Biomedical subjects

L S Miller

Publications and source records attributed to L S Miller.

At least 37 records · Page 2Linked to original sources

PubMed1999

Endoscopic ultrasound in the evaluation of portal hypertension.

There is no question that EUS has a role in the imaging of gastric varices. EUS can be used to accurately differentiate thickened folds or submucosal lesions from varices. Its use in the evaluation of perigastric varices has progressed from the days in which EUS scopes were used, but were not as sensitive as endoscopy, to the current use of EUS probes, which very accurately measure the radius and the wall thickness (WT) of esophageal varices. These probes can locate varices not seen at endoscopy and can be used to calculate the variceal WT. EUS has been used to predict which patients will respond to therapy and which will not and it can be used to assess the results of therapeutic intervention. EUS of periesophageal varices may also be used to predict which patients will and will not respond to therapy. Although the use of EUS imaging in the evaluation of varices is still in its infancy, it holds great promise for the future.

Endosonography↗

PubMed1998

Simultaneous endoluminal sonography and manometry to assess anal sphincter complex in normal subjects.

The purpose of this study was to use simultaneous anal manometry and high-frequency endoluminal ultrasonography (EUS) to determine the relationship between resting anal pressure and cross-sectional area of the internal and external anal sphincters. Eleven normal subjects underwent simultaneous anal EUS and manometry using catheters containing both pressure ports and ultrasound transducers. Resting pressure and cross-sectional area of the sphincters were made throughout the anal sphincter complex. The length of the internal anal sphincter (IAS) by sonography (27+/-5 mm) was significantly less than the length of the high pressure zone (HPZ) by manometry (44+/-8 mm; P < 0.001). Maximum IAS cross-sectional area (CSA) occurred 10+/-6 mm proximal to the peak resting pressure. The resting anal pressure correlated with external anal sphincter (EAS) CSA (r = 0.77), but not with IAS CSA (r = -0.17). The sum of EAS CSA and IAS CSA correlated strongly with resting pressure (r = 0.85). In conclusion, the IAS is shorter than the HPZ, with a significant distance separating maximum IAS CSA from peak resting pressure. The sum of the IAS and EAS CSAs, but not that of the IAS alone, correlated with resting pressure. Thus, this study suggests that the EAS, in addition to the IAS, contributes to resting anal pressure.

Adult↗

PubMed1998

Expenditures for treating schizophrenia: a population-based study of Georgia Medicaid recipients.

The study analyzed all claims data for reimbursable medical services and drugs rendered to 18- to 50-year-old Medicaid recipients in the State of Georgia over a 3-year period. A cohort of 6,443 schizophrenia patients were identified by inspecting the medical history data for claims indicative of schizophrenia (ICD-9-CM 295.xx). A crude prevalence of 6.02 percent was identified. Use patterns and charges associated with schizophrenia were stratified by major areas of service including ambulatory services, hospitalizations, and pharmacological treatment. The incidence of rehospitalization for chronic schizophrenia patients based on a 12-month hospitalization index format was also identified. Findings are discussed regarding using these data to focus strategies for assessing schizophrenia treatment outcome in relation to treatment cost.

Adult↗

PubMed1998

In vivo comparison of esophageal varices at and above the diaphragmatic high pressure zone using high resolution endoluminal sonography.

Our objective in this study was to use high resolution endoluminal sonography to compare the size of esophageal varices within 5 cm of and at the esophageal high pressure zone. We carried out the study in 36 patients with endoscopically proven esophageal varices. A 20-MHz 6.2F ultrasound catheter was passed through a 34F endoscope and used to image esophageal varices as it was slowly withdrawn through the high pressure zone (the level at which the diaphragm was imaged) and into the body of the esophagus approximately 5 cm above the high pressure zone. All images were captured on videotape and reviewed by one of the investigators. The mean, total, and percent cross-sectional surface areas occupied by varices were calculated and then compared within 5 cm and at the esophageal high pressure zone. Six of 36 (17%) patients had no varices imaged at the high pressure zone but did have varices imaged in the distal esophagus. The mean cross-sectional surface area per varix at the high pressure zone (0.036+/-0.006 cm2) was significantly less (p < or = 0.0001) than the mean cross-sectional area per varix 5 cm above the high pressure zone (0.142+/-0.018 cm2). The average total cross-sectional surface area occupied by varices at the high pressure zone (0.137+/-0.034 cm2) was significantly less (p < 0.0001) than the average cross-sectional surface area occupied by varices 5 cm above the high pressure zone (0.672+/-0.080 cm2). The mean percent esophageal wall cross-sectional surface area occupied by varices at the high pressure zone (16%) was significantly less (p < or = 0.0001) than 5 cm above the high pressure zone (49%). We conclude that the mean, total, and percent cross-sectional surface areas of esophageal varices at the high pressure zone are significantly less than those 5 cm above the high pressure zone.

