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Biomedical subjects

J I Miller

Publications and source records attributed to J I Miller.

At least 73 records · Page 4Linked to original sources
PubMed1992

Surgical treatment of syringomyelia based on magnetic resonance imaging criteria.

The treatment of syringomyelia includes many surgical options. We report a retrospective study of 65 patients with cavitary lesions of the spinal cord in whom the results of magnetic resonance imaging were used to develop specific treatment strategies. Intramedullary cavities were classified into three general types: 1) communicating syrinxes, which occurred with hydrocephalus and were anatomically continuous with the 4th ventricle (9 patients); 2) noncommunicating syrinxes, which were separated from the 4th ventricle by a syrinx-free segment of spinal cord (42 patients); and 3) atrophic syrinxes, which occurred with myelomalacia (14 patients). Noncommunicating syrinxes were further subdivided according to type: Chiari II malformations with hydrocephalus (5 patients), Chiari I malformations without hydrocephalus (11 patients), extramedullary compressive lesions (12 patients), spinal cord trauma (6 patients), intramedullary tumors and infections (6 patients), and multiple sclerosis (2 patients). Of the 65 patients, 39 underwent surgical treatment for progressive symptoms. Syrinxes occurring with hydrocephalus were treated empirically with a ventriculoperitoneal shunt. Excellent results were achieved in 7 of 7 patients with communicating syrinxes and in all 5 patients with Chiari II malformations. Two approaches were used in the treatment of syrinxes occurring with Chiari I malformations: Posterior fossa decompression improved symptoms but did not reduce syrinx size in 2 of 3 patients. In the third patient and in 3 patients who were not treated with decompression, shunting from the syrinx to the cerebellopontine angle cistern collapsed the cavity and resolved symptoms over the interval of follow-up (average follow-up, 1.5 years). Excision of extramedullary obstructions at the rostral end of noncommunicating syrinxes resulted in collapse or disappearance of the cavity in 6 of 7 patients. The remaining patient was treated effectively by a syringocisternal shunt. In all 4 patients with posttraumatic syringomyelia, good results were achieved by a spinal or syringocisternal shunt. Syrinxes associated with intramedullary masses were managed by biopsy or excision of the causal lesion and appropriate adjunctive therapy (6 patients). Patients with atrophic syrinxes were not operated upon except to relieve symptoms referrable to the causal lesion (4 patients). Recurrent syrinxes were not encountered in the 35 surviving patients over an average follow-up of 2.5 years. It is concluded that syringomyelia is a complex pathological disorder with several mechanisms of pathogenesis that requires a number of different treatment strategies.

Adolescent↗
PubMed1992

Syrinx shunt to posterior fossa cisterns (syringocisternostomy) for bypassing obstructions of upper cervical theca.

Syrinx shunts to the spinal subarachnoid space are likely to fail if the cerebrospinal fluid pathways rostral to the syrinx are blocked. To bypass obstructions at or below the level of the foramen magnum, a technique was developed for shunting the syrinx to the posterior fossa cisterns, termed "syringocisternostomy." Syrinxes were shunted to the cisterna magna in two patients with spinal arachnoiditis and to the cerebellopontine angle cistern in four patients with Chiari I malformations. There was symptomatic improvement and collapse of the syrinx in each case, with no complications or recurrences over a follow-up interval of 14 to 27 months (average 20.3 months). The surgical technique and results of treatment are described.

Adult↗
PubMed1991

Polytetrafluoroethylene injection for post-prostatectomy incontinence: experience with 20 patients during 3 years.

