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Biomedical subjects

J Milliken

Publications and source records attributed to J Milliken.

29 records · Page 2Linked to original sources
PubMed1990

Ascending aortic dissection in weight lifters with cystic medial degeneration.

We report 4 cases of ascending aortic dissection in patients with long histories of weight lifting. In 2 of the patients, the initial symptoms of dissection developed while they were lifting weights. Two patients had a history of hypertension and 2 had previously used anabolic steroids. All 4 were successfully treated surgically. Histopathology showed aortic medial changes in all 4. We believe that the hemodynamic stresses of weight lifting, namely, a rapid increase in systemic arterial blood pressure without a decrease in total peripheral vascular resistance, in combination with aortic medial degeneration may have contributed to the development of the aortic dissection.

Adult↗
PubMed1989

Estrogen receptor immunocytochemical assay on cytologic material from primary and metastatic breast cancer.

The determination of estrogen receptor (ER) status in primary and metastatic breast tumours has been facilitated by the recent advent of monoclonal antibodies to ER. The aim of this study was to determine the feasibility of estrogen receptor immunocytochemical assay (ER-ICA) applied to cytologic specimens from primary and metastatic breast tumours. One hundred and sixty specimens from 133 patients were evaluated by cytologic ER-ICA. Comparison with histologic ER-ICA was available for 28 of the specimens and with cytosol assay for 27 specimens. Some 101 of the 160 samples were breast lesions of which 87 had a definitive diagnosis of breast carcinoma. Of these, 68% were considered positive for ER. Metastatic breast cancers comprised 59 of the 160 specimens of which 37% were found to be positive for ER. The predominant staining intensity (SI) of the nuclei of the tumour cells added to the percentage of cells (PC) stained gave an estrogen receptor score (ERS) in both cytologic and histologic specimens. A positive threshold was determined for an ERS greater than 2, equivalent to ER levels greater than 10 fmol/mg of protein. We observed very good correlation between cytologic ERS and the corresponding cytosol assay values (r = 0.74; p less than 0.001; n = 27). The sensitivity was 95% and the specificity 88%. Correlation with histologic ER-ICA was also very high (r = 0.83; p less than 0.001; n = 28). We assessed the role of video image analysis (VIA) and did not find any additional advantages in evaluating cytologic ER-ICA.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenofibroma↗
PubMed1988

Nosocomial infections in a pediatric intensive care unit.

In a prospective 30-month study of nosocomial infections in a pediatric ICU (PICU), the incidence, sites, and causes of infection were determined. Factors associated with increased risk of infection were investigated. In 1,388 patients who remained in the PICU for a minimum of 72 h, 116 infections occurred (6.1 infections/100 admissions). Primary bacteremias comprised 38% of PICU infections and lower respiratory infections comprised 15%. The remaining infections were divided equally among GI, skin, eye, upper respiratory, postoperative wounds, and other sites. Coagulase-negative staphylococci, Pseudomonas aeruginosa, and Staphylococcus aureus were the most prevalent pathogens. Surgical patients had similar rates of infection to medical patients. Patients in the first 2 yr of life, particularly those between 7 and 30 days of age, had the highest rate of infection. Onset of infection was more common after the first week in the PICU with 11% of patients staying 14 to 20 days, 27% of patients staying 21 to 27 days, 48% of patients staying 28 to 34 days, and 52% of patients staying more than 35 days before the onset of infection. The risk of nosocomial infection increases with arterial and central line use, prolonged intubation, ventilation, intracranial pressure monitoring, and paralysis.

Age Factors↗
PubMed1987

Vancomycin pharmacokinetics and dose recommendations for preterm infants.

The pharmacokinetics of intravenous vancomycin was studied in 20 preterm infants (gestational age, 26.5 weeks +/- 2.6 weeks [standard deviation]; birthweight, 880 +/- 340 g). At the time of the studies their postconceptional age was 36.4 +/- 4.5 weeks. The drug was infused over 30 min in a dose between 9.2 and 18 mg/kg. A highly significant correlation existed between postconceptional age or body weight and vancomycin t1/2 and clearance. Serum creatinine concentrations correlated with vancomycin t1/2 and clearance. Serum creatinine tended to decrease with increasing postconceptional age. Based on the excellent correlation between age (or weight) and vancomycin pharmacokinetics, dose and dose-interval recommendations are presented.

Drug Administration Schedule↗
PubMed1987

Whither cytosolic estrogen receptor assays? A comparison of commercially available kits for estrogen receptor assay.

