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Biomedical subjects

C M Miller

Publications and source records attributed to C M Miller.

208 records · Page 12Linked to original sources
PubMedDate not supplied

Renal allograft survival in outbred mongrel dogs using rabbit anti-dog thymocyte serum in combination with immunosuppressive drug therapy with or without donor bone marrow.

Therapeutic renal transplantation in dogs is currently being investigated as a treatment for endstage renal disease. This pilot study examines the effect of donor bone marrow (DBM) infusion and antithymocyte serum (ATS) in combination with immunosuppressive drug therapy in prolonging renal allograft survival in dogs. Seven normal outbred mongrel dogs received an unmatched renal allograft. All dogs received rabbit anti-dog thymocyte serum (RADTS), prednisone (Pr), cyclosporine-A (CsA) and azathioprine (Aza). In addition, three dogs (group 1 test) received DBM and four dogs (group 2 control) did not receive DBM. Serum CsA levels were measured throughout the study. Immunosuppressive therapy was gradually reduced with Pr, CsA, and Aza withdrawn at 200, 450, and 680 days, respectively. Allograft rejection was treated with prednisolone sodium succinate. One dog in group 1 and one in group 2 died as a result of infectious canine rhinotracheitis and rejection early in the study. Renal allograft torsion occurred in one group 1 dog. The remaining four dogs survived the 2 years of the study. The dogs in group 2 (three dogs) all rejected the renal allograft after total drug withdrawal, the surviving dog in group 1 did not. This study demonstrates that RADTS, Pr, CsA, and Aza in combination can prolong renal allograft survival in mongrel dogs, whereas DBM may enhance the unresponsive state.

Animals↗
PubMedDate not supplied

The relationship of the axillary nerve to arthroscopically placed capsulolabral sutures. An anatomic study.

Ten cadaveric shoulders (mean donor age, 60.5 years) underwent arthroscopic placement of capsulolabral sutures as performed during arthroscopic reconstruction for shoulder instability. In relation to the glenoid face, the sutures were placed anterior, anteroinferior, inferior, posteroinferior, and posterior. All sutures entered the capsule approximately 1 cm away from the glenoid and exited beneath the labrum, and were tied using arthroscopic knot-typing techniques. The shoulders were frozen in the lateral arthroscopic position of approximately 45 degrees of abduction and 20 degrees of flexion and sectioned in the plane of the glenohumeral joint. The axillary nerve was then dissected, and the average distance from the nerve to each suture was found to be 16.7 mm at the anterior position, 12.5 mm at the anteroinferior position, 14.4 mm at the inferior position, 24.1 mm at the posteroinferior position, and 32.3 mm at the posterior position. In no specimen was any suture closer to the axillary nerve than 7 mm. We noted a statistically significant trend for the nerve to lie closest to the anteroinferior suture and gradually recede from the remaining sutures lying more posteriorly. This anatomic study is the first to demonstrate a relatively safe margin for arthroscopic suture placement between the capsule and axillary nerve when these sutures are placed approximately 1 cm from the glenoid rim.

Aged↗
PubMedDate not supplied

Injuries to the midtarsal joint and lesser tarsal bones.

Injuries to the midtarsal joint and lesser tarsal bones occur relatively infrequently and often present with a benign appearance on imaging studies. These facts may lead to failure of diagnosis and/or inadequate and improper treatment, with subsequent disability for the patient. The clinician with a general knowledge of the various injury patterns to the midfoot is able to approach these injuries rationally and with an appreciation of their potential severity. This article reviews the mechanism, clinical and radiologic presentation, and treatment of midtarsal joint injuries and midfoot fractures.

Foot Injuries↗
PubMedDate not supplied

Selective decontamination of the digestive tract helps prevent bacterial infections in the early postoperative period after liver transplant.

UNLABELLED: In liver transplant (LTx) recipients, gut-associated bacterial and fungal organisms produce significant postoperative morbidity and mortality. We sought to assess the role of selective digestive decontamination (SDD) in preventing postoperative infections in a large single-center cohort of liver recipients transplanted under two non-simultaneous protocols. In 212 consecutive patients transplanted between 1/1/91 and 7/31/92, SDD (gentamicin 80 mg, polymyxin B 100 mg, nystatin suspension 10 mL) was employed, starting after induction of anesthesia and continued until POD 21 (SDD Group). In 157 consecutive patients transplanted between 1/1/93 and 12/31/93, SDD was not used (non-SDD Group). Both groups received IV vancomycin and cefotaxime prophylaxis. All culture-positive infections within the first 30 days post-LTx were recorded and classified as bacterial or fungal. Infection-related mortality (patients who died of infectious complications without any technical complication) was recorded. Groups did not differ in patient demographics, United Network for Organ Sharing (UNOS) status, use of veno-venous bypass, total/warm ischemia, or length of ICU stay. Infections developed in fewer SDD patients (56/212; 26%) than non-SDD patients (69/157; 44%) (p<0.001). The incidence of gram-negative infection was less in the SDD group (11% vs. 26%, p<0. 001) as was gram-positive infection (16% vs. 26%, p<0.001). Among patients who developed infection, there was no difference between groups in infections per patient. Primary graft non-function (PNF) developed in 20 SDD patients (7/20 had infections) and 8 non-SDD patients (6/8 had infections) (p=0.06). There were no differences in incidence of fungal infections or of infection-related mortality between groups. In the SDD group, there were fewer abdominal (p<0. 001), lung (p<0.001), wound (p<0.01), and urinary tract infections (p<0.05). CONCLUSION: Use of SDD in liver recipients early after transplant was associated with significantly fewer infections in the early postoperative period.

Adolescent↗
PubMedDate not supplied

A less invasive approach to monitoring acute respiratory failure.

In a general ICU with a predominant surgical census, patients with acute respiratory failure can usually be treated on a clinical assessment and a minimum of invasive monitoring. An algorithm was used to manage the ventilatory support and weaning. When it failed (15% of the time), the patients' functional diagnoses were questioned and more advanced monitoring was used. The algorithm led to expeditious weaning of patients who did not need mechanical support and to a reduction of invasive monitoring.

Acid-Base Equilibrium↗
PubMedDate not supplied

The first in situ split of a liver in the USA performed by two geographically distant transplant centers--enhancing, sharing, and expanding the cadaveric liver organ pool.

In situ split of the liver was performed in a heart-beating cadaveric organ donor for the first time in the U.S.A. by two geographically distant transplant centers. The procedure, initiated by a transplant team in Oklahoma City, was a joint project of the transplant teams from Oklahoma City and New York City. The in situ split resulted in two liver grafts. A left graft (left lateral segment) which was transplanted into a 7-year-old pediatric recipient in Oklahoma City and a right graft (right lobe and segment IV) which was transplanted into a 52-year-old adult recipient in New York City. Initial graft function was excellent in the two patients. The adult recipient was discharged home 10 days after the transplant and is doing well. The pediatric recipient died two and a half months later from multi-system organ failure. The recently introduced in situ split technique provides two excellent liver grafts from one donor and enhances sharing of liver grafts between transplant centers.

Cadaver↗