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Murphy Sign

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2581. Percutaneous transhepatic gall bladder drainage: a better initial therapeutic choice for patients with gall bladder perforation in the emergency department. Full Text available with Trip Pro

before emergency department diagnosis was 5 days (range 0.5-30 days). Estimated incidence of gall bladder perforation was 5.6% (33/585). 27 patients (81.8%) had gallstones operatively or in image studies. All patients had either right upper quadrant pain/tenderness or epigastric pain/tenderness. Only 9 (27.3%) patients had positive Murphy's sign. Six patients in the percutaneous transhepatic gall bladder drainage group received further open cholecystectomy. Overall mortality was 24.2% (8/33

2007 Emergency Medicine Journal

2582. Diagnostic utility of cholescintigraphy in emergency department patients with suspected acute cholecystitis: comparison with bedside RUQ ultrasonography. (Abstract)

enrolled. Bedside ultrasonography was performed after an initial physical examination by a hospital-credentialed emergency sonologist. Criteria used to diagnose AC include the finding of gallstones with a sonographic Murphy sign, significant wall thickening over 5 mm, pericholecystic fluid, impacted stone, or a combination of these. US reports were compared to cholescintigraphy results, final diagnosis, disposition, and pathology results when applicable. Statistical analysis included descriptive

2007 Journal of Emergency Medicine

2583. Does this patient have acute cholecystitis? (Abstract)

authors independently abstracted data from the 17 included studies. Disagreements were resolved by discussion and consensus with a third author.No clinical or laboratory finding had a sufficiently high positive likelihood ratio (LR) or low negative LR to rule in or rule out the diagnosis of acute cholecystitis. Possible exceptions were the Murphy sign (positive LR, 2.8; 95% CI, 0.8-8.6) and right upper quadrant tenderness (negative LR, 0.4; 95% CI, 0.2-1.1), though the 95% CIs for both included 1.0 (...) without further testing (eg, right upper quadrant ultrasound). Combinations of certain symptoms, signs, and laboratory results likely have more useful LRs, and presumably inform the diagnostic impressions of experienced clinicians. Pending further research characterizing the pretest probabilities associated with different clinical presentations, the evaluation of patients with abdominal pain suggestive of cholecystitis will continue to rely heavily on the clinical gestalt and diagnostic imaging.

2003 JAMA

2584. Jaundice in Pregnancy

radiate towards the back and there may be epigastric or right upper-quadrant tenderness. Murphy's sign (right-sided tenderness at the tip of the 9th costal cartilage as the patient breathes in) is much less common in pregnancy. Management Obstructive jaundice requires surgical intervention, usually via laparoscopic cholecystectomy. There is an associated fetal loss of approximately 6%. [ ] Chronic liver disease Chronic liver disease in pregnancy is associated with an increased risk of fetal loss

2008 Mentor

2585. Abdominal Examination

inspiration, release your inward pressure but maintain your upward pressure. Your fingertips should then move over any palpable liver edge. Examination of the gallbladder Murphy's sign can be elicited by placing your examining fingers over the gallbladder area and then asking the patient to take a deep breath. If Murphy's sign is positive, there will be sudden accentuation of the pain on inspiration and inspiration will be inhibited. Examination of the spleen To detect splenomegaly, place the examining (...) the examination more difficult. Inspection [ , ] General inspection Does the patient look unwell? Is pain apparent? If the patient is writhing it could be due to colic in some form. A person with peritonitis lies still. Is there jaundice? This may not be easily apparent in artificial light. Is there evidence of dehydration? Are there signs of weight loss or wasting (may be a sign of malabsorption or malignancy)? Look for purpura (may be present in hypersplenism or impaired clotting function). Look for spider

2008 Mentor

2586. Gallstones and Cholecystitis

duct, which may cause continuous epigastric or RUQ pain, vomiting, fever, local peritonism, or a GB mass. The main difference from biliary colic is the inflammatory component (local peritonism, fever, raised white cell count (WCC)). If the stone moves to the CBD, jaundice may occur. Murphy's sign: lay two fingers over the RUQ. Ask the patient to breathe in. This causes pain and arrest of inspiration as the inflamed GB impinges on your fingers. The sign is only positive if a similar manoeuvre

2008 Mentor

2587. Open, Non-Comparative Study of Fluconazole in Patients With Coccidioidal Meningitis

. OR CSF antibody titer decrease of at least one dilution. OR Improvement in signs and symptoms of meningitis. Have received more than minimal systemic antifungal therapy (see Patient Inclusion Criteria), unless they meet criteria for previous treatment failure or relapse. They must not have received this therapy since the time relapse or failure was documented, except for minimal antifungal therapy allowed in Patient Inclusion Criteria. Immediately life-threatening coccidioidomycosis defined (...) the study research staff using the contact information provided by the sponsor. Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT00002010 Locations Layout table for location information United States, Arizona Tucson Veterans Administration Med Ctr Tucson, Arizona, United States, 85724 United States, California HIV Research Group San Diego, California, United States, 92102 United States, Texas Audie L Murphy Veterans Administration Hosp San Antonio, Texas, United States

