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Biomedical subjects

Mark D Miller

Publications and source records attributed to Mark D Miller.

At least 37 records · Page 2Linked to original sources
PubMed2005

Management of bony deficiency in revision anterior cruciate ligament reconstruction using allograft bone dowels: surgical technique.

Revision anterior cruciate ligament (ACL) reconstruction surgery has become increasingly common over the past decade and its popularity is likely to rise further as the number of primary ACL reconstructions increases each year. More than 75% of all cases of failed ACL reconstruction are the result of technical error and, of these, more than 70% are attributed specifically to malpositioned tunnels. Management of tunnel malposition in revision surgery often requires innovative approaches for dealing with the resultant bony defects. In addition, tunnel osteolysis may create bone loss that interferes with desired tunnel placement. A number of options have been described for handling these bony deficiencies, many of which are technically difficult and time consuming. We describe a novel technique to address bony defects during revision ACL reconstruction using freeze-dried allograft bone dowels. These allografts are readily available and can be used easily to fill deficiencies resulting from previous tunnels or osteolysis. The grafts provide sufficient structural support for redrilling of new tunnels through or next to the bony plug, allowing uncompromised tunnel placement.

Activities of Daily Living↗
PubMed2005

Physical examination of the knee.

Even with the rapid advancement in technology and medical imaging, there is still no substitute for the history and physical examination that can be obtained from a patient. With a well-performed history and physical, the majority of pathology can be determined prior to any expensive imaging or surgical procedures. The knee is one of the most commonly injured joints, and its function is critical to basic ambulation and participation in sports, work, and activities of daily living. This article reviews the key concepts to a complete evaluation of the knee and highlights aspects of the physical examination and radiographic imaging that best aid in diagnosing knee pathology.

Arthralgia↗
PubMed2005

Generalized anxiety disorder in late life: lifetime course and comorbidity with major depressive disorder.

OBJECTIVE: Generalized anxiety disorder (GAD) in elderly persons is highly prevalent, but little is known about its course, age at onset, and relationship to comorbid major depressive disorder (MDD). The authors assessed the course and comorbidity of late-life GAD and MDD. METHODS: Authors assessed elderly subjects in anxiety or depression intervention studies who had a lifetime history of GAD, with current MDD (N=57) or without (N=46). Subjects' lifetime course of illness was charted retrospectively. RESULTS: The 103 subjects had a mean age of 74.1 years, and a mean age at onset of GAD of 48.8 years; 46% were late-onset. GAD episodes were chronic, and 36% were longer than 10 years. Of the comorbid GAD-MDD patients, most had different times of onset and/or offset of the disorders; typically, GAD preceded MDD. CONCLUSIONS: Elderly subjects with GAD tended to have chronic symptoms lasting years-to-decades, without interruption, and many have late onset. Elderly persons with lifetime GAD and MDD tend to have different onset and offset of the two disorders. Findings characterize late-life GAD as a chronic disorder distinct from MDD.

Age of Onset↗
PubMed2005

A pilot study of standardized treatment in geriatric bipolar disorder.

OBJECTIVE: The authors sought to determine the feasibility of treating elderly adults with bipolar disorder under standardized-treatment conditions. METHODS: Thirty-one patients age 60 and older with bipolar disorder were treated in standardized pathways. Mood state was checked at each study visit with the Hamilton Rating Scale for Depression-17 item (Ham-D-17) and the Young Mania Rating Scale (YMRS). RESULTS: Defining "well days" as both Ham-D and YMRS scores of <or=10, the mean percentage of well days was 72.5 (range: 0%-100%) over study participation. CONCLUSIONS: Treating older adults with bipolar disorder under standardized treatment is feasible and is associated with low symptom levels. However, most older adults with bipolar disorder do not experience sustained recovery.

Adolescent↗
PubMed2005

Accelerating symptom-reduction in late-life depression: a double-blind, randomized, placebo-controlled trial of sleep deprivation.

OBJECTIVE: Authors tested the hypothesis that one night of total sleep deprivation (TSD) would accelerate antidepressant response to paroxetine, as compared with TSD+placebo (PBO) and paroxetine-alone, in late-life major depression. METHODS: Eighty elderly outpatients with current episodes of non-psychotic, non-bipolar major depression were randomly assigned to one of three treatment conditions: TSD+paroxetine (N = 27), TSD + PBO (N = 27), and paroxetine-only (N = 26). Primary outcome was percentage of subjects in each condition who demonstrated early response (Hamilton Rating Scale for Depression scores [Ham-D: 17-item] of < or = 10) or remission (score of < or = 7) on Day 14. RESULTS: Response rates after 14 days were 22% in subjects randomly assigned to the TSD + paroxetine condition, 41% in TSD + PBO, and 46% in paroxetine alone. Remission rates after 14 days were 11% in TSD+paroxetine, 22% in TSD + PBO, and 38% in paroxetine. After adjusting for baseline depression severity, there were no statistically significant differences in response or remission rates. CONCLUSION: Contrary to the study hypothesis, one night of total sleep deprivation did not accelerate onset of antidepressant response to paroxetine pharmacotherapy of late-life depression. The data suggest, rather, that the two interventions might have counteracted each other.

