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Biomedical subjects

R D Murray

Publications and source records attributed to R D Murray.

At least 127 records · Page 7Linked to original sources
PubMed1990

Efficacy and safety of a diazepam and meperidine combination for pediatric gastrointestinal procedures.

Little has been published about outpatient sedation for pediatric patients. We designed a study to evaluate the efficacy and adverse effects of diazepam and meperidine in combination for sedation in ambulatory pediatric patients undergoing endoscopy, colonoscopy, or liver biopsy. Thirty patients (7 months-20 years) were observed. Each patient received a single combined dose of intravenous diazepam and meperidine. The standard dose was 0.1 mg/kg for diazepam and 2.0 mg/kg for meperidine. In patients weighing greater than 100 lb, set doses of meperidine (100 mg) and diazepam (5 mg) were used. The time to achieve sedation and the vital signs were measured; cooperation, emotional state, and drowsiness were rated before, during, and after procedures. The amnesic effect was noted, as were any adverse effects. Diazepam and meperidine were effective in 26 of 30 patients, with sedation generally produced within 2-3 min. Cooperation and emotional state improved significantly following drug administration (p less than 0.05). When a prospective 24-h telephone follow-up study was instituted in 40 consecutive patients receiving diazepam and meperidine no significant adverse effects were noted. Only 20% of patients old enough to be questioned remembered the procedure. Diazepam and meperidine in combination appear to be effective and safe in pediatric patients undergoing gastrointestinal procedures. Prolonged monitoring of patients does not appear necessary in this patient population.

Adolescent↗
PubMed1990

Cisapride for intractable constipation in children: observations from an open trial.

Twelve patients with chronic constipation refractory to the vigorous use of emollients, enemas, and/or laxatives were chosen for study of the investigational prokinetic agent, Cisapride. The patients included 8 boys and 4 girls with diagnoses of functional constipation. Ages ranged from 2 to 13 years; duration of symptoms before Cisapride use ranged from 1.5 to 9.75 years; duration of previous treatment ranged from 0.75 to 6 years. The mean number of doses of anticonstipation agents employed per week was 14. Of the 12 patients, 10 had persistent encopresis, while 11 required hospitalization for disimpaction an average of 1.6 times in the year prior to Cisapride use. Three had chronic urinary tract complaints. Anal manometry suggested a sensory deficit in 8 of 10 patients tested. Ganglion cells were identified by rectal biopsy in all 12 patients. Cisapride treatment (0.14-0.3 mg/kg/dose) spanned 26-72 weeks (61 +/- 12). Stool frequency per week was not significantly changed, but five of seven patients who had reported hard stools had softer stools on the drug (p less than 0.05). Encopresis ceased in 8 of 10 cases, while the number of episodes decreased substantially in the other 2 cases (p less than 0.05). All alternate forms of anticonstipation therapy were withdrawn in 8 of 12 cases (p less than 0.001). Urinary problems improved in two of the three patients reporting symptoms. One patient showed no improvement in any parameter while on the agent, despite 26 weeks of administration. Side effects were infrequent, generally occurred early, and were limited to cramping, nausea, mild vomiting, anorexia, and headaches. One patient ceased use of the drug for persistent headaches.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

The uptake of amino acids and oxygen across the rabbit uterus in normal and postterm pregnancies.

Nineteen pregnant rabbits were studied at three different gestational ages in terms of uterine uptake of amino acids and oxygen under unstressed, steady-state conditions. The three gestational age groups were: (1) 23-25 days, (2) 26-31 days, and (3) 32-34 days (post term). The arteriovenous differences for all amino acids except glutamate and aspartate were significant in groups 1 and 2. Uterine amino acid coefficients of extraction were markedly reduced in the postterm animals (3), despite an increased uterine coefficient of extraction for oxygen. The uterine coefficients of extraction of amino acids were 2-2.5 times greater than those across the pregnant Uterus of the sheep. There was also an increased uptake of amino acid per millimoles/liter of oxygen in the rabbit compared to the sheep. Maternal arterial amino acid concentrations were not significantly different in groups 1 and 2, but the gluconeogenic amino acids serine and alanine were significantly increased in maternal arterial blood of postterm animals.

