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Biomedical subjects

G Murray

Publications and source records attributed to G Murray.

At least 19 recordsLinked to original sources
PubMed1992

Acute trauma and hypnosis.

Hypnosis is a valuable adjunct to the management of acute trauma. This is a case presentation of the management of severe burn injuries after fire and explosion on a United States Navy vessel. Hypnosis was used to calm one patient and facilitate intubation. Further suggestions of rapid healing and anxiety control were given. Hypnosis is not only helpful for management, but can be used to decrease the perceived severity of the incident. Patient well-being may also prevent sequelae of stress.

Burns↗
PubMed1992

Metabolic cardiac imaging in severe coronary disease: assessment of viability with iodine-123-iodophenylpentadecanoic acid and multicrystal gamma camera, and correlation with biopsy.

Fifteen patients with coronary disease and resting left ventricular ejection fractions of less than or equal to 0.35 underwent resting metabolic cardiac imaging utilizing 1 mCi [123I]iodophenylpentadecanoic acid (IPPA) intravenously and a multicrystal gamma camera. Parametric images of regional rates of IPPA clearance and accumulation were generated. Forty-two vascular territories (22 infarcted) were evaluated by metabolic imaging as well as transmural myocardial biopsy. Despite resting akinesis or dyskinesis in 20/22 (91%) infarcted territories, 16/22 (73%) of these territories were metabolically viable. Transmural myocardial biopsies in all patients (43 sites, 42 vascular territories) during coronary bypass surgery confirmed IPPA results in 39/43 patients (91%). When compared to biopsy, scan sensitivity for viability was 33/36 (92%) with a specificity of 6/7 (86%). Eighty percent of bypassed, infarcted but IPPA viable segments demonstrated improved regional systolic wall motion postoperatively as assessed by exercise radionuclide angiography. We conclude resting IPPA imaging identifies viable myocardium, thereby providing a safe, cost-effective technique for myocardial viability assessment.

Biopsy↗
PubMed1992

A randomized trial of nimodipine in severe head injury: HIT I. British/Finnish Co-operative Head Injury Trial Group.

We studied the efficacy of nimodipine in severely head-injured patients in a randomized study. Of 176 patients who received nimodipine, 2 mg/h iv for 2 day, 53% had a favorable outcome (moderate or good recovery). Of 175 control patients, 49% had a favorable outcome. This difference was not statistically significant but does not exclude the possibility that a study of a larger number of patients could show a clinically useful benefit.

Adult↗
PubMed1991

Recurrence of colorectal cancer after sutured and stapled large bowel anastomoses.

The purpose of this study was to compare surgical stapling and manual suturing techniques with respect to the incidence of tumour recurrence in patients with colorectal cancer: 294 patients undergoing potentially curative resections for colorectal cancer were randomly allocated to receive sutured (n = 142) or stapled (n = 152) anastomoses. The mean (s.e.m.) incidence of tumour recurrence at the end of 24 months was 29.4(4.4) per cent in the sutured group, compared with 19.1(3.9) per cent in the stapled group (P less than 0.05). The corresponding rates for cancer-specific mortality at 24 months were 22.3(4.1) per cent and 10.9(3.0) per cent respectively (P less than 0.01). A multiple regression analysis revealed that the influence of anastomotic technique on recurrence and mortality rate was independent of tumour stage. These results suggest that in colorectal cancer surgery the use of stapling instruments for anastomotic construction could be associated with a reduction in the incidence of recurrence and mortality rate by as much as 50 per cent.

Aged↗
PubMed1991

A trial of the effect of nimodipine on outcome after head injury.

We performed a randomised prospective double blind trial to study the effect of the calcium antagonist nimodipine on the outcome of head injured patients. The subjects were not obeying commands at the time of entry to the study, within 24 hours of injury. One hundred and seventy-five patients received nimodipine IV, 2 mg per hour for up to 7 days and 176 received placebo. The two groups were well matched for important prognostic features. Six months after injury 93 (53%) of the nimodipine group and 86 (49%) of the control group had a favourable outcome (moderate/good recovery). The relative increase in favourable outcomes (8%) was not significant but is compatible (95% C.I.) with an increase in favourable outcomes in treated patients by 33% or a decrease by 12%. Nimodipine was well tolerated and there were few adverse reactions; means of systolic and diastolic blood pressures and the intracranial pressure did not differ between the groups. It is unlikely that nimodipine has a marked effect on outcome (ie an increase in favourable outcome of greater than 15%) after head injury of this severity but the study does not exclude a modest but clinically useful benefit.

Adult↗
PubMed1991

The long term prognostic significance of oestrogen receptor analysis in early carcinoma of the breast.

The long term prognostic significance of oestrogen receptors was assessed in a prospective study of 767 patients presenting between the years 1975 and 1981 with stage 1 and 2 breast cancer treated by mastectomy with either full axillary dissection or nodal sampling. Oestrogen receptor binding was determined by a dextran coated charcoal method and median follow up was 11 years. Oestrogen receptors were present in 396 (54%) of tumours. Absence of oestrogen receptors was associated with tumours of high histological grade, but there was no relationship between nodal status or tumour size. Oestrogen receptor status did not predict survival for the group as a whole or when stratified by nodal status. In multivariate analysis both nodal status and tumour size were powerful independent prognostic factors, but oestrogen receptors failed to achieve statistical significance.

