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Biomedical subjects

T R Miller

Publications and source records attributed to T R Miller.

At least 181 records · Page 10Linked to original sources
PubMed1987

Fine-needle aspiration biopsy in the management of cervical carcinoma following primary therapy.

Thirty-five fine-needle aspiration biopsies (FNAB) in 30 patients who had previously received primary therapy for cervical carcinoma are reported. There were 22 positive FNABs, and in 11 cases the positive FNAB definitely changed the patient's planned therapy. There were no complications due to FNAB in these 30 patients. FNAB has an important role in follow-up and management of patients with cervical carcinoma.

Adenocarcinoma↗
PubMed1987

Isolated cardiac aspergillosis after bone marrow transplantation.

A 15-year-old girl developed isolated cardiac aspergillosis after allogeneic bone marrow transplantation. Predisposing factors included severe graft-vs-host disease with gastrointestinal tract involvement and immunosuppressive therapy including cyclosporine. The patient died of cardiopulmonary failure 11 weeks after transplantation.

Adolescent↗
PubMed1987

Detection of coronary artery disease by analysis of ventricular filling.

Rapid left-ventricular (LV) diastolic filling assessed by radionuclide ventriculography is reevaluated in patients with coronary artery disease and normal LV systolic function considering the effects of age and heart rate. Thirty normal subjects were studied along with 44 patients with coronary artery disease and normal LV ejection fractions. The peak filling rate was not quite significantly different between the controls and patients (2.67 +/- 0.95 EDV/sec versus 2.25 +/- 0.65 EDV/sec, p = 0.08), and the time to peak filling rate was not different. When an inappropriate young control group was compared with coronary disease patients aged 40-65 yr, large differences in peak filling rate were seen. Sensitivity for detection of disease was very low (0%-9%) except when the inappropriate young control group was used. Thus, analysis of rapid diastolic filling cannot detect individual patients with coronary disease who have normal LV ejection fractions. Previous reports to the contrary may have suffered from failure to include the effects of age and heart rate.

Adult↗
PubMed1987

Influence of training and experience in fine-needle aspiration biopsy of breast. Receiver operating characteristics curve analysis.

In an effort to assess the influence of training and experience on the interpretation of fine-needle aspiration biopsy (FNAB) specimens, five observers with varying degrees of training and experience reviewed a series of 50 breast FNAB specimens. The cases selected were from the cytology registry of the University of California, San Francisco; all cases necessarily had histologic follow-up. By using receiver operating characteristics analysis, we were able to show that training and experience significantly influenced the interpretation of breast FNAB specimens. The two experts operated at a higher level of sensitivity and specificity than did three nonexperts. This study shows that training and experience are important in the interpretation of breast FNAB specimens. It also demonstrates the utility of receiver operating characteristics analysis in anatomic pathology.

Biopsy, Needle↗
PubMed1986

Left ventricular diastolic filling and its association with age.

Thirty normal subjects, aged 22 to 80 years, were studied by radionuclide ventriculography to determine the age dependence of cardiac ventricular diastolic function and to evaluate the association of other factors with ventricular diastolic performance. A strong negative correlation was found between peak diastolic filling rate and age (r = -0.82, p less than 0.0001). Partial correlation analysis was used to factor out the strong age dependence and yielded additional significant correlations of peak filling rate with heart rate (r = 0.48, p less than 0.01) and time to peak filling rate (r = -0.48, p less than 0.01). Time to peak filling rate is also correlated with heart rate but not definitely with age. Analysis by multiple linear regression yields an equation predicting peak filling rate from age and heart rate. Thus, the rate of rapid diastolic filling declines markedly with age in normal subjects. The association of peak filling rate with age and with other factors indicates the need for careful consideration of these factors in the interpretation of scintigraphic findings in patients with heart disease.

Adult↗
PubMed1986

The (F)utility of the thallium-201 quantitative lung/myocardial ratio in the detection of coronary artery disease.

