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Biomedical subjects

L Miller

Publications and source records attributed to L Miller.

At least 181 records · Page 10Linked to original sources
PubMed1994

Visions and revisions: viewpoints on nuclear medicine & health care reform. Part 1: Outcomes research.

Although health care reform movements and the strategies that medical societies use to meet the challenges existed long before President Bill Clinton's September 1993 presentation of his reform bill, these strategies have since come into the foreground of medical reform discussions. Medical groups are carefully eying outcomes research as a method to both pinpoint their most effective procedures and to point up the effectiveness of their practice in overall patient care. Practice guidelines promise a way to sift out the optimal procedures and suggest them to all nuclear medicine physicians--to both unify the specialty and perhaps help protect practitioners in malpractice cases. Discussions of the specialty physician workforce question the need and practicality of any policy that substitutes generalists for specialists. And vigilance over the several pieces of legislation currently sifting through Congress alert members of specialty societies about political developments and how to influence congressmen. The question remains, are these strategies being employed in such a way as to best pull a specialty like nuclear medicine through the gantlet and optimize health care provision in the US? This four-part series will explore this question.

Health Care Reform↗
PubMed1993

Granulocyte colony-stimulating factor "mobilized" peripheral blood progenitor cells accelerate granulocyte and platelet recovery after high-dose chemotherapy.

Hematopoietic growth factors have been used to accelerate engraftment after bone marrow transplantation and to "mobilize" peripheral blood progenitor cells (PBPC). We report on the data in 85 consecutive patients with Hodgkin's disease who were treated in a single institution using different methods to obtain PB progenitor cells. Use of granulocyte colony-stimulating factor for mobilization resulted in a significantly accelerated time to recovery of granulocytes (10 days v 12 days, P < .01) when compared with "nonmobilized" PBPC recipients. Similarly, use of mobilized PBPC resulted in a significantly accelerated time to platelet engraftment (13 days v 30 days, P < .001) when compared with "nonmobilized" recipients. Moreover, there was a statistically significant difference in total costs in favor of the group receiving "mobilized" PBPC.

Adolescent↗
PubMed1993

Endoscopic assessment in children with tracheotomies.

Pediatric tracheotomy is a safe procedure, and the tube can be maintained for a prolonged period. There are, however, few guidelines regarding the endoscopic assessment of the airway following tracheotomy. From January 1988 through December 1989, the Division of Otolaryngology of The Children's Hospital of Philadelphia (Pa) performed tracheotomies on 81 patients. Thirty-two children had direct laryngoscopy and bronchoscopy at the time of the procedure, 1 week later, and at 6-month intervals for a minimum of 18 months. Four children had normal airways while 21 had intraluminal stomal granulomas, 16 had development of subglottic stenosis, nine had collapse of the anterior tracheal wall, and three had development of distal tracheal granulations. Sixteen children had multiple lesions. Anatomic changes occur in the airways of the majority of children with long-term tracheotomies, and endoscopic evaluation is an essential part of their care.

Airway Obstruction↗
PubMed1993

Amygdaloid sclerosis in temporal lobe epilepsy.

Hippocampal sclerosis is the sole abnormality found in approximately 65% of all temporal lobe specimens resected for intractable temporal lobe epilepsy. Up to 27% of en bloc temporal lobectomy specimens, however, show no definitive pathological changes. The lateral amygdaloid nucleus from 8 consecutive patients who underwent temporal lobectomy in whom no definitive hippocampal pathology was present and corresponding tissue from 8 consecutive patients with hippocampal sclerosis were subjected to quantitative estimation of neuronal density and astrogliosis. As compared to amygdaloid tissue from autopsy control subjects with no history of neurological disease, both the patient group with and that without hippocampal sclerosis consistently exhibited severe neuronal loss and gliosis with no quantitative differences between the two groups. Blinded clinical review of both groups of patients revealed that the development of hippocampal sclerosis was associated with a history of early brain insult; this history was absent in patients with isolated amygdaloid sclerosis. Neuropsychological testing prior to surgery demonstrated that patients with hippocampal sclerosis displayed a greater degree of memory impairment than did those without hippocampal sclerosis. We conclude that amygdaloid sclerosis occurs in the absence of hippocampal sclerosis, and that these patients form a distinct group with no history of early brain insult and milder memory impairment than that seen in patients afflicted with hippocampal sclerosis.

Adult↗