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Biomedical subjects

F A Miller

Publications and source records attributed to F A Miller.

At least 55 records · Page 3Linked to original sources
PubMed1993

Doppler hemodynamic profiles of 82 clinically and echocardiographically normal tricuspid valve prostheses.

BACKGROUND: Normal Doppler hemodynamics for tricuspid prostheses have not been well characterized in a large group of patients. Therefore, we analyzed comprehensive Doppler echocardiographic examinations of 82 patients with tricuspid prostheses that were normal by clinical and two-dimensional echocardiographic examinations to establish the normal hemodynamics of various types and sizes of tricuspid prostheses. METHODS AND RESULTS: The earliest complete postoperative echocardiographic study from each patient was chosen for analysis. Doppler examinations were analyzed on an off-line station from tapes or Doppler strip charts. Early velocity, atrial velocity, end-diastolic velocity, pressure half-time, and mean gradient were obtained by digitizing tricuspid velocity curves. The incidence of "physiological" tricuspid prosthetic regurgitation was noted. Ten Doppler cycles were measured for each patient, and maximal, minimal, and average measurements were recorded. The mean values +/- SD of early velocity, atrial velocity, end-diastolic velocity, mean gradient, and pressure half-time and incidence of mild prosthetic regurgitation were reported for each type of prosthesis, as were highest Doppler measurements for each valve type. Average pressure half-time was significantly lower for St Jude than for heterograft prostheses (P = .04). There were no significant differences between the valve types for mean gradient, early velocity, or incidence of prosthetic regurgitation. Increasing prosthesis size was associated with lower average pressure half-time for heterograft prostheses (P = .024). Average differences (respiratory- and cycle-length-dependent) between maximal and minimal values for 10 cardiac cycles were established for each prosthesis. CONCLUSIONS: This study establishes normal ranges for Doppler hemodynamics of various tricuspid prostheses and emphasizes the importance of measuring multiple cycles for each tricuspid prosthesis, regardless of cardiac rhythm.

Adolescent↗
PubMed1993

Alcoholism in a coronary care unit population.

To estimate prospectively the concordance between diagnoses of alcoholism by a physician and by use of a questionnaire-type screening test in patients in a coronary care unit, we studied 608 patients admitted to a coronary care unit in a 5 1/2-month period. The results from the Self-Administered Alcoholism Screening Test (SAAST) were compared with the diagnoses by physicians recorded in the medical records for the same patients. A strong association (P < 0.001) existed between the clinicians' identification of an alcohol problem and the SAAST scores indicative of such a problem. However, 23 (4.2%) patients were identified as alcoholics by the SAAST but not by clinicians, and 16 (2.9%) patients were identified as alcoholics by clinicians but not by the SAAST. The SAAST was well accepted in this coronary care unit and can complement and extend the clinicians' impression, although each approach may identify some patients that the other will miss. Routine use of the SAAST in the coronary care unit or other hospital settings is feasible and, with appropriate clinician assessment and physician involvement, should yield more complete evaluation and case finding for alcoholism.

Adult↗
PubMed1992

The frequency of familial dilated cardiomyopathy in a series of patients with idiopathic dilated cardiomyopathy.

BACKGROUND: Dilated cardiomyopathy is characterized by an increase in ventricular size and impairment of ventricular function. Most cases are believed to be sporadic, and familial dilated cardiomyopathy is usually considered to be a rare and distinct disorder. We studied the proportion of cases of idiopathic dilated cardiomyopathy that were familial in a large sequential series of patients whose first-degree relatives were investigated regardless of whether these relatives had cardiac symptoms. METHODS: We studied relatives of 59 index patients with idiopathic dilated cardiomyopathy of obtaining a family history and performing a physical examination, electrocardiography, and two-dimensional, M-mode, and Doppler echocardiography. A total of 315 relatives were examined. RESULTS: Eighteen relatives from 12 families were shown to have dilated cardiomyopathy. Thus, 12 of the 59 index patients (20.3 percent) had familial disease. There was no difference in age, sex, severity of disease, exposure to selected environmental factors, or electrocardiographic or echocardiographic features between the index patients with familial disease and those with nonfamilial disease. A noteworthy finding was that 22 of 240 healthy relatives (9.2 percent) with normal ejection fractions had increased left ventricular diameters during systole or diastole (or both), as compared with 2 of 112 healthy control subjects (1.8 percent) who were studied separately. CONCLUSIONS: Dilated cardiomyopathy was found to be familial in at least one in five of the patients in this study, a considerably higher percentage than in previous reports. This finding has important implications for family screening and provides direction for further investigation into the causes and natural history of dilated cardiomyopathy.