Aged↗
PubMed2005

Efficacy and tolerability of citalopram in the treatment of late-life anxiety disorders: results from an 8-week randomized, placebo-controlled trial.

OBJECTIVE: Anxiety disorders are highly prevalent in elderly persons. However, to date, the efficacy of selective serotonin reuptake inhibitors (SSRIs) for the treatment of anxiety disorders in this age group has not been established. METHOD: Thirty-four participants age 60 and older with a DSM-IV anxiety disorder (mainly generalized anxiety disorder) and a Hamilton Anxiety Rating Scale score of 17 or higher were randomly assigned under double-blind conditions to either citalopram or placebo. Response was defined as a score of 1 (very much improved) or 2 (much improved) on the Clinical Global Improvement scale or a 50% reduction in the Hamilton anxiety scale score. Response and side effects with citalopram and placebo were compared by using chi-square tests and linear modeling. RESULTS: Eleven (65%) of the 17 citalopram-treated participants responded by 8 weeks, versus four (24%) of the 17 placebo-treated participants. The most common and problematic side effect in the citalopram group was sedation. CONCLUSIONS: The authors believe this to be the first prospective controlled study to test the efficacy of an SSRI in the management of anxiety disorders among the elderly. These results support the efficacy of citalopram in late-life anxiety disorders. They need to be replicated in a larger study group.

Age Factors↗
PubMed2005

A systematic approach to magnetic resonance imaging interpretation of sports medicine injuries of the knee.

Magnetic resonance imaging is performed more commonly on the knee than on any other joint, and it is an excellent diagnostic tool that can aid in the evaluation of a host of sports-related injuries involving the ligaments, tendons, menisci, osseous structures, and articular surfaces. A thorough evaluation of the images, however, can be a daunting task, as the study often contains dozens of images obtained with multiple pulse sequences and in several imaging planes. A systematic approach will facilitate an accurate and timely evaluation of this complex examination and will ensure that all of the clinically relevant structures are adequately assessed. This article will provide a systematic approach to the interpretation of a magnetic resonance examination of the knee. The normal imaging appearance of each anatomical structure will be described, and the optimal pulse sequence and imaging plane for the evaluation of each structure will be discussed. Finally, the signs of injury will be described and illustrated.

Anterior Cruciate Ligament Injuries↗
PubMed2005

A systematic approach to magnetic resonance imaging interpretation of sports medicine injuries of the shoulder.

Magnetic resonance imaging has developed as a useful imaging modality in the evaluation of the athlete with shoulder pain. The multiplanar capabilities of magnetic resonance imaging make it ideal for detecting the anatomical variations of the osseous outlet that may contribute to the clinical syndrome of impingement. Its superb soft tissue contrast and spatial resolution allow for accurate differentiation between tendinopathy, partial-thickness tear, and full-thickness tear of the rotator cuff and also allow for detection of the subtle lesions of the capsule and labrum that are associated with shoulder instability. However, to accurately interpret the numerous images and pulse sequences obtained in a standard magnetic resonance examination of the shoulder, it is helpful to have a systematic approach to ensure that each of the pertinent anatomical structures are evaluated. This article will provide a systematic approach to the interpretation of a magnetic resonance examination of the shoulder. The normal imaging appearance of each anatomical structure will be described, and the most useful pulse sequences and imaging planes for the evaluation of each structure will be discussed. Finally, the signs of injury will be described and illustrated.

Acromion↗
PubMed2005

All-inside meniscal repair.

All-inside meniscal repair has become a popular technique. The number of meniscal repairs done in the United States has increased dramatically since the introduction of the Meniscal Arrow (Linvatec Corp, Largo, FL). Although these devices are easy to use, there have been several compliations reported with their use. Newer devices (Mitek RapidLoc and Smith and Nephew Fas-T-Fix) allow tensioning of the construct after insertion. There are also problems and pitfalls with their use, but improvements continue to be made in all-inside meniscal repair devices.

Absorbable Implants↗
PubMed2004

Semitendinosus regrowth: biochemical, ultrastructural, and physiological characterization of the regenerate tendon.

BACKGROUND: Previous studies have suggested that hamstring tendons can regenerate following harvesting for anterior cruciate ligament reconstruction. HYPOTHESIS: This "neo-tendon" is a true, functional tendon, not scar tissue. STUDY DESIGN: Controlled laboratory study. METHODS: Semitendinosus tendons were harvested from 35 New Zealand white rabbits using a standard tendon stripper. The rabbits were sacrificed 9 to 12 months following the index procedure and thoroughly evaluated. RESULTS: Thirty-one rabbits were available at the time of sacrifice. The neo-tendon was present in 26 rabbits but was highly variable in size and location of its tibial insertion. Histologic and immunohistochemical staining confirmed that the regenerate tissue was indeed tendon with normal cellularity, organization, and immunolocalization of type I collagen. Electron microscopy showed regeneration of organized collagen tissue that simulated native tendon but with a smaller cross-sectional diameter. Functionally, the neo-tendon was able to transmit force across the musculotendinous junction but at a significantly slower rate than the opposite, control leg. Biomechanical properties of the neo-tendon were significantly less than the control side. Biochemical analysis revealed that the neo-tendons contained glycosaminoglycans and collagen, but levels were significantly lower than normal tendons. CONCLUSIONS: Semitendinosus tendons regenerate with biologically reactive tendinous tissues in an animal model. This tissue has many of the characteristics of a normal tendon but appears to be inferior to the original musculotendinous unit at 9- to 12-month evaluation. Further characterization of the "lizard tail phenomenon" is still needed. CLINICAL RELEVANCE: Hamstring tendon regrowth may have a dramatic impact on postoperative function of patients who undergo anterior cruciate ligament reconstruction with these tendons. Further modulation of this regeneration may further reduce graft harvesting morbidity.

