Voiding symptoms and periurethral mass.
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Abscess↗
Biomedical subjects
D Miller
Publications and source records attributed to D Miller.
Oral complications of multimodality therapy for advanced squamous cell carcinoma of head and neck.
Investigational treatment of advanced localized stage III or stage IV squamous cell carcinoma of the head and neck may include chemotherapy in addition to radiotherapy and surgery. Such therapy, while effective in eradicating local tumors, often produces considerable oral toxicity. In this study we reviewed the oral complications of 22 patients receiving multimodality cancer treatment. The addition of chemotherapy to the treatment regimen did not increase the incidence of complications (osteoradionecrosis, mucositis, xerostomia, radiation caries, or infection) when compared with historical controls receiving radiotherapy alone. Pretreatment dental evaluation and close follow-up of these patients are encouraged.
Carcinoma, Squamous Cell↗
Comparison of the effect of fluosol DA and dextran 40 on regional cerebral blood flow, infarction size, and mortality in cats with temporary occlusion of the middle cerebral artery.
Twenty-four cats were divided into two groups and treated with an intravenous infusion of either fluosol DA or dextran. One-half of the animals in each group were ventilated with room air and one-half with 100% oxygen. The right middle cerebral artery was occluded for a period of 4 hours through a transorbital approach. Regional blood flow by the hydrogen clearance method was measured before and after the infusion of fluosol DA or dextran, after oxygenation in the animals on 100% oxygen, three times during the period of ischemia, and after reperfusion. Regional cerebral blood flow increased slightly with the infusion of fluosol or dextran, decreased slightly with hyperoxygenation in the animals so treated, and decreased markedly in the right hemisphere during temporary occlusion of the right middle cerebral artery in all groups. With reperfusion regional flows in the right hemisphere varied considerably, with some animals showing hyperperfusion and others essentially no flow. There was no significant difference in average regional cerebral blood flow between any of the groups. The severity of infarction in all groups was directly related to the decrease in regional cerebral blood flow in the right hemisphere during temporary occlusion. There was also a strong correlation between the regional cerebral blood flow in the right hemisphere after reperfusion and the severity of infarction. In general, the animals showing normal or increased flow after reperfusion had small infarcts and those showing no reflow had large infarcts. Mortality was high in all groups, was not significantly different between any of the groups, and was highly correlated to the size of infarction. In brief, in this study fluosol offered no advantage over dextran, and probably neither agent, in the dose used, offered any protection against cerebral ischemia.
Animals↗
Operating room surveillance: a new approach in reducing hip and knee prosthetic wound infections.
A prospective study of surgical wound infections (SWI) in hip prosthesis surgery and total hip and knee replacements at two community hospitals with common surgical staffs was begun in May 1982. The rates of SWI during the first 7 months for four orthopedic surgeons were 9% (3/32) for hip prosthesis surgery and 16.7% (3/18) for total hip and knee replacement, with 12% (6/50) overall. To reduce infections, each orthopedic surgeon agreed to intraoperative surveillance (IOS) of two procedures (hip prosthesis or total hip or knee replacement) by the infection control nurse at each hospital. Significant IOS findings were too many persons in the operating room (five to nine persons), operating room doors opened frequently (25 to 50 times), inconsistent use of prophylactic antibiotics, and excessive conversation. In January 1984, IOS data and recommendations were shared with each orthopedic surgeon, the operating room staff, and the anesthesia personnel. Subsequently, a statistically significant drop in SWI was realized for total hip and knee replacement (1/36 versus 5/36, p = 0.05) and overall (3/73 versus 14/116, p = 0.05). The drop in SWI for hip prosthesis surgery was not statistically significant (2/37 versus 9/80, p greater than 0.10). IOS and individualized communication were effective in reducing SWI.
Aged↗
Bacterial recovery from automated cataract surgical equipment.
Internal tubing involved in the venting and vacuum mechanism of CooperVision's models 8000-V, 7500, and 6500 units were cultured. Several species of bacteria were found including Staphylococcus epidermidis. The clinical implications of this are discussed as well as a solution to the possibility of intraoperative bacterial contamination from the reported source.
