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Biomedical subjects

E Miller

Publications and source records attributed to E Miller.

At least 235 records · Page 13Linked to original sources
PubMed1994

Effects of atenolol and diltiazem-SR on exercise and pressure load in hypertensive patients.

The effects of monotherapy with atenolol or diltiazem-SR on blood pressure, 24-h blood pressure (BP) load, and exercise capacity were tested in patients with mild to moderate (stages I and II) essential hypertension. After 3-week single-blind placebo therapy, patients with sitting diastolic blood pressure (SDBP) of 94-114 mmHg were randomized to atenolol 50 mg/day (62 patients) or diltiazem-SR 90 mg b.i.d. (60 patients) in a double-blind parallel study. Depending on SDBP response, the dose was increased to 100 mg/day for atenolol and 180 mg b.i.d. for diltiazem-SR. Twenty-four-hour ambulatory blood pressure measurements and exercise tolerance test by the Bruce protocol were done at the end of placebo and active treatment. Compared with placebo, both atenolol and diltiazem-SR significantly decreased heart rate (HR), sitting systolic blood pressure (SSBP), SDBP, ambulatory BP, BP load for waking and sleeping hours, area under the BP curve, rate-pressure product (p < 0.001), and exercise time (NS). Atenolol exerted a greater effect on ambulatory BP, HR, rate-pressure product, waking diastolic BP load, and area under the 24-h BP curve. The drugs were well tolerated and caused no serious side effects necessitating discontinuation of treatment. These findings indicate that (1) monotherapy for hypertension with atenolol or diltiazem-SR is effective and well tolerated, (2) it decreases the 24-h BP load, (3) it does not interfere with exercise capacity.

Adult↗
PubMed1994

Hematologic emergencies.

The most common life-threatening hematologic emergencies include hemorrhage and severe anemia. Successful treatment of these conditions depends on the emergency veterinarian having a thorough understanding of the possible etiologies of these conditions, and a systematic approach to diagnosis and therapy. Use of blood component therapy can be a life-saving technique in these patients. The goal of this article is to familiarize the emergency veterinarian with a systematic approach to the diagnosis and treatment of hematologic emergencies.

Anemia↗
PubMed1994

The impact of color duplex surveillance on the outcome of lower limb bypass with segments of arm veins.

PURPOSE: To evaluate prospectively 42 lower extremity arm vein bypasses with use of color duplex surveillance (CDS). METHODS: Twenty-seven bypasses (64%) were to tibial arteries, 12 (29%) were to popliteal arteries, and three (7%) were to superficial femoral arteries. Twelve bypasses were composed of a single arm vein segment, and 30 were composite vein bypasses. Bypasses were evaluated with CDS and ankle-brachial indexes before the patients were discharged from the hospital, at 1 month, and then every 3 months during the first year; every 6 months during the second year; and annually thereafter. The median follow-up period was 17 months, and the median number of scans performed per bypass was seven. Each examination consisted of a scan of the entire bypass with velocity measurements taken routinely at the proximal and distal anastomoses and at a proximal and distal bypass segment in addition to any high-velocity area identified on the CDS. Peak systolic velocity greater than three times that of an adjacent graft segment or peak systolic velocity less than 45 cm/sec throughout the vein conduit were indications for arteriography. RESULTS: Thirteen arteriograms were performed because of abnormal duplex findings on surveillance. Extension or interposition vein grafts (9), vein patch angioplasty (1), or inflow procedures (3) were used to maintain secondary patency. The 24-month primary and secondary patency rates were 46% and 85%, respectively. Three patients required amputation of a major extremity. CONCLUSIONS: Arm veins are satisfactory conduits for lower extremity revascularization. However, preocclusive lesions that require correction are commonly found on surveillance, especially when composite bypasses are required. Vein bypass surveillance with CDS allows identification and appropriate correction of preocclusive lesions.

Adult↗
PubMed1994

Age-specific antibody prevalence to hepatitis A in England: implications for disease control.

