Search PubMed⌕ Search

Biomedical subjects

M S Murphy

Publications and source records attributed to M S Murphy.

At least 37 records · Page 2Linked to original sources
PubMed1996

Glucose polymer as a cause of protracted diarrhea in infants with unsuspected congenital sucrase-isomaltase deficiency.

OBJECTIVE: To describe four infants with protracted diarrhea caused by glucose polymer intolerance resulting from congenital sucrase-isomaltase deficiency. METHODS: The diagnosis of congenital sucrase-isomaltase deficiency was established by mucosal disaccharidase assay. In each case the clinical response to discontinuation of glucose polymer was documented. RESULTS: The median age at the onset of symptoms was 3 weeks (range, 2 to 16 weeks). In three infants the formula had been prescribed for presumed postgastroenteritis diarrhea, and in a fourth it was begun after resection of a short-segment congenital ileal atresia. In each infant watery diarrhea occurred and persisted for many months, and it was assumed that the original gastrointestinal disorder was responsible. In two cases, parenteral nutrition was administered for persistent failure to thrive. Ultimately, investigation revealed the underlying congenital sucrase-isomaltase deficiency, and elimination of glucose polymer from the diet led to immediate recovery in each case. CONCLUSION: Congenital sucrase-isomaltase deficiency should be considered a possible cause of protracted diarrhea in infants receiving glucose polymer-based feedings.

Carbohydrate Metabolism, Inborn Errors↗
PubMed1996

Radial opening wedge osteotomy in Madelung's deformity.

Radiopalmar opening wedge osteotomy was used in 11 female patients (12 wrists) with Madelung's deformity who ranged in age from 9 to 31 years. Five patients met the radiographic criteria for generalized dyschondrosteosis. Clinically, there was dissatisfaction with the appearance of the wrist. The principal motion deficits were in radiocarpal extension and forearm pronosupination associated with varying degrees of discomfort with sustained activity. All had a decreased radioulnar angle, lunate subluxation shown radiographically, and various degrees of dorsal subluxation of the ulnar head. Indications for surgery were pain, limited motion, cosmetic appearance, and progressive deformity in two immature patients. Biplanar corrective opening wedge osteotomy of the radius was performed with iliac crest graft. Three patients had an added ulnar recession. Fixation was with a plate or Kirschner wire. Supplementary distracting external fixation was used in six cases. The follow-up period averaged 48 months. Pain relief in all patients was satisfactory. Range of motion and grip strength were not influenced. The radioulnar angle improved by 11 degrees, but lunate subluxation was minimally changed. Length of the forearm and bowed appearance of the forearm were improved. Reduction of the radioulnar joints was improved but remained incongruous.

Adolescent↗
PubMed1996

Risk factors for liver rejection: evidence to suggest enhanced allograft tolerance in infancy.

After liver transplantation, a relatively low intensity immunosuppressive regimen is employed in our unit: after initial triple therapy (prednisolone, azathioprine, cyclosporin), prednisolone is discontinued at three months and azathioprine at one year. A retrospective study was therefore performed to determine the incidence of rejection, and to identify risk factors for rejection in our patient population. Over a 10 year period, 135 transplants were performed on 109 children. Thirty four (25%) were on infants less than 1 year old. Incidences of acute rejection and irreversible chronic rejection were calculated for grafts surviving more than one and four weeks respectively. Acute rejection occurred in 51 of 101 allografts (50%), and irreversible chronic rejection in 11 of 91 allografts (12%). The immunosuppression strategy was not associated with an increased incidence of rejection. Acute rejection occurred in only eight of 28 allografts (29%) in those transplanted during their first year, compared with 43 of 73 (59%) in older children. Logistic and Cox regression analysis supported age at transplantation as a significant risk factor for acute rejection. Irreversible chronic rejection did not occur in any of 24 grafts in patients transplanted before one year, compared with 11 of 67 (16%) in older recipients. This suggests possible enhanced allograft tolerance with transplantation during the first year of life. This unexpected and potentially important finding now requires confirmation in other large patient series, with blind interpretation of post-transplant liver biopsies.

