Search PubMed⌕ Search

Biomedical subjects

R M Miller

Publications and source records attributed to R M Miller.

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

Amyotrophic lateral sclerosis severity scale.

The amyotrophic lateral sclerosis (ALS) severity scale has been developed to provide an ordinal staging system and a means of rapid functional assessment for patients with ALS. The scale allows an examiner to evaluate the symptoms of ALS numerically in four categories that describe speech, swallowing, lower extremity, and upper extremity abilities. These scores, combined with a vital capacity measured on a hand-held respirometer, provide a rapid, accurate assessment of a patient's disease status and can be used for treatment planning. The ALS severity scale has been shown to have an average estimated reliability coefficient of 0.95 between examiners. Speech ratings were correlated greater than 0.80 for objective speech measures. Rates of progression of the total score in a small group of patients ranged from -3.4 to -24.0 points/year with a mean of -11.3 points/year.

Adult↗
PubMed1989

Using phonation time to estimate vital capacity in amyotrophic lateral sclerosis.

Amyotrophic lateral sclerosis (ALS) is a neuromuscular disease in which progressive respiratory weakness is usually the proximate cause of death. Since continued assessment of respiratory function is important in predicting progression, phonation time was measured in a group of 41 ALS patients and correlated with measured vital capacity. The findings show that the variance in phonation time accounts for nearly 50% of the variability of vital capacity, and therefore, successive measurements of phonation time are a useful means of estimating the loss of vital capacity.

Adult↗
PubMed1988

Body surface potential maps with low-level exercise in isolated left anterior descending coronary artery disease.

One hundred and twenty-lead body surface potential maps (BSPMs) were recorded at rest, at immediate cessation of exercise and after 1 (early) and 5 minutes (late) of recovery in 14 patients with isolated, critical, left anterior descending (LAD) coronary artery stenosis. Exercise endpoints, at an average peak rate of 98 +/- 13, were usual pain worsening in 13 LAD patients, and diagnostic ST depression in lead V5 in 1 patient. Twelve patients also had positive thallium scans. BSPMs were also recorded in 8 normal subjects who exercised to peak heart rates similar to those of the LAD subjects. Spatially, there were similar exercise changes in QRS and ST-segment integral patterns over the precordium and inferior torso in both groups. These were transient in the control group but persisted to late recovery in the LAD group, particularly for ST integral. Quantitatively, multivariate analysis revealed significant temporal differences between the 2 groups. However, the only independent BSPM variable was the sum of ST integral decrease, averaging --2,323 +/- 1,809 microV.s for normal patients between rest and immediate cessation of exercise, compared with -3,828 +/- 2,329 microV.s for the LAD patients (p less than 0.05). Late recovery minus rest difference averaged -1,264 +/- 1,080 microV.s for normal subjects and -2,575 +/- 1,844 microV.s for LAD patients (p less than 0.01). To control for the physiologic changes of exercise, the ST integral temporal differential maps of the normal subjects were subtracted from those of the LAD patients and the sum of negative intergroup differences was assumed to reflect only ischemia. Correlation of ST integral ischemia values at immediate cessation of exercise and late recovery was high (r = 0.88); however, intertechnique correlations of the BSPM variables with quantitative angiographic scores and thallium perfusion scan scores revealed generally low r values (range 0 to 0.52). These data demonstrate that ischemic repolarization changes are detectable and quantifiable by BSPM at low levels of cardiac stress in patients with 1-vessel disease when the usual electrocardiographic criteria of myocardial ischemia are frequently absent. The data further suggest that ST integral changes reflective of myocardial ischemia persist well after the exercise recovery period and that they are complementary to, rather than substitutionary for, other indirect measures of myocardial ischemia.

Adult↗
PubMed1988

Photolysis primes biodegradation of benzo[a]pyrene.

14C-labeled benzo[a]pyrene (BaP) was used as a model-compound for polycyclic aromatic hydrocarbons (PAH) in order to assess the effect of photolytic pretreatment on the subsequent fate of BaP in sewage sludge and soil test systems. Photolysis was performed in methanolic solution with or without 0.1 M H2O2, under either UV light (300 nm) or natural sunlight. The presence of H2O2 greatly enhanced the rate of photolysis both with UV and with natural sunlight. Intact BaP resisted biodegradation in both test systems. Photolysis transformed BaP to polar materials that were subject to increased mineralization and binding in both biological test systems. As shown by the Ames assay, photolysis decreased the mutagenicity of BaP to test strains TA98 and TA104 only moderately. The photolysate had an increased acute toxicity and lost its need for activation by S-9 enzymes. However, during subsequent incubation in soil or sewage sludge, mutagenicity decreased rapidly by one to two orders of magnitude and acute toxicity disappeared due to the mineralization and binding of photoproducts to humic materials. Photolysis of BaP and similar PAH compounds represents a useful treatment option that could be applied to certain PAH-containing petroleum refinery sludge and to coal tar residues in order to facilitate their detoxification and environmentally safe disposal.