Animals↗
PubMed2004

Orthopedic pitfalls in the ED: calcaneal fractures.

Fractures of the calcaneus are usually associated with a high-force mechanism, which frequently can involve associated injuries and prolonged disability. Due to distracting injury and variations in clinical findings, calcaneal fractures may be initially missed or misdiagnosed. This review article examines the clinical presentation, diagnostic techniques, and management of calcaneal fractures applicable to the emergency practitioner.

Accidents, Occupational↗
PubMed2004

Recreating an acceptable angle of the tibial tunnel in the coronal plane in anterior cruciate ligament reconstruction using external landmarks.

Although it is still unclear what the ideal angle of the tibial tunnel in the coronal plane should be when performing anterior cruciate ligament (ACL) reconstruction using the endoscopic single-incision technique, researchers have recently shown that erroneous placement of the tibial tunnel in the coronal plane can lead to graft laxity and loss of extension. We have developed a simple, reproducible technique to provide an acceptable angle of the tibial tunnel in the coronal plane when using the endoscopic single-incision ACL reconstruction technique by using bony landmarks. With the ACL guide parallel to the femur, the external portion of the tibial tunnel guide is rotated so that the guidewire starting point is made at the bisection of a line between the tibial tubercle and the posteromedial border of the tibia. We have confirmed this technique in cadaver studies with angles of the tibial tunnel less than 75 degrees in the coronal plane in all cases. In addition, we have used this technique with good clinical results in over 100 ACL reconstructions.

Anterior Cruciate Ligament↗
PubMed2004

Return to play following surgical treatment of meniscal and chondral injuries to the knee.

Much has been written in the sports medicine literature regarding return to competition following anterior cruciate ligament reconstruction; however, little scientific work has been done regarding the return to competition following meniscal surgery or cartilage surgery. This article reviews the basic science of meniscal surgery and cartilage surgery in an attempt to promote rational rehabilitative protocols rooted in scientific investigation. A twofold approach is used. One approach is from a biologic standpoint; that is, when are the repaired tissues healed enough to withstand physiologic activity? The second approach is from a rehabilitative standpoint; when is the patient strong enough to play without recurrent injury?

Athletic Injuries↗
PubMed2004

Cognitive functioning in late-life bipolar disorder.

OBJECTIVE: This study characterized cognitive functioning in elderly patients with bipolar disorder. METHOD: The cognitive functioning of 18 euthymic patients with a history of bipolar disorder I or II, ages 60 years and older, was tested with the Mini-Mental State Examination (MMSE), the Mattis Dementia Rating Scale, and the Executive Interview. Cognitive functioning in these subjects was compared with that of an age- and education-matched group of 45 comparison subjects without mood disorders. RESULTS: Approximately half of the bipolar subjects scored one or more standard deviations below the mean of the comparison subjects on the MMSE (N=8, 44%) and the Mattis Dementia Rating Scale total (N=10, 56%). On the Executive Interview, three subjects (17%) scored between one and two standard deviations below the mean of the comparison subjects. CONCLUSIONS: A significant proportion of older bipolar subjects exhibited neuropsychological deficits when they were clinically euthymic.

Aged↗
PubMed2004

"All-inside" meniscal repair devices: an experimental study in the goat model.

BACKGROUND: Although the use of "all-inside" absorbable meniscal repair devices has become popular, numerous complications have been reported. The authors applied their well-established goat model to evaluate three "all-inside" meniscal repair devices. METHODS: A "tear" was created in the medial meniscus of both knees in 26 goats. The animals were randomized into four groups, and the meniscus was treated as follows: (A) meniscal repair with Mitek Fastner, (B) meniscal repair with BioStinger, (C) meniscal repair with Mitek Clearfix Screw, and (D) no repair. All animals were sacrificed at 6 months postoperatively, and all specimens were carefully evaluated and results recorded and compared with historical results of meniscal repair with suture in this same animal model. RESULTS: Meniscal repair results with all three all-inside devices studied were inferior to suture repair. Chondral injury was present in 75% to 100% of repairs with all-inside devices and none of the control specimens. DISCUSSION: / CONCLUSION: Although new all-inside meniscal repair devices are relatively quick and easy, results may not be as good as with traditional suture techniques. The high rate of chondral injury associated with these devices in the goat model is worrisome for chondral damage in humans, especially in patients with smaller or tighter knees.

Animals↗