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Biomedical subjects

M H Miller

Publications and source records attributed to M H Miller.

At least 73 records · Page 4Linked to original sources
PubMed1989

The scleroderma neck sign.

The scleroderma neck sign, as described by Barnett, is a visible and palpable tight band over platysma in the hyperextended neck. A recent survey of 76 patients with scleroderma revealed that more than 90% had the scleroderma neck sign. Our study was performed using 15 patients with scleroderma and 30 controls including 3 with primary Raynaud's disease to examine the specificity of the scleroderma neck sign, and to look for a correlation between the presence of the scleroderma neck sign and histological changes of scleroderma in the skin overlying platysma. The scleroderma neck sign was present in 12 of the 15 patients with scleroderma but in none of the 30 controls. It was found both in patients with diffuse (5 out of 5) and limited (7 out of 10) scleroderma. In 10 of the 12 cases where the scleroderma neck sign was positive, there were characteristic histological changes of scleroderma on biopsy of the skin overlying platysma, in 1 there were nondiagnostic abnormalities, and in 1 the biopsy was unsatisfactory. The 3 patients with scleroderma in whom the scleroderma neck sign was absent had either nondiagnostic changes (1) or normal biopsies (2). The 3 patients with Raynaud's disease had normal skin biopsies. The scleroderma neck sign appears to be produced by scleroderma changes in the skin of the neck. In limited or early scleroderma where these changes are otherwise clinically inapparent, the scleroderma neck sign may be diagnostically useful.

Adult↗
PubMed1989

Wound healing in an animal model of glaucoma fistulizing surgery in the rabbit.

We developed a model of glaucoma fistulizing surgery in the rabbit. As is the case with wound healing in general, there was inflammation followed by repair. The sclerostomy and bleb closed due to bulk filling by granulation tissue and contraction by migratory fibroblasts (observed at three days) and by myofibroblasts (observed at ten and 17 days). Fifty-eight percent of blebs had collapsed by ten days, and 94% by 17 days. The fibroblasts were migrating from the episcleral tissues, from the epimysium of the superior rectus, and from subconjunctival connective tissue. Intraocular pressure and facility of aqueous outflow were measured, but we concluded that intraocular pressure is not a reliable indicator of bleb function or of a patent sclerostomy in this model.

Animals↗
PubMed1989

Antiphospholipid antibodies in the connective tissue diseases: their relation to the antiphospholipid syndrome and forme fruste disease.

Anticardiolipin antibodies (aCL) were measured in the sera of patients with different connective tissue diseases and spondyloarthropathies. Elevated antibody binding was found in systemic lupus erythematosus (SLE), rheumatoid arthritis, scleroderma, primary sicca syndrome, dermatopolymyositis and psoriatic arthritis but not in ankylosing spondylitis. The 15 highest binding SLE patients included 10 with Raynaud's phenomenon, 5 with livedo reticularis, 7 with vasculitis, 3 with major thrombotic episodes and 3 with spontaneous abortions. aCL were also measured in patients with these clinical features in isolation. Seven of 18 patients with multiple thromboses and 3/22 with multiple spontaneous abortions had raised aCL binding. Normal or near normal levels were found in patients with idiopathic thrombocytopenia, livedo reticularis, a single cerebral thrombosis and uncomplicated myocardial infarction.

Abortion, Habitual↗
PubMed1988

Wound healing as a barrier to successful filtration surgery.

Trabeculectomy fails to control the intra-ocular pressure adequately in a proportion of patients. Approaches to solving this problem have involved modifications of surgery, histological studies of tissue from failed and functioning blebs, animal studies, and in vitro investigations of some of the basic processes of wound healing. This paper reviews the current state of investigations in these disciplines with particular reference to wound healing in this specialised site.

Animals↗
PubMed1988

Association between early inhibition of DNA synthesis and the MICs and MBCs of carboxyquinolone antimicrobial agents for wild-type and mutant [gyrA nfxB(ompF) acrA] Escherichia coli K-12.

Quinolone antimicrobial agents are known to interact with DNA gyrase, but the mechanism by which bacterial cell death occurs is not fully understood. In order to determine whether there is a correlation between quinolone-induced inhibition of early (i.e., 10 to 15 min) DNA synthesis and potency (MICs and MBCs), we measured the rate of DNA synthesis in log-phase Escherichia coli K-12 by using [3H]thymidine incorporation. Three quinolones (ciprofloxacin, norfloxacin, and difloxacin) were selected based on their decreasing activity against reference strain KL16. All three quinolones caused an early 50% inhibition of DNA synthesis which was proportional to MICs and MBCs (r greater than 0.99). Furthermore, 50% inhibition of DNA synthesis and MICs were nearly identical for mutant strains with an altered quinolone target (gyrA) or with decreased [nfxB(ompF)] or increased (acrA) permeability. There were significant differences (P less than 0.001) between individual quinolones in the degree of DNA synthesis inhibition in nalidixic acid-resistant gyrA and nfxB(ompF) mutant strains. The comparison of the three mutants with the wild-type strain permitted an in vivo examination of the effects of alterations of the drug target or entry on the activity determined by DNA synthesis inhibition and MICs.

