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Biomedical subjects

G A Miller

Publications and source records attributed to G A Miller.

At least 109 records · Page 6Linked to original sources
PubMed1990

Carotid body tumours: report of six cases and a review of management.

We have treated six patients with carotid body tumours in the period from 1972 to 1988. All patients had a neck mass on presentation. In addition one patient complained of tinnitus and another was noted to have Horner's syndrome. The diagnosis was confirmed by ultrasound and angiography in all cases. Five patients subsequently underwent successful surgical resection. At the time of surgery one of the tumours was found to be locally invasive. One elderly patient was deemed unfit for surgery and was managed non-surgically with a satisfactory outcome. A review of the literature reveals that surgery is still the preferred mode of treatment although preoperative embolization may be a useful adjunct. Although the incidence of peroperative stroke has gradually been reduced from that found in earlier series, injury to the cranial nerves remains high and is the main hazard of surgical management. The improved results of surgical resection in more recent reports support the view that these tumours should be treated in units with expertise in vascular surgery of the neck.

Adult↗
PubMed1989

Safety and efficacy of percutaneous transluminal coronary angioplasty performed at time of diagnostic catheterization compared with that performed at other times.

Performing diagnostic cardiac catheterization and percutaneous transluminal coronary angioplasty (PTCA) as a single, combined procedure might provide savings in patient hospitalization days and more efficient use of catheterization laboratory time. To assess the safety and efficacy of combined diagnostic coronary angiography and PTCA, we reviewed all elective PTCA procedures performed at our institution during 1985 and 1986 so that we could compare patients who had diagnostic angiography and angioplasty on separate days (n = 404) with those who had the combined procedure (n = 120). The success rate and incidences of urgent bypass surgery, acute myocardial infarction, transient azotemia and procedure-related death were not different in the 2 groups. The mean hospitalization time was 6.2 days in the group with combined angiography and angioplasty, and 7.3 days in the group having separate procedures.

Angiography↗
PubMed1989

Left heart catheterization by direct ventricular puncture: withstanding the test of time.

If retrograde arterial catheterization of the left ventricle fails because of a stenosed native or tissue valve or is contraindicated because of the presence of a mechanical aortic prosthesis, then alternative routes of access to the left ventricle are either transseptal or direct (transapical) left ventricular puncture. The transseptal approach is contraindicated in the presence of a mechanical mitral valve prosthesis. Under these circumstances we have used direct transapical left ventricular puncture in the treatment of 112 patients and have found this technique to be successful with little associated risk. A major complication occurred in 3% of the patients, but the study provided the required data in 95%, and these figures compare favorably with the reported results of transseptal catheterization.

Adult↗
PubMed1989

On "gentleness".

Explore the source record for details and available documents.

Cardiac Catheterization↗
PubMed1989

Comparing borderline definitions: DSM-III borderline and schizotypal personality disorders.

Compared the two types of borderline disorder formally defined by DSM-III, borderline personality disorder and schizotypal personality disorder, at the diagnostic category and individual criterion level. Unlike previous research in this area, which has focused on inpatient and outpatient populations, the sample was a psychometrically defined, nonpatient sample including Ss meeting DSM-III criteria for each disorder. The results indicated that the two diagnostic categories each define a type of borderline with distinctive combinations of features. Perceptual and cognitive distortion, however, seem to be present in both and define an area of overlap between the two disorders. The implications of these findings for the revision of the SPD diagnostic criteria in DSM-III-R are discussed, and the theoretical separation of two subtypes of borderline personality is affirmed.

Borderline Personality Disorder↗
PubMed1989

Aneurysms of the sinuses of Valsalva in Noonan's syndrome.

A case of Noonan's syndrome with aneurysmal dilatation of the sinuses of Valsalva is described. Enlargement of the left heart border on the postero-anterior chest radiograph was initially interpreted as dilatation of main pulmonary artery but aortography confirmed the presence of large aneurysms of two of the sinuses of Valsalva. Connective tissue abnormalities, known to occur in Noonan's syndrome, could be responsible for aortic abnormalities in this syndrome.

Adult↗
PubMed1989

Characterization and vaccine potential of a novel recombinant coccidial antigen.

A cDNA clone derived from sporulated oocysts of Eimeria tenella and encoding the expression product GX3262 was identified using a monoclonal antibody raised against Eimeria acervulina sporozoites. The cDNA fragment containing the coccidial antigen gene was cloned in bacteriophage lambda gt11, transferred to a plasmid, and introduced into Escherichia coli for analysis of the gene products. The strain carrying the plasmid produced GX3262 as part of a fusion protein consisting of the first 1,006 amino acids of E. coli beta-galactosidase and 112 amino acids of the E. tenella protein of approximately 12 kilodaltons. Partially purified antigen, heat-killed recombinant bacterin, and live E. coli containing the recombinant coccidial antigen were used to immunize 1-week-old or newly hatched broiler chicks. Several immunization protocols were utilized, including boosts with partially purified beta-galactosidase-GX3262, bacterin, or small numbers of live E. tenella oocysts. After challenge with an experimental E. tenella infection, the birds were evaluated by scoring cecal lesions to determine the level of protection. The greatest degree of protection was seen after only a single immunization of 2-day-old birds with a live recombinant E. coli preparation. The results presented here identify GX3262 as a potential candidate coccidial vaccine antigen and provide evidence for the first time that newly hatched chickens can be successfully vaccinated with a recombinant antigen.

Amino Acid Sequence↗
PubMed1988

Surgical risk factors in total anomalous pulmonary venous connection.

