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Biomedical subjects

G L Miller

Publications and source records attributed to G L Miller.

16 recordsLinked to original sources
PubMed1992

Occult glove perforations: frequency during interventional radiologic procedures.

Because the intact surgical glove is an important barrier against exposure to blood and other body fluids, occult glove perforations occurring during procedures may have implications for infection control and protection of health care workers. Although the frequency of occult glove perforations during surgery has been studied, no such data have been reported for interventional radiology. This study was designed to determine the frequency of occult glove perforations in interventional radiology. Gloves used during interventional radiologic procedures were collected and tested for occult perforations according to previously accepted methods. The frequency of occult defects in unused gloves was also determined. A form completed for each pair of gloves indicated length of use, awareness of perforations, and information about the procedure. The anatomic distribution of perforations was also studied. Occult perforations were found in 49 (10%) of 492 used gloves. The frequency of defects in unused gloves was 1% (2/160). Gloves worn fewer than 2 hr had a perforation rate of 7% (29/406), and those worn 2 hr or longer had a rate of 23% (20/86; p less than .0001). Perforations were noticed by the wearer in only three (6%) of the 49 perforations. The perforation rate for inner gloves of a double-glove set was 3% (1/34; the corresponding outer glove also was perforated). Although the 10% rate of occult glove perforation during interventional radiologic procedures found in this series is lower than rates described with surgical procedures, it is not insignificant. The significant increase in the rate of perforation when gloves are worn more than 2 hr suggests that gloves should routinely be changed at or before 2 hr of wear, particularly in procedures involving high-risk patients.

Equipment Failure↗
PubMed1991

Habituation of oromotor responding to oral infusions in rat pups.

The influence of oromotor experience on the pattern of ingestion in rat pups and the relation of this influence to age and pups' physiological state were investigated using a procedure designed to mimic the sham-feeding preparation in adult rats. Six-, 12-, and 18-day-old pups received brief intra-oral infusions of sucrose solutions once every minute. Small infusion volumes minimized postoral effects. Pups' oromotor responsiveness was assessed by recording the pattern of mouthing behavior continuously during the test. Pups were tested after 24, 6 or 0 h deprivation. During testing, the mouthing behavior of all pups except 24-hr deprived 6-day olds showed a marked decline. The specificity of this decrement was demonstrated in a second experiment in which the decremented response was restored by a switch in solution flavor. Finally, the influence of postoral signals on the decline in responsiveness was evaluated by comparing the oral responsiveness of 18-day-old pups following intragastric, oral, or no infusions. Oral infusions suppressed subsequent oral responding, but intragastric infusions did not. These results provide evidence for a habituation-like role of oromotor experience in determining patterns of ingestive behavior within a feeding test. Here, major determinants of the pattern of decline were pups' physiological state and developmental age.

Aging↗
PubMed1990

Deep venous thrombosis of extremities: role of MR imaging in the diagnosis.

Current noninvasive imaging techniques for diagnosis of deep venous thrombosis (DVT) of extremities are limited in their ability to demonstrate central vein involvement and to distinguish acute from chronic changes. The utility of spin-echo magnetic resonance (MR) imaging for DVT was evaluated in 100 patients suspected of having either upper- (n = 25) or lower-extremity (n = 75) DVT. Ninety-seven patients were imaged successfully. In a subset of 36 patients, prospective comparison of MR imaging with contrast venography revealed a sensitivity of 90%, specificity of 100%, and Kappa level of agreement of .752 (P less than .0001). MR imaging showed more central extent of thrombus than did venography in all five patients with upper-extremity DVT and in 13 of 25 patients (52%) with lower-extremity DVT. Although all patients in the study were evaluated for acute symptoms, 13 of 59 (22%) MR imaging studies positive for DVT demonstrated chronic disease. MR images demonstrated ancillary abnormalities in 18 of 41 (44%) patients who did not have DVT. Thus, MR imaging has a role as the definitive examination when the results of initial screening studies are unsatisfactory, or as a first-line examination if (a) there is suspicion of upper-extremity or pelvic vein thrombosis, (b) there is a history of prior DVT that necessitates distinction of acute from chronic changes, or (c) other tests are unavailable.

Acute Disease↗
PubMed1989

Cannulation of the cystic duct and gallbladder.

A hydrophilic polymer-coated, steerable guide wire with graduated stiffness can be used to cannulate the gallbladder. A catheter can then be placed in the gallbladder. This technique was successful in 9 out of 12 patients and took less than 10 minutes from the time of introduction of the guide wire until the catheter was placed in the gallbladder. There was one episode of perforation which was managed conservatively and two failures of cannulation. This technique will open up a new era in diagnostic and therapeutic endoscopy.

