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Biomedical subjects

D M Mills

Publications and source records attributed to D M Mills.

11 recordsLinked to original sources
PubMed1992

Binaural cochlear implants.

With the success of monaural cochlear implantation, patients frequently ask about having a second implant. We have performed binaural cochlear implants in 12 adult patients. Desire not to disrupt a functioning implant was the primary consideration in implanting the contralateral ear. Seven patients received a second 3M/House single-channel implant to upgrade to a magnetic external receiver. Four patients with a 3M/House device in one ear elected to place a Nucleus multichannel implant in the opposite ear. One patient with a poorly functioning Nucleus device elected to have a second Nucleus device. Four patients with a Nucleus and a 3M/House implant, one with binaural 3M/House implants, and one with binaural Nucleus implants were tested for auditory discrimination in order to quantify monaural versus binaural differences. The functional benefit of the second implant was mixed, but all patients showed some degree of objective improvement on one or more tests. Five of the six are regular users of both devices; the patient with binaural Nucleus implants wears only one. Despite the differing processing schemes, patients with a Nucleus device in one ear and a 3M/House device in the other ear are able to combine the two signals to advantage. We feel that cochlear implantation in the contralateral ear is an acceptable option in selected patients desiring an upgraded implant without placing a functioning implant at risk.

Aged↗
PubMed1991

Long-term follow-up evaluation of 1000 consecutive cemented total knee arthroplasties.

This is a report of a retrospective study of 1000 consecutive, cemented total knee arthroplasties performed by one surgeon from January 1976 to August 1989. Eighty-five percent of the patients were available after a mean of 51 months. Using The Knee Society Clinical Rating System, a good to excellent result was found in 95% of the knees; function was good to excellent in 54% of the knees. By using an actuarial method, 94% of the knees can be expected to survive 13 years. A deep venous thrombosis or pulmonary embolus was found in 1.7% and was no less common in the 25% of the patients who received pharmacologic anticoagulation. The mortality rate was 0.4%. The infection rate was 0.7% and did not correlate with intraoperative cultures. There were 14 failures for a variety of reasons, and six unsuccessful knees were revised. Preoperative medical problems did not generally predict the postoperative complications. The average duration of hospitalization during the last five years of the study was 9.7 days. Careful and consistent preoperative, intraoperative, and postoperative care is responsible for the low complication rate. The cemented knee arthroplasty consistently continues to yield good results.

Adult↗
PubMed1990

Proteinaceous lymphadenopathy due to monoclonal nonamyloid immunoglobulin deposit disease.

We report two cases of lymph node enlargement due to massive extracellular nonamyloid immunoglobulin deposits that obscured the underlying cellular pathologic condition. In both cases, the deposits were demonstrated to be restricted to a single heavy and light chain, consistent with a monoclonal paraprotein, and cytoplasmic staining in the lymphocytes or plasma cells was identical to that of the paraprotein. The use of the protein A-gold technique was instrumental in revealing a monoclonal pattern in one case in which light microscopic immunohistochemistry did not reveal a clear-cut monoclonal pattern in the extracellular deposits. This case was subsequently shown to have multiple myeloma, while the second case has had an unusual history of hypocomplementemic vasculitis and normal bone marrow. Neither case had evidence of significant renal disease.

Adult↗
PubMed1976

Hypertrophic osteoarthropathy in adults with cystic fibrosis.

Three adult patients with cystic fibrosis presented with arthralgia, and investigation for the usual causes of arthritis proved negative. Radiographs of long bones revealed periostitis and new bone fromation characteristic of hypertrophic osteoarthropathy. Symptomatic improvement occurred after analgesic and anti-inflammatory therapy. In patients with cystic fibrosis and bone or joint pain, the diagnosis of hypertrophic osteoarthropathy should be considered and long bone radiographs obtained.

Adult↗
PubMed1976

Polymorphonuclear leukocyte inclusions and impaired bacterial killing in patients with Felty's syndrome.

