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Biomedical subjects

S Miller

Publications and source records attributed to S Miller.

683 records · Page 38Linked to original sources
PubMedDate not supplied

Inverted arcuate osteotomy and external fixation for adolescent tibia vara.

The purpose of our review is to describe and report results of a surgical technique for the treatment of adolescent Blount's disease. We retrospectively reviewed the results of 15 inverted arcuate osteotomies combined with external fixation. The inverted arc provides a proximal and stable osteotomy that can correct deformity in three planes. External fixation provides stable fixation, access to surgical wounds, and postoperative adjustment. According to the criteria of Schoenecker, we had 80% good results. Two patients with poor results were the most overcorrected, suggesting that overcorrection may not be so desirable as once suggested. We conclude that the inverted arcuate osteotomy with external fixation is an effective, reliable, and simple technique for treating adolescent tibia vara.

Adolescent↗
PubMedDate not supplied

An analysis of factors determining the use of breast conserving surgery for treating early-stage breast cancer.

To determine the trend of breast conserving surgery (BCS) in West Virginia and to identify patient, hospital and surgeon factors associated with use of BCS, we conducted a study of all cases of Stage I and II invasive breast cancer treated surgically in West Virginia from 1991 through 1995 (N = 2411). These records were obtained from the State Cancer Registry. Multiple logistic regression was used to generate odds ratios (or) and 95% confidence intervals (CI) to determine factors associated with BCS. Our results showed the rate of BCS increased from 25% in 1991 to 37% in 1994 and 33% in 1995, with an overall rate of 33%. Multiple logistic regression identified the following factors associated with BCS: tumor size less than 1 cm (or = 1.47, 95% C1 = 1.4, 1.5), hospital bed size > 300 beds (or = 1.3, 95% C1 = 1.05-1.6) and a surgeon who had graduated from medical school since 1981 (or = 1.2, 95% C1 = 1.0, 1.36). We conclude the rate of BCS in West Virginia still remains low and that the women least likely to have BCS were women with tumors > 2 cm treated at small hospitals by older physicians.

Breast Neoplasms↗
PubMedDate not supplied

Hyperhomocysteinemia in West Virginians with documented atherosclerotic disease.

Plasma homocysteine levels in a population of 282 West Virginians with atherosclerotic disease were significantly lower than in previous population studies of atherosclerotic subjects. Elevated homocysteine levels correlated positively with age and with serum creatinine levels. There was a trend toward higher homocysteine levels in men, but this did not reach statistical significance. Elderly men and individuals with elevated serum creatinine were the most likely populations to have elevated homocysteine levels. In 54 patients treated with 1 mg folic acid, plasma homocysteine levels fell by 21% with similar responses in both men and women. Elevated creatinine levels decreased the efficacy of folic acid treatment in reducing plasma homocysteine levels. All three patients with a homocysteine level in excess of 100 mmoles/L were found to have B12 deficiency.

Adult↗
PubMedDate not supplied

Rat thyroid epithelial cells provide limited accessory function but fail to present allo antigens in vitro.

Human and mouse thyroid epithelial cells (TEC) have been reported to exhibit a number of immunological activities including partial, but not total, antigen presenting capability. In the studies described here, the thyroid stimulating hormone-dependent rat thyroid epithelial cell line FRTL-5 was tested for its abilities to provide accessory and antigen presenting cell (APC) activity. FRTL-5 cells alone were not able to function as accessory cells for ConA induced polyclonal proliferation of purified T-cells and were not capable of inducing alloreactive T-cell proliferation in mixed lymphocyte reaction (MLR) cultures. Furthermore, even following the induction and enhanced expression of MHC class II and class I MHC products, respectively by IFN-gamma, FRTL-5, cells could not function as accessory cells or induce alloreactive T-cell proliferation as the singular stimulatory population in MLR cultures. However, these epithelial cells could effectively synergize with either low numbers of spleen cells, or with supernatants from activated T-cells, to provide accessory function in ConA stimulated cultures. These findings suggest that hormone-dependent and functional rat TEC cannot directly activate resting syngeneic or unprimed allogeneic T-cells, although they can provide at least one accessory cell signal involved in T-cell activation by mitogen. Thus, the results presented here do not support contentions that such a nonhemopoietic resident cell population is capable of directly triggering the initial activation of anti-thyroid specific T-cells.

Animals↗
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Effect of clinical settings on the utilization of nurse practitioners.

