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Biomedical subjects

A Miller

Publications and source records attributed to A Miller.

At least 397 records · Page 22Linked to original sources
PubMed1990

Ultrastructure of the jejunal mucosa in human immunodeficiency virus infection.

The ultrastructural changes in the jejunal mucosa of 11 male patients, three with clinical AIDS, five with AIDS related complex-progressive generalized lymphadenopathy (ARC-PGL), and three who were only HIV antibody positive, were studied. In the enterocytes, major abnormalities were proliferation of smooth endoplasmic reticulum mitochondrial changes, vacuolization of cells, and fat hold up. In the lamina propria, degeneration of enteric nerve axons and smooth muscle were seen. Microvasculature showed both endothelial cell degeneration and hyperplasia. The presence of tubuloreticular inclusions in endothelial cells paralleled the stage of the disease. Since none of the 11 patients had any opportunistic infection, these changes are likely to be the effect of HIV infection.

AIDS-Related Complex↗
PubMed1990

Inhibition of offspring response to HEL-CFA by administration of anti-HEL MAB to the mother is not related to the predominant idiotype, IdXE, or specificity of the MAB.

In the neonatal suckling mouse, the antibody response to HEL-CFA can be inhibited by administration of certain anti-HEL monoclonal antibodies to the mother. The murine primary response to hen egg-white lysozyme (HEL), which can be elicited in A/J mice as early as 7 days of age, is characterized by a predominant specificity that includes the 3 N-terminal amino acids of HEL (TIP-dependence) and by a predominant idiotype, IdXE. A panel of murine IgG1 anti-HEL mAbs was administered to the suckling offspring via the mother. These mAbs were not equivalent in their effects on the offspring. Only two of six IgG1 mAbs, 2F4/2E5 (IdXE-positive, TIP-dependent) and 2D1 (IdXE-negative, TIP-independent), consistently induced suppression of the response of A/J offspring when immunized at 16-20 days of age with HEL-CFA. Suppression averaged 71% for 2F4/2E5 and 74% for 2D1 and was always statistically significant (P less than .05) when 275 micrograms mAb was administered IP to the mother within 24 hr postpartum. Since 2D1 is IdXE-negative and TIP-independent, neither of these properties appears to be crucial for suppression. Differences in transfer of the mAbs from the mother to the offspring or differences in catabolism of the mAbs in the offspring were not detected. When various characteristics of the mAbs such as affinity, idiotypy, and fine specificity were considered, there was no single factor which determined suppression. One of the two mAbs that suppressed the offspring response, 2D1, is idiotypically highly connected in the anti-HEL mAb panel. This observation suggests that idiotypic interactions in the developing neonatal repertoire with subsequent perturbation of T and B cell repertoire development may be an area for future investigation.

Animals↗
PubMed1990

Treatment of 29 patients with bulky squamous cell carcinoma of the cervix with simultaneous cisplatin, 5-fluorouracil, and split-course hyperfractionated radiation therapy.

Attempting to improve local disease control in bulky (greater than 8 cm) primary or recurrent pelvic tumors, 29 patients with squamous cell carcinoma of the cervix (stage II, 4; III, 10; IV, 6; recurrent, 9) were treated with concomitant chemotherapy and split-course hyperfractionated radiation therapy between April 1983 and August 1988. Cisplatin (CDDP) and 5-fluorouracil (5-FU) have been shown to be radiation enhancers; furthermore, CDDP, radiation therapy, and continuous-infusion 5-FU have elicited high local response rates in head and neck squamous cell carcinoma. A pilot study of cyclical week on/week off CDDP, continuous-infusion 5-FU, and hyperfractionated radiation therapy was developed. Radiation was administered at 116 cGy twice daily, Days 1-5, every other week for a median dose of 4600 cGy to a pelvic field, with paraaortic extension if indicated. Concomitant chemotherapy included CDDP 60 mg/m2 IV Day 1 and 5-FU 600 mg/m2 IV continuous infusion for 96 hr following CDDP infusion. Patients received a median of four cycles of combined treatment, and intracavitary or interstitial brachytherapy followed in 21 patients. Local pelvic response was achieved in 29 of 29 (100%): complete response (CR) in 19 of 29 (66%), partial response (PR) in 10 of 29 (34%). Among CR patients 10 of 19 (53%) were without evidence of disease at a mean follow-up of 29 (range 12-76) months. Five-year actuarial disease-free survival among complete responders was 65%. Of the 10 CR patients 2 failed in the pelvis, for a local control rate of 17/19 (89%). Chemotherapy-related and acute radiation morbidity was minimal but 2 patients required surgical correction of radiation injury. Aggressive combination of split-course hyperfractionated radiation therapy with radiation enhancers resulted in promising local control of bulky pelvic tumor, with an acceptable complication rate, in this otherwise very poor prognostic group of patients.

Adult↗
PubMed1990

Efficacy of the dorsal pedal bypass for limb salvage in diabetic patients: short-term observations.

