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Biomedical subjects

P Murphy

Publications and source records attributed to P Murphy.

At least 109 records · Page 6Linked to original sources
PubMed1997

The anthropometric assessment of dysmorphic features in schizophrenia as an index of its developmental origins.

BACKGROUND: Evidence suggests that schizophrenia may be a disorder with origins in early intrauterine mal-development. We have constructed a comprehensive anthropometric scale for the evaluation of dysmorphic features as an index of the nature and timing of developmental disturbance. METHOD: A detailed set of craniofacial and bodily measures was compiled and applied to 174 patients with schizophrenia and 80 matched control subjects. RESULTS: Patients had significantly higher scores on this scale and displayed multiple anomalies of the craniofacial region with an overall narrowing and elongation of the mid-face and lower face. Twelve craniofacial anomalies independently distinguished patients from controls and these variables correctly classified 95% of patients and 80% of control subjects. CONCLUSIONS: This new scale, while procedurally more exacting than the Waldrop scale, more clearly defines the topography of anomalies previously suspected in individuals with schizophrenia. These findings constitute direct evidence for disturbed craniofacial development in schizophrenia and indicate origins in the foetal period during which the characteristic human facial pattern evolves in close association with brain differentiation.

Abnormalities, Multiple↗
PubMed1997

Time quantified detection of fetal movements using a new fetal movement algorithm.

Primarily, the objective is to develop an automated ultrasound fetal movement detection system that will better characterize fetal movements. Secondarily, the objective is to develop an improved method of quantifying the performance of fetal movement detectors. We recorded 20-minute segments of fetal movement on 101 patients using a UAMS-developed fetal movement detection algorithm (Russell algorithm) and compared this to a Hewlett-Packard (HP) M-1350-A. Movements were recorded on a second-per-second basis by an expert examiner reviewing videotaped real-time ultrasound images. Videotape (86,592 seconds) was scored and compared with the electronic movement-detection systems. The Russell algorithm detected 95.53% of the discrete movements greater than 5 seconds, while the HP system (M-1350-A) detected only 86.08% of the discrete movements (p = 0.012). Both devices were less efficient at detecting the short discrete movements, obtaining sensitivities of 57.39 and 35.22, respectively. Neither system fully identifies fetal movement based on the second-per-second system. Improved methods of quantifying performance indicated that the Russell algorithm performed better than the HP on these patients.

Adolescent↗
PubMed1997

Effect of lipid and propofol on oxidation of haemoglobin by reactive oxygen species.

The clinical formulation of the i.v. anaesthetic propofol contains both the substrate for and inhibitor of lipid peroxidation. In these in vitro experiments we have investigated the importance of this potential conflict in a system where haemoglobin was oxidized by reactive oxygen species generated by hypoxanthine and xanthine oxidase. The presence of lipid in the system accelerated the rate of haemoglobin oxidation. Propofol inhibited lipid-induced acceleration but not the underlying rate of reactive oxygen species-induced oxidation. The rate of conjugated diene production, measured semi-quantitatively by ultraviolet absorption at 234 nm, was not reduced by propofol. Propofol may act by preventing haemoglobin oxidation by lipid hydroperoxides.

Anesthetics, Intravenous↗
PubMed1997

Left ventricular function during exercise testing and training.

Left ventricular function (LVEF) deteriorates during incremental exercise (GXT) in patients with ischemia (+ISCH). Left ventricular (LV) functional response during steady-state exercise, typical of that used in exercise training, are unknown. We compared LVEF in patients with documented coronary heart disease (CHD) who either had (+) or did not have (-) ISCH, and in healthy volunteers (CONTROL) during GXT and steady state. First pass RNA was performed during upright cycle GXT at rest (R), at the ventilatory threshold (VT), and at maximal exercise (Max); and during steady state at the workload associated with VT after 10, 20, and 30 min of exercise. RNA allowed measurement of ejection fraction (EF) and wall motion (WM); ISCH was mild, angina being relieved by momentary reductions in workload during steady state. Although +ISCH demonstrated the expected deterioration in LV function during GXT (decreased EF, abnormal WM)(EF = 58 to 56 to 54%), there was no evidence for progressive deterioration of LV function during steady state despite the presence of mild ISCH (56 to 56 to 54 to 54%). In -ISCH and CONTROL there were normal responses of EF during GXT (43 to 51 to 51% and 59 to 65 to 61%) and steady state (43 to 51 to 53 to 51% and 59 to 65 to 68 to 69%). We conclude that mild ischemia may be tolerated during steady-state exercise at levels consistent with exercise training without progressive deterioration of LV function.

