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Biomedical subjects

R Miller

Publications and source records attributed to R Miller.

At least 523 records · Page 29Linked to original sources

Counselling patients with HIV infection about laboratory tests with predictive values.

Laboratory tests, including CD4 counts, p24 antigen, raised levels of B2 microglobulin, neopterin and CMV antibodies, have been established as important predictive markers of disease progression in patients with HIV infection. As HIV antibody testing becomes more accepted in medical practice, counselling about these laboratory predictors of progression can help patients and doctors plan together the patients' care and treatment. Addressing patients' main concerns at each stage of investigation and illness may help them to plan ahead of crises, reduce stress, and enhance communication between patients and health care providers.

Adult↗

Dynamic stereotactic radiosurgery using a linear accelerator.

We describe a system for stereotactic radiosurgery with a linear accelerator. This technique allows treatment of small (less than 40 mm diameter) intracranial lesions, including vascular malformations, and primary and metastatic tumors that are deep within the brain or in areas not amenable to open surgery. A beam of ionizing radiation (1800 to 2500 cGy) is focused on the center of the lesion, which is determined by stereotactic localization. "Dynamic rotation" of the linac gantry and table continuously about this predetermined point ensures that only the lesion receives the full radiation dose, while the normal structures in the head receive minimal amounts of radiation. The system combines, for the first time in one place, elements of radiosurgical technique developed at various centers. Testing for accuracy compares favorably with results at other centers using linac-based systems as well as comparing favorably with the gamma knife.

Brain Neoplasms↗

Effect of storage on the plasma concentration of chlorpromazine and six of its metabolites.

The concentrations of chlorpromazine (CPZ) and six of its metabolites in patient plasma samples that had been stored for 24 h at -20 degrees C, for 1 week at -20 degrees C, and for 4 weeks at -70 degrees C were compared. The concentrations of CPZ and six of its metabolites in human plasma spiked with known concentrations and stored at -70 degrees C for either 3 or 12 months were also compared. No significant difference was seen in the concentrations after storage under nitrogen and analysis by a high-performance liquid chromatography technique.

Chlorpromazine↗

Dynamic aspects of cytoskeletal and karyoskeletal intermediate filament systems during the cell cycle.

IF are major cytoskeletal and karyoskeletal components of eukaryotic cells (Steinert and Roop 1988). In numerous instances, their constituent protein subunits have been shown to be substrates for a variety of kinases such as A-kinase, C-kinase, and Ca++/calmodulin kinase (Geisler and Weber 1988; Inagaki et. 1988; Ando et al. 1991), as well as p34cdc2 (Chou et al. 1990; Peter et al. 1990; Ward and Kirschner 1990; Dessev et al. 1991). To date, all of the phosphorylation sites that have been mapped are in the non-alpha-helical amino- or carboxy-terminal domains (Steinert 1988; Ando et al. 1989, 1991; Geisler et al. 1989; Chou et al. 1991), and these secondary modifications can lead to IF reorganization and/or disassembly in vivo and in vitro (see, e.g., Iganaki et al. 1988; Lamb et al. 1989; Chou et al. 1990; Peter et al. 1990; Heald and McKeon 1990; Dessev et al. 1991). In addition, it is possible that the exchange seen between subunits and polymerized IF in interphase following the microinjection of unpolymerized protein (Vikstrom et al. 1989; Miller et al. 1991) may also be regulated in some fashion by phosphorylation/dephosphorylation reactions. In cultured fibroblasts such as BHK-21, the interphase equilibrium state that favors IF polymerization is shifted dramatically to a disassembled state in mitosis, apparently due to enhanced phosphorylation at specific sites mediated through the activity of p34cdc2. However, in other cells in mitosis, such as HeLa, the mechanisms involved in the regulation of cytoskeletal IF remain unclear. Therefore, no one common mechanism appears to be responsible for IF regulation during cell division. On the basis of the majority of data available, it appears that the regulation of IF phosphorylation plays an important role in the regulation of the supramolecular organization of IF cytoskeletal and karyoskeletal networks, especially in the remodeling events that take place as cells enter and exit mitosis. Although the functional significance of IF phosphorylation during interphase is not as obvious as it is in some mitotic cells, we are tempted to speculate that there may be a connection with mechanisms involved in signal transduction, since IF proteins appear to be targets for kinases known to be activated by second messengers such as Ca++ and cAMP.

