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Biomedical subjects

M J Mills

Publications and source records attributed to M J Mills.

At least 19 recordsLinked to original sources
PubMed1992

Haematological splenectomy. Changing indications and complications.

Review of splenectomies carried out for haematological disease over a ten-year period, at a district hospital, shows that the indications for splenectomy have changed substantially over this time. Fewer patients with idiopathic thrombocytopenic purpura now require splenectomy, however its role in the management of lymphoproliferative disorders has expanded. Splenectomy remains an important therapeutic option for a range of haematological disorders: this series shows it to be a safe and effective operation in selected patients, although it is not without both short and long-term sequelae.

Adolescent↗
PubMed1989

Influence of human breast development on the growth properties of primary cultures.

In experimental animal models the susceptibility of the mammary gland to neoplastic transformation is related to its degree of development and proliferative activity; this observation led us to determine whether the human breast epithelium also exhibits development-related differences, and whether these differences could be detected in an in vitro system. Normal breast tissue obtained from reduction mammoplasties of 9 patients ranging in age from 18 to 56 years were characterized in both whole mount preparations and organoids obtained after collagenase-hyaluronidase digestion by their degree of development based upon the types of lobules present. Lobules were classified into type 1 (Lob 1), composed of approximately 11 alveolar buds, the less developed; lobules type 2 (Lob 2), of moderate development, composed of approximately 47 ductules each, and lobules type 3 (Lob 3), composed of 80 ductules each, represented the highest level of development. Epithelial organoids obtained after digestion were plated in DMEM:F12 medium supplemented with hydrocortisone, cholera toxin, insulin and 5% horse serum with a calcium concentration of 1.05 mM Ca++. Following attachment, the medium was replaced by medium containing 0.040 mM Ca++. The percentage of attachment of organoids to the flask was greater in cells from Lob 1 (89-99%) and Lob 1+2 (79-100%) than in cells from Lob 3, which had a 53-67% attachment. The total yield of cells after 7 weeks in culture was also greater in cells derived from Lob 1 and Lob 1+2 than in cells from Lob 3. The total yield of cells obtained from primary cultures was not related to the number of organoids plated, but to the degree of development of the gland. The DNA-labeling index (DNA-LI) in intact breast tissue correlated with that in primary cultures; it was greater in Lob 1 and Lob 1+2 than in Lob 3. By flow cytometry, the highest percentage of cells in S-phase was seen in cells with the highest DNA-LI. We concluded that the growth characteristics of mammary epithelial cells in vitro in a low Ca++ medium is modulated by the degree of development and differentiation of the gland.

Adult↗
PubMed1989

Medical and surgical management of spontaneous hyphaema secondary to immune thrombocytopenia.

The medical and surgical management of an unusual case of spontaneous 'black ball' hyphaema complicated by secondary haemorrhage, raised intraocular pressure and corneal blood staining, and secondary to immune thrombocytopenia is presented. The literature is reviewed with particular reference to the aetiology and treatment of spontaneous hyphaema and the role of intravenous immunoglobulins in the preoperative management of patients with thrombocytopenia who present for routine or emergency ocular surgery.

Female↗
PubMed1988

Parens patriae considerations in the commitment process.

Seventy-one commitment-seeking decisions made by 36 clinicians in a state-funded mental health center were studied to determine the extent to which clinicians attend to legally mandated "dangerousness" criteria in seeking commitment. A previous finding that clinicians rely largely on the dangerousness criteria was replicated. In addition, clinicians were found to be sensitive to clinical indicators of the patient's need for treatment, a question which is central to the parens patriae approach to involuntary hospitalization. Further, patients who were judged to be more seriously ill or more dangerous were more likely to retract their requests for discharge. This finding suggests that the patient's request for release and the psychiatrist's petition for commitment together constitute an interactive, transactional process in which the clinician's and the patient's views of the patient's need for hospitalization influence each other.

Commitment of Persons with Psychiatric Disorders↗
PubMed1988

Consent for dental therapy in severely ill patients.

Delirium, dementia, or depression is frequently seen in association with severe medical illness. Usually transient, it is precipitated by the stress of systemic illness and the medications used to treat the underlying disease. Unrecognized, it may invalidate the informed consent required for the provision of emergency dental care services.

