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Biomedical subjects

B A Miller

Publications and source records attributed to B A Miller.

At least 73 records · Page 4Linked to original sources
PubMed1994

The Maine Women's Health Study: I. Outcomes of hysterectomy.

OBJECTIVE: To assess the effect of hysterectomy for nonmalignant conditions on symptoms and quality of life and to identify adverse effects 1 year after surgery. METHODS: The Maine Women's Health Study was a prospective cohort study of 418 women ages 25-50 years undergoing hysterectomy for any nonmalignant condition. Patients recruited from the practices of 63 physicians performing hysterectomy throughout Maine were interviewed at the time of surgery and 3, 6, and 12 months later. Clinical and hospitalization data were obtained from physician reports and from a statewide hospital discharge data base. The primary outcomes of interest were symptom relief, changes in quality of life, and the development of new symptoms or problems during the year following surgery. RESULTS: The most frequent indications for hysterectomy were leiomyomas (35%), abnormal bleeding (22%), and chronic pelvic pain (18%). For these indications, hysterectomy resulted in marked improvements in a range of symptoms, including pelvic pain, urinary symptoms, fatigue, psychological symptoms, and sexual dysfunction. Significant improvements in scores for indices of mental health, general health, and activity were evident at 6 months and sustained at 1 year. New problems after hysterectomy (measured in those free of the symptom preoperatively) included hot flashes (13%), weight gain (12%), depression (8%), and lack of interest in sex (7%). CONCLUSIONS: Hysterectomy is highly effective for relief of symptoms associated with common nonmalignant gynecologic conditions. Symptom relief following hysterectomy is associated with a marked improvement in quality of life. New problems are reported after hysterectomy by a limited number of women.

Adult↗
PubMed1994

The Maine Women's Health Study: II. Outcomes of nonsurgical management of leiomyomas, abnormal bleeding, and chronic pelvic pain.

OBJECTIVE: To assess the effect of nonsurgical management of leiomyomas, abnormal uterine bleeding, and chronic pelvic pain on symptoms and quality of life. METHODS: We performed a prospective cohort study of women receiving nonsurgical management (n = 380) or hysterectomy (n = 311) for leiomyomas, abnormal uterine bleeding, or chronic pelvic pain. Patients recruited from the practices of 63 physicians throughout Maine were interviewed at the outset of treatment and 3, 6, and 12 months later. The principal outcome measures were frequency and severity of physical and psychological symptoms, and quality of life as measured by validated indices of mental and general health and physical activity. RESULTS: Medical therapy for abnormal bleeding and chronic pelvic pain produced significant improvements in symptoms and quality of life. However, almost one-quarter of patients initially treated nonsurgically subsequently underwent hysterectomy; of patients continuing nonsurgical therapy, 25% with abnormal bleeding and 50% with chronic pelvic pain reported substantial levels of symptoms after 1 year. There were no significant changes in symptoms and quality of life in patients treated nonsurgically for leiomyomas. New problems including tiredness, hot flashes, weight gain, and depression developed in 10% or less of women who did not report these symptoms preoperatively. A logistic regression analysis controlling for age, reproductive history, and severity of symptoms showed that hysterectomy was the factor most highly correlated with a positive outcome at 1 year for all three conditions. CONCLUSIONS: Many women with leiomyomas, abnormal bleeding, and chronic pelvic pain report improved symptoms over time with nonsurgical management. Hysterectomy remains an important alternative when conservative treatment fails.

Adult↗
PubMed1994

Efficacy of an influenza hemagglutinin-diphtheria toxoid conjugate vaccine in elderly nursing home subjects during an influenza outbreak.

OBJECTIVE: To compare the efficacy of an influenza hemagglutinin-diphtheria toxoid conjugate vaccine with the commercially available influenza hemagglutinin-subunit vaccine in preventing influenza in older adults living in a nursing home. DESIGN: A prospective, randomized, double-blind vaccine trial with 5 months of follow-up after vaccination. SETTING: Fourteen Wisconsin nursing homes. PARTICIPANTS: Nursing home residents at least 65 years old who were able to give informed consent and were free of malignancy and not receiving immunosuppressive therapy. INTERVENTIONS: Participants received, by intramuscular injection, 0.5 mL of a trivalent influenza vaccine containing 15 micrograms each of A/Leningrad/360/86 (H3N2), A/Taiwan/1/86 (H1N1), and B/Ann Arbor/1/86 (HA) or 0.5 mL of an influenza vaccine containing the same antigens conjugated to diphtheria toxoid (HA-D). MEASUREMENTS: Blood was obtained pre- and 1 month post-vaccination to assess for any vaccine-induced antibody titer change. Clinical surveillance for respiratory illness was performed twice weekly for 5 months. A record was kept of all signs and symptoms of new respiratory illness, and a viral culture and acute and convalescent sera were obtained. RESULTS: 204 participants received HA and 204 received HA-D. Both groups had similar baseline antibody levels to all influenza antigens. HA-D recipients seroconverted more frequently based on serum neutralizing activity (P < 0.05), had a greater increase in geometric mean titer (GMT), and sustained the increase in antibody titer longer than HA recipients. Vaccine hemagglutinin recall was greater in a subset of HA-D recipients as measured by lymphocyte proliferative assays (P < 0.05). During an outbreak of influenza A (H3N2 A/Shanghai/11/87-like and A/Victoria/7/87-like), fewer HA-D (29/195) than HA (43/204) recipients had laboratory-confirmed infection (P = 0.053), and, of these, fewer HA-D-treated subjects had lower respiratory tract involvement (5/29 HA-D and 17/43 HA) (P = 0.022). CONCLUSIONS: HA-D was more immunogenic in institutionalized elderly recipients and produced greater protection from influenza infection. Superior protection may be due to HA-D's ability to stimulate and recruit antigen-presenting cells, thus enabling the recipient to achieve and maintain functional antibody titers.