Aged↗
PubMed1992

The effect of preovulatory peritoneal fluid from cases of endometriosis on murine in vitro fertilization, embryo development, oviduct transport, and implantation.

OBJECTIVE: The null hypothesis of our study is that the success of in vitro and in vivo murine fertilization and embryo development is not decreased by gamete exposure to peritoneal fluid from superovulated patients with endometriosis. STUDY DESIGN: A murine in vitro fertilization model was used to test the effects of endometriosis versus nonendometriosis peritoneal fluid at concentrations of 1%, 5%, and 10% versus an unsupplemented control. Fertilization and blastocyst formation were compared by analysis of variance. In a second experiment superovulated mice were given intraperitoneal injections of endometriosis or nonendometriosis fluid or saline solution 8 hours after human chorionic gonadotropin and then mated. Some mice were killed 3 days after coitus to assess embryo number, cleavage stage, and uterine versus tubal position by means of analysis of variance and covariance with repeated measures. Others were killed 12 days after coitus with the mean number of implantations per animal between groups compared by Student's t test. RESULTS: In vitro fertilization rates decreased as peritoneal fluid concentration increased in both the endometriosis (65%, 43%, 33%) and nonendometriosis (65%, 52%, 35%) groups at 1%, 5%, and 10% peritoneal fluid concentration, respectively. Mice receiving intraperitoneal endometriosis or nonendometriosis fluid or saline solution injections showed no differences in embryo number, cleavage, uterine versus tubal position, or mean implantation number. CONCLUSION: Peritoneal fluid from superovulated patients had no differentially negative effect when compared with the effect of nonendometriosis peritoneal fluid on murine in vitro or in vivo fertilization and embryo development, tubal embryo transport, or implantation.

Adult↗
PubMed1992

Valvular heart disease in four patients with Maroteaux-Lamy syndrome.

BACKGROUND: Maroteaux-Lamy syndrome is a lysosomal storage disease of mucopolysaccharide metabolism (MPS type VI) that may involve the mitral and aortic valves. Affected patients have other skeletal and oropharyngeal malformations that complicate anesthetic and surgical management. METHODS AND RESULTS: The present report describes the clinical, echocardiographic, and pathological findings in four patients with Maroteaux-Lamy syndrome. Two of three siblings underwent successful double-valve replacement for aortic and mitral valve stenoses. The third sibling, whose aortic and mitral valves were thick and fibrotic, died from septicemia after hip surgery. A fourth, unrelated patient also had successful double-valve replacement. CONCLUSIONS: Our experience emphasizes the potential difficulties in preoperative assessment and surgical treatment as well as the unique problems related to airway management in patients with this syndrome.

Adult↗
PubMed1991

Value and limitations of two-dimensional echocardiography in predicting myocardial infarct size.

To investigate the quantitative relations between the severity of regional wall motion abnormalities and segmental infarct size and between the severity of overall left ventricular dysfunction and global infarct size, a clinicopathologic study was undertaken of 30 patients who had a 2-dimensional (2-D) echocardiogram within 7 days before death. The severity of regional wall motion abnormalities was graded for each segment with a 2-D echocardiographic 14-segment model. The severity of global left ventricular dysfunction was calculated as the mean of the visualized regional wall motion scores. On pathologic examination of autopsy specimens, segmental infarct size was estimated as a percentage of the segmental cross-sectional area. The global infarct size was expressed as a percentage of the total left ventricular mass. At the segmental level, regional wall motion score was positively correlated (r = 0.53) with the segmental infarct size. The sensitivity and specificity of detecting infarcted segments by abnormal wall motion scores were 81 and 71%, respectively. All dyskinetic segments revealed infarct size of greater than or equal to 10%. The wall motion score index was positively correlated (r = 0.52) with the global infarct size. The mean global infarct size was 7% for the 8 patients with a wall motion score index of less than 2, which was significantly lower than the mean of 27% for the 22 patients with a wall motion score index of greater than or equal to 2 (p less than 0.001). A 2-D echocardiogram is sensitive and specific in detecting infarcted segments and can be useful in quantitating myocardial damage after myocardial infarction.

