Biomedical subjects
W T Miller
Publications and source records attributed to W T Miller.
The functional role of structural complexities in the propagation of depolarization in the atrium of the dog. Cardiac conduction disturbances due to discontinuities of effective axial resistivity.
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The impact of adjacent isotropic fluids on electrograms from anisotropic cardiac muscle. A modeling study.
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Bronchopleural fistula complicating invasive pulmonary aspergillosis.
Pleural involvement has been notably absent in reviews of invasive pulmonary aspergillosis. This report describes the development of a bronchopleural fistula complicating invasive aspergillosis in a patient receiving chemotherapy for leukemia. The fungal hydropneumothorax occurred despite early diagnosis of the pulmonary infection and prompt treatment with amphotericin B. Closed pleural drainage and continued antifungal medication resulted in ultimate cure of the infection. The presumed pathophysiologic aspects of this event are discussed and the literature on pleural aspergillosis is reviewed.
Pleural thickening: its significance and relationship to asbestos dust exposure.
The admission chest radiographs of 824 were screened for the presence of bilateral pleural thickening. Those patients with pleural thickening were scored according to the ILO classification of radiographs of the pneumoconioses. The prevalence of bilateral pleural thickening was high (6.2%) in these patients, of whom 67% had an environmental or occupational history suggestive of asbestos exposure. The predictive value of bilateral pleural thickening alone as an indicator of previous asbestos exposure was 67%. If one excludes known medical or surgical etiologies of pleural thickening then the predictive value increased to 81%. The radiographic detection of bilateral pleural thickening has a strong association with prior asbestos exposure.
Lobar bronchioloalveolar cell carcinoma.
Bronchioloalveolar cell carcinoma has a variety of radiographic appearances. Usually it is a localized, well circumscribed nodule in the lung periphery. Nodules of various sizes that appear to coalesce in one or both lungs characterize a diffuse pattern of this disease. Occasionally, chronic lobar consolidation simulating a bacterial pneumonia may be seen. The clinical and radiographic course of eight patients whose bronchioloalveolar cell carcinoma appeared initially as lobar consolidation was analyzed. Four tumors rapidly progressed to involved the opposite lung. Attempts should be made by radiographic and other means to establish inoperability, since surgery is rarely useful in this type of lung cancer.
Sarcoidosis: a cause of intrathoracic lymphadenopathy after treatment of testicular carcinoma.
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Identification of patients with cholesterol or pigment gallstones by discriminant analysis of radiographic features.
In a search for a way to distinguish cholesterol gallstones from pigment gallstones by oral cholecystography, we evaluated 56 patients with surgically confirmed cholelithiasis. Only buoyancy was highly predictive of gallstone composition: all 14 patients with floating stones had cholesterol stones (P less than 0.01), but only one third of the patients with cholesterol stones had stone buoyancy. Using a function derived by stepwise discriminant analysis, we separated patients with cholesterol stones from those with pigment stones. The predictive accuracy was significantly improved: sensitivity was 95 per cent (37 of 39 patients with cholesterol stones), specificity was 82 per cent (14 of 17 patients with pigment stones), and efficiency was 91 per cent (51 of 56 total patients). The resultant function, applied prospectively to 17 additional cases, classified all of them correctly. In patients with cholelithiasis and gallbladders visualized on oral cholecystography, discriminant analysis can improve the prediction of gallstone composition and the subsequent selection of medial or surgical therapy.
The hypereosinophilic syndrome.
The hypereosinophilic syndrome is a spectrum of clinical disorders characterized by leukocytosis and marked eosinophilia without definable cause. Clinical symptoms and radiographic findings are most often due to congestive heart failure, although parenchymal lung infiltrates from the eosinophilia itself may be seen. Four documented cases with chest radiographs are presented.
"Semi-invasive" pulmonary aspergillosis: a new look at the spectrum of aspergillus infections of the lung.
A chronic cavitary form of pulmonary aspergillosis may occur with mild immunosuppression or underlying lung disease. In this "semi-invasive" type, the fungus is intermediate between a simple saprophyte and an invasive pathogen. Aspergillus may produce extensive lung destruction despite the lack of vascular invasion. The absence of a previous cavity distinguishes such cases from secondary noninvasive mycetomas. Radiographic features include a chronic infiltrate, progressive cavitation, and subsequent mycetoma formation. Biopsy may be helpful; however, marked squamous metaplasia can produce false-positive Class V cytological findings even though malignancy is excluded. This variety of aspergillosis supports the concept that the traditional allergic, saprophytic, and invasive forms may represent a spectrum of disease dependent on host immune status and lung architecture.
The discontinuous nature of propagation in normal canine cardiac muscle. Evidence for recurrent discontinuities of intracellular resistance that affect the membrane currents.
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Progressive systemic sclerosis subgroups: variable pulmonary features.
Evidence has accumulated which enables subdivision of progressive systemic sclerosis (scleroderma) into three categories: (1) classic progressive systemic sclerosis (PSS); (2) the CRST/CREST syndrome; or (3) overlap syndromes. Previous reports of the chest film manifestations of PSS have used only the broad category of scleroderma without subdivision. This study analyzed the chest film manifestations of 73 PSS patients which have been subgrouped. Radiographic abnormalities, either interstitial lung disease or pleural effusion, were present as follows: PSS, 18% (8/44); CRST/CREST, 0% (0/9); and PSS-overlap, 75% (15/20). Interstitial lung diseases in the PSS-overlap group was usually basilar and of mild severity on the initial chest film obtained. While the classic PSS group had a very much lower incidence of lung disease, it was usually more diffuse and severe.
Staging system for soft tissue sarcoma.
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Spontaneous pneumothorax: an uncommon manifestation of Wegener granulomatosis.
Pneumothorax is an unusual manifestation of Wegener granulomatosis. Two cases are presented which illustrate a definite association between the entities. Pneumothorax may be the initial and only pulmonary manifestation, or it may occur in combination with other evidence of the disease.
Oral barium sulfate in partial large-bowel obstruction.
Nine dogs underwent a surgically created partial obstruction of the large bowel and were then given oral barium sulfate. The residual lumen of the obstructed portion varied from 4 to 10 mm in diameter. Clinical obstruction did not develop, and all dogs passed the barium sulfate in 1 to 16 days. This limited study plus certain clinical observations would suggest that barium sulfate proximal to a partial large-bowel obstruction may not be as dangerous as commonly thought.
Total body surface potential mapping during exercise: QRS-T-wave changes in normal young adults.
Total body surface potential distributions were recorded from 20 normal young adults, 20-35 years old, during multistage maximal exercise testing on a bicycle ergometer. Using a system for measuring total body surface potential distributions from measurements at 24 locations, high-quality potential maps were obtained during exercise without requiring wave form averaging or special modes of exercise. Serial maps recorded at 1-msec intervals throughout QRS-T during exercise and during recovery from exercise were compared with corresponding maps recorded with the subjects at rest. During and after exercise, consistent changes appeared in the map patterns during early QRS and the ST segment and in the magnitude of the T-wave potentials. Increases in QRS duration (0-10 msec) also appeared during exercise. The changes in map patterns during early QRS in exercise strongly suggested changes in the initial sequence of activation in the ventricles. The results demonstrate the importance of analyses of total body surface potential distributions in understanding ECG changes during exercise.
Pleural thickening caused by Sansert and Ergotrate in the treatment of migraine.
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