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Biomedical subjects

L Miller

Publications and source records attributed to L Miller.

At least 145 records · Page 8Linked to original sources
PubMed1996

Comparison of efficacy of sulbactam: ampicillin to ampicillin and saline for treatment of experimentally induced Escherichia coli diarrhea in neonatal calves.

A study was conducted to compare the efficacy of sulbactam: ampicillin (SAMP) (3.3:6.6 mg/kg body weight (BW), IM, q24 h) to that of ampicillin trihydrate (AMP) (6 mg/kg BW, IM, q24 h) and 0.9% saline (SAL) (3 mL IM, q24 h) for the treatment of diarrhea in calves induced by oral inoculation with Escherichia coli strain B44 (O9:K30:K99:H-). Treatment was initiated when severe diarrhea was noted (T0) and continued for at least 3 d; or for 24 h after clinical signs resolved; or for a maximum duration of 7 d. Starting at T0, calves were examined twice daily: appetite; rectal temperature (TEMP); and fecal consistency (FECAL), mental status (ATTD), eye position (EYE), and skin elasticity (SKIN) scores were recorded. Feces collected at T0 were submitted for bacteriology, electron microscopy, and parasitology. A complete blood count was performed at T0 and T3 (24 h after third treatment). Severely dehydrated, depressed, and anorexic calves were euthanized and considered mortalities. Cause of death was determined by post mortem examination. A total of 30 calves were included in the study. Three calves were excluded from final analysis. E. coli strain B44 was cultured from feces of all calves at T0. At T2 (24 h after second treatment) mean TEMP of SAMP calves was significantly higher (P < 0.05) than mean TEMP of SAL calves; EYE and SKIN scores of SAMP calves were significantly lower (P < alpha beta = 0.025) than those of SAL and AMP calves; and ATTD and FECAL scores of SAMP calves were significantly lower (P < alpha beta = 0.025) than in SAL calves. At T3, SAMP calves had significantly lower (P < 0.05) mean hematocrit than SAL calves and lower mean total plasma protein concentration than AMP and SAL calves. Mean fibrinogen concentration in SAMP calves at T3 was significantly lower (P < 0.05) than that of calves receiving either SAL or AMP. The number of surviving SAMP calves (10/10) was significantly higher (P < alpha beta = 0.025) than the number of surviving SAL calves (2/9), but not significantly different from the surviving AMP calves (3/8).

Ampicillin↗
PubMed1996

Rehabilitation of acute and subacute low back and neck pain in the work-injured patient.

In spite of the favorable natural history and the nonserious nature of the problem of much work-related low back and neck pain, conventional rehabilitation methods have failed to reduce work disability. Recently, rehabilitation goals have shifted from exclusively reducing or eradicating pain to improving patients' work and activity tolerance, avoiding illness behaviors, and preventing deconditioning and chronicity. Rehabilitation programs must incorporate strategies that have been proved to improve outcome in randomized, controlled trials. Treatment should be based on duration of symptoms, severity of impairment, and patient response. Consideration must be given to physical and psychological therapeutic milieu. Acute patients should be educated that pain is a normal part of recovery, and that activity maintenance improves outcome. Therapy should focus on restoring or maintaining flexibility, strength, and level of fitness while maintaining maximum productivity. Some acute patients may wish to change health habits and may undergo several sessions of general and low back conditioning training with the development of a health-club or home maintenance regimen. Patients failing to respond favorably to acute treatment and other subacute patients should participate in quota-based graded exercise regimens, with behavioral management. Quantification of function for flexibility, trunk strength, lifting capacity, and cardiovascular fitness is recommended to document progress and guide treatment. "Wellness" is stressed. Incorporating direct return-to-work advice into the treatment plan is important, as is direct communication with the employer throughout treatment. Patients should be cleared for full-duty return to work at treatment end in most circumstances. Successfully managed patients will feel confident about abilities for work and general activities. Intensive management of subacute patients may require 4 to 6 weeks and 12 to 18 comprehensive rehabilitation sessions. Once such comprehensive treatment has been provided, patients may be deemed at a medical endpoint, and further "chronic" rehabilitation treatment should not be necessary. The rehabilitation principles discussed here for work-injured low back and neck pain patients may be used to treat other industrial injuries as long as medical clearance is given for applying the treatment model. Specific time frames for recovery and expected performance for specific diagnoses need to be developed.

Acute Disease↗
PubMed1996

Maintaining esthetic restorations in the periodontal practice.

Esthetic dentistry comprises one of the most rapidly growing segments of our profession, and patients receiving this type of treatment are often maintained on an alternating schedule. Improper maintenance care can quickly destroy many of these restorations. This article will serve as a resource for dental professionals who wish to offer these special patients customized maintenance care.

