ANA advocates 24-hour RN staffing.
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American Nurses' Association↗
Biomedical subjects
R Miller
Publications and source records attributed to R Miller.
D-meson production in 800-GeV/c pp interactions.
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Journal Article↗
Angular distribution of events from SN1987A.
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Journal Article↗
Clinical experience with theophylline. A case for monitoring serum concentrations.
Administration of theophylline has often been associated with serious serum concentration-related side-effects and toxicity as well as lack of efficacy. A therapeutic drug monitoring programme which enables individualisation of dosage on the basis of pharmacokinetic principles is described. Patients taking a standard dose of a slow-release theophylline preparation equivalent to 256, 1 mg anhydrous theophylline 12-hourly were monitored. Of 44 patients, 68% had theophylline serum concentrations below the generally accepted therapeutic range. Four case reports illustrate the use of pharmacokinetic principles to determine optimum doses in the individual patient. The clinical improvement observed confirms the axiom: 'Drugs don't have doses--people have doses!'
Adult↗
Assessment of microtransducers in anorectal manometry.
It has been reported that microtransducer-tipped catheters (transducer) produce reliable reproducible measurements which correlate well with water-filled balloon systems. Maximum resting pressure (MRP) and maximum voluntary contraction pressures (MVC) were compared using a standard station pull-through technique in 12 patients. There was a poor correlation for both MRP: microballoon, 115 cmH2O (60-160 cmH2O); transducer 60 (20-110), r = 0.62, P less than 0.05, and MVC: microballoon, 202 (60-375); transducer, 175 (60-210), r = 0.42, n.s. To determine whether this was due to radial variation in pressures measured by the transducer, we studied a further 39 patients with both systems. At each station, transducer measurements were made at each of four quadrants. We found better correlation for MRP: microballoon, 100 (40-175); transducer, 66 (34-120), r = 0.72, P less than 0.001, and MVC: microballoon, 225 (55-650); transducer, 180 (50-470), r = 0.87, P less than 0.001, but a significant radial variation for the transducer where rotation reduced MRP pressure measurements by 21 per cent (0-600 per cent), and MVC 17 per cent (0-76 per cent). Moreover there was a significant difference between anterior and posterior MRP in the upper anal canal, anterior 35 (5-80) versus posterior 25 (10-60), P less than 0.05. These results account for the poor correlation between random positioning of the microtransducer-tipped catheter and indicate that radial orientation must be taken into account.
Anal Canal↗
Anorectal sampling: a comparison of normal and incontinent patients.
It has been suggested that sampling of rectal contents by the anal canal may play a role in the continence mechanism. To investigate this concept we studied 18 patients with faecal incontinence and 18 age and sex matched controls. A microtransducer catheter was positioned so that pressures were recorded from the rectum, the junction of the upper and middle thirds of the anal canal and the lower anal canal. Recordings were taken at rest and while distending the rectum with air in a balloon, and then with air injected freely into the rectum. Sampling (equalization of the rectal and upper anal canal pressures) was seen to occur spontaneously in 16 of the controls and only 6 of the incontinent group (P less than 0.02) and induced sampling occurred at a higher rectal volume in the incontinent group than in controls for freely injected air (P less than 0.002). Defective anorectal sampling may be an important contributory factor in the pathogenesis of anorectal incontinence.
Adult↗
Prospective study of conservative and operative treatment for faecal incontinence.
To assess the functional results of treatment of faecal incontinence we carried out physiological and radiological measurements in 46 patients and 20 controls. Twenty patients were selected for conservative treatment and 26 for surgery (including 17 postanal repairs and 6 anterior sphincter repairs). The degree of incontinence was scored before and after treatment and postoperative investigations carried out on 17 patients (11 postanal repairs). Forty per cent of the conservative treatment group had a successful result compared with sixty-five per cent of the operative group as a whole and fifty-nine per cent of the postanal repair patients. Resting and 'squeeze' anal canal pressures were improved following postanal repair as was upper anal canal sensation but there was no change in the anorectal angle. We conclude that the anorectal angle is not crucial in maintaining continence.
