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Biomedical subjects

Suzanne Miller

Publications and source records attributed to Suzanne Miller.

9 recordsLinked to original sources
PubMed2005

Incidence of early radiolucent glenoid lines in patients having total shoulder replacements.

UNLABELLED: Glenoid loosening is the most common long-term complication occurring after total shoulder replacement. Imprecise cement technique and glenoid preparation may result in early radiolucent glenoid line formation. Early radiolucent lines may indicate inadequate initial fixation, which may contribute to early loosening. Improved cement techniques, refined instrumentation, and glenoid component design all may reduce early radiolucent lines. In our study, postoperative anteroposterior and axillary radiographs were obtained after 68 total shoulder replacements done by one surgeon using either an old free-hand, manual packing technique before November 1998 (n = 28) or a new instrument preparation and pressurization technique since November 1998 (n = 40). Three orthopaedic surgeons blindly reviewed the radiographs for the presence and thickness (mm) of radiolucent lines. The newer instrumented pressurization group had a lower incidence of radiolucent lines than the old manually packed group. In the new subgroup, pegged components had a lower incidence of radiolucent lines than keeled components. The incidence of radiolucent lines seems to be reduced using specially designed instruments, new glenoid designs, and modern cement techniques, which may lead to reduced long-term glenoid loosening. LEVEL OF EVIDENCE: Therapeutic study, Level III-2 (retrospective cohort study). See the Guidelines for Authors for a complete description of levels of evidence.

Adult↗
PubMed2005

Reliability and reproducibility of radiographs of greater tuberosity displacement. A cadaveric study.

BACKGROUND: Classification of fractures of the greater tuberosity has shown poor reliability, in part as a result of an inability to assess fracture displacement accurately. We used fluoroscopic images of prepositioned osteotomized greater tuberosity fragments in cadavers to determine the accuracy of radiographic interpretation, the interobserver reliability, and the effect that radiographs might have on surgical decision-making. METHODS: Twelve osteotomies of the greater tuberosity (three each with 2, 5, 10, and 15 mm of displacement) were created in whole-body cadavers. Six fluoroscopic images (anteroposterior views in external and internal rotation, anteroposterior views in neutral rotation with 15 degrees of cephalic and 15 degrees of caudal tilt, a lateral outlet view, and an axillary view) were made after each osteotomy. Four experienced orthopaedic surgeons measured displacement in millimeters on seventy-two randomized images. Four views in sequence (the anteroposterior view in internal rotation and the outlet view together, then the axillary view, and then the anteroposterior view in external rotation) of each osteotomy pattern were then viewed, and each surgeon was asked whether surgery would be indicated on the basis of each set of images. RESULTS: No one fluoroscopic view was significantly more accurate than another. There was a trend toward increased accuracy of imaging of minimally displaced (</=5 mm) tuberosity fragments with the anteroposterior view in external rotation. When viewed sequentially, the anteroposterior view in external rotation, evaluated last, altered treatment in nine of forty-eight situations. There was substantial agreement (kappa = 0.71) among the surgeons with respect to their recommendations for treatment of the displaced greater tuberosities after they had inspected the four images. CONCLUSIONS AND CLINICAL RELEVANCE: To our knowledge, we are the first to examine the accuracy and reliability of interpreting images of known displacements of the greater tuberosity. Multiple radiographic views are needed to evaluate displacement of the greater tuberosity appropriately. The anteroposterior view in external rotation can profile the greater tuberosity and help demonstrate small displacements. Treatment decisions should be consistent between surgeons when multiple views are used.

Cadaver↗
PubMed2004

A survey of women regarding factors affecting colorectal cancer screening compliance.