Adult↗
PubMed1997

Aspirin-induced post-gingivectomy haemorrhage: a timely reminder.

A case report is described of significant aspirin-induced haemorrhage following a gingivectory procedure in an organ transplant patient. Aspirin-induced platelet impairment secondary to low-dose aspirin was implicated as the cause of the haemorrhage. Haemostasis was eventually achieved after platelet transfusion. The case illustrates the problems that can arise when carrying out gingival surgery on patients medicated with low-dose aspirin.

Adult↗
PubMed1997

Test of Xq26.3-28 linkage in bipolar and unipolar affective disorder in families selected for absence of male to male transmission.

BACKGROUND: There have been several reports of linkage between genetic markers on the X chromosome at Xq26.3-28 and bipolar affective disorder in family samples obtained from distinct ethnic and geographical origins. As part of a genome search in a series of 23 UK and Icelandic families, specifically selected for their large size and power to resolve the issue of linkage heterogeneity, we have tested the hypothesis that there is a locus for a genetic subtype of bipolar affective disorder which is linked to this region. METHOD: In families selected on the basis of absent male to male transmission for affective disorder, we performed two-point and FASTMAP multipoint linkage analyses with markers spanning the region between the genetic loci DXS102 and F8. RESULTS: We found negative lod scores for several models of affection status in families selected under stringent and relaxed criteria for the absence of male to male transmission. CONCLUSIONS: In the family sample we have obtained, our study provides no support for the presence of a locus increasing genetic susceptibility to bipolar affective disorder in this region of the X chromosome. It is likely that our finding reflects heterogeneity of linkage for bipolar and genetically related unipolar disorder that exists in specific ethnic populations. Alternatively the X-linked subtype of the disorder may have been present only in a few of our small families resulting in loss of power to detect the Xq26.3-28 linked subtype.

Genetic Linkage↗
PubMed1997

The effects of platelet inhibitors on platelet uptake and restenosis after femoral angioplasty.

OBJECTIVE: To investigate the effects of two platelet inhibitors, aspirin and iloprost, on platelet uptake and restenosis at the site of angioplasty in patients undergoing femoral or popliteal angioplasty. EXPERIMENTAL DESIGN: Prospective, open, randomised group comparison. SETTING: Two university hospitals. PATIENTS: 43 patients undergoing femoral or popliteal angioplasty were randomised. INTERVENTIONS: Patients received either aspirin (300 mg/day), iloprost (8 hours/day i.v. infusion) or no antiplatelet medication during angioplasty and on the subsequent two days. MEASURES: Platelet uptake was measured using 111Indium-labelled platelets. Restenosis was assessed by repeat angiography at 3 months and clinical symptoms up to 12 months. RESULTS: Median changes in platelet uptake were similar in the three treatment groups, but all platelet radioactivity ratios > 2.0 occurred in the control group. Restenosis at 3 months was observed in 3 control, 5 aspirin and 1 iloprost patient. Further surgical intervention was performed in 3 control and 3 aspirin patients, but in none of the iloprost patients up to 12 months after angioplasty. CONCLUSIONS: Antiplatelet therapy may prevent large increases in platelet deposition at the angioplasty site, but the link between platelet deposition and restenosis was not substantiated in this study.

Aged↗
PubMed1997

Human immunodeficiency virus risk awareness. Evaluation of a CME program for family physicians.

