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Biomedical subjects

L C Miller

Publications and source records attributed to L C Miller.

At least 37 records · Page 2Linked to original sources
PubMed1997

Health of children adopted from the former Soviet Union and Eastern Europe. Comparison with preadoptive medical records.

CONTEXT: Children born in the countries of the former Soviet Union and Eastern Europe are now a main source of international adoptions in the United States, but often little information is available about these children prior to adoption. OBJECTIVE: To analyze the preadoptive medical reports of children adopted from Eastern Europe and the former Soviet Union and to compare these reports with their evaluations after arrival in the United States. DESIGN: Case series. SUBJECTS AND SETTING: A total of 56 children adopted from Eastern Europe and the former Soviet Union were evaluated in 2 international adoption clinics. Preadoptive medical records were available for 47 of these children. RESULTS: There were 43 (91%) of 47 medical reports available from the children's birth countries that included multiple unfamiliar neurologic diagnoses. Evaluations in the International Adoption Clinics frequently revealed growth delays (zscore < or = -1 for weight in 44% of children, height in 68%, and head circumference in 43%). Children had 1 month of linear growth lag for every 5 months in an orphanage (r=-0.48, P<.001). Developmental delays were also common (gross motor delays in 70% of children, fine motor in 82%, language in 59%, and social-emotional in 53%). While serious medical problems were found or corroborated in 11 (20%) of the 56 children evaluated in our clinics, neurologic diagnoses cited in preadoptive medical reports were not confirmed. CONCLUSIONS: Preadoptive medical records from these international adoptees included multiple diagnoses suggesting severe neurologic impairment. Although these diagnoses were not confirmed when the children were evaluated in the United States, substantial growth and developmental delays were identified.

Adoption↗
PubMed1997

Connectionism, parallel constraint satisfaction processes, and gestalt principles: (re) introducing cognitive dynamics to social psychology.

We argue that recent work in connectionist modeling, in particular the parallel constraint satisfaction processes that are central to many of these models, has great importance for understanding issues of both historical and current concern for social psychologists. We first provide a brief description of connectionist modeling, with particular emphasis on parallel constraint satisfaction processes. Second, we examine the tremendous similarities between parallel constraint satisfaction processes and the Gestalt principles that were the foundation for much of modem social psychology. We propose that parallel constraint satisfaction processes provide a computational implementation of the principles of Gestalt psychology that were central to the work of such seminal social psychologists as Asch, Festinger, Heider, and Lewin. Third, we then describe how parallel constraint satisfaction processes have been applied to three areas that were key to the beginnings of modern social psychology and remain central today: impression formation and causal reasoning, cognitive consistency (balance and cognitive dissonance), and goal-directed behavior. We conclude by discussing implications of parallel constraint satisfaction principles for a number of broader issues in social psychology, such as the dynamics of social thought and the integration of social information within the narrow time frame of social interaction.

Journal Article↗
PubMed1996

Prolonged fevers of unknown origin in children: patterns of presentation and outcome.

OBJECTIVE: To review the presentation, clinical characteristics, and outcome of children with prolonged fevers of unknown origin who are referred for pediatric rheumatologic evaluation. METHODS: We used a retrospective review of the charts of the 40 children (23 boys and 17 girls, aged 9 months to 14.6 years) with fevers persisting longer than 1 month who were referred to the Pediatric Rheumatology Clinic between 1984 and 1994, in whom evaluation did not result in diagnosis. Follow-up with children's families, pediatricians, or both was done by telephone. RESULTS: Of the 40 children, 29 had periodic fevers, and 11 had daily fevers without pattern. Patients with periodic fever were younger at onset, had longer duration of symptoms before referral, and higher maximum temperatures. The two groups did not differ in frequency of associated symptoms or signs. At follow-up (mean 60.5 +/- 5 months, n = 37), 10 children with daily fevers (within 24 months) and 23 children with periodic fevers (within 48 months) had completely recovered; three patients continue to have periodic fevers. In patients with daily fevers one had Crohn disease (7 months after initial evaluation) and another had uveitis (4 years after evaluation). One patient with periodic fevers had inflammatory bowel disease 3.5 years after the onset of fevers. Petit mal seizures developed in one patient with periodic fever, and another had mitochondrial encephalopathy. Four children with periodic fevers have attention-deficit hyperactivity disorder, and two have developmental delays. CONCLUSIONS: Fevers without an obvious source usually have a benign outcome, although patients should be monitored for changes in symptoms. Of the children with periodic fevers, 29% were later found to have neurologic problems; the relation to the previous fevers is uncertain.

