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Biomedical subjects

J I Miller

Publications and source records attributed to J I Miller.

103 records · Page 6Linked to original sources
PubMed1978

Thoracoscopy: a useful tool in the diagnosis of thoracic disease.

During a 12-month period, 11 patients underwent diagnostic thoracoscopy for previously undiagnosed thoracic disease. In all patients, the diagnosis had been unobtainable by the usual diagnostic modalities of bronchoscopy, scalene node biopsy, mediastinoscopy, thoracentesis, or closed pleural biopsy. Thoracoscopy was diagnostic in 10 of the 11 patients. There was no morbidity or mortality. In all patients the indication for thoracoscopy was suspected malignancy. The majority of patients had recurrent pleural effusions in which routine cytological studies and tissue biopsies had been nondiagnostic. Pathological findings were mesothelioma in 3 patients, primary carcinoma of the lung in 4, congestive heart failure with pleural effusion in 1, metastatic carcinoma in 2, and inflammatory disease in 1 patient. Indications, techniques, and results are discussed. Thoracoscopy is a valuable tool in the diagnosis of thoracic disease; with it, unneccessary thoracotomy can often be avoided.

Aged↗
PubMed1978

Bronchoscopy in the community hospital.

A new Pulmonary Medicine-Thoracic Surgery service was established in a community hospital in July 1974. This report details the experience of 409 bronchoscopies performed from July 1, 1974 through Dec 31, 1976. There were no deaths and four complications--one aspiration and three pneumothoraces resulting from transbronchial lung biopsy. Final diagnoses for which bronchoscopy was done were as follows: cancer--141; infectious disease--97; interstitial disease--33; obstructive lung disease--58; hemoptysis--35; miscellaneous--45. In the cancer group, a cytohistologic diagnosis was made in 82 patients by bronchoscopy alone, 31 additional diagnoses were made by scalene node biopsy or mediastinoscopy, and the remainder by surgical exploration and/or resection. In 268 patients with benign disease, bronchoscopy established the diagnosis in 87% of the cases. Pulmonary Medicine tended not to repeat nondiagnostic bronchoscopy but rather to refer immediately for a definitive surgical procedure. Thoracic Surgery tended not to reduplicate bronchoscopy for the purpose of "confirmation." A conjoint medical-surgical approach to bronchial disease, at the community level and based on a mutual understanding of capability and limitation, is feasible, productive, and economical.

Bronchoscopy↗
PubMed1978

Physicians' assistants on a university cardiothoracic surgical service. A five-year update.

In 1973 two physicans' assistants (P.A.'s) were employed on a cardiothoracic surgical service at Emory University Hospital. In 1974 our initial experience with these paramedical personnel was presented to this Association. Since that time eight additional P.A.'s have been added to our service. They are now employed in four hospitals of the Emory University Woodruff Medical Center. New guidelines and regulations have been imposed at both the state and federal levels regarding P.A.'s, and their role in our center has become rather well defined. With over 1,700 cardiac cases and 600 thoracic cases per year to cover on our service, the P.A. has assumed a position of increasing importance both in operating room assistance and in preoperative and postoperative care. Since the university has maintained a constant number of residents and fellows during this interval, P.A.'s have filled needs of expanded clinical service in the various hospitals. In the pediatric and community hospitals associated with a university, the P.A. now functions as a junior house officer. In our university center, with a large resident staff, their role has become narrowed with definite guidelines. A Credentials Committee now governs the hiring of all P.A.'s by the University. When properly utilized and supervised, the P.A. can be a vital member of the cardiothoracic team. This report details our experience with P.A.'s for the past 5 years--culminating in a staff of ten P.A.'s working on our service in four types of hospitals within our university medical center.

Georgia↗
PubMed1977

Echocardiographic manifestations of flail aortic valve leaflets.

Six patients with aortic regurgitation secondary to flail aortic valve leaflet syndrome were studied echocardiographically, angiographically, surgically, and pathologically. The etiology of flail aortic leaflet was myxomatous degeneration in four patients and bacterial endocarditis in two. The echocardiographic manifestations of flail aortic valve leaflet are diastolic fluttering of the aortic cusp echoes, abnormal systolic aortic leaflet movement, and abnormal diastolic fluttering echoes in the left ventricular outflow tract. Diastolic fluttering of the aortic valve leaflets is specific echocardiographic evidence of aortic regurgitation due to flail aortic leaflets, and demonstration of diastolic fluttering of the aortic leaflets and diastolic fluttering echoes in the left ventricular outflow tracts is direct evidence of flail and prolapsed aortic leaflets.

Adult↗
PubMed1976

Cardiac valve replacement in the first 21 years of life.

From 1969 through 1974, 25 patients under age 21 years had prosthetic cardiac vlave replacement at the Emory University Hospital. Twenty-nine valves were replaced in this group. Patients ranged in age from 2 to 21 years, with a mean of 14 years. Concomitant correction of associated cardiac lesions was required in 14 (56%). Five (21%) had had prior open valvuoplastic procedures. Operative mortality for the entire group was 12%, with an additional late mortality of 8%. There have been no early or late deaths in the last three years' experience. Best results are obtained when early correction of isolated valvular lesions is done as soon as clinical deterioration on vigorous medical management is recognized. The presence of multiple intrcardiac lesions or prior valve surgery does not preclude excellent results. Current indications for surgical correction and follow-up management are presented.

Adolescent↗
PubMed1975

Balanced drainage of the contaminated pneumonectomy space.

The patient who needs a pneumonectomy but has an infected pleural cavity faces the probability of an empyema of the pneumonectomy space. Balanced drainage of a contaminated space may avoid this very serious complication. A patient with obstructing bronchogenic carcinoma associated with distal parenchymal suppuration and empyema is discussed. A pneumonectomy with balanced drainage of the pleural space was performed. After three weeks the mediastinum was stable, and daily irrigation of the space with antibiotic solution was begun. Following foourteen days of irrigation, the cavity was filled with antibiotic solution and closed. Follow-up has shown no subsequent space problems or infection. Balanced drainage is a useful method of dealing with a contaminated pneumonectomy space.

Carcinoma, Bronchogenic↗