Biomedical subjects

A M Miles

Publications and source records attributed to A M Miles.

45 records · Page 3Linked to original sources

PubMed1992

Penicillin anaphylaxis: a review of sensitization, treatment, and prevention.

Penicillin and its derivatives are the commonest cause of drug-induced anaphylaxis, accounting for some 500 deaths per year in the United States. Penicillins are, however, sometimes withheld unnecessarily in patients who give spurious histories of penicillin allergy. A properly performed skin test will detect patients at risk of serious anaphylaxis. Many physicians do not fully appreciate the value of penicillin skin testing, however, and this has contributed to the withholding of penicillin and the use of other, often more expensive medications. Skin testing with a mixture of benzylpenicilloyl polylysine (major determinant) and a minor determinant mixture detects all patients at risk of major anaphylaxis. Of patients who test negative with these reagents, 1% to 4% will have non-life-threatening urticarial reactions. Skin testing is most useful in patients with a vague or inconsistent history of penicillin allergy for whom alternative antibiotics would not be effective or convenient. Aztreonam is the only semisynthetic penicillin that may safely be used in penicillin-allergic patients. Desensitization may be attempted in the patient with a positive skin test for whom there is no alternative to a penicillin-type drug.

Anaphylaxis↗

PubMed1984

The attitudinal impact of training in gerontology/geriatrics in medical school: a review of the literature and perspective.

The authors review the literature regarding the effect of education on medical student attitudes toward patient care and toward geriatric patient care in particular. The ability of gerontologic/geriatric programs to foster positive attitudes toward the elderly has been modest. Empathically oriented programs that stress the establishment of contact with healthy, functioning older persons, however, may be twice as effective as cognitively oriented programs that stress the acquisition of technical knowledge. The societal, institutional, and intra/interpersonal forces that work to facilitate or limit the impact of such programs are discussed, and the potential for educational intervention is assessed.

Aged↗

PubMedDate not supplied

Upper limb ischemia after vascular access surgery: differential diagnosis and management.

Hand ischemia following placement of upper limb arteriovenous accesses for dialysis may result in debilitating complications and contribute to morbidity and mortality on dialysis. Two distinct clinical variants of hand ischemia are recognized: vascular steal syndrome, in which a spectrum of severity of ischemic changes affect all tissues of the hand; and ischemic monomelic neuropathy, where ischemia is confined to the nerves of the hand. Early diagnosis and treatment of these complications (often including closure of the access) is imperative to prevent hand paralysis, and digital or hand amputation.

Arteriovenous Shunt, Surgical↗

PubMedDate not supplied

Comparison of two serotype 1 MDV isolates.

We compared the RB1B and T. King (TK) serotype 1 isolates of Marek's disease virus (MDV) in vivo. Body and organ weights, mortality, and lesions indicated that the TK inoculum established early infection more efficiently than RB1B and did greater damage to the bursa of Fabricius and thymus. Subsequent studies showed that the TK inoculum that we used contained chicken infectious anemia virus (CIAV). Therefore, pathogenicity profiles shown here should be interpreted with the presence of CIAV contamination in the TK stock in mind.

Animals↗

PubMedDate not supplied

Coinfection of specific-pathogen-free chickens with Marek's disease virus (MDV) and chicken infectious anemia virus: effect of MDV pathotype.

Both Marek's disease virus (MDV) and chicken infectious anemia virus (CIAV) infections are prevalent in chickens throughout the world. In the past decade, MDV strains with increased virulence (very virulent plus MDV pathotype [vv+MDV]) have been isolated. The purpose of this experiment was to determine the effects of coinfection of chickens with CIAV and a vv+MDV isolate. Specific-pathogen-free chickens were inoculated at 1 day posthatch with RB1B (very virulent MDV pathotype [vvMDV]) only, 584A (vv+MDV) only, CIAV only, RB1B + CIAV, 584A + CIAV, or nothing. Samples of spleen, thymus, and bursa of Fabricius were collected at 4, 7, 10, and 13 days postinoculation (DPI). Thymic and bursal atrophy at 13 DPI and final mortality at 30 DPI were significantly greater in chickens inoculated with 584A with or without added CIAV, or with RB1B plus CIAV, compared with birds inoculated with RB1B alone. Both amounts of virus reisolated and levels of virus detected by quantitative-competitive polymerase chain reaction were greater at 4 DPI in 584A inoculates compared with RB1B inoculates. To monitor the early cytolytic infection, northern analysis was done with a probe for the MDV immediate early gene ICP4 (infected cell protein 4). In the absence of CIAV, ICP4 expression was more apparent in chickens inoculated with 584A than in those inoculated with RB1B. CIAV coinfection increased ICP4 expression in the spleens of chickens infected with RB1B. These results indicated that inoculation of chickens with the 584A isolate caused a more robust early cytolytic infection compared with inoculation with RB1B alone and support the classification of 584A as a vv+MDV strain. Coinfection with CIAV exacerbated vvMDV strain RB1B infection. The extent of this exacerbation was less evident when birds were coinfected with 584A and CIAV.

Animals↗

PubMedDate not supplied

Field safety and efficacy of in ovo administration of HVT + SB-1 bivalent Marek's disease vaccine in commercial broilers.

