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Biomedical subjects

D Miller

Publications and source records attributed to D Miller.

At least 559 records · Page 31Linked to original sources
PubMed1985

AIDS--its implications for South African homosexuals and the mediating role of the medical practitioner.

The concerns of people affected by the current 'AIDS scare' are discussed from a holistic point of view, incorporating medical, psychological and social factors. Parameters of homosexual experience are described fully. The medical practitioner is encouraged to obtain an extensive psychosexual history from concerned patients on the guidelines presented. AIDS is a community health issue in which the medical practitioner plays a pivotal role in diagnosis, counselling, referral and patient education.

Acquired Immunodeficiency Syndrome↗
PubMed1985

Study of middle ear disease using tympanometry in general practice.

Tympanometry was used to provide evidence of middle ear effusions in a prospective study of middle ear disease in 264 children aged 3 months to 6 years in general practice. Adequate measurements on both ears were obtained in 220 children, of whom 68 (31%) had evidence of middle ear effusion in one ear (29 children) or both ears (39 children) at entry to the study. In 28 (42%) of the 68 children persistence of the tympanometric findings was recorded for at least three months. Children of European descent were more likely to have evidence of middle ear effusion at the initial examination compared with African and West Indian children, as were those children whose siblings had a positive history of otitis media compared with those whose siblings had no such history. Children under 3 years were more likely to have evidence of an effusion than older children. Middle ear effusion as shown by tympanometry was not associated with a previous history of otitis media in the child but was associated with recent symptoms of respiratory infection or otalgia. A previous consultation for otitis media was, however, strongly associated with a greater likelihood of a consultation for otitis media during the follow up period. Comparing evidence of effusion by tympanometry with that by pneumatic otoscopy showed that using the appearance of the eardrum alone the sensitivity of otoscopy was 55%; the addition of mobility improved the sensitivity to 76% with little reduction in specificity. Further studies on populations using tympanometry are needed to determine the natural history, aetiology, and indications for referring children with middle ear effusion.

Acoustic Impedance Tests↗
PubMed1985

Combined modality treatment of head and neck cancer with cisplatin, bleomycin, methotrexate-leucovorin chemotherapy.

The multidisciplinary treatment results of 114 patients with advanced, untreated Stage III and IV squamous cell carcinoma of the head and neck region are reported. Induction chemotherapy with two cycles of cisplatin 20 mg/m2/day intravenous bolus days 1 through 5, bleomycin 10 mg/m2/day as a continuous infusion days 3 through 7, and methotrexate 200 mg/m2 intravenous bolus on days 15 and 22 with leucovorin rescue was utilized before definitive surgery and/or radiation therapy. The total response rate was 78% with 30 (26%) patients achieving complete response and 59 (52%) patients achieving partial response. Patient age, performance status, histologic grade of tumor, and tumor site did not predict response to chemotherapy. Induction chemotherapy was well tolerated with myelosuppression and nephrotoxicity being dose-limiting in a few patients. The toxicity of subsequent local treatment with surgery and/or radiation is reported with an analysis of local treatment failures. A strong correlation was noted between local control of tumor and postchemotherapy tumor size before local treatment.

Adult↗
PubMed1985

An improved method for measuring human tear lysozyme concentration.

Previously described methods for measuring human tear lysozyme are fraught with shortcomings. A new method has been devised. Tear fluid was collected on Whatman filter paper discs. Each disc was placed in a tightly capped tube containing sodium phosphate buffer. Fluid from each tube was placed directly into a well of the lysozyme immunodiffusion plate. After the precipitation rings had reached maximum size, their diameters were measured. A linear standard curve was constructed, and lysozyme concentration was expressed as micrograms per milliliter. The tear lysozyme concentration was obtained from the standard curve and corrected for the assay dilution factor. The mean tear lysozyme concentration in 15 normal patients was 1.4 +/- 0.5 mg/mL. In ten patients with dry eyes, the mean was 0.7 +/- 0.5 mg/mL. The method used to collect, store, and transport tears is easily performed in the clinic and readily tolerated by patients. The technique of radial immunodiffusion is reliable and simple, compared with other assays.

