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Biomedical subjects

D C Miller

Publications and source records attributed to D C Miller.

At least 397 records · Page 22Linked to original sources
PubMed1978

Left ventricular-coronary sinus fistula following repeated mitral valve replacements.

After mitral valve replacement, symptomatic deterioration and new murmurs characterstistic of atrioventricular valvular regurgitation are usually the result of periprosthetic leaks or prosthetic dysfunction with or without endocarditis. In the case which we are reporting, an iatrogenic fistula between the left ventricle and coronary sinus was responsible for the murmur and symptoms. This type of shunt has not been previously reported. Thorough debridement of the anulus is necessary during mitral valve replacement; additionally, previously implanted prostheses are occasionally embedded in the endocardial wall and must be excised. Hematoma in the atrioventricular groove and perforations of the posterior left ventricular wall are widely recognized complications of mitral valve replacement. Similar mechanisms of injury can cause other problems such as left ventricular-right atrial communications and the unique anatomic shunt described in this report.

Adult↗
PubMed1977

Simplified field assessment of nutritional status in early childhood: practical suggestions for developing countries.

This paper proposes a simple and inexpensive method for the field assessment of certain objective indicators of nutritional status in children of preschool age. It emphasizes the need for statistically valid sample selection and presents a design for randomly selecting 30 children from each of 30 village sites in each region for which quantitative inferences are to be made, the main purpose being to estimate the prevalence of protein-energy undernutrition and anaemia. The need to train indigenous paraprofessional workers as assessors and periodically to control their accuracy is stressed. The method used is limited to an estimate of the location and magnitude of common childhood malnutrition and it is recommended that it be supplemented by detailed ecological analysis to determine causal factors and propose remedial action.

Anthropometry↗
PubMed1976

A case of Pyemotes dermatitis. With a note on the role of these mites in skin disease.

Acute dermatitis developed in a fisherman after contact with old cherry-wood. A Pyemotes mite, probably P. beckeri, found in the wood, was thought to be responsible--thus illustrating the importance of appropriate laboratory examinations for ectoparasites. Human skin erruptions caused by indigenous, in contrast to imported, Pyemotes species have not previously been reported in Britain. These tarsonemoid mites attack small insect hosts and their possible role in dermatoses is discussed. Dermatitis caused by these mites is probably world-wide in distribution, but during the last century the confusing acarological nomenclature surrounding Pyemotes has resulted in an equally confusing variety of dermatological diagnoses.

Dermatitis, Contact↗
PubMed1975

Coronary bypass surgery for unstable angina pectoris. Clinical follow-up and results of postoperative treadmill electrocardiograms.

The first 81 patients who underwent coronary artery bypass surgery at Stanford University Hospital for unstable angina pectoris have been followed up for an average of 18 months. The over-all surgical mortality was 8.6 per cent (seven patients). There have been no operative deaths in last 32 patients, which may be due to over 75 per cent of these patients being stabilized on intensive medical therapy from 24 to 72 hours before study or surgery. There was a 16 per cent (13 patients) perioperative and 15 per cent (12 patients) late incidence of myocardial infarction. Of 74 patients who survived the initial operation 2 died 2 and 3 months postoperatively. Good or complete relief from pain was obtained in 94 per cent (70 patients) of the survivors. Of 57 longterm survivors tested, 49 per cent (28 patients) had a definite ischemic response to treadmill exercise testing. This may reflect the severe nature of the occlusive coronary disease or mechanisms other than increased coronary flow being responsible for the relief of pain. Although coronary bypass surgery appears to be effective in relieving the pain of patients with unstable angina pectoris, the 18 month average follow-up indicates that the incidence of myocardial infarction in surgically treated patients is comparable to that in medically treated patients.

Adult↗
PubMed1975

Changes in survival and symptom relief in a longitudinal study of patients after bypass surgery.

The first 350 patients having coronary surgery at Stanford Medical Center (excluding patients with aneurysmectomy or valve replacement) have been followed sequentially utilizing a computer-based information system. Our experience spans 72 months (900 patient-years), with an average follow-up of 30 months. Hospital mortality was 4.9%. Actuarial analysis revealed survival of 91% at 1 year and 80% at 6 years. Forty patients (11.5%) had 43 late myocardial infarctions, of which 5 were fatal. Analyses of selected patient subgroups revealed significantly poorer survival in patients with prior myocardial infarction (P less than 0.05), significant congestive heart failure, or mitral regurgitation (P less than 0.01). Survival in multigrafted (and multivessel) patients was not significantly different from survival in single-grafted (predominantly single-vessel) patients. Actuarial studies suggest improved survival in patients with multivessel disease after coronary artery surgery. Between an initial evaluation at 9 months postoperatively (range: 2 to 40 months) and the most recent evaluation after 30 months (range: 6 to 72 months), 13% of patients showed further clinical improvement, 47% were unchanged, while 40% deteriorated with respect to chest pain. We conclude that initial symptomatic benefits may not be maintained in late follow-up studies owing to progression of underlying vascular disease.

Adult↗