Benzo(a)pyrene↗
PubMed1988

A phase 2 study of surveillance in patients with metastatic renal cell carcinoma and assessment of response of such patients to therapy on progression.

Following preliminary studies suggesting that some patients with metastatic renal cell carcinoma had accelerated tumor growth after entry into chemotherapy studies, 73 patients with measurable metastatic disease referred to a tertiary referral center for consideration for experimental treatment protocol have been observed to attempt to establish the incidence of spontaneous regression. Initially, patients went off study if metastases showed greater than 25% increase in products of bidimensional measurement but with increasing confidence patients only went into therapy protocols with the development of symptomatic progression. In this selective series, on observation, three complete (histologically documented) and two partial unexplained "spontaneous" regressions were observed and a further four patients had prolonged stable disease for more than 12 months. On progression, 52 were entered into treatment protocols (BCG n = 19, Mitozantrone n = 12, and Welferon n = 21). A further two complete and five partial responses (14%) and four prolonged stable disease were observed confirming that the previously reported responses with these agents are not totally explicable on the basis of "spontaneous" response.

BCG Vaccine↗
PubMed1987

Management of bulbar symptoms in amyotrophic lateral sclerosis.

The bulbar symptoms of ALS include difficulty with the management of swallowing, saliva, aspiration, and communication. These symptoms originate from the disability of the oropharyngeal muscles and actually represent varying degrees of severity of a single problem. The management of these symptoms requires the concerted effort of a rehabilitation team, which should include a surgeon, speech pathologist, neurologist, psychosocial worker, and dietitian. Early education of the patient and patient's family greatly facilitates successful management of bulbar symptoms. Early recognition of the signs of dysphagia, aspiration, and communicative disability are important in order to provide solutions before severe and possibly life-threatening debilitation occurs. The treatments and techniques presented in this chapter must be applied to each patient on an individual basis. The moral and social decisions regarding the providing or withholding of treatment to ALS patients are difficult ones. It is important, however, to realize that management decisions of ALS patients must deal not only with the quantity of life but also the quality of life. This distinction often falls into a 'gray zone' with management of bulbar symptoms since swallowing difficulties are life-threatening as well as uncomfortable. One of the difficulties that we present ourselves as health care providers in ALS is that, more often than not, our patient is in a noncommunicative position and cannot contribute to treatment decisions. If careful and aggressive care is taken to preserve the communicative abilities of our patients, the difficult situation of making decisions based on the family's inclinations and our own inclinations can be avoided. When we are confronted with a decision to maintain or cease support for a patient, the moral and emotional issues that present can be overwhelming. However, the patient's input, if it were direct and included the ability to express complex thoughts, could often provide the information necessary to make the decisions more clear.

Airway Obstruction↗
PubMed1987

The development of a new service for older adults.

In July, 1986, Wesley Long Community Hospital, Greensboro, North Carolina, opened its Older Adult Unit. Staffed to accommodate twelve patients, the unit is often operating at capacity. Key to the success of the unit is the process the hospital followed in its development. The hospital tested its preliminary concept for the unit with its consumer populations and tailored the concept to address the needs specifically identified by the populations. In addition, the hospital recognized the importance of an educational role in the promotion of a new service and incorporated this in its marketing strategy. This article outlines the steps followed in the development and successful introduction of the unit.

Aged↗
PubMed1986

Biotolerant and haemodynamic effects of copolymerization with acrylic acid on Dacron arterial prostheses.

The biotolerant and haemodynamic effects of three types of woven polyethylene terephthalate (Dacron) arterial prostheses were compared. Two of these were unmodified, one low, one high porosity; and the third was the latter type radiation graft copolymerized with 5% acrylic acid. The prostheses were implanted as aorto-aortic bypass grafts, in dogs, for periods ranging from three to seventeen months. The copolymerized prosthesis exhibited the smallest rise in circumferential elastance from the 'as supplied' state, as well as a significantly slower pulse wave velocity, a significantly thinner internal lining, and a markedly lower longitudinal impedance. Of the unmodified prostheses, the low porosity graft had a significantly greater circumferential elastance, the poorest handling characteristics, and a tendency for pseudo intimal detachment. It was concluded that, although there was little difference between the two unmodified prostheses, the low porosity one had little to recommend it for use in small calibre bypass grafting. Copolymerization with acrylic acid produced better haemotolerant and haemodynamic results as well as surface properties which appeared to discourage fibrin and platelet adherence, and promote a more complete and organised pseudointima.

