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Biomedical subjects

C M Miller

Publications and source records attributed to C M Miller.

At least 163 records · Page 9Linked to original sources
PubMed1993

Host effects on glutathione S-transferase activity in Fasciola hepatica.

Glutathione S-transferases (GST, E.C. 2.5.1.18) in Fasciola hepatica from sheep were previously found to be extremely variable with regard to specific GST activity and isoenzyme profile within and between parasite isolates. The effect of the host on GST activity and isoenzyme profile was examined by infecting mice, rats and cattle as well as sheep with one or the other of two isolates--either salicylanilide-resistant or salicylanilide-susceptible F. hepatica. In the case of both isolates, GST activity in hosts relatively resistant to reinfection--rats and cattle--was lower and more restricted in range compared with hosts susceptible to multiple infection--mice and sheep. In the case of the rat flukes, there was little variation in isozyme profiles whereas cattle flukes appeared to exhibit more variation than sheep flukes. In mice, despite the apparent variability in GST activity, only one GST band was found in the isoenzyme profiles. Therefore, the host appears to exert a pronounced effect on the activity and expression of GSTs in F. hepatica which may be related to variation in the immune responses of the different hosts during infection.

Animals↗
PubMed1993

Liver resection under total vascular isolation. Variations on a theme.

Total vascular isolation (TVI) of the liver was employed during parenchymal transection in 16 patients undergoing hepatic resection for large tumors (mean diameter, 10.7 cm) located near hilar structures, hepatic veins, or the inferior vena cava (IVC). In 14 cases, TVI was achieved by clamping the suprahepatic and infrahepatic IVC and the porta hepatis, with or without aortic occlusion; in two, selective hepatic vein clamping was possible, obviating IVC occlusion. Procedures included standard and extended right and left lobectomies and caudate lobe resections. Concomitant resection and reconstruction of the portal vein (one case), IVC (one case), and bile duct (three cases) was required. Postoperative hepatic and renal failure did not occur. Mean intensive care unit and hospital stays were 2.8 +/- 1.9 and 12.5 +/- 5.2 days, respectively. There were two perioperative deaths. Total vascular isolation permits safe resection of large, critically located tumors that would otherwise present prohibitive operative risks.

Adolescent↗
PubMed1993

Prolonged preservation in University of Wisconsin solution associated with hepatic artery thrombosis after orthotopic liver transplantation.

Hepatic artery thrombosis (HAT) after liver transplantation (LTx) usually mandates retransplantation. Prolonged preservation with Eurocollins solution has been associated with HAT. We reviewed our experience with 359 LTx patients to identify risk factors for HAT. All grafts were preserved in University of Wisconsin solution. HAT developed in 12 patients (3%) within 50 days. Seven patients were asymptomatic; four presented with biliary sepsis and 1 with poor graft function. Two patients had suffered acute rejection; another 2 had severe preservation injury. Technical problems accounted for 4 cases; in the remaining 8, no etiology was found. Diagnosis was at a mean 14.7 days after LTx. One patient maintains normal graft function 3 years after LTx without intervention. Eight underwent re-LTx, 3 of whom died. Routine surveillance via duplex enabled early diagnosis and revascularization in 3 patients; in all 3, no biliary complications occurred between 6 and 20 months. Overall graft and patient survival after HAT were 33.3% and 75%, respectively. Cold ischemic time (CIT) averaged 813 min in patients with HAT and 669 min in those without HAT (P < .05). HAT occurred in 7/165 patients with CIT > 12 hr, and in 3/234 patients with CIT < 12 hr (P = 0.0699). By avoiding CIT > 12 hr, we have recently avoided HAT in 78 consecutive patients. We conclude that CIT > 12 hr may increase the risk of HAT. When HAT is diagnosed before biliary sepsis develops, flow can often be restored and retransplantation averted.

Adenosine↗
PubMed1993

Multiple sclerosis: a literature review.

The pathology of multiple sclerosis (MS) was first described over 150 years ago. An estimated 250,000 to 350,000 people are affected with MS in this country. Young adults between the ages of 20 and 50 years are most commonly affected, with the majority of patients experiencing a relapsing course and progressive functional disability. To date, researchers have been unable to discover a precipitating cause. However, many now believe MS develops due to exposure to some unknown virus in a genetically predisposed individual. The incidence of disease is limited in temperate climates and higher in northern latitudes. Neuroscience nurses frequently care for individuals with MS and must, therefore, maintain a familiarity with the current literature and research.

Cause of Death↗
PubMed1993

Trajectory and empowerment theory applied to care of patients with multiple sclerosis.

Two theoretical frameworks were examined for their applicability to nursing care of multiple sclerosis (MS) patients. The Corbin and Strauss Trajectory Framework assumes that the course of chronic illness (eg, MS) varies over time and can be reconfigured by treatment and management. Miller's theory of chronically ill patient's empowerment to promote successful coping is derived by combining previously developed concepts of coping and empowerment to maintain control and enhance the quality of life. These theoretical frameworks offer great potential for guiding the nursing care of MS patients who require extensive repertoires of coping skills to deal with the stress of this chronic illness. However, further research is required to establish their validity.

Activities of Daily Living↗
PubMed1992

Simultaneous laparotomy and endoscopy for control of bleeding gastric ulcerations after liver transplantation without enterotomy.

Treatment of gastric peptic ulcerations, which requires both medical and surgical coordination in its management, is a complex subject. Despite advances in the medical therapy of ulcers, medications have little impact on the course of bleeding peptic ulceration. Newer endoscopic techniques of injection with adrenaline or alcohol, heater probes, and vicaps electrodes have controlled bleeding in many patients. Still, a subset of patients remains who will require surgical interventions with gastrotomy and oversewing of the ulcer crater. We describe a new technique for management of the acute gastric ulcer bleeding that avoids gastrotomy and potential contamination in the post-transplant patient.

Esophageal and Gastric Varices↗
PubMed1992

A longitudinal study of nurses' attitudes toward caring for patients with AIDS in Erie County.

The purpose of this study was to examine nurses' attitudes toward caring for patients with AIDS in a longitudinal context. Results of the 1990 survey were compared with those of a survey conducted in 1986 for the purpose of examining changes in attitudes over time. Findings indicated that there were no significant differences between the 1986 and 1990 scores on the attitude scales. The results of the study indicated that many nurses still have fears and concerns about caring for patients with AIDS.

Acquired Immunodeficiency Syndrome↗