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Biomedical subjects

S H Miller

Publications and source records attributed to S H Miller.

At least 19 recordsLinked to original sources
PubMed1992

Do forehead lifts lift or unfurl?

Forehead lifts are becoming increasingly more popular as an adjunct to facial rejuvenation. Considerable confusion exists as to how much the eyebrow should be elevated and how much scalp should be removed to achieve this goal. In an effort to evaluate this question, we have reviewed our recent forehead lift experience. These were done with forehead flap dissection down to glabella and supraorbital ridge, partial resection of corrugator supercilii, procerus, and frontalis muscles, and limited skin resection. We suggest that a natural-appearing, rejuvenating forehead lift should unfurl facial wrinkles without excessive eyebrow elevation. Technical maneuvers to obtain this goal are discussed.

Forehead↗
PubMed1992

Complications of nasoenteral tubes. Intragastric tube knotting and intragastric tube breakage.

We report two complications of nasoenteral tubes. A nasogastric tube became knotted during gastric intubation in a patient with a small gastric remnant, created during gastric surgery for morbid obesity. A clogged Dobbhoff tube ruptured while it was being flushed manually with a syringe containing normal saline under great pressure. To retrieve the knotted tube, we grasped the distal knotted part visible in the oropharynx with forceps, pulled it out of the mouth, and cut it. To retrieve the broken tube, we snared the intragastric fragment at endoscopy. These case reports suggest that a small gastric remnant may be a risk factor for nasogastric tube coiling and knot formation and that flushing a clogged tube at high pressure may rupture it. To prevent these complications, a nasogastric tube should be carefully passed just into the stomach in a patient with a small gastric remnant, and a clogged feeding tube should be flushed with only moderate pressure. Failure to clear a blocked tube by flushing with normal saline at moderate pressure should lead to tube removal and not to use of excessive pressure.

Adult↗
PubMed1992

Gastric lesions in the excluded gastric segment undetected by endoscopy or radiography in patients status post vertical banded gastroplasty.

A patient had two surgical revisions and another patient had one surgical revision of a vertical banded gastroplasty because of intraoperative findings of gastric ulceration, incomplete penetration, and transmural penetration of the silicone band. Preoperative esophagogastroduodenoscopy in all three cases and an upper gastrointestinal series in two of the cases failed to demonstrate these lesions, because the lesions were located in the surgically excluded gastric segment. These reports demonstrate that a normal upper gastrointestinal series or panendoscopy in a patient after vertical banded gastroplasty does not exclude significant lesions in the endoscopically inaccessible, excluded gastric segment, and that it may be necessary to perform a laparotomy on a severely symptomatic patient even when an endoscopy is normal.

Adult↗
PubMed1991

Studies with abanoquil (UK-52,046) a novel quinoline alpha 1-adrenoceptor antagonist: II. Duration of action, pharmacokinetics and concentration-effect relationships in normotensive subjects.

1. This study further examines the quinoline-derivative abanoquil with particular respect to the duration of its alpha 1-adrenoceptor antagonist activity and its concentration-effect relationship following a single intravenous bolus dose of 0.5 micrograms kg-1 in young, normotensive males. 2. alpha 1-adrenoceptor antagonism (as assessed by phenylephrine pressor responses) was detectable for up to 12 h post dosing: at 12 h there was a significant 1.5-fold rightward shift (95% CI: 2.2 to 1.1) of the pressor dose-response curve for diastolic blood pressure. 3. Despite evidence of substantial alpha 1-adrenoceptor antagonism abanoquil had no significant effect on blood pressure, supine and erect, but there were small and statistically significant increments in heart rate. 4. The degree of alpha 1-adrenoceptor antagonism was related to whole blood concentrations abanoquil: the PD-ratios of phenylephrine pressor responses performed at 1, 6, and 12 h post dosing were significantly correlated with log drug concentrations (r = 0.57 for systolic (P less than 0.05) and r = 0.78 for diastolic blood pressure (P less than 0.005). 5. In conclusion, abanoquil produced significant alpha 1-adrenoceptor antagonism which was related to circulating drug concentrations. The absence of other significant cardiovascular effects suggests that abanoquil warrants further clinical study as an antiarrhythmic agent.

Adrenergic alpha-Antagonists↗
PubMed1990

Chronic swim stress enhances the motoric inhibiting effects of a muscarinic agonist.

The authors previously demonstrated that chronic inescapable swim stress and footshock increase the capacity of a fixed dose of a muscarinic agonist to produce hypothermia in the rat. This project was designed to determine whether chronic inescapable swim stress in cold water would render a low dose of a muscarinic agonist, devoid of an effect on motor behavior in the naive rat (i.e., prior to subjection to the course of swim stress), an inhibitor of mobility. The study involved two groups of rats, an experimental group which received arecoline and a control group which received saline five minutes prior to being placed in an open field. Number of crossings, the dependent variable, was measured in both groups before and after a 14-day course of twice daily inescapable swim stress of 10 minutes duration at 12 degrees C. The arecoline-treated group, as hypothesized, exhibited a significantly greater reduction in number of crossings than the saline-treated groups following the course of swim stress.

Animals↗
PubMed1990

Healing in the irradiated wound.

Poor or nonhealing of irradiated wounds has been attributed to progressive obliterative endarteritis. Permanently damaged fibroblasts may also play an important part in poor healing. Regardless of the cause, the key to management of irradiated skin is careful attention to prevent its breakdown and conservative, but adequate, treatment when wounds are minor. When wounds become larger and are painful, complete excision of the wound or ulcer is called for and coverage should be provided by a well-vascularized nonparasitic distant flap.

