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Biomedical subjects

M Miller

Publications and source records attributed to M Miller.

1,096 records · Page 61Linked to original sources
PubMedDate not supplied

[Vasculitis in children's dermatomyositis (author's transl)].

Vascular lesions have been discovered by a number of authors in children's dermatomyositis, when they are not ordinary found in adults. Affecting capillaries, arterioles and veinlets, vasculitis appears as an hyperplasia of intima, then as an endothelial necrosis and formation of thrombi. Usually seen with light microscope, these lesions are sometimes only revealed by electron microscope. These vascular lesions are observed in the muscle and mainly in the perimysial interstitial tissue, in the skin, and in the various visceral localisations of the disease: pulmonary, ocular, renal, nervous and mainly digestives. The ulcerations of the digestive tube are due to little infarcts secondary to submucous arteriolar occlusions. The presence of necrotizing microangiopathy in the muscle, in the skin and in the viscera, and the observation by an author of macroglobulin, gammaglobulin and C3 deposits in the vascular walls allows to issue an aetiopathogenic hypothesis. The vascular lesions could be due, at least partly, to immune complex deposits, explained by an allergic mechanism of type III of Gell and Coombs. This process could be released by a viral factor which has to be determined. This pathogeny could bring children's dermatomyositis nearer to the other circulating immune complexe collagenosis: S. L. E., periarteritis nodosa with which many transition form exist, and could separate it to the adults dermatomyositis, which would rather be a disease due to an exacerbation of the delayed hypersensitivity type IV of Gell and Coombs.

Child↗
PubMedDate not supplied

Use of oxygen therapy.

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Graft Rejection↗
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Supporting staff health.

This paper continues the theme of health at work and explains how one company set in motion a corporate health promotion programme aimed at eliminating or reducing particular disease risk factors affecting the workforce.

Exercise↗
PubMedDate not supplied

Disposition of tirilazad (U74006F), a 21-aminosteroid, in the plasma, heart, brain, and liver of the rat.

Tirilazad mesylate (Freedox, Upjohn) is the first agent of a new class of compounds called lazaroids currently under clinical investigation for its potential beneficial effects following neurotrauma. Tirilazad's therapeutic effect is due to its ability to inhibit iron-dependent lipid peroxidation. This study was conducted in Sprague-Dawley rats to determine the basic pharmacokinetics and distribution of tirilazad into the brain, heart, and liver. Rats (N = 50) were killed in groups of five at 0, 10, 20, and 40 min, and at 1.5, 2, 3, 4, 6, and 8 hr after intravenous administration of 10 mg/kg of tirilazad mesylate. Tirilazad was assayed in plasma, heart, liver, and brain tissue by HPLC. Using the mean concentrations at each time point, pharmacokinetic parameters were estimated using standard noncompartmental techniques and statistical moment theory. Tirilazad was rapidly eliminated from the plasma with a half-life of 2.4 hr and clearance of 6.1 ml/min. The volume of distribution at steady-state was large, 4.8 liters/kg. The concentrations of tirilazad were highest in the liver and heart and lowest in the plasma and brain. Elimination from tissues paralleled elimination from plasma with half-lives of 1.9, 1.6, and 1.5 hr in the brain, heart, and liver, respectively. Tirilazad appears to be a highly extracted, hepatically eliminated drug, suggesting its clearance is dependent on liver blood flow, and alterations in plasma protein binding are unlikely to affect its clearance but may affect the fraction unbound.

Animals↗
PubMedDate not supplied

Fentanyl for epidural intravascular test dose in obstetrics.

BACKGROUND AND OBJECTIVES: Although dizziness and drowsiness may be produced with either intravenous or epidural fentanyl, their occurrence after an intravenous injection is more rapid and relatively more pronounced. The purpose of this study was to determine whether or not the difference between routes of administration would be a reliable method of detecting an accidental intravascular injection. METHODS: In part 1, using a double-blinded protocol, we prospectively assessed in laboring women the incidence of dizziness, drowsiness, or both associated with intravenous fentanyl (100 micrograms). In random order, subjects received two peripheral intravenous injections: 2 ml of fentanyl and 2 ml of saline, separated by a 3-minute observation period. RESULTS: In group 1 (18/18) and group 2 (22/22), all subjects reported a response to intravenous fentanyl within the one-minute assessment. In part 2, we evaluated in laboring patients the frequency of dizziness, drowsiness, or both to epidural fentanyl (100 micrograms). The study design was identical to part 1; however, the subjects received 2 ml of fentanyl and 2 ml of saline via a functional epidural catheter. In group 3 (1/18) and group 4 (1/22), one subject reported a response to epidural fentanyl within the 3-minute observation period. CONCLUSIONS: Overall, the responses to intravenous fentanyl (40/40) occurred in a remarkably more consistent fashion when compared to epidural fentanyl (2/40). Thus, the results suggest that in laboring patients, intravenous fentanyl produces predictable and easily detectable changes that may be useful in identifying an epidural catheter unintentionally placed intravascularly.

Analgesia, Epidural↗
PubMedDate not supplied

[Evaluation of bronchoscopic examinations in Poland].

The aim of the study was to assess the state of bronchoscopical examinations in Poland. The analysis was based on a quantitative method using a questionnaire. It encompassed the year 1986. 22,936 examinations were performed in 76 centers (61.0 per 100,000 population, 1.19 per one hospital bed per year). 239 physicians performed bronchoscopies annually. The mean was 96 bronchoscopies ranging from 14-835. Only 20 out of 76 centers were well equipped, 17-satisfactory. In 39 the equipment was judged to be below satisfactory level. The number of examinations is well below the level needed. If one would narrow down the number of patients requiring a bronchoscopy to only two groups--those with malignancy and unconfirmed tuberculosis the number of bronchoscopies per one patient is only 0.9. The authors suggest means of improving this situation in Poland.

Adult↗
PubMedDate not supplied

[The role of diabetes as a factor for increased risk of infection with tuberculosis].

The number of freshly registered sputum positive cases of pulmonary tuberculosis coexistent with diabetes mellitus was calculated from data of the Central Register of Tuberculosis in Poland. The incidence rate for this group in 1985 and 1986 was only 2.6%, while the calculated rate was only higher by 1/3 in comparison with rates of the general population. This leads to a conclusion that diabetes mellitus does not increase the risk of developing tuberculosis. Treatment did not differ from standard therapeutical regimes. Early results were comparable with those from a general population. The mortality rate analyzed in both years was three fold higher in the group with coexistent diabetes mellitus than in the general population treated for tuberculosis. This implies that tuberculosis coexistent with diabetes mellitus is a great clinical problem but epidemiologically is insignificant.

Adolescent↗
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Peer assistance.

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Confidentiality↗
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Recognising the smiles that cry for help.

This article describes a small project set up by nurses and a speech and language therapist in a day unit for people with learning difficulties. The project looked at communication between clients and their visitors.

Communication↗
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Determining cost drivers for pediatric home health services.

A variety of cost constraints threaten the financial viability of home health agencies. Thus, tools must be developed that expand the critical information resources that will be the key ingredient in successfully navigating the challenges in the volatile home health market. Identifying and analyzing the core processes with the pediatric home care team provided a template that could be used with other agency patient populations by producing cost trajectories based on anticipated care requirements and capturing information that could be used for both internal and external benchmarking. The cost drivers of key processes and activities must be known so that they can be controlled and appropriate rates for capitation contracts can be established. Activity-based management uses cost driver analysis, activity analysis and performance analysis, to determine strategies for redirecting the work processes and agency activities to achieve lasting cost reductions.

Child↗