Humoral factors, phagocytosis, bactericidal capability, and ultrastructural morphology of blood polymorphonuclear leukocytes were investigated in 10 patients with Felty's syndrome. Five patients had suffered significant bacterial infections in the past two years while five other patients had not had bacterial infections. The patients with infections had higher concentrations of serum cryoglobulins, and their neutrophils contained immunoglobulin inclusions as seen by immunofluorescent and electron microscopy. Additionally, leukocytes from these patients showed decreased ability to kill Staphylococcus aureus and a minor defect in phagocytosis. There was a generalized subcellular disorganization of these inclusion containing neutrophils and a slower than normal release of lysosomes. Several of the above abnormalities may contribute to an increased susceptibility to bacterial infections in patients with Felty's syndrome.

Adult↗
PubMed1975

HL-A antigens and sacroiliitis.

The histocompatibility antigen W27 has been found to have a high incidence in ankylosing spondylitis (96%), Reiter syndrome (74%), and other forms of arthritis that may involve the axial skeleton. In patients with Reiter syndrome, there was no correlation between the presence of W27 antigen and the extent or duration of the symptoms. Sacroiliitis was predominantly found in those patients with W27 antigen in all the axial arthropathies. Tissue-typing techniques may be of value in detecting early or atypical disease.

Arthritis, Reactive↗
PubMed1975

Cyclophosphamide therapy for rheumatoid arthritis.

Cyclophosphamide in high doses was given for six months to 19 patients with rheumatoid arthritis. A second group of patients with rheumatoid arthritis whose conditions were stable on low-dose prednisone received in addition either cyclophosphamide or placebo for six months. Measurements of joint function and joint inflammation were used to estimate disease activity. Joint inflammation progressively decreased and joint function improved in the high-dose group. The low-dose cyclophosphamide-plus-prednisone group had a similar response that was different from the prednisone-plus-placebo group. Cyclophosphamide toxicity was common in the high-dose group and minimal in the low-dose-plus-prednisone group. Cyclophosphamide therapy improved the arthritis of these patients. The results were almost as good in the low-dose-plus-prednisone group, and the toxicity was much less.

Administration, Oral↗
PubMed1975

Inhibition of leukocyte candidacidal activity by serum from patients with disseminated candidiasis.

The effect of normal serum and serum for seven patients with disseminated candidiasis (DC) on candidacidal activity of normal human neutrophils (PMNL) was studied. PMNL incubated in DC serum had depressed candiacidal activity when compared to studies with normal serum. The candidacidal defect was not related to differences in particle uptake since phagocytic indices were similar with either normal or DC serum. DC serum did not affect PMNL bactericidal activity against Staphylococcus aureus. When Candida albicans (CA) was incubated in either normal or DC sera, washed, and added to PMNL in normal serum, pronounced inhibition of candidacidal activity was seen in all studies with CA previously incubated in DC serum. Dilution of DC serum or absorption of DC serum with heat-killed CA reversed the candidacidal defect. Ultrastructural studies of phagocytized CA demonstrated small ("tight") phagolysosomes and a delay in breakdown of an electron-dense coating on CA previously incubated in DC serum when compared to controls. Inhibition of leukocyte candidacidal activity appeared to be related to high titers of IgG antibodies against CA present in DC serum.

Antibodies, Fungal↗
PubMedDate not supplied

Esophageal varices in Felty's syndrome: A case report and review of the literature.

A case of upper gastrointestinal tract hemorrhage secondary to esophageal varices in a patient with Felty's syndrome prompted a review of the pathogenesis and treatment of this condition. Six previously reported cases of this association were found. The clinical picture is that of long-standing rheumatoid arthritis with severe articular and extraarticular manifestations including splenomegaly, depression of the blood elements, mild liver function abnormalities, portal hypertension without cirrhosis or portal vein obstruction, an elevated splenic blood flow, and a reduction in portal hypertension by simple splenectomy. The presence of portal hypertension with varices may be another indication of splenectomy in patients with Felty's syndrome.

Aged↗
PubMedDate not supplied

Still's disease in an adult: A link between juvenile and adult rheumatoid arthritis.

A 52-year-old man developed rheumatoid factor negative, chronic, symmetrical polyarthritis associated with high intermittent fever and morbilliform evanescent rash at the onset. A detailed investigation and follow-up for two years failed to reveal any secondary cause. The onset and course resemble Still's disease in children. The synovial membrane histology and electron microscopy were consistent with early rheumatoid arthritis. Adult onset Still's disease reported in the literature is reviewed and compared with Still's disease in children.

Age Factors↗