Effects of prolactin upon cholesterol metabolism and progesterone biosynthesis in corpora lutea of rats hyophysectomized during pseudopregnancy.
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Acetates↗
Biomedical subjects
L S Miller
Publications and source records attributed to L S Miller.
Charnley compression clamp in treatment of nonunion of the tibia.
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Adult↗
Radiotherapy for carcinoma of the bladder.
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Adult↗
Comparison of cognitive performance in RDC-diagnosed schizoaffective and schizophrenic patients with the Luria-Nebraska Neuropsychological Battery.
Controversy continues regarding the differential diagnostic distinction between schizoaffective disorder and schizophrenia, and there are few published studies that examine the neuropsychological performance of schizoaffective patients. We evaluated 52 RDC-diagnosed schizophrenic and schizoaffective patients with equal numbers of medicated and unmedicated patients using the Luria-Nebraska Neuropsychological Battery and additional cognitive measures. Both groups performed at cognitively impaired levels. The cognitive performance level of schizoaffective patients was indistinguishable from that of the schizophrenic patients. The RDC subtype of schizoaffective disorder (depressed or manic) also was not related to cognitive performance level. Findings are consistent with the notion that cognitive impairment is found in a significant portion of schizophrenic (and possibly schizoaffective) patients and that the presence of this deficit may characterize a specific subgroup of patients.
Adult↗
Use of endoscopic laser therapy to prevent reflux.
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Animals↗
Pancreatic ductal stones: frequency of successful endoscopic removal and improvement in symptoms.
Pancreatic ductal stones may be responsible for attacks of acute pancreatitis (chronic relapsing pancreatitis) or exacerbations of chronic pain in patients with chronic pancreatitis. This study was undertaken to identify those patients with predominantly main pancreatic duct stones most amenable to endoscopic removal and to determine the effects on the patients' clinical course with such removal. Thirty-two patients with ductographic evidence of chronic pancreatitis and pancreatic duct stones underwent attempted endoscopic removal. Of the patients, 71.9% had complete or partial stone removal and 67.7% improved after endoscopic therapy. Symptomatic improvement was most evident in the group of patients with chronic relapsing pancreatitis. Factors favoring stone removal included (1) three or less stones, (2) stones confined to the head and/or body of the pancreas, (3) absence of a downstream stricture, (4) stone diameter less than or equal to 10 mm, and (5) absence of impacted stones. After successful stone removal, 25% of patients had regression of the ductographic changes of chronic pancreatitis and 41.7% had a decrease in the main pancreatic duct diameter. The only complication from therapy was mild pancreatitis in 8.2%. These data suggest that removal of pancreatic duct stones may result in symptomatic improvement. A longer follow-up will be necessary to determine whether endoscopic success results in long-standing clinical improvement and/or permanent regression of the morphologic changes of chronic pancreatitis.
Adolescent↗
Seasonality and infectious disease in schizophrenia: the birth hypothesis revisited.
Research literature supports the notion that more people diagnosed with schizophrenia are born during the winter months than other seasons [O'Hare A, Walsh D, Torrey F. Seasonality of schizophrenia births in Ireland. Br J Psychiatry 1980;137:74 7; Pulver AE, Stewart W, Carpenter WT, Jr., Childs B. Risk factors in schizophrenia: season of birth in Maryland, USA. Br J Psychiatry 1983;143:389-96.]. Researchers have postulated that this surge in winter-birth schizophrenia may be related to increases in viral infectious such as influenza and measles [Watson CG, Kucala T, Tilleskjor C, Jacobs L. Schizophrenic birth seasonality in relation to incidence of infectious diseases and temperature extremes. Arch Gen Psychiatry 1984:41:85-90; Mednick SA, Machon RA, Huttunen MO, Bonnett D. Adult schizophrenia following prenatal exposure to an influenza epidemic. Arch Gen Psychiatry 1988;45:189-92.]. However, data supporting significant relationships between infectious disease and schizophrenia incidence has been equivocal [Kendell R, Kemp I. Maternal influenza in the etiology of schizophrenia. Arch Gen Psychiatry 1989;46:878-82; McGrath J, Castle D. Does influenza cause schizophrenia? A five year review. Aust N Z J Psychiatry 1995;29:23-31.]. The purpose of this study was to replicate and expand previous studies by examining seasonal and infectious disease influences on schizophrenia prevalence. It was hypothesized that: (1) there would be an increase in schizophrenia prevalence during the winter months; and (2) that a significant amount of variability in schizophrenia birthrates would be accounted for by rates of influenza and measles. A Georgia Medicaid database (N = 746,615) and statewide infectious disease tables were used to identify correlations. Medicaid recipients were divided into schizophrenia (n = 11,736) and non-schizophrenia (n = 734,879) groups. A ratio of schizophrenic recipients to non-schizophrenic recipients was calculated for each birth cohort represented by each month of the year from 1948-1965. Multiple regression analyses indicated a significant relationship between winter season and schizophrenia incidence. However, neither influenza nor measles was predictive of schizophrenia prevalence. These findings were made using one of the largest sample of schizophrenic individuals in the literature to date. Limitations of the study are discussed, including the use of seasonal and prevalence correlations without data on patient linked maternal infections.