Adult↗
PubMed1985

Perioperative management of a patient with a malignant pheochromocytoma.

A case report is presented of a patient with a known malignant pheochromocytoma, who was to undergo an orthopaedic procedure using methylmethacrylate bone cement. Preoperative preparation of the patient included the use of prazosin and metyrosine. Epidural blockade was chosen as the anaesthetic technique for intraoperative management. Surgical fixation with methylmethacrylate did not produce profound or prolonged hypotension despite sudden massive blood loss prior to its use. Epidural morphine was administered for postoperative pain control.

Adrenal Gland Neoplasms↗
PubMed1985

Treatment complications after sequential combination chemotherapy and radiotherapy with or without surgery in previously untreated squamous cell carcinoma of the head and neck.

One hundred consecutive patients with previously untreated advanced squamous cell carcinoma of the head and neck were treated with induction combination chemotherapy followed by definitive surgery and/or radiotherapy, and were evaluated for radiotherapy related toxicity. The induction regimen consisted of cisplatin, bleomycin and methotrexate/leucovorin. Acute toxicity consisted predominantly of mucositis and weight loss, and was mild or moderate by degree in 94% of patients. Six percent of patients experienced severe or life threatening acute toxicities. Two acute toxic deaths were noted in this series, one from a combination of mucositis, weight loss and infection and one from hypoglycemia of unknown origin. Thirty-five percent of patients had radiation treatment interrupted briefly because of acute toxicity. Toxicity was greatest in patients who were nonresponders to induction chemotherapy and such may have been related to the continued presence of advanced tumor. Radiotherapy dose, surgical intervention and age did not have an impact on the presence or degree of acute toxicity. Late toxicities included: hypothyroidism in 32% of patients tested: osteoradionecrosis in 5% of patients, associated primarily with a composite resection (4 of 5 cases); and soft tissue ulcerations in 3%. Taken together, these data indicate that induction combination chemotherapy did not significantly increase the toxicity of subsequent radiotherapy with or without surgery.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1985

One-year experience in a regional pediatric trauma center.

During 1982, 267 children with life-threatening injuries were admitted to the Maryland Regional Pediatric Trauma Center at the Johns Hopkins Hospital. Seventy-three percent of patients arrived directly from the injury scene by helicopter (46%), ambulance (50%), or other (4%). Mechanisms of injury included motor vehicle accidents (MVA; 55%), falls (27%), assaults (8%), and sports and other injuries (10%). In 75% of MVA the child was a pedestrian. Fifty-one percent of injuries were single organ system, 29% involved two systems, and 20% involved three or more systems. Remarkably, the mortality of 6.7% was not affected by the number of organ systems involved, but was directly related to the presence or absence of head injury. Fourteen of seventeen deaths resulted from head injury. Eighty percent of documented liver and spleen injuries were managed nonoperatively. This nonoperative plan of management simplified the optimal treatment of head injury. The high frequency of head injury has mandated a more aggressive approach to the management of brain trauma including intracranial monitoring to facilitate control of cerebral edema. Our data demonstrate that an excellent quality of life may be anticipated even in children with severe head injury.

Adolescent↗
PubMed1985

Monoclonal antibodies to digoxin: comparison of in vitro and in vivo immunization.

We compared the primary response in vitro with the secondary response in vivo of A/J inbred and CD-1 outbred mice to digoxin-HSA. The frequencies of hybrid formation and growth, and of the hybridomas that secreted antibody to digoxin were similar in both strains regardless of the immunization procedure. The patterns of cross-reactivity of the monoclonal antibodies to two compounds structurally related to digoxin (ouabain and digitoxin) were likewise similar for both strains and immunization procedures.

Animals↗
PubMed1985

Fetoscopy in the assessment of unexplained fetal hydrops.

