Biomedical subjects

R J Murphy

Publications and source records attributed to R J Murphy.

At least 19 recordsLinked to original sources

PubMed2000

Cutaneous deciduosis.

Cutaneous deciduosis is an exceedingly rare manifestation of endometriosis potentially mistaken for malignancy and thus far documented solely within surgical scars. We describe two additional cases, one occurring in a pregnant 21-year-old woman as a solitary flat erythematous vulvar papule, an extraordinary location not previously recorded. Histologic examination in that case revealed a subepithelial nodular aggregate of atypical large dyscohesive cells with accompanying edema and inflammation. An immunohistochemical panel showed positivity of the cells for vimentin and Ki-1 (CD30). Intracellular sulfated mucin and glycogen were also demonstrated. In a second case, a 27-year-old woman had a nodule at the umbilicus, removed incidentally during the course of cesarean section. Microscopically there were several circumscribed, multilobulated, intradermal nodules with variably sized lumens formed by crowded large epithelioid cells. The disparate histologic appearance of these examples highlights an essential challenge in their diagnosis. Clinical recognition is difficult unless suggested by more characteristic history or location.

Adult↗

PubMed2000

Idiopathic familial onychomadesis.

Onychomadesis is defined as spontaneous separation of the nail plate from the nail bed, beginning at its proximal end and resulting in the shedding of the nail. It has been associated with a variety of clinical settings, including systemic illnesses, generalized skin diseases, and drug therapies. There have been a small number of reports in the older literature of idiopathic onychomadesis occurring in a familial pattern. We report the case of a healthy 12-year-old girl and her mother, both of whom have experienced recurrent onychomadesis affecting multiple digits, and in the absence of any causal disease or medication.

Adult↗

PubMed2000

Mechanisms leading to restoration of muscle size with exercise and transplantation after spinal cord injury.

We have shown that cycling exercise combined with fetal spinal cord transplantation restored muscle mass reduced as a result of complete transection of the spinal cord. In this study, mechanisms whereby this combined intervention increased the size of atrophied soleus and plantaris muscles were investigated. Rats were divided into five groups (n = 4, per group): control, nontransected; spinal cord transected at T10 for 8 wk (Tx); spinal cord transected for 8 wk and exercised for the last 4 wk (TxEx); spinal cord transected for 8 wk with transplantation of fetal spinal cord tissue into the lesion site 4 wk prior to death (TxTp); and spinal cord transected for 8 wk, exercised for the last 4 wk combined with transplantation 4 wk prior to death (TxExTp). Tx soleus and plantaris muscles were decreased in size compared with control. Exercise and transplantation alone did not restore muscle size in soleus, but exercise alone minimized atrophy in plantaris. However, the combination of exercise and transplantation resulted in a significant increase in muscle size in soleus and plantaris compared with transection alone. Furthermore, myofiber nuclear number of soleus was decreased by 40% in Tx and was not affected in TxEx or TxTp but was restored in TxExTp. A strong correlation (r = 0.85) between myofiber cross-sectional area and myofiber nuclear number was observed in soleus, but not in plantaris muscle, in which myonuclear number did not change with any of the experimental manipulations. 5'-Bromo-2'-deoxyuridine-positive nuclei inside the myofiber membrane were observed in TxExTp soleus muscles, indicating that satellite cells had divided and subsequently fused into myofibers, contributing to the increase in myonuclear number. The increase in satellite cell activity did not appear to be controlled by the insulin-like growth factors (IGF), as IGF-I and IGF-II mRNA abundance was decreased in Tx soleus and plantaris, and was not restored with the interventions. These results indicate that, following a relatively long postinjury interval, exercise and transplantation combined restore muscle size. Satellite cell fusion and restoration of myofiber nuclear number contributed to increased muscle size in the soleus, but not in plantaris, suggesting that cellular mechanisms regulating muscle size differ between muscles with different fiber type composition.

Animals↗

PubMed1999

Salbutamol effect in spinal cord injured individuals undergoing functional electrical stimulation training.