Aged↗
PubMed1991

The effects of electric field-mediated transfer of nonpermeable molecules of meiosis, fertilization, and early embryo development.

Currently there is no simple method of introducing nonpermeable molecules into oocytes or embryos. A technique that would allow direct access to the cytosol with minimal cell damage would be an extremely useful tool in gamete and embryo research. This study investigates the use of electric field-mediated transfer of nonpermeable molecules into mouse oocytes and embryos. Meiosis II stage oocytes, pronuclear stage zygotes, and two-cell embryos were used to determine optimal voltage settings needed for molecular transfer, viability, and blastocyst transformation in culture. Our highest voltage setting (7.0 kV) yielded molecular transfer, viability, and blastocyst transformation rates of 68%, 73%, and 46%, respectively, in two-cell embryos, whereas our lowest setting (3.75 kV) yielded rates of 28%, 90%, and 47%, respectively. Blastocyst transformation rates for control embryos not exposed to the electric field were significantly higher at 69% (p less than 0.01). Meiosis, as assessed by germinal vesicle breakdown, was not affected when compared with controls, 78% versus 83%, respectively. We conclude that electric field-mediated transfer of nonpermeable molecules into oocytes and embryos is a simple, relatively atraumatic technique that can be used to study intraoocyte physiologic characteristics and embryo development.

Animals↗
PubMed1991

Effect of baseline ovarian cysts on in vitro fertilization and gamete intrafallopian transfer cycles.

The presence of ovarian cysts may compromise the success of in vitro fertilization (IVF) and gamete intrafallopian transfer (GIFT). We prospectively studied 212 consecutive ovulation induction cycles in 120 patients for IVF and/or GIFT. A baseline cyst was defined as any intraovarian cystic structure greater than or equal to 12 mm noted on ultrasonography before superovulation. Cycle outcomes were compared between patients with cysts (n = 62) versus those with no cysts (n = 150). There were no differences in follicular or luteal phase lengths or amount of human menopausal gonadotropins used. Peak estradiol (E2) levels were significantly lower and cancellation rates significantly higher in the cyst group. For noncanceled cycles, there were no significant differences in peak E2 levels, the mean number of follicles greater than or equal to 12 mm, mature oocytes retrieved, or ova transferred for GIFT or embryos for IVF. The pregnancy rates overall and for noncanceled cycles were not significantly different.

Adult↗
PubMed1991

Value and limitations of transesophageal echocardiography in assessment of mitral valve prostheses.

BACKGROUND: Transthoracic Doppler echocardiography examination has become an integral part of the investigations performed in patients with mitral valve prostheses. The limitations of the transthoracic approach are well documented. Transesophageal echocardiography provides a unique window for achieving a clear view of the mitral prosthesis. METHODS AND RESULTS: This study shows the usefulness of transesophageal echocardiography in clinical practice for assessment of patients with a mitral valve prosthesis. This technique demonstrated an abnormality in 48% of patients who had normal results on transthoracic examination. The overall sensitivity of transesophageal echocardiography was 96%. CONCLUSIONS: Transesophageal echocardiography constitutes an essential part of a comprehensive two-dimensional/Doppler echocardiographic examination in patients with suspected malfunction of mitral prostheses.

Adolescent↗
PubMed1989

Effects of acute reperfusion on regional myocardial function: serial two-dimensional echocardiography assessment.

Serial two-dimensional echocardiography was performed in 23 patients with acute myocardial infarction who received intravenous thrombolytic therapy to evaluate the effect of acute reperfusion on regional wall motion abnormalities. Regional wall motion abnormalities improved in 4 of the 14 patients (29%) with successful reperfusion and in 1 of the 9 (11%) without successful reperfusion. In successfully reperfused patients, the main determinant of improvement in regional wall motion abnormalities was duration from the onset of chest pain to the time of reperfusion (3.3 vs. 6.3 h in successfully reperfused patients without recovery of regional wall motion abnormalities; P less than 0.001).

Adult↗
PubMed1989

Endomyocardial biopsy in hemochromatosis: clinicopathologic correlates in six cases.