Endosonography↗

PubMed1998

Caffeine, but not time of day, increases whole-arm physiological tremor in non-smoking moderate users.

1. Consumptive levels of caffeine significantly increased whole-arm physiological tremor in young adult males at 3 but not 1 mg caffeine/kg bodyweight. 2. Physiological tremor was not affected by time of day (TOD) or the interaction of caffeine and TOD. 3. Findings suggest that ingestion of a single oral dose of caffeine at typical consumptive levels results in measurable changes in physiological functioning and that whole-arm physiological tremor is a sensitive measure of physiological change due to drug effects. 4. However, the results suggest that whole-arm physiological tremor may not detect reliably TOD changes in functioning.

Adult↗

PubMed1998

Benign nonpeptic esophageal strictures. Diagnosis and treatment.

This article studies the causes and treatment of benign nonpeptic esophageal strictures. The authors also discuss various therapeutic techniques for esophageal strictures, including esophageal dilatation with various dilators and balloons. Although the goals of stricture therapy are to relieve dysphagia and prevent stricture reoccurrence, only the first of these goals (effective dilatation with bougienage or balloon dilatation) has been achieved. The prevention of stricture reoccurrence remains to be achieved.

Dilatation↗

PubMed1998

Health economics and cost implications of anxiety and other mental disorders in the United States.

BACKGROUND: Mental disorders impose a multi-billion dollar burden on the economy each year; translating the burden into economic terms is important to facilitate formulating policies about the use of resources. METHODS: For direct costs, data were obtained from national household interview and provider surveys; for morbidity costs, a timing model was used that measures the lifetime effect on current income of individuals with mental disorders, taking into account the timing of onset and the duration of these disorders, based on regression analysis of Epidemiologic Catchment Area study data. RESULTS: The total economic costs of mental disorders amounted to US$147.8 billion in 1990. Anxiety disorders are the most costly, amounting to $46.6 billion, or 31.5% of the total; schizophrenic disorders accounted for $32.5 billion, affective disorders for $30.4 billion, and other mental disorders for $38.4 billion. CONCLUSIONS: Mental illnesses, especially anxiety disorders, are costly to society. Although anxiety disorders have a higher prevalence than affective disorders and schizophrenia, use of medical care services is lowest for anxiety disorders. Anxiety disorders appear to be under-recognised and untreated even though treatment interventions have been shown to be effective and can be delivered in a cost-efficient manner.

Anxiety Disorders↗

PubMed1997

Neuroendocrine response to fenfluramine challenge in boys. Associations with aggressive behavior and adverse rearing.

BACKGROUND: There is evidence of relationships among serotonin, aggressive behavior, and a childhood history of socially adverse-rearing conditions. This study examines the prolactin response to fenfluramine hydrochloride challenge in young boys who show clinically significant aggressive behavior or who are raised in a social environment that is conducive to the development of chronic aggression. METHODS: A series of 34 younger brothers of convicted delinquents underwent standardized psychiatric and observation-based assessments of their social-rearing environments that were conducted during home visits. Approximately 2 years later, these boys underwent a reassessment of psychiatric status and an assessment of central serotonergic activity using the fenfluramine challenge procedure. RESULTS: Increasing degrees of aggressive behavior at either assessment were positively correlated with the prolactin response to fenfluramine challenge. Furthermore, adverse-rearing circumstances that were conducive to the development of aggressive behavior also exhibited positive correlations with the prolactin response. This association between adverse rearing and the prolactin response was statistically independent of that between aggression and the prolactin response. CONCLUSION: In young boys, aggressive behavior and social circumstances that are conducive to the development of aggressive behavior are positively correlated with a marker of central serotonergic activity.

