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Biomedical subjects

T P Murphy

Publications and source records attributed to T P Murphy.

At least 37 records · Page 2Linked to original sources
PubMed1998

Hearing results in pediatric patients after canal-wall-up and canal-wall-down mastoid surgery.

Hearing results were studied in pediatric patients after canal-wall-up and canal-wall-down mastoid surgery in a private practice setting. A retrospective chart review was performed on 69 patients who underwent surgery from 1991-1995. Twenty-six patients underwent canal-wall-up mastoidectomies, and 43 patients underwent canal-wall-down mastoidectomies. Various types of ossicular reconstruction were performed in patients in both groups. Hearing was evaluated for preoperative and postoperative pure-tone averages, speech-reception thresholds, and air-bone gaps for the various types of ossicular reconstruction. Patients with canal-wall-up mastoidectomies and an intact ossicular chain had an average postoperative air-bone gap of 15 dB, whereas reconstruction of the ossicular chain (regardless of technique) resulted in an average postoperative air-bone gap of 19 dB. Patients with canal-wall-down mastoidectomies and an intact ossicular chain had an average air-bone gap of 15 dB, while all techniques of ossicular reconstruction had an average air-bone gap of 29 dB. Canal-wall-up and canal-wall-down mastoid surgeries in pediatric patients have similar hearing results. Variables other than hearing should be used to make treatment decisions regarding the canal wall in pediatric candidates for mastoid surgery.

Adolescent↗
PubMed1998

GC/MS analysis of m-hydroxybenzoylecgonine in urine. Forensic implication in cocaine use.

m-Hydroxybenzoylecgonine (m-OH-BE) and d3-m- hydroxybenzoylecgonine (d3-m-OH-BE) have been synthesized, and a GC/MS procedure with d3-m-OH-BE as internal standard has been developed. Among 24 human urine specimens that were positive for BE, all of them have shown detectable levels of m-OH-BE with 75% of the specimens exceeding the LoQ (5 ng/mL), compared with only 50% of the specimens containing detectable levels of EME. The presence of m-OH-BE in urine suggested that this metabolite may serve as a valuable marker of cocaine use in addition to BE and EME.

Cocaine↗
PubMed1997

Cerebrospinal fluid fistulae in a canine model.

Various diagnostic techniques currently are used to detect the presence of a cerebrospinal fluid fistula. High resolution computerized tomography scanning with the instillation of an intrathecal nonionic contrast medium yields the most accurate diagnostic results. Occasionally, even with optimal conditions, little information is gained other than the confirmation of the presence of a fistula. Intrathecal fluorescein can provide accurate information on the exact location of the fistula. The current study was designed to refine the clinical examination for cerebrospinal fluid fistulae with the use of intrathecal fluorescein. The canine model that we used also served as a vehicle to investigate the histopathologic effects of fluorescein on the central nervous system. We modified a commonly used xenon light source to enable examination with 490 nm light. In the canine model, this allowed accurate visualization of surgically created fistulae using very low doses of intrathecal fluorescein. An examination of the histopathologic features of the central nervous system of the canine model after acute instillation of a higher dose of fluorescein revealed microscopic changes consistent with the introduction of an irritant material. The changes induced by the chemical trauma may explain the serious neurologic sequelae sometimes seen in patients after the instillation of intrathecal fluorescein. Recommendations on the correct dosage of intrathecal fluorescein for diagnosis of cerebrospinal fluid fistulae are proposed.

Animals↗
PubMed1997

Management of congenital atresia of the external auditory canal.

The management of a unilateral congenital atresia of the external auditory canal is nonuniform and debated. Various surgical approaches, timing, coordination with microtia repair, and variable hearing improvements all contribute to the debate regarding management of this entity. This paper outlines our craniofacial team approach to the congenital unilateral atresia and microtia in children. Selection criteria, timing of repair, coordination with microtia repair, surgical results, and pitfalls will be discussed. The results of surgery in 16 patients with unilateral congenital atresia of the external auditory canal and 2 children with bilateral atresia will be presented. Repair of the atresia was undertaken in children 5 years or older who had pneumatized mastoids and middle ears. Replacement of the malleus/incus complex with a partial ossicular reconstruction prosthesis improved closure of the air-bone gap. Drawbacks included meatal stenosis and deepithelization of the split thickness skin graft lining the external auditory canal. Repair of the unilateral congenital atresia is a demanding and challenging problem but one in which excellent results are achievable.

