Evan Miller

Publications of Evan Miller

• Ultrasound to identify cord knotting in monoamniotic monochorionic twins.

  Authors: Aaron B Deutsch, Evan Miller, William N Spellacy, Rhonda Mabry

  Twin research and human genetics : the official journal of the International Society for Twin Studies. 03/2007; 10(1):216-8.

  This case report demonstrates the use of ultrasound and doppler flow in the management of mono-amniotic monochorionic (M/M) twins. M/M twinning is a rare but significant event. It is associated withThis case report demonstrates the use of ultrasound and doppler flow in the management of mono-amniotic monochorionic (M/M) twins. M/M twinning is a rare but significant event. It is associated with high rates of fetal mortality, most commonly cited at anywhere from between 30% and 70%. A common cause of death is cord entanglement. The case presented is that of a 19-year-old gravida 1 at 30 weeks with M/M twins in which multiple cord knots were found by ultrasound color doppler flow after variable fetal heart rate decelerations occurred. This prompted a decision for immediate cesarean delivery with normal fetal outcomes. Improvements in perinatal imaging systems are therefore beneficial in the management of M/M twins.

• The administration of chemotherapy in a patient with Charcot-Marie-Tooth and ovarian cancer.

  Authors: Martin A Martino, Evan Miller, Edward C Grendys

  Gynecologic oncology. 06/2005; 97(2):710-2.

  BACKGROUND: Standard adjuvant chemotherapy for epithelial ovarian carcinoma most commonly consists of a combination of carboplatin with a taxane derivative. However, treatment-related side effectsBACKGROUND: Standard adjuvant chemotherapy for epithelial ovarian carcinoma most commonly consists of a combination of carboplatin with a taxane derivative. However, treatment-related side effects such as peripheral neuropathy and neutropenia can be debilitating and in certain patient populations alterations may need to be considered. CASE: We describe a case of a patient with epithelial ovarian carcinoma who had pre-existing peripheral neuropathy secondary to Charcot-Marie-Tooth Disease (CMT). She developed a distal sensory and motor neuropathy after her first treatment with carboplatin and paclitaxel and was unable to walk, write, or drive. Upon transfer of care to our center, we changed her taxane to docetaxel and her symptoms improved dramatically. We discuss the outcome of her treatment and the effects of paclitaxel on her underlying peripheral neuropathy. CONCLUSION: Patients with Charcot-Marie-Tooth Disease who require chemotherapy may not be able to tolerate the neurotoxic side effects of paclitaxel-based chemotherapy. Consideration of alternative, less neurotoxic treatment regimens containing docetaxel may be considered.

• Modification of ACC/ESC criteria for acute myocardial infarction.

  Authors: Peter W Macfarlane, David Browne, Brian Devine, Elaine Clark, Evan Miller, Jodat Seyal, David Hampton

  Journal of electrocardiology. 02/2004; 37 Suppl:98-103.

  The American College of Cardiology (ACC) and European Society of Cardiology (ESC) recently proposed criteria for acute ST elevation myocardial infarction (STEMI). These criteria were based on STjThe American College of Cardiology (ACC) and European Society of Cardiology (ESC) recently proposed criteria for acute ST elevation myocardial infarction (STEMI). These criteria were based on STj >0.1 mV in limbs leads and V4-V6, or STj >0.2 mV in V1 to V3 with criteria being met in two contiguous leads. The criteria were neither age nor sex dependent and the aim of the present study was to evaluate whether or not improved STEMI criteria that were age and gender dependent could be developed. A training set of 789 ECGs from patients presenting with chest pain due to cardiac and other causes was available for study. Revised criteria for STEMI were developed using these data as well as ECGs from a normal adult population of 859 males and 637 females. A test set of ECGs was available in the form of 1220 ECGs recorded from a separate hospital from patients presenting with chest pain. 248 patients had an acute myocardial infarction on the basis of conventional clinical criteria while 972 did not. There was an improvement in sensitivity using the new criteria compared to the old criteria from 41.5% to 46.7% while specificity improved from 96.0% to 98.5%. Specificity in normals improved from 92.6% to 99.8%. The conclusion drawn is that while the ACC/ESC criteria are simple to apply, they are not particularly specific and can be improved by being supplemented by other ECG measures and optimized for age and sex.