Biomedical subjects
D Miller
Publications and source records attributed to D Miller.
The influence of the nictitating membrane on steroid inhibition of limbal wound healing.
In a study involving 34 rabbits, it was found that local corticosteroids inhibit limbal wound healing in normal rabbit eyes, and do not inhibit similar wounds if the nictitating membrane has been removed. It was further found that the contact time of fluorescein labelled corticosteroids is almost 3 times longer in rabbit eyes with nictitating membranes than those in which the membranes have been removed.
Children's rights on entering therapeutic institutions.
The authors delineate aspects of adolescent psychological development that should be considered in decisions regarding psychiatric residential treatment, reviewing the issue of consent to treatment in the context of developmental psychology. They state that rather than jettisoning the whole system of placing treatable disturbed young people in residential facilities without their explicit consent, the court should take as its proper role to ensure that adolescents placed in residential psychiatric facilities receive adequate treatment.
The ethics of practice in adolescent psychiatry.
The author discusses ethical problems specific to practice with adolescents, a patient group which has special requirements in terms of their relations with authority figures and the kind and degree of external control they need. The psychiatrist who works with adolescents must be aware that his or her actions, attitudes, and personality can be crucial influences in the young person's development. Particular attention is needed in the areas of confidentiality, informed consent, and the impact of behavior control and other treatment techniques on adolescents.
Measurement of CBF and carotid artery pressure compared with cerebral angiography in assessing collateral blood supply after carotid ligation.
Angiographic assessment of collateral circulation to the brain at the circle of Willis was compared with measurements of cerebral blood flow (CBF) and internal carotid artery pressure during temporary carotid clamping in the prediction of tolerance of unilateral carotid ligation as treatment for intracranial carotid aneurysms in 92 patients. From CBF studies it was predicted that a substantial number of patients (27%) would suffer severe cerebral ischemia if carotid ligation were carried out. No single angiographic feature provided this predictive information. Bilateral fetal type of posterior communication arteries were associated with significantly lower carotid artery back pressure on temporary carotid occlusion, and unilateral absence of posterior communicating arteries was related to llower CBF, but neither feature was associated with a signifiant reduction in the rate of successful carotid ligation. We believe that preliminary percutaneous digital corotid compression with electroencephalographic monitoring, followed by intraoperative measurement of the change in regional CBF and internal carotid artery pressure during temporary carotid clamping provides a safe method of selecting patients for carotid ligation. Carotid angiography with or without contralateral carotid compression is of little value in this respect.
Chronic granulocytic leukemia: cytogenetic conversion of the bone marrow with cycle-specific chemotherapy.
Sixteen patients with Ph1-positive chronic granulocytic leukemic (CGL) were entered on a pulsing chemotherapy program consisting of cytosine arabinoside 100 mg/sq m/day X 5 and thioguanine 100 mq/sq m/day X 5 every 21 days in an attempt to convert the Ph1-positive marrow to a Ph1-negative state and thereby achieve a complete remission. Twelve patients had an adequate trail of drug treatment, and ten of these had adequate chromosome examinations. There were two "conversions," one of which was maintained for 5+ mo, while the other was transient. The program was unacceptable, however, to most patients due to intolerable nausea and vomiting. Thus a prospective chemotherapeutic attempt to convert a Ph1-positive marrow without splenectomy has induced a conversion in two of ten patients. Other regimens which might induce less nausea and vomiting and a higher rate of conversions should be sought in future attempts to alter the invariably fatal outcome of CGL.
Glare sensitivity in corrected aphakes.
Groups of elderly aphakic patients treated with contact lenses, spectacles and intraocular lenses, as well as elderly phakic patients, all with good visual acuity were tested for glare sensitivity. All groups showed comparable glare sensitivity. However, aphakic patients with lesn material, or postop membranes in the the pupil area, were statistically more glare sensitive. These membranes occur when the cataract extraction is extracapsular in nature. Finally, the study shows that measurement of visual acuity in the typical examination room environment does not accurately describe the manner in which the patient visually functions in a bright, glare laden environment.
Use of Na-hyaluronate during intraocular lens implantation in rabbits.
It is now established that there is a destructive biophysical interaction between a plastic intraocular lens and the corneal endothelium during intraocular lnes implantation. In the present study , Na-hyaluronate was placed into the anterior chamber of one eye of 20 rabbits, after lens extraction and prior to pseudophake implantation, in an attempt to protect the corneal endothelium. The other eye of each rabbit was subjected to a lens extraction and pseudophake implantation in the conventional manner. During the 4-week postoperative period, it was observed that the eye treated with Na-hyaluronate showed significantly less corneal edema as well as less iris engorgement and edema.
The effect of the honeycomb on glare function.
