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Biomedical subjects

C M Mills

Publications and source records attributed to C M Mills.

At least 19 recordsLinked to original sources
PubMed1992

A pharmacokinetic study of sulphasalazine and two new formulations of mesalazine.

We have examined the pharmacokinetics of enteric coated sulphasalazine compared with two new formulations of mesalazine. These consisted of microgranules of mesalazine coated with Eudragit S in a concentration of either 20 or 25% dry lacquer substance; these in turn were enclosed in capsules coated with Eudragit L. In-vitro dissolution studies of coated microgranules showed that drug release was pH dependent. Studies in 7 normal volunteers showed median peak concentrations of 5-amino-salicylic acid and N-acetyl-5-amino-salicylic acid occurred at about 6 hours with both microgranular preparations, compared with sulphasalazine at 15 h. The microgranule formulation coated with 20% Eudragit S gave serum levels and overall systemic absorption similar to values with sulphasalazine. This new formulation may be of value for delivering mesalazine and other therapeutic agents to the colon.

Adult↗
PubMed1992

Smoking habits in psoriasis: a case control study.

We have examined smoking habits in 108 patients with psoriasis, including some with palmoplantar distribution, and compared the results with matched controls from the community. There was a significant association between psoriasis, current smoking status (OR = 2.7, 95% CI 1.44-5.42, P less than 0.01) and smoking habits prior to the onset of disease (OR = 3.75, 95% CI 1.68-9.47, P less than 0.001). There was also a marked dose-response relationship; the relative risk of psoriasis in those currently smoking more than 20 cigarettes/day was significantly elevated (OR = 5.3, 95% CI 2.1-13.0, P less than 0.001). Separate analysis of patients without palmoplantar distribution of psoriasis showed a significant association with smoking prior to onset of psoriasis (OR = 3.6, 95% CI 1.5-9.8, P less than 0.001). Smoking may play a role in the aetiology of this common skin disorder.

Adolescent↗
PubMed1992

Accuracy of Borg's ratings of perceived exertion in the prediction of heart rates during pregnancy.

When using Borg's 6-20 scale during pregnancy, ratings of perceived exertion (RPE) did not significantly correlate with exercise heart rates (HR) (P greater than 0.05). The HR predicted from RPE significantly (P less than 0.05) underestimated the exercise HR in the second trimester during walking (Group 1: mean difference 16 beats min-1, n = 11), aerobics classes (Group 4: mean 15 beats min-1, n = 48) and circuit training (Group 3: mean 18 beats min-1, n = 24); and in the third trimester during cycling (Group 2: mean 16 beats min-1, n = 12) and aerobics classes (Group 5: mean 11 beats min-1, n = 29). Maximal individual HR under-estimations were large for each physical activity during pregnancy, with values up to 54 beats min-1. Consequently, exercise intensity should not be monitored solely with RPE during pregnancy.

Exercise Test↗
PubMed1990

Osteolytic lesions and bacillary angiomatosis in HIV infection: radiologic differentiation from AIDS-related Kaposi sarcoma.

Bacillary angiomatosis is a newly recognized multisystem bacterial infectious disease seen in the setting of human immunodeficiency virus (HIV) infection. The disease is marked by cutaneous vascular lesions that contain a bacterium similar to the cat scratch disease bacillus. Antibiotic therapy leads to the resolution of both cutaneous and systemic manifestations. Of 17 HIV-infected patients with cutaneous lesions of bacillary angiomatosis, six (35%) had symptomatic osteolytic bone lesions that improved following antibiotic therapy. The authors describe the appearance of the bone lesions on radiographs, computed tomographic (CT) scans, magnetic resonance (MR) images, and radionuclide studies. Osteolytic lesions are a relatively common feature of bacillary angiomatosis in patients with HIV infection. The presence of bone lesions aids in differentiation of bacillary angiomatosis from acquired immunodeficiency syndrome-related Kaposi sarcoma, which has similar cutaneous abnormalities but no associated bone lesions.

Acquired Immunodeficiency Syndrome↗
PubMed1990

The efficacy and clinical impact of brain imaging in neurologically symptomatic AIDS patients: a prospective CT/MRI study.