Aggression↗

PubMed1997

High-resolution endoluminal sonography is a sensitive modality for the identification of Barrett's metaplasia.

BACKGROUND: The "gold standard" and only accurate method for diagnosing Barrett's esophagus is by esophagogastroduodenoscopy with biopsy. We evaluated the ability of high-resolution endoluminal sonography (HRES) to detect the mucosal changes in Barrett's esophagus. METHODS: Seventeen patients with documented Barrett's and 12 normal controls underwent endoscopy with HRES examination using a 20 MHz ultrasound transducer to evaluate for mucosal changes. HRES examinations were videotaped then reviewed by an unblinded investigator to identify criteria possibly diagnostic of Barrett's and then by a blinded investigator to test the validity of these criteria. Barrett's was diagnosed by HRES if the second hypoechoic layer appeared thicker than the first hyperechoic layer of the mucosa. Normal mucosa was defined as having a pencil-thin second hypoechoic layer on HRES. Measurements of the second hypoechoic layer were made using a computer and compared in patients with Barrett's and patients with normal esophagus. RESULTS: All 17 patients with Barrett's were correctly identified by HRES (sensitivity 100%). Ten of 12 controls were correctly identified as normal (specificity 86%). There was good correlation between HRES and pathologic diagnoses (r 0.86). The second hypoechoic layer was significantly thicker in Barrett's patients than in normal controls (p < .001). CONCLUSIONS: HRES is a sensitive new method for identifying Barrett's esophagus. However, dysplasia could not be identified by HRES in this study.

Barrett Esophagus↗

PubMed1997

Gender and impulsivity differences in licit substance use.

Gender differences in ratings of impulsivity have shown increased impulsivity in men. Research also suggests higher impulsivity is correlated with increased use of alcohol, nicotine, and caffeine. In a large sample of young adults (N = 332), self-report data were collected on licit substance use and impulsivity/nonconformity. Among men, significant differences were found between higher and lower impulsivity groups for alcohol and caffeine use but not for nicotine use. Among women, significant differences were found between higher and lower impulsivity groups for alcohol and nicotine use but not for caffeine use. The data suggest the importance of recognizing gender differences in the relationship between personality factors and licit substance use.

Adult↗

PubMed1997

Teacher ratings of hyperactivity, inattention, and conduct problems in preschoolers.

Age and sex norms of classroom behavior in preschoolers were established on a standard measure, the Revised Conners Teacher Rating Scale, and the utility of this measure for assessing problem behavior in preschoolers was examined. Teachers provided ratings for 455 nonreferred preschoolers. In addition, ratings were obtained for 12 clinically referred preschoolers diagnosed with attention deficit hyperactivity disorder. The Conduct Problems, Inattention, and Hyperactivity subscales, as well as the Hyperactivity Index, were found to have good internal reliability and were related to each other in predictable ways. Normative data are presented by age and sex. Age was inversely related to scores for the Conduct Problems subscale, the Hyperactivity subscale and the Index. Sex was a significant predictor of subscale scores, with boys receiving higher scores than girls. Subscale scores and nearly all item scores were highly significantly different between clinically referred and nonreferred preschoolers. The results provide a standard upon which to evaluate preschool-aged children in clinical and research settings.

Attention Deficit Disorder with Hyperactivity↗

PubMed1997

Verbal dichotic listening in boys at risk for behavior disorders.

OBJECTIVE: The association between deficits in verbal processing skills and disruptive psychopathology remains one of the most frequently replicated findings in all of child psychiatry. This study uses a dichotic consonant-vowel listening test to examine the potential neural basis for this association. METHOD: A series of 87 young boys recruited from a sample at risk for disruptive disorders received standardized psychiatric, neuropsychological, and language skills assessments. Approximately 1 year later, these boys received a reassessment of their psychiatric status and a test that assesses the neural basis of language-processing ability, a dichotic consonant-vowel listening test. RESULTS: Disruptive psychopathology predicted reduced right ear accuracy for dichotic syllables, indicative of a deficit in left hemisphere processing ability. Deficits in reading and language ability also correlated with right ear accuracy for dichotic syllables. CONCLUSIONS: Boys with disruptive behavior disorders, relative to at-risk but nondisruptive boys, exhibit a deficit in verbal processing abilities on dichotic listening tasks. This deficit in verbal processing ability is also manifested as low scores on standardized tests of reading achievement and language comprehension.

