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Biomedical subjects

R R Miller

Publications and source records attributed to R R Miller.

At least 271 records · Page 15Linked to original sources
PubMed1979

Clinical importance of the interaction of phenytoin and isoniazid: a report from the Boston Collaborative Drug Surveillance Program.

Six (27 percent) of 22 hospitalized medical patients who received phenytoin and isoniazid concurrently for at least five days experienced toxic effects on the central nervous system (CNS). In contrast, only 30 (3 percent) of 1,093 patients who received phenytoin without isoniazid had toxic effects on the CNS. Thus, the risk of toxic effects from therapy with phenytoin is greatly increased among patients concurrently receiving isoniazid, probably because of isoniazid-induced impairment of the clearance of phenytoin. Schedules of dosage for phenytoin whould be appropriately adjusted to compensate for this clinically important interaction of drugs.

Central Nervous System↗
PubMed1978

Clinical effects of meperidine in hospitalized medical patients.

Of 26,294 hospitalized medical patients monitored in a drug surveillance program, 366 (1.4%) received meperidine orally and 3268 (12.4%) received meperidine parenterally during one or more admissions. Neoplastic disease was the most common category of primary diagnosis (43%) among oral recipients; among parenteral recipients cardiovascular and neoplastic diseases (23% each) were most common. Oral meperidine was prescribed almost exclusively (93%) for pain relief, whereas the parenteral drug also had substantial use (41%) as a diagnostic and preoperative adjunct. Oral meperidine was judged by attending physicians to have provided unsatisfactory pain relief in 22% of recipients, while parenteral meperidine was rated unsatisfactory in 11%. The drug was less effective in patients with a primary diagnosis of neoplastic disease than in patients with other primary diagnoses. Minor gastrointestinal disturbances were the most commonly reported adverse reactions among oral meperidine recipients (2.7%); among parenteral recipients central nervous system effects were most common (1.2%). Seven recipients had life-threatening adverse reactions. However, only two of these were judged definitely related to meperidine, and in both instances other drugs were also definitely implicated. Adverse reactions were dose related.

Administration, Oral↗
PubMed1978

Fortuitous rupture of aortic aneurysm: a catastrophic event affording time for surgical cure.

The rupture of an aortic aneurysm is generally a fatal event, but occasionally the rupture will occur into an adjacent vascular structure, thereby preventing exsanguination and affording temporary survival. Three cases are presented illustrating the fortuitous nature of the rupture of an aortic aneurysm into a vascular structure. The first patient had an atherosclerotic abdominal aortic aneurysm that ruptured into the inferior vena cava and was successfully repaired. The second case demonstrates the formation of a fistula from the aorta to the left pulmonary artery in a patient with a syphilitic thoracic aortic aneurysm. In the third patient a dissecting aneurysm of the aortic root that communicated with the right ventricle after coronary bypass surgery was successfully repaired. Rarely, aortic aneurysms will rupture fortuitously into vascular capacitance structures. These three cases emphasize the need for early accurate diagnosis and the institution of appropriate surgical measures.

Aged↗
PubMed1978

Effects of digitalis on sinus nodal function in patients with sick sinus syndrome.

The effect on sinus rhythmicity and automaticity of complete digitalization in a 24 hour period was observed in 14 patients with sick sinus syndrome. Sinus nodal function was evaluated in these patients by assessing sinus nodal recovery time and by treadmill exercise testing and 24 hour Holter monitoring, before and after digoxin administration. Corrected sinus nodal recovery times ranged from 240 to 2,065 msec (average 714) before digoxin and were shortened to 250 to 1,260 msec (average 565) after the glycoside. Further, digoxin induced accelerated infra sinus escape pacemaker activity in five patients: junctional and ventricular in one and atrial in four. Spontaneous sinus rate evaluated with Holter monitoring revealed an average of 56 beats/min (range 43 to 69) before digitalis that was unchanged (average 58 beats/min; range 48 to 74) after digoxin therapy. Similarly, the sinus nodal response to exercise was unaffected after digitalization (average 118 beats/min both before and during digitalis therapy). It is concluded that digoxin does not exert adverse effects on sinus nodal function in patients with sick sinus syndrome. The glycoside can be used safely in these patients when indicated for cardiac pump dysfunction or for control of tachyarrhythmia.

Adult↗
PubMed1978

Hemodynamic evaluation in acute myocardial infarction.

Bedside right heart catheterization in patients with acute myocardial infarction and hemodynamic dysfunction provides a rational basis for therapy aimed at maximizing cardiac performance and limiting infarct size. Readily performed and associated with minimal risk, this diagnostic approach is primarily indicated when myocardial infarction is associated with evidence of hemodynamic dysfunction. It affords precise information on cardiac performance and prognosis, allows identification of specific complications such as ventricular septal defect and acute mitral regurgitation, and is of critical importance in selection of therapy. Hemodynamic monitoring is also essential for safe, effective application of certain forms of treatment such as vasodilator therapy for the failing ventricle.

Acute Disease↗