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Biomedical subjects

T J Mills

Publications and source records attributed to T J Mills.

6 recordsLinked to original sources
PubMed2000

Indications for computed tomography in patients with minor head injury.

BACKGROUND: Computed tomography (CT) is widely used as a screening test in patients with minor head injury, although the results are often normal. We performed a study to develop and validate a set of clinical criteria that could be used to identify patients with minor head injury who do not need to undergo CT. METHODS: In the first phase of the study, we recorded clinical findings in 520 consecutive patients with minor head injury who had a normal score on the Glasgow Coma Scale and normal findings on a brief neurologic examination; the patients then underwent CT. Using recursive partitioning, we derived a set of criteria to identify all patients who had abnormalities on CT scanning. In the second phase, the sensitivity and specificity of the criteria for predicting a positive scan were evaluated in a group of 909 patients. RESULTS: Of the 520 patients in the first phase, 36 (6.9 percent) had positive scans. All patients with positive CT scans had one or more of seven findings: headache, vomiting, an age over 60 years, drug or alcohol intoxication, deficits in short-term memory, physical evidence of trauma above the clavicles, and seizure. Among the 909 patients in the second phase, 57 (6.3 percent) had positive scans. In this group of patients, the sensitivity of the seven findings combined was 100 percent (95 percent confidence interval, 95 to 100 percent). All patients with positive CT scans had at least one of the findings. CONCLUSIONS: For the evaluation of patients with minor head injury, the use of CT can be safely limited to those who have certain clinical findings.

Adolescent↗
PubMed1989

PTCA in the elderly: results and expectations.

Percutaneous transluminal coronary angioplasty (PTCA) is an excellent and safe alternative mode of revascularization in selected elderly (greater than 65 years) patients. The initial success rate at our institution for elective and non-elective procedures is essentially equal when compared with a younger (less than or equal to 65 years) population. Although the 24-hour mortality of 1.0% was higher during elective PTCA for the elderly versus 0.3% in those 65 and under, this is still very acceptable when compared with coronary artery bypass grafting. In a small number of patients, we found no increased mortality between the two groups during non-elective PTCA. We conclude that PTCA may be the procedure of choice for symptomatic single discrete stenosis in the elderly patient.

Age Factors↗
PubMed1988

Myocardial infarction, persistent coronary artery thrombosis and lupus anticoagulant.

A 40-year-old man who presented with exertional angina had had two myocardial infarctions within the same myocardial distribution several years earlier. Coronary arteriography revealed a large intramural thrombus in the right coronary artery and minimal atherosclerotic disease. Special coagulation studies detected a circulating lupus anticoagulant. The association of repeated episodes of thrombosis and lupus anticoagulant is important. In patients with repeated thrombotic events, the lupus anticoagulant should be sought, particularly in those less than 40 years of age.

Adult↗