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Biomedical subjects

T F Murphy

Publications and source records attributed to T F Murphy.

At least 127 records · Page 7Linked to original sources
PubMed1985

Actuarial analysis of variables associated with rupture of small abdominal aortic aneurysms.

This study identified risk factors associated with rupture of small abdominal aortic aneurysms in patients initially selected for nonoperative management. Sixty-seven patients, 53 men and 14 women, 50 to 91 years of age (mean 72 years) were followed 3 to 99 months (mean 36 months). All patients underwent serial aortic ultrasonography. The annual rate of aneurysm rupture was 6%, with an annual mortality rate caused by rupture of 5% and an annual mortality rate caused by coexistent disease of 6%. Thirty potential risk factors, including blood pressure, aneurysm size measured by ultrasonography, rate of aneurysm expansion, smoking, serum cholesterol levels, and cardiac, pulmonary, and renal risks, were analyzed by Cox proportional hazards regression to identify variables related to rupture. Aneurysm anteroposterior expansion rates varied from 0 to 1.5 cm/year but were not different in aneurysms that ruptured. Only diastolic blood pressure, initial aneurysm anteroposterior diameter, and degree of obstructive pulmonary disease were independently predictive of rupture (p less than 0.05, Wald test). With these data, actuarial rupture rates were predicted for patients with selected values of these three covariates. Predicted 5-year rupture rates varied from 2% when these risk factors were absent to 100% when all three risk factors were significant. Obstructive pulmonary disease, initial aneurysm size, and diastolic hypertension must be evaluated prospectively to assess their accuracy in predicting small aneurysm rupture.

Actuarial Analysis↗
PubMed1984

Fimbriation of Haemophilus species isolated from the respiratory tract of adults.

Twenty-two clinical isolates of Haemophilus species were studied within two passages of their original isolation for the presence of fimbriae by negative-staining electron microscopy. Six isolates were identified as fimbriated, including three strains of nontypable Haemophilus influenzae, one strain of Haemophilus parainfluenzae, and two strains of Haemophilus haemolyticus. In fresh isolates of fimbriated strains of nontypable H. influenzae, approximately 40%-50% of cells had fimbriae; after five passages in vitro, less than 1% of the cells had fimbriae. Thus, a variety of Haemophilus species that colonize the human respiratory tract can be fimbriated, and this fimbriation is rapidly lost on passage in vitro.

Adult↗
PubMed1984

Bacteremic pneumococcal pneumonia in the elderly.

Pneumococcal pneumonia is an increasingly important disorder of the elderly. We reviewed, retrospectively, the clinical and laboratory manifestations of 29 elderly patients with bacteremic pneumococcal pneumonia during a five year period and surveyed the capsular serotypes of all blood isolates. Pneumococcal pneumonia frequently presented with subtle manifestations in these elderly patients: 50% lacked historical features suggestive of pneumonia at the time of diagnosis. A common presentation was fever, altered mental status and dehydration. Recognizing this will allow earlier diagnosis and initiation of therapy. Sixty percent of patients had potential pulmonary pathogens other than pneumococcus in cultures of sputum at the time of pneumococcal bacteremia. Reversible abnormalities of liver function were frequent. Sixty-nine percent of pneumonias were caused by serotypes included in the commercially available vaccine. Continued surveillance of pneumococcal serotypes is important to determine if the widespread use of the vaccine will result in an increased incidence of infection by serotypes which are not in the vaccine. The high mortality associated with pneumococcal pneumonia (31% in this series), particularly in the elderly, emphasizes the need for an effective vaccine.

Aged↗
PubMed1984

Acute spasm of vein bypass graft and recipient artery in the immediate postoperative period.

This is a report of an unusual condition in a patient with simultaneous spasms of a vein graft and recipient artery, resulting in acute left ventricular failure in the immediate postoperative period. It is known that coronary artery spasm can complicate perioperative management of the cardiac surgical patient, and spasm of vein bypass grafts themselves can also occur in rare instances. Possible causes of the complication and successful management of this patient are discussed.

Journal Article↗
PubMed1983

A subtyping system for nontypable Haemophilus influenzae based on outer-membrane proteins.

Outer-membrane proteins from 48 isolates of nontypable Haemophilus influenzae from adults and children were examined by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and the biotypes were determined. Each strain had two principal outer-membrane proteins in the 32,000-42,000 molecular-weight range. Eight subtypes were identified based on the differences in molecular weights of the two principal outer-membrane proteins. The lower molecular-weight protein of those two major proteins was heat modifiable. There was no definite relationship between subtype and biotype. Future studies on the pathogenesis and epidemiology of infections due to nontypable H. influenzae must take into account the differences in outer-membrane proteins among various strains. A subtyping system based on major outer-membrane proteins may provide a basis for such studies.

