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Biomedical subjects

K S Miller

Publications and source records attributed to K S Miller.

At least 37 records · Page 2Linked to original sources
PubMed1996

Behavioral risks for HIV infection associated with HIV-testing decisions.

Adolescent and adult women were offered HIV testing as part of a clinic-based research program on HIV/AIDS in New York City. Sixty-four percent consented to testing and 87% of those tested returned to receive their results. This paper uses two-stage regression methods to identify sexual behavioral risk factors for HIV infection associated with the decision to accept the HIV test and subsequently to return for the results. Of the risk factors examined, having more than a single sex partner and never using a condom in the last year were strong predictors of taking the test; three or more sex partners had the strongest effects on the decision to return for the HIV test results. We conclude that voluntary HIV testing in this group can identify women with behavioral risks of HIV infection. Thus, voluntary HIV testing may be effective in targeting persons at high risk because behavioral risks are associated with the decision to take the HIV test.

AIDS Serodiagnosis↗
PubMed1995

Penile intracavernous hematoma: diagnosis and surgical considerations.

Soft tissue lesions of the penile corporeal bodies are rare and usually represent benign or malignant tumors, or Peyronie's disease. We report a unique case of a deep seated penile mass that at exploration proved to be an encapsulated hematoma of the inter-corporeal septum. Preoperative diagnosis of lesions of the corporeal bodies is facilitated by high resolution Doppler ultrasonography. Surgical exploration to exclude malignancy must be done unless the clinical and/or radiographic findings are unequivocally benign (Peyronie's plaque, simple cyst and so forth). Surgical exploration must be done according to the penile neurovascular anatomy to preserve potency and glanular sensation.

Hematoma↗
PubMed1995

Radiographic assessment of renal trauma: our 15-year experience.

PURPOSE: We sought to evaluate the continuing validity of our criteria for radiographic imaging of renal injuries, that is penetrating flank or abdominal trauma, blunt trauma with gross hematuria or microscopic hematuria and shock, deceleration or major associated abdominal injury and pediatric renal trauma. MATERIALS AND METHODS: We reviewed the records of 2,254 patients who presented to our institution with suspected renal trauma between 1977 and 1992. RESULTS: Of the 1,588 blunt trauma patients with microscopic hematuria and no shock 3 had significant injury but these cases were discovered during imaging or exploratory laparotomy for associated injuries. Followup in 515 of 1,004 patients (51%) who did not undergo initial imaging revealed no significant complications. CONCLUSIONS: Adults with blunt renal trauma, microscopic hematuria and no shock or major associated intra-abdominal injuries can safely be spared radiographic imaging.

Follow-Up Studies↗
PubMed1994

Phenotype and TCR gamma delta variable gene repertoire of intestinal intraepithelial lymphocytes in wild mice (Mus musculus domesticus): abundance of V gamma 1 transcripts and extensive delta gene diversity.

In order to study murine intestinal intraepithelial lymphocytes (IEL) independent of factors imparted by conditions of laboratory housing and breeding, and to provide a basis for comparison of IEL studies between inbred and outbred mouse populations, IEL from the domestic house mouse, Mus musculus domesticus, were analyzed by flow cytometric analyses using mAbs to murine lymphocyte markers, and by polymerase chain reaction to study the TCR gamma and delta V gene repertoires. The majority of IEL in wild mice were CD3+, CD8+CD4- T cells. CD4+CD8- also were present in IEL isolates from wild mice, although at low numbers. Among IEL, but not T cells from the spleen or lymph nodes, there was a notable lack of Thy-1 expression, a preponderance of CD8 alpha alpha + T cells, and a relatively high ratio (3:1) of TCR gamma delta + T cells over TCR alpha beta + T cells, suggesting that some IEL in wild mice may develop via an extrathymic pathway similar to that described for laboratory mice. Analyses of the IEL gamma and delta variable genes revealed rearrangements of three of six V region gamma genes (V gamma 1, V gamma 2, and V gamma 5), with an abundance of V gamma 1 transcripts as determined by Northern blot analyses. For the delta gene, rearrangement of five of seven V region elements had occurred (V delta 2, V delta 3, V delta 4, V delta 5, and V delta 6).(ABSTRACT TRUNCATED AT 250 WORDS)

Amino Acid Sequence↗
PubMed1993

Failure of the circulatory system limits exercise performance in patients with systemic sclerosis.

