Biomedical subjects
Publications and source records attributed to W W Miller.
Primary and secondary risk factors and prevention strategies for coronary artery disease are reviewed. Cigarette smoking, hypertension, dyslipidemia, heredity, diabetes mellitus, obesity, beta blockades, and coronary artery bypass surgery are some of the topics discussed.
Risk factors for the development and progression of coronary atherosclerosis, hypertension, and cerebrovascular diseases are found in more than 10 per cent of children and adolescents in the United States. This article presents the criteria for the diagnosis of three of these risk conditions--dyslipidemia, hypertension, and obesity--and it reviews principles and specifics of their management in young people.
An individual's functional ability in physiological responsiveness is thought to be an interaction between his heredity and his environment. This hypothesis was tested to determine if different extragenetic influences would alter functional adaptability in a set of MZ triplets. After a 3-month aerobic physical fitness training program varying only in frequency measured values for the triplets' maximum oxygen consumption (MaxVo2) were 59.1, 44.5, and 57.8 ml/min/kg, as compared to pretreatment values of 45.2, 45.1, and 49.1 ml/min/kg respectively. These results clearly indicate intrapair differences in functional adaptability, stemming from difference in the training frequency program. The split-triplet design of this study indicates that environmental factors contribute substantially to the intrapair variance found among MZ siblings. Data extrapolation suggests that environmental stimulation of sufficient magnitude is likely to alter the functional adaptability in the individual set by his genotype.
The present study was conducted to determine whether females exhibiting the Type A behavior pattern would exert greater effort and work to higher levels of physiological fatigue in a self-motivated ergometer test. Twenty female subjects, half of them Type A and the other half Type B, were administered an incremental ergometer test to determine their peak oxygen consumption value. On the first experimental session no experimenter encouragement was given to the subjects. Consequently the test measured physical motivation levels. During a second laboratory session, each subject was continuously encouraged by the experimenter to maintain exercising until she was truly incapable of further work. The highest rate of oxygen extraction during this latter session was considered the subject's maximum oxygen consumption (i.e., VO2 max). Type A and B subjects were compared in the nonmotivated testing session (experimental session 1) to their "true" individual capacities (maximum oxygen consumption demonstrated in experimental session 2). ANOVAs indicated no significant differences in self-initiated competitive behavior during a physical stressor.
Intravascular papillary endothelial hyperplasia (IPEH), a benign lesion histopathologically characterized by intravascular fibrous papillary fronds covered by pleomorphic endothelium, is usually found in the subcutaneous tissues of the head and extremities. We describe the clinical and histologic findings of IPEH in the upper eyelid of a 20-year-old woman. Intravascular papillary endothelial hyperplasia has been confused with angiosarcoma. The differential diagnosis and key distinguishing features are discussed and the literature is reviewed.
Suboptimal labeling of red blood cells with Tc-99m, using the modified in vivo technique, was observed in three patients in whom labeling was attempted following IV administration of iodinated contrast media in the previous 24 hours. The mechanism is not understood, but it may represent a change in either stannous ion distribution or redox potential. It is recommended that studies employing Tc-99m RBC labeling using this technique be performed prior to administration of iodinated contrast media. This effect should be kept in mind in gastrointestinal bleeding studies performed using Tc-99m RBC, as well as in cardiac imaging studies.
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Exercise testing was the means of finding functional cardiovascular abnormalities in two-thirds of the 400 young patients studied for this report. No complications occurred, and the test results were valuable in counseling and managing the patients.
Virgin female C3H/He mice (275) were fed a ration that included 0.1 per cent N-4-(5-nitro-2-furyl)-2-thiazolyl formamide (FANFT) and retinyl acetate. The mice were divided into five groups with Groups 1 through 4 receiving 300, 600, 1200, and 2400 IU of retinyl acetate per kilogram of feed plus FANFT respectively. Group 5 received 300 IU per kg of feed and no FANFT as a control. After 45 weeks the bladders were removed and inspected for neoplasms. There were no tumors found in any of the mice from Group 5. It was found that retinyl acetate significantly inhibited the formation of squamous cell tumors at all levels and inhibited transitional cell carcinoma when given as 600 IU per kilogram of feed.
