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Biomedical subjects

M L Murphy

Publications and source records attributed to M L Murphy.

At least 19 recordsLinked to original sources
PubMed1979

The reliability of coronary angiogram interpretation: an angiographic-pathologic correlation with a comparison of radiographic views.

This prospective study correlates premortem coronary angiographic interpretation with pathologic findings including the use of postmortem coronary angiograms. The reliability of a single radiographic view, left anterior oblique or right anterior oblique, or combined views (left anterior oblique plus right anterior oblique) was examined. The most reliable interpretation, the combined view, has a specificity of 93 per cent, but sensitivity is less at 61 per cent. Using a single view enhances diagnosis (sensitivity), but it leads to overestimation more frequently (decreased specificity). Proximal segments of the coronary arteries are prone to a significant per cent of false positive readings. The most accurate assessment of the anterior descending coronary artery system occurs with the use of the right anterior oblique with multiple views. Less routine use of the left anterior oblique view with increased use of the hemiaxial view is suggested for the angiography of the left coronary artery. Initial cusp injections of the right coronary artery may avoid a high per cent of false positive readings in the proximal segment.

Angiography↗
PubMed1979

Comparison of the size of the arterial vascular bed to the right ventricular mass in patients with chronic obstructive pulmonary disease.

Hearts from patients dying with severe chronic obstructive pulmonary disease were examined for right ventricular mass and coronary arterial vascular bed size. Normal hearts obtained from patients dying of other causes were also examined for comparison. The relationship between the size of the vascular bed and ventricular mass was examined and a definite but low correlation was found. Severe obstructive coronary artery disease was excluded, and chronic hypoxemia did not alter the results. The arterial vascular bed supplying the right ventricle of male patients with severe chronic obstructive pulmonary disease appears to undergo a compensatory increase in size as the ventricular mass enlarges, but this is highly variable and incomplete.

Blood Gas Analysis↗
PubMed1979

Evaluation of warning arrhythmias before paroxysmal ventricular tachycardia during acute myocardial infarction in man.

In order to determine the relationship of paroxysmal ventricular tachycardia (PVT) to any antecedent (premonitory) ventricular arrhythmias during the early phases of acute myocardial infarctions, 24-hour Holter monitoring was begun on 52 male patients an average of 12.6 hours after the onset of prolonged chest pain that was documented as acute infraction. Twenty-four patients had PVT and 28 did not. We analyzed in detail the incidence of frequency of premature ventricular complexes (PVCs), prematurity and pairing during the 10 minutes immediately preceding PVT from a continuous 10-minute rhythm strip. There was no positive correlation between PVT and the number or complexity of PVCs in the 10 minutes immediately before ventricular tachycardia. These findings suggest that there is no consistent pattern or frequency of ventricular arrhythmia that could be identified as premonitory for PVT during the immediate pre-PVT period, even during the acute phase of myocardial infarction in man.

Acute Disease↗
PubMed1978

Coronary angiogram interpretation. Interobserver variability.

Clinicopathological correlation of premortem coronary angiograms and postmortem data was performed to determine the degree of interobserver variability in the clinical interpretation of coronary angiograms using the pathological findings as the standard of accuracy. Comparison of the independent interpretations of the antemortem coronary angiograms by three cardiologists showed no substantial difference in overall diagnostic accuracy among the three observers. In the majority of instances where a substantial angiographic lesion was found on coronary angiography, it was verified pathologically. In false-positive or false-negative interpretations, a majority opinion was accurate when compared with a pathological lesion in 50% of the instances. Despite the fact that coronary angiography is an excellent diagnostic tool, there remain limitations of the accuracy of interpretation not solved by a majority opinion.

Angiography↗
PubMed1978

The relationship of paroxysmal ventricular tachycardia complicating the acute phase and ventricular arrhythmia during the late hospital phase of myocardial infarction to long-term survival.