Brain↗

PubMed1996

Economic costs of anxiety disorders.

Anxiety disorders are estimated to affect 26.9 million individuals in the United States at some point during their lives. This study used the human capital approach to estimate the direct and indirect costs of these highly prevalent disorders. In 1990, costs associated with anxiety disorders were $46.6 billion, 31.5% of total expenditures for mental illness. Less than one-quarter of costs associated with anxiety disorders were for direct medical treatment; over three-quarters were attributable to lost or reduced productivity. Most of these indirect costs were associated with morbidity, as mortality accounted for just 2.7% of the total. Greater availability of effective, relatively low-cost outpatient treatment could substantially reduce the economic and social burden of these common and often crippling disorders.

Absenteeism↗

PubMed1996

Comparison of high-resolution endoluminal sonography to video endoscopy in the detection and evaluation of esophageal varices.

High-resolution endoluminal sonography (HRES) was used to image and measure esophageal varices in control subjects and patients with portal hypertension and compared with endoscopic findings. Nine control patients and 68 patients with known cirrhosis or noncirrhotic portal hypertension underwent videotaped HRES and videotaped esophagoscopy (EGD). Two blinded investigators reviewed the videotapes to determine the presence and size of the largest esophageal varix in each patient. The largest varix by HRES was measured with the esophagus at rest at a point where the varix appeared most circular. The largest varix seen on EGD was graded on a 5-point scale. All nine of the control patients were correctly identified by both EGD and HRES as grade I (no varices). Eight of the 10 patients with no varices seen on EGD had varices identified by HRES. The interobserver correlation for HRES was r = .88 and for EGD was r = .79. The correlation between EGD and HRES was r = .50. High resolution endoluminal sonography allows quantitative measurement of variceal size, is a more sensitive and reproducible imaging modality than esophagoscopy for the detection and sizing of esophageal varices. There is poor correlation between monographic measurement and endoscopic grading of esophageal varices. Assessment of esophageal variceal presence and the measurement of variceal size by high resolution endoluminal sonography is an accurate, reproducible method of determining the size of esophageal varices.

Adult↗

PubMed1996

Treatment of symptomatic nonachalasia esophageal motor disorders with botulinum toxin injection at the lower esophageal sphincter.

The purpose of this study was to determine if botulinum toxin injection at the lower esophageal sphincter improves symptoms in patients with nonachalasia spastic esophageal motility disorders. Fifteen patients with nonachalasia spastic esophageal motility disorders (diffuse esophageal spasm, nonspecific esophageal motility disorders, and lower esophageal sphincter dysfunction) unresponsive to medical therapy underwent endoscopic injection of botulinum toxin at the level of the gastroesophageal junction. Symptoms were scored (0 = no symptoms, 1 = mild, 2 = moderate, 3 = severe and 4 = very severe) before treatment, at seven days and every 30 days after treatment. There was significant improvement in chest pain, dysphagia, and regurgitation at 7,30,60 and 90 days after treatment. At one month after treatment, 11 of 15 (73%) patients had a good or excellent response to treatment. At the last patient interview (mean follow-up of 10.6 months), five (33%) patients continued to have a good to excellent response, whereas 10 (67%) underwent subsequent treatment with repeat botulinum toxin, pneumatic dilation, or bougienage. We conclude that botulinum toxin injection at the gastroesophageal junction leads to significant symptom improvement in patients with nonachalasia esophageal motility disorders. These results suggest that botulinum toxin may be an effective treatment option in some of these patients not responsive to conventional medical therapy.

Adolescent↗

PubMed1996

Use of high-resolution endoluminal sonography to measure the radius and wall thickness of esophageal varices.