Aged↗
PubMed1994

Outcome after free flap reconstruction of the heel.

We reviewed six free flap reconstructions of the weight-bearing surface of the heel. Patients were seen for clinical evaluation at a mean follow-up of 4.7 years (range 2.7-6.0 years). Functional results using a modified Boston Children's Hospital Ankle Score were 33% excellent, 33% good, 17% fair, and 17% poor. The excellent functional results were related to the absence of chronic draining flap ulcers. All flaps lacked protective sensation by Semmes-Weinstein monofilament testing. Weightbearing plantar pressures in the flaps were elevated in all patients. Sequential radiographs from the time of flap coverage revealed the development of a bony protuberance (stalactite) projecting from the undersurface of the calcaneus in all patients with injuries to the plantar cortex of the calcaneus. In patients with flap ulceration, these stalactites projected into the ulcer at the site of maximum plantar pressure. A combination of loss of plantar calcaneal integrity, elevated pressure concentrations, and flap insensitivity appear causally related to the development of heel free flap ulceration and outcome.

Adolescent↗
PubMed1994

Mechanisms of erythropoietin signal transduction: involvement of calcium channels.

Erythropoietin (Epo) induces a dose-dependent increase in intracellular free calcium concentration ([Cai]) in single human BFU-E derived erythroblasts, which is specific for stage of differentiation and mediated through a voltage-independent ion channel permeable to calcium. This minireview examines the regulation of calcium channels by Epo during normal erythroid differentiation, as a model to delineate the immediate signaling events which follow interaction of Epo with its receptor.

Animals↗
PubMed1993

Flexoelectric effects in model and native membranes containing ion channels.

An experimental study of flexoelectricity in model membranes containing ion pores and native membranes containing ion channels has been undertaken with the objective of determining the relationship, if any, between flexoelectricity and ion transport. Model membrane patches containing ion pores induced by a blue-green algal toxin, microcystin-LR, and locust muscle membrane patches containing potassium channels were studied using patch-clamp techniques. A correspondence was established between the presence of open channels and pores and the amplitude of the 1st harmonic of the total membrane current when the membranes or patches were subjected to pressure oscillations. The 2nd harmonic of the membrane current provided a measure of the amplitude of a membrane curvature induced by pressure, thus making it possible to determine the membrane flexoelectric coefficient. This study shows that flexoelectricity could be an effective driving force for ion transport through membrane pores and channels, thus further highlighting the possible biological significance of this mechano-electric phenomenon.

Cell Membrane↗
PubMed1993

Interrelationships between victimization experiences and women's alcohol use.

The interrelationships between experiences of childhood victimization and the development of women's alcohol-related problems are explored. Two different forms of childhood victimization are examined: (1) parent-to-child violence and (2) childhood sexual abuse (familial and nonfamilial). Data were collected from 472 women between the ages of 18 and 45 during in-depth interviews. Women were grouped to allow for the following two sets of comparisons: comparison 1: alcoholics in alcoholism treatment (n = 98), drinking drivers (n = 100) and a household sample (without alcohol problems) (n = 82); comparison 2: women with alcohol problems in treatment (n = 178), women without alcohol problems in treatment (n = 92) and a household sample (n = 82). High rates of childhood victimization for women with alcohol problems suggest that there is a link between victimization and the development, specifically, of women's alcohol problems. The strength of the interrelationships between childhood victimization and the development of women's alcohol problems when holding the treatment condition constant is of particular interest in this study. The rates of childhood victimization were significantly greater for women with alcohol problems in treatment as compared to women without alcohol problems in treatment. Thus, even when holding the treatment condition and family background variables constant, childhood victimization has a specific connection to the development of women's alcohol problems. These findings remained significant even when controlling for demographic and family background differences, including parental alcohol problems.