Adult↗
Presentation and response of patients with upper extremity repetitive use syndrome to a multidisciplinary rehabilitation program: a retrospective review of 24 cases.
OBJECTIVE: To analyze retrospectively a group of patients presenting to an outpatient hand rehabilitation clinic with complaints related to repetitive tasks of the upper extremity. DESIGN: Retrospective case study reviewing 24 consecutive cases for presenting symptoms and response of patients to a multidisciplinary rehabilitation approach. SETTING: An outpatient hand rehabilitation clinic in a tertiary referral center offering simultaneous medical, psychological, and occupational evaluations. PATIENTS: Twenty-four patients with upper extremity symptoms related to repetitive use, who had all failed various prior therapeutic interventions. Fifty percent of the patients were receiving medical disability compensation because of their symptoms. Sixty-two percent had filed a worker's compensation claim. INTERVENTIONS: Treatment consisted of medical management with pharmacologic interventions, occupational therapy with workplace simulation and job-site evaluations, and psychological treatment with pain management and biofeedback training. Treatments were individualized to meet each patient's needs. OUTCOME MEASURES: Reduction in symptom intensity or frequency, increase in work and performance of activities of daily living, and termination of medical disability with return to work. RESULTS: Most cases (83%) were found to be related to occupational computer keyboard use. Bilateral hand and forearm pain were the major symptoms. A unique physical finding was diffuse tendon tenderness and tightness of the long flexor and extensor muscles of the forearm. Carpal tunnel syndrome was found in only one patient. Twenty-five percent of patients achieved resolution of most symptoms, although on a modified and often reduced activity level; 54% had moderate improvement; and 13% had only minimal or no improvement. Of the patients receiving medical disability compensation, 58% returned to their previous jobs. CONCLUSIONS: Patients with upper extremity symptoms related to repetitive use often have unique physical findings, distinct from those of carpal tunnel syndrome. Resulting work disability is high. Patients who have not responded to conventional interventions within a reasonable time may benefit from a multidisciplinary treatment approach. Most patients improve with this treatment but do not fully recover.
Adult↗
Adult aging and listening patterns for spoken prose: spontaneous segmentation versus self-paced listening.
Young and older adults were allowed to control the delivery rate of spoken prose for later recall using two methods. In one method (spontaneous segmentation), participants were allowed to interrupt speech passages whenever they wished. In the other method (self-paced listening), speech passages were presented in segments, with participants allowed to initiate presentation of subsequent segments via a key-press. Older adults' segment sizes in the spontaneous segmentation condition were unchanged when the passages were presented for a second time. By contrast, pause latencies to initiating subsequent segments in the self-paced listening condition were affected by experience with the passage. Results suggested that the segment sizes selected in the spontaneous segmentation condition were driven by the linguistic structure and prosody of the speech, rather than reflecting ineffective metamemory on the part of the older adults.
Adolescent↗
Gait asymmetry in patients with limb-length inequality.
One of the problems facing the clinician is the differentiation between functional and structural limb-length inequality. This study investigated 20 subjects (mean age, 9.0 +/- 3.9 years) with documented limb-length inequalities to determine the magnitude of discrepancies that result in gait abnormalities. The subjects were asked to walk on an 8-m walkway at a self-selected free pace. The contact time, first and second force peaks, and loading and unloading rates of the vertical ground-reaction force were measured for both limbs. These parameters were predictive for quantification of gait asymmetry. The asymmetry of these parameters increased as the limb-length inequality increased. In general, a limb-length inequality > 2.0 cm (3.7%) resulted in gait asymmetry that was greater than that observed in the normal population. However, the amount of asymmetry varied for each individual. A static examination can document an anatomic deformity, but this deformity may be compensated for by functional adaptations. An analysis of the patient's gait should be performed to identify asymmetries during ambulation. Dynamic gait findings, such as demonstrated in this study, are needed to support static measurements.
