Biomedical subjects
R Miller
Publications and source records attributed to R Miller.
Midazolam, hypotension and neurological sequelae.
Explore the source record for details and available documents.
Monoclonal anti-idiotypic antibodies regulate the expression of virus-induced murine myocarditis.
A monoclonal anti-idiotypic antibody (anti-Id), produced by electrofusion and designated anti-Id88, was able to modulate expression of murine autoimmune myocarditis mediated by coxsackievirus B3 (CVB3). The anti-Id was characterized as an immunoglobulin G2b species possessing kappa light chains and was able to reduce expression of inflammatory myocarditis in anti-Id-pretreated mice challenged with CVB3. Anti-Id88 was able to stimulate specific cell-mediated immunity against anti-Id88, as well as CVB3, and exerted a suppressive effect on the proliferation of mixed spleen cell populations from virus-exposed mice. Anti-Id stimulated an anti-anti-Id antibody 3 population able to bind antibody 2 F(ab')2 fragments or virus antigen in an indirect enzyme-linked immunosorbent assay. Western blot (immunoblot) analysis of anti-Id88 exhibited binding of syngeneic anti-Id antibody to idiotypes present on immunoglobulin G molecules from virus-immunized mice.
Sarcoidosis presenting with an acute Guillain-Barré syndrome.
A 28 year old Caucasian male presented with an acute Guillain-Barré syndrome and bilateral facial weakness. He had an abnormal chest radiograph. Lumbar puncture revealed acellular fluid with a raised protein count and lung function tests showed a restrictive ventilatory defect. The patient deteriorated and required mechanical ventilation for 14 days. Steroids and plasmapheresis were not used and the patient spontaneously recovered. Two months after presentation limb power was almost normal but there was residual partial bilateral facial weakness. The chest radiograph remained abnormal and repeat lung function tests showed a persistent restrictive ventilatory defect and a reduced gas transfer coefficient. A transbronchial biopsy revealed non-caseating granulomata. The association between neurosarcoidosis and Guillain-Barré polyneuropathy is discussed and the literature reviewed.
Workload of a new district AIDS counselling unit, April 1987 to March 1988.
The Hampstead district AIDS counselling unit in London was opened in January 1987. It is staffed by a clinical psychologist, a social worker, and an administrator. From April 1987 to March 1988, 141 new patients and their relatives were referred from a range of clinical departments and 544 counselling sessions were provided. In addition, 666 staff consultations were organised to help colleagues manage some of the psychosocial problems of patients. An increase in demand during 1988-89 and a need for additional resources are anticipated. A strong case is seen for training other members of health care teams so that they may counsel patients with AIDS without referring them to the unit.
Psychotherapeutic interventions for patients with the delusion of having AIDS.
Explore the source record for details and available documents.
Security safeguards in community rehabilitation of forensic patients.
Explore the source record for details and available documents.
Strategies for counselling the 'worried well' in relation to AIDS: discussion paper.
Explore the source record for details and available documents.
Long-term follow-up of testicular function following radiation therapy for early-stage Hodgkin's disease.
Seventeen male patients with pathological staged I-IIIA1 Hodgkin's disease were followed prospectively for radiation damage to the testes from low-dose scattered irradiation. During conventionally fractionated radiation therapy, the testicular dose ranged from 6 to 70 cGy. Testicular function was measured in a prospective fashion by repeated analyses (every 6 to 12 months) of serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), and testosterone. Patients were also followed by serial semen analyses and by a questionnaire on fertility. The follow-up period ranged from 3 to 7 years after completion of radiation therapy. In patients receiving greater than or equal to 20 cGy, there was a dose-dependent increase in serum FSH values following irradiation, with the maximum difference at 6 months compared with pretreatment levels. All patients showed a return to normal FSH values within 12 to 24 months following irradiation. No significant changes in LH and testosterone were observed in this patient group. Eight patients with a normal pretreatment semen analysis provided serial semen samples and two patients showed transient oligospermia with complete recovery by 18 months following treatment. Four patients have fathered normal offspring following radiation therapy. We conclude that low doses (greater than 20 cGy) of scatter irradiation during treatment for Hodgkin's disease can result in transient injury to the seminiferous tubule as manifested by elevations of FSH for 6 to 24 months following treatment. Below 20 cGy, FSH values remained in the normal range. No evidence of Leydig cell injury (using LH and testosterone) was seen in this dose range (up to 70 cGy). Thus, patients with early-stage Hodgkin's disease can be treated with radiation therapy with little to no risk of irreversible testicular injury. Radiation treatment techniques to shield the testes are discussed.
Treatment of refractory non-Hodgkin's lymphoma with radiolabeled MB-1 (anti-CD37) antibody.
The biodistribution, toxicity, and therapeutic potential of anti-CD37 monoclonal antibody (MoAb) MB-1 labeled with iodine 131 (131I) was evaluated in ten patients with advanced-, low- or intermediate-grade non-Hodgkin's lymphomas who failed conventional treatment. Sequential dosimetric studies were performed with escalating amounts of antibody MB-1 (0.5, 2.5, 10 mg/kg) trace-labeled with 5 to 10 mCi 131I. Serial tumor biopsies and gamma camera imaging showed that the 10 mg/kg MoAb dose yielded the best MoAb biodistribution in the ten patients studied. Biodistribution studies in the five patients with splenomegaly and tumor burdens greater than 1 kg indicated that not all tumor sites would receive more radiation than normal organs, and these patients were therefore not treated with high-dose radioimmunotherapy. The other five patients did not have splenomegaly and had tumor burdens less than 0.5 kg; all five patients in this group showed preferential localization and retention of MoAb at tumor sites. Four of these patients have been treated with 131I (232 to 608 mCi) conjugated to anti-CD37 MoAb MB-1, delivering 850 to 4,260 Gy to tumor sites. Each of these four patients attained a complete tumor remission (lasting 4, 6, 11+, and 8+ months). A fifth patient, whose tumor did not express the CD37 antigen, was treated with 131I-labeled anti-CD20 MoAb 1F5 and achieved a partial response. Myelosuppression occurred 3 to 5 weeks after treatment in all cases, but there were no other significant acute toxicities. Normal B cells were transiently depleted from the bloodstream, but immunoglobulin (Ig) levels were not affected, and no serious infections occurred. Two patients required reinfusion of previously stored autologous, purged bone marrow. Two patients developed asymptomatic hypothyroidism 1 year after therapy. The tolerable toxicity and encouraging efficacy warrant further dose escalation in this phase I trial.