OBJECTIVE: Preliminary study to investigate possible changes in skeletal muscle morphology and function, as well as hormonal and metabolic effects, after treatment with a selective beta2-adrenergic receptor agonist. DESIGN: Double-blind, placebo-controlled trial. PARTICIPANTS: Three individuals with spinal cord injury (SCI). INTERVENTION: Two-week treatment with salbutamol (2mg) or placebo (ascorbic acid, 50mg) twice a day. Program of functional electronic stimulation (FES) cycling for 30 minutes twice a week. MAIN OUTCOME MEASURES: Body weight, three measures of leg circumference (gluteal furrow, one third of subischial height up from tibial-femoral joint space, and minimum circumference above the knee), muscle fiber area, and total work output per session. RESULTS: There were increases in body weight (2.30 +/- .70kg), leg circumferences (gluteal furrow 1.70 +/- .27cm, one third subischial height 1.53 +/- 1.65cm, minimum circumference above the knee .43 +/- .04cm), and muscle (vastus lateralis) cross-sectional area (1,374 +/- 493 to 2,446 +/- 1,177microm2) after salbutamol treatment, whereas quadriceps muscle contractile function was not modified. Total work output during FES cycling sessions was increased more during salbutamol treatment (64%) compared with training alone (27%). Salbutamol treatment was associated with a large decrease in skeletal muscle beta-adrenergic receptor density. CONCLUSION: Although some side effects were noted, these results suggest that a short treatment with the beta2-adrenergic receptor agonist salbutamol during a training program with FES cycling could be beneficial in patients with SCI.

Adrenergic beta-Agonists↗

PubMed1999

Nifedipine does not impede clenbuterol-stimulated muscle hypertrophy.

The mechanism(s) responsible for beta2-adrenergic receptor-mediated skeletal muscle and cardiac hypertrophy remains undefined. This study examined whether calcium influx through L-type calcium channels contributed to the development of cardiac and skeletal muscle (plantaris; gastrocnemius; soleus) hypertrophy during an 8-day treatment with the beta2-adrenergic receptor agonist clenbuterol. Concurrent blockade of L-type calcium channels with nifedipine did not reverse the hypertrophic action of clenbuterol. Moreover, nifedipine treatment alone resulted in both cardiac and soleus muscle hypertrophy (6% and 7%, respectively), and this effect was additive to the clenbuterol-mediated hypertrophy in the heart and soleus muscles. The hypertrophic effects of nifedipine were not associated with increases in total beta-adrenergic receptor density, nor did nifedipine reverse clenbuterol-mediated beta-adrenergic receptor downregulation in either the left ventricle or soleus muscle. Both nifedipine and clenbuterol-induced hypertrophy increased total protein content of the soleus and left ventricle, with no change in protein concentration. In conclusion, our results support the hypothesis that beta2-adrenergic receptor agonist-induced muscle hypertrophy is mediated by mechanisms other than calcium influx through L-type calcium channels.

Adrenergic beta-Agonists↗

PubMed1999

Activated satellite cells fail to restore myonuclear number in spinal cord transected and exercised rats.

In this study, possible mechanisms underlying soleus muscle atrophy after spinal cord transection and attenuation of atrophy with cycling exercise were studied. Adult female Sprague-Dawley rats were divided into three groups; in two groups the spinal cord was transected by a lesion at T10. One group was transected and killed 10 days later, and another group was transected and exercised for 5 days starting 5 days after transection. The third group served as an uninjured control. All animals received a continuous-release 5'-bromo-2'-deoxyuridine pellet 10 days before they were killed. Transection alone and transection with exercise lead to activation of satellite cells, but only the exercise group showed a trend toward an increase in the number of proliferating satellite cells. In all cases the number of activated satellite cells was significantly higher than the number that divided. Although the number of cells undergoing proliferation increased with exercise, no increase in fusion of satellite cells into muscle fibers was apparent. Spinal cord transection resulted in a 25% decrease in myonuclear number, and exercise was not associated with a restoration of myonuclear number. The number of apoptotic nuclei was increased after transection, and exercise attenuated this increase. However, the decrease in apoptotic nuclei with exercise did not significantly affect myonuclear number. We conclude that apoptotic nuclear loss likely contributes to loss of nuclei during muscle atrophy associated with spinal cord transection and that exercise can maintain muscle mass, at least in the short term, without restoration of myonuclear number.

Animals↗

PubMed1999

Unusual presentation of a salivary pleomorphic adenoma: a case report and review of the literature.

Although pleomorphic adenomas are the most common neoplasms of salivary gland origin, our knowledge of the etiology, growth, and recurrence patterns, and significance of the varying histologic features of these tumors, remains limited. We present the case of a 66-year-old man with an unusual presentation of a pleomorphic adenoma, and review the important clinical and pathologic features of this entity.

Adenoma, Pleomorphic↗

PubMed1998

Bone fracture during electrical stimulation of the quadriceps in a spinal cord injured subject.

We report a fracture through the lateral femoral condyle of a paraplegic subject caused by electrical stimulation (ES). The subject was a 50-year-old man who 4 years earlier had sustained a complete spinal cord injury (SCI) at level T6. The fracture occurred during ES-induced measurement of maximal isometric torque of the quadriceps with the knee flexed at an angle of 90 degrees. ES was delivered through surface electrodes with biphasic square wave pulses from a constant current stimulator. The torque was calculated to be 93Nm, corresponding to 20.8kg at the ankle. The regional bone mineral density of the entire lower extremities was .83g/cm2, corresponding to 60% of sex- and age-matched able-bodied reference values. Several factors are suspected to have contributed to the fracture: maximal ES in combination with a muscle spasm, severe osteoporosis, increased muscular strength induced by regular ES cycling (twice a week), and testing position with the knee locked in 90 degrees flexion. The risk of fracture as well as various precautions are discussed and should be taken into consideration in future studies.

