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Biomedical subjects

H Miller

Publications and source records attributed to H Miller.

317 records · Page 18Linked to original sources
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Primary generalized seizure disorder: correlation of epileptiform discharges with seizure frequency.

The role of routine follow-up EEG in assessment of severity of a seizure disorder is not known. This retrospective chart review study of patients with primary generalized seizure disorders explored the relation between parameters of epileptiform discharge bursts on EEG and number of seizures experienced in the preceding months. Eighty-seven such patients were found, each with one to seven EEGs and corresponding clinical records, comprising a total of 201 clinicoelectrographic epochs. The 56 chronically attending patients (more than two attendances) differed from the 31 nonchronic attenders in receiving more antiepileptic drugs (AEDs) and having fewer EEG polyspikes; otherwise, the two groups were similar and were analyzed together. We noted a strong relation between number and maximum length of epileptiform bursts in the resting EEG record and number of absence seizures reported in the months preceding the EEG. Age did not affect this relation. After stepdown regression analysis, only the maximum length of epileptiform bursts remained significantly related to the reported number of absence seizures. These findings may prove useful in assessing clinical progress, e.g., in patients whose ability to estimate numbers of attacks is suspect. Neither number nor maximum length of epileptiform bursts in the resting EEG record had a significant relation with the number of generalized tonic-clonic seizures. Presence of polyspikes on resting or "activated" EEG had no added predictive value. The presence of epileptiform bursts after activation by sleep, hyperventilation, or photic stimulation was not associated with an increased likelihood of having had seizures.

Adolescent↗
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Nucleus taenia of the amygdala of birds: anatomical and functional studies in ring doves (Streptopelia risoria) and European starlings (Sturnus vulgaris).

Nucleus taenia (Tn) in birds is a discrete component of a loosely defined archistriatal structure, the posterior and medial archistriatum. By virtue of its hypothalamic projections, the posterior and medial archistriatum is thought to be an avian homolog of the amygdala in mammals. A recent fluorogold (FG) study of avian hippocampus revealed backfilled labels in nucleus Tn, suggesting that this nucleus may indeed be the homolog of mammalian amygdala. In the present study, we sought to characterize nucleus Tn in terms of its connections and function. We used the anterograde tracers Phaseolus vulgaris leucoagglutinin (PHAL) and biotinylated dextran amine (BDA) to map the efferent projections of Tn. The retrograde tracers FG and BDA were used to corroborate the efferent projections and to explore the pattern of afferent inputs to Tn. Finally, we explored the role of Tn in social behavior by observing behavioral changes associated with electrolytic lesions to Tn. The subjects of our studies were ring doves and European starlings, representing two avian orders. When a deposit of anterograde tracer was centered in Tn, it revealed projections to the hypothalamus, following the course of the hypothalamic-occipitomesencephalic tract previously reported in pigeons. The projections were bilateral in ring doves and ipsilateral in starlings. The BDA injections in the archistratum intermedium, lateral to Tn, did not yield the same projectional pattern. Together with corroborative data from FG retrograde experiments, these findings suggest that Tn is probably the primary origin of the hypothalamic projection. A robust projection to the hyperstriatal region was present along the lateral wall of the lateral ventricle, continuing into the anteroventral pole of the ventricle. Highly arborized terminal fields were found all along this pathway, notably in the medial parolfactory lobe (corresponding to the basal ganglia) and along the dorsal roof of the rostral hyperstriatum ventrale just ventral to the laminal frontalis superior (in ring doves) and the lamina frontalis suprema (in starlings). Projections to the hippocampal complex were mostly restricted to the parahippocampus. The FG data suggest the presence of afferent projections from the ovoidais shell and nucleus subrotundus region, the hippocampal complex in both species, and high vocal nucleus in starlings. Behavioral effects of Tn lesions suggest that nucleus taenia is involved in the control of social behavior through its influence on the affective state. Nucleus taenia thus exhibits many of the structural and functional features of the amygdaloid complex in mammals - that is, subcortical sensory inputs, hippocampal complex connections, and a functional role in adaptive patterns of social behavior.

Amygdala↗
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Occupational therapy with children with pervasive developmental disorders.

