Search PubMed⌕ Search

Biomedical subjects

J Miller

Publications and source records attributed to J Miller.

At least 793 records · Page 44Linked to original sources
PubMed1987

Primary cutaneous aspergillosis associated with Hickman intravenous catheters.

We describe nine patients with underlying hematologic cancer in whom primary cutaneous aspergillosis developed at the sites of Hickman intravenous catheters. Our patients, 17 to 74 years of age, were all immunocompromised either from their primary disease or from chemotherapy, and the Hickman catheters had been placed to provide venous access for chemotherapy or hyperalimentation or both. Clinical signs of infection included erythema, induration, and cutaneous or subcutaneous necrosis at the point of entry into the subclavian vein, in the subcutaneous tunnel, or at the exit site from the skin. Diagnosis was confirmed by positive wound culture for Aspergillus flavus in all but one patient. Treatment consisted of intravenous amphotericin B, oral flucytosine, and local wound care. Three patients recovered completely without operative débridement; three others recovered after operative débridement and delayed grafting. Two patients died of disseminated aspergillosis, and one died of unrelated causes while recovering from primary cutaneous aspergillosis. Successful treatment required resolution of aplasia or leukopenia, catheter removal, systemic treatment with amphotericin B, and local wound care. We conclude that primary cutaneous aspergillosis, a rare infection, may occur at the sites of Hickman catheters in immunocompromised patients, and that it is a serious complication requiring prompt diagnosis and treatment.

Adolescent↗
PubMed1987

Structural comparison of human apolipoproteins B-48 and B-100.

In this study we have investigated the structural relationship between human apolipoproteins B-48 and B-100 by comparing protein structure and by comparing nucleotide sequence from intestinal and hepatic cDNA clones. Sequences from intestinal and hepatic cDNA were identical over the entire distance analyzed (7194 bases), which is more than required to code for B-48. The amino-terminal amino acid sequences from intact B-48 and B-100 proteins were also identical over the entire distance analyzed (16 residues). Additional protein homology was evaluated by the combined techniques of peptide mapping and immunoblotting. Purified B-48 and B-100 were each digested with three different endoproteases, and the resulting peptides were separated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. Peptide bands were then detected by silver stain and by Western blotting with antisera against specific regions of B-48 and B-100. The resulting patterns suggest that B-48 is extensively homologous with the amino-terminal portion of B-100. We have identified only four peptides from B-48 (at least one in each digest) that are absent from the parallel digests of B-100. These peptides appear to arise from the ultimate carboxyl terminus of B-48 and appear to be totally homologous with a region located near the center of B-100. Our observations suggest that mature, circulating B-48 is homologous over its entire length (estimated to be between 2130 and 2144 amino acid residues) with the amino-terminal portion of B-100 and contains no sequence from the carboxyl end of B-100.(ABSTRACT TRUNCATED AT 250 WORDS)

Amino Acid Sequence↗
PubMed1987

Acrocephalopolysyndactyly type II--Carpenter syndrome: clinical spectrum and an attempt at unification with Goodman and Summit syndromes.

Carpenter syndrome (ACPS type II) was first described by Carpenter in 1901. The syndrome consists of acrocephaly, soft tissue syndactyly, brachy- or agenesis mesophalangy of the hands and feet, preaxial polydactyly, congenital heart disease, mental retardation, hypogenitalism, obesity, and umbilical hernia. Here we review the literature on Carpenter syndrome and add 2 affected sibs with marked intrafamilial variability. This review showed that 2 reported variations of Carpenter syndrome, Goodman and Summitt syndromes, actually fall within the clinical spectrum of this disorder. This confirms earlier suggestions of Gorlin (personal communication 1982) and Hall et al [Am J Med Genet 5:423-434, 1980].

Acrocephalosyndactylia↗
PubMed1987

Experimental analyses of the source of ABR wave II.

Recent reports based on direct recording from various locations along the auditory nerve in humans during neurosurgical procedures have suggested that the auditory nerve-brainstem response (ABR) wave II is generated by the same neurons which generate wave I. In order to analyze this possibility using a different approach, ABR was recorded in ten rats in response to several click intensities and click repetition rates. These studies were also repeated in ten human volunteers. The amplitudes and latencies of ABR waves I, II and III were analyzed in order to determine if wave I and II behaved in a parallel fashion with changes in stimulus intensity and latency, as would be expected from the physiological "all or none law" if both waves were generated by the same axons. Several types of analyses indicate that the amplitudes of ABR waves I and II do not grow in amplitude in a parallel fashion with increases in stimulus intensity and decreases in stimulus rate. This is evidence either for independent sources of waves I and II or for composite sources of wave II both from the auditory nerve and the cochlear nuclei.

Adolescent↗
PubMed1987

Effects of medial frontal cortex lesions on DRL performance in rats.

Rats with medial frontal cortical lesions (MFC) and control animals with sham operations were tested on an ascending series of 8 DRL schedules of reinforcement ranging from 5 to 70 seconds. Rats with MFC lesions did not differ from the control group in performance when response rate, responses per reinforcement and efficiency were analyzed. These results indicate that deficits in "response inhibition" often displayed by rats with MFC lesions may be task-specific.