Bacteria↗
Radiation-resistant and repair-proficient human tumor cells may be associated with radiotherapy failure in head- and neck-cancer patients.
Inherent cellular radioresistance and repair of x-ray damage was studied in 19 early-passage squamous cell carcinoma lines derived from head- and neck-cancer patients with known clinical results following radiotherapy. Human tumor cells that were radioresistant and/or proficient in accumulation/repair of x-ray damage were cultured from patients unsuccessfully treated with radiotherapy. Thus, the presence of radiation-resistant and repair-proficient tumor cells was associated with clinical radiation failure, suggesting the possibility of a predictive assay based on in vitro radiobiological parameters.
Carcinoma, Squamous Cell↗
Total parenteral nutrition in patients with insulin-requiring diabetes mellitus.
The clinical course of 24 patients with insulin-requiring diabetes mellitus who had received total parenteral nutrition (TPN) was retrospectively analyzed. Routine nutritional assessment disclosed significant depression of anthropometric indices and secretory protein levels in patients with chronic renal failure complicating juvenile onset diabetes mellitus (JODM). Biochemical complications including hypo- or hyperglycemia were significantly more frequent (p less than 0.001) in JODM than in maturity-onset diabetes and found to a lesser degree in patients with renal failure. The catheter infection rate was substantially higher (17%) than usually encountered in TPN therapy. Positive nitrogen balance was achieved in the majority of patients with an average 84% and 92% of estimated protein and caloric requirements being provided. Close monitoring and a protocol of infusion plus supplemental subcutaneous regular insulin was useful in providing adequate TPN safely to these high-risk patients.
Acute Kidney Injury↗
Cortical degeneration with swollen chromatolytic neurons: its relationship to Pick's disease.
We report two cases of dementia in which cortical degeneration with widespread swollen chromatolytic neurons (SCN) was the dominant pathologic feature. Each patient had received the diagnosis of Alzheimer's disease on the basis of clinical findings. There was no deficit of cortical choline acetyltransferase activity, assayed in one case, or lesions of the nucleus basalis of Meynert. The brains had moderate to marked frontal atrophy. Comparison of SCN with several other cerebral degenerative disorders indicates a similarity with certain features of the transmissible spongiform encephalopathies and with corticodentatonigral degeneration. The pathologic features of our cases are those of a number of other cases reported as "Pick's disease," and may represent an earlier stage in the pathogenetic process than the severe, sharply circumscribed atrophy with "nonspecific" cell loss and gliosis as the only microscopic residuals. Our findings re-emphasize the need to search for pathogenetically distinct subgroups which have been wholly or partially subsumed into the concept of Pick's disease.
Acetylcholine↗
Organising a counselling service for problems related to the acquired immune deficiency syndrome (AIDS).
Recent Department of Health and Social Security (DHSS) guidelines on screening procedures for antibody to human T cell lymphotropic virus type III (HTLV-III) have stressed the importance of providing adequate counselling for patients before and after testing. The establishment of a national acquired immune deficiency syndrome (AIDS) counselling training unit has enabled large numbers of National Health Service staff to be trained in this work. Suggestions for the establishment of district counselling facilities are made, based on this training, and some preliminary results showing change from high risk sexual behaviour after counselling are presented.
Acquired Immunodeficiency Syndrome↗
Affective disorders and violence in adolescents.
Many adolescent affective disorders are rooted in biological vulnerability to stress and a predisposition to mood variations that are latent in childhood. As these stress-sensitive children encounter the normative helplessness and struggle for autonomy of adolescence, they may use violence, explosive rage, self-starvation, grandiose self-idealization, drug abuse, and suicidal behavior to relieve psychological helplessness and tension. They may begin a lifelong cycle of failure, disruption, and rejection by family and schools. The author describes adolescent depression and its biological underpinnings, deprivation syndromes, and manic-depressive illness, as well as the concept of affective violence in organic affective syndromes and episodic dyscontrol syndromes. These disorders call for multimodal treatment in which appropriate medication facilitates psychosocial intervention.
Adjustment Disorders↗
Pathology of surgery after induction chemotherapy: an analysis of resectability and locoregional control.
