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J Miller

Publications and source records attributed to J Miller.

At least 217 records · Page 12Linked to original sources
PubMed1999

Heterotopic sternum transplant in rats: A new model of a vascularized bone marrow transplantation.

We introduced the heterotopic vascularized sternum transplant as a more simple and pure alternative to allogeneic hind limb transplantation for the study of bone marrow transplantation. We report the clinical and histopathological manifestations after transplantation of syngeneic and allogeneic sternal grafts with and without immunosuppression with FK-506. Syngeneic grafts maintained normal histology, whereas allografts showed rejection, which was prevented by FK-506. FK-506-treated allografts developed chimerism that was present throughout the observation period. Transplantation of the sternum may be a valuable model to study vascularized bone marrow transplantation and its effects on repopulation of bone marrow of the host, chimerism, and tolerance.

Animals↗
PubMed1999

Effect of a urinary control insert on quality of life in incontinent women.

The aim of the study was to evaluate the efficacy, safety and effect on quality of life of the Reliance urinary control insert (Uromed Corp., Needham, MA) in women with genuine stress incontinence. Efficacy was evaluated at baseline and at the end of the 12-month study period by standardized pad-weight studies and by rating scales measuring acceptability, incontinence symptom improvement, ease of learning, comfort and time to habituation, recorded in diaries at monthly intervals in 63 women. The SF-36 Health Survey questionnaire was used to assess quality of life status at baseline without the device and after 12 months of device use. A significant decrease in urine loss at 12 months compared with baseline was shown by standardized pad-weight studies, with and without the device in situ. Urine loss was reduced by more than 80% in 91% of the 63 patients, and 79% were completely dry. Patient diaries showed significant improvement in control of leakage, comfort, and ease of device use during the study period. Short-term-36 Health Status data also indicated significant improvement in the physical functioning score at 12 months. Urinary tract infection and hematuria were the most common adverse effects. The Reliance urinary control insert is an efficacious and safe means of controlling genuine stress incontinence in women. The device was perceived as easy to use and comfortable for these 63 women, and resulted in improved quality of life.

Adolescent↗
PubMed1999

[Clinical aspects of hydatid torsion. Diagnosis and therapy in 104 consecutive patients].

At the department of the urology of the university hospital in Giessen we observed 104 hydatid torsions with acute scrotal pain between 1977 and 1998. The average age of the affected patients showed a peak in boys with 12 years of age. 33.7% of the patients underwent primary conservative treatment and 66.3% were operated primarily. We only recommend conservative treatment after careful clinical evaluation and definitive detection of testicular perfusion. Scrotal ultrasound and color duplex sonography hereby serve as decisive tools.

Adolescent↗
PubMed1999

The value of renal scintigraphy during controlled diuresis in children with hydronephrosis.

Dynamic renal scintigraphy (DRS) during controlled diuresis is the method of choice to diagnose the functional relevance of urinary tract obstruction in children with sonographically demonstrated hydronephrosis. However, there are no commonly accepted scintigraphic criteria for surgical intervention. On the basis of our findings, we propose four stages of washout (WO) of tracer following diuresis: in stage I, WO>50%, neither further diagnosis nor intervention is necessary; in stage II, 50%>/=WO>/=12%, repetition of DRS is advised within 3-4 months; and in stage III, 12%>WO>/=5%, DRS should be repeated within 1-2 months. Only in stage IV, WO<5%, should surgery be done immediately. This procedure reduces surgical interventions by 50% without increasing the risk of residual renal damage.

Diuresis↗
PubMed1999

Temporary abdominal closure using an i.v. bag silo for severe trauma.

Patients with severe abdominal trauma injuries can have improved outcomes if a priority-oriented approach is taken to surgical intervention. This includes temporary abdominal closure and planned reoperation to complete complex, lengthy procedures when the patient is stabilized. Temporary abdominal closure can be achieved safely and cost-effectively by using a presterilized 3-liter cystoscopy fluid i.v. bag. This article discusses the rationale for temporary abdominal closure and planned reoperation, physiologic considerations in abdominal compartment syndrome (ACS), abdominal injuries or conditions leading to ACS, and manifestations of ACS. It compares and contrasts various materials used for temporary abdominal closure, illustrates bag preparation and silo application and removal, and analyzes complex intraoperative and postoperative nursing activities.