The blood pressure of 3,166 adolescents was measured periodically in Richmond during the period 1974-1977. The subjects were students in public and private schools and ranged in age from 14 to 18 years. Analysis of the readings showed minimal differences relating to age, sex, school and race but a strong correlation with obesity. Only two organic renal causes of hypertension were discovered. A 3 1/2-year followup of 902 students indicated significant tracking, with a correlation coefficient of .385 for systolic and .305 for diastolic pressure. At the conclusion of the study, 340 students (10.7%) were identified as needing followup for hypertension.
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Eight patients (different families) with syncopal attacks and a long QT interval in the ECG died suddenly. Five heard normally and three were born deaf. At postmortem examination of all eight hearts the single consistent abnormality was focal neuritis and neural degeneration within the sinus node, A-V node, His bundle and ventricular myocardium. Although the etiology of this intracardiac neural disease is uncertain, a chronic viral infection or some noninfectious degenerative process are among the plausible causes discussed. If intracardiac neuritis and neural degeneration prove to be a prevalent finding among other victims dying from the long QT syndromes, further consideration should be given to whether there is any genuine hereditary component in the pathogenesis. Because of the asymmetrical and focal distribution of the cardioneural lesions, the response to present forms of medical or surgical treatment of the lung QT syndromes may vary from benefit to harm. Until more is known of the true etiology of the neural disease, treatment will probably remain empirical in nature and should be conducted with cautious clinical observation.
The clinical course and postmortem findings of an unusual case of complete transposition of the great arteries, in which the Mustard operation was not performed until the patient was 12 years of age, are documented with serial catheterizations showing adequate repair. The clinical course of the patient was uneventful for 8 years after surgery, when right (systemic) ventricular failure occurred, resulting in the patient's death at 20 years of age. Late cardiac failure, the cause of death, is not a commonly described problem after successful surgical repair of transposition of the great arteries.
Lactoferrin, a non-heme, iron-binding glycoprotein, was isolated from mouse milk. The purification procedure involved an initial centrifugation to remove much of the casein and to separate the fat from the whey, followed by ammonium sulfate precipitation and chromatography on carboxymethyl-Sephadex. The lactoferrin preparation obtained was highly purified as judged by polyacrylamide gel electrophoresis under both non-denaturing and denaturing conditions, and the presence of lysine as the only NH2-terminal amino acid. Polyacrylamide gel electrophoresis in the presence of sodium dodecyl sulfate indicated a single component having a molecular weight of 78 000 +/- 2800. Sedimentation equilibrium ultracentrifugation studies suggested that in addition to monomers of molecular weight 75 000 +/- 1000, other oligomeric forms of the protein were also present. Amino acid and amino sugar analyses revealed that there were 5 methionine, 10 histidine, 10 tryptophan and 5 glucosamine residues per mol of protein. Isoelectric focusing of lactoferrin in a polyacrylamide gel stabilized pH gradient indicated a single component having an isoelectric point of about 9; however, depending on the preparation examined, a range of 8.7-9.6 was noted. A single precipitin line was observed with rabbit anti-mouse lactoferrin when examined by immunodiffusion and immunoelectrophoresis. No immunological cross-reaction was observed between mouse lactoferrin and mouse transferrin.
Pulmonary telangiectasia is an uncommon developmental anomaly characterized by minute arteriovenous fistulae disseminated throughout both lungs. It should be suspected in patients with cyanosis and digital clubbing who do not have chronic lung disease or a cyanotic cardiac anomaly. The presence of telangiectases of skin or mucous membranes in the patient or members of his family is an important diagnostic clue. The chest film usually shows a coarse spidery appearance of the peripheral vascular markings in the lungs. More specific findings are obtained in the pulmonary angiogram where the normally invisible capillary phase is replaced by irregular vascular channels bridging the peripheral branches of pulmonary arteries and veins. The intrapulmonary right-to-left shunt may be confirmed by pulmonary scintigraphy using technetium-labeled albumin. Two cases are presented with a brief review of the literature.
A previously healthy 5-year-old girl developed staphylococcal septicemia. Initially, cardiovascular failure with mitral insufficiency and purulent pericarditis dominated the clinical picture. Peripheral thromboembolic phenomena, meningitis, osteomyelitis, and persistent septicemia were subsequently encountered during antimicrobial and surgical therapy. Although staphylococcal septicemia is a potentially lethal disorder, anticipation of its natural course and its possible complications should lead to more successful management.
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