Effects of sports instruction on children's self-concept.
A sample of 120 children (69 boys and 51 girls), ranging in age from 9 to 14 yr., was administered the Harter Self-perception Profile for Children before and after a 5-wk. program of swimming instruction. It is predicted that children who improve most in swimming will also have the largest gains in athletic self-concept. The data supported the prediction for an association between gains in swimming skill and self-concept for certain skill groups.
Hyperactivity of associations in psychosis.
Disordered associative processes have long been regarded as central to the psychological description of psychotic states such as acute schizophrenia. Previous work is briefly summarised concerning the idea that hyperactive associative processes of thought underlie many of the symptoms of psychosis. The idea is developed further, with respect to several features of the psychotic state. Schneiderian symptoms are seen as a consequence of hyperactive associations of thought, combined with perceptual hypersensitivity characteristic of many psychotic individuals. Anxiety in psychotic states is seen as arising from the great ambiguity of mental images when associations are loosened. A vicious circle between high anxiety and hyperactive associations is postulated. The slow and variable response to neuroleptic treatment is seen as being determined in part by the dynamics of change of the memories acquired during a period of hyperactive associations.
An outbreak of hookworm infection associated with military operations in Grenada.
During 1983, a multinational military intervention took place on Grenada. After deployment, troops from several U.S. Army units noted signs and symptoms consistent with soil-transmitted helminthic infection. Of 684 soldiers screened five to seven weeks post-deployment, over 20% reported abdominal pain and/or diarrhea during or after the action. Eosinophilia of at least 10% was observed in 119 (22.5%) of 529 soldiers evaluated further; eosinophilia of 5-9% was documented in another 126 (23.8%) of the 529 soldiers. Stool examinations confirmed hookworm infection in 35 soldiers. One case of strongyloidiasis was also documented. Infection was attributed to ground exposure near homes with compromised sanitation. Units that joined the operation after the initial assault phase were at low risk of hookworm infection.
HIV and hemophilic children's growth.
The acquired immune deficiency syndrome (AIDS) often has profound effects on growth; however, the effects of human immunodeficiency virus (HIV) on asymptomatic children's growth are unknown. Before heat inactivation/HIV donor screening of factor concentrates, many hemophilic children became infected with HIV. We evaluated four hemophilic groups without AIDS, using age-standardized growth parameters: group 1, 41 HIV-seropositive children (median age of 13 years); group 2, 11 HIV-seronegative children (median age of 4 years); group 3, 20 children frequently receiving concentrates, evaluated before 1979 (median age of 9 years); and group 4, 11 children rarely receiving concentrates, evaluated before 1979 (median age of 6 years). Median height for age (HA), weight for age (WA), and weight for height (WH) of groups 1 and 2 exceeded the 50th percentile of referent norms. HA, WA, WH, and weight/height did not vary significantly by group, nor did these decline over periods of 11 to 70 months. However, for those less than 11 years of age in group 1, HA declined by 25 percentile points over at least a 3 year period. Also, group 1's T helper-to-suppressor cell ratios at 12 +/- 3 months following the latest growth evaluation were positively associated with both HA and WA at the last evaluation. Eight children were evaluated before 1979 and again after they seroconverted to HIV.(ABSTRACT TRUNCATED AT 250 WORDS)
A clinical study of 2.5 liter exchange volumes.
Comparisons of peritoneal clearances, hematologic and biochemical assays were performed on eleven CAPD patients using 2 liter and 2.5 liter daily exchanges. Group 1 consisted of 8 patients substituting all four daily 2 liter exchanges. These patients experienced statistically significant increases in urea and creatinine clearance (an average of 15% and 10% respectively). Corresponding reductions in serum levels occurred (8% and 9% respectively). Ultrafiltrate volume increased by an average of 12%. Group II consisted of 3 patients that substituted one 2 liter exchange. These patients also experienced increases in urea and creatinine clearance (8% and 11% respectively) and decreases in corresponding serum levels (1% and 4% respectively). Ultrafiltrate volume increased an average of 12%. After one month on the 2.5 liter regimen, patients were surveyed for their reactions to larger exchange volumes. Ninety-one percent of patients decided to continue using the 2.5 liter volume. Reasons cited included feeling better and having better weight and fluid control. None of the patients demonstrated complications such as catheter leakage or hernias. The use of four daily 2.5 liter exchanges can provide over 20% more clearance for many CAPD patients currently using 2 liter exchanges. This survey demonstrates most patients tolerate 2.5 liters, and they feel better. A 2.5 liter regimen may be indicated for patients who could benefit from more dialysis and for those at risk of dropping out of CAPD due to inadequate dialysis.
Secrecy-related problems in AIDS management.
Explore the source record for details and available documents.
Effect of source of population data on phenytoin dosage predictions in black patients.
Explore the source record for details and available documents.