OBJECTIVE: To determine whether a continuing medical education (CME) program on AIDS risk awareness would enhance physicians' knowledge of HIV and AIDS, their "intent-to-change" practice behaviour, and their ability to integrate their knowledge into hypothetical clinical scenarios; and to identify participant characteristics that affect their knowledge of risks and how they intend to behave regarding HIV testing. DESIGN: Before-and-after study using a questionnaire. SETTING: The city of Winnipeg and 16 rural communities in Manitoba. PARTICIPANTS: Convenience sample of physicians who attended the AIDS Risk Awareness Program and completed a questionnaire before the presentation (96 of 142 eligible physicians). MAIN OUTCOME MEASURE: A two-point or greater change on a Likert scale in the desired direction for each questionnaire item. RESULTS: Physicians were classified as sensitized or less sensitized depending on previous experience with HIV-positive and AIDS patients. Less sensitized physicians significantly improved their scores in all three areas. Sensitized physicians and women physicians significantly improved their knowledge and reported more intent to ask patients routinely about HIV risk behaviours. Physicians' sex, age, religion, and years in practice had an effect on these improvements. CONCLUSIONS: The AIDS Risk Awareness Program was successful in improving physicians' knowledge, attitude to intent-to-change behaviour and ability to integrate knowledge into practice scenarios. Physicians with true learning needs benefited the most from the CME program.

Adult↗
PubMed1996

Genetic counseling in a Navajo hereditary nonpolyposis colorectal cancer kindred.

BACKGROUND: Cross-cultural genetic counseling was provided to an extended Navajo Indian family in which the MLH1 gene mutation for hereditary nonpolyposis colorectal cancer (HNPCC) had been identified. The family had been observed by the authors since 1983 and over the years had been provided with intensive education regarding the natural history of HNPCC as well as recommendations for cancer surveillance and management that was responsive to this natural history. METHODS: Following identification of the MLH1 mutation, DNA from family members was evaluated by a reference laboratory (OncorMed, Gaithersburg, MD), where sequences were checked in both the forward and reverse directions against the published sequence for MLH1. The 4bp deletion beginning at the first nucleotide of codon 727 was easily visualized in the heterozygous condition in both affected and predispositional individuals. The family was reeducated as a group and then provided further education individually during genetic counseling sessions, at which time they were appraised of potential penalties, such as insurance and employer discrimination, and psychological sequelae that could result from knowledge of the MLH1 mutation. Strict confidentiality of this information was assured. RESULTS: DNA testing was performed on 51 family members. Twenty-three individuals were counseled, seven of whom were positive for MHL1. Reactions ranged from full acceptance of the genetic implications to traditional Navajo reasoning such as the family had been cursed. CONCLUSIONS: DNA-based genetic counseling requires comparison and empathy, coupled with intensive preeducation regarding potential penalties and advantages that might emanate from this knowledge. Special care must be given to patients' culture, beliefs, and traditions.

Adult↗
PubMed1996

Prevalence studies of GB virus-C infection using reverse transcriptase-polymerase chain reaction.

Among the three recently described GB viruses (GBV-A, GBV-B, and GBV-C), only GBV-C has been linked to cryptogenic hepatitis in man. Because of the limited utility of currently available research tests to determine antibody response to GBV-C proteins, the prevalence of GBV-C RNA in human sera was studied using reverse transcription-polymerase chain reaction (RT-PCR). The prevalence of GBV-C is higher among volunteer blood donors with elevated serum alanine aminotransferase (ALT) levels (3.9%) than among volunteer blood donors with normal ALT levels (0.8%). Higher rates were also noted among commercial blood donors (12.9%) and intravenous drug users (16.0%). GBV-C was frequently detected in residents of West Africa, where the prevalence was > 10% in most age groups. Approximately 20% of patients diagnosed with either acute or chronic hepatitis C virus (HCV) were found to be positive for GBV-C RNA. In addition, GBV-C RNA sequences were detected in individuals diagnosed with non-A-E hepatitis, with clinical courses ranging from mild disease to fulminant hepatitis. Fourteen of sixteen subjects with or without clinically apparent hepatitis were positive for GBV-C RNA more than 1 year after the initial positive result.

Flaviviridae↗
PubMed1996

Motor neuron disease, lymphoproliferative disease, and bone marrow biopsy.