At the Dana-Farber Cancer Institute Head and Neck Cancer Clinic, 114 previously untreated patients with advanced squamous cell carcinoma of the head and neck (17% stage III; 83% stage IV) were managed with induction chemotherapy using cis-platinum, bleomycin, and methotrexate, followed by definitive extirpative surgery and/or radiation therapy. The present report evaluates this group from a surgical and surgical pathology standpoint. The following aspects are evaluated: predictability of, and conversion to, resectability during induction chemotherapy; ease of surgical technique and intraoperative assessment; patterns of pre-op and post-op risks and complications; gross and histopathologic observations of the extent and character of residual primary and nodal disease, particularly after a response to chemotherapy; patterns of locoregional control or failure related to treatment variables. The issues subsequently addressed include: how does chemotherapy affect the operative candidacy and resectability of proposed surgical patients? Could, or should surgery be eliminated in the management of some patients treated with induction chemotherapy? Can less radical surgery be contemplated in patients significantly "downstaged" by prior chemotherapy treatment? Is increased locoregional or distant metastatic control observed in these patients? What is the role of surgery in the responder to chemotherapy?
Antineoplastic Combined Chemotherapy Protocols↗
Interleukin 2 enhances natural killing of varicella-zoster virus-infected targets.
Preincubation of peripheral blood non-adherent mononuclear cells with purified or recombinant interleukin 2 (IL-2) significantly enhanced natural killer (NK) activity against uninfected and varicella-zoster virus (VZV)-infected targets, while antibody-dependent cellular cytotoxicity (ADCC) against VZV-infected targets was not increased. Preincubation of effector cells with IL-2 had no effect on conjugate formation, but lysis of both targets was increased in single cell assays. IL-2-enhanced NK against VZV-infected targets was independent of gamma-interferon (gamma-IFN) production.
Adult↗
Aiding AIDS sufferers.
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Acquired Immunodeficiency Syndrome↗
Tips on drawing blood through a heparin lock.
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Blood Specimen Collection↗
A crossed polaroid-pinhole device.
The study describes the use of a pinhole device in which the light-absorbing area surrounding the holes is varied by polarizing filters. The study demonstrates that a pinhole aperture of 1.6-1.8 mm in diameter with polaroids crossed at 90 degrees will allow a visual acuity equal to or better than 20/40 in the face of refractive errors of 1, 2, and 3 diopters. The study next evaluates the effects of pinholes of different sizes and the polarizing components crossed at angles less than 90 degrees. The study concludes by showing that polaroids crossed at between 75 degrees and 85 degrees allow a greater depth of focus, a larger visual field, and greater illumination than traditional pinhole devices.
Humans↗
Extending the range of the surgical keratometer.
Interest in optical precision in ocular surgery has been increasing recently. The surgical keratometer is central to the practice of ocular surgery, and research is needed to increase the precision of surgical keratometry techniques. Animal corneas used for these purposes may be outside the range of the surgical keratometer. Extension of the lower range of the Terry keratometer is achieved by substituting a 200- or 250-mm-focal-length objective lens for the standard 175-mm lens on the Zeiss operating microscope. Conversion equations and graphs are presented that allow conversion of the values obtained with these lenses.
Cornea↗
Use of sodium hyaluronate in severe penetrating ocular trauma.
This study describes the surgical treatment and eventual outcome of 15 cases of anterior-segment penetrating ocular trauma that would be classically considered as having a poor prognosis. Signs of poor prognosis included: corneal lacerations, complicated by signs of infection ranging from infiltration to necrotic digestion; large scleral lacerations, with ciliary body or choroidal prolapse; and an exaggerated inflammatory response to the trauma. Treatment included careful microsurgical techniques, vitrectomy (when necessary), use of antibiotics and anti-inflammatory agents, and the liberal use of sodium hyaluronate to break fibrin adhesions and maintain the chamber at the close of surgery. Such treatment resulted in no enucleations, an average best corrected visual acuity of 20/80, an average normal angle of 314 degrees, and 13 cases of normal intraocular pressure without medication.
Combined Modality Therapy↗