The relative efficacies of cranial magnetic resonance imaging (MRI) and computed tomography (CT) brain scans for the detection of intracranial pathology in patients with the acquired immune deficiency syndrome (AIDS) were evaluated prospectively. Fifty homosexual or bisexual men with AIDS and neurologic symptoms were evaluated using both modalities. In 24 patients, MR images and CT scans provided the same diagnostic information (within normal limits in 16, cerebral atrophy only in 6, and similar lesions in 2 patients). In only one instance did CT show the presence of a lesion not seen on MRI. In the 25 remaining patients, MRI was the more sensitive modality. MRI also reflected more consistently the histopathologically documented extent and distribution of central nervous system disease. The greater sensitivity of MRI suggested significant alterations in the diagnostic evaluation and therapeutic management of 20 patients. Thus, MRI was as good or better than CT for the detection of intracranial pathology in 49 of 50 neurologically symptomatic AIDS patients and significantly affected the diagnosis and treatment of 40% of these patients. Although MRI does not appear to be more specific than other modalities in the differentiation of human immunodeficiency virus (HIV)-related neurologic diseases, its greater sensitivity suggests that MRI may be the best neuroimaging procedure for the initial radiologic evaluation of AIDS patients with neurologic illness.

Acquired Immunodeficiency Syndrome↗
PubMed1989

MRI of the knee in diffuse pigmented villonodular synovitis.

Magnetic resonance imaging (MRI) was performed on 11 patients with surgically proven pigmented villonodular synovitis (PVNS) of the knee. PVNS was diagnosed on the basis of presence of hemosiderin, joint effusion, and hyperplastic synovium without significant joint destruction. MRI provided a detailed map of the distribution of the disease within the joint, emphasizing the common occurrence of the disease behind the cruciate ligaments and in synovial cysts in the popliteal fossa. MRI aided in preoperative planning and postoperative follow-up for residual and recurrent disease. Nine additional cases of joint hemorrhage, hemophilia, desmoplastic tumors, and synovial chondromatosis were included to delineate differential diagnostic criteria.

Adult↗
PubMed1988

Hemodynamic response to treadmill exercise in normal volunteers: an assessment by Doppler ultrasonic measurement of ascending aortic blood velocity and acceleration.

Accurate assessment of ascending aortic blood velocity indices and reproducibility of a Doppler ultrasonic system during exercise were determined; the Doppler technique was then used to assess the effects of age, sex, and beta blockade on exercise hemodynamics. Doppler-determined velocity correlated well with an invasive electromagnetic system. Reproducibility of Doppler variables during three exercise tests was high (coefficient of variation less than 10%) and did not deteriorate appreciably with exercise. Peak velocity (PV) and maximum acceleration (MA) were inversely related to age, the relationship being more significant during exercise, whereas the systolic velocity integral showed no such relationship either at rest or during exercise. Doppler variables showed no difference between sexes, except at high levels of exercise. Beta blockade markedly attenuated the exercise response as shown by significant decreases in both MA and PV during exercise. The Doppler velocity data presented in this study provide a reference against which previously documented changes in exercising ischemic patients can be better related.

Adult↗
PubMed1988

White matter disease in AIDS: findings at MR imaging.

A review of the magnetic resonance (MR) images of 365 patients with acquired immunodeficiency syndrome (AIDS) revealed that 112 (31%) had signal abnormalities confined to the white matter. Four patterns were observed: (a) diffuse: widespread involvement of a large area; (b) patchy: localized involvement with ill-defined margins; (c) focal: well-defined areas of involvement; and (d) punctate: small foci less than 1 cm in diameter. Clinical or pathologic findings were available in 60 of the 112 patients and were correlated with the white matter patterns seen on MR images. The diffuse pattern correlated with AIDS dementia complex (ADC), which was the most common clinical diagnosis. Patchy or punctate lesions may be seen with ADC but are less common. Focal white matter lesions were not seen in patients with ADC but were seen in all six patients with progressive multifocal leukoencephalopathy, in both patients with lymphoma, and in one patient with toxoplasmosis. The authors conclude that white matter lesions are are common in AIDS and are often secondary to direct infection of the brain with human immunodeficiency virus, which causes the ADC and usually produces a diffuse white matter pattern. Biopsy is probably not indicated in these patients. Focal white matter lesions suggest a focal infection or tumor, and biopsy may be warranted.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Meningovascular syphilis: CT and MR findings.