Humans↗
PubMed1989

Effectiveness of prophylactic mastectomy in the prevention of breast tumors in C3H mice.

The effectiveness of prophylactic mastectomy in the prevention of breast tumors was studied in spontaneous breast-tumor-forming C3H mice. Prolactin levels were assayed to determine if this hormone was related to the incidence of mammary tumors. Two-hundred and fifty-six 1-month-old C3H mice were divided into four groups (control, 1; sham surgery, 2; mammectomy 50 percent, 3; and mammectomy 100 percent, 4). At the time of sacrifice (0 to 1 year postoperatively) estrus cycles were determined, ventral skin (breast) and ovaries were removed for histology, and serum was collected for prolactin assays. Prolactin levels 24 hours postoperatively were significantly elevated (p less than 0.01) in groups 2 to 4 when compared with group 1. Six months postoperatively, prolactin levels were significantly higher (p less than 0.05) in mice with tumors compared with those without tumors in groups 3 and 4. There were no differences in tumor incidence between the four groups. At 12 months postoperatively, no differences in prolactin levels were noted, but group 2 animals had the highest incidence of mammary tumors (89 percent; p less than 0.01) when compared to groups 3 and 4. Mammary tumor incidence was not decreased by 50 percent or 100 percent mammectomy in C3H mice. Prolactin levels rose in response to surgery and/or anesthesia and remained elevated only in tumor-bearing mice who underwent mammectomy, an occurrence similar to that reported in humans.

Adenocarcinoma↗
PubMed1988

The effect of food on the absorption of slow-release isosorbide-5-mononitrate tablets.

The influence of food on the absorption characteristics of slow release isosorbide-5-mononitrate tablets was investigated in 10 normal healthy volunteers. There were no differences in the peak concentration achieved or the area under the curve, but the peak concentration occurred later when the drug was administered after food. The apparent elimination half-life ranged from 4.7 to 10.1 h. Bioavailability of slow-release isosorbide-5-mononitrate is therefore unaffected by food, but there is a slower rate of absorption.

Absorption↗
PubMed1988

Effects of phenylephrine on tissue gas tension, bleeding, infection, and lidocaine absorption.

In an attempt to find a vasoconstrictor with less detrimental local and systemic effects than epinephrine, the effects of phenylephrine, a pure alpha agonist, on tissue gas tension, bleeding, infection rates, and lidocaine absorption were studied. All concentrations of phenylephrine significantly reduced tissue PO2 within 10 minutes of injection, and reduction of PO2 was dose-dependent. Phenylephrine 1:10,000 produced significant bacterial growth when simultaneously injected with 6 X 10(6) Staphylococcus aureus. Bacterial growth was insignificant with 1:20,000 phenylephrine and absent with 1:40,000 phenylephrine. Blood loss from a standard wound was significantly reduced at all concentrations of phenylephrine. Lidocaine absorption was significantly reduced with 1:20,000 and 1:40,000 phenylephrine. In a rat model, 1:40,000 phenylephrine significantly reduced blood loss and lidocaine absorption, produced minimal reduction of tissue PO2, and did not enhance bacterial invasion.

Adsorption↗
PubMed1988

Improved imaging of the augmented breast.

The breast containing an augmentation implant presents a challenge to the mammographer and is often considered unsuitable for adequate mammographic evaluation. A modified positioning technique is described. By displacing the implant posteriorly against the chest wall and pulling breast tissue over and in front of the implant, marked improvement in compression and visualization of substantially more breast tissue is achieved. Over 250 patients with augmentation implants have been successfully studied with this modified compression technique. After review of 50 consecutive cases, two experienced mammographers confirmed a significant improvement in image quality, amount of breast tissue visualized, and overall benefit of the modified technique. Modified positioning for women with breast implants substantially improves both image quality and amount of breast tissue imaged.

Breast↗
PubMed1987

Management of burned long bones.

The management of severely burned and exposed supportive osseous tissues is not fully standardized. We present two patients in whom extensive debridement and decortication of the involved bone may have contributed to subsequent stress fractures. We propose an alternative therapeutic approach for this problem, including: minimal debridement of the bone, early coverage of the exposed bone with vascularized muscle, and adequate prophylactic protection.

Adult↗
PubMed1987

Craniofacial biostereometrics.

We believe that biostereometrics can be useful to the craniofacial surgeon in providing a highly accurate, reproducible diagnostic and presurgical tool that is inexpensive and noninvasive. It can help visualize complex pathologic bony abnormalities, resolve ambiguous CT scans, and predict soft-tissue changes secondary to alterations in bony contours when used in conjunction with CT scans and cephalograms.

Face↗
PubMed1986

Tissue expansion as an adjunctive technique for the management of difficult wounds.

Replacement of lost or injured tissues with similar tissues is a major goal of the reconstructive surgeon. A relatively new modality, tissue expansion, appears to be an helpful adjunct in achieving this goal by providing tissues for reconstruction that are near at hand, possess similar characteristics to the lost tissue, and can even enhance vascularity within an ischemic area. Although the technique is a useful one, its indications and contraindications are incompletely defined. We have used this technique 65 times in 42 patients during a 2 1/2 year period. The overall complication rate has been 22 percent, similar to other reconstructive techniques, but the consequences of these complications have been relatively minor and have not, for the most part, added significantly to patient morbidity.

Adolescent↗