Exercise-induced increases in pulmonary uptake of thallium-201 (201Tl) have been associated with exercise-induced myocardial dysfunction. To evaluate this phenomenon more replicably, a quantitative semi-automated computer program was used to generate, from anterior exercise and delayed views, lung-myocardial ratios (LMR) of 201Tl uptake in 78 patients [40 normal, 38 with coronary artery disease (CAD)]. Patients with CAD had a significantly higher mean exercise lung myocardial ratio (EXLMR) than normals (30.8 vs. 27.3; P less than 0.003). In patients with adequate exercise (greater than or equal to 85% of an age-adjusted maximal heart rate), the EXLMRs of CAD patients were significantly higher than those of normals (29.7 vs. 25.5; P = 0.003). However, this difference between CAD and normal patients was not apparent in a patient subgroup with submaximal exercise levels (less than 85% of an age-adjusted maximal heart rate). In both normal and CAD patients, EXLMR decreased with increasing exercise levels (r = -0.555; P = 0.007). In patients with 201Tl scans lacking visually defined perfusion defects (visually normal), an elevated LMR detected 60% of CAD cases with 81% specificity. A considerably elevated EXLMR in patients achieving adequate exercise should suggest the presence of CAD, even if there are no visually apparent cardiac perfusion defects. With submaximal exercise, however, the EXLMR is not a useful discriminator between CAD patients and normals.

Adult↗
PubMed1986

Fine needle aspiration biopsy. Has its time come?

Fine needle aspiration biopsy has been undergoing a revival in the United States, but a recent survey showed that many clinicians were uncertain how to utilize this test. The scope of fine needle aspiration biopsy as practiced at the University of California, San Francisco, and the San Francisco General Hospital is described. The relevant accuracy data available in the world literature on this procedure are also reviewed.

Abdominal Neoplasms↗
PubMed1986

Benign lymphoepithelial cysts of the parotid gland. A histologic, cytologic, and ultrastructural study.

Five cases of benign lymphoepithelial cysts (BLCs) of the parotid gland are reported, and the histologic, aspiration cytologic, and ultrastructural findings are described in detail. These uncommon parotid lesions contain epithelium-lined cystic spaces encased by abundant lymphoid tissue with germinal centers. The epithelium was "mucoepidermoid" in three of our cases and squamous in two. Familiarity with the morphologic features of BLCs should make it possible to distinguish them from similar-appearing cystic lesions, especially low-grade cystic mucoepidermoid carcinoma and cystic types of benign lymphoepithelial lesion (so-called Mikulicz's disease). These distinctions, however, are difficult on aspiration cytology specimens.

Adult↗
PubMed1986

Enzyme histochemistry and thyroid neoplasia.

The authors have examined the enzyme histochemical staining of surgically removed human thyroid tissue in an attempt to identify markers that might be useful in the histopathologic diagnosis of thyroid neoplasms. Fresh thyroid glands and other tissues were fixed in cold (4 degrees C) 4% paraformaldehyde and embedded in glycol methacrylate. Forty-two specimens were studied in thin sections, which gave excellent histologic detail and enzyme preservation. Cytologic detail was similar to that in Papanicolaou-stained smears, with good definition of nuclear inclusions and grooves, particularly in cases of papillary carcinoma. The enzyme histochemical reactions studied were as follows: adenosine triphosphatase, alkaline and acid phosphatases, alpha-naphthyl acetate esterase, and 5'-nucleotidase. Thyroid epithelial cells and the benign neoplasms derived from them were typically positive for 5'-nucleotidase, alpha-naphthyl acetate esterase, and acid phosphatase, and negative for adenosine triphosphatase and alkaline phosphatase. Staining for adenosine triphosphatase was present in papillary and follicular carcinomas and was seen in benign glands only under certain circumstances such as Graves' disease. The adenosine triphosphatase reaction therefore appears to be helpful in distinguishing between benign and malignant neoplasms derived from thyroid epithelium in humans and may be a useful adjunct to routine morphology.