Eighty-three patients underwent surgical correction of total anomalous pulmonary venous connection (TAPVC) between 1973 and 1986. There were 46 boys and 37 girls. Median age at operation was 60 days (1 to 240) and median weight 3.9 kg (1 to 22). The anatomic types encountered included infracardiac connection (16 patients), supracardiac connection (32) and pulmonary venous drainage connected directly to the coronary sinus (27). Mixed anomalous drainage or pulmonary venous return connected directly to the right atrium occurred in 8 patients. Diagnosis was established by cardiac catheterization and angiography (56 patients), clinical examination (3) and cross-sectional echocardiography alone in 24 of the last consecutive 28 patients. Pulmonary hypertension was present in 26 (55%) of those who underwent cardiac catheterization. The median pulmonary vascular resistance was 4.2 units/m2 (body surface area) for all the patients, whereas in those with infracardiac pulmonary venous connection the median value was 10 units/m2. The median interval between admission and operation was 72 hours. Surgical correction was performed using profound hypothermia and circulatory arrest in 68; for the remainder, conventional cardiopulmonary bypass with profound to moderate hypothermia was used. Ten patients developed 1 or more pulmonary hypertensive crises during the early postoperative period. These were diagnosed in 8 by direct pulmonary artery pressure measurement and in 2 by clinical examination. Late reoperation was necessary in 6 patients (10%). Analyses of risk factors for 30-day survival for all patients showed that the risk of early death was associated with the type of anomaly (infradiaphragmatic), occurrence of pulmonary hypertensive crises, year of the operation, set of the patient and pressure of preoperative congestive heart failure.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Pressure↗
PubMed1988

Pulmonary embolectomy for acute massive pulmonary embolism: an analysis of 71 cases.

Between 1964 and 1986 a total of 71 pulmonary embolectomies were performed for acute massive pulmonary embolism. All patients were severely compromised haemodynamically. Sixteen (64%) of 25 patients who had sustained significant periods of cardiac arrest before operation died. The principal cause of death in this group was severe neurological damage. Five (11%) of the 46 who had not had a cardiac arrest died. The 50 (70%) patients who survived did so largely without morbidity during their hospital admission and in the follow up period. Most were not treated with long term anticoagulants and only two had another embolism. When a patient with acute massive pulmonary embolism is too ill to be given thrombolytic treatment, or when thrombolysis is either contraindicated or too slow in producing benefit, pulmonary embolectomy remains an effective alternative treatment with an acceptable mortality.

Acute Disease↗
PubMed1988

Intravenous and intrapulmonary recombinant tissue-type plasminogen activator in the treatment of acute massive pulmonary embolism.

Eight centers participated in a study in which intrapulmonary and intravenous administration of recombinant tissue-type plasminogen activator (rt-PA) were compared in 34 patients with acute massive pulmonary embolism. All patients received intravenous heparin in a bolus of 5,000 IU followed by 1,000 IU/hr. After 50 mg rt-PA given over 2 hr the severity of embolism, determined from pulmonary angiograms, declined by 12% in the intrapulmonary drug group (p less than .005) and 15% in the intravenous drug group (p less than .005); mean pulmonary arterial pressure fell from 31 +/- 7 to 22 +/- 6 mm Hg (p less than .005) and from 31 +/- 12 to 21 +/- 9 mm Hg (p less than .005) in the respective groups. After a further 50 mg given over 5 hr (22 patients), the angiographically determined severity of embolism had decreased by 38% from baseline in the intrapulmonary drug group and by 38% in the intravenous drug group. The mean pulmonary arterial pressure further declined to 18 +/- 7 and 12 +/- 5 mm Hg in the respective groups. Fibrinogen levels dropped to 48% of baseline after 50 mg and to 36% of baseline after 100 mg rt-PA. Some degree of bleeding at puncture and/or operation sites was noted in 16 patients, including four who required a transfusion of two or more units of blood and had been operated on an average of 7.5 days (range 2 to 13) before thrombolytic treatment was started.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1987

T-cell activation defect in common variable immunodeficiency: restoration by phorbol myristate acetate (PMA) or allogeneic macrophages.

Common variable immunodeficiency (CVI) represents a group of familial and sporadic diseases characterized by a range of B-cell, T-cell, and macrophage defects. A defect in T-cell activation, involving reduced proliferation and IL-2 production after stimulation with OKT3 antibody, has been described previously. In the present study we found that these defects could be corrected in vitro by adding phorbol myristate acetate (PMA) to OKT3-stimulated peripheral blood mononuclear cells (PBMC) of 14 patients with CVI. PBMC of 6 out of 7 patients with CVI studied also exhibited a profound defect in IL-2 receptor expression when incubated with OKT3 antibody. IL-2 receptor expression after stimulation with PMA alone was normal, indicating that the OKT3- but not the PMA-induced pathway of IL-2 receptor expression was defective. On the RNA level, the genes for IL-2 and IL-2 receptor were expressed after stimulation with OKT3 antibody. IL-2 and IL-2 receptor gene expression were normal, indicating a possible post-transcriptional defect. To investigate whether the defect in T-cell activation was at the macrophage or the T-cell level, we prepared adherent cells and monocyte-depleted T cells (E+) from 3 patients with CVI and from normal blood donors. Incubating CVI E+ cells with normal adherent cells resulted in normal proliferation and IL-2 production in the presence of OKT3, whereas incubation of normal E+ cells with adherent cells from patients with CVI under the same conditions showed reduced IL-2 production and proliferation, suggesting the macrophage as the origin of the failure in T-cell activation in the patients with CVI studied. Inhibition by macrophage-secreted prostaglandins was excluded by failure to correct the IL-2 production and proliferation defects in the presence of indomethacin.

Adult↗