury in experimental thoracic aortic occlusion: investigation of combined methods of protection.

The efficacy of combined methods of spinal cord protection during thoracoabdominal aortic reconstruction was evaluated because a recent clinical study failed to substantiate the value of cerebrospinal fluid drainage when used alone in the prevention of paraplegia. The effect of cerebrospinal fluid drainage and aortofemoral shunting were analyzed with regard to neurologic outcome and spinal cord blood flow in a model of thoracic aortic occlusion. In addition, we studied the use of motor-evoked potentials as compared with somatosensory-evoked potentials in monitoring cord perfusion. Thirty-two dogs underwent proximal and distal thoracic aortic occlusion for 60 minutes. The control group (n = 8) underwent thoracic aortic cross-clamping only. Spinal cord protection was used in three groups: cerebrospinal fluid drainage alone (n = 8), aortofemoral shunting alone (n = 8), and cerebrospinal fluid drainage and aortofemoral shunting (n = 8). Neurologic outcome improved in all treatment groups as compared with controls (p less than 0.001). The addition of cerebrospinal fluid drainage to aortofemoral shunting did not further improve neurologic outcome. Spinal cord blood flow measured with microspheres in the lumbar gray matter was significantly higher in the dogs with aortofemoral shunting (+/- cerebrospinal fluid drainage) as compared with those with cerebrospinal fluid drainage alone (p less than 0.05) or the controls (p less than 0.001). Aortofemoral shunting also prevented the development of acidosis and hyperglycemia. Loss or changes in amplitude and latency of motor-evoked potentials did not distinguish between the groups. Loss of somatosensory-evoked potentials had a high sensitivity (92%) but lower specificity (68%) in predicting neurologic injury, whereas loss of motor-evoked potentials had a high specificity (100%) but a very low sensitivity (16%). We conclude that cerebrospinal fluid drainage or aortofemoral shunting significantly improve spinal cord blood flow and neurologic outcome. The greatest increase in spinal cord blood flow was seen with aortofemoral shunting, which also prevented metabolic disturbances of reperfusion. Although the addition of cerebrospinal fluid drainage to aortofemoral shunting was the only group in which no neurologic injury occurred, this group did not have a significant improvement in outcome when compared with aortofemoral shunting alone. Spinal cord ischemia was more accurately detected with somatosensory-evoked potentials when aortofemoral shunting was used, whereas motor-evoked potentials recorded from the spinal cord were not sensitive enough to predict neurologic injury.

Analysis of Variance↗