The long-term prognosis of paroxysmal ventricular tachycardia (PVT) complicating acute myocardial infarction remains unevaluated. Significant ventricular arrhythmia in the patient after infarction is said to carry a poor prognosis with regard to survival. To evaluate these two important aspects of myocardial infarction in man, 56 patients with documented myocardial infarction had Holter monitoring performed during the initial 24 hours and prior to hospital discharge. In 38 of the 45 survivors, Holter monitoring was repeated an average of 19 months after infarction. There were eight cardiac deaths during follow-up. Data analysis revealed that of 18 patients with PVT during the acute phase, one died during follow-up and 17 survived long-term. Even though the incidence of complex PVCs prior to hospital discharge and at long-term follow-up was higher in patients with PVT during the acute phase than in those without PVT, survival appeared unaffected. Thus, PVT during the acute phase of myocardial infarction and complex PVCs at the time of hospital discharge are not incompatible with long-term survival.

Acute Disease↗
PubMed1978

Ventricular arrhythmias in chronic stable angina pectoris with surgical or medical treatment.

Since both propranolol therapy and saphenous-vein bypass surgery have become accepted treatments for patients with symptomatic coronary-artery disease, it is important to determine if either influences the prevalence of ventricular arrhythmias in these patients. Six-hour dynamic electrocardiography was done on 130 patients with chronic stable angina pectoris at least 1 year after being randomized to surgical or medical therapy. All surgical patients had saphenous-vein grafting; 90% of the medical patients received propranolol. Data analysis showed that even though the overall prevalence of premature ventricular contractions was no different in medical and surgical patients, the prevalence of complex premature ventricular contractions was significantly higher in surgically treated patients not receiving propranolol than in propranolol-treated medical patients (p less than 0.05). However, the survival rate was no different in either group, and the quality of life in the surgical patients remained superior.

Adult↗
PubMed1978

Survival of men treated for chronic stable angina pectoris. A cooperative randomized study.

During 1972 to 1974, 686 men aged 27 to 67 years, admitted to thirteen Veterans Administration Hospitals with stable angina, resting or exercise electrocardiographic abnormalities, "graftable" arteries, and abnormal left ventricular function (80 percent) were randomly assigned to surgery (332) or medical (354) treatment. There was no significant difference in clinical, angiographic, and ventriculographic characteristics. The over-all operative mortality rate (30 days) was 5.8 percent, 5 percent in the 95 percent who had saphenous vein aorta-coronary bypass alone. Eighty-nine percent of the 79 percent recatheterized at 1 year had at least one patent graft. Longevity for patients with one, two, and three vessel disease who were treated surgically was comparable to that previously described, but did not differ from that of the medically treated groups. Survival in the over-all surgical group was 86 percent at 4 years as compared to 83 percent in the medical group, which in these "operative candidates" is better than usually cited. This difference was eliminated when the 90 patients (13 percent) with left main disease, whose longevity was significantly improved (p = 0.005) by the operation, were excluded. Despite this exclusion, a slight trend in favor of surgery was still discernible in the largest subgroup, those having triple vessel disease with an abnormal left ventricle.

Adult↗
PubMed1977

Effect of coronary bypass surgery on longevity in high and low risk patients. Report from the V.A. Cooperative Coronary Surgery Study.

There is considerable uncertainty about the effects of bypass surgery on the longevity of patients with coronary-artery disease and angina. The Cleveland Clinic has reported improved survival after surgical treatment; the Duke University study indicated improvement in a high-risk subgroup only. The Veterans Administration (V.A.) randomised study initially reported improved survival only for patients with significant left main artery (L.M.) disease. Further analysis of the V.A. study shows that survival in the high-risk subgroup was 87% for the surgically treated patients and 74% for those treated medically--a highly significant difference after four years of follow-up. However, exclusion of the L.M. group reduced the difference to a non-significant one of 84% versus 79%. For patients not in the high-risk subgroup, survival at four years (with L.M. excluded) was 93% for those treated surgically and 96% for those treated medically. For all patients the rates were 85% and 86%, respectively. These findings indicate that in the evaluation of the effects of bypass surgery on longevity the characteristics of the coronary-artery disease are critical.

Angina Pectoris↗
PubMed1977

Effects of adenine nucleotide translocase inhibitors on dinitrophenol-induced Ca2+ efflux from pig heart mitochondria.

