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Biomedical subjects

G F Murray

Publications and source records attributed to G F Murray.

At least 55 records · Page 3Linked to original sources
PubMed1988

Drug abuse and prevention programs in 29 countries.

In this paper, drug prevention programs in 29 countries are reviewed and summarized. The material was gathered from the reports that each country had prepared for the World Health Organization project on Guidelines for Drug Abuse Prevention. Each report provided a detailed schedule of background data on drug abuse and prevention programs in that country. The sophistication of prevention programs varies considerably from one country to another and depends on the degree and nature of the problem. An analysis of this material indicates that the seriousness of the drug problem is well recognized in some countries but not in others. In some of the latter countries it is obvious that no real problem exists, while in others little is known about the extent of the problem and little effort is spent in this area.

Cross-Cultural Comparison↗
PubMed1986

Cardiopulmonary hypoxic response 5 years postpneumonectomy in beagles.

Ventilatory hypoxia was used to study the effects on pneumonectomy on the right heart and pulmonary vascular bed in purebred beagle dogs. Operated animals underwent pneumonectomy at 6 to 10 weeks of age (six, group I) or at 1 year (eight, group II). Eight unoperated adult beagles served as controls (group III). Five years following pneumonectomy, exposure to 10% O2 ventilation indicated that group I animals were more reactive to hypoxia than either group II or III. Increases in pulmonary flow were recorded as group I, 0.79 +/- 0.58 liter/min; II, 0.32 +/- 0.54 liter/min; III, 0.04 +/- 0.24 liter/min (P = 0.006, I vs III, two-tailed test). Also, the peak first derivatives of power and blood flow and the external work of the right ventricle increased significantly in group I compared to group III but not in group II compared to group III. On the contrary, hypoxic stress produced similar changes in pulmonary vascular resistance and characteristic impedance in all groups. It is concluded that the hyperdynamic response of the group I animals, those undergoing pneumonectomy as puppies, can be attributed to a primary change in pump characteristics.

Age Factors↗
PubMed1986

Marijuana use and social control: a sociological perspective on deviance.

Drug use must be understood within the larger context of deviance. Certainly, the tendency to examine drug use in isolation from the more general study of delinquent behavior requires redress. By definition, illicit drug use is delinquent behavior. In the present paper, a theory of delinquent behavior is applied to marijuana use. A powerful explanation of marijuana use is offered by this modified version of social control theory.

Adolescent↗
PubMed1985

Elective pulmonary lobectomy: factors associated with morbidity and operative mortality.

Periodic review of clinical results is essential to ensure that high-quality patient care is maintained. To that end, we reviewed the morbidity and operative mortality in a consecutive series of 369 pulmonary lobectomies performed between January 1, 1970, and December 31, 1983. There were 251 male and 118 female patients with a mean age of 50.6 years. The thirty-day operative mortality was 2.2% (8/369), with 6 of these deaths related primarily to respiratory insufficiency. Two hundred twenty-four postoperative management problems occurred in 151 patients and included arrhythmia, air leak, pneumothorax, respiratory difficulties, postoperative bleeding, pleural effusion, wound infection, myocardial infarction, pulmonary embolus, empyema, bronchial stump leak, and lobar gangrene. Multiple factors were related to the occurrence of postoperative morbidity and mortality using both chi-square analysis to examine each individual item and discriminant analysis to evaluate their interaction. Chi-square tabulation showed no difference in the occurrence of major postoperative complications (p greater than 0.05) related to the side of operation, an abnormal preoperative electrocardiogram, a forced vital capacity of 2.8 liters or less, a one-second forced expiratory volume (FEV1) of less than 1.7 liters, an oxygen tension of less than 60 mm Hg, or the seniority of the surgeon (resident versus attending). An increased number of complications (p less than 0.05) was found in male patients, in patients operated on for carcinoma, and in patients older than 60 years. Stepwise discriminant analysis included FEV1 as a significant predictor of postoperative complications.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1985

Surgical management of symptomatic pulmonary aspergilloma.

Pulmonary aspergilloma is a potentially life-threatening disease resulting from the colonization of lung cavities by the ubiquitous fungus Aspergillus fumigatus. Complex aspergilloma, characterized by thick-walled cavities with surrounding parenchymal inflammation, is a risk factor for increased morbidity and mortality. Fifteen patients with symptomatic aspergilloma underwent major thoracic procedures at North Carolina Memorial Hospital between January 1, 1972, and December 31, 1983. Twelve of the patients had hemoptysis; in 7 it was recurrent and in 5, life threatening. Tuberculosis and sarcoidosis were the most common underlying causes of lung disease, and more than half of the patients had other coexistent serious medical illness. Eleven of the 15 patients were seen with complex aspergilloma; all of the 4 major complications and the 2 deaths occurred in these patients. Bronchopleural fistula with persistent air space was the most common serious complication, and required thoracoplasty in 3 patients. Nine patients, including 5 with complex aspergilloma, had no postoperative complications, and there were no recurrent symptoms in any of the 13 operative survivors over a mean follow-up of five years. It is concluded that aggressive pulmonary resection can provide effective long-term palliation in critically ill patients with symptomatic pulmonary aspergilloma.