Aluminum Oxide↗
PubMed1995

Tissue-specific in vivo protein-DNA interactions at the promoter region of the Xenopus 63 kDa keratin gene during metamorphosis.

The Xenopus 63 kDa keratin gene is developmentally regulated and is expressed only in the epidermis. Full activation of the 63 kDa keratin gene requires two regulatory steps, the first independent and the second dependent on the thyroid hormone triiodothyronine (T3). Sequence analysis of a genomic clone of the 63 kDa keratin gene identified potential AP2 and SP1 binding sites upstream of the transcription initiation site. Electrophoretic mobility shift assays using purified or enriched proteins, as well as HeLa nuclear extract in conjunction with AP2- and SP1-specific antibodies, have been used to demonstrate that human AP2 and SP1 bind elements upstream of the transcription initiation site. In vivo footprinting with ligation mediated PCR revealed several footprints, within 350 bp upstream of the transcription initiation site, including those at the AP2 and SP1 sites, that are unique to epidermal cells which express the keratin gene. These footprints were absent in blood cells and XL177 cells which do not express the gene. Comparison of footprints between cells which express the 63 kDa keratin gene at low or high levels showed that the same binding sites are occupied, indicating that these sites are required for basal as well as T3-induced expression of the 63 kDa keratin gene.

Animals↗
PubMed1995

A phase I study of sequential versus concurrent interleukin-3 and granulocyte-macrophage colony-stimulating factor in advanced breast cancer patients treated with FLAC (5-fluorouracil, leucovorin, doxorubicin, cyclophosphamide) chemotherapy.

Cumulative thrombocytopenia is a dose-limiting toxicity of dose-intensive chemotherapy for advanced breast cancer. In this phase I study, we have studied the hematologic toxicity associated with sequential interleukin-3 (IL-3) and granulocyte-macrophage colony-stimulating factor (GM-CSF; molgramostim) administration after multiple cycles of FLAC (5-fluorouracil, leucovorin, doxorubicin, cyclophosphamide) chemotherapy compared with that after concurrent cytokine administration or to each cytokine administered alone. Ninety-three patients with advanced breast cancer were treated with five cycles of FLAC chemotherapy and either IL-3 alone, GM-CSF alone, sequential IL-3 and GM-CSF administered by schedule A (5 days of IL-3 followed by 10 days of GM-CSF) or schedule B (9 days of IL-3 followed by 6 days of GM-CSF), or concurrent administration of IL-3 and GM-CSF for 15 days. Cohorts of patients were treated with one of four dose levels of IL-3 (1,2.5, 5, and 10 micrograms/kg) administered subcutaneously for each schedule of cytokine administration. The GM-CSF dose in all schedules was 5 micrograms/kg/day. Sequential IL-3 and GM-CSF (schedule B) was associated with higher platelet nadirs, shorter durations of platelet counts less than 50,000/microL, and the need for fewer platelet transfusions over five cycles of FLAC chemotherapy compared with concurrent cytokines, sequential IL-3 and GM-CSF schedule A, and GM-CSF alone. Concurrent IL-3 and GM-CSF was associated with unexpected platelet toxicity. The duration of granulocytopenia after FLAC chemotherapy was significantly worse with IL-3 alone compared with each of the GM-CSF-containing cytokine regimens. Although no cycle 1 maximum tolerated dose for IL-3 was defined in this study, 5 micrograms/kg was well tolerated over multiple cycles of therapy and is recommended for future studies. The data from this phase I study suggest that sequential IL-3 and GM-CSF with IL-3 administered for 9 days before beginning GM-CSF may be superior to shorter durations of IL-3 administered sequentially with GM-CSF, to concurrent IL-3 and GM-CSF, and to either colony-stimulating factor alone in ameliorating the cumulative hematologic toxicity associated with multiple cycles of FLAC chemotherapy. Additional studies of sequential IL-3 and GM-CSF are warranted.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1995

Peripheral blood stem cell transplants for multiple myeloma: identification of favorable variables for rapid engraftment in 225 patients.