Animals↗

Autoanti-idiotypes exhibit mimicry of myocyte antigens in virus-induced myocarditis.

Mice infected with coxsackievirus B develop immunologically mediated inflammatory myocarditis in heart tissue that results in the development of autoantibodies with multiple idiotypes. The specificity and temporal development of autoantibodies produced during coxsackievirus B3 infection were assessed. Antiviral idiotypes and anti-idiotypic antibodies against coxsackievirus B3 idiotypes were detected and quantitated over 21- and 42-day periods, respectively. Both polyclonal and monoclonal anti-idiotypes exhibited greater but nonspecific binding to heart, liver, kidney, and spleen cells from virus-exposed animals and normal tissue. Binding of anti-idiotypes was also demonstrated to myosin and to solubilized heart-associated antigens but not to virus. Western immunoblot analysis revealed that monoclonal and polyclonal anti-idiotypes selectively bound to hypertonic, salt-extracted, solubilized proteins of myocyte extracts of virus-exposed animals.

Animals↗

Disseminated pneumocystis carinii infection in AIDS.

Eight patients with AIDS and Pneumocystis carinii infection were studied. Protean manifestations were a feature not untypical of disseminated pneumocystosis. Aerosolised pentamidine as prophylaxis against P carinii pneumonia was ineffective at suppressing dissemination. The knowledge that extrapulmonary infection can occur has implications for the detection and treatment of, and prophylaxis against, P carinii infection. The survival of patients with disseminated pneumocystosis is particularly poor, and may be due to a lack of clinical awareness and consequent delay in diagnosis.

Acquired Immunodeficiency Syndrome↗

Changing patterns in the workload of a district HIV/AIDS counselling unit 1987-90.

OBJECTIVES: To describe the changing workload of an HIV/AIDS counselling unit between 1987 and 1990. DESIGN: Retrospective examination of data collected by the HIV/AIDS counselling unit between 1987-90 on the number of counselling sessions with patients, family members and staff. SETTING: An HIV/AIDS counselling unit established in 1987 in a London teaching hospital. MAIN OUTCOME MEASURES: Number of new referrals to the HIV/AIDS counselling unit and the number of follow-up sessions. Number of counselling sessions with family members, hospital staff and people making telephone contact with the unit. RESULTS: New referrals to the HIV/AIDS counselling unit increased from 117 (1987-88) to 926 (1989-90). Follow-up appointments increased from 403 to 2016 in the same period. Telephone counselling sessions increased five-fold, and counselling sessions with family members nearly ten-fold over the three year period. Staff consultations doubled. CONCLUSION: The increase in the HIV/AIDS counselling unit's workload may be partly attributable to the rising incidence of AIDS in the community, reflecting earlier patterns of HIV infection. In addition, new HIV/AIDS services were developed in the hospital between 1987 and 1990. These included the establishment of a same-day HIV test and result clinic; integrated management of patients with HIV/AIDS, with an emphasis on early intervention in HIV infection; specialist services for families, antenatal clinic attenders and others affected by HIV; and the appointment of a designated HIV/AIDS consultant. New approaches to counselling and training health care providers in counselling skills will assume increasing importance in meeting future demand for HIV/AIDS counselling.

AIDS Serodiagnosis↗

Effects of 1,25(OH)2D3 on cardiovascular function.