Anti-Infective Agents↗
PubMed1988

EEG and cognitive performance following closed head injury.

Ten closed head-injured patients and 10 matched control subjects participated in a study that examined quantitated EEG data during cognitive task performance. The head-injured patients performed significantly worse than controls on all four tasks and had significantly higher EEG amplitudes and amplitude variances. A discriminant analysis function correctly identified 0% of the subjects on the basis of the EEG data. Frequency analysis indicated that these higher amplitudes were a product of across-frequency increases in voltage. In addition, EEG data were significantly correlated with performance on one cognitive task in the head-injured group. Results suggest that, contrary to standard clinical EEG findings, identifiable EEG changes may persist for years following moderate to severe closed head injury, and these changes are related to residual cognitive deficits.

Adolescent↗
PubMed1988

Chronic upper limb pain syndrome (repetitive strain injury) in the Australian workforce: a systematic cross sectional rheumatological study of 229 patients.

The epidemic of chronic upper limb pain is the most important and controversial issue in industrial rheumatology in Australia today. Two hundred and twenty-nine consecutive patients referred with chronic upper limb pain which had been labelled "repetitive strain injury" or "overuse syndrome" were assessed according to a protocol designed to give insight into the questions: Is the pain genuine or falsely reported, i.e., malingering? If genuine is it due to a physical injury, a pain syndrome, or a mixture of both? Twenty-nine patients fulfilled criteria for specific rheumatological diagnoses (fibrositis 15, rotator cuff syndrome 3, rheumatoid arthritis 3, cervical referred pain 3, lateral epicondylitis 2, de Quervain's tenosynovitis 1, carpal tunnel syndrome 1, and psoriatic monoarthritis 1). In the remaining 200 (mean age 37 years, range 19-58, 91.5% female) many different pain patterns and nonspecific associated symptoms were recorded. Eighty-nine percent had greater than or equal to 2 Smythe tender points, 1.5% had 1 tender point, and 9.5% had no tender point. Diffuse pain and greater than 7 tender points is sufficient to diagnose fibrositis, and localized pain and a smaller number of tender points strongly suggests a genuine chronic rheumatic pain syndrome. Stress, personal susceptibility and poor motivation appeared important in some cases. The liberal workers' compensation system, early labeling as repetitive strain injury, and social acceptability appeared important in the development of the epidemic.

Adult↗
PubMed1988

A survival study of patients with scleroderma diagnosed over 30 years (1953-1983): the value of a simple cutaneous classification in the early stages of the disease.

A longitudinal study was carried out on 177 patients with scleroderma between 1953 and 1983. Patients were classified into 3 types according to the extent of skin sclerosis within one year of presentation: Type 1 with sclerodactyly only; Type 2, skin stiffness proximal to the metacarpophalangeal joints but sparing the trunk; and Type 3, diffuse skin stiffness including the trunk. Ten year survival was 71% in Type 1, 58% in Type 2 and 21% in Type 3. Quality of life was best in Type 1, intermediate in Type 2 and worst in Type 3. Nailfold capillary abnormalities did not discriminate between the types, but anticentromere antibody correlated strongly with Type 1. The simple subdivision of scleroderma based on the early extent of clinical skin involvement has been found to be useful in predicting longterm outcome in this highly variable disease.

Adult↗
PubMed1987

The clinical significance of the anticentromere antibody.

To elucidate further the clinical significance of the anticentromere antibody (ACA), 32 Australian-born Caucasian patients with scleroderma (SD) or CREST (calcinosis, Raynaud's phenomenon, oesophageal dysmotility, sclerodactyly and telangiectasia) were reclassified as ACA-positive (19 patients) or ACA-negative (13 patients). The clinical features of the two groups were compared. Mean disease duration was 11.7 years for the ACA-positive group and 1.1 years for the ACA-negative group. No ACA-positive patient had generalized skin SD, whereas all ACA-negative patients with disease duration greater than 6 months had moderate or severe proximal scleroderma. Only one ACA-positive patient had serious extra-oesophageal internal organ involvement, excluding primary biliary cirrhosis (three patients) which is itself associated with ACA. Three ACA-negative patients had serious extra-oesophageal internal organ involvement. No ACA-positive patient had been treated with penicillamine or captopril compared with 11 ACA-negative patients. Thus ACA appears to be a favourable prognostic indicator. Analysis of individual CREST manifestations in ACA-positive patients revealed that most had 'incomplete CREST', lacking one or two of the five features. The classification of SD patients as ACA-positive or ACA-negative is suggested.