Adult↗
Sensory discrimination and dynamic activity in the anorectum: evidence using a new ambulatory technique.
The anal canal in health is extremely sensitive to thermal stimuli, If temperature sensation plays a part in sensory discrimination two conditions must be fulfilled: there must be a temperature gradient along the anorectum and rectal contents must be able to come into contact with the sensitive anal mucosa. In a study of 53 normal subjects we demonstrated this temperature gradient with a median temperature difference between the rectum and lower, mid and upper anal canal of 0.4, 0.2 and 0.1 degrees C respectively. The second condition was examined in 15 normal ambulatory subjects by measuring mid-anal sphincter (SP) and rectal pressures (RP) with a microtransducer catheter. The signals were digitalized and recorded in a portable electronic memory for later computer display, and analysis. Marked spontaneous sphincter relaxation resulting in equalization of RP and SP occurred 7 times per hour (1-4). The conscious sensation of the presence of flatus was associated with an SP reduction of 30 mmHg (20-50 mmHg) and an RP increase of 7 mmHg (0-15 mmHg), such that RP greater than or equal to SP in 80 per cent of 144 recorded events. Using this new technique we have demonstrated the highly dynamic nature of the anal sphincter. Several times an hour the sphincter relaxes with subsequent equalization of rectal and anal pressures, allowing entry of rectal contents into the anal canal so that its presence and nature can be determined.
Adult↗
Antibody-mediated peripheral neuropathies associated with ARC and AIDS: successful treatment with plasmapheresis.
Peripheral neuropathy is increasingly recognized in patients with AIDS as well as AIDS-related complex (ARC). Thirty homosexual men with polyneuropathy were evaluated in this study. Twenty-one had ARC and nine had AIDS. We observed three distinct clinical syndromes: distal sensorimotor polyneuropathy, chronic inflammatory demyelinating polyrediculoneuropathy (CIDP), and mononeuropathy multiplex. Circulating antibodies to peripheral nerve tissues were found in all patients. In six patients, treatment with plasma exchange was undertaken because of severe, progressive weakness. Four patients with clinical, electrophysiologic, and histologic evidence of CIDP improved with plasma exchange, three regaining normal function. These results suggest that the peripheral neuropathy associated with ARC and AIDS is immunologically mediated and that plasma exchange is an effective treatment in a subgroup of patients with this disorder.
AIDS-Related Complex↗
Medical students' attitudes towards cancer: influence of the type of clerkship experience.
Attitudes of third-year medical students relative to patients with cancer were assessed prior to and following three different 6-week pediatric clerkships. Clerkship I (N = 139) was conducted in a public hospital where student contact with all patients occurred in wards, supervised by pediatricians in all subspecialties. Clerkship II (N = 146) was in a pediatric hospital which is a cancer center. Contact with patients with cancer was directed by oncologists and nononcologists. Clerkship III (N = 31) was similar to II, with an exposure to an oncology ward. A 51-item instrument, employing a visual analog scale, which included general, adult, and pediatric items, was used (pre- & postclerkship) to evaluate attitudes in all 316 students and 49 faculty instructors associated with the clerkships. Factor analysis of student responses to pediatric items resulted in four factors: a) early diagnosis, b) aggressive therapy, c) long-range surveillance, and d) psychosocial support in reference to patients with cancer. Post-test differences between clerkship groups in items a and b were noted, with increasing positivity correlated with increased exposure to oncology and oncologists. Attitudes of faculty nononcologists differed significantly from those of oncologists irrespective of institutional affiliation.
Attitude of Health Personnel↗
Anal sensation and the continence mechanism.