Absorption↗
PubMed1990

Valproic acid-associated pancreatitis: report of three cases and a brief review.

We describe three patients with seizure disorders in whom pancreatitis or pancreatic injury was probably caused by valproic acid, a widely used anticonvulsant drug. Trivial or no increases of serum amylase (EC 3.2.1.1) but striking increases of serum lipase (EC 3.1.1.3) were common to all patients, as assayed in the Kodak Ektachem. In vitro, valproic acid does not cause any change in serum lipase. In patients with symptoms suggestive of pancreatitis and abnormal values for amylase and (or) lipase, treatment with valproic acid should be discontinued.

Adolescent↗
PubMed1990

Routine postcesarean urine culture. A cost-effectiveness analysis.

Paired urinalysis and urine culture reports on 302 postcesarean patients were studied to determine whether screening postcesarean urinalyses could be useful in predicting positive urine cultures. A positive culture was predicted with a specificity of 97.5% and a sensitivity of 90.4%. The screening urinalysis had a positive predictive value of 73.1% and a negative predictive value of 99.3%. Routine postcesarean urine cultures were not found to be cost effective.

California↗
PubMed1990

Epidural analgesia. Effect on the likelihood of a successful trial of labor after cesarean section.

From October 1984 to April 1986, 237 women who had had an earlier cesarean section underwent a trial of labor (TOL). The delivery outcomes for 87 who received epidural analgesia were compared retrospectively with those for the 150 who did not. There were no overt uterine ruptures. The rates were similar for successful TOL, uterine scar dehiscence, blood transfusions, endometritis and one- and five-minute Apgar scores. The rate of operative vaginal delivery was higher in the epidural group. When epidural subjects were divided into vaginal and cesarean delivery groups, the failed-TOL group differed from the successful-TOL group in greater maternal weight gain, heavier and longer infants, higher rate of oxytocin administration, less cervical dilation and higher station at epidural activation. When the oxytocin-treated subjects were excluded, however, the epidural and no-epidural patients had the same successful TOL rates (94% and 92%, respectively) and spontaneous vaginal delivery rates (70% and 76%, respectively). Epidural analgesia, when controlled for oxytocin use, appears to have no effect on the failed-TOL or operative vaginal delivery rate.

Adult↗
PubMed1990

Intestinal metaplasia is age related in Barrett's esophagus.

The correlation among cellular characteristics of Barrett's esophagus, patient age, and malignant neoplasm is not well documented. This study, which describes a population of 66 patients with Barrett's esophagus spanning 1 to 80 years of age, analyzes the cellular constituents of their lesional tissues by endoscopic biopsy and histochemical and morphometric studies. Goblet cell metaplasia, identified in 50% (n = 14) of pediatric patients, increased significantly to involve 84% (n = 32) of biopsy specimens from adult patients with Barrett's esophagus. This increase was exponential by linear regression analysis (R2 = .64) between the ages of 5 and 29 years. Pediatric patients usually had 25 or less goblet cells per square millimeter of Barrett mucosa with no identifiable epithelial dysplasia or cancer; Nissen fundoplication lessened esophageal inflammation, but the Barrett mucosa persisted. Goblet cell metaplasia maintained a plateau (mean of 57 cells per square millimeter of Barrett mucosa) between the ages of 41 and 80 years. Dysplasia, in situ carcinoma, or invasive carcinoma was found in patients with Barrett's esophagus who were aged 41 years or older. This study demonstrates persistence of Barrett mucosa, increased incidence of goblet cell metaplasia, and predictable changes in goblet cell number with advancing patient age. The relationship between Barrett mucosa and malignant neoplasm remains uncertain, but the goblet cell may serve as a marker of disease chronicity in which setting neoplasia evolves.