Animals↗
PubMed1987

Pure tone overstimulation changes the micromechanical properties of the inner hair cell stereocilia.

The effect of permanent noise-induced hearing loss on the auditory brainstem response (ABR) and the micromechanical properties of cochlear hair cell stereocilia in guinea pigs was investigated. The threshold of movement of the stereocilia was measured by applying force from a fluid filled pipette. After exposure to a 1.0 kHz pure tone signal at 105 dB(A) for 72 h the threshold of the ABR was broadly elevated by approximately 50 dB. Inner hair cell stereocilia showed a decrease in threshold while the outer hair cell stereocilia bundles remained unaltered. This effect was localized to the 13-15 mm distance from the stapes corresponding to the region of maximal stimulation. The effect was recorded within 1 h of exposure and remained constant with exposures up to 7 days. Following a one month recovery period from sound exposure, normal threshold values of stereocilia movement were observed, indicating recovery. At this time, swelling of the afferent dendrites beneath the inner hair cells was observed throughout the cochlea together with approximately 30% scattered loss of outer hair cells in the 13 to 15 mm region. The ABR showed some recovery (approximately 20 dB), yet a threshold shift remained.

Acoustic Stimulation↗
PubMed1987

Editorial.

Explore the source record for details and available documents.

Editorial↗
PubMed1987

Multiple neuropsychological deficits due to anoxic encephalopathy: a case study.

In this article we report the case of a woman who survived an out-of-hospital cardiac arrest but was left with severe neuropsychological impairments due to anoxia. The deficits included anterograde and retrograde amnesia, dysphasia, disorientation, intellectual deterioration, visual impairments, ataxia, and myoclonus. Despite this degree of impairment the patient retained some insight into her condition which, in turn, created additional emotional problems. Rehabilitation and the problems of long-term care are considered.

Adult↗
PubMed1987

Blunt cardiac injury in children.

Thirty-nine children admitted to the pediatric intensive care unit with multiple injuries from blunt trauma underwent serial EKGs, determination of creatinine phosphokinase (CPK) isoenzymes, echocardiography, and radionuclide angiography studies. Motor vehicle injuries were responsible for 83% (32 of 39) of admissions, the remainder (7 of 39) caused by falls from heights. Thirteen children sustained serious (Modified Injury Severity Score [MISS] greater than 25) multiple system injury. Chest injuries were sustained by 12 children, nine being serious thoracic injuries (MISS chest score greater than 2). Three children (7.7%) showed elevations of MB fraction of CPK isoenzymes in addition to EKG abnormalities and/or ejection fraction depression on radionuclide angiography and were considered to have sustained cardiac contusion. Eight other children (20%) had normal or borderline elevation of CPK-MB fraction and EKG abnormalities combined with abnormal echocardiograms or radionuclide angiograms, and were considered to have sustained cardiac concussion. An additional 14 children (36%) had EKG or radionuclide angiography abnormalities alone. Two children required lidocaine therapy for cardiac irritability manifesting as multifocal PVCs and ventricular tachycardia. Based on this study, a comprehensive diagnostic evaluation of the heart in all children sustaining multiple injuries from blunt trauma cannot be justified. Continuous cardiac monitoring should be initiated in the emergency room and maintained throughout intensive care unit confinement to identify transient dysrhythmias. In patients with significant dysrhythmias and in those with obvious thoracic injuries serial EKG and cardiac isoenzyme assay should be obtained. Dysrhythmias should be man-aged with appropriate anti-arrhythmic therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1987

The effects of phenylpropanolamine on food intake and body weight in the genetically obese (ob/ob) mouse.

The purpose of the present study was to compare the actions of the anorexigen phenylpropanolamine (PPA) on chronic feeding and body weight in lean and in genetically obese mice. Adult (8-week-old) female C57BL/6J ob/ob mice and female +/? lean control mice were treated (i.p.) twice daily (at 0800 hrs and 2000 hrs) for 21 days with either 0.9% saline or with 10 or 20 mg/kg PPA. Analyses of cumulative 72-hour food intake revealed that PPA induced significant and dose-dependent anorexia in ob/ob mice but that PPA was without significant anorectic effect in lean mice. PPA dose levels of 10 mg/kg and 20 mg/kg reduced food intake in ob/ob mice by 14 and 21%, but reduced food intake in lean mice by only 3 and 6%, respectively. Analyses of body weight, however, did not reveal significant changes in body weight induced by either PPA dose in ob/ob or lean mice. The enhanced anorexic effects induced by PPA and other adrenergic agents in the ob/ob mouse are discussed.

Animals↗
PubMed1987

Multicenter hypothermia survey.

