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Biomedical subjects

G M Miller

Publications and source records attributed to G M Miller.

At least 73 records · Page 4Linked to original sources
PubMed1991

Extraosseous spinal chordoma. Case report.

An extraosseous extradural tumor of the lumbar region with the histological appearance of chordoma produced symptoms in a 58-year-old woman. The tumor occupied the epidural space and produced scalloping of the adjacent vertebral body and pedicle without associated bone destruction. The location of the tumor within Batson's plexus and lack of osseous connection facilitated complete removal. Although the lesion exhibited the classic histological features of a chordoma, it differed significantly in its extraosseous location. Like the rare intradural chordoma arising in the cranium, this tumor presumably represents neoplastic development in an extraosseous notochordal rest.

Chordoma↗
PubMed1990

Right aortic arch with isolation of the left subclavian artery: case report and review of the literature.

Of the right aortic arch anomalies, a right arch with isolation of the left subclavian artery is the least common. Herein we describe a 52-year-old woman in whom this anomaly was discovered during cerebral angiography for evaluation of a giant symptomatic intracavernous carotid aneurysm. Isolation of the left subclavian artery may be suggested in a patient with a right arch in whom the blood pressure or pulse in the left upper extremity is diminished. Although the isolated left subclavian artery produces the hemodynamic alterations of a subclavian steal, review of the 39 cases reported in the literature revealed only 5 patients with symptoms suggestive of vertebrobasilar insufficiency and 5 patients with weakness of the left upper extremity. Although the patient we describe had no known heart disease, congenital heart disease was present in 23 of the 39 reported cases (59%), tetralogy of Fallot occurring most frequently.

Aneurysm↗
PubMed1989

Magnetic resonance imaging of the spine.

Magnetic resonance (MR) imaging offers the advantages of multiplanar capabilities, physiologic as well as anatomic imaging, and some tissue specificity. Since mid-1985, we have performed more than 2,800 MR examinations of the spine, and gadolinium has been used as a contrast agent in many MR studies since its release by the Food and Drug Administration last year. Although MR imaging has been promoted as the procedure of choice for all clinical indications, on the basis of our experience myelography still plays an important role in the imaging of many spinal disorders, including disk disease. Some pathologic conditions such as intraspinal vascular malformations and leptomeningeal metastatic lesions are best imaged by myelography. MR studies have been most useful in evaluating intraspinal neoplasms, spinal cord parenchymal lesions, infections, congenital abnormalities, and "postoperative failed back syndromes."

Humans↗
PubMed1989

Cerebral tuberous sclerosis: postmortem magnetic resonance imaging and pathologic anatomy.

We conducted postmortem magnetic resonance imaging (MRI) studies of five brains from patients with a clinical and pathologic diagnosis of tuberous sclerosis. Areas of prolonged T1 and T2 relaxation could easily be identified within the white matter subjacent to the cortical tubers despite formalin fixation and storage. The signal changes were identical to those reported in living patients with the disease. The detection of cortical tubers by MRI in two patients who were 34 and 35 years of age, respectively, at the time of death suggests that the signal changes on MRI are less affected by aging than are the low-attenuation changes on computed tomography, which are rarely identified in patients older than 27 years of age. Once the changes caused by fixation of tissues are considered, postmortem MRI is a viable investigative tool in studying tuberous sclerosis and other diseases, and it seems to correlate well with the MRI findings in living patients, as well as the gross and histopathologic changes seen at autopsy.

Adolescent↗
PubMed1989

Spinal cord sarcoidosis: a new finding at MR imaging with Gd-DTPA enhancement.

Three patients with histologically confirmed sarcoidosis with spinal cord involvement were examined with high-field-strength magnetic resonance imaging (1.5 T) before and after the administration of gadolinium diethylenetriaminepentaacetic acid. In addition to intramedullary expansion, areas of patchy, multifocal, parenchymal enhancement and areas of linear peripheral enhancement were seen in all three patients; these findings have not been previously reported and are unusual for other more common spinal cord lesions. This observation led to a correct diagnosis and a limitation of the extent of biopsy in two of the cases. Unfortunately, this enhancement pattern is not specific for sarcoidosis, as the authors have observed similar findings in two cases of biopsy-proved myelitis and multiple sclerosis. The peripheral enhancement is thought to be located in the leptomeninges due to leptomeningeal involvement, which was proved histologically in one case. This pattern of involvement, while not specific, is certainly consistent with and, in the appropriate clinical setting, highly suggestive of sarcoidosis.

Adult↗
PubMed1989

Neurofibromatosis type 1 with bilateral acoustic neuromas.

A patient diagnosed as having neurofibromatosis type 1 (NF-1) on the basis of 6 café-au-lait macules, multiple subcutaneous neurofibromas and 1 Lisch nodule is described. He later was found to have bilateral acoustic nerve tumors plus multiple intracranial meningiomas. This patient is one of a few adequately described cases who clinically meets diagnostic criteria for NF-1 and has bilateral acoustic nerve tumors.

Adult↗
PubMed1988

Effect of circumcision status on periurethral bacterial flora during the first year of life.