Clinical and pathologic features of cardiac hemochromatosis diagnosed by endomyocardial biopsy in six men, aged 32 to 75 years (mean 52), are described. Echocardiography demonstrated left ventricular enlargement and marked global systolic dysfunction in five. Cardiac catheterization demonstrated normal coronary arteries, increased left ventricular end-diastolic pressure and decreased left ventricular systolic function in all five so studied. Stainable iron was present in all endomyocardial biopsy specimens from the five patients with decreased left ventricular systolic function. Histologically, iron was detected only within the sarcoplasm, and its extent varied inversely with ventricular function. Thus, cardiac hemochromatosis represents a storage rather than an infiltrative disease. These results indicate that stainable iron is consistently observed in endomyocardial biopsy specimens from patients with impaired left ventricular systolic function. Iron staining is recommended for endomyocardial biopsy specimens from patients with idiopathic cardiac dysfunction.

Adult↗
PubMed1988

Familial dilated cardiomyopathy.

Idiopathic dilated cardiomyopathy is generally considered a sporadic, nongenetic disorder, and reports of familial cases are often regarded as rare occurrences. Results of the present investigation of 6 families with this disorder suggest that familial forms of dilated cardiomyopathy occur more frequently than previously suspected. The familial nature of the dilated cardiomyopathy was not readily apparent in 3 of these families until thorough family investigations had been performed. The clinical symptoms and age of onset were variable from one family to another and within families. Based on these observations, it is recommended that all persons diagnosed with dilated cardiomyopathy have a thorough review of their family history. If there are any cases of unexplained heart disease, sudden unexpected death or syncopal episodes, further investigations of relatives should be performed. Echocardiography is a convenient noninvasive tool for investigating relatives. Early diagnosis of affected relatives is important for 2 reasons--treatment of significant arrhythmias may prevent sudden unexpected death, and genetic counseling can be provided.

Adolescent↗
PubMed1987

Adnexal torsion as a complication of superovulation for ovum retrieval.

Adnexal torsion has not been reported previously following hMG/hCG for superovulation induction during an IVF cycle. It is clear that the enlarged ovary from the superstimulation cycle and coital activity contributed to the torsion in this case. Portable ultrasonography helped in making the diagnosis and may be an aid for diagnosis in future cases. Medications used for ovulation induction should be used cautiously and judiciously with close monitoring. Clinicians involved with this type of therapy are obligated to keep a constant watch for such infrequent but devastating complications.

Adnexal Diseases↗
PubMed1987

Evaluation of acute chest pain syndromes by two-dimensional echocardiography: its potential application in the selection of patients for acute reperfusion therapy.

Two-dimensional echocardiography is useful for the immediate diagnosis of acute myocardial infarction when diagnostic electrocardiographic changes are absent. The technique is also helpful in distinguishing myocardial infarction from other conditions that may clinically or electrocardiographically mimic infarction. The extent of myocardial infarction can be estimated by the two-dimensional echocardiographically derived wall motion score index. Therefore, two-dimensional echocardiography seems to be ideally suited for the initial noninvasive assessment of patients with acute chest pain syndromes, especially those who are considered for acute reperfusion therapy.

Adult↗
PubMed1987

To anticoagulate or not: implications for the management of patients with acute myocardial infarction complicated by both left ventricular thrombus and pericardial effusion.

We reviewed the clinical and echocardiographic characteristics of seven patients with left ventricular thrombus and pericardial effusion. Each patient had a recent anterior wall myocardial infarction with an apical left ventricular thrombus. Two patients had clinical evidence of pericarditis. On two-dimensional echocardiography, the effusion was judged to be small in five cases and moderate in two. All patients received parenteral heparin therapy; six of the seven patients subsequently received long-term oral anticoagulation therapy. None of the patients had any clinical or two-dimensional echocardiographic evidence of increasing pericardial effusion or tamponade. Documented systemic embolization was seen in only one patient, whose anticoagulant therapy was stopped 2 weeks after myocardial infarction. In five patients, repeat two-dimensional echocardiography was performed from 2 to 4 months after infarction; in four patients, neither pericardial effusion nor left ventricular thrombus was found. In this group of patients, both short- and long-term anticoagulants were safely administered despite pericardial effusion.

Aged↗