A multicenter survey evaluated the clinical presentation, treatment, and outcome of accidental hypothermia. Data were collected from 13 emergency departments, with 401 of the 428 cases presenting during a two-year study period. Core temperatures ranged from 35 C to 15.6 C (mean, 30.57 C +/- 3.53) with 272 cases (63.6%) less than or equal to 32.2 C. There were no significant differences by age in presenting temperature, rewarming strategies, or mortality. The first hour rewarming rate was significantly (P less than .05) faster in the population less than or equal to 59 years (1.08 +/- 1.39 C/hr) than in those greater than or equal to 60 years (0.75 +/- 1.16 C/hr). Male core temperatures averaged 30.27 +/- 3.44 C versus female temperatures of 31.1 +/- 3.61 C. There were no clinically significant differences in male (N = 296) versus female (N = 132) profiles. High ethanol levels (315 to 800 mg%) did not affect outcome. Nine of 27 (33%) patients who received CPR initiated in the field survived, versus six of 14 (43%) with CPR begun in the ED. The profile of the CPR versus non-CPR population differed significantly (P less than .05) in location (outdoors), initial temperature (24.8 +/- 3.77 C vs 30.94 +/- 3.12 C), third-hour rewarming rate (2.28 +/- 1.53 C vs 1.17 +/- 1.18 C/hr), and numerous laboratory parameters. Tracheal intubation was performed without incident in 117 cases, of which 97 were less than or equal to 32.2 C. There were 73 fatalities (17.1%). Of these, 84.9% (N = 62) were less than or equal to 32.2 C. Predisposing conditions in this group included "serious" illness (30), systemic infection (28), trauma (15), immersion (ten), frostbite (seven), and overdose (two). The initial pulse, hemoglobin, and first-hour rewarming rate was lower in the deceased population, while the potassium, urea nitrogen, creatinine, and phosphorus were elevated. Excluding treatment combinations, outcome with exclusive use of a single rewarming strategy was passive external rewarming, 14 deaths below 32.2 C, 13 above; active external rewarming, six deaths below 32.2 C, two above; active core rewarming, 38 deaths below 32.2 C, none above. Refinements of the American Heart Association's CPR standards in hypothermia and a Hypothermia Survival Index are proposed.

Age Factors↗
PubMed1987

Role of outcome conflict in dual-task interference.

The traditional explanation for dual-task interference is that tasks compete for scarce processing resources. Another possible explanation is that the outcome of the processing required for one task conflicts with the processing required for the other task (e.g., cross talk). To explore the contribution of outcome conflict to task interference, we manipulated the relatedness of the tasks. In Experiment 1, subjects searched concurrently for names of boys in one channel and names of cities in another channel. Responses were significantly delayed when a nontarget on one channel belonged to, or was even just related to, the category designated as the target for the other channel. No comparable effects were found when the tasks were performed in isolation. Thus, the difficulty of the individual tasks is not the only determinant of how much they will interfere when combined, and there must be substantial interactions between processes carrying out the two tasks. In Experiment 2 subjects searched one channel for specific target letters and another channel for specific target digits. The nontargets in a channel were either from the same alphanumeric category as the targets for that channel or from the opposite category (i.e., the category of the targets for the other channel). It was found that although between-category search was more efficient than within-category search in single tasks, it was less efficient in dual tasks. Thus, there appear to be significant task interactions due to the confusability emerging when the nontargets of one task belong to the same category as the targets of the concurrent task. In addition, the congruence of target presence or absence on the two channels was found to have a sizeable effect. We suggest four potential sources of outcome conflict that may contribute to dual-task interference, and we conjecture that a great deal of the residual interference might result from other sorts of outcome conflict.

Attention↗
PubMed1987

Urinary catecholamines before and after tracheostomy in patients with obstructive sleep apnea and hypertension.

Obstructive apnea (asphyxia) is accompanied by acute elevation of systemic blood pressure. The usual nocturnal fall in blood pressure seen during sleep in normals may be absent in patients with repetitive apneas, and daytime systemic hypertension is reported to occur in up to 90% of such patients. Increased sympathetic activity in response to repetitive nocturnal episodes of asphyxia could explain the reversal of the diurnal pressure variation but not the daytime systemic hypertension in this setting. We examined diurnal variation in urinary catecholamines in eight subjects with severe apnea before and after tracheostomy. Five obese hypertensive subjects without apnea served as controls. Three urine specimens, two awake (7 a.m. to 3 p.m. and 3 p.m. to 11 p.m.) and one asleep (11 p.m. to 7 a.m.) were collected preoperatively and again 10-14 days postoperatively when the patient was free of pain and signs of stoma infection. All specimens were analyzed for epinephrine, norepineprine, metanephrine, and normetanephrine by liquid chromatography with electrochemical detection. Urinary epinephrine and metanephrine were not different between subjects and controls. Norepinephrine and normetanephrine were significantly higher in apneic subjects pretracheostomy as compared either with controls or with their own values posttracheostomy. Diurnal variation was not seen before or after tracheostomy. Only two of the controls showed significant diurnal variation in norepinephrine. We conclude that the absence of diurnal variation in catecholamines prior to tracheostomy reflects increased nocturnal sympathetic activity. Elevation of daytime norepinephrine and normetanephrine with return to control levels following tracheostomy implies increased sympathetic activity throughout the day.

Adult↗