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Biomedical subjects

L B Miller

Publications and source records attributed to L B Miller.

At least 19 recordsLinked to original sources
PubMed1989

Torticollis.

Torticollis can be an isolated deformity or a sign of other neuromuscular disease. Underlying central nervous system or infectious disorders need to be considered and treated. In most patients, an improvement in the aesthetic disability is the primary objective. In general, an operation is indicated for the classical "congenital" muscular torticollis that does not respond to physiotherapy and forceful stretching of the restricting neck band. The mass or "tumor" of "congenital" torticollis requires no specific treatment. Operation may be delayed until age 1, but should probably be completed prior to school age. Reversal of craniofacial asymmetry is best achieved at an early age when there is maximum growth potential. Principles of surgery are (1) identification and release of all restricting bands involving the sternocleidomastoid muscle and other neck structures, (2) moving of the head and neck through a full range of motion prior to the completion of the procedure, and (3) resumption of physical therapy within 2 weeks of operation to prevent recurrent scar contracture. Various operations have been recommended, the most popular and reliable being inferior open tenotomy of the sternal and clavicular heads of the sternocleidomastoid muscle. Incisions should be placed low in the neck along skin lines and not over the clavicle in order to avoid hypertrophic scarring. Other procedures discussed are superior open sternocleidomastoid tenotomy (mastoid release), muscle lengthening procedures, and sternocleidomastoid excision. Only modest results should be anticipated in older children or adults with long-standing disease or advanced craniofacial asymmetry.

Humans↗
PubMed1988

The superiorly based rectus abdominis flap: predicting and enhancing its blood supply based on an anatomic and clinical study.

A detailed investigation of the blood supply of the superiorly based rectus abdominis muscle flap and the transverse rectus abdominis musculocutaneous flap was done to improve the understanding of variations in flap viability and to explain the survival of the flap after internal mammary artery division and radiation. The study involved dissections of the internal mammary and superior epigastric systems, evaluation of pertinent angiograms, and impressions from observations of the vascular anatomy correlated with flap survival in over 600 clinical dissections. There is a diffuse intrathoracic collateral network involving the internal mammary system, with multiple branches and intercommunications on the same side, as well as across the midline. This enhances flap predictability and survival in some patients with internal mammary artery division or compromise. There is also a laterally based blood supply to the flap from the costomarginal artery at the costal margin which is sometimes well developed and may prevent flap compromise if preserved.

Abdominal Muscles↗
PubMed1987

Resection of tumors in irradiated fields with subsequent immediate reconstruction.

With increased use of primary radiation therapy for treatment of cancer and adjuvant radiation therapy after surgical removal of a bulk tumor, recurrence in these fields has posed significant new and increasingly technical and biologic problems. We report our experience with ten such cases in which difficult wounds were reconstructed immediately after major regional resections of advanced or recurrent tumors in fields of previous irradiation. All of these patients could undergo extirpation of their recurrent tumors in irradiated fields because of improved techniques in reconstructive flap surgery allowing large amounts of well-vascularized tissue to be transferred, sometimes over a significant distance. Follow-up of these patients has ranged from three to 18 months (median, nine months). Primary healing, decreased deformity, reduced morbidity, and prolonged disease-free intervals have been achieved with the combination of extirpative and reconstructive techniques.

Abdominal Neoplasms↗
PubMed1984

Long-term effects of four preschool programs: ninth- and tenth-grade results.

Follow-up of achievement test and IQ data on low-income black youths who had participated for 1 year in Bereiter-Engelmann, DARCEE, Montessori, or Traditional prekindergarten was continued through ninth and tenth grades. Stable trends persisted. Montessori males and DARCEE females were high; Montessori males were performing at about grade level on reading and math; IQs parallelled achievement test results. Additional tests of fluid intelligence, task persistence, self-esteem, divergent thinking, task approach, and aspirations and expectations were administered in ninth and tenth grades. Results from program comparisons and factor analyses were consistent with those on IQ and school achievement. The possibility of relationships between techniques used in the different preschool programs and sex differences in children's developmental level was discussed.

Achievement↗
PubMed1983

Sudden death in three teenagers: conduction system studies.

