Biomedical subjects
Publications and source records attributed to M Miller.
Developments in laser dentistry have led to an increasing acceptance of this technology by both practitioners and the general public. This article provides an overview of laser systems and their dental applications.
Geographically based inpatient geriatric units are an increasingly common organizational approach throughout the world for the care of the hospitalized frail elderly with complex, multidisciplinary acute care needs. The unit provides comprehensive and efficient quality care to these patients by bringing together, in a geographically based unit, specialists from a multiplicity of disciplines to provide needed services in a coordinated manner. To accomplish its goals, the unit employs experts in geriatric medicine, nursing, social work, psychiatry, and other disciplines in a team approach to comprehensive assessment. The education of medical students, medical housestaff, and geriatrics fellows is a critical function of the unit. The unit also serves as a site for research in improving the care of the hospitalized frail elderly.
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The paper describes the current epidemiological situation of tuberculosis in Poland, its trends in the last 2-3 decades and its place on comparison to the global world-wide situation. The incidence of tuberculosis in Poland declined from 182.6 per 100,000 population in 1965 to 43.2 per 100,000 in 1991, but is still at least two times higher than the average for Europe. The rate of decline for the last few decades was about 5.5% annually, but last year an increase has been observed. Among newly detected cases of tuberculosis in Poland in comparison to other European countries there is a higher proportion of young adults, of severe clinical forms, and relatively lower proportion of relapses. The annual risk of tuberculosis infection, the indicator considered as a most reliable one, which ranges from 0.01 to more than 3% worldwide, in Poland as about 0.2%. The highest risk, and prevalence of tuberculosis infection is in African and Asian countries, where there is also the highest prevalence of HIV infection, and consequently an important increase in the incidence of tuberculosis. Such an increase has also been observed in the USA and in some European countries. The increase in the incidence of tuberculosis in Europe however, could not be directly connected with the HIV infection. The current epidemiological situation of tuberculosis and its worldwide perspectives seem to be closely related to: (i) existing geographical differences in the level of the risk and prevalance of tuberculosis (ii) the level and the spread of HIV infection (iii) the difference in the demographic structure of population in different parts of the world which will determine the frequency of dual (HIV/TB) infection, (iv) the effectiveness of tuberculosis control activities, and (v) the level of migratory movements of population, particularly from countries/areas with high prevalence of tuberculosis. The recently observed increase in the incidence of tuberculosis in many parts of the world including Poland indicates clearly the importance and the necessity to constantly monitor all the changes in the epidemiological situation of tuberculosis and of AIDS/HIV infection [corrected].
Research into the pathogenesis of scleroderma, which may ultimately yield a cure, is continuing. In the meantime much can be done for patients presenting with scleroderma today. In mild cases reassurance to allay unjustified fears is one of the most important aspects of management. In severe cases, the use of penicillamine and some of the other available therapies has improved quality of life and chances of survival.
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Applied methods and results of antituberculosis treatment of all registered patients in 1990 in Poland are presented. Tuberculosis prevention was achieved in 91.9% of sputum-positive patients similarly, diagnostic mistakes were detected in 10% patients with non-bacteriologically determined tuberculosis. In one year since registration 7.7% of sputum-positive patients and 3.9% of patients with non-bacteriologically confirmed tuberculosis have been dying in one year since registration time. Majority of patients in Poland were treated too long because of tuberculosis.
An analysis of tuberculosis case-finding programme in Poland in 1966-1991 was performed. The main methods applied in practice were--case-finding according to "symptoms" and according to results of "chest x-ray examination". About 90% of new cases were detected by above mentioned methods. Case-finding according to "symptoms" was increasing parallel to age of patients and reached 74% in group over 60 years. On the other hand, the efficacy of chest x-ray examination was decreasing parallel to age of patients one was calculated as 19%. The case-finding method according to "symptoms" is suggested by authors as a basic and useful, especially in family doctor's practice. Chest x-ray examinations should be limited to high risk population.
The aim of study was to determine a number of alcoholics in new diagnosed cases of bacteriological confirmed pulmonary tuberculosis in 1989-1990. Data were obtained from the Central Register of Tuberculosis. It was found that the number of alcoholics among new registered patients with tuberculosis increased from 8.8% to 10.5%. Young patients were more than 60% group. Results of treatment of severe types of pulmonary tuberculosis in alcoholics were also not so effective as in typical patients.
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Three previous studies have found significant positive correlations between pretreatment systolic orthostatic blood pressure (PSOP) and tricyclic antidepressant (TCA) response in geriatric depression (i.e., the greater the pretreatment orthostatic drop, the greater the treatment response). The purposes of this study were to revisit the question of whether PSOP predicts TCA response and also to examine whether large systolic orthostatic pressure (SOP) is a state or trait variable in late-life depression. We retrospectively examined PSOP data collected from 48 elderly patients with recurrent unipolar depression treated with nortriptyline (mean level in plasma, 85.3) in the open, acute-treatment phase of an ongoing double-blind, placebo-controlled study of maintenance therapies in late-life depression. PSOP was not significantly correlated with treatment response as measured by the Hamilton Rating Scale for Depression at weeks 7 to 9 (r = -0.12, not significant). Likewise, a 10-mm PSOP cutoff did not significantly differentiate patients by responder status. We did find that all five of our placebo-randomized, maintenance therapy patients with PSOPs greater than 10 mm had marked decreases in their SOPs in the nortriptyline-free, well state. Thus, our findings fail to replicate earlier reports of PSOP predicting TCA response in geriatric depression. However, our results do preliminary suggest that large SOP may be state dependent. We discuss plans to study prospectively whether large SOP is state dependent and whether SOP is a clinically useful predictor of recurrence in late-life depression.
