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Biomedical subjects

D T Miller

Publications and source records attributed to D T Miller.

At least 73 records · Page 4Linked to original sources
PubMed1983

Can the results of live donor kidney transplantation be improved?

According to an analysis of 100 consecutive kidney transplants from live donors performed at our center over a 25-month period beginning in June 1980, only two patients have died, and five other patients had graft loss from acute or chronic rejection; this resulted in an overall actuarial 2-year patient survival rate of 98% and a graft survival rate of 90%. Eighty-five of the 93 patients with functioning grafts have excellent renal function, with serum creatinine levels less than or equal to 2 mg/dl. Complications occurred in 24 patients but rarely jeopardized the patients' lives or grafts or resulted in permanent disability. The functional capacity of most of the patients was improved by transplantation or was excellent both before and after transplantation. Forty-three transplants were possible through the use of the original or Imuran-modified donor-specific transfusion protocol, so that the lack of compatible donors rarely limited the availability of this therapy. New therapies that might improve graft or patient survival rate cannot reasonably be evaluated in recipients of live donor kidney transplants, because these results are already good. We have estimated that as much as $3.6 million in health care funds could be saved every 2 years at our center if we offered kidney transplants from healthy willing donors to all recipients before instituting dialysis. From our study we conclude that live donor kidney transplantation is an available, highly effective, and cost-efficient form of therapy for patients with end-stage renal disease.

Adolescent↗
PubMed1983

Renal transplantation in patients with systemic lupus erythematosus.

The activity of systemic lupus erythematosus (SLE) was investigated in 18 recipients of 20 renal transplants by retrospective analysis of their medical records and by screening the ten patients with more than one year follow-up. Eight grafts were lost, all because of rejection occurring within the first year. From the 12 patients with functioning transplants, one was lost to follow-up at seven years and another had not completed one year. The remaining ten patients were studied, and no evidence of lupus nephritis was found despite serologically active SLE in four cases. Their follow-up was 4.5 +/- 1.3 years. Our study provides the relatively scarce literature on renal transplantation in patients with SLE with a series of 18 recipients of 20 allografts, confirms that the recurrence of lupus nephritis in the allografts is very rare, as previously suggested, and discloses that graft and patient survivals are comparable with those of the general nondiabetic transplant population.

Female↗
PubMed1983

Obstetric care of the affected carrier of hemophilia B.

Hemophilia B (factor IX deficiency) is an X-linked recessive clotting disorder similar to hemophilia A. In both diseases, phenotypic expression of the disorder may occur in significant numbers of heterozygous carriers. This is presumably due to random inactivation of one of the two X chromosomes of the female carrier as described by the Lyon hypothesis. Described herein is the obstetric care of a severely affected heterozygous carrier of hemophilia B. Predelivery automated plasma exchange was used to raise factor IX levels successfully. Commercial factor concentrates were avoided. The Lyon hypothesis is discussed in detail, and recommendations are made for the care of the clotting factor-deficient gravid woman.

Adult↗
PubMed1982

Influence of pre- and perioperative blood transfusions on renal allograft survival.

One hundred and seventy-nine patients who received transplants between January 1975 and May 1980 have been studied retrospectively in order to elucidate the effect of pre- and perioperative random third-party blood transfusions on first cadaveric renal allograft survival. The 179 patients were approximately evenly divided into four groups; those who received blood transfusions preoperatively only (group 1, n = 45), received blood both pre- and perioperatively (group 2, n = 48), received blood perioperatively only (group 3, n = 37), or were never transfused before transplantation or perioperatively (group 4, n = 49). Actuarial graft survival for group 1 was 73% at 1 to 4 years, which was significantly better (P less than or equal to 0.02) than each of the other three groups at all four intervals. Groups 2, 3, and 4 were statistically identical to each other and had graft survivals of 52% or less at 1 to 4 years. From our study we conclude that: (1) Preoperative transfusions confer significant benefit on recipients of first cadaveric renal allografts. (2) Perioperative blood transfusions are without significant benefit in previously untransfused patients, and significantly lower allograft survival in previously transfused patients. A rational blood transfusion policy based on these results would be to transfuse renal allograft recipients preoperatively and avoid perioperative blood transfusions as much as possible.

Actuarial Analysis↗
PubMed1982

Direct determination of the linoleate/oleate ratio in serum cholesterol esters by liquid chromatography.

We describe a convenient method for the direct determination of the serum cholesterol linoleate/cholesterol oleate (L/O) ratio by reversed-phase "high-performance" liquid chromatography. After removal of phospholipids by silicic acid chromatography, a serum extract is analyzed on a 5-micrometers particle size Ultrasphere-ODS column, eluted isocratically with acetonitrile/isopropanol (30/70, by vol). Detection is at 200 nm. Cholesterol palmitoleate interferes with the measurement when the analysis is based on peak area, but not when peak height is used. The overall precision of L/O measurements by this method was very similar to that observed with a gas-liquid chromatographic procedure, in which the cholesterol esters are first isolated and transesterified to the methyl esters. In both cases, the within-run CV for six replicate analyses was less than 2%. Analysis of 53 human serum samples by both methods yielded very similar L/O ratios. A plot of the data (our method = y) vs the usual gas-liquid chromatographic procedure gave a correlation coefficient of 0.988 and a regression equation of y = 1.03x + 0.013. Furthermore, direct analysis of serum cholesterol ester L/O ratios by our liquid-chromatographic method is simpler, quicker, and more readily adaptable to automation.

Cholesterol Esters↗
PubMed1978

Automation of diphenylhydantoin and phenobarbital measurements using the ABA-100 with emit reagents.

1. The EMIT-AED procedures for phenobarbital and diphenylhydantoin have been adapted for use on the ABA-100. 2. A basic language computer program has been developed for data reduction and quality control. 3. Within-run and run-to-run coefficients of variations were, in general, less than 8% across the concentration range tested. 4. Performance data on agreement of duplicates and recovery from "spiked" samples were aceptable. 5. The automated procedure provides a two-thirds savings in reagents.

Autoanalysis↗
PubMed1978

Neuron-thymic lymphocyte binding by serum IgG of 90- and 500-day-old female Wistar albino rats.

In vivo and in vitro IgG binding to neurons was determined by the direct and indirect immunofluorescence and immunoperoxidase techniques in 90- and 500-day-old female Wistar rats. The sera were also tested against other organs of 90- and 300-day-old rats, and an absorption technique was carried out with minced thymus. Only 1 90-day-old rat showed positive in vivo neuron binding. One serum of a young (6.7%) and 17 sera of old (42.5%) rats were positive by the in vitro procedures. The 1 young and 4 of the old positive sera cross-reacted with thymocytes, and when 3 of these were subjected to absorption, neuron igG binding capacity was removed. Significant cross-reactivity with other organs could not be demonstrated. These observations indicate that in these rats there are at least two kinds of serum neuron binding IgG which significantly increase with age; one of these cross-reacts with thymus and the other does not.

Age Factors↗
PubMed1976

Myocardial responses to acetylstrophanthidin during veratrum alkaloid refractoriness.

Studies were undertaken in the isolated blood perfused dog heart to determine the nature of the myocardial refractoriness induced by veratrum alkaloids. The initial intracoronary injection of cryptenamine acetates (Unitensin) was always associated with an increase in myocardial contractility and a loss of myocardial potassium. Subsequent doses produced refractoriness with respect to both the contractile and potassium responses. Acetylstrophanthidin still produced an inotropic and potassium losing effect duct of the glycoside was potentiated whereas the contractile response was not.

Animals↗