Adolescent↗
PubMed1995

Biliary complications after paediatric liver transplantation: Birmingham's experience.

Between 1983 and 1992, 112 children underwent liver transplantation. Of 138 grafts, 60 (43.4%) were whole livers, 77 (55.6%) were reduced livers, and 1 (0.7%) was a split liver. Biliary complications (BC) were defined as any abnormality, even minor, related to the biliary tract. Results were analysed with a minimum follow-up of 9 months. Some 36 grafts (26.1%) in 34 patients (30.4%) presented with BC: bile leaks (17 grafts), biliary obstructions or dilatations (16 grafts), and other complications (3 grafts). Management was mainly surgical with biliary reconstruction via a Roux-en-Y loop. Interventional radiology had an increasing role in recent years. BC were associated with a mortality of 1.8% (2/112), a graft loss rate of 4.3% (6/138), and significant morbidity. Among the various factors whose association with BC was studied, the date of transplantation, the use of reduced grafts and the use of gallbladder conduits appeared to be the main determining factors for BC. From multivariate analysis the use of reduced grafts emerged as the most important factor in reducing BC. We therefore conclude that BC are associated with significant morbidity, but general improvements in both surgical and medical management seem to account for better results in recent years.

Adolescent↗
PubMed1995

Nutritional care and candidates for small bowel transplantation.

Twenty two children were evaluated for small bowel transplantation between 1989 and 1994. Eight were unfit for transplantation and died within three months; a raised plasma bilirubin concentration (> 200 mumol/l) predicted death from liver failure within six months (p = 0.0001). The 11 children who were not managed by a multidisciplinary nutritional care team were less well nourished at referral, had more complications with intravenous feeding catheters, and greater early mortality while awaiting transplantation (p < 0.05). It is recommended that children with chronic intestinal failure be referred for assessment early, before liver dysfunction is established.

Adolescent↗
PubMed1995

Evaluation of the Abuscreen ONLINE assay for amphetamines on the Hitachi 737: comparison with EMIT and GC/MS methods.

The performance of the ONLINE Assay for Amphetamines on the Hitachi 737 was compared to the Syva Emit d.a.u. Assay and GC/MS. Randomly screened (n = 2964) patient urine samples were assayed using ONLINE and Emit d.a.u. assays concurrently, using d-amphetamine, 1000 ng/mL and d-methamphetamine, 1000 ng/mL as the screening cutoff for ONLINE and Emit d.a.u. assays, respectively. All presumptive positives were confirmed by GC/MS. The specificity was 99% (2937/2964) for ONLINE and 97% (2873/2964) for Emit. Agreement with GC/MS was 80% (110/137) for ONLINE and 55% (110/201) for Emit.

Amphetamines↗
PubMed1992

Gut hormones and gastrointestinal motility in children with cystic fibrosis.

Intestinal dysmotility may be an important factor contributing to various gastrointestinal complications associated with cystic fibrosis. Motilin, enteroglucagon, neurotensin, and peptide YY may each play a role as endocrine hormones influencing gastrointestinal motor activity. Fasting children with cystic fibrosis (N = 8) and controls (N = 18) received a liquid nutrient test meal (fat 4 g/100 ml, protein 4 g/100 ml, carbohydrate 20 g/100 ml, 125 kcal/100 ml; 200 ml/m2) containing lactulose (5 g/100 ml), and the plasma concentrations of these peptides were studied. Mouth-to-cecum transit time was simultaneously studied using the breath H2 technique. Fasting levels of peptide YY and the postprandial response of all four peptides were significantly increased in those with cystic fibrosis. In repeat studies on those with cystic fibrosis after a period of altered pancreatic enzyme supplementation, no significant changes in peptide concentrations were observed. A rise in breath H2 permitting estimation of mouth-to-cecum transit time was noted in 17 control subjects (70-220 min, median 140). In contrast, a rise occurred in only two with cystic fibrosis after low-dose enzyme (70 and 180 min), and four after high-dose enzyme replacement (120-230 min, median 155). Altered gut hormone secretion may play a role in the pathophysiology of intestinal dysmotility in patients with cystic fibrosis.