Frozen tissue sections and cytosols from 89 specimens of breast and ovarian tumours have been assayed for the presence of estrogen receptor (ER) or related protein using four commercially available monoclonal antibody methods. These were estrogen receptor enzyme immunoassay (ER-EIA), estrogen receptor enzyme immunocytochemical assay (ER-ICA), ER D5 antigen immunoradiometric assay and ER D5 antigen immunocytochemical assay. The results have been compared with those obtained using a standard dextran coated charcoal steroid binding assay (ER-DCC). The correlation coefficient (r) between ER-DCC and ER-EIA results was 0.72 while that of both monoclonal antibody cytosol methods and their respective immunocytochemical assays was 0.66. ER-ICA gave additional valuable information concerning receptor heterogeneity in breast cancer sections. However, the correlation between ER D5 antigen assays and both ER-DCC and ER-EIA was weak (r less than 0.4). We conclude that there are a number of methodological advantages in using the kit systems including their ability to detect receptor presence in small tumour specimens (e.g., "Tru-cut" biopsies) but that their usefulness is limited by the current lack of widely available monoclonal based methods for the concurrent determination of progestogen receptor. We believe that, once these are available, immunocytochemical technology could offer an alternative method of determining the steroid receptor concentration in both ovarian and breast tumours, thus obviating the need for costly and time-consuming cytosolic methods, with their inherent difficulties of quality control.

Adolescent↗
PubMed1983

Aortic saddle embolus. A twenty-year experience.

Clinical experience with aortic saddle embolus (ASE) is not extensive due to the relative infrequent lodging of emboli at the aortic bifurcation. During the period 1962-1982, 26 patients (mean age, 56 years) were treated at the UCLA Medical Center for ASE and followed from 2 to 158 months (mean, 45 months). These cases were reviewed in order to identify features of diagnosis, anticoagulation, and operation which impact on results. All 26 patients presented with bilateral lower extremity ischemia with or without extension of clot to the iliac bifurcation. Ninety-six per cent of emboli were of cardiac origin and one-third occurred in patients who had previous symptoms of chronic lower extremity ischemia. Rest pain and motor/sensory deficits were main complaints in 92% of the patients, but did not become manifest until more than 6 hours, unlike more distal emboli which have an earlier presentation. Preoperative angiography, even in the patient with a history of claudication, has a small role in planning the surgical approach to patients with ASE and, although performed in 11 patients, it influenced operation in only two. Operation within the "golden period" of 6 hours after embolization did not significantly influence outcome after ASE, since 20 patients were operated on more than 6 hours after embolization, with results similar to six patients who were operated on less than 6 hours after embolization. Early high-dose heparinization, used in all patients and maintained for a mean of 12 days, may have contributed to this effect. In 22 patients (85%) Forgarty catheter extraction via bilateral groin approaches was used with a mortality of 14%; only one death was directly attributed to the catheter embolectomy. In 15% of patients, a direct approach on the aorta was selected with a zero mortality rate. Postoperative functional result was excellent with an amputation rate of only 2% (one limb). Re-embolization occurred in seven patients (27%) after discharge, five of whom had not been maintained on Coumadin and two who were not anticoagulated adequately. The authors conclude that the keys to successful treatment of ASE include high dose heparin which is maintained through the perioperative period, embolectomy without preoperative angiography, and maintenance of long-term oral anticoagulation.

Adult↗
PubMed1980

The effects of diet on high density lipoprotein cholesterol.

Twenty-nine patients with normal blood lipids were placed on diets. Thirteen, mainly attending hospital for varicose veins, were prescribed low-energy diets: HDL-cholesterol was raised after one month and significantly after three months (P less than 0.02); total cholesterol was lowered (P less than 0.05). Sixteen patients, mainly with irritable bowel symptoms, were prescribed high-fibre diet: HDL-C was raised after one month (P less than 0.05), but not significantly so after three months; total cholesterol was unchanged.

Adult↗
PubMedDate not supplied

Disseminated fusarial infection in the immunocompromised host.

A report of the species Fusarium proliferatum causing systemic infection in a child with acute lymphoblastic leukemia is presented, with a review of the clinical and laboratory features relating to outcome in disseminated fusarial infections. Thirteen cases of disseminated infection due to Fusarium species have been reported, all but one of which were fatal. Hematologic malignancy is the commonest underlying illness. The frequent occurrence of multiple skin lesions, orbitofacial involvement, and fungemia is in contrast to the otherwise similar disseminated aspergillosis or mucormycosis. Fungemia in disseminated fusariosis may reflect a capacity for invasion of intravascular catheters by Fusarium species. Fusarium isolates from disseminated infections are variably sensitive to amphotericin B, ketoconazole, and miconazole and uniformly resistant to 5-fluorocytosine. The correlation between antifungal susceptibility status and clinical outcome is poor, reflecting problems in susceptibility testing, marginally effective chemotherapy, and serious impairment of host defenses. Attention to early diagnosis and the care of indwelling prosthetic devices may enhance survival until more effective chemotherapy is available.

Child↗