Patients with certain forms of cataract or corneal disease have diminished visual acuity in a brightly lit environment. This is due to increased light scattering, which causes increased glare sensitivity. In a series of experiments, a sequence of bottles containing a suspension of latex particles was used to simulate the effect of different degrees of cataract and corneal edema on visual acuity. It was shown that anodized honeycombs could substantially improve visual acuity through the latex-containing bottles. The mechanism of visual improvement was shown to be by reduction of glare and increase in contrast.
Endolaryngeal cryosurgery. An improved technique.
Crysurgery is a tissue-destroying technique that has been difficult to use in the larynx except for small or superficial lesions. An improved technique for creating precise but large endolaryngeal lesions was developed and studied in dogs. Six animals each had one true vocal cord destroyed with a large closed cryoprobe introduced through a tracheostoma. The larynges were removed at intervals from four to 63 days and were examined grossly and histologically. This technique was found to be a safe and simple method for treating selected laryngeal neoplasms without external laryngeal surgery.
The reliability of head film measurements. 3. Tracing superimposition.
The superimposition of tracings from lateral skull x-ray films taken at different timepoints is an important method for assessing developmental and treatment changes through time. The usefulness of the data derived is, however, limited by the fact that the physical act of superimposing tracings is performed with some error. The magnitudes of error for superimpositions on different "planes" have not been amenable to quantitation by previously available methods. Using newly developed computer-aided techniques, we have been able to quantitate both the primary errors of tracing superimposition and the associated secondary landmark displacements for four conventionally employed anatomic reference "planes". For each reference "plane," twenty-five independent film pairs were examined independently by each of four judges. Therefore, 100 acts of tracing superimposition were available for each reference "plane." Output data are presented which appear to support the conclusion that measurement errors in tracing superimposition are a consequential factor affecting the confidence which should be placed in head film comparisons, particularly with regard to individual cases. Some consequences of this conclusion with respect to growth prediction and to the evaluation of treatment effects are considered.
Effect of soft contact lenses on limbal wound healing.
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Letter: An inexpensive blowgun device for anterior chamber paracentesis.
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The serotypes of Bordetella pertussis isolated in Great Britain between 1941 and 1968 and a comparison with the serotypes observed in other countries over this period.
Classification, by agglutinogens, of 634 isolates of Bordetella pertussis collected from 1971 to 1968 in Great Britain demonstrated that a change from a predominantly 1,2,0,4 serotype (75% of those examined during 1941-4) to a predominantly 1,0,3,0 serotype (73% of those examined during 1966-8) occurred sometime after 1953. Furthermore, evidence from the examination of isolates collected between 1941 and 1953 suggests that the change may have been gradual. Isolates of serotype 1,2,3,4 made up 20-30% of the total of our cross-country selection for the periods 1941-4, 1946-9, 1950-3 and 1966-8, but over shorter periods in individual areas the percentage varied from negligible to as high as half of those isolated. Results from other countries show a similar drift towards a 1,0,3 sertype but more often from a 1,2,3 than from 1,2,0 serotype. The value, in epidemiological studies, of extended information obtained by monospecific typing sera to all six, rather than only two or three agglutinogens, and confirmation of the results by agglutinin production is demonstrated: for instance not all 1,0,3 isolates were identical.
Gunshot wounds of the extremities in children.
A ten-year review of gunshot trauma in Manitoba was prompted by an increasing incidence in gunshot trauma in children. Of 54 children treated from 1964 through 1973 60% sustained injury to one or more extremities. Fifteen children sustained long bone fractures, usually complete and often comminuted. All fractures united and there was only one instance of osteomyelitis. The major complication in gunshot wounds to the skeletally immature was limb length inequality secondary to epiphyseal plate injuries. This complication occurred in nine children. In three children there was in epiphyseal growth disturbance, even though the missile did not appear to pass through the plate but only in close proximity to it. Joint contractures secondary to skin loss and resulting subsequent skin contracture were also common. The amount of debridement required following gunshot trauma in children appears to be somewhat less than is recommended for similar injuries sustained by adults in time of war.
Haemangiomatous malformation of the orbito-sphenoidal region: cure by radiotherapy.
This case was previously reported in 1973 at the 46th annual general scientific meeting of this College. Following a suggestion made at the meeting the patient was referred for radiotherapy, with a result so satisfactory as to call for a restatement of the case.
Treatment plans for mental health care.
The authors present a method for the development of standard process criteria for the care of defined subpopulations of psychiatric patients using a two-dimensional problem category system to describe patients. Patient subpopulations, described by both a traditional psychopathological problem cluster and a less traditional psychosocial problem cluster, are matched to a list of problem-solving services to develop a model treatment plan. The authors present this method for developing standard treatment plans as an alternative to APA's Model Criteria Sets.
Adrenochrome staining of soft contact lenses.
A clinical case of adrenochrome staining of a soft contact lens is described. A laboratory model for such staining is then described in which a soft lens is boiled in a basic, saturated solution of L-DOPA. Repetition of this process in fresh solutions of L-DOPA can achieve any level of black staining desired. The lens can then be made transparent by immersing it in a 3% solution of hydrogen.