To determine whether bacterial colonization is a factor in the pathogenesis of urinary tract infection, we compared the periurethral bacterial flora of uncircumcised versus circumcised boys during the first year of life. Intraurethral and circumferential glans cultures were obtained from 25 circumcised and 25 uncircumcised infants at 2 days, 2 weeks, 2 months, 4 months, 6 months, and 12 months of age. Different children were used at each age (300 total). The types of bacteria and the total and specific colony counts were compared. The results of the glans cultures were similar to those from the urethra. Uncircumcised boys had significantly higher total colony counts (p less than 0.003) at all ages except 12 months. Escherichia coli was present significantly more often (p less than 0.01) in the urethras of uncircumcised boys at 2 weeks, 2 months, 4 months, and 6 months. Gram-negative uropathogenic organisms (Klebsiella-enterobacter, Proteus mirabilis, and Pseudomonas aeruginosa) were cultured more frequently (p less than 0.0005) from the urethras of uncircumcised boys at 2 months, 4 months, and 6 months. The specific colony counts for E. coli and the other uropathogenic organisms were significantly higher (p less than 0.05) at all ages except 12 months. We conclude that during the first 6 months of life, the presence of a foreskin is associated with a greater quantity of periurethral bacteria and a greater likelihood for the presence of, as well as higher concentrations of, potentially uropathogenic organisms.

Bacteria↗
PubMed1988

Central pontine myelinolysis and its imitators: MR findings.

The clinical, radiologic, and neuropathologic findings in 13 patients with central pontine myelinolysis were reviewed. Antemortem computed tomography (CT) had been performed in nine, and ante- or postmortem magnetic resonance (MR) imaging in 11. Chronic alcoholism or rapid correction of hyponatremia was present in over 75% of cases. One CT scan was positive, but only on retrospective review. In all but one patient, MR imaging eventually revealed an abnormality within the pons; in two patients the initial study was normal. The lesions varied in shape, with peripheral involvement in two patients and extrapontine involvement in four. The abnormality was smaller at 6-month follow-up in one patient and unchanged at 1 year in another. One patient never had a demonstrable pontine lesion but did have symmetric basal ganglia abnormalities, which were consistent with extrapontine myelinolysis. MR imaging disclosed similar central pontine alterations resulting from infarct, metastasis, glioma, multiple sclerosis, encephalitis, and radiation or chemotherapy; thus, such changes are not unique.

Adult↗
PubMed1984

Schizencephaly: a clinical and CT study.

Schizencephaly is a primary developmental defect of the brain, presumably caused by failure of formation of the cerebral mantle in the regions of the cerebral fissures. Identification has usually been at autopsy, in association with severe neurologic abnormalities. We identified the characteristic features of schizencephaly on CTs in 11 patients. Age at detection ranged from an infant at 8 months to a 30-year-old adult. Clinical abnormalities varied from mild to severe, including developmental delays and retardation, microcephaly, focal or generalized motor abnormalities, and seizures. CT findings included cerebral clefts, infolding of cortical gray matter along the clefts, an abnormal ventricular system, and other associated cerebral anomalies.

Adolescent↗
PubMed1982

Posterior tibial tendon transfer: a review of the literature and analysis of 74 procedures.

At Rancho Los Amigos Hospital on the Children's Orthopedic Service, 43 patients underwent anterior transfer of the posterior tibial tendon through the interosseous membrane between 1969 and 1979. This included 74 procedures for the following diagnoses: Duchenne muscular dystrophy, club-foot, cerebrospastic disease (cerebral palsy and head injury), Charcot-Marie-Tooth disease, scapuloperoneal dystrophy, and peroneal palsy. The purpose of this paper is to present the 54 of these transfers that have a minimum 2 year follow-up were performed with a uniform surgical technique, and had uniform postoperative management. This series is analyzed and compared with a review of the literature in order to set down guidelines for the use of the procedure. The analysis reveals that the patient with Duchenne muscular dystrophy who has decreasing gait function or brace fitting problems is the ideal candidate for the procedure with 26 of 28 satisfactory results. Gait electromyography was critical to the selection of the cerebrospastic patient for the transfer with those patients demonstrating swing-phase function of the posterior tibialis muscle yielding the best results. Finally, posterior tibial tendon transfer is generally not indicated in congenital clubfoot with six unsatisfactory results in 10 procedures, and the procedure should not be done in Charcot-Marie-Tooth disease as part of staged treatment that includes a possible future hindfoot stabilization.

Cerebral Palsy↗
PubMed1977

Immunobiology of primary intracranial tumors. Part 3: Microcytotoxicity assays of specific immune responses of brain tumor patients.

Fifty-six in vitro microcytotoxicity assays were conducted on 30 patients with intracranial tumors at various times during the postoperative course. Significant specific cellular cytotoxic responses were found in nine of 56 assays, humoral cytotoxic responses in nine of 54 assays, and host effector cell-dependent, antibody-dependent cytotoxic responses in four of 28 assays. Variables that might influence the occurrence of cytotoxicity were studied, and the relationship of these findings to other immune parameters was discussed.

Adolescent↗