Analysis of Variance↗
PubMed1991

A comparison of the efficacy and safety of ramipril and digoxin added to maintenance diuretic treatment in patients with chronic heart failure.

The efficacy and safety of ramipril were compared with that of digoxin in a prospective, randomized, double-blind, crossover study of 35 patients with congestive heart failure (CHF), New York Heart Association (NYHA) grades II to IV, stabilized on diuretic maintenance therapy. Major assessments were conducted at baseline and at the end of each 10-week treatment period: primary efficacy variables were total exercise duration (modified Bruce, treadmill), NYHA grade, and clinical signs and symptoms (by visual analogue score) of heart failure. Twenty-seven patients completed the study. There were two deaths (one on each study drug) and six patient withdrawals (one on ramipril and five on digoxin). Although the NYHA grade was significantly better on ramipril than on digoxin, there were no other important differences in the relief of either signs or symptoms of heart failure. A significant order effect was observed with the exercise testing data and therefore only data in the first active treatment period were analyzed; no significant differences were noted. There were fewer reports of adverse effects, and no clinically significant episodes of hyperkalemia or renal impairment on ramipril. We conclude that ramipril seems to be better tolerated and marginally more effective than digoxin in the management of patients with moderate to severe chronic CHF, stabilized on maintenance diuretic therapy.

Adult↗
PubMed1991

Effects of calcium chloride administration on the postischemic isolated rat heart.

Hypercalcemic reperfusion of the postischemic heart has been associated with ventricular dysfunction and with ultrastructural changes in the mitochondria. The isolated working rat heart model was used to correlate ventricular function, mitochondrial damage, and high-energy phosphate content with degree and timing of hypercalcemia during reperfusion. When administered early during reperfusion, calcium chloride caused a dose-dependent deterioration in ventricular function, whereas calcium augmented function when it was administered after a 15-minute period of normocalcemic reperfusion. Hearts treated with calcium early during reperfusion demonstrated more mitochondrial damage and decreased stores of adenosine triphosphate than those in which calcium administration was delayed. The data indicate that a period of normocalcemic reperfusion should precede calcium administration in the postischemic heart. Mitochondrial damage resulting in decreased synthesis of adenosine triphosphate is likely the cause of ventricular dysfunction associated with calcium administration in the postischemic heart.

Adenosine Triphosphate↗
PubMed1991

Management options in fulminant hepatic failure.

The diagnosis of FHF carries with it a high mortality rate. Though the early results of OLT for FHF are encouraging, some have called for caution as these results are in a select population and may be similar to the optimistic early reports of now-discredited therapies. However, OLT differs fundamentally from all other interventions and, as such, it is ethically unjustified to withhold potentially life-saving therapy from patients with a predicted mortality in excess of 60%. Therefore, patients with FHF should be transferred at an early stage to an experienced liver unit where the option of liver transplantation can be considered.

Acute Kidney Injury↗
PubMed1977

Serum myoglobin level as diagnostic test in patients with acute myocardial infarction.

Serum myoglobin levels were measured in normal subjects and patients by means of a newly developed radioimmunoassay. Myoglobin was identified in all of 135 sera from normal adults and ranged between 6 and 85 ng/ml (mean +/- SE 31 +/- 1.3). Raised myoglobin levels were present in 62 of 64 patients with documented acute myocardial infarction, the mean serum concentration being 528 +/- 76 ng/ml. Serial determinations in 46 patients with acute infarct showed that maximum values usually occurred within 4 hours after admission. In 19 of 42 cases, raised myoglobin levels preceded the rise in creatine kinase (CK) values; in the remaining patients, both serum myoglobin and creatine kinase were increased on admission. Only 2 of an additional 44 patients admitted with chest pain but without subsequent electrocardiographic, enzyme, or technetium-99m stannous pyrophosphate myocardial scintigraphic evidence of acute myocardial infarction had raised myoglobin levels; the mean value for this group was within the normal range (44 +/- 6 ng/ml). Serum myoglobin values also were normal in patients with congestive heart failure without acute myocardial infarction, and in patients after moderate exercise and cardiac catheterisation. Trasient myoglobinaemia appears to be one of the earliest laboratory abnormalities occurring in acute myocardial infarction and, therefore, should prove useful as a diagnostic aid in patients.

Acute Disease↗
PubMed1977

Echocardiographic findings in left ventricular to right atrial shunts.

The echocardiographic abnormalities of tricuspid valve motion in 2 patients with left ventricular to right atrial shunts are described. In both patients the abnormal anatomy was defined at surgery, in one patient the shunt being above the tricuspid valve leaflets (supravalvar) and in the other patient through the septal leaflet (intravalvar). Different patterns of tricuspid valve systolic fluttering were seen in these two cases and the possible reasons for this are discussed. After surgical closure of the defects the systolic fluttering of the tricuspid valve was no longer observed. Echocardiography appears to be useful in detecting the presence of left ventricular to right atrial shunts which otherwise may be difficult to diagnose.

Adult↗