Limbs of diabetic patients with distal tibial disease are frequently considered unreconstructible; however, when studied with intraarterial digital subtraction angiography, the dorsal pedal artery is frequently found to be patent. We have reviewed our recent experience with 96 patients, 94% of whom had diabetes and had 97 bypasses placed to the dorsal pedal artery. All procedures were for limb salvage. Superimposed infection was present in 42.3%. In 92 instances where intraarterial digital subtraction angiography successfully visualized the dorsal pedal artery, 91 bypasses were placed. In 12 other cases where the dorsal pedal artery was not visualized by intraarterial digital subtraction angiography but audible with the continuous-wave Doppler, bypasses were completed successfully in six. All procedures were performed with vein. Inflow was taken from the femoral artery in 48, popliteal artery in 45, tibial artery in 2, and from a femoral tibial graft in 2. Perioperative mortality was 1.92%. Actuarial graft patency, limb salvage, and patient survival were 82%, 87%, and 80%, respectively at 18 months. We conclude that bypass grafting to the dorsal pedal artery can be reliably performed with acceptable short-term results. An attempt should always be made to visualize the foot vessels angiographically, especially in diabetic patients, so that this valuable option in arterial reconstruction will not be overlooked.

Arterial Occlusive Diseases↗
PubMed1990

Carcinosarcoma (malignant mixed mesodermal tumor) of the uterus. A Gynecologic Oncology Group pathologic study of 203 cases.

We report on the pathologic findings in primary tumors and metastases in 203 cases of stage I and II endometrial carcinosarcoma (malignant mixed mesodermal tumor) subjected to hysterectomy and staging laparotomy. Metastases were studied in 40 of these cases, including 34 with positive findings in the pelvic and/or para-aortic lymph nodes. Features of the stromal component of the primary tumors, including grade, mitotic index, and the presence and types of heterologous elements, showed no relation to the presence of metastases at operation. High-grade, serous, and clear cell carcinomatous components, on the other hand, were associated with a higher frequency of metastases, as were deep myometrial invasion, lymphatic or vascular space invasion, and involvement of the isthmus or cervix. The current concepts of histogenesis and differentiation of these tumors are discussed, and the suggestion is made that they might represent metaplastic carcinomas.

Carcinosarcoma↗
PubMed1990

Chronic pleuritic pain in four patients with asbestos induced pleural fibrosis.

Four patients occupationally exposed to asbestos, each suffering at least eight years of disabling, persistent, and often bilateral pleuritic pain are described. Radiographic evidence of pleural disease ranged from plaques seen only on computed tomography to typical bilateral plaques or diffuse thickening to extensive diffuse and circumscribed pleural fibrosis and calcification. There was no history or evidence of acute pleuritis or pleural effusion in three patients. Intermittent pleural friction rubs have been present in all four; one patient showed pleural uptake of gallium-67. Extensive workups including repeated pulmonary ventilation-perfusion scans and cardiac catheterisation have not yielded other diagnoses to explain the pain. It is proposed that persistent pleuritic pain be added to the manifestations of benign asbestos induced pleural disease.

Aged↗
PubMed1990

Pulmonary diffusing capacity in left ventricular dysfunction.

The purpose of this study was to determine whether there are any consistent spirometric or Dsb findings in patients with LV dysfunction characterized by a clinical diagnosis of CHF and an EF less than 40 percent. We performed spirometry and Dsb in 34 patients, and found that EF correlated only with Dsb. When we separated the patients into those with rales and those without, Dsb correlated strongly with EF only in those with rales. There was no correlation with other spirometric values. Mean Dsb percent predicted was significantly lower in patients with rales despite similar mean EF. Only two of 23 patients without rales had a reduced Dsb while only one of 11 with rales had a normal Dsb. We conclude that Dsb is a good predictor of clinically evident heart failure. When rales are absent, Dsb should be normal in patients with LV dysfunction; when present, Dsb will be diminished in proportion to the EF.

Aged↗
PubMed1990

Pattern of postprandial carbohydrate metabolism and effects of portal and peripheral insulin delivery.

The importance of portal insulin delivery in the regulation of postprandial carbohydrate metabolism is uncertain. To address this question, three groups of dogs were studied: one group in which pancreatic venous drainage was transected and reanastomosed (portal insulin delivery), one in which the pancreatic drainage was transected and anastomosed to the inferior vena cava (peripheral insulin delivery), and one that received only a sham operation. Plasma insulin was greater (P less than 0.05) during peripheral insulin delivery than in either the portal or sham groups, respectively, before and after meal ingestion. On the other hand, C-peptide concentrations did not differ between groups, resulting in a higher (P less than 0.001) insulin to C-peptide ratio in the peripheral group. This indicated that the hyperinsulinemia in the peripheral group was due to decreased insulin clearance rather than increased insulin secretion. Isotopically determined splanchnic uptake of ingested glucose, postprandial suppression of hepatic glucose release, incorporation of CO2 into glucose (a qualitative measure of gluconeogenesis), and total-body glucose uptake were virtually identical in all groups. Similarly, plasma lipid, beta-hydroxybutyrate, and lactate concentrations did not differ between groups. Our data indicate that, despite differences in systemic insulin concentration, portal and peripheral insulin delivery comparably regulate hepatic and extrahepatic carbohydrate metabolism after meal ingestion.

