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Biomedical subjects

B L Miller

Publications and source records attributed to B L Miller.

At least 163 records · Page 9Linked to original sources
PubMed1989

Immunosuppression with chlorambucil, versus placebo, for scleroderma. Results of a three-year, parallel, randomized, double-blind study.

Placebo and chlorambucil (0.05-0.1 mg/kg/day) were compared as treatments for scleroderma in a 3-year, randomized, double-blind, parallel study of 65 patients. Slopes of change over time, calculated for each organ system of each patient, failed to show significant differences between treatment groups. An immunosuppressive effect in the chlorambucil-treated group was shown by decreases in the white blood cell counts (P = 0.02), platelet counts (P = 0.04), lymphocyte counts (P = 0.001), IgA/IgM concentrations (P less than or equal to 0.05), and wheal size on mumps skin tests (P = 0.02). Three years of immunosuppressive treatment with chlorambucil did not benefit this scleroderma population.

Chlorambucil↗
PubMed1989

Factors influencing erythrocyte choline concentrations.

Choline concentrations in human erythrocytes increase after freezing and thawing, during incubation in Krebs-phosphate for 30 min or on storage at 0 degrees C for 3-24 hr. The increase is prevented by protein precipitation by 10% perchloric acid, 10% zinc hydroxide, 10% sodium tungstate or boiling in water. It is not prevented by EDTA (10 mM) and is increased by oleate (5 mM). We suggest that the increase is due to the action of phospholipase D on erythrocyte phospholipids.

Calcium↗
PubMed1989

Brain white-matter lesions and psychosis.

In a prospective study of late-life onset psychosis, five of the first 27 patients studied had extensive white-matter lesions demonstrated by MRI and/or CT. None of 60 age-matched psychiatrically healthy controls demonstrated such lesions. All five patients had a mild dementia and a frontal behavioural syndrome. In addition, every patient performed poorly on neuropsychological tests of frontal function. Dysfunction of the frontal cortex associated with white-matter lesions appears to contribute to the clinical picture of some cases of late-life psychosis.

Aged↗
PubMed1988

Brain amyloid and Alzheimer disease.

Clinicopathologic features of Alzheimer disease, the commonest cause of presenile or senile dementia, are presented. Several of the microscopic brain lesions found in patients with this dementia share the staining properties of amyloid and at least two of these lesions (senile plaque cores and amyloid angiopathy) are biochemically identical. Theories pertinent to the origins of brain amyloid and its role in the pathogenesis of Alzheimer disease are discussed in relation to theories of the cause of this dementia. Possible treatments for Alzheimer disease developed from our knowledge of brain amyloid processing and biochemistry are considered.

Acetylcholine↗
PubMed1988

Philosophical, ethical, and legal aspects of resuscitation medicine. I. Deferred consent and justification of resuscitation research.

Informed prospective consent for clinical resuscitation research may not be possible. Deferred consent is an untenable notion. Consent to continue in research cannot be used to support a claim that there was, or would have been, consent to the initiation of research. The conditions for the justifiability of resuscitation research without informed consent are: a) patient is comatose; b) lifesaving treatment must be given immediately; c) given all available evidence, there is reason to believe that the probability of death or severe deficit with experimental or control therapy is not greater than the probability of death or severe deficit on usual therapy; d) given all available evidence, there is reason to believe that the probability of normal or near-normal outcome is greater on experimental or control therapy than on usual therapy; and e) the study can provide evidence on whether there is a significant difference between experimental and control therapies in the incidence of normal or near-normal survival.

Clinical Trials as Topic↗
PubMed1988

Neuropsychological and behavioral abnormalities in an adolescent with frontal lobe seizures.

A 13-year-old girl had a reversible frontal syndrome secondary to partial complex seizures. She developed sudden and dramatic behavioral changes including sexual disinhibition, loss of concern for personal hygiene, physical and verbal aggression, and pressured and tangential speech. Although the basic neurologic examination was normal, neuropsychological testing revealed selective impairment on tasks sensitive to frontal dysfunction with relatively normal performance on other tests. This case demonstrates that a frontal syndrome can be caused by partial complex seizures and that behavior comparable to that observed in adults with frontal dysfunction may occur in young adolescents.