Adolescent↗
PubMed1996

Methotrexate treatment of Wegener granulomatosis in children.

Wegener granulomatosis traditionally has been treated with glucocorticoids and cyclophosphamide. Both the disease and its treatments are associated with significant morbidity and mortality rates. There has been an effort to find effective but less toxic alternative treatments. We describe three children with Wegener granulomatosis who responded well to treatment with glucocorticoids and methotrexate, similar to a regimen used in adults.

Adolescent↗
PubMed1995

Developmental and nutritional status of internationally adopted children.

OBJECTIVES: To assess the relationship between developmental status of international adoptees at the time of entry into the United States and their nutritional status and concurrent medical problems. DESIGN: Prospective study. SETTING/PATIENTS: One hundred twenty-nine internationally adopted children attending the International Adoption Clinic at the Floating Hospital for Children, Boston, Mass, underwent detailed developmental assessments, anthropometric measurements, and medical examinations. RESULTS: The anthropometric measurements of the international adoptees were below the means for weight, height, and head circumference based on standards of the World Health Organization. Only 65 children (50%) were developmentally normal. Gross motor delays were identified in 43 children (33%), fine motor delays in 52 (40%), language delays in 23 (18%), cognitive delays in 21 (16%), and global delays in 18 (14%). The severity of delays were related to z scores for weight, height, and head circumference. The 36 children with medical problems had lower z scores compared with healthy children and were more likely to have delayed development. CONCLUSIONS: Careful developmental and growth screening of internationally adopted children at entry into the United States identifies adopted children at entry interventions and close follow-up. Longitudinal studies of internationally adopted children may provide evidence about the reversibility of growth and developmental delays, findings applicable to any environmentally deprived child.

Adoption↗
PubMed1995

Cross-linked elastin and collagen degradation products in the urine of patients with scleroderma.

OBJECTIVE: To measure the urinary excretion of specific cross-link amino acid markers for mature elastin (desmosine [DES] and isodesmosine [IDES]) and fibrillar collagen (hydroxylysylpyridinoline [HP] and lysylpyridinoline [LP]) in systemic sclerosis (SSc) patients and healthy controls. METHODS: Urine specimens from 20 patients with SSc and 22 controls were assessed for DES, IDES, HP, and LP using high performance liquid chromatography and ultraviolet absorption spectroscopy, in combination with an isotope dilution technique in which the urine specimen was spiked with isotopically labeled cross-link amino acids. RESULTS: Mean +/- SD levels of urinary DES and IDES were elevated in SSc patients by 2-3-fold, and urinary HP and LP by 3-4-fold, compared with controls (DES 21.0 +/- 9.4 versus 7.5 +/- 1.4 micrograms/gm creatinine; HP 109.0 +/- 72.9 versus 24.9 +/- 5.7 nmoles/mmole creatinine). Nineteen of the 20 SSc patients had urinary DES and HP values that were > 3 SD above the control mean. A significant elevation in the HP:LP ratio in SSc patients as compared with controls (mean +/- SD 6.9 +/- 1.5 versus 5.5 +/- 1.3) indicated a soft tissue origin for much of the increased HP. CONCLUSION: Patients with SSc have higher levels of urinary cross-link amino acids specific for the degradation of mature collagen and elastin. These markers distinguish most SSc patients from healthy controls.