Animals↗
PubMed1990

Subtypes of substance abusers: personality differences associated with MacAndrew scores.

Several earlier studies have reported clinically relevant personality correlates of high vs low scores on the MacAndrew Scale (Mac) of the MMPI. Unfortunately, these projects have not adjusted for age or nature of abuse. Also, most have assumed that the personality correlates are the same for female patients as for male patients. This study attempts to address these deficiencies. Even after correcting for age and diagnosis, high Mac patients differ from low Mac patients on major scales of the MMPI. The pattern of such differences varies considerably between men and women. Substance abuse treatment implications of these differences are discussed.

Alcoholism↗
PubMed1990

A simple spirometric clue to asthma: airways obstruction suggested by negative or reduced forced expiratory reserve volume despite normal FEV1-FVC ratio.

I report on 25 asthmatic patients in whom airways obstruction was not detectable by conventional spirometric indices, but was suggested by a reduced or negative forced expiratory reserve volume (FERV), that is, the ERV measured from the forced vital capacity (FVC) maneuver and preceding tidal breaths. Patients with known causes for reduced ERV were excluded. The ratio of forced expiratory volume-1 sec (FEV1) to FVC was normal or high in all 25 patients, and the forced expiratory time (FET)25-75% was normal in half (12). Using conventional spirometric algorithms, the condition of most (76%) of the patients would be interpreted as "restrictive impairment". The FERV is easily measured in a physician's office or clinic. If this simple test is to provide a clue to the presence of airways obstruction that is otherwise not demonstrable spirometrically, the FVC maneuver must be maximal and reproducible and the preceding tidal breaths, as well as the FVC, must be graphically recorded.

Adult↗
PubMed1989

A glass-fiber filtration assay for solution phase hapten-antibody binding. Effect of surface treatment with a polycation.

Radioligands bound to murine monoclonal and polyclonal antibodies in solution are rapidly and effectively separated from free ligand by filtration through either untreated or polyethylenimine (PEI)-pretreated glass-fiber filters. Ligand binding to selected anti-morphine monoclonal antibodies, determined by filtration through untreated filters, was significantly greater (1.5-3.0-fold) than the binding activities obtained by gel filtration. However, radioactivity retained by filters that were pretreated with PEI (pH 4) was essentially the same as that obtained using the Sephadex G-25 short-column assay. The pH dependence of the retention on the coated fibers suggests that the mechanism of binding of antibodies to glass is different from that to the PEI-treated surfaces. The quantitative aspects of the assay are reported. The method should prove useful where quantitative, rapid and inexpensive binding radioassays need to be performed.

Antibodies, Monoclonal↗
PubMed1989

Comparative sequence and immunochemical analyses of murine monoclonal anti-morphine antibodies.

A more complete characterization is given for four previously reported anti-morphine monoclonal antibodies that bind the hapten with high affinity and to which anti-idiotypic antibodies have been raised that mimic opiates at receptor binding sites. The variable (V) region nucleotide sequences of the heavy (H) and light (L) chains of these murine antibodies have been determined by direct sequencing of the poly(A)+ mRNAs using specific oligonucleotide primers and dideoxynucleotide chain-termination, and the deduced amino acid sequences are compared. The primary sequences predicted for the VH segments of 10C3 and 11C7 antibodies are closely associated with the VHIIIB subgroup of mouse H-chain (80 to 82% homology), while those for the V-regions of 3B9 and 12D4 H-chains correlate well with the VHIIC subgroup (64 to 67% homology). The 11C7, 10C3, 3B9 and 12D4 hybridoma cell lines use JH1, JH2, JH3 and JH4 DNA segments, respectively. Since considerable variations in length and primary sequence in the CDR3 (complementarity determining region) peptides of all the H-chains are evident, conservation of the D-region structure does not appear to be necessary for effective hapten binding. However, sequence homologies of the CDR2 regions of all the antibodies indicate that residues Glu H-50, Ile H-51, Pro H-52a and Tyr H-59 are conserved, and that these segments may be more critically involved in binding than the other H and L-chain hypervariable regions. The marked VL sequence homology, greater than 93%, among the L-chains and consensus lambda sequence, suggests derivation from a similar or identical VL germ-line gene. The L-chain J-region peptides for all the antibodies are classified JL1 and no VL-JL junctional diversity was apparent. The antimorphine antibody L-chains are apparently generated by the joining of a specific J-gene segment to a single germ-line V-gene segment, and minor sequence variations are the result of somatic mutations within the coding region. The leader sequence for one of the H-chains was determined. The inhibition of morphine binding by phenoxybenzylation or iodination of the affinity-purified immunoglobulins indicates the involvement of a single tyrosyl residue within or close to the antibody-combining site for the opiate. This conclusion is supported by the sequence data and nuclear magnetic resonance measurements reported in the accompanying paper, in which the results are used to interpret nuclear magnetic resonance measurements on one of the ligand-antibody systems. The possible importance of additional contact amino acids, tryptophan, aspartic and/or glutamic acids, is discussed.

Amino Acid Sequence↗