Adolescent↗
PubMed1990

Oxytocin use after previous cesarean: why a higher rate of failed labor trial?

When used for patients undergoing trial of labor after previous cesarean, oxytocin is associated with an increased failure rate. Previous reports have not studied why this occurs. From October 1984 to April 1986, 237 patients with previous cesareans underwent a trial of labor. The delivery outcomes of 73 women who received oxytocin were compared with those of the 164 who did not. Rates were similar for uterine scar dehiscence, uterine rupture, operative vaginal delivery, blood transfusions, endometritis, and low Apgar scores. Successful trial of labor occurred in 68% in the oxytocin group, compared with 89% in the no-oxytocin group. Failed trial of labor was significantly more frequent in patients who received oxytocin for induction of labor than in those who did not. When subjects who received oxytocin were divided into induction (N = 47) and augmentation (N = 26) groups, successful trial of labor occurred in 58% of the former group versus 88% of the latter group. Other characteristics of the augmentation group were spontaneous labor, greater cervical dilation and effacement at initiation of oxytocin, shorter duration of infusion, and lower oxytocin infusion rates. For patients who have had previous cesareans and who desire trial of labor, oxytocin by controlled infusion is safe. Successful trial of labor may be enhanced by awaiting spontaneous labor or inducing with a favorable cervix.

Adult↗
PubMed1989

Coumarins.

Explore the source record for details and available documents.

Coumarins↗
PubMed1989

Stimulatory effects of short-chain fatty acids on colonic absorption in newborn piglets in vivo.

This study examined the absorption of short-chain fatty acids (SCFA) and their effects on colonic conservation of water and sodium. Newborn York piglets, 2-23 days of age and exclusively suckled, were studied comparing absorption from a control/electrolyte solution with that from a SCFA solution. The results indicated that SCFA absorption is highest at birth, with a rapid decline over 72 h to a lower and relatively stable level. During the control perfusions, water and sodium absorption increased with age. The addition of SCFA to the perfusate stimulated both water and sodium uptake in the first 2 weeks. After the 14th day, sodium absorption continued to be enhanced by SCFA, but water movement remained unchanged from control levels. Right and left colon responses were similar. The results suggest that although luminal SCFA levels may be limited early in life, the presence of SCFA has stimulatory effects on the absorption of sodium and water from the colon in newborns.

Animals↗
PubMed1989

Routine predelivery coagulation screening in previous cesarean patients: impact on patient management.

Coagulation profiles (platelet count, prothrombin time, partial thromboplastin time) obtained as part of predelivery screening were examined in patients who presented for delivery with a history of previous cesarean section. Coagulation test results (N = 1439) were reviewed from charts of 482 patients. No change in patient management occurred and no cesarean sections or vaginal deliveries were deferred as a result of the laboratory tests. There were no hemorrhagic complications. No blood products were transfused as a result of the tests. Routine coagulation evaluation is not justified for subsequent delivery of patients who had a previous cesarean section.

Blood Coagulation Tests↗
PubMed1989

Digestion, absorption, and fermentation of carbohydrates.

Newborn infants born after a term gestation appear to have an adequate capacity for small intestinal digestion and absorption of carbohydrate. Premature infants do not have a mature level of intestinal lactase activity. Apparently, in the premature infant, colonic fermentation serves an important, if not the only major route, for lactose carbon absorption, and it also appears that signs of fermentation activity such as increased BH2 are not indicative of disease. Important questions remaining in the premature infant relate to developmental aspects of colonic fermentative activity, effects of systemic antibiotic treatment on colonic salvage, the effects of various fermentation pathways on energy balance, the capacity for absorption of sugars, SCFA, and electrolytes by colonic epithelia, and the effects of fermentation products on metabolism and on the mucosal cells of the intestine or colon. Research addressing these questions may have relevance in the following areas: further development of formula diets for healthy premature infants and for patients of all ages with intestinal or colon dysfunction; the effects of colonic disease or surgical resection; the nutritional or clinical effects of dietary fiber; and the effects of antibiotic therapy on intestinal and colon function.