Adult↗
PubMed1995

Neuropsychological assessment of children and adolescents with systemic lupus erythematosus.

Neuropsychological assessments of adults with SLE have shown cognitive impairment, sequential processing deficits, memory loss, increased incidence of left handedness, learning disabilities and emotional distress compared with healthy individuals or subjects with other medical conditions. Neuropsychological testing regarding these variables in children and adolescents with SLE has been infrequently reported. For this study, eight children with SLE (age 9-17 years at diagnosis) were assessed with neuropsychological testing at a median of 10.5 months (range 1 week to 30 months) after diagnosis. Tests included Wechsler Intelligence Scale for Children-Revised or Wechsler Adult Intelligence Scale-Revised, Wide Range Achievement Test-Revised, Standard Binet Intelligence Scale Fourth Edition Memory Subtests or Wechsler Memory Scale (all mean = 100 +/- 15) and Gates MacInitie Reading Comprehension Test, Achenbach Child Behavior Checklist and Achenbach Youth Self Report. Mean intellectual scores were in the low average range (Wechsler Full Scale mean = 85.0 +/- 11.9, Verbal Scale mean 85.2 +/- 13.9, Performance Scale mean = 88.0 +/- 13.9). Academic achievement was globally depressed (reading recognition mean = 79.5 +/- 22.0, spelling mean = 78.9 +/- 23.5), especially in arithmetic (mean = 70.5 +/- 14.9). Children with SLE averaged 5 years behind grade placement in reading comprehension. Visual memory was also depressed in patients with SLE. Behavior ratings failed to demonstrate any significant aberrations in the test subjects.

Adolescent↗
PubMed1995

Relative biological availability of manganese from manganese proteinate, manganese sulfate, and manganese monoxide in broilers reared at elevated temperatures.

The relative biological availabilities of Mn from Mn proteinate, MnSO4, and MnO were compared under two different environmental conditions. Commercial broilers were reared in brooder batteries between Days 1 and 21 and fed diets containing 0, 1,000, 2,000, or 3,000 mg supplemental Mn/kg diet. On Day 22, birds were transferred to individual cages in two environmental chambers maintaining the same dietary Mn sources and supplemental levels. The temperature in one chamber cycled between 18 and 23.9 C (thermoneutral, TN), and in the other chamber cycled between 23.9 and 35 C (heat distress, HD). Birds in the HD environment were exposed to 8 h of 23.9 C, 4 h of 23.9 to 35 C, 4 h of 35 C, and 8 h of 35 to 23.9 C. Tibia Mn increased linearly (P < .05) with level of supplementation when measured on Days 22 and 47. Based on ratios of slopes from multiple linear regression analysis of bone Mn on Mn intake from various sources, the biological availabilities of Mn proteinate and MnO relative to MnSO4 (100%) were 120 and 91%, respectively, in 21-d-old chicks. In 49-d-old birds, corresponding relative biological availabilities of Mn from proteinate and oxide were 125 and 83%, respectively, in birds reared under TN, and 145 and 82%, respectively, for HD birds.

Animals↗
PubMed1995

Synthesis of interleukin-1 beta in primary biliary cirrhosis: relationship to treatment with methotrexate or colchicine and disease progression.