Sera from an age-stratified sample of 7196 individuals, submitted for diagnostic purposes to four public health laboratories in England in 1986/7, were tested for hepatitis A antibody. The serological profiles, which showed marked regional differences, were consistent with declining incidence in the past. The decline in the incidence of hepatitis A has resulted in an increase in susceptibility in adults. This has three main consequences: an increase in the average age of infection may be leading to an increase in morbidity; normal immunoglobulin may become less protective against hepatitis A; the risk of transmission through blood products contaminated by viraemic blood donors may rise. Current average annual incidence in 5-14-year olds was estimated to vary between regions from 0.5-1.9%. This supports the view that, in the absence of a vaccination programme, hepatitis A will remain endemic unless there are further improvements in living conditions and standards of hygiene. A vaccine giving long-lasting protection could eliminate hepatitis A transmission with modest coverage at a young age. Targeting childhood vaccination on economically deprived areas or using vaccine to control outbreaks might be more effective policies.

Adolescent↗
PubMed1994

Outbreak of measles in a teenage school population: the need to immunize susceptible adolescents.

An outbreak of measles occurred in a community school and the surrounding area in Crowborough, East Sussex, UK, from December 1992 to February 1993. There were 96 suspected cases reported: 66 cases among 1673 students at one school and 30 community cases. The majority of suspected cases were in those aged 11-17 (78%), 2 cases occurred in infants < 1 year old and 8 cases in adults aged 18 years or over. Data collected on 60 (91%) of the 66 suspect school cases showed 56 (93%) had an illness which met a case definition of measles. Eighteen had confirmatory IgM measles antibody. Two cases were hospitalized. The local percentage uptake for measles immunization for the school age years affected varied between 64% and 84%. A survey of parents showed that approximately 74% of the students attending the school had a history of measles immunization. The immunization rates reported by parents for children who developed measles was 21%, (29% based on GP records) compared with 77% for those who remained well. Vaccine efficacy was estimated to be 92%. This outbreak, along with others recently reported in older unimmunized children in the UK, reinforces the need for catch-up immunization programmes to reach this susceptible group of adolescents.

Adolescent↗
PubMed1994

Ageing in learning difficulties: the development of health care outcome indicators.

A system of outcome indicators for the health and social care of ageing people with learning disabilities is required to ensure that clinicians, planners, purchasers and policy makers can monitor and evaluate the impact of health and social care. As longevity is increasing in people with learning disabilities, special problems are found in the physical health, psychological health and social wellbeing of the elderly. This paper reviews theoretical aspects of outcome indicators, and uses the various classes of outcome measures available to draw up a system of indicators for clinicians, researchers and planners. This paper represents the personal view of the authors, prepared for a conference in August 1992.

Adult↗
PubMed1994

Effects of treatment on outcome in mildly symptomatic patients with ischemia during daily life. The Atenolol Silent Ischemia Study (ASIST)

BACKGROUND: Detection of asymptomatic ischemia in patients with coronary artery disease has been associated with increased risk for adverse outcome, but treatment of patients with asymptomatic ischemia remains controversial. Accordingly, the purpose of this study was to determine if treatment reduces adverse outcome in patients with daily life ischemia. METHODS AND RESULTS: A multicenter, randomized, double-blind, placebo-controlled study of asymptomatic or minimally symptomatic outpatients with daily life silent ischemia due to coronary artery disease was conducted. The primary outcome measure was event-free survival at 1 year by Kaplan-Meier analysis. Events were death, resuscitated ventricular tachycardia/fibrillation, myocardial infarction, hospitalization for unstable angina, aggravation of angina, or revascularization. The secondary outcome was ischemia during ambulatory ECG monitoring at 4 weeks. Three hundred six outpatients with mild or no angina (Canadian Cardiovascular Society class I or II), abnormal exercise tests, and ischemia on ambulatory monitoring were randomized to receive either atenolol (100 mg/d) or placebo. After 4 weeks of treatment, the number (mean +/- SD, 3.6 +/- 4.2 versus 1.7 +/- 4.6 episodes, P < .001) and average duration (30 +/- 3.3 versus 16.4 +/- 6.7 minutes, P < .001) of ischemic episodes per 48 hours of ambulatory monitoring decreased in atenolol- compared with placebo-assigned patients (4.4 +/- 4.6 to 3.1 +/- 6.0 episodes and 36.6 +/- 4.1 to 30 +/- 5.5 minutes). Event-free survival improved in atenolol-treated patients (P < .0066), who had an increased time to onset of first adverse event (120 versus 79 days) and fewer total first events compared with placebo (relative risk, 0.44; 95% confidence intervals, 0.26 to 0.75; P = .001). There was a nonsignificant trend for fewer serious events (death, resuscitation from ventricular tachycardia/fibrillation, nonfatal myocardial infarction, or hospitalization for unstable angina) in atenolol-treated patients (relative risk, 0.55; 95% confidence intervals, 0.22 to 1.33; P = .175). The most powerful univariate and multivariate correlate of event-free survival was absence of ischemia on ambulatory monitoring at 4 weeks. Side effects were mild and generally similar comparing atenolol- and placebo-treated patients, although bradycardia was more frequent with atenolol. CONCLUSIONS: Atenolol treatment reduced daily life ischemia and was associated with reduced risk for adverse outcome in asymptomatic and mildly symptomatic patients compared with placebo.