Adolescent↗
The use of ultrasound for the diagnosis of soft-tissue masses in children.
Forty-four soft-tissue masses in 44 children (age range, 8 months to 18 years) were evaluated with high-resolution ultrasonography. Longitudinal and transverse images were obtained and interpreted within a classification scheme describing the masses as cystic, homogeneous solid, or mixed lesions. Diagnosis was confirmed surgically in all cases, allowing the accuracy of the ultrasound examination to be assessed. Of the 44 masses evaluated, 13 were cystic, 18 homogeneous solid, and 13 mixed masses. Ultrasound alone was independently diagnostic in 11 of 13 cystic masses (ganglions, Baker's cysts) and 12 of 18 homogeneous solid masses (foreign bodies). Ultrasound was useful but not independently diagnostic in six of 18 homogeneous solid masses and in 12 of 13 mixed solid masses and was misleading in three cases. Ultrasonography is a noninvasive, relatively low cost study, not involving radiation or sedation, that supplements the clinical examination and conventional radiography in the evaluation of musculoskeletal soft-tissue masses in children. It provides immediate characterization of mass size, consistency, and anatomic location. Ultrasonography is usually independently diagnostic in lesions such as cysts and foreign bodies and aids in clarifying the diagnosis of fibrous, cartilaginous, vascular, and lymphatic lesions.
Adolescent↗
Use of botulinum toxin in the treatment of achalasia.
Achalasia is a chronic esophageal motor disorder characterized by failure of the lower esophageal sphincter (LES) to relax during swallowing, aperistalsis of the esophageal body, and, often, an elevated resting LES pressure. Pneumatic dilation and Heller cardiomyotomy have been the time-honored, accepted treatments, but each may carry significant morbidity. Recently, intrasphincteric injection of botulinum toxin has been shown to be an effective treatment for achalasia, probably by reducing the excitatory cholinergic tone of the LES. Subjective and objective improvement have been reported in many patients with few reported adverse reactions. Clinical improvement generally lasts 2-6 months with patients often requiring repeat treatment. Although studies directly comparing botulinum toxin injection with pneumatic dilation and surgical myotomy are needed, botulinum toxin injection has rapidly become another therapeutic option in the treatment of achalasia.
Anti-Dyskinesia Agents↗
Suppression of cytokine-induced neutrophil accumulation in rat mesenteric venules in vivo by general anesthesia.
Most studies of neutrophil-endothelial interactions in vivo necessarily require the use of general anesthetic agents which are well known to be immunosuppressive. By using whole-mount preparations of the rat mesoappendix, we were able to study tumor necrosis factor alpha (TNF-alpha) induced neutrophil adhesion to the mesenteric venular endothelium in vivo without necessarily using general anesthesia. TNF-alpha significantly increased venular-neutrophil accumulation in a dose-dependent manner, accumulation was markedly increased at 1, 2, and 4 h, but returned to baseline after 24 h. After these preliminary dose-response and time-course studies, we evaluated the influence of standard clinically effective doses of several commonly used anesthetic agents (thiopental, pentobarbital, ketamine, alpha-chloralose, methoxyflurane, and halothane) on the extent of neutrophil-venular accumulation induced 2 h after intraperitoneal injection of 0.4 mg/kg TNF-alpha, compared to unanesthetized rats. All general anesthetics tested, with the exception of methoxyflurane, significantly suppressed this response. In most cases this suppression was striking (from 60 to 85%) such that a statistically significant proinflammatory response was obscured. Although methoxyflurane also tended to suppress this response to TNF-alpha, it was the only agent that allowed the response to be clearly seen. Because anesthesia markedly suppresses cytokine-induced neutrophil-venular adhesion, this model should provide an important complementary technique to the classical in vivo microcirculatory approaches which do necessarily require general anesthesia.
Anesthesia, General↗
The Magnuson-Stack procedure for treatment of recurrent glenohumeral dislocations.