5'-Nucleotidase↗
PubMed1986

Aspiration cytology characterization of inflammatory masses.

Fine-needle aspiration biopsy smears are useful in the workup of patients with abscesses and inflammatory masses. We report 37 cases classified into three groups: group I, in which a causative organism was seen on the smear; group II, in which a causative organism was cultured from a smear where organisms were not seen microscopically, and group III, in which the organism was not seen or cultured, but the smear findings were useful in determining further workup.

Abscess↗
PubMed1986

Fine-needle aspiration biopsy. Perceptions of physicians at an academic medical center.

In an earlier survey, we asked private practitioners in San Francisco about their perceptions of fine-needle aspiration biopsy (FNAB). In the present study we sent the same survey to clinicians in our hospital, a tertiary medical center. Although the response rate to this survey was lower, it appears that FNAB is used more often in our hospital than it is among private practitioners for the evaluation of palpable masses (53% vs 24%), and that it is most often performed by pathologists. Seventy percent of the FNAB at this institution were performed by pathologists; a small percentage (7%) of cases (nonpalpable) were performed by a radiologist for the evaluation of intra-thoracic and intra-abdominal lesions. Fifty-nine percent of private practitioners performed the FNAB themselves, and the remainder (39%) were referred to pathologists, radiologists, and surgeons. That there are differences in perceptions concerning the use of FNAB in a variety of specific clinical settings was also illustrated by this survey.

Academic Medical Centers↗
PubMed1985

Use of a nonstationary temporal Wiener filter in nuclear medicine.

The use of the Wiener filter is proposed for temporal filtering of nuclear medicine dynamic studies. This filter adapts to the signal and noise levels of each pixel activity curve in a dynamic study to produce an "optimal" suppression of noise, while maintaining the signal content of the curve. The filter is derived to be a simple function of the power spectrum of the time-activity curve. Examples of its use for temporally filtering gated blood-pool studies for cine viewing and functional image formation are shown.

Heart↗
PubMed1985

Interactive combining of functional images.

A technique of interactively combining digital images using virtual color tables is presented. The general combination algorithm, a particular implementation of this algorithm, and an interactive approach to combining functional images are described. Combined phase and amplitude images derived from gated blood-pool studies are presented to illustrate the method, and other applications of the technique in nuclear medicine are suggested.

Color↗
PubMed1985

Malignant fibrous histiocytoma of the vulva.

Primary sarcomas of the vulva are rare neoplasms; malignant fibrous histiocytoma is a sarcoma that usually occurs in the extremities of elderly patients, but it also has been seen in a number of other sites. Presented is the second case report of malignant fibrous histiocytoma arising in the vulva. The diagnosis and management of vulvar sarcomas are reviewed.

Adult↗
PubMed1985

A practical method of image enhancement by interactive digital filtering.

A generalized form of the Wiener digital filter is described in which the user interactively varies two filter parameters to produce any desired number of filtered versions of a given image with differing blends of sharpening and smoothing qualities. Filtering is performed sufficiently rapidly, even without use of an array processor, to make application of the filter truly interactive. Use of the filter is illustrated with typical nuclear medicine images.

Bone and Bones↗
PubMed1984

Hemicorporectomy--perioperative management: a case presentation and review of literature.

Hemicorporectomy , or translumbar amputation, is a dramatically drastic surgical salvage procedure for patients with uncontrolled locally extensive pelvic-perineal malignancies. Several successful cases have been reported in the world literature [3-6] and careful perioperative management has been crucial. The case presented is that of a massive recurrent chondrosarcoma of the pelvis with special emphasis on close monitoring and finely tuned supportive care; unusual manifestations of neuroleptic malignant syndrome and of narcotic withdrawal are discussed.

Amputation, Surgical↗
PubMed1984

Fine needle biopsy in retinoblastoma.

We studied three cases of retinoblastoma in which fine needle biopsy established the correct diagnosis inside the eye or at extraocular sites.

Adolescent↗