Participation of NICU staff in special education teacher training is discussed as a method for improving follow-up care of high-risk infants and for helping agencies comply with Public Law 99-457, which mandates services for disabled preschoolers and encourages intervention for infants and toddlers. Through a collaborative training program involving a medical center and a university, education students spent 15 to 20 hours in the NICU. Nurses gained a greater understanding of community-based early intervention programs and available providers and made referrals with more confidence. Student teachers witnessed the medical conditions and treatments experienced by NICU patients, gaining an understanding of the types of medical histories their future clients would have. The collaborating hospital developed working relationships with agencies that provide follow-up care to NICU graduates. The article discusses medical and educational models of care, implications and benefits of incorporating developmental care into NICU practice, effects of the law on early intervention programs, and features of the model collaborative program.
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Thirty-four psychiatric patients, assessed for a physical illness that was missed during diagnosis, underwent a CT scan. After investigation, the diagnosis of 14 patients changed from a functional to an organic illness. In nine patients, the CT scan was reported to be abnormal, and yet only two were diagnosed as having an organic syndrome. In seven patients, the CT scan was normal but the patients had an undisputed organic brain syndrome. These findings indicate that the use of CT scans should be restricted to cases in which the diagnosis is seriously in question. The clinical findings should dictate the use of CT scans either to clarify or to complement them.
We have previously shown that v-erb-B contained within a recombinant murine retroviral vector is capable of transforming pre-B lymphocytes (M. Miller, A. K. Kennewell, and G. Symonds, Leukemia, 6: 18-28, 1992) and early erythroid precursor cells [blast-forming units (erythroid) (M. Miller, A. Kennewell, Y. Takayama, A. Bruskin, J. M. Bishop, G. Johnson, and G. Symonds, Oncogene, 5: 1125-1131, 1990)] in vitro. To determine the sites and nature of v-erb-B-induced transformation in vivo, the hematopoietic systems of lethally irradiated mice were repopulated with v-erb-B-infected bone marrow. All mice became moribund within 4-12 weeks of reconstitution, with a median onset of disease at 6 weeks. Histopathological and flow cytometric evaluation of tissues from diseased mice, as well as morphological and phenotypic analysis (cytochemical as well as molecular) of the cell lines established from the mice, revealed that all but one of the mice examined at postmortem had developed a pre-B lymphoid leukemia or lymphoma. Abnormally high levels of mast cells in the spleen and bone marrow of the remaining mouse indicated a mast cell disease. The development of pre-B lymphoid malignancy in the majority of the reconstituted mice indicates a marked predisposition of v-erb-B to transform cells of the pre-B lymphoid lineage. The reconstitution of lethally irradiated mice with v-erb-B virus-infected bone marrow provides a model system for the analysis of events involved in the initiation and maintenance of acute lymphoid leukemia.
BACKGROUND: Between August 1984 and November 1989, the Hoosier Oncology Group conducted a Phase III study comparing cyclophosphamide (CTX) with cyclophosphamide, doxorubicin, and methotrexate (CAM) in patients with hormone-refractory metastatic prostatic cancer to determine whether the addition of doxorubicin and methotrexate to the cyclophosphamide regimen conferred any survival advantage. METHODS: One hundred three patients were registered and randomized, 99 were evaluable for response, and all were evaluable for survival results. All had histologically confirmed metastatic prostatic cancer and had not responded to hormonal therapy. Fifty-three patients received CTX alone, and 50 received CAM. Seventy-one patients (69%) had evaluable disease, and 32 (31%) had measurable disease. RESULTS: There were no complete responses and only four (13%) partial responses in the patients with measurable disease. There was no difference in overall survival time between the two treatment arms in either patients with a Karnofsky performance status (KPS) of 80-100 (median survival, 9.0 versus 9.5 months; P = 0.93) or in those with a KPS of 50-70 (median survival, 5.0 versus 6.0 months; P = 0.51). There was no difference in overall time to progression between the two treatment arms (median time to progression; 4.4 versus 6.2 months; P = 0.07). Toxicity was tolerable in both regimens. CONCLUSIONS: It was concluded that there was no survival advantage to CAM over CTX alone. New chemotherapeutic agents with greater activity against prostatic cancer must be identified.
Salmonella choleraesuis was isolated in pure or mixed bacterial cultures from 153 swine necropsied between Jan 1, 1987 and Dec 31, 1990. Pneumonia was seen in 99 of 109 swine from which this bacterium was isolated in the absence of other pathogenic bacteria. Pneumonia was seen more frequently than hepatitis, splenomegaly, or colitis. Pleuropneumonia that was grossly indistinguishable from the pleuropneumonia associated with Actinobacillus pleuropneumoniae was seen in 29 of 99 swine from which S choleraesuis was the only bacterium isolated.