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Biomedical subjects

James J Murphy

Publications and source records attributed to James J Murphy.

10 recordsLinked to original sources
PubMed2006

Necrotizing soft tissue infections--are they different in healthy vs immunocompromised children?

PURPOSE: Necrotizing soft tissue infection (NSTI) is rare and often devastating. We sought to define our experience and determine if differences in immune status influenced outcome. METHODS: A retrospective review (1993-2004), with institutional review board approval, was undertaken on children with NSTI. Presentation, laboratory results, and outcome were assessed. RESULTS: There were 19 cases; the median age was 5.9 years (range, 6 days-14 years). Eight were immunocompromised (IC). At presentation, 95% had pain and swelling; fever and tachycardia occurred in 84% and 74%, respectively. Severe tenderness was found in 100% of healthy vs 25% of IC patients. Compared with the healthy, in IC patients, more infections were perineal/buttock (75% vs 32%), polymicrobial (75% vs 58%), and fungal (38% vs 0%). Median intensive care unit stay and length of hospital stay in IC vs healthy were 4 vs 2 and 27 vs 16.5 days, respectively. Mortality rate was 16% (2 healthy and 1 IC). CONCLUSIONS: Most children with NSTI present with fever, tachycardia, pain, and swelling. Compared with healthy children, IC patients are less likely to have severe tenderness and more likely to have polymicrobial perineal/buttock infections. Although IC patients had a longer length of intensive care unit and hospital stay, their mortality (12%) was actually better than that seen in the otherwise healthy children (18%). Coagulopathy developed in 64% of the patients and may be an early marker for the presence of necrotizing soft tissue infections.

Adolescent↗
PubMed2005

Laparoscopic vs percutaneous endoscopic gastrostomy tube insertion: a new pediatric gold standard?

BACKGROUND/PURPOSE: Gastrostomy tube insertion is frequently performed in children. Percutaneous endoscopic gastrostomy (PEG) insertion, considered by many to be the "gold standard," is unavoidably associated with a risk of intestinal perforation and frequently requires a second anesthetic for its replacement with a low-profile "button." We hypothesized that a laparoscopic technique with low-pressure insufflation would yield comparable outcomes, a lower procedural complication rate, and require fewer anesthetics per patient. METHODS: A retrospective review of all surgeon-placed gastrostomy tubes (exclusive of those associated with fundoplication or other procedures) between January 2002 and December 2003 was undertaken. Data collected included type of procedure (PEG vs laparoscopic), indication, patient demographics (including neurologic comorbidity), operative time, complications (procedure-specific and nonspecific), and number of procedural anesthetics to "achieve" a low-profile tube. Groups were compared by univariate and multiple logistic regression analyses. RESULTS: One hundred nineteen gastrostomy tubes (26 laparoscopic = 21.8%) were inserted. The PEG and laparoscopic gastrostomy groups were comparable from the perspectives of age, size, indications for tube placement, and operative time. The complication rate after PEG placement was significantly higher than after LG (14% vs 7.7%; P = .023), and 72 (77.4%) of PEG patients required a second anesthetic for tube change. CONCLUSIONS: Laparoscopic gastrostomy tube insertion is safe and easy to perform, with outcomes comparable to that of PEG tube insertion. It obviates the need for a second procedural anesthetic and may emerge as the gold standard for gastrostomy tube placement.

Child↗
PubMed2003

Are localized intestinal perforations distinct from necrotizing enterocolitis?

BACKGROUND/PURPOSE: Localized intestinal perforation (LP) is thought to be a distinct entity when compared with perforation associated with necrotizing enterocolitis (NEC). Studies have indicated that LP is more amenable to percutaneous drainage and associated with a better outcome. We sought to determine whether LP and NEC could be distinguished based on clinical parameters alone. METHODS: A retrospective review of 40 neonates with gastrointestinal perforations between January 1990 and May 1998 was performed. All had undergone laparotomy and had histologic specimens available for evaluation. RESULTS: Twenty-one neonates had necrotizing enterocolitis (NEC), and 19 had localized perforation (LP) based on histologic criteria. More neonates with LP were exposed to prenatal indomethacin (37% v 5%; P <.05), received intravenous dexamethasone (42% v 10%; P <.05), had umbilical artery catheters (63% v 14%; P <.05), and had a higher white blood cell (WBC) count (27.1 +/- 23.1 v 14.3 +/- 11.5; P <.05). More neonates with NEC had pneumatosis intestinalis (47% v 11%; P <.05). No significant differences existed in enteral feeding (16% LP v 38% NEC) or overall mortality rate (37% LP v 38% NEC). No statistical differences in the timing of perforation or clinical presentation were found. CONCLUSIONS: NEC and LP are difficult to distinguish based on clinical parameters alone. The authors did find associations between LP and prenatal indomethacin, intravenous dexamethasone, umbilical artery catheters, and a higher WBC count. Mortality rate and clinical outcome were nearly identical in both groups. Pneumatosis intestinalis, thought to be pathognomonic for NEC, was seen on abdominal radiograph in 2 babies with histologically proven LP.