OBJECTIVE: To determine the mechanisms for exercise impairment in symptomatic patients with systemic sclerosis (SSc) using breath-by-breath expired-gas analysis with incremental exercise testing. DESIGN: Prospective, open trial. PATIENTS AND METHODS: Fifteen consecutive patients with SSc seen at the Medical University Hospital (a tertiary referral center) with complaints of exercise intolerance underwent pulmonary function testing (spirometry, helium dilution lung volumes, and diffusing capacity of carbon monoxide) and incremental exercise testing on a cycle ergometer measuring oxygen consumption (VO2), carbon dioxide production (VCO2), respiratory exchange ratio (R), oxygen saturation, blood pressure, and heart rate (HR). Values for oxygen uptake at anaerobic threshold (VO2AT) were derived graphically by blinded clinicians experienced in exercise testing, and the results were averaged. Ventilatory reserve and oxygen pulse were calculated from measured values, and all data were subjected to analysis by standard clinical algorithms. MEASUREMENTS AND MAIN RESULTS: Of 15 patients studied, 14 had either restrictive lung disease or normal results of spirometry on pulmonary function testing. One patient with a history of tobacco use had evidence of airways obstruction. Three patients were unable to exercise maximally (as determined by maximum respiratory exchange ratio [Rmax] greater than 1.09 or maximum heart rate [HRmax] greater than 85% predicted), and exercise testing was terminated in one with Mobitz type II atrioventricular block. The following data (mean +/- SEM) were obtained from 11 maximally exercising patients: VO2max 795 +/- 75 mL oxygen (O2)/min, R 1.34 +/- 0.05, VO2AT/VO2max predicted 0.21 +/- 0.02, O2 pulse 5.1 +/- 0.4 mL O2/beat, ventilatory reserve 0.52 +/- 0.06, and tidal volume/forced vital capacity ratio 0.46 +/- 0.02. Of the 11 patients completing breath-by-breath expired-gas analysis, all had circulatory impairment to exercise, as determined by low O2 pulse and low VO2 at anaerobic threshold, and circulatory impairment was limiting in 9 of 11 patients. Of those nine patients, four had evidence of impaired gas exchange compatible with pulmonary vascular disease. Arterial oxygen desaturation occurred in 2 of 11 patients. CONCLUSION: Circulatory impairment to exercise is common in SSc patients with exercise intolerance. Restrictive lung disease, although also common, does not limit exercise tolerance in patients capable of maximal effort.

Adult↗
PubMed1993

T cell receptor delta gene repertoire and diversity of intestinal intraepithelial lymphocytes in athymic mice.

T cell receptor (TCR) delta gene rearrangements in intestinal intraepithelial lymphocytes (IEL) were studied in athymic radiation chimeras using polymerase chain reaction (PCR) and sequence analysis of DNAs spanning the variable (V), diversity (D), and junctional (J) genes. In both thymus-bearing and athymic mice, IEL delta gene rearrangements occurred for V delta 3, V delta 4, V delta 5 and V delta 6. V-D-J junctional-site sequence analyses of cloned DNAs from rearranged IEL delta genes in athymic mice revealed a predominance of in-frame rearrangements; junctional diversity consisting of nucleotide removal from V, D and/or J genes; N segment nucleotide insertions; and high overall gene diversity. Evaluation of PCR-amplified cDNAs made from IEL RNA indicated that all four rearranged V delta genes were expressed in IEL from athymic mice. The high diversity observed at the gene level also was present in amino acid sequences encoded by the V-D-J region of IEL delta genes in athymic mice. These data demonstrate that there is extensive diversity of rearranged delta genes in IEL which develop extrathymically, and suggest that the delta chain of IEL TCR-gamma delta+ T cells has the potential for interactions with polymorphic structures.

Amino Acid Sequence↗
PubMed1993

Wegener's granulomatosis presenting as a primary seizure disorder with brain lesions demonstrated by magnetic resonance imaging.