The pathologic substrate for sudden death in the middle-aged or elderly adult is usually ischemic heart disease. In contrast, few data are available regarding the pathology of sudden death in teenagers. This report describes three teenagers without clinically suspected heart disease dying suddenly. Patient 1 (age 15, male) was known to have right ventricular premature ventricular beats. Postmortem examination revealed marked premature aging, sclerosis of the cardiac skeleton extending to the right side of the summit with fibrosis of the left and right bundle branches. Patient 2 (age 17, male) was a trained athlete who died during football scrimmage. Autopsy revealed moderate mitral valve prolapse and marked premature aging, sclerosis of the left side of the cardiac skeleton, which extended to the right ventricular side, and secondary involvement of the trifascicular conduction system with mononuclear cell infiltration. Patient 3 (age 19, female) died suddenly at home. Autopsy revealed mitral valve prolapse, thrombosis of the sinoatrial (SA) node artery, and premature aging, sclerosis of the left side of the cardiac skeleton, with involvement of the ventricular septum more on the right ventricular side and involvement of the atrioventricular bundle and trifascicular conduction system. In conclusion, unexpected deaths in three teenagers occurred with demonstrable pathologic findings in the heart. Two of the three patients had mitral valve prolapse, one of whom also had thrombosis or embolism of the sinoatrial node artery. All three had sclerosis of not only the left side but also the right side of the ventricular septum with involvement of the conduction system. The anatomic substrate demonstrated in these three patients could relate to lethal bradyarrhythmia or tachyarrhythmia, or both.

Adolescent↗
PubMed1981

Orthopedic patients in an ambulatory surgery facility.

There is no doubt that ambulatory surgical intervention is here to stay. The advantages afforded the patient are substantial. Orthopedic procedures that previously required one to two nights of hospitalization are now routinely performed on an outpatient basis. This is a result of an increase in the use of arthroscopic surgery and an awareness of the importance of preoperative preparation and postoperative follow-up of the patient. Given the usual localized nature of orthopedic problems, the usual pre-existing good health of the orthopedic patient, and his or her desire to return to normal functioning as soon as possible, the scope of what can be accomplished on an ambulatory surgical basis is just beginning to be realized.

Adult↗
PubMed1976

Soft tissue radiography in determining contact and near-contact gunshot wounds.

Contact and near-contact gunshot wounds ordinarily show distinctive gunpowder patterns, muzzle imprints, or tearing of the skin. Microscopic and chemical examination have been used to estimate firing distances. A new method that utilizes soft tissue radiography is described. Nonjacketed lead bullets deposit a pattern of fragments and residues in tissue circumscribing contact and close gunshot wounds. Various patterns are presented to contrast the appearance of contact from distant gunshot wounds using various firearms and different types of bullets. This procedure may be used as an adjunct in the determination of contact and close gunshot wounds.

Forensic Medicine↗
PubMedDate not supplied

Neuropathic ulcerations plantar to the lateral column in patients with Charcot foot deformity: a flexible approach to limb salvage.

Neuroarthropathy of the midfoot may lead to a structural deformity that predisposes the diabetic patient to skin breakdown and ulceration. In some cases, conservative management is not adequate, making surgical intervention necessary. The authors performed a retrospective study to look at those patients who required surgical intervention for a specific pattern of neuroarthropathy. Over a 2 1/2-year period, 32 feet (31 patients) underwent surgical procedures for treatment of nonhealing neuropathic ulcerations beneath the lateral column of Charcot feet. All feet underwent exostectomy with 17 undergoing excision of the ulcer with primary closure, 8 closure via rotational fasciocutaneous flap with transpositional intrinsic muscle flap, and 6 through an incision placed adjacent to the ulcer. One patient whose ulcer was healed at the time of surgery had the incision placed directly over the prominence. Overall, 29 of 32 feet maintained functional limb salvage. This included eight patients who required revisional surgery, either by resection of more bone or creation of a local flap for coverage. Life-table analysis resulted in an 89% overall success rate. The results show that a flexible approach to skin and soft tissue coverage is necessary to heal these patients, provided attention is directed to the underlying bony prominence.

Adult↗