Transfusion of autologous peripheral blood stem cells (PBSCs) of good quality ensures fast hematopoietic engraftment after myeloablative therapy with a decrease in procedure-related morbidity and mortality. We have analyzed variables influencing the kinetics of engraftment, and therefore reflecting the quality of PBSC collections, in 225 patients with newly diagnosed or refractory multiple myeloma (MM) who received an autotransplant in support of high dose melphalan (200 mg/m2); 132 of these patients also completed a second transplant. All PBSCs were collected before the first transplant after high-dose cyclophosphamide (6 g/m2) and hematopoietic growth factors, mainly granulocyte-macrophage colony-stimulating factor. PBSCs were administered either alone (91 patients) or with bone marrow (134 patients). A highly significant correlation was observed between the number of CD34+ cells per kilogram infused and prompt recovery of both granulocytes (P = .0001) and platelets (P = .0001). After correction for the proportion of patients with > or = 2 x 10(6)/kg CD34 PBSCs infused and with < or = 12 months of prior therapy, no difference in engraftment kinetics was seen between patients receiving PBSCs only and those also receiving bone marrow. Exposure to chemotherapy, even to < or = 6 months of alkylating agents, significantly delayed hematopoietic recovery posttransplantation. The threshold dose of CD34 cells necessary for prompt engraftment was > or = 2.0 x 10(6)/kg for patients with < or = 24 months of chemotherapy before the first transplant, whereas greater than 5 x 10(6)/kg CD34 cells were required to assure rapid recovery also in those with longer exposure. Such quantities, easily collected in the large majority of patients with shorter exposure (91%), were obtained in only 28% of patients with more than 24 months of prior chemotherapy. Rapid platelet recovery within a narrow range of time (before day 14) was almost invariably seen (94%) when greater than 5 x 10(6)/kg CD34 cells were infused, irrespective of the duration of prior therapy, whereas the range widened progressively when less CD34 cells were infused. In the absence of CD34 measurements, fast recovery of platelets to greater than 50 x 10(9)/L within 14 days after high-dose cyclophosphamide and < or = 12 months of prior chemotherapy were the best predictors of early engraftment. Prudent use of stem cell-damaging agents, such as melphalan and nitrosoureas, is recommended in MM patients who might be candidates for autotransplantation. Alternatively, PBSCs should be collected early after diagnosis.

Adult↗
PubMed1995

Clinical correlates of Alzheimer's disease with and without silent radiographic abnormalities.

OBJECTIVE: To determine whether patients with Alzheimer's disease (AD) who do not have historical or clinical evidence of stroke but who do have computed tomographic or magnetic resonance imaging evidence of noncortical lesions smaller than 2 cm or periventricular "caps" differ from other patients with AD. METHODS: The computed tomographic or magnetic resonance imaging scans of 158 patients meeting criteria of the National Institute of Neurological Disorders and Stroke-Alzheimer's Disease and Related Disorders Association for probable AD were reviewed by one neuroradiologist. Two measures of disease severity--the Modified Mini-Mental State examination and the Blessed Dementia Rating Scale (Part I)--were subjected to two-way analysis of variance with scan type (computed tomography or magnetic resonance imaging) and lesion number as between-group factors and age and disease duration as covariates. RESULTS: No relationship was seen between lesion number or periventricular caps and disease severity. CONCLUSION: In this cross-sectional analysis using these clinical measures, patients with AD who have well-defined radiographic abnormalities cannot be differentiated from patients with AD who do not have them.

Adult↗
PubMed1995

Pontine ischemic rarefaction.

To investigate apparently asymptomatic, bilateral symmetrical predominantly pontine hyperintensities (PHI) on magnetic resonance imaging (MRI) scans in elderly patients, we examined the pons histopathologically in two brains of elderly hypertensives with PHI, and in three without PHI, on postmortem MRI scans. We also reviewed 85 serial in vivo MRI scans of patients over 60 and compared scan findings, vascular risk factors, and clinical symptoms between patients with PHI and a control group. A subcortical arteriosclerotic encephalopathy (SAE)-like pathology was present in the pons in only the two autopsy brains with PHI and corresponded with the location of PHI on the postmortem MRI scans and with the most frequent sites of PHI on in vivo scans. SAE also involved the hemispheric white matter in one of the autopsy brains. Five of 16 (31%) patients with, and 4 of 69 (6%) without, PHI on in vivo MRI scans had marked periventricular hyperintensity (PVHI) compatible with SAE (p = 0.01). We conclude that an SAE-like pathology may be seen in the pons in elderly hypertensives and this pathology is probably the cause of PHI seen on MRI scans of patients over 60 years of age.

Aged↗
PubMed1995

Concomitant sclerosing mesenteritis and inflammatory pseudotumor simulating gastric lymphoma or linitis plastica.

Both inflammatory pseudotumors and sclerosing (retractile) mesenteritis are uncommon conditions of unknown origin. A number of authors have reported patients presenting with complaints that were attributed to one or the other of these entities. In our review of the literature, we were unable to find a single case report of mixed abdominal findings that could be explained by the presence of both conditions. We report a case of the patient presenting with abdominal mass that was identified as having features of both sclerosing mesenteritis and inflammatory pseudotumor on pathologic diagnosis.

Diagnosis, Differential↗
PubMed1995

Synaptic linkages between red nucleus cells and limb muscles during a multi-joint motor task.