Adult↗
PubMed2003

Metastatic testicular rhabdomyosarcoma--a report of two cases.

Rhabdomyosarcoma is the most common type of soft tissue sarcoma in children. The tumor spreads by local extension, to regional lymph nodes, or by distant metastases. Metastatic spread to the testicle has been rarely described. The authors describe 2 boys who were found to have intratesticular metastases after presenting with primary tumors in their extremities. The first patient, an 11-year-old boy presented with primary disease in his left foot and an enlarged testicle. Rhabdomyosarcoma was found histologically in both the foot and the testicle. A second boy 17 years of age had a primary tumor involving the left upper extremity treated with amputation, chemotherapy, and radiotherapy. A relapse was noted 2 years later in the left testicle and was treated with orchiectomy. The authors discuss the implications and the management of this rare presentation of metastatic rhabdomyosarcoma.

Adolescent↗
PubMed2002

The health and visibility cost of air pollution: a comparison of estimation methods.

Air pollution from motor vehicles, electricity-generating plants, industry, and other sources can harm human health, injure crops and forests, damage building materials, and impair visibility. Economists sometimes analyze the social cost of these impacts, in order to illuminate tradeoffs, compare alternatives, and promote efficient use of scarce resource. In this paper, we compare estimates of the health and visibility costs of air pollution derived from a meta-hedonic price analysis, with an estimate of health costs derived from a damage-function analysis and an estimate of the visibility cost derived from contingent valuation. We find that the meta-hedonic price analysis produces an estimate of the health cost that lies at the low end of the range of damage-function estimates. This is consistent with hypotheses that on the one hand, hedonic price analysis does not capture all of the health costs of air pollution (because individuals may not be fully informed about all of the health effects), and that on the other hand, the value of mortality used in the high-end damage function estimates is too high. The analysis of the visibility cost of air pollution derived from a meta-hedonic price analysis produces an estimate that is essentially identical to an independent estimate based on contingent valuation. This close agreement lends some credence to the estimates. We then apply the meta hedonic-price model to estimate the visibility cost per kilogram of motor vehicle emissions.

Air Pollutants↗
PubMed2002

Cytogenetic and histologic findings in Wilms' tumor.

PURPOSE: The cytogenetic abnormalities occurring in Wilms' tumors diagnosed and treated at the authors' institution were reviewed. Correlation with tumor histopathology, stage, and outcome were evaluated. METHODS: Sixty-seven Wilms' tumors were encountered between 1984 and 1997. Tissue culture was obtained in 63 (94%) cases. Charts were reviewed retrospectively to obtain tumor histopathology, stage, and outcome. RESULTS: All tumors were examined in accordance with the National Wilms' Tumor Study (NWTS). Sixty-one were unilateral (54 unicentric, 7 multicentric), and 6 were bilateral (2 multicentric). Five Wilms' tumors showed anaplasia, whereas 62 showed favorable histology. Twenty children were stage I, 17 stage II, 20 stage III, 4 stage IV, and 6 stage V. Forty-eight (72%) tumors showed an abnormal karyotype. Chromosomal gain was more common than chromosomal loss, because hyperdiploidy was seen in 30 cases and hypodiploidy in 4. The most common aneuploidies were gains of chromosomes 6, 7, 8, 12, 13, and 18. In general, there was no correlation between specific chromosomal abnormalities with either tumor stage or histologic subtype. The only exceptions were anaplastic changes that were associated with poor prognosis and showed a variety of chromosomal changes including hyperdiploidy, hypodiploidy, and structural rearrangements. The 3 tumors causing mortality exhibited tetraploidy, hypodiploidy, and diploidy with a t(1p:11q) karyotype, respectively. Clonal progression was identified in Wilms' tumors when compared with its accompanying nephrogenic rest. A normal karyotype was seen more commonly in younger patients. CONCLUSIONS: Wilms' tumors display a variety of chromosomal abnormalities. These are particularly seen in anaplastic tumors and are less likely seen in younger patients. Overall, chromosomal gain was more common than loss with trisomies of chromosomes 12, 8, and 6 being the most frequently seen.

Child↗
PubMedDate not supplied

Compression of mediastinal structures treated by extra-anatomic bypass grafting.

Extra-anatomic bypass grafts have been used to treat complex and recurrent forms of coarctation of the aorta. Here we describe the use of an extra-anatomic bypass graft from the ascending to supraceliac aorta to treat an unusual complication of compression of mediastinal structures caused by a bucket handle graft.

Anastomosis, Surgical↗