Biomechanical Phenomena↗

PubMed1997

Chronic beta-blockade increases skeletal muscle beta-adrenergic-receptor density and enhances contractile force.

The effects of a chronic 14-day administration of a selective beta2-adrenergic-receptor antagonist (ICI-118551) on skeletal muscle were evaluated in female Sprague-Dawley rats. Chronic ICI-118551 treatment did not modify muscle mass, oxidative potential, or protein concentration of the medial gastrocnemius muscle, suggesting that maintenance of these skeletal muscle characteristics is not dependent on beta2-adrenergic-receptor stimulation. However, the drug treatment increased beta-adrenergic-receptor density of the lateral gastrocnemius (42%) and caused an increase in specific (g/g) isometric in situ contractile forces of the medial gastrocnemius [twitch, 56%; tetanic (200 Hz), 28%]. The elevated contractile forces observed after a chronic treatment with ICI-118551 were completely abolished when the beta2-adrenergic antagonist was also administered acutely before measurement of contractile forces, suggesting that this response is beta2-adrenergic-receptor dependent. Possible mechanisms for the increased forces were studied. Caffeine administration potentiated twitch forces but had little effect on tetanic force in control animals. Administration of dibutyryl adenosine 3',5'-cyclic monophosphate in control animals also resulted in small increases of twitch force but did not modify tetanic forces. We conclude that increases in beta-adrenergic-receptor density and the stimulation of the receptors by endogenous catecholamines appear to be responsible for increased contractile forces but that the mechanism remains to be demonstrated.

Adrenergic beta-Antagonists↗

PubMed1996

Clenbuterol has a greater influence on untrained than on previously trained skeletal muscle in rats.

The effects of clenbuterol, a selective beta 2-adrenergic agonist, and of exercise training on the properties of skeletal muscle were studied in the hindlimb of sedentary and trained rats. A 2-week training programme, consisting of climbing on a grid with a load attached to the tail, did not increase the muscle mass of the soleus, the plantaris and the gastrocnemius muscles or modify the isometric in situ contractile properties of the medial gastrocnemius muscle. The only change observed in a 12-week training regimen was a significant increase in contractile forces (expressed in grams per gram of muscle) of the medial gastrocnemius muscle at sub-tetanic stimulating frequencies (twitch 42%, 25Hz 45% and 50Hz 47%). Both training programmes significantly increased fatigue resistance of the medial gastrocnemius muscle. A 2-week oral treatment with clenbuterol significantly increased the muscle mass of the soleus (19.8%), plantaris (16.9%) and gastrocnemius (15.3%) muscles in all animals treated with the agonist. However, clenbuterol had different effects in animals beginning their training programme than in animals that had been trained for the previous 10 weeks. Specifically, clenbuterol caused a significant increase in gastrocnemius muscle mass in the former group but not in the latter. These results suggest that the responses to the combination of clenbuterol and training in previously trained skeletal muscles are not as marked as those observed in untrained muscles.

Adrenergic beta-Agonists↗

PubMed1996

Eliciting the views of experienced midwives about the assessment of competence in midwifery.

OBJECTIVE: to investigate the views of the English National Board for Nursing, Midwifery and Health Visiting (ENB) Professional Midwifery Advisory Network (PMAN) members about the assessment of competence in midwifery. DESIGN: initial questionnaire followed by a group discussion of a summary of the data from the completed questionnaires. PARTICIPANTS: 54 PMAN midwives representing education, management, research, practice and supervision; plus six ENB Education Officers (midwifery). FINDINGS: the response rate to the questionnaires was 75%. In the group discussion the PMAN members commented particularly on: the large number of items identified as needing assessment in practice and by written work; lack of total agreement on the assessment in practice of normal delivery; differences in practitioners' perceptions of assessment; the number and range of areas to be assessed; differences in expectation of 'task' assessment versus 'holistic' assessment; lack of assessment in simulation; heavy reliance on written work in assessment. CONCLUSIONS: the group's discussion of the questionnaire data revealed further interesting data, which added considerably to the initial analysis and overview. Some participants had misinterpreted the instructions and found that what they had filled in did not accurately reflect their beliefs about assessment. General consensus was reached on the need for a national standard or framework for assessment and more emphasis to be placed on assessing students in the practice setting whilst ensuring this includes knowledge and understanding and not merely psycho-motor skills. The major implications include effective preparation of assessors and more teacher involvement in practice to support the midwife assessors.