Thermal sensation is thought to be important in sensory discrimination between different substances. The aim of this study was to determine the thermal sensitivity in the anal canal in continent patients with hemorrhoids (N = 20), a group that has been reported to have a sensory deficit, and to compare the results with control subjects (N = 40) and patients with idiopathic fecal incontinence (IFI) (N = 22). Anal manometry was performed and sensation to mucosal electrostimulation and temperature change in the lower, middle, and upper zones of the anal canal assessed. Thermal sensation was impaired in the hemorrhoid group as compared with controls, but not to the same degree as in IFI (e.g., median thermal sensitivity in mid anal canal, control 0.9 degrees C, hemorrhoid 1.2 degrees C, IFI 2.0 degrees C, P less than .05 and less than .001, respectively). The correlation between the two tests of sensation was 0.54 (P less than .001) and the reproducibility of thermal sensory thresholds was 0.82 (P less than .001). In conclusion, patients with hemorrhoids have a mild anal sensory deficit, but continence in this group is likely to be augmented by other factors.
Adult↗
Individual knowledge of emotions in asthmatic children.
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Aggression↗
Nasal presentation of an intracranial vascular anomaly.
Intracranial vascular anomalies uncommonly present as a nasal mass. We report the first documented intranasal extension of a venous angioma of the anterior and middle cranial fossas. The diagnostic evaluation and differential diagnosis of an intranasal vascular mass is emphasized. In addition, recommendations are offered regarding the surgical approach of such a lesion.
Diagnosis, Differential↗
Surgical ciliated cyst of the maxilla.
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Adult↗
A case of congenital ectropion in Down's syndrome.
A rare case of primary congenital ectropion of all 4 eyelids in a child with Down's syndrome is reported to emphasise the problems of surgical management and to distinguish the condition from congenital eversion of the eyelids. Congenital ectropion is associated with other eyelid abnormalities and usually requires surgical measures to protect the cornea in contrast to congenital eversion which is characterised by the protrusion of oedematous conjunctiva from everted eyelids. This usually resolves spontaneously with simple supportive measures and no structural or functional eyelid abnormality remains.
Down Syndrome↗
The HAP3 regulatory locus of Saccharomyces cerevisiae encodes divergent overlapping transcripts.
Activation of the CYC1 upstream activation site, UAS2, and transcription of several other genes encoding respiratory functions requires the product of the regulatory gene HAP2. We report here the isolation and characterization of a second UAS2 regulatory gene, HAP3. Like mutations in HAP2, a mutation in HAP3 abolishes the activity of UAS2 and prevents growth on nonfermentable carbon sources. The HAP3 gene was cloned and, surprisingly, was found to encode two divergently transcribed, overlapping transcripts: a 570-base RNA and a 3-kilobase (kb) RNA. Chromosomal disruption experiments defined the critical region for HAP3 function to a 1.3-kb segment in which the two transcripts overlap. Analysis of the HAP3 DNA sequence showed that the 570-base transcript could encode a protein of 144 amino acids. Synthesis of the 144-amino-acid protein under regulatory control in vivo demonstrated that this protein is essential for activity of UAS2 as well as for growth on nonfermentable carbon sources. The largest open reading frame in the critical region of the 3-kb transcript is only 86 amino acids. Using site-directed mutagenesis, we demonstrated that the 86-amino-acid open reading frame was not involved in UAS2 activity. The possible role of this 3-kb antisense RNA in HAP3 expression or function is discussed.
Amino Acid Sequence↗
Sclerosing cholangitis in acquired immunodeficiency syndrome. Case reports and review of the literature.
Four patients with acquired immunodeficiency syndrome (AIDS) (CDC group IV) were investigated for biliary disease because of the presence of both severe upper abdominal pain and raised levels of serum alkaline phosphatase. None was clinically jaundiced. Upper abdominal ultrasound was abnormal in three. All had endoscopic retrograde cholangiographic evidence of both an intrahepatic sclerosing cholangitis suggestive of primary sclerosing cholangitis and an irregular suprapapillary common bile duct dilation suggestive of papillary stenosis. Three had evidence of gastrointestinal cryptosporidiosis and two of disseminated cytomegalovirus infection. Endoscopic sphincterotomy, performed in two patients, gave good pain relief. We propose the name 'AIDS sclerosing cholangitis' for this form of secondary cholangitis. The cause of this disorder remains unclear. Recent evidence is discussed which suggests that it is not due to HIV itself but to an opportunistic infection. Cryptosporidium appears to be the most likely candidate.
Acquired Immunodeficiency Syndrome↗