The radiologic findings in three cases of meningovascular syphilis are presented. Angiography demonstrated varying degrees of narrowing and ectasia of the supraclinoid carotid, basilar, and proximal anterior and middle cerebral arteries, as well as distal branches. Computed tomography (CT) showed multifocal infarction with variable enhancement. Similarly, in the one case studied with magnetic resonance (MR), several regions of high signal intensity on T2-weighted sequences were found, which were compatible with foci of ischemia. Although the radiologic findings are nonspecific, the diagnosis of meningovascular syphilis should be considered in patients with vasculitis of uncertain etiology.

Adult↗
PubMed1985

Multiple spin-echo magnetic resonance imaging.

Spin-echo magnetic resonance (MR) imaging detects a variety of pathologic states with great sensitivity. A technique for producing multiple spin-echo images in multisection operation is presented. This method of intensity-image acquisition is compared with retrospective intensity-image synthesis from routine data sets. Both yield long echo time (TE) images with similar image contrast and comparable and often increased diagnostic utility. Technical and clinical considerations are addressed, including signal-to-noise levels, flow effects, and patient throughput.

Brain Diseases↗
PubMed1985

Variable magnetic resonance imaging parameters: effect on detection and characterization of lesions.

With change in the imaging technique and magnetic field strength used in magnetic resonance imaging, wide variations in the delineation of pathologic features occur. Using imaging data from patients with known pathologic conditions, we evaluated the intensity images in spin-echo and inversion-recovery imaging at varying repetition times, echo times, and inversion times over broad ranges and changing magnetic field strengths. Differences in conspicuity and the apparent size of the lesions are important to consider in diagnosing and evaluating pathologic conditions, especially when different imagers and techniques are employed.

Brain Diseases↗
PubMed1985

Hydrogen MR imaging of the head at 0.35 T and 0.7 T: effects of magnetic field strength.

To determine whether hydrogen magnetic resonance imaging at 0.7 T provides added clinical value over imaging at 0.35 T, images of the heads of patients with various intracranial disorders were obtained at these field strengths. Measurements of tissue contrast (C), signal-to-noise (S/N) ratio, and T1 and T2 relaxation times were determined. For a given spin-echo sequence with equal imaging time, resolution, and data sampling window, the product C X S/N was somewhat lower for the lower field strength. Under conditions of imaging with equal chemical shift artifact, C X S/N at 0.35 T was equal to or greater than that measured at 0.7 T. With an increase in field strength, T1 of pathologic areas and surrounding normal tissues increased, resulting in a corresponding loss of absolute signal level and decrease in contrast. Lesions were equally well seen at both 0.35 T and 0.7 T. The increased T1 and decreased C X S/N for higher magnetic fields--when measured with a fixed imaging time, resolution, chemical shift, and sequence--suggest that such field strengths may not improve tissue contrast, diagnostic ability, or clinical throughput when compared with lower field strength systems.

Brain↗
PubMed1984

High-resolution magnetic resonance imaging. Technical concepts and their implementation.

In magnetic resonance (MR) imaging manipulating spatial resolution, contrast resolution, and imaging time separately results in improvement in some parameters without degradation of others. The authors have found that MR imaging of the head with a repetition time TR = 2.0 seconds produces images with high signal-to-noise levels and excellent sensitivity to demyelinating disease and brain water content. In the body, a long TR yields large signal levels that permit delineation of low-intensity structures such as patent vessels and bone. The long TR technique can be used in a high-resolution mode (256 X 256 data acquisition elements, each 0.8 X 0.8 mm) while maintaining image times of 50 or 100 sec/section. For normal resolution (1.7 X 1.7 mm), imaging time is 25 or 50 sec/section. It is concluded that the combination of slow-imaging techniques with simultaneous multisection imaging will prove practical for clinical MR.