Adolescent↗
PubMed1996

Stapedectomy in the pediatric patient.

The purpose of this study was to evaluate and compare the results of stapedectomy in pediatric patients with otosclerosis and tympanosclerosis. A retrospective review of 14 patients (15 ears) who underwent stapedectomy from 1993 to 1995 was conducted. In 5 ears stapedectomy for tympanosclerosis was performed; 9 patients had otosclerosis and 1 had Treacher Collins syndrome. Patients were evaluated for preoperative and postoperative air-bone gaps, preoperative and postoperative speech reception thresholds, postoperative air conduction hearing improvement, and preoperative and postoperative speech discrimination. Children with otosclerosis who underwent stapedectomies had an average postoperative air-bone gap of 16 dB with an average air conduction hearing improvement of 17.6 dB. Children with tympanosclerosis who underwent stapedectomies had an average air-bone gap of 14 dB with an average air conduction hearing improvement of 28 dB. Stapedectomy is a safe and effective treatment for otosclerosis and tympanosclerosis in pediatric patients.

Adolescent↗
PubMed1994

Nipple placement in simple mastectomy with free nipple grafting for severe gynecomastia.

Severe gynecomastia with excessive skin is difficult to treat by only periareolar excision or suction-assisted lipectomy or both. In these patients, total mastectomy and free nipple grafting may be the best option. Placement of the nipple, however, has been arbitrary. With use of 20 "aesthetically perfect" men as models, standard nipple distances were identified. The average sternal notch-to-nipple measurement was 21 cm. In addition, two consistent ratios were identified. The nipple plane was located 0.33 times the distance from the sternal notch to the pubis, and the internipple distance was 0.23 times the chest circumference. With use of preoperatively obtained measurements of the sternal notch to pubis and chest circumference, accurate nipple placement can be accomplished.

Adult↗
PubMed1994

Vascular ultrasound in the intensive care unit.

Ultrasonography plays an increasingly important role in the evaluation of the vascular system. It is especially useful for the intensive care patient because of its ability to be performed at the patient's bedside, as well as the relatively high frequency of vascular complications in the ICU. Ultrasonography is the method of choice for evaluation of deep vein thromboembolic disease of the lower extremity in all patients, demonstrating excellent sensitivity and specificity for this condition. It also should be the initial method of evaluating upper extremity deep vein thrombosis. It may be limited in this assessment, however, because it does not reliably demonstrate the central subclavian and innominate veins, and therefore may be inadequate for evaluation of malfunctioning central venous catheters. Ultrasonography can reliably identify the presence of abdominal aortic aneurysms, although computed tomography is better able to demonstrate location and extent of these lesions. Finally, ultrasonography can be used to diagnose complications of arterial catheterization and, in selected patients, may direct compression of pseudoaneurysms, resulting in thrombosis and thereby averting surgical repair.

Critical Care↗
PubMed1994

Vestibular autorotation and electronystagmography testing in patients with dizziness.

One hundred and two patients were evaluated with electronystagmography (ENG) and vestibular autorotation tests (VAT). Results indicate that ENG is the best test in the initial evaluation of the patient whose dizziness is believed to be peripheral in origin; whereas, patients who have sustained head trauma and nondescript dizziness are best evaluated with VAT.

Dizziness↗
PubMed1993

Use of preprocedural tests by interventional radiologists.

A direct survey was taken of 1,238 members of the Society of Cardiovascular and Interventional Radiology (SCVIR) concerning the routine use of 14 tests (most frequently, prothrombin and partial thromboplastin times, complete blood cell counts, and blood urea nitrogen and serum creatinine levels) performed before 10 invasive percutaneous procedures (peripheral angiography, neuroangiography, transluminal angioplasty, thrombolysis, percutaneous needle biopsy, abscess drainage, percutaneous nephrostomy, biliary drainage, myelography, and venography). The survey was undertaken to determine the current practices and appropriateness of current routine use of preprocedural tests. The response rate was 34%, representing a cumulative annual volume of 322,208 cases. The practice of performing routine preprocedural tests is common among interventional radiologists. Data provided by this survey suggest that use of these tests is excessive. Adherence to suggested proposals derived from previously reported experience would result in an annual estimated savings of $20.0-$34.9 million (extrapolated for all procedures performed by SCVIR members in 1989).