Adolescent↗
PubMed1988

Neurologic complications of cocaine abuse.

Over a 24-month period we evaluated 14 patients with neurologic disease associated with cocaine abuse. Five patients developed previously unreported complications: anterior spinal artery syndrome, lateral medullary syndrome, transient ischemic attacks in the middle cerebral artery and vertebrobasilar artery territories, and partial motor seizures. The recent availability of crack has led to a great increase in neurologic problems associated with the use of this drug.

Adult↗
PubMed1988

Passive hepatic congestion in heart failure: CT abnormalities.

Using bolus-enhanced CT, we encountered an unusual constellation of findings in seven patients with clinical evidence of right heart failure. These included retrograde hepatic venous opacification on the early bolus scans and a diffusely mottled pattern of hepatic enhancement seen only during the vascular phase of contrast administration. Ancillary CT findings include cardiomegaly, pleural effusions, ascites, and intrahepatic perivascular radiolucency. We believe that these CT abnormalities are caused by passive hepatic congestion. This pattern of abnormal hepatic enhancement represents a potential pitfall in the use of dynamic bolus-enhanced CT for the detection of focal hepatic masses. Recognition of passive hepatic congestion as a possible cause of mottled hepatic enhancement on CT may help explain clinical abnormalities of liver function in patients with heart failure and prevent confusion with other disease processes that produce abnormalities of hepatic attenuation.

Adult↗
PubMed1988

Late-life psychosis and modern neuroimaging.

A historical review of the literature on late-life psychosis (LLP) is presented with special emphasis on the relationship of structural and metabolic brain disease to this condition. The study of this patient population with modern neuroimaging is described. With the use of magnetic resonance imaging (MRI), single photon computerized emission tomography (SPECT), and computerized EEG, the authors estimate that approximately 50 to 60 per cent of cases will have structural or metabolic brain disease as a significant contributing factor to their psychosis. In their experience, silent vascular disease is seen in approximately one quarter of all cases. A logical clinical approach to these patients is presented.

Age Factors↗
PubMed1987

High molecular weight Alzheimer's disease amyloid peptide immunoreactivity in human serum and CSF is an immunoglobulin G.

A radioimmunoassay (RIA) was developed to detect the 4200 Dalton amyloid (A4) peptide or it's precursor (A4P) in human serum or cerebrospinal fluid (CSF). A synthetic peptide containing the first 28 amino acids of the 43 amino acid A4 peptide was covalently coupled to bovine thyroglobulin and a polyclonal antiserum in rabbits was prepared. This antiserum was specific for vascular amyloid and neuritic plaques in Alzheimer's disease brain as detected by immunoperoxidase. The synthetic peptide, which has a tyrosine at residue 10, was iodinated with chloramine T and [125I]iodine and was purified to homogeneity by C4 reverse phase high performance liquid chromatography (HPLC). Extraction of human serum over a C18 Sep Pak cartridge indicated immunoreactive A4 peptide was not detectable in human serum. Conversely, high molecular weight A4 peptide immunoreactivity was detectable in human serum, at a concentration of 8.9 +/- 1.2 pmol-eq./ml, and in human CSF, at a concentration of 0.25 +/- 0.01 pmol-eq./ml, giving a CSF/serum ratio of 3.2%. The immunoreactivity in human serum was nearly completely removed by affinity deletion of serum immunoglobulin G (IgG), but not by affinity removal of IgA or IgM. Serum immunoreactivity was decreased 90% in hypogammaglobulinemia, and was increased 83% in human cord serum. There was no statistical difference in serum A4 immunoreactivity in Alzheimer's serum or CSF. Serum immunoreactivity in Down's syndrome was increased 50%. These studies indicate the high molecular weight A4P immunoreactivity in human serum or CSF is an IgG. Whether the A4 precursor in Alzheimer's disease is, in fact, an IgG, or whether there is an antibody in human serum and CSF that cross reacts with the A4 precursor cannot be determined until the serum immunoreactivity is purified and structurally characterized.

