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Biomedical subjects

L Miller

Publications and source records attributed to L Miller.

At least 199 records · Page 11Linked to original sources
PubMed1993

Superior accuracy of anatomic positioning with echocardiographic- over fluoroscopic-guided endomyocardial biopsy.

To assess the superior anatomic positioning of echocardiographic-guided endomyocardial biopsy compared to traditional fluoroscopic-guided technique, these two modalities were compared in a blinded fashion during femoral sheath endomyocardial biopsy in 21 patients, 19 being evaluated after orthotopic cardiac transplantation. The simultaneous fluoroscopic and echocardiographic imaging indicated that traditional fluoroscopic positioning of the bioptome against the septum is inaccurate in over half of patients undergoing biopsy. This finding should be considered in cardiomyopathy patients or those at high risk for biopsy-related complications.

Biopsy↗
PubMed1993

Toradol, an NSAID used for renal colic, decreases renal perfusion and ureteral pressure in a canine model of unilateral ureteral obstruction.

Toradol is a new parenteral, nonsteroidal anti-inflammatory drug which is efficacious in treating renal coli. In the present experiments, Toradol was administered to both control dogs and dogs with unilateral ureteral obstruction. In control dogs, Toradol had no effect on RBF or GFR, despite inhibition of renal prostaglandin synthesis (measured as urinary prostaglandin release). In contrast, RBF fell acutely by 35% (p < 0.001) within 15 minutes of Toradol administration in the setting of ureteral obstruction; contralateral RBF was unaffected. Ipsilateral ureteral pressure also fell. Changes in RBF and ureteral pressure, together with the known effects of NSAIDs on pain pathways, may contribute to the pain relief observed clinically with Toradol. However, the abrupt changes in renal hemodynamics brought on by Toradol to the obstructed kidney may compromise renal reserve, and Toradol should be used cautiously in treating renal colic.

Animals↗
PubMed1993

Direct in vivo gene transfer to airway epithelium employing adenovirus-polylysine-DNA complexes.

Adenovirus-polylysine-DNA complexes were evaluated for their capacity to accomplish direct in vivo gene transfer to airway epithelium employing a rodent model. Binary complexes containing transferrin or adenovirus, or combination complexes containing both transferrin and adenovirus, were evaluated. The highest in vitro gene transfer efficiency in primary cultures of airway epithelial cells was accomplished by the combination complexes. This result was paralleled in vivo. Transient gene expression of up to 1 week was observed with localization of the transduced cells to the region of the small airways. These results establish the feasibility of this type of approach for gene therapy applications.

Adenoviridae↗
PubMed1993

Multicenter study of predictors of disease course in Alzheimer disease (the "predictors study"). I. Study design, cohort description, and intersite comparisons.

Clinicians should be able to provide the patient with Alzheimer disease (AD) and the family with an accurate prediction of what to expect, but the variability in the rate of disease progression precludes this. In several previous studies, specific clinical signs such as muscular rigidity, myoclonus, and hallucinations or delusions were associated with rapid progression to a more severe stage of dementia or death. The "Predictors Study," a longitudinal study at three independent sites, was designed to develop a predictor model of the natural history of Alzheimer disease. The study was conducted at three study sites, New York, Baltimore, and Boston in a cohort of 224 patients with early probable AD. This article describes the design and implementation of the Predictors Study, and compares features of the study cohort at baseline across sites. Patients were all at the mild stage of disease at entry and were relatively comparable across sites. Extrapyramidal signs and delusions were common, but myoclonus was rarely observed.

Activities of Daily Living↗
PubMed1993

Multicenter study of predictors of disease course in Alzheimer disease (the "predictors study"). II. Neurological, psychiatric, and demographic influences on baseline measures of disease severity.

The "Predictors Study" is a prospective cohort study of the natural history of Alzheimer disease (AD), the aim of which is to identify milestones in disease progression and to develop a model to predict disease course in individual patients. The empirical background to this study is based on previous reports that the presence of extrapyramidal signs (EPS), myoclonus, and psychosis in AD may signify greater disease severity at any given stage and a more rapid course of the disease over time. The present analyses were conducted to determine whether these independent "predictor" variables were associated with greater disease severity at baseline within a new cohort of 224 mild AD patients recruited from three different medical centers (in New York, Baltimore, and Boston). Measures of disease severity were provided by the modified Mini-Mental State Examination (mMMSE) and the Blessed Dementia Rating Scale (BDRS), which measures functional capacity. Independent variables were EPS, delusions, and slowing of the posterior dominant EEG rhythm. The frequency of myoclonus and hallucinations was too low to permit adequate statistical assessment of their effects at this time. EPS and EEG slowing were associated with low mMMSE scores, whereas delusions were primarily associated with impaired functional capacity. These effects were independent of the influence of age and disease duration. These results indicate that the effects of these independent variables can be detected at mild stages of AD and that these effects can be generalized across different geographical regions.