1,25(OH)2D3 enhances myocardial contractility with pharmacological doses from 1 to 20 micrograms within 30-60 min. dp/dt modifications induced by 1,25(OH)2D3 are dose dependent and approach linearity from 1 to 10 micrograms. The inotropic effects are not dependent on extracellular Ca2+ levels; but cellular Ca2+ influx or internal Ca2+ movement may be implied. The effect seems not related to the described 1,25(OH)2D3 receptors which implies protein de novo synthesis. A modulation on other receptor-mediated substances acting on Ca2+ movements seems probable.

Angiotensin II↗

Fluid delivery systems: high flow, low pressure, the key to safe resection.

The transurethral resection of the prostate (TURP) syndrome has been attributed to the effects of the excess absorption of irrigating fluid. Absorption may be reduced by preventing bladder distension using continuous irrigating resectoscopes or suprapubic trocar drainage. Pressure rises should be limited by the head of pressure in the fluid delivery systems. The flow pressure characteristics of two competing systems, Flowfusor (Kendall-McGaw) and Uromatic (Baxter), were evaluated. We have demonstrated that the Kendall-McGaw Flowfusor V4537 system provides adequate flow at a reduced head of pressure by virtue of the rigid container system and intrinsic negative pressure. The safety of TURPs is increased by reducing the risk of absorption.

Humans↗

Use of a monoclonal antibody enzyme-linked immunosorbent assay to measure human respiratory glycoprotein production in vitro.

High-molecular-weight glycoprotein from human airway cultures was used to generate murine monoclonal antibodies, one of which recognizes a high-molecular-weight, hyaluronidase-resistant glycoprotein localized by immunofluorescent microscopy and immunogold electron microscopy to the secretory granules of human airway submucosal gland mucous cells and goblet cells. This monoclonal antibody was used to develop an enzyme-linked immunosorbent assay (ELISA) that was adapted to the study of respiratory glycoprotein secretion from human airways in vitro. Using the assay, the effect of a known mucus secretagogue, the cholinergic agonist methacholine, was studied on explant cultures of tissue from human bronchus or from human nasal mucosa. In studies of human bronchus explants, methacholine, 100 and 10 microM, stimulated increased secretion of respiratory glycoprotein (RGP) by 109 +/- 8% (n = 14; P less than 0.001) and 96 +/- 14% (n = 9; P less than 0.001), respectively, above control values. In studies of human nasal turbinate mucosal explants, methacholine, 100 and 10 microM, stimulated increased secretion of RGP by 75 +/- 28% (n = 7; P less than 0.01) and 70 +/- 21% (n = 4; P less than 0.01) above control values. An ELISA for the measurement of RGP secretion may provide a sensitive and more specific method for the performance of in vitro studies of RGP secretion from human tissues.

Animals↗

The effects of adenotonsillectomy on growth in young children.

A history of poor weight gain can often be elicited in young children with chronic upper airway obstruction resulting from adenotonsillar hypertrophy. A series of 41 consecutive children under 3 years of age, who underwent inpatient adenotonsillectomy, were reviewed for changes in weight and height. Thirty-seven patients had adequate long-term follow-up. Of these, many had dramatic improvements in growth after adenotonsillectomy. Indications for surgery in this group were recurrent infection in three patients (7%), unilateral tonsillar mass in one patient (3%), and upper airway obstruction in 37 patients (90%). A clear history of sleep apnea was elicited in 59%. At the time of surgery, 19 of 41 patients (46%) were of the fifth percentile or lower for age-corrected weight. The inpatient hospital stay averaged 3.2 days. The postoperative complication rate was 27%, with postoperative stridor as the most common complication. After surgery, 28 children (75%) showed a change to a higher percentile for weight. Twenty-four (65%) had percentile changes of 15% or more. This change is significant according to results of the Wilcoxon signed-rank test (p less than 0.001). We conclude that a relationship exists between improved growth rate and adenotonsillectomy in our study group. The rapid improvement in growth appears to be most obvious in children with upper airway obstruction resulting from adenotonsillar hypertrophy. Upper airway obstruction (including andenotonsillar hypertrophy) should be suspected as a possible cause in the workup of children with suboptimum growth.

Adenoidectomy↗