We treated 20 men who were incontinent after prostatectomy and who had failed sphincter exercises with periurethral polytetrafluoroethylene (Teflon or Polytef) injections. Injections were done with the patient under brief general or spinal anesthesia as an outpatient or during a 24-hour hospitalization. Incontinence was due to radical prostatectomy in 17 patients and simple prostatectomy for benign disease in 3. Most patients had more than 1 injection and mean followup was 17 months. Of the 20 men 7 (35%) reported long-term improvement and 4 (20%) recommend the procedure to others. Complications were limited to 1 spontaneously resolving 48-hour bout of urinary retention and 1 episode of perineal polytetrafluoroethylene migration that produced pain for 3 months. We found the procedure to be simple, generally well tolerated and capable of producing clinical improvement in a significant minority of patients in whom it was used.

Aged↗
PubMed1991

Urinary hematin calculi.

We report 2 cases of nephrolithiasis owing to hematin stones. One patient had no apparent explanation for this finding, while the other was receiving warfarin anticoagulation for a prosthetic aortic valve. The chemical nature, etiology and clinical features of hematin calculi are discussed.

Aged↗
PubMed1991

Phage typing of Staphylococcus intermedius.

Staphylococcus intermedius, a coagulase-positive staphylococcal species, is a common canine pathogen and a rare human wound pathogen. A total of 145 strains of S. intermedius (ATCC 29663, 4 reference strains, 4 human isolates, 44 canine infection isolates, and 92 isolates from canine gingiva) were screened for lysogenic phage by a modified Fisk method. Nineteen phage preparations were prepared for preliminary typing experiments. Lytic activity was observed on 93 of 145 (64.1%) isolates, yielding 44 lytic patterns with individual strains susceptible to one or more phages. Five phages lysed only a single strain, but lytic patterns varied from 1 to 11 lytic phages per isolate. A distinct lytic pattern did not separate canine or human wound isolates from canine gingival isolates. All human wound isolates fell into the two most common canine gingival or wound patterns; the single human nasopharyngeal isolate was not lysed by any phage. Twenty-two of 44 (55%) canine wound isolates and 65 of 92 (71%) gingival isolates yielded lytic patterns. Lysogenic phages are common in S. intermedius. This preliminary study suggests that phage typing may be a useful tool in distinguishing epidemiologically related strains.

Animals↗
PubMed1991

Histopathology of experimental hematomyelia.

The pathology of hematomyelia was examined in 35 rats following the stereotactic injection of 2 microliters blood into the dorsal columns of the thoracic spinal cord. This experimental model produced a small ball-hemorrhage without associated neurological deficits or significant tissue injury. Histological sections of the whole spinal cord were studied at intervals ranging from 2 hours to 4 months after injection. In acute experiments (2 to 6 hours postinjection), blood was sometimes seen within the lumen of the central canal extending rostrally to the level of the fourth ventricle. Between 24 hours and 3 days, the parenchymal hematoma became consolidated and there was an intense proliferation of microglial cells at the perimeter of the lesion. The cells invaded the hematoma, infiltrated its core, and removed erythrocytes by phagocytosis. Rostral to the lesion, the lumen of the central canal was found to contain varying amounts of fibrin, proteinaceous material, and cellular debris for up to 15 days. These findings were much less prominent in the segments of the canal caudal to the lesion. Healing of the parenchymal hematoma was usually complete within 4 to 6 weeks except for residual hemosiderin-laden microglial cells and focal gliosis at the lesion site. It is concluded that the clearance of atraumatic hematomyelia probably involves two primary mechanisms: 1) phagocytosis of the focal hemorrhage by microglial cells; and 2) drainage of blood products in a rostral direction through the central canal of the spinal cord.

Animals↗
PubMed1990

Neodymium:YAG laser and brachytherapy in the management of inoperable bronchogenic carcinoma.