BACKGROUND: Women participate in colorectal cancer (CRC) screening less often than men. Our study objective was to understand factors related to women's use of CRC screening. We examined the personal health, medical care, and psychosocial responses to CRC and screening use of a community-based sample of women. METHODS: Women aged 50-80 years at average CRC risk completed a telephone questionnaire. We asked about demographics, past use of CRC and other cancer screening tests, preventive health measures, source of primary care, and comorbidities. We also inquired about attitudes and risk perceptions regarding CRC, knowledge about CRC screening, and other frequent health concerns. Logistic regression identified predictors of screening compliance. RESULTS: Four hundred six women (52% of women contacted, average age 63 years) provided responses. Sixty-five percent had completed some form of CRC screening in the past 5 years. Four factors were positively related to CRC screening: increasing age [adjusted odds ratio (AOR) = 1.05, (95% CI 1.03, 1.08)], perceived CRC risk [AOR = 1.92, (95% CI 1.19, 3.16)], belief that screening reduces CRC risk (AOR = 2.49, 95% CI 1.45, 4.27), and belief in following screening guidelines [AOR = 4.95, (95% CI 2.07, 11.90)]. Belief that screening would be painful [AOR = 0.52, (95% CI 0.32, 0.84)] was inversely related. CONCLUSIONS: Fear about CRC screening-related pain was the strongest impediment to screening, whereas positive attitudes about the value of CRC screening were strongly related to compliance. Addressing fears and emphasizing positive messages by providers should be included in programs promoting CRC screening in women.

Aged↗
PubMed2004

Ictal single-photon emission computed tomography imaging in extra temporal lobe epilepsy using statistical parametric mapping.

PURPOSE: To examine the application of statistical parametric mapping (SPM) to analyze ictal single-photon emission computed tomography (SPECT) scans in surgical candidates with extratemporal lobe epilepsy. METHODS: The authors selected patients who underwent successful ictal SPECT acquisition in the process of surgical treatment of intractable partial epilepsy. Thirteen patients were identified who met inclusion criteria for confident seizure localization from either intracranial electroencephalogram recordings or epilepsy surgery outcome. In these cases, ictal scans were registered to an in-house-developed normal SPECT atlas composed of 14 spatially normalized brains of normal subjects. SPM96 was used to test on a voxel-by-voxel basis for statistically significant increases in blood flow associated with each patient's ictal scan. The results were then mapped back onto the patient's magnetic resonance image (MRI) for final interpretation. Statistical parametric mapping (SPM) analysis of ictal SPECT scans was compared to both conventional visual interpretation and the analysis of subtraction ictal SPECT co-registered to MRI (SISCOM). RESULTS: Ten of 13 patient scans showed localizing focal ictal increases in regional cerebral blood flow, all of which were concordant with ultimate epilepsy localization. Of the 3 cases not localized with SPM, 1 was localized by conventional visual interpretation and another, not localized by visual interpretation, was correctly localized with SISCOM. Two cases not localized by SISCOM were localized by both visual and SPM analysis. CONCLUSIONS: This work provides supportive evidence for proof of principle that SPM can be used to provide objective, accurate analysis of ictal SPECT scans in patients with extratemporal lobe epilepsy.

Adolescent↗
PubMed2003

Suprascapular nerve entrapment secondary to a lipoma.

Many causes of suprascapular nerve entrapment have been described including a small spinoglenoid notch, a tight ligament, boney spurs, and ganglion cysts. In the current patient, suprascapular nerve entrapment was caused by a lipoma in the suprascapular notch. The patient presented with painful shoulder motion that could have been attributed to rotator cuff and acromioclavicular joint disease. However, magnetic resonance imaging and electromyography were consistent with suprascapular nerve entrapment. Treatment of the rotator cuff disease and excision of the lipoma led to resolution of the patient's symptoms. This case is presented as an unusual cause of suprascapular nerve entrapment with a review of its course and anatomy.

Humans↗
PubMed2003

The effect of systemic administration of lipopolysaccharide on cerebral haemodynamics and oxygenation in the 0.65 gestation ovine fetus in utero.