Attitude of Health Personnel↗

PubMed1996

Patients' views of low back pain and its management in general practice.

BACKGROUND: Low back pain is a common and persistent problem. Research studies seeking to improve the quality of management of this condition have tended to ignore the opinions of patients. There is a growing acceptance of the importance of taking patients' views into account in developing management and educational programmes for a variety of conditions. AIM: This study set out to elicit the views of patients concerning low back pain and its management in general practice. METHOD: Fifty-two in-depth interviews were conducted with patients selected from a broad range of 12 general practices. RESULTS: Analysis of the interviews identified seven themes relating to: quality of life, prognosis, secondary prevention, help-seeking behaviour, explanation of underlying pathology, satisfaction with general practitioner management, and complementary therapy. Different patient viewpoints or perspectives were expressed within each of these themes. Patients adapted to the progress of their low back pain and were not seeking a 'magical cure' from either conventional or complementary therapies. CONCLUSION: Patients' views on low back pain are heterogeneous. The dissatisfaction expressed with medical explanations for the pain may be related to superficial clinical management and the constraints of general practice. Good management of low back pain needs to take patients' complex views of the condition into account.

Adolescent↗

PubMed1995

Patient education for low back pain in general practice.

This comparative study of patient and general practitioner perceptions of patient education for low back pain (LBP) revealed significant differences in perspective. It suggests that although some general practitioners recognise the importance of patient education, they blame patients for its assumed failure as a management strategy. The patients in this study identified a range of reasons which explain their difficulties in following prevention advice which relate to not only limitations in themselves, but also to broader contextual factors over which they have little control. It is argued that both the inadequacy of current professional assumptions and the contextual factors that influence patients' prevention behaviours need to be acknowledged as a first step towards improving patient education for LBP in general practice.

Adult↗

PubMed1995

General practitioner perceptions of low back pain patients.

General practitioners' perceptions of low back pain (LBP) patients were investigated through a series of in-depth semi-structured interviews, as part of a wider study which also investigated patient perceptions. An exhaustive analysis of the interview transcripts revealed six principal ways in which GPs distinguished between different patients as a means of deciding how to treat them. This differentiation, on the basis of patient characteristics, is the major focus for the resulting discussion and conclusions, and is used as a way of exploring more effective strategies for the future.

Attitude of Health Personnel↗

PubMed1994

Towards an integrated model of competence in midwifery.

Currently in the UK, there is no consensus as to what constitutes an adequate definition of a competent midwife. Yet, given the rapidly changing midwifery needs of childbearing women and society, such clarification has never been more important. In this paper some concepts of competence taken from a review of midwifery, nursing, educational and industrial literature are reviewed, and it is hoped that discussion leading to conceptualisation of an integrated model of competence in midwifery will be stimulated. Questions raised include--What is it that makes midwives competent? Can competence be inferred from performance? How can capability be recognised? Can competence be broken into elements for assessment without losing meaning?

Clinical Competence↗

PubMed1988

Congenital rickets associated with magnesium sulfate infusion for tocolysis.

The records of five neonates born to mothers treated with intravenously administered magnesium sulfate for tocolysis were retrospectively reviewed to assess the presence of radiographic, clinical, and biochemical abnormalities. Two infants had radiographic bony abnormalities; one had frank rachitic changes and dental enamel hypoplasia. One of these patients, as well as an additional infant, had transient hypocalcemia. We hypothesize that prolonged infusion of magnesium sulfate, especially when initiated during the second trimester, may lead to fetal parathyroid gland suppression with consequent abnormalities resembling rickets.

Adult↗

PubMed1988

Heat problems in the tennis player.

Any athlete, regardless of the sport or exercise, should allow an appropriate period to get in condition before exerting maximal effort. Athletes should be encouraged to observe environmental conditions and sharply curtail or postpone activity if the humidity reaches 95 per cent at any temperature. In addition, athletes should expose as much skin as possible to the air, and remain well hydrated before, during, and after exercise.

Athletic Injuries↗

PubMed1987

Thrombocytopenia in a bisexual adolescent male with a history of intravenous drug use.

Immunologically mediated thrombocytopenia has been reported as a manifestation of human T-lymphotropic virus type III (HTLV-III) infection and intravenous (IV) drug abuse. The case report describes thrombocytopenia in a bisexual adolescent male with antibody to the HTLV-III virus and a history of infrequent IV drug abuse. The case underscores the need to consider HTLV-III infection and/or IV drug abuse in the differential diagnosis of thrombocytopenia in an adolescent.

Acquired Immunodeficiency Syndrome↗