Pure fetal blood samples, obtained fetoscopically from 30 patients with unexplained fetal hydrops at 16 to 32 weeks gestation were investigated for cytogenetic, haematological, biochemical and virological properties. In two patients with oligohydramnios, the fetoscope was introduced transabdominally into the fetal peritoneal cavity and sampling was undertaken from the intra-abdominal portion of the umbilical vein; in all the other patients an umbilical cord vessel was sampled. Ten (33%) of the fetuses had chromosomal abnormalities, one an erythroblastic process, possibly erythroleukaemia, one alpha-thalassaemia and one cytomegalovirus infection. Blood-film abnormalities were seen in 23 (88%) of 26 fetuses that had this examination. Biochemical analysis of fetal plasma was undertaken in 18 fetuses and hypoproteinaemia was found in all cases. One fetus was subsequently found to have a paroxysmal tachyarrhythmia that responded to digitilization. Three (10%) of the fetuses survived.

Adolescent↗
PubMed1985

Psychological support and counselling for patients with acquired immune deficiency syndrome (AIDS).

The growing numbers of patients with the acquired immune deficiency syndrome (AIDS) in England had led to the development of a counselling service for patients, their sexual partners, contacts, and others. The nature of the counselling is described with reference to the primary qualitative issues arising from diagnosis. The necessity for preventative education for patients and those at risk is stressed, and guidelines for low risk sexual activities are outlined.

Acquired Immunodeficiency Syndrome↗
PubMed1985

Chronic pain: lifetime psychiatric diagnoses and family history.

Thirty-seven patients with chronic pain admitted to a 3-week inpatient pain program were interviewed using the NIMH Diagnostic Interview Schedule and the family history method. The most frequent psychiatric diagnoses were major depressive disorder (current episode = 32.4%, past episode = 43.2%) and alcohol abuse (40.5%). More than half of the patients had a history of one or more episodes of major depression and/or alcohol abuse before the onset of their chronic pain. Family history revealed that 59.5% of the patients had at least one first-degree family member with chronic pain, 29.7% had a family member with affective illness, and 37.8% had a family member with alcohol abuse.

Adult↗
PubMed1985

Urinary iron loss and physical fitness of Kenyan children with urinary schistosomiasis.

Daily urinary iron loss and physical fitness were determined in Kenyan primary school children who had low-medium (16-177 eggs/10 ml adj) or high (200-1,194 eggs/10 ml adj) S. hematobium egg counts compared with a matched group of control or uninfected children before and after antischistosomal treatment with metrifonate. The 3 groups did not differ significantly before treatment in age, sex ratio, anthropometry or prevalence of other parasite infections. Before treatment, mean iron loss in the high egg count group (n = 14) was 652 micrograms/24 hr and was significantly higher than losses in the low-medium and control groups (losses = 278, 149 micrograms; n = 19, 12 respectively). Iron loss in infected children was correlated with egg count (r = 0.40) and log of egg count (r = 0.56, P less than 0.0003). After treatment iron loss decreased in the infected groups and post-treatment iron losses did not differ significantly. Physical fitness scores, measured with the Harvard Step Test, showed that the control group (score 81) was significantly more fit than the high egg count group (score 69) before treatment. Fitness scores improved significantly in both infected groups after treatment, and post-treatment fitness scores did not differ significantly between the 3 groups. This study provides evidence that relatively heavy infections of S. hematobium can cause urinary iron loss which, if it persists, is great enough to produce iron deficiency anemia and can also reduce physical fitness of children, but that both of these negative effects are reversible with treatment.

Child↗
PubMed1985

Pertussis vaccine and whooping cough as risk factors in acute neurological illness and death in young children.

The National Childhood Encephalopathy Study received reports on 1182 cases of serious acute neurological illnesses in children admitted to hospital in Britain. The frequency of risk factors in cases was compared with matched controls. A personal or family history of convulsions was found significantly more often in cases than in controls, but no such excess was found for a history of allergy. Case children were significantly more likely to have received diphtheria, tetanus and pertussis (DTP) vaccine within seven days before onset and to have a history of whooping cough during the month of onset. The risk of serious acute brain conditions after the disease was more than six times that of three doses of DTP. In addition, there is evidence that deaths attributed to whooping cough may seriously underestimate the number associated with pertussis infection.

Brain Diseases↗