Adult↗
PubMed1987

Mediastinal trauma and other acute mediastinal conditions.

Acute mediastinal diseases most often result from penetrating or blunt trauma and from iatrogenic injuries related to the misplacement of tubes and catheters. The commonest chest film findings of mediastinal disease include mediastinal contour alteration, such as obliteration of normal structures, mediastinal widening, and pneumomediastinum. Characteristic mediastinal findings indicating injury to specific mediastinal structures are presented.

Acute Disease↗
PubMed1987

Computed tomography in blunt chest trauma.

While most injuries to the chest can be diagnosed by a portable supine radiograph, computed tomography (CT) adds significant findings that will influence patient management. In addition to requested CT chest examinations, we routinely obtain a limited chest CT during the initial work-up of traumatized patients referred to our radiology department for other CT examinations. The major categories of new information provided by CT are: occult pneumothorax, malpositon of chest tubes, inadequately drained pleural collections, differentiating between posttraumatic abscess and empyema, noninvasive diagnosis of tracheal rupture, and cause of mediastinal widening.

Aorta↗
PubMed1987

Lupus and non-lupus cutaneous manifestations in systemic lupus erythematosus.

Mucocutaneous manifestations occur frequently in systemic lupus erythematosus (SLE). Common non-lupus dermatoses may be confused with lupus rashes, with important clinical consequences. A study of 84 consecutive patients with SLE was performed to determine the comparative frequency of lupus and non-lupus mucocutaneous abnormalities, the comparative sensitivity of routine histology and immunofluorescence in the diagnosis of lupus rashes, and the association of skin manifestations with other clinical and serological features. Thirty-five patients had dermatoses attributable to SLE (mean 3.7 per patient) and 58 had dermatoses which were not directly attributable to SLE (mean 2.1 per patient), highlighting the need for accurate diagnosis of skin rashes in SLE patients. Routine histology confirmed the clinical diagnosis of typical cutaneous lupus in 100% of malar lupus rashes and in approximately 90% of subacute cutaneous and discoid lupus rashes. Direct immunofluorescence of the affected skin provided supportive evidence of cutaneous lupus in 60% of malar lupus rashes and approximately 50% of subacute cutaneous and discoid lupus rashes. This reaffirmed the poor sensitivity of immunofluorescence, compared with routine histology, in the diagnosis of lupus rashes. The association of subacute cutaneous lupus with anti-Ro antibodies was confirmed.

Biopsy↗
PubMed1987

Early effects of beta-lactams on aminoglycoside uptake, bactericidal rates, and turbidimetrically measured growth inhibition in Pseudomonas aeruginosa.

In vitro studies of tircarcillin or cefsulodin combined with [3H]tobramycin were performed with Pseudomonas aeruginosa. The rate of bacterial killing, the uptake of tobramycin, and the effects on optical density were measured. Both beta-lactams increased the uptake of subinhibitory concentrations of tobramycin. This result was quantitatively associated with a 2- to 4-h time-kill potentiation and confirmed earlier studies on the mechanism of beta-lactam-aminoglycoside synergy in Escherichia coli (P. H. Plotz and B. D. Davis, Science 135:1067-1068, 1962).

Cefsulodin↗
PubMed1987

Livedo reticularis associated with increased titers of anticardiolipin antibodies in systemic lupus erythematosus.

Seventy-eight consecutive patients with systemic lupus erythematosus were assessed for the presence of livedo reticularis. The possible association of livedo reticularis with other clinical and laboratory features including anticardiolipin antibodies was explored. Thirty-eight patients had livedo reticularis. Four cases were severe, 11 moderate, and 23 mild. There was a statistically significant association between the combined moderate and severe livedo reticularis group and elevated levels of anticardiolipin antibodies. The recognized association of anticardiolipin antibodies with thrombotic events suggests a possible pathogenetic role. The presence or history of central nervous system disease, renal disease, vasculitis, or lupus inhibitor was significantly associated with the moderate and severe livedo reticularis group. Livedo reticularis may be a cutaneous marker for the later development of important systemic events in systemic lupus erythematosus.

Adolescent↗