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Biomedical subjects

H C Miller

Publications and source records attributed to H C Miller.

At least 19 recordsLinked to original sources
PubMed1992

Effect of "fast track" admission for acute myocardial infarction on delay to thrombolysis.

OBJECTIVE: To evaluate the impact of a fast track triage system for patients with acute myocardial infarction. DESIGN: Comparison of delays in admission to hospital and in receiving thrombolytic treatment before and after introducing fast track system with delays recorded in 1987-8. Patients fulfilling clinical and electrocardiographic criteria for myocardial infarction were selected for rapid access to the cardiac care team, bypassing evaluation by the medical registrar. SETTING: Major accident and emergency, cardiac and trauma centre. SUBJECTS: 359 patients admitted to the cardiac care unit during 1 February to 31 July 1990 with suspected acute infarction. MAIN OUTCOME MEASURES: Accuracy of diagnosis and delay from arrival at hospital to thrombolytic treatment. RESULTS: 248 of the 359 patients had myocardial infarction confirmed, of whom 127 received thrombolytic treatment. The fast track system correctly identified 79 out of 127 (62%) patients who subsequently required thrombolytic treatment. 95% (79/83) of patients treated with thrombolysis after fast track admission had the diagnosis confirmed by electrocardiography and enzyme analysis. The median delay from hospital admission to thrombolytic treatment fell from 93 minutes in 1987-8 to 49 minutes in fast track patients (p less than 0.001). Delay in admission to the cardiac care unit was reduced by 47% for fast tract patients (median 60 minutes in 1987-8 v 32 minutes in 1990, p less than 0.001) and by 25% for all patients (60 minutes v 45 minutes, p less than 0.001). CONCLUSION: This fast track system requires no additional staff or equipment, and it halves inhospital delay to thrombolytic treatment without affecting the accuracy of diagnosis among patients requiring thrombolysis.

Aged↗
PubMed1992

Preoperative and postoperative dynamic cavernosography and cavernosometry: objective assessment of venous ligation for impotence.

A total of 11 men (mean age 51.4 years, 1-year followup) with venous leakage impotence underwent surgical venous ligation. Of the men 8 had erections twice per week immediately after the procedure but at 3 months only 2 remained potent. Dynamic pharmacological cavernosography and cavernosometry were repeated 3 months postoperatively and 6 of the 11 men had venous leakage. These men with venous leakage underwent percutaneous embolization with platinum coils and 4 had successful results. Three additional men became potent after embolization. Of the 11 men 9 are documented to have normal dynamic cavernosography and cavernosometry findings after the combination of an operation and embolization, and 5 are potent. The postoperative and post-embolization dynamic cavernosometry data show that all 11 men have a marked decrease in the flow to maintain erection. Eight men have erections with papaverine or prostaglandin E1 intracorporeal injections. Postoperative dynamic cavernosography and cavernosometry can be diagnostic as well as therapeutic with embolization.

Adult↗
PubMed1991

Twelve-year comparison of a Bjork-Shiley mechanical heart valve with porcine bioprostheses.

BACKGROUND: Patients undergoing heart-valve replacement may receive a mechanical prosthesis, necessitating lifelong anticoagulant treatment, or a porcine bioprosthesis, which involves no absolute need for anticoagulants. METHODS: We carried out a randomized, prospective trial to compare the durability of the Bjork-Shiley mechanical prosthesis (spherical tilting-disk model) and the incidence of valve-related complications with those variables in the Hancock and the Carpentier-Edwards porcine prostheses. The mitral valve was replaced in 261 patients, the aortic valve in 211, and both in 61; the survivors have been followed up for a mean of 12 years. RESULTS: We found a trend toward improved actuarial survival after 12 years with the Bjork-Shiley prosthesis, but this trend was not statistically significant (group with Bjork-Shiley valve vs. group with porcine valve [mean +/- SE], 51.5 +/- 3.2 vs. 44.4 +/- 3.2 percent; P = 0.08). There was no significant difference in the actuarial incidence of reoperation after 5 years, but after 12 years significantly more patients with a porcine prosthesis had undergone reoperation (8.5 +/- 2.0 vs. 37.1 +/- 4.1 percent, P less than 0.001). An analysis combining death and reoperation as end points for an actuarial assessment of survival with the original prosthesis intact confirmed that the patients with Bjork-Shiley Shiley prostheses had improved survival (48.6 +/- 3.2 vs. 30.0 +/- 3.0 percent after 12 years, P less than 0.001). Bleeding requiring hospitalization or blood transfusion was significantly more frequent in the patients with Bjork-Shiley prostheses (18.6 +/- 3.2 vs. 7.1 +/- 2.3 percent after 12 years, P less than 0.01). There was no significant difference after 12 years in the actuarial occurrence of embolism (Bjork-Shiley vs. porcine, 21.1 +/- 3.1 vs. 26.4 +/- 3.5 percent) or endocarditis (3.7 +/- 1.4 vs 4.6 +/- 1.6 percent). CONCLUSIONS: Survival with an intact valve is better among patients with the Bjork-Shiley spherical tilting-disk prosthesis than among patients with porcine bioprostheses, but use of the Bjork-Shiley valve carries an attendant increased risk of bleeding associated with the need for anticoagulant treatment.