1999 Clinical Trials

2588. A Double-Blind Group Comparative Study To Evaluate the Long-Term Safety and Effectiveness of Two Different Doses of Aerosol Pentamidine in the Prophylaxis of Pneumocystis Carinii Pneumonia in AIDS Patients With Multiple Episodes of PCP

infection at time of study entry. AIDS-defining opportunistic infection prior to study entry such as toxoplasmosis and cryptococcosis. Pulmonary Kaposi's sarcoma. Unwilling to sign informed consent. Asthma poorly controlled by medication. Unwilling to cooperate with study procedures. Receiving active therapy for tuberculosis. Prior Medication: Excluded within 30 days of study entry: Antiretrovirals (other than zidovudine (AZT)). Immunomodulating agents. Corticosteroids. Prior Treatment: Excluded within (...) for location information United States, District of Columbia Georgetown Univ Washington, District of Columbia, United States, 20007 Veterans Administration Med Ctr Washington, District of Columbia, United States, 20422 United States, Illinois Northwestern Univ Med School Chicago, Illinois, United States, 60611 United States, Massachusetts Beth Israel Deaconess - West Campus Boston, Massachusetts, United States, 02215 Sponsors and Collaborators Fisons More Information Go to Publications: Lavelle J, Murphy R

1999 Clinical Trials

2589. A Double-Blind Study To Evaluate the Long-Term Safety and Effectiveness of 60 mg Versus 120 mg of Aerosol Pentamidine in the Prophylaxis of Pneumocystis Carinii Pneumonia in AIDS Patients

Kaposi's sarcoma. Unwilling to sign informed consent. Cannot cooperate with study procedures. Asthma poorly controlled by medication. Receiving active therapy for tuberculosis. Active substance abuse. Contacts and Locations Go to Information from the National Library of Medicine To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor. Please refer to this study by its ClinicalTrials.gov identifier (NCT number (...) Conf AIDS. 1992 Jul 19-24;8(2):C314 (abstract no PoC 4419) Lavelle J, Murphy R, Harding P, Pierce P. Aerosolized pentamidine prophylaxis following Pneumocystis carinii pneumonia in patients with AIDS. Int Conf AIDS. 1990 Jun 20-23;6(2):374 (abstract no 2083) Layout table for additonal information ClinicalTrials.gov Identifier: Other Study ID Numbers: 022C 87-71 (Part C) First Posted: August 31, 2001 Last Update Posted: June 24, 2005 Last Verified: October 1989 Keywords provided by NIH AIDS Clinical

1999 Clinical Trials

2590. A Study of 141W94 Used Alone or in Combination With Zidovudine Plus 3TC in HIV-Infected Patients

. Alternative therapies such as vitamins, acupuncture and visualization techniques are permitted (excluding herbal medications). NOTE: Patients should report the use of these therapies; alternative therapies will be recorded. Patients must have: HIV-1 infection as documented by ELISA and confirmed. >= 5,000 HIV-1 RNA copies/ml (within 30 days prior to study entry). CD4 cell count >= 50 cells/mm3 within 60 days prior to study entry. Signed, informed consent for patients < 18 years of age. Prior Medication (...) Philadelphia, Pennsylvania, United States, 19104 Sponsors and Collaborators National Institute of Allergy and Infectious Diseases (NIAID) Investigators Layout table for investigator information Study Chair: Murphy R Study Chair: Gulick R More Information Go to Publications: Murphy R, Degruttola V, Gulick R, D'Aquila R, Eron J, Sommadossi JP, Smeaton L, Currier J, Tung R, Kuritzkes D. 141W94 with or without zidovudine/3TC in patients with no prior protease inhibitor or 3TC therapy-ACTG 347. Conf