The field safety and efficacy of a bivalent Marek's disease (MD) vaccine (herpesvirus of turkeys + strain SB-1) administered in ovo were evaluated. The vaccine was administered to commercial broiler chicken eggs using Embrex's INOVOJECT automated egg-injection system. Comparisons were made with a conventional method of vaccination, in which the vaccine was administered subcutaneously to chicks at hatching. In ovo administration of the vaccine at day 17.5-18.5 of incubation significantly reduced the number of culled chicks, early mortality, and overall mortality during the grow-out period compared with conventional vaccination. However, hatchability was significantly lower in in ovo-treated chicks. Overall livability and feed efficiency were higher in the in ovo-treated chicks than in conventionally vaccinated chicks. Total field-caused condemnations and condemnations due to airsacculitis and septicemia/toxemia were also lower in the in ovo-vaccinated chicks. No difference in the leukosis (MD) condemnation rate was observed between the two treatment groups. In ovo vaccination provided 93.25% protection against challenge with a very virulent strain of MD virus (strain RB1/B); by comparison, the conventional vaccination method provided 89.58% protection.

Animals↗

PubMedDate not supplied

Intermediate-term outcome of renal retransplants in the cyclosporine era.

To determine the influence of selected parameters on intermediate-term outcome of renal retransplants, univariate and multiple regression analyses were performed on all 100 consecutive cyclosporine treated retransplants performed between 1984 and 1990 (mean follow up, 4.6 +/- 2.3 years). Actual 1 year and actuarial 5 year graft survivals were higher in living compared with cadaver donor transplants (84% and 79% vs 69% and 56%, respectively; p < 0.05). Among cadaver donor transplant recipients, allografts with immediate early function had better 1 and 5 year graft survivals when compared with those with delayed function (81% and 62% vs 59% and 38%, respectively; p < 0.05). Recipients with acute rejection had inferior 1 year and 5 year graft survivals when compared with rejection free patients (65% and 35% vs 80% and 57%, respectively; p < 0.05). Graft survival time of primary transplants was also a significant predictor of retransplant outcome with 1 and 5 year graft survivals of 50% and 36%, respectively, in patients in whom primary grafts survived less than 3 months, compared with 75% and 58% in those in whom grafts survived longer than 3 months (p < 0.05). Recipient age, race, renal disease, and levels of panel reactive antibodies had no effect on intermediate-term outcome. In a multiple regression analysis, delayed graft function, acute rejection, and primary graft survival time less than 3 months correlated inversely with long-term survival of retransplants (multiple r = 0.65). A total of 39 grafts were lost due to rejection (22), sepsis (6), graft nonfunction (5), death with a functioning graft (4), noncompliance (1), and recurrent renal disease (1).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMedDate not supplied

Erythrocytosis after renal transplantation. A prospective analysis.

A prospective analysis of all cyclosporine treated renal transplants performed between 1987 and 1990 was performed to determine the incidence and etiologic factors of post transplant erythrocytosis (PTE) and its effect on short-term outcome. PTE developed in 25 (8.1%) recipients (mean age, 41 +/- 10 years). PTE occurred more frequently in men (12.8%) than women (1.6%) (p < 0.001), diabetic patients (22.9%) than nondiabetic patients (6.2%) (p < 0.001), and rejection-free recipients (11%) compared with those with early rejection (4%) (p < 0.05) but was independent of recipient race and donor source. Sixteen patients in whom PTE subsequently developed had pretransplant hematocrits above 30%. PTE occurred most frequently in the first year posttransplant (range, 2-29 months). Serum erythropoietin levels were inappropriately elevated in all patients (mean, 24 +/- 2.2 mU/ml), but serum iron, folate, and B12 levels were all normal. Mean serum creatinine and creatinine clearance were 1.7 +/- 0.5 mg/dl and 58 +/- 20 ml/min, respectively. Twenty-three patients underwent phlebotomy (mean, 3.5 +/- 0.5 units) and six had PTE-related complications. In 14 patients, PTE persisted with hematocrit of 53 +/- 1.5% (range, 51-56) compared with 57 +/- 2.6% (range, 54-64) at the time of PTE onset. In conclusion, PTE occurs primarily in the first year posttransplant and is characterized by inappropriate elevation of erythropoietin. Predictors for PTE include male gender, diabetes mellitus, pretransplant hematocrit above 30%, absence of rejection, and excellent renal allograft function.

Adult↗

PubMedDate not supplied

Transmissibility of live Mycoplasma gallisepticum vaccine strains ts-11 and 6/85 from vaccinated layer pullets to sentinel poultry.

In separate trials, layer pullets were vaccinated with Mycoplasma gallisepticum (MG) strain 6/85 or strain ts-11 commercially produced live vaccines. For a 15-wk postvaccination (PV) period, vaccinates were commingled with unvaccinated pullets and were in indirect contact with sentinel groups of pullets, broiler breeders, turkey breeders, or meat turkeys in adjoining pens. Infectivity and transmissibility of vaccine strains were determined by tracheal culture and serology at 1 wk followed by 3-wk intervals PV. Strain 6/85 was recovered from 0%-20% of vaccinates, but not from commingled pullets or sentinel birds. Strain ts-11 was recovered from 60%-90% of vaccinates and 0%-40% of commingled pullets but not from any of the sentinel birds. No birds in the 6/85 vaccine trial tested positive for MG antibodies by serology. MG enzyme-linked immunosorbent assays detected positive responses in ts-11 vaccinates (range = 10%-70%) at 42, 63, 84, and 105 days PV, and commingled pullets (10%) at 84 and 105 days PV. MG serum plate agglutination tests detected positive responses in 90% and 20% of ts-11 vaccinates at 42 and 105 days PV, respectively, and commingled pullets (10%) at day 42 PV. Clinical signs, morbidity, or mortality suggestive of pathogenic MG infection were not observed in any bird during either trial, and no gross lesions were observed at necropsy. Random amplified polymorphic DNA analysis was capable of distinguishing each of the vaccinal strains 6/85 and ts-11 from each other by their distinct DNA banding patterns.

Agglutination Tests↗