Bacterial Outer Membrane Proteins↗
PubMed1983

Croup: an 11-year study in a pediatric practice.

The etiology and epidemiology of croup were studied in a pediatric group practice over an 11-year period, 1964 to 1975. Croup was diagnosed in 951 instances in 6,165 cases of lower respiratory tract infection (LRI) studied. As census figures of the practice clientele were available, attack rates were calculated. The incidence of total LRI was highest in the first year of life. In contrast, the attack rate for croup was highest in the second year of life; the rate declined gradually after that age. Croup was not diagnosed in the first month of life. Boys were 1.43 times more likely to develop croup than were girls. Three hundred sixty agents were isolated from the 951 croup cases. The parainfluenza viruses accounted for 74.2% of all isolates; 65% of the parainfluenza isolates were classified as parainfluenza virus type 1. Respiratory syncytial virus, influenza viruses A and B, and Mycoplasma pneumoniae were the only other agents isolated in appreciable numbers. The propensity of various agents to produce croup symptoms in children with LRI due to specific microorganisms was 58% for parainfluenzae type 1,60% for parainfluenzae type 2, and 29% for parainfluenzae type 3; similar figures for the other agents varied from 5% to 16%. The role of the various agents in the etiology of croup varied with patient age and depended on the propensity of the agent to produce the croup syndrome and the frequency of isolation of the agent at that age. The parainfluenza viruses were the most important croup agents at all ages; respiratory syncytial virus caused croup in children less than 5 years of age whereas the influenza viruses and M pneumoniae were significant causes of croup only in children more than 5 to 6 years old. Croup occurred predominately in late fall and early winter, times when the parainfluenza viruses, especially type 1, occurred most frequently. The epidemiology of croup differs from that of bronchiolitis, pneumonia, and tracheobronchitis; knowledge of this should be helpful to the clinician caring for children with LRI.

Age Factors↗
PubMed1982

Clinical experience with Moxalactam in the treatment of pseudomonal and nonpseudomonal infections.

A total of 38 patients with 39 infections involving a variety of organ systems were treated with moxalactam. The overall cure rate was 79.5%. Most of the failures occurred in patients with severe underlying disease such as peripheral vascular disease. The cure rate for infections with Pseudomonas aeruginosa was 62.5% (10 of 16) and for nonpseudomonal infections was 91% (21 of 23). However, excluding the six infections involving organisms which were initially resistant to moxalactam, the cure rate for pseudomonal infections was 77% (10 of 13) compared with 90% (18 of 20) for nonpseudomonal infections. Two patients with gram-negative bacillary meningitis were cured, as were seven of eight with mixed aerobic-anaerobic infections. There were no serious adverse drug effects. Three patients became colonized with the enterococcus and two became colonized with Candida albicans; one other patient developed candida vaginitis. These results suggest that moxalactam will be a valuable drug in therapy of gram-negative bacillary and anaerobic infections.

Adult↗
PubMed1982

TRANSACT--a model for integrating clinical practice and longitudinal research.

To effectively deal with the high-risk infant and his outcome, it would appear that clinicians and researchers must, in a sense, place themselves "at-risk." They must recognize the limitations of a reductionistic, biomedical model when applied to this population and its problems. They must move beyond this traditional model to a so-called "biopsychosocial model" which acknowledges the uncertainties of human development and its transactional character. To do so, they must also seek to break down many traditional "boundaries" that have served to inhibit a better understanding of the high-risk infant. These boundaries include those between disciplines, between clinicians and researchers, between assessment and treatment, between cost efficiency and comprehensiveness, and those between quantitative and qualitative methodologies to name a few. This process must not be one of all or none exclusion, where a uniform perspective is adopted in isolation and applied to all aspects of the problem. Rather it must be a combination and synthesis of many perspectives. In essence, the construct used to understand and study the high-risk infant and his outcome should be consistent with the transactional and multifactorial nature of the problem. These tasks are formidable and threatening to undertake, particularly when they do not always yield the type of outcomes we have been conditioned to expect: "hard" data; narrow etiologies; and successful cures. However, failure to take such "risks" would seem to impede a further understanding of the at-risk infant. The T.R.A.N.S.A.C.T. model presented here is offered as a working construct which has yet to be fully operationalized. Its perceived limitations will reflect the background, biases and perspectives of the reader. Hopefully, it will serve to stimulate those interested and involved in the high-risk infant and his outcome to modify, refine or build upon their current approaches.