Aged↗
PubMed1993

Intensively timed induction therapy followed by autologous or allogeneic bone marrow transplantation for children with acute myeloid leukemia or myelodysplastic syndrome: a Childrens Cancer Group pilot study.

PURPOSE: Childrens Cancer Group (CCG) protocol 2861 was designed to test the feasibility of aggressively timed induction therapy followed by autologous or allogeneic bone marrow transplantation (BMT) as the sole postremission therapy for newly diagnosed children with acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS). PATIENTS AND METHODS: Between April 1988 and October 1989, 142 patients were eligible for study. All patients entered received a timing-intensive five-drug induction of dexamethasone, cytarabine (Ara-C), thioguanine, etoposide, and daunorubicin (DCTER) over 4 days with a second cycle administered after 6 days of rest, irrespective of hematologic status at that time. Most patients subsequently received a second two-cycle induction course. Those who achieved remission were eligible for bone marrow ablative therapy with busulfan and cyclophosphamide, followed by 4-hydroperoxy-cyclophosphamide (4-HC)-purged autologous or allogeneic BMT rescue. RESULTS: One hundred eight (76%) patients achieved remission: 19 (13%) died of complications of the leukemia and/or chemotherapy, and 15 (11%) failed to achieve remission. Seventy-four patients subsequently underwent BMT with either autologous (n = 58) or allogeneic (n = 16) rescue. For patients who received autologous rescue with 4-HC-purged grafts, the actuarial disease-free survival (DFS) rate at 3 years from the day of transplant is 51%, compared with 55% for patients who received allogeneic grafts (P = .92). At 3 years, the overall actuarial survival rate for all 142 patients entered on this study is 45%, with an event-free survival (EFS) rate of 37%. Adverse prognostic factors for outcome included an elevated WBC count or the presence of CNS leukemia at the time of AML diagnosis. CONCLUSION: Results suggest that aggressively timed induction therapy followed by marrow ablation and BMT rescue with either autologous or allogeneic grafts for children with newly diagnosed AML or MDS is both feasible and effective.

Actuarial Analysis↗
PubMed1993

Professional allocations of counseling service to persons with Alzheimer's disease: an exploration.

Individual, family, and group counseling service recommendations made by California's diagnostic and treatment center staff to a clinical sample of Alzheimer's disease clients (N = 822) are examined using logistic regression. Predictors included the patients' enabling, need, and predisposing characteristics. Analysis shows that staff tend to consider fewer patient characteristics, and rely more on assessed family problems and payment source when deciding whether they recommend counseling to their patients.

Activities of Daily Living↗
PubMed1993

Why home health services are provided to Alzheimer's disease patients in California's Alzheimer's disease program: an exploration.

Logistic regression is used to examine why formal home health service recommendations are made to Alzheimer's disease patients (N = 822) by staff at each of six Alzheimer's Disease Diagnostic and Treatment Centers (ADDTCs) in California. Patients are selected on the basis of their having Alzheimer's disease, and not having any physical co-morbid health problems noted at the time of their clinical assessment. Using Medicare Part A to pay for care, previous home health use, having regular access to and prior use of a primary care physician, prior hospitalization, client agitation and apathy, and family's social isolation were significant predictors of the latent propensity to recommend formal home health services to members of this sample.

Aged↗
PubMed1993

Diffusing capacity decreases after heart transplantation.

We evaluated the following spirometric values: forced vital capacity (FVC), first second expiratory volume (FEV1), FEV1/FVC, the lung volumes, total lung capacity (TLC), residual volume (RV), and single breath diffusing capacity for CO in 22 patients, before and after heart transplant. We found abnormal pulmonary function in 21 patients before heart transplantation. Despite postoperative increases in lung volumes in 10 patients, abnormal pulmonary function persisted in 20 patients after heart transplant. Mean values for lung volumes and flow rates did not change but diffusion for CO decreased significantly after heart transplantation. Diffusion failed to correlate with ejection fraction, pulmonary arterial pressure, pulmonary capillary wedge pressure (PCWP), and pulmonary vascular resistance; however, in a subset of patients with improved postoperative lung volumes, preoperative diffusion for CO correlated with preoperative PCWP. We conclude that pulmonary function abnormalities are common among heart transplant recipients. Diffusion abnormalities are not linearly related to indices of cardiac function measured before transplantation and diffusion abnormalities appear to be multifactorial in cause. The posttransplant decrease in diffusion appears to result from the combined effects of decreased postoperative lung volumes in some patients and relief of heart failure induced pulmonary vascular engorgement in others. Improvement in lung volumes and flow rates may occur but cannot be expected after heart transplantation, and diffusion decreases after heart transplantation. The fact that pulmonary function and lung volumes do not improve following heart transplantation implies to underlying lung disease or permanent lung alterations result from chronic heart failure.