1999 Clinical Trials

2591. Combination Chemotherapy With or Without Rituximab in Treating Patients With Non-Hodgkin's Lymphoma

systemic antibiotics or antiviral medications No severe uncompensated diabetes mellitus No clinical signs of cerebral dysfunction No severe psychiatric disease PRIOR CONCURRENT THERAPY: Biologic therapy No prior murine antibodies Chemotherapy No other concurrent anticancer chemotherapy Endocrine therapy Not specified Radiotherapy No concurrent response-adapted (slow response or unconfirmed complete response) radiotherapy Surgery Not specified Other No prior lymphoma-specific treatment More than 12 (...) , Alberta Tom Baker Cancer Centre Calgary, Alberta, Canada, T2N 4N2 Cross Cancer Institute Edmonton, Alberta, Canada, T6G 1Z2 Canada, Manitoba CancerCare Manitoba Winnipeg, Manitoba, Canada, R3E 0V9 Canada, New Brunswick The Moncton Hospital Moncton, New Brunswick, Canada, E1C 6Z8 Canada, Newfoundland and Labrador Dr. H. Bliss Murphy Cancer Centre St. John's, Newfoundland and Labrador, Canada, AIB 3V6 Canada, Nova Scotia QEII Health Sciences Center Halifax, Nova Scotia, Canada, B3H 1V7 Canada, Ontario

2003 Clinical Trials

2592. Effects of Treatment Changes on Fat Wasting in the Arms and Legs of HIV Patients

to Information from the National Library of Medicine To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor. Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT00028314 Sponsors and Collaborators National Institute of Allergy and Infectious Diseases (NIAID) Investigators Layout table for investigator information Study Chair: Robert L Murphy, MD Northwestern University Medical Center Study (...) Immune System Diseases Skin Diseases, Metabolic Skin Diseases Lipid Metabolism Disorders Metabolic Diseases Emaciation Weight Loss Body Weight Changes Body Weight Signs and Symptoms Nutrition Disorders Ritonavir Lopinavir Atazanavir Sulfate Nevirapine Abacavir HIV Protease Inhibitors Protease Inhibitors Enzyme Inhibitors

2001 Clinical Trials

2593. Brain Dynamics Involved in Generating Tics and Controlling Voluntary Movement

, only those with no more than mild to moderate severity of symptoms will be accepted into the study. This will be ascertained using the following instruments and their respective cut-off scores: Y-BOCS (Goodman et al, 1989) a 10 item scale with a range of 0 - 4 and maximum possible score of 40 (0-7: subclinical; 8 - 15: mild; 16 -23: moderate; 24 - 31 severe; 32 - 40: extreme). Inclusion criteria: 23 or below. ADHD Behavior Checklist for Adults (Barkley, 1995, Murphy and Barkley, 1995): An 18 Item (...) Processes Basal Ganglia Diseases Brain Diseases Central Nervous System Diseases Nervous System Diseases Movement Disorders Heredodegenerative Disorders, Nervous System Neurodegenerative Diseases Genetic Diseases, Inborn Neurodevelopmental Disorders Mental Disorders Dyskinesias Neurologic Manifestations Signs and Symptoms

2003 Clinical Trials

2594. Safety and Antifungal Activity of Recombinant Interferon-Gamma 1b (rIFN-Gamma 1b) Given With Standard Therapy in Patients With Cryptococcal Meningitis

is allowed. Are receiving AMB for C. neoformans within 30 days of starting treatment for the present episode. Are receiving rIFN-gamma 1b treatment within 90 days prior to starting the study drug. Have had therapy which affects the immune system within 30 days prior to starting the study drug. Are receiving investigational therapy for all other signs within 30 days prior to starting the study drug. Are not able to meet the study requirements, in the opinion of the investigator. Require chronic treatment (...) with H2-blockers, and are able to receive only itraconazole in Stage 2. Show signs of or get treatment for another serious opportunistic infection within 4 weeks of starting the study drug. Contacts and Locations Go to Information from the National Library of Medicine To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor. Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT00012467

2001 Clinical Trials

2595. TBTC NAA Study: Pilot Study of Surrogate Markers for Outcome of TB Treatment

with INH, rifampin and PZA, and if the M. tuberculosis isolate is susceptible to INH and rifampin. If this induction regimen is not tolerated by the patient, a rifampin-containing regimen compatible with CDC/ATS recommendations is an acceptable alternative. Age 18 years or older Willingness to practice effective contraception (if female and of child-bearing potential) Provision of written informed consent. Signed by both the patient and investigator, in accordance with Institutional Review Board (...) York Harlem Hospital Center New York, New York, United States, 10037 United States, Texas University of North Texas Health Science Center Fort Worth, Texas, United States, 76107-2699 Audi L. Murphy VA Hospital San Antonio, Texas, United States, 78284 United States, Washington Seattle King County Health Department Seattle, Washington, United States, 98104 Canada, British Columbia University of British Columbia Vancouver, British Columbia, Canada, Canada V5Z 4R4 Canada, Manitoba University

2001 Clinical Trials

2596. Ceruletide analgesia in biliary colic. (Abstract)

, referred pain, and Murphy's sign were scored before and after treatment. Data indicate that ceruletide is effective in biliary colic.

