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Biomedical subjects

H A Miller

Publications and source records attributed to H A Miller.

At least 37 records · Page 2Linked to original sources
PubMed1987

Blunt liver trauma at Sunnybrook Medical Centre.

Between 1 June 1976 and 30 June 1985 Sunnybrook Medical Centre Regional Trauma Unit admitted 2,016 patients of whom 220 (11%) sustained liver injury. Of these 220 patients, 211 (96%) sustained blunt liver trauma; 175 of 176 patients who underwent open peritoneal lavage had a true positive lavage. Resuscitation was successful in 212 patients, of whom 209 underwent laparotomy and three were treated nonoperatively: 129 of 209 patients (62%) required only minor surgical treatment; the remaining 80 patients (38%) required major surgical procedures. The overall mortality was 29% (64/220). Eight patients died during resuscitation, one of them of liver hemorrhage. Of the 56 patients who died after admission, the cause of death was head injury in 31, liver hemorrhage in 11 (five intraoperatively) and 14 died of other causes. Overall, liver hemorrhage was the cause of death in 12 of 64 deaths (19%). In other words, 12 of the total of 220 patients (6%) died from liver-related mortality.

Accidents↗
PubMed1987

Abdominopelvic computerized tomography and open peritoneal lavage in patients with blunt abdominal trauma: a prospective study.

This prospective trial compares abdominopelvic computerized tomography and open peritoneal lavage in the diagnosis of blunt abdominal trauma. Fifteen patients (group 1) were evaluated by both methods. Another 15 patients (group 2) had only computerized tomography. Criteria for a "positive" scan were hemoperitoneum and evidence of solid organ injury. Criteria for "positive" lavage were a grossly bloody return, erythrocyte count greater than 20.0 X 10(9)/L and leukocyte count greater than 0.5 X 10(9)/L. At laparotomy, only injuries requiring repair or excision were considered "true positive". Patients who did not have laparotomy and had an uncomplicated clinical course were considered "true negative". With tomographic criteria alone for diagnosis there would have been one false-positive and three false-negative results, compared with three false positive and no false negatives for open peritoneal lavage alone. None of the three patients who had negative findings on laparotomy suffered any morbidity or died. Results of computerized tomography and open peritoneal lavage agreed in 8 of 15 patients (kappa value = 0.52), indicating a low level of agreement between the two. The authors believe that open peritoneal lavage remains the diagnostic procedure of choice in blunt abdominal trauma.

Abdominal Injuries↗
PubMed1986

Elastofibroma: chest wall pseudotumor.

A 68-year-old man had a painless, nontender lump in the right infrascapular region. An unenhanced computed tomography (CT) scan showed a soft-tissue mass attached to the scapula, causing muscular displacement. A similar, smaller mass was found on the left side. The appearance of the masses on CT scans was suggestive of infiltrating malignancy, but pathologic examination disclosed findings typical of elastofibroma. Biopsy is recommended in similar cases to exclude sarcoma.

Aged↗
PubMed1985

Analysis of peritoneal lavage parameters in blunt abdominal trauma.

Peritoneal lavage is the most valuable diagnostic modality presently available for the evaluation of patients with blunt abdominal trauma. A retrospective review of 523 patients who underwent open peritoneal lavage for blunt abdominal trauma over a 3 1/2-year period revealed serious intra-abdominal pathology in 83% of patients undergoing laparotomy with RBC lavage counts in the range of 20,000 to 100,000 cells/mm3, a level considered by many authors to be negative or indeterminate. Two patients with isolated small bowel perforations had an elevated amylase level as the only measured abnormality. The data indicate that the standard guidelines for RBC positivity (positive count greater than 100,000 cells/mm3 and indeterminate count 50,000 to 100,000 cells/mm3) result in missed intraperitoneal injuries in a large percentage of patients and therefore require reevaluation. Lavage amylase determinations, previously stated to be costly and of insignificant yield, should be performed on patients whose lavage would otherwise be considered negative by RBC and WBC counts.

Abdominal Injuries↗
PubMed1985

Blunt liver trauma at the Sunnybrook Regional Trauma Unit.

Between June 1, 1976 and Mar. 31, 1983, the Sunnybrook Medical Centre Regional Trauma Unit in Toronto, Ont., admitted 145 patients with liver trauma; of these, 141 (97%) had sustained blunt liver trauma. Of 113 patients who underwent open peritoneal lavage, 112 had a true-positive lavage. Resuscitation was successful in 137 patients and 134 of these underwent laparotomy. Seventy-nine (59%) of the 134 patients required only minor surgical treatment; the other 55 (41%) required major surgical procedures. The overall mortality was 32% (47 of 145). Eight patients died during resuscitation but only one of them died of liver hemorrhage. Of the 39 patients who died after admission, the cause of death was head injury in 22, while 6 died of liver hemorrhage and 11 of other causes. Overall, liver hemorrhage was the cause of death in 15% of cases (7 of 47).

Female↗
PubMed1984

Blunt splenic trauma: diagnosis and management.