Catheterization↗
PubMed1987

Outcome of acute cholecystitis in patients with diabetes mellitus.

Prophylactic cholecystectomy has been recommended in patients who have diabetes and silent gallstones because of the reports of increased mortality resulting from acute cholecystitis in such patients. To assess recent mortality rates, we reviewed the course of acute cholecystitis in patients hospitalized between 1960 and 1981 at one hospital. Death occurred in 3 of 46 patients with diabetes and in 7 of 263 patients without the disease (p = 0.55). The age-adjusted estimate of the relative risk for death was 2.2 (95% confidence interval, 0.5 to 9.4) for diabetic compared with nondiabetic patients. All 3 diabetic patients who died had been diagnosed as having diabetes within 5 years of death, and only one had been taking insulin. Patients who had elevated blood urea nitrogen levels (greater than 20 mg/dL) were found to have an increased mortality rate when compared with patients with normal levels (27% compared with 2%; p less than 0.001). Results were similar for the outcome of serious complications. These results suggest the need for reconsideration of the recommendation for prophylactic cholecystectomy in diabetic patients with silent gallstones.

Acute Disease↗
PubMed1978

Management of premature rupture of the membranes.

A 14-month prospective study of patients with premature rupture of the membranes was performed. The purpose of the study was to determine the effect of different therapeutic regimens for management of premature rupture of the membranes (PROM) on perinatal morbidity and mortality, as well as on maternal morbidity. Maternal and fetal risk factors and predictive factors in pregnancy outcome were prospectively defined. In patients with PROM whose gestational age was 34 weeks or more, induction within the first 12 hours of membrane rupture resulted in minimal maternal and fetal morbidity and mortality. Patients with gestational age of less than 34 weeks had an improved maternal and fetal outcome if left alone until spontaneous labor or 34 weeks' gestation was reached unless signs of sepsis developed. Respiratory distress syndrome (RDS) was the leading cause of morbidity and mortality in the infants of patients who delivered prematurely due to premature rupture of the membranes. Incidence of fetal infection was significantly less than that of RDS as a cause for fetal morbidity and mortality.

Bacterial Infections↗
PubMed1976

Antibiotic treatment of parturient women colonized with group B streptococci.

A prospective study was conducted among third-trimester parturient women with cervical or urethral colonization with group B streptococci to determine the influence of antibiotic treatment on subsequent colonizations among their infants. Cultures were obtained from dry swabs inoculated directly onto selective blood agar media containing neomycin and naladixic acid. Seventy-four women were found to be colonized among 1,098 cultured (7%). A significant reduction in colonization was noted among mothers treated with ampicillin within three weeks of completion of therapy. This difference was no longer apparent at delivery. There was likewise no difference in the colonization rate of infants in the treatment and no-treatment groups. The data suggest that additional measures must be undertaken to prevent maternal recolonization.

Ampicillin↗
PubMed1975

Effects of ischemia on forelimb weight and lymph protein concentration.

The aim of this study was to determine if edema develops in the canine forelimb after relief of prolonged ischemia. Two hours of ischemia was induced either by interrupting brachial artery inflow in collateral-free innervated, naturally and constantly perfused preparations or by applying a pressure cuff in intact preparations. Changes in extravascular fluid volume were inferred from changes in limb weight. Relief of ischemia produced a transient 1.7% increase in weight in the collateral-free, naturally perfused preparation but had no effect on weight in the collateral-free, constantly perfused or intact preparations. Skin lymph flow failed to change significantly and total lymph protein concentration increased only slightly. Thus, relief of 2 hr of ischemia does not produce marked edema or a large increase in microvascular permeability to plasma proteins in the dog forelimb.

Albumins↗
PubMedDate not supplied

Outpatient argon laser iridectomy for angle closure glaucoma: a two-year study.

A technique for iridectomy in the the treatment of angle-closure glaucoma utilizing laser beams has been developed. The operation is performed in two steps. In step 1 a partially penetrating burn of the iris is made to produce an iris hump. In step 2 a penetrating burn is used to pierce the crown of the previously produced hump. Tables 1, 2, and 3 summarize current recommendations and the detailed steps that must be followed (without exception) to achieve success with this technique. Of 22 phakic eyes, fellow eyes, or eyes with narrow-angle glaucoma, instantaneous, permanent iris perforation was produced in all except two. In these two, a second treatment on the following day produced a permanent perforation. Serious complications were encountered in only one patient who received treatment at a greater energy level than we now recommend. In that patient striate keratopathy became apparent, as well as a decrease in vision which has lasted five months. No significant complication was encountered in any eye treated with the currently recommended procedure.

Ambulatory Care↗