The magnocellular red nucleus (RNm) becomes highly active when a monkey reaches to grasp an object. However, the only spike-triggered averaging studies of the RNm to date have been restricted to a simple wrist tracking paradigm and electromyographic (EMG) measurements of muscles of the forearm. We have now measured EMG signals from a large number of muscles throughout the shoulder, arm, forearm, and hand during a variety of tasks, including unconstrained reaching and grasping movements. Relations between these EMG signals and single-unit activity were assessed by on-line spike-triggered averaging and revealed significant post-spike effects among muscles of the shoulder and proximal arm, as well as intrinsic hand muscles. Although there remained a strong bias toward the extensor muscles of the forearm, as has been shown earlier, these results reinforce the importance of the RNm in the control of coordinated, whole-limb reaching movements.

Animals↗
PubMed1995

The human face of elderly care?

Communication and interactions between nurses and patients with dementia of the Alzheimers type is often inadequate. It would be inappropriate to suggest that nursing staff make no effort to communicate with patients who have dementia, but the communication difficulties that confront them require that a conscious effort is made to invest extra energy to provide meaningful communication. A number of interactive approaches are used by staff, traditionally those of reality orientation, behaviour modification, reminiscence therapy, and more recently, music therapy, touch therapy and aromatherapy. This paper overviews one other therapy which specifically addresses the communication needs of patients who suffer from dementia of the Alzheimers type, validation therapy.

Aged↗
PubMed1995

Progressive pulmonary cryptococcosis in a patient who is immunocompetent.

Pulmonary cryptococcal disease can have variable clinical and roentgenographic presentations. Symptoms and radiographic abnormalities can resolve prior to therapy, even in a patient who is immunocompromised. Antifungal therapy is generally not recommended for a patient who is immunocompetent with nonprogressive, nondisseminated pulmonary cryptococcosis. We present a case of pulmonary cryptococcosis that progressed despite fluconazole therapy in a patient who was immunocompetent. This appears to be the second reported case of a discrete endobronchial cryptococcoma.

Cryptococcosis↗
PubMed1995

Factors in the quality of patient evaluations in general hospital psychiatric emergency services.

OBJECTIVES: The study examined the usefulness of a three-perspective model for determining the quality of evaluations in psychiatric emergency services. The model was used to evaluate the hypothesis that the provision of high-quality care in emergency services is primarily influenced by service objectives related to patients' clinical characteristics rather than by institutional constraints, such as workload or physical facilities, or by social biases, such as clinicians' attitudes toward patients or perceptions of community expectations. METHODS: The evaluation of 683 persons assessed in nine California public facilities were independently observed. Multivariate techniques were used to test the relative importance of patients' clinical characteristics, possible sources of social bias among clinicians, and institutional constraints in influencing three quality-of-care dimensions: technical quality, the art of patient care, and optimum investment of time. RESULTS: The findings generally confirmed the hypothesis that patients' clinical characteristics have more influence on the quality of care provided than institutional constraints or social biases. However, one institutional constraint--increased workload demands--led to reduced technical quality and to less than optimal use of time. Further, social biases reflected in the clinician's like for and preconceptions about the patient also influenced the quality of their evaluations. CONCLUSIONS: The model is a useful tool for examining quality of care in the psychiatric emergency service. Increasing workload pressures negatively affect quality of care.

Attitude of Health Personnel↗
PubMed1995

Establishing partnerships with family caregivers. Local and cosmopolitan knowledge.

Families now provide most of the care received by older people in the United States. Proposed changes in the health care system will mean that families must take an even greater role in delivering health care. It is crucial that nurses practicing in a variety of settings be prepared to establish partnerships with family caregivers in order to attend to the long-term care needs of older people.

Aged↗
PubMed1995

Coronary artery stenting in active duty soldiers.

The treatment of coronary artery disease in young patients must take into account the long-term success of the treatment modality and the possibility of repeat interventions. Elective placement of Palmaz-Schatz coronary stents have been shown to reduce six month restenosis rates in discrete, de novo lesions in native coronary arteries albeit at a significant risk of bleeding and vascular complications. The present study was undertaken to evaluate the role of intracoronary stenting in young active duty soldiers. Between March 1988 and December 1994, fifteen active duty soldiers (age 37 to 53 years) underwent elective placement of one or more Palmaz-Schatz coronary stents at our institution. Angiographic success was 100% with no complications (acute/subacute closure, bleeding requiring transfusion, vascular repair, myocardial infarction, death, or in-hospital coronary artery bypass grafting). Six month angiographic follow-up is available in 13 patients (87%) with angiographic restenosis in one patient (8%) and no target vessel revascularization at six months. Clinical follow-up is available on all patients at a mean of 33 months (range 6-65) after the procedure. There was one death (7%) attributed to progression of coronary disease in another vessel and one patient (7%) who underwent target vessel revascularization for silent ischemia at 24 months after the procedure. These preliminary encouraging results suggest there may be a significant role for intracoronary stenting in active duty soldiers with coronary artery disease.

Adult↗