Abdomen↗
PubMed1999

A prospective study of endoluminal ultrasound versus computerized tomography angiography for detecting crossing vessels at the ureteropelvic junction.

PURPOSE: Crossing vessels at the ureteropelvic junction are associated with bleeding complications and a higher risk of failure after endopyelotomy. We compared computerized tomography (CT) angiography and endoluminal ultrasound for detecting crossing vessels before planned endopyelotomy. MATERIALS AND METHODS: Preoperatively patients underwent CT angiography. Intraoperative evaluation included retrograde ureteropyelography, endoluminal ultrasound and ureteroscopy. Intraoperative findings were used to direct treatment. RESULTS: Endoluminal ultrasound detected 19 crossing vessels in 14 of 20 patients (70%), while CT detected 9 crossing vessels in 7 (35%). Endoluminal ultrasound identified a septum between the ureter and renal pelvis in 7 patients (35%) but CT demonstrated none. On the basis of imaging findings we selected 5 patients for pyeloplasty, and endoluminal ultrasound accurately predicted the absence or presence of crossing vessels in all 5. CT angiography was accurate in 3 patients. However, in 2 patients a total of 4 vessels were missed by CT. A total of 15 patients underwent endopyelotomy with no bleeding complications. The presence or absence of a septum on endoluminal ultrasound was confirmed in all patients. Imaging findings altered the treatment chosen in 4 patients and changed the direction of the incision at the ureteropelvic junction in another 4. Clinical and radiographic success was achieved in all 13 patients (100%) with adequate followup. CONCLUSIONS: Endoluminal ultrasound was more sensitive than CT angiography for identifying crossing vessels and septa. Treatment based on endoluminal ultrasound findings may decrease complications and improve the results of minimally invasive treatment for ureteropelvic junction obstruction.

Adolescent↗
PubMed1999

Nephron-sparing surgery for renal cell carcinoma--is tumor size a suitable parameter for indication?

OBJECTIVES: Because patients with small renal cell carcinomas (RCC) are being treated by nephron-sparing surgery with increased frequency, a generally accepted parameter giving additional information as to which kind of tumor is suitable for this treatment is urgently required. METHODS: In a retrospective analysis of 245 patients who underwent radical nephrectomy for RCC, we investigated whether tumor size could provide the necessary information. We analyzed the association of tumor size with pTNM classification, grade, and the findings of the flow cytometric analysis of the DNA content analyzing the DNA index (DI). RESULTS: Stage pT1 was found in 23 patients (9.4%), pT2 in 100 (40.8%), pT3 in 109 (44.5%), and pT4 in 13 patients (5.3%). Grade 1 was found in 87 patients (35.5%), grade 2 in 120 (49.0%), and grade 3 in 38 patients (15.5%). A low DI was found in 71%, a moderately increased DI in 20%, and a high DI in 9%. Lymph node metastases were detected in 14% and -distant metastases in 22%. Closer examination of the tumors less than 2.5 cm (n = 23) revealed a significantly lower incidence (P <0.001) of infiltration of the renal capsule (n = 0) than in the rest of the group. Positive lymph nodes or distant metastases could not be found in this subgroup. A multifocal appearance of RCC was detected in only 2 (8.7%) of the 23 patients; it was detected in 67 (30.2%) of the 222 patients in the rest of the group. None of the 23 patients had grade 3 tumors (P <0.05). Fifty-two percent of the tumors were grade 1 and 48% grade 2. None of the 23 had a high DI; a moderately increased DI was found in 1 patient and a low DI in 22 of the 23 patients. Detailed examination of the tumors between 2.5 and 4 cm (n = 29) revealed an infiltration of the renal capsule in 11 (38%); lymph node metastases were found in 2 (6.9%) and metastases in 4 (13.8%). A multifocal appearance was found in 4 (13.9%) of the 29 patients; grade 3 tumors were detected in 3 (10.3%) of 29 patients, grade 2 tumors in 12 (41.4%), and grade 1 tumors in 14 (48.3%). In this subgroup, a high DI was found in 14% (not significant). The examination of tumors larger than 4 cm in size revealed worse results in the pTNM classification, grade, and flow cytometric results. CONCLUSIONS: Only tumors smaller than 2.5 cm should be considered suitable for nephron-sparing surgery in patients eligible for elective surgery. In patients in whom nephron-sparing surgery is imperative, even tumors between 2.5 and 4 cm appear to be suitable. In patients requiring extensive resection, however, the risk of local recurrence seems to be higher because of the higher incidence of multifocality.