Child↗
PubMed1981

Pneumonia: an eleven-year study in a pediatric practice.

Data from an 11-year study of acute lower respiratory tract illness were analyzed to provide added insight into the causes and patterns of occurrence of pneumonia in an outpatient pediatric population. Over 80% of all episodes of pneumonia occurred in children less than seven years of age; the peak attack rate was observed in 2-4-year-old children. A virus or Mycoplasma pneumoniae was isolated from 24% of children with pneumonia; 57% of all episodes occurred during outbreaks for which a viral or mycoplasmal cause could usually be identified. Respiratory syncytial virus (RSV), parainfluenza viruses types 1 and 3, adenoviruses, influenza A viruses and M. pneumoniae accounted for 86% of all isolates. Attack rates of pneumonia in preschool children were highest during periods of RSV and influenza A virus prevalence; M. pneumoniae was the most frequent isolate from school aged children. The data contained in this report augment the understanding of the causes of pneumonia in children and provide a data base for scientists interested in the prevention of lower respiratory tract illness in children.

Adolescent↗
PubMed1981

Penicillin-binding proteins in Clostridium perfringens.

The penicillin-binding proteins (PBPs) of Clostridium perfringens were studied. Six PBPs ranging in molecular weight from approximately 42,000 to 100,000 were detected in the cytoplasmic membrane. The relative affinities of the PBPs for 16 beta-lactam antibiotics were determined. Most of the drug saturated PBP 3 and 4 at concentrations equal to their minimal inhibitory concentrations, suggesting that these PBPs are the killing targets for beta-lactams. Mecillinam showed unique properties; it had a higher affinity for PBP 5 than for other PBPs, and it was the only agent tested which caused inhibition of growth without saturating PBP 4. Interestingly, all beta-lactam antibiotics tested induced filament formation despite having different binding patterns to the PBPs of C. perfringens.

Azlocillin↗
PubMed1981

The cotton rat as an experimental model of human parainfluenza virus type 3 disease.

Intranasal or aerosol inoculation of cotton rats (Sigmodon hispidus) with human parainfluenza virus type 3 (P3) produces pulmonary changes which closely resemble human disease due to this agent. Active viral replication resulted in peak titers by day 2 of infection. Viral antigen was localized by immunofluorescence in bronchial epithelial cells alone (aerosol inoculation) or epithelial and alveolar cells (intranasal instillation). Cytopathic effects in epithelial cells was noted as early as day 2, and marked cellular proliferation occurred by day 7. Intranasal instillation of virus resulted in development of patchy interstitial pneumonitis. Mononuclear cell infiltration in the peribronchial and perivascular areas peaked on days 6 and 7. A brisk systemic antibody response was measured both by complement fixation and virus neutralization techniques. These data establish the value of the cotton rat as an experimental model for the study of bronchiolitis and pneumonia due to P3. Since previous work has demonstrated that respiratory syncytial virus and Mycoplasma pneumoniae also will replicate and cause pulmonary disease in cotton rats, comparative studies in a single animal species are facilitated.

Animals↗
PubMed1980

Arthralgia associated with acute urinary retention. A syndrome of probable viral etiology.

Four patients are described in whom paresthesia and arthralgia developed in association with acute urinary retention. Neurologic and musculoskeletal complaints persisted for varying periods, up to five year, after cessation of urinary symptoms. Significantly elevated titers to Herpes simplex and Herpes zoster viruses were observed in three and four subjects, respectively, although none exhibited cutaneous lesions of herpetic infection. The symptom complex, presumably the result of viral radiculitis, may present in varying patterns that can be confused with lumbar disc protrusion, obstructive uropathy or primary rheumatic disorder. Diagnostic studies requisite for documentation of a viral etiology of the syndrome are discussed.

Adult↗
PubMed1980

Biliary tract obstruction due to tuberculous adenitis.

A 25 year old woman presented with constitutional symptoms and biochemical evidence of biliary tract obstruction. A mass in the region of the head of the pancreas was detected and she underwent laparotomy which revealed isolated tuberculous adenitis of peripancreatic lymph nodes. Complete recovery resulted following the administration of isoniazid and ethambutal.

Adult↗
PubMed1980

Chronic eosinophilic pneumonia: an unusual cause of acute respiratory failure.

A 75-year-old man developed dyspnea, cough, peripheral radiographic infiltrates, eosinophilia, and severe hypoxemia requiring mechanical ventilation. An open lung biopsy revealed chronic eosinophilic pneumonia, and the patient recovered with corticosteroid therapy. Chronic eosinophilic pneumonia is a disease that should be included in the different diagnosis of treatable causes of acute respiratory failure.

Acute Disease↗