OBJECTIVE: To investigate the effect of intravenous lipopolysaccharide on systemic and cerebral haemodynamics and oxygenation in the preterm ovine fetus. DESIGN: Prospective observational study. SETTING: Research centre for perinatal brain injury. SAMPLE: Nine fetal sheep at circa 93 days of gestation (0.65). METHODS: Fetal sheep were chronically instrumented with arterial and venous catheters and a flow probe in the carotid artery. Near-infrared spectroscopy was used to measure changes in cerebral oxygenation and total haemoglobin concentration. Three days after surgery, each fetus was given 100 ng/kg Escherichia coli lipopolysaccharide. Observations were continued for 48 hours post-injection and compared with baseline control values. MAIN OUTCOME MEASURES: Fetal heart rate, mean arterial pressure, carotid blood flow. RESULTS: Three fetuses died after administration of the lipopolysaccharide. In the survivors fetal heart rate rose from 193 (SEM 7) to a mean maximal level of 226 (SEM 31 bpm) (P = 0.01) after 6.5 (SEM 1.0) hours. The mean arterial pressure decreased from 40.5 (SEM 4.2) to 29.4 (SEM 1.6) mmHg (P < 0.05) after 7.0 (SEM 2.0) hours, and carotid blood flow increased from 29.6 (SEM 1.6) to 45.8 (SEM 5.7) mL/min (P = 0.0002) at 12 (SEM 3) hours. All values returned to control levels by 48 hours. Histological assessment showed evidence of periventricular leucomalacia in three out of six brains studied. CONCLUSION: These data do not suggest that cerebral ischaemia is the main aetiological factor in endotoxin-related fetal brain injury. Fetal tachycardia and cerebral vasodilation may indicate endotoxaemia in fetuses exposed to prenatal infection.

Animals↗
PubMed2002

Carotid intima media thickness decreases after pancreas transplantation.

BACKGROUND: Pancreas transplantation (PTX) improves diabetic microvascular complications, but it is unknown whether PTX alters macrovascular disease. Carotid intima media thickness (IMT) has been shown to correlate with cardiovascular events, so this study was designed to evaluate changes in carotid IMT after PTX. METHODS: Four groups were studied: PTX candidates (n=60); successful PTX recipients (n=89; mean time since PTX=4.0+/-0.3 years); patients with type 1 diabetes but without nephropathy (n=20); and normal controls (n=32). Mean IMT and mean of maximum carotid IMT measurements (mean-max IMT), hemoglobin A1C, serum creatinine, body mass index (BMI), blood pressure, smoking status, use of hypolipidemic medications, and fasting lipids were determined in all groups. RESULTS: Age, gender distribution, and BMI were not different among the groups. Duration of diabetes was also equal between pre- and post-PTX groups. Mean and mean-max IMT were greatest pre-PTX and decreased after PTX (P<0.05) to a value that was not different from controls. Hemoglobin A1C and creatinine decreased, and high density lipoprotein (HDL) increased after PTX (P<0.05), but there were no significant differences in other lipids, BMI, use of lipid lowering agents, blood pressure, or smoking status. CONCLUSIONS: Carotid IMT is lower after PTX, suggesting a reduction in overall cardiovascular risk independent of changes in use of hypolipidemic agents, smoking, blood pressure, BMI, or lipids, except HDL. Improved carotid IMT after successful PTX predicts a reduction in future vascular disease events and suggests that the macrovascular disease of type 1 diabetes is at least partially reversible with improved glucose control.

Adult↗
PubMedDate not supplied

Effectiveness of replacement arthroplasty with calcar grafting and avoidance of greater tuberosity osteotomy for the treatment of humeral surgical neck nonunions.

A retrospective review was conducted on 12 patients (mean age, 63 years) undergoing replacement arthroplasty with calcar grafting for humeral surgical neck nonunions. Patients were evaluated preoperatively for pain and range of motion and postoperatively by use of the American Shoulder and Elbow Surgeons and Constant scores. Indications included severe pain, disability, humeral head destruction, and inadequate bone stock. Nine patients were available for a mean of 69 months' follow-up. Eight underwent humeral head replacement, and one underwent total shoulder replacement. None required greater tuberosity osteotomy. Previously, open reduction-internal fixation had failed in 2 and closed reduction and percutaneous pinning had failed in 1. Calcar grafts were incorporated in 7 of 9 patients. Postoperative pain was absent in 7 and mild in 2. Mean active forward elevation improved by 64 degrees . Mean active external rotation improved by 45 degrees . Postoperatively, American Shoulder and Elbow Surgeons scores averaged 80 and Constant scores averaged 64. Replacement arthroplasty with calcar grafting is a reliable treatment option for surgical neck nonunions.

Adult↗