Adult↗
PubMed1999

Endogenous digoxin-like immunoreactive factor (DLIF) serum concentrations are decreased in manic bipolar patients compared to normal controls.

BACKGROUND: A decrease in sodium pump activity in erythrocytes has been associated with manic episodes of bipolar illness relative to euthymic moods. Since red blood cells are long-lived and lack a nucleus, it is likely that a plasma factor is responsible for the observed decrease in sodium pump activity. METHODS: Utilizing a radioimmunoassay, we examined the serum concentrations of the digoxin-like immunoreactive factor (DLIF) in ill and well bipolar patients and compared the values to those of normal controls. RESULTS: DLIF was significantly decreased in manic individuals as compared to normal controls (143.6+/-S.E.M. 20.94 vs. 296.6+/-12.76 pg digoxin equivalents/ml, respectively, F = 4.77, P<0.05), but not compared to euthymic bipolar subjects 213.8+/-86.92, P = 0.77). There were no significant differences in DLIF concentrations between manic and euthymic bipolar individuals (P = 0.8). Since relapse in bipolar patients appears to display a seasonal pattern, we also measured the plasma concentration of this factor over a 12-months period. Normal controls exhibited a seasonal pattern of change in serum DLIF concentrations with a nadir in the winter months. Plasma concentrations of DLIF in bipolar patients did not show a seasonal pattern and maintained low levels throughout the year. LIMITATIONS: Due to the nonspecificity of our antibody, we could measure only total DLIF. Furthermore, it is unclear what the role of circulating DLIF, if any, may be on brain function. CONCLUSION: DLIF may be involved in the pathophysiology of mania.

Adult↗
PubMed1999

Analysis of post-transplant immune status in recipients of liver/bone marrow allografts.

The aims of this study were to assess the effect of donor bone marrow infusion on the reactivity of recipient peripheral blood lymphocytes (PBL) to mitogen and to donor and third-party cells after primary liver allotransplantation and to identify any correlation between altered immunoreactivity and HLA mismatches, occurrence of rejection, and immunosuppression. The immunoreactivity of recipient PBL toward frozen donor splenocytes was evaluated in mixed lymphocyte culture (MLC) (n = 29) and cell-mediated lympholysis (CML) (n = 27) assays in time intervals ranging from 0.7 to 27 months after transplant. Overall, the mean anti-donor MLC stimulation index (SI) fell from 25.6 +/- 5.2 preoperatively to 4.8 +/- 1.7 after transplantation (p < 0.002), with 14 out of 29 (48.3%) patients developing donor-specific MLC hyporeactivity. HLA class II mismatches were significantly associated with recipient post-transplant immune profile (p < 0.05): MLC donor specific hyporesponsiveness was observed in 70%, versus 37% of patients who shared a class II antigen, versus those that did not. Of the control group, 61.1% developed donor-specific nonreactivity versus 27.2% in the donor bone marrow cells (DBMC) group (p = 0.02). Donor-specific CML hyporeactivity was observed after transplantation, independent of DBMC infusion, with mean percentage values of pre- and post-transplant donor-specific lysis of 22.4% +/- 4.1% versus 3.1% +/- 1.6%, p = 0.0004, respectively. Our results suggest that DBMC infusion favors development of nonspecific MLC hyporesponsiveness to donor and third-party alloantigen, with maintenance of reactivity to mitogen and no additional effect on T-cell cytotoxicity.