Diagnostic Tests, Routine↗
PubMed1993

Mal de debarquement syndrome: a forgotten entity?

Mal de debarquement syndrome is defined by a persistent sensation of rocking and swaying commonly felt with sea travel that is first noted on return to land. Mal de debarquement syndrome is not to be confused with seasickness, which causes nausea, vomiting, diaphoresis, and headache. Four female patients with mal de debarquement syndrome are reviewed. Mal de debarquement is normally a short-lived phenomenon. The need for extensive evaluations may be avoided by an awareness of this entity.

Adult↗
PubMed1993

Is bilateral lower extremity compression sonography useful and cost-effective in the evaluation of suspected pulmonary embolism?

OBJECTIVE: Because deep venous thrombosis is clinically linked with pulmonary embolism and often treated similarly, we sought to assess the usefulness of obtaining bilateral lower extremity compression sonograms when findings on ventilation-perfusion lung scans indicate a low or indeterminate probability of pulmonary embolism. Demonstration of deep venous thrombosis would provide a rationale for treating both pulmonary embolism and deep venous thrombosis. MATERIALS AND METHODS: Two hundred twenty-three consecutive patients with suspected pulmonary embolism had ventilation-perfusion lung scans and concurrent bilateral lower extremity compression sonograms; 34 also had pulmonary arteriography. RESULTS: In 75 cases, the results of ventilation-perfusion lung scanning indicated an indeterminate probability of pulmonary embolism. Evidence of thrombosis was seen on sonograms in 11 of these 75. In the remaining 64, 17 underwent pulmonary arteriography and four (24%) had pulmonary embolism. Findings on lung scans indicated a low probability of pulmonary embolism in 70 of 223 patients. Evidence of thrombosis was seen on sonograms in 11 of these 70. Five of the remaining 59 underwent pulmonary arteriography and one (20%) had pulmonary embolism. According to the 1993 Medicare Fee Schedule, if all 145 patients whose lung scans were nondiagnostic had sonography and only those with normal sonograms had pulmonary arteriography, the professional and hospital charges would be $359,552. If all 145 had pulmonary arteriography without sonography, the charges would be $395,031. CONCLUSION: If ventilation-perfusion lung scans indicate a low or an indeterminate probability of pulmonary embolism and bilateral lower extremity compression sonography is performed, only those patients with normal sonographic findings would need further study. Thus, 15% (22/145) of patients could be spared pulmonary arteriography, and the estimated savings in cost would be 9%.

Algorithms↗
PubMed1992

Arteriosclerosis obliterans in a rabbit model.

RATIONALE AND OBJECTIVES: The authors induced atherosclerotic occlusions in a rabbit model, using and comparing different experimental methods. METHODS: Lesions were induced in 40 femoral arteries in 20 rabbits. Four combinations of lesion induction methods were used: 1) drying of the endothelium with carbon dioxide gas; 2) gas-drying of the artery plus mechanical injury; 3) gas-drying plus induced thrombosis of the treated segment using thrombin; and 4) gas-drying, mechanical injury, and induced thrombosis. All rabbits were fed a high-fat, high-cholesterol diet for 1 to 2 months after lesion induction. RESULTS: Seventeen rabbits were available for follow-up. Sixty-eight percent (13 of 19) of femoral arteries treated with thrombin-induced thrombosis demonstrated atherosclerotic occlusions, compared with 27% of those that did not receive this treatment (4 of 15; P < .01). CONCLUSIONS: Thrombin-induced thrombotic occlusion of a segment of artery which has been de-endothelialized, followed by a high-fat, high cholesterol diet, results in a higher yield of experimental occlusive atherosclerosis in rabbits than is achievable by other methods.

Animals↗