Since the earliest attempt by Klinger in 1931 to describe the systemic vasculitis subsequently characterized in 1936 by Wegener as Wegener's granulomatosis, this disorder has been reported to present in a number of differing fashions. No previous description relates Wegener's presenting as a seizure disorder, and no reports of MRI of the brain in such patients exists. We relate such a case, along with MRI findings, prior to and after treatment, with a review of neurologic manifestations of the disorder.

Adult↗
PubMed1993

Expression cloning exploiting PCR rescue of transfected genes.

Expression cloning in eukaryotic cells has allowed the isolation of many genes for which no protein or nucleic acid sequence information was available. In this paper we describe a model methodology for PCR-mediated rescue of transfected genes from eukaryotic cell lines after functional selection. This protocol should allow any readily transfectable cell line to serve as a host for functional selection of cDNA expression libraries.

3T3 Cells↗
PubMed1992

The effects of retrotransposon-derived sequence insertions on gene expression in a model system.

Retrotransposition has been well documented as a significant source of mutagenesis in diverse eukaryotic organisms, including humans. Insertions of retrotransposons within or in close proximity to transcription units cause many spontaneous mutations, and have been implicated as a source of heritable genetic defects and as a cause of carcinogenesis. The mechanisms by which retrotransposon insertions produce mutant phenotypes are diverse and, in many cases, not fully understood. A model transcriptional system was utilized to test the effects of copia retrotransposon-derived sequence insertions upon gene expression in different cellular environments. The results of these experiments indicate that retrotransposon insertions within nontranslated regions of a transcription unit inhibit gene expression by at least two concurrently acting mechanisms: 1) transcriptional interference due to an active internal promoter and, 2) trans RNA hybridization interactions between transcripts containing complementary retrotransposon sequences.

3T3 Cells↗
PubMed1992

A note on the historical aspects of dysphagia lusoria.

There is a lack of appreciation for the fact that, in less than 1 per cent of the general population, the right subclavian artery has an anomalous origin and course. Fortunately, most of these persons do not have symptoms; however, if they should have neck surgery, they may be at increased risk for damage to the right inferior laryngram nerve. The earliest reported description of an anomalous right subclavian artery was that of Hunald in 1735; 52 years passed before the clinical syndrome of dysphagia lusoria was published by Bayford in 1787. Bayford did not mention the associated displacement of the right inferior laryngeal nerve. In 1823, Stedman described the entire anatomical picture.

Aorta, Thoracic↗
PubMed1991

Rearrangement and junctional-site sequence analyses of T-cell receptor gamma genes in intestinal intraepithelial lymphocytes from murine athymic chimeras.

The molecular organization of rearranged T-cell receptor (TCR) gamma genes intraepithelial lymphocytes (IEL) was studied in athymic radiation chimeras and was compared with the organization of gamma gene rearrangements in IEL from thymus-bearing animals by polymerase chain reaction and by sequence analyses of DNA spanning the junction of the variable (V) and joining (J) genes. In both thymus-bearing mice and athymic chimeras, IEL V-J gamma-gene rearrangements occurred for V gamma 1.2, V gamma 2, and V gamma 5 but not for V gamma 3 or V gamma 4. Sequence analyses of cloned V-J polymerase chain reaction-amplified products indicated that in both thymus-bearing mice and athymic chimeras, rearrangement of V gamma 1.2 and V gamma 5 resulted in in-frame as well as out-of-frame genes, whereas nearly all V gamma 2 rearrangements were out of frame from either type of animal. V-segment nucleotide removal occurred in most V gamma 1.2, V gamma 2, and V gamma 5 rearrangements; J-segment nucleotide removal was common in V gamma 1.2 but not in V gamma 2 or V gamma 5 rearrangements. N-segment nucleotide insertions were present in V gamma 1.2, V gamma 2, and V gamma 5 IEL rearrangements in both thymus-bearing mice and athymic chimeras, resulting in a predominant in-frame sequence for V gamma 5 and a predominant out-of-frame sequence for V gamma 2 genes. These findings demonstrate that (i) TCR gamma-gene rearrangement occurs extrathymically in IEL, (ii) rearrangements of TCR gamma genes involve the same V gene regardless of thymus influence; and (iii) the thymus does not determine the degree to which functional or nonfunctional rearrangements occur in IEL.

Animals↗
PubMed1991

Benign thyroid hyperplasia presenting as bilateral vocal cord paralysis. Complete remission following surgery.