Bongkrekic acid and atractyloside, inhibitors of adenine nucleotide translocase, do not inhibit Ca2+ uptake and H+ production by pig heart mitochondria. However, bongkrekic acid, but not atractyloside, inhibits dinitrophenol-induced Ca2+ efflux and H+ uptake. Conversely, ruthenium red blocks Ca2+ uptake and H+ production but does not prevent dinitrophenol-induced Ca2+ efflux and H+ uptake by mitochondria. These results suggest that mitochondrial Ca2+ uptake and release exist as two independent pathways. The efflux of Ca2+ from mitochondria is mediated by a bongkrekic acid sensitive component which is apparently not identical to the ruthenium red sensitive Ca2+ uptake carrier.

Adenosine Diphosphate↗
PubMed1977

Treatment of chronic stable angina. A preliminary report of survival data of the randomized Veterans Administration cooperative study.

We evaluated the effect of saphenous-vein-bypass grafting on survival in patients with chronic stable angina by comparing medical and surgical treatment in a large-scale, prospective randomized study. Excluding patients with left-main-coronary-artery disease who have already been reported, a total of 596 patients were entered into this study; when randomized into a medical group (310 patients) and a surgical group (286 patients), entry clinical and angiographic base lines were comparable. Operative mortality at 30 days was 5.6 per cent. At an average of one year after operation, 69 per cent of all grafts were patent, and 88 per cent of the surgical patients had atleast one patent graft. There was no statistically significant difference in survival, at a minimal follow-up interval of 21 months, between patients treated medically and those treated with saphenous-vein-bypass grafting. At 36 months, 87 per cent of the medical group and 88 per cent of the surgical group were alive.

Adult↗
PubMed1977

Treatment of acute nonlymphoblastic leukemia in children with a multiple-drug protocol.

Twenty-one children with acute nonlymphoblastic leukemia (ANLL) were treated with a combination regimen consisting of arabinosyl cytosine (Ara-C), 6-thioguanine (TG), and Adriamycin, The incidence of complete remission was 74%. For consolidation, addition courses of Ara-C and TG were given, followed by L-asparaginase. The maintenance program was the same as that for the lymphoblastic type (L-2) including intrathecal methotrexate for prophylaxis of meningeal leukemia. Of the 16 who were evaluable for the duration of complete remission, six developed bone marrow relapse, one meningeal leukemia within 3-14 months after entering complete remission and one was lost to follow-up. Eight remain in complete remission for 9-72 months. In five of eight, chemotherapy has been terminated after 3 years, and all continue in remission for 11-32 months post-treatment. Although the results do not compare well to those of the lymphoblastic morphology, long-term disease-free survival can be achieved with multiple-drug intensive treatment in childhood ANLL.

Acute Disease↗
PubMed1977

Detecting ventricular arrhythmia after myocardial infarction: comparison of Hoiter monitoring and treadmill exercise.

The effectiveness of Holter monitoring is compared to modified treadmill exercise for detecting ventricular arrhythmia in 54 patients during the third week after a documented myocardial infarction. Treatment with digoxin and antiarrhythmic agents had been discontinued for 48 hours. Whereas 76% of the patients had no PVCs during treadmill exercise, only 7% were free of PVCs during Holter monitoring. Complex PVCs occurred in 37% of the subjects during Holter monitoring and in 4% of the subjects during treadmill stress. Although Holter monitoring was significantly more reliable in detecting ventricular arrhythmia, assessment of exercise tolerance and angina status during modified treadmill stress makes both technics desirable in carefully selected patients awaiting discharge from the hospital after myocardial infarction.

Adult↗
PubMed1977

Evaluation of cardiac size in chronic bronchitis and pulmonary emphysema.

The accuracy of interobserver variability of roentgenographic analysis for cardiac size in patients dying with chronic bronchitis and pulmonary emphysema were correlated with pathologic data derived from special studies. Three trained observers were able to accurately and consistently diagnose chronic bronchitis and pulmonary emphysema and to detect cardiomegaly on the chest x-ray film. The best criteria for chronic bronchitis and pulmonary emphysema were those of overinflation; however, none of the roentgenographic criteria usually suggested for the specific diagnosis of right ventricular or left ventricular hypertrophy were found to be reliable. The inaccuracy and interobserver variability in the detection of enlargement of specific chambers make it evident that the usual criteria are not valid and that roentgenographic appraisal of cardiac size in these patients in limited to findings of normalcy or cardiomegaly.

Autopsy↗