Adolescent↗
PubMed1991

Celiac disease.

Explore the source record for details and available documents.

Celiac Disease↗
PubMed1990

Non-invasive assessment of intraluminal lipolysis using a 13CO2 breath test.

Techniques available for the study of lipase activity in the gut are unsatisfactory. Breath tests measuring labelled carbon dioxide (13CO2) may provide a useful means for this assessment. Six subjects with cystic fibrosis and pancreatic insufficiency and 10 controls received a test meal containing [13C] trioctanoin, and breath 13CO2 was measured using a dual inlet, dual detector isotope ratio mass spectrometer. Comparison of postprandial breath 13CO2 enrichment allowed complete separation between children with pancreatic insufficiency and controls. Administration of one capsule of pancreatic enzyme with the test meal resulted in an increase in 13CO2 production in all six patients, and four capsules produced a further increase in five of the six. Serial fat balance studies on four of the patients while receiving comparable doses of oral enzyme failed to demonstrate a progressive improvement in fat absorption. The [13C]trioctanoin breath test may prove a safe, non-invasive technique not only for the detection of pancreatic insufficiency, but also for the quantitative study of intraluminal lipolysis.

Breath Tests↗
PubMed1990

An adjustable splint for forearm supination.

The adjustable supination splint is used in select cases in which traditional mobilization therapy is not productive in supination gains. The success of the splint varies depending on many factors, including the type and severity of the injury; the timing of the intervention; the patient's age; and the patient's tolerance of and compliance with the treatment program. The therapist must consult with the physician and have his or her approval before initiating the treatment regimen. Splint use is contraindicated in patients with unstable fractures or with injuries that require surgical intervention before splinting. Therapists should watch for edema, pain, and neurological changes. Depending on the severity of these symptoms, the splint may need to be discontinued or the wearing time and tension adjusted. In our experience at Union Memorial Hospital and in our weighing of the above considerations, we have found favorable results in the use of the adjustable supination splint, with gains in range of motion and function in select patients.

Adolescent↗
PubMed1989

Active and passive sugar absorption in pancreatic insufficiency.

Urinary excretion of lactulose, mannitol, and 3-0-methylglucose, following oral administration (5 g, 5 g, and 2 g, respectively, in 100 ml H2O; 80 ml/m2), has been measured in subjects with cystic fibrosis (CF) (22), Shwachman syndrome (3), chronic pancreatitis (3), and normal controls (46). Mean lactulose excretion was increased 10-fold in CF (p less than 0.001), and two-fold in other disorders associated with pancreatic insufficiency (PI) (p less than 0.05). Mean mannitol excretion was 1.6 times greater in CF (p less than 0.001), compared with controls, but was reduced in other forms of PI (p less than 0.03). The mean lactulose/mannitol excretion ratio was increased in all types of PI (p less than 0.001). There were no significant differences in 3-0-methylglucose excretion. This study confirms the large increase in lactulose absorption recently reported in CF and also demonstrates increased absorption of mannitol; these changes are different than those in other forms of PI. This study provides further evidence for a specific abnormality of the mucosal barrier to the absorption of passively absorbed, water soluble molecules in CF.

3-O-Methylglucose↗
PubMed1989

Intestinal permeability in Crohn's disease.

Crohn's disease may present insidiously, especially in childhood, and diagnosis may be delayed. In addition, the clinical assessment of the extent of disease activity may be inaccurate. Using mannitol and lactulose as probe molecules we have carried out a cross sectional study of intestinal permeability in patients with active Crohn's disease (n = 17) and control subjects (n = 31). Activity was assessed by an activity index score. The lactulose:mannitol urinary excretion ratio was significantly increased in Crohn's disease. Overall sensitivity was 82%, and 92% when activity was moderate or severe. When permeability was compared with the activity index there was a significant correlation among patients. In five patients studied longitudinally a significant correlation was also present. Measurement of intestinal permeability is non-invasive, and may be useful both as a screening test in patients with non-specific symptoms, and for the assessment of the extent of disease activity in patients with Crohn's disease.

Adolescent↗