Adult↗
PubMed1985

Narcotic drug abuse in 152 countries: social and economic conditions as predictors.

This study examines the relationships between the level of narcotic drug abuse and the prevailing socioeconomic and health conditions and education levels in 152 countries. Drug abuse, as classified in this paper, is related to socioeconomics, health, and education in complex ways. The data do not support the proposition that drug abuse is more common among technologically developed societies than among developing ones. The best predictors of drug abuse were those related to health.

Cross-Cultural Comparison↗
PubMed1984

Transferrin level derived from total iron-binding capacity: is it a reliable relationship?

Serum transferrin is an important protein used to assess visceral protein status in patients requiring nutritional support. Since serum transferrin assays are not readily available in all institutions and there is a correlation between the serum transferrin level and TIBC, Blackburn's formula to compute the serum transferrin level is widely used. To evaluate the relationship between TIBC and serum transferrin, as described by Blackburn et al, we observed the TIBC and serum transferrin levels of 91 patients at our institution. Rajamaki et al [14] and Miller et al [13] have suggested that when Blackburn's formula was used, there was a significant difference in actual and derived serum transferrin values. Our formula, derived from such a comparison, approximates Blackburn's more closely than those of Rajamaki et al [14] and Miller et al [13]; however, they are still statistically significantly different. We agree with Miller et al, that each institution using serum transferrin as a nutritional index should either derive its own formula by regression analysis or should determine the actual serum transferrin level with radial immunodiffusion kits.

Adult↗
PubMed1984

International drug treaties: the connexion between ratification and social and economic conditions.

This study examines social and economic conditions in 152 countries and relates them to ratification of the two major international drug control treaties , the Single Convention on Narcotic Drugs and the Convention on Psychotropic Substances. The findings show that: (i) countries which ratified only the Single Convention had the greatest drug problems; (ii) ratifications were more common among developed countries than developing ones; (iii) ratifications were not more common among larger countries or those having higher expenditures on health and education, but they were more common among older U.N. member countries and those having ratified more non-drug treaties ; (iv) the best predictors of ratifications were a high level of life expectancy, a high degree of economic development and a substantial drug problem. The trend has been for more countries to ratify these treaties over time. However, a shorter-term solution would involve international support for those poorer countries which have not yet ratified them. Technical advice in the form of legal experts and translators is one example of such support.

Developing Countries↗
PubMed1984

Selective application of fundoplication in achalasia.

Although esophagomyotomy alone may effectively relieve dysphagia in patients with achalasia, utilization of a complementary fundoplication procedure should be considered for selected patients. Fundoplication is a sensible addition to myotomy in circumstances that suggest high risk for the development of reflux esophagitis. Also, in complicated achalasia, relief of esophageal obstruction by simple myotomy may not be achieved safely. Identification of those pathological features associated with achalasia that merit consideration of fundoplication should improve operative results and reduce morbidity. This paper examines the application of a complementary fundoplication procedure in the operative management of 21 patients with achalasia over a ten-year period.

Adolescent↗
PubMed1984

Major pulmonary resection for suspected but unconfirmed malignancy.

Thoracotomy is not infrequently performed in patients with suspected pulmonary carcinoma but with no histological or cytological confirmation of malignancy. The intraoperative decision to proceed with major pulmonary resection (lobectomy or pneumonectomy) is difficult if a large or central lesion precludes total excisional biopsy. Incisional or needle biopsies violate the principles of good cancer surgery, and the results may be inconclusive if the tumor is missed and areas of associated inflammation or necrosis are sampled. Between January 1, 1970, and December 31, 1980, 303 patients underwent thoracotomy for suspected but unconfirmed malignancy. One hundred twenty-two had a minor resection only, 79 had a major resection (lobectomy or pneumonectomy) after a diagnosis was established by frozen section, and 102 had a major resection without a definitive diagnosis of cancer. Carcinoma subsequently was found in 68% (69) of this group of 102 patients, and benign lesions were identified in the remaining 32% (33), all of whom underwent lobectomy. The diagnoses in these 33 patients included seven granulomas, three hamartomas, nine instances of tuberculosis, and fourteen instances of fibrosis, inflammation, or cystic degeneration. The 2 thirty-day operative deaths in this group of 102 patients occurred among the 69 with malignant disease; 1 died of hemorrhage following pneumonectomy and 1, of respiratory insufficiency after lobectomy. In all 303 patients, there was no difference in operative mortality (p less than 0.01) between lobectomy (2%) and a lesser resection (1.6%). In a patient with a suspicious but inaccessible pulmonary lesion, lobectomy can be performed safely without violating the principles of cancer surgery. This recommendation should probably not be extended to lesions requiring pneumonectomy, because of the increased rates of morbidity and mortality associated with that procedure.