Delirium↗
PubMed1987

Alcoholism and dental management.

Alcohol is widely used and abused in the United States. Because alcohol affects all parts of the body, it is important for dentists as well as all other medical practitioners to be aware of the signs of alcoholism. Some dental problems occur more frequently in alcoholic patients, and often general dental care for these patients must be modified.

Alcoholism↗
PubMed1987

Dental management considerations for the patient with post-traumatic stress disorder.

Vietnam veterans with post-traumatic stress disorder are frequently encountered in the dental office. They are often anxious, hostile, depressed, withdrawn, or resistant to treatment. Their psychological set and relatively high incidence of alcohol and drug-related problems frequently require modification of their dental therapy. An attractive and biologically sound restoration of the orofacial structures may improve long-term rehabilitation by enhancing self-esteem and social interactions.

Adult↗
PubMed1987

Protecting third parties: a decade after Tarasoff.

The authors discuss current public policy concerning the treatment of potentially violent psychiatric patients and outline some legal and ethical precedents of the current policy. Therapeutic interventions before and after the Tarasoff decision are compared. The authors make specific recommendations for clinicians, who they believe tend to interpret laws too restrictively. They suggest that courts need to rethink current liability standards so that legal decisions can be more clinically informed. Finally, they believe that legislative interventions which specify that warning the potential victim and notifying the police absolve psychotherapists from liability may lead to reflexive rather than reflective management of violent patients.

California↗
PubMed1987

Consent and liability: special problems with anxiolytics.

The use of benzodiazepine anxiolytic therapy has sometimes been associated with certain adverse reactions. The authors discuss the extent to which the clinician is responsible for warning patients that benzodiazepine therapy may result in addiction, withdrawal problems, and/or impaired cognitive and motor skills. The development of new anxiolytics such as buspirone, which seem to exert less effect on cognitive and motor skills and lack addiction potential (and thus withdrawal problems), presents the clinician with a treatment alternative. The authors review two legal cases involving benzodiazepine-induced driving impairment and discuss whether the clinician is obligated to prescribe the agent that generally demonstrates the least interference with such common activities as driving. Primary issues that arise in the discussion of physician responsibility are informed consent (both verbal and written) and the documentation of all treatment decisions. The authors recommend quality care and individualized treatment to avoid liability.

Anti-Anxiety Agents↗
PubMed1987

Civil commitment by conservatorship: the workings of California's law.

This article summarizes the conservatorship provisions of the California Civil Commitment Statute, the Lanterman-Petris-Short (LPS) Act and reviews the major findings from previous studies. By studying the hospital records of eighty-five gravely disabled patients affected by LPS, the authors address issues raised by these reports. The results indicate that the law's provisions work unevenly. Patients with acute and current disability received conservatorships more frequently than those who had been disabled in the past. There is some evidence that the process is used to confine threatening patients and does not function equally well for all diagnostic groups.

Activities of Daily Living↗
PubMed1987

Legal liability with psychotropic drug use: extrapyramidal syndromes and tardive dyskinesia.

The use of medication has become essential to the practice of modern psychiatry. Despite the enormous benefits associated with the administration of psychotropics, these drugs also carry the risk of significant adverse reactions. The legal implications of side effects of antipsychotic agents are explored. The particular focus is on the potentially serious liability confronting the psychiatrist whose patient develops delayed neuromuscular complications. Whenever neuroleptic medication is used, it is crucial for all psychiatrists to be cognizant of the need to obtain voluntary informed consent in the context of clinically appropriate treatment.

Basal Ganglia Diseases↗
PubMed1986

Mutism: review, differential diagnosis, and report of 22 cases.

Mutism is a common manifestation of both psychiatric and neurologic illness. Psychiatric disturbances associated with mutism include schizophrenia, affective disorders, conversion reactions, dissociative states, and dementias. Neurologic disorders producing mutism involve the basal ganglia, frontal lobes, or limbic system structures. In psychiatric and neurologic conditions, mutism is often associated with other signs of catatonia. The authors review the literature on mutism, including psychiatric, neurologic, toxic-metabolic, and drug-induced causes. Methods to discriminate among the many causes of mutism in the clinical setting are discussed, and 22 new cases of mutism are reported to emphasize the wide differential diagnosis.

Adolescent↗