Actuarial Analysis↗
PubMed1991

EDAP LT-01 piezoelectric lithotriptor.

This is a first-rate, well thought out lithotriptor. It is very user friendly. Although not as powerful as some of the earlier devices, it has the distinct advantage of not causing any tissue damage during treatment. The advantage is the ability to vary the delivery of the amount of power according to the needs of the situation. The learning curve for the operator is steep, and he/she very quickly becomes very proficient. Patience is needed with some stones to give enough shocks for total fragmentation, but that comes with experience. Balancing the ease of treatment against the occasional need for retreatment results in a definite bias for the patient being treated with this machine, and avoiding the reported problems attendant with spark gap equipment. This, in my opinion, is an excellent machine.

Humans↗
PubMed1990

Coronary angioplasty in patients with prior coronary artery bypass grafting.

We studied the clinical and angiographic outcome of patients with prior coronary arterial bypass grafting who underwent percutaneous transluminal coronary angioplasty at the Royal Infirmary of Edinburgh. Over a 4 year period, 47 patients with prior bypass surgery underwent angioplasty of 23 stenotic graft sites and 37 stenotic sites of native vessels. The procedure was performed a mean of 31.3 months after surgery for recurrence of symptoms refractory to maximal medical treatment. Satisfactory angiographic results were achieved in 42 patients (58 stenotic grafts or native vessels). At a median follow up period of 18 months, 20 patients were symptomatically improved, but 22 patients experienced recurrence of symptoms a mean of 4.7 months after angioplasty, despite a good initial angiographic result. Overall, 4 patients had a repeat bypass grafting and 9 patients had a repeat angioplasty. Angioplasty can be used as an alternative to a repeat operation in patients with prior bypass grafting who experience recurrence of symptoms. Initial success rates are high and complication rates low. Restenosis or development of new lesions in the native circulation, and/or in the grafts, remain significant problems. Patients with a long asymptomatic interval (greater than 6 months) between the bypass operation and recurrence of symptoms are more likely to have better long-term results after successful angioplasty, perhaps because of slower progression of atherosclerotic heart disease.

Adult↗
PubMed1990

Atrial pacing: who do we pace and what do we expect? Experiences with 100 atrial pacemakers.

The records of 100 patients with permanent atrial pacemakers implanted over a 7-year period were reviewed to assess the role and results of this mode of pacing. Indications for pacing were sick sinus syndrome in 91, carotid sinus hypersensitivity in 3, and use of an antitachycardia device in 6 patients. The mean follow-up period was 32.9 months. Symptomatic relief was good. Lead dislodgment occurred in 11 patients (usually in the first week). Threshold rises not amenable to reprogramming occurred in three patients and loss of sensing occurred in seven patients but only one required intervention. Overall, 21 patients required reoperation. The type of lead did not influence the need for reoperation that appeared to be related to the experience of the operator. Complete atrioventricular block occurred in three patients, two of whom had carotid sinus hypersensitivity and one had sick sinus syndrome. Chronic atrial fibrillation occurred in five patients, none of whom required revision of the pacemaker system. Atrial pacing is a satisfactory pacing mode in patients with sick sinus syndrome. Provided satisfactory atrioventricular conduction has been shown by incremental atrial pacing to at least 120 beats/min and carotid hypersensitivity is absent, progression to complete atrioventricular block is uncommon. Greater implanting skills are required for good results.

Adult↗
PubMed1990

Delays in admission of patients with acute myocardial infarction to coronary care: implications for thrombolysis.

Of 408 patients presenting to a coronary care unit over a six month period 237 had an acute myocardial infarction. Two-thirds presented to hospital within three hours of the onset of symptoms. The median delay between arrival in hospital and admission to the Coronary Care Unit was 60 minutes. Only a minority of patients with acute myocardial infarction were eligible to receive thrombolysis, the most common exclusion criteria being an electrocardiograph that was not diagnostic of infarction at presentation. In-hospital transfer delay has increased considerably since 1972. It did not exclude many patients from receiving thrombolysis but it caused delayed thrombolysis.

Coronary Care Units↗
PubMed1989

Initial EDAP LT-01 lithotripsy group experience in the United States.