Primary biliary cirrhosis (PBC) is a chronic, progressive, cholestatic liver disease. Interleukin-1 beta (IL-1 beta) may play a role in the pathogenesis of PBC by contributing to altered immune function and fibrosis. Colchicine or methotrexate has some beneficial effects in the treatment of PBC, and also affects interleukin-1 (IL-1). Therefore, we prospectively studied the synthesis of IL-1 beta by peripheral blood mononuclear cells (PBMC) from 42 patients with PBC entered into a randomized, double-blind, double-dummy controlled trial of colchicine and methotrexate. PBMC obtained at entry, 6, 12, 18, and 24 months were stimulated to produce IL-1 beta with phytohemagglutinin (PHA), lipopolysaccharide (LPS), Staphylococcus epidermidis, recombinant IL-2, or mitochondrial antigen. Patients in the two treatment groups did not differ at entry in biochemical measures or liver histological stage. Over 24 months in both groups, serum bilirubin and histologic stage remained stable and alkaline phosphatase decreased significantly. For all patients, synthesis of IL-1 beta increased constitutively and in response to immune-mediated stimulants (PHA, IL-2, and mitochondrial antigen) but not the bacterial stimulants LPS or S epidermidis. Compared with levels of IL-1 beta at entry, PHA induced increases for patients treated with methotrexate (12, 18, and 24 months) or colchicine (18 and 24 months). At 24 months, IL-2-induced IL-1 beta synthesis was increased in patients treated with methotrexate, whereas S epidermidis-induced IL-1 beta was enhanced in colchicine-treated patients. Before treatment, IL-1 beta production did not relate to severity of disease except in response to S epidermidis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

von Willebrand factor in juvenile dermatomyositis.

OBJECTIVE: To evaluate whether plasma von Willebrand factor (vWF) levels are a useful indicator of disease activity in juvenile dermatomyositis (DM). METHODS: Serum vWF levels were prospectively measured in 15 patients with juvenile DM and were compared to serum muscle enzyme levels, muscle strength, and presence of extramuscular manifestations. RESULTS: 6/15 active disease periods were accompanied by an increase in vWF; 9 were not. Elevated vWF levels did not relate to the presence of active skin disease or calcinosis. vWF was not consistently related to muscle strength, CPK, or aldolase in the study group. Two patients had elevations of vWF in association with viral infections while their DM was quiescent. CONCLUSION: An elevated vWF level is often indicative of a disease exacerbation in DM, and thus may be helpful in managing difficult cases. However, it is not consistently elevated in, nor specific for active disease in DM. It therefore cannot be recommended as a routine test in patients with DM. When used, results should be interpreted with caution.

Adolescent↗
PubMed1995

Trained traditional birth attendants as educators of refugee mothers.

Following training courses for traditional birth attendants among refugee Afghan women in Pakistan, a survey was conducted to test the knowledge and practices of the participants and of mothers whose babies had been delivered by them, using untrained birth attendants as the basis for comparison. Marked improvements in knowledge and skills were demonstrated, and recommendations made by the trained birth attendants about breast-feeding, maternal nutrition, immunization and hygiene were generally followed by mothers before and after delivery. Furthermore, far fewer complications and deaths were associated with deliveries performed by trained birth attendants than with those conducted by their untrained colleagues. The training of traditional birth attendants was clearly an effective way to educate women about hygiene and health.

Adult↗
PubMed1995

Treatment of diarrhoea in infants by medical doctors in Balochistan, Pakistan.

Diarrhoea is an important public health problem in Balochistan, the westernmost province of Pakistan. Although the use of oral rehydration solutions (ORS) has been widely promoted, no studies have been reported on the actual uses of ORS in treating infant diarrhoea by the medical doctors in this region. The medical practices of 30 doctors in Balochistan were surveyed. The surveyors posed as the mothers of infants with diarrhoea. The questions asked by the doctors, the physical examinations performed, and the treatments prescribed were noted. The histories and physical examinations were incomplete, as performed by most practitioners. In addition, 80% of the doctors prescribed drugs, usually kaolin preparations to treat diarrhoea. However, 18 of the 30 (60%) practitioners also prescribed ORS for treating diarrhoea and most of them gave some recommendations about ORS use. It is concluded that many medical practitioners have incorporated ORS treatment into their practices. Ongoing educational programmes and refresher courses would likely improve the use of ORS further in this region.

Child, Preschool↗
PubMed1995

Bicipital synovial cysts in juvenile rheumatoid arthritis: clinical description and sonographic correlation.