Adult↗
PubMed1993

Freud's brain: toward a unified neuropsychodynamic model of personality and psychotherapy.

Neuropsychological findings and principles are not by themselves sufficient to provide definitive answers to broad questions of personality, psychopathology, or psychodynamics, nor should they be seen as attempting to usurp other approaches. This review has briefly noted some of the directions in which neuropsychology is being applied to psychoanalysis and psychodynamic personality theory, as well as to clinical practice. The purpose of any model is to try to weave disparate observations and findings into a coherent theoretical framework that can be productively employed for further clinical and research purposes. To this end, the neuropsychodynamic approach can contribute. Man--as Freud recognized--is neither "organic" or "functional." He is both, and our commitment to psychological knowledge must entail a search for unities.

Brain↗
PubMed1993

An assessment of the risk of foreign animal disease introduction into the United States of America through garbage from Alaskan cruise ships.

The United States Department of Agriculture, Animal and Plant Health Inspection Service (USDA-APHIS) has been exploring methods of quantitative risk assessment to support decision-making, provide risk management options and identify research needs. With current changes in world trade, regulatory decisions must have a scientific basis which is transparent, consistent, documentable and defensible. These quantitative risk assessment methods are described in an accompanying paper in this issue. In the present article, the authors provide an illustration by presenting an application of these methods. Prior to proposing changes in regulations, USDA officials requested an assessment of the risk of introduction of foreign animal disease to the United States of America through garbage from Alaskan cruise ships. The risk assessment team used a combination of quantitative and qualitative methods to evaluate this question. Quantitative risk assessment methods were used to estimate the amount of materials of foreign origin being sent to Alaskan landfills. This application of quantitative risk assessment illustrates the flexibility of the methods in addressing specific questions. By applying these methods, specific areas were identified where more scientific information and research were needed. Even with limited information, the risk assessment provided APHIS management with a scientific basis for a regulatory decision.

Alaska↗
PubMed1993

Developing a quantitative risk assessment process.

The international animal health community is advocating a more widespread use of quantitative risk assessment in making international trade decisions. In this article, the authors explain why quantitative risk assessment is a valuable tool, outline a process with key steps for developing a quantitative risk assessment, and describe a method for quantifying the uncertainty associated with the results of a risk assessment.

Animal Diseases↗
PubMed1993

Standardization of nomenclature for animal health risk analysis.

The authors propose standard definitions for terms and concepts commonly used in agricultural risk analysis. The differences between risk analysis and risk assessment are explained, and the relationship of these two terms with the more familiar terms "epidemiology" and "biostatistics" is discussed. The authors stress the importance of differentiating words and phrases which share similar sounds but are subtly different, and the necessity of developing a common nomenclature in agricultural risk analysis. An opportunity is provided for readers to comment on the definitions presented.

Agriculture↗
PubMed1993

Options for small employers.

Although offering health benefits is very expensive, many employers (small, medium, and large) make health care purchasing decisions based on very little information. This is largely because employers have not taken the time to learn how to be knowledgeable health care purchasers. Higher health care costs result when employers: purchase programs and services that employees and their dependents do not need and seldom use; pay (unknowingly) for services not offered in their benefit plan; accept and pay for ineffective cost containment programs that increase (not decrease) health care costs (remember that cost containment is a business in itself); make standard recommended changes (e.g., increased copays or deductibles) to their benefit plans, hoping to reduce costs (the result has been higher costs for too many employees); fail to assess whether health plans and insurance companies have effective internal quality and cost management programs; use financial incentives to encourage employees and dependents to enroll in managed care plans without examining whether the health plan or insurer used quality criteria, high standards, and capable processes in developing provider networks. (Capable processes consistently deliver quality products or services.) Most health plans and insurance companies have chosen providers based on their willingness to discount their charges, which places all parties (health plans or insurance companies, employers, and patients) at risk. Most of the problems listed above could be avoided if small employers based their health care purchasing decisions on information obtained from a careful analysis of needs and expectations.(ABSTRACT TRUNCATED AT 250 WORDS)

Administrative Personnel↗