The initial United States cooperative experience with the EDAP LT-01 second generation piezoelectric extracorporeal shock wave lithotriptor using ultrasonic guidance is presented. Particular to the machine are lack of radiation exposure, no need for anesthesia, a purely outpatient procedure, no electrocardiographic problems, a high degree of safety and a paucity of complications. The equipment is described briefly. The same machine currently is being used to destroy renal and biliary stones. The results are encouraging and highly comparable to the initial experience with the earlier machines. Fragmentation rates are approximately 86%, with destruction rates of 63.4% over-all. Ultrasound localization and monitoring proved surprisingly easy to learn and were increasingly less of a problem as experience was gained. No serious complications were observed, and there were no renal losses and no deaths. Only 3 cases of steinstrasse were noted among 461 with 633 stones targeted during 595 treatments.

Adolescent↗
PubMed1989

Action of a thymic cytokine TsIF in reversing the autoimmune disease state of the MRL/1pr mouse.

T suppressor cells differentiate from bone marrow precursors when cocultured with thymic epithelium, a thymic-derived cytokine TsIF, or mixture of both. (TsIF is a trademark of Ventrex Laboratories, Inc., Portland, ME, and is the subject of a U.S. patent by Ventrex Laboratories, Inc., Portland, ME.) These cells, when transplanted into the lupus-rheumatoid arthritis-prone mouse, prevent acquisition of disease as assessed by lack of both antinuclear antibody, rheumatoid factor, and survival beyond mean time for MRL/lpr mice. When TsIF is administered directly into these lupus-rheumatoid arthritis-prone mice, an equivalent sparing effect is manifested.

Animals↗
PubMed1989

Experience in diagnosis and treatment of impotence caused by cavernosal leak syndrome.

To delineate neural, arterial, and venous components contributing to impotence, we used a previously described noninvasive screening sequence combined with stimulation of artificial erection with papaverine injection, selective pudendal arteriography (SPA), and dynamic cavernosography (DC). Among 572 men with impotence, age range 17 to 78 years (average age 54.8 years), 26 men with potential cavernosal leaks in absence of other factors were identified; 16 underwent DC; among these five had normal cavernous venous drainage. Eight men with abnormal cavernosal venous drainage required cavernous infusion flow rates higher than 120 ml/min to obtain erection and higher than 40 ml/min to maintain erection. Radiographic studies showed cavernosal leakage in all eight patients. Eight men, ages 39 to 61 years, underwent surgical ablation of abnormal cavernosal venous drainage. Among these, five men have had excellent results for up to 3 years. One failure was related to unrecognized penile arterial disease later shown by SPA. In two men small doses of papaverine now induce erection. We now recommend SPA before DC to rule out an arterial abnormality. Accurate identification of factors contributing to erectile failure is critical for successful treatment; in this experience candidates for correction of cavernosal leak syndrome were uncommon.

Adolescent↗
PubMed1988

Stress prostatitis.

A group of 218 men complaining of symptoms of chronic prostatitis were identified. Symptoms included pelvic and genital pain with or without voiding or ejaculation, urinary frequency and/or urgency, and often a thin watery urethral discharge. Of the group 134 (60%) were followed carefully. With nothing but stress management therapy 110 patients (86%) reported that they were "better," "much better," or "cured." Physiologically, the therapy makes sound medical sense. It is suggested that the term "stress prostatitis" is an appropriate label for this condition.

Behavior Therapy↗
PubMed1987

Permanent pacing.

Explore the source record for details and available documents.

Arrhythmias, Cardiac↗
PubMed1987

2,8-Dihydroxyadenine urolithiasis: report of an adult case in the United States.

2,8-Dihydroxyadeninuria is a rare purine metabolic disorder that has been reported to have caused urolithiasis in 14 cases, mostly children. Excretion of the hydroxylated metabolites of adenine results from a deficiency of adenine phosphoribosyltransferase. The insoluble calculi have a similar chemical structure to uric acid and frequently are misdiagnosed as uric acid calculi. Management differs from that of uric acid urolithiasis. We report on an adult with 2,8-dihydroxyadenine urolithiasis in the United States.

Adenine↗
PubMed1987

Severe pulmonary hypertension and multiple left coronary arterial fistulas in association with congenital hepatic fibrosis.

Multiple fistulous communications between the left anterior descending coronary artery and the left ventricle were found in a 55 year old woman with congenital hepatic fibrosis presenting with breathlessness. At cardiac catheterisation severe pulmonary hypertension was also found. In view of the persistent hypoprothrombinaemia, severe thrombocytopenia, and the multiple fistulas the risk of operation was thought to be unacceptable and she continues on medical treatment.

Coronary Vessel Anomalies↗