OBJECTIVE: To describe the presentation and clinical course of bicipital synovial cysts in 6 patients with juvenile rheumatoid arthritis (JRA) and to elucidate their anatomy using ultrasonography. METHODS: A clinical description of the cyst, JRA subtype, activity of concurrent arthritis, systemic disease features, and erythrocyte sedimentation rate was recorded for each patient. Ultrasonographic examination of the cyst was performed for each patient. RESULTS: Bicipital cysts generally presented as a sudden painless swelling on the flexor aspect of the upper arm, but on was in the forearm. Five of 6 patients had systemic disease. All patients had active arthritis when the cysts developed. Five of 6 cysts resolved spontaneously in less than 12 weeks. Ultrasonography confirmed a cystic structure in all patients, and in all cases was associated with thickening of the biceps tendon. Fluid was found within or adjacent to the biceps tendon in all cases. CONCLUSION: Bicipital synovial cysts should be considered a cause of acute arm swelling in patients with JRA, especially those with systemic disease. Ultrasonography is a useful diagnostic adjunct in this condition. This condition is generally self-resolving.

Arm↗
PubMed1994

Afghan refugee children and mothers.

OBJECTIVE: Although the more than 6 million Afghan refugees represent the largest single group of refugees worldwide, little information is available about their health status. RESEARCH DESIGN: Case series assessing the health and socioeconomic status of female Afghan refugees and their families and the nutritional and developmental status of their children. SETTING AND PATIENTS: Fifty-one female Afghan refugees and their children accompanying them at a maternal child health clinic in Quetta, Pakistan. RESULTS: All families had suffered serious losses from the war. Thirty-three women (65%) had lost at least one liveborn child, most commonly to gastroenteritis, "hunger," or neonatal tetanus. Thirteen children had been killed by bombardment, mine injuries, or gunshot wounds. The nutritional status of the children was markedly poor: z scores were less than -2 for weight in 67% of children and also less than -2 for head circumference in 50% of children. Serial z scores for weight in 23 children showed marked decline in 15 children (65%). Sixty-nine percent of children were overdue for vaccinations. Developmental milestones were significantly delayed. CONCLUSION: Afghan refugee children and their mothers are extremely needy and vulnerable and may be considered among the hidden casualties of war.

Adolescent↗
PubMed1994

Cytokines in rheumatic diseases.

IL-1 and related cytokines have multiple biologic activities relevant to the rheumatic diseases. In addition to mediating inflammatory and immune responses, these proteins regulate many aspects of connective tissue metabolism. The cytokines interact in complex cascades: because of this, and various technical reasons, the exact role of cytokines in the pathogenesis of rheumatic diseases remains uncertain. However, considerable experimental data suggest that the abnormal regulation of cytokines contributes to such siseases as inflammatory arthritis, systemic lupus erythematosus, scleroderma, and dermatomyositis. Animal models of these diseases have contributed to understanding the role of cytokines in pathogenesis. Furthermore, drugs useful in treating these diseases affect cytokine pathways; some cytokines, their antagonists, or related substances have been used therapeutically to treat rheumatic diseases. The therapeutic use of these agents will likely increase as knowledge about the role of cytokines in the pathogenesis of rheumatic diseases expands.

Animals↗
PubMed1994

Self-disclosure and liking: a meta-analytic review.

Self-disclosure plays a central role in the development and maintenance of relationships. One way that researchers have explored these processes is by studying the links between self-disclosure and liking. Using meta-analytic procedures, the present work sought to clarify and review this literature by evaluating the evidence for 3 distinct disclosure-liking effects. Significant disclosure-liking relations were found for each effect: (a) People who engage in intimate disclosures tend to be liked more than people who disclose at lower levels, (b) people disclose more to those whom they initially like, and (c) people like others as a result of having disclosed to them. In addition, the relation between disclosure and liking was moderated by a number of variables, including study paradigm, type of disclosure, and gender of the discloser. Taken together, these results suggest that various disclosure-liking effects can be integrated and viewed as operating together within a dynamic interpersonal system. Implications for theory development are discussed, and avenues for future research are suggested.

Female↗