Acrylates↗
PubMed1985

Haemodynamic effects of copolymerization with acrylic acid on woven Dacron arterial prostheses.

A polyester/acrylic acid copolymer was compared with unmodified polyester as control. These were implanted as an aorto-aortic bypass graft, in 18 dogs, for periods ranging from 3 to 17 months. The copolymer had a smaller rise in circumferential elastance, a significantly slower pulse wave velocity, and a markedly lower longitudinal impedance. In addition, it had a more organised and significantly thinner pseudointima. We conclude, therefore, that copolymerization produced improved haemodynamic results and surface properties which appeared to discourage fibrin and platelet adherence. We anticipate that this type of prosthesis could be expected to produce better long term results than those polyester prostheses at present available.

Acrylates↗
PubMed1985

Optokinetic nystagmus and upper extremity dressing independence after stroke.

Right hemisphere brain-damaged stroke patients demonstrate a variety of neurologic deficits which seem to impair their ability to regain self-care independence. Visual perceptual and visual search disorders have been implicated with persistent functional deficits. The objective of this study was to measure the extent to which defects of optokinetic nystagmus (OKN), an ocular movement reflex, may be associated with inability to regain independent function. Eighteen right hemisphere brain-damaged stroke patients suffering similar sensory-motor deficits were followed up from admission as they underwent self-care training in a comprehensive stroke rehabilitation center. Ten subjects demonstrated unilateral absence of OKN and eight subjects demonstrated bilaterally intact responses upon admission. Upper extremity (UE) dressing independence was used as an indicator of functional skill level at admission, during treatment, and at discharge. Subjects with unilateral loss of OKN were significantly less independent at admission and at discharge when compared to subjects with intact OKN. Although both groups of patients made statistically significant gains in UE dressing, those with defective OKN had a 40% greater inpatient length of stay and were more likely to be discharged to a nursing home or needed care by a significant other after rehabilitation.

Activities of Daily Living↗
PubMed1985

Multiple sclerosis: Part I. Common physical disabilities and rehabilitation.

Rehabilitation of the multiple sclerosis patient must be individualized because of the varied manifestations and fluctuating course of the disease. The activity schedule must be modified to compensate for muscle weakness and fatigability. Spasticity and the preventable complication of joint contractures may be treated with joint ranging, medications, motor-point blocks and surgical intervention. Mobility problems, such as foot drop, may be improved with an ankle-foot orthosis, but ultimately a patient may require a wheelchair. Measures to prevent pressure sores include position change, pressure release, incontinence management and special equipment.

Adult↗
PubMed1985

Multiple sclerosis: Part II. Common functional problems and rehabilitation.

Cognitive impairments, often unrecognized in multiple sclerosis, include memory loss, new learning problems, denial and depression. Spasticity and incoordination of the oropharyngeal and respiratory muscles create functional problems with speech and swallowing. Genitourinary problems include sexual dysfunction and neurogenic bladder. Specific measures can be used to alleviate these problems.

Cognition Disorders↗
PubMed1982

Stroke rehabilitation: part I. Cognitive deficits and prediction of outcome.

In many cases, the family physician will set the tone for rehabilitation of the stroke patient. It is imperative that the physician understand the recovery process, as well as the nature, benefits and limitations of rehabilitation. Since there are no precise predictors of individual outcome, no patient should be excluded from rehabilitation unless he is too ill or too cognitively devastated to participate.

Brain↗
PubMed1982

Stroke rehabilitation: Part II. Recovery and complications.

Return of neurologic function after a stroke tends to be complete within six months after the insult. Initial flaccidity is superseded by spasticity, which is most prominent distally. Movements initially occur in synergistic patterns. Return of voluntary movements begins proximally in the lower extremity. In the upper extremity, proximal recovery usually occurs first, but finger movement occasionally is the earliest sign. Proper positioning and early, passive range-of-motion exercises help to avoid complications.

Activities of Daily Living↗
PubMed1981

Something new: a radiology policies and procedures outline guide.

The American Hospital Radiology Administrators Midwest Region Education Committee felt the need for a guide to assist radiology administrators in developing departmental policies and procedures unique to their own institutions. The outline guide was undertaken as the education project for the committee of 1980/81. The completed guide was presented at the April, 1981 Midwest regional meeting. This article is presented to you to introduce the outline guide and also emphasize the importance of the development of a comprehensive policy and procedure manual for improved radiology management.

Hospital Departments↗