A 52-year-old woman developed respiratory arrest on two separate occasions that required mechanical ventilation. Fiberoptic bronchoscopy demonstrated bilateral vocal cord paralysis, and a CT scan of the neck demonstrated a right neck mass. On surgical exploration, the mass was found extending from the thyroid gland and was identified as benign thyroid tissue. Thyroid hyperplasia should be considered in the differential diagnosis of bilateral vocal cord paralysis.

Female↗
PubMed1990

Evaluation and management of scleroderma lung disease using bronchoalveolar lavage.

PURPOSE: Bronchoalveolar lavage (BAL) was performed in 43 nonsmoking patients with scleroderma (systemic sclerosis) to determine the frequency of alveolitis, the status of BAL findings over time, and the relationship of such findings to pulmonary status initially and at follow-up. PATIENTS AND METHODS: Forty-three nonsmoking patients with systemic sclerosis underwent extensive pulmonary evaluation including pulmonary function tests, chest radiographs, and BAL with analysis of cells, IgG, albumin, immune complexes, and fibronectin. RESULTS: Alveolitis was detected on initial BAL evaluation in 21 patients (49%). Alveolitis was characterized by hypercellular lavage fluid, due to an absolute increase in alveolar macrophages and due to an increase in both the absolute number and percentage of granulocytes (neutrophils and eosinophils). Patients with systemic sclerosis had significantly higher levels of IgG and immune complexes in BAL fluid than did control subjects, and alveolar macrophages from patients with systemic sclerosis released higher amounts of fibronectin in vitro. In serial studies, alveolitis was found to persist. Patients with alveolitis had greater dyspnea than patients without alveolitis (p = 0.02), and they had greater reductions in lung volumes and carbon monoxide diffusing capacity (DLCO) (p = 0.004). Furthermore, patients with persistent alveolitis had significantly greater reductions in pulmonary function over time than patients without alveolitis (forced vital capacity [FVC]: -0.69 L versus -0.05 L, p less than 0.001; DLCO: -2.94 mL/minute/mm Hg versus +0.16 mL/minute/mm Hg, p = 0.03). BAL was used to select patients with alveolitis and at risk of pulmonary deterioration, and treatment was instituted with cyclophosphamide and prednisone, resulting in significant improvement in dyspnea (p less than 0.001) and the rate of change of FVC (p = 0.02) and DLCO (p less than 0.001). CONCLUSION: We conclude that alveolitis occurs frequently in systemic sclerosis and that BAL is useful in identifying such patients who are at risk for a further decline in pulmonary status. Preliminary observations suggest that treatment of patients with active alveolitis may result in improvement in pulmonary status.

Adult↗
PubMed1990

Lung disease associated with progressive systemic sclerosis. Assessment of interlobar variation by bronchoalveolar lavage and comparison with noninvasive evaluation of disease activity.

Progressive systemic sclerosis (PSS), or scleroderma, is a disease of unknown etiology that involves many organ systems, including the lungs. The interstitial lung disease of systemic sclerosis is becoming an increasing cause of morbidity and mortality. This process has been previously evaluated with single-site bronchoalveolar lavage (BAL), gallium scanning, pulmonary function testing, and, occasionally, by open lung biopsy. As BAL has been shown to correlate well with open lung biopsy in systemic sclerosis, we sought to determine if single-site BAL accurately reflects alveolitis in a second site in the lung, and if BAL results correlate with other noninvasive tests of lung inflammation: gallium uptake, chest radiography, or arterial blood gas analysis. We performed 17 studies in 13 patients with scleroderma and found no significant lobar differences in lavage results or gallium scanning. By our criteria for normal versus active alveolitis, only two of 17 patient lavages would have been classified as normal by one side and abnormal by the other side. Although percent gallium uptake was equal bilaterally and supported the concept of alveolitis uniformity, gallium uptake intensity did not correlate with activity as measured by BAL. Furthermore, chest radiograph and arterial blood gas analysis did not correlate with BAL results or gallium scanning. We believe these data support the suitability of single-site lavage in the investigation of systemic-sclerosis-associated alveolitis and diminish the importance of gallium scanning in the investigation of systemic sclerosis pulmonary disease.

Blood Gas Analysis↗