To examine the morbidity and mortality associated with blunt splenic injuries, the authors reviewed the results in 106 such patients treated in the Sunnybrook Regional Trauma Unit between June 1, 1976 and June 30, 1983. Initial assessment included peritoneal lavage in 86 patients. No patient with known or suspected splenic injury was treated nonoperatively nor were any patients found to have had splenic injuries missed at the initial assessment. Seventy-one splenectomies and 35 splenorrhaphies were performed. The overall mortality was 25% and 10 surviving patients had serious complications. The splenic injury itself was never the cause of death. Only one patient who initially underwent splenorrhaphy later required splenectomy. It is concluded that blunt splenic injury is rarely the cause of death or serious morbidity when a policy of immediate diagnosis and operative treatment is carried out. Furthermore, in selected patients, splenorrhaphy is a safe and effective treatment.

Abdominal Injuries↗
PubMed1983

Management of flail chest.

This paper compares the management of two groups of patients with flail chest. The 25 patients in group 1 had a flail chest without other significant injuries or shock, whereas the 57 in group 2 had a flail chest with multiple injuries, shock or both. The group 1 patients were treated with repeated multiple intercostal nerve blocks or high segmental epidural analgesia, oxygen, intensive chest physiotherapy, fluid restriction, furosemide diuretics, methylprednisolone sodium succinate and colloid infusion in an intensive care unit. In addition to these measures, the group 2 patients underwent endotracheal intubation and assisted mechanical ventilation with a volume respirator that provided continuous positive airway pressure and positive end-expiratory pressure. Of the 57 group 2 patients 36 required prolonged ventilation, eventually through a tracheostomy, because of severe head injury, pneumonia, severe facial injury, quadriplegia, pre-existing lung disease or severe sepsis. However, tracheostomy was avoided in the other 21 patients in group 2. There were no deaths in group 1, but 8 (14%) of the patients in group 2 died. These results show that avoidance of tracheostomy and ventilation in selected patients with flail chest is consistent with a low morbidity and mortality.

Adult↗
PubMed1983

Investigation of the nature and specificity of antinuclear antibody in dogs.

A liquid phase radioimmunoassay was used to test sera from 34 dogs in 3 categories, determined by presence of antinuclear antibody (ANA) and disease, for antibodies against native canine DNA and dAdT, a synthetic double-stranded DNA analog. Antibodies to dAdT were absent in healthy dogs which, as a group, had levels of DNA antibodies consistent with those reported for healthy persons. Canine patients with a variety of illnesses, but which remained ANA negative, had slightly increased levels of binding of DNA and dAdT. As a group, ANA-positive dogs had significantly increased binding of dAdT and native DNA, which was shown to be mainly, but not entirely, double stranded. In the ANA-positive group, no correlation was found among ANA titer, % DNA binding, and % dAdT binding, indicating that these 3 procedures detect antibodies with differing specificities. In dogs, ANA are heterogeneous in antigenic specificity. Antibodies to double-stranded nucleic acid in dogs do not appear to be as specific for systemic lupus erythematosus as they are reported to be in persons with autoimmune disease.

Animals↗
PubMed1982

Controversies in the management of pulmonary contusion.

Most polytraumatized patients with lung contusion also have injury to the chest wall. Both are serious but the lung contusion is most important in contributing to respiratory failure. A small and localized injury to the lung leads to generalized edema in surrounding lung and even in the opposite lung. The permeability of capillaries is affected and there is an outpouring of the fluid through a leaking pulmonary membrane. Diagnosis is easy when the condition is straightforward and severe, but may be complicated in a confused or unconscious patient with or without head, abdominal and orthopedic injuries producing shock. Pulmonary aspiration and pneumonia may cloud the issue. Aggressive chest physiotherapy combined with the reduction of pain by local intercostal blockade or epidural anesthesia may obviate the need for mechanical ventilation.

Contusions↗
PubMed1979

Therapy for septic shock.

To adequately appraoch the therapeutics of such a diffuse disorder as sepsis, a firm grasp of the multiple pathophysiologic subsets is imperative. With this as a basis, therapy comes as close to applied physiology as is possible in medicine today.

Acid-Base Equilibrium↗
PubMed1977

Echocardiography in cystic fibrosis.

Echocardiograms were obtained for 25 patients with cystic fibrosis (CF) and 20 controls to evaluate this technique as a means of assessment of right ventricular changes in patients with CF. Right ventricular anterior wall thickness per square meter of body surface (RVAW/sq m) and right ventricular internal dimension per square meter of body surface (RVID/sq m) were compared with other techniques for detection of cor pulmonale. Significant correlations existed between both RVAW/sq m and RVID/sq m and the forced vital capacity, forced expiratory volume in one second, midmaximal expiratory flow rate, clinical score of severity of disease, and roentgenographic score of pulmonary involvement. The RVAW/sq m was slightly more sensitive than RVID/sq m; RVAW/sq m thickness on echocardiogram in vivo compared well with actual measurements at autopsy in five patients. No correlations were found between echocardiography and electrocardiograms, vectorcardiograms, thoracic index, or cardiothoracic ratio.

Adolescent↗