The Magnuson-Stack procedure was developed in 1943 as a treatment for recurrent anterior dislocation of the glenohumeral joint. Since that time, very little literature has been published on this procedure. The purpose of our study is to evaluate its efficacy in preventing further dislocations and, also, introduce the Cybex Isokinetic Dynamometer as a quantitative tool in scientifically evaluating total shoulder function. At the Bryn Mawr (Pennsylvania) Hospital from 1971 to 1978, 43 patients underwent a Magnuson-Stack procedure. Twenty-nine returned detailed questionnaires; 26 of these patients returned for clinical and roentgenographic examination by one of the authors, and 18 had their shoulder motion and power quantitatively compared to their contralateral normal arms with the Cybex Isokinetic Dynamometer. Eighty-five percent of shoulders did not dislocate postoperatively; 90% considered their results satisfactory. By gross physical examination, no shoulder atrophy was noted. Strength seemed to equal the uninjured shoulder. Range of motion showed a 10 degrees loss of external rotation as measured with a hand-held goniometer. However, by testing range of motion with the Cybex system, a 25 degrees lack of external rotation was noted. Force values measured at 60 degrees of arc/sec and 180 degrees of arc/sec showed an 18 and 10% deficit, respectively, in external rotation. The authors believe that the Magnuson-Stack procedure has a place in the treatment of recurrent anterior dislocations of the shoulder. Also, the Cybex II isolated joint testing system provides an accurate reproducible method of comparing the postoperative results of all patients treated for dislocation of the shoulder.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Management of congenital fibular deficiency by Ilizarov technique.
Between April 1987 and January 1990, 11 patients with congenital fibular deficiency underwent tibial lengthening of 12 involved limbs by the Ilizarov technique. The average follow-up was 23.2 months. The mean lengthening was 8.3 cm, representing an average lengthening of 31%. No knee or ankle subluxation occurred despite preoperative cruciate ligament laxity and ankle abnormalities in all patients. The most significant complications included regenerate bone deformation and delayed consolidation. With the Ilizarov technique, the limb length discrepancy, angular and rotational deformities, and foot and ankle deformities frequently associated with congenital fibular deficiency can be addressed simultaneously.
Adolescent↗
Estimates of economic costs of alcohol and drug abuse and mental illness, 1985 and 1988.
The high prevalence of alcohol and drug abuse and mental illness imposes a substantial financial burden on those affected and on society. The authors present estimates of the economic costs from these causes for 1985 and 1988, based on current and reliable data available from national surveys and the use of new costing methodology. The total losses to the economy related to alcohol and drug abuse and mental illness for 1988 are estimated at $273.3 billion. The estimate includes $85.8 billion for alcohol abuse, $58.3 billion for drug abuse, and $129.3 billion for mental illness. The total estimated costs for 1985, $218.1 billion, include $51.4 billion for direct treatment and support costs; $80.8 billion for morbidity costs, the value of reduced or lost productivity; $35.8 billion for mortality costs, the value of foregone future productivity for the 140,593 premature deaths associated with these disorders, based on a 6 percent discount rate and including an imputed value for housekeeping services; and $47.5 billion in other related costs, including the costs of crime, motor vehicle crashes, fire destruction, and the value of productivity losses for victims of crime, incarceration, crime careers, and caregiver services. The cost of acquired immunodeficiency syndrome associated with drug abuse is estimated at $1 billion, and the cost of fetal alcohol syndrome is estimated at $1.6 billion. The estimates may be considered lower limits of the true costs to society of alcohol and drug abuse and mental illness in the United States.
Age Factors↗
Smoking estimate correction.
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Health Expenditures↗
State estimates of Medicaid expenditures attributable to cigarette smoking, fiscal year 1993.
OBJECTIVE: To develop estimates of state Medicaid expenditures attributable to smoking for fiscal year 1993. METHODS: The smoking-attributable fractions (SAFs) of state Medicaid expenditures were estimated using a national model that describes the relationship between smoking and medical expenditures, controlling for a variety of sociodemographic, economic, and behavioral factors. RESULTS: In fiscal year 1993, the SAF for all states (all types of expenditures) was 14.4%, with a range from 8.6% in Washington DC to 19.2% in Nevada. On average, SAFs ranged from a low of 7.9% for home health services expenditures to 21.7% for hospital expenditures. An estimated total of $12.9 billion of fiscal year 1993 Medicaid expenditures was attributable to smoking. The relative error of this estimate was 40.3%. CONCLUSIONS: Cigarette smoking accounts for a substantial portion of annual state Medicaid expenditures, with considerable variation among states. The range in expenditures among the states is due to differences in smoking prevalence, health status, other socioeconomic variables used in the model, and the level and scope of the Medicaid program.
Adult↗