Adolescent↗
PubMed1993

Visual fields with protective eyewear.

Sports-related eye injuries are quite common, yet the number of athletes who utilize protective eyewear is extremely low. The purpose of this study was to determine if there is a significant visual field loss associated with wearing eye protection. One of the authors was subjected to standard kinetic visual field testing with and without eye goggles. No significant difference was revealed. Physicians, physical therapists, and trainers should promote the use of protective eyewear and reassure athletes that they will not lose visual field.

Athletic Injuries↗
PubMed1992

Breast cancer.

Explore the source record for details and available documents.

Breast Neoplasms↗
PubMed1992

Influence of steel factor on hemoglobin synthesis in sickle cell disease.

A new hematopoietic growth factor (Steel factor) has been identified which stimulates erythroid proliferation both in vitro and in vivo. We evaluated the influence of recombinant Steel factor on hemoglobin synthesis in peripheral blood (PB) BFU-E-derived cells from normal donors by radioimmunoassay (RIA) and compared it with stimulation with GM-CSF and interleukin-3 (IL-3). Only Steel factor stimulated a significant increase in BFU-E-derived colony size and a significant increase in fetal hemoglobin (HbF) in BFU-E-derived erythroblasts from 0.49% +/- 0.27% to 6.33% +/- 1.11% in serum-deprived media and from 1.88% +/- 0.24% to 11.17% +/- 0.91% in serum. To determine whether this influence on hemoglobinization also occurred in sickle cell disease, we studied 13 patients with sickle cell disease. In serum-deprived conditions, there was a significant increase in the number and size of BFU-E-derived colonies with Steel factor that was dose-dependent. In addition, the proportion of HbF in progenitor-derived cells increased by 66% from 4.1% +/- 0.6% to 6.8% +/- 1.2% with Steel factor. In serum-containing conditions studied in 12 patients, the increase in percentage of HbF was even greater, from 10.7% +/- 0.9% in control cultures to 22.5% +/- 2.6% with Steel factor. These increases in percentage of HbF were significant and dose-dependent. An increase in percentage of HbF was observed in erythroblasts harvested on day 11, 14, and 18 of culture. A decrease in mean picograms of total Hb per cell after coculture with Steel factor was noted, suggesting that growth kinetics influenced complete hemoglobinization. In serum-deprived conditions, picograms of HbF per cell was not affected by Steel factor, and in serum-containing conditions that augment in vitro HbF production it was enhanced. Thus, Steel factor stimulated a significant increase in percentage of HbF in erythroid cells from normal donors and patients with SCA in vitro.

Anemia, Sickle Cell↗
PubMed1992

Preliminary typology designed for treatment matching of driving-while-intoxicated offenders.

A typology of 156 convicted driving-while-intoxicated (DWI) offenders was developed using cluster analysis and external validation procedures. The typology was derived from 4 variables (alcohol dependence severity, psychiatric severity, bad-driving index, and social instability) selected to maximize the feasibility of performing treatment matching with DWI offenders. Five clusters that suggested specific treatment matching opportunities were identified. The largest, Cluster 4 (31% of cases), showed a low problem profile. However, a moderate-severity group (Cluster 1), a high-risk driver group (Cluster 2), and two high problem-severity groups (Clusters 3 and 5) were also found. Clusters 3 and 5 had high levels of alcohol dependence and psychiatric symptoms but differed significantly on social instability.

Adult↗
PubMed1992

Effect of chronic alcohol ingestion on the binding of high density lipoproteins to rat hepatic membranes: involvement of apolipoprotein E.

Feeding alcohol to rats produces high density lipoproteins (HDL) particles that exhibit lowered apolipoprotein (apo) E:apo A1 ratio. In this study, we have carried out experiments to compare the abilities of apo E-deficient HDL particles of the alcohol-fed rat and apo E-sufficient HDL particles of the control rat to bind to hepatic membranes. When rat hepatic membranes were incubated with rat serum HDL of physiological concentrations (< or = 200 micrograms HDL-apo A1/ml), binding of HDL to hepatic membranes showed concentration dependent on HDL-apo A1. Polyclonal antibodies that specifically recognize apo A1 and apo E inhibited HDL binding to hepatic membrane while the antibody against apo AIV did not. The binding of 125I-apo A1-HDL was diminished by adding excess amount of unlabeled HDL to the incubation mixture. Apo E-deficient serum HDL obtained from alcohol-fed rats competed less efficiently against radiolabeled HDL for binding to rat hepatic membrane than normal HDL from control animals. The defect in apo E-deficient serum HDL obtained from alcohol-fed rats can be corrected by preincubation with added purified apo E. We hypothesize that this weaker binding may result in slower degradation of apo E-deficient HDL particles by the liver and in part explains the higher plasma HDL levels found in alcohol-drinking animals.

Alcohol Drinking↗