Brain↗
PubMed1984

Cerebral abnormalities: use of calculated T1 and T2 magnetic resonance images for diagnosis.

The potential clinical importance of T1 and T2 relaxation times in distinguishing normal and pathologic tissue with magnetic resonance (MR) is discussed and clinical examples of cerebral abnormalities are given. T1 and T2 values may be used in three ways: (a) Relative values, obtained by an analysis of intensity images with varying dependence on T1 and T2, may be used if absolute values for T1 and T2 are not required for diagnosis. (b) If an absolute value is desired, the numerical values for the relaxation times may be generated using a region of interest on the intensity images. (c) In cases in which both T1 and T2 change may require a calculated image to indicate the contribution of each to the signal intensity, the numerical value may be used to generate analogue images of T1 or T2 calculations. Five patients with cerebral infarction, 15 with multiple sclerosis, two with Wilson disease, and four with tumors were imaged. Hemorrhagic and ischemic cerebrovascular accidents were distinguished using the spin echo technique. In the patients with multiple sclerosis, lesions had prolonged T1 and T2 times, but the definition of plaque was limited by spatial resolution. No abnormalities in signal intensity were seen in the patient with Wilson disease who was no longer severely disabled; abnormal increased signal intensity in the basal ganglia was found in the second patient with Wilson disease. Four tumors produced abnormal T1 and T2 relaxation times but these values alone were not sufficient for tumor characterization.

Brain Diseases↗
PubMed1984

Primary intracranial tumor imaging: a comparison of magnetic resonance and CT.

Twenty-six patients with primary intracranial tumors were evaluated by magnetic resonance (MR) and a comparison was made with CT findings. The SE technique with TR = 2,000 ms and TE = 56 ms was most useful in delineating normal anatomy, in differentiating gray and white matter, and in optimizing the visualization of edema. The use of TR = 500 ms optimized sensitivity to T1 relaxation time differences in disparate tissue and best defined the cerebrospinal fluid spaces. Although prolongation of T1 and T2 relaxation values was seen with most malignant lesions, several cases produced no obvious prolongation of T1. Separation of tumor from surrounding edema was possible in several instances. In 16/26 patients information not available on CT was obtained with MR. This included detection of altered tissue characteristics where CT showed only mass effect, more accurate depiction of full extent and location of tumor, and visualization of associated abnormalities. However, a small inner ear epidermoid tumor seen with high-resolution CT (1.5-mm sections) was difficult to identify with certainty on MR, and in two other cases punctate foci of calcification were not identified on MR.

Adolescent↗
PubMed1984

Magnetic resonance of the brain: the optimal screening technique.

Seventy consecutive patients were examined with magnetic resonance (MR) and computed tomography (CT) of the brain. Each study was independently reviewed. Focal abnormalities were detected by one or both modalities in 51 patients. Neoplastic, infectious, vascular, demyelinating, metabolic, and congenital disorders of the brain were included. The MR pulse sequence that best detected these abnormalities was a spin-echo multisection technique that used a long interval between RF excitations (TR = 1500 or 2000 msec). Forty-eight of 51 patients showed focal lesions with this technique. A supplementary MR pulse sequence with a short TR (500 msec) was useful in helping to characterize certain lesions with a long T1 relaxation component, but in 10 of 26 positive cases in which this sequence was added it would have missed the abnormality had it been the sole sequence used. MR missed focal lesions in 3 of 51 patients. These were lesions that required thin-section (1.5 mm) CT techniques. Two were intrasellar, and one was an intracanalicular neurinoma. In 17 of 48 patients, CT missed the focal lesion seen with MR. Based on this experience, it is concluded that the long TR multisection spin-echo sequence is the optimal MR screening technique for detection of most brain abnormalities, and is more sensitive than CT. Currently, CT remains the screening modality of choice when high-resolution, thin-section studies in the pituitary, inner ear, and orbital regions are indicated.

Brain Diseases↗