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Biomedical subjects

G Miller

Publications and source records attributed to G Miller.

At least 613 records · Page 34Linked to original sources
PubMedDate not supplied

Low-dose bupivacaine-fentanyl spinal anesthesia for cesarean delivery.

BACKGROUND AND OBJECTIVES: The hypotension following spinal anesthesia remains commonplace in cesarean delivery. Intrathecal opioids are synergistic with local anesthetics and intensify sensory block without increasing sympathetic block. The combination makes it possible to achieve spinal anesthesia with otherwise inadequate doses of local anesthetic. We hypothesized that this phenomenon could be used to provide spinal anesthesia for cesarean delivery while incurring less frequent hypotension. METHODS: Thirty-two women scheduled for cesarean delivery were divided into 2 groups of patients who received a spinal injection of either 10 mg of isobaric (plain) bupivacaine 0.5% or 5 mg of isobaric bupivacaine with 25 microg fentanyl added. Each measurement of a systolic blood pressure less than 95 mm Hg or a decrease in systolic pressure of greater than 25% from baseline was considered as hypotension and treated with a bolus of 5 to 10 mg of intravenous ephedrine. RESULTS: Spinal block provided surgical anesthesia in all patients. Peak sensory level was higher (T3 v T4. 5) and motor block more intense in the plain bupivacaine group. The plain bupivacaine patients were more likely to require treatment for hypotension (94% v 31%) and had more persistent hypotension (4.8 v 0.6 hypotensive measurements per patient) than patients in the minidose bupivacaine-fentanyl group. Mean ephedrine requirements were 23.8 mg and 2.8 mg, respectively, for the 2 groups. Patients in the plain bupivacaine group also complained of nausea more frequently than patients in the minidose bupivacaine-fentanyl group (69% v 31%). CONCLUSIONS: Bupivacaine 5 mg + fentanyl 25 microg provided spinal anesthesia for cesarean delivery with less hypotension, vasopressor requirements, and nausea than spinal anesthesia with 10 mg bupivacaine.

Adjuvants, Anesthesia↗
PubMedDate not supplied

Internal neurolysis.

One hundred seventy-eight patients diagnosed with a lower extremity nerve compression syndrome were treated conservatively using orthopedic, medical, and physical therapy modalities. Eighty-two per cent of these patients improved and recovered, and required no further care. Eighteen per cent of these patients did not recover or experience significant improvement in their sensory or motor loss. This chronic group was treated by internal neurolysis. Ninety-five per cent of this chronic group treated by internal neurolysis improved. Only 5% did not have significant prolonged relief or improvement and eventually required excision of a sensory peripheral nerve. Internal neurolysis may not be indicated in those patients who suffer from transient sensory paresthesias; conservative care and/or an external peripheral nerve decompression may suffice. Internal neurolysis is indicated in those patients who have constant sensory aberations or motor loss from a chronic peripheral nerve compression syndrome or any other nerve lesion that has not responded well to conservative care or to an external nerve decompression procedure. Internal neurolysis, in addition to conservative care regimes presented here, has been found to be effective in reversing heretofore thought to be irreversible pain syndromes in the lower extremity even when significant atrophy has already occurred.

Foot Diseases↗
PubMedDate not supplied

An assessment of the effect of "DOC talk" on school children in rural Iowa.

The effectiveness of family physicians as health educators through a community health organization (Doctors Ought To Care/DOC) was studied. Seventh-grade students in a rural school system received a series of uniquely prepared slide presentations (DOC talks) on smoking, alcohol, drug use, and venereal disease to study the effect of such talks on knowledge gain and behavior change. The presentations were made during the semester in which the students were also taking a required health education course. A second group of seventh graders in the same school system did not receive the presentations but had the same health education course and served as the control group. Both groups showed similar gains in knowledge during their semester of health education. However, only the group which received the DOC talks showed a continuation of knowledge gains on a follow-up questionnaire. Also, only the group which saw the presentations showed positive behavior changes including decreased substance use. While aware of the study's methodologic limitations, we believe the results support the value of the community physician presenting DOC talks to supplement the usual school health curriculum.

Adolescent↗
PubMedDate not supplied

The switch between EBV latency and replication.

This paper reviews experiments done in the author's laboratory which led to the discovery of an Epstein-Barr virus (EBV) gene, BZLF1, whose product, ZEBRA, switches the virus from latency to the replicative phase of its life cycle. Recent experiments are summarized which explore the effects of EBV genome rearrangements and cell background on the expression of ZEBRA, and which investigate the viral targets of ZEBRA action.

Cell Line↗
PubMedDate not supplied

Some recent developments in the molecular epidemiology of Epstein-Barr virus infections.

We have applied two different recombinant DNA techniques to the study of the epidemiology of Epstein-Barr virus infections. In the first application, cloned subfragments of viral DNA were used as probes to detect EBV DNA in a variety of lymphoproliferative disorders and in lymphoid cell lines. Patients who are epidemiologically unrelated harbor EBV genotypes which can readily be distinguished from each other. Patients who are epidemiologically related (such as mothers and infants) have similar EBV genotypes. Some patients, especially those who are immunocompromised, are infected with two distinct genotypes. In the second application, we have examined the immune response to specific EBV antigens expressed from small cloned viral DNA subfragments. We have identified a group of patients with presumed chronic EBV infection who selectively fail to recognize one subcomponent of the EB nuclear antigen complex.

Antibodies, Viral↗
PubMedDate not supplied

AIDS and antibodies to human immunodeficiency virus (HIV) in children and their families: clinical experience at Yale-New Haven Hospital.

As of December 1986, we have identified 23 symptomatic children with human immunodeficiency virus (HIV) infection in New Haven. Twelve developed AIDS as manifested by lymphocytic interstitial pneumonitis, Pneumocystis carinii pneumonia (PCP), and/or disseminated mycobacterial infections; seven of them have died. The remainder have milder clinical syndromes, which include failure to thrive, diffuse lymphadenopathy, and parotid swelling. When compared to adults with AIDS, children often have hypergammaglobulinemia and normal numbers of T4 lymphocytes. Intravenous drug abuse by the mother or mother's consort is the risk factor in 87 percent of these children. Two families have now been identified with more than one symptomatic child, but in no family is there evidence of spread from symptomatic children to uninfected siblings. A prospective study was begun to attempt to assess the risk of developing symptomatic HIV infection when a child is born to a mother with antibodies to HIV.

Acquired Immunodeficiency Syndrome↗