In this study, 143 medical and pediatric nurse practitioners in 61 agencies identified problems in role implementation and formulated recommendations for more effective utilization in clinical settings which employ, or plan to employ, nurse practitioners. Physician-intensive settings appeared to utilize nurse practitioners least effectively and more practitioners left such settings, citing inability to implement the role, than did practitioners employed by other types of health agencies. Different kinds of health agencies integrated and implemented the role at different rates.

Adult↗
PubMedDate not supplied

Tissue uptake and metabolism of amiodarone after chronic administration in rabbits.

This study was designed to determine serum and tissue concentrations of amiodarone and its metabolite desethylamiodarone after chronic amiodarone administration in rabbits. Rabbits were administered 20 mg/kg amiodarone for 6 weeks. Serum, liver, kidney, heart, lung, spleen, bile, adipose tissue, and muscle were collected upon sacrifice. Amiodarone and desethylamiodarone concentrations were determined in serum and tissues by an HPLC procedure standardized in our laboratory. Amiodarone concentrations were the highest in fat tissue followed by lung, liver, and muscle, with the lowest concentration in serum and only traces in the brain. Desethylamiodarone concentrations in liver, lung, and kidney approached those of the parent drug while the metabolite was present in negligible amounts in fat tissue and in brain. Bile from amiodarone-treated rabbits showed the presence of two more new metabolites which have not been characterized. Desethylamiodarone/amiodarone ratios in serum and tissues after chronic administration in rabbits were lower than in man. Nevertheless, differential accumulation of amiodarone and desethylamiodarone may be relevant to efficacy and toxicity studies.

Amiodarone↗
PubMedDate not supplied

A multicentre study of the safety and efficacy of amlodipine in mild to moderate hypertension.

An open, non-comparative study of 10 weeks' duration was conducted in general practice to assess the safety of amlodipine in patients with mild to moderate hypertension. Of the 5352 patients entering the study, 5135 received amlodipine; 4621 patients (90%) with a mean age of 58.2 years completed the study. Normalisation of blood pressure was achieved in over 80% of patients with a mean reduction of 21/15 mmHg. The mean final dose of amlodipine was 6.8 mg/day. Adverse experiences possibly related to amlodipine were reported by 19.3% of patients, and overall adverse events led to withdrawal in 6.7% of patients. The most common reported side-effect was oedema. The frequency of headache was almost identical in older and younger patients and oedema, flushing and dizziness were seen only slightly more often in elderly patients. Ninety per cent of patients were considered by their GP to have shown excellent or good toleration of therapy. Over 85% of patients elected to continue on amlodipine therapy after completion of the study.

Adolescent↗
PubMedDate not supplied

Induction of Theiler's murine encephalomyelitis virus (TMEV)-induced demyelinating disease in genetically resistant mice.

Theiler's murine encephalomyelitis virus-induced demyelinating disease, a murine model for multiple sclerosis, is the result of persistent infection which leads to a T cell-mediated immunopathology. Susceptible strains develop virus-specific DTH responses while resistant strains do not, and this response has been proposed as the basis for inflammation and demyelination. (C57BL/6 x DBA/2)F1 hybrid animals, normally resistant to TMEV-induced demyelinating disease, become susceptible when treated in vivo prior to infection with low dose cyclophosphamide. Comparable pretreatment of other resistant animals, C57BL/6 and CB6 (BALB/c x C57BL/6) F1 hybrids, does not render them susceptible (despite the H-2 identity of CB6F1 and B6D2F1 hybrids). Thus the "latent" susceptibility in B6D2F1 hybrids must be attributed to non-H-2 genes from the susceptible D2 parent. Resistance can be restored to CY-treated B6D2F1 animals by the adoptive transfer of splenic cells (including T cell enriched populations) from non-CY-treated donors. Resistance to TMEV-IDD in these animals, therefore, may involve active inhibition of a "latent" disease susceptibility.

Animals↗
PubMedDate not supplied

Urban adolescent females' views on the implant and contraceptive decision-making: a double paradox.

Focus groups and in-depth interviews were used to explore the decline in popularity of the contraceptive implant in a clinic-based sample of 41 ethnically diverse, urban, sexually active adolescents. While these teenagers' socioeconomic status and patterns of inconsistent contraceptive use made them potentially ideal implant recipients, they were unlikely to select this method. Negative media reports about the method were less influential than social conditions such as peer perspectives and gender relations. Oral networks that propagated misinformation went unchallenged because of the silence of satisfied users. Personal factors such as future orientation, autonomous decision-making and value of control also influenced contraceptive decision-making.

Adolescent↗