Animals↗
PubMed1988

Determination of steroid hormones in goats' milk and plasma as an aid to pregnancy diagnosis using an ELISA.

Commercial ELISA kits for the determination of steroid hormones in milk and blood of domestic animals have been used by veterinary surgeons in practice as a method of pregnancy diagnosis in cattle, horses and pigs. In goats, the complex metabolism of steroid hormones in the mammary gland has made the test unsatisfactory. In five non-pregnant Saanen does, milk and blood samples were taken daily through a complete oestrous cycle, and the concentrations of progesterone measured by ELISA. A wide variation in the pattern of progesterone concentration was recorded. In seven non-pregnant and early pregnant does (less than 35 days) the mean concentration of oestrogens in milk was 0.5 ng/ml. Pregnancy in 88 does was subsequently predicted, based upon a concentration of oestrone sulphate in milk over 0.5 mg/ml, and was approximately 80 per cent accurate for determination of both pregnancy and non-pregnancy when compared with actual kidding data. Reasons are given for these errors.

Animals↗
PubMed1988

Do regional variations in prevalence of cryptosporidiosis occur? The central Ohio experience.

We screened 2,780 consecutive stool specimens submitted for routine ova and parasite examination to assess the prevalence of cryptosporidiosis in a pediatric patient population in central Ohio. The stools were prepared by formalin-ethyl acetate concentration followed by cold Kinyoun acid-fast stain of the sediment. In addition, 912 consecutive intestinal biopsies were monitored for the presence of the parasite. Cryptosporidium oocysts were found in only 0.3 per cent of stool specimens (seven specimens from three patients) and in none of the intestinal biopsies. Due to this low prevalence of cryptosporidiosis, we conclude that routine screening of stool specimens for Cryptosporidium sp. is unnecessary in our patient population. Screening should be targeted to immune compromised patients and patients with persistent diarrhea and no apparent etiology. Our study also supports the concept that there are geographic variations in the prevalence of cryptosporidiosis.

Child↗
PubMed1987

Estrogen, progesterone, prolactin, prostaglandin E2, prostaglandin F2 alpha, 13,14-dihydro-15-keto-prostaglandin F2 alpha, and 6-keto-prostaglandin F1 alpha gradients across the uterus in women in labor and not in labor.

Before or during labor in humans, changes in peripheral levels of estrogen and progesterone are not evident. Local alterations of estrogen, progesterone, and prolactin concentrations may be present and be accompanied by prostaglandin changes. The purpose of this study was to investigate the differences in concentrations of these hormones across the uterus and to evaluate their interrelationships in patients at term gestation with and without labor. Blood samples were obtained from a radial artery and a uterine vein in 22 women without and in 10 with labor. The difference between levels in the two blood vessels was designated as the gradient. Neither levels nor gradients were different between the two groups for estrone, estradiol, estriol, progesterone, or prolactin. The plasma levels of prostaglandin F2 alpha, 13,14-dihydro-15-keto-prostaglandin F2 alpha, and prostaglandin E2 were significantly increased in labor. Prostacyclin levels, as indicated by the 6-keto-prostaglandin F1 alpha metabolite, were not altered. The gradients for prostaglandin F2 alpha and E2 were significantly increased in labor. The results of the study also suggested that, in gestation at term, serum prolactin is produced mainly by the pituitary and that estrone may originate from peripheral conversion of estradiol. We conclude that in humans prostaglandin gradients of the E and F groups are increased in labor. These increases are not associated with changes in sex steroids or prolactin. Prostacyclin metabolite gradients also appear not to be altered in labor, suggesting that some prostaglandins are selectively increased in early labor either by enhanced production or decreased metabolism or both.

6-Ketoprostaglandin F1 alpha↗