OBJECTIVE: Although the prevalence of children with pervasive developmental disorders (PDD) has increased, empirical data about the role and practices of occupational therapists have not been reported in the literature. This descriptive study investigated the practice of occupational therapists with children with PDD. METHOD: A survey was mailed to 500 occupational therapists in the Sensory Integration Special Interest Section or School System Special Interest Section of the American Occupational Therapy Association in eastern and midwestern United States. The valid return rate was 58% (292 respondents). The survey used Likert scale items to measure frequency of performance problems observed in children with PDD, performance areas addressed in intervention, perceived improvement in performance, and frequency of use of and competency in intervention approaches. RESULTS: The respondents primarily worked in schools and reported that in the past 5 years they had served an increasing number of children with PDD. Most respondents provided direct services and appeared to use holistic approaches in which they addressed multiple performance domains. They applied sensory integration and environmental modification approaches most frequently and believed that they were most competent in using these approaches. Respondents who reported more frequent use of and more competence in sensory integration approaches perceived more improvement in children's sensory processing. Respondents who reported more frequent use of and more competence in child-centered play perceived more improvement in children's sensory integration and play skills.

Adult↗
PubMedDate not supplied

Effect of subarachnoid morphine on the incidence of spinal headache.

BACKGROUND AND OBJECTIVES: The addition of fentanyl to hyperbaric local anesthetics has been shown to reduce the incidence of post dural puncture headache in the obstetric patient. This study was undertaken to evaluate the effects of subarachnoid morphine on the incidence of headache. METHODS: Eighty-two healthy patients undergoing cesarean delivery with spinal anesthesia were studied. All patients were hydrated with 1500 ml lactated Ringer's solution. Patients were randomly assigned to receive, in a double-blind fashion, 0.2 mg of either morphine (Group 1, n = 40) or saline (Group 2, n = 42) in 0.2 ml volume mixed with 0.75% bupivacaine in 8.25% dextrose plus 0.2 ml 1:1000 epinephrine. Spinal anesthesia was induced using a 25-gauge spinal needle at L3-4 interspace with the bevel, in most cases, parallel to the dural fibers. Patients were followed for three days to evaluate the incidence and severity of headache using a four-category rank scale (none, mild, moderate, severe). Data were analyzed for statistical significance using Student's t-test or chi-square test as appropriate. A p value less than 0.05 was considered significant. Results. The incidence of post dural puncture headache did not differ significantly between groups. Eight patients in Group 1 versus nine patients in Group 2 developed headache (p greater than 0.05). Similarly, the use of blood patch or intravenous caffeine sodium benzoate to treat the headache did not differ significantly between groups. CONCLUSION: It is concluded from our study that subarachnoid morphine did not decrease the incidence of post dural puncture headache in the obstetric patient.

Adult↗
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The decade ahead.

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Community Health Services↗
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Comparative flow rates of saline in commonly used spinal needles including pencil-tip needles.

BACKGROUND AND OBJECTIVES: Certain characteristics of spinal needles that can influence their clinical usefulness were examined, namely, flow rates, internal diameters, and size of orifices of pencil-type needles. METHODS: Flow rates of 0.9% sodium chloride solution were measured in spinal needles with an infusion pressure of 10 mmHg at isothermic and steady-state conditions. In 15 different types, a new needle was used for each experiment, and 6 experiments were performed with each needle type for a total of 90 experiments. The Hagen-Poisseuille Law for laminar flow was used to calculate the internal diameters. RESULTS: The flow rates of needles of the same gauge varied considerably depending on the manufacturer. Compared with 26-gauge ultrathin-wall spinal needle produced by the same manufacturer (Braun, Bethlehem, Pennsylvania), the flow rate through 29-gauge spinal needle was 18% that of the former needle. The flow rate through 27-gauge Quincke Whitacre needle (Becton Dickinson, Rutherford, New Jersey) was not statistically different from that through 26-gauge needle by the same manufacturer. By arbitrarily choosing < or = 2 seconds to be the in vitro desirable period for saline to traverse the needle from one end to the other, all needles with the exception of 29-gauge and standard 26-gauge Quincke Braun needles met this criterion. The length and size of the orifices of Whitacre needles were found to be significantly smaller than those of Sprotte needles (Havel, Cincinnati, Ohio). The orifice of Sprotte needle was longer than the known thickness of the dura while that of the Whitacre needle was smaller. CONCLUSIONS: Needles of the same gauge do not necessarily have the same flow rate. Flow rate correlates well with internal, not external, diameter. By considering < or = 2 seconds to be the desirable time for saline to traverse a spinal needle, all, except two, meet this criterion. The orifice of Whitacre needle has more desirable features than that of Sprottle needle. Anesthesiologists are encouraged to use 27-gauge needles since their flow rate is not slower than that of 26-gauge needles.

Needles↗
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Freedom to choose.

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Aged↗