Neodymium:yttrium-aluminum garnet (Nd:YAG) laser therapy and endobronchial brachytherapy are useful modalities in the palliation of inoperable bronchogenic carcinoma. From 1983 to 1989, 218 patients underwent a total of 371 procedures involving endobronchial brachytherapy, Nd:YAG laser therapy, or both. Group 1 consisted of 130 patients who received Nd:YAG laser therapy. Group 2 consisted of 67 patients who had endobronchial brachytherapy only. Group 3 comprised 21 patients who underwent combined endobronchial brachytherapy and Nd:YAG laser therapy. All patients had received or were receiving concurrent radiotherapy. Three late deaths occurred in group 1, and 1 death occurred in group 2. More than 80% of patients achieved a good to excellent result. When applicable, we now use combined Nd:YAG laser therapy and endobronchial brachytherapy as part of the initial management of inoperable non-small cell bronchogenic carcinoma. A detailed analysis of these patients is given.

Brachytherapy↗
PubMed1990

Massive bleeding in a Zenker's diverticulum.

Massive bleeding from a pharyngoesophageal diverticulum is a rarely reported condition, with only two reported cases in the literature. This report describes a patient who had massive bleeding due to ulceration in the base of a pharyngoesophageal diverticulum, presumed to have been caused by chronic aspirin ingestion. The diagnosis was made on upper gastrointestinal endoscopy, and surgical treatment (cricopharyngeal myotomy and diverticulectomy) was curative.

Aged↗
PubMed1990

Phrenic nerve pacing of the quadriplegic patient.

Phrenic nerve pacing can be used to free a quadriplegic patient from ventilatory dependency. During a 6-year period (1982 to 1988), 23 patients with an age range of 17 to 63 years (mean 31 years) underwent implantation of a phrenic nerve pacemaker because of ventilatory dependency resulting from quadriplegia. Fourteen patients had a unilateral phrenic nerve implant and nine had a bilateral implant. The time from injury to implantation was 12 to 16 weeks. The site of implantation was the cervical phrenic nerve in 13 patients and the thoracic phrenic nerve in 10 patients. During the past 24 months, only a transthoracic approach has been used. The indication for pacing was failure to be weaned from ventilatory support in all patients. Failure to stimulate the phrenic nerve at implantation was noted in three patients, despite preoperative testing indicating an acceptable response. There were no deaths, and minor complications developed in three patients. Follow-up is available in all patients: Eight patients are completely free from the ventilator; nine patients are in markedly improved condition but require the ventilator at night; three patients are in moderately improved condition; and three patients had no response. Three patients required reexploration for component failure from 6 weeks to 18 months after implantation.

Adult↗
PubMed1989

Repair of the dehisced median sternotomy incision.

Mediastinitis after open-heart surgery is a potentially disabling, even lethal, condition. The utilization of muscle flaps in treatment has lowered the mortality rate from 40 to 5 per cent and decreased the hospitalization time to 12 days. The authors recommend a single reverse turnover pectoralis major flap based on the internal mammary perforators as the procedure of choice in these cases.

Humans↗
PubMed1987

Limited resection of bronchogenic carcinoma in the patient with marked impairment of pulmonary function.

Surgical resection is the treatment of choice for non-small cell bronchogenic carcinoma, and it is the only method providing prolonged arrest and chance for cure. From 1974 through 1984, 32 patients with marked impairment of pulmonary function had a limited resection for carcinoma of the lung. Marked impairment is defined as a maximum breathing capacity less than 35 to 40% of predicted, forced expiratory volume in one second less than or equal to 1 liter, and forced expiratory flow (FEV25-75) of less than or equal to 0.6 liter. Limited resection is defined as an operation that is less than a lobectomy, generally a wide wedge or segmental resection. The pathological stage of disease was Stage I in 31 patients and Stage II in 1 patient. Ten patients were treated by segmental resection and 22 by wide wedge resection. Two-year and three-year survival is 84 and 78%, respectively, and 10 patients (31%) have survived for five years. Recurrent disease developed in 8 patients, 5 of whom died. Recurrence was highest when the lesion crossed an intersegmental plane. In 1978, postoperative radiation therapy was added to the treatment of all patients whose lesion crossed an intersegmental plane. Since then, 18 patients have undergone wedge resection and postoperative irradiation with only 2 local recurrences at two years.

Aged↗