Some have suggested that nonfamilial motor neuron disease (MND) may be autoimmune, and the neurological disorder may benefit from immunotherapy. There have been reports of over 30 cases of lymphoproliferative disease (lymphoma, multiple myeloma, Waldenström's macroglobulinemia) with MND, and these patients might he offered immunosuppressive therapy. Bone marrow examination might increase the sensitivity of the diagnostic workup for lymphoma and other lymphoproliferative disorders. We examined the bone marrow in our first evaluation of 161 patients with MND seen at Columbia-Presbyterian Medical Center during 1991-1994. Four of 161 patients (2.5%) had lymphoproliferative disease in the marrow; only 1 of these had a monoclonal paraprotein. Routine bone marrow examination of patients with MND increases the diagnostic yield of lymphoproliferative diseases. The frequency of these bone marrow abnormalities in comparison with a group of age-matched control subjects should be studied further.

Adolescent↗
PubMed1996

Embryonic development of Schwann cells: multiple roles for neuregulins along the pathway.

During the past few years important advances have been realized in the understanding of the molecular and cellular mechanisms operating in the differentiation of Schwann cells from neural crest cells. In particular the development of in vitro culture systems has allowed the analysis of commitment to the Schwann cell lineage, identification of an intermediate between the neural crest cell and the Schwann cell, and initial analysis of the factors controlling determination and differentiation processes. These studies point in particular to major roles for neuregulins which appear to be involved in the control of cell survival, proliferation, and differentiation, as well as of gene expression at different levels of the pathway.

Animals↗
PubMed1996

Generalization effects of training on the Wisconsin Card Sorting Test for schizophrenia patients.

Several studies have demonstrated that schizophrenia patients can improve their performance on the Wisconsin Card Sorting Test if given appropriate training. However, it is not clear if they are learning a generalizable problem-solving strategy rather than a circumscribed rule. We examined this question by training patients on one of two related problem-solving tests and assessing transfer of training effects across the two instruments; a third group received practice on both tests, but no training. Subjects were 27 schizophrenia patients in the latter stages of an acute hospital admission. While subjects in both training conditions exhibited marked improvement on the trained test, the results failed to reveal any evidence of generalization. Subjects trained on one test performed no better on the other instrument than subjects who received practice only. These results suggest that gains in WCST performance reported in the literature after brief training or instructions may not reflect any meaningful changes in problem solving capacity or in any underlying neurological function. Implications of the findings for rehabilitation programs are discussed, along with limitations of the data and recommendations for future research.

Adult↗
PubMed1996

Comparison of magnetic resonance imaging measurements of abdominal aortic aneurysms with measurements obtained by other imaging techniques and intraoperative measurements: possible implications for endovascular grafting.

PURPOSE: Abdominal aortic aneurysm morphologic evaluation with conventional imaging techniques is inadequate when endovascular repair is being contemplated. This study has addressed the problem with magnetic resonance imaging (MRI). METHODS: Twenty patients (14 men, 6 women) with a median age of 73 years were recruited and assessed according to current endovascular graft selection criteria. Thirteen patients subsequently underwent open aneurysmorrhaphy, and the intraoperative parameters have been compared with those of duplex ultrasonography and MRI. RESULTS: No significant difference was demonstrated in the diameter of the infrarenal neck among ultrasonography, MRI, and intraoperative findings (p > 0.05, Mann Whitney U Test) and also during assessment of infrarenal neck length; however, duplex sonography accurately defined the renal ostia in only five cases. MRI visualized 38 of 40 renal arteries. Distal aortic involvement (cuff diameter and length) and the length and diameter of the common iliac arteries were accurately determined by MRI in all cases, and no significant difference was demonstrated with the intraoperative findings. Comparison of the intraoperative and MRI aneurysm lengths suggested a slight trend of overestimation by MRI resulting from angulation of the aneurysm, but this figure did not reach statistical significance. Only two patients met the current criteria for endoluminal straight grafting. CONCLUSIONS: Both MRI and duplex sonography accurately predicted aortic morphologic characteristics; however, MRI provided the most comprehensive anatomic picture for patient selection and should be considered the nonionizing imaging modality of choice when an endovascular repair is being contemplated.

Aged↗