1984 Clinical pharmacology and therapeutics

2597. Radiation Therapy to Relieve Symptoms in Patients With Non-small Cell Lung Cancer

Centre Victoria, British Columbia, Canada, V8R 1J8 Canada, Manitoba CancerCare Manitoba Winnipeg, Manitoba, Canada, R3E 0V9 Canada, New Brunswick Doctor Leon Richard Oncology Centre Moncton, New Brunswick, Canada, E1C 8X3 Saint John Regional Hospital Saint John, New Brunswick, Canada, E2L 4L2 Canada, Newfoundland and Labrador Dr. H. Bliss Murphy Cancer Centre St. Johns, Newfoundland and Labrador, Canada, A1B 3V6 Canada, Nova Scotia Nova Scotia Cancer Centre Halifax, Nova Scotia, Canada, B3H 1V7 (...) Lung Neoplasms Carcinoma, Non-Small-Cell Lung Fatigue Nausea Vomiting Respiratory Tract Neoplasms Thoracic Neoplasms Neoplasms by Site Neoplasms Lung Diseases Respiratory Tract Diseases Carcinoma, Bronchogenic Bronchial Neoplasms Signs and Symptoms Signs and Symptoms, Digestive

1999 Clinical Trials

2598. The Safety and Effectiveness of BI-RG-587 in HIV-Infected Patients

antiretroviral therapy, after signing informed consent, 28 days prior to receipt of a first dose of Nevirapine. Screening lab tests, including p24 antigen and plasma viremia, and CD4+ cell count determination are performed 21 days prior to drug dosing in Part I. Patients are notified of screening laboratory measures that exclude them from study participation. Upon such notification patients have the option to resume prior antiretroviral therapy or to repeat those values in one week. Part II consists of two 8 (...) 164 and 168 Study Teams. Int Conf AIDS. 1993 Jun 6-11;9(1):69 (abstract no WS-B26-1) Richman DD. Loss of nevirapine activity associated with the emergence of resistance in clinical trials. The ACTG 164/168 Study Team. Int Conf AIDS. 1992 Jul 19-24;8(2):B183 (abstract no PoB 3576) Hattox S. Pharmacokinetics of nevirapine alone and in combination with zidovudine. The ACTG 164/168 Study Team. Int Conf AIDS. 1992 Jul 19-24;8(2):B185 (abstract no PoB 3591) Cheeseman SH, Murphy RL, Saag MS, Havlir D

1999 Clinical Trials

2599. A Study of Different Doses of Megestrol Acetate in Patients With AIDS Who Have Anorexia and Malnutrition

and Med Ctr New York, New York, United States, 10011 Mem Sloan - Kettering Cancer Ctr New York, New York, United States, 10021 United States, Pennsylvania Univ of Pennsylvania Philadelphia, Pennsylvania, United States, 19104 United States, Texas Audie L Murphy Veterans Administration Hosp San Antonio, Texas, United States, 78284 Sponsors and Collaborators Bristol-Myers Squibb More Information Go to Additional Information: Publications: Layout table for additonal information ClinicalTrials.gov (...) Diseases, Viral Sexually Transmitted Diseases Immunologic Deficiency Syndromes Immune System Diseases Signs and Symptoms, Digestive Signs and Symptoms Emaciation Weight Loss Body Weight Changes Body Weight Metabolic Diseases Nutrition Disorders Megestrol Megestrol Acetate Contraceptives, Oral, Synthetic Contraceptives, Oral Contraceptive Agents, Female Contraceptive Agents Reproductive Control Agents Physiological Effects of Drugs Antineoplastic Agents, Hormonal Antineoplastic Agents

1999 Clinical Trials

2600. Clinical diagnosis of gall-bladder disease Full Text available with Trip Pro

Clinical diagnosis of gall-bladder disease An investigation into the diagnosis of gall-bladder disease in general practice by simple clinical methods was carried out over seven years; 916 patients were seen in 1018 episodes of illness. These patients were examined particularly for oedema in the skin and subcutaneous tissue of the right hypochondrium, Murphy's sign, clinical jaundice and bilirubinuria.Oedema was found in 89% of the episodes of confirmed gall-bladder disease and in 74 (...) % of the suspected cases, but in only 4% of the other abdominal and thoracic conditions studied. Clinical jaundice or bilirubinuria or both occurred in 28% of the confirmed episodes of gall-bladder disease and in 12% of the suspected ones.If oedema, Murphy's sign and jaundice were all present there was a 72% probability of the condition being gall-bladder disease.During the study, there was a 45% increase in the number of new cases of gall-bladder disease correctly diagnosed each year compared with the previous

1985 The Journal of the Royal College of General Practitioners

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