Diagnosis, Differential↗
PubMed1984

Esophagogastrectomy as palliative treatment for esophageal carcinoma: results obtained in the setting of a thoracic surgery residency program.

The palliative treatment of esophageal carcinoma has included intubation, bypass, dilation, irradiation, and esophagogastrectomy. The last has been criticized by some on the basis of high operative morbidity and mortality. To assess the success of this method at our institution, we reviewed the 60 consecutive resections performed for carcinoma of the esophagus from January, 1972, through June, 1983. Forty-six patients had squamous cell tumors and 14, adenocarcinomas. There were 47 men and 13 women, and the mean age was 59.9 years (range, 38.5 to 78.9 years). The most frequent preoperative findings included dysphagia (55), weight loss (34), chest pain (22), and vomiting (49). Fifty (83%) out of the 60 resections were performed by the resident staff under the supervision of an attending surgeon. Four patients died within 30 days of operation, an operative mortality of 6.7%. Immediate causes of death included respiratory failure, myocardial infarction, hemorrhage, and renal failure. One of the patients who died and 3 of the survivors had an anastomotic leak. There were 27 additional complications in 24 patients: respiratory problems (8), arrhythmias (5), pleural effusion (4), gastric outlet obstruction (2), wound infection (2), and 1 each of pulmonary embolus, acute brain syndrome, congestive heart failure, myocardial infarction, chylothorax, and empyema. The one-, two-, three-, and five-year actuarial survival rates were 46%, 27%, 10%, and 5%, respectively. Mean survival for the 46 patients dead at the time of this study was 13.5 months. Outpatient follow-up data were available on 53 (95%) of the operative survivors and showed an absence of dysphagia in 87.5% during most of the follow-up period.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1984

Bilateral pneumothoraces secondary to latrogenic buffalo chest. An unusual complication of median sternotomy and subclavian vein catheterization.

Pneumothorax following subclavian venipuncture is a well-known risk. Less well recognized is the potential for life-threatening bilateral pneumothoraces occurring at the time of subclavian vein catheterization in patients who have previously undergone median sternotomy. Inadvertent bilateral pleural entry at the time of sternotomy may result in a common pleural space which subsequently places the patient in special jeopardy when the complication of pneumothorax occurs. This report documents the successful management of this important sequence of complications associated with now widely applied therapeutic interventions.

Aged↗
PubMed1983

Drug abuse and affluence in five countries: a study of economic and health conditions, 1960-1975.

Studies have reported a positive relationship between alcohol consumption and general levels of affluence in society. The present paper suggests that drug use and abuse should also be related to affluence since, to some extent, alcohol and drugs are substitute products. Levels of drug abuse and levels of affluence, in society, change over time. Therefore, indicators of affluence (economic and health conditions) and various types of illicit drug abuse in five countries were examined for the period 1960-1975. The results of our investigation show that officially recorded measures of drug abuse, in each of five countries, were related to improvements in economic and health conditions.

Amphetamine↗
PubMed1983

Correlation of preoperative pulmonary function testing with clinical course in patients after pneumonectomy.

Postoperative morbidity and mortality were correlated with the preoperative results of three widely used tests of pulmonary function in 90 patients who underwent pneumonectomy for carcinoma of the lung. Factors analyzed following operation included thirty-day mortality, the incidence of arrhythmias, the frequency of respiratory complications, and the number of individuals requiring prolonged mechanical ventilation. Fourteen patients had a forced vital capacity (FVC) of 70% or less of predicted normal value. Eleven had a one-second forced expiratory volume (FEV1) of 1.5 liters or less, and 32 had an FEV1 of less than 2 liters. Twenty-six had an FEV1/FVC ratio of 0.6 or less. There were no differences in morbidity or mortality between these individuals and the patients whose test scores exceeded these criteria. As a general rule, decisions regarding operability and extent of resection cannot be made solely on the basis of the three spirometry tests reviewed.

Adolescent↗