Activities of Daily Living↗
PubMed1994

[Huntington chorea: (CAG)n repeats on gene IT 15 in Austria].

In March 1993 the gene IT 15 was identified on chromosome 4p and it was demonstrated that it contained an unstable (CAG)n trinucleotide repeat that is elongated in patients with Huntington's chorea (HC). Persons with more than 37 (CAG)n repeats tend to have a higher risk of developing the disease. Testing the (CAG)n repeats in Austrian HC patients with PCR techniques shows correspondence between the clinical diagnosis of HC and genotypes [more than 42 (CAG)n repeats]. There was a weak correlation between the number of (CAG)n repeats and age of onset, however, this finding is without diagnostic value due to the scatter of the values.

Adolescent↗
PubMed1993

Risk of aseptic meningitis after measles, mumps, and rubella vaccine in UK children.

Cases of aseptic meningitis associated with measles/mumps/rubella vaccine were sought in thirteen UK health districts following a reported cluster in Nottingham which suggested a risk of 1 in 4000 doses, substantially higher than previous estimates based on cases reported by paediatricians (4 per million). Cases were ascertained by obtaining vaccination records of children with aseptic meningitis diagnosed from cerebrospinal fluid samples submitted to Public Health Laboratories or discharged from hospital with a diagnosis of viral meningitis. Both methods identified vaccination 15-35 days before onset as a significant risk factor and therefore indicative of a causal association. With both, half the aseptic meningitis cases identified in children aged 12-24 months were vaccine-associated with onset 15-35 days after vaccine. The study confirmed that the true risk was substantially higher than suggested by case reports from paediatricians, probably about 1 in 11,000 doses. However, the possibility that the aseptic meningitis induced by vaccination was largely asymptomatic and a chance laboratory finding in children investigated for other clinical conditions, particularly febrile convulsions, could not be excluded. Comparison of national reports of virus-positive mumps meningitis cases before and after the introduction of this vaccine indicated that the risk from wild mumps was about 4-fold higher than from vaccine. Altogether, 28 vaccine-associated cases were identified, all in recipients of vaccines containing the Urabe mumps strain. The absence of cases in recipients of vaccine containing the Jeryl Lynn strain, despite its 14% market share, suggested a higher risk from Urabe vaccine. A prospective adverse event surveillance system using the study methods is currently being established to assess the risk, if any, from the Jeryl Lynn strain which is now the only mumps vaccine used in the UK.

Child, Preschool↗
PubMed1993

Rubella surveillance to December 1992: second joint report from the PHLS and National Congenital Rubella Surveillance Programme.

The high uptake of measles/mumps/rubella vaccine since October 1988 has had a major impact on rubella susceptibility in children under five years of age, with interruption of the epidemic cycle and reduction in incidence to a low endemic level. The number of infections in pregnancy reported in England and Wales to the PHLS Communicable Disease Surveillance Centre fell to 23 in 1990, and to 12 and two, respectively, in 1991 and 1992. The reduction was greatest in parous women, a group who were previously at risk through exposure to their own children. During 1991, however, susceptibility in parous antenatal women rose from 0.7% to 1%, suggesting that post-partum immunisation rates may have declined recently. If continued, this could give rise to outbreaks of congenital rubella in the future during the brief periods of rubella resurgence expected before disease elimination is achieved. Susceptibility among Asian women was four times higher than among non-Asians. Of the total of 94 births of congenitally infected infants since January 1987, only 19 occurred during 1990-92 (but this may increase due to late diagnoses). Factors contributing to the continuing occurrence of congenital rubella include missed opportunities for immunisation at school or post-partum, maternal reinfection, and recent immigration into the United Kingdom. Twenty-two (24%) of the women giving birth to congenitally infected infants since 1987 were Asian or Oriental women, of whom at least three acquired their infections abroad. Imported cases will be distinguished in future surveillance reports.

