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Biomedical subjects

A R Miller

Publications and source records attributed to A R Miller.

96 records · Page 6Linked to original sources
PubMedDate not supplied

Impact of therapeutic endoscopy on the treatment of bleeding duodenal ulcers: 1980-1990.

Therapeutic endoscopy (TE) has provided a new means for treating peptic ulcer disease, prompting a reevaluation of surgery's role. The aim of this study was to determine if surgical therapy of bleeding duodenal ulcers has changed since the advent of TE. This retrospective review involved consecutive time periods during which TE was (1985-1990) and was not (1980-1984) widely available. Exclusion criteria were prior gastric surgery, nonpeptic conditions, and untreated ulcers. Inclusion standards were met by 252 patients (180 men, 72 women) whose mean age was 67 years. Patients were grouped by the initial therapeutic intervention. Groups were similar in age, medical condition (mean APACHE II score 16), and morbidity. Seventy-five patients had surgery alone during 1980-1984 and 38 during 1985-1990. TE was initially performed on 134 patients during 1985-1990. Bleeding (n = 30) and perforation (n = 1) prompted emergent operation in 23% of cases following TE. Thus 69 (38 + 31) patients underwent surgery between 1985 and 1990. Preprocedure transfusions averaged 4.1 units in the endoscopic group and 8.2 units in the operative groups (p < 0.0001). Disagreement existed between the endoscopic and surgical descriptions of ulcer location in 53% of cases. Emergent surgery was required in 45% of hemodynamically unstable patients versus 14% of stable patients who initially underwent TE (p < 0.0001). Sixty-one percent of incompletely visualized TE-treated lesions required operation, and 18% of well visualized ulcers underwent operation (p < 0.0001). Hospital mortality was similar (8% versus 16%) in the endoscopic and operated groups (p = 0.7). Mean follow-up was 540 days.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMedDate not supplied

Multidisciplinary management of recurrent colorectal cancer.

Isolated pelvic recurrence of rectal carcinoma may occur in up to one third of patients following definitive resection of primary disease. The means by which recurrence is diagnosed, methods by which it may be treated, and reported outcomes are all evolving and improving. Current data indicate that a substantial proportion of patients treated by aggressive multi-modality salvage therapy may be provided with durable survival. This review highlights current concepts in the diagnosis and management of locally recurrent rectal carcinoma.

Carcinoma↗
PubMedDate not supplied

Initial medical reception, intervention and survey work in combined military and civilian humanitarian aid: operation 'Safe Haven', northern Iraq 1991.

Service medical teams were involved in the medical screening and initial reception of displaced Kurds into the first United Nations Relocation Camp in Zakho, Northern Iraq in April 1991. Massive logistic support and adequate security were required for the delivery of the essential elements of relief. The prompt deployment of such teams enabled rapid surveys of the medical extent of the disaster to be undertaken during the screening process whilst individuals were prioritized for rehydration, supplement feeding and therapy. Over 12,000 displaced persons entered the camp in the first 10 days. Reported perinatal mortality during the two-month exodus crisis in an unselected group of 2,200 was 375 per 1,000 births. In the same group of families surviving to tell the tale, one in five of the infants who had been in the mountains had died and the fertility rate may have been as high as 380 per 1,000 women of child-bearing age in the previous year. In a larger survey of 3,825 unselected persons entering the camp, 745 (19.5 per cent) were estimated to be under five years of age and a quarter of these had a significant medical problem. There were 290 (7.6 per cent) estimated to be under two, and a quarter of these were judged to be severely malnourished. A high degree of international cooperation between military and civilian medical and relief teams was demonstrated in dealing with this crisis.

Adolescent↗
PubMedDate not supplied

Irofulven (6-hydroxymethylacylfulvene, MGI 114) induces caspase 8 and 9-mediated apoptosis in human pancreatic adenocarcinoma cells.

BACKGROUND: Irofulven (MGI 114) is a novel, clinically active sesquiterpene whose mechanism of action is not fully understood. We sought to identify apoptotic effectors induced by this agent in human pancreatic cancer cells. MATERIALS AND METHODS: MTT assay was used to assess IC50-Apoptosis was quantitated by flow cytometry and DAPI staining. Caspase activation was identified by western blot analysis. RESULTS: Irofulven was cytotoxic against all pancreatic cancer cell lines tested (IC50 1-18 microM), and induced 10-fold (4%+/- 2, vs. 41% +/- 5) induction of apoptosis. Irofulven-treated cells also demonstrated PARP3 cleavage and DAPI staining. Apoptosis was reduced to baseline levels by Z-VAD-FMK, a broad-spectrum caspase inhibitor. Western blot analysis revealed that caspases-3, -7, -8, and -9 were activated by irofulven. Time course evaluation demonstrated that caspases-8 and -9 were the initial species activated. CONCLUSION: Our data demonstrate that the cytotoxicity of irofulven in human pancreatic carcinoma cell lines is mediated by caspase-induced apoptosis.

Amino Acid Chloromethyl Ketones↗
PubMedDate not supplied

Preoperative chemoradiation and pancreaticoduodenectomy for adenocarcinoma of the pancreas.

The goal of multimodality therapy for localized pancreatic cancer is to maximize local-regional disease control and patient survival. In contrast to surgery for other solid tumors, prolonged recovery following pancreaticoduodenectomy may prevent the timely delivery of postoperative adjuvant therapy. Therefore, efforts at The University of Texas, M.D. Anderson Cancer Center have focused on the delivery of chemotherapy and radiation therapy prior to surgery in patients with localized pancreatic cancer. Clinical trials have emphasized the use of altered-fractionation schedules of radiation therapy combined with novel radiation-sensitizing agents. All treatment schemes aim to decrease toxicity and treatment time while improving therapeutic efficacy.

Adenocarcinoma↗