Bone Marrow Cells↗
PubMed1999

Small ruptured abdominal aneurysm diagnosed by emergency physician ultrasound.

Ruptured abdominal aortic aneurysms currently have a high rate of both mortality and misdiagnosis. Aneurysms smaller than 4 cm are not commonly considered for surgical repair. This report describes the case of a ruptured abdominal aneurysm measuring less than 4 cm diagnosed by the emergency physician utilizing bedside ultrasound. Within 30 minutes of arrival at the emergency department the patient's abdominal pain resolved spontaneously after defecation. If the bedside ultrasound had not been performed it is possible the patient would have been discharged from the hospital without surgical intervention. Bedside ultrasound by emergency physicians may improve the diagnosis of ruptured aortic aneurysms, particularly if the presentation is atypical.

Aged↗
PubMed1999

The usefulness of partial information: effects of go probability in the choice/Nogo task.

In the present study, we examined whether the use of partial information for response preparation depends on the utility of that partial information for meeting task demands. Using a choice/Nogo task, the utility of the partial information was varied by manipulating the proportion of Go relative to Nogo signals, and preliminary response preparation was indexed by the degree of lateralized readiness potential (LRP) activity on Nogo trials. The Nogo LRP was clearly present when Go probability was high (67% Go) and, to a lesser extent, when Go and Nogo signals were equiprobable. However, the Nogo LRP disappeared when the probability of a Go signal was low (25% Go). This pattern of results supports the hypothesis that response preparation will be based on partial stimulus information only when the information has significant utility in the context of the overall task requirements.

Adult↗
PubMed1999

Pseudoaneurysm of the superior mesenteric artery with an arteriovenous fistula after simultaneous kidney-pancreas transplantation.

Vascular complications remain a significant source of morbidity after pancreatic transplantation. We describe a pseudoaneurysm of the superior mesenteric artery (SMA) with an arteriovenous fistula (AVF) involving the SMA and the superior mesenteric vein (SMV) discovered and treated surgically in the second week after kidney pancreas transplantation. The patient experienced pain over the graft, and subsequent radionuclide and Doppler ultrasound scan were suggestive of a pseudoaneurysm in the head of the pancreas. Awaiting confirmatory angiography, the patient became hypotensive and after resuscitation, underwent emergency surgery when a pseudoaneurysm was found in the head of the pancreas. After looping the proximal and distal recipient iliac artery and base of the donor Y vascular graft, the AVF was separated and ligated. The SMV was dissected off the pancreatic head and repaired over a tamponading intraluminal Foley catheter. Graft function was preserved. Based on this experience, an AVF with or without a pseudoaneurysm in the pancreas allograft should be corrected as soon it is suspected.

Adult↗
PubMed1999

Ten-year experience of unrelated bone marrow donor transplants in children with malignant and non-malignant conditions.

Children who require a marrow transplant may receive such hematopoietic cells from one of many sources. This study reviews the experience of one center with 58 children who received marrow from unrelated donors over a 10-year period. These children had a variety of malignant and non-malignant diseases. During that time period, only three of these children had failed to meet engraftment criteria. All donor marrow specimens were T-lymphocyte-depleted using an antibody/complement methodology. No difference was demonstrated in outcome between donors who were perfectly HLA-DR DNA matched versus those who were only partially matched. The increased size of various marrow donor registries has increased the number of potential donors available for these patients. The lack of a requirement for perfect matching means that there is an ever-increasing number of donors available. No graft-versus-host disease (GvHD) or grade III-IV GvHD was associated with a poorer outcome. Stable, long-term engraftment with minimal morbidity has been demonstrated in these children as evidenced by stability of survival curves by two years after marrow transplant.

Adolescent↗