Abortion, Eugenic↗
PubMed1993

Angiotensin II and sympathetic activity in patients with congestive heart failure.

OBJECTIVES: This study was designed to determine the effects of intravenous angiotensin II infusions and the short-term effects of enalaprilat on venous plasma norepinephrine and norepinephrine spillover in patients with stable chronic congestive heart failure. BACKGROUND: Angiotensin II has been shown experimentally to stimulate norepinephrine release. Such effects, if present in humans with congestive heart failure, could be of pathophysiologic and pharmacologic importance. METHODS: In study 1, 60-min angiotensin II (5 ng/kg per min) infusions were administered in eight patients with chronic New York Heart Association functional class II and III congestive heart failure. Heart rate, arterial pressure, forearm venous plasma norepinephrine, norepinephrine clearance (estimated from the clearance of tritiated norepinephrine) and norepinephrine spillover were measured after 30 min in the supine position and after 15 min each of head-up and head-down tilt. All patients were studied in a double-blind manner on two occasions with vehicle control infusions. In study 2, 14 patients comparable to those in the first study had similar measurements made in the supine position before and 30 and 60 min after the administration of enalaprilat (1 mg intravenously). Eight patients received a double-blind vehicle control. RESULTS: In study 1, there were no effects of angiotensin II on heart rate, plasma norepinephrine, norepinephrine clearance or norepinephrine spillover compared with the vehicle control when the patient was in the supine position. Mean arterial pressure increased from 85 +/- 13 to 95 +/- 10 mm Hg with angiotensin II. During upright tilt, plasma norepinephrine and norepinephrine spillover increased comparably with angiotensin II and the vehicle control. During head-down tilt, plasma norepinephrine decreased with both angiotensin II and the vehicle control. Norepinephrine spillover remained elevated relative to control values on both study days during head-down tilt. In study 2, both enalaprilat and vehicle control administration were associated with a slight decrease in mean arterial pressure (5 +/- 2 vs. 3 +/- 4 mm Hg, p = NS), but no changes were seen in plasma norepinephrine. Norepinephrine clearance and spillover decreased comparably with time after both enalaprilat and vehicle control. CONCLUSIONS: Neither the infusion of angiotensin II nor the acute administration of enalaprilat significantly alters the activity of the sympathetic nervous system as reflected by plasma norepinephrine or systemic venous norepinephrine spillover in patients with chronic congestive heart failure. These data weaken the hypothesis that angiotensin II is an important regulator of sympathetic activity in congestive heart failure.

Adult↗
PubMed1993

Age-specific efficacy of pertussis vaccine during epidemic and non-epidemic periods.

A national survey was conducted of 3150 notified cases of whooping cough in order to determine age-specific pertussis vaccine efficacy by the 'screening' method. The cases were collected over two periods, one just prior to the start and one at the first peak of the whooping cough epidemic of 1989-90. Vaccination status was determined by a postal questionnaire to the reporting doctor and clinical data were also collected to provide efficacy estimates according to standardized case definitions. Overall, observed vaccine efficacy was high but differed between epidemic (87%) and non-epidemic (93%) periods (P = 0.03). Efficacy estimates were generally higher for typical or severe cases than for children with an atypical illness. Vaccine efficacy declined with age (P < 0.01) but estimates remained high up to the age of 8 years. This study will provide baseline data for comparison with efficacy observed from similar studies of children immunized at an accelerated schedule and from phase III studies of acellular pertussis vaccines performed elsewhere.

Age Factors↗
PubMed1993

Dissociating single cases in neuropsychology.

Monte Shapiro had a marked and very varied influence on clinical psychology. His contributions included the advocacy of single-case experimentation, some elegant neuropsychological investigations and the presentation of carefully thought-out views on a number of logical and methodological issues. This paper attempts to follow these three strands by considering some recent neuropsychological research based on the detailed investigation of single cases. In particular, the methodology used to lead to some provocative and potentially exciting findings is examined and it is argued that the methodology is less able to bear the interpretations offered than has hitherto been assumed. Possible ways of developing the methodology and making it more robust are indicated.

Cognition↗