BACKGROUND: Measurement of variceal wall tension theoretically provides the most accurate method of predicting future variceal bleeding. Using high-resolution endoluminal sonography in 45 patients with known portal hypertension, we measured and correlated the two previously unmeasured variables involved in the calculation of variceal wall tension (radius and wall thickness) by the Laplace equation. METHODS: A 20 MHz 6.2F ultrasound transducer was used to image esophageal varices during standard esophagoscopy. All images were captured on videotape and later reviewed by two blinded investigators. Outer and inner variceal wall circumferences were measured at a cross section of each varix. The radius of each varix and the variceal wall thickness were calculated. The radius of each varix was then correlated with its wall thickness. The interobserver and intraobserver variabilities were measured. RESULTS: The mean variceal radius was .86 +/- .34 cm for the inner radius and 1.48 +/- .41 cm for the outer radius; mean variceal wall thickness was .099 +/- 0.037 cm. Intraobserver and interobserver correlation for the radius was r = .98 and r = .97, respectively. The intraobserver and interobserver correlations for the wall thickness were r = .92 and r = .91, respectively. Variceal radius did not correlate with the wall thickness of the varix. CONCLUSIONS: High-resolution endoluminal sonography provides a method for the accurate measurement of esophageal variceal radius and wall thickness. Variceal radius does not correlate with variceal wall thickness, implying that variceal wall tension cannot be accurately estimated by measurement of variceal size alone. Combining these data with measurements of variceal pressure should allow for the direct determination of wall tension and, subsequently, identification of patients at risk for variceal bleeding.

Adult↗

PubMed1996

Use of high-resolution endoscopic ultrasonography to assess esophageal wall damage after pneumatic dilation and botulinum toxin injection to treat achalasia.

OBJECTIVE: The purpose of this study was to utilize high-resolution endoscopic ultrasonography to assess esophageal wall damage in patients with achalasia treated by either pneumatic dilation or botulinum toxin injection and to compare their symptomatic response. METHODS: Twenty-nine patients were treated with pneumatic dilation (11) or botulinum toxin injection (18) in a nonrandomized, controlled manner. An achalasia balloon dilator inflated at the gastroesophageal junction was used for dilation. Botulinum toxin was injected during endoscopy into the gastroesophageal junction. Endoscopic ultrasonography was performed at the level of the diaphragm before, immediately after, and 24 hours after treatment. Symptoms were assessed before and 7, 30, 60, and 90 days after therapy. RESULTS: The mucosal-submucosal thickness increased significantly immediately after pneumatic dilation, but normalized by 24 hours. No significant change in mucosal-submucosal thickness occurred after botulinum toxin injection. No significant alteration in muscularis propria thickness was observed after either procedure. Dysphagia and regurgitation improved significantly at 7, 30, 60, and 90 days after both procedures. CONCLUSIONS: Pneumatic dilation produced transient thickening of the mucosa-submucosa, but no thickening or breaks in the muscularis propria. This transient wall damage suggestive of edema was not seen after botulinum toxin injection. Over a 3-month period, botulinum toxin was equivalent to pneumatic dilation in relieving dysphagia and regurgitation in patients with achalasia.

Adolescent↗

PubMed1996

PSA divergence. A new parameter for the accurate longitudinal assessment of prostatic disease.

Prostate-specific antigen (PSA) and the various parameters derived utilizing this marker have increased our ability to diagnose early prostatic disease; however, their accuracy in identifying the etiology of the disease remains somewhat limited. We propose a new PSA derivative, termed "PSA divergence" (PSADI), defined as the change in serum PSA over time (years) divided by the change in prostatic volume over time (years), to more accurately distinguish benign, premalignant, and malignant prostatic diseases. In this study, we evaluated 160 subjects with a PSA >4.0 ng/ml who were found by transrectal ultrasound-guided biopsy (TRUS) to have either benign prostatic hyperplasia or prostatic intraepithelial neoplasia. These men were followed at 6 or 12 months with serial PSA, digital rectal exam (DRE), and TRUS with rebiopsy. Data analysis demonstrated a statistically significant (p < 0.05) correlation between PSADI and each final pathologic outcome, suggesting that PSADI is useful in distinguishing among intraepithelial neoplasia and benign and malignant prostatic disease.

Aged↗