Alzheimer Disease↗
PubMed1987

Position-dependent and -independent mechanisms regulate cell-specific expression of the SpoC1 gene cluster of Aspergillus nidulans.

Many genes that are expressed specifically in the differentiating asexual spores (conidia) of Aspergillus nidulans are organized into clusters. We investigated the effects of altered chromosomal position on expression of a gene from the conidiation-specific SpoC1 gene cluster. The gene became deregulated when integrated at nonhomologous chromosomal sites, in that transcript levels were elevated in vegetative cells (hyphae) and variably altered in conidia. We also investigated the effects on expression of insertion of the nonregulated argB gene into the SpoC1 region. Levels of argB transcripts were markedly reduced in hyphae. The results suggest that a cis-acting regional regulatory mechanism represses transcription of SpoC1 genes in hyphae. They also indicate that expression of individual SpoC1 genes is modulated during conidiation by trans-acting factors. We propose that the two types of regulation act together to produce the major differences in transcript levels observed in hyphae versus conidia.

Aspergillus nidulans↗
PubMed1987

Visual hallucinations. Clinical occurrence and use in differential diagnosis.

Visual hallucinations occur in diverse clinical circumstances including ophthalmologic diseases, neurologic disorders, toxic and metabolic disorders and idiopathic psychiatric illnesses. Their content, duration and timing relate to their cause and provide useful differential diagnostic information. Hallucinations must be distinguished from delusions and confabulation. A systematic approach to differentiating among hallucinatory syndromes may improve diagnostic accuracy.

Diagnosis, Differential↗
PubMed1986

Abnormal erythrocyte choline and influx in Alzheimer's disease.

Choline transport and levels were studied in erythrocytes from patients with Alzheimer's disease and age-matched controls using stable isotopic tracer techniques. The mean erythrocyte choline in the Alzheimer group was 50.1 nmol ml-1 compared to 15.5 nmol ml-1 in the controls. This was significant using a Student's t test at a P of less than 0.0005. Influx of choline into the erythrocyte correlated inversely with erythrocyte choline with high significance. This study suggests that erythrocyte choline is elevated in a subset of patients with Alzheimer's disease and that the low affinity transport system is also abnormal in these patients. This abnormality of choline transport may play a role in the pathogenesis of Alzheimer's disease in some patients.

Aged↗
PubMed1986

Dual personality associated with epilepsy.

Two individuals with well-defined seizure problems developed dual personalities. One personality was irritable and hostile, the other placid; in each case, a major seizure preceded the shift from the former to the latter. Each personality was amnesic for the other. The incidence of seizures in patients with multiple personality disorder is higher than expected, and these cases demonstrate a direct relationship.

Adult↗
PubMed1986

The validity of hysterical signs and symptoms.

In an attempt to validate recent assertions that the strongest indicators of hysteria are the "positive" findings in the neurological examination, seven of the most accepted features (history of hypochondriasis, secondary gain, la belle indifference, nonanatomical sensory loss, split of midline by pain or vibratory stimulation, changing boundaries of hypalgesia, giveaway weakness) were sought in 30 consecutive neurology service admissions with acute structural nervous system damage. All subjects showed at least one of these findings; most presented three or four. The presence of these "positive" findings of hysteria in patients with acute structural brain disease invalidates their use as pathognomonic evidence of hysteria. A second, retrospective study on the misdiagnosis of hysteria demonstrated that women, homosexual men, the psychiatrically ill, and patients presenting plausible psychogenic explanations for their illness are most liable to be misdiagnosed. Certain disorders, particularly movement disorders and paralysis, are most often mislabeled as hysteria. A diagnosis of hysteria must be made with great caution as it so often proves incorrect.

Acute Disease↗